bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and simulation of an accelerometer based on NV center spin–strain coupling
Authors: Ji 季 Lu-Min 鲁敏 , Zhao 赵 Li-Ye 立业 , Wang 王 Yu-Hai 裕海
Published: November 2023

The nitrogen-vacancy (NV) center quantum systems have emerged as versatile tools in the field of precision measurement because of their high sensitivity in spin state detection and miniaturization potential as solid-state platforms. In this paper, an acceleration sensing scheme based on NV spin–strain coupling is proposed, which can effectively eliminate the influence of the stray noise field introduced by traditional mechanical schemes. Through the finite element simulation, it is found that the measurement bandwidth of this ensemble NV spin system ranges from 3 kHz to hundreds of kHz with structure optimization. The required power is at the sub-μW level, corresponding to a noise-limited sensitivity of

6.7
×

10

−
5

g
/

Hz

. Compared with other types of accelerometers, this micro-sized diamond sensor proposed here has low power consumption, exquisite sensitivity, and integration potential. This research opens a fresh perspective to realize an accelerometer with appealing comprehensive performance applied in biomechanics and inertial measurement fields.
Sleep Deficits Inter-Link Lower Basal Forebrain–Posterior Cingulate Connectivity and Perceived Stress and Anxiety Bidirectionally in Young Men
Authors: Li Guangfei , Zhong Dandan , Li Bao , Chen Yu , Yang Lin , Li Chiang-Shan R
Published: November 2023

Background

The basal nucleus of Meynert (BNM), a primary source of cholinergic projections to the cortex, plays key roles in regulating the sleep-wake cycle and attention. Sleep deficit is associated with impairment in cognitive and emotional functions. However, whether or how cholinergic circuit, sleep, and cognitive/emotional dysfunction are inter-related remains unclear.

Methods

We curated the Human Connectome Project data and explored BNM resting state functional connectivities (rsFC) in relation to sleep deficit, based on the Pittsburgh Sleep Quality Index (PSQI), cognitive performance, and subjective reports of emotional states in 687 young adults (342 women). Imaging data were processed with published routines and evaluated at a corrected threshold. We assessed the correlation between BNM rsFC, PSQI, and clinical measurements with Pearson regressions and their inter-relationships with mediation analyses.

Results

In whole-brain regressions with age and alcohol use severity as covariates, men showed lower BNM rsFC with the posterior cingulate cortex (PCC) in correlation with PSQI score. No clusters were identified in women at the same threshold. Both BNM-PCC rsFC and PSQI score were significantly correlated with anxiety, perceived stress, and neuroticism scores in men. Moreover, mediation analyses showed that PSQI score mediated the relationship between BNM-PCC rsFC and these measures of negative emotions bidirectionally in men.

Conclusions

Sleep deficit is associated with negative emotions and lower BNM rsFC with the PCC. Negative emotional states and BNM-PCC rsFC are bidirectionally related through poor sleep quality. These findings are specific to men, suggesting potential sex differences in the neural circuits regulating sleep and emotional states.
A new function of thymol nanoemulsion for reversing colistin resistance in Salmonella enterica serovar Typhimurium infection
Authors: Sheng Qiushuang , Wang Nan , Zhou Yonglin , Deng Xuming , Hou Xiaoning , Wang Jianfeng , Qiu Jiazhang , Deng Yanhong
Published: November 2023

Background

Adjuvant addition of approved drugs or foodborne additives to colistin might be a cost-effective strategy to overcome the challenge of plasmid-mediated mobile colistin resistance gene emergence, which poses a threat in the clinic and in livestock caused by infections with Gram-negative bacteria, especially carbapenem-resistant Enterobacteriaceae.

Methods

Chequerboard assay was applied to screen the colistin adjuvants from natural compounds. The killing–time curve, combined disc test and membrane permeation assay were conducted to identify the synergy efficacy of thymol and colistin in vitro. Thin-layer chromatography (TLC), LC-MS and fluorescence spectra were used to indicate the interaction of thymol and MCR-1. The potential binding sites were then investigated by molecular simulation dynamics. Finally, a thymol nanoemulsion was prepared with high-pressure homogenization as the clinical dosage form.

Results

Thymol presented an excellent synergistic effect in vitro with colistin against Salmonella enterica serovar Typhimurium and Escherichia coli bacteria. Thymol addition, forming a complex with MCR-1, might interfere with the efficacy of MCR-1. Moreover, thymol strengthened colistin activity associated with potentiating membrane damage, destroying the biofilm and enhancing reactive oxygen species-mediated oxidative damage. Thymol nanoemulsion combined with colistin remarkably prevented the intestinal damage caused by S. Typhimurium infection, resulting in a survival rate higher than 60%.

