Impact of NHS Direct on other services: the characteristics and origins of its nurses \\ud

OpenAIRE

Morrell, C.J.; Munro, J.F.; O'Cathain, A.; Warren, K.; Nicholl, J.

2002-01-01

OBJECTIVE:: To characterise the NHS Direct nurse workforce and estimate the impact of NHS Direct on the staffing of other NHS nursing specialties. \\ud \\ud METHOD: A postal survey of NHS Direct nurses in all 17 NHS Direct call centres operating in June 2000. \\ud \\ud RESULTS: The response rate was 74% (682 of 920). In the three months immediately before joining NHS Direct, 20% (134 of 682, 95% confidence intervals 17% to 23%) of respondents had not been working in the NHS. Of the 540 who came f...

Measuring progress towards a primary care-led NHS.

Science.gov (United States)

Miller, P; Craig, N; Scott, A; Walker, A; Hanlon, P

1999-07-01

The push towards a 'primary care-led' National Health Service (NHS) has far-reaching implications for the future structure of the NHS. The policy involves both a growing emphasis on the role of primary care practitioners in the commissioning of health services, and a change from hospital to primary and community settings for a range of services and procedures. Although the terminology has changed, this emphasis remains in the recent Scottish Health Service White Paper and its English counterpart. To consider three questions in relation to this policy goal. First, does the evidence base support the changes? Secondly, what is the scale of the changes that have occurred? Thirdly, what are the barriers to the development of a primary care-led NHS? Programme budgets were compiled to assess changes over time in the balance of NHS resource allocation with respect to primary and secondary care. Total NHS revenue expenditure for the 15 Scottish health boards was grouped into four blocks or 'programmes': primary care, secondary care, community services, and a residual. The study period was 1991/2 to 1995/6. Expenditure data were supplied by the Scottish Office. Ambiguity of definitions and the absence of good data cause methodological difficulties in evaluating the scale and the appropriateness of the shift. The data that are available suggest that, at the aggregate level, there have been changes over time in the balance of resource allocation between care settings: relative investment into primary care has increased. It would appear that this investment is relatively small and from growth money rather than a 'shift' from secondary care. In addition, the impact of GP-led commissioning is variable but limited. General practitioners' (GPs') attitudes to the policy suggest that progress towards a primary care-led NHS will continue to be patchy. The limited shift to date, alongside evidence of ambivalent attitudes to the shift on the part of GPs, suggest that this is a policy

New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands

NARCIS (Netherlands)

Florijn, Ralph J.; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J. J. M.; Mannens, Marcel M. A. M.; Tijmes, Nel; Brooks, Simon P.; Hardcastle, Alison J.; Bergen, Arthur A. B.

2006-01-01

Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the

Understanding the roles of NHS trust board members.

Science.gov (United States)

Deffenbaugh, J

1996-01-01

The establishment of NHS trust boards on a business format was a recent innovation resulting from the NHS reforms. In order to realize benefits for patients, it is essential that boards operate effectively. Explores within the framework of corporate governance, the practical implications of board member roles. Drawing on experience of strategy formulation at board level, analyses and clarifies the roles, and presents recommendations to increase board effectiveness.

Lessons from 2012: What the NHS Can Learn from Britain's Olympic Success.

Science.gov (United States)

Maile, Edward J; Blake, Alastair M

2013-01-01

The 2012 London Olympic and Paralympic Games were widely regarded as an organisational and sporting success for the United Kingdom. Therefore, it is prudent to consider what other large, public endeavours might learn from the Games' success. Team GB worked to develop a positive team culture based around shared values. This is something the National Health Service (NHS) could learn from, as an organisation which can appear to lack this culture. The NHS should also work harder to adopt evidence-based practices, and to adopt them quickly, as is often the case in sport. Sport is the ultimate example of transparent results reporting, and the NHS ought to consider systematic reporting of risk-adjusted performance data, which may drive improved performance. The NHS should pay attention to the experiences of successful Olympic sports with centralised centres of excellence, and to medical data which suggests that better outcomes result from centres of excellence. The NHS and wider government should look to Olympic athletes and place more emphasis on prevention of disease by encouraging positive lifestyle choices. Finally, the NHS should develop private sector partnerships carefully. We must look to gather knowledge and ideas from every area of life in pursuit of excellence in the NHS. Experience of the Olympics offers a number of instructive lessons.

A model of organisational dysfunction in the NHS.

Science.gov (United States)

Pope, Rachael

2013-01-01

This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS. This paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement. The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to "knowing". The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable. Organisations need to embrace the identity of a listening and learning organisation; a "wise" organisation. The "Elephant in the room" of persistent negative behaviour has to be acknowledged; the silence must be broken. There is a need for cultures of "respect", exhibiting "intelligent kindness". A model has been developed to increase understanding of dysfunctional organisational behaviour in the NHS primarily for leaders/managers of health services, health service regulators and health researchers/academics. Research, with ethical approval, is currently being undertaken to test and develop the conceptual model to further reflect the complexities of the NHS culture.

Medical Tourism: A Cost or Benefit to the NHS?

Science.gov (United States)

Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

Medical tourism: a cost or benefit to the NHS?

Directory of Open Access Journals (Sweden)

Johanna Hanefeld

Full Text Available 'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS; interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health

Medical tourism: a cost or benefit to the NHS?

Science.gov (United States)

Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

Customer care in the NHS.

Science.gov (United States)

Ruddick, Fred

2015-01-20

Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

A novel NHS mutation causes Nance-Horan Syndrome in a Chinese family.

Science.gov (United States)

Tian, Qi; Li, Yunping; Kousar, Rizwana; Guo, Hui; Peng, Fenglan; Zheng, Yu; Yang, Xiaohua; Long, Zhigao; Tian, Runyi; Xia, Kun; Lin, Haiying; Pan, Qian

2017-01-07

Nance-Horan Syndrome (NHS) (OMIM: 302350) is a rare X-linked developmental disorder characterized by bilateral congenital cataracts, with occasional dental anomalies, characteristic dysmorphic features, brachymetacarpia and mental retardation. Carrier females exhibit similar manifestations that are less severe than in affected males. Here, we report a four-generation Chinese family with multiple affected individuals presenting Nance-Horan Syndrome. Whole-exome sequencing combined with RT-PCR and Sanger sequencing was used to search for a genetic cause underlying the disease phenotype. Whole-exome sequencing identified in all affected individuals of the family a novel donor splicing site mutation (NM_198270: c.1045 + 2T > A) in intron 4 of the gene NHS, which maps to chromosome Xp22.13. The identified mutation results in an RNA processing defect causing a 416-nucleotide addition to exon 4 of the mRNA transcript, likely producing a truncated NHS protein. The donor splicing site mutation NM_198270: c.1045 + 2T > A of the NHS gene is the causative mutation in this Nance-Horan Syndrome family. This research broadens the spectrum of NHS gene mutations, contributing to our understanding of the molecular genetics of NHS.

What does patient feedback reveal about the NHS? A mixed methods study of comments posted to the NHS Choices online service

Science.gov (United States)

Brookes, Gavin; Baker, Paul

2017-01-01

Objective To examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation. Design Computer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback. Participants Contributors posting comments about the NHS between March 2013 and September 2015. Results Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback. Conclusions Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The

New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands.

Science.gov (United States)

Florijn, Ralph J; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J J M; Mannens, Marcel M A M; Tijmes, Nel; Brooks, Simon P; Hardcastle, Alison J; Bergen, Arthur A B

2006-09-01

Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the Netherlands, by dHPLC and direct sequencing. We identified an unique mutation in each family. Three out of these four mutations were not reported before. We report here the first splice site sequence alteration mutation and three protein truncating mutations. Our results suggest that X-linked cataract and NHS are allelic disorders.

Five-year workplace wellness intervention in the NHS

OpenAIRE

Blake, Holly; Zhou, Dingyuan; Batt, Mark E.

2013-01-01

aims:\\ud Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace.\\ud method:\\ud A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to e...

Tackling racism in the NHS.

Science.gov (United States)

Dean, Erin

2016-11-30

Essential facts Trade union Unite has developed a policy briefing on a new toolkit to combat racism in the NHS. It can help nurses and other staff tackle racial discrimination in health, with black and minority ethnic (BME) nurses often treated unequally compared with their white colleagues.

Hopewell Furnace NHS : alternative transportation study

Science.gov (United States)

2009-12-31

This study assesses the potential for an alternative transportation system (ATS) at Hopewell Furnace National Historic Site (NHS). The Volpe Center investigated internal circulation and potential partnerships with local historic, cultural, and recrea...

Policy and organizational implications of gender imbalance in the NHS.

Science.gov (United States)

Miller, Karen

2007-01-01

The purpose of the paper is to examine the policy and organizational implications of gender imbalance in management, which research suggests exists in the NHS. The research in this paper involved a qualitative approach with an analysis of elite interviews conducted with a non-random sample of officials involved in health policy and interviews with a random sample of senior managers in NHS Scotland. The research formed part of a larger study, which explored the enablers and inhibitors to female career progression in various Scottish sectors. The paper finds that gender imbalance in management exists in the NHS. This is manifested in a masculine organizational context, leadership and policy decision-making process, which have implications for female career advancement opportunities and subsequently access to macro policy decisions. The paper involved a sample (30 percent) of senior managers and examined policy processes in NHS Scotland. To improve the external validity of the findings further research should be conducted in NHS organizations in England and Wales. The findings in the paper suggest that gender imbalance in management and a masculine organizational context and leadership style within the NHS create a less than conducive environment for female employees. This has practical implications in terms of levels of part-time employment, career progression and attrition rates. The paper adds to the debate of gender and organizational studies by examining the health sector, which has high levels of female employment but low levels of female representation at senior management levels. The paper therefore adds to an often-neglected area of study, women in leadership and senior managerial positions. The paper is original in its approach by examining the micro and meso organizational dimensions which impact on women's ability to influence macro health policy.

Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks.

Science.gov (United States)

Cook, Erica J; Sharp, Chloe; Randhawa, Gurch; Guppy, Andy; Gangotra, Raj; Cox, Jonathon

2016-01-20

NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual's ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50-75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with 'White British' 'Black Caribbean' and 'Indian' patients most likely to take up a NHS Health Check. However, patients from 'Any Other White Background' and 'Black African' were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities.

Five-year workplace wellness intervention in the NHS.

Science.gov (United States)

Blake, Holly; Zhou, Dingyuan; Batt, Mark E

2013-09-01

Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace. A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to encourage employees to make healthy lifestyle choices and sustained behaviour changes. An employee questionnaire survey was distributed at baseline (n = 1,452) and at five years (n = 1,134), including measures of physical activity, BMI, diet, self-efficacy, social support, perceived general health and mood, smoking behaviours, self-reported sickness absence, perceived work performance and job satisfaction. Samples were comparable at baseline and follow-up. At five years, significantly more respondents actively travelled (by walking or cycling both to work and for non-work trips) and more were active while at work. Significantly more respondents met current recommendations for physical activity at five years than at baseline. Fewer employers reported 'lack of time' as a barrier to being physically active following the intervention. Significantly lower sickness absence, greater job satisfaction and greater organisational commitment was reported at five years than at baseline. Improvements in health behaviours, reductions in sickness absence and improvements in job satisfaction and organisational commitment were observed following five years of a workplace wellness intervention for NHS employees. These findings suggest that health-promoting programmes should be embedded within NHS infrastructure.

Approaches to leadership and managing change in the NHS.

Science.gov (United States)

Lumbers, Melanie

2018-05-24

The NHS is continually changing as research evidence leads to new practices and technology transforms the workplace. Resistance to some changes may occur because of staff fears about adapting to and coping with new methods. This is where change models and leadership are important. This article discusses changes taking place in the NHS, and some theoretical models of change. Leadership styles are also discussed, including those most useful for the nurse to use when leading a team and implementing change.

Job evaluation for clinical nursing jobs by implementing the NHS JE system.

Science.gov (United States)

Kahya, Emin; Oral, Nurten

2007-10-01

The purpose of this paper was to evaluate locally all the clinical nursing jobs implementing the NHS JE system in four hospitals. The NHS JE was developed by the Department of Health in the UK in 2003-2004. A job analysis questionnaire was designed to gather current job descriptions. It was distributed to each of 158 clinical nurses and supervisor nurses in 31 variety clinics at four hospitals in one city. The questionnaires were analysed to evaluate locally all the identified 94 nursing jobs. Fourteen of 19 nursing jobs in the medical and surgical clinics can be matched to the nurse national job in the NHS JE system. The results indicated that two new nursing jobs titled nurse B and nurse advanced B should be added to the list of national nursing jobs in the NHS JE system.

International patients within the NHS: a case of public sector entrepreneurialism.

Science.gov (United States)

Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

2015-01-01

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

Xcat, a novel mouse model for Nance-Horan syndrome inhibits expression of the cytoplasmic-targeted Nhs1 isoform.

Science.gov (United States)

Huang, Kristen M; Wu, Junhua; Duncan, Melinda K; Moy, Chris; Dutra, Amalia; Favor, Jack; Da, Tong; Stambolian, Dwight

2006-01-15

Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features and mental retardation. A recent report suggests that the novel gene NHS1 is involved in this disorder due to the presence of point mutations in NHS patients. A possible mouse model for NHS, Xcat, was mapped to a 2.11 Mb interval on the X-chromosome. Sequence and FISH analysis of the X-chromosome region containing the Xcat mutation reveal a large insertion between exons 1 and 2 of the mouse Nhs1 gene. The insertion inhibits the expression of the Nhs1 isoform containing exon 1 and results in exclusive expression of the alternative isoform containing exon 1A. Quantitative RT-PCR of Xcat cDNA shows reduced levels of Nhs1 transcripts. The Nhs1 protein is strongly expressed within the cytoplasm of elongating lens fiber cells from wild-type neonate lens, but is significantly reduced within the Xcat lens. Transient transfection studies of CHO cells with Nhs1-GFP fusion proteins were done to determine whether the amino acids encoded by exon 1 were critical for protein localization. We found the presence of Nhs1 exon 1 critical for localization of the fusion protein to the cytoplasm, whereas fusion proteins lacking Nhs1 exon 1 are predominantly nuclear. These results indicate that the first exon of Nhs1 contains crucial information required for the proper expression and localization of Nhs1 protein. Inhibition of expression of the exon 1 containing isoform results in the abnormal phenotype of Xcat.

The fallacy of choice in the common law and NHS policy.

Science.gov (United States)

Whiteman, Ingrid

2013-06-01

Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on 'consent', look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of 'choice', focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

Self-rostering can improve work-life balance and staff retention in the NHS.

Science.gov (United States)

Barrett, Renee; Holme, Annie

2018-03-08

Renee Barrett, Staff Nurse, ITU, Great Ormond Street Hospital NHS Trust, renee.barrett@gosh.nhs.uk , and Annie Holme, Lecturer, King's College London, look at how e-rostering can benefit health organisations and staff.

Clinical psychologists' experiences of NHS organisational change

OpenAIRE

Colley, Rich; Eccles, Fiona; Hutton, Cheryl

2015-01-01

Organisational-change experiences of eight clinical psychologists working in the NHS were captured. Three themes revealed the challenges they experienced and how their knowledge and skills have helped them understand, cope with, and respond to change.

Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform

OpenAIRE

Sharma, Shiwani; Burdon, Kathryn P.; Dave, Alpana; Jamieson, Robyn V.; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E.

2008-01-01

Purpose Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junction...

Team performance in the Italian NHS: the role of reflexivity.

Science.gov (United States)

Urbini, Flavio; Callea, Antonino; Chirumbolo, Antonio; Talamo, Alessandra; Ingusci, Emanuela; Ciavolino, Enrico

2018-04-09

Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

The NHS and market forces in healthcare: the need for organisational ethics.

Science.gov (United States)

Frith, Lucy

2013-01-01

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the ?NHS Services, Seven Days a Week? project 2013?2016

OpenAIRE

Gan, Hoong-Wei; Wong, Danny Jon Nian; Dean, Benjamin John Floyd; Hall, Alistair Scott

2017-01-01

Background The cause of adverse weekend clinical outcomes remains unknown. In 2013, the ?NHS Services, Seven Days a Week? project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national...

Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the "NHS Services, Seven Days a Week" project 2013-2016

OpenAIRE

Gan, H-W; Wong, D. J. N.; Dean, B. J. F.; Hall, A. S.

2017-01-01

Background: The cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods: Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained f...

Provider diversity in the English NHS: a study of recent developments in four local health economies.

Science.gov (United States)

Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda

2012-01-01

To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

Differential biotin labelling of the cell envelope proteins in lipopolysaccharidic diderm bacteria: Exploring the proteosurfaceome of Escherichia coli using sulfo-NHS-SS-biotin and sulfo-NHS-PEG4-bismannose-SS-biotin.

Science.gov (United States)

Monteiro, Ricardo; Chafsey, Ingrid; Leroy, Sabine; Chambon, Christophe; Hébraud, Michel; Livrelli, Valérie; Pizza, Mariagrazia; Pezzicoli, Alfredo; Desvaux, Mickaël

2018-06-15

Surface proteins are the major factor for the interaction between bacteria and its environment, playing an important role in infection, colonisation, virulence and adaptation. However, the study of surface proteins has proven difficult mainly due to their hydrophobicity and/or relatively low abundance compared with cytoplasmic proteins. To overcome these issues new proteomic strategies have been developed, such as cell-surface protein labelling using biotinylation reagents. Sulfo-NHS-SS-biotin is the most commonly used reagent to investigate the proteins expressed at the cell surface of various organisms but its use in lipopolysaccharidic diderm bacteria (archetypical Gram-negative bacteria) remains limited to a handful of species. While generally pass over in silence, some periplasmic proteins, but also some inner membrane lipoproteins, integral membrane proteins and cytoplasmic proteins (cytoproteins) are systematically identified following this approach. To limit cell lysis and diffusion of the sulfo-NHS-SS-biotin through the outer membrane, biotin labelling was tested over short incubation times and proved to be as efficient for 1 min at room temperature. To further limit labelling of protein located below the outer membrane, the use of high-molecular weight sulfo-NHS-PEG4-bismannose-SS-biotin appeared to recover differentially cell-envelope proteins compared to low-molecular weight sulfo-NHS-SS-biotin. Actually, the sulfo-NHS-SS-biotin recovers at a higher extent the proteins completely or partly exposed in the periplasm than sulfo-NHS-PEG4-bismannose-SS-biotin, namely periplasmic and integral membrane proteins as well as inner membrane and outer membrane lipoproteins. These results highlight that protein labelling using biotinylation reagents of different sizes provides a sophisticated and accurate way to differentially explore the cell envelope proteome of lipopolysaccharidic diderm bacteria. While generally pass over in silence, some periplasmic proteins

Market--what market? A review of Health Authority purchasing in the NHS internal market.

Science.gov (United States)

West, P A

1998-05-01

This paper argues that the British NHS Reforms (the 'Reforms') set out in Working for Patients [1] largely failed to create a market, to achieve the changes that market forces might have been expected to achieve or to meet the objectives set for the NHS in Working for Patients. It draws on the available literature and the author's experience of work with the NHS during the 6 years after Working for Patients. It is hampered, as are all such reviews of the UK Reforms, by the lack of a detailed and systematic research appraisal of the internal market. Many small changes, resulting from market mechanisms, may have occurred throughout the NHS without being publicized or well documented. But overall, there is little convincing evidence that the Reforms have achieved their goals or met the objectives of the politicians who initiated them. The argument here is necessarily limited by the space available (but see [2] for a detailed analysis of the NHS Reforms). The initial sections of the paper examine the characteristics of markets and market power and the extent to which the NHS Reforms created a market, with health authorities and fund-holders as its buyers. The paper concentrates in particular on health authorities. Later sections then examine the extent to which the Reforms met the objectives set out in Working for Patients.

Do NHS walk-in centres in England provide a model of integrated care?

Directory of Open Access Journals (Sweden)

C. Salisbury

2003-08-01

Full Text Available Purpose: To undertake a comprehensive evaluation of NHS walk-in centres against criteria of improved access, quality, user satisfaction and efficiency. Context: Forty NHS walk-in centres have been opened in England, as part of the UK governments agenda to modernise the NHS. They are intended to improve access to primary care, provide high quality treatment at convenient times, and reduce inappropriate demand on other NHS providers. Care is provided by nurses rather than doctors, using computerised algorithms, and nurses use protocols to supply treatments previously only available from doctors. Data sources: Several linked studies were conducted using different sources of data and methodologies. These included routinely collected data, site visits, patient interviews, a survey of users of walk-in centres, a study using simulated patients to assess quality of care, analysis of consultation rates in NHS services near to walk-in centres, and audit of compliance with protocols. Conclusion & discussion: The findings illustrate many of the issues described in a recent WHO reflective paper on Integrated Care, including tensions between professional judgement and use of protocols, problems with incompatible IT systems, balancing users' demands and needs, the importance of understanding health professionals' roles and issues of technical versus allocative efficiency.

NHS constitution values for values-based recruitment: a virtue ethics perspective.

Science.gov (United States)

Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann

2018-05-17

Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Employee engagement within the NHS: a cross-sectional study.

Science.gov (United States)

Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-02-01

Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. We found that the score for vigor and dedication is significantly lower than comparison group (Pengagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one's effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

The early NHS and the crisis of public health nursing.

Science.gov (United States)

Webster, C

2000-01-01

Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office

Fluorescence studies on the aggregation behaviors of collagen modified with NHS-activated poly(γ-glutamic acid).

Science.gov (United States)

Zhang, Min; Yang, Junhui; Yang, Qili; Huang, Liulian; Wu, Hui; Chen, Lihui; Ding, Cuicui

2018-06-01

The poly(γ-glutamic acid)-NHS (γ-PGA-NHS) esters were used to endow collagen with both of excellent water-solubility and thermal stability via cross-linking reaction between γ-PGA-NHS and collagen. In the present work, the effect of γ-PGA-NHS on the aggregation of collagen molecules was studied by fluorescence techniques. The fluorescence emission spectra of pyrene in collagen solutions and the intrinsic fluorescence emission spectra of collagen suggested different effects of γ-PGA-NHS on collagen molecules: inhibiting aggregation below critical aggregation concentration (CAC) and promoting aggregation above CAC. The two-dimensional (2D) fluorescence correlation spectra indicated that the intermolecular hydrogen bonding and cross-linking between γ-PGA-NHS and collagen would influence the aggregation of collagen molecules. By the ultra-sensitive differential scanning calorimeter (VP-DSC), it was found that the main denaturational transition temperature (T m2 ) of modified collagen increased, while its calorimetric enthalpy changes (ΔH 2 ) decreased compared to those of native collagen, further indicating that the modification of γ-PGA-NHS influenced the aggregation of collagen molecules. The study provide useful information for the utilizing and or the processing of water-soluble collagen in aqueous solution in the fields such as cosmetics, health care products, tissue engineering and biomedical materials, etc. Copyright © 2018 Elsevier B.V. All rights reserved.

Can Six Sigma be the "cure" for our "ailing" NHS?

Science.gov (United States)

Antony, Jiju; Downey-Ennis, Kay; Antony, Frenie; Seow, Chris

2007-01-01

The purpose of this research is to analyse whether Six Sigma business strategy can be used to improve the financial and operational performance of the NHS. The paper will also look at some of the major challenges and barriers in the implementation of this powerful process improvement strategy within the healthcare sector. This paper discusses whether Six Sigma DMAIC methodology can be a useful and disciplined approach to tackle process- and quality-related problems in the NHS. The paper presents some key findings from other researchers in the field, followed by some comments on whether Six Sigma is a useful approach to be considered by the NHS for cost reduction and defect reduction strategies. The paper illustrates the point that Six Sigma is not confined just to manufacturing industry, rather it is equally applicable to service industry, especially the healthcare and financial sectors. The application of Six Sigma in the UK health sector is relatively new and the purpose of the paper is to increase the awareness of this powerful business strategy in healthcare discipline.

Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform.

Science.gov (United States)

Sharma, Shiwani; Burdon, Kathryn P; Dave, Alpana; Jamieson, Robyn V; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E

2008-01-01

Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junctions in epithelial cells. This study aimed to identify the causative mutations in new patients diagnosed with Nance-Horan syndrome and to investigate the effect of mutations on subcellular localization of the NHS-A protein. All coding exons of NHS were screened for mutations by polymerase chain reaction (PCR) and sequencing. PCR-based mutagenesis was performed to introduce three independent mutations in the NHS-A cDNA. Expression and localization of the mutant proteins was determined in mammalian epithelial cells. Truncating mutations were found in 6 out of 10 unrelated patients from four countries. Each of four patients carried a novel mutation (R248X, P264fs, K1198fs, and I1302fs), and each of the two other patients carried two previously reported mutations (R373X and R879X). No mutation was found in the gene in four patients. Two disease-causing mutations (R134fs and R901X) and an artificial mutation (T1357fs) resulted in premature truncation of the NHS-A protein. All three mutant proteins failed to localize to the cellular periphery in epithelial cells and instead were found in the cytoplasm. This study brings the total number of mutations identified in NHS to 18. The mislocalization of the mutant NHS-A protein, revealed by mutation analysis, is expected to adversely affect cell-cell junctions in epithelial cells such as the lens epithelium, which may explain cataractogenesis in Nance-Horan syndrome patients. Mutation analysis also shed light on the significance of NHS-A regions for

Local Purchasing of Journals is Required in Addition to a Nationally Purchased Collection to Meet the Information Needs of NHS Staff. A review of: Glover, Steven William, John Addison, Colette Gleghorn, and John Bramwell. “Journal Usage in NHS Hospitals: A Comparison Report of Total Usage at an Acute NHS Trust and a Specialist NHS Trust in the North West of England.” Health Information and Libraries Journal 24.3 (2007: 193‐9.

Directory of Open Access Journals (Sweden)

Jennie Kelson

2008-03-01

Full Text Available Objective ‐ To compare journal usage between an acute National Health Service (NHS Trust and a specialist NHS Trust located in North West England to provide some evidence as to how well the National Core Content Collection (provided by ProQuest meets the needs of staff in these settings.Design ‐ Comparative studySetting ‐ An acute NHS Trust, comprising four hospital sites, and a cancer specialist NHS Trust based on a single site. Both Trusts are located in North West England. The cancer specialist NHS Trust is a teaching hospital with undergraduate nurses, medical students, and student radiographers. This Trust is also closely associated with an adjoining cancer research institute. The acute NHS Trust has a large number of healthcare staff in training and was not described as a teaching hospital.Subjects ‐ Staff of the respective NHS Trusts. The staff numbers for each organisation were not provided.Methods ‐ COUNTER usage statistics of online journals, obtained from publisher administration tools, were collected for one year covering the period 1 December 2005 to 30 November 2006. Where available, the number of photocopies made from print journals during the same period by library users for their own use was also included. All full‐text downloads of journal articles were counted as part of this study, hence the possibility of double counting if a single article was requested in both HTML and PDF versions. Details of free or open access articles accessed without the need for a username and password were not included in the study. To encourage use of the electronic journals, library services at both Trusts implemented a number of initiatives to maximize publicity. These included direct e‐mails to staff, posters, and presentations to staff. Athens registration, required for access to the electronic journal collections, was promoted as part of the induction process for new library users. Staff members were encouraged to apply for the

Provision of NHS generalist and specialist services to care homes in England: review of surveys.

Science.gov (United States)

Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

2016-03-01

The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

Volunteering and overseas placements in the NHS: a survey of current activity.

Science.gov (United States)

Chatwin, John; Ackers, Louise

2016-10-19

The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the National Health Service (NHS) in the North West of England. Cross-sectional survey. Descriptive statistics. 4 main regional hospitals in the North West of England, and additional NHS staff training events. Convenience sample of NHS staff (n=911). 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% men; 40.6% women). Medium-term placements were undertaken by 46.7% of men, and 52.5% of women. Settlement stays (ie, over 1 year) were reported by 7.6% men, and 8.3% women). The majority of respondents engaged in international placement were from the age groups incorporating 'below 25' to '41-50' (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife/nurse/health visitor, and medical and dental. This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Owing to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that the numbers will continue to rise if current policy initiatives gain momentum. Published by the BMJ Publishing Group Limited. For permission to use

The National Health Service (NHS) at 70: some comparative reflections.

Science.gov (United States)

Tuohy, Carolyn H

2018-03-16

As the National Health Service (NHS) turns 70, it bears comparison with another universal system celebrating an anniversary this year: Canada's 50-year-old medicare model. Each system is iconically popular, and each revolves around a profession-state accommodation. Both the popularity and the central axis of each system have been tested by external shocks in the form of periodic fiscal cycles of investment and austerity, and internal stresses generating organizational cycles of centralization and decentralization. In addition, the English NHS has undergone periodic bursts of major policy change, which have arguably moved the system closer to the Canadian single-payer model.

Managing clinical negligence litigation and costs in the NHS.

Science.gov (United States)

Tingle, John

2016-11-24

John Tingle, Reader in Health Law, Nottingham Trent University, discusses recent Government proposals to improve NHS maternity services and make changes to litigation and patient safety investigation procedures.

Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

Science.gov (United States)

Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

2017-04-01

2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health

'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

Science.gov (United States)

Gorsky, Martin

2013-01-01

This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

Science.gov (United States)

Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

2011-09-01

The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

The costs to the NHS of multiple births after IVF treatment in the UK.

Science.gov (United States)

Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

2006-01-01

To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

Science.gov (United States)

Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

2016-01-01

Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

Employee Engagement within the NHS: A Cross-Sectional Study

Directory of Open Access Journals (Sweden)

Yadava Bapurao Jeve

2015-02-01

Full Text Available Background Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES at a teaching hospital. Methods We have conducted a cross-sectional study within the National Health Service (NHS Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption and total score compared with control score from test manual. Results We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both. The score for absorption was significantly higher than comparison group (P< 0.0001. However, total score is not significantly different. Conclusion The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

Next Generation Hemostatic Materials Based on NHS-Ester Functionalized Poly(2-oxazoline)s.

Science.gov (United States)

Boerman, Marcel A; Roozen, Edwin; Sánchez-Fernández, María José; Keereweer, Abraham R; Félix Lanao, Rosa P; Bender, Johan C M E; Hoogenboom, Richard; Leeuwenburgh, Sander C; Jansen, John A; Van Goor, Harry; Van Hest, Jan C M

2017-08-14

In order to prevent hemorrhage during surgical procedures, a wide range of hemostatic agents have been developed. However, their efficacy is variable; hemostatic devices that use bioactive components to accelerate coagulation are dependent on natural sources, which limits reproducibility. Hybrid devices in which chain-end reactive poly(ethylene glycol) is employed as active component sometimes suffer from irregular cross-linking and dissolution of the polar PEG when blood flow is substantial. Herein, we describe a synthetic, nonbioactive hemostatic product by coating N-hydroxysuccinimide ester (NHS)-functional poly(2-oxazoline)s (POx-NHS) onto gelatin patches, which acts by formation of covalent cross-links between polymer, host blood proteins, gelatin and tissue to seal the wound site and prevent hemorrhage during surgery. We studied different process parameters (including polymer, carrier, and coating technique) in direct comparison with clinical products (Hemopatch and Tachosil) to obtain deeper understanding of this class of hemostatic products. In this work, we successfully prove the hemostatic efficacy of POx-NHS as polymer powders and coated patches both in vitro and in vivo against Hemopatch and Tachosil, demonstrating that POx-NHS are excellent candidate polymers for the development of next generation hemostatic patches.

Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust.

Science.gov (United States)

Milkhu, C S; Howell, D C J; Glynne, P A; Raptis, D; Booth, H L; Langmead, L; Datta, V K

2008-09-01

Lack of knowledge of an NHS trust's major incident policies by clinical staff may result in poorly coordinated responses during a mass casualty incident (MCI). To audit knowledge of the major incident policy by clinical staff working in a central London major acute NHS trust designated to receive casualties on a 24-h basis during a MCI. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. A reply rate of 34% was obtained, with a reasonable representation from all disciplines ranging from nurses to consultants. Despite only 41% having read the policy in full, 70% knew the correct immediate action to take if informed of major incident activation. 76% knew the correct stand-down procedure. 56% knew the correct reporting point but less than 25% knew that an action card system was utilised. Nurses had significantly (p<0.01) more awareness of the policy than doctors. In view of the heightened terrorist threat in London, knowledge of major incident policy is essential. The high percentage of positive responses relating to immediate and stand-down actions reflects the rolling trust-wide MCI education programme and the organisational memory of the trust following several previous MCI in the capital. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs.

NHS should provide nurses with decent catering facilities.

Science.gov (United States)

Whelan, Adrian

2016-11-16

How about the NHS gives us access to decent catering facilities or even tables and chairs that aren't a 10 to 15-minute walk away from the ward or unit - which must be taken out of the already paltry half-hour meal break?

Measuring and modelling occupancy time in NHS continuing healthcare

Directory of Open Access Journals (Sweden)

Millard Peter H

2011-06-01

Full Text Available Abstract Background Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time. Methods An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31 London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly. Results We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days, some others staying for few months and the third category of patients staying for a long period of time (years. Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model. Conclusions The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards

Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial.

Science.gov (United States)

Baos, Sarah; Brigden, Amberly; Anderson, Emma; Hollingworth, William; Price, Simon; Mills, Nicola; Beasant, Lucy; Gaunt, Daisy; Garfield, Kirsty; Metcalfe, Chris; Parslow, Roxanne; Downing, Harriet; Kessler, David; Macleod, John; Stallard, Paul; Knoop, Hans; Van de Putte, Elise; Nijhof, Sanne; Bleijenberg, Gijs; Crawley, Esther

2018-02-22

Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.

Leadership in the NHS: does the Emperor have any clothes?

Science.gov (United States)

Checkland, Kath

2014-10-01

In this essay, I explore the rise of the concept of 'leadership' in the English NHS, highlighting the similarity with a previous shift from (bad, old) 'administration' to (good, new) 'management'. I take a critical look at this discursive shift and highlight some of the overblown claims made for the value of 'clinical leadership'. I argue that, rather than turning all NHS staff into leaders, we should perhaps tone down the level of our rhetoric and instead emphasize the need for a service full of good followers who will maintain a relentless focus on care, quality and efficiency. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

Science.gov (United States)

de Viggiani, Nick

2013-08-01

Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Market-driven production of biospecimens and the role of NHS hospital-led biobanks.

Science.gov (United States)

Timmons, Stephen; Vezyridis, Paraskevas

2017-09-01

Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital-led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare. © 2017 Foundation for the Sociology of Health & Illness.

Mutations in a novel gene, NHS, cause the pleiotropic effects of Nance-Horan syndrome, including severe congenital cataract, dental anomalies, and mental retardation.

Science.gov (United States)

Burdon, Kathryn P; McKay, James D; Sale, Michèle M; Russell-Eggitt, Isabelle M; Mackey, David A; Wirth, M Gabriela; Elder, James E; Nicoll, Alan; Clarke, Michael P; FitzGerald, Liesel M; Stankovich, James M; Shaw, Marie A; Sharma, Shiwani; Gajovic, Srecko; Gruss, Peter; Ross, Shelley; Thomas, Paul; Voss, Anne K; Thomas, Tim; Gécz, Jozef; Craig, Jamie E

2003-11-01

Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features, and, in some cases, mental retardation. NHS has been mapped to a 1.3-Mb interval on Xp22.13. We have confirmed the same localization in the original, extended Australian family with NHS and have identified protein-truncating mutations in a novel gene, which we have called "NHS," in five families. The NHS gene encompasses approximately 650 kb of genomic DNA, coding for a 1,630-amino acid putative nuclear protein. NHS orthologs were found in other vertebrates, but no sequence similarity to known genes was identified. The murine developmental expression profile of the NHS gene was studied using in situ hybridization and a mouse line containing a lacZ reporter-gene insertion in the Nhs locus. We found a complex pattern of temporally and spatially regulated expression, which, together with the pleiotropic features of NHS, suggests that this gene has key functions in the regulation of eye, tooth, brain, and craniofacial development.

The National Health Service (NHS) at 70: Bevan's double-edged legacy.

Science.gov (United States)

Klein, Rudolf

2018-01-08

The paper analyses the achievements and problems stemming from Nye Bevan's model of a tax funded national health care system, on the assumption that only so could equity be achieved. The evidence shows that indeed the National Health Service (NHS) scores highly on equity, so vindicating Bevan's vision. The price paid is that fiscal crises are the norm for the NHS, with ever more centralisation, intensive regulation and performance management. Successive reorganisations represent attempts to square the circle - to combine the strengths of Bevan's model and those of a less hierarchic system - but have so far failed to deliver and can be expected to continue.

Caseload of NHS plastic surgeons in Scotland, 2005-2006: analysis of Scottish hospital activity data.

Science.gov (United States)

Brewster, Colin T; Shoaib, Taimur

2009-04-01

To assess the contemporary caseload of NHS plastic surgeons. Descriptive study. Scotland. Analysis of routinely collected NHS hospital activity data relating to the financial year 2005-2006. Number of inpatient/day-case episodes and bed-days by principal diagnosis and main operative procedure. During the study period, 12,844 inpatient and 9439 day-case episodes were recorded in 19,166 patients, accounting for 36,300 bed-days. There were more female patients, especially among middle-age groups. Socioeconomic deprivation was more common than expected (P accounted for a higher proportion of bed-days (37.3%) than neoplasms (23.8%). Only approximately half of all surgical procedures were assigned to the skin chapter of the OPCS-4 classification. Despite some limitations, this study provides an insight into the current caseload of NHS plastic surgeons working in Scotland. The data suggest that cosmetic surgery for purely aesthetic reasons represents a relatively small part of NHS plastic surgery activity in Scotland, and that the majority of caseload is in reconstructive plastic surgery.

First evaluation of the NHS direct online clinical enquiry service: A nurse-led web chat triage service for the public

NARCIS (Netherlands)

Eminovic, Nina; Wyatt, Jeremy C.; Tarpey, Aideen M.; Murray, Gerard; Ingrams, Grant J.

2004-01-01

Background: NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their

Centralised 3D printing in the NHS: a radiological review.

Science.gov (United States)

Eley, K A

2017-04-01

In recent years, three-dimensional (3D) printing has seen an explosion of interest fuelled by improvements in technology and associated reduction in costs. The literature is replete with novel medical applications of custom anatomical models, prostheses, and surgical guides. Although the fundamental core of 3D printing lies in image manipulation, the driving force in many National Health Service (NHS) trusts has come from individual surgical specialties with 3D printers independently run and confined to respective departments. In this review of 3D printing, experience of establishing a new centralised 3D-printing service within an NHS hospital trust is reported, focusing on the requirements and challenges of such an endeavour. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Radical 10-point plan to refocus NHS estate.

Science.gov (United States)

Ellis, Conor; Baldwin, Ed; Dick, Rachel

2010-11-01

Conor Ellis, head of health, Ed Baldwin, partner, and Rachel Dick, consultant, at international built asset consultancy EC Harris, present a "10-step guide" to help the NHS achieve radical efficiency savings, optimise the use of its estate, maximise the value of under-utilised land, buildings, and other assets, and harness better value from its existing FM operations.

Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

Science.gov (United States)

Hamarneh, Ashraf

2015-01-01

International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

Science.gov (United States)

Crawford, Louise

2016-02-01

This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested. © 2016 John Wiley & Sons Ltd.

Part-time work and job sharing in health care: is the NHS a family-friendly employer?

Science.gov (United States)

Branine, Mohamed

2003-01-01

This paper examines the nature and level of flexible employment in the National Health Service (NHS) by investigating the extent to which part-time work and job sharing arrangements are used in the provision and delivery of health care. It attempts to analyse the reasons for an increasing number of part-timers and a very limited number of job sharers in the NHS and to explain the advantages and disadvantages of each pattern of employment. Data collected through the use of questionnaires and interviews from 55 NHS trusts reveal that the use of part-time work is a tradition that seems to fit well with the cost-saving measures imposed on the management of the service but at the same time it has led to increasing employee dissatisfaction, and that job sharing arrangements are suitable for many NHS employees since the majority of them are women with a desire to combine family commitments with career prospects but a very limited number of employees have had the opportunity to job share. Therefore it is concluded that to attract and retain the quality of staff needed to ensure high performance standards in the provision and delivery of health care the NHS should accept the diversity that exists within its workforce and take a more proactive approach to promoting a variety of flexible working practices and family-friendly policies.

Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms.

Science.gov (United States)

Laverty, Louise; Harris, Rebecca

2018-06-01

Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect of Some Synthetic Parameters on Size and Polydispersity Index of Gelatin Nanoparticles Cross-Linked by CDI/NHS System

Directory of Open Access Journals (Sweden)

S. Zinatloo-Ajabshir

2015-04-01

Full Text Available In our previous work, the effect of use of a water soluble CDI/NHS system as nontoxic cross-linking agent on fabrication of gelatin nanoparticles was investigated. In this research, the effect of variation in some synthetic parameters of gelatin nanoparticles cross-linked by CDI/NHS system such as type of gelatin and formulation of cross- linking agent on their size and distribution was examined. The conventional two step desolvation method was used for preparation of gelatin nanoparticles. The morphology, mean size and size distribution of the formed nanoparticles were evaluated and compared with each other. In addition, intrinsic viscosities of all the nanoparticles were measured and compared under different conditions. The results showed that the presence of more NHS and absence of NHS catalyst in CDI/NHS system lead to the large particle size and broad size distribution of nanoparticles that were attributed to the fast and slow cross-linking rate, respectively.

NHS Trusts' clinical research activity and overall CQC performance - Is there a correlation?

Science.gov (United States)

Jonker, L; Fisher, S J

2015-11-01

Since the late 2000's, the creation of the National Institute for Health Research (NIHR) has transformed clinical research activity in the United Kingdom. This study sought to establish if there is a link between clinical research activity and overall NHS Trust performance. Retrospective cohort study. Data for NHS Trust performance were obtained from public databases, namely the Care Quality Commission (CQC) 2013 risk rating for overall performance, and 2012-13 NIHR records for clinical research activity. Applying Spearman's rank analysis, none of the Trust categories showed a correlation with CQC risk rating: small hospitals, r = -0.062 (P = 0.76; n = 27); medium, r = -0.224 (P = 0.13; n = 47); large, r = -0.008 (P = 0.96; n = 57); academic, r = -0.18 (P = 0.41; n = 24). Similar results were observed when CQC risk rating was compared with the number of different clinical research studies conducted per Trust. The degree of NIHR National Portfolio clinical research activity is not significantly related to CQC risk rating, used as an indicator of overall NHS Trust performance. Other studies have previously shown that increased research activity correlates with improved mortality rates, one component of CQC risk rating scores. Alternative tools may have to be explored to evaluate the impact of clinical research on NHS Trusts and its patients. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Capitalising on leadership fellowships for clinicians in the NHS.

Science.gov (United States)

Nicol, Edward D

2011-04-01

Clinical leadership has become a primary focus of the NHS with many leadership programmes, particularly those aimed at junior clinicians, being developed. This article illustrates the potential of these programmes but also urges caution when assessing the success of these schemes both from an individual and organisational perspective.

Hypnobirth within the NHS: time to ditch the parent craft?

Science.gov (United States)

Gavin-Jones, Teri

2016-05-01

Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. "Participative preparation for childbirth can enhance women's overall satisfaction with the childbirth experience" (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional 'parent craft' classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education?

Barriers and facilitators to using NHS Direct: a qualitative study of 'users' and 'non-users'.

Science.gov (United States)

Cook, Erica J; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M; Ali, Nasreen

2014-10-25

NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK's diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both 'users' and 'non- users'. Focus groups were held with NHS Direct 'users' (N = 2) from Bedfordshire alongside 'non-users' from Manchester (N = 3) and Mendip, Somerset (N = 4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants' permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts. The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. 'Non-users' were unaware of the range of services that NHS Direct provided. Furthermore, 'non-users' highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a '0845' number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by 'non-users' from deprived communities. NHS Direct 'users' identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service. An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through

Refinement of the NHS locus on chromosome Xp22.13 and analysis of five candidate genes.

Science.gov (United States)

Toutain, Annick; Dessay, Benoît; Ronce, Nathalie; Ferrante, Maria-Immacolata; Tranchemontagne, Julie; Newbury-Ecob, Ruth; Wallgren-Pettersson, Carina; Burn, John; Kaplan, Josseline; Rossi, Annick; Russo, Silvia; Walpole, Ian; Hartsfield, James K; Oyen, Nina; Nemeth, Andrea; Bitoun, Pierre; Trump, Dorothy; Moraine, Claude; Franco, Brunella

2002-09-01

Nance-Horan syndrome (NHS) is an X-linked condition characterised by congenital cataracts, dental abnormalities, dysmorphic features, and mental retardation in some cases. Previous studies have mapped the disease gene to a 2 cM interval on Xp22.2 between DXS43 and DXS999. We report additional linkage data resulting from the analysis of eleven independent NHS families. A maximum lod score of 9.94 (theta=0.00) was obtained at the RS1 locus and a recombination with locus DXS1195 on the telomeric side was observed in two families, thus refining the location of the gene to an interval of around 1 Mb on Xp22.13. Direct sequencing or SSCP analysis of the coding exons of five genes (SCML1, SCML2, STK9, RS1 and PPEF1), considered as candidate genes on the basis of their location in the critical interval, failed to detect any mutation in 12 unrelated NHS patients, thus making it highly unlikely that these genes are implicated in NHS.

Addressing current and future challenges for the NHS: the role of good leadership.

Science.gov (United States)

Elton, Lotte

2016-10-03

Purpose This paper aims to describe and analyse some of the ways in which good leadership can enable those working within the National Health Service (NHS) to weather the changes and difficulties likely to arise in the coming years, and takes the format of an essay written by the prize-winner of the Faculty of Medical Leadership and Management's Student Prize. The Faculty of Medical Leadership and Management ran its inaugural Student Prize in 2015-2016, which aimed at medical students with an interest in medical leadership. In running the Prize, the Faculty hoped to foster an enthusiasm for and understanding of the importance of leadership in medicine. Design/methodology/approach The Faculty asked entrants to discuss the role of good leadership in addressing the current and future challenges faced by the NHS, making reference to the Leadership and Management Standards for Medical Professionals published by the Faculty in 2015. These standards were intended to help guide current and future leaders and were grouped into three categories, namely, self, team and corporate responsibility. Findings This paper highlights the political nature of health care in the UK and the increasing impetus on medical professionals to navigate debates on austerity measures and health-care costs, particularly given the projected deficit in NHS funding. It stresses the importance of building organisational cultures prizing transparency to prevent future breaches in standards of care and the value of patient-centred approaches in improving satisfaction for both patients and staff. Identification of opportunities for collaboration and partnership is emphasised as crucial to assuage the burden that lack of appropriate social care places on clinical services. Originality/value This paper offers a novel perspective - that of a medical student - on the complex issues faced by the NHS over the coming years and utilises a well-regarded set of standards in conceptualising the role that health

Obtaining corporate information from NHS foundation trusts.

Science.gov (United States)

Woodward, Valerie; Endacott, Ruth; Sheaff, Rod; Jones, Ray

Foundation trusts have boards of directors that are responsible for the day-to-day running of the organisation, planning services and developing strategy. Unlike non-foundation trusts and primary care trusts (PCTs), foundation trusts are not obliged to hold directors' board meetings in public. This article describes the online availability and accessibility of the minutes of such meetings in a number of foundation trusts, non-foundation trusts and PCTs. The implications for transparency in the NHS are also discussed.

The clinician impact and financial cost to the NHS of litigation over pregabalin: a cohort study in English primary care.

Science.gov (United States)

Croker, Richard; Smyth, Darren; Walker, Alex J; Goldacre, Ben

2018-06-07

Following litigation over pregabalin's second-use medical patent for neuropathic pain, National Health Service (NHS) England was required by the court to instruct general practitioners (GPs) to prescribe the branded form (Lyrica) for pain. Pfizer's patent was found invalid in 2015, a ruling subject to ongoing appeals. If the Supreme Court appeal in February 2018, whose judgement is awaited, is unsuccessful, the NHS can seek to reclaim excess prescribing costs. We set out to describe the variation in prescribing of pregabalin as branded Lyrica, geographically and over time; to determine how clinicians responded to the NHS England instruction to GPs; and to model excess costs to the NHS attributable to the legal judgements. English primary care. English general practices. Variation in prescribing of branded Lyrica across the country before and after the NHS England instruction, by practice and by Clinical Commissioning Group; excess prescribing costs. The proportion of pregabalin prescribed as Lyrica increased from 0.3% over 6 months before the NHS England instruction (September 2014 to February 2015) to 25.7% afterwards (April to September 2015). Although 70% of pregabalin is estimated to be for pain, including neuropathic pain, only 11.6% of practices prescribed Lyrica at this level; the median proportion prescribed as Lyrica was 8.8% (IQR 1.1%-41.9%). If pregabalin had come entirely off patent in September 2015, and Pfizer had not appealed, we estimate the NHS would have spent £502 million less on pregabalin to July 2017. NHS England instructions to GPs regarding branded prescription of pregabalin were widely ignored and have created much debate around clinical independence in prescribing. Protecting revenue from 'skinny labels' will pose a challenge. If Pfizer's final appeal on the patent is unsuccessful, the NHS can seek reimbursement of excess pregabalin prescribing costs, potentially £502 million. © Article author(s) (or their employer(s) unless

NHS-Esters As Versatile Reactivity-Based Probes for Mapping Proteome-Wide Ligandable Hotspots.

Science.gov (United States)

Ward, Carl C; Kleinman, Jordan I; Nomura, Daniel K

2017-06-16

Most of the proteome is considered undruggable, oftentimes hindering translational efforts for drug discovery. Identifying previously unknown druggable hotspots in proteins would enable strategies for pharmacologically interrogating these sites with small molecules. Activity-based protein profiling (ABPP) has arisen as a powerful chemoproteomic strategy that uses reactivity-based chemical probes to map reactive, functional, and ligandable hotspots in complex proteomes, which has enabled inhibitor discovery against various therapeutic protein targets. Here, we report an alkyne-functionalized N-hydroxysuccinimide-ester (NHS-ester) as a versatile reactivity-based probe for mapping the reactivity of a wide range of nucleophilic ligandable hotspots, including lysines, serines, threonines, and tyrosines, encompassing active sites, allosteric sites, post-translational modification sites, protein interaction sites, and previously uncharacterized potential binding sites. Surprisingly, we also show that fragment-based NHS-ester ligands can be made to confer selectivity for specific lysine hotspots on specific targets including Dpyd, Aldh2, and Gstt1. We thus put forth NHS-esters as promising reactivity-based probes and chemical scaffolds for covalent ligand discovery.

Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.

Science.gov (United States)

Harries, U; Elliott, H; Higgins, A

1999-03-01

The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.

UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability.

