bluuebunny/crossref_metadata_2025 huggingface dataset:
Inpatient Admission versus Emergency Department Management of Intussusception in Children: A Systemic Review and Meta-Analysis of Outcomes
Authors: Amuddhu Sanjena , Chen Yong , Nah Shireen
Published: August 2018

Introduction Recent literature advocates outpatient emergency department (ED) management of intussusception citing low recurrence rates and postreduction events after uncomplicated ileocolic reduction. However, few studies include both inpatient and outpatient cohorts. We performed a systematic review and meta-analysis to compare recurrence rates and length of hospital stay between the groups.

Materials and Methods Studies published in English up to January 2018 were searched from Medline, Embase, Google Scholar, and Cochrane databases, using a combination of the terms ‘intussusception,’ ‘reduction,’ and ‘management’. A meta-analysis of studies comparing outcomes after successful intussusception reduction in children between inpatients and ED patients was performed.

Results No randomized controlled trials (RCT) were found. Nine observational studies (eight retrospective and one prospective) were included, comprising 546 inpatients and 776 ED cases. There was no statistical difference in overall recurrence rate between inpatients (8.8%) and ED (10.1%) (pooled odds ratio [OR] = 1.09; 95% confidence interval [CI] 0.74–1.62; P = 0.66; I
2 = 0). Five studies reported early recurrence (<48 hours) with no difference (pooled OR = 1.27; 95% CI 0.46–3.48; P = 0.65; I
2 = 0). Five studies reported postdischarge recurrence rate with no difference (pooled OR = 1.57; 95% CI 0.71–3.48; P = 0.27; I
2 = 34%). Five studies reported recurrence requiring surgery with no difference (pooled OR = 0.99; 95% CI 0.32–3.06; P = 0.99; I
2 = 0). Methods of reduction were air, barium, or other contrast enema.

Conclusion Management of intussusception in the ED after uncomplicated reduction appears acceptable. However, evidence levels are low, and RCT should be performed to adequately evaluate the safety of outpatient management of pediatric intussusception.
Novel facets of multifunctional Ag@Fe3O4 core-shell nanoparticles for multimodal imaging applications
Authors: Singh Pinki , Gupta Bipin Kumar , Prasad Nand Kishore , Yadav Pramod Kumar , Upadhyay Chandan
Published: August 2018

Biocompatible nanoparticles, with magnetic cores and optically active shells, acting as multifunctional materials with a core size of 6 nm encapsulated in silver shells of varying thickness were synthesized through a novel single phase microemulsion method. Incorporation of silver shells onto the magnetite core enhances the intensity of the highest luminescence peak observed for magnetite by a significant luminescence enhancement factor. A blue photoluminescence peak observed in the visible region of spectrum brightens further with the increase in the thickness of silver shell. The magnetic properties of these core-shell nanomaterials show superparamagnetic behavior at room temperature, which is a mandatory criterion for MRI contrast enhancement agents. The hyperthermic response of synthesized magnetite nanoparticles elevates its temperature to 43 °C in a sharp span of time, which is above the desired temperature for the therapeutic application of these multifunctional nanomaterials. These excellent optical and magnetic properties, of the material having a size range suitable for cellular uptake, make it a potential candidate for both diagnostic and therapeutic uses in biomedical applications.
A compact and alignment-free tube-type device for femtosecond pulses measurement
Authors: Zhu Jingxin , Shen Xiong , Lin Lei , Si Zhe , Liu Jun
Published: August 2018

A compact and alignment-free device based on transient grating self-referenced spectral interferometry is proposed to realize the temporal profile measurement of femtosecond laser pulses. The entire optical setup is composed of two lenses and two glass plates on a straight line with tubes, thereby avoiding complicated optical alignment and improving the stability and practicality of the device. Two 51.0 fs and 16.9 fs laser pulses at 800 nm and a 60.6 fs pulse at 1800 nm are all successfully measured by this device, which verifies the reliability of the device.
Coordinated performance of interline power flow controller and superconducting magnetic energy storage in combined ALFC and AVR system under deregulated environment
Authors: Rajbongshi Rumi , Saikia Lalit Chandra
Published: August 2018

This study presents a two area combined Automatic Load Frequency Control (ALFC) and Automatic Voltage Regulator (AVR) system having reheat thermal and wind as Generating Companies (GENCOs) of area1 while reheat thermal and diesel as GENCOs of area2 in a deregulated environment. The thermal plant is considered with system nonlinearities. A proportional-integral and fractional order derivative having a filter controller is introduced for the combined ALFC-AVR system. A lightning search algorithm is employed for finding the best values of controller parameters. The comparative performance of the proposed controllers with some classical controllers proves the superiority of the proposed controller to others. The significance of the Interline Power Flow Controller (IPFC) and IPFC in combination with Superconducting Magnetic Energy Storage (SMES) in the considered system is investigated under bilateral transaction. The analysis reflects that addition of IPFC improves the dynamic responses. The combination of both IPFC and SMES enhances the system dynamics further. The sensitivity analysis against different Distribution Companies Participation Matrix and variation of the contact violation amount gives the robust performance of the introduced controller parameters.
Three characterisations of the sequential product
Authors: van de Wetering John
Published: August 2018

