bluuebunny/crossref_metadata_2025 huggingface dataset:
Making mountains
Authors: Zalasiewicz Jan
Published: November 2020

It has been a quiet 20 million years for the pebble: an interlude, at somewhere around 3–4 kilometres under the sea floor. The rock has still been crystallizing, but only very slowly. The water has by now mostly been squeezed out, so little fluid has flowed through that rock. At this depth it is hot, well above 1008°C. The pebble-form is sterile, lifeless. The time is now a little under 400 million years ago. We are in the Devonian Period. Above, at the Earth’s surface, changes have been taking place, but as far as they affected the pebble they could be on another planet. In the sea, the graptolites have been going through an evolutionary rollercoaster, with explosions of diversity separated by bad times, when they only just survive. Soon, one of those bad times will be terminal, and they will disappear from the open seas, never to return. By contrast, the fish are beginning to thrive both in the sea and in rivers and lakes. The land is greening, almost explosively, as plants evolve furiously. None of this affects the future pebble. But something soon will. The sea above has been gradually shallowing, filled in with sediment from the encroaching land. Eventually, it changed, some few million years ago, into a vast coastal plain, traversed by rivers. We are about at the time, now, when that lowland is about to rear up to form a range of mountains that—although much reduced from their early glory—can still be climbed today. What took them so long? For the Iapetus Ocean to the north, which, 50 million years ago, was more than 1000 kilometres across, had effectively disappeared 20 million years ago, the ocean plate sliding beneath the northern continent of Scotland and north America. But on Avalonia, the effect was as if these continents had just slid neatly into place, with only minor distortion of the Avalonian crust (and, in truth, these landmasses did approach each other partly from the side, rather than headon). Did the mountain-building force still come from the north, perhaps as some mysteriously delayed intensification of the vice-like grip that held these landmasses together?
Types of research
Authors: Carr James , Chadwick David
Published: November 2020

You have decided on the area you wish to research, reviewed the relevant literature, and developed a research question; your next task is to decide what method is most appropriate to address that question. The first issue you need to consider is whether your study is research or audit. This is important as research and audit, while similar in many respects, have a number of differences that have important ethical, methodological, and management implications. The vogue for ‘call this research project an audit and we don’t need ethics’ is thankfully passing, due not least to intolerance by the General Medical Council (GMC) and National Health Service (NHS) disciplinary panels of such slippery practice. A second issue is broadly methodological, and concerns whether you intend to use quantitative or qualitative methods. Finally, you need to consider whether your research can be done in a clinical setting or is better suited to laboratory conditions, which will have important implications for the manner in which you approach your study. We begin the chapter by considering service investigation and audit and will examine how audit differs from research. Following this we consider quantitative and qualitative approaches and examine their philosophical underpinnings, methods and analysis. Finally we examine basic science concepts and laboratory-based research. For any clinician the main priority in service investigation is the process of auditing one’s own practice. There are, however, other means of evaluating practice. This section will focus in on the assessment of service quality. This, as it turns out, is rather difficult to define. The Department of Health (DoH; 1) defi ne quality as ‘doing the right things, at the right time, for the right people and doing them right — first time’. This, as you may notice, is a rather broad definition which may be of limited value to you when you are planning to use the concept of quality as the central theme of your investigation. However, as this concept of quality is at the centre of pretty much every document the DoH publishes, it is worth keeping it in mind.
Taking your research career further
Authors: Chadwick David , McGregor Alison
Published: November 2020

Now you’ve completed, and possibly even published your first project, you may experience a gamut of emotions — maybe you’ll be relieved, or maybe you’ll be desperate to do it all again. Whether it’s due to a love of knowledge, or a serious coffee habit you couldn’t accommodate in clinical practice, there’s a chance you’ll want to continue in your new found academic vein. If so, you need to think about how you approach this. Your options range from total immersion in full-time academia to research ‘on the side’ whilst remaining in clinical practice — for most, an option combining the two is best. This can be achieved either by a period of full-time research before re-entering clinical practice, or an academic training post whereby a proportion of your time is protected for academic work. In the rest of this chapter, we’ll look through the options, including for those coming from a non-medical background. Until recently there was no clear route for doctors wanting to pursue an academic career in research. However, in 2005, the Walport Report recommended the integration of periods of research into specific medical training programmes through a process called Integrated Academic Training. Under this system, which has developed over the past few years, a number of postgraduate academic programmes have emerged, providing academic training alongside standard medical training. Although these programmes may appear to be a streamlined process whereby doctors pass from one academic programme to another, in reality there is considerable flexibility in the system. Hence, final year medical students who have done an intercalated BSc, PhD, or MB/PhD and know they want to be academic clinicians may reasonably decide not to apply to Academic Foundation programmes, and rather apply for an NIHR Academic Clinical Fellowship (ACF), and will almost certainly not be disadvantaged through not having held an Academic Foundation post. Whilst there is no doubt that Integrated Academic Training represents a considerable advance in the career structure for doctors wishing to become researchers, these academic posts are very competitive and given the number available most posts are only likely to be awarded to ‘high flyers’.
Diffraction
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

