bluuebunny/crossref_metadata_2025 huggingface dataset:
Applied Archaeology in the Andes: The Contribution of Pre-Hispanic Agricultural Terracing to Environmental and Rural Development Strategies
Authors: Kendall Ann
Published: November 2020

Patterns of civilization in the Central Andes can be seen to have fluctuated over the last 5,000 years in relation to climate changes. Starting with the first American civilization at Caral, on the Peruvian coast, other impressive coastal centres and cultural areas followed and subsequently the highland cultural areas and civilizations took over in what now seems to have been at least partly a response to periods of climate changes. While the early coastal environment offered economic advantages of maritime resources and made it easy to adapt and benefit from the early arrival of imported cultigens, greater effort was required to develop agriculture from wild local species at high altitudes in rugged terrains. However, by the first millennium BC, following adverse effects of droughts in coastal areas, the highland religious centre at Chavin de Huantar developed an influential impact in the Early Horizon Period (c.500–c.200 BC), expanding through trade networks to adjacent regions and southwards towards Paracas on the southern coast. Following the centre’s demise around 200 BC (due to the increasing impoverishment of the highland environment) impetus returned to a new surge of coastal developments, notably the emergence of the Mochica and Nazca cultures on the northern and southern coasts respectively, and at Pucara in the altiplano. Here Rowe’s chronological system of Intermediate Periods characterized by regional states and Horizon Periods characterized by broader dominating cultures can be seen to be influenced by the swings of past climate. Temperature and precipitation have been shown to be prime influences underlying the sustainability of cultural developments, driven by agricultural developments, at key centres of Andean power (Kendall and Rodríguez 2009),. Early economic and cultural developments centred on Lake Titicaca in the southern altiplano were supported by agricultural systems, including cocha (ponds) networks developed for specialized cultivation (Flores Ochoa and Paz 1986) and camellones or wayru wayru (raised fields) around wetland shores (Erickson 1985).
Memories and Expectations of Environmental Disaster: Some Lessons from the Marshall Islands
Authors: Rudiak-Gould Peter
Published: November 2020

The Republic of the Marshall Islands, an archipelago of low-lying coral atolls in eastern Micronesia, is one of four sovereign nations that may be rendered uninhabitable by climate change in the present century. It is not merely sea level rise which is expected to undermine life in these islands, but the synergy of multiple climatic threats (Barnett and Adger 2003). Rising oceans and increasingly frequent typhoons will exacerbate flooding at the same time that the islands’ natural protection—coral reefs—will die from warming waters and ocean acidification. Fresh water resources will be threatened by both droughts and salt contamination from flooding. Although the reaction of the coral atoll environment to climate change is uncertain, it is likely that the islands will no longer be able to support human habitation within fifty or a hundred years (Barnett and Adger 2003: 326)—quite possibly within the lifetimes of many Marshall Islanders living today. In the public imagination, climate change in vulnerable, remote locations is the intrusion of contamination into a formerly pristine environment, of danger into a once secure sanctuary, of change into a once static microcosm (see Lynas 2004: 81, 124). Archaeologists, of course, know better than this: every place has a history of environmental upheavals, and the Marshall Islands is no exception. Researchers agree that coral atolls are among the most precarious and marginal environments that humans have managed to inhabit (Weisler 1999; Yamaguchi et al. 2005: 27), existing only ‘on the margins of sustainability’ (Weisler 2001). The islands in fact only recently formed: while the reefs are tens of millions of years old, the islets that sit on them emerged from the sea only recently, probably around 2000 BP (Weisler et al. 2000: 194; Yamaguchi et al. 2005: 31–2), just before the first people arrived (Yamaguchi et al. 2005: 31–2). The new home that these early seafarers found was not so much an ancient safe haven as a fragile geological experiment—land whose very existence was tenuous long before humans were altering the global climate.
Archaeology and Environmental Anthropology: Collaborations in Historical and Political Ecology
Authors: Fairhead James
Published: November 2020