It has already been established that the properties required of an abstract sequential product as introduced by Gudder and Greechie are not enough to characterise the standard sequential product a◦b=aba on an operator algebra. We give three additional properties, each of which characterises the standard sequential product on either a von Neumann algebra or a Euclidean Jordan algebra. These properties are (1) invariance under the application of unital order isomorphisms, (2) symmetry of the sequential product with respect to a certain inner product, and (3) preservation of invertibility of the effects. To give these characterisations, we first have to study convex σ-sequential effect algebras. We show that these objects correspond to unit intervals of spectral order unit spaces with a homogeneous positive cone.
Fabrication and manipulation of nanopillars using electron induced excitation
Authors: Rajput Nitul S. , Le Marrec Francoise , El Marssi Mimoun , Jouiad Mustapha
Published: August 2018

Controlled fabrication and maneuvering of nanostructures has been of great interest in nanotechnology because of the potential applications it could deliver. In this study, we demonstrate the in situ fabrication and manipulation method of nanopillars made of a Pt-C composite by means of electron induced bending. Hereafter, we propose novel experiments contributing to unfold the mechanisms responsible for the bending process. Our results confirm that this bending is due to the phase transformation of the as-grown Pt-C nanopillars induced by the electron beam irradiation. The optimized beam energy and the beam irradiation dose necessary for the bending have been experimentally determined and corroborated by Monte Carlo simulations. The results further advance the understanding of electron matter interaction and pave the way for designing 3D nanostructures for various applications.
Large-eddy simulations of stratified plane Couette flow using the anisotropic minimum-dissipation model
Authors: Vreugdenhil Catherine A. , Taylor John R.
Published: August 2018

The anisotropic minimum-dissipation (AMD) model for large-eddy simulation (LES) has been recently developed, and here the model performance is examined in stratified plane Couette flow. To our knowledge, this is the first use of the AMD model for resolved LES of stratified wall-bounded flow. A comparison with previously published direct numerical simulations (DNS) provides insight into model and grid requirements. Prandtl numbers of Pr = 0.7–70 and a range of Richardson numbers show that the AMD LES performs well even with a strong stabilising buoyancy flux. We identify three new requirements for accurate LES of stratified wall-bounded flow. First, the LES must resolve the turbulent structures at the edge of the viscous sublayer in order to satisfy the Obukov length scale condition, Ls+>200. Otherwise the LES solution may laminarise where the DNS solution remains turbulent. Second, the LES must have enough vertical grid resolution within the viscous and diffusive sublayers to resolve the wall fluxes. Third, the grid must be reasonably isotropic (vertical-to-horizontal grid aspect ratio >0.25) at the edge of the sublayer and through the turbulent interior for the AMD LES to correctly simulate the scalar flux. When these model requirements are fulfilled, the AMD LES performs very well, producing vertical mean profiles, friction Reynolds numbers, and Nusselt numbers consistent with DNS solutions at significantly higher grid resolution.
High temperature magnetic studies on Bi1-xCaxFe1−yTiyO3-δ nanoparticles: Observation of Hopkinson-like effect above TN
Authors: Mocherla Pavana S. V. , Prabhu D. , Sahana M. B. , Hebalkar Neha Y. , Gopalan R. , Ramachandra Rao M. S. , Sudakar C.
Published: August 2018

The magnetic properties of Bi1-xCaxFe1-yTiyO3-δ (BCFO: y = 0 and BCFTO: x = y) nanoparticles are studied across a wide range of temperatures (20 K to 960 K) for different Ca (and Ti) concentrations [x (= y) = 0, 0.025, 0.05, and 0.1]. X-ray diffraction and electron microscopy revealed the gradual emergence of the orthorhombic phase (Pnma) with an increase in the Ca2+ content in BCFO, contrary to the retention of parent rhombohedral symmetry (R3c) in Ca2+-Ti4+ co-doped BCFTO. XPS indicates the presence of 3+ valence states for Bi and Fe and under-coordinated defect peaks in O 1s spectra. The ordering of oxygen vacancies in BCFO affects the FeO6 octahedral alignment, resulting in a systematic shift of Fe-O Raman modes. Oxygen vacancies formed due to Ca2+ doping in BCFO and the non-magnetic Ti4+ ion at the Fe3+ site in BCFTO disrupt the spin-cycloid propagation in BiFeO3, largely influencing the magnetic properties. These substitutional changes, in addition to the large surface area, are the sources of net magnetization in these systems. Magnetic hysteresis and field dependent zero field cooled-field cooled curves indicate the combined presence of anti-ferromagnetic and ferromagnetic components in BCFO and BCFTO nanoparticles. High temperature magnetic studies present a clear bifurcation of magnetic Néel transition centered at ∼600 K associated with the structural variation in BCFO. A strong anomaly observed at 860 ± 40 K in all the samples suggests a Hopkinson-like effect arising due to sudden loss of anisotropy by the FM component.
Metasurface absorber based on water meta “molecule” for X-band microwave absorption
Authors: Gogoi Dhruba Jyoti , Bhattacharyya Nidhi Saxena
Published: August 2018

