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Little is known of helminth parasites of tropical Remote Oceania, in either archaeological or modern contexts. This study presents a parasitological analysis of soil samples from Lapita and Polynesian contexts in Vanuatu, Fiji, Tonga, Samoa, the Marquesas Islands, and the Gambier Islands. Microscopic eggs of the dog (Canis familiaris) nematode Toxocara canis , which could have adversely affected local people and their dogs, were found at all sites. We comment on the variability in size and appearance of T. canis eggs found in archaeological contexts and compare these differences to modern reference eggs. The study represents the first confirmed record of pre-European helminth parasites in tropical Remote Oceania, and the first confirmed physical evidence of dog in Vanuatu. [ABSTRACT FROM AUTHOR]

New Zealand's kākāpō parrot, once widespread, is now critically endangered due to habitat loss and introduced mammalian predators. Prior to major population decline, a unique kākāpō cestode, Stringopotaenia psittacea,  was found in the 1880s and first described in 1904. Here we report the discovery of eggs of this cestode in kākāpō coprolites of pre-human settlement age from the Honeycomb Hill cave system, north-west Nelson. Analysis of 52 samples, including coprolites of post-human settlement age, from nine sites within six South Island locations across a wide geographic range, yielded only eight infected samples in this single cave system. Results suggest that prior to human settlement, S. psittacea was not widespread within and between kākāpō populations, in marked contrast to other parasite types of the extinct moa spp. Intense management of the last remaining kākāpō has endangered or possibly caused the extinction of this cestode. This is the first confirmed record of  S. psittacea  since its discovery in 1884. [ABSTRACT FROM AUTHOR]

Here we report on microfossil analysis of human dental calculus from Lapita (3000–2600 yr BP) and post-Lapita (2300–2000 yr BP) burials from Vao and Uripiv, Vanuatu. Phytoliths of introducedMusaand indigenousHeliconiain the calculus suggest the use of these taxa as food wrappings. Phytoliths and most other material in the calculus, namely sponge spicules, calcium oxalate crystals, xylem and charcoal, are unequivocal identifications. Another type of material, comprising degraded objects with a general morphology suggesting starch grains, is uncertain, however, as the unequivocal starch indicator, the Maltese cross, was not observed. We used a new method for calculus analysis, Fourier Transform InfraRed spectroscopy (FTIR), comparing the suspected starch with modern reference starch of prehistoric Pacific crops. Although the ancient FTIR analysis was limited to a small number of suspected starch grains, the results provide another line of evidence for starch. The calculus data are consistent with previous microfossil studies of Lapita deposits at the sites, and demonstrate the efficacy of this technique in contributing to the definition of the history of plant use and diet of early Pacific Island populations. [ABSTRACT FROM AUTHOR]

A shoreline and archaeological excavations at Cook's Cove, eastern North Island, New Zealand were examined for stratigraphy and plant microfossils and results compared with previous interpretations of this site. Buried soils, distal tephras and pollen revealed evidence of pre- and post-settlement forest disturbance. Microfossil starch and calcium oxalate crystals of introduced sweet potato (Ipomoea batatas) and taro (Colocasia esculenta) were identified throughout the deposits, indicating intensive local cultivation and processing of these crops. Results are consistent with revised New Zealand geochronological models and, bearing in mind loss of evidence by erosion, differ in several respects to those of previous studies, as follows. The sea-rafted Taupo Pumice (AD 200) and Loisel's Pumice (from multiple off-shore sources) were not as widespread. Although microscopic charcoal was present to the full depth of all profiles, we did not observe macroscopic pieces below the Loisel's Pumice. The only material we found that appeared to equate to the deposit previously identified tentatively as air-fall Kaharoa Tephra (AD 1300) appeared not to be a tephra. Finally, we found little evidence for marine inundation of the site. [ABSTRACT FROM AUTHOR]

Analysis of deposits at a Lapita site in Vanuatu revealed putative starch grains of Dioscorea nummularia in ~2800-3100cal. BP layers and of Dioscorea pentaphylla in a ~2000 cal. BP layer, suggesting local cultivation of these tuberous crops. The Dioscoreaceae are a new addition to the introduced cultigens thus far directly identified for prehistoric Vanuatu. [ABSTRACT FROM AUTHOR]

