Background: Paramedics require an effective prehospital tool to eliminate stroke mimics and to assist in the identification of suitable candidates for thrombolytic therapy. The Faster Access to Stroke Therapies study combined two validated stroke assessment tools (the Los Angeles Prehospital Stroke Screen, LAPSS, and the Cincinnati Prehospital Stroke Scale, CPSS) to form the Melbourne Ambulance Stroke Screen (MASS), and performed an in-field validation by Australian paramedics. Methods: Over a 12-month period, 18 paramedics participated in the Faster Access to Stroke Therapies study and prospectively collected data contained in the MASS on all stroke dispatches, and for other patients with a focal neurological deficit. Sensitivity and specificity analysis of the LAPSS, CPSS and MASS was calculated and equivalence analysis performed. Results: Paramedics completed 100 MASS assessments for 73 (73%) stroke/transient ischemic attack patients and 27 (27%) stroke mimics. The sensitivity of the MASS (90%, 95% CI: 81–96%) showed statistical equivalence to the sensitivity of the CPSS (95%, p = 0.45) and superiority to the LAPSS (78%, p = 0.008). The specificity of the MASS (74%, 95% CI: 53–88%) was equivalent to that of the LAPSS (85%, p = 0.25) and superior to the CPSS (54%, p = 0.007). All patients misidentified by the MASS (7 strokes, 7 mimics) were ineligible for thrombolytic therapy. Conclusion: The MASS is simple to use, with accurate prehospital identification of stroke. It distinguishes stroke mimics, with good recognition of suitable patients for thrombolytic therapy.

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Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with pre-notification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.

We cannot say anymore that the immutable is truth, and that the mobile, transitory is appearance. Adorno (1973: 361) This chapter attempts to bring an empirical phenomenon, the mobile, into some kind of theoretical focus: that is to say, to begin to set out some aspects of its possible sociological significance. The technology and the behaviour it facilitates are already ubiquitous, and the wealth of folk-lore that surrounds it indicates that it is certainly a note-worthy social phenomenon. At the same time, its ready-to-hand (or even hands-free) quality, and the very speed ofits development and adoption suggest that there is some value in considering how it can be rendered visible; for some of its qualities might be said to be obscured by its status as both an already routine feature of everyday life, and yet one which continues to be subject to rapid change.The principal aim then is neither to locate the mobile and its use within some grand theoretical narrative of the state of communication and society, nor to survey a range of possibly relevant social theories but, more modestly, to consider some theoretical resources (fr9m within sociology, science and technology studies, philosophy and media studies) for thinking about certain features of a technology which seems manifestly socially significant -it introduces changes in social interaction for example -but, in some respects, evades sociological analysis. It should be noted that the features of interest emerge from an ongoing empirical research project, and that part of my argument will be that theoretical work carried out in isolation from the study of the practicalities of situated mobile use can easily go astray.!The title is an allusion to Latour's (1986) concept of an "immutable mobile" which, playfully reconciling two traditionally opposed elements within philosophical thought, denotes a technology (an inscription or representation such as a map for example) in which the portability of unchangeable (though recombinable) information from one setting to another makes possible action at a distance. The mobile on which we are focusing has something in common with this but, with respect to emerging patterns of use and social behaviour, can also be said to be mutable, transitory and malleable.The chapter is organised as follows. I first consider the issue of the technology's transparency, and the challenge that this poses to analysis. I then look at three

Within environmental sociology realist critiques of the use of social constructionist approaches abound. This paper challenges features of the realist critique and emphasises the appeal and utility of social constructionist approaches for the study of environmental issues. We start by outlining the criticisms levelled at social constructionism, particularly the claim that the approach amounts to a denial of the existence of environmental problems and provides no contribution to managing them. We argue that this characterisation of `extreme' constructionism is problematic in two senses. First, in that it bears little resemblance to the mild approach actually used in the majority of empirical studies and, secondly, that it is a misleading characterisation of a more radical constructionism. We conclude that the utility of constructionism can be formulated in terms of two distinct approaches. One refrains from making overt moral and political claims, and treats such claims as topics for analysis; such an approach can, however, provide resources for social criticism. Another adopts an overtly political or environmentally motivated stance towards the issues investigated. Underlying these suggestions is our conviction that a particular model of engagement is implicit in many realist critiques and that others are possible, and perhaps, preferable.