bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning from the Vikings: Hávamál and occupational rehabilitation
Authors: O’Neill Desmond
Published: August 2020

In Learning from the Vikings: Hávamál and occupational rehabilitation Desmond O’Neill briefly explores the inclusion of occupational health and preventive medicine in an ancient Norse poetic saga: Hávamál.
Early thoughts on g
Authors: Gibson Mike
Published: August 2020

In Early thoughts on g Mike Gibson briefly explores Fleet Surgeon R.C. Munday’s work on the effects of gravity (g) on pilots.
Fifty years ago: ‘Genesis of a new society’
Authors: Anon
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘Genesis of a New Society’ the author briefly explores the criticism they received over an article that was favourable to the proposed new constitution, and the forming of the Society of Occupational Medicine.
Why I didn’t become an occupational physician …
Authors: Bailey Alan
Published: August 2020

In Why I didn’t become an occupational physician … Alan Bailey briefly explores why he chose not to go down the occupational physician path, and his experience working at the BBC.
Time to ditch occupational health
Authors: Shepherd Gordon
Published: August 2020

In Time to ditch Occupational Health Gordon Shepherd briefly explores the misunderstanding and problems often caused by the term ‘occupational physician’ and contemplates possible new names.
Tales of Kieran: The occupational physician’s odyssey 6—Sniffing about
Authors: Hunter J.A.
Published: August 2020

In Tales of Kieran: The occupational physician’s odyssey 6: Sniffing about J.A. Hunter briefly explores the humorous encounters with his occupational physician friend Kieran. This article recounts Kieran’s battle for new office space.
One hundred years of the health and safety laboratory 2
Authors: Anon
Published: August 2020

In One hundred years of the health and safety laboratory 2 the author briefly explores research into the safety of miners’ lamps.
Why I became an occupational physician …
Authors: Asogwa Simon E.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Simon E. Asogwa’s decision to pursue a career in occupational medicine. It takes us through his initial interest in medical jurisprudence, studies at the London School of Hygiene and Tropical Medicine, and return to Nigeria.
One hundred years of the health and safety laboratory 3
Authors: Anon
Published: August 2020

In One hundred years of the health and safety laboratory 3 the author briefly explores coal dust explosion testing in Buxton in the 1920s.
Fifty years ago: ‘Malaises and Discontents’
Authors: Anon
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘Malaises and Discontents’ the author briefly explores a 1960s publication by the Office of Health Economics on the impact of employee sick days.
Why I became an occupational physician …
Authors: Cashman Clodagh
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Clodagh Cashman’s decision to pursue a career in occupational medicine. It takes us through his travels with his veterinary surgeon father, interest in preventing illness, and natural progression to occupational medicine.
The Ontario Workplace Health Champions programme
Authors: Holness D. Linn , Liss Gary
Published: August 2020

In The Ontario Workplace Health Champions Program D. Linn Holness and Gary Liss briefly explore a program set up in Ontario to increase the presence of occupational health content in the medical school curriculum.
Why I became an occupational physician …
Authors: Finnegan Timothy P.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Timothy P. Finnegan’s decision to pursue a career in occupational medicine. It takes us through his medical student days with Prof. Pat Lawther of the Barts Air Pollution Unit, and move to the army to pursue an interest in preventative medicine.
Hammerfest: Occupational medicine at 70° north
Authors: Hirons Emma
Published: August 2020

In Hammerfest: occupational medicine at 70° north Emma Hirons briefly explores her work in occupational medicine in the Arctic, at a natural gas plant in Hammerfest, Norway.
The raincoat sign
Authors: Hobson John
Published: August 2020

In The raincoat sign John Hobson briefly explores a memory of a particularly difficult patient he signed off work.
Why I became an occupational physician …
Authors: Glass W.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind W. Glass’s decision to pursue a career in occupational medicine. It takes us through his first occupational medicine job as a ship’s doctor, arrival in London from New Zealand, and studies at the London School of Hygiene and Tropical Medicine.
Worst job ads from history—situation vacant plague doctor
Authors: Gibson Kirstie
Published: August 2020

In Worst job ads from history—situation vacant plague doctor Kirstie Gibson shows us a shocking job advert for a plague doctor from 1665.
Stones
Authors: Seaton Anthony
Published: August 2020

In Stones Anthony Seaton recalls the types of stones he has collected over the years- oil shale, haematite, anthracite, quartz, and limestone, and the memories from each.
Why I became a part time occupational physician …
Authors: Verow Peter
Published: August 2020

Why I became a part time occupational physician … briefly explores Peter Verow's decision to go part time. It takes us through his period of depression, how it affected his work, and how it has influenced his relationships with patients in the same situation.
A multidisciplinary clinic for occupational disease
Authors: Holness Dorothy Linn
Published: August 2020