Two different sizes of water “atoms” embedded in a flexible silicone matrix are combined together to form water “molecules” and used as the resonating elements of the metasurface to achieve wideband microwave absorption. The sizes of the two “atoms” are chosen such that their resonating frequencies couple to give a whole X-band absorption with a bandwidth of –10 dB. The design and simulation of the unit cell are carried out to achieve the desired results with an overall absorber thickness of ∼3.0 mm (i.e., only λ/12 of the lower cut off frequency). A wide absorption bandwidth of 4.2 GHz with an absorption efficiency of 90% is observed for the fabricated metasurface absorber in an X-band waveguide environment. The evaporation of water is prevented by embedding the water “molecules” in a silicone substrate, and its flexibility helps in retaining the designed shape. The arrayed structure of the water “molecules” provides the required effective permittivity and permeability of the metasurface by generating Mie resonance. Numerical investigation shows the polarization insensitive absorbance of the symmetrical unit cell structure and wide-angle absorption performance of the absorber for both transverse magnetic and electric modes.
Investigation of the thermal stability of MoOx as hole-selective contacts for Si solar cells
Authors: Zhang Tian , Lee Chang-Yeh , Wan Yimao , Lim Sean , Hoex Bram
Published: August 2018

The stoichiometry and work function of molybdenum oxide (MoOx) are of crucial importance for its performance as hole selective contact for crystalline silicon solar cells. Hydrogenated amorphous silicon (a-Si:H) is typically used as an interface passivation layer in combination with MoOx to reduce surface recombination. As the fabrication process of a solar cell typically contains subsequent high-temperature processes, the consideration of thermal stability of MoOx with and without a-Si:H becomes critical. In this work, in situ x-ray spectroscopy (XPS)/ultraviolet photoelectron spectroscopy and Fourier transform infrared spectroscopy in the temperature range from 300 K to 900 K are used to investigate the thermal stability of MoOx with and without a-Si:H. In addition, both the passivation and contact performance are studied by evaluating the surface saturation current density J0s, carrier lifetime τeff, and contact resistivity ρc. The XPS results reveal that the as-evaporated MoOx on top of both c-Si and a-Si:H is sub-stoichiometric, and the work function of both films is higher than 6 eV. While after in situ annealing, the evolution of MoOx phase on top of a-Si:H shows a different behavior compared to it on c-Si which is attributed to H diffusion from a-Si:H after 600 K, whereas the work function shows a similar trend as a function of the annealing temperature. The J0s of a p-type Si symmetrically passivated by MoOx is found to be 187 fA/cm2 and the ρc is ∼82.5 mΩ·cm2 in the as-evaporated state. With a-Si interface passivation layer, J0s is significantly lower at 5.39 fA/cm2. The J0s and the ρc increase after post-deposition annealing. The evolution of these functional properties can be attributed to the material properties.
Low lattice thermal conductivity in arc-melted GeTe with Ge-deficient crystal structure
Authors: Serrano-Sánchez F. , Funes M. , Nemes N. M. , Dura O. J. , Martínez J. L. , Prado-Gonjal J. , Fernández-Díaz M. T. , Alonso J. A.
Published: August 2018

GeTe is a well-known thermoelectric material, with transport properties strongly dependent on the composition and crystal structure. Phase-pure polycrystalline GeTe has been prepared by a straightforward arc-melting technique, and its structural and physical properties are studied by neutron powder diffraction (NPD), electron microscopy, calorimetry, and transport measurements. The structural analysis from NPD data reveals a conspicuous Ge deficiency in the bulk structure (∼7% atomic vacancies), confirmed by the Hall-carrier concentration. The analysis of the atomic displacement parameters shows strong anisotropy of Ge ellipsoids, revealing a considerable anharmonicity of the chemical bonds. Concerning the thermoelectric properties, the samples display high electrical conductivity and reduced lattice contribution to the total thermal conductivity, exhibiting record-low 0.8 W m−1 K−1 at 770 K, as a consequence of the highly defective crystal structure. Both are essential ingredients of useful thermoelectric materials, indicating the applicability of defective GeTe in polycrystalline form.
Broadband optical response of graphene measured by terahertz time-domain spectroscopy and FTIR spectroscopy
Authors: Arts Karsten , Vervuurt René , Bhattacharya Arkabrata , Gómez Rivas Jaime , Oosterbeek Johan Willem , Bol Ageeth A.
Published: August 2018

