bluuebunny/crossref_metadata_2025 huggingface dataset:
Corticospinal deficits
Authors: Noth Johannes , Fromm Christoph
Published: November 2023

Our knowledge about the consequences of corticospinal (CS) lesions in humans rests on three lines of evidence: (i) behavioural studies on animals and, in particular, on non-human primates which provide detailed anatomical and physiological information about the corticospinal system, (ii) conclusions drawn from experimental lesions of the corticospinal tract in non-human primates, and (iii) case reports of neurological syndromes following small well-defined cortical, peduncular, or pyramidal lesions of the corticospinal tract. To avoid overlap with other contributions to this volume, only those aspects that are essential for the understanding of corticospinal deficits will be discussed here.
Apraxias as traditionally defined
Authors: Leiguarda Ramon
Published: November 2023

Apraxia is a term used to denote a wide spectrum of higher-order motor disorders due to acquired brain disease affecting the performance of skilled learned movements with or without preservation of the ability to perform the same movement outside the clinical setting in the appropriate situation or environment. The disturbance of purposive movements cannot be termed apraxia, however, if it results from a language comprehension disorder or from dementia, or if the patient suffers from any elementary motor or sensory deficit (i.e. paresis, dystonia, ataxia) which could fully explain the abnormal motor behaviour (Heilman and Rothi 1985; Roy and Square 1985; De Renzi 1989).
Cortical plasticity and motor disorders
Authors: Celnik Pablo A , Cohen Leonardo G
Published: November 2023

The view of the central nervous system as rigidly organized has been replaced by a more dynamic conception that emphasizes its ability to change. This paradigm shift took place over several decades and has led, in the last few years, to a tighter connection between basic scientists working in animal models of plasticity and clinicians interested in the application of principles of plasticity to the treatment of human disease. Influential studies leading the way of this new trend included those of Hubel and Wiesel (1965), who showed that visual experience during the early life of kittens has a profound impact in shaping the responsiveness of individual cortical neurons, the discovery of nerve growth factor in the adult mammal brain (Levi-Montalcini and Angeletti 1968), and the characterization of long-term potentiation and depression (Bliss and Gardner 1973; Douglas and Goddard 1975; Lynch et al. 1977).
The unpopular age
Authors: Graham Philip
Published: November 2023

As a psychiatrist working for over 25 years in a children ‘s hospital, I have listened and talked to young men and women of Fergus ‘s age referred for emotional and behavioural problems. As a researcher over an even longer period of time, I have been involved in studies of ‘ordinary ‘ school students of this age who were selected at random from school populations and from ‘young people ‘ on lists of family doctors. Some of these lived in very deprived areas, others were much better off. As a university teacher, I have discussed issues to do with adolescence with undergraduates, themselves only just out of their teenage years. Finally, like everyone else, I have learned about the teenage years from my own adolescence, as well as that of members of my family and friends.
The invention of adolescence
Authors: Graham Philip
Published: November 2023

The term ‘adolescence ‘ was first used in ancient Rome, probably by Plautus, around 193 BC. ‘Adolescere ‘ is Latin for ‘to grow up ‘ and adultus means ‘to have grown up ‘. So, in a sense, adults are defined in terms of the completion of their adolescence. The term ‘adolescent ‘ was used by churchmen and other scholars in classical times and in the Middle Ages to describe young people who had not achieved full adult social rights. This might take a long time and some eminent doctors and churchmen who wrote about the young laid it down that the end of adolescence did not arrive until the age of 35 or even 42 years. But it always began round about the time of the beginning of puberty. In those days this was later than it is today, on average at about 14–15 years.
Teens in the family
Authors: Graham Philip
Published: November 2023

In Chapter 1, I suggested that most young people in their teens did not con-form to the stereotypes the media and sometimes even professionals put out about them. In this chapter, I shall first look at the ways in which most of those in their teens actually do behave in families. Then I shall go on to suggest that one of the most important reasons why most teenage children do not show the appalling behaviour their reputation might lead one to expect is that their parents have, since early childhood, taken account of their children ‘s feelings, listened to them, and eventually arrived at family relationships that are reasonably democratic. They have empowered their children.
More cheerful than moody
Authors: Graham Philip
Published: November 2023

In this chapter I suggest that most of those in their teens are cheerful, happy, and reasonably stable most of the time. As we shall see in more detail later in this chapter, three out of four 13–15-year-olds report that they have never or only occasionally been unhappy over the past years. Contrary to popular belief, young people in their teens, if compared to those in their twenties and thirties, are not moodier or more depressed. Rates of low self-esteem, depression, and suicidal ideas increase in the early teens and then remain stable from about the age of 14 years onwards through the rest of young adulthood and middle age. Thus, as far as mood and mood disorders are concerned, those in their teens are very like those in later adulthood, as they are in so many other aspects of life.
Sex: same hormones, different lives
Authors: Graham Philip
Published: November 2023

