bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis and optimization of a novel high cooling flux stacked T-shaped thermoelectric cooler
Authors: Yin Shengchao , Zhao Huadong , Zhang Jingshuang , Li Cheng
Published: November 2023

To meet the cooling demands of high heat flow density hotspots in scenarios such as electronic chips, a novel three-dimensional stacked T-shaped thermoelectric cooler (STTEC) is designed in this study. Under steady-state conditions, a finite element method with coupled thermal–electrical–mechanical physical fields is utilized, and the temperature dependence of thermoelectric (TE) materials is considered. First, the cooling flux, coefficient of performance (COP), and minimum cooling temperature of STTEC under different input-current and thermal boundary conditions are investigated and compared to the traditional π-shaped thermoelectric cooler (π-TEC). Second, the effects of geometrical parameter variations under optimal currents on the cooling performance and reliability of STTEC are studied. Finally, the structural parameters are optimized. The results show that the STTEC altered the path of TE conversion and transfer, which significantly improved the optimal current. The STTEC has a remarkable advantage in cooling performance under low temperature differences or high cooling loads. Compared to the π-TEC, STTEC enhances cooling flux by 101.6%, rises COP by 358.5%, and lowers the cold-end temperature by 46.6 K. At optimal current conditions, by optimizing the thickness of the T-shaped copper slice and the height difference between the TE leg and the T-shaped copper slice, the thermal stress decreased by 18.4%. The STTEC’s novel design could inspire the manufacturing and commercialization of high-performance thermoelectric coolers.
The contingency of prophetic semantics in Walter Chatton’s
Lectura
Authors: Bornholdt Jon
Published: November 2023

This paper examines Walter Chatton’s discussion of the problem
of prophesied future contingents in his Lectura super
Sententias. Faced with the challenge of reconciling the supposedly
veridical character of divine prophecy with human freedom to do otherwise,
Chatton casts the relation of prophecy to event in the form of a logical
consequentia and formulates two rules which depend on the
character of the antecedent in question. In the case of antecedents involving
divine knowledge and related phenomena, the freedom of the wayfarer to do
otherwise is secured by the assumption that the consequence is necessary but the
antecedent is semantically contingent. In the case of concrete utterances and
phenomena, on the other hand, the wayfarer’s freedom is secured by the
assumption that the consequence itself is contingent. Chatton’s treatment, while
analytically subtle and rigorous, leaves a number of important questions
unanswered, most notably that of the ontological openness or closure of the
future. Nevertheless, it is interesting both in its own right and insofar as it
provides a clarifying source for Chatton’s later discussion of the same topic in
his Quodlibet.
Examining the communication of female political leaders in the Global South
Authors: Nartey Mark
Published: November 2023

This Special Issue expands on the ongoing dialogue on the decolonial project by bringing together thought-provoking
papers that examine the communication of female political leaders in the Global South. It draws on data from West Africa, Latin
America, the Caribbean and the Middle East to elucidate how female politicians deploy language (including multimodal forms) to
position themselves in the political arena and utilize linguistic resources to navigate the discursive practices associated with
their political roles and responsibilities. The issue offers a critical discursive perspective on the complex interplay of gender,
culture and political leadership, and holds implications for how key issues such as voice, agency, solidarity and empowerment are
conceptualized and enacted in specific sociocultural contexts. It also contributes to overcoming epistemicide by decentring
knowledge production and underscoring the importance of valuing and engaging with different knowledge systems, especially
non-Western epistemologies.
Zero-Field ODMR and relaxation of Si-vacancy centers in 6H-SiC
Authors: Singh Harpreet , Anisimov Andrey N , Baranov Pavel G , Suter Dieter
Published: November 2023

Silicon vacancies in silicon carbide (SiC) have been proposed as interesting candidates for quantum technology applications such as quantum sensing and quantum repeaters. SiC exists in many polytypes with different plane stacking sequences, and in each polytype, the vacancies can occupy a variety of different lattice sites. In this work, we focus on the three important charged silicon vacancies in the 6H-SiC polytype. We record the photoluminescence and continuous-wave optically detected magnetic resonance (ODMR) spectra at different radio-frequency power levels and different temperatures. We individually select the zero-phonon lines of the different silicon vacancies at low temperatures and record the corresponding ODMR spectra. ODMR allows us to correlate optical and magnetic resonance spectra and thereby separate signals from V
1 and V
3. The results also explain the observed sign change of the ODMR signal as a function of temperature.
Long-term stability of hydroxyapatite bone phantoms for the calibration of in vivo x-ray fluorescence spectrometry-based systems of bone lead and strontium quantification
Authors: Micsa Matthew , Ha Diana , Da Silva Eric
Published: November 2023

