bluuebunny/crossref_metadata_2025 huggingface dataset:
Graves and grave-goods
Authors: Harding Dennis
Published: November 2020

It has been stressed that the archaeological remains of the dead in a formal grave represent only the final stage in what may well have been a protracted and complex series of stages in funerary ritual. From this final stage, however, the archaeologist is potentially able to make an informed assessment of several aspects of the prevailing funerary practice, notably: • the context of burial, whether individual, grouped, or collective; • its structure, whether simple pit, with or without coffin, cist, or more elaborate tomb with the provision of additional space for accompaniments; • the placement of the remains, whole or part, cremation or inhumation, in the latter case including factors such as orientation and posture; • the presence or absence of grave-goods, their intrinsic character, and their choreography within the burial area; • any adjacent features, such as remains of pyres or related structures that might reflect pre-depositional stages in funerary ritual; • any secondary episodes of activity, such as subsequent burials or ‘grave robbing’. There is an implicit assumption that cemeteries should be relatively compact groups of graves, with or without a defining enclosure boundary. In the case of a larger cemetery, it might even be possible from grave associations to determine that it expanded over time in one particular direction, as in the case of Wetwang Slack or in the classic instance at Münsingen. Some graves in larger cemeteries were collectively ordered in regular ranks, as at Rudston or Harlyn Bay, implying an informed rather than random pattern of expansion. Smaller burial grounds, however, perhaps used over a shorter period of time, may be dispersed, or in small clusters over a wider area, as at Adanac Park, Cockey Down, Melton, or Little Woodbury, making their recognition more difficult in the absence of widespread stripping. This pattern could arise if a family group, for example, was segregated from the next allowing for infilling over time, which may not have happened if the settlement served by the cemetery for some reason was abandoned. In present-day western society a grave is simply a place of burial, designed for the disposal and commemoration of the dead.
Hand Hygiene and Infection Control
Authors: Lovegrove Jane
Published: November 2020

Each year hundreds of millions of people contract an infection while in the receipt of heath care. At any time 1.4 million people worldwide are suffering from an infectious complication associated with health care (WHO 2005). Health care acquired infections not only lead to pain discomfort, disability, and possible death for the recipient but also place a huge emotional and physical burden on relatives and carers. In England and Wales an average of one in 11,000 people die of a hospital acquired infection (HAI) each year; this figure rises to 1 in 300 for patients over the age of 80 (Bandolier 2006). Hospital admission is now a major risk factor for health care related infection (Gould 2009). In 2007 around 9,000 people in England died with an MRSA bloodstream infection or related Clostridium difficile infection (National Audit Office 2009). These figures do not include deaths from other HAIs so in fact the number of deaths from HAIs could be greater. In addition, it is also believed that many people die from a health care acquired infection which is not identified on the death certificate. In England, health care related infections have been estimated to cost a billion pounds annually (WHO 2005). The World Health Organization has identified hand hygiene as the primary measure to reduce infections (WHO 2009). Everyone involved in the provision of health care must be trained in effective hand decontamination (NICE 2003). Unclean hands move microorganisms from one place to another. Transmission of infection by hands has been identified with recent hospital outbreaks of MRSA and Clostridium difficile. Good hand hygiene is one of the most effective methods of reducing hospital acquired infections. Hand decontamination removes transient bacteria acquired from recent contact with an infected item or person. While hand decontamination is advocated before contact with every patient regardless of setting, patients in hospital are at greatest risk of acquiring an infection. In the UK 7.6% of patients admitted to hospital become infected. In England the figure is even higher at 8.19% (Nazarko 2008). It is essential for health care students to not only be able to perform effective hand washing, but also understand the principles of the procedure, as well as the possible physical, emotional and financial consequences of failing to perform hand hygiene.
Principles of clinical pharmacology
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

