University College London Qatar

CONTEXT: The extensive research literature on electronic patient records (EPRs) presents challenges to systematic reviewers because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. METHODS: Using the meta-narrative method and searching beyond the Medline-indexed literature, this review used "conflicting" findings to address higher-order questions about how researchers had differently conceptualized and studied the EPR and its implementation. FINDINGS: Twenty-four previous systematic reviews and ninety-four further primary studies were considered. Key tensions in the literature centered on (1) the EPR ("container" or "itinerary"); (2) the EPR user ("information-processer" or "member of socio-technical network"); (3) organizational context ("the setting within which the EPR is implemented" or "the EPR-in-use"); (4) clinical work ("decision making" or "situated practice"); (5) the process of change ("the logic of determinism" or "the logic of opposition"); (6) implementation success ("objectively defined" or "socially negotiated"); and (7) complexity and scale ("the bigger the better" or "small is beautiful"). CONCLUSIONS: The findings suggest that EPR use will always require human input to recontextualize knowledge; that even though secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper may offer a unique degree of ecological flexibility; and that smaller EPR systems may sometimes be more efficient and effective than larger ones. We suggest an agenda for further research.

OBJECTIVE: To investigate what going to medical school means to academically able 14-16 year olds from different ethnic and socioeconomic backgrounds in order to understand the wide socioeconomic variation in applications to medical school. DESIGN: Focus group study. SETTING: Six London secondary schools. PARTICIPANTS: 68 academically able and scientifically oriented pupils aged 14-16 years from a wide range of social and ethnic backgrounds. MAIN OUTCOME MEASURES: Pupils' perceptions of medical school, motivation to apply, confidence in ability to stay the course, expectations of medicine as a career, and perceived sources of information and support. RESULTS: There were few differences by sex or ethnicity, but striking differences by socioeconomic status. Pupils from lower socioeconomic groups held stereotyped and superficial perceptions of doctors, saw medical school as culturally alien and geared towards "posh" students, and greatly underestimated their own chances of gaining a place and staying the course. They saw medicine as having extrinsic rewards (money) but requiring prohibitive personal sacrifices. Pupils from affluent backgrounds saw medicine as one of a menu of challenging career options with intrinsic rewards (fulfillment, achievement). All pupils had concerns about the costs of study, but only those from poor backgrounds saw costs as constraining their choices. CONCLUSIONS: Underachievement by able pupils from poor backgrounds may be more to do with identity, motivation, and the cultural framing of career choices than with low levels of factual knowledge. Policies to widen participation in medical education must go beyond a knowledge deficit model and address the complex social and cultural environment within which individual life choices are embedded.

BACKGROUND: Measurements and models of current flow in the brain during transcranial Direct Current Stimulation (tDCS) indicate stimulation of regions in-between electrodes. Moreover, the folded cortex results in local fluctuations in current flow intensity and direction, and animal studies suggest current flow direction relative to cortical columns determines response to tDCS. METHODS: Here we test this idea by using Transcranial Magnetic Stimulation Motor Evoked Potentials (TMS-MEP) to measure changes in corticospinal excitability following tDCS applied with electrodes aligned orthogonal (across) or parallel to M1 in the central sulcus. RESULTS: Current flow models predicted that the orthogonal electrode montage produces consistently oriented current across the hand region of M1 that flows along cortical columns, while the parallel electrode montage produces non-uniform current directions across the M1 cortical surface. We find that orthogonal, but not parallel, orientated tDCS modulates TMS-MEPs. We also show modulation is sensitive to the orientation of the TMS coil (PA or AP), which is thought to select different afferent pathways to M1. CONCLUSIONS: Our results are consistent with tDCS producing directionally specific neuromodulation in brain regions in-between electrodes, but shows nuanced changes in excitability that are presumably current direction relative to column and axon pathway specific. We suggest that the direction of current flow through cortical target regions should be considered for targeting and dose-control of tDCS.

