bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Functional Bowel Disorders
Authors: Gordon Jenny
Published: November 2020

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with the group of conditions often described as functional bowel disorders (FBD)—see definitions below—in an evidence-based and person-centred way. The chapter will provide an overview of the causes and impact of FBDs, before exploring best practice to deliver care, as well as to prevent or to minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with FBDs can be found in Chapters 16, 23, 24, and 25, respectively. This chapter discusses the group of conditions often described as functional bowel disorders (FBDs). The term ‘functional gastrointestinal disorders’ is also used in the literature, but, for the purpose of this book, the term FBDs will be adopted. This refers to a group of disorders that are characterized by chronic gastrointestinal symptoms that currently have an unknown structural or biochemical cause that could explain those symptoms. Rome III is an internationally agreed set of diagnostic criteria and related information on functional gastrointestinal disorders (Longstreth et al., 2006). It includes six major domains for adults: oesophageal; gastro/duodenal; bowel; functional abdominal pain syndrome; biliary; and anorectal. This chapter will cover the FBDs that specifically relate to chronic abdominal symptoms. General abdominal symptoms include functional dyspepsia, non-cardiac chest pain, which may mimic functional abdominal symptoms, chronic abdominal pain, functional constipation, functional diarrhoea, functional bloating, and irritable bowel syndrome (IBS). The chapter will concentrate on irritable bowel syndrome. Coeliac disease and Crohn’s disease are included: to give an understanding of these disorders, and to differentiate between inflammatory and non-inflammatory conditions; to highlight the impact of the symptoms on the people who suffer from them; and to give an insight into the contribution that effective nursing makes. The amount of research and the number of publications concerning FBDs has risen considerably since the mid 1990s, and has contributed to the increasing legitimacy of these conditions as disorders in their own right and not simply by virtue of exclusion of all other possibilities.
Managing Nutrition
Authors: Green Sue
Published: November 2020

This chapter addresses the essential nursing responsibility to ensure that adequate nutritional care is offered to all patients, whether in hospital or community-based settings. To provide appropriate nutritional care to patients or clients, nurses must have a good knowledge and understanding of the principles of human nutrition, and be able to deliver nutritional support that is informed by current clinical guidelines and up-to-date evidence, as well as to evaluate that care. Healthcare organizations have a duty to ensure that patients and clients receive high-quality nutritional care. The Council of Europe (2003) has published guidelines on food and nutritional care in hospitals, and a recent Europe-wide campaign has been launched to improve nutritional care in all types of care facility (Ljungqvist et al., 2010). A European strategy to address obesity has also been launched (Commission of the European Communities, 2007). In England, the Care Quality Commission (CQC, 2010), which regulates care settings, has set national standards concerning nutrition. The provision of high-quality nutritional care involves a range of services and requires a multidisciplinary team approach. As a nurse, your role within the multidisciplinary team is fundamental in ensuring the delivery of appropriate nutritional care. In the UK, this is clearly identified by the incorporation of ‘Nutrition and Fluid Management’ within the Essential Skills Clusters for pre-registration nursing education (Nursing and Midwifery Council, 2010). Human nutrition is the study of nutrients and their effect on health, and the processes by which individuals obtain nutrients and use them for growth, metabolism, and repair. The term ‘human nutrition’ therefore incorporates many aspects of behaviour and physiology. The way in which the body obtains, ingests, digests, absorbs, and metabolizes nutrients is described in core anatomy and physiology textbooks (for example, Marieb and Hoehn, 2010), and it is important that a good knowledge and understanding of these processes is gained before considering the nursing management of nutritional care. This chapter considers the principles of human nutrition that underpin the nursing management of nutritional care and focuses on the key nursing interventions that you should be able to provide with confidence. The amount and type of nutrients that a person obtains influences his or her ‘nutritional status’.
Managing Perioperative Care
Authors: Jackson Jane
Published: November 2020

This chapter focuses on the preparation and care of adult patients undergoing elective surgery, the associated challenges, and supporting evidence in providing safe and effective care. A key principle is the identification of relevant health issues and optimizing comorbidities prior to admission for surgery, which will minimize cancellations on the day ofsurgery. Informed consent, patient education, and teamworking all contribute to effective care and efficient service delivery. To provide the optimum healthcare, it is essential that the health professional has a full understanding of the patient’s physical and psychological health and social history, allowing tailored care to be shaped and implemented. It is important that the patient understands the associated risks and benefits of planned treatment. Patients often present for elective surgery with comorbidities. In optimizing the treatment, it is possible to prevent negative consequences related to planned care, and to increase the patient’s understanding of these so that he or she they can make an informed choice. Gathering information prior to admission is important because patients are often anxious on the day of surgery, and medication/anaesthetic agents can render them unable to provide clear decisions relating to treatment. This is commonly referred to as the preoperative assessment (POA), but is probably better referred to as patient preparation. Patient preparation is the process by which a patient’s health status is identified and comorbidities made known to the relevant healthcare professionals. The healthcare professional will interpret the information, decide on additional investigations and examinations, and then determine the risk factors associated with the patient’s health and the anticipated anaesthetic and surgical intervention. The patient must be informed of the risk and benefits and be provided with sufficient information to ensure an informed choice. Integral to patient preparation is the anticipation of potential outcomes, including length of hospitalization, ability to complete activities of daily living, and discharge planning. The process will involve the patient and his or her carer(s) and all healthcare professionals appropriate to the individual patient in primary and secondary care. It may be that, at the end of the patient preparation stage, the patient decides not to proceed with surgery.
Diseases of the teeth and supporting structures
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip
Published: November 2020

