bluuebunny/crossref_metadata_2025 huggingface dataset:
Glide insertion to break a hiatus across words in European Portuguese
Authors: Oliveira Pedro , Cruz Marisa , Paulino Nuno , Vigário Marina
Published: April 2017

Glide insertion to breakhiatus has long been reported in the literature to occur in the Northern and Central varieties of Portuguese but this has not been systematically investigated before. From a larger corpus of speech material collected in several locations in the North and Center of Portugal, we selected for analysis a sample coming from six locations in the Northwest of Portugal and one location in the Center. The effects of several linguistic and extralinguistic factors were evaluated, namely, prosodic domain, level of prominence in the second vowel, prosodic status of first word (W1), region, task, and age. A binary logistic regression model showed that all factors considered are good predictors of the presence of the glide, some considered in isolation (prosodic status of W1 and task), and some in interaction with others (prosodic domain*region, prominence level*task, prominence level*age).
Conditions on variation in pre-nominal possessives in European Portuguese
Authors: Brito Ana Maria
Published: April 2017

Developing previous studies by Brito (2001, 2007), Castro and Costa (2002, 2003), Castro (2005), Miguel (2002a, 2002b, 2002c, 2004), this paper argues that there is a continuum of variation regarding the syntax of pre-nominal possessives in European Portuguese. There is a dominant, standard grammar, in which pre-nominal possessives occupy the spec of a high functional category in the DP (AgrP or PossP); in general they are used with definite articles and are [−degree]. Furthermore, there is a non-dominant grammar, where pre-nominal possessives are almost clitics to the definite article and can be phonetically reduced. In some written and formal registers pre-nominal possessives may occur immediately after indefinites and may even have the feature [+degree]. This paper argues that this is due to several linguistic conditions: in particular, lexical and semantic conditions. We also argue that the common property of possessives is that they are φP. Our paper also shows that the co-occurrence or non co-occurrence of the possessive with the definite article is not due to the different category of the possessive (contrary to Giorgi & Longobardi 1991 Parameter) but to the presence or absence of the definite article itself, a proposal already made in different ways by Brito (2007), Castro (2005) and Rinke (2010).
Feasibility of urinary extracellular vesicle proteome profiling using a robust and simple, clinically applicable isolation method
Authors: Bijnsdorp Irene V. , Maxouri Olga , Kardar Aarzo , Schelfhorst Tim , Piersma Sander R. , Pham Thang V. , Vis Andre , van Moorselaar R. Jeroen , Jimenez Connie R.
Published: April 2017

Extracellular vesicles (EVs) secreted by prostate cancer (PCa) cells contain specific biomarkers and can be isolated from urine. Collection of urine is not invasive, and therefore urinary EVs represent a liquid biopsy for diagnostic and prognostic testing for PCa. In this study, we optimised urinary EV isolation using a method based on heat shock proteins and compared it to gold‐standard ultracentrifugation. The urinary EV isolation protocol using the Vn96‐peptide is easier, time convenient (≈1.5 h) and no special equipment is needed, in contrast to ultracentrifugation protocol (>3.5 h), making this protocol clinically feasible. We compared the isolated vesicles of both ultracentrifugation and Vn96‐peptide by proteome profiling using mass spectrometry‐based proteomics (n = 4 per method). We reached a depth of >3000 proteins, with 2400 proteins that were commonly detected in urinary EVs from different donors. We show a large overlap (>85%) between proteins identified in EVs isolated by ultracentrifugation and Vn96‐peptide. Addition of the detergent NP40 to Vn96‐peptide EV isolations reduced levels of background proteins and highly increased the levels of the EV‐markers TSG101 and PDCD6IP, indicative of an increased EV yield. Thus, the Vn96‐peptide‐based EV isolation procedure is clinically feasibly and allows large‐scale protein profiling of urinary EV biomarkers.
Dances with oligarchs: performing the nation in Armenian civic activism
Authors: Adriaans Rik
Published: April 2017

Among the cultured classes of Armenia, the country’s system of governance through oligarchic patron–client networks is widely believed to reflect negatively on cultural fields such as architecture, music and folklore. In particular, the concept of rabiz, in earlier times referring primarily to a genre of “oriental” music, has emerged as a ubiquitous term signifying moral corruption, backwardness and passive complacency. This paper examines this perceived decay through an ethnographic study of the transformation of Yerevan’s monumental Covered Market into a shopping mall after it was acquired by an enterprising member of parliament. Bringing together militant intelligentsia and young activists, a civic initiative emerged that framed the events as a conquest of the city centre by its semi-rural margins and propagated a boycott of the oligarch’s businesses with a repertoire of protest marches, folk dances and choir performances. The initiative was soon countered by spectacular mobilizations in favour of the oligarch that foregrounded the values of kinship and work, contesting the activists’ claims to represent the grassroots of the nation. The paper locates the contention in the contradictory legacies of Soviet-era urbanization, economic restructuring and the Karabakh Movement, and illustrates how oligarchic power is expressed through the cooptation of activist repertoires.
Radiotherapy for laryngeal cancer—technical aspects and alternate fractionation
Authors: Yamazaki Hideya , Suzuki Gen , Nakamura Satoaki , Yoshida Ken , Konishi Koji , Teshima Teruki , Ogawa Kazuhiko
Published: April 2017

