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Previous work by these authors have quantified cumulative greenhouse gas (GHG) emissions for several woody and herbaceous perennial species, in interaction with several standard best management practices (container size, fertilizer application and irrigation delivery methods, and light level). In this study, the greenhouse production of three annual species [coleus (Solenostemon scutellarioides Thonn. ‘Redhead'), vinca (Catharanthus roseus L. ‘Cooler Grape'), and impatiens (Impatiens walleriana Hook. f. ‘Super Elfin XP White')] was evaluated in three substrates [80:20 peat:perlite, 80:20 peat:WholeTree (a whole pine tree-based substrate), 60:40 peat:WholeTree]. Emissions of CO2, N2O and CH4 were collected over a period of 52 days. Without regard to media, coleus had the highest cumulative CO2 efflux (statistically similar to vinca), due to its increased size in comparison with both vinca and impatiens. Without regard to species, plant-pot systems using the highest proportion of WholeTree (40%) had numerically the most cumulative CO2 efflux (statistically similar to those containing only 20% WholeTree). No differences were observed for the main effect of species or media for N2O or CH4. Results suggest that using a more sustainable high wood fiber substrate in similar proportions to that of perlite in an industry standard mix (20%) could yield similarly sized plants with no negative impact on GHG emissions.Index words: alternative substrate, WholeTree, carbon sequestration, carbon dioxide, nitrous oxide, methane, global climate change.Species used in this study: ‘Redhead' coleus, Solenostemon scutellarioides Thonn. ‘Redhead'; ‘Cooler Grape' vinca, Catharanthus roseus L. ‘Cooler Grape'; ‘Super Elfin XP White' impatiens, Impatiens walleriana Hook. f. ‘Super Elfin XP White'.

Optimal patient care frequently requires the safe inter-hospital transfer of critically ill patients for time-sensitive treatments, often outside of normal working hours. Safe transfer requires a multi-disciplinary approach including doctors (typically anaesthesiologists), nurses and paramedics. In a 2018 survey of anaesthesiology trainees in Ireland, 81% agreed that specific training in this area was ‘deficient’ or ‘absent’ Recognizing the lack of formal training, we identified the need for training in the transport of critically ill patients including familiarization with the ambulance environment and common critical transfer scenarios The ACCT methodology consists of (1) comprehensive Video-Assisted Learning (VAL) material for pre-course completion; (2) on-site face-to-face simulation; (3) an ACCT Train the Trainer (ACCT-TTT) for trainers to subsequently deliver the programme.The VAL material includes lectures (e.g. transport physiology), clinical skills demonstrations (e.g. transport and ambulance equipment) and simulation (e.g. safe packaging for transfer). There is an accompanying multiple-choice questionnaire (MCQ) to ensure full engagement and testing of core knowledge prior to the on-site component. On-site, small multispecialty delegate groups comprising of doctors, nurses and paramedics rotate through three simulations, allowing for enhanced experiential learning. Two take place in high-fidelity simulation laboratories, and one occurs in a fully operational ambulance. Delegates assume their real work roles and deal with common transport scenarios and adverse incidents. Debriefing focuses on reinforcing prescribed learning objectives. A post-course MCQ is used to validate learning, with feedback forms used for course evaluation. We plan to pilot the course and subsequently conduct ACCT-TTT courses. We aim to implement and expand ACCT nationwide, making it a mandatory component of anaesthesiology training.

