bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishment and Evaluation of Recombinant Expression of HCV Transmembrane Protein (p7) and Detection of Anti-p7 Antibody in Serum of HCV-Infected Patients by Chemiluminescence
Authors: Zhou Huajun , Wu Jie , Yu Yu , Dai Yuzhu , Jin Xiaojuan , Sun Qingyang , Che Feihu , Zhang Yingjie , Cheng Jun
Published: October 2022

Objective

Our aim was to establish a chemiluminescence method for detecting anti-transmembrane protein (p7) antibody in the serum of patients with hepatitis C virus (HCV) infection.

Methods

The p7 gene was amplified by polymerase chain reaction using the plasmid PUC-p7 containing the p7 nucleic acid sequence of the HCV 1b genotype as the template, and recombinant plasmid pGEX-KG-p7 was constructed. After p7 fusion, the protein was induced and expressed in the prokaryote, extracted, and purified; the anti-p7 antibody detection kit was prepared, and its efficacy was evaluated.

Results

The plasmid pGEX-KG-p7 was constructed correctly, and p7 fusion protein was obtained. The methodological indexes of the kit, the precision test, blank limit and detection limit, etc, met the requirements. The positive rate of serum anti-p7 antibody in 45 patients with HCV infection was 20%.

Conclusions

The kit can be used in screening diagnosis, condition monitoring, prognosis, and disease mechanism and epidemiological study of HCV infection. The p7 protein has immune response in HCV-infected patients.
An atlas of glucose uptake across the entire human body as measured by the total-body PET/CT scanner: a pilot study
Authors: Lu Weizhao , Cheng Zhaoping , Xie Xue , Li Kun , Duan Yanhua , Li Min , Ma Chao , Liu Sijin , Qiu Jianfeng
Published: October 2022

Glucose uptake differs in organs and tissues across the human body. To date, however, there has been no single atlas providing detailed glucose uptake profiles across the entire human body. Therefore, we aimed to generate a detailed profile of glucose uptake across the entire human body using the uEXPLORER positron emission tomography/computed tomography scanner, which offers the opportunity to collect glucose metabolic imaging quickly and simultaneously in all sites of the body. The standardized uptake value normalized by lean body mass (SUL) of 18F-fluorodeoxyglucose was used as a measure of glucose uptake. We developed a fingerprint of glucose uptake reflecting the mean SULs of major organs and parts across the entire human body in 15 healthy-weight and 18 overweight subjects. Using the segmentation of organs and body parts from the atlas, we uncovered the significant impacts of age, sex, and obesity on glucose uptake in organs and parts across the entire body. A difference was recognized between the right and left side of the body. Overall, we generated a total-body glucose uptake atlas that could be used as the reference for the diagnosis and evaluation of disordered states involving dysregulated glucose metabolism.
Arithmetical and Hyperarithmetical Worm Battles
Authors: FernÁndez-Duque David , Joosten Joost J , Pakhomov Fedor , Papafilippou Konstantinos , Weiermann Andreas
Published: October 2022

Japaridze’s provability logic ${\operatorname {GLP}}$ has one modality $[n]$ for each natural number and has been used by Beklemishev for a proof theoretic analysis of Peano arithmetic (${\operatorname {PA}}$) and related theories. Among other benefits, this analysis yields the so-called Every Worm Dies (${\operatorname {EWD}}$) principle, a natural combinatorial statement independent of ${\operatorname {PA}}$. Recently, Beklemishev and Pakhomov have studied notions of provability corresponding to transfinite modalities in ${\operatorname {GLP}}$. We show that indeed the natural transfinite extension of ${\operatorname {GLP}}$ is sound for this interpretation and yields independent combinatorial principles for the second-order theory ${\operatorname {ACA}}$ of arithmetical comprehension with full induction. We also provide restricted versions of ${\operatorname {EWD}}$ related to the fragments ${\operatorname {I\varSigma }}_n$ of PA. In order to prove the latter, we show that standard Hardy functions majorize their variants based on tree ordinals.
Introduction
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

This Introduction begins by setting the context for the remainder of the book. It starts by detailing the authors’ backgrounds and clinical experience working in clinical, research, and advocacy settings. The diversity of Latinx persons in the United States is then discussed, as is the need for the culturally sensitive practice that is highlighted throughout the book. Several topics important in the Latinx mental health literature, like the Hispanic Health Paradox, the Immigrant Paradox, acculturation, and acculturative stress, are introduced. An exploration of ethical principles for mental health practitioners, including psychologists, social workers, and other clinicians, follows. The chapter ends with the importance and timeliness of psychological advocacy and the critical role of culturally informed psychological assessment with people of color, specifically Latinx groups.
Understanding Latinx Cultural Perspectives in Relation to Assessment
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

This chapter focuses on Latinx cultural values in relation to psychological assessment and discusses the role of acculturation in psychological assessment including acculturation measures commonly used with the Latinx population.
Instruments for Psychological Assessment with Latinx Persons
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