Early laryngeal, especially glottic, cancer is a good candidate for radiotherapy because obvious early symptoms (e.g. hoarseness) make earlier treatment possible and with highly successful localized control. This type of cancer is also a good model for exploring the basic principles of radiation oncology and several key findings (e.g. dose, fractionation, field size, patient fixation, and overall treatment time) have been noted. For example, unintended poor outcomes have been reported during transition from 60Cobalt to linear accelerator installation in the 1960s, with usage of higher energy photons causing poor dose distribution. In addition, shell fixation made precise dose delivery possible, but simultaneously elevated toxicity if a larger treatment field was necessary. Of particular interest to the radiation therapy community was altered fractionation gain as a way to improve local tumor control and survival rate. Unfortunately, this interest ceased with advancements in chemotherapeutic agents because alternate fractionation could not improve outcomes in chemoradiotherapy settings. At present, no form of acceleration can potentially compensate fully for the lack of concurrent chemotherapy. In addition, the substantial workload associated with this technique made it difficult to add extra fractionation routinely in busy clinical hospitals. Hypofractionation, on the other hand, uses a larger single fractionation dose (2–3 Gy), making it a reasonable and attractive option for T1–T2 early glottic cancer because it can improve local control without the additional workload. Recently, Japan Clinical Oncology Group study 0701 reprised its role in early T1–T2 glottic cancer research, demonstrating that this strategy could be an optional standard therapy. Herein, we review radiotherapy history from 60Cobalt to modern linear accelerator, with special focus on the role of alternate fractionation.
Psychiatric Factors
Authors: Bullock Kim , Barry John J.
Published: April 2017

Psychogenic nonepileptic seizures (PNES) is a multifactorial illness requiring a personalized biopsychosocial (BPS) formulation across the lifespan to understand its causes. This chapter reviews the current evidence focusing on predisposing, precipitating, perpetuating, and prognostic variables (4P’s), merging them into a chronologically based 4P-BPS model. Positive PNES randomized controlled trials suggest that self-efficacy and illness beliefs, avoidance behaviors, trigger sensitization, and comorbid psychiatric disorders are important etiological variables to target during treatment. Epidemiological and neurobiological research suggests that further treatment development focusing on the causal impact of trauma and affect dysregulation is lacking and is warranted going forward. The clinical implications for the evidence to date, as well as recommendations for translating current knowledge into therapeutic behaviors, are discussed.
The Neurobiology of PNES and Other Functional Neurological Symptoms
Authors: Perez David L. , Voon Valerie
Published: April 2017

Patients with psychogenic nonepileptic seizures (PNES) and related functional neurological symptoms are highly prevalent yet poorly understood on a neurobiological level. Clinical and research efforts in PNES and other functional neurological symptoms have lagged behind clinical neuroscience advancements in other neuropsychiatric conditions, despite the high frequency with which clinicians encounter PNES and other functional neurological symptoms. In this chapter, systems-level neurobiological studies in PNES are reviewed. Specific emphasis is given to structural and functional neuroimaging, electrophysiology, autonomic, and neuroendocrine investigations. Early systems-level neurobiology research suggests that PNES may develop in the context of alterations within and across brain networks mediating emotion processing, regulation and expression, cognitive control, multimodal integration, and sensory-motor functions. An improved biological understanding of PNES may reduce the stigma associated with this neuropsychiatric disorder and aid the development of biologically informed treatments and biomarkers of treatment response in this population.
Diagnostic Challenges for the Neurologist
Authors: Rathod Jigar , Benbadis Selim R.
Published: April 2017