The level to which ornamental plant production impacts rising atmospheric greenhouse gas (GHG) concentrations remains unknown. Research to date has focused on developing baseline estimations of GHG emissions from plant-pot production systems and their contribution to global warming potential. To date, pot size, irrigation delivery method and fertilizer application method have been evaluated in the production of common woody ornamental crops. In this study, two perennial herbaceous plants, full-sun-grown ‘Stella D'Oro' daylily (Hemerocallis × ‘Stella D'Oro' L.) and shade-grown ‘Royal Standard' hosta (Hosta × ‘Royal Standard') (Hosta plantaginea Aschers × Hosta sieboldiana N.Fujita) were grown utilizing one of three common fertilizer application methods (dibbled, incorporated or top-dressed). Plants were grown in 3.8 L (1 gal) nursery containers in a 6:1 pinebark:sand substrate with standard amendments. Gas samples were collected in situ according to standard GRACEnet protocols weekly for five months. Cumulative emissions for both CO2 and N2O were least for plant-pot systems using the dibbled fertilizer method, regardless of species. Cumulative CO2 emissions were highest for plants fertilized by incorporation, followed by those fertilized by top-dressing. No differences were observed between N2O efflux measurements for systems fertilized by either the incorporated or top-dressed methods. Results suggest that dibbling fertilizer could significantly decrease both CO2 and N2O emission. Index words: carbon dioxide, nitrous oxide, methane, trace gas. Species used in this study: ‘Stella D'Oro' daylily (Hemerocallis × ‘Stella D'Oro' L.); ‘Royal Standard' hosta [(Hosta × ‘Royal Standard') (Hosta plantaginea Aschers × Hosta sieboldiana N.Fujita)].

Agriculture is one of the largest contributors of greenhouse gas (GHG) emissions. To date, much work on reducing GHG emissions has centered on row crops, pastures, forestry, and animal production systems, while little emphasis has been placed on specialty crop industries such as horticulture. In this horticulture container study, Japanese boxwood (Buxus microphylla Siebold & Zucc.) was used to evaluate the interaction of irrigation (overhead vs drip) and fertilizer placement (dibble vs incorporated) on GHG emissions (CO2, N2O, and CH4). Plants were grown in 11.4 L (#3) containers with a 6:1 pine bark:sand substrate with standard amendments. All containers received 6.35 mm (0.25 in) water three times daily. Gas samples were collected in situ using the static closed chamber method according to standard protocols and analyzed using gas chromatography. Total cumulative CO2 loss was not affected by differences in irrigation or fertilizer placement. Total cumulative N2O efflux was least for drip-irrigated plants, regardless of fertilizer placement. For overhead-irrigated plants, N2O efflux was greatest for those with incorporated fertilizer. Efflux of CH4 was generally low throughout the study. Findings suggest that utilizing drip irrigation could decrease N2O emissions, regardless of fertilizer placement. However, when limited to overhead irrigation, dibbled fertilizer placement could decrease N2O emissions. Index words: carbon dioxide, methane, nitrous oxide, trace gas Species used in this study: Japanese boxwood (Buxus microphylla Siebold & Zucc.)

Current weed control practices in nursery container plant production consist primarily of hand weeding and application of preemergence herbicides. Non-chemical weed control methods, such as mulches, could reduce herbicide use, reduce potential environmental concerns from offsite herbicide movement, and decrease the expense of weed control. Before implementation, alternative methods of weed control must be evaluated for effects on the growth of common container-grown species. Mulches made from readily available tree species, including eastern red cedar (Juniperus virginiana), ground whole loblolly pine (Pinus taeda), Chinese privet (Ligustrum sinense), and sweetgum (Liquidambar styraciflua), were evaluated at multiple depths with and without the herbicide dimethenamid-P (Tower®). Wax-leaf ligustrum (Ligustrum japonicum) and snowball viburnum (Viburnum macrocephalum) treated with dimethenamid-P, averaged over mulch treatments, had up to 7% less growth compared to non-herbicide treated plants, but marketability was not affected. Mulch species and depth had no effect on plant growth. Results indicate that these readily available mulch species can be applied at depths up to 10.2 cm (4 in) for weed control in container plant production.

