Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

OBJECTIVES: To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. DESIGN: Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. MAIN OUTCOME MEASURES: Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. RESULTS: By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). CONCLUSION: The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1

Tomographically reconstructed master equations for any open quantum dynamics

Memory effects in open quantum dynamics are often incorporated in the equation of motion through a superoperator known as the memory kernel, which encodes how past states affect future dynamics. However, the usual prescription for determining the memory kernel requires information about the underlying system-environment dynamics. Here, by deriving the transfer tensor method from first principles, we show how a memory kernel master equation, for any quantum process, can be entirely expressed in terms of a family of completely positive dynamical maps. These can be reconstructed through quantum process tomography on the system alone, either experimentally or numerically, and the resulting equation of motion is equivalent to a generalised Nakajima-Zwanzig equation. For experimental settings, we give a full prescription for the reconstruction procedure, rendering the memory kernel operational. When simulation of an open system is the goal, we show how our procedure yields a considerable advantage for numerically calculating dynamics, even when the system is arbitrarily periodically (or transiently) driven or initially correlated with its environment. Namely, we show that the long time dynamics can be efficiently obtained from a set of reconstructed maps over a much shorter time.Comment: 10+4 pages, 5 figure

Dismantling the signposts to public health? NHS data under the Health and Social Care Act 2012

The Health and Social Care Act 2012 will replace the administrative structure of the NHS in England, currently based on the resident populations of defined geographical areas, with one that relates instead to the shifting populations of individuals registered with specific general practices at given points in time.1 This will radically change the longstanding basis for collecting data routinely about the health needs of local populations, making it difficult to monitor the effect of new legislation on the health of the population locally or nationally.2 3 We discuss some of the implications of the act for existing routine data systems and the production of routine statistics that underpin essential NHS functions, including monitoring healthcare provision and ensuring equity of access, allocation of resources, and measurement of outcomes

Non-Markovian memory in IBMQX4

We measure and quantify non-Markovian effects in IBM's Quantum Experience. Specifically, we analyze the temporal correlations in a sequence of gates by characterizing the performance of a gate conditioned on the gate that preceded it. With this method, we estimate (i) the size of fluctuations in the performance of a gate, i.e., errors due to non-Markovianity; (ii) the length of the memory; and (iii) the total size of the memory. Our results strongly indicate the presence of non-trivial non-Markovian effects in almost all gates in the universal set. However, based on our findings, we discuss the potential for cleaner computation by adequately accounting the non-Markovian nature of the machine.Comment: 8 page

High-performance thermionic converter Quarterly progress report, 13 Aug. - 13 Nov. 1965

Fabrication and testing of cesium loaded thermionic converter test vehicl

The Structure of Quantum Stochastic Processes with Finite Markov Order

Non-Markovian quantum processes exhibit different memory effects when measured in different ways; an unambiguous characterization of memory length requires accounting for the sequence of instruments applied to probe the system dynamics. This instrument-specific notion of quantum Markov order displays stark differences to its classical counterpart. Here, we explore the structure of quantum stochastic processes with finite length memory in detail. We begin by examining a generalized collision model with memory, before framing this instance within the general theory. We detail the constraints that are placed on the underlying system-environment dynamics for a process to exhibit finite Markov order with respect to natural classes of probing instruments, including deterministic (unitary) operations and sequences of generalized quantum measurements with informationally-complete preparations. Lastly, we show how processes with vanishing quantum conditional mutual information form a special case of the theory. Throughout, we provide a number of representative, pedagogical examples to display the salient features of memory effects in quantum processes.Comment: 15.5+8 pages; 11 figure

Tightening Quantum Speed Limits for Almost All States

Conventional quantum speed limits perform poorly for mixed quantum states: They are generally not tight and often significantly underestimate the fastest possible evolution speed. To remedy this, for unitary driving, we derive two quantum speed limits that outperform the traditional bounds for almost all quantum states. Moreover, our bounds are significantly simpler to compute as well as experimentally more accessible. Our bounds have a clear geometric interpretation; they arise from the evaluation of the angle between generalized Bloch vectors.Comment: Updated and revised version; 5 pages, 2 figures, 1 page appendi