Forecasting and inventory control for hospital management

This thesis was submitted for the degree of Doctor of Philosophy and was awarded by Brunel University.Economic stringencies have compelled Canadian hospitals to examine their administrative effectiveness critically. Improved supplies and inventory procedures adopted by leading industrial corporations, suggest that hospitals might benefit from such systems. Lack of the profit incentive, and the high ratio of wages to total expenses in hospitals, have delayed adoption of modern inventory management techniques. This study examined the economic status of Canadian hospitals, and endeavoured to discover whether a computer-based inventory management system, incorporating short-term statistical demand forecasting, would be feasible and advantageous. Scientific forecasting for inventory management is not used by hospitals. The writer considered which technique would be most suited to their needs, taking account of benefits claimed by industrial users. Samples of demand data were subjected to a variety of simple forecasting methods, including moving averages, exponentially smoothed averages and the Box-Jenkins method. Comparisons were made in terms of relative size of forecast errors; ease of data maintenance, and demands upon hospital clerical staffs. The computer system: BRUFICH facilitated scrutiny of the effect of each technique upon major components of the system. It is concluded that either of two methods would be appropriate: moving averages and double exponential smoothing. The latter, when combined with adaptive control through tracking signals, is easily incorporated within the total inventory system. It requires only a short run of data, tracks trend satisfactorily, and demands little operator intervention. The original system designed by this writer was adopted by the Hospital for Sick Children, Toronto, and has significantly improved their inventory management.Lakehead University and the Ministry of Health, Government of Ontario

Education for health services administration : an examination of met and unmet needs

Health systems in Canada, as in many other countries, have been crisis oriented. Expenditure upon all areas of the disease curing professions has risen at an accelerating rate in the past decade. The post-war introduction and development of national health insurance has led to massive construction and operating costs of health services institutions, with complex technology and expensive employment of specialists in all areas of medicine and allied health services. A substantial burden has been placed upon the taxpayer. His Support of institutional health care remains strong, but governments and their planners are attempting to control the growth pattern by altering the emphasis from hospital care to health maintenance systems. This is causing chamges, not least in demands upon present and future managers, and the object of this thesis is to examine these changes, with direct reference to educational implications. It is held by this researcher that administrators have needs for education which are presently not being satisfied. An investigation of present programs has been undertaken and evaluations made of the extent to which their graduates will be able to meet managerial demands made upon them. Account has been taken of publications by experts in this area, and the writer has discussed education for health services administration with experts in several countries. Concerns such as health management as a profession; the level of education needed* and the conflict between generic and specialist programs have been carefully examineds all these have been studied in the context of future requirements. Recent developments in Canadian universities have been investigated. In 1979 significant changes are taking place* affecting several higher degree programs* and caused by the introduction of three baccalaureate degrees. This writer criticizes them in terms of their ability to satisfy unmet needs* and presents his own national program. It is intended to meet and satisfy both ongoing and anticipated future requirements* with the objective that Canadian health administrators shall be better equipped to undertake future complex tasks

The first close-up of the "flip-flop" phenomenon in a single star

We present temperature maps of the active late-type giant FK Com which exhibit the first imagining record of the ``flip-flop'' phenomenon in a single star. The phenomenon, in which the main part of the spot activity shifts 180 degrees in longitude, discovered a decade ago in FK Com, was reported later also in a number of RS CVn binaries and a single young dwarf. With the surface images obtained right before and after the ``flip-flop'', we clearly show that the ``flip-flop'' phenomenon in FK Com is caused by changing the relative strengths of the spot groups at the two active longitudes, with no actual spot movements across the stellar surface, i.e. exactly as it happens in other active stars.Comment: 4 pages, accepted by A&A Letter

ProtoEXIST: Advanced Prototype CZT Coded Aperture Telescopes for EXIST

{\it ProtoEXIST1} is a pathfinder for the {\it EXIST-HET}, a coded aperture hard X-ray telescope with a 4.5 m$^2$ CZT detector plane a 90$\times$70 degree field of view to be flown as the primary instrument on the {\it EXIST} mission and is intended to monitor the full sky every 3 h in an effort to locate GRBs and other high energy transients. {\it ProtoEXIST1} consists of a 256 cm$^2$ tiled CZT detector plane containing 4096 pixels composed of an 8$\times$8 array of individual 1.95 cm $\times$ 1.95 cm $\times$ 0.5 cm CZT detector modules each with a 8 $\times$ 8 pixilated anode configured as a coded aperture telescope with a fully coded $10^\circ\times10^\circ$ field of view employing passive side shielding and an active CsI anti-coincidence rear shield, recently completed its maiden flight out of Ft. Sumner, NM on the 9th of October 2009. During the duration of its 6 hour flight on-board calibration of the detector plane was carried out utilizing a single tagged 198.8 nCi Am-241 source along with the simultaneous measurement of the background spectrum and an observation of Cygnus X-1. Here we recount the events of the flight and report on the detector performance in a near space environment. We also briefly discuss {\it ProtoEXIST2}: the next stage of detector development which employs the {\it NuSTAR} ASIC enabling finer (32$\times$32) anode pixilation. When completed {\it ProtoEXIST2} will consist of a 256 cm$^2$ tiled array and be flown simultaneously with the ProtoEXIST1 telescope

