bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular Treatment of Basilar Artery Stenosis
Authors: Haas Leandro José , Przysiezny Bernardo , Mees Wallace , Camilo Liz Caroline de Oliveira , Schuster Anna Lydia , Domingos João Pedro Latrônico
Published: November 2023

Objective To analyze epidemiological characteristics and therapeutic evolution of patients with basilar artery (BA) stenosis who underwent endovascular therapy in a reference service.

Methods Observational retrospective study of a case report of individuals with BA stenosis who underwent endovascular therapy in an endovascular neurosurgery reference service, between November 2005 and May 2018.

Results The prevalence was higher among male patients, with 60% of the cases. As for age, it ranged from 18 to 81 years old, with a mean of 60.2 years old. In terms of comorbidities, systemic arterial hypertension was found in 93% of the patients, and dyslipidemia in 86.7%. The initial symptoms were previous history of ischemic cerebrovascular accident (CVA) in 43.3% of the cases and dizziness in 46.7%. The degree of stenosis ranged from 90 to a 98% of obstruction, with a mean of 92.8%. Neurological deficit was observed in 23.3% of the cases postoperatively, and the postoperative death rate was 10% (3/30). There were no intraoperative adverse events.

Conclusion The applicability of endovascular stenting therapy in high-grade BA stenosis proved to be a safe and effective technique with lower morbimortality rates and faster recovery.
Traumatic Brain Injury: in-hospital Survival Rates and the Main Predictors of in-hospital Mortality in Northeastern Brazil*
Authors: Pereira Diego Henrique Gois , Neto José Nolasco de Carvalho , Melo Thaís Cristina de Souza , Santos Catharine Natielle Oliveira Dias Belarmino dos , Silva Elisa Ribeiro Carvalho , Oliveira Arthur Maynart Pereira , Santos Bruno Fernandes de Oliveira
Published: November 2023

Introduction Upper middle-income countries have epidemiological peculiarities that should be considered to identify the main predictive factors of intrahospital mortality regarding traumatic brain injury (TBI) to address modifiable problems.

Objective To assess the in-hospital survival of patients with TBI and to identify the predictors of in-hospital death.

Methods This is a retrospective dynamic cohort study of victims of TBI who were admitted to the Hospital de Urgência de Sergipe (HUSE, in the Portuguese acronym) between March 1, 2017 and April 29, 2018. The outcome considered was in-hospital death from any cause. Cox regression was used to assess predictors of in-hospital mortality.

Results The sample comprised 596 patients, with a median age of 31.0 (12–94) years old, 504 (84%) of whom were men. Regarding TBI severity, 250 had mild TBI; 121 had moderate TBI; and 225 had severe TBI. The average follow-up was 20.6 ± 4.0 days, with 60 in-hospital deaths and a 30-day mortality of 22.9%. Four independent predictors of in-hospital death were identified: acute subdural hemorrhage (ASDH) (risk ratio [RR] = 1.926; 95% confidence interval [CI] = 1.15–3.22; p = 0.013), swelling (risk ratio [RR] = 3.706; 95%CI = 2.21–6.19; p < 0.001), skull fracture (RR = 2.551; 95%CI = 1.36–4.75; p = 0.003), and severe TBI (RR = 2.039; 95%CI = 1.29–4.12; p = 0.005).

Conclusions Acute subdural hemorrhage, swelling, skull cap fracture, and a Glasgow Coma Scale score of < 9 at admission were independent predictors of in-hospital mortality in patients with TBI.
Use of a Modified Intramedullary Pinning Technique for Distal Femoral Physeal Salter–Harris Type I and II Fracture Management: A Retrospective Study of 31 Cats
Authors: Bondonny Laura , Jacqmin Maxime , Ferrand François-Xavier , Taroni Mathieu , Rivier Pablo
Published: November 2023

Objective To report a modified intramedullary pinning technique, and associated outcomes, for distal femoral physeal Salter–Harris type I and II fracture management in cats.

Study Design Retrospective study including client-owned cats presented between November 2014 and February 2022 with distal femoral physeal fractures treated with an intramedullary pin and one antirotational pin inserted in the lateral femoral condyle. Collected data included signalment, fracture characteristics according to the Salter–Harris classification, surgical data (intramedullary and antirotational pin sizes), and outcome data (radiographic and functional outcomes and complications).

Results Thirty-one cats were included in this study. Bone healing was radiographically confirmed 6 to 8 weeks postoperatively in all cases. The majority of cats (30/31) were classified as full functional outcomes at mid-term follow-up. The overall mid-term complication rate was 3% (1/31). Implant migration was not observed and implant removal was not needed in any case.