This chapter examines the importance of integrating archaeological perspectives within contemporary environmental anthropology. It does this through exposing key questions raised by environmental anthropologists concerning West African relations with soil and forests that can only be addressed through collaboration with archaeological investigation (see also Balée, Chapter 3 this volume). Environmental anthropological research has been particularly important in revealing the ecological knowledge and environmental practices of land users and how these practices interplay with ecological and economic processes in the shaping of landscapes. This research has systematically undermined a paradigm of environmental reasoning that equates land use with the progressive degradation of otherwise ‘natural’, ‘equilibrial’, or ‘pristine’ environments (whether of soils, forests, or faunal assemblages). Whilst equilibrial ecology is apparently no longer upheld in ecological sciences either, in its shift to non-equilibrium ecology and recognition of path dependency, and whilst nature is no longer so easily configured simply as the absence of people, assumptions rooted in such simplistic ideas of nature still strongly inform and mislead the way West African environments are understood and problematized. Anthropologically derived critiques of the way landscapes are understood have been associated with a rereading of the history of those landscapes. Yet given how oral historical and anthropologically derived historical evidence can so easily be delegitimized and dismissed by apparently ‘harder’ sciences, environmental archaeology becomes a crucial player in these debates. In this brief chapter I shall focus on two key debates which can only be resolved (or reconceptualized) through environmental archaeology. The first of these concerns the degradation (or otherwise) of soils and vegetation linked to farming in West Africa’s Guinea savannah and forest-savannah transition zones. The second concerns the legacy of past land use on current ‘old growth’ forest in the Central and West African humid forest zones. These are not only interesting debates, but are at the heart of sustainable development policy deliberation in West Africa. The continued power of the paradigm in environmental reasoning that equates land use with the progressive degradation of otherwise ‘natural’ or ‘pristine’ environments is visible in the way that landscape features are often interpreted uncritically as ‘relicts’ of that nature.
Acidification: Background and History
Authors: Gattuso Jean-Pierre , Hansson Lina
Published: November 2020

The ocean and the atmosphere exchange massive amounts of carbon dioxide (CO2). The pre-industrial influx from the ocean to the atmosphere was 70.6 Gt C yr –1 , while the flux in the opposite direction was 70 Gt C yr –1 ( IPCC 2007 ). Since the Industrial Revolution an anthropogenic flux has been superimposed on the natural flux. The concentration of CO2 in the atmosphere, which remained in the range of 172–300 parts per million by volume (ppmv) over the past 800 000 years ( Lüthi et al. 2008 ), has increased during the industrial era to reach 387 ppmv in 2009. The rate of increase was about 1.0% yr –1 in the 1990s and reached 3.4% yr –1 between 2000 and 2008 ( Le Quéré et al. 2009 ). Future levels of atmospheric CO2 mostly depend on socio-economic parameters, and may reach 1071 ppmv in the year 2100 ( Plattner et al. 2001 ), corresponding to a fourfold increase since 1750. As pointed out over 50 years ago, ‘human beings are now carrying out a large scale geophysical experiment of a kind that could not have happened in the past nor be reproduced in the future’ ( Revelle and Suess 1957 ). Anthropogenic CO2 has three fates. In the years 2000 to 2008, about 29% was absorbed by the terrestrial biosphere and 26% by the ocean, while the remaining 45% remained in the atmosphere ( Le Quéré et al. 2009 ). The accumulation of CO2 in the atmosphere increases the natural greenhouse effect and generates climate changes ( IPCC 2007 ). It is estimated that the surface waters of the oceans have taken up 118 Pg C, or about 25% of the carbon generated by human activities since 1800 ( Sabine et al. 2004 ). By taking CO2 away from the atmosphere, the oceanic and terrestrial sinks mitigate climatic changes. Should their efficiency decrease, more CO2 would remain in the atmosphere, generating larger climate perturbations. This book has four main groups of chapters.
Effects of Ocean Acidification on Benthic Processes, Organisms, and Ecosystems
Authors: Andersson Andreas J. , Mackenzie Fred T.
Published: November 2020

The benthic environment refers to the region defined by the interface between a body of water and the bottom substrate, including the upper part of the sediments, regardless of the depth and geographical location. Hence, benthic environments, their organisms, and their ecosystems are highly variable as they encompass the full depth range of the oceans with associated changes in physical and chemical properties as well as differences linked to latitudinal and geographical variation. The effects of ocean acidification on the full range of different benthic organisms and ecosystems are poorly known and difficult to ascertain. Nevertheless, by integrating our current knowledge on the effects of ocean acidification on major benthic biogeochemical processes, individual benthic organisms, and observed characteristics of benthic environments as a function of seawater carbonate chemistry, it is possible to draw conclusions regarding the response of benthic organisms and ecosystems to a world of increasingly higher atmospheric CO2 levels. The fact that there are large-scale geographical and spatial differences in seawater carbonate system chemistry (see Chapter 3), owing to both natural and anthropogenic processes, provides a powerful means to evaluate the effect of ocean acidification on marine benthic systems. In addition, there are local and regional environments that experience high-CO2 and low-pH conditions owing to special circumstances such as, for example, volcanic vents (Hall- Spencer et al . 2008 ; Martin et al . 2008 ; Rodolfo-Metalpa et al . 2010), seasonal stratification (Andersson et al . 2007), and upwelling (Feely et al . 2008 ; Manzello et al . 2008 ) that may provide important clues to the impacts of ocean acidification on benthic processes, organisms, and ecosystems. The objective of this chapter is to provide an overview of the potential consequences of ocean acidification on marine benthic organisms, communities, and ecosystems, and the major biogeochemical processes governing the cycling of carbon in the marine benthic environment, including primary production, respiration, calcification, and CaCO3 dissolution. The depth of the euphotic zone, i.e. the depth of water exposed to sufficient sunlight to support photosynthesis, varies depending on a range of factors affecting the clarity of seawater, including river input and run-off to the coastal ocean, upwelling, mixing, and planktonic production.
The Physics, Clinical Measurement and Equipment of Anaesthetic Practice for the FRCA
Authors: Magee Patrick , Tooley Mark
Published: November 2020

