bluuebunny/crossref_metadata_2025 huggingface dataset:
A new method of image encryption using advanced encryption Standard (AES) for network security
Authors: Inam Saba , Kanwal Shamsa , Firdous Rabia , Zakria Khansa , Hajjej Fahima
Published: November 2023

With the rapid increase in the use of technology, images have become a major source of sharing personal, confidential and official information and there is a dire need to protect this secret data. Image encryption plays major role in the security of images and there are many techniques developed for this purpose. Chaos based image encryption has now become most applicable and beneficial technique for image encryption. The purpose of this paper is to highlight a new method of image encryption with the use of advanced encryption standard (AES) and chaotic maps. This technique is composed of substitution and permutation phases. AES is found to be most secure cipher until now against different kinds of attacks. The round keys are generated by AES using key expansion algorithm. The sensitivity of this technique is that it is dependent on initial values and input image. S-boxes in AES introduce non-linearity, confusion, and an avalanche effect, enhancing security and resistance to cryptographic attacks by substituting bytes in the encryption process. The combination of AES and chaotic maps in encryption schemes provides a two-tiered approach to enhance security. AES offers a strong and well-established encryption method, while chaotic maps introduce randomness and complexity, making it more difficult for attackers to decipher encrypted data. This combination is often used to achieve a higher level of encryption security in various applications, including data transmission and storage. Different kinds of analysis and tests are performed on the technique which includes information entropy, number of pixel change rate (NPCR), and peak signal-to-noise ratio (PSNR), unified average changing intensity (UACI) and histogram correlation of adjacent pixels. The results of these tests show that this technique is secure and resistant towards attacks.
The explicit power series solution formation and computationof Lie point infinitesimals generators: Lie symmetry approach
Authors: Faridi Waqas Ali , AlQahtani Salman A
Published: November 2023

This work scrutinizes the well-known nonlinear non-classical Sobolev-type wave model which addresses the fluid flow via fractured rock, thermodynamics and many other fields of modern sciences. The nonlinear non-classical Sobolev-type wave model provides a more comprehensive and accurate description of wave phenomena in a wide range of fields. By incorporating both nonlinearity and the complexities of dispersive waves, these models enhance our understanding of natural phenomena and enable more precise predictions and applications in various scientific and engineering disciplines. Therefore, this study is investigating it. Prior to this study, no previous research has performed Lie symmetry analysis and achieved invariant solutions of this kind. The symmetry generators are taking into account the Lie invariance criteria. The suggested approach produces the three dimensional Lie algebra, where translation symmetries in space and time are associated with mass conservation and conservation of energy, respectively and the other symmetries are scaling or dilation. The nonlinear non-classical Sobolev-type wave partial differential equation is transformed into a system of highly nonlinear ordinary differential equations by employing appropriate similarity transformations through using Lie group methodology. The power series technique is used to generate exact wave solutions because the inverse scattering transform cannot solve the Cauchy problem for this equation. The graphical behaviour of certain solutions is demonstrated in 3-D and 2-D for particular quantities of the physical factors in the investigated equation.
Characterisation of graphene nano-ribbon field effect transistor and design of high performance PPN 12T GNRFET Full adder
Authors: Elangovan M , Sharma Kulbhushan , Sachdeva Ashish
Published: November 2023

Owing to the balanced electrical properties of graphene nanoribbon field effect transistors (GNRFETs), they are suitable next-generation devices for designing high performance circuits. However, as the fabrication for GNRFETs is at premature stage the performance of GNRFET device need to be explored with variation in its parameters. This article comprehensively analyses the impact of variations in GNRFET parameters on its threshold voltage, subthreshold swing and I

ON

/I

OFF
ratio. As an application example high performance PPN 12 T full adder is proposed using GNRFET device. The proposed full adder circuit shows dynamic power, propagation delay, low power-delay product and unity noise gain of 43.3 nW, 0.47 pS, 0.02 × 10−18 J and 0.46 respectively using supply voltage of 0.7 V. The performance of proposed full adder is compared with five previously proposed full adders using 16 nm GNRFET model in HSPICE simulation tool. Further, the impact of the GNRFET parameters on performance of proposed FA is investigated. A study of this nature is expected to improve performance of computing systems used in internet of things (IoT)-based infrastructure and health industry which demand for high performance next generation devices-based circuits.
Non-static plane symmetric perfect fluid solutions and Killing symmetries in f(R, T) gravity
Authors: Dalal Preeti , Singh Karanjeet , Kumar Sachin
Published: November 2023

