bluuebunny/crossref_metadata_2025 huggingface dataset:
Controversies in Aquatic Sciences
Authors: Weis Judith S.
Published: November 2020

The aquatic sciences have their share of scientific controversies. In some cases the controversy is the classic situation of economic benefit versus environmental protection; in other cases it involves “genuine” scientific debate over uncertainties of the science or debate over what management option is optimal. This chapter discusses two pollution cases that pit scientists from universities or government agencies against those supported by the industry responsible for the pollution. Additional controversies that are also discussed are a disagreement over management options for shoreline protection, and a scientific disagreement over uncertainties in data on fish populations, which is usually the reason for controversies over fisheries. Controversies over effects of pollution often focus on how much (what concentration) of a chemical is needed to produce a certain harmful effect. Chemical companies tend to argue that levels of a chemical found in the environment are too low to cause problems, while environmentalists typically contend that lower levels can be harmful. One chemical about which there is sometimes controversy is oil. In the case of oil spills, debate commonly centers on how long the effects of pollution last. Oil degrades over time, resulting in less oil in the environment. The critical issue here is: When does this degradation reach a point where spilled oil is no longer harmful? Oil is a complex combination of various hydrocarbons that generally floats on water, although some lighter-weight components (the water-soluble fraction) dissolve. Weathering is a process that takes place in the air and water, in which the lightweight components evaporate, thus leaving the heavier components (e.g., tar), which have traditionally been viewed as less toxic. When oil comes into shallow water and marshes, it can coat and smother resident communities. It can sink below the surface of beaches and marshes and remain there for many years. Oil in marsh sediments undergoes some microbial breakdown but very slowly. Effects of a small oil spill (190,000 gallons of number 2 fuel oil) in Falmouth, Massachusetts, in the late 1960s lasted for over a decade, according to Sanders et al. (1980).
The Importance of Oxides and Oxide–Water Reactions
Authors: Bunker Bruce C. , Casey William H.
Published: November 2020

Earth is composed primarily of oxides (Fig. 1.1, Plate 1, Table 1.1). The interior is a iron-nickel core that represents 35% of the planetary mass. The core is encapsulated within a plastic zone called the mantle. Floating on top of the mantle, like the slag on top of a blast furnace, is a thin skin called the crust. Both the mantle and the crust (65% of the planetary mass) are primarily oxides. Although the crust is thin (8–13 km thick under the ocean basins and up to 70 km thick under the continents), it still represents a massive amount of material, corresponding to 7 billion km3, with a weight of 2.5 · 1019 metric tons. Of this mass, 46% is tied up in the relatively light element oxygen, predominantly in oxides containing silicon, aluminum, and iron. Almost every material that we humans encounter or use is derived from the oxide building blocks that comprise Earth’s crust. Water is by far the most abundant liquid on the planet. In fact, it can be difficult to comprehend just how much water is contained in Earth. Most of our liquid water is in the oceans, which cover a total surface area of 361 million km2 (70% of Earth’s surface) at an average depth of almost 4 km (Plate 1). The volume of water in the oceans is 1.4 billion km3, which is one-fifth the volume of the entire crust. The total mass of the hydrosphere is 1.7 · 1018 MT. However, the total water content of the planet is estimated to be 100 times greater than the liquid we see; most of the water on Earth (2 · 1020 MT) is tied up in hydrous oxide minerals in Earth’s interior. We all know that life on Earth could not exist without water. However, to put things in perspective, the total mass of all living things on Earth is 3.6 · 1011 MT, which is 5 million times less than the mass of liquid water on our planet.
The Chemistry of Extended Oxide Surfaces
Authors: Bunker Bruce C. , Casey William H.
Published: November 2020

In Chapters 4 and 5, we demonstrated that local structures and charge distributions have an enormous impact on the equilibrium constants, trajectories, and kinetics of reactions involving soluble oxide precursors. In this chapter, we highlight those features that make reactions on extended oxide surfaces either similar to or dramatically different from the reactions documented in hydrolysis diagrams for each metal cation (see Chapter 5). We first describe oxide surface structures and then discuss how these structures impact both acid–base and ligand-exchange phenomena. In addition to dense oxides, we also introduce some of the chemistry associated with layered materials. Lamellar materials are important from both a fundamental and technological perspective, because water and ions can readily penetrate such structures and provide conditions under which almost every oxygen anion is at an oxide–water interface (see Chapter 10 and Chapter 11). This chapter focuses on oxides containing octahedral cations. The distinctive chemistry of oxides based on tetrahedral cations, including the clay minerals and the zeolites, are the focus of Part Five. The structures of bulk oxides were introduced in Chapter 2. However, for many oxides, the surface structures that interact with aqueous solutions are substantially different from structures found in the bulk. Here, we introduce the basic principles of oxide surfaces that make them chemically active. As a starting point, consider ideal oxide surfaces containing +2 octahedral cations. Pristine oxide surfaces can be created by cleaving perfect crystals in an ultrahigh-vacuum environment. The creation of new surfaces requires an expenditure of energy corresponding to the cohesive energy of the solid, which in turn represents the energy required to break every bond along a given fracture plane. For MgO, the Mg−O bond energy is 380 kJ/mole. Each surface created contains 1.4.1019 oxygen atoms/m2, or 2.4.10−5 moles of bonds. Because two surfaces are created in the fracture event, the initial interfacial energy of each resulting MgO surface is (1/2)(380 kJ/mole)/(2.4_10−5 mole/m2 )=4560 mJ/m2.
The Ion Exchange Behavior of Oxides
Authors: Bunker Bruce C. , Casey William H.
Published: November 2020

