Which patients with renal colic should be referred?

Around 1-2 people per thousand present with an acute episode of pain caused by renal stones each year. Renal colic is classically sudden in onset, unilateral, and radiates from loin to groin. Renal pelvic or upper ureteric stones usually cause more flank pain and tenderness while lower ureteric stones cause pain radiating towards the ipsilateral testicle or labia. Other common symptoms include nausea and vomiting, haematuria and irritative LUTS. A febrile patient with renal colic requires immediate hospital admission. Symptoms suggestive of renal colic along with a positive dipstick for haematuria have a reported sensitivity of 84% and specificity of 99% but it is important to consider other differential diagnoses. An NSAID is preferred over an opiate drug as an initial analgesic choice as the NSAID can help reduce ureteric spasm. Diclofenac has the best evidence base for this class of analgesic. About 90% of stones will pass spontaneously and thus it is often appropriate to manage renal colic at home. Patients with signs of peritonitis, systemic infection, septic shock as well as those whose diagnosis is unclear should be referred urgently to hospital. Patients who are systemically unwell with renal stones are more likely to have an infected and obstructed urinary tract system that needs urgent imaging and possible drainage. All patients who are managed at home should have renal tract imaging within a week by fast track referral to radiology or as an urgent urology outpatient referral as per local guidelines to rule out an obstructed urinary system. Patients with recurrent stones should be advised to maintain a copious fluid intake (>2 L/day) to reduce the concentration of the urine. A reduction in salt intake (ideally

Changing climate, changing process: implications for salt transportation and weathering within building sandstones in the UK

Salt weathering is a crucial process that brings about a change in stone, from the scale of landscapes to stone outcrops and natural building stone facades. It is acknowledged that salt weathering is controlled by fluctuations in temperature and moisture, where repeated oscillations in these parameters can cause re-crystallisation, hydration/de-hydration of salts, bringing about stone surface loss in the form of, for example, granular disaggregation, scaling, and multiple flaking. However, this ‘traditional’ view of how salt weathering proceeds may need to be re-evaluated in the light of current and future climatic trends. Indeed, there is considerable scope for the investigation of consequences of climate change on geomorphological processes in general. Building on contemporary research on the ‘deep wetting’ of natural building stones, it is proposed that (as stone may be wetter for longer), ion diffusion may become a more prominent mechanism for the mixing of molecular constituents, and a shift in focus from physical damage to chemical change is suggested. Data from ion diffusion cell experiments are presented for three different sandstone types, demonstrating that salts may diffuse through porous stone relatively rapidly (in comparison to, for example, dense concrete). Pore water from stones undergoing diffusion experiments was extracted and analysed. Factors controlling ion diffusion
relating to ‘time of wetness’ within stones are discussed, (continued saturation, connectivity of pores, mineralogy, behaviour of salts, sedimentary structure), and potential changes in system dynamics as a result of climate change are addressed. System inputs may change in terms of increased moisture input, translating into a greater depth of wetting front. Salts are likely to be ‘stored’ differently in stones, with salt being in solution for longer periods (during prolonged winter wetness). This has myriad implications in terms of the movement of ions by diffusion and the potential for chemical change in the stone (especially in more mobile constituents), leading to a weakening of the stone matrix/grain boundary cementing. The ‘output’ may be mobilisation and precipitation of elements leading to, for example, uneven cementing in the stone. This reduced strength of the stone, or compromised ability of the stone to absorb stress, is likely to make crystallisation a more efficacious mechanism of decay when it does occur. Thus, a delay in the onset of crystallisation while stonework is wet does not preclude exaggerated or accelerated material loss when it finally happens.

The use and meanings of 'time of wetness' in understanding stone decay

Moisture is a well documented, and crucial, control on the nature of stone decay. The term time of wetness has frequently been adopted to describe how long a stone block is wet, with a view to understanding the impact of this on decay processes. Although this term has proved conceptually useful, it has been used in different ways, by different groups to mean mean quite different things. For example, the time of wetness for a stone block surface (the traditional understanding) may be quite different from that of a block interior, controlled by the different dynamics of wetting and drying in those zones. Thus, surface wetting will occur regularly (sometimes swiftly followed by drying, depending on the time of year), with block interior wetting requiring the accumulation of surface moisture to penetrate to depth (more likely in autumn and winter months), and drying out much more slowly. This relatively new but important perspective, framed in the context of climate change, is crucial to understanding the length of time stone may remain damp at depth following a period of prolonged precipitation. The nature and speed of drying is also relevant in quantifying time of wetness of both surfaces and the interior of building stones.
These ideas related to time of wetness have implications for decay processes, specifically how a prolonged time of deep wetness may re-focus the emphasis of salt weathering in natural building stones toward chemical action. Literature on chemical change is discussed, suggesting that chemical change occurring during periods of prolonged wetness is likely to be significant in itself, with implications for weakening the stone (in terms of, for example, cement dissolution or grain boundary weakening) and exacerbating physical damage from salt crystallisation when blocks finally dry out.

