bluuebunny/crossref_metadata_2025 huggingface dataset:
Global Climate Change: Real or Myth?
Authors: Fox Michael H.
Published: November 2020

We, the teeming billions of people on earth, are changing the earth’s climate at an unprecedented rate because we are spewing out greenhouse gases and are heading to a disaster, say most climate scientists. Not so, say the skeptics. We are just experiencing normal variations in earth’s climate and we should all take a big breath, settle down, and worry about something else. Which is it? A national debate has raged for the last several decades about whether anthropogenic (man-made) sources of carbon dioxide (CO2 ) and other so-called “greenhouse gases“ (primarily methane and nitrous oxide) are causing the world to heat up. This phenomenon is usually called “global warming,” but it is more appropriate to call it “global climate change,” since it is not simply an increase in global temperatures but rather more complex changes to the overall climate. Al Gore is a prominent spokesman for the theory that humans are causing an increase in greenhouse gases leading to global climate change. His movie and book, An Inconvenient Truth, gave the message widespread awareness and resulted in a Nobel Peace Prize for him in 2008. However, the message also led to widespread criticism. On the one hand are a few scientists and a large segment of the general American public who believe that there is no connection between increased CO2 in the atmosphere and global climate change, or if there is, it is too expensive to do anything about it, anyway. On the other hand is an overwhelming consensus of climate scientists who have produced enormous numbers of research papers demonstrating that increased CO2 is changing the earth’s climate. The scientific consensus is expressed most clearly in the Fourth Assessment Report in 2007 by the United Nations–sponsored Intergovernmental Panel on Climate Change (IPCC), the fourth in a series of reports since 1990. The IPCC began as a group of scientists meeting in Geneva in November 1988 to discuss global climate issues under the auspices of the World Meteorological Organization and the United Nations Environment Program.
The Siren Song of Renewable Energy
Authors: Fox Michael H.
Published: November 2020

Renewable energy from the sun—which includes solar, wind, and water energy— can meet all of our energy needs and will allow us to eliminate our dependence on fossil fuels for electricity production. At least, that is the “Siren song” that seduces many people. Amory Lovins, the head of the Rocky Mountain Institute,
has been one of the strongest proponents of getting all of our energy from renewable sources (what he calls “soft energy paths”) (1) and one of the most vociferous opponents of nuclear power. A recent article in Scientific American proposes that the entire world’s needs for power can be supplied by wind, solar, and water (2). Is this truly the nirvana of unlimited and pollution-free energy? Can we have our cake and eat it, too? Let’s take a critical look at the issues surrounding solar and wind power. Let me be clear that I am a proponent of solar energy. I built a mountain cabin a few years ago that is entirely off the grid. All of the electricity comes from solar photovoltaic (PV) panels with battery storage. The 24 volt DC is converted to AC with an inverter and is fed into a conventional electrical panel. It provides enough energy to power the lights, run a 240 volt, three-quarter horsepower water pump 320 feet deep in the well, and electrical appliances such as a coffee pot, toaster,
and vacuum cleaner. But I am not implying that all of my energy needs come from solar. The big energy hogs—kitchen range, hot water heater, and a stove in the bedroom—are all powered with propane. Solar is not adequate to power these appliances. In 2010 I also had a 2.5 kW solar PV system installed on my house that ties into the utility grid. When the sun is shining, I use the electricity from the solar panels, and if I use less than I generate, it goes out on the grid to other users. If it does not produce enough for my needs, then I buy electricity from the grid.
The Quest for Uranium
Authors: Fox Michael H.
Published: November 2020

The name rises as a phantom from the heart of the Congo. The dawn of the nuclear age began there, though no one knew it at the time. King Leopold II of Belgium claimed the Congo as his colony during the surge of European colonization in the 1870s, promising to run the country for the benefit of the native population. Instead, he turned it into a giant slave camp as he raped the country of its riches. Leopold didn’t care much about mineral wealth, preferring the easy riches of rubber, but aft er he died in 1909, the Belgium mining company Union Minière discovered ample resources of copper, bismuth, cobalt, tin, and zinc in southern Congo. The history-changing find, though, was high-grade uranium ore at Shinkolobwe in 1915. The real interest at the time was not in uranium—it had no particular use—but in radium, the element the Curies discovered and made famous. It was being used as a miracle treatment for cancer and was the most valuable substance on earth—30,000 times the price of gold. Radium is produced from the decay of uranium aft er several intermediates (see Figure 8.3 in Chapter 8), so it is inevitable that radium and uranium will be located together. The true value of the uranium would not be apparent until the advent of the Manhattan Project to build the atomic bomb during World War II. Edgar Sangier, the director of Union Miniere, which owned the mine at Shinkolobwe, hated the Nazis and was afraid—correctly, as it turned out—that they would invade Belgium. In 1939, as Europe was sliding into war, Sangier learned that uranium could possibly be used to build a bomb. He secretly arranged to transfer 1,250 tons of the uranium ore out of the Congo to a warehouse in New York City. There it sat until 1942, when General Leslie Groves, the man whom President Roosevelt put in charge of the Manhattan Project, found out about it and arranged to purchase it.
Comparative Analysis, Tools, and Questions
Authors: Araújo Kathleen
Published: November 2020