Oxides comprise the most common ion-exchange materials on our planet, with the clay minerals alone, formed by the weathering of rock, having a total mass of around 1025 g. This mass represents almost one-third of the total mass of Earth’s crust and is more than six times the mass of Earth’s oceans. These fine-grained ion exchange materials play a major role in mediating the concentrations of ionic species found in freshwater, groundwater, and our oceans (see Chapter 18). Oxide ion exchangers are also of critical importance in removing contaminants from the environment. Nowhere is this role more apparent than in the removal and sequestration of radioactive elements such as 137Cs, 90Sr, and 99Tc, which are serious hazards present in nuclear wastes. Oxide ion exchangers exhibit several properties that make them materials of choice for treating nuclear wastes, including high selectivity, enhanced stability to radiation damage relative to organic exchangers, and the potential as materials to be condensed further into solid waste after they are loaded with radioactive species. Oxide exchangers are extremely useful for extracting valuable cations from complex fluids, such as the lithium used in our highest energy density batteries. Ion exchange also represents a pathway for creating unique nanomaterials, with applications including battery separators, catalysts, optical materials, magnets, and materials for drug delivery. Oxides materials can exhibit exceptional properties as both cation and anion exchangers for a wide range of separation and water treatment technologies. Although the total ion-exchange capacity of an oxide is important for some applications, such as the deionization of water, separations require the use of oxides and hydroxides having the highest degree of ion-exchange selectivity. For selectivity, oxides must be designed with specific sites that exhibit a much higher affinity for one ion than any other, which requires much more sophistication than just generating a net charge. Here, we describe the key factors that control both the capacity and selectivity of inorganic ion exchangers, including (1) the role of acid–base reactions in controlling surface charge and ion-exchange capacity, (2) the role of local charge distributions in determining ion-exchange selectivity, and (3) the effect of shape and selective solvation on enhancing that selectivity.
Stress Corrosion Cracking: Chemically Activated Nanomechanics
Authors: Bunker Bruce C. , Casey William H.
Published: November 2020

Although dissolution reactions involving water can etch and decompose oxides, truly catastrophic failures of oxide structures usually involve fractures and mechanical failures. Geologists and geochemists have long recognized that water and ice both play key roles in promoting the fracture and crumbling of rock (see Chapter 17). Freezing and thawing create stresses that amplify the rate at which water attacks metal–oxygen bonds at the crack tip. The interplay between water and stressed oxides also leads to common failures in man-made objects, ranging from the growth of cracks from flaws in windshields to the rupture of optical fibers in communication systems. In this chapter, we outline how mechanical deformations change the reactivity of metal–oxygen bonds with respect to water and other chemicals, and how reactions on strained model compounds have been used to predict time to failure as a function of applied stress. The basic phenomenon of stress corrosion cracking is illustrated in Figure 16.1. Cracks can propagate through oxide materials at extremely fast rates, as anyone who has dropped a wine glass on the floor can attest. High-speed photography reveals that when glass shatters, cracks can spread at speeds of hundreds of meters per second, or half the speed of sound in the glass. At the other end of the spectrum, cracks in glass can grow from preexisting flaws so slowly that only a few chemical bonds are broken at the crack tip per hour. Because mechanical failures are associated with cracking, it is critical for design engineers to understand the factors that control crack growth rates for this enormous range of crack velocities (a factor of 1012). In addition, because it is difficult to measure crack velocities slower than 10−8 m/second, it is often necessary to make major extrapolations from measured data to predict the long-term reliability of glass and ceramic objects. Will an optical fiber under stress fail in 1 year or 10 years? Answering this question can require accurate extrapolations down to crack growth rates as low as 10−10 m/second.
Introduction
Authors: Kemmerer Lisa
Published: November 2020