In this paper, the non-static solutions for perfect fluid distribution with plane symmetry in f(R, T) gravitational theory are obtained. Firstly, using the Lie symmetries, symmetry reductions are performed for considered vector fields to reduce the number of independent variables. Then, corresponding to each reduction, exact solutions are obtained. Killing vectors lead to different conserved quantities. Therefore, we figure out the Killing vector fields corresponding to all derived solutions. The derived solutions are further studied and it is observed that all of the obtained spacetimes, at least admit to the minimal symmetry group which consists of ∂
y
, ∂
z
and −z∂
y
+ y∂
z
. The obtained metrics, admit to 3, 4, 6, and 10, Killing vector fields. Conservation of linear momentum in the direction of y and z, and angular momentum along the x axis is provided by all derived solutions.
Anisotropic quintessence compact star in f(T) gravity with Tolman–Kuchowicz metric potentials
Authors: Bhar Piyali , Rahaman Farook , Das Shyam , Aktar Somi , Errehymy Abdelghani
Published: November 2023

To obtain analytically relativistic quintessence anisotropic spherical solutions in the f(T) paradigm is the primary objective of this paper. To do this, the pressure anisotropy condition is imposed, and we employ a metric potential of the Tolman–Kuchowicz (TK) type. We also suppose that our current model incorporates a quintessence field characterized by a parameter ω

q
, in addition to the anisotropic matter distribution. In the presence of the parameter α, the field equations are modified by the choice of the f(T) function. The f(T) gravity parameter α adds new components to the basic physical characteristics, such as density, pressure, subliminal sound velocity, surface redshift, etc, of the present model. By selecting the compact star Her X-1 and varying α from 0.5 to 2.5, we examined all the physical characteristics of the model parameter of the configuration. The graphical process demonstrates that a more compact item is produced with greater values of α. The hydrostatic equilibrium condition of the model is discussed, as well as the mass-radius relationship for our current model is obtained.
Effect of grain size on gas bubble evolution in nuclear fuel: Phase-field investigations
Authors: Sun 孙 Dan 丹 , Yang 杨 Qingfeng 青峰 , Zhao 赵 Jiajun 家珺 , Gao 高 Shixin 士鑫 , Xin 辛 Yong 勇 , Zhou 周 Yi 毅 , Yin 尹 Chunyu 春雨 , Chen 陈 Ping 平 , Zhao 赵 Jijun 纪军 , Wang 王 Yuanyuan 园园
Published: November 2023

Numerous irradiation-induced gas bubbles are created in the nuclear fuel during irradiation, leading to the change of microstructure and the degradation of mechanical and thermal properties. The grain size of fuel is one of the important factors affecting bubble evolution. In current study, we first predict the thermodynamic behaviors of point defects as well as the interplay between vacancy and gas atom in both UO2 and U3Si2 according to ab initio approach. Then, we establish the irradiation-induced bubble phase-field model to investigate the formation and evolution of intra- and inter-granular gas bubbles. The effects of fission rate and temperature on the evolutions of bubble morphologies in UO2 and U3Si2 have been revealed. Especially, a comparison of porosities under different grain sizes is examined and analyzed. To understand the thermal conductivity as functions of grain size and porosity, the heat transfer capability of U3Si2 is evaluated.
Application of 3D printing technology in tumor diagnosis and treatment
Authors: Wu Jinmei , Liang Bing , Lu Shuoqiao , Xie Jinlan , Song Yan , Wang Lude , Gao Lingfeng , Huang Zaiyin
Published: November 2023

3D printing technology is an increasing approach consisting of material manufacturing through the selective incremental delamination of materials to form a 3D structure to produce products. This technology has different advantages, including low cost, short time, diversification, and high precision. Widely adopted additive manufacturing technologies enable the creation of diagnostic tools and expand treatment options. Coupled with its rapid deployment, 3D printing is endowed with high customizability that enables users to build prototypes in shorts amounts of time which translates into faster adoption in the medical field. This review mainly summarizes the application of 3D printing technology in the diagnosis and treatment of cancer, including the challenges and the prospects combined with other technologies applied to the medical field.
A potential for climate benign direct air CO2 capture with CO2-driven geothermal utilization and storage (DACCUS)
Authors: Leveni Martina , Bielicki Jeffrey M
Published: November 2023

To reduce the overaccumulation of carbon dioxide (CO2) in the atmosphere, direct air CO2 capture (DACC) technologies must (a) satisfy the process requirements for heat and electricity with energy that has few if any CO2 emissions, and (b) physically isolate the CO2 from the atmosphere after its extraction from the air. To isolate the CO2 from the atmosphere at meaningful scale, the CO2 will likely need to be geologically stored in deep saline aquifers. Here we propose to leverage geologic CO2 storage (GCS) in sedimentary basin geothermal resources to produce geothermal heat and electricity for the process energy requirements of solid sorbent DACC. This sedimentary basin CO2-driven geothermal utilization (SB-CO2DGU, also known as CO2 Plume Geothermal) circulates some of the emplaced CO2 to extract geothermal heat in a closed loop between the subsurface reservoir and surface geothermal facility. The proposed integration of DACC and CO2-driven geothermal Utilization and Storage (DACCUS) adds CO2 from the air to this closed loop system that produces renewable energy for use in the DACC process. The strategy first primes the GCS reservoir with CO2 from large point sources, and then integrates CO2 from DACC facility to form the DACCUS system. We focus on the process integration of DACCUS and present a case study of its potential deployment and scaling in the Gulf Coast of the United States. We combine data from prior analyses for a novel investigation of two DACCUS configurations: (1) a DACCUS heat system uses the geothermal heat to regenerate the solid sorbent in the DACC process, and (2) a DACCUS heat and power system uses the electricity generated from the produced geothermal heat for the DACC process. In general, deeper CO2 storage reservoirs (>3.5 km) with higher geothermal temperature gradients (>35 °C km−1), may provide sufficient production wellhead temperatures (>100 °C), and satisfy the electric load in 93% of the combinations of reservoir characteristics we examined.
A benchmark study of data normalisation methods for PTR-TOF-MS exhaled breath metabolomics
Authors: Roquencourt Camille , Lamy Elodie , Bardin Emmanuelle , Devillier Philippe , Grassin-Delyle Stanislas
Published: November 2023

