bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial Stewardship
Authors: Ameen Sarfaraz , NicFhogartaigh Caoimhe
Published: November 2020

Antimicrobial stewardship (AMS) is a healthcare- system- wide approach to promoting and monitoring the judicious use of antimicrobials (including antibiotics) to preserve their future effectiveness and optimize outcomes for patients. Put simply, it is using the right antibiotic, at the right dose, via the right route, at the right time, for the right duration (Centres for Disease Control, 2010). Antimicrobial resistance (AMR) is a serious and growing global public health concern. Antibiotics are a unique class of drug as their use in individual patients may have an impact on others through the spread of resistant organisms. Antibiotics are essential for saving lives in conditions such as sepsis, and without effective antibiotics even minor operations could be life-threatening due to the risk of resistant infections. Across Europe approximately 25,000 people die each year as a result of hospital infections caused by resistant bacteria, and others have more prolonged and complicated illness. By 2050, AMR is predicted to be one of the major causes of death worldwide. Protecting the use of currently available antibiotics is crucial as discovery of new antimicrobials has stalled. Studies consistently demonstrate that 30–50% of antimicrobial prescriptions are unnecessary or inappropriate. Figure 18.1 shows some of the reasons behind this. As well as driving increasing resistance, unnecessary prescribing leads to unwanted adverse effects, including avoidable drug reactions and interactions, Clostridium difficile-associated diarrhoea, and healthcare-associated infections with resistant micro-organisms, all of which are associated with adverse clinical outcomes, including increased length of hospital stay and mortality, with increased cost to healthcare systems. Prudent use of antibiotics improves patient care and clinical outcomes, reduces the spread of antimicrobial resistance, and saves money. There are a number of global and national guidelines outlining what a robust AMS programme should consist of (see Further reading and useful resources), including: ● Infectious Diseases Society of America (IDSA): Guidelines for Developing an Institutional Programme to Enhance Antimicrobial Stewardship. ● National Institute for Health and Care Excellence (NICE): Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use [NG15]. ● Department of Health (DoH): Start Smart Then Focus, updated 2015. ● DoH: UK 5- Year Antimicrobial Resistance Strategy 2013 to 2018.
Blood-Borne Viruses
Authors: William Tong C. Y. , Hopkins Mark
Published: November 2020

Blood- borne viruses (BBVs) are viral infections transmitted by blood or body fluid. In practice, any viral infection that achieves a high viral load in blood or body fluid can be transmitted through exposure to infected biological materials. In western countries, the most significant BBVs are human immunodeficiency viruses (HIV1 and HIV2), hepatitis B virus (HBV) and hepatitis C virus (HCV). Other viruses that can be transmitted by blood and body fluid include human T cell lymphotropic viruses (HTLV1 and HTLV2), cytomegalovirus, West Nile virus and viruses responsible for viral haemorrhagic fever such as Ebola virus, Lassa virus, and Crimean-Congo haemorrhagic fever virus. BBVs are transmitted via exposure to blood and body fluid. Some examples of routes of transmission include: ● Sharing needles in people who inject drugs (PWID); ● Medical re-use of contaminated instruments (common in resource poor settings); ● Sharps injuries in healthcare setting, including in laboratories (less commonly through mucosal exposure); ● Transfusion of blood contaminated with BBVs (failure to screen blood donors); ● Transplantation of organs from BBV-infected donors; ● Sexual exposure to BBV-infected body fluid; and ● Exposure to maternal BBV infection: intrauterine, perinatally, or postnatally. If exposure to a BBV is via a needle stick injury in a healthcare setting, immediate first aid needs to be carried out by gently encouraging bleeding and washing the exposed area with soap and water. Prompt reporting of the incident is required so that an assessment can be done as soon as possible to determine if post-exposure prophylaxis (PEP) is required. The decision may be aided by urgent assessment of source patient infection status. The British Medical Association has issued guidance for testing adults who lack the capacity to consent. In the case of a sexual exposure to a BBV, immediate consultation to a genito-urinary medicine (GUM) clinic is warranted. The risk of transmission of BBVs associated with exposure depends on the nature of the exposure and the body fluid involved. The following factors are important in needle stick injuries: ● Deep percutaneous injury. ● Freshly used sharps. ● Visible blood on sharps.
Infection of the Central Nervous System
Authors: Rosmarin Caryn
Published: November 2020

