bluuebunny/crossref_metadata_2025 huggingface dataset:
I Need a Refill
Authors: Miller Elissa G.
Published: April 2020

Opioid misuse, abuse, and diversion are serious concerns due to the risk of addiction and death from overdose. Rising addiction and overdose rates in the United States have led providers to establish a set of standard practices by which they assess patient risk and monitor closely while the patient is receiving opioid therapy for pain management. Pediatric patients and their families are not immune to the risks of opioids, and they should therefore be monitored closely in accordance with the adult standard of care. This chapter discusses universal precautions for opioid prescribing and makes recommendations for pediatric palliative care providers.
They’re Taking Away Her Health Insurance!
Authors: Nourie Cory Ellen
Published: April 2020

Pediatrics, by nature, is focused on treating children and their adult caregivers. With deliberate interdisciplinary supports such as therapy services, social work, and the Child Life, pediatrics is designed with the recognition that the patient is rarely autonomous and instead requires the opinions and decision-making of adult caregivers, most often family members. Trained in developmental approaches and pediatric-onset conditions, pediatric teams are the experts and go-to resource for families with children and adolescents with special health care or ongoing medical needs. This chapter addresses what to consider as the patient grows older and moves away from pediatric-based care.
The Unexpected Question
Authors: Hayes Amelia
Published: April 2020

Having difficult conversations with sick children or with healthy siblings of sick children can be anxiety provoking for providers, even more so if the patient is not expected to survive their illness. Children are incredibly perceptive and will sense when something significant changes. When they ask unexpected questions, they deserve honest explanations, as they inevitably are making up their own story, which may or may not be scarier than reality. Although difficult, with advanced preparation, proceeding at the child’s pace with slow, concrete explanations and a focus on the most common developmental fears, these conversations can be held successfully and can aid in building a trusting relationship between the family and the provider.
Maximizing the Time Left
Authors: Pasichow Keith
Published: April 2020

When a patient has a prognosis of 6 months or less, they can choose to participate in hospice, a program that provides comfort-directed therapies and support for the patient and family in the home, in long-term care or skilled nursing facilities, or anywhere that the patient and family choose to spend their time. The transition to home hospice is a challenge for all patients, with unique challenges for pediatric, adolescent, and young adult populations. Deprescribing of unnecessary medications or those with intolerable side effects, development of a comfort-directed plan of care, evaluation of and support for the resources in the home and community, and helping the patient and family transition their focus and energies toward quality of life are all essential parts of the process. With pediatric patients, it is important that they be included in the decision-making process to the greatest extent possible, based on their desire to participate and the limitations set by their family (for those younger than the age of majority). When done well, and with careful planning, the transition process can be smooth and supportive for all involved.
Gallbladder
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The endodermal diverticulum of the caudal foregut develops into the GB. The GB lies between liver segments 4B and 5 and is supplied by the cystic artery. Cholecystokinin and vagal stimulation result in GB contraction, delivering bile (synthesized in the liver) into the duodenum. More than 80% of gallstones (cholelithiasis) are of the cholesterol type. Porcelain GBs can be seen on plain radiographs. Unless GB cancer is suspected preoperatively, or dense adhesions are likely, laparoscopic cholecystectomy is the operation of choice. Injury to the CBD (0.5%), duodenum, and liver parenchyma is uncommon but is a serious complication.
Liver
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The liver arises from the foregut-midgut junction. It is contained in the Glisson capsule, and the falciform ligament attaches the liver to the anterior abdominal wall. Hepatocytes perform approximately 500 functions. Chronic hepatitis C, alcoholic liver disease, and nonalcoholic steatohepatitis may cause cirrhosis and give rise to liver failure and potentially HCC. MRI, CT, and US are helpful for determining the extent of cirrhosis and detecting ascites, tumors, and blood flow. Fifty percent to 80% of the liver can be resected if the remainder functions well. Liver resections may bleed, leak bile, or lead to infection.
Soft Tissue
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The integumentary system is formed from the mesoderm. Skin and its appendages compose the largest bodily organ. The integumentary system and underlying soft tissue (fat, fascia, and muscle) protect the body from damage and infection. Skin lesions are typically asymptomatic, but they occasionally itch, bleed, or ulcerate. Work-up for diagnosis of soft tissue sarcomas includes CT, MRI, and biopsy. First-line treatment for symptomatic benign lipomas is surgical resection. Complications of surgical treatment of malignant tumors of the skin and soft tissue are postoperative bleeding, infection, hematoma, and recurrence.
Stomach
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The stomach develops during the fifth week of gestation from the dilated caudal portion of the foregut. The gastric cardia is just distal to the gastroesophageal junction, the fundus is the upper curvature to the left of the cardia, the body is the central region between the fundus and antrum, and the antrum tapers into the pylorus. Gastric parietal cells secrete hydrochloric acid and intrinsic factor, chief cells secrete pepsinogen, and G cells secrete gastrin. PUD is the most common cause of massive UGI bleeding. Although a UGI series can be used for diagnosis of gastric lesions, some are indistinguishable from benign peptic ulcers. Possible complications of gastric surgery include bleeding, anastomotic leak or stricture, or reflux esophagitis.
Introduction
Authors: Rhodes Rosamond
Published: April 2020

