Piecing It Together

I'm an idealist who believes in Fairy Tales. At times I feel like the Ugly Duckling waiting to become a swan. I identify with the passive Sleeping Beauty waiting for Prince Charming to carry her off into the night. I believe that anything is possible if one works ardently for it, saves long enough and doesn't pass the opportunity by when it's staring one straight in the face or knocking lightly at the back door. I hope I never become so disillusioned or frustrated that I fall off my wall like Humpty Dumpty who couldn't be put back together again.&nbsp; All types of communication are very important to me. I feel that a nonverbal visual expression can be communicated, experienced and be given an emotional response without the superficiality of words being attached. Words are a different type of response.&nbsp; &nbsp;</p

Development of a Habitat Suitability Index Model for the Sage Sparrow on the Hanford Site

Mitigation threshold guidelines for the Hanford Site are based on habitat requirements of the sage sparrow (Amphispiza belli) and only apply to areas with a mature sagebrush (Artemisia tridentata) overstory and a native understory. The sage sparrow habitat requirements are based on literature values and are not specific to the Hanford Site. To refine these guidelines for the Site, a multi-year study was undertaken to quantify habitat characteristics of sage sparrow territories. These characteristics were then used to develop a habitat suitability index (HSI) model which can be used to estimate the habitat value of specific locations on the Site

Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

Background: Serum procalcitonin levels have been used as a biomarker of invasive bacterial infection and recently have been advocated to guide antibiotic therapy in patients with chronic obstructive pulmonary disease (COPD). However, rigorous studies correlating procalcitonin levels with microbiologic data are lacking. Acute exacerbations of COPD (AECOPD) have been linked to viral and bacterial infection as well as noninfectious causes. Therefore, we evaluated procalcitonin as a predictor of viral versus bacterial infection in patients hospitalized with AECOPD with and without evidence of pneumonia. Methods: Adults hospitalized during the winter with symptoms consistent with AECOPD underwent extensive testing for viral, bacterial, and atypical pathogens. Serum procalcitonin levels were measured on day 1 (admission), day 2, and at one month. Clinical and laboratory features of subjects with viral and bacterial diagnoses were compared.Results: In total, 224 subjects with COPD were admitted for 240 respiratory illnesses. Of these, 56 had pneumonia and 184 had AECOPD alone. A microbiologic diagnosis was made in 76 (56%) of 134 illnesses with reliable bacteriology (26 viral infection, 29 bacterial infection, and 21 mixed viral bacterial infection). Mean procalcitonin levels were significantly higher in patients with pneumonia compared with AECOPD. However, discrimination between viral and bacterial infection using a 0.25 ng/mL threshold for bacterial infection in patients with AECOPD was poor. Conclusion: Procalcitonin is useful in COPD patients for alerting clinicians to invasive bacterial infections such as pneumonia but it does not distinguish bacterial from viral and noninfectious causes of AECOPD

Public-Access Defibrillation and Survival After Out-of-Hospital Cardiac Arrest

Background The rate of survival after out-of-hospital cardiac arrest is low. It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of automated external defibrillators (AEDs). Methods We conducted a prospective, community-based, multicenter clinical trial in which we randomly assigned community units (e.g., shopping malls and apartment complexes) to a structured and monitored emergency-response system involving lay volunteers trained in cardiopulmonary resuscitation (CPR) alone or in CPR and the use of AEDs. The primary outcome was survival to hospital discharge. Results More than 19,000 volunteer responders from 993 community units in 24 North American regions participated. The two study groups had similar unit and volunteer characteristics. Patients with treated out-of-hospital cardiac arrest in the two groups were similar in age (mean, 69.8 years), proportion of men (67 percent), rate of cardiac arrest in a public location (70 percent), and rate of witnessed cardiac arrest (72 percent). No inappropriate shocks were delivered. There were more survivors to hospital discharge in the units assigned to have volunteers trained in CPR plus the use of AEDs (30 survivors among 128 arrests) than there were in the units assigned to have volunteers trained only in CPR (15 among 107; P=0.03; relative risk, 2.0; 95 percent confidence interval, 1.07 to 3.77); there were only 2 survivors in residential complexes. Functional status at hospital discharge did not differ between the two groups. Conclusions Training and equipping volunteers to attempt early defibrillation within a structured response system can increase the number of survivors to hospital discharge after out-of-hospital cardiac arrest in public locations. Trained laypersons can use AEDs safely and effectively

Citizen Journalism at the Margins

Amidst burgeoning literature on citizen journalism, we still know relatively little about how and why genuinely marginalised groups seek to use this form of reporting to challenge their exclusion. In this article, we aim to address this gap by analysing two UK citizen journalism initiatives emanating from The Big Issue Foundation, a national homeless organisation, and Access Dorset, a regional charity for disabled and elderly people. These case studies are united by the authors’ involvement in both instances, primarily through designing and delivering bespoke citizen journalism education and mentoring. Based on over 40 hours of interviews with participants of the workshops and 36 hours of participant observation, we analyse the challenges participants faced in their journey to become citizen journalists. This included: low self-esteem, physical health and mental wellbeing, the need for accessible and adaptable technology, and overcoming fear associated with assuming a public voice. We also analyse marginalised groups’ attitudes to professional journalism and education, and its role in shaping journalistic identity and self-empowerment. Whilst demonstrably empowering and esteem building,our participants were acutely aware of societal power relations that were seemingly still beyond their ability to influence. Those who are marginalised are, nevertheless, in the best position to use citizen journalism as a conduit for social change, we argue - though challenges remain even at the grassroots level to foster and sustain participatory practices