Background Catatonia, a severe neuropsychiatric syndrome, has few studies of sufficient scale to clarify its epidemiology or pathophysiology. We aimed to characterise demographic associations, peripheral inflammatory markers and outcome of catatonia. Methods Electronic healthcare records were searched for validated clinical diagnoses of catatonia. In a case–control study, demographics and inflammatory markers were compared in psychiatric inpatients with and without catatonia. In a cohort study, the two groups were compared in terms of their duration of admission and mortality. Results We identified 1456 patients with catatonia (of whom 25.1% had two or more episodes) and 24 956 psychiatric inpatients without catatonia. Incidence was 10.6 episodes of catatonia per 100 000 person-years. Patients with and without catatonia were similar in sex, younger and more likely to be of Black ethnicity. Serum iron was reduced in patients with catatonia [11.6 v. 14.2 μmol/L, odds ratio (OR) 0.65 (95% confidence interval (CI) 0.45–0.95), p = 0.03] and creatine kinase was raised [2545 v. 459 IU/L, OR 1.53 (95% CI 1.29–1.81), p < 0.001], but there was no difference in C-reactive protein or white cell count. N-Methyl-d-aspartate receptor antibodies were significantly associated with catatonia, but there were small numbers of positive results. Duration of hospitalisation was greater in the catatonia group (median: 43 v. 25 days), but there was no difference in mortality after adjustment. Conclusions In the largest clinical study of catatonia, we found catatonia occurred in approximately 1 per 10 000 person-years. Evidence for a proinflammatory state was mixed. Catatonia was associated with prolonged inpatient admission but not with increased mortality.

This paper explores the tensions and opportunities involved in becoming a 'critical friend' to government agency planners trying to practise more inclusive forms of governance. It thus tackles two interrelated issues: how to build and manage rapport while retaining a critical research agenda, and how to locate niches for further democratising participation within congested multi-level governance structures. A five-year research programme allowed researchers to explore practices by planners charged with developing and implementing natural resource management plans in Scotland. The focus reflects a research interest in opening up governance structures beyond the 'usual suspects' to enhance the democratic promise of participatory approaches. The paper reflects on how the balance between rapport and critique influenced the goal of opening up these processes to more public participation. The paper concludes by arguing that analysis of participatory geography must attend to the ways in which transformative opportunities are embraced, resisted or co-opted.

ObjectiveThe bowel habit in the first few weeks is relevant in the assessment of symptoms which are often nonspecific and may or may not be indicative of underlying pathology. There is very little available data. We therefore undertook a study to investigate the normal bowel habit in healthy, term infants. Design, settingInfants were assessed by the health visitor at the initial contact (10-14 days) and sample and at the 6-week check. Details of feeding method and bowel habit were collected by simple questionnaire. ResultsA total of 238 infants were recruited after 14 exclusions; 87.3% of babies passed meconium within 24 and 99.2% within 48 hours of birth. The majority of infants at 2 weeks passed at least one stool every day (95.3%). At 6 weeks most babies (87.8%) continued to pass a daily stool, although the range widened, with 98.3% passing a stool within the range three or more per day to once every 3 days. Implications forThis study suggests in the first 2 weeks of life that most infants have a practice daily bowel motion. By 6 weeks, although the range has increased, 98.3% will have a bowel motion at least once every 3 days. This means a bowel frequency of less than every 3 days is unusual and requires consideration of underlying pathology.

