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

Distributed and Parallel Algorithms for Set Cover Problems with Small Neighborhood Covers

In this paper, we study a class of set cover problems that satisfy a special property which we call the {\em small neighborhood cover} property. This class encompasses several well-studied problems including vertex cover, interval cover, bag interval cover and tree cover. We design unified distributed and parallel algorithms that can handle any set cover problem falling under the above framework and yield constant factor approximations. These algorithms run in polylogarithmic communication rounds in the distributed setting and are in NC, in the parallel setting.Comment: Full version of FSTTCS'13 pape

A Near-linear Time Constant Factor Algorithm for Unsplittable Flow Problem on Line with Bag Constraints

Consider a scenario where we need to schedule a set of jobs on a system offering some resource (such as electrical power or communication bandwidth), which we shall refer to as bandwidth. Each job consists of a set (or bag) of job instances. For each job instance, the input specifies the start time, finish time, bandwidth requirement and profit. The bandwidth offered by the system varies at different points of time and is specified as part of the input. A feasible solution is to choose a subset of instances such that at any point of time, the sum of bandwidth requirements of the chosen instances does not exceed the bandwidth available at that point of time, and furthermore, at most one instance is picked from each job. The goal is to find a maximum profit feasible solution. We study this problem under a natural assumption called the no-bottleneck assumption (NBA), wherein the bandwidth requirement of any job instance is at most the minimum bandwidth available. We present a simple, near-linear time constant factor approximation algorithm for this problem, under NBA. When each job consists of only one job instance, the above problem is the same as the well-studied unsplittable flow problem (UFP) on lines. A constant factor approximation algorithm is known for the UFP on line, under NBA. Our result leads to an alternative constant factor approximation algorithm for this problem. Though the approximation ratio achieved by our algorithm is inferior, it is much simpler, deterministic and faster in comparison to the existing algorithms. Our algorithm runs in near-linear time ($O(n*log^2 n)$), whereas the running time of the known algorithms is a high order polynomial. The core idea behind our algorithm is a reduction from the varying bandwidth case to the easier uniform bandwidth case, using a technique that we call slicing

Predicting direct protein interactions from affinity purification mass spectrometry data

<p>Abstract</p> <p>Background</p> <p>Affinity purification followed by mass spectrometry identification (AP-MS) is an increasingly popular approach to observe protein-protein interactions (PPI) <it>in vivo</it>. One drawback of AP-MS, however, is that it is prone to detecting indirect interactions mixed with direct physical interactions. Therefore, the ability to distinguish direct interactions from indirect ones is of much interest.</p> <p>Results</p> <p>We first propose a simple probabilistic model for the interactions captured by AP-MS experiments, under which the problem of separating direct interactions from indirect ones is formulated. Then, given idealized quantitative AP-MS data, we study the problem of identifying the most likely set of direct interactions that produced the observed data. We address this challenging graph theoretical problem by first characterizing signatures that can identify weakly connected nodes as well as dense regions of the network. The rest of the direct PPI network is then inferred using a genetic algorithm.</p> <p>Our algorithm shows good performance on both simulated and biological networks with very high sensitivity and specificity. Then the algorithm is used to predict direct interactions from a set of AP-MS PPI data from yeast, and its performance is measured against a high-quality interaction dataset.</p> <p>Conclusions</p> <p>As the sensitivity of AP-MS pipeline improves, the fraction of indirect interactions detected will also increase, thereby making the ability to distinguish them even more desirable. Despite the simplicity of our model for indirect interactions, our method provides a good performance on the test networks.</p

Outbreak of acute hepatitis C following the use of anti-hepatitis C virus--screened intravenous immunoglobulin therapy

BACKGROUND and AIMS: Hepatitis C virus (HCV) infection has been associated with intravenous (IV) immunoglobulin (Ig), and plasma donations used to prepare IV Ig are now screened to prevent transmission. Thirty-six patients from the United Kingdom received infusions from a batch of anti-HCV antibody-screened intravenous Ig (Gammagard; Baxter Healthcare Ltd., Thetford, Norfolk, England) that was associated with reports of acute hepatitis C outbreak in Europe. The aim of this study was to document the epidemiology of this outbreak. METHODS: Forty-six patients from the United Kingdom treated with Gammagard (34 exposed and 12 unexposed to the batch) returned epidemiological questionnaires. RESULTS: Eighty-two percent of the exposed patients (28 of 34) became positive for HCV RNA. Eighteen percent of the patients (6 of 34) who had infusions with this batch tested negative for HCV RNA, but 2 of the patients had abnormal liver function and subsequently seroconverted to anti-HCV antibody positive. Twenty-seven percent of the patients (9 of 34) developed jaundice, and 79% (27 of 34) had abnormal liver transferase levels. Virus isolates (n=21), including an isolate from the implicated batch, were genotype 1a and virtually identical by sequence analysis of the NS5 region, consistent with transmission from a single source. CONCLUSIONS: Hepatitis C infection can be transmitted by anti-HCV-screened IV Ig. Careful documentation of IV Ig batch numbers and regular biochemical monitoring is recommended for all IV Ig recipients

An Insight in to Paget’s Disease of Bone

Paget’s disease of bone (PDB) is a common disorder which may affect one or many bones. Although many patients are asymptomatic, a variety of symptoms and complications may occur. PDB is a focal disorder of bone turnover characterized by excessive bone resorption coupled with bone formation. PDB begins with a period of increased osteoclastic activity and bone resorption, followed by increased osteoblast production of woven bone that is poorly mineralized. In the final phase of the disease process, dense cortical and trabecular bone deposition predominates, but the bone is sclerotic and poorly organized and lacks the structural integrity and strength of normal bone. This article briefly reviews the etiopathogenesis, clinical radiographic and histological features of Paget’s disease.Keywords: Osteoclast, osteoprotegerin, receptor activator of NF‑kB, receptor activator of NF‑kB ligan