When psychological testing is a critical component of the referral at hand, it is crucial that a careful selection of measures is undertaken. This chapter discusses the importance of carefully selecting psychological measures in the assessment of Latinx groups. It also provides an overview of psychological assessments commonly used in clinical settings with Latinx groups, with particular attention paid to cognitive and personality measures. In addition, assessment with children is discussed with a particular focus on trauma assessments and youth psychopathology measures. The chapter closes with a summary of the importance of training, competency, and a careful selection of measures that takes into account validity and reliability.
Electrophysiological Generators in Clinical Neurophysiology
Authors: Lagerlund Terrence D.
Published: October 2022

This chapter reviews the structural generators of the various potentials that are recorded during clinical neurophysiological studies. It also discusses the specific types of potentials or components that are produced by each generator. These include peripheral nerves and muscles, whose function is assessed by nerve conduction studies and the electromyogram; sweat glands, which are assessed through the peripheral autonomic surface potential and quantitative sudomotor axon reflex test; spinal cord, which generates components of somatosensory evoked potentials (SEP), brainstem, which generates components of SEP and brainstem auditory evoked potential (BAEP) studies, special sensory receptors in the retina and cochlea, which generate the electroretinogram and early components of the BAEP, optic and auditory pathways, which generate components of SEP, BAEP, and visual evoked potential studies, and cerebral cortex, which generates the electroencephalogram and late components of SEP, BAEP, and visual evoked potential studies.
Adult Electroencephalography
Authors: Britton Jeffrey W.
Published: October 2022

In this chapter features of the normal adult electroencephalogram (EEG) and benign variants are described. Analysis of the EEG is important in the evaluation of patients with a number of brain disorders. Knowledge and familiarity of normal EEG features are essential in order to accurately identify abnormalities and avoid misdiagnosis. The sources of EEG activity and the fundamentals of EEG recording and EEG display are discussed. Characteristics of the normal EEG background during wakefulness and sleep and during activation procedures are clarified. Finally, benign variants are covered in detail; as these are a common cause of EEG misdiagnosis.
Assessment of Spells and Seizures in the Outpatient Setting
Authors: Feyissa Anteneh M.
Published: October 2022

Neurologists are frequently tasked to evaluate patients with paroxysmal spells that are characterized by changes in awareness, attention, or perception or by abnormal movements. These can be broadly classified as epileptic seizures (ESs) and nonepileptic spells (NESs). NESs could mimic ESs but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES could have psychologic or physiologic underpinning. Psychological causes of NES, also known as psychogenic nonepileptic seizures, are the most common causes of NES. Physiologic causes of NES include syncope, movement disorders, and sleep-related disorders. Familiarity with a variety of crucial features for different spell types helps create an appropriate differential diagnosis to guide further diagnostic testing. Accurate diagnosis of NES is crucial to prevent inappropriate treatment, impact on employment and driving status, delay of appropriate treatment, and overuse of healthcare resources. This chapter discusses the most common causes of spells encountered in the outpatient setting.
Epilepsy Surgery Evaluation
Authors: Drazkowski Joseph F.
Published: October 2022

The use of numerous types of electroencephalography (EEG) in the evaluation of people with refractory partial epilepsy for possible resective surgery remains integral to the comprehensive epilepsy evaluation. A progression in the use of the various forms of EEG, from routine EEG to intracranial recordings, remains integral to the person with epilepsy and the evaluation process when contemplating therapeutic epilepsy surgery. Surgery remains a potentially curative procedure for people with intractable epilepsy. Using a multidisciplinary team to evaluate the patient with epilepsy requires that essential elements of the evaluation are in agreement before surgery is offered. The use of specialized tests and sometimes invasive EEG recording techniques can assist in localizing the ictal zone for possible surgical resection when standard monitoring techniques are not conclusively localizing. Continued study of high-frequency oscillations, stereoelectroencephalography (SEEG), and perhaps chronic EEGs (implantables and wearable devices) may provide even more surgery for the person with epilepsy. SEEG is becoming more widely utilized and may provide improved localization in many cases. The utilization of many specific clinical neurophysiology (CNP) techniques remains essential to the presurgical evaluation process for people with epilepsy. This chapter reviews the techniques and approach to surgical evaluation of patients with intractable epilepsy.
Needle Electromyography
Authors: Rubin Devon I.
Published: October 2022

Needle electromyography (EMG) is a technique used, along with nerve conduction studies (NCSs), to identify and characterize neuromuscular disorders, including diseases involving anterior horn cells or motor neurons, peripheral nerves, neuromuscular junctions, and muscles. Motor and sensory NCSs provide important information about the function of these structures, and in some conditions (e.g., carpal tunnel syndrome or demyelinating neuropathies) are the most useful electrodiagnostic (EDX) tests to determine the underlying disorder. However, in many situations (e.g., mild radiculopathies or myopathies), NCSs alone are insufficient to identify a disorder or are able to localize the disease but cannot provide other important information, such as how long the disease has been present or whether recovery is occurring. Therefore, nearly all EDX studies require a needle EMG evaluation. Needle EMG refers to the recording of the electrical signals derived from muscle fibers using a needle recording electrode. This technique requires specialized knowledge of muscle anatomy, neuromuscular physiology and disease pathophysiology, changes in signals with diseases, techniques of waveform interpretation, electricity, and patient interaction. Successful performance of needle EMG relies on the skills of inserting, moving, and recording with a needle electrode and analyzing electrical signals recorded from muscle using auditory pattern recognition and semiquantitation techniques. This chapter reviews the technique of needle EMG and EMG waveform analysis and details the methods of identification and the significance of EMG waveforms recorded during the needle examination.
Electrodiagnostic Assessment of Radiculopathies
Authors: Shah Jaimin S.
Published: October 2022