Science.gov (United States)

Lambert, Trevor; Surman, Geraldine; Goldacre, Michael

2014-10-01

To seek doctors' views about the NHS as an employer, our surveys about doctors' career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good 'equal opportunities' employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Surveys undertaken in the UK by mail and Internet. UK medical graduates in selected graduation years between 1993 and 2012. Respondents were asked to rate their level of agreement with three statements starting 'The NHS is a good equal opportunities employer for…' and ending 'women doctors', 'doctors from ethnic minorities' and 'doctors with disabilities'. Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000-2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. © The Royal Society of Medicine.

Considerations, clues and challenges: Gaining Ethical and Trust research approval when using the NHS as a research setting

International Nuclear Information System (INIS)

Jonker, Leon; Cox, Diane; Marshall, Gill

2011-01-01

Substantial changes have been made in recent years to the process of obtaining ethical and research governance approval for research projects in the NHS. The advent of the Integrated Research Application System (IRAS) has streamlined the process, providing a single point of entry. Ethical approval gained in one part of the country is now valid throughout the UK. The previous process of gaining research governance approval in NHS Trusts was maligned and it has been overhauled with the introduction of the National Institute of Health Research (NIHR) Coordinated System for gaining NHS Permission. In addition to updating the reader about the new processes around gaining ethical and Trust approval for research within an NHS setting, essential research project documentation needed for submission are discussed. The aspects of a proposal that Ethics Committees and Trust R and D Departments consider when reviewing applications are highlighted. The implemented changes to the research approval processes will mostly benefit large multi-centre studies; small scale unfunded studies and student projects are potentially at risk of being marginalised in the quest for a streamlined ethics and NHS Trust research governance approval process. However, researchers' familiarity with the approval system should minimise rejection rates and delays.

Considerations, clues and challenges: Gaining Ethical and Trust research approval when using the NHS as a research setting

Energy Technology Data Exchange (ETDEWEB)

Jonker, Leon, E-mail: leon.jonker@cumbria.ac.uk [Faculty of Health and Wellbeing, University of Cumbria, Lancaster LA1 3JD (United Kingdom); Research and Development Department, North Cumbria University Hospitals NHS Trust, Carlisle CA2 7HY (United Kingdom); Cox, Diane; Marshall, Gill [Faculty of Health and Wellbeing, University of Cumbria, Lancaster LA1 3JD (United Kingdom)

2011-08-15

Substantial changes have been made in recent years to the process of obtaining ethical and research governance approval for research projects in the NHS. The advent of the Integrated Research Application System (IRAS) has streamlined the process, providing a single point of entry. Ethical approval gained in one part of the country is now valid throughout the UK. The previous process of gaining research governance approval in NHS Trusts was maligned and it has been overhauled with the introduction of the National Institute of Health Research (NIHR) Coordinated System for gaining NHS Permission. In addition to updating the reader about the new processes around gaining ethical and Trust approval for research within an NHS setting, essential research project documentation needed for submission are discussed. The aspects of a proposal that Ethics Committees and Trust R and D Departments consider when reviewing applications are highlighted. The implemented changes to the research approval processes will mostly benefit large multi-centre studies; small scale unfunded studies and student projects are potentially at risk of being marginalised in the quest for a streamlined ethics and NHS Trust research governance approval process. However, researchers' familiarity with the approval system should minimise rejection rates and delays.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts.

Science.gov (United States)

Thompson, Charles Dr; Mahay, Arun; Stuckler, David; Steele, Sarah

2017-09-01

We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Freedom of Information requests were sent to the 105 England's NHS Trusts delivering acute care in England. NHS Trusts providing secondary care in England. English NHS Trusts. We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.

Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts

Science.gov (United States)

Mahay, Arun; Stuckler, David; Steele, Sarah

2017-01-01

Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation. PMID:28904806

Exploring HRD in two Welsh NHS Trusts: analysing the discursive resources used by senior managers.

Science.gov (United States)

Sambrook, Sally

2007-01-01

The purpose of this paper is to examine human resource development (HRD) in the UK National Health Service (NHS), and particularly in two Welsh NHS Trusts, to help illuminate the various ways in which learning, training and development are talked about. The NHS is a complex organisation, not least with its recent devolution and separation into the four distinct countries of the UK. Within this, there are multiple and often conflicting approaches to human resource development associated with the various forms of employee, professional (nursing, medical etc.), managerial and organisational development. How people are developed is crucial to developing a modern health service, and yet, with the diverse range of health workers, HRD is a complex process, and one which receives little attention. Managers have a key role and their perceptions of HRD can be analysed through the discursive resources they employ. From an interpretivist stance, the paper employs semi-structured interviews with seven Directorate-General Managers, and adopts discourse analysis to explore how HRD is talked about in two Welsh NHS Trusts. The paper finds some of the different discourses used by different managers, including those with a nursing background and those without. It examines how they talk about HRD, and also explores their own (management) development and the impact this has had on their sense of identity. The paper highlights some of the tensions associated with HRD in the NHS, including ambiguities between professional and managerial development, the functional and physical fragmentation of HRD, conflict between a focus on performance/service delivery and the need to learn, discursive dissonance between the use of the terms training and learning, a delicate balance between "going on courses" and informal, work-related learning, inequities regarding "protected time" and discourses shifting between competition and cooperation. These tensions are exposed to help develop a shared

Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS

Directory of Open Access Journals (Sweden)

Aston Louise M

2011-06-01

Full Text Available Abstract Background The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes. This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW by the NHS. Method Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years; median BMI 35.1 kg/m2 (IQR 31.8 - 39.5 kg/m2. Participants received vouchers (funded by the PCT following referral by a healthcare professional to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database. Results Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight. Conclusions A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care.

Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

Directory of Open Access Journals (Sweden)

Sharp Debbie

2006-06-01

Full Text Available Abstract Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent, recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors" and attractive aspects of complementary therapies ("pull factors". While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy

Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

Science.gov (United States)

Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

2015-04-01

To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

Directory of Open Access Journals (Sweden)

Cochrane Thomas

2012-11-01

Full Text Available Abstract Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p Conclusions The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Corneal Stromal Cell Growth on Gelatin/Chondroitin Sulfate Scaffolds Modified at Different NHS/EDC Molar Ratios

Directory of Open Access Journals (Sweden)

Jui-Yang Lai

2013-01-01

Full Text Available A nanoscale modification strategy that can incorporate chondroitin sulfate (CS into the cross-linked porous gelatin materials has previously been proposed to give superior performance for designed corneal keratocyte scaffolds. The purpose of this work was to further investigate the influence of carbodiimide chemistry on the characteristics and biofunctionalities of gelatin/CS scaffolds treated with varying N-hydroxysuccinimide (NHS/1-ethyl-3-(3-dimethyl aminopropyl carbodiimide hydrochloride (EDC molar ratios (0-1 at a constant EDC concentration of 10 mM. Results of Fourier transform infrared spectroscopy and dimethylmethylene blue assays consistently indicated that when the NHS to EDC molar ratio exceeds a critical level (i.e., 0.5, the efficiency of carbodiimide-mediated biomaterial modification is significantly reduced. With the optimum NHS/EDC molar ratio of 0.5, chemical treatment could achieve relatively high CS content in the gelatin scaffolds, thereby enhancing the water content, glucose permeation, and fibronectin adsorption. Live/Dead assays and interleukin-6 mRNA expression analyses demonstrated that all the test samples have good cytocompatibility without causing toxicity and inflammation. In the molar ratio range of NHS to EDC from 0 to 0.5, the cell adhesion ratio and proliferation activity on the chemically modified samples significantly increased, which is attributed to the increasing CS content. Additionally, the materials with highest CS content (0.143 ± 0.007 nmol/10 mg scaffold showed the greatest stimulatory effect on the biosynthetic activity of cultivated keratocytes. These findings suggest that a positive correlation is noticed between the NHS to EDC molar ratio and the CS content in the biopolymer matrices, thereby greatly affecting the corneal stromal cell growth.

The NHS could learn from inspiring leaders like Barack Obama.

Science.gov (United States)

Coghill, Yvonne

2017-02-01

I remember November 2008 like it was yesterday. I was the lead for the NHS Leadership Academy's national Breaking Through programme for black and minority ethnic staff, and recall being at our annual conference bursting with pride at the news that Barack Obama had been elected president of the United States.

Employee engagement within the NHS: a cross-sectional study

Science.gov (United States)

Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

2015-01-01

Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (Pemployees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

The disposal of redundant teletherapy units from NHS hospitals

International Nuclear Information System (INIS)

Gaffka, A.P.; Ord, M.A.

1994-01-01

The removal/disposal of redundant teletherapy units from NHS hospitals is described, detailing the operational procedures and the transport package background. The Harwell section of the Transport Technology Department has been carrying out these operations since 1991, where initially the service was just offered to the NHS; however, today their specialist transport service has significantly widened and is now offered to other business sectors. Due to the level of radioactivity found in each teletherapy unit, it was necessary to design a special transport packaging to meet the requirements for shipment of these units. Approval was sought from the Department of Transport to adapt a standard Type B package as no other packaging could be found to comply with the necessary requirements. All work undertaken on the removal and disposal of these units complied with an approved scheme of work and was carried out in accordance with a Quality Assurance workplan. However, to keep abreast of modern standards in a manner which is cost effective to customers and acceptable to the general public, the full development of a new Type B packaging is taking place, which is specifically designed to undertake these removal/disposal duties. (author)

The Effects of Immigration on NHS Waiting Times

OpenAIRE

Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

2015-01-01

This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases...

NHS Gene Mutations in Ashkenazi Jewish Families with Nance-Horan Syndrome.

Science.gov (United States)

Shoshany, Nadav; Avni, Isaac; Morad, Yair; Weiner, Chen; Einan-Lifshitz, Adi; Pras, Eran

2017-09-01

To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.

Tracing experiences of NHS change in England: a process philosophy perspective.

Science.gov (United States)

McMurray, Robert

2010-01-01

For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration.

From NHS Choices to the integrated customer service platform.

Science.gov (United States)

Gann, Bob; Grant, Maria J

2013-03-01

In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

The NHS as a learning organization: aspirations beyond the rainbow?

Science.gov (United States)

Timpson, J

1998-09-01

It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se. Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation. The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS). During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS. The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.

Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

Science.gov (United States)

Seaton, Andrew

2015-01-01

This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

Assessing the impact of a new health sector pay system upon NHS staff in England

Directory of Open Access Journals (Sweden)

Buchan James

2008-06-01

Full Text Available Abstract Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions, and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact

Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

Science.gov (United States)

Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

2018-05-03

Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.

Science.gov (United States)

Gray, N; Womack, C; Jack, S J

1999-04-01

NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future.

Lean and Six Sigma Methodologies in NHS Scotland: An Empirical Study and Directions for Future Research

Directory of Open Access Journals (Sweden)

Jiju Antony

2012-12-01

Full Text Available In recent years, the healthcare industry is constantly concerned to provide better quality of patient care with less waste of resources through application of continuous improvement (CI initiatives such as Lean and Six Sigma. The purpose of this paper is to evaluate the status of Lean and Six Sigma methodologies in the National Health Service (NHS Scotland. Data was collected using survey instrument to determine the status of these strategies within the NHS. Although the personnel of NHS do seem to have the basic skills to successfully implement Lean Six Sigma, there appears to be a failure on the part of senior management to successfully communicate the desires and needs of these powerful CI initiatives with personnel. Moreover, a lack of encouragement and motivation, resistance to change and blame culture are quite prevalent across the sector which prevents Lean and Six Sigma strategies from being utilized in a systematic manner.

Can NHS politics, power and conflict ever be a good thing for nurses?

Science.gov (United States)

Lees, Carolyn

2016-07-14

This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute.

An investigation into the move towards electronic journals: a case study of NHS libraries in Kent, Surrey and Sussex.

Science.gov (United States)

England, Rebecca

2013-09-01

Electronic journals are so embedded into practice in academic libraries that it is easy to forget that this is not the case everywhere. In NHS libraries, for example, the staff face a particular set of issues. This article is based on Rebecca England's dissertation on this topic, completed as part of the MSc Econ course in Information and Library studies at Aberystwyth University. Rebecca is E-resources Librarian at the Maidstone and Tunbridge Wells NHS Trust. She investigated the momentum towards electronic journals in NHS libraries in the Kent, Surrey and Sussex region and the potential for a regional purchasing consortium. © 2013 The author. Health Information and Libraries Journal © 2013 Health Libraries Group.

Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers.

Science.gov (United States)

Browne, John; Jamieson, Liz; Lewsey, Jim; van der Meulen, Jan; Copley, Lynn; Black, Nick

2008-04-09

There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs) introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres) in England during 2006-07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction) or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D) instrument) was assessed either 3-months (day surgery) or 6-months (hip/knee) after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression) for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity). Post-operative response rates varied by procedure (73%-88%) and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other procedures. Patients treated in ISTCs were less likely to

Medical Tourism: A Cost or Benefit to the NHS?

OpenAIRE

Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

2013-01-01

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policym...

Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

Science.gov (United States)

Addicott, Rachael

2016-01-01

For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

Overseeing oversight: governance of quality and safety by hospital boards in the English NHS.

Science.gov (United States)

Mannion, Russell; Davies, Huw; Freeman, Tim; Millar, Ross; Jacobs, Rowena; Kasteridis, Panos

2015-01-01

To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). English NHS boards largely hold a wide range of attitudes and

Carbon reduction in the NHS : a role for finance

OpenAIRE

Brown, Steve

2009-01-01

HFMA briefing sponsored by ACCA NHS bodies’ performance on carbon reduction is increasingly having an impact on annual audit assessments, and a new energy efficiency scheme, involving the purchase and trading of carbon emissions allowances, will provide real financial consequences for under or over consumption of carbon. But perhaps the biggest driver for the finance community is the fact that carbon reduction should in fact help them meet their key challenge – the need for efficienc...

The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program.

Science.gov (United States)

Almeida, Álvaro S

2017-06-01

The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality. Copyright © 2017 Elsevier B.V. All rights reserved.

Combination Therapy with NHS-muIL12 and Avelumab (anti-PD-L1) Enhances Antitumor Efficacy in Preclinical Cancer Models.

Science.gov (United States)

Xu, Chunxiao; Zhang, Yanping; Rolfe, P Alexander; Hernández, Vivian M; Guzman, Wilson; Kradjian, Giorgio; Marelli, Bo; Qin, Guozhong; Qi, Jin; Wang, Hong; Yu, Huakui; Tighe, Robert; Lo, Kin-Ming; English, Jessie M; Radvanyi, Laszlo; Lan, Yan

2017-10-01

Purpose: To determine whether combination therapy with NHS-muIL12 and the anti-programmed death ligand 1 (PD-L1) antibody avelumab can enhance antitumor efficacy in preclinical models relative to monotherapies. Experimental Design: BALB/c mice bearing orthotopic EMT-6 mammary tumors and μMt - mice bearing subcutaneous MC38 tumors were treated with NHS-muIL12, avelumab, or combination therapy; tumor growth and survival were assessed. Tumor recurrence following remission and rechallenge was evaluated in EMT-6 tumor-bearing mice. Immune cell populations within spleen and tumors were evaluated by FACS and IHC. Immune gene expression in tumor tissue was profiled by NanoString® assay and plasma cytokine levels were determined by multiplex cytokine assay. The frequency of tumor antigen-reactive IFNγ-producing CD8 + T cells was evaluated by ELISpot assay. Results: NHS-muIL12 and avelumab combination therapy enhanced antitumor efficacy relative to either monotherapy in both tumor models. Most EMT-6 tumor-bearing mice treated with combination therapy had complete tumor regression. Combination therapy also induced the generation of tumor-specific immune memory, as demonstrated by protection against tumor rechallenge and induction of effector and memory T cells. Combination therapy enhanced cytotoxic NK and CD8 + T-cell proliferation and T-bet expression, whereas NHS-muIL12 monotherapy induced CD8 + T-cell infiltration into the tumor. Combination therapy also enhanced plasma cytokine levels and stimulated expression of a greater number of innate and adaptive immune genes compared with either monotherapy. Conclusions: These data indicate that combination therapy with NHS-muIL12 and avelumab increased antitumor efficacy in preclinical models, and suggest that combining NHS-IL12 and avelumab may be a promising approach to treating patients with solid tumors. Clin Cancer Res; 23(19); 5869-80. ©2017 AACR . ©2017 American Association for Cancer Research.

NHS trust chief executives as heroes?

Science.gov (United States)

Learmonth, M

2001-01-01

This paper presents a reading of the transcripts of interviews with NHS Trust Chief Executives. Using a poststructuralist understanding of the interviews, it privileges a reading that (ironically) represents these Chief Executives as heroes. Following the classic hero story line, they leave the civilized order of home and journey into a threatening wilderness where they encounter dangerous and magical things but overcome them all because of their masculine characteristics such as rationality, strength and resourcefulness. One way in which these stories can be understood to have significance is that they (misleadingly but powerfully) portray management as obvious and necessary by evocatively drawing on a myth of ancient origin. The piece concludes with some reflections on the ontological implications of the analysis and reflexive comments on the production of truth as a problem.

Determination of risk identification process employed by NHS for a PFI hospital project in the UK

Directory of Open Access Journals (Sweden)

F. E. Mohamed Ghazali

2009-12-01

Full Text Available Long-term concession contracts associated with Private Finance Initiative (PFI projects, such as National Health Service (NHS hospitals, are subject to substantial risks, which may not only emerge from project activities such as design and construction, but also from global issues beyond the control of project parties, such as commercial, legal and political risks. Therefore, the principal parties involved must manage risks effectively and efficiently, as early as the project initiation stage, in order to ensure a successful delivery. The aim of this paper is to examine the risk identification process of the NHS PFI hospital in the UK, as a case study, in order to determine the techniques used in risk identification, and their significance, based on estimated probabilities of occurrence. These objectives were achieved through interviews with key personnel within the NHS Trust involved. Results found the sole technique used in risk identification to be brainstorming, through which more than thirty risks were identified and classified under six risk categories: planning, pre-commissioning, design, land purchasing, construction and operation. Thirteen risks were identified as significant based on their estimated probability of occurrence had the project been developed via public procurement. The results of this research will enable public sector clients like the NHS Trust to not only identify the significant risks, which will allow them to focus more attention on developing appropriate mitigation strategies and contingency plans, but also to improve its risk identification process through the use of other techniques in order to support findings from the brainstorming process.

Healthcare reform. Is the NHS ready for US business guru's strategy?

Science.gov (United States)

Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

2006-12-07

The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

Organisational innovation in health services: lessons from the NHS treatment centres

National Research Council Canada - National Science Library

Gabbay, J

2011-01-01

... design and methods References Index 103 133 147 149 155 165 v List of abbreviationsOrganisational innovation in health services List of abbreviations A&E ACAD DH DTC GP G-Supp NHS NIHR PCT PFI SDO SHA TC accident and emergency (department) Ambulatory Care and Diagnostic Centre Department of Health ('the Department') diagnosis and treatment centr...

Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers

Directory of Open Access Journals (Sweden)

van der Meulen Jan

2008-04-01

Full Text Available Abstract Background There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Methods Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres in England during 2006–07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D instrument was assessed either 3-months (day surgery or 6-months (hip/knee after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity. Results Post-operative response rates varied by procedure (73%–88% and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other

A novel small deletion in the NHS gene associated with Nance-Horan syndrome.

Science.gov (United States)

Li, Huajin; Yang, Lizhu; Sun, Zixi; Yuan, Zhisheng; Wu, Shijing; Sui, Ruifang

2018-02-05

Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), and 2 female carriers were heterozygous for the same variant. All 3 affected males presented with typical Nance-Horan syndrome features. One female carrier displayed lens opacities centered on the posterior Y-suture in both eyes, as well as mild dental abnormalities. We recorded the clinical features of a Chinese Nance-Horan syndrome family and broadened the spectrum of mutations in the NHS gene.

Interventions for information systems introduction in the NHS.

Science.gov (United States)

Maguire, Stuart; Ojiako, Udechukwu

2007-12-01

This article provides a historical review of five long-term interventions which were undertaken within the NHS. The objective of the exercise was to examine how information systems (IS) were introduced into operational environments. The length of the interventions ranged from 9 months to almost 3 years. The five sites were all at different stages of system development and the research was carried out using a combination of participant observation and action research. The research question asks, 'How can organizations think about and hence go about their information provision in such a way that successful IS are introduced?'

Immobilization of heparin to EDC/NHS-crosslinked collagen. Characterization and in vitro evaluation

NARCIS (Netherlands)

Wissink, M.J.B.; Beernink, R.; Pieper, J.S.; Poot, Andreas A.; Engbers, G.H.M.; Beugeling, T.; Beugeling, T.; van Aken, W.G.; Feijen, Jan

2001-01-01

In the present study, heparin immobilization to a non-cytotoxic crosslinked collagen substrate for endothelial cell seeding was investigated. Crosslinking of collagen using N-(3-dimethylaminopropyl)-N′-ethylcarbodiimide (EDC) and N-hydroxysuccinimide (NHS) resulted in a material containing 14 free

Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

Science.gov (United States)

Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

2013-11-01

This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Refinement of the X-linked cataract locus (CXN) and gene analysis for CXN and Nance-Horan syndrome (NHS).

Science.gov (United States)

Brooks, Simon; Ebenezer, Neil; Poopalasundaram, Subathra; Maher, Eamonn; Francis, Peter; Moore, Anthony; Hardcastle, Alison

2004-06-01

The X-linked congenital cataract (CXN) locus has been mapped to a 3-cM (approximately 3.5 Mb) interval on chromosome Xp22.13, which is syntenic to the mouse cataract disease locus Xcat and encompasses the recently refined Nance-Horan syndrome (NHS) locus. A positional cloning strategy has been adopted to identify the causative gene. In an attempt to refine the CXN locus, seven microsatellites were analysed within 21 individuals of a CXN family. Haplotypes were reconstructed confirming disease segregation with markers on Xp22.13. In addition, a proximal cross-over was observed between markers S3 and S4, thereby refining the CXN disease interval by approximately 400 Kb to 3.2 Mb, flanked by markers DXS9902 and S4. Two known genes (RAI2 and RBBP7) and a novel gene (TL1) were screened for mutations within an affected male from the CXN family and an NHS family by direct sequencing of coding exons and intron- exon splice sites. No mutations or polymorphisms were identified, therefore excluding them as disease-causative in CXN and NHS. In conclusion, the CXN locus has been successfully refined and excludes PPEF1 as a candidate gene. A further three candidates were excluded based on sequence analysis. Future positional cloning efforts will focus on the region of overlap between CXN, Xcat, and NHS.

An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable?

Science.gov (United States)

Duane, B; Lee, M Berners; White, S; Stancliffe, R; Steinbach, I

2017-10-27

Introduction National Health Service (NHS) England dental teams need to consider from a professional perspective how they can, along with their NHS colleagues, play their part in reducing their carbon emissions and improve the sustainability of the care they deliver. In order to help understand carbon emissions from dental services, Public Health England (PHE) commissioned a calculation and analysis of the carbon footprint of key dental procedures.Methods Secondary data analysis from Business Services Authority (BSA), Health and Social Care Information Centre (HSCIC) (now called NHS Digital, Information Services Division [ISD]), National Association of Specialist Dental Accountants (NASDA) and recent Scottish papers was undertaken using a process-based and environmental input-output analysis using industry established conversion factors.Results The carbon footprint of the NHS dental service is 675 kilotonnes carbon dioxide equivalents (CO2e). Examinations contributed the highest proportion to this footprint (27.1%) followed by scale and polish (13.4%) and amalgam/composite restorations (19.3%). From an emissions perspective, nearly 2/3 (64.5%) of emissions related to travel (staff and patient travel), 19% procurement (the products and services dental clinics buy) and 15.3% related to energy use.Discussion The results are estimates of carbon emissions based on a number of broad assumptions. More research, education and awareness is needed to help dentistry develop low carbon patient pathways.

Mountains

Science.gov (United States)

Regina M. Rochefort; Laurie L. Kurth; Tara W. Carolin; Robert R. Mierendorf; Kimberly Frappier; David L. Steenson

2006-01-01

This chapter concentrates on subalpine parklands and alpine meadows of southern British Columbia, Washington, Oregon, and western Montana. These areas lie on the flanks of several mountain ranges including the Olympics, the Cascades of Oregon and Washington, and the Coast Mountains in British Columbia.

Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.

Science.gov (United States)

Radnor, Zoe; Lovell, Bill

2003-01-01

Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure".

NHS England Patient Online - Patient Access to their Medical Record in General Practice

Directory of Open Access Journals (Sweden)

Jana Dale

2015-10-01

Patient Online can be promoted quickly and successfully when the clear evidence demonstrates it reduces workload. Its implementation will then result in the improved patient care and changes in behaviour necessary for the NHS National Information Board “Personalised Health and Care 2020” Implementation.

Investigating the governance of autonomous public hospitals in England: multi-site case study of NHS foundation trusts.

Science.gov (United States)

Allen, Pauline; Keen, Justin; Wright, John; Dempster, Paul; Townsend, Jean; Hutchings, Andrew; Street, Andrew; Verzulli, Rossella

2012-04-01

To investigate the external and internal governance of NHS foundation trusts (FTs), which have increased autonomy, and local members and governors unlike other NHS trusts. In depth, three-year case studies of four FTs; and analysis of national quantitative data on all FT hospitals and NHS Trust hospitals to give national context. Data included 111 interviews with managers, clinicians, governors and members, and local purchasers; observation of meetings; and analysis of FTs' documents. The four case study FTs were similar to other FTs. They had used their increased autonomy to develop more business-like practices. The FT regulator, Monitor, intervened only when there were reported problems in FT performance. National targets applying to the NHS also had a large effect on FT behaviour. FTs saw themselves as part of the local health economy and tried to maintain good relationships with local organisations. Relationships between governors and the FTs' executives were still developing, and not all governors felt able to hold their FT to account. The skills and experience of staff members and governors were under-used in the new governance structures. It is easier to increase autonomy for public hospitals than to increase local accountability. Hospital managers are likely to be interested in making decisions with less central government control, whilst mechanisms for local accountability are notoriously difficult to design and operate. Further consideration of internal governance of FTs is needed. In a deteriorating financial climate, FTs should be better placed to make savings, due to their more business-like practices.

Efficiency in pathology laboratories: a survey of operations management in NHS bacteriology.

Science.gov (United States)

Szczepura, A K

1991-01-01

In recent years pathology laboratory services in the U.K. have experienced large increases in demand. But the extent to which U.K. laboratories have introduced controls to limit unnecessary procedures within the laboratory was previously unclear. This paper presents the results of a survey of all 343 NHS bacteriology laboratories which records the extent to which such operations management controls are now in place. The survey shows large differences between laboratories. Quality controls over inputs, the use of screening tests as a culture substitute, the use of direct susceptibility testing, controls over routine antibiotic susceptibility testing, and controls over reporting of results all vary widely. The survey also records the prevalence of hospital antibiotic policies, the extent to which laboratories produce antibiograms for user clinicians, the degree of computerisation in data handling, and the degree of automation in processing specimens. Finally, the survey uncovers a large variation between NHS labs in the percentage of bacteriology samples which prove positive and lead to antibiotic susceptibility tests being carried out.

Private patients in NHS hospitals: comparison of two sources of information.

Science.gov (United States)

Williams, B T; Pearson, J

1999-03-01

The use of National Health Service (NHS) hospitals to treat private patients is debatable on the grounds of equity of access. Hospital Episodes Statistics (HES) annual reports are the only routine source of information on the scale of this activity. The accuracy of the information is doubted. This enquiry tested the completeness of HES data against information obtained directly from private patient unit managers. Managers of the 71 pay bed units in NHS hospitals in England were asked to supply from local registers and accounts the numbers of in-patients and day cases admitted in 1995-1996. Their reports were matched with the numbers of first consultant episodes for private in-patients and day cases shown for those hospitals in the HES data file for that year. Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62,572 against 54,131; 13 per cent more in-patient admissions, 39,776 against 35,319; and 21 per cent more day cases, 22,796 against 18,812. More total admissions were reported by managers of 38 pay bed units than were recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases. Reasons for the under-reporting of private patients in HES included the use of separate patient administration systems for private patients with a failure to feed data to HES, and the omission of some provider units altogether by a minority of trusts from the returns made to the Department of Health. Overall, HES underestimates the amount of private patient activity reported directly by NHS hospitals. No method of validating private patient data is currently available. An amendment to an existing statistical return would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by

Paternity leave experiences of NHS doctors.

Science.gov (United States)

Gordon, Hannah; Szram, Joanna

2013-10-01

This study assesses NHS doctors' experiences of paternity leave and evaluates whether practices have changed since the introduction of additional paternity leave (APL) in April 2011. An anonymised online survey designed to discover experiences and uptake of APL and ordinary paternity leave (OPL) was distributed to all members of the London Deanery Synapse® network. In total, 364 fathers responded. Their seniority ranged from foundation trainees to consultants. Following the formal introduction of OPL in 2003, the number of fathers taking any paternity leave increased (from 50% to 95.6%). The majority of respondents (76.7%) felt well supported by their employer. Since the introduction of APL, 3% of respondents took additional leave. Reasons for the low uptake of APL included the impracticalities of the law, poor awareness and perceived attitudes and implications for training. Problems with OPL included the inadequate provision of cover and difficulties in timing the leave appropriately.

Recent population trends of mountain goats in the Olympic Mountains, Washington

Science.gov (United States)

Jenkins, Kurt J.; Happe, Patricia J.; Beirne, Katherine F.; Hoffman, Roger A.; Griffin, Paul C.; Baccus, William T.; Fieberg, John

2012-01-01

Mountain goats (Oreamnos americanus) were introduced in Washington's Olympic Mountains during the 1920s. The population subsequently increased in numbers and expanded in range, leading to concerns by the 1970s over the potential effects of non-native mountain goats on high-elevation plant communities in Olympic National Park. The National Park Service (NPS) transplanted mountain goats from the Olympic Mountains to other ranges between 1981 and 1989 as a means to manage overabundant populations, and began monitoring population trends of mountain goats in 1983. We estimated population abundance of mountain goats during 18–25 July 2011, the sixth survey of the time series, to assess current population status and responses of the population to past management. We surveyed 39 sample units, comprising 39% of the 59,615-ha survey area. We estimated a population of 344 ± 72 (90% confidence interval [CI]) mountain goats in the survey area. Retrospective analysis of the 2004 survey, accounting for differences in survey area boundaries and methods of estimating aerial detection biases, indicated that the population increased at an average annual rate of 4.9% since the last survey. That is the first population growth observed since the cessation of population control measures in 1990. We postulate that differences in population trends observed in western, eastern, and southern sections of the survey zone reflected, in part, a variable influence of climate change across the precipitation gradient in the Olympic Mountains.

Developing leadership interventions for black and minority ethnic staff: A case study of the National Health Service (NHS) in the U.K.

Science.gov (United States)

Kalra, V S; Abel, P; Esmail, A

2009-01-01

The National Health Service (NHS) is the largest employer in the U.K. but, despite decades of equal opportunities legislation, its senior management workforce does not reflect the diversity of either the wider NHS workforce or the U.K. population. The aim of the paper is to consider the range of management interventions available to organisations like the NHS to deliver change in the area of promotion of Black and minority ethnic staff. Intervention programmes in a range of public and private organisations are reviewed and the nature of barriers to promotion and the range of interventions to overcome these are explored. The paper uses the paradigm of institutional racism to examine the ways in which the NHS discriminates against certain sections of its workforce. The methods used include a literature review combined with key stakeholder interviews. A comparative dimension which involved a review of research on leadership initiatives in the U.S.A. was also undertaken. The literature review found that there were a range of initiatives which could be implemented by public organisations such as the NHS to increase the presence of Black and Minority Ethnic (BME) staff in senior management positions. Most of these interventions were largely focused on the individual. Much more progress on institutional or organisational change needed to be made before the NHS could be perceived as a model employer in this area. The literature review also indicated that there is little published research on such initiatives within other European Union countries. The paper is targeted at both policy makers and human resource officers responsible for equality and diversity issues within large organisations, who have a remit to improve the career pathways of staff. The analysis provided offers a set of critical tools and interventions that have not hitherto been well examined in the U.K. context.

Mortality in NHS Greater Glasgow and Clyde employees: 2007-2009.

Science.gov (United States)

Freer, K; Waclawski, E

2013-09-01

Just over a fifth of all deaths in Scotland occur in those under the age of 65. This study examined deaths in service in employees of the National Health Service Greater Glasgow and Clyde (NHS GG&C) Health Board over a 3-year period. To assess crude death rates by occupational group, the main causes of death and evidence of causes that could have been prevented or modified by lifestyle changes. Demographic details, occupational grouping and death certificate data were obtained for all NHS GG&C employees who died in service between 2007 and 2009. A total of 138 employees died in this period. The occupational groups in which most deaths occurred were support services (porters, domestic and catering staff; 35%) and nurses (34%). The commonest causes of death were lung cancer (15%), ischaemic heart disease (9%) and suicide (9%). The overall crude death rate was 1.2/1000 persons/year (females 1.0 and males 1.7) and was highest among support services employees (2.4) and lowest among medical staff (0.5). The relative risk of death in support services was significantly greater than the majority of occupational groups. These findings suggest health inequality within this workforce. The main causes of death identified in the support services group could potentially be modified through workplace risk factor screening and health promotion.

Advances in global mountain geomorphology

Science.gov (United States)

Slaymaker, Olav; Embleton-Hamann, Christine

2018-05-01

Three themes in global mountain geomorphology have been defined and reinforced over the past decade: (a) new ways of measuring, sensing, and analyzing mountain morphology; (b) a new emphasis on disconnectivity in mountain geomorphology; and (c) the emergence of concerns about the increasing influence of anthropogenic disturbance of the mountain geomorphic environment, especially in intertropical mountains where population densities are higher than in any other mountain region. Anthropogenically induced hydroclimate change increases geomorphic hazards and risks but also provides new opportunities for mountain landscape enhancement. Each theme is considered with respect to the distinctiveness of mountain geomorphology and in relation to important advances in research over the past decade. The traditional reliance on the high energy condition to define mountain geomorphology seems less important than the presence of unique mountain landforms and landscapes and the distinctive ways in which human activity and anthropogenically induced hydroclimate change are transforming mountain landscapes.

Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

Directory of Open Access Journals (Sweden)

McEwen Andy

2010-07-01

Full Text Available Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate. Of these, 58.3% (n = 56 ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%, group (73%, and individual (54%. Just under half (48%, n = 27 offered nicotine replacement therapy (NRT, 21.4% (n = 12 bupropion; 19.6% (n = 11 varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22 believed that the government focus on four-week quit rates, and 42.9% (14 services believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings

Science.gov (United States)

Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

2012-01-01

The recent turmoil within the banking sector has led to the development of the most significant recession since the “great depression” of the 1930s. Although the coalition government has promised to “guarantee that health spending increases in real terms in each year of Parliament”, this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

Enhanced invitation methods to increase uptake of NHS health checks: study protocol for a randomized controlled trial.

Science.gov (United States)

Forster, Alice S; Burgess, Caroline; McDermott, Lisa; Wright, Alison J; Dodhia, Hiten; Conner, Mark; Miller, Jane; Rudisill, Caroline; Cornelius, Victoria; Gulliford, Martin C

2014-08-30

NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated. The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods, using the Question-Behaviour Effect (QBE), will increase uptake of NHS Health Checks compared with a standard invitation. Participants comprise individuals eligible for an NHS Health Check registered in two London boroughs. Participants are randomized into one of three arms. Group A receives the standard NHS Health Check invitation letter, information sheet, and reminder letter at 12 weeks for nonattenders. Group B receives a QBE questionnaire 1 week before receiving the standard invitation, information sheet, and reminder letter where appropriate. Group C is the same as Group B, but participants are offered a £5 retail voucher if they return the questionnaire. Participants are randomized in equal proportions, stratified by general practice. The primary outcome is uptake of NHS Health Checks 6 months after invitation from electronic health records. We will estimate the incremental health service cost per additional completed Health Check for trial groups B and C versus trial arm A, as well as evaluating the impact of the QBE questionnaire, and questionnaire plus voucher, on the socioeconomic inequality in uptake of Health Checks.The trial includes a nested comparison of two methods for implementing allocation, one implemented manually at general practices and the other implemented automatically through the information systems used to generate invitations for the Health Check. The research will provide evidence on whether asking individuals to complete a preliminary questionnaire, by using the QBE, is effective

Is overseas volunteering beneficial to the NHS? The analysis of volunteers' responses to a feedback questionnaire following experiences in low-income and middle-income countries.

Science.gov (United States)

Yeomans, Daniel; Le, Grace; Pandit, Hemant; Lavy, Chris

2017-10-16

Locally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas. 88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF. 85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the 'working with others' domain. There is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers' essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers' continued professional development. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless

Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries

Science.gov (United States)

Yeomans, Daniel; Le, Grace; Pandit, Hemant; Lavy, Chris

2017-01-01

Introduction Locally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas. Methods 88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF. Results 85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the ‘working with others’ domain. Discussion There is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers’ essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers’ continued professional development. PMID:29042388

Liberating the NHS; commissioning, outsourcing and a new politics debate.

Science.gov (United States)

Regan, Paul; Ball, Elaine

2010-10-01

In the short months following the result of the UK 2010 General election, a new Government White Paper has been released entitled: Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010a). It strives to distance itself from previous health-care proposals (DH, 2009), yet if the initiatives of this latest paper are combined against previous initiatives, also using high impact declarative terms, such as competition and choice, it is clear that little has changed and more important principles than saving money are at risk.

Mountain goat abundance and population trends in the Olympic Mountains, Washington, 2011

Science.gov (United States)

Jenkins, Kurt; Happe, Patricia; Griffin, Paul C.; Beirne, Katherine; Hoffman, Roger; Baccus, William

2011-01-01

We conducted an aerial helicopter survey between July 18 and July 25, 2011, to estimate abundance and trends of introduced mountain goats (Oreamnos americanus) in the Olympic Mountains. The survey was the first since we developed a sightability correction model in 2008, which provided the means to estimate the number of mountain goats present in the surveyed areas and not seen during the aerial surveys, and to adjust for undercounting biases. Additionally, the count was the first since recent telemetry studies revealed that the previously defined survey zone, which was delineated at lower elevations by the 1,520-meter elevation contour, did not encompass all lands used by mountain goats during summer. We redefined the lower elevation boundary of survey units before conducting the 2011 surveys in an effort to more accurately estimate the entire mountain goat population. We surveyed 39 survey units, comprising 39 percent of the 59,615-hectare survey area. We estimated a mountain goat population of 344±44 (standard error, SE) in the expanded survey area. Based on this level of estimation uncertainty, the 95-percent confidence interval ranged from 258 to 430 mountain goats at the time of the survey. To permit comparisons of mountain goat populations between the 2004 and 2011 surveys, we recomputed population estimates derived from the 2004 survey using the newly developed bias correction methods, and we computed the 2004 and 2011 surveys based on comparable survey zone definitions (for example, using the boundaries of the 2004 survey). The recomputed estimates of mountain goat populations were 217±19 (SE) in 2004 and 303±41(SE) in 2011. The difference between the current 2011 population estimate (344±44[SE]) and the recomputed 2011 estimate (303±41[SE]) reflects the number of mountain goats counted in the expanded lower elevation portions of the survey zone added in 2011. We conclude that the population of mountain goats has increased in the Olympic Mountains at

Truncating mutation in the NHS gene: phenotypic heterogeneity of Nance-Horan syndrome in an asian Indian family.

Science.gov (United States)

Ramprasad, Vedam Lakshmi; Thool, Alka; Murugan, Sakthivel; Nancarrow, Derek; Vyas, Prateep; Rao, Srinivas Kamalakar; Vidhya, Authiappan; Ravishankar, Krishnamoorthy; Kumaramanickavel, Govindasamy

2005-01-01

A four-generation family containing eight affected males who inherited X-linked developmental lens opacity and microcornea was studied. Some members in the family had mild to moderate nonocular clinical features suggestive of Nance-Horan syndrome. The purpose of the study was to map genetically the gene in the large 57-live-member Asian-Indian pedigree. PCR-based genotyping was performed on the X-chromosome, by using fluorescent microsatellite markers (10-cM intervals). Parametric linkage analysis was performed by using two disease models, assuming either recessive or dominant X-linked transmission by the MLINK/ILINK and FASTLINK (version 4.1P) programs (http:www.hgmp.mrc.ac.uk/; provided in the public domain by the Human Genome Mapping Project Resources Centre, Cambridge, UK). The NHS gene at the linked region was screened for mutation. By fine mapping, the disease gene was localized to Xp22.13. Multipoint analysis placed the peak LOD of 4.46 at DSX987. The NHS gene mapped to this region. Mutational screening in all the affected males and carrier females (heterozygous form) revealed a truncating mutation 115C-->T in exon 1, resulting in conversion of glutamine to stop codon (Q39X), but was not observed in unaffected individuals and control subjects. conclusions. A family with X-linked Nance-Horan syndrome had severe ocular, but mild to moderate nonocular, features. The clinical phenotype of the truncating mutation (Q39X) in the NHS gene suggests allelic heterogeneity at the NHS locus or the presence of modifier genes. X-linked families with cataract should be carefully examined for both ocular and nonocular features, to exclude Nance-Horan syndrome. RT-PCR analysis did not suggest nonsense-mediated mRNA decay as the possible mechanism for clinical heterogeneity.

The NHS: assessing new technologies, NICE and value for money.

Science.gov (United States)

Stevens, A; Chalkidou, K; Littlejohns, P

2011-06-01

The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. In healthcare, most advanced countries favour the last of the three. This is for three reasons: distribution (not only are the poor less able to pay for sickness, but sickness exacerbates poverty), information (markets operate poorly when providers can easily outsmart customers) and externalities (it is in the interest of everyone that infectious diseases and the other knock-on consequences of ill health are ameliorated). So in the UK, the state, with a good deal of cross-party consensus, directs most of health service supply. This system has become more complex over the decades since the formation of the NHS in 1948. A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy.

Transforming dementia care in an NHS trust.

Science.gov (United States)

Robinson, Jennifer; Longden, Jane; Murphy, Jayne

2015-02-01

Walsall Healthcare NHS Trust was one of nine trusts selected to take part in the RCN development programme transforming dementia care in hospitals during 2013. The programme aimed to improve the experience of care for people with dementia and their carers in hospital. This article outlines a two-day training programme delivered to staff on two pilot wards with a larger cohort of adults with dementia than other wards in Manor Hospital. A range of staff were trained including nurses, clinical support workers and allied health professionals and also, in a bespoke format, housekeepers, porters and security staff. The programme has led to a noticeable cultural change and significantly improved care and management of patients with cognitive impairment and/or dementia on the two pilot wards. As a result, the training programme has been implemented more widely across the hospital.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

OpenAIRE

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern...

Identification of a novel NHS mutation in a Chinese family with Nance-Horan syndrome.

Science.gov (United States)

Li, Aijun; Li, Bingzhen; Wu, Lemeng; Yang, Liping; Chen, Ningning; Ma, Zhizhong

2015-04-01

To identiy the disease causing mutation in a Chinese family presenting with early-onset cataract and dental anomalies. A specific Hereditary Eye Disease Enrichment Panel (HEDEP) (personalized customization by MyGenostics, Baltimore, MD) based on targeted exome capture technology was used to collect the protein coding regions of 30 early-onset cataract associated genes, and high throughput sequencing was done with Illumina HiSeq 2000 platform. The identified variant was confirmed with Sanger sequencing. A novel deletion in exon 4 (c.852delG) of NHS gene was identified; the identified 1 bp deletion altered the reading frame and was predicted to result in a premature stop codon after the addition of twelve novel amino acid (p.S285PfsX13). This mutation co-segregated in affected males and obligate female carriers, but was absent in 100 matched controls. Our findings broaden the spectrum of NHS mutations causing Nance-Horan syndrome and phenotypic spectrum of the disease in Chinese patients.

The mutuality metaphor: understanding healthcare provision in NHS Scotland.

Science.gov (United States)

Howieson, Brian

2016-06-20

Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding.

Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review.

Science.gov (United States)

Mills, Katie; Harte, Emma; Martin, Adam; MacLure, Calum; Griffin, Simon J; Mant, Jonathan; Meads, Catherine; Saunders, Catherine L; Walter, Fiona M; Usher-Smith, Juliet A

2017-11-15

To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice. A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data. An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers. Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice. Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues. The success of the NHS Health Check Programme relies on engagement by those responsible for its

Creating an impersonal NHS? Personalization, choice and the erosion of intimacy.

Science.gov (United States)

Owens, John

2015-02-01

Personalization - most often understood in terms of granting patients greater opportunity to participate in, and make choices about, the services they receive - has become a key principle guiding reform of the English NHS. This study sets out to explore the relationship between two senses of the term 'personal' within the context of personalization. Firstly, much of the policy literature equates a 'personal' service with one that is responsive to the choices of individual patients. Secondly, the term 'personal' can be thought to refer to the intimate relationships between patients and medical professionals that have typified traditional models of good practice. I combine a review of the relevant academic and policy literature on personalization with a process of conceptual analysis to uncover three arguments, which suggest that personalization based on choice may adversely affect standards of care by eroding the qualities of intimacy at the heart of the care process. Thus, an unintended consequence of the drive for personalization may be the creation of an NHS that is, in an important sense, less personal than it once was. Whilst personalization may deliver many potential benefits, the tension between promoting patient choice and retaining intimate professional-patient relationships ought to be taken seriously. Thus, the task of promoting choice whilst retaining intimacy represents a key policy challenge for advocates of personalization. © 2012 John Wiley & Sons Ltd.

Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

Science.gov (United States)

Wilkinson, G

1986-01-01

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

Annual Copper Mountain Conferences on Multigrid and Iterative Methods, Copper Mountain, Colorado

International Nuclear Information System (INIS)

McCormick, Stephen F.

2016-01-01

This project supported the Copper Mountain Conference on Multigrid and Iterative Methods, held from 2007 to 2015, at Copper Mountain, Colorado. The subject of the Copper Mountain Conference Series alternated between Multigrid Methods in odd-numbered years and Iterative Methods in even-numbered years. Begun in 1983, the Series represents an important forum for the exchange of ideas in these two closely related fields. This report describes the Copper Mountain Conference on Multigrid and Iterative Methods, 2007-2015. Information on the conference series is available at http://grandmaster.colorado.edu/~copper/

Annual Copper Mountain Conferences on Multigrid and Iterative Methods, Copper Mountain, Colorado

Energy Technology Data Exchange (ETDEWEB)

McCormick, Stephen F. [Front Range Scientific, Inc., Lake City, CO (United States)

2016-03-25

This project supported the Copper Mountain Conference on Multigrid and Iterative Methods, held from 2007 to 2015, at Copper Mountain, Colorado. The subject of the Copper Mountain Conference Series alternated between Multigrid Methods in odd-numbered years and Iterative Methods in even-numbered years. Begun in 1983, the Series represents an important forum for the exchange of ideas in these two closely related fields. This report describes the Copper Mountain Conference on Multigrid and Iterative Methods, 2007-2015. Information on the conference series is available at http://grandmaster.colorado.edu/~copper/.

Reconnaissance and economic geology of Copper Mountain metamorphic complex, Owl Creek Mountains, Wyoming

International Nuclear Information System (INIS)

Hausel, W.D.

1983-01-01

The Copper Mountain metamorphic complex lies within a westerly trending belt of Precambrian exposures known as the Owl Creek Mountains uplift. The metamorphic complex at Copper Mountain is part of a larger complex known as the Owl Creek Mountains greenstone belt. Until more detailed mapping and petrographic studies can be completed, the Copper Mountain area is best referred to as a complex, even though it has some characteristics of a greestone belt. At least three episodes of Precambrian deformation have affected the supracrustals, and two have disturbed the granites. The final Precambrian deformation event was preceded by a weak thermal event expressed by retrogressive metamorphism and restricted metasomatic alteration. During this event, a second phase of pegmatization was accompanied by hydrothermal solutions. During the Laramide orogeny, Copper Mountain was again modified by deformation. Laramide deformation produced complex gravity faults and keystone grabens. Uranium deposits were formed following major Laramide deformation. The genesis of these deposits is attributable to either the leaching of granites or the leaching of overlying tuffaceous sediments during the Tertiary. Production of metals and industrial minerals has been limited, although some gold, copper, silver, tungsten, beryl, feldspar, and lithium ore have been shipped from Copper Mountain. A large amount of uranium was produced from the Copper Mountain district in the 1950s

Attendance at NHS mandatory training sessions.

Science.gov (United States)

Brand, Darren

2015-02-17

To identify factors that affect NHS healthcare professionals' attendance at mandatory training sessions. A quantitative approach was used, with a questionnaire sent to 400 randomly selected participants. A total of 122 responses were received, providing a mix of qualitative and quantitative data. Quantitative data were analysed using statistical methods. Open-ended responses were reviewed using thematic analysis. Clinical staff value mandatory training sessions highly. They are aware of the requirement to keep practice up-to-date and ensure patient safety remains a priority. However, changes to the delivery format of mandatory training sessions are required to enable staff to participate more easily, as staff are often unable to attend. The delivery of mandatory training should move from classroom-based sessions into the clinical area to maximise participation. Delivery should be assisted by local 'experts' who are able to customise course content to meet local requirements and the requirements of different staff groups. Improved arrangements to provide staff cover, for those attending training, would enable more staff to attend training sessions.

A case study into labour turnover within an NHS Trust.

Science.gov (United States)

Bamford, David; Hall, Catherine

2007-02-01

This paper investigates turnover in a British NHS Trust, to find out why staff left and whether factors identified in the literature with regards to improving turnover were pertinent to the organization. The research also investigated staff groups with high turnover--staff with less than 12 months service, and the unqualified nursing staff group--to ascertain whether there were any reasons for leaving or areas of dissatisfaction particular to these groups. The outcomes of the research complied with much of the published research with some interesting differences. The main reasons for leaving were identified as moving house, promotion or career development and taking up education and training opportunities elsewhere. There was no evidence of 'level of pay', commonly given as a significant influence behind turnover, as a reason for leaving. It was also found that the retention strategies identified in the published research were mainly applicable to the research, with evidence to support the improvement of line management skills, training and development, career development, appraisal, communications and induction in order to reduce turnover. There was less evidence for introducing work-life balance policies, improving communications, pay and working relationships as retention strategies. Recommendations for future management of labour turnover within the NHS Trust and elsewhere are made, with observations about the validity of some existing models. The core contribution of this research is in adding to the body of knowledge about labour turnover issues. This is of value to those working in the UK health-care and wider public sector. Specific recommendations for future research are made.

A cross-sectional study of all clinicians' conflict of interest disclosures to NHS hospital employers in England 2015-2016.

