Modelling for the planning and management of bed capacities in hospitals

The internal dynamics of a hospital represent a complex non-linear structure. Planning and management of bed capacities must be evaluated within an environment of uncertainty, variability and limited resources. A common approach is to plan and manage capacities based on simple deterministic spreadsheet calculations. This paper demonstrates that these calculations typically do not provide the appropriate information and result in underestimating true bed requirements. More sophisticated, flexible and necessarily detailed capacity models are needed. The development and use of such a simulation model is presented in this paper. The modelling work, in conjunction with a major UK NHS Trust, considers various types of patient flows, at the individual patient level, and resulting bed needs over time. The consequence of changes in capacity planning policies and management of existing capacities can be readily examined. The work has highlighted the need for evaluating hospital bed capacities in light of both bed occupancies and refused admission rates. The relationship between occupancy and refusals is complex and often overlooked by hospital managers.     

Determination of iphosphamide and seven metabolites in blood plasma,as stable trifluoroacetyl derivatives,by electron capture chemical ionization GC-MS

A method is described for the determination of the antitumor agent iphosphamide and seven of its metabolites in the plasma of cancer patients by multiple ion monitoring (MIM) GC-MS, mainly using the electron capture chemical ionization mode, of stable methyl and/or trifluoroacetyl derivatives. The metabolites determined were 2- and 3-dechloroethyliphosphamide, 4-ketoiphosphamide, carboxyiphosphamide, iphosphamide mustard, and two previously undetected metabolites, chloroethylamine and 1,3-oxazolidine-2-one. The isolation of the acidic and neutral metabolites was performed by solid phase extraction on to C₁₈ adsorbent at pH 4. The weakly acidic iphosphamide mustard, isolated under these conditions with a yield of ca 50%, was measured as a stable methyltrifluoroacetyl derivative, in contrast to the corresponding phosphoramide mustard of the isomer cyclophosphamide which decomposes during derivatization. Chloroethylamine and 1,3-oxazolidine-2-one were isolated with high yield by liquid extraction with ethyl acetate at pH 10. Selective measurement of several metabolite derivatives with similar retention times was performed by multiple ion monitoring MS of specific ion masses, using a methyl phenyl siloxane capillary column previously employed in the study of cyclophosphamide metabolites. Quantitation of metabolites in patient plasma samples could be performed in the concentration range 3 ng to 20 μg per ml of original plasma.     

Mother-to-child transmission of HIV: a simulation-based approach for the evaluation of intervention strategies

Mother-to-child transmission (MTCT) of HIV is the most significant source of HIV infection in children below the age of 15 years. In 2000 alone, about 600 000 new infections occurred, the vast majority from mothers living in developing countries who were not aware of their HIV-positive status. To date, at least 4.3 million children have died from AIDS. In this paper, we discuss the development of an operational model that can be used to evaluate intervention options for the prevention of MTCT of HIV. The problem was approached by defining suitable pregnancy risk groups, prevention options and the required model outputs to evaluate different intervention strategies. The method chosen to approach the problem was a discrete-event, three-phase simulation, built in Visual Basic, with a stochastic semi-Markov structure. The developed model takes individual pregnant women through each stage of their pregnancy, labour and birth. Different intervention strategies may be modelled at any time, including short-course antiretroviral drugs and cessation of breastfeeding. The model is demonstrated with data from Botswana, which has one of the highest HIV-infection rates in the world.     

On the challenges of healthcare modelling and a proposed project life cycle for successful implementation

OR methods and tools are being increasingly applied within the health services domain to support objective decision-making for the effective and efficient provision of resources. Healthcare modelling, however, is beset with many challenges and this paper examines a number of issues that define the primary challenges faced by the modeller in this field. It is fair to say that their resolution determines the likely success or failure of healthcare modelling in general. Working with a number of participating health service organizations, a proposed framework towards successful implementation has evolved and is presented in this paper     

Speciation and biosynthetic variation in four dictyoceratid sponges and their cyanobacterial symbiont, Oscillatoria spongeliae

Four species of marine sponges (Phylum Porifera, Order Dictyoceratida), which contain the filamentous cyanobacterial symbiont Oscillatoria spongeliae, were collected from four locations in Palau. The halogenated natural products associated with the symbiont were characterized from each sample, revealing that each species contained either chlorinated peptides, brominated diphenyl ethers, or no halogenated compounds. Analysis of the host sponges and the symbionts indicated that each species of sponge contained a distinct strain of morphologically similar cyanobacteria. Although cospeciation may be present in this group, we have identified that at least one host switching event has occurred in this symbiosis. Only the strain of O. spongeliae in the sponge containing the chlorinated compounds possessed genes involved in the biosynthesis of chlorinated leucine precursors, indicating that the chemical variation observed in these animals has a genetic foundation.     

Vitamin B12 as an allosteric cofactor; dual fluorescence, hysteresis, oscillations and the selection of corrin over porphyrin

Studies of the emission spectra of four Co(III) cobinamides (diaquo-, aquohydroxo-, dihydroxo- and dicyano-) show (1) that the excited states corresponding to the alphabeta and epsilon absorption bands behave like the S(1) and S(2) levels in the non-alternant hydrocarbon azulene (with emission from S(2)> S(1) in violation of Kasha's rule) and (2) that the excited states include a TICT (twisted intramolecular charge transfer) mechanism, as in the simpler cyanines, but where the TICT state gives rise to dual fluorescence instead of cis-trans isomerisation. Combined with the previously reported dual fluorescence from the S(1) level in synthetic metal corrinoids and in the naturally-occurring metal-free corrin, this provides evidence that the existence of an additional (metastable) ground state with a significantly different vibronic splitting and nuclear configuration is an intrinsic property of the basic corrin ligand (irrespective of the nature of the side-chains and the metal ion or even the absence of a metal) which distinguishes it from porphyrin. The occurrence of hysteresis (and its associated oscillations) in redox reactions of the cobinamides involving both the Co(III/II) and Co(II/I) couples indicates that the corrin ligand also has an intrinsic ability to exist in different conformations or "allosteric" forms with differing redox potential, which further distinguishes it from the porphyrin ligand. Possible links between the existence of an additional metastable ground state and of allosteric changes and the likely reasons for the selection of corrin over a porphyrin for the vitamin B(12)-dependent enzymes are discussed.     

Experimental studies of the dynamics of the bond-forming reactions of CF2(2+) with H2O using position-sensitive coincidence spectroscopy

The dynamics of the product channels forming OCF(+)+H(+)+HF and HCF(2) (+)+H(+)+O following the collisions of CF(2) (2+) with H(2)O have been investigated with a new position-sensitive coincidence experiment at a center-of-mass collision energy of 5.6 eV. The results show the formation of OCF(+) occurs via the formation of a doubly charged collision complex [H(2)O-CF(2)](2+) which subsequently undergoes a charge separating dissociation to form H(+) and HOCF(2) (+). The HOCF(2) (+) monocation subsequently fragments to form HF+OCF(+). The lifetimes of the collision complex and the HOCF(2) (+) ion are at least of the order of their rotational period. The kinetic energy release in this reaction indicates that it involves the ground state of CF(2) (2+) and forms the ground electronic states of OCF(+) and HF. The mechanism for forming HCF(2) (+) involves the direct and rapid abstraction of a hydride ion from H(2)O by CF(2) (2+). The resulting OH(+) ion subsequently fragments to H(+)+O, on a time scale at least comparable with its rotational period.