A&E tipping points
248 British Journal of Healthcare Management 2015 Vol 21 No 5 © 2 01 5 M A H ea lth ca re L td Figure 2 clearly shows the impact of the last two of these tipping points on AE 2013). No sane health care administration would ever expect to run hospitals at the level of occupancy common in the UK—but sanity appears to be sadly lacking in this case, and the consequences are entirely predictable. The reasons for the sudden jumps in AE Jones and Beauchant, 2015)—although politicians appear determined to avoid any discussion of the real issues for fear of jeopardising their own pet policies. There will be Rod Jones A&E tipping points
A Previously Uncharacterized Infectious-like Event Leading to Spatial Spread of Deaths Across England and Wales: Characteristics of the most Recent Event and a Time Series for Past Events.
Aims: In 2003, 2008 and 2012, deaths in the UK showed unexpected and unexplained large increases similar in magnitude to the larger influenza epidemics seen before 2000. However there were no unusual levels of influenza to explain these spikes. This study aims to investigate the spread of a presumed infectious agent across England and Wales during the 2012 event, and to establish a longer time-series for these outbreaks. Study Design: Longitudinal study of deaths. Place and Duration of Study: Deaths for residents of Local Authority (LA) and regional areas in England and Wales from January 2009 to July 2014. Analysis of monthly deaths from January 1951 to December 2012 for the whole of England & Wales, to detect events prior to 2012. Analysis of calendar year deaths between 1963 and 2013. Methodology: Running twelve month totals are used to detect the onset of a step-like increase in deaths which endures for twelve to eighteen months before abating. Results: These events can be traced back to the early 1950’s where they were intertwined with influenza epidemics. Moderately slow infectious-like spread across the UK occurs over a two year Original Research Article Rodney P. Jones; BJMMR, 5(11): 1361-1380, 2015; Article no.BJMMR.2015.154 1362 period. The last event which peaked in 2012 and 2013 led to a minimum estimate of 42,000 excess deaths, although 60,000 deaths are a more likely estimate. An additional event in 2010, which affects around 30% of LAs, appears linked with the swine flu epidemic and leads to underestimation of deaths in these locations for the 2012 event. The magnitude of the increase associated with the 2012 event decreased with increasing LA size, an effect which is due to the modifiable areal unit problem (MAUP). These events are always linked to large increases in emergency medical activity and emergency department attendances. The increase in deaths at local authority level is highly variable ranging from +5% to +30%, and this variability leads to large differentials in the cost pressures experienced by the local health services. In particular, 90% of LAs in London experienced the lowest percentage increase from the 2012 event. As a general rule it was observed that local authorities experiencing a low percentage increase in death for the 2012 outbreak, had experienced a high percentage increase following the 2008 outbreak and vice versa. This implies that the events are linked to the same agent. Conclusion: The existence of a new type of infectious outbreak, with relatively slow spread, has been confirmed and is part of a longer time-series of outbreaks. Large numbers of deaths appear to be associated with each event, although the 2012/2013 event appears to have led to the highest number of deaths in any of these outbreaks since 1950. Urgent action is required since the next outbreak is due around 2016 to 2018.
Microfiltration: Effect of retentate protein concentration on limiting flux and serum protein removal with 4-mm-channel ceramic microfiltration membranes.
The objective of our study was to determine if the limiting flux and serum protein (SP) removal were different at 8, 9, or 10% true protein (TP) in the microfiltration (MF) retentate recirculation loop using 0.1-µm ceramic graded permeability membranes with 4-mm-channel diameters operated at 50 °C using a diluted milk protein concentrate with 85% protein on a total solids basis (MPC85) as the MF feed. The limiting flux for the MF of diluted MPC85 was determined at 3 TP concentrations in the recirculation loop (8, 9, and 10%). The experiment was replicated 3 times for a total of 9 runs. On the morning of each run, MPC85 was diluted with reverse osmosis water to an MF feed TP concentration of 5.4%. In all runs, the starting flux was 55 kg/m(2) per hour, the flux was increased in steps until the limiting flux was reached. The minimum flux increase was 10 kg/m(2) per hour. The limiting flux decreased as TP concentration in the recirculation loop increased. The limiting flux was 154 ± 0.3, 133 ± 0.7, and 117 ± 3.3 kg/m(2) per hour at recirculation loop TP concentrations of 8.2 ± 0.07, 9.2 ± 0.04, and 10.2 ± 0.09%, respectively. No effect of recirculation loop TP concentration on the SP removal factor was detected. However, the SP removal factor decreased from 0.80 ± 0.02 to 0.75 ± 0.02 as flux was increased from the starting flux of 55 kg/m(2) per hour to the limiting flux, with a similar decrease seen at all recirculation loop TP concentrations.