Pharmacology is defined as the study of the effects of drugs on the function of a living organism. It is an inte­grative discipline that tackles drug/ compound behaviours in varied physiological systems and links these to cellular and molecular mechanisms of action. As a scientific endeavour, pharmacology evolved from the early identification of therapeutic properties of nat­ural compounds, with herbal medicines and relatively complex pharmacopoeias widely used in early cultures. Despite this, lack of understanding of the physio­logical, pathological, and chemical processes governing the human body prevented the early establishment of pharmacology as a scientific discipline. Since then, pharmacology has progressed to be considered a fully developed integrative science that employs techniques and theories from various disciplines, such as chemistry, biochemistry, genomics, medicinal chemistry, physi­ology, and cellular and molecular biology. Collectively, these are applied to study disease causality and the rele­vant mechanistic action of compounds, to establish new treatments. In the last 100 years, the importance of clinical pharmacology has increased in line with the scientific and technological advances in biomedical research. Benefits gained from molecular and cellular approaches have enabled a more comprehensive analysis of drugs and their actions in functional context. Now, clinical pharmacology and therapeutics encompass the dis­covery, development, regulation, and application of drugs in a process that integrates scientific research with clinical practice to better treat illness and preserve health. Within this textbook the principles of pharmacology are discussed by therapeutic area so that the reader can link disease pathophysiology, drug mechanism, and modern prescribing behaviours for conditions commonly seen in clinical practice. There are, however, fundamental concepts that are universal in understanding the interaction between drugs and their ‘targets’, including receptor pharmacology, genomic pharmacology, and pharmacokinetics. The pharmacological receptor models preceded by many years the knowledge of the receptor as an entity. It was not until the last 150 years that a series of contributions from many notable biologists and chemists established the principles that founded modern day pharmacology. They produced a significant paradigm shift in therapeutics, where empirical descriptors of the activities observed (heating, cooling, moistening, emetic, etc.) were replaced by the concept of a ‘target’. After more than a century, the basic receptor concept is still the foundation of biomed­ical research and drug discovery.
Endocrinology
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

The pituitary gland (hypophysis) is an endocrine organ located at the base of the skull in a bony recess, called the sella turcica, consisting primarily of an anterior (adenohypophysis) and posterior (neurohypophysis) lobe. Collectively, under the influence of the hypothalamus, these lobes control the hormone secretions responsible for growth, reproduction, behaviour/ emotion, metabolism, and homeostasis, via a complex interplay of feedback loops. Dysfunction through failed synthesis of hormones, ‘breaks’ in the feedback pathways, or receptor malfunction can have diverse effects on plasma hormone levels and, hence, end organ function. The hypothalamus is located within the base of the third ventricle in the diencephalon and is responsible for maintaining homeostasis, as well as influencing emo­tion and behaviour. It is linked to the pituitary gland, which sits outside the dura, via the pituitary stalk and the hypothalamic– hypophyseal portal system. The anterior pituitary lobe makes up about 80% of the pituitary gland and is linked indirectly to the hypothalamus. It receives hormones released from neurosecretory cells in the paraventricular region of the hypothalamus, via a dense network of capillaries that make up the hypothalamic– hypophyseal portal system. These hormones subsequently bind to specific receptors on the pituitary cells to regulate a number of physio­logical processes including stress, growth, metabolism, reproduction, and lactation. There are six hormones re­leased by the anterior pituitary— adrenocorticotropic hormone (ACTH), growth hormone (GH), thyroid-stimulating hormone (TSH), follicle- stimulating hor­mone (FSH)/ luteinizing hormone (LH), and prolactin (PRH) (see Table 4.1). The posterior pituitary lobe is controlled via axons and nerve terminals that extend down from the hypothalamus through the pituitary stalk and into the lobe, which sub­sequently releases neurohormones (oxytocin and vaso­pressin) into the blood stream (see Table 4.2). Vasopressin (also called antidiuretic hormone, ADH), is essential in maintaining fluid homeostasis to ensure adequate blood volume and salt concentration. Its release is modulated by osmoreceptors (rising osmolality) in the hypothal­amus and baroreceptors (falling BP) in the cardiovascular system, and acts directly on the distal nephron to ensure water is conserved. Dysregulation of ADH may lead to conditions such as diabetes insipidus (DI) or SIADH (syn­drome of inappropriate ADH).
Anaesthetics
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

Anaesthesia is a state of reversible unconsciousness that comprises some or all of the ‘triad of anaesthesia’— hypnosis, analgesia, and muscle relaxation. Safe and ef­fective anaesthesia requires information of the drug’s potency at effector sites and knowledge of administration concentrations, as well as an understanding of the degree of noxious stimulus and how a patient’s physiology may modulate drug actions. Historically, the first compounds used as anaesthetics were diethyl ether, nitrous oxide, and chloroform. Diethyl ether was demonstrated to the wider medical commu­nity in 1846 by William Morton in the removal of a jaw lump from Gilbert Abbot, and the introduction of chloro­form followed within the year. It was noted by James Simpson, Professor of Obstetrics in Edinburgh in 1847, that chloroform was much more potent, but had a ten­dency to precipitate death in the anxious and could cause severe liver damage. This tendency demonstrates clearly that the depth of anaesthesia is critical. Too much cir­culating drug can lead to respiratory depression, cardiac arrhythmias, and death, while too little permits persistent consciousness, pain, and muscular spasm. This is of particular concern with regards to laryngospasm, which when combined with an unsecured airway can rapidly lead to hypoxia and death. Nowadays, death is incredibly rare, with signs of hypotension, tachy- , or bradycardia detected early and easily reversed by controlling drug dosage. The risk of drug- induced side effects when using anaesthetic drugs means that the depth of anaesthesia must be closely monitored. This is achieved subjectively with experience and training, in combination with ob­jective clinical assessment, such as pulse, BP, and mean alveolar concentration. See Table 8.1 for ideal properties of anaesthetic agents. There are many approaches to the application of gen­eral anaesthesia, and these depend on clinical situation, depth, and length of anaesthesia required, the type of sur­gical or interventional procedure to be undertaken and as­sociated patient risk factors. The stages of anaesthesia (outlined in Table 8.2) was a concept introduced at a time when induction was rou­tinely achieved through the use of inhalational anaes­thetics. More recently the use of IV induction agents has meant that transition between these stages is smoother, resulting in a rapid induction with minimal excitation responses, compared with inhalation agents. Inhalation agents also carry the risk of airway irritation.
Food for Thought: Enzyme Action
Authors: Atkins Peter
Published: November 2020

