bluuebunny/crossref_metadata_2025 huggingface dataset:
Convent and Family Property in New Spain
Authors: Loreto López Rosalva
Published: August 2018

The process of establishing women’s convents in Hispanic America must be understood as the result of converging expectations from the crown, the church, and important laypeople who were interested in re-creating a Catholic world in the cities of the New World. The importance of women’s convents depended on the regular clergy as well as the secular, both of whom were invested in replicating their own religious identity. The role of families was also critical in the processes of establishing and populating the fifty-eight convents, as it was the nun’s families who expanded their networks of power, pedigree, and the reproduction of their own lineage by way of these institutions. Finally, the study of convent wealth is also essential to understanding the mutual dependence between the urban growth of cities and the expansion of these women’s institutions.
Political Economy, Race, and National Identity in Central America, 1500–2000
Authors: Euraque Dario A.
Published: August 2018

The relationship between historically specific ideas of race and national identity in Central America between the onset of Spanish colonialism in the region, in about 1500, and the end of the 20th century is very complicated. The relationship is rooted not only in the political economy of the region and subregions that were under Spanish colonialism, but also in Spain’s resistance to incursions of British colonialism in the area, particularly on the North Coast, well into the late 18th century, and in some areas of Central America into the 1850s. The nexus between the political economy of nation-state formation in the postcolonial setting deepened after break of the Federation of Central America in the late 1830s, especially after the rise of coffee and bananas as major regional exports. Independent governments in Guatemala, El Salvador, Honduras, Nicaragua, and Costa Rica tried to impose “imagined political communities” over these exports that would be different from the colonial identities designed by the Spanish imperialism of the past. In this 20th century context, mestizaje, or ladinizaje, became state sanctioned; it promoted racialized national identities in each of these countries, mostly the idea of ethnicity, albeit with critical regional and subregional differences, particularly between Guatemala and Costa Rica. Historiographies that have been influenced by postmodern sensibilities, particularly critical race theory, the new cultural history, and subaltern studies, have influenced recent understanding of the political economy of race and nationality in Central America.
Mexico and the Outside World
Authors: Schuler Friedrich E.
Published: August 2018

Mexican elites emerging out of the political civil wars of the 19th century threw their support behind French positivism and its theory that a nation could thrive through economic, industrial, and foreign-financed development. The strategy’s very success created the profound economic dislocations that triggered regional revolutions in Mexico’s center and north. Foreign observers misread these events as small rebellions and acted accordingly.

In this environment Francisco Madero became Mexico’s first democratic president. Even though he leaned toward the United States, he pleased no foreign and domestic faction and was deposed and murdered by a domestic-foreign element. Emerging dictator Victoriano Huerta perplexed all foreign observers. As US president Woodrow Wilson made fighting against Huerta’s tenure a symbol of an idealistic new policy, Canadian, European, and Latin American governments picked Venustiano Carranza at the Conference of Niagara Falls to be his successor.

The new context of World War I interrupted all of Mexico’s bilateral economic relations. The country’s national revolutions became side theaters of the global war. By 1918 the collapse of empires had changed all politicians’ outlooks.

The 1920s were dominated by strife with the Vatican and US laissez-faire policy but also pragmatic US-Mexican border relations steered by President Abelardo Rodriguez.

During the Great Depression, Mexico attempted to avoid importing food. US artists, tourists, and Europeans were inspired by Mexico’s murals and social justice movements for peasants. After 1934 Lazaro Cardenas steered these policies to the left; in 1938 he expropriated US, British, and Dutch-owned oil companies as well as US agrarian property.

After 1940 government technocrats under Ávila Camacho turned the country toward exploiting the Allies’ economic war needs. World War II found Mexico on the side of the Allies, as expressed in unprecedented security, economic, and military cooperation. The Mexican air force flew missions in the Philippines. This US-Mexican rapprochement and its architects were replaced after 1943, and the rise of the Cold War changed international linkages once again.
Mixed Languages
Authors: Meakins Felicity
Published: August 2018

Mixed languages are a rare category of contact language which has gone from being an oddity of contact linguistics to the subject of media excitement, at least for one mixed language—Light Warlpiri. They show considerable diversity in structure, social function, and historical origins; nonetheless, they all emerged in situations of bilingualism where a common language is already present. In this respect, they do not serve a communicative function, but rather are markers of an in-group identity. Mixed languages provide a unique opportunity to study the often observable birth, life, and death of languages both in terms of the sociohistorical context of language genesis and the structural evolution of language.
The Language of the Economy and Business in the Romance Languages
Authors: Rainer Franz
Published: August 2018

