bluuebunny/crossref_metadata_2025 huggingface dataset:
Die Haut als Hormonfabrik: eine kurze Übersicht über die Vitamin-D-Versorgung in Deutschland
Authors: Reichrath J. , Saternus R. , Reichrath S. , Vogt T.
Published: February 2018

Die optische Strahlung der Sonne, gerade auch deren für die kutane Vitamin-D-Synthese relevantes ultraviolettes Spektrum, ist seit Beginn der Evolution der Motor des Lebens auf unserem Planeten. Die Haut ist für den Vitamin-D-Stoffwechsel des Menschen von zentraler Bedeutung, da sie sowohl den Ort der UV-induzierten Vitamin-D-Synthese als auch ein wichtiges Zielorgan für die physiologische Wirkung des biologisch aktiven Vitamin-D-Metaboliten 1,25-Dihydroxyvitamin D (1,25(OH)2D3) darstellt. Die Bedeutung der positiven und negativen Effekte von UV-Strahlung für unsere Gesundheit wird derzeit sowohl in medizinischen Fachkreisen als auch in der allgemeinen Bevölkerung intensiv und kontrovers diskutiert. Dabei befinden wir uns in einem Dilemma. Einerseits stellt die solare UV-Strahlung den wichtigsten umweltbedingten Risikofaktor für die Entstehung von hellem Hautkrebs (Basalzellkarzinome, aktinische Keratosen, Plattenepithelkarzinome der Haut) dar und ist auch für die Pathogenese des malignen Melanoms von Bedeutung. Folgerichtig stellen Maßnahmen zum Sonnenschutz insbesondere bei Risikogruppen einen wichtigen Bestandteil zur Prävention von Hautkrebs dar. Andererseits wissen wir heute, dass auch eine unzureichende UV-Exposition der Haut durch den resultierenden Vitamin-D-Mangel mit schwerwiegenden gesundheitlichen Risiken (u. a. erhöhtes Risiko für zahlreiche Herz-/Kreislauf-, Infektions-, Autoimmun- und Krebserkrankungen) assoziiert ist. Denn der überwiegende Anteil des vom menschlichen Organismus benötigten Vitamin D wird in der Haut unter der Einwirkung von Sonnenlicht gebildet. Wenn diese natürliche Quelle der Vitamin-D-Versorgung nicht ausreichend genutzt wird, resultiert daraus meist ein Vitamin-D-Mangel. In diesem Beitrag wird das Spannungsfeld zwischen positiven und negativen Effekten der UV-Strahlung unter Berücksichtigung neuer Forschungsergebnisse erörtert, zusätzlich werden Empfehlungen zu einem gesundheitsbewussten Umgang mit der Sonne gegeben.
Inflammatory bowel disease and Clostridium difficile infection: contrasting views of international clinical professionals
Authors: Stallmach Andreas , Anttila Veli-Jukka , Hell Markus , Gwynn Simon , Merino-Amador Paloma , Petrosillo Nicola , Ráčil Zdenek , Warren Tim , Wenisch Christoph , Wilcox Mark
Published: February 2018

Introduction In patients with inflammatory bowel disease (IBD), Clostridium difficile infection (CDI) is a risk factor for both morbidity and mortality. Currently, appropriate management is unclear. Guidance on best practice in the diagnosis and treatment of CDI in IBD patients is therefore needed.

Methods A multidisciplinary group of clinicians involved in the treatment of patients with IBD and CDI developed 27 consensus statements. Respondents were asked to rate their agreement with each statement using a 4-point Likert scale. A modified Delphi methodology was used to review responses of 442 physicians from different specialties (including infectious disease specialists [n = 104], microbiologists [n = 95], and gastroenterologists [n = 73]). A threshold of 75 % agreement was predefined as consensus.

Results Consensus was achieved for 17 of the 27 statements. Unprompted recognition of risk factors for CDI was low. Intensification of immunosuppressive therapy in the absence of clinical improvement was controversial. Clear definitions of treatment failure of antibiotic therapy in CDI and recurrence of CDI in IBD are needed. Respondents require further clarity regarding the place of fecal microbiota transplantation in CDI patients with IBD. Differences were observed between the perceptions of microbiologists and gastroenterologists, as well as between countries.

