Background: Our prior six-year review (n=2165) revealed 24% of patients undergoing posterior decompression surgeries (laminectomy or discectomy) sought emergency department (ED) care within three months post-surgery. We established an integrated Spine Assessment Clinic (SAC) to enhance patient outcomes and minimize unnecessary ED visits through pre-operative education, targeted QI interventions, and early post-operative follow-up. Methods: We reviewed 13 months of posterior decompression data (n=205) following SAC implementation. These patients received individualized, comprehensive pre-operative education and follow-up phone calls within 7 days post-surgery. ED visits within 90 days post-surgery were tracked using provincial databases and compared to our pre-SAC implementation data. Results: Out of 205 patients, 24 (11.6%) accounted for 34 ED visits within 90 days post-op, showing a significant reduction in ED visits from 24% to 11.6%, and decreased overall ED utilization from 42.1% to 16.6% (when accounting for multiple visits by the same patient). Early interventions including wound monitoring, outpatient bloodwork, and prescription adjustments for pain management, helped mitigate ED visits. Patient satisfaction surveys (n=62) indicated 92% were “highly satisfied” and 100% would recommend the SAC. Conclusions: The SAC reduced ED visits after posterior decompression surgery by over 50%, with pre-operative education, focused QI initiatives, and its individualized, proactive approach.

Bentonite is one of the more safety-critical components of the engineered barrier system in the disposal concepts developed for many types of radioactive waste. It is used due to its favourable properties (including plasticity, swelling capacity, colloid filtration, low hydraulic conductivity, high retardation of key radionuclides) and its stability in relevant geological environments. However, bentonite is unstable under alkaline conditions and this has driven interest in low-alkali cements (leachate pH of 10–11). To build a robust safety case, it is important to have supporting natural analogue data to confirm understanding of the likely long-term performance of bentonite. In Cyprus, the presence of natural bentonite in close proximity to natural alkaline groundwaters permits the zones of potential bentonite/alkaline water reaction to be studied as an analogy of the potential reaction zones in the repository. Here, the results indicate minimal volumetric reaction of bentonite, with production of a palygorskite secondary phase.

The Cyprus Natural Analogue Project was carried out due to the requirement to support ongoing laboratory and modelling efforts on the potential reaction of the bentonite buffer with cementitious leachates in the repository engineered barrier system. Although it is known that the higher pH (12.5–13) leachates from ordinary Portland cement will degrade bentonite, it is unclear if this will also be the case for the lower pH (10–11) leachates typical of low alkali cements. Ongoing laboratory and underground rock laboratory programmes, which are currently investigating this, face the obstacle of slow kinetics and the production of short-lived metastable phases, meaning obtaining unambiguous results may take decades. It was therefore decided to implement a focussed natural analogue study on bentonite/low alkali cement leachate reactions to provide indications of the probable long-term reaction products and reaction pathways to provide feedback on the existing short-term investigations noted above and to ascertain if any critical path research and development needs to be instigated now. The results of the analyses presented here, in this short overview of the project, suggest that there has been very limited alkaline groundwater reaction with the bentonite. This is generally supported by both the geomorphological evidence and the natural decay series data which imply groundwater/rock interaction in the last 105 a.

An outbreak of waterborne cryptosporidiosis affecting 27 persons, diagnosed stool positive, occurred in Ayrshire in April 1988. Twenty-one of the 27 confirmed cases required some form of fluid replacement therapy. Local general practitioners indicated a two- to fivefold increase in diarrhoeal disease during the outbreak, and following enquiries made by Environmental Health Officers it became apparent that many hundreds of people had suffered a diarrhoeal illness at that time. Cryptosporidium spp. oocysts were detected in the treated chlorinated water supply system, in the absence of faecal bacterial indicators. Oocyst contamination of a break-pressure tank containing final water for distribution was the cause of this waterborne outbreak. An irregular seepage of oocyst-containing water, which increased during heavy rains, was the cause of the break-pressure tank contamination, rather than a failure of the water-treatment processes. The waterborne route should be considered when clusters of cryptosporidiosis associated with potable water occur. Waterborne cryptosporidiosis can occur in the absence of other faecal indicators of contamination.