Nature makes use of the tools that I have been developing, and does so in the most extraordinary and subtle manner. After all, she has had about four billion years to come up with solutions to problems with which human chemists have striven seriously for only a century or so. Most of the reactions that go on in organisms—including you—are controlled by the proteins called ‘enzymes’ (a name derived from the Greek words for ‘in leaven’, as in yeast). Enzymes are biological catalysts (Reaction 11) that are extraordinarily specific and highly effective in their role. One of these complex molecules might serve as the merest foot soldier in the army of reactions going on inside you, with a role such as severing the bond between two specific groups of atoms in a target molecule. Because their function may be highly specific, enzyme molecules need to be large: they have to recognize the molecule they act on, act on it, then release it so that they can act again. Thus, they have to have several functions built into them. As you will see, enzymes are the ultimate in functional blindness: they feel around in their surroundings in order to identify their substrate, the species they can act on. Life is ultimately blind chemical progress guided by touch. I am going to introduce you to one particular group of enzymes, the ‘proteases’, and focus on one example from this group, namely chymotrypsin. A protease is a traitor to its kind: it is a protein that breaks down other proteins. It plays a role in digestion, of course, but its range is much wider. One protease enables a lucky sperm to eat through the cell wall of an egg and ensure its at least temporary immortality. Another facilitates the clotting of blood to terminate possibly fatal bleeding. Chymotrypsin itself is an enzyme that is secreted from the pancreas into the intestine, and makes an essential contribution to the process of digestion. Its name is derived slightly circuitously from the Greek words for animal fluid, a bodily ‘humour’, and rubbing, as it was obtained as a fluid by rubbing the pancreas.
Grand Designs: Synthesis
Authors: Atkins Peter
Published: November 2020

In this final reaction I am going to show you in the broadest of outlines how chemists build the equivalent of a cathedral. That is, how they synthesize a complicated molecule from scratch. The aim of a synthesis is to take a reasonably readily available laboratory chemical and process it—add bits on, take things off, close rings of atoms, open rings, build flying buttresses, and so on—until the target compound has been made. You could take the view that you should really start from absolute scratch, from the elements themselves, typically hydrogen, carbon, nitrogen, and oxygen, and build the molecule from those. However, that would be a waste of time and not crucial to the demonstration of the synthetic route because it is possible to argue that there are already plenty of methods for synthesizing the simple starting materials from scratch, and the real challenge is to build the intricate molecule. That is rather like accepting that a contractor can supply windows, bricks, and beams when constructing a real house and that it isn’t necessary to go all the way back to the sand, clay, and iron ore from which they are made to demonstrate that the house can be built literally from the ground up. Of course, the starting materials in a modern chemical synthesis might seem a bit recondite, but be assured that they are reasonably acceptable and purchasable from suppliers of laboratory reagents or easily made from what they do supply. Now for the particular cathedral on which I intend to focus. That scourge of humanity, malaria (‘bad air’), was introduced into the New World in the fifteenth century and soon wrought the havoc that had for long, and still, afflicts millions. The natives there found that an extract of the bark of the quina-quina tree, in due course to be classified as Cinchona Officinalis, was an effective cure, in particular having saved the life of the Countess of Cinchona. In due course the active component, quinine, was identified and extracted.
Defining Issues
Authors: Harding Dennis
Published: November 2020