Conclusion The modified intramedullary pinning technique for distal femoral Salter–Harris I and II fracture management in cats was associated with an full functional outcome.
Epitaxial growth of black phosphorene monolayer on ZnO(110) substrate
Authors: Zhao Chengyu , Zhang Mingjun , Zhao Songtao , Li Zhenyu
Published: November 2023

As a new generation of semiconductor materials, two-dimensional black phosphorene (BlackP) has broad application prospects because of its tunable band gap and high carrier mobility. However, BlackP cannot be directly prepared on a large scale at present, which limits its further research and application. Molecular beam epitaxy is a widely used way to grow single crystal films with higher epitaxial quality, which is promising for preparing BlackP. Herein, four potential substrates ZnO(110), GaN(110), BP(110) and SiC(110) were screened, and the growth of BlackP on these substrates was studied based on first principles. Our study shows that the structure of black phosphorus monolayer on ZnO(110) is stable and P diffusion on this surface has desirable properties for BlackP growth. This study provides useful guidances for the effective preparation of BlackP and the growth of other two-dimensional materials.
Anionic clusters produced in low-energy electron irradiation of methanol liquid
Authors: Chen Ziwei , Li Ziyuan , Tian Shan Xi
Published: November 2023

In the low-energy electron impacts with a liquid beam of methanol, we detect the anionic yields using a linear time-of-flight mass spectrometer. With help of quantum chemistry calculations, we further identify these anionic products as the hydrogenbonding clusters, i.e., CH3OH·CH3O− and CH3OH·CH3OH·CH3O−, and their singly occupied molecular orbitals show the valence-bound feature. In contrast, CH3OH·CH3OH− and CH3OH−CH3OH·CH3OH− are unfavored in energetics with respect to the dehydrogenated ones, although they also correspond to the minima on the potential energy surfaces. Furthermore, the singly occupied molecular orbitals of CH3OH·CH3OH− and CH3OH·CH3OH·CH3OH− indicate the typical feature of aqueous-solvated electron.
Enhanced photocatalytic performance of anatase TiO2 by deposition-precipitation treatment
Authors: Wan Mengqi , Wen Qian , Ci Mengyi , Li Wangyang , Zhang Zhen
Published: November 2023

Deposition-precipitation (DP) method is commonly used to prepare the supported metal catalysts. In this study, the modification effect of the mild DP method on the photocatalytic performance of TiO2 was investigated. The TiO2 samples with DP treatment, as well as Au/TiO2 prepared under the same conditions, showed enhanced photocatalytic performance of the degradation of methylene blue (MB). · OH generated by photoexcited holes is identified as the main intermediate reactive species during the degradation reaction. X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared spectroscopy (FTIR) show that TiO2(A)-17 after DP treatment has the most amount of surface OHad− species. The presence of surface OHad− species not only changes the surface zeta potential, favoring the attraction of cationic MB; but also depresses the electron-hole recombination, favoring photodegradation of MB by hole-produced • OH. An implication of these findings is that the modification of support properties should be taken into account while preparing supported metal catalysts using DP methods.
Modulating interlayer and intralayer excitons in WS2/WSe2 van der Waals heterostructures
Authors: Ge Cuihuan , Huang Lanyu , Zhang Danliang , Tong Qingjun , Zhu Xiaoli , Wang Xiao , Pan Anlian
Published: November 2023

Intralayer and interlayer excitons are fundamental quasiparticles that can appear simultaneously in transition metal dichalcogenide van der Waals heterostructures. The understanding and modulation of the interaction of interlayer and intralayer excitons are of great importance for both fundamental studies and device applications. Here, we demonstrate the modulation of photoluminescence (PL) emissions of interlayer and intralayer excitons in WSe2/WS2 heterostructures using different stacking configurations in a single sample, including with and without hexagonal boron nitride (hBN) encapsulation and different hBN spacing layers. By temperature dependent PL spectroscopy, we observed the suppression of interlayer exciton formation and exciton complexes at high temperatures due to enhanced phonon scattering. We also verify the formation of these states via power dependent spectroscopy. Our electric field and doping dependent PL studies reveal that the interlayer exciton peaks shift linearly with the applied gate voltage and the intralayer excitons of WSe2 (WS2) are dominant at high n-doping (p-doping). Our results contribute to the understanding of the interplay between interlayer and intralayer excitons in WSe2/WS2 heterostructures and could promote the related exitonic device applications.
Pulsed laser ablation synthesis of Cu-based and Ni-based nanostructured electrodes for highly active alkaline oxygen and hydrogen evolution reactions
Authors: Iacono V. , Lo Pò C. , Scalese S. , Boninelli S. , Condorelli G. G. , Grimaldi M. G. , Ruffino F.
Published: November 2023

