bluuebunny/crossref_metadata_2025 huggingface dataset:
Upcycling agro-waste fibres for cleaner production of concrete – technical feasibility and environmental considerations
Authors: Jayaraman A , Balaji V , Sowsuriya S , Bhuvanesh S , Vasudevan M
Published: October 2023

The construction sector is actively adapting various measures such as use of green materials, optimization of design, activities and clean technology for the reuse of waste materials to reduce the environmental footprints. Among the green materials, replacement of concrete constituents has tremendous impact on the overall environmental benefits. The recycling of agro-waste fibres in concrete construction is comparatively less attempted due to the limitations in their applications. Present study focuses on comparative evaluation of proportioning coconut fibre and sisal fibre in concrete as singular and binary mixtures. The mechanical properties of the agro-waste fibre reinforced concrete in various proportions (from 0.5% to 2.5%) revealed a substantial increase in the compressive, tensile and flexural strength values. The binary mixture with a maximum value of 1.5% is found to be the best performing combination. The associated environmental impacts were identified using a two-step cause-evidence-impact methodology, suggesting the identification of critical steps in reducing environmental pollution and increasing the benefits.
Micropatterning the organization of multicellular structures in 3D biological hydrogels; insights into collective cellular mechanical interactions
Authors: Ergaz Bar , Goren Shahar , Lesman Ayelet
Published: October 2023

Control over the organization of cells at the microscale level within supporting biomaterials can push forward the construction of complex tissue architectures for tissue engineering applications and enable fundamental studies of how tissue structure relates to its function. While cells patterning on 2D substrates is a relatively established and available procedure, micropatterning cells in biomimetic 3D hydrogels has been more challenging, especially with micro-scale resolution, and currently relies on sophisticated tools and protocols. We present a robust and accessible ‘peel-off’ method to micropattern large arrays of individual cells or cell-clusters of precise sizes in biological 3D hydrogels, such as fibrin and collagen gels, with control over cell–cell separation distance and neighboring cells position. We further demonstrate partial control over cell position in the z-dimension by stacking two layers in varying distances between the layers. To demonstrate the potential of the micropatterning gel platform, we study the matrix-mediated mechanical interaction between array of cells that are accurately separated in defined distances. A collective process of intense cell-generated densified bands emerging in the gel between near neighbors was identified, along which cells preferentially migrate, a process relevant to tissue morphogenesis. The presented 3D gel micropatterning method can be used to reveal fundamental morphogenetic processes, and to reconstruct any tissue geometry with micrometer resolution in 3D biomimetic gel environments, leveraging the engineering of tissues in complex architectures.
Assessing the effectiveness of the shear-tensile-compressive model in earthquake source inversions: synthetic experiments and field application
Authors: Ren Yi , Vavryčuk Václav , Zhao Li
Published: October 2023

As an alternative to the moment tensor (MT) model for earthquake sources, the shear-tensile-compressive (STC) model offers a kinematic description of the source mechanism and leads to a more robust inversion problem. However, the premise of the source inversion based on STC is to ensure the accuracy of parameter $\kappa $ defined as the ratio of the Lamé constants, $\kappa $=$\lambda /\mu $, in a fault zone. In this study, we carry out a series of synthetic experiments using P-wave amplitudes in source mechanism inversions based on both the STC and MT models, and consider the influence of noise, the uncertainties in source locations and in the velocity model. We show that the nonlinear STC inversion with an appropriate value of $\kappa $ leads to more accurate result compared to the linear MT inversion. We also propose a new joint-STC inversion method to jointly invert for parameter $\kappa $ and the remaining parameters of the STC model (magnitude and the strike, dip, rake and slope angles). The results indicate that our proposed method yields robust results for both the parameter $\kappa $ and focal mechanisms. We apply our joint-STC inversion method to field microearthquake data observed in the West Bohemia region to validate some of the conclusions drawn from the synthetic experiments.
Stereotypes and Belief Updating
Authors: Coffman Katherine , Collis Manuela R , Kulkarni Leena
Published: October 2023

We explore how feedback shapes, and perpetuates, gender gaps in self-assessments. Participants in our experiment take tests of their ability across different domains. We elicit their beliefs of their performance before and after feedback. We find that, even after the provision of highly informative feedback, gender stereotypes influence posterior beliefs, beyond what a Bayesian model would predict. This is primarily because both men and women update their beliefs more positively in response to good news when it arrives in a more gender congruent domain (i.e. more male-typed domains for men, more female-typed domains for women), fueling persistence in gender gaps.
A new step forward in realistic cluster lens mass modelling: analysis of Hubble Frontier Field Cluster Abell S1063 from joint lensing, X-ray, and galaxy kinematics data
Authors: Beauchesne Benjamin , Clément Benjamin , Hibon Pascale , Limousin Marceau , Eckert Dominique , Kneib Jean-Paul , Richard Johan , Natarajan Priyamvada , Jauzac Mathilde , Montes Mireia , Mahler Guillaume , Claeyssens Adélaïde , Jeanneau Alexandre , Koekemoer Anton M , Lagattuta David , Pagul Amanda , Sánchez Javier
Published: October 2023

