Equating Exams as a Prerequisite for Maintaining Standards: Experience with Dutch centralised secondary examinations

The Federal Mine Safety and Health Act of 1977 requires that the average concentration of respirable coal mine dust be measured with a device approved by the Secretary of Labor and the Secretary of Health, Education, and Welfare. Title 30, Code of Federal Regulations, Part 70, specifies that approved sampling device be calibrated at a flowrate of 2.0 liters per minute or at a different flowrate as prescribed by the Secretary of Labor and the Secretary of Health, Education, and Welfare for the particular device. This informational report presents the standard procedures used by the Mine Safety and Health Administration (MSHA) for calibration of currently approved personal samplers and associated equipment and maintenance procedures for the equpiment. Currently there are five samplers approved by the Secretary of Labor and the Secretary of Health, Education, and Welfare. They are the Bendix 3900 Micronair, Bendix BDX 30/31 and 44, Bendix C-115, and the MSA model G Monitaire. These samplers use similar sampling heads and have an operational flowrate of 2.0 liters per minute. The purpose of this report is to make standard procedures for calibration available to all MSHA and industry personnel that use these samplers in their daily routines. Use of standard calibration procedures will reduce or eliminate measurement differences resulting from different calibration procedures.

در منطقه جنوب و باختر بلوک لوت، نرخ گشتاور ژئودتیک بیشتر از نرخ گشتاور لرزه­ای و زمین­شناسی است. بر پایه نوع دگرشکلی و هندسه گسل­ها، منطقه مورد مطالعه به چهار بخش شمالی، مرکزی، جنوبی و جنوب خاوری (جنوب بلوک لوت) تقسیم‌بندی شد. در این مناطق، مقادیر به دست آمده از هر سه نوع نرخ گشتاور با همدیگر مقایسه شدند. بیشترین مقدار نرخ گشتاور ژئودتیک به ترتیب در بخش شمالی، مرکزی، جنوبی، جنوب خاوری به دست آمد. مقادیر نرخ گشتاور ژئودتیک در بخش شمالی: 2.28E+18 Nm.yr، بخش مرکزی: 1.86E+18 Nm.yr، بخش جنوبی: 1.20E+18 Nm.yr و بخش جنوب خاوری: 1.10E+18 Nm.yr است. بیشترین مقدار نرخ گشتاور لرزه­ای به ترتیب در بخش مرکزی، جنوب خاوری، جنوبی، شمالی به دست آمد. مقادیر نرخ گشتاور لرزه­ای در بخش مرکزی: 5.62316E+17 Nm.yr، جنوب خاوری: 2.05331E+17 Nm.yr، جنوبی: 1.18984E+17 Nm.yr و شمالی: 1.03408E+17 Nm.yr است. بر پایه پهنه‌بندی گشتاور لرزه­ای صورت گرفته، بیشترین مقدار گشتاور لرزه­ای به ترتیب در امتداد گسل­های گوک، راندگی‌های شهداد، گسل‌های داوران، خاور کرمان، ماهان، بم، کوهبنان، داهوئیه و شمال فاریاب است که همه آنها مسبب زمین‌لرزه­های بزرگ در منطقه مورد مطالعه بوده­اند. بیشترین مقدار نرخ گشتاور زمین‌شناسی به ترتیب در بخش جنوبی، شمالی، مرکزی و جنوب خاوری به دست آمد. مقادیر نرخ گشتاور زمین­شناسی برای بخش جنوبی 4.16246E+15 Nm.yr، بخش شمالی 2.74157E+15 Nm.yr، بخش مرکزی 2.5895E+15 Nm.yr و بخش جنوب خاوری 1.08894E+15 Nm.yr است. در منطقه مورد مطالعه بیشترین نرخ گشتاور زمین‌شناسی به ترتیب مرتبط با گسل باختر سبزواران، جیرفت، راور، دلفارد، کوهبنان، نایبندان، بم، گوک و داوران است. با توجه به مقادیر نرخ گشتاور زمین‌شناسی و ژئودتیک در بخش‌های چهارگانه منطقه مورد بررسی و آزاد شدن بیشترین انرژی لرزه­ای در بخش­های مرکزی و جنوب خاوری، به نظر می­رسد، در آینده بیشترین احتمال رخداد لرزه­ای و آزاد شدن ناگهانی انرژی به ترتیب مرتبط باشد با بخش‌های شمالی، جنوبی، مرکزی، جنوب خاوری. بیشترین مقدار گشتاور لرزه­ای یا به عبارتی انرژی آزاد شده در منطقه (بر پایه سال‌های موجود در کاتلوگ لرزه­ای) عبارتند از: سال 1981، 1998، 2003، 2010، 2011، 1999 و 2005. در منطقه مطالعاتی، نسبت نرخ گشتاور ژئودتیک به نرخ گشتاور لرزه­ای بیش از 9/7 به دست آمد. این نسبت بیانگر نقش مهم دگرشکلی میان‌لرزه­ای در منطقه است. بر پایه نسبت نرخ گشتاور لرزه­ای به ژئودتیک می­توان به این نتیجه رسید که بخش شمالی و جنوبی به ترتیب با نسبت بیش از 04/0 و 09/0 جزو مناطق با واتنش کند و بخش مرکزی و بخش جنوب خاوری به ترتیب با نسبت 30/0 و 18/0 جزء مناطق با واتنش به نسبت سریع هستند. نسبت نرخ گشتاور لرزه­ای به نرخ گشتاور زمین‌شناسی برای زمین‌لرزه­های دستگاهی 93/0 درصد است. این مقدار نشان‌دهنده این است که 93/0 درصد از انرژی پتانسیل گسل­های منطقه به‌صورت انرژی لرزه­ای در طی سال­های موجود در کاتالوگ زمین‎لرزه­ای (از سال 1911 تا 2015) آزاد شده و هنوز بخش زیادی از انرژی الاستیکی موجود در منطقه آزاد نشده است و منطقه پتانسیل لرزه‌خیزی بالایی دارد.

