bluuebunny/crossref_metadata_2025 huggingface dataset:
Iron Age landscape, society, and regionality : The material culture
Authors: Rippon Stephen
Published: November 2020

In his review of South East Britain in the later Iron Age, Hill (2007, 16) observed that ‘Since the 1980s, little attention has been given to large-scale social explanations and narratives in British Iron Age archaeology. Debates over core–periphery models, the interpretation of hillforts, and the nature of social organization, were—for good reason—eclipsed by a focus on the symbolic meanings of space, structured deposition, and ritual.’ He goes on to argue that British archaeology is in need of more ‘straightforward storyboards’ around which data can be arranged (Hill 2007, 16), and Brudenell (2012, 52) has similarly noted how ‘close-grained understandings have often been won at the expense of broader pictures . . . [and that] with a few exceptions, recent approaches have atomized the study of later prehistoric society, focussing on the specifics of the local social milieu at the expense of broader scales of social analysis’. There have been some ‘big picture’ studies—most notably Cunliffe’s (1974; 1978; 1991; 2005) Iron Age Communities in Britain—but all too often studies of this period have focused on specific counties, types of site, or artefact, and it is noticeable how little systematic mapping of data there was in three recent collections of papers (Gwilt and Haselgrove 1997; Haselgrove and Moore 2007; Haselgrove and Pope 2007). This study, in contrast, aims to shed light on one important ‘storyboard’: the territorial structures within which communities built their landscapes. The written history of Britain begins in the first century BC when we first get insights into its political and territorial arrangements, although as this was a period when the island was becoming embroiled in the political instability caused by the expansion of the Roman world, the trends seen then may not reflect the longer-term patterns of territorial stability or instability that preceded it. In 54 BC, for example, Caesar describes how his major opponents were a civitas (usually translated as ‘tribe’) who had recently surpassed the neighbouring Trinovantes as the paramount group in South East Britain (Gallic War, 20–1; Dunnett 1975, 8; Moore 2011).
The rural landscape of the Romano-British land-owning elite
Authors: Rippon Stephen
Published: November 2020

Rural settlement in Roman Britain has been the subject of many previous studies (e.g. Rivet 1958; 1964; Thomas 1966a; Dark and Dark 1997; Taylor 2007a), although in the past there has been a tendency to assume that lowland regions were uniformly ‘Roman’ and characterized by villas. The construction of villas represents the conscious adoption of a distinctively ‘Roman’ style of architecture by the land-owning class, and rather than being ‘nouveaux riche’ (Russell and Laycock 2010, 111), they are more likely to have been descended from old elites within the pre-Roman kingdoms. The Latin term villa referred simply to a country house, and while in practice the vast majority appear to have lain at the centre of agricultural estates, it is in this true sense—of a country house—that the term is used here (Percival 1988). Most books on Roman Britain try to illustrate the distribution of villas and through simple small-scale maps such as these, and with knowledge of well-known sites such as Bignor and Chedworth, it is easy to draw three assumptions: first, that we know what a Roman villa is, second, that we can map their distribution quite easily, and third that they were a typical feature of lowland areas. All of these assumptions, however, can be questioned. The first—that we understand the nature of Roman villas—seems the most straightforward, although the amount of recent excavation is in fact surprisingly limited as scheduling has protected so many sites from development, andmost of the early work focused on the main residential building as opposed to its ancillary structures. The expansion in first ‘rescue’ and latterly developerfunded excavation has, however, led to a far greater range of rural settlements being excavated and rather than there being a clear divide between ‘villa’ and ‘nonvilla’ sites, we can see that there was a continuum, with low-status timber structures at one end of the scale, palatial houses at the other, and a large number of sites in the middle that meet some, but not necessarily all, of the criteria for being regarded as a villa.
Regionality under the new order: The seventh to tenth centuries
Authors: Rippon Stephen
Published: November 2020

Around the late sixth century dress styles and burial practices started to change, with regionally distinctive sets of grave goods giving way initially to the greater uniformity seen in ‘final phase’ cemeteries before the regular deposition of artefacts ceased altogether in the late seventh century. It has been argued that this reflects how a common identity had started to emerge across Anglo-Saxon society, and that the change in the character of grave goods away from those expressing a strongly Germanic identity to ones with a more Romano-Byzantine character reflects how kings sought to legitimize their power through association with the Roman world (e.g. Geake 1997, 133–5; 1999b). This hypothesis, however, presents something of a paradox because, just as the archaeologically visible and regionally distinctive group identities expressed in material culture such as dress accessories disappeared, a new form of territoriality was emerging in the form of relatively stable kingdoms within which one might imagine the expression of identity was just as important. Indeed, many have argued that changes in the character of grave goods being deposited in ‘final phase’ cemeteries had less to do with secular identity and kingship and was instead associated with the spread of Augustinian Christianity, which was both a unifying cultural tradition and one with strong associations with the Roman world (e.g. Crawford 2004; Hoggett 2010, 107). It seems inherently unlikely that group identities will have disappeared just as stable kingdoms started to emerge, and it is therefore likely that identity was expressed in other ways. This is in fact exactly what we see if we look beyond the burial record: while eighth-century and later graves contain few expressions of identity, as Christianity dictated a uniform burial practice, the circulation of new forms of material culture, such as coinage and mass-produced pottery, was closely tied to particular political territories. This new material culture was associated with specialist forms of settlement that were closely involved in the circulation of coinage both in coastal emporia and in inland places that archaeologists have termed ‘productive sites’.
Object biographies
Authors: Brück Joanna
Published: November 2020

