Evaluation of demand in a rural English hospital emergency department

The purpose of this article is to analyse the patient demand placed on a rural district general hospital (DGH) emergency department within the context of the Purpose, Process, People (PPP) framework used in the private sector. This analysis was undertaken to inform wider evaluation of the implementation of the enterprise culture—the NHS policy to adopt private sector best practice to produce resource use, quality and efficiency improvements. The article concludes with a view that the PPP framework provides methods of calculating the level of discharge necessary to meet the four-hour wait target. Data describing the characteristics and patterns of attending patients can be used to develop an emergency department’s processes and people to achieve its time-based target

Seeing through the Effects of Crustal Assimilation to Assess the Source Composition beneath the Southern Lesser Antilles Arc

Assessing the impact of crustal assimilation on the composition of oceanic arc lavas is important if source composition is to be correctly interpreted. This is particularly the case in the Lesser Antilles where lavas encompass a very large range in radiogenic isotope compositions. Here we present new 176Hf/177Hf and trace element data for a suite of samples from St Lucia in the southern Lesser Antilles arc where assimilation of sediments located within the arc crust has been shown to influence significantly Sr–Nd–Pb isotope compositions. We show that a high rate of assimilation (r = 0·8) of sediment is responsible for the co-variation of Th/Th*, La/Sm, 87Sr/86Sr, 206/207/208Pb/204Pb, 143Nd/144Nd and 176Hf/177Hf towards extreme ‘continental’ compositions. Lavas that escaped sediment assimilation have a typical oceanic arc signature and provide the best indication of mantle source characteristics beneath St Lucia. They display similar Ba/Th, La/Sm and Nd isotopic compositions to lavas further north in the arc, but with slightly more radiogenic Sr and Pb. Addition of less than 2% of local bulk subducting sediment, or less than 3·5% of sediment partial melt or fluid, to the mantle wedge can explain these compositions; these estimates are similar to those previously proposed for the northern arc. After correction for the effects of sediment assimilation, the St Lucia lavas have only slightly more radiogenic Pb and Sr isotope signatures compared with the northern islands; this can be attributed to differences in the isotopic composition of the local subducting sediment rather than to greater sediment input, as has been previously proposed. Comparison of St Lucia with the other southern Lesser Antilles islands suggests that similar mantle source compositions exist beneath Martinique, St Vincent and perhaps Bequia, whereas a more ‘continental’ source might characterize Ile de Caille, Kick ’em Jenny and Grenada

Global Hydromagnetic Simulations of Protoplanetary Disks with Stellar Irradiation and Simplified Thermochemistry

Outflows driven by large-scale magnetic fields likely play an important role in the evolution and dispersal of protoplanetary disks, and in setting the conditions for planet formation. We extend our 2-D axisymmetric non-ideal MHD model of these outflows by incorporating radiative transfer and simplified thermochemistry, with the twin aims of exploring how heating influences wind launching, and illustrating how such models can be tested through observations of diagnostic spectral lines. Our model disks launch magnetocentrifugal outflows primarily through magnetic tension forces, so the mass-loss rate increases only moderately when thermochemical effects are switched on. For typical field strengths, thermochemical and irradiation heating are more important than magnetic dissipation. We furthermore find that the entrained vertical magnetic flux diffuses out of the disk on secular timescales as a result of non-ideal MHD. Through post-processing line radiative transfer, we demonstrate that spectral line intensities and moment-1 maps of atomic oxygen, the HCN molecule, and other species show potentially observable differences between a model with a magnetically driven outflow and one with a weaker, photoevaporative outflow. In particular, the line shapes and velocity asymmetries in the moment-1 maps could enable the identification of outflows emanating from the disk surface.Comment: 35 pages, 20 figures, accepted for publication in Ap

Developments in the fluidised bed process for fibre recovery from thermoset composites

Carbon fibre reinforced plastic (CFRP) is being used in increasing quantities particularly in the transport industry to reduce carbon emissions through weight reduction and in the energy industries for renewable technologies, such as wind turbines. As a high value and energy intensive material to manufacture a good case can be made for recovering and reusing carbon fibre from waste material. A number of companies in Europe and the USA are now in the early stages of commercial operation, but the focus is upon the recycling of clean, uncontaminated scrap from manufacturing processes and it is recognised that CFRP that is mixed with other materials eg. sandwich panels, metal inserts, painted surfaces and composites made from toughened polymers are more difficult to recycle effectively with existing commercial processes. The fluidised bed process developed at the University of Nottingham for recovering carbon fibre from waste composite material has the potential to process mixed and contaminated CFRP waste. The oxidising conditions allow full removal of any organic materials and the fluidised bed effectively separates the carbon fibres from other incombustible materials, such as metals. The process has now been developed to a scale representative of commercial operation and a waste CFRP comprising intermediate modulus carbon fibre and toughened epoxy resin has been processed successfully and good quality recycled fibres recovered. This paper will present the results and discuss the quality of the carbon fibre recovered from the process. A discussion of some of the key requirements to build a viable fluidised bed plant will also be presented

Elevated Paracellular Glucose Flux across Cystic Fibrosis Airway Epithelial Monolayers Is an Important Factor for Pseudomonas aeruginosa Growth.