Conclusions Different perceptions both between specialties and geographical locations complicate the development of an internationally accepted algorithm for the diagnosis and treatment of CDI in patients with IBD. This study highlights the need for future studies in this area.
Phylogenetic relationships and evolution of reproductive modes within flattened syllids (Annelida : Syllidae) with the description of a new genus and six new species
Authors: Álvarez-Campos Patricia , Taboada Sergio , San Martín Guillermo , Leiva Carlos , Riesgo Ana
Published: February 2018

Syllid annelids from the so-called ‘ribbon clade’ are flattened, ribbon-shaped worms of the genera Parahaplosyllis Hartmann-Schröder, 1990, Eurysyllis Ehlers, 1864, Xenosyllis Marion & Bobretzky, 1875, Trypanosyllis Claparède, 1864, Ramisyllis Glasby, Schroeder & Aguado, 2012, Trypanobia Imajima & Hartman, 1964, Plakosyllis Hartmann-Schröder, 1956, Pseudosyllis Grube, 1863 and Trypanedenta Imajima & Hartman, 1964. Some species possess a remarkable reproductive strategy using multiple stolons that has been recently suggested to be ancestral to the group. Here, to evaluate the evolution of reproductive modes in the group, we assess, for the first time, the phylogenetic relationships within the ribbon clade and related genera. We collected new material of Trypanobia and Trypanosyllis from Japan, Spain, Philippines and Indonesia and sequenced it for the nuclear markers 18S rRNA and the mitochondrial markers 16S rRNA and cytochrome c oxidase I for phylogenetic inference and also performed ancestral character reconstruction for the reproductive strategy in the entire group. Formal taxonomic descriptions of a new genus and six new species are provided. The new genus, Trypanospina, gen. nov., is characterised by the spines that cover its surface. Most genera within the ‘ribbon clade’ are monophyletic and the relationships appeared well supported in most cases. However, our phylogenetic hypotheses are not conclusive in regard to the relationships of the genera Trypanedenta and Trypanobia, nor to the status of those to genera as distinctive, since they seem to be paraphyletic and they appear in low-supported clades. In contrast, our results shed light on the evolution of the reproductive modes within the group, showing that scissiparity (development of a single stolon each time) is the ancestral character for the entire group and gemmiparity (development of more than one stolon at the same time) then appeared twice in two independent clades.
Molecular phylogeny of the crab genus Metopograpsus H. Milne Edwards, 1853 (Decapoda : Brachyura : Grapsidae) reveals high intraspecific genetic variation and distinct evolutionarily significant units
Authors: Fratini S. , Cannicci S. , Schubart C. D.
Published: February 2018

The Indo-Pacific genus Metopograpsus belongs to the family Grapsidae and comprises six species of intertidal crabs inhabiting sheltered rocky shores and mangrove forests. All species are opportunistic feeders and four of them are associated with roots and trunks of mangroves. So far, no comprehensive molecular phylogenetic study has been conducted on this genus, despite the fact that some species are not easily separable from a morphological point of view. We performed a phylogenetic and phylogeographic investigation based on sequences corresponding to both ribosomal mitochondrial DNA genes from 44 samples of Metopograpsus spp., covering the distribution ranges of each species. Our main aims were to validate species identification across their respective distribution ranges and depict the phylogeographic patterns within each species. Our phylogenetic inference reconstructions confirmed monophyly of the six species. We also recorded a high intraspecific genetic variation and strong phylogeographic structure within M. thukuhar and M. quadridentatus. This indicates the occurrence of distinct evolutionarily significant units within these two taxa, possibly corresponding to undescribed species. Further nuclear DNA-based phylogeographic analyses, as well as morphological investigations, will be necessary to assign a taxonomic value to the recorded evolutionarily significant units.
Process redesign of a surgical pathway improves access to cataract surgery for Aboriginal and Torres Strait Islander people in South East Queensland
Authors: Penrose Lisa , Roe Yvette , Johnson Natalie A. , James Erica L.
Published: February 2018

The Institute for Urban Indigenous Health (IUIH) aimed to improve access to cataract surgery in urban South East Queensland (SEQ) for Indigenous Australians, without compromising clinical visual outcomes. The Penchansky and Levesque concept of access as the ‘fit’ between the patient’s needs and the ability of the system to meet those needs was used to inform the redesign of the mainstream cataract surgical pathway. The IUIH staff and community stakeholders mapped the traditional external cataract surgical pathway and then innovatively redesigned it to reduce the number of patients being removed by the system at key transition points. The integration of eye health within the primary health care (PHC) clinic has improved the continuity and coordination of care along the surgical pathway, and ensured the sustainability of collaborative partnerships with key external organisations. Audit data demonstrated a significant increase in utilisation of cataract surgical services after the process redesign. Previous studies have found that PHC models involving integration, coordination and continuity of care enhance patient health outcomes; however, the IUIH surgical model extends this to tertiary care. There is scope to apply this model to other surgical pathways and communities who experience access inequity.
A method for extensive spatiotemporal assessment of soil temperatures during an experimental fire using distributed temperature sensing in optical fibre
Authors: Tangney Ryan , Issa Nader A. , Merritt David J. , Callow John N. , Miller Ben P.
Published: February 2018