Volatilomics is the branch of metabolomics dedicated to the analysis of volatile organic compounds in exhaled breath for medical diagnostic or therapeutic monitoring purposes. Real-time mass spectrometry (MS) technologies such as proton transfer reaction (PTR) MS are commonly used, and data normalisation is an important step to discard unwanted variation from non-biological sources, as batch effects and loss of sensitivity over time may be observed. As normalisation methods for real-time breath analysis have been poorly investigated, we aimed to benchmark known metabolomic data normalisation methods and apply them to PTR-MS data analysis. We compared seven normalisation methods, five statistically based and two using multiple standard metabolites, on two datasets from clinical trials for COVID-19 diagnosis in patients from the emergency department or intensive care unit. We evaluated different means of feature selection to select the standard metabolites, as well as the use of multiple repeat measurements of ambient air to train the normalisation methods. We show that the normalisation tools can correct for time-dependent drift. The methods that provided the best corrections for both cohorts were probabilistic quotient normalisation and normalisation using optimal selection of multiple internal standards. Normalisation also improved the diagnostic performance of the machine learning models, significantly increasing sensitivity, specificity and area under the receiver operating characteristic (ROC) curve for the diagnosis of COVID-19. Our results highlight the importance of adding an appropriate normalisation step during the processing of PTR-MS data, which allows significant improvements in the predictive performance of statistical models.

Clinical trials: VOC-COVID-Diag (EudraCT 2020-A02682-37); RECORDS trial (EudraCT 2020-000296-21).
Study on spatiotemporal changes and influencing factors of frozen soil moisture during freeze-thaw period under different ecological construction measures in the loess plateau of China
Authors: Cheng Shengdong , Wu Heng , Wu Qinqin , Ke Ganggang , Liu Hangyu , Zhou Xin
Published: November 2023

The climatic conditions and soil characteristics of the Loess Plateau in China make it have a unique freeze–thaw process and the distribution of soil unfrozen water. In order to elucidate the spatio-temporal variation of soil unfrozen water during freeze–thaw period and its influencing factors under different ecological construction measures, The spatial and temporal variation of soil unfrozen moisture and its main influencing factors in five different ecological plots in the Loess Plateau during freeze–thaw period were studied by combining field monitoring and indoor calculation. The results showed that: (1) the spatiotemporal changes of unfrozen water content in soil were different under different vegetation restoration methods. The variation of unfrozen water content in fallow land was the largest at 20cm depth, while the variation in surface 10cm was the largest in the other four plots. (2) The average unfrozen water content of soil in the representative soil layer can be estimated more accurately, and the best representative soil layer in the five sample plots is concentrated in 20–30 cm. (3) During seasonal freeze–thaw period, the main controlling environmental factors of unfrozen water content are air temperature and surface temperature. The results can provide reference for soil protection and water resources management in northwest China, especially in the Loess Plateau.
Core–shell Cu1−x
NCo3−y
/a-CuFeCo antiperovskite as high-performance anode for Li-ion batteries
Authors: Hossain Sk Mujaffar , Kumar Nikhil , Debnath Bharati , Ogale Satishchandra
Published: November 2023

Currently, there is an emergent interest in the antiperovskite family of materials in the context of energy applications in view of their distinct and peculiar set of structural and electronic properties. This work examines the surface-modified antiperovskite nitride CuNCo3 as a high-performance anode material for Li-ion storage devices. The antiperovskite CuNCo3 was prepared by the hydrothermal method followed by calcination in the NH3 atmosphere. An amorphous layer on the surface of CuNCo3 (Cu1−x
NCo3−y
/a-CuFeCo) was also fabricated to enhance its performance as an anode material for Li-ion batteries. The surface-modified Cu1−x
NCo3−y
/a-CuFeCo material was noted to deliver an extraordinarily high reversible capacity of ∼1150 mAh g−1 at a current density of 0.1 A g−1, whereas the CuNCo3 showed a reversible capacity of ∼408 mAh g−1 at the same current density. The initial capacity of Cu1−x
NCo3−y
/a-CuFeCo exhibited excellent retention (>62%) even after 350 cycles. A ∼6 nm thin amorphous layer around the surface of pure CuNCo3 helped almost double the specific capacity as compared to the pure CuNCo3 due to the presence of a multi-redox center for Li-ion to react and also concomitantly improved electrical conductivity property. The cyclic stability of the Cu1−x
NCo3−y
/a-CuFeCo material at a higher current density (0.5 and 1.0 A g−1) was also noticeable. This work opens up new materials routes and promising processing strategies to develop high reversible capacity anodes for alkali ion batteries.
An efficient 3D IC partitioning approach using satin bowerbird optimization for reduced TSV count and improved heat dissipation
Authors: Roy Sharadindu , Banerjee Siddhartha
Published: November 2023

