Search

Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents’ mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents’ mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health; school work; and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

Monitoring vegetation restoration is challenging because monitoring is costly, requires long-term funding, and involves monitoring multiple vegetation variables that are often not linked back to learning about progress toward objectives. There is a clear need for the development of targeted monitoring programs that focus on a reduced set of variables that are tied to specific restoration objectives. In this paper, we present a method to progress the development of a targeted monitoring program, using a pre-existing state-and-transition model. We (1) use field data to validate an expert-derived classification of woodland vegetation states; (2) use these data to identify which variable(s) help differentiate woodland states; and (3) identify the target threshold (for the variable) that signifies if the desired transition has been achieved. The measured vegetation variables from each site in this study were good predictors of the different states. We show that by measuring only a few of these variables, it is possible to assign the vegetation state for a collection of sites, and monitor if and when a transition to another state has occurred. For this ecosystem and state-and-transition models, out of nine vegetation variables considered, the density of immature trees and percentage of exotic understory vegetation cover were the variables most frequently specified as effective to define a threshold or transition. We synthesize findings by presenting a decision tree that provides practical guidance for the development of targeted monitoring strategies for woodland vegetation.

Functional movement disorders (FMD) are complex neurobehavioral disorders that can be a significant source of disability for both children and their caregivers. While FMD in the adult population is better characterized, the aim of this paper is to review the pertinent clinical and historical features, diagnostic criteria, and multi-disciplinary management of FMD in the pediatric population. We highlight recent trends in pediatric FMD, including the increase in functional tic-like behaviors that has been observed during the COVID-19 pandemic.

The UK Supreme Court has granted the appeal of supermarket chain WW Morrison Supermarkets plc (Morrisons), finding that the Court of Appeal had misunderstood a number of the governing principles of vicarious liability. Considering Morrisons’ liability afresh, the Supreme Court clarified that the motive and authorized acts of the wrongdoing employee are highly material to a finding of vicarious liability, whilst a causal chain of events is not. Whilst Morrisons’ victory is a welcome clarification on the law of vicarious liability, data controllers should take note: had Morrisons not been a sophisticated data controller paying particular attention to its obligations under data protection legislation, the outcome would likely have been more of a cautionary tale.

Importance Data on the efficacy of hydroxychloroquine for the treatment of coronavirus disease 2019 (COVID-19) are needed. Objective To determine whether hydroxychloroquine is an efficacious treatment for adults hospitalized with COVID-19. Design, Setting, and Participants This was a multicenter, blinded, placebo-controlled randomized trial conducted at 34 hospitals in the US. Adults hospitalized with respiratory symptoms from severe acute respiratory syndrome coronavirus 2 infection were enrolled between April 2 and June 19, 2020, with the last outcome assessment on July 17, 2020. The planned sample size was 510 patients, with interim analyses planned after every 102 patients were enrolled. The trial was stopped at the fourth interim analysis for futility with a sample size of 479 patients. Interventions Patients were randomly assigned to hydroxychloroquine (400 mg twice daily for 2 doses, then 200 mg twice daily for 8 doses) (n = 242) or placebo (n = 237). Main Outcomes and Measures The primary outcome was clinical status 14 days after randomization as assessed with a 7-category ordinal scale ranging from 1 (death) to 7 (discharged from the hospital and able to perform normal activities). The primary outcome was analyzed with a multivariable proportional odds model, with an adjusted odds ratio (aOR) greater than 1.0 indicating more favorable outcomes with hydroxychloroquine than placebo. The trial included 12 secondary outcomes, including 28-day mortality. Results Among 479 patients who were randomized (median age, 57 years; 44.3% female; 37.2% Hispanic/Latinx; 23.4% Black; 20.1% in the intensive care unit; 46.8% receiving supplemental oxygen without positive pressure; 11.5% receiving noninvasive ventilation or nasal high-flow oxygen; and 6.7% receiving invasive mechanical ventilation or extracorporeal membrane oxygenation), 433 (90.4%) completed the primary outcome assessment at 14 days and the remainder had clinical status imputed. The median duration of symptoms prior to randomization was 5 days (interquartile range [IQR], 3 to 7 days). Clinical status on the ordinal outcome scale at 14 days did not significantly differ between the hydroxychloroquine and placebo groups (median [IQR] score, 6 [4-7] vs 6 [4-7]; aOR, 1.02 [95% CI, 0.73 to 1.42]). None of the 12 secondary outcomes were significantly different between groups. At 28 days after randomization, 25 of 241 patients (10.4%) in the hydroxychloroquine group and 25 of 236 (10.6%) in the placebo group had died (absolute difference, −0.2% [95% CI, −5.7% to 5.3%]; aOR, 1.07 [95% CI, 0.54 to 2.09]). Conclusions and Relevance Among adults hospitalized with respiratory illness from COVID-19, treatment with hydroxychloroquine, compared with placebo, did not significantly improve clinical status at day 14. These findings do not support the use of hydroxychloroquine for treatment of COVID-19 among hospitalized adults. Trial Registration ClinicalTrials.gov:NCT04332991