In September 1886, John and Richard Mortimer excavated a large barrow at Garton Slack, East Yorkshire (Mortimer 1905, 229). At the centre of the barrow lay the inhumation burial of a young adult male. A flint knife, a clay button, and two lumps of yellow ochre had been arranged behind his head; at his left hand were two quartz pebbles and fragments of two boar’s tusks, while the scapula of a pig had been laid on top of his ribs. One detail of this burial seems particularly alien to contemporary eyes, however. When the body had begun to decompose, his mandible was removed and placed carefully on his chest, and a miniature Food Vessel inserted into his mouth. Here, a pot replaced an element of the human self and the physical boundary between person and object was elided: the open mouths of both pot and body worked as channels through which relationships flowed in processes of communication and commensality. This chapter will explore the relationship between people and objects in the Bronze Age. The Bronze Age saw the introduction of new technologies, notably metalworking, which had a significant impact on concepts of personhood and identity. A greater diversity of materials was employed than in previous centuries, including visually striking substances such as amber and faience, while more ‘mundane’ materials such as bone were used to make a new and wider variety of objects, particularly during the later part of the period. Such objects were incorporated into new contexts too, notably settlements and burials, and our interpretation of these finds—especially those from burials and hoards—has had a significant impact on our understanding of the period. We will start by examining objects from Early Bronze Age contexts, focusing in particular on burials, before moving on to consider what technologies such as metalworking and cloth production can tell us about the construction of concepts of the self in the Middle and Late Bronze Age. During the early part of the period, artefacts such as copper-alloy daggers, bone pins, pottery vessels, and stone tools were buried with the dead.
Local anaesthesia for children
Authors: Meechan J G , Jackson G
Published: November 2020

A child’s future perceptions and expectations are likely to be conditioned by early experiences of dental treatment. Just under half of all children report low to moderate general dental anxiety, and 10–20% report high levels of dental anxiety. Montiero et al. (2014) indicate that the prevalence of needle phobia may be as high as 19% in 4- to 6-year-olds. Davidovich et al. (2015) reflected that, for general practitioners and specialists alike, Local anaesthetic (LA) injection for an anxious child was the most stressful procedure regardless of the operator’s age, gender, or years of professional experience. Despite impressive reductions in caries in children in recent years, there still exists a social gradient with inequalities in experience of dental disease, and there remains a significant cohort of children for whom extractions and restoration of teeth are necessary. Aside from emerging restorative strategies that do not require LA (e.g. atraumatic restorative technique or placement of preformed metal crowns using the Hall technique), effective and acceptable delivery of LA remains an important tool to enable successful operative dental treatment to be carried out comfortably for child patients. Effective surface anaesthesia prior to injection is very important as a child’s initial experience of LA techniques may influence their future perceptions and help in establishing trust. Cooling tissues prior to injection has been described but is rarely used, and surface anaesthesia is generally achieved with intra-oral topical agents. Although the main use of topical agents is as a pre-injection treatment, they have been used as the sole means of anaesthesia for some procedures including the extraction of mobile primary teeth. It is possible to achieve a depth of 2–3mm of anaesthesia if topical agents are used correctly: • the area of application should be dried • topical anaesthetic agent should be applied over a limited area • the anaesthetic agent should be applied for sufficient time. In the UK 5% lidocaine (lignocaine) and 18–20% (17.9%) benzocaine gels are the most commonly used agents. Benzocaine topical anaesthetic gel is not recommended for use on children under 2 years old because of an increased risk of methaemoglobinaemia.
Rediscovering the Body: Cremation and Inhumation in Early Iron Age Central Europe
Authors: Rebay-Salisbury Katharina
Published: November 2020