Meningism is the syndrome of the triad of symptoms of headache, neck stiffness, and photophobia caused by irritation of the meninges. While it is often associated with a diagnosis of meningitis, it is also present in other conditions causing meningeal irritation such as subarachnoid haemorrhage, trigeminal neuralgia, migraine, or febrile illness in children. Meningitis is process of inflammation of the meninges, which may or may not be due to an infectious agent. Strictly speaking, it is a pathological diagnosis, but in lieu of the impracticability of biopsying the meninges, surrogate markers are used to infer inflammation. These include raised cerebrospinal fluid (CSF) white cell count and protein; and meningeal enhancement using contrast enhanced MRI or CT of the brain. Encephalitis is process of inflammation of the brain parenchyma. Strictly speaking, it is again a pathological diagnosis, and again surrogate markers are used to infer this inflammation, although it is slightly more difficult due to the protected nature of the brain. CSF white cell count and protein are expected to be elevated and parenchymal inflammation may be seen on contrast enhanced MRI. Meningoencephalitis is a combination of the above with inflammation of both the meninges and the adjoining brain parenchyma. Aseptic meningitis is said to be present when there is meningism and signs of meningeal inflammation on CSF and imaging, but no bacterial cause is found on culture or molecular diagnostics. Viral meningitis is the commonest cause, although post-neurosurgical aseptic meningitis is often chemical in nature. Meningism plus fever are the classic symptoms of meningitis. The onset may be acute, subacute, or chronic, depending on the cause. Neck stiffness may range from mild discomfort to an almost rigid neck and is not a sensitive test in young children or elderly. While not used routinely and with low sensitivity particularly in young children and elderly, Kernig’s and Brudkzinski’s signs, both of which stretch the meninges worsening the irritation and increasing pain, have a good positive predictive value. Non-specific signs of intracranial pathology may be present, such as signs of raised intracranial pressure (ICP), vomiting, reduced level of consciousness, focal neurological signs, seizures, or irritability, especially in the immunocompromised, elderly, and young children who may not have classic signs and symptoms.
Infections in the Immunocompromised Host
Authors: Riddell Anna , Sanz Marta Gonzalez
Published: November 2020

An understanding of the main aspects and functions of the immune system is important, i.e. physical barriers, innate, humoral, and cell-mediated immunity (see Chapter 6, Basic Immunology), when caring for the immunocompromised patient. In adults, secondary immunodeficiency is much more common than primary, and is most often due to iatrogenic immunosuppression with drugs, e.g. corticosteroids, chemotherapy agents, immunosuppressive agents, ‘biological’ therapies. For example, treatment with corticosteroids for more than one month is enough to increase the risk of some fungal infections such as Candida and Pneumocystis jirovecii, such that PCP prophylaxis should be considered in patients receiving ≤ 20mg/day prednisolone for four or more weeks. Chemotherapy and immunosuppressive agents may cause profound immunosuppression. The degree and duration of immunosuppression following a transplant, and the conditioning regimen used before the transplant varies with respect to the type of transplant: heart and lung transplant recipients typically receive more significant immunosuppression, and so are at increased risk of opportunistic infection compared to other solid-organ transplant recipients. Infections (e.g. HIV), cancer, and autoimmune disorders and the treatment of these conditions can also affect the immune system. Other diseases are also considered immunosuppressive although the exact nature of this is less well defined, for example, poorly controlled diabetes mellitus increases the risk of candidal infections and common bacterial infections. Cirrhosis is also considered to be a relatively immunosuppressed state. Understanding the nature of immune defects in both primary and secondary immunodeficiency allows more accurate prediction of overall infection risk and risk of specific pathogens, allowing a rational approach to infection prevention and investigation when patients become unwell. The initial assessment of the immunocompromised host should be to identify why the patient is immunocompromised, how long they have been immunocompromised (is it a congenital or acquired immunodeficiency?), and whether there is potential for immune recovery. Clearly, a person with a congenital immunodeficiency will have lifelong susceptibility to specific infections, unlike an acquired deficiency due to chemotherapy or transplantation which may be transient. If the immunosuppression is due to a drug, is it possible to reduce or change the immunosuppression? If an infection is suspected, pre-immunosuppression infection screening results can help identify whether the current presentation represents reactivation of a latent infection or primary infection.
Different Types of Vaccines
Authors: William Tong C. Y.
Published: November 2020