The use of distributed temperature sensing (DTS) for ecological applications has increased rapidly in the last 6 years. Here we demonstrate the first use of DTS to measure soil temperatures during a fuel reduction burn – in an urban grassy Tuart–Banksia woodland remnant near Perth, Western Australia. Optical fibre with an acrylate material coating (diameter 242μm), but no other jacketing or cabling, was buried in the soil at depths between 0 and 5cm. Measurements were recorded over 316m of optical fibre using a DTS measurement unit, providing data over a 5.5-h period at 20-s intervals; resulting in 1243 temporal measurements at 60-cm spatial resolution. Soil temperatures were calibrated to an error of±6.8% at 250°C. Methods for installation, calibration and data visualisation are presented. Issues associated with assessment of DTS data in a fire ecology context are discussed.
Modern Chinese confirmative shi
Authors: Long Haiping , Kuang Pengfei
Published: February 2018

Modern Chinese confirmative shi (as in mei cuo, wo shi yao dusi ni (沒錯，我是要毒死你) ‘that’s right. I really wanted to poison you to death’) is not an auxiliary but an adverb. It derives from the adjective shi ‘true, real’ in Old Chinese (Yan zhi yan shi ye (偃之言是也) ‘what Yan said was true’). The grammaticalization pathway of the Modern Chinese confirmative shi is different from that of the copula shi (Laozhang shi huoche siji (老張是貨車司機) ‘Laozhang is a truck driver’) or the auxiliary shi (Laozhang shi kai huoche, wo shi kai keche (老張是開貨車，我是開客車) ‘Laozhang drives a truck and I drive a coach car’). Modern Chinese confirmative shi, copula shi, and auxiliary shi have the same morphological form because they all appear to derive from the adjective shi or demonstrative (
shi ke ren, shu bu ke ren (
是可忍，孰不可忍) ‘if this could be endured, is there anything else that could not be endured’) in Old Chinese. Such a pattern of morphological sameness seems to be cross-linguistically rare, if not unique.
“He tells us that”
Authors: Brownlees Nicholas
Published: February 2018

In this paper, I examine a form of argumentation employed by one of the most prominent parliamentarian news pamphlets of the English Civil War (1642–1649). The pamphlet in question isMercurius Britanicus. It was founded to counter through its pages the news that was being published inMercurius Aulicus, the foremost royalist publication. In its animadversion ofAulicus’s news,Britanicusfirst repeated the royalist text, and then responded to it. In my study, I shall focus on instances where the not wholly faithful reporting ofAulicus’s text leads to (socio)pragmatic meanings. I have taken into consideration both the wider social context in which the pamphlet writers were writing as well as the immediate situational context – the pamphlet as a genre. In my analysis ofBritanicus’s animadversion, I examine titles of courtesy and the omission and substitution of words.
Initiating contact in institutional correspondence
Authors: Włodarczyk Matylda
Published: February 2018

When addressing family members or friends, letter writers enter a common ground of some sort, where, as research has shown, the rules of everyday interaction apply (Nurmi and Palander-Colin 2008). In different historical periods, familiar correspondence is thus very much about maintaining existing bonds and about phatic communion. The situation is likely to be very different in the case of institutional recipients, in particular if somebody addresses a given institution for the first time. The data selected for the study, the 1819 applications to the British Colonial Office for the Cape of Good Hope colonisation scheme (TNA 48/41–6), include many letters written by “first timers” (i.e., the encoders1 who have not addressed the institution before). These letters may provide some insights into the specific participation framework of the first-time writers in their interaction with the institution.

In the paper, I propose that contact initiation may be related to the literacy levels of letter-writers, focusing on what I refer to as “technical literacy”. Based on some parameters thereof, I distinguish between two broad groups of informants, reflecting what may be described as standard and non-standard literacies, respectively. The two groups, I assume, do not operate within the same participation framework and, therefore, display pragmatic and linguistic differences in constructing the initial encounters. Moreover, the analysis of these initiations offers a new perspective on the routinisation of institutional correspondence.
Context and historical (socio-)pragmatics twenty years on
Authors: Archer Dawn
Published: February 2018

This paper has two purposes. First, it constitutes an exploration ofcontextfrom the perspective of some prominent historical pragmaticians, and/or as demonstrated by publications which represent/exemplify a particular approach within historical pragmatics (Jacobs and Jucker 1995;Archer and Culpeper 2003,2011;Nevala 2011;Traugott 2004,2011;2012;Jucker and Taavitsainen 2014) as well as related disciplines such as historical sociolinguistics (Nevalainen and Raumolin-Brunberg 2003). Second, it explores my own (evolving) view in respect to context, often in response to the influential work of others, as evidenced in a selection of my work (Archer 2005,2011,2012,2013,2014).
Surface carburizing during hot isostatic pressing
Authors: Huang Xina , Lang Lihui , Xu Wencai , Meng Fandi
Published: February 2018