Myths, or widely held inaccurate ideas about sex and the teens, are common in the adult world, so that much discussion is poorly informed. What are these myths? First, is the idea that the physical changes of puberty begin in the teens. In fact, they begin well before this. Indeed they begin well before these physical changes are visible. Another myth is that sexual development is beginning earlier these days than it did even 20 years ago. The evidence for this is weak or non-existent. A third myth is those in their teens have extraordinarily high levels of sex hormones, and that these gradually decline in the twenties. Finally, there is a widespread and mistaken notion that all those in their teens are, or at least would like to be, highly promiscuous in their sexual behaviour.
Schools: the solution or the problem?
Authors: Graham Philip
Published: November 2023

Education is empowering. Without educational success young people are condemned to low paid jobs, a much higher likelihood of unemployment and inability to appreciate many of the good things of life. But inevitably, from the perspective of those in their teens, making schooling compulsory risks being seen as disempowering. One can understand how they feel. Highly competent young people have the freedom to decide how they will spend their weekdays taken away from them until the age of 16 years. Even after that, the job market and benefits system, with no minimum wage protection and no allowance to benefit under 18 years, are arranged in such a way that most have little choice but to continue in some sort of educational setting however boring or unrewarding they may find it.
Introduction
Authors: Fenchel Tom
Published: November 2023

This book is about the development of life from its origin and until multicellular plants, fungi, and animals arose-corresponding approximately to the time period from 4 to 0.6 billion years ago. If the reader expects a complete explanation for the origin of life and its earliest differentiation then she or he will be disappointed. First of all these questions will never be fully answered because the origin of life is a historical event. Plausible ideas about mechanisms that possibly led to the origin of life may be suggested and perhaps, in some cases at least, tested experimentally. But it will never be possible to prove that this is how it happened. Also, there are huge gaps in our understanding of the earliest evolution of life.
Origin of life
Authors: Fenchel Tom
Published: November 2023

The fact that no one knows how life originated is generally acknowledged, but the formidable difficulties in formulating even modestly reasonable models is perhaps appreciated less. And so many simplistic proposals have been made without addressing fundamental difficulties. Understanding the physical-chemical conditions under which life arose, simple chemical processes in the environment that may have provided the energy for the earliest life, and the spontaneous (‘self-organizing’) mechanisms that might have created some sort of mechanical scaffolding ( e.g. coacervates) for the earliest life are all important. It appears to me, however, that the most essential problem remains that of explaining the origin of replicators that were subject to Darwinian evolution.
From the RNA world to the first cell
Authors: Fenchel Tom
Published: November 2023

Evolution from the (hypothetical) RNA world to the first bacterial cell is in many ways as difficult to explain as the origin of life itself. It is possible to formulate problems, but their solution seems in many cases to be almost insurmountable. Comparative studies combined with palaeontology can provide convincing descriptions on how, for example, Devonian lobe-finned fish developed into terrestrial vertebrates. But going from simple ideas on how life could have originated and relatively simple chemical systems with replicating RNA molecules to the first cell represents a huge gap with little but speculation to fill it.
The evolution of metabolism
Authors: Fenchel Tom
Published: November 2023

If one could speak of bacteria having a purpose in life it would be to grow and pro duce two new bacteria. This requires free energy and building materials-the same requirements that must have applied to the first RNA quasi-species as well as to all other kinds of life. The energy always comes from the hydrolysis (splitting with concomitant uptake of H2O) of energy-rich phosphate bonds. In the case of microorgan isms and fast growing other kinds of organisms, by far the greatest energy demand is for the production of polymers (proteins, RNA, DNA) and for active (energy requiring) uptake of molecules from the surroundings.
The eukaryotic cell
Authors: Fenchel Tom
Published: November 2023

Eukaryotes include all organisms that are not bacteria (prokaryotes = eubacteria + archaebacteria). The eukaryotes include the three large groups of multicellular organ isms. That is, animals, (vascular) plants, and the higher fungi plus a large number of rather unrelated groups of unicellular organisms often referred to as protozoa, protophytes (unicellular algae), multicellular algae, and some fungi-like organisms. Eukaryotes that belong to neither the animals, plants, or fungi are often collectively referred to as protists.
Sex, species concepts, and evolution
Authors: Fenchel Tom
Published: November 2023

Although horizontal gene transfer is known from bacteria it is not possible to speak about bacterial sex in the sense that it applies to eukaryotes. Many groups of unicellular protists also seem to be sexless. This applies, for example, to naked amoebae: the classical textbook amoeba Amoeba proteus has been grown in laboratories for almost a century, but no sexual phenomenon has ever been recorded. Totally sexless forms also occur among many groups in which other representatives display some sort of sexual phenomena. Many groups of unicellular eukaryotes display different components of sexual processes and in other cases protozoan sex resembles that of animals.
Evidence from geology
Authors: Fenchel Tom
Published: November 2023

