bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Neutralizing Ability of a CpG-Adjuvanted S-2P Subunit Vaccine Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants of Concern
Authors: Lien Chia-En , Kuo Tsun-Yung , Lin Yi-Jiun , Lian Wei-Cheng , Lin Meei-Yun , Liu Luke Tzu-Chi , Cheng Jinyi , Chou Yu-Chi , Chen Charles
Published: November 2021

Background

Variants of concern (VoCs) have the potential to diminish the neutralizing capacity of antibodies elicited by vaccines. MVC-COV1901 is a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine consisting of recombinant prefusion stabilized spike protein S-2P adjuvanted with CpG 1018 and aluminum hydroxide. We explored the effectiveness of MVC-COV1901 against the VoCs.

Methods

Serum samples were taken from rats and phase 1 clinical trial human subjects immunized with a low, medium, or high dose of MVC-COV1901. The neutralizing titers of serum antibodies were assayed with pseudoviruses coated with the SARS-CoV-2 spike protein of the wild-type (WT), D614G, Alpha, or Beta variants.

Results

Rats vaccinated twice with vaccine containing high doses of antigen retained high levels of neutralization activity against the Beta variant, albeit with a slight reduction compared to WT. After the third dose, neutralizing titers against the Beta variant were noticeably enhanced regardless of the amount of antigen used for immunization. In humans, vaccinated phase 1 subjects still showed appreciable neutralization abilities against the D614G, Alpha, and Beta variants, although neutralizing titers were significantly reduced against the Beta variant.

Conclusions

Two doses of MVC-COV1901 were able to elicit neutralizing antibodies against SARS-CoV-2 variants with an overall tendency of inducing higher immune response at a higher dose level. The neutralizing titers to the Beta variant in rats and humans were lower than those for WT and the Alpha variant. An additional third dose in rats was able to partially compensate for the reduction in neutralization against the Beta variant. We have demonstrated that immunization with MVC-COV1901 was effective against VoCs.
Multisystem Inflammatory Syndrome in Adults After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and Coronavirus Disease 2019 (COVID-19) Vaccination
Authors: Belay Ermias D , Godfred Cato Shana , Rao Agam K , Abrams Joseph , Wyatt Wilson W , Lim Sarah , Newton-Cheh Christopher , Melgar Michael , DeCuir Jennifer , Webb Brandon , Marquez Paige , Su John R , Meng Lu , Grome Heather N , Schlaudecker Elizabeth , Talaat Kawsar , Edwards Kathryn , Barnett Elizabeth , Campbell Angela P , Broder Karen R , Bamrah Morris Sapna
Published: November 2021

Background

Multisystem inflammatory syndrome in adults (MIS-A) was reported in association with the coronavirus disease 2019 (COVID-19) pandemic. MIS-A was included in the list of adverse events to be monitored as part of the emergency use authorizations issued for COVID-19 vaccines.

Methods

Reports of MIS-A patients received by the Centers for Disease Control and Prevention (CDC) after COVID-19 vaccines became available were assessed. Data collected on the patients included clinical and demographic characteristics and their vaccine status. The Vaccine Adverse Events Reporting System (VAERS) was also reviewed for possible cases of MIS-A.

Results

From 14 December 2020 to 30 April 2021, 20 patients who met the case definition for MIS-A were reported to CDC. Their median age was 35 years (range, 21–66 years), and 13 (65%) were male. Overall, 16 (80%) patients had a preceding COVID-19-like illness a median of 26 days (range 11–78 days) before MIS-A onset. All 20 patients had laboratory evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Seven MIS-A patients (35%) received COVID-19 vaccine a median of 10 days (range, 6–45 days) before MIS-A onset; 3 patients received a second dose of COVID-19 vaccine 4, 17, and 22 days before MIS-A onset. Patients with MIS-A predominantly had gastrointestinal and cardiac manifestations and hypotension or shock.

Conclusions

Although 7 patients were reported to have received COVID-19 vaccine, all had evidence of prior SARS-CoV-2 infection. Given the widespread use of COVID-19 vaccines, the lack of reporting of MIS-A associated with vaccination alone, without evidence of underlying SARS-CoV-2 infection, is reassuring.
Looped wire advancement—not always safe! Fat—not so useless! a case series
Authors: Gawalkar Atit A , Singh Navreet , Gupta Ankush , Barwad Parag
Published: November 2021

Background

Coronary artery perforation (CAP), although rare, can often be a life-threatening complication of percutaneous coronary intervention. Looped wire tip or buckling of wire is conventionally considered safer due to reduced risk of migration into smaller branches and false lumen. Occasionally, buckling can indicate the entry of tip into dissection plane, or the advancement of looped wire can cause small vessel injury leading to perforation. Distal coronary perforation can be life threatening and coil, foam, and thrombin injection are some of the material widely used for sealing it.

