bluuebunny/crossref_metadata_2025 huggingface dataset:
Microstructure, static and fatigue properties of refill friction stir spot welded 7075-T6 aluminium alloy using a modified tool
Authors: Shen Z. , Ding Y. , Chen J. , Fu L. , Liu X. C. , Chen H. , Guo W. , Gerlich A. P.
Published: February 2019

Defect-free joints were produced in 2.0 mm thick 7075-T6 Al alloy by refill friction stir spot welding using a modified tool. Weld performance was evaluated in terms of microstructure, interfacial bonding, hardness, static and fatigue strength based on the experimental observations. The results indicated that grain size, interfacial bonding quality and lap shear strength significantly depend on sleeve penetration depth (SPD), with sufficient interfacial bonding and stable lap shear strength achieved when SPD ≥ 1.8 mm. The SPD and applied load played a dominant role in determining the static lap shear and fatigue failure mechanisms, respectively. More precisely, the lap shear failure mode was an interfacial failure when SPD ≤ 1.8 mm, and nugget pullout when SPD ≥ 2.0 mm. The fatigue fracture mode involved nugget pullout under high applied load, while fracture through the parent sheet occurs under medium and lower applied loads.
Posttraumatic Stress Disorder
Authors: North Carol S. , Yutzy Sean H.
Published: January 2019

Posttraumatic stress disorder (PTSD) is a disorder that can emerge after exposure to an extreme traumatic stressor involving actual or threatened death or serious injury. PTSD has not been demonstrated to represent a unified construct such as that established for other validated psychiatric disorders identified in this text, but a developing knowledge base for PTSD is promising for future validation of this diagnosis. PTSD is an unusual diagnosis because of the conditional nature of this disorder that requires exposure to a traumatic event for consideration of the diagnosis. Individuals who have not been exposed to a traumatic event cannot meet criteria for PTSD. This feature of PTSD has created difficulties in applying this diagnosis in both clinical and research settings.
Obsessive-Compulsive Disorder
Authors: North Carol S. , Yutzy Sean H.
Published: January 2019

Obsessions are persistent distressing thoughts, images, or impulses experienced as unwanted and senseless but irresistible. Compulsions are repetitive behaviors aimed to prevent or reduce anxiety or distress but not to provide pleasure or gratification. Obsessive-compulsive disorder (OCD) is a chronic illness dominated by obsessions and compulsions. Common presenting complaints are obsessional fears of contamination or injuring oneself or another person, often a child or close relative. Fearful of losing control, these patients may develop avoidances or rituals that lead in turn to social incapacity. They may refuse to leave the house and may avoid sharp objects or wash repeatedly. When medical attention is finally sought for OCD—often years after the illness began—it may be because of depression, acute anxiety, exacerbation of obsessions, or social incapacity resulting from any of these conditions.
Stress Cardiac Magnetic Resonance Imaging
Authors: Yoon Yeonyee E. , Wann L. Samuel
Published: January 2019

The chapter Stress Cardiac Magnetic Resonance Imaging reviews how cardiovascular magnetic resonance imaging (CMR) has become a gold standard for evaluating stress induced wall motion abnormalities based on regional endocardial excursion and myocardial thickening. The high spatial and temporal resolution of CMR without limitations imposed by body habitus and acoustic windows allows outstanding visualization of myocardial function. CMR can also be combined with vasodilator stress to perform dynamic first-pass myocardial perfusion imaging. The addition of late gadolinium enhancement allows the accurate of nonviable scar tissue in combination with wall motion and myocardial perfusion assessment. Case studies highlight the opportunity provided by stress CMR.
Combining Coronary Artery Calcium Scanning and Treadmill Exercise in the Assessment of Coronary Artery Disease
Authors: Adams James R.
Published: January 2019

Coronary calcium scoring (CAC) by noncontrast computed tomography is a powerful predictor of coronary artery disease (CAD) prognosis. Exercise testing is a powerful predictor of CAD severe enough to cause ischemia. Both tests predict CAD in a graded incremental fashion. The higher the CAC score, the greater than chance of a coronary event or all cause mortality. The greater the ST depression and the shorter the exercise duration of an exercise test, the greater the cardiac event rate. Both tests are inexpensive and provide incremental information. In 2013, Alan Rozanski and colleagues suggested combining the tests, calling it a “Treadmill Calcium Test.” Such a test can inform the patient and physician with a measure of atherosclerosis with CAC and a measure of ischemia and fitness with an exercise test. CAC can also provide incremental information when combined with an exercise imaging study such as myocardial perfusion imaging or stress echocardiography.
Cardiopulmonary Exercise Testing
Authors: Kao Andrew
Published: January 2019

