Demographic and temporal trends in out of hospital sudden cardiac death in belfast

Objective: To determine the epidemiology of out of hospital sudden cardiac death (OHSCD) in Belfast from 1 August 2003 to 31 July 2004.

Design: Prospective examination of out of hospital cardiac arrests by using the Utstein style and necropsy reports. World Health Organization criteria were applied to determine the number of sudden cardiac deaths.

Results: Of 300 OHSCDs, 197 (66%) in men, mean age (SD) 68 (14) years, 234 (78%) occurred at home. The emergency medical services (EMS) attended 279 (93%). Rhythm on EMS arrival was ventricular fibrillation (VF) in 75 (27%). The call to response interval (CRI) was mean (SD) 8 (3) minutes. Among patients attended by the EMS, 9.7% were resuscitated and 7.2% survived to leave hospital alive. The CRI for survivors was mean (SD) 5 (2) minutes and for non-survivors, 8 (3) minutes (p < 0.001). Ninety one (30%) OHSCDs were witnessed; of these 91 patients 48 (53%) had VF on EMS arrival. The survival rate for witnessed VF arrests was 20 of 48 (41.7%): all 20 survivors had VF as the presenting rhythm and CRI ? 7 minutes. The European age standardised incidence for OHSCD was 122/100 000 (95% confidence interval 111 to 133) for men and 41/100 000 (95% confidence interval 36 to 46) for women.

Conclusion: Despite a 37% reduction in heart attack mortality in Ireland over the past 20 years, the incidence of OHSCD in Belfast has not fallen. In this study, 78% of OHSCDs occurred at home.

Time Out of Time: Derrida, Cixous, Improvisation

This article considers the paradox of improvisation as a gift out of time, which is completely in tune with time, subject to time. It does so through an alignment of Jacques Derrida’s philosophy and the poetic writings of Hélène Cixous. Ever mindful of the possible impossibility of improvisation in Derrida’s work, improvisation here is given over to Cixous, to the side of life, and is theorised as a type of ‘feminine writing’, as an inventive strategy that calls forth the unknown other and dreams of a gift in life that is out of time.

Out of the wilderness? Achieving sustainable development within Scottish national parks

The introduction of national parks to Scotland represents a significant shift in the evolution of protected area management within the UK. Although the National Parks (Scotland) Act 2000 adopts the established national park aims of conservation and recreation, provisions are also made for advancing notions of sustainable development. This paper provides an assessment of the degree to which the Scottish national park model is likely to enable the realisation of multiple national park objectives. Five key areas are considered for analysis. These relate to management aims, institutional arrangements, implementation, democratic accountability and funding. The evaluation reveals that whilst management provisions have been established in accordance with international sustainable development guidelines, a number of concerns relating to operational processes remain.