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 email@example.com
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.
Life was rather quiet for the United Nations Peacekeeping Force in Cyprus (Unficyp) in early 1974. The high levels of intercommunal violence that defined its establishment a decade earlier had largely receded to a relatively peaceful coexistence between Greek and Turkish Cypriots. Part of Unficyp’s civilian police component since 1964, the Australian civilian police – known as Austcivpol – with its headquarters in Limassol, smaller substations at Ktima and Polis, and men attached to Unficyp headquarters in Nicosia, had settled into a daily routine of village patrols and liaising with local police in the Limassol Zone, their south-western portion of the island.
Recent research by climate scientists suggest that New Orleans, much of which is below sea level and protected from the sea only by a rapidly eroding marshland, may someday become uninhabitable. The city’s literature of the last few decades has been preoccupied with the theme of fatalism and apocalypse, and the deadly epidemics of the nineteenth century have provided rich symbolic terrain for figuring the troubles that “plague” the city and that will someday mean its end. Some recent work by women of color – notably Erna Brodber and Brenda Marie Osbey – delineates a different literary project, one appropriate to a post-apocalyptic diaspora, namely the work of remembering. Both the traditional fatalism and this emerging interest in memory will likely be central themes to watch for in the major literature associated with the New Orleans in coming decades.
Background: Almost all patients admitted at acute crisis to a psychiatric ward experience clinically significant symptoms of insomnia. Ward environments pose challenges to both sleep and the delivery of therapy. Despite this, there is no description of how to adapt cognitive behavioural therapy (CBT) for insomnia to overcome these challenges. Aims: (i) To describe the key insomnia presentations observed in the Oxford Ward Sleep Solution (OWLS) trial and (ii) outline key adaptations aimed to increase accessibility and hence effectiveness of CBT for insomnia for a ward setting. Methods: Trial therapists collaboratively agreed the key insomnia presentations and therapy adaptations based on their individual reflective logs used during the trial. Results: Three key insomnia presentations are outlined. These are used to illustrate the application of 10 CBT for insomnia therapy adaptations. These include use of sleep monitoring watches to engage patients in treatment, stabilizing circadian rhythms, reducing the impact of night-time observations and managing discharge as a sleep challenge. Conclusions: Whilst inpatient wards bring challenges for sleep and therapy delivery, creative adaptations can increase the accessibility of evidence based CBT for insomnia techniques. This therapy has proven popular with patients.
When patients are admitted onto psychiatric wards, sleep problems are highly prevalent. We carried out the first trial testing a psychological sleep treatment at acute admission (Oxford Ward sLeep Solution, OWLS).
This assessor-blind parallel-group pilot trial randomised patients to receive sleep treatment at acute crisis [STAC, plus standard care (SC)], or SC alone (1 : 1). STAC included cognitive–behavioural therapy (CBT) for insomnia, sleep monitoring and light/dark exposure for circadian entrainment, delivered over 2 weeks. Assessments took place at 0, 2, 4 and 12 weeks. Feasibility outcomes assessed recruitment, retention of participants and uptake of the therapy. Primary efficacy outcomes were the Insomnia Severity Index and Warwick–Edinburgh Mental Wellbeing Scale at week 2. Analyses were intention-to-treat, estimating treatment effect with 95% confidence intervals.
Between October 2015 and July 2016, 40 participants were recruited (from 43 assessed eligible). All participants offered STAC completed treatment (mean sessions received = 8.6, s.d. = 1.5). All participants completed the primary end point. Compared with SC, STAC led to large effect size (ES) reductions in insomnia at week 2 (adjusted mean difference −4.6, 95% CI −7.7 to −1.4, ES −0.9), a small improvement in psychological wellbeing (adjusted mean difference 3.7, 95% CI −2.8 to 10.1, ES 0.3) and patients were discharged 8.5 days earlier. One patient in the STAC group had an adverse event, unrelated to participation.
In this challenging environment for research, the trial was feasible. Therapy uptake was high. STAC may be a highly effective treatment for sleep disturbance on wards with potential wider benefits on wellbeing and admission length.