The chapter Cardiopulmonary Exercise Testing focuses on the opportunities provided by cardiopulmonary exercise (CPX) testing. The coordination of 5 organ systems is described in normal exercise physiology to understand abnormal exercise findings. From a few measured expired gas analysis parameters, most of the important exercise variables can be derived, including the peak oxygen consumption (peak VO2). The contribution of both the aerobic and anaerobic phases of exercise to total exercise capacity are described, including the methods for determination of the anaerobic threshold. The calculation of the normative values of peak VO2 are included, and a suggested template of a CPX report is included. The use of CPX testing in the determination of prognosis in heart failure patients is included.
Craniosynostosis Syndromes
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses craniosynostosis syndromes and includes discussion on Apert syndrome, Pfeiffer syndrome, Antley-Bixler syndrome, Saethre-Chotzen syndrome, Baller-Gerold syndrome, Carpenter syndrome, Muenke syndrome, and bent bone dysplasia-FGFR2 type. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Spondylocostal Dysostoses
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses spondylocostal dysostoses. The discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Gilles de la Tourette the Poet?
Authors: Walusinski Olivier
Published: January 2019

This chapter focuses on Georges Gilles de la Tourette’s poetical pursuits. A man of many talents, these poems provide insight into yet another facet of Gilles de la Tourette’s personality. As well, they may provide some clue to his mental state as he suffered from the long-term effects of syphilis. It is difficult to know whether these poems should be taken as initial signs of Gilles de la Tourette’s disease or whether they are a simple manifestation of his imagination and the pleasure he took in writing. His poetry can be found at the family archive in Loundun.
Recapitulative List of All Gilles de la Tourette’s Publications
Authors: Walusinski Olivier
Published: January 2019

Gilles de la Tourette was a prolific author from the time he started his medical studies; he published his first article in 1881. All of his publications are listed here, in chronological order, including the list of his books and journal articles. Also listed are theses he inspired as well as his article co-authors. The most important texts are analyzed, notably his book, Les états neurasthéniques, which includes a description of restless legs syndrome; “Benedikt syndrome,” co-authored with Jean-Baptiste Charcot, which is placed within the historical context of the condition’s isolation; Le traitement pratique de l’épilepsie, in which Gilles de la Tourette improved treatment by specifying the effective dose of bromide; and the debate between Babiński and Gilles de la Tourette that took place at a 1900 session of the Société de neurologie and pertained to the specificity of the Babiński sign.
Congenital Heart Disease Considerations
Authors: Williams Feifei Z. , Wolf Michael J.
Published: January 2019

Children with congenital heart disease (CHD) are at an increased risk for sedation-related complications. The number of these patients with unrepaired or palliated disease requiring procedural sedation outside of the operating room continues to increase as staged surgeries and techniques are associated with better survival. CHD patient characteristics associated with the highest risk of sedation-related complications include age less than 2 years; single-ventricle physiology, including hypoplastic left heart syndrome; left ventricular outflow tract obstruction; cardiomyopathy with impaired ventricular function; and pulmonary hypertension. Before sedating a child with CHD, providers must recognize the anatomic variations, surgical history, and physiologic implications for each individual patient. An understanding of the hemodynamic principles involved in managing intracardiac shunts is essential. Commonly used sedation medications in patients with CHD and their potential adverse effects are discussed, as well as presedation and postsedation considerations.
Monitoring
Authors: Reilly Lorie
Published: January 2019

Recovery from sedation is a dynamic, multiphase process that warrants attentive monitoring by a team of knowledgeable, skillful providers. In addition to automated monitor interpretation and documentation, the team caring for the patient from the immediate postsedation phase through discharge to home or transfer back to the inpatient unit must be knowledgeable about the patient and comorbidities, the procedure just completed, the pharmacologic properties of the sedation regimen employed, and the adverse events that may occur as recovery unfolds, and they must have the necessary skills to navigate and rescue the patient from any such adverse events. Availability of basic and advanced airway equipment, reversal medications, and intravenous fluids is critical. Direct observation with attention to level of consciousness, cardiorespiratory status, temperature, and pain status is required. Monitoring must continue until the patient returns to the presedation baseline state prior to discharge. Written instructions and verbal, interpersonal communication with caregivers are essential to the conclusion of sedation recovery monitoring.
Risks of Sedation
Authors: Chin Peter A. , Walls Sara
Published: January 2019

This section summarizes the risks and complications of sedation. Topics include what should be discussed with parents when obtaining consent. The sedation plan should be discussed with parents during the consent process. “Material” risks should be disclosed, including both minor but frequent events such as nausea, and rare but severe complications such as cardiac arrest. Limits of sedation should also be discussed. Written consent should be documented in an anesthesia (or sedation)-specific consent form. This section also includes the topic of anesthesia- and sedation-related neurotoxicity. Data from animal and human studies are reviewed, with emphasis on larger human studies either recently completed or underway.
Procedural Aspects Affecting Sedation Care
Authors: Fugok Kimberly , Kost Susanne
Published: January 2019