We present a new method to simultaneously and self-consistently model the mass distribution of galaxy clusters that combines constraints from strong lensing features, X-ray emission, and galaxy kinematics measurements. We are able to successfully decompose clusters into their collisionless and collisional mass components thanks to the X-ray surface brightness, as well as use the dynamics of cluster members, to obtain more accurate masses exploiting the fundamental plane of elliptical galaxies. Knowledge from all observables is included through a consistent Bayesian approach in the likelihood or in physically motivated priors. We apply this method to the galaxy cluster Abell S1063 and produce a mass model that we publicly release with this paper. The resulting mass distribution presents different ellipticities for the intra-cluster gas and the other large-scale mass components as well as deviation from elliptical symmetry in the main halo. We assess the ability of our method to recover the masses of the different elements of the cluster using a mock cluster based on a simplified version of our Abell S1063 model. Thanks to the wealth of mutliwavelength information provided by the mass model and the detected X-ray emission, we also found evidence for an ongoing merger event with gas sloshing from a smaller infalling structure into the main cluster. In agreement with previous findings, the total mass, gas profile, and gas mass fraction are all consistent with small deviations from the hydrostatic equilibrium. This new mass model for Abell S1063 is publicly available, as the lenstool extension used to construct it.
STAB2: an updated spatio-temporal cell atlas of the human and mouse brain
Authors: Yang Yucheng T , Gan Ziquan , Zhang Jinglong , Zhao Xingzhong , Yang Yifan , Han Shuwen , Wu Wei , Zhao Xing-Ming
Published: October 2023

The brain is constituted of heterogeneous types of neuronal and non-neuronal cells, which are organized into distinct anatomical regions, and show precise regulation of gene expression during development, aging and function. In the current database release, STAB2 provides a systematic cellular map of the human and mouse brain by integrating recently published large-scale single-cell and single-nucleus RNA-sequencing datasets from diverse regions and across lifespan. We applied a hierarchical strategy of unsupervised clustering on the integrated single-cell transcriptomic datasets to precisely annotate the cell types and subtypes in the human and mouse brain. Currently, STAB2 includes 71 and 61 different cell subtypes defined in the human and mouse brain, respectively. It covers 63 subregions and 15 developmental stages of human brain, and 38 subregions and 30 developmental stages of mouse brain, generating a comprehensive atlas for exploring spatiotemporal transcriptomic dynamics in the mammalian brain. We also augmented web interfaces for querying and visualizing the gene expression in specific cell types. STAB2 is freely available at https://mai.fudan.edu.cn/stab2.
Introduction
Authors: Bannister Sir Roger
Published: October 2023

This represents a record of the exact onset and evolution of the symptoms, supported by any observations that may be obtained from witnesses or family. In no branch of medicine is a good history more important than in neurology. It makes all the difference in the diagnosis of a difficult case in which the physical signs may not be in doubt. Time spent on it is well worth while. The poor witness can be helped by leading questions. After taking the detailed history it should be possible to list the probable site or sites of the nervous system affected, from muscle to cerebral cortex. Also, from the course of development of the symptoms (for example, whether episodic or progressive), it should be possible to suggest the likely pathological diagnosis. For example, vascular lesions tend to cause sudden or episodic symptoms; cerebral tumours more often cause slowly progressive symptoms.
Language and higher cortical function
Authors: Bannister Sir Roger
Published: October 2023

Speech is a mode of communication by means of sounds which stand for something which may be called their meaning. The object of communication may be, amongst other things, to convey an idea, a feeling, or a command. Speech therefore involves in its expressive aspect the production of the appropriate movements of the lips, tongue, palate, vocal cords, and respiratory muscles to cause the appropriate sounds. In its receptive aspect it implies the auditory discrimination of these sounds. Between the two, as it were, exist the psychological functions concerned with the meanings of the sounds heard or uttered. Speech having been acquired by the individual, reading and writing involve a superstructure whereby words are represented by means of visual symbols.
Headache and migraine
Authors: Bannister Sir Roger
Published: October 2023

There are many causes of pain in the head, but comparatively few ways in which it can be produced. The principal pain-sensitive structures within the skull are the large blood vessels, and · there is abundant evidenee that many of the common causes of headache produce it through their effect. upon the intracranial vessels.. The extracranial branches of the external carotid artery are also pain J sensitive and contribute to some forms of headache. The other important pain-sensitive structures in the head are the sensory nerves and nerve roots; and they are responsible for the pain associated with the various forms .of neuritis, neuralgia, and radiculitis.
Intracranial abscess
Authors: Bannister Sir Roger
Published: October 2023

