bluuebunny/crossref_metadata_2025 huggingface dataset:
Hierarchical analysis of RNA-seq reads improves the accuracy of allele-specific expression
Authors: Raghupathy Narayanan , Choi Kwangbom , Vincent Matthew J , Beane Glen L , Sheppard Keith S , Munger Steven C , Korstanje Ron , Pardo-Manual de Villena Fernando , Churchill Gary A
Published: February 2018

Motivation

Allele-specific expression (ASE) refers to the differential abundance of the allelic copies of a transcript. RNA sequencing (RNA-seq) can provide quantitative estimates of ASE for genes with transcribed polymorphisms. When short-read sequences are aligned to a diploid transcriptome, read-mapping ambiguities confound our ability to directly count reads. Multi-mapping reads aligning equally well to multiple genomic locations, isoforms or alleles can comprise the majority (>85%) of reads. Discarding them can result in biases and substantial loss of information. Methods have been developed that use weighted allocation of read counts but these methods treat the different types of multi-reads equivalently. We propose a hierarchical approach to allocation of read counts that first resolves ambiguities among genes, then among isoforms, and lastly between alleles. We have implemented our model in EMASE software (Expectation-Maximization for Allele Specific Expression) to estimate total gene expression, isoform usage and ASE based on this hierarchical allocation.

Results

Methods that align RNA-seq reads to a diploid transcriptome incorporating known genetic variants improve estimates of ASE and total gene expression compared to methods that use reference genome alignments. Weighted allocation methods outperform methods that discard multi-reads. Hierarchical allocation of reads improves estimation of ASE even when data are simulated from a non-hierarchical model. Analysis of RNA-seq data from F1 hybrid mice using EMASE reveals widespread ASE associated with cis-acting polymorphisms and a small number of parent-of-origin effects.

Availability and implementation

EMASE software is available at https://github.com/churchill-lab/emase.

Supplementary information

Supplementary data are available at Bioinformatics online.
Mayo Clinic Essential Neurology
Authors: Adams Andrea C.
Published: February 2018

Mayo Clinic Essential Neurology, Second Edition, is designed to provide clinicians the necessary neurologic information for the diagnosis and management of these common neurologic problems. This book will be useful to all clinicians who evaluate patients who have neurologic problems. It will also be useful to medical students and residents in neurology, internal medicine, and psychiatry. The book also will be helpful to paramedical personnel who need a concise source of information on outpatient neurologic practice. The book addresses 3 main areas: the neurologic examination and diagnostic testing, common neurologic symptoms, and common neurologic diseases. Neurology is a rapidly changing specialty, with an increasing number of therapeutic options available for managing neurologic disease. Neurologic symptoms such as headache, backache, and dizziness are frequent complaints that cause patients to seek medical care.
Diagnostic Tests
Authors: Adams Andrea C.
Published: February 2018

The diagnostic tests used most often to evaluate patients who have disease of the central nervous system (CNS) include cerebrospinal fluid (CSF) analysis, electroencephalography (EEG), evoked potentials, electromyography (EMG), computed tomography (CT), and magnetic resonance imaging (MRI). These tests should be used to supplement or to extend the clinical examination.
Headache
Authors: Adams Andrea C.
Published: February 2018

Headache is a universal problem, with a lifetime prevalence of 99%, and it is the most common reason for neurologic referral. Headache may be of little clinical significance or it may represent the onset of a life-threatening illness. To the patient, the symptom is always of major concern, and the relationship you establish with the patient at the initial visit will determine the success of treatment.
Movement Disorders
Authors: Adams Andrea C.
Published: February 2018

Movement disorders are neurologic syndromes in which movement is either excessive (hyperkinesia) or too little (hypokinesia). A general term used for both hyperkinesia and hypokinesia is dyskinesia, which is defined as difficulty performing voluntary movements. The prototypic hypokinetic movement disorder is Parkinson disease (PD). Other terms used to describe this movement disorder are bradykinesia (slowness of movement) and akinesia (loss of movement).
A Protocol of No Sedation for Critically Ill Patients Receiving Mechanical Ventilation
Authors: Schmidt Ulrich , McMillan Zeb
Published: February 2018

This chapter provides a summary of the landmark study known as a protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Can duration of mechanical ventilation be reduced with a protocol of no sedation versus daily interruption of sedation? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Understanding that not all patients receiving mechanical ventilation require sedation is an important first step to determining the best regimen.
Saline versus Albumin for Resuscitation of Critically Ill Adults
Authors: Jabaley Craig S.
Published: February 2018