Henry George Ward's Mexico in 1827 (published in 1828) is one of the most exhaustive accounts of Mexico and its mining activities in the years following its independence from Spain. Written with a meticulous attention to detail, it provided a unique first-hand interpretation both of Mexico's early governments’ achievements and of the not insignificant problems they had as yet to overcome. It highlighted the risks and opportunities Mexico presented to potential British investors and emphasised the benefits of free trade, the need for patience, and how important it was to become meaningfully acquainted with the country before investing in one or several ventures there. This study provides for the first time an analysis of Ward's two-volume survey-cum-travelogue. It shows how Ward's cautiously optimistic appraisal faithfully reflected the short-lived hopes of Guadalupe Victoria's 1824–9 government and provides a sympathetic account of the young republic that would prove anything but common in subsequent British representations of Mexico, as the country's inability to service the London debt and its ensuing instability went on to hinder British–Mexican relations for the greater part of the nineteenth century.
To characterize contacts in general wards, a prospective survey of healthcare workers (HCWs), patients and visitors was conducted using self-reported diary, direct observation and telephone interviews. Nurses, doctors and assorted HCWs reported a median of 14, 18 and 15 contact persons over one work shift, respectively. Within 1 h, we observed 3·5 episodes with 25·6 min of cumulative contact time for nurses, 2·9 episodes and 22·1 min for doctors and 5·0 episodes with 44·3 min for assorted-HCWs. In interactions with patients, nurses had multiple brief episodes of contact; doctors had fewer episodes and less cumulative contact time; assorted-HCWs had fewer contact episodes of longer durations (than for nurses and doctors). Assortative mixing occurred amongst HCWs: those of the same HCW type were the next most frequent class of contact after patients. Over 24-h, patients contacted 14 persons with 23 episodes and 314·5 min of contact time. Patient-to-patient contact episodes were rare, but a maximum of five were documented from one patient participant. 22·9% of visitors reported contact with patients other than the one they visited. Our study revealed differences in the characteristics of contacts among different HCW types and potential transmission routes from patients to others within the ward environment.
This article examines the influence of the Magna Carta on the development of rights and liberties in the Anglo-American common law tradition, especially in the seventeenth century. Originally issued by King John of England in 1215, the Magna Carta set forth numerous prototypical rights and liberties that helped to shape subsequent legal developments in England, America, and the broader Commonwealth. The Magna Carta served as an inspiration for seventeenth-century English jurists, like Sir Edward Coke, and Puritan pamphleteers, like John Lilburne, who advocated sweeping new rights reforms on the strength of the charter. It also inspired more directly the new bills of rights and liberties of several American colonies, most notably the expansive 1641 Body of Liberties of Massachusetts crafted by Nathaniel Ward, which anticipated many of the constitutional rights formulations of eighteenth- and nineteenth-century America.
Admission of a cancer patient to a palliative unit when near the final stage of their disease trajectory undoubtedly impacts their relatives. The aim of our study was to illuminate and interpret relatives' lived experiences of health personnel's provision of care in a palliative ward.
A phenomenological/hermeneutic approach was employed that was inspired by the philosophical tradition of Heidegger and Ricoeur and further developed by Lindseth and Nordberg. The perspectives of the narrator and the text were interpreted by highlighting relatives' views on a situation in which they have to face existential challenges. The analysis was undertaken in three steps: naïve reading, structural analysis, and comprehensive understanding, including the authors' professional experiences and theoretical background.
Six subthemes appeared: the dying person, the bubble, the sight, the cover, the provision for children's needs, and the availability of immediate help. These components were further constructed into three themes: the meaning of relating, the meaning of action, and the meaning of resources. Our comprehensive understanding of the results suggests that the most important theme is “acting with dedication and expertise.”
Significance of results:
The following aspects are crucial for relatives of cancer patients hospitalized in a palliative ward: time and existence, family dynamics, and care adjusted to the situation. Our study results led to reflections on the impact of how nurses behave when providing care to patients during the palliative phase, and how they interact with relatives in this situation. We found that cancer patients in a palliative unit most appreciate nurses who act with dedication and expertise.