This chapter returns to the overarching questions of this book, namely, how can national energy transitions be explained, to what extent do patterns of change align and differ in the transitions of this study, and how does policy play a role, particularly with innovations that emerged amid the transitions. To broadly answer, the four cases are comparatively examined here. The conceptual tools from Chapter 3 are also elaborated based on the findings. Implications of the results are discussed, and will serve as a basis for further discussion in Chapter 9 on how to think about energy transitions as a planner, decision-maker, and researcher. Among the more significant findings are the following. Greater energy substitution (in relative terms) occurred initially within the countries that extended or repurposed existing energy systems versus the country (i.e., Denmark) that developed a new energy system from a nearly non-existent one. Cost improvements were evident in all cases; however, a number of caveats are worth noting. Among the energy technologies and their services that were studied, only Icelandic geothermal-based heating was competitive in its home market in the 1970s; nonetheless, the remaining energy technologies that were studied later became cost competitive. As the national industries of this book became globally recognized, increases in the quality of living within the given countries also occurred, as gauged by the Human Development Index (HDI). With respect to timescales, substantial energy transitions were evident in all cases within a period of 15 years or less. In terms of technology complexity, this attribute was not a confounding barrier to change. Finally, government was instrumental to change, but not always the driver. There are countless ways to compare national energy transitions. This section illustrates ways of doing so, first by describing broadly observed, socio-technical patterns with the tool typologies outlined in Chapter 3. A discussion of tool refinement follows. The section then turns to more systematically assess key, qualitative and quantitative dimensions of the four transition cases.
What Is a Glacier?
Authors: Taillant Jorge Daniel
Published: November 2020

It’s mind-boggling (and a bit scary) to consider that while most of our planet’s surface is covered with water, only about 2–3% of this water is actually freshwater—that is, water that we can drink. That means that most of the world’s water (about 98%) is of no use for human consumption or for agriculture. But perhaps a more startling statistic that few actually realize is that of this minuscule percentage of water that is actually apt for consumption, three-fourths of it is packed away in dense millenary ice located in the polar ice caps; this is water that we will probably never see in fresh liquid form. Except for documentaries we see occasionally on television about fearsome adventurers who traveled to Antarctica or to the ice sheets of the North Pole, most of us have never ventured (and probably never will) to the North or South Pole where this ice is located. These are rather inhospitable places of our planet that we could only tolerate on extremely nice days and only for a few days at best, if we were ever able to get there at all. We hear about the polar caps melting due to climate change. We see images of penguins in the Southern Hemisphere or polar bears in the north suffering from a warming climate, and we even see entertaining animated movies about these obscure and rapidly changing environments and how odd creatures adapt or succumb to these changes. We hear from many media sources, from scientists and from environmentalists, that enormous ice masses at the poles are melting fast and breaking away into our oceans. James Balog, a photographer and cryoactivist, recently produced a documentary film called Chasing Ice, which incredibly captured the calving (the collapse) of a chunk of glacier ice half the size of Manhattan Island, breaking off from the Ilulissat Glacier and rolling into gelid waters off Greenland. Pieces of glacier ice more than 200 meters (650 ft) tall—as tall as skyscrapers—suddenly sank, vanished, resurfaced, and bounced around in the water as this colossal glacier crumbled into the sea. Since then, much larger calvings have been reported around the world.
Mysteries in the Marsh
Authors: Giblin Anne
Published: November 2020

I feel as though my graduate student experiences “preadapted” me to become involved in long-term ecological research. I already enjoyed collaborative research and instantly felt comfortable in the Long-Term Ecological Research (LTER) program when I first had the opportunity to work in it. Working on large, collaborative projects offers a great number of opportunities for students and postdoctoral fellows, but their mentors need to ensure that they develop intellectually independent ideas. Giving students and postdoctoral fellows the long-term collaborative view of science while having them develop as fully independent scientists is a balancing act that I try to always keep in mind. The LTER program has led me into an increased level of communication with the public, students, and local and regional level managers and policy-makers. I have found that at every level people are hungry for scientific information, and my interactions with all of them have been extremely rewarding—although challenging. It has forced me to expand my communication skills and work with others who have the gift of science translation. There are costs and benefits to scientific collaboration that change with the size of the project and with one’s level of involvement in the project. Entraining young scientists is a challenge for large-sized projects, such as those in the LTER program. It was 1975 when I and several other beginning graduate students first walked down a short path through the woods to the Great Sippewissett Marsh in Falmouth, Massachusetts. Ahead of me marched my major professor, Ivan Valiela. As we explored the marsh, Ivan pointed out numerous circular plots staked in the grass. These, it turned out, defined the bounds of his fertilization experiments. The grass within some of the plots was distinctly greener and taller compared to others. Ivan began explaining the marsh fertilization experiment that he had begun 5 years earlier with John Teal. He described how the responses of the marsh seemed to differ with the amount of added fertilizer. The community composition of the vegetation had been changing over time.
Comparative Materials and Methods for the Sunghir Human Remains
Authors: Trinkaus Erik , Buzhilova Alexandra P. , Mednikova Maria B. , Dobrovolskaya Maria V.
Published: November 2020