The saline versus albumin fluid evaluation (SAFE) study was a pragmatic multicenter, double-blind, randomized controlled trial that investigated the impact of fluid resuscitation with albumin in the intensive care unit on the primary outcome of 28-day mortality. Approximately 7000 critically ill adults in need of fluid resuscitation were randomized to receive either 0.9% sodium chloride or 4% human albumin. No statistically significant differences were observed in the primary outcome or any secondary outcomes. Subgroup analysis revealed an increase in mortality among patients with traumatic brain injury that received albumin and a non-significant trend toward reduced mortality among patients with sepsis who were resuscitated with albumin.
The Use of the Pulmonary Artery Catheter in Critical Care
Authors: Shaefi Shahzad , Pannu Ameeka
Published: February 2018

The PAC-Man trial published in 2005 was a prospective randomized controlled trial in the United Kingdom that examined the effectiveness of the use of the pulmonary artery catheter (PAC). Critically ill adults were randomized to management with or without a PAC with further treatment at the discretion of the treating physician. The study noted no difference in hospital mortality between these groups; in addition, ICU and hospital lengths of stay were similar. While use of a PAC was randomized, this study did not examine whether PAC data was correctly collected or interpreted when used to make decisions. There appears to be no clear mortality benefit to using PA catheters to manage critically ill patients despite clinicians in this study using PAC-derived data to guide treatment. Given this conclusion and risks associated with PAC placement, we recommend that a decision to place a PAC be made on a case-to-case basis.
The Acute Respiratory Distress Syndrome Network
Authors: Jalilian Laleh , Wiener-Kronish Jeanine
Published: February 2018

The diagnosis of adult respiratory distress syndrome, even now with the new Berlin definition, is sensitive but not specific for finding diffuse alveolar damage on pathology. The definition is limited by the very poor information obtained using chest radiographs; PET scans can discern whether inflammation is present, which would distinguish fluid and atelectasis from infection or an inflammatory state. Nonetheless, the treatment of patients who meet the Berlin definition should include lung protective ventilation, which involves the use of low tidal volumes (6mL/kg of predicted body weight as determined by height). Furthermore, a plateau pressure of less than 30 should be achieved with the tidal volume, or the tidal volume needs to be lowered or a rescue therapy needs to be utilized. The timing of rescue therapy, the best rescue therapy, and the methods for determining PEEP are still being investigated.
Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome
Authors: McLean Duncan , Eikermann Matthias
Published: February 2018

This chapter provides a summary of the landmark study known as Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome. Do neuromuscular blocking agents (NMBs) improve outcomes in patients with acute respiratory distress syndrome who are receiving mechanical ventilation? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism, and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The study found that patients with severe ARDS may benefit from short-term NMB infusions with certain caveats, as noted in the chapter.
Noninvasive Ventilation for Acute COPD Exacerbations
Authors: Loflin Robert , Kaufman David
Published: February 2018

In “Non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease,” Brochard and colleagues compared the use of non-invasive positive pressure ventilation (NPPV) to supplemental oxygen delivered by nasal cannula in patients with respiratory failure due to acute COPD exacerbation. The authors found a significant reduction in endotracheal intubation and mechanical ventilation, complications, hospital length of stay, and mortality in the NPPV group. This landmark trial helped establish NPPV as the standard of care for respiratory support in patients with COPD exacerbation. This chapter describes the basics of the study, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. It briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Continuous Venovenous Hemodiafiltration versus Intermittent Hemodialysis for Acute Renal Failure in Patients with Multiple-Organ Dysfunction Syndrome
Authors: Jelly Christina Anne , Bittner Edward
Published: February 2018

This chapter provides a summary of the landmark study known as “Continuous Venovenous Hemodiafiltration Versus Intermittent Hemodialysis for Acute Renal Failure in Patients with Multiple-Organ Dysfunction Syndrome: A Multicenter Randomized Trial.” Does continuous renal replacement therapy (CRRT) have a survival benefit compared with intermittent hemodialysis (IHD) for the treatment of acute renal failure in critically ill patients? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Randomized Trial of Combination versus Monotherapy for the Empiric Treatment of Suspected Ventilator-Associated Pneumonia
Authors: Pollock Kimberly , Meier Angela
Published: February 2018

