bluuebunny/crossref_metadata_2025 huggingface dataset:
Bayesian optimization approach to quantify the effect of input parameter uncertainty on predictions of numerical physics simulations
Authors: McCallum Samuel G. , Lerpinière James E. , Jensen Kjeld O. , Friederich Pascal , Walker Alison B.
Published: November 2023

An understanding of how input parameter uncertainty in the numerical simulation of physical models leads to simulation output uncertainty is a challenging task. Common methods for quantifying output uncertainty, such as performing a grid or random search over the model input space, are computationally intractable for a large number of input parameters represented by a high-dimensional input space. It is, therefore, generally unclear as to whether a numerical simulation can reproduce a particular outcome (e.g., a set of experimental results) with a plausible set of model input parameters. Here, we present a method for efficiently searching the input space using Bayesian optimization to minimize the difference between the simulation output and a set of experimental results. Our method allows explicit evaluation of the probability that the simulation can reproduce the measured experimental results in the region of input space defined by the uncertainty in each input parameter. We apply this method to the simulation of charge-carrier dynamics in the perovskite semiconductor methyl-ammonium lead iodide (MAPbI3), which has attracted attention as a light harvesting material in solar cells. From our analysis, we conclude that the formation of large polarons, quasiparticles created by the coupling of excess electrons or holes with ionic vibrations, cannot explain the experimentally observed temperature dependence of electron mobility.
Extreme weather makes monitoring snowpack increasingly relevant
Authors: Feder Toni
Published: November 2023

A dedicated satellite would provide global coverage to improve understanding of the hydrologic cycle and inform water-use and risk-management strategies.
The synergistic health impacts of exposure to multiple stressors in Tulare County, California
Authors: Gee Michael , McKone Thomas E
Published: November 2023

Tulare County is located in the Central Valley region of California (CA). Its population is exposed to stressors that include high levels of air, water, and soil pollution, socioeconomic strain, and poor access to walkable areas and healthy foods. As a result, this population suffers from a high disease burden compared to other CA counties. We hypothesize that environmental and socioeconomic stressors interact in complex ways to raise the burden of disease in the Tulare population beyond additive impacts. We used CalEnviroScreen to select Tulare County as the subject of the study and characterized the geographical interaction of stressors. The CalEnviroScreen indicators provided the basis for population-weighted average calculations to determine the most critical environmental and socioeconomic stressors in Tulare County. We also analyzed and interpreted walkability and dietary access through open-source data. In addition, we compared disease-based mortality in Tulare County to CA state averages. Our evaluation reveals that the population living within the census tracts of Tulare County is exposed to environmental stressors at significantly higher levels relative to many other Californian census tracts, specifically for fine particulate matter, ozone, and drinking water quality. Relatively high exposures to socioeconomic stressors can compound resulting health impacts. We use dose–response curves and stressor mapping to characterize how multiple stressors may augment a population’s vulnerability and effective doses from exposure to multiple stressors. According to the Centers for Disease Control and Prevention Data, the differences in mortality rates between Tulare and CA were not significant. However, notable differences in mortality between CA and Tulare occur for Alzheimer’s disease, diseases of the circulatory system, influenza, and pneumonia, which were all statistically higher in Tulare County, and for diabetes, endocrine, nutritional and metabolic diseases, and neoplasms, which were statistically lower Tulare. Previous health-impact studies have linked individual environmental stressors to their respective measures of disease. However, many communities continue to be exposed daily to numerous stressors that individually are within regulatory limits but could significantly magnify risk due to the synergistic effects. Dose–response curves tailored to population vulnerability provide a basis for quantifying the synergistic risks of multiple stressors on specific measures of disease.
Response of CO2 and CH4 emissions from Arctic tundra soils to a multifactorial manipulation of water table, temperature and thaw depth
Authors: Best K , Zona D , Briant E , Lai Chun-Ta , Lipson D A , McEwing K R , Davidson S J , Oechel W C
Published: November 2023