Science.gov (United States)

Feldman, Harriet Ruth; DeVito, Nicholas J; Mendel, Jonathan; Carroll, David E; Goldacre, Ben

2018-03-05

We set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees. Cross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers. NHS Trusts (secondary/tertiary care organisations) in England. 236 Trusts were contacted, of which 217 responded. We assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency. 185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria. Overall, recording of employees' conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees' conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and

Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.

Science.gov (United States)

Pinder, Richard J; Greaves, Felix E; Aylin, Paul P; Jarman, Brian; Bottle, Alex

2013-07-01

There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England. Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups. Over 60 000 respondents from 147 NHS trusts were included in the analysis. There was a weak negative correlation with HSMR where staff agreed that patient care was their trust's top priority (Kendall τ = -0.22, psatisfaction with the quality of care delivered by oneself and institutional HSMR. In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.

Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

Science.gov (United States)

Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

2015-01-01

Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential

Master of science in medical leadership and management and its role in the current NHS.

Science.gov (United States)

Barratt, Shaney; Bateman, Kathryn; Harvey, John

2010-10-01

Traditionally there has been little formal leadership and management education in the core medical curriculum. The Department of Health has recently emphasised the development of clinical leadership within the NHS. In this article, trainees share their experience of the Master of Science in medical leadership and management postgraduate qualification.

Introduction into the NHS of magnetic sphincter augmentation: an innovative surgical therapy for reflux - results and challenges.

Science.gov (United States)

Prakash, D; Campbell, B; Wajed, S

2018-04-01

Introduction Gastro-oesophageal reflux disease (GORD) is a common, chronic debilitating condition. Surgical management traditionally involves fundoplication. Magnetic sphincter augmentation (MSA) is a new definitive treatment. We describe our experience of introducing this innovative therapy into NHS practice and report the early clinical outcomes. Methods MSA was introduced into NHS practice following successful acceptance of a cost-effective business plan and close observation of National Institute for Health and Care Excellence (NICE) recommendations for new procedures, including a carefully planned prospective data collection over a two-year follow-up period. Results Forty-seven patients underwent MSA over the 40-month period. Reflux health-related quality of life (GERD-HRQL) was significantly improved after the procedure and maintained at one- and two-year (P business plan and compliance with NICE recommendations.

YUCCA MOUNTAIN SITE DESCRIPTION

International Nuclear Information System (INIS)

Simmons, A.M.

2004-01-01

The ''Yucca Mountain Site Description'' summarizes, in a single document, the current state of knowledge and understanding of the natural system at Yucca Mountain. It describes the geology; geochemistry; past, present, and projected future climate; regional hydrologic system; and flow and transport within the unsaturated and saturated zones at the site. In addition, it discusses factors affecting radionuclide transport, the effect of thermal loading on the natural system, and tectonic hazards. The ''Yucca Mountain Site Description'' is broad in nature. It summarizes investigations carried out as part of the Yucca Mountain Project since 1988, but it also includes work done at the site in earlier years, as well as studies performed by others. The document has been prepared under the Office of Civilian Radioactive Waste Management quality assurance program for the Yucca Mountain Project. Yucca Mountain is located in Nye County in southern Nevada. The site lies in the north-central part of the Basin and Range physiographic province, within the northernmost subprovince commonly referred to as the Great Basin. The basin and range physiography reflects the extensional tectonic regime that has affected the region during the middle and late Cenozoic Era. Yucca Mountain was initially selected for characterization, in part, because of its thick unsaturated zone, its arid to semiarid climate, and the existence of a rock type that would support excavation of stable openings. In 1987, the United States Congress directed that Yucca Mountain be the only site characterized to evaluate its suitability for development of a geologic repository for high-level radioactive waste and spent nuclear fuel

Human impacts to mountain streams

Science.gov (United States)

Wohl, Ellen

2006-09-01

Mountain streams are here defined as channel networks within mountainous regions of the world. This definition encompasses tremendous diversity of physical and biological conditions, as well as history of land use. Human effects on mountain streams may result from activities undertaken within the stream channel that directly alter channel geometry, the dynamics of water and sediment movement, contaminants in the stream, or aquatic and riparian communities. Examples include channelization, construction of grade-control structures or check dams, removal of beavers, and placer mining. Human effects can also result from activities within the watershed that indirectly affect streams by altering the movement of water, sediment, and contaminants into the channel. Deforestation, cropping, grazing, land drainage, and urbanization are among the land uses that indirectly alter stream processes. An overview of the relative intensity of human impacts to mountain streams is provided by a table summarizing human effects on each of the major mountainous regions with respect to five categories: flow regulation, biotic integrity, water pollution, channel alteration, and land use. This table indicates that very few mountains have streams not at least moderately affected by land use. The least affected mountainous regions are those at very high or very low latitudes, although our scientific ignorance of conditions in low-latitude mountains in particular means that streams in these mountains might be more altered than is widely recognized. Four case studies from northern Sweden (arctic region), Colorado Front Range (semiarid temperate region), Swiss Alps (humid temperate region), and Papua New Guinea (humid tropics) are also used to explore in detail the history and effects on rivers of human activities in mountainous regions. The overview and case studies indicate that mountain streams must be managed with particular attention to upstream/downstream connections, hillslope

How does the outcome of research training fellowships funded via the NHS compare with that from competitively funded fellowships from the MRC and other charities: a cross-sectional retrospective survey of trainees undertaking research training in the West Midlands.

Science.gov (United States)

Maybury, Charlotte; Morgan, Matthew David; Smith, Russell; Harper, Lorraine

2018-01-23

This study aimed to investigate the impact of research training funded via the National Health Service (NHS) on medical trainees compared with traditional clinical research training fellowships (CRTFs). Online survey of 221 clinical trainees who had completed a period of research during their clinical training between 2009 and 2015 in the West Midlands. Research outcomes. Overall response rate was 59%, of whom 72 participants were funded by CRTFs and 51 funded by the NHS. Although participants with CRTFs were more likely to be awarded a higher degree compared with those on NHS-administered funding (66/72 CRTFs and 37/51 NHS, P=0.005), similar proportions of NHS-funded and CRTF-funded participants entered clinical lecturer posts on completing initial research training (8/51 NHS and 16/72 CRTF, P=0.37). 77% of participants had three or more publications (CRTF 57 and NHS 39, P=0.72). 57 participants had completed clinical training; similar proportions of CRTF-funded and NHS-funded trainees had research included in their consultant contract (12/22 NHS and 14/26 CRTF, P=0.96) or were appointed to academic posts (3 of 25 NHS funded and 6 of 32 CRTF, P>0.05). 95% of participants would recommend to colleagues and 82% of participants felt the research experience improved their provision of clinical care with no difference between CRTF-funded and NHS-funded participants (P=0.49). Continuing to participate in clinical work during the research reduced reports of trainee difficulty on returning to clinical work (23/108 continued clinical work vs 12/22 no clinical work, P=0.001). Research training funded by the NHS provides a quality experience and contributes to the clinical academic capacity within the UK. More needs to be done to support NHS participants to successfully achieve a higher degree. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly

Healthcare scandals in the NHS: crime and punishment.

Science.gov (United States)

Alghrani, Amel; Brazier, Margaret; Farrell, Anne-Maree; Griffiths, Danielle; Allen, Neil

2011-04-01

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of 'shocking' systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

YUCCA MOUNTAIN SITE DESCRIPTION

Energy Technology Data Exchange (ETDEWEB)

A.M. Simmons

2004-04-16

The ''Yucca Mountain Site Description'' summarizes, in a single document, the current state of knowledge and understanding of the natural system at Yucca Mountain. It describes the geology; geochemistry; past, present, and projected future climate; regional hydrologic system; and flow and transport within the unsaturated and saturated zones at the site. In addition, it discusses factors affecting radionuclide transport, the effect of thermal loading on the natural system, and tectonic hazards. The ''Yucca Mountain Site Description'' is broad in nature. It summarizes investigations carried out as part of the Yucca Mountain Project since 1988, but it also includes work done at the site in earlier years, as well as studies performed by others. The document has been prepared under the Office of Civilian Radioactive Waste Management quality assurance program for the Yucca Mountain Project. Yucca Mountain is located in Nye County in southern Nevada. The site lies in the north-central part of the Basin and Range physiographic province, within the northernmost subprovince commonly referred to as the Great Basin. The basin and range physiography reflects the extensional tectonic regime that has affected the region during the middle and late Cenozoic Era. Yucca Mountain was initially selected for characterization, in part, because of its thick unsaturated zone, its arid to semiarid climate, and the existence of a rock type that would support excavation of stable openings. In 1987, the United States Congress directed that Yucca Mountain be the only site characterized to evaluate its suitability for development of a geologic repository for high-level radioactive waste and spent nuclear fuel.

MOUNTAIN TOURISM INTERCONNECTIONS. VARIATION OF MOUNTAIN TOURIST FLOW IN SUCEAVA COUNTY

Directory of Open Access Journals (Sweden)

George CHEIA

2013-12-01

Full Text Available Mountain tourism, in addition to one of the most common types of tourism, is generated by a complex of factors and at the same time, triggers a series of processes involving tourism phenomenon, especially the environment where it is taking place. This paper aims to discuss some of these causal factors, and the relationship between this type of tourism and the tourist area itself (1. By using SPSS analytical methods , it can be practically demonstrated the impact of mountain tourist flow in spas (2 and mountain resorts (3 in Suceava county.

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs.

Science.gov (United States)

Scarborough, Peter; Bhatnagar, Prachi; Wickramasinghe, Kremlin K; Allender, Steve; Foster, Charlie; Rayner, Mike

2011-12-01

Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93. Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07. In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion. The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Doing transformational change in the English NHS in the context of "big bang" redisorganisation.

Science.gov (United States)

Hunter, David J; Erskine, Jonathan; Small, Adrian; McGovern, Tom; Hicks, Chris; Whitty, Paula; Lugsden, Edward

2015-01-01

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very

Artificial Intelligence Techniques to Optimize the EDC/NHS-Mediated Immobilization of Cellulase on Eudragit L-100

Directory of Open Access Journals (Sweden)

Min-Chao He

2012-06-01

Full Text Available Two artificial intelligence techniques, namely artificial neural network (ANN and genetic algorithm (GA were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl carbodiimide (EDC concentration, N-hydroxysuccinimide (NHS concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R² = 0.99. Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful.

One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process.

Science.gov (United States)

Thompson, Andrew G H; France, Emma F

2010-05-13

Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland), which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes. We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia. Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale. If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for gaining research governance approval need improvement. Attention is

Towards Religious/Spiritual Competence for Applied Psychologists in NHS Settings in the UK

OpenAIRE

Koce, Precious

2013-01-01

The profession of psychology in the UK is gradually showing signs of renewed interest in the area of religion/spirituality (e.g., Collicut, 2011). The present study aimed to (i) explore applied psychologists‟ accounts of their practice in the NHS, UK, with clients with religious/spiritual issues; and (ii) from these accounts identify participants‟ indications of religious/spiritual competencies. Thematic analysis as outlined by Braun and Clarke (2006) was employed and subscribed to a critical...

Human trafficking and health: a cross-sectional survey of NHS professionals' contact with victims of human trafficking.

Science.gov (United States)

Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

2015-08-20

(1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals' knowledge and confidence to respond to human trafficking. A cross-sectional survey. Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. NHS professionals working in secondary care are in contact with potential victims of human trafficking, but lack knowledge and confidence in

Clinical audit of core podiatry treatment in the NHS.

Science.gov (United States)

Farndon, Lisa; Barnes, Andrew; Littlewood, Keith; Harle, Justine; Beecroft, Craig; Burnside, Jaclyn; Wheeler, Tracey; Morris, Selwyn; Walters, Stephen J

2009-03-13

Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. 1047 patients completed both questionnaires, with an age range from 26-95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories - better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the evidence base for podiatry.

Clinical audit of core podiatry treatment in the NHS

Directory of Open Access Journals (Sweden)

Burnside Jaclyn

2009-03-01

Full Text Available Abstract Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the

YUCCA MOUNTAIN PROJECT - A BRIEFING -

International Nuclear Information System (INIS)

2003-01-01

This report has the following articles: Nuclear waste--a long-term national problem; Spent nuclear fuel; High-level radioactive waste; Radioactivity and the environment; Current storage methods; Disposal options; U.S. policy on nuclear waste; The focus on Yucca Mountain; The purpose and scope of the Yucca Mountain Project; The approach for permanently disposing of waste; The scientific studies at Yucca Mountain; The proposed design for a repository at Yucca Mountain; Natural and engineered barriers would work together to isolate waste; Meticulous science and technology to protect people and the environment; Licensing a repository; Transporting waste to a permanent repository; The Environmental Impact Statement for a repository; Current status of the Yucca Mountain Project; and Further information available on the Internet

Mountain Weather and Climate, Third Edition

Science.gov (United States)

Hastenrath, Stefan

2009-05-01

For colleagues with diverse interests in the atmosphere, glaciers, radiation, landforms, water resources, vegetation, human implications, and more, Mountain Weather and Climate can be a valuable source of guidance and literature references. The book is organized into seven chapters: 1, Mountains and their climatological study; 2,Geographical controls of mountain meteorological elements; 3, Circulation systems related to orography; 4, Climatic characteristics of mountains; 5, Regional case studies; 6, Mountain bioclimatology; and 7, Changes in mountain climates. These chapters are supported by l78 diagrams and photographs, 47 tables, and some 2000 literature references. The volume has an appendix of units and energy conversion factors and a subject index, but it lacks an author index.

Protein quantitation using Ru-NHS ester tagging and isotope dilution high-pressure liquid chromatography-inductively coupled plasma mass spectrometry determination.

Science.gov (United States)

Liu, Rui; Lv, Yi; Hou, Xiandeng; Yang, Lu; Mester, Zoltan

2012-03-20

An accurate, simple, and sensitive method for the direct determination of proteins by nonspecies specific isotope dilution and external calibration high-performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS) is described. The labeling of myoglobin (17 kDa), transferrin (77 kDa), and thyroglobulin (670 kDa) proteins was accomplished in a single-step reaction with a commercially available bis(2,2'-bipyridine)-4'-methyl-4-carboxybipyridine-ruthenium N-succinimidyl ester-bis(hexafluorophosphate) (Ru-NHS ester). Using excess amounts of Ru-NHS ester compared to the protein concentration at optimized labeling conditions, constant ratios for Ru to proteins were obtained. Bioconjugate solutions containing both labeled and unlabeled proteins as well as excess Ru-NHS ester reagent were injected onto a size exclusion HPLC column for separation and ICPMS detection without any further treatment. A (99)Ru enriched spike was used for nonspecies specific ID calibration. The accuracy of the method was confirmed at various concentration levels. An average recovery of 100% ± 3% (1 standard deviation (SD), n = 9) was obtained with a typical precision of better than 5% RSD at 100 μg mL(-1) for nonspecies specific ID. Detection limits (3SD) of 1.6, 3.2, and 7.0 fmol estimated from three procedure blanks were obtained for myoglobin, transferrin, and thyroglobulin, respectively. These detection limits are suitable for the direct determination of intact proteins at trace levels. For simplicity, external calibration was also tested. Good linear correlation coefficients, 0.9901, 0.9921, and 0.9980 for myoglobin, transferrin, and thyroglobulin, respectively, were obtained. The measured concentrations of proteins in a solution were in good agreement with their volumetrically prepared values. To the best of our knowledge, this is the first application of nonspecies specific ID for the accurate and direct determination of proteins using a Ru-NHS ester

A novel small deletion in the NHS gene associated with Nance-Horan syndrome

OpenAIRE

Li, Huajin; Yang, Lizhu; Sun, Zixi; Yuan, Zhisheng; Wu, Shijing; Sui, Ruifang

2018-01-01

Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), a...

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

Science.gov (United States)

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Yucca Mountain digital database

International Nuclear Information System (INIS)

Daudt, C.R.; Hinze, W.J.

1992-01-01

This paper discusses the Yucca Mountain Digital Database (DDB) which is a digital, PC-based geographical database of geoscience-related characteristics of the proposed high-level waste (HLW) repository site of Yucca Mountain, Nevada. It was created to provide the US Nuclear Regulatory Commission's (NRC) Advisory Committee on Nuclear Waste (ACNW) and its staff with a visual perspective of geological, geophysical, and hydrological features at the Yucca Mountain site as discussed in the Department of Energy's (DOE) pre-licensing reports

Recreational mountain biking injuries.

Science.gov (United States)

Aitken, S A; Biant, L C; Court-Brown, Charles M

2011-04-01

Mountain biking is increasing in popularity worldwide. The injury patterns associated with elite level and competitive mountain biking are known. This study analysed the incidence, spectrum and risk factors for injuries sustained during recreational mountain biking. The injury rate was 1.54 injuries per 1000 biker exposures. Men were more commonly injured than women, with those aged 30-39 years at highest risk. The commonest types of injury were wounding, skeletal fracture and musculoskeletal soft tissue injury. Joint dislocations occurred more commonly in older mountain bikers. The limbs were more commonly injured than the axial skeleton. The highest hospital admission rates were observed with head, neck and torso injuries. Protective body armour, clip-in pedals and the use of a full-suspension bicycle may confer a protective effect.

Rocky Mountain spotted fever

Science.gov (United States)

... spotted fever on the foot Rocky Mountain spotted fever, petechial rash Antibodies Deer and dog tick References McElligott SC, Kihiczak GG, Schwartz RA. Rocky Mountain spotted fever and other rickettsial infections. In: Lebwohl MG, Heymann ...

Options for change in the NHS consultant contract.

Science.gov (United States)

Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

The effects of immigration on NHS waiting times.

Science.gov (United States)

Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

2018-03-01

This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3-4 years). Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Man-induced transformation of mountain meadow soils of Aragats mountain massif (Armenia)

Science.gov (United States)

Avetisyan, M. H.

2018-01-01

The article considers issues of degradation of mountain meadow soils of the Aragats mountain massif of the Republic of Armenia and provides the averaged research results obtained for 2013 and 2014. The present research was initiated in the frames of long-term complex investigations of agroecosystems of Armenia’s mountain massifs and covered sod soils of high mountain meadow pasturelands and meadow steppe grasslands lying on southern slope of Mt. Aragats. With a purpose of studying the peculiarities of migration and transformation of flows of major nutrients namely carbon, nitrogen, phosphorus in study mountain meadow and meadow steppe belts of the Aragats massif we investigated water migration of chemical elements and regularities of their leaching depending on different belts. Field measurement data have indicated that organic carbon and humus in a heavily grazed plot are almost twice as low as on a control site. Lysimetric data analysis has demonstrated that heavy grazing and illegal deforestation have brought to an increase in intrasoil water acidity. The results generated from this research support a conclusion that a man’s intervention has brought to disturbance of structure and nutrient and water regimes of soils and loss of significant amounts of soil nutrients throughout the studied region.

Engaging dental professionals in NHS leadership - the challenges, the opportunities and the risks.

Science.gov (United States)

Ford, J

2014-09-01

Leadership training in dentistry and the wider NHS is often overlooked or seen as an unnecessary distraction from front line duties. Dentists themselves are often reluctant to adopt formal leadership learning due to the way work is structured and rewarded. So, what is it like for a dentist to undertake leadership training and how can the gap be bridged between the need for highly trained leaders in dentistry and the reticence of front line professionals to take time away from practice?

What motivates doctors to leave the UK NHS for a "life in the sun" in New Zealand; and, once there, why don't they stay?

Science.gov (United States)

Gauld, Robin; Horsburgh, Simon

2015-09-08

At 44%, New Zealand has the highest proportion of international medical graduates (IMGs) in its workforce amongst OECD member countries. Around half of New Zealand's IMGs come from the UK NHS, yet only around 50% stay longer than 1 year post-registration with significant costs to the New Zealand health care system. Why these doctors go to New Zealand and do not stay for long is an important question. UK-trained doctors who had gained registration with the Medical Council of New Zealand and currently practising in New Zealand were surveyed (n = 1357) on the motivation for their move to New Zealand, experiences once there and what was prompting any intentions to move away from New Zealand. Multivariate proportional odds models (POM) were used to quantify various associations. The survey had a 47% response (n = 632). Quality of life considerations motivated 96% of respondents to move to New Zealand, although 65% indicated they were pushed by a desire to leave the NHS. POM analyses revealed older respondents were significantly less likely than younger respondents to be motivated by quality of life considerations. Younger doctors were significantly more likely to be seeking to leave the NHS. Seventy-six per cent of respondents signalling an intention to leave New Zealand indicated that the desire to return to the UK was the primary reason for this. There is a long history of medical migration from the UK to New Zealand. However, the 65% of respondents in this study seeking to leave the NHS was much higher than found elsewhere, perhaps reflecting increasing workplace and funding pressures in recent years. Of concern to policy makers were the higher odds of seeking to leave the NHS motivating younger doctors. Various changes "down under", in New Zealand as well as Australia, mean their IMG markets may well be tightening up.

Rocky Mountain Spotted Fever

Science.gov (United States)

... with facebook share with twitter share with linkedin Rocky Mountain Spotted Fever Credit: CDC A male cayenne tick, Amblyomma cajennense, ... and New Mexico. Why Is the Study of Rocky Mountain Spotted Fever a Priority for NIAID? Tickborne diseases are becoming ...

One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process

Directory of Open Access Journals (Sweden)

France Emma F

2010-05-01

Full Text Available Abstract Background Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland, which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes. Methods We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia. Results Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale. Conclusions If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for

Does competition between hospitals improve clinical quality?: a review of evidence from two eras of competition in the English NHS

OpenAIRE

Gwyn Bevan; Matthew Skellern

2011-01-01

Gwyn Bevan and Matthew Skellern review evidence on the effects of hospital competition on quality of care within the English NHS and question whether they support government proposals to extend competition.

Mantle Subduction and Uplift of Intracontinental Mountains: A Case Study from the Chinese Tianshan Mountains within Eurasia.

Science.gov (United States)

Li, Jinyi; Zhang, Jin; Zhao, Xixi; Jiang, Mei; Li, Yaping; Zhu, Zhixin; Feng, Qianwen; Wang, Lijia; Sun, Guihua; Liu, Jianfeng; Yang, Tiannan

2016-06-29

The driving mechanism that is responsible for the uplift of intracontinental mountains has puzzled geologists for decades. This study addresses this issue by using receiver function images across the Chinese Tianshan Mountains and available data from both deep seismic profiles and surface structural deformation. The near-surface structural deformation shows that the Tianshan crust experienced strong shortening during the Cenozoic. The receiver function image across the Tianshan Mountains reveals that the lithosphere of the Junggar Basin to the north became uncoupled along the Moho, and the mantle below the Moho subducted southwards beneath the northern part of the Tianshan Mountains, thereby thickening the overlying crust. Similar deep structures, however, are not observed under the Tarim Basin and the adjacent southern Tianshan Mountains. This difference in the deep structures correlates with geomorphological features in the region. Thus, a new model of mantle subduction, herein termed M-type subduction, is proposed for the mountain-building processes in intracontinental compressional settings. The available geomorphological, geological and seismic data in the literatures show that this model is probably suitable for other high, linear mountains within the continent.

A sightability model for mountain goats

Science.gov (United States)

Rice, C.G.; Jenkins, K.J.; Chang, W.-Y.

2009-01-01

Unbiased estimates of mountain goat (Oreamnos americanus) populations are key to meeting diverse harvest management and conservation objectives. We developed logistic regression models of factors influencing sightability of mountain goat groups during helicopter surveys throughout the Cascades and Olympic Ranges in western Washington during summers, 20042007. We conducted 205 trials of the ability of aerial survey crews to detect groups of mountain goats whose presence was known based on simultaneous direct observation from the ground (n 84), Global Positioning System (GPS) telemetry (n 115), or both (n 6). Aerial survey crews detected 77 and 79 of all groups known to be present based on ground observers and GPS collars, respectively. The best models indicated that sightability of mountain goat groups was a function of the number of mountain goats in a group, presence of terrain obstruction, and extent of overstory vegetation. Aerial counts of mountain goats within groups did not differ greatly from known group sizes, indicating that under-counting bias within detected groups of mountain goats was small. We applied HorvitzThompson-like sightability adjustments to 1,139 groups of mountain goats observed in the Cascade and Olympic ranges, Washington, USA, from 2004 to 2007. Estimated mean sightability of individual animals was 85 but ranged 0.750.91 in areas with low and high sightability, respectively. Simulations of mountain goat surveys indicated that precision of population estimates adjusted for sightability biases increased with population size and number of replicate surveys, providing general guidance for the design of future surveys. Because survey conditions, group sizes, and habitat occupied by goats vary among surveys, we recommend using sightability correction methods to decrease bias in population estimates from aerial surveys of mountain goats.

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011.

Science.gov (United States)

Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

2013-05-28

To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners' experience, personal characteristics or role at work. Cross-sectional survey of 345 National Health Service (NHS) staff members. The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (pfinance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for Clinical Excellence (NICE) guidance and government publications (eg, National Service

Evidence-based commissioning in the English NHS: who uses which sources of evidence? A survey 2010/2011

Science.gov (United States)

Clarke, Aileen; Taylor-Phillips, Sian; Swan, Jacky; Gkeredakis, Emmanouil; Mills, Penny; Powell, John; Nicolini, Davide; Roginski, Claudia; Scarbrough, Harry; Grove, Amy

2013-01-01

Objectives To investigate types of evidence used by healthcare commissioners when making decisions and whether decisions were influenced by commissioners’ experience, personal characteristics or role at work. Design Cross-sectional survey of 345 National Health Service (NHS) staff members. Setting The study was conducted across 11 English Primary Care Trusts between 2010 and 2011. Participants A total of 440 staff involved in commissioning decisions and employed at NHS band 7 or above were invited to participate in the study. Of those, 345 (78%) completed all or a part of the survey. Main outcome measures Participants were asked to rate how important different sources of evidence (empirical or practical) were in a recent decision that had been made. Backwards stepwise logistic regression analyses were undertaken to assess the contributions of age, gender and professional background, as well as the years of experience in NHS commissioning, pay grade and work role. Results The extent to which empirical evidence was used for commissioning decisions in the NHS varied according to the professional background. Only 50% of respondents stated that clinical guidelines and cost-effectiveness evidence were important for healthcare decisions. Respondents were more likely to report use of empirical evidence if they worked in Public Health in comparison to other departments (pfinance OR  0.19, 95%CI 0.05 to 0.78, other departments OR 0.35, 95%CI 0.17 to 0.71) or if they were female (OR 1.8 95% CI 1.01 to 3.1) rather than male. Respondents were more likely to report use of practical evidence if they were more senior within the organisation (pay grade 8b or higher OR 2.7, 95%CI 1.4 to 5.3, p=0.004 in comparison to lower pay grades). Conclusions Those trained in Public Health appeared more likely to use external empirical evidence while those at higher pay scales were more likely to use practical evidence when making commissioning decisions. Clearly, National Institute for

Adult patients' experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England.

Science.gov (United States)

Broughton, Jessica; Harris, Sarah; Beasant, Lucy; Crawley, Esther; Collin, Simon M

2017-06-02

Few studies have explored patients' experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England. Semi-structured interviews were conducted during the period June-September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views. Three themes were identified: 'Journey to specialist services'; 'Things that help or hinder treatment'; and 'Support systems'. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants' experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients' experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society. The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients' journeys towards an improved quality of life. This improvement came about through a process which included validation of patients' experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

Barriers to healthy eating by National Health Service (NHS hospital doctors in the hospital setting: results of a cross-sectional survey

Directory of Open Access Journals (Sweden)

Wilson Sue

2008-08-01

Full Text Available Abstract Background With high levels of obesity and related illness, improving the health of the nation is a major public health concern. This study aimed to identify factors that prevent healthy eating among doctors, and that are associated with satisfaction with catering services. Findings Methods: Cross-sectional survey of 328 NHS doctors working in two NHS Trusts with on-site hospital canteen. Questionnaire to establish perceived barriers to healthy eating, weekly use and satisfaction with the hospital canteen, lifestyle and dietary habits, gender, age, height, weight, job details, and affect. Results: 70% of doctors reported using their hospital canteen each week, with 2 visits per week on average. Canteen opening times, lack of selection and lack of breaks were the most commonly perceived barriers to healthy eating. Availability of healthy options caused the most dissatisfaction. Only 12% felt the NHS was supportive of healthy eating. 74% did not feel their canteen advocated healthy eating. Canteen use is associated with younger age (r = -0.254, p Conclusion Interventions to encourage regular meal breaks, eating breakfast and drinking more water each day need developing. Improved canteen accessibility and availability of healthy options at evenings and weekends may be beneficial.

Enacting localist health policy in the English NHS: the 'governing assemblage' of Clinical Commissioning Groups.

Science.gov (United States)

Hammond, Jonathan; Coleman, Anna; Checkland, Kath

2018-01-01

Objectives The Health and Social Care Act 2012 introduced Clinical Commissioning Groups to take responsibility for commissioning (i.e. planning and purchasing) the majority of services for local populations in the English NHS. Constituted as 'membership organizations', with membership compulsory for all GP practices, Clinical Commissioning Groups are overseen by, and are accountable to, a new arm's-length body, NHS England. This paper critically engages with the content and policy narrative of the 2012 Act and explores this in relation to the reality of local policy enactment. Methods Set against a careful review of the 2012 Act, a case study of a nascent Clinical Commissioning Groups was conducted. The research included observations of Clinical Commissioning Group meetings and events (87 h), and in-depth interviews (16) with clinical commissioners, GPs, and managers. Results The 2012 Act was presented as part of a broader government agenda of decentralization and localism. Clinical Commissioning Group membership organizations were framed as a means of better meeting the needs and preferences of local patients and realizing a desirable increase in localism. The policy delineated the 'governing body' and 'the membership', with the former elected from/by the latter to oversee the organization. 'The membership' was duty bound to be 'good', engaged members and to represent their patients' interests. Fieldwork with Notchcroft Clinical Commissioning Group revealed that Clinical Commissioning Groups' statutory duty to NHS England to 'ensure the continuous improvement' of GP practice members involved performance scrutiny of GP practices. These governance processes were carried out by a varied cast of individuals, many of whom did not fit into the binary categorization of membership and governing body constructed in the policy. A concept, the governing assemblage, was developed to describe the dynamic cast of people involved in shaping the work and direction of the Clinical

Nance-Horan syndrome in females due to a balanced X;1 translocation that disrupts the NHS gene: Familial case report and review of the literature.

Science.gov (United States)

Gómez-Laguna, Laura; Martínez-Herrera, Alejandro; Reyes-de la Rosa, Alejandra Del Pilar; García-Delgado, Constanza; Nieto-Martínez, Karem; Fernández-Ramírez, Fernando; Valderrama-Atayupanqui, Tania Yanet; Morales-Jiménez, Ariadna Berenice; Villa-Morales, Judith; Kofman, Susana; Cervantes, Alicia; Morán-Barroso, Verónica Fabiola

2018-01-01

The Nance-Horan syndrome is an X-linked disorder characterized by congenital cataract, facial features, microcornea, microphthalmia, and dental anomalies; most of the cases are due to NHS gene mutations on Xp22.13. Heterozygous carrier females generally present less severe features, and up to 30% of the affected males have intellectual disability. We describe two patients, mother and daughter, manifesting Nance-Horan syndrome. The cytogenetic and molecular analyses demonstrated a 46,X,t(X;1)(p22.13;q22) karyotype in each of them. No copy-number genomic imbalances were detected by high-density microarray analysis. The mother had a preferential inactivation of the normal X chromosome; expression analysis did not detect any mRNA isoform of NHS. This is the first report of Nance-Horan syndrome due to a skewed X chromosome inactivation resulting from a balanced translocation t(X;1) that disrupts the NHS gene expression, with important implications for clinical presentation and genetic counseling.

The origins of mountain geoecology

Directory of Open Access Journals (Sweden)

Ives, Jack D.

2012-05-01

Full Text Available Mountain geoecology, as a sub-discipline of Geography, stems from the life and work of Carl Troll who, in turn, was inspired by the philosophy and mountain travels of Alexander von Humboldt. As founding chair of the IGU Commission on High-Altitude Geoecology (1968, Troll laid the foundations for inter-disciplinary and international mountain research. The paper traces the evolution of the Commission and its close links with the UNESCO Man and Biosphere Programme (1972- and the United Nations University’s mountain Project (1978-. This facilitated the formation of a major force for inclusion of a mountain chapter in AGENDA 21 during the 1992 Rio de Janeiro Herat Summit (UNCED and the related designation by the United Nations of 2002 as the International Year of Mountains. In this way, mountain geoecology not only contributed to worldwide mountain research but also entered the political arena in the struggle for sustainable mountain development and the well-being of mountain people.La geoecología de montaña, como sub-disciplina de la Geografía, entronca con la vida y trabajo de Carl Troll, quien, a su vez, fue inspirado por la filosofía y viajes de Alexander von Humboldt. Como presidente fundador de la comisión de la UGI sobre High Altitude Geoecology (1968, Troll colocó las bases para la investigación interdisciplinar e internacional de las montañas. Este trabajo presenta la evolución de la Comisión y sus estrechas relaciones con el Programa Hombre y Biosfera de UNESCO (1972- y con el Proyecto de montaña de la Universidad de Naciones Unidas (1978-. Esto facilitó la inclusión de un capítulo sobre la montaña en AGENDA 21 durante la Cumbre de la Tierra de Río de Janeiro (UNCED, y la consiguiente designación de 2002 como el Año Internacional de las Montañas por parte de Naciones Unidas. En este sentido, la geoecología de montaña no sólo contribuyó a la investigación de las montañas del mundo sino que también empujó a la pol

Can UK NHS research ethics committees effectively monitor publication and outcome reporting bias?

Science.gov (United States)

Begum, Rasheda; Kolstoe, Simon

2015-07-25

Publication and outcome reporting bias is often caused by researchers selectively choosing which scientific results and outcomes to publish. This behaviour is ethically significant as it distorts the literature used for future scientific or clinical decision-making. This study investigates the practicalities of using ethics applications submitted to a UK National Health Service (NHS) research ethics committee to monitor both types of reporting bias. As part of an internal audit we accessed research ethics database records for studies submitting an end of study declaration to the Hampshire A research ethics committee (formerly Southampton A) between 1st January 2010 and 31st December 2011. A literature search was used to establish the publication status of studies. Primary and secondary outcomes stated in application forms were compared with outcomes reported in publications. Out of 116 studies the literature search identified 57 publications for 37 studies giving a publication rate of 32%. Original Research Ethics Committee (REC) applications could be obtained for 28 of the published studies. Outcome inconsistencies were found in 16 (57%) of the published studies. This study showed that the problem of publication and outcome reporting bias is still significant in the UK. The method described here demonstrates that UK NHS research ethics committees are in a good position to detect such bias due to their unique access to original research protocols. Data gathered in this way could be used by the Health Research Authority to encourage higher levels of transparency in UK research.

Protection of the Mountain Ridgelines Utilizing GIS

Science.gov (United States)

Lee, S.; Lee, M.

2013-12-01

Korean peninsula is characterized by numerous hills and mountains. The longest mountain ridgeline starting from Mt. Baekdusan to Mt. Jirisan is called Baekdudaegan which is similar to the continental divide or topographical watershed. In this study, GIS data, such as remotesensing images, national digital map, and watershed map, are used to analyze Korean mountain ridgelines structure and one Baekdudaegan data and nine Ridgelines are extracted. When extracted Baekdudaegan and other Ridgelines are overlaid on geologic maps, granite and gneiss are main components on the mountain ridgelines. The main mountain ridgelines are considered as the spiritual heritage overlapped in the land in Korea. As the environmental state is relatively better than those of other region in Korea, so many mountain ridgelines are legally protected by national legislation. The mountain ridgelines has hierarchical system; Baekdudaegan, Jeongmaek, Gimaek and Jimaek etc. according to their scale and total lengths of ridgelines. As only part of mountain ridgelines are currently protected by law or managed in environmental impact assessment (EIA) procedure, we think that most part of them should be under protection. Considering the environmental state of the ridgelines, we think that some protective measures should be set up nearby 1 km on both sides of them. If there goes a development plan or project near the main mountain ridgelines, topographical change index (TCI) and topographical scale index (TSI) etc. are to be applied in EIA. This study intends: firstly, to analyze the topological characteristics of the Korean mountain ridgelines using GIS, secondly, to analyze the geological characteristics of nearby mountain ridgelines, and lastly, to find a way to utilize the results on EIA.

Does a modified mindfulness-based cognitive therapy (MBCT) course have the potential to reduce stress and burnout in NHS GPs? Feasibility study.

Science.gov (United States)

Hamilton-West, Kate; Pellatt-Higgins, Tracy; Pillai, Neil

2018-04-19

AimTo explore, for the first time, whether a modified mindfulness-based cognitive therapy (MBCT) course has the potential to reduce stress and burnout among National Health Service (NHS) General Practitioners. There is a crisis of low morale among NHS GPs, with most describing their workload as 'unmanageable'. MBCT has been demonstrated to improve stress and burnout in other populations, but has not yet been evaluated in a cohort of NHS GPs. NHS GPs in South East England (n=22) attended a modified version of the MBCT course approved by National Institute for Health and Care Excellence for prevention of depressive relapse. This comprised eight weekly 2-h sessions with homework (mindfulness practice) between sessions. Participants completed the Maslach Burnout Inventory (MBI) and Perceived Stress Scale (PSS) before (baseline) and then again one month (T2) and three months (T3) after attending the course. We also obtained qualitative data on participants' experiences of the course.FindingsCompliance with the intervention was very high. All GPs attended at least six sessions and all completed baseline questionnaires. At T2, data were obtained from 21 participants (95%); PSS scores were significantly lower than at baseline (P<0.001), as were MBI emotional exhaustion (P<0.001) and depersonalization scores (P=0.0421). At T3 we obtained data for 13 participants (59%); PSS scores and MBI emotional exhaustion scores were significantly lower (P<0.001; P=0.0024, respectively) and personal accomplishment scores were significantly higher (P<0.001) than at baseline. Participants reported that the course helped them to manage work pressures, feel more relaxed, enjoy their work and experience greater empathy and compassion (for self, colleagues and patients). Findings of this preliminary evaluation are promising. Further research is needed to evaluate this approach within a larger randomized-controlled trial.

Exploring a shared leadership perspective for NHS doctors.

Science.gov (United States)

Willcocks, Stephen George; Wibberley, Gemma

2015-01-01

The purpose of this paper is to explore involving doctors in shared leadership. It examines the policies that have led to the focus on shared leadership and the implications for practice. This is a conceptual paper, examining policy developments and key literature to understand the move towards shared leadership. It focuses on UK NHS, and in particular doctors, although the concepts will be relevant to other disciplines in healthcare, and healthcare systems in other countries. This paper suggests that the shared-leadership approach for doctors has potential given the nature of clinical practice, the inherently collaborative nature of healthcare and the demands of new healthcare organisations. Health policy reform, generally, will mean that all doctors need to be engaged with leadership, albeit, perhaps, at different levels, and with different degrees of formality. Leadership will remain an important precondition for the success of the reforms. This is likely to be the case for other countries involved in healthcare reform. To highlight the benefits and barriers to shared leadership for doctors. Offers an alternative to traditional approaches to leadership.

Electrochemical impedance and spectroscopy study of the EDC/NHS activation of the carboxyl groups on poly(ε-caprolactone/poly(m-anthranilic acid nanofibers

Directory of Open Access Journals (Sweden)

Z. Guler

2016-02-01

Full Text Available Electrochemical impedance spectroscopy (EIS and spectroscopy was applied to investigate the surface activation of carboxyl group (–COOH containing nanofibers by the reaction of 1-ethyl-3-(dimethyl-aminopropyl carbodiimide hydrochloride (EDC/N-hydroxyl succinimide (NHS in different concentrations. Poly(!-caprolactone/poly(m-anthranilic acid (PCL/P3ANA nanofibers were fabricated by electrospinning and were activated with 5/0.5, 0.5/5, 5/5 and 50/50 mM of EDC/NHS. The surface activation was investigated by Attenuated Total Reflectance Fourier transform infrared spectroscopy (FTIR-ATR and activation yield was estimated. Albumin was immobilized after surface activation and the amount of covalently immobilized protein was determined by bicinchoninic acid (BCA assay. Morphology and composition of albumin immobilized nanofibers were characterized by Scanning Electron Microscopy/Energy-Dispersive X-ray Spectroscopy (SEM/EDX and Atomic force microscope (AFM. EIS measurements indicated that nanofibers become resistant after albumin immobilization. The obtained data revealed that the highest amount of albumin bound to nanofibers activated with 50/50 mM of EDC/NHS which was found to be the optimum concentration for the activation of PCL/P3ANA nanofibers.

Phytogeography of the tropical north-east African mountains

Directory of Open Access Journals (Sweden)

I. Friis

1983-11-01

Full Text Available The tropical north-east African mountains are tentatively divided into four phytochoria, the formal rank of which is not defined. The division is based on patterns of distribution and endemism in the region. The recognition of a distinct Afromontane phytochorion is now well established (Chapman & White, 1970; Werger, 1978; White, 1978. However, there is still very little information on the phytogeography of the individual mountains or mountain systems. This study hopes to fill a little of the gap by analysing distribution patterns and patterns of endemism in the flora of the tropical north-east African mountains. The north-east African mountain system is the largest in tropical Africa (see e.g. map in White, 1978. At the core of this system is the large Ethiopian massif, around which are located various mountains and mountain chains. These include the Red Sea Hills in the Sudan, the mountain chain in northern Somalia, the south-west Arabian mountains, and the Imatong mountains of south-east Sudan. The latter are often referred to the East African mountain system (White, 1978 but. as I will point out later, they also have a close connection with the south-west highlands of Ethiopia. The paper presents some results of my study of the mountain flora of tropical north-east Africa, particularly the forest species. Where no source is indicated, the data are from my own unpublished studies.

Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

Science.gov (United States)

Blancher, Marc; Albasini, François; Elsensohn, Fidel; Zafren, Ken; Hölzl, Natalie; McLaughlin, Kyle; Wheeler, Albert R; Roy, Steven; Brugger, Hermann; Greene, Mike; Paal, Peter

2018-02-15

Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue. High Alt Med Biol. 00:000-000, 2018. Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

Mountain Biking Injuries.

Science.gov (United States)

Ansari, Majid; Nourian, Ruhollah; Khodaee, Morteza

With the increasing popularity of mountain biking, also known as off-road cycling, and the riders pushing the sport into extremes, there has been a corresponding increase in injury. Almost two thirds of acute injuries involve the upper extremities, and a similar proportion of overuse injuries affect the lower extremities. Mountain biking appears to be a high-risk sport for severe spine injuries. New trends of injury patterns are observed with popularity of mountain bike trail parks and freeride cycling. Using protective gear, improving technical proficiency, and physical fitness may somewhat decrease the risk of injuries. Simple modifications in bicycle-rider interface areas and with the bicycle (bike fit) also may decrease some overuse injuries. Bike fit provides the clinician with postural correction during the sport. In this review, we also discuss the importance of race-day management strategies and monitoring the injury trends.

Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008.

Science.gov (United States)

Cookson, Richard; Laudicella, Mauro; Donni, Paolo Li

2012-10-01

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement. Copyright © 2012 Elsevier Ltd. All rights reserved.

Mountain cedar allergens found in nonpollen tree parts.

Science.gov (United States)

Goetz, D W; Goetz, M A; Whisman, B A

1995-09-01

Mountain cedar (Juniperus ashei) pollen is the principal aeroallergen in south central Texas from late December through February. The major mountain cedar allergen is a 40-kD glycoprotein, gp40. To identify allergens in mountain cedar wood, leaves, and berries and to detect mountain cedar allergen in smoke from burning male or female trees. SDS-PAGE plus mountain cedar human sIgE and monoclonal antibody immunoblots identified mountain cedar allergens within pollen and nonpollen tree part extracts. IgE immunoblots identified a single wood allergen at 36 kD and three berry allergens at 36, 26-27, and 21 kD, in addition to known pollen allergens. Mountain cedar monoclonal antibody bound an allergen epitope present not only on 40, 33, and 28-kD pollen allergens, but also on 36 and 32-kD wood allergens, and the 26-27-kD berry allergen. Immunoblot studies detected no mountain cedar allergen in leaves and no allergen in smoke from burning male and female trees. Allergens constituted a much smaller percentage of extractable protein in wood and berries than in pollen. Mountain cedar berry allergen content is too small to give credence to the ingestion of berries as a folk medicine treatment of mountain cedar pollinosis. In addition, while smoke from burning mountain cedar trees may be irritating, it contains no allergens that could cause allergic rhinoconjunctivitis.

Reengineering NHS Hospitals in Greece: Redistribution Leads to Rational Mergers.

Science.gov (United States)

Nikolentzos, Athanasios; Kontodimopoulos, Nick; Polyzos, Nikolaos; Thireos, Eleftherios; Tountas, Yannis

2015-03-18

The purpose of this study was to record and evaluate existing public hospital infrastructure of the National Health System (NHS), in terms of clinics and laboratories, as well as the healthcare workforce in each of these units and in every health region in Greece, in an attempt to optimize the allocation of these resources. An extensive analysis of raw data according to supply and performance indicators was performed to serve as a solid and objective scientific baseline for the proposed reengineering of the Greek public hospitals. Suggestions for "reshuffling" clinics and diagnostic laboratories, and their personnel, were made by using a best versus worst outcome indicator approach at a regional and national level. This study is expected to contribute to the academic debate about the gap between theory and evidence based decision-making in health policy.

Mountain-Scale Coupled Processes (TH/THC/THM)

International Nuclear Information System (INIS)

Dixon, P.

2004-01-01

The purpose of this Model Report is to document the development of the Mountain-Scale Thermal-Hydrological (TH), Thermal-Hydrological-Chemical (THC), and Thermal-Hydrological-Mechanical (THM) Models and evaluate the effects of coupled TH/THC/THM processes on mountain-scale UZ flow at Yucca Mountain, Nevada. This Model Report was planned in ''Technical Work Plan (TWP) for: Performance Assessment Unsaturated Zone'' (BSC 2002 [160819], Section 1.12.7), and was developed in accordance with AP-SIII.10Q, Models. In this Model Report, any reference to ''repository'' means the nuclear waste repository at Yucca Mountain, and any reference to ''drifts'' means the emplacement drifts at the repository horizon. This Model Report provides the necessary framework to test conceptual hypotheses for analyzing mountain-scale hydrological/chemical/mechanical changes and predict flow behavior in response to heat release by radioactive decay from the nuclear waste repository at the Yucca Mountain site. The mountain-scale coupled TH/THC/THM processes models numerically simulate the impact of nuclear waste heat release on the natural hydrogeological system, including a representation of heat-driven processes occurring in the far field. The TH simulations provide predictions for thermally affected liquid saturation, gas- and liquid-phase fluxes, and water and rock temperature (together called the flow fields). The main focus of the TH Model is to predict the changes in water flux driven by evaporation/condensation processes, and drainage between drifts. The TH Model captures mountain-scale three dimensional (3-D) flow effects, including lateral diversion at the PTn/TSw interface and mountain-scale flow patterns. The Mountain-Scale THC Model evaluates TH effects on water and gas chemistry, mineral dissolution/precipitation, and the resulting impact to UZ hydrological properties, flow and transport. The THM Model addresses changes in permeability due to mechanical and thermal disturbances in

Geology of Gable Mountain-Gable Butte Area

International Nuclear Information System (INIS)

Fecht, K.R.

1978-09-01

Gable Mountain and Gable Butte are two ridges which form the only extensive outcrops of the Columbia River Basalt Group in the central portion of the Pasco Basin. The Saddle Mountains Basalt and two interbedded sedimentary units of the Ellensburg Formation crop out on the ridges. These include, from oldest to youngest, the Asotin Member (oldest), Esquatzel Member, Selah Interbed, Pomona Member, Rattlesnake Ridge Interbed, and Elephant Mountain Member (youngest). A fluvial plain composed of sediments from the Ringold and Hanford (informal) formations surrounds these ridges. The structure of Gable Mountain and Gable Butte is dominated by an east-west-trending major fold and northwest-southeast-trending parasitic folds. Two faults associated with the uplift of these structures were mapped on Gable Mountain. The geomorphic expression of the Gable Mountain-Gable Butte area resulted from the comlex folding and subsequent scouring by post-basalt fluvial systems

Causal Chains Arising from Climate Change in Mountain Regions: the Core Program of the Mountain Research Initiative

Science.gov (United States)

Greenwood, G. B.

2014-12-01

Mountains are a widespread terrestrial feature, covering from 12 to 24 percent of the world's terrestrial surface, depending of the definition. Topographic relief is central to the definition of mountains, to the benefits and costs accruing to society and to the cascade of changes expected from climate change. Mountains capture and store water, particularly important in arid regions and in all areas for energy production. In temperate and boreal regions, mountains have a great range in population densities, from empty to urban, while tropical mountains are often densely settled and farmed. Mountain regions contain a wide range of habitats, important for biodiversity, and for primary, secondary and tertiary sectors of the economy. Climate change interacts with this relief and consequent diversity. Elevation itself may accentuate warming (elevationi dependent warming) in some mountain regions. Even average warming starts complex chains of causality that reverberate through the diverse social ecological mountain systems affecting both the highlands and adjacent lowlands. A single feature of climate change such as higher snow lines affect the climate through albedo, the water cycle through changes in timing of release , water quality through the weathering of newly exposed material, geomorphology through enhanced erosion, plant communities through changes in climatic water balance, and animal and human communities through changes in habitat conditions and resource availabilities. Understanding these causal changes presents a particular interdisciplinary challenge to researchers, from assessing the existence and magnitude of elevation dependent warming and monitoring the full suite of changes within the social ecological system to climate change, to understanding how social ecological systems respond through individual and institutional behavior with repercussions on the long-term sustainability of these systems.

Mountains as early warning indicators of climate change

Science.gov (United States)

Williams, M. W.

2015-12-01

The panoramic splendor and complexity of mountain environments have inspired and challenged humans for centuries. These areas have been variously perceived as physical structures to be conquered, as sites of spiritual inspiration, and as some of the last untamed natural places on Earth. In our time, the perception that "mountains are forever" may provide solace to those seeking stability in a rapidly changing world. However, changes in the hydrology and in the abundance and species composition of the native flora and fauna of mountain ecosystems are potential bellwethers of global change, because these systems have a propensity to amplify environmental changes within specific portions of this landscape. Mountain areas are thus sentinels of climate change. We are seeing effects today in case histories I present from the Himalaya's, Andes, Alps, and Rocky Mountains. Furthermore, these ecosystem changes are occurring in mountain areas before they occur in downstream ecosystems. Thus, mountains are early warning indicators of perturbations such as climate change. The sensitivity of mountain ecosystems begs for enhanced protection and worldwide protection. Our understanding of the processes that control mountain ecosystems—climate interactions, snowmelt runoff, biotic diversity, nutrient cycling—is much less developed compared to downstream ecosystems where human habitation and development has resulted in large investments in scientific knowledge to sustain health and agriculture. To address these deficiencies, I propose the formation of an international mountain research consortium.