Appropriately skilled personnel, equipment, and organized space should be in place prior to the initiation of a sedated procedure. The use of procedural carts or kits for commonly performed procedures can increase safety and efficiency. The intended level of sedation should be appropriate for the procedure, with the understanding that not every procedural situation is predictable. In the setting of a sedation service, matching provider level to sedation level can improve the efficiency of the service. In settings where sedationist and proceduralist are one and the same, the presence of another clinician dedicated solely to monitoring the patient and assisting in rescue is essential. Preparation and organization of the sedation/procedural room, maximizing flow for the scheduled event, will expedite care. The personal safety of the sedation staff should be considered during the procedural event.
Nitrous Oxide
Authors: Zier Judith L. , Farrell MaryKay
Published: January 2019

Nitrous oxide is an inhaled sedative/analgesic with rapid onset and recovery, making it a useful agent for procedural sedation. Because of the anxiolysis, analgesia, and amnesia it provides, it is suitable as a single agent for distressing but mildly to moderately painful procedures. Combined use with opioids or benzodiazepines extends the utility to more painful procedures. Successful procedural sedation with nitrous oxide in children depends on effective distraction techniques and adequate topical and/or local anesthesia. Nausea and vomiting are the most common side effects. Avoiding administration to patients with known contraindications to nitrous oxide may avert other more serious side effects, such as expansion of trapped gas. Specialized equipment is required to blend nitrous oxide with oxygen and must include the ability to scavenge and remove nitrous oxide from the environment to minimize occupational exposure. Occupational exposure is also minimized through proper administration technique and equipment maintenance.
Anesthesiology: A Problem-Based Learning Approach
Authors: Anitescu Magdalena
Published: January 2019

Anesthesiology - A problem based learning discussion is a textbook which will give a comprehensive overview of general anesthesiology. The case based problem learning discussions allow for more interesting reading and possibly better retention of information. With progressive technology, advanced surgical procedures have been introduced, and confounding complications need to be anticipated and managed. Anesthetic technologies have also progressed and enhanced surgical advancements, This textbook will effectively address current surgical procedures and their anesthetic implications in evidence based learning approach. This textbook will undoubtedly be an asset to trainees, as well as practicing anesthesiologists.
Ruptured Abdominal Aortic Aneurysm—Open Abdominal Aortic Aneurysm Revisited
Authors: Bastien Alexandra , Tavarez Edwin
Published: January 2019

Abdominal aortic aneurysm ruptures are significant challenges to health care facilities and possess a high morbidity and mortality rate. The management of these patients requires well-coordinated efforts by health care providers. The decisions for management perioperatively are important for improved survival rates and diminished morbidities. The current approach for endoscopic repair has been shown to reduce morbidity and hospital stay, but not all abdominal aortic aneurysms can be approached endoscopically, and not all centers have the resources for this type of management. This chapter presents the case study of a 75-year-old male who presents to the emergency room complaining of abdominal and left groin pain.
Massive Transfusion
Authors: Berger Jay
Published: January 2019

Massive transfusion is defined as transfusion of 3 units of packed red blood cells in less than 1 hour in an adult, replacement of more than 1 blood volume in 24 hours, or replacement of more than 50% of blood volume in 3 hours. Massive transfusion protocols are implemented in cases of life-threatening hemorrhage after trauma, during a surgical procedure, or during childbirth. These protocols are intended to minimize the adverse effects of hypovolemia, dilutional anemia, metabolic complications, and coagulopathy with early empiric replacement of blood products and transfusion of fresh frozen plasma, platelets, and packed red blood cells in a composition that approximates that of whole blood.
Patient with Liver Failure Presenting for Transjugular Intrahepatic Portosystemic Shunt
Authors: Moguilevitch Marina
Published: January 2019

This chapter presents a case study of a 66-year-old man with a history of hepatitis C and cirrhosis complicated by intractable ascites who presents for an elective transjugular intrahepatic portosystemic shunt (TIPS) procedure. TIPS remains an important tool for the management of the complications of portal hypertension. Technical advances and clinical studies provide the evidence to define the best indications for the procedure. Patients who were successfully treated by TIPS still need regular follow up with a hepatologist. These patients remain at risk for development of other complications of cirrhosis such as hepatocellular carcinoma. This chapter discusses these issues and other concepts related to anesthetics for a liver transplant patient presenting for TIPS.
Rheumatoid Arthritis Patient Presenting for a Total Knee Replacement
Authors: Kothari Perin , Kolli Sree
Published: January 2019

Rheumatoid arthritis (RA) is a progressive connective tissue disorder. Patients with RA have several concerns relevant to the anesthesiologist. RA can affect multiple organ systems beyond simply the joints. A thorough history and physical is needed to evaluate for cardiac, respiratory, and neurologic abnormalities. Furthermore, cervical spine involvement is very common for patients with RA. Special consideration is needed for airway management of these patients. In addition, radiographic imaging may be helpful in evaluating the extent of the disease. Regional and neuraxial anesthesia may be alternatives to general anesthesia in patients with RA when possible. This chapter discusses preoperative assessment and intraoperative management of patients with RA.
Anesthesia in a Pregnant Patient Presenting for Urgent Nonobstetric Surgery
Authors: Bharadwaj Shobana , Galey Jessica
Published: January 2019