This chapter provides an overview of the use of nerve conduction studies and electromyography in the assessment of radiculopathy. Radiculopathy is one of the most frequent reasons for referral to the electrodiagnostic laboratory. It reviews the anatomy of nerve roots and pathophysiology of radiculopathy important in the understanding of electrodiagnostic findings in radiculopathy. It also discusses expected electrodiagnostic abnormalities in radiculopathy and recommended approaches to performing electrodiagnostic studies tailored to specific clinical scenarios. Important limitations and pitfalls of electrodiagnostic examinations are also reviewed. Electromyography and nerve conduction studies may provide an external validation to the clinical assessment and imaging studies in the evaluation of radiculopathy.
Electrodiagnostic Assessment of Myopathies
Authors: Liewluck Teerin
Published: October 2022

Myopathies include a group of acquired and inherited disorders of skeletal muscle with marked clinical and pathological heterogeneity. Electrodiagnostic studies can be used as an extension of neurologic examination, in conjunction with serologic tests, to help confirm the presence of myopathy and exclude its mimickers. The pattern of findings, including the presence of fibrillation potentials, myotonic discharges, an underlying peripheral neuropathy, or a concomitant defect of neuromuscular transmission can help narrow the differential diagnosis of myopathy subtypes. Although none of the electrodiagnostic abnormalities are specific for any given types of myopathies and the final diagnosis frequently relies on histopathologic, antibody, or genetic confirmation, electrodiagnostic studies can assist in selecting the suitable muscle for biopsy or guiding the appropriate molecular study. In cases of immune-mediated myopathies, needle electromyography can be used to assess the treatment response.
Pediatric Sleep Assessment
Authors: Kotagal Suresh
Published: October 2022

There is considerable overlap in the categories of sleep-wake disorders of adults and children. The indications for various sleep diagnostic tests, the recording scenarios, scoring of various sleep-related events in children, and reference values, however, differ from those of adults. Many childhood sleep disorders are treatable, hence their early recognition and diagnosis is important. Certain aspects of the pediatric sleep history and examination are also unique due to developmental influences that change with age. This chapter provides an overview of these aspects. The optimum assessment requires integration of patient and parental concerns, questionnaire surveys, a sleep-focused examination and data from the various diagnostic modalities.
Brainstem and Cranial Nerve Monitoring
Authors: Muzyka Iryna M. , Hoffman E. Matthew
Published: October 2022

The brainstem and cranial nerves are at risk during many surgeries on or near the skull base. Detailed knowledge of the neuroanatomy and electrophysiologic techniques available for assessing the integrity of brainstem function is necessary to plan and execute successful intraoperative monitoring of brainstem and cranial nerves. Electromyography, brainstem auditory evoked potentials, long tract monitoring, and reflex testing are discussed. In addition, description of monitoring plans and interpretation for common skull base surgeries are outlined. Though recent innovative modalities provide theoretical improvements for monitoring cranial nerve and brainstem function over the more established techniques, additional studies of these techniques are needed prior to more widespread adoption.
Trauma to the hollow organs of the gastrointestinal tract
Authors: den Boer Robin B. , Hietbrink Falco , van Hillegersberg Richard , Ruurda Jelle P.
Published: October 2022

The trauma patient with suspected abdominal injury is initially resuscitated according to the principles of Advanced Trauma Life Support (ATLS). Focused assessment with sonography in trauma (FAST) and computed tomography (CT) are the preferred imaging modalities to detect injuries of the gastrointestinal tract, depending on the patients’ physiology. Injuries found in combination with the patient’s physiological state dictate operative or non-operative management. If surgical treatment is indicated, a decision has to be made between damage control surgery or early total care. Surgical and non-surgical decisions are dependent on the patient’s physiology, the mechanism of trauma (e.g. blunt vs penetrating), the anatomical location of the injury and on the extent of injury. In this chapter, the diagnosis and therapy are described of injuries to the oesophagus, stomach, duodenum, small intestine, colon, and rectum.
Physiology of the small bowel
Authors: Wells Cameron I. , O’Grady Greg
Published: October 2022

The small intestine has multiple physiological roles, including digestion, absorption, motility, secretion, sensation, intestinal barrier, and immunological functions. Small bowel activity takes place almost entirely unnoticed by healthy individuals; however, these functions are often affected in pathological and postoperative states. A complex interplay of tightly controlled luminal, neural, and hormonal processes regulate small intestinal function, with bidirectional signalling in neural, endocrine, and immunological pathways. An understanding of normal and altered small bowel physiology is critical for the care of patients undergoing gastrointestinal surgery.
Intestinal failure, short bowel syndrome, and intestinal transplantation
Authors: Wright Danette B. , Soop Mattias
Published: October 2022