A wide variety of processes can affect the formation of teeth during development. The number, size, shape, and quality of dental hard tis­sue may be abnormal and teeth may erupt early or be prematurely shed or resorbed. When a child presents with a tooth abnormality, the clin­ical and radiographic features are often distinctive and management depends on diagnosis (Box 5.1). Broadly, developmental abnormal­ities of the teeth can be either genetically determined or acquired as a result of injurious processes affecting the developing teeth. It can be problematic to make a diagnosis, particularly when teeth initially erupt. Sometimes pathological examination of a shed or extracted tooth by ground sectioning (for enamel) or conventional sectioning of a decalci­fied tooth can provide a diagnosis. Research has provided insights into the genetic and structural basis of dental anomalies, and has resulted in a complex and extensive classification of subtypes. Minor abnormal­ities, such as failure of development of a few teeth or enamel erosion in adult life, may be dealt with in general dental practice, but it is advisable to refer younger patients with more complex or extensive dental abnor­malities to a specialist in child dental health, with links to expert diag­nostic facilities and input from orthodontic and restorative colleagues. The publically available Online Mendelian Inheritance in Man (OMIM) database provides an invaluable resource for genetic disorders, including dental abnormalities. Supernumerary teeth are common and may be rudimentary in form or of normal morphology, when they are referred to as supplemental teeth. The most common supernumerary tooth occurs in the mid- line of the maxillary alveolus and is referred to as a mesiodens, which usually has a conical shape. Eruption of adjacent normal successor teeth may be impeded by a mesiodens, which is an indication for its removal. Most supernumerary teeth occur as a sporadic event in devel­opment, but multiple extra teeth can be found in certain developmen­tal disorders. Failure of development of tooth germs results in teeth missing from the dental arch and is referred to as hypodontia. Most often the missing teeth are third molars, second premolars, and upper lateral incisors. Hypodontia is more common in the permanent dentition than in the primary teeth.
Skin diseases affecting the oro-facial region
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip
Published: November 2020

Examination of the face and hands can identify significant skin diseases and also provide clues to the presence of underlying systemic disease. Many patients ignore even malignant skin tumours because they are often painless, subtle in appearance, and may be slow-growing. Dental healthcare professionals should be aware of how to recognize malig­nant skin tumours. If suspicious, but unsure of the nature of the lesion, the patient should be referred to their general medical practitioner for further evaluation. If malignancy is obvious, then an urgent referral to an appropriate specialist (dermatologist, plastic surgeon, or oral and max­illofacial surgeon) should be made using the ‘2-week wait’ (2WW) path­way (Chapter 1). Benign lesions and inflammatory diseases are more common and are important considerations in the differential diagnosis of head and neck skin abnormalities. It is important that the dental healthcare professional should be able to recognize common skin infections involving the oro-facial region. Some infections, such as erysipelas, can mimic cellulitis associated with a dental infection. When infection is diagnosed, it is vital to consider the underlying or predisposing factors, as these may be not only important diagnoses, but also may require treatment to achieve an effective clin­ical outcome. The adage ‘infection is the disease of the diseased’ is a useful reminder when dealing with patients presenting with infection. Direct inoculation of Streptococcus into skin through minor trauma is the most common initiating factor for erysipelas, which occurs in iso­lated cases. Infection involves the upper dermis and, characteristically, spreads to involve the dermal lymphatic vessels. Clinically, the disease starts as a red patch that extends to become a fiery red, tense, and indurated plaque. Erysipelas can be distinguished from cellulitis by its advancing, sharply defined borders and skin streaking due to lymphatic involvement. The infection is most common in children and the elderly, and whilst classically a disease affecting the face, in recent years it has more frequently involved the leg skin of elderly patients. Although a clinical diagnosis can be made without laboratory testing, and treat­ment is antibiotic therapy, when the diagnosis is suspected in dental practice, referral to a medical practitioner is recommended.
Information and Evidence: Sources and Evaluation
Authors: Brack Graham , Franklin Penny , Caldwell Jill
Published: November 2020

