bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Long-Term Ventilator Hospitals
Authors: Kahn Jeremy M
Published: July 2014

Long-term ventilator facilities play an increasingly important role in the care of chronically critically ill patients in the recovery phase of their acute illness. These hospitals can take several forms, depending on the country and health system, including �step-down� units within acute care hospitals and dedicated centres that specialize in weaning patients from prolonged mechanical ventilation. These hospitals may improve outcomes through increased clinical experience at applying protocolized weaning approaches and specialized, multidisciplinary, rehabilitation-focused care; they may also worsen outcomes by fragmenting the episode of acute care across multiple hospitals, leading to communication delays and hardship for families. Long-term ventilator facilities may also have important �spillover effects�, in that they free ICU beds in acute care hospitals to be filled with greater numbers of acute critically ill patients. Current evidence suggests that mortality of chronically critically ill patients is equivalent between acute care hospitals and specialized weaning centres; however, mechanical ventilation may be longer and cost of care higher in patients who remain in acute care hospitals. Given the rising incidence of prolonged mechanical ventilation and capacity constraints on acute care ICUs, long-term ventilator hospitals are likely to serve a key function in critical illness recovery.
Quality of Life after Critical Illness
Authors: Hofhuis José GM , Spronk Peter E
Published: July 2014

The demand for critical care is on the rise and is expected to grow significantly in coming decades. Health-related quality of life (HRQoL) is a relevant outcome measure for patients recovering from critical illness. This chapter addresses several key questions about HRQoL, namely: Why measure HRQoL in critically ill patients? What do we mean with HRQoL? Which HRQoL instruments are being used? How to estimate HRQoL before ICU admission, and what is the impact of critical illness on HRQoL, particularly in the elderly? This chapter also addresses the phenomenon of response shift in survivors of critical illness related to their perceived HRQoL. It is argued that HRQoL measures for physical and psychological factors, functional status, and social interactions should be incorporated as standard quality indicators of ICU performance. These measurements will provide further insight on long-term post-ICU recovery and might be used to evaluate and track the utility of follow-up clinics after hospital discharge.
Survival and Recovery: A Patient’s Perspective
Authors: Misak Cheryl
Published: July 2014

This chapter addresses, from a patient's perspective, what happens after the intensivist takes his or her job to be done. If it turned out that intensivists were successful in getting their patients out the ICU door alive, only to find that some great number of them died in the coming weeks or had an astoundingly poor quality of life in subsequent years, we would not count this as a success. Physical, cognitive, and emotional impairment is reviewed, with the conclusion that clinical care and research should focus not only on short-term outcomes of ICU patients, but also on their rehabilitation and recovery.
One Family’s Perspective on the Legacy of Critical Illness
Authors: Dyzenhaus David
Published: July 2014

This chapter sets out a narrative of one family’s perspective on the legacy of critical illness. It begins with an account of the onset of the illness and the hospital treatment and shows how the issue of legacy is bound up with these initial stages. It explains how difficult it is to cope for the family, even with the best of medical care and generous support from extended family and friends. It discusses how essential information and care become after the patient is released from hospital. Finally, a perspective on the role of patient resilience is provided.
Introduction: Chronic Organ Dysfunction Following Critical Illness
Authors: Hermans Greet
Published: July 2014

Chapter 12 introduces various issues surrounding organ dysfunction following critical illness and ICU hospitalizations. It covers possible complications that can arise from various organ system failures or problems during ICU stays, including difficult ventilator weaning and tracheostomy, local complications from endotracheal tubes (ETTs), surviving acute kidney injury (AKI), and decreased functional capacity and decreased QoL.
Prolonged Respiratory Insufficiency and Ventilator Dependence in the ICU
Authors: Beduneau Gaëtan , Richard Jean-Christophe M , Brochard Laurent
Published: July 2014

The process of separation or weaning from mechanical ventilation can be arbitrarily separated into three categories: (1) simple weaning when patients are separated from the ventilator after the first attempt of unsupported spontaneous breathing. This usually represents slightly more than half of the patients; (2) difficult weaning when up to three attempts or 1 week is necessary to successfully separate the patient from the ventilator; (3) prolonged weaning for the remaining patients. This last group represents between 6 and 20% of the ICU population arriving at the stage of weaning and carries a considerable human and economic cost. A global approach, including measures to optimize psychological status, nutritional support, and sleep, is essential in the management of these patients, and referral to specialized weaning centres may be helpful. Muscle weakness is a very frequent finding in patients undergoing prolonged mechanical ventilation and may be worsened by excessive sedation, prolonged immobilization, and the use of controlled mechanical ventilation modes. It follows that approaches that include sedation sparing, early mobilization, and the transition to spontaneous breathing are likely to be beneficial.
Introduction: Cognitive and Behavioural Disorders Following Critical Illness
Authors: Wesley Ely E
Published: July 2014

Chapter 18 provides an outline to cognitive and behavioural disorders following critical illness, and introduces topics that include a spectrum of acquired or exacerbated ‘neck-up’ disorders, such as ‘dementia-like’ long-term cognitive impairment, major depression, and post-traumatic stress disorder (PTSD).
Long-Term Implications of ICU-Acquired Muscle Weakness
Authors: Latronico Nicola , Piva Simone , McCredie Victoria
Published: July 2014

Intensive care unit-acquired weakness (ICUAW) is a significant and common complication with major implications for survivors of critical illness. ICUAW is a clinical diagnosis made in the presence of generalized muscle weakness that occurs in the setting of critical illness when other causes of muscle weakness have been excluded. Critical illness polyneuropathy and myopathy are the most common causes of ICUAW. Short-term implications of ICUAW include alveolar hypoventilation and an increased risk of pulmonary aspiration, atelectasis, and pneumonia—factors which may contribute to acute respiratory failure and ICU re-admission. In the long term, ICUAW has been associated with physical disturbances, including unsteady gait, sensory loss, foot drop, and, in more severe cases, persistent quadriparesis and ventilator dependency. ICUAW appears to heavily influence the failure of ICU patients to return to baseline health status post-discharge. There is a paucity of evidenced-based therapeutic strategies to reduce the incidence of ICUAW; however, early rehabilitative therapy might represent an effective measure in improving functional status.
Introduction: Biological Mechanisms of Injury and Repair
Authors: Stevens Robert D
Published: July 2014

Chapter 26 is an introduction to devoted to biological mechanisms underpinning organ dysfunction and repair in critical illness, and how research has generated fundamental insights into the biology of conditions, such as sepsis and ARDS, and has suggested important new therapeutic paradigms. It also specifically addresses issues surrounding genetic susceptibility, cognitive deficiency, frailty, myocardial ischaemia, muscle wasting, sepsis-associated encephalopathy (SAE), CIP, and structural muscle alterations.
Physiological Reserve and Frailty in Critical Illness
Authors: McDermid Robert C , Bagshaw Sean M
Published: July 2014

Physicians have long sought to define a ‘physiologic age’ distinct from chronologic age which might account for some of the variance in response to critical illness and injury. This has led to the concept of ‘physiologic reserve’ which might represent a major driver of outcome in patients requiring intensive care. The human body is a complex system that adapts to a multitude of external stressors; however, senescence or illness can reduce inherent adaptive mechanisms, reducing complexity and reducing the threshold for decompensation (i.e. acute illness or injury). This theoretical critical threshold can be considered ‘physiologic reserve’. The phenotypic expression of this process is frailty. Frailty is a condition in which small deficits accumulate which individually may be insignificant but collectively produce an overwhelming burden of disease and heightened vulnerability to adverse events. Frail patients expend a greater proportion of their reserve simply to maintain homeostasis, and seemingly trivial insults can contribute to catastrophic decompensation. While frailty has generally been described among older populations, the concept of frailty as a surrogate of physiologic reserve may have relevance to critically ill patients across a wide spectrum of age. Research is needed to characterize the biological underpinnings of frailty, optimal ways to measure it, and its importance in determining survival and functional outcomes after critical illness. The utilization of ICU resources by older patients is rising, and the prevalence of frailty in those admitted to the ICU is likely to increase.
Cognitive Reserve
Authors: Raymont Vanessa , Stevens Robert D
Published: July 2014

The cognitive reserve hypothesis suggests that the structure and function of an individual’s brain can modulate the clinical expression of brain damage and illness. This chapter describes passive and active models of reserve, their impact on neurological illness, and how these effects can be assessed. Passive models focus on the protective potential of anatomical features, such as brain size, neural density, and synaptic connectivity, while active models emphasize the connectivity and efficiency of neural networks and active compensation by alternative networks. It is likely that both models represent features of a common biological substrate and could help in the development of strategies to improve outcome following critical illness.
Pathophysiology of Acute Kidney Injury, Repair, and Regeneration
Authors: Tsai Ching-Wei , Noel Sanjeev , Rabb Hamid
Published: July 2014

Acute kidney injury (AKI), regardless of its aetiology, can elicit persistent or permanent kidney tissue changes that are associated with progression to end-stage renal disease and a greater risk of chronic kidney disease (CKD). In other cases, AKI may result in complete repair and restoration of normal kidney function. The pathophysiological mechanisms of renal injury and repair include vascular, tubular, and inflammatory factors. The initial injury phase is characterized by rarefaction of peritubular vessels and engagement of the immune response via Toll-like receptor binding, activation of macrophages, dendritic cells, natural killer cells, and T and B lymphocytes. During the recovery phase, cell adhesion molecules as well as cytokines and chemokines may be instrumental by directing the migration, differentiation, and proliferation of renal epithelial cells; recent data also suggest a critical role of M2 macrophage and regulatory T cell in the recovery period. Other processes contributing to renal regeneration include renal stem cells and the expression of growth hormones and trophic factors. Subtle deviations in the normal repair process can lead to maladaptive fibrotic kidney disease. Further elucidation of these mechanisms will help discover new therapeutic interventions aimed at limiting the extent of AKI and halting its progression to CKD or ESRD.
Myocardial Remodelling after Myocardial Infarction
Authors: Vimalesvaran Kavitha , Marber Michael
Published: July 2014

