Recognizing and Moving on from a Failed Paradigm: The Case of Agricultural Landscapes in Anglo-Saxon England c. AD 400–800

A central preoccupation for archaeologists is how and why material culture changes. One of the most intractable examples of this problem can be found between AD 400 and 800 in the enigmatic transformation of sub-Roman into Anglo-Saxon England. That example lies at the heart of this review, explored through the case of the agricultural economy. Although the ideas critically examined below relate specifically to early medieval England, they represent themes of universal interest: the role of migration in the transformation of material culture, politics, and economy in a post-imperial world, the significance of ‘‘core’’ and ‘‘periphery’’ in evolving polities, ethnogenesis as a strategy in kingdom building, property rights as a lens for investigating cultural change, and the relationship between hierarchical political structures and collective forms of governance. The first part of my argument proposes a structured response to paradigmatic stalemate by identifying and testing each underlying assumption, premise, and interpretative framework. The recognition of any fallacies, false premises, and flawed arguments might assist with an overall evaluation of the continuing utility of a discourse—whether it has life in it yet, or should be set aside. In either case, the recognition of its structure should enable arguments to be developed that do not lead into a disciplinary cul-de-sac, prevented by the orthodoxy from exploring new avenues for research. In the second part of the review, I deliberately adopt a starting point outside the limits of the current discourse. Freed from the confines of the conventional consensus, I experiment with an alternative ‘‘bottom-up’’ approach to change in early medieval England that contrasts with conventional ‘‘top-down’’ arguments. I focus in particular on how rights over agricultural property—especially collective rights—and the forms of governance implied by them may assist in illuminating the roles of tradition and transformation in effecting cultural change.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s10814-015-9088-

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology