bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health in the community
Authors: Dowrick Chris
Published: November 2023

British health care is moving from a hospital focus to a community orientation, and from a doctor-centred approach to one based on collaboration and multidisciplinary teamwork. However, conventional hospital-based medical education and training have failed in the task of enabling new generations of doctors to develop the psychological experience and emotional maturity to cope with the stresses of clinical practice. Some have argued that traditional medical education encouraged the suppression rather than the acknowledgement of feelings (Ross and Stanley 1985), and the search for certainty rather than the acceptance of complexity and ambivalence (Light 1979). These contradictions are acute in the field of mental health. The rapid growth of communications skills-training (Marteau et al. 1991) and the creative use of behavioural science courses (de Groot 1987) have gone some way towards redressing these deficiencies, but emotional issues probably still receive less attention in undergraduate medical education than they deserve.
The purpose of assessing medical students
Authors: Holsgrove Gareth
Published: November 2023

Students may be assessed for three different reasons, to measure their potential, their progress, or their attainment. As already mentioned, formative assessment is used to inform students and their teachers about areas of strength and weakness as they progress through the course, while summative assessment counts towards their final mark or grade. Traditionally, assessment throughout the educational system has placed strong, sometimes overpowering, influence on summative assessment of attainment, with comparatively little attention to monitoring progress and virtually none at all to assessing potential. Where consideration is given to a student’s potential, for example, during the selection process for entry to a course, it is usually on the presumption that previous performance indicates aptitude and predicts future performance. In other words, the results of earlier tests of attainment are used as indicators of potential. Although aptitude tests need not differ significantly from tests of achievement, except in their application and interpretation, the latter are often used without much evidence that the interpretation is correct.
Assessing communication skills
Authors: Southgate Lesley
Published: November 2023

There is now general agreement amongst medical educators about the importance of learning communication skills as part of undergraduate medical education (Canadian Medical Association 1992). In Tomorrow’s doctors the Education Committee of the General medical council emphasized that good communication with patients was a core skill for clinicians and this has been discussed previously, especially in Chapters 4 and14. People have reported the rapid increase of complaints against doctors directed at the quality of the doctor-patient relationship rather than poor clinical skills. However, although there is some evidence (Simpson et al. 1991) about the negative effect of poor communication on the outcomes of patient care, some clinicians and life scientists remain unconvinced that a significant amount of time in the curriculum should be devoted to improving the communication skills of medical students. Others pay lip service to such initiatives but undermine them by allowing the students to realize that in their view it is not the really important business of medical education.
Guidelines for assessing clinical competence
Authors: Southgate Lesley
Published: November 2023

The assessment of competence, what the student ‘knows how’ to do, is the task of all those who develop and engage in the undergraduate curriculum. It is important for the support of students as they graduate and enter the world of work, it is important for the public who are protected via the requirements of the GMC and it is important for the teachers and learners in the medical school who will suffer frustration and disappointment if the assessed hidden curriculum and the published taught curriculum are not congruent.
A parents’ view
Authors: Appleton Richard E , Baldwin Tony
Published: November 2023

This brief chapter gives a detailed (and unedited) account of how one family perceived and coped with their daughter’s severe brain injury. The account begins with her arrival on the neuro-rehabilitation ward.
Vascular and lymphatic systems
Authors: Smith Francis W
Published: November 2023

The popularity of radionuclide first-pass studies has diminished in recent years due to the improvements in echocardiography, digital subtraction angiography (DSA), and the advent of magnetic resonance angiography. Prior to these developments, radionuclide first-pass studies were popular and often used for the initial assessment of children with congenital heart disease to ascertain the degree of intracardiac shunt before proceeding to X-ray angiography. Today these patients are usually assessed by echocardiography prior to angiography, and no radionuclide first-pass study is performed. However, there are occasions where a relatively noninvasive method for assessing the degree of intracardiac shunt is necessary, and it is important to understand how to perform a radionuclide first-pass angiogram.
Musculo-skeletal problems with no history of recent injury
Authors: Wardrope Jim. , English Bryan
Published: November 2023

The spectrum of diagnoses in non-traumatic musculo-skeletal problems encompasses almost the whole of acute medicine. The misdiagnosis of these problems gives rise to complications that may be life- or limb-threatening. All medical students are taught that the limping adolescent with pain in the knee is the classical presentation of a slipped upper femoral epiphysis, but such cases are regularly missed in A&E departments. Shoulder pain is a ‘classical’ site for referred pain from the chest or abdomen but it may be disregarded with lifethreatening results. The diagnosis of these conditions is difficult and often time consuming, but more time must be spent on these cases, just as there is an expectation to properly assess a case of chest pain.
The elbow joint
Authors: Wardrope Jim. , English Bryan
Published: November 2023