Conclusions

This study achieved a promising thymol oral formulation as colistin adjuvant to combat S. Typhimurium infection, which could be used to extend the lifespan of colistin in clinical veterinary medicine.
SCR106 splicing factor modulates abiotic stress responses by maintaining RNA splicing in rice
Authors: Alhabsi Abdulrahman , Butt Haroon , Kirschner Gwendolyn K , Blilou Ikram , Mahfouz Magdy M
Published: November 2023

Plants employ sophisticated molecular machinery to fine-tune their responses to growth, developmental, and stress cues. Gene expression influences plant cellular responses through regulatory processes such as transcription and splicing. Pre-mRNA is alternatively spliced to increase the genome coding potential and further regulate expression. Serine/arginine-rich (SR) proteins, a family of pre-mRNA splicing factors, recognize splicing cis-elements and regulate both constitutive and alternative splicing. Several studies have reported SR protein genes in the rice genome, subdivided into six subfamilies based on their domain structures. Here, we identified a new splicing factor in rice with an RNA recognition motif (RRM) and SR-dipeptides, which is related to the SR proteins, subfamily SC. OsSCR106 regulates pre-mRNA splicing under abiotic stress conditions. It localizes to the nuclear speckles, a major site for pre-mRNA splicing in the cell. The loss-of-function scr106 mutant is hypersensitive to salt, abscisic acid, and low-temperature stress, and harbors a developmental abnormality indicated by the shorter length of the shoot and root. The hypersensitivity to stress phenotype was rescued by complementation using OsSCR106 fused behind its endogenous promoter. Global gene expression and genome-wide splicing analysis in wild-type and scr106 seedlings revealed that OsSCR106 regulates its targets, presumably through regulating the alternative 3'-splice site. Under salt stress conditions, we identified multiple splice isoforms regulated by OsSCR106. Collectively, our results suggest that OsSCR106 is an important splicing factor that plays a crucial role in accurate pre-mRNA splicing and regulates abiotic stress responses in plants.
Sacred Homelands
Authors: Smith Anthony D
Published: November 2023

Since its origins in the eighteenth-century ideal of a ‘return to nature’, the notion of a national homeland and of the nation as possessor of a unique and peculiar land has been central to nationalist ideologies. But here, too, the modern ideal has pre modern foundations. The contrast between ‘home’ and ‘abroad’, which we take for granted in our everyday speech and action, has a much longer history; and the idea of a special territory that is sanctified and set apart can be found in various parts of the world in different periods of history. Yet, only in the modern world has this older collective attachment to the homeland come to serve as another sacred foundation and cultural resource for the maintenance, and reinterpretation, of national identities. For modernists, the nationalist demarcation of territory as a homeland stems from the activities of the centralizing and reflexive state. These are mainly of two kinds: census taking and map making. Together, these modern activities enabled states to constitute the ‘body’ of the nation, to make the abstraction of the nation imaginable and palpable. Benedict Anderson points out that the census and map made it possible for nationalists to imagine and to maintain an
An Introduction to Children’s Literature
Authors: Hunt Peter
Published: November 2023

Passionately enjoyed as much by the young as by adults, children's literature is a vital part of Western culture. Attracting increasing scholarly attention, its indelible influences on most people's psyche attest to its widespread importance. Well-known for his work in the field, Peter Hunt here offers a history of children's literature--primarily British, although including American and other works as well--along with an assessment of its literary, sociological, and pedagogical roles. In addition, Hunt looks at the uses to which children's literature is put, the claims that are made for it, and the difference between children's and adults' ways of reading.
History and Histories
Authors: Hunt Peter
Published: November 2023

Children used books long before books were produced specifically for children—a fact that has given rise to the not very helpful argument that, as childhood was scarcely recognized or recognizable before the eighteenth century, all pre-1700 texts can be considered as (also) children’s texts. It would undoubtedly be interesting to discover what children made of Shakespeare or Reynard the Fox, but only if we could discover with any certainty what adults made of them. Because the twentieth-century reader sees a repressive, dry, crude, or simple text which would not appeal to the modern, liberated, multi-media child, we cannot assume that such texts would not appeal to the child of the time. None the less, historical evidence about childhood is lacking, and territorial lines have to be drawn somewhere, and so I propose to give only the briefest mention to texts produced before 1700 and, more radically, relatively little space to texts produced before about 1860.
The Long Weekend, 1920-1939
Authors: Hunt Peter
Published: November 2023

One answer is that children’s books reflect the world as we would like it to be; they react to the adult world. Just as, after the trauma of the Second World War, children’s books reacted by turning to fantasy, so, after the First, they looked towards various kinds of freedom. It may have been an effect of the change in attitudes to childhood; but, more concretely, there had been a sea-change, and the world after 1914 is much closer to ours than the world before. Certainly—although there are many exceptions—the tone of voice, the mode of telling, and the narrative contract between narrator and implied child reader of the children’s book that we recognize today were fully established.
The development, growth, and distribution of public and private medical resources in the Philippines
Authors: Griffin Charles C , Paqueo Vincent B
Published: November 2023

