Indicators are Relational: Navigating Knowledge and Power in the Development and Implementation of Coastal-Marine Indicators.

In many environment and resource management contexts (e.g., integrated coastal management, ecosystem-based fisheries management), indicator selection and development are perceived as a largely technical, bureaucratic, and scientific challenge. As such, choices about indicators and their application are often treated as external from everyday politics and dynamics of social power. Our aim here is to highlight the value of a relational perspective that weaves power and knowledge together in the context of indicator development and implementation. We highlight four critical dimensions of this relational perspective that may lead to better indicator process outcomes: 1) centering identity and positionality to reflect power differentials; 2) emphasizing the importance of indicator 'fit' and the politics of scale; 3) engaging rather than erasing social-ecological complexity; and 4) reflecting on social norms and relationships to foster adaptation and learning. These four dimensions are rarely considered in most indicator initiatives, including those that are more participatory in design and implementation. The dimensions we outline here emerge from the grounded experience of managers and practitioners, including indicator processes in which we are currently engaged, as well as a scoping review of the literature on indicators for coastal and marine governance and conservation specifically. However, the four dimensions and relational focus are relevant to a wide range of resource and environmental management contexts and provide a pathway to catalyze more effective indicator processes for decision-making and governance more generally.

The role of the London Hospital in the development of the treatment of spinal injury.

While the role of the London Hospital in delineating diseases of the nervous system is widely accepted, its role in developing the speciality of spinal injuries in the United Kingdom has not been acknowledged. The pioneering efforts of Henry Head and George Riddoch provided the foundation for the successful treatment of patients with spinal injuries. Julian Holland-Hibbert, a trustee of the London Hospital and himself a paraplegic, by his magnificent unselfish effort made sure that patients with a spinal injury could live independent, fulfilled lives in society.

Operative efficiency: comparison of methods to optimize the use of chlorhexidine gluconate applicators.

BACKGROUND: With the high costs of operating room time, minimizing potential causes of time waste is financially beneficial to surgeons and hospitals. The time needed to activate a chlorhexidine gluconate surgical solution applicator presents an opportunity for optimization. Many techniques are employed to expedite the process, but there have been no studies comparing these techniques. AIM: To determine the most efficient method for utilizing a chlorhexidine gluconate surgical prep applicator. METHODS: Six techniques were tested to determine which caused the sponge of a Chloraprep™ applicator to become saturated quickest. These were a single squeeze (control), up-and-down shaking, side-to-side shaking, pressing the sponge on a surface (dab), pressing with cotton swabs (poke), and continuously squeezing the lever of the applicator. The time between the internal glass breaking in the applicator to the time of sponge saturation with solution was measured for each technique. Times were then compared to determine which technique best expedited the process. FINDINGS: The side-to-side shake, up-and-down shake, and 'dab' techniques were each significantly faster than the control group. Side-to-side shaking had the fastest time to sponge saturation on average. The average difference in time to saturation between the side-to-side shake technique and the 'poke' technique may be as much as 27.5 s. CONCLUSIONS: Utilization of the side-to-side shake technique, as well as the up-and-down shake and 'dab' techniques, significantly expedite the time it takes to use a chlorhexidine gluconate applicator. The time savings from employing these techniques could result in significant financial benefits.

Urtication (flogging with stinging nettles) and flagellation (beating with rods) in the treatment of paralysis.

Urtication and flagellation were used as a last resort in the treatment of paralysis when all other means were exhausted, and very few cases are reported in the literature. Two cases were identified and reviewed, one of urtication (flogging with nettles) and one of flagellation (beating with rods). In both cases the symptoms were alleviated, but there was insufficient detail to evaluate the therapeutic value of each treatment.

George Riddoch (1888-1947): the driving force behind the treatment of spinal injuries in the UK during the Second World War.

The development of the successful treatment of spinal injuries has been inextricably linked to Sir Ludwig Guttmann and Stoke Mandeville Hospital. The role of George Riddoch has largely been ignored or mentioned merely in relation to Ludwig Guttmann and his appointment as the first Resident Medical Officer at Stoke Mandeville Hospital. Riddoch's contribution was far more significant. New material, comprising Riddoch's letters and memoranda written between 1939 and 1944, reveals his paramount involvement in the setting up of spinal injury units across the UK between 1941 and 1944, and his skill as an administrator and a clinician. Riddoch must be given credit for finding and appointing Ludwig Guttmann.

Ultrathin Y2O3:Eu3+nanodiscs: spectroscopic investigations and evidence for reduced concentration quenching.

Here, we report the synthesis and spectral properties of ultrathin nanodiscs (NDs) of Y2O3:Eu3+. It was found that the NDs of Y2O3:Eu3+ with a thickness of about 1 nm can be fabricated in a reproducible, facile and self-assembling process, which does not depend on the Eu3+ concentration. The thickness and morphology of these NDs were determined with small angle x-ray scattering and transmission electron microscopy. We found that the crystal field in these nanoparticles deviates from both the cubic and monoclinic characteristics, albeit the shape of the 5D0 â†’ 7F J (J = 0, 1, 2) transitions shows some similarity with the transitions in the monoclinic material. The Raman spectra of the non-annealed NDs manifest various vibration modes of the oleic acid molecules, which are used to stabilise the NDs. The annealed NDs show two very weak Raman lines, which may be assigned to vibrational modes of Y2O3 NDs. The concentration quenching of the Eu3+ luminescence of the NDs before annealing is largely suppressed and might be explained in terms of a reduction of the phonon density of states.

