Fish for the city: meta-analysis of archaeological cod remains and the growth of London’s northern trade

The growth of medieval cities in Northern Europe placed new demands on food supply, and led to the import of fish from increasingly distant fishing grounds. Quantitative analysis of cod remains from London provides revealing insight into the changing patterns of supply that can be related to known historical events and circumstances. In particular it identifies a marked increase in imported cod from the thirteenth century AD. That trend continued into the fifteenth and sixteenth centuries, after a short downturn, perhaps attributable to the impact of the Black Death, in the mid fourteenth century. The detailed pattern of fluctuating abundance illustrates the potential of archaeological information that is now available from the high-quality urban excavations conducted in London and similar centres during recent decades

Non-technical skills learning in healthcare through simulation education: Integrating the SECTORS learning model and Complexity theory

Background: Recent works have reported the SECTORS model for non-technical skills learning in healthcare. The TINSELS programme applied this model, together with complexity theory, to guide the design and piloting of a non-technical skills based simulation training programme in the context of medicines safety. Methods: The SECTORS model defined learning outcomes. Complexity Theory led to a simulation intervention that employed authentic multi-professional learner teams, included planned and unplanned disturbances from the norm and used a staged debrief to encourage peer observation and learning. Assessment videos of non-technical skills in each learning outcome were produced and viewed as part of a Non-Technical Skills Observation Test (NOTSOT) both pre and post intervention. Learner observations were assessed by two researchers and statistical difference investigated using a student’s t-test Results: The resultant intervention is described and available from the authors. 18 participants were recruited from a range of inter-professional groups and were split into two cohorts. There was a statistically significant improvement (P=0.0314) between the Mean (SD) scores for the NOTSOT pre course 13.9 (2.32) and post course 16.42 (3.45). Conclusions: An original, theoretically underpinned, multi-professional, simulation based training programme has been produced by the integration of the SECTORS model for non-technical skills learning the complexity theory. This pilot work suggests the resultant intervention can enhance nontechnical skills

Patient-Reported Outcomes Screening for Improved Patient Wellness: A Cancer Center Initiative

Background: People experiencing serious illness have significant unmet physical, emotional, social and spiritual needs. The Quality Oncology Practice Initiative (QOPI) requires patients to be screened for emotional wellbeing and pain by their second oncology visit. This project details one cancer center’s quality improvement initiative to (a) implement electronic screening of every cancer patient by their second oncology visit, (b) design processes for ongoing assessment and intervention of need(s), and (c) develop measurable and sustainable evaluation metrics to ensure that palliative care needs are met. Methods: In June 2015, we launched electronic collection of patient-reported outcomes (PROs) using the Patient Reported Outcome Measurement Instrument System (PROMIS) global screen. Screening was completed via the health portal or clinic computer prior to the first return visit and at 30-day intervals. Results: The primary measures of interest were the percentage of completed PROMIS questionnaires and the percentage of relevant answers, with a target completion rate of 60%. The highest completion rate was 25.3%. Six weeks of relevant answers were collated from August 18, 2015 through September 30, 2015 with a range of 3.6% to 5.3% of patients having relevant answers. Conclusions: The utilization of a screening tool is only the method by which assessment and evaluation of comprehensive care needs is initiated. Evidence-based practice guidelines and clinical care pathways must also be in place to manage each symptom identified in a standardized way. Support for oncology nurses to lead assessment and connect patients with resources is an opportunity to incorporate primary palliative care into oncology practice

Intergalactic Property Law: A New Regime for a New Age

In November 2015, Congress passed the Spurring Private Aerospace Competitiveness and Entrepreneurship Act of 2015 ( the SPACE Act\u27), which allows private American companies to own any resources they collect from mining in space. This, however, conflicts with current international treaties to which the United States is a party, such as the Treaty on Principles Governing the Activities of States in the Exploration and Use of Outer Space ( the Outer Space Treaty\u27), which was adopted by the United Nations in 1967. Thus, without some changes, either the SPACE Act will be rendered useless or the United States will be in direct violation of the international laws to which it abides. As a result, this Note suggests that there is a great need to develop a governing body of law for outer space, which will both allow for the development of space mining as an industry and keep the United States within the bounds of its international agreements