A good knowledge of physics, measurement, and equipment is essential for practising anaesthetists. However, these subjects do present considerable problems because few anaesthetists have any background in physics. This book explains the physical principles and applications of physics in anaesthesia, and the statistical methods that anaesthetists are required to understand. The book includes sections on equipment and safety in anaesthesia, and electrical safety. Fully updated for the second edition, the book also includes new chapters on the depth of anaesthesia and on electrical safety. The contents are based on the syllabus of the FRCA exam in mathematics, physics, clinical measurement, monitoring, and equipment. The book starts with mathematics, statistics and physics background, not only to enhance the understanding for what follows in the book, but also because these basic sciences are fundamental to many other aspects of medical science. Areas, which in the authors' teaching experience, candidates have found particularly troublesome, such as electricity and electrical safety, are discussed in some detail in order to clarify.
Electrical Safety
Authors: Magee Patrick , Tooley Mark
Published: November 2020

Domestic ‘mains’ systems in the UK use AC at 50 Hz. In the USA the systems use 60 Hz. These frequencies are used as they are efficient frequencies for transmission from power generation to the users and minimise the effect of leakage currents due to capacitance, which is discussed later in this chapter. The mains is initially generated in a power station and the power generated there (volts × amps) is enough to supply a number of hospitals and consumers. The voltage and the potential to do work must be transmitted to the user and this is usually achieved with overhead pylons, or sometimes by underground cables. Both types of cable will be designed to carry current, but the higher the current, the greater power lost to heat (I 2R). It is desirable to keep the current as low as possible to reduce this transmission heat loss, and this can be done by making the voltage as high as possible. For a given power, (V × I) there can be a high V and low I or vice versa. The transmission voltage is normally greater than 11 kV. It arrives at a domestic substation and is transformed down to (in the UK) 230 V RMS by a transformer. At the substation, as illustrated in Figure 6.1, one connection of the transformer is firmly bound to earth at what is called the star point, and this forms the start of what is called the neutral lead. The earth connection forms a vital part of electrical safety. The connection on the other side of the transformer is called the live lead and this is at 230 V RMS. These two leads are taken to the individual outlets or mains sockets, the live carrying the voltage to the load, and the neutral lead carrying the return current back to the source of the supply. The earth connection of the mains socket is connected back to the star point separately, although sometimes in older installations this can be earthed locally. In this way only one of the socket points is live, and the other is at near zero potential.
Surgical Diathermy
Authors: Magee Patrick , Tooley Mark
Published: November 2020

As discussed in Chapter 4, when a voltage is applied across a conductor, a current will flow. If the voltage is applied across the body via suitable electrodes the body becomes part of the circuit and a current will also flow, the magnitude depending on the properties of the tissues in its path, particularly the resistance. This current can cause heating or other physiological effects, depending on the frequency of the driving voltage. The effects of the domestic mains current flowing through the body was discussed in Chapter 6, but different effects occur as the frequency of the voltage is increased. As the frequency goes up, the heating increases but the tissue stimulation decreases and, at frequencies above 100 kHz (i.e. radio frequencies), the effect is entirely heating. This heating effect in the body by electric current is called diathermy, but the location, concentration and how this heat is used is dependant on the electrode design and the current concentration or current density at any point in the circuit. For a certain applied voltage, the average current throughout the circuit will be the same. The current density is the current per unit area, and so if the material in which the current passes is smaller, the heating effect increases. The resistance of the material is proportional to its size, so as the material becomes smaller then its resistance gets larger. The heating power is the product of the current squared and the resistance (power = I2 × R). Surgical diathermy (or electrosurgery) is where either one or both of the electrodes are very small, and it is used to cut and coagulate tissue. The smaller electrode can be made into a pointed surgical tool and localised heating will occur at the tip of the instrument. The smaller and more pointed the instrument is, the greater the current density will be at the tip. This electrode is classified as the active or live one. The current densities around this electrode can be as much as 10 A cm−2, and the total heating power typically around 200 W.
Airway Management Devices
Authors: Magee Patrick , Tooley Mark
Published: November 2020