Significant uncertainties persist concerning how Arctic soil tundra carbon emission responds to environmental changes. In this study, 24 cores were sampled from drier (high centre polygons and rims) and wetter (low centre polygons and troughs) permafrost tundra ecosystems. We examined how soil CO2 and CH4 fluxes responded to laboratory-based manipulations of soil temperature (and associated thaw depth) and water table depth, representing current and projected conditions in the Arctic. Similar soil CO2 respiration rates occurred in both the drier and the wetter sites, suggesting that a significant proportion of soil CO2 emission occurs via anaerobic respiration under water-saturated conditions in these Arctic tundra ecosystems. In the absence of vegetation, soil CO2 respiration rates decreased sharply within the first 7 weeks of the experiment, while CH4 emissions remained stable for the entire 26 weeks of the experiment. These patterns suggest that soil CO2 emission is more related to plant input than CH4 production and emission. The stable and substantial CH4 emission observed over the entire course of the experiment suggests that temperature limitations, rather than labile carbon limitations, play a predominant role in CH4 production in deeper soil layers. This is likely due to the presence of a substantial source of labile carbon in these carbon-rich soils. The small soil temperature difference (a median difference of 1 °C) and a more substantial thaw depth difference (a median difference of 6 cm) between the high and low temperature treatments resulted in a non-significant difference between soil CO2 and CH4 emissions. Although hydrology continued to be the primary factor influencing CH4 emissions, these emissions remained low in the drier ecosystem, even with a water table at the surface. This result suggests the potential absence of a methanogenic microbial community in high-centre polygon and rim ecosystems. Overall, our results suggest that the temperature increases reported for these Arctic regions are not responsible for increases in carbon losses. Instead, it is the changes in hydrology that exert significant control over soil CO2 and CH4 emissions.
The infection control committee
Authors: Mehtar Shaheen
Published: November 2023

The role of the infection control committee The role of the Infection Control Committee (ICC) is to: Formulate and monitor patient-care policies. Advise on the purchase of clinical and non-clinical equipment (as this may be involved, directly or indirectly, in cross-infection). Liaise with nursing and medical staff on new policies and procedures. Educate all hospital staff in the infection control programme. Realize savings resulting from the infection control programme and redeploy these funds to improve patient care. Take part in medical audit, as well as being subject to medical audit itself.
Outbreaks
Authors: Mehtar Shaheen
Published: November 2023

Any increase in the isolation rate of a particular organism, or any clustering of clinical cases should be investigated by the IC team. Infection rates and isolates of particular interest may be monitored by: a daily report from the Microbiology Department; a prevalence survey of infection; notification from the national surveillance centre (the communicable diseases centre), which reports national epidemics. If an outbreak occurs the aim of investigation is to: discover how the outbreak arose;treat the infected patients; prevent spread of the infection with the minimum of disruption to the patients and staff.
Design of wards and specialized units
Authors: Mehtar Shaheen
Published: November 2023

Most hospital in-patients are treated in wards, which require considerable planning to minimize the risk of cross-infection. The ward layout depends on whether a pre-existing building has been converted, or whether the unit has been purpose-built. There are three main designs: Nightingale wards. These are dormitory in style, with toilets, bathrooms, sluice areas, etc., at both ends and a nursing station in the centre. There may be a few rooms off the main wards, which are used as treatment rooms, offices, or isolation cubicles. Wash-hand basins are usually at either end of the ward and near the nursing station.
Other departments
Authors: Mehtar Shaheen
Published: November 2023

The IC team should be involved with the tender for contracts for domestic and associated services, advising on: general cleaning schedules; terminal cleaning requirements; high-risk or dependency area cleaning; cleaning of the bedpan disinfector; cleaning schedules for dirty areas;cleaning the wash-hand dispensers and replacing stocks on the wards; damp dusting schedules; the use of disinfectants.
The development of health care technology
Authors: Banta H David , Luce Bryan R
Published: November 2023

A new technology results from a long and complicated set of activities. In summary, this can be referred to as the process of technological change. This process covers the wide range of interacting events by which technology evolves over time, and includes not only scientific activities, but empirical observations, and is based not only on rational experimentation but on serendipity.
Lipids and lipoproteins
Authors: Neil Andrew
Published: November 2023

Cholesterol is a sterol which is essential for the synthesis of cell membranes and various hormones. It is transported in the plasma in macromolecular solubilizing complexes termed lipoproteins. The cholesterol concentration is an aggregate measure of the total amount of cholesterol carried in the various lipoproteins. About two-thirds of cholesterol in plasma is transported as low density lipoprotein (LDL) cholesterol. In excess it is potentially atherogenic which explains the relationship between elevated total cholesterol concentrations and coronary heart disease (CHD). High density lipoprotein (HDL) cholesterol accounts for 15-25 per cent of the total plasma cholesterol. It plays a major role in the mobilization and removal of tissue cholesterol and its concentration has been shown to be inversely related to the incidence of CHD. Very low density lipoprotein (VLDL) accounts for only about 10 per cent of total cholesterol but for over half of triglyceride concentration in the normal subject with the remaining triglycerides transported by other lipoproteins.
Antioxidants
Authors: Silagy Chris , Mant David
Published: November 2023

There is now considerable biochemical and experimental animal evidence in support of oxidative modification of lowdensity lipoprotein (LDL) playing an important causative role in atherosclerosis. More recently, this has been strengthened by some impressive epidemiological evidence. The oxidative process depends on the presence of free radicals. The main contribution of antioxidants appears to be in scavenging these free radicals and converting them to inactive substances. As a result, antioxidants have been postulated as potential protective agents which help to guard against atherosclerosis and its clinical manifestations. Antioxidants can be classified into two main groups:
Prevention of stroke
Authors: Mant Jonathan
Published: November 2023