BackgroundThe reorganisation of hospital services in Ireland, the development of hospital groups, centralisation of specialties and reconfiguring of smaller hospitals necessitates inter hospital transfer of patients requiring specialist care to an appropriate hospital that meets their clinical needs. In Ireland, in excess of 1000 adult critical care inter hospital transfers occur per annum(1). The ‘hub-and-spoke’ model is aligned with the hospital group structure and connectivity between hospitals is provided through agreed transport and retrieval services. These transfers are generally undertaken by local teams (usually an anaesthetic NCHD and a nurse) using an emergency ambulance and crew. Multidisciplinary team training is provided, by Critical Care Retrieval Services, using local resources in a framework enhancing safety and preparedness.Aims A critical care transfer checklist with a systematic approach provides a framework to address the elements of critical care, transport physiology changes and reduce potential adverse events when transferring critically ill patients (2). The use of transport specific adjuncts and packaging the patient systematically not only addresses transport issues e.g. temperature, but also facilitates emergency interventions en route.Conclusion Patient safety is a fundamental principle in healthcare and is the responsibility of healthcare practitioners to apply quality improvement methods to effect process and system improvements. The use of a systematic approach to patient management when transporting critically ill patients establishes a higher level of performance reduces cognitive dissonance and provides a framework for clinical teams and reduces the potential for human error (3).

Objective Postoperative acute kidney injury is a frequent and serious consequence of cardiac surgery. We undertook to investigate the association of obesity and the risk of acute kidney injury development after cardiac surgery. Methods A total of 432 patients who underwent cardiac surgery with cardiopulmonary bypass between October 2009 and August 2010 were included in the final retrospective analysis. Obesity was defined as body mass index 30 kg/m 2 or greater. Acute kidney injury was defined as a creatinine increase of 25% or more from baseline at 48 hours after surgery. Results The overall incidence of acute kidney injury was 29.9% (n = 129). There was an increased incidence of postoperative renal impairment in the obese versus nonobese cohort; however, this was not statistically significant (39% vs 25.9%, P = .007). Multivariate logistic regression revealed that body mass index 30 kg/m 2 or greater was independently associated with the development of postoperative acute kidney injury (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.27-3.54; P = .004), as were age (OR, 0.98; 95% CI, 0.96-1.0; P = .04) and cardiopulmonary bypass time (OR, 0.99; 95% CI, 0.98-1.0; P = .048). Conclusions Obesity with body mass index 30 kg/m 2 or greater is independently associated with an increased risk of acute kidney injury after cardiac surgery. Further understanding of the molecular basis of this association is critical to the design of preventative strategies.

Due to the relatively small market, volatility concerns, and high crop-value-per-acre associated with ornamental crops, no preemergence (PRE) herbicides are currently labeled for use in greenhouses containing plants. The objective of this study was to evaluate indaziflam SC for potential use as a PRE herbicide on gravel in greenhouses containing sensitive crops grown in extreme environmental conditions. Mini-greenhouses (MG) were designed and constructed to fit within gravel ground beds as an initial component to this study in order to evaluate herbicide volatility. Species evaluated included ‘Better Boy’ tomato (Lycopersicon esculentum Mill.), ‘Extreme Orange’ impatiens (Impatiens walleriana Hook. f.) and two species of petunia (Petunia × hybrida Juss. ‘Dreams White’ and ‘Dreams Neon Rose’). Indaziflam SC was applied at the manufacturer's labeled rate [40 g ai·ha−1 (0.04 lbs ai·A−1)] (1×) and at twice the labeled rate [80 g ai·ha−1 (0.07 lbs ai·A−1)] (2×). Each rate was applied using one of three different methods: 1) applied to only the gravel in ground beds with plants placed on gravel and covered with MG immediately following application; 2) applied over the top of plants on gravel inside the ground beds and covered with MG immediately application; and 3) applied over the top of plants outside the ground beds on adjacent gravel and left outside of MG. Two nontreated control treatments were maintained for each species and were placed either on nontreated gravel inside ground beds and covered with MG or placed outside ground beds on adjacent nontreated gravel and not covered with MG. Little to no injury was observed on any of the species after being placed on treated gravel and covered with a MG regardless of indaziflam rate. However when indaziflam was applied over-the-top, impatiens and tomatoes exhibited severe injury and death by 30 days after treatment (DAT). Additionally, fresh weights showed that all species receiving either over-the-top treatment were severely injured, while the plants placed on treated gravel inside the MG and both nontreated control treatments (both inside and outside of MG) exhibited no signs of injury or stunted growth. Results from this study indicate that while indaziflam may cause crop injury to ornamental species when applied over-the-top, it is likely that little to no injury will be observed as a result of volatility due to a gravel application in an enclosed structure.