This work describes the broadband optical response of graphene grown by chemical vapor deposition by combining terahertz time-domain spectroscopy (THz-TDS) at 0.25–1.7 THz (8–60 cm−1) with Fourier Transform Infrared Spectroscopy (FTIR) at 11–210 THz (370–7000 cm−1). It is shown that the measured response is well described by a combination of the Drude model, expressing free-carrier absorption/reflection, and an expression for interband absorption. The THz-TDS and FTIR transmittance curves are fitted consistently using this model. This indicates that these techniques are complementary to each other. Both can thus be employed together or individually to characterize the electronic properties of graphene (e.g., carrier density and mobility). To exemplify this, we demonstrate that this equivalency can be used to study the effect of substrate-dependent doping on the optical response of graphene. Furthermore, the amount of reflection and absorption corresponding to the measured transmittance curve is calculated. The toolbox for the non-invasive broadband characterization of graphene is thus extended by this work.
Simple and Practical Synthesis of Various New Nickel Boride-Based Nanocomposites and their Applications for the Green and Expeditious Reduction of Nitroarenes to Arylamines under Wet-Solvent-Free Mechanochemical Grinding
Authors: Mousavi Hossein , Zeynizadeh Behzad , Younesi Reza , Esmati Mozhgan
Published: August 2018

In this paper, we report a simple synthesis of four new nickel boride-based nanocomposites, namely Ni2B@ZrCl4, Ni2B@Cu2O, Ni2B@CuCl2 and Ni2B@FeCl3, from commercially available and cheap starting materials. All of the new Ni2B-based nanocomposites were well characterized by Fourier-transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Further, the catalytic applications of these new nanocomposites were successfully evaluated in the wet-solvent-free reduction of aromatic nitro compounds to arylamines with sodium borohydride (NaBH4) at room temperature by a mechanochemical grinding technique. All the introduced catalytic systems provide excellent yields of arylamines in very short reaction times for a wide range of substrates. Also, recoverability and reusability of the new nanocomposites were investigated.
Microbiologically influenced corrosion in floating production systems
Authors: Machuca Suarez Laura , Polomka Anthony
Published: August 2018

Microbiologically influenced corrosion (MIC) represents a serious and challenging problem in Floating, Production, Storage and Offloading vessels (FPSOs), one of the most common type of offshore oil production facilities in Australia. Microorganisms can attach to metal surfaces, which under certain conditions, can result in corrosion rates in excess of 10 mm per year (mmpy) leading to equipment failure before their expected lifetime. Particularly, increasing water cut (ratio of water vs. total fluids produced), normally resulting from the age of the assets, results in an increased risk of MIC. This paper provides an overview of causative microorganisms, their source of contamination and the areas within FPSOs that are most prone to MIC. Although mitigation practices such as chemical treatments, flushing and draining and even cathodic protection are effective, MIC can still occur if the systems are not properly monitored and managed. A case study is presented that describes the microorganisms identified in a FPSO operating in Australia suspected of having MIC issues.
What Counts in Second Language Oral Communication Ability? The Perspective of Linguistic Laypersons
Authors: Sato Takanori , McNamara Tim
Published: August 2018

Applied linguists have developed complex theories of the ability to communicate in a second language (L2). However, the perspectives on L2 communication ability of speakers who are not trained language professionals have been incorporated neither into theories of communication ability nor in the criteria for assessing performance on general-purpose oral proficiency tests. This potentially weakens the validity of such tests because the ultimate arbiters of L2 speakers’ oral performance are not trained language professionals. This study investigates the perspectives of these linguistic laypersons on L2 communication ability. Twenty-three native and non-native English-speaking linguistic laypersons judged L2 speakers’ oral performances and verbalized the reasons for their judgments. The results showed that the participants focus not only on the linguistic aspects of the speaker’s output but also on features that applied linguists have less paid attention to. Even where speaker’s linguistic errors were acknowledged, message conveyance and comprehensibility of the message contributed to their judgment. The study has implications for language testing and the development of tests reflecting the construct of English as a lingua franca.
Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?
Authors: Carvajal Jenny , Carvajal Melissa , Hernández Gilma
Published: August 2018

Background

Capsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.

Objectives

The authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.

Methods

In June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.

Results

Pearson’s chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.

Conclusions

CHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.

Level of Evidence: 3
Generalized integrative principal component analysis for multi-type data with block-wise missing structure
Authors: Zhu Huichen , Li Gen , Lock Eric F
Published: August 2018

High-dimensional multi-source data are encountered in many fields. Despite recent developments on the integrative dimension reduction of such data, most existing methods cannot easily accommodate data of multiple types (e.g. binary or count-valued). Moreover, multi-source data often have block-wise missing structure, i.e. data in one or more sources may be completely unobserved for a sample. The heterogeneous data types and presence of block-wise missing data pose significant challenges to the integration of multi-source data and further statistical analyses. In this article, we develop a low-rank method, called generalized integrative principal component analysis (GIPCA), for the simultaneous dimension reduction and imputation of multi-source block-wise missing data, where different sources may have different data types. We also devise an adapted Bayesian information criterion (BIC) criterion for rank estimation. Comprehensive simulation studies demonstrate the efficacy of the proposed method in terms of rank estimation, signal recovery, and missing data imputation. We apply GIPCA to a mortality study. We achieve accurate block-wise missing data imputation and identify intriguing latent mortality rate patterns with sociological relevance.
Interventions to Support Patients Affected by an Altered Appearance
Authors: Lewis-Smith Helena , Harcourt Diana , Clarke Alex
Published: August 2018

