bluuebunny/crossref_metadata_2025 huggingface dataset:
Ghosts observed
Authors: Zalasiewicz Jan
Published: November 2020

Life is ubiquitous on the Earth’s surface. Exuberant, fantastical, tough, and very, very persistent, it gets pretty well everywhere. Darwin marvelled at what could be found in a simple tangled thicket by a footpath, while a spadeful of soil can keep a zoologist occupied for weeks—all those mites and worms and springtails and leatherjackets—and a microbiologist busy for months. There is life in the hottest deserts and in Antarctic ice and nestling up against boiling volcanic vents. It flies high through the air too—not just birds and bees, but spores and pollen and aerial bacteria (so abundant that they can make rain fall more copiously by acting as nuclei for the raindrops). In death, too, the organisms can be tough. Not every corpse gets recycled back to form new generations of the living, and not all fossils are such scarcities that each becomes a museum piece or commands a handsome reserve price at an auction of ancient curiosities. The ghosts of the past are all around us, in solid form. Indeed, we owe to them the comfortable contemporary life (not enjoyed by all, admittedly), of centrally heated houses and easy travel and an abundance of food. The remains of dead plants and animals power contemporary human civilization, in the form of oil and gas and coal. At a price, of course, that is still to be paid. The pebble contains a little coaly stuff within it—tiny flecks of what is now essentially carbon, which gives the dark laminae their colour. It probably makes up, today, something over one per cent of the pebble; when the pebble stuff had been layers of mud and sand on that Silurian sea floor, it would have been nearer 10 per cent. That carbon was once living things—but how does one go about finding what kind of living things these once were? The easiest way to release the cornucopia of ancient life locked in the pebble might strike a disinterested bystander as a little harsh. Indeed, it would be quite terminal for the pebble, albeit highly revealing. The procedure is, by now, quite standard.
Funding
Authors: Page Piers
Published: November 2020

As it makes the world go round, it is very unlikely you’ll have got this far in planning a research project without someone asking you about money. Unfortunately no research is free — even a project that seems to carry no costs whatsoever will suddenly seem quite expensive when costed by an R&D department. It’s very important, therefore, that you anticipate all costing issues and submit a sensible bid for your project, as it gives you significantly more credibility as someone who knows what they are doing. There are many ‘hidden’ costs of an apparently simple research project. Photocopying of questionnaires is often contentious; although it’s all NHS money for NHS research, the copying will be billed to an individual department and clinical departments with massive running costs are rarely happy to underwrite research costs. Staff planning has to be done exceptionally carefully to ensure that NHS clinical time isn’t being used on the project without permission from someone with sufficient authority to give it. This often does end up being a hidden cost, as the way round it is often simply to fund a session per week to cover the half hour per day spent on the project. These are, of course, just examples. Detailed breakdown of costing points to consider is given later in the chapter; use this section to prepare a good business case and you will impress from the outset. Aside from the fact that you need it to spend on your project, funding is often (maybe unfairly) seen as a guarantee of the quality of your work. The theory that paid-for research will be better peer reviewed than its public sector or charitable equivalent is somewhat naïve, especially when one considers what agendas could underlie commercial research, but it still abounds. The current climate for research funding is confusing but awash with opportunities. The last few years have seen the creation of national funding programmes and prioritized ‘themes’ with some quite substantial budgets, in addition to the traditional sources. The Medical Research Council (MRC) was brought about by Act of Parliament in the early part of the twentieth century, setting aside a penny per working person per year from the National Insurance scheme of the time to fund tuberculosis sanitoria and medical research.
Evidence-based medicine
Authors: Khakha Raghbir , Hill Adam
Published: November 2020

The aim of research is to faithfully observe and describe, predict, determine causation, explain the hitherto unexplained, and conjure further questions. Medical research is concerned with the application of the scientific method to investigating both our population at risk, and our patients. However, it is often impossible to study entire populations. Therefore, many studies are undertaken to analyse representative cohorts before extrapolating the data to the population of interest. Every study is susceptible to bias and error. It is important to determine whether the evidence from an individual or groups of studies is strong or weak. In other words, are these data sets truly representative of the entire population of interest, or are the data distorted due to potential confounding factors? Furthermore, have the investigators presented a measured interpretation of their results in the context of the potential errors within their experimental system? It is these questions that have led to the concept of research evidence, or the hierarchical system in which the strength of the argument within some studies is simply better, or more persuasive, than others. When planning a research study, design is the first consideration. The highest possible level of evidence is a systematic review or meta-analysis of randomized controlled trials (RCTs), or an individual RCT. These are considered the ‘gold standard’ of clinical research. The design of RCTs allows exclusion of confounding factors and bias as much as possible. These studies work very well for certain interventions, such as drug trials. However, where the control and sample groups cannot be blinded, (e.g. ‘sham acupuncture’ or ‘sham manipulation’ as the control), RCTs may be less appropriate. Meta-analyses are considered as type 1 evidence. The more data is pooled, the more valid the results. However, the data may be less relevant to individual patients. Therefore, although potentially the most powerful type of evidence, meta-analyses can have some important limitations. A meta-analysis takes a number of trials from the literature, e.g. 10 trials of 100 patients each.
Cardiology
Authors: Ismail Tevfi k F. , Fisher Mike
Published: November 2020