Rocky Mountain elk (Cervus canadensis) is a major reservoir for Brucella abortus in the Greater Yellowstone area, which has significant economic implications to the cattle industry. Vaccination attempts against intracellular bacterial diseases in elk populations have not been successful due to a negligible adaptive cellular immune response. A lack of genomic resources has impeded attempts to better understand why vaccination does not induce protective immunity. To overcome this limitation, PacBio, Illumina, and HiC sequencing with a total of 686-fold coverage was used to assemble the elk genome into 35 pseudomolecules. A robust gene annotation was generated resulting in 18,013 gene models and 33,422 mRNAs. The accuracy of the assembly was assessed using synteny to the red deer and cattle genomes identifying several chromosomal rearrangements, fusions and fissions. Because this genome assembly and annotation provide a foundation for genome-enabled exploration of Cervus species, we demonstrate its utility by exploring the conservation of immune system-related genes. We conclude by comparing cattle immune system-related genes to the elk genome, revealing nine putative gene losses in elk.Author SummaryBrucellosis, also known as contagious abortion, is a bacterial disease that commonly affects livestock and remains prevalent in Rocky Mountain elk (Cervus canadensis). Since the 1920’s the USDA has led a program to eradicate Brucellosis from cattle, yet wild Rocky Mountain elk continue to be a source of transmission. Attempts to vaccinate wild elk herds have been unsuccessful, due to a poor and short-lived immune response. To investigate the genetic basis for this inherent difference, we created the first genome and annotation for the Rocky Mountain elk. This genome assembly is of the highest quality and contains single linear sequences for all 35 chromosomes. In order to generate gene models, an array of RNA-Seq data and proteins from many different organ tissues and cells were used in gene prediction software. Specifically, we compare cattle immune system genes with the Rocky Mountain elk, revealing the putative loss of nine immune-system related genes in elk.

Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy.Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627.Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95% CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05).Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision.Funding: British Heart Foundation.

Artistic researchers within the Australian public university system offer an opportunity to see national and institutional research management systems and their impact upon academic staff from a particular viewpoint. Australia’s higher education system, with its unionised workforce and strong reliance upon government research funding, presents a specific case that may differ from other international settings; however, the examples revealed may provide useful considerations for other higher education systems. Australia has been highly active in discussions about the position of creative arts within the university sector, including producing one of the few comprehensive studies into research in creative arts. This book, and the study behind it, continues this tradition through a detailed consideration of the experiences artistic researchers practicing within the university sector today and impact of the government and institutional frameworks which manage research.