Injuries in mountain biking.

Science.gov (United States)

Gaulrapp, H; Weber, A; Rosemeyer, B

2001-01-01

Despite still growing attraction mountain biking as a matter of sports traumatology still lacks relevant data based on large cross-sectional surveys. To obtain an overview of risk factors, types, and main body sites of injuries occurring in mountain biking we assessed the results of a questionnaire answered by 3873 athletes. A total of 8133 single lesions were reported by 3474 athletes, 36% of whom regularly participated in competitions. The incidence of injuries in mountain biking is comparable to that in other outdoor sports, the majority of injuries being minor. Mountain biking athletes were found to have an overall injury risk rate of 0.6% per year and 1 injury per 1000 h of biking. The main risk factors included slippery road surface, cyclist's poor judgement of the situation, and excessive speed, representing personal factors that could be altered by preventive measures. Of all injuries 14% were due to collision with some part of the bike, especially the pedals and the handlebar. While 75% of the injuries were minor, such as skin wounds and simple contusions, 10% were so severe that hospitalization was required. A breakdown of the injuries according to body site and frequency of occurrence is presented.

Extinction of Harrington's mountain goat

International Nuclear Information System (INIS)

Mead, J.I.; Martin, P.S.; Euler, R.C.; Long, A.; Jull, A.J.T.; Toolin, L.J.; Donahue, D.J.; Linick, T.W.

1986-01-01

Keratinous horn sheaths of the extinct Harrington's mountain goat, Oreamnos harringtoni, were recovered at or near the surface of dry caves of the Grand Canyon, Arizona. Twenty-three separate specimens from two caves were dated nondestructively by the tandem accelerator mass spectrometer (TAMS). Both the TAMS and the conventional dates indicate that Harrington's mountain goat occupied the Grand Canyon for at least 19,000 years prior to becoming extinct by 11,160 +/- 125 radiocarbon years before present. The youngest average radiocarbon dates on Shasta ground sloths, Nothrotheriops shastensis, from the region are not significantly younger than those on extinct mountain goats. Rather than sequential extinction with Harrington's mountain goat disappearing from the Grand Canyon before the ground sloths, as one might predict in view of evidence of climatic warming at the time, the losses were concurrent. Both extinctions coincide with the regional arrival of Clovis hunters

Supporting staff in employment: the emotional wellbeing of staff in an NHS psychiatric hospital.

Science.gov (United States)

Patterson, I D; Bell, J S

2000-09-01

The objective of this study was to assess the emotional wellbeing of a broad sample of NHS employees in a psychiatric setting; to seek their views on sources of distress; and to identify preferred ways of dealing with it. A cross-sectional postal survey, employing two questionnaires: GHQ-28, and a semi-structured questionnaire. These were sent to a nominal 50% sample (n = 599). The population was the staff of a large Scottish psychiatric service. A 47.9% response rate was achieved; 32.9% of respondents exceeded a cut-off score of four on the GHQ-28. Neither occupational, group nor gender effects were significant on this measure. The reporting of emotionally-distressing problems affecting their performance was found to be more common amongst doctors; males, overall, showed a non-significant trend towards having been affected more than females by such problems; and older staff (above 45) were affected significantly more often than younger staff. Almost a third of staff were unaware of the availability of an internal organisational resource (the Occupational Health service). NHS Trusts should ensure the culture at work is appropriate from a preventative point of view and be aware that factors outwith the workplace can affect employees emotional wellbeing and performance. Preventative and supportive measures to minimise psychological distress in the workforce should be considered; the Scottish Needs Assessment Programme: Mental Health in the Workplace offers useful guidance.

THE MOUNTAIN REGIONS IN CONTEXT OF STRATEGY 2020

Directory of Open Access Journals (Sweden)

ANTONESCU Daniela

2014-07-01

Full Text Available The mountain regions in Romania and European Union represent a special territory of interest, with a huge economic, social, environmental and cultural potential. More, mountain area is considerate a natural-economic region and constitutes an important objective for regional development policy. The main sectors of mountain area are presented in agriculture and tourism fields that lead the key role in safeguarding the sensitive eco-system and thereby maintaining the general living and working space.Mountain areas should have a specific policy defined by the sustainable development principle, which meets the needs of the present without compromising the opportunities of future generations. The specific mountain policy aims to reduce the imbalance between favored and disadvantaged mountain regions, permanently marked by natural, economic, social, cultural and environmental constraints. In previous programming period, mountain regions among have profited from the intensive regional support, in specially, for constructing of and connecting them to fresh water and waste water networks, in particular for increasing of life quality. In context of 2020 Strategy, the Member States will concentrate investments on a small number of thematic objectives. In advanced regions, 60 % of funds will used for only two of these objectives (competitiveness of SME and research/innovation. The all less developed regions will received about 50% of Structural Funds In Romania, mountain representing 29.93% out of the total national surface and 20.14% from UAA (Utilised Agricultural Area of total national. The mountain territory has around 20% of the national population and is overlapping almost 100% with the Carpathian Mountains. Due to these conditions, Romania's regional development policy must take into account the specificities of mountain area, the problems they faced, and the requirements of 2020 Strategy.This paper presents the main aspects to be taken into account

Sustainability and Mountain Tourism: The Millennial’s Perspective

Directory of Open Access Journals (Sweden)

Alessandro Bonadonna

2017-07-01

Full Text Available Evidence from several studies illustrates the different points of view through which sustainability and mountains have been studied over the years. Nowadays, interest in Millennials is increasing but no research has compared Millennials and sustainability in the mountain context. This study aims at defining sustainability with reference to Millennial perception of both winter and summer mountain sports. By analysing data gathered from a sample of 2292 Millennials (Piedmont area, the authors confirm their high degree of sensitivity towards sustainable issues and, above all, discover that there are differences in the sustainable perception Millennials have of both mountain winter and summer sports. More specifically, Millennial perception is deeply influenced by the place where they are used to living―mountains or cities―and by their gender. From a managerial point of view, results have direct implications on the administrators of mountain institutions who can implement appropriate initiatives in order to correctly sensitise Millennials towards mountain sports. Moreover, from a theoretical perspective, the study opens a new scenario on two important topics linked to sustainability, namely Millennials and mountain sports.

Unmeasured improvement work: the lack of routinely collected, service-related data in NHS endoscopy units in England involved in "modernisation"

Directory of Open Access Journals (Sweden)

Hutchings Hayley A

2008-01-01

Full Text Available Abstract Background The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. Methods This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely collected by the unit – Referral numbers, Activity, Number of patients waiting and Number of lost slots. Nine of the endoscopy units had previously participated in the Modernising Endoscopy Services (MES project during 2003 to redesign their endoscopy services. These MES sites had access to additional funding and data collection software. The other ten (Control sites had modernised independently. All data was requested in two phases and corresponded to eight specific time points between January 2003 and April 2006. Results Only eight of 19 endoscopy units submitted routinely collected, service-related data. Another site's data was collected specifically for the study. A further two units claimed to routinely collect service-related data but did not submit any to the study. The remaining eight did not collect any service-related endoscopy data routinely and liaised with their Trust for data. Of the eight sites submitting service-related data, only three were MES project sites. Of these three, the data variables collected were limited and none collected the complete set of endoscopy data variables requested. Of the other five sites, two collected all four endoscopy data types. Data for the three MES project sites went back as far as January 2003, whilst the five Control sites were only able to submit data from December 2003 onwards. Conclusion There was a lack of service-related endoscopy data routinely collected by the study sites, especially those who had participated in the MES project. Without this data, NHS endoscopy services cannot have a true understanding of their services, cannot identify problems and cannot measure the impact of any

AHP 35: An Abandoned Mountain Deity

Directory of Open Access Journals (Sweden)

Limusishiden (Li Dechun 李得春

2015-02-01

Full Text Available Lasizi are cairns where mountain deities dwell, and the same word also refers to the deities that dwell in these cairns. There are many lasizi in Tu areas in Huzhu Tu Autonomous County, Haidong Municipality, Qinghai Province. The most famous are: Chileb, located in the north part of both Danma Town and Donggou Township Durizang, located in the northern part of Wushi Town Lawa, located atop a mountain on the border between Danma Town and Wushi Town. The mountain is referred to as Lawa Lasizi. Lawa Village is located at the foot of Lawa Lasizi's west side, which is within Danma Town territory. Tughuan Village is located at the foot of Lawa Lasizi's east side, which belongs is within Wushi Town jurisdiction. Sughua, located atop a mountain on the border between Danma Town and Dongshan Township. The mountain is locally known as Sughua Lasizi. Qighaan Dawa Village is located at the foot of Sughua Lasizi's west side, which is part of Dongshan Township. Sughua Village is located at the foot of Sughua Lasizi's east side, which is part of belongs Danma Town. Walighuan, located atop a mountain in Hongyazigou Township and Sunduu, located on the border between Songduo and Bazha (two autonomous Tibetan townships in Huzhu County and Ledu Region. ...

A new network on mountain geomorphosites

Science.gov (United States)

Giusti, Christian

2013-04-01

Since about two decades, the value of geoheritage in mountain areas has been re-discovered in various parts of the Alps (Reynard et al., 2010) and other mountain ranges, and various initiatives (protection of sites worthy of protection, inventories of geomorphosites, geotourist promotion, creation of geoparks, etc.) to conserve or promote mountain geoheritage have been developed. As mountains are recognized as natural areas with a very high geodiversity, and at the same time as areas with a great potential for the development of soft tourism, a new Network on Mountain Geomorphosites was created in October 2012 in conclusion to a workshop organized by the University of Lausanne (Switzerland). The Network is open to all researchers active in geoheritage, geoconservation and geotourism studies in mountain areas. For the first years research will focus on three main issues: - Geoheritage and natural processes: Mountains are very sensitive areas where climate change impacts are very acute and where active geomorphological processes rapidly modify landscapes. It is hypothesized that geoheritage will be highly impacted by global change in the future. Nevertheless, at the moment, very little research is carried out on the evolution of landforms recognized as geoheritage and no specific management measures have been developed. Also, the tourist activities related to geoheritage, especially the trails developed to visit geomorphosites, are sensitive to geomorphological processes in mountain areas in a context of global change, and need, therefore, to be better addressed by geomorphologists. - Geotourism: During the last two decades numerous initiatives have developed geotourism in mountain areas. Nevertheless, studies addressing issues such as the needs of the potential public(s) of geotourism, the evaluation of the quality of the geotourist products developed by scientists and/or local authorities, and the assessment of the economic benefits of geotourism for the regional

Mountains: top down.

Science.gov (United States)

Woodwell, George M

2004-11-01

Mountainous regions offer not only essential habitat and resources, including water, to the earth's more than 6 billion inhabitants, but also insights into how the global human habitat works, how it is being changed at the moment as global climates are disrupted, and how the disruption may lead to global biotic and economic impoverishment. At least 600 million of the earth's more than 6 billion humans dwell in mountainous regions. Such regions feed water into all the major rivers of the world whose valleys support most of the rest of us. At least half of the valley dwellers receive part or all of their water from montane sources, many from the melt water of glaciers, others from the annual snow melt. Glaciers are retreating globally as the earth warms as a result of human-caused changes in the composition of the atmosphere. Many are disappearing, a change that threatens municipal water supplies virtually globally. The warming is greatest in the higher latitudes where the largest glaciers such as those of Greenland and the Antarctic Continent have become vulnerable. The melting of ice in the northern hemisphere raises serious concerns about the continued flow of the Gulf Stream and the possibility of massive climatic changes in Scandinavia and northern Europe. Mountains are also biotic islands in the sea life, rich in endemism at the ecotype level. The systematic warming of the earth changes the environment out from under these genetically specialized strains (ecotypes) which are then maladapted and vulnerable to diseases of all types. The process is systematic impoverishment in the pattern conspicuous on mountain slopes with increasing exposure to climatic extremes. It is seen now in the increased mortality and morbidity of plants as climatic changes accumulate. The seriousness of the global climatic disruption is especially clear in any consideration of mountains. It can and must be addressed constructively despite the adamancy of the current US administration.

An investigation into dental digital radiography in dental practices in West Kent following the introduction of the 2006 NHS General Dental Services contract.

Science.gov (United States)

Mauthe, Peter W; Eaton, Kenneth A

2011-04-01

The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners' (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006. Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient. Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these 'mainly private' GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 'mainly NHS' GDPs reported using digital radio-graphic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more. In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radio graphy. Mainly private GDPs were more likely to use digital radiography than

Are NHS foundation trusts able and willing to exercise autonomy? 'You can take a horse to water...'.

Science.gov (United States)

Exworthy, Mark; Frosini, Francesca; Jones, Lorelei

2011-10-01

Foundation trusts (FTs) have been a central part of the government's National Health Service (NHS) reforms in England since 2004. They illustrate the government's claim to decentralization, by granting greater autonomy to high performing organizations. The number of FTs has grown steadily, reaching 131 in September 2010, over 50% of eligible trusts. Despite this growth, and notwithstanding the fact that organizations which initially became FTs were previously high performing, doubts remain about the implementation of the FT policy. This article examines the implementation of FTs in the NHS and focuses on the nature and exercise of autonomy by FTs. It argues that the ability of FTs to exercise autonomy is in place, but the (relatively limited) extent of implementation may be explained by trusts' lack of willingness to exercise such autonomy. Such unwillingness may be because of continued centralization, unclear policy and financial regimes, fear of negative impacts on relations with other local organizations, and awareness of greater risk to the FT, among others. Addressing the tension between FTs' ability and willingness to exercise autonomy will largely explain the extent to which the government's provider side reforms will be implemented.

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

Science.gov (United States)

Desombre, T; Eccles, G

1998-01-01

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

The association of diagnosis in the private or NHS sector on prostate cancer stage and treatment.

Science.gov (United States)

Barbiere, J M; Greenberg, D C; Wright, K A; Brown, C H; Palmer, C; Neal, D E; Lyratzopoulos, G

2012-03-01

To examine associations of private healthcare with stage and management of prostate cancer. Regional population-based cancer registry information on 15 916 prostate cancer patients. Compared with patients diagnosed in the National Health Service (NHS) (94%), those diagnosed in private hospitals (5%) were significantly more affluent (69 versus 52% in deprivation quintiles 1-2), younger (mean 69 versus 73 years) and diagnosed at earlier stage (72 versus 79% in Stages Private hospital of diagnosis was independently associated with lower probability of advanced disease stage [odds ratio (OR) 0.75, P = 0.002], higher probability of surgery use (OR 1.28, P = 0.037) and lower probability of radiotherapy use (OR 0.75, P = 0.001). Private hospital of diagnosis independently predicted higher surgery and lower radiotherapy use, particularly in more deprived patients aged ≤ 70. In prostate cancer patients, private hospital diagnosis predicts earlier disease stage, higher use of surgery and lower use of radiotherapy, independently of case-mix differences between the two sectors. Substantial socioeconomic differences in stage and treatment patterns remain across centres in the NHS, even after adjusting for private sector diagnosis. Cancer registration data could be used to identify private care use on a population basis and the potential associated treatment disparities.

The impact of integrated team care taught using a live NHS contract on the educational experience of final year dental students.

Science.gov (United States)

Radford, D R; Holmes, S; Woolford, M J; Dunne, S M

2014-11-01

To investigate the responses of the dental student body in the first three years of outreach education (2010-13) at the University of Portsmouth Dental Academy in the areas of integrated team work and use of a current NHS contact. Use of a questionnaire to allow both quantitative and qualitative data to be obtained, administered to the three cohorts of students at the end of their longitudinal attendance at the Academy in their final year of education at King's College London Dental Institute. Data were obtained from 227 students which represented a 95% return rate. Sixty-four percent of students strongly agreed with both statements: 'I am confident with working with a dental nurse' and 'I now understand properly the scope of practice of dental hygiene-therapists'. Sixty-seven percent strongly agreed with the statement 'I have had useful experience of working in NHS primary care during the final year'. Eighty percent either strongly agreed or agreed with the statement 'My experience of real Units of Dental Activity and Key Performance Indicators has encouraged me to positively consider NHS high street dentistry as a career option'. Within the limitations of this study the dental students reported having gained useful experience of working in integrated team care dentistry. They expressed strong support for the education that is being delivered in an outreach environment and, most importantly, the student body was looking forward to entering general dental practice in the UK.

MOUNTAIN TOURISM-PLEASURE AND NECESSITY

Directory of Open Access Journals (Sweden)

Gabriela Corina SLUSARIUC

2015-07-01

Full Text Available Tourism has a more and more important role in the economic development of many countries. Mountain tourism is an anti-stress solutions and a type of disconnection from the citadel life style through replacing some activities of media consuming type, games and virtual socializing with therapy through movement, the physical activity being an essential dimension in assuring the high life quality. Mountaineering is searched for: practicing winter sports, its invigorating and comforting, relaxing role, medical spa treatments practicing hiking, alpinism. Mountain tourism generates increased economic benefits for the surrounding areas, improves the life quality of the local communities and can assure the prosperity of some disadvantaged areas, being able to be a remedy for unindustrialised regions. Mountain tourism contributes to the economic development of the region and also to satisfying spiritual and psychological needs of the people, representing a necessity for a touristic area and a pleasure for tourist consumers.

ACUTE MOUNTAIN SICKNESS

Directory of Open Access Journals (Sweden)

Jakub Krzeszowiak

2012-03-01

Full Text Available This paper presents the most likely pathophysiological causes of the development of acute mountain sickness (AMS, also known as altitude sickness, its pulmonary form i.e. high altitude pulmonary edema (HAPE, and high altitude cerebral edema (HACE. These diseases constitute extraordinary environmental hazards because they are directly connected with low atmospheric pressure, and thus low partial oxygen pressure. The above adverse atmospheric conditions start to affect humans already at an altitude of 2,500 meters above the sea level and, coupled with extreme physical exertion, can quickly lead to respiratory alkalosis, which is not present under any other conditions in the lowlands. Mountaineering above 4,500 m a.s.l. leads to hypoxia of internal organs and, primarily, reduced renal perfusion with all its consequences. The above adverse changes, combined with inadequate acclimatization, can lead to a situation of imminent danger to life and health. This paper describes in detail the consequences of acute mountain sickness, which can ultimately lead to the development of AMS and one of severe forms of HACE and/or HAPE.

Personal and professional profile of mountain medicine physicians.

Science.gov (United States)

Peters, Patrick

2003-01-01

The purpose of this study was to define and describe the personal and professional profile of mountain medicine physicians including general physical training information and to include a detailed overview of the practice of mountain sports. A group of physicians participating in a specialized mountain medicine education program filled out a standardized questionnaire. The data obtained from this questionnaire were first analyzed in a descriptive way and then by statistical methods (chi2 test, t test, and analysis of variance). Detailed results have been provided for gender, age, marital status, general training frequency and methods, professional status, additional medical qualifications, memberships in professional societies and alpine clubs, mountain sports practice, and injuries sustained during the practice of mountain sports. This study has provided a detailed overview concerning the personal and professional profile of mountain medicine physicians. Course organizers as well as official commissions regulating the education in mountain medicine will be able to use this information to adapt and optimize the courses and the recommendations/requirements as detailed by the UIAA-ICAR-ISMM (Union Internationale des Associations Alpinistes, International Commission for Alpine Rescue, International Society for Mountain Medicine).

A comparative study of mid-life, women nurses working in the NHS and UK care homes.

OpenAIRE

Durant, Lesley.

2010-01-01

This thesis examines the working lives of mid-life (aged 40-55) women who are currently working as nurses. The research focuses on why these mid-life nurses demonstrate occupational and organisational commitment, and compares the NHS and care home sectors. The research explores how the differences in organisational structure, culture and context of these two sectors influence nurses' work orientation, job satisfaction and their motivation to continue nursing, incorporating sociological perspe...

Influence of EDC/NHS coupling chemistry on stability and cytotoxicity of ZnO nanoparticles modified with proteins

Science.gov (United States)

Keleştemur, Seda; Altunbek, Mine; Culha, Mustafa

2017-05-01

The toxicity of ZnO nanoparticles (NPs) is a growing concern due to its increasing use in several products including sunscreens, paints, pigments and ceramics for its antibacterial, antifungal, anti-corrosive and UV filtering properties. The toxicity of ZnO NPs is mostly attributed to the Zn2+ release causing an increase in the intracellular reactive oxygen species (ROS) level. The surface modification with a biocompatible ligand or a polymer can be a good strategy to reduce dissolution based toxicity. In two previous studies, the conflicting results with EDC/NHS coupling chemistry for ZnO NPs were reported. In this study, the same surface modification strategy with an emphasis on the stability of ZnO NPs is clarified. First, the density of -OH groups on the ZnO NPs is increased with hydrogen peroxide (H2O2) treatment, and then a silica coating on the ZnO NPs (Si-ZnO) surface is performed. Finally, a covalent attachment of bovine serum albumin (BSA) on three different concentrations of ZnO-Si is carried out by EDC/NHS coupling chemistry. ZnO NPs have a very high dissolution rate under acidic conditions of EDC/NHS coupling chemistry as determined from the ICP-MS analysis. In addition, the amount of ZnO NPs in coupling reaction has an important effect on the dissolution rate of Zn2+ and dependently BSA attached on the ZnO NP surfaces. Finally, the cytotoxicity of the BSA modified Si-ZnO NPs on human lung cancer (A549) and human skin fibroblast (HSF) is evaluated. Although an increased association of BSA modified ZnO NPs with cells was observed, the modification significantly decreased their cytotoxicity. This can be explained with the decreased active surface area of ZnO NPs with the surface modification. However, an increase in the mitochondrial depolarization and ROS production was observed depending on the amount of BSA coverage.

Mountains of Our Future Earth: Defining Priorities for Mountain Research—A Synthesis From the 2015 Perth III Conference

Directory of Open Access Journals (Sweden)

Erin H. Gleeson

2016-11-01

Full Text Available The Perth conferences, held every 5 years in Perth, Scotland, bring together people who identify as mountain researchers and who are interested in issues related to global change in mountain social-ecological systems. These conferences provide an opportunity to evaluate the evolution of research directions within the mountain research community, as well as to identify research priorities. The Future Earth Strategic Research Agenda provides a useful framework for evaluating the mountain research community's progress toward addressing global change and sustainability challenges. Using a process originally set up to analyze contributions to the 2010 conference, the abstracts accepted for the 2015 conference in the context of the Future Earth framework were analyzed. This revealed a continued geographic underrepresentation in mountain research of Africa, Latin America, and South and Southeast Asia but a more even treatment of biophysical and social science themes than in 2010. It also showed that the Perth conference research community strongly focused on understanding system processes (the Dynamic Planet theme of the Future Earth research agenda. Despite the continued bias of conference contributions toward traditional observation- and conservation-oriented research, survey results indicate that conference participants clearly believe that transdisciplinary, transformative research is relevant to mountains. Of the 8 Future Earth focal challenges, those related to safeguarding natural assets, promoting sustainable land use, increasing resilience and understanding the water-energy-food nexus received considerable attention. The challenges related to sustainable consumption, decarbonizing socioeconomic systems, cities, and health were considerably less well represented, despite their relevance to mountain socioeconomic systems. Based on these findings, we outline a proposal for the future directions of mountain research.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

Science.gov (United States)

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

Reasons for decision in the matter of Trans Mountain Pipeline Inc. (formerly Terasen Pipelines (Trans Mountain) Inc.) : tariffs

International Nuclear Information System (INIS)

2007-01-01

In 2006 and 2007 Terasen Pipelines (Trans Mountain) Inc. (now Trans Mountain Pipeline Inc.) submitted a series of applications to the National Energy Board for revisions to the Trans Mountain Tariffs. They were filed in response to apportionment concerns on the Trans Mountain pipeline. Four of the applications involved pronounced and contentious changes to the capacity allocation procedures on the pipeline system. For ease of reference, the Board amalgamated its 4 decisions on these applications into a single document. A map of the Trans Mountain pipeline system as a whole was presented along with a detailed map indicating the delivery locations served by the system in the lower mainland of British Columbia and the state of Washington. The issues considered by the Board in each of these decisions included capacity allocation for Westridge Dock; capacity allocations to export destinations; common carriage requirements; and the need for creating a new barge subcategory. Relevant sections of the National Energy Board Act referred to in the decisions were highlighted. This document also listed the Trans Mountain Tariffs that have introduced notable revisions to the capacity allocation procedures on the system since September 2003. 16 refs., 2 figs., 3 appendices

Separating Trends in Whitebark Pine Radial Growth Related to Climate and Mountain Pine Beetle Outbreaks in the Northern Rocky Mountains, USA

Directory of Open Access Journals (Sweden)

Saskia L. van de Gevel

2017-06-01

Full Text Available Drought and mountain pine beetle (Dendroctonus ponderosae Hopkins outbreaks have affected millions of hectares of high-elevation conifer forests in the Northern Rocky Mountains during the past century. Little research has examined the distinction between mountain pine beetle outbreaks and climatic influence on radial growth in endangered whitebark pine (Pinus albicaulis Engelm. ecosystems. We used a new method to explore divergent periods in whitebark pine radial growth after mountain pine beetle outbreaks across six sites in western Montana. We examined a 100-year history of mountain pine beetle outbreaks and climate relationships in whitebark pine radial growth to distinguish whether monthly climate variables or mountain pine outbreaks were the dominant influence on whitebark pine growth during the 20th century. High mortality of whitebark pines was caused by the overlapping effects of previous and current mountain pine beetle outbreaks and white pine blister rust infection. Wet conditions from precipitation and snowpack melt in the previous summer, current spring, and current summer benefit whitebark pine radial growth during the following growing season. Whitebark pine radial growth and climate relationships were strongest in sites less affected by the mountain pine beetle outbreaks or anthropogenic disturbances. Whitebark pine population resiliency should continue to be monitored as more common periods of drought will make whitebark pines more susceptible to mountain pine beetle attack and to white pine blister rust infection.

Report on accreditation learning sets in the West Midlands region of the NHS.

Science.gov (United States)

Giles, G

2000-12-01

This article reports on the evaluation of the first year of a project, which utilized learning sets to support librarians undergoing the accreditation process, in the health libraries in the West Midlands region of the NHS. The West Midlands Health region is divided up into education consortia patches. Each group of patch librarians was allocated a local accreditation facilitator. The groups met regularly to discuss problems and progress relating to their library's accreditation. The results of the evaluation suggest that this is a valuable approach to use. The recommendations state that regular, frequent meetings are needed. Extra training and guidance would help the facilitators to be more effective in their role.

Mountaineering Tourism

Directory of Open Access Journals (Sweden)

Patrick Maher

2016-08-01

Full Text Available Reviewed: Mountaineering Tourism Edited by Ghazali Musa, James Higham, and Anna Thompson-Carr. Abingdon, United Kingdom: Routledge, 2015. xxvi + 358 pp. Hardcover. US$ 145.00. ISBN 978-1-138-78237-2.

Stratigraphic and structural framework of Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Spengler, R.W.; Fox, K.F. Jr.

1988-01-01

Yucca Mountain is located within the southwestern Nevada volcanic field, ∼140 km northwest of Las Vegas, Nevada, and 50 km northeast of Death Valley, California. The mountain consist of a series of long, linear, north-trending volcanic ridges that approach an 1800-m maximum elevation near The Prow. The broad intermontane alluviated valleys of Crater Flat, the Amargosa Desert, and Jackass Flats, averaging 800 to 1100 m in elevation, form the western, southern, and eastern margins of Yucca Mountain, respectively. North of The Prow, Yucca Mountain merges with other volcanic highlands that flank the southern rim of the Timber Mountain-Oasis Valley caldera complex. The stratigraphy and structure of the area are discussed. Future geologic studies will attempt to determine if faults extend beneath Yucca Mountain, and, if present, their potential effects on the hydrologic and tectonic regimes

Yucca Mountain project prototype testing

International Nuclear Information System (INIS)

Hughes, W.T.; Girdley, W.A.

1990-01-01

The U.S. DOE is responsible for characterizing the Yucca Mountain site in Nevada to determine its suitability for development as a geologic repository to isolate high-level nuclear waste for at least 10,000 years. This unprecedented task relies in part on measurements made with relatively new methods or applications, such as dry coring and overcoring for studies to be conducted from the land surface and in an underground facility. The Yucca Mountain Project has, since 1988, implemented a program of equipment development and methods development for a broad spectrum of hydrologic, geologic, rock mechanics, and thermomechanical tests planned for use in an Exploratory Shaft during site characterization at the Yucca Mountain site. A second major program was fielded beginning in April 1989 to develop and test methods and equipment for surface drilling to obtain core samples from depth using only air as a circulating medium. The third major area of prototype testing has been during the ongoing development of the Instrumentation/ Data Acquisition System (IDAS), designed to collect and monitor data from down-hole instrumentation in the unsaturated zone, and store and transmit the data to a central archiving computer. Future prototype work is planned for several programs including the application of vertical seismic profiling methods and flume design to characterizing the geology at Yucca Mountain. The major objectives of this prototype testing are to assure that planned Site Characterization testing can be carried out effectively at Yucca Mountain, both in the Exploratory Shaft Facility (ESF), and from the surface, and to avoid potential major failures or delays that could result from the need to re-design testing concepts or equipment. This paper will describe the scope of the Yucca Mountain Project prototype testing programs and summarize results to date. 3 figs

Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales.

Science.gov (United States)

Cooper, Andrew; Gray, Jonathon; Willson, Alan; Lines, Chris; McCannon, Joe; McHardy, Karina

2015-03-01

Effective communication is critical to successful large-scale change. Yet, in our experience, communications strategies are not formally incorporated into quality improvement (QI) frameworks. The 1000 Lives Campaign ('Campaign') was a large-scale national QI collaborative that aimed to save an additional 1000 lives and prevent 50 000 episodes of harm in Welsh health care over a 2-year period. We use the Campaign as a case study to describe the development, application, and impact of a communications strategy embedded in a large-scale QI initiative. A comprehensive communications strategy guided communications work during the Campaign. The main aims of the communications strategy were to engage the hearts and minds of frontline National Health Service (NHS) staff in the Campaign and promote their awareness and understanding of specific QI interventions and the wider patient safety agenda. We used qualitative and quantitative measures to monitor communications outputs and assess how the communications strategy influenced awareness and knowledge of frontline NHS staff. The communications strategy facilitated clear and consistent framing of Campaign messages and allowed dissemination of information related to the range of QI interventions. It reaffirmed the aim and value of the Campaign to frontline staff, thereby promoting sustained engagement with Campaign activities. The communications strategy also built the profile of the Campaign both internally with NHS organizations across Wales and externally with the media, and played a pivotal role in improving awareness and understanding of the patient safety agenda. Ultimately, outcomes from the communications strategy could not be separated from overall Campaign outcomes. Systematic and structured communications can support and enhance QI initiatives. From our experience, we developed a 'communications bundle' consisting of six core components. We recommend that communications bundles be incorporated into existing QI

Mountain biking injuries: a review.

Science.gov (United States)

Carmont, Michael R

2008-01-01

Mountain biking is a fast, exciting adventure sport with increasing numbers of participants and competitions. A search of PubMed, Medline, CINAHL, DH data, and Embase databases was performed using the following keywords: mountain, biking and injuries. This revealed 2 review articles, 17 case controlled studies, 4 case series and 5 case reports. This review summarises the published literature on mountain biking injuries, discusses injury frequency and common injury mechanisms. Riders are quick to adopt safety measures. Helmet usage is now increasingly common and handlebar adaptations have been discontinued. Although the sport has a reputation for speed and risk with research and awareness, injury prevention measures are being adopted making the sport as safe as possible.

Assessing psychological well-being: a holistic investigation of NHS employees.

Science.gov (United States)

Loretto, W; Popham, F; Platt, S; Pavis, S; Hardy, G; MacLeod, L; Gibbs, J

2005-10-01

A substantial body of research has investigated the effects of work on the psychological well-being of employees. However, there has been little assessment of the ways in which workplace factors (such as job demands, working conditions, inter-personal relations and workplace change) interact with personal factors (such as work-life balance, family circumstances, key personality traits or demographic characteristics) to affect psychological health. This article reports findings from a study which aimed to construct and test a comprehensive model of the influences on employee well-being within the UK National Health Service (NHS). The results show that psychological well-being is influenced by a complex array of personal, environmental and work factors. A key finding is that there are clear associations between workplace change and well-being and between work-life (im)balance and well-being. These effects appear to be independent of one another and therefore require separate attention from managers and employers.

Preparation and properties of EDC/NHS mediated crosslinking poly (gamma-glutamic acid)/epsilon-polylysine hydrogels

Energy Technology Data Exchange (ETDEWEB)

Hua, Jiachuan [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Li, Zheng, E-mail: lizheng_nx@163.com [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Xia, Wen; Yang, Ning; Gong, Jixian [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Zhang, Jianfei, E-mail: zhangjianfei1960@126.com [Key Laboratory of Advanced Textile Composites, Tianjin Polytechnic University, Ministry of Education, Tianjin 300387 (China); School of Textiles, Tianjin Polytechnic University, Tianjin 300387 (China); Qiao, Changsheng [Key Laboratory of Industrial Microbiology, Tianjin University of Science and Technology, Ministry of Education, Tianjin 300457 (China)

2016-04-01

In this paper, a novel pH-sensitive poly (amino acid) hydrogel based on poly γ-glutamic acid (γ-PGA) and ε-polylysine (ε-PL) was prepared by carbodiimide (EDC) and N-hydroxysuccinimide (NHS) mediated polymerization. The influence of PGA/PL molar ratio and EDC/NHS concentration on the structure and properties was studied. Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectroscopy (XPS) proved that hydrogels were crosslinked through amide bond linkage, and the conversion rate of a carboxyl group could reach 96%. Scanning electron microscopy (SEM) results showed a regularly porous structure with 20 μm pore size in average. The gelation time in the crosslink process of PGA/PL hydrogels was within less than 5 min. PGA/PL hydrogels had excellent optical performance that was evaluated by a novel optotype method. Furthermore, PGA/PL hydrogels were found to be pH-sensitive, which could be adjusted to the pH of swelling media intelligently. The terminal pH of swelling medium could be controlled at 5 ± 1 after equilibrium when the initial pH was within 3–11. The swelling kinetics was found to follow a Voigt model in deionized water but a pseudo-second-order model in normal saline and phosphate buffer solution, respectively. The differential swelling degrees were attributed to the swelling theory based on the different ratio of –COOH/–NH{sub 2} and pore size in hydrogels. The results of mechanical property indicated that PGA/PL hydrogels were soft and elastic. Moreover, PGA/PL hydrogels exhibited excellent biocompatibility by cell proliferation experiment. PGA/PL hydrogels could be degraded in PBS solution and the degradation rate was decreased with the increase of the molar ratio of PL. Considering the simple preparation process and pH-sensitive property, these PGA/PL hydrogels might have high potential for use in medical and clinical fields. - Highlights: • We prepared a biocompatible and degradable poly amino acids hydrogel via EDC/NHS

Enhancing nurse satisfaction: an exploration of specialty nurse shortage in a region of NHS England.

Science.gov (United States)

Gray, Keith; Wilde, Rebecca; Shutes, Karl

2018-03-22

This article offers nurse managers guidance on analysing, managing and addressing a potentially dissatisfied nursing workforce, focusing on three priority shortage specialties: emergency care, paediatrics and cardiology. The aim of the study was to explore to what extent registered nurses and healthcare assistants, referred to collectively here as 'nursing staff', are satisfied with teamworking opportunities, continuing professional development (CPD) opportunities and workplace autonomy. A survey questionnaire was developed to evaluate three derived determinants of nurse satisfaction: team working, CPD and autonomy. The NHS West Midlands region was the focus given that it is among the poorest performing regions outside London in filling nursing posts. Overall, nursing staff respondents were satisfied with teamworking, CPD and autonomy, which challenges the perception that nurses in NHS England are dissatisfied with these satisfaction determinants. The findings give a complex picture of nurse satisfaction; for example a large minority of respondents were dissatisfied with their ability to carry out duties as they see fit. When developing management systems to investigate, manage and enhance nurse satisfaction, nurse managers must recognise the complexity and subtleties of determining factors. This will increase as nursing becomes more specialised. Subsequently, nurse managers need to work closely with staff at higher education institutions and other professional agencies to commission appropriate professional development. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data.

Science.gov (United States)

Keogh, Brad; Culliford, David; Guerrero-Ludueña, Richard; Monks, Thomas

2018-05-24

To quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels. Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies. NHS trusts in England submitting routine nationally reported measures to NHS England. 142 acute non-specialist trusts operating in England between 2012 and 2016. The primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations. Univariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care. Univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%). The flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous

SNL Yucca Mountain Project data report: Density and porosity data for tuffs from the unsaturated zone at Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Schwartz, B.M.

1990-02-01

Yucca Mountain, located on and adjacent to the Nevada Test Site in southern Nevada, is being evaluated as a potential site for underground disposal of nuclear wastes. At present, the physical, thermal, and mechanical properties of tuffaceous rocks from Yucca Mountain are being determined as part of the Yucca Mountain Project. This report documents experiment data, which have been obtained by Sandia National Laboratories or its contractors, for the density and porosity of tuffaceous rocks that lie above the water table at Yucca Mountain. 7 refs., 2 figs., 3 tabs

HYDROLOGIC CHARACTERISTICS OF FAULTS AT YUCCA MOUNTAIN, NEVADA

International Nuclear Information System (INIS)

R.P. Dickerson

2000-01-01

Yucca Mountain comprises a series of north-trending ridges composed of tuffs within the southwest Nevada volcanic field, 120 km northwest of Las Vegas, Nevada. These ridges are formed of east-dipping blocks of interbedded welded and nonwelded tuff that are offset along steep, mostly west-dipping faults that have tens to hundreds of meters of vertical separation. Yucca Mountain is currently under study as a potential site for underground storage of high-level radioactive waste, with the principle goal being the safe isolation of the waste from the accessible environment. To this end, an understanding of the behavior of ground-water flow through the mountain in the unsaturated zone and beneath the mountain in the saturated zone is critical. The percolation of water through the mountain and into the ground-water flow system beneath the potential repository site is predicated on: (1) the amount of water available at the surface as a result of the climatic conditions, (2) the hydrogeologic characteristics of the volcanic strata that compose the mountain. and (3) the hydrogeologic characteristics of the structures, particularly fault zones and fracture networks, that disrupt these strata. This paper addresses the hydrogeologic characteristics of the fault zones at Yucca Mountain, focusing primarily on the central part of the mountain where the potential repository block is located

Symposium 9: Rocky Mountain futures: preserving, utilizing, and sustaining Rocky Mountain ecosystems

Science.gov (United States)

Baron, Jill S.; Seastedt, Timothy; Fagre, Daniel B.; Hicke, Jeffrey A.; Tomback, Diana; Garcia, Elizabeth; Bowen, Zachary H.; Logan, Jesse A.

2013-01-01

In 2002 we published Rocky Mountain Futures, an Ecological Perspective (Island Press) to examine the cumulative ecological effects of human activity in the Rocky Mountains. We concluded that multiple local activities concerning land use, hydrologic manipulation, and resource extraction have altered ecosystems, although there were examples where the “tyranny of small decisions” worked in a positive way toward more sustainable coupled human/environment interactions. Superimposed on local change was climate change, atmospheric deposition of nitrogen and other pollutants, regional population growth, and some national management policies such as fire suppression.

A Safe Place to Stay Sharp: Action Learning Meets Cooperative Inquiry in the Service of NHS OD Capacity Building

Science.gov (United States)

Traeger, James; Norgate, Carolyn

2015-01-01

This is an account of practice. It explores the meeting point between action learning and action research, as a way of doing capacity building in organisational development (OD) in the NHS in the UK. The authors were part of a short cooperative inquiry (Heron, J. 1996. "Co-operative Inquiry: Research into the Human Condition." London:…

Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): results after one year.

Science.gov (United States)

Artac, Macide; Dalton, Andrew R H; Majeed, Azeem; Car, Josip; Millett, Christopher

2013-08-01

We aimed to assess whether the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program, was associated with reduction in CVD risk in attendees after one year. We extracted data from patients aged 40-74 years, with high estimated CVD risk, who were registered with general practices in a deprived, culturally diverse setting in England. We included 4748 patients at baseline (July 2008-November 2009), with 3712 at follow-up (December 2009-March 2011). We used a pre-post study design to assess changes in global CVD risk, individual CVD risk factors and statin prescription in patients with a complete and partial Health Check. There were significant reductions in mean CVD risk score (28.2%; 95% confidence interval (CI)=27.3-29.1 to 26.2%; 95% CI, 25.4-27.1), diastolic blood pressure, total cholesterol levels and lipid ratios after one year in patients with a complete Health Check. Statin prescription increased from 14.0% (95% CI=11.9-16.0) to 60.6% (95% CI=57.7-63.5). The introduction of NHS Health Check was associated with significant but modest reductions in CVD risk among screened high-risk individuals. Further cost-effectiveness analysis and work accounting for uptake is required to assess whether the program can make significant changes to population health. Copyright © 2013 Elsevier Inc. All rights reserved.

How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

Science.gov (United States)

Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

2005-01-01

Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

[Life cycles of ground beetles (Coleoptera, Carabidae) from the mountain taiga and mountain forest-steppe in the Eastern Sayan].

Science.gov (United States)

Khobrakova, L Ts; Sharova, I Kh

2005-01-01

Seasonal dynamics and demographic structure was studied in 15 dominant ground beetle species in the mountain taiga and mountain forest-steppe belts of the Eastern Sayan (Okinskoe Plateau). Life cycles of the dominant ground beetle species were classified by developmental time, seasonal dynamics, and intrapopulation groups with different reproduction timing. The strategies of carabid life cycles adapted to severe mountain conditions of the Eastern Sayan were revealed.

Floristic analysis of the wanda mountain in north eastern china

International Nuclear Information System (INIS)

Wang, H.; Xu, L.; Zhang, Z.

2016-01-01

The plants of the Wanda Mountain area were investigated between 2009 to 2013. The results show that Wanda Mountain has 95 families of seed plants distributed in 334 genera and 705 species. A geographical component analysis shows that in addition to a small number of cosmopolitan species, cold, temperate and tropical species account for 14.9%, 77.3% and 4.4% of the total species, respectively, indicating that the flora of the Wanda Mountains exhibits a significant temperate nature and includes a small number of tropical components and certain cold components. In addition, the Wanda Mountains show a remarkable level of endemism and are geographically related to other regions in East Asia, particularly Japan. Furthermore, the Wanda Mountains present a complicated species composition, with a total of 14 distribution patterns and 10 variants. The coefficient of similarity between the flora of the Wanda Mountain area and the flora of the Changbai Mountain area is 43.1%, and the coefficient of similarity between the flora of the Wanda Mountain area and the flora of the Lesser Xingan Mountain area is 49.2%, indicating that the plants of the Wanda Mountain area are more common to those of the Lesser Xingan Mountain area. (author)

ACUTE PHASE PROTEIN INCREASE IN HIGH ALTITUDE MOUNTAINEERS

Directory of Open Access Journals (Sweden)

Tolga Saka

Full Text Available ABSTRACT Introduction: Many middle-aged Turks go hiking in mountains to breathe some fresh air or to maintain fitness. Objective: This study investigated the effects of regular high altitude mountain climbing on the metabolic and hematological responses of mountaineers. Methods: Hematological and biochemical parameters were studied, as well as some hormonal values of 21 mountaineers and 16 healthy age-matched sedentary volunteers. Results: The neutrophil to lymphocyte ratio (NLR was significantly lower (p<0.04 in mountaineers compared with the sedentary group. Total protein (p<0.001 and albumin (p<0.001 were lower, while the levels of ferritin (p<0.04, creatine (p<0.03 and creatine phosphokinase (p<0.01 were higher in mountaineers. Other hematological and biochemical parameters, i.e., erythrocytes, leukocytes, hemoglobin and hematocrit, did not change significantly. Conclusion: Our results show that regular exposure to high altitude increased the serum levels of some acute phase proteins with anti-inflammatory properties.

An evaluation of seven methods for controlling mountain laurel thickets in the mixed-oak forests of the central Appalachian Mountains, USA

Science.gov (United States)

Patrick H. Brose

2017-01-01

In the Appalachian Mountains of eastern North America, mountain laurel (Kalmia latifolia) thickets in mixed-oak (Quercus spp.) stands can lead to hazardous fuel situations, forest regeneration problems, and possible forest health concerns. Therefore, land managers need techniques to control mountain laurel thickets and limit...

MOUNTAIN-SCALE COUPLED PROCESSES (TH/THC/THM) MODELS

International Nuclear Information System (INIS)

Y.S. Wu

2005-01-01

This report documents the development and validation of the mountain-scale thermal-hydrologic (TH), thermal-hydrologic-chemical (THC), and thermal-hydrologic-mechanical (THM) models. These models provide technical support for screening of features, events, and processes (FEPs) related to the effects of coupled TH/THC/THM processes on mountain-scale unsaturated zone (UZ) and saturated zone (SZ) flow at Yucca Mountain, Nevada (BSC 2005 [DIRS 174842], Section 2.1.1.1). The purpose and validation criteria for these models are specified in ''Technical Work Plan for: Near-Field Environment and Transport: Coupled Processes (Mountain-Scale TH/THC/THM, Drift-Scale THC Seepage, and Drift-Scale Abstraction) Model Report Integration'' (BSC 2005 [DIRS 174842]). Model results are used to support exclusion of certain FEPs from the total system performance assessment for the license application (TSPA-LA) model on the basis of low consequence, consistent with the requirements of 10 CFR 63.342 [DIRS 173273]. Outputs from this report are not direct feeds to the TSPA-LA. All the FEPs related to the effects of coupled TH/THC/THM processes on mountain-scale UZ and SZ flow are discussed in Sections 6 and 7 of this report. The mountain-scale coupled TH/THC/THM processes models numerically simulate the impact of nuclear waste heat release on the natural hydrogeological system, including a representation of heat-driven processes occurring in the far field. The mountain-scale TH simulations provide predictions for thermally affected liquid saturation, gas- and liquid-phase fluxes, and water and rock temperature (together called the flow fields). The main focus of the TH model is to predict the changes in water flux driven by evaporation/condensation processes, and drainage between drifts. The TH model captures mountain-scale three-dimensional flow effects, including lateral diversion and mountain-scale flow patterns. The mountain-scale THC model evaluates TH effects on water and gas

MOUNTAIN-SCALE COUPLED PROCESSES (TH/THC/THM)MODELS

Energy Technology Data Exchange (ETDEWEB)

Y.S. Wu

2005-08-24

This report documents the development and validation of the mountain-scale thermal-hydrologic (TH), thermal-hydrologic-chemical (THC), and thermal-hydrologic-mechanical (THM) models. These models provide technical support for screening of features, events, and processes (FEPs) related to the effects of coupled TH/THC/THM processes on mountain-scale unsaturated zone (UZ) and saturated zone (SZ) flow at Yucca Mountain, Nevada (BSC 2005 [DIRS 174842], Section 2.1.1.1). The purpose and validation criteria for these models are specified in ''Technical Work Plan for: Near-Field Environment and Transport: Coupled Processes (Mountain-Scale TH/THC/THM, Drift-Scale THC Seepage, and Drift-Scale Abstraction) Model Report Integration'' (BSC 2005 [DIRS 174842]). Model results are used to support exclusion of certain FEPs from the total system performance assessment for the license application (TSPA-LA) model on the basis of low consequence, consistent with the requirements of 10 CFR 63.342 [DIRS 173273]. Outputs from this report are not direct feeds to the TSPA-LA. All the FEPs related to the effects of coupled TH/THC/THM processes on mountain-scale UZ and SZ flow are discussed in Sections 6 and 7 of this report. The mountain-scale coupled TH/THC/THM processes models numerically simulate the impact of nuclear waste heat release on the natural hydrogeological system, including a representation of heat-driven processes occurring in the far field. The mountain-scale TH simulations provide predictions for thermally affected liquid saturation, gas- and liquid-phase fluxes, and water and rock temperature (together called the flow fields). The main focus of the TH model is to predict the changes in water flux driven by evaporation/condensation processes, and drainage between drifts. The TH model captures mountain-scale three-dimensional flow effects, including lateral diversion and mountain-scale flow patterns. The mountain-scale THC model evaluates TH effects on

A discussion: the future role of homeopathy in the National Health Service (NHS).

Science.gov (United States)

Ng, Daniel Yu-Hin

2011-07-01

Homeopathy has been provided by the National Health Service in the UK for over 60 years, funded largely by taxpayer's money. However, in recent years, its provision has come under much criticism questioning its true value. Taking a neutral stance, arguments both for and against the provision of homeopathy on the NHS is presented. It includes issues such as the evidence and safety profile of homeopathy, but also takes into account costs and benefits of homeopathy in a wider perspective. Overall, the provision of homeopathy is justified as long as there is a need within the population, occupying a complementary role alongside conventional medicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

Mountain biking injuries: an update.

Science.gov (United States)

Kronisch, Robert L; Pfeiffer, Ronald P

2002-01-01

This article reviews the available literature regarding injuries in off-road bicyclists. Recent progress in injury research has allowed the description of several patterns of injury in this sport. Mountain biking remains popular, particularly among young males, although sales and participation figures have decreased in the last several years. Competition in downhill racing has increased, while cross-country racing has decreased somewhat in popularity. Recreational riders comprise the largest segment of participants, but little is known about the demographics and injury epidemiology of noncompetitive mountain cyclists. Most mountain bikers participating in surveys reported a history of previous injuries, but prospective studies conducted at mountain bike races have found injury rates of bike racing the risk of injury may be higher for women than men. Minor injuries such as abrasions and contusions occur frequently, but are usually of little consequence. Fractures usually involve the torso or upper extremities, and shoulder injuries are common. Head and face injuries are not always prevented by current helmet designs. Fatal injuries are rare but have been reported. Improvements in safety equipment, rider training and racecourse design are suggested injury prevention measures. The authors encourage continued research in this sport.