When i was in my twenties on a Watson Fellowship that took me to the Tibetan Plateau, I met an Irishman at a low-end restaurant. We had dinner together. Though each of us had met many other people in our travels, there was something magnetic about our connection—I refer to the negative ends of a magnet. We disagreed about pretty much everything. At the time, I would best have been described as a budding philosopher, ethicist, atheist, feminist, and animal liberationist; he was a scientist, mathematician, born-again Christian, and environmentalist. Ideologically we had almost nothing in common, but since we had both been traveling for months with little opportunity to speak English (and even less to engage in meaningful discussions) we spent our days together . . . and argued almost perpetually. Because we tended to meet at dinner, and because I was a vegetarian, our disagreements usually began over food, then spread to innumerable other areas of discord. Despite the discord, we continued our discussions long after we returned to our respective homes. Yet neither reason nor heartfelt pleas shifted the Irishman to a plant-based diet. He was sympathetic to human moral responsibilities for animal suffering (ever the Christian), but on learning of the cruelty of animal agriculture, he merely shifted to “happy meat” and the eggs of “free range” chickens. Though I feverishly pointed to the horrific transport and dependable adolescent slaughter of grass-fed and “free range” animals, and the absence of any nutritional need for animal products in our diet, my energy was wasted. Ultimately, it was the Irishman’s concern for the environment, combined with his predilection for numbers, that altered his dietary choices. Recently my friend composed an essay for an anthology I was putting together, about animal advocacy and environmentalism and the search for common ground. In the process, he applied his math and science skills to calculate the ratio of the mass of wild birds to the ratio of the mass of chickens in the U.K.—1:104. His horror was palpable despite his wry response: “For every ten grams of wild bird, somewhere out there (and close) lies a full kilo of chicken.”
A Fishy Business
Authors: Kemmerer Lisa
Published: November 2020

Oceans cover the majority of the planet and are home to a vast quantity of diverse yet interconnected ecosystems. The volume of living space provided by the sea is 168 times greater than that provided by the earth’s landscapes (Clark et al. 5). Given the wealth of creatures living in the seas, as well as those in lakes, swamps, and rivers, and given the much-touted health aspects of aquatic flesh and the environmental nightmare linked with animal agriculture, should we turn to a diet of pollock, shrimp, and salmon? In the 18th and 19th centuries, a mercury wash was used to produce felt hats. In the process workers were exposed to and absorbed bits of the substance and developed mercury poisoning. As a consequence, those who were employed in the felt hat industry often stumbled about “in a confused state with slurred speech and trembling hands” and “were sometimes mistaken for drunks” (“Mad as a Hatter”). Mercury poisoning “attacks the nervous system, causing drooling, hair loss, uncontrollable muscle twitching, a lurching gait, and difficulties in talking and thinking” (“Mad as a Hatter”). From this comes the term made famous in Lewis Carroll’s Alice in Wonderland, “mad as a hatter.” Between 1973 and 1997, fish consumption rose from 45 to 91 million metric tons (Delgado 1). The American Heart Association recommends eating fish at least twice a week for heart health (“Omega-3 Fatty Acids”). The National Healthy Mothers, Healthy Babies Coalition accepted “thousands of dollars from the fishing industry” to promote a recommendation that pregnant women eat “at least 12 ounces of fish per week” (“Fishy Recommendations” 23). Fish flesh is touted as “healthy meat” in comparison with the flesh of terrestrial animals. Omega-3 fatty acids found in fish are credited with helping everything from heart disease to diabetes, but fish flesh also contains deadly mercury (as well as “dioxins . . . and poly-chlorinated biphenyls”—PCBs) (“Omega-3 Fatty Acids”). Longer-living predator fish such as tuna, marlin, shark, mackerel, and swordfish “can have mercury concentrations that are hundreds or thousands of times, possibly even a million times, greater than concentrations in the water in which they swim” (Smith and Lourie 151).
Causality and Filling the Ignorance Gap
Authors: Gorman Sara E. , Gorman Jack M.
Published: November 2020

There is an old adage: “What you don’t know can’t hurt you.” In the science denial arena, however, this adage seems to have been recrafted to something like: “What you don’t know is an invitation to make up fake science.” Before it was dis¬covered that tuberculosis is caused by a rather large bacteria called Mycobacterium tuberculosis it was widely believed to be the result of poor moral character. Similarly, AIDS was attributed to “deviant” lifestyles, like being gay or using intravenous drugs. When we don’t know what causes something, we are pummeled by “experts” telling us what to believe. Vaccines cause autism. ECT causes brain damage. GMOs cause cancer. Interestingly, the leap by the public to latch onto extreme theories does not extend to all branches of science. Physicists are not certain how the force of gravity is actually conveyed between two bodies. The theoretical solutions offered to address this question involve mind-boggling mathematics and seemingly weird ideas like 12 dimensional strings buzzing around the universe. But we don’t see denialist theories about gravity all over the Internet. Maybe this is simply because the answer to the question does not seem to affect our daily lives one way or the other. But it is also the case that even though particle physics is no more or less complex than molecular genetics, we all believe the former is above our heads but the latter is within our purview. Nonphysicists rarely venture an opinion on whether or not dark matter exists, but lots of nonbiologists will tell you exactly what the immune system can and cannot tolerate. Even when scientific matters become a little more frightening, when they occur in some branches of science, they register rather mild atten¬tion. Some people decided that the supercollider in Switzerland called the Large Hadron Collider (LHC) might be capable of producing black holes that would suck in all of Earth. Right before the LHC was scheduled to be tested at full capacity, there were a few lawsuits filed around the world trying to stop it on the grounds that it might induce the end of the world.
Avoidance of Complexity
Authors: Gorman Sara E. , Gorman Jack M.
Published: November 2020

