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The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
We conducted unmanned aerial vehicle lidar missions in the Maya Lowlands between June 2017 and June 2018 to develop appropriate methods, procedures, and standards for drone lidar surveys of ancient Maya settlements and landscapes. Three site locations were tested within upper Usumacinta River region using Phoenix Lidar Systems: Piedras Negras, Guatemala, was tested in 2017, and Budsilha and El Infiernito, both in Mexico, were tested in 2018. These sites represent a range of natural and cultural contexts, which make them ideal to evaluate the usefulness of the technology in the field. Results from standard digital elevation and surface models demonstrate the utility of deploying drone lidar in the Maya Lowlands and throughout Latin America. Drone survey can be used to target and efficiently document ancient landscapes and settlement. Such an approach is adaptive to fieldwork and is cost effective but still requires planning and thoughtful evaluation of samples. Future studies will test and evaluate the methods and techniques for filtering and processing these data.
This chapter explores current research on how young people make judgements about the information they encounter. There will be a discussion on why some young people appear to trust, without question, online information whilst others show remarkable powers of insight and critique. Evidence on how this might affect their physical and mental well-being will be provided. Why this is important both in educational and political terms is discussed. There will then be an exploration of the approaches that can be employed to help young people develop a more discerning approach to engaging with the information they see, hear and read in any context.
The discussion put forward here is based upon a synthesis of research findings involving three groups of young people from the UK – 16–17-year-olds, at a secondary school, 18–19-year-old university students in their first undergraduate year and finally 18–24-year-old men recruited for an experiment, mostly undergraduates – all carried out in the UK. For the first two groups there was a concern voiced by teachers and academic tutors respectively that their students exhibited a noticeable lack of the necessary capabilities to make well-calibrated judgements in order to select good-quality information to support their work for assignments. The 16–17-year-olds were working towards gaining their Extended Project Qualification (EPQ)1 – a mini-dissertation in addition to their A-level study. Walton et al. (2018a) provide a comprehensive reflection of these studies. The 18–19-year-olds were working towards completing their first assignment and had to find good quality information about a sporting issue of their choice (see Walton and Hepworth, 2011; 2013 for a more detailed account). These two groups are quite similar in their context and we will see that their comments and experiences and our analyses align in an encouraging way. How? They both appear to indicate that most (but by no means all) students present with remarkably poor capabilities in making judgements about information, which prevent them from making the most suitable choices. The third group were recruited to find out whether the cognitive process of information discernment has a physiological component. Why? We wanted to find out whether being good at information discernment is related to positive responses to stress.
The years between 1258 and 67 comprise one of the most influential periods in the Middle Ages in England. This turbulent decade witnessed a bitter power struggle between King Henry III and his baronsover who should control the government of the realm. Before England eventually descended into civil war, a significant proportion of the baronage had attempted to transform its governance by imposingon the crown a programme of legislative and administrative reform far more radical and wide-ranging than Magna Carta in 1215. Constituting a critical stage in the development of parliament, the reformist movement would remain unsurpassed in its radicalism until the upheavals of the seventeenth century. Simon de Montfort, the baronial champion, became the first leader of a political movement to seize power and govern in the king's name. The essays collected here offer the most recent research into and ideas on this pivotal period. Several contributions focus upon the roles played in the political struggle by particular sections of thirteenth-century society, including the Midland knights and their political allegiances, aristocratic women, and the merchant elite in London. The events themselves constitute the second major theme of this volume, with subjects such as the secret revolution of 1258, Henry III's recovery of power in 1261, and the little studied maritime theatre during the civil wars of 1263-7 being considered.
Adrian Jobson is an Associate Lecturer at Canterbury Christ Church University.
Contributors: Sophie Ambler, Nick Barratt, David Carpenter, Peter Coss, Mario Fernandes, Andrew H. Hershey, Adrian Jobson, Lars Kjaer, John A. McEwan, Tony Moore, Fergus Oakes, H.W. Ridgeway, Christopher David Tilley, Benjamin L. Wild, Louise J. Wilkinson.