Abstract: We present results of phytolith analysis of deposits from three prehistoric settlement sites in Vanuatu: the small islands of Vao and Uripiv off the north east coast of the main island of Malekula and at Mafilau on the west coast of Epi Island. Samples from Vao Island coarsely encompass the period from Lapita times (c. 3000 BP) to the present. The data from this site suggest deforestation by people, with a decrease in palms and increase in grasses. The data from the three sites show evidence of an introduced cultigen during different prehistoric periods. Banana (Musa) phytoliths were found in one recent Vao layer (500 BP-present) and in Mafilau layers, the latter representing the immediate post-Lapita period (c. 2800–2500 BP). This phytolith type was also found at Uripiv in Lapita layers (c. 3000–2700 BP). Banana phytoliths are diagnostic so their presence in archaeological deposits in Remote Oceania, outside their natural distribution, provides secure evidence of cultivation. This demonstrates the potential of this line of evidence for identifying both the cultigens transported by early colonists and subsequent plant introductions. The data provide the first direct evidence of banana cultivation at a Lapita site in Remote Oceania and support the contention that horticulture was an integral part of the Lapita Cultural Complex. [Copyright &y& Elsevier]

Abstract: Plant microfossil analysis was carried out on anthropogenic deposits from Yuku rock shelter, possibly occupied from before 14,200 cal. BP to recent times, in the Papua New Guinea Highlands. Elaeocarpus pollen has extremely high percentages throughout. Starch residues of lesser yam (Dioscorea esculenta) and one or more, undifferentiated Dioscorea species were identified, suggesting processing of these taxa since first use of the site. The latter include Dioscorea alata, Dioscorea bulbifera, Dioscorea nummularia and Dioscorea pentaphylla. Pollen and phytoliths of banana (Musa) appear 5200 cal. BP. We cannot differentiate between naturally growing and cultivated yams and bananas. Putative truffle (hypogeous Ascomycotina) spores in the deposits suggest foraging of truffles. [Copyright &y& Elsevier]

Abstract: Plant microfossil analysis was carried out on deposits bearing Podtanean (2700–1800years BP) ceramics from Mé Auré Cave, Moindou, New Caledonia. Starch residues of introduced Colocasia esculenta, Dioscorea esculenta and one or more, undifferentiated Dioscorea species were identified. The latter include Dioscorea alata, D. bulbifera, D. nummularia and D. pentaphylla. The data provide the first direct evidence of prehistoric horticulture in New Caledonia. [Copyright &y& Elsevier]

Presented here are results of analyses of sediments from a maar crater at Matukutureia, south Auckland. The record is discontinuous, reflecting formation of peat on the tuff surface after the eruption. The tuff section of the profile (3–7 million years old) has pollen of numerous extinct taxa and suggests broad-leaf beech ( Brassospora) forest with Casuarina and Agathis, and warm temperate conditions. A date of 15 051 ± 80 14C yr BP from the base of the overlying peat provides a minimum date for the eruption of McLauchlins Hill volcano. We cannot determine the timing of early Polynesian activities. [ABSTRACT FROM AUTHOR]

Abstract: We present results of starch analysis of archaeological deposits from Pitcairn Island. High concentrations of starch grains preserved in cell membranes, and xylem tracheary elements, consistent with introduced Colocasia esculenta (taro) were found. Because of limited age control, we are uncertain if the microfossils are prehistoric. Problems associated with identifying taxa with small starch grains in extractions from weathered deposits are highlighted. [Copyright &y& Elsevier]

Abstract: Presented is a combined procedure for recovering phytoliths and starch residues from soils, sedimentary deposits and similar materials. It is designed to be reliable, simple and time efficient, and is outlined in detail and summary as a practical, step-by-step method. It has been carried out successfully on many types of soils and other deposits, including clays, silts and sands; waterlogged, porous, peaty, volcanic and coralline soils; and sediment cores and coprolites from a range of environmental settings in both tropical and temperate climates. Mounting phytoliths and starch residues on slides for microscopy is included. [Copyright &y& Elsevier]