National Audit Project (MINAP) database and patient notes. Mortality data was confirmed using the Office of National Statistics database with follow-up ranging from 3 to 44 months. Results: The mean age was 60Ϯ14years and 80.3% patients were male. The incidence of previous coronary disease in the cohort was 27.8%, 32.8% patients were hypertensive, 37.7% smokers, 24.6% hypercholesterolaemic and 8.2% had known diabetes. 45% patients had a witnessed arrest and 43.4% were directly conveyed to the pPCI centre. Mean arrest-to-arrival time in the cohort was 115Ϯ24mins with a mean call-to-balloon time of 168Ϯ24mins. The rate of successful pPCI in the cohort was 85% with 21.7% having 3-vessel disease. Shock was present in 16% and severe left ventricular impairment in 25% patients. The in-hospital mortality within the cohort was 21%. Of the patients who died 14 were cardiovascular deaths, 3 being shortly after return of spontaneous circulation in the catheterisation laboratory, and 6 of all deaths were secondary to hypoxic brain injury in Intensive Care. 79% of all patients survived to discharge. Of the patients who survived 92% were discharged with no neurological deficit. At follow-up (12-44 months in 62% patients) 100% of patients who survived to discharge were still alive. Conclusions: Here we present descriptive data of a large, contemporary cohort of STEMI admissions for pPCI that are complicated by OOHCA. Here we show a 79% survival rate to discharge, a higher proportion than previously reported, with good long term prognosis after discharge.Background: ST elevation myocardial infarction (STEMI) complicated by out of hospital cardiac arrest (OOHCA) is associated with significant mortality. Small observational studies have shown survival benefit with primary percutaneous coronary intervention (pPCI) in this setting. We sought to identify clinical characteristics and predictors of outcome in STEMI complicated by OOHCA in a large patient cohort in the era of pPCI. Methods: Between January 2008 and October 2011, STEMI admissions to a regional cardiac centre were retrospectively analysed. 122 patients with OOHCA in the context of STEMI were identified. Clinical and procedural data was collected from the UK Myocardial Ischaemia National Audit Project (MINAP) database and patient notes. All cause mortality data was confirmed using the Office of National Statistics mortality database with follow-up ranging from 3 to 44 months. Results: The mean age of patients was 60Ϯ14years, 80.3% were male and 43% were direct admissions via the ambulance service, 57% being transferred from district hospitals. The in-hospital mortality within the cohort was 21% with 96/122 patients surviving to discharge. There were no significant differences in patient demographics, previous cardiac history, arrest rhythm or referral source between patients who survived to discharge compared with those who died. Patients who died had significantly higher incidence of cardiogenic shock (pϭ0.0289), 3-vessel coronary disease (pϭ0.0125), severe left ventricul...

Objectives To assess the characteristics and prognosis of ST‐elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States. Background Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late‐presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era. Methods Using a two‐center registry‐based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3−6, 6−12, and 12−24 h (late presenters). Results Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid‐19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door‐to‐balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In‐hospital and 1‐year death risks were comparable between late and earlier presenters. Conclusion Despite the unfavorable risk profile and longer door‐to‐balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.

Objectives/Aims Catatonia is an important neuropsychiatric disorder with a high morbidity and mortality. However, due to a perception that it is very infrequent and because of the acuity of the patients, it has remained poorly studied and research has often been confined to small groups. We aimed to establish the demographic, disease-related variables and blood-based biomarkers for catatonia in a large dataset. Methods We used the Clinical Records Interactive Search (CRIS) system hosted at the NIHR Maudsley Biomedical Research Centre to search the clinical records for patients with catatonia. An initial free-text search was refined by use of a natural language processing app. The results of the app were validated by three of the authors, who included patients in the analysis only if a clinician had made a diagnosis of catatonia and two or more items of the Bush-Francis Catatonia Screening Instrument were in evidence. Demographics, diseaserelated variables and blood-based biomarkers could then be extracted for these patients and compared, where relevant, to non-catatonic psychiatric patients. Results The natural language processing app extracted the records of 2766 patients with at least one mention of catatonia in their records. The majority of cases identified by the app could be validated by the researchers. A high proportion of patients had more than one episode of catatonia.Full results will be available in time for the presentation. Conclusions This study demonstrates that catatonia is not very rare, even relying on clinician identification. The frequency of recurrence is interesting, as it suggests that catatonia might indicate an underlying trait, rather than merely a transient state.

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ing anticoagulation, and two patients (14%) with postoperative edema. Eight of nine patients (89%) with venous reconstruction underwent imaging at a mean of 292 days postoperatively. All reconstructions were patent. There have been no recurrences to date after a mean follow-up of 483 days (range, 6-3800 days). All patients with PE were anticoagulated for 6 months, and those with DVT were anticoagulated for 3 to 6 months.Conclusions: Lower extremity venous aneurysms are infrequently encountered and most often present with symptoms of pain or DVT. Rupture is rare but possible. Popliteal and saphenous vein aneurysms can present with DVT. Surgical options vary depending on aneurysm location and need for maintenance of vessel patency.