This chapter focuses on myocardial remodelling, a process that affects the heart’s shape, structure, and function, following myocardial injury (MI). Post-MI remodelling can be divided into three phases, with the first phase 0–72 hours beginning at the time of ischaemic injury, the second phase 72 hours to 6 weeks, and the third and last phase 6 weeks and beyond. During post-infarction remodelling, hypertrophy is an adaptive response that compensates for the increased load, reduces the effect of progressive dilatation, and balances contractile function. The chapter discusses the factors involved in ventricular remodelling and its association with heart failure progression. The effects of therapies designed to prevent or attenuate post-infarction left ventricular remodelling, with reference to the pathophysiological mechanisms involved, are then considered. Therapies specifically discussed include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β‎-adrenoreceptor blockers, and aldosterone receptor antagonists.
Choice of Renal Replacement Therapy and Renal Recovery
Authors: Schneider Antoine G , Glassford Neil J , Bellomo Rinaldo
Published: July 2014

Acute kidney injury (AKI) is a major complication of critical illness, associated with increased mortality and morbidity. Among survivors of AKI, a subset will develop the need for chronic dialysis. Chronic dialysis imposes a major physical, emotional, economic, and social burden on ICU survivors and their caregivers. Evidence suggests that the type of renal replacement therapy used in the acute setting may affect renal recovery differently. For example, intermittent haemodialysis (IHD) increases the risk of hypotension and acute volume and solute fluctuations, and such physiological events have been associated with fresh renal injury. In contrast, continuous renal replacement therapy (CRRT) does not carry such risks. Consistent with such physiological and experimental observations and differences, several observational studies and some randomized controlled trials suggest that using IHD, instead of CRRT, as the preferred form of RRT increases the risk of patients entering a chronic dialysis programme. A recent meta-analysis confirmed these findings. Clinicians making decisions about the choice of RRT modality in ICU patients should carefully consider these observations.
Prolonged Weaning
Authors: Creagh-Brown Benedict , Steier Joerg , Hart Nicholas
Published: July 2014

In 25% of critically ill patients, weaning from mechanical ventilation takes longer than 10 days; indeed, 5–10% of patients still require ventilation at 30 days. Those with prolonged weaning, after adjustment for other variables, have a higher mortality within the intensive care unit than those without weaning delay or failure. The pathophysiological processes that result in weaning failure are complex and result of an imbalance between the neural respiratory drive, respiratory muscle load, and capacity. The clinical conditions resulting in these pathophysiological conditions should be methodically considered in patients requiring prolonged weaning. These patients often need a personalized weaning and rehabilitation approach, based on their underlying pathological condition as well as their psychological and physiological status.
Post-ICU Rehabilitation
Authors: Elliott Doug , Denehy Linda
Published: July 2014

More than three-quarters of patients who experience a critical illness and intensive care unit admission survive their initial physiological insult and are subsequently discharged from hospital. Some of these survivors have physical, psychological, or cognitive deficits that persist and delay optimal recovery in the following months and, in some instances, years. A range of generic screening and functional assessment strategies has been used with post-ICU cohorts, but methodological limitations were evident. Further research is therefore required, possibly using a battery of instruments to cover a broad range of function across the recovery period, to explore optimal screening times. Commencing or continuing rehabilitation strategies for patients after ICU discharge in both hospital and post-hospital environments have their own set of challenges. A key step is to improve awareness and understanding of the sequelae of critical illness among rehabilitation specialists, primary care practitioners, and the broader health community. Coordination and optimal use of scarce resources in hospital and community settings is required. Evidence supporting post-ICU rehabilitation interventions is mixed. Studies are needed to discern which patients likely to respond and the optimal amount, type, and timing of interventions. Innovative use of wearable technologies and smartphone or tablet applications may offer some solutions for monitoring, motivation, compliance, and optimal recovery for survivors of a critical illness who have identified functional deficits.
Narratives of Illness and Healing after the ICU
Authors: Jones Christina
Published: July 2014

There is a significant difference in the narrative of critical illness as experienced by the patient and that of their family, friends, and carers. Morse and Johnson proposed a model of illness which takes into account of this difference in perception and so helps to understand the processes the patient and their family go through. In some patients who have survived critical illness, there is a preponderant investment in the recovery process and the sense of purpose in life seems to be heightened. In others, the post-ICU period is tainted by frightening delusional memories of the period of critical illness; such patients actively seek to avoid memories of illness or being in the hospital. Patients recovering from critical illness have a need for a coherent story about what happened in ICU, but those experiencing delusional memories may need structured counselling. ICU diaries can help with this process by attempting to assemble the pieces of an authentic and meaningful narrative. This intervention can significantly reduce the distress of recovering ICU patients.
ICU Follow-Up Clinics
Authors: Goddard Shannon L , Cuthbertson Brian H
Published: July 2014

