Technical efficiency of blood component preparation in blood centres of 10 European countries

Various reasons, such as ethical issues in maintaining blood resources, growing costs, and strict requirements for safe blood, have increased the pressure for efficient use of resources in blood banking. The competence of blood establishments can be characterized by their ability to predict the volume of blood collection to be able to provide cellular blood components in a timely manner as dictated by hospital demand. The stochastically varying clinical need for platelets (PLTs) sets a specific challenge for balancing supply with requests. Labour has been proven a primary cost-driver and should be managed efficiently. International comparisons of blood banking could recognize inefficiencies and allow reallocation of resources. Seventeen blood centres from 10 countries in continental Europe, Great Britain, and Scandinavia participated in this study. The centres were national institutes (5), parts of the local Red Cross organisation (5), or integrated into university hospitals (7). This study focused on the departments of blood component preparation of the centres. The data were obtained retrospectively by computerized questionnaires completed via Internet for the years 2000-2002. The data were used in four original articles (numbered I through IV) that form the basis of this thesis. Non-parametric data envelopment analysis (DEA, II-IV) was applied to evaluate and compare the relative efficiency of blood component preparation. Several models were created using different input and output combinations. The focus of comparisons was on the technical efficiency (II-III) and the labour efficiency (I, IV). An empirical cost model was tested to evaluate the cost efficiency (IV). Purchasing power parities (PPP, IV) were used to adjust the costs of the working hours and to make the costs comparable among countries. The total annual number of whole blood (WB) collections varied from 8,880 to 290,352 in the centres (I). Significant variation was also observed in the annual volume of produced red blood cells (RBCs) and PLTs. The annual number of PLTs produced by any method varied from 2,788 to 104,622 units. In 2002, 73% of all PLTs were produced by the buffy coat (BC) method, 23% by aphaeresis and 4% by the platelet-rich plasma (PRP) method. The annual discard rate of PLTs varied from 3.9% to 31%. The mean discard rate (13%) remained in the same range throughout the study period and demonstrated similar levels and variation in 2003-2004 according to a specific follow-up question (14%, range 3.8%-24%). The annual PLT discard rates were, to some extent, associated with production volumes. The mean RBC discard rate was 4.5% (range 0.2%-7.7%). Technical efficiency showed marked variation (median 60%, range 41%-100%) among the centres (II). Compared to the efficient departments, the inefficient departments used excess labour resources (and probably) production equipment to produce RBCs and PLTs. Technical efficiency tended to be higher when the (theoretical) proportion of lost WB collections (total RBC+PLT loss) from all collections was low (III). The labour efficiency varied remarkably, from 25% to 100% (median 47%) when working hours were the only input (IV). Using the estimated total costs as the input (cost efficiency) revealed an even greater variation (13%-100%) and overall lower efficiency level compared to labour only as the input. In cost efficiency only, the savings potential (observed inefficiency) was more than 50% in 10 departments, whereas labour and cost savings potentials were both more than 50% in six departments. The association between department size and efficiency (scale efficiency) could not be verified statistically in the small sample. In conclusion, international evaluation of the technical efficiency in component preparation departments revealed remarkable variation. A suboptimal combination of manpower and production output levels was the major cause of inefficiency, and the efficiency did not directly relate to production volume. Evaluation of the reasons for discarding components may offer a novel approach to study efficiency. DEA was proven applicable in analyses including various factors as inputs and outputs. This study suggests that analytical models can be developed to serve as indicators of technical efficiency and promote improvements in the management of limited resources. The work also demonstrates the importance of integrating efficiency analysis into international comparisons of blood banking.

Das Tagebuch von Ilse Jacob 1940-1944 1940-1944

Diary of Ilse Jacob, born in Berlin in 1924. Emigrated on children's transport to England in 1940, later followed by her brother Hans. He was interned on the Isle of Man and later sent to Canada. At first Ilse Jacob was housed by the Jewish immigrant community, then got a position of bookkeeper in a store owned by a British Jew. Finally she was accepted by the ATS where she was trained as a cook for the military service. Eventually she passed the entry exams for the university.

Franks family papers, 1711-1821, [1965-1968].

Contains business correspondence, accounts and documents relating to Jacob Franks of New York, his two sons, Moses and David, a nephew, Isaac, and a John Franks of Halifax, possibly a member of the family.

