A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson's disease in the United Kingdom.

BACKGROUND: The number of people affected by Parkinson's disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality. METHODS: A Discrete Event Simulation model was developed to represent the PD care structure including patients' pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model. RESULTS: Shifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients. CONCLUSIONS: The simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients and carers to help inform management choices and care plans

A new gender-specific model for skin autofluorescence risk stratification

Advanced glycation endproducts (AGEs) are believed to play a significant role in the pathophysiology of a variety of diseases including diabetes and cardiovascular diseases. Non-invasive skin autofluorescence (SAF) measurement serves as a proxy for tissue accumulation of AGEs. We assessed reference SAF and skin reflectance (SR) values in a Saudi population (n = 1,999) and evaluated the existing risk stratification scale. The mean SAF of the study cohort was 2.06 (SD = 0.57) arbitrary units (AU), which is considerably higher than the values reported for other populations. We show a previously unreported and significant difference in SAF values between men and women, with median (range) values of 1.77 AU (0.79–4.84 AU) and 2.20 AU (0.75–4.59 AU) respectively (p-value « 0.01). Age, presence of diabetes and BMI were the most influential variables in determining SAF values in men, whilst in female participants, SR was also highly correlated with SAF. Diabetes, hypertension and obesity all showed strong association with SAF, particularly when gender differences were taken into account. We propose an adjusted, gender-specific disease risk stratification scheme for Middle Eastern populations. SAF is a potentially valuable clinical screening tool for cardiovascular risk assessment but risk scores should take gender and ethnicity into consideration for accurate diagnosis

Vertical spinal electronic device with large room temperature magnetoresistance

We report experimental transport measurements of a vertical hybrid ferromagnetic (FM)/III-V semiconductor (SC)/ferromagnetic(FM) type structure, i.e., Cr(20ML)/Co(15ML)/GaAs(50 nm, n-type)/Al/sub 0.3/Ga/sub 0.7/As(200 nm, n-type)/FeNi(30 nm). The current-voltage (I-V) characteristics reveal Schottky/tunneling type behavior in the direction of FeNi/Semiconductor/Co and observed to be dependent on external magnetic field. The magnetoresistance (MR) behavior shows a strong dependence on the measured current and field. At low fields no significant change in MR has been observed with increasing current. However, at high fields the MR initially increases with increasing current and becomes stable beyond a critical current of 10 /spl mu/A. A maximum of 12% change in the MR has been observed at room temperature, which is far larger than that of the conventional AMR effect. This property of the device could be utilized as field sensors or magnetic logic devices

Time Reversal with Post-Equalization for OFDM without CP in Massive MIMO

This paper studies the possibility of eliminating the redundant cyclic prefix (CP) of orthogonal frequency division multiplexing (OFDM) in massive multiple-input multiple-output systems. The absence of CP increases the bandwidth efficiency in expense of intersymbol interference (ISI) and intercarrier interference (ICI). It is known that in massive MIMO, different types of interference fade away as the number of base station (BS) antennas tends to infinity. In this paper, we investigate if the channel distortions in the absence of CP are averaged out in the large antenna regime. To this end, we analytically study the performance of the conventional maximum ratio combining (MRC) and realize that there always remains some residual interference leading to saturation of signal to interference (SIR). This saturation of SIR is quantified through mathematical equations. Moreover, to resolve the saturation problem, we propose a technique based on time-reversal MRC with zero forcing multiuser detection (TR-ZF). Thus, the SIR of our proposed TR-ZF does not saturate and is a linear function of the number of BS antennas. We also show that TR-ZF only needs one OFDM demodulator per user irrespective of the number of BS antennas; reducing the BS signal processing complexity significantly. Finally, we corroborate our claims as well as analytical results through simulations.Comment: 7 pages, 3 figure

Annealing-induced Fe oxide nanostructures on GaAs

We report the evolution of Fe oxide nanostructures on GaAs(100) upon pre- and post-growth annealing conditions. GaAs nanoscale pyramids were formed on the GaAs surface due to wet etching and thermal annealing. An 8.0-nm epitaxial Fe film was grown, oxidized, and annealed using a gradient temperature method. During the process the nanostripes were formed, and the evolution has been demonstrated using transmission and reflection high energy electron diffraction, and scanning electron microscopy. These nanostripes; exhibited uniaxial magnetic anisotropy. The formation of these nanostructures is attributed to surface anisotropy, which in addition could explain the observed uniaxial magnetic anisotropy

Innovation through Design Strategy: Case Study of SMEs in Bandung

The rise of business in the city of Bandung has caused the intensity of competition to be very high. Small-scale businesses are very difficult to survive especially facing companies that have larger economies of scale. Innovation can be one way for SMEs to compete. Previous research stated that implementing a design strategy can trigger opportunities to create innovation in the company. This study examines how design is used by Soca companies to produce innovation as a strategy to survive in competition. Soca is an SME in Bandung that produces glasses with wood materials. As a startup, Soca is considered successful in penetrating the market amid intense competition. This study uses a qualitative method with a descriptive case study approach. Primary data is obtained through document review, in-depth interviews and observations. The results of this study are expected to be a reference for how design strategies are used by SMEs to generate innovation Keywords Innovations, SMEs, Design Strateg