‘Hillfort’ is a term of convenience. It is widely recognized that the monuments in question are not restricted topographically to hills, and that their role may not have been primarily, and certainly not exclusively, for military defence. Nor are they restricted chronologically to the Iron Age, though during that period they are particularly prominent. The term came into general currency following the publication in 1931 of Christopher Hawkes’ paper, simply entitled ‘Hillforts’, in Antiquity, which also established their predominantly Iron Age date in Britain. Prior to that, Christison (1898) in Scotland had discussed ‘fortifications’, and Hadrian Allcroft (1908) for England had classified ‘earthwork’, both extending their studies into the Medieval period. But ‘hillfort’ for all its limitations has remained in general usage in Britain. Chronologically, this study is concerned with the ‘long Iron Age’; that is, including the post-Roman Iron Age in northern Britain especially, and with later Bronze Age antecedents. Geographically it is concerned with regional groups throughout Britain, but with further reference to Ireland, and in the wider context of relevant sites and developments in continental Europe. The key element of the sites under consideration is enclosure, physically or conceptually demarcating an area to which access is restricted or controlled. This may be achieved by rampart and ditch, stockade or fence, or by the incorporation of topographical and natural features such as cliff-edge or marsh. The scale of enclosing works may range from a relatively modest barrier to massive earthworks that reshape the landscape, and in structural morphology, from single palisade or bank to multiple lines, variously disposed. Topographically they may be located around hilltop contours, on cliffedge, ridge, or promontory, on spurs or hill slopes, in wetlands or spanning river bends, or across variable terrain. In area enclosed they may range from well under a hectare to 20 ha and more, with the territorial or terrain oppida of the late pre-Roman Iron Age attaining 300 ha or more. From size alone, therefore, we may infer a great diversity in the practical, social, and symbolic purposes that they may have served. At the smaller end of the scale, the distinction between hillforts and other enclosed settlements is sometimes a matter of subjective assessment, but otherwise their size and scale suggests that they were community sites, serving a social unit larger than a single family or household.
Paediatric surgery
Authors: Fisher Simon
Published: November 2020

Understanding that children are not small adults, and that they come in different sizes and stages of development, is fundamental to paediatric surgery. Knowledge of a child’s weight is crucial when considering fluid and medication administration. Moreover, babies have immature physiology and less functional reserve compared to older children. Understanding basic embryology will unravel some of the mysteries of developmental pathology encoun­tered by the paediatric surgeon, such as oesophageal atresia, malrotation of the gut, annular pancreas, and maldescent of the testis. The paediatric surgeon deals with some of the same surgical condi­tions that affect adults, but even management of a common condition such as inguinal hernia, has different therapeutic implications in children and adults. Paediatric surgery demands gentle tissue handling and deli­cate technique. Good communication skills are a prerequisite for dealing with the distraught or ill child and anxious parents, and the surgeon often retains a clinical interest in his or her patient, well into young adulthood. This chapter will test your knowledge of principles of surgical manage­ment of sick children and your understanding of presentations of some of the more commonplace conditions encountered by surgeons in this demanding, yet rewarding, discipline.
Vascular surgery
Authors: Old Oliver
Published: November 2020

As the patient in clinic describes the cramp-like pain that he gets in his calf when he walks, a pain that disappears on resting but which is exac­erbated by walking up hills and necessitates him stopping to look in shop windows when out and about, you will be thinking about questioning him for risk factors for vascular disease. Atherosclerosis is a systemic disease. Identification and early treatment of diabetes, hypercholesterolaemia, hypertension, and provision of antiplatelet agents and smoking cessation therapy will confer important cardio- and cerebroprotective benefits. Acute vascular emergencies requiring an urgent response include the patient with sudden onset, limb-threatening ischaemia; the collapsed patient with a ruptured aortic aneurysm; and the patient in whom haemorrhage or ischaemia comprises part of the picture of complex trauma. Rapid, but thorough examination, appropriate resuscitation, and judicious use of diagnostic imaging will help to underpin urgent manage­ment and interventions necessary to obtain the best outcomes for these patients. Despite increasing reliance on minimally invasive diagnostic modali­ties including duplex Doppler ultrasound, magnetic resonance angiog­raphy, and computed tomography angiography, principles of history taking and good clinical examination remain of paramount importance. Observation to detect nuances of ischaemic trophic changes and skin colour, as well as more overt signs of necrosis, gangrene, and ulceration, complements palpation of pulses, detection of subtle changes in skin temperature, delayed capillary refill, and presence of sensory neuropa­thy. A positive Buerger’s test, with pallor of the foot and venous gutter­ing on leg elevation, and rubor (redness), due to reactive hyperaemia on dependency, may help clinch the diagnosis of critical limb ischaemia when other diagnostic features are equivocal. Careful distinction between features of arterial insufficiency, venous hypertension, and diabetic neuropathy may help to determine aetiol­ogy of a recalcitrant lower limb ulcer and the consequent course of management. In the UK, vascular surgery has recently become an independent surgi­cal specialty. This chapter will test your understanding of signs and symp­toms of vascular disease and will hopefully stimulate your understanding of priorities for investigation and management of the range of conditions comprising this exciting sphere of surgery.
Understanding Dementia
Authors: Dewing Jan
Published: November 2020

