Ellesmere Port Hospital

The problem of aggression to staff in a general hospital was examined from the perspective of Poyner & Warne's (1986) model of workplace violence. A total of 396 staff (39% response rate) provided information on their experience of violence in the past year and a subsample were additionally interviewed about their current levels of mental health (GHQ). Some 72 staff (21% of respondents had been physically assaulted and 90% of these assaulted staff worked beyond the accident and emergency department, e.g. in medical wards. Nurses were physically assaulted, threatened and verbally abused at higher rates than other professionals. Employee factors (younger age, shorter National Health Service experience and attendance at violence training) were significantly associated with assault (P < 0.05). Postoperative confusion, receiving treatment and delayed treatment were common precursors of aggression. Mental health was significantly worse amongst staff exposed to threats (P < 0.01). This exploratory study establishes that violence is a problem across a number of general hospital departments and occupations and we argue that effective training should be made more available for staff at risk of assault.

Cold mix asphalt manufactured using bitumen emulsion, by its very nature, has struggled to gain market penetration in the UK due to lack of design guidance and specifications and the need to comply with prevailing hot mix asphalt specification requirements. Despite this, a number of contractors have successfully utilized emulsion cold mix asphalt materials containing recycled asphalt planings on various categories of road. Whilst the majority of schemes in the UK have been on lower category traffic roads, in this paper we discuss the use of one material which has been used on a strategic highway (trunk road) in 2008 which saved 43 t of CO2 during construction and is still performing well in situ to this day. Site construction details along with an analysis of traffic loading are presented. Laboratory simulations of in-situ curing of material supplied to site demonstrated an indirect tensile stiffness modulus at 10 °C of 5 GPa was achieved within 6 months. Binder recovered from site cores was found to be in line with comparable hot mix materials, whilst wheel tracking of site cores demonstrated excellent deformation resistance which has been borne out by site performance over the last decade. The continued development of standards enabling engineers to design and specify cold mix asphalt in the UK is also reviewed.

It is postulated that health effects of air pollution may be direct and indirect through people's perception about the severity of pollution and concerns over its impact on their health. A cross sectional postal survey of some 6,559 households was conducted in the area of Ellesmere Port and Neston Borough Council. A total of 3,402 (51.9%) usable questionnaires were returned and included in the subsequent analyses. Childhood asthma was associated with central heating. Adult asthma was associated with the number of people in the house who had ever smoked and 'crowding'. General adult respiratory symptoms were associated with perception of industrial air pollution and neighbour noise in univariable but not multivariable analyses. In the multivariable model number of people in the household who had ever smoked, exposure to traffic fume pollution, crowding and living in rented accommodation. This suggests a complex relationship between actual levels of pollution (though not directly measured in this study), social deprivation, socio-behavioural factors and people's perceptions about pollution. A model of the relationship of these factors is proposed and it is argued that studies of the health impact of air pollution that concentrate only on chemical exposure will be flawed unless they are placed in the context of perception and socio-behavioural factors.

Major efforts have been made by veterinary professionals to reduce the need for antibiotic use in animals. An online survey launched by the Federation of Veterinarians of Europe (FVE) aimed to gather responses from practicing veterinarians with field experience in metaphylactic livestock group treatment. Only 17% of all veterinarians (n = 183/1087, all species-specific responses merged) applied metaphylactic group treatments to 75% or more of all their treatments. Significantly less metaphylactic group treatments were reported in mixed practices (p = 0.002) and practices specialized in cattle (p < 0.001) as well as small (p = 0.007) and very small practices (p = 0.009). Gram-negative bacteria, mostly composed of Enterobacteriaceae and Pasteurellaceae, were considered by 75.3% (n = 967/1385) as the most devastating bacterial pathogens. Respondents alleged morbidity (20.1%, n = 201/998) and mortality (42.2%, n = 421/998) as major consequences for animal health and welfare if metaphylaxis would be banned. Responding veterinarians pointed towards vaccinations; improved biosecurity, including hygiene measures; and improved herd health management as the three most effective alternative measures to prevent metaphylactic treatment. However, more research is needed on how to implement appropriate alternatives in a holistic hurdle approach. Active support on a national level will be necessary for the development and application of targeted veterinary treatment guidelines for practitioners, which promote the understanding of drivers and include initiation criteria for metaphylactic group treatments in livestock.

