bluuebunny/crossref_metadata_2025 huggingface dataset:
Compressive Myelopathy Caused by Arachnoid Cyst and Extramedullary Hematopoietic Tissue in a Patient with Thalassemia Major
Authors: Amaral Leandro Custódio do , Pedrosa Hugo Abi-Saber Rodrigues
Published: November 2023

Thalassemias, inherited diseases of hemoglobin synthesis, are characterized by the presence of deficient hemoglobin chains that deposit in red blood cells, inducing hemolytic anemia. Extramedullary hematopoiesis represents a compensatory picture that usually affects the liver, the spleen, and lymph nodes. The involvement of the epidural space with spinal cord compression is extremely rare. Our objective was to describe the case of RMS, 31 years old, male, β-thalassemia major carrier, admitted with 2-month progressive paraparesis and urinary retention due to medullary compression by extramedullary hematopoietic tissue and thoracic arachnoid cyst, and to discuss therapeutic options. Magnetic resonance imaging (MRI) showed an extensive intraspinal and extramedullary lesion with homogeneous contrast enhancement of T3-T11 in addition to a T1-T3 cystic lesion isointense to cerebrospinal fluid (CSF). After the presumed diagnosis of spinal cord compression by proliferative hematopoietic tissue, a 10-session fractional radiotherapy treatment was immediately performed. After the radiotherapy treatment, the neurological deficits of the patient persisted despite the excellent image response with almost complete disappearance of the intraspinal mass. However, the MRI showed a persistent T1-T3 cystic lesion with significant mass effect on the spinal cord. The patient was submitted to microsurgery for total resection of this cystic lesion. In the postoperative period, the patient improved his sphincter control and motor deficits. Medullary compression by extramedullary epidural hematopoiesis is a rare complication in thalassemic patients and may be treated with surgery and/or radiotherapy. There are successful cases with the exclusive use of radiotherapy, especially in extensive lesions.
Interfacial modification of NiOx by self-assembled monolayer for efficient and stable inverted perovskite solar cells
Authors: Yu Xin , Wang Yandong , Li Liufei , Zhang Shantao , Gao Shuang , Liang Mao , Zhang Wen-Hua , Yang Shangfeng
Published: November 2023

NiOx as a hole transport material for inverted perovskite solar cells has received great attention owing to its high transparency, low fabrication temperature, and superior stability. However, the mismatched energy levels and possible redox reactions at the NiOx/perovskite interface severely limit the performance of NiOx-based inverted perovskite solar cells. Herein, we introduce a p-type self-assembled monolayer between NiOx and perovskite layers to modify the interface and block the undesirable redox reaction between perovskite and NiOx. The self-assembled monolayer molecules all contain phosphoric acid function groups, which can be anchored onto the NiOx surface and passivate the surface defect. Moreover, the introduction of self-assembled monolayers can regulate the energy level structure of NiOx, reduce the interfacial band energy offset, and hence promote the hole transport from perovskite to NiOx layer. Consequently, the device performance is significantly enhanced in terms of both power conversion efficiency and stability.
Enhanced oxygen evolution reaction performance by dynamic adsorption of intermediates on C2N-supported single atom catalysts
Authors: Li Chongchong , Sheng Li , Zhou Yanan , Zhang Wenhua
Published: November 2023

The dynamic adsorption of possible intermediates on single-atom catalysts (SACs) under working condition plays a key role in the electrocatalytic performance by the oxygen evolution reaction (OER), and therefore the performance of the dynamic adsorption should be fully considered in the theoretical screening of potential SACs. Based on density functional theory calculations, the OER performance of 27 types of C2N-supported single transition metal atoms (TM@C2N) is systematically investigated without and with considering the dynamic adsorption of possible intermediates. Without considering dynamic adsorption, only Rh@C2N and Ni@C2N are screened out as good catalysts. However, by further considering the dynamic adsorption configurations of possible intermediates, more promising TM@C2N SACs including Fe(Co, Ni, Ru, Rh, Ir)@C2N toward the OER are screened out. The presence of the intermediates (*HO, *O) on SACs could shift their d band center toward lower energy level, which makes the interaction between the adsorbate and SACs moderate and thus enhances their OER performance. The present work is instructive for further screening and designing of efficient single-atom catalysts for the oxygen evolution reaction.
The spatiotemporal variations of total column ozone concentration over Ethiopia
Authors: Alemu Abebaw Bizuneh , Seid Abdu Mohammed , Damtie Baylie , Parakash Raju U. Jaya
Published: November 2023