This chapter presents a comprehensive understanding of dementia as a commonly encountered condition/syndrome in the nursing care of older adults and offers insights into the health challenges faced by people living with dementia. It will provide nurses with the knowledge to be able to assess, manage, and care for people with dementia in an evidence-based and person-centred way. After a comprehensive overview of the causes, risk factors, and impact of dementia, it will outline best practice to deliver care, as well as to prevent or minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with dementia can be found in Chapters 14 and 17, respectively. In the past, dementia was most often described in terms of mental disability. However, it is now more often described in terms of neurological disability (i.e. changes in the brain). For example, the Mental Health Foundation describes dementia as:…A decline in mental ability which affects memory, thinking, problem-solving, concentration and perception….The NHS Choices website states:…Dementia describes the effects of certain conditions and diseases on a person’s mental ability, personality and behaviour….Dementia is generally classified according to two international classification systems: the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV); and the International Classification of Diseases tenth edition (ICD-10). Dementia can be defined as a syndrome whereby there is gradual death of brain cells, resulting in a loss of brain ability that is severe enough to interfere with normal activities of living for more than 6 months. Problems with brain function should not have been present at birth and it is not associated with a loss or alteration of consciousness. This latter point distinguishes dementia from delirium, which is a state of mental disorientation that can happen if you become medically unwell, also known as an ‘ acute confusional state’ (Royal College of Psychiatrists, 2009). (See Chapter 11). It is vital that nurses hold central what dementia means for people living with it. For example, people will commonly experience changes to their perception, senses, memory, and the range of skills they need to carry out everyday activities.
Managing Anxiety
Authors: Kendal Sarah , Baker John
Published: November 2020

This chapter explores anxiety, providing a clinical description of its impact on patients with guidance for evidence-based assessment and management. Anxiety has a defined physiological mechanism and merits a planned management approach. Every nurse should possess the knowledge and skills to identify patients with and/or at risk of anxiety, to select and implement evidence-based strategies to manage anxiety, and to review the effectiveness of these to inform any necessary changes in care. It can be useful to think of most mental and emotional phenomena as being a combination of four systems: autonomic, behavioural, cognitive, and environmental (Box 14.1). Emotions that we experience, such as happiness, sadness, anxiety, and anger, depend on how the systems interact with each other. These four systems combine to form a common model in mental health, known as the ABC-E model of emotion (Briddon et al., 2008) (also see Chapter 8), which will be used as a framework for the chapter. An ABC-E-based assessment helps to clarify nursing interventions in each one of these four areas. An intervention in one of these systems can often help to alleviate distressing emotions. A commonly used classification system for mental disorders is the International Classification of Diseases version 10 (ICD-10) (World Health Organization (WHO), 2010). An alternative classification system is the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1994). The main types of anxiety are listed in Box 14.2. Many features of anxiety disorder also present in the patient who is agitated. Agitation is a form of anxiety that can raise particular concerns about safety. As illustrated in Table 14.1, the main difference is in the cognitive and behavioural domains, i.e. what the person is thinking and doing. The descriptions in Table 14.1 apply to anxiety as a clinical problem, as in the case of David, whose story is described in Case study 14.1. The difference between non-clinical and clinical anxiety is explained in the ‘Making a clinical assessment’ section. There are other approaches to defining anxiety.
Diagnosis of oral disease
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip
Published: November 2020

The most common oral diseases are dental caries and periodontal dis­ease. The diagnosis and treatment of these diseases are the focus of the majority of dentists, dental therapists, and dental hygien­ists. Nevertheless, it is the responsibility of the dental healthcare pro­fessional to provide a holistic approach to management that ensures both good oral and general health for their patients. A broad knowledge of the range of diseases that affect the oral cavity is essential and also an appreciation that oral disease may be the first sign of an underlying systemic disease. Before this knowledge can be applied, the clinician must obtain an accurate patient history and undertake a systematic clinical examination. These key clinical skills underpin both medicine and dentistry, and are an absolute requirement to formulate a differ­ential diagnosis. The use of imaging modalities and laboratory tests are often required to reach a definitive diagnosis, and it is the justification and informed choice of these additional investigations that will facili­tate a timely and accurate diagnosis. Following diagnosis, appropriate treatment can be instituted, the ideal outcome being a return to health or control of the patient’s symptoms in recalcitrant chronic diseases. Obtaining a clear and precise clinical history is essential. The clinician must listen carefully to the information conveyed by the patient and then use direct questioning to collect additional data to construct an accurate picture of the patient’s problem. This can be a significant challenge and requires excellent communication skills to build a good patient–clinician relationship. The most common presenting problems relate to pain or the development of a lesion: swelling, lump, ulcer, or white/red patch. To establish a comprehensive pain history, the features listed in Table 1.1 should be addressed. Obtaining an accurate history for a lesion is dependent on the patient noticing the abnormality in the first instance and, as a consequence, the information may be rather vague; however, it is important to ascertain the key points listed in Table 1.2. A comprehensive medical history (Box 1.1) will identify any concur­rent disease that may be relevant to the presenting oral condition (Chapter 10) and highlight any issues relating to proposed medical or surgical interventions.
Disorders of bone
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip
Published: November 2020