Intestinal failure (IF) is a term which encompasses a broad range of clinical conditions that result in the loss of a patient’s nutritional independence to the point where they are reliant on artificial supplementation to maintain homeostasis and growth. It is now well recognized that IF is not just a chronic condition requiring lifelong parenteral nutrition with limited prospects of rehabilitation. IF also encompasses patients with an acute self-limiting condition requiring short-term supportive therapy frequently encountered in the postoperative period. Furthermore, it also includes patients with an acute severe illness often associated with intestinal fistulation resulting from complications of abdominal surgery. This group of patients require specialist management in order to avoid progressing to chronic irreversible IF. Developments in medical therapy, artificial nutrition, critical care, and surgery have led to improved outcomes and survival for patients with IF. Programmes of multidisciplinary intestinal rehabilitation and small bowel transplantation have also allowed many patients with chronic irreversible IF to regain nutritional independence, and avoid the long-term complications often associated with long-term PN supplementation.
Tuberculosis, typhoid, and other infectious diseases of the small bowel
Authors: Pal Partha , Nabi Zaheer , Nageshwar Reddy D.
Published: October 2022

The small bowel absorbs ingested fluids, extracts nutrients, excludes pathogens, and propels food by its unique architecture and strict regulatory mechanisms driven by hormones and neurotransmitters. This intricate balance is altered by various enteric infections with bacteria, viruses, protozoa, parasites, or fungi. These infective agents interact with different small intestinal cells, but the pathophysiological consequences such as diarrhoea, malabsorption, abdominal pain, and signs of systemic disease are similar due to a common final pathway for all such infections. Most of them are self-limiting or short lasting so that the functions of the small intestine are restored quickly. However, some of the infections are chronic and lead to long-term dysfunction of the small bowel. Both acute and chronic small intestinal infections cause a significant disease burden, morbidity, and mortality across the globe and are among the most common causes of disease worldwide. Hence, knowledge about the diagnosis and treatment of small bowel infectious diseases is important.
The Phenomenology of Attention-Deficit/Hyperactivity Disorder in Tourette Syndrome
Authors: Rothenberger Aribert , Roessner Veit
Published: October 2022

This chapter focuses on the complex epidemiological and phenomenological aspects of attention-deficit/hyperactivity disorder (ADHD) in Tourette syndrome (TS). Research on this topic is relatively recent and elucidated the high importance of comorbidity in TS and the need for an early assessment of ADHD in TS. Several observational studies have confirmed that ADHD is the most common comorbidity in TS, possibly anticipating TS onset and influencing the male gender predominance of TS. ADHD exerts a negative impact on externalizing and internalizing symptoms, as well as on psychosocial functioning and quality of life in TS. The impact of comorbid ADHD upon sleep disturbances in TS remain a neglected issue. Approaches to model the coexistence of TS and ADHD are still ongoing. Whereas basic neurobiological aspects fit with an additive model, complex cognitive functioning supports an interactive model. Specific pathophysiological features for TS plus ADHD have not yet been identified, but common heritability between TS and ADHD might be explained, at least in part, by the comorbidity of ADHD and obsessive–compulsive disorder. Future studies on the phenomenology of TS plus ADHD should consider not only the core symptoms of TS and ADHD but also obsessive–compulsive behavior traits, emotional aspects, neuropsychological aspects, quality of life, early risk factors, resilience, and other possible mediators and moderators.
The Phenomenology of Obsessive–Compulsive Symptoms in Tourette Syndrome
Authors: Ferrão Ygor Arzeno , de Alvarenga Pedro Gomes , Hounie Ana Gabriela , de Mathis Maria Alice , Farhat Luis Carlos , do Rosário Maria Conceição , Miguel Eurípedes Constantino
Published: October 2022

In clinical practice, the boundary between symptoms arising from obsessive–compulsive disorder (OCD) and Tourette syndrome (TS) is not easily determined. There are important areas of overlap between tics and compulsions that likely indicate a shared genetic vulnerability and a probable intersection of neurobiological structures and circuits, especially involving the basal ganglia. The frequency of this behavioral comorbidity varies across studies, confirming the heterogeneity of symptoms presentation in both disorders. Psychiatric comorbid diagnoses are more frequent in TS with comorbid OCD and include separation anxiety disorder, attention-deficit/hyperactivity disorder, grooming behaviors, post-traumatic stress disorder, and social and simple phobia. This chapter describes the complex phenomenology of obsessive–compulsive symptoms in TS and highlights the impact of this comorbidity on the occurrence of other behavioral problems, the burden of other psychiatric comorbidities, and its consequence with regard to treatment approaches.
Other Psychiatric Comorbidities in Tourette Syndrome
Authors: Cath Danielle C. , Müller-Vahl Kirsten R. , Mathews Carol A.
Published: October 2022