Aims and Method A postal survey was sent to all consultant child and adolescent psychiatrists in the UK and Eire examining recruitment, retention, job satisfaction and job stress. Results A response was received from 333 (60%) child and adolescent psychiatrists. Sixty-one per cent indicated their service was inadequately resourced and 89% reported that their service failed to meet the College's minimum staffing requirements. Safe access to in-patient beds was not available to 71%. One hundred and thirty vacant posts were identified. Rates of psychological distress and burnout were high. Adequate services and the presence of a close, supportive colleague were associated with higher rates of satisfaction and lower rates of psychological distress and emotional exhaustion. Clinical Implications A multi-faceted approach is suggested and recommendations are described under the headings of self-management, training, recruitment and commissioning.

Abstract A combination of different physio‐chemical treatment steps was applied to purify industrially derived crude glycerol at laboratory scale. The full process included acid–base treatments, phase separation, and adsorption, and the glycerol purity and recovery were optimized by varying the pH during saponification and acidification, the solvent‐to‐glycerol ratio, and type of base used in the process to enhance both. The testing campaign resulted in a final purity of up to 87% wt starting from a very low‐quality ‘end‐of‐life’ waste glycerol sampled from different refineries. The net glycerol recovery at laboratory scale reached 42% of the initial glycerol in the feedstock and the maximum ash removal exceeded 90% given the low quality of the feedstock and high content of impurities and the attempt to achieve high glycerol recovery. The experiment showed that mild operations such as saponification with KOH (pH of 8), acidification with H 3 PO 4 (pH of 6), an ideal 2‐propanol to glycerol volume ratio equal to 3 and potassium hydroxide as a base for the neutralisation step were the optimum conditions despite the differences between samples. The sequence of the processes proposed was therefore considered a viable option to treat any kind of crude glycerol to make it profitable for fuel and chemical applications.

Fixation of CO2 by lithium amides derived from pyrrole and diisopropylamine generates a lithium carbamate polymer and dodecamer respectively. Moving to lithium-sodium hexamethyldisilazide produces a more complicated, intriguing reaction, where unusually the bimetallic composition is maintained in the product but its composition contains both carbamato and anhydride functionalities.

Patients who have had a stroke are often unable to support their full weight when moving. Recent guidelines on patient handling stress the risk of injury to nurses' backs if they lift patients or support their body weight. Nurses in one stroke rehabilitation unit who used a 'pivot' transfer had to reconsider their practice and explore other options for moving patients.

WildlifeService, spent the period

The most sensitive index of hepatic encephalopathy in 29 patients following a porta-caval shunt appeared to be the assessment of a close relative who had known the patient pre-operatively. They noticed that 19 of the 20 patients were mentally slower; 11 were markedly aggressive and 8 had become placid and uncaring about family problems. Only 9 of these patients had clinical encephalopathy as judged by two independent observers, 14 had a prolonged trail test and 8 produced an abnormal five-pointed star. Eight patients were forced to retire prematurely after the operation due to ill health and 20 felt that their marriage had deteriorated. Eighteen of the 29 patients had a lie score on the Eysenck personality questionnaire (an index of 'social naïvety') which was more than one standard deviation above the mean value for a large control group (P less than 0.01). This did not correlate with other measurements of encephalopathy, but 8 out of the 11 patients who exhibited aggressive behaviour had an abnormal score.

Cancer and palliative care service users can often feel isolated and disempowered. (Tower, 1999). Physical changes, medical interventions and pain can mean that they no longer feel in control of their bodies or their futures. In recognition of this, many health professionals within cancer and palliative care have adopted the mantra of 'patient empowerment', but it is not always clear what it means for either the patients or the professionals. Empowerment is an interactive process that develops and increases power through cooperation, sharing and working together (Marquis and Huston, 2000), and it plays a central role in health professionals' personal and working lives. A person's ability to make decisions and choices demonstrates control of his or her own destiny. This article aims to direct health professionals' participation and involvement in restoring this ability to patients who have pain related to cancer.