Most invasive dental procedures involving removal of teeth or bone are followed by uneventful healing. However, dentists should be aware that generalized abnormalities of bone, such as osteoporosis and Paget’s dis­ease of bone, may complicate these procedures and, rarely, can lead to ongoing clinical problems. The effects of radiotherapy to the jaws and bisphosphonate treatment are well-described causes of osteonecrosis and delayed healing. Diagnosis of bone disorders often depends on integrating the results of clinical, imaging, pathological, genetic, and biochemical investigations. Although the bony skeleton is often thought of as forming just a rigid framework, it should be remembered that bone is a living, responsive tissue that plays an important role in metabolism. During development, some bones develop from a cartilaginous template and others, such as most of the craniofacial bones, form in fibrous membranes. Bone matrix is laid down by osteoblasts that are derived from the extensive meshwork of bone-lining cells that cover the bone surfaces. The bone matrix contains osteocytes that are responsive to mechanical stresses. Bone matrix is removed by osteoclasts that move over the bone sur­face, resulting in scalloped pits termed Howship’s lacunae. Bone mat­rix can be woven or lamellar in pattern. Pathologists often examine sections of bony lesions in polarized light to determine whether the pattern of the collagenous matrix is woven or lamellar, because it can be pivotal for diagnosis. It is also important for clinicians to be aware that, in order to produce a histological section of bone, the tissue must first be fixed and then demineralized to soften the matrix. When a bone biopsy is performed, the patient should be made aware that additional time will be needed to process the biopsy. Following extraction of a tooth, the socket rapidly fills with blood, which then clots. Granulation tissue, which consists of proliferating endothelial cells and fibroblasts derived from remnants of the periodontal ligament and surrounding alveolar bone, grows into the clot and organization commences. Osteoclasts begin to remodel the crestal bone and remove any small spicules of bone detached during the extraction.
Pharmaceutics and Routes of Drug Administration
Authors: Brack Graham , Franklin Penny , Caldwell Jill
Published: November 2020

All medicines must be administered as prescribed and following the manufacturers’ guidance. The main aim of medicines management is to achieve the desired therapeutic effect for the patient. In order to do this you need to:… ● give the correct medicine, ● at the correct dose, ● to the correct person, ● in the correct formulation, ● by the correct route, and ● at the appropriate time intervals…. This has already been mentioned in Chapter 1. You must consider the dosage, the patient’s weight where appropriate, method of administration , route, and timing (NMC, 2008a). Equally, when preparing to administer any medication, it is important to follow the principles of standard precautions (Glasper et al, 2009). For example, when administering oral medicines you should first wash your hands and then use a non-touch technique to prevent cross infection and to ensure that the drug does not cause you any harm. The way in which a drug is administered will affect the rate and extent of absorption. There are three basic routes for administration of medicines: enteral (via the GI tract), parenteral, and topical (Lilley et al, 2007 ). However, within these a variety of methods can be used. Medicines are introduced into the body via many routes, which include:… ● Oral ● Enteral (via a nasogastric or gastrostomy tube) ● Rectal ● Vaginal ● Respiratory ● Intradermal injection ● Subcutaneous injection ● Intramuscular injection ● Intravenous injection ● Infusions ● Intrathecal and epidural ● Topical/transdermal. …The aim of treatment is to deliver the optimal amount of medication to the part of the body where it will act. Usually we would like the concentration of drug to reach therapeutic levels (the level at which it exerts its medicinal action) as quickly as possible. This usually means that we want a particular level of drug in the bloodstream. The quickest route to achieve therapeutic levels of drugs is the intravenous route, because the drugs are delivered directly into the bloodstream and levels rise as soon as the drug is given. However, this may not be the most appropriate route for the administration of medicines for many reasons.
Keeping Up to Date
Authors: Brack Graham , Franklin Penny , Caldwell Jill
Published: November 2020

