Summary Background The inconsistent effect of hypothermia treatment on severe brain injury in previous trials might be because hypothermia was induced too late after injury. We aimed to assess whether very early induction of hypothermia improves outcome in patients with severe brain injury. Methods The National Acute Brain Injury Study: Hypothermia II (NABIS: H II) was a randomised, multicentre clinical trial of patients with severe brain injury who were enrolled within 2·5 h of injury at six sites in the USA and Canada. Patients with non-penetrating brain injury who were 16–45 years old and were not responsive to instructions were randomly assigned (1:1) by a random number generator to hypothermia or normothermia. Patients randomly assigned to hypothermia were cooled to 35°C until their trauma assessment was completed. Patients who had none of a second set of exclusion criteria were either cooled to 33°C for 48 h and then gradually rewarmed or treated at normothermia, depending upon their initial treatment assignment. Investigators who assessed the outcome measures were masked to treatment allocation. The primary outcome was the Glasgow outcome scale score at 6 months. Analysis was by modified intention to treat. This trial is registered with ClinicalTrials.gov, NCT00178711. Findings Enrolment occurred from December, 2005, to June, 2009, when the trial was terminated for futility. Follow-up was from June, 2006, to December, 2009. 232 patients were initially randomised a mean of 1·6 h (SD 0·5) after injury: 119 to hypothermia and 113 to normothermia. 97 patients (52 in the hypothermia group and 45 in the normothermia group) did not meet any of the second set of exclusion criteria. The mean time to 35°C for the 52 patients in the hypothermia group was 2·6 h (SD 1·2) and to 33°C was 4·4 h (1·5). Outcome was poor (severe disability, vegetative state, or death) in 31 of 52 patients in the hypothermia group and 25 of 56 in the normothermia group (relative risk [RR] 1·08, 95% CI 0·76–1·53; p=0·67). 12 patients in the hypothermia group died compared with eight in the normothermia group (RR 1·30, 95% CI 0·58–2·52; p=0·52). Interpretation This trial did not confirm the utility of hypothermia as a primary neuroprotective strategy in patients with severe traumatic brain injury. Funding National Institute of Neurological Disorders and Stroke.
The Cautley Mudstone Formation and Cystoid Limestone Member of the Ashgill Formation (Windermere Supergroup; Ashgill Series), from the Cautley district of northern England, has yielded an ostracod fauna of more than 30 species. Many of these have short ranges, permitting recognition of stratigraphically successive Pusgillian-lower Cautleyan, middle-upper Cautleyan, and Rawtheyan ostracod faunas. Several species are also known from the upper Ordovician of North America (Anticosti Island), Scotland (Girvan district) and the Baltic region (Estonia, glacial erratic boulders of northern Germany), providing evidence to correlate upper Ordovician successions in these areas. The ostracods include abundant podocopes, at some horizons accounting for more than 80 % of the fauna. Binodicopes are also common, but palaeocopes are rare. Assemblages are typical of a clastic dominated open marine shelf setting. Diversity at most horizons is low (c. 3-5 species), but reaches a peak of between 13-14 species in middle Cautleyan horizons. Lower diversity at Pusgillian and Rawtheyan horizons coincides with the encroachment of deeper marine-shelf facies which were probably hostile to Ordovician benthonic ostracods. Some of the ostracods (particularly Aechmina) have distributions suggesting tolerance of a range of mid-to deep shelf benthonic palaeoenvironments, but none were pelagic. During Ashgill times the Cautley district (part of palaeocontinental Avalonia) was replete with ostracod genera and species which also occur in the Baltic region (palaeocontinental Baltica; more than 90 % generic similarity) and to a lesser, but nonetheless significant extent in North America and Scotland (parts of palaeocontinental Laurentia). Such trans-Tornquist Sea and Iapetus Ocean distributional patterns add to previous ostracod data that support models which show palaeogeographical proximity of Avalonia and Baltica, and Avalonia and Laurentia, by Ashgill times. The widely cited observation, that trans-Iapetus ostracod faunas remained strictly provincial until the midor late Silurian, cannot be sustained. § Author for correspondence: m.williams@bgs.ac.uk
The Indigenous Education and Training Alliance (IETA) is a staff college of Education Queensland. Its primary focus is to broker and deliver professional development to educators around the policies contained within Partners for Success: strategy for the continuous improvement of education and employment outcomes for Aboriginal and Torres Strait Islander Peoples in Education Queensland (Education Queensland, 2000b). This paper describes how IETA's work to support one of the policies, Literacy for Aboriginal and Torres Strait Islander Students, has been theorised and enacted. It also discusses the organisation's successes and challenges in the significant area of language and literacy pedagogy for Indigenous students.
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