Hydroxyapatite (HAp) phantoms have been proposed as an alternative to plaster of Paris (poP) phantoms for the calibration of x-ray fluorescence-based systems for the in vivo quantification of bone lead and strontium which employ a coherent normalization procedure. The chemical composition of the material becomes critical in the calculation, or omission, of the coherent correction factor (CCF) required in this normalization procedure. This study evaluated the long-term chemical stability of HAp phantoms. Phantoms were prepared and allowed to age for a two week period and over a seven year period in ambient conditions. The chemical composition of the phantoms was then assessed by powder x-ray diffraction. Two week old phantoms were found to be composed of HAp with only a small amount of contamination from CaHPO4·2H2O. Seven year old phantoms were found to have converted nearly completely to a carbonate-bearing apatite in the form of Ca10(PO4)6(CO3)0.75(OH)0.5 indicating that the HAp phantom material likely reacts with carbon dioxide in air over time forming a carbonate-bearing apatite. The influence of this chemical conversion was assessed at the level of relevant cross-sections. Calibration under the assumption that the material is HAp when in fact it is a carbonate-bearing apatite would result in not more than a 0.2%–2% bias in the total mass attenuation coefficient within the photon energy range of 0–100 keV. Differential scattering cross-section for coherent scattering was found to differ between HAp and carbonate-bearing apatite by 0.9%–2% for both a 35.5 keV and 88.0 keV γ-ray. This variation in the differential scattering cross-section for coherent scattering may introduce a ca. 2% bias in the CCF used within the coherent normalization-based calibration procedure. Using HAp phantoms as calibrators thus requires acknowledgement of this conversion in chemical form and possible introduction of uncertainty into the calibration procedure.
Droplet-based assembly of magnetic superballs
Authors: Schyck S , Meijer J-M , M Schelling M P , Petukhov A V , Rossi L
Published: November 2023

The self-assembly of materials driven by the inherent directionality of the constituent particles is of both practical and fundamental interest because it enables the fabrication of complex and hierarchical structures with tailored functionalities. By employing evaporation assisted self-assembly, we form opal-like structures with micro-sized magnetic superball particles. We study the structure formation of different superball shapes during evaporation of a dispersion droplet with in-situ small angle x-ray scattering with microradian resolution in the absence and presence of an external magnetic field. In the absence of a magnetic field, strong shape-dependent structures form as the water evaporates from the system. Applying a magnetic field to the droplet has a unique effect on the system; strong magnetic fields inhibit the growth of well-ordered assemblies due to the formation of out-of-equilibrium dipolar structures while lower magnetic fields allow particles to rearrange and orient without inhibition. In this work, we show how the superball assembly inside a droplet can be controlled by the magnetic field strength and the superball shape. The tunability of these parameters not only enables the controllable formation of macroscopic colloidal assemblies but also opens up possibilities for the development of functional materials with tailored properties on a macro-scale.
Misperceptions, Intergroup Prejudice, and the Varied Encounters Between European Citizens and Non-EU Foreigners
Authors: Herda Daniel
Published: November 2023

How does interpersonal exposure to immigrants influence citizens’ opinions about immigrants? The Intergroup Contact Theory (ICT) famously predicts improved attitudes under certain circumstances. However, research on the population innumeracy phenomenon predicts that this same exposure may worsen demographic misperceptions about immigrants. The current study seeks to analyze these contradictory possibilities with data on native-born citizens’ encounters with non-EU immigrants from the 2017 Eurobarometer survey. The analysis considers a wide variety of exposure contexts and generates hypotheses about which will matter most for each outcome based on cognitive availability processes and the optimal conditions outlined in the original ICT. The results indicate that intergroup exposure increases both positive attitudes toward immigrants and incorrect perceptions about immigrants. However, context matters. Those with exposure to immigrants among their primary networks or through their participation in sport, volunteer, and cultural activities exhibit the most pro-immigrant evaluations. Those with exposure through their neighborhoods and workplaces exhibit the most inflated perceptions. The study concludes by considering the implications of these findings for future research.
Recovery of the Nonlinearity From the Modified Scattering Map
Authors: Chen Gong , Murphy Jason
Published: November 2023

We consider a class of one-dimensional nonlinear Schrödinger equations of the form $$ \begin{align*} & (i\partial_{t}+\Delta)u = [1+a]|u|^{2} u. \end{align*}$$For suitable localized functions $a$, such equations admit a small-data modified scattering theory, which incorporates the standard logarithmic phase correction. In this work, we prove that the small-data modified scattering behavior uniquely determines the inhomogeneity $a$.
Apple-blossom in June?
Authors: Rowson Martin
Published: November 2023

The early nineteenth-century novelists inherited from their Gothic predecessors a sense that, where landscape was concerned, lies were more beautiful than truth and, for that reason, often preferable. In his essay on Mrs Radcliffe in The Lives of the Novelists, Scott notes the pervasive vagueness of her scene-painting, a quality which at its best aligns her word-drawn settings with the imaginary landscapes of Claude:

For all the realism of his historical analysis and characterization, Scott often found a similar ‘haze’ very useful in his own higher-flying landscape descriptions3
How does Victor make his monsters?
Authors: Rowson Martin
Published: November 2023