● To gain an understanding of strategies that can be used to keep your skills in medicines management up to date, including clinical supervision and change management. ● To acknowledge the implications of clinical governance as related to keeping up to date within medicines management. It is hoped that this book will provide a useful resource in the future to help keep your skills and knowledge up to date. This final chapter covers some of the strategies that may help. It will discuss some of the relevant developments and offer some thoughts about future advances in medicines management. The world of medicines management is constantly evolving although, having said that there are given constants and principles that will remain the same in all settings. For example, patient safety is obviously in the forefront of all practice as is efficacy of treatment and effective resource management. As explained within the context of this book there are a number of ways of ensuring that the instructions for giving medicines are clear and that medicines are legally and safely dispensed, supplied, and administered to patients. Other terms for ways to dispense, supply, or administer medicines are process or mechanism. Some of these mechanisms have been in place for many years; for example, before the Medicines Act 1968 . Others have been enforced more recently; nonmedical prescribing only came into being in the mid- 1990s and continues to expand in the current decade (Association for Nurse Prescribers). It can be safely stated that all of the legal mechanisms for the dispensing, supply, and administration of medicines have been reviewed and tightened up either locally, nationally, or both within the last 10 years. This reinforcement has occurred because of the following factors; you may be able to think of more:… ● Concerns about patient safety and medicines management. ● Directives for a changing and evolving health service moving, for example, towards the management of the care of patients with long term conditions in the community setting. ● Delivery of medicines management by more advanced non-medical healthcare practitioners other than doctors, such as nurses and pharmacists. ● As a result of the Fourth Shipman Report. (2004).
Blockbuster Drugs
Authors: Li Jie Jack
Published: November 2020

For the world's largest prescription drug manufacturers, the last few years have been a harrowing time. Recently, Pfizer's Lipitor, GlaxoSmithKline's Advair, AstraZeneca's Seroquel, and Sanofi-Aventis and Bristol-Myers Squibb's Plavix all came off patent in the crucial U.S. market. This so-called "patent cliff" meant hundreds of billions of dollars in lost revenue and has pharmaceutical developers scrambling to create new drugs and litigating to extend current patent protections. Having spent most of his career in drug discovery in "big pharma," Dr. Li now delivers an insider's account of how the drug industry ascended to its plateau and explores the nature of the turmoil it faces in the coming years. He begins with a survey of the landscape before "blockbuster drugs," and proceeds to describe how those drugs were discovered and subsequently became integral to the business models of large pharmaceutical companies. For example, in early 1980s, Tagamet, the first "blockbuster drug," transformed a minor Philadelphia-based drug maker named SmithKline & French into the world's ninth-largest pharmaceutical company in terms of sales. The project that delivered Tagamet was nearly terminated several times because research efforts begun in 1964 produced no apparent results within the first eleven years. Similar stories accompany the discovery and development of now-ubiquitous prescription drugs, among them Claritin, Prilosec, Nexium, Plavix, and Ambien. These stories, and the facets of the pharmaceutical industry that they reveal, can teach us valuable lessons and reveal many crucial aspects about the future landscape of drug discovery. As always, Dr. Li writes in a readable style and intersperses fascinating stories of scientific discovery with engaging human drama.
Resources for Historical Background
Authors: Brown Jeannette
Published: November 2020

Many historians have written about the history of African Americans in science, but most of the articles focus only on the men and very little is written about the women. It would take additional research to find information pertaining only to the women. However, since both men and women lived through the same era, much of what affected the men also affected the women. The background information about black women chemists could probably fit into another book or at least a paper, but that was not within the scope of this book. Dr. Wini Warren, author of Black Women Scientists in the United States, did some extensive research on the background history of black women in science, which she planned to put into a future book; due to health problems it was never written. However, the Introduction to Dr. Warren’s book is well worth reading for some of the background history of the women. The endnotes in that chapter provide an extensive bibliography about the history of blacks in science. In addition, Dr. Warren includes an extensive discussion about the background history of black women scientists in the introduction of her thesis, “Hearts and Minds: Black Women Scientists in the United States 1900–1960.” Sisters in Science by Diann Jordan features author interviews of black women scientists, some of whom are chemists. The Introduction of her book, discusses the background history. Dr. Jordan also includes a history of black colleges in the section “The Role of the Black College in Educating African American Scientists.” Since many of the women in this book had their first college education in a black college, it is worth reading. Information about several of the African American women chemists in this book can be found in Contributions of Black Women to America, Volume 2. The Introduction and Chapter 1 in the “Science” section give some background information about the history of women in science.
Chemical Engineers
Authors: Brown Jeannette
Published: November 2020