Abstract: Changes to appearance as a result of disease and treatment can be a source of considerable distress for many patients. This chapter applies a stepped model of care as a framework to consider the use of psychosocial approaches to support people whose appearance and/or body image has changed as a result of cancer. In doing so, it explores the use of a range of interventions, from societal-level approaches aiming to shift attitudes toward appearance amongst the general population through to high-level interventions for patients with high levels of distress, delivered by psychosocial specialists with expertise in this field. The chapter also reflects on the challenges facing health professionals and researchers who are looking to provide evidence-based care and offers suggestions for the future direction of research.
Altered Appearance from Cancer
Authors: Paraskeva Nicole , Clarke Alex , Harcourt Diana
Published: August 2018

Abstract: This chapter delineates various appearance alterations that can result from cancer and its treatment. It focuses on describing the impact of appearance changes involving weight, scarring from surgery, alopecia, ascites, and lymphedema. It also examines the influence of patient-related factors (i.e., gender, age) and treatment-related factors on appearance-related distress. Various models of adjustment to alterations in appearance are presented with particular attention to predisposing factors, intervening cognitive processes, and measurable outcomes identified by large-scale research studies conducted by the Appearance Research Collaboration. Finally, the chapter identifies gaps in knowledge and directions for future research needed to advance the understanding of an individual’s experiences of living with an altered appearance due to cancer.
Sexuality, Fertility, and Cancer
Authors: Carpenter Kristen M. , Black Lora L.
Published: August 2018

Abstract: Advances in screening and treatment have improved long-term survival for individuals diagnosed with cancer, necessitating an increased focus on issues of survivorship. Sexual function can be impacted by anatomical and hormonal changes, psychological concerns, and body image disruption following cancer treatments. In addition, cancer treatments and their sequelae can have devastating impact on fertility for individuals who have not yet completed planned childbearing. While some of these problems are acute, others are chronic and outlast many of the most common survivorship concerns (e.g., fatigue, psychological distress, insomnia). Although these problems are common and distressing, discussions of these concerns are rarely initiated by survivors or their providers. This chapter reviews common concerns related to sexuality and fertility among male and female cancer survivors, as well as special considerations for pediatric cancer survivors. It also provides a review of evidence-based interventions for sexual problems and fertility preservation.
Age-Related Considerations for Treating Body Image Issues in Cancer Patients (Older Adults)
Authors: Schuler Tammy A. , Roth Andy , Holland Jimmie
Published: August 2018

Abstract: It is vital to improve knowledge regarding body image concerns in older cancer patients. This chapter describes complex interactions of cancer and body image in women and men 65 years and older. The chapter is broadly divided by diagnosis, and discusses research from around the globe. Overall, the empirical literature does not (yet) provide enough evidence that attitudes affecting body image in older cancer patients are unequivocally different than younger patients. However, there appears to be a trend which parallels findings regarding attitudes toward body image in healthy populations—namely that body image investment (i.e., the importance placed on appearance) decreases with age. In addition, anecdotes from patients indicate that distress from internal changes that occur with such cancers as ovarian, uterine, and prostate may have a profound impact despite external normal appearance. The chapter includes empirically supported clinical recommendations for approaching body image concerns in this group.
Health Humanities in Post-Graduate Medical Education
Authors: Peterkin Allan D. , Skorzewska Anna
Published: August 2018

Arts and humanities education is widespread in undergraduate but almost nonexistent in postgraduate medical education where it is arguably more helpful. This book fills that gap. It covers a wide range of arts and humanities subjects including film, theatre, narrative, visual art, history, ethics, and social sciences. Each chapter provides not only 1) a literature review of the relevant subject in postgraduate medical education and, where helpful, undergraduate medical education but 2) a theoretical discussion of the subject as it relates to medicine and medical education 3) challenges to implementing arts and humanities programming and 4) appendices with a number of different and relevant resources as well as sample lesson plans. There is a chapter on the use of humanities in interprofessional education, a domain whose importance has recently gained prominence. Finally there are also chapters guiding the medical humanities educator on evaluating the impact of their programs, an ever-present challenge, and on the thorny issue of how to fund programs in medical humanities.
“Learning on the Job”
Authors: McAlister Chryssa , Gupta Mona , Bernard Carrie , Ghiam Neda , Hébert Philip C.
Published: August 2018