Yucca Mountain Milestone

International Nuclear Information System (INIS)

Hunt, Rod

1997-01-01

The Department of Energy project to determine if the Yucca Mountain site in Nevada is suitable for geologic disposal of high-level nuclear waste reached a major milestone in late April when a 25-foot-diameter tunnel boring machine ''holed through'' completing a five-mile-long, horseshoe-shaped excavation through the mountain. When the cutting-head of the giant machine broke through to daylight at the tunnel's south portal, it ended a 2 1/2-year excavation through the mountain that was completed ahead of schedule and with an outstanding safety record. Video of the event was transmitted live by satellite to Washington, DC, where it was watched by Secretary of Energy Frederico Pena and other high-level DOE officials, signifying the importance of the project's mission to find a repository for high-level nuclear waste and spent nuclear fuel produced by nuclear power plants. This critical undertaking is being performed by DOE's Office of Civilian Radioactive Waste Management (OCRWM). The tunnel is the major feature of the Exploratory Studies Facility (ESF), which serves as an underground laboratory for engineers and scientists to help determine if Yucca Mountain is suitable to serve as a repository for the safe disposal of high-level nuclear waste. Morrison Knudsen's Environmental/Government Group is providing design and construction-management services on the project. The MK team is performing final design for the ESF and viability assessment design for the underground waste repository that will be built only if the site is found suitable for such a mission. In fact, if at anytime during the ESF phase, the site is found unsuitable, the studies will be stopped and the site restored to its natural state

Mountain laurel toxicosis in a dog.

Science.gov (United States)

Manhart, Ingrid O; DeClementi, Camille; Guenther, Christine L

2013-01-01

To describe a case of mountain laurel (Kalmia latifolia) toxicosis in a dog, including case management and successful outcome. A dog presented for vomiting, hematochezia, bradycardia, weakness, and ataxia, which did not improve with supportive treatment. Mountain laurel ingestion was identified as cause of clinical signs after gastrotomy was performed to remove stomach contents. Supportive treatment was continued and the dog made a full recovery. This report details a case of mountain laurel toxicosis in a dog, including management strategies and outcome, which has not been previously published in the veterinary literature. © Veterinary Emergency and Critical Care Society 2013.

75 FR 69080 - Ocean Transportation Intermediary License Applicants

Science.gov (United States)

2010-11-10

... license as a Non-Vessel-Operating Common Carrier (NVO), and/or Ocean Freight Forwarder (OFF)--Ocean..., Building 14-A, Kenner, LA 70062, Officers: Gary J. Cheramie, President (Qualifying Individual), George...: License Transfer. Total Global Solutions, Inc. (NVO & OFF), 4290 Bells Ferry Road 224, Suite 106, Kennesaw...

Teaching Analytical Method Transfer through Developing and Validating Then Transferring Dissolution Testing Methods for Pharmaceuticals

Science.gov (United States)

Kimaru, Irene; Koether, Marina; Chichester, Kimberly; Eaton, Lafayette

2017-01-01

Analytical method transfer (AMT) and dissolution testing are important topics required in industry that should be taught in analytical chemistry courses. Undergraduate students in senior level analytical chemistry laboratory courses at Kennesaw State University (KSU) and St. John Fisher College (SJFC) participated in development, validation, and…

76 FR 72000 - Patent, Trademark & Copyright Acts

Science.gov (United States)

2011-11-21

... DEPARTMENT OF THE INTERIOR Geological Survey Patent, Trademark & Copyright Acts AGENCY: U.S... Consultants, 1255 Roberts Boulevard NW., Suite 200, Kennesaw, GA 30144, on U.S. Patent Application Serial No. 12/133,666, and a divisional patent application to be filed shortly at the Patent and Trademark...

Complexity in the new NHS: longitudinal case studies of CCGs in England.

Science.gov (United States)

Checkland, Katherine; McDermott, Imelda; Coleman, Anna; Perkins, Neil

2016-01-07

The reform in the English National Health Services (NHS) under the Health and Social Care Act 2012 is unlike previous NHS reorganisations. The establishment of clinical commissioning groups (CCGs) was intended to be 'bottom up' with no central blueprint. This paper sets out to offer evidence about how this process has played out in practice and examines the implications of the complexity and variation which emerged. Detailed case studies in CCGs across England, using interviews, observation and documentary analysis. Using realist framework, we unpacked the complexity of CCG structures. In phase 1 of the study (January 2011 to September 2012), we conducted 96 interviews, 439 h of observation in a wide variety of meetings, 2 online surveys and 38 follow-up telephone interviews. In phase 2 (April 2013 to March 2015), we conducted 42 interviews with general practitioners (GPs) and managers and observation of 48 different types of meetings. Our study has highlighted the complexity inherent in CCGs, arising out of the relatively permissive environment in which they developed. Not only are they very different from one another in size, but also in structure, functions between different bodies and the roles played by GPs. The complexity and lack of uniformity of CCGs is important as it makes it difficult for those who must engage with CCGs to know who to approach at what level. This is of increasing importance as CCGs are moving towards greater integration across health and social care. Our study also suggests that there is little consensus as to what being a 'membership' organisation means and how it should operate. The lack of uniformity in CCG structure and lack of clarity over the meaning of 'membership' raises questions over accountability, which becomes of greater importance as CCG is taking over responsibility for primary care co-commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

Mountain Warfare: The Need for Specialist Training

National Research Council Canada - National Science Library

Malik, Muhammad

2003-01-01

This study focuses on the need for specialist training for mountain warfare. It analyzes the special characteristics of mountain and high altitude terrain which affect conduct of military operations...

Yucca Mountain Project public interactions

International Nuclear Information System (INIS)

Reilly, B.E.

1990-01-01

The US Department of Energy (DOE) is committed to keeping the citizens of Nevada informed about activities that relate to the high-level nuclear waste repository program. This paper presents an overview of the Yucca Mountain Project's public interaction philosophy, objectives, activities and experiences during the two years since Congress directed the DOE to conduct site characterization activities only for the Yucca Mountain site

ARCOS Network: A Sustainable Mountain Development Hub for Africa

Directory of Open Access Journals (Sweden)

Gilbert Muvunankiko

2017-05-01

Full Text Available The African continent is endowed with mountains of high productivity, biodiversity, endemism, and cultural diversity. African mountain ecosystems play an important role in economic development, poverty alleviation, and environmental protection. However, climate change and extreme events, as well as human activities, alter the capacity of mountains to provide such services to millions of Africans who depend on them. Since the creation in 1995 of the Albertine Rift Conservation Society (ARCOS, mountains have been at the core of its programs, and collaboration among stakeholders is a key aspect of its search for sustainable solutions to threats affecting African mountains.

Extreme ground motions and Yucca Mountain

Science.gov (United States)

Hanks, Thomas C.; Abrahamson, Norman A.; Baker, Jack W.; Boore, David M.; Board, Mark; Brune, James N.; Cornell, C. Allin; Whitney, John W.

2013-01-01

Yucca Mountain is the designated site of the underground repository for the United States' high-level radioactive waste (HLW), consisting of commercial and military spent nuclear fuel, HLW derived from reprocessing of uranium and plutonium, surplus plutonium, and other nuclear-weapons materials. Yucca Mountain straddles the western boundary of the Nevada Test Site, where the United States has tested nuclear devices since the 1950s, and is situated in an arid, remote, and thinly populated region of Nevada, ~100 miles northwest of Las Vegas. Yucca Mountain was originally considered as a potential underground repository of HLW because of its thick units of unsaturated rocks, with the repository horizon being not only ~300 m above the water table but also ~300 m below the Yucca Mountain crest. The fundamental rationale for a geologic (underground) repository for HLW is to securely isolate these materials from the environment and its inhabitants to the greatest extent possible and for very long periods of time. Given the present climate conditions and what is known about the current hydrologic system and conditions around and in the mountain itself, one would anticipate that the rates of infiltration, corrosion, and transport would be very low—except for the possibility that repository integrity might be compromised by low-probability disruptive events, which include earthquakes, strong ground motion, and (or) a repository-piercing volcanic intrusion/eruption. Extreme ground motions (ExGM), as we use the phrase in this report, refer to the extremely large amplitudes of earthquake ground motion that arise at extremely low probabilities of exceedance (hazard). They first came to our attention when the 1998 probabilistic seismic hazard analysis for Yucca Mountain was extended to a hazard level of 10-8/yr (a 10-4/yr probability for a 104-year repository “lifetime”). The primary purpose of this report is to summarize the principal results of the ExGM research program

Running an NHS community homeopathy clinic - 10-year anniversary 2001-2011.

Science.gov (United States)

Bawden, Stella

2012-01-01

An outcome series was conducted over a five-year period of patients attending a community NHS homeopathy clinic in Dorchester, Dorset. 273 new patients were seen. 183 (67%) questionnaires were completed at six months after initial consultation. 44% of patients had been unwell for more than five years; 19% of all patients for more than 15 years. A wide variety of conditions were seen, the largest group with depression, anxiety or grief. For follow-up patients 75-81% indicated an improvement in their symptoms and activity while 58% recorded an improvement in their overall wellbeing. Six months after the initiation of treatment 155 (84.7%) felt an improvement in their condition with 148 (81%) attributing this to homeopathy. Nobody reported deterioration due to homeopathic treatment; conventional drug use was reduced in 46 patients (25%). Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Enhanced invitation methods to increase uptake of NHS health checks: study protocol for a randomized controlled trial

OpenAIRE

Forster, Alice S; Burgess, Caroline; McDermott, Lisa; Wright, Alison J; Dodhia, Hiten; Conner, Mark; Miller, Jane; Rudisill, Caroline; Cornelius, Victoria; Gulliford, Martin C

2014-01-01

Background NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated. Method The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods, using the Question-Be...

Critical Care nurses' understanding of the NHS knowledge and skills framework. An interpretative phenomenological analysis.

Science.gov (United States)

Stewart, Laura F M; Rae, Agnes M

2013-01-01

This small-scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role. The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified. This qualitative study adopted an Interpretative Phenomenological Analysis framework. Data were collected from five Critical Care nurses using semi-structured interviews that were transcribed for analysis. Two super-ordinate themes of 'engagement' and 'theory-practice gap' were identified. Six subthemes of 'fluency', 'transparency', 'self-assessment', 'achieving for whom', 'reflection' and 'the nursing role' further explained the super-ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self-assessment skills. Two theory-practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the 'essence' of their nursing role in Critical Care. Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses. © 2012 The Authors. Nursing in Critical Care © 2012 British Association of Critical Care Nurses.

Hydrologeologic characteristics of faults at Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Dickerson, Robert P.

2001-01-01

Yucca Mountain is under study as a potential site for underground storage of high-level radioactive waste, with the principle goal being the safe isolation of the waste from the accessible environment. This paper addresses the hydrogeologic characteristics of the fault zones at Yucca Mountain, focusing primarily on the central part of the mountain where the potential repository block is located

Clinical negligence in foot and ankle surgery: A 17-year review of claims to the NHS Litigation Authority.

Science.gov (United States)

Ring, J; Talbot, C L; Clough, T M

2014-11-01

We present a review of litigation claims relating to foot and ankle surgery in the NHS in England during the 17-year period between 1995 and 2012. A freedom of information request was made to obtain data from the NHS litigation authority (NHSLA) relating to orthopaedic claims, and the foot and ankle claims were reviewed. During this period of time, a total of 10 273 orthopaedic claims were made, of which 1294 (12.6%) were related to the foot and ankle. 1036 were closed, which comprised of 1104 specific complaints. Analysis was performed using the complaints as the denominator. The cost of settling these claims was more than £36 million. There were 372 complaints (33.7%) involving the ankle, of which 273 (73.4%) were related to trauma. Conditions affecting the first ray accounted for 236 (21.4%), of which 232 (98.3%) concerned elective practice. Overall, claims due to diagnostic errors accounted for 210 (19.0%) complaints, 208 (18.8%) from alleged incompetent surgery and 149 (13.5%) from alleged mismanagement. Our findings show that the incorrect, delayed or missed diagnosis of conditions affecting the foot and ankle is a key area for improvement, especially in trauma practice. ©2014 The British Editorial Society of Bone & Joint Surgery.

Transport of neptunium through Yucca Mountain tuffs

International Nuclear Information System (INIS)

Triay, I.R.; Robinson, B.A.; Mitchell, A.J.; Overly, C.M.; Lopez, R.M.

1993-01-01

Neptunium has a high solubility in groundwaters from Yucca Mountain [1]. Uranium in nuclear reactors produces 237 Np which has a half-life of 2.1 4 x 10 6 years. Consequently, the transport of 237 Np through tuffs is of major importance in assessing the performance of a high-level nuclear waste repository at Yucca Mountain. The objective of this work is to determine the amount of Np retardation that is provided by the minerals in Yucca Mountain tuffs as a function of groundwater chemistry

Autonomy and performance in the public sector: the experience of English NHS hospitals.

Science.gov (United States)

Verzulli, Rossella; Jacobs, Rowena; Goddard, Maria

2018-05-01

Since 2004, English NHS hospitals have been given the opportunity to acquire a more autonomous status known as a Foundation Trust (FT), whereby regulations and restrictions over financial, management, and organizational matters were reduced in order to create incentives to deliver higher-quality services in the most efficient way. Using difference-in-difference models, we test whether achieving greater autonomy (FT status) improved hospital performance, as proxied by measures of financial management, quality of care, and staff satisfaction. Results provide little evidence that the FT policy per se has made any difference to the performance of hospitals in most of these domains. Our findings have implications for health policy and inform the trend towards granting greater autonomy to public-sector organizations.

The Correlation of Geo-Ecological Environment and Mountain Urban planning

Science.gov (United States)

Yang, Chun; Zeng, Wei

2018-01-01

As a special area with the complex geological structure, mountain city is more prone to geological disasters. Due to air pollution, ground subsidence, serious water pollution, earthquakes and floods geo-ecological environment problems have become increasingly serious, mountain urban planning is facing more severe challenges. Therefore, this article bases on the correlation research of geo-ecological environment and mountain urban planning, and re-examins mountain urban planning from the perspective of geo-ecological, coordinates the relationship between the human and nature by geo-ecological thinking, raises the questions which urban planning need to pay attention. And advocates creating an integrated system of geo-ecological and mountain urban planning, analysis the status and dynamics of present mountain urban planning.

Mountain tourism development in Serbia and neighboring countries

Directory of Open Access Journals (Sweden)

Krunić Nikola

2010-01-01

Full Text Available Mountain areas with their surroundings are important parts of tourism regions with potentials for all-season tourism development and complementary activities. Development possibilities are based on size of high mountain territory, nature protection regimes, infrastructural equipment, provided conditions for leisure and recreation as well as involvement of local population in processes of development and protection. This paper analyses the key aspects of tourism development, winter tourism in high-mountain areas of Serbia and some neighboring countries (Slovakia, Romania, Bulgaria, and Greece. Common determinants of cohesion between nature protection and mountain tourism development, national development policies, applied models and concepts and importance of trans-border cooperation are indicated.

Numerical studies of rock-gas flow in Yucca Mountain; Yucca Mountain Site Characterization Project

Energy Technology Data Exchange (ETDEWEB)

Ross, B.; Amter, S.; Lu, Ning [Disposal Safety, Inc., Washington, DC (United States)

1992-02-01

A computer model (TGIF -- Thermal Gradient Induced Flow) of two-dimensional, steady-state rock-gas flow driven by temperature and humidity differences is described. The model solves for the ``fresh-water head,`` a concept that has been used in models of variable-density water flow but has not previously been applied to gas flow. With this approach, the model can accurately simulate the flows driven by small differences in temperature. The unsaturated tuffs of Yucca Mountain, Nevada, are being studied as a potential site for a repository for high-level nuclear waste. Using the TGIF model, preliminary calculations of rock-gas flow in Yucca Mountain are made for four east-west cross-sections through the mountain. Calculations are made for three repository temperatures and for several assumptions about a possible semi-confining layer above the repository. The gas-flow simulations are then used to calculate travel-time distributions for air and for radioactive carbon-14 dioxide from the repository to the ground surface.

Mountaineering and photography. Contacts between 1880 and 1940

Directory of Open Access Journals (Sweden)

Maria Andorno

2014-12-01

Full Text Available Since the second half of the nineteenth century, the photograph produced in high altitude mountain (mountaineering photography gives rise to peculiar images that do not belong to the tradition of landscape painting. Mountaineering is similar to the art of performance, if we talk about physical and mental commitment. Therefore, photos taken during the ascent of a peak shows both conceptual and formal values.

Pyritic ash-flow tuff, Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Castor, S.B.; Tingley, J.V.; Bonham, H.F. Jr.

1994-01-01

The Yucca Mountain site is underlain by a 1,500-m-thick Miocene volcanic sequence that comprises part of the southwestern Nevada volcanic field. Rocks of this sequence, which consists mainly of ash-flow tuff sheets with minor flows and bedded tuff, host precious metal mineralization in several areas as near as 10 km from the site. In two such areas, the Bullfrog and Bare Mountain mining districts, production and reserves total over 60 t gold and 150 t silver. Evidence of similar precious metal mineralization at the Yucca Mountain site may lead to mining or exploratory drilling in the future, compromising the security of the repository. The authors believe that most of the pyrite encountered by drilling at Yucca Mountain was introduced as pyroclastic ejecta, rather than by in situ hydrothermal activity. Pyritic ejecta in ash-flow tuff are not reported in the literature, but there is no reason to believe that the Yucca Mountain occurrence is unique. The pyritic ejecta are considered by us to be part of a preexisting hydrothermal system that was partially or wholly destroyed during eruption of the tuff units. Because it was introduced as ejecta in tuff units that occur at depths of about 1,000 m, such pyrite does not constitute evidence of shallow mineralization at the proposed repository site; however, the pyrite may be evidence for mineralization deep beneath Yucca Mountain or as much as tens of kilometers from it

Approach to identification and development of mountain tourism regions and destinations in Serbia with special reference to the Stara Planina mountain

Directory of Open Access Journals (Sweden)

Milijić Saša

2010-01-01

Full Text Available This paper deals with theoretical-methodological issues of tourism offer planning and regulation of settlements in mountain destinations. The basic determinants of the development of mountain tourist regions destinations in EU countries, in which respectable development results have been achieved, first of all in terms of income, together with appropriately adjusted development and environmental management system, have been emphasized. The ongoing transition and structural processes in Serbia will have an impact on application of these experiences. At the same time, a basis for competitiveness of mountain regions will not be determined only by spatial capacity and geological location, but also by creative-innovative developing environment. Taking into account the spatial-functional criteria and criteria for the development and protection, the possible spatial definition of mountain tourist regions/destinations in Serbia are presented. The justifiability and positioning of tourism development projects are analyzed aiming at uniform regional development, where two segments of demand are of particularly importance, i.e. demand for mountain tourism services and for real estates in mountain centers. Furthermore, holders of tourism offer will be analyzed through a contemporary approach which may be defined as the development and noncommercial and market and commercial one. International criteria which are evaluated while selecting city/mountain destination for Winter Olympic Games are particularly analyzed. Considering experience of countries with higher level of development of mountain regions, the main starting point for positioning projects for sustainable development of tourist destinations are defined by specifying them according to specific local and regional conditions. A rational model for spatial organization of tourism offer is shown on the example of the Stara Planina tourist region.

Spiders in mountain habitats of the Giant Mountains

Czech Academy of Sciences Publication Activity Database

Růžička, Vlastimil; Vaněk, J.; Šmilauer, P.

2012-01-01

Roč. 43, č. 4 (2012), s. 341-347 ISSN 1067-4136 Institutional research plan: CEZ:AV0Z50070508 Keywords : Giant Mountains (Krkonoše, Karkonosze) * spider s * anemo-orographic systems Subject RIV: EH - Ecology, Behaviour Impact factor: 0.236, year: 2012 http://www.springerlink.com/content/0k5g721q1155r146/fulltext.pdf

Eastern Arc Mountains and their national and global importance ...

African Journals Online (AJOL)

The Eastern Arc Mountains comprise a chain of separate mountain blocks running from southern Kenya through Tanzania in a crescent or arc shape. In Tanzania, the Eastern Arc consists of North and South Pare, East and West Usambaras, Nguru, Ukaguru, Rubeho, Uluguru, Udzungwa and Mahenge Mountains.

The current approach to human error and blame in the NHS.

Science.gov (United States)

Ottewill, Melanie

There is a large body of research to suggest that serious errors are widespread throughout medicine. The traditional response to these adverse events has been to adopt a 'person approach' - blaming the individual seen as 'responsible'. The culture of medicine is highly complicit in this response. Such an approach results in enormous personal costs to the individuals concerned and does little to address the root causes of errors and thus prevent their recurrence. Other industries, such as aviation, where safety is a paramount concern and which have similar structures to the medical profession, have, over the past decade or so, adopted a 'systems' approach to error, recognizing that human error is ubiquitous and inevitable and that systems need to be developed with this in mind. This approach has been highly successful, but has necessitated, first and foremost, a cultural shift. It is in the best interests of patients, and medical professionals alike, that such a shift is embraced in the NHS.

Winter Tourism and mountain wetland management and restoration

Science.gov (United States)

Gaucherand, S.; Mauz, I.

2012-04-01

The degradation and loss of wetlands is more rapid than that of other ecosystems (MEA 2005). In mountains area, wetlands are small and scattered and particularly sensitive to global change. The development of ski resorts can lead to the destruction or the deterioration of mountain wetlands because of hydrologic interferences, fill in, soil compression and erosion, etc. Since 2008, we have studied a high altitude wetland complex in the ski resort of Val Thorens. The aim of our study was to identify the impacts of mountain tourism development (winter and summer tourism) on wetland functioning and to produce an action plan designed to protect, rehabilitate and value the wetlands. We chose an approach based on multi-stakeholder participatory process at every stage, from information gathering to technical choices and monitoring. In this presentation, we show how such an approach can efficiently improve the consideration of wetlands in the development of a ski resort, but also the bottlenecks that need to be overcome. We will also discuss some of the ecological engineering techniques used to rehabilitate or restore high altitude degraded wetlands. Finally, this work has contributed to the creation in 2012 of a mountain wetland observatory coordinated by the conservatory of Haute-Savoie. The objective of this observatory is to estimate ecosystem services furnished by mountain wetlands and to find restoration strategies adapted to the local socio-economical context (mountain agriculture and mountain tourism).

Lithospheric Strength Beneath the Zagros Mountains of Southwestern Iran

Science.gov (United States)

Adams, A. N.; Nyblade, A.; Brazier, R.; Rodgers, A.; Al-Amri, A.

2006-05-01

The Zagros Mountain Belt of southwestern Iran is among the most seismically active mountain belts in the world. Early seismic studies of this area found that the lithosphere underlying the Zagros Mountains follows the "jelly sandwich" model, having a strong upper crust and a strong lithospheric mantle, separated by a weak lower crust. More recent studies, which analyzed earthquakes originating within the Zagros Mountains that were recorded at teleseismic distances, however, found that these earthquakes occurred only within the upper crust, thus indicating that the strength of the Zagros Mountains' lithosphere lies only within the upper crust, in accordance with the "creme brulee" lithospheric model. Preliminary analysis of regionally recorded earthquakes that originated within the Zagros Mountains is presented here. Using earthquakes recorded at regional distances will allow the analysis of a larger dataset than has been used in previous studies. Preliminary results show earthquakes occurring throughout the crust and possibly extending into the upper mantle.

Rocky Mountain spotted fever in children.

Science.gov (United States)

Woods, Charles R

2013-04-01

Rocky Mountain spotted fever is typically undifferentiated from many other infections in the first few days of illness. Treatment should not be delayed pending confirmation of infection when Rocky Mountain spotted fever is suspected. Doxycycline is the drug of choice even for infants and children less than 8 years old. Copyright © 2013 Elsevier Inc. All rights reserved.

MOUNTAIN NATURAL BIODIVERSITY CONSERVATION IN RUSSIA

Directory of Open Access Journals (Sweden)

Arkady Tishkov

2012-01-01

Full Text Available High biodiversity and degree of endemism of mountain biota strengthen the mountain regions’ status for the territorial nature conservation. Analysis of the protected areas’ representativeness in various mountain regions of Russia shows some discrepancy between their quantity, square and regional biodiversity originality. The biggest divergences are marked for the Northern Caucasus. The main problems: small area of the protected territories and also cluster character of their spatial distribution, mostly in the high mountains are not supposed to conform with the highest values of the regional flora’s and fauna’s uniqueness, to compensate representativeness of the protected biota and, in anyway, to correspond with the purpose of nature protection frame—the protected territories ecologic network’s forming. The situation in the Urals, Siberia and the Far East seems to be better. The large areas of the protected territories are in general agreement with the high originality of the nature ecosystems. Nevertheless each concrete case needs analysis of the regional biota’s and ecosystems’ biodiversity distribution within the protected areas, including character and (or unique elements of the regional biodiversity to be held. The development of the effectual territorial conservation of mountain regions needs differential approach. The creation of the large representative parcels of nature landscapes in the key-areas has the considerable meaning in the low-developed regions, difficult to access. And well-developed regions have the necessity of nature protected territories’ network development and the planning of the ecological frame’s forming. The territorial biodiversity conservation, including the system of federal, regional and local levels with protective conservation of the rare species has to be combined with ecosystem’s restoration, especially in the zones disturbed by erosion, recreation and military actions. Also it is

The Olympic Mountains Experiment (OLYMPEX)

Energy Technology Data Exchange (ETDEWEB)

Houze, Robert A. [University of Washington, Seattle, Washington; Pacific Northwest National Laboratory, Richland, Washington; McMurdie, Lynn A. [University of Washington, Seattle, Washington; Petersen, Walter A. [NASA Marshall Space Flight Center, Huntsville, Alabama; Schwaller, Mathew R. [NASA Goddard Space Flight Center, Greenbelt, Maryland; Baccus, William [Olympic National Park, Port Angeles, Washington; Lundquist, Jessica D. [University of Washington, Seattle, Washington; Mass, Clifford F. [University of Washington, Seattle, Washington; Nijssen, Bart [University of Washington, Seattle, Washington; Rutledge, Steven A. [Colorado State University, Fort Collins, Colorado; Hudak, David R. [Environment and Climate Change Canada, King City, Ontario, Canada; Tanelli, Simone [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California; Mace, Gerald G. [University of Utah, Salt Lake City, Utah; Poellot, Michael R. [University of North Dakota, Grand Forks, North Dakota; Lettenmaier, Dennis P. [University of California, Los Angeles, Los Angeles, California; Zagrodnik, Joseph P. [University of Washington, Seattle, Washington; Rowe, Angela K. [University of Washington, Seattle, Washington; DeHart, Jennifer C. [University of Washington, Seattle, Washington; Madaus, Luke E. [National Center for Atmospheric Research, Boulder, Colorado; Barnes, Hannah C. [Pacific Northwest National Laboratory, Richland, Washington

2017-10-01

the Olympic Mountains Experiment (OLYMPEX) took place during the 2015-2016 fall-winter season in the vicinity of the mountainous Olympic Peninsula of Washington State. The goals of OLYMPEX were to provide physical and hydrologic ground validation for the U.S./Japan Global Precipitation Measurement (GPM) satellite mission and, more specifically, to study how precipitation in Pacific frontal systems is modified by passage over coastal mountains. Four transportable scanning dual-polarization Doppler radars of various wavelengths were installed. Surface stations were placed at various altitudes to measure precipitation rates, particle size distributions, and fall velocities. Autonomous recording cameras monitored and recorded snow accumulation. Four research aircraft supplied by NASA investigated precipitation processes and snow cover, and supplemental rawinsondes and dropsondes were deployed during precipitation events. Numerous Pacific frontal systems were sampled, including several reaching "atmospheric river" status, warm and cold frontal systems, and postfrontal convection

Rocky Mountain Spotted Fever: Statistics and Epidemiology

Science.gov (United States)

... Search Form Controls Cancel Submit Search the CDC Rocky Mountain Spotted Fever (RMSF) Note: Javascript is disabled or is not ... message, please visit this page: About CDC.gov . Rocky Mountain Spotted Fever (RMSF) Transmission Signs and Symptoms Diagnosis and Testing ...

Evolution of endemism on a young tropical mountain.

Science.gov (United States)

Merckx, Vincent S F T; Hendriks, Kasper P; Beentjes, Kevin K; Mennes, Constantijn B; Becking, Leontine E; Peijnenburg, Katja T C A; Afendy, Aqilah; Arumugam, Nivaarani; de Boer, Hugo; Biun, Alim; Buang, Matsain M; Chen, Ping-Ping; Chung, Arthur Y C; Dow, Rory; Feijen, Frida A A; Feijen, Hans; Feijen-van Soest, Cobi; Geml, József; Geurts, René; Gravendeel, Barbara; Hovenkamp, Peter; Imbun, Paul; Ipor, Isa; Janssens, Steven B; Jocqué, Merlijn; Kappes, Heike; Khoo, Eyen; Koomen, Peter; Lens, Frederic; Majapun, Richard J; Morgado, Luis N; Neupane, Suman; Nieser, Nico; Pereira, Joan T; Rahman, Homathevi; Sabran, Suzana; Sawang, Anati; Schwallier, Rachel M; Shim, Phyau-Soon; Smit, Harry; Sol, Nicolien; Spait, Maipul; Stech, Michael; Stokvis, Frank; Sugau, John B; Suleiman, Monica; Sumail, Sukaibin; Thomas, Daniel C; van Tol, Jan; Tuh, Fred Y Y; Yahya, Bakhtiar E; Nais, Jamili; Repin, Rimi; Lakim, Maklarin; Schilthuizen, Menno

2015-08-20

Tropical mountains are hot spots of biodiversity and endemism, but the evolutionary origins of their unique biotas are poorly understood. In varying degrees, local and regional extinction, long-distance colonization, and local recruitment may all contribute to the exceptional character of these communities. Also, it is debated whether mountain endemics mostly originate from local lowland taxa, or from lineages that reach the mountain by long-range dispersal from cool localities elsewhere. Here we investigate the evolutionary routes to endemism by sampling an entire tropical mountain biota on the 4,095-metre-high Mount Kinabalu in Sabah, East Malaysia. We discover that most of its unique biodiversity is younger than the mountain itself (6 million years), and comprises a mix of immigrant pre-adapted lineages and descendants from local lowland ancestors, although substantial shifts from lower to higher vegetation zones in this latter group were rare. These insights could improve forecasts of the likelihood of extinction and 'evolutionary rescue' in montane biodiversity hot spots under climate change scenarios.

Copper Mountain, Wyoming, a uranium district--rediscovered

International Nuclear Information System (INIS)

Cramer, R.T.; Yellich, J.A.; Kendall, R.G.

1979-01-01

The Copper Mountain area is physiographically located along the Owl Creek Mountains. Economic uranium mineralization was delineated in the late 1950's with production of approximately 500,000 pounds from 1961-1970. Continued exploration and research has discovered additional resources. 20 refs

Continuous Improvement Implementation in the Nottingham University Hospitals NHS Trust: A Case Study of a Continuous Improvement Programme & Project

OpenAIRE

Velzen, Jeena

2012-01-01

This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...

Yucca Mountain Biological resources monitoring program

International Nuclear Information System (INIS)

1991-01-01

The US Department of Energy (US DOE) is required by the Nuclear Waste Policy Act of 1982 (as amended in 1987) to study and characterize Yucca Mountain as a possible site for a geological repository for high-level radioactive waste. To ensure site characterization activities do not adversely affect the Yucca Mountain area, an environmental program, the Yucca Mountain Biological Resources Monitoring Program, has been implemented monitor and mitigate environmental impacts and to ensure activities comply with applicable environmental laws. Potential impacts to vegetation, small mammals, and the desert tortoise (an indigenous threatened species) are addressed, as are habitat reclamation, radiological monitoring, and compilation of baseline data. This report describes the program in Fiscal Years 1989 and 1990. 12 refs., 4 figs., 17 tabs

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

Science.gov (United States)

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

Impact of Hypoxia on Man on Mountaineering

Directory of Open Access Journals (Sweden)

A. N. Kislitsyn

2006-01-01

Full Text Available External respiratory function was studied in those engaged in mountaineering. A negative correlation was found between the intensity of exercise and the changes in vital capacity under mountainous conditions. Changes occurring in the levels of glucose and cholesterol were considered in tourists.

Acute mountain sickness

Science.gov (United States)

... GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Acute mountain sickness URL of this page: //medlineplus.gov/ency/article/ ...

DANGERS AND SAFETY MEASURES IN A MOUNTAIN

Directory of Open Access Journals (Sweden)

Jovica Petković

2013-07-01

Full Text Available Mountaineering and everything that is connected with it is a sport with con¬tro¬lled risk. Mountaineers, alpinists, climbers, cavers and all the others who visit and sojourn in mountains are faced with many risks and dangers, which are caused by na¬ture and also by their own mistakes. The dangers in the mountains, like dangers in any other environment, are mainly predictable, so it is best to deal with them with good esti¬mation, knowledge and skill. One has to be aware of his surroundings – the moun¬tain, to respect it and to know what is dangerous and how much it is dangerous at any moment. The organization of the mountaineering expeditions and leadership per¬haps re¬present the highest level of security control. To develop skills for organizing and lead¬ing a group means to ensure the safety of the entire group – to work pre¬ven¬ti¬ve¬ly at the level of the entire group, not only at the level of an individual. The success of the enti¬re group as well as safety depends on the organization and leadership.

75 FR 29656 - Amendment of Class E Airspace; Mountain View, AR

Science.gov (United States)

2010-05-27

...-1181; Airspace Docket No. 09-ASW-36] Amendment of Class E Airspace; Mountain View, AR AGENCY: Federal... Mountain View, AR. Decommissioning of the Wilcox non-directional beacon (NDB) at Mountain View Wilcox Memorial Field Airport, Mountain View, AR, has made this action necessary to enhance the safety and...

Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England.

Science.gov (United States)

Scragg, B; Shaikh, S; Robinson, L; Mercer, C

2017-08-01

Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

78 FR 29366 - Green Mountain Power Corporation

Science.gov (United States)

2013-05-20

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. TS04-277-002] Green Mountain Power Corporation Notice of Filing Take notice that on May 2, 2013, Green Mountain Power Corporation filed additional information in support of its request for continued waiver of Standards of Conduct. Any...

Mountain Plover [ds109

Data.gov (United States)

California Natural Resource Agency — Point locations representing observations of mountain plover (Charadrius montanus) feeding and roosting flocks (and occasional individuals) documented during an...

Origin, development, and impact of mountain laurel thickets on the mixed-oak forests of the central Appalachian Mountains, USA

Science.gov (United States)

Patrick H. Brose

2016-01-01

Throughout forests of the northern hemisphere, some species of ericaceous shrubs can form persistent understories that interfere with forest regeneration processes. In the Appalachian Mountains of eastern North America, mountain laurel (Kalmia latifolia) may interfere in the regeneration of mixed-oak (Quercus spp.) forests. To...

Review article: The mountain motif in the plot of Matthew

Directory of Open Access Journals (Sweden)

Gert J. Volschenk

2010-09-01

Full Text Available This article reviewed T.L. Donaldson’s book, Jesus on the mountain: A study in Matthean theology, published in 1985 by JSOT Press, Sheffield, and focused on the mountain motif in the structure and plot of the Gospel of Matthew, in addition to the work of Donaldson on the mountain motif as a literary motif and as theological symbol. The mountain is a primary theological setting for Jesus’ ministry and thus is an important setting, serving as one of the literary devices by which Matthew structured and progressed his narrative. The Zion theological and eschatological significance and Second Temple Judaism serve as the historical and theological background for the mountain motif. The last mountain setting (Mt 28:16–20 is the culmination of the three theological themes in the plot of Matthew, namely Christology, ecclesiology and salvation history.

Mountain biking. Breezy ups and traumatic downs

International Nuclear Information System (INIS)

Schueller, G.

2010-01-01

For more than two decades the popularity of mountain biking as a national pastime as well as a competitive sport has been undiminished. However, its related risks are not monitored as closely as those, for example, of skiing. The injuries caused by mountain biking are specific and cannot be compared with those caused by other cycling sports. This is due not only to the characteristics of the terrain but also to the readiness to assume a higher risk compared to cycle racing. The particular value of radiology is in the acute trauma setting. Most often musculoskeletal lesions must be examined and digital radiography and MRI are the most useful techniques. Severe trauma of the cranium, face, spine, thorax and abdomen are primarily evaluated with CT, particularly in dedicated trauma centers. Therefore, radiology can play a role in the rapid diagnosis and optimal treatment of the trauma-related injuries of mountain biking. Thus, the unnecessarily high economical damage associated with mountain biking can be avoided. (orig.) [de

[Mountain biking : Breezy ups and traumatic downs].

Science.gov (United States)

Schueller, G

2010-05-01

For more than two decades the popularity of mountain biking as a national pastime as well as a competitive sport has been undiminished. However, its related risks are not monitored as closely as those, for example, of skiing. The injuries caused by mountain biking are specific and cannot be compared with those caused by other cycling sports. This is due not only to the characteristics of the terrain but also to the readiness to assume a higher risk compared to cycle racing.The particular value of radiology is in the acute trauma setting. Most often musculoskeletal lesions must be examined and digital radiography and MRI are the most useful techniques. Severe trauma of the cranium, face, spine, thorax and abdomen are primarily evaluated with CT, particularly in dedicated trauma centers. Therefore, radiology can play a role in the rapid diagnosis and optimal treatment of the trauma-related injuries of mountain biking. Thus, the unnecessarily high economical damage associated with mountain biking can be avoided.

Health information technology and sociotechnical systems: a progress report on recent developments within the UK National Health Service (NHS).

Science.gov (United States)

Waterson, Patrick

2014-03-01

This paper summarises some of the research that Ken Eason and colleagues at Loughborough University have carried out in the last few years on the introduction of Health Information Technologies (HIT) within the UK National Health Service (NHS). In particular, the paper focuses on three examples which illustrate aspects of the introduction of HIT within the NHS and the role played by the UK National Programme for Information Technology (NPfIT). The studies focus on stages of planning and preparation, implementation and use, adaptation and evolution of HIT (e.g., electronic patient records, virtual wards) within primary, secondary and community care settings. Our findings point to a number of common themes which characterise the use of these systems. These include tensions between national and local strategies for implementing HIT and poor fit between healthcare work systems and the design of HIT. The findings are discussed in the light of other large-scale, national attempts to introduce similar technologies, as well as drawing out a set of wider lessons learnt from the NPfIT programme based on Ken Eason's earlier work and other research on the implementation of large-scale HIT. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Turonian Radiolarians in the Section of Ak Mountain, Crimea

Science.gov (United States)

Bragina, L. G.

2018-01-01

In the sections from the western and eastern peaks of Ak Mountain, the Patellula selbukhraensis Zone (upper part of the lower Turonian), which is established for the first time in the southwestern Mountainous Crimea, is traced. The first data on the radiolarian distribution in the section of the eastern peak of Ak Mountain, which is stratotypical of the Phaseliforma turovi (middle Turonian, without the upper part) and Actinomma (?) belbekense (upper part of the middle Turonian-upper Turonian) zones, are presented. These zones are also traced in the parallel section of the western peak of Ak Mountain.

Can nuclear waste be stored safely at Yucca mountain?

International Nuclear Information System (INIS)

Whipple, C.G.

1996-01-01

In 1987 the federal government narrowed to one its long-term options for disposing of nuclear waste: storing it permanently in a series of caverns excavated out of the rock deep below Yucca mountain in southern Nevada. Whether it makes sense at this time to dispose permanently of spent fuel and radioactive waste in a deep geologic repository is hotly disputed. But the Nuclear Waste Policy Act amendements of 1987 decree that waste be consolidated in Yucca Mountain if the mountain is found suitable. Meanwhile the spent fuel continues to pile up across the country, and 1998 looms, adding urgency to the question: What can science tell us about the ability of the mountain to store nuclear waste safely? This paper discusses this issue and describes how studies of the mountain's history and geology can contribute useful insights but not unequivocal conclusions

The mountains influence on Turkey Climate

International Nuclear Information System (INIS)

Sensoy, Serhat

2004-01-01

Since the Black sea mountains at the north of the country and the Taurus mountains in the south lay parallel to the seashore and rise very sharply rain clouds can not penetrate to the internal part of the country. Rain clouds drops most of their water on the slopes opposite the sea. As rain clouds pass over the mountains and reach Central Anatolia they have no significant capability of rain. For this reason, the Central Anatolia does not have very much precipitation. The difference between the rates of precipitation on the inner and outer slopes seems to be effective on the expansion of plants. For example, there is a subtropical climate prevailing on the Black sea shore between Sinop and Batum where precipitation is more than 1000-2000 mm yearly. Going from Sinop to the mouth of the Sakarya River the rate of precipitation goes down to 800-1250 mm in a year. Running from the Sakarya River to the western area covering Thrace the climate seems to be continental, and in the area dominant plant cover is of the Mediterranean type. Since the succession of the mountains in Western Anatolia lay perpendicular to the seashore, rain clouds penetrate towards the inner regions for about 400 km. The continental climate with long, dry and summer affects this area. In the Eastern region of Anatolia, since the elevation of the mountains exceeds 2500-3000 m, valleys are disorderly scattered and located at high elevations, and the northern Black sea mountains and Caucasian mountains hold the rain clouds, the area is effected by the continental climate with long and very cold winters. Consequently precipitation at the lgdir River goes down to 300 mm while it is 500-800 mm in most of areas and 1000-1500 mm in some regions towards northern Mu and Bingol provinces. As mentioned above, high mountains, which hold rain clouds, surround the Central Anatolia, which has caused drought in this region. In the central Anatolia covering Afyon, Eski hir, Ankara, Qankiri, Qorum, Amasya, Kayseri

Geology of the Saddle Mountains between Sentinel Gap and 119030' longitude

International Nuclear Information System (INIS)

Reidel, S.P.

1978-09-01

Members and flows of the Grande Ronde, Wanapum, and Saddle Mountains basalts of the Columbia River Basalt Group were mapped in the Saddle Mountains between Sentinel Gap and the eastern edge of Smyrna Bench. The Grande Ronde Basalt consists of the Schwana (low-MgO) and Sentinel Bluffs (high-MgO) members (informal names). The Wanapum Basalt consists of the aphyric and phyric units of the Frenchman Springs Member, the Roza-Like Member, and the Priest Rapids Member. The Saddle Mountains Basalt consists of the Wahluke, Huntzinger, Pomona, Mattawa, and Elephant Mountain basalts. The Wanapum and Saddle Mountains basalts are unevenly distributed across the Saddle Mountains. The Wanapum Basalt thins from south to north and across a northwest-southeast-trending axis at the west end of Smyrna Bench. The Priest Rapids, Roza-Like, and aphyric Frenchman Springs units are locally missing across this zone. The Saddle Mountains basalt has a more irregular distribution and, within an area between Sentinel Gap and Smyrna Bench, is devoid of the basalt. The Wahluke, Huntzinger, and Mattawa flows are locally present, but the Pomona is restricted to the southern flank west of Smyrna Bench, and the Elephant Mountain Basalt only occurs on the flanks and in three structurally controlled basins on the northwest side. The structure of the Saddle Mountains is dominated by an east-west trend and, to a lesser degree, controlled by a northwest-southeast and northeast-southwest trend. The geomorphological expression of the Saddle Mountains results from the east-west fold set and the Saddle Mountains fault along the north side. The oldest structures follow the northwest-southeast trend. The distribution of the flows, combined with the structural features, indicates a complex geologic history for the Saddel Mountains

Mountains and energy transition. Status of use of renewable energies and challenges for their development in mountain areas - Renewable energies Volume 1

International Nuclear Information System (INIS)

Peguin, Marion; Moncorps, Sebastien; Fourcade, Michel; Denis, Helene

2013-10-01

After an overview of challenges related to the development of renewable energies in mountain areas (conservation of biodiversity and landscapes, main legal measures regarding biodiversity and landscapes), this report proposes an overview of the status and potentials of the different renewable energies (solar, wind, hydroelectricity, bio-energies, geothermal) in mountain areas. It proposes an assessment (strengths and weaknesses) and recommendations for solar, wind, hydroelectricity and bio energies in mountain areas

Thermally driven gas flow beneath Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Amter, S.; Lu, Ning; Ross, B.

1991-01-01

A coupled thermopneumatic model is developed for simulating heat transfer, rock-gas flow and carbon-14 travel time beneath Yucca Mountain, NV. The aim of this work is to understand the coupling of heat transfer and gas flow. Heat transfer in and near the potential repository region depends on several factors, including the geothermal gradient, climate, and local sources of heat such as radioactive wastes. Our numerical study shows that small temperature changes at the surface can change both the temperature field and the gas flow pattern beneath Yucca Mountain. A lateral temperature difference of 1 K is sufficient to create convection cells hundreds of meters in size. Differences in relative humidities between gas inside the mountain and air outside the mountain also significantly affect the gas flow field. 6 refs., 7 figs

Sport and Recreation Influence upon Mountain Area and Sustainable Tourism Development

Directory of Open Access Journals (Sweden)

Jelica J. MARKOVIĆ

2013-10-01

Full Text Available In contemporary tourism, sport and recreation are increasingly becoming the dominant motives for undertaking the journey, and as a result of modern living, active holidays are more frequent. Mountain areas have always been attractive to deal with the various sports activities. Winter sports were the initiators of the development of mountain resorts. Mountain resorts invest in construction of hotels, ski lifts, snowmaking equipment, for the sake of attracting a growing number of tourist clientele. On the other hand, sport and recreation also serve to promote summer mountain tourism. Tennis, golf, swimming, horseback riding are key tools to attract visitors in the summer months toward the resorts facilities. The main problems regarding the development of mountain tourism centers come in the form of the growing concern for the preservation of the environment, of the human and traffic congestion in the mountains and the intensive use of natural resources by tourists. This paper aims to highlight the positive and negative impacts of sport and recreation in the development of mountain tourism and to present possible solutions to reduce negative impacts. Methodology is based on document review of many bibliographic resources, which are related with skiing and mountain biking as examples of winter and summer sport activities on mountains.

Facilitating Sustainable Waste Management Behaviors Within the Health Sector: A Case Study of the National Health Service (NHS in Southwest England, UK

Directory of Open Access Journals (Sweden)

Janet Richardson

2012-04-01

Full Text Available Waste costs the National Health Service (NHS £71.2 million in 2007/2008; recycling all papers, newspapers and cardboard produced by the NHS in England and Wales could save up to 42,000 tonnes of CO2. As the largest employer in the UK, the NHS is in a prime position to both lead the way towards a sustainable future, but also act as a test bed for organizational change and provide evidence of what works at an individual level to change attitudes and behavior. However these require changes in mindset, including values, attitudes, norms and behaviors which are required along with clear definitions of the problems faced in terms of economics, society and culture. Initial investigations of the literature indicate that behavior change theory may provide a feasible means of achieving constructive changes in clinical waste management; such approaches require further investigation. This paper describes a feasibility study designed to examine issues that might affect the introduction of a behavior change strategy and improve waste management in a healthcare setting. Guided by the evidence gained from our systematic review, 20 interviews were carried out with senior managers, clinicians and support staff involved in the management of healthcare waste from a broad range of agencies in South West England. Interviews were audio-recorded and transcribed for analysis. Thematic content analysis was conducted in order to identify key issues and actions. Data extraction, coding and analysis were cross checked independently by the four members of the research team. Initial findings suggest tensions, between Government and local policies, between packaging and storage space at ward level and, and between the operational requirements of infection control and maintaining appropriate and ethical patient care. These tensions increase pressures on staff already trying to maintain high quality care in a resource restricted and changing environment.

CURRENT MICROBIOLOGICAL ASPECTS IN HIGH MOUNTAIN

OpenAIRE

KURT HANSELMANN; MUNTI YUHANA

2006-01-01

Remote and normally unpolluted high mountain lakes provide habitats with no or very limited anthropogenic influences and, therefore, their hydrodynamics are mostly regulated by the natural c onditions. Researches in high mountain lakes deal with measuring and modeling the response of the habitats to environmental changes especially correlated to acid deposition, pollutants influx and climatic variability. The microbial world has also become a focus in many studies of these extreme ecosystem...

Room at the Mountain: Estimated Maximum Amounts of Commercial Spent Nuclear Fuel Capable of Disposal in a Yucca Mountain Repository

International Nuclear Information System (INIS)

Kessler, John H.; Kemeny, John; King, Fraser; Ross, Alan M.; Ross, Benjamen

2006-01-01

The purpose of this paper is to present an initial analysis of the maximum amount of commercial spent nuclear fuel (CSNF) that could be emplaced into a geological repository at Yucca Mountain. This analysis identifies and uses programmatic, material, and geological constraints and factors that affect this estimation of maximum amount of CSNF for disposal. The conclusion of this initial analysis is that the current legislative limit on Yucca Mountain disposal capacity, 63,000 MTHM of CSNF, is a small fraction of the available physical capacity of the Yucca Mountain system assuming the current high-temperature operating mode (HTOM) design. EPRI is confident that at least four times the legislative limit for CSNF (∼260,000 MTHM) can be emplaced in the Yucca Mountain system. It is possible that with additional site characterization, upwards of nine times the legislative limit (∼570,000 MTHM) could be emplaced. (authors)

How is success achieved by individuals innovating for patient safety and quality in the NHS?

Science.gov (United States)

Sheard, Laura; Jackson, Cath; Lawton, Rebecca

2017-09-11

Innovation in healthcare is said to be notoriously difficult to achieve and sustain yet simultaneously the health service is under intense pressure to innovate given the ever increasing demands placed upon it. Whilst many studies have looked at diffusion of innovation from an organisational perspective, few have sought to understand how individuals working in healthcare innovate successfully. We took a positive deviance approach to understand how innovations are achieved by individuals working in the NHS. We conducted in depth interviews in 2015 with 15 individuals who had received a national award for being a successful UK innovator in healthcare. We invited only those people who were currently (or had recently) worked in the NHS and whose innovation focused on improving patient safety or quality. Thematic analysis was used. Four themes emerged from the data: personal determination, the ability to broker relationships and make connections, the ways in which innovators were able to navigate organisational culture to their advantage and their ability to use evidence to influence others. Determination, focus and persistence were important personal characteristics of innovators as were skills in being able to challenge the status quo. Innovators were able to connect sometimes disparate teams and people, being the broker between them in negotiating collaborative working. The culture of the organisation these participants resided in was important with some being able to use this (and the current patient safety agenda) to their advantage. Gathering robust data to demonstrate their innovation had a positive impact and was seen as essential to its progression. This paper reveals a number of factors which are important to the success of innovators in healthcare. We have uncovered that innovators have particular personal traits which encourage a propensity towards change and action. Yet, for fruitful innovation to take place, it is important for relational networks and

The White Mountain Recreational Enterprise: Bio-Political Foundations for White Mountain Apache Natural Resource Control, 1945–1960

Directory of Open Access Journals (Sweden)

David C. Tomblin

2016-07-01

Full Text Available Among American Indian nations, the White Mountain Apache Tribe has been at the forefront of a struggle to control natural resource management within reservation boundaries. In 1952, they developed the first comprehensive tribal natural resource management program, the White Mountain Recreational Enterprise (WMRE, which became a cornerstone for fighting legal battles over the tribe’s right to manage cultural and natural resources on the reservation for the benefit of the tribal community rather than outside interests. This article examines how White Mountain Apaches used the WMRE, while embracing both Euro-American and Apache traditions, as an institutional foundation for resistance and exchange with Euro-American society so as to reassert control over tribal eco-cultural resources in east-central Arizona.

