Availability and utilisation of physician-based pre-hospital critical care support to the NHS ambulance service in England, Wales and Northern Ireland

Background: Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. Objective: To identify the current availability and utilisation of physician-based pre-hospital critical care capability across England, Wales and Northern Ireland. Design: A postal and telephone survey was undertaken between April and December 2009 of all 13 regional NHS ambulance services, 17 air ambulance charities, 34 organisations affiliated to the British Association for Immediate Care and 215 type 1 emergency departments in England, Wales and Northern Ireland. The survey focused on the availability and use of physician-basedpre-hospital critical care support. Results: The response rate was 100%. Although nine NHS ambulance services recorded physician attendance at 6155 incidents, few could quantify doctor availability and utilisation. All but one of the British Association for Immediate Care organisations deployed ‘only when available’ and only 45% of active doctors could provide critical care support. Eleven air ambulance services (65%) operated with a doctor but only 5 (29%) operated 7 days a week. Fifty-nine EDs (27%) had a pre-hospital team but only 5 (2%) had 24 h deployable critical care capability and none were used regularly. Conclusion: There is wide geographical and diurnal variability in availability and utilisation of physician-based pre-hospital critical care support. Only London ambulance service has access to NHS-commissioned 24 h physician-based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability

Copper speciation in coastal rain and estuarine water

Copper exists in two oxidation states in natural waters, Cu(I) and Cu(II). Determining the speciation of copper rather than its total concentration is essential in order to assess the atmospheric reactivity and environmental fate of copper in the troposphere. The concentration and speciation of copper was determined in rainwater samples from Wilmington, North Carolina, from August 25, 2000 to September 24, 2002. Volume weighted average concentrations of Cutotal, Cu(I), and Cu(II) in rainwater were 5.3 nM, 1.4 nM, and 3.2 nM, respectively. An undetermined ligand may be stabilizing Cu(I) in authentic rainwater. Rainwater Cu(II) concentrations were significantly higher in the summer, whereas Cu(I) concentrations were significantly higher in the winter. The calculated atmospheric flux of copper, 504 µg m-2 yr-1, is in good agreement with the calculated copper flux at Florianopolis, Brazil and two Maryland Chesapeake Bay sites. Copper(I) and Cu(II) concentrations were not correlated with each other and Cu(II) concentrations did not correlate with any other rainwater analyte. Significant positive correlations were found between Cu(I) and DOC, SO42-, NO3-, and Fetotal. All copper species (Cu(I), Cu(II), Cutotal, Cuparticulate) showed an inverse correlation with rainfall amount. All copper species increased in concentration with decreasing rainwater pH. All copper species were higher for storms of continental origin versus storms of coastal origin. No diurnal variations were seen with Cu(I). However, Cu(II) concentrations had a maximum between 12 pm – 6 pm. It is possible that Fe oxyhydroxides with adsorbed Cu(II) undergo reactions that release Cu(II) in the presence of sunlight. Contamination by trace metals, such as copper, contributes to the degradation of estuarine systems in many areas, including North Carolina. Speciation, or the distribution of copper among its various chemical forms, controls the reactivity, toxicity, and bioavailability of the metal in estuarine sediments and water, as in rain. Estuarine water samples were collected and analyzed for Cu(I) during April, July, and November of 2001 and March 2002. The percentage of total copper as Cu(I) varied from 1.9% - 4.1% with an overall average of 3.4%. No flux of Cu(I) was observed into or out of the water overlying the estuarine sediments in controlled laboratory experiments. Almost the same amount of copper that enters the Cape Fear River estuary from atmospheric deposition (8.7 X 102 moles Cu/year) fluxes into the sediments (5.8 X 102 moles Cu/year)