A common approach to crystal structure analysis by X-ray diffraction presented in texts that have been written for nonspecialists involves the Bragg equation, and a discussion in terms of “reflection” of X rays from crystal lattice planes (Bragg, 1913). While the Bragg equation, which implies this “reflection,” has proved extremely useful, it does not really help in understanding the process of X-ray diffraction. Therefore we will proceed instead by way of an elementary consideration of diffraction phenomena generally, and then diffraction from periodic structures (such as crystals), making use of optical analogies (Jenkins and White, 1957; Taylor and Lipson, 1964; Harburn et al., 1975). The eyes of most animals, including humans, comprise efficient optical systems for forming images of objects by the recombination of visible radiation scattered by these objects. Many things are, of course, too small to be detected by the unaided human eye, but an enlarged image of some of them can be formed with a microscope—using visible light for objects with dimensions comparable to or larger than the wavelength of this light (about 6 × 10−7 m), or using electrons of high energy (and thus short wavelength) in an electron microscope. In order to “see” the fine details of molecular structure (with dimensions 10−8 to 10−10 m), it is necessary to use radiation of a wavelength comparable to, or smaller than, the dimensions of the distances between atoms. Such radiation is readily available (1) in the X rays produced by bombarding a target composed of an element of intermediate atomic number (for example, between Cr and Mo in the Periodic Table) with fast electrons, or from a synchrotron source, (2) in neutrons from a nuclear reactor or spallation source, or (3) in electrons with energies of 10–50 keV. Each of these kinds of radiation is scattered by the atoms of the sample, just as is ordinary light, and if we could recombine this scattered radiation, as a microscope can, we could form an image of the scattering matter.
Critical care
Authors: Nethercott Daniel , Shelly Maire
Published: November 2020

It is well recognized that errors of communication are associated with causing harm to patients on the Intensive Care Unit (ICU). By means of presenting a patient-based narrative, this chapter looks at communication in intensive care medicine focusing attention on styles of communication that are useful in different areas of common practice. It must be accepted that communication needs to convey a message that sits within its own context. For instance, the way that proxy decisions are made for patients who lack capacity varies with both culture and region. Resources are variable, and this includes the time that can be allocated to communication. It is clearly beyond the scope of this chapter to offer guidance on exactly what information should be given to patients and their relatives, but we aim to highlight useful ways of making the communication of that information more effective. 03:00 in a District General Hospital Emergency department. The on-call intensive care doctor is fast-bleeped to the resuscitation bay to see a 35-year-old man called Stephen who has been brought in by ambulance from a roadside accident. He is conscious but distressed, with significant injuries to both legs and thorax. A ‘trauma team’ of doctors is assembled, plus the delivering paramedics, accident and emergency-qualified nurses and healthcare assistants. Communicating with teams in time-critical situations presents a clear challenge. Team members can be unknown to each other with an unknown skill mix, the clinical problems are undefined, different personnel have different—sometimes conflicting—motives, and goals, and clinical priorities can shift over time. The anaesthetist must be confident to communicate with authority in these circumstances. Under stress, most team members will respond well to someone else taking the lead. They will usually do what they are asked if they understand the instruction, are competent to undertake the task, and are not overloaded with other tasks. Closed-loop communication is a good way to keep communication efficient: ‘Someone get me a tube!’ can be misunderstood or ignored by most of the team. ‘Sarah, I want you to get a size 8 endotracheal tube from the trolley and test the cuff for me. Do you know how to do that?’ is specific, directed to a named individual and asks for confirmation of understanding and competence to complete the task.
Effective communication in the exam
Authors: Zengeya Stanley Tamuka , Serane Tiroumourougane V
Published: November 2020