By the end of this chapter, you should understand… ● The range of possible sources of information about medicines ● Their positive and negative characteristics ● Some trustworthy sources of evidence ● The role of medicines information departments ● Some basic principles of critical analysis of evidence ● How the British National Formulary (BNF) is structured ● How to read a BNF monograph ● A selection of terms used in the literature about medicines…. While nurses will not usually be selecting medicines, they still need information to make the best use of the medicines prescribed for their patients. Information of all kinds is much more readily available today than it was a generation ago when the authors were students, but much of it is of low quality and today’s student must learn to test the quality of the evidence offered to see if it can be relied upon. In all fields of healthcare it has become usual to insist that practice must be evidence based. This is very desirable, but it begs the question—what is evidence? This chapter will examine some of the sources of evidence about medicines that are available and give some guidance on their reliability. Later, there will be an introduction to critical analysis of sources, and a description of some of the key terms used in evaluating clinical evidence about medicines. Sources of information may be conveniently divided into two main types—people and publications. It is natural that many healthcare professionals should rely upon their mentors and instructors to supplement the knowledge they gain in formal teaching. Indeed, for many years much of the practical information about medicines that junior doctors received came from participation in ward rounds under the tutelage of a consultant. In medical school they learned some general pharmacology, but the actions of many drugs were learned following graduation (Maxwell and Walley, 2009 ) The same will be true for nurses, and it will continue to be true throughout their careers. New medicines will come into use, and nurses will have to learn about them. It is therefore important to realize that pharmacology will be a lifelong study and does not end with registration as a nurse.
More Blockbuster Drugs for Ulcers: Prilosec, Nexium, and Other Proton-Pump Inhibitors
Authors: Li Jie Jack
Published: November 2020

In the first half of the 19th century, British physician William Prout conclusively showed that gastric juice contains hydrochloric acid. U.S. Army officer William Beaumont examined the physiological control mechanism of gastric acid secretion by studying Alexis St. Martin’s chronic gastric fistula that had resulted from a gunshot wound in the 1820s. Gastric acid is essential to digest protein and emulsify fats. It breaks down food so it can go on to the small intestine where nutrients are absorbed. Low levels of gastric acid can contribute to a myriad of discomforts and diseases. On the other hand, too much of a good thing is bad. High levels of gastric acid often result in heartburn and ulcers. Heartburn is a symptom produced by reflux when digesting food and gastric acid passes back up into the esophagus through the sphincter muscle at the top of the stomach. It is also known as GERD, for gastroesophageal reflux disease. If reflux occurs often and the body fails to sufficiently clear the acidic mixture back into the stomach, the tissue of the esophagus can be damaged, and that is when ulcers develop. Forty million Americans experience heartburn two days a week, and 60 million have it at least once a month. The disorder costs an estimated $10 billion in the United States, counting visits to doctors and hospitals, medications, and time lost from work, according to the American Gastroenterology Association. Before the emergence of Tagamet and Zantac as H2 histamine-receptor blockers for the treatment of heartburn and ulcers, numerous medicines were available, but none were satisfactory. For over a century, heartburn sufferers had been taking over-the-counter (OTC) antacid products such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Tums. Most of them contain simple inorganic bases as the principal active ingredients. Americans alone spend approximately $1 billion a year on these antacids, which bring relief within minutes and work by neutralizing the stomach acid that causes heartburn.
Antihistamines as Allergy Drugs
Authors: Li Jie Jack
Published: November 2020

Most blockbusters have at least one thing in common—they are all widely prescribed to treat common illnesses such as hypertension, high cholesterol, pain, ulcers, and depression. Allergies are another malady that afflicts more and more Americans. To many, allergies are no longer an inconvenience but a major annoyance with constant sneezing and itching. For them, an allergy medicine is often needed to relieve the symptoms. As a consequence, many antihistamine allergy drugs, especially nonsedating antihistamines, have become blockbuster drugs. Allergies are the sixth leading cause of chronic illness in the United States. More than 50 million Americans have allergies and spend in excess of $18 billion a year on medical treatment. The word allergy was coined by Austrian pediatrician Clemens von Pirquet in 1906. According to his definition, allergy was manifest in cases of serum sickness, hay fever, sensitivities to mosquito bites and beestings, and various idiosyncratic food reactions, as well as in individuals who had been exposed to, or successfully immunized against, common infectious diseases such as diphtheria and tuberculosis. Today, the word allergy is broadly associated with allergic rhinitis, asthma, hay fever, and food allergies. Allergies are the malady of civilization. In ancient times, allergies like hay fever and food allergies were virtually nonexistent. The first report of a case of allergy did not appear until the 1870s in Europe. The beginning of the 20th century saw a sharp rise in allergies. Nowadays, hay fever is so prevalent in the United Kingdom, that there are 1.4 to 1.8 million students who are drowsy from taking antihistamines. U.K. educational authorities even schedule the exams away from the peak of pollen season. In the United States, hay fever is the number-one chronic disease. Until we learn how to turn off the genes responsible for hay fever and asthma, these afflictions will remain among the most irritating of our existence. During evolution, humans developed the immune system to fight the real danger of foreign invaders like bacteria and viruses. It turns out that the human body has two types of responses toward tissue damage or infection.
Conquest of Pain: Analgesics: From Morphine to Lyrica
Authors: Li Jie Jack
Published: November 2020

