bluuebunny/crossref_metadata_2025 huggingface dataset:
Interference filter based external-cavity diode laser with combined dual interference filters and largely adjustable feedback range
Authors: Chang Rui , He Jun , Wang Junmin
Published: November 2023

External-cavity diode lasers (ECDL) are widely used as light sources in laser spectroscopy, atomic physics, and quantum optics. This study demonstrated a home-made 852–nm ECDL with variable feedback, using the combined dual narrow-band interference filters (IFs) as the laser longitudinal mode selection element. The combination of narrow-band IFs, mainly for the current commercially available narrow-band IFs with the full width at half maximum (FWHM) of approximately 0.5 nm for 780-895 nm. We designed different narrow-band IFs combinations to achieve a narrower FWHM, and applied them in the ECDL. The combination of the dual narrow-band IFs further reduces the laser linewidth. We measured the laser linewidth using a high-finesse Fabry-Perot cavity with a linewidth of approximately 10 kHz. The laser linewidth is approximately 176 kHz for the Single-IF-ECDL and 96 kHz for the Dual-IF-ECDL with the same feedback. In addition, we have experimentally verified the results of narrower laser linewidth and larger tuning range with increase in the feedback. The developed Dual-IF-ECDL has the capability of narrow linewidth and wavelength tunability and can be applied to precision spectroscopy, cooling and trapping of neutral atoms.
Optical absorption of electron inter-band transitions in asymmetric Mg
x
Zn1−x
O/ZnO/Mg
y
Zn1−y
O quantum wells with mixed phases
Authors: Zan Y H , Ban S L
Published: November 2023

The inter-band optical absorption of electron transitions in asymmetric Mg
x
Zn1−x
O/ZnO/Mg
y
Zn1−y
O quantum wells (QWs), which are the prime functional units of multi-color ultraviolet photodetectors (UVPDs), is investigated with the consideration of mixed phases (0.37 < x(y) < 0.62) by using the density matrix method combined with a weight model. Our results show that the intensity and number of absorption peaks can be modulated by controlling the Mg composition x in single or mixed phases with a given y in mixed phases. The single peak or dual absorption peaks will appear for x being in a single phase. While x is in the mixed phases, at most three observable peaks can be observed to instruct the designation of multi-color UVPDs. Meanwhile, the size dependence of the left barrier and well in the QWs is also discussed. It is shown that relative wider left barrier and narrower well is more beneficial to obtain multi-detectable absorption peaks for photodetectors.
Fresnel coefficients, coherent optical scattering, and planar waveguiding
Authors: Doval Alejandro , Rodríguez-Fernández Carlos Damián , González-Núñez Héctor , de la Fuente Raúl
Published: November 2023

The Fresnel formalism of transmission and reflection of coherent waves on the abrupt interface between two different optical media is revisited and extended to study optical phenomena concerning guided waves. Using the Fresnel formalism, the propagation of light through different sequences of parallel layers of constant refractive index is analysed, revealing that, in all cases, the solutions corresponding to waveguiding share major features. In the analysis, aiming to connect waveguiding with coherent optical scattering, the possibility of the system having a resonance is examined, and it is shown that guided modes always emerge as singular solutions of the associated coherent scattering configuration. Invariably, the resonance condition that must be satisfied to obtain waveguiding corresponds to the pole of the associated total reflection and transmission coefficients. Even more, the fulfilment of the requirements to meet the resonance condition is a clear indication of the possibility of waveguiding.
Transcranial dipole localization and decoding study based on ultrasonic phased array for acoustoelectric brain imaging
Authors: Zhang Hao , Zhang Yanqiu , Wang Xue , Chen Guowei , Jian Xiqi , Xu Minpeng , Ming Dong
Published: November 2023

Objective. Neuroimaging is one of the effective tools to understand the functional activities of the brain, but traditional non-invasive neuroimaging techniques are difficult to combine both high temporal and spatial resolution to satisfy clinical needs. Acoustoelectric brain imaging (ABI) can combine the millimeter spatial resolution advantage of focused ultrasound with the millisecond temporal resolution advantage of electroencephalogram signals. Approach. In this study, we first explored the transcranial modulated acoustic field distribution based on ABI, and further localized and decoded single and double dipoles signals. Main results. The results show that the simulation-guided acoustic field modulation results are significantly better than those of self-focusing, which can realize precise modulation focusing of intracranial target focusing. The single dipole transcranial localization error is less than 0.4 mm and the decoding accuracy is greater than 0.93. The double dipoles transcranial localization error is less than 0.2 mm and the decoding accuracy is greater than 0.89. Significance. This study enables precise focusing of transcranial acoustic field modulation, high-precision localization of source signals and decoding of their waveforms, which provides a technical method for ABI in localizing evoked excitatory neuron areas and epileptic focus.
Adaptive Tikhonov regularization and dynamic control points for accurate shape parameter control of plasmas
Authors: Inoue S. , Kojima S. , Miyata Y. , Urano H. , Suzuki T.
Published: November 2023