A striking feature of primary health programmes, and more generally of government health planning, is a failure to realize that the government is one among many providers of health services in developing countries.
A study of hospital fees in the Dominican Republic
Authors: Lewis Maureen A
Published: November 2023

Most public health systems in the developing world have been built in the belief that health care is a fundamental right; that the state must meet the health needs of the population; and that public services should be free at the point of use. Concerns over equal access and affordability have further enhanced the appeal of free-services policies. Yet despite the desirability of ensuring access to health services, recent economic events have made it clear − for the foreseeable future at least − that such policies are unaffordable for much of the developing world.
Economic determinants of demand for modern infant-delivery in low-income countries: the case of the Philippines
Authors: Brad Schwartz J , Akin John S , Popkin Barry M
Published: November 2023

A majority of births in the Philippines take place at home, and a significant proportion are either attended by a traditional midwife or friends and relatives of the mother. Women continue to choose this pattern of delivery despite large investments by the health sector in modern prenatal and obstetrical health services. Even though a large majority of the pregnant women have direct contact with modern delivery services, there still appears to be a preference for traditional home deliveries.
Quantity rationing and the demand of adults for medical care in rural C ô te D’Ivoire
Authors: Dor Avi , van der Gaag Jacques
Published: November 2023

The principal providers of health care in many developing countries are ministries of health and other public-sector institutions. Slow economic growth and record budget deficits in the 1980s have forced reductions in public spending. This has placed severe pressures on public health-care systems, unable to meet growing needs even during the economic growth periods of the 1960s and 1970s. Whereas funds for capital investment are often funded by international donors, recurrent costs are typically financed by the public treasury. Revenues from user charges usually contribute only about 10 per cent of recurrent expenditures (Ainsworth 1983; de Ferranti 1985). Consequently, little attention has been paid to market forces.
Exposure measurement
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

Epidemiology is a comparatively new science. Its methods were first developed when the study of diseases due to infectious organisms was its main focus. The measurement of exposure was then grounded in microbiology, and most epidemiologists had substantial training or experience in this discipline. Interest in non-microbiological determinants of disease was commonly confined to the more readily measurable host factors such as age, sex, race, etc. Measurement of the microbiological determinants was simplified by the possibility of isolation and culture of a specific organism from the presumed agent of disease, the short interval that commonly separated exposure from onset of clinical symptoms, and the possibility of serological documentation of exposure that had occurred in the distant past.
Exposure measurement error and its effects
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

Measurement error is one of the major sources of bias in epidemiological studies. It can lead to spurious conclusions about the relationship between exposure and disease. In this book we confine our attention to error in the measurement of exposure.
The design of questionnaires
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

For our purposes, a questionnaire can be defined as a tool designed to elicit and record, or guide the elicitation and recording of, recalled exposures from subjects of an epidemiological study. It contains questions to be put to the subject, and may also include answers to those questions from which the subject must choose those which are appropriate to him or her. The objectives of questionnaire design are:

These objectives are potentially in conflict, and any questionnaire usually represents a compromise among them. For example, it may be necessary to trade off some ease in processing and analysis against ease in completion by the interviewer or the subject. Similarly, the addition of some questions essential to the objectives of the study, for example questions about sexual behaviour in a study of the aetiology of cancer of the cervix, may make a questionnaire more difficult for an interviewer to administer and more threatening to the respondent. Judgement must be exercised in making
The personal interview
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

In epidemiology, an interview is’ a structured procedure with a scientific purpose by means of which the respondent [subject of research], through a series of questions or presented stimuli, is induced to give verbal information.’ (Scheuch 1967). The personal interview, whether face-to-face or by telephone, is the commonest method of collecting data on exposure in epidemiological studies.
Measurements in the human body or its products
Authors: Armstrong Bruce k. , White Emily , Saracci Rodolfo
Published: November 2023

An exposure always leaves a trace, either transient or permanent, in the exposed subject. As a result, the exposure can sometimes be measured directly in the subject’s internal environment: in cells, body fluids, or body products. These measurements are commonly described as ‘biological measurements’ or measurements of ‘biological markers’, although the measurement procedures, in most cases, do not make use of biological properties but are, rather, chemical or physical in nature.
The Evaluation of National Health Systems
Authors: Cumper George E
Published: November 2023

As the demand for health care grows faster than the finance available, many developing countries (and some developed ones) are forced to evaluate their health systems, and even reorganize them. This needs more than an endorsement of international health policies and the accumulation of evaluations of individual projects. It needs the use of all available data on health system performance and a comparison with the standards the system is meant to meet: these standards relate not only to biomedical matters, but to administration, resource use and public demand. This requires a good understanding of the structure and working of the system, and of how the evaluator's results may be applied. This book is based particularly on experience in the Caribbean and the countries of south east Asia.
The follow-up study
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