The diagnosis of psychogenic nonepileptic seizures (PNES) can be challenging for the neurologist. This chapter aims to help navigate such challenges and is organized into three sections: suspecting the diagnosis, establishing the diagnosis, and delivering the diagnosis of PNES. Often these patients present to an epilepsy center with a long-standing history of refractory “epilepsy,” have tried multiple antiepileptic drugs to no avail, and have had “abnormal EEGs.” Therefore, a clear history about the seizures needs to be obtained by the neurologist. The patient needs to be evaluated using gold standard testing: long-term video-EEG monitoring. Challenges that can arise during monitoring include unsuccessful recording of habitual events, and events established as PNES yet with EEG evidence of interictal epileptic discharges. If a typical event has not been captured, the neurologist needs to navigate this situation by either attempting to provoke an event on EEG, remonitoring the patient with long-term video-EEG, or asking the patient’s family to capture an event on video, to get closer to the correct diagnosis. Once the diagnosis is established, there are challenges in delivering the diagnosis, especially if patients have carried a diagnosis of epilepsy for many years.
Evidence-Based Treatments
Authors: LaFrance W. Curt , Goldstein Laura H.
Published: April 2017

Psychogenic nonepileptic seizures (PNES) have been in the medical literature for centuries. However, treatments were limited, being based on uncontrolled data, until the past decade. Treatment advances published since 2010 have included pilot controlled trials using psychotherapies, psychoeducational approaches, medications, and combined pharmacological and psychotherapeutic approaches that provide new treatment options for patients with PNES. This chapter describes these controlled trials in detail. It also covers studies of treatments for other functional neurological disorders including PNES. One conclusion from this review is that future studies still need to improve on as-yet limited sample sizes and provide insights into predictors of treatment outcome so that rational decisions can be made about which treatments offer the best outcome and who is likely to best respond to which treatment.
Long-Term Outcomes
Authors: Duncan Roderick
Published: April 2017

The scope of research into long-term outcomes of psychogenic nonepileptic seizures (PNES) has broadened in recent years, to take into account of social, economic, psychiatric, and other outcome measures. The quantity of long-term outcome information remains limited, to a great extent because of practical difficulties in obtaining good long-term outcome information in this patient group. Because of differing methodology and other factors, the available studies are difficult to compare directly. Nonetheless, they agree that most patients continue to report seizures long term. Healthcare use outcome appears better, with many patients not accessing medical care for seizures. However, many patients have poor psychiatric and economic outcomes. The reasons for this are poorly understood, but may relate more to underlying psychological processes than to the seizures themselves. A better understanding of the psychological underpinnings of PNES will allow more informative study of outcome and thus of the impact of interventions. However, obtaining good outcome information in PNES patients remains a major challenge and may be difficult in some medical systems.
Treatment Adherence in Chronic Pain
Authors: Harrison Anthony M. , Graham Christopher , McCracken Lance M.
Published: April 2017

It is widely accepted that treatment adherence is a complex problem, and rates of nonadherence in chronic pain are around 50% or more. Nonadherence is important, not only because it may decrease treatment effectiveness but because it is dangerous and a potential confound in assessing treatment effectiveness, both in research and clinical service, and it is wasteful. Unfortunately, available interventions to promote better adherence appear limited. This chapter introduces the current models of adherence in the context of chronic pain and selectively summarizes related evidence. It also introduces the Psychological Flexibility Model, a newer organizing framework underpinning Acceptance and Commitment Therapy (ACT), and examines the potential applicability of ACT in this challenging context.
The Use of Drug Testing in Promoting Treatment Adherence in Pain Medicine
Authors: Gourlay Douglas L. , Heit Howard A.
Published: April 2017