As creative arts disciplines settled into the university sector, the numbers of staff and students engaged in research increased dramatically. The tertiary creative arts sector today displays diversity in both its creative genres and in the structures through which it is organised and managed. Creative disciplines are included in arts-only schools, faculties and departments as well in combination with a variety of other multi-disciplinary groupings, and the extent to which research or practice forms part of their workload varies from institution to institution. The university has provided, for many, a satisfactory home for their practice creating communities of practice, financial stability for arts employees, infrastructure to continue artistic practice and a supportive attitude towards new and experimental work. Yet locating artistic practice within the research agenda has introduced a framework which can challenge how artists approach and produce their work.

The creation of a Unified National System in the 1980s gave the university sector custody of practice-based creative arts previously conducted in independent art and music schools, and in colleges of advanced education. The relocation created upheaval for many disciplines as these new staff and their universities adjusted to organisational restructure, multi-campus sites and new cultural traditions. For those in creative arts disciplines, whose practice had previously been considered outside their tertiary employment as teachers, the move brought practice into their research obligations as university employees. Despite taking place over twenty years ago, the changes catalysed by this reform continue to resonate in art and music schools and influence the relationship between artistic researchers and their host universities, although as exploration of a recent breakdown in relationship between one university and its art school indicates, subsequent developments play an important role.

This book set out to explore not only where and how artistic research has been positioned within the Australian university sector but also the reasons why it may be so positioned. It actively looked for factors that may have influenced the relationship between artistic researchers and their universities: the historical underpinnings of the relationship and its continuing influence and the drivers that shape the perceptions of university staff and leadership as they devise and implement the management systems, which inform artistic researchers’ responses to the university model. It captures how different personal viewpoints of the relationship between art and research can unconsciously affect how systems operate and how individual institutional responses shape this relationship. The findings show that artistic researchers experience their research as poorly positioned within many aspects of the university research management framework, an observation that is given at least prima facie credence by independent data. The examples presented suggest strategies and actions that are needed if artistic research is to avoid negative outcomes. This chapter summarises the current climate for artistic research in Australia and considers ways that it may be better positioned within the higher education sector to deliver advantages for researchers, institutions and government.

The national reforms that brought creative arts into the university sector also brought greater government involvement in university research. Focus and direction has become increasingly driven by national government policy through direct funding, governance regulation and influence over non-government research funders. Successive reforms have prioritised disciplinary research which the government perceives as able to contribute more to the national economy. In return for access to government funding, universities have introduced conditions that reflect the regulation and advancement of such disciplines within the policies and procedures that they apply across their academic communities. Tracing government research direction since 1988 reveals how, despite frequent and high-profile reviews of the system, artistic research has been largely ignored and excluded from participating equitably in national research and innovation endeavour. This in turn continues to influence its standing, importance and value within the university research management system.

Artists working in higher education suggest that while academia provides much that is conducive to creativity and a satisfactory environment for practice, the research agenda creates disruptions to artistic attitude, direction and outputs. As custodians and mentors of current and future artists, the structure and processes that universities apply to guide or regulate artistic practice represent more than just an issue of employee equity; they influence the future direction of our national artistic heritage. Artistic researchers, longstanding observers of research in creative disciplines and university research managers suggest ways in which the university sector and the arts community can enhance the research management system.

By directing and managing the research which takes place within their walls, universities represent the intermediary through which governments achieve their research policy objectives. Governments use a range of strategies to steer universities towards national objectives and universities, in turn, apply similar approaches to shape the direction of their academic research endeavour. With a multidisciplinary community whose research interests may not always intersect with the government’s ambitions, the way that universities pursue their role as intermediary can magnify or ameliorate the impact of national policy objectives upon academic disciplines. Common research management practices adopted by the Australian university sector can retard the development of artistic research and researchers.

Underlying personal beliefs about the relationship between artistic practice and research can influence how research management systems are designed, how individuals approach the task of evaluating artistic research and for artistic researchers themselves, the degree to which they engage with the university research agenda. This chapter explores three broad stances in relation to this relationship: that artistic practice fundamentally different from research, that artistic practice meets the criteria defining research and that artistic practice is a form of legitimate research that differs in process and output. It explores how artistic researchers themselves understand and recognise when artistic work constitutes research and the challenges that artistic research brings to traditional university expectations and practices in research management.