Intracranial abscess is the result of the extension of a pyogenic infection to the brain. This is usually due to a direct spread from an air-containing structure having a connection with the upper respiratory passages, i.e. one of the nasal sinuses, the middle ear, or the mastoid. Less frequently the infection of the brain is haematogenous, the source often being intrathoracic suppuration. Congenital heart disease is a predisposing cause, because the valves may be the site of thrombus formation and with septal defects paradoxical embolism may occur. Sometimes a fracture of the base of the skull offers a portal of entry. Any of the common pyogenic cocci may be the infecting agent; Escherichia coli is also found. Actinomycotic and amoebic abscesses of the brain occur.
Hydrocephalus
Authors: Bannister Sir Roger
Published: October 2023

The term hydrocephalus means an excess of cerebrospinal fluid. This necessarily occurs in all conditions . in which there is a diffuse atrophy of the brain, as in cerebral arteriosclerosis, general paresis, and the presenile dementias. The hydrocephalus is then compensatory and is of no clinical significance. Hydrocephalus produces symptoms when the· cerebrospinal fluid is under increased pressure. Two varieties of this are recognized. In one, the raised pressure of the fluid is due to an obstruction at some point in its course between its formation by the choroid plexuses and its exit from the fourth ventricle by the median and lateral apertures of the fourth ventricle.
Some neurological disorders of childhood
Authors: Bannister Sir Roger
Published: October 2023

Paediatric neurology is now a speciality in its own right, but it is helpful to survey briefly a few illustrative examples of neurological disorders of infancy and childhood. The first of these likely to be recognized in the infant are movement disorders, which may arise from a variety of causes. Cerebral palsy covers a wide spectrum of non-progressive disability occurring in about 1-2 per 1000 live births in Britain and America and is usually the result of. some complication of labour or delivery.
Disorders of the limbic system and hypothalamus
Authors: Bannister Sir Roger
Published: October 2023

Limbus means the border of the cerebral hemisphere but it is a ‘system’ rather than a series of precisely defined brain structures. It includes the olfactory areas, hippocampus and amygdaloid complex, cingulate cortex, and septal area, and regulates the hypothalamic area and is critical for emotional and affective display. In phylogenetic development it represents the older or palaeomammalian cortex as opposed to the neomammalian cortex. Its function is thought to be concerned with levels below cognitive behaviour and inductive and deduc(ive reasoning, though it nevertheless is concerned with a feeling of individuality and identity.
Encephalomyelitis
Authors: Bannister Sir Roger
Published: October 2023

A very large number of living organisms may invade the nervous system or its membranes, thus causing many forms of encephalomyelitis, meningitis, and meningoencephalomyelitis. The pyogenic organisms mostly cause pyogenic menil1gitis or cerebral abscess. The tubercle bacillus causes tuberculous meningitis or tuberculoma. Treponema pallidum, various yeasts, and moulds also attack the nervous system. Though any of these by invading the brain may cause a disorder which can accurately be described as encephalitis, the process is not usually acute, and the term acute encephalomyelitis is in practice reserved for two groups of disorder, namely those due to the direct invasion of the nervous system by a virus, and those in which, although the primary cause is an infection of the body, usually with a virus, the changes which occur in the nervous system are not directly due to its invasion by the virus, but are the result of some incompletely understood hypersensitivity reaction to the systemic infection, which leads to acute disseminated or demyelinating encephalomyelitis, especially if the patient is immunosuppressed.
Genetically determined degenerations of the nervous system
Authors: Bannister Sir Roger
Published: October 2023

Certain regions of the nervous system are, for reasons which we do not yet clearly understand, particularly vulnerable to genetically determined degenerative disorders. These are rare disorders. The structures at risk include the optic nerves, the cerebral cortex, the cerebellum, the olives, the long tracts of the spinal cord, and the peripheral nerves. The different systems of the nervous system which appear to be vulnerable will be grouped under separate headings but, although in any particular syndrome the most prominent damage affects one part of the nervous system, there is frequently less obvious involvement of other vulnerable parts of the nervous system and they are therefore difficult to classify precisely. Degenerative processes which affect the optic nerve (p.39) and the cerebral cortex (p.259) and the leucodystrophies (p.545) are considered elsewhere in this book.
Psychological factors in neurology
Authors: Bannister Sir Roger
Published: October 2023

The brain and the mind constitute a unity, and we may leave to the philosophers who have separated them in thought, the task of putting them together again. In practice, there are two ways of explaining disorders of the mind. They may be the result of damage to the brain, for example, by transmitter defects, trauma, inflammation, tumour, impaired blood supply, etc. In such cases the cause itself is notmental, though its result is a disorder of mental function. In the other group of cases, the cause is mental, because the patient’s present mental symptoms can be traced back to, and explained in terms of, one of his previous mental experiences, or a whole series of such experiences, which constituted his reactions to what happened to him in the past.
The nature of fatigue
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