Dr. Lilia Abron is an engineer, an entrepreneur, mother, and activist who works twelve-hour days. She is another true Renaissance woman. Lilia was born at home in Memphis, Tennessee, on March 8, 1945. She was small, premature, and almost did not survive were it not for her aunt, who rushed her to the hospital in a cab because ambulances were not available to black people at the time. She was the second of four daughters of Ernest Buford Abron and Bernice Wise Abron, who were both educators. Both of her parents had attended LeMyone College. Her father entered college and played football. Because of an injury he was ineligible to serve in the military in World War II. He then worked as a Pullman porter, because his father had been a Pullman porter. After the war, when the trains were not as popular, he became a teacher in the Memphis public schools. Lilia’s mother and father were very active during the civil rights era. Lilia’s mother was from Arkansas; and she typed the briefs for Wiley Branton, defense attorney for the Little Rock Nine, the group that integrated Central High School in Little Rock, Arkansas. Because Lilia’s parents were active in Memphis society, Lilia was involved in programs that included the Girl Scouts and the church. She went to public school in Memphis, Tennessee. In 1957, the Soviet Union launched Sputnik, which led the United States to improve math and science education. The school system tracked each student’s education, even in the segregated schools. Therefore, Lilia was placed in the math and science track. This meant she participated in a science fair, which was held at Lemoyne College. In addition, she had to prepare other science projects. Her segregated schools were well equipped for science teaching. In addition to well-stocked labs, the Memphis high school that she attended offered higher-level mathematics, including algebra and introduction to calculus. She graduated from high school in Memphis and decided to go to college with the intention of studying medicine, which was the one of the few occupations available to black people at the time.
Mechanisms of Hormone Action
Authors: Hammes Stephen R. , Mendelson Carole R.
Published: November 2020

The capacity of a cell to respond to a particular hormone depends on the presence of cellular receptors specific for that hormone. After binding hormone, the receptor is biochemically and structurally altered, resulting in its activation; the activated receptor then mediates all of the actions of the hormone on the cell. The steroid and thyroid hormones as well as retinoids and 1,25-dihydroxyvitamin D3 diffuse freely through the lipophilic plasma membrane of the cell and interact with receptors that are primarily within the nucleus. On activation, the receptors alter the transcription of specific genes, resulting in changes in the levels of specific messenger RNAs (mRNAs), which are in turn translated into proteins. Hormones that are water soluble, such as the peptide and polypeptide hormones, catecholamines, and other neurotransmitters, as well as the relatively hydrophobic prostaglandins, interact with receptors in the plasma membrane. After hormone binding, the activated membrane receptors initiate signal transduction cascades that result in changes in enzyme activities and alterations in gene expression. In this chapter, the properties of various classes of receptors that are localized within the plasma membranes of target cells and the signal transduction mechanisms that mediate interactions with their ligands will first be addressed. This will be followed by consideration of the structural properties of the nuclear hormone receptors, the events that result in their activation, and the mechanisms whereby the activated nuclear receptors alter the expression of specific genes. Finally, a number of endocrine disorders that are caused by alterations in the number and/or function of plasma membranes and nuclear receptors will be reviewed. The function of a receptor is to recognize a particular hormone among all the molecules in the environment of the cell at a given time and, after binding the hormone, to transmit a signal that ultimately results in a biological response. Hormones are normally present in the circulation in extremely low concentrations, ranging from 10 –9 to 10 –11 M.
The Thyroid
Authors: Lingvay Ildiko , Holt Shelby A.
Published: November 2020

The thyroid gland, which is the largest endocrine organ, secretes primarily thyroid hormones that play a critical role in the normal growth and development of the maturing human. In the adult, thyroid hormones maintain metabolic stability by regulating oxygen requirements, body weight, and intermediary metabolism. Thyroid function is under hypothalamic-pituitary control, and thus, like the gonads and adrenal cortex, it serves as a classical model of endocrine physiology. In addition, the physiological effects of thyroid hormones are regulated by complex extrathyroidal mechanisms resulting from the peripheral metabolism of the hormones, mechanisms that are not under hypothalamic-pituitary regulation. Thyroid function abnormalities are very prevalent, especially in females and in certain geographic areas, and are often a result of autoimmunity or iodine deficiency. The thyroid originates from two distinct parts of the embryonic endoderm: • The follicular structures arise from a midline thickening of the anterior pharyngeal floor (the base of the tongue), adjacent to the differentiating heart. This thyroid diverticulum first expands ventrally while still attached to the pharyngeal floor by its stalk (thyroglossal duct), and then expands laterally, leading to the characteristic bilobed structure. As the developing heart descends, the thyroid gets pulled into its final position, a process that leads to the rapid stretch and degeneration of the thyroglossal duct. • The parafollicular cells are derived from the ultimobranchial bodies (originating from the neural crest) but ultimately are surrounded by the medial thyroid. The parafollicular cells represents <10 % of the adult thyroid gland. The thyroid completes its structural development by 9 weeks of gestation, the first endocrine organ to assume its definitive form during organogenesis; yet full functional maturation and integration with the hypothalamic-pituitary axis continues throughout gestation. Abnormal thyroid development can lead to persistence of the thyroglossal duct, presence of ectopic thyroid tissue (lingual thyroid, lateral aberrant thyroid), and malposition (thoracic goiter), all of which can remain clinically silent or present later in life as diagnostic challenges. The shape of the human thyroid resembles that of a butterfly.