Pilottitutkimus apteekkien yksilöllisestä tupakoinninvieroituspalvelusta

Apteekkien yksilöllinen tupakoinninvieroituspalvelu on tupakoinnin lopettamiseen motivoituneille asiakkaille tarkoitettu maksullinen erikoispalvelu, joka sisältää 4–6 tapaamista vieroitusohjaajana toimivan farmaseutin tai proviisorin kanssa. Palvelu sisältää asiakkaalle räätälöityä neuvontaa, henkilökohtaisen vieroitussuunnitelman sekä seurantajakson. Apteekkien yksilöllinen tupakoinninvieroituspalvelu perustuu Isossa-Britanniassa kehitettyyn palvelumalliin, ja sitä on tarjottu suomalaisissa apteekeissa vuodesta 2006. Tämä pro gradu -tutkielma käsittelee apteekkien yksilöllisen tupakoinninvieroituspalvelun pilottitutkimusta, joka toteutettiin Suomen Apteekkariliiton ja Helsingin yliopiston farmasian tiedekunnan sosiaalifarmasian osaston yhteistyönä ja se kuului osana Hengitysliitto Heli ry:n koordinoimaa tupakasta vieroituksen hankekokonaisuutta. Tässä pro gradu -tutkielmassa tarkastellaan pilottitutkimuksessa saadun asiakasaineiston avulla apteekkien yksilöllisen tupakoinninvieroituspalvelumallin toimivuutta, asiakkaiden kokemuksia palvelusta, asiakkaiden onnistumista tupaakoinnin lopettamisessa sekä asiakkaiden kyvykkyyden tunteen kehittymistä palvelun aikana. Tässä interventiotutkimuksessa oli mukana 14 apteekkia, jotka rekrytoivat yhteensä 36 palveluasiakasta. Ennen asiakkaiden rekrytointia apteekit perehdytettiin palvelun tarjoamiseen. Apteekit tiedottivat pilottitutkimuksesta paikallisen terveydenhuollon lääkäreitä ja muita terveydenhuollon ammattilaisia, jotka voivat ohjata asiakkaita palveluun. Sosiaali- ja terveysministeriön pilottitutkimukselle myöntämä rahoitus mahdollisti asiantuntijapalkkion maksamisen apteekeille ja palvelun tarjoamisen asiakkaille ilmaiseksi tai pientä omakustannusosuutta vastaan. Asiakkaiden tupakoimattomana pysymistä sekä kokemuksia tupakoinninvieroituspalvelusta kartoitettiin kyselylomakkeilla, jotka asiakkaat saivat täytettäväkseen palvelun alussa sekä noin 3 kuukauden kohdalla palvelun alkamisesta. Asiakkaiden taustatiedot kerättiin ensimmäisen tapaamisen yhteydessä erillisille taustatietolomakkeille ja palvelun aikana tehtyjä huomioita niille tarkoitetuille kaavakkeille. Ensimmäisen kyselylomakkeen palauttaneista 28 henkilöstä 20 ja toisen kyselylomakkeen palauttaneista 17 henkilöstä 13 oli pysynyt tupakoimattomana (55,6 % ja 36,1 % kaikista asiakkaista). Kaikki tupakoinnin lopettaneet käyttivät jotakin tupakasta vieroituslääkettä. Tupakoinnin lopettaneilla asiakkailla kyvykkyyden tunne oli keskimääräistä parempi sekä palvelun alussa että koko palvelun ajan. Asiakkaat pitivät palvelua tarpeellisena ja apteekin vieroitusohjaajalta saatua tukea tärkeänä. Asiakkaat kokivat myös palvelun saamisen apteekista tärkeäksi. Noin 32 % ensimmäiseen kyselyyn vastanneista ja 41 % toiseen kyselyyn vastanneista oli valmis maksamaan palvelusta. Heidän ilmoittamansa maksuvalmius oli keskimäärin noin 45 euroa (10–100 euroa). Muusta terveydenhuollosta lähetettiin palveluun vain vähän tai ei lainkaan asiakkaita. Tästä syystä apteekit rekrytoivat asiakkaita myös ilman kontaktia muuhun terveydenhuoltoon. Palvelun 36 asiakkaasta noin 36 % oli pysynyt tupakoimattomana 3 kuukauden kohdalla. Verrokkiryhmä jouduttiin jättämään tutkimuksesta pois verrokkihenkilöiden rekrytoinnin epäonnistuttua. Tulos on kuitenkin vertailukelpoinen kansainvälisiin tutkimuksiin, joissa on saatu vastaavanlaisia tuloksia. Apteekkien yksilöllisestä tupakoinninvieroituspalvelusta saattaa olla hyötyä tupakoinnin lopettamisessa siihen motivoituneille henkilöille ja erityisesti henkilöille, jotka käyttävät lisäksi tupakasta vieroituslääkettä. Asiakkaat kokivat palvelun tärkeäksi ja tarpeelliseksi, mutta heikko maksuvalmius asettaa haasteita palvelun tarjoamiselle apteekeissa. Yhteistyömallia muun terveydenhuollon kanssa tulisi kehittää.

