Seal Coat Productivity

The Indiana Department of Transportation (INDOT) conducts chip seal operations on state highways to prolong the life of the road. The chip seal operation is labor, equipment and material intensive. A typical chip seal operation may involve 35 or more INDOT employees including truck drivers, flagmen, and equipment operators (brooms, rollers, aggregate spreader, and distributors). This project was launched to better understand and document variations in how each of the six INDOT districts, approach the planning and execution of their respective chip seal operations. The goal was to identify areas in the operation where there were differences between districts and to determine best practices that could be shared among the districts. Two observers joined the chip seal operations in all six districts. The observers spent a total of 10 days with the chip seal crews (2 days each with the crews from Fort Wayne, La Porte, Greenfield, and Seymour and 1 day each with the crews from Vincennes and Crawfordsville). One additional day was spent in Crawfordsville observing the Fog Seal operation that takes place a few days following chip seal. During the initial phases of this project, many differences were observed regarding various aspects of the operation including the stone and equipment used, truck loading procedures, traffic control, and covering raised pavement markers (RPNs). These observations were shared with key stakeholders on November 4, 2013 and with a second group of stakeholders on January 22, 2014. With the help of stakeholders, best practices were identified from the observations and a list of 14 recommendations was created to be shared across all districts. A series of meetings were then scheduled to share the recommendations with each district and to determine which recommendations they were interested in piloting. The three ideas found during this project that provide the greatest opportunities for improving the overall operational efficiency of the chip seal operation are (1) the importance of closing roads during chip seal whenever possible, (2) the importance of choosing the best locations for stone stockpiles and oil tanker deliveries, and (3) the importance of fully loading dump trucks to their maximum safe and legal limit

Food production, distribution and processing in Cornwall and the Isles of Scilly

Cornwall Taste of the West; Cornwall Agricultural Counci

Helicopter emergency medical services for adults with major trauma.

BACKGROUND: Although helicopters are presently an integral part of trauma systems in most developed nations, previous reviews and studies to date have raised questions about which groups of traumatically injured people derive the greatest benefit. OBJECTIVES: To determine if helicopter emergency medical services (HEMS) transport, compared with ground emergency medical services (GEMS) transport, is associated with improved morbidity and mortality for adults with major trauma. SEARCH METHODS: We ran the most recent search on 29 April 2015. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library (Cochrane Central Register of Controlled Trials; CENTRAL), MEDLINE (OvidSP), EMBASE Classic + EMBASE (OvidSP), CINAHL Plus (EBSCOhost), four other sources, and clinical trials registers. We screened reference lists. SELECTION CRITERIA: Eligible trials included randomized controlled trials (RCTs) and nonrandomized intervention studies. We also evaluated nonrandomized studies (NRS), including controlled trials and cohort studies. Each study was required to have a GEMS comparison group. An Injury Severity Score (ISS) of at least 15 or an equivalent marker for injury severity was required. We included adults age 16 years or older. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data and assessed the risk of bias of included studies. We applied the Downs and Black quality assessment tool for NRS. We analyzed the results in a narrative review, and with studies grouped by methodology and injury type. We constructed 'Summary of findings' tables in accordance with the GRADE Working Group criteria. MAIN RESULTS: This review includes 38 studies, of which 34 studies examined survival following transportation by HEMS compared with GEMS for adults with major trauma. Four studies were of inter-facility transfer to a higher level trauma center by HEMS compared with GEMS. All studies were NRS; we found no RCTs. The primary outcome was survival at hospital discharge. We calculated unadjusted mortality using data from 282,258 people from 28 of the 38 studies included in the primary analysis. Overall, there was considerable heterogeneity and we could not determine an accurate estimate of overall effect.Based on the unadjusted mortality data from six trials that focused on traumatic brain injury, there was no decreased risk of death with HEMS. Twenty-one studies used multivariate regression to adjust for confounding. Results varied, some studies found a benefit of HEMS while others did not. Trauma-Related Injury Severity Score (TRISS)-based analysis methods were used in 14 studies; studies showed survival benefits in both the HEMS and GEMS groups as compared with MTOS. We found no studies evaluating the secondary outcome, morbidity, as assessed by quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). Four studies suggested a small to moderate benefit when HEMS was used to transfer people to higher level trauma centers. Road traffic and helicopter crashes are adverse effects which can occur with either method of transport. Data regarding safety were not available in any of the included studies. Overall, the quality of the included studies was very low as assessed by the GRADE Working Group criteria. AUTHORS' CONCLUSIONS: Due to the methodological weakness of the available literature, and the considerable heterogeneity of effects and study methodologies, we could not determine an accurate composite estimate of the benefit of HEMS. Although some of the 19 multivariate regression studies indicated improved survival associated with HEMS, others did not. This was also the case for the TRISS-based studies. All were subject to a low quality of evidence as assessed by the GRADE Working Group criteria due to their nonrandomized design. The question of which elements of HEMS may be beneficial has not been fully answered. The results from this review provide motivation for future work in this area. This includes an ongoing need for diligent reporting of research methods, which is imperative for transparency and to maximize the potential utility of results. Large, multicenter studies are warranted as these will help produce more robust estimates of treatment effects. Future work in this area should also examine the costs and safety of HEMS, since multiple contextual determinants must be considered when evaluating the effects of HEMS for adults with major trauma

Poly[[μ-(1-ammonio­ethane-1,1-di­yl)bis­(hydrogenphospho­nato)]diaquachloridodisodium]: a powder X-ray diffraction study

The title compound, [Na2(C2H8NO6P2)Cl(H2O)2]n, has a polymeric two-dimensional structure extending parallel to (001). The asymmetric unit contains two Na+ cations located on a centre of symmetry and on a mirror plane, respectively, one half of a bis-phospho­nate anion (the entire anion is completed by mirror symmetry), one chloride anion on a mirror plane and one water mol­ecule in general positions. The two Na+ cations exhibit distorted octa­hedral NaCl2O4 coordination polyhedra, each consisting of two deprotonated O atoms of the bis-phospho­nate anion, of two water mol­ecules and of two chloride anions. Strong O—H⋯O hydrogen bonds between the –OH group and one of the free O atoms of the bis-phospho­nate anion connect adjacent layers along [100], supported by N—H⋯Cl inter­actions. Intra­layer O—H⋯O and N—H⋯O hydrogen bonds are also observed