Drug testing has become an important component of a comprehensive risk assessment and mitigation program when prescribing controlled substances to patients with chronic pain. State and federal opioid prescribing guidelines strongly recommend the use of drug testing, although there is lack of evidence in the literature supporting the efficacy of drug testing in reducing prescription opioid abuse. Drug testing can be useful in facilitating adherence to prescribed medications. This chapter provides an overview of the strengths and weaknesses of drug testing in pain medicine, insights into laboratory and test selection, test interpretation, and communicating results to patients within a patient-centered model.
Adherence
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to pharmacists and other healthcare professionals related to adherence. The health and social impacts of non-adherence are discussed. Reasons why patients may not take their medicines and the concepts of intentional and non-intentional adherence are included. Practical tips on conduction and adherence consultation are listed. It also covers methods of assessing adherence and various approaches to assist patients to improve adherence. Practical aids to supporting adherence are discussed including a section on writing patient information leaflets. The concept of health coaching and its use to support adherence is briefly covered.
Adverse drug reactions and drug interactions
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter provides an overview of adverse drug reactions and drug interactions for pharmacists and other healthcare professionals. It provides a practical guide to determining whether a reaction is related to the drug or disease. A classification of adverse drug reactions is given and how this relates to immediate management of the reaction and future drug choices is discussed. Tips are given on how to discuss adverse drug reactions and explain risks to patients. Mechanisms of drug interactions are covered and a practical guide for predicting and managing interactions is given.
Anaphylaxis
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to pharmacists and other healthcare professionals related to anaphylaxis. Signs and symptoms are discussed and guidance given on recognizing anaphylaxis. Emergency treatment with adrenaline (epinephrine) and follow-on therapy with antihistamine, corticosteroids, and other supportive measures are covered. The role and use of adrenaline auto-injectors is included. The importance of managing late sequel and patient follow-up is discussed.
Clinical trials
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to clinical pharmacists related to clinical trials. In particular, this chapter covers clinical trial regulations and the European Clinical Trials Directive, development phases and licensing of clinical trials, hospital pharmacy guidance on setting up and running clinical trials, clinical trial design, and ethical committees.
Pharmaceutical calculations
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at junior staff starting their careers in healthcare, and provides a brief summary of some of the different concepts in medicines preparation and administration that involve calculation. It also recaps some of the terms and units that are used to ensure the safe use of medicines, and the importance of understanding the interaction of weights and volumes with molecular quantities for drugs with a known defined molecular weight. This chapter also offers a quick reference source to double-check methodology when undertaking calculation for more experienced pharmacists, technicians, doctors, and nurses.
Research
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at pharmacists wishing to undertake research projects. It differentiates between research and audit, provides advice on preparing research proposals, and has a couple of useful sections on citation rules and managing citations in bibliographic databases.
Therapy-related issues: infections
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to pharmacists and other healthcare professionals related to microbiology and infectious diseases. Basic microbiology is covered including modes of action of antibacterials and the selection and use of antimicrobials. Key aspects of antimicrobial stewardship (including resistance, antimicrobial prophylaxis, and writing guidelines) and of infection control are covered. The chapter includes an extensive review of the treatment of human immunodeficiency virus and a discussion of key principles in the treatment of tuberculosis.
Therapy-related issues: malignant diseases and immunosuppression
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to clinical pharmacists related to malignant disease and immunosuppression and is loosely based on the British National Formulary, Chapter 8. In particular, this chapter covers administration and handling of cytotoxic drugs, clinical screening of chemotherapy prescriptions, chemotherapy dosing and toxicity, antiemetics for chemotherapy-induced nausea and vomiting, extravasation, and intrathecal administration of chemotherapy.
Therapy-related issues: nutrition and blood
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to clinical pharmacists related to nutrition and blood and is loosely based on the British National Formulary, Chapter 9. In particular, this chapter covers intravenous administration and devices, management of electrolyte imbalances, nutritional support and requirements, enteral feeding, giving medicines via feeding tubes, and intravenous therapy at home
Therapy-related issues: musculoskeletal
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to clinical pharmacists related to musculoskeletal diseases and is loosely based on the British National Formulary, Chapter 10. In particular, this chapter covers rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, osteoarthritis, osteoporosis, and gout.
Therapy-related issues: palliative care
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter covers important information for the pharmacist relating to palliative care. Conditions commonly seen when caring for patients at the end of life are covered, including anorexia, fatigue, and anaemia. Other topics include hypercalcaemia of malignancy, mouth care, noisy breathing, insomnia, spinal cord compression, and malignant bowel obstruction. In addition, this chapter includes detail on the priorities for end-of-life care, relating these to prescribing in the dying patient.
Therapy-related issues: miscellaneous
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at junior hospital pharmacists and steps outside the normal format of complementing the British National Formulary. It introduces a number of interesting clinical topics that will be introduced as the pharmacist’s training progresses. Subject topics include therapy-related topics encountered in intensive care units, supporting patients with alcohol dependence, interpreting blood gases, and other interesting specialist topics.
Effort perception
Authors: Lamb Kevin L , Parfitt Gaynor , Eston Roger G
Published: April 2017

As the Borg rating of perceived exertion scale was not appropriate for children, investigators set about developing child-specific scales which employed numbers, words and/or images that were more familiar and understandable. Numerous studies have examined the validity and reliability of such scales as the CERT, PCERT and OMNI amongst children aged 5 to 16 years, across different modes of exercise (cycling, running, stepping, resistance exercise), protocols (intermittent vs. continuous, incremental vs. non-incremental) and paradigms (estimation vs. production). Such laboratory-based research has enabled the general conclusion that children can, especially with practise, use effort perception scales to differentiate between exercise intensity levels, and to self-regulate their exercise output to match various levels indicated by them. However, inconsistencies in the methodological approaches adopted diminish the certainty of some of the interpretations made by researchers. The scope for research in the application of effort perception in physical education and activity/health promotion is considerable.
Sport, physical activity, and other health behaviours
Authors: Trost Stewart G , Joschtel Barbara
Published: April 2017