This book begins by rejecting the reigning view of medical ethics as the application of common morality, that is, the ethics of everyday life, to dilemmas that arise in today’s medical practice. Instead, it argues for a new theory of medical ethics that is actually in line with the codes of ethics and professional oaths proclaimed by physicians around the world. This introduction explains how a philosopher who has spent 30 years as a bioethicist at an academic medical center and medical school is in a good position to propose a novel approach to the ethics of medicine. The proposed theory of medical ethics makes sense of the concept of medical professionalism and serves as a useful guide for doctors who confront ethically challenging situations in their clinical practice.
Medicine’s Commitment to Truth
Authors: Rhodes Rosamond
Published: April 2020

This chapter explains truth-telling as a critical duty of medical ethics. Truthfulness and honesty promote trust in doctors and the profession, while withholding information or lying undermines society’s trust. Truth-telling also promotes the interests of patients and society because it allows decision-makers to rely on the reports of doctors. Doctors are obliged to be truthful and provide their patients with the information that they need in order to conduct their lives in accordance with their own priorities. Patients need to know their diagnosis and prognosis even when there are no medical decisions that turn on the information. Nevertheless, doctors are often reluctant to be forthcoming with patients. After explaining the importance of truthfulness in medicine, this chapter explores the reasons doctors give for being less truthful than they should be and debunks their withholding information with psychology research about affective and empathic forecasting and evidence from social science.
Commitments to Fellow Professionals
Authors: Rhodes Rosamond
Published: April 2020

Doctors’ ability to satisfy their responsibilities to society and patients involves fulfilling the duties that one medical professional owes to another. These duties include the interrelated obligations of peer responsiveness, peer communication, and peer scrutiny, which all derive from medicine’s commitments to make the profession worthy of trust and serve the interests of patients and society. Even though these obligations are rarely mentioned in medical association codes of ethics, they are recognized by most physicians. Their omission from formal declarations of physician responsibilities and from the standard accounts of medical ethics, however, leaves some doctors unaware that these are important professional duties. To address that lacuna, this chapter explains these duties and illustrates their importance with case examples to make it clear that they are essential elements of professionalism. The chapter also includes a discussion of the contentious issue of responsibilities for both acts and omissions.
I’m a Hot Baby
Authors: Ramgopal Sriram
Published: April 2020

The management of febrile neonates presents a diagnostic challenge. Most infections are viral and run a benign course. Important pathologies may be identified on examination including herpes simplex virus infection, otitis media, dacyrocystitis, conjunctivitis, or omphalitis. For those without focal findings, a careful evaluation is required to evaluate for serious bacterial infections (SBI). SBI are present in approximately 10% to 12% of febrile infants and include urinary tract infections, bacteremia, and bacterial meningitis. A variety of risk stratification models have been developed to identify those not at low risk, and conservative use of empiric antimicrobial therapy is recommended to reduce the morbidity and mortality of these rare but serious infections.
Shake It Baby
Authors: Ho Susana , McGuire Melissa A.
Published: April 2020

Every neonate undergoes normal physiologic hypoglycemia within the first few hours of birth given the unique transition between glucose sources. In utero, the mother is the primary source of glucose while, after birth, the newborn slowly transitions to gluconeogenesis, glycogenolysis, and oral feeds to help maintain blood sugar. Though determination of physiologic and pathologic hypoglycemia necessitating treatment may be difficult within the first few hours of life, it is an important one. There are numerous causes of hypoglycemia including maternal diabetes, congenital adrenal hyperplasia, and neonatal stress, among others. It is important to determine the etiology of hypoglycemia, as the prevention of recurrent hypoglycemia is important for neurologic development. Symptoms of hypoglycemia are nonspecific and can be indicative of other disease pathology such as sepsis. Symptoms include high pitched cry, poor suck, lethargy, coma, irritability, and inconsolability, among others. Long-term sequelae for babies with recurrent hypoglycemia and symptomatic hypoglycemia are mainly neurodevelopmental in nature. It is therefore of utmost importance to ensure that proper treatment is initiated to infants necessitating treatment.
Why Is My Child Shaking All Over?
Authors: Battisti Katherine
Published: April 2020