Communication is not just giving information; rather, it is a two-way process and involves the exchange of information, ideas, and knowledge. Eff ective communication is the key to success and can be achieved only if the receiver understands the exact information the sender is aiming to transfer. Medical communication is the art of speaking clearly and professionally, while reducing the possibility of being misunderstood. It will increase patient satisfaction and trust and improve understanding of treatment and compliance. Examiners consider effective communication to be the most essential skill any doctor requires to deal with the patient’s problems. The General Medical Council has highlighted the importance of communicating well by stating that ‘medical graduates must be able to communicate clearly, sensitively and effectively, not only with patients and their relatives, but also with colleagues and other healthcare professionals’. The Royal College of Paediatrics and Child Heath has put so much emphasis on communication that this is the only skill that is tested in two independent stations in the clinical examination. The College feels that a careful assessment of communication skills distinguishes the good candidates from the bad ones. Often, overseas-trained candidates and non-native English speakers find this station difficult, as they may not have grasped the basic skills of this assessment. In this station, the examiner will watch a communication scenario between the candidate and the patient’s family. It is of utmost importance to read the instructions carefully and understand them. A common mistake is to confuse this station with history taking. The examiner’s task is to observe only and not to ask any questions or make any comments on the candidate's performance. At the end of the episode, the examiner will evaluate the candidate’s performance. The key competence skills required in the communication station are given in table 2.1. Effective communication is a two-way process in which there is an exchange of thoughts, feelings, or ideas towards a mutually accepted goal. Speaking and listening are the two arms of effective communication. One cannot be an effective communicator if both speaking and listening are not mastered. Medical communication starts with speaking, which requires a sender, a message, a medium or channel, and a receiver. The sender encodes a package of information and transmits this by a medium to the receiver. Commonly used media include air, noise, signal, and paper. Content and context are the two elements of information that will be transmitted via the medium. Content is the actual words or symbols. Context is the way the message is delivered, that is the non-verbal components such as body language, facial expressions, posture, gestures, eye contact, and state of emotion. During communication, context is extremely important as it helps the patient and the doctor to understand one another. On receiving the message, the recipient decodes it and can give the sender feedback (figure 2.1).
Developmental examination
Authors: Zengeya Stanley Tamuka , Serane Tiroumourougane V
Published: November 2020

All doctors working with children should have good knowledge of normal developmental milestones, as early diagnosis of developmental problems and appropriate intervention is desirable to improve the outcome. Candidates should be able to identify key warning signals and know the practical relevance of the milestones. ‘Developmental assessment’ is the comprehensive evaluation of a child’s physical, intellectual, language, emotional, and social development, and is an area where most candidates lack competence and confidence. It should be distinguished from ‘developmental screening’, which is a brief, formal, standardized evaluation for the early identification of children at risk of a developmental disorder. In the developmental assessment station, a candidate can be assessed in different ways: a developmental history with the parent and child; assessment of specific developmental domains (such as gross motor skills, fine motor skills, speech, language skills, etc.); or global assessment of an infant or older child. Occasionally, the candidate might be asked to just ‘observe the child’s play’ and comment on the development. The candidate should anticipate and be prepared for these scenarios. In the exam, a detailed assessment of development is impossible, as it is complicated and time consuming. Ideally, observations of the child should take place with several people in varied settings, which is not feasible in the exam. However, useful assessment of a child’s development can be easily performed as part of routine examination. The main purpose of the developmental assessment in the exam is to identify the child’s strengths and weaknesses, the developmental problem, and, if possible, the cause of the problem. The candidate is expected to give an approximate developmental age at the end of the assessment. Before we continue, it is important to understand the commonly used terminology. A child is said to have ‘developmental delay’ when he or she shows a significant lag (more than two standard deviations) in acquiring milestones in one or more domains. Global developmental delay is defined as a delay in two or more developmental domains. ‘Developmental deviance’ occurs when a child develops milestones outside or apparently ahead of the typical acquisition sequence. ‘Developmental regression’ is the loss of previously acquired milestones. Children develop skills in various areas, also called developmental domains: gross motor, speech and language, fine motor, cognitive, personal–social, and emotional.
Examination of the skin and skin appendages
Authors: Zengeya Stanley Tamuka , Serane Tiroumourougane V
Published: November 2020

Examination of the skin can provide information about cutaneous or systemic diseases. As always, examination of the skin is best performed in correlation with the available medical history. Even if the examination is conducted in a different order, you should have a systematic method of presenting the findings. Examination comprises inspection and palpation of skin and skin appendages (hair, nails, teeth, and mucous membranes) and is performed in one of two scenarios. 1. The skin may be sequentially examined alongside the examination of other systems (e.g. neurocutaneous syndromes, which are disorders with neurological features, characteristics lesions on the skin, and tumours in different parts of the body) (table 14.1). 2. A dedicated examination of the skin may need to be carried out when it is the suspected primary involved organ and includes evaluation of the hair, nails, teeth, and mucous membranes of the mouth and genitalia. Key competence skills required in examination of the skin are given in table 14.2. Some of the clinical features of common paediatric dermatoses are given in table 14.3. These steps are repeated in every system to reiterate their importance and to help you recollect the initial approach of any clinical exam. Also refer to chapter 4. • On entering the examination room, demonstrate strict adherence to infection control measures by washing your hands or by using alcohol rub. • Introduce yourself both to the parents and the child. • Talk slowly and clearly with a smile on your face. • Establish rapport with the child and parents. • Expose adequately while ensuring their privacy. • Positioning: the patient must be undressed adequately to carry out a complete examination. Inadequate skin exposure with the cloth pushed to one side or lifted momentarily often casts shadows on the skin and is not conducive for proper examination. Infants and very young children should be undressed completely. The younger child is examined preferably on the parent’s lap. Older children can lie down except for the examination of back, which can be examined in the sitting position.
Biogeochemical Consequences of Ocean Acidification and Feedbacks to the Earth System
Authors: Gehlen Marion , Gruber Nicolas
Published: November 2020