The joints of the elbow (including the proximal radioulnar joint) have strong ligaments. The main movements of the elbow joint are flexion and extension while forearm pronation and supination occur at the radioulnar joints.TraumaFractures are common but may be hard to detect on X-ray leading to a misdiagnosis of a soft-tissue injury. (Especially radial head fractures and children’s fractures.)The presence of a traumatic effusion within the elbow joint often indicates an occult fracture.
The hand
Authors: Wardrope Jim. , English Bryan
Published: November 2023

The hand is a highly complex structure capable of tasks as diverse as power grip, punching, and high speed, del­icate, precise actions.It is also a highly sensitive sense organ.Minor injury can lead to permanent disability either in work or leisure pastimes.Joints depend on ligaments for stability.
Hip and thigh
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Trauma—Falls in patients over 50 years of ageHip fractures are common—always X-ray patients.Fractures may not be visible on initial films, admission/ follow-up, bone scan may be required.Elderly patients, living alone, rendered immobile by a fall may require admission or nursing-home care.Trauma—Direct blow to the thigh May cause large intramuscular haematoma.Refer if patient unable to flex knee beyond 90 degrees.
The knee
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Anatomy Major weight-bearing joint.Depends on ligaments and muscle power for stability.Injuries often damage ligaments leading to instability.Injuries always limit muscle power leading to instability.Normal ROM-flexion 135 degrees, extension O degrees to 10 degrees hyperextension.
Cervical spine
Authors: Wardrope Jim. , English Bryan
Published: November 2023

Problems of the neck and cervical spine account for approximately 2 per cent of accident and emergency attendances. There is a high incidence of presentation with non-traumatic problems, a low incidence of fractures, and almost half the patients will have injured their neck in a road traffic accident. Many soft-tissue injuries of the neck give rise to significant problems that may take many months to settle. A small minority of patients will have severe damage to the soft tissues that may lead to spinal cord injury, even in the absence of any evidence of fracture or dislocation.
Introduction
Authors: Williams J R , Thwaites D I
Published: November 2023

The beginnings of radiotherapy followed quickly on the discovery of ionizing radiations. X-rays were identified by Roentgen in 1895 and radioactivity by Becquerel in the following year. It was recognized at a very early stage that these radiations produced dramatic effects on normal tissues and it was a natural progression that within a few years of the discovery of radioactivity the effects of radiation should be investigated on superficial tumours. In the early days, progress in radiation therapy was largely determined by the production of satisfactory sources. The isolation of radium by the Curies was one key to this development, as was the improvement in the technology associated with X-ray production. In parallel with the developments of radiation sources, there came the recognition that it was essential to be able to define and measure the quantity of radiation being delivered. The formation of the International Committee on Radiological Units (ICRU), now called the International Commission on Radiation Units and Measurements, in 1925 was a key element in this area.
Relative dosimetry
Authors: Horton J L
Published: November 2023

After a therapy machine is accepted and before it can be placed in clinical service the physicist must acquire an extensive set of radiation measurements that characterize its performance. All measurements discussed in this chapter will be relative to the calibrated output that is described in Chapter 3. This chapter will discuss relative measurements that are required before a high-energy linear accelerator with photons and electrons can be placed in clinical service. A high-energy linac has been chosen because it demands the most measurements, but this schema can easily be modified for low-energy photons-only linacs or cobalt units.
Antihypertensive therapy in type 2 diabetes with nephropathy
Authors: Villarosa Imelda P , Bakris George L
Published: November 2023

Data from epidemiological studies clearly indicate that diabetes confers more than an additive risk for development of both cardiovascular events as well as renal disease in people who are hypertensive. This is particularly true among women. Moreover, the protection against cardiovascular events offered by oestrogens to pre-menopausal women is eliminated in the presence of diabetes.
The uraemic patient with type 2 diabetes: therapeutic approaches and perspectives of renal replacement therapy—a view from the other side of the Atlantic
Authors: Friedman Eli A
Published: November 2023

Retrospective and prospective observation of kidney function during the course of type 1 and type 2 diabetes indicates an equivalent risk of progression of diabetic nephropathy to ESRD. Nephropathy in diabetes—when suboptimally managed—follows a predictable course starting with microalbuminuria evolving to proteinuria and azotaemia, culminating in ESRD (Fig. 15.3). Elsewhere in this volume details of contemporary management of type 2 diabetes are presented. Regimens that slow renal functional decline in diabetes include: normalization of hypertensive blood pressure, establishment of euglycaemia, and restricted dietary protein intake.
The 75-and-over screening programme and the Community Care act - one step forwards, two steps back?
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