Positron emission tomography with radioactive nitrogen gas as well as CT were performed in seven patients with diffuse panbronchiolitis (DPB) to evaluate regional changes on pulmonary ventilation and lung attenuation values. Special focus of this study was on the difference between the central and peripheral parts of the lung. Mean ventilatory time constants measured in the peripheral parts of the lung were significantly greater than those in the central parts. Moreover, mean CT attenuation values in the peripheral parts were also significantly lower than those in the central parts, indicating that hyperinflation of the lung in DPB was located mainly in the peripheral parts. Such stratified distribution of ventilatory impairment is considered to be characteristic of diffuse bronchiolar narrowing because, in the peripheral parts of the lung, there are no large airways. In addition, different branching patterns of airways between the central and peripheral parts of the lung may play an important role in the mechanism of selective injury of bronchioles in the peripheral parts.

After each central exam organized by OSYM (Measuring, Selection and Placement Centre), traffic jam occurs since thousands of vehicles of candidates and instructors enter into a two lane way, which is the only road that combines the Cukurova University (CU) campus to city center, within a short period of time. In order to organize traffic flow and reduce queue lengths and vehicle delays occur in main roads, traffic signalization plays an important role. There are number of simulation tools used in order to understand traffic flow trend and minimize problems associated with vehicle concentration such as CMEM, VISSIM, SYNCHRO, TRANSYT-7F and VISGAOST. Among them VISSIM comes front which has the ability to simulate complex traffic flow and convert the field data into processable mathematical values. In this study, VISSIM program was used decide best signal timing in order to deal with traffic problem created by vehicle concentration after central exams.