This volume is concerned with the morphology and paleobiology of the human remains from Sunghir. As such, it is intended to contribute to our knowledge and understanding of the occupants of that locale in northern Russia during the Interpleniglacial [marine isotope stage (MIS) 3]. However, the Sunghir human remains take on meaning, and can be properly evaluated, only in the context of a broader sample of Late Pleistocene humans. The paleontological sources of the comparative samples are indicated below. In most cases, references are not provided for the specimens or sites, since to do so would be to provide an extensive bibliography for Late Pleistocene human remains. References are provided principally for the smaller non-western Eurasian and immature samples and for those of debated affinities. The principal sample of concern consists of individuals from the same general time period during MIS 3 as the Sunghir humans and those who generated the same general archeological complex. The time frame, sensu lato, is between ~30,000 and ~20,000 14C years BP, or ~34,000 and ~24,000 cal years BP. The archeological technocomplex (which is defined by more than just lithic technology), is the Mid Upper Paleolithic (or the Gravettian sensu lato, especially in central and western Europe). This complex is taken here to include a variety of regional variants, including the “Sunghirian” (see discussion in chapter 2). The regional differences in the archeological complexes, technologically or stylistically, are not of concern here; it is apparent that, despite differences in details of especially lithic technology, there was a broad level of cultural uniformity that extended across western Eurasia (Roebroeks et al. 2000) and probably continued into eastern Asia (Gerasimov 1935; Norton and Gao 2008). What is of most relevance is the general level of cultural elaboration and related patterning, as it might have affected the behavior, biology, and adaptations of the Sunghir humans. As a result, the comparative framework is principally that provided by the human remains from this time period.
The Pelves of Sunghir 1, 2, and 3
Authors: Trinkaus Erik , Buzhilova Alexandra P. , Mednikova Maria B. , Dobrovolskaya Maria V.
Published: November 2020

The pelvis forms the interface between the trunk and the lower limb, as well as supporting the pelvic viscera, and as such its size and morphology reflect a diversity of biological pressures. Aspects of the Sunghir pelvic remains relating to the assessment of sex (pubic morphology, greater sciatic notch shape) and age (auricular surface, epiphyses) are presented in chapter 6, and the features of the sacrum (and coccyx) that are more strictly axial are discussed in chapter 10. The discussion here is concerned with the overall configurations of the Sunghir pelvic remains and more detailed aspects related to function. Given the male sex of Sunghir 1 and the prepubescent ages of Sunghir 2 and 3, reproductive issues beyond those related to sex assessment are not relevant to these remains. Unfortunately, the pelvis for which comparative data and biomechanical models of function exist, that of the adult male Sunghir 1, is the least complete, sufficiently so as to prevent the articulation of the elements. In contrast, the two immature pelves are quite complete, despite problems with reassembly given their immature status. Yet assessing their proportions is inhibited by issues of growth and development. The pelvis of Sunghir 1, as with most of its trunk (chapter 10), suffered extensively from vertical compres­sion in situ. The pubic bones are absent, and the ilia and ischia sustained considerable damage, much of which has been restored in wax. For example, the left acetabular rim is largely intact, but the lunate surface and acetabular notch are blended together with wax, obscuring details. The sacrum retains neither of its alae intact to the auricular surface. The Sunghir 2 and 3 pelves, in contrast, are largely present, with varying degrees of edge damage and loss of the thinner cortical bone, especially within the iliac fossae of Sunghir 3. However, both pelves retain their more cranial sacra, at least one intact sacroiliac articulation, and variable portions of the ischia and pubic bones. The primary difficulties in assessing the Sunghir 2 and 3 pelves derive from their immature status.
The Abnormalities of the Sunghir People
Authors: Trinkaus Erik , Buzhilova Alexandra P. , Mednikova Maria B. , Dobrovolskaya Maria V.
Published: November 2020