The Late Bronze Age Urnfield Period in Central Europe (BA D, Ha A/B, c.1300 to 800 BC) is characterized by the dominance of cremation as a burial rite. The simple appearance of urn burials give an impression of simplicity, but they are the endpoint of a chain of actions and practices that constitute the funerary ritual, many of which may not be simple at all, but include a large number of people and resources. The washing, dressing, and furnishing of the body as it is laid out prior to cremation leave no traces. The funerary pyre, as spectacular as it may have looked, smelled, and felt during the cremation, preserves only under exceptional circumstances. The rituals and feasts associated with selecting the cremated remains from the funerary pyre and placing them in a suitable organic container or a ceramic urn prior to their deposition do not leave much evidence. The large-scale spread of cremation during the Late Bronze Age has traditionally been explained by the movements of peoples (e.g. Kraft 1926; Childe 1950), or a change in religious beliefs (e.g. Alexander 1979). More recently, a change in how the human body is ontologically understood and how it has to be transformed after death is seen as the more likely underlying cause (Harris et al. 2013; Robb and Harris 2013; Sørensen and Rebay-Salisbury in prep.), although a simple and single reason is rarely the driver of such pan-European developments. This chapter will be concerned with another transition, the change from cremation back to inhumation, several hundred years later during the Early Iron Age, and investigates its background and causes. In Central Europe, cremation is given up as the solitary funerary rite, and a range of different options, including inhumations in burial mounds, bi-ritual cemeteries, and new forms of cremation graves emerge. This change happens at a different pace in the various areas of the Hallstatt Culture and adjacent areas, which will be surveyed here. Despite doubts about the validity of the term ‘Hallstatt Culture’ as a cultural entity (e.g. Müller-Scheeßel 2000), it remains a convenient shorthand to the Early Iron Age in Central Europe, c.800–450 BC, in eastern France, southern Germany, Switzerland, Austria, the Czech Republic, Slovakia, Hungary, Slovenia, Croatia, and parts of northern Italy.
Sterilization and Decontamination
Authors: Chegra Sylvia , Cummins Martina N.
Published: November 2020

Decontamination is the combination of processes (including cleaning, disinfection, and sterilization) used to make a re-usable item safe for medical use. It is important to have an understanding of the meaning of each of these terms as well as their application. Cleaning: a process to remove infectious agents and organic matter. The effectiveness of reducing microbial contamination will vary dependent upon the efficacy of the cleaning process and the initial bio- burden. It is important to note that this process does not necessarily destroy infectious agents and is a pre-requisite to disinfection and/ or sterilization. Disinfection: a process to reduce the number of viable infectious agents and which is commonly achieved either chemically or thermally. For some infectious agents (such as certain viruses and bacterial spores) it is not an effective method for inactivation and will not achieve the same level of reduction as is achieved through terminal sterilization. Sterilization: a process which renders an object free from viable infectious agents, including viruses and bacterial spores. Sterilization is achieved most commonly using a prescribed ratio of time, temperature, and steam or chemicals such as hydrogen peroxide, gas plasma, or ethylene oxide. The effective decontamination of re- usable medical devices is essential in reducing the risk of transmission of infectious agents with the chosen method of decontamination being detailed in the manufacturer’s decontamination guidance or instructions for use (IFU), supplied when a medical device is purchased. The guidance will reflect the validation that was carried out prior to the release of the product by accredited laboratories to ensure that the cleaning guidance is both effective and will not adversely affect the device. The aim of the decontamination process is to: 1. Reduce or completely remove microbial contamination to such a level that it is both safe to handle for staff and safe for further use on patients. 2. Ensure that there is no toxic chemical residue on the surface of the device that could cause adverse reactions when used on a patient. 3. Ensure that the decontamination process is compatible with the device and that it does not damage the device through the use of chemicals that can have an adverse effect on the device or by exposing it to either heat or water, which may cause damage.
Device- Associated Infections
Authors: Millar Michael
Published: November 2020

A great variety of biomedical devices are used in patient care. Almost all hospitalized patients will have a vascular catheter placed to support administration of drugs, fluids, electrolytes, blood products, feeding solutions, or for haemodynamic monitoring. Many will also be exposed to urinary catheters, or tracheal tubes. There is also increasing use of a variety of prosthetic devices. Different biomedical devices have different infection associations. Examples of associations include cardiac pacemakers with Staphylococcus aureus blood-stream infection, contact lenses with amoebic keratitis, tampons with toxic shock, and historically, intra-uterine devices with pelvic actinomycosis. The most common causative organisms associated with device infections are bacteria (less commonly fungi). For many devices coagulase-negative staphylococci are the most frequent cause of infection. It is important to remember that an enormous range of microbes have been reported to cause device-associated infection. Biomedical devices predispose to infection through a wide range of mechanisms. These may include (depending on the device) traversing of anatomical barriers (such as the skin), protected niches for microbial proliferation, inappropriate immune activation, and provision of a surface(s) for biofilm formation. Few devices are completely inert. Most devices elicit an immune response, which depletes local complement levels and reduces oxidative killing by neutrophils, some directly damage tissues, and some release biologically-active products. There is much interest in the molecular mechanisms and physical interactions that underlie the formation of communal microbial structures on biomaterial surfaces. Many difference strategies have been proposed both to prevent, and to destroy microbial biofilms associated with biomedical devices. Complications associated with devices are most likely to be mechanical or infective. It is estimated that up to 25% of patients with a central venous catheter (CVC) will suffer a serious mechanical or infection related complication. Risk factors for infection include host, device, and operator factors. Extremes of age, co-morbidities such as diabetes, active infection at the time of insertion, and loss of relevant anatomical barriers to infection are host risk factors that apply to most devices. Operator risk factors include poor compliance with insertion or post-insertion ‘best practice’.
Pregnancy-Associated Infections
Authors: Riddell Anna , Millar Michael
Published: November 2020