In 1990 the government unilaterally changed the conditions of service for general practitioners, introducing a contractual obligation on members of primary health care teams to offer annual assessments of health to patients aged 75 and over.1 These offers of assessment, which have to be made in writing, should be based on a home visit unless otherwise requested by the patient, and should include the following headings: Whilst there had been extensive research into the possible benefits of regular screening or assessment of older people (see Chapter 1), at the time of the introduction of the 75-and-over checks there was still a lack of conclusive evidence that routine screening of whole populations was worthwhile. Nor was there a consensus on the best methods for such a screening approach, despite nearly 40 years of study.
Chronic obstructive pulmonary disease and asthma
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

Mr X. retired from his caretaker’s job six years ago and moved to a new flat further up the hill from his general practitioner’s surgery. Every month he would walk down to the surgery for a check on his lung function, his blood pressure (for he also had essential hypertension), and his weight. He had always been ‘large’, he said, but was mostly unconcerned about his obesity, (which gave him a BMI of 31), unless his clothes would not fit. The diagnosis of non-insulin dependent diabetes mellitus (NIDDM) at 68 years came as no great shock to his GP, although it seemed to make Mr X. think very hard about what he ate, at least for a while. During the war and for the first part of his working life he had been a heavy smoker, never smoking less than one packet a day and sometimes two when he could afford to.
Changing primary care for older people
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

The previous chapter examined the process of health needs assessment for a population of older people. This chapter explores the issues in changing services and ends with an agenda for change for primary care groups. A health needs assessment process identifies the problems in individuals and whole populations but a separate process is required to identify the most appropriate solutions. The pressures of the daily workload invariably make practitioners draw on their immediate knowledge in identifying solutions, rather than focus outward to use other sources for generating ideas and solutions. Without a wider perspective we are destined to fail to learn from past experience and ignore sources of potential creativity. The ethos of looking outward for knowledge is inherent in many current policy documents, for example in continuing professional education for doctors and nurses, and is cited as an aspect of clinical governance.
Extra-corporeal renal replacement therapies
Authors: Petitclerc Thieny , Jacobs Claude
Published: November 2023

The survival for an unlimited period of time of patients suffering from end-stage renal failure (ESRF), by the means of blood-purification systems, is a true and important landmark in medical history insofar as it represents the first successful long-term replacement of a human vital organ by a human-built machine. Barely four decades separate us from the pioneering endeavour undertaken by B.H. Scribner and associates, in their first attempt to apply intermittent hemodialysis to a single patient with non-reversible terminal renal insufficiency, from the contemporary scene where hundreds of thousands of patients worldwide benefit from the prolongation of their lives thanks to the ongoing advances made all over this timespan in the conceptual, pathophysiological, and techical aspects of this completely novel area of clinical medicine.
Oesophagus, stomach, and duodenum
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair
Published: November 2023

Heartburn is a very common complaint. Regurgitation of acid into the mouth is part of the same spectrum. The gastro-oesophageal sphincter fails to prevent stomach acid into the lower oesophagus giving rise to the burning retrosternal pain. A boring back pain would indicate that the patient may have developed an ulcer at the lower end of the oesophagus.

Dysphagia is an important symptom as it may indicate the development of a benign stricture or the presence of oesophageal cancer.
Small bowel
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair
Published: November 2023

This is one of the most frequent indications for urgent admission to a surgical unit. Most patients with appendicitis present like this with a history of periumbilical pain with nausea and vomiting, with the pain shifting to the right iliac fossa.

There are numerous causes of abdominal pain, especially in young women, that may cause confusion with appendicitis. A careful history and physical examination are vital. For women of child-bearing age, pregnancy (excluded by a pregnancy test), and gynaecological conditions need to be considered.
Vascular conditions
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair
Published: November 2023

‘Intermittent claudication’ is pain in muscle (calf, thigh, buttock) only associated with exercise and resolves quickly (less than 5 minutes) with stopping walking. It does not occur at rest.

Exercise requires the delivery of more oxygen as the muscle fibres perform more work. This is achieved by delivering more blood (200400%) by increasing the output of the heart.

In patients with peripheral vascular disease this increase in blood delivery is impeded or prevented by narrowing (stenosis) or blockage (occlusions) of the arteries leading to the exercising muscle (usually the calves). The muscle therefore receives less oxygen than it requires and due to muscle ischaemia becomes increasingly painful forcing the sufferer to stop.
Choosing the statistical method
Authors: Bland Martin , Peacock Janet
Published: November 2023

Many statistical problems involve one of the following: the comparison of two means of a continuous variable, the relationship between two quantitative variables, the relationship between two qualitative variables. Most data can be described as being one of the following types of scale: ratio, where the ratio of two quantities has a meaning, e.g. human height, interval, where the difference between observations has a meaning, though their ratio may not, e.g. calendar year,
Mortality statistics
Authors: Bland Martin , Peacock Janet
Published: November 2023