Rapid mortality transition of Pacific Islands in the 19th century

The depopulation of Pacific islands during the 16th to 19th centuries is a striking example of historical mass mortality due to infectious disease. Pacific Island populations have not been subject to such cataclysmic infectious disease mortality since. Here we explore the processes which could have given rise to this shift in infectious disease mortality patterns. We show, using mathematical models, that the population dynamics exhibited by Pacific Island populations are unlikely to be the result of Darwinian evolution. We propose that extreme mortality during first-contact epidemics is a function of epidemiological isolation, not a lack of previous selection. If, as pathogens become established in populations, extreme mortality is rapidly suppressed by herd immunity, Pacific Island population mortality patterns can be explained with no need to invoke genetic change. We discuss the mechanisms by which this could occur, including (i) a link between the proportion of the population transmitting infectious agents and case-fatality rates, and (ii) the course of infection with pathogens such as measles and smallpox being more severe in adults than in children. Overall, we consider the present-day risk of mass mortality from newly emerging infectious diseases is unlikely to be greater on Pacific islands than in other geographical areas

Aspects of Bunuba grammar and semantics

This thesis is a study of Bunuba, a language spoken around the township of Fitzroy Crossing in the West Kimberley region of Western Australia. Chapter 1 introduces Bunuba by discussing the location and sociolinguistic information and providing the reader with background to the language and its speakers. In this Chapter details of different speech registers and dialects are introduced and a brief review is undertaken of the previous research which has been carried out on the language and its speakers. Also included is a discussion of some contemporary uses of Bunuba and a description of my fieldwork methodology. This Chapter also sets this work apart from previous research on Bunuba, particularly that undertaken by Alan Rumsey. The differences between his work and the work presented in this thesis are outlined in Chapter 1. Chapter 2 describes the structure of the language detailing phonology and morphophonological procedures, word classes and nominal morphology. Chapter 3 discusses the formal structure of Bunuba verbal morphology

Orangutans Not Infected with Plasmodium vivax or P. cynomolgi, Indonesia

After orangutans in Indonesia were reported as infected with Plasmodium cynomolgi and P. vivax, we conducted phylogenetic analyses of small subunit ribosomal RNA gene sequences of Plasmodium spp. We found that these orangutans are not hosts of P. cynomolgi and P. vivax. Analysis of >1 genes is needed to identify Plasmodium spp. infecting orangutans

Individual aerosol particles from biomass burning in southern Africa: 1. Compositions and size distributions of carbonaceous particles

Individual aerosol particles in smoke plumes from biomass fires and in regional hazes in southern Africa were studied using analytical transmission electron microscopy ( TEM), which allowed detailed characterization of carbonaceous particle types in smoke and determination of changes in particle properties and concentrations during smoke aging. Based on composition, morphology, and microstructure, three distinct types of carbonaceous particles were present in the smoke: organic particles with inorganic ( K- salt) inclusions, " tar ball'' particles, and soot. The relative number concentrations of organic particles were largest in young smoke, whereas tar balls were dominant in a slightly aged ( similar to 1 hour) smoke from a smoldering fire. Flaming fires emitted relatively more soot particles than smoldering fires, but soot was a minor constituent of all studied plumes. Further aging caused the accumulation of sulfate on organic and soot particles, as indicated by the large number of internally mixed organic/ sulfate and soot/ sulfate particles in the regional haze. Externally mixed ammonium sulfate particles dominated in the boundary layer hazes, whereas organic/ sulfate particles were the most abundant type in the upper hazes. Apparently, elevated haze layers were more strongly affected by biomass smoke than those within the boundary layer. Based on size distributions and the observed patterns of internal mixing, we hypothesize that organic and soot particles are the cloud-nucleating constituents of biomass smoke aerosols. Sea- salt particles dominated in the samples taken in stratus clouds over the Atlantic Ocean, off the coast of Namibia, whereas a distinct haze layer above the clouds consisted of aged biomass smoke particles

Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness

The primary survey assessment is a cornerstone of resuscitation processes. The name itself implies that it is the first step in resuscitation. In this article, we argue that in an organized resuscitation the primary survey must be preceded by a series of steps to optimize safety and performance and set the stage for the execution of expert team behavior. Even in the most time critical situations, an effective team will optimize the environment, perform self-assessments of personal readiness and participate in a preemptive team brief. We call these processes the ‘zero point survey’ as it precedes the primary survey. This paper explains the rationale for the zero point survey and describes a structured approach designed to be suitable for all resuscitation situations