The most important interface between the breathing system and the patient’s lungs is an airway management device (AMD). Post-operatively it can be considered to be a means of delivering oxygen enriched air to the patient. Intraoperatively it is intended to secure the patient’s airway, which might otherwise obstruct due to deep anaesthesia, to provide a reasonably gas tight seal to ensure accurate delivery of anaesthetic gases and, if necessary, to protect the lungs against aspiration of gastric contents. Postoperatively, the AMD can be nasal prongs or a variable performance mask, whose efficiencies may not be predictable [Wagstaff et al. 2007]. Intraoperatively it might be an artificial airway with a facemask, a supraglottic airway of one of the many types now available or an endotracheal tube (ETT). A supraglottic airway is one that sits in the pharynx or larynx above the vocal cords and these days is usually a laryngeal mask airway (LMA) of the numerous types now available, a cuffed oropharyngeal airway (COPA), or a Combitube. The LMA types available consist of: the classical LMA; the flexible (reinforced) LMA with a flexible tube to the breathing system; the ‘Proseal’, which has a gastric drainage tube as well as a gas transport tube; the intubating LMA, a device with a rigid right angled tube that acts as a ventilation conduit in the usual way, but through which an endotracheal tube may also be blindly introduced into the trachea; the ‘I-gel’ which has a gastric and a respiratory port as does the Proseal, but is less bulky, and whose bowl does not require inflation with air, but is filled with a gel that expands with body heat to form a seal. These days, almost all devices are made of material that excludes latex, but care should be taken to ensure this is indeed the case when there is a latex sensitive patient. Depending on the exact surgical and anaesthetic circumstances, the anaesthetist’s experience and equipment availability, a choice is made between these devices to secure the airway for a given operation. Additionally, there are other devices available to assist in securing the airway, such as the laryngoscope, the fibre optic bronchoscope and the cricothyrotomy tube.
Environmental Safety
Authors: Magee Patrick , Tooley Mark
Published: November 2020

For these to occur, there is a need for combustible material, oxygen and a source of ignition. The risk of these being present results from the use of high oxygen partial pressures and the use of inflammable anaesthetic agents or other inflammable materials. If the pressure of any gas is increased, heat is liberated. If the gas is oxygen and this comes into contact with something flammable like oil or grease in a confined space, the heat liberated may cause an explosion. Hence oil or grease should be kept well away from pressurised oxygen sources. These include not only oxygen, but pressurised air and pressurised nitrous oxide, which can dissociate into nitrogen and oxygen. Although modern anaesthetic volatile agents are non-flammable, ether and cyclopropane are flammable and may still be used in some parts of the world. Ethyl chloride, used to test sensory perception in local anaesthetic blocks and methyl alcohol for cleaning skin, are also flammable. Ignition sources include sparks from static electricity, or faulty electrical apparatus from the diathermy machine or from mains plugs sparking when disconnected. To prevent static electricity causing ignition, not only should efforts be made to minimise the generation of static electricity, but also to discharge any static slowly to earth. There should therefore be an upper and a lower limit to the electrical resistance between the antistatic floor and earth, of between 5MΩ and 20 kΩ respectively. All equipment capable of generating static electricity should make electrical contact with the floor through a medium made of antistatic (conducting) rubber. Staff footwear should also have antistatic rubber soles and the tubing of breathing systems should also be made of antistatic material. Classification of anaesthetic proof equipment is based on the ignition energy required to ignite the most flammable mixture of ether and air. ‘AP’ standard equipment can be used between 5 and 25 cm from such an inflammable anaesthetic gas mixture escaping from a breathing system; furthermore its temperature should not exceed 200◦C. ‘APG’ standard is a more stringent one for anaesthetic proof equipment; it is based on the ignition energy required to ignite the most flammable mixture of ether and oxygen, which should be less than 1 μJ.
FRCR Part 1: Cases for the anatomy viewing paper
Authors: Thomas James D.
Published: November 2020

Exclusively focused on preparing candidates for the FRCR Part 1 anatomy viewing paper, this book enables them to practice questions that have the look and feel of the actual exam. Containing eight practice examinations, each with 20 cases which have been thoroughly reviewed and tested by radiology registrars who have sat the exam, the questions are at increasing levels of difficulty. Screenshots from Osirix and advice on how to approach the exam familiarize candidates with its format. Each exam in the book contains a wide selection of images with all body parts and modalities equally represented to thoroughly test candidates interpretation skills. The 160 images cover all major plain films, CT, MRI, barium studies and other contrast examinations, as well as some of the newer techniques, based on the examples published online by the Royal College of Radiologists.
Europe: The Birthplace of Mining?
Authors: O'Brien William
Published: November 2020