Mountain-Plains Curriculum.

Science.gov (United States)

Mountain-Plains Education and Economic Development Program, Inc., Glasgow AFB, MT.

The document lists the Mountain-Plains curriculum by job title (where applicable), including support courses. The curriculum areas covered are mathematics skills, communication skills, office education, lodging services, food services, marketing and distribution, welding support, automotive, small engines, career guidance, World of Work, health…

Conservation of biodiversity in mountain ecosystems -- At a glance

OpenAIRE

MacKinnon, K.

2002-01-01

Metadata only record Mountains are especially important for biodiversity conservation since many harbor unique assemblages of plants and animals, including high levels of endemic species. Mountain biodiversity and natural habitats bestow multiple ecosystem, soil conservation, and watershed benefits. Mountains are often centers of endemism, where species are prevalent in or peculiar to a particular region, and Pleistocene refuges, which are hypothesized to have high levels of diversity wher...

Paleogene Sediment Character of Mountain Front Central Sumatra Basin

Directory of Open Access Journals (Sweden)

P. A. Suandhi

2014-07-01

Full Text Available DOI: 10.17014/ijog.v8i3.164The SE-NW trending Mountain Front of Central Sumatra Basin is located in the southern part of the basin. The Mountain Front is elongated parallel to the Bukit Barisan Mountain, extending from the Regencies of North Padang Lawas (Gunung Tua in the northwest, Rokan Hulu, Kampar, Kuantan Singingi, and Inderagiri Hulu Regency in the southeast. The Palaeogene sediments also represent potential exploration objectives in Central Sumatra Basin, especially in the mountain front area. Limited detailed Palaeogene sedimentology information cause difficulties in hydrocarbon exploration in this area. Latest age information and attractive sediment characters based on recent geological fieldwork (by chaining method infer Palaeogene sediment potential of the area. The Palaeogene sedimentary rock of the mountain front is elongated from northwest to southeast. Thickness of the sedimentary unit varies between 240 - 900 m. Palynology samples collected recently indicate that the oldest sedimentary unit is Middle Eocene and the youngest one is Late Oligocene. This latest age information will certainly cause significant changes to the existing surface geological map of the mountain front area. Generally, the Palaeogene sediments of the mountain front area are syn-rift sediments. The lower part of the Palaeogene deposit consists of fluvial facies of alluvial fan and braided river facies sediments. The middle part consists of fluvial meandering facies, lacustrine delta facies, and turbidity lacustrine facies sediments. The upper part consists of fluvial braided facies and transitional marine facies sediments. Volcanism in the area is detected from the occurrence of volcanic material as lithic material and spotted bentonite layers in the middle part of the mountain front area. Late rifting phase is indicated by the presence of transitional marine facies in the upper part of the Palaeogene sediments.

Small fishes crossed a large mountain range: Quaternary stream capture events and freshwater fishes on both sides of the Taebaek Mountains.

Science.gov (United States)

Kim, Daemin; Hirt, M Vincent; Won, Yong-Jin; Simons, Andrew M

2017-07-01

The Taebaek Mountains in Korea serve as the most apparent biogeographic barrier for Korean freshwater fishes, resulting in 2 distinct ichthyofaunal assemblages on the eastern (East/Japan Sea slope) and western (Yellow Sea and Korea Strait slopes) sides of the mountain range. Of nearly 100 species of native primary freshwater fishes in Korea, only 18 species occur naturally on both sides of the mountain range. Interestingly, there are 5 rheophilic species (Phoxinus phoxinus, Coreoleuciscus splendidus, Ladislavia taczanowskii, Iksookimia koreensis and Koreocobitis rotundicaudata) found on both sides of the Taebaek Mountains that are geographically restricted to the Osip River (and several neighboring rivers, for L. taczanowskii and I. koreensis) on the eastern side of the mountain range. The Osip River and its neighboring rivers also shared a rheophilic freshwater fish, Liobagrus mediadiposalis, with the Nakdong River on the western side of the mountain range. We assessed historical biogeographic hypotheses on the presence of these rheophilic fishes, utilizing DNA sequence data from the mitochondrial cytochrome b gene. Results of our divergence time estimation indicate that ichthyofaunal transfers into the Osip River (and several neighboring rivers in East Sea slope) have occurred from the Han (Yellow Sea slope) and Nakdong (Korea Strait slope) Rivers since the Late Pleistocene. The inferred divergence times for the ichthyofaunal transfer across the Taebaek Mountains were consistent with the timing of hypothesized multiple reactivations of the Osip River Fault (Late Pleistocene), suggesting that the Osip River Fault reactivations may have caused stream capture events, followed by ichthyofaunal transfer, not only between the Osip and Nakdong Rivers, but also between the Osip and Han Rivers. © 2016 International Society of Zoological Sciences, Institute of Zoology/Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

A measure for the promotion of mountain ecological villages in South Korea: focus on the national mountain ecological village investigation of 2014

OpenAIRE

Choi, Soo Im; Kang, Hag Mo; Kim, Hyun; Lee, Chang Heon; Lee, Chong Kyu

2016-01-01

Background Although South Korean mountain villages occupy 44 and 55?% of land and forest areas, respectively, these villages account for only 3?% of the national population and they suffer from a declining workforce owing to aging, wage inflation, and low forestry productivity. As a result, the South Korean government implemented a mountain ecological village development project from 1995 to 2013 in 312 of the 4972 mountain villages and investigated project performance in 2014. The present st...

The Mountains of Io: Global and Geological Perspectives from Voyager and Galileo

Science.gov (United States)

Schenk, Paul; Hargitai, Henrik; Wilson, Ronda; McEwen, Alfred; Thomas, Peter; Bredekamp, Joe (Technical Monitor)

2001-01-01

To search for local and global scale geologic associations that may be related to the internal dynamics of Io, we have completed a global catalog of all mountains and volcanic centers. We have identified 115 mountain structures (covering approx. 3% of the surface) and 541 volcanic centers, including paterae (calderas and dark spots) and shield volcanoes. The average length of an Ionian mountain is 157 km, with the longest being 570 km. The mean height of Ionian mountains is 6.3 km, and the highest known mountain is Boosaule Montes (17.5 +/- 3 km). Five basic morphologic types of mountains have been identified; mesa, plateau peak, ridge, and massif. Very few mountains bear any physical similarity. to classic volcanic landforms, but many resemble flatiron mountains on Earth and are interpreted as tilted crustal blocks. This would be consistent with the hypothesis that most mountains are thrust blocks formed as a result of compressive stresses built up in the lower crust due to the global subsidence of volcanic layers as they are buried over time. More than one mechanism may be responsible for all Ionian mountains, however. The proximity of some mountains to paterae may indicate a direct link between some mountains and volcanism, although it is not always clear which came first. In contrast to earlier studies, a pronounced bimodal pattern is observed in the global distribution of both mountains and volcanic centers. The regions of highest areal densities of volcanic centers are near the sub- and anti-Jovian regions, but are offset roughly 90deg in longitude from the two, regions of greatest concentration of mountains. This anticorrelation may indicate the overprinting of a second stress field on the global compressive stresses due to subsidence. The bimodal distribution of volcanic centers and mountains is consistent with models of asthenospheric tidal heating and internal convection developed by Tackley et al.Over regions of mantle upwelling, compressive stresses in

Rocky Mountain Research Station: 2011 Annual Accomplishments

Science.gov (United States)

Rick Fletcher

2011-01-01

The Rocky Mountain Research Station is one of seven regional units that make up the USDA Forest Service Research and Development organization ­ the most extensive natural resources research organization in the world. We maintain 12 field laboratories throughout a 12-state territory encompassing the Great Basin, Southwest, Rocky Mountains, and parts of the Great Plains...

Rocky Mountain Research Station: 2010 Research Accomplishments

Science.gov (United States)

Rick Fletcher

2010-01-01

The Rocky Mountain Research Station is one of seven regional units that make up the USDA Forest Service Research and Development organization ­ the most extensive natural resources research organization in the world. We maintain 12 field laboratories throughout a 12-state territory encompassing the Great Basin, Southwest, Rocky Mountains, and parts of the Great Plains...

The effect of changing from one to two views at incident (subsequent) screens in the NHS breast screening programme in England: impact on cancer detection and recall rates

International Nuclear Information System (INIS)

Blanks, R.G.; Bennett, R.L.; Patnick, J.; Cush, S.; Davison, C.; Moss, S.M.

2005-01-01

AIM: To assess the effect on cancer detection and recall rates of changing from one to two views for incident (subsequent) screens. METHODS: Controlled, comparative, observational study of programmes in NHS breast screening programme in England. Subjects: women aged 50-64 years were screened by the NHSBSP between 1 April 2001 and 31 March 2003. RESULTS: The effect of changing to two-view mammography was a 20% increase in overall incident screen cancer detection rate, with the biggest effect seen for small (<15 mm) invasive cancers. This increased detection rate was achieved with an 11% drop-in recall rate. CONCLUSION: The introduction of two-view mammography for incident screens has resulted in considerable improvements in overall NHS breast screening performance

75 FR 29686 - Proposed Establishment of the Pine Mountain-Mayacmas Viticultural Area

Science.gov (United States)

2010-05-27

... states that local growers report that Pine Mountain vineyards are naturally free of mildew, a vineyard... often stall over Pine Mountain and the Mayacmas range, dropping more rain than in other areas. Pine..., these mountain soils include large amounts of sand and gravel. Pine Mountain soils are generally less...

Estimating abundance of mountain lions from unstructured spatial sampling

Science.gov (United States)

Russell, Robin E.; Royle, J. Andrew; Desimone, Richard; Schwartz, Michael K.; Edwards, Victoria L.; Pilgrim, Kristy P.; Mckelvey, Kevin S.

2012-01-01

Mountain lions (Puma concolor) are often difficult to monitor because of their low capture probabilities, extensive movements, and large territories. Methods for estimating the abundance of this species are needed to assess population status, determine harvest levels, evaluate the impacts of management actions on populations, and derive conservation and management strategies. Traditional mark–recapture methods do not explicitly account for differences in individual capture probabilities due to the spatial distribution of individuals in relation to survey effort (or trap locations). However, recent advances in the analysis of capture–recapture data have produced methods estimating abundance and density of animals from spatially explicit capture–recapture data that account for heterogeneity in capture probabilities due to the spatial organization of individuals and traps. We adapt recently developed spatial capture–recapture models to estimate density and abundance of mountain lions in western Montana. Volunteers and state agency personnel collected mountain lion DNA samples in portions of the Blackfoot drainage (7,908 km2) in west-central Montana using 2 methods: snow back-tracking mountain lion tracks to collect hair samples and biopsy darting treed mountain lions to obtain tissue samples. Overall, we recorded 72 individual capture events, including captures both with and without tissue sample collection and hair samples resulting in the identification of 50 individual mountain lions (30 females, 19 males, and 1 unknown sex individual). We estimated lion densities from 8 models containing effects of distance, sex, and survey effort on detection probability. Our population density estimates ranged from a minimum of 3.7 mountain lions/100 km2 (95% Cl 2.3–5.7) under the distance only model (including only an effect of distance on detection probability) to 6.7 (95% Cl 3.1–11.0) under the full model (including effects of distance, sex, survey effort, and

Winter severity and snowiness and their multiannual variability in the Karkonosze Mountains and Jizera Mountains

Science.gov (United States)

Urban, Grzegorz; Richterová, Dáša; Kliegrová, Stanislava; Zusková, Ilona; Pawliczek, Piotr

2017-09-01

This paper analyses winter severity and snow conditions in the Karkonosze Mountains and Jizera Mountains and examines their long-term trends. The analysis used modified comprehensive winter snowiness (WSW) and winter severity (WOW) indices as defined by Paczos (1982). An attempt was also made to determine the relationship between the WSW and WOW indices. Measurement data were obtained from eight stations operated by the Institute of Meteorology and Water Management - National Research Institute (IMGW-PIB), from eight stations operated by the Czech Hydrological and Meteorological Institute (CHMI) and also from the Meteorological Observatory of the University of Wrocław (UWr) on Mount Szrenica. Essentially, the study covered the period from 1961 to 2015. In some cases, however, the period analysed was shorter due to the limited availability of data, which was conditioned, inter alia, by the period of operation of the station in question, and its type. Viewed on a macroscale, snow conditions in the Karkonosze Mountains and Jizera Mountains (in similar altitude zones) are clearly more favourable on southern slopes than on northern ones. In the study area, negative trends have been observed with respect to both the WSW and WOW indices—winters have become less snowy and warmer. The correlation between the WOW and WSW indices is positive. At stations with northern macroexposure, WOW and WSW show greater correlation than at ones with southern macroexposure. This relationship is the weakest for stations that are situated in the upper ranges (Mount Śnieżka and Mount Szrenica).

Yucca Mountain Biological Resources Monitoring Program

International Nuclear Information System (INIS)

1992-01-01

The US Department of Energy (DOE) is required by the Nuclear Waste Policy Act of 1982 (as amended in 1987) to study and characterize Yucca Mountain as a possible site for a geologic repository for high-level nuclear waste. During site characterization, the DOE will conduct a variety of geotechnical, geochemical, geological, and hydrological studies to determine the suitability of Yucca Mountain as a repository. To ensure that site characterization activities (SCA) do not adversely affect the Yucca Mountain area, an environmental program has been implemented to monitor and mitigate potential impacts and to ensure that activities comply with applicable environmental regulations. This report describes the activities and accomplishments during fiscal year 1991 (FY91) for six program areas within the Terrestrial Ecosystem component of the YMP environmental program. The six program areas are Site Characterization Activities Effects, Desert Tortoises, Habitat Reclamation, Monitoring and Mitigation, Radiological Monitoring, and Biological Support

Computation of spatial significance of mountain objects extracted from multiscale digital elevation models

International Nuclear Information System (INIS)

Sathyamoorthy, Dinesh

2014-01-01

The derivation of spatial significance is an important aspect of geospatial analysis and hence, various methods have been proposed to compute the spatial significance of entities based on spatial distances with other entities within the cluster. This paper is aimed at studying the spatial significance of mountain objects extracted from multiscale digital elevation models (DEMs). At each scale, the value of spatial significance index SSI of a mountain object is the minimum number of morphological dilation iterations required to occupy all the other mountain objects in the terrain. The mountain object with the lowest value of SSI is the spatially most significant mountain object, indicating that it has the shortest distance to the other mountain objects. It is observed that as the area of the mountain objects reduce with increasing scale, the distances between the mountain objects increase, resulting in increasing values of SSI. The results obtained indicate that the strategic location of a mountain object at the centre of the terrain is more important than its size in determining its reach to other mountain objects and thus, its spatial significance

Grimstone v Epsom and St Helier University Hospitals NHS Trust: (It's Not) Hip To Be Square.

Science.gov (United States)

Austin, Louise V

2017-11-24

In Montgomery v Lanarkshire Health Board [2015] UKSC 11 the Supreme Court redefined the standard of disclosure in informed consent to medical treatment, rejecting the application of the doctor-focused Bolam standard in favour of one focused on what was significant to patients. In Grimstone v Epsom and St Helier University Hospitals NHS Trust [2015] EWHC 3756 (QB), despite acknowledging a new standard now applied, McGowan J nevertheless used the Bolam test to determine liability for non-disclosure. This illustrates ongoing judicial deference to the medical profession and this case commentary explores that decision and its implications. © The Author 2017. Published by Oxford University Press.

Modeling fluid-rock interaction at Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Viani, B.E.; Bruton, C.J.

1992-08-01

Volcanic rocks at Yucca Mountain, Nevada aie being assessed for their suitability as a potential repository for high-level nuclear waste. Recent progress in modeling fluid-rock interactions, in particular the mineralogical and chemical changes that may accompany waste disposal at Yucca Mountain, will be reviewed in this publication. In Part 1 of this publication, ''Geochemical Modeling of Clinoptilolite-Water Interactions,'' solid-solution and cation-exchange models for the zeolite clinoptilolite are developed and compared to experimental and field observations. At Yucca Mountain, clinoptilolite which is found lining fractures and as a major component of zeolitized tuffs, is expected to play an important role in sequestering radionuclides that may escape from a potential nuclear waste repository. The solid-solution and ion-exchange models were evaluated by comparing predicted stabilities and exchangeable cation distributions of clinoptilolites with: (1) published binary exchange data; (2) compositions of coexisting clinoptilolites and formation waters at Yucca Mountain; (3) experimental sorption isotherms of Cs and Sr on zeolitized tuff, and (4) high temperature experimental data. Good agreement was found between predictions and expertmental data, especially for binary exchange and Cs and Sr sorption on clinoptilolite. Part 2 of this publication, ''Geochemical Simulation of Fluid-Rock Interactions at Yucca Mountain,'' describes preliminary numerical simulations of fluid-rock interactions at Yucca Mountain. The solid-solution model developed in the first part of the paper is used to evaluate the stability and composition of clinciptilolite and other minerals in the host rock under ambient conditions and after waste emplacement

Aspen biology, community classification, and management in the Blue Mountains

Science.gov (United States)

David K. Swanson; Craig L. Schmitt; Diane M. Shirley; Vicky Erickson; Kenneth J. Schuetz; Michael L. Tatum; David C. Powell

2010-01-01

Quaking aspen (Populus tremuloides Michx.) is a valuable species that is declining in the Blue Mountains of northeastern Oregon. This publication is a compilation of over 20 years of aspen management experience by USDA Forest Service workers in the Blue Mountains. It includes a summary of aspen biology and occurrence in the Blue Mountains, and a...

Mechanical excavator performance in Yucca Mountain tuffs

International Nuclear Information System (INIS)

Ozdemir, L.; Hansen, F.D.

1991-01-01

A research effort of four phases is in progress at the Colorado School of Mines. The overall program will evaluate the cutability of welded tuff and other lithologies likely to be excavated at Yucca Mountain in the site characterization process. Several mechanical systems are considered with emphasis given to the tunnel boring machine. The research comprises laboratory testing, linear drag bit and disc cutter tests and potentially large-scale laboratory demonstrations to support potential use of a tunnel boring machine in welded tuff. Preliminary estimates of mechanical excavator performance in Yucca Mountain tuff are presented here. As phases of the research project are completed, well quantified estimates will be made of performance of mechanical excavators in the Yucca Mountain tuffs. 3 refs., 2 tabs

Mechanical excavator performance in Yucca Mountain tuffs

International Nuclear Information System (INIS)

Ozdemir, L.; Hansen, F.D.

1991-01-01

A research effort of four phases is in progress at the Colorado School of Mines. The overall program will evaluate the cutability of welded tuff and other lithologies likely to be excavated at Yucca Mountain in the site characterization process. Several mechanical systems are considered with emphasis given to the tunnel boring machine. The research comprises laboratory testing, linear drag bit and disc cutter tests, and potentially large-scale lab. demonstrations to support potential use of a tunnel boring machine in welded tuff. Preliminary estimates of mechanical excavator performance in Yucca Mountain tuff are presented here. As phases of the research project are completed, well-quantified estimates will be made of performance of mechanical excavators in the Yucca Mountain tuffs

A SPECIAL FOEHN CASE IN NORTH-EASTERN APUSENI MOUNTAINS

Directory of Open Access Journals (Sweden)

T. TUDOSE

2016-03-01

Full Text Available The paper presents a case study for the 9-10 January 2015 period, when foehn processes were occurred on the eastern slope of the Apuseni Mountains. With a view to establishing the synoptic context in which the phenomenon was manifested, an analysis of the atmospheric fields was used, while for determining the intensity of the process several meteorological parameters (temperature, wind and relative humidity were analyzed along three west-east profiles across the Apuseni Mountains. The analysis points out the presence of foehn processes on the eastern part of the Apuseni Mountains, the highest thermal and hygric differences being recorded on the north-eastern part of the mountains. The most important effect of this synoptic situation was the reduction of the snow cover depth.

Respiratory disease, behavior, and survival of mountain goat kids

Science.gov (United States)

Blanchong, Julie A.; Anderson, Christopher A.; Clark, Nicholas J.; Klaver, Robert W.; Plummer, Paul J.; Cox, Mike; Mcadoo, Caleb; Wolff, Peregrine L.

2018-01-01

Bacterial pneumonia is a threat to bighorn sheep (Ovis canadensis) populations. Bighorn sheep in the East Humboldt Mountain Range (EHR), Nevada, USA, experienced a pneumonia epizootic in 2009–2010. Testing of mountain goats (Oreamnos americanus) that were captured or found dead on this range during and after the epizootic detected bacteria commonly associated with bighorn sheep pneumonia die‐offs. Additionally, in years subsequent to the bighorn sheep epizootic, the mountain goat population had low kid:adult ratios, a common outcome for bighorn sheep populations that have experienced a pneumonia epizootic. We hypothesized that pneumonia was present and negatively affecting mountain goat kids in the EHR. From June–August 2013–2015, we attempted to observe mountain goat kids with marked adult females in the EHR at least once per week to document signs of respiratory disease; identify associations between respiratory disease, activity levels, and subsequent disappearance (i.e., death); and estimate weekly survival. Each time we observed a kid with a marked adult female, we recorded any signs of respiratory disease and collected behavior data that we fit to a 3‐state discrete hidden Markov model (HMM) to predict a kid's state (active vs. sedentary) and its probability of disappearing. We first observed clinical signs of respiratory disease in kids in late July–early August each summer. We observed 8 of 31 kids with marked adult females with signs of respiratory disease on 13 occasions. On 11 of these occasions, the HMM predicted that kids were in the sedentary state, which was associated with increased probability of subsequent death. We estimated overall probability of kid survival from June–August to be 0.19 (95% CI = 0.08–0.38), which was lower than has been reported in other mountain goat populations. We concluded that respiratory disease was present in the mountain goat kids in the EHR and negatively affected their activity levels and survival

The Geologic Story of the Uinta Mountains

Science.gov (United States)

Hansen, Wallace R.

1969-01-01

The opening of the West after the Civil War greatly stimulated early geologic exploration west of the 100th Meridian. One of the areas first studied, the Uinta Mountains region, gained wide attention as a result of the explorations of three Territorial Surveys, one headed by John Wesley Powell, one by Clarence King, and one by Ferdinand V. Hayden. Completion of the Union Pacific Railroad across southern Wyoming 100 years ago, in 1869, materially assisted geologic exploration, and the railheads at Green River and Rock Springs greatly simplified the outfitting of expeditions into the mountains. The overlap of the Powell, King, and Hayden surveys in the Uinta Mountains led to efforts that were less concerted than competitive and not without acrimony. Many parts of the area were seen by all three parties at almost the same time. Duplication was inevitable, of course, but all three surveys contributed vast quantities of new knowledge to the storehouse of geology, and many now-basic concepts arose from their observations. Powell's area of interest extended mainly southward from the Uinta Mountains to the Grand Canyon, including the boundless plateaus and canyons of southern Utah and northern Arizona. King's survey extended eastward from the High Sierra in California to Cheyenne, Wyoming, and encompassed a swath of country more than 100 miles wide. Hayden's explorations covered an immense region of mountains and basins from Yellowstone Park in Wyoming southeast throughout most of Colorado. Powell first entered the Uinta Mountains in the fall of 1868, having traveled north around the east end of the range from the White River country to Green River, Wyoming, then south over a circuitous route to Flaming Gorge and Browns Park, and finally back to the White River, where he spent the winter. In 1869, after reexamining much of the area visited the previous season, Powell embarked on his famous 'first boat trip' down the Green and Colorado Rivers. This trip was more exploratory

A digital intervention to increase motivation and access to NHS Stop Smoking Services: Applying the Behaviour Change Wheel to develop the ‘Stop-app’.

Directory of Open Access Journals (Sweden)

Emily Fulton

2015-10-01

Full Text Available Background: Smokers are four times more likely to stop smoking with the help of an NHS Stop Smoking Service (SSS. However attendance is in decline, possibly due to the increase in popularity of e-cigarettes. SSS’s will support smokers who choose to use e-cigarettes as part of a quit attempt, therefore interventions are needed to encourage continued access and uptake of SSS. Aim: To design an evidence based intervention (Stop-app to increase referrals, 4 week quit rates and reduce ‘did not attend’ (DNA rates within SSS. Methods/Results: In Phase 1 we collected data to explore the barriers and facilitators to people using SSS. Smokers and ex-smokers identified a number of barriers, including a lack of knowledge about what happens at the service; the belief that there would be ’scare tactics’, ‘nagging’, that the service would be unfriendly and clinical; and a lack of perceived efficacy of the service. In Phase 2, data from extant literature and phase 1 were subject to behavioural analysis as outlined by the Behaviour Change Wheel framework. A range of factors were identified as needing to change. These aligned with capability (e.g. a lack of knowledge about the benefits of SSS, opportunity (e.g. beliefs that SSS are not easy to access and to motivation to act (e.g. beliefs that they did not need and would not benefit from SSS. We describe the content development process, illustrating the choice of 19 ‘Behaviour Change Techniques’ included in our digital intervention. In Phase 3 we assessed the acceptability of the proposed intervention by interviewing stop smoking service advisors and non-NHS provider sites (e.g. library services and children’s centres. Findings from interviews are presented and have been used to consider the best path for implementation of the web-app within service provision. Conclusion: The ‘Stop –app’ is in development and will be accessible online, linking with the SSS booking system used by Public

Peculiarities of high-altitude landscapes formation in the Small Caucasus mountains

Science.gov (United States)

Trifonova, Tatiana

2014-05-01

Various mountain systems differ in character of landscapes and soil. Basic problem of present research: conditions and parameters determining the development of various landscapes and soils in mountain areas. Our research object is the area of Armenia where Small Caucasus, a part of Armenian upland is located. The specific character of the area is defined by the whole variety of all mountain structures like fold, block folding mountain ridges, volcanic upland, individual volcanoes, and intermountain depressions. As for the climate, the area belongs to dry subtropics. We have studied the peculiarities of high-altitude landscapes formation and mountain river basins development. We have used remote sensing data and statistic database of climatic parameters in this research. Field observations and landscape pictures analysis of space images allow distinguishing three types of mountain geosystems clearly: volcanic massifs, fold mountainous structures and closed high mountain basins - area of the lakes. The distribution of precipitation according to altitude shows some peculiarities. It has been found that due to this factor the investigated mountain area may be divided into three regions: storage (fold) mountainous area; Ararat volcanic area (southern macro exposure); closed high mountainous basin-area of the lake Sevan. The mountainous nature-climatic vertical landscapes appear to be horizontally oriented and they are more or less equilibrium (stable) geosystems, where the stable functional relationship between the landscape components is formed. Within their limits, definite bioclimatic structure of soil is developed. Along the slopes of fold mountains specific landscape shapes like litho-drainage basins are formed. They are intensively developing like relatively independent vertical geosystems. Mechanism of basin formation is versatile resulting in formation of the polychronous soil mantle structure. Landscapes and soils within the basin are of a different age, since

Climate Change Adaptation in the Carpathian Mountain Region

NARCIS (Netherlands)

Werners, Saskia Elisabeth; Szalai, Sándor; Zingstra, Henk; Kőpataki, Éva; Beckmann, Andreas; Bos, Ernst; Civic, Kristijan; Hlásny, Tomas; Hulea, Orieta; Jurek, Matthias; Koch, Hagen; Kondor, Attila Csaba; Kovbasko, Aleksandra; Lakatos, M.; Lambert, Stijn; Peters, Richard; Trombik, Jiří; De Velde, Van Ilse; Zsuffa, István

2016-01-01

The Carpathian mountain region is one of the most significant natural refuges on the European continent. It is home to Europe’s most extensive tracts of montane forest, the largest remaining virgin forest and natural mountain beech-fir forest ecosystems. Adding to the biodiversity are semi-natural

The physiology of mountain biking.

Science.gov (United States)

Impellizzeri, Franco M; Marcora, Samuele M

2007-01-01

Mountain biking is a popular outdoor recreational activity and an Olympic sport. Cross-country circuit races have a winning time of approximately equal 120 minutes and are performed at an average heart rate close to 90% of the maximum, corresponding to 84% of maximum oxygen uptake (VO2max). More than 80% of race time is spent above the lactate threshold. This very high exercise intensity is related to the fast starting phase of the race; the several climbs, forcing off-road cyclists to expend most of their effort going against gravity; greater rolling resistance; and the isometric contractions of arm and leg muscles necessary for bike handling and stabilisation. Because of the high power output (up to 500W) required during steep climbing and at the start of the race, anaerobic energy metabolism is also likely to be a factor of off-road cycling and deserves further investigation. Mountain bikers' physiological characteristics indicate that aerobic power (VO2max >70 mL/kg/min) and the ability to sustain high work rates for prolonged periods of time are prerequisites for competing at a high level in off-road cycling events. The anthropometric characteristics of mountain bikers are similar to climbers and all-terrain road cyclists. Various parameters of aerobic fitness are correlated to cross-country performance, suggesting that these tests are valid for the physiological assessment of competitive mountain bikers, especially when normalised to body mass. Factors other than aerobic power and capacity might influence off-road cycling performance and require further investigation. These include off-road cycling economy, anaerobic power and capacity, technical ability and pre-exercise nutritional strategies.

Risk management among mountain bikers in selected clubs in ...

African Journals Online (AJOL)

Risk management among mountain bikers in selected clubs in Malaysia. ... Journal of Fundamental and Applied Sciences. Journal Home · ABOUT ... is more risky. Keywords: mountain biking, risk management, event management, Malaysia ...

Characterize Eruptive Processes at Yucca Mountain, Nevada

International Nuclear Information System (INIS)

D. Krier

2004-01-01

The purpose of this scientific analysis report, ''Characterize Eruptive Processes at Yucca Mountain, Nevada'', is to present information about natural volcanic systems and the parameters that can be used to model their behavior. This information is used to develop parameter-value distributions appropriate for analysis of the consequences of volcanic eruptions through a repository at Yucca Mountain. This scientific analysis report provides information to four other reports: ''Number of Waste Packages Hit by Igneous Intrusion'', (BSC 2004 [DIRS 170001]); ''Atmospheric Dispersal and Deposition of Tephra from Potential Volcanic Eruption at Yucca Mountain, Nevada'' (BSC 2004 [DIRS 170026]); ''Dike/Drift Interactions'' (BSC 2004 [DIRS 170028]); ''Development of Earthquake Ground Motion Input for Preclosure Seismic Design and Postclosure Performance Assessment of a Geologic Repository at Yucca Mountain, NV'' (BSC 2004 [DIRS 170027], Section 6.5). This report is organized into seven major sections. This section addresses the purpose of this document. Section 2 addresses quality assurance, Section 3 the use of software, Section 4 identifies the requirements that constrain this work, and Section 5 lists assumptions and their rationale. Section 6 presents the details of the scientific analysis and Section 7 summarizes the conclusions reached

The mountain Cer: Potentials for tourism development

Directory of Open Access Journals (Sweden)

Grčić Mirko D.

2003-01-01

Full Text Available In northwest of Serbia in the meridians directions an elongated mountain range of Cer with Iverak and Vlašić stretches itself. On the north it goes down to Mačva and Posavina, on the west to Podrinje, on the east to the valley of Kolubara, on the south to the basins and valleys of Jadar and upper Kolubara, which separate it from the mountains of Valjevo and Podrinje area. Cer mountain offers extremely good condition for development of eco-tourism. The variety of relief with gorgeous see-sites, natural rarities, convenient bio-climatic conditions, significant water resources, forest complexes, medieval fortresses, cultural-historic monuments, richness of flora and fauna, preserved rural environment, traditions and customs of local population, were all neglected as strategic factors in the development of tourism. This mountain’s potentials are quite satisfactory for the needs of eco-tourism, similar to the National Park of Fruška Gora, but it has lacked an adequate ecotourist strategy so far. This study aims to pointing to the potential and possibilities of ecotourist valorization of this mountain.

Raising the veil: mountains from a masculine and a feminine angle

OpenAIRE

2012-01-01

Context The present call for papers seeks to offer a feminine/masculine reading of mountains. Many works have already analysed the roles of human activity in mountain spaces, in agricultural production, the travel trade, the economy and the arts. But such investigation has often focused on the masculine side, revealing the practices, customs and narratives of men in the mountains. However the relations between humans and mountains do not all take a masculine form, their feminine side being eq...

The status of Yucca Mountain site characterization activities

International Nuclear Information System (INIS)

Gertz, Carl P.; Larkin, Erin L.; Hamner, Melissa

1992-01-01

The U.S. Department of Energy (DOE) Office of Civilian Radioactive Waste Management (OCRWM) is continuing its studies to determine if Yucca Mountain, Nevada, can safely isolate high-level nuclear waste for the next ten thousand years. As mandated by Congress in 1987, DOE is studying the rocks, the climate, and the water table at Yucca Mountain to ensure that the site is suitable before building a repository adopt 305 meters below the surface. Yucca Mountain, located 160.9 kilometers northwest of Las Vegas, lies on the western edge of the Nevada Test Site. Nevada and DOE have been in litigation over environmental permits needed to conduct studies, but recent court decisions have allowed limited new work to begin. This paper will examine progress made on the Yucca Mountain Site Characterization Project (YMP) during 1991 and continuing into 1992, discuss the complex legal issues and describe new site drilling work. Design work on the underground exploratory studies facility (ESF) will also be discussed. (author)

Yucca Mountain biological resources monitoring program

International Nuclear Information System (INIS)

1993-02-01

The US Department of Energy (DOE) is required by the Nuclear Waste Policy Act of 1982 (as amended in 1987) to study and characterize Yucca Mountain as a potential site for a geologic repository for high-level nuclear waste. During site characterization, the DOE will conduct a variety of geotechnical, geochemical, geological, and hydrological studies to determine the suitability of Yucca Mountain as a potential repository. To ensure that site characterization activities (SCA) do not adversely affect the environment at Yucca Mountain, an environmental program has been implemented to monitor and mitigate potential impacts and ensure activities comply with applicable environmental regulations. This report describes the activities and accomplishments of EG ampersand G Energy Measurements, Inc. (EG ampersand G/EM) during fiscal year 1992 (FY92) for six program areas within the Terrestrial Ecosystem component of the YMP environmental program. The six program areas are Site Characterization Effects, Desert Tortoises, Habitat Reclamation, Monitoring and Mitigation, Radiological Monitoring, and Biological Support

Rocky Mountain High.

Science.gov (United States)

Hill, David

2001-01-01

Describes Colorado's Eagle Rock School, which offers troubled teens a fresh start by transporting them to a tuition- free campus high in the mountains. The program encourages spiritual development as well as academic growth. The atmosphere is warm, loving, structured, and nonthreatening. The article profiles several students' experiences at the…

Change management of mergers: the impact on NHS staff and their psychological contracts.

Science.gov (United States)

Cortvriend, Penny

2004-08-01

The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times.

Modeling the Biophysical Impacts of Global Change in Mountain Biosphere Reserves

NARCIS (Netherlands)

Bugmann, H.; Björnsen Gurung, A.; Ewert, F.; Haeberli, W.; Guisan, A.; Fagre, D.; Kääb, A.

2007-01-01

Mountains and mountain societies provide a wide range of goods and services to humanity, but they are particularly sensitive to the effects of global environmental change. Thus, the definition of appropriate management regimes that maintain the multiple functions of mountain regions in a time of

Yucca Mountain Site characterization project bibliography, January--June 1991

International Nuclear Information System (INIS)

1992-06-01

Following a reorganization of the Office of Civilian Radioactive Waste Management in 1990, the Yucca Mountain Project was renamed Yucca Mountain Site Characterization Project. The title of this bibliography was also changed to Yucca Mountain Site Characterization Project Bibliography. Prior to August 5, 1988, this project was called the Nevada Nuclear Waste Storage Investigations. This bibliography contains information on this ongoing project that was added to the Department of Energy's Science and Technology Database from January 1, 1990, through December 31, 1991

Periodic Burning In Table Mountain-Pitch Pine Stands

Science.gov (United States)

Russell B. Randles; David H. van Lear; Thomas A. Waldrop; Dean M. Simon

2002-01-01

Abstract - The effects of multiple, low intensity burns on vegetation and wildlife habitat in Table Mountain (Pinus pungens Lamb.)-pitch (Pinus rigida Mill.) pine communities were studied in the Blue Ridge Mountains of North Carolina. Treatments consisted of areas burned from one to four times at 3-4 year...

Landforms of High Mountains

Directory of Open Access Journals (Sweden)

Derek A. McDougall

2016-05-01

Full Text Available Reviewed: Landforms of High Mountains. By Alexander Stahr and Ewald Langenscheidt. Heidelberg, Germany: Springer, 2015. viii + 158 pp. US$ 129.99. Also available as an e-book. ISBN 978-3-642-53714-1.

Preparing to Submit a License Application for Yucca Mountain

International Nuclear Information System (INIS)

W.J. Arthur; M.D. Voegele

2005-01-01

In 1982, the U.S. Congress passed the Nuclear Waste Policy Act, a Federal law that established U.S. policy for the permanent disposal of spent nuclear fuel and high-level radioactive waste. Congress amended the Act in 1987, directing the Department of Energy to study only Yucca Mountain, Nevada as the site for a permanent geologic repository. As the law mandated, the Department evaluated Yucca Mountain to determine its suitability as the site for a permanent geologic repository. Decades of scientific studies demonstrated that Yucca Mountain would protect workers, the public, and the environment during the time that a repository would be operating and for tens of thousands of years after closure of the repository. A repository at this remote site would also: preserve the quality of the environment; allow the environmental cleanup of Cold War weapons facilities; provide the nation with additional protection from acts of terrorism; and support a sound energy policy. Throughout the scientific evaluation of Yucca Mountain, there has been no evidence to disqualify Yucca Mountain as a suitable site for the permanent disposal of spent nuclear fuel and high-level radioactive waste. Upon completion of site characterization, the Secretary of Energy considered the results and concluded that a repository at Yucca Mountain would perform in a manner that protects public health and safety. The Secretary recommended the site to the President in February 2002; the President agreed and recommended to Congress that the site be approved. The Governor of Nevada submitted a notice of disapproval, and both houses of Congress acted to override the disapproval. In July 2002, the President's approval allowed the Department to begin the process of submittal of a license application for Yucca Mountain as the site for the nation's first repository for spent nuclear fuel and high-level radioactive waste. Yucca Mountain is located on federal land in Nye County in southern Nevada, an arid region

Yucca Mountain Project bibliography, January--June 1989

International Nuclear Information System (INIS)

1990-01-01

Following a reorganization of the Office of Civilian Radioactive Waste Management, the Yucca Mountain Project was renamed Yucca Mountain Site Characterization Project. The title of this bibliography was also changed to Yucca Mountain Site Characterization Project Bibliography. Prior to August 5, 1988, this project was called the Nevada Nuclear Waste Storage Investigations. This bibliography contains information on this ongoing project that was added to the Department of Energy's Energy Science and Technology Database from January 1990 through June 1990. The bibliography is categorized by principal project participating organization. Participant-sponsored subcontractor reports, papers, and articles are included in the sponsoring organization's list. Another section contains information about publications on the Energy Science and Technology Database that were not sponsored by the project but have some relevance to it

Education and Yucca Mountain

International Nuclear Information System (INIS)

Lamont, M.A.

1995-01-01

This paper outlines a middle school social studies curriculum taught in Nevada. The curriculum was designed to educate students about issues related to the Yucca Mountain project. The paper focuses on the activities used in the curriculum

Mixed messages: An evaluation of NHS Trust Social Media policies in the North West of England

International Nuclear Information System (INIS)

Scragg, B.; Shaikh, S.; Robinson, L.; Mercer, C.

2017-01-01

Introduction: Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. Method: The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. Results: The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers' reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Conclusion: Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff. - Highlights: • Practitioners are discouraged from using SoMe by employers' policies. • This is at odds with national strategy of engagement with all stakeholders. • Policies are skewed towards protecting reputation and

Geology of the Yucca Mountain Region, Chapter in Stuckless, J.S., ED., Yucca Mountain, Nevada - A Proposed Geologic Repository for High-Level Radioactive Waste

International Nuclear Information System (INIS)

J.S. Stuckless; D. O'Leary

2006-01-01

Yucca Mountain has been proposed as the site for the Nation's first geologic repository for high-level radioactive waste. This chapter provides the geologic framework for the Yucca Mountain region. The regional geologic units range in age from late Precambrian through Holocene, and these are described briefly. Yucca Mountain is composed dominantly of pyroclastic units that range in age from 11.4 to 15.2 Ma. The proposed repository would be constructed within the Topopah Spring Tuff, which is the lower of two major zoned and welded ash-flow tuffs within the Paintbrush Group. The two welded tuffs are separated by the partly to nonwelded Pah Canyon Tuff and Yucca Mountain Tuff, which together figure prominently in the hydrology of the unsaturated zone. The Quaternary deposits are primarily alluvial sediments with minor basaltic cinder cones and flows. Both have been studied extensively because of their importance in predicting the long-term performance of the proposed repository. Basaltic volcanism began about 10 Ma and continued as recently as about 80 ka with the eruption of cones and flows at Lathrop Wells, approximately 10 km south-southwest of Yucca Mountain. Geologic structure in the Yucca Mountain region is complex. During the latest Paleozoic and Mesozoic, strong compressional forces caused tight folding and thrust faulting. The present regional setting is one of extension, and normal faulting has been active from the Miocene through to the present. There are three major local tectonic domains: (1) Basin and Range, (2) Walker Lane, and (3) Inyo-Mono. Each domain has an effect on the stability of Yucca Mountain

European mountain biodiversity

Directory of Open Access Journals (Sweden)

Nagy, Jennifer

1998-12-01

Full Text Available This paper, originally prepared as a discussion document for the ESF Exploratory Workshop «Trends in European Mountain Biodiversity - Research Planning Workshop», provides an overview of current mountain biodiversity research in Europe. It discusses (a biogeographical trends, (b the general properties of biodiversity, (c environmental factors and the regulation of biodiversity with respect to ecosystem function, (d the results of research on mountain freshwater ecosystems, and (e climate change and air pollution dominated environmental interactions.- The section on biogeographical trends highlights the importance of altitude and latitude on biodiversity. The implications of the existence of different scales over the different levels of biodiversity and across organism groups are emphasised as an inherent complex property of biodiversity. The discussion on ecosystem function and the regulation of biodiversity covers the role of environmental factors, productivity, perturbation, species migration and dispersal, and species interactions in the maintenance of biodiversity. Regional and long-term temporal patterns are also discussed. A section on the relatively overlooked topic of mountain freshwater ecosystems is presented before the final topic on the implications of recent climate change and air pollution for mountain biodiversity.

[fr] Ce document a été préparé à l'origine comme une base de discussion pour «ESF Exploratory Workshop» intitulé «Trends in European Mountain Biodiversity - Research Planning Workshop»; il apporte une vue d'ensemble sur les recherches actuelles portant sur la biodiversité des montagnes en Europe. On y discute les (a traits biogéographiques, (b les caractéristiques générales- de la biodiversité, (c les facteurs environnementaux et la régulation de la biodiversité par rapport à la fonction des écosystèmes, (d les résultats des études sur les écosystèmes aquatiques des montagnes et (e les

Rocky Mountain Research Station: 2012-2013 Annual Report

Science.gov (United States)

Cass Cairns

2013-01-01

The Rocky Mountain Research Station is one of seven regional units that make up the USDA Forest Service Research and Development organization - the most extensive natural resources research organization in the world. We maintain 12 field laboratories throughout a 12-state territory encompassing the Great Basin, Southwest, Rocky Mountains, and parts of the...

Refresher Course on Mountain Hydrology and Climate Change

Indian Academy of Sciences (India)

IAS Admin

2016-01-29

Jan 29, 2016 ... The programme focuses on hydrology of mountains, which provide water around 40 % of the world population. Changes in temperature and precipitation have in recent years led to the retreat of glaciers in mountains. Climatic changes do not only affect glaciers or the nival zone; a change in climatic ...

Revised potentiometric-surface map, Yucca Mountain and vicinity, Nevada

International Nuclear Information System (INIS)

Ervin, E.M.; Luckey, R.R.; Burkhardt, D.J.

1994-01-01

The revised potentiometric-surface map presented in this report updates earlier maps of the Yucca Mountain area using mainly 1988 average water levels. Because of refinements in the corrections to the water-level measurements, these water levels have increased accuracy and precision over older values. The small-gradient area to the southeast of Yucca Mountain is contoured with a 0.25-meter interval and ranges in water-level altitude from 728.5 to 73 1.0 meters. Other areas with different water levels, to the north and west of Yucca Mountain, are illustrated with shaded patterns. The potentiometric surface can be divided into three regions: (1) A small-gradient area to the southeast of Yucca Mountain, which may be explained by flow through high-transmissivity rocks or low ground-water flux through the area; (2) A moderate-gradient area, on the western side of Yucca Mountain, where the water-level altitude ranges from 775 to 780 meters, and appears to be impeded by the Solitario Canyon Fault and a splay of that fault; and (3) A large-gradient area, to the north-northeast of Yucca Mountain, where water level altitude ranges from 738 to 1,035 meters, possibly as a result of a semi-perched groundwater system. Water levels from wells at Yucca Mountain were examined for yearly trends using linear least-squares regression. Data from five wells exhibited trends which were statistically significant, but some of those may be a result of slow equilibration of the water level from drilling in less permeable rocks. Adjustments for temperature and density changes in the deep wells with long fluid columns were attempted, but some of the adjusted data did not fit the surrounding data and, thus, were not used

Implications of the UK NHS consent policy for nuclear medicine practice.

Science.gov (United States)

Greaves, Claire D; Tindale, Wendy B

2005-02-01

To comply with government policy on consent, the Sheffield Teaching Hospitals (STH) National Health Service (NHS) Trust introduced a new consent policy in February 2002. Verbal or written consent (depending on the level of risk) must be obtained prior to each study. The patient must be fully informed and given time to reach a decision. Consideration needs to be given to the following: to whom, when and how to provide such information and obtain consent. Each study type and patient circumstance needs to be classified according to risk. Consideration of the risks resulted in a local policy in which written consent is required for the following: therapeutic procedures, studies on pregnant women, studies in which pregnancy needs to be avoided, research procedures, cardiac stress for myocardial perfusion scintigraphy and intrathecal administration. Patient information leaflets have been updated with new information about the study and any risks. Information is now available for both patients and hospital staff. Compliance with the consent policy in a service department provides logistic challenges, but it is possible to fully inform patients in advance about their treatment, allowing them to give informed consent.

Productivity of Mountain Reedbugk Redunca Fulvorufula (Afzelius, 1815 at the Mountain Zebra National Park

Directory of Open Access Journals (Sweden)

J. D Skinner

1980-12-01

Full Text Available Eighty two adult mountain reedbuck Redunca fulvoru- fula were collected during four seasons, autumn, winter, spring and summer at the Mountain Zebra National Park mainly during 1975 and 1976. Body mass and carcass characteristics varied little with season, body mass varying from 24,0-35,5 kg for all buck shot and dressing percentage always exeeded 50. According to KFI animals were all in fair to good condition. Sixty four percent of all ewes were pregnant and 38,5 lactating. Females and males bred throughout the year but there was a peak in births during mid-summer. The species is highly productive, well adapted to the niche it occupies and lends itself to exploitation for meat production.

eBook management in NHS libraries in the North of England: perceptions and practice.

Science.gov (United States)

Nicholas, Katie

2018-03-01

In this article, Katie Nicholas presents the findings of a very topical piece of research into the use of eBooks in health libraries, which she completed for a Masters dissertation. Katie graduated with an MA in Library and Information Management (Distinction) from Manchester Metropolitan University in July 2017. She would like to acknowledge the support of her supervisor, Rachel Delbridge, in helping her to gain a Distinction in her dissertation. In the article, she points out that the use of eBooks in the NHS is low compared to other sectors and she presents the findings from her research, which help to explain this. She outlines the development of an electronic tool to help library and information staff make sense of the complexity around eBooks and makes further very practical recommendations for practitioners. A. M. © 2018 Health Libraries Group.

Characterize Eruptive Processes at Yucca Mountain, Nevada

Energy Technology Data Exchange (ETDEWEB)

D. Krier

2004-10-04

The purpose of this scientific analysis report, ''Characterize Eruptive Processes at Yucca Mountain, Nevada'', is to present information about natural volcanic systems and the parameters that can be used to model their behavior. This information is used to develop parameter-value distributions appropriate for analysis of the consequences of volcanic eruptions through a repository at Yucca Mountain. This scientific analysis report provides information to four other reports: ''Number of Waste Packages Hit by Igneous Intrusion'', (BSC 2004 [DIRS 170001]); ''Atmospheric Dispersal and Deposition of Tephra from Potential Volcanic Eruption at Yucca Mountain, Nevada'' (BSC 2004 [DIRS 170026]); ''Dike/Drift Interactions'' (BSC 2004 [DIRS 170028]); ''Development of Earthquake Ground Motion Input for Preclosure Seismic Design and Postclosure Performance Assessment of a Geologic Repository at Yucca Mountain, NV'' (BSC 2004 [DIRS 170027], Section 6.5). This report is organized into seven major sections. This section addresses the purpose of this document. Section 2 addresses quality assurance, Section 3 the use of software, Section 4 identifies the requirements that constrain this work, and Section 5 lists assumptions and their rationale. Section 6 presents the details of the scientific analysis and Section 7 summarizes the conclusions reached.

The interaction of katabatic winds and mountain waves

Energy Technology Data Exchange (ETDEWEB)

Poulos, Gregory Steve [Colorado State Univ., Fort Collins, CO (United States)

1997-01-01

The variation in the oft-observed, thermally-forced, nocturnal katabatic winds along the east side of the Rocky Mountains can be explained by either internal variability or interactions with various other forcings. Though generally katabatic flows have been studied as an entity protected from external forcing by strong thermal stratification, this work investigates how drainage winds along the Colorado Front Range interact with, in particular, topographically forced mountain waves. Previous work has shown, based on measurements taken during the Atmospheric Studies in Complex Terrain 1993 field program, that the actual dispersion in katabatic flows is often greater than reflected in models of dispersion. The interaction of these phenomena is complicated and non-linear since the amplitude, wavelength and vertical structure of mountain waves developed by flow over the Rocky Mountain barrier are themselves partly determined by the evolving atmospheric stability in which the drainage flows develop. Perturbations to katabatic flow by mountain waves, relative to their more steady form in quiescent conditions, are found to be caused by both turbulence and dynamic pressure effects. The effect of turbulent interaction is to create changes to katabatic now depth, katabatic flow speed, katabatic jet height and, vertical thermal stratification. The pressure effect is found to primarily influence the variability of a given katabatic now through the evolution of integrated column wave forcing on surface pressure. Variability is found to occur on two scales, on the mesoscale due to meso-gamma scale mountain wave evolution, and on the microscale, due to wave breaking. Since existing parameterizations for the statically stable case are predominantly based on nearly flat terrain atmospheric measurements under idealized or nearly quiescent conditions, it is no surprise that these parameterizations often contribute to errors in prediction, particularly in complex terrain.