In the field of sustainability, hydrogen (H2) is considered a clean fuel and a renewable energy source with no pollutant emissions. The production of H2 by water electrolysis is well-known among the scientific community. Still, alkaline electrolysis represents a challenging process and requires expensive materials have to be avoided in order to lower the impact of H2 production. This work deals with the production of copper (Cu) and nickel (Ni) nanoparticles (NPs) as catalysts for alkaline water splitting reactions. These NPs are synthesized using the pulsed laser ablation in liquid involving the ablation of Cu and Ni targets in methanol and ethanol. The morphological, structural, and compositional properties of the obtained NPs are studied. Then, a low amount of NPs-based catalyst (∼1μg/cm2) was loaded onto a nickel foam substrate and tested for both alkaline Hydrogen Evolution Reaction (HER) and Oxygen Evolution Reaction (OER). The best performance at 10 mA cm−2, in terms of overpotential (η), for OER was shown by Ni NPs, η = 327 mV, while for the HER, Cu NPs reached η = 211 mV at 10 mA cm−2 in aqueous 1M KOH. The ultra-low amount of the catalyst material makes these electrodes challenging in terms of mass activity [up to 14 A/mg at 10 mA cm−2] compared to the state of the art. In addition, the correlation between overpotential and the availability of electrons at the surface of the catalyst for H2 production was studied by using Mott–Schottky analysis.
Optimal protocols for entangling gates inN-qubit atomic systems
Authors: Sola Ignacio R. , Shin Seokmin , Chang Bo Y.
Published: November 2023

We use a novel optimization procedure that includes the temporal and spatial parameters of the pulses acting on arrays of trapped neutral atoms to prepare entangling gates in N-qubit systems. The spatiotemporal control allows treating a denser array of atoms, where each pulse acts on a subset of the qubits, potentially allowing to speed up the gate operation by two orders of magnitude by boosting the dipole-blockade between the Rydberg states. Studying the rate of success of the algorithm under different constraints, we evaluate the impact of the proximity of the atoms and, indirectly, the role of the geometry of the arrays in three and four-qubit systems, as well as the minimal energy requirements and how this energy is used among the different qubits. Finally, we characterize and classify all optimal protocols according to the mechanism of the gate using a quantum pathway analysis.
Learning from the 4-(dimethylamino)benzonitrile twist: Two-parameter range-separated local hybrid functional with high accuracy for triplet and charge-transfer excitations
Authors: Grotjahn Robin
Published: November 2023

The recent ωLH22t range-separated local hybrid (RSLH) is shown to provide outstanding accuracy for the notorious benchmark problem of the two lowest excited-state potential energy curves for the amino group twist in 4-(dimethylamino)benzonitrile (DMABN). However, the design of ωLH22t as a general-purpose functional resulted in less convincing performance for triplet excitations, which is an important advantage of previous LHs. Furthermore, ωLH22t uses 8 empirical parameters to achieve broad accuracy. In this work, the RSLH ωLH23ct-sir is constructed with minimal empiricism by optimizing its local mixing function prefactor and range-separation parameter for only 8 excitation energies. ωLH23ct-sir maintains the excellent performance of ωLH22t for the DMABN twist and charge-transfer benchmarks but significantly improves the errors for triplet excitation energies (0.17 vs 0.24 eV). Additional test calculations for the AE6BH6 thermochemistry test set and large dipole moment and static polarizability test sets confirm that the focus on excitation energies in the optimization of ωLH23ct-sir has not caused any dramatic errors for ground-state properties. Although ωLH23ct-sir cannot replace ωLH22t as a general-purpose functional, it is preferable for problems requiring a universally good description of localized and charge-transfer excitations of both singlet and triplet multiplicity. Current limitations on the application of ωLH23ct-sir and other RSLHs to the study of singlet-triplet gaps of emitters for thermally activated delayed fluorescence are discussed. This work also includes the first systematic analysis of the influence of the local mixing function prefactor and the range-separation parameter in an RSLH on different types of excitations.
Noise-assisted transport mechanism analysis and synaptic characteristics in ZrOX/HfAlOX-based memristor for neuromorphic systems
Authors: Heo Jungang , Cho Youngboo , Ji Hyeonseung , Kim Min-Hwi , Lee Jong-Ho , Lee Jung-Kyu , Kim Sungjun
Published: November 2023

In this work, we compare the resistive switching characteristics between Ti/ZrOX/TiN and Ti/ZrOX/HfAlOX/TiN. The bilayer structure of the ZrOX-based device enables power consumption reduction owing to a lower forming voltage and compliance current. Moreover, the on/off ratio of the Ti/ZrOX/HfAlOX/TiN device (>102) is higher than that of the Ti/ZrOX/TiN device (>10). We use the 1/f noise measurement technique to clarify the transport mechanism of the Ti/ZrOX/HfAlOX/TiN device; consequently, ohmic conduction and Schottky emission are confirmed in the low- and high-resistance states, respectively. In addition, the multilevel cell, potentiation, and depression characteristics of the Ti/ZrOX/HfOX/TiN device are considered to assess its suitability as a neuromorphic device. Accordingly, a modified National Institute of Standards and Technology database simulation is conducted using Python to test the pattern recognition accuracy.
Prediction of elastic wave propagation in composites using 3D CNN
Authors: Xu Xiaoming , Wei Jianjun , Sang Sheng
Published: November 2023