Seizures are a common reason for pediatric patients to present to the emergency department for evaluation. Differentiating between the different categories of seizures is essential when determining the approach to evaluation and management of these patients. These categories include simple and complex febrile seizures, first time non-febrile seizures, and known epilepsy. There are no universal guidelines so understanding these categories can help the emergency provider obtain appropriate laboratory evaluation, neuroimaging, and possibly electroencephalogram as indicated. Management of pediatric seizures and special considerations are discussed, taking into consideration key history and physical exam findings.
The Not-So-Happy Wheezer
Authors: Carter Hannah , Barata Isabel
Published: April 2020

Bronchiolitis is a common viral infection of the lower respiratory tract that usually affects young infants. Bronchiolitis commonly presents with rhinorrhea, increased work of breathing, and wheezing, caused by inflammation in the bronchioles of the lung. Bronchiolitis remains a clinical diagnosis. Laboratory studies, viral panels, and radiographs are not helpful. Once the diagnosis of bronchiolitis is made, the next important step is to assess the severity of the illness since this will drive the treatment options as well as the disposition. Many therapeutic options such as albuterol, steroids, and hypertonic saline have been shown to not be effective. High flow oxygen as compared to continuous positive airway pressure therapy has been shown to be the only modality that decreases intensive care unit length of stay and intubation rates. Patients with mild/moderate cases of bronchiolitis can be discharged home, if they are able to maintain oxygen saturation of 90% with appropriate work of breathing, adequate oral intake, and reliable follow-up. In moderate to severe cases of bronchiolitis, care should be taken to monitor the vital signs and the respiratory status and escalate supportive care as necessary.
Taking a headache history
Authors: Lance James W. , Dodick David W.
Published: April 2020

The first tip is to take a full medical history. The trick is to interpret it. Around 400 bc Hippocrates described exertional and sex headaches with no aid other than a reed pen and papyrus or parchment. The second tip is to let patients tell the story in their own words as much as possible. The trick is to extract the salient features of the headache syndrome from what is often a cascade of irrelevancies while still trying to let the patient do most of the talking. This is a form of guided democracy. The final tip is to regard the headache as a pain problem to be analysed and hopefully solved by including a traditional pain history as taught in medical school. The trick is not to take shortcuts unless the patient is in extremis on being brought to the Emergency Department, when leaping straight to testing for neck rigidity and looking for signs of infection, a dilating pupil, and other warning signs is preferable.
Headache in history
Authors: Eadie Mervyn J.
Published: April 2020

Headache began to be mentioned in surviving recorded material from various earlier civilizations from as long as 6000 years ago. Over most of that time, individual types of headache were not recognized, the symptom usually being ascribed to various supernatural factors. More physical and increasingly medical interpretations began to appear in the writings of Hippocrates. Early in the Christian era, headache subtypes (cephalalgia, cephalaea, and hemicrania) began their nearly 2000 year-long existences. The modern varieties of headache began to emerge from these venerable and never consistently demarcated entities at various stages in late medieval and modern times, with several types being recognized only in the past century. However, migraine (megrim) was recognized much earlier, although a major interest in it developed only in the latter half of the nineteenth century. Its pathogenesis increasingly became interpreted in terms of either cranial vascular or primary neural disturbance, and its first specific drug treatment became available in the 1920s.
Retinal migraine
Authors: Grosberg Brian M. , Sollars C. Mark
Published: April 2020

The relationship between migraine and a large number of other diseases has been studied to varying degrees. Both clinical and population-based studies, cross-sectional and longitudinal, have been performed, indicating a relationship of migraine with ischaemic stroke, epilepsy, vertigo, psychiatric disorders, sleep disorders, pain disorders, and others. The association of migraine with depression is one of the most extensively studied comorbidities. The bidirectional nature of this comorbidity indicates possible shared genetic factors. Furthermore, the risk of migraine chronification is increased in migraine patients with a depression. Also, anxiety and bipolar disorder show clear associations with migraine. Sleep disorders have been reported to occur more often in migraineurs than in persons without migraine. A clear association was found for restless legs syndrome and familial advanced sleep phase syndrome. Furthermore, associations have been described with insomnia, daytime sleepiness, sleep apnoea, and narcolepsy. Among pain disorders associated with migraine are low back pain, fibromyalgia, and abdominal pain. The magnitude and the background of these comorbidities remain unclear, and should be further investigated. Other described comorbidities of migraine include syncope, movement disorders, asthma and allergies, gynaecological disturbances, obesity, diabetes, multiple sclerosis, and cancer.
Treatment and management
Authors: Magis Delphine
Published: April 2020