In A multidisciplinary clinic for occupational disease Dorothy Linn Holness briefly explores the work of the Occupational Disease Specialty Program (ODSP) at St. Michael’s Hospital in Toronto, Canada.
Fifty years ago: ‘The teaching of occupational medicine to undergraduate medical students’
Authors: Anon
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘The teaching of occupational medicine to undergraduate medical students’ the author briefly explores the type of training required for a career in occupational medicine and what should be taught at undergraduate and postgraduate levels.
Why I became an occupational physician …
Authors: Jenkinson William R.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind William R. Jenkinson’s decision to pursue a career in occupational medicine. It takes us through his beginnings as a GP near a linen mill, and training under Dr Richard Welch and Dr Steve Searle.
What clinicians should look for in health and lifestyle apps
Authors: Williams Nerys
Published: August 2020

In What clinicians should look for in health and lifestyle apps Nerys Williams briefly explores The Royal College of Physicians’ (RCP) guidelines on the use of medical apps.
Mellifluous
Authors: Hobson John
Published: August 2020

In Mellifluous John Hobson recalls the soothing voice of Paul Vaughan, who played an important part in his decision to pursue science and medicine.
Why I became an occupational physician …
Authors: Madan Ira
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Ira Madan’s decision to pursue a career in occupational medicine. It takes us through her interest in occupational medicine after an inspirational lecture, and what she enjoys about her specialty.
Slum clinics
Authors: Baxendine Dianne
Published: August 2020

In Slum clinics Dianne Baxendine briefly explores her summer working medical clinics in an Indian slum, and the many occupational hazards that she came across.
Fifty years ago: ‘Laser hazards’
Authors: Rich John
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: ‘Laser hazards’ John Rich briefly explores the hazards of lasers in the workplace, particularly in relation to the eyes.
A sovereign remedy to all diseases
Authors: Seaton Anthony
Published: August 2020

In A sovereign remedy to all diseases Anthony Seaton briefly explores his memory of a patient in the pottery trade who took aspirin to avoid silicosis.
Why I became an occupational physician …
Authors: Goodall Henry N.
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Henry N. Goodall’s decision to pursue a career in occupational medicine. It takes us through his beginnings in general practice and A&E, move to Ford Motor Company and Atos Healthcare, and training under Ewan Macdonald and Monty Brill.
What’s in a name?
Authors: Gibson Mike
Published: August 2020

In What’s in a name? Mike Gibson briefly explores the origins of the name ‘Tourette syndrome’.
Why I became a respiratory physician with an occupational interest
Authors: Fishwick David
Published: August 2020

In Why I became a respiratory physician with an occupational interest David Fishwick briefly explores the early influence of his lighthouse-keeper grandfather, work under Tony Pickering, and combined interest in respiratory and occupational medicine.
Piles
Authors: Hobson John
Published: August 2020

In Piles John Hobson briefly explores the stress and bother stemming from untidy desks and offices.
Why I became an occupational physician …
Authors: Franco Giuliano
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Giuliano Franco’s decision to pursue a career in occupational medicine. It takes us through his work under Professor Salvatore Maugeri and involvement in the foundation of the Institute of Research and Care.
Philosophical Transactions: 350 years of publishing at the Royal Society
Authors: Baranyiová Eva
Published: August 2020

In Philosophical Transactions: 350 years of publishing at the Royal Society Eva Baranyiová briefly explores the Royal Society of London, its publication history, and a tribute to Henry Oldenburg.
Risk assessments: Good and bad
Authors: Seaton Anthony
Published: August 2020

In Risk assessments: good and bad Anthony Seaton briefly explores the role of occupational risk assessments, including the story of a badly executed bank robbery in West Virginia.
Why I became an occupational physician …
Authors: Aldridge John
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind John Aldridge’s decision to pursue a career in occupational medicine. It takes us through his various appointments in institutions such as the Royal Armoured Corps, Cambridge Hospital in Aldershot, Queen Alexandra Hospital in Millbank, and the Military Hospital in Tripoli in Libya, before becoming interested in occupational mental health.
PTSD induced by the trauma of subordinates: The Robert Gates syndrome
Authors: Altschuler Eric
Published: August 2020

In PTSD induced by the trauma of subordinates: the Robert Gates syndrome Eric Altschuler briefly explores Robert Gates’ resignation as US Secretary of Defense after experiencing PTSD related symptoms on behalf of the soldiers he organized, and wonders about ‘secondary’ PTSD more widely.
Why I became an occupational physician …
Authors: Beach Jerry
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Jerry Beach’s decision to pursue a career in occupational medicine. It takes us through his visit to a silica and glass manufacturer as a medical student, interest in machinery, and work under David Hendrick.
Shaking all over
Authors: Hobson John
Published: August 2020