Educational change and ICT: an exploration of priorities 2 and 3 of the DfES e-strategy in schools and colleges: the current landscape and implementation issues

Landscape review of integrated online support for learners and collaborative approaches to personalised learning activities

Natural history of falls in an incident cohort of Parkinson’s disease: early evolution, risk and protective features

The natural history of falls in early Parkinson’s disease (PD) is poorly understood despite the profound effect of falls on outcome. The primary aim of this study was to describe the natural history of falls, and characterise fallers over 54 months in 99 newly diagnosed people with PD. Seventy-nine (79.7%) participants fell over 54 months and 20 (20.3%) remained falls-naïve. Twenty six (26.2%) reported retrospective falls at baseline. Gait outcomes, disease severity and self-efficacy significantly discriminated across groups. Subjective cognitive complaints emerged as the only significant cognitive predictor. Without exception, outcomes were better for non-fallers compared with fallers at any time point. Between group differences for 54 month fallers and non-fallers were influenced by the inclusion of retrospective fallers and showed a broader range of discriminant characteristics, notably stance time variability and balance self-efficacy. Single fallers (n = 7) were significantly younger than recurrent fallers (n = 58) by almost 15 years (P = 0.013). Baseline performance in early PD discriminates fallers over 54 months, thereby identifying those at risk of falls. Clinical profiles for established and emergent fallers are to some extent distinct. These results reiterate the need for timely interventions to improve postural control and gait

Natural history of falls in an incident cohort of Parkinson’s disease: early evolution, risk and protective features

The natural history of falls in early Parkinson’s disease (PD) is poorly understood despite the profound effect of falls on outcome. The primary aim of this study was to describe the natural history of falls, and characterise fallers over 54 months in 99 newly diagnosed people with PD. Seventy-nine (79.7%) participants fell over 54 months and 20 (20.3%) remained falls-naïve. Twenty six (26.2%) reported retrospective falls at baseline. Gait outcomes, disease severity and self-efficacy significantly discriminated across groups. Subjective cognitive complaints emerged as the only significant cognitive predictor. Without exception, outcomes were better for non-fallers compared with fallers at any time point. Between group differences for 54 month fallers and non-fallers were influenced by the inclusion of retrospective fallers and showed a broader range of discriminant characteristics, notably stance time variability and balance self-efficacy. Single fallers (n = 7) were significantly younger than recurrent fallers (n = 58) by almost 15 years (P = 0.013). Baseline performance in early PD discriminates fallers over 54 months, thereby identifying those at risk of falls. Clinical profiles for established and emergent fallers are to some extent distinct. These results reiterate the need for timely interventions to improve postural control and gait

Enhancing health care non-technical skills: the TINSELS programme

Background and Context: Training in ‘non-technical skills’, social (communication and team work) and cognitive (analytical and personal behaviour) skills, in healthcare have been of great interest over the last decade. Whilst the majority of publications focus on ‘whether’ such education can be successful, they overlook the question of ‘how’ they enhance skills. We designed and piloted an original, theoretically robust and replicable teaching package that addresses non-technical skills in the context of medicines safety through simulation-based inter professional learning: the TINSELS (Training In Non-technical Skills to Enhance Levels of Medicines Safety) Programme. Innovation: A modified Delphi process was completed to identify learning outcomes, and recruitment of multi-professional teams was through local publicity. The faculty developed a three-session simulation based intervention: session one was a simulated ward encounter with multiple medicine related activities; session two was an extended debrief and facilitated discussion; and session three a ‘chamber of horrors’ where inter professional teams identified potential sources of error. Each session was completed in the simulation suite with 6 – 9 participants, lasted approximately 90m minutes, and took place over 2 weeks. Full details of the course will be presented to facilitate dissemination. Implications: Likert scale feedback was collected after the course (1 strongly disagree-5 strongly agree). Mean scores were all greater than 4, with qualitative feedback noting the fidelity of the authentic inter professional learner groups. A previously validated safety attitudes questionnaire found changes in attitudes towards handover of care and perceptions of safety levels in the workplace post intervention. An original, simulation based, multi-professional training programme has been developed with learning and assessment materials available for widespread replication