Fatigue is a convenient but problematic concept. We all ‘know’ what it means in common parlance, but when attempts have been made to define it for the purpose of more precise discourse, the essential meaning can seem vague, elusive, and difficult to operationalize. This problem has vexed many previous writers on fatigue and has even led to the suggestion that the term ‘fatigue’ be abandoned altogether1. We are, as the title of this book suggests, less nihilistic. In our view, the problem with the definition of fatigue has arisen because of a failure to differentiate between its various meanings. This chapter will outline those specific meanings of fatigue and will briefly review the history, definition, and method of measurement of each. In this way we aim to prepare the reader for the chapters that follow.
Epidemiology of fatigue
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

Epidemiology is the population-based, quantitative study of the distribution, determinants, and outcome of disease. The epidemiological approach offers a methodology for the acquisition and evaluation of new information about the cause of disease. There are several reasons why the study of chronic fatigue is suited to this approach; these include the ubiquity of the symptom of fatigue, the lack of a definitive fatigue test, and the number of possible causes. We hope to show that the application of epidemiological principles can shed light on the nature of fatigue as both symptom and syndrome.
Viruses, immunity, and CFS
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

The neurasthenia story showed how clinicians observed that fatigue syndromes could follow infective episodes, with the chief culprits assumed to be first the influenza virus, and second the typhoid bacillus. With the demise of neurasthenia, these clinical observations did not cease. Each of the general fatigue syndromes (neurasthenia, effort syndrome, chronic exhaustion) have at times been associated with infection, whilst such a link is implicit in the more specific syndromes, such as chronic brucellosis.
The role of psychological factors in CFS
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

In Chapter 10 we considered the role of emotional disorders in CFS. We concluded that whilst they may be important, and sometimes adequate, explanations for the symptoms of CFS, other factors have to be considered for a more complete under standing of the illness. We then reviewed possible neurobiological mechanisms, concluding that whilst an exciting line of inquiry, the findings so far are only just beginning to add to our knowledge. In this chapter we focus on the role of psychosocial variables and their influence on CFS. In particular we consider the nature and origin of patients’ beliefs about the illness, and their importance in determining its expression and outcome.
The Effect Of Smoking On Oxygen Transfer And Placental Circulation
Authors: Symonds E Malcolm
Published: October 2023

The important structural component of the placenta is the chorionic villus, for it is at this level that the fetus has its most intimate contact with the maternal circulation; it is here that nutrient transfer and gaseous exchange occurs. The chorionic villi develop over the decidua basalis, initially from main stem villi, which subsequently split into a series of second- and third-order stems. These stems may also subdivide to form minor villous stems, which are called anchoring villi. This pattern of division and growth vastly increases the available space for gaseous transfer.
Smoking And Pre-Eclampsia
Authors: Hall Marion H , Harper Valerie
Published: October 2023

A substantially lower incidence of hypertensive complications of pregnancy in cigarette smoking was shown 20-30 years ago in some large hospital-based studies (Underwood et al. 1965; Duffus and MacGillivray 1968; Kullander and Kallen 1972; Palmgren et al. 1973) although this was not found in the first study to look at the topic (Zabriskie 1963). Community-based studies (Butler and Alberman 1969; Andrews and McGarry 1972; Chamberlain et al. 1978) subsequently confirmed the phenomenon, and some recent case-control studies (Ounsted and Scott 1982; Moore and Redman 1983; Marcoux et al. 1989) again identified the association. The effect is dose-dependent (Kullander and Kallen 1972; Palmgren et al. 1979; Chamberlain et al. 1978; Marcoux et al. 1989), suggesting it may be causally related to maternal smoking. However, many different definitions of pre-eclampsia were used, making it difficult to assess whether the effect is on gestational hypertension or on pre-eclampsia, as defined by international agreement (Davey and MacGillivray 1986). Smoking habit was recorded after delivery in most studies, with possible ascertainment bias.
Polymyositis/dermatomyositis
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Polymyositis is an acquired, inflammatory myopathy of unknown aetiology involving striated skeletal and, less commonly, cardiac muscle. Associated clinical features include skin rash (dermatomyositis), dysphagia, arthritis, Raynaud’s phenomenon, interstitial lung disease, and other visceral manifestations; however, proximal limb girdle muscle weakness is the dominant feature of this disorder (Plotz 1989; Dalakos 1991). The epidemiology of polymyositis was reviewed by Cronin (1990); this chapter will summarize current knowledge of classification criteria, descriptive and analytic epidemiology, the relationship of malignancy with polymyositis/dermatomyositis, and the course and prognosis of patients with this disease.
Soft tissue rheumatism
Authors: Croft Peter
Published: October 2023

Nonarticular musculoskeletal pain is common. One in JO adults in Britain will consult a general practitioner at least once in the course of a year with this symptom (Royal College of General Practitioners 1986). Half of them present because of low back pain, and the rest have a mixture of conditions which are considered in this chapter under the rubric of soft tissue rheumatism.
Dental Surgery
Authors: McNeil M
Published: October 2023