There is considerable overlap between the risk factors for coronary heart disease and stroke. The major modifiable risk factors for stroke are smoking1 and hypertension2 (see Chapters 1 and 2). Other modifiable risk factors include alcohol consumption and lack of exercise. Diabetes and coronary heart disease6 are also risk factors. Lowering serum cholesterol does not appear to protect against stroke. Risk factors which relate largely to cerebrovascular disease rather than coronary heart disease include atrial fibrillation, a past history of a transient ischaemic attack (TIA) or stroke, and presence of carotid artery stenosis.
Multiple risk
Authors: Muir John , Mant David
Published: November 2023

‘The combined effect of all risk factors on risk is striking. The difference in incidence between the highest and lowest deciles (of multivariant risk) is thirty-fold for men and seventy-fold for women.’ This quotation, taken from an early report of the Framingham Study in 1967, indicates why it is important not to consider individual risk factors in isolation. Many commonly recognized risk factors for ischaemic heart disease, such as smoking, blood pressure, and diet, exert a largely independent effect on risk and their overall effect is cumulative. The Framingham investigators recognized not only the epidemiological importance of their observation but also its implication for clinical practice: ‘Programmes require a rational method for identifying persons at high risk so as to focus attention on them and to avoid needlessly alarming persons at lower risk, because of a single stigma. By the same token, it is important not to provide false reassurance to persons with multiple marginal risk factors who may be at a much greater than average risk’.
Taking the initiative: strategies and implications
Authors: Agass Martyn , Mant David
Published: November 2023

Medical practice has traditionally been a demand led service. Until recently, the accepted role of primary health care teams was to respond to patients’ requests for help but seldom to take the initiative. This attitude is changing rapidly. The quality of clinical care is often better if health professionals are prepared to take the initiative in both the primary and secondary prevention of chronic disease. In addition, many factors which affect the health of our society, such as attitudes, unhealthy life-styles, and social inequalities, are no longer judged to be beyond the professional concern and influence of health professionals.
Introduction
Authors: Guly H R
Published: November 2023

Skill in the arts of history taking, physical examination and record keeping is essential for good medical care. Although taught at length at medical school, pressures on the curriculum may mean that not enough emphasis is given to trauma and other musculoskeletal problems. Preregistration house officer appointments are usually in general medicine and surgery and therefore many ‘casualty officers’ begin their work in accident and emergency with little knowledge of trauma and musculoskeletal problems.
Medical history
Authors: Guly H R
Published: November 2023

The main aim of taking a history from a patient is to establish a diagnosis and to ensure that there are no factors in the past medical history which would interfere with treatment. There are also other aims which may be as important. Treatment, and certainly the explanation of the injury and the advice which one gives to a patient will usually need to be individualized depending on the patient’s age, occupation, interests, intelligence, etc.
Pain
Authors: Guly H R
Published: November 2023

Pain, of various sorts, is the commonest presenting symptom in A& E departments and in many other medical specialties. Adequate pain relief must be sought, not just for humanitarian reasons but because pain has adverse effects on the cardiovascular, respiratory, and neuroendocrine systems. Also, from the practical point of view, the patient in pain is anxious and difficult to manage. If pain is to be adequately controlled its severity before and after analgesia must be measured in some way.
Final diagnosis
Authors: Guly H R
Published: November 2023

Diagnosis is fundamental to medicine. The diagnosis you make will label the patient. It may be entered into a computer, copied into the general practitioner’s notes, and will be referred to in the absence of the rest of the clinical notes. It may be coded and used to generate statistics. It is therefore important that the diagnosis is as complete as possible. ‘Fall’ or ‘injury right hand’ are not diagnoses. ‘Fractured right 4th metacarpal’ is a diagnosis but better still is ‘Undisplaced transverse fracture base right 4th metacarpal’.
Treatment
Authors: Guly H R
Published: November 2023

The A& E record card may be used for prescribing drugs given in the department. Any prescription made in this way must contain the same information as any other prescription.

Drug dosage, frequency, and duration (or total number of tablets prescribed) should be written down even if the prescribing is being done on a separate form. It is not helpful when a patient returns and requests more medication to find that all that is written in the notes is ‘ibuprofen’ without any mention of dose and frequency of administration or, even worse, ‘NSAIDs’.
Joint injuries
Authors: Guly H R
Published: November 2023

The most important thing to feel for is to identify the point of maximum tenderness. For example in the ankle, if the most tender point is over a malleollus then a fracture is a possibility but if the maximum tenderness is over the soft tissues then a significant fracture is unlikely.
Bone injuries
Authors: Guly H R
Published: November 2023

If there is an obvious fracture the limb should not be moved unnecessarily but it may be necessary, even if just to splint the limb. If the limb is moved then the presence of crepitus should be noted. In less severe injuries, the limb will be moved as part of the examination of the joints at either end. If there is doubt as to whether there is a fracture or whether a known fracture has healed, then the bone can be stressed.
Abdominal injury
Authors: Guly H R
Published: November 2023