In Shaking All Over John Hobson briefly explores the role of the handshake, and the differences he found between the French and UK workplace.
Preparing for retirement
Authors: Deacon Stephen
Published: August 2020

In Preparing for retirement Stephen Deacon briefly explores the considerations and preparations doctors must take into account when approaching retirement.
Golden Jubilee Travel Fellowship 2016
Authors: Adenekan Folashade
Published: August 2020

In Golden Jubilee Travel Fellowship 2016 Folashade Adenekan briefly explores her interest in the management of psychological ill-health in the workplace, and her work with ‘sick doctors’ in Nigeria where there was poor mental health awareness.
Which way is up?
Authors: Gibson Mike
Published: August 2020

In Which way is up? Mike Gibson briefly explores his involvement in the course named ‘Top Knife’ that trained Air Force medical staff in air flight and combat.
Tales of Kieran: The occupational physician’s odyssey 8—The HAVS and the Have Nots
Authors: Hunter J.A.
Published: August 2020

In Tales of Kieran: The occupational physician’s odyssey 8: The HAVS and the Have Nots J.A. Hunter briefly explores the humorous encounters with his occupational physician friend Kieran. This article recounts Hunter’s discovery of Kieran with a large collection of hand photos and a magnifying glass.
One hundred years of the health and safety laboratory 5
Authors: Anon
Published: August 2020

In One hundred years of the health and safety laboratory 5 the author briefly explores the Buxton site locomotive ‘Nippy’ and its role in coal dust explosion tests.
Why I became an occupational physician …
Authors: Sharp Chris
Published: August 2020

Why I became an occupational physician. … briefly explores the reasons and influences behind Chris Sharp’s decision to pursue a career in occupational medicine. It takes us through his interest in flying, time in the RAF, and progression to aviation and occupational medicine.
The silent killer
Authors: Seaton Anthony
Published: August 2020

In The silent killer Anthony Seaton briefly explores his clinical experience of carbon monoxide poisoning, and how such accidents can be prevented.
Why I might become an occupational physician
Authors: Devonport Joshua
Published: August 2020

In Why I might become an occupational physician Joshua Devonport briefly explores his work experience placement at an occupational health (OH) service provider, and his insight into the positive and negative aspects of the profession.
Fifty years ago: ‘Pulmonary function tests in asbestos workers’
Authors: Leathart G.L.
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: Pulmonary function tests in asbestos workers G.L. Leathart briefly explores the symptoms of asbestosis, including the commonly found crepitations at lung bases.
It’s not all hot air
Authors: Gibson Mike
Published: August 2020

In It’s not all hot air Mike Gibson briefly explores possible occupational hazards in playing the bagpipes, including fainting, hearing loss, and infections.
Why I became an occupational physician …
Authors: Scarisbrick Douglas
Published: August 2020

Why I became an occupational physician … briefly explores the reasons and influences behind Douglas Scarisbrick’s decision to pursue a career in occupational medicine. It takes us through his beginnings as a GP and work at a chest clinic, and move to the post of an industrial medical officer at the National Coal Board (NCB) in South Wales.
Why doctors need to be careful with social media
Authors: Williams Nerys
Published: August 2020

In Why doctors needs to be careful with social media Nerys Williams briefly explores guidance for doctors on their use of social media, including advice from the General Medical Council (GMC), British Medical Association (BMA), and the Royal College of General Practitioners (RCGP).
More hot air
Authors: Gibson Mike
Published: August 2020

In More hot air Mike Gibson briefly explores an unusual assignment he received from British Caledonian Airways (BCal), to advise on how to prevent bagpipe players from fainting due to altitude when travelling to Quito in Ecuador.
Hazard, risk and a bullet
Authors: Challenor John
Published: August 2020

In Hazard, risk and a bullet John Challenor briefly explores the hazard risk assessment and preparation he undertook for a charity motorcycle ride through Southern India.
Fifty years ago: ‘Productivity, morale and occupational medicine’
Authors: Garnett John
Published: August 2020

This series provides a selection of articles from the past. In Fifty years ago: Productivity, morale and occupational medicine John Garnett briefly explores the problems of the 20th century workplace, including stress, boredom, and lack of motivation.
Young people and developmentally appropriate transitional care in rheumatology
Authors: McDonagh Janet E. , Gleeson Helena
Published: August 2020