Vaccines can be classified according to their nature into the following types: ● Inactivated vaccines: ■ Whole organism; ■ Acellular extracts. ● Live attenuated vaccines. ● Toxoid vaccines. ● Subunit vaccines. ● Conjugate vaccines. ● DNA vaccines. ● Recombinant vector vaccines. Inactivation of the whole organism is the most basic form of vaccine produced by killing the micro-organism causing the disease using heat, chemical or radiation and presents all the antigens in the inactivated organism as a vaccine to induce immunity in the recipient. Other methods to produce an inactivated vaccine is by extracting acellular components of the organism through filtration. Examples of inactivated bacterial vaccines currently in use include: ● Anthrax—sterile filtrate from cultures of the Sterne strain of B. anthracis. ● Cholera—oral inactivated vaccine with 1mg of recombinant cholera toxin B (rCTB) in a liquid suspension of four strains of killed V. cholerae O1, representing subtypes Inaba and Ogawa and biotypes El Tor and classical. ● Pertussis—acellular vaccine has replaced previously used whole cell vaccine. ● Typhoid—purified Vi capsular polysaccharide from S. typhi; NB: the injectable, killed, whole-cell typhoid vaccine which contains heat-inactivated, phenol-preserved S. typhi organisms is no longer in use in the UK. Examples of inactivated viral vaccines currently in use in the UK include: ● Hepatitis A virus. ● Hepatitis E virus. ● Influenza A and B viruses. ● Japanese encephalitis virus. ● Polio viruses 1, 2, and 3 (IPV). ● Rabies virus. ● Tick-borne encephalitis virus. ● Bacterial vaccines: Bacillus Calmette-Guerin (BCG) vaccine is a live attenuated vaccine against tuberculosis derived from a Mycobacterium bovis strain. The oral typhoid vaccine contains a live attenuated strain of S. typhi (Ty21a) in an enteric-coated capsule. ● Viral vaccines: The measles, mumps, and rubella (MMR) vaccine contain live attenuated strains of measles, mumps, and rubella viruses, which are cultured separately and mixed before being lyophilized. Oral polio vaccine (OPV) against polio viruses 1, 2, and 3—OPV contains live attenuated strains of poliomyelitis virus types 1, 2, and 3 grown in cell cultures.
Vaccination Schedules
Authors: Shin Gee Yen
Published: November 2020

The vaccines included in the current UK Immunisation Schedule offer protection against the following pathogens: A. Viruses ● Measles ● Mumps ● Rubella ● Polio ● Human Papilloma Virus (certain serotypes) ● Rotavirus ● Influenza virus (flu A and B) ● Varicella zoster virus (shingles) ● Hepatitis B virus B. Bacteria ● Corynebacterium diphtheriae (Diphtheria) ● Clostridium tetani (Tetanus) ● Bordetella pertussis (Pertussis) ● Haemophilus influenzae type B (Hib) ● Neisseria meningitidis (Meningococcal disease—certain serotypes) ● Streptococcus pneumoniae (Pneumococcal disease—certain serotypes) The UK Immunisation Schedule has evolved over several decades and reflects changes in vaccine development and commercial availability, national and sometimes international disease epidemiology, and the latest expert opinion. It is designed to offer optimal protection against infectious diseases of childhood to infants and children at the most appropriate age. The most up-to-date information about the UK Immunisation Schedule is available on the online version of the Department of Health publication commonly known as the ‘Green Book’: Immunisation Against Infectious Disease Handbook (see Further reading. Various chapters of the online version are updated at regular intervals; thus, it is very important to refer to the online version of the Green Book on the website for current guidance. Changes to the UK Immunisation Schedule are made on the recommendation of the independent Joint Committee on Vaccines and Immunisation (JCVI). Several of the UK Immunisation Schedule vaccines are combined vaccines: ● Measles, mumps, and rubella (MMR). ● Hexavalent diphtheria, tetanus, acellular pertussis, inactivated polio virus, Haemophilus influenza type b, hepatitis B (DTaP/IPV/Hib/HepB). ● Diphtheria, tetanus, acellular pertussis, inactivated polio, and Haemophilus influenzae (DTaP/IPV/Hib). ● Diphtheria, tetanus, acellular pertussis, inactivated polio (DTaP/IPV). ● Tetanus, diphtheria, and inactivated polio (Td/IPV). ● Inactivated influenza vaccine: influenza A H1N1, H3N2, influenza B. ● Live attenuated intranasal influenza vaccine: influenza A H1N1, H3N2, influenza B. In the UK, vaccines against single pathogens covered by the MMR vaccine are not recommended and not available in the National Health Service (NHS). There has been some limited demand for single-target vaccines, e.g. measles, due to misguided and unfounded concerns about the alleged risks of autism following MMR.
Post-Exposure Prophylaxis
Authors: William Tong C. Y.
Published: November 2020