A useful mnemonic for any examination routine is HELP. Every case should begin with: • Hello: introduce yourself to the patient and explain what you are going to do. • Expose: expose the patient adequately for the proposed examination but with utmost care to preserve the patient’s modesty and dignity. For the cardiovascular examination, you need to expose from the waist up as well as the arms, and the lower limbs. Once you have finished inspecting, cover the patient up to avoid exposing for an unnecessary length of time. • Lighting: a spotlight should be shone upwards at the neck at 45 ° (90 ° away from your viewing angle) to enable you to maximize the chances of seeing any pulsations. • Pain and Position: always ensure that the patient is comfortable and is appropriately positioned at 45 ° to enable accurate assessment of the venous pressure. 1. Look at the patient from the end of the bed and don’t forget to look around the bed for additional clues. Vital clues such as a raised JVP can be identified at an early stage with appropriate inspection. 2. Check hands, nails, lips, mouth and conjunctivae for peripheral signs of possible cardiac disease. 3. Feel the radial pulse noting the 5 features (rate, rhythm, character, volume and nature of the vessel wall, then feel both radial pulses simultaneously, eliciting for radial–radial delay or a difference in volume between the 2 sides. Then assess for radial–femoral delay. While you are doing this, look for the JVP at the same time. 4. Check for a collapsing pulse. (This is frequently forgotten by candidates.) 5. Palpate the apex, noting position and character – if you can’t feel it, be honest, but remember to check on the right! 6. Listen at the apex remembering to time against the carotid pulse and while you are doing this note for any abnormality (slow-rising, bisferiens, jerky). If you hear a systolic murmur, check for radiation to axilla. If you don’t hear a diastolic murmur, listen with the bell and if necessary perform the reinforcement manoeuvres described later.
Neurology
Authors: Christofi Gerry , Leschziner Guy
Published: November 2020

The neurology section of the PACES examination is often the major cause of (unnecessary!) anxiety for MRCP candidates. The key is to approach the patient in a logical fashion. Some neurology cases are simply an exercise in pattern recognition – noticing the frontal balding and ptosis of myotonic dystrophy, the distal wasting and pes cavus of Charcot–Marie–Tooth disease, for example. However, in those cases without obvious clues to the underlying diagnosis, a clear systematic approach will usually pay dividends. When faced with a neurological problem, the first question that should be posed is the site of the lesion. During the course of the examination, identify signs that might help in localization: • Cortex: signs of dysfunction of higher cognitive function. • Subcortical: upper motor neuron (UMN) signs (hypertonia, pyramidal pattern of weakness, hyper-reflexia, extensor plantars), slowness of thought. • Basal ganglia: cogwheel rigidity, resting tremor, bradykinesia, postural instability, dyskinesias, dystonias. • Brainstem: cranial nerve abnormalities with contralateral UMN signs. • Cerebellum: gait ataxia, nystagmus, finger-nose ataxia, past-pointing. • Spinal cord: bilateral UMN signs, presence of a sensory level. • Nerve root: lower motor neuron (LMN) signs (wasting, weakness, hyporeflexia, sensory loss) in a myotomal or dermatomal distribution. • Single or multiple nerve/plexus: LMN signs that are focal, and are not consistent with a nerve root lesion. • Polyneuropathy: LMN signs, more pronounced distally, affecting the legs more than the hands, diminished reflexes, sensory signs. • Neuromuscular junction: weakness without sensory involvement or significant wasting, usually but not invariably proximal, which fluctuates (either with time of day or during the course of the examination). • Muscle: wasting and weakness with normal reflexes and sensation. Once the lesion has been localized, consider the disease processes that commonly affect that site. Clues may be obtained from the history, if you are permitted to ask questions. The most helpful aspect of the history is usually the speed of onset: • Seconds: electrical disturbance (i.e. epilepsy), trauma. • <5 minutes: infarction. • > 5 minutes: migraine, haemorrhage. • Minutes–hours: infection, inflammation, drugs. • Hours–days: infection, inflammation, nutritional, drugs.
Brief clinical consultation
Authors: Bessant Rupa , Birns Jonathan
Published: November 2020