The expression language of the economy and business refers to an extremely heterogeneous linguistic reality. For some, it denotes all text and talk produced by economic agents in the pursuit of economic activity, for others the language used to write or talk about the economy or business, that is, the language of the economic sciences and the media. Both the economy and business contain a myriad of subdomains, each with its own linguistic peculiarities. Language use also differs quite substantially between the shop floor and academic articles dealing with it. Last but not least, language is itself a highly articulate entity, composed of sounds, words, concepts, etc., which are taken care of by a considerable number of linguistic disciplines and theories. As a consequence, this research landscape offers a very varied picture.

The state of research is also highly diverse as far as the Romance languages are concerned. The bulk of relevant publications concerns French, followed at a certain distance by Spanish and Italian, while Romanian, Catalan, and Portuguese look like poor relations. As far as the dialects are concerned, only those of some Italian cities that held a central position in medieval trade, like Venice, Florence, or Genoa, have given rise to relevant studies. As far as the metalanguage used in research is concerned, the most striking feature is the overwhelming preponderance of German and the almost complete absence of English. The insignificant role of English must probably be attributed to the fact that the study of foreign business languages in the Anglo-Saxon countries is close to nonexistent. Why study foreign business languages if one own’s language is the lingua franca of today’s business world? Scholars from the Romance countries, of course, generally write in their mother tongue, but linguistic publications concerning the economic and business domain are relatively scarce there. The heterogeneity of the metalanguages used certainly hinders the constitution of a close-knit research community.
Use of Property Values and Location Decisions for Environmental Valuation
Authors: Ma Lala
Published: August 2018

The economics literature has developed various methods to recover the values for environmental commodities. Two such methods related to revealed preference are property value hedonic models and equilibrium sorting models. These strategies employ the actual decisions that households make in the real estate market to indirectly measure household demand for environmental quality. The hedonic method decomposes the equilibrium price of a house based on the house’s structural and neighborhood/environmental characteristics to recover marginal willingness to pay (MWTP). The more recent equilibrium sorting literature estimates environmental values by combining equilibrium housing outcomes with a formal model of the residential choice process. The two predominant frameworks of empirical sorting models that have been adopted in the literature are the vertical pure characteristics model (PCM) and the random utility model (RUM). Along with assumptions on the structure of preferences, a formal model of the choice process on the demand side, and a characterization of the supply side to close the model, these sorting models can predict outcomes that allow for re-equilibration of prices and endogenous attributes following a counterfactual policy change.

Innovations to the hedonic model have enabled researchers to more aptly value environmental goods in the face of complications such as non-marginal changes (i.e., identification and endogeneity concerns with respect to recovering the entire demand curve), non-stable hedonic equilibria, and household dynamic behavior. Recent advancements in the sorting literature have also allowed these models to accommodate consumer dynamic behavior, labor markets considerations, and imperfect information. These established methods to estimate demand for environmental quality are a crucial input into environmental policymaking. A better understanding of these models, their assumptions, and the potential implications on benefit estimates due to their assumptions would allow regulators to have more confidence in applying these models’ estimates in welfare calculations.
International Child Development Accounts
Authors: Sherraden Michael , Cheng Li-Chen , Ssewamala Fred M. , Kim Youngmi , Loke Vernon , Zou Li , Chowa Gina , Ansong David , Johnson Lissa , Lee YungSoo , Grinstein-Weiss Michal , Clancy Margaret M. , Huang Jin , Beverly Sondra G. , Nam Yunju , Han Chang-Keun
Published: August 2018

Child Development Accounts (CDAs) are subsidized savings or investment accounts to help people accumulate assets for developmental purposes and life course needs. They are envisioned as universal (everyone participates), progressive (greater subsidies for the poor), and potentially lifelong national policy. These features distinguish CDAs from most existing asset-building policies and programs around the world, which are typically regressive, giving greater benefits to the well-off. With policy innovation in recent years, several countries now have national CDA policies, and four states in the United States have statewide programs. Some of these are designed to be universal and progressive. Evidence indicates that true universality can be achieved, but only with automatic account opening and automatic deposits. In the absence of automatic features, advantaged families participate and benefit more. Today, momentum for universal and automatic features is gradually gaining traction and accelerating. At this stage in the emergence of inclusive asset-based policy, this is the most important development.
Racial Disparities in the Criminal Justice System
Authors: McCarter Susan A.
Published: August 2018