For obstetric patients undergoing nonobstetric surgeries, the anesthesiologist has to take into consideration both maternal and fetal safety during the pre-, intra-, and postoperative periods. The goal of the anesthetic management should be to apply maternal physiologic changes, avoid teratogenic agents, avoid decreased uteroplacental perfusion and/or fetal oxygenation, and prevent preterm labor. Decisions on the timing of the procedure and intraoperative fetal and uterine monitoring must be multidisciplinary. The chapter uses a case study of a 24-year-old woman who is admitted at 33 weeks gestation with nausea, vomiting, and right upper quadrant pain. Topics covered include teratogenicity, uteroplacental perfusion, and reversal agents.
Anesthetic Considerations in Patients with Automatic Implantable Cardio Defibrillator Presenting for Noncardiac Surgery
Authors: Khanna Sandeep , Sreedharan Roshni
Published: January 2019

Patients with automatic implantable cardioverter defibrillators commonly present for noncardiac surgery. It is imperative that anesthesiologists be aware of perioperative considerations in such patients. Preoperative evaluation includes determining indication for placement, date of last interrogation, pacemaker dependency, battery longevity, and magnet responses. Site of surgery and use of devices that generate EMI are also important for determining appropriate management strategy for such devices. If a cardiac implantable electronic device (CIED) team is available, it should be consulted for a perioperative plan. In this chapter a case study of a 60-year-old woman presenting for open radical abdominal hysterectomy in view of recently diagnosed endometrial cancer is used as an example.
NPO Guidelines
Authors: Mann Glenn , Liebling Dustin
Published: January 2019

Nil per os (NPO), a Latin term, that means “nothing by mouth” is used in medicine to describe the instruction to withhold fluids and solid foods from a person. Patients are kept NPO prior to a scheduled procedure in order to minimize the risk of emesis and pulmonary aspiration of gastric contents when placed under general anesthesia—the sequelae of which can have significant consequences on morbidity and mortality. The American Society of Anesthesiologists created practice guidelines for preoperative fasting that guides health care providers when a patient must abstain from drinking and eating prior to a procedure. NPO guidelines play a large role in the perioperative management of patients of all ages—from pediatrics to geriatrics—undergoing nonemergent procedures.
Integrative Nursing Management of Anxiety
Authors: Lusk Pamela , Kahn-John Michelle
Published: January 2019

Anxiety is a sense of perceived threat to one’s physical safety or emotional wellbeing, and symptoms are experienced in body, mind, and spirit. This chapter focuses on anxiety as a normal reaction to stressors—external, internal, or existential. Everyone experiences anxiety, both trait anxiety and state anxiety at multiple points in their lives; however, prolonged and severe symptoms of anxiety can evolve into a clinical form of anxiety, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder. This chapter reviews assessment of anxiety, including evidence-based screening measures and the patient-centered interview. Symptom identification and management incorporating integrative nursing principles are presented, including patient self-management strategies as well as provider-directed treatment options. In clinical decision-making for anxiety symptom management, concordance with the patient in establishing a treatment plan is emphasized. A case study highlights a patient-centered and culturally sensitive approach to the management of anxiety.
Integrative Nursing in Palliative Care and End-of-Life
Authors: Katseres Julie , Rosa William E.
Published: January 2019

Contrary to popular belief, palliative care, or hospice, is not withdrawing care but rather shifting the focus from curing disease and illness to a journey of living with disease/illness, optimizing quality of life, while at the same time finding value and meaning in the transitions toward conscious dying—guiding the sacred passage. The purpose of this chapter is to disarm the fear and discomfort around illness and death through exploring integrative nursing principles that guide palliative and end-of-life care and by reframing how care is delivered during these crucial moments, inviting an ethic of evolving human-centered care with nurse as the primary healing instrument.
Integrative Nursing Education
Authors: Koithan Mary , Miller Connie S. , Linck Raney
Published: January 2019

Integrative nursing provides an opportunity for the discipline to return to its roots, transforming curriculum and programmatic that reflects our beliefs and values while honoring current scope and standards of practice and clinical guidelines. The principles of integrative nursing calls us to consider our students as whole people who come into our academic settings with lives full of rich and varied experiences that provide both gifts and challenges as they complete their educational programs. They also call us to re-consider the nature of our classroom, how we create and nurture relationships with students, how we use teaching/learning and evaluation strategies to fit our outcomes, and how we instill the need to care for self while caring for others. This chapter is a call to action for educators across programs.
The Fragmented Personality
Authors: Svrakic Dragan M. , Jovanovic Mirjana Divac
Published: January 2019