The brief clinical consultation station, which was introduced in the 3rd diet of the PACES examination in 2009, aims to assess the way in which the candidate approaches a clinical problem in an integrated manner, using history taking, examination and communication with a patient or a surrogate patient. The objective of this station is to reflect the way in which clinical problems are considered in the ward, emergency medical admissions unit, or medical outpatient clinic in normal clinical practice. During this station the candidate will be assessed on their ability to focus on the most important parts of history and examination when posed with a clinical problem. In addition, the candidate will be expected to explain their management plan succinctly to the patient and answer any questions they might have. Careful preparation for this station is vital, particularly as it carries a third of the overall marks of the PACES examination. There are 2 cases in this 20-minute station – each lasting 10 minutes. Candidates will be given written instructions for each of the 2 cases, usually in the form of short notes or referral letters, during the 5-minute interval before this station. During this time candidates ought to draw up a list of differential diagnoses based on the presenting complaint. They should plan the questions that they will need to ask and the most important aspects of the clinical examination that they will be required to perform in order to enable them to differentiate between these diagnoses. The timekeeper will sound a bell to signal the start of the station and 1 examiner will take the candidate into the first of the 2 cases. Candidates will have 8 minutes to take a focused history, carry out a relevant examination, and respond to the patient’s concerns. After 6 minutes have elapsed, candidates will be alerted that they have 2 minutes left with the patient. During the remaining 2 minutes, an examiner will ask the candidate to describe the positive physical findings and discuss the preferred diagnosis and any differential diagnosis as well as the management plan.
MRCPI
Authors: Cheriyan Danny , Patchett Stephen
Published: November 2020

The MRCPI part 2 clinical examination is the final hurdle in the membership trilogy, and can be viewed as a practical interview before entering higher specialist training. It is equivalent to the UK PACES; however, there are some important variations in its format, and this chapter will guide a candidate through the appropriate preparation required to succeed in the examination. Unlike the written examination, it affords examiners a relatively short period of time to judge a candidate’s history taking and examination skills. They must also evaluate a candidate’s ability to formulate differential diagnosis, investigations and management plans. The examiners will also ‘get a feel’ for the candidate’s confidence, and their empathy in dealing with patients. The examination is generally fair in that the examiners try to find out what the candidate knows, rather than try to catch them out. It is important to realize, however, that each examiner will vary in their personality, patience and style of examining. While some may forgive or overlook an outlandish candidate response during questioning, others may choose to further expose a potential weakness. The aim of this chapter is to provide a comprehensive approach to the MRCPI ‘long case’. The format and approach to MRCPI short cases will also be addressed in brief. Whilst the basic principles of history taking do not differ between the 2 examinations, it is important to note that candidates are given a fixed 15 minutes for the history-taking station on the PACES examination, whereas MRCPI candidates have 45 minutes for history and examination. In light of this, we have adapted the timing of the history-taking pro forma, permitting a more in-depth exploration of certain aspects of the history. As a coherent presentation of the history and examination is crucial to the success of the candidate, particular importance has been given to not just what to say, but also how to say it. The first case, therefore, is a fully detailed dialogue between candidate and patient, and provides a foundation for the general manner of successful history taking.
The diffraction pattern obtained
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

In this chapter we will describe those factors that control the intensities of Bragg reflections and how to express them mathematically so that we can calculate an electron-density map. The Bragg reflections have intensities that depend on the arrangement of atoms in the unit cell and how X rays scattered by these atoms interfere with each other. Therefore the diffraction pattern has a wide variety of intensities in it. Measured X-ray diffraction data consist of a list of the relative intensity I (hkl), its indices (h, k, and l), and the scattering angle 2θ, for each Bragg reflection. All the values of the intensity I (hkl) are on the same relative scale, and this entire data set describes the “diffraction pattern.” It is used as part of the input necessary to determine the crystal structure. As already indicated from a study of the diffraction patterns from slits and from various arrangements of molecules, the angular positions (2θ) at which scattered radiation is observed depend only on the dimensions of the crystal lattice and the wavelength of the radiation used, while the intensities I (hkl) of the different diffracted beams depend mainly on the nature and arrangement of the atoms within each unit cell. It is these two items, the unit-cell dimensions of the crystal and its atomic arrangement, that comprise what we mean by “the crystal structure.” Their determination is the primary object of the analysis described here. As illustrated in Figure 1.1b and the accompanying discussion, and mentioned again at the start of Chapter 3, X rays scattered by the electrons in the atoms of a crystal cannot be recombined by any known lens. Consequently, to obtain an image of the scattering matter in a crystal, the “structure” of that crystal, we need to simulate this recombination, which means that we must find a way to superimpose the scattered waves, with the proper phase relations between them, to give an image of the material that did the scattering, that is, the electrons in the atoms.
Refinement of the trial Structure
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