The product preparation and surface carburizing of Ti–6Al–4V alloy are usually carried out separately, which leads to a low production efficiency and high processing costs. In this study, hot isostatic pressing (HIP) was proposed to complete the product preparation and surface carburizing of Ti–6Al–4V alloy simultaneously. Ti–6Al–4V powder compact with carburized layer is successfully fabricated using this method. X-ray diffraction and Energy dispersive spectrometer analyses illustrate the carburized layer is mainly composed of C, TiC and Ti. Scanning electron microscope shows a uniform TiC layer and an obvious diffusion region in the carburized layer and the total thickness is about 104 μm. The Ti–6Al–4V region is composed of equiaxed grains and typical lathlike structures. The Vickers hardness of the carburized layer especially the TiC layer is higher than the Ti–6Al–4V region. These results indicate that HIP is a promising process for product preparation and surface carburizing of Ti–6Al–4V alloy.
Bacterial quorum sensing in symbiotic and pathogenic relationships with hosts*
Authors: Kai Kenji
Published: February 2018

Gram-negative bacteria communicate with each other by producing and sensing diffusible signaling molecules. This mechanism is called quorum sensing (QS) and regulates many bacterial activities from gene expression to symbiotic/pathogenic interactions with hosts. Therefore, the elucidation and control of bacterial QS systems have been attracted increasing attention over the past two decades. The most common QS signals in Gram-negative bacteria are N-acyl homoserine lactones (AHLs). There are also bacteria that employ different QS systems, for example, the plant pathogen Ralstonia solanacearum utilizes 3-hydroxy fatty acid methyl esters as its QS signals. The QS system found in the endosymbiotic bacterium associated with the fungus Mortierella alpina, the development of an affinity pull-down method for AHL synthases, and the elucidation of a unique QS circuit in R. solanacearum are discussed herein.
Interactive medical word sense disambiguation through informed learning
Authors: Wang Yue , Zheng Kai , Xu Hua , Mei Qiaozhu
Published: February 2018

Objective

Medical word sense disambiguation (WSD) is challenging and often requires significant training with data labeled by domain experts. This work aims to develop an interactive learning algorithm that makes efficient use of expert’s domain knowledge in building high-quality medical WSD models with minimal human effort.

Methods

We developed an interactive learning algorithm with expert labeling instances and features. An expert can provide supervision in 3 ways: labeling instances, specifying indicative words of a sense, and highlighting supporting evidence in a labeled instance. The algorithm learns from these labels and iteratively selects the most informative instances to ask for future labels. Our evaluation used 3 WSD corpora: 198 ambiguous terms from Medical Subject Headings (MSH) as MEDLINE indexing terms, 74 ambiguous abbreviations in clinical notes from the University of Minnesota (UMN), and 24 ambiguous abbreviations in clinical notes from Vanderbilt University Hospital (VUH). For each ambiguous term and each learning algorithm, a learning curve that plots the accuracy on the test set against the number of labeled instances was generated. The area under the learning curve was used as the primary evaluation metric.

Results

Our interactive learning algorithm significantly outperformed active learning, the previous fastest learning algorithm for medical WSD. Compared to active learning, it achieved 90% accuracy for the MSH corpus with 42% less labeling effort, 35% less labeling effort for the UMN corpus, and 16% less labeling effort for the VUH corpus.

Conclusions

High-quality WSD models can be efficiently trained with minimal supervision by inviting experts to label informative instances and provide domain knowledge through labeling/highlighting contextual features.
On the Value of Work
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

Work is essential to healthy and adaptive human psychological functioning. The work ethic couples work and reward in order to endow work with meaning. The healthy workplace supports relationships and behaviors that promote a strong work ethic and cohesive group function such that the overall goals of the workplace can be accomplished and the mental health of the individual workers is enhanced. This book describes key drivers that disrupt the workplace environment and provides strategies and tools to address problematic behaviors and emotions that place the mental health of employees at risk and reduce the effectiveness of the organization. These tools can help managers, employees, and company leaders to optimize work functioning and informs mental health professionals who treat employees in distress.
The Culture of Risk, Diminished Loyalty, and the Dangerous Insider
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

While technology, globalization, and litigation have brought remarkable changes, many good, there are negative consequences as well. Changes in the psychological contract driven by these three forces have created a climate of organizational risk and security vulnerability. This is particularly the case in the world of information technology, in which “knowledge entrepreneurs” prioritize their own security and career over loyalty to the company. Globalization challenges the closeness necessary to build loyalty. Feelings go underground and managers may be unaware of the estranged and resentful employee on the path to committing fraud or sabotage. Because of sensitivity to litigation, employees’ behavior may not be observed or documented. If management is not alert and responsive to the changes taking place in the culture, the work environment may slowly evolve into one that supports behavior and attitudes that are both damaging to the employees and dangerous for the organization.
Supporting Workers in Distress
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