ICU follow-up clinics have been proposed and, in some cases, adopted in an effort to improve post-ICU care. Clinics are heterogeneous in staffing and organization and may provide a range of services, from drug reconciliation to mental health referrals. Some clinics integrate support services for family members and caregivers. In other cases, the clinics exist largely as a research environment where they may help to better understand long-term outcomes of survivors of critical illness. Thus far, clinical trials have not shown these clinics to improve patient-centred outcomes or to be cost-effective. However, qualitative literature does suggest a subjective sense of benefit for patients and family members. The lack of quantitative evidence in support of clinics does not mean that the long-term needs of ICU patients cannot be addressed in a formal way. However, it does suggest that clinics are not effective as delivered in the trials. Critical care researchers should be directed by both the qualitative and quantitative literature in conceiving new interventions and testing them in clinical trials. The model of an interdisciplinary clinic including rehabilitation specialists should be further explored.
Secondary syphilis
Authors: Houston Angela , French Patrick
Published: July 2014

Over the past 10 years syphilis has once again become endemic in the UK with highest rates in those with HIV and men who have sex with men (MSM). Primary syphilis should be considered as part of the differential diagnosis in all individuals with mouth or anogenital ulceration, and secondary syphilis should be considered in all those with rash and constitutional symptoms. A case of meningovascular syphilis is presented here and exemplifies how neurosyphilis should be considered in patients with a wide range of neurological presentations. The key to managing syphilis is considering the diagnosis in the first place. Screening for syphilis is easy and cheap using the new IgG/IgM and this test is always positive in patients with syphilis, apart from the rare individuals with incubating or very early primary infection who are unlikely to be seen in general medical settings.
HIV: cryptococcal meningitis and timing of antiretroviral treatment
Authors: Loyse Angela , Harrison Tom
Published: July 2014

Cryptococcal meningitis is a common opportunistic infection in late-stage HIV infection in much of the world. The correct management of cryptococcal meningitis through early diagnosis, use of lumbar puncture, correct choice of antifungal agents, and intracerebral pressure monitoring is paramount to prevent long-term sequelae. A case of cryptococcal meningitis is presented and the diagnosis and management discussed with particular focus on when to start antiretroviral therapy with regard to the immune reconstitution syndrome.
Management of viral haemorrhagic fevers in the UK
Authors: Lambourne Jonathan , Brooks Tim
Published: July 2014

Viral haemorrhagic fever is a descriptive term embracing over a dozen different diseases, with varying pathologies and risks of transmission to other persons and healthcare workers. The most dangerous fevers from a healthcare perspective are the Arenaviruses (principally Lassa fever), Ebola, Marburg and Congo Crimean Haemorrhagic Fever. The chapter presents a theoretical case of Lassa fever and management of the case is discussed. Particular attention is made to early management and differential diagnosis, testing algorithms, infection control, and prophylaxis.
Severe Clostridium difficile infection
Authors: Islam Jasmin , Llewelyn Martin
Published: July 2014

The dramatic decline in C. difficile (CDI) rates seen in the UK since 2006 and the waning of ribotype 027 should not be a reason for complacency about this disease. With the recognition of novel virulent strains of other ribotypes and an aging population it is clear that CDI diarrhoea will remain a threat to elderly patients, particularly those in hospital. This case illustrates the importance of early recognition, diagnosis, and assessment of severe CDI to ensure both optimal infection control and management. The advent of fidaxomicin represents a significant advance but important questions remain around selection of patients to receive this treatment. Faecal therapy is now supported by randomized controlled trial evidence but more extensive clinical evaluation of this approach, in particular the role of synthetic stool, is needed before it is likely to be widely adopted.
Pneumococcal meningitis: antibiotic options for resistant organisms
Authors: Subbarao Sathyavani , Thomas Claire P.
Published: July 2014

Pneumococcal meningitis continues to be associated with high rates of mortality and long-term neurological sequelae. Colonization is the first step towards infection, and vaccination has reduced rates of invasive Streptococcus pneumoniae in both adults and children. Although rates of infection with penicillin non-susceptible strains is low in the UK as a whole, certain infections may occur, especially in those who have been living in high-risk areas of the world. The chapter highlights a case of pneumococcal meningitis due to an isolate that is non-susceptible to penicillin and with reduced susceptibility to third-generation cephalosporins. The clinical management of the case including timing of computed tomography and lumbar puncture, and the antibiotic choice in such a patient is discussed.
The treatment of Mycobacterium abscessus lung disease
Authors: Mirfenderesky Mariyam , Griffith David E.
Published: July 2014

