State Legislative Update

Vermont House Bill 663 would modify current law to follow a national trend of special medical malpractice statutes that require the arbitration of such claims, as well as following a similar trend to limit noneconomic and non-pecuniary damage recovery.\u27 Arbitration for medical malpractice claims has been allowed under state law for more than thirty years. The bill, sponsored by nine members of the General Assembly, sought to amend the Voluntary Arbitration Chapter, chapter 215 (§§ 7001-7009) and add a provision to section 1913 of Vermont Statute Title 12

An Identification of the Enabling Factors for the Development of a Unified Approach to Maintenance Strategy Development within the Automotive Supply Chain

The maintenance of modern production equipment has become an increasingly important and complex activity – particularly within the automotive supply chain. Tier-1 suppliers need a world-class manufacturing infrastructure to remain competitive, and therefore a matching maintenance strategy to support their operations. The opportunity exists for many automotive Tier 1, and potentially Tier 2 suppliers, to see substantial improvements to their competitiveness and profitability by improving their maintenance performance within an industry where research has shown modern maintenance practices are, at best, limited. Other Industrial sectors have a different performance profile in terms of maintenance. For example, aerospace production and their supply chain companies are seen to be ‘high achievers’ in maintenance. Part of the reason for these differences is the ability, within an individual sector, to identify the cost benefits of improving maintenance performance, as well as other drivers – such as health and safety, or regulatory requirements. The adoption of modern maintenance practices within the automotive industry is often led by available budgets and the absence of any strategic vision. This paper will present a review of the literature regarding manufacturing and Proceedings of 1st International Conference on Maintenance Engineering, IncoME-I 2016 The University of Manchester, UK Paper No ME2016_1110 maintenance practices within two industrial sectors, automotive and aerospace. In addition, the paper will identify the need for the development of a unified approach to maintenance which could be suited to automotive Tier 1 and Tier 2 suppliers

Effect of cytokine growth factors on the prevention of acute wound failure

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73237/1/j.1067-1927.2004.012109.x.pd

Borrowing from the palaeolimnologists toolkit; the use of lake sediment cores in diagnosing the causes of freshwater species decline

Populations of freshwater species are experiencing dramatic declines globally. Tools that facilitate the diagnosis of decline and identify management solutions and/or restoration targets are thus vital. Typically approaches taken to diagnose decline are carried out over short timescales and rely upon identifying spatial associations between presence or abundance of declining species and variables hypothesised to be driving decline. The potential to contextualise observed declines on longer time scales, with a broader range of potential explanatory variables is frequently dismissed, because of a perceived lack of existing long-term data. In this study we explore the value of incorporating a longer-term perspective to decline diagnosis using the common scoter as a case study. The number of scoter breeding in Scotland has declined substantially since the 1970s. Hypotheses for decline include a reduction in macroinvertebrate food available for females and young at the breeding lakes. In this study we apply palaeolimnological techniques to generate standardised, long-term ecological data, enabling us to characterise recent changes at four common scoter breeding lakes. Our results demonstrate that the (macroinvertebrate) food resource of common scoter has, in fact, gradually increased in abundance at all four sites from ca. 1900, and that a further statistically significant increase in macroinvertebrate abundance occurred at ca. 1970. We draw on our palaeolimnological data, to explore alternative hypotheses for common scoter decline. Increases in overall abundance across multiple algal, macrophyte and macroinvertebrate taxa, combined with specific increases in nutrient tolerant taxa, and concurrent declines in nutrient sensitive taxa indicate that the lakes have experienced enrichment within their current oligotrophic state during the last 100 years, and that this trajectory has become more marked during the period of common scoter decline. There is no evidence of changes to habitat, turbidity or increased competition from fish. In the absence of within lake changes that could be detrimental to the benthic (and generalist) feeding common scoter, we conclude that factors outside of the lake, such as increased predation, associated with afforestation in the surrounding area, are the most plausible drivers of common scoter decline. Prioritisation/testing of management solutions that address these issues are indicated