To live is to endure pain has been understood by almost everybody who is mature enough to gain some philosophical perspective on life. C’est la vie! as the French would say. Indeed, pain existed before the dawn of humanity—some research suggests that even plants respond to pain. According to ancient Greek myth, Prometheus stole fire from Olympus to give it to mortals. Zeus punished him by chaining him to a rock and having a great eagle feast on his liver daily, inflicting unbearable agony. Zeus also sent Pandora to Earth, unleashing pain (one of the items in Pandora’s box) and many evils as a vengeance to mankind. Without an understanding of pain, our ancestors resorted to many measures to ease pain; some were successful to some extent, and some were completely futile. Witches and shamans were sought out to exorcise pain from the body. From a psychological perspective, they might be effective for some believers. The hypnotizing technique reached its crescendo in the 18th century in France when Monsieur Anton Mesmer “mesmerized” many French citizens, liberating them from their pains. As civilization progressed, alcohol became more and more a universal painkiller after it was observed that drunkards were oblivious to pain. Chinese surgeon Hua Tuo (115–205 ad) gave his patients an effervescent powder (possibly cannabis) in wine that produced numbness and insensibility before surgical operations. Another ancient invention in Chinese medicine was the use of acupuncture to ease pain. Acupuncture, now an increasingly popular treatment for persistent as well as intermittent pain, is thought to work by increasing the release of endorphins, chemicals that block pain signals from reaching the brain. A recent survey by the National Institute of Health (NIH) indicated that acupuncture showed efficacy in adult postoperative pain, chemotherapy nausea and vomiting, and postoperative dental pain. There is no doubt that acupuncture works for some patients’ minor pain, through either physiological or psychological means, or both. or both. During the hype of the Great Culture Revolution (1966–1976), it was even claimed that major operations were carried out using acupuncture without any other anesthetics.
Reflections
Authors: Li Jie Jack
Published: November 2020

Most blockbusters have at least one thing in common—they are widely prescribed to treat a common illness, such as hypertension, high cholesterol, pain, ulcers, allergies, and depression. The larger the potential patient population, the higher the likelihood for a drug to become a blockbuster. Obviously, the drug has to be effective. If it does not work, or works only marginally, the average patient is not going to be enthusiastic about taking it. However, efficacy alone is not good enough. For instance, the old tricyclic antidepressants worked if patients finished the full course of treatment. Unfortunately, they were nonselective, hitting many targets. As a consequence, they were so toxic and replete with side effects that only a fraction of patients (less than 20 percent) were able to tolerate them until completion of a treatment course. In contrast, the newer selective serotonin reuptake inhibitors (SSRIs) are more selective and thus possess fewer side effects. As a result, SSRIs like Prozac, Zoloft, Paxil, Wellbutrin, and revolutionized the treatment of depression. Similarly, atypical antipsychotics such as Zyprexa, Geodon, and others Abilify helped schizophrenia patients tremendously. These drugs transformed debilitating diseases into treatable chronic illnesses. Most psychiatric patients these days do not need to be institutionalized as they were half a century ago. A drug with good efficacy and a high safety profile treating a widespread disease does not necessarily sell itself, however. Direct advertisements to consumers and a strong sales force are essential to create and sustain the popularity of a drug. Blockbuster drugs save lives and support a vibrant pharmaceutical industry. What do we, as a society, do to ensure their sustainability? While realizing that there is no single prescription for this problem, one could certainly begin by talking about patent reform. The current patent system is antiquated as far as innovative drugs are concerned. Decades ago, 17 years of patent life was somewhat adequate for drug companies to recoup their investments in R&D because the life cycle from discovery to marketing at the time was relatively short and the cost was lower. Today’s drug R&D is a completely new ball game.
Marie Maynard Daly
Authors: Brown Jeannette
Published: November 2020