An accurate history is important as it may not only help in establishing the diagnosis but may assist in the management of the patient. A blow to the abdomen with the force of a kick may cause injury to a solid organ (e.g. spleen), but in these circumstances it can often be treated conservatively. A more severe force such as occurs in a high velocity road accident may injure liver, spleen, or kidney but may also injure a hollow organ. If further investigation reveals intra¬abdominal bleeding, a high velocity injury is much more likely to need to be surgically explored.
Leg and calf injuries
Authors: Guly H R
Published: November 2023

The tibia runs subcutaneously throughout its whole length and tenderness is easily localized. The examining doctor must, however, not neglect the fibula as although isolated fractures of this are much less significant, they are easily and frequently overlooked in e.g. the footballer who has been kicked.
Child limping or unable to weight bear
Authors: Guly H R
Published: November 2023

The small child who falls over and refuses to walk without any signs of a major limb injury is a common problem. As the child may be unable to say where the pain is and tenderness may be difficult to localize especially if they are crying, he or she must be examined from the toes to the hip even if the site of injury appears to be in one area. Common injuries causing this problem are greenstick fractures of the first metatarsal, spiral and greenstick fractures of the tibia and, less commonly, greenstick fractures of the femur.

The child who is limping following an injury must be examined similarly but it is less likely there is a fracture of a long bone if the child is walking.
Gene structure and regulation and the application of laboratory techniques
Authors: Jeffery Stephen , Saggar-Malik Anand K
Published: November 2023

Cell activity is essential for cell survival and organ function and is determined by the integrated activity of almost 100 000 genes through control of protein synthesis at the nuclear and cytoplasmic level. It was first believed that proteins were more likely candidates than DNA as components of the genetic code, but by the beginning of the 20th century it was apparent that chromosomes determined inheritance. In the late 1940s, Linus Pauling demonstrated that gene function could be studied not only by gross phenotypic change but also through encoded protein products, e.g. by gel electrophoresis. In 1953, James Watson and Francis Crick, from x-ray crystallographic data, described the double helical structure for DNA of two intertwined chains running in opposite directions.
Chromosomal and development anomalies
Authors: Crawfurd Martin d’ A
Published: November 2023

Although renal and lower urinary tract anomalies are seldom the presenting feature of chromosomal disorders, they frequently form part of a multisystem malformation due to chromosomal anomaly. The renal abnormalities seen in chromosomal disorders include fused kidneys, duplication defects, renal agenesis or hypoplasia, hydronephrosis and hydroureter, renal dysplasia or cystic disease and hypospadias, micropenis, and cryptorchidism.The overall pattern of malformation in individual chromosomal disorders is usually sufficient ly characteristic to enable a clinical diagnosis to be made. However, within the broad picture there is considerable variation from case to case, even for the whole chromosome trisomies and monosomies.
Purine metabolism
Authors: Watts R W E
Published: November 2023

The inherited disorders of purine metabolism associated with renal disease are listed in Table 24.1. They are the sole cause of only a small proportion of all renal disease and are therefore best considered as part of the overall problem of purine, especially uric acid metabolism-related renal disease. Genetic factors may precipitate the occurrence or determine the severity of acquired disorders in this area. Conversely, environmental factors and acquired diseases modify the phenotypic expression of the primary genetic conditions.
Renal manifestations of neurofibromatosis and tuberous sclerosis
Authors: Milliner D S , Torres V E
Published: November 2023

Neurofibromatosis is one of the most common inherited disorders and occurs in approximately one out of every 3000 births (Riccardi 1987). It is fundamentally a hamartomatous disorder of neural crest tissue. Neuroectodermal and mesodermal changes in neural structures and their accompanying blood vessels lead to diverse manifestations in multiple organ systems. Historical ly, as many as eight different subtypes of neurofibromatosis have been described, many with overlapping features (McKusick et al. 1992). In order to provide consistency in diagnosis and widely accepted recommendations for evaluation and management, a National Institutes of Health (NIH) consensus conference in 1987 considered all available information and recognized two main subtypes, termed NFl and NF2 (National Institutes of Health 1988).
Introduction
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Law and medicine are unlike disciplines. The practice of medicine is based on direct logic yet requires the application of many assumptions and traditions. Law uses an inductive logic an is concerned with interpretation of the language of actual utterances, either written or spoken.
Avoiding trouble
Authors: Montague Alan , Hopper Andrew
Published: November 2023