Young people are distinctly different from children and adults and as such require developmentally appropriate, youth-friendly rheumatology services to meet their medical and psychosocial needs. Adolescent development continues into the third decade of life and both influences and is affected by, health and illness (including) during this time. Effective transitional care in rheumatology is underpinned by the core principles of adolescent medicine, self-management of long-term conditions, and a developmentally appropriate, youth-friendly rheumatology service including staff trained in adolescent and young adult (AYA) health.
The elderly patient
Authors: Birrell Fraser , O’Connell Janice
Published: August 2020

In this chapter, we describe how the process of ageing can itself affect the diagnosis and treatment of musculoskeletal conditions. We outline general principles concerning the clinical presentation of rheumatological diseases in older patients, as well as providing specific guidance on the diagnosis and management of the commoner conditions encountered in practice in the United Kingdom.
Principles of clinical examination in children
Authors: Jandial Sharmila , Foster Helen
Published: August 2020

The clinical examination of children and adolescents is an essential component of assessment, facilitates appropriate interpretation of investigations and is integral to the process of making a diagnosis. The clinical assessment of children and young people differs from that of adults, requiring greater reliance on physical examination as the history may be vague and illocalized and requires knowledge of normal musculoskeletal development, normal motor milestones and different patterns of clinical presentations across the ages. The interpretation of clinical findings needs to be in the context of the whole child and the clinical presentation. The degree of expertise required in clinical skills varies with the clinical practice of the examiner and ranges from the basic screening assessment to a more detailed examination of joints, muscles and anatomical regions. The evidence base for clinical assessment in children and young people is accruing and undoubtedly, competent clinical skills requires learning to be embedded in core child health teaching and assessment starting at medical school and reinforced in postgraduate training.
Spinal pain
Authors: Gaffney Karl , Hamilton Louise
Published: August 2020

Spinal pain is a very common complaint, and one which rheumatologists must be confident in managing. While most cases are non-specific and self-limiting it is important not to miss the small proportion of patients with pain caused by inflammation, infection, or infiltration. A thorough history is of key importance in this respect, and the approach to the patient with back pain is discussed including physical examination and the value of targeting investigations. The management of common and important causes of back pain is outlined.
Cardiovascular system
Authors: Coghlan J. Gerry , Schreiber Benjamin E.
Published: August 2020

Rheumatology, as a specialty that encounters many multisystem diseases, requires knowledge of many of the more exotic cardiovascular conditions including large- and small-vessel vasculitis, pulmonary hypertension, and myopericarditis. In addition, many rheumatology patients will suffer from cardiovascular pathology due to its common nature and association with an older population, since many previously lethal conditions are now associated with better survival. This requires a detailed knowledge of the drug—drug interactions that arise and the off-target consequences of rheumatological therapies that may aggravate atheroma and hypertension. The rheumatologist therefore needs a broad knowledge of cardiovascular diseases.
The kidney
Authors: Little Mark , Salama Alan
Published: August 2020

Kidney dysfunction is common in patients with rheumatological disease, be it secondary to renal (usually glomerular) involvement by a multisystem rheumatological disorder, renal impairment due to nephrotoxic medication use, or incidentally noted during a rheumatological work-up. It is therefore important for the rheumatologist to know how to assess kidney function biochemically and radiologically, to appreciate when an organ-threatening process is present, and to understand the basic steps to take in the event of acute kidney injury. This chapter reviews assessment of kidney function with respect to estimating excretory function, and the degree of proteinuria and haematuria. It provides an in-depth review of the causes, assessment, and management of acute kidney injury as encountered in rheumatological practice, and a summary of the causes and approach to chronic kidney disease.
Design of clinical trials in rheumatology
Authors: Strand Vibeke , Sokolove Jeremy , Chu Alvina D.
Published: August 2020

Development of new therapies for rheumatic diseases requires a series of randomized controlled trials (RCTs) progressing from phase 1, ’first-in-human’ to generate initial safety, pharmacokinetic (PK) and pharmacodynamic (PD) data; to phase 2, proof of concept for efficacy with safety and PK/PD data; and phase 3, designed to demonstrate definitive efficacy and safety to support regulatory approval. Important aspects of RCT designs include selection of patient population, sample size estimations, treatment allocation, rescue, blinding, and statistical analyses of prespecified endpoints to preserve trial integrity. Over the past 20 years, significant progress has been made in the design of RCTs in rheumatoid arthritis (RA). Similarly, development and validation of composite outcome measures in psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), gout, and osteoarthritis (OA) have furthered trial design and treatment approvals. RCTs in systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis and other multisystem, heterogeneous diseases pose more challenges. Trial design will continue to evolve as promising therapies are introduced into the clinic and more therapies are approved for each indication.
Outcomes of paediatric rheumatic disease
Authors: Minden Kirsten
Published: August 2020