Every day scores of scientific articles are published that report on the results of studies examining the causes and treatments of diseases. Each of these articles usually has five sections: 1. Abstract: an overall summary of what the paper is about 2. Introduction: an explanation of what the problem is and why the present study may offer new insights 3. Methods: a detailed account of exactly what the investigators did, usually including a statistical section in which the authors explain what mathematical tools they used to decide if their results are meaningful 4. Results: the data collected during the study (full of numbers, tables, and figures) 5. Discussion: the conclusion, in which the scientists explain the significance of their findings, what shortcomings their study had, and what should be done next to further understanding of the field in question It is hoped that other biomedical scientists and clinicians will read as many of these papers as possible so that they can keep up- to-date on the newest information. We expect that our doctors are on the cutting edge of medical science. But of course no individual can approach reading all of these papers, even if he or she narrows the field down by reading only the most relevant topics. Furthermore, scientific papers generally do not make the most gripping reading. Although editors of scientific journals expect the papers they publish to conform to proper spelling, grammar, and syntax, they place a premium on conveying scientific accuracy, not on producing page-turners. So at the end of a long day in the laboratory or clinic, what parts of a paper do scientists and clinicians actually read? The first thing to be ignored is the Methods section. A typical Methods section is full of technical details about who or what the subjects of the study were, what measurements were made, how the data were collected and stored, how informed consent was obtained if human subjects were involved, and what kinds of statistical analyses were done. Of course, this is the most important part of the paper.
Fundamental skills of mental health nursing
Authors: Jim Chapman , Chessum Cheryl
Published: November 2020

A mental health nurse practises the skill and craft of their role in a variety of different settings to reflect the varied range of services provided in today’s mental health services. Whatever the setting or nature of the mental health problem, a set of adaptable mental health nursing skills will be required to enable the nurse to facilitate the safe and effective care of the service user. This care is expected to be individually tailored to the needs of the service user, developed (with only occasional exceptions) collaboratively with the service user, and evaluated with the service user and key partners in care. The principles of the nurse’s practice have to be underpinned and informed by the policies and guidelines that shape contemporary and future services. In the UK, nurses must respond to the essential capabilities (Department of Health 2006a) and the Chief Nursing Officer’s review of mental health nursing (Department of Health 2006b) in order to deliver a service that reflects the reform and quality improvements expected in modern mental health services. Practical skills have to be backed up by a strong knowledge base, with nurses knowing why they do what they do and being able to explain their actions whenever called upon to do so. Where possible and available, what mental health nurses do needs to be done on the basis of the most up-to-date evidence or guidance, which comes in many forms (Sainsbury Centre for Mental Health 2004, National Institute for Clinical Health and Excellence 2004a, Nursing and Midwifery Council 2008a and 2008b). As not all the scenarios that nurses encounter have a textbook answer, it is important that other complementary skills are developed to help them make decisions and deal with scenarios for which there is no clear and obvious answer available. These skills include: • Reasoning using principles and frameworks to weigh up a situation, e.g. ‘To adhere to the NMC Code of Conduct, what do I need to be aware of in this case?’ • Reflecting in or on practice (Schön 1987, Rolfe and Freshwater 2001, Johns 2004) to get a deeper understanding of situations and your own reactions and judgements, especially those values and attitudes you hold that may cause conflict with service users and significant others.
Cardiovascular system
Authors: Green Michelle , Huby Kirsten
Published: November 2020

This chapter will outline the anatomy and physiology of the cardiovascular system and the changes that occur during childhood as this body system matures. Signs and symptoms of cardiovascular failure and nursing assessment and monitoring of the child will also be discussed. This knowledge will enable the nurse to recognize cardiovascular failure as early as possible and commence appropriate interventions. A range of interventions and clinical skills required for cardiovascular support are also explained, utilizing evidence-based guidelines. All aspects of care will be discussed using a family centred and child-friendly approach. The Nursing and Midwifery Council (NMC) introduced the use of essential skills clusters (ESC) to help pre-registration nursing students meet the standards of proficiency required for registration (NMC, 2007b). They are written from the perspective of what the public can expect of a newly qualified nurse and are designed to improve safe and effective practice. The information contained within this chapter covers aspects of most of the skills clusters. In particular, the underpinning principles from: care, compassion, and communication (1); organizational aspects of care (9, 10); infection prevention and control (22, 25, and 26); and nutrition and fluid management (29, 32) which are integrated throughout the discussion. At the end of this chapter you will: ● Understand the anatomy and physiology of the cardiovascular system and the changes that occur during childhood as this body system matures. ● Learn to recognize signs and symptoms of cardiovascular failure. ● Be familiar with nursing assessment and cardiovascular monitoring of the child. ● Understand how the nurse recognizes cardiovascular failure as early as possible and commences appropriate interventions. ● Begin to develop an understanding of the range of interventions and clinical skills required for cardiovascular support. The cardiovascular system is vital for supplying the tissues of the body with blood. This blood supply enables the needs of individual cells for oxygen and nutrients and removal of waste products to be met (metabolic demands). The body is also able to achieve these functions under a variety of circumstances: at rest or sleeping; during exertion through exercise; and during the extra demands placed on the body as a result of illness.
The Planet in a Pebble
Authors: Zalasiewicz Jan
Published: November 2020