An important consideration in pregnancy is the relationship between infection in the mother and the developing foetus. Infections can indirectly impact the foetus through effects on the mother, for example, maternal urinary tract infection is associated with preterm birth, or can infect the foetus. Routes of infection can be ascending from the birth canal through the cervical os, transplacentally, or rarely, contiguously. The effect on the mother is also important: pregnancy is considered an immunosuppressive state and the growing foetus causes significant mechanical and physiological changes. Although the first trimester is the key developmental phase for the growing foetus, during the third trimester the mother is more susceptible to severe respiratory infection and some viral infections such as varicella zoster virus (VZV), due to the mechanical changes produced by the growing foetus. There is a paucity of evidence supporting the safety of drugs in pregnancy. Use of any medicinal drug in pregnancy, including antibiotics, requires good reasons. The optimum choice of antibiotics depends on the trimester of the pregnancy. In general, beta-lactams are safe and tetracyclines should be avoided throughout pregnancy. Nitrofurantoin is safe until after thirty-five weeks gestation and trimethoprim should be avoided in the first trimester but is safe otherwise (perhaps with folic acid supplementation if < 20 weeks). Specific patterns of colonization and infection of the genitourinary tract can be associated with an increased risk of an adverse pregnancy outcome, particularly preterm birth. Sexually transmitted diseases such as gonorrhoea and chlamydia are associated with an increased risk of spontaneous preterm birth, which may extend to infection in the pre-conception period. Bacterial vaginosis is an abnormal pattern of vaginal colonization and is also linked with an increased risk of preterm birth. The US Center for Disease Control recommends screening all pregnant women for chlamydia, gonorrhoea, syphilis, HIV, and hepatitis B, symptomatic women for trichomonas and genital herpes, women considered at high risk of preterm birth for bacterial vaginosis, and women at high risk of blood-borne virus infection for hepatitis C. Treatment is administered to reduce the risk of an adverse pregnancy outcome (syphilis, gonorrhoea, chlamydia, trichomonas, and bacterial vaginosis) or to prevent transmission to the infant (herpes, HIV, hepatitis B, and C).
Use of Antimicrobials and Toxicity
Authors: Sefton Armine
Published: November 2020

Broad-spectrum antibacterial agents kill most bacteria including gram-positive rods and cocci, gram-negative rods and cocci, and often anaerobes too. Narrow-spectrum agents kill a narrow range of microbes, e.g. benzylpenicillin is mainly active against gram-positive cocci. By and large a narrow-spectrum antimicrobial is less likely to disrupt a patient’s normal flora than a broad-spectrum agent. Hence, if the likely organism is causing an infection it is best to give a narrow-spectrum antimicrobial to treat that specific organism. If a patient presents ‘septic’ and the source of infection is unknown, relevant cultures should be taken followed by broad-spectrum antimicrobial cover. This can later be modified either when the source of infection is found or as a result of microbiology culture results. ● Agents mostly active against gram-positive bacteria include: ■ Penicillin (Also active against Neisseria spp.). ■ Fusidic acid. ■ Macrolides (Also active against Legionella, Campylobacter, Bordetella spp.). ■ Clindamycin. ■ Glycopeptides. ■ Oxazolidinones. ■ Streptogramins. ● Agents mainly active against gram-negative bacteria include: ■ Polymyxin. ■ Trimethoprim. ■ Aminoglycosides (also active against staphylococci and show synergy when combined with beta-lactams against/glycopeptides against streptococci). ■ Monobactams. ■ Temocillin. ● Broad-spectrum antimicrobials include: ■ Beta-lactam plus beta-lactamase inhibitor combinations. ■ Cephalosporins. ■ Carbapenems. ■ Chloramphenicol, Tetracyclines/Glycyclines. A bactericidal agent is a compound that actively kills multiplying bacteria. A bacteriostatic compound inhibits the growth of bacteria. Whether or not an antimicrobial is bactericidal or bacteriostatic depends on a variety of things, including the type of agent, its concentration, and the organism it is being used to treat. It is especially important to try and use a bactericidal agent if the patient’s immune system is impaired or the infection is at a site where it is difficult for the immune system to access, e.g. the heart valves in bacterial endocarditis, the meninges in meningitis. Examples of each are given here: ● Bactericidal agents include beta-lactams, glycopeptides, fluoroquinolones, and aminoglycosides. ● Bacteriostatic agents include macrolides, clindamycin, tetracyclines, trimethoprim, and sulphonamides. The therapeutic index of a drug is the ration of the concentration of drug likely to be toxic to the patient divided by the concentration of drug likely to be clinically effective.
Antivirals
Authors: William Tong C. Y.
Published: November 2020