We have studied spatiotemporal characteristics of ozone concentration over Ethiopia using data from the Ozone Mapper and Profiling Suite-Nadir Mapper (OMPS-NM). Daily total column ozone data of 108 observation points with spatial resolution 1° × 1° over the study area for the period of 2012–2019 have been analyzed. The spatial variations over the region have been studied by considering longitudinal and latitudinal bands separately through the sample mean difference among different bands using multi-comparison analysis of variance technique in order to identify the clusters in the region. For the temporal variability, we model the total column ozone timeseries observation as a sum of seasonal, trend, and temporally correlated noise components. We have found that the total column ozone concentration has a maximum value of 301DU during summer on August 18, 2013 and a minimum value of 216DU during winter on January 03, 2013 over the study period. The 95% confidence level of the overall mean of the total column ozone concentration during the study period was found to be (261.35 ± 2.38)DU. Our spatial data analysis revealed that the spatial distribution of ozone over Ethiopia can be classified into three clusters: southern cluster (4.5°N–8.5°N and 33.5°E–47.5°E), north-eastern cluster (9.5°N to 14.5°N and 41.5°E–47.5°E), and north-western cluster (9.5°N–14.5°N and 33.5°E–40.5°E). We have checked the coefficient of determination among bands in the same cluster to see if the concentration of ozone in one band can be explained by the concentration in another band for each cluster and confirmed the reliability of the classification. In order to capture temporal characteristics, we have computed the spectral periodogram for each cluster and obtained a power peak at frequency f = 0.002 768 Hz, which indicates that the ozone concentration over the region exhibits an annual cyclic behavior. A truncated Fourier series fit is used to determine the annual seasonal component. The non-parametric Mann–Kendall’s trend test with a 95% confidence level of significant has indicated a decreasing linear trend with a depletion rate of 0.77, 0.73, and 0.43 DU/yr over north-western, north-eastern, and southern clusters, respectively. The analysis of residuals for each cluster indicated that the residuals are normally distributed with no significant outliers, and the model explains 85%, 86%, and 79% of the variance in the north-western, north-eastern, and southern clusters, respectively, demonstrating the reliability of the model considered in this study.
Circular cumulant reductions for macroscopic dynamics of oscillator populations with non-Gaussian noise
Authors: Dolmatova Anastasiya V. , Tyulkina Irina V. , Goldobin Denis S.
Published: November 2023

We employ the circular cumulant approach to construct a low dimensional description of the macroscopic dynamics of populations of phase oscillators (elements) subject to non-Gaussian white noise. Two-cumulant reduction equations for α-stable noises are derived. The implementation of the approach is demonstrated for the case of the Kuramoto ensemble with non-Gaussian noise. The results of direct numerical simulation of the ensemble of N=1500 oscillators and the “exact” numerical solution for the fractional Fokker–Planck equation in the Fourier space are found to be in good agreement with the analytical solutions for two feasible circular cumulant model reductions. We also illustrate that the two-cumulant model reduction is useful for studying the bifurcations of chimera states in hierarchical populations of coupled noisy phase oscillators.
Tutorial: Simulating modern magnetic material systems in mumax3
Authors: Joos Jonas J. , Bassirian Pedram , Gypens Pieter , Mulkers Jeroen , Litzius Kai , Van Waeyenberge Bartel , Leliaert Jonathan
Published: November 2023

This Tutorial article focuses on magnetic phenomena and material systems that have gained significant importance since the original development of mumax3, but are challenging to simulate for users who rely solely on the originally provided examples. Alongside the physical background, we provide hands-on examples of advanced magnetic systems, including detailed explanations of complete mumax3 input files (13 in total, often showing different ways to achieve things), and highlighting potential pitfalls where applicable. Specifically, we explore two approaches to incorporate spin–orbit torques in mumax simulations, considering the trade-off between versatility and speed. We also examine complex multilayer material stacks, including synthetic antiferromagnets, demonstrating different implementation methods that again vary in speed, versatility, and realism. A key criterion for selecting the optimal simulation strategy is its suitability for modeling systems where the magnetization varies significantly in the third dimension. The material covered in this Tutorial paper includes content developed for the mumax3 workshop presented during the summer of 2020 within the context of the IEEE online spintronics seminar, along with additional new topics. Throughout the explanations, we ensure broad applicability beyond specific examples.
Detection of temporal fluctuation in superconducting qubits for quantum error mitigation
Authors: Hirasaki Yuta , Daimon Shunsuke , Itoko Toshinari , Kanazawa Naoki , Saitoh Eiji
Published: November 2023

We have investigated instability of a superconducting quantum computer by continuously monitoring the qubit output. We found that qubits exhibit a step-like change in the error rates. This change is repeatedly observed, and each step persists for several minutes. By analyzing the correlation between the increased errors and anomalous variance of the output, we demonstrate quantum error mitigation based on post-selection. We have reduced the errors from 5.4% to 1.6% in a Bell state measurement and from 17.5% to 12.0% in a quantum volume circuit. Numerical analysis on the proposed method was also conducted.
Automated design of a 3D passive microfluidic particle sorter
Authors: Lai Kuan-Ming , Liu Zhenya , Zhang Yidan , Wang Junchao , Ho Tsung-Yi
Published: November 2023

Microfluidic chips that can sort mixtures of cells and other particles have important applications in research and healthcare. However, designing a sorter chip for a given application is a slow and difficult process, especially when we extend the design space from 2D into a 3D scenario. Compared to the 2D scenario, we need to explore more geometries to derive the appropriate design due to the extra dimension. To evaluate sorting performance, the simulation of the particle trajectory is needed. The 3D scenario brings particle trajectory simulation more challenges of runtime and collision handling with irregular obstacle shapes. In this paper, we propose a framework to design a 3D microfluidic particle sorter for a given application with an efficient 3D particle trajectory simulator. The efficient simulator enables us to simulate more samples to ensure the robustness of the sorting performance. Our experimental result shows that the sorter designed by our framework successfully separates the particles with the targeted size.
A data-driven model to determine the infiltration characteristics of air curtains at building entrances
Authors: Song Linye , Zhang Cong , Hua Jing , Li Kaijun , Xu Wei , Zhang Xinghui , Duan Chengchuan
Published: November 2023

