Shipley Hospital

This book explores the rise of the new gentry class and the market for armorial services through the case study of the Pendock Barry service.

Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied. To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift. Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models. NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001). Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress. Strategies are needed for reducing stress in NICU nurses who work night shift.

The k-means clustering algorithm has been implemented to find patterns in the time-averaged stored energy distribution in various filter networks. A large data set comprising of numerous topologies for 50 different single band specifications has been investigated. By finding key characteristics within this data set, general guidelines for predicting the optimum topology for power handling have been established.

Introduction: Remote monitoring has become an accepted and utilised tool for use with implantable cardiac devices: with safety at heart it is easy to see why when it comes to implantable defibrillators. The same is not so evident for implantable loop recorders (ILRs). This paper explores the impact of remote ILR monitoring on cardiac departmental workload. Method: Patients receiving an ILR at a single implanting centre were recruited. Following informed consent, they were randomised to control or experimental groups. Patients in the control group were reviewed by 6 monthly follow-up plus additional ad hoc checks if symptoms occurred. In-office follow-up, routine or ad hoc is allocated 30 minutes. In the experimental group, patients were asked to send transmissions fortnightly or following a symptom. Remote follow-up appointments were allocated 20 minutes; this included contacting the patient by telephone unless prior arrangements were made with the patient to send them a letter if there were no abnormalities. The primary outcome variable, which is reported separately, was median time to clinical diagnosis. Results: There were 37 patients were randomised, 19 to the control and 18 to the experimental group. The control group comprised 11 males and 8 females with a median age of 60 (36-86) years. The experimental group comprised 10 males and 8 females, median age 58 (36-84) years. Over the median 9 (0-23) month follow-up period, 23 (67%) of patients received a diagnosis based on ILR output. In total the study produced data from 5526 events (total with and without ECG) for review in the analysis. This equated to 1711 ECG recordings requiring review and 3815 text recordings. When breaking down the 5526 recordings into recordings per study group there were 1264 events logged for the control group, 481 with ECGs and 783 without ECG to review and 4262 events logged for the experimental group, 1230 with ECGs and 3032 without ECG to review. 122 (25%) of the ECGs recorded in the control group were classified as true events compared to 153 (12%) in the experimental group. In total here were 362 follow-ups carried out, 65 for the control group and 297 for the experimental group. Calculated into hours of follow-up time, that was 32.5 hours for control and 99 hours for experimental. Conclusion: With a threefold increase in both the amount of data requiring review, and the amount of time required to follow-up ILRs remotely, the process would have to be streamlined in order to make it a viable option. However, with the study data suggesting that a significant reduction in patient diagnostic time can be achieved, investment in service improvement should not be overlooked.

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Four great exhibitions (two in London and two in Paris) put on show 1850s and 1860s international rivalries and achievements across wide realms of art and industry. Even before it opened, the 1862 London Exhibition illustrated how steam power could facilitate speedy completion of a major building project and the manoeuvring of heavy machinery exhibits. Once opened, the Exhibition included a galaxy of machinery, much of it demonstrated ‘in motion’. Getting the ‘Engineering Department’ operational in good time owed much to the diligence of its ‘Superintendent’, Daniel Kinnear Clark. His domain, extensively equipped with under-floor steam pipes and over-head rotating drive shafts, embraced machine tools, cotton spinning ‘mules’, water-pumping demonstrations, sugar mills — and a great deal more. Records of the Exhibition provide plentiful information about mid-nineteenth-century engineering progress. Clark’s own Cyclopædia of the Exhibited Machinery enlighteningly illustrates machine efficiency challenges and engineering design issues of the time.

In a complex dispute concerning the use of the Hard Rock Café trade marks, the Bundesgerichtshof has clarified its application of the acquiescence defence and expressly re-evaluated its own precedents by allowing the parallel application of trade mark and unfair competition laws in cases of a deception concerning the commercial origin of goods or services in light of the EU Unfair Commercial Practices Directive.