We present direct microbotanical evidence from New Zealand of the prehistoric cultivation of four introduced Polynesian plants. Pollen, phytoliths, starch grains and xylem of bottle gourd (Lagenaria siceraria), paper mulberry (Broussonetia papyrifera), sweet potato (Ipomoea batatas) and taro (Colocasia esculenta) have been identified. The microremains are from a range of locations (spanning 600 km) and were found in a variety of depositional settings, including sediment cores, and prehistoric agricultural structures and coprolites. The data identify combinations of early Polynesian crops, including both field- and tree-cropping systems, and provide the first direct field evidence of prehistoric taro cultivation in the South Island. [Copyright &y& Elsevier]

Microfossil (pollen, phytolith and diatom) analyses of 16 coprolites from a prehistoric settlement at Kohika, Bay of Plenty, New Zealand, provide evidence for coprolite age, season of site occupation, prehistoric Maori diet and palaeoenvironmental conditions. Because human and dog diets may overlap considerably, the microfossil evidence does not indicate with certainty which of these two species deposited them. However, we argue that it was very probably dog. The microfossil evidence suggests that the coprolites are pre-European (pre- c. ad 1800) and post-large scale Polynesian deforestation (post- c. 700 yr bp ), and that some were deposited in mid-summer. High values for puwhaSonchus type and raupo Typha pollen in some of the coprolites may provide direct evidence that these taxa were used as food by prehistoric Maori, as described later in ethnographic times. [Copyright &y& Elsevier]

Pollen diagrams from four sites along an altitudinal sequence on Mt Hauhungatahi support fossil wood data (Ogden et al., 1997) in suggesting a fluctuating Holocene tree-line not exceeding the altitude reached in the early Holocene. Tree-line forest at 1340–1390 m during the periods 10 100–7500 and 5400–3800 cal. BP was associated with patchy Subalpine scrub communities above and below this altitude. Rapid decline of this Halocarpus-Phyllocladus forest at c. 7500 cal. BP, and again c. 3800 cal. BP was probably due to volcanism. During 7500–5400 and 3800–1718 cal. BP tree-line forest was replaced by Subalpine scrub. The failure of forest to replace scrub during these two periods implies a long-lasting influence of the event which destroyed the forest, a continuation of disturbance events, or changed environmental conditions. After the Taupo volcanic eruption (1718 cal. BP) expansion of Libocedrus indicates an upwards movement of forest species into Subalpine scrub, followed by a decline. Volcanism has probably affected the vegetation of Mt Hauhungatahi directly and indirectly (through effects on soil drainage) throughout the Holocene. Results are consistent with increased climatic variability since 7500 cal. BP, and support the hypothesis that disturbance events can have persistent long-term effects on community composition and species distribution patterns. [ABSTRACT FROM AUTHOR]

An altitudinal series of eleven fine resolution pollen diagrams were used to examine the role of volcanism in forest dynamics on Mt Hauhungatahi. Partial pollen diagrams from four of these sites, chosen to illustrate the major effects of the 1718 BP Taupo eruption, are presented. Following the eruption Libocedrus bidwillii expanded in all sites. Open sites created by the eruption may have facilitated an expansion already underway as a result of more variable climatic conditions since c. 3000 BP. Weinmannia racemosa invaded upper montane forest c. 650 BP. The current altitudinal sequence of forest types, with Libocedrus dominating the subalpine and Weinmannia the upper montane forests, has thus been synthesized only within the last 1800years. This is interpreted as a consequence of individualistic species' responses to major disturbance by the eruption. The results support nonequilibrium theories of community composition. [ABSTRACT FROM AUTHOR]