The air curtain reduces heat exchange between the two sides by creating a virtual partition and works as a solution for improving building sealing and energy efficiency. Currently, the analytical numerical coupling method has achieved some success in describing the low-order theoretical descriptions of air curtain flow, but its application scope is limited. This paper introduces a data-driven model (DDM) to predict the operation state of the air curtain and the volume flow rate through the entrance. A computational fluid dynamics model is built to generate the dataset, which is validated by comparing velocity and volume flow rate with the published data in the literature. Three of the widely used algorithms are tested: support vector machine, random forest, and backpropagation neural network (BPNN). The main conclusions are as follows: (1) The combination of pressure difference and air supply velocity can quickly determine the operation state of the air curtain in the scene (f1-score = 0.9). (2) A single hidden layer BPNN can achieve high-precision prediction of volume flow rate (R2 = 0.92). (3) Compared to theoretical methods, the DDM can retain three-dimensional characteristics of the jet and capture additional details. The approach proposed in this paper can be applied to practical environments to rapidly and accurately optimize the operating parameters of air curtains.
H2O–HCN complex: A new potential energy surface and intermolecular rovibrational states from rigorous quantum calculations
Authors: Vindel-Zandbergen Patricia , Kȩdziera Dariusz , Żółtowski Michał , Kłos Jacek , Żuchowski Piotr , Felker Peter M. , Lique François , Bačić Zlatko
Published: November 2023

In this work the H2O–HCN complex is quantitatively characterized in two ways. First, we report a new rigid-monomer 5D intermolecular potential energy surface (PES) for this complex, calculated using the symmetry-adapted perturbation theory based on density functional theory method. The PES is based on 2833 ab initio points computed employing the aug-cc-pVQZ basis set, utilizing the autoPES code, which provides a site-site analytical fit with the long-range region given by perturbation theory. Next, we present the results of the quantum 5D calculations of the fully coupled intermolecular rovibrational states of the H2O–HCN complex for the total angular momentum J values of 0, 1, and 2, performed on the new PES. These calculations rely on the quantum bound-state methodology developed by us recently and applied to a variety of noncovalently bound binary molecular complexes. The vibrationally averaged ground-state geometry of H2O–HCN determined from the quantum 5D calculations agrees very well with that from the microwave spectroscopic measurements. In addition, the computed ground-state rotational transition frequencies, as well as the B and C rotational constants calculated for the ground state of the complex, are in excellent agreement with the experimental values. The assignment of the calculated intermolecular vibrational states of the H2O–HCN complex is surprisingly challenging. It turns out that only the excitations of the intermolecular stretch mode can be assigned with confidence. The coupling among the angular degrees of freedom (DOFs) of the complex is unusually strong, and as a result most of the excited intermolecular states are unassigned. On the other hand, the coupling of the radial, intermolecular stretch mode and the angular DOFs is weak, allowing straightforward assignment of the excitation of the former.
Towards structural optimization of gold nanoclusters with quantum Monte Carlo
Authors: Tiihonen Juha , Häkkinen Hannu
Published: November 2023

We study the prospects of using quantum Monte Carlo techniques (QMC) to optimize the electronic wavefunctions and atomic geometries of gold compounds. Complex gold nanoclusters are widely studied for diverse biochemical applications, but the dynamic correlation and relativistic effects in gold set the bar high for reliable, predictive simulation methods. Here we study selected ground state properties of few-atom gold clusters by using density functional theory (DFT) and various implementations of the variational Monte Carlo (VMC) and diffusion Monte Carlo. We show that the QMC methods mitigate the exchange-correlation (XC) approximation made in the DFT approach: the average QMC results are more accurate and significantly more consistent than corresponding DFT results based on different XC functionals. Furthermore, we use demonstrate structural optimization of selected thiolated gold clusters with between 1 and 3 gold atoms using VMC forces. The optimization workflow is demonstrably consistent, robust, and its computational cost scales with nb, where b < 3 and n is the system size. We discuss the implications of these results while laying out steps for further developments.
Aerothermal optimization of turbine cascade squealer tip with non-uniform squealer height
Authors: Cheng Hongzhi , Shahid Hanzla , Zhou Shuyu , Wang Wei , Xu Quanyong , Duan Penghao
Published: November 2023

