bluuebunny/crossref_metadata_2025 huggingface dataset:
Turing and the paranormal
Authors: Leavitt David
Published: November 2020

Of the nine arguments against the validity of the imitation game that Alan Turing anticipated and refuted in advance in his ‘Computing machinery and intelligence’, the most peculiar is probably the last, ‘The argument from extra-sensory perception’. So out of step is this argument with the rest of the paper that most writers on Turing (myself included) have tended to ignore it or gloss over it, while some editions omit it altogether.1 An investigation into the research into parapsychology that had been done in the years leading up to Turing’s breakthrough paper, however, provides some context for the argument’s inclusion, as well as some surprising insights into Turing’s mind. Argument 9 (of the nine arguments against the validity of the imitation game) begins with a statement that to many of us today will seem remarkable. Turing writes:… I assume that the reader is familiar with the idea of extra-sensory perception and the meaning of the four items of it, viz. telepathy, clairvoyance, precognition, and psycho-kinesis. These disturbing phenomena seem to deny all our usual scientific ideas. How we should like to discredit them! Unfortunately the statistical evidence, at least for telepathy, is overwhelming…. To what ‘statistical evidence’ is Turing referring? In all likelihood it is the results of some experiments carried out in the early 1940s by S. G. Soal (1899–1975), a lecturer in mathematics at Queen Mary College, University of London, and a member of the London-based Society for Psychical Research (SPR). To give some background, the SPR had been founded in 1882 by Henry Sidgwick, Edmund Gurney, and F. W. H. Myers—all graduates of Trinity College, Cambridge—for the express purpose of investigating ‘that large body of debatable phenomena designated by such terms as mesmeric, psychical and spiritualistic . . . in the same spirit of exact and unimpassioned enquiry which has enabled science to solve so many problems, once no less obscure nor less hotly debated’. Although the membership of the SPR included numerous academics and scientists—most notably William James, Sir William Crookes, and Lord Rayleigh, a Nobel laureate in physics—it had no academic affiliation. Indeed, in the view of their detractors, the ‘psychists’, as they were known, occupied the same fringe as the mediums and mind-readers whose claims it sought to verify—or disclaim.
Questions Raised in Excavating the Recent Dead
Authors: Anthony Sian
Published: November 2020

The decision to excavate a modern cemetery in the heart of Copenhagen prompted questions which revealed how the sensitive borderlines surrounding the recent dead are dealt with by archaeologists. When the plans for a new metro line were revealed in Copenhagen, the location of one station within a historic cemetery was controversial. Assistens cemetery is an early example of a landscape, or garden, cemetery (Rugg 1998; Tarlow 2000), designed and ordered according to fashionable contemporary garden principles and aesthetics. It has remained a much-loved place where famous personalities are buried as well as many ordinary citizens of Copenhagen. Although burial within the cemetery has become increasingly rare, it is still in occasional use for new interments and for gardens of remembrance for the burial and disposal of ashes. However, in the 1980s changing municipal plans for the cemetery re-designated large sections of it as a park, as described in Helweg and Linnée Nielsen (2010). This change of status enabled the Copenhagen metro company (Metroselskabet) to consider the placement of a station in one corner of the cemetery. Excavation of this site from 2009 to 2011 resulted in the archaeological recording of the material culture of the cemetery including around one thousand burials, their grave-pits, funerary material culture, and some aspects of the working life of the cemetery (Anthony et al. 2016). Assistens cemetery was originally created in 1760 and later expanded in 1805/6. The excavation focused on the north-west corner of the 1805/6 extension, an area surrounding a cemetery administration building (graverbolig). The area was filled by the mid-nineteenth century and continued to be used intensively for the next hundred years. In the latter part of the twentieth century, coffin burial became less frequent but continued until the 1980s. The occasional placement of cremation urns began in the early twentieth century and continued in large numbers into the 1990s (Helweg and Linnée Nielsen 2010). Burial is now uncommon in the entire cemetery and only takes place in special circumstances. In contrast to UK cemetery regulations, Danish law allows for graves to be removed after only twenty years, so there is the possibility of reusing grave plots after this short period by removing the previous coffins.
Slave-Trade Archaeology and the Public: The Excavation of a ‘Liberated African’ Graveyard on St Helena
Authors: Pearson Andrew , Jeffs Ben
Published: November 2020