Net list partitioning achieves paramount importance in the physical architecture design step of Three Dimensional (3D) Very Large Scale Integrated (VLSI) circuits. The performance of all subsequent steps like floor layout, placement, pin assignment, and routing in the physical architecture design of the VLSI circuit are heavily affected by the outcomes of partitioning steps. Wire length between gates is reduced by 3D Integrated Circuit (IC) due to compact footprint as well as vertical inter connections among dies. This reduced wire length in turns responsible for less energy consumption and reduced connection delays. In this paper, Satin Bowerbird Optimization (SBO) is applied to solve 3D IC partitioning challenges. The suggested 3D IC partitioning technique is aimed at reducing the number of Through Silicon Vias (TSV) and measurements have also been taken to reduce heat dissipation. The presence of a significant amount of TSVs expands the chip area. 3D ICs have considerably greater densities of power because of advances in the technology and a vastly increased variety of components with high frequency. The heat generated by the used power has an impact on the performance and dependability of the chip. In this experiment, SBO is used as a multi-objective optimization method to achieve two objectives simultaneously - TSV count minimization and heat dissipation reduction. The performance of the suggested SBO - based approach is assessed utilizing the Giga Scale Research Center (GSRC) benchmark circuits. The applicability of the suggested technique is judged by comparing the outcomes with thermal-aware multilevel hyper-graph partitioning method. The findings of the comparison reveal that the suggested technique outperforms the thermal-aware multilevel hyper-graph partitioning approach by lowering the number of TSV count, maximum area requirement, and power density by 16.99%, 9.94% and 29.10% respectively. The performance of the experiment is also compared with existing Simulated Annealing and Tabu search based techniques. In both cases, the proposed method achieves better result by lowering TSV by 26.03% and 27.31%, and reducing area by 6.59% and 6.59%, respectively.
Application of composite material models to determine the Young’s modulus of the grid pattern of partially infilled 3D printed samples
Authors: Tognana Sebastián , Pomarico Micaela , Montecinos Susana , Salgueiro Walter
Published: November 2023

Additive manufacturing makes it possible to fabricate samples with partial internal infill. This type of sample has a different Young’s modulus than a completely filled sample. In this work, the dependence of the apparent Young’s modulus of samples manufactured by 3D printing on the infill percentage has been experimentally determined, for a given pattern and using a non-destructive technique. Young’s modulus was assumed as an apparent modulus and values were found between 3.39 GPa for the sample with 100% infill and 1.32 GPa for the sample with 20% infill. In particular, a non-linear variation of the apparent Young’s modulus was observed. The specific Young’s modulus presents a minimum for an intermediate infill percentage. The use of a model of composite materials was proposed, as a first approach to determine the apparent Young’s modulus of the parts. The mixture law, the Halpin-Tsai equation generalized by Kerner, a model of foams and the Mori Tanaka method were applied to the dependence of the apparent Young’s modulus on the infill percentage, giving all, except the mixture law, acceptable results. The advantage of applying each model was discussed. This type of analysis would allow a fast semi-empirical approach of the apparent Young’s modulus in partially filled samples with a grid pattern.
Graph machine learning framework for depicting wavefunction on interface
Authors: Wu Ao , Liu Li , Wang Zifeng , Pan Shurong , Huang Jiangxue , Huang Qijun , He Jin , Wang Hao , Chang Sheng
Published: November 2023

The wavefunction, as the basic hypothesis of quantum mechanics, describes the motion of particles and plays a pivotal role in determining physical properties at the atomic scale. However, its conventional acquisition method, such as density functional theory, requires a considerable amount of calculation, which brings numerous problems to wide application. Here, we propose an algorithmic framework based on graph neural network to machine-learn the wavefunction of electrons. This framework primarily generates atomic features containing information about chemical environment and geometric structure and subsequently constructs a scalable distribution map. For the first time, the visualization of wavefunction of interface is realized by machine learning methods, bypassing complex calculation and obscure comprehension. In this way, we vividly illustrate quantum mechanics, which can inspire theoretical exploration. As an intriguing case to verify the ability of our method, a novel quantum confinement phenomenon on interfaces based on graphene nanoribbon is uncovered. We believe that the versatility of this framework paves the way for swiftly linking quantum physics and atom-level structures.
Does rehabilitation work?
Authors: Ebrahim Shah
Published: November 2023