Answering from one’s visual recollections of the films, the answer to the question in the title is easy. Colin Clive (in James Whale’s and Universal Pictures’ 1931 modern-dress classic), Peter Cushing (in a string of Hammer-produced, Terence Fisher-directed gothics from 1957 onwards), James Mason (in the 1973 TV-movie, scripted by Christopher Isherwood), Gene Wilder (in Mel Brooks’s hilarious 1974 spoof Young Frankenstein), Kenneth Branagh (in the 1994 blockbuster, Mary Shelley’s Frankenstein), and even the heroes in such delightfully zany send-ups as Frankenhooker (a story based on monstrous exploding prostitutes) and Frankenstein, the College Years are –– all of them –– half surgeons of genius, half mad scientists.
Does Becky kill Jos?
Authors: Rowson Martin
Published: November 2023

Students of literature are routinely told that Thackeray is an ‘omniscient’ novelist; indeed, that with Fielding he is probably the perfect specimen of the type. He himself tells us, repeatedly and with apparently complacency in Vanity Fair, that ‘the novelist knows everything’. But this omniscience has its holes. The reader is teased by what this allegedly all-knowing narrator would seem not to know, will not acquaint himself with, or declines to impart. Omniscient he may be; omnidictive he is not.

Most provoking of the text’s silences is that concerning Jos’s death. He dies in mysterious circumstances on the continent, sometime in the early 1830s, while in the dangerous company of Becky Crawley. From his first encounter with her, some twenty years before, Jos has been in danger from this fatal woman. In 1813 she almost netted him; but George Osborne, unwilling to have a governess marry into the family (‘low enough already, without her’, p. 71) frightened the fat man off.
Is Melmotte Jewish?
Authors: Rowson Martin
Published: November 2023

In his monumental survey of anti-Semitism in the works of Thackeray, Israel at Vanity Fair (1992), S. S. Prawer refers in passing to Melmotte, the financier villain of Trollope’s The Way We Live Now, as a ‘Jewish crook’ (p. 418). This is a common assumption among critics and readers of Trollope and can be found in print in any number of places. It is, very probably, a misapprehension –– although it is not easy to come to a final resolution on the matter.

The novelist apparently connives at our uncertainty about Melmotte’s origins by not being as straightforward as he normally is on such matters. There is, for instance, no ambiguity about the race or religion of Samuel Cohenlupe, ‘Member of Parliament for Staines, a gentleman of the Jewish persuasion’ (i. 84), the amiable Ezekiel Brehgert, or the less amiable Mr Goldsheiner. Of Madame Melmotte, it is clearly explained not just that she is a Jewess, but that she is a particular variety of nonEnglish Jewess –– doubly alien: ‘She was fat and fair, –– unlike in colour to our traditional Jewesses; but she had the Jewish nose and the Jewish contraction of the eyes’ (i. 31). Georgiana Longestaffe’s accepting the proposal of Brehgert provokes an anathema worthy of a medieval Pope from her despairing, patrician, incurably xenophobic mother: ‘It’s worse than your wife’s sister.
Why does this novel disturb us?
Authors: Rowson Martin
Published: November 2023

Early critical reaction to The Picture of Dorian Gray ‘was almost unanimously hysterical’, Isobel Murray’s introduction to the World’s Classics edition tells us. Why? The story would seem to be excessively moralistic –– a parable, no less (what shall it profit a man if he keep his good looks and lose his soul?). The homosexual hints are deeply buried beneath Dorian’s conventional heterosexual villainies (the seduction of Sibyl Vane, the debauching of society wives, the ruining of young girls, the inhaling of opium). There were enough sops to the straight, lateVictorian world to have kept even Mr Pecksniff happy, one would have thought.
Whose side is Hawk-eye on?
Authors: Rowson Martin
Published: November 2023

The first half of The Last of the Mohicans is taken up with the perilous journey through the Indian-infested wilderness which lies between Fort Edward and Fort William Henry in the war-torn summer of 1757. There is much mystery attaching to this section of Cooper’s tale. Why does Colonel Munro want his daughters to join him at the very moment that the poorly defended fort under his command is about to be attacked by an overwhelming force of French soldiers and their savage Huron allies? Does he want his daughters to be scalped, or worse? Why does he release one of his senior aides, Major Duncan Heyward, to bring his daughters to him instead of a junior officer? It is the more mysterious since Heyward, as it emerges, does not know the route and gets hopelessly lost. Why does Heyward employ as scout the treacherous Magua, whom he knows to have a burning grudge against Colonel Munro? If ever a trip through the woods was destined for disaster, this is it.
Can Jane Eyre be happy?
Authors: Rowson Martin
Published: November 2023

Margaret Smith’s introduction to the World’s Classics Jane Eyre summarizes the formative influence of Charlotte Brontë’s reading in the Bible, Bunyan, Shakespeare, Scott, and Wordsworth. Smith expertly identifies the Byronic and Miltonic elements which fuse into the mighty conception of Edward Fairfax Rochester. There is, however, a principal source for Jane Eyre which Smith does not mention –– a ‘fairy story’ which, one assumes, was read by or to the Brontë children in their nursery years.