Peat moss is the main component used in soilless greenhouse substrates and is thus in high demand commercially. Due to both perceived environmental and economic concerns associated with peat harvest and production, an increased search for alternative substrates has occurred. A majority of the viable alternatives available to growers are wood-based substrates. These substrates are readily available and could be considered more sustainable, depending on geographic location, than peat moss. One example of these wood-based substrates is eastern redcedar (Juniperus virginiana L.). The objectives of these experiments were to evaluate post-distilled, milled eastern redcedar shavings, in varying volumetric concentrations, as a substrate component, and to compare its effectiveness to a grower's standard peat-lite mix. Petunia ×hybrida Vilm. ‘Celebrity Blue’ and Impatiens walleriana Hook.f. ‘Extreme Violet’ grown in substrates containing up to 40% eastern redcedar product had equal or greater growth index than in the standard peat-lite mix, although bloom count was reduced in one experiment. Therefore, growers could amend their substrates with up to 40% eastern redcedar shavings and see little to no change in marketable plant growth for these two annual species.

Flumioxazin is commonly used in nursery production for PRE weed control. Container nursery producers are of the opinion that the granular formulation is less effective than the sprayable formulation. Under the hypothesis that the granular formulation may require more water for activation, an experiment was conducted to evaluate the interaction of flumioxazin formulation, rate, and activation moisture for PRE control of spotted spurge in a pine-bark substrate. Experiment consisted of a factorial arrangement of four experimental variables; flumioxazin formulation (granular and spray), and flumioxazin rate (0.28 and 0.42 kg ai ha−1), substrate moisture level at the time of application (dry, medium, and wet), and after-application irrigation level (a single irrigation at 0.6, 1.3, 2.5, and 5.1 cm). Treated pots were seeded with spotted spurge 2 d after the herbicide application, which was 1 d after the first irrigation. Control as indicated by spotted spurge counts and fresh weight was influenced only by flumioxazin rate and formulation. The sprayable formulation provided excellent control regardless of rate. Granular formulation was generally less effective, and additional activation moisture did not improve efficacy. Further studies were conducted with the granular formulation to determine the maximum separation distance between the spotted spurge seed and herbicide prills at which control is possible. Individual prills and spotted spurge seeds were placed on media surface at progressively increasing separation distances. Nonlinear regression of seedling survival data revealed that ≥99% control required a prill–seed separation of ≤5.2 mm. This prill–seed separation requirement is only marginally obtained with the current registered rate, i.e., 0.42 kg ai ha−1 or 168 kg product ha−1. The relationship between control and prill–seed separation distance cannot be manipulated by additional activation moisture. Inadequate contact between the spotted spurge seeds and the flumoioxazin-containing prills is likely the sole cause of inadequate control.