It is widely believed that participation in organized sports and physical activity offers protection against the negative social influences that can lead to problem behaviour and experimentation with tobacco, alcohol, and illicit drugs. It also widely believed that youth who engage in regular physical activity are more likely to adopt other healthy lifestyle behaviours. This chapter critically evaluates these assertions by summarizing the empirical research evidence on the relationship between sport, physical activity, and nine other health behaviours in youth. It shows that sports participation and physical activity are indeed related to other health behaviours, but the strength and direction of the associations are dependent on the health behaviour under examination, the child’s age, gender, race/ethnicity, and the nature of the sport or physical activity.
Development of the young athlete
Authors: Armstrong Neil , McManus Alison M
Published: April 2017

Success in youth sport is underpinned by a range of chronological age- and biological maturity status-related factors which affect performance in a sex- and sport-specific manner. Pubertal changes in body size, shape, composition, muscle metabolism, muscle strength, aerobic fitness, and anaerobic fitness strongly influence sport performance but biological clocks run at different rates. As selection and retention in youth sport is based on chronological age, competition is not always on a level playing field. Young athletes benefit from exercise training but there is no convincing evidence of the existence of a ‘maturation threshold’ below which the effects of training will be minimal or will not occur, or of ‘windows of opportunity’ during which training effects are enhanced. Participation in sport provides a positive environment for the promotion of personal development but evidence is accumulating that elite youth sport also presents risks to current and future health and well-being.
High-intensity interval training
Authors: Tolfrey Keith , Smallcombe James W
Published: April 2017

High-intensity interval training (HIIT) is characterized by brief, intermittent bursts of near- or maximal-intensity exercise, interspersed by periods of active or passive recovery. The limited available evidence suggests that HIIT is an efficacious training method for young athletes. The effect of HIIT on cardiorespiratory fitness, endurance performance, explosive strength, and sport-specific performance has been examined in a range of young athletic populations from various sports. Furthermore, promising preliminary findings suggest that HIIT may confer further benefits to a range of health outcome measures including fasting insulin, lipoproteins, systolic blood pressure, and endothelial function; obese youth may benefit particularly from this type of training. Improved cardiorespiratory fitness has been observed consistently after HIIT in athletic and non-athletic populations. Larger studies, extended over longer periods, that include valid measures of exercise compliance, tolerance, and enjoyment are required to further delineate the priority that could be afforded to this type of training.
Resistance training
Authors: Faigenbaum Avery D , Lloyd Rhodri S
Published: April 2017

Traditional fears and misinformed concerns regarding youth resistance training have been replaced by scientific evidence that indicates regular participation in well-designed resistance-training programmes can be safe and effective for both children and adolescents. In addition to increasing muscular strength and power, regular participation in a structured resistance training-programme can increase bone mineral density, improve cardiovascular risk factors, fuel metabolic health, facilitate weight control, enhance psychosocial well-being, and prepare youth for the demands of daily physical activity and sport. An integrative approach to training, grounded in resistance exercise and motor skill development, can optimize children’s fitness potential and maximize their athletic performance while reducing the risk of sports-related injury. Qualified professionals are needed to plan, implement and progress developmentally appropriate resistance training to attain a level of muscular fitness that facilitates long-term physical development.
Physiological monitoring of elite young athletes
Authors: Armstrong Neil , Barker Alan R
Published: April 2017

As part of a scientific support programme, physiological monitoring has the potential to enhance knowledge and understanding of the development of elite young athletes in order to optimize their present and future sporting performance. However, the ethics of physiological testing of minors and the development of individualized, reliable, valid, and sport-specific physiological monitoring programmes are challenging. For example, the assessment of body composition, muscle strength, and anaerobic and aerobic fitness in sport-specific contexts and environments is complex. A plethora of laboratory and field tests have been developed to monitor young athletes. However, adequate interpretation of elite performance in youth can only be accomplished by procedures that satisfy rigorous criteria. Clear understanding of the merits and limitations of physiological tests is required for the development of appropriate scientist-coach-young athlete relationships.
Epidemiology and prevention of injuries in competitive contact sports
Authors: Nauta Joske , Verhagen Evert ALM
Published: April 2017

Generally, sports injuries in contact sports are more frequent than in non-contact sports. Contact sports are those sports in which contact with the opponent is common or intentional. This chapter focuses on sport-specific injuries that occur in various contact sports, including soccer, American football, ice hockey, basketball, martial arts, and wrestling. Each sport is covered by exploring practical information concerning the particular sport, as well as the epidemiology and aetiology of sport-specific injuries, and there is also a summary containing sport-specific preventive strategies. Where possible, this chapter also covers trends that can be drawn from the literature to give a foundation on which to develop and promote injury prevention strategies.
Upper extremity and trunk injuries
Authors: Shaw Christopher M , Cil Akin , Micheli Lyle J
Published: April 2017