When approximate positions have been determined for most, if not all, of the atoms, it is time to begin the refinement of the structure. In this process the atomic parameters are varied systematically so as to give the best possible agreement of the observed structure factor amplitudes (the experimental data) with those calculated for the proposed trial structure. Common refinement techniques involve Fourier syntheses and processes involving least-squares or maximum likelihood methods. Although they have been shown formally to be nearly equivalent—differing chiefly in the weighting attached to the experimental observations—they differ considerably in manipulative details; we shall discuss them separately here. Many successive refinement cycles are usually needed before a structure converges to the stage at which the shifts from cycle to cycle in the parameters being refined are negligible with respect to their estimated errors. When least-squares refinement is used, the equations are, as pointed out below, nonlinear in the parameters being refined, which means that the shifts calculated for these parameters are only approximate, as long as the structure is significantly different from the “correct” one. With Fourier refinement methods, the adjustments in the parameters are at best only approximate anyway; final parameter adjustments are now almost always made by least squares, at least for structures not involving macromolecules. As indicated earlier (Chapters 8 and 9, especially Figure 9.8 and the accompanying discussion), Fourier methods are commonly used to locate a portion of the structure after some of the atoms have been found—that is, after at least a partial trial structure has been identified. Initially, only one or a few atoms may have been found, or maybe an appreciable fraction of the structure is now known. Once approximate positions for at least some of the atoms in the structure are known, the phase angles can be calculated. Then an approximate electron-density map calculated with observed structure amplitudes and computed phase angles will contain a blend of the true structure (from the structure amplitudes) with the trial structure (from the calculated phases).
How words hurt
Authors: Cyna Allan M , Lang Elvira V
Published: November 2020

Suggestions are statements that evoke an image in the listener’s mind. They may be positive, evoking an image of peace and hope or a desirable mood and behaviour, or they may be negative, eliciting thoughts of pain and doom. Once mentioned, the suggestion is front and centre: ‘You probably even didn’t think of an endotracheal tube before we mentioned it right now—even if we had instructed you not to do so or just reminded you that there is absolutely no need to think of it right now ’. When anaesthetists tell patients that a procedure such as intravenous or arterial line placement ‘will hurt’, the communication itself increases the likelihood of this possibility, and the perception referred to becomes more likely to be experienced as pain. Fortunately, suggestibility can also be used in a positive way — for example, telling patients that there are ways to improve their comfort such as coughing during IV cannulation or that breathing exercises after abdominal surgery can make things more comfortable. Also just not mentioning words with negative connotations significantly reduces pain and anxiety associated with potentially painful stimuli such as injection of local anaesthetic. Remaining factual ‘I will give you the local anaesthetic now’ or ‘the numbing medicine’ as some prefer, will suffice. In times of stress, patients assume a focus of attention that leads to a hypnotic frame of mind that is highly suggestible to communications from the anaesthetist, whether the communications are negative or positive. Hence an important step is to avoid wording with negative connotations. Often, however, even well-meaning comments are misunderstood. Many words have double meanings, and in this setting patients will cling to the more pessimistic interpretation. ‘I will put you to sleep’ may conjure images of the veterinarian euthanizing a pet. Also interpretations are highly individual. We (EL) had one patient who objected to being made ‘numb’ since ‘numb’ meant ‘dumb’ for him. The effects of suggestion become all too evident when considering the widely recognized phenomenon of placebo.
Needle phobia
Authors: Cyna Allan M , Andrew Marion I
Published: November 2020

Needle phobia describes an anticipatory fear of needle insertion, and is a well-recognized clinical entity of particular relevance to the anaesthetist. It may affect up to 10 % of the general population, is more common in the young, and can prevent patients from seeking medical care by avoiding immunizations, necessary blood tests or hospital procedures. The development of trust, a perception of control and an understanding of the conscious–subconscious aspects of the problem can help patients. In addition, patience, time and recognized communication skills are frequently needed if this distressing problem is to be managed effectively . Needle phobia is usually a learned response. Trust, control and perceptions rather than the pain itself are the key issues in needle phobia. Nevertheless pain reduction strategies such as EMLA, ice , premedication such as dexometomidine, stress-reducing medical devices and hypnosis, may have a role in management. Anaesthetists have traditionally used reassurance, EMLA and avoidance of needle insertion in the awake patient by giving inhalational inductions. However, this approach tends to reinforce the avoidance behaviour of both anaesthetist and patient! In addition, it wastes a valuable opportunity to educate patients in ways that can provide them with the necessary skills to manage future blood tests, drips and the like more easily. In some cases avoiding IV access prior to inducing anaesthesia—for example, at a Caesarean section — can put patients at increased risk of complications. Patients with needle phobia are like all patients only more so! At one level they function consciously and logically and are amenable to reason. However, in the context of hospital procedures such as blood tests and IV cannulation, subconscious responses take over. These patients often recognize that their behaviour is silly or even stupid, but find that they just can’t help themselves. They may describe their predicament as being in ‘two minds about it’ or ‘beside themselves’. This mind set illustrates, probably more clearly than any other, the conscious–subconscious basis of the problem.
Examination of cranial nerves
Authors: Zengeya Stanley Tamuka , Serane Tiroumourougane V
Published: November 2020