Introduction : The reorganisation of health services and the delivery of the ‘hub and spoke’ Model of Care for Adult Critical Care (HSE 2014) necessitates the requirement to transfer critically ill patients between hospitals to an appropriate location. As specialty services and critical care units are centralised and consolidated, more critically ill patients will need to move between hospitals (NOCA MTA Report 2016). It is generally accepted that trained specialist retrieval teams have lower rates of morbidity, mortality and adverse clinical events (Droogh 2015), yet most critically ill patients in Ireland are transferred by non specialist teams. (Murphy 2016). Funding was made available to develop three regional critical care retrieval hubs to form a national service for the retrieval of critically ill patients in Ireland. A framework did not exist through which these hubs could be connected and enabled. Short Description of Practice Change Implemented : In 2016, the National Transport Medicine Programme, underwent a transformation to a National Transport Medicine Service. The adult retrevial service (MICAS - Mobile Intensive Care Ambulance Service) is identified as the mechanism to enable the three adult critical care retreival hubs. Three local working groups of local and national stakeholders were formed. These included medical and nursing staff from critical care specialties, ambulance personnel, biomedical engineering and the new National Transport Medicine Service. Agreement was reached on ambulance and equipment specifications. A training programme, modelled on a national training programme for inter hosptial transfers, was introduced. Clinical governance strucutres were agred and staff operating in the NTMS follow national Standard Operating Proceedures. Aim and Theory of Change : The philosophy of care in MICAS to provide the highest quality care to critically ill patients whilst transporting them to a facility that meets their medical needs by an appropriately qualified and skilled team of critical care staff. It ensures every patient is transported in a way that maximised, not only their medical care but the safety, dignity and comfort of the patient and their families. It is hypothesised that, an increasing numbers of transports undertaken by MICAS, will result in a reduction in adverse clinical events in transfer and increased staff and patient satisfaction. Additionally, the use of the specialist retrieval team removes the need to deplete the referring hospital of resources. Targeted population and Stakeholders : Targeted population is adult critially ill patients who require transfers between two hospitals under the supervision of a critical care medical team. Stakeholder engagement was important both nationally and locally. Stakeholders included critical care doctors and nurses as both providers and users of the service. Integration with the ambulance service and clinical engineering was a key enabler. Timeline : There are three hubs identified in the model of care: One hub has an existing 5/7 service, which is funded to expand to 7/7. Two new hubs are funded to provide a 5/7 service. A pilot 3/7 serviceis in operation since Q4 2016 on the second site, and is scaling to 5/7 in Q1 2017. The third hub is scheduled to commence operations in Q2 2017. A scaled approach has allowed the integration of care with existing clinical teams prior to expansion on a larger scale. Highlights : The impact of this is yet to be felt systemically. Hoewever, it is estimated that in the region of 1000 critically ill adult patients are transported between hospitals annually, with approximately 100 moved by specialist teams. The outcome of this integration will be that up to 75% of existing transfers are moved by specialist teams. Those that are time critical and out of hours, will still be moved by local (non specialist) teams. Sustainability : Staffing models using a high specialist to trainee ratio are the desired model in the longer term. A secondment model of employment are felt to be sustainable in the short term in order to allow integration and confidence in the new service to grow. Dedicated resources for this service are ringfenced so that as teams are integrated, the level of service can increase.

Peat moss and perlite have been major components in greenhouse substrates for over 50 years; however, shortages could occur due to restrictions from environmental concerns, fuel cost, and weather conditions. Due to these factors, research continues to seek available materials as alternative substrate components. These studies evaluated processed eastern redcedar (Juniperus virginiana L.) as an alternative substrate in the greenhouse production of four annual species: petunia (Petunia ×hybrida Juss.), annual vinca [Catharantus roseus (L.) G. Don], wax begonia (Begonia semperflorens-cultorum Hort.), and plumed cockscomb (Celosia argentea L.). Three screen sizes of hammer-milled eastern redcedar (ERC) were used including 0.64, 0.95, and 1.27 cm (0.25, 0.38, and 0.5 in). Plants were grown in peat moss amended with either 25 or 50% ERC (combinations of three screen sizes) and compared to a standard 80:20 peat:perlite mix. Plant growth was similar for petunia and vinca in 50% ERC (1.27 cm screen size) compared to those grown in 80:20 peat:perlite. Plants grown in 25% ERC were similar to plants grown in 80:20 peat:perlite mix for all species in all screen sizes. Root growth was similar to or greater for plants in substrates with 25% ERC when compared to the standard peat:perlite treatment. Amending peat with up to 25% eastern redcedar is an acceptable practice for the four annual species used in this study.