This book pioneers a new model of personality disorder primarily intended to serve mental health professionals, those already in practice and equally those in training. In contrast to the static concepts of mental normalcy and pathology, the presented nosology is dynamic (accounts for the reversibility of mental functioning) and personalized, context- and time sensitive. In a 3D diagnostic cylinder, the coordinates cross match the person’s common level of mental functioning (vertical diagnosis) with his or her behavior style (horizontal diagnosis) at a point in space and a unit of time, giving the clinician precise milestones to monitor changes in diagnosis and progress in therapy. The central problem with persons suffering from personality disorder does not rest in their extreme behaviors but rather underneath the surface, in the fragmented substrate of personality (a core deficit sine qua non shared by all individual variants), while extreme behaviors merely represent variable compensatory strategies. Based on this model, mechanism-based treatments are outlined: reconstructive interpersonal psychotherapy (a novel, integrative, transtheoretical approach which relies on psychoanalytic and humanist traditions) and mechanism-based pharmacotherapy of neurobiological vulnerabilities associated with excessive temperament traits.
Surviving Vietnam
Authors: Dohrenwend Bruce P. , Turse Nick , Yager Thomas J. , Wall Melanie M.
Published: January 2019

Surviving Vietnam: Psychological Consequences of the War for U.S. Veterans presents a unique combination of historical material, military records of combat exposure, clinical diagnoses of post-traumatic stress disorder (PTSD), and interviews with representative samples of veterans surveyed both a little over decade after the war’s conclusion in the National Vietnam Veterans Readjustment Study (NVVRS), and again nearly four decades after the war’s conclusion in the National Vietnam Veterans Longitudinal Study (Longitudinal Study). It focuses specifically on veterans’ war-zone experiences and the development in some of PTSD, a relatively new and controversial diagnosis. The monograph begins with a brief history of the Vietnam war that provides context for the discussions of the relevance to their mental health outcomes of the severity of veterans’ exposure to combat, their personal involvement in harm to civilians and prisoners, their race/ethnicity, and their military assignments. It discusses nurses’ experiences in Vietnam and the psychological impact on families of veterans’ chronic war-related PTSD. The monograph then examines factors affecting surveyed veterans’ post-war readjustment, including the effects of changing public attitudes toward the war and the veterans’ own appraisals of the impact of the war on their lives after the war. It concludes by discussing the policy implications of its research findings.
The Meaninglessness of the Mean
Authors: Montgomery Erwin B.
Published: January 2019

The mean (average) or other central tendencies of a set of data is an internal construct that does not necessarily reflect reality. It is possible to determine the central tendency from any arbitrary collection of data as long as they vary on the same dimension. Even if applied to a relevant sample of data, the central tendency may be a poor reflection of data. A virtually infinite number of different collections of data may have the same central tendency and variance. This has very important implications when reasoning from studies reporting means and standard deviations. The same concerns apply to medians as the central tendencies and quartiles as the variability. When translating studies to the individual patient, the cumulative percentage (probability) function may be more helpful. There is a strong inclination to attribute some ontological status (reality) to measures of central tendency that can be misleading.
The False Notion of Intention, Choice, and Inhibition
Authors: Montgomery Erwin B.
Published: January 2019

A ubiquitous metaphysical presumption in medicine, particularly in neurology, derives from Aristotle’s notion of contraries. The variety within a domain of phenomena can be considered as some mixture of a few components. For example, a grayscale continuum is not an infinite number of shades of gray but rather varying mixtures of black and white. This metaphysical presupposition provides an enormous economization of principles critical to allopathic medicine and research. Epistemically and ontologically, this results in methodological, ontological, and theoretical reductionism. The presupposition leads to one-dimensional push–pull dynamics. In neurology, this metaphysical presupposition resulted in a notion of hierarchy in the physiology of the nervous system affected by inhibition. This led to notions of potentiality, intention, and choice creating problematic notions and misunderstandings. For example, the popular notion that the role of the frontal lobes prevents antisocial behavior, suggesting its potentiality, leaves unanswered the question of what is inhibited by the intact frontal lobe?
Consent to Treatment
Authors: Elliston Sarah
Published: January 2019

This chapter considers general principles of consent to treatment. The need to obtain valid consent is a fundamental principle of medical ethics and law. The law recognizes the individual’s right to autonomy, which includes protection of bodily integrity and freedom of choice. Failing to obtain a valid consent before providing treatment may have consequences in both criminal and civil law. It may, in addition, raise human rights issues. Any treatment given to a patient without consent—indeed, any touching of a patient—could result in the practitioner being sued or it may even lead to prosecution in sufficiently serious cases. It may also be a disciplinary matter for the General Medical Council or employers. There are special considerations where a person temporarily or permanently lacks capacity to consent to treatment. Consent also requires one to be sufficiently informed, and failure to provide adequate information can result in a negligence claim.
Organ Donation and Transplantation
Authors: Rigg Keith
Published: January 2019

