Objective: To assess the effectiveness of the PAST (Pre‐hospital Acute Stroke Triage) protocol in reducing pre‐hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic therapy. Design: Prospective cohort study using historical controls. Setting: Hunter Region of New South Wales, September 2005 to March 2006  (pre‐intervention) and September 2006 to March 2007 (post‐intervention). Participants: Consecutive patients presenting with acute stroke to a regional, tertiary referral hospital. Intervention: PAST protocol, comprising a pre‐hospital stroke assessment tool for ambulance officers, an ambulance protocol for hospital bypass for potentially thrombolysis‐eligible patients, and pre‐hospital notification of the acute stroke team. Main outcome measures: Proportion of patients who received intravenous tissue plasminogen activator (tPA), process of care time points (symptom onset to ED arrival, ED arrival to tPA treatment, and ED transit time), and clinical outcomes of patients treated with tPA. Results: The proportion of ischaemic stroke patients treated with tPA increased from 4.7% (pre‐intervention) to 21.4% (post‐intervention) (P < 0.001). Time point outcomes also improved, with a reduction in median times from symptom onset to ED arrival from 150 to 90.5 min (P = 0.004) and from ED arrival to stroke unit admission from 361 to 232.5 minutes (P < 0.001). Of those treated with tPA, 43% had minimal or no disability at 3 months. Conclusions: Organised pre‐hospital and ED acute stroke care increases patient access to tPA treatment, which is proven to reduce stroke‐related disability.

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Background:The foramen magnum (FM) has garnered broad interest across the disciplines of anthropology, comparative anatomy, evolutionary biology, and clinical sciences. Most studies regarding the structure of the FM in humans have been intrapopulation morphometric studies rather than interpopulation morphologic studies. The few studies assessing the morphology of the foramen have utilized ambiguous and subjective descriptors to describe foraminal shape and are, consequently, difficult to reproduce. Therefore, detailed study of FM shape among craniofacially and geographically diverse populations through reproducible methods is warranted.Objectives:The aim of this study was to assess intersex and interpopulation differences in FM size and shape among diverse populations.Materials and Methods:The study analyzed 152 FMs of varied sex and race via traditional and geometric morphometric methods.Results and Conclusions:The study demonstrates that, within each distinct population, the size of the FM is significantly larger in males than in females; however, there are no significant differences in the shapes of the foramina between sexes. However, when comparing different populations to one another, there are significant differences with regard to both the size and shape of the FM. This study also presents a new model of FM ontogeny. Specifically, the growth occurring between the anterior and posterior foraminal boundaries before 5 years of age predicts the ultimate shape of the adult FM.

Burkholderia pseudomallei is a biothreat agent and an important natural pathogen, causing melioidosis in humans and animals. A type III secretion system (TTSS‐3) has been shown to be critical for virulence. Because TTSS components from other pathogens have been used successfully as diagnostic agents and as experimental vaccines, it was investigated whether this was the case for BipB, BipC and BipD, components of B. pseudomallei's TTSS‐3. The sequences of BipB, BipC and BipD were found to be highly conserved among B. pseudomallei and B. mallei isolates. A collection of monoclonal antibodies (mAbs) specific for each Bip protein was obtained. Most recognized both native and denatured Bip protein. Burkholderia pseudomallei or B. mallei did not express detectable BipB or BipD under the growth conditions used. However, anti‐BipD mAbs did recognize the TTSS needle structures of a Shigella strain engineered to express BipD. The authors did not find that BipB, BipC or BipD are protective antigens because vaccination of mice with any single protein did not result in protection against experimental melioidosis. Enzyme‐linked immunosorbent assay (ELISA) studies showed that human melioidosis patients had antibodies to BipB and BipD. However, these ELISAs had low diagnostic accuracy in endemic regions, possibly due to previous patient exposure to B. pseudomallei.

SUMMARY Fifty two patients with psoriatic spondyloarthropathy were monitored prospectively over a mean of 57 months (range 30-107). A comprehensive protocol was used to assess clinical and radiological features of disease activity and severity. Serial radiographs showed a significant increase in the number of patients with syndesmophyte formation and sacroiliitis. In contrast, there was no significant increase in the number of patients with inflammatory neck pain or stiffness, back pain or stiffness, cervical spine limitation, or sacroiliac tenderness. Similarly, there were no significant changes in any of the direct or indirect measurements of thoracolumbar spine mobility. The presence of HLA-B27 did not appear to influence disease progression. These results suggest that although patients with psoriatic spondyloarthropathy have radiological progression of their disease, this remains clinically silent and does not compromise spinal mobility.