Cranial nerve examination is one of the commonly assessed areas of the nervous system in the MRCPCH clinical examination. The examiner may ask you to examine some of the cranial nerves or just the eye. This guide will take you through a systematic nerve examination, which is followed by most practitioners. You may need to individualize the examination sequence to suit your style. The key competence skills required in the cranial nerve examination are given in table 9.1. Cranial nerves cases commonly encountered in the MRCPCH Clinical Exam are listed in table 9.2. Causes of the different cranial nerve lesions are given in table 9.3. These steps are repeated in every system to reiterate their importance and to help you recollect the initial approach of any clinical exam. Also refer to chapter 4. • On entering the examination room, demonstrate strict adherence to infection control measures by washing your hands or by decontaminating them with alcohol rub. • Introduce yourself both to the parents and the child. • Talk slowly and clearly with a smile on your face. • Establish rapport with the child and parents. • Ensure privacy. • Positioning: examine the older child while they sit on the edge of the bed or on a chair. It is preferable to examine the younger child on a parent’s lap rather than on a couch, as this can cause much anxiety. The aim of the visual survey is to capture every available clue, which may help you to reach the correct diagnosis. • Look at the child and try to estimate their approximate age. • Always consider whether the findings combine to form a recognizable clinical syndrome. Common syndromes with cranial nerve involvement include Aicardi’s syndrome, Angelman’s syndrome, Arnold–Chiari malformation, Crouzon’s syndrome, Lesch–Nyhan syndrome, Sturge–Weber syndrome, and Werdnig–Hoff man disease.
Environment in North American and European Archaeology
Authors: Davies Matthew I. J.
Published: November 2020

Environment has always been a central concept for Western archaeologists, although it has been conceived in many ways and its role in archaeological explanation has fluctuated from a mere backdrop to human action to a primary factor in the understanding of society and social change. Archaeology also has something of a unique position, for its base of interest positions it temporally between geological and ethnographic timescales, spatially between global and local dimensions, and epistemologically between empirical studies of environment change and more heuristic studies of cultural practice (See Crumley, Chapter 17 and Gosden, Chapter 18 in this volume; see also McIntosh et al. 2000; van der Leeuw and Redman 2002). Archaeology should therefore take on a prominent role when it comes to discussion of long-term human–environment interactions up to the present; however, archaeologists have not always been successful in promoting their data or consolidating a clear approach (Fisher and Feinman 2005; Mitchell 2008). As a point of departure, this introductory chapter aims to trace some of the fluctuating conceptions and applications of ‘environment’ within North American and European archaeology, with a particular emphasis on new trends and fruitful points of intersection between seemingly diverse paradigms. The history of concepts of the environment could take up a whole volume of its own and so this chapter is necessarily partial; however, I hope that it will raise a number of points of interest that can be explored further through the references given. The geographical range is also limited to broadly North American and European (especially British) archaeology. In the following chapter Olena Smyntyna will discuss the concept of environment in Soviet and post-Soviet archaeology, while it is hoped that future scholars may fruitfully write the history of such issues in other regional traditions. The chapter is split into three parts. The first deals with diverse ways in which ‘environment’ has been conceived or defined in Western thought, particularly within archaeology.
Archaeology’s Potential to Contribute to Pools of Agronomic Knowledge: A Case of Applied Agro-Archaeology in the Bolivian Yungas
Authors: Isendahl Christian , Sánchez Walter
Published: November 2020