Ventilator associated pneumonia (VAP) is a complication of mechanically assisted ventilation, and the ideal initial treatment strategy is unclear. Heyland et al. explore monotherapy versus combination therapy for the initial treatment of suspected VAP, in a randomized trial of ICU patients with suspected VAP who received either Meropenem in combination with Ciprofloxacin or Meropenem alone. There was no mortality difference between treatment groups, and the duration of intensive care unit and hospitals stays was similar. There was no difference between the clinical and microbiological treatment response or the emergence of antibiotic-resistant bacteria. The adequacy of initial antibiotics was higher in the combination therapy group only in a subgroup of patients infected with difficult-to-treat gram-negative bacteria, but clinical outcomes still did not differ. The authors concluded that, for critically ill patients with suspected VAP, monotherapy is an adequate treatment regimen except for patients at high risk for difficult to treat gram-negative bacteria.
Nasopharyngeal and Oropharyngeal Decontamination to Prevent Nosocomial Infection in Cardiac Surgery Patients
Authors: Diaz-Gomez Jose L. , Robison Sarah W.
Published: February 2018

Preventing nosocomial infections is important to improve postoperative outcomes for cardiac surgery patients. The patient’s own flora is thought to be the primary source of potentially pathogenic bacteria. Therefore, decontamination is an appealing preventative strategy for reducing nosocomial infections. This study investigated the use of topical chlorhexidine gluconate for perioperative nasal and oropharyngeal decontamination in cardiac surgery patients. The intervention resulted in a significant reduction in lower respiratory tract infections, deep surgical site infections, use of nonprophylactic antibiotics, and duration of hospitalization. There was an absolute risk reduction in total nosocomial infection of 6.4%; 16 patients would have to be treated with the chlorhexidine decontamination strategy to prevent one nosocomial infection. Chlorhexidine is an advantageous antimicrobial because it has broad-spectrum coverage, is inexpensive, and is very well tolerated.
Mayo Clinic Principles of Shoulder Surgery
Authors: Sanchez-Sotelo Joaquin
Published: February 2018

Mayo Clinic Principles of Shoulder Surgery was written for individuals just starting to learn about shoulder surgery or health care providers who need a clear understanding of the basics when they occasionally evaluate a patient with a shoulder condition (i.e., family practitioners, physician assistants, physical therapists, nurses, operating room personnel), with a clear goal: convey the fundamentals of shoulder surgery concisely and thus serve as a strong foundation upon which knowledge and experience can be built. If you are a shoulder expert, this book is too simple for you. You already know the basic principles of shoulder surgery. Currently, most shoulder books are authored by multiple contributors under the guidance of one or more editors; however, the author believed that his vision would be achieved best by a single author reflecting the shoulder surgery practice at Mayo Clinic.
The Scapula
Authors: Sanchez-Sotelo Joaquin
Published: February 2018

Most orthopedic surgeons, and even many shoulder experts, are a little intimidated by the evaluation and management of patients with conditions affecting the scapula, periscapular muscles, and scapulothoracic joint. Explanations for this include relative unfamiliarity with the anatomy, function, physical examination, and diagnostic categories related to the scapula, and the fact that surgical procedures around the scapula are not performed commonly. Dysfunction of the scapulothoracic joint may play a major role in patients with diverse shoulder conditions such as disorders of the clavicle and the acromioclavicular joint, shoulder instability, and rotator cuff disease. Additionally, the scapulothoracic joint and periscapular muscles may be affected by disorders such as traumatic muscle avulsions, injuries to various nerves, fractures of the scapula and the glenoid cavity, bursitis, osteochondromas, and congenital abnormalities. Finally, some patients present with pain and dysfunction secondary to poor control of the periscapular muscles in the absence of specific structural pathology.
Forces Disrupting Relationships at Work: Technology and Globalization
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

Advances in technology and an increasingly global marketplace have brought about many positive changes in business, but they have also had some negative effects on workplace relationships. Incrementally and over time, these two drivers of change have significantly reshaped workplace relationships at both the company and employee level. Managers work in this ever-changing context each day, facing the impact of technology and globalization on their emotional lives as well as the ways in which they relate to others in their Credibility Crosses—a concept that is developed in this chapter. Unfortunately, managers often have time only to react to these changes rather than consider how they affect the bigger relationship picture. Consciously understanding the interpersonal impact of technology and globalization provides managers with opportunities to improve workplace relationships.
Epidemiology of malnutrition in different care settings
Authors: Correia Maria Isabel Toulson Davisson , de Vasconcelos Generoso Simone
Published: February 2018

Determining the epidemiology of malnutrition is of utmost importance, since it is one of the most prevalent conditions in the community, residential care, and hospital settings. Nutrient imbalance, such as decreased provision of calories, proteins, vitamins, minerals and trace elements, leads to a progressive deficiency status, while the excess is associated with overweight and obesity. Both are considered malnutrition. Furthermore, malnutrition is associated with increased risk of morbidity and mortality, length of hospital stay, hospital readmissions, cost and decreased quality of life. Therefore, a stable nutritional status should be targeted as an integral part of healthcare, and routine nutritional assessment should be carried out as a quality assurance practice. Despite this, healthcare providers, including physicians and medical administrators, often overlook nutritional aspects.
Risk factors
Authors: Putaala Jukka , Martinez-Majander Nicolas
Published: February 2018

