Consolidation and competition in Second District banking markets

The consolidation rate in the Federal Reserve's Second District banking markets generally outpaced the national average between 1989 and 1994. Nevertheless, these banking markets remain relatively unconcentrated, with midsized banks increasing their market share at the expense of large banks.Bank competition ; Bank mergers ; Federal Reserve District, 2nd

Economic evaluation of the proposed surgical scheme at Auburn Hospital: Final report, CHERE Project Report No 19

Background Public hospitals have experienced budget constraints but as demand for admissions has been growing at the same time, occupancy levels have been increasing. As emergency and urgent admissions are given priority, the effect has been not just longer waiting times and larger waiting lists for non-urgent admissions, but also frequent cancellations of elective surgery, thus adding to patients? waiting time. Consequently, there have been a number of attempts to reduce elective surgical waiting lists. The Auburn Elective Surgical Program (AESP) was a pilot program funded by the NSW Health Department, to improve elective surgery for patients in Western Sydney Area Health Service (WSAHS). The program commenced 19th July 2001 and ended 15th November 2001. Initially, the program targeted three specific surgical procedures, laparoscopic cholecystectomy, hernia repair, and haemorrhoidectomy, and was expanded to include thyroidectomy, ligation and stripping of varicose veins and endoscopy. The program sought to improve the effectiveness and efficiency of administrative and clinical aspects of elective surgery by: > Using spare operating theatre capacity at Auburn Hospital; > the use of a new booking and waiting list system, managed by a nurse co-ordinator, which offered suitable patients a definite date for surgery; > increasing surgical sessions by paying participating surgeons on a fee for service basis; > however, surgery could be performed by a surgeon other than their treating surgeon; > re-structuring elective surgical sessions to eliminate meal breaks; > planning post discharge care so that surgery could be performed on a day only basis. The Centre for Health Economics Research and Evaluation (CHERE) was commissioned to undertake an independent evaluation of the AESP. This study has examined the throughput, health outcomes, costs and patient satisfaction. Throughput data on the program were defined as time spent on the waiting list, number of failures to attend planned surgery, average length of stay, and number of surgical interventions. Health consequences were defined as complications, unplanned readmissions to hospital, wound infection after surgery, mortality, percentage of same day admissions and conversion rate to open cholecystectomy. Costs were estimated from a health service perspective. Patient acceptability was assessed by the proportion of eligible patients having their surgery under the AESP, and patient satisfaction by questionnaire.Economic evaluation, waiting times, hospitals

At a Glance: Defining Missouri’s Homeschooling Regulations

American parents have a right to homeschool their children, and it is only growing in popularity. Each state has the power to regulate homeschooling, and some do not regulate it at all. In this article, Christine Hall analyzes the practical application of Missouri\u27s homeschooling statute and argues for a change in these regulations.https://scholarship.law.slu.edu/lawjournalonline/1109/thumbnail.jp

Evaluation of Iron and Manganese Control for a Volcanic Surface Water Supply Treated with Conventional Coagulation, Sedimentation and Filtration Processes