Medical ethics is both a pedagogical tool and an educational component of postgraduate medical education. Residency ethics is not about ensuring trainees have the right answers. It is about encouraging self-reflection and an awareness of alternatives. This is the best preparation for independent professional practice. We examine four areas of specialization—Family Medicine, Psychiatry, Surgery, and Pediatrics—to illustrate how current standards and future directions in postgraduate training reflect this understanding of ethics. While we believe that the most appropriate preparation of residents for medical professionalism is the development of residency specific graduate ethics teaching, there is little reliable empirical evidence for the best approach to designing an ideal ethics curriculum. There is no one right way to do so. We provide an ethics decision-making tool and suggest steps that programmers might wish to take planning their postgraduate ethics teaching.
The Use of Theater with Medical Residents
Authors: Nelles L. J. , Hamilton Peggy , D’Alessandro Paul Robert , Butterworth Sonia Anne , Frager Gerri , Rezmovitz Jeremy , Gao Lu , Lena Suvendrini , Skorzewska Anna
Published: August 2018

This chapter looks at the use of theatre as a tool for teaching self-awareness, the effects of bias, the understanding of complex human conditions, empathy, attunement, self-confidence, and decision-making in medical resident education. While more common in undergraduate medical programs and used across the health professions, theatre is emerging as a meaningful tool for education and research in the resident experience. The chapter is set within a performance studies paradigm that includes current understanding of the neuroscientific effect of theater on the body and in relationship, information that provides an explanation of how and why theater is an effective educational tool. It includes a brief literature review and examines four different projects that reflect the ways that theater is being used with Canadian residents in programs across the country.
Difficult Conversations
Authors: Kelly Martina
Published: August 2018

Evaluation of the medical humanities/health humanities is contentious. Medicine, steeped in a world of accountability, seeks evidence of effectiveness or impact, where evidence is confined to the measurable. Medical humanities, an eclectic interdisciplinary field, values the experiential, more suited to descriptive, qualitative forms of investigation. Rather than prize one approach over the other, clinician educators need to be methodologically flexible. The decision about which approach to use is best determined by the question(s) they wish to answer. This chapter briefly reviews some of the tensions medical educators face when deciding how to evaluate their teaching. It outlines a number of approaches to evaluation and gives examples from the medical humanities literature. Finally, it provides some resources to direct further inquiry.
A Developmental Approach to Children’s Communications
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Chapter 3 addresses the implications of age and developmental stage of the youth on the therapist’s behavior and how the therapist conducts treatment. The authors provide a theoretical overview across development as it relates to child and adolescent anxiety psychodynamic psychotherapy (CAPP) (Piaget, Bowlby, Erikson, Mahler, Winnicott, among others), and the authors explain how making therapeutic contact is adjusted to the stage related competence for understanding. Particular attention is paid to language, development of communicative abilities in general, and the capacity to treat nonverbal play as well as verbal story telling symbolically, by providing a framework built on the most prominent developmental theorists and researchers (Vygostky, Bowlby, Stern, Fonagy, Nelson, among others). The capacity for empathy and reflection across the developmental span is explored. Examples of encounters with children of all ages, school-aged children, preteens, and teenagers are offered and prefaced by comments about their respective developmental uniqueness and how this affects communication between child and therapist.
The Three Phases of CAPP
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Chapter 4 describes how to perform child and adolescent anxiety psychodynamic psychotherapy (CAPP) and includes clinical vignettes. Each phase is followed by a delineation of Tom’s treatment. The opening phase describes how the therapist’s listening and assessment of the material lead to a provisional psychodynamic formulation, which is verbalized to the youth. Typical dynamisms are separation anxiety; difficulties tolerating angry, aggressive, and ambivalent feelings; conflicted sexual fantasies; guilt; and ambivalence regarding independence. During the middle phase, therapist and patient collaboratively understand the central psychological conflicts identified and make adjustments to this formulation as needed. The goal is a deepening understanding of the meaning of the anxiety symptoms, with improvement in reflective functioning. The termination phase serves to review the recent changes and to revisit earlier symptoms, particularly if there is a rearousal of symptoms in which separation conflicts are experienced with the therapist. Adaptive and sensible autonomy-seeking is encouraged.
The clinical course and outcome of psoriatic arthritis
Authors: Eder Lihi
Published: August 2018

In contrast to early reports, it is now appreciated that psoriatic arthritis (PsA) can present as a destructive, progressive, and disabling arthritis with consequences as severe as those of rheumatoid arthritis. Longitudinal cohort studies of PsA patients contributed important knowledge about long-term outcomes, such as development of structural joint damage, remission achievement, and physical function. These studies identified predictors for improved outcomes including male gender and lower burden of inflammation at presentation while delayed diagnosis, disability, and joint damage are associated with worse long-term outcomes. These findings suggest early diagnosis and aggressive control of inflammation are important as they may prevent the occurrence of subsequent joint damage. The latter is strongly correlated with long-term outcomes, such as reduced physical function and increased mortality. Development of prediction models using clinical measures, laboratory biomarkers, and imaging is warranted to stratify patients with early disease into risk groups for long-term outcomes.
Psoriasis treatment
Authors: Saraiya Ami , Joshipura Deep , Gottlieb Alice
Published: August 2018