Viruses are obligate intracellular pathogens that utilize many of the host metabolic machineries for reproduction. Unlike the binary fission of bacteria, the replication process of viruses is more like a production line with a final assembly process to produce their progenies. Any agents used to prevent viral replication must be specific to the virus and cause as little problem for the host as possible. The rate of virus replication can also cause problems. In rapidly reproducing viruses, the high replication rate generates mutants that could be selected for resistance to antivirals. On the other hand, viruses could remain latent with little metabolic activity. None of the current antivirals are effective against latent viruses. The life cycle of a typical virus goes through the following stages: ● Attachment; ● Entry and uncoating; ● Replication of viral nucleic acid; ● Establishing latency or persistent infection (in some viruses); ● Translation of viral protein and post-translational modifications; ● Secretion and assembly of viral particles; and ● Release from host cells. Each of these steps can be used as antiviral targets. The most common strategy is to use a nucleoside analogue as a false substrate. However, such a false substrate can also be taken up by host polymerase and could result in toxicity, e.g. mitochondrial toxicity in some of the earlier antiretroviral drugs. The most successful example to circumvent this problem is aciclovir, which is the prodrug of the active agent aciclovir tri-phosphate. Aciclovir is a substrate for the viral enzyme thymidine kinase carried by the herpes simplex virus (HSV) and varicella-zoster virus (VZV), which converts it into aciclovir monophosphate. As this only happens inside cells infected by HSV or VZV, it is concentrated only in infected cells. Host enzymes then add further phosphates to form the active agent aciclovir triphosphate, which has a higher affinity to viral polymerase than host polymerase. It acts as a false substrate for the viral polymerase and results in premature termination of nucleic acid replication. A similar mechanism is utilized in ganciclovir against cytomegalovirus (CMV). The viral phosphate kinase involved in the case of CMV is the UL97 protein.
Epidemiology and Natural History of HIV
Authors: Khan Palwasha , Parry Sarah
Published: November 2020

The human immunodeficiency virus (HIV) is a member of the genus Lentivirus, a subgroup of retrovirus (Retroviridae), that causes HIV infection, which, if untreated, results in acquired immunodeficiency syndrome (AIDS) and death. It was first described in 1981 during an epidemic of a previously unknown immunodeficiency syndrome in the US. The term HIV was accepted in 1986. HIV is thought to originate from simian immune deficiency virus (SIV). HIV-1 was discovered first, with the epidemic of AIDS in the US in 1981. In 1986, a related virus subsequently known as HIV-2, was identified in West Africa. The viruses differ in several aspects; HIV-1 is found worldwide, whereas HIV-2 is predominantly found in West Africa. HIV-1 is a more virulent and rapidly progressive virus; HIV-2 tends to be present in lower viral quantities and progresses more slowly. The number of people living with HIV (PLWH) rose from an estimated 9.0 million in 1990 to 36.9 million in 2014, due in part to a substantial improvement in survival rates as a result of effective anti-retroviral treatment. By 2014, annual new HIV infections had dropped to 2.0 million, down from 3.1 million in 2000, representing a decline of about 35%, although there remain an estimated 5600 people newly infected with HIV every day. It is estimated that without the global response that was mounted in 2000, notably the ‘Combatting of HIV/AIDS’ (the 6th Millennium Development Goal, which focused on halting and reversing trends for HIV by the end of 2015) there would have been six million new infections in 2013 alone. The main driver of progress has been widespread roll-out of antiretroviral treatment (ART) and behavioural change interventions, resulting in increased condom use, fewer multiple sexual partnerships, and delayed sexual debut. HIV-related deaths peaked in 2004–2005, and deaths fell by 24% between 2000 and 2014 from 1.2 million (0.98–1.6 million) in 2014 compared to 1.6 million (1.3–2.1 million) in 2000. The drop in AIDS-related mortality has been even steeper among children aged under fifteen years of age due to the enormous progress made with prevention of mother-to-child transmission (PMTCT).
Orthopaedics
Authors: Davies Nev , Vusirikala Anuhya
Published: November 2020

