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

Increased expression of matrix metalloproteinase-9 in patients with temporal lobe epilepsy

Aim: The molecular mechanism of epileptogenesis in temporal lobe epilepsy is still unclear. Experimental studies have suggested that matrix metalloproteinases have important roles in this process, but human studies are limited. The aim of this study was to assess the expression of MMP-9, MMP-2 and their tissue inhibitors (TIMP-1 and TIMP-2) in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Material and Methods: The tissue samples from temporal neocortex and hippocampus were obtained from patients with temporal lobe epilepsy with hippocampal sclerosis who had undergone anterior temporal lobectomy for recurrent medically resistant seizures. Immunohistochemical methods were used to determine the expression of MMP-9, MMP-2 and their tissue inhibitors. Tissue samples were also analyzed with transmission electron microscopy. Results: The immunoreactivity for MMP-9 both in hippocampal and temporal neocortical neurons was stronger than that of MMP-2. Additionally, there was a mild reaction for its tissue inhibitor TIMP-1 as with TIMP-2. The TEM analysis of the hippocampus revealed that there was apparent ultra-structural damage on the pericarya and neuropil of some neurons. There was obvious damage in the mitochondria and the nuclear membrane. Conclusion: The preliminary results of this study revealed that MMP-9 may have a role in patients with drug resistant TLE-HS

Neutrino Masses and the Gluino Axion Model

We extend the recently proposed gluino axion model to include neutrino masses. We discuss how the canonical seesaw model and the Higgs triplet model may be realized in this framework. In the former case, the heavy singlet neutrinos are contained in superfields which do not have any vacuum expectation value, whereas the gluino axion is contained in one which does. We also construct a specific renormalizable model which realizes the mass scale relationship $M_{SUSY} \sim f_a^2/M_U$, where $f_a$ is the axion decay constant and $M_U$ is a large effective mass parameter.Comment: 8 pages, no figur

Realistic Gluino Axion Model Consistent with Supersymmetry Breaking at the TeV Scale

The recently proposed model of using the dynamical phase of the gluino to solve the strong CP problem is shown to admit a specific realization in terms of fundamental singlet superfields, such that the breaking of supersymmetry occurs only at the TeV scale, despite the large axion scale of 10^{9} to 10^{12} GeV. Phenomenological implications are discussed.Comment: 12 pp, 2 fig

Electroweak Breaking and the mu problem in Supergravity Models with an Additional U(1)

We consider electroweak symmetry breaking in supersymmetric models with an extra non-anomalous U(1)' gauge symmetry and an extra standard-model singlet scalar S. For appropriate charges the U(1)' forbids an elementary mu term, but an effective mu is generated by the VEV of S, leading to a natural solution to the mu problem. There are a variety of scenarios leading to acceptably small Z-Z' mixing and other phenomenological consequences, all of which involve some but not excessive fine tuning. One class, driven by a large trilinear soft supersymmetry breaking term, implies small mixing, a light Z' (e.g., 200 GeV), and an electroweak phase transition that may be first order at tree level. In another class, with m_S^2 < 0 (radiative breaking), the typical scale of dimensional parameters, including M_{Z'} and the effective mu, is O(1 TeV), but the electroweak scale is smaller due to cancellations. We relate the soft supersymmetry breaking parameters at the electroweak scale to those at the string scale, choosing Yukawa couplings as determined within a class of string models. We find that one does not obtain either scenario for universal soft supersymmetry breaking mass parameters at the string scale and no exotic multiplets contributing to the renormalization group equations. However, either scenario is possible when the assumption of universal soft breaking is relaxed. Radiative breaking can also be generated by exotics, which are expected in most string models.Comment: 45 pages, revtex, 20 eps figures, psfig.sty; Minor numerical renormalization group results corrected. Erratum to appear in Phys. Rev.

The CP properties of the lightest Higgs boson with sbottom effects

In the framework of the recently proposed gluino-axion model, using the effective potential method and taking into account the top-stop as well as the bottom-sbottom effects, we discuss the CP--properties of the lightest Higgs boson, in particular its CP--odd composition, which can offer new opportunities at collider searches. It is found that although the CP-odd composition of the lightest Higgs increases slightly with the inclusion of the sbottom effects, it never exceeds %0.17 for all values of the renormalization scale Q ranging from top mass to TeV scaleComment: 24 pp, 12 eps fig

Relaxation of the Dynamical Gluino Phase and Unambiguous Electric Dipole Moments

We propose a new axionic solution of the strong CP problem with a Peccei-Quinn mechanism using the gluino rather than quarks. The spontaneous breaking of this new global U(1) at 10^{11} GeV also generates the supersymmetry breaking scale of 1 TeV (solving the so-called \mu problem at the same time) and results in the MSSM (Minimal Supersymmetric Standard Model) with R parity conservation. In this framework, electric dipole moments become calculable without ambiguity.Comment: Typos corrected and a footnote added, 10 p

Non-Gravitating Scalar Field in the FRW Background

We study interacting scalar field theory non-minimally coupled to gravity in the FRW background. We show that for a specific choice of interaction terms, the energy-momentum tensor of the scalar field vanishes, and as a result the scalar field does not gravitate. The naive space dependent solution to equations of motion gives rise to singular field profile. We carefully analyze the energy-momentum tensor for such a solution and show that the singularity of the solution gives a subtle contribution to the energy-momentum tensor. The space dependent solution therefore is not non-gravitating. Our conclusion is applicable to other space-time dependent non-gravitating solutions as well. We study hybrid inflation scenario in this model when purely time dependent non-gravitating field is coupled to another scalar field.Comment: 7 Pages, 2 figures, RevTeX4, v2:added a section on regularized energy-momentum tensor, references and conclusions modifie