The risk of dying depends very strongly on age and sex, so the comparison of mortality between different populations must take their age and sex distributions into account. Mortality is usually analysed separately for males and females. Mortality rates can be presented as crude rates which ignore the age distribution, or as a series of age-specific rates for narrow age groups.
The DRCOG examination
Authors: Neuberg Roger
Published: November 2023

The new format of the examination for the Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG) is not only a very thorough assess ment of your knowledge and of the skills you have gained through experience, but also of your ability to apply what you know to different clinical situations as met in General Practice. A pass in the DRCOG is a recognition of your particular interest in the subject without being a specialist qualification.
Obstetric history-taking and examination
Authors: Neuberg Roger
Published: November 2023

In addition to a written examination and/or OSCE, medical schools will often require their students to sit a clinical and oral examination at the end of their undergraduate attachment in Obstetrics and Gynaecology. Although these do not now feature as part of the Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG), it is still a requirement for the higher Diploma of Membership of the RCOG (MRCOG).
Risk and risk factors
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

In common with most chronic diseases, strokes do not have a single cause but are due to multiple factors. Even in tuberculosis which does have a single necessary cause —Mycobacterium tuberculosis—the risk of being infected, and then of developing tuberculosis, is dependent on a chain of causal factors, some very closely related to the pathogenic process (e.g. inhaling bacilli from a close relative), while others are much further back in the causal chain (e.g. poor childhood nutrition). Epidemiologists are concerned with discovering the characteristics of people and populations that increase or decrease their chances (or risk) of suffering diseases. The mechanisms by which disease occurs in those at increased risk is often suggested by epidemiological enquiry, but working out the detailed pathological pathways is a goal for laboratory scientists.
Time, places, and people
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Stroke mortality rates have shown a consistent decline in many countries (Anonymous 1983; Bonita et al. 1990; McGovern et al. 1992; Wolf et al. 1992; Brown et al. 1996; Tuomilehto et al. 1996b; Thorvaldsen et al. 1997; Gale and Martyn 1997). In the USA the rate of decline has been about 0.5 per cent/year from 1900 to 1920, 1 per cent/year from 1920 to 1950, about 1.5 per cent/year from 1950 to 1970 and about 4-5 per cent/year from 1974 onwards (Ostfeld 1980; Whisnant 1984). In England and Wales, a similar decline starting in 1900 and affecting all age groups has been seen (Wolfe and Burney, 1992; Charlton et al. 1997; Ebrahim, 1998) and is shown in Fig. 3.1. The rise in stroke mortality rates over the war years remains unexplained but affected both men and women and is probably due to coding changes to causes of death that occurred when a new version of the International Classification of Diseases was introduced. The pattern is markedly different from that for ischaemic heart disease deaths, which increased from 1929 to the 1950s, and only started to decline in the 1980s.
Clinical disagreement
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Whenever two or more doctors are asked to assess the same patient it is unlikely that they will agree completely on their clinical findings. This phenomenon is well recognized in several fields of medicine, ranging from taking a history (Cochrane et al. 1951), examination of the pedal pulses (Meade et al. 1968), chest examination (Spiteri et al. 1988), to interpretation of exercise electrocardiograms (Blackburn et al. 1968). It is not surprising, therefore, that in the assessment of stroke patients, agreement is not absolute. Information on which doctors disagree can be considered in terms of its importance in diagnosis, management, and prognosis. If the information is crucial, every effort must be made to reduce disagreements; if the information is of little value, there is no point in wasting time collecting it, much less trying to improve its reliability. Disagreements may matter. For example, if two clinicians disagree on the presence of a carotid bruit, the patient may or may not be exposed to the risk of investigation or denied the benefits of treatment. Disagreements on factors that determine rehabilitation potential (e.g. mental state, severity of stroke, pre-stroke ability) may lead to patients being denied access to therapy and discharged to nursing homes inappropriately or before their full potential has been achieved.
Investigation
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

A test is commonly considered to be of value if it alters management. This is an oversimplification of the way most doctors use investigations. The value of any investigation can be thought of at any one of six levels (shown in Table 6.1). These range from technical efficacy (how good are the pictures?) through to patient outcome and health policy considerations.
Effects of stroke
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Many of the effects of stroke are not obvious for weeks or months, and by this time the patient is often at home without the support of specialist care. Follow-up by rehabilitation teams, hospital, and family doctors after a stroke is patchy, and certainly not related to need—if impairments and disability are accepted as indicators of need (Ebrahim et al. 1987Z?)—so it is likely that many complications may go undetected. Avoidable complications of stroke are common and have been reviewed (Mulley 1982). Painful hemiplegic shoulders, spasticity, contractures, and constipation would benefit from more research examining their causes and management options. In the areas of depressed mood, cognition, dysphasia, urinary incontinence, dysphagia, deep-vein thrombosis and pulmonary embolism, quality of life, falls and fractures, and stress affecting carers, much more is now known about occurrence and causes than a decade ago, but more attention is still needed to find practical solutions to these problems.
Familial and predisposition syndromes
Authors: Sheridan Eamonn G , Woods C Geoffrey
Published: November 2023

