To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Patients who experience Transient Ischaemic Attack (TIA) should be assessed and treated in a specialist clinic to reduce risk of further TIA or stroke. But referrals are often delayed. We aimed to identify published studies describing pathways for emergency assessment and referral of patients with suspected TIA at first medical contact: primary care; ambulance services; and emergency department.
We conducted a scoping literature review. We searched four databases (PubMed, CINAHL, Web of Science, Scopus). We screened studies for eligibility. We extracted and analysed data to describe setting, assessment and referral processes reported in primary research on referral of suspected TIA patients directly to specialist outpatient services.
We identified eight studies in nine papers from five countries: 1/9 randomized trial; 6/9 before-and-after designs; 2/9 descriptive account. Five pathways were used by family doctors and three by Emergency Department (ED) physicians. None were used by paramedics. Clinicians identified TIA patients using a checklist incorporating the ABCD2 tool to describe risk of further stroke, online decision support tool or clinical judgement. They referred to a specialist clinic, either directly or via a telephone helpline. Anti-platelet medication was often given, usually aspirin unless contraindicated. Some patients underwent neurological and blood tests before referral and discharge. Five studies reported reduced incident of stroke at 90 days, from 6–10 percent predicted rate to 1.2-2.1 percent actual rate. Between 44 percent and 83 percent of suspected TIA cases in these studies were directly referred to stroke clinics through the pathways.
Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalization of TIA patients. No pathways for paramedic use were reported. Since many suspected TIA patients present to ambulance services, effective pre-hospital assessment and referral pathways are needed. We will use review results to develop a paramedic referral pathway to test in a feasibility trial.
Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilize and long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated (1).
We undertook a randomized controlled feasibility trial using novel audited scratchcard randomization to allocate eligible patients to FICB or usual care. Paramedics are recruited and trained to assess patients for hip fracture and carry out FICB. We will follow up patients to assess accuracy of paramedic diagnosis, acceptability to patients and paramedics, compliance of paramedics and also measures of pain, side effects, time in hospital and quality of life in order to plan a full trial if appropriate. The primary outcome measure is health related quality of life, measured using Short Form (SF)-12 at 1 and 6 months. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. This study was funded by Health and Care Research Wales (1003).
We have developed:
•paramedic pathway to assess patients for hip fracture and FICB
•paramedic training package, delivered by Consultant Anaesthetist
To date we have recruited nineteen paramedics; ten are fully trained and recruiting patients, the remainder are being trained. Fifty-four patients have been randomized and thirty-five have consented to follow-up. Thirteen 1-month and five 6-month follow-up questionnaires have been received.
This study will enable us to recommend whether to undertake a definitive multi-centre randomized controlled trial of FICB by paramedics for hip fracture to determine if the procedure is effective for patients and worthwhile for the National Health Service.
Diets rich in fruits and vegetables (FV), which contain (poly)phenols, protect against age-related inflammation and chronic diseases. T-lymphocytes contribute to systemic cytokine production and are modulated by FV intake. Little is known about the relative potency of different (poly)phenols in modulating cytokine release by lymphocytes. We compared thirty-one (poly)phenols and six (poly)phenol mixtures for effects on pro-inflammatory cytokine release by Jurkat T-lymphocytes. Test compounds were incubated with Jurkat cells for 48 h at 1 and 30 µm, with or without phorbol ester treatment at 24 h to induce cytokine release. Three test compounds that reduced cytokine release were further incubated with primary lymphocytes at 0·2 and 1 µm for 24 h, with lipopolysaccharide added at 5 h. Cytokine release was measured, and generation of H2O2 by test compounds was determined to assess any potential correlations with cytokine release. A number of (poly)phenols significantly altered cytokine release from Jurkat cells (P<0·05), but H2O2 generation did not correlate with cytokine release. Resveratrol, isorhamnetin, curcumin, vanillic acid and specific (poly)phenol mixtures reduced pro-inflammatory cytokine release from T-lymphocytes, and there was evidence for interaction between (poly)phenols to further modulate cytokine release. The release of interferon-γ induced protein 10 by primary lymphocytes was significantly reduced following treatment with 1 µm isorhamnetin (P<0·05). These results suggest that (poly)phenols derived from onions, turmeric, red grapes, green tea and açai berries may help reduce the release of pro-inflammatory mediators in people at risk of chronic inflammation.