Paediatric rheumatic illnesses are among the most common chronic diseases in children and adolescents. These illnesses have important impacts on patient’s body functions and structures, activities, and social participation. Knowledge about the effect and consequences of these diseases is necessary to formulate appropriate aims of treatments. The multidimensional outcomes of paediatric rheumatic diseases and their measurement are reviewed in this chapter.
Outcome measurement is complex in patients who have growing needs and changing expectations as they develop, especially in chronic conditions that have a variable and often unpredictable course, such as juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis. Considerable work has been conducted recently in an effort to better define and value global outcomes for these patients. New and reliable outcome measures have been developed to capture all aspects of the patient’s life and integrate the patients’ perspective.
Existing outcome studies of paediatric rheumatic diseases have consistently shown, even though differing in their methodology, that patient outcomes have improved over the last decade. More patients with chronic inflammatory rheumatic conditions survive into adulthood, and patients’ long-term health, functional, and quality of life outcomes have improved. However, outcomes are still less than ideal. More than one-half of the patients with paediatric rheumatic diseases have ongoing active disease in early adulthood. Over one-third have evidence of disability and organ damage, with each underlying disease being associated with specific complications. Clearly, given the inherent potential for disability, morbidity, even mortality, young people with paediatric-onset rheumatic diseases require ongoing medical care into adulthood.
Basics of genetics
Authors: Barton Anne
Published: August 2020

Genetic factors are important in predisposing to nearly all of the conditions managed by rheumatologists; indeed, musculoskeletal diseases, like other complex diseases, are thought to be caused by environmental triggers in genetically susceptible individuals. Studying genetic susceptibility factors is more straightforward than environmental factors because, first, genetic changes are stable and do not vary throughout life; second, genetic changes exist before disease onset and so could be causative rather than occurring as a result of disease; and, third, genetic variation is easy to measure reliably using modern technologies. By comparison, environmental exposures can occur many years before disease onset, may vary during life, and are hard to accurately capture and measure. Enormous progress has been made in recent years in identifying susceptibility genes. This knowledge may allow better targeting of available therapies, the development of novel therapies, and an improved understanding of what determines disease severity in individual patients. In this chapter, the basic concepts in genetics are explained.
Environment
Authors: Holroyd Christopher R. , Harvey Nicholas C. , Edwards Mark H. , Cooper Cyrus
Published: August 2020

Musculoskeletal disease covers a broad spectrum of conditions whose aetiology comprises variable genetic and environmental contributions. More recently it has become clear that, particularly early in life, the interaction of gene and environment is critical to the development of later disease. Additionally, only a small proportion of the variation in adult traits such as bone mineral density has been explained by specific genes in genome-wide association studies, suggesting that gene-environment interaction may explain a much larger part of the inheritance of disease risk than previously thought. It is therefore critically important to evaluate the environmental factors which may predispose to diseases such as osteorthritis, osteoporosis, and rheumatoid arthritis both at the individual and at the population level. In this chapter we describe the environmental contributors, across the whole life course, to osteoarthritis, osteoporosis and rheumatoid arthritis, as exemplar conditions. We consider factors such as age, gender, nutrition (including the role of vitamin D), geography, occupation, and the clues that secular changes of disease pattern may yield. We describe the accumulating evidence that conditions such as osteoporosis may be partly determined by the early interplay of environment and genotype, through aetiological mechanisms such as DNA methylation and other epigenetic phenomena. Such studies, and those examining the role of environmental influences across other stages of the life course, suggest that these issues should be addressed at all ages, starting from before conception, in order to optimally reduce the burden of musculoskeletal disorders in future generations.
Genetics of rheumatoid arthritis
Authors: Eyre Steve , Orozco Gisela , Worthington Jane
Published: August 2020

A range of epidemiological studies have clearly established that susceptibility to rheumatoid arthritis (RA) is determined by both genetic and environmental factors. Studies over the last five decades have used a variety of approaches to identify the genetic variants associated with disease. HLA-DRB1 was the first RA susceptibility locus to be discovered and has the largest effect size. We describe current understanding of the complexities of HLA association for RA. Linkage and small-scale association studies prior to 2007 provided convincing evidence for only one more RA susceptibility locus, PTPN22. Major breakthroughs in high-throughput genotyping, and systematic discovery and mapping of hundreds of thousands of single nucleotide polymorphisms (SNPs) led to large-scale genome-wide association studies used for the first time for RA in 2007. Widespread utilization of this approach has had a dramatic impact on our knowledge of the susceptibility loci for RA, such that over 100 risk variants have now been robustly identified. We present an overview of these studies and the loci that have been identified. We consider how this knowledge is contributing to a greater understanding of the aetiology and pathology of the disease, and in turn how this can influence management of patients presenting with an inflammatory arthritis. We consider some of the unanswered questions and the approaches that will need to be taken to address them.
Genetics of chronic musculoskeletal pain
Authors: Nair Nisha , Holliday Kate L. , Thomson Wendy , McBeth John
Published: August 2020