Aims: The three index operations for vascular training comprise abdominal aortic aneurysm repair, carotid artery endarterectomy and femorodistal bypass graft operations. We feel that during the last decade, the number of primary femorodistal bypass operations performed has continued to decline in institutions where percutaneous transluminal angioplasty (PTA) has become the primary treatment for critical limb ischaemia (CLI). Methods: A retrospective study of the management of chronic CLI in our institution over a 6-year period (1994–1999). Patients were grouped according to the date of first presentation into three groups: group 1 presented between 1994 and 1995, group 2 between 1996 and 1997 and group 3 between 1998 and 1999. Results: • Group 1 comprised 185 patients with 222 ischaemic limbs, of those 19 primary crural lesions were treated (6 by PTA alone and 13 by PTA and/or surgery). • Group 2 comprised 180 patients with 204 ischaemic limbs, of those 29 primary crural lesions were treated (16 by PTA alone and 13 by PTA and/or surgery). • Group 3 comprised 161 patients with 182 ischaemic limbs, of those 24 primary crural lesions were treated (13 by PTA alone and 11 by PTA and/or surgery). Conclusions: PTA is becoming the primary choice for the treatment of CLI including distal lesions, and primary femorodistal bypass graft procedures are declining (six–eight per year). We question the rationale of including such an uncommon operation into the vascular training index procedures. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the ability of three contemporary obturation techniques to resist microleakage, using root canals prepared in extracted single rooted teeth by a standardized method. Methodology: The shaping technique involved the use of tapered nickel titanium rotary files to create a uniform 0.08-mm/mm taper. Six groups were compared, two representing control groups, a third group being obturated with a warm vertical condensation technique, a fourth group by an injection thermoplasticized system, a fifth group with a thermomechanical compaction method and a sixth group using cold lateral condensation. A zinc oxide/eugenol sealer was used as the sealant in all the obturation procedures. Forty-six extracted teeth were used in the study, three teeth in each control group and 10 teeth in each of the remaining four groups. Microleakage was compared using dye leakage with Indian ink. Penetration of the dye at the gutta percha/dentine interface was visualized after the root had been rendered transparent. Dye leakage was then measured from four aspects with the use of a stereomicroscope and export of a digital image to a software package, to facilitate accurate assessment of dye penetration. Two parameters were measured for each sample, the mean dye penetration and maximum dye penetration. Results: The mean values for linear dye leakage in the thermomechanical compaction group was 0.53 mm, the warm vertical condensation group was 0.73 mm, the injection thermoplasticized group was 0.15 mm and the cold lateral condensation group was 0.53 mm. There was no statistical difference between the means of the different groups (P > 0.05). The mean of the maximum values for dye leakage in the thermomechanical compaction group was 0.65 mm, the warm vertical condensation group was 1.02 mm, the injection-thermoplasticized group was 0.28 mm and the cold lateral condensation group was 0.74 mm. There was no statistical difference between the means of the ... [ABSTRACT FROM AUTHOR]

Question: This paper compares published palynological studies from coastal swamps containing the same suite of species. We ask the following questions: (1) does succession follow the same pathways in different swamp systems, or (2) at different times? If not, (3) how variable are the patterns and (4) what are the likely driving factors? Location: Great Barrier Island, Northern New Zealand. Methods: Eighteen pollen profile diagrams were studied from four estuarine wetlands, ranging from mangroves to swamp forest. Recognition of a transition between vegetation stages was by subjective consideration of the relative abundances of pollen of key indicator species at different depths in the sedimentary sequence. Results: A linear sequence of vegetation communities beginning with mangroves and followed by estuarine marsh communities composed of Juncus kraussii, Leptocarpus similis and Baumea juncea was recognised in almost all pollen diagrams. Further transitions, from Baumea to a terrestrial system of Leptospermum shrubland or Cordyline/Dacrycarpus swamp forest, followed two main pathways associated with autogenic accumulation of peat and terrigenous sediment input respectively. At Kaitoke and Awana the marine/freshwater transition occurred before the arrival of humans on Great Barrier Island. At Whangapoua, increased sedimentation followed anthropogenic burning of adjacent forest, and this transition was faster and is still in progress. Conclusion: Palynology and current vegetation zonation patterns concur to demonstrate that the marine sedimentation phase of estuarine succession is predictable and linear. Baumea marks the transition to the freshwater phase, in which varied successional patterns are determined by interactions between hydrology, sediment input, and peat accumulation. Natural and human disturbances drive sedimentation rates, and interact with autogenic factors, to dictate vegetation transitions in these later stages. The intensive impact (mainly burning) during Polynesian times had a much greater effect on estuaries and swamps than the pre Polynesian natural processes, greatly accelerating plant succession. [ABSTRACT FROM AUTHOR]