Dr. Marie Maynard Daly was the first African American woman chemist to receive a PhD in chemistry. In addition, she was part of a research team that was working on the precursors to DNA . Marie was born Marie Maynard Daly on April 16, 1921, to Ivan C. Daly and Helen Page, the first of three children. Her father, who had emigrated from the West Indies, received a scholarship from Cornell University to study chemistry; however, he had to drop out because he could not pay his room and board, and he became a postal worker. Daly’s interest in science came from her father’s encouragement and the desire to live his dream.” He later encouraged his daughter to pursue his dream, even though she was a woman and had brothers who were twins. In the 1920s, as a result of the women’s suffrage movement, some women began to aspire to achievement in areas outside the domestic sphere. Marie’s mother encouraged reading and spent many hours reading to her and her brothers. Marie’s maternal grandfather had an extensive library, including books about scientists, such as The Microbe Hunters by Paul De Kruff; she read that book and many others like it. Growing up in Queens, one of the boroughs of New York City, she attended the local public school, where she excelled. She was able to attend Hunter College High School, an all girls’ school affiliated with Hunter College for women. Since this was a laboratory school for Hunter College, the faculty encouraged the girls to excel in their studies. Since Marie had an aptitude for science, the teachers there encouraged her to study college-level chemistry while still in high school. One of the many advantages of living in New York City during that time was that students who had good grades could enter one of the tuition-free colleges run by the City of New York. As a result, Daly enrolled in Queens College, then one of the newest institutions in the City College system, in Flushing, New York.
The Posterior Pituitary and Water Metabolism
Authors: Samson Willis K.
Published: November 2020

The neurohypophysis, also called the posterior pituitary or neural lobe , is the ventral extension of hypothalamic tissue derived from a developmental down growth of the neuroectoderm forming the floor of the third cerebroventricle. It weighs approximately 0.10–0.15 g in humans and is well developed at birth, having been present since the fifth month of intrauterine life. In addition to containing glial elements called pituicytes, the posterior pituitary is composed of unmyelinated nerve fibers and axon terminals of neurons whose cell bodies reside primarily in the supraoptic and paraventricular hypothalamic nuclei. These hypothalamo-neurohypophyseal fibers deliver the two primary posterior pituitary hormones, oxytocin (OT) and arginine vasopressin (AVP), to the neural lobe in association with specific proteins, the neurophysins, once thought to be carrier proteins but now known to be portions of the OT and AVP precursor molecules. The neurons produce either OT or AVP, and under some circumstances both, and recent studies indicate that in addition to one of these two hormones, other neuropeptides, such as corticotropin-releasing hormone (CRH) and nesfatin-1, and neurotransmitters are also produced in OT- or AVP-containing cells. The phenomenon of colocalization of neuromodulatory agents has aroused a great deal of clinical interest in the role of neuropeptides such as OT and AVP in brain function. Both OT- and AVP-containing nerve fibers, originating in the supraoptic and paraventricular nuclei, project to a variety of other brain structures that are thought to be the sites of their observed central nervous system actions, and to the vicinity of the hypophyseal portal vessels in the median eminence. Release from these fibers of both OT and AVP explains the high levels of these hormones in portal blood and provides the framework for the actions of OT and AVP as modulators of anterior pituitary function. The arterial blood supply of the posterior pituitary is via the inferior (and to some degree the superior) hypophyseal arteries, which originate from the cavernous and postclinoid portions of the internal carotid artery.
Forehead, Eyebrows, Eyelids, And Canthi
Authors: Jordan David , Mawn Louise , Anderson Richard L.
Published: November 2020

Numerous oculoplastic surgical procedures are performed on the forehead, eyebrows, eyelids, and canthi. An understanding of the anatomy of these structures, as well as of the nearby temporal artery and facial nerve, is essential for the surgeon working in this region. In this chapter, the surface anatomy is described first, followed by a more detailed description of the tissue beneath. The skin of the forehead and cranium, or the “scalp,” is traditionally considered as five layers (Fig. 1-1): skin, subcutaneous tissue, galea aponeurosis, loose areolar tissue, and periosteum. These layers are present consistently throughout the head, with some slight modifications in certain areas (e.g., the brow area). These layers can be easily remembered with the mnemonic “SCALP” (S = skin, C = subcutaneous tissue, A = galea aponeurotica, L = loose areolar tissue, P = pericranium). The skin of the forehead and temporal region is usually relatively thick and rich in sebaceous glands. However, in some elderly individuals the skin of the temporal forehead can be quite thin and consequently requires a greater degree of care during surgical procedures (e.g., endobrow lift ) and resurfacing (e.g., laser or chemical). Although the eyebrows are technically part of the scalp rather than of the eyelids, they have important functional and surgical relationships to the lids. The eyebrows lie at the junction between the upper eyelids and the forehead. They lie over each superior orbital rim, are separated by the glabella, and are formed by thick, strong, skin-bearing hairs. The underlying muscle fibers, with their cutaneous insertions, move the brows freely over a suborbicularis fat pad adjacent to the underlying periosteum. Each brow has a head, a body, and a tail. The head lies between the supraorbital ridge and the orbital margin, overlying the frontal sinus. The medial brow hairs are almost vertical; the body of the brow follows the supraorbital margin and has hair in a more horizontal direction.
The Extraocular Muscles
Authors: Jordan David , Mawn Louise , Anderson Richard L.
Published: November 2020