Problem Statement: The “right selection” of doctoral candidates is of great importance for the effectiveness of doctoral programs. There are programs in which one can directly begin with the dissertation, as well as programs that require the completion of credits through mandatory and elective courses. It is widely accepted that academic thesis supervisors play an important role at every stage in PhD programs. Purpose of Study: The purpose of this study is to compare the selection and training of PhD students of the education faculties of the University of Bremen and Ege University, as well as the role of the supervisor by investigating the views of PhD students, graduates and thesis supervisors. Methods: In this study, integrated multi-case design was used. The study group was determined with a criterion sampling method. The data was collected by interviews and analyzed by a content analysis technique. Findings and Results: The competencies required of doctoral candidates vary under themes such as “awareness of the process”, “academic qualifications and personal characteristics”, “professional experience”, and “the originality of the doctoral dissertation”. In Germany, there is failure to make PhD programs sufficiently attractive to attract students, while in Turkey, the selection of students through central exams that do not measure suitability for doctoral qualifications are criticized. It was deemed more appropriate to train PhD candidates by practicing in colloquiums and academic environments addressing networks and needs rather than by programs in which candidates begin their dissertation after completing a certain number of credits. Being “directive, preparative and motivational” stood out as the preferred roles of an academic thesis supervisor.

Sanitary procedures play an important role in achieving food safety. The application of sanitation in the food industry has a standard procedure, namely the Sanitation Standard Operating Procedure (SSOP). SSOP is important to apply, not only in large industries but also in small and medium enterprises. XYZ UMKM is located in Mojokerto, East Java. This MSME is engaged in processed catfish. UMKM XYZ products in particular are shredded catfish meat and spines. There are problems related to sanitation in these MSMEs, such as the use of untested water for production, workers who do not understand the principles of sanitation, the layout of the storage room that is integrated with the production room, to the workers' sanitation facilities that are not properly maintained for cleanliness. This situation can be corrected by evaluating the SSOP in the production process which is the scope of this community service activity. The method of implementing this community service activity consists of internal coordination and coordination with partners, carrying out SSOP reviews by observation and through partner interviews, to evaluating the results of the review and Focus Group Discussion between teams and partners. Data analysis was carried out based on 8 key aspects of SSOP requirements. Observation results are described using tables and explained in narrative form. The implementation of SSOP in the scope of the production area and toilets at UMKM XYZ is in accordance or meets the SSOP of 57.57%. Other SSOP parameters need to be improved by improving the quality of sanitation, through the application of solutions provided according to SSOP, so it is hoped that this evaluation can guarantee quality and increase product competitiveness in the market.

Young-of-the-year (0-group) fish in the Barents Sea have been investigated in an annual joint Norwegian-Russian pelagic trawl survey in autumn, using a standardized procedure since 1980. We use a conceptual framework of ‘upstream’ spawning areas and ‘downstream’ nursery areas, recorded as 0-group distribution in the Barents Sea, to address spatial (geographical) and temporal (1980–2017) variation in 0-group length. Four boreal species (cod Gadus morhua, haddock Melanogrammus aeglefinus, herring Clupea harengus, and deepwater redfish Sebastes mentella) tended to have smaller 0-group individuals in the northern and eastern parts of the Barents Sea, with the largest individuals found in the central part where they were also most abundant. We interpret this to reflect slower growth as the ‘fore-runners’ of the seasonal cohort of juveniles are transported into colder waters (through lateral mixing). The Arctic species (capelin Mallotus villosus and polar cod Boreogadus saida) showed a different pattern with increasing 0-group length with increasing distance away from the spawning areas, seen most clearly for capelin. The longer juveniles in northern areas are probably older and stemming from early spawning.There was temporal covariation in 0-group length between the six species over the 38-year time series, with highest correlation between cod and haddock. The covariation reflected similar fluctuations in four decadal ‘waves’, with maxima in 0-group length in the early/mid 1980s, 1990s, 2000s, and 2010s. There was a high degree of spatial consistency in the temporal patterns of variation in 0-group length, with synchronous variations in different geographical areas. There were also increasing linear trends over the time series for cod, haddock, and polar cod, which represented increase of about 20%, 40%, and 15% of the initial length for the three species, respectively. The fluctuations and trends in 0-group length were positively correlated with seawater temperature, which suggests a strong effect of climate variability and warming (by 1.5–2.0 °C since 1980) on 0-group length. The clear differences among the species, and the limited fraction of variance explained by temperature, suggest that other factors such as food play additional roles. Zooplankton biomass integrated over the water column had low explanatory power, but this may reflect intrinsic limitations in the data (e.g., depth-integrated, end of season) in providing an adequate representation of feeding conditions, rather than suggesting that food was not important.