Performing time-dependent finite element simulations for wave propagation in composites is a particularly complex task that consumes a lot of computational energy as it involves modeling the interactions between waves and various constituents that make up the composite material. In this study, we have developed a surrogate model of elastic wave propagation in composites based on three-dimensional conventional neural networks. The input to the model consists of a three-dimensional matrix representing the architecture of the composites and a vector representing the input waves, while the output is a vector representing the output elastic waves. After training the model using 60 000 randomly generated samples, it has shown high accuracy and efficiency in predicting the output elastic waves. This significantly reduces computational resources required to conduct simulation using commercial software, making it a more practical solution for real-world applications, such as composite optimization, nondestructive testing, and material characterization.
Coffee Leaf Rust: Wreaking Havoc in Coffee Production Areas Across the Tropics
Authors: Koutouleas Athina
Published: November 2023

Coffee (
Coffea
spp.) originates from the tropical montane rainforest understorey. In this shaded environment, the coffee plant has co-evolved with a wide array of pests and diseases. The fungal pathogen
Hemileia vastatrix
is the most notorious of all known coffee plant diseases. With a rich history rooted in colonial trade and power struggles,
H. vastatrix
has had its lion’s share of research and scrutiny by the plant pathology community. Though this disease was discovered more than 150 years ago, many unknowns concerning its spread and persistence across the tropics still exist today. Despite its relevance to coffee production, there is little global data that synthesizes the impact of this disease on coffee yield and plant health. Best practices for control of coffee leaf rust are contentious. Genetic resistance has been breaking down in cultivars across the coffee belt over the past decade. How can farmers best control outbreaks of the disease? Are these practices at odds with new trends and challenges in coffee farming (e.g. organic, biodiversity-friendly, agroforestry etc.). What are the future prospects of our global coffee supply under pressure from this rampant disease? All these questions are examined in this case study using pertinent literature sources and supplemented by coffee farmers or extension service providers in Latin America and Africa.

Information

© The Author 2023

Cover photo courtesy of the author.
Final report, on-going key comparison BIPM.QM-K1, ozone at ambient level, comparison with NIMT, September 2022
Authors: Viallon Joële , Idrees Faraz , Moussay Philippe , Wielgosz Robert , Norris James , Trask Peter , Laongsri Bunthoon
Published: November 2023

Main text

As part of the ongoing key comparison BIPM.QM-K1, a comparison has been performed between the ozone national standard of Thailand maintained by the National Institute of Metrology (Thailand) (NIMT) and the common reference standard of the key comparison, maintained by the Bureau International des Poids et Mesures (BIPM). The instruments have been compared over a nominal ozone amount fraction range of 0 nmol mol−1 to 500 nmol mol−1.

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/.

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Periodic trajectories in planar discontinuous piecewise linear systems with only centers and with a nonregular switching line
Authors: Alves A M , Euzébio R D
Published: November 2023

In this paper periodic trajectories of dynamical systems presenting discontinuities are studied. The considered model consists of two distinct linear differential systems, each one containing a single equilibrium point of centre type. Each system is defined on disjoint regions of the plane, the separation line is a union of two half-straight lines contained on the coordinate axes. The obtained differential system is non-smooth, so we apply Filippov’s theory to study the transitions from one dynamical system to another. The combination of the two linear plus the Filippov system acting on the separation line generates a nonlinear regime observed by the presence of limit cycles, sliding and tangential periodic trajectories as well as the coexistence of such objects. In theorem 1 we establish the location, stability and hyperbolicity of limit cycles for certain classes of the considered model. In theorem 2 we perform the global analysis of a representative model through bifurcation theory to analyse the birth of limit cycles, sliding periodic trajectories and tangential ones. We also provide some results addressing the coexistence of periodic trajectories and two potential physical interpretations of the model considered in the paper, one addressing nonlinear oscillations and the other considering slow-fast systems of neuron models. The main techniques employed to obtain the results are first integrals, Poincaré half return maps, and elements of bifurcation theory.
Leaf ontogeny modulates epinasty through shifts in hormone dynamics during waterlogging in tomato
Authors: Geldhof Batist , Novák Ondřej , Van de Poel Bram
Published: November 2023

Waterlogging leads to hypoxic conditions in the root zone that subsequently cause systemic adaptive responses in the shoot, including leaf epinasty. Waterlogging-induced epinasty in tomato has long been ascribed to the coordinated action of ethylene and auxins. However, other hormonal signals have largely been neglected, despite evidence of their importance in leaf posture control. To cover a large group of growth regulators, we performed a tissue-specific and time-dependent hormonomics analysis. This revealed that multiple hormones are differentially affected throughout a 48 h waterlogging treatment, and that leaf age determines hormone homeostasis and modulates their changes during waterlogging. In addition, we distinguished early hormonal signals that contribute to fast responses to oxygen deprivation from those that potentially sustain the waterlogging response. We found that abscisic acid (ABA) levels peak in petioles within the first 12 h of the treatment, while its precursors only increase much later, suggesting that ABA transport is altered. At the same time, cytokinins (CKs) and their derivatives drastically decline during waterlogging in leaves of all ages. This drop in CKs possibly releases the inhibition of ethylene- and auxin-mediated cell elongation to establish epinastic bending. Auxins themselves rise substantially in the petiole of mature leaves, but mostly after 48 h of root hypoxia. Based on our hormone profiling, we propose that ethylene and ABA might act synergistically as an early signal to induce epinasty, while the balance of indole-3-acetic acid and CKs in the petiole ultimately regulates differential growth.
Home-care services in Italy (with special reference to Genoa)
Authors: Costanzi Carla
Published: November 2023