Precise control of plasma shape parameters, such as elongation and triangularity is duly needed to achieve high-performance tokamak plasmas, for which we propose adaptive search schemes of (1) optimum regularization parameter for the Tikhonov regularization, and (2) control points to specify the key shape parameters such as elongation and triangularity. Many control points that exceed the number of actuator coils become an ill-conditioned problem, which is successfully resolved by Tikhonov regularization with adaptively optimized free parameters. Furthermore, we develop dynamically changed control points by using the Cauchy Condition Surface scheme, where elongation and triangularity become direct control values. By virtue of both the adaptive Tikhonov regularization scheme and the dynamic control point, we achieved accurate shape control with elongation up to 1.93 and triangularity up to 0.65 in JT-60SA, where the allowable speed for the change of the elongation is 0.1 s−1. We also verified the resilience of our developed our logics to the noises. The sequence of the result will contribute to enhance equilibrium controllability in upcoming JT-60SA experiments and provide the robust shape parameter control scheme for ITER and DEMO.
Residential’s Household Intention to Utilize Their Food : A Case Study in Solo, Indonesia
Authors: Satriyono Raden Danang Aryo Putro , Ramadani Dinda Safitri
Published: November 2023

Food loss and food waste leads to severe effect such as economic, environment and social consequences in Indonesia as the third largest contributor of food waste In the world. Most of the food waste source in Indonesia is from household sector. This phenomenon needs to be analyzed more deeply with tested variables related to human behaviour and perception. This study investigates determinants of residents’ participation intention and behaviour to waste their food in a framework that incorporates Extended theory of planned behaviour (TPB). The modified TPB questionnaire was given to 300 respondent samples ever used waste bank in Solo, Central Java. The analysis in this study was carried out using Structural Equation Modeling (SEM), The result of this research is that there are five significant correlations between variables, namely Perceived Circular Knowledge, Perceived Economic Usage, Perceived Economic Knowledge, Descriptive Norms and attitude have a significant effect on Intention to Use. This study also found that the Perceived Effectiveness, Perceived Usefulness, Perceived Behavioural Control factors had no significant effect on Intention to Use.
Type 1 interferon auto-antibodies are elevated in patients with decompensated liver cirrhosis
Authors: Greville Gordon , Cremen Sinead , O’Neill Shauna , Azarian Sarah , Brady Gareth , McCormack William , Dyer Adam H , Bourke Nollaig M , Touzelet Olivier , Courtney David , Power Ultan F , Dowling Paul , Gallagher Tom K , Bamford Connor G G , Robinson Mark W
Published: November 2023

Patients with decompensated liver cirrhosis, in particular those classified as Childs-Pugh class C, are at increased risk of severe coronavirus disease-2019 (COVID-19) upon infection with severe acute respiratory coronavirus 2 (SARS-CoV-2). The biological mechanisms underlying this are unknown. We aimed to examine the levels of serum intrinsic antiviral proteins as well as alterations in the innate antiviral immune response in patients with decompensated liver cirrhosis. Serum from 53 SARS-CoV-2 unexposed and unvaccinated individuals, with decompensated liver cirrhosis undergoing assessment for liver transplantation, were screened using SARS-CoV-2 pseudoparticle and SARS-CoV-2 virus assays. The ability of serum to inhibit interferon (IFN) signalling was assessed using a cell-based reporter assay. Severity of liver disease was assessed using two clinical scoring systems, the Child-Pugh class and the MELD-Na score. In the presence of serum from SARS-CoV-2 unexposed patients with decompensated liver cirrhosis there was no association between SARS-CoV-2 pseudoparticle infection or live SARS-CoV-2 virus infection and severity of liver disease. Type I IFNs are a key component of the innate antiviral response. Serum from patients with decompensated liver cirrhosis contained elevated levels of auto-antibodies capable of binding IFN-α2b compared to healthy controls. High MELD-Na scores were associated with the ability of these auto-antibodies to neutralize type I IFN signalling by IFN-α2b but not IFN-β1a. Our results demonstrate that neutralizing auto-antibodies targeting IFN-α2b are increased in patients with high MELD-Na scores. The presence of neutralizing type I IFN-specific auto-antibodies may increase the likelihood of viral infections, including severe COVID-19, in patients with decompensated liver cirrhosis.
Eastern Europe, the Balkans, Greece, And Turkey
Authors: Robinson Jane
Published: November 2023

It is now that we begin to enter the realms of romance. There may be nothing quite like the silence of an Alpine dawn, a shady siesta in some fabulous Spanish cloister, the fragrance of an Italian garden at dusk, or a glimpse—as long a glimpse as you like—of the Midnight Sun (and Paris, of course, at any time of the day or night): they all have an allure. But not until one turns towards the East does travel become seriously exotic. Gertrude Bell, who might at first seem the most level-headed of women, was well aware of this. More appreciative still were two other trespassers behind the jewelled curtain: Frey a Stark and, most notably, Lady Mary Wortley Montagu.
The Clinical Epidemiology of Stroke
Authors: Ebrahim Shah
Published: November 2023