The story of Bluebeard (‘Barbe Bleue’) was given its authoritative literary form in Charles Perrault’s Histoire du temps passé (1697). Perrault’s fables were much reprinted and adapted by the Victorians into children’s picture books, burlesque, and pantomime. By the 1840s the story of the bad man who locked his superfluous wives in his attic would have been among the best-known of fables. In the twentieth century the Bluebeard story, with its savagely misogynistic overtones, has fallen into disfavour.
What happens to Mrs Woodcourt?
Authors: Rowson Martin
Published: November 2023

During the libel trial which entertained the nation in July 1996, cricketer Ian Botham was asked under cross-examination if it was true that he had said after a tour of Pakistan, ‘it is the kind of place where you would send your mother-in-law for a week’s holiday –– all expenses paid’. No, the great sporting hero replied, he would never say such a thing. What he had said was that Pakistan was the kind of place you would send your mother-in-law for two weeks –– all expenses paid. When the laughter died down, Botham was pressed by the cross-examining counsel on whether this was not a racist slur –– a kind of verbal Paki-bashing. No, Botham replied, it was a slur against mothers-in-law.
How good a swimmer is Magwitch?
Authors: Rowson Martin
Published: November 2023

Great Expectations has the most vivid of all Dickensian openings, designed to burst explosively on the first page of All the Year Round, where it was initially serialized. Pip mournfully regards the graves of his parents and five little brothers, ‘who gave up trying to get a living exceedingly early in that universal struggle’. The narrative halts for a paragraph to depict the dreary marsh landscape on a late winter afternoon. It is all too much for the 7-year-old orphan, who begins to cry:

It is not until much later in the novel (II.3), and sixteen years later in Pip’s life, that we learn the details of how Abel Magwitch, Pip’s ‘fearful man’, escaped from the hulks and came to be hiding behind the gravestone (of Pip’s father, as illustrators have felicitously assumed).
What is Elfride’s rope made of?
Authors: Rowson Martin
Published: November 2023

One of the zanier stories in the American press in 1993 told of an inmate in a high-security prison who had escaped using a rope made out of the dental floss which his custodians had thoughtfully provided over the years. It is the kind of article that sticks in the mind (was it used floss? one wonders). There is a similar episode, similarly memorable, in Thomas Hardy’s early novel A Pair of Blue Eyes. The blue-eyed heroine, Elfride Swancourt, is the daughter of the rector of Endelstow (i.e. St Juliot), whose deserted parish is on the ‘sea-swept’ Wessex (Devonshire and Cornwall) coast. The nearest town is Castle Boterel (i.e. Boscastle).
Why is Moll’s younger brother older than she is?
Authors: Rowson Martin
Published: November 2023

As Ian Watt notes in The Rise of the Novel, the attentive reader will find an ‘inordinate number of cracks’ in the plot of Moll Flanders. Some, in fact, are less cracks than gaping fissures. There are, Watt goes on to observe, two possible lines on the inconsistencies in Moll’s account of her life. We can read her narrative ‘ironically’. In this mode of reading ‘errors’ are assumed to have been cunningly planted by Defoe to be picked up by the wideawake reader. Defoe designed such glaring anomalies as Moll’s remembering to the farthing the value of gold watches she stole twenty years ago, but forgetting the names (and even, apparently, the number) of her children. These are to be taken ‘ironically’ as signs of her incorrigible callousness. Similarly ironic are such jarring pieties as her reflection, after stealing a little girl’s gold necklace, that by her theft she had ‘given the parents a just reproof for their negligence, in leaving the poor lamb to come home by itself, and it would teach them to take more care next time’ (p. 194). Like the sadistic Victorian flogger telling his victim that ‘this hurts me more than it hurts you’, Moll is –– if we follow this line of explanation –– a double-dyed hypocrite.
Apple-blossom in June–– again
Authors: Rowson Martin
Published: November 2023

In Is Heathcliff a Murderer? I defended what is thought to be Jane Austen’s most egregious ‘error’ in her fiction, arguing that it was no error at all if one read it aright. The company go for a picnic to the grounds of Donwell Abbey. It is ‘the middle of June’, ‘almost Midsummer’, as we are precisely informed (the actual day can be calculated as the 22nd of the month). Strawberries are in prospect:‘the best fruit in England –– every body’s favourite’. They are in plentiful supply, we understand. It has been a good crop –– and on time. During a quiet moment on the expedition, standing on a hill, Emma gazes at the Surrey landscape spread out before her. It is ‘a sweet view –– sweet to the eye and the mind. English verdure, English culture, English comfort, seen under a sun bright, without being oppressive.’
How does Ruth end up in Wales?
Authors: Rowson Martin
Published: November 2023