Social work and criminal justice have a shared history in the United States dating back to the 19th century when their combined focus was rehabilitation. But with an increase in crime, this focus shifted to punishment and incapacitation, and a schism resulted between social work and criminal justice. Given current mass incarceration and disparities in criminal justice, social work has returned in force to this important practice. The latest Bureau of Justice Statistics research reports that 1% of all adult males living in the United States were serving a prison sentence of a year or longer (Carson & Anderson, 2016) and rates of diversion, arrest, sentencing (including the death penalty), incarceration, etc., vary considerably by race/ethnicity (Nellis, 2016). This entry explores race and ethnicity, current population demographics, and criminal justice statistics/data analysis, plus theories and social work-specific strategies to address racial and ethnic disparities in the criminal justice system.
15. Exams and Revision
Authors: Moore Imogen , Newbery-Jones Craig
Published: August 2018

Exams are the most common form of assessment in UK law schools, and the student will almost inevitably sit quite a few of them during their legal studies. A successful law student wants their success reflected in their results — and exams will make up a big part of those results. By understanding the format of exams, knowing how best to prepare for them, and thinking about effective approaches to them, the student can approach exams calmly and be in the best possible position to achieve the results they feel that they deserve. This chapter looks at all these things, with hints and tips on things to do and things to avoid in revision, preparation, and exam.
19. Preparing to move on
Authors: Moore Imogen , Newbery-Jones Craig
Published: August 2018

Inevitably, legal studies will come to an end and it will be time to move on. Preparing to move on is something to give thought to throughout the period of legal studies, even if the focus is quite strong towards the later stages. The student will need to apply for many opportunities, such as vacation schemes with law firms, quite early on in their degree — particularly if they want to make full use of the time they have before graduation. This chapter looks at what the student can do to be prepared to move on, to increase their chances of success in the next stage of their life, and maximise the value of their time as a law student. It looks in particular at the importance of planning and reflection, sources of support and guidance, preparing CVs and applications and dealing with setbacks.
20. Career pathways
Authors: Moore Imogen , Newbery-Jones Craig
Published: August 2018

This chapter discusses the valuable, marketable features of a law degree, before moving on to consider particular career pathways. It discusses traditional legal pathways — towards a career as a solicitor, barrister or legal executive. It considers other career pathways that have little to do with the law on a day-to-day basis, but welcome law graduates because of the skills they offer. The chapter also looks at the opportunities for, and merits of, further study. A book of this nature cannot cover absolutely everything, nor tell you everything you need to do on any particular path. But it highlights the breadth of possibilities open to you as a successful law student, and gives you some things to consider as you contemplate options and head on to a career pathway.
10. Funding legal services
Authors: Partington Martin
Published: August 2018

This chapter focuses on how legal services, in particular litigation, to the less well-off and the poor are paid for. It considers first the radically changed shape of legal aid and publicly funded legal services. It discusses developments designed to control the costs of litigation. It summarizes new ideas that have been developing for the funding of litigation and improving access to justice. Finally it asks whether other processes—alternatives to courts—might be better at providing cost effective and proportionate dispute resolution services.
11. The transformation of the English legal system: pressures and challenges
Authors: Partington Martin
Published: August 2018

This examines the transformation of the legal system over the last twenty years. It contemplates the further changes that are now in progress. It examines the political and financial pressures that have led to the need for reform and the challenges that the transformation programme must face, stressing in particular the need to ensure access to justice. It considers briefly the importance of public legal education in helping people understand their legal rights and obligations.
10. Regional shifts and US foreign policy
Authors: Trubowitz Peter
Published: August 2018

This chapter examines the impact of regional shifts on the making of US foreign policy. One of the most distinctive features of American politics is regionally based political competition and conflict. Scholars argue that regionalism in American politics is rooted in the geographically uneven nature of economic growth and development. The chapter first revisits debates over American foreign policy in the 1890s, the 1930s, and the current era, focusing on issues such as those relating to expansionism and hegemony, internationalism, militarism, and the disagreement between ‘red America’ and ‘blue America’ over foreign policy matters. It then explains how regional diversity causes tension and conflict in foreign policy and argues that conflicts over the purposes of American power, as well as the constitutional authority to exercise it, stem from the distribution of wealth and power in American society among coalitions with divergent interests and claims on the federal government’s resources.
19. Religion
Authors: Marsden Lee
Published: August 2018

