Paramedic identification of stroke : community validation of the Melbourne ambulance stroke screen

Background: Paramedics require an effective prehospital tool to eliminate stroke mimics and to assist in the identification of suitable candidates for thrombolytic therapy. The Faster Access to Stroke Therapies study combined two validated stroke assessment tools (the Los Angeles Prehospital Stroke Screen, LAPSS, and the Cincinnati Prehospital Stroke Scale, CPSS) to form the Melbourne Ambulance Stroke Screen (MASS), and performed an in-field validation by Australian paramedics.

Methods: Over a 12-month period, 18 paramedics participated in the Faster Access to Stroke Therapies study and prospectively collected data contained in the MASS on all stroke dispatches, and for other patients with a focal neurological deficit. Sensitivity and specificity analysis of the LAPSS, CPSS and MASS was calculated and equivalence analysis performed.

Results: Paramedics completed 100 MASS assessments for 73 (73%) stroke/transient ischemic attack patients and 27 (27%) stroke mimics. The sensitivity of the MASS (90%, 95% CI: 81-96%) showed statistical equivalence to the sensitivity of the CPSS (95%, p = 0.45) and superiority to the LAPSS (78%, p = 0.008). The specificity of the MASS (74%, 95% CI: 53-88%) was equivalent to that of the LAPSS (85%, p = 0.25) and superior to the CPSS (54%, p = 0.007). All patients misidentified by the MASS (7 strokes, 7 mimics) were ineligible for thrombolytic therapy.

Conclusion: The MASS is simple to use, with accurate prehospital identification of stroke. It distinguishes stroke mimics, with good recognition of suitable patients for thrombolytic therapy.

Unfree associations : inside psychoanalytic institutes

In an age of managed care and new biological therapies for mental illness, psychoanalysis is generally seen as a 'profession on the ropes' whose hour is up. What went wrong? While external factors have played their part in the fall of psychoanalysis, psychoanalysts have generally disregarded their own crucial role in creating this decline. This thesis examines this role as played out through their own institutions, the freestanding psychoanalytic institutes. Freud was an explorer but he also codified his ideas. His work has been taken as an inspiration to explore without presuppositions but also as Holy Writ. Psychoanalysis deals with emotions and excites passions. Like religion, psychoanalysis asks big questions, and, like religion, is easily influenced and seduced by dogmatic answers to these difficult questions. Psychoanalytic institutes have been notable as closed shops. Their solid walls have kept them sealed off and mysterious to the outside world, including the mental health professions and the academy. Authoritarian cliques, power struggles and intrigues have predominated inside the institutes. Institute life has been secret, the subject of rumour rather than knowledge. Insiders often know little about of other institutes (unless they are involved in site visits to particular institutes). Sometimes, insiders have a limited view of their own institutions because they see them through the vantage points of their own experience and that of some close colleagues. I have interviewed central participants of the dramas of the histories of some key psychoanalytic institutes in the US. For the first time, this thesis recounts the intricate inside history of these organizations. The thesis reveals the detailed inner political histories of arguably the four most important and varied psychoanalytic institutes affiliated with the APsaA. The New York Psychoanalytic Institute was the first and for decades the prestigious institute which set the model for many others. It became pre-eminent on a world scale with the immigration of leading European analysts fleeing the Nazis. The Boston Psychoanalytic Society and Institute, the Chicago Psychoanalytic Institute and the Los Angeles Psychoanalytic Society and Institute are quite varied in their organization and histories. The cultures are often quite different yet many of the problems will be found to be similar at base. I first examine the detailed political history of the New York Psychoanalytic Institute which provides a quintessential example of analytic anointment in practice, together with its pitfalls. I then examine a split that occurred in the Boston Psychoanalytic Society and Institute, which demonstrates some of the tensions and ambiguities that seem inherent in psychoanalytic organizations, especially where society and institute are part of the same institution. I move on to investigate a very different history in the Chicago Psychoanalytic Institute, which is quite differently organized: in Chicago, the institute with a lay Board of Trustees is quite separate from the society, and has for most of its history been headed by a powerful director. Then I look at the very complex history of the Los Angeles Psychoanalytic Society and Institute which in the 1970s came very close to being closed down by the APsaA. The Los Angeles Institute history is especially colourful and informative, given the introduction of Kleinian and object relations ideas into the institute and the reactions to them. These histories provide dramatic insights into what psychoanalysts and their institutions have contributed to what has gone wrong with psychoanalysis from the basis of a critique. A major aspect of the problem, in my view, is that a basically humanistic discipline has conceived and touted itself as a positivist science while organizing itself institutionally as a religion. I argue that psychoanalysts approach psychoanalysis with an inappropriate paradigm, 'as if it were a science. Their systemic misconception of their own discipline, and the resultant, widespread creation of what Christopher Bollas calls a 'false expertise' contributes to their present-day decline. I argue that qualification from an institute assumes the transmission of a body of knowledge which has not really been established as knowledge. This presumed knowledge is then transmitted by means of anointment reminiscent of the Bible. There is no unified body of knowledge within the psychoanalytic field nor is there a unified practice that can be readily empirically tested. Therefore, by default, psychoanalytic education has become a process of anointment, transmission through a subjective process akin to consecration. The large gap between the small knowledge base of psychoanalysis and the high level of 'pretend' knowledge which is inculcated during training and upon which qualification is based entrench conditions which themselves make real knowledge in this complex field more and more difficult to attain. This argument has implications not only for psychoanalysis but for many other professions where knowledge and qualification have unrealistic and inappropriate bases.