Although a common template may be apparent across university research management systems, there are differences in the way in which institutions apply, interpret and implement their policy intentions. The way that an individual university’s processes, plans and people implement their research agenda affect the attitudes and morale of artistic researchers and the nature of artistic research. For most artistic researchers, their personal institutional experience tells them how artistic research fits within the higher education system as they presume that all institutions operate in the same way. The examples presented in this chapter show that this is not the case. While many challenges are shared, individual institutional responses can create different perspectives of how artistic research fits within Australian higher education and offer examples for better inclusion.

Problem statement: Cyclodextrin complexation has previously been shown to improve the solubility and dissolution properties of trimethopr im; however, no report provides an account of the e ffect cyclodextrin complexation has on the antibacterial activity of this agent. Approach: β-cyclodextrin and 2- hydroxypropyl β-cyclodextrin inclusion complexes of trimethoprim were prepared and confirmed by differential scanning calorimetry and proton nuclea r magnetic resonance. The in-vitro antibacterial activity, in terms of minimum inhibitory concentrations, of c yclodextrin-drug complexes were compared to uncomplexed free trimethoprim by a broth-microdilution method against several sensitive and resistant Gram-positive and Gram-negative bacteria. The effect of complexation on the apparent permeability coefficients was also determined using a Caco-2 per meability assay to account for potential alteration s in bioavailability that could influence in-vivo antibacterial activity. Results: Inclusion complexation of trimethoprim with both unsubstituted and hydroxylat ed versions of β-cyclodextrin produced a reduction in the MIC 80 required to inhibit the growth of S. aureus ATCC 29213, S. pneumoniae ATCC 4961, S. epidermidis ATCC 14990 and E. coli ATCC 25922 (p>0.05). The effect was limited to bacteria normally susceptible to trimethoprim. Neither complex negati vely affected the antibacterial activity of trimeth oprim. Hydroxypropyl-β-cyclodextrin and β-cyclodextrin inclusion complexes significantly (p< 0.01) increased the apparent intestinal permeability of trimethoprim by 39.8 and 56.1%, respectively. Considering the effe ct cyclodextrin inclusion complexation has on the anti bacterial activity of trimethoprim, the improved intestinal permeability of these complexes has the potential to improve the in-vivo antibacterial activity of the agent by enhancing the steady-state concentrati on of the drug when dosed orally. Conclusion: These results would suggest that physical complexation wi th either of these cyclodextrins would provide a feasible strategy to improve the pharmaceutical and pharmacokinetic properties of trimethoprim.

Eye problems are common and account for 1.5% of general practice consultations in the UK. True ophthalmic emergencies are rare; however, it is vital that they are recognized and treated early in order to prevent visual loss and resulting disability. This article aims to provide an overview of diagnosis and management of eye emergencies in the primary care setting and will focus on sight threatening conditions not to be missed.

PURPOSE The purpose of this study was to determine parent and therapist perceptions regarding the effect of an intense model of physical therapy for children with cerebral palsy. METHODS Informants included 5 parents, 5 therapists, and 5 children with cerebral palsy who previously participated in an intense program (ie, strengthening and functional activities 4 hours/day, 5 days/week for 3 weeks). Parents and therapists were interviewed, and children were observed. Data were collected and analyzed using qualitative methodology. RESULTS Five common themes emerged, based on perceptions: (1) improvement in motor function, (2) improvement in confidence and independence, (3) stress during the program but a time of no therapy between sessions, (4) increased participation in the community, and (5) fatigue during the program but perceived rapid attainment of goals. CONCLUSIONS The constructs identified should be considered by clinicians in program development and by researchers for further study.