Over the past 30 years a number of rare DNA repair disorder phenotypes were delineated, for example, Bloom syndrome, ataxia-telangiectasia (AT), and Fanconi anaemia. In each phenotype it was hypothesized that the underlying defect was an inability to repair a particular type of DNA damage. For a number of these disorders this hypothesis was supported by cyto genetics studies using DNA damaging agents; these tests detected the so-called chromosome breakage syndromes. More recently a number of the genes causing these phenotypes have been discovered, confirming that often one phenotype may have more than one genotype, for example, xeroderma pigmentosa.
The central and peripheral autonomic nervous system and possible implications in Rett syndrome patients
Authors: Dahlstrom Annica
Published: November 2023

Also in the human fetus, catecholamine (CA) nerve terminals have been demonstrated in brain areas long before birth. Thus, it is possible that also in man these ‘classical neurotransmitters’ have non-neurotransmitter actions, and should be taken into consideration whenever defects in the development and maturation of the human brain are discussed. They may also work in consort with various neurotrophic factors, by influencing intracellular common pathways. Therefore, in this section will be described what is presently known about the ‘autonomic nervous system’, its ontogeny and distribution as well as physiological aspects, in order to provide a basis for further investigations and discussions concerning the basic mechanisms that may go wrong in Rett girls.
Behavioural and emotional features of Rett syndrome
Authors: Mount Rebecca , Hastings Richard , Charman Tony , Reilly Sheena , Cass Hilary
Published: November 2023

Behavioural and emotional problems were assessed in 143 girls with Rett syndrome (age 18 years or younger). They were compared to 84 girls with severe and profound cognitive impairments of mixed aetiologies (age 18 years or younger). Age and level of physical ability were controlled for in the between group analyses. Behavioural and emotional problems were assessed using two parental questionnaires. The Developmental Behaviour Checklist, a well-validated measure of behavioural and emotional disturbance in children with.
The Science of Chronic Pain From Theory To Clinical Practice
Authors: Yull Derek , Munglani Rajesh
Published: November 2023

There always seems to be a dichotomy between academic research into pain and practical treatment. There seems to be a sense of random choice as to whether, for example, one treats back pain with drugs, injections, psychotherapy, or physiotherapy or a combination of some or all of these. Any model of pain has to explain why such different therapies may achieve similar results—lip service is given to a biopsychosocial model, but the details of this model on a neurobiological level are still be elucidated. This chapter provides a brief overview of pain mechanisms and in a small way attempts to provide a rational basis for various modalities of treatment. Some of the treatments mentioned here will be covered in more detail in other chapters but it is important to provide a framework on which to add further knowledge.
Special Groups
Authors: Speed Cathy
Published: November 2023

With the ever-increasing age of our population, special consideration of soft tissue complaints in older people is warranted. Older people are physiologically, structurally, and psychosocially different from younger adults in their predisposition and response to injury. Along with a greater predisposition to general medical problems and a range of cardiovascular, respiratory, renal, metabolic, and neuropsychiatric changes, a number of musculoskeletal changes occur. Many of these are at least in part related to a decline in activity levels and therefore perhaps the greatest threat to the older person is a sedentary lifestyle.
Neural Blockade
Authors: Chong Carol , Munglani Rajesh
Published: November 2023

Neural blockade is very commonly performed for the diagnosis and treatment of chronically painful conditions. In this chapter the rationale for the use of neural blockade and why it may fail will be explained. In addition, mention is made of the commonly performed blocks and the evidence for their continued use.
The Management of Soft Tissue Disorders: The Role of The Physiotherapist
Authors: Hunter Glenn
Published: November 2023

Physiotherapy can be defined as a health care profession with an emphasis on the analysis of movement, based on the structure and function of the body, and the use of physical approaches to the promotion of health, and the prevention, treatment, and management of disease and disability.(1) This definition places the emphasis on physical treatments, such as manipulation, massage, and exercise, that have been valued as ‘healing’ arts for centuries(2) and have been the mainstay of the physiotherapy profession since its formation as a professional organization in 1894.(3)
The elbow and forearm
Authors: Speed Cathy
Published: November 2023

The elbow is a compound synovial joint, composed of a complex of two closely related articulations between the humerus and both the ulna and radius. The superior radioulnar joint is continuous with these articulations and functionally forms part of the elbow complex. The capsule and joint cavity are continuous for all three joints.
The Pelvis, Hip, and Thigh
Authors: Speed Cathy , Hackney Roger
Published: November 2023