The King James Bible was widely celebrated in 2011 for its literary, religious and cultural significance over the past 400 years, yet its staunch critics are important to note as well. This article draws attention to Catholic critics of the King James Bible (KJB) during its first 300 years in print. By far the most systematic and long-lived Catholic attack on the KJB is found in the argument and afterlife of a curious counter-Reformation text, Thomas Ward's Errata of the Protestant Bible. This book is not completely unknown, yet many scholars have been puzzled over exactly what to make of it and all its successor editions in the nineteenth century – at least a dozen, often in connection with an edition of the Catholic Douai-Rheims Bible (DRB). Ward's Errata, first published in 1688, was based on a 1582 book by Catholic translator and biblical scholar Gregory Martin. The book and its accompanying argument, that all Protestant English Bibles were ‘heretical’ translations, then experienced a prosperous career in nineteenth-century Ireland, employed to battle the British and Foreign Bible Society's campaign to disseminate the Protestant King James Bible as widely as possible. On the American career of the Counter-Reformation text, the article discusses early editions in Philadelphia, when the school Bible question entered the American scene. In the mid-nineteenth century, led by Bishop John Purcell in Cincinnati, Bishop Francis Patrick Kenrick in Philadelphia and Bishop John Hughes in New York City, many Catholics began opposing the use of the KJB as a school textbook and demanding use of the Douai Rheims Bible instead. With reference to Ward's Errata, they argued that the KJB was a sectarian version, reflecting Protestant theology at the expense of Catholic teachings. These protests culminated in the then world-famous Bible-burning trial of Russian Redemptorist priest, Fr Vladimir Pecherin in Dublin, in late 1855. The Catholic criticisms of the KJB contained in Ward's Errata, which was reprinted for the last time in 1903, reminded the English-speaking public that this famous and influential Protestant version was not the most perfect of versions, and that it was not and never had been THE BIBLE for everyone.
This chapter provides an overview of hospital and departmental service delivery issues, which hospitals may use in formulating a service for the critically ill parturient. In general, critically ill parturients are cared for in the delivery unit or in an obstetric high dependency unit (HDU); alternatively they may be admitted or transferred to a medical or surgical intensive care unit (ICU). Generally, the HDU may be appropriate for pregnant or puerperal women who are conscious and who have single-organ dysfunction. Ideally, the HDU should be located in or in close proximity to the labor and delivery ward. The HDU physician director and nurse/midwife director can give clinical, administrative and educational direction through guidelines and education of the HDU nursing, medical, and other ancillary staff. Simulation can encompass a large range of activities ranging from basic skills and drills to more sophisticated multidisciplinary training in purpose-built simulation centers.
Generating new understandings of the contributions of W. E. B. Du Bois's The Philadelphia Negro (1899) for sociology and social science more generally, this article posits that the urban analysis provided in the book demonstrates how interwoven cultural and economic factors undergird the social organization of urban communities more so than any pragmatic economic pattern or logic. It is the interwoven nature of these factors (defined in this article as the counterintuitive economic logics of the study) that have been insufficiently acknowledged in recent decades of social scientific urban studies research. Exploring the interwoven nature of cultural and economic factors in the sustenance of Philadelphia's Black Seventh Ward, this article suggests that the agency of African Americans is a critical, yet undervalued, aspect of their urban living. This article situates W. E. B. Du Bois as the first of some later voices (mostly within urban ethnography) that offer a corrective and alternative to urban spatial conceptual frameworks that did not and do not fully account for the persistent influence of race and the agency of racial minorities on the landscape of American cities.
Ward round is an integral platform for patients and the multidisciplinary team to communicate, assess and plan treatment. With such a key process, it is vital that the effectiveness of the ward round is maximised and that reliable follow of information is addressed. This can be achieved using lean methodology.
: To improve the quality of ward rounds, particularly reliability and patient experience.
: This is a quantitative quality improvement study that used a plan-do-study-act cycle, including process mapping. The improvements were measured by an objective patient survey, staff survey and a checklist.
: Process mapping identified the use of templates for the ward round plan, nursing and medical summaries. There was an increase in the reliability of ward round relating to flow of information measured by the checklist. Patient experience improved, rated by both patient and staff surveys, after series of changes were put in place.
: Checklists in the form of templates improved the reliability of information flow for patient treatment. If the multidisciplinary team is clear about what information and tasks are necessary, there will be a more reliable assessment. With the implementation of the plan template, more treatment plans are fully comprehensive enabling the consistent delivery of high quality of care.
Change affects all areas of healthcare organizations and none more so than each aspect of the oncology ward, beginning with the patient's room. It is there that the issues faced by the major players in healing environments – administrator, caregiver, family member, and, most importantly, the patient – come sharply into focus. Hospitals are building new facilities or renovating old ones in order to adapt to new environmental demands of patient care and security. Driven by ethical and professional responsibility, the oncological team headed by Professor Hellmut Samonigg of Graz Medical University Graz pursued a vision of designing a model oncology ward unique in Europe. Friedensreich Hundertwasser, the world-famous artist, was the creative force behind the design. The oncology ward became a place of healing, permeated with a colorful sense of life and harmonious holistic care. The successful outcome was confirmed by the extraordinarily positive feedback by patients, families, and healthcare staff.