The term ‘defensive medicine’ implies medical practice directed to protect the doctor from being sued rather than care of a patient. In particular it infers excessive and unnecessary investigation. Of course, good lawyers reassure us, this is quite unnecessary for as long as we act in accordance with a responsible body of medical opinion we cannot successfully be sued. Unfortunately this is not the invariable interpretation by hospital management and defence unions. They are known to pay off smaller claims whether meritorious or not.
Controlled drugs
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Emergency department staff handle controlled drugs so often they may give little thought to the risks. The inevitable arrival of addicts at emergency departments and their attendant warring bands of ‘unlicensed pharmacists’ place staff at risk of exceeding their privileges and having their actions questioned.
Mental health law
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Our great grandchildren will probably look upon contemporary psychiatric practice as being as primitive as we view that of the eighteenth and nineteenth centuries. However modest the progress in treatment for mental disorder it cannot be denied that the law, although imperfect, now permits a humane and respectful care of the afflicted.
Classification of cystic kidneys
Authors: Zerres Klaus
Published: November 2023

Renal cysts are common and have an important role in many areas of medicine. Cystic lesions may be hereditary, developmental, or acquired. At least about 5-10 per cent of all patients on dialysis suffer from cystic kidney diseases. In paediatric autopsy material, cystic changes of the kidneys arc among the most common malformations, and the obstetrician is frequently confronted with renal cysts in prenatal ultrasound examination. Autosomal dominant polycystic kidney disease (ADPKD) is one of the most frequent inherited diseases with an incidence of about 1/1000 (Dalgaard 1957).
Acquired renal cystic disease
Authors: Cohen Eric P
Published: November 2023

The development of cysts in non-cystic kidneys has been recognized by pathologists for over a century (Simon 1847; Mallory 1914). Simple cysts of the kidney are more common in older subjects (Laucks and McLachlan 1981) and are uncommon under age 40. They are thus acquired in life, and probably not congenital. They are usually asymptomatic but may cause pain and may become infected. An association between simple cysts and hypertension has been noted, with reduction in blood pressure after cyst puncture or surgical cyst removal (Ltischer et al. 1986).
What do kidneys do?
Authors: Cameron Stewart
Published: November 2023

To understand better what goes wrong when kidneys fail to function, it’s worth knowing a little about what they do in health, and their role in maintaining a healthy state of well-being. If you are a patient, or a patient’s relative, who is already in kidney failure and facing the prospect of dialysis or transplantation, you may prefer to skip to the chapters which deal with the particular disease you suffer from (Chapters 3 and 4), what happens in kidney failure (Chapter 5), or to those on dialysis (Chapters 6 and 7), or after transplantation (Chapter 8).
Potentially treatable causes of chronic kidney failure. how can we prevent kidney failure?
Authors: Cameron Stewart
Published: November 2023

Kidney failure is not nearly so common as a cause of death or medical problems as (for instance) heart and blood vessel disease, or cancers as a whole, which each cause more than 200 000 deaths a year each in the UK alone. In the UK, about 7000 people reach end-stage kidney failure each year. This figure may not seem large for the whole country, but kidney failure is more common than a number of diseases which are well known to the public-for example muscular dystrophy and multiple sclerosis.
National and international patterns of drug use
Authors: Taylor Ross
Published: November 2023

Good data on drug utilization are not readily available. Data for commercial purposes are obtained by the pharmaceutical industry and associated bodies such as the Association of the British Pharmaceutical Industry (ABPI). These data may come from information on sales of medicines or from special studies by commercial survey organizations such as Intercontinental Medical Statistics (IMS). Apart from sales data, the other main source is operational data from general practice.
How doctors choose drugs
Authors: Denig Petra , Bradley[AU] Colin
Published: November 2023

Prescribing drugs is a routine behavior for most doctors. Many prescriptions are written during consultations, apparently without the doctor giving it much thought. However, each time a prescription is written a decision has been made. This decision making can be considered from a prescriptive or normative point of view; discussing how doctors ought to choose drugs and the factors that properly ought to influence that process.
Prescribing a complementary therapy: an introduction to homoeopathy
Authors: Greenfield Sheila , Wearn Andy , Hunton Mollie
Published: November 2023

Homoeopathy is one of an increasing number of therapeutic approaches to health problems that are proving more popular with patients and some doctors. These therapeutic approaches are sometimes referred to as ‘alternative therapies’ but this depiction of them is too antagonistic and rejecting by allopathic medicine based on scientific rationalism. A preferable term is ‘complementary therapies’, which suggest their use alongside allopathic medicine.
Conclusions: psychiatry first
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

We opened this book with the paradox that psychiatry, although the most deeply value-laden area of medicine, has been relatively neglected by bioethics in favour of more high-tech medical specialties. The reason for this neglect, we argued, has been the stigmatization of psychiatry, by bioethics no less than by biomedicine, as a second-class medical citizen. Psychiatry, according to this ‘psychiatry second’ picture, is the muddled end of medicine. Hence the problems (ethical and scientific) to which it is subject will be resolved. in due time, by methods and ideas derived from what are taken to be the unmuddled disciplines of physical medicine.
Imaging and other investigations
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