Over the years, orthopaedic surgery has evolved into a vast specialty that is ever growing, with new technology, techniques, and implants. Computer-assisted surgery and minimally invasive approaches are current hot topics that are pushing the boundaries of what constitutes gold standard care for patients. This specialty touches people of all ages from all walks of life. The practicality and logic in decision-making and management appeal to today’s modern ‘orthopods’. Common paediatric orthopaedic conditions, such as developmental dysplasia of the hip and septic arthritis, can have serious consequences for the rest of the child’s life if unrecognized and so are represented in this chapter. Arthroplasty has been one of the true successes of the twenty-first century, and now over 160 000 knee and hip replacements are performed each year in the UK, revolutionizing the quality of life of patients with painful disabling arthritis. To be a good orthopaedic surgeon requires not only a wide knowledge base, but also common sense, logic, and practical skills. ‘A good surgeon knows how to operate; a great surgeon knows when to operate’ is a classic saying that was drilled into me as a young houseman. In this specialty, there are often several management options facing the surgeon and the patient, and through careful discussion and the process of informed consent, a joint plan can be formulated and executed. The questions in this chapter will help you to prepare both for your exams and for a future career as a doctor.
Pre-hospital care
Authors: Harrison Oliver
Published: November 2020

Many doctors are attracted to pre-hospital emergency medicine (PHEM) because of the variety of challenges that it presents. With limited time and resources, the doctor is expected to assess and treat a range of medical and traumatic pathologies in patients of any age, without delaying transport to the most appropriate location for definitive care. This must be done in spite of what is usually a suboptimal environment, e.g. in a ditch at the roadside, on a rainy building site, or in a crowded town centre. Recognizing the limitations of what can be achieved on scene is a key skill that must be balanced against the increasing range of lifesaving interventions at the disposal of pre-hospital teams. While PHEM has been practised by a variety of doctors for many years, it has only recently gained General Medical Council (GMC) subspecialty recognition. A formal training programme may now be undertaken by trainees with base specialties of acute medicine, anaesthetics, emergency medicine, and intensive care medicine, leading to a dual certificate of completion of training. The challenging nature of the pre-hospital environment, the high-risk nature of the interventions that can be undertaken, and the lack of availability of immediate assistance on scene mean that PHEM is a service delivered by consultants and senior trainees. Medical students and foundation doctors who may be interested in PHEM training should seek to spend time in the above mentioned acute specialties, as well as looking for opportunities to observe alongside some of the services that operate nationally. The following questions represent a small selection of the range of scenarios that may be faced by a PHEM practitioner on a day-to-day basis.
Mock exam
Authors: Whymark Caroline , Junkin Ross , Ramsey Judith
Published: November 2020

To pass the written part of the FRCA, candidates must achieve the pass mark for the SAQs and the MCQ/ SBA papers combined. Therefore, doing particularly well in one paper, or one area, can compensate for another in which you have scored poorly. The 30 SBA questions is an area that candidates commonly find difficult. There is a feeling these questions are unjust and that it is impossible to second guess the examiners and choose the correct option. They feel further punished that four marks are awarded for each correct answer or lost for an incorrect choice. While this reflects the fact that four answers have been eliminated in the course of choosing the best answer, candidates often state it is an unfair ‘all or nothing’ way to mark these questions. They can commonly narrow the choice down to a final two options but report finding it difficult to then choose between them. They receive no credit having successfully eliminated three of the options and cite the SBA element as being the reason they failed the examination. These comments however are not supported by examination success data published by the RCoA. The pass rate for this paper was consistent at around 70% before and after the introduction of the SBA component in September 2011. We believe the concepts behind the SBAs are misunderstood by many. When asked to write a SBA question, candidates inevitably produce a five- part A to E multiple choice question but with only one correct answer. The finer points of SBA questions are lost among quickly written revision aids containing what the authors believe to be examination standard questions, when often they are not. Further, because SBAs are a relatively new element to the FRCA there is a limited bank of questions, and a highly restricted number in the public domain. Both these factors make practice of these questions difficult. Part of exam success is practice of the technique and question type in advance. We believe the practice of SBAs is an area to which candidates do not give enough attention.
Technology and Urbanism in Late Bronze Age Egypt
Authors: Hodgkinson Anna   K.
Published: November 2020

This book provides the first systematic and comprehensive discussion of the intra-urban distribution of high-status goods, and their production or role as a marker of the nature of the settlements known as royal cities of New Kingdom Egypt (c.1550-1069 BC). Using spatial analysis to detect patterns of artefact distribution, the study focuses on Amarna, Gurob, and Malqata, incorporating Qantir/Pi-Ramesse for comparison. Being royal cities, these three settlements had a great need for luxury goods. Such items were made of either highly valuable materials, or materials that were not easily produced and therefore required a certain set of skills. Specifically, the industries discussed are those of glass, faience, metal, sculpture, and textiles. Analysis of the evidence of high-status industrial processes throughout the urban settlements, has demonstrated that industrial activities took place in institutionalized buildings, in houses of the elite, and also in small domestic complexes. This leads to the conclusion that materials were processed at different levels throughout the settlements and were subject to a strict pattern of control. The methodological approach to each settlement necessarily varies, depending on the nature and quality of the available data. By examining the distribution of high-status or luxury materials, in addition to archaeological and artefactual evidence of their production, a deeper understanding has been achieved of how industries were organized and how they influenced urban life in New Kingdom Egypt.
Embers from the House of Blazes: Fragments, Relics, Ruins of Chicago
Authors: Graff Rebecca S.
Published: November 2020