The origins of mining extend back several million years to when the first hominines in Africa, and subsequently in Europe and Asia, used their bare hands to collect loose rock to make stone tools. This gradually evolved into the systematic collection of rocks with desired properties, as well as an interest in earth minerals such as iron ochre. A desire for these substances led in some cases to more organized collection, involving surface quarrying and eventually underground mining. This activity increased significantly in Europe with the adoption of farming after 7000 BC in the Neolithic period. There is evidence for highly organized mining of flint and other hard rocks to make stone axes and other tools at centres such as Grimes Graves in England, Spiennes in Belgium, and Casa Montero near Madrid, among many others. Mining is also the process by which metal was obtained from the Earth’s surface. Metal objects were first made in the Middle East approximately 10,000 years ago; however, the oldest known copper mines are recorded in Europe. The discovery there of thousands of copper, bronze, and gold objects is a strong indicator that the mining of these metals was a widespread activity during the late prehistoric period. This began with the first use of copper and gold in what is known as the Chalcolithic (‘Copper Age’), which occurred in different regions between the sixth and third millennia BC. Technical advances and growing demand for metal led to the widespread adoption of bronze by 2000 BC, or soon afterwards. This was made possible by the discovery of copper and tin sources in many parts of Europe. Some of these were mined intensively over long periods during the Bronze Age that followed, while others were worked on a smaller scale. The copper produced was supplied to areas without their own resources, creating trade networks that provided economic opportunities and played an important role in cultural exchanges across the Continent. This book is concerned with the prehistory of copper mining and its important place in shaping European societies during the period 5500–500 BC.
Getting started
Authors: Roe Simon D.
Published: November 2020

This chapter provides a more detailed overview of the equipment requirements for protein purification and the practical aspects of developing a purification strategy, including the ordering of unit operations, buffer preparation, and approaches to minimizing yield losses. A well-equipped laboratory is an essential prerequisite to successful protein purification and time spent in deciding needs and purchasing essential items will help to avoid panics mid-way through a protocol when a key piece of equipment is lacking. This said, one should avoid expensive purchases (unless budget is no object) as the majority of purifications can be achieved with fairly routine equipment. The few essential pieces of expensive equipment are a spectrophotometer, a centrifuge, and a chromatography set-up. In general, money is best spent in purchasing plenty of the cheaper items such as tubes, beakers, measuring cylinders, salts, and buffers. Chromatography equipment is an essential item for any purification laboratory. There are plenty of expensive chromatography set-ups available which can provide a remarkable saving in time for process development purposes. If you are not familiar with such equipment and are new to the world of protein purification, I suggest you make do with a simple chromatography set-up to start with, until you become familiar with the technique and learn more about your exact requirements and how alternative tailor-made process development kits differ. A protein purification laboratory should be equipped with supplies of tapwater, de-mineralized water, and distilled water. Electricity and sinks are taken for granted. Required equipment can be roughly grouped into three categories: • those for ancillary purposes • those for detection • those for separation Table 1 lists the essential items for the protein purification laboratory. Time and money spent wisely on buying adequate supplies of support materials will pay dividends. There is nothing more irritating than having to rush around in search of a clock or some salt half-way through a delicate purification with your enzyme degrading in front of your eyes! Key requirements are tubes, beakers, pipettes, stirrers, and timers. In addition essential chemicals include salts and buffers. Adjustable pipettes (e.g. Gilson) are essential and those suitable for sample volumes from 10 μl to 5000 μl are recommended.
Clarification techniques
Authors: Reed Ian , Mackay Duncan
Published: November 2020

Proteins can be produced by a number of different routes such as fermentation, tissue culture, and by extraction from plasma or plants. Whatever route is chosen, the raw protein-bearing stream is likely to be a complex mixture containing both dissolved species and particulate material. The target protein will be present at very low concentration and with a host of contaminants such as cells or cell debris, DNA, proteins and polysaccharides, and a large quantity of water. Such a mixture is very difficult to treat using the highly selective processes that are required to obtain the target product at high purity since the presence of particulate material impairs their function. The first challenge of protein purification is therefore to convert the complex fermentation broth which is a mixture of dissolved and suspended solids into a form that is amenable to further purification. Although there is much interest in direct recovery of protein from such materials, the most frequent first step currently is to clarify the raw protein source to remove suspended matter. It is then possible to use a range of highly selective techniques to purify the target protein. There are a number of clarification techniques that can be adopted and the choice of which to use depends on both the source of raw feed and the scale of operation. There are two main classes of process; sedimentation and filtration. Sedimentation can be carried out under normal gravity conditions or, as is almost always the case for biological streams, using a centrifuge. Filtration can be performed using either conventional filter media or using membrane filters for removal of finer particles. The aim of this chapter is to describe these methods, and their underlying principles, the advantages of each are discussed, and examples of equipment are presented. Practical advice is presented on how and when to use each technique. Sedimentation processes operate primarily on the basis of density differences between the various components of a mixture. They are most commonly applied to suspensions of solid in liquid, but also to disengage immiscible liquids. If there is no density difference between particulates and the suspending medium, sedimentation cannot occur.
Introduction—a retrospective viewpoint
Authors: Sheppard R C
Published: November 2020