Dental chair anaesthesia is primarily performed on children who require dental extractions and are unable to tolerate local anaesthesia. The practice of dental chair anaesthesia has been the subject of considerable controversy following some well publicized, tragic fatal accidents. Sadly, these cases have illustrated areas of practice that are quite unacceptable. Certainly, there is no justification for the anaesthetic and surgery being performed by the same individual. Similarly, it is quite unthinkable that a child could be given a general anaesthetic in a location which has inadequate monitoring or resuscitation facilities.
General
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

In any severe cardiorespiratory disturbance the order of priority should be: secure the airway maintain respiration (with manual ventilation if necessary) restore the circulation (with cardiac massage if necessary) consider mechanical ventilation CPR may be indicated in cases of severe bradycardia with weak pulse. In the severely hypoxaemic patient oxygen therapy should be in high concentration and at high flow unless there is known chronic CO2 retention [see algorithm 2.5].
Cardiovascular
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

The effect of cardiac massage is explained by two theories. Cardiac massage at 80-100 compressions/min is a compromise satisfying the cardiac compression and thoracic pump theories. Higher cardiac outputs are generated with higher rates if cardiac compression predominates and with longer compressions if thoracic pumping predominates.
Endocrine
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

In severe diabetic ketoacidosis (DKA) approximate losses are: water 5™10 litres sodium 400™700 mmol potassium 250™700 mmol The fluid loss is relatively hypotonic (urine sodium concentration is about 55 mmol/1) as about half is derived from the intracellular compartment. Fluid and electrolyte repletion should not follow a strict regimen but must be tailored to individual needs.
Gastrointestinal
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

The patient should be adequately resuscitated first. Early endoscopy should be performed for all large bleeds. Therapeutic injection, laser therapy, etc. may prove highly successful.
Dialysis Amyloid
Authors: Ypersele Charles Van , Droeke Tilman B
Published: October 2023

Dialysis amyloidosis is a syndrome observed in dialysis patients characterized initially by joint pain, followed later by joint destruction. It is at present one of the few compliations in these patients. The factors involved in the genesis of this syndrome are not yet known with certainty and there is as yet no proven efficacious treatment otehr then renal transplantation. As a result, the interest in this topic among nephrologists remains very high. Dialysis amyloid gives general information on the pathophysiology, and the clinical aspects of all types of amyloidosis. It then goes on to discuss recently discovered B2, type of dialysis amyloidosis, from clinical and pathological features to physiological and pathophysiological aspects of this serious complication which effects patients suffering from chronic renal failure. This book will give nephrologists and rheumatologists a clear understanding of the dialysis amyloidosis syndrome as well as making a valuable contribution to identifying strategies for treatment and prevention.
Circadian rhythms in mental performance
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

A successful athlete needs to be at the peak of his or her mental capacities when competing. Do mental processes show circadian rhythmicity? If so, when are the best times for skills requiring vigilance, decision-taking and precision movements? It is these issues that will be the topics of this chapter.
The travelling athlete
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

Competitive sport is now recognized on a global scale and people at many levels, from the Olympic Games athlete to the recreational runner, have the opportunity of competing abroad. Travelling to strange places for purposes of competing in sport seems highly alluring. In reality, this foreign travel makes great demands on team-managers, athletes, and coaches, whether they are planning trips abroad for a single competition or a prolonged tour. Whatever country is the destination, a vast surveillance exercise is called for to glean information about the culture and customs of the host country, the immunization necessary, climatic factors including temperature, seasonal variations in climate, altitude, and so on.
Seasonal variations
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

Throughout the chapters of this textbook on biological rhythms, a spectrum of rhythm periods has been examined, ranging from the ultradian stages of sleep, through the circadian fluctuations in physiological and performance variables, to the infradian rhythm of the menstrual cycle. In this chapter, biological rhythms with even longer periods than the circamensal cycle are examined − those that recur once per year. Such rhythms may be defined as ‘circannual’, which denotes a period of about 1 year ± 2 months, or ‘seasonal’. Strictly speaking, seasonal changes are brought about by changes in environmental fluctuations and are not observed in the absence of such changes, whereas circannual rhythms may be endogenous and/or desynchronized from the calendar year.
Weaning
Authors: Frca J Goldstone Md
Published: October 2023

A 65-year-old man with a known history of COPD was admitted with acute respiratory failure requiring intubation and mechanical ventilation. A chest infection was treated with antibiotic therapy and resolved to the point whereweaning was contemplated.
Transportation of the critically ill
Authors: Mrcp J B Salmon
Published: October 2023

A 25-year-old man was admitted to A&E. in a district general hospital following a road traffic accident in .which he was the passenger. After initial assessment and colloid resuscitation in A&E he was conscious and haemodynamically stable. He was breathing with difficulty and complained of pain in the chest, and left leg. His injuries included numerous abrasions; compound fracture, left tibia; and closed fracture, left femur.
Right ventricular infarction
Authors: Mrcp H Montgomery
Published: October 2023