The first home-care services in Italy were set up in 1972 in some local authorities in the north, and towards the end of the decade in the centre and south of the country. In the north, local authorities often organized this service without any regional direction. In the south it was developed as a result of regional legislation surrounding the setting up of local health authorities, which followed the institution of the National Health Service under National Law No. 833 of 1978. Almost all the regional legislation directed the service specifically towards the elderly.
Home-care services in the Netherlands
Authors: Heuvel Wim van den , Gerritsen Hans
Published: November 2023

In the Netherlands, the home-help service is largely subsidized by the government. Up to 1989 the money was allocated from general tax revenue to private organizations by the Ministry of Health, Welfare and Culture. Since January 1989, services have been funded through the Exceptional Medical Expenses Scheme (AWBZ). The AWBZ is a law which originally applied to long-term care (nursing homes; care longer than one year in general or psychiatric hospitals), but which now, under the reconstruction of the Dutch health insurance system, is gradually being extended to cover a large part of the costs of all health and social-care services (Commissie Structuur en Financiering 1987).
Trends in home-care policies
Authors: Jamieson Anne
Published: November 2023

All the chapters on home-care provision in individual countries discuss problems and shortcomings in that provision. But what exactly have been the successes and failures in the different countries? There is, of course, no one way of measuring this, but I will try to summarize some of the trends discussed by the different contributors in order to get some way towards an understanding of policies and their implementation.
Everyday life in institutional care: an evaluation of hospital and nursing home care for the elderly in City and Hackney
Authors: Bowling Ann , Formby Juliet
Published: November 2023

There is increasing interest among policy makers in the United Kingdom (UK) in the concept of the nursing home as an alternative to long-stay geriatric wards. Such homes are run, clinically and administratively, by qualified nurses. They cater for patients who need continuous, non-psychiatric nursing care to a degree that cannot be provided in the community, but who do not need the full range of hospital facilities or active medical treatment. Nursing homes aim to have a domestic atmosphere and an environment to enable frail and dependent patients to maintain their individuality and dignity. They are run flexibly and are not bound by rigid timetables for eating and waking. Nursing homes aim to offer principally nursing care, with an emphasis on the maintenance of residual abilities through appropriate stimulative and recreational activities. They also aim to meet the emotional, psychological, and spiritual needs of patients, and to provide relief of pain and other features associated with terminal care.
Incontinence and the older woman
Authors: Mandelstam Dorothy
Published: November 2023

Although incontinence is an age old problem with references to it being found in early Egyptian writings, it is only in the last twenty years or so that the problem has been addressed. It is estimated that it affects over two million people in the United Kingdom at any one time, but the very nature of the subject often inhibits progress being made into the aetiology and management of the problem. The simple message for the lay person is that incontinence is a common symptom and that it is treatable. A dilemma exists, however, in that by fostering an increased awareness and a consequent demand for treatment, the medical and nursing professions will be largely unable to respond because of inadequate knowledge. This results in negative attitudes. Ignorance of the subject is hard to admit.
Women, sex, and ageing
Authors: Greengross Wendy
Published: November 2023

Women who are now in their sixties, seventies, and older are the ones who seem to have missed out on most of the sexual revolutions for most of their lives.
Depressed mood in older women
Authors: Cattell Howard , Wilkinson Greg
Published: November 2023

In addition to the physical and social developments that accompany ageing come disturbances in psychological functioning, of which disturbances in mood occupy prime importance. By convention clinical mood disorders include depression and anxiety, but depression is by far the commoner and it is with this condition, as it affects older women, that this review is concerned.
Elder abuse
Authors: Bennett Gerald
Published: November 2023

The subject of elder abuse, ‘discovered’ in the 1980s and destined to become one of the major socio-medical issues of the 1990s, has become the focus of many attempts at a definition. Eastman (1984), in his book Old Age Abuse, set a template with his definition, ‘The physical, emotional, and psychological abuse of an older person by a formal or informal carer. The abuse is repeated and is the violation of a person’s human and civil rights by a person or persons who have power over the life of a dependent’ .
Thetreatment of infection
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

This chapter turns to the question of treatment of infection and in particular the use of antibiotics. In the period 1977-87, about 50 million prescriptions for antimicrobial agents were written in the UK representing 12.5% of all prescriptions.1 Over the period 1980-91 there was an overall increase of 45.8% in England for the number of prescriptions for antibiotics with the greatest rise in prescriptions for quinolones.2 The decision to treat a patient with antibiotic therapy should not be entered into lightly. Reaching for the prescription pad to offer a patient antibiotic therapy unnecessarily must be one of the commonest ways that harm is done to patients in modern general practice.
Infections of the gastrointestinal tract
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