By the year 2008, the ocean had taken up approximately 140 Gt carbon corresponding to about a third of the total anthropogenic CO2 emitted to the atmosphere since the onset of industrialization (Khatiwala et al. 2009 ). As the weak acid CO2 invades the ocean, it triggers changes in ocean carbonate chemistry and ocean pH (see Chapter 1). The pH of modern ocean surface waters is already 0.1 units lower than in pre-industrial times and a decrease by 0.4 units is projected by the year 2100 in response to a business-as- usual emission pathway (Caldeira and Wickett 2003). These changes in ocean carbonate chemistry are likely to affect major ocean biogeochemical cycles, either through direct pH effects or indirect impacts on the structure and functioning of marine ecosystems. This chapter addresses the potential biogeochemical consequences of ocean acidification and associated feedbacks to the earth system, with focus on the alteration of element fluxes at the scale of the global ocean. The view taken here is on how the different effects interact and ultimately alter the atmospheric concentration of radiatively active substances, i.e. primarily greenhouse gases such as CO2 and nitrous oxide (N2O). Changes in carbonate chemistry have the potential for interacting with ocean biogeochemical cycles and creating feedbacks to climate in a myriad of ways (Box 12.1). In order to provide some structure to the discussion, direct and indirect feedbacks of ocean acidification on the earth system are distinguished. Direct feedbacks are those which directly affect radiative forcing in the atmosphere by altering the air–sea flux of radiatively active substances. Indirect feedbacks are those that first alter a biogeochemical process in the ocean, and through this change then affect the air–sea flux and ultimately the radiative forcing in the atmosphere. For example, when ocean acidification alters the production and export of organic matter by the biological pump, then this is an indirect feedback. This is because a change in the biological pump alters radiative forcing in the atmosphere indirectly by first changing the nearsurface concentrations of dissolved inorganic carbon and total alkalinity.
The Last Greenhouse World
Authors: Zalasiewicz Jan , Williams Mark
Published: November 2020

Ellesmere Island today is a destination only to a particular type of tourist: rich enough to afford the most exclusive of package tours, and hardy (or ascetic) enough to yearn for the spiritual purity of an icy wasteland, rather than the sensual pleasures of a Mediterranean seashore. The island is large—twice the size of Iceland. Yet, its largest settlement, Grise Fjord (or, in the local Inuktitut language, Aijuittuk—‘the place that never thaws’) has but some 140 souls—while its smallest, Eureka, bizarrely but somehow appropriately, was listed in 2006 as having precisely none. Squeezed between northern Canada and Greenland, Ellesmere Island is well within the Arctic Circle, and its northern tip is not much more than 700 kilometres from the North Pole. A land of mountains, fjords, glaciers, and ice-fields, it has been dubbed ‘the horizontal Everest’. In the short summer, the Sun never leaves the sky, and temperatures might, on brief sunny days, exceed 20 °C. When the winter months come, the Sun never rises, and temperatures drop below –40 °C. The only tree that can grow, here and there, is the dwarf Arctic willow, usually knee-high, while the mammals—musk ox, caribou, seals—have attracted Inuit hunters for some 4,000 years (and more lately, Viking explorers too). It was the handsomely whiskered First Lieutenant Adolphus Washington Greely (1844–1935) of the United States Army who discovered the ancient forest that had lain there, deeply buried, for fifty million years, a forest as expressive of bygone glories as any Arthurian legend. As part of the First International Polar Year, in 1882, he had been given charge of a party of soldiers, and tasked with making magnetic and meteorological measurements in the far north. They explored the Greenland coast, and traversed Ellesmere Island from east to west, stumbling upon the forest in the course of these journeys. The voyage killed most of his men, and almost killed him. When the relief crews arrived, two years late (the expedition had not been ideally planned) only six men, including Greely, were left alive. They had survived—just—by eating their own boots and, it seems, the remains of their dead colleagues.
The Last of the Warmth
Authors: Zalasiewicz Jan , Williams Mark
Published: November 2020