The organ donation and transplantation sector in the UK has a comprehensive legal and regulatory framework, with some important differences between England, Scotland, Wales, and Northern Ireland. The Human Tissue Act 2004 and the Human Tissue (Scotland) Act 2006 are the key pieces of primary legislation, with the Human Tissue Authority being the regulatory authority. Consent, or authorization in Scotland, is the golden thread that runs through the legislation and is key for the removal, storage, and use of organs for transplantation. The specific aspects of the legislation that cover deceased donor transplantation are: (1) consent/authorization; (2) when the wishes of the deceased take precedence; and (3) preservation of organs for transplantation whilst awaiting consent. For living donor transplantation, the legislation governs: (1) the regulations pertaining to all living donor transplantation; (2) paired/pooled donation; (3) non-directed stranger donation; and (4) the illegality of commercial dealings in human organs.
Elderly Care Law
Authors: Biram Richard
Published: January 2019

The Royal College of Physicians describes geriatric medicine as a branch of general medicine that is concerned with the clinical, preventative, remedial, and social aspects of illness in older age. The constellation of medical problems encountered by the elderly patient requires a holistic, team-based approach to care, utilizing a process known as the ‘comprehensive geriatric assessment’. This is an evidence-based approach to the assessment and treatment of older adults, which returns more patients to their own homes, and reduces inpatient mortality compared with standard ward care. Legal issues in the care of older adults are essentially the same as in younger adults. However, some areas that feature more frequently in the care of the elderly, which are considered further in this chapter, are age discrimination, elder abuse, safeguarding of vulnerable adults, deprivation of liberty, and the regulations related to driving in the elderly population.
Illness narratives in practice
Authors: Lucius-Hoene Gabriele , Breuning Martina , Helfferich Cornelia
Published: January 2019

Illness narratives—first-person stories about experiences with illness—have become highly popular as research data and as practical instruments, and are used and exploited in many health-related contexts. However, their epistemological properties and problems concerning the relation of their content to events and realities are often neglected when these stories are taken as direct representations of what happened. This chapter exposes why the reflection of these properties and their relation to their use in research or practical contexts is crucial. It expands on three different approaches of handling the epistemological and methodical questions: a ‘naturalistic’ approach, an experiential approach, and a performative approach. Each approach demands different criteria and guidelines to deal with the questions of truth or authenticity as well as with the observance of their context of origin according to the purposes users have in mind.
Illness narratives in counselling—narrative medicine and narrative ethics
Authors: Haker Hille
Published: January 2019

The attention to illness narratives echoes the narrative turn in the humanities. This chapter explores the implications of counselling and confronts the narrative medicine approach with the correlated, yet distinct, concept of narrative ethics. It considers ethics standards of counselling and, more specifically, models of decision-making that counsellors use as orientation and ethical guidelines. Narrative ethics is one way to bridge the experiences and value the moral norms that govern decision making. This chapter explores ways to integrate a narrative ethics approach as part of ethical counselling to ensure that both individual experiences and the normative dimensions of actions are included in the conversations. While non-directive counselling emphasizes the moral agency of the individual and calls for the respect of the client concerning their choices, the introduced model of decision making is better equipped to attend to the ethical dimension of counselling.
Which type of epidemiological study?
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

A key issue in epidemiology is to choose an appropriate study design. The design chosen will depend on the question of interest and some designs will offer clear advantages over others. However, other factors such as current state of knowledge will be important. The decision will be based not only on methodological but also on practical considerations, including the resources available, and the speed with which a result is required. For example, the most appropriate study may be too expensive or take too long to provide an answer. In such circumstances a compromise will need to be made—to undertake a study which can be conducted within the budget and time available, and which delivers information that is suitable for addressing the question of interest.
Ethical issues in epidemiology
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

There are several major ethical issues that face an epidemiological study. There is always the challenge in studying free-living individuals in the modern society, of balancing the needs for robust methods with individual freedoms. The key concerns reflect ensuring an appropriate consent process, maintaining confidentiality, and minimizing any negative consequences for a participant. The most commonly collected information for an epidemiological study come either from material already available in databases, material such as hard copies of records that can have key data items extracted, or data that is gathered directly from the subject. Occasionally a limited physical examination is undertaken. Much less often, there is a requirement to take samples of biological fluid such as blood and urine, or to undergo simple investigations such as electrocardiography or plain radiography, but even such investigations are typically associated with trivial risk to health.
Radio–infrared correlation for local dusty galaxies and dusty AGNs from the AKARI All-Sky Survey
Authors: Solarz Aleksandra , Pollo Agnieszka , Bilicki Maciej , Pȩpiak Agata , Takeuchi Tsutomu T , Pia̧tek Paweł
Published: February 2019