Although spatial thinking has long been a part of anthropological inquiry, it has waxed and waned in its perceived utility and centrality to the field. Although the papers in this volume attest to a vigorous tradition of spatial thinking in anthropology and further suggest that, for at least some branches of the field, spatial thinking and analysis are truly central to their definition and mission, it is nevertheless clear that this has not always been the case. Further, despite differences in historical trajectories of development between the two major subfields of anthropology—cultural anthropology and archaeology—in terms of the way space has been used, it is also clear that the two subfields share a number of common interests and themes that deserve discussion and exploration. This exploration is not only interesting from a purely historical perspective, but also has a very practical, down-to-earth dimension. The literature on the history of science is replete with cases of communication failures both within and between scientific disciplines. While in many cases this is merely annoying (different terms used to describe the same procedure, for instance), there are occasions when these failures lead to the creation of a highly idiosyncratic jargon used by small cliques of investigators, which clearly offers the opportunity to inhibit scholarly communication. This, in turn, can lead to redundancy of effort, failure to learn from the mistakes of others, and wasted time and money. By providing a forum in which similarities and differences can be examined, the natural tendency of scientific disciplines to form these cliques can be overcome. I intend this paper to be such a forum for an exploration of the ways in which geographic information systems (GIS) have been employed by anthropologists and archaeologists as represented by the authors of the papers presented in this volume. I will briefly describe the GIS for those readers unfamiliar with it and then turn to a review of the history of spatial thinking and the kinds of tools used to implement this thinking for each of the subdisciplines.
Decision Making in Adult Nursing
Authors: Atkinson Deborah , McGrath Jane
Published: November 2020

This chapter explores clinical decision making in the field of adult nursing practice. It draws upon the actual experiences of a third-year student nurse prior to qualifying as a nurse, to provide real-world examples of the types of decision that you, as a student nurse, will face whilst out on placement and once qualified. The case studies include learning exercises for you to complete, which aim to explore how you might have addressed the situation and made decisions. This will help you to develop skills for safer professional practice and to put the patient at the centre of your decision making. The role of the nurse has grown significantly over recent years as a result of changes in health policy, enabling the nurse to take on far greater levels of responsibility, such as independent nurse prescribing and advanced levels of nursing practice. This has resulted in nurses working in an increasingly complex clinical environment. On a daily basis, nurses are required to make decisions in relation to the care that they provide and how they manage their individual workloads (Banning 2005). As such, clinical judgement is considered to be an essential skill (Tanner 2006). Nurses now have far greater independence over their decisions in clinical practice owing to the influence of the changing policy context (Thompson 2001). However, this level of independence brings increased responsibility to the nurse, who will be judged and held accountable for his or her actions. Nurses are frequently required to make decisions in practice, often with limited information available to them (Ellis 1997). This requires critical thinking and problem-solving abilities, which are important elements of student nurse education (Garrett 2005). Clinical decision making is a highly complicated process, not yet fully understood, and there is considerable debate relating to its constructs and definitions evident in the literature (Shabban 2005). Furthermore, a variety of terms are used interchangeably within the literature referring to clinical decision making, which demonstrates a lack of consensus and may cause confusion: ‘clinical judgement’, ‘clinical decision making’, and ‘clinical reasoning’ are phrases used interchangeably to discuss and describe similar activity (Maharmeh 2011).
Listen
Authors: Shroff Gautam
Published: November 2020