The squealer tip has significant influence on both the aerodynamic and heat transfer characteristics of the high-pressure turbine blade. However, due to the complexity of parameterization and meshing of the squealer and the complicated flow structure within the over-tip region, the existing squealer designs in the open literature have constant squealer heights. In this paper, the design space to the squealer height with non-uniform squealer height is extended and the new flow features it may bring are investigated. A parameterization system specifically designed for the non-uniform squealer height using five control parameters is implemented to automatically generate the geometry and hybrid meshes. Combining it with the multi-objective optimization system using genetic algorithms, a transonic turbine cascade squealer tip is optimized employing Reynolds-averaged Navier–Stokes k–ω shear stress transport model. The main objective of this study is to obtain a squealer configuration with the lowest total pressure loss coefficient and heat transfer coefficient. The optimum configuration with non-uniform squealer height achieves improvements in both the aerodynamic efficiency and the heat transfer performance, relative to the baseline conventional squealer tip geometry with the constant squealer height. Additionally, this work demonstrates that a flow structure in which the main flow forms a “blanket” below the leakage flow in the squealer is beneficial for aerothermal performance, especially reducing heat transfer losses, which provides valuable insight into the squealer tip design of advanced high-pressure turbines.
Nano/microfluidic device for high-throughput passive trapping of nanoparticles
Authors: Wells Tanner , Schmidt Holger , Hawkins Aaron
Published: November 2023

We present a design and a fabrication method for devices designed for rapid collection of nanoparticles in a fluid. The design uses nanofluidic channels as a passive size-based barrier trap to isolate particles near a central point in the channel, which is also covered by a thin membrane. Particles that enter the collection region are trapped with 100% efficiency within a 6–12 μm radius from a central point. Flow rates for particle-free fluid range from 1.88 to 3.69 nl/s for the pressure and geometries tested. Particle trapping tests show that high trapped particle counts significantly impact flow rates. For suspensions as dilute as 30–300 aM (20–200 particles/μl), 8–80 particles are captured within 500 s.
The complementary contribution of each order topology into the synchronization of multi-order networks
Authors: Ren Xiaomin , Lei Youming , Grebogi Celso , Baptista Murilo S.
Published: November 2023

Higher-order interactions improve our capability to model real-world complex systems ranging from physics and neuroscience to economics and social sciences. There is great interest nowadays in understanding the contribution of higher-order terms to the collective behavior of the network. In this work, we investigate the stability of complete synchronization of complex networks with higher-order structures. We demonstrate that the synchronization level of a network composed of nodes interacting simultaneously via multiple orders is maintained regardless of the intensity of coupling strength across different orders. We articulate that lower-order and higher-order topologies work together complementarily to provide the optimal stable configuration, challenging previous conclusions that higher-order interactions promote the stability of synchronization. Furthermore, we find that simply adding higher-order interactions based on existing connections, as in simple complexes, does not have a significant impact on synchronization. The universal applicability of our work lies in the comprehensive analysis of different network topologies, including hypergraphs and simplicial complexes, and the utilization of appropriate rescaling to assess the impact of higher-order interactions on synchronization stability.
Sex of co-twin in utero environment does not alter reproductive fitness of Australian Merino sheep
Authors: Kleemann David O. , Walker Simon K. , Kelly Jennifer M. , Ponzoni Raul W.
Published: November 2023

Context Reproductive efficiency in ewes can vary widely depending on their fertility (pregnancy rate) and fecundity (litter size) and on their ability to rear multiple litters. Litter size and sex are important factors that contribute to lamb mortality, and hence reproductive efficiency. However, little is known about their interaction when fetuses of either sex grow in utero as co-twins, nor the impact that this interaction has on subsequent performance in domestic flocks. Aims and methods We examined the effect of type of birth (single, twin) and of sex of co-twin (F, F[F], F[M], M, M[M], M[F] where the symbol within brackets indicates sex of co-twin) on birth weight, survival to weaning, weaning and hogget liveweights and scrotal circumference. In addition, reproductive performance (fertility, fecundity, lamb survival, weaning rate) of female progeny was examined as well as the performance of their lambs (birth and weaning weight). This large-scale study (>13 000 lambing observations) was conducted with Australian Merino sheep from four studs, mated over nine annual cycles. Key results Sex of co-twin had no effect on birth weight and on later stages of growth. Sex of co-twin altered survival, with fewer of the M[M] class surviving to weaning compared with other co-twin classes (P < 0.05). Scrotal circumference did not vary between the male classes. Although reproductive performance (fecundity, lamb survival, weaning rate) was greater in ewes twin to a male (F[M]) than in single females (F) (P < 0.05), this difference could be due to greater genetic merit of twin versus single-born progeny. Conclusions Reproductive performance of females with a male co-twin exceeded that of single females; the difference could be due to greater genetic merit of twin-born ewes rather than a direct effect of in utero environment. There was no difference between females with a male co-twin and females with a co-twin of the same sex. Reproductive capacity of males was not affected by co-twin class or type of birth. Implications These results suggest that an increase in twinning rate by managerial or genetic means will not result in undesirable side effects due to sex of co-twin in utero.
The recognition of dental anxiety. A comment on ‘Dental clinicians recognizing signs of dental anxiety: a grounded theory study’ by M. Höglund, I. Wårdh, S. Shahnavaz and C. Berterö
Authors: R. Chapman Helen , Moghaddam Nima , Kirby-Turner Nick
Published: November 2023