Frances Twinn, a graduate student working on the fiction of Elizabeth Gaskell, points to a troubling inconsistency at the heart of Ruth. The narrative opens with a depiction of the poor-but-genteel heroine apprenticed to a harsh milliner, Mrs Mason, in ‘an assize town in one of the eastern counties’. It is ‘many years ago’ (p. 3). We should picture, it seems, a sleepy county town like Ipswich or Norwich in the 1830s. The heroine, Ruth Hilton, is an orphan. Her mother had been the daughter of a Norfolk curate –– a ‘delicate, fine lady’ (p. 36); her father had been a farmer –– a good-hearted but tragically unlucky man. The delicate Mrs Hilton died early of physical exhaustion, unable to cope with the physical demands of being a farmer’s wife. He followed soon after of a broken heart and bankruptcy. Ruth, alone in the world, falls into the unfeeling custody of a ‘hard-headed’ guardian, who disposes of the waif to Mrs Mason so as to be rid of her, at the small expense of her indenture fee.
Name Games
Authors: Rowson Martin
Published: November 2023

An Oxford World’s Classics reader, John Cameron, writes to ask if I have noticed that between pages 123 and 147 of Oliver Twist

Other suspicious readers and some critics have wondered whether Dickens is making an off-colour joke with ‘Master Bates’. There is no doubt that Dickens often uses embedded word-association in the names of his characters. Murdstone and Merdle, for instance, combine the overtones of the French merde (‘shit’) and ‘murder’. Murdstone is a stony-hearted murderer; Merdle deals with ‘filthy’ lucre. ‘Uriah Heep’ brings with it, every time the name and its owner crop up in David Copperfield, a subliminal vision of a heap of ordure (‘uria’ is defined in the dictionary as ‘urine’ and ‘urea’, even less attractively, as ‘the solid component of mammalian urine’).
Diagnosis
Authors: Ebrahim Shah
Published: November 2023

Strokes are caused by arteriovascular events: thrombosis; haemor-rhage; and emboli. However, not all patients who present with signs and symptoms of hemiplegia have had a stroke. The nomenclature used to describe patients can lead to problems, in particular calling all patients with signs suggestive of a stroke a ‘CVA’ or cerebrovascular accident. By using CVA the implication is that a stroke has occurred and no further pathological processes need to be ruled out. The term CVA can also cause confusion because it may refer to the side of the lesion or the side of the signs.
Recovery
Authors: Ebrahim Shah
Published: November 2023

Giving a prognosis for recovery is of obvious importance to patients and relatives. Prognostic information is also needed for deciding who should continue to have rehabilitation and should help in planning services and policy. Highlighting the problems of patients who make a poor recovery should make us look for new solutions and treatments. Indicators of recovery may also be used as a yardstick to audit the work done during rehabilitation.
What is a function?
Authors: Cruickshank Steven
Published: November 2023

We use the idea of a function throughout this book, but what do we mean by a ‘function’? We will treat a function as a rule that transforms one set of real numbers to another set of real numbers. The function is a process; we feed in a value at one end and the function rule generates an output value at the other end. We may need to be rather particular about defining the range of values that we may input into the function; for instance, the function x) = 1/(x) is undefined at x = 0, and we must restrict the input range when defining the function to exclude x = 0, since it is impossible to divide by zero.
Pattern functions and transformations
Authors: Cruickshank Steven
Published: November 2023

We shall look at the properties of a number of important classes of function which are useful in modelling. In each case we shall emphasize that there is a ‘basic pattern’ function, which we may transform to other related functions by means of simple manoueuvres. These transformations will be demonstrated in general here graphically. This approach is intended to give a feel for how the mathematical solution to problems is found, rather than to give the ability actually to manipulate the functions.
The teacher and self-directed learners
Authors: Bouhuijs Peter A J
Published: November 2023

Teaching in medicine has always been an important aspect of the physician’s professional job. The Hippocratic Oath, which is still considered as a valid description of the tasks of physicians, stipulates that the physician will teach his professional knowledge and skills to future generations of physicians. In many languages physicians are called ‘doctor’ which means teacher. For a long time, medical education consisted of apprenticeships during which a junior learned the trade by working with a senior physician for some time. Although the teaching in medicine at medieval and renaissance universities also contained some formal teaching, students would usually stay with one or a few professors who would teach all relevant (and irrelevant) aspects of medicine. The Renaissance ideal of the learned man, who was supposed to be knowledgeable about most aspects oflife dominated the teaching of medicine for a long time. The practical use of what was learned in universities was limited, and in many countries only limited funds were given to universities to pay for stipends and buildings. In the nineteenth century, the rapid evolution of the sciences caused major changes in university teaching. New disciplines emerged and it was no longer possible to teach everything that was known. Von Humboldt in Germany introduced the idea of a formal medical curriculum which would be based on sciences. This model was advocated later by Flexner in his reform of US medical education. Gradually this model was introduced in most countries around the world (Jolly 1994). Disciplinary teaching and specialization replaced a holistic model of expertise. It is clear that these changes affected the role of medical teachers deeply. Today, medical schools are composed of twenty or more departments, which are themselves sometimes divided in various sections, each of which covers a different aspect of medicine. The great teachers of the past have been replaced by experts in specialized areas of the medical sciences.
Biology and pharmacology: some differences
Authors: Mather S J
Published: November 2023

