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Background: No study has examined the performance of emergency department (ED) nurses in establishing intraosseous access (IO) access. This study aimed to evaluate ED nurses' success rate in establishing pediatric IO access using semiautomatic devices., Methods: A randomized crossover simulation study was conducted. The success rates of ED nurses were compared with those of paramedics with similar years of experience. The study instruments were the new spring-loaded injector (NIO) and the battery power drill (EZ-IO). Uncooked piglets' bones were used as the study model. All attempts were filmed by a video camera. Successful placement was defined as the visualization of flow from the marrow cavity. Participants recorded their ranking of the "ease of use" of each device., Results: No differences in 1-attempt success rate was found between nurses and paramedics (27/34 [79.4%] vs 25/30 [83.3%], P = 0.68). Nurses and paramedics had similar success rates with the 2 semiautomatic IO devices (12/17 vs 12/15 with the spring-loaded injector, P = 0.69, and 15/17 vs 13/15 with the battery power drill, P = 0.9). The number of failed attempts and the causes for failure were equally distributed between nurses and paramedics. Median ease-of-use Likert-scale scores of the spring-loaded injector and the battery power drill were 4 (interquartile range [IQR] = 3-4) and 5 (IQR = 5-5) (P < 0.04) for the nurses and 5 (IQR = 4-5) and 5 (IQR = 4-5) (P = 0.44) for the paramedics, respectively., Conclusions: Emergency department nurses and paramedics had a similarly high insertion success rates on a pediatric bone model. This pilot study suggests that ED nurses can successfully perform this procedure., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.)

Our study describes how brown-necked ravens (Corvus ruficollis) are able to take advantage of an ordinarily inaccessible, high-quality food source by relying upon their innovative and manipulative thinking capabilities to exploit methods used by Egyptian vulture (Neophron percnopterus) to overcome the problem. In five observed interactions, the ravens were first seen in the vicinity of an abandoned clutch of ostrich eggs (Struthio camelus). The area was frequented by a pair of Egyptian vultures that bred on the cliffs across the road from the nature reserve. The Egyptian vulture exhibits tool use in birds, and is able to crack the hard shells of ostrich eggs by lifting a rock in the beak and pounding at the egg till it breaks open or cracks. If the egg is only cracked, the vulture inserts its narrow bill into the fissure and widens it by opening the mandibles. Pieces of eggshell are removed from around the crack in order to further open the egg. This is the point at which the pair of ravens attacked the vulture and harassed it till it abandoned the egg and left the area. The ravens then jointly enjoyed the contents of the egg which was otherwise inaccessible to them because of the strong egg shell.