Management of northern fur seals on the Pribilof Islands, Alaska, 1786-1981

This paper includes information about the Pribilof Islands since their discovery by Russia in 1786 and the population of northern fur seals, Cailorhinus ursinus, that return there each summer to bear young and to breed. Russia exterminated the native population of sea Oilers, Enhydra lulris, here and nearly subjected the northern fur seal to the same fate before providing proper protection. The northern fur seal was twice more exposed to extinction following the purchase of Alaska and the Pribilof Islands by the United States in 1867. Excessive harvesting was stopped as a result of strict management by the United States of the animals while on land and a treaty between Japan, Russia, Great Britain (for Canada), and the United States that provided needed protection at sea. In 1941, Japan abrogated this treaty which was replaced by a provisional agreement between Canada and the United States that protected the fur seals in the eastern North Pacific Ocean. Japan, the U.S.S.R., Canada, and the United States again insured the survival of these animals with ratification in 1957 of the "Interim Convention on the Conservation of North Pacific Fur Seals," which is still in force. Under the auspices of this Convention, the United States launched an unprecedented manipulation of the resource through controlled removal during 1956-68 of over 300,000 females considered surplus. The biological rationale for the reduction was that production of fewer pups would result in a higher pregnancy rate and increased survival, which would, in turn, produce a sustained annual harvest of 55,000-60,000 males and 10,000-30,000 females. Predicted results did not occur. The herd reduction program instead coincided with the beginning of a decline in the number of males available for harvest. Suspected but unproven causes were changes in the toll normally accounted for by predation, disease, adverse weather, and hookworms. Depletion of the animals' food supply by foreign fishing Heets and the entanglement of fur seals in trawl webbing and other debris discarded at sea became a prime suspect in altering the average annual harvest of males on the Pribilof Islands from 71,500 (1940-56) to 40,000 (1957-59) to 36,000 (1960) to 82,000 (1961) and to 27,347 (1972-81). Thus was born the concept of a research control area for fur seals, which was agreed upon by members of the Convention in 1973 and instituted by the United States on St. George Island beginning in 1974. All commercial harvesting of fur seals was stopped on St. George Island and intensive behavioral studies were begun on the now unharvested population as it responds to the moratorium and attempts to reach its natural ceiling. The results of these and other studies here and on St. Paul Island are expected to eventually permit a comparison between the dynamics of unharvested and harvested populations, which should in turn permit more precise management of fur seals as nations continue to exploit the marine resources of the North Pacific Ocean and Bering Sea. (PDF file contains 32 pages.)

GB Non-native Species Information Portal: documenting the arrival of non-native species in Britain

Information on non-native species (NNS) is often scattered among a multitude of sources, such as regional and national databases, peer-reviewed and grey literature, unpublished research projects, institutional datasets and with taxonomic experts. Here we report on the development of a database designed for the collation of information in Britain. The project involved working with volunteer experts to populate a database of NNS (hereafter called “the species register”). Each species occupies a row within the database with information on aspects of the species’ biology such as environment (marine, freshwater, terrestrial etc.), functional type (predator, parasite etc.), habitats occupied in the invaded range (using EUNIS classification), invasion pathways, establishment status in Britain and impacts. The information is delivered through the Great Britain Non-Native Species Information Portal hosted by the Non-Native Species Secretariat. By the end of 2011 there were 1958 established NNS in Britain. There has been a dramatic increase over time in the rate of NNS arriving in Britain and those becoming established. The majority of established NNS are higher plants (1,376 species). Insects are the next most numerous group (344 species) followed by non-insect invertebrates (158 species), vertebrates (50 species), algae (24 species) and lower plants (6 species). Inventories of NNS are seen as an essential tool in the management of biological invasions. The use of such lists is diverse and far-reaching. However, the increasing number of new arrivals highlights both the dynamic nature of invasions and the importance of updating NNS inventories.