Fragments imply a former whole, and ruins invoke a material landscape once cared for and conserved, now neglected. What meaning is conveyed when fragments of formerly whole structures—ruined or plundered as ‘relics’—are incorporated into new ones, devoid of prior context? Does an aesthetic appreciation for in situ ruins also relate to interest in their fragments? This tradition of, and fascination with, reusing and recontextualizing fragments of ruined structures spans the broad sweep of time from antiquity to the present day (see also Shanahan and Shanahan, Chapter 5). Rome’s Arch of Constantine (erected 315 CE) incorporated fragments from the arches of Hadrian and Marcus Aurelius, visually and materially connecting their collective glory to the new reign. Such reuse is found plentifully in indirect gestures, such as the Beaux-Arts municipal buildings of the United States that draw stylistic influences from classical antiquity, as reimagined in the Italian Renaissance and incorporated into the nineteenth-century architectural canon. Still other examples of direct reuse of fragments, such as architectural fragments from New York’s World Trade Center that have been incorporated into myriad 9/11 monuments, are often a way to commemorate the tragic circumstances that created such ruins, reminding us how the materiality of age, added by narrative and even literal labels, provides a space for nostalgic reminiscence or communion with an event that might be personally distant, though emotionally compelling just the same (see White and Seidenberg, Chapter 1, for discussion of a similar phenomenon in Berlin). Inspired by the increasing impact of contemporary archaeology on considerations of materiality, temporality, and erasure within archaeologically produced ‘present pasts’ (see Harrison et al. 2014), this essay focuses on two cases of creative reuse of fragmentary architectural and building materials in Chicago, one still extant, and the other no longer even a ruin. The first case, once made of ‘ruins’, has been demolished and, more significantly, erased: the Relic House, built in 1872 from ‘leavings’ of the 1871 Chicago Fire. Serving as a saloon, salon, and speakeasy until its demolition in 1929, the Relic House drew guests who wished to commune with the ‘ruins’ of the tragic fire in a space mediated by recreational consumption and novelty. One of these uses included a venue for the bohemian Dill Pickle Club, whose founder renamed the structure the ‘House of Blazes’, evoking its fabrication from Fire debris.
Future Mortality in Low Mortality Countries
Authors: Caselli Graziella , Drefahl Sven
Published: November 2020

This chapter provides an overview of past and expected future trends in life expectancy in populations with low levels of mortality. High and low mortality populations were separated on the basis of the level of child mortality in the year 2010 according to the revised estimates of the United Nations Inter-agency Group for Child Mortality Estimation (2011), with the threshold being 40 deaths per 1,000 children below the age of 5 years. The low mortality population is comprised of 132 countries including Europe, North America, most of Oceania and Latin America, large parts of Asia (excluding the high mortality area in Central and Southern Asia), and Northern Africa. The populations of these countries are already engaged in an advanced phase of the demographic and ‘epidemiologic transition’. Because they previously experienced strong decreases in infant mortality, the future mortality trends are driven mainly by mortality in adult ages, primarily the old and oldest-old. Although the data sources on which the existing estimates of life expectancy for these populations are based vary considerably (owing to differences in the death registration systems and the estimation techniques, see, e.g., Luy, 2010), we have relatively good knowledge of past and current mortality levels and trends and their causes. Despite the similar general trends, today’s low mortality countries are very heterogeneous in various aspects, including medical standards, access to health care, and behavioural risk factors, such as smoking prevalence. These diversities are strongly related to the populations’ stages of economic development and contribute to a broad variance of life expectancy levels. Among men, life expectancy at birth for the years 2005–10 ranges between 60.2 in Kazakhstan and 79.5 in Iceland. Among women, the range is between 67.8 in the Solomon Islands and 86.1 in Japan. To demonstrate this relationship between economic development and life expectancy we classified countries according to their current per capita income as an indicator of the economic development level of the populations. We used the World Bank classification, which groups countries into high income (≥$12,276 annually), upper middle income ($3,976–$12,275), lower middle income ($1,006–$3,975), and low income (≤$1,005).
Future Mortality in High Mortality Countries
Authors: Garbero Alessandra , Pamuk Elsie
Published: November 2020