Remission is a new research outcome indicating long-term wellness. Remission not only sets a standard for minimal severity of symptoms and signs (resolution); it also sets a standard for how long symptoms and signs need to remain at this minimal level (6 months). Individuals who achieve remission from schizophrenia have better subjective well-being and better functional outcomes than those who do not. Research suggests that remission can be achieved in 20–60% of people with schizophrenia. There is some evidence of the usefulness of remission as an outcome indicator for clinicians, service users and their carers. This article reviews the literature on remission in schizophrenia and asks whether it could be a useful clinical standard of well-being and a foundation for functional improvement and recovery.
Excavation on the Thames floodplain in London revealed traces of Early Neolithic occupation and burial on a sand and gravel bar beneath alluvium. A large expanse of peat also buried by alluvium was recorded between these finds and the modern river Thames suggesting that the occupation was situated on or close to the foreshore. A single grave cut into the natural sand contained a poorly preserved crouched inhumation, possibly of a woman. The burial was accompanied by a fragment of carinated bowl, a flint knife, and other struck flints. A radiocarbon date from an oak retaining plank within the grave of 5252±28 BP (4220–3970 cal BC: KIA20157) makes this burial one of the earliest from the British Isles and the earliest known for London. A scatter of struck flint and pottery predominantly of Early Neolithic date was recovered from adjacent areas of the sand. A nearby hearth contained fragments of Early Bronze Age pottery pointing to later prehistoric activity nearby.
Charred plant remains indicate both the collection of wild plant foods and cultivated cereals in the Early Neolithic. Radiocarbon dating of the adjacent peat deposits indicated their rapid growth within the Middle Bronze Age with a marked decline in woodland cover at the start of the sequence and a rise in grassland and herb species. Cereal pollen then briefly became a significant component of the sequence before declining to more modest levels.
The later sixteenth and early seventeenth centuries were marked by an outpouring of historical work about Ireland. From Holinshed's Chronicles of England, Scotland and Ireland in 1577, to the publication of the lifetime's labours of Colgan and the Irish Franciscan hagiographers from 1645, the writing of history was at the forefront of Irish scholarship. Indeed, such was the scale of intellectual endeavour that this period can justly be designated the Irish historical renaissance, the beginning of the investigation of Ireland's past using recognisably modern scholarly methods.
The intellectual currents which nourished this dramatic growth can easily be outlined. An essential foundation was provided by the medieval method of annalistic compilation, together with the antiquarian instinct for unearthing manuscripts and artefacts, both of which helped to establish essential facts and chronologies without which history could not have been written. The methodological breakthrough in identifying and analysing original sources was provided by Renaissance humanism, with its determination to return ad fontes. More specific to Irish scholarship were the professional historians, poets, brehons and scribes who sought to maintain the vitality of the Gaelic historical tradition with its rich inheritance of genealogies, annals and saints' lives, and the distinctive form of Anglo-Irish colonial historiography created by that master of racial stereotyping, the twelfth-century Welsh historian, Giraldus Cambrensis. And, finally, there were two crucial driving forces common across all European nations: the growing sense of patriotic pride which led scholars to try and defend and glorify their native land and its past; and the polemical historiography of the reformation and the counter-reformation, inspired by each side's determination to establish its own exclusive historical legitimacy.
In 1615 Richard Stanihurst gave an account of the torture and death of the Catholic archbishop of Cashel, Dermot O'Hurley at the hands of his Protestant gaolers in 1584:
The officials put the archbishop's bare feet in boots which they filled with oil, tied his legs to the uprights of the stocks, and then lit a fire underneath. The boiling-hot oil worked its way up from his feet to his shins and other parts, torturing him unbearably, so that bits of skin fell away from the flesh, and pieces of flesh from the bare bones. The official in charge of the torture, unaccustomed to such bizarre mutilation, rushed suddenly from the room not wanting to continue looking at such monstrous barbarity, worse than that of wild beasts, nor to hear any longer in his fleeing ears the cries of the innocent archbishop which resounded in the vicinity. The Calvinist torturers feasted for a while on these extraordinary cruelties, but were clearly not satisfied. Accordingly after a few days they took the mangled archbishop early in the morning, almost dying from his continual torture … to a field not far away from Dublin Castle … and there hanged the innocent man from the gallows with a noose roughly made from brushwood…
In 1646 Sir William Temple described Catholic atrocities in the 1641 rising:
Others they buried alive, a manner of death they used to severall British in severall places: and at Clownis within the Countie of Fermanagh, there were seventeen persons, having been hanged till they were halfe dead, cast together into a pit, and being covered over with a little earth, lay pittifully, sending out the most lamentable groanes for a good time after.[…]