A cluster of disease often initiates a case-control study, but a clustering of diseases could easily escape notice. Good record keeping or registers are often very helpful; but experience, intuition, or chance may play a role. You have a problem and you need a solution. You have a group of diseases and you look for a cause. Epidemiological principles may also be applied if you have a new work process which might influence the health of the workers or a potential cause of harm and you need to know if it will influence the health of the workers. It is necessary to find out whether a particular exposure damages workers’ health. In this case you have an exposure-a number of people are exposed. The problem is: does it damage the workers’ health? In the Kentucky example, it would have been possible to identify a group of workers exposed to vinyl chloride and study new diseases occurring in the study period: a control group, which might be non-exposed workers from the same factory would be needed.
An ‘occupational ‘flu ‘ epidemic
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

April 15 1965; a phone call from a more than desperate manager to a department of occupational health was the beginning of the end of a puzzling situation that nearly spelled disaster for the relatively small factory that was the scene of this ‘drama’. Twenty years ago, just after the Second World War, the father of the present manager, together with two of his brothers, set up a small plant where various kinds of metal cans were manufactured. Through hard work this family business prospered and developed into a small factory, with half a dozen or so unskilled workers. However, the demand for metal cans diminished, and it was thought worthwhile to change to a new technology. A second workshop was opened in which ‘plastic’ boxes were produced. The ‘plastic’ base material was delivered in large sheets to be cut and moulded. The manager himself and three new unskilled workers spent a week learning the technical procedures in a large factory in Germany, and production started at the end of February 1965. Initially everything went smoothly and the productivity of the workmen was considered quite good. Then things went wrong.
A small cluster of spontaneous abortions
Authors: Olsen Jørn , Merletti Franco , Snashall David , Vuylsteek Karel
Published: November 2023

At a small factory close to a town in a rural area, about 40 women were mainly engaged in sewing men’s shirts. The work was monotonous and badly paid. Previously, most women only stayed in the job for a short period of time and left when other work opportunities presented. However, because of a high rate of unemployment among unskilled women in the area, these 40 women had been at the factory from two to ten years. They knew each other well, not only because they worked together, but also because most of them lived within a short distance of the factory in a sparsely populated area. Thirty-two of the women were under 45 years of age. One day the factory nurse was contacted personally by one of the women. She told her that she and her husband had been trying to have a child for some time. When she had finally become pregnant, she had lost the child after about three months. She had discussed the matter with some of the other women at the work place, and three others reported that they had also had a spontaneous abortion within the last two years.
An historical perspective
Authors: Elwood Harold
Published: November 2023

Anencephalus and spina bifida are known to have occurred in ancient times. A mummified anencephalic human fetus discovered in a sarcophagus at Hermopolis on the Nile was demonstrated at a meeting of the Academy of Sciences in Paris by Etienne Saint-Hilaire (1826). It was found in the catacombs of that city in the area where sacred animals, the ape and ibis, normally were buried according to the religious beliefs of ancient Egypt (Fig. 1.1). Brothwell and Powers (1968) note that the embalmer followed the usual methods of mummification, attempting to remove the brain via an opening made through the nose, and apparently the significance of the deformities in the head and neck region posteriorly were not noticed. This specimen was acquired by the King of Prussia and formed part of the collection of the Berlin Museum which was later destroyed by one of the Allied Forces' bombing raids during the Second World War (Powers 1978). The earliest post-Renaissance description of an anencephalic is probably that by Lycosthenes (1557) and another is included in the register prepared by Ambrosinus (1642) of a collection of specimens of monstrosity assembled by Aldrovandus. Taruffi (1891) wrote that the term 'anencephaly' was used by Schlegal in 1812 and after this date the term 'anencephalus' became more widely adopted. Further details of various historical aspects are given by Warkany (1959, 1971) and Lemire et al. (1978).
Fetal loss
Authors: Little Julian , Elwood Mark
Published: November 2023

Almost all epidemiological studies of anencephalus and spina bifida are based on the recorded prevalence at birth, counting only livebirths and legally accepted stillbirths, defined by a minimum estimated gestational age, currently 20 or 28 weeks in most countries. The number of such affected births is the number of embryos or fetuses in which the defects occur (the true incidence) minus the number of fetuses lost as spontaneous or induced abortions before the legal gestational limit, and the prevalence rate at birth (the proportion of all births which are affected) depends on the incidence rate of the defect and the ratio of the abortion rates in affected and unaffected pregnancies. To know to what extent prevalence at birth reflects incidence, it is necessary to calculate prevalence rates at different stages of gestation.
Maternal age and reproductive history
Authors: Elwood Mark , Little Julian
Published: November 2023