Throughout the previous chapters detailing and comparing the Sunghir human remains, there have been frequent references to their abnormalities. Some of these unusual features are obvious and sufficiently pronounced as to remove the bones from direct paleobiological consideration (e.g., the Sunghir 1 pollical osteoarthrosis and the Sunghir 3 femoral diaphyses). Other features are modest and had no apparent effect on the functional anatomical interpretations (e.g., the Sunghir 1 ulnar carpometacarpal osteoarthrosis). A few aspects may modify either the considerations of the osteometric morphology (e.g., the Sunghir 1 frontal midline protrusion) or discrete traits (e.g., the Sunghir 2 dental asymmetries). Some of these features are obviously pathological and represent reflections of developmental or degenerative strains on the body (e.g., Sunghir 2 and 3 dental enamel hypoplasias (DEH), or the Sunghir 1 manual osteoarthrosis). Other aspects may not be pathological sensu stricto but they represent variations that push the limits of “normal” human variation (e.g., the Sunghir 1 femoral asymmetry and the Sunghir 3 foramina transversaria). These aspects that have been described in detail in previous chapters are referred to here, but the others, whose description has been deferred, are detailed in this chapter. A number of these abnormalities of the Sunghir human remains have been noted previously, beginning with Debetz’s (1967) initial observations on the Sunghir 1 skeleton, the initial description of the Sunghir 2 and 3 remains (Nikityuk and Kharitonov 1984), and Bukhman’s (1984) radiographic analysis of the Sunghir 3 remains. These and further observations and interpretations were made in the context of the 1990s’ reanalysis of the Sunghir remains (Buzhilova 2000b, 2000c; Mednikova 2000c, 2000d). There have subsequently been additional analyses of specific aspects of these abnormalities, including differential diagnosis of the Sunghir 3 femoral deformities (Formicola and Buzhilova 2004), description of the T1 injury to Sunghir 1 discovered in 2009 (Trinkaus and Buzhilova 2012), detailed assessment of the Sunghir 2 and 3 DEH (Guatelli-Steinberg et al. 2013), and assessment of the degree to which the deformities of Sunghir 3 might have affected her activity levels (Cowgill et al. 2012b).
Respiratory System
Authors: Mehta Gautam , Iqbal Bilal
Published: November 2020

Interstitial lung disease is a common case for the respiratory section of the MRCP PACES examination. Quite often they are cases of idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) or in the context of systemic (commonly rheumatological) disease. The above cases reflect these common scenarios. To make the diagnosis of interstitial lung disease is relatively straightforward, but presenting other physical signs of underlying aetiologies, mentioning important negatives, and appreciating and recognizing complications of therapy and the disease will impress examiners, not to mention gain considerable extra marks. 1. In approaching a respiratory patient, it is often useful in starting to present the case with a comment on functional status. They may be breathless at rest. They may be on oxygen therapy. Ask the patient to cough. The presence of a non-productive or a productive cough should give clues to underlying diagnosis. Patients with interstitial lung disease often have a non-productive cough, unless this has been complicated by infection. 2. Patients often have peripheral cyanosis. Central cyanosis may be present in advanced disease. 3. Clubbing may not always be present in cases of interstitial lung disease. If present, don’t miss it! 4. Spend a little extra time when examining hands and making general observations. There are many systemic disorders that are associated with pulmonary fibrosis. The presence of peripheral stigmata of systemic disease, usually connective tissue or rheumatological disease, will provide an important clue to the respiratory diagnosis. Look for • rheumatoid arthritis (symmetrical deforming arthropathy of the hands, rheumatoid nodules) • systemic sclerosis (tight and shiny skin, telangiectasia, sclerodactyly, calcinosis, atrophic nails, and Raynaud’s phenomenon) • SLE (petechial rash, livedo reticularis, purpura, arthropathy, butterfly skin rash) • dermatomyositis (Gottron’s papules, heliotrope rash of eyelids/periorbital areas, proximal myopathy) • ankylosing spondylitis (loss of lumber lordosis, fixed kyphosis, stooped posture) • neurofibromatoisis (neurofibromata, café au lait patches) • sarcoidosis (erythema nodosum, maculopapular skin lesions, lupus pernio, lympahdenopathy) • drugs, i.e. amiodarone (grey slate skin pigmentation—the irregular pulse of atrial fibrillation (AF) may be a clue) • radiation therapy (erythema and/or field markings on chest wall)
Concluding Remarks
Authors: Issever Cigdem , Peach Ken
Published: November 2020