Research over the last few decades has greatly enhanced our understanding of the production and distribution of glass across time and space, resulting in an almost kaleidoscopically colourful and complex picture. We now recognise several major ‘families’ of glass composition, including plant-ash based glass in Late Bronze Age Egypt and Mesopotamia, and the Islamic World; mineral natron glass in the Greek, Roman and Byzantine Empires; mineral-based lead- and lead–barium glass in Han period China and medieval Europe; and wood-ash and ash-lime glass in medieval Europe. Other glass groups include a peculiar granite-based glass in medieval Nigeria, and probably mineral-based glass in Bronze Age southern Europe. However, despite two centuries of research, we know very little about the actual production locations and technologies for most of these glass groups, and how and where glass making was invented. The early literature reflects the comparatively limited number of individuals and research groups working on glass; only recently there is a significant broadening of the research community and expansion and refinement of the data base. This enables us now to take stock of our current understanding and identify major lacunae and areas where additional work may make the most significant contributions to our understanding of the complex picture. Hopefully this will help moving from the traditional descriptive and often fragmented opportunistic data-gathering phase (asking ‘what’, ‘where’ and ‘when’) to a more interpretative period looking with fresh eyes at the ‘why’ and ‘how’ of compositional and technical developments. This opening of the research field includes addressing the relationship of the different glass industries to the societies that used glass, and how they organised its production and distribution. A major overarching issue remains the question of the initial invention of glass, and how the idea as well as the material itself spread. Major debates should ask whether there were multiple inventions of glass making; how best to identify and interpret long-distance trade; how to ensure data compatibility and quality; and how to integrate different types of data, from archaeology through craftsmanship and typology to chemistry and optical properties.

The earliest known iron artefacts are nine small beads securely dated to circa 3200 BC, from two burials in Gerzeh, northern Egypt. We show that these beads were made from meteoritic iron, and shaped by careful hammering the metal into thin sheets before rolling them into tubes. The study demonstrates the ability of neutron and X-ray methods to determine the nature of the material even after complete corrosion of the iron metal. The iron beads were strung into a necklace together with other exotic minerals such as lapis lazuli, gold and carnelian, revealing the status of meteoritic iron as a special material on a par with precious metal and gem stones. The results confirm that already in the fourth millennium BC metalworkers had mastered the smithing of meteoritic iron, an iron–nickel alloy much harder and more brittle than the more commonly worked copper. This is of wider significance as it demonstrates that metalworkers had already nearly two millennia of experience to hot-work meteoritic iron when iron smelting was introduced. This knowledge was essential for the development of iron smelting, which produced metal in a solid state process and hence depended on this ability in order to replace copper and bronze as the main utilitarian metals.

PURPOSE: The aim was to critically appraise, synthesise and present the evidence of medication errors amongst hospitalised patients in Middle Eastern countries, specifically prevalence, nature, severity and contributory factors. METHODS: CINAHL, Embase, Medline, Pubmed and Science Direct were searched for studies published in English from 2000 to March 2018, with no exclusions. Study selection, quality assessment (using adapted STROBE checklists) and data extraction were conducted independently by two reviewers. A narrative approach to data synthesis was adopted; data related to error causation were synthesised according to Reason's Accident Causation model. RESULTS: Searching yielded 452 articles, which were reduced to 50 following removal of duplicates and screening of titles, abstracts and full-papers. Studies were largely from Iran, Saudi Arabia, Egypt and Jordan. Thirty-two studies quantified errors; definitions of 'medication error' were inconsistent as were approaches to data collection, severity assessment, outcome measures and analysis. Of 13 studies reporting medication errors per 'total number of medication orders'/ 'number of prescriptions', the median across all studies was 10% (IQR 2-35). Twenty-four studies reported contributory factors leading to errors. Synthesis according to Reason's model identified the most common being active failures, largely slips (10 studies); lapses (9) and mistakes (12); error-provoking conditions, particularly lack of knowledge (13) and insufficient staffing levels (13) and latent conditions, commonly heavy workload (9). CONCLUSION: There is a need to improve the quality and reporting of studies from Middle Eastern countries. A standardised approach to quantifying medication errors' prevalence, severity, outcomes and contributory factors is warranted.