Nuclear magnetic resonance (NMR) spectroscopy was used to investigate the transfer of sialic acid from a range of sialic acid donor compounds to acceptor molecules, catalyzed by Trypanosoma cruzi trans-sialidase (TcTS). We demonstrate here that NMR spectroscopy is a powerful tool to monitor the trans-sialidase enzyme reaction for a variety of donor and acceptor molecules. The hydrolysis or transfer reactions that are catalyzed by TcTS were also investigated using a range of N-acetylneuraminosyl-based donor substrates and asialo acceptor molecules. These studies showed that the synthetic N-acetylneuraminosyl donor 4-methylumbelliferyl alpha-d-N-acetylneuraminide (MUN) is hydrolyzed by the enzyme approximately 3-5 times faster than either the disaccharide Neu5Acalpha(2,3)Galbeta1Me or the trisaccharide Neu5Acalpha(2,3)Lacbeta1Me. In the transfer reaction, we show that Neu5Acalpha(2,3)Lacbeta1Me is the most favorable substrate for TcTS and is a better substrate than the naturally-occurring N-acetylneuraminosyl donor alpha1-acid glycoprotein. In the case of MUN as the donor molecule, the transfer of Neu5Ac to different acceptors is significantly slower than when other N-acetylneuraminosyl donors are used. We hypothesize that when MUN is bound by the enzyme, the orientation and steric bulk of the umbelliferyl aglycon moiety may restrict the access for the correct positioning of an acceptor molecule. AutoDock studies support our hypothesis and show that the umbelliferyl aglycon moiety undergoes a strong pi-stacking interaction with Trp-312. The binding properties of TcTS towards acceptor (lactose) and donor substrate (Neu5Ac) molecules have also been investigated using saturation transfer difference (STD) NMR experiments. These experiments, taken together with other published data, have clearly demonstrated that lactose in the absence of other coligands does not bind to the TcTS active site or other binding domains. However, in the presence of the sialic acid donor, lactose (an asialo acceptor) was observed by NMR spectroscopy to interact with the enzyme's active site. The association of the asialo acceptor with the active site is an absolute requirement for the transfer reaction to proceed.

Saturation transfer difference (STD) (1)H NMR experiments were used to probe the epitope binding characteristics of the sialidase [EC 3.2.1.18] from the bacterium Vibrio cholerae, the causative agent of cholera. Binding preferences were investigated for N-acetylneuraminic acid (Neu5Ac, 1), the product of the sialidase catalytic reaction, for the known sialidase inhibitor 5-acetamido-2,6-anhydro-3,5-dideoxy-D-glycero-D-galacto-non-2-enoic acid (Neu5Ac2en, 2), and for the uronic acid-based Neu5Ac2en mimetic iso-propyl 2-acetamido-2,4-dideoxy-alpha-L-threo-hex-4-enopyranosiduronic acid (3), in which the native glycerol side-chain of Neu5Ac2en is replaced with an O-iso-propyl ether. The STD experiments provided evidence, supporting previous studies, that Neu5Ac (1) binds to the sialidase as the alpha-anomer. Docking experiments using DOCK (version 4.0.1) revealed further information regarding the binding characteristics of the enzyme active site in complex with Neu5Ac2en (2) and the Neu5Ac2en mimetic (3), indicating an expected dominant interaction of the acetamide moiety with the protein.

Commercial laying hens were infected with Salmonella typhimurium DT104 strain 16 alternatively via the crop (10(7) cfu per bird) or by an aerosol delivered directly to the beaks using a Collison nebuliser and Henderson apparatus (2 x 10(2) or 2 x 10(4) cfu per bird). Infection by both routes caused systemic infection and prolonged contamination of faeces. Contamination rates of eggs and muscle were much higher following the aerosol challenges despite the much lower doses given by this route. The frequency of Salmonella isolation from eggs rose from 1.7% following oral challenge to 14% and 25%, for each of the aerosol challenges respectively, and the frequency of isolation from muscle rose from 0% following the oral challenge to 27% following each of the aerosol challenges.