Epidemiology is a basic medical science that is fundamental to understanding diagnosis, treatment, and prognosis. Diagnosis requires answers to a series of questions: is this patient sick or well? If sick, what are the chances of a particular disease causing the problem? What investigations will be most useful in obtaining the diagnosis? Epidemiology applied to the bedside problems of patients’clinical epidemiology - can help to provide solutions. The ability of a detail of the patient's history, or a clinical sign which could confirm or disprove diagnosis can be described by using simple arithmetic. The probability that a disease is or is not present can be given a numerical value, and the extent to which investigation increases or reduces the likelihood of discovering disease can also be measured. Stroke is one of the most common diagnoses made by physicians. Patients with signs and symptoms suggestive of stroke require careful assessment to avoid diagnostic error. This book is written by a clinician who is also trained in epidemiology and is intended for clinicians who treat patients with stroke, for epidemiologists who want to apply epidemiology to clinical problems, for therapists who wish to develop their understanding of the application of scientific method to rehabilitation practice, and for medical students who may wish to accelerate and complement the process of acquiring clinical experience about stroke.
Investigation
Authors: Ebrahim Shah
Published: November 2023

The question of which patients merit a CT scan does not arise for many stroke patients. Hospital admission for patients sustaining a stroke in the UK varies from around half to three-quarters(Oxford shire Community Stroke Project 1983; Barer et al. 1984) admitted. It is certainly possible to arrange a CT scan for those patients remaining at home. In the Oxford study (where an attempt to CT scan all patients was made) a creditable 80 per cent of all stroke patients were scanned. However, there were delays, with only 62 per cent of both hospital and community patients getting a scan within three weeks of onset of the stroke. After this time it is quite possible that small haemorrhages will have resolved (Dennis et al. 1987) and will be no longer visible on CT scan films.
Acute management
Authors: Ebrahim Shah
Published: November 2023

The first decision at the onset of a stroke is whether the patient re quires hospital admission. The reasons for admission are diagnostic (‘Is it really a stroke?’), to start rehabilitation early, to give treatment to prevent further strokes, and because of needs for a level of nursing care that cannot be given at home. It is estimated that between 40 and 70 per cent of all strokes in the United Kingdom are not admitted to hospital, but are managed at home by primary health care teams (Bamford et al. 1986). In practice, it is remarkably difficult to know how many people are not admitted to hospital, because unless a special project is set up to count them, they are not routinely noted. From estimates of incidence of stroke and numbers of patients admitted to hospital it is possible to make a guess at the proportion of patients kept at home. In Nottingham, this estimate was around 30 per cent kept at home (Barer et al. 1984).
Mortality after stroke
Authors: Ebrahim Shah
Published: November 2023

Why should doctors bother to understand the pattern and predictors of death after a stroke? Knowing when death is most likely and what causes it should help decide where to concentrate effort and lead to innovations in treatment. Perhaps the devastating nature of some strokes leads doctors to feel that death is not a bad outcome, and indeed preferable to a lengthy period of rehabilitation leading to a long-stay hospital bed. This gloomy outlook is far from the truth for the majority of patients (see Chapter 12, on recovery).
Transit time, clearance, distribution volume and extraction fraction
Authors: Peters A M , Myers M J
Published: November 2023

One of the major attributes of nuclear medicine is its ability to quantify physiological processes, and to do so non-invasively. The most important physiological variables in nuclear medicine are: through a discrete space (its ‘mean transit time’) or the average time it spends in a space (its ‘mean residence time’). Some physiological variables are expressed as a transit or residence time (for example, perfusion in units of ml/min/ml) or as combinations of time with volume, giving flow rate (ml/min), or time with mass, giving a flux rate (mg/min).
Choosing the topic and getting started
Authors: Lawrence Martin
Published: November 2023

Starting an audit can feel like a major decision. Will it be a lot of work? Will it be worth the effort? Should we not rather be looking at something else? Are we ready to take it on? Should we not first get more staff, or better records? There are always plenty of uncertainties, plenty of reasons for putting things off. This not only applies to the first audit. Practices who have already embarked on audit still face the same decisions when it comes to taking on a new topic—What shall we drop?, Is this particular topic the next most important?, and so on. We need to get past the ‘blocks’ and have some guidelines as to where our efforts may be most worthwhile.
Repeating the cycle
Authors: Lawrence Martin
Published: November 2023