Whereas skeletal muscles generally perform specific limited roles, extraocular muscles (EOMs) have to be responsive over a wider dynamic range. As a result, EOMs have fundamentally distinct structural, functional, biochemical, and immunological properties as compared to other skeletal muscles.
At birth, the extraocular muscles are at approximately 50 % to 60 % of their final dimension. Their relative growth within the enlarging orbit and their angular relations with the globe remain nearly constant from infancy to adulthood. The adult rectus muscles are approximately the same length (40 mm) but differ in thickness and in the length of their tendons. There are six extrinsic, or extraocular, muscles of the eye: four recti and two obliques. Only the horizontal and vertical recti insert on the eyeball in front of its equator. Both obliques have their insertions behind the equator of the globe. All six muscles consist of striated muscle fibers with abundant elastic fibers. The EOMs have muscle fibers and innervations that differ from those of skeletal muscle. There are three distinct types of muscle fibers (fine, granular, and coarse) that contribute to the action of the EOMs. The fine fibers are thought to be responsible for slow twitch movements, the granular fibers for fast twitch movements, and the coarse fibers for slow tonic movements. The EOMs are more richly innervated than other voluntary muscles of the body and have three types of nerve terminals: single endplate (driving eye movements), multiple endplates (tonic tension), and palisade endings (can be sensory receptors). In addition, there are both singly and multiply innervated nerve fibers present. EOMs are able to vary their contractile force by small increments. The maximum firing frequency of ocular motor units is about four times greater than those of limb muscle motor units. To allow them to operate at a higher frequency, EOMs also have faster contractile properties, with their time to peak tension and their one-half relaxation time being at least half of those in limb muscles.
Causal Thinking in Developmental Disorders
Authors: Costello E. Jane , Angold Adrian
Published: November 2020

In this chapter we (1) lay out a definition of development as it relates to psychopathology; (2) make the case that nearly all psychiatric disorders are ‘‘developmental’’; and (3) examine, with some illustrations, methods from developmental research that can help to identify causal mechanisms leading to mental illness. The philosopher Ernst Nagel (1957, p. 15) defined development in a way that links it to both benign and pathological outcomes: . . . The concept of development involves two essential components: the notion of a system possessing a definite structure and a definite set of pre-existing capacities; and the notion of a sequential set of changes in the system, yielding relatively permanent but novel increments not only in its structure but in its modes of operation. . . . As summarized by Leon Eisenberg (1977, p. 220), "the process of development is the crucial link between genetic determinants and environmental variables, between individual psychology and sociology." It is characteristic of such systems that they consist of feedback and feedforward loops of varying complexity. Organism and environment are mutually constraining, however, with the result that developmental pathways show relatively high levels of canalization (Angoff, 1988; Cairns, Gariépy, & Hood, 1990; Gottlieb & Willoughby, 2006; Greenough, 1991; McGue, 1989; Plomin, DeFries, & Loehlin, 1977; Scarr & McCartney, 1983). Like individual ‘‘normal’’ development, diseases have inherent developmental processes of their own—processes that obey certain laws and follow certain stages even as they destroy the individual in whom they develop (Hay & Angold, 1993). A developmental approach to disease asks what happens when developmental processes embodied in pathogenesis collide with the process of ‘‘normal’’ human development. The progression seen in chronic diseases (among which we categorize most psychiatric disorders) has much in common with this view of development. It is "structured" by the nature of the transformation of the organism that begins the process, and in general, it follows a reasonably regular course, although with wide variations in rate.
Unstable
Authors: Hoffmann Roald
Published: November 2020

Words are our enemies, words are our friends. In science, we think that words are just an expedient for describing some inner truth, one that is perhaps ideally represented by a mathematical equation. Oh, the words matter, but they are not essential for science. We might admit there is a real question as to whether a poem is translatable, but we argue that it is irrelevant whether the directions for the synthesis of a molecule are in Japanese or Arabic or English—if the synthesis is described in sufficient detail, the same molecule will come out of the pot in any laboratory in the world. Yet words are all we have, and all our precious ideas must be described in these history- and value-laden signifiers. Furthermore, most productive discussion in science takes place on the colloquial level, in simple conversation. Even if we know that a concept signaled by a word has a carefully defined and circumscribed meaning, we may still use that word colloquially. In fact, the more important the argument is to us, the more we want to be convincing, the more likely we are to use simple words. Those words, even more than technical terms, are unconsciously shaped by our experience—which may not be the experience of others. I was led to reflect on this by the reaction of a friend of mine, a physicist, to my use of the word “stable.” I had said that an as yet unmade form of carbon was unstable with respect to diamond or graphite by some large amount of energy. Still, I thought it could be made. My friend said, “Why bother thinking about it at all, if it’s unstable?” I said, “Why not?,” and there we were off arguing. Perhaps we should have pondered why the simple English word “stable” has different meanings for a physicist and a chemist. First, a little background. Diamond and graphite are the two well-known modifications, or allotropes, of carbon.
Narrative
Authors: Hoffmann Roald
Published: November 2020