Within the framework of contractual archaeology in the UK (in which both authors largely operate) individual graves and funerary sites are regularly encountered, while they are also the object of targeted research projects. The ability to investigate a burial and to exhume human remains is a practical skill that can be taught and which may be mastered by practice. The investigation of a cemetery of any age is essentially a repetition of this basic technique, in which each grave (or indeed any feature-type containing human remains) is revealed, excavated, and the human remains recorded and lifted. Such exercises vary in scale, but the largest can address very significant numbers of bodies: one obvious example is the cemetery at Spitalfields, London, in which several thousand skeletons were exhumed. Post-excavation methods are also fairly standardized, both in terms of general archaeological reporting and the specific osteological analysis of human remains. These approaches can reasonably be said to be universal within European and North American archaeology, though inevitably with some variation in detail. As a consequence, field archaeologists are, in a technical sense, expert in dealing with the dead. Archaeologists, however, are often less familiar with the more esoteric aspects relating to the dead. Taking the British example again, the field archaeologist generally arrives at a site only after any discussion about the moral or social aspects of exhumation has been concluded. Thus, while provided with technical guidance and being aware of the wider issues involved, they are essentially there to dig. But away from such controlled circumstances, governmental frameworks for dealing with cultural heritage are either less developed or do not exist at all. Here, archaeologists can find themselves enmeshed in matters that go far beyond the technical and, not uncommonly, do so in societies where local attitudes and belief systems are very different to their own. This requires a skill-set for which ‘standard’ archaeological education and training has not necessarily equipped them. This chapter offers a narrative of one such example, which took place on the remote South Atlantic island of St Helena during 2007–8. Here, a team of experienced British field archaeologists, tasked with the excavation of a graveyard of considerable size and international significance, came to deal with the dead— and the living—on a number of fundamental levels that extended far beyond the project brief.
Firing the Imagination: Cremation in the Museum
Authors: Williams Howard
Published: November 2020

The displays of articulated, unburned, and fleshed human remains in European museums are often claimed to fixate and simultaneously repulse the modern viewer, and provoke all manner of varied responses in between these extremes (Brooks and Rumsey 2007: 279–80). Unused to the sights (and smells) of corpses and skeletons, the modern visitor is certainly fascinated by the uncanny nature of the archaeological dead. While bearing the signs of transformation by time and treatment, they often retain an unsettling individual persona, regularly enhanced by being posed, re-clothed, and sometimes awarded facial reconstructions when selected for museum display (Swain 2002, 2007a; Wallace 2005). Seemingly denying and disrupting the passage of time and drawing the past into the present, these cadavers afford the illusion of sleeping persons suspended between animation and oblivion (see also Nordström this volume). Such ‘immortals’ can become emblematic of entire societies and periods in the human past and icons of archaeology itself as a discipline that deals with the traces of human mortality through time (Nordström 2007, this volume; Williams 2009). It is the strikingly ‘human’ and ‘whole’ cadavers that have provoked the strongest emotional responses from the public as well as securing direct spiritual connections for particular religious minority groups. Such is the case of the campaign by the British Order of Druids who focused their claim for reburial centred on the memorable and evocative skeleton of a Neolithic child ‘Charlie’ on display in the Keiller Museum at Avebury (see Giles and Williams this volume; Tatham this volume; Rathouse this volume). Such claims of affection and affinity are clearly predicated on the corporeal integrity and the emotive responses this integrity evokes for the viewer. While human remains provoke the most powerful emotive engagements with the archaeological dead, other strategies for displaying mortuary contexts, such as casts of human bone (Goodnow 2006a: 18–19) and artist’s reconstructions of funerals (Williams 2009; Giles this volume), can inspire strong reactions. The same also applies to dioramas with mannequins: their uncanny resemblances to living persons can create powerful imaginative and educational connections between visitors and past individuals and the societies they represent within the museum context.
Writing About Death, Mourning, and Emotion: Archaeology, Imagination, and Creativity
Authors: Trevor Kirk
Published: November 2020

Imagination has informed ‘the writing of the past’ since the birth of European antiquarianism. However, the prominence and reputation of the archaeological imagination has fluctuated greatly through time. Both a product of its times and a force for change, the archaeological imagination has been variously central to the discipline, marginalized, and ridiculed. Between the sixteenth and eighteenth centuries, antiquarians such as John Leland, John Aubrey, and William Stukeley referenced druids, proto-Christianity, and classical Rome to creatively people England’s past, producing past worlds that ‘made sense’ in the context of the nationalist politics and religious mores of the time (Daniel 1981; Piggott 1985; Trigger 1989). By contrast, the tendency towards empirical study squeezed imagination to the margins of mid-twentieth-century processual archaeology (Hodder 1989). This chapter picks up some threads of the story of archaeological imagination as it has been ‘written’ during the last few decades, as well as reflecting on some opportunities for the future, specifically in the study of death, mourning, and emotion. In recent years, many archaeologists have experimented with different styles of writing in an attempt to give faces and voices to people in the past. For example, Mark Edmonds (1999) wrote imaginative vignettes of life in Neolithic Britain, while Ruth Tringham (1991) evoked the drama and emotion surrounding the death of people and the burning of houses in Neolithic south-east Europe. These attempts to ‘people the past’ were, at the time, complemented by multi-vocal narratives that sought to give voice to different contemporary interpreters of the past, such as Barbara Bender’s collaborative work on Stonehenge and Leskernick (Bender 1998; Bender et al. 1997). These bodies of work encourage us to think critically about the process ofwriting the past and the ‘will to truth’ in our stories. We are also invited to ask who is writing, whose voices are heard, what types of language are being used, and to what effect. These genres also question the type of past that we wish to write. Narratives may be variously based on power and politics (Parker Pearson and Richards 1999), emotion and bereavement (Tarlow 1999, 2000, 2012), action and performance (Pearson and Shanks 1991; Shanks 2012), material culture and identity (Thomas 1996).
Reflections on Intersections of Mortuary Archaeology and Contemporary Society
Authors: Goldstein Lynne
Published: November 2020

