A systematic literature review of operational research methods for modelling patient flow and outcomes within community healthcare and other settings

An ambition of healthcare policy has been to move more acute services into community settings. This systematic literature review presents analysis of published operational research methods for modelling patient flow within community healthcare, and for modelling the combination of patient flow and outcomes in all settings. Assessed for inclusion at three levels – with the references from included papers also assessed – 25 “Patient flow within community care”, 23 “Patient flow and outcomes” papers and 5 papers within the intersection are included for review. Comparisons are made between each paper’s setting, definition of states, factors considered to influence flow, output measures and implementation of results. Common complexities and characteristics of community service models are discussed with directions for future work suggested. We found that in developing patient flow models for community services that use outcomes, transplant waiting list may have transferable benefits

Patients’ Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study

Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Eligible patients were identified in a service evaluation of emerge ncy presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in n iterative process. Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients’ (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients’ capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek further healthcare. The findings also point to potentially avoidable breakdowns in the diagnostic process. In particular, to encourage patients to return to the GP if symptoms escalate, a stronger emphasis is needed on diagnostic uncertainty in discussions between patients and doctors in both primary and secondary care. To improve appropriate access to rapid investigations, systems are needed for primary care to communicate directly with secondary care at the time of referral

New Exactly Solvable Two-Dimensional Quantum Model Not Amenable to Separation of Variables

The supersymmetric intertwining relations with second order supercharges allow to investigate new two-dimensional model which is not amenable to standard separation of variables. The corresponding potential being the two-dimensional generalization of well known one-dimensional P\"oschl-Teller model is proven to be exactly solvable for arbitrary integer value of parameter $p:$ all its bound state energy eigenvalues are found analytically, and the algorithm for analytical calculation of all wave functions is given. The shape invariance of the model and its integrability are of essential importance to obtain these results.Comment: 23 page

A solution to the zero-hamiltonian problem in 2-D gravity

The zero-hamiltonian problem, present in reparametrization invariant systems, is solved for the 2-D induced gravity model. Working with methods developed by Henneaux et al. we find systematically the reduced phase-space physics, generated by an {\it effective} hamiltonian obtained after complete gauge fixing.Comment: 5 pages, revte

Determining the 7Li(n,gamma) cross section via Coulomb dissociation of 8Li

The applicability of Coulomb dissociation reactions to determine the cross section for the inverse neutron capture reaction was explored using the reaction 8Li(gamma,n)7Li. A 69.5 MeV/nucleon 8Li beam was incident on a Pb target, and the outgoing neutron and 7Li nucleus were measured in coincidence. The deduced (n,gamma) excitation function is consistent with data for the direct capture reaction 7Li(n,gamma)8Li and with low-energy effective field theory calculations.Comment: Accepted for publication in Phys. Rev.

Quantum gravity correction, evolution of scalar field and inflation

We take the first nontrivial coefficient of the Schwinger-DeWitt expansion as a leading correction to the action of the second-derivative metric-dilaton gravity. To fix the ambiguities related with an arbitrary choice of the gauge fixing condition and the parametrization for the quantum field, one has to use the classical equations of motion. As a result, the only corrections are the ones to the potential of the scalar field. It turns out that the parameters of the initial classical action may be chosen in such a way that the potential satisfies most of the conditions for successful inflation.Comment: 11 pages, 3 figure

Ultra-sensitive in-beam gamma-ray spectroscopy for nuclear astrophysics at LUNA

Ultra-sensitive in-beam gamma-ray spectroscopy studies for nuclear astrophysics are performed at the LUNA (Laboratory for Underground Nuclear Astrophysics) 400 kV accelerator, deep underground in Italy's Gran Sasso laboratory. By virtue of a specially constructed passive shield, the laboratory gamma-ray background for E_\gamma < 3 MeV at LUNA has been reduced to levels comparable to those experienced in dedicated offline underground gamma-counting setups. The gamma-ray background induced by an incident alpha-beam has been studied. The data are used to evaluate the feasibility of sensitive in-beam experiments at LUNA and, by extension, at similar proposed facilities.Comment: accepted, Eur. Phys. J.