Risk factors in young-onset stroke include both traditional and unconventional as well as both chronic and temporal ones. In young patients, unconventional risk factors such as oral contraceptive use, antiphospholipid antibodies, genetic thrombophilia, acute infections, illicit drug use, and migraine may play a greater role than in elderly patients. However, recent large studies have challenged this traditional view suggesting that young adult stroke would occur mostly due to such unconventional risk factors. These studies have shown a high prevalence of in particular modifiable behavioural risk factors, including physical inactivity, high-risk alcohol consumption, and smoking. Since consequences of a young-onset stroke are greater regarding quality-adjusted life and economic impact, detection and treatment of especially modifiable risk factors are of paramount importance. This chapter reviews the burden of both traditional and less well-documented risk factors in young ischaemic stroke patients and discusses their strength of evidence and mechanisms of association.
Brain imaging (CT/MRI)
Authors: Gattringer Thomas , Enzinger Christian , Ropele Stefan , Fazekas Franz
Published: February 2018

In the acute phase of a suspected stroke, timely brain imaging with rapid and qualified interpretation is a crucial diagnostic step to inform patient management. While brain computed tomography is usually sufficient to indicate thrombolysis within the approved time window (by rapidly excluding intracranial haemorrhage), it often fails to show the actual site and extent of infarction as well as other pathologies, which may mimic a stroke. Magnetic resonance imaging (MRI) has a much higher sensitivity and specificity for ischaemic vascular brain changes and thus allows direct demonstration of the area(s) of acute ischaemic damage. This helps in the diagnosis of clinically uncertain cases, may give aetiological clues, and can also provide pathophysiologic insights into stroke evolution with respective consequences for patient treatment. The capability to rule out many other disorders that may mimic stroke is also an important asset of MRI. All these advantages make MRI the preferred tool in the workup of young individuals with suspected stroke. However, this needs ready availability and adequately tailored and short imaging protocols in order not to delay treatment.
Vascular imaging: Ultrasound
Authors: Waje-Andreassen Ulrike , Logallo Nicola
Published: February 2018

After computed tomography and computed tomography angiography or magnetic resonance imaging and magnetic resonance angiography at admission, ultrasound is the most important diagnostic tool to confirm angiographic findings and to closely follow-up patients until the clinical situation has stabilized. Thrombolysis and interventional therapy have given transcranial ultrasound a very important role in bedside monitoring of occlusions, collaterals, cerebral haemodynamics, and vasoreactivity. Detection of flow changes in sickle cell disease, circulating emboli, and right-to-left shunts may guide treatment decisions. Sonothrombolysis and targeted drug delivery are today’s research projects for acute treatment by ultrasound. Extracranial cerebrovascular ultrasound is an ‘all-round’ diagnostic tool modifying angiographic results, showing minor arterial wall disease, plaques, and plaque instability. Microembolic signals during scanning may contribute to finding the cause of stroke. In stroke prevention, ultrasound delivers the possibility for staging of arteries and improving targeted intervention. Ultrasound images may also serve as educational tools for patients to underline the need for continuous medical treatment and lifestyle changes, and may improve compliance.
Urban landscapes and public health
Authors: Beatley Timothy , van den Bosch Cecil Konijnendijk
Published: February 2018

Increasing urbanization patterns have resulted in significant and serious environmental health concerns (e.g. caused by a lack of physical activity). Urban planners face the challenge of developing healthy, resilient, and sustainable urban environments. This chapter addresses this challenge from an urban landscape perspective, promoting a socioecological approach, and recognizing that landscapes are shaped in close interaction between nature and culture—with cities being an ultimate example of human shaping and impact. It provides examples of how urban landscapes have contributed to better public health, from urban agriculture and community gardening, to therapeutic settings and urban wildscapes. Landscape-related approaches such as green urbanism, urban resiliency, and biophilic urbanism are introduced and examples are offered of how cities have worked with these. Suggestions are provided for the planning and development of health-promoting urban landscapes.
Green infrastructure—approach and public health benefits
Authors: Lafortezza Raffaele , van den Bosch Cecil Konijnendijk
Published: February 2018