The major imaging techniques do not play an important part in the long term management of mild head injury. In the acute stage a CT scan is likely to be done if recovery is not rapid or straightforward, and in the next six weeks or so if persistent headache or other symptoms make it necessary to rule out a subdural haematoma. When symptoms persist diagnosis is made essentially on the clinical history and the neuropsychological assessment. If there are, in addition, focal neurological features such as diplopia or atypical headache, CT or MR may be needed to exclude other pathology. However CT, MR, PET, and SPECT have been used extensively in research on the causes of the late effects of mild head injury, as described in the section on mechanisms and pathology.
Assessment of cognition and behaviour
Authors: Wrightson Philip , Gronwall Dorothy
Published: November 2023

Of all the deficits affecting the patient with a severe head injury the behavioural and cognitive changes are usually the most difficult for the clinician to manage, and are those that researchers rate as the most difficult for families to cope with (Lezac 1996). This applies as much if not more to cases of mild head injury, because problems with memory and concentration and mood swings may be the only persistent after- effects. Thus the patients may appear to others to be fully recovered, yet continue to complain that they are forgetful, and that they get tired and irritable very quickly. Further, it may be difficult to accept their claim that they do have problems. They are generally very aware that they cope badly when they are tired, and may prepare themselves for the doctor’s appointment by having a rest or a sleep, so that he or she sees them at their unrepresentative best.
Pharmacologic approaches to preventing hemodialysis access failure
Authors: Himmelfarb Jonathan
Published: November 2023

While intermittent hemodialysis for the treatment of patients with acute renal failure was introduced by Willem Kolff in 1943, the development of chronic hemodialysis therapy for patients with end-stage renal disease was not feasible until the 1960s with the introduction of the external arteriovenous shunt by Quinton and colleagues. The 1960s were further characterized by the development of the endogenous arteriovenous fistula, and the subsequent development of prosthetic subcutaneous interpositional ‘bridge’ graft.
Autosomal recessive inheritance
Authors: Young Ian D
Published: November 2023

The provision of risks to the parents of a child with an autosomal recessive disorder is generally straightforward, as it does not require too much mathematical expertise to establish that there will be a risk of 1 in 4 for siblings of an affected individual. For other family members, however, risk calculation can be much more complex, particularly if there is a history of consanguinity or if only limited carrier testing is available. Several such situations are considered in this chapter.
Cancer genetics
Authors: Young Ian D
Published: November 2023

There is now clear evidence that genetic factors play an important role in causing cancer. In most instances the associated nuclear mutations are not inherited but are acquired somatically, possibly as part of the normal aging process or as a result of prolonged exposure to particular carcinogens. In these situations any observed small increase in risk to close family relatives is much more likely to be due to shared environmental exposure than to an inherited germ line susceptibility. However, in approximately 5 per cent of cases of the common cancers, such as breast and colorectal, there is evidence of a strong inherited susceptibility. In addition, a relatively large number of single gene disorders have been identified in which particular cancers show a high incidence. Although rare individually, recognition of these high-risk family cancer syndromes is important because of the potential for early detection and prevention by screening and possibly also chemoprophylaxis. Increasing aware ness of familial susceptibility to common cancer and the existence of high-risk familial cancer predisposing syndromes has led to the widespread introduction of cancer family clinics at which the assessment of an individual’s risk for developing a particular cancer is an integral component.
Repetitive brain stimulation
Authors: Mills K R
Published: November 2023

The initial magnetic stimulators were limited in their frequency of stimulation by the recharging time of the capacitors and, depending on the intensity used, frequencies no faster than 0.5 Hz were achievable. It had been known for many years that certain effects of brain stimulation were only seen if the brain area was repetitively stimulated, presumably because of some cumulative excitatory (or inhibitory) effect. The develop ment of stimulators capable of producing trains of higher frequency stimuli was therefore an imperative. This required the solving of a number of technical problems by the designers of stimulators, not least of which was the heating of coils by the passage of frequent high currents. A number of repetitive stimulators are now commercially available capable of discharge rates up to 100 Hz; in some the problem of coil heating has been solved by oil (Nielsen et al. 1995b) or water cooling (Pascual Leone et al. 1991). The terms rapid-TMS or rapid-rate-TMS have been used but repetitive TMS (rTMS) is preferred. High-frequency rTMS refers to stimulation at frequencies greater than 1 Hz whereas low-frequency rTMS refers to frequencies below 1 Hz. The effects offrequency modulated rTMS are unexplored.
Degenerative diseases of the nervous system
Authors: Mills K R
Published: November 2023