As the scandal over Rupert Murdoch’s News Corporation’s illegal phone hacking activities broke to television audiences around the world, I could not help but wonder why?’And I am sure many others asked themselves the same question. What prompted Murdoch’s executives to condone illegal activities aimed at listening into private conversations? Obvious, you might say: getting the latest scoop on a murder investigation, or the most salacious titbit about the royal family. But let us delve deeper and ask again, as a child might, why? So that more readers would read the News of the World, of course! Stupid question? What drove so many people, estimated at over 4 million, a significant fraction of Britain’s population, to follow the tabloid press so avidly? The daily newspaper remains a primary source of news for the vast majority of the world’s population. Of course, most people also read more serious papers than the News of the World. Still, what is it that drives some news items to become headlines rather than be relegated to the corner of an inside page? The scientific answer is Information; capitalized here because there is more to the term than as understood in its colloquial usage. You may call it voyeurism in the case of News of the World, or the hunger to know what is happening around the world for, say, the New York Times. Both forms of enquiry suffer from the need to filter the vast numbers of everyday events that take place every second, so as to determine those that would most likely be of interest to readers. The concept of Information is best illustrated by comparing the possible headlines ‘Dog Bites Man’ and ‘Man Bites Dog’. Clearly the latter, being a far rarer event, is more likely to prompt you to read the story than the former, more commonplace occurrence. In 1948, Claude E. Shannon published a now classic paper entitled ‘A Mathematical Theory of Communication’. By then the telegraph, telephone, and radio had spawned a whole new communications industry with the AT&T company at its locus. Shannon, working at AT&T Bell Laboratories, was concerned with how fast one could communicate meaning, or information in its colloquial sense, over wires or even the wireless.
Mountains and Maoists: Annapurna, Manaslu
Authors: Searle Mike
Published: November 2020

Sarangkhot village is perched on top of a hill overlooking the Phewa Lake and Nepal’s second city of Pokhara. The views from here are some of the most wonderful in all the Himalaya. To the north-west, the huge snowy ramparts of Dhaulagiri rise above the Kali Gandaki Gorge, one of the world’s deepest canyons. East of the Kali Gandaki the whole Annapurna Range forms an icy rampart that blocks the entire northern horizon, with the majestic spire of Machapuchare, the ‘Fish Tail’, rearing up in the foreground. Hanging glaciers clinging to the side of Machapuchare glisten in the sunlight and cascade down to the green bamboo jungles of the Seti khola. The Annapurnas extend east into the Lamjung Himal, and then across another deep canyon, the Burhi Gandaki, the 8,000-metre-high massif Manaslu appears on the far eastern horizon. Winds funnel down the Pokhara Valley and rise up to the ridge at Saranghot, making this the perfect take-off place for hang-gliders. To jump off the ridge at Saranghot and see the whole Nepalese Himalaya unfurl to the north, ride the thermals with the black kites, eagles, and vultures cruising alongside, and land back at the lakeside is one of the new wave of extreme sports to have recently caught on in Nepal. It is difficult not to like Pokhara. The monsoonal rains in Nepal can be dramatic. Clouds gradually form in the late morning, welling up the valley to hug the high peaks, with just the tips of the mountains standing clear and proud above a sea of cloud. Suddenly the skies darken, streaks of lightning appear out of nowhere, and thunderclaps ricochet around the mountain walls. One or two large raindrops herald a torrential monsoonal downpour, rain falling out of black clouds in sheets. Trickles of water in rivulets become raging torrents in minutes, and very soon waterfalls gush over every cliff. The rains finally ease as suddenly as they started, the skies gradually clearing as mists linger in the deep forested valleys.
Governance
Authors: Dryzek John S. , Norgaard Richard B. , Schlosberg David
Published: November 2020

It is all very well to contemplate what policies are likely to prove effective and just, as we did in Chapters 4 and 5, but that assumes we have some effective authority to put them into practice. So comparisons of (for example) emissions trading schemes against carbon taxes as ways of achieving greenhouse gas emissions reduction need some kind of body to craft the policy and implement it effectively. Sometimes that body will be a sovereign government, but sometimes the government is missing altogether or has only partial jurisdiction—for example, if a carbon trading scheme can extend across national boundaries. When government is missing we can however still speak of processes of governance— notably at the global level. “Governance” is a broader concept that allows for more fluid, informal, and transnational arrangements, though it can also include government as conventionally defined. Global inaction on greenhouse gas emission reduction and inadequate national policies are sometimes blamed simply on an absence of political will. But a big part of the story is that if we can’t get the structure and process of governance right, we are not going to get the policies right. So it remains remarkable that some high-profile proposals either ignore the governance question altogether, or treat it in simplistic terms. For an example of ignoring governance altogether (doubly remarkable in that the person doing it is a political scientist) consider the policy proposals ranked by a group of experts assembled by Bjørn Lomborg under the auspices of his Copenhagen Consensus Center (Lomborg, 2010). Using cost–benefit analysis plus expert judgment, the top three solutions were: 1. Marine cloud whitening research 2. Energy research and development 3. Stratospheric aerosol insertion research The first of these would require creating mists from sea water to create clouds that better reflect sunlight, the third injecting tiny particles into the atmosphere to simulate the cooling effects of volcanic eruptions. Though cast in terms of “research” the reason for this ranking is the anticipated net benefit of the anticipated policy (policies to reduce greenhouse gas emissions came bottom).
Assessment And Interviewing Skills
Authors: Fairweather Susannah
Published: November 2020