M. abscessus is a rapid growing non-tubercuous mycobacterium (NTM) which may cause considerable pulmonary morbidity in certain individuals. The disease process is usually an indolent one allowing the physician time to assess the significance of respiratory isolation in individual patients. The indolent nature of the disease process combined with the very difficult and poorly tolerated treatment regimens essentially mandates that both the physician and patient should be convinced of the need for therapy, which will inevitably require significant sacrifices on the patient’s part, including outpatient antibiotic therapy. The choice of therapeutic regimens remains problematic and is discussed with regard to the case presented. Mounting evidence suggests that lung disease due to M. abscessus ssp bolletii (M. massiliense) is considerably more responsive to current therapeutic regimens than disease due to M abscessus ssp abscessus, likely due in no small part to the absence of a functional erm gene in M. abscessus ssp bolletii.
Diagnostic and management issues in tuberculous meningitis
Authors: Dawood Naghum , Cosgrove Catherine
Published: July 2014

Tuberculous meningitis (TBM) is associated with high levels of morbidity and mortality. Diagnosis continues to pose a challenge due to the low sensitivity of microbiological culture and molecular diagnostics when performed on CSF. Diagnosis is dependent on considering the diagnosis and hunting for diagnostic clues from history and examination, radiological assessment and, CSF analysis. Taking microbiological specimens from other sites is also important. The chapter presents a case of TBM and the reader is taken step by step through the diagnosis and management of TBM with particular attention to side effects of medications such as adjuvant corticosteroids.
What is general practice?
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

What is general practice?

General practice in the UK

Good medical practice for GPs

Stress in general practice

General practice within the wider NHS

Organizations important to general practice

Practice in other countries

‘Generalism describes a philosophy of practice which is person, not disease, centred; continuous, not episodic; integrates biotechnical and biographical perspectives; and views health as a resource for living and not an end in itself...
Education, monitoring, and research
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Education in primary care

Foundation doctors in primary care

Becoming a GP in the UK

Membership of the Royal College of GPs

Appraisal and revalidation

Career options for GPs

Clinical governance and CQC

Evidence-based medicine

Glossary of terms used in evidence-based medicine

Clinical guidelines, protocols, and integrated care pathways...
Medicines and prescribing
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

NHS prescriptions

Writing prescriptions

Cost-effective prescribing

Medicines management and concordance

Repeat prescribing

Adverse drug reactions

Licensing

Controlled drugs

Prescribing for special groups

Complementary medicine

‘A doctor is a man who writes prescriptions till the patient either dies or is cured by nature’

John Taylor (1694–1761)...
Minor surgery
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

‘A minor operation: one performed on someone else’

Unaccredited

Penguin Dictionary of Humorous Quotations, 2001

Providing minor surgery

Basic techniques

Removal of skin lesions

Lower and upper limb injections

Under the GMS contract, minor surgery can be provided as an additional service or directed enhanced service....
Chronic disease and elderly care
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Chronic disease management

Medically unexplained symptoms

Normal ageing

Elderly care and rehabilitation

Prescribing for the elderly

Falls amongst the elderly

Assessment of pain

Principles of pain control

Pain-relieving drugs

Morphine and other strong opioids

Neuropathic pain

Carers

Pensions and benefits

In other sections of this book, where management differs from the norm for elderly patients, the text is highlighted in a box marked with this symbol....
Endocrinology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Symptoms of endocrine disease

Diabetes mellitus

Organization and monitoring of care

Management of diabetes: education

Treatment of type 2 diabetes

Treatment with insulin

Diabetic complications: cardiovascular

Diabetic complications: renal and eye

Diabetic complications: nerve and skin

The diabetic foot

Lumps in the thyroid gland and goitres...
Musculoskeletal problems
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Symptoms of musculoskeletal disease

Neck pain

Low back pain

Shoulder problems

Elbow problems

Wrist and hand problems

Hip and pelvis problems

Knee problems

Ankle and foot problems

Sports medicine

Management of sporting injuries

Bone disorders

Rickets and osteomalacia

Osteoporosis

Treatment options for osteoporosis

Osteoarthritis

Rheumatoid arthritis...
Dermatology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Skin assessment

Treatment of skin conditions

Changes in skin colour and eruptions

Itching and blistering of the skin

Erythema

Pigmentation disorders

Hair and sweat gland problems

Nail changes

Atopic eczema

Other eczemas

Ulcers

Urticaria and angio-oedema

Acne

Psoriasis

Lichen planus and keratinization disorders

Pityriasis and seborrhoeic warts...
Gynaecology
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

The menstrual cycle

Premenstrual syndrome

Amenorrhoea

Menorrhagia

The menopause

Hormone replacement therapy

Pelvic pain

Endometriosis and adenomyosis

Prolapse

Uterine problems

Ovarian disease

Ovarian cancer and polycystic ovaries

Conditions of the cervix

Cervical cancer screening

Vaginal and vulval problems

A good working knowledge of the menstrual cycle is essential to understand its endocrine disorders and their management. One menstrual cycle lasts from the start of one period until the day before the start of the next. The average length of a cycle is 28d, but anything from 24–35d is common. The menstrual cycle is split into four (see ...
Sexual health and contraception
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Assessment of sexual health

Vaginal discharge

Sexually transmitted infection

Chlamydia, gonorrhoea, and trichomonas

Hepatitis B and C

HIV infection: prevention and testing

HIV infection: clinical disease

Other sexually transmitted infections

Summary of contraceptive methods

Combined hormonal contraception

Progestogen-only contraceptives

Intrauterine devices

Other contraceptive methods

Teenagers and women over 40...
Pregnancy
Authors: Simon Chantal , Everitt Hazel , van Dorp Françoise , Burkes Matt
Published: July 2014

Pre-conception and early pregnancy counselling

Antenatal care

Health promotion for pregnant women

Who should deliver where?