Growing up in my family, we were taught that education was the solution (or one of the most important solutions) to many problems. So, it is not so surprising that I once believed something that many still believe—that education about archaeology will result in better public understanding of what we do, and some level of agreement vis-à-vis the value of archaeology. After experiencing that this long-held belief (or perhaps more accurately, hope) was not always true, I realized the obvious fact that someone can be educated on a topic and still disagree with you. Education does not guarantee agreement with the educator (see Goldstein and Kintigh 1990 for another discussion of this point regarding human remains and mortuary sites). In other words, there is not a single truth, especially on this topic. This is certainly not to argue against education, it is just a reminder about realities. For this volume, Giles and Williams invited eighteen papers from archaeologists who have struggled with a wide range of topics associated with the intersection of mortuary archaeology, public archaeology, and contemporary society. This intersection provides the space and the opportunity for examination of problems and issues that are often not raised in discussions of archaeology or public archaeology or contemporary society alone. The breadth, depth, and diversity of perspectives presented in this volume are both fascinating and enlightening. The chapters are often self-reflexive and attempt to be fair, looking at multiple sides of very complex issues. Museums, governments, news media, and other archaeologists would be wise to carefully read these papers. As an American archaeologist who conducts archaeology in the USA, I find the case studies especially important and relevant since most of the examples are not constrained by the kinds of post-colonial circumstances that exist in the USA and countries like Australia (this is not to say that there are not other constraints in the case studies). At a minimum, these papers represent a different set of perspectives on problems with which all archaeologists and museum professionals have struggled. The volume is unusual because the authors do not simply state their opinions and present certain facts; they use a variety of tools to try to determine what happened, how public opinion may be measured, and how decisions are made.
Start
Authors: Hanson Robin
Published: November 2020

You should expect the next great era after ours to be as different from our era as ours is from past eras. In the last few million years, the three biggest changes on Earth were arguably the arrival of humans, the arrival of civilization based on farming, and then civilization based on industry ( Boserup 1981 ; Morris 2015 ). As I’ll discuss more in Chapter 2 , prior Eras section, each of these three eras greatly changed people, society, and the Earth. people who adopted these new ways of life quickly displaced and dominated those who continued with old ways. Compared with primates, wandering human hunter-gatherers greatly expanded technology, art, language, norms, and politics, and displaced many top animal predators. Then farmers and herders stopped wandering, expanded marriage, war, trade, law, class, and religion, and hunted many animals to extinction. Finally, our industrial era has expanded schools, cities, firms, and individual wealth; it has displaced even more of nature and almost all foragers, and it has seen a partial return to forager values. Over this whole period, we’ve seen increases in travel, talk, organization, and specialization. We’ve also had faster change, innovation, and economic growth, and a more integrated and unequal world culture. We have also, I will argue, become increasingly maladaptive. Our age is a “dreamtime” of behavior that is unprecedentedly maladaptive, both biologically and culturally. Farming environments changed faster than genetic selection could adapt, and the industrial world now changes faster than even cultural selection can adapt. Today, our increased wealth buffers us more from our mistakes, and we have only weak defenses against the super-stimuli of modern food, drugs, music, television, video games, and propaganda. The most dramatic demonstration of our maladaptation is the low fertility rate in rich nations today. While the industrial era has deluded many into thinking that old constraints no longer apply, as we will see in Chapter 2, Limits section, many recent constraint-evading trends simply cannot continue forever. Even if our descendants eventually conquer the stars, if we haven’t greatly misunderstood physics then our long-lived but bounded universe must eventually limit innovation and growth. And without strong regulation from a universespanning government, we should eventually see less change, more adaptive behavior, and (perhaps surprisingly) near-subsistence living standards.
Farewells
Authors: Hanson Robin
Published: November 2020