Infections of the gastrointestinal tracl arc common and important problems in general practice. As well as the everyday event of patienb presenting with diarrhoea and vomiting, newer infections such as hepatitis-C or Helicobactcr pylori infections require attention and increasingly, imported infections and infestations must be dealt with by the GP.
Hormone Replacement Therapy
Authors: Daly Edel , Vessey Martin
Published: November 2023

Diseases of the circulatory system are the leading causes of death and serious illness among post-menopausal women in most developed countries. Epidemiological evidence suggests that endogenous oestrogen plays a role in protecting younger women from coronary heart disease (CHD). First, incidence rates of CHD are substantially higher in men than in women before the menopause, at which point the sex differential begins to diminish. Secondly, among women with premature ovarian failure, higher rates of CHD are seen compared with pre¬ menopausal women of the same age. The most compelling evidence comes from studies of the effects of replacement oestrogen on cardiovascular disease risk in post-menopausal women. The great majority of studies suggest that treatment is protective against CHD;3 however, evidence of a protective effect against stroke is less conclusive.
Cervical spine injury
Authors: Guly H R
Published: November 2023

As with all injuries it is important to try to understand the forces involved in a neck injury. Many such injuries occur in road accidents and details of how to assess these can be found in Chapter 37. Clearly a patient who turned quickly and developed severe neck pain is unlikely to have a significant bony injury whereas the patient involved in a high velocity injury or who falls down stairs is greatly at risk of a fracture.
Vascular injury
Authors: Guly H R
Published: November 2023

The circulation distal to any displaced fracture or dislocation should always be examined and noted. The obvious thing to record is the presence of the peripheral pulses but unfortunately this does not reliably exclude an arterial injury. It is possible to have a palpable pulse distal to a complete arterial division because of the collateral circulation.
Major trauma
Authors: Guly H R
Published: November 2023

The safe management of life-threatening injuries demands that they are recognized early, resuscitated aggressively, and that definitive surgery is performed rapidly. This means that patients are treated by a senior and experienced doctor. Unfortunately, life-threatening injuries may not always be immediately obvious. Various studies have investigated the mechanisms which are likely to predict serious injury, and in the United States protocols have been drawn up to provide criteria for transporting patients to a trauma centre rather than to the nearest hospital.
Deliberate self-harm
Authors: Guly H R
Published: November 2023

In patients whose injuries are the result of deliberate selfharm the assessment and management of the physical injuries is frequently much easier and faster than sorting out the psychological and social problems underlying the selfharm. However, it is important and a requirement of the Department of Health that a psycho-social history and assessment is carried out.
Definition and natural history of autosomal dominant polycystic kidney disease
Authors: Gabow Patricia A
Published: November 2023

This chapter serves to present in broad overview much of what will be discussed in detail in subsequent chapters. It is hoped that it will present a panoramic snapshot of the entire disorder while permitting subsequent chapters to take ‘close-up’ views.
Attempts to influence prescribing in the UK
Authors: Bradley Colin , Hobbs Richard
Published: November 2023

The prescribing of drugs has always been central to the function of the general practitioner and indeed to the role of all healers in all societies. One of the key components of the Medical Act of 1858 was to limit the right to prescribe drugs to those who were properly trained and hence recognized as being entitled to describe themselves as doctors.
Approaches to rational prescribing
Authors: Bateman Nicholas
Published: November 2023

Expenditure on prescription drugs is increasing in all developed countries at a rate which is disproportionate to the growth in the overall cost of healthcare. This has led governments to focus on prescribing, in an attempt to devise policies which can address this perceived problem (Audit Commission, 1994).
In hospital
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

The care of someone with a head injury starts with first aid at the site of the accident, continues with rescue by the paramedics and ambulance, and is followed through by a team working in the hospital, using a wide range of facilities. Whether you are the patient or one of the family, if you have not been involved with a hospital before you may feel very lost and frightened by this large organization, with all its power and prestige. It is a good idea, therefore, to know how a hospital works, who you may meet and what they do. It is also a good idea to remember that you have very definite rights in this situation, and that the whole of this organization has been set up for your benefit.
The pathological classification of lupus nephritis
Authors: Schwartz Melvin M
Published: November 2023

In the pretreatment era systemic lupus erythematosus (SLE) was a malignant disease, and the patients commonly died of infections and overwhelming sepsis. However, many had evidence of glomerulonephritis (GN), and renal insufficiency frequently caused or contributed to the morbidity.
The natural history and treatment of lupus nephritis
Authors: Lewis Edmund J
Published: November 2023

Lupus nephritis, its clinical course, prognosis, and optimal therapy are subjects which are plagued by a surfeit of authoritative opinion, however there is limited scientifically valid information. Much of the literature suffers from the burden of small, anecdotal or insufficiently designed clinical experiences. Hardly any of the reported therapeutic experiences deserve elevation to the status of a controlled clinical trial. Many of the clinical studies are retrospective in nature. Despite all this, an extensive literature has accumulated and a variety of opinions are held regarding the best and safest approach to the therapy of this patient population. Truer of religion than science, many opinions are based upon faith rather than observation. As is the case with religious beliefs, the treatment chosen becomes a matter of personal preference.
Problem Drinking
Authors: Heather Nick , Robertson Ian
Published: November 2023