The Pan-American Highway rises in the far north of the Americas at Prudhoe Bay, Alaska and, except for a small gap in Panama, runs the entire length of the two American continents to terminate at Ushuaia in southernmost Argentina. Along its way it travels nearly 50,000 kilometres, from the polar landscape of the far north, through the boreal forests of Canada, the temperate plains and hot deserts of the USA and Mexico, and on further into the tropical zones of Central and South America, until it reaches the sub-polar landscape of Tierra del Fuego. The American landscape was not always like this. To travel along the Pan-American Highway some three million years ago, in the Pliocene Epoch, would have revealed a different world. It was a little warmer than our own. Far away, the Greenland ice sheet covered only a small part of that land mass. At the other end of the world, there was less ice covering the West Antarctic than we are familiar with today. Going south, from Prudhoe Bay along the Pan-American Highway of the Pliocene, there was none of the scrub tundra now seen by the ice road truckers. Forests then extended far to the north, covering vast areas of northern Canada and Alaska, and draping the coastal margins of Greenland. They stretched, too, into Siberia, a mass of forest extending thousands of kilometres from Norway to Kamchatka. There was almost no tundra in the north, except for a few patches in Greenland and on the far northern extremities of Siberia. Instead the polar sun rose across that well-nigh endless green Pliocene forest. Such a prehistoric journey south along the Pan-American Highway would take one across the grasslands of temperate America. These are truly ancient, having been long established even then. Patterns of seasonal temperature and rainfall, though, allowed forests to grow where none are present today. There were no humans to cut down the trees or hunt the animals that lived in the forests. There were no Great Lakes either, for no northern ice had grown yet, to scour out their floors and fill them with melt water.
Solubility, Vaporisation and Vaporisers
Authors: Magee Patrick , Tooley Mark
Published: November 2020

In discussing humidity in the preceding chapter, the concept of equilibrium between water and its vapour has been introduced as a thermodynamic concept. The concept of vaporisation of other liquids such as volatile anaesthetic agents follows on naturally from that, but first of all it will be worth taking a detour through a discussion on solubility of gases and vapours in their own and other liquids [Davis 2003]. To maintain simplicity in the discussion on humidity, no mention was made of the presence of air or other gas above the surface of the water, only the water vapour. Depending on the solubility of the gas in the liquid, a variable amount of the gas dissolves in the liquid, whether that be air in water or carbon dioxide in blood. As will be discussed in the section on vaporisation, some molecules of gas enter the liquid and some leave it, depending on their individual kinetic energies, until equilibrium is reached. If the pressure inside the container with the gas or vapour and liquid is increased, then the partial pressure of the gas above the liquid surface increases; this increases the population density of gas molecules, resulting in more of the gas molecules dissolving in the liquid. Henry’s Law states that for a fixed temperature the solubility of a gas in a liquid is proportional to its partial pressure in equilibrium with the liquid. Note the condition of constant temperature because, in addition, solubility decreases with increased temperature. This occurs because an increase in the thermal energy of the dissolved gas molecules increases the partial pressure of the gas and encourages it to come out of solution (see below on vaporisation). Thus gas bubbles are more apparent in liquids that are heated. A historical clinical example of the relevance of ambient pressure and nitrogen solubility in body tissues is in decompression sickness associated with tunnel workers. Modern examples include underwater diving and, to a lesser extent, aviators and space walking astronauts. Nitrogen is a compressible gas and goes into solution in body tissue spaces under compression if the miner, tunnel worker, or diver is breathing ambient air.
The early development of diagnostic ultrasound in Denmark
Authors: Jørgensen Jørgen
Published: November 2020

The development of diagnostic ultrasound in medicine began in Denmark in November 1965 at the Surgical Department H at Gentofte County Hospital in Copenhagen, and a prosperous time for diagnostic ultrasound began. It was the young surgeon Hans Henrik Holm who took the initiative, strongly supported by the head of the department Professor P.A. Gammelgaard. Hans Henrik Holm had for years studied ultrasound and earlier in 1965 he had visited Helmuth Hertz in Lund in Sweden to discuss the prospects of ultrasound. A grant from a national scientific foundation of 60 000 Danish kroner (approximately $10 000) made it possible to buy the American Physionic A-mode ultrasound machine. It was installed in a spare room at the Surgical Department H at Gentofte County Hospital in Copenhagen. An ultrasound laboratory was hereby established, and it was increasingly involved in a variety of clinical ultrasound studies and in the development and testing of new ultrasound equipment. The expenses were met by both the hospital and the University of Copenhagen, and a great deal of the research was financed by foundations. Hans Henrik Holm became the day-to-day head of the laboratory and he kept this position for many years. The Surgical Department and the ultrasound laboratory, designated the Ultrasound Department, were relocated to the new Herlev County Hospital in 1976 where Hans Henrik Holm became consultant at the Urology Department and Professor in Ultrasound and Interventional Ultrasound affiliated with the Surgical Department. The Ultrasound Department at Herlev had an increasing number of rooms and staff members. A senior registrar (Jø rgen Kvist Kristensen) was associated to the department in 1975 and Søren Torp-Pedersen was appointed consultant at the department in 1989. In 1966, 250 patients were examined annually. Thirty years later the Ultrasound Department at Herlev Hospital examined 17 000 patients annually, and ultrasound departments had been established at other hospitals in the Copenhagen area. By 1966 two papers in Danish were published and two papers in English were published in 1967 and 1968 . The number of staff rapidly increased, and a group of enthusiastic doctors and technicians was formed, working with patients and on scientific projects.
The development of ultrasound in ophthalmology
Authors: Ossoinig Karl C .
Published: November 2020