Analysis of metal objects with portable and handheld X-ray fluorescence spectrometry has become increasingly popular in recent years. Here, methodological concerns that apply to non-destructive, surface examination with XRF instruments of ancient metal artefacts are discussed based on the comparative analyses of a set of copper-based objects by means of portable X-ray fluorescence (pXRF) and electron probe microanalyser (EPMA). The analytical investigation aims to explore issues of instrument comparability and reliability of the non-invasive pXRF results. The different analytical approaches produce a comparable pattern for the major element concentrations, but substantial variation is evident when it comes to the absolute values for major and minor/trace elements.

The earliest tin bronze artefacts in Eurasia are generally believed to have appeared in the Near East in the early third millennium BC. Here we present tin bronze artefacts that occur far from the Near East, and in a significantly earlier period. Excavations at Pločnik, a Vinča culture site in Serbia, recovered a piece of tin bronze foil from an occupation layer dated to the mid fifth millennium BC. The discovery prompted a reassessment of 14 insufficiently contextualised early tin bronze artefacts from the Balkans. They too were found to derive from the smelting of copper-tin ores. These tin bronzes extend the record of bronze making by c . 1500 years, and challenge the conventional narrative of Eurasian metallurgical development.

Eighty-seven glass fragments from Roman and Late Antique layers at Tell Basta/Bubastis in the Eastern Nile Delta were typologically evaluated and chemically analysed to determine chronological and compositional patterns of glass use at this important Egyptian city, and how this relates to larger pattern of glass production and consumption in the first half of the first millennium AD. Bubastis is situated in geographical proximity to Alexandria, an important seaport, and at the same time close to the raw glass production areas in the Wadi Natrun and Sinai peninsula. This paper reports the first substantial set of compositional data of Roman to Late Antique glass from a settlement in northern Egypt, filling an important gap in our knowledge of glass consumption pattern in the first half of the first millennium AD. The glass from Bubastis falls into several compositional groups known already from elsewhere in the Roman and Late Antique world, including antimony- and manganese-decoloured glass and two varieties of HIMT glass. Changes in glass composition over more than 500 years are in line with earlier observations concerning changes in prevalence of these glass groups. However, compositional groups known to dominate archaeological glass assemblages elsewhere, such as Roman blue/green during the earlier part of the period under study, or Levantine I in the later period, are notably absent. For the later period, this is probably due to the proximity of Tell Basta to the suspected production region of HIMT glass in northern Sinai/Egypt. By analogy, this might indicate that the earlier Roman blue/green glass has a production origin further away from the Delta than the decolourised glasses prevailing in Bubastis. A particular vessel type, small-volume thick-walled dark green unguentaria, is made of probably Egyptian plant ash glass, indicating the existence of a specialised glassmaker during the early first millennium AD.

Elemental analysis of ancient ceramics is primarily used in provenance research, where defined compositional groups are attributed to particular raw materials sources or production locations. Requirements in data quality and analytical performance are high, as is the need for clear and reproducible methodologies and the availability of information on the above to ensure interlaboratory comparability and long‐term data validity. This paper outlines the measurement parameters of a dedicated calibration set‐up for the analysis of ancient ceramics using wavelength‐dispersive X‐ray fluorescence spectrometry. The specimens are prepared as concentrated glass beads, allowing the measurement of 26 elements from a single sample, thus minimising sample size requirements. Certified and non‐commercial standards are used to evaluate the performance of the method in terms of detection limits, precision, repeatability and accuracy. The materials used cover a range of compositions in line with the matrix variability encountered in archaeological ceramics. The data confirm the high standard of the method and highlight specific limitations. An initial assessment of comparability with other set‐ups used in ceramic analyses, primarily neutron activation analysis, is given through a discussion of performance on commonly analysed materials. The advantages of the proposed method include excellent analytical performance, analysis of a large suite of elements including all major, minor and a good range of traces, relatively small sample sizes and preparation of samples that can be stored and reanalysed. Copyright © 2017 John Wiley & Sons, Ltd.