Rehabilitation is ‘about the tertiary response to insult or disease’ (Goodwill and Chamberlain 1988), and thus is concerned with the prevention of complications of disease. The effects and complications of stroke are discussed in Chapter 12, but rehabilitation is about more than just prevention of complications. It is concerned with reablement-the restoration to former rights, and resettlement—the use of new or prosthetic environments. The World Health Organization defines rehabilitation as: ‘the combined and coordinated use of medical, social, educational and vocational measures for training or retraining the individual to the highest possible level of functional ability’. Using this definition a case could be made for everyone, sick or well, receiving their share of ‘rehabilitation’.
Reducing the risk of recurrent stroke
Authors: Ebrahim Shah
Published: November 2023

To be of use to doctors, information from trials must be generalizable to as many potential patients as possible. This is usually achieved by two means: a large trial, and few restrictions to trial entry. A major problem in many trials of secondary prevention is that they are too small, and if negative run the risk of falsely accepting the null hypothesis (a type II error). Or, in other words, thinking that the difference observed between treated and untreated groups is due to chance. Furthermore, trials should use defined criteria and blind assessment of recurrence to avoid diagnostic and ascertainment bias. Although recurrence rates do not appear to vary with time since onset of the initial stroke, it is sensible to compare recurrence rates over at least one year, and preferably for two to three years. First and subsequent recurrences should be analysed separately to avoid ‘double counting’ of events. Finally, not all stroke recurrences are equally damaging yet most of the published trials treat them as if they were. An indicator of final dis ability (such as functional ability, walking, etc.) used as a trial outcome would help clinicians weigh the true benefits of preventing recurrences.
The genitourinary system
Authors: Peters A M , Myers M J
Published: November 2023

The functional unit of the kidney is the nephron of which there are two types: cortical and juxtamedullary. Cortical nephrons are relatively short, with loops of Henle that extend into the medulla only as far as the outer medulla. Juxtamedullary nephrons, which comprise about 15% of the total nephron population, have long loops of Henle extending into the medulla almost as far as the papilla. The nephron starts at the glomerulus and finishes at the distal collecting tubule. Blood is carried into the glomerulus by the afferent arteriole and away from it by the efferent arteriole. Between the afferent and efferent arterioles is the glomerular papillary network, which is situated within Bowman’s capsule, and through which filtration occurs to form the glomerular filtrate. The efferent arteriole then supplies blood to a second capillary network.
Exercises
Authors: Peters A M , Myers M J
Published: November 2023

During continuous infusion of bromosulphtha lein (BSP) at a rate of 1200 mg/min, the steady-state arterial concentration was 1 mg/ml and the hepatic venous BSP concentration was 0.2 mg/ml; what was liver blood flow? (Assume no extrahepatic uptake of BSP). A patient with a cardiac output of 5600 ml/min and a pulse rate of 70/min has a left ventricular ejection fraction of 0.64. What are the left ventricular end-diastolic and end-systolic volumes? Following injection of a labelled intravascular tracer, cerebral blood volume was found to be 75 ml; if cerebral blood flow was 250 ml/min, what was the mean cerebral vascular transit time? The area under an arterial fluorine-18 time concentration curve, recorded in a cerebral region of interest up to 10 min after bolus intravenous injection of fluorine-18-fluorodeoxyglucose (FDG), was 15 MBq•ml-1-min.
Disorders of the mother-inf ant relationship
Authors: Brockington Ian
Published: November 2023

Just as adjustment to pregnancy, and the emerging relationship with the fetus, are important prepartum psychological processes, so the growth of the mother-infant relationship is a vital part of postpartum development. In popular parlance this is often called ‘bonding’ -a good short word. Scientists, however, dislike it, because it has become linked to the idea of an all-or-none relationship, fully established in the first few hours of life.
Postpartum mental illness and the family
Authors: Brockington Ian
Published: November 2023

Rituals. The term ‘couvade’ was first introduced by Tylor in 1865190, from the word couver (to brood or hatch). It refers to a custom observed among many races from ancient times, in which the father of a new-born child lies in bed for a certain period, e.g. a month, eating prescribed foods, abstaining from work and the use of weapons, nursing the new-born, and tended by his wife as if he were ill, while she, the newly delivered mother, carries on her usual occupation. According to Licht121,
Setting the standards of surgical practice
Authors: Greig J D , Quick Clive R
Published: November 2023

Standards in surgery are both consciously and unconsciously part of everyday surgical practice. Standards of access to care, waiting times to consultation and to elective operation are regularly debated in the media and are subject to much angst within government. Indeed, an excessive amount of attention is given to these subjects, with far less attention to the vital matters of the management of emergency admissions, the quality and outcome of operations, and the calibre of perioperative care.
Principles of anaesthesia and intraoperative onitoring
Authors: Smith Howard
Published: November 2023

Some form of anaesthesia is required for almost every surgical procedure. Whatever method is chosen, it should cause minimal stress to the patient and allow normal physiology to be maintained The choice of technique lies between anaesthetizing part of the body (regional anaesthesia) and the whole body (general anaesthesia). Methods other than general anaesthesia may be supplemented with intravenous sedation.
Minimizing perioperative risk
Authors: Bailey Ian , Quick Clive R
Published: November 2023

