The impact of a new regional air ambulance service on a large general hospital

Background: Helicopter air ambulance crews are influenced in their selection of the destination hospital for their patients by several factors including: distance from the scene; facilities, on site specialties, and senior cover of the receiving hospital; and the proximity of the helicopter landing area to the emergency department (ED). Only a limited number of hospitals have landing sites adjacent to the ED from which patients can be taken directly into the department (primary landing sites). Helicopter crews will often elect to over fly hospitals that do not have primary landing sites because secondary land transfers will add delays in delivering patients. Birmingham Heartlands Hospital has an elevated helideck adjacent to the ED. In October 2003, the Warwickshire and Northamptonshire Air Ambulance (WNAA) service was launched; the hospital sits on the western periphery of the area served by the service. Methods: Prospective data was collated on all patients brought by WNAA to Heartlands Hospital between 1 October 2003 and 31 August 2004. Results: In the 10 month period after the launch of the service, the helicopter delivered 83 patients to the ED; 74 of these were "off patch". This additional workload generated 163 ward days, 19 operative procedures, and 85 intensive care unit, high dependency unit, or coronary care unit days. The direct costs of this additional workload approached £160 000. Conclusions: In future discussions on the cost effectiveness of air ambulances, it will be important to consider both the direct and indirect costs to the receiving hospitals arising from the redistribution of emergency workload. Abbreviations: ED, emergency department; HDU, high dependency unit; HEMS, helicopter emergency medical service; ICU, intensive care unit; ISS, injury severity score; WNAA, Warwickshire and Northamptonshire Air Ambulance; WMCAA, West Midlands County Air Ambulance

CO2 laser waveguiding in proton implanted GaAs

Surface layers capable of supporting optical modes at 10.6 microns have been produced in n-type GaAs wafers through 300 keV proton implantation. The dominant mechanism for this effect appears to be free carrier compensation. Characterization of the implanted layers by analysis of infrared reflectivity spectra and synchronous coupling at 10.6 microns produced results in good agreement with elementary models. These results of sample characterization by infrared reflectivity and by CO2 laser waveguiding as implanted are presented and evaluated

Graphology in print advertising : iconic functions

Published ArticleTypography and layout are two powerful graphic tools in print advertising. They are used to arrest the attention of the target market by creating a positive association, a controversy or stimulate some kind of intellectual game. This means that much of the message has already been conveyed by creatively expanding and diversifying the conventional values embedded in certain graphic means and basing the advertisements on prevailing textual norms and our past experiences before the message itself has even been read, by just focusing on the typography used (e.g. compare the text layout and typography of a newspaper or a cell phone SMS). Based on a randomly selected South African dataset, aspects of the graphological options with their functional values will be described

Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse

The original publication is available at www.springerlink.comPeer reviewedPostprin

Barriers to Providing Physical Education and Physical Activity in Victorian State Secondary Schools

An on-line questionnaire was completed by 115 physical education teachers to establish the barriers to their implementation of physical education in Victorian state secondary schools. In addition, the barriers perceived by teachers to impact on students’ participation in school-based physical education and physical activity were examined. The barriers to the provision of physical education were found to be largely institutional, although two-thirds of respondents recognised their own difficulties in engaging students when teaching as potential obstacles to student participation. Students were also perceived to be influenced by their own (45 per cent) and their peers (62 per cent) low levels of interest when choosing to participate. An awareness of these barriers has implications for physical education teaching, curriculum design, teacher training and adolescent participation in the school environment

Delivering organisational adaptation through legislative mechanisms: Evidence from the Adaptation Reporting Power (Climate Change Act 2008)

There is increasing recognition that organisations, particularly in key infrastructure sectors, are potentially vulnerable to climate change and extreme weather events, and require organisational responses to ensure they are resilient and adaptive. However, detailed evidence of how adaptation is facilitated, implemented and reported, particularly through legislative mechanisms is lacking. The United Kingdom Climate Change Act (2008), introduced the Adaptation Reporting Power, enabling the Government to direct so-called reporting authorities to report their climate change risks and adaptation plans. We describe the authors' unique role and experience supporting the Department for Environment, Food and Rural Affairs (Defra) during the Adaptation Reporting Power's first round. An evaluation framework, used to review the adaptation reports, is presented alongside evidence on how the process provides new insights into adaptation activities and triggered organisational change in 78% of reporting authorities, including the embedding of climate risk and adaptation issues. The role of legislative mechanisms and risk-based approaches in driving and delivering adaptation is discussed alongside future research needs, including the development of organisational maturity models to determine resilient and well adapting organisations. The Adaptation Reporting Power process provides a basis for similar initiatives in other countries, although a clear engagement strategy to ensure buy-in to the process and research on its long-term legacy, including the potential merits of voluntary approaches, is required

Diseño, fabricación y aplicaciones analíticas de nanocelulosa y sus híbridos

El gran avance nanotecnológico que ha experimentado la Química Analítica en los últimos años ha sido un indicador del grado de bienestar de la sociedad. La multidisciplinaridad de la Nanociencia y Nanotecnología ha sido esencial para el avance de los métodos y herramientas analíticas, así como para llevar a cabo la automatización, simplificación y miniaturización de los procesos analíticos integrados en los laboratorios [1]. En este campo, son muchos los nanomateriales explorados por sus propiedades excepcionales (ópticas, eléctricas, magnéticas) como sensores y sorbentes así como su amplio rango de aplicación de interés medioambiental o en bienes de consumo, cosmética, agroalimentación, entre otros. Sin embargo, la nanocelulosa no se ha explorado en química analítica aun siendo postulada como uno de los nanomateriales emergentes del siglo XXI, debido a su carácter biodegradable y su abundancia en la naturaleza, así como a otras fascinantes propiedades que le confieren un sinfín de aplicaciones. No cabe duda que en la búsqueda de los nanomateriales del futuro la nanocelulosa revolucionará las industrias electrónica, textil, farmacéutica y la energética, por su producción a gran escala con bajo coste a partir de un recurso natural renovable. Teniendo en cuenta lo anteriormente expuesto, la Tesis Doctoral tiene como objetivo general el estudio de la nanocelulosa en química analítica, centrándonos en el diseño de nanofibras de celulosa como herramienta en la mejora de los procesos analíticos, así como en la separación de productos farmacéuticos y otros

Explicit Delegation Using Configurable Cookies

Password sharing is widely used as a means of delegating access, but it is open to abuse and relies heavily on trust in the person being delegated to. We present a protocol for delegating access to websites as a natural extension to the Pico protocol. Through this we explore the potential characteristics of delegation mechanisms and how they interact. We conclude that security for the delegator against misbehaviour of the delegatee can only be achieved with the cooperation of the entity offering the service being delegated. To achieve this in our protocol we propose configurable cookies that capture delegated permissions.We are grateful to the European Research Council for funding this research through grant StG 307224 (Pico)

Research unbundling and market liquidity: evidence from MiFID II

The second Markets in Financial Instruments Directive (MiFID II) mandated the unbundling of payments for research and trading. This research explores whether the impact of MiFID II differs between large and small firms in terms of analyst coverage and stock liquidity. Focusing on the UK stock markets we find a significant drop in analyst coverage on the Main Market, which leads to a deterioration in market liquidity. In contrast, the requirement of AIM firms to retain a Nominated Adviser, who often provides research coverage, has mitigated the impact of MiFID II

O-mannosylation in Candida albicans enables development of interkingdom biofilm communities

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