Alternate Fuel Cell Membranes for Energy Independence

The overall objective of this project was the development and evaluation of novel hydrocarbon fuel cell (FC) membranes that possess high temperature performance and long term chemical/mechanical durability in proton exchange membrane (PEM) fuel cells (FC). The major research theme was synthesis of aromatic hydrocarbon polymers of the poly(arylene ether sulfone) (PAES) type containing sulfonic acid groups tethered to the backbone via perfluorinated alkylene linkages and in some cases also directly attached to the phenylene groups along the backbone. Other research themes were the use of nitrogen-based heterocyclics instead of acid groups for proton conduction, which provides high temperature, low relative humidity membranes with high mechanical/thermal/chemical stability and pendant moieties that exhibit high proton conductivities in the absence of water, and synthesis of block copolymers consisting of a proton conducting block coupled to poly(perfluorinated propylene oxide) (PFPO) blocks. Accomplishments of the project were as follows: 1) establishment of a vertically integrated program of synthesis, characterization, and evaluation of FC membranes, 2) establishment of benchmark membrane performance data based on Nafion for comparison to experimental membrane performance, 3) development of a new perfluoroalkyl sulfonate monomer, N,N-diisopropylethylammonium 2,2-bis(p-hydroxyphenyl) pentafluoropropanesulfonate (HPPS), 4) synthesis of random and block copolymer membranes from HPPS, 5) synthesis of block copolymer membranes containing high-acid-concentration hydrophilic blocks consisting of HPPS and 3,3'-disulfonate-4,4'-dichlorodiphenylsulfone (sDCDPS), 6) development of synthetic routes to aromatic polymer backbones containing pendent 1H-1,2,3-triazole moieties, 7) development of coupling strategies to create phase-separated block copolymers between hydrophilic sulfonated prepolymers and commodity polymers such as PFPO, 8) establishment of basic performance properties of experimental membranes, 9) fabrication and FC performance testing of membrane electrode assemblies (MEA) from experimental membranes, and 10) measurement of ex situ and in situ membrane durability of experimental membranes. Although none of the experimental hydrocarbon membranes that issued from the project displayed proton conductivities that met DOE requirements, the project contributed to our basic understanding of membrane structure-property relationships in a number of key respects. An important finding of the benchmark studies is that physical degradation associated with humidity and temperature variations in the FC tend to open new fuel crossover pathways and act synergistically with chemical degradation to accelerate overall membrane degradation. Thus, for long term membrane survival and efficient fuel utilization, membranes must withstand internal stresses due to humidity and temperature changes. In this respect, rigid aromatic hydrocarbon fuel cell membranes, e.g. PAES, offer an advantage over un-modified Nafion membranes. The benchmark studies also showed that broadband dielectric spectroscopy is a potentially powerful tool in assessing shifts in the fundamental macromolecular dynamics caused by Nafion chemical degradation, and thus, this technique is of relevance in interrogating proton exchange membrane durability in fuel cells and macromolecular dynamics as coupled to proton migration, which is of fundamental relevance in proton exchange membranes in fuel cells. A key finding from the hydrocarbon membrane synthesis effort was that rigid aromatic polymers containing isolated ion exchange groups tethered tightly to the backbone (short tether), such as HPPS, provide excellent mechanical and durability properties but do not provide sufficient conductivity, in either random or block configuration, when used as the sole ion exchange monomer. However, we continue to hypothesize that longer tethers, and tethered groups spaced more closely within the hydrophilic chain elements of the polymer, will yield highly conductive materials with excellent mechanical properties. Another key finding is the superior performance of PAES membranes upon being subjected to open circuit voltage (OCV) testing. Throughout the course of the experiment, OCV for the PAES not only stayed higher but also decayed at a much lower rate, which is attributed to better dimensional stability and improved mechanical and gas barrier properties. The rigid backbone reinforcement of PAES adds gas diffusion tortuosity that restricts membrane degradation and OCV loss due to reduced fuel crossover. The overall results of creep, contractile stress and mechanical tensile tests confirm the conclusion that degraded MEAs of PAES membrane can handle stress and are more likely to be more durable in a fuel cell, even after subjected to 62h of OCV degradation

Developing pedagogies that work for Pre-Service and Early Career Teachers to reduce the Attainment Gap in Literacy, Numeracy and Health and Wellbeing. Research Question 3: What other practice or research might assist us in our purpose?