Question: Following a volcanic eruption of ca. 232 AD, known as the Taupo eruption, the emergent conifer Libocedrus bidwillii expanded on Mt. Hauhungatahi, upwards above the current tree-line, and downwards into the mixed montane forest. We ask: (1) if current age-structures at different altitudes support the patterns predicted by the temporal stand replacement model, with cohort senescence and progressively depleting recruitment at ca. 600 year intervals (average cohort age) since the eruption: and (2) if the case history of the population sheds light on the persistence of mixed conifer-hardwood forests in general. Location: Mt. Hauhungatahi, Tongariro National Park, New Zealand. Methods: The species composition and structure of seven stands covering the altitudinal range of Libocedrus bidwillii, were quantified. Libocedrus trees were cored, and regression equations used to predict ages. Cohorts were identified. Results: Libocedrus densities and basal areas, and the abundance of seedlings and saplings, peaked at different altitudes. At the species' lower limits there has been no recruitment for ca. 550 years, and the angiosperm Weinmannia racemosa has gained dominance. In the tree line and sub-alpine forest stands, a low level of continuous regeneration has been boosted by periodic cohort recruitment following exogenous disturbances. Conclusions: In the montane zone, the Libocedrus age structure, and its replacement by Weinmannia, are consistent with a model of depleting cohorts separated by ca. 600 years since the Taupo eruption. At higher altitudes more frequent disturbances and reduced competition have allowed Libocedrus persistence. Comparison with other studies suggests longterm relationships between gymnosperms and angiosperms are mediated by the scale and frequency of disturbance. [ABSTRACT FROM AUTHOR]

Background: Graft patency is usually the primary endpoint in studies of peripheral arterial bypass surgery, but gives only a limited indication of clinical outcome. The aim of this study was to evaluate reintervention as a study endpoint after femorodistal bypass surgery. Methods: The database from a multicentre, prospectively planned study of 517 patients undergoing femorodistal bypass for severe ischaemia was used to investigate the predictive value of technical endpoints. Clinical symptoms, graft patency, vascular interventions and clinical outcomes were recorded for 12 months after operation. Results: Complete follow-up data were obtained on 498 patients (96 per cent). Success in terms of patients' need for reintervention agreed with clinical outcome in 90 (95 per cent confidence interval (c.i.) 87–93) per cent of cases. Primary and secondary patency agreed with the clinical outcome in 80 (95 per cent c.i. 77–84) and 81 (95 per cent c.i. 78–85) per cent of patients respectively. However, the best agreement with clinical outcome was obtained from the composite endpoint of ‘patient alive without reintervention’: 92 (95 per cent c.i. 90–94) per cent. Conclusion: Recording the number of patients who did not need reintervention for 12 months after femorodistal bypass gave a more accurate assessment of the number with clinical improvement than was obtained by recording bypass graft patency. Inclusion of patient survival in a composite endpoint increased the clinical relevance of this endpoint in patients with severe ischaemia who had femorodistal bypass surgery. [ABSTRACT FROM AUTHOR]

SummaryBackground: A review was conducted of published clinical trials of adjuvant medical therapy in infrainguinal bypass procedures to evaluate the strength of the evidence for the use of various agents. Methods: Trials were identified by literature search. The methods used were reviewed and the results with each agent tested were assessed taking into account the soundness of the study design. Results: Thirty-three studies were identified; fewer than half had a randomized and double-blind design. Most were single-centre studies including a mixture of different surgical procedures and patients with varying degrees of lower limb ischaemia. Clinical outcomes were seldom reported. The median sample size was 61. The median follow-up duration was 12 months, but was often not standardized for all patients in a trial. Only aspirin in prosthetic grafts and ticlopidine in vein grafts have been shown in well designed, double-blind, randomized, controlled trials to reduce the likelihood of occlusion in infrainguinal bypass grafts. Conclusion: The majority of the trials reviewed had significant deficiencies in their design, reducing the reliance that can be placed on their results. Further studies are required to investigate adequately the effectiveness of existing medical therapies for the maintenance of infrainguinal bypass grafts. [ABSTRACT FROM AUTHOR]

