Critical incident frameworks applied within schools are a means to support school staff to respond and guide planning to reduce critical incidents rates. This article explores the significance of the Therapeutic Crisis Intervention in Schools (TCI-S) critical incident framework to decrease the prevalence of behavioural critical incidents and to improve staff and student emotional competence in schools. The application of the TCI-S framework to reduce critical incidents within the United States and the United Kingdom school systems are demonstrated through upskilling school staff in social-emotional and co-regulation skills. It is suggested that TCI-S has the potential to support students with behavioural and emotional challenges and increase staff competency to implement trauma-informed practices that ultimately will reduce critical incidents.

The restricted use of antibiotics in the poultry sector has greatly enhanced the search for environment-friendly alternatives and complementary therapeutic approaches to manage infectious diseases in poultry. Cytokines, as natural immune-modulators, offer alternatives to conventional chemical-based therapeutics. Cytokine usage is becoming more feasible in poultry due to recent advancements in the field of immunology and vaccination, leading to the identification and cloning of avian cytokine genes. Existing adjuvants for poultry vaccines can have deleterious side-effects on the health and products of poultry and a subsequent reduction in profits. Therefore, alternative adjuvants must be developed to enhance the impact of vaccination. The use of cloned cytokines as adjuvants in poultry is attracting attention after the identification of new cytokine genes in chicken. Hence, cytokines may be used as therapeutics and vaccine adjuvants for enhancing immune response during infection and vaccination. This review focuses on the recent advancements in the application of avian cytokines as therapeutics or vaccine adjuvants.

The provision of therapeutic residential care offers opportunities for traumatised children and young people to build relationships through establishing a safe and nurturing environment that can facilitate healthy recovery. For the Aboriginal child and young person demonstrating symptoms of trauma, cultural connections have been severed, relationships broken and there can be an overwhelming sense of abandonment. Aboriginal children's experiences of trauma go beyond the individualistic or familial and incorporate pervasive intergenerational trauma. This means that healing for Aboriginal children requires a therapeutic response embedded within an Aboriginal cultural framework. This paper presents the approach undertaken by an Aboriginal community organisation in developing a therapeutic residential care programme for Aboriginal children in their care. The model developed has implications for all therapeutic care programmes.

This paper provides a snapshot of early work undertaken to develop a trauma-informed complex case management and therapeutic practice model for kinship and foster care within a family and community services agency. The approach taken has initially involved supporting case workers and carers and working towards organisational cultural change. The shift in focus described arose from a concern that stability and healing goals were not well supported within the existing programmatic framework and practice approaches. Purposeful integration of theory with practice has been central to the change process. There is a clear rationale that working from a strong evidence base can create better outcomes for children and young people in out-of-home care. The paper reflects on work in progress. Action taken to date has educated the workforce around trauma-informed responses, developed clear protocols and a set of practice tools. This has embedded a strong foundation for further development as resources become available.

Treatment of auricular arteriovenous fistula (AVF) is a challenge with surgery being the preferred option until now. We present three cases of auricular AVFs who underwent pre-operative embolization and its outcome on surgery. Three patients were diagnosed to have auricular AVF by angiography. All three patients underwent pre-operative embolization with n-butyl 2-cyanoacrylate after which they underwent surgical resection of the AVF. Pre-operative embolization resulted in significant devascularization of the AVF thus leading to near bloodless and clean surgery. Pre-operative embolization of auricular AVFs is a good treatment option, leading to significantly reduced blood loss during surgical excision.

The authors present a case of bilateral cavernous haemangiomas affecting the posterior ends of both inferior turbinates of the nose. The condition was treated by angiographically controlled embolization. Review of the literature back to 1967 has revealed no other report of embolization being used specifically for this condition. All previous treatments have involved surgery; we describe an alternative therapeutic option.

We investigated the effects of controlled hypotension with haemodilution under isoflurane anaesthesia on splanchnic perfusion in elderly patients. We determined the intramucosal pH using gastric tonometry in 28 patients scheduled for hip surgery. Patients without cardiac disease were assigned to two groups according to age. Group A (adult patients, n=14) included patients aged less than 60 years (range 29–58 years, 47±11 years, mean±SD) and group B(elderly patients, n=14) more than 65 years (68–78 years, 72±5 years). Anaesthesia was maintained with N2O-O2-isoflurane. After induction of anaesthesia, haemodilution was produced by drawing 800–1000 mL of blood and replacing it with the same amount of hydroxyethyl starch. Final haematocrit values were 23–24% in all groups. Controlled hypotension was induced with prostaglandin E1 (PGE1) and mean blood pressure was maintained at approximately 60 mmHg for approximately 80 min. Measurements, including gastric intramucosal pH (pHi), arterial blood pH (pHa) and serum lactate were measured before haemodilution (T0), after haemodilution (T1), 80 min after starting hypotension (T2), 60 min after recovery from hypotension (T3) and on the 1st post-operative day (T4). The values of pHa and lactate showed no change in the groups throughout the time course. The gastric pHi values showed significant decreases from 7.418±0.035 to 7.334±0.024 (P < 0.05) in group A and from 7.428±0.029 to 7.320±0.039 (P < 0.05) in group B after haemodilution, while no further decreases were found at 80 min after starting the hypotension (7.329±0.038 in group A and 7.322±0.031 in group B) and 60 min after recovery from hypotension (7.331±0.029 in group A and 7.328±0.034 in group B). It can be concluded that moderate haemodilution under isoflurane anaesthesia might impair splanchnic perfusion in adult and elderly patients. The addition of controlled hypotension with PGE1 or an increase in age did not further impair splanchnic perfusion nor the splanchnic oxygen supply.

A case is presented of a patient undergoing pre-operative embolization of a glomus tumour who developed a facial palsy one hour after embolization. At the time of surgery it was found to be due to the embolization material (polyvinyl alcohol foam) blocking the stylomastoid artery. The blood supply of glomus tumours and the variations in the blood supply of the facial nerve are discussed.

The value of embolization in surgery for nasopharyngeal angiofibroma is a controversial matter. We analysed retrospectively the results of surgical treatment in ten patients with a nasopharyngeal angiofibroma, the last five of whom underwent pre-operative embolization with Gelfoam®. Embolization reduced the intraoperative blood loss at primary surgery from an average of 1510 ml in the non-embolized patients to 510 ml in the embolized patients and transfusions from an average of 4.4 units to none. Seven reoperations were performed on four non-embolized patients on account of tumour recurrence, while no recurrences were diagnosed among the pre-operatively embolized patients. Blood loss in the reoperations averaged 4065 ml, and transfusions 7.1 units. The results indicate that embolization is effective in reducing intraoperative blood loss and contributes to improved surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

We present an unusual case of iatrogenic arteriovenous malformation following a myringoplasty and its treatment by embolization. Thorough examination and investigation of patients with pulsatile tinnitus is stressed. Angiography is essential to diagnose life-threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment and enhanced computed tomography.