Chronic pain disorders are prevalent and a large burden on health care resources. Around 10% of the general population report chronic widespread pain, which is the defining feature of fibromyalgia. Fibromyalgia is a poorly understood idiopathic disorder which is also characterized by widespread tenderness and commonly occurs with comorbid mood disorders, fatigue, sleep disturbance, and cognitive dysfunction.
A role for genetics in chronic pain disorders has been identified by twin studies, with heritability estimates of around 50%. Susceptibility genes for chronic pain are likely to be involved in pain processing or the psychological component of these disorders. A number of genes have been implicated in influencing how pain is perceived due to mutations causing monogenic pain disorders or an insensitivity to pain from birth. The role of common variation, however, is less well known. The findings from human candidate gene studies of musculoskeletal pain to date are discussed. However, the scope of these studies has been relatively limited in comparison to other complex conditions.
Identifying susceptibility loci will help to determine the biological mechanisms involved and potentially new therapeutic targets; however, this is a challenging research area due to the subjective nature of pain and heterogeneity in the phenotype. Using more quantitative phenotypes such as experimental pain measures may prove to be a more fruitful strategy to identify susceptibility loci. Findings from these studies and other potential approaches are discussed.
Cellular side of acquired immunity (B cells)
Authors: Dörner Thomas , Lipsky Peter E.
Published: August 2020

B cells have gained interest in rheumatoid arthritis (RA) beyond being the precursors of antibody-producing plasma cells since they are also a broader component of the adaptive immune system. They are capable of functioning as antigen-presenting cells for T-cell activation and can produce an array of cytokines. Disturbances of peripheral B-cell homeostasis together with the formation of ectopic lymphoid neogenesis within the inflamed synovium appears to be a characteristic of patients with RA. Enhanced generation of memory B cells and autoreactive plasma cells producing IgM-RF and ACPA-IgG antibodies together with formation of immune complexes contribute to the maintenance of RA, whereas treatment with B-cell-directed anti-CD20 and CLTA4-Ig therapy provides clinical benefit.
Enthesitis
Authors: Rudwaleit Martin
Published: August 2020

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents and other biologics have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.
Skeletal muscle physiology and damage
Authors: Dinser Robert , Müller-Ladner Ulf
Published: August 2020

This chapter summarizes muscle structure and physiology, the genesis and adaptions of muscle throughout life, and clinical assessment of muscle disease. The anatomical and molecular structure of muscle tissue is described, as well as the basic function of the neuromuscular junction, the energy metabolism of muscle tissue, and the mechanisms of fatigue. Key elements of embryological myogenesis, the adaptions of muscle to exercise and damage, and physiological ageing are depicted. A summary of the clinical analysis of muscle function including laboratory, electrophysiological, and imaging testing is provided.
Complement
Authors: Pickering Matthew C. , Bakshi Jyoti
Published: August 2020

In this chapter we summarize clinically important aspects of complement biology. This information is used to present a comprehensive overview of complement deficiency states and provide a logical basis for understanding complement assays in clinical practice. Hypocomplementaemic urticarial vasculitis syndrome, a condition associated with anti-C1q antibodies and complement consumption, is discussed. We summarize the use of eculizumab, a monoclonal antibody that targets and inhibits complement C5, in the treatment of haemolysis in paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome.
Radiographic imaging
Authors: Rowbotham Emma L. , Grainger Andrew J.
Published: August 2020

Plain film radiography is often the first imaging modality employed in the assessment of patients with a rheumatological condition. More recently this has been superseded by cross-sectional imaging, in particular ultrasound and MRI, which have improved sensitivity in detection of early disease when compared with plain film imaging. However, there remains a role for conventional radiography in both the initial diagnosis and monitoring of disease progression. A standard approach to assessing radiographs in the context of arthropathy is usually employed by radiologists; by following this structured review a diagnosis or narrow differential may be reached on plain film imaging alone. Plain film radiograph findings of the most common rheumatological disorders are covered in detail in this chapter including osteoarthritis, the inflammatory arthritides, and crystal arthropathy. Findings in the connective tissue disorders are then covered, followed by less commonly encountered conditions such as SAPHO, neuropathic arthropathy, and haemochromotosis.
Ultrasound
Authors: Kane David , Platt Philip
Published: August 2020