This chapter examines the influence of religion on US foreign policy. It first considers how religion affected American policy during the Cold War, from the time of Harry S. Truman to George H. W. Bush, before discussing the bilateral relationship between Israel and the United States. It then looks at the rise of the American Israel Public Affairs Committee (AIPAC), a US-based interest group, and how its work has been complemented by conservative evangelicals and fundamentalists who ascribe to Christian Zionism. It also explores the ways in which religion has intersected with the global war on terror and US foreign policy, how the US resorted to faith-based diplomacy, the issue of religious freedom, and George W. Bush’s Emergency Plan for AIDS Relief (PEPFAR) in Africa. The chapter concludes with an analysis of the Office of Religion and Global Affairs (ORGA), created by Barack Obama.
21. Global environment
Authors: Eckersley Robyn
Published: August 2018

This chapter examines how US foreign policy on environmental issues has evolved over a period of nearly five decades, from Richard Nixon to Barack Obama. It first considers the United States’ environmental multilateralism as well as environmental initiatives under Nixon, Jimmy Carter, Ronald Reagan, George H. W. Bush, Bill Clinton, George W. Bush, Obama, and Donald Trump before discussing key trends and puzzles in US foreign environmental policy. It shows the United States as an environmental leader during the Cold War, but an environmental laggard in the post–Cold War period, with the Obama administration’s re-engagement in climate diplomacy as a significant exception. The chapter also explains how the larger trend of waning environmental leadership from the United States has occurred at the same time as international environmental problems, especially climate change, have increasingly moved from the periphery towards the centre of world politics.
22. The American liberal order: from creation to crisis
Authors: Ikenberry G. John
Published: August 2018

This chapter examines the rise and evolution of the liberal order that was created by the United States and and other liberal democratic states in the decades after World War II, along with the modern challenges to it. The liberal order that emerged after World War II paved the way for a rapid expansion in world trade, the successful integration of former enemies such as Japan and Germany, and the transition to liberal democracy in formerly authoritarian states. Furthermore, the collapse of communism was considered a triumph of liberalism. The chapter first explains how the American liberal order was constructed after World War II before discussing the successes of that order and the end of the ‘socialist’ project in the 1980s. It also analyzes some of the major threats to this liberal order today, particularly those from within, as a result of Donald Trump’s rejection of the American liberal tradition.
2. Politics and the State
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter discusses the importance of the state and sovereignty to the study of politics. It first provides an empirical typology of the state, from the minimalist night-watchman state to the totalitarian state, before considering various theories of the state such as Marxism, pluralism, elitism, and the New Right. Two key general points about these competing theories are examined. First, an organizing theme relates to what each of these theories say about the distribution of power. Second, the theories can be analysed in both empirical and normative terms. The chapter concludes with a discussion of the claim that the state has significantly declined in importance, mainly as a result of economic globalization.
4. Democracy
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter examines key aspects of democratic theory. It first defines what democracy means and traces the historical evolution of the term, from the time of the ancient Greeks to the French and American revolutions up to the nineteenth-century, when democracy began to take on more popular connotations in theory and practice. The chapter goes on to discuss the debate between advocates of the protective theory and the participatory theory of democracy. It also considers alleged problems with democracy — relating to majoritarianism, its impact on economic efficiency, and its relationship with desired outcomes — before concluding with an analysis of the new directions democratic theory has taken in recent years, including associative, deliberative, cosmopolitan, and ecological versions of democracy.
16. Civil Society, Interest Groups, and Populism
Authors: Ferdinand Peter , Garner Robert , Lawson Stephanie
Published: August 2018

This chapter explores the role of civil society, interest groups, and populism in politics. It first considers the concept of ‘civil society’ and how it came to be associated with the protests that brought down communist regimes in Eastern Europe, along with its role in the Arab Spring. It then looks at interest groups as a major component of civil society, the rise of corporatism, and the notion of ‘infrapolitics’ or politics from below. It also discusses the growing phenomenon of populism as a way of enhancing the status and position of previously neglected groups in democracies as well as a challenge to liberal democracies. A case study on populism online involving Beppe Grillo and the Five star Movement is presented. The chapter suggests that populist politicians make use of the media to forge a direct relationship with their supporters.
2. The Political Organization of Parliament
Authors: Norton Philip
Published: August 2018