The world swimmers

Nine short stories that move between Victoria’s Little Desert, Sydney’s Kings Cross, Japan’s Inland Sea, Okinawa and Los Angeles, 19th century Budapest, post-war Berlin… and a fantastical landscape of a far-flung future, this collection is an exciting contribution to international and Australian writing about place.

An analysis of household beef consumption of Japanese expatriates in U.S.: implications for future beef consumption in Japan

This paper uses a novel approach to investigate how food consumption in Japan may change as Japanese consumers become more westernised in their tastes and preferences for food. It is widely believed that as food prices in Japan fall to international levels and as Japanese consumers become more westernised in their taste and preferences for food, their meat consumption patterns, in particular, will approach those of western countries. The approach undertaken in this paper involves a comprehensive survey of Japanese expatriates in Los Angeles, California, regarding their food consumption habits. The findings are interesting as they shed some light on the changing nature of food consumption of accultured Japanese faced with competitive food prices. The results indicate that although household meat consumption of Japanese expatriates have changed, it remains debatable, however, that their food consumption habits will approach those of western consumers in the foreseeable future. The findings have important implications for food marketeers in Japan and elsewhere, particularly as further liberalisation of food import in that country gains momentum.

Racialized urban America and Holocaust film : negotiating the limits of representation

Sidney Lumet’s influential film The Pawnbroker (1964) is one of the earliest films to consider the encounter between Holocaust narratives and low-income, urban American racial minorities. As much concerned with contemporary ‘race relations’ in the United States as it is with the Nazis’ persecution of Europe’s Jews, the film intertwines the story of Holocaust survivor Sol Nazerman with the social tensions of 1960s America, represented in his relationship with the young Puerto Rican shop assistant Jesus Oritz. The film stylistically juxtaposes raw footage of concentration camp existence with dismal images of New York slum life. Against these backdrops, the protagonist’s climactic ‘silent scream’ emblematically merges the repressed trauma of the survivor with the filmmaker’s interest in race relations, a theme that has undergone various transformations in a number of films since. One film that contemporizes this encounter is Richard LaGravenese’s Freedom Writers (2007). As opposed to the tragic outcome of the pawnbroker’s induction into urban America, here the Holocaust is a redemptive tool that permits inner-city Black and Latino youth to contextualize their own suffering. After reading The Diary of Anne Frank, this group of ‘at-risk’ sophomores to inspired to collaborate on an ultimately successful effort to bring Miep Geis, the woman who sheltered Anne Frank, to speak at their high school. Foregrounded by the 1992 Los Angeles riots, gentiles teacher Erin Gruwell and savior Miep Geis transform the Holocaust from an amplified parallel of American slums into an event that permits the children of American postcoloniality to triumph in spite of their socio-economic circumstances. Underlining the tension between the Jewish specificity and unprecedented nature of the Holocaust, and the need to generate Holocaust narratives that intersect with intrinsically racialized American narratives, such films have significant implications for how collective memories of suffering are constructed and contested.