Problem Drinking aims to bridge the wide gap that exists between the modern, scientific account of the nature of alcohol problems, and the popular understanding of the subject. In particular, it presents detailed evidence and arguments against the commonly accepted view that 'alcoholism' is best regarded as a disease. Instead, it outlines an alternative approach to alcohol problems, based on the premise that they are best seen as examples of socially learned behaviour. In the third edition, the authors have brought the book up to date by covering the major developments that have taken place in recent years, in particular in the field of genetics. The book is also one of the first to discuss the results and recommendations of the 5 year long Project MATCH study, probably the most extensive alcohol study ever undertaken, the results of which are due to be published in 1997. The book provides a useful textbook for students undertaking courses in alcoholism, as part of psychology and psychiatry degrees, and provides practical advice for counsellors, social workers, and health promotion officers. Reviews of the 2nd edition '... a valuable and clearly written exposition of problem drinking...' British Journal of Psychiatry, 1990 'Certainly this book should provoke general practitioners to reassess their views about the problem and should be read by those people working in the field.' Family Practice, 1991
Growth of systems
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

Not all systems of the body follow the same pattern of growth. This is best illustrated by considering the development of the systems as a percentage of their attainment at maturity, taken at the arbitrary age of 20. Figure 4.1 illustrates the curve obtained for weight (solid line) plotted in this way. Similar curves are produced when the respiratory, digestive, and excretory systems are plotted on the chart, indicating that their relative sizes remain more or less constant during growth. The skeleton behaves in a similar manner, but some other important body systems follow different growth curves.
Indices of maturity
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

There are a number of important reasons why it might be necessary to assess the maturity of the child, especially in medical conditions which may affect growth and development. Clearly, the actual or chronological age of a child is a most unreliable guide to maturity as each child will mature at a different rate due to influences of its genetics, race, social background, and environment. The measurement of height and weight is also of very little value due to similar reasons. As a result, a number of methods have been developed which aid us in our estimation of the maturity of a child and allow us the opportunity to see if they are behind or ahead of their growth and development towards becoming an adult.
Environmental factors influencing growth and
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

Today we are aware of more and more situations where the growth and maturation of organisms appear to be influenced by events taking place outside their cellular structures. These events can influence the development of the human fetus if they are poisons or infections or even the maternal genetic composition. The growing child can be adversely affected by diet, social environment, or poisons in the atmosphere. Adults and the elderly can be seriously damaged or even killed, for example, by chemicals in the environ ment or by eating infected food. It is clear that some of these effects may not directly influence growth as such but all have some detrimental effect on the way the body maintains itself in peak condition. Thus we all should appreciate that being green and environmentally aware is important to all and especially to the more vulnerable members of our society.
Physiology of the normal menopause and end-points of treatment
Authors: Rees Margaret C P
Published: November 2023

Overall, the mean age of menopause is 51 years, which means that with the increased longevity of the population most women in Western societies will spend 30 or more years in the post-menopausal state (McKinlay et al. 1992; Luoto et al. 1994). Various definitions are used to describe the menopause (McKinlay et al. 1992; Richardson 1993): the menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity the menopause transition describes the period prior to the final menstrual period with the endocrinological, biological, and clinical features of the approaching menopause. The length of this transition has been reported to be four years (onset of perimenopause 47.5 years) and to be shorter in smokers (McKinlay et al. 1992). Furthermore, 10% of women may not experience this phase but cease menstruation abruptly the postmenopause should be defined as dating from the final menstrual period, although it cannot be determined until a period of 12 months of spontaneous amenorrhoea has been observed the perimenopause includes the menopause transition and ends 12 months after the final menstrual period.
The benefits and risks of hormone replacement therapy
Authors: Rees Margaret C P
Published: November 2023

The menopause results in oestrogen deficiency which in turn results in an increased risk of cardiovascular disease and an accelerated loss of bone mass. The leading cause of death in women in Western societies is cardiovascular disease (Table 2.1). Postmenopausal hormone replacement therapy (HR T) has both benefits and risks, including decreased risks of osteoporosis and cardiovascular disease which must be offset against a slightly increased risk of breast cancer and venous thromboembolism. On average, mortality among women who use HR T is lower than among non-users (Grodstein et al. 1997). Although these benefits are well known, compliance to treatment is, in general, poor with few women taking it for more than one year (Hope and Rees 1995). In the UK, in the age group 40-65 years, 17% of women are currently taking HRT (Hope et al. 1998).
Irregular bleeding with hormone replacement therapy
Authors: Rees Margaret C P
Published: November 2023