Em minds age with experience, becoming less flexible and thus less able to adapt to new skills and environments. Because of this, old ems eventually become substantially less productive than young competitors, and need to retire. Here is why. Imagine that you were asked to modify an ordinary (i.e., stock) car into a truck to haul rocks. If after that you were asked to create a racecar, you would probably prefer to start from another stock car, rather than the stock car that you had turned into a truck. Similarly, species of beetles that have adapted to a varied and oft changing environment have simpler designs than beetles adapted to more stable environments. These simpler beetles are more likely to successfully invade and adapt to new environments that become available, relative to beetles that have adapted to specific stable environments ( Fridley and Sax 2014 ). A similar effect causes large software systems to “rot” with time. As software that was designed to match one set of tasks, tools, and situations is slowly changed to deal with a steady stream of new tasks, tools, and situations, such software becomes more complex, fragile, and more difficult to usefully change ( Lehman and Belady 1985 ). Eventually it is better to start over and write whole new subsystems, and sometimes whole new systems, from scratch. Similarly, while more complex and higher quality business products tend to become better adapted to circumstances, and to sell for higher prices, simpler cheaper products tend to have more descendants in new products, at least for products sold to firms ( Christensen 1997 ; Thompson 2013 ). In multi-cellular animals, flexible generic stem cells create other more varied cells that are better adapted to particular body tasks. Yet new organisms descend mostly from generic stem cells, which have far more descendant cells in the long run. All of these examples suggest that as systems become better adapted in detail to particular situations, they become more fragile and less able to adapt in detail to very different situations.
Signals
Authors: Hanson Robin
Published: November 2020

Today, we make many choices with an eye to how those choices influence how others see us. For example, we try to give others a favorable impression of our general capacities, such as wealth, health, vigor, intelligence, knowledge, skills, conscientiousness, and artistic sense. With this in mind, we try to appear impressive in our arts, sports, schooling, hobbies, vocabularies, and other markers. For example, we plausibly pay extra for visibly nice clothes, cars, houses, etc., in part to show that we can afford such things. We use big words and witty banter in part to show our intelligence and schooling. We go to school in part to show our intelligence, conscientiousness, and conformity. We play sports in part to show our intelligence, health, strength, self-control, toughness, and cooperativeness. We play music in part to show our intelligence, self-control, passion, and creativity. We also try to give others a favorable impression of our loyalties and connections. That is, we try to credibly show that we feel strong positive ties toward certain individuals and groups, who feel similarly toward us. We can also try to show negative feelings toward rivals and outsiders. With this in mind, we choose with whom we spend our time, who we praise or criticize, and our styles of clothing, music, movies, etc. We follow gossip, news, and fashion in part to help show that we are well connected to respected sources of information. We enjoy stories and participate in politics in part to convince associates of our moral sympathies. We sometimes even cry for help, to show who will come running. Today, we spend a large fraction of our energy and wealth on such “signaling,” both because humans naturally care greatly about gaining status and respect in the eyes of others, and because being rich allows us to attend more to such concerns. As mentioned in Chapter 2, Era Values section, in terms of simple functionality, we seem today to spend excessive amounts on schools, medicine, financial intermediation, and huge projects. In contrast, while ems share most of our desires for respect, they live in a more competitive world, where they can less afford to indulge such desires.
Objects in the Swahili World
Authors: Wynne-Jones Stephanie
Published: November 2020

The stone towns of the Swahili coast define and embody both contemporary Swahili society and the ways that the archaeology of that region is known. The series of large-scale projects that have explored their architecture and changing material culture provide the means through which the past is conceived, even though these stone towns were themselves a particular material expression of a broader eastern African society, linked through networks of trade and interaction from earliest times. Urban centres provided the setting for the practices and lifestyles that came to be construed as Swahili, and twenty-first-century stone towns such as Lamu, Mombasa, and Zanzibar are still the quintessential expression of coastal culture. Stone-town excavations therefore structure our understandings of ancient Swahili materiality, and explorations of the wider society use these urban trajectories and developmental sequences as their reference point for exploration of the broader context. The objects of the Swahili world, reviewed in this chapter, are therefore presented through the archaeology of some of the more prominent stone-town excavations that together have defined our understandings. Rather than offering a comprehensive review of the archaeology of the coast (for which see Horton and Middleton 2000; Kusimba 1999b), this chapter discusses the material settings of the town. After a brief consideration of these key excavations, discussion focuses on themes in the study of Swahili materiality, and the ways that this has been conceptualized. Objects are implicated in understandings of identity from two angles, first as a reflection of some kind of ethnic identity, and second as part of the practices of daily life and the ways that people have constructed the urban social world. These discussions introduce more sites into consideration, and attempt to position them with relation to material understandings. The Swahili world presents itself as a ‘material culture’, in which objects are and were crucial to the performance of social roles and the construction of the urban environment. The evidence suggests that the Swahili themselves have long manipulated the material world to create a certain form of urban life, which defines and also creates certain types of person and activity.
Swahili Material Worlds
Authors: Wynne-Jones Stephanie
Published: November 2020