The literature on maternal age and parity has been regarded as ‘very confusing’ (Elwood J.M. and Elwood J. H. 1980, p. 181). This is still the situation and in at least one way the confusion has increased. In earlier work from developed countries, using data predominantly from the 1950s to the 1970s, variations in the prevalence at birth of neural tube defects by maternal age and parity could be taken to represent to a large degree biological processes, and coherent hypotheses to explain the variations could be considered. In the more recent data from the 1980s, the extent to which such variations reflect sociological rather than biological effects has increased and brings another complex element into the interpretation. With the wide availability of effective contraceptive methods since the 1960s, and the dramatic increase in induced abortion since the 1980s, the biological meaning of a birth at a particular age or a particular birth order is more questionable. Methodological limitations also exist. Data sets which are large enough to allow the separation of the effects of variables such as age and parity are usually based on routine birth certificate and vital statistical systems, which are restricted to the consideration of legally registered stillbirths and livebirths, and often have no information on other important factors such as social class. More detailed data sets may allow the consideration of spontaneous and induced abortions and relevant other factors but are often too small to separate the effects of related variables. The associations seen between the frequency of a defect and characteristics such as maternal age or parity on a population basis may differ from those seen in studies of individual mothers because of confounding factors: studies allowing the consideration of events linked by sibships are therefore particularly useful.
Socio-economic status and occupation
Authors: Little Julian , Elwood Harold
Published: November 2023

The theoretical background for the concept of social class and related indicators of relative position within society, together with a comprehensive review of measures of social class and a comparison of indicators used in epidemiological studies, have been documented by Liberatos et al. (1988). In epidemiological studies, indicators have been based on occupation, education, income, composite measures, and area of residence. In studies of neural tube defects in the British Isles, the social class measure used in virtually all studies has been based on occupation, classified according to the Registrar General's system (OPCS 1970, 1980). The classification was originally devised by Stevenson, statistician at the General Register Office, London, in 1911. The system divides the occupations of individuals into five social classes depending on the degree of skill involved and the social position implied.
Diet
Authors: Elwood Mark , Elwood Harold , Little Julian
Published: November 2023

Several aspects of the epidemiology of anencephalus and spina bifida may be interpreted as consistent with a dietary aetiology. The most important results are those of the randomized trial of dietary supplementation, which has shown a major protective affect of folic acid supplementation in high risk women (MRC Vitamin Study Research Group 1991). These results became available as this work was going to press, and are discussed at the end of this chapter and further in Chapter 20. We will here review the studies related to diet which have led up to this trial. Many dietary hypotheses have been suggested; Table 15 .1 shows the main areas and the types of study which are relevant to each.
Smoking and osteoporosis
Authors: Law Malcolm
Published: November 2023

The mineral density of bone is a useful simple index of its propensity to fracture. This chapter reviews 13 studies that have compared bone mineral density in cigarette smokers and non-smokers. In women who are 8 years or more post-menopausal, and in older men, bone density is lower in smokers than non-smokers, by about half a standard deviation (i.e. about one-eighth of the range of bone density in the population). In women who are pre-menopausal or less than 5 years post-menopausal, bone density is similar in smokers and non-smokers. These observations, and measures of the rate of bone loss in one study, indicate that smoking does not have an important influence on peak bone density but is associated with an increased rate of subsequent bone loss. It is likely that smoking directly causes this faster bone loss, as confounding with other determinants of bone density, or other sources of bias, appear unlikely. Of the possible mechanisms for this effect of smoking, the lower body weight of smokers is partly responsible, but an important action independent of body weight is likely. In women, the earlier menopause of smokers can be no more than a minor factor, and the effects of smoking in inhibiting oestrogen synthesis and inducing the selective production of inert metabolites appears irrelevant to the effect of smoking on the rate of bone loss, as the former action seems confined to pre-menopausal women, and the latter to post-menopausal women. The effects of smoking on other hormones, notably androstenedione and cortisol, could be important.
Health systems—a critical analysis of existing and suggested models
Authors: Ellencweig Avi Yacar
Published: November 2023

Health systems are characterized by many complex interactions. The complexity of these interactions permits the creation of innumerable varieties of policies, delivery mechanisms and control mechanisms. Perhaps, the only axiomatic statement that can unify all health systems and their subdivisions would be that they differ from each other. Those differences are not due to chance alone, rather they are rooted in the organization of societies. Societal determinants and attributes which have shaped each system and geared it into its present pattern can be described in several ways as shown in the next section.
Assessing the outcomes of health systems
Authors: Ellencweig Avi Yacar
Published: November 2023