A 46-year-old man with a past history of hypertension presents with a 4-hour history of typical cardiac chest pain. The ECG shows ST elevation in the inferior leads consistent with an acute myocardial infarction, and he is treated with streptokinase at once. BP at presentation is 170/110 mmHg. Over the subsequent 30 hours, his pain continues despite treatment with intravenous nitrates and opioids. BP then slowly falls reaching 90/60 mmHg at 48 hours, a mounting sinus tachycardia develops, and he com plains of breathlessness. Aurinary catheter is inserted, upon which urine flow is found to be negligible.
Croup
Authors: Frca D J Macrae
Published: October 2023

A two-year-old child presented with a 3-day history of coryzal symptoms. Until that morning her symptoms had apparently been well-palliated with regular administration of paracetamol suspension, and she had continued to eat and drink. However, her parents were awoken at Sam by her coughing, and on the advice of their GP, took the child to the emergency department.
Anaesthetic Algorithms
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

The success of the algorithm approach as a means of teaching management strategies has led to their increasing use in teaching texts. In this book, up-to-date strategies are presented in an algorithm format enabling easy review, access, and revision. The algorithms deal with common anaesthetic problems and include reminders of dangers and controversies. Each algorithm is combined with a page of short notes and a small number of selected references. The text is intended to be an easily accessible reference for practising anaesthetists. In addition, it would act as a useful guide for entrance to the FRCA examinations as well as an in-theatre prompt.
Respiratory
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

It is important to recognize the patient with a potential for developing bronchospasm. A history of nocturnal dyspnoea, cough, wheezing, and morning chest tightness should alert the anaesthetist as should recent chest infections. Smoking increases airway secretions and bronchial hyperreactivity and ideally should be stopped 2-4 weeks before surgery. PEFR is a good objective method of assessing bronchospasm. In patients considered to have a high risk of bronchospasm, P2 agonists(salbutamol 5 mg in 2 ml 0.9% saline by nebulizer) and steroids(hydrocortisone 1-3 mg/kg) should be given 1-2 hours pre-op. Patients withexisting bronchospasmshould have steroids 8-hourly for the preceding 24 hours. Glycopyrrolate will cause significant bronchodilation if given earlyenough (30 mins pre-op.). The Hl receptor blockers such as promethazineare useful and also cause sedation. Though controversy exists, thiopentone, morphine, and curare all producehistamine release and are classically avoided in the asthmatic patient. Pethidine and atropine are known to be bronchodilators. Propofol, vecuronium, and fentanyl are not associated with histaminerelease and are recommended in asthmatics. Lignocaine spray to the trachea will reduce responses to mechanical stimuli. If appropriate, epidural or spinal anaesthesia is probably the best option,though motor blockade of the intercostal muscles should be avoided.
Sleep disorders and hypnotic drugs
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

We spend a third of our lives asleep and yet sleep largely remains an enigma. The purpose of sleep has been speculated about repeatedly but, apart from some relationships with hormone secretion, little of note has been discovered. Yet we all know how unpleasant lack of sleep can be whether this is spontaneous as in insomnia or self-inflicted. The complaint of insomnia is one of the most frequent encountered by the family physician and it is also one of the commonest reasons for prescribing one group of drugs, namely, the hypnotics.
Miscellaneous disorders and drugs
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

In this chapter we outline the drug treatment of a variety of conditions which the general psychiatrist may be called on to treat or about which his advice may be sought. He may be asked to treat the psychiatric complications of a neurological or general medical condition, or encounter a medical or surgical patient with psychiatric co-morbidity. The many interfaces between psychiatry and neurology, internal medicine, and clinical psychology are moving rapidly and the psychiatnst has to be proficient in adjusting his role, and be aware of changing technologies, practices and views in other specialties, so that his advice is feasible and compatible with other management strategies.
Ventilation and intravenous cannulation
Authors: Skinner David V , Vincent Richard
Published: October 2023

It is important to point out that the fully conscious non arrested patient suffering an acute myocardial infarction or trauma also needs care of the airway and oxygen. All too often such patients, because they are breathing, are denied the opportunity of enhanced inspired oxygen concentrations-a deprivation which is likely to be to their detriment. The airway must be protected against inhalation of vomit .. There are a variety of methods of ventilating the cardiacarrested patient, and the method used will depend on: the circumstances of the arrest; the skill levels available for airway control; and the availability of an appropriate form of airway for the individual patient.
Burns and scalds
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 Thermal injuries may be extremely painful and analgesia should be a priority after resuscitation.