A significant proportion of migraine patients appears reluctant to take migraine preventive drugs, or do not sufficiently improve when on available medications. The concept of non-pharmacological migraine approaches includes a large diversity of treatments: oral therapies (nutraceuticals or herbal medicines); exercise, behavioural therapies, and multidisciplinary care; acupuncture; peripheral invasive or non-invasive nerve stimulation; and, finally, brain neuromodulation (transcranial magnetic stimulation and transcranial direct current stimulation). The majority of these treatments have few adverse events and their efficacy often seems within the range of usual migraine preventive drugs. However, large placebo-controlled studies are often lacking. Thus, keeping these alternatives in mind when taking care of migraine patients in daily clinical practice is worthwhile.
SUNCT/SUNA
Authors: Pareja Juan A. , Wilbrink Leopoldine A. , Cuadrado María-Luz
Published: April 2020

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA) are currently classified in the section of the trigeminal autonomic cephalalgias as separate subtypes of the same disorder (short-lasting unilateral neuralgiform headache attacks). There is no therapy consistently effective for SUNCT or SUNA. During the worst periods intravenous lidocaine or phenytoin may decrease the frequency of SUNCT/SUNA attacks. Lamotrigine is the drug of choice for the preventive treatment of SUNCT, but it is less effective for SUNA. Gabapentin may be also effective for both SUNCT and SUNA. Topiramate can be effective in SUNCT, but it has not shown an effect in SUNA. Some medically refractory cases have obtained benefit from surgical procedures. These include microvascular decompression of the trigeminal nerve, ablative procedures involving the trigeminal nerve, Gasserian ganglion or sphenopalatine ganglion, occipital nerve stimulation, and hypothalamic deep brain stimulation.
Headache and neurovascular disorders
Authors: Wermer Marieke J.H. , van Os Hendrikus J. A. , Dodick David W.
Published: April 2020

This chapter discusses headaches and neurovascular disorders. The relationship between migraine, ischaemic stroke, and elevated cardiovascular Framingham risk factors has been a well-documented association in case–control, cohort, observational studies, and population-based studies. The risk of stroke appears to be independent of typical vascular risk factors and is best established in those with migraine with aura, especially in women younger than 45 years of age. Smoking and the use of oral contraceptive agents appear to magnify the risk substantially. The risk also appears to increase with increasing migraine attack frequency. The risk of stroke in women with migraine has also been demonstrated in those older than 45 years of age. Migraine with aura was also found to be a risk factor for myocardial infarction, coronary revascularization, and death due to cardiovascular disease. Similar results suggest that the risk of adverse cardiovascular events in migraine patients may be seen in men over the age of 45 years as well.
Reversible cerebral vasoconstriction syndrome
Authors: Singhal Aneesh B.
Published: April 2020

Reversible cerebral vasoconstriction syndrome (RCVS) is a term used to describe a group of conditions characterized by reversible segmental narrowing and dilatation of multiple intracranial arteries. Most patients present with an explosive-onset, severe (thunderclap) headache. Thunderclap headaches frequently recur over days to weeks. Recent studies suggest that RCVS and primary thunderclap headache belong to the same spectrum of disorders, justifying the inclusion of RCVS in this textbook of headache syndromes. Up to one-third of patients do not have any identifiable trigger; however, most cases have been associated with exposure to vasoconstrictive medications, illicit drug use, over-the-counter agents, sexual activity, and childbirth.
Headache and hormones, including pregnancy and breastfeeding
Authors: Labruijere Sieneke , Ibrahimi Khatera , Couturier Emile G.M. , Maassen van den Brink Antoinette
Published: April 2020

Migraine is much more common in women than in men, especially during the reproductive years. Furthermore, the incidence of migraine attacks depends on hormonal changes, such as those that occur during menstruation or pregnancy, or in patients who use exogenously administered hormones. This chapter describes the role of ovarian hormones (primarily oestradiol and progesterone) on neurotransmission and vascular function. Furthermore, the treatment of different forms of hormonally related headaches is discussed.
Visual snow
Authors: Onderwater Gerrit L. J. , Ferrari Michel D.
Published: April 2020

Visual snow is characterized by continuous visual disturbances in the form of countless tiny particles present in the entire visual field, often interpreted as television static. The visual disturbances are almost always accompanied by additional symptoms, including palinopsia, nyctalopia, photophobia, entoptic phenomenon, bilateral tinnitus, concentration problems, lethargy, and irritability. Visual snow has been linked to migraine and the migrainous aura. The clinical phenotype of visual snow clearly different from migraine; however, the co-occurrence with migraine (aura) might imply that both conditions share underlying pathophysiological mechanism(s). Visual snow is currently diagnosed on patient history alone, as additional investigations are typical normal and do not contribute to the diagnosis. However, ophthalmological investigation, neuroimaging, and, in selected cases, electroencephalography are recommend to rule out other disorders. Although self-limiting in some cases, visual snow typically remains a chronic condition that is very difficult to suppress with drug or non-pharmacological treatment.
Ethics and research in psychiatry: Engagement with patients and public
Authors: Hatch Stephani L. , Gazard Billy , Rose Diana
Published: April 2020