Reading Elizabeth Bishop's "Artifact of [Words]"

As Emerson noted in his essay 'The Poet' "we are not pans and barrows, not even porters of the fire and torch-bearers, but children of the fire, made of it, and only the same divinity transmuted, and at two or three removes, when we least know about it." For Emerson, the fire is poetry, an elemental force capable of transmutation, transformation and enduring relevance. Moving from Emerson, Elizabeth Bishop rises as the twentieth-century poet most aligned with the possibility of poetry and the powers of its practice, as 'At The Fishhouses' indicates in her clear referencing of Emerson:

"If you should dip your hand in,
your wrist would ache immediately,
your bones would begin to ache and your hand would burn
as if the water were a transmutation of fire
that feeds on stones and burns with a dark gray flame."

This essay will look in detail at Bishop's understanding of the possibility of poetry and how art functions as a multi-dimensional structure that is unsettled as much as it unsettles. In particular, Bishop's poem 'The Monument' will be unpicked as testament both to the practice of Bishop's art and also the role of the poet critic responding to what they uncover

Shifting Ground:Beyond National Architecture

The Irish Pavilion at the Venice Architecture Biennale 2012 charts a position for Irish architecture in a global culture where the modes of production of architecture are radically altered. Ireland is one of the most globalised countries in the world, yet it has developed a national culture of architecture derived from local place as a material construct. We now have to evolve our understanding in the light of the globalised nature of economic processes and architectural production which is largely dependent on internationally networked flows of products, data, and knowledge. We have just begun to represent this situation to ourselves and others. How should a global architecture be grounded culturally and philosophically? How does it position itself outside of shared national reference points?
heneghan peng architects were selected as participants because they are working across three continents on a range of competition-winning projects. Several of these are in sensitive and/or symbolic sites that include three UNESCO World Heritage sites, including the Grand Egyptian Museum in Cairo, the Giants Causeway Visitor Centre in Northern Ireland, and the new Rhine Bridge near Lorelei.
Our dialogue led us to discussing the universal languages of projective geometry and number are been shared by architects and related professionals. In the work of heneghan peng, the specific embodiment of these geometries is carefully calibrated by the choice of materials and the detailed design of their physical performance on site. The stone facade of the Giant’s Causeway Visitor Centre takes precise measure of the properties of the volcanic basalt seams from which it is hewn. The extraction of the stone is the subject of the pavilion wall drawings which record the cutting of stones to create the façade of the causeway centre.
We also identified water as an element which is shared across the different sites. Venice is a perfect place to take measure of this element which suggests links to another site – the Nile Valley which was enriched by the annual flooding of the River Nile. An ancient Egyptian rod for measuring the water level of the Nile inspired the design of the Nilometre - a responsive oscillating bench that invites visitors to balance their respective weights. This action embodies the ways of thinking that are evolving to operate in the globalised world, where the autonomous architectural object is dissolving into an expanded field of conceptual rules and systems. The bench constitutes a shifting ground located in the unstable field of Venice. It is about measurement and calibration of the weight of the body in relation to other bodies; in relation to the site of the installation; and in relation to water. The exhibit is located in the Artiglierie section of the Arsenale. Its level is calibrated against the mark of the acqua alta in the adjacent brickwork of the building which embodies a liminal moment in the fluctuating level of the lagoon.
The weights of bodies, the level of water, changes over time, are constant aspects of design across cultures and collectively they constitute a common ground for architecture - a ground shared with other design professionals. The movement of the bench required complex engineering design and active collaboration between the architects, engineers and fabricators. It is a kind of prototype – a physical object produced from digital data that explores the mathematics at play – the see-saw motion invites the observer to become a participant, to give it a test drive. It shows how a simple principle can generate complex effects that are difficult to predict and invites visitors to experiment and play with them.

Care and Management of Ancient Stone Monuments During Environmental Change

Ancient stone monuments (ASMs), such as standing stones and rock art panels, are powerful and iconic expressions of Britain’s rich prehistoric past that have major economic and tourism value. However, ASMs are under pressure due to increasing anthropogenic exposure and changing climatic conditions, which accelerate their rates of disrepair. Although scientific data exists on the integrity of stone monuments, most applies to “built” systems; therefore, additional work specific to ASMs in the countryside is needed to develop better-informed safeguarding strategies. Here, we use Neolithic and Bronze Age rock art panels across Northern England as a case study for delineating ASM management actions required to enhance monument preservation. The state of the rock art is described first, including factors that led to current conditions. Rock art management approaches then are described within the context of future environments, which models suggest to be more dynamic and locally variable. Finally, a Condition Assessment and Risk Evaluation (CARE) scheme is proposed to help prioritise interventions; an example of which is provided based on stone deterioration at Petra in Jordon. We conclude that more focused scientific and behavioural data, specific to deterioration mechanisms, are required for an ASM CARE scheme to be successful.