The aim of surgical diagnosis and treatment is to cure disease and to palliate symptoms caused by disease. This usually involves a variety of healthcare workers and carries a range of potential hazards for them and for their patients. All surgical treatments should be considered in terms of their potential harm as well as their potential benefit.
Nutrition and nutritional support in surgical practice
Authors: Gardiner K
Published: November 2023

The importance of artificial nutritional support for patients with critical illness has been demonstrated convincingly in many studies over the past 20 years. More recently there have been significant shifts in nutritional management with regard to nutrient composition, route of administration, and organization of delivery: There is increasing evidence that the enteral route of administration is often possible in critically ill patients and is associated with reduced complications and lower costs than parenteral nutrition. Enteral nutrition has been facilitated by technological improvements in access devices and equipment for nutrient delivery.
Surgical aspects of haematology
Authors: Baglin T P
Published: November 2023

It is essential that all samples sent to the laboratory are identified correctly. In the case of samples sent for red cell compatibility testing, with a view to transfusion therapy, the need for correct labelling cannot be emphasized strongly enough. The majority of fatal transfusion reactions are the result of clerical errors (see below). All samples should be labelled with four points of identification: first name, surname, hospital number, date of birth. The destination for the result should be clearly indicated to prevent delays, and relevant clinical details indicated to assist interpretation of results and the need for further laboratory evaluation.
Abdominal surgical Emergencies
Authors: Whyman M , Thomas Paul
Published: November 2023

The ‘acute abdomen’ is still one of the most common surgical emergencies. The skill required to look after patients with acute intra-abdominal disease is acquired by first recognizing the common diseases likely to be present and then understanding the pathological changes occurring in the acute phases of these disorders. Some acute conditions, such as leaking aneurysm, require immediate surgical correction; others require urgent surgery after a period of active resuscitation (e.g. perforation or strangulated hernia). A proportion can be managed conservatively with the intention of converting an emergency into an elective condition (e.g. acute cholecystitis or diverticulitis). This concept of ‘defusing’ an emergency situation wherever possible and allowing the disease to settle before carrying out elective surgery is important. The management of the acute abdomen still presents a challenge to every surgeon, primarily because of these differing priorities. Developing the skills of ‘timing’ is an essential component of training in emergency abdominal surgical care.
Arterial surgery and lower-limb amputations
Authors: Quick Clive R , Davies Alun
Published: November 2023

Arterial surgery is largely about treating ischaemia and actual or potential rupture of vessels. The main underlying problems are degenerative arterial diseases, obliterative arterial disease (usually atherosclerotic), and aneurysmal disease. In addition, acute arterial trauma may demand the skills of a vascular surgeon.
External hernias
Authors: Costa M L Da , Redmond H P
Published: November 2023

A hernia is defined as the protrusion of an organ or viscous, or part of one, through a defect in its containing cavity. This definition covers not only the common varieties of hernias (inguinal, femoral, incisional, umbilical), but also herniation of other organs, such as the brain through fascia! defects or foramina in the cranium with raised intracranial pressure.
The World—Things, Classes and Qualities
Authors: Cutting J
Published: November 2023

One of the major preoccupations of philosophers, probably the major, from Plato onwards, has been the nature of the distinction between individual things encountered in the world and our knowledge of the sort of thing that they are. The dichotomous terms used in the debate have varied in different epochs-particular/universal, nominalism/ realism, percept/concept, reference/sense. However, as Rorty (1980) has argued,1 the change in terminology largely reflects a different approach to the same problem.
Setting standards in practice
Authors: Johnson Neil
Published: November 2023

It is only logical to define what it is one is aiming to achieve and set targets for this, before collecting data about performance and trying to interpret it. However, a large number of audits omit this stage altogether. This may not be as surprising as it seems. The language and the definitions involved in standard setting may seem cumbersome and confusing, and while we all tend to resent standards set by others, it is often difficult and time consuming to set our own. This chapter will explore the concept of ‘standard setting’ and how this can be achieved in practice.
Collecting and analysing data
Authors: Mant David , Yudkin Patricia
Published: November 2023

All of the audits described in other chapters of this book require some collection and analysis of data. These tasks need special skills which are simple and well worth acquiring. They will not only save energy and resources, but will mean that the information obtained from reviewing the data is more likely to be an accurate reflection of what is happening in practice. Collecting and analysing data is a common cause of problems. It tends to generate large amounts of paper covered with figures which never quite add up.
Auditing teamwork
Authors: Munro Karen
Published: November 2023

One of the major themes of this book is that the delivery of most of the services in general practice depends on the contribution of members of different disciplines in the primary health care team, and that those involved in delivering the service should also be involved in auditing its quality. If this reveals areas in which the service could be improved, this may be related to the quality and effectiveness of the process of teamwork. This chapter will explore the audit of teamwork itself. The link between the quality of teamwork and the quality of the service provided has been documented more fully in industrial settings than in primary health care (Adair 1986).
The primary /secondary care interface
Authors: Coulter Angela
Published: November 2023