Symptoms of anxiety and depression occur at elevated rates in patients with Tourette syndrome (TS) and their family members. In children and young adolescents, anxiety symptoms put persons at risk for later tic persistence. Obsessive–compulsive disorder (OCD) symptoms in childhood put persons at risk for later development of anxiety and depressive symptoms. In adults (specifically adult women), there is a relationship between tic severity and anxious and depressive symptoms. Specifically comorbid OCD in children and adolescents puts TS individuals at risk to develop (internalizing) anxiety and depressive symptoms, whereas comorbid attention-deficit/hyperactivity disorder (ADHD) mostly puts individuals at risk to develop disruptive and externalizing behaviors. Environmental adversities (negative family environment factors and psychosocial stressors) strongly contribute to comorbidity with anxiety and depression in TS. In adults with TS, personality disorders are prevalent. Dimensional personality ratings indicate that neuroticism seems to be mostly associated with tics. Dysfunctions of cognitive flexibility and planning are more often related to comorbid OCD and autism traits in TS, and inhibition problems are more often linked to comorbid ADHD in TS. Intellectual ability is normally distributed in TS. The prevalence of learning disabilities (LDs) in TS is similar to that in the general population. Comorbidities with ADHD and—to a lesser extent—with OCD seem to increase the prevalence of LDs. In addition to the fact that dyslexia is the most common learning disability in general, children with TS tend to have problems with mathematics and written language. Rage attacks are frequent in TS.
Cellular and Molecular Pathology in Tourette Syndrome
Authors: Fasching Liana , Brady Melanie , Vaccarino Flora M.
Published: October 2022

This chapter summarizes the available literature and data on pathological findings in Tourette syndrome. In severe, unremitting Tourette syndrome, there are decreases in somatostatin-positive/nitric oxide synthase–positive interneurons, fast spiking parvalbumin-positive/γ-aminobutyric acid-ergic interneurons, as well as tonically active cholinergic interneurons in the caudate nucleus and putamen. There is also a prominent increase in inflammation throughout the basal ganglia along with activation of microglial cells. Overall, neuroimaging studies suggest that the basal ganglia, a set of nuclei situated deep within the cerebral cortical hemispheres, are a central component of the pathophysiology of TS. These findings are discussed in light of current views on the pathogenic mechanisms underlying tic disorders.
Pharmacological Treatment of Tics
Authors: Roessner Veit , Rothenberger Aribert
Published: October 2022

This chapter provides a literature review and a critical commentary of the available evidence on pharmacological treatment of tics in Tourette syndrome (TS). Because of the waxing and waning nature of tics, a meaningful appraisal of treatment efficacy in TS can only be given in most cases after a longer observation time. Environmental or situational factors have a modulating influence on tics, possibly biasing the appraisal of treatment efficacy. Many affected children, adolescents, and adults do not seek/require pharmacological treatment (tic severity: mild to moderate). Nonpharmacological and/or pharmacological interventions are beneficial for persons with subjective discomfort, social and/or emotional problems, functional interference, etc. The clinical experience is that the pharmacotherapy induces faster and probably more prominent tic reduction in comparison to behavioral treatment options. The goal of pharmacological treatment is a reduction in tic symptoms. Antipsychotic drugs may lead to the most reliable and fastest treatment effectiveness, but they also pose the greatest risk of side effects. Risperidone can be favored as a first-choice agent for the treatment of tics. Pimozide, tiapride, sulpiride, and aripiprazole are regarded as second-choice agents. Clonidine might be helpful mainly in case of TS plus attention-deficit/hyperactivity disorder. For high-quality evidence on pharmacological treatment in TS, future studies should include, for instance, longer observation periods, larger groups, a more standardized methodological approach, placebo controls, and a double-blind design.
Complementary and Integrative Health Medicine in Tourette Syndrome
Authors: Cruz Maria , Coffey Barbara
Published: October 2022

Complementary and integrative medicine (CIM) approaches are among the most popular and widely utilized treatments in Tourette syndrome (TS). CIM approaches most frequently reported to be used by patients with TS are dietary modification, allergy treatment, prayer, vitamins, massage, nutritional and dietary supplements, chiropractic manipulation, meditation, yoga, acupuncture, hypnosis, homeopathy, and biofeedback. Research evidence suggests that a number of CIM approaches are potentially useful in TS, yet there are methodological limitations in all studies. The approaches that appear to have most promise based on the evidence to date are 5-Ling Granule, hypnosis, biofeedback, ω3 fatty acids, cannabinoids, and Ningdong granule.
Albert Hoffer
Authors: Lambrinidou Yanna
Published: October 2022

Albert Hoffer was 78 years old when he was diagnosed with cancer of the throat. A deeply private man, he found it painful to endure the invasions of his body and the strong feelings he experienced in the last months of his life. He was an opinionated, forthright, and mistrustful person who tested everyone intensely before allowing them to get close. Years of alcohol abuse had cost Mr. Hoffer his career and damaged his relationship with his wife and children. The complex, interwoven medical and family issues in the context of the Hoffer family’s limited financial means posed a significant challenge for the hospice team.
Klara Bergman
Authors: Boston Patricia
Published: October 2022