Employees look to their managers and their company to provide support and understanding. When problems arise in the workplace, employees want their company to address them and quickly resolve them. Employees know their company cannot solve all the problems that arise both within and outside the workplace, but they appreciate expressions of concern and support from their manager. Managers who become aware of an employee in distress need to take action. They should approach these situations with an understanding of the Credibility Cross and the psychological contract. The manager should develop a plan to address the concerns of the employee and/or organization. Whether disruptive problems are the result of globalization, technology, or litigation, addressing them in a timely manner will have a positive impact on the workplace.
Know Your Blind Spots
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

This chapter focuses on blind spots, the qualities and behaviors that a manager brings to the workplace of which he or she is not aware. Three case studies are presented of managers who have both strengths and maladaptive work behaviors. Discussion follows about the potential impact of these blind spots before they are brought to the manager’s consciousness. Blind spots change over time, so managing them requires constant attention. Common interpersonal and workplace blind spots include those involved in the psychological contract around the themes of interpersonal predictability, psychological distance, dependency, change, and danger. Useful tools are presented, including the development of introspection, a personal perspective, and a work culture conducive to input from colleagues. While finding blind spots requires personal effort, courage, and determination, doing this psychological work will diminish their potentially destructive impact, will enhance the manager’s overall effectiveness, and will improve the workplace environment.
Epidemiology
Authors: Ekker Merel Sanne , de Leeuw Frank-Erik
Published: February 2018

Epidemiology can be used to reveal new causes of ischaemic stroke in young adults. Each year, about 2 million patients worldwide suffer a young stroke between the ages of 18 and 49 years. The overall stroke incidence is decreasing; however, an increase in the incidence of young stroke has been witnessed, possibly due to better awareness, new imaging techniques, and the increased prevalence of traditional risk factors already at a young age. Nevertheless, not all young stroke patients have cardiovascular risk factors. The proportion of patients with arterial dissection, cardioembolic stroke, and cryptogenic stroke is higher in young patients than in older patients. This chapter uses sex differences in both incidence and prognosis to provide leads for new risk factors in young men and women. Lastly, prognosis after young stroke is poor. The risk of death is higher than expected from the general population and remains high even years after stroke. Young stroke strikes suddenly, with attendant life-long consequences.
Cardiac aetiology
Authors: Turc Guillaume , Calvet David , Mas Jean-Louis
Published: February 2018

Cardiac aetiology accounts for approximately 20% of strokes in young adults. Although atrial fibrillation is a leading cause of stroke in the general population, it is uncommon in young adults. In such patients, more diverse causes of ischaemic stroke are observed, including valvular heart diseases, infective endocarditis, Libman–Sacks endocarditis, dilated cardiomyopathies, congenital heart diseases, myocardial infarction, and intracardiac tumours. Patent foramen ovale is commonly observed in young adults with ischaemic stroke, but this association may be incidental in a sizeable proportion of patients. Young adults who are the most likely to have a stroke-related patent foramen ovale are also those with the lowest recurrence risk.
Vascular imaging (CTA/MRA)
Authors: Gattringer Thomas , Enzinger Christian , Ropele Stefan , Fazekas Franz
Published: February 2018

Non-invasive computed tomography angiography (CTA) and magnetic resonance angiography (MRA) constitute an integral part of the diagnostic workup of stroke patients, which—among the various techniques to image the complex cerebrovascular tree—can be conceptually placed between duplex sonography and digital subtraction angiography. CTA and especially MRA can be performed with different techniques and protocols that need to be used according to the clinical questions. In the setting of acute ischaemic stroke with the therapeutic option of endovascular thrombectomy, the rapid and reliable detection of large vessel occlusion has become of paramount importance. Both CTA and MRA can accomplish this and there is no need for contrast material when performing intracranial MRA. Vascular imaging is also essential to identify vessel-related causes of stroke such as large artery atherosclerosis, dissection, and some forms of arteritis mandating specific management or therapeutic intervention to avoid recurrence. Considering these aspects, frequent and targeted use of CTA or MRA is highly encouraged and especially relevant in young patients with stroke.
Echocardiography
Authors: Saeed Sahrai , Gerdts Eva
Published: February 2018

Current guidelines recommend extensive cardiovascular imaging in patients who experience ischaemic stroke or a transient ischaemic attack to prevent recurrent stroke. High-quality echocardiography is crucial for detection of the wide range of cardiac and proximal aortic conditions that can predispose to cerebral embolism. These conditions may be classified as major, minor, or uncertain risk sources of embolism. Although both transthoracic (TTE) and transoesophageal echocardiography (TOE) have substantial clinical utility in patients with cryptogenic stroke, these methods offer complementary information. TOE is typically used for assessment of defects in the atrial septum or detection of thrombus in the left atrial appendage. In contrast, TTE is the recommended method for assessment of cardiac chamber structure and function, and valvular disease. Furthermore, assessment of aortic stiffness and electrocardiography may offer additional insight to cardiac function. This chapter gives an overview of the use of echocardiography in ischaemic stroke patients.
Genetics
Authors: Pezzini Alessandro
Published: February 2018