No Abstract
Synthesis of scale-like nano-hydroxyapatite and preparation of biodegradable woven scaffolds for bone tissue engineering
Authors: Wang Shiqi , Zhang Ying , Peng Hao-Kai , Ren Hai-Tao , Lin Jia-Horng , Liu Xing , Lou Ching-Wen , Li Ting-Ting
Published: November 2023

Bone tissue engineering scaffolds should have bone compatibility, biological activity, porosity, and degradability. In this study, flake-like hydroxyapatite was synthesized by hydrothermal method and mixed with sodium alginate to make a gel, which was injected into a hollow braid. Porous and degradable SA/n-Hap woven scaffolds were prepared by freeze-drying technology. The morphology of hydroxyapatite was characterized by scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FTIR), and x-ray diffraction. The scaffolds were characterized by an improved liquid replacement method, compression test, and degradation test. The results showed that the hydroxyapatite synthesized at 160 °C had a scaly morphology. The prepared scaffold had a pore size of 5–100 μm, a porosity of 60%−70%, and a swelling rate of more than 300%. After 21 d the degradation rate reached 5.54%, and a cell survival rate of 214.98%. In summary, it is feasible to prepare porous bone scaffolds for potential bone tissue engineering. This study shows the feasibility of applying textile structures to the field of tissue scaffolds and provides a new idea for the application structure of tissue engineering scaffolds.
Gynaecology in older women
Authors: Savage Wendy
Published: November 2023

Gynaecology in older women is not a popular topic in the literature, nor does it merit a chapter heading in the average textbook, although since the conference on ‘Health Care for Older Women’ a new book on the topic has been published. I have defined older women as those over the age of 65, and have started by looking at the incidence of gynaecological cancers as a cause of death relative to other reasons for older women dying. These data have been presented in Table 4.1 as a death rate per 1000 women in the relevant age-group.
Successful ageing: the product of biological factors, environmental quality, and behavioural competence
Authors: Baltes Margret M , Reichert Monika
Published: November 2023

Successful ageing seems a contradiction in terms. In general, the term successful or optimal refers to gains accrued, whereas the term ageing refers to losses experienced. This holds true even if ageing represents a much more differentiated picture (as proven amply by empirical research) characterized by both gains and losses and by great heterogeneity.
Hospital Infection Control
Authors: Mehtar Shaheen
Published: November 2023

The spread of infection is a major problem in developing countries but the principles of effective control are the same throughout the world. However, alternative methods are sometimes necessary due to a lack of resources, such as clean water, electricity, or disposables. Recommendations for control of infection in the industrial countries are often not based on good evidence, and simpler methods can be equally effective; for example, clinical waste (apart from syringe needles) represents a minimal infection hazard, and provided it is handled and stored safely, does not require incineration as a control of infection measure. A return to the production of reprocessible items such as syringes and gloves may also be worth-while in the absence of reliable supplies of single-use items. The uncontrolled use of antibiotics leads to the emergence of resistant bacterial strains, and the resultant requirement for new antibiotics can considerably increase the cost of infection control. The rapid spread of HIV infection in some countries has also emphasized the need for good infection control techniques.
Infection control and management structure
Authors: Mehtar Shaheen
Published: November 2023

The Cooke report (1988) recommends that every hospital in the UK should have an Infection Control (IC) team. However, in other, developing, countries infection control is in its infancy and often relies on the goodwill of staff. Unfortunately, infection control programmes in these countries are often given little credibility, although effective control measures have been found to save hospitals significant amounts of money and are therefore vital for economic, as well as for patient health, reasons.
Evaluation of efficacy and safety
Authors: Banta H David , Luce Bryan R
Published: November 2023

Efficacy (benefits) and safety are the basic starting points for evaluating the overall utility of a health care technology. If a technology is not efficacious, it could not be used, and if its efficacy is unknown, statements about its overall value cannot be made. In addition, efficacy and safety data are needed to evaluate the cost-effectiveness of a technology (see Chapter 8). Neither the need for a technology nor it appropriate u e can be established without good information on efficacy and safety.
The assessment of surgical practice
Authors: Banta H David , Luce Bryan R
Published: November 2023

The assessment of surgery in a formal sense has been limited. The Office of Technology Assessment (496) concluded in 1983 that ‘The impact of RCTs on surgery has been minimal, largely because RCTs in surgery are the exception rather than the rule’. None the less, the situation seems to be changing slowly. Since the land-mark publication Costs, risks, and benefits of surgery in 1977 (99), surgery has been subject to increasing scrutiny.
The assessment of drugs
Authors: Banta H David , Luce Bryan R
Published: November 2023

Perhaps more information is available on the efficacy and safety of drugs than of any other technology. The main reason that this is true is because of the regulation of pharmaceutical products, which requires manufacturers to test drugs rigorously before they can be marketed. At the same time, organizations that fund technology assessments pay a great deal of attention to drugs. For example, a study by the OTA published in 1978 and based on 1975 data found that of the 755 clinical trials supported by the US National Institutes of Health (NIH) in that year, 400 tested drugs in isolation, while another 135 tested drugs in relation to another possible intervention (487). It should also be noted, how ever, that more than 300 of the 400 trials of drugs tested cancer chemotherapy. What this may indicate is that information on drugs may vary quite a lot, depending on the type of drug and its possible uses.
The development and assessment of health care technology in Mexico
Authors: Cruz Carlos , Frenk Julio , Martuscelli, Jaime , Faba Gladys
Published: November 2023