It is now well established that general practitioners’ referral rates often vary widely: studies have demonstrated three-to four-fold variations between practices in the rate at which they refer patients to out-patient clinics, with individual general practitioners’ rates being even more variable (Wilkin and Dornan 1990). These variations are indicative of a lack of consensus about the appropriate use of specialist services. For this reason, many general practitioners have been interested in reviewing their performance in this important area, with a view to developing guidelines for referral. As we shall see, this task is far from straightforward.
Practice visiting
Authors: Schofield Theo
Published: November 2023

Earlier chapters in this book have described methods of auditing particular aspects of a practice and its work. This chapter will consider methods that can be used to make more global evaluations of the whole practice by visiting. The methodology was originally designed by a working party of the Royal College of General Practitioners, and described in their report ‘What sort of doctor?’ (1981). It has since been developed for assessing training practices and for practice team visiting. The remit of the first ‘What sort of doctor?’ working party was to devise a method for established general practitioners to evaluate their performance in the setting of their own practices. It was seen as an educational method which would enable doctors to receive feedback about the strengths and weaknesses of their own practice and to encourage continued development, but the potential for assessment for Fellowship or Membership of the College or for re-accreditation was also recognized.
Practice reports and profiles
Authors: Schofield Theo
Published: November 2023

A growing number of practices and teams produce an annual report on their activities. Some of these are intended solely for their own consumption, while others are shared with patients or other groups in the health services. Their content varies considerably from practice to practice, but many contain the results of audits that they have conducted and thus can be a focus of audit activity and a means of disseminating its results. This chapter will discuss the different purposes of practice annual reports and the contribution that they can make to team based audit.
Vitamin B6
Authors: Bender David A , Bender Arnold E
Published: November 2023

Vitamin B6 has a central role in the metabolism of amino acids: in transaminase reactions (and hence the interconversion and catabolism of amino acids and the synthesis of non-essential amino acids); in decarboxylation to yield biologically active amines; and in a variety of elimination and replacement reactions. It is also the cofactor for glycogen phosphorylase and a variety of other enzymes. In addition, pyridoxal phosphate, the metabolically active Vitamin, has a role, as yet inadequately defined, in the release of steroid hormone receptors from tight nuclear binding. Vitamin B6 thus affects the responsiveness of target tissues to hormone action.
Folic acid and vitamin B12
Authors: Bender David A , Bender Arnold E
Published: November 2023

Folic acid functions in the transfer of one-carbon fragments in a wide variety of biosynthetic and catabolic reactions; it is therefore metabolically closely related to vitamin B12, which also functions in onecarbon transfer. Deficiency of either vitamin has similar clinical effects, and the main effects of vitamin B12 deficiency are exerted by effects on folate metabolism.
Iron
Authors: Bender David A , Bender Arnold E
Published: November 2023

The total body content of iron is about 800-1040 mmol (45-60 mg)/kg body weight in men, and 630- 730 mmol (35-41 mg) in women. The distribution of this iron in metabolically active and storage pools is shown in Table 24.2. Men have considerable iron reserves (equivalent to up to 50 per cent of the functional body pool), and as discussed in section 24.5 are potentially at risk of iron overload. By contrast, women have low reserves of iron (from almost none to 16 per cent of the functional pool) and, as discussed in section 24.4 are at considerable risk of iron deficiency.
Symposium: non-immune fetal hydrops
Authors: Weiner Carl P
Published: November 2023

Non-immune hydrops (NIH) is defined as fetal oedema plus free fluid within one or more of the body cavities. It is a morphologic description whose identification is the beginning not the end of the investigation. The list of abnormalities associated with NIH is lengthy (Table 4A.1). However, there is no need to review them individually. More important is the approach to the evaluation and treatment.
How students learn: the process of learning
Authors: Coles Colin
Published: November 2023

In this chapter we will look at how people learn. Drawing on theories of learning, we will explore the practical implications for educators, and address the following questions: How do medical students learn? What makes them learn the way they do? How should they be learning? What can educators do to help? In what ways should educational events be arranged so that learners can learn as they should?The chapter is arranged as follows: first, there is a review of studies on how medical students learn, and then a discussion of the mechanisms that link the curriculum arrangement and learning outcomes. Following this, we shall examine educational theories, and establish a number of principles. Out of this we will derive and explain a model of learning, and finally discuss some of the implications for medical educators. Throughout the chapter we shall see that learning is something that only learners can do.
The problem of pain
Authors: Coniam S W , Diamond A W
Published: November 2023

We have the means and the skills to relieve pain but we do not always use them. Why not? There are several reasons. We believe that other things are more important, we believe that the relief of pain may not always be a good thing, we do not believe people who are in pain, and we believe that it is a good thing to endure pain uncomplainingly.
The assessment of pain
Authors: Coniam S W , Diamond A W
Published: November 2023