The linear increment of Sphagnum fuscum and S. magellanicum in ombrotrophic mires of Western Siberia has been measured during two years over a transect about 2500 km long extending from forest–steppe to forest–tundra. Along the latitudinal gradient, the increment of both species has proved to be correlated with annual average air temperature and, in S. magellanicum, also with annual precipitation. The determinants of their growth differ between the southern, central, and northern parts of the study region. At the regional level, the annual and summer precipitation plays a more important role than the average air temperature. The increment of S. fuscum in the southern part is positively correlated with the amount of precipitation and negatively correlated with summer temperature, whereas the situation in the central part is inverse. In S. magellanicum, the linear increment is directly dependent on the annual average temperature and annual and summer precipitation in the south and on the annual and summer precipitation in the north of Western Siberia. The dynamics of linear growth of both species in bog pine forests during the growing season are similar: its rate is the highest in June, when the linear increment of S. fuscum and S. magellanicum amounts to 60 and 85% of the annual total, respectively.

Keeping in mind the central part national exams have been performing in the design and implementation of learning and curricula, the analysis of the evolution of national exams shows the dynamic implications between the exams and the curricula, in the realm of the curricular reforms that happened in Portugal. As it is never too much to highlight, it is not possible to reflect on the exams focusing exclusively around the students and the technical concern of measuring their performance without keeping in mind the factors in play regarding learning, such as curriculum, Portuguese cultural characteristics, the organization of the School Community, and the educational legislation driven by several national and international historical factors.

Telomerase activity and telomere on stem progeny senescence

IntroductionPectoral fascia (PF) removal during mastectomy still seems to be the standard procedure. However, preservation of the PF might improve postoperative and cosmetic outcomes, without compromising oncological safety. Here, we report on a national survey among Dutch plastic surgeons and oncological breast surgeons to evaluate their techniques and opinions regarding the PF. Materials and methodsA survey based study was performed in the Netherlands, in which both plastic surgeons and oncological breast surgeons were included, each receiving a different version of the survey. The surveys were distributed to 460 and 150 e-mail addresses, respectively. ResultsA total of 68 responses were included from more than half of all Dutch medical centers. The results of this study indicate that circa one in five plastic surgeons and breast surgeons routinely preserve the PF during mastectomies and even more surgeons preserve the PF in specific cases. The surgical techniques and opinions regarding PF preservation widely differ between surgeons. ConclusionsPreservation of the PF does occur in a substantial part of the Dutch medical centers and techniques and opinions are contradictory. Future studies on this topic should clarify the effect of PF preservation on oncological safety, complication rates, postoperative pain, cosmetic outcomes, and patient satisfaction.

Modification of proteins by small ubiquitin-like modifier (SUMO) is emerging as an important control of transcription and RNA processing. The human factor TCERG1 (also known as CA150) participates in transcriptional elongation and alternative splicing of pre-mRNAs. Here, we report that SUMO family proteins modify TCERG1. Furthermore, TCERG1 binds to the E2 SUMO-conjugating enzyme Ubc9. Two lysines (Lys-503 and Lys-608) of TCERG1 are the major sumoylation sites. Sumoylation does not affect localization of TCERG1 to the splicing factor-rich nuclear speckles or the alternative splicing function of TCERG1. However, mutation of the SUMO acceptor lysine residues enhanced TCERG1 transcriptional activity, indicating that SUMO modification negatively regulates TCERG1 transcriptional activity. These results reveal a regulatory role for sumoylation in controlling the activity of a transcription factor that modulates RNA polymerase II elongation and mRNA alternative processing, which are discriminated differently by this post-translational modification.