It is widely agreed that the most important aspect of audit is the production of change and improvement in patient services. Assessment of such change, and guarantee of its persistence, can only be ensured by regular review of activity. The question becomes not so much why one should do repeated audit, but rather how it can be included in a crowded practice schedule. After a brief review of the reasons for recommending a cyclical approach for audit, this chapter will concentrate mainly on how it can be achieved. With primary care teams increasingly being accountable to patients for services and to government for use of resources it is essential that the service is regularly reviewed, and seen to be reviewed. It is neither necessary nor possible to audit every aspect of care, but enough tracer conditions need to be covered to provide assurance that the whole practice is likely to be of comparable standard.
Chronic disease management
Authors: Hasler John
Published: November 2023

Chronic disease is one of the key areas for audit in primary health care, for several reasons. It uses up a substantial amount of resources, both in time and money; it is often possible to draw conclusions about outcome from the examination of process, by reference to published evidence; some of the parameters are easily measurable (for example, blood pressure levels, blood glucose measurements, serum phenytoin measurement, and peak flow rates); the data are easily extractable, provided that the manual or electronic records systems are designed appropriately; chronic diseases are frequently supervised by nurses as well as doctors and therefore it is possible to audit team care rather than simply medical care. In this section we will examine two common chronic diseases, although the principles are the same for most chronic diseases and readers should constantly consider the applicability of the messages to other long-term conditions in which they have an interest.
The role of the Medical Audit Advisory Group
Authors: Forbes Alan , Lawrence Martin
Published: November 2023

In 1987 the Government began changes to the NHS with a White Paper entitled ‘Promoting better health’ (Secretaries of State 1987). A second White Paper, ‘Working for patients’, was followed by the imposition of a new general practitioner contract, and relations between the profession and government became very hostile, with general practitioners angry, distrustful, and dispirited (Secretaries of State 1989; Department of Health 1989). Yet within this legislation were proposals for the enhancement of audit in the health service in general and in primary care in particular. Even opponents of the new contract usually agree that this initiative offered great opportunity for the profession, but even this benefit may be lost unless the opportunity is taken up.
Mathematics and Statistics in Anaesthesia
Authors: Cruickshank Steven
Published: November 2023

Anaesthetic trainees often have enormous trouble understanding the quantitative aspects of the basic sciences underlying clinical anaesthetic practice. The subjects of pharmokinetics and statistics are often unpopular with trainees, and studied with little enthusiasm. In spite of their reluctance, this is an area that they are required to study and understand as a core part of their training for postgraduate exams. Mathematics and Statistics for Anaesthetists presents simple mathematical ideas, and explains how these can be used to model and understand problems which arise in clinical anaesthesia. The common features of the underlying mathematics are emphasized through a pictorial/graphical approach, in preference to vast amounts of algebra. The book presents statistics in an informal and less intimidating style that most standard statistical texts, incorporating illustrations and cartoons throughout. The book will be valuable to anaesthetists, in guiding them through what can be an intimidating part of their training.
Models and modelling
Authors: Cruickshank Steven
Published: November 2023

The idea of modelling physiological processes by mathematics is an ambitious one. Physiology is hugely complex and poorly understood in many aspects, but this does not mean that we should just shrug our shoulders and give up. There are things we can achieve and insights we cahgain, but we must remain critical at all times of what we do. The most important part of the process is the modelling, not the mathematics. The intention in this book is to concentrate on the modelling process, using simple examples and giving enough of the mathematical back ground for the solutions to be understood. The mathematical equations may look quite impressive when written out, but if the model on which they are based is a bad one, even clever manipulations of the equations ‘Nill still produce nonsense; garbage in-garbage out.
Modelling steady states: VA and Paco2
Authors: Cruickshank Steven
Published: November 2023

We continue with a straightforward example that will form the basis of the more complex models that we shall develop later. The steady state relationship of alveolar ventilation VA and the Paco2 is well known: increase the ventilation and the Paco2 falls, reduce it and the Paco2 rises. But what is the exact relationship and how can we model it? In order to start modelling we need to make some assumptions about the physiological problem. We want to describe the steady state Paco2 which results from any chosen value of VA after the system has had time to ‘settle down’ from any change.
Flux and fluxoids
Authors: Cruickshank Steven
Published: November 2023

Consider a pipe carrying a solution of salt at concentration 1 g/1, flowing at a rate of Q= 10 I/min. We collect the effluent from the pipe for 10 min in a bucket. How much salt have we collected? The answer is trivially easy-100 g, which we obtain quite easily by multiplying the three quantities together: We have transferred a mass of salt from one end of the pipe to the other, and the magnitude of this mass is given by the triplet product above, which is termed the flux. Flux is a transfer of a quantity from one region to another. We shall normally be concerned with mass transfer, but we shall also model one example of an energy flux.
Apnoeic oxygenation
Authors: Cruickshank Steven
Published: November 2023

