The Early Warning Score (EWS) is a simple physiological scoring system suitable for bedside application. The ability of a modified Early Warning Score (MEWS) to identify medical patients at risk of catastrophic deterioration in a busy clinical area was investigated. In a prospective cohort study, we applied MEWS to patients admitted to the 56-bed acute Medical Admissions Unit (MAU) of a District General Hospital (DGH). Data on 709 medical emergency admissions were collected during March 2000. Main outcome measures were death, intensive care unit (ICU) admission, high dependency unit (HDU) admission, cardiac arrest, survival and hospital discharge at 60 days. Scores of 5 or more were associated with increased risk of death (OR 5.4, 95%CI 2.8-10.7), ICU admission (OR 10.9, 95%CI 2.2-55.6) and HDU admission (OR 3.3, 95%CI 1.2-9.2). MEWS can be applied easily in a DGH medical admission unit, and identifies patients at risk of deterioration who require increased levels of care in the HDU or ICU. A clinical pathway could be created, using nurse practitioners and/or critical care physicians, to respond to high scores and intervene with appropriate changes in clinical management.

SummaryThe prevalence of latex allergy has increased since the 1980s. As latex is found throughout hospitals and operating theatres, careful planning is required for latex-allergic patients who present pre-operatively. We conducted a postal survey of 269 departments of anaesthesia in England and Wales; responses were received from 208 (77%). Of these, 198 (95%) had a latex allergy protocol and 181 (87%) had a store of latex-free equipment. Only 113 (54%) had a named nurse and 58 (28%) had a named consultant responsible for the update of latex allergy provisions. Access to allergy clinics and further investigations were available to 189 (91%). Many respondents called for national guidelines. We are reassured that the majority of trusts have an up-to-date latex allergy protocol and latex-free equipment store. However, relatively few have nominated members of staff responsible for these and peri-operative care of susceptible patients.

Previous immunochemical studies have shown that NHE3 is an apical Na+/H+ exchanger in some renal epithelia. The purpose of the present study was to develop high-affinity, isoform-specific monoclonal antibodies (MAbs) that would be useful for carrying out high-resolution immunocytochemical studies of NHE3 in the adult and neonatal mammalian kidney. Three MAbs were developed to a fusion protein containing amino acids 702-832 of rabbit NHE3. Specificity was established by immunoblotting membranes from NHE-deficient LAP cells that had been transfected with either NHE1,-2, -3, or -4. With the use of high-resolution immunocytochemical techniques, NHE3 was found in vesicles in the apical cytoplasm of proximal tubule cells, as well as in the apical plasma membrane of the proximal tubule, and in both the thin and thick limbs of the loop of Henle. When localized in the 1-day-old rat kidney, NHE3 was first detected in the late stages of the S-shaped body. In later stages of nephron development, the pattern of NHE3 staining was similar to that seen in the adult. This study demonstrates 1) the specificity of three MAbs for Na+/H+ exchanger isoform NHE3; 2) NHE3 is present in an intracellular vesicular compartment in cells of the proximal tubule, consistent with possible regulation by membrane recycling; and 3) NHE3 is expressed on the apical membrane in early stages of the developing nephron.

No abstract

Given the growing relevance of the sustainability agenda to the professions of the built environment, one way to ensure that its mandates are effectively integrated in architecture and urban design is to revisit the role that education, particularly at university level, can play. It is well understood that this requires a significant paradigm shift in the underlying pedagogies involved in educating for sustainability. It could be argued therefore that one of the main challenges is to address the dichotomy between effectively integrating creative expression with rigorous technical exploration, this being a core demand of high‐quality sustainable design. As such, advances in curriculum development must seek to promote this integration more effectively, and, in so doing, facilitate knowledge transfer between both the creative and the scientific disciplines that are core to a sustainable architecture and urban design process. In response, this paper explores the outcomes of a European project, EDUCATE (Environmental Design in University Curricula and Architectural Training in Europe), seeking to look critically at the barriers and opportunities afforded by implementing sustainability in pre‐ and post‐professional education in architecture and urban design, and exploring some of the strategies required to promote such integration. Copyright © 2012 John Wiley & Sons, Ltd and ERP Environment.

8 This paper will explore the potential of employing thermotropic (TT) windows as a means of 9 improving overall building energy performance. Capitalising on their ability to dynamically 10 alter solar and visible light transmittance and reflectance based on window temperature,

No abstract

Purpose This study aims to explore the opportunities offered by interactive and situated learning (e-learning and m-learning) in support of education for sustainability in disciplines of the built environment. Design/methodology/approach The paper illustrates the development of an online portal and a mobile app aimed at promoting students’ motivation and engagement with sustainability in design, and discusses the outcomes of their testing, investigating users’ acceptance, comparing academic results and analysing feedback. Findings The findings add empirical evidence to the view that information and communication technology-enhanced pedagogies can substantially contribute to the agenda of sustainability in higher education, primarily due to their affordance of interactive communication and contextualisation of knowledge, while guaranteeing flexible time and pace of learning. Research limitations/implications The study solely focused on the development and testing of e-learning and m-learning tools to foster students’ competence of sustainability in design studio work. The tools trialled were mostly at their prototypical stage and their testing included a relatively short-term evaluation and a narrow, self-selected, user base. However, the approach and findings are felt to be applicable to a much wider range of educational contexts. Originality/value Interactive and situated pedagogical methods and tools have the potential to prompt a departure from transmissive educational models, encompassing at once theoretical, experiential and analytic learning processes. This is of value to education for sustainability in disciplines of the built environment due to the requirement to holistically consolidate multi-/inter-/trans-disciplinary knowledge into a coherent design whole.