‘Giving a talk’, to colleagues, to peers or to the general public, is an important part of our professional duties as scientists. Whatever the context, we have a duty to make sure that the science is communicated clearly, and that the audience is able to understand the science at an appropriate level. Communication of science and about science is becoming more important, for many reasons. Science is becoming more expensive—the simple (that is, cheap) experiments have been done. Science, and the technology that results from it, has brought great benefits to society, but science has also given society cause for concern. Science should be dispassionate, the results independent of cultural background and beliefs of the individual scientist; but science can also be controversial, especially when it challenges generally accepted beliefs or attitudes. We believe that there are no absolute rules governing what makes a good slide, or how to assemble a series of good slides into a good talk. Even if there were such a recipe, how a talk is received depends upon many other things—the subject, the speaker, the venue, the size (and the mood) of the audience. There is never enough time to discuss all the details, and so we always have to make choices about what to include and what to omit. How we make these choices depends upon many things— what might be highly appropriate in one context could be completely inappropriate in another. Nevertheless, we can think of a few principles that should help you, which have underpinned the approach taken in this book. • Understand the scope of your talk—where do you start, what is the key point, how will you conclude, what is the message? • Understand your hosts—why did they invite you to give the talk or, if you invited yourself, why did they agree? • Understand your audience—why have they come to hear you, what do they know already, what do they expect to learn and what do they need to learn? • Be professional—understand and be master of the technology of the presentation.
The Burden of Tribalism: The Social Context of Southern African Iron Age Studies (1984)
Authors: Hall Martin
Published: November 2020

The study of the archaeology of farming communities in southern Africa is an inherently political activity but there has been little critical analysis of the role of social context in forming problems and in shaping answers. It is argued in this chapter that the history of Iron Age research south of the Zambezi shows the prevalent influence of colonial ideologies, both in the earliest speculations about the nature of the African past and in the adaptations that have been made to contemporary archaeological methodologies in their application to the subcontinent. Concepts such as ethnicity have acquired specific meanings in southern Africa that contrast with the use of similar ideas in other contexts such as Australasia. Such relativity reinforces the view that specific, detailed critiques of archaeological practice in differing social environments are necessary for an understanding of the manner in which the present shapes the past. In those countries where descendants of the colonizers mostly practise the archaeology of those colonized, the study of the past must have a political dimension. This has become overt in Australasia where, as one Aboriginal representative has put it, the colonizers ‘have tried to destroy our culture, you have built your fortunes upon the lands and bodies of our people and now, having said sorry, want a share in picking out the bones of what you regard as a dead past’ (Langford 1983: 2). In African countries, such opinions have been less explicit and consequently archaeologists have not frequently been faced with political accountability. Schmidt (1983) points out that there is some awareness that the intellectual constructs of Western archaeologists may have little meaning to African communities, but current literature describing research south of the Zambezi River of precolonial farming societies (by convention, termed the Iron Age) shows little acknowledgement that the social environment of the investigator may play a part in defining issues and colouring interpretations, or indeed, that the results themselves may have diverse political implications.
Kultur and the World War (1996)
Authors: Marchand Suzanne L.
Published: November 2020

The two decades that preceded the outbreak of the Great War present a puzzling blend of vastly expanded international cultural contact and enormously increased nationalist chauvinism. Bitter colonial rivalries and the British–German naval arms race broke out just as Europeans of the middling sort were seeing more of one another than ever before, in photographs and at international exhibitions, by means of faster, cheaper transportation routes, and the expanding embrace of the popular press. Commerce among European and American scholars accelerated as international conferences and scholarly organizations grew in number. The reverse side of this expansion, however, was the demand for equal access to information (and, as we have seen, equivalent ownership of objects) by national groups and institutions previously dependent on others for scientific and cultural materials. Paradoxically, as scholarly advancement became more and more dependent upon international contact, it also came increasingly to be regarded as a national bragging point. On the eve of the First World War, then, Kultur and Wissenschaft were both more international in scope and more nationalist in sentiment than ever before. Coinciding with and complexly related to the rise of this curious mixture of extended contact and narrowed mindset was the increasing activity of the German state in cultural affairs, as patron, organizer, and publicizer. During the tenures of Richard Schöne and Friedrich Althoff, the Reich had vastly increased both its generosity and its control in the cultural sphere. But the state had not acted alone or without encouragement from cultural interest groups that saw the state as the guarantor of scholarly autonomy against the incursion of party-political demands (vom Brocke 1980: 89). In fact, much of the cultural reorganization in the late nineteenth and early twentieth centuries took place at the insistence of commercial interests or para-academic organizations such as the Prussian Academy of Sciences, the Deutsche-Archäologisches Institut (DAI), and the Royal Museums. Of course, these groups did not turn to the state merely to avoid the politicization of their causes; specialization and escalating international rivalries required high levels of investment to build laboratories and provide research materials, particularly in ‘applied’ fields such as electro-magnetics, medicine, and agronomy.
Introduction
Authors: Palaniyappan Lena , Krishnadas Rajeev
Published: November 2020