During the 1960s geology obtained a coherent description of structures and processes in the surface layers of Earth. These theories are collectively termed plate tectonics. Radioactive decay and thus heat generation in the mantle leads to slow convective flow somewhat comparable with that in a viscous fluid exposed to heat from below: hot fluid rises in some places from the bottom to the surface, cools at the surface to sink down in other places. In a similar way molten magma rises in certain zones below the oceanic sea bottom and spreads to the sides as new ocean bottom. These spreading zones show through mid-oceanic ridges, volcanism, and hydrothermal vents.
Molecular aspects of myotonic dystrophy: our current understanding
Authors: Monckton Darren G , Ashizawa Tetsuo
Published: November 2023

Myotonic dystrophy is a hereditary multisystemic disease characterized by myotonia, muscle weakness and atrophy, cataracts, cardiac abnormalities, excessive daytime sleepiness, neuropsychological deficits, and disorders of other systems such as the endocrine system, gastrointestinal tract, skin and bone (Harper 2001). Myotonic dystrophy is inherited from either mother or father to offspring of either sex, without a preference for affecting one sex more than the other and usually without skipping generations. This pattern of inheritance is known as autosomal dominant. However, unlike the majority of autosomal dominant diseases, myotonic dystrophy exhibits a phenomenon known as anticipation, which is defined as progressively younger onset of the disease with increasing severity in successive generations within a family.
Behavior scoring and adaptive control systems
Authors: Hopper M A , Lewis E M
Published: November 2023

Every credit grantor has in effect a set of strategies that specify how each aspect of the credit portfolio is to be managed. There is a strategy for handling delinquent accounts: for each stage of delinquency and account condition a specific action is called for. There is a strategy for credit limits, how they are to be set and how they are to be changed. There is a strategy for reissuing credit cards. There is a strategy for handling accounts that are over limit. There are even rules for the treatment of satisfactory accounts and these rules also constitute a strategy.

However, traditional credit strategies fail to take advantage of the power that is available in the data processing system and in modem statistical methods. In consequence, accounts that should, and could. be treated differently because they present different risks are treated alike, to the disadvantage of both the credit grantor and the customer. It is also usually the case that the automated billing systems normally produce reports on each credit portfolio as a whole and do not address the individual aspects of management ‘s strategies. For example, a report may show the total number of accounts that were delinquent on the last cycle and that are now current, but does not show how many delinquent accounts recovered following the application of each of several alternative collection strategies.
The use of affordability data-does it add real value?
Authors: Wilkinson George , Tingay Jon
Published: November 2023

Affordability is a high profile issue. This is a case study of an unsecured personal loan operation that wanted to understand the impact of affordability data on decision-making. Four scorecards were built, including and excluding affordability information, to assess the real value that income and expenditure data adds. Ability to repay is often treated as a subjective me. Is that right for your business and is it responsible?

Regulators and industry practoners have, for some time, been debating the importance and means of assessing affordability in the credit-granting process. Indeed, the report published by the UK Government-inspired industry taskforce on tackling over indebtedness (July 2001) concluded that ‘Lenders should continue to invest in the development of more sophisticated scoring techniques to better identify overcommitment ... ‘. It went on to say that ‘Lenders who use data scoring should consider during the development of decision systems making use of all available data to assess ability to repay ‘.
Efficient frontier cut-off policies in credit portfolios
Authors: Oliver Robert M , Wells E
Published: November 2023

Historically. account acquisition in scored retail credit and loan portfolios has focused on risk management in the sense of minimizing default losses. We believe that acquisition policies should focus on a broader set of business measures that explicitly recognize tradeoffs between conflicting objectives of losses, volume and profit. Typical business challenges are: ‘How do I maximize portfolio profit while keeping acceptance rate (volume. size) at acceptable levels? ‘ ‘How do I minimize the risk of large loss exposures for a given market share? ‘ In this chapter we are concerned with which combination of objectives are appropriate, but rather focus on the cut-off policies that allow us to capture a number of different portfolio objectives. When there are conflicting objectives we show that optimal policies yield meaningful tradeoffs between profit and market share. Some of the graphical solutions that we obtain are simple to derive and easy to understand without explicit mathematical formulations but even simple constraints may require formal use of non-linear programming techniques. We concentrate on models and insights that yield decision strategies and cut-off policies rather than the techniques for developing good predictors.
Inferring the inferred
Authors: Bennett Gaynor , Platts, Graham , Crossley Jane
Published: November 2023