As the rate and level of youth athletic participation continues to rise, so does the frequency of injury to the trunk and upper extremities in these young athletes. Injuries are varied in severity and frequency. Additionally, injury patterns are unique to the growing musculoskeletal system and specific to the demands of the sport. The treatment of these injuries is also varied, ranging from preventative, to non-operative, to operative. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can potentially prevent invasive treatments, future deformity, or disability, and return the young athlete to sport. This chapter discusses the diagnosis and management of common upper extremity and trunk injuries in the paediatric athlete, including joint injuries, fractures, repetitive microtrauma, tendonitis, ligament injuries, and back pain.
Nutrition and eating disorders
Authors: Sundgot-Borgen Christine , Sundgot-Borgen Jorunn
Published: April 2017

This chapter covers the energy and nutrient requirements and the continuum of disordered eating in adolescent athletes. Studies focusing on nutrition and adolescent athletes are limited, but there is potential for nutritional improvement, especially among female adolescent athletes. Additionally for young athletes, the risk of inadequate micronutrient intake is associated with energy restriction. Abnormal vitamin-D status is reported for both genders, with lack of exposure to sunlight likely to produce the greatest risk. There is a continuum of normal to abnormal eating that ranges from a healthy body image, body weight, body composition, and energy balance to abnormal eating, including clinical eating disorders. Prevention of disordered eating should integrate education and screening for early identification. Education should target not only athletes, but also parents, volunteers, coaches, officials, and health care providers.
Evolution: medicine’s most basic science
Authors: Nesse Randolph M. , Dawkins Richard
Published: April 2017

The role of evolutionary biology as a basic science for medicine has been expanding rapidly. Some evolutionary methods are already widely applied in medicine, such as population genetics and methods for analysing phylogenetic trees. Newer applications come from seeking evolutionary as well as proximate explanations for disease. ...
Anthrax
Authors: Brown Arthur E. , Sirisanthana Thira
Published: April 2017

Anthrax is primarily a disease of herbivorous mammals, caused by the Gram-positive rod Bacillus anthracis, which causes human infection when its spores enter the body, most commonly from handling infected animals or animal products. The disease occurs in most countries of the world, but not in those where the condition is controlled in livestock by vaccination programmes. Anthrax is a leading agent of biological warfare....
Buruli ulcer: Mycobacterium ulcerans infection
Authors: Meyers Wayne M. , de Jong Bouke , Portaels Françoise
Published: April 2017

Buruli ulcer is caused by Mycobacterium ulcerans, which secretes a cytotoxic and immunosuppressive toxin, mycolactone. The disease is characterized by necrosis of skin, subcutaneous tissue, and bone, and is re-emerging as a potentially disabling affliction of inhabitants of tropical wetlands. Major foci are in West and Central Africa, but there are minor endemic foci in Australia, Mexico, South America, and South-East Asia. It is not contagious; environmental sources include water, vegetation, and insects, with humans probably becoming infected by traumatic introduction of the bacillus into the skin from the overlying ...
Lysosomal disease
Authors: Deegan P.B. , Cox T.M.
Published: April 2017

The lysosome is an intracellular organelle that recycles biological macromolecules derived either endogenously, from digestion of cellular components (autophagy), or from the breakdown of material that has been incorporated from outside the cell by, for example, phagocytosis. The lysosome is now known to be involved in nutrient sensing and central to the regulation of the metabolic economy of the cell....
Pancreatic endocrine disorders and multiple endocrine neoplasia
Authors: Martin N.M. , Bloom S.R.
Published: April 2017

Pancreatic neuroendocrine tumours (islet cell tumours) are rare and usually sporadic, but they may be associated with complex familial endocrine cancer syndromes. Recognized types of pancreatic neuroendocrine tumours are those that are nonfunctioning (often advanced at diagnosis due to the absence of symptoms attributable to hormone hypersecretion), insulinoma (the most frequent type, see ...
Peptic ulcer disease
Authors: Sung Joseph
Published: April 2017

Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin are the most important causes of peptic ulcer disease. Cigarette smoking also increases the risk, but—although often alleged—there is little evidence to implicate psychological stress. Zollinger–Ellison syndrome, which consists of a gastrin-secreting islet cell tumour (gastrinoma) leading to marked hypergastrinemia, is a rare cause of recurrent peptic ulceration....
Autoimmune hepatitis
Authors: Hodgson H.J.F.
Published: April 2017

Case History—A 24 yr old woman presenting with a short history of jaundice.