Pelvic pain arising from the groin, pelvis, and hip has a very wide differential diagnosis, crossing many clinical specialist boundaries (Table 1). Potential causes of groin and pelvic pain include disorders of the abdominal and pelvic organs, referred pain from the spine, neurological complaints, and localized articular and soft tissue complaints. Symptoms can be non-specific and diffuse and may have unusual patterns of referral.(1–4) It is not surprising then that making a diagnosis can be challenging and a multispeciality approach may be necessary.(5)
Fibromyalgia and Myofascial Pain and Chronic Fatigue Syndromes
Authors: O’Gradaigh Donncha , Hazleman Brian
Published: November 2023

Patients with these conditions have diffuse symptoms and a paucity of clinical signs. Their presentations vary considerably, though common factors identify distinct patterns. Despite a number of theories to explain the disorders, management remains largely empirical, comprising physical, medical, and alternative approaches. Opponents of these terms argue that such labelling of ‘non-diseases’ legitimizes patients’ illness behaviour, creating a population of ‘worried well’ with the attendant adverse social and psychological consequences observed with the Australian experience of the diagnosis ‘repetitive strain injury’. The counterargument is that a positive diagnosis (e.g. fibromyalgia) relieves the anxiety and frustration of many years of unhelpful investigations and treatment (the average duration of symptoms before diagnosis of fibromyalgia is 5 years).
Commentary on subcortical strokes
Authors: Fisher C M
Published: November 2023

This chapter is in response to an invitation from the Editors to comment in general on the current lacunar infarct scene. Since the other chapters cover every facet of the subject, the broad-ranging assignment has been interpreted as an invitation to record recent personal experiences and review old precepts.
Prognosis of patients with lacunar infarction syndromes
Authors: Norrving B
Published: November 2023

As more specific therapies are developed for the prevention and treatment of stroke, definition of the pathophysiological mechanism assumes greater importance in clinical practice. For different subgroups of patients, prognostic data are needed by clinicians for counselling and managing the individual patient. Also, for the planning of treatment trials, background data on prognosis from clinical series are essential. It should be recognized that almost no prognostic study on stroke patients reflects the true natural course, but rather the prognosis in patients given some form of treatment, such as active management of risk factors and antiplatelet therapy.
Therapy for lacunar and subcortical stroke
Authors: Wright P M , Donnan G A
Published: November 2023

Lacunar infarction, as discussed earlier, was first recognized by Fisher following his clinico-pathological observations. With sophisticated imaging techniques, there is now evidence that the classic lacunar syndromes are usually accompanied by a compatible acute small, deep white matter infarction, and each syndrome typically is associated with specific locations, most commonly the internal capsule or pons (Schonewille et al. 1999, Lindgren et al. 2000).
The pharmacodynamic process: Is the drug producing the required pharmacological effect?
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

The different ways in which drugs may produce their pharmacological effects are classified in Table 4.1. As we unfold this classification, it will be seen that several of the examples we shall quote cross the boundaries of the classification. For example, the cardiac glycosides can be considered as ligands that act by binding to their receptor (the Na/K-ATPase), as inhibitors of an enzyme (the Na/K-ATPase), or as inhibitors of a transport process (the Na/K pump). However, this should not be seen as a defect of the system of classification, more a reflection of the complexities of pharmacology.
The therapeutic process: Is the pharmacological effect being translated into a therapeutic effect?
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

We have seen how the pharmaceutical process, involving the formulation of a drug, can affect the systemic availability of the drug, how the pharmacokinetic process determines the concentrations of the drug at its sites of action, and how in the pharmacodynamic process a pharmacological effect occurs. We can now examine how this pharmacological effect is translated into a therapeutic effect.
Drug therapy and reproduction
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

Contraceptive methods can be divided into two broad categories: mechanical methods (condoms, diaphragms, caps, and intrauterine devices, all of which can be combined with chemical spermicides) and hormonal methods. We shall deal here only with the hormonal methods. The practical aspects of the subject have become much more complicated during the last few years, and all GPs should have at least some specialist postgraduate training in the subject if they are to give their patients the best care.
Principles of prescribing
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

Good prescribing is not an easy discipline to master. By good prescribing, we mean prescribing the appropriate drug, in the correct dosage of an appropriate formulation, at the correct frequency of administration, and for the correct length of time. This definition includes not prescribing any drug at all if no prescription is called for. To achieve this requires detailed knowledge of the pathophysiology of the diseases you intend to treat and of the clinical pharmacology of the drugs you intend to use, as we shall show here in dealing with the questions you should ask before prescribing.
Drugs and the kidney and thedrug therapy of renal, urinary tract, and prostatic disorders
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