The Shearing HI Spiral Pattern of NGC 1365

The Tremaine-Weinberg equations are solved for a pattern speed that is allowed to vary with radius. The solution method transforms an integral equation for the pattern speed to a least squares problem with well established procedures for statistical analysis. The method applied to the HI spiral pattern of the barred, grand-design galaxy NGC 1365 produced convincing evidence for a radial dependence in the pattern speed. The pattern speed behaves approximately as 1/r, and is very similar to the material speed. There are no clear indications of corotation or Lindblad resonances. Tests show that the results are not selection biased, and that the method is not measuring the material speed. Other methods of solving the Tremaine-Weinberg equations for shearing patterns were found to produce results in agreement with those obtained using the current method. Previous estimates that relied on the assumptions of the density-wave interpretation of spiral structure are inconsistent with the results obtained using the current method. The results are consistent with spiral structure theories that allow for shearing patterns, and contradict fundamental assumptions in the density-wave interpretation that are often used for finding spiral arm pattern speeds. The spiral pattern is winding on a characteristic timescale of ~ 500 Myrs.Comment: Accepted for publication in The Astrophysical Journa

Alberta Heritage Fund for Medical Research Senior Scholar and a Canadian Institutes of Health Research (CIHR) investigator

PURPOSE. To determine the genetic and biochemical defects that underlie Axenfeld-Rieger malformations, identify the pathogenic mutation causing these malformations, and understand how these mutations alter protein function. METHODS. FOXC1 was amplified from a proband with AxenfeldRieger malformations and the proband's mother. PCR products were sequenced to identify the pathogenic mutation. Sitedirected mutagenesis was used to introduce this mutation into the FOXC1 cDNA. A synthetic mutation at the same position was also introduced, and both natural and synthetic proteins were tested for their ability to localize to the nucleus, bind DNA, and transactivate gene expression. RESULTS. A novel missense mutation (L86F) was identified in FOXC1 in this family. The mutation is located in ␣-helix 1 of the forkhead domain. Biochemical assays showed that the L86F mutation does not affect nuclear localization of FOXC1, but reduces DNA binding and significantly reduces transactivation. The severity of the disruption to FOXC1 protein activity does not appear to correspond well with the severity of the phenotype in the patient. Analogous studies using a L86P, a known ␣-helix breaker, severely disrupts FOXC1 function, revealing the importance of helix 1 in FOXC1 structure and function. CONCLUSIONS. A novel mutation in helix 1 of the FOXC1 forkhead domain has been identified and the importance of position 86 in FOXC1 activity demonstrated. These studies also identified the role of helix 1 in FOXC1 function and provide further evidence for the lack of strong genotype-phenotype correlation in FOXC1 pathogenesis. Normal development appears to be dependent on tight upper and lower thresholds of T he FOX (forkhead box) proteins have been defined by the presence of the forkhead domain (FHD), a 110-amino-acid DNA-binding motif, originally identified as a region of homology between Drosophila melanogaster forkhead protein and rat hepatocyte nuclear factor 3 proteins. 1 Since that time, the forkhead family of transcription factors has grown rapidly, establishing the FOX family as critical regulators of embryogenesis, tissue-specific cell differentiation, cell migration, tumorigenesis, and even language and speech acquisition. 5-14 The penetrance of ocular AR malformations is highly variable. Patients may manifest iris hypoplasia, posterior embryotoxon, adhesions of the iris and the cornea, an underdeveloped or aberrantly developed angle between the cornea and iris, and corectopia. In approximately half of the patients with AR malformations, glaucoma, a progressive, blinding condition, develops. Nonocular features include dental anomalies, maxillary hypoplasia, and redundant periumbilical skin. Congenital cardiac anomalies may also rarely be found in patients with FOXC1 mutations. 18 Studies of the FHD reveal how different missense mutations disrupt specific FOXC1 activities, showing the utility of using these naturally occurring missense mutations to understand the function of FOXC1. We report herein the identification, patient phenotype, and molecular analysis of a novel disease-causing missense mutation in FOXC1. Molecular analysis revealed that the L86F missense mutation, located in helix 1 of the FHD, reduces the ability of FOXC1 to bind DNA and disrupts its ability to transactivate gene expression. Analysis of a synthetic L86P mutation demonstrates the importance of helix 1 in contributing to the overall function of FOXC1. METHODS Patient Report This research adhered to the tenets of the Declaration of Helsinki. The proband was a male with congenital glaucoma in the right eye leading to a complete loss of vision in the eye by age 22. In the left eye, the patient had posterior embryotoxon, iris hypoplasia, iridocorneal adhesions in the angle, and mild corectopia. Interocular pressure was more than 40 mm Hg in the patient's left eye. Systemic anomalies included short stature and obesity, a myocardial infarction that occurred at age 41, and dental anomalies. The mother had diagnoses of iris processes to Schwalbe's line, Haab's striae, congenital glaucoma, obesity, short stature, and hypercholesterolemia. From th