Screening in pregnancy

Common symptoms in pregnancy

Pruritus and rashes in pregnancy

Rubella and parvovirus in pregnancy

Other rash illnesses in pregnancy

Other infections in pregnancy

Bleeding in early pregnancy...
Stress cardiomyopathy
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: July 2014

Stress cardiomyopathy is defined, and its management is presented.
Iron overload cardiomyopathies
Authors: Katritsis Demosthenes G. , Gersh Bernard J. , Camm A. John
Published: July 2014

Cardiomyopathies due to iron overload are discussed, and their diagnosis and management are presented.
Case 1.5
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

33-year-old woman with multiple liver lesions on CT performed elsewhere

Axial fat-suppressed FSE T2-weighted (Figure 1.5.1), coronal SSFSE (Figure 1.5.2), and axial postgadolinium 3D SPGR (Figure 1.5.3) images demonstrate multiple, very small, nonenhancing cystic lesions

Biliary hamartomas...
Case 1.8
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

36-year-old woman with early satiety and abdominal discomfort

Axial fat-suppressed FSE T2-weighted image (Figure 1.8.1) demonstrates a large mass in the left hepatic lobe with high signal intensity, greatest in the center of the lesion. Axial arterial, portal venous, and equilibrium phase postgadolinium 3D SPGR images (...
Case 1.9
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

63-year-old female potential kidney donor with an indeterminate liver mass

Axial fat-suppressed FSE T2-weighted (Figure 1.9.1) and SSFP (Figure 1.9.2) images demonstrate a focal lesion with high signal intensity in the right hepatic lobe. Diffusion-weighted image (b=600 s/mm2) and corresponding ADC map (...
Case 1.13
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

51-year-old woman with abdominal pain. The radiologist chose to use Eovist

Axial fat-suppressed FSE T2-weighted image (Figure 1.13.1) and diffusion-weighted (b=600 s/mm2) image (Figure 1.13.2) demonstrate a right hepatic lobe mass with mild increased signal intensity relative to liver on the FSE image and moderate hyperintensity on the diffusion-weighted image. There was no signal dropout from IP to OP T1-weighted 2D SPGR images (images ...
Case 1.14
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

50-year-old woman with a hepatic mass discovered incidentally on chest CT

Axial fat-suppressed FSE T2-weighted image (Figure 1.14.1) demonstrates subtle focal enlargement of the lateral left hepatic lobe without an obvious mass. Axial T1-weighted IP (Figure 1.14.2A) and OP (...
Case 1.16
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

22-year-old woman with a history of diabetes mellitus, hyperlipidemia, and polycystic ovarian syndrome; she was involved in a motor vehicle accident, and abdominal CT demonstrated multiple hepatic masses

Axial fat-suppressed FSE T2-weighted image (Figure 1.16.1) demonstrates at least 2 hyperintense masses in the periphery of the right hepatic lobe. Diffusion-weighted image (b=600 s/mm...
Case 1.17
Authors: Lee Christine U. , Glockner James F.
Published: July 2014

33-year-old woman with abnormal liver tests and liver masses seen on CT performed elsewhere

Axial fat-suppressed FSE T2-weighted image (Figure 1.17.1) demonstrates a lobulated hypointense mass in the medial left hepatic lobe. Another similar-appearing mass in the lateral left hepatic lobe is not shown in these images. The lesion is hypointense relative to adjacent liver on a diffusion-weighted image (b=600 s/mm...
Constraint on the gas-to-dust ratio in massive star-forming galaxies at z ∼ 1.4
Authors: Seko Akifumi , Ohta Kouji , Hatsukade Bunyo , Yabe Kiyoto , Takeuchi Tomoe , Iono Daisuke
Published: July 2014