Alginates are often added to antacid formulations as foaming agents. They act by forming a layer of foam on top of gastric contents and are thereby supposed to reduce oesophageal reflux. In contrast, the antifoaming agent dimethicone decreases the surface tension of gastric fluid, thereby reducing bubble formation; it too is supposed to reduce oesophageal reflux.
Drug dependence and abuse
Authors: Grahame-Smith D G , Aronson J K
Published: November 2023

Drug dependence and misuse pose serious threats to the wellbeing of society and are responsible for much illness and death among addicts. Although most illicit drug misusers are young people, misuse of benzodiazepines, barbiturates, alcohol, and tobacco tends to occur among older people.
History of pancreas transplantation
Authors: Sutherland David E R , Groth Carl G
Published: November 2023

The history of pancreas transplantation is intertwined with that of other organ transplants and with the evolution of treatment of diabetes mellitus. Once diabetes was recognized as a consequence of a defect in the internal secretion of the pancreas, the idea of pancreas transplantation took root. From the late 1920s to the mid-1960s, various investigators worked out some of the surgical details of pancreas allotransplantation in dogs [1–8], setting the stage for clinical application [9].

The first pancreas allograft in a human was performed by Drs William D. Kelly and Richard C. Lillihei on 16 December 1966 at the University of Minnesota, a duct ligated segmental graft done simultaneous with a kidney in an uraemic diabetic recipient that resulted in immediate insulin independence (Fig. 1.1). The graft was still functioning 2 months later when the recipient died of sepsis related to surgical complications [10].
An historical view of the development of cellular and islet transplantation
Authors: Gray Derek W R
Published: November 2023

In most research fields advancement comes in hesitant steps; periods of slow progress punctuated by occasional leaps forward. Each advance is built on a foundation that mixes the contributions of numerous individuals. The record of this advancement is the published literature and this is the basis on which this historical account will be largely based, each key historical reference being distinguished by superscript numbering. Which publication should be chosen for distinction? Some studies are of such quality that they stand out, but most are either flawed or inconsequential. Only those studies that are repeatable can be considered as true contributions to the development of the field, and many remarkable claims that cannot be independently confirmed must be consigned to the historical discard bin. This is a particular problem for some areas of islet transplantation research, which have suffered (the term is used deliberately) from a surfeit of commercial interest and secrecy.
Achilles tendinitis
Authors: Stanish William D , Curwin Sandra , Mandel Scott
Published: November 2023

All running athletes, including anyone who participates in the sport that involves running and jumping, risk the risk of Achilles tendinitis than ever before. In fact, Achilles tendinitis has become by far the most common athletic injury (Clancy 1982).
Pliny the Elder
Authors: Tanford Charles
Published: November 2023

A Young couple moved into the house next door about the time I was writing this chapter, and I introduced myself to my new neighbors. “I know you, “ the young man said, “I ‘ve used your book. “ It ‘s a nice distinction, used rather than read, and I felt flattered. Ben Franklin had read Pliny and had smiled at what he wrote, which implies he did not use him, and modern historians of science would applaud his caution. Pliny the Elder, born at Lake Como in the reign of Tiberius, was an indefatigable reader and prolific writer, who needed little sleep, had a slave read to him even during rubdowns after his bath, and had a secretary at his side for dictation at all times.
Ben Franklin Wonders Why (Molecular Interpretation)
Authors: Tanford Charles
Published: November 2023

We take off in a completely new direction now. We are no longer asking whether atoms and molecules exist or groping to understand those who opposed the concept. We are no longer asking about molecular size. We know how small a molecule is. The new direction is to ask about molecular behavior. After all, the spontaneous spreading of the oil is truly unexpected, even through our own modern eyes, accustomed to marvels of nature and technology. Knowing about molecules and their size makes it, at least numerically, even more startling. One teaspoonful of oil spreads to half an acre; that constitutes a 107-fold increase in area.
Biology—Cells and Membranes
Authors: Tanford Charles
Published: November 2023

Life began in water, about three billion years ago — the first “thing ” that could hold itself together and derive energy from food or sunlight and make clones of itself. And water has remained indispensable to all forms of life. There is life without oxygen — some organisms prefer it that way— but there is never life without water. It goes without saying that living matter, like any other matter, is composed of molecules. The most prominent among them are special molecules, found in every known form of living matter and thus presumably essential to the living state. It is noteworthy that the molecules that Irving Langmuir used for his research — fatty acids, oils, and fats — belong to one of these essential categories, called “lipoids ” early in this century but going by the name of “lipids ” today.
1822–1832
Authors: Gill Stephen
Published: November 2023