Mexico is a federal republic covering an area of almost 2000 square kilometers. The 1990 census reported a total population of 81. 1 million inhabitants, 72 per cent of whom reside in urban areas (354). In 1989, the country had a gross domestic product (GDP) of 200 730 million dollars, with a GDP per capita of US$ 2010. The average annual growth rate was 3 per cent during 1965-1989. Mexico is a country with a heavy external debt of US$95 642 million.
Selected experiences of other countries
Authors: Banta H David , Luce Bryan R
Published: November 2023

The development of health care technology is an international activity. Bio medical researchers in different specialized fields work hard to know exactly the state of research in their own areas, especially through reading journals and attending international conferences. Industry is international as we11, with a large multinational industry dealing with health products. A health research finding anywhere in the world may lead to a technology.
Personality and psychological environment
Authors: Muir John
Published: November 2023

Physiology links stress to the fight and flight reaction, whilst in psychology increasing stress is related to improving performance on a curve which peaks at an optimum level and then deteriorates. Pathophysiology relates extreme stress to sudden death —the fate of John Hunter when flatly contradicted at a hospital board meeting. With this background to heighten curiosity and fervour, researchers in the last 40 years have addressed the task of searching for a relationship between stress, personality, environment, and disease. The results provide intriguing conflicts in findings and have led to swings in consensus.
Diabetes
Authors: Mann Jim
Published: November 2023

Coronary heart disease (CHD) is a major cause of serious morbidity and the commonest cause of mortality among people with diabetes. It accounts for much of the excess morbidity and mortality associated with both insulin dependent (IDDM) and non insulin dependent diabetes (NIDDM). There are four major issues which are considered in this chapter: Over many decades, autopsy studies have suggested that people with diabetes have more extensive coronary atherosclerosis than non-diabetic people of the same age. The early studies were potentially biased since patients with diabetes may be more likely to come to autopsy than people without diabetes.
Secondary prevention of coronary heart disease
Authors: Lancaster Tim , Sleight Peter
Published: November 2023

Survivors of myocardial infarction have a four to eight times increased risk of recurrence and death. Coronary artery disease is common, so this represents a high absolute risk. In the British Regional Heart Study 14 per cent of 242 men with electrocardiographic signs of definite infarction had reinfarctions over a 4.2 year follow-up, compared with only 2 per cent of those with a normal electrocardiogram at entry to the study. Focusing clinical resources on such patients is attractive because of the health gain that can be achieved from small reductions in their high absolute risk, and because they may be more highly motivated to change damaging behaviours and comply with medical treatment.3 Unfortunately, effective treatments are not offered as often they could be, perhaps because physicians mistakenly believe that it is too late to improve coronary disease once infarction has occurred.
Reasons for note keeping
Authors: Guly H R
Published: November 2023

To remind the doctor of details of the consultation. The patient will often be asked to return for review or may reattend without an appointment if their symptoms become worse. Many patients need reports written for an employer, the police or an insurance company. A doctor seeing 40 patients a shift, will find it impossible to remember details of every patient even a week later, let alone the following year, but, not infrequently, if shown the notes of a patient seen several years earlier, will be able to remember much about the patient, the injury, and the consultation.
Thoracic and lumbar injuries
Authors: Guly H R
Published: November 2023

When talking to someone who presents with a back injury or back pain it is wise at an early stage in taking the history to ask them to point to the site of the pain. It is very common for patients who say they have injured their back to have an injury of the posterior chest wall or loin rather than the spine. This will affect the way you approach the history and examination and early identification of the injured area will speed the consultation.
Shoulder injury
Authors: Guly H R
Published: November 2023

That ‘X-rays’ are not the be all and end all of establishing a diagnosis in traumatized patients is perfectly illustrated in the shoulder where there are several skeletal injuries not shown or easily missed on routine shoulder X-rays but in which correct clinical method will lead to correct X-rays being taken.
Elbow injury
Authors: Guly H R
Published: November 2023

It is important to take an accurate history of the mechanism of injury as there are a number of mechanisms which may give clues to the diagnosis. In one injury in particular the history alone is almost diagnostic. The ‘pulled elbow’ (sub luxation of the proximal radio-ulnar joint) in children is caused by a longditudinal force applied to the forearm.
Hand injury
Authors: Guly H R
Published: November 2023

The middle finger can also be described as the long finger to avoid any confusion in the similar sound of little and middle. The metacarpals are normally numbered 1 to 5 but they too can be described in relation to their digit (e.g. the first metacarpal can be described as the thumb metacarpal, the second as the index metacarpal etc.) The web spaces are usually numbered 1 to 4 but can be described as e.g. ‘Web between index and middle’.
Forefoot injury
Authors: Guly H R
Published: November 2023