Green infrastructure (GI) planning is becoming a pre-eminent approach for delivering essential goods and services to people while reversing trends such as landscape and habitat fragmentation. By means of sound ecosystems delivering multiple services and benefits, GI can contribute to public health, including physical, psychological, and social aspects. These services and benefits are provided at the local, regional, and national scales, and are therefore closely knit to planning and policymaking at various levels. The Green Infrastructure Framework was conceptualized to incorporate the multifunctional, multiscale, and temporal dimensions of GI and to demonstrate the associations between ecosystem services and human well-being. It stresses biodiversity, social and territorial cohesion, and sustainable development as key contributions of GI, creating the environmental settings for well-being and community health. Adopting the GI approach and its characteristics of connectivity (by connecting ecological and social systems), accessibility, and functionality in urban planning may contribute to healthier societies.
Healthy Islands
Authors: de Leeuw Evelyne , Martin Erik , Waqanivalu Temo
Published: February 2018

Small Island Developing States (SIDS) form a special setting where nature and (population) health become intimately connected. This chapter outlines the nature of such small states, their development and health challenges, and a common health solution that has been advanced in the Pacific. The Yanuca Declaration established a Healthy Island programme in 1995. It is a specific example of a ‘healthy settings’ approach (Nutbeam, 1996). Healthy Islands form an integrated element of the Pacific development agenda and explicitly pursue a comprehensive agenda at the interface of nature, health, and development. Examples of this agenda are provided in two case studies. First, the WHO-led ‘Healthy Island Recognition’ programme, and second, the commitments among Pacific islands to the Framework Convention on Tobacco Control.
The role of the health professional
Authors: Zarr Robert , Bird William
Published: February 2018

There is a shift in healthcare from treatment of diseases based on the medical model, to a more holistic approach based on prevention and health promotion, using social and environmental factors that impact on an individual to improve their health and prevent disease. This shift is in response to the rapid rise in long-term conditions such as obesity, diabetes, dementia, and mental illness. Healthcare professionals are only slowly adjusting to this shift of healthcare and in this chapter we will look at how the healthcare professional can connect patients with green space to help them increase physical activity and reduce stress. Four initiatives have been used to illustrate how healthcare professionals can engage patients with nature to help tackle the main disease burden.
The role of civil society and organizations
Authors: van den Bosch Matilda , Falvo Cathey E. , Jensen Génon K. , Karliner Joshua , Stancliffe Rachel
Published: February 2018

Civil society and non-governmental organizations play a major role in advocating for environment and health interactions in policy and practice. They work to influence the future healthcare agenda towards more sustainable practices, where also the role of nature is part of a general mindset among healthcare politicians, practitioners, and researchers. This chapter will give examples of how the translation of science into practice can be facilitated through the channels of such organizations. Four international organizations are selected to provide examples of how organizations can be developed, what missions and goals are common themes, how they can function, and what kind of activities they may be engaged in.
Microbes, the immune system, and the health benefits of exposure to the natural environment
Authors: Rook Graham
Published: February 2018

Humans, like essentially all complex multicellular animals, are ecosystems. We evolved in symbiosis with microorganisms, notably the ~1,014 organisms in the gut microbiota that provide signals for organ development, perform multiple digestive and metabolic services, and educate the immune system. Humans also evolved to tolerate certain ‘old infections’ that could persist for life in small hunter-gatherer groups. Modern medicine eliminates the ‘old infections’, while the urban lifestyle reduces our contact with organisms from other humans, animals, and the natural environment that contribute to the microbiotas, while increasing our exposure to the more recently evolved crowd infections. These changes compromise regulation of the immune system and increase the prevalence of chronic inflammatory disorders. Changes to the microbiota also predispose to metabolic disturbances. We need to restore our interaction with the natural environment because it is a reservoir of genetic and metabolic flexibility, and it fine-tunes regulation of the immune system.
Preventing stress and promoting mental health
Authors: van den Bosch Matilda , Thompson Catharine Ward , Grahn Patrik
Published: February 2018