The sustainability and assessment of drystone retaining walls

The art of drystone walling is a highly sustainable traditional practice which uses local materials and craftsmen. As no
mortar is used they have low embodied carbon, and much repair work or rebuilding can be carried out using very little if any new
materials. However local practices developed to suit local materials, leading to a range of construction styles, making them difficult to
assess. This paper examines a range of construction styles of drystone retaining walls in use across the United Kingdom.
Understanding of the substantial variations of construction style is essential to enable proper assessment of these structures. Different
frictional and weathering characteristics, and the naturally occurring shapes of stone found in an area, all affect the ways in which the
stones have traditionally been assembled into walls. Ease of construction also plays a part, as the craftsman will naturally wish to
achieve a robust construction in a way that is economical of time and effort. Aesthetics may be very important, for both client and
craftsman. It is also shown that construction style is influenced by the location and function of the structures, with harbour walls
particularly likely to have unique characteristics, and the reasons for this are explored.

De-linkage Processes and Grassroots Movements in Transitional Justice

Transitional justice literature has highlighted a negative relationship between enforced disappearances and reconciliation in post-conflict settings. Little attention has been paid to how human rights issues can become stepping-stones to reconciliation. The article explains the transformation of the Cypriot Committee on Missing Persons (CMP) from an inoperative body into a successful humanitarian forum, paving the way for the pro-rapprochement bi-communal grassroots mobilization of the relatives of the missing. By juxtaposing the experience of Cyprus with other societies confronting similar problems, the article shows how the issue of the missing can become a driving force for reconciliation. The findings indicate that a policy delinking humanitarian exhumations from the prospect of a wider political settlement facilitates positive transformation in protracted human rights problems and opens up a window of opportunity to grassroots actors.

The Map of Connections 3.1: Unofficial and previously unmapped Irish border crossings

I charted unofficial border-crossings along Ireland's border, those not found on any other map.

During many surveys of Ireland's border I discovered that it is often perforated. Gates are set in hedgerows for the convenience of farmers, stepping stones and community-built bridges span rivers, walkers’ routes and muddy by-ways go wherever they please. These kinds of connections have always been there, although I think it is fair to say that their numbers have increased during the Peace Process. Roads blocked or cratered during the Troubles are being re-connected at a rate too fast for the Ordnance Survey to keep up with. On the local level cross-border movement is quietly happening, unchecked and often unmapped, until now.

This map attempts to throw the borderline in perpendicular, showing it as a place of connection rather than division.

The Application of Digital Photogrammetric Techniques and Aerial Photography to the Preservation of Archaeological Detail. Case Study: The Copney Stone Circle Complex, Co. Tyrone, N. Ireland

The Copney Stone Circle Complex, Co. Tyrone, N. Ireland, is an important Bronze Age site forming part of the Mid-Ulster Stone Circle Complex. The Environment Service: Historic Monuments and Buildings (ESHMB) initiated a program of bog-clearance in August 1994 to excavate the stone circles. This work was completed by October 1994 and the excavated site was surveyed in August 1995. Almost immediately, the rate at which the stones forming the circles were breaking down was noted and a program of study initiated to make recommendations upon the conservation of this important site. Digital photogrammetric techniques were applied to aerial images of the stone circles and digital terrain models created from the images at a range of scales. These provide base data sets for comparison with identical surveys to be completed in successive years and will allow the rate of deterioration, and the areas most affected, of the circles to be determined. In addition, a 2D analysis of the stones provides an accurate analysis of the absolute 2D dimensions of the stones for rapid desktop computer analysis by researchers remote from the digital photogrammetric workstation used in the survey.

The products of this work are readily incorporated into web sites, educational packages and databases. The technique provides a rapid and user friendly method of presentation of a large body of information and measurements, and a reliable method of storage of the information from Copney should it become necessary to re-cover the site.

Overweight and obesity on the island of Ireland: an estimation of costs

Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches.

Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality.

Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease.

Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.

POINTS OF VIEW: Multi-Roling Performance in Ireland in the 1990s, Part 1 (Layering)

This series of posts will consider the acting techniques required for this style of performance with reference to four productions from the 1990s in which two actors took on multiple roles: Frank Pig Says Hello (1992), Co-Motion’s stage adaptation of Pat McCabe’s novel; The Butcher Boy, Corca Dorca’s production of Disco Pigs (1996) by Enda Walsh; DubbleJoint’s production of Stones in his Pockets by Marie Jones (1996) and its subsequent award-winning revival which I produced at Belfast’s Lyric Theatre in 1999; and Kabosh’s production of Mojo Mickybo by Owen McCafferty (1998). The discussion will focus primarily on my own empirical exploration of the demands multi-roling places on an actor through the direction of recent revivals of Mojo Mickybo for Belfast’s Chatterbox Theatre Company (2013) and Bedlam Productions (2015).

Exploring an Ancestral Irish Adage

This paper will examine the various processes through which the folktale ‘On the Advantage of Silence’, first recorded by the Persian poet Sa’di in his The Gulistān (Rose Garden) (1258),has been altered in terms of content, style and function since the 13th century. Particular emphasis will be placed on the expression ‘tied stones and loose dogs’ which became its punch line in jest tales of the 17th and 18th centuries, and which was subsequently appropriated in the Irish language as a blason populaire denigrating the town of Ballyneety,Co. Limerick, and then as a legal expression in the Irish legal system in the 20th century.