The technique of apnoeic oxygenation is most frequently employed during the apnoea test in assessment of brain stem function in the intensive care unit. It has uses in anaesthesia where there is competition for the airway, e.g. in bronchoscopy or laryngoscopy, or in emergency when ventilation is impossible. In the technique, the intubated apnoeic patient-perhaps from muscle relaxants, perhaps because of brain stem destruction-is kept oxygenated by means of a catheter inserted through the tube into the trachea, through which oxygen is passed at about 4 I/min. No positive pressure is applied. Under ideal circumstances, adequate haemoglobin saturation can be maintained for a considerable period, measured in tens of minutes. How does it work and what are these ideal circumstances? As usual, the key to modelling is the IOP.
Basics
Authors: Cruickshank Steven
Published: November 2023

This part on mathematical background should be viewed as a toolbox, from which the necessary implements are picked for a particular purpose; it is not meant to be read through from start to finish. There are certain patterns of relationship which occur frequently in modelling applications and we need a general familiarity with their behaviour. The emphasis is graphical and pictorial and relies heavily on the notion of the tr<1nsformation which allows us to modify a basic pattern function to produce another related function. We also find composite functions arising by combining these basic pattern functions; for instance, a damped oscillation is a product of a sinusoid and an exponential function ( 1.17).
Polynomial functions
Authors: Cruickshank Steven
Published: November 2023

Quadratics, cubics, and quartics

where a, b, c, d, are constants. They are sums of powers of x multiplied by constants —the coefficients of the powers of x. Polynomial functions are extremely important in modelling and statistical analysis. We shall not be concerned in any detail with any polynomials involving powers greater than x2 Polynomial functions are classed according to the highest power of x in the equation.
Functions of more than one variable
Authors: Cruickshank Steven
Published: November 2023

We have concentrated largely on situations in which the function value (the dependent variable) is determined by the value of a single independent variable. However, there are many circumstances in which we have functions that are dependent upon a number of variables. The first model that we constructed for the relationship of Paco2 and VA assumed a fixed value of CO2 production, Vco2• We later allowed this to change and produced a 3-D graph, the surface of which showed all possible combinations of VAco2, V co 2, and the resulting Paco2 according to the model.
The derivative and differentiation
Authors: Cruickshank Steven
Published: November 2023

Modelling processes frequently give rise to equations that describe the rate of change of a quantity. We saw this in the applications of the IOP to time-dependent variables such as step change in ventilation, nitrogen washout, pharmacokinetics, and simple harmonic motion. The simplest rate of change to deal with is when this is zero-the system is in steady state and the value of the quantity remains constant.
Summary measures: location and dispersion
Authors: Cruickshank Steven
Published: November 2023

When faced with a list of data, we naturally want to make sense of them, and this will involve making some sort of summary assessment of the data. We have seen a few examples of random phenomena and noted some of the features-the shape of the distribution of the data, whether we are dealing with discrete or continuous data, and so on. We need to describe summary measures of location of the data where they are on the number line. This requires some measure of where the ‘centre of gravity’ of the data is-a measure of central tendency-and how spread they are about this central value-a measure of dispersion.
Samples of unknown mean and variance
Authors: Cruickshank Steven
Published: November 2023

Like the other distributions we have met, the t-distributions form a family. These are defined by a single parameter, the degrees of freedom, 11. The value of v required for any application depends upon the sample size(s) n and how many parameters have been estimated from the data. We shall see particular examples of this. In general, the larger the sample size, the greater the value of vis, and the more nearly does the t-distribution become like the standard normal.
Related variables: linear regression
Authors: Cruickshank Steven
Published: November 2023

Look at the data list (simulated data) and the plot of these points. If this is all the information that we have, then we can calculate a mean x = 10.14 and TSS = 75.79 for the data and hence derive a value for the sample variance and standard deviation. We know from our study of error functions that we cannot make the TSS about a chosen ‘fit’ any smaller than that about the mean value. Using the techniques of (3.16.2) we can calculate a CI for the mean at a chosen level, and this is about all we can do..
Energy balance and an overview of metabolism
Authors: Bender David A , Bender Arnold E
Published: November 2023

The primary need of the body is for a source of metabolic fuels (fat, carbohydrate, protein and alcohol) to meet energy expenditure. Food in excess of immediate requirements for energy-yielding metabolism is stored as reserves of glycogen in muscle and liver, and as fat in adipose tissue. There is also an increase in tissue protein synthesis after a meal. In the fasting state, or when energy intake is inadequate to meet expenditure, these reserves, and labile tissue protein reserves, are used as metabolic fuels. Normally, energy expenditure and food intake are closely balanced, at least when averaged over several days. The result of a prolonged positive energy balance (an excess of intake over expenditure) is the accumulation of excessive amounts of body fat-the development of overweight and obesity, see Chapter 11. Prolonged negative energy balance (an intake less than expenditure) is protein-energy malnutrition wasting and emaciation, see section 12.2. As discussed in section 6.5, the physiological mechanisms by which people are able to adjust their food intake to meet energy expenditure are not known.
Protein nutrition
Authors: Bender David A , Bender Arnold E
Published: November 2023