The current state of abortion law and practice in Northern Ireland

This paper reviews current abortion law and practice in Northern Ireland (NI). It explores the origins of NI's abortion law and its complexity in relation to current practice. it reviews issues relating to women seeking terminations in NI and Great Britain and reviews attempts by the Family Planning Association NI to require the Department of Health and Social Services and Public Safety NI to provide guidance for health professionals engaged in this practice. The paper also discusses some of the issues surrounding abortion in NI and seeks to explain why this subject is causing controversy and debate, especially following a judicial review in February and Marie Stopes opening a termination service in Belfast.

Attitudes of Irish dental graduates to vocational training

INTRODUCTION: Vocational training (VT) is a mandatory 12 month period for UK dental graduates after graduation. Graduates of Irish Dental Schools are eligible to enter the general dental service in Ireland or obtain an NHS performers list number in the UK immediately after qualification. Reports would suggest that some graduates of Irish Dental Schools are choosing to take part in VT in the UK and find the experience beneficial. This study aimed to record the uptake of VT amongst recent graduates from University College Cork and to document their experiences. It was designed to compare the attitudes and experiences of graduates of Irish Dental Schools who undertook VT compared with those who entered the general dental service.

METHOD: A self-completion questionnaire was distributed by e-mail to dental graduates from University College Cork who had graduated 2001-2007. Responses were returned by e-mail or post.

RESULTS: The response rate was 68.9%. There has been an increase in the numbers of graduates taking part in VT each year since 2004. 92.5% of Vocational Dental Practitioners (VDPs) found their experience beneficial as they received a guaranteed source of income, had a supportive peer network and worked in a positive learning environment. However, some felt that they earned a lower income than their associate colleagues, others found the pace of practice slow and that the duration of the training period was excessive. Eighty-five per cent of VDPs would choose the same position again after graduation as compared with 61.8% of associates (P < 0.001). Ninety per cent of VDPs would advise current undergraduates to take part in VT as compared with 51% of associates (P < 0.001). A larger proportion of VDPs had taken part in postgraduate studies but there was no significant difference between the two groups.

CONCLUSIONS: Larger proportions of recent graduates are undertaking vocational training.--The majority of VDPs and associates find their initial employment position beneficial.--VDPs benefit from a guaranteed source of income, a supportive peer network and a positive learning environment.--Some associates suffered from a lack of support, feeling isolated and overwhelmed with patients.--The majority of previous VDPs and associates would recommend VT to current undergraduates.--Almost 40% of associates would now choose to take part in VT if given the opportunity.

Bird diversity and environmental gradients in Britain:a test of the species-energy hypothesis

1. We tested the species diversity-energy hypothesis using the British bird fauna. This predicts that temperature patterns should match diversity patterns. We also tested the hypothesis that the mechanism operates directly through effects of temperature on thermoregulatory loads; this further predicts that seasonal changes in temperature cause matching changes in patterns of diversity, and that species' body mass is influential.

2. We defined four assemblages using migration status (residents or visitors) and season (summer or winter distribution). Records of species' presence/absence in a total of 2362, 10 x 10-km, quadrats covering most of Britain were used, together with a wide selection of habitat, topographic and seasonal climatic data.

3. We fitted a logistic regression model to each species' distribution using the environmental data. We then combined these individual species models mathematically to form a diversity model. Analysis of this composite model revealed that summer temperature was the factor most strongly associated with diversity.

4. Although the species-energy hypothesis was supported, the direct mechanism, predicting an important role for body mass and matching seasonal patterns of change between diversity and temperature, was not supported.

5. However, summer temperature is the best overall explanation for bird diversity patterns in Britain. It is a better predictor of winter diversity than winter temperature. Winter diversity is predicted more precisely from environmental factors than summer diversity.

6. Climate change is likely to influence the diversity of different areas to different extents; for resident species, low diversity areas may respond more strongly as climate change progresses. For winter visitors, higher diversity areas may respond more strongly, while summer visitors are approximately neutral.

The cost of treating severe refractory asthma in the UK: an economic analysis from the British Thoracic Society Difficult Asthma Registry

Severe refractory asthma poses a substantial burden in terms of healthcare costs but relatively little is known about the factors which drive these costs. This study uses data from the British Thoracic Society Difficult Asthma Registry (n=596) to estimate direct healthcare treatment costs from an National Health Service perspective and examines factors that explain variations in costs. Annual mean treatment costs among severe refractory asthma patients were £2912 (SD £2212) to £4217 (SD £2449). Significant predictors of costs were FEV1% predicted, location of care, maintenance oral corticosteroid treatment and body mass index. Treating individuals with severe refractory asthma presents a substantial cost to the health service.