2 Children with injuries of over 10 per cent of their body surface always require admission and intravenous fluids.

3 Inhalation injury is potentially fatal and its possibility should be actively considered.

4 Even trivial burns should be followed up as they may develop complications.

5 Consider the possibility of non-accidental injury.
Office hysteroscopy and suction curettage in the evaluation of abnormal uterine bleeding
Authors: Goldrath Milton
Published: October 2023

The dilatation and curettage (D&C) has long been considered the method of choice for investigating abnormal uterine bleeding and obtaining samples of endometrium for histologic examination. In 1975, approximately 977, 000 patients underwent diagnostic D&C in short stay, non-federal hospitals (Grimes 1982). This number had dropped by 65 per cent by 1991 according to data from the National Health Survey. This probably still makes D&C one of the most commonly performed operations in the United States today. Because of the current emphasis on cost containment for health care there has been increasing motivation to find less expensive procedures to substitute for the routine hospital diagnostic curettage. In addition, a hospital procedure is inconvenient and time-consuming. Initially we moved to outpatient procedures instead of the usual two-day admission. This has reduced costs. However, the increasing costs of hospital operation necessitated raising the charges even for out patient surgery to very high levels.
Fetal origins of adult disease
Authors: Parker Louise
Published: October 2023

Life expectancy has increased dramatically over the last century as a consequence of improved social conditions, better nutrition, and advances in medicine. A baby born in 1900 had a life expectancy of under 50 years whereas a child born in 2000 will be expected to live for over 80 years (Central Statistics Office: Social Trends 1996). This dramatic change is due in part to the fact that infectious diseases are now both preventable and curable and are no longer a major cause of death. In 1921, 15% (70 497) of deaths in England and Wales were from infection (Registrar-General’s Statistical Review of England and Wales 1921). By 1971 this figure had dropped to 3300, and the rate continues to fall (Registrar General’s Statistical Review of England and Wales 1921, 1971, 1992). Deaths from infection now make up fewer than 0.5% of all deaths in England and Wales.
The primary care physician’s perspective
Authors: Marcusson Jan , Sloan John P
Published: October 2023

Epidemiological studies show that 5 to 15 per cent of persons over 70 years of age exhibit signs of dementia. Thus, the primary care or general practitioner often meets persons with possible dementia and is in an important position in the basic investigation and further management of the case (Fig. 20.1). The general practitioner, who often cares for the whole family, has unique opportunities to detect early cases of dementia through contact with the patient and his or her relatives. In many countries, the general practitioner also has the medical responsibility for special living facilities for elderly people where dementia often occurs. In recent years, specific treatments for Alzheimer’s disease (tacrine and donepezil) have become available in North America and parts of Europe. As such treatments have been largely studied in patients with mild or moderate disease, it is important at the primary care level to detect possible Alzheimer patients early in the disease process.
Emergency Management of Hand Injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

This compact yet comprehensive handbook will allow Accident and Emergency staff to investigate and treat hand injuries with confidence - and just as importantly, to see at a glance which patients should be referred immediately to a specialist hand surgeon. Written in a concise and accessible style, it is illustrated throughout with clear and informative diagrams.
Introduction
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Patients with hand injuries or non-traumatic disorders of the hand commonly present to accident and emergency (A&E) departments. Although rarely life threatening in themselves, such injuries are the cause of considerable morbidity and loss of earnings. The majority are assessed initially by junior doctors in the A&E department where injuries may be overlooked or their severity underestimated.
Onward referral
Authors: Heath Iona
Published: October 2023

Whereas the responsibilities of the general practitioner in relation to both child abuse and domestic violence are relatively clearly defined, the correct response to elder abuse remains elusive (Fig. 18.1). In child abuse, the practitioner must prioritize the interests and protection of the child; in domestic violence, the prime responsibility is to respect and promote the autonomy of the abused women and support her in making her own decisions. In elder abuse, a delicate balance must be struck depending on the mental competence of the abused older person.
Acquired cystic disease and renal tumors in long-term dialysis patients
Authors: Ishikawa Isao
Published: October 2023

Advances in dialysis treatment have prolonged the lives of many dialysis patients, but long-term dialysis has led to a new set of complications, such as beta-2 microglobulin¬ induced amyloidosis, renal osteodystrophy, and aluminum intoxication; as well as acquired cystic disease and renal cell carcinoma (Dunnill et al., 1977; Ishikawa, 1991b). Autopsy examination (Dunnill et al., 1977) and diagnostic imaging (Ishikawa et al., 1980) have revealed acquired cystic disease of the diseased kidney and its complications. In 1977, Dunnill et al. described the very important observation that 14 cases with acquired cysts, including six accompanied by renal tumors, were found among 30 autopsy cases—one of the patients had died due to metastasis of a renal cell carcinoma. In 1980, Ishikawa et al. reported the findings, using computed tomographic scanning of the diseased kidneys, in 96 of their patients undergoing dialysis due to chronic glomerulonephritis.
Men’S Troubles
Authors: Greaves Mel
Published: October 2023