The abiding importance of objects and spaces in the Swahili world makes this a fertile ground for archaeological exploration, as well as for material ethnography. This volume therefore picks up on a rich history of writing on objects and settings on the coast, and in the Indian Ocean world more generally. As such, the eastern African coast has potential for broader considerations of the role of objects in social life, an important field of both archaeological and anthropological interest. The more recent past on the Swahili coast has long been recognized for this potential. Contemporary understandings of materiality on the Swahili coast—notably in Lamu and Zanzibar—have provided key case studies for archaeological treatments of objects and spaces (particularly Donley 1982, 1987; Donley-Reid 1990a, b) as well as for the growing field of material culture studies in global history (Prestholdt 1998, 2008). The contemporary world of objects and structured spaces also, of course, provides a framework for viewing the precolonial coast, and tropes that have emerged in Swahili historiography often owe their roots to ethnography. The importance of the Swahili house, for example, has been stressed in contemporary Lamu and Zanzibar, with authors demonstrating links between stone-house ownership, ancestry, modes of occupancy, and the self-identification of groups in the Swahili world (Allen 1979, 1981; Bissell 2000; el-Zein 1974; Ghaidan 1971, 1974, 1975; Myers 1996; Sheriff 1992, 2001–2). The importance of cosmopolitanism and overseas connections is also emphasized in the interiors of these houses—a practice that appears of long standing (Meier 2009; Prestholdt 2008). Forms of consumption and display, and particularly the practice of conspicuous generosity, also have a particular power on the Swahili coast, wielded more recently by newcomer groups as a means of creating identities in coastal society (Fair 1998, 2001; Glassman 1995). Even the identity claims of coastal urbanites, which in the twentieth century emphasized Arab ancestry in order to gain a competitive advantage under European colonial powers, echoed the claims for ‘Shirazi’ origins found in the origin stories of earlier Swahili settlements and families (Allen 1982; Pouwels 1984; Spear 2003).
Getting in to University
Authors: Willetts David
Published: November 2020

Our system of university admissions is medieval—and was created in 1961 when UCAS, originally called UCCA (the Universities Central Council on Admissions, now the Universities and Colleges Admissions Services), was set up. We have a single national system of competitive application to university, based on the assumption that most students will move away from home. It is very different from the classic Continental and American model in which you go to your local college or university for a tertiary education, which is neither highly selective nor highly specialized. Nearly half of American undergraduates study at a two-year college and then obtain what we would have called an ordinary degree. If they have higher ACT or SAT scores they are more likely to start at a university providing a full four-year course from the beginning but this is still likely to be in their home state and open to students who can arrive after two years at a college. Then if they really have an aptitude for academic study and wish to specialize or need to get a professional qualification they do a postgraduate Masters course: perhaps at this point they may move out of the state. Ask an American professional where they went to university and you will be told which business or law or medical school they went to as a postgraduate. But they may well have started their undergraduate studies somewhere very different and much closer to home. And their whole time in higher education is likely to have been longer than in England. The English system by contrast is the medieval model of a young gentleman leaving home (or boarding school—meaning it would be very peculiar to return home for university) to go to Oxford or Cambridge. It has been shaped by a long history as a unitary state with very few universities and nationwide migration of students to get to them. It is so deeply embedded that the decision to set up the nationwide admissions system provoked very little discussion or challenge. So that medieval model now applies to a million English undergraduates and over a hundred universities.
The Student Academic Experience
Authors: Willetts David
Published: November 2020

I can still remember going to my first economics lecture when I arrived at Oxford to study Politics, Philosophy, and Economics. It was a rather plodding account of the main British industries of the 1970s—manufacturing, mining, etc. The only vivid moment came when we were breaking up at the end and a student sitting nearby turned to me with a question: ‘What’, he asked, ‘is coal?’ International students really do bring different perspectives. Looking back now I can see that the economics faculty could have done so much more with that first lecture. They should have fielded Oxford’s most eminent professor to give us a powerful account of the shape and significance of economics. That first lecture was always going to stick in the memory: it was a missed opportunity. Oxford subsequently reformed their lectures for new students and deploy their most prestigious academics. Other universities have done this too. One academic told me, with just a hint of cynicism, the first lecture to new students was like empty skips appearing in your street—you need to fill them with your rubbish before anyone else can put their rubbish in. The teaching of economics has been caught up in swirling controversy. It involves big arguments about the role of the state and how the global financial crisis should change the discipline. But it is also about what constitutes good teaching. Here is an account of how the subject was taught at one university: ‘Tutorials consist of copying problem sets off the board rather than discussing economic ideas, and 18 out of 48 modules have 50% or more marks given by multiple choice.’ Proper teaching involves keeping a subject fresh by endlessly updating it as some contested issues are resolved or just become moribund whilst new areas of exploration and dispute emerge. Einstein is supposed to have set students the same physics questions two years in succession, but when he was challenged he replied that although the question was the same the answer had changed. The quality of teaching is the biggest problem facing our universities.
History, examination, risk assessment, and treatment planning
Authors: Gilchrist F , Rodd H D
Published: November 2020

