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This study demonstrates a national programme which has been accepted in Wales as a mandatory part of the induction process for the rotating ENT SHO cohort.
Methods
The ENT Induction Bootcamp was established based on the learning needs of ENT SHOs. Pre- and post-course assessment of the subjective and objective benefit of the 1-day course was captured.
Results
Between 2022 and 2024, 152 participants have attended the bootcamp; all of whom (100 per cent) found the course beneficial. The greatest improvements in participant confidence were observed in emergency tracheostomy management, flexible nasendoscopy and nasal examination (all p < 0.01). Based on objective assessment, participant knowledge improved from a mean of 68.5 per cent to 96.5 per cent.
Conclusion
This initiative highlights the value of a bootcamp approach to standardise junior doctors’ abilities to manage ENT emergencies. This bootcamp is now a mandatory component for all SHO entering ENT attachments in Wales, in an easily adoptable format.
This work investigates the effect of surface roughness on cylinder flows in the postcritical regime and reexamines whether the roughness Reynolds number ($Re_{k_s}$) primarily governs the aerodynamic behaviour. It has been motivated by limitations of many previous investigations, containing occasionally contradictory findings. In particular, many past studies were conducted with relatively high blockage ratios and low cylinder aspect ratios. Both of these factors appear to have non-negligible effects on flow behaviour, and particularly fluctuating quantities such as the standard deviation of the lift coefficient. This study employs a 5 % blockage ratio and a span-to-diameter ratio of 10. Cylinders of different relative surface roughness ratios ($k_s/D$), ranging from $1.1\times 10^{-3}$ to $3\times 10^{-3}$, were investigated at Reynolds numbers up to $6.8 \times 10^5$ and $Re_{k_s}$ up to 2200. It is found that the base pressure coefficient, drag coefficient, Strouhal number, spanwise correlation length of lift and the standard deviation of the lift coefficient are well described by $Re_{k_s}$ in postcritical flows. However, roughness does have an effect on the minimum surface pressure coefficient (near separation) that does not collapse with $Re_{k_s}$. The universal Strouhal number proposed by Bearman (Annu. Rev. Fluid Mech., vol. 16, 1984, pp. 195–222) appears to be nearly constant over the range of $Re_{k_s}$ studied, spanning the subcritical through postcritical regimes. Frequencies in the separating shear layers are found to be an order of magnitude lower than the power law predictions for separating shear layers of smooth cylinders.
Ambulance times are internationally recognized Key Performance Indicators (KPI) for prehospital care. International benchmarking by comparing ambulance times between countries is a valuable method to help to identify strengths and weaknesses across healthcare systems. However, ambulance times are not standardized across or sometimes even within countries. Thus, this benchmarking study aims to compare terminology and definitions of ambulance times from the ambulance services of a range of countries to facilitate international benchmarking.
Method:
A 23-point questionnaire was developed and pilot-tested on members of international emergency care organizations. The final questionnaire was administered to domestic and international Ambulance Services, who use the Advanced Medical Priority Dispatch System, asking for the terminology and definitions for times from “call received” to “arrival at hospital”. This included “clock start” and “clock stop” times. We asked for the ambulance terms and related variable names in the computer aided dispatch/reporting system. We engaged with clinical stakeholders and Patient and Public Involvement Contributors throughout the process.
Results:
We gathered information from 10 international ambulance services, representing nine countries, and three continents. Some services in the United Kingdom have standardized ambulance times terminology and definitions. However, in the majority of cases terminology differed greatly between countries, and at times within countries and between reports. Definitions of ambulance times varied between countries and regions, with some having different clock start and stop times and others not collecting data on the same time periods.
Conclusion:
The current level of variation in international ambulance times terminology and definitions poses a challenge for international benchmarking and research. International consensus or harmonization of language and definitions would result in more efficient and accurate global comparison. On a smaller scale, defining terms in publications and reports would begin facilitating this process.
International reports suggest there have been prehospital delays for time-sensitive emergencies like stroke and TIA during the COVID-19 pandemic. The aim was to investigate the impact of the COVID-19 pandemic on ambulance times and emergency call volume for adults with suspected stroke and TIA in Ireland.