The unequivocal ultimate goal of any health system is the improvement of the health of populations of a given region or country. For overall goals, there is general agreement with the World Health Organization ‘Health for all’ policy. However, at the population level, definitions of health outcomes, methods for outcome measurement, and the cause and effect relationships between factors and their effects on outcomes are characterized by confusion and disagreement. As we already mentioned in Chapter 2, there is disagreement about both the definition of health and the boundaries of the health system. In systems where there is a comprehensive welfare strategy, health is only one dimension in a multifaceted array of social networks. Thus, positive health outcomes depend not only on the health system but on society’s success in the general social and psychological arenas. This relationship reflects the WHO definition of health, in which social and psychological well-being are equal to physical health. Nevertheless, in many countries there are narrower boundaries for the national social systems, for health, welfare, and education, and thus they are strictly separated. Because in some countries the social systems are interrelated, and in some strictly separated, it is not feasible to standardize these boundaries. The picture is made even more complex by the modern definitions of health in which factors shaping up health outcomes but external to the health care system, are emphasi?’.ed. These factors are societal norms, environmental factors and biological phenomena. (See for example De Miguel 1975; Alan Dever 1980; Blum 1981).
Cross-national comparisons—correlating input factors and determinants of process with outcomes
Authors: Ellencweig Avi Yacar
Published: November 2023

For cross-comparisons of a number of countries there are two main ways in which we can apply our modular approach. One, discussed in Chapter 11, is an in-depth comparison of some of the modules of the health system over a small number of countries. In the other, as discussed in this chapter, we can study the statistical associations among a few of the health system’s modules for a larger number of countries. We can use these statistical associations to link health outcomes with their possible causes. This approach is very attractive because researchers and decision-makers are always intrigued by questions about how health outcomes may have been affected by a health system’s inputs and processes. So, it is not surprising that cross-comparative studies of this kind have been made by researchers in many disciplines. These include historians, epidemiologists, demographers, economists, and health services researchers. All of these have attempted to test the hypothesis that there are significant relationships between the input and processes of health systems, on the one hand, and their outcomes on the other. From an historical perspective, McKeown (1976) examined several factors that can explain the decline in the mortality rate in developed societies, particularly in Britain, over the last two hundred years. After excluding several other factors, he concluded that nutritional levels were a major vehicle for improving the health outcomes of populations. Other factors outside of the health care system like water supply, sanitation, housing, and education, also played important roles in explaining the improvement in health status.
A modular approach to competitive refarm in health systems
Authors: Chinitz* David
Published: November 2023

In Chapters 10 and 11 we used the modular approach to compare health systems in two ways. In one, we dealt with countries which are similar over several modules while diverging widely in one module. In the other, we based our comparison on a larger array of modules, attempting to characterize health systems more completely. For both approaches, we assumed that each module shares the same content validity across various countries.
The biology of healing
Authors: Iocono J A , Ehrlich H P , Gottrup F , Leaper D J
Published: November 2023

Despite great efforts in the study of wound repair, discerning the mechanisms for its control remains far from complete. As late as the early 20th century, poor healing and non-healing wounds were the rule rather than the exception. The additions of aseptic technique, careful observation, and supportive care of wounds markedly improved wound management and outcome. Today, as we prepare to enter the 21st century, clinicians and researchers alike toy with the notions of scarless repair and eradicating the complications of wound healing. Ideas that topical additions or new dressings may close wounds more rapidly and eliminate scarring complications are plentiful.
Zoonoses
Authors: Palmer S R , Soulsby Lord , Simpson D I H
Published: November 2023

Zoonoses are diseases naturally transmissible between vertebrate animals and man including those transmitted by direct contact with infected animals or carcases, by food or water contamination, and by inhalation of infected dust. They are increasingly important in public health issues. This multidisciplinary book is written by international specialists in human and veterinary medicine. Divided into three sections along the lines of bacteriology, parasitology and virology, this book comprehensively covers all zoonoses. Each of the seventy chapters covers the history of the disease, the scientific basis for the control of zoonoses, the microbiology of the causative agent, pathogenesis, clinical features, symptoms and signs, diagnosis, treatment and prognosis. The epidemiology of each disease is described alongside the strategies for prevention and control.
The relation of risk to exposure
Authors: Rose Geoffrey
Published: November 2023

The shape of the dose-effect curve is critical for the planning of control policy. Figure 3.1 illustrates schematically four possibilities, with some examples. Each of the four carries quite different policy implications. In Fig. 3.l(a) exposure is without adverse effects until it reaches a certain high level, beyond which the risk increases rapidly. This applies, for example, to intra-ocular pressure, which can vary over a wide range (‘the normal range’) without any problems, but when it exceeds the critical level there is a rapid rise in the incidence of glaucoma (one of the commonest causes of preventable blindness). It also applies to anemia and its associated symptoms, for there is no evident disadvantage to being mildly anemic and hence there may be no benefit if treatment is given in order to raise a hemoglobin level of, say, 10 g/dl up to the ‘normal’ level of 14.8 g/dl (Elwood 1973). It is generally supposed, though on inadequate evidence, that a curve of this type also describes the relationship between the level of blood alcohol and the risk of involvement in a road traffic accident, and this is the basis for punishing drivers whose levels exceed the ‘legal’ limit whilst condoning lower levels. (Some countries, such as Norway, punish any driver found to have detectable alcohol in the blood, perhaps with the aim of deterrence rather than from any different view on the dose-effect curve.)
Individuals and populations
Authors: Rose Geoffrey
Published: November 2023