Pain is a subjective experience, and therefore it cannot be measured by an observer. It is essentially what the person experiencing pain says it is. The expression ‘real pain’ is meaningless. It suggests existence of pain which is not real, although nobody can describe a personal experience of pain which was not real. We therefore have to accept that when another person complains of pain, it is a real sensation which causes distress. We may consider that the pain described is inappropriate for a given degree of injury or disease. We may feel that the sufferer is not behaving in the way in which we expect someone in pain to behave. We may be unable to explain in terms of pathology why the sufferer is experiencing pain at all, or we may decide that a psychological disorder is responsible for or aggravating the pain. Nevertheless, the pain is a personal experience of the sufferer and we only have that person’s description of it.
Analgesic drugs
Authors: Coniam S W , Diamond A W
Published: November 2023

Analgesic drugs are generally the first-line approach to managing pain in both acute and chronic situations. They are not always effective, and may have undesirable side-effects which limit their usefulness. An analgesic drug may act peripherally at the site of pain generation, it may affect the transmission of painful stimuli to or in the CNS, or it may affect the way in which painful stimuli are processed in the spinal cord and brain.
Patient assessment: skills
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

If health professionals are to establish the exact nature and extent of their patients’ main problems, they need to develop skills that promote disclosure, and avoid using those that make people less likely to disclose their concerns.
Spiritual issues
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

In recent years, there has been an increase in concern about the spiritual care of patients who are suffering from fear-provoking diagnosis or prognosis. A major difficulty appears to be the interpretation of the phrase ‘spiritual care’. At a basic level, it is interpreted as meaning that ‘spiritual’ equals ‘religious’; but this over-simplifies a very important area. Stoter (1991) makes the point that ‘So often spiritual care is seen as religious care for the few who request it and therefore becomes dismissed as a footnote.’ By believing that spiritual care is tied in in some way with religion, it is very easy for health professionals to delegate such care and concern to members of the clergy.
Assessing the bereaved
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

Most people who lose a close friend or relative through cancer find the strength to cope with it from within and from others close to them, and are able to grieve normally. However, a substantial minority fail to cope, and are at risk of psychiatric and physical illness.
Fluid, nutritional, metabolic and haematological support in critically ill children
Authors: Morton N S , Munro F
Published: November 2023

The composition of the intracellular and extracellular compartments changes significantly during fetal and neonatal life and for a considerable period there after (Fig. 8.1). The preterm infant has a very high proportion of its total body weight as water, with two-thirds residing in the extracellular fluid compartment. As the cells grow and multiply and organs develop, the intracellular proportion of the total body water increases with a corresponding reduction in the extracellular water.
Ethnic groups
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

Britain has become a multi-racial, multi-cultural and multi-lingual society. Naturally this has implications for the planning and delivery of health care. Irish migration to Britain on a large scale began in the eighteenth and nineteenth centuries followed by Jews from eastern Europe and then, amongst others, Poles, Italians, Germans and Ukrainians, Greek and Turkish Cypriots. The most recent large migration was that of people from the Indian subcontinent and the West Indies. This began after the Second World War as a response to the demand for labour in Britain. Migrants in smaller numbers include the Maltese, Chinese, Vietnamese, and Iranians. In addition, the majority of more recent arrivals from Africa are political refugees from Somalia, Ethiopia and Za”ire (French speaking). In 1992, there were an estimated 25 000 asylum seekers in Britain, a third from Europe, mainly the former Yugoslavia (Social Trends 1994).
The gut
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

When faced with diarrhoea and vomiting, especially in an infant, the GP’s initial tasks are to decide whether gastro-enteritis is indeed the diagnosis and to assess the state of hydration. The latter is the most important factor in deciding whether the child with gastro-enteritis should be treated at home or in hospital. Several conditions can be confused with gastro-enteritis. First, normality. Diar-rhoea is usually defined as the too frequent passage of too fluid stools, but the stools of breast-fed babies are not formed, may be frequent, explosive, and sometimes contain mucus-however, true gastro-enteritis is rare in fully breast fed babies. Parents often seem to worry unnecessarily if the colour of the faeces deviates from the standard brown. A green colour is not important, although a jet-black or red stool is another matter.
.The eye
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

At birth the size of an infant’s eye is about three-quarters that of an adult, full size being reached at puberty. In infants the sclera is relatively thin and translucent, giving the eye a bluish tinge. When this is very marked osteogenesis imperfecta is a possible diagnosis. A clear red reflex, best demonstrated using a + lens on an ophthalmoscope, rules out a significant congenital cataract. A white reflex suggests a retinoblastoma. Screening for visual acuity is discussed on p. 29. Occasionally developmental abnormalities affecting the eyes and eyelids may occur. These include congenital ptosis and haemangioma (which may extend to the face, scalp or conjunctiva). Both will need treatment if there is a risk of vision being obscured. As limited acuity in one eye, and even blindness, may be overlooked by both a child and his parents, it is important to test visual acuity in each eye separately.