Method:
We conducted a retrospective cohort study of patients ≥ 18 years with suspected stroke/TIA, based on data from the National Ambulance Service. We included all cases assigned code 28 (suspected stroke/TIA) by the emergency call-taker, from 2018-2021. We compared ambulance times and emergency call volume by week, the four COVID-19 waves (defined by the Health Protection Surveillance Centre) and annually. The COVID-19 period was from March 1, 2020 - December 19, 2021 and the pre-COVID-19 period January 1, 2018 - February 29, 2020. Continuous variables were compared with t-tests and categorical variables with Pearson’s χ2 tests.
Results:
40,012 cases were included: 20,281 in the pre-COVID-19 period and 19,731 in the COVID-19 period. Mean patient age significantly decreased between the two periods, from 71 years (±16.5) to 69.8 years (±17.1); p<0.001. Mean ambulance response time increased between the two periods from 17 minutes 31 seconds to 18 minutes 59 seconds (p<0.001). The number of cases with symptom onset to emergency call time of >4 hours significantly increased from 5,581 to 6,060 during the COVID-19 period (p<0.001). Mean calls/day increased from 25.1/day to 30.1/day during the COVID-19 period.
Conclusion:
Early findings from the study suggest an increase in call volume for stroke/TIA between the COVID-19 and pre-COVID-19 periods. An increase in response times during the same periods was also found. We concluded that longer symptom-to-call times indicate a change in healthcare-seeking behavior. Sustaining high levels of compliance with stroke code protocols is crucial during healthcare crises. Future research will involve further analysis including controlling for confounders.
This paper demonstrates experimentally that imposed periodic forcing can significantly alter the global flow characteristics of the flow over a double backward-facing step. The geometry consists of two equal height steps spaced up to eight step heights apart. A periodic zero-mass flux jet located at the first step's top corner was issued at frequencies ranging from below the step-mode instability frequency up to approximately five times the shear-layer instability frequency. Reattachment of the flow onto the first step was achieved for step separations as low as three single-step heights with imposed forcing; significantly shorter than the five single-step heights that occurred without forcing. A significant reduction in mean base pressure on the first step, and increase on the second step, occurred for low forcing frequencies. Even for large step separations, the effect of forcing on the flow persisted sufficiently far downstream to appreciably influence the development of the second recirculation zone. Importantly, previous forced single and unforced double backward-facing step flows provide reference cases to examine and discuss similarities and differences. This study offers insight into possibilities and potential outcomes of flow control for applications ranging from the drag reduction of ground vehicles such as pickup trucks, to enhanced mixing in industrial processes.
The backward-facing step is perhaps the quintessential geometry used to study separated flow. Extensive previous research has quantified its detailed flow characteristics. However, often regions of separated flow do not exist in isolation; rather, interaction occurs between multiple regions. This motivated an experimental investigation into the time-averaged and dynamic flow features of a double backward-facing step, covering separations of zero to eight step heights between equal-height steps. Three flow regimes are identified. A single reattachment regime occurs for separations of less than four step heights, perhaps remarkable for the lack of variation in key flow characteristics from a single backward-facing step response. Next, an intermediate regime is identified for a separation of four step heights. In this case, the flow does not yet reattach on the first step, although significant differences in reattachment length, surface pressure on the vertical step faces and turbulence statistics occur. Finally, for greater step separations, a double reattachment regime, with reattachment on both steps, is identified. Downwash, induced by the first recirculation zone, reduces the reattachment length and turbulent fluctuations of the second recirculation zone. The surface pressure on the first-step vertical face is reduced, seemingly a result of an upstream influence due to the low pressure in the second-step recirculation zone. Detailed characterisation of the regimes offers insight into the fundamental interaction of regions of separated flow, revealing aspects of complex dynamics relevant to a broad range of practical scenarios.
