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This chapter seeks to give an overview of the place of Quality Management (QM) in contemporary fertility practice. It provides the reader with an understanding of the terminology used in QM and explores the definition of quality and success in fertility care. An examination of process modelling in the organisation of services is outlined and an analysis in practical terms as to how QM is applied in practice is provided, covering key issues such as document control, organisational structure and the role of the quality manager. Audit as a tool for improving quality is a fundamental tool and its use within a clinical governance framework including risk management/assessment, and other key responsibilities is detailed. Measuring what we do, analysing performance and setting targets to improve should be fundamental to how we approach our work in contemporary clinical practice.
This chapter discusses the epidemiology of infertility and the importance of the initial assessment of the infertile individual. Profound changes in society over the last two decades challenge previously agreed on norms in our understanding of the nature of parenthood and family. Defining infertility in a contemporary context has thus also changed as the profile of those seeking advice has evolved. Nevertheless it remains essential that efficient mechanisms for referral and investigation are established for those involved in the planning of fertility services. These must involve good liaison between primary care providers and medical, nursing and diagnostic laboratory staff in specialist centres. Adherence to agreed on protocols will facilitate appropriate and timely investigation along standardised paths, thereby minimising risk of delay and repetition of tests which those seeking assistance find particularly demoralising. Once a diagnosis is reached it should be possible to offer people with infertility an accurate prognosis and the opportunity to consider the issues relevant to treatment choices for their particular situation.
An authoritative account of the causes of infertility that fully explores the clinical assessment of patients and covers the decision-making behind treatment options. The content follows the MRCOG syllabus as well as delving deeper into subjects covered by the RCOG Advanced Training Skills Modules (ATSMs), leaving readers well prepared for their examinations. Written by nationally recognised leaders in the field, this volume concisely reviews contemporary clinical practice. Using an aetiology-based approach, chapters discuss ovulatory dysfunction, endometriosis, male infertility, uterine/tubal factors and unexplained infertility. The increasing use of third-party reproduction and surrogacy is explored, along with the psychosocial aspects of this type of treatment. Ethical dilemmas surrounding reproductive medicine and their management are covered in depth. With an emphasis on practical approaches to the delivery and organisation of clinical and laboratory services, readers learn how to ensure the support and care they offer is of the highest quality.
The evidence of funerary archaeology, historical sources and poetry has been used to define a ‘heroic warrior ethos’ across Northern Europe during the first millennium AD. In northern Britain, burials of later prehistoric to early medieval date are limited, as are historical and literary sources. There is, however, a rich sculptural corpus, to which a newly discovered monolith with an image of a warrior can now be added. Comparative analysis reveals a materialisation of a martial ideology on carved stone monuments, probably associated with elite cemeteries, highlighting a regional expression of the warrior ethos in late Roman and post-Roman Europe.
As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards (MERs) are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Value and Entry (PAVE) Award proposal, which combines a MER with payment reforms, transitioning from volume-based to “value-based” payments for antimicrobials. Here, the PAVE Award and similar MERs are reviewed, focusing on further refinement and avenues for implementation.
Absolute dating of mortars is crucial when trying to pin down construction phases of archaeological sites and historic stone buildings to a certain point in time or to confirm, but possibly also challenge, existing chronologies. To evaluate various sample preparation methods for radiocarbon (14C) dating of mortars as well as to compare different dating methods, i.e. 14C and optically stimulated luminescence (OSL), a mortar dating intercomparison study (MODIS) was set up, exploring existing limits and needs for further research. Four mortar samples were selected and distributed among the participating laboratories: one of which was expected not to present any problem related to the sample preparation methodologies for anthropogenic lime extraction, whereas all others addressed specific known sample preparation issues. Data obtained from the various mortar dating approaches are evaluated relative to the historical framework of the mortar samples and any deviation observed is contextualized to the composition and specific mineralogy of the sampled material.
Recently a cremation cemetery was excavated at the site of Wijnegem where 29 cremation graves and 9 funerary monuments were uncovered. Thirty radiocarbon (14C) dates were carried out, mostly on cremated bone but also 10 charcoal samples were dated. Twenty-four cremations were studied. Four ring ditches were dated by charcoal samples from the infill of the ditch. The 14C dates showed an interesting long-term occupation of the cemetery. Different phases were ascertained. The history of the cemetery starts in the northern part of the site around a circular funerary monument. Two cremations were dated at the transition of the Early to Middle Bronze Ages. Two other graves represent the transition from the Middle to the Late Bronze Ages. The main occupation period dates between the end of the Late Bronze Age and the Early Iron Age. Finally, an isolated cremation grave marks the definite abandonment of the site during the Late Iron Age.