The provision of dental care for children presents some of the greatest challenges and rewards in clinical dental practice. High on the list of challenges is the need to devise a comprehensive yet realistic treatment plan for these young patients. Successful outcomes are very unlikely in the absence of thorough short-and long-term treatment planning. Furthermore, decision-making for children has to take into account many more factors than is the case for adults. This Chapter aims to highlight how history-taking, examination, and risk assessment are all critical stages in the treatment planning process. Principles of good treatment planning will also be outlined. When making decisions about children’s dental care, the clinician’s foremost ethical responsibility is to do no harm, to act in the child’s best interests, and to respect the child’s right to refuse treatment. However, reconciling this last principle with the preceding two might well present a dilemma, in which case the clinician should ask him/herself the following questions. • Is what is being proposed really in the child’s best interests? • Is the child happy to go ahead? If not, is there an alternative? • If there is no alternative, what will really be the outcome if treatment does not proceed? In most cases, failure to provide dental care for a child at a specific moment in time will not be life-threatening and a delay will be acceptable. However, there are circumstances in which failure to provide treatment may cause a child pain and distress. On these occasions, the clinician may feel that he/she has no alternative other than to proceed with treatment. Having weighed up the ethical considerations, he/she must then seek valid consent for what is proposed. Valid consent to examination, investigation, or treatment is fundamental to the provision of dental care. The most important element of the consent process is ensuring that the patient/parent understands the nature and purpose of the proposed treatment, together with any alternatives available, and the potential benefits and risks. In this context, where clinician and patient/parent do not share a common language, the assistance of an interpreter is essential.
Parasites and Worms
Authors: Wani Robert Serafino
Published: November 2020

A parasite is an organism that lives on or in a host and gets its food from or at the expense of its host. Worms or helminths either live as parasites or free of a host in aquatic and terrestrial environments. Parasites and worms are found worldwide but mainly in the tropics. It is estimated that 20% of immigrants from endemic countries may have helminthic infections at their arrival to the UK. These people could be asymptomatic, but tend to present with unexplained symptoms, especially gastrointestinal in nature or eosinophilia. Travellers to endemic countries tend to be newly infected and have greater immune response and pronounced eosinophilia in some but not all parasitic infections. Parasites that can cause disease in humans fall under three classes: protozoa, helminths, and Ectoparasites Protozoa are microscopic, one- celled organisms that can be free living or parasitic in nature. Transmission of protozoa that live in a human’s intestine to another human typically occurs through a faeco-oral route (for example, contaminated food or water, or person- to-person contact). Protozoa that live in the blood or tissue of humans are transmitted to other humans by an arthropod vector (for example, through the bite of a mosquito or sand fly). Helminths are large, multicellular organisms that are generally visible to the naked eye in their adult stages. Like protozoa, helminths can be either free living or parasitic. There are three main groups of helminths that parasitize humans: cestodes, trematodes, and nematodes. These are flat worms that comprise Echinococcus species: intestinal tapeworms and neurocysticercosis (Taenia solium) These are leaf- shaped, and they vary in length from a few millimetres to 8 cm. They include: ■ Liver fluke: Clonorchis sinensis, Fasciola hepatica ■ Intestinal fluke: Fasciola buski, Heterophyes heterophyes, ■ Lung fluke: Paragonimus westernmani ■ Blood flukes: Schistosoma species These are cylindrical in structure. Blood- sucking arthropods such as mosquitoes are considered as ectoparasites because they depend on blood meal for their survival. Narrowly speaking, ectoparasites include organisms like ticks, fleas, lice, and mites (scabies) that attach or burrow into the skin and remain there for relatively long periods of time (e.g. weeks to months).
Bacteriology Diagnostic Methods
Authors: Dolphin Heather , Ahmad Fatima
Published: November 2020

This is summarized in Table 8.1. a) Microscopy— A cell count is performed on sterile fluids and CSF samples using the Neubauer chamber or a similar device. The number of white blood cells (WBC) and red blood cells seen under the microscope are reported as well as the differential WBC count (i.e. the number or percentage of lymphocytes and neutrophils in the sample). A Gram stain is then done and the presence of any organism reported. b) Culture samples are plated onto the appropriate media and streaked out for single colonies as shown. Blood agar is normally used; however, other media are used depending on the site of the specimen, e.g. chocolate agar is used if a fastidious organism is a potential pathogen such as Haemophilus sp.; anaerobic agar for anaerobes; selective agar such as MacConkey can be used on non-sterile specimens to differentiate between the colony types. Plates are incubated for eighteen to forty-eight hours at the correct conditions; most plates being CO2, others at O2 and anaerobically. c) Identification plates are examined for growth. Potentially significant isolates are identified either by MALDI-TOF MS, by API, or other biochemical tests. d) Sensitivities are performed on significant organisms by manual and automated methods. This is summarized in Table 8.2. Selective agar is necessary when isolating pathogens from faeces, although further confirmatory tests are needed. ● Black or colourless colonies on xylose lysine deoxycholate (XLD) or other chromogenic agar plates are tested with oxidase reagent. ● Oxidase negative isolates are identified by MALDI-TOF, API and or biochemically using triple-sugar iron (TSI) tubes. ● Serology is then performed on suspicious isolates and sent to a reference laboratory for confirmation. ● Campylobacter is confirmed by testing grey flat colonies on campylobacter agar with oxidase reagent. Oxidase positive samples are Gram stained and if ‘seagull’-shaped gram-negative bacteria are observed under the microscope, campylobacter is confirmed. The catalase test is a simple biochemical test to differentiate between Staphylococcus species and Streptococcus species, with the use of hydrogen peroxide (H2O2). It tests for the presence of the enzyme catalase which is found in Staphylococcus species.
Vaccine-Preventable Diseases
Authors: William Tong C. Y.
Published: November 2020