Reject inference has an established role in the development of scorecards for credit applications. The performance of the rejects, had they been accepted, is inferred to be good or bad in order to obtain a complete picture of the population applying for credit. Once this is done, the scorecard to assess this population can then be developed. But consider the following problem. A company mails its customer base with an offer of additional finance facilities. The problem is: who should it mail to maximize response while minimizing risk, while also minimizing the number of responders who are rejected at application time to avoid jeopardizing the existing customer relationship? 1bis problem has three inferences required to tackle it completely. First, there is the classic inference at the point of application to infer which rejects, had they been accepted, would have been good (or bad). Second, there is the inference at the point of mailing to infer which customers, had they been previously mailed, would have responded-a response inference. But third, and most interesting, is the double inference of inferring which of the inferred responders would have subsequently been good, bad, or rejected-an inference on an inference!
A single European scorecard? Does data predict differently across Europe: An Experian Scorex investigation
Authors: Platts Graham , Howe Ian
Published: November 2023

The direction of Europe and the pace and extent of integration across the European countries is the political debate of the decade.

Trade barriers and borders are coming down and Europe is moving towards a single European currency as the economies of Europe harmonize. But the question for our industry is whether credit granting in different countries is fundamentally different. Does data predict differently across Europe or is it similar? Could a scorecard built in one country work well in another country? Could there be a single European scorecard?
Small sample scoring
Authors: Lucas Alan , Powell Joanna
Published: November 2023

Barclaycard ‘s principal tools for controlling credit risk are ‘Credit Scorecards ‘ and ‘Behaviour Scorecards ‘. These are linear models which predict the chance that a customer will continue to make regular repayments within, say, the next year. Usually these scorecards are built using large samples (e.g. 10,0(X) accounts).
Principles of planning health services
Authors: Melding Pamela S
Published: November 2023

There are so many directions to follow in planning health services for a population that Alice ‘s exchange with the Cheshire Cat in Lewis Carroll ‘s classic story may seem like an exemplar. Planning health services on a national, statewide, or regional basis has multiple considerations to be taken into account and can be an overwhelming task. There are many key stakeholders including politicians, policy-makers, planners, purchasers, providers, practitioners, patients, potential patients, and premium or taxpayers (James, 1995 ). Some of these key stakeholders have multiple investments; all have points of view, and values that they want to have considered, and too often these are diametrically opposed.
Evidence-based psychogeriatric service delivery
Authors: Draper Brian , Low Lee-Fay
Published: November 2023

Over the last 15 years it has become apparent that old age psychiatry services need to provide evidence of their effectiveness to health administrators, whether it be in terms of patient outcomes, acceptability to consumers, or economic considerations ( Draper, 1990, 2000a).
Psychogeriatric services: trends in Australia and New Zealand
Authors: Draper Brian , Melding Pamela , Brodaty Henry
Published: November 2023

Although separate countries, Australia and New Zealand are linked by their location in the South Pacific, history, and in many respects, culture. The countries also share the same five-year training programme for psychiatrists run by the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
Psychogeriatric services: trends in Nigeria and South Africa
Authors: Baiyewu Olusegun , Potocnik Felix
Published: November 2023

Nigeria has a predominantly young population, which has been estimated at 108.9 million, with 4.9 per cent aged 60 years and over (WHO, 2000). Psychogeriatric facilities are few, and those available are concentrated in the cities, especially in southern Nigeria. At present care of older people is primarily family care and there is limited public assistance. Older persons with dementia and other mental health disorders rarely seek help, because Nigerian caregivers see most of the symptoms as part of ageing (Hendrie et al., 1996; Sokoya and Baiyewu, 2003).
How To Structure A Six-Session Course Of Problem-Solving Treatment
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

As explained in Chapter 3, problem-solving is a collaborative, structured, time-limited treatment which focuses on issues in the here and now rather than dwelling on problems of the past. The problem-solving process can be broken down into seven stages, the details of which have been set out already. The purpose of this chapter is to provide information for the therapist as to how to structure a six-session course of problem-solving treatment. Much of the information needed for the first problem-solving session is contained in Chapter 3. This chapter will discuss the context of the first session and provide practical resources to support the session. The chapter will then explain how the therapist should organize session two and the subsequent sessions.
Three Courses Of Problem-Solving Treatment
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

In this chapter, three worked-through examples of problem-solving treatment will be set out. These provide illustrations as to how problem-solving treatment unfolds over the six sessions. In the first example, of Elizabeth, a narrative history is provided alongside examples of problem-solving worksheets. In the examples of Jenny and Bill, the sessions are documented as they are written up after therapy with a brief history and then a focus on events and progress, as documented in the problem-solving worksheets. All three courses illustrate how problems and solutions change during therapy.
Potential Problems With Problem-Solving Treatment
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