Among the more common explanatory theories for nature’s impact on health is the potential for stress recovery. Both epidemiological and experimental research have confirmed stress reducing effects of exposure to natural environments. As stress is a major risk factor for many common diseases, particularly mental disorders this indicates that nature may play an important role in preventing ill-health. Mental disorders are dominating the burden of disease in many countries and a variety of actions are required to tackle the issue. This chapter outlines how nature may promote stress recovery both directly and indirectly protect mental health. It describes the current state of the art regarding nature, stress, and mental health, and provides a theoretical framework for the associations.
Chest medicine
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing lung, respiratory infections, influenza, pneumonia, pneumonia treatment, vaccinating against pneumonia and influenza, pulmonary fibrosis, rib fractures, pleural effusions, pulmonary embolism, aspiration pneumonia/pneumonitis, lung cancers, chronic cough, presentation of tuberculosis, tuberculosis investigation, treatment of tuberculosis, assessment of asthma and chronic obstructive pulmonary disease (COPD), drug treatment of asthma and COPD, non-drug treatment of asthma and COPD, oxygen therapy, and asbestos-related disease.
Gastroenterology
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing gastrointestinal system, the elderly mouth, nutrition, enteral feeding, the ethics of clinically assisted feeding, oesophageal disease, dysphagia, peptic ulcer disease, the liver and gall bladder, constipation, diverticular disease, inflammatory bowel disease, diarrhoea in older patients, other colonic conditions, the ‘acute surgical abdomen’, obstructed bowel in older patients, and obesity in older people.
Ears
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on deafness and the ageing ear, audiology, hearing aids, tinnitus, vertigo, assessment of vertigo, and management of vertigo.
Death and dying
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on breaking bad news, bereavement, palliative care, symptom control in the terminally ill, assisted dying, documentation after death, other issues after death, and the coroner.
Ethics
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on capacity, the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, making financial decisions, making medical decisions, making social decisions, advance directives, diagnosing dying and estimating when treatment is without hope, making complex decisions, cardiopulmonary resuscitation (CPR), the process of CPR decision-making, rationing and ageism, and elder abuse.
Finances
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on making a will, taxation, pensions, and benefits.
Peri-operative medicine
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on models of care, elective surgery, emergency surgery, perioperative delirium, and perioperative medication management.
Oral mucosa, saliva, and speech
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

Oral mucosa, saliva, and speech in relation to dentistry are the topics in this chapter. The chapter starts with the normal structure and function of oral mucosa, leading on to a discussion of problems in normal physiology leading to ulceration and to oral precancer and carcinoma. This is followed by a consideration of saliva, its production and properties, and important issues arising from lack of saliva. Swallowing, its phases and control and dental relevance, are next discussed. The concluding section deals with speech, vocalization, phonation, and articulation together with problems of dental relevance, that may arise.
Immune system
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The immune system in relation to dentistry is the topic of this chapter. Non-specific body defences are explored. Then follows specific body defences, humoral and cell mediated responses; antibody types and their mechanisms of action and the clinical application in immunization. Inflammation, both acute and chronic, is explored in relation to infections of dental origin and their complications. Problems with the immune system and hypersensitivity follow. Normal oral flora and dental plaque and the body’s response in periodontal inflammation are explored. The final section deals with the implications of what has gone before for infection control in the dental surgery.
Central nervous system
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The central nervous system (CNS) in relation to dentistry is the topic of this chapter. Nerve conduction is described, then the physiology of facial and dental pain and processing of afferent pain nerve impulses in the cerebral cortex. We discuss abnormal sensations of allodynia and paraesthesia. Pain control with non-steroidal anti-inflammatory drugs or paracetamol is explained. The function of the cranial nerves and the autonomic nervous system are described. We explain the nerve pathways involved in salivation, lachrymation, and taste sensation. We propose some techniques for treating the nervous patient, e.g. modelling, systematic desensitization, and feedback. Effective local anaesthesia is essential in gaining the cooperation of nervous patients. The major types of local anaesthetics are compared. The techniques for inferior alveolar and superior alveolar nerve blocks are described as are drugs commonly used in dental sedation. There are final sections on drug problems encountered in dental practice and on dementia.
The injured patient
Authors: Perry Mike
Published: February 2018

This chapter gives an overview of the assessment of patients presenting to an emergency department with injuries to head or neck (above the collar bones). The Advanced Trauma Life Support® (ATLS®) programme is now widely accepted as the gold standard in trauma management, but its strict application to patients with coexisting facial injuries can result in a number of dilemmas and complex decision-making. These issues are discussed. The approach to head and neck injuries remains the same as for the multiply injured patient but those aspects related specifically to injuries to the head and neck are discussed in detail. Emergency procedures undertaken in head and neck injuries are also discussed. Useful clinical signs and symptoms indicating significant injuries are listed at the end of the chapter.
The front of the neck
Authors: Perry Mike
Published: February 2018

This chapter looks at diseases and conditions of the front of the neck that may present acutely to an emergency department, general practice, or ward. It aims to equip the reader with the necessary knowledge to enable them to quickly and accurately triage and diagnose common clinical problems. Referral pathways and management are also discussed. Generally speaking, patients do not present with a ready-made diagnosis, but rather with either a symptom located to an anatomical region (e.g. toothache, lump, or headache), or an obvious problem (e.g. nose bleed or injury). This is the starting point (‘Common presentations’ and ‘Common problems and their causes’). The next section (‘Useful questions and what to look for’) lists key diagnostic elements in relation to each symptom. The remainder of each chapter details how to examine each site, useful investigations (emergency department and outpatients), and some notes on the conditions themselves. This is a useful aid for the non-specialist and those preparing for clinical examinations.
The ear
Authors: Perry Mike
Published: February 2018