This chapter explores the ethical issues that arise in psychiatric research in relation to engagement with patients and the general public. Over the past decade, there has been a significant shift in psychiatric and other medical research that places an emphasis on the engagement and involvement of patients and the public. This shift has resulted in changes in the expectations of the way research is conducted and disseminated, specifically regarding the level of scientific knowledge that should be accessible to service users and the public. The chapter begins by making the distinction between patient and public engagement and patient and public involvement. It then discusses basic ethical principles as they relate to engagement, and provides examples of how patient and public engagement is situated within psychiatric research agendas, particularly as it relates to participatory action approaches. It concludes with three brief case studies of engagement approaches in psychiatric research with discussion of ethical issues that may arise in different types of engagement.
Cross-sectional surveys
Authors: Prince Martin , Das-Munshi Jayati
Published: April 2020

This chapter provides an overview of cross-sectional study designs. The chapter covers the application of cross-sectional surveys, the importance of defining the base population and methods to determine sampling, the issues of non-response, representativeness, and generalizability in cross-sectional surveys, as well as more specific methodological issues such as two-phase surveys. The practicalities of conducting cross-sectional surveys from initial design stages through to analyses and dissemination stages are covered. An overview is provided on the strength and limitations of cross-sectional surveys and their application to wider contexts, where there may be concerns around service planning and the population-level impact of mental disorders. The chapter concludes with an overview of landmark international cross-sectional surveys which have informed psychiatric epidemiology worldwide.
The case–control study
Authors: Aschan Lisa , Hotopf Matthew
Published: April 2020

This chapter explores the case control study, one of the most widely used designs in epidemiology. We explore the rationale and main advantages of the design (particularly its usefulness for rare disorders or disorders with long latent periods) and some of its disadvantages (including selection and recall bias). We discuss the application of the case-control study in psychiatry and the main steps taken in conducting a case control study, including identification of cases and controls, steps taken to minimize bias and confounding, and the main considerations in describing analysis.
Critical appraisal
Authors: Coon Jo Thompson , Abbott Rebecca
Published: April 2020

This chapter provides an introduction to the principles of critical appraisal and explains why critical appraisal skills are important in practice and research. Guidance is provided on how to approach the critical appraisal of different types of study including cross-sectional studies, case–control studies, cohort studies, clinical trials, systematic reviews, and qualitative studies. A worked example is provided at the end of the chapter to illustrate the process. Developing skills in critical appraisal will help readers to assess the credibility, relevance, and value of the results of research and is an essential component of practising evidence-based medicine.
Statistical techniques in psychiatric epidemiology
Authors: Aschan Lisa , Das-Munshi Jayati , Hayes Richard , Prince Martin , Richards Marcus , Schofield Peter , Stewart Robert
Published: April 2020

Epidemiology and medical statistics have been partner disciplines since the nineteenth century, despite disagreement between their founding fathers. This chapter begins with a summary of the discrete uses of statistical techniques in epidemiological research, followed by some guidance on constructing regression models—a common task, but one which it is important to think through carefully. This topic is developed further through a more detailed consideration of mediating and causation, which are particularly important in psychiatric epidemiology because of the long and complex pathways of causation, and lifelong interrelationships between exposure and outcome states characteristic of mental disorders and their risk factors. Finally, four key emerging themes are considered: the use of propensity scores, dealing with missing data, multilevel modelling, and latent class analyses.
Cardiac embryogenesis
Authors: Kelly Robert G.
Published: April 2020

The embryonic heart forms in anterior lateral splanchnic mesoderm and is derived from Mesp1-expressing progenitor cells. During embryonic folding, the earliest differentiating progenitor cells form the linear heart tube in the ventral midline. The heart tube extends in length and loops to the right as new myocardium is progressively added at the venous and arterial poles from multipotent second heart field cardiovascular progenitor cells in contiguous pharyngeal mesoderm. While the linear heart tube gives rise to the left ventricle, the right ventricle, outflow tract, and a large part of atrial myocardium are derived from the second heart field. Progressive myocardial differentiation is controlled by intercellular signals within the progenitor cell niche. The embryonic heart is the template for septation and growth of the four-chambered definitive heart and defects in progenitor cell deployment result in a spectrum of common forms of congenital heart defects.
Chronic heart failure diagnosis: biomarkers
Authors: Mueller Christian
Published: April 2020

