Oscillatory regulation of Hes1: Discrete stochastic delay modelling and simulation.
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ABSTRACT:
SUBMITTER: Barrio M
PROVIDER: S-EPMC1560403 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesThis feasibility study aimed to model in silico the current healthcare system for patients triaged to a primary care disposition following a call to National Health Service (NHS) 111 and determine the effect of reconfiguring the healthcare system to ensure a timely primary care service contact.DesignDiscrete event simulation.SettingSingle English NHS 111 call centre in Yorkshire.ParticipantsCallers registered with a Bradford general practitioner who contacted the NHS 111 service in 2021 and were triaged to a primary care disposition.Primary and secondary outcome measuresFace validity of conceptual model. Comparison between real and simulated data for quarterly counts (and 95% CIs) for patient contact with emergency ambulance (999), 111, and primary and secondary care services. Mean difference and 95% CIs in healthcare system usage between simulations and difference in mean proportion of avoidable admissions for callers who presented to an emergency department (ED).ResultsThe simulation of the current system estimated that there would be 39 283 (95% CI 39 237 to 39 328) primary care contacts, 2042 (95% CI 2032 to 2051) 999 calls and 1120 (95% CI 1114 to 1127) avoidable ED attendances. Modifying the model to ensure a timely primary care response resulted in a mean percentage increase of 196.1% (95% CI 192.2% to 199.9%) in primary care contacts, and a mean percentage decrease of 78.0% (95% CI 69.8% to 86.2%) in 999 calls and 88.1% (95% CI 81.7% to 94.5%) in ED attendances. Avoidable ED attendances reduced by a mean of -26 (95% CI -35 to -17).ConclusionIn this simulated study, ensuring timely contact with a primary care service would lead to a significant reduction in 999 and 111 calls, and ED attendances (although not avoidable ED attendance). However, this is likely to be impractical given the need to almost double current primary care service provision. Further economic and qualitative research is needed to determine whether this intervention would be cost-effective and acceptable to both patients and primary care clinicians.
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Project description:Dynamic changes in the active portion of stream networks represent a phenomenon common to diverse climates and geologic settings. However, mechanistically describing these processes at the relevant spatiotemporal scales without huge computational burdens remains challenging. Here, we present a novel stochastic framework for the effective simulation of channel network dynamics capitalizing on the concept of 'hierarchical structuring of temporary streams'-a general principle to identify the activation/deactivation order of network nodes. The framework allows the long-term description of event-based changes of the river network configuration starting from widely available climatic data (mainly rainfall and evapotranspiration). Our results indicate that climate strongly controls temporal variations of the active length, influencing not only the preferential configuration of the active channels but also the speed of network retraction during drying. Moreover, we observed that-while the statistics of wet length are mainly dictated by the underlying climatic conditions-the spatial patterns of active reaches and the size of the largest connected patch of the network are strongly controlled by the spatial correlation of local persistency. The proposed framework provides a robust mathematical set-up for analysing the multi-faceted ecological legacies of channel network dynamics, as discussed in a companion paper.
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