It is beyond the scope of this chapter to discuss the molecular basis of local anaesthetic action, which could justify a book in itself. The purpose of the following chapter is to outline some of the differences between babies and larger children and adults in the ways in which they behave toward painful stimuli and their handling of local anaesthetic drugs.
Opioid pharmacology
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Opioid agents have effects on many systems in the body. This chapter describes some of these effects. Figure 6.1 summarizes these effects. Opioid agents have a variety of effects on the central nervous system, which can be broadly classified as depressant or excitatory.
Local anaesthetic techniques
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Some useful nerve blocks are described in this chapter. Not all of the techniques are suitable for readers of this book to perform but they are described to encourage understanding amongst those who may not be familiar with the methods, but who may have to care for patients before or after nerve blocks. Other blocks described may well be suitable for house officers to perform. This book complements more specialized instruction manuals and is not a substitute for adequate instruction in the practical points. It is expected that before performing these nerve blocks, doctors will be proficient in resuscitation skills and that immediate access to resuscitation equipment, drugs, and assistance is available.
Epidural and intrathecal opioids
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Experiments in animals have shown the effect of small doses of opioid drugs on nociceptive transmission at the spinal cord level. Transmission of impulses from noxious stimuli upwards to the brain was inhibited. When chronic spinal catheterization was performed in animals intrathecal administration of opioids produced significant and long-lasting increases in nociceptive thresholds using thermal, electrical, and mechanical pain stimuli. Spinal effects of opioid drugs result from alterations in pain transmission at the level of the first- and second-order neurones in the dorsal grey matter. Receptors for the opioid drugs are located in the substantia gelatinosa in the vicinity of the primary afferent terminals. Activation of opioid receptors results in hyperpolarization of the cell preventing excitation and its ability to conduct pain invoking signals.
Psychological morbidity: its recognition and management
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

The diagnosis and treatment of cancer is associated with a substantial social and psychological morbidity (Derogatis et al. 1983; Greer 1985). Unfortunately, this morbidity often remains unrecognized and unresolved (Maguire 1992). Patients and their relatives are reluctant to disclose any problems, while health professionals are loath to enquire actively about them. This chapter will review the nature and extent of this morbidity and discuss the reasons why it remains undetected and unresolved.
‘Distancing’ by health professionals
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

Caring for patients and their families when there is a diagnosis such as cancer, and/or a poor prognosis, is not easy. The work is often emotionally charged, and the health professional may have to answer awkward and challenging questions, for example ‘Am I dying?’, ‘Can’t they find a cure?’; deal with difficult situations, for instance collusion; and risk becoming involved in painful issues and decisions. These situations will be discussed in Chapter 7.

.
Training resources available
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

There are many courses to help individuals improve their communication skills and develop the ability to take on a counselling role. Some universities, for example, offer a diploma in counselling, which can be taken full or part-time. Others offer a basic degree in communication, which covers both theory and practice.
Sexual deviance and the law
Authors: Freeman Michael
Published: November 2023

Sexual mores vary from culture to culture, and there is an approximate correspondence between the law and the pattern of accepted behaviour. A survey of the world’s legislation on sexual deviance and methods of treating it would thus present a variegated picture. The United States of America, according to Slovenko (1965), has more laws on the subject than all of the European countries combined.
Managing the peer review process
Authors: Grol Richard , Lawrence Martin
Published: November 2023

The importance of adequate supervision of peer review has been pointed out earlier (Chapter 6). This supervision may be either recruited externally or taken on by one of the group members. This may take various forms: The supervisor will generally function as chair rather than as an active participant and will need to maintain some distance and keep the group process going, when necessary. This chapter includes some instructions for supervisors of peer review. It is recommended that training of peer group leaders is provided, as is currently done in countries like The Netherlands, Ireland, and Germany.
Instruments for review of general consultation skills
Authors: Grol Richard , Lawrence Martin
Published: November 2023

To perform adequately in patient care general practitioners need a method of problem-solving which is adapted to the specific features of their particular general practice. This style of problem-solving is noticeable particularly in the management of the contacts with patients. The handling of consultations is a central aspect of general practice which may be viewed from two perspectives. In the first place performance in specific cases with specific complaints and disorders may be evaluated: what should a GP ask, examine, prescribe when confronted with a patient with a sore throat (see Chapter 16)? Secondly it is necessary to evaluate the regular patterns of behaviour in contacts with patients, irrespective of the specific complaint or disorder.
Talking with Patients
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

This book introduces the reader to the basic skills necessary for good communication between doctors (and other health professionals) and patients. The practical importance of such skills is outlined, making the doctor much more effective in all fields of medicine. This is not a book for the specialist reader, but aimed at all those who need to talk with patients.
Conducting an interview
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

Before considering the conduct of an interview in detail, it is useful to look at the elements involved in interpersonal communication. They include both verbal and non-verbal ‘messages’, which may be classified into four varieties.