We carried out 12CO (J = 2–1) observations toward three star-forming galaxies on the main sequence at z ∼ 1.4 with the Nobeyama 45 m radio telescope. These galaxies have been detected with Spitzer/MIPS in 24 μm, Herschel/SPIRE in 250 μm and 350 μm; their gas metallicity, derived from optical emission line ratios based on near-infrared spectroscopic observations, is close to the solar metallicity. Although weak signal-like features of CO were seen, we could not detect significant CO emission. The dust mass and the upper limits on the molecular gas mass are (3.4–6.7) × 108 M⊙ and (9.7–14) × 1010 (αCO/4.36) M⊙, respectively. The upper limits on the gas-to-dust ratios at z ∼ 1.4 are 150–410, which are comparable to the gas-to-dust ratios in local galaxies with similar gas metallicity. A line stacking analysis enables us to detect significant CO emission and to derive an average molecular gas mass of 1.3 × 1011 M⊙ and gas-to-dust ratio of 250. This gas-to-dust ratio is also near to that in local galaxies with solar metallicity. These results suggest that the gas-to-dust ratio in star-forming galaxies with solar metallicity does not evolve significantly up to z ∼ 1.4. By comparing to a theoretical calculation, a rapid increase of the dust mass in an earlier epoch of galaxy evolution is suggested.
Molecular screening of carbapenemase-producing Gram-negative strains in Romanian intensive care units during a one year survey
Authors: Gheorghe Irina , Czobor Ilda , Chifiriuc Mariana Carmen , Borcan Elvira , Ghiţă Camelia , Banu Otilia , Lazăr Veronica , Mihăescu Grigore , Mihăilescu Dan Florin , Zhiyong Zong
Published: July 2014

This is the first study, to our knowledge, performed on a significant number of strains (79 carbapenem-resistant Enterobacteriaceae and 84 carbapenem-resistant non-fermenting Gram-negative rods, GNRs) isolated from tissue samples taken from patients in the intensive care units of two large hospitals in Bucharest, Romania, between 2011 and 2012. The results revealed a high prevalence and great diversity of carbapenemase genes (CRG), in both fermenting and non-fermenting Gram-negative carbapenem-resistant strains. The molecular screening of carbapenem-resistant GNRs revealed the presence of worldwide-distributed CRGs (i.e. bla
OXA-48 and bla
NDM-1 in Enterobacteriaceae and bla
OXA-23, bla
VIM-4, bla
OXA-10-like, bla
OXA-60-like, bla
SPM-like and bla
GES-like in non-fermenting GNRs), reflecting the rapid evolution and spread of carbapenemase producers, particularly in hospitals. Rapid identification of the colonized or infected patients is required, as are epidemiological investigations to establish the local or imported origin of the respective strains.
Molecular epidemiology of Pneumocystis jiroveci in human immunodeficiency virus-positive and -negative immunocompromised patients in The Netherlands
Authors: Vanspauwen Marijke J. , Knops Vera E. J. , Bruggeman Cathrien A. , van Mook Walther N. K. A. , Linssen Catharina F. M.
Published: July 2014

Pneumocystis jiroveci infections can cause pneumocystis pneumonia (PCP) or lead to colonization without signs of PCP. Over the years, different genotypes of P. jiroveci have been discovered. Genomic typing of P. jiroveci in different subpopulations can contribute to unravelling the pathogenesis, transmission and spread of the different genotypes. In this study, we wanted to determine the distribution of P. jiroveci genotypes in immunocompetent and immunocompromised patients in The Netherlands and determine the clinical relevance of these detected mutations. A real-time PCR targeting the major surface glycoprotein gene (MSG) was used as a screening test for the presence of P. jiroveci DNA. Samples positive for MSG were genotyped based on the internal transcribed spacer (ITS) and dihydropteroate synthase (DHPS) genes. Of the 595 included bronchoalveolar lavage fluid samples, 116 revealed the presence of P. jiroveci DNA. A total of 52 of the 116 samples were ITS genotyped and 58 DHPS genotyped. The ITS genotyping revealed 17 ITS types, including two types that have not been described previously. There was no correlation between ITS genotype and underlying disease. All ITS- and DHPS-genotyped samples were found in immunocompromised patients. Of the 58 DHPS-genotyped samples, 50 were found to be WT. The other eight samples revealed a mixed genotype consisting of WT and type 1. The majority of the latter recovered on trimethoprim–sulfamethoxazole suggesting no clinical relevance for this mutation.
A cAMP-independent carbohydrate-driven mechanism inhibits tnaA expression and TnaA enzyme activity in Escherichia coli
Authors: Li Gang , Young Kevin D.
Published: July 2014