This chapter looks at diseases and conditions of the ear that may present acutely to an emergency department, general practice, or ward. It aims to equip the reader with the necessary knowledge to enable them to quickly and accurately triage and diagnose common clinical problems. Referral pathways and management are also discussed. Generally speaking, patients do not present with a ready-made diagnosis, but rather with either a symptom located to an anatomical region (e.g. toothache, lump, or headache), or an obvious problem (e.g. nose bleed or injury). This is the starting point (‘Common presentations’ and ‘Common problems and their causes’). The next section (‘Useful questions and what to look for’) lists key diagnostic elements in relation to each symptom. The remainder of each chapter details how to examine each site, useful investigations (emergency department and outpatients), and some notes on the conditions themselves. This is a useful aid for the non-specialist and those preparing for clinical examinations.
The lower jaw and face
Authors: Perry Mike
Published: February 2018

This chapter looks at diseases and conditions of the lower jaw and face that may present acutely to an emergency department, general practice, or ward. It aims to equip the reader with the necessary knowledge to enable them to quickly and accurately triage and diagnose common clinical problems. Referral pathways and management are also discussed. Generally speaking, patients do not present with a ready-made diagnosis, but rather with either a symptom located to an anatomical region (e.g. toothache, lump, or headache), or an obvious problem (e.g. nose bleed or injury). This is the starting point (‘Common presentations’ and ‘Common problems and their causes’). The next section (‘Useful questions and what to look for’) lists key diagnostic elements in relation to each symptom. The remainder of each chapter details how to examine each site, useful investigations (emergency department and outpatients), and some notes on the conditions themselves. This is a useful aid for the non-specialist and those preparing for clinical examinations.
The Psychiatry of Adult Autism and Asperger Syndrome
Authors: Brugha Traolach S.
Published: February 2018

Within general psychiatry, awareness of autism spectrum disorder (ASD) and the use of the terms ‘autism’, ‘autistic disorder’, ‘Asperger syndrome’, the ‘autism spectrum’, and ‘high functioning autism’ (HFA) are growing. However, autism has yet to become part of the accepted mainstream, core curriculum of general psychiatry. Psychiatrists are now expected to be able to recognize autism and consider its effects on their adult patients, particularly those showing signs of comorbid mental disorder, for example, schizophrenia, personality disorder, mood disorder, or attention-deficit/hyperactivity disorder (ADHD). From childhood through to adulthood and old age there is a failure in autism to develop skills in reciprocal social interaction, understanding, and flexibility. This can profoundly affect behaviour in the community, personal independence, employability, and social relationships, including marriage and parenting. Most cases of autism in adults are unrecognized and undiagnosed, both within the general population and in adults using psychiatric services. This book gives a comprehensive introduction to autism and Asperger syndrome written to fit the adult clinician’s perspective. It will assist with autism recognition and diagnosis in adulthood. It is designed to enhance the clinician’s role in treating patients with co-morbid mental disorder, while understanding and taking account of the autism component. It will also help in signposting patients with autism to appropriate care and support, as family involvement diminishes, or ceases in adulthood and old age, and in the psychiatrist’s role in providing advice to the courts and in the context of detention in accordance with mental health law.
Obtaining an assessment
Authors: Brugha Traolach S.
Published: February 2018

This chapter on obtaining an assessment begins by considering why, when, and where to obtain an assessment. Sources of referrals can be from child services (transition referral), primary care, other specialist colleagues, and occasionally other agencies such as social care, education (e.g. higher and further education), and the criminal justice system. Assessment services may be limited to performing a basic diagnostic function or may have access to more sophisticated needs assessment methods. A reasoned case for referral needs to be considered and developed. Alternative ways of meeting needs such as short-term problem-solving should also be considered. Information required for a referral for an assessment, whether brief or lengthy, is important. Pre-assessment tests and their evaluation should be considered. Experiences and expectations of the process of referral are also covered.
Approaches to treatment and care
Authors: Brugha Traolach S.
Published: February 2018

Sharing with the patient and their carers the results of an assessment in autism and of what that means and the principles of post diagnostic support is covered. Conventional medically orientated ways of thinking about the treatment of autism including considerations of approaches to evaluating treatments are discussed. Also covered are the sought after targets of treatment, the role of patients, carers, and the public in choosing what their wishes and objectives are, uses of medication, structured psychological interventions including those focusing on adaptive and social skills, the limited role of genetic counselling, the role of guidelines and recent systematic reviews of the evidence base, and the treatment of comorbidities. Future prospects for treatment development are also touched on. Armed with a complete assessment and treatment recommendations, duties in relation to legal aspects of the psychiatry of autism are introduced.
Social care, the personal passport, and reasonable adjustments
Authors: Brugha Traolach S.
Published: February 2018