Although problem-solving treatment is a clear, organized, and structured treatment, the complexities of patients’ lives mean that it is not always easy to conceptualize their difficulties as clear, defined problems. Even when clear defined problems are set, it is not always easy to formulate achievable goals. The skill of the problem-solving therapist is to facilitate the problem-solving process as best they can. It will of course be the case, however, that some patients’ difficulties are too longstanding and entrenched to be helped by a six-session course of psychological treatment. The therapist needs to be aware of the limitations of problem-solving treatment and be realistic with the patient about the potential benefits that therapy can offer.
Teaching Problem-Solving Treatment
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

This chapter sets out the structure of a two-day course to introduce problem-solving treatment to potential practitioners. The information in this chapter is based on courses which have been run for a range of professionals including GPs, nurses, medical students, and counsellors. The course does assume a knowledge of basic skills in delivering psychological treatments including confidentiality, time-keeping, and communication skills. The skills acquisition part of the course comprises five sessions, each of two hours’ duration. Additional components can be added according to the context or more time can be spent rehearsing and practising the key skills.
Experience with topiramate in patients with refractory migraine
Authors: Pascual J , Rio M Sanchez del , Mateos V , Lainez J M , Hernandez-Gallego J , Leira, R , Jimenez M D
Published: November 2023

Migraine is a frequent condition affecting 18% of women and 6% of men in the United States. The American Migraine Study reported that 24% of migraine sufferers experience four or more migraine attacks every month. However, only 3-5% of migraine sufferers receive preventive therapy.1 Classes of agents used as preventives for migraine include beta-blockers, calcium-channel blockers, serotonin antagonists, antidepressants, non-steroidal anti-inflammatory drugs, and antiepileptics. Many patients with migraine find the currently available preventives unsatisfactory, due to their limited efficacy and not infrequent adverse effects. Consequently, there is a need for better prophylactic options.2
Other Prophylactic Anti-Migraine Agents: Riboflavin, Feverfew, Magnesium, Botulinum Toxin, And Calcium Antagonists
Authors: Schoenen J , Clemente, L Di , Coppola G
Published: November 2023

There are two major shortcomings with prophylactic therapies in migraine. The first is that the average efficacy rate of any prophylactic agent does not exceed 50%, the second that most prophylactic drugs are associated with uncomfortable and sometimes intolerable adverse effects. It is therefore of clinical interest that several treatments almost devoid of adverse effects are available for migraine pro phylaxis. These are riboflavin, feverfew, magnesium salts, and Botulinum toxin. Some of them are widely used in certain countries despite lacking scientific evidence of efficacy, others have been proven efficacious, but are not considered seriously or not used adequately in migraine. In this article, we will review published data for all these treatments and examine the case of certain calcium antagonists that remain controversial. We will focus for efficacy data on 50% responder rates in absolute and placebo-subtracted values and compare the data with those published in a recent trial for slow release propranolol 160 mg and for valproate, two mainstays of preventive anti-migraine treatment.
Treatment of chronic tension-type headache with mirtazapine
Authors: Kulaksizoglu I B , Cakir, S , Ertas M
Published: November 2023

Mirtazapine is a novel antidepressant which acts by enhancing noradrenergic and serotonergic neurotransmission via blockade of a-adrenoceptors. Evidence-based studies have shown that overall antidepressants may have an antinociceptive effect in chronic pain. These studies also strongly suggested that serotonergic-noradrenergic antidepressants may have a more consistent antinociceptive effect than the serotonergic antidepressants. In this clinical trial we examined the efficacy of mirtazapine, 30 mg/day, in the treatment of chronic tension-type headache comorbid with major depression in 22 patients by using Visual Analogue Scale(VAS), Hamilton Rating Scale of Depression(HAMD), and Clinical Global Impression Scale(CGI).
Promise study (PROphylaxis of Migraine with SEglor®)
Authors: Pradalier A , Lanteri-Minet N , Lucas, Ch , Geraud G
Published: November 2023

The objective of the trial was to evaluate the efficacy of Seglor® (dihydroergotamine) in migraine prophylaxis. It was a double-blind, randomized, multicentre, placebo-controlled and parallel group study conducted in GP practice and according to the IHS criteria. u An important patient management program was also implemented: the 113 investigators were specialized in clinical research and conscious of the importance of patient education, the patients were followed-up during 6 months with 7 visits, the compliance was measured by classical pill counts by the investigator and by electronic caps that registered each open of the bottle. The investigators and the patients were aware of the electronic measurement of the compliance.
Phosphodiesterases, cyclic nucleotides, and their role in migaine
Authors: Kruuse C , Beavo J A
Published: November 2023