In 1860 Voit measured the difference between the intake of nitrogenous compounds (mainly protein, but also including nucleic acids) and the urinary excretion of nitrogenous compounds. He showed that dogs fed less than 1.5 kg of meat per day were unable to maintain nitrogen balance, but suffered a net loss of nitrogen from the body, thus establishing the technique of nitrogen balance studies that still provide the basis of estimates of protein requirements.
The psychological costs of caring for cancer patients
Authors: Faulkner Ann , Maguire Peter
Published: November 2023

The main thrust of this book has been concerned with helping health professionals, and all those involved in caring for cancer patients and their families, to improve their communication skills and their ability to work with people who are often distressed and visibly upset. In this chapter, the needs of the health professionals are considered. ‘The cost of caring’ has become almost a cliche in health care, but nevertheless it has to be accepted that there is a cost to working effectively with cancer patients and their families, and that this needs to be addressed if individual members of staff are to survive to continue caring at a high level. It might be argued that the prime consideration in cancer care is the patient and his or her family, and that it is selfish to worry about the professional’ s personal need for survival. The other side of this argument is that if health carers do not consider their own needs and take some steps to meet them, then they may not be able to go on working in the field.
A general psychiatric approach to sexual deviation
Authors: Bee Brockman , Bluglass Robert
Published: November 2023

Developments in the understanding of normal human sexual behaviour in the 1960s and 1970s coincided with a more tolerant social attitude and healthier climate in which to encourage the scientific study of the sociological, physiological and endocrinological aspects of sexuality. Wakeling (1979), for example, reviewed the development of sexual dysfunction clinics, describing how change in social attitudes enabled patients with sexual deviancy to come forward and seek help.
Integrating the general psychoanalytical theory of perversion
Authors: Rosen Ismond
Published: November 2023

This chapter collates current psychoanalytical research with the existing general theory of perversion. See also chapter reviews in previous editions by Gillespie (1964), Rosen (1979) and recent work by Socarides (1988) and Chapter 11, and Etchegoyen (1989). The last fifteen years have produced many advances in the psychoanalytical understanding and treatment of perversion.
Reflections on homosexuality in women
Authors: McDougall Joyce
Published: November 2023

Freud’s revolutionary discoveries concerning the psychology and the dynamic importance of human sexuality in child and adult life are now almost a century old. They are so much an established part of Western thought today that we take them for granted and are highly critical of Freud’s conceptual limitations, above all his theories on female sexuality. This is, in fact, an area of research in which Freud is particularly vulnerable. However, it is interesting to recall that Freud owed to women the initial insights that led him to the concept of the ‘unconscious’.
Dynamic psychotherapy with sex-off enders
Authors: Cox Murray
Published: November 2023

Returning to a chapter written seventeen years ago is a salutary experience for an author. As it is reprinted verbatim in the present edition, certain introductory comments are called for. There are several matters of fact which are obviously now out of date. Since the 1979 edition the following changes have occurred. Broadmoor Hospital is now managed, not by the Department of Health and Social Security, but by the Special Hospitals Service Authority, which may become a ‘purchaser’ of that which a special hospital ‘provides’ if ‘Trust status’ is achieved.
The adult sequelae of childhood sexual abuse
Authors: Rosen Ismond
Published: November 2023

This chapter briefly reviews the clinical consequences and psychodynamic treatment in adults who have experienced sexual abuse in childhood. (See also the recent review by Green 1993.)

No specific syndrome exists for the adult consequences of child sexual abuse, the contributory factors and responses being so varied. Psychiatric symptoms may occur such as anxiety, phobias, depression, and low self-esteem, together with physical manifestations of a psychosomatic kind.
Peer review by means of audio or video recordings
Authors: Grol Richard , Lawrence Martin
Published: November 2023

Peer review employing audio or video recordings of patient encounters has acquired a considerable tradition and has shown its value in a variety of situations. Large studies on general practice performance were carried out on the basis of such material (for example, Yerby et al. 1979; Grol et al. 1988b; Smith et al. 1991). Exceptionally good experiences have been acquired with audiotapes in peer review and in the instruction of GP trainees (Grol et al. 1988a). In Great Britain a tradition of audit with videotapes has been developed (for example, Pendleton et al. 1984). Both methods offer a very good basis for the audit of consultation skills in a group of care providers in general practice (5-10 participants). The audit is livened up due to the fact that the participants are directly confronted with a real consultation situation. Initially, it may prove threatening: having recording apparatus in the consulting room takes some getting used to, as does asking the patient’s permission to record and having one’s personal performance evaluated in the peer review group. In our experience, the difficulties soon fade, and the use of video- or audiotapes gradually becomes a greatly prized aid in the quality improvement process.
Structured peer group methods: quality circles, case analysis, and critical incident analysis
Authors: Grol Richard , Lawrence Martin
Published: November 2023