When Klara Bergman’s doctors told her that she had incurable lung cancer, she did not question the diagnosis. But she felt it was a terrible injustice. She felt that she had been cheated and was being punished for no good reason. Mrs. Bergman, who was 80 years old, had suffered in Nazi concentration camps during World War II and lost most of her loved ones. She had cared for her sick father for many years after they were freed from the camp. Since then she had strived to repair and alleviate the suffering of victims of concentration camps, never thinking of herself or of her own needs. Why had God inflicted such a terrible injustice on her? A good and loving God would not do such a thing. Perhaps there was no God. All her life she had been deeply religious and committed to her Jewish faith. But if God existed, he was not there for her now.
Richard Johnson
Authors: Towers Anna
Published: October 2022

Many people, especially those who are relatively young, opt to fight their illness to the end. Richard Johnson refused chemotherapy at first, but when his disease became far advanced, he asked for aggressive treatments. Although he understood that his chemotherapy was a purely experimental treatment, he nonetheless hoped that his life would be prolonged. It made him feel safe to be on a medical ward where he thought that he might get aggressive biomedical interventions for as long as possible. Both Mr. Johnson and his wife Linda wanted to be totally involved with the decision-making concerning his illness, down to the last detail. Yet Mr. Johnson did not involve his wife in some of the crucial choices he made. Mrs. Johnson disagreed with his aggressive approach at the end, when she saw him get sicker and realized that he was dying. Mr. Johnson died a conflicted death, and the course of his wife’s and son’s bereavement reflected this.
Costas Metrakis
Authors: Boston Patricia
Published: October 2022

It was unusual for the palliative care team to see someone like Costas Metrakis, a 58-year-old man who had only recently been diagnosed with terminal illness, on the Palliative Care Unit. Usually, the people they cared for, and their families, had time to absorb some of the anguish and turmoil that accompanies the news of a fatal illness. For the Metrakis family there was no time. From the date of his diagnosis of incurable cancer of the stomach to his reluctant admission to palliative care was a period of only two weeks. The whole family felt numbed. They could not accept palliative care. “It is a place where they send people to die,” Elie Metrakis, the patient’s wife, said. Reluctantly, recognizing that help for Mr. Metrakis’s symptoms would be available on the unit, the couple agreed to be transferred there from the medical ward. After only three days on the unit, despite his burdensome symptoms, Mr. Metrakis asked to go home. The team mobilized the support they could, and Mr. Metrakis went home on a weekend pass. As soon as he came back to the unit, he insisted on returning home again. Four days later he was dead.
Research Methods
Authors: Barnard David
Published: October 2022

The aims of this final chapter of the book are to outline the premises of qualitative research, show the relevance of qualitative methods to palliative care, and explain the specific methods of qualitative research underlying this book. The discussion aims to provide an understanding of ethnographic, narrative inquiry, which was the authors’ approach to the experiences of patients, families, and caregivers in palliative care. The authors outline their rationale for a case narrative study, the ethnographic methods and techniques used to gather and analyze data, the role of the participant-observer, and the ethical issues related to qualitative research in palliative care.
Preoperative assessment
Authors: Ho Roger H. Y. , Lam David M. H.
Published: October 2022

The aims of preoperative assessment are to evaluate and optimize pre-existing medical conditions and medications, to stratify the risk of perioperative complications, and to inform the planning of perioperative care. This chapter outlines the specific challenges brought about by the range of different oromaxillofacial pathologies requiring surgery, airway evaluation and planning, the preoperative management of patients with pre-existing medical conditions in the context of oromaxillofacial surgery, environmental considerations, the preoperative management of commonly encountered long-term medications, and the various risk stratification tools available to facilitate optimal planning of the perioperative care.
Imaging
Authors: Mitra Indu
Published: October 2022

A basic knowledge of head and neck anatomy, an understanding of the associated pathologies and patterns of injury, and their appearance on the most commonly used imaging modalities can greatly assist the anaesthetist in anticipating and planning for potential difficulties, particularly with regard to airway management interventions and in avoiding further injury from manipulation of the head and neck. The relative advantages and disadvantages of imaging modalities are described in this chapter, with reference to craniofacial anatomy relevant to the anaesthetist managing the oromaxillofacial patient. Important pathologies and their radiological appearance are discussed, including craniofacial and orbital fractures, cervical spinal injuries, dental disease, infection, and tumours, and the relevance of each to the anaesthetist are explained.
Aesthetic surgery
Authors: Lee Corina
Published: October 2022

Orofacial aesthetic surgery concerns operative procedures of the mouth and face specifically undertaken for cosmetic purposes. This type of surgery has been part of a rapidly expanding healthcare sector, often undertaken in non-hospital-based environments, that is consequently relatively less evidence based than more established surgical specialities. This chapter describes a safe approach to anaesthesia for these procedures, highlighting procedure-specific requirements, as well as discussing the tenets of orofacial aesthetic surgery—smooth emergence from anaesthesia, meticulous blood pressure control, avoidance of nausea and vomiting, and provision of adequate analgesia—all measures designed to reduce postoperative haematoma formation. Important aspects of non-surgical facial procedures relevant to the anaesthetist are also described, with particular attention to the potential risks and safety strategies pertinent to laser surgery.
Burns and inhalational injury
Authors: Nicholas Caroline A. R. , Vorster Tim N.
Published: October 2022