Ischaemic stroke is a heterogeneous multifactorial disorder. Although epidemiological data from twin and family studies provide substantial evidence for a genetic basis for stroke, the contribution of genetic factors identified so far is small. Large progress has been made in single-gene disorders associated with ischaemic stroke, particularly at young age. By contrast, little is known about the genes associated with multifactorial stroke. The reported genome-wide association studies of ischaemic stroke have shown that no single common genetic variant imparts major risk, but data on early-onset disease are scarce in this regard. Larger studies with samples numbering in the thousands are ongoing to identify common variants with smaller effects on risk. This approach, in addition with new analytic techniques, will likely contribute to the identification of additional genes, novel pathways, and eventually novel therapeutic approaches to cerebrovascular disorders in the near future. The aims of this review are to summarize data on clinical, genetic, and epidemiologic aspects of monogenic conditions associated with juvenile ischaemic stroke, to discuss recent findings and methodological limitations regarding the genetics of sporadic ischaemic stroke in this age category, and to provide a brief overview of the potential future approaches to stroke genetics.
Long-term prognosis
Authors: Naess Halvor
Published: February 2018

Knowledge of prognosis is important for patients in the prime of life in order to make informed decisions about treatment, choice of education, and profession. Median first-year mortality after first-ever cerebral infarction among young adults is about 4% while median annual average mortality after the first year is about 1.7%. Likewise, median first-year recurrence rate of cerebral infarction is 2% and thereafter 1.5% per year. Risk factors for recurrent cerebral infarction include hypertension, diabetes mellitus, symptomatic atherosclerosis, and smoking. Recurrent cerebral infarction and mortality are associated with increasing number of traditional risk factors. About 10% of patients develop post-stroke seizures within 6 years of the acute stroke. Almost 90% of patients report good functional outcome (modified Rankin Scale score ≤2) on long-term follow-up, but up to 30–50% of patients do not resume employment. Many patients have cognitive impairment. Fatigue and depression are also common on long-term follow-up.
Nature in buildings and health design
Authors: Kellert Stephen R.
Published: February 2018

This chapter discusses a hypothesized inherent human need to affiliate with nature (‘biophilia’), its continuing importance to human health and well-being, and how to meet this need in modern society through design of the built environment, with particular focus on healthcare facilities. The theory of biophilia is introduced, its evolutionary origins, effects on human health and well-being, and impediments to its functional development in modern society, particularly the prevailing paradigm of design of the built environment. The chapter describes the notion of ‘biophilic design’, the attempt to address biophilia in the modern built environment. Principles and practices of biophilic design are delineated. The chapter concludes with a brief description of examples of biophilia and biophilic design in existing healthcare facilities.
Therapeutic landscapes, restorative environments, place attachment, and well-being
Authors: Townsend Mardie , Henderson-Wilson Claire , Ramkissoon Haywantee , Weerasuriya Rona
Published: February 2018