Musculoskeletal ultrasound (MSUS) is now a standard part of many rheumatologists’ daily clinical practice. MSUS is safe, increasingly widely available, relatively low cost, non-invasive, and hence very acceptable to the patient. Current problems with availability of training, mentoring, and accreditation procedures need to be overcome for MSUS to reach its full potential for rheumatologists. MSUS is capable of improving clinical diagnosis and the accuracy of intervention. MSUS is more sensitive than clinical examination in the detection of synovitis and effusion and is capable of rapid targeted assessment of widely spaced joints coupled with immediate clinical correlation. MSUS has advantages over other imaging modalities; the ability to display dynamic real-time movement makes it the imaging modality of choice for tendon problems. It is significantly more sensitive than plain radiology in the demonstration of early erosive changes, and although its sensitivity is less than that of MRI for the detection of erosions it is far more practical, timely, and available. The combination of sensitivity in detection of synovitis, tenosynovitis, and erosions makes it an ideal imaging modality in the context of an early arthritis clinic. Power Doppler has been shown to be an effective way of evaluating synovitis and hence is of value in early diagnosis and monitoring of inflammatory arthritides. The accuracy of placement of local injection therapies is enhanced by MSUS, and it significantly increases the diagnostic success rate of aspiration of joints and bursas. The flexibility of ultrasound as a tool for rheumatologists is shown by its application in the assessment of vasculitides, peripheral nerve pathology, salivary glands, and skin lesions.
Imaging in children
Authors: Gerety Emma , Johnson Karl
Published: August 2020

The radiological findings of the rheumatological conditions that occur in childhood, are in the majority of cases similar to those in the adult. However, there are some specific and unique features seen only in the paediatric population. Often these features reflect the immature nature of the child’s skeleton and the fact that growth is not yet complete. Radiology is important in helping to establish the diagnosis and in the long-term management of the child. The most appropriate test, promptly performed and avoiding the child unnecessary discomfort, is the ideal. An understanding of the disease process, as well as the advantages and the limitations of each imaging modality, by both clinician and radiologist, is important. Collaboration between the requesting physician and radiologist will improve the quality of the service provided to the child.
Multidisciplinary treatment
Authors: Ryan Sarah , Adams Jo , O’Brien Anne , Williams Anita
Published: August 2020

Multidisciplinary treatment is required to optimize the physical, psychological, and social function of people living with a long-term musculoskeletal condition. Multidisciplinary treatment is usually provided by a team which includes doctors, nurses, and allied health professionals. Each member of the team provides their own unique contribution with the shared goal of suppressing the activity and impact of the condition while educating and supporting people to manage their own symptoms effectively. This chapter focuses on treatment from the perspective of four disciplines: nursing, physiotherapy, occupational therapy, and podiatry.
Immunosuppressants
Authors: Ledingham Joanna , Westlake Sarah
Published: August 2020

A variety of immunosuppressants and disease-modifying anti-rheumatic drugs (DMARDs) with beneficial effects on inflammatory rheumatic diseases have been identified over the last 50 years. Their use for these conditions is now well established and has led to considerable improvements in disease management. Their use earlier in the inflammatory disease process and the use of combination therapies have also led to significantly improved patient outcomes.
This chapter provides an overview of the immunosuppressants and DMARDs used to treat rheumatic disease, focusing particularly on those in common use and with the best evidence for efficacy. The mechanism of action, toxicity, and clinical indications are outlined. Tips for practical prescribing and for monitoring for potential complications are also included.
Transient gravitational waves from pulsar post-glitch recoveries
Authors: Yim Garvin , Jones D I
Published: August 2020

This work explores whether gravitational waves (GWs) from neutron star (NS) mountains can be detected with current second-generation and future third-generation GW detectors. In particular, we focus on a scenario where transient mountains are formed immediately after an NS glitch. In a glitch, an NS’s spin frequency abruptly increases and then often exponentially recovers back to, but never quite reaches, the spin frequency prior to the glitch. If the recovery is ascribed to an additional torque due to a transient mountain, we find that GWs from that mountain are marginally detectable with Advanced LIGO at design sensitivity and is very likely to be detectable for third-generation detectors such as the Einstein Telescope. Using this model, we are able to find analytical expressions for the GW amplitude and its duration in terms of observables.
TESS light curves of γ Cas stars
Authors: Nazé Yaël , Rauw Gregor , Pigulski Andrzej
Published: August 2020