This chapter discusses the political organization of the UK Parliament, at the heart of which are the political parties. It first considers the internal organization of Parliament, focusing on how political parties are structured. There are two principal parties facing one another in Parliament: the party in government and opposition parties. The opposition comprises frontbench Members (shadow ministers) and backbenchers. Smaller parties may also designate some Members as ‘frontbenchers’ (official spokespeople for the party). The frontbench of each party includes whips. The chapter provides an overview of these whips as well as parliamentary parties before considering legislative–executive relations. In particular, it examines how parties shape the relationship between Parliament and the executive, and how these have changed over time.
5. The Significance of Rituals in Parliament
Authors: Crewe Emma , Evans Paul
Published: August 2018

This chapter examines the significance of rituals in the UK Parliament, focusing on the centrality of rules in such rituals, how parliamentary debates are ritualized, and how ceremonies order relationships between different groups in our political world. It first explains the purpose of parliamentary rituals and how they are regulated, showing that the value attached to the way Parliament ritualizes its interaction is strongly contested between Members of Parliament (MPs) and by outside commentators. In particular, it considers Standing Orders, rules made by either the House of Commons or the House of Lords to set out the way certain aspects of House procedures operate. The chapter also discusses how rituals result in conflict and conciliation and as markers of power, hierarchy, and identity in Parliament.
7. The Legislative Cycle
Authors: Smyth Liam Laurence , McKee Glenn , Korris Matt
Published: August 2018

This chapter focuses on the legislative cycle in the UK Parliament and how it operates within the annual parliamentary session (typically June to May). The session commences with the ceremonial State Opening of Parliament highlighted by the Queen's Speech announcing the main items in the government's forthcoming legislative programme. There is no requirement for government bills to be pre-announced in the Queen's Speech, and all the bills mentioned are not necessarily brought forward by the government. The chapter first provides an overview of Parliament's legislative programme before discussing the process of legislative drafting, pre-legislative scrutiny of bills, parliamentary procedure with regard to bills, and how the consideration of a bill is managed. It also outlines the legislative stages of a bill and the time taken to pass a bill and concludes with an analysis of Money Bills and Finance Bills.
17. Questioning the Government
Authors: Bates Stephen , Kerr Peter , Serban Ruxandra
Published: August 2018

This chapter examines how accountability is carried out in the UK Parliament through various questioning procedures which enable ministers and the government to explain and defend their decisions. Questioning the government provides an important means for Members of Parliament (MPs) and peers to hold the government, the prime minister, ministers, and departments to account. There are two main types of parliamentary questions: oral questions and written questions. Oral questions are both asked and answered on the Floor of the House of Commons or the House of Lords, whereas written questions are ‘often used to obtain detailed information about policies and statistics on the activities of government departments’. The chapter first explains these two types of parliamentary questions before discussing their purposes. It also considers debates over the issue of reforming parliamentary questions, and more specifcally Prime Minister's Questions (PMQs).
25. MPs and their Constituencies
Authors: Judge David , Partos Rebecca
Published: August 2018

This chapter examines what ‘constituency’ means for Members of Parliament (MPs) and their local electorates, and how perceptions of locality affect the work of MPs and the expectations of their constituents. As the representatives of their respective geographical areas, MPs bring the opinions, concerns, and tribulations of their constituents into the workings of the UK Parliament. Such representational work is ofen overlooked or ignored by outside observers and commentators, but it provides a necessary ‘reality check’ for all MPs that links them to the lives of those they are elected to represent. The chapter first provides an overview of MPs as representatives of territorially defined constituencies and of ‘communities of interest’ before discussing ‘constituencies’ within constituencies. It also considers how constituents make sense of parliamentary constituencies and their connection to their representatives by invoking notions of ‘locality’. It shows that constituency work and parliamentary work are often counterposed.
Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project
Authors: Biswas Arunava , Bhattacharya Sangeeta Das , Singh Arun Kumarendu , Saha Mallika
Published: August 2018

Objective

Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit.

Materials and Methods

We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively.

Results

A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9–5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36–16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities.