A research project assessing the effectiveness of potassium permanganate (KMnO4) for the treatment of iron (Fe) and manganese (Mn) has been conducted by the University of Central Florida (UCF) on behalf of the United States Navy with regards to the water supply on the island of Guam, located in the Marianas Islands. The study consisted of three basic investigative components: one that examined the use of potassium permanganate for iron and manganese control for Fena Lake, a second that examined the existing unit operations that comprised the Navy\u27s water treatment plant (NWTP), and a third that examined iron and manganese field sampling analytical procedures. In the first and primary component of the research, surface water from Fena Lake located within the Naval Magazine in proximity of Santa Rita, Guam was collected at several different lake depths and initially analyzed for iron and manganese using inductively coupled plasma. Subsequent aliquots of Fena Lake collected at the various water depths were transferred to jars then dosed with varying amounts of potassium permanganate after which iron and manganese content was determined. The jars were covered to simulate actual lake to plant transfer conditions experienced at the Navy\u27s on-island facilities. A portion of the jars was dosed with potassium permanganate prior to metals analysis in order to allow for comparisons of baseline conditions. To represent conventional treatment processes, the water samples were then coagulated with aluminum sulfate prior to filtration to remove the oxidized manganese and iron formed from the addition of the potassium permanganate. Coagulated aliquots were filtered and collected to evaluate residual dissolved iron and manganese content. Based on the results of the jar tests it was determined that manganese was reduced by 95% or greater and that iron was completely removed to below the analytical detection limit (0.001 mg/L). It was determined that the potassium permanganate dose required for oxidation of iron was 0.94 mg/mg iron and for manganese was 1.92 mg/mg manganese. It was also observed that when the jars containing aliquots that turned brown in color after potassium permanganate dosing meant that iron and manganese were present and were being oxidized; however, water samples that turned pink were found to be over-dosed with potassium permanganate. The pink water is an undesired characteristic and could result in customer complaints when distributed to the system. The second component of research focused on NWTP existing conditions. Water samples were collected after each key unit operation within the NWTP and analyzed for iron and manganese. This was to determine if pre-chlorination at Fena Lake was effective at removing iron and manganese that could be present in the source water. Analysis was conducted where pre-chlorination at Fena Lake was practiced as well as when no pretreatment was practiced prior to the NWTP. It was determined that the iron and manganese were not detected downstream of the coagulation unit operation within the NWTP even when pre-chlorination was not practiced. Consequently pre-chlorination of Fena Lake source water was not required for controlling iron and manganese under the conditions experienced in this study. A third study was also implemented to confirm that 0.1-micron filters are appropriate for use in preparing samples for analytical determination of iron and manganese analysis at various points within the NWTP. The filtration step is important to delineate between dissolved and suspended iron and manganese forms. Standard Methods 3120B recommends the use of 0.45-micron filters, although based on literature it has been shown that oxidized manganese particles may be smaller than a 0.45-micron pore size. Unless a coagulant was used, the oxidized manganese may not be fully removed via the 0.45-micron filter. To verify the effectiveness of using a 0.1-micron filter, a jar test was conducted to compare the use of a 0.1-micron filter, a 0.45-micron filter, and a 0.45-micron filter after the sample has been coagulated. It was found that the use of a 0.1-micron filter was superior to the use of 0.45-micron filters even with coagulant addition when directly comparing between dissolved and suspended iron and manganese forms. It is recommended that 0.1-microns be utilized in lieu of historically recommended 0.45-micron filters for sample preparation procedures

Die Pflanzengesellschaften des Rubbenbruchs bei Osnabrück und ihre Gefährdung durch Erholungsnutzung

Im Sommer 1987 wurde die Vegetation des Rubbenbruchs, etwa 3 km westlich von Osnabrück, kartiert. Damit sollten der derzeitige Zustand dokumentiert und Veränderungen in der Pflanzenwelt seit 1872 bis heute aufgezeigt werden. Anhand von 120 Vegetationsaufnahmen wurde eine Vegetationskarte angefertigt. Eine Pflanzenliste zeigt 357 Pflanzen- und 27 Moosarten. Veränderungen in der Pflanzenwelt drücken sich in einer bedenklichen Vereinheitlichung der Vegetation aus. Nur noch an wenigen Stellen sind typische Pflanzengesellschaften eines Niedermoores anzutreffen, und die Vermischung mit .Allerweltsarten" ist deutlich zu sehen. Die Gefährdung der Pflanzengesellschaften durch Erholungsnutzung wurde anhand von Literaturstudien bearbeitet und kann als besorgniserregend eingestuft werden. Der Konflikt zwischen Naturschutz und Erholung ist am ehesten dadurch zu lösen, daß das Gebiet unter Naturschutz gestellt und gleichzeitig ein Pflege- und Entwicklungsplan erarbeitet und realisiert wird

The effects of parenteral or dietary omega-3 polyunsaturated fatty acids in rat models of spinal cord injury