Upper and lower airway cultures in children with cystic fibrosis: Do not neglect the upper airways

AbstractBackgroundAirways of cystic fibrosis (CF) patients are colonised with bacteria early in life. We aimed to analyse differences between results of simultaneously taken upper airway (UAW) and lower airway (LAW) cultures, to describe clinical characteristics of patients with positive versus negative cultures and to follow up the patients with P. aeruginosa positive UAW cultures.MethodsBacteriological and clinical data from 157 children were collected during annual check up. The number of positive UAW and LAW cultures and correspondence between these results and clinical characteristics were analysed.ResultsPositive LAW and UAW cultures were found in 79.6% and 43.9% of patients respectively (p<0.001). Patients with positive LAW cultures were significantly older (11.9 vs. 9.8years, p<0.05) and had more LAW symptoms (73.6% vs. 46.7%, p<0.05), especially when P. aeruginosa was found. Patients with positive UAW cultures (especially S. aureus) had more nasal discharge (50.7% vs. 25.0%, p<0.001). In 65% of patients with positive UAW and negative LAW culture for P. aeruginosa the next LAW became P. aeruginosa positive.ConclusionUAW cultures and LAW cultures differ in children with CF and there are differences in clinical characteristics between patients with positive versus negative culture results. P. aeruginosa positive UAW cultures appeared to precede positive LAW cultures in a substantial part of patients, suggesting some kind of cross-infection between the UAW and LAW

Hydroclimate changes in eastern Africa over the past 200,000 years may have influenced early human dispersal

Abstract: Reconstructions of climatic and environmental conditions can contribute to current debates about the factors that influenced early human dispersal within and beyond Africa. Here we analyse a 200,000-year multi-proxy paleoclimate record from Chew Bahir, a tectonic lake basin in the southern Ethiopian rift. Our record reveals two modes of climate change, both associated temporally and regionally with a specific type of human behavior. The first is a long-term trend towards greater aridity between 200,000 and 60,000 years ago, modulated by precession-driven wet-dry cycles. Here, more favorable wetter environmental conditions may have facilitated long-range human expansion into new territory, while less favorable dry periods may have led to spatial constriction and isolation of local human populations. The second mode of climate change observed since 60,000 years ago mimics millennial to centennial-scale Dansgaard-Oeschger cycles and Heinrich events. We hypothesize that human populations may have responded to these shorter climate fluctuations with local dispersal between montane and lowland habitats

Pleistocene climate variability in eastern Africa influenced hominin evolution

AbstractDespite more than half a century of hominin fossil discoveries in eastern Africa, the regional environmental context of hominin evolution and dispersal is not well established due to the lack of continuous palaeoenvironmental records from one of the proven habitats of early human populations, particularly for the Pleistocene epoch. Here we present a 620,000-year environmental record from Chew Bahir, southern Ethiopia, which is proximal to key fossil sites. Our record documents the potential influence of different episodes of climatic variability on hominin biological and cultural transformation. The appearance of high anatomical diversity in hominin groups coincides with long-lasting and relatively stable humid conditions from ~620,000 to 275,000 years bp (episodes 1–6), interrupted by several abrupt and extreme hydroclimate perturbations. A pattern of pronounced climatic cyclicity transformed habitats during episodes 7–9 (~275,000–60,000 years bp), a crucial phase encompassing the gradual transition from Acheulean to Middle Stone Age technologies, the emergence of Homo sapiens in eastern Africa and key human social and cultural innovations. Those accumulative innovations plus the alignment of humid pulses between northeastern Africa and the eastern Mediterranean during high-frequency climate oscillations of episodes 10–12 (~60,000–10,000 years bp) could have facilitated the global dispersal of H. sapiens.</jats:p