Sustainability and the Multifunctional Landscape: An Assessment of the Cairngorms National Park Authority’s Approach to Planning and Management in Upland Scotland.

Upland Scotland contains some of Britain’s most prized areas of natural heritage value. However, although such areas may appear both ‘wild’ and ‘remote’, these are typically working landscapes which symbolise the interdependence of nature and society. The complexity of this relationship means that management responses will need to address a multitude of potentially conflicting priorities whilst at the same time ensuring that sufficient social and institutional capital exists to allow for the promotion of landscape integrity. The introduction of national parks to Scotland in the form of the National Parks (Scotland) Act 2000 allows for a high-level of protection for designated areas in upland Scotland. Yet, whilst the recent Act outlines the statutory purpose and direction national parks should take, it allows a significant degree of flexibility in theway in which the Actmay be implemented. This level of discretion allows for significant local distinctiveness within the model but also raises questions about the potential effectiveness of chosen responses. In order to assess the potential implications of a model rooted in self-determination,we provide a case study review of the institutional basis of the Cairngorms National Park along with an assessment of the strategic character of the first National Park Plan. It is argued that whilst the Cairngorms National Park Authority has developed a significant level of stakeholder engagement, the authority may struggle to bridge the policy-implementation gap. Although a number of shortcomings are identified, particular concerns relate to the potential mismatch between strategic ambition and local level capacity.

Can we characterise ‘openness’ in the Holocene palaeoenvironmental record? Modern analogue studies of insect faunas and pollen spectra from Dunham Massey deer park and Epping Forest, England

This paper examines the degree to which tree-associated Coleoptera (beetles) and pollen could be used to predict the degree of ‘openness’ in woodland. The results from two modern insect and pollen analogue studies from ponds at Dunham Massey, Cheshire and Epping Forest, Greater London are presented. We explore the reliability of modern pollen rain and sub-fossil beetle assemblages to represent varying degrees of canopy cover for up to 1000m from a sampling site. Modern woodland canopy structure around the study sites has been assessed using GIS-based mapping at increasing radial distances as an independent check on the modern insect and pollen data sets. These preliminary results suggest that it is possible to use tree-associated Coleoptera to assess the degree of local vegetation openness. Additionally, it appears that insect remains may indicate the relative intensity of land use by grazing animals. Our results also suggest most insects are collected from within a 100m to 200m radius of the sampling site. The pollen results suggest that local vegetation and density of woodland in the immediate area of the sampling site can have a strong role in determining the pollen signal.

High tech start-ups in University Science Park incubators: The relationship between the start-up’s lifecycle progression and use of the incubator’s resources

University Science Park incubators (USIs) have emerged as a means by which Government, academia and business can develop high technology business firms (spin out HTBFs) from initial conception through to becoming established small firms, which are ready to move beyond the Science Park confines. Although there is considerable literature on how USIs can be improved and developed there is a paucity of studies, which explore how lifecycle development within HTBFs in USIs can affect how they use the unique resources and opportunities of the USI. Moreover, there is a focus on single point in time studies, which do not adequately investigate the longitudinal dynamics of HTBF lifecycle development within USIs. Therefore, the aim of this paper is to explore the longitudinal use of the unique resources of the USI by HTBFs at different lifecycle stages. The research methodology involved 18 HTBFs within two separate USIs. A series of longitudinal interviews and focus groups were conducted with HTBFs and USI staff over a 36-month period. NUD*IST software was used in developing the coding and analysis of transcripts. The results show that a HTBF's propensity to make effective use of the USI's resources and support increases as the lifecycle stage of the company increases and the small-firm searches for independence and autonomy. Therefore, further research is required to investigate the following two outstanding questions; firstly, which usage pattern is associated with the HTBF's ultimate success or failure in the marketplace? And secondly, are there any services missing from the observed array that the USI could provide to enhance the HTBF's degree of ultimate success? © 2007 Elsevier Ltd. All rights reserved.

Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

BACKGROUND: Despite the fact that outreach and early warning systems (EWS) are an integral part of a hospital wide systems approach to improve the early identification and management of deteriorating patients on general hospital wards, the widespread implementation of these interventions in practice is not based on robust research evidence. OBJECTIVES: The primary objective was to determine the impact of critical care outreach services on hospital mortality rates. Secondary objectives included determining the effect of outreach services on intensive care unit (ICU) admission patterns, length of hospital stay and adverse events. SEARCH STRATEGY: The review authors searched the following electronic databases: EPOC Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) and other Cochrane databases (all on The Cochrane Library 2006, Issue 3), MEDLINE (1996-June week 3 2006), EMBASE (1974-week 26 2006), CINAHL (1982-July week 5 2006), First Search (1992-2005) and CAB Health (1990-July 2006); also reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series designs (ITS) which measured hospital mortality, unanticipated ICU admissions, ICU readmissions, length of hospital stay and adverse events following implementation of outreach and EWS in a general hospital ward to identify deteriorating adult patients versus general hospital ward setting without outreach and EWS were included in the review. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data and two review authors assessed the methodological quality of the included studies. Meta-analysis was not possible due to heterogeneity. Summary statistics and descriptive summaries of primary and secondary outcomes are presented for each study. MAIN RESULTS: Two cluster-randomised control trials were included: one randomised at hospital level (23 hospitals in Australia) and one at ward level (16 wards in the UK). The primary outcome in the Australian trial (a composite score comprising incidence of unexpected cardiac arrests, unexpected deaths and unplanned ICU admissions) showed no statistical significant difference between control and medical emergency team (MET) hospitals (adjusted P value 0.640; adjusted odds ratio (OR) 0.98; 95% confidence interval (CI) 0.83 to 1.16). The UK-based trial found that outreach reduced in-hospital mortality (adjusted OR 0.52; 95% CI 0.32 to 0.85) compared with the control group. AUTHORS' CONCLUSIONS: The evidence from this review highlights the diversity and poor methodological quality of most studies investigating outreach. The results of the two included studies showed either no evidence of the effectiveness of outreach or a reduction in overall mortality in patients receiving outreach. The lack of evidence on outreach requires further multi-site RCT's to determine potential effectiveness.

Dendrochronology and Deer Park Farms

This chapter examines some aspects of the environmental
context for the constructional activity observed at Deer
Park Farms (DPF). This can be done at several levels by
observing what dendrochronology suggests in terms of
environment and environmental change across the period
from around AD 500 to 1000. Looking at the broad sweep
of tree growth across the period, something not previously
attempted, we can make comparisons between tree
growth in Ireland and elsewhere in Europe. We can study
abrupt events in the records and draw on information
from other sources in an attempt to paint a picture of the
period against which to view the constructional activity
on the site itself. It is worth remarking that there is no
blueprint for this work. Most of the information used has
only recently been produced and it is largely independent
of conventional history.

Prior colonisation with Candida species fails to guide empirical therapy for candidaemia in critically ill adults

Objectives Pre-emptive fluconazole (fcz) anti-fungal therapy is often based upon Candida colonisation of at least 2 non-contiguous non-sterile sites. The aim of this study was to evaluate the relationship between candidaemia and prior colonisation of non-sterile sites. Methods A retrospective observational study was performed in the intensive care unit/high dependency unit (ICU/HDU) of a University hospital on alternate years from 1999–2007, where a pre-emptive anti-fungal therapy policy was introduced in 2005. Results A higher proportion of blood isolates were Candida glabrata compared with non-sterile isolates (16/46 vs 106/1062; p

Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis.

Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.

Design Systematic review.

Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions.

Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults.

Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information.

Results Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I(2)=76%, P

Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.

C5a-mediated neutrophil phagocytic dysfunction is RhoA-dependent and predicts nosocomial infection in critically ill patients.

Critically ill patients are at heightened risk for nosocomial infections. The anaphylatoxin C5a impairs phagocytosis by neutrophils. However, the mechanisms by which this occurs and the relevance for acquisition of nosocomial infection remain undetermined. We aimed to characterize mechanisms by which C5a inhibits phagocytosis in vitro and in critically ill patients, and to define the relationship between C5a-mediated dysfunction and acquisition of nosocomial infection. In healthy human neutrophils, C5a significantly inhibited RhoA activation, preventing actin polymerization and phagocytosis. RhoA inhibition was mediated by PI3Kd. The effects on RhoA, actin, and phagocytosis were fully reversed by GM-CSF. Parallel observations were made in neutrophils from critically ill patients, that is, impaired phagocytosis was associated with inhibition of RhoA and actin polymerization, and reversed by GM-CSF. Among a cohort of 60 critically ill patients, C5a-mediated neutrophil dysfunction (as determined by reduced CD88 expression) was a strong predictor for subsequent acquisition of nosocomial infection (relative risk, 5.8; 95% confidence interval, 1.5-22; P = .0007), and remained independent of time effects as assessed by survival analysis (hazard ratio, 5.0; 95% confidence interval, 1.3-8.3; P = .01). In conclusion, this study provides new insight into the mechanisms underlying immunocompromise in critical illness and suggests novel avenues for therapy and prevention of nosocomial infection.

Dogs as a diagnostic tool for ill-health in humans

Researchers have long reported that dogs and cats improve the physical and psychological health of their human caregivers, and while it is still inconclusive, a substantial amount of research now lends support for the commonly held view that "pets are good for us." Recently, studies have directed attention toward exploring the use of animals, most notably dogs, in the detection of disease and other types of health problems in people. This article reviews the evidence for dogs' ability to detect ill health in humans, focusing specifically on the detection of cancer, epileptic seizures, and hypoglycemia. The author describes the research carried out in this area and evaluates it in an effort to determine whether dogs have a role to play in modern health care as an "alert" tool or screening system for ill health. Where necessary, the author has highlighted weaknesses in the work and proposed directions for future studies.