Cosine components in water levels at Yucca Mountain

International Nuclear Information System (INIS)

Rice, J.; Lehman, L.; Keen, K.

1990-01-01

Water-level records from wells at Yucca Mountain, Nevada are analyzed periodically to determine if they contain periodic (cosine) components. Water-level data from selected wells are input to an iterative numerical procedure that determines a best fitting cosine function. The available water-level data, with coverage of up to 5 years, appear to be representative of the natural water-level changes. From our analysis of 9 water-level records, it appears that there may be periodic components (periods of 2-3 years) in the groundwater-level fluctuations at Yucca Mountain, Nevada, although some records are fit better than others by cosine functions. It also appears that the periodic behavior has a spatial distribution. Wells west of Yucca Mountain have different periods and phase shifts from wells on and east of Yucca Mountain. Interestingly, a similar spatial distribution of groundwater chemistry at Yucca Mountain is reported by Matuska (1988). This suggests a physical cause may underlie the different physical and chemical groundwater conditions. Although a variety of natural processes could cause water-level fluctuations, hydrologic processes are the most likely, because the periodicities are only a few years. A possible cause could be periodic recharge related to a periodicity in precipitation. It is interesting that Cochran et al., (1988), show a crude two-year cycle of precipitation for 1961 to 1970 in southern Nevada. Why periods and phase shifts may differ across Yucca Mountain is unknown. Different phase shifts could indicate different lag times of response to hydrologic stimuli. Difference in periods could mean that the geologic media is heterogeneous and displays heterogeneous response to a single stimulus, or that stimuli differ in certain regions, or that a hydraulic barrier separates the groundwater system into two regions having different water chemistry and recharge areas. 13 refs., 5 figs., 1 tab

Eye problems in mountain and remote areas: prevention and onsite treatment--official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM.

Science.gov (United States)

Ellerton, John A; Zuljan, Igor; Agazzi, Giancelso; Boyd, Jeffrey J

2009-01-01

Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.

Big mountains but small barriers: population genetic structure of the Chinese wood frog (Rana chensinensis) in the Tsinling and Daba Mountain region of northern China.

Science.gov (United States)

Zhan, Aibin; Li, Cheng; Fu, Jinzhong

2009-04-09

Amphibians in general are poor dispersers and highly philopatric, and landscape features often have important impacts on their population genetic structure and dispersal patterns. Numerous studies have suggested that genetic differentiation among amphibian populations are particularly pronounced for populations separated by mountain ridges. The Tsinling Mountain range of northern China is a major mountain chain that forms the boundary between the Oriental and Palearctic zoogeographic realms. We studied the population structure of the Chinese wood frog (Rana chensinensis) to test whether the Tsinling Mountains and the nearby Daba Mountains impose major barriers to gene flow. Using 13 polymorphic microsatellite DNA loci, 523 individuals from 12 breeding sites with geographical distances ranging from 2.6 to 422.8 kilometers were examined. Substantial genetic diversity was detected at all sites with an average of 25.5 alleles per locus and an expected heterozygosity ranging from 0.504 to 0.855, and two peripheral populations revealed significantly lower genetic diversity than the central populations. In addition, the genetic differentiation among the central populations was statistically significant, with pairwise FST values ranging from 0.0175 to 0.1625 with an average of 0.0878. Furthermore, hierarchical AMOVA analysis attributed most genetic variation to the within-population component, and the between-population variation can largely be explained by isolation-by-distance. None of the putative barriers detected from genetic data coincided with the location of the Tsinling Mountains. The Tsinling and Daba Mountains revealed no significant impact on the population genetic structure of R. chensinensis. High population connectivity and extensive juvenile dispersal may account for the significant, but moderate differentiation between populations. Chinese wood frogs are able to use streams as breeding sites at high elevations, which may significantly contribute to the

Geodesy and contemporary strain in the Yucca Mountain region, Nevada

International Nuclear Information System (INIS)

Keefer, W.R.; Coe, J.A.; Pezzopane, S.K.; Hunter, W.C.

1997-01-01

Geodetic surveys provide important information for estimating recent ground movement in support of seismotectonic investigations of the potential nuclear-waste storage site at Yucca Mountain, Nevada. Resurveys of established level lines document up to 22 millimeters of local subsidence related to the 1992 Little Skull Mountain earthquake, which is consistent with seismic data that show normal-slip rupture and with data from a regional trilateration network. Comparison of more recent surveys with a level line first established in 1907 suggests 3 to 13 centimeters of subsidence in the Crater Flat-Yucca Mountain structural depression that coincides with the Bare Mountain fault; small uplifts also were recorded near normal faults at Yucca Mountain. No significant deformation was recorded by a trilateration network over a 10-year period, except for coseismic deformation associated with the Little Skull Mountain earthquake, but meaningful results are limited by the short temporal period of that data set and the small rate of movement. Very long baseline interferometry that is capable of measuring direction and rates of deformation is likewise limited by a short history of observation, but rates of deformation between 8 and 13 millimeters per year across the basin and Range province are indicated by the available data

Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS.

Science.gov (United States)

Checkland, Kath; Allen, Pauline; Coleman, Anna; Segar, Julia; McDermott, Imelda; Harrison, Stephen; Petsoulas, Christina; Peckham, Stephen

2013-12-10

One of the key goals of the current reforms in the English National Health Service (NHS) under the Health and Social Care Act, 2012, is to increase the accountability of those responsible for commissioning care for patients (clinical commissioning groups (CCGs)), while at the same time allowing them a greater autonomy. This study was set out to explore CCG's developing accountability relationships. We carried out detailed case studies in eight CCGs, using interviews, observation and documentary analysis to explore their multiple accountabilities. We interviewed 91 people, including general practitioners, managers and governing body members in developing CCGs, and undertook 439 h of observation in a wide variety of meetings. CCGs are subject to a managerial, sanction-backed accountability to NHS England (the highest tier in the new organisational hierarchy), alongside a number of other external accountabilities to the public and to some of the other new organisations created by the reforms. In addition, unlike their predecessor commissioning organisations, they are subject to complex internal accountabilities to their members. The accountability regime to which CCGs are subject to is considerably more complex than that which applied their predecessor organisations. It remains to be seen whether the twin aspirations of increased autonomy and increased accountability can be realised in practice. However, this early study raises some important issues and concerns, including the risk that the different bodies to whom CCGs are accountable will have differing (or conflicting) agendas, and the lack of clarity over the operation of sanction regimes.

Mountain Plant Community Sentinels: AWOL

Science.gov (United States)

Malanson, G. P.

2017-12-01

Mountain plant communities are thought to be sensitive to climate change. Because climatic gradients are steep on mountain slopes, the spatial response of plant communities to climate change should be compressed and easier to detect. These expectations have led to identifying mountain plant communities as sentinels for climate change. This idea has, however, been criticized. Two critiques, for alpine treeline and alpine tundra, are rehearsed and supplemented. The critique of alpine treeline as sentinel is bolstered with new model results on the confounding role of dispersal mechanisms and sensitivity to climatic volatility. In alpine tundra, for which background turnover rates have yet to be established, community composition may reflect environmental gradients only for extremes where effects of climate are most indirect. Both plant communities, while primarily determined by energy at broad scales, may respond to water as a proximate driver at local scales. These plant communities may not be in equilibrium with climate, and differently scaled time lags may mean that ongoing vegetation change may not signal ongoing climate change (or lack thereof). In both cases a double-whammy is created by scale dependence for time lags and for drivers leading to confusion, but these cases present opportunities for insights into basic ecology.

Rethinking risk and disasters in mountain areas

OpenAIRE

Hewitt, Kenneth; Mehta, Manjari

2012-01-01

This chapter presents a view of risk and disaster in the mountains that finds them fully a part of public safety issues in modern states and developments, rather than separated from them. This contrasts with prevailing approaches to disaster focused on natural hazards, “unscheduled” or extreme events, and emergency preparedness; approaches strongly reinforced by mountain stereotypes. Rather, we find the legacies of social and economic histories, especially relations to down-country or metropo...

Mechanisms of carbon storage in mountainous headwater rivers

Science.gov (United States)

Ellen Wohl; Kathleen Dwire; Nicholas Sutfin; Lina Polvi; Roberto Bazan

2012-01-01

Published research emphasizes rapid downstream export of terrestrial carbon from mountainous headwater rivers, but little work focuses on mechanisms that create carbon storage along these rivers, or on the volume of carbon storage. Here we estimate organic carbon stored in diverse valley types of headwater rivers in Rocky Mountain National Park, CO, USA. We show that...

GEOLOGICAL ANDGEOMORPHOLOGICAL MAPPING ARCHAEOLOGICAL MONUMENTS OF MOUNTAIN ALTAI

Directory of Open Access Journals (Sweden)

G. Y. Baryshnikov

2015-01-01

Full Text Available The article discusses the results of geological and geomorphological mapping of archaeological monument, mainly Paleolithic age, the location of which is confined to low-mountain spaces of the Mountain Altai. Using this mapping would greatly clarify the sequence of relief habitat of ancient people and more objectively determine the age characteristics of archaeological monument. 

Yucca Mountain and the environmental issue

International Nuclear Information System (INIS)

Gertz, C.P.

1991-01-01

The scientists and engineers who work on the Yucca Mountain Project keenly feel their responsibility - to solve an important national environmental issue. Addressing the issue of nuclear waste disposal may also help keep the nuclear option viable. Under congressional mandate, they are working to find that solution despite tough opposition from the state of Nevada. Nevada and the US Department of Energy (DOE) have been litigating the issue of environmental permits for almost 2 years now, and the court decisions have all favored DOE. The DOE's site characterization efforts are designed to determine whether Yucca Mountain can safely store spent nuclear fuel for the next 10,000 yr. DOE is studying the rocks, the climate, and the water table to make sure that the site is suitable before anything is built there. The success of the Yucca Mountain Project is vital to settling existing environmental issues as well as maintaining the viability of nuclear energy. Through efforts in Congress and outreach programs in Nevada, DOE hopes to inform the public of the mission and begin the process of site characterization

Yucca Mountain Project bibliography, 1988--1989

International Nuclear Information System (INIS)

Lorenz, J.J.

1990-11-01

This bibliography contains information on the Yucca Mountain Project that was added to the Department of Energy's Energy Data Base from January 1988 through December 1989. This supplement also includes a new section which provides information about publications on the Energy Data Base that were not sponsored by the project but have some relevance to it. The bibliography is categorized by principal project participating organization. Participant-sponsored subcontractor reports, papers, and articles are included in the sponsoring organization's list. Indexes are provided for Corporate Author, Personal Author, Subject, Contract Number, Report Number, Order Number Correlation, and Key Word in Context. All entries in the Yucca Mountain Project bibliographies are searchable online on the NNW database file. This file can be accessed through the Integrated Technical Information System (ITIS) of the US Department of Energy (DOE). Technical reports on the Yucca Mountain Project are on display in special open files at participating Nevada Libraries and in the Public Document Room of the US Department of Energy, Nevada Operations Office, in Las Vegas

Geology of the Yucca Mountain Region, Chapter in Stuckless, J.S., ED., Yucca Mountain, Nevada - A Proposed Geologic Repository for High-Level Radioactive Waste

Energy Technology Data Exchange (ETDEWEB)

J.S. Stuckless; D. O' Leary

2006-09-25

Yucca Mountain has been proposed as the site for the Nation's first geologic repository for high-level radioactive waste. This chapter provides the geologic framework for the Yucca Mountain region. The regional geologic units range in age from late Precambrian through Holocene, and these are described briefly. Yucca Mountain is composed dominantly of pyroclastic units that range in age from 11.4 to 15.2 Ma. The proposed repository would be constructed within the Topopah Spring Tuff, which is the lower of two major zoned and welded ash-flow tuffs within the Paintbrush Group. The two welded tuffs are separated by the partly to nonwelded Pah Canyon Tuff and Yucca Mountain Tuff, which together figure prominently in the hydrology of the unsaturated zone. The Quaternary deposits are primarily alluvial sediments with minor basaltic cinder cones and flows. Both have been studied extensively because of their importance in predicting the long-term performance of the proposed repository. Basaltic volcanism began about 10 Ma and continued as recently as about 80 ka with the eruption of cones and flows at Lathrop Wells, approximately 10 km south-southwest of Yucca Mountain. Geologic structure in the Yucca Mountain region is complex. During the latest Paleozoic and Mesozoic, strong compressional forces caused tight folding and thrust faulting. The present regional setting is one of extension, and normal faulting has been active from the Miocene through to the present. There are three major local tectonic domains: (1) Basin and Range, (2) Walker Lane, and (3) Inyo-Mono. Each domain has an effect on the stability of Yucca Mountain.

Repository site data report for unsaturated tuff, Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Tien, P.L.; Updegraff, C.D.; Siegel, M.D.; Wahi, K.K.; Guzowski, R.V.

1985-11-01

The US Department of Energy is currently considering the thick sequences of unsaturated, fractured tuff at Yucca Mountain, on the southwestern boundary of the Nevada Test Site, as a possible candidate host rock for a nuclear-waste repository. Yucca Mountain is in one of the most arid areas in the United States. The site is within the south-central part of the Great Basin section of the Basin and Range physiographic province and is located near a number of silicic calderas of Tertiary age. Although localized zones of seismic activity are common throughout the province, and faults are present at Yucca Mountain, the site itself is basically aseismic. No data are available on the composition of ground water in the unsaturated zone at Yucca Mountain. It has been suggested that the composition is bounded by the compositions of water from wells USW-H3, UE25p-1, J-13, and snow or rain. There are relatively few data available from Yucca Mountain on the moisture content and saturation, hydraulic conductivity, and characteristic curves of the unsaturated zone. The available literature on thermomechanical properties of tuff does not always distinguish between data from the saturated zone and data from the unsaturated zone. Geochemical, hydrologic, and thermomechanical data available on the unsaturated tuffs of Yucca Mountain are tabulated in this report. Where the data are very sparse, they have been supplemented by data from the saturated zone or from areas other than Yucca Mountain. 316 refs., 58 figs., 37 tabs

Repository site data report for unsaturated tuff, Yucca Mountain, Nevada

Energy Technology Data Exchange (ETDEWEB)

Tien, P.L.; Updegraff, C.D.; Siegel, M.D.; Wahi, K.K.; Guzowski, R.V.

1985-11-01

The US Department of Energy is currently considering the thick sequences of unsaturated, fractured tuff at Yucca Mountain, on the southwestern boundary of the Nevada Test Site, as a possible candidate host rock for a nuclear-waste repository. Yucca Mountain is in one of the most arid areas in the United States. The site is within the south-central part of the Great Basin section of the Basin and Range physiographic province and is located near a number of silicic calderas of Tertiary age. Although localized zones of seismic activity are common throughout the province, and faults are present at Yucca Mountain, the site itself is basically aseismic. No data are available on the composition of ground water in the unsaturated zone at Yucca Mountain. It has been suggested that the composition is bounded by the compositions of water from wells USW-H3, UE25p-1, J-13, and snow or rain. There are relatively few data available from Yucca Mountain on the moisture content and saturation, hydraulic conductivity, and characteristic curves of the unsaturated zone. The available literature on thermomechanical properties of tuff does not always distinguish between data from the saturated zone and data from the unsaturated zone. Geochemical, hydrologic, and thermomechanical data available on the unsaturated tuffs of Yucca Mountain are tabulated in this report. Where the data are very sparse, they have been supplemented by data from the saturated zone or from areas other than Yucca Mountain. 316 refs., 58 figs., 37 tabs.

Employing post-DEA cross-evaluation and cluster analysis in a sample of Greek NHS hospitals.

Science.gov (United States)

Flokou, Angeliki; Kontodimopoulos, Nick; Niakas, Dimitris

2011-10-01

To increase Data Envelopment Analysis (DEA) discrimination of efficient Decision Making Units (DMUs), by complementing "self-evaluated" efficiencies with "peer-evaluated" cross-efficiencies and, based on these results, to classify the DMUs using cluster analysis. Healthcare, which is deprived of such studies, was chosen as the study area. The sample consisted of 27 small- to medium-sized (70-500 beds) NHS general hospitals distributed throughout Greece, in areas where they are the sole NHS representatives. DEA was performed on 2005 data collected from the Ministry of Health and the General Secretariat of the National Statistical Service. Three inputs -hospital beds, physicians and other health professionals- and three outputs -case-mix adjusted hospitalized cases, surgeries and outpatient visits- were included in input-oriented, constant-returns-to-scale (CRS) and variable-returns-to-scale (VRS) models. In a second stage (post-DEA), aggressive and benevolent cross-efficiency formulations and clustering were employed, to validate (or not) the initial DEA scores. The "maverick index" was used to sort the peer-appraised hospitals. All analyses were performed using custom-made software. Ten benchmark hospitals were identified by DEA, but using the aggressive and benevolent formulations showed that two and four of them respectively were at the lower end of the maverick index list. On the other hand, only one 100% efficient (self-appraised) hospital was at the higher end of the list, using either formulation. Cluster analysis produced a hierarchical "tree" structure which dichotomized the hospitals in accordance to the cross-evaluation results, and provided insight on the two-dimensional path to improving efficiency. This is, to our awareness, the first study in the healthcare domain to employ both of these post-DEA techniques (cross efficiency and clustering) at the hospital (i.e. micro) level. The potential benefit for decision-makers is the capability to examine high

Rocky Mountain Riparian Digest

Science.gov (United States)

Deborah M. Finch

2008-01-01

The Rocky Mountain Riparian Digest presents the many facets of riparian research at the station. Included are articles about protecting the riparian habitat, the social and economic values of riparian environments, watershed restoration, remote sensing tools, and getting kids interested in the science.

Overview of the status of the Cheat Mountain salamander

Science.gov (United States)

Thomas K. Pauley

2010-01-01

Plethodon nettingi, the Cheat Mountain salamander, is endemic to the high elevations of the Allegheny Mountains in eastern West Virginia. In 1938, N.B. Green named the species from specimens collected at Barton Knob, Randolph County, in honor of his friend and colleague Graham Netting.

A case of Rocky Mountain spotted fever.

Science.gov (United States)

Rubel, Barry S

2007-01-01

Rocky Mountain spotted fever is a serious, generalized infection that is spread to humans through the bite of infected ticks. It can be lethal but it is curable. The disease gets its name from the Rocky Mountain region where it was first identified in 1896. The fever is caused by the bacterium Rickettsia rickettsii and is maintained in nature in a complex life cycle involving ticks and mammals. Humans are considered to be accidental hosts and are not involved in the natural transmission cycle of this pathogen. The author examined a 47-year-old woman during a periodic recall appointment. The patient had no dental problems other than the need for routine prophylaxis but mentioned a recent problem with swelling of her extremities with an accompanying rash and general malaise and soreness in her neck region. Tests were conducted and a diagnosis of Rocky Mountain spotted fever was made.

Preliminary conceptual model for mineral evolution in Yucca Mountain

International Nuclear Information System (INIS)

Duffy, C.J.

1993-12-01

A model is presented for mineral alteration in Yucca Mountain, Nevada, that suggests that the mineral transformations observed there are primarily controlled by the activity of aqueous silica. The rate of these reactions is related to the rate of evolution of the metastable silica polymorphs opal-CT and cristobalite assuming that a SiO 2(aq) is fixed at the equilibrium solubility of the most soluble silica polymorph present. The rate equations accurately predict the present depths of disappearance of opal-CT and cristobalite. The rate equations have also been used to predict the extent of future mineral alteration that may result from emplacement of a high-level nuclear waste repository in Yucca Mountain. Relatively small changes in mineralogy are predicted, but these predictions are based on the assumption that emplacement of a repository would not increase the pH of water in Yucca Mountain nor increase its carbonate content. Such changes may significantly increase mineral alteration. Some of the reactions currently occurring in Yucca Mountain consume H + and CO 3 2- . Combining reaction rate models for these reactions with water chemistry data may make it possible to estimate water flux through the basal vitrophyre of the Topopah Spring Member and to help confirm the direction and rate of flow of groundwater in Yucca Mountain

The Impact Snow Albedo Feedback over Mountain Regions as Examined through High-Resolution Regional Climate Change Experiments over the Rocky Mountains

Science.gov (United States)

Letcher, Theodore

As the climate warms, the snow albedo feedback (SAF) will play a substantial role in shaping the climate response of mid-latitude mountain regions with transient snow cover. One such region is the Rocky Mountains of the western United States where large snow packs accumulate during the winter and persist throughout the spring. In this dissertation, the Weather Research and Forecast model (WRF) configured as a regional climate model is used to investigate the role of the SAF in determining the regional climate response to forced anthropogenic climate change. The regional effects of climate change are investigated by using the pseudo global warming (PGW) framework, which is an experimental configuration in a which a mean climate perturbation is added to the boundary forcing of a regional model, thus preserving the large-scale circulation entering the region through the model boundaries and isolating the mesoscale climate response. Using this framework, the impact of the SAF on the regional energetics and atmospheric dynamics is examined and quantified. Linear feedback analysis is used to quantify the strength of the SAF over the Headwaters region of the Colorado Rockies for a series of high-resolution PGW experiments. This technique is used to test sensitivity of the feedback strength to model resolution and land surface model. Over the Colorado Rockies, and integrated over the entire spring season, the SAF strength is largely insensitive to model resolution, however there are more substantial differences on the sub-seasonal (monthly) timescale. In contrast, the SAF strength over this region is very sensitive to choice of land surface model. These simulations are also used to investigate how spatial and diurnal variability in warming caused by the SAF influences the dynamics of thermally driven mountain-breeze circulations. It is shown that, the SAF causes stronger daytime mountain-breeze circulations by increasing the warming on the mountains slopes thus enhancing

The Table Mountain Field Site

Data.gov (United States)

Federal Laboratory Consortium — The Table Mountain Field Site, located north of Boulder, Colorado, is designated as an area where the magnitude of strong, external signals is restricted (by State...

Stream capture to form Red Pass, northern Soda Mountains, California

Science.gov (United States)

Miller, David; Mahan, Shannon

2014-01-01

Red Pass, a narrow cut through the Soda Mountains important for prehistoric and early historic travelers, is quite young geologically. Its history of downcutting to capture streams west of the Soda Mountains, thereby draining much of eastern Fort Irwin, is told by the contrast in alluvial fan sediments on either side of the pass. Old alluvial fan deposits (>500 ka) were shed westward off an intact ridge of the Soda Mountains but by middle Pleistocene time, intermediate-age alluvial fan deposits (~100 ka) were laid down by streams flowing east through the pass into Silurian Valley. The pass was probably formed by stream capture driven by high levels of groundwater on the west side. This is evidenced by widespread wetland deposits west of the Soda Mountains. Sapping and spring discharge into Silurian Valley over millennia formed a low divide in the mountains that eventually was overtopped and incised by a stream. Lessons include the importance of groundwater levels for stream capture and the relatively youthful appearance of this ~100-200 ka feature in the slowly changing Mojave Desert landscape.

Wild mountains, wild rivers: Keeping the sacred origins

Science.gov (United States)

Linda Moon Stumpff

2007-01-01

For many indigenous peoples in North America, wild mountains and rivers and other natural formations exist as physical beings formed as part of a whole by forces that interconnect people with them. This perspective frames a discussion around an idea that expresses time and space as wrapped up in the mountain. If time is within the being of place and space within the...

Managing Rocky Mountain spotted fever.

Science.gov (United States)

Minniear, Timothy D; Buckingham, Steven C

2009-11-01

Rocky Mountain spotted fever is caused by the tick-borne bacterium Rickettsia rickettsii. Symptoms range from moderate illness to severe illness, including cardiovascular compromise, coma and death. The disease is prevalent in most of the USA, especially during warmer months. The trademark presentation is fever and rash with a history of tick bite, although tick exposure is unappreciated in over a third of cases. Other signature symptoms include headache and abdominal pain. The antibiotic therapy of choice for R. rickettsii infection is doxycycline. Preventive measures for Rocky Mountain spotted fever and other tick-borne diseases include: wearing long-sleeved, light colored clothing; checking for tick attachment and removing attached ticks promptly; applying topical insect repellent; and treating clothing with permethrin.

A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

Science.gov (United States)

Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

2008-08-01

Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

The Dilemma of Mountain Roads

Science.gov (United States)

Mountain roads and trails are proliferating throughout developing Southeast Asia with severe but largely unrecognized long-term consequences related to effects of landslides and surface erosion on communities and downstream resources.

The development of mountain risk governance: challenges for application

Science.gov (United States)

Link, S.; Stötter, J.

2015-01-01

The complexity the management of mountain risks in the Alps has considerably increased since its institutionalisation in the late nineteenth century. In the history of approaches to dealing with mountain risks four successive paradigms can be distinguished on the basis of key indicators such as guiding principles, characteristic elements and typical instruments: "hazard protection", "hazard management", "risk management", and "risk governance". In this contribution, special attention is paid to the development of hazard zone planning and the growing importance of communication and participation over the course of this transformation. At present, the risk management paradigm has reached maturity. In the Alps, risk governance frameworks are not yet applied to risks from natural hazards. Based on a historical analysis, the suitability and applicability of general risk governance frameworks in the context of mountain risks are discussed. Necessary adaptations (e.g., in administration, educational, and legal structures) are proposed for the upcoming transformation towards mountain risk governance.

Ecology of Land Cover Change in Glaciated Tropical Mountains

Directory of Open Access Journals (Sweden)

Kenneth R. Young

2014-12-01

Full Text Available Tropical mountains contain unique biological diversity, and are subject to many consequences of global climate change, exasperated by concurrent socioeconomic shifts. Glaciers are in a negative mass balance, exposing substrates to primary succession and altering downslope wetlands and streams. A review of recent trends and future predictions suggests a likely reduction in areas of open habitat for species of high mountains due to greater woody plant cover, accompanied by land use shifts by farmers and pastoralists along the environmental gradients of tropical mountains. Research is needed on the biodiversity and ecosystem consequences of successional change, including the direct effects of retreating glaciers and the indirect consequences of combined social and ecological drivers in lower elevations. Areas in the high mountains that are protected for nature conservation or managed collectively by local communities represent opportunities for integrated research and development approaches that may provide ecological spaces for future species range shifts.

Widespread introgression of mountain hare genes into Fennoscandian brown hare populations.

Directory of Open Access Journals (Sweden)

Riikka Levänen

Full Text Available In Fennoscandia, mountain hare (Lepus timidus and brown hare (Lepus europaeus hybridize and produce fertile offspring, resulting in gene flow across the species barrier. Analyses of maternally inherited mitochondrial DNA (mtDNA show that introgression occur frequently, but unavailability of appropriate nuclear DNA markers has made it difficult to evaluate the scale- and significance for the species. The extent of introgression has become important as the brown hare is continuously expanding its range northward, at the apparent expense of the mountain hare, raising concerns about possible competition. We report here, based on analysis of 6833 SNP markers, that the introgression is highly asymmetrical in the direction of gene flow from mountain hare to brown hare, and that the levels of nuclear gene introgression are independent of mtDNA introgression. While it is possible that brown hares obtain locally adapted alleles from the resident mountain hares, the low levels of mountain hare alleles among allopatric brown hares suggest that hybridization is driven by stochastic processes. Interspecific geneflow with the brown hare is unlikely to have major impacts on mountain hare in Fennoscandia, but direct competition may.

Glacial erosion, rock, and peak uplift within the central Transantarctic Mountains

International Nuclear Information System (INIS)

Stern, T.A.; Baxter, A.K.

2002-01-01

About 1500 m of peak elevation can be ascribed to the isostatic response of valley incision within the central Transantarctic Mountains. This estimate, based on a 3D analysis of topography, and on rock uplift history, represents c. 33% of the maximum peak elevation within the Transantarctic Mountains. Input to the calculation includes a previoulsy published estimate for the variation of flexural rigidity across the western margin of East Antarctica, and a lithospheric free-edge at the Transantarctic Mountains Front. The rebound response is a complex function of lithospheric rigidity, wavelength or erosion, and lithospheric boundary conditions. We also calculate a maximum 4000 m of total rebound due to both valley incision and erosion of mountain tops. This represents 60% of the maximum rock uplift inferred for the mountain front on the bases of fission track data and flexure analysis. (author). 34 refs., 5 figs., 3 tabs

Geography and Weather: Mountain Meterology.

Science.gov (United States)

Mogil, H. Michael; Collins, H. Thomas

1990-01-01

Provided are 26 ideas to help children explore the effects of mountains on the weather. Weather conditions in Nepal and Colorado are considered separately. Nine additional sources of information are listed. (CW)

75 FR 12163 - Class E Airspace; Mountain View, AR

Science.gov (United States)

2010-03-15

...-1181; Airspace Docket No. 09-ASW-36] Class E Airspace; Mountain View, AR AGENCY: Federal Aviation... Class E airspace at Mountain View, AR. Decommissioning of the Wilcox non-directional beacon (NDB) at... View, AR. Airspace reconfiguration is necessary due to the decommissioning of the Wilcox NDB and the...

76 FR 66629 - Establishment of the Pine Mountain-Cloverdale Peak Viticultural Area

Science.gov (United States)

2011-10-27

... explains. The petition states that local growers report that Pine Mountain vineyards are naturally free of.... Southern storms often stall over Pine Mountain and the Mayacmas range, dropping more rain than in other..., and very well to excessively well-drained. Also, these mountain soils include large amounts of sand...

The Army Ground Forces Training for Mountain and Winter Warfare - Study No. 23

National Research Council Canada - National Science Library

Govan, Thomas

1946-01-01

This general study of the experiments in mountain and winter warfare training from 1940 to 1944 is designed as an introduction to the histories of the Mountain Training Center and The 10th Mountain...

Atmospheric Research and Public Outreach Activities at Grandfather Mountain, North Carolina

Science.gov (United States)

Perry, B.; Pope, J.; Kelly, G.; Sherman, J. P.; Taubman, B.

2012-12-01

Promoting scientific and public understanding of mountain meteorological processes, particularly in the context of climate variability and change, remains a formidable challenge. Mountain environments present considerable difficulties in the collection of surface and atmospheric observations due to complex topography and resulting high spatial and temporal variability of the atmospheric processes. A collaborative partnership between Appalachian State University (ASU) and the Grandfather Mountain Stewardship Foundation (GMSF) in the southern Appalachian Mountains of North Carolina has provided an outstanding opportunity to integrate atmospheric research and outreach activities. The NASA-funded Climate Action Network through Direct Observations and Outreach (CAN-DOO) project directly supports the research and education activities and places them in the context of climate variability and change. This paper introduces the manual observations and citizen science activities, automated meteorological measurements, and public outreach initiatives on Grandfather Mountain and presents preliminary findings. In support of project objectives, GMSF staff makes daily measurements of precipitation, snow water equivalent, snow depth, and aerosol optical depth, while also encouraging citizen scientists to participate in the daily meteorological measurements. Team members have developed real-time displays of meteorological conditions for the two main visitor's centers and website, and have also created interactive climate science public displays. ASU scientists and GMSF staff have worked together to install and operate two research-quality meteorological stations at 1609 m asl that measure temperature, relative humidity, wind speed and direction, pressure, precipitation, and present weather. Preliminary results of research activities suggest that extreme wind gusts >50 m s -1 and severe icing due to riming and freezing rain are a frequent occurrence on Grandfather Mountain

Big mountains but small barriers: Population genetic structure of the Chinese wood frog (Rana chensinensis in the Tsinling and Daba Mountain region of northern China

Directory of Open Access Journals (Sweden)

Li Cheng

2009-04-01

Full Text Available Abstract Background Amphibians in general are poor dispersers and highly philopatric, and landscape features often have important impacts on their population genetic structure and dispersal patterns. Numerous studies have suggested that genetic differentiation among amphibian populations are particularly pronounced for populations separated by mountain ridges. The Tsinling Mountain range of northern China is a major mountain chain that forms the boundary between the Oriental and Palearctic zoogeographic realms. We studied the population structure of the Chinese wood frog (Rana chensinensis to test whether the Tsinling Mountains and the nearby Daba Mountains impose major barriers to gene flow. Results Using 13 polymorphic microsatellite DNA loci, 523 individuals from 12 breeding sites with geographical distances ranging from 2.6 to 422.8 kilometers were examined. Substantial genetic diversity was detected at all sites with an average of 25.5 alleles per locus and an expected heterozygosity ranging from 0.504 to 0.855, and two peripheral populations revealed significantly lower genetic diversity than the central populations. In addition, the genetic differentiation among the central populations was statistically significant, with pairwise FST values ranging from 0.0175 to 0.1625 with an average of 0.0878. Furthermore, hierarchical AMOVA analysis attributed most genetic variation to the within-population component, and the between-population variation can largely be explained by isolation-by-distance. None of the putative barriers detected from genetic data coincided with the location of the Tsinling Mountains. Conclusion The Tsinling and Daba Mountains revealed no significant impact on the population genetic structure of R. chensinensis. High population connectivity and extensive juvenile dispersal may account for the significant, but moderate differentiation between populations. Chinese wood frogs are able to use streams as breeding sites at high

The limits of market-based reforms in the NHS: the case of alternative providers in primary care.

Science.gov (United States)

Coleman, Anna; Checkland, Kath; McDermott, Imelda; Harrison, Stephen

2013-01-01

Historically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as 'Alternative Provider Medical Services', were encouraged by two centrally-driven rounds of procurement (2007/8 and 2008/9). This research investigated the commissioning and operation of such Alternative Providers of Primary Care (APPCs). Two qualitative case studies were undertaken in purposively sampled English Primary Care Trusts (PCTs) and their associated APPCs over 14 months (2009-10). We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation. We found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was 'transactional', in marked contrast to the 'relational' contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services. The Coalition Government elected in 2010 is committed to 'Any Qualified Provider' of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between

NHS-based Tandem Mass Tagging of Proteins at the Level of Whole Cells: A Critical Evaluation in Comparison to Conventional TMT-Labeling Approaches for Quantitative Proteome Analysis.

Science.gov (United States)

Megger, Dominik A; Pott, Leona L; Rosowski, Kristin; Zülch, Birgit; Tautges, Stephanie; Bracht, Thilo; Sitek, Barbara

2017-01-01

Tandem mass tags (TMT) are usually introduced at the levels of isolated proteins or peptides. Here, for the first time, we report the labeling of whole cells and a critical evaluation of its performance in comparison to conventional labeling approaches. The obtained results indicated that TMT protein labeling using intact cells is generally possible, if it is coupled to a subsequent enrichment using anti-TMT antibody. The quantitative results were similar to those obtained after labeling of isolated proteins and both were found to be slightly complementary to peptide labeling. Furthermore, when using NHS-based TMT, no specificity towards cell surface proteins was observed in the case of cell labeling. In summary, the conducted study revealed first evidence for the general possibility of TMT cell labeling and highlighted limitations of NHS-based labeling reagents. Future studies should therefore focus on the synthesis and investigation of membrane impermeable TMTs to increase specificity towards cell surface proteins.

Combat Operations in Mountainous Terrain: Are United States Army Light Infantry Divisions Preparing Properly?

Science.gov (United States)

1987-06-05

Mountain Division, Charles Hauptman, Comeany I. 97th Mountain Infantry Regiment by CPT George Earle, and PFC Hugh Graves (1945), and 10th Mountain...training in this country is believed to depend primarily ’Albert H. Jackman , "The Tenth Mountain Division, A Successful Experiment," The Algine Journal...44-48. Houston, Charles S., Dr. "Altitude Sickness and the Army," 112zard. 2d Qtr 1986: n.p. Jackman , Albert H. "The Tenth Mountain Division, A

DETERMINATION OF CHARACTERISTICS MAXIMAL RUNOFF MOUNTAIN RIVERS IN CRIMEA

Directory of Open Access Journals (Sweden)

V. A. Ovcharuk

2016-05-01

Full Text Available This article has been examined maximum runoff of the rivers of theCrimeanMountains. The rivers flow through the western and eastern part of the northern slope Crimean Mountains, and on its southern coast. The largest of them: Belbek, Alma, Salgir, Su-Indol and others. To characterize the maximum runoff of rain floods (the layers of rain floods and maximum discharge of water on the rivers of the Crimean Mountains were used materials of observations for long-term period (from the beginning of observations to 2010 inclusive on 54 of streamflow station with using a the so-called «operator» model for maximum runoff formation.

Ride with Abandon: Practical Ideas to Include Mountain Biking in Physical Education

Science.gov (United States)

Palmer, Steve

2006-01-01

Cycling and mountain biking are among the most popular fitness activities in America. Considering that the purpose of physical education is to encourage lifelong activity for all, it is logical to include lifetime activities such as mountain biking in physical education programs. Many perceived barriers to adding mountain biking in physical…

Mountains on Io: High-resolution Galileo observations, initial interpretations, and formation models

Science.gov (United States)

Turtle, E.P.; Jaeger, W.L.; Keszthelyi, L.P.; McEwen, A.S.; Milazzo, M.; Moore, J.; Phillips, C.B.; Radebaugh, J.; Simonelli, D.; Chuang, F.; Schuster, P.; Alexander, D.D.A.; Capraro, K.; Chang, S.-H.; Chen, A.C.; Clark, J.; Conner, D.L.; Culver, A.; Handley, T.H.; Jensen, D.N.; Knight, D.D.; LaVoie, S.K.; McAuley, M.; Mego, V.; Montoya, O.; Mortensen, H.B.; Noland, S.J.; Patel, R.R.; Pauro, T.M.; Stanley, C.L.; Steinwand, D.J.; Thaller, T.F.; Woncik, P.J.; Yagi, G.M.; Yoshimizu, J.R.; Alvarez Del Castillo, E.M.; Beyer, R.; Branston, D.; Fishburn, M.B.; Muller, Birgit; Ragan, R.; Samarasinha, N.; Anger, C.D.; Cunningham, C.; Little, B.; Arriola, S.; Carr, M.H.; Asphaug, E.; Morrison, D.; Rages, K.; Banfield, D.; Bell, M.; Burns, J.A.; Carcich, B.; Clark, B.; Currier, N.; Dauber, I.; Gierasch, P.J.; Helfenstein, P.; Mann, M.; Othman, O.; Rossier, L.; Solomon, N.; Sullivan, R.; Thomas, P.C.; Veverka, J.; Becker, T.; Edwards, K.; Gaddis, L.; Kirk, R.; Lee, E.; Rosanova, T.; Sucharski, R.M.; Beebe, R.F.; Simon, A.; Belton, M.J.S.; Bender, K.; Fagents, S.; Figueredo, P.; Greeley, R.; Homan, K.; Kadel, S.; Kerr, J.; Klemaszewski, J.; Lo, E.; Schwarz, W.; Williams, D.; Williams, K.; Bierhaus, B.; Brooks, S.; Chapman, C.R.; Merline, B.; Keller, J.; Tamblyn, P.; Bouchez, A.; Dyundian, U.; Ingersoll, A.P.; Showman, A.; Spitale, J.; Stewart, S.; Vasavada, A.; Breneman, H.H.; Cunningham, W.F.; Johnson, T.V.; Jones, T.J.; Kaufman, J.M.; Klaasen, K.P.; Levanas, G.; Magee, K.P.; Meredith, M.K.; Orton, G.S.; Senske, D.A.; West, A.; Winther, D.; Collins, G.; Fripp, W.J.; Head, J. W.; Pappalardo, R.; Pratt, S.; Prockter, L.; Spaun, N.; Colvin, T.; Davies, M.; DeJong, E.M.; Hall, J.; Suzuki, S.; Gorjian, Z.; Denk, T.; Giese, B.; Koehler, U.; Neukum, G.; Oberst, J.; Roatsch, T.; Tost, W.; Wagner, R.; Dieter, N.; Durda, D.; Geissler, P.; Greenberg, R.J.; Hoppa, G.; Plassman, J.; Tufts, R.; Fanale, F.P.; Granahan, J.C.

2001-01-01

During three close flybys in late 1999 and early 2000 the Galileo spacecraft ac-quired new observations of the mountains that tower above Io's surface. These images have revealed surprising variety in the mountains' morphologies. They range from jagged peaks several kilometers high to lower, rounded structures. Some are very smooth, others are covered by numerous parallel ridges. Many mountains have margins that are collapsing outward in large landslides or series of slump blocks, but a few have steep, scalloped scarps. From these observations we can gain insight into the structure and material properties of Io's crust as well as into the erosional processes acting on Io. We have also investigated formation mechanisms proposed for these structures using finite-element analysis. Mountain formation might be initiated by global compression due to the high rate of global subsidence associated with Io's high resurfacing rate; however, our models demonstrate that this hypothesis lacks a mechanism for isolating the mountains. The large fraction (???40%) of mountains that are associated with paterae suggests that in some cases these features are tectonically related. Therefore we have also simulated the stresses induced in Io's crust by a combination of a thermal upwelling in the mantle with global lithospheric compression and have shown that this can focus compressional stresses. If this mechanism is responsible for some of Io's mountains, it could also explain the common association of mountains with paterae. Copyright 2001 by the American Geophysical Union.

Bedrock geologic map of the Yucca Mountain area, Nye County, Nevada

International Nuclear Information System (INIS)

Day, W.C.; Potter, C.J.; Sweetkind, D.S.; Fridrich, C.J.; Dickerson, R.P.; San Juan, C.A.; Drake, R.M. II

1998-01-01

Yucca Mountain, Nye County, Nevada, has been identified as a potential site for underground storage of high-level radioactive nuclear waste. Detailed bedrock geologic maps form an integral part of the site characterization program by providing the fundamental framework for research into the geologic hazards and hydrologic behavior of the mountain. This bedrock geologic map provides the geologic framework and structural setting for the area in and adjacent to the site of the potential repository. The study area comprises the northern and central parts of Yucca Mountain, located on the southern flank of the Timber Mountain-Oasis Valley caldera complex, which was the source for many of the volcanic units in the area. The Timber Mountain-Oasis Valley caldera complex is part of the Miocene southwestern Nevada volcanic field, which is within the Walker Lane belt. This tectonic belt is a northwest-striking megastructure lying between the more active Inyo-Mono and Basin-and-Range subsections of the southwestern Great Basin

Bedrock geologic map of the Yucca Mountain area, Nye County, Nevada

Energy Technology Data Exchange (ETDEWEB)

Day, W.C.; Potter, C.J.; Sweetkind, D.S.; Fridrich, C.J. [Geological Survey, Denver, CO (US); Dickerson, R.P.; San Juan, C.A.; Drake, R.M. II [Pacific Western Technologies, Inc., Denver, CO (US)

1998-11-01

Yucca Mountain, Nye County, Nevada, has been identified as a potential site for underground storage of high-level radioactive nuclear waste. Detailed bedrock geologic maps form an integral part of the site characterization program by providing the fundamental framework for research into the geologic hazards and hydrologic behavior of the mountain. This bedrock geologic map provides the geologic framework and structural setting for the area in and adjacent to the site of the potential repository. The study area comprises the northern and central parts of Yucca Mountain, located on the southern flank of the Timber Mountain-Oasis Valley caldera complex, which was the source for many of the volcanic units in the area. The Timber Mountain-Oasis Valley caldera complex is part of the Miocene southwestern Nevada volcanic field, which is within the Walker Lane belt. This tectonic belt is a northwest-striking megastructure lying between the more active Inyo-Mono and Basin-and-Range subsections o f the southwestern Great Basin.

Faith Moves Mountains-Mountains Move Faith: Two Opposite Epidemiological Forces in Research on Religion and Health.

Science.gov (United States)

Hvidt, N C; Hvidtjørn, D; Christensen, K; Nielsen, J B; Søndergaard, J

2017-02-01

Research suggests opposite epidemiological forces in religion and health: (1). Faith seems to move mountains in the sense that religion is associated with positive health outcomes. (2). Mountains of bad health seem to move faith. We reflected on these forces in a population of 3000 young Danish twins in which all religiosity measures were associated with severe disease. We believe the reason for this novel finding is that the sample presents as a particularly secular population-based study and that the second epidemiological force has gained the upper hand in this sample. We suggest that all cross-sectional research on religion and health should be interpreted in light of such opposite epidemiological forces potentially diluting each other.

Glaciological studies near the Soer Rondane Mountains, East Antarctica

Directory of Open Access Journals (Sweden)

Hideaki Motoyama

1997-03-01

Full Text Available In the area west of Mizuho Plateau, outflow of the ice sheet is hindered by a chain of mountains (Sor Rondane, Belgica and Yamato Mountains etc. lying along the coast of the continent and ice shelves are developing at the margin of the ice sheet. Therefore the ice sheet geomorphology and dynamical behavior in this area are quite different from those on the Mizuho Plateau. In order to describe the response of the East Antarctic ice sheet to climatic change, we need to know the influence of the presence of mountains on stability of the ice sheet. This glaciological study aims to investigate whether the ice sheet and the ice shelf in this area are now increasing or decreasing in size possibly, in response to atmospheric warming, how far this part of the ice sheet departs from a steady state, and how the influence of climatic change is left inside the ice sheet and the ice shelf. For this purpose the following studies were performed in 1988 and 1989. 1 A series of shallow drillings along a selected flow line upstream of the Sor Rondane Mountains to Breid Bay. 2 Surface flow velocity, strain and mass balance measurements on the flow line. 3 Monitoring of a valley glacier in the Sor Rondane Mountains.

Waste management outlook for mountain regions: Sources and solutions.

Science.gov (United States)

Semernya, Larisa; Ramola, Aditi; Alfthan, Björn; Giacovelli, Claudia

2017-09-01

Following the release of the global waste management outlook in 2015, the United Nations Environment Programme (UN Environment), through its International Environmental Technology Centre, is elaborating a series of region-specific and thematic waste management outlooks that provide policy recommendations and solutions based on current practices in developing and developed countries. The Waste Management Outlook for Mountain Regions is the first report in this series. Mountain regions present unique challenges to waste management; while remoteness is often associated with costly and difficult transport of waste, the potential impact of waste pollutants is higher owing to the steep terrain and rivers transporting waste downstream. The Outlook shows that waste management in mountain regions is a cross-sectoral issue of global concern that deserves immediate attention. Noting that there is no 'one solution fits all', there is a need for a more landscape-type specific and regional research on waste management, the enhancement of policy and regulatory frameworks, and increased stakeholder engagement and awareness to achieve sustainable waste management in mountain areas. This short communication provides an overview of the key findings of the Outlook and highlights aspects that need further research. These are grouped per source of waste: Mountain communities, tourism, and mining. Issues such as waste crime, plastic pollution, and the linkages between exposure to natural disasters and waste are also presented.

The Mountaineer-Malaysia Connection.

Science.gov (United States)

Young, Jeff

1997-01-01

A 26-day summer field course of West Virginia University's (WVU) Recreation and Parks Department took students to Malaysia's mountains and rainforests to observe how Malaysians are managing national parks, problem elephants, and population pressures on parks. The adventure provided powerful learning experiences. Further exchanges between WVU and…

Convective boundary layer heights over mountainous terrain - A review of concepts -

Science.gov (United States)

De Wekker, Stephan; Kossmann, Meinolf

2015-12-01

Mountainous terrain exerts an important influence on the Earth's atmosphere and affects atmospheric transport and mixing at a wide range of temporal and spatial scales. The vertical scale of this transport and mixing is determined by the height of the atmospheric boundary layer, which is therefore an important parameter in air pollution studies, weather forecasting, climate modeling, and many other applications. It is recognized that the spatio-temporal structure of the daytime convective boundary layer (CBL) height is strongly modified and more complex in hilly and mountainous terrain compared to flat terrain. While the CBL over flat terrain is mostly dominated by turbulent convection, advection from multi-scale thermally driven flows plays an important role for the CBL evolution over mountainous terrain. However, detailed observations of the CBL structure and understanding of the underlying processes are still limited. Characteristics of CBL heights in mountainous terrain are reviewed for dry, convective conditions. CBLs in valleys and basins, where hazardous accumulation of pollutants is of particular concern, are relatively well-understood compared to CBLs over slopes, ridges, or mountain peaks. Interests in the initiation of shallow and deep convection, and of budgets and long-range transport of air pollutants and trace gases, have triggered some recent studies on terrain induced exchange processes between the CBL and the overlying atmosphere. These studies have helped to gain more insight into CBL structure over complex mountainous terrain, but also show that the universal definition of CBL height over mountains remains an unresolved issue. The review summarizes the progress that has been made in documenting and understanding spatio-temporal behavior of CBL heights in mountainous terrain and concludes with a discussion of open research questions and opportunities for future research.

Slingram survey at Yucca Mountain on the Nevada Test Site

International Nuclear Information System (INIS)

Flanigan, V.J.

1981-01-01

Electromagnetic (EM) data presented in this report is part of study by the US Geological Survey aimed at evaluating the Miocene and Pliocene Yucca Mountain Member of various units of the Paintbrush Tuff in the vicinity of Yucca Mountain as a possible repository for nuclear wastes. The survey area is located about 97 km northwest of Las Vegas, Nevada on the Nevada Test Site. Data contained in this report were taken along the eastern edge of Yucca Mountain. The specific purpose of this survey was to determine with EM methods, whether or not northwest-trending valleys in the Yucca Mountain area were fault controlled. Fault and fracture zones in the tuff units were expected to have a somewhat higher conductivity than the unfractured tuff. This is due to the greater porosity, clay and moisture content expected in the fault zones than in unfaulted rock. Depending upon a number of factors, such as the conductivity contrast between fault zones and unfaulted rock, and the depth and conductivity of the overburden, it may be possible to recognize fault zones from surface EM measurements. Several EM methods were tested to determine which one gave the best results in this environment. The methods tried included slingram, Turam and VLF (very low frequency). Slingram data proved to be most diagnostic in delineating a mapped fault on the east edge of Yucca Mountain, and hence was used in the survey traverses crossing the northwest valleys cutting into Yucca Mountain

New composite materials prepared by calcium phosphate precipitation in chitosan/collagen/hyaluronic acid sponge cross-linked by EDC/NHS.