This chapter considers inherited conditions of the nervous system which tend to affect specific fibre tracts or nuclei. These conditions are increasingly being characterized genetically, but the correlation between genotypes and the variable phenotypes continues to be of interest to clinicians. Central motor conduction studies have a role in the refining of these correlations. The hereditary ataxias are a heterogeneous group of disorders in which gait ataxia and dysarthria are the predominant features. There are a number of inherited conditions with a known metabolic cause (abetalipoproteinaemia, ataxia telangiectasia and xeroderma pigmentosum), but the majority of the inherited ataxias are of unknown cause. The inherited ataxias are divided on clinical grounds into early onset cerebellar ataxias (EOCAs) (onset before 20 years) of which the commonest, comprising about two-thirds of all hereditary ataxias, and the best studied is Friedreich’s ataxia, and the late onset cerebellar ataxias (LOCAs) (onset after 20 years).
Spinal cord diseases
Authors: Mills K R
Published: November 2023

This chapter considers those spinal cord diseases in which there is a structural abnormality such as external compression or syringomyelia. Conditions in which there is a myelopathy of inflammatory or degenerative aetiology are considered elsewhere. Magnetic brain stimulation has been used to address a number of questions in relation to spinal cord injury. It is important to decide whether a spinal cord injury is complete or incomplete. Clearly if brain stimulation results in responses in muscles below the level of the lesion then the injury must be incomplete. Conversely, lack of a response should not lead to the conclusion that the lesion is complete. It should be remembered that magnetic stimulation excites only a small fraction of the total corticospinal outflow and lack of response can only be interpreted as disruption of this small fraction.
Monitoring motor function during surgery
Authors: Mills K R
Published: November 2023

Techniques for monitoring the sensory tracts during surgery on the spinal cord are well established and are routine in many centres (Nash et al. 1977; Tamaki et al. 1984; Forbes et al. 1991; Epstein et al. 1993; Fujioka et al. 1994; Fisher et al. 1995; Nuwer et al. 1995). Equally, it has long been recognized that motor monitoring would be far more useful than sensory monitoring if it could protect against the serious complication of cord surgery, motor paresis. The ‘wake up’ test (Vauzelle et al. 1973) whereby anaesthesia is lightened sufficiently for the patient to cooperate with the surgeon in voluntarily testing the integrity of the sensory and motor tracts is a most unsatisfactory method and has been abandoned in many centres in favour of sensory evoked potential monitoring. There is, however, a small but significant number of cases in whom sensory evoked potential monitoring remains unchanged during the operation but the patient wakes with a neurological deficit (Lesser et al. 1986; Mustain and Kendig 1991), presumably because ischaemic injury has spared the dorsal sensory pathways.
Integrated Cancer Care
Authors: Barraclough Jennifer
Published: November 2023

Complementary therapies such as acupuncture, aromatherapy and spiritual healing are now being offered within many oncology and palliative care settings. Benefits of improved symptom control, quality of life and patient satisfaction have been demonstrated, but various questions remain. Is further integration with mainstream medicine desirable? What are the priorities for service provision and research? Are the specific techniques as important as their shared "holistic" context? Can they have significant unwanted effects? And besides making patients feel better, can they help to improve survival from cancer? Such questions are considered in this book. Jennifer Barraclough, former director of psycho-oncology at the Churchill Hospital in Oxford, has assembled specialist contributions from oncology and palliative care, complementary therapy, general practice, healthcare planning and research. Academic reviews are balanced by personal accounts from patients. The book is relevant to all stages of the "cancer journey" and includes a chapter on childhood cancer. This overview of a controversial and evolving field will interest those with professional or personal involvement in oncology or palliative care.
Healing the whole person
Authors: Neate Ann
Published: November 2023

Tony Neate is a healer, transpersonal counsellor and nutritional adviser. He offers help in these areas as a support to other forms of treatment being received by the patient. Ann Neate is a healer and counsellor, trained in the transpersonal and humanistic traditions. She is particularly interested in psychological causes of illness. ‘The cure of a part should not be attempted without treatment of the whole’ Plato c. 480 BC Healing has existed throughout history. There is evidence among early civilizations dating back to 3000 BC in Mesopotamia; the Egyptian healer Imhotep who founded the tradition of healing in the temples; and around 1200 BC, the famous Greek healer Asclepius who founded healing temples throughout the Greek states and subsequently in various parts of the Roman Empire. In the latter, the patients were clothed in white and slept near the statue of Asclepius. In dream-state, the patient saw the spirit of the healer appear at his side and prescribe appropriate treatment. History shows that cures were frequent (Jones 1983).
Homoeopathy
Authors: Lewith George , Kenyon Julian
Published: November 2023

George Lewith is honorary senior research fellow at Southampton University and honorary consultant physician at Southampton General Hospital. His research interests include evaluating the effectiveness of complementary medicine, particularly acupuncture and homoeopathy, in a variety of clinical conditions. Julian Kenyon is a partner in the Centre for the Study of Complementary Medicine in Southampton and London. He is also Research Director of the Dove Healing Trust, a medical research charity looking at the scientific nature of subtle energies. He has a particular interest in cancer and its treatment using an eclectic complementary approach.
Music therapy
Authors: Lee Colin
Published: November 2023