(1) verbal: the choice of spoken words;

(2) intonational: the pitch, tone, or cadence of speech, the modulation of the voice; the whisper of confidentiality; the rising crescendo of anger or concern; the warm tones of interest and friendliness; the flat tones of despair;

(3) paralinguistic: non-verbal sound or utterances, e.g. the noncommittal nasal ‘hm-hm’; the sharp inspiration of surprise—‘phew’; the expiratory puff signifying disgust;

(4) kinesic: communication through movements, facial expressions, posture or gesture—’body language’. (A clear, popular account of this aspect of communication may be found in Desmond Morris’s Manwatching [24].)
Talking about babies
Authors: Laing I A
Published: November 2023

There is a common misapprehension that neonatology is diminished as a specialty because infants cannot articulate, and therefore there is little need for good communication. On the contrary, the neonatologist is meeting the needs of a family, often at the most stressful time of young parents’ lives. High expectations of a normal pregnancy and delivery, with a resultant delightful infant, are shattered when at (say) 24 weeks gestation a creature hardly recognizable as human emerges and is cocooned for weeks or months within the confines of a transparent plastic box in a strange intensive care unit. At no time can it be more important for a physician to impart information clearly, pitching the dialogue at a level appropriate for a single unsupported mother, a mutually supportive couple, or the entire family involved. This chapter first touches briefly on talking to infants themselves.
A legacy of opportunities
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

Before we start to consider the ways that general practice teaching should develop in the future, we must first acknowledge the substantial achievements and strengths of our present system of training. Then we need to identify those areas in which improvement is still required.
Vocational training schemes
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

A great deal of activity is organized outside the training practice to provide education, support, and administration for both the trainer and the trainee. This activity can be very varied, depending on whether the trainee is on a three-year fully integrat d scheme or a one-off trainee year: the frequency and length of course activities will also be relevant. In this chapter we examine all the important aspects of vocational training schemes, with the exception of the hospital posts which are the subject of Chapter 10.
Evaluating the teaching
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

In his review of training for general practice, published in 1982, Pereira Gray asked the question ‘Does vocational training work?’ and concluded, on the basis of available evidence, that no study satisfactorily demonstrated that vocationally trained general practitioners provided a better standard of care than untrained practitioners. The same remains true today, and indeed some evidence, such as that of Cartwright and Anderson (1981), indicates that there was no significant difference between trained and untrained general practitioners in the way they viewed their patients or the satisfaction they obtained from their work.
Quality control of megavoltage therapy units
Authors: Johansson K -A , Sernbo G , Dam J Van
Published: November 2023

Every radiotherapy department must have a quality assurance (QA) programme, including all the different steps in the radiotherapy process, in order to ensure safety and quality of treatments. One of the elements of such a general programme is devoted to the equipment used for radiotherapy. Components in a QA programme for therapy equipment include planning for installation, acceptance tests, commissioning, training, quality control (QC), and preventative maintenance. This chapter deals with a QC protocol for megavoltage equipment (i.e. electron accelerators and cobalt units).
Unsealed-source therapy
Authors: Flower M A , Chittenden S J
Published: November 2023

The use of unsealed sources of radioactivity for therapy is a small but growing branch of nuclear medicine and a unique form of radiotherapy. Techniques used in the diagnostic applications of nuclear medicine have already been described in a companion volume in this series (Sharp et al. 1998). Only those aspects that are specific to therapy applications of unsealed sources will be considered here.
Heart disease
Authors: Round Jonathan
Published: November 2023

Paediatric heart disease is a particularly common topic for examiners to focus on. It is common (about 1/50 individuals will have an identifiable lesion at some point in their childhood) and it is important in terms of morbidity, mortality, hospital attendances, and resources. Fortunately, it is also easy to understand at a simple level once the anatomy and a few bits of physiology are assimilated.
Paediatric surgery
Authors: Round Jonathan
Published: November 2023

False. Circumcision remains a common operation. Most circumcisions are performed for religious reasons (Jews and Muslims), and this is usually done by a religious representative. Another common reason is for ‘hygiene’, although there is little scientific support for this indication. The foreskin should be left intact unless it is a site of recurrent infection or it is obstructing the flow of urine.
The Aetiology of Cancer
Authors: Russell Hilary
Published: November 2023

It is now accepted that cancer arises within a single cell as a result of an accumulation of abnormalities (mutations) within the DNA of that cell. When these mutations occur within key genes, e.g. those involved in control of the cell cycle, apoptosis, DNA repair, etc., it can lead to uncontrolled cell growth and eventually, perhaps, to a cell type that has acquired the ability to metastasize. A large number of aetiological agents have been recognized that cause genetic damage and lead to neoplastic transformation.
The principles of radiotherapy
Authors: Sullivan Frank
Published: November 2023

