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Hospitals today face a huge number of challenges, including new patterns of disease, rapidly evolving medical technologies, ageing populations and continuing budget constraints. This book is written by clinicians for clinicians and hospital managers, and those who design and operate hospitals. It sets out why hospitals need to change as the patients they treat and the technology to treat them changes. In a series of chapters by leading authorities in their field, it challenges existing models, reviews best practice from many countries and presents clear policy recommendations for policymakers and hospital administrators. It covers the main patient groups and conditions as well as those departments that make modern effective care possible, in imaging and laboratory medicine. Each chapter looks at patient pathways, aspects of workforce, required levels of specialisation and technology, and the opportunities and challenges for optimising the delivery of services in the hospital of the future.This title is also available as Open Access on Cambridge Core.
This book explores one of the most intractable problems of human existence - our propensity to inflict violence. It provides readers with case studies of political, social, economic, religious, structural and interpersonal violence from across the entire globe since 1800. It also examines the changing representations of violence in diverse media and the cultural significance of its commemoration. Together, the chapters provide in-depth understanding of the ways that humans have perpetrated violence, justified its use, attempted to contain its spread, and narrated the stories of its impacts. Readers also gain insight into the mechanisms by which the parameters about the acceptable limits to and locations of violence have dramatically altered over the course of a few decades. Leading experts from around the world have pooled their knowledge to provide concise, authoritative examinations of the complex phenomenon of human violence. Annotated bibliographies provide overviews of the shape of the research field.
The Nakhla meteorite represents basaltic rock from the martian upper crust, with reduced carbon indicative of the ingress of carbonaceous fluids. Study of a terrestrial analogue basalt with reduced carbon from the Ordovician of Northern Ireland shows that remote analysis could detect the carbon using Raman spectroscopy. Analysis of gases released by crushing detects methane-rich fluids in the basalt and especially in cross-cutting carbon-bearing veinlets. The results suggest that automated analysis on Mars could detect the reduced carbon, which may be derived from magmatic and/or meteoritic infall sources.
A log-coffin excavated in the early nineteenth century proved to be well enough preserved in the early twenty-first century for the full armoury of modern scientific investigation to give its occupants and contents new identity, new origins and a new date. In many ways the interpretation is much the same as before: a local big man buried looking out to sea. Modern analytical techniques can create a person more real, more human and more securely anchored in history. This research team shows how.
In this investigation we have evaluated whether blockade of endothelin receptors influenced the renal haemodynamic and excretory responses to a period of ischaemia and reperfusion in the anaesthetised rat. The renal artery was occluded for 30 min and renal haemodynamic and excretory function followed for 90 min of reperfusion while either saline, the non-selective endothelin 1 receptor (ETA/ETB) antagonist SB209670 or the selective ETA receptor antagonist UK-350,926 was infused. In the post-ischaemic period, renal cortical and medullary perfusions were reduced by 40-50 %. When SB209670 was administered (30 µg kg-1 min-1 I.V.) for 30 min before, during and for 90 min after renal artery occlusion, cortical and medullary perfusions returned to baseline levels, responses different from those obtained during saline infusion (both P < 0.05). In the presence of UK-350,926 (30 µg kg-1 min-1 I.V.), perfusion in the medulla returned to baseline on clamp removal whereas that in the cortex remained depressed (P < 0.05). Renal ischaemia for 30 min decreased glomerular filtration rate during reperfusion and increased urine flow and sodium excretion 5- to 15-fold. UK-350,926 (30 µg kg-1 min-1 I.V.) reduced (P < 0.05) fluid excretion prior to ischaemia but during reperfusion, glomerular filtration rate returned to basal levels and there were progressive increases in fluid excretion which were smaller compared to the saline-treated group (all P < 0.05). The ischaemic challenge may cause release of endothelin, which acts on ETB receptors in the cortex and ETA receptors in the medulla to decrease perfusion. The blunted natriuresis and diuresis during blockade of ETA receptors may result from either a vascular or tubular action of endothelin. Experimental Physiology (2003) 88.4, 483-490.
Two plants are described from fragmentary remains preserved in the Windyfield chert, situated c. 600 m from the classic Rhynie chert locality. Both are sometimes coated by a microbial film. The larger, fertile axes are placed in the new genus and species Ventarura lyonii. They possess a distinctive, sclerenchymatous middle cortex and terete xylem, and marginally dehiscent, lateral sporangia. The new taxon is similar to the Rhynie zosterophyll Trichopherophyton teuchansii, but is placed in a new genus on sporangial differences. Associated smaller axes with unicellular epidermal outgrowths lack the middle cortex of the larger axes and often have medullated protosteles. They are interpreted as subterranean rhizomes and probably belong to the new fertile taxon, but organic continuity between the two has not been demonstrated.
‘Prescription-event monitoring’ (PEM) is one of two national systems of post-marketing surveillance in operation in Britain. It identified 22 065 patients who had received NHS prescriptions for alprazolam, and data available on 10 895 of these were analysed. The main reasons for treatment with alprazolam were anxiety and depression. The patients provided 3360 patient-years of treatment and 7540 patient-years of follow-up. No serious events clearly associated with treatment were recorded. The main events reported during treatment, albeit infrequently, were drowsiness and depression, although depression is more likely to be due to the disorder being treated than to the drug. Some of the other alleged unwanted effects of alprazolam in published reports were not encountered. Since PEM is unable to determine the dependence potential of alprazolam, further evaluation of this problem is called for.