Over the last two decades the concept of applied archaeology has been used increasingly to refer to how archaeology can contribute more broadly to society at large. Depending on the intellectual and geographical context there are many different ways that applied archaeology is understood. One important set of approaches builds on the standard definition of applied science as the application of scientific knowledge in creative problem-solving. Many archaeologists find that evidence which sheds light on resource exploitation strategies in the past is particularly rewarding in this regard, arguing that the insights gained from archaeological research can guide land use planning and resource management and make a positive impact on local livelihoods for people today and in the future (Costanza et al. 2007a; Hayashida 2005). This kind of applied archaeology is usually associated with rural livelihood development, but there is also an emerging applied archaeology of land use planning in predominantly urban sectors (Smith 2010). Some of the most prolific projects of applied agro-archaeology for rural development are those engaging in rejuvenating prehistoric agricultural features that have fallen into disuse or are being mismanaged. Groundbreaking applied agro-archaeology in the Andean region demonstrates considerable advances in this field, reconstructing abandoned raised fields, irrigation canals, and cultivation terraces in order to understand pre-Hispanic agricultural systems and long-term land-use dynamics and to re-apply ancient technologies for contemporary use (Chepstow-Lusty and Winfield 2000; Erickson 1985, 1994, 1998; Kendall 1997b, 2005, Chapter 9 this volume). The Andes are exceptionally rich in archaeological remains of pre-Hispanic agriculture and demonstrate considerable diversity in peoples’ approaches in the past in addressing the many different managerial issues associated with sustaining a farming livelihood in these environments (Denevan 2001; Donkin 1979). Linking the broad scope of applied agro-archaeology to the theoretical framework of historical ecology (Balée 1998, 2006; Balée and Erickson 2006; Crumley 1994, 2000, 2007), the motive of this contribution is to discuss some of the problems and opportunities facing an on-going applied agro-archaeological project in the Yungas of the Bolivian Andes (Isendahl 2008).
Past and Present Farming: Changes in Terms of Engagement
Authors: Oma Kristin Armstrong
Published: November 2020

In archaeology, changes in human–animal relationships are rarely considered beyond the moment of domestication. This is influenced by Ingold’s idea that domestication led to a shift in the human engagement with animals (Ingold 2000: 61–76; see Armstrong Oma 2007: 62–4, 2010 for critique). I do not question the validity of such a claim; however, I argue that changes in terms of engagement also happened beyond domestication, and that various configurations of human–animal relationships have existed throughout history. Further, I argue that such changes also have consequences for the environment, by choice of land use strategies and husbandry regimes. A twofold purpose is pursued: first, to investigate how changes in social systems, in my case changes in terms of engagement between humans and animals, affect land use in such a way as to impinge upon natural systems and ecosystems. Second, I wish to grasp the political underpinnings of the models that are employed by archaeologists and, by doing so, to deconstruct the political use of the past (see also Stump, Chapter 10 this volume). Alternative models regarding economic strategies are sought, and the implications of these are discussed. Human–environment studies frequently deal with the impact of human intrusive land use strategies on ecosystems. Awareness has been created around these processes regarding land use techniques and practices (for example Denham and White 2007; Mazoyer and Roudart 2006). However, in European archaeology the impact of husbandry practices upon ecosystems has received considerably less, if any, attention. People in past societies from the Neolithic onwards made the conscious decision to live with animals as herders or as farmers, blending together social and economic choices that had repercussions for landscape developments and ecosystems. Investigations into the relationship between environmental changes caused by husbandry practices and the social systems that instigated those changes are an important contribution to research on past environmental development. These changes are identifiable in the archaeological record.
The Archaeology of Global Environment Change
Authors: Crumley Carole L.
Published: November 2020

Recent, widely recognized changes in the Earth system are, in effect, changes in the coupled human–environment system. We have entered the Anthropocene, when human activity—along with solar forcing, volcanic activity, precession, and the like—must be considered a component (a ‘driver’) of global environmental change (Crutzen and Stoermer 2000; Levin 1998). The dynamic non-linear system in which we live is not in equilibrium and does not act in a predictable manner (see Fairhead, chapter 16 this volume for further discussion of non-equilibrium ecology). If humankind is to continue to thrive, it is of utmost importance that we identify the ideas and practices that nurture the planet as well as our species. Our best laboratory for this is the past, where long-, medium-, and short-term variables can be identified and their roles evaluated. Perhaps the past is our only laboratory: experimentation requires time we no longer have. Thus the integration of our understanding of human history with that of the Earth system is a timely and urgent task. Archaeologists bring two particularly useful sets of skills to this enterprise: how to collaborate, and how to learn from the past. Archaeology enjoys a long tradition of collaboration with colleagues in both the biophysical sciences and in the humanities to investigate human activity in all planetary environments. Archaeologists work alongside one another in the field, live together in difficult conditions, welcome collaboration with colleagues in other disciplines—and listen to them carefully—and tell compelling stories to an interested public. All are rare skills and precious opportunities. Until recently few practitioners of biophysical, social science, and humanities disciplines had experience in cross-disciplinary collaboration. Many scholars who should be deeply engaged in collaboration to avert disaster (for example, specialists in tropical medicine with their counterparts in land use change) still speak different professional ‘languages’ and have very different traditions of producing information. C. P. Snow, in The Two Cultures (1993 [1959]), was among the first to warn that the very structure of academia was leading to this serious, if unintended, outcome.
Job Applications
Authors: Watkin Sara , Vincent Andrew
Published: November 2020

