Holocene drainage systems of the English Fenland : roddons and their environmental significance

The roddons of the English Fenlands are fossilised silt and sand-filled tidal creek systems of mid- to late-Holocene age, incised into contemporaneous clay deposits. However, anthropogenic change (drainage and agriculture) has caused the former channels to become positive topographical features. Three stratigraphically discrete generations of roddon have been discriminated. They all show well-developed dendritic meander patterns, but there is little or no evidence of sand/silt infill during meandering; thus, unlike modern tidal creeks and rivers they typically lack laterally stacked point bar deposits, suggesting rapid infill. Major “trunk” roddons are rich in fine sands and there is little change in grain size from roddon mouth to the upper reaches, suggesting highly effective sand transport mechanisms and uniform conditions of deposition. Tributaries are silt-rich, while minor tributaries also have a significant clay component. During infill, active drainage networks appear to have been choked by sediment, converting mudflat/salt-marsh environments into widespread peat-forming freshwater reed swamps

Identification of Limited English Proficient Patients in Clinical Care

BackgroundStandardized means to identify patients likely to benefit from language assistance are needed.ObjectiveTo evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English.DesignWe investigated the sensitivity and specificity of the Census-LEP alone or in combination with a question on preferred language for medical care for predicting patient-reported ability to discuss symptoms and understand physician recommendations in English.ParticipantsThree hundred and two patients > 18 who spoke Spanish and/or English recruited from a cardiology clinic and an inpatient general medical-surgical ward in 2004-2005.ResultsOne hundred ninety-eight (66%) participants reported speaking English less than "very well" and 166 (55%) less than "well"; 157 (52%) preferred receiving their medical care in Spanish. Overall, 135 (45%) were able to discuss symptoms and 143 (48%) to understand physician recommendations in English. The Census-LEP with a high-threshold (less than "very well") had the highest sensitivity for predicting effective communication (100% Discuss; 98.7% Understand), but the lowest specificity (72.6% Discuss; 67.1% Understand). The composite measure of Census-LEP and preferred language for medical care provided a significant increase in specificity (91.9% Discuss; 83.9% Understand), with only a marginal decrease in sensitivity (99.4% Discuss; 96.7% Understand).ConclusionsUsing the Census-LEP item with a high-threshold of less than "very well" as a screening question, followed by a language preference for medical care question, is recommended for inclusive and accurate identification of patients likely to benefit from language assistance

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Archaeological Investigations at Vicarage Way, Yaxley, Cambridgeshire 1993

An archaeological assessment was conducted at Vicarage Way, Yaxley, in advance of proposed housing development. Archaeological remains dating to the Medieval and Post-medieval period indicated that the area had once formed part of the field system associated with the Medieval manorial complex situated to the west (SMR 1028)

Architectural Recordings within the East Wing, Master's Lodge, Jesus College, Cambridge

During November 2000, in advance of the construction of a new staircase in the East wing of the Master’s Lodge, Jesus College, parts of the original wall fabric were exposed. The CAU, which monitored the removal of existing features and plasterwork, undertook the recording of the exposed wall fabrics and architectural elements

Archaeological Investigations at Owl's End Road, Bury, Cambridgeshire

Fieldwork was carried out by the Cambridge Archaeological Unit on behalf of Galliford Homes, at Bury, near Ramsay, in advance of residential development on 3.5ha of land immediately to the east of Owl's End Road (TL 284 387). The work took place in two phases, between the 22nd August and 7th September and again between the 26th September and 6th Oct. 1994. The initial phase comprised a survey of surviving earthworks and subsequent trial trenching with excavation of archaeological features

The Heywood Theatre, the Gallery, Ely: Desktop Study and Test Pit Monitoring

This desk-based report presents the archaeological implications of a proposed construction of a Music School and Recital Hall for the King's School, Ely on the site of the former Bishop's Palace Gardens, currently within the grounds of the Heywood Theatre (fig.l; TL 5397 8015). It was commissioned by the architects Purcell Miller Tritton & Partners and on the recommendation of the County Archaeology Office

Impact of concentration of oesophageal and gastric cardia cancer surgery on long-term population-based survival

Background: The objective was to evaluate the impact of concentration of surgery for oesophageal and gastric cardia cancer on long-term survival in the population-based Eindhoven Cancer Registry area. In contrast to most previous studies, this study aimed to evaluate both surgically and non-surgically treated patients, to avoid the confounding effect of selective referral. Methods: This retrospective cohort study included all patients diagnosed with oesophageal or gastric cardia cancer between 1995 and 2006. Results for the period 1995-1998 were compared with those for 1999-2006, after concentration of surgery. Results: Between 1995 and 2006, 2212 patients were registered with the diagnosis, of whom 638 underwent resection. Before 1999, 73.4 per cent of surgically treated patients underwent a resection in a low-volume hospital (fewer than 4 resections per year) and 23.2 per cent were referred to an academic hospital. After concentration, 63.2 per cent of surgically treated patients underwent resection in one of two regional high-volume centres (15-20 resections per year) and 13.8 per cent were referred to an academic hospital. Three-year survival rates increased from 32.0 to 45.1 per cent for patients who had surgery (P = 0.004), and from 13.1 to 17.9 per cent for all included patients (P = 0.026). These improvements remained after adjustment for case mix or (neo) adjuvant treatments, and were similar for patients with squamous cell carcinoma or adenocarcinoma. However, adjustment for annual hospital volume attenuated this association for patients who had surgery. Conclusion: Concentration of oesophageal and gastric cardia cancer surgery was associated with improvements in long-term, population-based overall survival for surgically as well as non-surgically treated patients, apparently mediated by an increase in volume