Psoriasis is an immune-mediated skin disease that is associated with various factors, including genetics, stress, infections, and environmental triggers. Numerous treatment options exist for plaque psoriasis including topical therapy, phototherapy, systemic therapy, and biological therapy. In order to select a treatment for a patient, a clinician must consider many aspects. First, one must assess the impact and burden of the disease on a patient as well as a patient’s expectations from therapy. Other important factors to consider include the severity of skin disease, location of psoriatic plaques, comorbidities and presence of psoriatic arthritis, efficacy of different treatments, potential side-effects, safety, and cost. In this chapter, an evidence-based review is presented on the treatment armamentarium for psoriasis as well as new biological treatments and those under investigation. In order to guide practitioners, several treatment algorithms are provided and others are referenced from the literature.
Small molecules in the treatment of psoriatic arthritis
Authors: Fragoulis George E. , McInnes Iain B.
Published: August 2018

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, occurring in about one third of psoriasis patients, and exhibiting very varied clinical manifestations and comorbidities. Although the clinical outcome of the disease has been significantly improved recently, mainly due to utilization of novel agents targeting the IL-23/-17 axis, unmet needs still exist. Emerging insights into the disease’s pathogenesis led to development of new drugs acting against critical molecular targets and their efficacy in psoriasis and/or PsA has been tested in Phase III clinical trials. Some of these therapeutic regimens have been already approved; some look promising but others have been proven inefficacious. Future studies are expected to determine the place of these compounds within the therapeutic algorithm of PsA. In this chapter we describe the rationale and clinical impact of incorporating small molecules in PsA treatment, as well as specific molecules involved in pathogenesis that may serve as therapeutic targets.
Incorporation of myocardial progenitors at the arterial pole of the heart
Authors: Rammah Mayyasa , Rochais Francesca , Kelly Robert G.
Published: August 2018

The arterial pole of the heart is a hotspot for life-threatening forms of congenital heart defects (CHDs). It is formed by progressive addition of myocardium from epithelial progenitor cells in the second heart field (SHF). SHF cells contribute successively to the right ventricle and proximal and distal outflow tract myocardial walls which, after neural crest influx and cardiac septation, give rise to myocardium at the base of the aorta and pulmonary trunk. SHF cells are characterized by continued proliferation and differentiation delay controlled by an array of transcriptional regulators and signalling pathways which define the SHF progenitor cell niche in pharyngeal mesoderm. Failure of normal SHF deployment leads to a shortened outflow tract and failure of ventriculo-arterial alignment, resulting in a spectrum of conotruncal CHD. We discuss the origins of the SHF in cardiopharyngeal mesoderm and focus on the mechanisms driving SHF deployment, summarizing current understanding of critical signalling pathways and transcription factors.
Origin and development of the cardiac conduction system
Authors: Miquerol Lucile
Published: August 2018

The cardiac conduction system represents the ‘wiring’ of the heart and orchestrates the propagation of the electrical activity to synchronize heartbeats. It is built from specialized cardiomyocytes expressing a subset of ion channels and gap junctions indispensable for their electrophysiological properties. Although representing only a very small volume of the heart, the conduction system plays a crucial role in the appearance of cardiac arrhythmias. The cells forming the conduction system are derived from the same cardiac progenitors as the working cardiomyocytes, and the choice between these two fates is acquired during embryonic development. The components of the conduction system are progressively established during cardiac morphogenesis and converge to form an integrated electrical system in the definitive heart. This chapter will discuss recent advances using mouse genetic approaches which have improved understanding of the cellular origin and the transcriptional regulatory networks involved in the development of the conduction system.
The development of coronary vascularization
Authors: Tomanek Robert J. , Silva Pires-Gomes Adriana A. , Pérez-Pomares José Maria
Published: August 2018

The coronary vascular system is a complex network of arteries, veins, and capillaries that supports myocardial performance, a topic previously reviewed by other authors. Disruption of coronary blood vessel form and/or function can underlie severe congenital and acquired cardiovascular conditions, from myocardial infarction to sudden death. Coronary blood vessels are an evolutionary innovation of vertebrates and form from multiple cell sources. Accordingly, the developmental complexity of coronary vessel morphogenesis is likely to reflect evolutionary constraints, as well as to explain the origins of coronary congenital anomalies (CCAs). In this chapter we summarize the current knowledge on coronary vascular development and identify the essential mechanistic cellular and molecular components of coronary morphogenesis. We will also provide plausible developmental explanations for some relevant CCAs.
Development of the outflow tract
Authors: Anderson Robert H. , Brown Nigel A. , Bamforth Simon D. , Chaudhry Bill , Henderson Deborah J. , Mohun Timothy J.
Published: August 2018