Sedimentary, geochemical, microfossil and geochronological analyses were carried out on 10 sediment cores across the south-eastern corner of Mataora-Wairau Lagoon (M-WL), South Island, Aotearoa-New Zealand. This multi-proxy approach provides strong evidence for three late Holocene palaeotsunamis (two previously unreported) and a historical tsunami generated by rupture of the Wairarapa Fault in 1855 CE. The main scientific evidence for these events consists of anomalous, high-energy marine sediment layers that overlie material of contrasting composition. These layers coincide with peaks in planktonic and benthic marine to brackish-marine diatoms and geochemical signatures indicative of sudden changes in environmental conditions. Palaeotsunami I (maximum date 2095 cal. BP) and Palaeotsunami II (maximum date 915 cal. BP - previously identified by Clark et al., 2015) appear to represent large events contemporaneous with major earthquakes inducing tectonic uplift and coseismic subsidence around the Cook Strait region. Palaeotsunami II is close to the date of the earliest settlement of the M-WL area by Māori, and a traditional narrative that references loss of life following waves over-washing the Wairau boulder bank. Given the boulder bank was likely to have been seaward of its current position during events I and II, we surmise that the inundation distances would have been greater than the most landward extent (340 m) inferred from the deposits found in this study. Palaeotsunami III (maximum date 525 cal. BP) was associated with tectonic subsidence across the study site, most likely associated with rupture of the southern Hikurangi subduction zone. We expect the ongoing refinement of the methods used in this study, and the results from future studies of analogue sites and offshore fault systems, will improve our understanding of the significant tsunami hazard facing this region. [ABSTRACT FROM AUTHOR]

Background: Patients who have severe narrowing at or near the origin of the internal carotid artery as a result of atherosclerosis have a high risk of ischaemic stroke ipsilateral to the arterial lesion. Previous trials have shown that carotid endarterectomy improves long-term outcomes, particularly when performed soon after a prior transient ischaemic attack or mild ischaemic stroke. However, complications may occur during or soon after surgery, the most serious of which is stroke, which can be fatal. It has been suggested that performing the operation under local anaesthesia, rather than general anaesthesia, may be safer. Therefore, a prospective, randomised trial of local versus general anaesthesia for carotid endarterectomy was proposed to determine whether type of anaesthesia influences peri-operative morbidity and mortality, quality of life and longer term outcome in terms of stroke-free survival.Methods/design: A two-arm, parallel group, multicentre randomised controlled trial with a recruitment target of 5000 patients. For entry into the study, in the opinion of the responsible clinician, the patient requiring an endarterectomy must be suitable for either local or general anaesthesia, and have no clear indication for either type. All patients with symptomatic or asymptomatic internal carotid stenosis for whom open surgery is advised are eligible. There is no upper age limit. Exclusion criteria are: no informed consent; definite preference for local or general anaesthetic by the clinician or patient; patient unlikely to be able to co-operate with awake testing during local anaesthesia; patient requiring simultaneous bilateral carotid endarterectomy; carotid endarterectomy combined with another operation such as coronary bypass surgery; and, the patient has been randomised into the trial previously. Patients are randomised to local or general anaesthesia by the central trial office. The primary outcome is the proportion of patients alive, stroke free (including retinal infarction) and without myocardial infarction 30 days post-surgery. Secondary outcomes include the proportion of patients alive and stroke free at one year; health related quality of life at 30 days; surgical adverse events, re-operation and re-admission rates; the relative cost of the two methods of anaesthesia; length of stay and intensive and high dependency bed occupancy.Trial Registration: Current Controlled Trials ISRCTN00525237. [ABSTRACT FROM AUTHOR]