BACKGROUND: We aimed to conduct a systematic review and meta-analysis of RHR's efficiency and safety, in addition to comparison between open and laparoscopic techniques. METHODS: A literature review was conducted from 2000 to 2020 including studies reporting on their centre's outcomes for robotic hernial repairs. A meta-analysis was conducted. For continuous data, Mantel-Haenszel chi-squares test was used and inverse variance was used for dichotomous data. RESULTS: In total, 19 studies were included. A total of 8987 patients were treated for hernia repairs, 4248 underwent open repairs, 2521 had robotic repairs and 1495 had laparoscopic repair. Cumulative analysis of robotic series: The overall average operative time was 90.8 min (range 25-180.7 min). The overall conversation rate was 0.63% (10/1596). The overall complication rate was 10.1% (248/2466). The overall recurrence rate was 1.2% (14/1218). Readmission rate was 1.6% (28/1750). Comparative meta-analysis outcomes include robotic versus open and robotic versus laparoscopic. Robotic versus open: The robotic group had significantly longer operative times and less readmission rates. There was no difference between the two groups regarding complications, post-operative pain occurrence and hernia recurrence rates. Robotic versus laparoscopic: The robotic group had significantly longer operative times and less complications. There was no difference regarding post-operative pain occurrence, hernia recurrence rates or readmission rates. CONCLUSION: Robotic hernia repair is a safe and efficient technique with minimal complications and a short learning curve; however, it remains inferior to the standard open technique. It does, however, have a role in minimally invasive technique centres. A multicentre randomized control trial is required comparing robotic, open and laparoscopic techniques.

A group of finds (vessels, raw glass chunks, window panes) from three sites in present-day Bulgaria was selected as representative of the circulation and usage of glass in the Lower Danube region during the 6th c. AD. In total, 79 samples were analysed by EPMA and/or LA-ICP-MS techniques. The data quality was assessed for each analytical run according to the measurement of reference glasses and to pairs of results obtained from representative samples of archaeological glass analysed by both techniques. Combining EPMA and LA-ICP-MS data allowed a sufficiently consistent and unified set of primary results to be formed. As already suggested in an earlier preliminary paper, only a single glass composition was found to dominate the 6th c. contexts in the region. The current study recognises this 6th c. glass from the Lower Danube as identical with the so called 'Serie 2.1.' defined by D. Foy and co-workers (2003) in various assemblages in Southern France and North Africa. The major, minor and trace oxide evidence presented here indicates that this is a distinct primary glass composition, with an iron-rich sub-group tentatively differentiated within the main group. Accordingly, an attempt is made to situate it relative to the other main primary compositions in the region. The proposed interpretation is that the 6th c. glass should not be linked to the HIMT glass despite the nominal similarity between them due to their elevated iron oxide, manganese, and titania concentrations. Instead, a possible link between the geochemical characteristics of the 6th c. glass and an earlier group of manganese decolourised glass, equivalent to 'Serie 3.2.' outlined by D. Foy and co-workers (2003) is suggested. This may imply the use of sand from a broadly identical geological area, hence it is possible that both the 6th c. glass and the manganese decolourised composition are likely to share a common origin.

Abstract

The Antikythera Mechanism, an ancient Greek astronomical calculator, has challenged researchers since its discovery in 1901. Now split into 82 fragments, only a third of the original survives, including 30 corroded bronze gearwheels. Microfocus X-ray Computed Tomography (X-ray CT) in 2005 decoded the structure of the rear of the machine but the front remained largely unresolved. X-ray CT also revealed inscriptions describing the motions of the Sun, Moon and all five planets known in antiquity and how they were displayed at the front as an ancient Greek Cosmos. Inscriptions specifying complex planetary periods forced new thinking on the mechanization of this Cosmos, but no previous reconstruction has come close to matching the data. Our discoveries lead to a new model, satisfying and explaining the evidence. Solving this complex 3D puzzle reveals a creation of genius-combining cycles from Babylonian astronomy, mathematics from Plato's Academy and ancient Greek astronomical theories.