The use of music therapy can be crucial for many patients living with cancer. When diag nosed with a life-threatening illness many people feel the need to re-evaluate their lives; to find that creative part that has been suppressed by the realities of day-to-day living. Music therapy, as a co-creative process between patient and therapist, can empower people to find their artistic selves and use their musical expression as a means for exploration and health. Music provides the opportunity to communicate that which cannot be spoken. It can facilitate powerful experiences of reminiscence and distract from the real ities of physical pain. It is the portend of this chapter that music should not be used casually or prescriptively. Often in healthcare settings music is abused; the constant use of background sounds from radios, televisions, and hi-fi systems can become aggravating and potentially stressful. Silence is preferable to the use of uninformed music. Music chosen with and for the patient can, however, be intensely therapeutic. Music therapy as an intricate therapeutic phenomena, should only be practised by qualified and experienced individuals. Music should, however, be embraced and used by all healthcare professionals and is an ideal therapeutic tool that can be used in conjunction with more formal treatment procedures. The empathic use of music, and its potential to inspire the spirit, can enrich all our lives.
The vascular anatomy of the cerebral and craniofacial circulation
Authors: Mounayer C , Maurice J P Saint , Chapot R , Merland J J , Houdart E
Published: November 2023

The topographical vascular anatomy of the brain and craniofacial system is complex. This chapter outlines this anatomy for the interventional neuroradiologist, emphasizing how such anatomical knowledge can be applied in clinical practice. The blood supply of the head can be divided into two parts: the cerebral circulation, comprising the internal carotid and vertebrobasilar arterial networks, and the craniofacial circulation, which is largely derived from the external carotid arterial network. These two systems are not isolated from each other. There are a large number of anastomoses between the two networks and recognizing and understanding them are fundamental skills for anybody performing endovascular treatments, particularly in the external carotid arterial network.
Treatment of arteriovenous malformations of the brain
Authors: Wikholm G , Pellettieri L , Karlsson B
Published: November 2023

The principal treatment options for patients with arteriovenous malformations of the brain—neuro- surgical treatment, stereotactic radiotherapy and endovascular embolization—will be considered in this chapter. Endovascular embolization is the main focus of the chapter, but since it is frequently supplemented with radiosurgery or neurosurgery it is appropriate to discuss all three options together. Treatment strategies vary between different centres and commonly depend as much on local expertise and medical culture as on evidence from comparative clinical trials. Evidence from prospective randomized trials is difficult to obtain because arteriovenous malformations of the brain are relatively rare and ill-defined.
Organization of an interventional neuroradiology service
Authors: Royston D D , Forie P
Published: November 2023

Interventional neuroradiology has emerged along- side neurosurgery as a medical specialty offering minimally invasive therapies for neurovascular dis- eases (Byrne 1997). The unique skills and expertise of the interventional neuroradiologist are complementary to those of neurosurgeons and neurologists. Interventional neuroradiology cannot be successfully practised without the support of colleagues in both these specialties. Of these relationships, that with neurosurgery is crucial, and because the interventional neuroradiologist needs to work closely with neurosurgeons, the subspecialty is best practised within the framework of a neurovascular unit.
Reproductive system
Authors: Fortune Farida
Published: November 2023

Vaginal discharge may be caused by vaginosis or cervicitis, the main cause in either case being of infective aetiology. Other causes of vaginal discharge include retained tampons or other foreign objects.
Making and implementing timely legal decisions for children: research on a court sample
Authors: Hunt Joan
Published: November 2023

The principle enacted in the legislation, that delay was poten tially damaging and should be avoided, was informed both by a venerable general literature on attachment and separation for example, Rowe and Lambert published their seminal study, Children who wait. This highlighted the numbers of young children who were ‘drifting’ in long-term public care because there was little active planning for their future
Computerized tomography scanning
Authors: Mester Adam R , Mako Erno K , Karlinger Kinga , Nemeth Laszlo
Published: November 2023

Separation of superimposed structures occurs with both computerized and conventional (mechanical) tomography. Conventional tomography was performed using linear, circular, or elliptical movements of the X-ray tube and the film. This technique gave good definition of a layer of the patient of variable thickness, while the structures above and below were obscured. This technique nowadays is largely obsolete. Computerized tomography (CT) provides cross-sectional scans, digitally imaged.
Imaging in muscle disease
Authors: Scott David L
Published: November 2023

Imaging methods do not have a primary role in either the diagnosis or assessment of the majority of patients with muscle diseases. This is in contradistinction to their key role in evaluating other forms of musculoskeletal disease and, in particular, arthritis. However, the continuing development of new imaging methods is changing this situation, and in a minority of patients with muscle disease imaging methods can make substantial impacts on the clinical care patients are given.