The theory and empirical basis of the demographic transition includes the important role played by mortality declines in generating a societal shift from high mortality and high fertility to low mortality and low fertility. In particular, it is the improved survival of children into adulthood that initially produces increasingly large populations with a very young age structure. Because the level of childhood mortality is strongly linked to fertility levels (Angeles, 2010; Becker and Barro, 1988) and adult mortality rates, the definition of a high mortality country used in the IIASA–Oxford survey reported in this book is in terms of the level of childhood mortality, that is, the probability of death before the age of five (5q0 in the life table designation). In accordance with recent practice at the World Health Organization (WHO) and UNICEF in monitoring progress toward the Millennium Development Goals, we use a cutoff point of 40 deaths before age 5 per thousand live births to designate a country as having high mortality (Hill et al., 2012). In 2010, the under-5 mortality rate exceeded 40 in one-third of the 193 member countries of United Nations (UN), and in only one of these countries did life expectancy at birth exceed 70 years (Azerbaijan, e0 = 70.1) (United Nations, 2011a). Despite its relatively low under-five mortality rate (estimated at 0.025 in 2011), Botswana is also considered here as a country with high mortality because its life expectancy is estimated at 53 years (United Nations, 2011a). The geographic distribution of these countries is shown in Figure 6.1, while Table 6.1 lists all 65 high mortality countries, along with current estimates of life expectancy, child mortality, and the change in life expectancy between the periods 1995–2005 and 2005–2010. As shown, high mortality countries include all of sub-Saharan Africa except the island nations of Cape Verde, Mauritius, Mayotte, and Réunion. Most of South Asia meets the criterion of high mortality, including the populous countries of India, Pakistan, and Bangladesh. Many demographers have, over the last 50 years, predicted a general convergence worldwide toward low mortality and fertility resulting in higher levels of life expectancy.
Is Schizophrenia Inherited?
Authors: Glatt Stephen J. , Faraone Stephen V. , Tsuang Ming T.
Published: November 2020

We have known for some time, from family studies done in Europe in the first half of the 1900s, that schizophrenia runs in families. These studies found the risks for the parents, brothers, and sisters of people with schizophrenia to be be­tween 4% and 14%— on average about ten times as high as that for the general population. For children of those with schizophrenia, the risk was 12%, nearly 15 times the general population risk. When both parents had schizophrenia, the risk increased to about 40%. The risk to uncles and aunts, nephews and nieces, grandchildren, and half- brothers or -sisters was roughly three times the risk in the general population. This risk was much lower than the risk to the relatives in the immediate family circle. On the whole, these pioneering studies showed thatthe closer the blood relationship of a person to an individual with schizophrenia, the higher the risk for the disorder.Modern studies using morestrict research methods and reliable definitions of schizophrenia also found the disorder to run in families. However, they find risk estimates that are a bit lower than those found in earlier studies. For ex­ample, in a large family study from Iowa, Tsuang and his team reported the risk of schizophrenia to brothers and sisters of individuals with schizophreniato be about 3%. This level of risk was five times greater than the risk to relatives of persons without schizophrenia. Other modern studies found similar results. Diagnostic practises seem to play a strong role in these different estimates. The early European studies usually used a fairly broad definition of the illness while the modern studies used a strict criterion- based diagnosis developed for use in research. Indeed, modern researchers have noted that their family risk figures for schizophrenia are similar to the figures obtained by the earlier European studies when atypical cases are included in the definition of schizophrenia. In other words, the level of risk that we can pin on a family history of schizophrenia depends on how broadly we define the disorder and whether or not we include atypical cases and spectrum disorders.
Place Your Bets: In It to Win It
Authors: Vedral Vlatko
Published: November 2020

Until now we have discussed how life propagates and how life eventually ends; but I guess what most of us are preoccupied with is ‘what we do in between.’ In this chapter, I would like to stay in-between these two extremes and enjoy the moment. What more could we ask for? Excitement is what I, for one, would like to have. Whilst the concept of excitement may be subjective, most would agree that some modicum of risk comes as a given. It is much harder to get excited by certainty (let’s face it, we all find certainty boring). Let us instead choose life and discuss the various ways to make it more exciting. It’s 1962 Las Vegas, the city of dreams. Millions are made and lost every minute of every day. The city is littered with dreams of rookies making their way across the Nevada desert with borrowed money to chance their arm. Perhaps he will come back a millionaire or perhaps he will come back with his tail between his legs. But this day is different. Today a new cowboy is in town. He enters one of the casinos, the music is going, the cameras are on him, and the wine and the girls are on tap. He looks around, spots the blackjack table and makes a beeline straight for it. When the sexiest game in town is poker – why is this guy spending all his time on the blackjack table? He has a strategy, he thinks, that will beat the dealer. In his pocket, he has $10,000 to play with (in 1962 not an insignificant amount – worth around a cool quarter of a million dollars today), so this guy clearly means business. He starts to play the game like any rookie, placing small bets, quite innocuous, but as the game wears on, whilst others were leaving the table, this guy is still going. Slowly but surely his strategy seemed to be working. Of course, no casino likes winners, and is particularly wary of those that go about their business with such ruthless efficiency in such a cool and methodical manner.