MRCPsych exams are the most important exams a psychiatry trainee in the UK will sit during his or her career. Passing the MRCPsych is the most perceptible of the criteria that demonstrate the achievement of a number of competencies during the training. Since spring 2008, there has been a significant change in the pattern of the exam. The structure, syllabus, and the format of questions have changed significantly. The details are clearly given in the Royal College website. They are summarized below for quick reference. Please note that these details are subject to change and so we recommend checking with information at www.rcpsych.ac.uk before you apply. The college has brought out new exam regulations that came into effect on January 2009. Candidates must have completed the mandatory training period of 12 months of post foundation training in psychiatry by the date of sitting the written exams. The recommended time frame for attempting Paper 3 is when the candidate is 18–30 months into training. Posts must be part of a programme of training approved by PMETB OR recognized by the Hospital or Trusts as having specific time, programme (journal clubs, grand rounds, teaching, supervision, etc.), and funds allocated for training. Individual posts can be of either 4 or 6 months’ duration. In addition, the college also has placed emphasis on successful completion of annual review of competency progression (ARCP) and other workplace based assessments (WPBA) to be eligible for training. The exact details need be confirmed from the college website as they are subject to regular reviews. The MRCPsych Paper 3 is 3 hours long and contains 200 questions. The paper consists of multiple choice questions (MCQs = 75%) and extended matching items (EMI = 25%). MCQs are in the ‘best of five’ (BOF) format. A BOF MCQ comprises a question stem of varying length, followed by a list of five options. Candidates should choose the single best option that answers the question. The college has retained the EMI format from the previous pattern in the new format. An EMI comprises of a specific theme (sometimes with a short description), followed by a set of answer choices (often in an alphabetical order) and a lead-in statement explaining what the candidate is being asked to do.
History Taking Skills
Authors: Mehta Gautam , Iqbal Bilal , Bowman Deborah
Published: November 2020

Recent years have seen a shift in the perception of communication skills from being considered subjective personal traits, to an objective, evidence-based curriculum of skills and techniques. This development was founded on the recognition that core communication skills are identifiable, can be taught, and form the basis of the majority of professional encounters. The core skills required for the patient interview in the MRCP (PACES) examination can be broadly divided into three areas: content skills, process skills, and perceptual skills. The content of the medical interview refers to the information the candidate is attempting to gather, or to give, during the course of the interview. The detail of this content is covered in the subsequent case histories of this book. However, the ability of the candidate to communicate or acquire this content depends largely on the process of the interview, and their perceptual skills. The process of the interview refers to the manner in which the candidate communicates with the patient. Although the candidate’s agenda may be to establish the content of the interview, this will not be successful unless the patient’s agenda in considered. In Stations 2 and 4 of the PACES examination, the candidate is provided with clear written instructions (such as a GP letter), followed by 14 minutes for patient interaction. The candidate then has 1 minute for reflection, followed by 5 minutes of discussion with the examiners. Despite the limited time available in the PACES Stations 2 and 4, the examiners will expect the candidate to develop rapport, show empahty, appropriately use silencce during the interview, and interpret non-verbal cues. Indeed, these processes are the key to obtaining the content of the interview, not just for the examination but also for clinical practice. Perceptual skills refer to the candidate’s decision making, problem solving, and clinical reasoning skills. These are complex, higher-order skills, which reflect the individual’s attitudes, beliefs, and self-perception. Indeed, if the content of the interview reflects the candidate’s ‘knowledge’, and the process of the interview is a reflection of ‘technique’, then these perceptual skills are a demonstration of appropriate ‘behaviour’ or ‘performance’.
Drug administration
Authors: Barron Carol , Hollywood Eleanor
Published: November 2020

By the end of this chapter you will be introduced to the concepts of pharmacokinetics and pharmacodynamics with specific emphasis on the infant, child, and young person. You will be presented with the current evidenced- based practice in relation to differing routes of drug administration in children and young people, underpinned by a firm rationale throughout. The key points to consider when administering medications via differing routes to children will be explored. Throughout this chapter the importance and method of drug calculations and mental mathematics will be highlighted, as befits their importance in the safe preparation and administration of all medications. It is anticipated that you will be able to do the following once you have read and studied this chapter: ● Discuss pharmacokinetics and pharmacodynamics as they relate to drug administration with children. ● Understand the mathematical calculations required to accurately prepare and administer medications in children. ● Understand the key nursing skills required to administer medications to children and young people via differing routes. Historically, drug development specifically for children was only conducted for common disorders/diseases where medication was part of the accepted treatment. Examples are medicines for epilepsy or asthma, antibiotics, or vaccines (Rose, 2005). Because the numbers of children are small in comparison with adults, and the child population is subdivided into age groups from neonates to teenagers, pharmaceutical companies are governed by the commercial market. Consequently they assign limited resources to drug development in the child population because of more limited profit margins. However, this situation is changing, as the European Union established a European Network for Drug Investigation in Children in 1998, with a commitment to improve both clinical use and research into drugs for children (Van den Anker & Choonara, 1999). An international meta-register of controlled clinical trials has been created where particular emphasis is placed on paediatric aspects (Bonati et al., 2001). All of these initiatives serve to change the prevailing view of children as ‘therapeutic orphans’ to an acknowledgement that children are consumers of healthcare services and as such have the right both ethically and morally to medications that are designed and trialled for them specifically.
Writing your research proposal
Authors: Eardley William
Published: November 2020