Burton highlights the complexity of Buddhist attitudes to religious experience, thus challenging a western overemphasis on the role of personal experience and subjective factors in Buddhist religious experience, to the neglect of such social factors as rituals and scriptural components. He considers whether the Buddhist doctrine of no enduring, unchanging self can be justified by introspective experience, and he observes that this is a matter of controversy among Buddhist scholars.
Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist.
Methods:
To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors.
Results:
Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders.
Conclusions:
Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
The Gold Coast 2018 Commonwealth Games presented the host city with a number of opportunities to improve its infrastructure and sporting facilities in line with its long-term strategic vision to transition to being a more mature and sustainable Australian city. However, major events such as the Commonwealth Games have a chequered history of bestowing lasting benefits and a positive legacy on the host city. This article examines the ways in which infrastructure planning for the 2018 Games was used to underpin the success experienced by the Gold Coast in harnessing the event to achieve broader city building objectives. It also reflects critically on how major event-led development can be used to support existing strategic city plans.
Every profession needs an introductory text to its core body of knowledge. This brand new, definitive text from renowned authors Gobinda Chowdhury, Paul F. Burton, David McMenemy and Alan Poulter provides an introduction to librarianship for students and new entrants to the profession. This handbook is the first to give a complete overview of all aspects of professional librarianship in the 21st century, and to offer an up-to-date, authoritative analysis of modern libraries and librarianship. The key areas covered are: libraries and information services: evolution or revolution; information resources and services; information organization and access; library and information users and society; library technologies; library and information management; and, LIS education and training. Each chapter in this user-friendly text features clear learning aims and objectives and a list of revision questions to test and consolidate knowledge and understanding. Mapping onto course content for library and information studies internationally, this handbook is a single source of introductory explanations of library and information concepts for the student. It is also the quintessential primer for new professionals.
In greenhouse studies, the calculated I50 (herbicide application resulting in 50% inhibition of shoot regrowth) in tall fescue was approximately 0.004 kg/ha for both sethoxydim and haloxyfop. In red fescue, the I50 for sethoxydim and haloxyfop was 9.4 kg/ha and 0.04 kg/ha, respectively. As measured in crude cell extracts of tall fescue, incorporation of 14C-acetyl-coenzyme A into fatty acids was inhibited 62 and 71% by 10 μM sethoxydim and 10 μM haloxyfop, respectively. In red fescue, 10 μM haloxyfop inhibited 14C-acetyl-CoA incorporation into fatty acids by 29%, whereas 10 μM sethoxydim had no effect. The I50 for inhibition of acetyl-coenzyme A carboxylase activity in tall fescue with sethoxydim and haloxyfop was 6.9 and 5.8 μM, respectively. In red fescue the I50 for haloxyfop was 118 μM. Sethoxydim concentrations as high as 1 mM had little effect on acetyl-coenzyme A carboxylase activity in red fescue. These results suggest that acetyl-coenzyme A carboxylase is a sensitive site of action for sethoxydim and haloxyfop in tall fescue, and that tolerance to these herbicides in red fescue is due to the presence of a more tolerant form of the enzyme.
BAS 145 138, CGA 154 281, and 1,8 naphthalic anhydride were evaluated as seed treatments to safen 'Silver Xtra Sweet,’ ‘How Sweet It Is,’ ‘Zenith,’ and 'Sweetie 76’ sweet corn against nicosulfuron injury. Nicosulfuron POST injured sweet corn by causing slight leaf chlorosis and leaf base widening in Sweetie 76 and severe plant injury and total yield loss in Silver Xtra Sweet. Naphthalic anhydride or CGA 154 281 provided limited or no safening activity, respectively, and resulted in plant height reduction when applied alone. BAS 145 138 reduced nicosulfuron injury to Silver Xtra Sweet and prevented visible injury from nicosulfuron in How Sweet It Is, Zenith, and Sweetie 76.