Where treatment and health care is no longer able to bring relief and improve functioning, social care should take over. In this chapter, we discuss the development of social care in the context of adult autism, and the range of its concerns and interests is considered. The key role of the social worker, particularly as a broker of social care, is developed. Health professionals define the need for reasonable adjustments to assessed disability, and the content of a personal passport, summarizing individual’s needs. Health professionals also have a key role in risk management, although the social worker may have a key co-ordinating role. A wide range of contexts for social care within and beyond health care is considered. The distinction between individual need and care planning, and the role of the wider society, which will be covered in Chapter 14, concludes this chapter.
The Fourth Domain of Palliative Care
Authors: Strada E. Alessandra
Published: February 2018

This chapter proposes palliative psychology competencies in the fourth domain of palliative care, which addresses the social needs of the patient and the family. The unit of care in palliative care is represented by the patient and the family; thus, this chapter highlights the unique needs of family caregivers. The many challenges of caregiving are described by reviewing the literature and using clinical case scenarios. The risk factors and protective factors in caregiving are discussed and incorporated in assessment templates. Psychological and psychosocial interventions that can effectively support family caregivers are discussed. The function, structure, and execution of a family meeting in the palliative care setting is described. This chapter also describes bereavement support for family caregivers and the management of complications of bereavement.
Large-scale CO J = 1–0 observations of the giant molecular cloud associated with the infrared ring N35 with the Nobeyama 45 m telescope
Authors: Torii Kazufumi , Fujita Shinji , Matsuo Mitsuhiro , Nishimura Atsushi , Kohno Mikito , Kuriki Mika , Tsuda Yuya , Minamidani Tetsuhiro , Umemoto Tomofumi , Kuno Nario , Hattori Yusuke , Yoshiike Satoshi , Ohama Akio , Tachihara Kengo , Shima Kazuhiro , Habe Asao , Fukui Yasuo
Published: February 2018

We report an observational study of the giant molecular cloud (GMC) associated with the Galactic infrared ring-like structure N35 and two nearby H ii regions G024.392+00.072 (H ii region A) and G024.510−00.060 (H ii region B), using the new CO J = 1–0 data obtained as a part of the FOREST Unbiased Galactic Plane Imaging survey with the Nobeyama 45 m telescope (FUGIN) project at a spatial resolution of 21″. Our CO data reveals that the GMC, with a total molecular mass of 2.1 × 106 M⊙, has two velocity components of over ∼10–15 km s−1. The majority of molecular gas in the GMC is included in the lower-velocity component (LVC) at ∼110–114 km s−1, while the higher-velocity components (HVCs) at ∼118–126 km s−1 consist of three smaller molecular clouds which are located near the three H ii regions. The LVC and HVCs show spatially complementary distributions along the line-of-sight, despite large velocity separations of ∼5–15 km s−1, and are connected in velocity by the CO emission with intermediate intensities. By comparing the observations with simulations, we discuss a scenario where collisions of the three HVCs with the LVC at velocities of ∼10–15 km s−1 can provide an interpretation of these two observational signatures. The intermediate-velocity features between the LVC and HVCs can be understood as broad bridge features, which indicate the turbulent motion of the gas at the collision interfaces, while the spatially complementary distributions represent the cavities created in the LVC by the HVCs through the collisions. Our model indicates that the three H ii regions were formed after the onset of the collisions, and it is therefore suggested that the high-mass star formation in the GMC was triggered by the collisions.
The Impact of Positive Agricultural Income Shocks on Rural Chinese Households
Authors: Leight Jessica
Published: February 2018

In the post-collectivization period, rural Chinese households were required to sell part of their grain output to the state at a below-market price; however, increases in this quota price beginning in 1993 generated substantial positive income shocks. These income shocks also varied cross-sectionally in accordance with crop composition given that quotas were systematically larger for rice-producing households, generating a quasi-random source of variation in the size of the shock driven by climatic variation in suitability for rice cultivation. Households induced to experience relatively larger income shocks show evidence of decreased agricultural investment, increased investment in non-agricultural businesses, and increased migration as households gain increased income, consistent with the hypothesis that credit constraints may have constrained some households from entering non-agricultural production ex ante. In addition, there is evidence that these households were concentrated among households who had not previously diversified out of agriculture.
Management of delirium across an integrated health system
Authors: Holle Cynthia L. , Rudolph James L.
Published: February 2018

Facilitating throughput with systems thinking