Conclusions

Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.
Cancer-Related Fatigue
Authors: Yennurajalingam Sriram
Published: August 2018

Cancer-related fatigue is the most common and severe symptom patients experience while receiving palliative care. It is also the most underdiagnosed and undertreated. Fatigue has substantial adverse physical, psychosocial, and economic consequences for patients and caregivers, and it is an important predictor of patients’ quality of life. Management of fatigue involves thorough assessment of severity and various dimensions of the symptoms, including the physical, psychological, and cognitive domains. A focused exam and laboratory evaluation should be conducted to treat the reversible causes. All patients should be managed using nonpharmacological strategies such as exercise and counseling whenever feasible. A short trial of steroids or methylphenidate should be considered for symptom relief.
Nausea and Vomiting
Authors: Dalal Shalini
Published: August 2018

Nausea is an unpleasant sensation of being about to vomit, can occur alone or can accompany vomiting, dyspepsia, or other gastrointestinal symptoms. It is common symptoms in patients receiving palliative care and is associated with substantial physical and psychological distress and worsening of quality of life. In cancer patients, cancer treatments and opioids are the most common causes. Management include supportive measures such as maintaining proper oral hygiene, frequent small volume food and fluid intake at regular intervals, intravenous fluids if appropriate, and discontinuation of unnecessary medications. Specific treatment should target the underlying cause, e.g., aggressive bowel regimen for opioid related constipation, and 5HT3 receptor antagonists for chemotherapy induced nausea.
Delirium
Authors: Bush Shirley H. , Gratton Valérie
Published: August 2018

Delirium is one of the most frequent symptoms in palliative care patients, especially during the last weeks of life. It is characterized by disturbance of attention, awareness, and fluctuating levels of severity over the course of a day. It is also usually associated with anxiety, restlessness, irritability, disorientation, and sleep disturbances. Delirium is frequently missed or misdiagnosed by the health care team. This may relate to symptom fluctuation and transient lucidity, in addition to overlapping clinical features with dementia and depression, compounded by a lack of or inadequate delirium screening. Although the nonpharmacological management of delirium is a key component of care, delirious patients who are very distressed or a potential risk to themselves or others may require pharmacological management for their symptoms, including “rescue” doses of midazolam or lorazepam if not responding to antipsychotics.
Dyspnea
Authors: Vijhani Praveen , Kazzaz Farah , Faiz Saadia A. , Balachandran Diwakar D.
Published: August 2018

Dyspnea or breathlessness is one of the most distressing symptom experienced by patients with advanced disease such as cancer, end-stage chronic obstructive pulmonary disease, and heart failure. It can be either continuous or episodic (more frequent). Management is usually interdisciplinary and individualized to a given patient. A combination of strategies, such as use of opioids, oxygen, short-term steroids, and counseling, is likely to reduce the symptom burden related to dyspnea.
Palliative Care Emergencies
Authors: Yennurajalingam Sriram
Published: August 2018

Palliative care emergencies are both cancer and non-cancer-related events that demand immediate remedy or action because they cause acute exacerbation of symptoms that affect quality of life. Decision-making with regard to the type of treatment for these emergencies is critical and should be based on (a) reversibility of the problem, (b) improvement/maintenance of the patient’s quality of life with reversal, (c) the patient’s general condition and prognosis, (d) patient and family goals, and (e) the risk and benefit of treatment versus distress of symptoms. Common emergencies include spinal cord compression, hypercalcemia, impeding pathological fracture, superior vena caval syndrome, seizures, bleeding, and uncontrolled symptoms such as pain and dyspnea.
Psychosocial and Spiritual Issues in Palliative Care
Authors: Guay Marvin Omar Delgado , Yennurajalingam Sriram
Published: August 2018

In patients with serious life-limiting illness, there is a complex interplay of psychosocial, cultural, and spiritual issues. Increasing evidence demonstrates that psychosocial as well as spiritual distress play a significant role in the overall distress in palliative care patients. These also negatively factor in the patient’s well-being and control of symptoms. However, the differentiation between psychosocial and spiritual is often difficult. An interdisciplinary approach is critical so as to alleviate this distress among patients receiving Palliative Care. This chapter reviews the assessment and management of key issues related to psychosocial, cultural, and spiritual issues in patients with serious life-limiting illness.
Palliative Sedation
Authors: Walker Paul W.
Published: August 2018

The goal of palliative sedation is to relieve suffering due to refractory symptoms by inducing a state of decreased or absence in awareness—a reduction in consciousness—by administering sedating medications. It is a legally and ethically acceptable treatment and is distinct from euthanasia. However, prior to consideration of palliative sedation, necessary steps are required after a thorough interdisciplinary assessment. One of the most important step is that the patient must be suffering from a refractory symptom, defined as a symptom that “cannot be adequately controlled despite aggressive efforts to identify a tolerable therapy that does not compromise consciousness.” The intention of palliation sedation is to palliate the refractory symptom(s) and not to shorten the duration of life. This chapter reviews the common reasons for and various important aspects involved in palliative sedation.
Palliative Care in Long-Term Care Settings
Authors: Yennurajalingam Sriram
Published: August 2018