What does a political campaign have to do with tetrahedrane, a beautiful yet unstable hydrocarbon with four CH groups at the corners of a tetrahedron? Just look and listen (you’ll have a hard time not doing so) to the onslaught of masterfully crafted oversimplifications thrown at you in any campaign, by all the parties. And think about why people—no, not you, of course—succumb to it. It has something to do with the reasons why we lust for the elegantly simple molecule in the shape of a Platonic solid or the beautiful (and preferably, soluble) equation. I want to think about what gives us satisfaction in science when simplicity fails us, as it must, in a real world. If one can make any generalization about the human mind, it is that it craves simple answers. The ideology of the simple reigns in science, as it does in politics. So we have the romantic dreams of theoreticians (for example, Dirac) preferring simple and/or beautiful equations. And the moment Richard Smalley, Harold Kroto, Robert Curl and their coworkers intuited that the C60 peak in their laser-ablated carbon mass spectrum came from a molecule that should grace the flag of Brazil, I believed it. It could not be otherwise. And they were right. Simplicity, symmetry, and order ride a straight ray into our souls. I wonder why? Perhaps (this is far out) we have evolved a psychobiological predilection for the qualities of the world that rationalize our existence as locally contraentropic creatures that build molecules and poems. And I am a little unfair to the creative force implicit in the psychological imperative for the simple. The cult of mathematical simplicity as beauty is a reaching for essences that parallels the compact truthtelling of poetry. This is what Dalton, Dirac, and Einstein aspired to. And this perspective has led to “the majesty, subtlety, and grace of science, and her deepest insights and discoveries,” as Michael Fisher so aptly put it. But what if the world is determined by us, by scientific us, to be complex, unsymmetrical, and moderately chaotic? How do we find satisfaction, and I do mean psychological satisfaction, in such a world? I think the answer is simple (I’m smiling).
Representation in Chemistry
Authors: Hoffmann Roald , Laszlo Pierre
Published: November 2020

Chemical structures are among the trademarks of our profession, as surely chemical as flasks, beakers, and distillation columns. When someone sees one of us busily scribbling formulas or structures, he has no trouble identifying a chemist. Yet these familiar objects, which accompany our work from start to end, from the initial doodlings to the final polished artwork in a publication, are deceptively simple. They raise interesting and difficult questions about representation. It is the intent of this article to reflect upon molecular graphics. We are hooked on these little diagrams, aren’t we? Yet what are they? Are they representations of reality, just a simplified two-dimensional version of the models that can be built from interpretation of X-ray diffraction patterns of a molecular crystal—in a word, are they realistic? A look at a few papers by others (not ours or yours, of course) will show how far short of realism these structures fall. They mix convention and realism in the most innocent manner. Take the case of the bicyclo[2.2.1]heptane skeleton: This commonly seen, supposedly three-dimensional representation actually sports an inverted perspective, the vanishing point being not in back, where it should be, but on the viewer’s side. Most chemical drawings eschew obvious primitive artistic stratagems for communicating three-dimensionality; they float in a world of their own. Perhaps they are “art,” then, an abstraction from reality of the essence of norbornanes. If so, it’s interesting to reflect on what kind of art they are. This is part of what we will do. Perhaps chemical drawings do not need to be realistic representations because they are symbols, signs that in a chemist’s mind are reconstructed into the three-dimensional structure, or at least the ball-and-stick model. Chemical structures are then part of a chemical language. What is interesting about language (it doesn’t matter whether it is German or English or . . . ) is that (1) despite its impreciseness, people communicate with it and (2) it, language, inevitably brings us complications, ambiguities, and richnesses that we did not expect.
The Metaphor, Unchained
Authors: Hoffmann Roald
Published: November 2020

Scientists write, first of all for other scientists. It’s not publish or perish, but rather that an open system of communication, a commitment (shading to an addiction) to telling others what you have done, is essential to the functioning of science. The primary medium of communication in the profession is the peer-reviewed article. This, our stock in trade, has a ritual format with strong historical roots. Once more diverse, the language of published articles is now 85 percent English, or an approximation thereto. Declining mastery of language aside, it’s probably okay for most papers to be written in a bare style, for the vast majority of more than 500,000 articles published in chemistry and related fields last year is highly specialized (and routine) science. I do wonder about the collective effect of so much stylistically undistinguished writing. Is more harm done by selling lesser science through good style (I’m not talking about hype), or by poor writing pulling down sound science? A second intersection of science and writing reaches out to nonspecialists. Here we have science journalism and the popularization of science. The best examples shape a genre onto itself. Some are authored by writers, by journalists or historians, and are just superb, as in K. C. Cole’s tours through higher dimensions. But let me focus on practicing scientists who write in this mode. I would claim that when scientists themselves write for a general audience, their research is likely to improve. Why? Because writing sets free the oft-suppressed metaphor. Paragons among the kind of general-audience books I have in mind are those of Oliver Sacks, Carl Sagan, George Klein, and Jacques Monod, all of whom are (or were) both distinguished scientists and gift ed authors. In their volumes, stories of science are told in a strong narrative vein. In some, a philosophical framework is explicit; in others it remains for us to find. Such books have recently won Pulitzer Prizes, National Book Awards and their worldwide equivalents. This recognition is something new in letters, and well-deserved. Another facet of the genre is made up of articles written by scientists who lay out their research in popular terms.
Some Heretical Thoughts on What Our Students Are Telling Us
Authors: Hoffmann Roald , Coppola Brian P .
Published: November 2020