The signalling molecule nitric oxide (NO) has long been known to play a major part in pain mechanisms along with the neuropeptide calcitonin gene-related pep tide (CGRP). Both inhibitors of NO synthase (NOS) and CGRP receptor antagonists have within recent years proven effective in the treatment of migraine. NO is released from endothelial cells or neurons and works mainly by increasing intracellular concentrations of cyclic guanosine monophosphate (cGMP) in adjacent cells through activation of soluble guanylate cyclase (sGC). CGRP is released from the sensory nerve fibres and seems mainly to exert its actions by increasing intracellular cyclic adenosine monophosphate ( cAMP). Since both pathways involve production of cyclic nucleotides, a crosstalk between cAMP and cGMP seems very likely and the intracellular enzymes regulating the degradation of these second messengers, cyclic nucleotide phosphodiesterases (PDE), are interesting targets for investigating this interaction and for finding new principles of migraine treatment.
New targets II: discussion summary
Authors: Hill R G
Published: November 2023

This last session of the seminar covered a large amount of pharmacological territory in a search for novel mechanisms that might be exploitable for the preventive treatment of migraine. The interesting data on the prophylactic effect of ACE blockade with lisinopril or candesartan illustrates that we still have much to learn. Of particular interest in this study was the efficacy of the ACE inhibitors in reducing the occurrence of all headaches, not just migraine. Clearly confirmatory studies are needed but as this is an extremely safe class of drug the prospects for further clinical use are attractive. In discussion, the issue of the well-described polymorphism in ACE was raised and it was encouraging to learn that a posthoc analysis is being performed to see if there is any correlation with the efficacy of treatment and the presence or absence of the polymorphism. Schouenen had perhaps the most challenging assignment in dealing with a spread of topics from Ca2+ channel blockers to riboflavin.
Using Complementary/ Alternative Medicine (CAM)
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

One way of managing a long-term illness that you may consider is to use complementary or alternative therapies. These are treatments that lie outside conventional medicine. The distinction between complementary and alternative can be somewhat blurred. Complementary therapies tend to be those that it is suggested are used alongside conventional medicine. Indeed, some doctors have trained in some of these treatments such as homeopathy and acupuncture. Alternative therapies (as the name suggests), on the other hand, are more likely to be suggested as an alternative to conventional treatment. These therapies can range from things that your doctor might be happy to recommend to some that are frankly bizarre and possibly dangerous.
Managing Pain
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

Living with pain can be especially hard. Pain may be a constant background to your life, or it may be intermittent, perhaps made worse by activity. It can be a very lonely experience too; pain is not visible to other people, who can probably never understand just what it is like for you. Pain can be very tiring in itself, as well as interfering with your sleep. It can get in the way of things you want to do. We do not believe that ‘what can’t be cured must be endured’. We do believe that it can be managed. Anything that you can do to manage your pain—to reduce it or to lessen its impact—will be a help to your body and to your mind. There really are things that you can do that will help.
Managing Your Emotions
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

Managing the emotions and feelings that go with a long-term illness is as important as managing the physical problems. Mind and body cannot be separated. Emotions and moods have a physical effect on the body, and what happens to the body, and how you react to it, has an effect on the mind. If you are ill, you are likely to have moments when you experience feelings of loss, envy, anger, frustration, worry and anxiety, fear or low spirits. You may find that stress makes you feel worse and that you do not cope with it as well as you once did. Old problems may still be with you, and you may notice them more now that you have less to distract you from them.
Getting Psychological Help
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

You are not alone if you have some emotional problems as well as physical ones; a large proportion of people with a long-term illness suffer in this way .Such problems might have been there before you became ill, or they could be a reaction to the difficulties, distress and losses associated with your illness. Getting help with your emotional problems could do a lot to improve your quality of life now. Such things as anxiety or depression can be very distressing and can add physical symptoms to those caused by your illness.
Caring and being cared for
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

A long-term illness affects both the carer and the person being cared for. It can change both their lives. It may help to think of it as a new joint project that can bring positive as well as negative things to both of you. It is not always easy either caring or being cared for. Both sides can be dealing with loss, resentment (even if it is not expressed) and difficulties. A carer may have had to give up important areas of his or her life to allow them to care; the person cared for may have had to give up independence as well as carrying their burden of illness. So it is a particular type of relationship that needs special attention. Whilst the amount of care needed and the time involved will vary with the severity of the illness and the disability it causes, the dynamic is that one person needs care and the other person is giving it.
Your Relationship with Your Doctors
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

If you have a long-term illness, the relationship you have with your doctor is important. It is worth thinking about what you can do to foster this key partnership. You both bring things to it—you bring your expertise and your experience of your illness and perhaps detailed medical information, your doctor brings expert medical knowledge, perspective, and judgement based on wider experience of illness in general. Even if this relationship is not too good at the moment, it may be possible to improve it. Clear, calm communication can be the key. It is in your own interest to be tactful, polite and quietly assertive rather than aggressive.
Common renal problems
Authors: Marks Stephen , Trompeter Richard
Published: November 2023