The purification of synthetic and pre-treated impure glycerol from 2 nd generation biodiesel refineries is addressed to reduce the ash content below 1 % wt. Electrodialysis purification has been selected for its ability to selectively remove salts from the glycerol. First, synthetic glycerol-rich samples are tested to optimise cell voltage, membrane type and time on stream to achieve the target of 1 % wt. ash. After that, industrial pre-treated glycerol is used as a feed stream and compared. The comprehensive testing campaign demonstrated a recovery greater than 60 % with a glycerol purity greater than 82.2 % (wet and 90.4 % wt. dry basis) and ash content below 1 % wt. for 130–280 min and specific energy consumption ranging from 4.5 to 8.9 MWh∙m − ³ depending on the sample and conditions. to further decreases the ash content (below 0.5 % wt. corresponding to conductivity <2 mS∙cm −1 ) the energy requirement increases by almost three times confirming that while electrodialysis is a suitable technology for deeper waste stream purification, but energy supply and costs may hamper the implementation at scale. • Crude glycerol is purified with electrodialysis to a purity >90 % (dry basis). • Depending on time on stream ash content decreases from 15 % to <1 %. • The calculated energy requirements to achieve 1 % ash content is 4–8.9 MWh/m3. • The presence of MONG increases the membrane fouling and requires regeneration.

Sandra Birnie and colleagues describe the development of a training programme designed to educate staff in nursing homes in order to help deliver higher quality care to older people

OBJECTIVES: To describe the techniques for preparation and placement of peripheral intravenous catheters (PIVCs), to describe the complications associated with PIVCs, and to identify factors associated with PIVC complications in small animal practice in the United Kingdom. MATERIALS AND METHODS: A prospective multicentre observational study was undertaken between January 2022 and January 2023. Data collected included patient information, information regarding the placement and maintenance of PIVCs, and PIVC complications, from privately owned cats and dogs presenting to veterinary institutes in the United Kingdom. Patients required a PIVC to be placed as part of their care and the PIVC was anticipated to be in situ for >24 hours to be eligible for PIVC complication analysis. RESULTS: A total of 19 institutes recorded data regarding 382 PIVCs, with 325 (85.1%) placed in dogs and 57 (14.9%) in cats. The most common reasons for placement were to administer intravenous fluid therapy (74.3%) and intravenous medications (71.7%). There were 102 of 382 (26.7%) PIVCs associated with a complication, with limb swelling/suspected phlebitis in 44 of 382 (11.5%) and PIVC dislodgement/patient interference in 30 of 382 (7.9%) PIVCs. Factors associated with increased risk of complication were more than 1 attempt to place the PIVC, a second or subsequent PIVC being placed during hospitalisation, flush frequency different than every 1 to 24 hours, and flush solution with compound sodium lactate. CLINICAL SIGNIFICANCE: Veterinary professionals must be vigilant when monitoring a patient with a PIVC in situ, particularly if a PIVC is associated with one of the aforementioned factors of increased likelihood of complication.