Long-term care is a setting of provision of health and supportive services to patients unable to practice self-care, usually over months or years. For older frail patients, nursing homes have increasingly become a common setting for long-term care. Approximately 65% of nursing home residents die within 12 months of nursing home placement. A vast majority of these patients experience significant symptom distress, and frequent hospital admissions. Palliative care in these at risk patients is essential to improve symptom management, aligning care with patient care, and reduce hospital readmissions. This chapter outlines the important aspects involved in provision of palliative care in long-term settings.
Palliative Care in End-Stage Neurological Disease
Authors: Walbert Tobias , Phillips Joel
Published: August 2018

Neurological disorders are among the leading causes of morbidity and death worldwide. Although stroke is the third leading cause of death, after heart disease and cancer, in the United States, other neurological diseases have a more chronic course that leads to protracted disability, morbidity, and death. Unfortunately, for many of these disorders, such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), no cure is currently available. Patients suffer from dysarthria, dysphagia, muscle spasm, bladder and bowel difficulties, pain syndromes, and fatigue. Adequate symptom management and palliative care have the potential to maintain good quality of life for patients for as long as possible and ease the burden on both caregivers and patients. This chapter outlines the principles of clinical symptom management for some of the most important neurological diseases, specifically ALS, stroke, MS, and Parkinson’s disease.
Crystal-induced musculoskeletal disease
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter describes crystal-induced musculoskeletal disease, which encompasses gout, hyperuricaemia, calcium pyrophosphate dihydrate disease, basic calcium phosphate-associated disease, and calcium oxalate arthritis. Their epidemiology, aetiopathogenesis, classification criteria, presenting features, clinical manifestations, and management are discussed. Diet, lifestyle, non-pharmacological and pharmacological approaches to their management are considered. User-friendly algorithms for the management of gout and calcium pyrophosphate dihydrate disease are provided, allowing both rheumatologists and non-rheumatologists to confidently manage these diseases in clinic, ward, or community settings.
Ambulatory ECG monitoring
Authors: Cygankiewicz Iwona
Published: August 2018