Science.gov (United States)

Kaczmarek, B; Sionkowska, A; Kozlowska, J; Osyczka, A M

2018-02-01

Nowadays, fabrication of composite materials based on biopolymers is a rising field due to potential for bone repair and tissue engineering application. Blending of different biopolymers and incorporation of inorganic particles in the blend can lead to new materials with improved physicochemical properties and biocompatibility. In this work 3D porous structures called scaffolds based on chitosan, collagen and hyaluronic acid were obtained through the lyophilization process. Scaffolds were cross-linked by EDC/NHS. Infrared spectra for the materials were made, the percentage of swelling, scaffolds porosity and density, mechanical parameters, thermal stability were studied. Moreover, the scaffolds were used as matrixes for the calcium phosphate in situ precipitation. SEM images were taken and EDX analysis was carried out for calcium and phosphorous content determination in the scaffold. In addition, the adhesion and proliferation of human osteosarcoma SaOS-2 cells was examined on obtained scaffolds. The results showed that the properties of 3D composites cross-linked by EDC/NHS were altered after the addition of 1, 2 and 5% hyaluronic acid. Mechanical parameters, thermal stability and porosity of scaffolds were improved. Moreover, calcium and phosphorous were found in each kind of scaffold. SEM images showed that the precipitation was homogeneously carried in the whole volume of samples. Attachment of SaOS-2 cells to all modified materials was better compared to unmodified control and proliferation of these cells was markedly increased on scaffolds with precipitated calcium phosphate. Obtained materials can provide the support useful in tissue engineering and regenerative medicine. Copyright © 2017 Elsevier B.V. All rights reserved.

Road Cycling and Mountain Biking Produces Adaptations on the Spine and Hamstring Extensibility.

Science.gov (United States)

Muyor, J M; Zabala, M

2016-01-01

The purposes of this study were as follows: 1) to analyse the influence of training in road cycling or cross-country mountain biking on sagittal spinal curvatures, pelvic tilt and trunk inclination in cyclists of both cycling modalities; 2) to evaluate the specific spinal posture and pelvic tilt adopted on the road bicycle and cross-country mountain bike; and 3) to compare the spinal sagittal capacity of flexion and pelvic tilt mobility as well as hamstring muscle extensibility among road cyclists, cross-country mountain bikers and non-cyclists. Thirty matched road cyclists, 30 mountain bikers and 30 non-cyclists participated in this study. The road cyclists showed significantly greater thoracic kyphosis and trunk inclination than did the mountain bikers and non-cyclists in a standing posture. On the bicycle, the road bicycling posture was characterised by greater lumbar flexion and more significant anterior pelvic tilt and trunk inclination compared with the mountain biking posture. The thoracic spine was more flexed in mountain biking than in road cycling. Road cyclists had significantly greater hamstring muscle extensibility in the active knee extension test, and showed greater anterior pelvic tilt and trunk inclination capacity in the sit-and-reach test, compared with mountain bikers and non-cyclists. © Georg Thieme Verlag KG Stuttgart · New York.

"Christ is the Mountain"

Directory of Open Access Journals (Sweden)

Carl Hallencreutz

1979-01-01

Full Text Available In this paper the author focuses on the religious function of symbols in the encounter and interaction of Christianity and other religions. Some observations on the religious function of the symbol of the Holy Mountain in different African contexts are presented. These contexts are a traditional Kikuyu religion, b a Christian hymn from Northern Tanzania, and c the New Year's Fiest of the independent Nazaretha Church among Zulu in South Africa. The examples of how the symbol of the holy mountain is used in different religious contexts in Africa are, of course, too limited to provide a basis for far-reaching generalizations on how symbols function religiously in the encounter of Christianity and other religions. However, this kind of analysis can be applied also when studying other encounters of religions inside and outside Africa. The symbol functions both as a carrier of a new religious message and as an indigenous means to appropriate this message locally and give it adequate form in different milieus. The symbols, which most likely have the religious functions are those which are of a general nature; light, way, living water, and which some are tempted to speak of as archetypes. Yet the comparison between the Chagga-hymn to the holy mountain and Shembe's interpretation of the blessing of the New Year's Fiest on Inhlangakozi indicates, that in the encounter of Christianity and other religions it is not only the symbols as such which produce the local appropriation of the new religious message and give it adequate localized form. Not even in the encounter of Christianity and other religions the symbols function religiously without human beings as actors in the historical process.

Multi-Chromatic Ultrashort Pulse Filamentation and Bulk Modification in Dielectrics

Science.gov (United States)

2016-05-05

AFRL-AFOSR-VA-TR-2016-0194 Multi- Chromatic Ultrashort Pulse Filamentation and Bulk Modification in Dielectrics Jeremy Gulley KENNESAW STATE...Jan 2016 4. TITLE AND SUBTITLE Multi- chromatic Ultrashort Pulse Filamentation and Bulk Modification in Dielectrics 5a. CONTRACT NUMBER 5b. GRANT...in, and modification of, dielectric solids by multi- chromatic ultrashort laser pulses. It was a theoretical effort to develop models of multi

Policies for the environment and rural development in the mountain area of Austria

OpenAIRE

Hovorka, Gerhard

1998-01-01

38th European Regional Science Association ? Congress 1998 Topic G: Environmental Management, Sustainability and Development Policies for the Environment and Rural Development in the Mountain Area of Austria (Abstract) by Gerhard Hovorka The cultural landscape in Austria is characterised by the high proportion of mountain areas. Mountain agriculture bears the key role in safeguarding the sensitive eco-system in the mountain areas and thereby maintaining the general living and working space as...

An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

Science.gov (United States)

McCormick, Carol; Pickard, Alison Jane

2013-06-01

Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Plant invasions in mountains: Global lessons for better management

Science.gov (United States)

McDougall, K.L.; Khuroo, A.A.; Loope, L.L.; Parks, C.G.; Pauchard, A.; Reshi, Z.A.; Rushworth, I.; Kueffer, C.

2011-01-01

Mountains are one of few ecosystems little affected by plant invasions. However, the threat of invasion is likely to increase because of climate change, greater anthropogenic land use, and continuing novel introductions. Preventive management, therefore, will be crucial but can be difficult to promote when more pressing problems are unresolved and predictions are uncertain. In this essay, we use management case studies from 7 mountain regions to identify common lessons for effective preventive action. The degree of plant invasion in mountains was variable in the 7 regions as was the response to invasion, which ranged from lack of awareness by land managers of the potential impact in Chile and Kashmir to well-organized programs of prevention and containment in the United States (Hawaii and the Pacific Northwest), including prevention at low altitude. In Australia, awareness of the threat grew only after disruptive invasions. In South Africa, the economic benefits of removing alien plants are well recognized and funded in the form of employment programs. In the European Alps, there is little need for active management because no invasive species pose an immediate threat. From these case studies, we identify lessons for management of plant invasions in mountain ecosystems: (i) prevention is especially important in mountains because of their rugged terrain, where invasions can quickly become unmanageable; (ii) networks at local to global levels can assist with awareness raising and better prioritization of management actions; (iii) the economic importance of management should be identified and articulated; (iv) public acceptance of management programs will make them more effective; and (v) climate change needs to be considered. We suggest that comparisons of local case studies, such as those we have presented, have a pivotal place in the proactive solution of global change issues. ?? International Mountain Society.

Volcanism Studies: Final Report for the Yucca Mountain Project

International Nuclear Information System (INIS)

Crowe, Bruce M.; Perry, Frank V.; Valentine, Greg A.; Bowker, Lynn M.

1998-01-01

This report synthesizes the results of volcanism studies conducted by scientists at the Los Alamos National Laboratory and collaborating institutions on behalf of the Department of Energy's Yucca Mountain Project. An assessment of the risk of future volcanic activity is one of many site characterization studies that must be completed to evaluate the Yucca Mountain site for potential long-term storage of high-level radioactive waste. The presence of several basaltic volcanic centers in the Yucca Mountain region of Pliocene and Quaternary age indicates that there is a finite risk of a future volcanic event occurring during the 10,000-year isolation period of a potential repository. Chapter 1 introduces the volcanism issue for the Yucca Mountain site and provides the reader with an overview of the organization, content, and significant conclusions of this report. The risk of future basaltic volcanism is the primary topic of concern including both events that intersect a potential repository and events that occur near or within the waste isolation system of a repository. Future volcanic events cannot be predicted with certainty but instead are estimated using formal methods of probabilistic volcanic hazard assessment (PVHA). Chapter 2 describes the volcanic history of the Yucca Mountain region (YMR) and emphasizes the Pliocene and Quaternary volcanic record, the interval of primary concern for volcanic risk assessment. The distribution, eruptive history, and geochronology of Plio-Quaternary basalt centers are described by individual center emphasizing the younger postcaldera basalt ( than about 7 x 10 -8 events yr -1 . Simple probability estimates are used to assess possible implications of not drilling aeromagnetic anomalies in the Amargosa Valley. The sensitivity of the disruption probability to the location of northeast boundaries of volcanic zones near the Yucca Mountain sit

Baboquivari Mountain plants: Identification, ecology, and ethnobotany [Book Review

Science.gov (United States)

Rosemary L. Pendleton

2011-01-01

The Sky Islands of southern Arizona and northwestern Mexico make up a region that is rich, both biologically and culturally. These isolated mountain ranges, separated by desert "seas," contain a unique and diverse flora and have long been home to indigenous peoples of the southwestern US. This book, Baboquivari Mountain Plants: Identification, Ecology, and...

Discussing the Future of U. S. Western Mountains, Climate Change, and Ecosystems

Science.gov (United States)

Henry F. Diaz; Constance I. Millar

2004-01-01

Mountain regions are uniquely sensitive to changes in climate, and are especially vulnerable to climate effects acting on many biotic systems and the physical settings. Because mountain regions serve as sources of needed natural resources (e.g.,water, forests) and as foundations for desired human activities (e.g., tourism, places to live),changes in mountain systems...

Mountain lions prey selectively on prion-infected mule deer

Science.gov (United States)

Krumm, Caroline E.; Conner, Mary M.; Hobbs, N. Thompson; Hunter, Don O.; Miller, Michael W.

2010-01-01

The possibility that predators choose prey selectively based on age or condition has been suggested but rarely tested. We examined whether mountain lions (Puma concolor) selectively prey upon mule deer (Odocoileus hemionus) infected with chronic wasting disease, a prion disease. We located kill sites of mountain lions in the northern Front Range of Colorado, USA, and compared disease prevalence among lion-killed adult (≥2 years old) deer with prevalence among sympatric deer taken by hunters in the vicinity of kill sites. Hunter-killed female deer were less likely to be infected than males (odds ratios (OR) = 0.2, 95% confidence intervals (CI) = 0.1–0.6; p = 0.015). However, both female (OR = 8.5, 95% CI = 2.3–30.9) and male deer (OR = 3.2, 95% CI = 1–10) killed by a mountain lion were more likely to be infected than same-sex deer killed in the vicinity by a hunter (p < 0.001), suggesting that mountain lions in this area actively selected prion-infected individuals when targeting adult mule deer as prey items. PMID:19864271

Ecohydrologic process modeling of mountain block groundwater recharge.

Science.gov (United States)

Magruder, Ian A; Woessner, William W; Running, Steve W

2009-01-01

Regional mountain block recharge (MBR) is a key component of alluvial basin aquifer systems typical of the western United States. Yet neither water scientists nor resource managers have a commonly available and reasonably invoked quantitative method to constrain MBR rates. Recent advances in landscape-scale ecohydrologic process modeling offer the possibility that meteorological data and land surface physical and vegetative conditions can be used to generate estimates of MBR. A water balance was generated for a temperate 24,600-ha mountain watershed, elevation 1565 to 3207 m, using the ecosystem process model Biome-BGC (BioGeochemical Cycles) (Running and Hunt 1993). Input data included remotely sensed landscape information and climate data generated with the Mountain Climate Simulator (MT-CLIM) (Running et al. 1987). Estimated mean annual MBR flux into the crystalline bedrock terrain is 99,000 m(3) /d, or approximately 19% of annual precipitation for the 2003 water year. Controls on MBR predictions include evapotranspiration (radiation limited in wet years and moisture limited in dry years), soil properties, vegetative ecotones (significant at lower elevations), and snowmelt (dominant recharge process). The ecohydrologic model is also used to investigate how climatic and vegetative controls influence recharge dynamics within three elevation zones. The ecohydrologic model proves useful for investigating controls on recharge to mountain blocks as a function of climate and vegetation. Future efforts will need to investigate the uncertainty in the modeled water balance by incorporating an advanced understanding of mountain recharge processes, an ability to simulate those processes at varying scales, and independent approaches to calibrating MBR estimates. Copyright © 2009 The Author(s). Journal compilation © 2009 National Ground Water Association.

Using hydraulic head, chloride and electrical conductivity data to distinguish between mountain-front and mountain-block recharge to basin aquifers

Science.gov (United States)

Bresciani, Etienne; Cranswick, Roger H.; Banks, Eddie W.; Batlle-Aguilar, Jordi; Cook, Peter G.; Batelaan, Okke

2018-03-01

Numerous basin aquifers in arid and semi-arid regions of the world derive a significant portion of their recharge from adjacent mountains. Such recharge can effectively occur through either stream infiltration in the mountain-front zone (mountain-front recharge, MFR) or subsurface flow from the mountain (mountain-block recharge, MBR). While a thorough understanding of recharge mechanisms is critical for conceptualizing and managing groundwater systems, distinguishing between MFR and MBR is difficult. We present an approach that uses hydraulic head, chloride and electrical conductivity (EC) data to distinguish between MFR and MBR. These variables are inexpensive to measure, and may be readily available from hydrogeological databases in many cases. Hydraulic heads can provide information on groundwater flow directions and stream-aquifer interactions, while chloride concentrations and EC values can be used to distinguish between different water sources if these have a distinct signature. Such information can provide evidence for the occurrence or absence of MFR and MBR. This approach is tested through application to the Adelaide Plains basin, South Australia. The recharge mechanisms of this basin have long been debated, in part due to difficulties in understanding the hydraulic role of faults. Both hydraulic head and chloride (equivalently, EC) data consistently suggest that streams are gaining in the adjacent Mount Lofty Ranges and losing when entering the basin. Moreover, the data indicate that not only the Quaternary aquifers but also the deeper Tertiary aquifers are recharged through MFR and not MBR. It is expected that this finding will have a significant impact on the management of water resources in the region. This study demonstrates the relevance of using hydraulic head, chloride and EC data to distinguish between MFR and MBR.

Using hydraulic head, chloride and electrical conductivity data to distinguish between mountain-front and mountain-block recharge to basin aquifers

Directory of Open Access Journals (Sweden)

E. Bresciani

2018-03-01

Full Text Available Numerous basin aquifers in arid and semi-arid regions of the world derive a significant portion of their recharge from adjacent mountains. Such recharge can effectively occur through either stream infiltration in the mountain-front zone (mountain-front recharge, MFR or subsurface flow from the mountain (mountain-block recharge, MBR. While a thorough understanding of recharge mechanisms is critical for conceptualizing and managing groundwater systems, distinguishing between MFR and MBR is difficult. We present an approach that uses hydraulic head, chloride and electrical conductivity (EC data to distinguish between MFR and MBR. These variables are inexpensive to measure, and may be readily available from hydrogeological databases in many cases. Hydraulic heads can provide information on groundwater flow directions and stream–aquifer interactions, while chloride concentrations and EC values can be used to distinguish between different water sources if these have a distinct signature. Such information can provide evidence for the occurrence or absence of MFR and MBR. This approach is tested through application to the Adelaide Plains basin, South Australia. The recharge mechanisms of this basin have long been debated, in part due to difficulties in understanding the hydraulic role of faults. Both hydraulic head and chloride (equivalently, EC data consistently suggest that streams are gaining in the adjacent Mount Lofty Ranges and losing when entering the basin. Moreover, the data indicate that not only the Quaternary aquifers but also the deeper Tertiary aquifers are recharged through MFR and not MBR. It is expected that this finding will have a significant impact on the management of water resources in the region. This study demonstrates the relevance of using hydraulic head, chloride and EC data to distinguish between MFR and MBR.

Succession status on mountain farms in Slovenia

Directory of Open Access Journals (Sweden)

Boštjan Kerbler-Kefo

2008-12-01

Full Text Available This paper is based on the hypothesis that the offi cial statistical data does not refl ect actual succession status on mountain farms in Slovenia and also on Slovene farms in general, since the census criteria defi ning succession are still incomplete. With the purpose of confi rming our assumption, we formulated more accurate criteria and also determined as to what is the real status of succession on mountain farms in Slovenia. It has proved to be more favourable, than it is presented by the offi cial statistics.

Nuclear waste disposal: Gambling on Yucca Mountain

International Nuclear Information System (INIS)

Ginsburg, S.

1995-01-01

This document describes the historical aspects of nuclear energy ,nuclear weapons usage, and development of the nuclear bureaucracy in the United States, and discusses the selection and siting of Yucca Mountain, Nevada for a federal nuclear waste repository. Litigation regarding the site selection and resulting battles in the political arena and in the Nevada State Legislature are also presented. Alternative radioactive waste disposal options, risk assessments of the Yucca Mountain site, and logistics regarding the transportation and storage of nuclear waste are also presented. This document also contains an extensive bibliography

Investigation of uranium 238 level in phosphate rock samples from kurun mountain Eastern Nuba Mountains in the State of Kordfan (western Sudan)

International Nuclear Information System (INIS)

Yagoub, N. H. M.

2014-06-01

The natural radionuclide content of 20 samples collected from Kurun Mountain, western Sudan, has been determined using gamma spectrometry. The data showed that ''2''3 8 U and its decay products were the principal contributors of radioactivity in phosphate deposits. The range of the activity concentration was measured in apatite phosphate rock samples was 378.03-1332.58 Bq/Kg with a mean value of 815.46 Bq/Kg and the data showed that most of samples concentrated in medial comparable with top and bottom of mountain. The distribution of samples indicated that the weathering effect and the rainfall may be the main reasons to enhance the mobility and solubility of uranium from top to bottom of mountain.(Author)

Influencing organisational change in the NHS: lessons learned from workplace wellness initiatives in practice.

Science.gov (United States)

Blake, Holly; Lloyd, Scott

2008-01-01

This article presents a discussion of the key issues in influencing organisational change in NHS settings, in the development of workplace wellness interventions to improve employee health and wellbeing. To tackle poor public health and associated rising healthcare costs, there must be a focus on the root cause of many preventable diseases - unhealthy lifestyle choices. Workplace wellness initiatives are now an important prevention strategy adopted by socially responsible organisations to target the health and wellbeing of working age adults. Lessons learned from initiatives in secondary care suggest that effective implementation requires change in organisational 'health culture', through a combination of education, behaviour change intervention, needs-based facilities, and services and strategies for developing supportive and health-promoting work environments. Most of all, employers must demonstrate a commitment to health and wellness that is fully integrated with their mission, values and long-term vision, paving the way for sustainable lifestyle changes. Evaluation systems must be in place to measure the impact and outcomes of wellness schemes.

Evidence synthesis on the occurrence, causes, consequences, prevention and management of bullying and harassment behaviours to inform decision making in the NHS

OpenAIRE

Illing, Jan; Carter, Madeline; Thompson, Neill; Crampton, Paul; Morrow, Gill; Howse, Jenny; Cooke, A.; Burford, Bryan

2013-01-01

Background\\ud Workplace bullying is a persistent problem in the NHS with negative implications for individuals, teams, and organisations. Bullying is a complex phenomenon and there is a lack of evidence on the best approaches to manage the problem.\\ud \\ud Aims\\ud Research questions\\ud \\ud What is known about the occurrence, causes, consequences and management of bullying and inappropriate behaviour in the workplace?\\ud \\ud Objectives\\ud Summarise the reported prevalence of workplace bullying ...

Minerals in the foods eaten by mountain gorillas (Gorilla beringei.

Directory of Open Access Journals (Sweden)

Emma C Cancelliere

Full Text Available Minerals are critical to an individual's health and fitness, and yet little is known about mineral nutrition and requirements in free-ranging primates. We estimated the mineral content of foods consumed by mountain gorillas (Gorilla beringei beringei in the Bwindi Impenetrable National Park, Uganda. Mountain gorillas acquire the majority of their minerals from herbaceous leaves, which constitute the bulk of their diet. However, less commonly eaten foods were sometimes found to be higher in specific minerals, suggesting their potential importance. A principal component analysis demonstrated little correlation among minerals in food items, which further suggests that mountain gorillas might increase dietary diversity to obtain a full complement of minerals in their diet. Future work is needed to examine the bioavailability of minerals to mountain gorillas in order to better understand their intake in relation to estimated needs and the consequences of suboptimal mineral balance in gorilla foods.

Minerals in the foods eaten by mountain gorillas (Gorilla beringei).

Science.gov (United States)

Cancelliere, Emma C; DeAngelis, Nicole; Nkurunungi, John Bosco; Raubenheimer, David; Rothman, Jessica M

2014-01-01

Minerals are critical to an individual's health and fitness, and yet little is known about mineral nutrition and requirements in free-ranging primates. We estimated the mineral content of foods consumed by mountain gorillas (Gorilla beringei beringei) in the Bwindi Impenetrable National Park, Uganda. Mountain gorillas acquire the majority of their minerals from herbaceous leaves, which constitute the bulk of their diet. However, less commonly eaten foods were sometimes found to be higher in specific minerals, suggesting their potential importance. A principal component analysis demonstrated little correlation among minerals in food items, which further suggests that mountain gorillas might increase dietary diversity to obtain a full complement of minerals in their diet. Future work is needed to examine the bioavailability of minerals to mountain gorillas in order to better understand their intake in relation to estimated needs and the consequences of suboptimal mineral balance in gorilla foods.

Geologic reconnaissance of the Hot Springs Mountains, Churchill County, Nevada

Science.gov (United States)

Voegtly, Nickolas E.

1981-01-01

A geologic reconnaissance of the Hot Springs Mountains and adjacent areas, which include parts of the Brady-Hazen and the Stillwater-Soda Lake Known Geothermal Resource Areas, during June-December 1975, resulted in a reinterpretation of the nature and location of some Basin and Range faults. In addition, the late Cenozoic stratigraphy has been modified, chiefly on the basis of radiometric dates of volcanic rocks by U.S. Geological Survey personnel and others. The Hot Springs Mountains are in the western part of the Basin and Range province, which is characterized by east-west crustal extension and associated normal faulting. In the surrounding Trinity, West Humboldt, Stillwater, and Desert Mountains, Cenozoic rocks overlie ' basement ' rocks of the Paleozoic and Mesozoic age. A similar relation is inferred in the Hot Springs Mountains. Folding and faulting have taken place from the late Tertiary to the present. (USGS)

Habitat use by mountain nyala Tragelaphus buxtoni determined using stem bite diameters at point of browse, bite rates, and time budgets in the Bale Mountains National Park, Ethiopia

Directory of Open Access Journals (Sweden)

Solomon A. TADESSE, Burt P. KOTLER

2013-12-01

Full Text Available We studied the habitat use of mountain nyala Tragelaphus buxtoni in the northern edge of the Bale Mountains National Park, Ethiopia. The aims of this study were to: (1 measure and quantify habitat-specific stem bite diameters of mountain nyala foraging on common natural plant species in two major habitat types (i.e. grasslands versus woodlands, and (2 quantify the bite rates (number of bites per minute and the activity time budgets of mountain nyala as functions of habitat type and sex-age category. We randomly laid out three transects in each habitat type. Following each transect, through focal animal observations, we assessed and quantified stem diameters at point of browse (dpb, bite rates, and time budgets of mountain nyala in grasslands versus woodlands. Stem dpb provide a measure of natural giving-up densities (GUDs and can be used to assess foraging costs and efficiencies, with greater stem dpb corresponding to lower costs and greater efficiencies. The results showed that stem dpb, bite rates, induced vigilance, and proportion of time spent in feeding differed between habitats. In particular, mountain nyala had greater stem dpb, higher bite rates, and spent a greater proportion of their time in feeding and less in induced vigilance in the grasslands. In addition, adult females had the highest bite rates, and the browse species Solanum marginatum had the greatest stem dpb. Generally, grasslands provide the mountain nyala with several advantages over the woodlands, including offering lower foraging costs, greater safety, and more time for foraging. The study advocates how behavioural indicators and natural GUDs are used to examine the habitat use of the endangered mountain nyala through applying non-invasive techniques. We conclude that the resulting measures are helpful for guiding conservation and management efforts and could be applicable to a number of endangered wildlife species including the mountain nyala [Current Zoology 59 (6 : 707

The Centre for Mountain Studies: Active From Scottish to Global Scales

Directory of Open Access Journals (Sweden)

Amy Woolvin

2016-11-01

Full Text Available The Centre for Mountain Studies (CMS, located at Perth College, University of the Highlands and Islands, Scotland, hosts the United Nations Educational, Scientific and Cultural Organization Chair in Sustainable Mountain Development. Since 2000, CMS staff and students have been active in research and knowledge exchange activities at scales from the local—in Scotland—to the global (Price 2011; Glass et al 2013. In addition to hosting the Mountains of our Future Earth conference (Perth III, recent international activities have focused on climate change, biosphere reserves, social innovation, and stakeholder engagement in biodiversity research. Projects in Scotland have mainly addressed land management and local communities. The CMS also runs a part-time online MSc program in Sustainable Mountain Development.

Mountains of the world: vulnerable water towers for the 21st century.

Science.gov (United States)

Messerli, Bruno; Viviroli, Daniel; Weingartner, Rolf

2004-11-01

Mountains as "Water Towers" play an important role for the surrounding lowlands. This is particularly true of the world's semiarid and arid zones, where the contributions of mountains to total discharge are 50-90%. Taking into account the increasing water scarcity in these regions, especially for irrigation and food production, then today's state of knowledge in mountain hydrology makes sustainable water management and an assessment of vulnerability quite difficult. Following the IPCC report, the zone of maximum temperature increase in a 2 x CO2 state extends from low elevation in the arctic and sub-arctic to high elevation in the tropics and subtropics. The planned GCOS climate stations do not reach this elevation of high temperature change, although there are many high mountain peaks with the necessary sensitive and vulnerable ecosystems. Worldwide, more than 700 million people live in mountain areas, of these, 625 million are in developing countries. Probably more than half of these 625 million people are vulnerable to food insecurity. Consequences of this insecurity can be emigration or overuse of mountain ecosystems. Overuse of the ecosystems will, ultimately, have negative effects on the environment and especially on water resources. New research initiatives and new high mountain observatories are needed in order to understand the ongoing natural and human processes and their impacts on the adjacent lowlands.

75 FR 30282 - Airworthiness Directives; Quartz Mountain Aerospace, Inc. Model 11E Airplanes

Science.gov (United States)

2010-06-01

... Airworthiness Directives; Quartz Mountain Aerospace, Inc. Model 11E Airplanes AGENCY: Federal Aviation... airworthiness directive (AD) for all Quartz Mountain Aerospace, Inc. Model 11E airplanes. This AD requires you... reference of certain publications listed in this AD. ADDRESSES: Quartz Mountain Aerospace, Inc. is in...

Investigating a high ozone episode in a rural mountain site

International Nuclear Information System (INIS)

Monteiro, A.; Strunk, A.; Carvalho, A.; Tchepel, O.; Miranda, A.I.; Borrego, C.; Saavedra, S.; Rodríguez, A.; Souto, J.; Casares, J.; Friese, E.; Elbern, H.

2012-01-01

A very high ozone episode with observed hourly values above 350 μg m −3 occurred in July 2005 at the Lamas d’Olo air quality monitoring station, located in a mountainous area in the north of Portugal. Aiming to identify the origin and formation of this ozone-rich episode, a statistical analysis and a modelling approach were applied. A cross-spectrum analysis in the frequency domain and a synoptic analysis of the meteorological and air quality time series were performed. In order to go further in this analysis, a numerical modelling approach was applied. The results indicate that the transport of ozone and its precursors is the main responsible for the high ozone concentrations. Together with the local mountain breeze and subsidence conditions, the sea-breeze circulation transporting pollutants from the coastal urban and industrialized areas that reach the site during late afternoon turn out to be the driving forces for the ozone peaks. - Highlights: ► A very high ozone episode occurred in a rural mountain site of Portugal in 2004. ► Data cross-spectrum analysis in the frequency domain was performed. ► A numerical modelling approach was also applied. ► The sea-breeze circulation transported pollutants from the urban and industrialized coast. ► The mountain breeze and subsidence conditions were also driving forces for ozone peaks. - The sea-breeze transporting pollutants from the coast, the mountain breeze and subsidence conditions, were the driving forces for the ozone episode occurred in a rural mountain site.

Genetic analysis of scats reveals minimum number and sex of recently documented mountain lions

Science.gov (United States)

Naidu, Ashwin; Smythe, Lindsay A.; Thompson, Ron W.; Culver, Melanie

2011-01-01

Recent records of mountain lions Puma concolor and concurrent declines in desert bighorn sheep Ovis canadensis mexicana on Kofa National Wildlife Refuge in Arizona, United States, have prompted investigations to estimate the number of mountain lions occurring there. We performed noninvasive genetic analyses and identified species, individuals, and sex from scat samples collected from the Kofa and Castle Dome Mountains. From 105 scats collected, we identified a minimum of 11 individual mountain lions. These individuals consisted of six males, two females and three of unknown sex. Three of the 11 mountain lions were identified multiple times over the study period. These estimates supplement previously recorded information on mountain lions in an area where they were historically considered only transient. We demonstrate that noninvasive genetic techniques, especially when used in conjunction with camera-trap and radiocollaring methods, can provide additional and reliable information to wildlife managers, particularly on secretive species like the mountain lion.

A New Estimate of North American Mountain Snow Accumulation From Regional Climate Model Simulations

Science.gov (United States)

Wrzesien, Melissa L.; Durand, Michael T.; Pavelsky, Tamlin M.; Kapnick, Sarah B.; Zhang, Yu; Guo, Junyi; Shum, C. K.

2018-02-01

Despite the importance of mountain snowpack to understanding the water and energy cycles in North America's montane regions, no reliable mountain snow climatology exists for the entire continent. We present a new estimate of mountain snow water equivalent (SWE) for North America from regional climate model simulations. Climatological peak SWE in North America mountains is 1,006 km3, 2.94 times larger than previous estimates from reanalyses. By combining this mountain SWE value with the best available global product in nonmountain areas, we estimate peak North America SWE of 1,684 km3, 55% greater than previous estimates. In our simulations, the date of maximum SWE varies widely by mountain range, from early March to mid-April. Though mountains comprise 24% of the continent's land area, we estimate that they contain 60% of North American SWE. This new estimate is a suitable benchmark for continental- and global-scale water and energy budget studies.

A vegetation description and floristic analyses of the springs on the Kammanassie Mountain, Western Cape

OpenAIRE

G. Cleaver; L.R. Brown; G.J. Bredenkamp

2004-01-01

The Kammanassie Mountain is a declared mountain catchment area and a Cape mountain zebra Equus zebra zebra population is preserved on the mountain. The high number of springs on the mountain not only provides water for the animal species but also contributes to overall ecosystem functioning. Long-term conservation of viable ecosystems requires a broader understanding of the ecological processes involved. It was therefore decided that a classification, description and mapping of the spring veg...

OS X Mountain Lion Portable Genius

CERN Document Server

Spivey, Dwight

2012-01-01

Essential tips and techniques on the Mac OS X features you use most! If you want the kind of hip, friendly help you'd get from friends on how to get the most of out of Mac OS X Mountain Lion, this is the guide you need. Jump right into the coolest new Mac OS X features like Game Center, Messages, and Notification, or get a better handle on the basic tools and shortcuts that will help keep your mountain cat purring. From customizing to using multimedia to syncing your Mac to other devices, this book saves you time and hassle, avoids fluff, and covers what you want to know most. New addition t

Investigations of natural groundwater hazards at the proposed Yucca Mountain high level nuclear waste repository. Part A: Geology at Yucca Mountain. Part B: Modeling of hydro-tectonic phenomena relevant to Yucca Mountain. Annual report - Nevada

International Nuclear Information System (INIS)

Szymanski, J.S.; Schluter, C.M.; Livingston, D.E.

1993-05-01

This document is an annual report describing investigations of natural groundwater hazards at the proposed Yucca Mountain, Nevada High-Level Nuclear Waste Repository.This document describes research studies of the origin of near surface calcite/silica deposits at Yucca Mountain. The origin of these deposits is controversial and the authors have extended and strengthened the basis of their arguments for epigenetic, metasomatic alteration of the tuffs at Yucca Mountain. This report includes stratigraphic, mineralogical, and geochronological information along with geochemical data to support the conclusions described by Livingston and Szymanski, and others. As part of their first annual report, they take this opportunity to clarify the technical basis of their concerns and summarize the critical geological field evidence and related information. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database

Evaluating Risk Perception based on Gender Differences for Mountaineering Activity

Science.gov (United States)

Susanto, Novie; Susatyo, Nugroho W. P.; Rizkiyah, Ega

2018-02-01

In average 26 death events in mountaineering per year for the time span from 2003 to 2012 is reported. The number of women dying during the mountaineering is significantly smaller than males (3.5 deaths male for one female death). This study aims to analyze the differences of risk perception based on gender and provide recommendations as education basic to prevent accidents in mountaineering. This study utilizes the Kruskal-Wallis test and the Delphi Method. A total of 200 mountaineer respondents (100 males and 100 females) participated in this study. The independent variable in this study was gender. The dependent variable was risk perception including perception toward the serious accident, perception toward the probability of accident event as well as anxiety level and perception of efficacy and self-efficacy. The study result showed that the risk perception of women is higher than men with significant difference (p-value = 0.019). The recommendations from Delphi method result are by developing a positive mental attitude, showing about the risks that exist in nature, implementing Cognitive Behaviour Therapy (CBT) to raise awareness of the safety of ownself, following the climbing or mountaineer school, and using instructors to give lessons about safety in outdoor activities.

Evaluating Risk Perception based on Gender Differences for Mountaineering Activity

Directory of Open Access Journals (Sweden)

Susanto Novie

2018-01-01

Full Text Available In average 26 death events in mountaineering per year for the time span from 2003 to 2012 is reported. The number of women dying during the mountaineering is significantly smaller than males (3.5 deaths male for one female death. This study aims to analyze the differences of risk perception based on gender and provide recommendations as education basic to prevent accidents in mountaineering. This study utilizes the Kruskal-Wallis test and the Delphi Method. A total of 200 mountaineer respondents (100 males and 100 females participated in this study. The independent variable in this study was gender. The dependent variable was risk perception including perception toward the serious accident, perception toward the probability of accident event as well as anxiety level and perception of efficacy and self-efficacy. The study result showed that the risk perception of women is higher than men with significant difference (p-value = 0.019. The recommendations from Delphi method result are by developing a positive mental attitude, showing about the risks that exist in nature, implementing Cognitive Behaviour Therapy (CBT to raise awareness of the safety of ownself, following the climbing or mountaineer school, and using instructors to give lessons about safety in outdoor activities.

Geologic map of the Paintbrush Canyon Area, Yucca Mountain, Nevada

International Nuclear Information System (INIS)

Dickerson, R.P.; Drake, R.M. II

1998-01-01

This geologic map is produced to support site characterization studies of Yucca Mountain, Nevada, site of a potential nuclear waste storage facility. The area encompassed by this map lies between Yucca Wash and Fortymile Canyon, northeast of Yucca Mountain. It is on the southern flank of the Timber Mountain caldera complex within the southwest Nevada volcanic field. Miocene tuffs and lavas of the Calico Hills Formation, the Paintbrush Group, and the Timber Mountain Group crop out in the area of this map. The source vents of the tuff cones and lava domes commonly are located beneath the thickest deposits of pyroclastic ejecta and lava flows. The rocks within the mapped area have been deformed by north- and northwest-striking, dominantly west-dipping normal faults and a few east-dipping normal faults. Faults commonly are characterized by well developed fault scarps, thick breccia zones, and hanging-wall grabens. Latest movement as preserved by slickensides on west-dipping fault scarps is oblique down towards the southwest. Two of these faults, the Paintbrush Canyon fault and the Bow Ridge fault, are major block-bounding faults here and to the south at Yucca Mountain. Offset of stratigraphic units across faults indicates that faulting occurred throughout the time these volcanic units were deposited

Geologic map of the Paintbrush Canyon Area, Yucca Mountain, Nevada

Energy Technology Data Exchange (ETDEWEB)

Dickerson, R.P. [Geological Survey, Denver, CO (United States); Drake, R.M. II [Pacific Western Technologies, Ltd., Lakewood, CO (United States)

1998-11-01

This geologic map is produced to support site characterization studies of Yucca Mountain, Nevada, site of a potential nuclear waste storage facility. The area encompassed by this map lies between Yucca Wash and Fortymile Canyon, northeast of Yucca Mountain. It is on the southern flank of the Timber Mountain caldera complex within the southwest Nevada volcanic field. Miocene tuffs and lavas of the Calico Hills Formation, the Paintbrush Group, and the Timber Mountain Group crop out in the area of this map. The source vents of the tuff cones and lava domes commonly are located beneath the thickest deposits of pyroclastic ejecta and lava flows. The rocks within the mapped area have been deformed by north- and northwest-striking, dominantly west-dipping normal faults and a few east-dipping normal faults. Faults commonly are characterized by well developed fault scarps, thick breccia zones, and hanging-wall grabens. Latest movement as preserved by slickensides on west-dipping fault scarps is oblique down towards the southwest. Two of these faults, the Paintbrush Canyon fault and the Bow Ridge fault, are major block-bounding faults here and to the south at Yucca Mountain. Offset of stratigraphic units across faults indicates that faulting occurred throughout the time these volcanic units were deposited.

A Mountain-Scale Monitoring Network for Yucca Mountain Performance Confirmation

International Nuclear Information System (INIS)

Freifeld, Barry; Tsang, Yvonne

2006-01-01

Confirmation of the performance of Yucca Mountain is required by 10 CFR Part 63.131 to indicate, where practicable, that the natural system acts as a barrier, as intended. Hence, performance confirmation monitoring and testing would provide data for continued assessment during the pre-closure period. In general, to carry out testing at a relevant scale is always important, and in the case of performance confirmation, it is particularly important to be able to test at the scale of the repository. We view the large perturbation caused by construction of the repository at Yucca Mountain as a unique opportunity to study the large-scale behavior of the natural barrier system. Repository construction would necessarily introduce traced fluids and result in the creation of leachates. A program to monitor traced fluids and construction leachates permits evaluation of transport through the unsaturated zone and potentially downgradient through the saturated zone. A robust sampling and monitoring network for continuous measurement of important parameters, and for periodic collection of agrochemical samples, is proposed to observe thermo-hydrogeochemical changes near the repository horizon and down to the water table. The sampling and monitoring network can be used to provide data to (1) assess subsurface conditions encountered and changes in those conditions during construction and waste emplacement operations; and (2) for modeling to determine that the natural system is functioning as intended

A computer simulation model to compute the radiation transfer of mountainous regions

Science.gov (United States)

Li, Yuguang; Zhao, Feng; Song, Rui

2011-11-01

In mountainous regions, the radiometric signal recorded at the sensor depends on a number of factors such as sun angle, atmospheric conditions, surface cover type, and topography. In this paper, a computer simulation model of radiation transfer is designed and evaluated. This model implements the Monte Carlo ray-tracing techniques and is specifically dedicated to the study of light propagation in mountainous regions. The radiative processes between sun light and the objects within the mountainous region are realized by using forward Monte Carlo ray-tracing methods. The performance of the model is evaluated through detailed comparisons with the well-established 3D computer simulation model: RGM (Radiosity-Graphics combined Model) based on the same scenes and identical spectral parameters, which shows good agreements between these two models' results. By using the newly developed computer model, series of typical mountainous scenes are generated to analyze the physical mechanism of mountainous radiation transfer. The results show that the effects of the adjacent slopes are important for deep valleys and they particularly affect shadowed pixels, and the topographic effect needs to be considered in mountainous terrain before accurate inferences from remotely sensed data can be made.

Modeling the biophysical impacts of global change in mountain biosphere reserves

Science.gov (United States)

Bugmann, H.K.M.; Bjornsen, F. Ewert; Haeberli, W.; Guisan, Antoine; Fagre, Daniel B.; Kaab, A.

2007-01-01

Mountains and mountain societies provide a wide range of goods and services to humanity, but they are particularly sensitive to the effects of global environmental change. Thus, the definition of appropriate management regimes that maintain the multiple functions of mountain regions in a time of greatly changing climatic, economic, and societal drivers constitutes a significant challenge. Management decisions must be based on a sound understanding of the future dynamics of these systems. The present article reviews the elements required for an integrated effort to project the impacts of global change on mountain regions, and recommends tools that can be used at 3 scientific levels (essential, improved, and optimum). The proposed strategy is evaluated with respect to UNESCO's network of Mountain Biosphere Reserves (MBRs), with the intention of implementing it in other mountain regions as well. First, methods for generating scenarios of key drivers of global change are reviewed, including land use/land cover and climate change. This is followed by a brief review of the models available for projecting the impacts of these scenarios on (1) cryospheric systems, (2) ecosystem structure and diversity, and (3) ecosystem functions such as carbon and water relations. Finally, the cross-cutting role of remote sensing techniques is evaluated with respect to both monitoring and modeling efforts. We conclude that a broad range of techniques is available for both scenario generation and impact assessments, many of which can be implemented without much capacity building across many or even most MBRs. However, to foster implementation of the proposed strategy, further efforts are required to establish partnerships between scientists and resource managers in mountain areas.

Surface pressure drag for hydrostatic two-layer flow over axisymmetric mountains

Energy Technology Data Exchange (ETDEWEB)

Leutbecher, M.

2000-07-01

The effect of partial reflections on surface pressure drag is investigated for hydrostatic gravity waves in two-layer flow with piecewise constant buoyancy frequency. The variation of normalized surface pressure drag with interface height is analyzed for axisymmetric mountains. The results are compared with the familiar solution for infinitely long ridges. The drag for the two-layer flow is normalized with the drag of one-layer flow, which has the buoyancy frequency of the lower layer. An analytical expression for the normalized drag of axisymmetric mountains is derived from linear theory of steady flow. Additionally, two-layer flow over finite-height axisymmetric mountains is simulated numerically for flow with higher stability in the upper layer. The temporal evolution of the surface pressure drag is examined in a series of experiments with different interface and mountain heights. The focus is on the linear regime and the nonlinear regime of nonbreaking gravity waves. The dispersion of gravity waves in flow over isolated mountains prevents that the entire wave spectrum is in resonance at the same interface height, which is the case in hydrostatic flow over infinitely long ridges. In consequence, the oscillation of the normalized drag with interface height is smaller for axisymmetric mountains than for infinitely long ridges. However, even for a reflection coefficient as low as 1/3 the drag of an axisymmetric mountain can be amplified by 50% and reduced by 40%. The nonlinear drag becomes steady in the numerical experiments in which no wave breaking occurs. The steady state nonlinear drag agrees quite well with the prediction of linear theory if the linear drag is computed for a slightly lowered interface. (orig.)

Earthquake-induced water-level fluctuations at Yucca Mountain, Nevada, June 1992

International Nuclear Information System (INIS)

O'Brien, G.M.

1993-01-01

This report presents earthquake-induced water-level and fluid-pressure data for wells in the Yucca Mountain area, Nevada, during June 1992. Three earthquakes occurred which caused significant water-level and fluid-pressure responses in wells. Wells USW H-5 and USW H-6 are continuously monitored to detect short-term responses caused by earthquakes. Two wells, monitored hourly, had significant, longer-term responses in water level following the earthquakes. On June 28, 1992, a 7.5-magnitude earthquake occurred near Landers, California causing an estimated maximum water-level change of 90 centimeters in well USW H-5. Three hours later a 6.6-magnitude earthquake occurred near Big Bear Lake, California; the maximum water-level fluctuation was 20 centimeters in well USW H-5. A 5.6-magnitude earthquake occurred at Little Skull Mountain, Nevada, on June 29, approximately 23 kilometers from Yucca Mountain. The maximum estimated short-term water-level fluctuation from the Little Skull Mountain earthquake was 40 centimeters in well USW H-5. The water level in well UE-25p number-sign 1, monitored hourly, decreased approximately 50 centimeters over 3 days following the Little Skull Mountain earthquake. The water level in UE-25p number-sign 1 returned to pre-earthquake levels in approximately 6 months. The water level in the lower interval of well USW H-3 increased 28 centimeters following the Little Skull Mountain earthquake. The Landers and Little Skull Mountain earthquakes caused responses in 17 intervals of 14 hourly monitored wells, however, most responses were small and of short duration. For several days following the major earthquakes, many smaller magnitude aftershocks occurred causing measurable responses in the continuously monitored wells

Rocky Mountain spotted fever from an unexpected tick vector in Arizona.

Science.gov (United States)

Demma, Linda J; Traeger, Marc S; Nicholson, William L; Paddock, Christopher D; Blau, Dianna M; Eremeeva, Marina E; Dasch, Gregory A; Levin, Michael L; Singleton, Joseph; Zaki, Sherif R; Cheek, James E; Swerdlow, David L; McQuiston, Jennifer H

2005-08-11

Rocky Mountain spotted fever is a life-threatening, tick-borne disease caused by Rickettsia rickettsii. This disease is rarely reported in Arizona, and the principal vectors, Dermacentor species ticks, are uncommon in the state. From 2002 through 2004, a focus of Rocky Mountain spotted fever was investigated in rural eastern Arizona. We obtained blood and tissue specimens from patients with suspected Rocky Mountain spotted fever and ticks from patients' homesites. Serologic, molecular, immunohistochemical, and culture assays were performed to identify the causative agent. On the basis of specific laboratory criteria, patients were classified as having confirmed or probable Rocky Mountain spotted fever infection. A total of 16 patients with Rocky Mountain spotted fever infection (11 with confirmed and 5 with probable infection) were identified. Of these patients, 13 (81 percent) were children 12 years of age or younger, 15 (94 percent) were hospitalized, and 2 (12 percent) died. Dense populations of Rhipicephalus sanguineus ticks were found on dogs and in the yards of patients' homesites. All patients with confirmed Rocky Mountain spotted fever had contact with tick-infested dogs, and four had a reported history of tick bite preceding the illness. R. rickettsii DNA was detected in nonengorged R. sanguineus ticks collected at one home, and R. rickettsii isolates were cultured from these ticks. This investigation documents the presence of Rocky Mountain spotted fever in eastern Arizona, with common brown dog ticks (R. sanguineus) implicated as a vector of R. rickettsii. The broad distribution of this common tick raises concern about its potential to transmit R. rickettsii in other settings. Copyright 2005 Massachusetts Medical Society.

SP mountain data analysis

Science.gov (United States)

Rawson, R. F.; Hamilton, R. E.; Liskow, C. L.; Dias, A. R.; Jackson, P. L.

1981-01-01

An analysis of synthetic aperture radar data of SP Mountain was undertaken to demonstrate the use of digital image processing techniques to aid in geologic interpretation of SAR data. These data were collected with the ERIM X- and L-band airborne SAR using like- and cross-polarizations. The resulting signal films were used to produce computer compatible tapes, from which four-channel imagery was generated. Slant range-to-ground range and range-azimuth-scale corrections were made in order to facilitate image registration; intensity corrections were also made. Manual interpretation of the imagery showed that L-band represented the geology of the area better than X-band. Several differences between the various images were also noted. Further digital analysis of the corrected data was done for enhancement purposes. This analysis included application of an MSS differencing routine and development of a routine for removal of relief displacement. It was found that accurate registration of the SAR channels is critical to the effectiveness of the differencing routine. Use of the relief displacement algorithm on the SP Mountain data demonstrated the feasibility of the technique.

A mountain of millipedes IV

DEFF Research Database (Denmark)

Enghoff, Henrik

2016-01-01

Two species of the genus Prionopetalum Attems, 1909, are recorded from the Udzungwa Mountains: P. asperginis sp. nov. and P. kraepelini (Attems, 1896). Prionopetalum stuhlmanni Attems, 1914, is synonymized under P. kraepelini. Odontopyge fasciata Attems, 1896, is transferred from Prionopetalum...

The Haptic Sublime and the ‘cold stony reality’ of Mountaineering

Directory of Open Access Journals (Sweden)

Alan McNee

2014-10-01

Full Text Available This article looks at how the Victorian sport of mountaineering, and the new genre of literature associated with it, mirrored the wider societal preoccupation with physicality and tactility. It traces the various ways in which developments in physiology, psychophysiology, and aesthetics in the late nineteenth century were reflected in the accounts of mountaineers, and suggests that a new aesthetic of mountain appreciation - the ‘haptic sublime’ - emerged in this period, as an expression of this new emphasis on physical engagement.

Analysis of photo linear elements, Laramie Mountains, Wyoming

Science.gov (United States)

Blackstone, D. L., Jr.

1973-01-01

The author has identified the following significant results. Photo linear features in the Precambrian rocks of the Laramie Mountains are delineated, and the azimuths plotted on rose diagrams. Three strike directions are dominant, two of which are in the northeast quadrant. Laramide folds in the Laramie basin to the west of the mountains appear to have the same trend, and apparently have been controlled by response of the basement along fractures such as have been measured from the imagery.

The age-related performance decline in ultraendurance mountain biking.

Science.gov (United States)

Haupt, Samuel; Knechtle, Beat; Knechtle, Patrizia; Rüst, Christoph Alexander; Rosemann, Thomas; Lepers, Romuald

2013-01-01

The age-related changes in ultraendurance performance have been previously examined for running and triathlon but not mountain biking. The aims of this study were (i) to describe the performance trends and (ii) to analyze the age-related performance decline in ultraendurance mountain biking in a 120-km ultraendurance mountain bike race the "Swiss Bike Masters" from 1995 to 2009 in 9,325 male athletes. The mean (±SD) race time decreased from 590 ± 80 min to 529 ± 88 min for overall finishers and from 415 ± 8 min to 359 ± 16 min for the top 10 finishers, respectively. The mean (±SD) age of all finishers significantly (P Bike Masters" appears to start earlier compared with other ultraendurance sports.

Ongoing Cerebral Vasculitis During Treatment of Rocky Mountain Spotted Fever.

Science.gov (United States)

Sun, Lisa R; Huisman, Thierry A G M; Yeshokumar, Anusha K; Johnston, Michael V

2015-11-01

Rocky Mountain spotted fever is a tickborne infection that produces a systemic small-vessel vasculitis; its prognosis is excellent if appropriate treatment is initiated early. Because the advent of effective antirickettsial therapies predates the widespread use of brain magnetic resonance imaging, there are limited data on the effect of untreated Rocky Mountain spotted fever infection on neuroimaging studies. We describe a 7-year-old girl with delayed treatment of Rocky Mountain spotted fever who suffered severe neurological impairment. Serial brain magnetic resonance images revealed a progressive "starry sky appearance," which is proposed to result from the same small vessel vasculitis that causes the characteristic skin rash of this infection. Neurological injury can continue to occur despite specific antirickettsial therapy in Rocky Mountain spotted fever. This child's clinical features raise questions about the optimal management of this infection, particularly the utility of immune modulating therapies in cases of delayed treatment and neurological involvement. Copyright © 2015 Elsevier Inc. All rights reserved.

Reaching for the Sky: The Growth of Mountain Tourism in Switzerland.