Tres pruebas básicas se realizaron en esta investigación; efecto de la temperatura en la germinación de las semillas de gandúl en condiciones reguladas; efecto de la temperatura en la germinación en condiciones de campo; y efecto de la fecha de siembra y el genotipo en el desarrollo vegetativo, tiempo a maduración y madurez de las vainas. En condiciones reguladas, se requirieron de 2 a 5 días a 20° C. para que la germinación ocurriera. La temperatura constante más baja a la que hubo un porcentaje significativo de germinación en un período de tiempo aceptable (4 a 9 días) fue 17.5° C. Hubo germinación a 12.5° C, pero fue en extremo baja y tardía. En condiciones de campo, una temperatura media del suelo de 19° C. (primera fecha de siembra, el 19 de mayo) produjo un porcentaje de brotación satisfactoria, pero estuvo significativamente por debajo del de las otras fechas de siembra, y requirió más tiempo (12 días). Las temperaturas medias del suelo para las otras fechas de siembra (2 de junio, 16 de junio, 1 de julio y 14 de julio) fueron 22° C. o más. Las plantitas emergieron en 6 ó 7 días en estas condiciones. Las plantas más altas al momento de la floración se obtuvieron de las semillas sembradas en la primera fecha. El tamaño disminuyó con las fechas de siembra mas tardías. Las plantas de la última fecha de siembra (las que florecieron antes de que el experimento conduyera) requirieron el menor tiempo para florecer. El tiempo de la siembra a la floración disminuyó en las fechas de siembras más tardías. El tamaño de la planta y el tiempo para florecer también estuvieron afectados significativamente por los genotipos. 2B-Bushy fue usualmente el más alto y consistentemente el más tardío con relación a la floración. PR2 7/16 mostró consistentemente el porte más bajo, excepto en la quinta fecha de siembra, mientras que PR2 7/13 fue consistentemente el que más temprano floredo.

Abstract In this paper, we interrogate and justify the design of a local project that used collaborative design research in a secondary school in England. As authors, we represent teachers and teacher educators engaged in design research, whereby we acknowledge the difficulties implicit to university and school collaborations within a performative culture. Our analysis recognises the struggle for research‐informed professional judgement in the decision‐making and actions of educators that are situated in schools. A professional learning project is analysed to position teachers and teacher educators as practitioner researchers. In this respect, Stenhouse's work provides an analytical framework that is both a lens through which to interpret the nature of collaborations, as well as a methodology that allows us to understand the way in which we navigate the gap between educators' aspirations and the curriculum design and teaching within the project. The collaborative design research project was stimulated by an aspiration to make trigonometry accessible to low prior attaining pupils in a secondary mathematics classroom. This provides a stimulus for understanding the conditions that enable collaborative lesson inquiry and to question whether it can provoke raised aspirations for young people in inclusive classrooms. This allows us to understand the work of teachers as researchers and research users in an increasingly messy teacher education context. We interrogate the potentially problematic connection between research and practice within collaborative inquiry, as we understand how we enable research that is “held accountable for its relevance to practice” because “that relevance can only be validated by practitioners” (Stenhouse, 1988, p. 49).

Two nurses who are clinical leaders in school health explain why education about puberty and adolescence is so much needed by 10 and 11-year-old pupils in Years 6 and 7. The transition from primary to secondary school coincides with the transition from childhood to puberty and adolescence. With such major physical, emotional and psychological development at this stage in their lives, boys and girls need support and information which the school nurse is well placed to provide. Based on extensive experience of giving talks and working with pupils of this age group, the authors provide some practical tips for school nurses and others giving sex and relationship education to Years 6 and 7.

Accompanying a school trip to the Austrian alps was a perk of being a children’s nurse for Christopher Mayer

Low temperature asphalts, often categorised into warm, half-warm and cold mix asphalts, are being promoted as a way of reducing the carbon dioxide footprint of pavement construction and maintenance. A trial with sections of low temperature asphalt surface and binder course was laid and monitored for initial properties. Based on the results and information from other trial and contracted constructions, a series of specifications have been drafted in order to encourage the greater use of such mixtures.

The Black Death epidemic of Yersinia pestis (1347-50 CE) killed about half the population of England, and many historical changes have been ascribed to it. But we still know surprisingly little about how the epidemic actually affected people's daily lives. This study reports results from a broad bioarchaeological study, with 18 skeletal and molecular indicators from 336 adults from Cambridge, England (940-1561 CE). Results reveal two major findings. First, although the epidemic killed millions, no dramatic changes in skeletal indicators of health and lifestyle are directly ascribable to the epidemic. Most indicators either remained stable, or changed in response to other known historical trends. Traumatic though the plague was, it did not transform medieval people's health and lifeways radically. Secondly, there were important long-term health trends beginning before the Black Death, notably a decline in stature. This may be due to a general 14th -century environmental and economic deterioration which left the population more vulnerable to novel epidemic diseases.