Co-existing infection/inflammation and birth asphyxia potentiate the risk of developing neonatal encephalopathy (NE) and adverse outcome. In a newborn piglet model we assessed the effect of E. coli lipopolysaccharide (LPS) infusion started 4 h prior to and continued for 48 h after hypoxia on brain cell death and systemic haematological changes compared to LPS and hypoxia alone. LPS sensitized hypoxia resulted in an increase in mortality and in brain cell death (TUNEL positive cells) throughout the whole brain, and in the internal capsule, periventricular white matter and sensorimotor cortex. LPS alone did not increase brain cell death at 48 h, despite evidence of neuroinflammation, including the greatest increases in microglial proliferation, reactive astrocytosis and cleavage of caspase-3. LPS exposure caused splenic hypertrophy and platelet count suppression. The combination of LPS and hypoxia resulted in the highest and most sustained systemic white cell count increase. These findings highlight the significant contribution of acute inflammation sensitization prior to an asphyxial insult on NE illness severity.

Structure-from-motion and multiview-stereo together offer a computer vision technique for reconstructing detailed 3D models from overlapping images of anything from large landscapes to microscopic features. Because such models can be generated from ordinary photographs taken with standard cameras in ordinary lighting conditions, these techniques are revolutionising digital recording and analysis in archaeology and related subjects such as palaeontology, museum studies and art history. However, most published treatments so far have focused merely on this technique's ability to produce low-cost, high quality representations, with one or two also suggesting new opportunities for citizen science. However, perhaps the major artefact scale advantage comes from significantly enhanced possibilities for 3D morphometric analysis and comparative taxonomy. We wish to stimulate further discussion of this new research domain by considering a case study using a famous and contentious set of archaeological objects: the terracotta warriors of China's first emperor.

The trace element boron is present in most ancient glasses as an impurity, and high boron (≥ 300 ppm) marks raw material sources that are geologically specific and relatively uncommon. Recent analyses of Byzantine glass with high boron contents suggest that glass‐making was not limited to the traditional regions of the Levant and Egypt, and a production origin in or near western Anatolia is proposed. Glass bracelets from Ḥiṣn al‐Tīnāt in southern Turkey give fresh evidence for the production and circulation of high‐boron glasses that closely correlates with object typology. The patterning of findspots suggests that high‐boron glass was closely connected to the Byzantine world.

We describe two crucible fragments from an early Islamic context at the West African site of Tadmekka, in the Republic of Mali. They are made from a very sandy fabric and contain numerous gold particles and mineral grains in a matrix of lightly-coloured glass-based crucible slag. We interpret these as remains of a process separating freshly-panned gold concentrate from residual mineral inclusions, by melting the concentrate together with crushed glass beads. The process has similarities in modern artisanal practice, and shows the versatility of craftspeople in this major urban trading centre famous for its gold wealth. © 2014 The Authors.

This paper discusses what it means to label heritage as being ‘at risk’ in post-disaster landscapes in the city of Banda Aceh, Indonesia, following the 2004 Indian Ocean tsunami. It questions the relevance of a ‘heritage at risk’ framework, pointing out the issues associated with starting from this popular threat-based model of preservation in the aftermath of near or total destruction. By challenging the hegemony of a ‘heritage at risk’ rhetorical device that constructs heritage typologies, this debate focuses instead on the emergence and mastering of new heritage in post-tsunami Aceh, and the ways in which a shift in focus is able to document and preserve the emergence of unique heritage constructs and priorities. This paper promotes the study of heritage as a performance that transcends an emphasis on victimhood, toward framing a heritage construct that is productive and dynamic, a steward for post-disaster identities.

The Royal City of Meroe, ca. 200 km north of Khartoum in the modern-day Republic of the Sudan, was an ancient capital of the Kingdom of Kush. From the 3rd century b.c. to the 4th century a.d., Kushite rulers controlled significant territory from the banks of the Nile at Meroe, in part through their ability to ensure the production of significant quantities of iron. The extensive archaeological remains of Meroitic iron production have been investigated over decades, and recently a series of experimental iron smelts in a replica Meroitic furnace has shed new light on the archaeometallurgical evidence. The data generated during the smelting campaigns has provided an understanding of the type of iron ore used, the construction and operating parameters of the furnace, and the workshop space created by the ancient iron smelters during the later and post-Meroitic times.