Motor car manufacturers try to design the best possible car to meet the requirements of a particular market and then, in theory if not always in practice, every car coming off the production line conforms to this ideal design. Humans are not like this; they are all different. Some elements of their distinctiveness may be common to a whole population. Kalahari bushmen and Eskimos, for example, are clearly built according to different designs (corresponding no doubt to the demands of their contrasting environments), but even within any one population individual people differ much more than individual motor cars—in their size, physical strength and stamina, intelligence, energy intake, patterns of behavior and temperament, blood pressure, and a host of other personal attributes. This is surprising. Why, after some millions of years of Darwinian selective survival, do we not all conform to an ideal height, intelligence, and athletic performance? Our variability cannot all be blamed on defects in manufacture, since near-perfect standardization is achievable when such uniformity is required. For example, humans vary but little in their basic biochemical and physiological mechanisms: we all have almost identical concentrations of sodium and potassium in the blood, delicately and accurately stabilized.
Antidepressant treatment of functional somatic symptoms
Authors: Katon Wayne , Sullivan Mark
Published: November 2023

In this chapter Dr Katon and Dr Sullivan review the role of antidepressant drugs in the treatment of patients with functional somatic symptoms. They first review the prevalence and importance of depression and anxiety in the aetiology of functional somatic symptoms and then go on to use their recent research into chronic tinnitus to illustrate the complex relationship between depression and the experience of symptoms. The evidence for the efficiency of antidepressants is reviewed and practical guidelines for treatment outlined.
Treatment of patients with multiple symptoms
Authors: Smith Jr G Richard
Published: November 2023

Dr Smith begins by describing the wide range of terms that have been used to describe patients with multiple functional somatic symptoms. The high prevalence of patients with ‘chronic somatization’ in different medical settings is emphasized and the consequences of failing to identify and treat them is described.
Psychological treatment of irritable bowel syndrome and abdominal pain
Authors: Creed Francis
Published: November 2023

Professor Creed describes the high prevalence of functional gastrointestinal com plaints – as high as 22 per cent in some community studies – as well as the considerable health care costs incurred by this group of patients. He also points out that patients attending a gastrointestinal clinic with irritable bowel syndrome differ from those in the community and that these critical differences have to be addressed in treatment. An overview of the physical and psychological treatment of patients with functional bowel disorders is presented and the importance of selection criteria and concurrent psychiatric illness emphasized. Professor Creed describes those factors that predict a favourable outcome with psychological treatment and concludes with practical guidelines for treatment.
Psychological aspects of premenstrual syndrome: developing a cognitive approach
Authors: Blake Fiona , Gath Dennis , Salkovskis Paul
Published: November 2023

Many symptoms have been reported to be associated with the changes of the menstrual cycle. The premenstrual syndrome has been difficult to define but refers to symptoms which are clearly premenstrual, recurrent and distressing. Whilst many aetiological mechanisms have been proposed, there is substantial evidence that psychological factors are of particular importance in the determinance of the severity of symptoms and associated disability. Dr Blake and her colleagues describe a pilot study which focuses on the cognitions of people with premenstrual syndrome and of a new cognitive behavioural treatment. Their findings suggest that this approach can be effective and that it has practical implications for the provision of both primary and specialist care.
Chronic fatigue, chronic fatigue syndrome, and fibromyalgia
Authors: Wessely Simon , Sharpe Michael
Published: November 2023

In this chapter Drs Sharpe and Wessely discuss the nature of fatigue as a symptom. They then examine the chronic fatigue syndrome emphasizing the arbitrary quality of existing definitions. The aetiology of chronic fatigue syndrome is reviewed and it is concluded that it is a functional syndrome strongly shaped by social and cultural factors. Finally a cognitive behavioural model of the perpetuation of symptoms and disability is described. Practical guidelines for the cognitive behavioural treatment of patients with chronic fatigue syndrome are outlined.
The management of functional somatic symptoms in children
Authors: Garralda M Elena
Published: November 2023

Professor Garralda points out that children whose powers of expression are more limited than those of adults, are likely to express distress as in the form of somatic symptoms. She cites evidence of the frequency of such problems both in the general population and in primary care, as well as in specialist paediatric and child psychiatry clinics. Whilst functional somatic symptoms in children generally have a good prognosis, they may be persistent and often cause distress to both the children ·and their families. In many aspects the aetiology and management of functional somatic symptoms in children differs little from that in adults but in children the family is of particular importance.
Terminology, introduction, diagnostic criteria, and overview
Authors: Calin Andrei
Published: November 2023