In 1822 Jeffrey pronounced, ‘The Lake School of Poetry … is now pretty nearly extinct’. Seven years later, on the other hand, Parson and White in their invaluable Directory of the Lake District listed Wordsworth, amongst the ‘Eminent Men’ of Westmorland, as ‘the father of the Lake School of Poetry’.2 Both comments were right in a sense. ‘The Lake School of Poetry’ had always been a critics’ label, but it had not been entirely foolish. There was a link, an obvious and strong one, between the Lyrical Ballads and the River Duddon. But by 1822 the vein seemed to have run out. Memorials and Ecclesiastical Sketches were not at all ‘Lakeish’, and they marked the beginning of a decade that was barren of significant poetry, ‘Lake School’ or not. Wordsworth’s reputation, however, continued to grow despite the dearth of new poems. In Jeffrey’s mouth ‘Lake School’ had been a taunt. By the end of the decade every Ambleside innkeeper knew that when tourists asked the way to Rydal they were hoping for at least a glimpse of the ‘father of the Lake School of Poetry’.
Expectation and prediction
Authors: Medawar Peter
Published: November 2023

Wise folk may or may not form expectations about what the future holds in store but the foolish can be relied upon to predict with complete confidence that certain things will come about in the future or that others will not.
Son of stroke
Authors: Medawar Peter
Published: November 2023

Where to be ill. Large teaching hospitals are recommended. Unless privacy is of overriding importance or you really dislike your fellow men don’t go into a private ward. The nursing won’t be better than in a public ward, and may easily be much worse. Besides, in a public ward you will be entertained all day by the unfolding of the human comedy and by contemplating what literary people call the Rich Tapestry of Life.
Introduction
Authors: Marston Nicholas
Published: November 2023

This book, as its series title proclaims, is a study in musical genesis and structure. More specifically, it deals with the genesis and structure of a single musical work, Beethoven’s Piano Sonata in E, Op. 109. The purpose of this introduction is to consider how these two aspects of Op. 109 have been approached and to draw attention to the limitations—some inevitable, others consciously self-imposed—by which the following chapters are constrained and shaped.
Beethoven in 1820: The Sources for the Piano Sonata, Op. 109
Authors: Marston Nicholas
Published: November 2023

The Sonata in E belongs unquestionably to the year 1820. The first theme of the first movement is found in the Conversation Book of April; the work was sketched in part before he began the Benedictus [of the Missa solemnis], in part while he was at work on this section, the Credo, the Agnus Dei and the Bagatelles [Op. 119 Nos. 7–11] for Starke. It was dedicated to Maximiliane Brentano, and published in November, 1821, by Schlesinger in Berlin.1
The Sketches for the First Movement
Authors: Marston Nicholas
Published: November 2023

Grasnick 206, folio 3r is not given over entirely to Op. 109. On staves 1–2 there is a sketch for the Credo of the Missa solemnis, and on staves 3/4 an incipit for a piano composition in F minor which was not pursued further. On staves 5/6 Beethoven shifted from F minor to E major and wrote the sketch shown in Ex. 3.1a. If this was indeed his very first sketch for Op. 109, it is clear that little effort on paper was required before he reached a satisfactory opening for the work.1
The Sketches for the Third-Movement Theme
Authors: Marston Nicholas
Published: November 2023

In Chapter 2 it was argued that the composition of the first movement of Op. 109, originally as an independent work, probably marked Beethoven’s return to serious composition after a period of relative inactivity caused by the mounting struggle for guardianship of his nephew Karl. Having thus renewed his compositional drive, he worked hard at the Credo of the Missa solemnis. This new burst of activity overflowed from the Wittgenstein sketchbook into Artaria 195, the first thirty-four pages of which are entirely taken up with Credo sketches.
The Second Movement: The First Phase
Authors: Marston Nicholas
Published: November 2023

Whereas the sketches for the first movement and for the third-movement theme have each been discussed in a single chapter, those for the second movement and the third-movement variations require two chapters each (the variation sketches also require a substantial introduction: see Chapter 7). In the case of the second movement the division into two chapters stems not only from the fact that there are a larger number of sketches to be dealt with but also from important differences in sketch-type. A brief overview of the sketches will help to make this clear.
Conclusion
Authors: Marston Nicholas
Published: November 2023

The nature of Beethoven’s original musical idea for Op. ro9 remains concealed. However, the sketches and autograph revisions suggest that he had in mind a plan for the entire work, a plan which during the compositional process was amplified and refined until all elements had been coordinated to form a cogent totality.1
Posture
Authors: Quine Hector
Published: November 2023

A Comfortably balanced sitting posture is of fundamental importance to the development of a sound technique; arms, hands, and fingers can only work efficiently from a stable base, which a sitting position free from unnecessary tension provides.

Faulty posture, a fairly common problem for guitarists, is often due to unequal distribution of bodily weight (see Fig. l); there is a tendency to lean to one side—usually the left—so that the back is curved instead of being kept straight from the hips to the neck (see Fig. 2). This fault can be caused by too low a chair or too low a footstool; the left knee being allowed to point outwards (or inwards) instead of remaining on the centre line of the body (see Fig. 3).