The management of irregular bleeding with hormone replacement therapy (HR T) will be discussed in terms of investigation and treatment. On monthly sequential HR T abnormal bleeding is denoted by a change in pattern of withdrawal bleeds and breakthrough bleeding which persists for three cycles or more. With three-monthly sequential HR T irregular bleeding is common in the first six months but should have stopped there-after. In women taking a continuous combined regime bleeding may occur at the start of treatment but usually stops after a few weeks; if it persists for more than four to six months or is not lessening, endometrial assessment is required. Similarly, women who are amenorrhoeic on a continuous combined regime and then have a bleed, need to be assessed. It is important to ensure that the abnormal bleeding cannot be accounted for by missing tablets or faulty patch adhesion.
Hormone replacement therapy and thrombosis
Authors: Keeling David
Published: November 2023

A simplified version of the coagulation cascade is shown in Figure 7.1. The inactive zymogens IX, X, and II (prothrombin) are sequentially activated to IXa, Xa, and Ila (thrombin), the latter then acts on fibrinogen to form a fibrin clot. There are two sequential very similar steps, IXa needs the cofactor VIII to activate X, and then in turn Xa needs the cofactor V to activate prothrombin. This is an explosive amplification system which needs to be kept under control. There are two main natural anticoagulant mechanisms to do this, antithrombin and the protein C system.
Treatment of osteoporosis
Authors: Elsheikh Mohgah , Wass John A H
Published: November 2023

Osteoporosis is a chronic disorder characterized by an increased susceptibility to fractures as a result of a reduction in bone mass and abnormal bone architecture. It is common in Caucasians, with a higher frequency in women, and the incidence increases steeply after the menopause. A SO-year-old woman has a 40% lifetime risk of a fragility fracture (Melton et al. 1992), which typically occurs in the femoral neck, vertebra, and distal forearm. Hip fractures account for 20% of orthopaedic bed occupancy in the UK and are associated with up to 20% mortality within the first year (Cooper et al. 1993). There is considerable morbidity in survivors, with a third losing their independence. Overall, it is estimated that osteoporosis-related fractures account for an annual expenditure in excess of £750 million in health care costs (Department of Health 1994). As the population ages, the prevalence of osteoporosis, and thus its financial burden, is expected to increase dramatically.
The consultation in general practice
Authors: Hope Sally
Published: November 2023

The great strength of general practice is the unique band of individuals practising medicine in different ways. This chapter is not intended to be full of dogmatic protocols, but to be helpful in offering a variety of menus. Practices will have different members of the primary health care team doing various aspects of the work, depending on their skill mix. There are three ways women present for a consultation on the menopause and hormone replacement therapy (HR T). Firstly, there are women who specifically make an appointment in order to see a member of the primary health care team to discuss the menopause and gather information. Many women are driven to see general practitioners (GPs) when they are experiencing symptoms, and can be in quite a distressed state (Hope and Rees 1995). The second group come to the surgery for other reasons, and a discussion about the menopause may happen opportunistically. The third group of women are those who have planned repeat visits because they either require a repeat HR T prescription or wish for another consultation.
Future hormone replacement therapy
Authors: Rees Margaret C P
Published: November 2023

The number of treatment options for hormone replacement therapy (HRT) has increased massively in the past few years with new delivery systems such as matrix patches and gels, and treatment regimens with different types of bleeding patterns (monthly and three-monthly sequential, and continuous combined regimens). This chapter will discuss new developments in oestrogen and progestogen HRT, and the development of new agents such as selective oestrogen receptor modulators (SERMs) and phytoestrogens.
Biophysics of magnetic stimulation
Authors: Mills K R
Published: November 2023

Magnetic stimulators work by inducing brief currents in the brain which excite nerve cells. Electrical energy stored in a capacitor is released into a coil held over the scalp. A brief surge of current flows through the coil to produce a transient magnetic field. This field passes freely into the surrounding medium and induces in it an electric field which impedes the magnetic field. This is Faraday’s law. If the electric field falls in a conductor, then current will flow. The ability of this current to excite nerve cells depends upon its time course, magnitude and direction. The basic magnetic stimulator has a simple design (Barker 1991). A capacitor which can hold a high voltage is charged up and the stored energy is released through a switch to cause current to flow through a coil (Fig. 2.1). The rate at which the power supply can charge the capacitor is limited and sets the maximal repetition rate which the stimulator can achieve. The switch clearly must be able to sustain the large current surges involved.
Demyelinating diseases of the central nervous system
Authors: Mills K R
Published: November 2023

Multiple sclerosis (MS) is by far the commonest disease of the central nervous system in which the major pathological feature is demyelination of nerve fibres. Multiple sclerosis may occur as an isolated event involving a single site, as in optic neuritis or transverse myelitis, but usually the picture is of multiple lesions causing a variety of symptoms and signs which commonly remit only to recur at some later time. Some 80% of patients with MS present with relapsing and remitting disease; the interval between relapses averages once every 2 years, but recurrence of new symptoms after periods up to 20 years can occur. Patients with relapsing and remitting disease usually enter a phase of slowly progressive deterioration. Some 20% of patients present with a chronic progressive form of the disease, especially those presenting after the fifth decade.