To assess the acceptability and adherence to daily doses of lipid-based nutrient supplement (LNS) among children and micronutrient powder (MNP) among children and pregnant and lactating women.
Household interviews and sachet counting were conducted to measure acceptability and adherence, 15 and 30 d after product distribution. Qualitative information on product acceptability was collected using focus group discussions.
LNS was distributed to 123 children aged 6–35 months (LNS-C), and MNP to 112 children aged 36–59 months (MNP-C) and 119 pregnant or lactating women (MNP-W).
At the end of the test 98·4 % of LNS-C, 90·4 % of MNP-C and 75·5 % of MNP-W participants reported that they liked the product (P<0·05). Other measures of acceptability did not differ. Median consumption of sachets was highest in the LNS-C group (P<0·001). ‘Good’ adherence to the daily regimen (consumption of 75–125 % of recommended dose) was 89·1 % in the LNS-C, compared with 57·0 % in the MNP-C and 65·8 % in the MNP-W groups (P<0·001). Qualitative findings supported the quantitative measures and guided selection of local product names, packaging designs, distribution mechanisms, and the design of the information campaign in the subsequent programme scale-up.
Acceptability, consumption and adherence were higher in participants receiving LNS compared with MNP. However, both products were found to be suitable when compared with predefined acceptability criteria. Acceptability studies are feasible and important in emergency nutrition programmes when the use of novel special nutritional products is considered.
Congenital cardiac malformations which include isomerism of the atrial appendages are amongst the most challenging of problems for diagnosis and also for medical and surgical management. The nomenclature for pathological description is controversial, but difficulties can be overcome by the use of a segmental approach. Such an approach sets out the morphology and the topology of the chambers of the heart, together with the types and modes of the atrioventricular, ventriculo-arterial, and venous connections. We have applied this method to a study of 35 hearts known to have isomerism of the atrial appendages. We have already published accounts of 27 of these cases, but these were reviewed for this study in the light of our increased awareness of the implications of isomerism, and 8 new cases were added. After examining, or re-examining, the morphology of every heart in detail, we grouped them together according to their ventricular topology and modes of atrioventricular connection. Then we studied the course of the specialised conduction system, by the use of the light microscope, first in each individual case, and then together in their groups. We conclude that the pathways for atrioventricular conduction in hearts with isomerism of the atrial appendages are conditioned both by ventricular topology, and by the atrioventricular connections. Based on our experience, we have been able to establish guidelines that direct the clinician to the likely location of the conduction tissues.
Ploughing is probably the greatest agent of attrition to archaeological sites world-wide. In every country, every year, a bit more is shaved off buried strata and a bit more of the past becomes unreadable. On the other hand, people must eat and crops must be planted. How can the fields be best managed to get the best of both worlds? Perhaps the most pressing need for resource managers is to know how quickly a particular field is eroding: negotiation and protection is then possible. Up to now that has been difficult to measure.
The new procedure presented here, which draws on the unexpected benefits of nuclear weapons testing, shows how variation in the concentration of the radioisotope 137Cs can be used to monitor soil movements over the last 40 years. The measurements allow a site's ‘life expectancy’ to be calculated, and there are some promising dividends for tracking site formation processes.
Congenitally corrected transposition is a complex cardiac lesion that is often associated with ventricular septal defect, obstruction of the outflow tract of the morphologically left ventricle, and abnormalities of the morphologically tricuspid valve.1,2 Nomenclature for this lesion has been variable and confusing.1 In this review, we define, and hopefully clarify this terminology. The lesion is a combination of discordant union of the atrial chambers with the ventricles, and the ventricles with the arterial trunks.1,2 In rare circumstances, discordant atrioventricular connections can be associated with concordant ventriculo-arterial connections. This malformation has been called “isolated ventricular inversion”. The term is less than precise, and the descriptive approach using the phrase “discordant atrioventricular connections with concordant ventriculo-arterial connections” is preferred, as discussed below.