The clinical applications of diagnostic ultrasound in ophthalmology were initiated by G.H. Mundt and w.F. Hughes ( 1 ) (1956) as well as A. Oksala and A. Lehtinen ( 2 ) (1957) introducing A-scan, and by G. Baum ( 3 ) (1958) introducing and pioneering B-scan. The first medical society for diagnostic ultrasound was founded in 1964 (Societas Internationalis de Diagnostica Ultrasonica in Ophthalmologia) with subsequent biennial congresses. Ophthalmic diagnostic ultrasound is the only ultrasonographic method heavily relying on A-scans besides the B-scans. Today, four distinct echographic methods (utilizing different types of instrumentation) are being used in ophthalmology: 1) Biometric A-scans for measuring the axial eye length. 2) Low-frequency B-scans for the examination of the posterior eye segment and the anterior orbit utilizing 10–20MHz. 3) High-frequency B-scans for the evaluation of the anterior eye segment applying 25–50MHz. 4) Standardized Echography , a combination of diagnostic as well as biometric A-scan (8MHz) and B-scan echography (10–50MHz) for a comprehensive ultrasonographic examination of the eye (anterior and posterior segments) and of the entire orbit and periorbital region. A-scan (8–12MHz) is used for measurements of the axial eye length, today an important contribution to the calculation of intraocular lens power in cataract surgery. F. Jansson ( 4 ) (1963) proposed biometric A-scan as an immersion (non-touch) technique and also measured the involved sound velocities of the anterior chamber, the lens, and the vitreous cavity which since then have been the accepted standard values. At first, axial eye length measurements were mostly used in studies regarding glaucoma and myopia. when, in the early 1970s, the implantation of artificial lenses during cataract surgery spread quickly, the much more precise but more time-consuming and demanding immersion method temporarily gave way to an easier and quicker contact method. Lately, however, advances in cataract surgery, especially the use of multifocal lenses as well as the competition from laser technology, resulted in a return of Jansson’s immersion method.
Iberia and The Western Mediterranean
Authors: O'Brien William
Published: November 2020

The Iberian Peninsula is one the most mineralized parts of Europe, with a long history of metal mining from prehistoric and Roman to modern times. The earliest evidence for copper metallurgy dates to the fifth millennium BC; however, distinctive Chalcolithic metalworking traditions did not emerge in most regions until 3000 BC onwards. There are widespread occurrences of copper mineralization in Spain and Portugal, including many areas with deposits of lead, tin, silver, and gold. Copper deposits occur in the Galician and Cantabrian mountain ranges of northern Spain, extending east to the Pyrenees. They are also numerous in central Spain, in the provinces of Madrid, Avila, Salamanca, and Segovia in the Central Range, and also in the Toledo and Betic mountains of Cordoba. Farther south, there are major copper deposits in the so-called Pyrite Belt, extending from Seville to Huelva into southern Portugal, and also in the Penibetic range from Cartagena to Malaga crossing the sierras of Almeria (Rovira 2002: fig. 3c; see Delibes de Castro and Montero Ruiz 1999 for regional surveys of copper deposits and indications of early mining; also Gómez Ramos 1999; Hunt Ortiz 2003). The widespread availability of ore deposits was a significant factor in the establishment of copper metallurgy in Iberia. How early is contentious, as is the means by which the new technology first developed in different parts of the peninsula. The older explanation of metal-seeking colonists from the east Mediterranean introducing this technology to southern Spain was replaced in the 1960s by a model that emphasized autonomous development (Renfrew 1967, 1973; Montero Ruiz 1994). This was based on the apparent antiquity of copper mining and metallurgy in Iberia and the distinctive technological processes that developed there relative to other parts of Europe. The earliest indication of copper metallurgy in Iberia may come from the settlement of Cerro Virtud in Almeria, south-west Spain. A single sherd from a metallurgical crucible used to reduce oxidized copper ore was discovered in a layer dated to the early fifth millennium BC (Montero Ruiz and Ruíz Taboada 1996; Ruíz Taboada and Montero Ruiz 1999).
Central and Eastern Europe
Authors: O'Brien William
Published: November 2020