We use the new release of the AKARI Far-Infrared All-Sky Survey (FIS) matched with the NVSS radio database to investigate the local ($z$ < 0.25) far-infrared–radio correlation (FIRC) of different types of extragalactic sources. To obtain the redshift information for the AKARI FIS sources we cross-match the catalogue with the SDSS DR8. This also allows us to use emission line properties to divide sources into four categories: (i) star-forming galaxies (SFGs), (ii) composite galaxies (displaying both star formation and active nucleus components), (iii) Seyfert galaxies, and (iv) low-ionization nuclear emission-line region (LINER) galaxies. We find that the Seyfert galaxies have the lowest far-infrared/radio flux ratios and display excess radio emission when compared to the SFGs. We conclude that the FIRC can be used to separate SFGs and AGNs only for the most radio-loud objects.
Understanding Urea Kinetic Factors That Enhance Personalized Hemodialysis Prescription in Children
Authors: Gotta Verena , Marsenic Olivera , Pfister Marc
Published: January 2019

Urea dialyzer clearance (KD) has been suggested to be underpredicted from blood flow (QB), dialysate flow (QD), and in vitro mass transfer-area coefficient of urea (KoA) in pediatric hemodialysis (HD) patients using a widely accepted mechanistic equation. We characterize factors that could explain this, assuming that it results from a bias between reported in vitro and actual in vivo KoA. An adult urea kinetic model was scaled to 923 patients aged 1–29 years based on pediatric physiologic knowledge (intercompartmental clearance, volumes of distribution). Using data from 2,676 HD sessions of those patients (pre-/post-HD urea concentrations and HD treatment parameters), mixed effect modeling was applied to estimate individual KoA correction factors (fKoA) required for unbiased KD and post-HD urea concentration predictions in vivo. QD/QB ratio was most strongly associated with individual fKoA estimates (P < 0.001; fKoA = −1%, 18%, and 110% at QD/QB ratios of 1.5, 2, and 5). Additional factors included in the model were filter flux (−12% lower fKoA for low- vs high-flux filters), ultra-filtration rate, and true QB (lower than nominal QB ≥200 ml/min). Of note, high QD/QB ratios used in children ≤6 years were associated with significant underprediction of KD
in vivo, with post-HD urea concentrations being 23% lower than expected. In conclusion, dialyzers should be characterized under pediatric conditions where high QD/QB ratios are used. Our model can be used to prevent underestimation of urea clearance, allowing shorter dialysis sessions, higher quality of life, and individualized treatment prescription in children on maintenance HD.
The Relation of Psychosocial Distress With Myocardial Perfusion and Stress-Induced Myocardial Ischemia
Authors: Pimple Pratik , Hammadah Muhammad , Wilmot Kobina , Ramadan Ronnie , Al Mheid Ibhar , Levantsevych Oleksiy , Sullivan Samaah , Lima Bruno B. , Kim Jeong Hwan , Garcia Ernest V. , Nye Jonathon , Shah Amit J. , Ward Laura , Raggi Paolo , Bremner J. Douglas , Hanfelt John , Lewis Tené T. , Quyyumi Arshed A. , Vaccarino Viola
Published: January 2019

Objective

Mental stress–induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease (CAD). The link between an integrated measure of chronic psychosocial distress and mental stress–induced myocardial ischemia, and whether it differs by sex, has not been examined before.

Methods

We used latent class analysis to derive a composite measure of psychosocial distress integrating scales of depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress in 665 individuals with stable CAD. Participants underwent myocardial perfusion imaging with mental stress and perfusion defects were quantified at rest (summed rest score), with mental stress (summed stress score), and their difference (summed difference score), the latter being an index of inducible ischemia.

Results

The M (SD) age was 63 (9) years, and 185 (28%) were women. Latent class analysis characterized the study sample into four distinct classes of incremental psychosocial distress. In women, class 4 (highest distress) had an adjusted 4.0-point higher summed rest score (95% confidence interval = 0.2–7.7) as compared with class 1 (lowest distress), whereas no difference was observed in men (−0.87 points, 95% confidence interval = −3.74 to 1.99, p = .04 for interaction). There was no association between the psychosocial distress latent variable and summed difference score in either women or men.

Conclusions

Among patients with CAD, a higher level of psychosocial distress is not associated with mental stress ischemia, but it is associated with more resting (fixed) perfusion abnormalities in women only, as well as with blunted hemodynamic response to mental stress in both men and women.
Current Evidence in the Diagnosis and Treatment of Children With Celiac Disease
Authors: Gallegos Cara , Merkel Rachel
Published: January 2019

Recent statistics report that 3 million people, or 1% of the population in the United States (U.S.), are affected by celiac disease (CD). In addition, in the U.S., as many as 1 in 80 children is affected with CD. However, CD can be challenging to diagnose and many children are not correctly diagnosed or live without a diagnosis for several years. Symptoms, if present, are often nonspecific and may be common manifestations of many pediatric illnesses. The purpose of this review is to examine the current evidence regarding incidence, pathophysiology, diagnosis, and treatment of a child with CD. Clinical implications for nurses caring for children and families are discussed.
Capnography Monitoring for Patients Undergoing Moderate Sedation
Authors: Kummer Deborah Jo , Walden Bonnie J.
Published: January 2019