Post-exposure prophylaxis (PEP) is a treatment administered to an individual to prevent the development of infection or reduce the severity of illness after a potential or documented exposure to a microorganism. This may primarily be for the protection of the exposed individual concern, or in the case of a pregnant woman, for protecting the foetus in utero. PEP may also be useful in public health to reduce the risk of secondary spread of infection. A good history is required in order to make a proper assessment of the risk. The following questions should be asked: A. Which infection is suspected and is the source infectious? It is straight forward if the diagnosis of the source of exposure is already known, e.g. known HIV, established diagnosis of tuberculosis. However, in many cases, the diagnosis of the source may not be certain, e.g. needle stick injury involving a needle of unknown origin, bitten by a stray dog, exposed to a child with a non-specific rash. In such cases, a risk assessment is required to assess the likelihood that the source may be infectious. Knowledge of local epidemiology or recent outbreaks in a particular locality may help in such risk assessment. B. What is the nature of the exposure? Knowledge of the mode of transmission of a microorganism is important to establish if there is any risk of transmission through the exposure In the case of mother-to-child transmission, PEP to the neonate born to a mother with an infection is effective if the mode of transmission is predominately perinatal, e.g. hepatitis B. If the mode of transmission is transplacental, it is too late to administer PEP to the baby after delivery. Instead, the expected mother should be given prophylaxis during pregnancy to prevent infection, e.g. chicken pox, or given antivirals to reduce infectivity, e.g. maternal hepatitis B with a high viral load when transplacental infection may occur. In HIV, where transmission can occur both transplacentally and perinatally, antiretroviral therapy (ART) needs to be given during pregnancy and often during labour as well as to the baby after birth.
Geographical Pattern of Infectious Diseases and Infection Prevention for Travellers
Authors: Hsu Desmond , Eltahir Babiker Zahir Osman
Published: November 2020

Infectious diseases are transmitted either directly from person to person via direct contact or droplet exposure, or indirectly through a vector organism (mosquito or tick) or a non-biological physical vehicle (soil or water). Vector-borne infectious diseases are highly influenced by climate factors such as temperature, precipitation, altitude, sunshine duration, and wind. Therefore, climate change is a major threat for the emergence and re-emergence of infectious diseases, e.g. re-emergence of dengue fever in some parts of southern Europe. The natural reservoirs of infectious diseases are either humans (anthroponoses) or animals (zoonoses). Population movement due to travel or civil unrest risks introducing non-immune populations to regions that are endemic for certain infectious diseases. By contrast, global trade contributes to the movement of animals or arthropods across the world and this poses a major risk for introducing infectious diseases to previously non-endemic settings, e.g. rats on board commercial ships and the global spread of hantaviruses; international trade in used car tyres and the risk of introducing flavivirus-infected mosquitoes into non-endemic settings; and the contribution of migratory birds to the introduction and the spread of West Nile virus in the United States. The unprecedented growth of international travel facilitates the swift movement of pathogens by travellers from one region to another. The main determinants of travel-related infections are destination country, activities undertaken during travel, and pre-existing morbidities. Therefore, the pre-travel consultation aims to assess potential health hazards associated with the trip, give advice on appropriate preventative measures, and educate the traveller about their own health. Attitudes towards seeking pre-travel health advice vary by the type of traveller. For example, those visiting friends and relatives (VFRs) in their country of origin are less likely to seek pre-travel health advice compared to tourists and therefore stand a higher chance of presenting with preventable infections such as malaria. The key aspects of a pre-travel consultation include: ● comprehensive risk assessment based on the demographic and clinical background of the traveller as well as the region of travel and itinerary.
Gynaecology and genitourinary medicine
Authors: Hayes Kevin
Published: November 2020

Gynaecological practices are changing constantly, with more emphasis on management in primary care, conservative, rather than surgical, management of conditions, and an increase in sub-specialization such as gynaecological oncology and urogynaecology. This chapter reflects these changes and covers the commonest areas in this interesting field. Sexual health is a specialty in its own right. The number of cases of sexually transmitted infections are rising in the UK, despite efforts to raise awareness of safe sex, so knowledge of their presentations is important. The UK also has the highest rate of teenage pregnancy in Europe, and the Government has set targets to improve access to contraceptive advice for women. In recent years, astounding advances have been made in the treatment of human immunodeficiency virus (HIV) infection, and people with HIV can now expect to have a much better quality of life. Although this chapter primarily focuses on diseases affecting women, we have included questions on the sexual health of men to represent the full spectrum of sexual health practice.
Primary care
Authors: Edwards Philippa
Published: November 2020