The definitive cardiac outflow tracts have three components: the intra-pericardial arterial trunks, the arterial roots, and the ventricular outflow tracts. Improved correlations between normal development and cardiac malformations can be obtained by analysing the developing outflow tract in tripartite fashion with proximal, intermediate, and distal components. When first seen, the walls of the entire outflow tract express myocardial markers. With ongoing development, the distal border regresses away from the edges of the pericardial cavity. Subsequently, the distal outflow tract becomes the intra-pericardial arterial trunks, with a protrusion from the dorsal wall of the aortic sac forming the aortopulmonary septum. The arterial valves form in the intermediate part of the outflow tract. The proximal part eventually becomes transformed into the ventricular outflow tracts, with muscularization of the proximal cushions producing the right ventricular infundibulum. This approach provides rational explanations for the congenital lesions involving the different parts of the outflow tracts.
Management of theatre imaging
Authors: Hughes Jim
Published: August 2018

This chapter covers the basics of managing surgical imaging across one or more theatres/operating rooms, with examples of potential pitfalls and errors that may occur and how to remedy them. Professional working and management of conflict and issues is also covered, at the level of both the individual radiographer and the team manager. As C-arm systems are expensive, it is unlikely that each operation theatre in a hospital will have its own, and imaging systems will hence be shared across the theatre department. It is therefore important for radiographers working in theatre departments to manage their resources and coordinate with theatre teams to avoid delaying procedures.
Haematemesis
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

Haematemesis is the vomiting of fresh or altered blood. Haematemesis is almost exclusively dealt with in the hospital setting, as it is correctly viewed as a medical emergency. Mallory–Weiss tear, which typically occurs after prolonged vomiting and retching, usually is of small volume, without haemodynamic compromise, and is usually self-limiting, may be recognized as such and not always referred to secondary care. Rare causes of haematemesis are unlikely to be encountered by most general practitioners. No cause for the haematemesis is found in 17% of cases, despite investigation. Haemoptysis and vomiting of red-stained food can be mistaken for haematemesis, possibly accounting for some cases where a diagnosis is not established. This chapter deals with differential diagnosis, key diagnostic tests, therapies, prognosis, and dealing with uncertainty.
Abdominal mass
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

Abdominal mass describes a visible or palpable swelling in the abdomen that is abnormal. It may arise from one of the internal organs, such as an enlarged liver or spleen, or from musculoskeletal structures such a floating rib; alternatively, it may be a hernia containing mesenteric or visceral tissue. Abdominal mass is an uncommon presenting complaint, except where patients notice a hernia. Frequently, the herniation is intermittent or minor, and can be missed on examination. Organomegaly and neoplastic masses can be hard to detect until they are large, and the question of whether or not there really is a mass frequently has to be settled by imaging such as ultrasound or CT scanning. This chapter covers the approach to diagnosis, key diagnostic tests, therapies, and prognosis as well as dealing with uncertainty when it comes to the initial diagnosis.
Hearing loss
Authors: Ramsden James
Published: August 2018

Hearing loss must be divided into conductive hearing loss (CHL) and sensorineural hearing loss (SNHL). CHL is caused by sound not reaching the cochlear (abnormality of the ear canal, tympanic membrane, middle ear, or ossicles), whereas SNHL is a condition affecting the cochlear or auditory (eighth cranial) nerve. Hearing loss may be accompanied by other cardinal signs of ear disease, such as pain or discharge from the ear, vertigo, facial nerve palsy, and tinnitus, which guide the diagnosis. This chapter describes the approach to the patient with hearing loss.
Limb ischaemia
Authors: Ratliff David
Published: August 2018

Acute limb ischaemia is defined as a decrease in the arterial blood flow, over a period of minutes to days, which threatens the viability of the limb. Presentation is within 2 weeks of the onset of symptoms. Chronic limb ischaemia (presentation >2 weeks after the onset of symptoms) can be divided into critical ischaemia—a potential threat to limb viability, with ischaemic rest pain, ischaemic ulcers, or gangrene—and non-critical ischaemia, which may be symptomatic (typically with claudication) or asymptomatic. This chapter discusses limb ischaemia, including differential diagnosis, context, approach to diagnosis, specific clues to the diagnosis, key diagnostic tests, treatment and therapy, prognosis, and how to handle uncertainty in the diagnosis of the symptom.
Hypothermia
Authors: Wise Matt , Frost Paul
Published: August 2018

Hypothermia is defined by a core body temperature of <35.0°C, and may be further characterized as mild (32.0°C–34.9°C), moderate (28.0°C–31.9°C), or severe (<28.0°C). Primary hypothermia is the result of environmental exposure, while in secondary hypothermia there is an underlying medical condition which perturbs thermoregulation. Mild hypothermia (32.0°C–34.0°C) is used as a therapeutic modality in intensive care for traumatic brain injury (to lower intracranial pressure) and following out-of-hospital cardiac arrest (to improve neurological outcomes). Hypothermia and even hypothermic circulatory arrest are also used during cardiac surgery and aortic root replacement surgery.