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We retrospectively audited the records of 708 patients who presented with the diagnosis of fractured mandible between January 2009 and July 2013 at the Queen Elizabeth Hospital, Birmingham. We assessed the different factors that may have altered their outcomes, and found that delay before definitive fixation caused no harm in either the short or the long term. [ABSTRACT FROM AUTHOR]

• ANaRM is a simple ecosystem service model for NBS effects on flood hydrology. • Validated model provides realistic flood peak estimates across an urban catchment. • Ponds are most effective for reducing peak flow in channels and fluvial flooding. • LUC and SuDS reduce localized runoff, peak flow and pluvial flooding. • Sensitivity analysis to key NBS/runoff parameters, code and user guide provided. Ecosystem Service (ES) toolkits are increasingly used to quantify and visualize the benefits gained from Nature-based-solutions (NBS) but modules for hydrology are often absent, or if present they lack meaningful hydrological functionality or validation. This leads to gaps in the evidence base required by decision makers. To bridge the gap between such limitations and more complex hydrological models this paper presents a hydrologically based NBS model compatible with spatial ES toolkits. The approach 'Adapted Nature-based-solutions Rational Method' (ANaRM) is based on the Rational Method, widely used in hydrology. We apply this model to the city of Birmingham, England, to validate its performance and to analyse the effects of different NBS scenarios. The validated ANaRM model provided robust estimates of peak flow using design storm rainfall. It proved capable of simulating the hydrological effects of NBS such as land use change from urban to green, or installation of SuDS and ponds. Results suggest ponds are found most effective for achieving peak flow reduction in channels and are the best option for mitigating fluvial flooding downstream. Reduction in localised runoff and pluvial flooding is best achieved by converting impervious surfaces such as buildings, hardstanding and roads to green solutions such as green roofs, permeable pavements and greenspace. This paper highlights the importance of considering the spatial effects of urban NBS on hydrology, and that these can be captured with relatively simple modelling approaches such as ANaRM. Its ease of use means it suits any level of user looking to represent the flood mitigation aspect of NBS spatially and has high potential as part of any ES toolkit focused on representing the spatial effects of NBS on ecosystem services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the experience, opinions and recommendations of pharmacists when dispensing hospital generated prescriptions in community pharmacy. METHODS: Descriptive, cross-sectional, prepiloted, self-administered postal survey sent from Birmingham Children''s Hospital (BCH) to community pharmacists known to have dispensed hospital prescriptions (HPs) issued by BCH during June 2008 to May 2009 (n=1282). Survey commenced 22nd September 2009 with two reminders if necessary. The 48 point questionnaire included: demographics; experience and opinions concerning problems when dispensing hospital prescriptions; sources of further information and improving existing arrangements. Responses were entered into SPSS v16 for analysis. RESULTS: Response rate of 47.3% (n=607). Length of experience of the respondents working as community pharmacists ranged from 0 to 44 years with median 14 years. Overall approximately 0.3% of prescriptions dispensed or supervised by respondents were HPs, considerably lower than the national average of 0.6% (personal communication). Time to dispense HPs (mean 8.15 min, SD 9.86, median 5 min) was significantly different (p < 0.001) to GP prescriptions (mean 3.37 min, SD 2.86, median 2 min). There is a significant positive correlation (p = 0.002) between the experience of respondents dispensing HPs and the additional time they take to dispense HPs in comparison to GP prescriptions. When asked the question ‘In comparison to an average GP prescription what is the likelihood of problems when dispensing a HP in a community pharmacy?’ 87.4% (n=528) replied more or much more. Commonly reported problems include: illegible prescriptions, unfamiliar drug and missing information on the prescription, for example, quantity. The problems seem unrelated to unlicensed drugs. 61.1% (n=368) believe that there is more risk of error when dispensing a HP compared to a GP prescription. Pharmacists needing further advice were likely or very likely to consult a standard text (84.7%), the hospital prescriber (84%) or the prescriber''s support staff (67.3%). The study estimates the frequency of calls to prescribers made by respondents with 1 call for 923 GP prescriptions compared to 1 call for 10.7 HPs: quantifying observations in a published audit.1Recommended service improvements are (1) include direct contact details of prescriber on prescription forms and (2) ensure prescriptions are printed. CONCLUSION: Community pharmacists report frequent problems when dispensing HPs and a higher risk of error in comparison to dispensing GP prescriptions. As a consequence average dispensing time is more than doubled for HPs. Calls to HP prescribers are proportionally much more frequent than to GPs. Greater experience of dispensing HPs prompts longer dispensing times for HPs. Recommended service improvements are print prescriptions and include contact details of prescriber on the prescription form. [ABSTRACT FROM AUTHOR]