Background: Carotid endarterectomy (CEA) reduces the risk of stroke in patients with internal carotid stenosis of 50-99 per cent. This study assessed national surgical practice through audit of CEA procedures and outcomes. Methods: This was a prospective cohort study of UK surgeons performing CEA, using clinical audit data collected continuously and reported in two rounds, covering operations from December 2005 to December 2007, and January 2008 to September 2009. Results: Some 352 (92·6 per cent) of 380 eligible surgeons contributed data. Of 19 935 CEAs recorded by Hospital Episode Statistics, 12 496 (62·7 per cent) were submitted to the audit. A total of 10 452 operations (83·6 per cent) were performed for symptomatic carotid stenosis; among these patients, the presenting symptoms were transient ischaemic attack in 4507 (43·1 per cent), stroke in 3572 (34·2 per cent) and amaurosis fugax in 1965 (18·8 per cent). The 30-day mortality rate was 1·0 per cent (48 of 4944) in round 1 and 0·8 per cent (50 of 6151) in round 2; the most common cause of death was stroke, followed by myocardial infarction. The rate of death or stroke within 30 days of surgery was 2·5 per cent (124 of 4918) in round 1 and 1·8 per cent (112 of 6135) in round 2. Conclusion: CEA is performed less commonly in the UK than in other European countries and probably remains underutilized in the prevention of stroke. Increasing the number of CEAs done in the UK, together with reducing surgical waiting times, could prevent more strokes. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Chatham Island in the southwest Pacific Ocean is exposed on all sides to potential tsunami impact. In historical time, tsunamis are known to have inundated the coast on several occasions, with the largest event in 1868. Coastal dunes along the northeast coast of Chatham Island preserve sedimentary evidence of this and possibly earlier tsunami events, as localised gravel lags. However, these deposits lack a clear stratigraphic context and establishing their age is difficult. This study examines the sediment record in a freshwater wetland at Okawa Point, located directly landward of the dunes where apparent tsunami gravels occur. Sediment descriptions, pollen, foraminifera, chemical data and radiocarbon dates from cores are used to reconstruct the environmental history of the wetland. The record extends from ca. >43ka to the present and incorporates glacial, post-glacial and human-influenced phases. Throughout this time the wetland appears to have remained isolated from catastrophic marine inundation. The only evidence for saltwater intrusion is observed in the historic period, via geochemical, grain size and pollen data, which record a marine inundation event that forced the transport of a thin (cm-thick) deposit of dune and beach sand into the seaward edge of the wetland. This is interpreted as the signature of the 1868 tsunami. The lack of more widespread physical evidence for this and other tsunami events in the wetland is attributed to the morphological roughness afforded by coastal dunes and limited accommodation space for Holocene deposits. [Copyright &y& Elsevier]

This discussion paper argues for a creative synthesis between simulation and clinical practice, where an iterative process of continual interaction ensures that skills are learned and reinforced within the context of everyday professional life.Evidence is mounting that long-established approaches to surgical training are no longer acceptable in the current ethical and professional climate. This paper considers alternatives to the traditional approach of‘learning by doing’ in a clinical context, focusing on recent developments in the technology of simulation and virtual reality. Clinical expertise is a complex phenomenon and no single theory can account for its acquisition. After a brief contextualising overview, Vygotsky's‘zone of proximal development’ is proposed as a conceptual framework for task-based surgical learning that takes place within skills laboratories. The discussion is located within a wider context of educational theory, drawing on current thinking about situated learning and apprenticeship. The notion of‘legitimate peripheral participation’ in a complex professional environment places technical skill alongside a range of other competencies that are necessary to safe practice.Simulation offers a safe environment within which learners can repeatedly practise a range of clinical skills without endangering patients. Comprehensive simulated environments allow a move away from isolated tasks to more complex clinical situations, recreating many of the challenges of real life. Such simulations, however, can operate in isolation from their clinical context, ignoring the learning needs of individuals within a real health care environment. To realise its full potential as a learning aid, simulation must be usedalongsideclinical practice and linked closely with it. [ABSTRACT FROM AUTHOR]

An abstract of the article "General Anaesthesia Versus Local Anaesthesia for Carotid Surgery (GALA): An Open Multi-Centre Randomised Trial," by D. Dellagrammaticas et al is presented.