This chapter deals with the application process. By the end, you should have a thorough understanding of: • The regulations that apply • How to apply • Critical considerations when applying • How to improve your chances of being short-listed • Key pitfalls to avoid All appointments to the role of consultant are governed by specific regulations at both a health service level and an employment law level. All potential employers must adhere to the rules and regulations existing under British law that relate to equality, diversity and discrimination. Additionally, NHS Trusts, Primary Care Trusts (PCTs) and other healthcare bodies employing clinical staff need to adhere to certain regulations that are healthcare specific, e.g. advertising widely and having a Royal College Representative on the interview panel. However, although many still comply with the spirit of the regulations, Foundation Trusts are not required to follow the same rules and this is increasingly apparent as the number of Trusts holding Foundation status increases. Often, their divergence includes dispensing with the Royal College Representative, atypical patterns of advertising and even not specifying a particular CCT. This is a trend that we believe will only increase as Trusts grapple with workforce redesign as a solution to increasing austerity. As the chapter unfolds, we will endeavour to raise critical considerations that need addressing regardless of whether it is a Foundation or non-Foundation Trust you are applying to. However, regardless of whether a Trust is currently Foundation or non-Foundation, it is likely that all Trusts will become Foundation Trusts over the next few years. Wherever feasible, we will include specific pointers on how to improve your application’s chances of success, i.e. getting you short-listed for the job you really want. . . . When can you apply? . . . It is a legal requirement to be on the GMC Specialist Register before taking up a consultant appointment. However, you are eligible to apply for a consultant post when the interview date is within 6 months of the expected date of your CCT (or recognized equivalent if outside the UK).
Pre-Interview Visit
Authors: Watkin Sara , Vincent Andrew
Published: November 2020

The pre-interview visit is one of the most important parts of your interview preparation. Done properly you will: • Learn of all the issues and concerns of your future colleagues and Trust • Have a high chance of predicting the types of questions likely to be asked at interview • Recognise what is important to key individuals on your interview panel, allowing you to phrase your answers appropriately in the interview itself • Discover the behaviour and psychology of panel members, allowing you to build strong rapport and better tailor the language of your interview answers • Form a clear idea of whether the job you have applied for, the hospital, the people and the area are right for you so that you can make an informed decision before proceeding to interview Although this is your opportunity to ask questions and discover more about the department, its members and the Trust, you must remember that the people you will meet will also want to ask questions about you. You need to be prepared for this and carefully consider how you wish to position yourself for the interview. As individuals, we form impressions of other people very quickly and although the interview process is meant to be completely detached from the pre-interview visits, the impression you make will carry through into the interview itself. . . . Why are pre-interview visits important? . . . At a very simple level, if you do not go and visit a job before the interview itself, it is highly unlikely you will get the job. A consultant job is still very much seen as a job for life and the panel will want to appoint someone who is genuinely interested in their post and their Trust, evidenced by taking the trouble to visit and have a thorough look around. The two key reasons for doing a pre-interview visit, besides deciding on whether this is the right job, location and Trust for you, are to position yourself as the candidate of choice and to learn as much as possible to help you be successful in the interview.
Statistics
Authors: Magee Patrick , Tooley Mark
Published: November 2020

This chapter will provide background to enable the reader to understand basic statistics and be able then to follow more complex statistical ideas. Although statistics is more than the mere analysis of data, it is a subject largely about data, so this will be discussed first. Data can be categorical or numerical, and in these two classifications there are various different types of data. This is the allocation of the individual to one of two categories. Often these relate to the presence or absence of some attribute. These data also have many other names such as binary, dichotomous and attribute data. Examples of such categorisations for patients include: ◆ Male/Female ◆ Smoker/Non-smoker ◆ Anaesthetist/Surgeon ◆ Married/Single. Each of these can be only be one or the other – they could be coded ‘1’ or ‘0’ to be binary (or on, off). For example male = 0, female = 1, or vice versa. Many classifications require more than two categories, such as: blood group, type of doctor, country of birth. Also the two categories, such as described previously, might be expanded into several categories. For example the married/single could be expanded to: married/single/divorced/separated/ widowed. This sort of data is called nominal data where there are several categories, but with no logical order. When there is a natural order (such as in seniority), the data are then called ordinal data. For example, anaesthetists could be divided into: ‘Foundation year 1’, ‘Foundation year 2’, ‘speciality doctor’, consultants’, ‘senior consultants’ and ‘clinical directors’. Ordinal data can be reduced to two categories, with possibly a considerable loss of information (e.g. ‘senior doctors’, ‘junior doctors’). Discrete numerical data are where the observation takes exact numerical values. Counts or events are discrete values. For example: number of children, number of ectopic beats in a time period and so on. Continuous (or analogue) data are usually obtained by some form of measurement. Examples are body temperature, blood pressure, height and weight. These values have an infinite number of possibilities, depending on the measurement interval, and variation. Although there are infinite possibilities, measurement systems usually round the continuous data up, or down, to discrete values. Blood pressure is often rounded up to the nearest 5 mmHg, for example.
Principles and Standards of Anaesthetic Monitoring
Authors: Magee Patrick , Tooley Mark
Published: November 2020