This is the story of a single pebble. It is just a normal pebble, as you might pick up on holiday - on a beach in Wales, say. Its history, though, carries us into abyssal depths of time, and across the farthest reaches of space. This is a narrative of the Earth's long and dramatic history, as gleaned from a single pebble. It begins as the pebble-particles form amid unimaginable violence in distal realms of the Universe, in the Big Bang and in supernova explosions and continues amid the construction of the Solar System. Jan Zalasiewicz shows the almost incredible complexity present in such a small and apparently mundane object. Many events in the Earth's ancient past can be deciphered from a pebble: volcanic eruptions; the lives and deaths of extinct animals and plants; the alien nature of long-vanished oceans; and transformations deep underground, including the creations of fool's gold and of oil. Zalasiewicz demonstrates how geologists reach deep into the Earth's past by forensic analysis of even the tiniest amounts of mineral matter. Many stories are crammed into each and every pebble around us. It may be small, and ordinary, this pebble - but it is also an eloquent part of our Earth's extraordinary, never-ending story.
Ghosts in absentia
Authors: Zalasiewicz Jan
Published: November 2020

One of the books that changed my perception of the world is The Open Sea, Part 1, by the marine biologist Sir Alister Hardy. He had set out to write one book about the sea, but found that there was so much to say about the world of the plankton that it took up a whole book (he then had to write another book about everything else). It’s now more than half a century old, and yet this hidden world remains marvellously evoked by his words, and by the antique black and white photographs and line drawings. Coming to this as a palaeontologist, it was eye-opening. I was aware that in the strata, one normally only finds the remains of those forms of life that had some hard parts to fossilize. Bones, teeth, shells—and in the case of the acritarchs, chitinozoa and graptolites, their tough organic casings and homes. I knew that there had been other soft-bodied things out there of course, but alas these don’t register often enough on the radar of the geologically programmed. So the sheer variety and exuberance of this world, revealed in those pages, took me by surprise. The remains of some of this life, within the pebble, lie somewhere within the amorphous black carbon that gives this object its dark colour, and in some of the subtle chemical signals of the rock itself. Parts of the hidden Silurian sea are beginning to be decoded from this unpromising material, and the stories emerging—fragmentary, ambiguous, tantalizing— sometimes have surprising uses. Tow a fine-mesh net behind a ship for a few minutes, as Hardy did as a working scientist, and then examine its contents with a microscope, and a small fraction of this world is revealed—enough to reveal its almost boundless diversity. There are microscopic plants, the base of the food chain: the diatoms, for instance, single-celled algae with a silica skeleton that looks like a tiny ornate hatbox; the coccolithophores, even smaller algae with a bizarre calcium carbonate skeleton made of overlapping shield-like discs, and the dinoflagellates, too.
The literature review
Authors: William Eardley
Published: November 2020

A major part of any study, the literature review has a variety of influences over a project which may not be immediately apparent to those new to the research field. In essence, pulling a number of citations out of a search engine to request from the library is only one small element of this important tool in addressing the research question. Before discussing the practicalities of the literature review we need to establish what it is, why it is necessary to do one in the first place, and how such a review fits into both the research process and the finished dissertation. Before being able to establish a research question or decide on a design to address a clinical problem, it is necessary to have an awareness of published material pertaining to that subject. In broad terms, what do we already know? Through an appraisal of the literature, one can identify if further investigation is merited, avoid duplication, and benefit from the experiences of those exploring similar issues. . . . It is generally unwise to define something as important as a dissertation topic without first obtaining a broad familiarity with the field. (Rudestam and Newton, 1992, p.9) ( 1 ) . . . A comprehensive review of the literature will ensure you have a grasp of up-to-date knowledge, which is key to putting any research project into context. Whilst in-depth critical appraisal of the relevant literature may not be necessary at this point, one can see that a literature review is required to turn an interesting idea into a research question. Having established its role in the conception of a research question, once the project is underway the review serves a variety of purposes. No research is unique in all its aspects — at least some of the features addressed in the project will have been previously described and may be used to justify why further investigation is required. To this end each individual research project forms one part of a bigger ‘evidence-based jigsaw puzzle’. Without an appreciation of all the other bits of the puzzle it is impossible to provide a background and identify a gap in the knowledge base which we wish to address.
Abdomen
Authors: Afzali Behdad , Negus Rupert P. M.
Published: November 2020