The aim of this chapter is to concentrate on the range of clinical renal problems that may present to a primary care physician. We will not concentrate on severe childhood renal disease as this is relatively rare and paediatric nephrologists and general paediatricians with an interest in nephrology manage these children. This chapter will deal with the initial management of children with renal disease.
Height: short and tall stature—when to worry and refer
Authors: Cole Tim , Preece Michael
Published: November 2023

Adult stature is one of the least variable biological measures, yet an individual’s position in the height distribution is important for their self-image. This is particularly true during the growth period in childhood, where different rates of growth can exacerbate differences in height between individuals. Those who enter puberty early are for a time appreciably taller than their late maturing coevals, and a late-maturing short child is doubly disadvantaged. So both a child’s height and their growth tempo are important when assessing possible growth problems.
Orthopaedic problems
Authors: Jacobs Benjamin , Eastwood Deborah
Published: November 2023

Orthopaedics means ‘straight child’ in Greek. When the term was introduced by Nicolas Andry in 1741, the main bone problems were crippling childhood diseases such as rickets and tuberculosis (Andry 1742). Today’s orthopaedic surgeon treats children with a wide variety of conditions that range from simple growing pains to congenital malformations, developmental anomalies, inflammatory arthropathies, benign and malignant tumours, and the complications of metabolic diseases. Fractures remain a common problem and infection is a diagnosis that should not be forgotten.
Endocrine disorders
Authors: Massoud Ahmed
Published: November 2023

Both general paediatricians and healthcare professionals in primary care often think of paediatric endocrine disorders as being rare and rather esoteric. While there is an element of truth in this, it remains a fact that, collectively, paediatric endocrine disorders are common, though, individually, many are rare and may not ever be encountered within the practising lifetime of a primary care health professional.
Immunization
Authors: Elliman David , Bedford Helen
Published: November 2023

Immunization is one of the most cost-effective health procedures currently available. In countries with effective vaccination programmes with high uptake of vaccines, the incidence of vaccine preventable diseases and the associated morbidity and mortality has decreased to low levels. For example, polio has been eradicated from the Western hemi- sphere and the prospects for global eradication look good. As a result of a two-dose programme of MMR vaccination, indigenous measles, mumps, and rubella have been eliminated from Finland (Peltola et al.1994).
Growth and survival factors in malignant pleural mesothelioma
Authors: Edwards J G , Zangemeister-Wittke U , O’Byrne K J
Published: November 2023

Growth factors play a key role in the evolution and progression of malignant pleural mesothelioma (MPM) through the induction of increasingly well understood cell-signalling cascades (Fig. 8.1). Inhalation of asbestos or exposure to viral agents associated with transformation of mesothelial cells results in the induction of a number of growth factors and cytokines, which induce angiogenesis and a relative downregulation of cell-mediated immunity that may precede the development of malignancy [1,2]. In this regard, the resultant chronic exposure of mesothelial cells to growth factors may give rise to an environment favourable for the development of MPM. The surrounding stromal cells, particularly macrophages, play a crucial role in the secretion of and responses to growth factors and cytokines, acting in concert with the exposed mesothelial cells themselves.
Gene therapy for malignant pleural mesothelioma
Authors: DeLong D H Sterman P A
Published: November 2023

Malignant pleural mesothelioma (MPM) is minimally responsive to most chemotherapy and radiotherapy regimens, and is almost uniformly fatal. Radiation therapy is primarily useful for palliation of localized chest wall invasion or after debulking surgery. Furthermore, radical surgical resection of all involved pleural surfaces, ipsilateral lung, pericardium, and diaphragm has not been demonstrated to prolong survival, although non-randomized large phase II studies have yielded encouraging results in highly selected groups of patients as part of multimodality treatment involving surgery, chemotherapy, and/or radiation therapy . New chemotherapy drugs administered in combination may provide symptomatic relief and clinical/radiographic responses in a subset of patients with advanced disease, but have been shown to prolong survival at best by only a few months (see Chapters 14–16 and 18). In this context new therapeutic approaches to the management of MPM are urgently needed. The genetic revolution in biology in general, and in oncology in particular, over the past 30 years has facilitated the investigation of gene therapy as a new therapeutic modality. Investigations of the role of gene therapy in cancer have involved the insertion of ‘therapeutic’ genes via various delivery systems (‘vectors’) into tumour cells for the purpose of inducing apoptosis, necrosis, and antitumour immune responses.
Endovascular Brachytherapy
Authors: Coyle Catherine
Published: November 2023