In February and in June 1998, two people developed acute hepatitis B following in-patient care in a district general hospital. Initial enquiries indicated their infections were not attributable to staff undertaking exposure-prone procedures (EPPs). We report the findings and implications of the subsequent investigation: a multi-disciplinary, multi-agency investigation, including molecular epidemiological analysis. Occupational Health records showed that staff involved in EPPs with the patients were HBsAg negative. No contact between the patients was identified nor were there failures in sterilization. The patients' HBV strains were identical, indicating a common source. A total of 231 out of 232 staff who might have treated either patient were tested for HBsAg; the remaining doctor, working abroad, was HBsAg- and HBeAg-positive and had the same HBV strain as the patients. On two occasions the doctor's hand had been cut while breaking glass vials, but there was no documentation linking these events to the two patients. The doctor had been vaccinated in 1993 and tested for anti-HBs prior to commencing work in 1997. The doctor was recalled to Occupational Health but did not attend and was not followed up. In total, 4948 patients potentially treated by the doctor received an explanatory letter and 3150 were tested for HBsAg. Only one was positive, and HBV sequencing showed no link to the doctor. Occasionally transmission of HBV from heath-care workers can occur in a non-EPP setting and the implications of this require examination by those setting national policy. Occupational Health Services should investigate clinical heath-care workers who do not respond to vaccination. They should ensure HBV carriers are identified and offer them appropriate advice to prevent transmission to patients.

The room temperature mechanical properties of a mixed conducting perovskite Sm1?xSrxCo0.2Fe0.8O3 (x = 0.2 to 0.8) were examined. Density, crystal phase, and microstructure were characterized. It was found that the grain size increased abruptly with increasing Sr content. Mechanical properties of elastic modulus, microhardness, indentation fracture toughness, and biaxial flexure strength were measured. Young's modulus of 180–193 GPa and shear modulus of 70–75 GPa were determined. The biaxial flexure strength was found to decrease with increasing Sr content from ∼70 to ∼20 MPa. The drop in strength was due to the occurrence of extensive cracking. Indentation toughness showed a similar trend to the strength in that it decreased with increasing Sr content from ∼1.1 to ∼0.7 MPa m1/2. In addition, fractography was used to characterize the fracture behavior in these materials.

A current controlled HTS switch (CCSS) has been fabricated using the Si-YBCO reactive patterning technique. The Si films were deposited on MgO substrates by e-beam evaporation and patterned via a lift-off process. The YBCO films were deposited thereafter by pulsed laser deposition to form micron-sized HTS strip lines with different widths and lengths. A typical line has a normal resistance ranging from 10 Ω to 100 KΩ. A CCSS was constructed using such a HTS line as a resistor in parallel with a load resistor. The operation of CCSS is similar to that of a current divider. Applications of CCSS includes HTS logic gates and circuit breakers.

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, ‘in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great’. This paper examines the extent and causes of this ‘implementation gap’ in respect of services for people with mental handicaps—a consistent priority group for national policymakers. We examine centre–periphery relations in the health and personal social services in the light of Rhodes' power–dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.

Does Aristotle in the Nicomachean Ethics give one consistent answer to the question what life is best or two (at least) mutually inconsistent answers? In the First Book (E.N. I) he says that we can agree to say that the best life is eudaimonia or eupraxia (well-being or well-doing) but must go on to say in what eudaimonia consists (1097b22–24). By considering the specific nature of man as a thinking animal he reaches a conclusion: eudaimonia, the human good (agathon), is the activity of soul (psuchē) in accordance with virtue (aretē), and if there are more than one virtue in accordance with the best and most complete (teleia), and (since one swallow does not make a summer) in a complete life (1098a16–20). Aristotle states that his formula is no more than a sketch or outline (perigraphē), but that a good sketch is important since, if the outline is right, anyone can articulate it and supply details. He seems to be thinking here not just of the rest of his own treatise but of the work of pupils and successors; he speaks, as at the end of the Topics, of progress in a science.

During the past three years there has been increased activity in many fields where photometric methods are employed; more telescopes have been commissioned or adapted for photometric measurements and new magnitude systems have been proposed and tried, but much of the observing is now of a routine nature. Most of this continues to be done in the wide-band UBV system, but more measurements are now being made in the red and infra-red.

More interest is being shown in narrower band-widths that emphasize particular features of a stellar spectrum, because these offer better prospects of separating the effects of temperature, luminosity, interstellar reddening, composition and duplicity. Attention has been given to finding the most useful bands and practical ways of measuring them, both photoelectrically and photographically.

Aristotle maintains that every man has, or should have, a single end (τλος), a target at which he aims. The doctrine is stated in E.N. I 2. ‘If, then, there is some end of the things we do which we desire for its own sake (everything else being desired for the sake of this), and if we do not choose everything for the sake of something else (for at that rate the process would go on to infinity, so that our desire would be empty and vain), clearly this must be the good and the chief good. Will not the knowledge of it, then, have a great influence on life ? Shall we not, like archers who have a mark to aim t, be more likely to hit upon what is right?’ (1094a 18–24). Aristotle does not here prove, nor need we understand him as claiming to prove, that there is only one end which is desired for itself. He points out correctly that, if there are objects which are desired but not desired for themselves, there must be some object which is desired for itself. The passage further suggests that, if there were one such object and one only, this fact would be important and helpful for the conduct of life.