The cost of trauma operating theatre inefficiency.

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Marys Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends

Using simulation studies to evaluate statistical methods

Simulation studies are computer experiments that involve creating data by pseudorandom sampling. The key strength of simulation studies is the ability to understand the behaviour of statistical methods because some 'truth' (usually some parameter/s of interest) is known from the process of generating the data. This allows us to consider properties of methods, such as bias. While widely used, simulation studies are often poorly designed, analysed and reported. This tutorial outlines the rationale for using simulation studies and offers guidance for design, execution, analysis, reporting and presentation. In particular, this tutorial provides: a structured approach for planning and reporting simulation studies, which involves defining aims, data-generating mechanisms, estimands, methods and performance measures ('ADEMP'); coherent terminology for simulation studies; guidance on coding simulation studies; a critical discussion of key performance measures and their estimation; guidance on structuring tabular and graphical presentation of results; and new graphical presentations. With a view to describing recent practice, we review 100 articles taken from Volume 34 of Statistics in Medicine that included at least one simulation study and identify areas for improvement.Comment: 31 pages, 9 figures (2 in appendix), 8 tables (1 in appendix

Retinal gene therapy with a large MYO7A cDNA using adeno-associated virus.

Usher 1 patients are born profoundly deaf and then develop retinal degeneration. Thus they are readily identified before the onset of retinal degeneration, making gene therapy a viable strategy to prevent their blindness. Here, we have investigated the use of adeno-associated viruses (AAVs) for the delivery of the Usher 1B gene, MYO7A, to retinal cells in cell culture and in Myo7a-null mice. MYO7A cDNA, under control of a smCBA promoter, was packaged in single AAV2 and AAV5 vectors and as two overlapping halves in dual AAV2 vectors. The 7.9-kb smCBA-MYO7A exceeds the capacity of an AAV vector; packaging of such oversized constructs into single AAV vectors may involve fragmentation of the gene. Nevertheless, the AAV2 and AAV5 single vector preparations successfully transduced photoreceptor and retinal pigment epithelium cells, resulting in functional, full-length MYO7A protein and correction of mutant phenotypes, suggesting successful homologous recombination of gene fragments. With discrete, conventional-sized dual AAV2 vectors, full-length MYO7A was detected, but the level of protein expression was variable, and only a minority of cells showed phenotype correction. Our results show that MYO7A therapy with AAV2 or AAV5 single vectors is efficacious; however, the dual AAV2 approach proved to be less effective

Study on the selectivity of anion receptors by adjusting the distance of two urea fragments and their analytical application

Three anion receptors based on urea: 1 N, N'-bis-(p-nitrophenylaminocarbonyl)-Hydrazine, 2 N, N'-bis-(p-nitrophenylaminocar-bonyl)-ethylenediamine and 3 N, N'-bis-(p-nitrophenylaminocarbonyl)-1, 3-propane-diamine are designed and synthesized. Studies of UV-vis spectra presented that 1 was an excellent sensor of F- and 2 was sensitive to H2PO4 (-). Unfortunately, 3 can not distinguish the anions investigated in this paper. The color changes of the hosts upon the addition of a variety of structurally different anions were also utilized as naked-eye detection which is very convenient. It also revealed significantly that the distance between two recognition sites of receptor had an immediate effect on the selectivity of receptor for anions, which had been confirmed by the H-1 NMR titration and IR

Effectiveness of Hindman's theorem for bounded sums

We consider the strength and effective content of restricted versions of Hindman's Theorem in which the number of colors is specified and the length of the sums has a specified finite bound. Let $\mathsf{HT}^{\leq n}_k$ denote the assertion that for each $k$-coloring $c$ of $\mathbb{N}$ there is an infinite set $X \subseteq \mathbb{N}$ such that all sums $\sum_{x \in F} x$ for $F \subseteq X$ and $0 < |F| \leq n$ have the same color. We prove that there is a computable $2$-coloring $c$ of $\mathbb{N}$ such that there is no infinite computable set $X$ such that all nonempty sums of at most $2$ elements of $X$ have the same color. It follows that $\mathsf{HT}^{\leq 2}_2$ is not provable in $\mathsf{RCA}_0$ and in fact we show that it implies $\mathsf{SRT}^2_2$ in $\mathsf{RCA}_0$. We also show that there is a computable instance of $\mathsf{HT}^{\leq 3}_3$ with all solutions computing $0'$. The proof of this result shows that $\mathsf{HT}^{\leq 3}_3$ implies $\mathsf{ACA}_0$ in $\mathsf{RCA}_0$

An acetate sensor based on azo in aqueous media

A colorimetric sensor 1,N,N'-di-(2-hydroxy-5-(phenldiazenyl)benzaldehyde)-1,3-diiminothiourea for acetate in DMSO and 9/1 DMSO/H(2)O (v/v) mixtures was designed and synthesized. The binding ability evaluated by UV-vis experiment reveals that sensor 1 can selectively recognize acetate. In addition, the color changes induced by anions can provide a way of detection by 'naked-eye'. The further insights to the nature of interactions between the sensor 1 and AcO(-) were investigated by (1)H NMR titration experiments in 9/1 DMSO-d(6)/H(2)O (v/v). (c) 2010 Elsevier B.V. All rights reserved

Historical changes in the phenology of British Odonata are related to climate

Responses of biota to climate change take a number of forms including distributional shifts, behavioural changes and life history changes. This study examined an extensive set of biological records to investigate changes in the timing of life history transitions (specifically emergence) in British Odonata between 1960 and 2004. The results show that there has been a significant, consistent advance in phenology in the taxon as a whole over the period of warming that is mediated by life history traits. British odonates significantly advanced the leading edge (first quartile date) of the flight period by a mean of 1.51 ±0.060 (SEM, n=17) days per decade or 3.08±1.16 (SEM, n=17) days per degree rise in temperature when phylogeny is controlled for. This study represents the first review of changes in odonate phenology in relation to climate change. The results suggest that the damped temperature oscillations experienced by aquatic organisms compared with terrestrial organisms are sufficient to evoke phenological responses similar to those of purely terrestrial taxa

A Genomic-Based Approach Combining In Vivo Selection in Mice to Identify a Novel Virulence Gene in Leishmania

Parasites of the genus Leishmania cause a variety of human diseases that range from destructive skin lesions caused by L. major to visceral infections of the liver and spleen caused by L. donovani that result in death. The Leishmania genes responsible for these different pathologies are not known. In the present study, we used a comparative genome-based approach to introduce and over-express L. donovani genes in L. major to determine whether this results in increased virulence of L. major in visceral organs of infected mice. Through this approach, a novel gene termed Li1040 was identified that is potentially involved in protein transport and was shown to increase pathogenesis in the visceral organs in mice. The Li1040 gene may therefore represent a Leishmania virulence gene that has the potential to regulate the pathology of infection in the mammalian host. These observations help to define how Leishmania causes fatal infections in humans and therefore provide a parasite-specific target for therapy

Are L-myc genotypes prognostic markers in non-small cell lung carcinoma (NSCLC) in our Chinese patients?

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