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...