Seven radiocarbon laboratories: Åbo/Aarhus, CIRCE, CIRCe, ETHZ, Poznań, RICH, and Milano-Bicocca performed separation of carbonaceous fractions suitable for 14C dating of four mortar samples selected for the MOrtar Dating Inter-comparison Study (MODIS). In addition, optically stimulated luminescence (OSL) analyses were completed by Milano-Bicocca and IRAMAT-CRP2A Bordeaux. Each laboratory performed separation according to laboratory protocol. Results of this first intercomparison show that even though consistent 14C ages were obtained by different laboratories, two mortars yielded ages different than expected from the archaeological context.
A special type of coastal settlement, promontory forts defended by inland-facing walls, appeared in the Balearic Islands in an imprecise time during the Bronze Age. A research project was initiated in 2011 to study one of these sites on each of the two major islands of the archipelago. The first one, Es Coll de Cala Morell (north Menorca), is a walled promontory with a relatively large plateau, with 13 horseshoe-shaped houses (navetes). The second, Sa Ferradura (east Mallorca), is a smaller coastal cape, with a different spatial planning, with only two large built-up areas, both attached to the enclosure wall. Two of the navetes have been excavated at Es Coll de Cala Morell, showing a domestic space with a central hearth in both cases. The occupation has been dated to around 1600–1200 cal BC. At Sa Ferradura seven hearths have been recorded in a large, open-air area. Their chronology falls within the interval of approximately 1200/1100–900 cal BC. From a chronological point of view, fortified settlements in coastal promontories are not, as was expected, a unitary phenomenon in Menorca and Mallorca and have to be related to different cultural periods.
Only domestic mammals (sheep, goat, cattle, pig, and dog) and two rodent species constituted the faunal package introduced to the Balearic Islands by the early settlers in the 3rd millennium cal BC. Later animal introductions in the archipelago were thought to occur by the end of the 1st millennium cal BC due to contacts with Punic merchants or, more than likely, to the Roman conquest of the islands. Recently, several faunal remains belonging to different vertebrates (red deer, chicken, and rabbit) were found in the Talayotic site of Cornia Nou (Minorca), in contexts that date to the early 1st millennium cal BC. A series of radiocarbon (14C) dates was made directly on samples of small species to exclude the possibility of infiltration into lower layers. The obtained results show that chicken and rabbit were already present on Minorca in the early 1st millennium cal BC. Chicken is recorded in Phoenician colonies in south Iberia as early as the 8th century cal BC. Rabbit, on the other hand, is indigenous to the Iberian Peninsula. These new faunal introductions recorded in Minorca could be related to the Late Bronze and Phoenician maritime activity.
In 1981, the first 14C and Archaeology Symposium was organized because it was felt necessary to have a symposium that focused on the specific problems related to the use of 14C dating in archaeology. The dating method has been constantly changing and approving itself technically as well as in the application of the method. The relationship between the archaeologists and the 14C dating laboratories has, however, never been straightforward. For a lot of 14C laboratories, archaeology was not their core business. For archaeologists, the main problem arose from an insufficient knowledge of natural sciences. The last decennia, however, 14C and archaeology are growing towards one another. One of the reasons might be the introduction of small exclusively 14C-dedicated machines and the availability of fully automatic graphitization lines.
Cathars have long been regarded as posing the most organised challenge to orthodox Catholicism in the medieval West, even as a "counter-Church" to orthodoxy in southern France and northern Italy. Their beliefs, understood to be inspired by Balkan dualism, are often seen as the most radical among medieval heresies. However, recent work has fiercely challenged this paradigm, arguing instead that "Catharism" was a construct of its persecutors, mis-named and mis-represented by generations of subsequent scholarship, and its supposedly radical views were a fantastical projection of the fears of orthodox commentators. This volume brings together a wide range of views from some of the most distinguished international scholars in the field, in order to address the debate directly while also opening up new areas for research. Focussing on dualism and anti-materialist beliefs in southern France, Italy and the Balkans, it considers a number of crucial issues. These include: what constitutes popular belief; how (and to what extent) societies of the past were based on the persecution of dissidents; and whether heresy can be seen as an invention of orthodoxy. At the same time, the essays shed new light on some key aspects of the political, cultural, religious and economic relationships between the Balkans and more western regions of Europe in the Middle Ages.
Antonio Sennis isSenior Lecturer in Medieval History at University College London Contributors: John H. Arnold, Peter Biller, Caterina Bruschi, David d'Avray, Jörg Feuchter, Bernard Hamilton, Robert I. Moore, MarkGregory Pegg, Rebecca Rist, Lucy Sackville, Antonio Sennis, Claire Taylor, Julien Théry-Astruc, Yuri Stoyanov