In many ways it’s a reflection of yourself as a researcher and an insight into your proposed work. A poorly written proposal has the ability to wreck a project and embarrass the researcher before it has even begun. Similarly, a well-constructed proposal bodes well for the success of the project and displays the researcher in a good light amongst their peers and supervisors. The research proposal identifies: • What the topic is, both in terms of background and the individual area of interest. • What you plan to accomplish and why it needs doing. • What in particular you are trying to find out, i.e. the research question. • How you will get the answer to your question, i.e. your methodology. • What others will learn from it and why it is worth learning. • How long it will take. • How much money it will cost. Through your research proposal you are attempting to convince potential supporters that your project is worth doing, you are scientifically competent to run it, and are in possession of the necessary management skills to ensure its completion. The proposal concisely describes the key elements of the study process, although in sufficient depth to permit evaluation. It is a stand-alone document that must contain evidence of an answerable question, demonstrate your grasp of the literature, and also clearly show that your methodology is sound. A research time-table is required to demonstrate a realistic appreciation of how the study will progress through time. The research proposal serves many purposes to many different parties. Amongst these purposes, some of the key ones are: • Acting as a route map and timetable for all involved in your project. • Giving a clear overview of your planned work to ensure favourable decision at ethical review. • Gaining funding to carry out your proposed study. • Securing a place to undertake a higher scientific degree. • Being an opportunity to ‘blow your own trumpet’ on paper. Although there are several bodies who will be obliged to see your proposal, there is a reasonable chance it will end up being wider read than this, so a coherent piece of work will reflect well on you.
Data collection and research conduct issues
Authors: Page Piers
Published: November 2020

A large proportion of this chapter is common sense. We’ll start with the most basic of all — looking after your participants. You have a clear legal, ethical, and procedural duty to do this and events such as Alder Hey demonstrate what happens when the academic good is held to be of higher priority than this. By definition, any participant enrolling in your study is vulnerable, simply by means of a doctor–patient relationship (and a scientist – patient or nurse – patient dynamic can be every bit as uneven). If participants are perfectly physically and mentally well, they are still letting you intrude into their world for the sake of research; in pathological research, of course, patients may be far from well. Take the time to talk to participants, even if they are only giving a few cc’s of blood for a lab project. Was it easy to find you? Do they have any further questions? Was there anything about their encounter they felt could have been better? At the next level, observational studies have potential to create a degree of symptom awareness, so the participant looks harder and harder for a symptom you’ve asked if they have. This can be very hard for them to deal with and they may need reassurance. Your patient information leaflet should have a contact number for your study; larger, well-funded studies sometimes even have on-call clinically trained cover for advice and reassurance. At the highest level, although you won’t be responsible for this in your first foray into research, clinical trials have rigorous requirements for patient and clinician support. Patients will generally carry some kind of identification card with a 24-hour contact number on it, to ensure that advice is available to them or someone treating them whenever it is required. Any kind of adverse clinical event must be reported to the appropriate bodies. Drug reactions must be notifi ed to the Medicines and Healthcare Regulator Agency, in addition to your local R&D department. Any other form of harm, including allegations of it, should be discussed with R&D.
The phase problem and electron-density maps
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

In order to obtain an image of the material that has scattered X rays and given a diffraction pattern, which is the aim of these studies, one must perform a three-dimensional Fourier summation. The theorem of Jean Baptiste Joseph Fourier, a French mathematician and physicist, states that a continuous, periodic function can be represented by the summation of cosine and sine terms (Fourier, 1822). Such a set of terms, described as a Fourier series, can be used in diffraction analysis because the electron density in a crystal is a periodic distribution of scattering matter formed by the regular packing of approximately identical unit cells. The Fourier series that is used provides an equation that describes the electron density in the crystal under study. Each atom contains electrons; the higher its atomic number the greater the number of electrons in its nucleus, and therefore the higher its peak in an electrondensity map.We showed in Chapter 5 how a structure factor amplitude, |F (hkl)|, the measurable quantity in the X-ray diffraction pattern, can be determined if the arrangement of atoms in the crystal structure is known (Sommerfeld, 1921). Now we will show how we can calculate the electron density in a crystal structure if data on the structure factors, including their relative phase angles, are available. The Fourier series is described as a “synthesis” when it involves structure amplitudes and relative phases and builds up a picture of the electron density in the crystal. By contrast, a “Fourier analysis” leads to the components that make up this series. The term “relative” is used here because the phase of a Bragg reflection is described relative to that of an imaginary wave diffracted in the same direction at a chosen origin of the unit cell.
The derivation of trial structures. II. Patterson, heavy-atom, and isomorphous replacement methods
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