Natriuretic peptides including B-type natriuretic peptide (BNP), N-terminal (NT)-proBNP, and midregional pro-atrial natriuretic peptide (MR-proANP) are the biomarkers of choice in the diagnosis of heart failure. Assays measuring either BNP, NT-proBNP, or MR-proANP are widely available and run on large analysers operating in the central laboratory or as point-of-care options. Natriuretic peptides are considered quantitative markers of haemodynamic cardiac stress and therefore quantitative markers of heart failure itself. The clinical introduction of natriuretic peptides constitutes the most important advance in the diagnosis of heart failure in the last decade.
Hypertensive disorders of pregnancy
Authors: Frise Charlotte , Collins Sally
Published: April 2020

This chapter covers physiology and blood pressure in the pregnant patient, followed by hypertensive disorders in pregnancy. This includes pre-existing hypertension, and hypertension induced by pregnancy. It also describes the background, investigations, management, and counselling of pre-eclampsia, HELLP syndrome, and eclampsia. Postnatal management is also covered, and the uses of antihypertensives in the pregnant patient are indicated, along with contraindications and possible side effects.
Respiratory
Authors: Frise Charlotte , Collins Sally
Published: April 2020

This chapter describes the respiratory changes that take place in pregnancy, infections, and pre-existing conditions that may be exacerbated or changed prior to birth. Lung function tests, including spirometry, static lung volumes, and diffusion capacity, are all described. Diseases such as tuberculosis, bronchiectasis, cystic fibrosis, and so on are described, with evidence-based management strategies. Respiratory failure and lung transplantation as well as difficulties associated with pre-existing conditions in pregnancy are also covered.
Infectious diseases
Authors: Frise Charlotte , Collins Sally
Published: April 2020

This chapter covers a range of infectious diseases, including Ebola and Zika, and their associated risk to both the patient and the fetus in pregnancy. Management strategies are discussed. Management, counselling, and preconception advice for couples where one or both have HIV are covered extensively, and vaccination indications and contraindications are explained.
Age and the pelvic floor
Authors: Jefferis Helen , Price Natalia
Published: April 2020

The pelvic floor changes with age. This chapter begins by discussing daytime and nocturnal urinary incontinence in children alongside treatment strategies. Urinary tract infection in children is also described. Impact of the menopause on the urogenital tract, vulvovaginal symptoms, and lower urinary tract are all covered. Finally, the scope of the problem of incontinence in older people is discussed, with diagnostic and treatment considerations included.
Psychosocial/non-pharmacologic treatment of negative symptoms
Authors: Savill Mark
Published: April 2020

Current best practice regarding the treatment of negative symptoms of schizophrenia supports the use of psychological interventions in addition to medication. This chapter reviews the literature evaluating different non-pharmacological approaches to treating these symptoms. Meta-analytic studies suggest that social skills training, music therapy, non-invasive brain stimulation, mindfulness, and exercise-based interventions are all effective at improving negative symptoms, relative to treatment as usual (TAU). Effect sizes for these interventions range from small to moderate. The long-term benefits of these interventions are currently unclear, and there has been some debate as to whether the impact of these interventions constitute consistent, clinically meaningful change. Evidence for other therapies such as arts therapies other than music therapy, cognitive behavioural therapies for psychosis, neurocognitive therapies, and family-based interventions is more inconsistent. As a result, primary negative symptoms of schizophrenia can still be considered an important unmet therapeutic need where more research is needed.
Case 7
Authors: Humphreys Hilary
Published: April 2020

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent cause of acute admission to hospital. These may be characterized by increased sputum production or a change in character, from mucoid to purulent, but microbiological analysis of sputum in such patients is usually not rewarding. With the use of molecular diagnostics, viral causes are increasingly recognized such as respiratory synctial virus and meta-pneumovirus. Many patients do not require an antibiotic as part of therapy but where indicated an agent such as co-amoxyclav may be appropriate. Further research on the respiratory microbiome may provide new insights into the dynamics of the normal flora in patients with COPD. Prophylactic antibiotics, such as with a macrolide, is controversial; the immunomodulatory impact may be outweighed by the risk of antibiotic resistance and drug side-effects.
Case 8
Authors: Humphreys Hilary
Published: April 2020

Influenza occurring during pregnancy is associated with increased cardio-respiratory complications which are exacerbated by underlying disease. Oseltamavir is recommended despite the potential risks to the foetus. Influenza may be complicated by bacterial pneumonia or co-infection with other viruses such as metapneumovirus. Patients with suspected influenza should be isolated with respiratory precautions on admission to hospital to prevent nosocomial spread. Poor uptake of influenza vaccination amongst healthcare professionals is partly due to the mistaken belief that it may cause influenza and the fear of side-effects. In the United Kingdom, pregnant women, those with chronic diseases, immunosuppression, diabetes mellitus, morbid obesity, members of the public over 65 years of age, residents in long-stay homes, and children 2–9 years of age should all be vaccinated. Avian influenza was first described in 1997, occurs in younger patients, has a mortality of 50%, and, through adaptive mutations, may result in pandemic strains.
Case 15
Authors: Humphreys Hilary
Published: April 2020