A debate continues as to what name should be given to the spondylarthritides. We find no compelling reason to change from the title of our initial text (Calin 1984) and so continue to favour the use of spondylarthropathies or the spondylarthritides. We accept that Fran9ois and colleagues (1995) have made some suggestions towards a new glossary for the rheumatic spinal diseases. They base this on pathology and appear to favour the term ‘spondyloarthropathy’ originally proposed by Moll and Wright in 1974. However, as pointed out by Braun and Sieper (1996), spondylarthropathy and spondarthritis, and even spondyloarthropathy, have all been used interchangeably to describe the heterogeneous group of diseases that have a number of features in common.
Enteric infections and arthritis: bacteriological aspects
Authors: Uksila Jaakko , Toivanen, Paavo , Granfors Kaisa
Published: November 2023

ReA has provided investigators with an opportunity to focus on the properties of the triggering organisms, and recent studies have indicated that microorganisms are intimately involved not only in the pathogenesis during the intestinal phase of disease, but also in the target organ, the joint. It is anticipated that a continued study of microorganisms and the immune reactions directed against them will reveal how synovial inflammation is initiated, how the immune system maintains the reactivity, and what dictates the final outcome of the disease-either recovery or chronicity.
Triggering mechanisms and T-cell responses in the spondylarthropathies
Authors: Sieper Joachim , Braun Jurgen
Published: November 2023

The term spondylarthropathy (SpA) applies to a group of different, although closely related, diseases: ankylosing spondylitis (AS); reactive arthritis (ReA); a subset of psoriatic arthritis (PsA); arthritis/sacroiliitis in inflammatory bowel disease; and undifferentiated SpA. All these diseases have an HLA-B27 association, sacroiliitis, a characteristic type of peripheral joint involvement, enthesitis, and some extra-articular manifestations in common (Dougados et al. 1991a). Their pathogenesis is not clear, but the interaction of bacteria, T cells, and the HLA-B27 molecule seems to be important (Kingsley and Sieper 1993).
Microcephaly
Authors: Baraitser Michael
Published: November 2023

Microcephaly is defined as a head circumference of more than two standard deviations below the mean. It is common to many conditions, both genetic and environmental, and it occurs in 1.9% of the ‘normal’ population. Many different figures exist for the birth frequency. Book et al. (1953) suggested a figure of 1.6 in 10 000 live births and Quazi and Reed (1973) suggested a figure of 1 in 40 000 for true recessive microcephaly.
Vascular conditions
Authors: Baraitser Michael
Published: November 2023

Abstract: Most arteriovenous malformations are not genetically determined, but there are a small number of families in which inheritance appears to be as a dominant. There are no vascular skin lesions and it is not possible to detect the familial type without a positive family history.
Epilepsy
Authors: Baraitser Michael
Published: November 2023

Epilepsy in the neonatal and infantile period; Generalized epilepsy in the slightly older child: Tonic—clonic (Grand mal); Absences (Petit mal); Atypical absences; myoclonic (see Chapter 13); tonic (these patients fall stiffly to the ground but this is not a specific genetic entity); atonic (these patients slump to the ground; some probably have myoclonus—see p. 127);
Cerebral palsy
Authors: Baraitser Michael
Published: November 2023

Abstract: This is a non-progressive, evolving, extrapyramidal disorder, most frequently the result of prolonged jaundice and anoxia. Intelligence is often normal but communication can be very difficult. Because of additional features, Foley (1983) distinguishes between pure athetosis, ataxic athetosis, and athetoid quadriparesis.
Myasthenia
Authors: Baraitser Michael
Published: November 2023

The congenital myasthenic syndromes are caused by congenital defect in neuromuscular transmission. They can be subdivided as follows (Shillito et al., 1993; Janas and Barohn, 1995): presynaptic familial infantile (possibly small vesicle size); paucity in density of synaptic vesicles; other presynaptic disorders—synthesis, release, and mobilization; acetylcholinesterase deficiency;
Extrapyramidal disorders
Authors: Baraitser Michael
Published: November 2023

Previous studies have tended to emphasize the unimportance of genetic factors in Parkinson’s disease. This is mostly based on the finding of considerable discordance in a number of recent twin studies (note however the PET scan findings in clinically unaffected twins might suggest that concordance is higher, Holthoff et al., 1994). One study looked at a cohort of twins and reviewed previous clinical studies, and found that only 5 out of 81 pairs of monozygotic twins to be concordant and for dizygotic twins 5 out of 56 were concordant (Sommer and Rocca, (1996). The offspring risks are therefore small, possibly no higher than a couple of percent.