The two methods to be described here, the Patterson method and the isomorphous replacement method, have made it possible to determine the three-dimensional structures of large biological molecules such as proteins and nucleic acids. In addition, the Patterson function is still useful for small-molecule studies if problems are encountered during the structure analysis. If a crystal structure determination proves to be difficult, the Patterson map should be determined to see if it is consistent with the proposed trial structure. The Patterson method involves a Fourier series in which only the indices (h, k, l) and the |F (hkl)|2 value of each diffracted beam are required (Patterson, 1934, 1935). These quantities can be obtained directly by experimental measurements of the directions and intensities of the Bragg reflections. The Patterson function, P(uvw), is defined in Eqn. (9.1).
Outline of a crystal structure determination
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

The stages in a crystal structure analysis by diffraction methods are summarized in Figure 14.1 for a substance with fewer than about 1000 atoms. The principal steps are: (1) First it is necessary to obtain or grow suitable single crystals; this is sometimes a tedious and difficult process. The ideal crystal for X-ray diffraction studies is 0.2–0.3mm in diameter. Somewhat larger specimens are generally needed for neutron diffraction work. Various solvents, and perhaps several different derivatives of the compound under study, may have to be tried before suitable specimens are obtained. (2) Next it is necessary to check the crystal quality. This is usually done by finding out if the crystal diffracts X rays (or neutrons) and how well it does this. (3) If the crystal is considered suitable for investigation, its unitcell dimensions are determined. This can usually be done in 20 minutes, barring complications. The unit-cell dimensions are obtained by measurements of the locations of the diffracted beams (the reciprocal lattice) on the detecting device, these spacings being reciprocally related to the dimensions of the crystal lattice. The space group is deduced from the symmetry of, and the systematic absences in, the diffraction pattern. (4) The density of the crystal may be measured if the crystals are not sensitive to air, moisture, or temperature and can survive the process. Otherwise an estimated value (about 1.3g cm−3 if no heavy atoms are present) can be used. This will give the formula weight of the contents of the unit cell. From this it can be determined if the crystal contains the compound chosen for study, and how much solvent of crystallization is present. (5) At this point it is necessary to decide whether or not to proceed with a complete structure determination. The main question is, of course, whether the unit-cell contents are those expected. One must try to weigh properly the relevant factors, among which are: (i) Quite obviously, the intrinsic interest of the structure. (ii) Whether the diffraction pattern gives evidence of twinning, disorder, or other difficulties that will make the analysis, even if possible, at best of limited value.
Patients with special needs
Authors: Hood Gillian M , Tan Suyin GM
Published: November 2020

Most anaesthetists recognize that there are specific groups of patients with whom communication is especially difficult due to issues relating to language. These groups are patients in whom a disease process interferes with communication—for example intellectual disability or hearing impairment, those with whom we do not share a common tongue, and those patients whose cultural background differs from ours. Patients with communication difficulties are disproportionately represented in the hospital population for a variety of reasons. The elderly form the bulk of hospital inpatients and are much more likely to have problems such as dementia, confusion, sedation and dysphasia. It is important to be cognisant of the issues that may arise with patients who have communication problems and, in addition to being aware of these problems, it helps to have a structured way of approaching the issue. Reading the patients’ notes prior to consultation gives advance warning of issues such as dementia or hearing impairment and allows communication to be tailored to the patients’ needs. Sometimes the patients’ understanding of language may be difficult to assess on first meeting—anaesthetists have all encountered patients who answer questions with a smiling ‘yes’ or ‘no’, only to subsequently discover their comprehension has been minimal. Enquiring of relatives, friends and staff helps to give a picture of a patient’s ability to communicate in the chosen language. Similarly, enquiring of the patient how communication can be facilitated, is helpful. … ‘It says in your notes that you have trouble finding words since your strok —is there anything I can do to make it easier for you to speak?’… Once the communication problem has been delineated it makes it easier to move on to the next step. Having orientated oneself to the patient’s particular problems with communication, it is also important to orientate the staff with whom one is working. …‘Rob, we are going to see Mr Smith now. He’s had problems with alcohol withdrawal over the last few days and he is still a bit confused. It is probably best if just one of us does the talking — are you happy to do that? ’ Not: ‘I wish you wouldn’t contradict me when I’m talking to patients…’ …