Background: A proposal to introduce metal cutlery onto a PICU in order to create a more homely environment prompted staff concerns about safety.
Aims: Based on the premise that past behaviour is a strong predictor of future behaviour, we undertook a pilot audit of history of weapon use as a measure to guide decision making on weapons security on our PICU.
Methods: Retrospective case note audit of 30 PICU patients to determine historical rates of weapon use. Secondary measures included level and type of weapon use, and mental disorder. 30 ‘non PICU pathway’ general ward patients were sampled as a ‘control’.
Results: 19/30 patients on the PICU had a history of weapon use, compared to 7/30 on the general ward. There were 23 recorded incidents in the PICU sample and 7 on the general ward.
Conclusions: The majority of the PICU sample had a history of weapon use, often recent, including improvised and bladed weapons, at times of acute disturbance and non-compliance with medications. Comparison with the non-PICU group indicates that the measure had good construct validity as rates in this group were significantly lower. Therefore history of weapon use could be a useful measure in guiding decision making about security protocols on PICU, however, further research is required.
How should Anglicans regard other religions? The approaches of a number of Anglican writers considered in this article are valuable, both to Anglicans and to others, beginning with F.D. Maurice in the late nineteenth century. Others include Kenneth Cragg, an Arabist and Evangelical; Alan Race, author of the Exclusivist, Inclusivist, and Pluralist paradigm; Kwok Pui-Lan, a contemporary Asian feminist; Ian S. Markham, who proposes a ‘Theology of Engagement’; Rowan Williams, Archbishop of Canterbury and an important writer on the theology of Raimon Panikkar; David F. Ford, proponent of the Cambridge Scriptural Reasoning (SR) program that seeks ‘better quality disagreement’; and Keith Ward, whose systematic theology develops a concept of ‘convergent spirituality’. Moving from the theoretical to the practical, the article discusses the global United Religions Initiative of William E. Swing, former Episcopal Bishop of California. Collectively, these authors provide a range of intersecting Anglican approaches to the evolving question of Anglican relations with other world religions.
Background: In many parts of the world the provision of psychogeriatric inpatient units (PGUs) remains limited. More units will be required over coming decades given rapid population aging.
Methods: Medline (1950–2010), psycINFO (1806–2009), EMBASE (1980–2009) and CINAHL (1982–2009) were searched for papers about PGU design. Selected non-peer reviewed literature such as government reports and unpublished academic dissertations were also reviewed. Data were also obtained from the literature related to general adult psychiatry inpatient units where there was limited information from studies of units designed for older people. Over 200 papers were reviewed and 130 were included.
Results: There are few good quality studies to guide the design of acute PGUs and much of the existing literature is based on opinion and anecdote or, at best, based on observational studies. Randomized controlled studies comparing different designs and assessing outcomes are virtually non-existent. Several studies have identified violence and trauma resulting from hospitalization as significant problems with current acute PGU care. Despite its limitations the available literature provides useful guidance on how PGU design can optimize patient and staff safety and improve clinical outcomes.
Conclusions: There are significant problems with current acute PGUs, and patient mix on existing units is an important issue. Future research should examine patient and staff perceptions of different PGU ward environments, the relationship between ward design and clinical outcomes, the effects of segregating patients with challenging behaviors in dementia and the benefits or otherwise of gender segregation.
All women, regardless of whether their pregnancies are high or low risk, should be treated with respect and should be in control of and involved in what is happening to them in labour. Intrapartum causes of maternal mortality are extremely rare; nevertheless, good intrapartum care and monitoring of the woman with a high-risk pregnancy is essential in ensuring a good maternal and fetal outcome. In the UK, the National Institute for Health and Clinical Excellence (NICE) has published comprehensive guidelines on the intrapartum care of the woman at low risk at term. All maternity units and labour wards should have a lead named midwife, obstetrician, paediatrician and anaesthetist. It is imperative that staffing levels and competencies of staff on labour wards comply with national standards. Guidelines provide a framework from which healthcare providers can design clinical care pathways and organisational structures to improve care of the high-risk woman in labour.