With today’s National Health Service (NHS) facing huge financial pressures the healthcare profession cannot afford to carry on spending at the current rate. Individual clinicians should be encouraged to critically appraise their own practices to bring about a more efficient and cost-effective service.The purpose of this project was to analyse the way that carpal tunnel surgery was being performed within our institution and bring about safe changes to practice that reduce expenditure.By critiquing our practices and applying simple changes based around sound evidence an annual saving of over £15 500 to the department was made. The changes instigated are simple, sustainable and safe to implement while providing improved patient satisfaction. They are also easily transferrable across institutions and to other minor hand surgical procedures to afford even greater ongoing savings to the NHS.

Shallow gas and its associated operational procedures have been the subject of much opinionated debate. Previous work in the area has focused either on regulatory issues or on the steps that can be taken while drilling to minimise the consequences of a shallow gas kick. Although some attention has been given to modelling the behaviour of wells under shallow gas blowout conditions, this has not resulted either in a practical design tool nor in a structured procedure for checking well designs. This paper puts forward a provisional framework which highlights the design checks that should be made to ensure that rig systems, well designs and operational procedures are safe and fit for purpose. The framework should permit engineers to approach the problem of shallow gas well design in an analytic and structured fashion, using a specified set of analysis techniques. These techniques are reviewed and transient well unloading and quasi-steady blowout simulations are identified as critical elements. The basis and operation of a practical software tool which addresses these elements is described. Some examples of its use are given and areas where modelling improvements could be made are suggested.

Young adults experiencing first-episode psychosis have historically been difficult to retain in mental health treatment. Communities across the United States are implementing Coordinated Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This mixed-methods research study examined the relationship between program services and treatment retention, operationalized as the likelihood of remaining in the program for 9 months or more. In the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy were associated with an increased likelihood of remaining in treatment. The key informant interview findings suggest the shared decision-making process and the breadth, flexibility, and focus on functional recovery of the home-based cognitive behavioral therapy intervention may have positively influenced treatment retention. These findings suggest the use of shared decision-making and improved access to home-based cognitive behavioral therapy for first-episode psychosis patients may improve outcomes for this vulnerable population.

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A biological attack would present an unprecedented challenge for local, state, and federal agencies, the military, the private sector, and individuals on many fronts, ranging from vaccination and treatment to prioritization of cleanup actions to waste disposal. To prepare for recovery from this type of incident, the Seattle Urban Area Security Initiative (UASI) partners collaborated with military and federal agencies to develop a regional recovery framework. The goal was to identify key information that will assist policymakers and emergency managers in shortening the timeline for recovery and minimizing the economic and public health impacts of a catastrophic anthrax attack. Based on discussions in workshops, tabletop exercises, and interviews with local, state, federal, military, and private sector entities responsible for recovery, the authors identified goals, assumptions, and concepts of operation for various areas to address critical issues the region will face as recovery progresses. Although the framework is specific to a catastrophic, wide-area biological attack using anthrax, it was designed to be flexible and scalable so it could also serve as the recovery framework for an all-hazards approach in other regions and jurisdictions. Benefits from this process include enhanced coordination and collaboration across agencies, a more thorough understanding of the anthrax threat, an opportunity to proactively consider long-term recovery, and a better understanding of the specific policy questions requiring resolution.