<b>PB-PG-0407-13084 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>Improving the quality of ambulance crew hand-overs: a qualitative study of knowledge transfer in emergency care teams<br /> <br /> <b>Authors:</b> Professor Robert Crouch - University Hospital Southampton NHS Foundation Trust<br /> Mr Mark Ainsworth-Smith - South Central Ambulance Service NHS Foundation Trust<br /> Professor Charles Deakin - South Central Ambulance Service NHS Foundation Trust<br /> Professor Valerie Lattimer - University of East Anglia<br /> Mr Stephen Murray - Health Education South West<br /> Professor Catherine Pope - University of Oxford<br /> Mrs Fizz Thompson - South Central Ambulance Service NHS Foundation Trust<br /> <br /> <b>Plain language summary</b><br /> <br /> Nationally, ambulance crews make over 3 million patient journeys a year. These journeys involve the ‘handover’ of information between patients, crews and hospital staff. Our research looks in detail at these journeys and handover communication. We observed ambulance journeys and transfers to hospital, interviewed staff and patients, and examined patient records. We studied verbal, written and non-verbal communication across the patient journey to describe handover, and how it is affected by patients, staff&nbsp; and technologies. We explored how information, experience and knowledge is combined to create an understanding of the patient, and identified some of the problems (i.e. information decay, communication failures) which may lead to handover breakdown. We hope that these findings will inform practice and training for handover and contribute to improving communication and patient safety.<br /> Handover transfers information and responsibility. It occurs when the ambulance is assigned, at scene, on the ambulance and at hospital. Verbal transfer of information occurs between patients/public/carers, health and other professionals (e.g. police, crew, nurses). Written information can be paper or digital. Non-verbal communication includes gestures and facial cues. Multiple transfers of information/responsibility occur in a single journey, at different times and places. Communication can be affected by behaviour (e.g. it is difficult obtaining information from people under the influence of alcohol) relationships (e.g. between different professions or teams) and technologies (e.g. telemetry – equipment that transfers information remotely).<br /> Handover in the pre-hospital setting is more frequent and complex than usually acknowledged. Staff combine different sources of information with experiential and clinical knowledge to build up an understanding of the patient. Huge amounts of information are collected in a short time, and there are a number of potentially critical points and reasons why communication can breakdown (e.g. information decay/loss, poor communication, distractions/interruptions, lack of trust, technology failure). This study provides the first detailed examination of handover. Training for pre-hospital care should consider the complexity of handovers and address potential risks.&nbsp;<br /> <br /> <b>Keywords</b><br /> Handover; communication; pre-hospital setting; ambulance; emergency care; patient journey; information transfer; qualitative research.<br /> <br /> <b>Summary of research findings</b><br /> BACKGROUND: Handover is a vital but poorly described part of pre-hospital care. Effective handover enables continuity of care, patient safety, faster decision-making and better record keeping (1-6) . Previous research has focussed on hospitals and/or nurses, and on views and experiences (largely from staff perspectives, not patients), or used observation, including quasi-experimental studies with simulated patients testing new training or standardised procedures.&nbsp; Ambulance crews have been shown to provide accurate handovers (6,7) but other research highlights poor communication (8). Written communication is believed to reduce information loss but structured procedures can reduce accuracy and retention (6,9-14). Numerical values are more likely to be forgotten than descriptions and information provided at the beginning of the handover is more likely to be recalled (15,16) . Information passed via a third person is often distorted or lost (2,7,8,10-12). There is more information decay in resuscitation rooms than wards (5 12). Ambulance crews report difficulties in delivering handovers (6,8,16-19) and studies have shown that time pressures and distractions prevent good handovers (1,3,5,7,8,13,15,18).&nbsp;<br /> <br /> AIM: The aim of this study was to describe and understand the process of handover and show how this impacts on patient care.