Autoimmune hepatitis describes chronic inflammation in the liver attributed to immune responses against self-antigens in the liver, typically in the form of a marked portal tract infiltrate containing both plasma cells and T cells. It usually affects women (female:male, 8:1), is often familial, and 60% of patients have other autoimmune diseases (e.g. thyroiditis, type 1 diabetes) in addition....
Alcoholic liver disease
Authors: Stewart Stephen F. , Day Chris P.
Published: April 2017

The incidence of alcoholic liver disease (ALD) follows the trend of per capita alcohol consumption, with hepatic injury which extends from fatty liver to alcoholic hepatitis and cirrhosis. It is unclear how alcohol causes liver disease, but postulated mechanisms include (1) oxidative stress and acetaldehyde generated by the metabolism of ethanol, and (2) innate and adaptive immune responses. Factors determining the susceptibility to liver disease in heavy drinkers are believed to include a variety of host and environmental factors....
Specific heart muscle disorders
Authors: McKenna William J. , Elliott Perry
Published: April 2017

Cardiovascular involvement is very common, but may be occult and often goes undetected. Any anatomical structure in the heart can be involved, hence patients may present with pericarditis, myocarditis, endocarditis, or coronary vasculitis. There is usually no correlation between the extent of systemic disease and cardiac involvement....
Cardiac disease in HIV infection
Authors: Currie Peter F.
Published: April 2017

Symptomatic heart disease can affect up to 10% of HIV-positive patients and cause death in around 2%. Echocardiographic screening is recommended.

In resource-poor countries where access to antiretroviral drugs is limited the typical manifestations are (1) HIV heart-muscle disease—this occurs in the late stages of HIV infection, with dilated cardiomyopathy having a dismal prognosis, the median survival after diagnosis being about 100 days; angiotensin converting enzyme (ACE) inhibitors and ...
Cholesterol embolism
Authors: Dudley Christopher
Published: April 2017

Cholesterol embolism occurring after vascular surgery or intra-arterial angiographic procedures is not uncommon, but is often unrecognized. The clinical features mimic a number of conditions, including contrast nephropathy and systemic vasculitis, and—if misdiagnosed—can result in the inappropriate use of powerful immunosuppressive drugs. A high index of suspicion is required when an elderly patient with widespread vascular disease develops a nonspecific systemic illness with progressive renal impairment, particularly after vascular surgery or arteriography. Biopsy of affected tissue, especially skin or kidney, is diagnostic—showing biconvex, needle-shaped cholesterol clefts within the lumen of arteries or arterioles. Treatment is supportive and the prognosis is often poor....
Pulmonary hypertension
Authors: Morrell Nicholas W.
Published: April 2017

Symptoms of unexplained exertional breathlessness or symptoms out of proportion to coexistent heart or lung disease should alert the clinician to the possibility of pulmonary hypertension, and the condition should be actively sought in patients with known associated conditions, such as scleroderma, hypoxic lung disease, liver disease, or congenital heart disease. Heterozygous germ-line mutations in the gene encoding the bone morphogenetic protein type II receptor (...
Systemic lupus erythematosus and related disorders
Authors: Rahman Anisur , Isenberg David A.
Published: April 2017

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disorder that can present with symptoms in almost any organ or system of the body. It is 10 to 20 times commoner in women than men, and commoner in Afro-Caribbeans than Asians than whites.

Aetiology is multifactorial, incorporating genetic, hormonal, and environmental elements. No single abnormality of the immune system can be considered responsible, pathogenesis depending on the interplay of a number of different factors, including autoantibodies, T lymphocytes, cytokines, the complement system, and apoptosis....
Respiratory physiology in anaesthetic practice
Authors: Lumb Andrew B. , Drury Natalie
Published: April 2017

Moving away from the structure of traditional texts, this chapter follows the journey of oxygen molecules as they move from inspired air to their point of use in mitochondria, with some digressions along the way to cover other relevant aspects of respiratory physiology. The chapter encompasses all the key aspects of respiratory physiology and also highlights physiological alterations that occur under both general and regional anaesthesia, moving the physiological principles discussed into daily anaesthetic practice. The chapter explores relevant anatomy of the airways, lungs, and pleura. The histology and function of the airway lining and alveoli are described, so illustrating the importance of pulmonary defence mechanisms for protecting the internal milieu of the body from this large and fragile interface with the outside world. Key principles and concepts including resistance, compliance, and diffusion are all discussed in their clinical context. Concepts relating to the mechanics of breathing and the control of airway diameter are considered along with lung volumes and their measurement. Both the central and peripheral mechanisms involved in the control of breathing are discussed with particular attention to the impact of anaesthesia. The relationship between ventilation and perfusion and the carriage of oxygen and carbon dioxide are all discussed in detail. The principles behind key respiratory measurements such as dead space, lung volumes, diffusing capacity, and shunt are all described. Overall the chapter provides a comprehensive review of respiratory physiology as well as including additional aspects of variation that occur under anaesthesia.
Gastrointestinal physiology in anaesthetic practice
Authors: Gordon Joanna K. , Bellamy Mark C.
Published: April 2017