In previous chapters some specific methods for peer review in a group of general practitioners or care providers in general practices have been presented in some detail. There are, of course, many other methods for peer review which may be very helpful in improving patient care. From the various methods we have selected three which will be described here briefly with some examples: Practice-based quality circle method: this is a structured group method, aimed at improving patient care and solving problems in general practice by involving all the relevant people related to a certain problem (GPs, staff, other care providers, patients, policy-makers).
Screening for cancer in women
Authors: Niloff Jonathan , Chamberlain Jocelyn
Published: November 2023

It cannot necessarily be assumed that screen-detected cancers will behave in exactly the same way as symptomatic disease and one cannot infer that simply by detecting early disease one has improved prognosis. It is first necessary to find out by research what proportion of women can be helped by screening, before offering it to all women as a means of reducing their risk. As in all forms of preventive medicine which offer a service to well people (as opposed to patients), there is a particular ethical responsibility on the health care providers to be certain that the benefits of screening outweigh the disadvantages (Fig. 6.1).
Female sterilization
Authors: Peterson Herbert B , Wilcox Lynne S
Published: November 2023

The health of women and infants the world over is affected by the ability of women to control the numher and timing of their pregnancies. Although maternal mortality has decreased dramatically in recent decades in developed countries, the risk of death and serious morbidity from pregnancy remains high in much of the developing world. Even in developed countries. maternal morbidity and mor tality are important considerations for women’s health. It is estimated that, some where in the world, a woman die every minute from pregnancy-related causes. Infant health is inextricably related to maternal health. Further, the health of infants has been conclusively linked to child spacing (Park 1986; Klebanoff 1988).
Maternal health care in the developing world
Authors: Philpott R H
Published: November 2023

Many policy makers and over-extended health workers in the developing world treat maternal health as an isolated issue, such as oral health or leprosy control, failing to recognize its complexity and the need for a comprehensive approach. When I joined two other doctors in a busy mission hospital in West Africa in the early 1950s, I was given charge of the maternity unit because I had done a 6 month obstetric job since qualifying 18 months previously as a doctor. That was 6 months more experience than either of my colleagues, but woefully inadequate for the enormity of the task. Fortunately, a team of midwives was kind enough to protect their patients from me and at the same time introduce me to both obstetrics and the much wider concepts of motherhood and quality of life.
Infections in pregnancy that may affect the development of the baby
Authors: Peckham Catherine S
Published: November 2023

About one in 20 women is likely to experience an infectious illness in pregnancy. Mo t of these infections are harmless, but a small minority may cause damage to the fetus or newborn infant. The fetus may become infected in utero (congenital infection), or the newborn may acquire infection at the time of birth through con tact with infected blood or vaginal secretions (intrapartum infection). Maternal infections that are associated with congenital or intrapartum infection and which may result in damage arc listed in Table 20.1 and include rubella (German mea sles), cytomegalovirus, toxoplasmosis, hepatitis B, and herpes simplex infection.
Professional liability and the practice of obstetrics
Authors: Pinshaw Alan , Hiatt Howard
Published: November 2023

The first American medical malpractice suit was filed in Connecticut in 1794 (Stetler 1957) Even then, the issue of medical professional liability was not new, having had its humble beginnings in England over 400 earlier (Stetler 1957). Ever since, and particularly over the last 20 years, professional liability issues have gained momentum, having an impact on society, on physicians’ clinical decision making, on physician—patient relationships, and even on the availability of health care itself. In 1970, one in 25 American physicians had been sued (Jacobs 1980). Twenty years later, in 1990, over 75 per cent of all obstetricians practicing in the USA had been sued.
Obstacles to communication
Authors: Myerscough Philip R , Ford Michael J , Currie C T , Doyle D , Hewitt A N M , Laing I A , Speirs A L , Wrate R M
Published: November 2023

The time available for an interview varies from doctor to doctor, and from day to day. The conduct of the interview is bound to be influenced by this constraint, but the doctor must not let the pressure of time cramp his interviewing style in a way that inhibits open communication. In contemporary hospital practice, more rapid turnover in the wards, the growth of high-technology, high-dependency care, and expanding day-case care have all progressively increased the pressures on staff. Doctors and nurses alike are often short of time, have to watch over monitors as well as patients, and may be, at times, short of sleep. The quest for cost-efficiency itself involves many obstacles to communication.
Testing topics
Authors: Ford Michael J
Published: November 2023

At least one-third of all patients referring themselves to a general practitioner or presenting to a general medical clinic have no evidence of underlying organic disease to account for their symptoms. They do not have frank psychiatric illness, and are conventionally considered to have functional disorders. The term ‘functional disorder’ is, unfortunately, sometimes used in a pejorative or dismissive manner, as biomedical science has become the focus of medical attention.