γ Cas stars constitute a subgroup of Be stars showing unusually hard and bright X-ray emission. In search for additional peculiarities, we analysed the TESS light curves of 15 γ Cas analogues. Their periodograms display broad frequency groups and/or narrow isolated peaks, often superimposed over red noise. The detected signals appear at low frequencies, with few cases of significant signals beyond 5 d−1 (and all of them are faint). The signal amplitudes, and sometimes the frequency content, change with time, even in the absence of outburst events. On the basis of their optical photometric variability, γ Cas stars reveal no distinctive behaviour and thus appear similar to Be stars in general.
Teaching and Learning Decision-Making in Child Welfare and Protection Social Work
Authors: Taylor Brian J.
Published: August 2020

This chapter begins with reflections on the author’s own “journey into risk and decision-making” during 10 years of practice and 25 years teaching social workers on this topic. Challenges in teaching and learning the knowledge and skills required for professional judgment in child welfare and protection are considered in terms of models of decision-making and models of cognitive learning processes. This is illustrated with aspects of teaching about decision-making on qualifying and post-qualifying social work courses in Northern Ireland, such as relating understandings of professional judgment and decision-making processes to assessment and care planning practice; legal aspects of making reasonable, reasoned decisions; understanding the value of and challenges in using statistical data on risk factors within decision-making; using models of professional judgment to reflect on practice; ensuring role clarity; and developing skills in engaging other professionals in decision processes. The chapter concludes with a discussion of future directions in learning and teaching about professional judgment in child welfare and protection, including (1) the science of decision-making (including use of risk factors), (2) the art of decision-making (including understanding judgment processes using psychosocial rationality concepts), (3) evidencing what works in terms of teaching decision-making, and (4) building a knowledge base to inform teaching.
People
Authors: Miller Kenneth P.
Published: August 2020

Chapter 3 argues that demography is not, by itself, “destiny.” The two states’ demographic characteristics cannot fully explain their political polarization. Based on Census-level categories, the two states look much alike. Among other similarities, they are the nation’s most populous states and both are highly urbanized and majority-minority. In both Texas and California, the white share of the population has plunged; the percentage of African Americans has remained relatively steady; the number of Asians has increased rapidly; and Hispanics have achieved the greatest population gains—now nearly 40 percent of both states. Although growing racial diversity contributed to California’s conversion to the Democratic Party, it has not yet produced similar results in Texas. Whites vote very differently in the two states, and, to a lesser degree, so do Hispanics. Demography alone is not political destiny—other factors are at play.
How California Turned Blue
Authors: Miller Kenneth P.
Published: August 2020

This chapter describes California’s transformation into a deep blue state. For many years, the Republican Party was the dominant force in California politics. Yet the state was never overwhelmingly conservative. It was a leader of the national Progressive movement of the early twentieth century and for decades continued to support a range of liberal policies even under Republican governors. Democrats began to gain ground in the 1950s and the two parties were highly competitive in the four decades between 1958 and 1998. In the 1990s, California began to shift from a competitive two-party system to Democratic control. Changes in the state’s demographics, economy, and culture contributed to this transformation. Once the parties polarized along ideological lines, California more naturally aligned with the party of the left. Democrats have now gained near total control over California, making it the nation’s most consequential blue state.
Rival Models
Authors: Miller Kenneth P.
Published: August 2020

This chapter discusses how gaining one-party control of state government (also known as a “trifecta”) has allowed the governing coalitions in Texas and California to develop their contrasting policy models. The Texas Republican coalition includes business interests, libertarians, and social conservatives. These groups are unified in their commitment to small government, low taxes, and light regulations, but sometimes divide over social issues. In California, the governing Democratic coalition includes organized labor, environmentalists, social progressives, and advocates of minority rights. This coalition broadly agrees on the state’s fusion of progressive economic, social, and environmental goals, but sometimes disagrees on how to manage trade-offs between them. The chapter compares these coalitions’ effectiveness in shaping state policy and describes how both states have intensified their efforts to influence federal policy, especially through federal litigation.
Energy and Environment
Authors: Miller Kenneth P.
Published: August 2020

This chapter examines the deep Texas-California divide over energy and environmental policies. The modern Texas economy was built on energy, and the state remains the nation’s leading producer. The state’s development of fracking has revolutionized the oil and gas industry and has helped the nation break its dependence on foreign oil. Texas has also increased its production of renewable energy, but believes the global economy will rely for the foreseeable future on fossil fuels and resists restrictions on these resources. California, by contrast, has become a global leader in the fight against climate change. It has aggressively regulated carbon emissions and mandated a massive switch to renewable energy sources. California is the only state that can impose emissions regulations more strict than federal standards. As power has shifted in Washington, California has alternated between translating its environmental policies into federal law and defending its policies from federal challenge.