The World Federation of Societies of Anaesthesiology (WFSA) adopted standards relating to the safe practice of anaesthesia in 1992 and such standards had already been proposed by a number of countries in order to cut the morbidity due to anaesthesia itself. In the modern era it is easy to forget that historically anaesthesia and surgery did indeed have associated morbidity and mortality and there was very little assistance from technology to monitor patients. The evolution of these standards is based on two main requirements of monitoring. The first is to record anticipated deviations from normal values, which require accurate measurement to ensure patient safety. The second is to warn of unexpected, life-threatening events that, by definition, occur without warning, and could affect the fit, young patient as easily as the old and infirm. All international standards stress the importance of the continual presence of a fully trained and accredited anaesthetic person, and one Australian study demonstrated that many mishaps occur in the absence of such a person [Runciman 1988]. This applies to general and regional anaesthesia, sedation and recovery. Because perceptions of safety and standards vary throughout the world, despite the presence of an International Standards Organisation, debate about the minimum requirements for monitoring continue. Central to the maintenance of these standards is the quality of persons entering the specialty, the quality of training programmes, and the continuing education of specialists throughout a professional lifetime [Sykes 1992]. It is difficult to determine with certainty the effect that additional technological monitoring has on safety. One clear example is the inability of the trained human eye to detect cyanosis, this human failure occurring maximally at 81–85% oxygen saturation. Clearly, the pulse oximeter has improved the quality of cyanosis detection. Numerous studies all over the world have shown that mortality due to anaesthesia itself fell significantly between the 1950s and the 1980s, by which time extensive technological monitoring was being introduced, and training programmes had been very much improved. Utting [1987] reviewed 750 cases of death and cerebral damage reported to the British General Medical Council between 1970 and 1982 that were thought to be the result of errors in technique.
Breathing Systems
Authors: Magee Patrick , Tooley Mark
Published: November 2020

An anaesthetic breathing system is a means of transferring the breathing gas mixture from the anaesthetic machine common gas outlet to the patient. It is also the means of transferring the exhaled gas from the patient to the outside world, usually via a scavenging system. Alternatively, after the carbon dioxide is absorbed from the exhaled gas, the unused fresh gas components of the exhaled gas are recirculated back to the patient. In general, a breathing system consists of a fresh gas limb, an inspiratory and expiratory limb, an expiratory valve, a reservoir bag and it may also consist of one or more unidirectional valves and a CO2 absorber. The simpler devices have fewer components and usually involve some rebreathing of expiratory gas, depending on the level of fresh gas flow. The ability to minimise rebreathing at as economical a fresh gas flow as possible is a measure of the breathing system’s efficiency. Depending on the precise design of the breathing system, such efficiency will vary depending on whether the patient is breathing spontaneously or is undergoing controlled artificial ventilation (see Chapter 26). The more complex systems ensure minimum rebreathing by the use of unidirectional valves and CO2 absorption systems; in this way, the additional complexity allows more economical use of fresh gas and volatile agent. The systems that use higher fresh gas flows (FGF) and involve some rebreathing were classified in 1954 by Professor Mapleson, according to their behaviour in terms of the FGF requirement to prevent CO2 rebreathing [Mapleson 1954]. At the time and for three decades beyond, they were the most popular breathing systems in UK anaesthetic practice. The Mapleson Classification of rebreathing systems is shown in Figure 25.1. Their design lends their structure and function to mathematical analysis [Dorrington 1989]. The Magill breathing system was invented by Sir Ivan Whiteside Magill in the early twentieth century. As shown in Figure 25.1A and Figure 25.2, the system is characterised by having the expiratory valve close to the patient and the fresh gas inflow at a distance from the patient, but close to the reservoir bag. Because of this particular configuration, the system is very economical in spontaneous breathing.