General practitioners (GPs) are the gatekeepers of the National Health Service in the UK, and virtually all referrals to secondary care are made through them. The breadth and depth of the discipline can at times seem overwhelming, although the old adage ‘common things occur commonly’ still holds. GPs need to be confident in the diagnosis and management of conditions from birth to the grave, and to know their boundaries of competence and when to refer to secondary care. The complexity of the GP consultation includes the following two points: 1. Many conditions present in a relatively undifferentiated form to the GP, whose job it is to try to identify whether the condition is normal or abnormal, and whether it is serious or minor. 2. GPs develop a close professional relationship with many of their patients and may also be the point of contact for other members of the family, neighbours, and friends of the patient. This knowledge is an important aspect of their holistic approach to medicine and is much valued by their patients. As the nineteenth-century physician Sir William Osler (1849–1919) said, ‘The good physician treats the disease; the great physician treats the patient who has the disease.’ The commonest presentations to GPs in the UK are for respiratory problems, chronic disease management, musculoskeletal disorders, and psychological problems. Health promotion, in particular smoking cessation and the management of obesity, is also important in preventing chronic illness. Although many presentations are minor and self-limiting, serious illnesses also occur, and GPs need to be able to recognize them, sometimes in the early stages. The questions in this chapter will assess your knowledge in the common areas that present, testing diagnostic skills and reasoning. They also test negotiating skills to ensure patient compliance, teamworking within the primary care setting, and risk management.
Anaesthesia and intensive care
Authors: Bonner Alex
Published: November 2020

Anaesthesia is a relatively young specialty by comparison with its counterparts. William Morton administered the first anaesthetic in 1846 in Boston, Massachusetts, and the Royal College of Anaesthetists was cleaved from the Royal College of Surgeons in 1948. Now anaesthetists form the largest group of hospital-based doctors. Anaesthetists are highly trained physicians whose role is by no means limited to the operating theatre. They oversee the patient journey through the peri-operative period, i.e. preoperative assessment and optimization of the sick surgical patient, ensuring safe intra-operative provision of anaesthesia as well as care of the patient in the early post-operative period. Anaesthetic skills are also requested during management of the critically ill in the Emergency Department, during the care of the parturient mother in providing analgesic, anaesthetic, and intensive care input, and increasingly in the pre-hospital environment. Anaesthetists have an important role in the practice of intensive care where complementary experience in medicine is useful. Other roles of the anaesthetist include provision of acute and chronic pain services. and subspecialty interests include regional, paediatric, cardiothoracic, vascular, and neuroanaesthesia. Anaesthesia is a highly practical specialty, with a strong emphasis on the basic sciences underpinning its practice. Physiology and pharmacology exert their effects with immediacy; therefore, an affinity for these disciplines is desirable. Anaesthetists need to be able to assimilate knowledge of the basic sciences with skills in history and examination, in order to plan for, and respond to, patient needs. In answering these questions, you will be asked to use similar skills.
Trauma
Authors: Davies Nev , Vusirikala Anuhya
Published: November 2020

Trauma is a major public health problem and it is the commonest cause of death in those under the age of 40. Trauma care is a multidisciplinary specialty, and orthopaedic surgeons play an essential role in the initial and definitive management of patients with musculoskeletal injuries—saving lives and saving limb. The care provided to seriously injured trauma patients has improved significantly for a variety of reasons, including enhanced pre-hospital input, provision of care within a network of Major Trauma Units, and the availability of specialist rehabilitation services in hospital and in the community. The primary aim of the trauma team is to rapidly assess, resuscitate, and stabilize trauma patients and determine the extent of injuries sustained, so that the most appropriate immediate treatment can be administered. The questions in this chapter will highlight the important principles of trauma care and help you better comprehend the management of a seriously injured trauma patient.
Introduction
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.
Neurosurgery
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.
Malqata: Manufacturing at a Ceremonial Settlement
Authors: Hodgkinson Anna   K.
Published: November 2020