The abdominal station in MRCP PACES should be a ‘set piece’ that can be approached with confidence. You are likely to encounter patients with chronic stable disease such as chronic liver disease, haematological malignancy with associated hepatosplenomegaly and chronic kidney disease, particularly those undergoing some form of renal replacement therapy, for instance dialysis or transplantation. Signs in the abdomen are generally straightforward to elicit and the commonest obstacles to passing are poor presentation or a failure to put the features together in a logical fashion. Many diagnostic findings in the abdominal station can be identified by inspection alone, so particular attention should be paid to adequate exposure and the identification of extra-abdominal signs (e.g. multiple spider naevi of chronic liver disease, telangiectasia of hereditary haemorrhagic telangiectasia and xanthelasmata in primary biliary cirrhosis). Do not forget to have a good look at the back as important signs may be restricted there (e.g. spider naevi or posterior nephrectomy scars). During the observation phase, attention should be paid to the nutritional status of the patient and to any other available clues (for instance, one of the authors, BA, diagnosed bilateral adrenalectomies from a medic alert bracelet at the bedside in his MRCP exam). The presence of abdominal scars is very useful as they usually overlie the organs that have been surgically handled. Whist surgery is frequently concerned with resecting parts or the whole of organs, remember that organs, including kidneys, pancreas and liver, may also be transplanted. As a result of a detailed end-of-the bed examination, sufficient information may be garnered to allow a diagnosis to be formulated, with subsequent palpation, percussion and auscultation, simply confirming the suspected diagnosis. Keep to a well-practised order to produce a fluid display which you should be able to complete in around 5 minutes. 1. Introduce yourself to the patient and lie them down if this has not already been done. Ask if there is pain or tenderness anywhere. 2. Inspect the patient from the end of the bed. Ensure that you look for any additional clues, such as those around the bedside.
Introduction
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

Much of our present knowledge of the architecture of molecules has been obtained from studies of the diffraction of X rays or neutrons by crystals. X rays are scattered by the electrons of atoms and ions, and the interference between the X rays scattered by the different atoms or ions. in a crystal can result in a diffraction pattern. Similarly, neutrons are scattered by the nuclei of atoms. Measurements on a crystal diffraction pattern can lead to information on the arrangement of atoms or ions within the crystal. This is the experimental technique to be described in this book. X-ray diffraction was first used to establish the three-dimensional arrangement of atoms in a crystal by William Lawrence Bragg in 1913 (Bragg, 1913), shortly after Wilhelm Conrad Röntgen had discovered X rays and Max von Laue had shown in 1912 that these X rays could be diffracted by crystals (Röntgen, 1895; Friedrich et al., 1912). Later, in 1927 and 1936 respectively, it was also shown that electrons and neutrons could be diffracted by crystals (Davisson and Germer, 1927; von Halban and Preiswerk, 1936; Mitchell and Powers, 1936). Bragg found from X-ray diffraction studies that, in crystals of sodium chloride, each sodium is surrounded by six equidistant chlorines and each chlorine by six equidistant sodiums. No discrete molecules of NaCl were found and therefore Bragg surmised that the crystal consisted of sodium ions and chloride ions rather than individual (noncharged) atoms (Bragg, 1913); this had been predicted earlier by William Barlow and William Jackson Pope (Barlow and Pope, 1907), but had not, prior to the research of the Braggs, been demonstrated experimentally. A decade and a half later, in 1928, Kathleen Lonsdale used X-ray diffraction methods to show that the benzene ring is a flat regular hexagon in which all carbon–carbon bonds are equal in length, rather than a ring structure that contains alternating single and double bonds (Lonsdale, 1928).Her experimental result, later confirmed by spectroscopic studies (Stoicheff, 1954), was of great significance in chemistry.
Symmetry and space Groups
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

A certain degree of symmetry is apparent in much of the natural world, as well as in many of our creations in art, architecture, and technology. Objects with high symmetry are generally regarded with pleasure. Symmetry is perhaps the most fundamental property of the crystalline state and is a reason that gemstones have been so appreciated throughout the ages. This chapter introduces some of the fundamental concepts of symmetry—symmetry operations, symmetry elements, and the combinations of these characteristics of finite objects (point symmetry) and infinite objects (space symmetry)—as well as the way these concepts are applied in the study of crystals. An object is said to be symmetrical if after some movement, real or imagined, it is or would be indistinguishable (in appearance and other discernible properties) from the way it was initially. The movement, which might be, for example, a rotation about some fixed axis or a mirror-like reflection through some plane or a translation of the entire object in a given direction, is called a symmetry operation. The geometrical entity with respect to which the symmetry operation is performed, an axis or a plane in the examples cited, is called a symmetry element. Symmetry operations are actions that can be carried out, while symmetry elements are descriptions of possible symmetry operations. The difference between these two symmetry terms is important. It is possible not only to determine the crystal system of a given crystalline specimen by analysis of the intensities of the Bragg reflections in the diffraction pattern of the crystal, but also to learn much more about its symmetry, including its Bravais lattice and the probable space group. As indicated in Chapter 2, the 230 space groups represent the distinct ways of arranging identical objects on one of the 14 Bravais lattices by the use of certain symmetry operations to be described below. The determination of the space group of a crystal is important because it may reveal some symmetry within the contents of the unit cell.
Structural parameters: Analysis of results
Authors: Glusker Jenny Pickworth , Trueblood Kenneth N.
Published: November 2020