Other nomenclatures have been described including one based on the nursery rhyme ‘This little piggy goes to market... .’ but this will be incomprehensible to those unfamiliar with English nursery rhymes. If names are used, the big, little, and middle toes are easily identifiable and the other two can be named after the equivalent fingers (i.e. the index and ring toes). 3 Whereas the sides of a finger are described as radial and ulna, the sides of a toe are best described as medial and lateral.
Developmental anatomy and physiology
Authors: Woolf Adrian S
Published: November 2023

The more complicated an organ in its development the more subject it is to maldevelopment, and in this aspect the kidney outranks most other organs (Potter 1972).Thus wrote Edith Potter in 1972 when she provided the most complete summary of the normal and abnormal development of the kidney, or nephrogenesis. Her work describes in detail the complex normal morphogenesis of the kidney and classifies the histopathology of diseases such as the renal dysplasias, cystic diseases, and Wilm’s tumours that, she argued, appeared to arise from abnormal development. Two decades on, the science of molecular and cellular biology has begun to dissect both the pathways of normal nephrogenesis and the genetic mutations which lead to a wide range of inherited and congenital aberrations of renal anatomy and physiology (Woolf 1997).
Prenatal diagnosis
Authors: Crawfurd Martin d’A
Published: November 2023

Clearly, genetically determined renal disorders are not sufficiently common to warrant routine prenatal screening, although more common developmental anomalies may be detected routinely. Definitive prenatal diagnosis in high-risk pregnancies is based on the techniques of prenatal diagnosis in use for genetic disorders in general. This subject has been extensively reviewed, as for example in a recent monograph (Brock et al. 1992). The techniques specifically relevant to renal genetic disorders fall into two main categories: fetal sampling procedures combined with cytogenetic, biochemical, or molecular genetic analyses; and imaging techniques. Recent advances that use various techniques of fetal cell enrichment combined with PCR-based DNA analyses for the analyses of fetal cells isolated from the maternal circulation raise hopes that this may prove feasible in future (Adinolfi 1992; Busch et al. 1994; Lo et al. 1994).
Growth, development, and management of renal disease in children
Authors: Maxwell Heather
Published: November 2023

One of the goals of management of children with chronic renal disease is to ensure continued growth and development. Short stature, however, is a significant problem, and for many children it is the only visible sign of disease.This chapter addresses growth and development in children with renal disease. Growth in specific renal conditions will be mentioned in the relevant chapters; more general issues will be dealt with here. The effect of renal disease on growth is influenced by a number of factors, the most important of which are age and type of renal disease.
Cystic diseases of the kidney
Authors: Gabow Patricia A
Published: November 2023

The renal cystic diseases encompass a wide array of disorders which vary in their modes of inheritance, their associated abnormalities, and the degree to which they impact the health of the individual. Renal cystic disease can be congenital, inherited, or acquired (Table 8.1) (Gilbert Barness et al. 1990). The number of disorders which are accompanied by renal cysts suggests that they are a somewhat non-specific kidney response to a variety of genetic and non-genetic aberrations. Renal cysts can be an isolated abnormality or a part of systemic disease. Similarly, cysts can be an incidental finding discovered during abdominal imaging procedures, surgery, or autopsy or can contribute to significant morbidity and mortality.
Disorders of the basement membrane: hereditary nephritis
Authors: Flinter Frances A
Published: November 2023

Alport’s syndrome is a predominantly X-linked hereditary glomerulonephropathy which is associated with sensorineural deafness and characteristic eye lesions. The gene frequency of Alport’s syndrome is about 1 in 5000, and the disease accounts for about 0.6% of all patients who start renal replacement therapy in Europe (Atkin et al. 1988a). The recent cloning of a gene involved in at least 40% of cases means that accurate carrier detection and prenatal diagnosis are becoming available, and should soon be followed by an improved understanding of the pathology of the disease at a molecular level.
Bardet-Biedl syndrome
Authors: Parfrey Patrick S , Green, Jane , Harnett John D
Published: November 2023

Traditionally, Laurence-Moon-Biedl syndrome has been described as characterized by retinal dystrophy, polydactyly, obesity, mental retardation, and hypogenitalism (Ammann 1970; McKusick 1988). However, it is likely that this syndrome comprises two genetic disorders: the Laurence-Moon and Bardet-Biedl syndromes (Bartlet 1920; Biedl 1922; Schachat and Maumenee 1982; Lancet 1988). In the former, polydactyly is rare and spastic paraparesis dom inates, whereas in the latter syndrome neurologic manifestations are very unusual and renal abnormalities are frequent (Harnett et al. 1988). We have suggested that the cardinal manifesta tions ofBardet-Biedl syndrome are dystrophic extremities, retinal dystrophy, obesity, hypogeni talism in males, and renal abnormalities (Green et al. 1989). This chapter will focus on the manifestations (Table 14.1.1) and management ofBardet-Biedl syndrome.
Mitochondrial cytopathies and other rare inherited diseases affecting the kidney
Authors: Cameron J Stewart
Published: November 2023