Nine species of container-grown plants were treated over-the-top with Roundup Pro® (41% glyshosate) at four rates: 0.28, 0.56, 1.12, and 2.24 kg ai·ha−1 (0.25, 0.5, 1.0 and 2.0 lb ai·A−1) either in June 2007, September 2007, or February 2008. A fourth group was treated on all three dates (June + September + February) (JSF). The experiment was repeated on eight species in 2008–2009. Growth indices (GI) were taken before the spring growth flush in March and after the first growth flush in June. In Exp. 1, dwarf mondo grass (Ophiopogon japonicus ‘Nana’), mondo grass (O. japonicus), liriope (Liriope muscari ‘Cleopatra’), variegated liriope (L. muscari ‘Variegata’), and ‘Blue Pacific’ juniper (Juniperus rigida subsp. conferta ‘Blue Pacific’) were not affected by glyphosate rates up to 1.12 kg ai·ha−1 (1.0 lb ai·A−1) applied singly or JSF, except for temporary injury on ‘Blue Pacific’ from February applications. The remainder of the species had reduced growth as Roundup Pro® rates increased. ‘Blue Rug’ juniper (J. horizontalis ‘Wiltonii’) was tolerant in February but injured at ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in June and September (JS). Asiatic jasmine (Trachelospermum asiaticum) was tolerant of single applications at rates ≤ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in JS, but showed stunting of new foliage from all February applications. Dwarf yaupon (Ilex vomitoria ‘Stoke's Dwarf’) showed injury at 74 days after treatment (DAT) after June applications, no injury at rates ≤ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in September, and stunting and delay of new foliage from all February applications and rates ≥ 0.56 kg ai·ha−1 (0.5 lb ai·A−1) in June. ‘Pink Gumpo’ azalea (Rhododendron eriocarpum ‘Gumpo Pink’) was injured by rates ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) applied in June, February, and JSF, however no injury occurred with any September treatment. In Exp. 2, dwarf mondo and mondo tolerated all single application rates up to 1.12 kg ai·ha−1 (1.0 lb ai·A−1). Asiatic jasmine was injured by all February treatments and growth was reduced and stunted by ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in February and JSF. Dwarf yaupon GI were reduced by rates ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in February, 2.24 kg ai·ha−1 (2.0 lb ai·A−1) in June, and by all treatments in JSF. February treatments ≥ 0.28 kg ai·ha−1 (0.25 lb ai·A−1) delayed shoot growth of dwarf yaupon for at least 6 weeks. ‘Hardy Daisy’ gardenia (Gardenia jasminoides ‘Hardy Daisy’) showed slight injury from February rates ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1), but growth was reduced at 2.24 kg ai·ha−1 (2.0 lb ai·A−1) for June and JSF. Sky pencil holly (Ilex crenata ‘Sky Pencil’) showed stunting from all February applications, but was tolerant up to 2.24 kg ai·ha−1 (2.0 lb ai·A−1) in June and September; GI were similar for all treatments. Purpleleaf wintercreeper euonymus (Euonymus fortunei ‘Coloratus’) was injured by rates ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) applied in June and JS, all February treatments, and stunted by two or three applications of 2.24 kg ai·ha−1 (2.0 lb ai·A−1), but all other treatments had similar GI. Wintergreen boxwood (Buxus sempervirens ‘Wintergreen’) was injured at 2.24 kg ai·ha−1 (2.0 lb ai·A−1) in June, ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in JS, and all February applications. Growth was reduced by rates of 2.24 kg ai·ha−1 (2.0 lb ai·A−1) in February and ≥ 1.12 kg ai·ha−1 (1.0 lb ai·A−1) in JSF.