LAB 145 138 (LAB) was evaluated as a safener to improve sweet corn tolerance to nicosulfuron applied POST alone or with terbufos applied in the planting furrow or bentazon applied POST. To ensure enhanced injury for experimental purposes, nicosulfuron was applied at twice the registered rate alone or mixed with bentazon at the six- to seven-leaf growth stage of corn previously treated with the highest labeled rate of terbufos 15 G formulation. LAB applied as a seed treatment (ST) or POST at the two- to three-, four- to five-, or six- to seven-leaf growth stages reduced height reduction and yield loss from nicosulfuron applied POST in combination with terbufos applied in-furrow. LAB applied POST at the four- to five-leaf growth stage was most effective in preventing injury from this treatment, with yield reduced only 8% compared with 54% from the nicosulfuron and terbufos treatment. LAB applied POST at the eight- to nine-leaf growth stage did not alleviate injury. With the nicosulfuron, terbufos, and bentazon combination, LAB applied POST at the three- to four- or six- to seven-leaf growth stages decreased height reduction and yield loss caused by this combination, with LAB at the three- to four-leaf growth stage being most effective.
The low-nitrogen status of highly weathered soils may offer a potential alternative for weed suppression in agricultural systems with N2-fixing crops. In this study, we used sicklepod as a model to evaluate weed response that might occur with managed reductions in nitrogen-soil fertility. A field study was conducted with the parental generation supplied 0, 112, 224, or 448 kg N ha−1. Decreased nitrogen fertility led to reduced shoot biomass, seed number, and total seed mass. Individual seed mass was lower, but seed % nitrogen was not affected. Analysis of seed-mass distribution confirmed that low parental fertility was associated with more small seeds as a proportion of total seeds produced. Additional experiments in hydroponics culture revealed slower growth rates of seedlings produced from small seeds when grown under low-nitrogen conditions. Competitiveness of plants from small (low nitrogen) and large (high nitrogen) seed classes was determined in a replacement-series experiment conducted in sand culture in a controlled environment at two densities and two levels of nitrogen nutrition. Plants produced from smaller seeds were less competitive in low-nitrogen fertility conditions, but plants from small and large seeds competed similarly when grown under high-nitrogen fertility. The results support the hypothesis that comprehensive management strategies to reduce nitrogen availability for weed growth in low-fertility conditions could decrease weed interference by decreasing growth and seed production of parental plants and through maternal effects that lower competitiveness of offspring.
Doveweed is becoming more common in agronomic crops in North Carolina. Laboratory and greenhouse experiments were conducted to determine the effect of temperature and seed burial depth on doveweed germination and emergence. Germination of lightly scarified seed at constant temperature was well described by a Gaussian model, which estimated peak germination at 28 C. Similar maximum percentage of germination was observed for optimal treatments under both constant and alternating temperatures. Among alternating temperatures, a 35/25 C regime gave greatest germination (77%). In spite of similar average daily temperatures, germination was greater with alternating temperature regimes of 40/30 and 40/35 C (65 and 30%, respectively) than constant temperatures of 36 and 38 C (4 and 0%, respectively). No germination was observed at 38 C constant temperature or for alternating temperature regimes of 20/10 and 25/15 C. Light did not enhance germination. Greatest emergence occurred from 0 to 1 cm, with a reduction in emergence as depth increased to 4 cm. No emergence occurred from 6 cm or greater depth. This information on seedbank dynamics may aid in developing tools and strategies for management.
Interference for 40 d after emergence (DAE) of corn, cotton, peanut, and
snap bean by four glyphosate-resistant (GR) and four glyphosate-susceptible
(GS) Palmer amaranth populations from Georgia and North Carolina was
compared in the greenhouse. Greater interference from Palmer amaranth,
measured as crop height and fresh weight reduction, was noted in cotton and
peanut compared with corn or snap bean. Crop height 15 to 40 DAE was reduced
similarly by GR and GS populations. Crop fresh weight, however, was reduced
25 and 19% in the presence of GS and GR populations, respectively. Measured
as percent reduction in fresh weight, GR and GS populations of Palmer
amaranth were controlled similarly by glufosinate, lactofen, paraquat, and
trifloxysulfuron applied POST. Atrazine and dicamba controlled GR
populations more effectively than GS populations.