Ambulatory electrocardiogram (AECG) monitoring has been used as a diagnostic procedure in cardiology for over 60 years. Current techniques used for AECG monitoring include continuous and/or intermittent external recorders, patch monitors, smartphone-based devices, and implantable loop recorders. The major goal of AECG monitoring, independently of the applied technique, is to detect and characterize arrhythmic events during daily activities of patients and to correlate symptoms with electrocardiogram (ECG) findings. It is particularly important in case of intermittent symptoms and/or transient ECG disturbances that cannot be detected by means of short, resting surface ECG recordings. The main indications for AECG monitoring include (1) detection and characterization of arrhythmias in order to correlate them with patients’ symptoms such as syncope, dizziness, palpitations, or chest pain; (2) diagnosis and risk stratification in specific cardiac diseases; and (3) evaluation of the efficacy of pharmacological or invasive treatment of arrhythmias.
Current Surgical Guidelines
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Current Surgical Guidelines provides a unique summary of current guidelines in surgery, covering all key topics in surgical practice, and formulated to answer most real-life clinical practice questions with contemporary facts and figures, decision recommendations, and treatment options. The book uses a bullet-point concise format to allow easy digestion of rather scattered information, and ‘anchor points’ for easy recall of relevant information when and where needed. The book organizes clinical information in a special uniform and structured way to allow better knowledge management and to enhance readers’ ability to apply evidence–based practice in real case scenarios. The authors have ensured that the 2nd edition include all key updates in guidelines, with second reviewers from each specialty to ensure the recommendations reflect current best practice in the field. The book follows the training curriculum for basic and higher surgical training for doctors and nurses in the UK, but also provide an invaluable source of best practice in surgery to hospital managers at different levels, to admin staff, and to all those involved in the care of patients in surgery. Medical students can benefit from having a reference guide to real–life contemporary practical recommendations in surgery, allowing them to bridge the ever-widening gap between theory and practice.
Perioperative medical complications
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Every surgical procedure carries a risk of perioperative complications. These can affect a number of physiological systems with cardiovascular, respiratory, neurological, and renal most commonly affected. Optimal management of these complications relies on prompt, thorough assessment both clinically and with appropriate biochemical and radiological investigations. Early treatment and, where necessary, referral to relevant specialties is essential in mitigating the risk to patients and optimizing their management.
Prevention of infective endocarditis (IE)
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Infective endocarditis is a serious condition due to bacteraemia resulting from interventions. Current guidelines suggested antibiotic prophylaxis should not be used for routine dental or non-dental patients even in high-risk patients. However, it should be considered for high-risk patients for interventional dental work and also in other circumstances if the operative site suspected to be infective and might result in bacteraemia in high-risk patients.
Principles of care of critically ill patients
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Surgeons should be competent in identifying and treating high-risk patients in the perioperative period, including ability to identify, assess, and initiate treatment for organ dysfunction and circulatory shock, obtain and interpret blood gases, use blood products and fluid composites, support nutrition, treat sepsis, and identify and diagnose brain stem death. The chapter tackles main issues in the diagnosis and treatment of such patients, defines criteria and scoring systems in use for critically ill patients, and summarize treatment principles and approaches recommendations.
Sepsis and septic shock
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Sepsis is very common; however, goal–directed therapy significantly helps to reduce mortality rate following septic shock. Sepsis Six should be delivered within one hour of initial diagnosis of sepsis. The sepsis resuscitation and management bundle includes delivery of high flow O2, blood culture, measurement of lactate, empirical antibiotic therapy, and IV fluid resuscitation and renal support.
Gastric cancer
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Gastric cancer presents in the majority of cases at a locally advanced/metastatic stage. Initial investigations should be on the dyspepsia pathway. Multiple biopsies are necessary from any suspicious endoscopic lesions. Accurate staging and MDT assessment is essential for optimum patient selection for surgery. Endoscopic resection can now be recommended for very early lesions with good prognostic features. In gastrectomy, controversy exists across the world as to the extent of lymphadenectomy. This is discussed, as well as neoadjuvant and adjuvant oncological therapy.
Haemorrhoid disease
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Haemorrhoids may affect over 70% of the Western population. Symptoms include prolapse, bleeding, and discomfort. Classification of haemorrhoids is important before deciding on therapy or conservative management. Treatment may include submucosal sclerotherapy, elastic band ligation, haemorrhoidal artery ligation, stapled haemorrhoidectomy, and conventional open or closed haemorrhoidectomy.
Thyroid nodules and cancer
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

True prevalence of thyroid nodules on ultrasound surveys range from 37% to 57% of the population. The risk of malignancy is 5% of all thyroid nodules, independent of their size. Thyroid nodules are often discovered incidentally by patients or their physicians. The absence of symptoms does not rule out the presence of malignancy. A through history of family disease, and previous exposure to radiation, should be taken. Blood thyroid tests, ultrasound scans, and fine needle aspiration cytology should be performed to confirm diagnosis. Surgical and conservative management can be considered depending on the case.
Effects of Intranasal Oxytocin on Stress-Induced Cigarette Craving in Daily Smokers
Authors: Van Hedger Kathryne , Bershad Anya K , Lee Royce , de Wit Harriet
Published: August 2018

Background

Cigarette smoking is a well-known public health concern, and there is an urgent need to develop new treatments to reduce smoking or facilitate abstinence. One factor that is known to contribute to relapse is stress, making the stress response an important target for treatment. The neuropeptide oxytocin (OT) is believed to have stress-reducing effects, and in addition there is evidence that it reduces drug craving. The purpose of the present study was to examine the effects of intranasal OT on stress-induced cigarette craving in regular smokers after 12 h of abstinence.

Method

Daily smokers (n = 48) completed a stress induction task and a nonstressful control task at two different sessions, receiving intranasal OT (40 IU) or placebo (PBO) before or after the task. Subjects were randomly assigned to one of three groups: Group PP (n = 16) received PBO before and after the stress/control tasks, Group OP (n = 16) received OT before the tasks and PBO after, and Group PO (n = 16) received PBO before the tasks and OT shortly after completing the tasks. Cigarette craving as well as subjective and physiological responses to stress was assessed.

Results

OT did not alter responses to stress, whether it was administered before or after the stressful task, on measures of cigarette craving, anxiety, heart rate, blood pressure, and cortisol levels.

Conclusions

The current study findings do not support several previous reports that OT reduced either stress or drug craving.

Implications

This study finds a null result of the neuropeptide oxytocin on stress-induced cigarette craving. Reporting null findings is part of the process of identifying potential treatments for addictive disorders.