These are diseases in which an effective preventive vaccine exists. A death that could have been prevented by vaccination is a vaccine- preventable death. The World Health Organization (WHO) has identified twenty-five diseases as vaccine preventable. This list may expand as new vaccines are being developed. The Expanded Programme on Immunization, or EPI, is vaccination programme introduced in 1974 by the WHO to all nations. The EPI initially targeted diphtheria, whooping cough, tetanus, measles, poliomyelitis, and tuberculosis. The aim was to provide universal immunization for all children by 1990 and to achieve health for all by 2000. In 2010, about 85% of children under one year of age in the world had received at least three doses of DTP vaccine (diphtheria, tetanus, and polio). Additional vaccines have now been added to the original six targets. Most countries have now added Hepatitis B (not in UK) and Haemophilus influenzae type b (Hib) to their routine infant immunization schedules, and an increasing number are in the process of adding pneumococcal conjugate vaccine and rotavirus vaccines to their schedules. Immunization is a proven tool for controlling and even eradicating infectious diseases. The immunization campaign against smallpox between 1967 and 1977 resulted in the eradication of smallpox. Apart from smallpox, the only other viral infection that was declared eradicated through vaccination campaign was rinderpest in cattle (2011), a close relative of measles virus in humans. Another major infection target for global eradication is against poliomyelitis—the global polio eradication initiative (GPEI). When the programme began in 1988, polio threatened 60% of the world’s population. Eradication of poliomyelitis is now within reach: infections have fallen by 99%; wild type polio type 2 was last detected in 1999 and declared eradicated in 2015; wild-type poliovirus type 3 has not been detected in the world since 2012. Poliovirus type 1 is the only wild- type virus in circulation and endemic transmission is only reported in Afghanistan and Pakistan. Currently, the old trivalent oral poliovirus vaccine is replaced by the more potent bivalent poliovirus type 1 and 3 vaccine. Many western countries have switched from oral vaccine to the injected inactivated vaccine to avoid the problem of vaccine- induced paralysis, which could be associated with the oral live attenuated vaccine.
Multisystem Infections
Authors: Melzer Mark
Published: November 2020

Many bacterial infections can cause multisystem or metastatic infection, commonly through haematogenous spread, with preferred sites or tropism depending upon specific organism. For example, Staphylococcus aureus is a well-recognized cause of infective endocarditis, joint infection, and vertebral osteomyelitis. Klebsiella pneumoniae can cause endogenous endophthalmitis in association with a pyogenic liver abscess, a syndrome well described in East Asia. Streptococcus pneumoniae typically causes lower respiratory tract infections or bacterial meningitis. The combination of meningitis, pneumonia, and endocarditis is called ‘Austrian syndrome’ and is strongly associated with hyposplenism or alcohol abuse. Other examples of bacteria that disseminate and cause multisystem infection are covered elsewhere. C. albicans or non-albicans species in the blood can metastasize to the eye (causing chorioretinitis or endophthalmitis) or to the heart (causing infective endocarditis). The primary sites of infection are commonly the GI tract or intravascular catheters, and high-risk groups include patients who have recently undergone abdominal surgery, received multiple courses of intravenous antibiotics, and are receiving total parenteral nutrition. Empirical treatment is with either IV liposomal amphotericin or an echinocandin before stepping down to an oral azole, commonly fluconazole at a dose of 400mg od. Because of the risk of metastatic spread, minimum duration is normally two weeks after the first negative blood culture. Cryptococcosis is caused by one of two species: Cryptococcus neoformans or Cryptococcus gattii. Unlike C. neoformans, C. gattii can cause infection in immunocompetent people. The clinical syndrome, Cryptococcosis, is an opportunistic infection for AIDS, but other conditions that predispose to infection are lymphoma, sarcoidosis, liver cirrhosis, and corticosteroids. Following inhalation, cryptococci can disseminate to the cerebrospinal fluid (CSF) and cause meningitis. Occasionally, Cryptococcoma—umbilicated papules on the skin— can occur. Symptoms are often subacute and include fever and dry cough. Following dissemination to the CSF, headache and confusion can occur. Diagnosis is based upon detection of capsular antigen by latex particle agglutination or culture, typically from blood or CSF. For meningitis, treatment consists of three phases. The induction phase is two weeks of IV liposomal amphotericin and flucytosine, followed by consolidation with eight weeks of oral fluconazole 800mg once daily, then finally secondary prophylaxis, 200mg orally once daily.
Upper and Lower Respiratory Tract Infections
Authors: Tiber Simon
Published: November 2020

