Analyzing the proposed reconfiguration of accident-and-emergency facilities in England

The Keogh Report of 2013 proposed a major reconfiguration of the accident and emergency (A&E) system under National Health Service (NHS) England to improve service. The proposed reconfiguration includes centralized facilities with multiple specialties as well as small local minor-injury facilities. We use stylized queuing models to analyze cost and service implications of the proposed reconfiguration. We find that increasing numbers of specialty patients that require admission to hospital makes splitting off specialty A&Es from general ones more attractive. The same applies for patients with minor injuries. Our work generally supports the reconfiguration recommended in the Keogh report but with some fine-tuning: For instance, a merger of A&Es (pooling) does not always make sense even though it increases patient numbers when the patients in the two A&Es are of different types. We provide simple quantitative rules to indicate whether the proposed reconfiguration could lower costs in any particular region of the country. The results here are consistent with some NHS England providers attempting specialty A&Es for geriatric patients and mobile drunkenness treatment centers on weekends. Our rules and approach can be useful for identifying candidate reconfiguration opportunities not only for NHS England but also for any other context where pooling and arrival heterogeneity are important considerations

Public service markets: their economics, institutional oversight and regulation

Public services in the UK have been transformed over the past 25 years with the introduction of market oriented solutions into their provision. This has been characterised by a shift away from state provision to independent providers, and by the introduction of competition and choice. This shift was partly ideologically motivated and partly driven by budget cutting considerations following the financial crisis. As such it has been lacking a comprehensive economic justification or method of analysis. It is now commonly accepted that the language of economic markets is essential to frame arguments about how effectively public services are achieving their intended outcomes. Using market language and concepts may not always be comfortable for those from a traditional policy-making background. It can nevertheless be very useful when designing investigations into the effectiveness and value for money in the mechanisms of delivery of such services, whenever these services entail a degree of user choice as is currently the case in large parts of health, social care and education (referred to as competition in the market). Our paper wants to provide a conceptual basis on the way of thinking in these terms. We provide a description of the current state and then comment on the desirability of this quasi market approach. Uniquely in the literature, we analyse the expected and desired developments by distinguishing between choice and compulsory merit goods. In choice merit goods markets many users are unable to choose effectively because of the existence of a number of demand side or supply side market failures. Moreover, conflicts may exist between how service users actually make choices, and policy objectives such as universality or equity which may not be achieved simply by ‘leaving it to the market’. The users of compulsory merit goods are typically a minority and unable to internalise the full social benefits of their actions; hence it may be welfare-enhancing for society to coerce them ‘consume’ these services. As choice cannot be an objective, the commissioning (competition for the market) or direct provision by the state of such goods may meet public policy objectives more effectively than the market mechanism alone. Building on these foundations the paper discusses when public service markets are likely to be an effective method of achieving public policy objectives, and when they may not be. Our paper analyses the implications for the institutional and legal framework, funding oversight and regulation of public service markets as a result of their transformation into quasi-markets. The paper concludes with some suggestions for those charged with overseeing public service markets in practice based on this analysis

Professional Writing in the English Classroom: Literature-Based Professional Writing: An Oxymoron Whose Time Has Come

The article discusses a study regarding the integration of professional writing in English classes. It mentions the proposal of the National Council of Teachers of English (NCTE) in its annual convention on associating professional writing with literature. It also states that connecting literature with technical writing in English classrooms provides students with opportunities to absorb real life writing experiences

Chemical Toxicants in Water: A \u3ci\u3eGeoHealth\u3c/i\u3e Perspective in the Context of Climate Change

The editorial focuses on four major themes contextualized in a virtual GeoHealth workshop that occurred from June 14 to 16, 2021. Topics in that workshop included drinking water and chronic chemical exposure, environmental injustice, public health and drinking water policy, and the fate, transport, and human impact of aqueous contaminants in the context of climate change. The intent of the workshop was to further define the field of GeoHealth. This workshop emphasized on chemical toxicants that drive human health. The major calls for action emerged from the workshop include enhancing community engagement, advocating for equity and justice, and training the next generation

Phase II study of second-line therapy with DTIC, BCNU, cisplatin and tamoxifen (Dartmouth regimen) chemotherapy in patients with malignant melanoma previously treated with dacarbazine

This study assessed response rates to combination dacarbazine (DTIC), BCNU (carmustine), cisplatin and tamoxifen (DBPT) chemotherapy in patients with progressive metastatic melanoma previously treated with DTIC, as an evaluation of DBPT as a second-line regimen, and as an indirect comparison of DBPT with DTIC. Thirty-five consecutive patients received DBPT. The patients were divided into two groups. Group 1 comprised 17 patients with progressive disease (PD) on DTIC + tamoxifen therapy who were switched directly to DBPT. Group 2 comprised 18 patients not immediately switched to DBPT and included patients who had either a partial response (PR; one patient) or developed stable disease (SD; four patients) with DTIC, or received adjuvant DTIC (nine patients). All except four patients had received tamoxifen at the time of initial DTIC treatment. Median times since stopping DTIC were 22 days (range 20–41) and 285 days (range 50–1240) in Groups 1 and 2 respectively. In Group 1, one patient developed SD for 5 months and the remainder had PD. In Group 2, there were two PRs, four patients with SD (4, 5, 6, and 6 months), and 11 with PD. These results indicate that the DBPT regimen is not of value in melanoma primarily refractory to DTIC. There were responses in patients not directly switched from DTIC to DBPT, suggesting combination therapy may be of value in a small subgroup of melanoma patients. © 2000 Cancer Research Campaig

Remodelling of microRNAs in colorectal cancer by hypoxia alters metabolism profiles and 5-fluorouracil resistance

AN, HT and AP are Constance Travis post-graduate fellows. NS is a Barts and The London post-doctoral fellow. SMD is a Bowel & Cancer Research post-doctoral fellow. TS is supported by a Grant-in-Aid for scientific research on Innovative Areas, Japan (No. 22134007 to T.S.), and the Yamagata Prefectural Government and City of Tsuruoka