The eighteenth-dynasty royal city of Malqata has been selected, since much evidence has been discovered here, particularly with regard to faience-production and glass-working, and there is also limited evidence of metalworking and sculpture-production. The settlement itself dates to the reign of Amenhotep III, and more specifically to his thirtieth regal year, when it was established to celebrate the king’s first ḥb-sd (Sed-) festival, the jubilee and rejuvenation celebration of his thirty years of reign. He celebrated a total of three festivals, the other two taking place in his thirty-fourth and thirty-eighth regal years. Due to the somewhat patchy nature of the early excavations and survey work done at Malqata, especially between 1888 and 1971, no genuine spatial analysis, such as was done for the material from Amarna or Gurob, has been possible for Malqata. The early excavation reports, for instance that by Tytus, or those by Winlock for the Metropolitan Museum missions, simply state in a matter-of-fact way that they located the remains of glass factories in, for example, the South Village. They usually continue to list some of the artefacts that were found, which would indicate the presence of glass-working and faience-manufacture in the area, but they do not describe these objects in any detail, and nor do they indicate where—within the large area covered by the South Village—they were found. However, the author has had the opportunity to study the unpublished archive material from the early excavations at Malqata by the Metropolitan Museum of Art, New York, which took place during the early years of the last century. The excavation diaries kept in these archives revealed no detailed information as to more precise locations or quantities of finds. They did, however, make possible a better understanding of the origins of these interpretations, and the sample of relevant artefacts examined made possible further identification and clarification of their nature. In addition, the author was able to access some of the objects relevant to glass-working and faience-production from Malqata at the Brooklyn Museum and was furthermore given permission to study some of the unpublished site reports, plans, and finds lists from the University Museum of Pennsylvania mission, which took place between 1971 and 1977.
Luxury Goods Manufacture at Amarna, Gurob, and Malqata Compared
Authors: Hodgkinson Anna   K.
Published: November 2020

It should be borne in mind that the data from all archaeological excavations and surveys over the world, not only with the evidence from Amarna, Gurob, and Malqata, ought to be treated with a certain amount of caution. One problem that affects the data from all sites discussed here is that early excavations resulted in many objects being lost or being held unprovenanced in collections. The particular challenge with the archaeological evidence from Amarna is the fact that the site was very short-lived and that there was an abrupt move away from Amarna at the end of the Amarna Period. Many objects of high value would have been removed by their owners, or stolen by those using the opportunity. Certain areas of settlement, especially those to the extreme north and south of the site, were also more exposed than others, thus being more vulnerable to looters. In addition, conditions of preservation differ across the site, resulting in the better survival of objects in some areas than in others. While finds at Amarna, at least from the DOG excavations onwards, were fairly well catalogued according to their provenance, the origins of the objects excavated in the settlement areas of Gurob by Hughes-Hughes on behalf of Petrie are not possible to reconstruct. Hence, this data can only be generally compared to the results of the modern spatial analysis, and only tentatively be used to better understand the use of the site. In addition, the exposure of the site to much modern human activity, in particular during its period of use by the army, has resulted in much destruction and subsequent loss of data. The name of Malqata alone, in Arabic meaning ‘the place where things are found’, highlights the vulnerability of the site in the past and present and the fact that the corpus of material from this site is far from complete. Moreover, the insufficient level of documentation supplied by the 1888–1920 excavators (and the fact that the finds from these missions have still not been completely acquisitioned by museums) means that neither spatial nor statistical analyses are feasible for this site.
Commemorating Melbourne’s Past: Constructing and Contesting Space, Time, and Public Memory in Contemporary Parkscapes
Authors: Shanahan Madeline , Shanahan Brian
Published: November 2020

Melbourne’s urban parkscapes contain a range of memorials, monuments, and features, all of which have a role in the creation, performance, and reiteration of public memory and contemporary identity. These include a collection of sites and objects that originated in Australia’s pre-colonial and colonial past, but which were recontextualized and memorialized in the twentieth or twenty-first centuries. Despite the earlier origins of the material and remains incorporated at these sites, their subsequent recontextualization can tell us a great deal about the changing values and identities of the city’s communities over time. Thus, in this chapter we will argue that Melbourne’s urban parks have been used as places for reflection on the foundation stories of the city, and that through this engagement contemporary identities are reinforced, contested, and negotiated. Considerable attention has been paid previously to sites such as the Shrine of Remembrance, which commemorate Australia’s involvement in the World Wars, but in this chapter we will examine the practice and process of memorializing older material (see also Graff, Chapter 4, for examples of long-term memorial practices in Chicago). We are interested in what each site tells us about contemporary Melbourne’s changing relationship with its colonial and pre-colonial past, and the current nature of its post-colonial discourse. The terms ‘memorial’, ‘memorialization’, and ‘monument’ will appear throughout this chapter. We use ‘memorial’ to refer to an object erected or modified to commemorate an individual, organization, or event. This adheres to the literal definition (‘memorial’ 1, OED Online), but is also the way in which the term is used by local park and heritage authorities (City of Melbourne 2003: 1). By extension, ‘memorialization’ refers to the process by which something or someone is memorialized, or, as is more relevant to this chapter, the process through which an object or site becomes a memorial. We use the term ‘monument’ to refer more specifically to architectural or archaeological sites, which are commonly defined by their large or physically imposing presence (see Carver 1996). These may also have amemorial function, but they are not inherently defined by their commemorative value (Cooper et al. 2005: 240; Carman 2002: 46–7).
Repercussions of Differential Deindustrialization in the City: Memory and Identity in Contemporary East Belfast
Authors: McAtackney Laura
Published: November 2020