The management of acute orofacial burns and inhalational injury can be extremely challenging and emotive, requiring a calm but expeditious systematic, multidisciplinary approach. Airway interventions necessitate involvement of a skilled, senior anaesthetist and, therefore, must be carefully timed with a full array of difficult airway equipment immediately available. This chapter describes the principles in managing any emergency admission with major burns with a special focus upon the specific issues and treatment strategies associated with severe facial burns and inhalational injury. The importance of thorough assessment, resuscitation, fluid and temperature management, and analgesia are highlighted in the context of the pathophysiological changes that occur. Priorities for intraoperative and intensive care management are also discussed, as well as the challenges these patients pose for repeated surgical procedures.
Postoperative care and planning
Authors: Atkins Joshua H. , Rassekh Christopher H. , Herlich Andrew
Published: October 2022

Patients undergoing complex major oromaxillofacial surgical procedures are at substantial risk of postoperative complications, potentiated by the multiple comorbidities common to this population, and being associated with significant morbidity and mortality. Effective postoperative care relies upon thorough preoperative assessment, optimization of these chronic medical conditions (and medications), delivery of precise intraoperative care, and meticulous planning for the postoperative period—enabling transfer to an appropriate postoperative care facility and facilitating the streamlining of patient care. Continuous and close postoperative physiological monitoring is essential, accompanied by regular and frequent clinical reassessment by a well-staffed multidisciplinary team, capable of delivering specialist supportive care, and trained in early identification (and prompt management) of clinical deterioration, such that patient outcomes are optimized and a return to baseline function can be expeditiously achieved. This chapter outlines the principles in postoperative planning and care of the oromaxillofacial surgical patient, highlighting some procedure-specific strategies, and emphasizing the importance of a multidisciplinary approach.
Epidemiology of hypertension
Authors: Nadar Sunil K. , Harrison Stephanie L.
Published: October 2022

Hypertension is a common condition and is associated with a high risk of future cardiovascular, cerebrovascular, and cardiovascular-related events. Hypertension is a leading risk factor for cardiovascular disease and death worldwide. Many modifiable and non-modifiable factors influence the prevalence of hypertension. Potentially modifiable risk factors for hypertension include high salt consumption, low consumption of fruits and vegetables, high alcohol consumption, not maintaining optimal body weight, and low physical activity/sedentary lifestyle. Non-modifiable risk factors include age, male sex, ethnicity, and genetic factors. Although the prevalence of hypertension is increasing worldwide, there are disparities between countries, with low- and middle-income countries experiencing the highest increase in prevalence of hypertension. From a public health point of view, population and opportunistic screening and patient education of lifestyle influences of hypertension are important in the diagnosis, management, and prevention of hypertension.
The eye in hypertension
Authors: Lip Peck Lin
Published: October 2022

Hypertensive retinopathy is a manifestation of retinal microvascular damage in the eye related to the chronic insult of high blood pressure. The eye is perhaps the only organ where changes due to hypertension can be directly visualized on examination. The chapter describes the pathological changes of the retinal vasculature with corresponding clinical features related to chronic exposure to high blood pressure. It also revisits the classifications of hypertensive retinopathy which have been simplified to correlate more closely with risk stratification of end-organ damage and prognosis. The chapter also covers some common specific disease entities of eye complications secondary to hypertension, its ocular presentation, and current treatment options.
Diagnosis and management of resistant hypertension
Authors: Wei Fang-Fei , Liu Chen , Staessen Jan A.
Published: October 2022

Resistant hypertension refers to a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Patients with resistant hypertension are at high risk of complications, particularly cardiovascular events. This chapter reviews the prevalence and risks associated with treatment-resistant hypertension, and new insights in the diagnosis and management of treatment-resistant hypertension by medication and devices. The conclusion is that optimization of medical treatment remains the cornerstone of management of resistant hypertension. The efficacy of device-based therapies for resistant hypertension has not been proven; however, these approaches provide opportunities for further research.
Hypertension in patients with diabetes mellitus
Authors: Cuthbertson Daniel J.
Published: October 2022

The frequent coexistence of hypertension with diabetes increases the risk of macrovascular or atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications (including retinopathy, nephropathy, and neuropathy). Randomized clinical trials have demonstrated the effectiveness of blood pressure lowering in reducing these diabetes complications. Multiple pathophysiological mechanisms explain this coexistence, including insulin resistance and hyperinsulinaemia, activation of the renin–angiotensin system, plasma volume expansion, and increased arterial stiffness. Effective management of diabetes should target optimal blood pressure and lipid management with individualized glycaemic control. Use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should be used as first-line therapy for blood pressure lowering, as monotherapy or in combinations, to prevent or reduce the burden of ASCVD, heart failure, and microvascular complications.
Identification of Grand-design and Flocculent spirals from SDSS using deep convolutional neural network
Authors: Sarkar Suman , Narayanan Ganesh , Banerjee Arunima , Prakash Prem
Published: October 2022

