Capita (United Kingdom)

Major trauma is a leading cause of death and disability. Specialised care in major trauma centres has been associated with improved outcomes and prehospital triage tools are used to ensure injured patients are treated in the right place and the right time. However, there is a trade-off between under- and over-triage, and this study aimed to externally validate current and newly developed major trauma triage tools. A diagnostic case-cohort study was performed between November 2019 and February 2020 in 4 English regional trauma networks as part of the Major Trauma Triage Study (MATTS). The accuracy of 22 adult major trauma triage tools, including 3 newly developed MATTS tools was evaluated. Consecutive patients with acute non-trivial injury presenting to participating ambulance services were included and matched to data from the English national major trauma database. Theoretical accuracy was examined, with index tests assessed according to objective ambulance service data, regardless of the final triage decision or hospital destination. The primary reference standard was a consensus definition of serious injury that would benefit from expedited major trauma centre care. The case-cohort sample consisted of 2,607 patients, including 928 primary reference standard positive patients. The population weighted prevalence of major trauma meeting the primary reference standard definition was 3.1% (95% CI 2.3-4.0). Four optimally performing triage tools were identified with Pareto decision analysis: the Trauma score (sensitivity 0.1, specificity 0.99), MATTS specific tool (sensitivity 0.37, specificity 0.95), MATTS balanced tool (sensitivity 0.58, specificity 0.87), and the MATTS sensitive tool (sensitivity 0.72, specificity 0.76). This finding was unchanged in subgroup analyses of different age-groups and injury mechanisms; secondary analyses examining alternative reference standards (ISS ≥ 16, US consensus definition); and sensitivity analyses exploring missing data. Four optimal triage tools, demonstrating a trade-off between sensitivity and specificity, were identified by this validation study. The choice of ideal tool will depend on prevalence of major trauma, and valuation of false positive and false negative cases. Further prospective investigation of real-life triage tool performance, including compliance and clinical judgment, is necessary.

El fenómeno turístico aparece como la principal característica de la presente generación con una doble importancia: social y económica. Para algunos países constituye la primera fuente de ingresos. En el aspecto cuantitativo se muestra una nueva fórmula matemática que engloba el nivel de ingresos en diferentes paríses, su madurez social y su capacidad productiva para el turismo. Se hace especial referencia al caso español.

Le groupe aéronaval autour du porte-avions Charles-de-Gaulle , alors juste entré en service, a été engagé pour Héraclès . Le saut qualitatif fut important avec cette opération et a fait progresser nos forces. Ses leçons restent pertinentes avec l’arrivée de nouveaux systèmes comme les Fremm et les SNA de la classe « Suffren ».

O objetivo do trabalho foi avaliar a influencia do consorcio com quiabeiro nas caracteristicas fisico-quimicas da couve de folha ( Brassica oleracea L. var. acephala ). O experimento foi conduzido em delineamento de blocos ao acaso, com quatro repeticoes. Os tratamentos foram constituidos dos consorcios (T1 = tres linhas de couve com quiabeiro nas entrelinhas, T2 = tres linhas de couve com quiabeiro a cada duas entrelinhas, T3 = tres linhas de couve com quiabeiro adensado nas entrelinhas, T4 = tres linhas de couve com quiabeiro adensado a cada duas entrelinhas) e monocultivo (T5 = tres linhas de couve). Nos monocultivos, a couve e o quiabeiro possuiam espacamento entre linhas de 1,20 e de 0,50 m entre plantas. O quiabeiro adensado estava no espacamento entre plantas de 0,25 m. Nos consorcios as linhas de plantio estavam afastas entre si a uma distância de 0,60 m. Mensalmente durante 50, 80, 110 e 140 dias apos o transplante (DAT) na couve de folha, foram realizadas leituras do indice de SPAD e coletadas amostras de tecidos vegetais para as analises: teor de clorofila a, b e total, carotenoides totais, acidez titulavel, solidos soluveis e teor de acido ascorbico. Para pH, o T5 foi maior ao longo das epocas avaliadas; para o teor de solidos soluveis, os tratamentos T1 e T4 foram maiores aos 82 e 101 DAT, com 8,63 e 8,36 °Brix respectivamente. Nao foram observadas alteracoes na acidez titulavel. Para acido ascorbico, pigmentos fotossinteticos (clorofila a, b , total e carotenoides totais) e indice SPAD, a diferenca ocorreu somente nas epocas de avaliacoes; a fase em que a planta atingiu maiores teores para essas caracteristicas ocorreu a partir dos 80 DAT. Essas oscilacoes nos teores quimicos analisados nas folhas podem estar associadas aos periodos na fase vegetativa da couve de folha, assim como as condicoes meteorologicas durante o periodo de avaliacao das culturas a campo.

O presente artigo teve por objetivo analisar, por um viés semiótico, como o quadrinho Captain America Comics 1foi utilizado, enquanto arma ideológica, durante a Segunda Guerra Mundial. Concluiu-se que Capitão América tema capacidade de convencer seus leitores que os EUAsão uma potência mundial tão grande que poderiam até mesmo ganhar a Segunda Grande Guerra sem estar nela, já que o país somente tem participação registrada meses após o lançamento do quadrinho.

Published on: January 2019 Journal of Young Pharmacists, 2019; 11(1):88-91 Original Article | doi:10.5530/jyp.2019.11.18 Authors: Eudiana Vale Francelino1,2*, Sarah Resende Araújo1,2, Janaira Fernandes Severo Ferreira3,4, Fabiane Milena de Castro Araújo3,4, Kaila Barroso Medeiros Bulgarelli3,4, Patrícia Barros Nunes3,4, Aparecida Tiemi Nagao-Dias5,2 1Department of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, BRAZIL. 2Rua Capitão Francisco Pedro 1210,

: This practitioner presentation answers the 6 honest men questions in relation to the data governance of Irish food reputation and safety.

This paper is an account of the 16th Joint ICE/Capita Symonds annual safety lecture, one of the prestige lectures at the Institution of Civil Engineers, given by Stephen Williams, chief construction inspector of the UK Health and Safety Executive, at the ICE on 26 September 2007.