Contemporary archaeology has often combined the study of material culture with a strong social justice imperative, including examining the causes of abandonment of social housing (Buchli and Lucas 2001) and constructing lived experiences of homelessness (Zimmerman et al. 2010). Within this burgeoning field, archaeologies of cities have a significant role to play in interpreting the social implications of transition and change in the city by engaging with the spatial and temporal dimensions of material realities. By explicitly materializing the forgotten or hidden aspects of the post-industrial city, contemporary archaeology allows us to view global processes through the lens of local material expressions. Hilary Orange’s edited volume Reanimating Industrial Spaces (2014) is indicative of the current fascination in contemporary archaeology with the meaning of abandoned places of industry, the link between people and places and the often difficult transition from functional industrial places to post-industrial heritage spaces. Such volumes use a variety of methodological approaches to show how people, place and materials constitute the contemporary, post-industrial city. In doing so they reveal how contemporary archaeology has the potential to critique official narratives that frequently highlight resurgence and development while ignoring inconvenient truths of degradation, unemployment and poverty (see also Ernsten, Chapter 10). The latter experiences speak to this case study of East Belfast in Northern Ireland. For a society of its size Northern Ireland has been the subject of intense political and academic scrutiny, indeed often being accused of over-analysis to the point of exceptionalism (including Whyte 1990). Much of the research has centred on social relationships in urban areas impacted by internecine violence, however, in recent years this focus has shifted to the persisting problems of segregation and sectarianism as a remnant from the Troubles (c.1968–c.98) into the peace process. With the fifteen-year anniversary of the Belfast Agreement of 1998 (hereafter ‘the Agreement’) in 2013—a peace accord that at the time was positively greeted as the end of violence and initiating a move toward ‘normalisation’ (Irish News 2005)—there has been much debate as to the ongoing lack of substantive societal change. At the level of civic politics progress has been made, even if it has been non-linear and at times in danger of derailment.
A Renaissance with Revenants: Images Gathered from the Ruins of Cape Town’s Districts One and Six
Authors: Ernsten Christian
Published: November 2020

In this chapter I explore District One and District Six, two inner-city areas in Cape Town, South Africa, by means of a series of images gathered from its ruins. As a point of departure I quote Neville Lister. Lister is the first-person narrator of Ivan Vladislavić’s novel Double Negative (2011). He is a white middle-class young man from Johannesburg whose life overlaps with the city’s post-apartheid transformation. Vladislavić’s story, in which Lister becomes a photographer, was inspired by a volume of photographs of Johannesburg taken by renowned South African photographer David Goldblatt (Goldblatt 2010). As his protagonist finds himself in the post-apartheid city, Vladislavić highlights the complexities of attempts at representing a coherent visual narrative regarding South Africa’s disjunctive urban history. Over the course of the last decade or so I have visited Cape Town many times. My personal life converged with the city’s transformation as a result of fortuitous encounters I had first as a student, then as a tourist, and finally as a researcher. The six photographs discussed as part of this chapter are the product of collaborations in 2013 and 2014. Recalling the epigraph of Bettina Malcomess and Dorothee Kreutzfeldt’s book about Johannesburg, Not No Place (2013), I suggest the impressions conveyed by the images include, at best, ‘fragments of spaces and times’ representing post-apartheid Cape Town. Referring to Walter Benjamin and Thomas More, Malcomess and Kreutzfeldt describe the capture of the ‘double negative’ of the utopia (translated as ‘no place’), the materialization of ‘impossibility and always deferred potential’ (Malcomess and Kreutzfeldt 2013: 12). Like these critics, I focus on the difficulty of capturing the complex transformation undergone by Cape Town’s District One and District Six (see also Penrose, Chapter 8, for issues in capturing complex, capitalist transitions). Cape Town appeared as number one on the New York Times list ‘52 places to go to in 2014’. Journalist Sarah Khan wrote, ‘Cape Town is reinventing itself, and the world is invited to its renaissance’ (Khan 2014). It is a story about boutique shops, property values, gentrification, self-stylization, and the self-conscious craft of hipster appeal.
The static general equilibrium model
Authors: Fehr Hans , Kindermann Fabian
Published: November 2020