The physiology of the human gut and gastrointestinal tract is complex. Studying it is difficult, and much of what we know relies on extrapolation from animal models. The interactions between normal physiology, deranged physiology, and anaesthetic drugs and procedures are likewise extremely complex, and in some cases paradoxical. A clear understanding of these is likely to be beneficial in achieving best clinical outcomes in anaesthesia for patients undergoing gastrointestinal tract procedures, but also for the critically ill patient undergoing coincidental anaesthetic procedures. Strategies aimed at monitoring the function of the gastrointestinal tract during anaesthesia have in the past been used as research tools, but have potential for use as therapeutic guides. However, further development of these technologies and clinical trials of their application are required, before any firm recommendation in this area can be made.
Neuroendocrine physiology in anaesthetic practice
Authors: Nicholson Grainne , Hall George M.
Published: April 2017

This chapter describes the hormonal, metabolic, and inflammatory response to surgery—commonly known as the surgical stress response. The changes in protein, carbohydrate, and fat metabolism to provide fuel for oxidation are outlined as well as changes in salt and water metabolism. Psychological sequelae of fatigue and malaise are also common in patients undergoing surgery. Attenuating the metabolic and endocrine changes associated with surgery may reduce postoperative morbidity and expedite recovery; the choice of anaesthetic drugs and techniques (regional vs general anaesthesia) and the increasing use of laparoscopic surgery have all been used to try to achieve this objective. The most common metabolic disease which anaesthetists have to manage is diabetes mellitus (DM) and its pathophysiology and medical management, as well as that of the related metabolic syndrome are discussed. Adrenal tumours are rare but usually require surgical excision. Phaeochromocytomas present unique anaesthetic challenges, but pre-, intra-, and postoperatively in terms of fluid management and blood pressure control. Conn’s syndrome (primary hyperaldosteronism) can also result in hypertension and electrolyte disturbances. Cushing’s disease (glucocorticoid excess) presents with the clinical effects of steroid excess and many patients have concomitant DM. Finally, perioperative steroid supplementation for patients already taking steroids and undergoing surgery is discussed.
Immune system physiology in anaesthetic practice
Authors: Galley Helen F. , Wilson Heather M.
Published: April 2017

The immune system provides protection against invading pathogens, foreign cells including tumour cells, and macromolecules. It comprises an early, non-specific, innate immune response and a later, specific, adaptive immune response that helps prevent disease or recurrence of disease. Innate and adaptive immune systems work together with mutual interactivity distinguishing ‘self’ from ‘non-self components’ to provide effective immune responses and prevent infection. This chapter describes the basic processes involved in immune responses and illustrates the particular relevance for some disease processes as well as highlighting stresses associated with anaesthesia and surgery that can modulate responses.
Neuromuscular blockade and reversal
Authors: Hunter Jennifer M. , Fuchs-Buder Thomas
Published: April 2017

Over the past 70 years since the introduction of d-tubocurarine, the search for an ideal neuromuscular blocking agent has led to the development of the depolarizing drug, succinylcholine (suxamethonium), with its rapid onset of action and plasma metabolism, and a series of non-depolarizing agents of which there are two groups: benzylisoquinoliniums (e.g. atracurium, cisatracurium and mivacurium) and aminosteroidal agents (e.g. pancuronium, vecuronium and rocuronium). The need to monitor neuromuscular block perioperatively to ensure the appropriate dose of any neuromuscular blocking drug is given has led to the development of several nerve stimulation techniques. Particularly useful clinically are the train-of-four twitch response, double-burst stimulation, and the post-tetanic count. Their benefits and limitations are considered in this chapter. The most suitable equipment to monitor neuromuscular block and the appropriate anatomical sites for stimulation are discussed. To prevent residual block with its pathophysiological consequences such as upper airway and pharyngeal dysfunction and potential respiratory failure at the end of surgery, antagonizing agents are used. These are of two types: anticholinesterases such as neostigmine and edrophonium, and the γ‎-cyclodextrin, sugammadex. The pharmacodynamics and pharmacokinetics of neuromuscular blocking drugs and their antagonists are altered by the extremes of age, obesity, and several disease states including renal and hepatic failure, neuromuscular disorders, and critical illness. The altered response to all these drugs in these pathologies, which is related to their metabolism and excretion, is considered in detail, together with their other side-effects including the particular disadvantages to the use of succinylcholine.