Whilst women have been getting a raw deal from cancer, the tables may now be turning. Cancer of the male prostate gland is fast becoming the most commonly diagnosed cancer in the USA and will overtake lung cancer as a leading cause of mortality in men. And it’s out of the closet with the likes of golfer Arnold Palmer and Stormin’ Norman Schwarzkopf confronting their own diagnoses on prime time TV. What was previously endured in embarrassed silence is now the talk of boardrooms, golf courses, and the pub. Current treatments for prostate cancer are crude and provide a sad parallel with breast cancer - surgical prostectomy plus chemical castration with antiandrogens for metastatic disease. The treatment is feminizing and not particularly effective.
Drugs commonly encountered in patients with cardiac disease
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

The aim of treatment is to restore the balance of myocardial oxygen supply and demand. Three classes of compounds commonly employed are nitrates, -blockers, and calcium-channel blockers. Recently, potassium-channelactivators have been included. Nitrates relieve both exertional (stable and unstable) and vasospastic angina. The mechanism of action appears to depend on their conversion to the nitrite ion (No2-) which is believed to generate nitric oxide (NO•). The predominant effect of nitrates is venodilatation of the capacitance vessels. This allows venous pooling and reduces venous return to the heart. The reduction in preload reduces left ventricular enddiastolic volume and pressure and hence oxygen consumption. The reduction of afterload achieved through arteriolar dilatation also decreases myocardial work and oxygen consumption. Nitrates also appear to redistribute myocardial blood flow to improve perfusion of ischaemic regions.
Theatre preparation
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Drugs Induction drugs Fentanyl (1 mg) Etomidate (10 mg) Pancuronium (8 mg) Suxamethonium (100 mg) Vasoactive drugs For bolus doses (resuscitation drugs) Atropine (0.6 mg/ml) Metaraminol (10 mg diluted to 10 ml, 1 mg/ml) Isoprenaline (100 µg diluted to 10 ml, 10 µg/ml) Phentolamine (10 mg diluted to 10 ml, 1 mg/ml) Calcium chloride (10 ml undiluted, 13.4 per cent)
Preoperative visit and premedication
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

As well as obtaining information such as the age and weight of the child, the medical therapy (diuretics with or without digoxin are prescribed to treat excessive pulmonary flow and heart failure), and the history of previous operations (reoperations require external defibrillation pads and availability of blood in the theatre prior to opening of the chest), review the echocardiography, Doppler, and cardiac catheterization reports to understand the cardiac anomalies. Determine whether there is excessive or restricted blood flow to the pulmonary or systemic circulation. An understanding of the pathology will aid planning of resuscitative measures if the child deteriorates during anaesthesia. The limbs should be examined for potential venous and arterial access. Infants and children with congenital heart diseases are usually scheduled for either palliative or definitive surgery because of severe hypoxaemia, excessive pulmonary blood flow, congestive heart failure, obstructive left heart lesions, or dysrhythmias. Older children may need surgical intervention to prevent impairment of ventricular function by chronic volume overload due to aortic or mitral regurgitation or septal defects.
Theatre preparation
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Drugs Induction drugs Fentanyl Thiopentone (4-7 mg/kg) Pancuronium (diluted to 0.4 mg/ml for a child less than 20 kg)) Suxamethonium (undiluted) Vasoactive drugs For bolus doses (resuscitation drugs) Atropine in 1 ml syringe (0.6 mg)

Metaraminol (diluted to either 0.1 or 1 mg/ml) or phenylephrine (10 µg/ml)

Isoprenaline (10 µg/ml)
Ectopic and familial polyglandular syndromes ( C finical)
Authors: Laycock John , Wise Peter
Published: October 2023

In regard to ectopic hormone syndromes (the production of hormones from non endocrine tumour tissue), which of the following is/are true? The incidence and spectrum of hormone excess is similar whatever primary tumour is considered The syndromes most commonly result from tumour synthesis and release of simple peptides resembling those of normal hypothalamic origin Hormone secretion is an epiphenomenon of advanced tumour status, and is normally of minor clinical significance.
Doing good?
Authors: Lomas Peter
Published: October 2023

Over the past decade, psychotherapy and counselling have become more and more popular, with many people turning to therapists in the hope of finding a better, happier, more fulfilling life. In this cogently argued and beautifully written book, Peter Lomas, argues that as psychotherapy enters the mainstream, therapists have become dependent on the technical aspects of their profession at the expense of the many moral issues involved. Indeed, they have become so afraid of moralizing or of departing from what Lomas views as a spurious scientific neutrality that the dialogue between therapist and patient tends to be distorted, potentially confusing, and too remote from the healthy reality of ordinary conversation. In this provocative analysis, drawing on his day-to-day experience of working with patients, Peter Lomas explores the consequences of this dichotomy, such as the loss of spontaneity and avoidance of closeness which may hinder rather than help the healing process. He looks at the problems associated with issues of power, and its abuse, which is central to psychotherapy, and explores the dilemmas involved when there is a clash of moral beliefs between the two people. This is a lucid and thought-provoking addition to the literature on psychotherapy, and will appeal both to trainee and practising therapists and counsellors, for people in therapy, and for those considering embarking upon it.