Coronary artery and peripheral vascular disease are major world health concerns. Sophisticated invasive techniques such as vessel wall stenting are increasingly utilized. Radiation treatment to impair neo-intimal proliferation is a rapidly expanding area of interest. Angioplasty and stenting, performed by interventional radiologists, has an in stent re-stenosis rate of 30 to 50%. It has been shown that under the guidance of angiography, and in some cases intravascular ultrasound (IVUS), low doses of gamma or beta irradiation can be used to significantly reduce the stenosis rate. It has been pointed out that intravascular irradiation is not a compensation for a technically poor angioplasty, and the angioplasty must be optimized before the brachytherapy is carried out. There are already multiple, randomized single, and multi-institutional studies evaluating many aspects of vascular brachytherapy.
Levorphanol
Authors: Davis Mellar P
Published: November 2023

Levorphanol [(-)-3-hydroxy-N-methyl morphinan] is a morphine analogue that has broad opioid receptor binding capability and is an N-methyl-D-aspartate (NMDA) receptor antagonist, as well as a monoamine reuptake inhibitor. It has been marketed since the 1950s and used anecdotally in advanced cancer patients. Unfortunately, it has become difficult to obtain. A recent positive trial of the use of levorphanol in neuropathic pain has rekindled interest in this opioid. Levorphanol is a mu opioid receptor (MOR), delta opioid receptor (DOR) and kappa opioid receptor (KOR 1+3) agonist. In animal studies, analgesia is predominantly related to MOR. There is also some analgesia derived from the kappa 3 receptor.
Oxymorphone
Authors: Glare Paul
Published: November 2023

Oxymorphone (dihydrohydroxymorphinone) is a potent semisynthetic derivative of morphine that is available commercially in the USA and Canada, but not the UK or Australia. It is available as a solution for injection and as a rectal suppository (US trade name, Numorphan). Oxymorphone is synthesized from morphine by replacing the hydroxyl group at C6 with a methyl group and, like many other derivatives, there is a double bond between C7 and C8, and a hydroxyl group added to C14. Oxymorphone is also the -O demethylated metabolite of oxycodone, but is present in only small concentrations after oxycodone doses. It is believed to play a role in analgesia in rats administered oxycodone but not in humans.
Choice of opioids and the WHO ladder
Authors: Glare Paul
Published: November 2023

Approximately one-third of patients with advanced cancer receiving anticancer treatment and 70–90% of patients with far-advanced cancer experience moderate to severe pain. For such patients, guidelines recommend a trial of opioids. Which opioid they should receive and how it is best delivered remains controversial. Prior to the 1970s, neurosurgical and neurolytic techniques were the mainstay of cancer pain management. In 1976, Balfour Mount et al. showed that Brompton’s cocktail was superior to these traditional methods of pain relief , and by the late 1970s pharmacological management became the mainstay, with a resulting decline in neurosurgical procedures.
Principles and applications of gene testing for common cancers
Authors: Evans D Gareth R , Møller Pål , Kerr Bronwyn
Published: November 2023

This chapter outlines the principles of gene testing for hereditary breast and ovarian cancer and HNPCC. Testing for cancer syndromes is covered in the individual chapters, and ethical and legal issues in Chapter 18.
Multiple endocrine neoplasias
Authors: Lalloo Fiona
Published: November 2023

The multiple endocrine neoplasias refer to inherited conditions predisposing to the development of tumours within more than one endocrine gland within the same patient. The term multiple endocrine adenopathy has been used in the past but the term multiple endocrine neoplasia (MEN) is now preferred.
Differences in Prognostication Between Early and Advanced Cancer
Authors: Mackillop William J
Published: November 2023

Prognosis plays an important role in the management of patients with early, potentially curable cancer, and there is an extensive literature devoted to prognostic factors in that context. Prognosis is perhaps even more important in the management of patients with advanced and incurable cancer, but here it has received much less attention. This is unfortunate because, despite many advances in cancer treatment over the last century, 50 per cent of all cancer patients diagnosed today will die of their disease, and the quality of their end-of life care is often highly dependant on the accuracy of prognostic judgements.
Tools for Formulating Prognosis
Authors: Piccirillo Jay F , Vlahiotis Anna
Published: November 2023

Appropriate treatment methods and accurate prognosis become especially important in the palliative care of patients with advanced or terminal cancer, where clinical factors related to the tumour seem less important than those factors related to the individual with the disease. Doctors attempt to determine a so-called ‘cancer death trajectory’ by coupling individual factors such as quality of life and presence or severity of comorbid ailments with biological measures to facilitate more comprehensive prognostication. Much research has examined the individual prognostic importance of a host of clinical, biological, psychosocial and quality of life parameters.
Brain Cancer
Authors: Ohgaki Hiroko
Published: November 2023

Tumours of the nervous system amount to less than 2 per cent of the total human cancer burden, their overall annual incidence being in the range of 7–9 new cases per 100,000 population. More than 40 histological types of nervous system tumours have been classified by the World Health Organization (WHO), and this makes difficult the identification of factors with unequivocal prognostic value. The most frequent histological types of malignant brain tumour are diffusely infiltrating gliomas in adults and medulloblastomas in children.