This survey of prehistoric copper mines in Europe began with the oldest known examples, namely Rudna Glava and Ai Bunar in the Balkans. It is now time to consider some of the largest Bronze Age mines, which were major producers of copper that influenced its supply across large parts of the continent. Much of the focus is on Austria, where the earliest scientific investigations of early copper mines were undertaken in Europe. The earliest use of copper in central Europe can be linked to a Late Neolithic culture called the Münchshöfen group, best known in south-eastern Bavaria. A small number of copper objects can be associated with this culture group, including axe-hammers and flat axes, awls, beads, and rings. Scientific analysis of these objects reveals that they probably originated in the Balkans, as part of a spread of metal use into central Europe from that area during the second half of the fifth millennium BC (Höppner et al. 2005). This is supported by the material culture of the Münchshöfen group, in particular the ceramic evidence, which finds close typological parallels with metal-using groups in the Carpathian Basin. It is likely that the same spread of copper use into Austria and southern Germany eventually led to the first attempts to exploit the copper resources of the Alpine region. The evidence comes from the hill-top settlement of Mariahilfbergl near Brixlegg in the Inn Valley of North Tyrol, Austria. Excavation uncovered traces of metallurgical processes in the form of a fireplace with fragments of copper slag, two clay nozzles, and two items of copper metal (Bartelheim et al. 2002, 2003). Radiocarbon analysis indicates a 4500–3640 BC date range, however, the wider cultural context of the site may place these discoveries in the later fifth millennium BC. It is not certain whether smelting took place in this site, though some of the slag-like material suggests the heat treatment of a type of fahlore (tetrahedrite) that is common in the Brixlegg area. Interestingly, chemical and lead isotope analyses of a copper bead and copper strip from the same site context revealed a different chemical composition from that of the slag, one that matches with copper metalwork from Bulgaria and Serbia (Pernicka et al. 1997).
From Centre to Circumference
Authors: Bradley Richard
Published: November 2020

This book began with one site in Ireland and closes with another. The Loughcrew Hills in County Meath include at least twenty-five megalithic tombs, located on three summits along a prominent ridge. Many of them were investigated in the nineteenth century when Neolithic artefacts were found there. More recent work has been less extensive but features an analysis of the carved decoration inside these monuments, for the Loughcrew complex is one of the main concentrations of megalithic art in Europe (Shee Twohig 1981: 205–20). Early excavation in the westernmost group of monuments had an unexpected result, for Cairn H contained a remarkable collection of artefacts which must have been deposited three thousand years after the tomb was built. They included bronze and iron rings, glass beads, and over four thousand bone flakes (Conwell 1873). A new excavation took place in 1943, but its results only added to the confusion and, perhaps for that reason, they were not published for more than six decades (Raftery 2009). They seemed to show that the artefacts, which obviously date from the Iron Age, were directly associated with the construction of the monument; today it seems more likely that they were a secondary deposit. When they were introduced to the site, the tomb may have been rebuilt. One reason why the bone flakes attracted so much attention is that a small number of them—about a hundred and fifty in all— were decorated in the same style as Iron Age metalwork. Most of the patterns are curvilinear and show the special emphasis on circles and arcs that characterize ‘Celtic’ art (Raftery 1984: 251–63). This discovery illustrates a problem in Irish archaeology. A few stone tombs in other regions were decorated in a style that has been identified as either Neolithic or Iron Age (Shee Twohig 1981: 235–6), but in the case of the flakes from Loughcrew there is no such ambiguity. Not only do the incised patterns compare closely with those on metalwork, the decorated artefacts were associated with beads and rings dating to the end of the first millennium BC. Even so, two problems remain.
Leadership, Management, Team Working, and Decision Making
Authors: Lappin Mike
Published: November 2020

It is important that we differentiate between leadership and management right at the outset, and this differentiation can be seen in this statement. However, initially, we will consider both individually and as different facets of what you as a student nurse are required to learn to achieve your competencies to practise as a registered nurse. The concept of team working is explicit throughout this chapter. Recent years have seen the issue of nursing leadership become an important issue for the future of nursing generally, and, most importantly, specifically in relation to the major changes in health and social care, and subsequently in direct nursing care. Patients now require more intensive interventions; bedside technology continues to thrive and, with a more rapid discharge system and quicker throughput of patients in hospitals, many organizations are in search of a workforce who can manage their workload effectively, whilst providing leadership to others. Employers are looking for qualified nurses who can provide supervision, management, development, administration, and coordination of services to patients and employees (Mahoney 2001: 269). In his letter to the Prime Minister summarizing the interim report of the National Health Service (NHS) Next Stage Review (Department of Health 2007: 3), Lord Darzi set out his aim to convince and inspire everyone working in the NHS to embrace and lead change. Every time you go on duty with an aim to care for patients, whatever their number, you require some degree of skill and potential to lead others to help you to collaborate with your colleagues. The Nursing and Midwifery Council (NMC) Standards for Pre-Registration Nursing Education (NMC 2010) now make it explicit how student nurses are expected to achieve competencies in these areas and state in the Standards: Each field of practice also has its own field-specific competencies related to this domain—that is, competencies that are specific to the main service users that are the focus of the respective field of care.
The Dreaming Spires of the Karakoram
Authors: Searle Mike
Published: November 2020