<br /> <br /> OBJECTIVES: The study employed an ethnographic case study design, using real time observation and video, interviews and documentary analysis to: <ul> <li>Provide a unique and detailed description of handover processes&nbsp;</li> <li>Compare the content and use of different types of information (e.g. written and verbal)</li> <li>Critically examine handover and consider its impact on patient care.</li> </ul> <br /> METHODS: We observed 223 ambulance journeys on 56 shifts at different times/days over 18 months from 2009-11. 109 patients consented to the inclusion of their data in the study. We estimated needing 120 patients but ‘data saturation’ (no more emerging themes) occurred earlier than this. Contemporaneous notes were taken to describe verbal, written and non-verbal communication and the technologies used in handover: notes were anonymised and transcribed. Video recordings and photographs were taken to supplement the notes.<br /> 19 semi-structured interviews were conducted with crew, staff and patients to understand handover practice. These were audio-recorded, anonymised and transcribed. Anonymised copies of patients’ records were made for consented patients. Data were read independently, discussed collectively and coded, to develop themes and analytical categories. The analysis was inductive (from data) and deductive (guided by the proposal) and the findings below are structured around two overarching themes in line with the project objectives.&nbsp;<br /> <br /> KEY FINDINGS: Pre-hospital handovers are far more frequent and complex than usually acknowledged. 652 hours of observation covered 851 handovers during 109 (consented) patient journeys – approx 9 per patient, sometimes as many as 18. Handovers are verbal, non-verbal and written and occur in different environments, often where communication is difficult. Given this frequency and complexity, the risk of error is significant and should not be underestimated.<br /> <br /> i) Handover complexity&nbsp;<br /> The first handover of information occurs with the 999 call. Information is taken by a call handler and transferred digitally via a Mobile Data Terminal (MDT), or (less frequently) by radio or mobile phone. This information includes patient details, address and incident description.&nbsp; Receipt of this information may allow the crew to prepare and plan for the incident and gather appropriate equipment. At the scene (or patient’s home) carers, relatives and the patient provide verbal handover. Sometimes a first responder is at scene to provide a verbal handover that may include clinical observations and details of any treatment provided. Documents such as record forms, GP or hospital discharge letters and carer’s notes also provide information. Other objects – notably collections of prescribed medicines may be used to help the attending crew to understand the patient. Further information may be sought by contacting the Clinical Support Desk (CSD) or other health professionals by telephone.<br /> <br /> Various technologies are used at scene and on the ambulance to send information/data. Telemetry transfers written messages, clinical observations (e.g. ECG) to the Emergency Department and can allow two way communication between crew and hospital. Occasionally&nbsp; telephone or radio is used to convey this information, notably when technologies fail.<br /> <br /> The crew take details from the patient or carers and write this on the patient record form. They also commonly make notes on gloves. The collecting of information may be structured around the forms used, or less commonly, according to a memorised rubric or standardised template.<br /> <br /> At hospital crews transfer patients to triage, minors, majors or resuscitation bays/areas. Communication en route with hospital staff, and experience, tacit and formal and clinical knowledge informs decisions about handover processes.&nbsp; Crews may provide several handovers or partial information transfers to different hospital staff they encounter. In the majors and minors areas handover is given to the Rapid Assessment and Treatment (RAT) nurse. They often tailor what they say to different health professionals. While there is an expectation that handover will be listened to, this is not always met, and distractions and interruptions to verbal handovers are common. At the end of handover the formal transfer of responsibility is marked by the crew requesting a signature from the receiving nurse/doctor and the transfer of a copy of the signed paper Patient Report Form (PRF) to the hospital notes. Information may also be transferred to digital records, and crew may do this verbally, often dictating information to a nurse or administrator/clerical worker.