Altered emotional states are commonly associated with physical symptoms, and most people will have experienced (say) urinary frequency before an interview or an examination. Some individuals do not find it easy to admit to, much less to express, the emotions which are disturbing them; others lack the insight and emotional vocabulary which would help them to associate their physical symptoms with an emotional problem. As Balint [124] has said, some illnesses allow patients to complain of a problem.
Opportunities for the future
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

In this chapter we look back to previous parts of the book to draw together the main themes and look forward to how these should influence the development of vocational training in the future.
Planning and acceptance testing of megavoltage therapy installations
Authors: Almond P R , Horton J L
Published: November 2023

Planning and acceptance testing of a megavoltage therapy installation is a major undertaking whatever the size of the institution or department. Because the equipment and site preparation are expensive, and most of the machines are complex and can be supplied by several different manufacturers, it is imperative that a great deal of thought and care go into the decision, with the aim being that the specification of the machine that is installed meets the need of the institution at that time and for the projected lifetime of the equipment. In this chapter, the various types of equipment that are available and their general specification are described. Criteria for machine selection are then presented, followed by a discussion of treatment-room design and protection considerations. Finally, acceptance test procedures, which ensure that the institution obtains the equipment that was planned, are presented.
Absolute dose determination for high-energy photon and electron beams
Authors: Mijnheer B J , Thwaites D I , Williams J R
Published: November 2023

The principal aim of absolute dose determination is to enable an ionization chamber to be used at a reference point in a phantom and, with the use of appropriate conversion and correction factors, to yield the absorbed dose to water at that point for the situation in which the chamber is replaced by water. Ideally chamber calibration factors need to be available for every radiation quality used in the radiotherapy centre. The objective is achieved through the use of an ionization chamber calibrated at an accredited standards laboratory and the application of an appropriate protocol.
Simulation and imaging for radiation therapy planning
Authors: Dyk J Van , Mah K
Published: November 2023

The process of radiation therapy for malignant disease is complex and involves many steps, as is shown in the block diagram of Figure 7.1. It begins with patient diagnosis, contains a number of steps to patient treatment, and carries through with on-going follow-up. One crucial step in this process is the determination of the location and extent of disease relative to adjacent critical normal tissues. This can be done in a variety of ways, ranging from simple clinical examination to the use of complex imaging modalities, sometimes aided by contrast agents. Another step of the process is the selection of the necessary radiation beams to provide an adequate coverage of the tissues at risk, while minimizing the dose to healthy normal tissues. Before treatment is initiated, this treatment plan needs to be confirmed by an imaging procedure to ensure that the beams traverse the desired anatomical volume and correlate accurately with respect to critical structures.
Treatment planning for external beam therapy: advanced techniques
Authors: Redpath A T , McNee S G
Published: November 2023

It is now accepted that computerized tomography (CT) has a major role in treatment planning. Its diagnostic worth in the detection of malignant disease is significant, and the assessment of the extent of the disease may be vital in determining the choice of treatment. The specification of the anatomy of the patient in three dimensions, as a map of electron density values, allows accurate calculation of the dose distribution. It also permits accurate localization of the planning target volume and of critical normal structures.
Electron beam treatment-planning techniques
Authors: Thwaites D I
Published: November 2023

The attractive feature of electron beams for a variety of clinical applications is the shape of the depth-dose curve, characterized by a relatively steep fall-off and a finite range. This enables reasonably uniform doses to be delivered to a well-defined region extending from the surface, whilst at the same time sparing underlying tissue. Above about 20 MeV the fall-off of the curve becomes progressively less steep with energy, and the separation of the high-dose and spared regions becomes increasingly blurred. Energies higher than this can be used for deeper-seated tumours in a manner similar to megavoltage photons. However, the majority of linear accelerators that provide clinical electron beams provide energies within the range 4-20 MeV and this chapter is mainly concerned with their use. Discussion is limited to the parameters affecting either the dose distribution or the link between monitor units (mu) and dose. Calculation methods are considered, where appropriate, but no detailed discussion is given of more complex algorithms.
Developing primary care services for older people
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

In this final section of the book we return to, and expand upon, the earlier themes explored in the first four chapters. We examine the potential for improvement and change in services for older people by considering issues which focus beyond the care of an individual and beyond the activities of an individual primary care professional. This chapter includes a discussion of: Most primary care practitioners experience their work as dealing with the individual person - whether as a consultation or a referral because that is how the ‘work’ arrives. During the nineties primary care professionals have experienced major service changes imposed from without through legislative and fiscal changes, the possible exception to this imposition being fundholding, which was not only voluntary but also inspired some practices to think in innovative ways. Most notably this external imposition included the introduction of:
Palliative care in cancer
Authors: Kelly Sheila
Published: November 2023

Palliative medicine is defined as the study and management of patients with active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is quality of life (Doyle et al., 1993).
Skin cancer
Authors: Atkinson Ronnie J
Published: November 2023

The skin is unique in three ways. First, it is a living covering for the body to pro- tect it from loss of water and injury from light, heat, chemicals, and infectious organisms. Second, it is the main organ for regulating body temperature. Last, apart from the eye, it is the only organ easily visible, making it an excellent model for early diagnosis treatment and prevention.