Peat and perlite have served as industry standards in greenhouse substrates for over 50 years. The continued availability of peat, paralleled with its inert characteristics, as well as its ability to stay generally pathogen-free have all contributed to its success in the horticulture industry. Expanded perlite has long been used as an amendment in container mediums to provide air space to container substrates without adding to bulk density or affecting substrate pH and EC. However, due to increased restrictions on the harvesting of peat, as well as fluctuations in fuel prices necessary for shipping, the future availability of peat is a largely unknown factor in greenhouse production. Additionally, growers consider perlite to be a general nuisance due to the lung and eye irritation problems. Because of these problems, researchers have focused on identifying and evaluating possible alternatives to standard substrates. These studies evaluated three possible substrate alternatives for use in greenhouse production, including fresh sweetgum (SG), hickory (H), and eastern redcedar (RC), in addition to WholeTree (WT) substrate. Three greenhouse annual crops (petunia, impatiens, and vinca) were planted in varying ratios of these species mixed with peat. Plants grown with SG and H as amendments did not perform as well as a traditional peat:perlite mix with respect to flower number, growth indices, and plant dry weight. However, plants grown in RC tended to be equivalent to those grown in a traditional mix. Data showed that greenhouse producers could amend their standard greenhouse substrate with up to 50% eastern redcedar with little to no differences in plant growth.

A limited supply of pine bark (PB) over the past several years has caused concern among many nursery producers. In continuing the search for alternative substrates and working to quantify the extent to which substrates can be amended with high wood content alternatives, this study was developed to evaluate substrate treatments comprised of PB with 25, 50, and 75% clean chip residual (CCR) or WholeTree substrate (WT), as well as 100% substrates of each high wood fiber substrate. By 180 and 365 DAT, pH and electrical conductivity (EC) values for all treatments were similar to those of the 100% PB control. Growth data at 365 days after planting (DAT) showed that with all nursery crops tested, nursery producers could use 75% CCR or 75% WT in their standard PB substrate with limited impact on crop growth. The purpose of this study was to allow nursery producers the opportunity to become comfortable using CCR or WT as amendments before switching completely to 100% alternative substrates.

Introduction: The reorganisation of health services and the delivery of the ‘hub and spoke’ Model of Care for Adult Critical Care (HSE 2014) and Paediatric Model of care (2010) necessitates the requirement to transfer critically ill patients between hospitals to an appropriate location. Transporting critically ill patients is an integral part of the role of doctors and nurses in Intensive care, Anaesthesia, Emergency Medicine and Paediatrics. Trained specialist retrieval teams have lower rates of morbidity, mortality and adverse clinical events (Droogh et al 2015) and is recommended by most Intensive Care Societies (ICSI,AAGBI, ESICM), yet most critically ill patients in Ireland are transferred by non specialist teams. The isolated nature of transporting the critical patient means that supervision and support is difficult. Short Description of Practice Change Implemented: A one day national training programme was developed for medical, nursing and ambulance staff to address deficits in knowledge and skills regarding the transport environment and in the risks of transporting critically ill patients. Aim and Theory of the change: A standardised approach to patient assessment, preparation and packaging is taught. As this is taught nationally, it is hypothesised that, as there is increasing familiarity with the training programme, this will become the norm across disciplines and hospital sites. A reduction in adverse clinical events in transfer and increased staff and patient satisfaction is expected. Targeted Population and stakeholders: The target population include doctors, nurses and ambulance staff involved in the transport of critically ill adults and children. Stakeholders include the above and also the referring and receiving critical care units nationally, who will benefit from an improved standard of patient care. Timeline: A direct and indirect needs analysis and international standards and practice review was undertaken over a 6 month period, highlighting the deficit in training and the lack awareness of the transport environment. Over 14 months 228 number of participants were taught on 11 days of education. Highlights: An education programme was developed by a consensus of experts. The assessment of the programme was evaluated by satisfaction and feedback from registrants on completion. Feedback from participants has been consistently positive. Sustainability: The programme is limited by the small numbers of faculty specialising in transport medicine. Future expansion will require further development of the training programme to build a national faculty, which can continue roll out of the education. Transferability: The programme has demonstrated already, transferability between hospital sites. CPD accreditation has been granted by the College of Anaesthetists. It is anticipated that the programme can be incorporated into existing post graduate education programmes for doctors, nurses and ambulance staff.