<br /> <br /> ii) Challenges to handover<br /> The sheer frequency, the multiple locations, and numbers of people involved in handover make it extremely complex and challenging. While we were not in a position to clinically assess handover communication we witnessed many examples of good practice (for example assessing pain by asking the patient for a subjective score, providing medication for pain relief and re-checking the pain score). Crews, hospital staff (and indeed patients) manage the difficult tasks required for communication, often in difficult circumstances/settings and in a relatively short time frame. There are multiple transfers of information and responsibility throughout the patient journey. Handover information is used to inform decisions about diagnosis, treatment and management at the scene, on the journey and at transfer to hospital. The different environments and the people involved may make collecting and giving information difficult. Poor verbal communication skills, misunderstandings and inaccurate or illegible written or digital information can compromise handover and communication. Some decisions may be based on misinformation, or on value judgements, stereotypes and these may not enable best patient care.<br /> <br /> We note the following challenges or potential problem areas for ambulance handovers: <ul> <li>information decay: as information passes between multiple people it is more likely to get lost or changed.&nbsp; Lack of understanding or failure to see the relevance of information, withholding or forgetting will resulting in incomplete handover;</li> <li>partial information: if inaccurate or limited information is communicated this makes it harder for the receiving professional to plan and manage care effectively;</li> <li>lack of trust: if people providing information are regarded as competent, truthful and reliable, information is more likely to be used and or retained. Patients who appear to be under the influence of alcohol or drugs, less experienced staff or different professional groups may not be trusted and this can compromise handover;</li> <li>technology failures: equipment breakdown (notably telemetry) reduces the amount of information available and hinders transfer of information, repeated equipment failure produces scepticism and lack of trust;</li> <li>tacit knowledge and preconceptions: mobile data terminal messages may cause crew to construct preconceived ideas about the incident or the patient, for example based on location or prior knowledge and this may not always be helpful;</li> <li>difficult environments: crews often found that handovers were not listened to due to the noise levels, competing tasks, frequent interruptions and distractions.</li> </ul> <br /> CHANGES AND IMPACT ON THE FIELD<br /> <br /> SCAS and SUHT have collaborated on improvements to practice which have impacted handover. New technologies with better performance or enhanced functionality (e.g. mobile data transfer, satellite navigation) have addressed some of the challenges surrounding technologies. Training and continuing professional development has been used to improve the use of technologies (e.g. telemetry) and new operational directives have been emailed to staff to improve practice. Dr Crouch and Ms Thompson led the introduction of new standard operating procedures to clarify handover processes and responsibility, and a RAT nurse takes the initial handover information from crews.<br /> <br /> The research team has fed back to the advisory team and patient representative. This has informed some of the improvements noted above. We are engaged in further discussions about presenting findings to staff in both Trusts, and at local leadership training.<br /> <br /> CONCLUSIONS: Ambulance handover is complex and challenging. The number of different handovers (averaging 9 per journey), different people involved, types of information, the nature of the environments and tasks presents a range of potential risks. Our findings should be used and widely disseminated to inform training and practice.&nbsp;<br /> <br /> <b>Patient and public involvement</b><br /> It was not easy to identify relevant patient and public involvement due to the general (wide range of conditions) and emergency nature of the care studied.&nbsp; Unlike projects focussed on a single disease there is no single support group or network whom we could approach. Changes to the way PPI is organised also made identifying potential advisors difficult. We are grateful to our PPI contributor (Vice Chair Oxford and Bucks division of SCAS PPI Forum) for input to the research design, ethics application and early part of the project. In the analysis and closing phase of the project, the PPI advisor to SCAS kindly agreed to join the advisory group and has provided very helpful feedback about the report and our dissemination plans. We hope that we will be able to maintain this link with him as outputs are produced from the project.<br /> <br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0407-13084). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between April 2009 and March 2011. This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

