Michael H. Fisher

Historical criteria that distinguish syncope from seizures.

OBJECTIVES We prospectively sought evidence-based criteria that distinguished between seizures and syncope. BACKGROUND Loss of consciousness is usually due to either seizures or syncope. There are no evidence-based historical diagnostic criteria that distinguish them. METHODS A total of 671 patients with loss of consciousness completed a 118-item historical questionnaire. Data sets were complete for all subjects. The data set was randomly divided into two equal groups. The contributions of symptoms to diagnoses in one group were estimated with logistic regression and point scores were developed. The accuracy of the decision rule was then assessed using split-half analysis. Analyses were performed with and without inclusion of measures of symptom burden, which were the number of losses of consciousness and the duration of the history. The scores were tested using receiver-operator characteristic analysis. RESULTS The causes of loss of consciousness were known satisfactorily in 539 patients and included seizures (n = 102; complex partial epilepsy [50 patients] and primary generalized epilepsy [52 patients]) and syncope (n = 437; tilt-positive vasovagal syncope [267 patients], ventricular tachycardia [90 patients] and other diagnoses such as complete heart block and supraventricular tachycardias [80 patients]). The point score based on symptoms alone correctly classified 94% of patients, diagnosing seizures with 94% sensitivity and 94% specificity. Including symptom burden did not significantly improve accuracy, indicating that the symptoms surrounding the loss of consciousness accurately discriminate between seizures and syncope. CONCLUSIONS A simple point score of historical features distinguishes syncope from seizures with very high sensitivity and specificity.

The Office of Akhbār Nawīs: The Transition from Mughal to British Forms

The persistence and yet transformation of the office of akhbār nawīs (‘newswriter’) reflected fundamental aspects of the transition from the Mughal to the British Empires. The Mughals appointed akhbār nawīs to collect and transmit specific kinds of information. This office continued, albeit with new functions, through the decentralizing of political power that characterized eighteenth-century South Asia. The expansion fo hte English East India Company meant constant change in the essential nature of political relations, changes mirrored in this office. Indeed, the Company, and its political Residents, subordinated and redefined this office. Under the British Raj, the concept ‘akhbār nawīs’ stood transformed, like the nature of the information it conveyed.

Indirect Rule in the British Empire: The Foundations of the Residency System in India (1764–1858)

The British Empire established itself and expanded largely through its incorporation of existing indigenous political structures. A single British Resident or Political Agent, controlling a regional state through ‘advice’ given to the local prince or chief, became the norm for much of the Empire. Indias princely states, where from the mid-eighteenth century the British first employed and developed this system of indirect rule, stood as the conscious model for later imperial administrators and politicians who wished to extend the Empire without the economic and political costs of direct annexation. In dealing with Malaya, East and West Africa from the mid-nineteenth century onward, officials in the field and notables in London sought to justify imperial expansion and to establish indirect rule efficiently by drawing upon the Indian example.Thus, during a century of empirical learning from relations with Indiasprincely states, the British established a body of theory and policies about indirect rule which then spread throughout the rest of the Empire.

Forming an Identity: A Social History of the Jats

This volume examines how a Jat identity was formed and shaped in rural southeast Punjab. The author analyses popular religious traditions and different strands that went into the making of the Jat identity.

The politics of the British annexation of India, 1757-1857

In the hundred years between 1757 and 1857 the British annexed 60 per cent of the Indian subcontinent. This book collects the debates that took place at that time by Indian and British participants as well as some by subsequent historians to present a rich source of information.

Finding Lascar ‘Wilful Incendiarism’: British Ship-Burning Panic and Indian Maritime Labour in the Indian Ocean

Abstract From the 1790s to the 1850s, three dozen major merchant ships burned in Indias important ports. Panic-stricken British shipowners, merchants and East India Company officials apprehended disruption of their intercontinental trade, so vital to the burgeoning British Empire. In all these cases, they accused Indian seamen (lascars) of selfish ship-burning. As a context, the lascars had, for centuries prior to European arrival in the Indian Ocean, worked collectively under their own petty officers. They and Indian recruiters in each port had long resisted colonial efforts to appropriate their maritime labour system. Britons used this half-century of alleged arson to finally impose British controls over lascar recruitment ashore and conditions of service aboard ships.

Procedural certification program: Enhancing resident procedural teaching skills

13 residents on how to develop a Quality Improvement (QI) project during their one-month rotation at the clinic. Using the Plan, Do, Study, Act (PDSA) model, residents implemented multiple interventions to improve the rate of standardized developmental screenings at well-child visits for children aged 9 months to 36 months (N1⁄4 1061) between January 2009 and June 2010. The rate of standardized developmental screening increased from 7% to 56% after residents initiated QI interventions. Barriers were encountered during the project, such as limited education and socioeconomic resources of the patient population, scarce time in the clinic setting, and suboptimal resident/staff knowledge of developmental screening tools and recommendations. By familiarizing themselves with the barriers that existed, and taking advantage of the AAP’s mission for health promotion and connection to communitybased resources, the residents were able to positively impact the developmental screening rates in the clinic. The residents’ successful outcomes suggest that combining resident education and AAP mentorship in QI interventions can lead to substantial gains in the quality of patient care (Akins & Handel 2009). In this case, the rate of developmental screening at a general pediatric clinic improved as a result of this collaborative effort.

Representations of India, the English East India Company, and Self by an Eighteenth-Century Indian Emigrant to Britain

By writing about the late eighteenth-century revolution which led to the East India Company rule, members of a largely Muslim pre-colonial administrative elite in eastern India sought take control over their own history. They explained the society and ancien regime of India, as well as themselves, to the new British rulers for whom they worked. In so doing, they strove to inform and guide the new British colonial authorities into employing them in the new administration as well as into valuing the cultural mores and bureaucratic experience which they embodied. They also wrote introspectively for the own class, trying to understand the causes of the revolution that had displaced their own traditional rulers and themselves with rule by Europeans and administrations staffed increasingly by Indians with backgrounds different from their own.

British Expansion in North India: The Role of the Resident in Awadh

Our acquisition of India was made blindly. Nothing great that has ever been done by Englishmen was done so unintentionally, so accidentally, as the conquest of India. [The Empire was acquired] in a fit of absence of mind. J. R. SEELEY

Representing 'his' women: MirzĀ Abū Talib KhĀn's 1801 'Vindication of the liberties of Asiatic women'

In their historic confrontations, European and Asian peoples have each frequently used the alleged status of women as the measure of a society’s moral standing. Many male European imperialists sought to gender all Asians collectively as female and therefore as inferior and accessible to them, with Asian women as the special objects of their ministrations, and idealised European womanhood as their immaculate inspiration.’ In response, various (mostly male) Indian nationalists often either defended or sought to reform their society, with Indian womanhood as the site of their resistance to, or compliance with, European assertions.’ Nevertheless, even at the height of British expansion over India, numerous South Asians travelled to the imperial metropolis. Some challenged these dominant European assertions by locating the gendered cultural confrontation on British soil, contrasting an idealised Indian womanhood with the European patriarchal and relatively ’immoral’ practices they personally observed. This article analyses the rhetoric and historical context of Mirza Abu Tali Khan’s ’Vindication of the Liberties of Asiatic Women’, his argument for the