The purpose of this Society of Gastroenterology Nurses and Associates Fellowship project was to determine whether capnography is more accurate than oximetry in identifying symptoms of respiratory depression in patients undergoing moderate sedation. Capnography provides an early warning of respiratory depression and airway compromise, especially when the medications used for sedation include opiates and benzodiazepines. It is a standard of care according to the American Society of Anesthesiologists that should be adopted in order to provide the safest possible environment for the delivery of moderate sedation. During this project, the nursing staff were educated on the importance and usage of capnography. Evidence was gathered that helped show that by using capnography, nurses were able to identify signs of respiratory depression earlier and more frequently than with the use of oximetry and cardiac monitoring alone.
Enhanced virus filtration in hybrid membranes with MWCNT nanocomposite
Authors: Németh Zoltán , Szekeres Gergő Péter , Schabikowski Mateusz , Schrantz Krisztina , Traber Jacqueline , Pronk Wouter , Hernádi Klára , Graule Thomas
Published: January 2019

Membrane separation is proved to be a powerful tool for several applications such as wastewater treatment or the elimination of various microorganisms from drinking water. In this study, the efficiency of inorganic composite-based multi-walled carbon nanotube (MWCNT) hybrid membranes was investigated in the removal of MS2 bacteriophages from contaminated water. With this object, multi-walled carbon nanotubes were coated with copper(I) oxide, titanium(IV) oxide and iron(III) oxide nanoparticles, respectively, and their virus removal capability was tested in both batch and flow experiments. Considering the possible pH range of drinking water, the filtration tests were carried out at pH 5.0, 7.5 and 9.0 as well. The extent of MS2 removal strongly depended on the pH values for each composite, which can be due to electrostatic interactions between the membrane and the virus. The most efficient removal (greater than or equal to 99.99%) was obtained with the Cu
2
O-coated MWCNT membrane in the whole pH range. The fabricated nanocomposites were characterized by X-ray diffraction, specific surface area measurement, dynamic light scattering, zeta potential measurement, Raman spectroscopy, transmission electron microscopy and scanning electron microscopy. This study presents a simple route to design novel and effective nanocomposite-based hybrid membranes for virus removal.
Nitrogen and chlorine co-doped carbon dots as probe for sensing and imaging in biological samples
Authors: Li Jin , Tang Kai , Yu Jianxin , Wang Hanqin , Tu Mingli , Wang Xiaobo
Published: January 2019

A facile one-step hydrothermal synthesis approach was proposed to prepare nitrogen and chlorine co-doped carbon dots (CDs) using
l
-ornithine hydrochloride as the sole precursor. The configuration and component of CDs were characterized by transmission electron microscopy and X-ray photoelectron and Fourier transform infrared spectroscopies. The obtained CDs (Orn-CDs) with a mean diameter of 2.1 nm were well monodispersed in aqueous solutions. The as-prepared CDs exhibited a bright blue fluorescence with a high yield of 60%, good photostability and low cytotoxicity. The emission of Orn-CDs could be selectively and effectively suppressed by Fe
3+
. Thus, a quantitative assay of Fe
3+
was realized by this nanoprobe with a detection limit of 95.6 nmol l
−1
in the range of 0.3–50 µmol l
−1
. Furthermore, ascorbic acid could recover the fluorescence of Orn-CDs suppressed by Fe
3+
, owing to the transformation of Fe
3+
to Fe
2+
by ascorbic acid. The limit of detection for ascorbic acid was 137 nmol l
−1
in the range of 0.5–10 µmol l
−1
. In addition, the established method was successfully applied for Fe
3+
and ascorbic acid sensing in human serum and urine specimens and for imaging of Fe
3+
in living cells. Orn-CD-based sensing platform showed its potential to be used for biomedicine-related study because it is cost-effective, easily scalable and can be used without additional functionalization and sample pre-treatment.
High-purity lignin isolated from poplar wood meal through dissolving treatment with deep eutectic solvents
Authors: Chen Yujie , Zhang Lili , Yu Juan , Lu Yingzhao , Jiang Bo , Fan Yimin , Wang Zhiguo
Published: January 2019

Deep eutectic solvents (DESs) have potential applications in biomass conversion and green chemicals due to their cost-effectiveness and environmentally friendly properties. This study reports on a feasible method of using DESs for lignin selective extraction from poplar wood meal. DESs obtained from various hydrogen-bond donors and acceptors were used to evaluate the dissolving capacity of lignin from poplar wood meal. Among the various DESs, lactic acid: choline chloride (9 : 1) exhibits the optimal extraction capacity, which is capable of selectively dissolving 95% of lignin from poplar wood meal at 120°C for 6 h. The purity of isolated lignin reaches 98% after regeneration in water. From Fourier Transform-IR, nitrobenzene oxidation and nuclear magnetic resonance analysis, the results demonstrate that the DESs can selectively cleave ether linkages and damage the non-condensation section of lignin, thereby facilitating lignin dissolution from wood meal. Thus, this study provides a promising route for the extraction of high-purity lignin from biomass materials.