Spiral galaxies can be classified into the Grand-designs and Flocculents based on the nature of their spiral arms. The Grand-designs exhibit almost continuous and high contrast spiral arms and are believed to be driven by stationary density waves, while the Flocculents have patchy and low-contrast spiral features and are primarily stochastic in origin. We train a deep convolutional neural network model to classify spirals into Grand-designs and Flocculents, with a testing accuracy of $\mathrm{97.2{{\ \rm per\ cent}}}$. We then use the above model for classifying 1354 spirals from the SDSS. Out of these, 721 were identified as Flocculents, and the rest as Grand-designs. Interestingly, we find the mean asymptotic rotational velocities of our newly classified Grand-designs and Flocculents are 218 ± 86 and 146 ± 67 km s−1, respectively, indicating that the Grand-designs are mostly the high-mass and the Flocculents the intermediate-mass spirals. This is further corroborated by the observation that the mean morphological indices of the Grand-designs and Flocculents are 2.6 ± 1.8 and 4.7 ± 1.9, respectively, implying that the Flocculents primarily consist of a late-type galaxy population in contrast to the Grand-designs. Finally, an almost equal fraction of bars ∼0.3 in both the classes of spiral galaxies reveals that the presence of a bar component does not regulate the type of spiral arm hosted by a galaxy. Our results may have important implications for formation and evolution of spiral arms in galaxies.
An analytical solution to measure the gas size in protoplanetary discs in the viscous self-similar scenario
Authors: Toci Claudia , Lodato Giuseppe , Livio Francesco Gerardo , Rosotti Giovanni , Trapman Leon
Published: October 2022

In order to understand which mechanism is responsible for accretion in protoplanetary discs, a robust knowledge of the observed disc radius using gas tracers such as 12CO and other CO isotopologues is pivotal. Indeed, the two main theories proposed, viscous accretion and wind-driven accretion, predict different time evolution for the disc radii. In this letter, we present an analytical solution for the evolution of the disc radii in viscously evolving protoplanetary discs using 12CO as a tracer, under the assumption that the 12CO radius is the radius where the surface density of the disc is equal to the threshold for CO photodissociation. We discuss the properties of the solution and the limits of its applicability as a simple numerical prescription to evaluate the observed disc radii of populations of discs. Our results suggest that, in addition to photodissociation, also freeze out plays an important role in setting the disc size. We find an effective reduction of the CO abundance by about two orders of magnitude at the location of CO photodissociation, which, however, should not be interpreted as the bulk abundance of CO in the disc. The use of our analytical solution will allow to compute disc sizes for large quantities of models without using expensive computational resources such as radiative transfer calculations.
Boosting molecular diffusion following the generalized Murray's Law by constructing hierarchical zeolites for maximized catalytic activity
Authors: Sun Ming-Hui , Gao Shu-Shu , Hu Zhi-Yi , Barakat Tarek , Liu Zhan , Yu Shen , Lyu Jia-Min , Li Yu , Xu Shu-Tao , Chen Li-Hua , Su Bao-Lian
Published: October 2022

Diffusion is an extremely critical step in zeolite catalysis that determines the catalytic performance, in particular for the conversion of bulky molecules. Introducing interconnected mesopores and macropores into a single microporous zeolite with the rationalized pore size at each level is an effective strategy to suppress the diffusion limitations, but remains highly challenging due to the lack of rational design principles. Herein, we demonstrate the first example of boosting molecular diffusion by constructing hierarchical Murray zeolites with a highly ordered and fully interconnected macro–meso–microporous structure on the basis of the generalized Murray's Law. Such a hierarchical Murray zeolite with a refined quantitative relationship between the pore size at each length scale exhibited 9 and 5 times higher effective diffusion rates, leading to 2.5 and 1.5 times higher catalytic performance in the bulky 1,3,5-triisopropylbenzene cracking reaction than those of microporous ZSM-5 and ZSM-5 nanocrystals, respectively. The concept of hierarchical Murray zeolites with optimized structural features and their design principles could be applied to other catalytic reactions for maximized performance.
Bebtelovimab for High-Risk Outpatients With Early COVID-19 in a Large US Health System
Authors: Dryden-Peterson Scott , Kim Andy , Joyce Mary-Ruth , Johnson Jennifer A , Kim Arthur Y , Baden Lindsey R , Woolley Ann E
Published: October 2022

There are limited data for the clinical efficacy of bebtelovimab in preventing severe coronavirus disease 2019. Among outpatients unable to take nirmatrelvir-ritonavir at a large health system, 10 of 377 (2.7%) patients who received bebtelovimab and 17 of 377 (4.5%) matched untreated patients were hospitalized or died. The 43% observed risk reduction with bebtelovimab was not statistically significant (P = 0.14).