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Honeybees [1] and bumblebees [2] perform learning flights on leaving a newly discovered flower. During these flights, bees spend a portion of the time turning back to face the flower when they can memorise views of the flower and its surroundings. In honeybees, learning flights become longer, when the reward offered by a flower is increased [3]. We show here that bumblebees behave in a similar way and we add that bumblebees face an artificial flower more when the concentration of the sucrose solution that the flower provides is higher. The surprising finding is that a bee’s size determines what a bumblebee regards as a 'low' or a 'high' concentration and so affects its learning behaviour. The larger bees in a sample of foragers only enhance their flower facing when the sucrose concentration is in the upper range of the flowers that are naturally available to bees [4]. In contrast, smaller bees invest the same effort in facing flowers, whether the concentration is high or low, but their effort is less than that of larger bees. The way in which different sized bees distribute their effort when learning about flowers parallels the foraging behaviour of a colony. Large bumblebees [5, 6] are able to carry larger loads and explore further from the nest than smaller ones [7]. Small ones with a smaller flight range and carrying capacity cannot afford to be as selective and so accept a wider range of flowers.

Aims & Objectives: To determine whether a low-dose intravenous insulin regimen reduces blood glucose levels at a timely rate and associated side effects among patients with Acute Coronary Syndrome and Left Ventricular Failure. Background: Induced hypoglycaemia and the associated risks have questioned the benefits of intensive insulin therapy in patients presenting with raised blood glucose levels and Acute Coronary Syndromes. Local audit data identified that patients with Acute Coronary Syndrome and Left Ventricular Failure experienced more hypoglycaemic episodes than those with Acute Coronary Syndrome alone. Consequently, a new regimen of low-dose insulin for this group was implemented and audited over 12 months. Design: Audit Methods: 36 consecutive patient notes with a diagnosis of Acute Coronary Syndrome and blood glucose of ≥10 mmol/L treated with a new insulin therapy regimen were analysed. Data were extracted using a standardised form and entered into Excel spreadsheet for analysis. Results: The mean age of the sample was 70 years with 66% of subjects being men and 50% presenting with Acute Coronary Syndrome and Left Ventricular Failure. The low dose regimen was effective in achieving normoglycaemia, (range 4-8mmol/L) for a consecutive six hour period. This was achieved in 72% of patients and within a median time of 13 hours. Conclusion: The audit suggests that a low-dose insulin regimen can effectively stabilise blood glucose in patients presenting with both Acute Coronary Syndrome and Left Ventricular Failure. The importance of regularly monitoring blood sugar levels is vital and highlights the role of nurses in minimising patient risk and promoting safety. Relevance to practice: Nurses are instrumental in the safe implementation of intensive insulin guidelines. Close monitoring of patients is essential, enabling timely adjustments to treatments and ensuring patient safety. Regular audits allow nurses to evaluate care provision and continue to drive practice forward.

This book is part of that effort on the journey to understand homicidal behavior and offenders better in order to prevent similar future crimes. Each chapter is a case study.

Objective To verify or refute the value of hospital episode statistics (HES) in determining 30 day mortality after open congenital cardiac surgery in infants nationally in comparison with central cardiac audit database (CCAD) information. Design External review of paediatric cardiac surgical outcomes in England (HES) and all UK units (CCAD), as derived from each database. Setting Congenital heart surgery centres in the United Kingdom. Data sources HES for congenital heart surgery and corresponding information from CCAD for the period 1 April 2000 to 31 March 2002. HES was restricted to the 11 English centres; CCAD covered all 13 UK centres. Main outcome measure Mortality within 30 days of open heart surgery in infants aged under 12 months. Results In a direct comparison for the years when data from the 11 English centres were available from both databases, HES omitted between 5% and 38% of infants operated on in each centre. A median 40% (range 0-73%) shortfall occurred in identification of deaths by HES. As a result, mean 30 day mortality was underestimated at 4% by HES as compared with 8% for CCAD. In CCAD, between 1% and 23% of outcomes were missing in nine of 11 English centres used in the comparison (predominantly those for overseas patients). Accordingly, CCAD mortality could also be underestimated. Oxford provided the most complete dataset to HES, including all deaths recorded by CCAD. From three years of CCAD, Oxford's infant mortality from open cardiac surgery (10%) was not statistically different from the mean for all 13 UK centres (8%), in marked contrast to the conclusions drawn from HES for two of those years. Conclusions Hospital episode statistics are unsatisfactory for the assessment of activity and outcomes in congenital heart surgery. The central cardiac audit database is more accurate and complete, but further work is needed to achieve fully comprehensive risk stratified mortality data. Given unresolved limitations in data quality, commercial organisations should reconsider placing centre specific or surgeon specific mortality data in the public domain.