This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.

The Bronze Age in Britain is now a term often used to include both the first use of copper c. 2400 bc and also tin-bronze from c. 2100 bc, all of which required the extensive use of copper. Prehistoric mining for this metal has been identified in surface and underground workings in Parys Mine, Mynydd Parys, Anglesey, although almost all of the surface workings are now obscured by the extensive deep spoil from more recent mining in the industrial period. These copper-bearing ores are in bedded lodes, together with some intruded vein deposits. The Bronze Age workings have been exposed underground where they have been intersected by the early 19th century industrial workings on and above the 16 fathom and 20 fathom levels in the Parys Mine. Spoil exposures contain stone hammers (‘mauls’), wood fragments, and charcoal; samples of the latter have been radiocarbon dated with chronological modelling suggesting activity took place in the first half of the 2nd millennium cal bc. Although relatively limited in extent, these important prehistoric mining sites are among the earliest found in the UK. They have survived due to their protection from surface erosion and limited accessibility.

This article revisits a locus classicus of British Catholic History, the interpretation of the coin-hoard found in 1611 by the Lancashire squire William Blundell of Little Crosby.1 This article offers new information, approaching the Harkirk silver from several perspectives: Mark Blundell offers a memoir of his ancestor William Blundell, as well as lending his voice to the account of the subsequent fate of the Harkirk silver; Professor Jane Stevenson and Professor Peter Davidson reconsider the sources for William Blundell’s historiography as well as considering wider questions of memory and the recusant community; Dr Dora Thornton analyses the silver pyx made from the Harkirk coins in detail, and surveys analogous silverwork in depth.

Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.

This article illustrates and describes in detail a fine central European chasuble of the late c17 which, together with two dalmatics, ‘The Fetternear Vestments,’ were bequeathed to the Diocese of Aberdeen, in 1921 by the Leslie family, many of whom had been distinguished soldiers on the continent and especially in the Empire. After some contextual discussion of the alleged origins of the Leslie family and of their success in Imperial service, the article examines the traditional belief that the vestments, now at the Blairs Museum, Aberdeen, were made for Count James Leslie (c.1621-1694) partly out of Turkish textiles captured in 1683 at the Siege of Vienna. Detailed analysis of the embroidery on the chasuble, especially of the use of metal thread and ‘plate,’ demonstrates that the gold work is indeed of Turkish origin, the rest of the needle work central European, and thus makes the case that this extraordinary hybrid object is indeed a votive vestment made for the Catholic Leslies partly from captured Turkish work.

Little is known about the Endangered Grevy's zebra Equus grevyi in far northern Kenya, where the species exists in small, isolated populations at the periphery of its range. Understanding the threats facing this species is a prerequisite for effective conservation planning but its rarity makes obtaining accurate information challenging. We set out to establish the current status of, and attitudes towards, Grevy's zebra in northern Kenya using local knowledge as the primary source of information. Pastoralists perceived Grevy's zebra to be in decline as a result of drought, lack of pasture and water, and hunting for consumptive use. There was also evidence of competition with livestock. Attitudes towards Grevy's zebra were predominantly positive, influenced by a range of perceived benefits of living alongside the species, and an absence of severe costs. Coupled with evidence of local conservation efforts in several locations, this is a positive starting point for community-based conservation.