The origins of sport for disabled people.

The disabled sports movement is considered to have started in 1948 when, under the aegis of Ludwig Guttmann, England hosted the first wheelchair games at Stoke Mandeville Hospital. In this review, we challenge the assumption that sport for disabled people started after the Second World War and contend that it was already practised in an organised fashion in France, Germany and the UK before and after the First World War.

Transvenous pacemaker placement: left lateral decubitus position and wireless digital radiography.

A patient presented with symptomatic third degree atrioventricular block requiring emergency transvenous pacemaker placement. During the procedure, wireless digital radiographs tracked the position of the pacemaker electrode, which repeatedly missed the target right ventricle. The patient was then rolled to left lateral decubitus position and the electrode was advanced into the right ventricle, achieving electrical capture, hemodynamic stability, and symptom resolution. We review the published literature on transvenous pacemaker placement and identify two innovations: left lateral decubitus position to facilitate catheter placement and wireless digital radiography for procedure guidance.

St Hugh's Military Hospital (Head Injuries), Oxford 1940-1945.

Despite being open for only five years, St Hugh's Military Hospital (Head Injuries) has a seminal place in the history of neurology, neurosurgery and rehabilitation medicine. At its peak, during the Normandy campaign of 1944, it provided 430 beds for the treatment of service personnel. Between 1940 and 1945, 13,000 patients were referred to St Hugh's providing a unique opportunity for ground-breaking research into the management of head injuries. The doctors at St Hugh's collaborated with research scientists at Oxford University in many areas of fundamental research including the treatment of infection, the mechanics of brain injury, brain surgery, neuropsychiatry and rehabilitation, and the use of electroencephalograms. This paper documents these scientific advances and considers their influence on the practice of neurology and neurosurgery in the UK.

Mary Riddoch (1901-1966), an extraordinary tale of survival.

In 1934 Mary Riddoch sustained a traumatic spinal injury as a result of a road traffic accident. Although a few surviving servicemen from the First World War have been recorded, this is the first account of a female paraplegic patient surviving a traumatic spinal injury. Her personal circumstances greatly contributed to her long survival: she was a qualified doctor, she was the sister of George Riddoch the neurologist who treated soldiers who had sustained spinal cord injuries during the First World War, and she was fortunate to have benefited from the dedicated care of nurse Dorothy Fiddes. Her great-nephew, Graeme Riddoch, is one of the authors of this paper and his recollections provide a unique perspective to this case report.

The place of James Arnott (1797-1883) in the development of local anaesthesia in dentistry.

Dental disease in the form of caries and abscesses has been known since antiquity. Before the advent of anaesthesia, operations upon the mouth were painful. The introduction of general anaesthesia in the form of ether and chloroform seemed to provide a solution, but there was an unacceptable level of mortality. James Arnott introduced local anaesthesia by means of freezing with ice, which he considered safer. He waged a long campaign and his method received recognition and was used in France and the USA. His method stimulated the development of pharmacological anaesthesia.

Targeting protein tyrosine phosphatase σ after myocardial infarction restores cardiac sympathetic innervation and prevents arrhythmias.

Millions of people suffer a myocardial infarction (MI) every year, and those who survive have increased risk of arrhythmias and sudden cardiac death. Recent clinical studies have identified sympathetic denervation as a predictor of increased arrhythmia susceptibility. Chondroitin sulfate proteoglycans present in the cardiac scar after MI prevent sympathetic reinnervation by binding the neuronal protein tyrosine phosphatase receptor σ (PTPσ). Here we show that the absence of PTPσ, or pharmacologic modulation of PTPσ by the novel intracellular sigma peptide (ISP) beginning 3 days after injury, restores sympathetic innervation to the scar and markedly reduces arrhythmia susceptibility. Using optical mapping we observe increased dispersion of action potential duration, supersensitivity to ß-adrenergic receptor stimulation and Ca(2+) mishandling following MI. Sympathetic reinnervation prevents these changes and renders hearts remarkably resistant to induced arrhythmias.

Comparison of clinical and cone beam computed tomography measurements to diagnose furcation involvement.

AIM: This study aimed to determine the degree of discrepancy between clinical measurement of furcation involvement (FI) and cone beam computed tomography image analysis of multirooted teeth. METHODS: FI measurements obtained from clinical records were compared to CBCT images of the same teeth to determine the degree of discrepancy between CBCT FI grading and clinical FI grading. RESULTS: Of the hundred and fifty-four sites analysed, 22% of FI measurements from probing and CBCT were in agreement. Fifty-eight percent of clinical FI recordings were overestimated, and 20% were underestimated when compared to CBCT analysis. CONCLUSION: Clinical recording of FI is both over and underestimated compared to CBCT analysis. This was highest for probing recording grade I furcation involvement where it was highly overestimated. The occurrence of over and under estimation of FI will affect the assignment of prognosis to multirooted teeth, which can influence treatment planning for periodontal therapy and may result in inappropriate treatment.