Secondary peritonitis arises from a perforated viscus and is usually polymicrobial. Empiric antimicrobial therapy should include agents active against aerobic Gram-negative bacilli and anaerobes, but not necessarily enterococci. There are a variety of potential treatment regimens but the choice will depend on whether community-acquired or healthcare-associated, local antimicrobial resistance patterns, and the severity of the illness. Controversy exists as to whether β‎-lactam/β‎-lactamase inhibitors can be used for infections involving extended-spectrum β‎-lactamase-producing bacteria as some argue in favour of this if the minimum inhibitory concentrations are low. The duration of treatment is variable but less than 5 days is probably adequate for uncomplicated cases, especially if there is adequate source control, and the patient does not require admission to a critical care unit. Up to a half of all patients undergoing an emergency laparotomy for a perforated viscus will develop a surgical site infection.
Case 23
Authors: Humphreys Hilary
Published: April 2020

Infection is one of the commonest complications of continuous ambulatory peritoneal dialysis (CAPD) which often presents with a cloudy bag and sometimes abdominal pain. Gram-positive bacteria, such as coagulase negative staphylococci, are the commonest cause. The diagnosis is confirmed by markedly elevated white cells in the CAPD fluid and a positive culture. Empiric antibiotics should cover Gram-positive and Gram-negative bacteria—e.g intra-peritoneal vancomycin and gentamicin—which are modified when culture and antibiotic susceptibility results are available. Removal of the peritoneal dialysis catheter is indicated in pseudomonal and fungal peritonitis and when there is recurrent infection. Culture-negative CAPD infection may be due to tuberculosis. Minimizing infection is largely achieved through good standards of personal hygiene, patient training and education, and home visits.
Case 30
Authors: Woodhouse Andrew
Published: April 2020

Progressive multifocal leucoencephalopathy (PML) is an opportunistic infection of the central nervous system caused by the JC polyomavirus (JCV) It is seen almost exclusively in individuals with severe immunosuppression and has become much more widely recognized since the AIDS/HIV epidemic. Classical imaging appearances can be highly suggestive of the diagnosis but definitive evidence would include detection of JCV in CSF or a brain biopsy. Treatment is supportive and focused on immune reconstitution.
Case 31
Authors: Woodhouse Andrew
Published: April 2020

Fever for which there is no obvious cause after initial evaluation and which persists remains a diagnostic challenge even for modern medicine with its plethora of investigative tools. The classical definition of pyrexia of unknown origin (PUO) is still useful but more recent modifications take into account specific patient groups and the changes in the way in which patients are evaluated, with less emphasis on in-patient investigation. While infection remains an important underlying cause of PUO, a substantial proportion of patients have other conditions, particularly malignancy and inflammatory and autoimmune diseases. Approaching a patient with PUO in a systematic way and gathering information from history, examination, and initial investigations allow a targeted approach to investigations which will reveal a diagnosis in a majority of patients.
Case 33
Authors: Wong T H Nicholas
Published: April 2020

Culture-negative infective endocarditis comprises up to one-third of all cases of infective endocarditis. The commonest cause may be a consequence of recent antibiotic use. Pathogens associated include the HACEK group (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, and Kingella spp.) of organisms as well as fastidious organisms such as Brucella, Bartonella, Coxiella, or Mycobacteria. History-taking is essential to understand the potential pathogens involved, with particular emphasis on exposure, contact with animals, or ingestion of contaminated food. Diagnosis can range from special tissue stains to polymerase chain reaction (PCR) and special culture techniques. Management of culture-negative infective endocarditis varies depending on the organism isolated, and may involve combination antimicrobial therapy with potentially long durations (up to 18 months).
Case 40
Authors: Kadambari Seilesh
Published: April 2020

Neonatal herpes is a rare but serious viral infection and can cause significant morbidity and mortality. Neonatal herpes is classified as either disease localized to skin, eye, and mouth (SEM), central nervous system disease (CNS), or disseminated infection with multiple organ involvement. More than 80% of neonates with SEM have skin vesicles. Disseminated infection should be considered in neonates with sepsis-like syndrome, severe hepatic dysfunction, or coagulation abnormalities. Infants with disseminated and SEM disease typically present within the first 2 weeks of life and infants with CNS disease within the second and third week of life.
Case 41
Authors: Humphreys Hilary
Published: April 2020