Evidence of declining well-being and increasing rates of depression and other mental illnesses has been linked with modern humans’ separation from nature. Landscapes become therapeutic when physical and built environments, social conditions, and human perceptions combine. Highlighting the contextual factors underpinning this separation from nature, this chapter outlines three Australian case studies to illustrate the links between therapeutic landscapes, restorative environments, place attachment, and well-being. Case study 1, a quantitative study of 452 park users near Melbourne, Victoria, focuses on place attachment and explored the links between pro-environmental behaviour and psychological well-being. Case study 2, a small pilot mixed-methods study in a rural area of Victoria, explores the restorative potential of hands-on nature-based activities for people suffering depression, anxiety, and social isolation. Case study 3, a qualitative study of users’ experiences of accessing hospital gardens in Melbourne, highlights improved emotional states and social connections.
Organizing geriatric services
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on using geriatric services, acute services for older people, the integration debate, admission avoidance schemes, complex day services/day hospitals, specialty clinics, intermediate care, community hospitals, domiciliary (home) visits, care homes, paying for residential care, home care, informal carers, other services, chronic disease management, primary care, careers in geriatric medicine in the United Kingdom, and the diploma in geriatric medicine (DGM).
Rehabilitation
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the process of rehabilitation, aims and objectives, measurement tools and instruments, selecting patients, patients unlikely to benefit from rehabilitation, physiotherapy, walking aids, occupational therapy, occupational therapy assessments and interventions, doctors, nurses, and other members of the rehabilitation team, social work and care management, as well as community nurses and health visitors.
Falls and funny turns
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on falls and fallers, assessment following a fall, interventions to prevent falls, syncope and presyncope, balance and disequilibrium, dizziness, drop attacks, orthostatic (postural) hypotension, situational hypotension, carotid sinus syndrome, and falls services.
Drugs
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on pharmacology in older patients, prescribing ‘rules’, taking a drug history, drug sensitivity, adverse drug reactions, angiotensin-converting enzyme inhibitors, analgesia, steroids, warfarin, direct oral anticoagulants, proton pump inhibitors, herbal medicines, and breaking the rules.
Neurology
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing brain and nervous system, tremor, neuropathic pain/neuralgia, presentation of Parkinson’s disease, management of Parkinson’s disease, diseases masquerading as Parkinson’s disease, epilepsy and its drug treatment, neuroleptic malignant syndrome, motor neuron disease, peripheral neuropathies, subdural haematoma, sleep and insomnia, and other sleep disorders.
Cardiovascular
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing cardiovascular system, chest pain, stable angina, acute coronary syndromes, myocardial infarction, hypertension, treatment of hypertension, presentation of arrhythmias, management of arrhythmias, atrial fibrillation, rate/rhythm control in atrial fibrillation, stroke prevention in atrial fibrillation, bradycardia and conduction disorders, common arrhythmias and conduction abnormalities, heart failure assessment, acute heart failure, chronic heart failure, dilemmas in heart failure, heart failure with preserved left ventricular function, valvular heart disease, peripheral oedema, preventing venous thromboembolism in an older person, peripheral vascular disease, gangrene in peripheral vascular disease, and vascular secondary prevention.
Homeostasis
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on volume depletion and dehydration, management of dehydration, assessment of hyponatraemia, treatment of hyponatraemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypernatraemia, diagnosis of hypothermia, management of hypothermia, and heat-related illness.
Endocrinology
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing endocrine system, diabetes mellitus, treatment of diabetes, oral drug treatment of diabetes, insulin treatment of diabetes, complications of diabetes, diabetic emergencies, diagnosis of hypothyroidism, treatment of hypothyroidism, diagnosis of hyperthyroidism, investigation of hyperthyroidism, drug treatment of hyperthyroidism, non-drug treatment of hyperthyroidism, primary adrenal insufficiency, and hormone replacement therapy and the menopause.
Musculoskeletal system
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on osteoarthritis, management of osteoarthritis, osteoporosis, management of osteoporosis, polymyalgia rheumatica, giant cell arteritis, muscle symptoms, Paget’s disease, gout, pseudogout, contractures, cervical spondylosis and myelopathy, osteomyelitis, the elderly foot, the elderly hand, the painful hip, the painful back, and the painful shoulder.
Malignancy
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on malignancy in older people, an approach to malignancy, presentation of malignancy, treating malignancy in older people, and cancer with an unknown primary.
Oral cavity and gut
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The oral cavity and gut in relation to dentistry are the topics in this chapter. A brief summary of tooth development and eruption is followed by a description of the dental and supporting tissues. Throughout the clinical implications are highlighted. Consideration of dental caries and aspects of its prevention follow. The digestive tract is then followed with a discussion of digestion and co-ordination at each stage. Finally, diet and nutritional requirements are explored, together with common problems that are especially relevant to dentistry.
Heart and blood supply
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The heart in relation to dentistry is the topic of this chapter. Heart physiology is described with respect to the cardiac cycle, control of contraction, ECG, and arrhythmias. Control of the cardiovascular system is next considered and the clinical application of this in fainting, shock, and blood loss. Atherosclerosis, angina, and myocardial infarction are described. This leads to a discussion of heart failure and drugs commonly used in cardiovascular disease. Infective endocarditis and rheumatic fever are discussed and the associations between oral bacteria and cardiovascular disease. The concluding section deals with stroke (cerebrovascular accident or CVA), transient ischaemic attacks (TIA) and vascular dementia.
Blood
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The blood in relation to dentistry is the topic of this chapter. Components of blood are described, including the blood cell types, their development and functions. Anaemias are discussed and their dental implications. Haemostasis and the coagulation pathway are described, followed by the bleeding disorders, how they are detected in blood tests and managed so as to avoid complications arising from dental treatment. The main malignancies of white blood cells are described in relation to dental care. The final section deals with blood and tissue types and their relevance to blood transfusion and tissue transplantation.
History and development of the concept of autism
Authors: Brugha Traolach S.
Published: February 2018

This first chapter covers autism definitions, concepts of autism, of atypical and typical development, and the valuable idea of neuro-diversity. The historical emergence of autism is then described including the contributions of Kanner, Asperger, and Wing, the autism triad, and autism as a spectrum condition. Current official definitions are then introduced. The development of clinical research is then considered. A section on the factors associated with autism in adulthood follows. Manifestations in the population, and epidemiology from birth to old age are set out. Psychiatric epidemiology and psychiatric genetics, and the testing of disease concepts are introduced briefly.
Comorbidity assessment
Authors: Brugha Traolach S.
Published: February 2018