This report contributes to the Scottish Council of Deans of Education project related to the Scottish Attainment Challenge. It presents a literature review that responds to the third research question of the SCDE collaborative project: What other practice or research might assist us in our purpose? The purpose of this phase was to resource professional conversations and thinking in the teacher education sector, and to inform the final trial phase of the project. A literature search was undertaken using a range of strategies, to identify published accounts of innovative work from beyond Scotland in the following fields: initial teacher education for high poverty settings; pedagogies in literacy, numeracy and health and wellbeing; mentoring and induction. Each group of studies is summarised under themes with their potential for the SAC, ITE programmes and professional learning noted

Complexity in decision making: Determining university library opening hours

Making decisions on academic library opening hours is complex with many pressures on managers. This research surveys senior academic library managers from the UK, using a questionnaire to reveal views on library opening hours, the decision making process, and the pressures which influenced their decisions. A variety of factors were found, in particular satisfying undergraduate demands. The research also revealed the sources of information important in making decisions on opening hours and the influence of ‘political’ issues in the decision making process. Some institutions remove complexity by utilising 24/7 opening, though this is not an option for many

Ondansetron and metoclopramide as second-line antiemetics in women with nausea and vomiting in pregnancy: the EMPOWER pilot factorial RCT

Background Around one-third of pregnant women suffer from moderate to severe nausea and vomiting, causing physical and emotional distress and reducing their quality of life. There is no cure for nausea and vomiting in pregnancy. Management focuses on relieving symptoms and preventing morbidity, and often requires antiemetic therapy. National guidelines make recommendations about first-, second- and third-line antiemetic therapies, although care varies in different hospitals and women report feeling unsupported, dissatisfied and depressed. Objectives To determine whether or not, in addition to intravenous rehydration, ondansetron compared with no ondansetron and metoclopramide compared with no metoclopramide reduced the rate of treatment failure up to 10 days after drug initiation; improved symptom severity at 2, 5 and 10 days after drug initiation; improved quality of life at 10 days after drug initiation; and had an acceptable side effect and safety profile. To estimate the incremental cost per treatment failure avoided and the net monetary benefits from the perspectives of the NHS and women. Design This was a multicentre, double-dummy, randomised, double-blinded, dummy-controlled 2 × 2 factorial trial (with an internal pilot phase), with qualitative and health economic evaluations. Participants Thirty-three patients (who were < 17 weeks pregnant and who attended hospital with nausea and vomiting after little or no improvement with first-line antiemetic medication) who attended 12 secondary care NHS trusts in England, 22 health-care professionals and 21 women participated in the qualitative evaluation. Interventions Participants were randomly allocated to one of four treatment groups (1 : 1 : 1: 1 ratio): (1) metoclopramide and dummy ondansetron; (2) ondansetron and dummy metoclopramide; (3) metoclopramide and ondansetron; or (4) double dummy. Trial medication was initially given intravenously and then continued orally once women were able to tolerate oral fluids for a maximum of 10 days of treatment. Main outcome measures The primary end point was the number of participants who experienced treatment failure, which was defined as the need for further treatment because symptoms had worsened between 12 hours and 10 days post treatment. The main economic outcomes were incremental cost per additional successful treatment and incremental net benefit. Results Of the 592 patients screened, 122 were considered eligible and 33 were recruited into the internal pilot (metoclopramide and dummy ondansetron, n = 8; ondansetron and dummy metoclopramide, n = 8; metoclopramide and ondansetron, n = 8; double dummy, n = 9). Owing to slow recruitment, the trial did not progress beyond the pilot. Fifteen out of 30 evaluable participants experienced treatment failure. No statistical analyses were performed. The main reason for ineligibility was prior treatment with trial drugs, reflecting an unpredicted change in prescribing practice at several points along the care pathway. The qualitative evaluation identified the requirements of the study protocol, in relation to guidelines on anti-sickness drugs, and the diversity of pathways to care as key hurdles to recruitment while the role of research staff was a key enabler. No important adverse events or side effects were reported. Limitations The pilot trial failed to achieve the recruitment target owing to unforeseen changes in the provision of care. Conclusions The trial was unable to provide evidence to support clinician decisions about the best choice of second-line antiemetic for nausea and vomiting in pregnancy