PhDThere is currently no effective treatment for spinal cord injury (SCI). Long chain omega-3 polyunsaturated fatty acids (PUFA) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have beneficial effects in various neurological disorders. DHA and EPA have neuroprotective effects when given intravenously (i.v.) after SCI, but dietary enrichment with these fatty acids is less well-characterized. It is important to characterize the effect of these compounds after parenteral and oral administration, as both regimes could be used clinically. The aims of this thesis were to: i) characterize the inflammatory response in the rat after T12 compression SCI, ii) characterize the effects of acute i.v. injection of DHA or EPA on inflammation after SCI, iii) explore the effects of i.v. DHA in a rat contusion model of SCI, iv) assess the effects of dietary enrichment with DHA or EPA before and/or after SCI. Compression SCI led to acute infiltration of neutrophils and delayed accumulation of macrophages/microglia in the spinal cord, and a systemic inflammatory response in plasma and liver. DHA i.v. injection reduced neutrophil infiltration to the epicentre and C-reactive protein in the plasma, whereas EPA had no significant effect. There was no effect of i.v. EPA or DHA on the increase in cytokines/chemokines following injury. Acute DHA restored stepping ability after contusion SCI, but there was no effect on histological markers. Dietary enrichment with EPA after compression SCI had a detrimental effect on recovery, but this was not correlated with changes in neurones, oligodendrocytes or macrophages/microglia. Dietary pre-treatment with DHA had no effect on locomotor outcome after compression SCI. Therefore, the inflammatory response after SCI is not changed significantly by acute administration of EPA and DHA. The study did not reveal a beneficial prophylactic effect of dietary DHA, but highlighted a possible risk associated with dietary EPA after SCI

Barriers to the inclusion of refugee and asylum-seeking children in schools in England

© 2018, © 2018 Educational Review. This article reports a study of the barriers faced by headteachers seeking to include young asylum seekers and refugees into secondary schools in England. We trace the new discourses and assemblages of authority created at city level by recent policy changes. Drawing on in-depth interviews with headteachers, we share their experiences of navigating layered ecologies of systemic challenges to their inclusive stance towards provision for newly arrived children. We argue that structural and policy moves in England towards greater emphasis on controlling (im)migration and economistic measures of educational performance, alongside centralised funding and governance and the reduction of place-based regional autonomy, have led to greater invisibility of asylum-seeking and refugee pupils and to greater vulnerability and visibility/accountability of school leaders. These changes have had an adverse impact on inclusion in English schools and cities

The educational needs of qualified nurses caring for children following trauma.

This study has identified the knowledge, skills and attitudes required by qualified nurses who care for children in Accident and Emergency (A and E) following trauma. These requirements were then compared with the current attributes of such nurses. The researchm ethodologyw as carriedo ut in three phasesa fter an extensives urveyo f the relevant literature. The identification of the level of knowledge, skill and attitudes required for best practice was achieved by the first phase: a Delphi study, being a structured approach to collecting the opinions of a panel of qualifieda nd experiencedc hildren's nurses.T he actualk nowledge,s kills and attitudes that nurses have and apply in practice were identified by the second and third phases of the research.R egisteredn ursesc aring for children in three A and E units were surveyedb y questionnairew hilst further dataw as obtainedb y nine sessionso f participant observationi n three A and E units. Ile three sets of results have been compared and contrasted with each other and with the review of the literature and this triangulation approach has led to a number of key findings. The care needs of traurnatised children are different from those of adults; at present the majority of children are not cared for by nurses with the necessary competence or within an appropriate environment. Children need holistic care, not just the treatment of their medical injury. ibis study has uncovered a specific education and training challenge, because most of the registered nurses in this survey who do care for traumatiscd children think they arc competent in that specific and distinct role, although the observations showed that this is not always the case. Such nurses should be trained in both paediatric and A and E nursing skills. Tl-ýs can and should be achievedb y personaliseda nd flexible courses. The recommendationsa rising from the key outcomesh ave been made separatelyto educationa nd training providers, to the nurses themselves and finally to the health care policy makers and managers who control the clinical environment for the A and E nursing of children's care. 11c recommendations to the education and training providers arc specific to the content of the curricula for training nurses who care for children and to the structure of the corresponding courses. Adult-trained nurses, however expert in that context, are recommended to seek the advice of their child-traincd colleaguesw ho care for children. Managersa rc recommendedt o benchmark the physical environment, culture and practices of their A and E Units against those in the Children's hospital. Iley are also recommended to work with education and training providers to support three different models of continuous professional development; models which reflect the different backgrounds and initial levels of compctcncc of nurses who care for children. The researchers uggeststh at, if theser ecommendationsa re actedu pon, then nursesc aring for children wiH be better educated and in turn the practices of caring for traumatiscd chUdrcn in A and E wiU also improve, and wiU better meet the needs of both the children and their families