A three-dimensional proton treatment planning system called PROXELPLAN has been used at the National Accelerator Centre (NAC) since October 1994. This system is entirely based on the VOXELPLAN planning system, developed at the Deutches Krebsforschungszentrum (DKFZ), Heidelberg, Germany. The VOXELPLAN system provides the treatment planning infrastructure while the proton dose distributions are calculated using a software module that was initially developed at the Royal Marsden Hospital, UK. The proton module has been extensively modified and refined. It uses a rayline-tracing algorithm which is suitable for planning current treatments but is not sufficiently dynamic to accommodate the use of compensators. A sophisticated pencil beam algorithm is currently under development.

Aberrant host immune responses to bacterial components of the resident microflora may initiate and perpetuate gastrointestinal inflammation. To investigate how microbial perturbation promotes host immunological responsiveness to commensal bacteria and contributes to the development of typhlocolitis, we selectively colonized defined (altered Schaedler) flora C3H mice with either Helicobacter bilis or Brachyspira hyodysenteriae. Following selective colonization, tissues were analyzed for gross/histopathologic lesions and bacterial antigen-specific B- and T-cell responses. Gnotobiotic mice colonized with H. bilis or B. hyodysenteriae developed typhlocolitis of varying severity, with the most severe gross and histopathogical lesions observed in B. hyodysenteriae-colonized mice. Antigen-specific IgG1 and IgG2a responses to the resident microflora were increased in both H. bilis-and B. hyodysenteriae-colonized mice. The greater antibody responses were associated with less severe cecal inflammation in H. bilis-colonized mice. Altered Schaedler flora (ASF)-stimulated mesenteric lymphocytes from B. hyodysenteriae-colonized mice produced higher levels of interferon-gamma and interleukin (IL)-4 than did lymphocytes from H. bilis-colonized mice. However, ASF-stimulated mesenteric and splenic lymphocytes from both H. bilis and B. hyodysenteriae-colonized mice secreted higher amounts of IL-10 compared to similarly stimulated lymphocytes recovered from control mice. These results indicate that microbial perturbation may induce differential immune responses to nonpathogenic resident bacteria that can lead to intestinal inflammation.

Prompt and effective cardiopulmonary resuscitation (CPR) is the first link in the chain of survival following cardiac arrest. We assessed a new device, the CPR-Ezy (Medteq Innovations Pty Ltd., Brisbane, Australia), to aid timing and effectiveness of external cardiac compressions (ECC), by 32 subjects who had prior community-based training in CPR. ECC was performed on a manikin for 4 min by all subjects without and with the device. There was a statistically significant improvement in timing of ECC. Effectiveness of compressions was also improved over the whole time period, especially so in the last minute. We conclude that the CPR-Ezy can improve timing and effectiveness of ECC, and reduce the effects of resuscitator fatigue, in community-trained subjects.

The Centers for Disease Control and Prevention is partnering with the National Association of Chronic Disease Directors and the North Carolina Office of EMS to design, develop, and implement an emergency medical services (EMS) performance improvement toolkit to evaluate opportunities to improve the emergency identification and treatment of acute stroke. The EMS Acute Stroke Care Toolkit is being developed, tested, and implemented in all 100 counties in the state by the EMS Performance Improvement Center, the agency that provides technical assistance for EMS in North Carolina. The toolkit helps each EMS system in defining, measuring, and analyzing their system of care and promotes collaboration through public education, regional stroke planning with hospitals, EMS service configuration, EMS staffing patterns, EMS education, and timely care delivery. We outline the issues surrounding acute stroke care, the role of emergency medical systems in stroke care, and the components of the EMS Acute Stroke Care Toolkit designed to improve EMS systems and outcomes for stroke patients.

This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

Previous studies have shown that PNS by emergency medical services (EMS) reduces time to reperfusion. PNS was introduced into all PCI capable public and one private hospital in the state of Victoria, Australia in early 2010. We report on the outcomes. STEMI patients were taken to the nearest PCI