Known as the father of ion implantation technology, Peter Henry Rose died peacefully at his home in Rockport, Massachusetts, on 23 March 2017. Peter Henry Rose PPT|High resolutionPeter was born on 16 January 1925 in Lincoln, UK; his father was a ship builder. For many years he and his family lived on the Isle of Wight off the UK’s south coast. That introduction to country life, with water as a central part, greatly influenced his life and lifestyle. He was for many years an avid sculler on the Charles River in Boston; later he loved sailing his 18-foot catamaran at high speed and on one hull across Lake Sebago in Maine. He also was an enthusiastic skier; on one occasion, while giving a technical paper to an international audience in the Alps, he wore his ski boots so that he would not lose a single moment on the slopes.Peter received a PhD in nuclear physics from the University of London. Without any instruction, he also was given an adjunct divinity degree, which gave him great amusement throughout his life.Peter’s first job after graduation was at Frank Whittle’s innovative turbojet-engine research laboratory. Then, as a Fulbright scholar and research associate, he spent two years at MIT. Peter returned to the UK in 1954 before emigrating permanently to the US in 1956 to join a new and innovative company, High Voltage Engineering Corp. HVEC was dedicated to building large particle accelerators for fundamental nuclear structure research. During his 15-year tenure there, he worked closely with one of its founders, Robert Van de Graaff, and rose to be director of its research laboratory. As well as improving the performance of the machines, Peter was author or coauthor of more than 50 peer-reviewed technical papers.In 1968, while at HVEC, Peter was asked to build a much smaller accelerator to be used for semiconductor device development at Fairchild Semiconductor. At that time, the desired junction doping of a transistor was achieved by thermal diffusion of dopants into the substrate. That resulted in devices with a distribution of threshold voltages from which those with the desired operating voltage were sorted, and it led to a low product yield. Using ion implantation made the threshold voltage precise and resulted in a 100% yield. Unfortunately, the HVEC machine used the existing technology, which had the dopant-ion selection magnet at ground potential after the ion acceleration stage. That configuration resulted in a machine that was nearly 11 meters long; although useful for research, it was quite unsuitable for a production setting.That experience was the inspiration for Peter’s invention of a radically different compact accelerator design, with the selection magnet placed prior to acceleration. Almost no one in the scientific or technical community believed the arrangement could work. But the ion implanter design continues to be used worldwide by semiconductor factories.In 1971 Peter chose that risky design for the product of his first start-up company, Extrion Corp, which grew to employ 1500 people; it was acquired by Varian in 1975 and still exists today as a division of Applied Materials. The repetitive reproduction of the ion implanters required standard manufacturing procedures that were not in line with Peter’s entrepreneurial talents, and he left Varian in 1976 to form his second start-up, Nova Associates (now Axcelis Corp). The company grew rapidly and created an innovative high-current ion implanter. Peter also contributed to the start-up and operation of a subsidiary, Sumitomo Eaton Nova, because sales to semiconductor fabrication factories were particularly strong in Japan at the time. Additionally, he helped colleagues found or agreed to serve as a director of several other start-ups, including Ibis Technology and Passport Systems.Peter was a superb leader, which contributed to his being an outstanding entrepreneur. People loved to work with him because they trusted and believed in him. He created a wonderful environment that didn’t seem like work because it was so much fun. Customers knew he would make good on his promises. Because of his integrity and reputation, Peter was often able to sell complex ion implanters based on just a simple concept sketch. For the same reason, he was also able to convince investors to support the development of his numerous innovations.Among Peter’s many honors, he received the National Medal of Technology and Innovation in 1996. His most cherished award was from the City of Gloucester, Massachusetts, which recognized Peter for helping turn the city into a high-tech center from a one-industry fishing town, to the benefit of residents in the city and surrounding areas.Peter was a gentleman who worked hard and played hard. Rather than raise his voice in anger, he would raise a glass in celebration. He was great fun to be with, both in and out of work. We and the semiconductor community miss him.© 2018 American Institute of Physics.

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