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Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).
We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.
We conducted three interrelated activities to produce the TIER intervention:
•Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use
•Scoping review of literature describing prehospital care of patients with TIA
•Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.
The panel used results to define the TIER intervention, to include:
1.Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic
2.Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic
3.Referral process via ambulance control room
4.Training package for paramedics
5.Agreement with TIA clinic service provider including rapid review of referred patients
We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
The article is one of a number of articles stemming from a Ph.D research project researching learning and emotional difficulties amongst year eight students at a State High School in Adelaide. Twenty students identified as having learning and behaviour difficulties are participating in an alternative program for two days a week. The program involves camping, outdoor education and a good deal of intensive ‘direct instruction’ in basic literacy and numeracy. It is anticipated that this program will serve as a model for other state schools developing alternative programs for disaffected adolescent students.
Three years of intervention to improve the language skills of children with severe intellectual disability are reported. Family based teaching, therapy and counselling programs were used as the basis of the interventions. Repeated language measures (norm referenced) were used to assess the effects of the interventions. Comparison with other language intervention studies are made. The distinct features of the effective behaviourally oriented teaching program are identified.
Pliny's intention that the oratio (i.e. the written version, Ep. 1.20.9) of his Panegyricus be available to posterity was explicit (Ep. 3.13, 3.18). So if his self-important aspiration that the speech prove directly instructive to future emperors (Ep. 3.18.2–3; Pan. 4.1) was not to be realized, it was not for lack of effort on his behalf, since his conscious attempt to revise and expand the original version and to secure the speech's survival through distribution seems to have been an ambitious and original project. This process of revision and publication was in keeping not only with Pliny's general practice in publishing his oratory, but also perhaps with his long-term commitment to publish his letters. As his own literary agent for his speeches and letters, Pliny was bold and innovative, but if he would have been pleased with the reception of his Panegyricus in later antiquity, it was perhaps not what he would have imagined.
Forty-three years after Pliny's suffect consulship, Fronto was to take similar office, in July and August. In a letter to Marcus Aurelius in early July 143 ce, prompted by a question from the Caesar, Fronto explained that he was postponing delivery of his gratiarum actio to Augustus Antoninus Pius for the consulship until 13 August.