People with cystic fibrosis (CF) who develop related diabetes (CFRD) have accelerated pulmonary decline, increased infection with antibiotic-resistant Pseudomonas aeruginosa and increased pulmonary exacerbations. We have previously shown that glucose concentrations are elevated in airway surface liquid (ASL) of people with CF, particularly in those with CFRD. We therefore explored the hypotheses that glucose homeostasis is altered in CF airway epithelia and that elevation of glucose flux into ASL drives increased bacterial growth, with an effect over and above other cystic fibrosis transmembrane conductance regulator (CFTR)-related ASL abnormalities. The aim of this study was to compare the mechanisms governing airway glucose homeostasis in CF and non-CF primary human bronchial epithelial (HBE) monolayers, under normal conditions and in the presence of Ps. aeruginosa filtrate. HBE-bacterial co-cultures were performed in the presence of 5 mM or 15 mM basolateral glucose to investigate how changes in blood glucose, such as those seen in CFRD, affects luminal Ps. aeruginosa growth. Calu-3 cell monolayers were used to evaluate the potential importance of glucose on Ps. aeruginosa growth, in comparison to other hallmarks of the CF ASL, namely mucus hyperviscosity and impaired CFTR-dependent fluid secretions. We show that elevation of basolateral glucose promotes the apical growth of Ps. aeruginosa on CF airway epithelial monolayers more than non-CF monolayers. Ps. aeruginosa secretions elicited more glucose flux across CF airway epithelial monolayers compared to non-CF monolayers which we propose increases glucose availability in ASL for bacterial growth. In addition, elevating basolateral glucose increased Ps. aeruginosa growth over and above any CFTR-dependent effects and the presence or absence of mucus in Calu-3 airway epithelia-bacteria co-cultures. Together these studies highlight the importance of glucose as an additional factor in promoting Ps. aeruginosa growth and respiratory infection in CF disease

Workflows for Quantitative Data Analysis in The Social Sciences

The background is given to how statistical analysis is used by quantitative social scientists. Developing statistical analyses requires substantial effort, yet there are important limitations in current practice. This has motivated the authors to create a more systematic and effective methodology with supporting tools. The approach to modelling quantitative data analysis in the social sciences is presented. Analysis scripts are treated abstractly as mathematical functions and concretely as web services. This allows individual scripts to be combined into high-level workflows. A comprehensive set of tools allows workflows to be defined, automatically validated and verified, and automatically implemented. The workflows expose opportunities for parallel execution, can define support for proper fault handling, and can be realised by non-technical users. Services, workflows and datasets can also be readily shared. The approach is illustrated with a realistic case study that analyses occupational position in relation to health

A major genetic locus in <i>Trypanosoma brucei</i> is a determinant of host pathology

The progression and variation of pathology during infections can be due to components from both host or pathogen, and/or the interaction between them. The influence of host genetic variation on disease pathology during infections with trypanosomes has been well studied in recent years, but the role of parasite genetic variation has not been extensively studied. We have shown that there is parasite strain-specific variation in the level of splenomegaly and hepatomegaly in infected mice and used a forward genetic approach to identify the parasite loci that determine this variation. This approach allowed us to dissect and identify the parasite loci that determine the complex phenotypes induced by infection. Using the available trypanosome genetic map, a major quantitative trait locus (QTL) was identified on T. brucei chromosome 3 (LOD = 7.2) that accounted for approximately two thirds of the variance observed in each of two correlated phenotypes, splenomegaly and hepatomegaly, in the infected mice (named &lt;i&gt;TbOrg1&lt;/i&gt;). In addition, a second locus was identified that contributed to splenomegaly, hepatomegaly and reticulocytosis (&lt;i&gt;TbOrg2&lt;/i&gt;). This is the first use of quantitative trait locus mapping in a diploid protozoan and shows that there are trypanosome genes that directly contribute to the progression of pathology during infections and, therefore, that parasite genetic variation can be a critical factor in disease outcome. The identification of parasite loci is a first step towards identifying the genes that are responsible for these important traits and shows the power of genetic analysis as a tool for dissecting complex quantitative phenotypic traits

Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis

Background: Cochrane systematic reviews collate and summarise studies of the effects of healthcare interventions. The characteristics of these reviews and the meta-analyses and individual studies they contain provide insights into the nature of healthcare research and important context for the development of relevant statistical and other methods. Methods: We classified every meta-analysis with at least two studies in every review in the January 2008 issue of the Cochrane Database of Systematic Reviews (CDSR) according to the medical specialty, the types of interventions being compared and the type of outcome. We provide descriptive statistics for numbers of meta-analyses, numbers of component studies and sample sizes of component studies, broken down by these categories. Results: We included 2321 reviews containing 22,453 meta-analyses, which themselves consist of data from 112,600 individual studies (which may appear in more than one meta-analysis). Meta-analyses in the areas of gynaecology, pregnancy and childbirth (21%), mental health (13%) and respiratory diseases (13%) are well represented in the CDSR. Most meta-analyses address drugs, either with a control or placebo group (37%) or in a comparison with another drug (25%). The median number of meta-analyses per review is six (inter-quartile range 3 to 12). The median number of studies included in the meta-analyses with at least two studies is three (interquartile range 2 to 6). Sample sizes of individual studies range from 2 to 1,242,071, with a median of 91 participants. Discussion: It is clear that the numbers of studies eligible for meta-analyses are typically very small for all medical areas, outcomes and interventions covered by Cochrane reviews. This highlights the particular importance of suitable methods for the meta-analysis of small data sets. There was little variation in number of studies per metaanalysis across medical areas, across outcome data types or across types of interventions being compared