There are a large number of rare inherited disorders, in many of which survival is limited and the conditions are rarely if ever seen in renal units dealing with adult patients. These conditions are more the subject of specialist paediatric nephrology, and accounts of them have been given by Crawford (1988), Gilbert-Barness et al. (1989), McKusick (1990), Barness and Opitz (1993), and Clarren (1994). This brief account is confined to inherited disorders which are likely to be encountered, albeit rarely in most cases, in adult clinics and which are not dealt with elsewhere in this book. Some rare inherited disorders affecting the glomeruli are dealt with elsewhere in this book, including familial dysautonomia, acro-osteolysis, collagen type III nephropathy, and famil ial fibronectin glomerulopathy.
Obtaining consent
Authors: Montague Alan , Hopper Andrew
Published: November 2023

This chapter is about obtaining valid consent in any circumstance. The law is outlined in Chapter 10. Consent does not require any formality, it can be verbal or even a gesture, such as baring a limb for an injection, but it is sensible to demand a signature for anything invasive, complex, risky, or involving sedation or general anaesthesia.
Special patients with special problems
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Jehovah’s witnesses are taught that it is wrong to receive elements of another’s body including blood or its components. They usually refuse consent to it while accepting other medical treatment and technology such as plasma substitutes.
Going to court
Authors: Montague Alan , Hopper Andrew
Published: November 2023

A reluctant witness is an antagonistic witness and lawyers pause before coercing a doctor into court. They are easily persuaded that doctors are busy and that unnecessary absence from their work will cause suffering to others.
Consent
Authors: Montague Alan , Hopper Andrew
Published: November 2023

In law the very basis of all we are allowed to do to a patient stems from their agreement that we shall do it. ‘The fundamental principle, plain and incontestable, is that every person’s body is inviolate’.1 The law sees consent as a part of everyday affairs and not confined to medical contexts. Note that consent obtained by fraud or deceit is no consent2 and that no one can consent to an illegal act.3
In vivo models of PKO in non-murine species
Authors: Benjamin D. Cowley , Vincent H. Gattone
Published: November 2023

Cystic kidney disease has been reported in numerous animal species (Table 4.1) and murine models of this disease are reviewed in another chapter. Many of the reports listed in Table 4.1 described isolated or limited numbers of cases, and therefore the characteristics of cystic disease in these animals are not well defined. In this review, we will concentrate on non-murine models of cystic kidney disease that have been used or continue to be used in attempts to understand pathogenetic mechanisms of polycystic kidney disease (PK.D).
Autosornal recessive polycystic kidney disease: clinical and genetic profiles
Authors: Guay-Woodford Lisa M
Published: November 2023

Autosomal recessive polycystic kidney disease (ARPKD) is an inherited malformation complex that involves the kidney and the biliary tract. ARPKD encompasses a spectrum of clinical and histopathological manifestations. Yet, there are two invariant features: (1) fusiform dilatation of the renal collecting ducts; and (2) biliary dysgenesis associated with portal tract fibrosis (Bernstein and Slovis 1992).
Polycystic liver disease
Authors: Torres Vicente E
Published: November 2023

The term ‘Polycystic liver disease’ (PLO) is often used to describe a condition with numerous cysts scattered throughout the liver parenchyma (Poinso et al. 1954; Melnick 1955; Peltokallio 1970; Sanfelippo et al. 1974; Vauthey et al. 1991). Whether PLD exists as an entity independent from autosomal dominant polycystic kidney disease (AOPKD) has been controversial. In this chapter we will consider under PLO: (1) the association of hepatic cysts with AOPKD; (2) the familial aggregation of hepatic cysts with an autosomal dominant pattern of inheritance in the absence of renal cystic disease; and (3) the sporadic presentation of numerous hepatic cysts in patients without renal cysts and without a personal or a family history of other conditions associated with hepatic cysts.
Intracranial aneurysms in autosomal dominant polycystic kidney disease
Authors: Yves Pirson , Dominique Chauveau
Published: November 2023

Intracranial aneurysm (ICA) rupture entails a 30 to 50 per cent mortality rate in the general population. The association of ICA and autosomal dominant polycys tic kidney disease (ADPKD) has been established for many years. Although it remains a rare manifestation of ADPKD, ICA rupture is part of the spectrum of extrarenal features that may occur at any time in the ADPKD patient. (Pirson and Griinfeld 1992).
Men at work
Authors: Skan Delia , Addley Ken
Published: November 2023

General practitioners are likely to come across work related illness more often nowadays because of the rapid increase in small businesses which cannot afford their own full-time medical advisor. This chapter is written by two occupational physicians both of whom used to be GPs. They highlight the importance of history taking, social class and common illnesses in men at work. The reluctance of men to consult is again pointed out. However the type of illness is dictated by the type of work more than by gender. Alcohol appears again as it relates to work. Some employers are adopting enlightened attitudes to both alcohol abuse and to psychological problems in the workplace.
Problems of not working
Authors: Beale Norman
Published: November 2023

‘Lying in harbour rots good ships and good men’ is a maxim attributed to Lord Nelson. Like all successful military leaders he had an innate grasp of the male psyche. He understood that idle men are soon unhappy. The sooner he could put to sea and divert his sailors with activity, however repetitive or unpleasant, the fewer the disciplinary problems for him and his officers. Unfortunately, national economies cannot be run along the lines of nineteenth-centurybattleships.