Psychiatry is unique as a specialty. In the past century, medical technology has advanced at breakneck speed supporting diagnostic refinement, yet this has had limited impact in the area of mental health. It is not possible to diagnose mental illness with a blood test, a radiological investigation, or other such investigative tools. It requires a doctor to hone their ‘end of the bed’ observation skills and develop a sophisticated understand­ing of psychopathology. This familiarity of descriptive psychopathology then needs to be applied in everyday practice to recognize the symp­toms being presented, allowing interpretation of illness states. Similar symptoms can present in different illnesses and their relevance needs to be understood in the context of the history of the person. Psychiatric assessments with well-developed interview skills are the cornerstone of psychiatric practice. This can feel a daunting task to medical students and junior doctors who are well used to the protection of many investigation options at their fingertips. Psychiatric patients are often the most challenging to interview. They can present in ways that confront even the most experienced doctor— highly distressed, aggressive, withdrawn, disconnected from reality, or uncooperative, to describe just a few situations. They may not have cho­sen to see a doctor and may have come willingly or unwillingly due to someone else’s worry about them. These factors often create a difficult starting point from which to engage patients and establish a trusting doc­tor–patient relationship. The reasons for a person’s presentation, especially in the acute set­ting, are often highly anxiety provoking—attempted suicide, threatened suicide, or highly disturbed behaviour. This challenges doctors to remain calm in order to maintain the capacity to manage the assessment without relying on the armoury of procedures other specialties often can. A firm grasp of the MSE and the core aspects of a psychiatric history helps to negotiate numerous potential challenges during the interview. Interviewing and interpretative skills can be developed, akin to a cardi­ologist learning the sounds of different heart murmurs.
Mental Health and the Law
Authors: Murphy Paula , Exworthy Tim
Published: November 2020

Mental health law is concerned with the legislation governing the man­agement and treatment of people with a mental disorder. It includes the detention and treatment of patients and covers consent to treatment, mental capacity, deprivation of liberty, human rights, and ethical issues. The law is necessary to safeguard the interests of the patients and also to protect the public from potentially serious harm from a mentally disordered offender. It is crucial that mental health practitioners under­stand the relevant legislation to ensure that they are practising within the realms of the law and also so that they can offer help and advice to patients and carers if required to do so. Mental health legislation is constantly evolving and there are always challenges and changes to existing legislation, so practitioners need to keep up to date with new statutory legislation and case law. An example of this is the Mental Health Act (MHA) 1983, which was amended by the MHA 2007, and amended again by the Health and Social Care Act 2012. In addition, the Mental Capacity Act 2005 was a new statute which came into force in 2007, alongside Deprivation of Liberty Safeguards. There are Codes of Practice for the MHA, the Mental Capacity Act, and the Deprivation of Liberty Safeguards. These provide supplemen­tary guidance on good practice. Mental health practitioners need to take account of the Codes of Practice in their work. Mental health law can be a complex and challenging area, even for the most knowledgeable and experienced practitioners. Most organizations will have an MHA administrator and/or a legal advisor who can provide advice and guidance in matters of uncertainty.
The obstetric outcome of pregnant women with psychotic disorders
Authors: Howard Louise M.
Published: November 2020

In 1996, when I was working with Channi as a psychiatry trainee, we were both struck by how often we were seeing women with psychotic disorders in the outpatient clinic who were seeking advice on whether or not they should try to conceive and have a family. Although there was a small amount of literature on the parenting difficulties some of these women would experience, there was a very limited evidence base on their risk of adverse obstetric outcomes. We felt we needed to know more about the outcome of pregnancy for women with pre-existing psychotic disorders, and this led to my PhD, funded by a Wellcome Trust Clinical Training Fellowship, with Channi as my primary supervisor. Channi became too ill to continue working on this project, but our work together led to my perinatal mental health research programme, for which I will always be in his debt. This chapter describes this early PhD research, and the research it has led on to, over the subsequent years. We initially thought about collecting detailed clinical outcome data from the women we were seeing locally, who came from a large catchment area. However, to obtain a large enough sample size would take many years and it became clear we needed large epidemiological datasets in order to optimize statistical power and minimize bias. We therefore started to look for such data, with the first dataset available coming from colleagues at the Institute of Psychiatry—the PriSM psychosis study (Thornicroft et al. 1998). The PRiSM psychosis study research team conducted the complete ascertainment of all prevalent cases of psychosis in the two study catchment areas in the index year (1991–1992) providing us with a representative population of mothers with psychotic disorders. We found that 63% of women with psychotic disorders (n = 155) were mothers, and that these women were more likely to be older and live in unsupported accommodation than women who had not had children, although they had similar levels of disability and health and social care needs (Howard et al. 2001).