Travelling by bus across the northern areas of Pakistan on my way back to England after our first climbing expedition to Kulu in 1978, I remember it being hot, dry, and dusty down in the plains of the Peshawar basin, but the distant sight of glinting snowfields way to the north of Swat and Gilgit heralded the mightiest mountain range of them all. The Karakoram Range has the highest concentration of mountains over 7,000 metres anywhere in the world including K2, at 8,614 metres high the second highest peak, and three other mountains which are over 8 kilometres above sea level (Broad Peak 8,047 m, Gasherbrum II 8,034 m, Gasherbrum I also called Hidden Peak, 8,068 m). Literally hundreds of peaks over 6 kilometres high are clustered along the length and breadth of the range, which spans the borders of Afghanistan, Pakistan, and the Chinese province of Xinjiang, also just clipping the far northern Indian state of Ladakh. The Karakoram Range contains the longest continental glaciers outside the polar regions, the four longest being the Siachen (73 km long), and the Hispar, Biafo, and Baltoro Glaciers, all about 60 km long. In the middle of the Karakoram is a huge continental icecap, Snow Lake or the Lukpe-lawa, surrounded by glistening, improbably steep and high granite spires. The mountains here leap out of the glacier like the wildly imaginative lines of a child’s drawing. During the later stages of the Great Trigonometrical Survey of India, the chaotic array of contours and mountain ranges around the north-western Himalaya was surveyed. The main Himalayan Ranges extend west into the Zanskar and Kashmir regions, but to the north of the Indus River lie another whole series of ranges, the Ladakh Range (the ‘Transhimalaya’ of Sven Hedin, the greatest of all Tibetan explorers), the Karakoram, and the Pamir Ranges. In 1856, Colonel T. G. Montgomery first spied the great peaks bordering the Baltoro Glacier from the distant Kashmir foothills over 150 km away. Two giants stood above the rest, K1 (Masherbrum) and K2. Everest had just been computed as the highest mountain at 29,002 feet (8,829 m), later increased to its now widely accepted height of 29,064 feet (8,848 m).
Extruding Indochina: Burma, Vietnam, Yunnan, Thailand
Authors: Searle Mike
Published: November 2020

Geographically, Indochina consists of the South East Asian countries Thailand, Laos, Cambodia, and Vietnam. Geologically, Indochina includes all the land bounded by two very large-scale strike-slip faults—the Sagaing fault, which runs down the length of Burma, and the Red River fault, which extends more than 1,100 kilometres from the south-eastern corner of Tibet south-east through Yunnan and North Vietnam to Hanoi and the Gulf of Tonkin. Both faults are active, and show that Indochina is moving south-east relative to both the Burma micro-plate to the west and the South China block north of the Red River fault. The unresolved questions were how far Indochina was extruding away from the India–Asia collision zone and when these faults became active. The eastern margin of the Indian plate lies along the Burma–Andaman– Sumatra–Java trench, where the Indian oceanic plate is subducting beneath the great island arc chain of Indonesia. Behind the island arc, a new oceanic basin has formed in the past 5 million years, with basaltic ocean crust forming along a small active spreading centre in the Andaman Sea. The northern extension of the Andaman trench extends into the Arakan-Yoma Hills of western Burma, but the nature and location of the transition from oceanic lithosphere beneath the Bay of Bengal to continental lithosphere in Burma is poorly known. In the south of Burma, where the Irrawaddy River drains into the Andaman Sea, a vast delta has built up with over 10 kilometres’ thickness of sediments eroded off the mountains of Burma. The Sagaing fault continues offshore and is connected to the young oceanic spreading centre in the Andaman Sea. In northern Burma the fault passes close to the cities of Meiktyla and Mandalay and then splays into several branches that terminate in the Jade belt and other mountain ranges that ripple northwards towards the eastern Himalayan syntaxis. Burma is a hauntingly beautiful country of serene landscapes, golden pagodas, green rice fields, range upon range of distant hills, teak forests, and wide muddy rivers. It is also a land of great mineral riches.