There is a time, twice a year, when those of us who teach introductory courses sit down in a comfortable chair, pour ourselves a middling portion of single malt Scotch whisky, and begin to read the comments that students write about our teaching. For the overall ratings, numerical in nature, we can bear to wait—the computer will dutifully compile these single point undifferentiating indicators. What we settle down to read are the “free-style comments,” where the students are encouraged to write (anonymously, of course) what they think of the book, the exams, and, of course, of the lecturer. Many, not all, universities give students the opportunity to express themselves in this way. Some of us have learned to avoid asking silly questions with predictable responses, such as “What is the best part of the course?” So we sit down, perhaps turning on some Chopin to complement the whisky, and face those student responses. Many are positive, as (with a trace of mild astonishment) “I didn’t think I’d like chemistry, but Prof. Coppola made it fun!,” “I actually enjoyed going to the lectures,” or “I didn’t get a very good grade, but I sure learned a lot.” It’s not always easy for a student (or us) to say a word of praise, to give thanks graciously harder still. Positive feelings generally wash over us leaving small marks. Happiness is often diffuse. But pain is sharp—the small pain of a torn cuticle, the stronger incapacitating pain of a broken bone. Or, negating the validity of the familiar litany “sticks and stones . . . ” the mental anguish of reading an evaluation such as “Prof. Hoffmann spends all his time on digressions, relating chemistry to politics, history, God knows what else. Who cares how hemoglobin or catalytic converters work? I want to know what’s on the MCATs.” Or “I got an A by memorizing equations and doing exam problems that were exactly like the problems that I had seen on the previous tests . . . ” Or, “As far as I am concerned I did not need to go to class.”
Best Synthetic Methods: Functional Group Protection
Authors: Taber Douglass
Published: November 2020

Benzyl esters are easily deprotected by hydrogenolysis. It is often observed, however, as exempliﬁed by the conversion of 1 to 2 reported (Adv. Synth. Catal. 2008, 350, 406) by Hironao Sajiki of Gifu Pharmacutical University, that alkene hydrogenation can be carried out selectively. Fernando Albericio of the University of Barcelona has developed (Tetrahedron Lett. 2008, 49, 3304) a family of thiophene-based esters 3 that can be removed with acid in the presence of t-butyl esters, and that are stable to the removal of FMOC groups. Vassiliki Theodorou of the University of Ioannina has found (Tetrahedron Lett. 2008, 49, 8230) that esters were rapidly saponiﬁed by methanolic NaOH in solvent CH2Cl2. Specific oligosaccharide synthesis depends heavily on the use of orthogonal methods for alcohol protection and deprotection. This is illustrated by the work (J. Org. Chem. 2008, 73, 1008) of Carolyn R. Bertozzi of the University of California, Berkeley, who deployed p-methoxybenzyl (PMB), 3,4-dimethoxybenzyl (DMB), p-chlorobenzyl (PCB) and p-iodobenzyl (PIB) ethers to enable construction of a disaccharide, by way of 9. Piers R. J. Gaffney of Imperial College London has reported (Tetrahedron Lett. 2008, 49, 1836) a practical preparation of the ether 11, that should make this symmetrical protecting group more readily available. George W. J. Fleet of the University of Oxford and Sigthur Petursson of the University of Akureyri have found (Tetrahedron Lett. 2008, 49, 2196) that diphenyl diazomethane 14, easily prepared from benzophenone, reacted under neutral conditions with primary, secondary and tertiary alcohols to form the benzyhydryl ethers. Harsh conditions have often been employed to remove aryl methyl ethers such as 16. Wei Wang of the University of New Mexico and Wenhu Duan of the Shanghai Institute of Materia Medica have developed (Tetrahedron Lett. 2008, 49, 4054) a simple protocol to effect this transformation, by heating the ether to reflux in DMF in the presence of iodocyclohexane 17. Dithianes such as 19 have often been deprotected with stoichiometric heavy metals. Andreas Kirschning of Leibniz Universität Hannover has devised (J. Org. Chem. 2008, 73, 2018) a set of three anionic resins, charged, respectively, with I(O2CCF3 )2 - , HCO3 -, and S2O3 - . Exposure of 19 to the three resins in sequence delivered the very sensitive ketone 20.