Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

Objective: Healthcare faces the continual challenge of improving outcome whilst aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design:  Discrete event simulation was used to model and analyse cost and resource utilisation with an activity based costing approach. Data for a full comparison before the process change was unavailable so we utilised a modelling approach, comparing a Virtual Fracture Clinic (VFC) to a simulated Traditional Fracture Clinic (TFC). Setting:  The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures: Our study focused exclusively on non-operative trauma patients attending Emergency Department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries in association with activity costs from the models.ResultsPatients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p=<0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI: 21.74, 23.92) per patient compared with £36.81 (95% CI: 35.65, 37.97) for the TFC pathway.  Conclusions:  Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional face-to-face clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings

Public health outcome of Tuberculosis Cluster Investigations, England 2010–2013

Objectives: Tuberculosis (TB) is a serious re-emergent public health problem in the UK. In response to rising case incidence a National TB Strain-Typing Service based on molecular strain-typing was established. This facilitates early detection and investigation of clusters, targeted public health action, and prevention of further transmission. We review the added public health value of investigating molecular TB straintyped (ST) clusters. Methods: A structured questionnaire for each ST cluster investigated in England between 1 January 2010 and 30 June 2013 was completed. Questions related to epidemiological links and public health action and the perceived benefits of ST cluster investigation. Results: There were 278 ST cluster investigations (CIs) involving 1882 TB cases. Cluster size ranged from 2 to 92. CIs identified new epidemiological links in 36% of clusters; in 18% STs were discordant refuting transmission thought to have occurred. Additional public health action was taken following 23% of CI. Conclusions: We found positive benefits of TB molecular ST and CI, in identifying new epidemiological links between cases and taking public health action and in refuting transmission and saving resources. This needs to be translated to a decrease in transmission to provide evidence of public health value in this low prevalence high resource setting

Service re-design in healthcare : the impact of innovative methods to compare costs and benefits

This article describes research conducted by University of Strathclyde academics that has successfully impacted upon policy implementation. Specifically, we describe the innovative application of Discrete Event Simulation (DES) in an action research framework to develop bottom-up micro costing models to determine the cost effectiveness of a radically new ‘virtual clinic’ pathway for orthopaedic trauma patients. The use of DES allowed stakeholders to compare the costs of the new approach (virtual fracture clinic) against the baseline (traditional fracture clinic) in sufficient detail. The insights generated from this research enabled health policy stakeholders to build a convincing case for the diffusion and reliable implementation of virtual pathways for orthopaedic trauma patients in other hospitals in Scotland and well beyond. Wider dissemination of this work has seen continued government funding for the use of DES for cost effectiveness studies in other healthcare settings, as well as training and capacity building in DES-supported service redesign amongst healthcare professionals throughout NHS Scotland

Dinosaur tracks from the Kilmaluag Formation (Bathonian, Middle Jurassic) of Score Bay, Isle of Skye, Scotland, UK

Tracks of a juvenile theropod dinosaur with footprint lengths of between 2 and 9 cm as well as adults of the same ichnospecies with footprints of about 15–25 cm in length were found in the Bathonian (Middle Jurassic) Kilmaluag Formation of Score Bay, northwestern Trotternish Peninsula, Isle of Skye, Scotland, UK. Two footprint sizes occur together on the same bedding plane in the central portion of Score Bay, both in situ and on loose blocks. Another horizon containing footprints above this was also identified. The footprints from the lowest horizon were produced in a desiccated silty mud that was covered with sand. A close association of both adults and juveniles with similar travel direction indicated by the footprints may suggest post-hatching care in theropod dinosaurs. Other footprints, produced on a rippled sandy substrate, have been found on the slightly higher bedding plane at this locality. Loose blocks found 130 m to the northeast in the central part of Score Bay have not been correlated with any in situ sediments, but were preserved in a similar manner to those from the higher bedding plane. These tracks represent the youngest dinosaur remains yet found in Scotland

Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study

Background: To allow direct comparison of bloodstream infection (BSI) rates between hospitals for performance measurement, observed rates need to be risk adjusted according to the types of patients cared for by the hospital. However, attribute data on all individual patients are often unavailable and hospital-level risk adjustment needs to be done using indirect indicator variables of patient case mix, such as hospital level. We aimed to identify medical services associated with high or low BSI rates, and to evaluate the services provided by the hospital as indicators that can be used for more objective hospital-level risk adjustment

WASP-23b: a transiting hot Jupiter around a K dwarf and its Rossiter-McLaughlin effect

We report the discovery of a new transiting planet in the Southern Hemisphere. It has been found by the WASP-south transit survey and confirmed photometrically and spectroscopically by the 1.2m Swiss Euler telescope, LCOGT 2m Faulkes South Telescope, the 60 cm TRAPPIST telescope and the ESO 3.6m telescope. The orbital period of the planet is 2.94 days. We find it is a gas giant with a mass of 0.88 \pm 0.10 Mj and a radius estimated at 0.96 \pm 0.05 Rj . We have also obtained spectra during transit with the HARPS spectrograph and detect the Rossiter-McLaughlin effect despite its small amplitude. Because of the low signal to noise of the effect and of a small impact parameter we cannot place a constraint on the projected spin-orbit angle. We find two confiicting values for the stellar rotation. Our determination, via spectral line broadening gives v sin I = 2.2 \pm 0.3 km/s, while another method, based on the activity level using the index log R'HK, gives an equatorial rotation velocity of only v = 1.35 \pm 0.20 km/s. Using these as priors in our analysis, the planet could either be misaligned or aligned. This should send strong warnings regarding the use of such priors. There is no evidence for eccentricity nor of any radial velocity drift with time.Comment: 13 pages, 8 figures, 7 tables, accepted for publication in A&

Ultrafast entangling gates between nuclear spins using photo-excited triplet states

The representation of information within the spins of electrons and nuclei has been powerful in the ongoing development of quantum computers. Although nuclear spins are advantageous as quantum bits (qubits) due to their long coherence lifetimes (exceeding seconds), they exhibit very slow spin interactions and have weak polarisation. A coupled electron spin can be used to polarise the nuclear spin and create fast single-qubit gates, however, the permanent presence of electron spins is a source of nuclear decoherence. Here we show how a transient electron spin, arising from the optically excited triplet state of C60, can be used to hyperpolarise, manipulate and measure two nearby nuclear spins. Implementing a scheme which uses the spinor nature of the electron, we performed an entangling gate in hundreds of nanoseconds: five orders of magnitude faster than the liquid-state J coupling. This approach can be widely applied to systems comprising an electron spin coupled to multiple nuclear spins, such as NV centres, while the successful use of a transient electron spin motivates the design of new molecules able to exploit photo-excited triplet states.Comment: 5 pages, 3 figure