WhenEscherichia coliis grown in a medium lacking glucose or another preferred carbohydrate, the concentration of cAMP–cAMP receptor protein (cAMP–CRP) increases, and this latter complex regulates the expression of more than 180 genes. To respond rapidly to changes in carbohydrate availability,E. colimust maintain a suitable intracellular concentration of cAMP by either exporting or degrading excess cAMP. Currently, cAMP export via the TolC protein is thought to be more efficient at reducing these levels than is CpdA-mediated degradation of cAMP. Here, we compared the contributions of TolC and CpdA by measuring the expression of cAMP-regulated genes that encode tryptophanase (TnaA) and β-galactosidase. In the presence of exogenous cAMP, atolCmutant produced intermediate levels of these enzymes, suggesting that cAMP levels were held in check by CpdA. Conversely, acpdAmutant produced much higher amounts of these enzymes, indicating that CpdA was more efficient than TolC at reducing cAMP levels. Surprisingly, expression of thetnaAgene halted rapidly when glucose was added to cells lacking both TolC and CpdA, even though under these conditions cAMP could not be removed by either pathway andtnaAexpression should have remained high. This result suggests the existence of an additional mechanism that eliminates intracellular cAMP or terminates expression of some cAMP–CRP-regulated genes. In addition, adding glucose and other carbohydrates rapidly inhibited the function of pre-formed TnaA, indicating that TnaA is regulated by a previously unknown carbohydrate-dependent post-translational mechanism.
Chlorophyll Degradation: The Tocopherol Biosynthesis-Related Phytol Hydrolase in Arabidopsis Seeds Is Still Missing
Authors: Zhang Wei , Liu Tianqi , Ren Guodong , Hörtensteiner Stefan , Zhou Yongming , Cahoon Edgar B. , Zhang Chunyu
Published: July 2014

Phytyl diphosphate (PDP) is the prenyl precursor for tocopherol biosynthesis. Based on recent genetic evidence, PDP is supplied to the tocopherol biosynthetic pathway primarily by chlorophyll degradation and sequential phytol phosphorylation. Three enzymes of Arabidopsis (Arabidopsis thaliana) are known to be capable of removing the phytol chain from chlorophyll in vitro: chlorophyllase1 (CLH1), CLH2, and pheophytin pheophorbide hydrolase (PPH), which specifically hydrolyzes pheophytin. While PPH, but not chlorophyllases, is required for in vivo chlorophyll breakdown during Arabidopsis leaf senescence, little is known about the involvement of these phytol-releasing enzymes in tocopherol biosynthesis. To explore the origin of PDP for tocopherol synthesis, seed tocopherol concentrations were determined in Arabidopsis lines engineered for seed-specific overexpression of PPH and in single and multiple mutants in the three genes encoding known dephytylating enzymes. Except for modestly increasing tocopherol content observed in the PPH overexpressor, none of the remaining lines exhibited significantly reduced tocopherol concentrations, suggesting that the known chlorophyll-derived phytol-releasing enzymes do not play major roles in tocopherol biosynthesis. Tocopherol content of seeds from double mutants in NONYELLOWING1 (NYE1) and NYE2, regulators of chlorophyll degradation, had modest reduction compared with wild-type seeds, although mature seeds of the double mutant retained significantly higher chlorophyll levels. These findings suggest that NYEs may play limited roles in regulating an unknown tocopherol biosynthesis-related phytol hydrolase. Meanwhile, seeds of wild-type over-expressing NYE1 had lower tocopherol levels, suggesting that phytol derived from NYE1-dependent chlorophyll degradation probably doesn’t enter tocopherol biosynthesis. Potential routes of chlorophyll degradation are discussed in relation to tocopherol biosynthesis.
A ten year analysis of dissertation bibliographies from the Department of Spanish and Portuguese at Rutgers University
Authors: Gasparotto Melissa
Published: July 2014

Purpose

– The purpose of this paper is to analyze the bibliography citations from dissertations submitted to the Department of Spanish and Portuguese at Rutgers University from the ten-year period of 2003-2012. The objective of the analysis is to aid in collection development decisions, facilitate outreach to graduate students in the department and to understand possible changes in disciplinary methodologies and research needs in the field over the last decade.

Design/methodology/approach

– Descriptive research design was used for the study. Bibliography citation data were extracted from all dissertations submitted to the Department of Spanish and Portuguese from the period 2003-2012. Statistical analysis was performed on the collected citation data, and conclusions were drawn from the results.

Findings

– The study demonstrates that, despite the oft-mentioned “decline of the monograph”, the monograph remains very heavily used by PhD students in Spanish and Portuguese at Rutgers University, and that monographs continue to be cited at significantly higher rates and for longer periods than journal articles. This holds true for the humanities dissertations in Spanish literature as well as social science dissertations in Spanish linguistics. The study further finds that open access journals in Spanish literature are cited more frequently than closed access journals.

Practical implications

– The findings suggest that it is more user-responsive to allocate retrospective collections funds for filling in monographic gaps than journal coverage gaps, as journal articles are cited less frequently and for shorter periods, while monographs are cited more frequently and for slightly longer periods after they are published. The findings also suggest that current monographic expenditures be maintained or augmented to continue serving current and future graduate student research needs in Spanish and Portuguese. Further, the large number of monograph chapters cited suggests that book chapter document delivery services could be an important addition to a library’s suite of services if it is not already provided.

Originality/value

– This paper is the first analysis of Spanish and Portuguese dissertations conducted at Rutgers University and provides important contextual information for meeting the research needs of graduate students in the department through collection development and related services. Other research has documented that dissertation citation patterns are at least partially predictive of faculty citation patterns, making the findings of this study applicable to serving faculty research and collections needs in the department, as well. The findings are relevant to collection development, access services and librarian-department liaison relationships.