HRM and the employment of older workers: Germany and Britain compared

This study examines Human Resource Management (HRM) policies and practices towards older workers in Britain and Germany. While it is widely suggested that older workers have to be better integrated into the labour market, youth-centric HRM is still prevalent. However, HRM is shaped by multiple and contradictory pressures from the international and national institutional environments. We test this dynamic by analysing two national surveys, the German firm panel (IAB)1 and the British Workplace and Employment Relations Survey (WERS).2 Our findings suggest that the institutional environment shapes HR policies and practices distinctively in both countries. We find that age discrimination at the workplace is more prevalent in Germany than in Britain, which can be explained by divergent institutional patterns. As a result, we argue that although both countries will have to continue fostering an age-neutral HR approach, this has to take country-specific institutional peculiarities into account.

The Marquess of Londonderry: Aristocracy, Power and Politics in Britain and Ireland

The decline and fall of the British aristocracy looked headlong and irreversible in the twentieth century yet many grandees tried to preserve their power, wealth and influence by every means - and with some success. There is no better example than the Seventh Marquess of Londonderry whose life from 1878 to 1949 spanned and mirrored the period. The Londonderrys had enjoyed immense wealth in land and minerals in Britain and Ireland for centuries, played leading roles in Parliament and the state, and in an earlier time the Seventh Marquess would have continued in the family tradition of patrician prominence. Drawing upon original state and family papers, N.C. Fleming places the Londonderrys in the context of the history and the political theory of aristocracy and shows the constant struggle - not without success - against marginalisation. The theme runs through Londonderry's career as Conservative MP, on the Irish Viceroy's Council, as a junior minister in Lloyd Geroge's coalition, at the Air Ministry with Trenchard - the 'father of the RAF' - and in the National Government. Perhaps an element of desperation entered in his private business ventures and with contacts with the far Right - all in sharp contrast to past family achievement.

Commemorative stamps, British, American and Canadian, 1974-1977, 1982-1984, 1996.

The Guernsey post office stamps consist of 2 exhibition series souvenir sheets commemorating Major-General Sir Issac Brock, 1769-1812. The stamp was issued in 1996 to celebrate Guernsey’s attendance at Canada’s international stamp exhibition CAPEX 96. The stamps issued by the United States postal service consist of 1 sheet of stamps commemorating the 50th anniversary of the Peace Bridge, 1927-1977. The stamps issued by Canada Post include 5 commemorative day-of-issue envelopes with stamps featuring William Hamilton Merritt and the Welland Canal. This stamp was issued in 1974 to celebrate the 150th anniversary of the canal. There is also a set of 4 inscription corner blocks of stamps. These items are contained in an envelope addressed to Mr. J.N. Jackson, St. Catharines, ON. There is also a separate sheet of the same stamp. Also issued by Canada Post are 2 full sheets of stamps, one commemorating the 50th anniversary of the Peace Bridge (1927-1977), and one commemorating 25 years of the St. Lawrence Seaway (1959-1984). Lastly, there are 2 full sheets of stamps commemorating the 100th anniversary of the Royal Henley Regatta, issued in 1982.

Clopton Charter

Translation of Clopton Charter Let those who are present and those in future know that I Robert de Clopton gave and granted to my son, William, one yardland which is part of the Clopton estate / manorial demesne with all its appurtenances in exchange for his homage and service , and that I have confirmed it with this charter . The yardland in question is that which he once held as heriot / heritable property . [I have given and granted it to him] to be held and kept by him and his heirs freely and undisputedly as a holding granted in return for services and as hereditable property from me and my heirs. For this he has to pay an annual rent of twelve silver pennies, in two installments per year: six on the Feast Day of St. Michael and six on the Feast Day of St. Mary in March , on the income that belongs to me and to my heirs, without neglecting income from elsewhere; together with all goods and privileges attached to the aformentioned land in the form of fields and pastures and everything which belongs to said yardland. And I, Robert, and all my heirs shall warrant all this aforementioned yardland together with all its appurtenances to said William and his heirs against all other claims in perpetuity . However, in order that this gift and grant of mine may remain firm and immovable, I have validated this charter with my seal in the presence of [the following] witnesses: the knights Sir William of Ludinton [and] Sir Robert of Valle. William of Edricheston, William of Waleford, Robert of Sidesam, Richard of Ludinton, Nicholas the scribe , and others.

The Butler papers - Pt. I. 1711-1777

Documents and papers relating to Colonel John Butler and his corps of rangers. Pt.I. 1711-1777