Our first application is the static general equilibrium model. The model is called static since intertemporal aspects, such as savings and investment, are excluded by assumption. Consequently the capital stock of the economy is constant and we concentrate on the intersectoral allocation of resources and labour–leisure choices. In this chapter, we start the discussion with the most simple model structure and then successively introduce additional complexities, like government activity, intermediate goods production, or international trade. The most simple model structure comprises a closed economy with a representative consumer who supplies labour and capital in fixed amounts which are used by firms to produce two consumption goods. Section 3.1.1 develops the so-called ‘command optimum’ using this basic model. This is the allocation that would be chosen by a social planner who knows endowments, technologies, and preferences. After that we compare the command optimum to the allocation in a market economy. Then we introduce variable labour supply and government activities. The representative household supplies his endowment of capital .K̅ and labour .L̅ to the firms which use these inputs to produce output Y1 and Y2 of goods 1 and 2. Household consumption is denoted by X1 and X2 respectively. The economic problem is to allocate the scarce factor resources K and L to the two different types of firms in order to produce an output combination which maximizes the utility of the representative household. The latter is called an efficient allocation. In order to find the efficient allocation we first have to specify preferences and technologies.
The overlapping generations model
Authors: Fehr Hans , Kindermann Fabian
Published: November 2020

In discussing the life-cycle model, we focused on the individual-choice problem without taking into account the interaction between households, the production sector of the economy, and the government. In this chapter we take a broader perspective and embed the life-cycle model into a general equilibrium framework. In this framework, prices adjust in order to balance supply and demand in goods and factor markets and the government has to operate under some balanced-budget rules.As in the previous chapter, individuals save in order to smooth consumption over the life cycle. However now, individual savings behaviour endogenously determines the capital stock. This is the central difference from the static general equilibrium model discussed in Chapter 3. Since in our equilibrium framework we have to distinguish households within a given period according to their age or birth year, the models we study are called overlapping generations (OLG) models. In this chapter we introduce the most basic version of the OLG model and discuss the computation of a transition path and the intergenerational welfare effects of policy reforms. In Chapter 7 we extend this baseline model version in various directions. This subsection sketches the economic environment used in this chapter and Chapter 7. We describe the lifetime of people who inhabit the economy as well as their consumption decisions. Then we move on to the production side and the government structure. Finally, the equilibrium conditions for goods and factor markets which close the model are derived. Demographics As in Chapter 5 we assume that households in the model live for three periods. For simplicity we do not account for income and lifespan uncertainty. However, now in each successive period t a new cohort is born, where the number of households Nt in this cohort grows at a rate np,t, i.e. Nt = (1 + np,t)Nt−1. From Figure 6.1 one can understand why this demographic structure is called ‘overlapping generations’. In each period t a cohort Nt is born, but this ‘new’ cohort overlaps with the two cohorts Nt−1 and Nt−2 born in the previous two periods.
Foundation Programme Selection
Authors: Metcalfe David , Dev Harveer
Published: November 2020

New doctors intending to work in the United Kingdom (UK) should complete the Foundation Programme. This two- year schedule of rotations ensures core competencies are achieved before doctors enter further training. The first foundation year (FY1) is intended for medical graduates to begin taking supervised responsibility for patient care. Completion of FY1 will usually lead to full registration with the General Medical Council (GMC) and automatic progression to a further year of training. Doctors take on additional responsibility in the second foundation year (FY2) and its successful completion results in the award of a Foundation Achievement of Competence Document (FACD). The FACD indicates that a doctor has achieved the competences necessary to begin one of the many core or specialty training programmes. Selection to the Foundation Programme is overseen by the UK Foundation Programme Office (UKFPO). This organization is responsible for allocating final- year medical students to their new foundation schools. Allocation to foundation schools depends on a score achieved by each student. Applicants through the UKFPO must rank all foundation schools (Units of Application) during the online application process. The system begins with the highest- scoring applicant and assigns them their first- choice foundation school. It does the same for the second highest- scoring applicant and continues in this vein. Once the system reaches an applicant whose first- choice foundation school is ‘full’, they are assigned their second choice, and so on. Therefore, the key determinants as to whether an applicant is placed in their first- choice location are their UKFPO ‘score’ and the popularity of their chosen foundation school. The ratio of first- choice applicants to places varies every year, but some foundation schools (e.g. Oxford and those in London) are almost always oversubscribed. Therefore, it is important to understand how scores are assigned and maximize your performance on these measures. Until 2012 entry, student preferences were allocated according to two measures: 1. Position within their medical school cohort by quartile. Quartiles were determined locally by each medical school with only general guidance from the UKFPO. 2. Answers provided on an application form which asked about academic achievements but weighted most points towards short essaytype answers.