Radiation therapy is a clinical speciality dealing with the use of ionizing radiation on the treatment of patients with malignant neoplasia (and occasionally benign conditions). The aim of radiation therapy is to deliver a precisely measured dose of radiation to a defined tumour volume with as minimal damage as possible to surrounding healthy tissue, resulting in eradication of the tumour, a high quality of life, and prolongation of survival at reasonable cost.
Bone tumours and soft tissue sarcomas
Authors: Harmon Angus J Patterson ,David C
Published: November 2023

The commonest malignant primary bone tumours are the matrix-producing tumours, osteosarcoma and chondrosarcoma. Less frequently seen is the small round cell tumour, Ewing’s sarcoma. Malignant fibrous histiocytomas, primary bone lymphomas, and malignant giant cell tumours are rare but well recognized.
Paediatric Solid Tumours
Authors: Adamson Peter C , Widemann Brigitte C
Published: November 2023

Remarkable progress in the treatment of childhood cancer has been made over the past 40 years, such that today more than 70% of children diagnosed with cancer can be expected to be cured of their disease. Cancer remains, however, the second leading cause of death in children younger than 15 years, and the leading cause of death from disease (Fig. 21.1).
Endocrine tumours
Authors: Bell Patrick M , Atkinson A Brew
Published: November 2023

Pituitary tumours are common, accounting for about 10% of brain tumours coming to surgery. They are almost invariably benign, and present with symptoms either of a mass lesion or hormonal dysfunction (Table 24.1). Annual clinical incidence rates are about 2 per 100 000 population but recently, sophisticated imaging techniques suggest that 20% of the pituitary glands of ‘normal’ individuals harbour an incidental pituitary abnormality.
Multifactorial methods
Authors: Bland Martin , Peacock Janet
Published: November 2023

Multiple regression is a method of investigating the relationship of a continuous variable with two or more other variables. A regression equation is calculated which predicts the mean value of the outcome variable for subjects with any given values of the predictor variables. We can test for interaction, where the effects of one predictor variable on the outcome variable depend on the level of another. We can fit non-linear relationships using polynomial regression, including several powers of a predictor variable in the equation. We can include qualitative predictor variables, such as tumour stage or social class, by using dummy variables, one for each level of the predictor variable except for a base category, to which the others are compared.
Acute management
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

The first decision at the onset of a stroke is whether the patient requires hospital admission. The main reasons for admission are diagnostic (is it really a stroke?), to avoid or treat complications, to start rehabilitation early, to give treatment to prevent further strokes, and because of needs for nursing care that cannot be given at home. At present there is no established acute treatment for the neurological damage resulting from a stroke, but this is an area of intense research activity. If convincing and consistent benefits are shown for thrombolytic or neuroprotective drugs, not only will there be an additional reason for seeking hospital admission, but administering therapy will likely require very rapid access.
Blots, dots, amplification, and sequencing
Authors: O’Leary John J , Martin, Cara , Sheils Orla
Published: November 2023

Restriction enzymes (REs) are bacterial proteins that cut long, linear DNA molecules into smaller fragments. Restriction endonucleases are a major tool in recombinant DNA technology. A RE recognizes a specific sequence in DNA such as AGCT and cuts DNA wherever this combination of bases occurs in the genome. The enzymes are isolated from bacteria and are named with a three or four letter sequence, usually followed by a roman numeral (eg. EcoRI). The prime function of REs is to destroy bacteriophages or other viruses that invade bacteria. Bacteria have developed these enzyme systems to cut the invading DNA sequences of viruses, etc., thereby rendering the virus harmless.
Leukemia
Authors: Weitzman Sheila , Squire Jeremy A
Published: November 2023

Leukemia is the commonest cancer in children, comprising 25-30% of malignant disease in this population. From being universally fatal, today the cure rate of patients with acute lymphoblastic leukemia (ALL) has reached approximately 75% and that of acute myeloid leukemia (AML) approximately 40%. The improvement in survival has occurred as a result of improvements in methods of diagnosis and classification, a better understanding of leukemia cell biology and of the various clinical and biological prognostic factors, which dictate therapy. Further significant improvements in survival however, will require new approaches to therapy. Better understanding of the leukemic cell at the molecular level will ultimately allow therapy to be selectively directed at specific molecular targets on the malignant cell.
Lymphoma
Authors: Gresik Mary V
Published: November 2023

Lymphomas are malignancies of the immune system and may derive from any of a number of stages in lymphocyte differentiation, accounting for their heterogeneous histologic appearance and the inordinate number of complex classification systems that continue to proliferate. Despite the large number of lymphoma subtypes seen in adults, only three types are seen commonly in children-Burkitt, lymphoblastic, and large cell lymphoma. The low grade B lymphomas, so common in adults, are not seen in the pediatric age group with very rare exceptions. The types of lymphoma seen in children are all of high grade, but paradoxically may be more amenable to conventional chemotherapy than those disorders seen in adults.