The results of an X-ray structure analysis are coordinates of the individual, chemically identified atoms in each unit cell, the space group (which gives equivalent positions), and displacement parameters that may be interpreted as indicative of molecular motion and/or disorder. Such data obtained from crystal structure analyses may be incorporated into a CIF or mmCIF (Crystallographic Information File or Macromolecular Crystallographic Information File). These ensure that the results of crystal structure analyses are usefully archived. There are many checks that the crystallographer can make to ensure that the CIF or mmCIF file is correctly informative. For example, the automated validation program PLATON (Spek, 2003) checks that all data reported are up to the standards required for publication by the International Union of Crystallography. It does geometrical calculations on the structure, illustrates the results, finds if any symmetry has been missed, investigates any twinning, and checks if the structure has already been reported. We now review the ways in which these atomic parameters can be used to obtain a three-dimensional vision of the entire crystal structure. When molecules crystallize in an orthorhombic, tetragonal, or cubic unit cell it is reasonably easy to build a model using the unit-cell dimensions and fractional coordinates, because all the interaxial angles are 90◦. However, the situation is more complicated if the unit cell contains oblique axes and it is often simpler to convert the fractional crystal coordinates to orthogonal coordinates before calculating molecular geometry. The equations for doing this for bond lengths, interbond angles, and torsion angles are presented in Appendix 12. If the reader wishes to compute interatomic distances directly, this is also possible if one knows the cell dimensions (a, b, c, ∝ , β , γ ,), the fractional atomic coordinates (x, y, z for each atom), and the space group.
Language and the subconscious
Authors: Cyna Allan M , Tan Suyin GM
Published: November 2020

Many of the communications commonly encountered in anaesthetic practice elicit subconscious responses, and, because this is so, they frequently go unrecognized. This form of communication involves verbal and non-verbal cues also known as suggestions that can elicit automatic changes in perception or behaviour. Much of this chapter is based on language structures that are thought to make subconscious changes in perception, mood or behaviour more likely, both with patients and anaesthetists themselves. Recognizing subconscious responses will facilitate communication. As is discussed later, anaesthetists can communicate with patients and colleagues in ways that utilize subconscious functioning. To all intents and purposes this looks like intuitive communication, when in reality it has structure and therefore can be learned and taught. The conscious and unconscious states are familiar to all anaesthetists. However, it is frequently unappreciated that all patients, whether in an unconscious or conscious state, will also be functioning subconsciously. In the unconscious patient it is well recognized that subconscious activities still occur—for example, in implicit awareness. Most people would appreciate that there are times during consciousness when they switch off the ‘logical brain’ and enter ‘daydream’-type thinking or they ‘tune out’. People including anaesthetists tend to function subconsciously most of the time—for example, during routine activities such as driving home on ‘autopilot’ and arriving home without realizing it consciously. The ability we all have to function automatically—that is, subconsciously—frees up the conscious part of the mind to focus on other things such as planning tomorrow’s ‘neuro’ case. The teleological basis for this ability lies in being able to filter the massive amount of information continuously presented to the individual. This allows the conscious mind to focus on what it perceives to be important—facilitating learning, logical thinking and problem solving. During activities where logical thinking is not a requirement, the subconscious comes to the fore. This is characterized by dissociation from the external environment—being ‘in your own world’. Paradoxically, at times of extreme stress, the subconscious tends to take over when the conscious part of the mind becomes so overwhelmed by external inputs it ceases to function logically.
The pre-anaesthetic visit
Authors: Kopp Vincent J
Published: November 2020