Listeriosis is an opportunist bacterial infection, usually caused by Listeria monocytogenes, and which may be carried in the gastrointestinal tract of approximately 5% of the healthy population. At-risk patients include pregnant females, neonates, patients with leukaemia or following solid organ transplantation, and those on high dose steroids and biological agents. Physiological changes during pregnancy predispose, for example, alterations in the balance between T-helper 1 and T-helper 2 cells due to increased progesterone levels. The most common presentation is a ‘flu-like illness’ followed by bloodstream infection, meningitis, or both. Amoxicillin/ampicillin with or without an aminoglycoside is the treatment of choice but the bacterium is resistant to cephalosporins and clindamycin. Prevention is through avoidance of food sources such as soft cheeses, smoked fish, pate, cantaloupe, and cold meats, as well as attention to hygiene in the kitchen, for example, hand hygiene and avoiding the storage of cooked and raw foodstuffs side-by-side.
Weak lensing minima and peaks: Cosmological constraints and the impact of baryons
Authors: Coulton William R , Liu Jia , McCarthy Ian G , Osato Ken
Published: April 2020

We present a novel statistic to extract cosmological information in weak lensing data: the lensing minima. We also investigate the effect of baryons on cosmological constraints from peak and minimum counts. Using the MassiveNuS simulations, we find that lensing minima are sensitive to non-Gaussian cosmological information and are complementary to the lensing power spectrum and peak counts. For an LSST-like survey, we obtain $95{{\ \rm per\ cent}}$ credible intervals from a combination of lensing minima and peaks that are significantly stronger than from the power spectrum alone, by $44{{\ \rm per\ cent}}$, $11{{\ \rm per\ cent}}$, and $63{{\ \rm per\ cent}}$ for the neutrino mass sum ∑mν, matter density Ωm, and amplitude of fluctuation As, respectively. We explore the effect of baryonic processes on lensing minima and peaks using the hydrodynamical simulations BAHAMAS and Osato15. We find that ignoring baryonic effects would lead to strong (≈4σ) biases in inferences from peak counts, but negligible (≈0.5σ) for minimum counts, suggesting lensing minima are a potentially more robust tool against baryonic effects. Finally, we demonstrate that the biases can in principle be mitigated without significantly degrading cosmological constraints when we model and marginalize the baryonic effects.
Cataclysmic variables as possible counterparts of ancient Far Eastern guest stars
Authors: Hoffmann Susanne M , Vogt Nikolaus
Published: April 2020

Continuing our efforts to select possible classical nova candidates among Far Eastern guest stars and to identify them with modern cataclysmic variables (CVs), we present a search for counterparts in 24 promising areas of the sky corresponding to ancient observations between 204 bce and 1690 ce. These areas were derived by us in a previous paper. Based on the physical entities of the CVs in our areas and reasonable magnitude limits compatible with the distribution of known eruption amplitudes of telescopic classical novae, we present a catalogue of a total of 80 CVs and related targets that could possibly have caused the historical sightings. This list could potentially be reduced by additionally discussing further information such as brightness or duration. In some cases, we present a detailed discussion of the interpretation of ancient sources comparing them with properties of the brightest CVs in the field. In order to estimate whether this list is representative, we discuss the distribution of CV types in our catalogue of counterparts for the historical events. Compared to the entire sky, the surface densities of most CV subtypes in our search fields reveal similar values, except for polars and intermediate polars, i.e. strongly magnetic CVs, for which a significant excess in our search fields was detected. Finally, we give an outlook towards future research in this topic, and provide in the online supplementary information a complete atlas of the celestial maps of all 24 guest star events, displaying the search areas and locations of CVs within them.
Heart of darkness: the influence of galactic dynamics on quenching star formation in galaxy spheroids
Authors: Gensior Jindra , Kruijssen J M Diederik , Keller Benjamin W
Published: April 2020

Quenched galaxies are often observed to contain a strong bulge component. The key question is whether this reflects a causal connection – can star formation be quenched dynamically by bulges or the spheroids of early-type galaxies? We systematically investigate the impact of these morphological components on star formation, by performing a suite of hydrodynamical simulations of isolated galaxies containing a spheroid. We vary the bulge mass and scale radius, while the total initial stellar, halo, and gas mass are kept constant, with a gas fraction of 5 per cent. In addition, we consider two different sub-grid star formation prescriptions. The first follows most simulations in the literature by assuming a constant star formation efficiency per free-fall time, whereas in the second model it depends on the gas virial parameter, following high-resolution simulations of turbulent fragmentation. Across all simulations, central spheroids increase the gas velocity dispersion towards the galactic centre. This increases the gravitational stability of the gas disc, suppresses fragmentation and star formation, and results in galaxies hosting extremely smooth and quiescent gas discs that fall below the galaxy main sequence. These effects amplify when using the more sophisticated, dynamics-dependent star formation model. Finally, we discover a pronounced relation between the central stellar surface density and star formation rate (SFR), such that the most bulge-dominated galaxies show the strongest deviation from the main sequence. We conclude that the SFR of galaxies is not only set by the balance between accretion and feedback, but carries a (sometimes dominant) dependence on the gravitational potential.