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Purpose This discussion paper aims to highlight the role of occupational therapy (OT) in understanding stalking and in interventions designed to assist the perpetrator to lead a more fulfilling life through healthier occupations. Design/methodology/approach This study highlights the role of OT in understanding stalking and in designing interventions to assist the perpetrator by extending discussions, drawing on the authors’ practitioner experiences and upon recent study findings on what drives men who stalk. Findings Stalking is a problem behaviour that is often effort-intense, all-consuming, emotionally driven and psychologically damaging for both victims and perpetrators. It consists of a patterned occupation of time which is overarchingly dysfunctional, yet intrinsically purposeful. As humans, our actions and occupations have meaning to us. Stalking can be conceptualised as a meaningful yet self-defeating and harmful pattern of occupations. This paper illustrates how stalking could be addressed through the additional contribution of OT to multi-agency approaches. Research limitations/implications This paper extends the discussion by drawing on the authors’ clinical practitioner experiences and upon recent study findings on what drives men who stalk. Practical implications This paper highlights the role of OT in understanding stalking and in interventions designed to assist the perpetrator to lead a more fulfilling life through healthier occupations. Originality/value This marriage of knowledge from OT and stalking research is set out in support of the application of OT within multi-agency approaches to working with people who stalk.

Infection with the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may cause viral pneumonia and acute respiratory distress syndrome (ARDS). Treatment of ARDS often requires mechanical ventilation and may take weeks for resolution. In areas with a large outbreaks, there may be shortages of ventilators available. While rudimentary methods for ventilator splitting have been described, given the range of independent ventilatory settings required for each patient, this solution is suboptimal. Here, we describe a device that can split a ventilator among up to four patients while allowing for individualized settings. The device has been validated in vitro and in vivo .

Introduction: We designed a novel mitral annuloplasty ring based on healthy human imaging to allow for the mitral valve (MV) annular conformational changes while restricting the anteroposterior (AP) distance. The objectives were to evaluate ex vivo biomechanics of the novel ring and to validate the annular dynamics after ring implantation in vivo. Methods: Cardiac MRI exams were obtained for 3 healthy volunteers. The MV annulus was tracked (Fig. A-C). Based the imaging data, a novel ring was manufactured (Fig. D-F). An ex vivo annular dilation model of mitral regurgitation was used in a left heart simulator (Fig. G, H) to measure hemodynamics and chordal forces at dilated baseline and after repair using the novel, rigid, and flexible rings in 5 porcine MVs. Novel (n = 6) or rigid rings (n = 5) were implanted into male Dorset sheep. Pre- and post-operative cardiac MRI exams were analyzed. Results: Repair using the novel, rigid, and flexible ring reduced regurgitation fraction from 30.0 ± 5.8% at dilated baseline to 4.7 ± 2.7%, 2.4 ± 3.2%, and 17.8 ± 10.0% ( p < .0001, Fig. I-N ). Peak forces on the primary chordae decreased after ring annuloplasty repair ( p < .0001, Fig. O ). The novel ring also showed lower peak forces compared to the rigid ring (p = .03) in secondary chordae ( Fig. P ). MV annular motion was preserved in vivo using the novel ring but restricted to a planar geometry using the rigid ring ( Fig. Q-S ). Annular height to intercommissure ratio at midsystole were similar pre-repair (0.2 ± 0.1) and after novel ring repair (0.2 ± 0.0, p = .89). The variance of AP distance during the cardiac cycle was similar between the novel (0.4 ± 0.3) and rigid ring (0.5 ± 0.1, p = .58). Conclusions: This novel mitral annuloplasty ring demonstrated excellent capability in reducing AP dimension and repairing regurgitation with a superior chordal force profile while facilitating the annular flexible motion. Future studies will focus on evaluating repair durability and effect on left ventricular remodeling.

Respiratory failure complicates most critically ill patients with COVID-19 and is characterized by heterogeneous pulmonary parenchymal involvement, profound hypoxemia and pulmonary vascular injury. The high incidence of COVID-19 related respiratory failure has exposed critical shortages in the supply of mechanical ventilators, and providers with the necessary skills to treat. Traditional mass-produced ventilators rely on an internal compressor and mixer to moderate and control the gas mixture delivered to a patient. However, the current emergency has energized the pursuit of alternative designs, enabling greater flexibility in supply chain, manufacturing, storage, and maintenance considerations. To achieve this, we hypothesized that using the medical gasses and flow interruption strategy would allow for a high performance, low cost, functional ventilator. A low-cost ventilator designed and built-in accordance with the Emergency Use guidance from the US Food and Drug Administration (FDA) is presented wherein pressurized medical grade gases enter the ventilator and time limited flow interruption determines the ventilator rate and tidal volume. This simple strategy obviates the need for many components needed in traditional ventilators, thereby dramatically shortening the time from storage to clinical deployment, increasing reliability, while still providing life-saving ventilatory support. The overall design philosophy and its applicability in this new crisis is described, followed by both bench top and animal testing results used to confirm the precision, safety and reliability of this low cost and novel approach to mechanical ventilation. The ventilator meets and exceeds the critical requirements included in the FDA emergency use guidelines. The ventilator has received emergency use authorization from the FDA.

Influenza ("flu") is a contagious viral infection causing approximately 600 deaths/year in the United Kingdom. Annual vaccination is the most effective prevention strategy with a target of 75% uptake in 'at-risk' patient groups. Before 2012, immunisation was conducted in General Practice (GP), but uptake was below target. NHS Wales therefore introduced a programme allowing community pharmacists to administer the vaccine to certain patient groupsA longitudinal study was undertaken by secondary data analysis on data related to all NHS funded flu vaccinations administered in CP between 2012 and 2018 (n = 103941). Data were analysed using IBM SPSS® and Excel®. Pearson's correlation and independent sample t-test were conducted to compare the number of vaccines administered in CP vs overall numbers and those under 65 years and in the 'at risk' category in CP and GP respectively. Ethical approval was not required.In total, pharmacists administered 103941 vaccinations. Vaccination numbers increased each season from 1568 in 2012/13 to 36238 in 2017/18. The main risk group was those aged 65 and over (59.9% of vaccinations). The proportion of those vaccinated who were aged65 years and in an 'at risk' category was significantly higher in CP than GP (p 0.01). There was a shift in balance between vaccinations administered by GPs and CPs in which CPs increased their share of all vaccinations in the flu programme from 0.3% in 2012-13 to 5.7% in 2017-18. A strong positive correlation was observed between increasing CP vaccinations and total vaccination numbers (R = 0.9316, p 0.01).Community pharmacists are providing increasing numbers of flu vaccinations in Wales, benefitting patients in all at-risk groups and reinforcing the valuable role of pharmacists at the heart of their communities, in terms of public choice and accessibility.

China has operated its exchange rate regime as a de-facto peg to the dollar since the devaluation of August 1994. Given the stunning growth in foreign exchange reserves in 2003, this paper argues that the optimal currency adjustment is a one-time maxi revaluation of roughly 15% versus the U.S. dollar to a new fixed rate but to a modified anchor, that is, a trade-weighted currency basket. Once the currency was repegged and the new reference basket was implemented, any additional moves, such as widening the trading band, could be phased during a transition period of some years, providing a safe and effective path to a more flexible exchange rate regime in the medium to long term.