This final chapter in Part II captures the distinctions between autism and other mental disorders (and intellectual disability). Issues and challenges in comorbidity assessment are discussed including development and course of social interaction. Under recognition of autism by psychiatrists and the conditions they tend to diagnose in such cases (depression, BPD, anxiety) are considered. Possible harmful effects of misdiagnosis in clinical contexts and in advice (employers, benefits system, courts, etc.) are discussed. How to differentiate symptoms that might seem to be part of two conditions (e.g. OCD versus RRBs) is discussed as is the possible confusion between autism and other similar clinical presentations. Specific comorbidities covered include ADHD, Intellectual Disability, suicidality, anxiety, depression, and masking issues and any major mental disorder in adulthood. Issues of law are also covered.
The First Domain of Palliative Care
Authors: Strada E. Alessandra
Published: February 2018

This chapter proposes palliative psychology competencies in the first domain of palliative care based on the framework of the Clinical Practice Guidelines for Quality Palliative Care. Competencies are conceptualized as comprising knowledge, skills, and attitudes. The role of palliative psychologists is presented through the discussion of clinical case scenarios. These roles for psychologists are discussed in the context of different palliative care settings (inpatient; outpatient, home-based palliative care, hospice). The relevant application of clinical skills is discussed. The difference between palliative care and hospice is also presented. Finally, this chapter approaches the topic of professional self-care, which is conceptualized as a necessary competence for palliative psychologists. The discussion presents risk factors, protective factors, and interventions especially relevant to palliative psychologists.
The Third Domain of Palliative Care
Authors: Strada E. Alessandra
Published: February 2018

This chapter describes palliative psychology competencies in the third domain of palliative care, which focuses on identifying and addressing psychological and psychiatric needs in the patient and the family. Palliative psychology is a holistic discipline. It emphasizes not only the management of distress, but also the importance of facilitating psychospiritual well-being for the patient and for family caregivers. Because psychotherapy is one of the main psychological interventions provided by psychologists, this chapter defines palliative psychotherapy as a relevant framework for the palliative care setting. The essential components related to structure, delivery, and therapeutic stance are discussed. This chapter also discusses major depression, anxiety, and anticipatory grief reactions. Nonpharmacological and pharmacological approaches are discussed.
The Sixth Domain of Palliative Care
Authors: Strada E. Alessandra
Published: February 2018

This chapter proposes and describes palliative psychology competencies in the cultural domain of palliative care. It focuses on the importance of providing care that is consistent with the patient and family culture, including values, beliefs systems, and meaning-making processes. The construct culture is explored in its different applications pertaining to the health-care system. Cultural barriers to adequate palliative care are explored, identifying challenges and pitfalls that clinicians should avoid to provide culturally competent palliative care. Biases inherent in medical and psychological culture are also explored to promote palliative psychologists’ ability to recognize countertransference reactions that may negatively affect patient care. The essential components of multicultural psychotherapy are also described. Finally, the construct of microaggression is adapted to the palliative care setting through a series of case vignettes that exemplify culturally insensitive behaviors.
The Seventh Domain of Palliative Care
Authors: Strada E. Alessandra
Published: February 2018

This chapter describes palliative psychology competencies in the seventh domain of palliative care, which addresses palliative care for the patient approaching end of life and the patient’s family. The medical context of dying is reviewed by discussing the interplay of psychological and medical factors related to approaching death and the dying process. The physiological and psychological changes expected in advanced illness and during the dying process are also discussed. The chapter presents a role for the palliative psychologist at different junctures during advanced illness and the dying process. Complications that may arise during the dying process, including hemorrhage and agitated delirium, are discussed and psychological interventions that can promote safety and comfort for the patient and the family are described.
Testing modified gravity with globular clusters: the case of NGC 2419
Authors: Llinares Claudio
Published: February 2018

The dynamics of globular clusters has been studied in great detail in the context of general relativity as well as with modifications of gravity that strongly depart from the standard paradigm such as Modified Newtonian Dynamics. However, at present there are no studies that aim to test the impact that less extreme modifications of gravity (e.g. models constructed as alternatives to dark energy) have on the behaviour of globular clusters. This Letter presents fits to the velocity dispersion profile of the cluster NGC 2419 under the symmetron-modified gravity model. The data show an increase in the velocity dispersion towards the centre of the cluster which could be difficult to explain within general relativity. By finding the best-fitting solution associated with the symmetron model, we show that this tension does not exist in modified gravity. However, the best-fitting parameters give a model that is inconsistent with the dynamics of the Solar system. Exploration of different screening mechanisms should give us the chance to understand if it is possible to maintain the appealing properties of the symmetron model when it comes to globular clusters and at the same time recover the Solar system dynamics properly.