Pharyngitis is common with incidence peaking from autumn to spring. Respiratory viruses are most commonly implicated, and are generally self-limiting conditions not requiring diagnostic workup or treatment. Bacterial pharyngitis is less common, is spread by droplets or direct transmission, and Streptococcus pyogenes (Group A strep, or GAS) is the most frequent cause. Haemophilus influenzae, Mycoplasma pneumoniae, and Neisseria gonorrhoeae are less frequent causes. Rapid antigen detection tests make the point-of-care assessment of GAS pharyngitis possible, although a negative test does not exclude infection. No method can distinguish oropharyngeal colonization from actual infection, but culture can obtain antibiotic susceptibility testing. Suspicion of infection with Neisseria gonorrhoeae, Bordetella pertussis, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Corynebacterium diptheriae should be communicated to the laboratory so that the appropriate culture media is utilized. The Centor criteria provide a clinical predictive score that can give the likelihood a sore throat is due to a bacterial infection with the following: the presence of tonsillar exudate, tender anterior cervical adenopathy, fever over 38°C, and absence of cough. If three or four of these criteria are met, the positive predictive value is 40% to 60%. The absence of three or four of the Centor criteria has a relatively high negative predictive value of 80%, and may be use to evaluate whether antibiotics can be withheld or deferred. Oral penicillin or macrolide are used to treat streptococcal pharyngitis. Treatment may reduce severity, duration, transmission, and risk of post-infectious sequelae like rheumatic heart disease and post-streptococcal glomerulonephritis. Other complications include scarlet fever, streptococcal toxic shock syndrome, and quinsy. Otitis media, is frequent in the young children, possibly due to a short and horizontal Eustachian tube. Purulent material buils up leading to a bulging, red tympanic membrane which may rupture and discharge. Intense local pain and fevers may occur. Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae are frequently implicated. Frequently there are no sequelae, although complications include hearing impairment, and less common are mastoiditis, bacteraemia, and meningitis. Diagnosis is clinical based on presentation and otoscopic examination. Microbiological diagnosis is possible through culture of exuate on swab or following tympanocentesis.
Urinary Tract and Genital Infections including Sexually Transmitted Infections (STIs)
Authors: Dave Jayshree , William Tong C. Y.
Published: November 2020

Urethritis, characterized by inflammation of the urethra in men, is caused by Neisseria gonorrhoeae (gonococcus), Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Other causes of non-gonococcal urethritis include ureaplasmas, adenoviruses, and herpes simplex viruses. The presence of urethritis is confirmed by the presence of five or more polymorphs in urethral smear by high-power microscopy. Symptoms can be minor to profound and vary from clear to mucopurulent discharge. Gonococcus is commoner in men who have sex with men (MSM) compared to heterosexuals, and high-risk activities such as chemsex parties increase spread with significant public health consequences. Antibiotic resistance in gonococcus has clinical and public health implications as three cases of extensively drug-resistant Neisseria gonorrhoeae with resistance to ceftriaxone (MIC = 0.5 mg/L) and high-level resistance to azithromycin (MIC > 256 mg/L) have been described compromising current treatment recommended by British Association for Sexual Health and HIV Guidelines (BASHH). In England an outbreak of high level azithromycin-resistant gonococcus has also been described by Public Health England (PHE), who alerted clinicians about the need for follow up and test of cure, contact tracing, and treatment failure. C. trachomatis infection can be treated with azithromycin 1g orally as a single dose or with seven days of oral doxycycline. Risk factors for chlamydia include age younger than twenty-five years, multiple sexual partners, and avoidance of barrier methods for contraception. Metronidazole 2g single dose or 400– 500mg twice daily for seven days is recommended for treatment of trichomonas, which can cause a moderate discharge in up to 60% of males. Resistance to azithromycin and doxycycline is common in M. genitalium strains and management of these patients with urethritis requires GUM referral for comprehensive investigation, contact tracing, and public health notification. Molecular methods are used for the diagnosis of these organisms and gonococcal culture is undertaken to obtain antimicrobial susceptibility data from patients with a previous diagnosis by molecular method, in GUM attendees, and their contacts. Herpes simplex infection results in a painful ulcer preceded by a vesicle. The diagnosis can be confirmed using polymerase chain reaction (PCR) tests of a swab taken from the vesicle or ulcer.