This chapter addresses deficiencies in pre-anaesthesia communication. Here, the use of medical narrative illustrates communication-enhancing techniques and attitudes that may help anaesthetists anticipate and respond to the biopsychosocial content, extant in the pre-anaesthesia assessment setting. By any measure, the pre-anaesthesia evaluation sets anaesthesia care in motion. Until now, little has been written about the development of a learnable framework for effective communication, in this or any other anaesthesia care setting. With respect to pre-anaesthesia communication, the need for heuristics or ‘rules of thumb’ is ever acute to improve rapport, elicit and respond to questions, manage ambiguity, as well as to obtain valid consent. Furthermore, anaesthetists have to communicate effectively with patients about conflicting advice, prior negative anaesthetic experiences and fears about awareness and intraoperative death. A 56-year-old man scheduled for an elective left inguinal herniorrhaphy meets his anaesthetist minutes before surgery is to begin. Three days before, the patient presented to hospital with his hernia incarcerated. It was easily reduced. A follow-up office visit with his surgeon preceded the surgery. The patient’s sole co-morbidity is benign prostatic hypertrophy. On the morning of surgery this otherwise healthy-appearing man, accompanied by his wife, meets the anaesthetist for the first time. After record review the patient is told three anaesthetic options exist—local anaesthesia with intravenous sedation, general anaesthesia and spinal anaesthesia — and that ‘spinal is the way to go’. Unquestioningly, the patient agrees to spinal anaesthesia. The spinal block is easy to place. The surgery is uneventful. Post-operatively, the patient cannot urinate. His discharge from the day-surgery unit is delayed by hours. He is told it is because of ‘the spinal’. Bladder catheterization ensues. The rest of his recuperation is uneventful, except for lingering feelings of betrayal, distrust and disappointment. He wonders why he was not told spinal anaesthesia might cause urinary retention. He becomes angry. He resolves never to use that anaesthetist’s or hospital’s services again. His wife even urges him to sue them both for pain and suffering. What could have been done to effect a more positive outcome for the patient, the anaesthetist and the hospital? The answer lies, at least in part, in improved communication.
Perioperative care
Authors: Smith Andrew F , Cyna Allan M
Published: November 2020

The perioperative period can be a life-changing event for many patients, the effects of which can be lifelong for better or worse. The anaesthetist’s communication at this time can have a profound impact on the care of their patients in the matter of both short-term cooperation and long-term perceptions of their hospital experience. Induction of anaesthesia is a stressful time for many patients, young and old. There is an inevitable loss of control when the patient hands this over temporarily to the anaesthetist. In order to enhance cooperation, anaesthetists will reap unexpected benefits by avoiding the use of negative language. Well-meaning staff may, however, sabotage an otherwise smooth induction by telling patients, ‘There is nothing to worry about’ with the implicit suggestion that there is ‘something to worry about’. Unfortunately such well-meaning statements, even when directed at children, tend to yield the opposite effect of what is intended. Patient stress at this time increases suggestibility such that comments frequently function as inadvertent suggestions—be they positive or negative. This can be utilized to enhance the anaesthetist’s ability to provide a smooth, safe and stress-free induction. A typical series of pre-induction communications may go something like, … ‘Don’t worry we won’t drop you’. As the patient is transferred from a trolley to the operating table. ‘The blood pressure cuff gets really tight and may hurt and try not to move while it’s pumping up’. ‘That noise over there is just the nurse checking the drill!’… Explaining what is happening in simple straightforward non-technical language, and at the same time communicating in a positive way, is invariably the more useful approach. For example, …‘Welcome to the operating room Mr P ’. ‘You can relax as we move you to this other bed—you are quite safe’. ‘We will place some monitoring leads on so we can keep you safe and comfortable. A pulse monitor gently placed on your finger, an ECG on your chest and a blood pressure cuff on your arm. As the blood pressure cuff tightens and we take its reading this often allows patients to relax knowing how closely we are looking after them’. …
The paediatric patient
Authors: Sainsbury David , Cyna Allan M
Published: November 2020

Anaesthetists usually develop their communication skills through experience over many years of trial and error. Much angst can be avoided by learning some simple techniques that can facilitate interactions during the delivery of anaesthesia care. Caring for children from newborn to adolescence provides the anaesthetist with unique opportunities to use communication to improve anaesthesia care. To a parent, the matter of handing over control and protection of their child to the anaesthetist is invariably difficult, emotional and can lead to significant distress. This is irrespective of whether the surgical intervention is major or not. For their child to attend the hospital for a procedure, families have frequently made unspoken and intricate arrangements in their schedule. Making these arrangements adds to the other stresses of coming in for surgery. Being mindful of this can help the anaesthetist communicate in a way that recognizes the possible complexity for some families of even attending the hospital on time. In recent years the increasing popularity of day-surgery admission has meant that many parents meet their child’s anaesthetist for the first time only minutes before the procedure. However, much can be done to enhance patient and parent rapport even when only a short time is available. Flexibility in approach is paramount. The age of the child determines how the ‘LAURS’ of communication can be implemented to facilitate patient rapport, trust and engagement during anaesthesia care. Communicating with children is similar to, yet differs from, communicating with adults. Children live in a subconscious world of play and make-believe. They are highly responsive to suggestion, and the use of subconscious language and non-verbal cues is frequently more effective than the usual adult logical communication most doctors are familiar with. Because of this, children often do not appear to be paying attention and instead frequently behave spontaneously, subconsciously or contrary to what is being asked of them. Adults when stressed will often do this too. As with adults, the aim of communicating effectively with children is to promote autonomy and a sense of control.