Flipper beat frequency and amplitude changes in diving green turtles, Chelonia mydas

Using a turtle-borne camera system, changing flipper beat frequency and amplitude were measured in five diving green turtles (Chelonia mydas Linnaeus 1758) in the Bahía de los Angeles, Mexico (28°58′N, 113°33′W). These observations were made between June and August 2002. Turtles worked hardest (i.e., had the highest flipper beat frequency and amplitude) at the start of descents when positive buoyancy is predicted to oppose their forward motion. During the later part of descents, turtles worked less hard in line with opposing buoyancy forces being reduced. For example, flipper beat frequency declined from about 60–80 beats min−1 at the start of descent to around 25–40 beats min−1 after 30 s of the descent. At the start of ascents the flipper beat frequency was around 30 beats min−1, lower than on descent, and declined as the ascent progressed with often passive gliding for the final few meters to the surface. This pattern of effort during diving appears to apply across a range of marine reptiles, birds and mammals suggesting that graded effort during descent and ascent is an optimum solution to minimising the cost of transport during diving.

Rewriting history

 Rewriting History is a contemporary political story about taking action in the face of seemingly insurmountable odds – a David Vs Goliath tale that bears testament to the power of conviction and the importance of fighting for the historical truth. SCREEN HISTORY : 14 May, 20 May, 3 Jun., 15 Jul. 2012, The Sydney Jewish Museum, Australia 28 Jun. – 3 May 2012, Classic Cinema Melbourne, Australia SBS TV, Australia 14 Sep. 2012 16 Apr. 2013, George Washington University, in conjunction with the Washington DC Jewish Community Centre, Washington DC, USA 18 Apr. 2013, Jay Ipson Holocaust Lecture Series, Richmond, Virginia, USA 28 Apr.2013, American Jewish University, in conjunction with LA Holocaust Museum and Survivor Mitzvah Project, Los Angeles, USA 10 Jun. 2013, Limmud Oz, Sydney, Australia 10 Jul. 2013, Borehamwood & Elstree Synagogue, London 16 Jul. 2013, Simultaneous United Synagogue Screenings across the UK: Scotland, Newcastle, Leeds, Manchester and multiple locations in London, to coincide with the Jewish day of mourning of Tish B’Av 4 Aug. 2013, Limmud South Africa, Cape Town 7 Oct. 2013, Jewish Eye Film Festival, Israel “Official Selection"

Investigating the effectiveness of teacher education for early career teachers in diverse settings: the longitudinal research we have to have

There have been more than 100 reports focusing on the effectiveness of teacher education in Australia over the last 35 years with many positioning teacher education as flawed and in need of reform. These frequent criticisms have drawn attention to the difficulty teacher educators can experience when trying to interrupt or contest this representation: a situation not unique to Australia. In the United States, for example, Pam Grossman has suggested that those in teacher education “seem ill prepared to respond to critics who question the value of professional education for teachers with evidence of our effectiveness” (Grossman in J Teach Educ 59(1):10–23, 2008). A key question facing teacher educators, therefore, concerns the kinds of research that will most effectively allow us to lead debates about teacher preparation. This paper outlines an approach to the conceptualization and conduct of research into the effectiveness of teacher education that seeks to move debates in new directions. Drawing upon the theoretical resources of Soja (Thirdspace: journeys to Los Angeles and other real-and-imagined places, 1996) and Lefebre (The production of space, 1991) we outline the ways in which a spatial approach to conceptualizing teacher education influenced the design and conduct of a large scale, longitudinal project that investigated the question of the effectiveness of teacher education in Australia. In exploring the design features of this ARC linkage grant the paper demonstrates how research changes when teacher education is conceptualised from a spatial point of view and illustrates the ways in which consideration of the conceived, perceived and lived spaces of teacher education can move research about effectiveness into new directions.