Case summary

We hereby report three different cases illustrating the vessel injury that the looped wire can cause in the distal vasculature related to various mechanisms like high elastic recoil tension, dissection by the non-leading wire tip, or hard wire lacerating the fragile small branches. All these mechanisms lead to distal coronary perforation leading to cardiac tamponade. Each case also illustrate the novel technique of autologous fat globule embolization for the management of distal CAP.

Discussion

Distal coronary perforation is often due to guidewire-related vessel injury and is more common with hydrophilic wires. Looped wire tip can sometime indicate vessel injury and its advancement further down the coronary artery may result in serious vessel injury and perforation. Management of distal coronary perforation is challenging, and here we demonstrate the steps of using the readily available autologous fat globules by selectively injecting them into the small coronary artery to control the leak.
Rubidium Chloride Increases Life Span Through an AMPK/FOXO-Dependent Pathway in Caenorhabditis elegans
Authors: Hao Mengjiao , Zhang Zhikang , Guo Yijun , Zhou Huihao , Gu Qiong , Xu Jun
Published: November 2021

AMP-activated protein kinase (AMPK) is involved in life-span maintenance, stress responses, and germ cell cycle arrest upon dauer entry. AMPK is currently considered a promising target for preventing age-related diseases. Rubidium is one of the trace elements in the human body. As early as the 1970s, rubidium chloride (RbCl) was reported to have neuroprotective effects. In this work, we report the antiaging effect of RbCl in Caenorhabditis elegans. Specifically, we reveal that (a) RbCl does increase the life span and enhance stress resistance in C. elegans without disturbing their fecundity. (b) RbCl induces superoxide dismutase expression, which is essential for its antiaging and antistress effect. (c) AAK-2 and DAF-16 are essential to the antiaging efficacy of RbCl, and RbCl can promote DAF-16 translocating into the nucleus, suggesting that RbCl delays aging by regulating the AMPK/FOXO pathway. RbCl can be a promising agent against aging-related diseases.
Characterization of damage processes in Montney siltstone under triaxial compression using acoustic emission and diagnostic imaging
Authors: Jia Suzie Q , Wong Ron C K , Eaton David W
Published: November 2021

Crack nucleation and rock failure processes in a fine-grained siltstone (Montney Formation) under triaxial compression are investigated using combined diagnostic techniques, including ultrasonic-wave measurement, acoustic-emission (AE) monitoring, computed tomography (CT) scanning, and thin-section imaging. The sample displays a weak-to-moderate inherent seismic anisotropy and noticeable stress-induced anisotropy prior to failure. No AE event was detected until the applied axial stress reached 95 per cent of the peak value. The signal-to-noise ratio is relatively low, however, and detectable AE events are more diffuse than those observed in highly brittle rocks. The AE locations correlate with a shear fracture zone imaged by CT scanning. AE moment-tensor analysis reveals that events with larger relative magnitudes are characterized by high volumetric (tensile or compressive) components, and the initiation of the failure zone is dominated by combined shear-tensile (ST) failure. Stress inversion of the AE events with high tensile components is in good agreement with the known applied stress. Microscopic imaging of thin sections from the failed sample shows that the failure zone is an en echelon structure consisting of a major fracture with branching micro and minor cracks. This failure mechanism is consistent with a ST source mechanism and is interpreted to be associated with the fine granular structure and mineral composition of Montney siltstone.
International NGOs as intermediaries in China's ‘going out’ strategy
Authors: Farid May , Li Hui
Published: November 2021

China's ascendancy as a global development actor has significant implications for geostrategic dynamics and international development. While the push to ‘go out’ has been seen as a major strategy of the Chinese state, the actors are increasingly diversifying, including Chinese state agencies, businesses and non-governmental organizations (NGOs). We analyse the inconspicuous but important involvement of international NGOs (INGOs) in China's globalizing strategy. Drawing on in-depth interviews, we develop an integrated framework for INGOs as intermediaries in China's ‘going out’ strategy, based on the content of intermediary support (tangible vs intangible resources) and the function of the intermediary (bridging vs initiating). These intermediary roles have implications for how INGOs navigate conflicts between their domestic work in China and their outbound efforts, INGO legitimacy as actors that promote global norms or as ambassadors of the party-state, and the extent to which they facilitate Chinese expansion and soft power or shape China's global engagement. We show how INGOs as northern actors continue to play a role in South–South Cooperation. Our findings shed light on how global civil society chooses to invest its significant material and discursive resources, and how global actors under authoritarianism internalize, resist or promote its projects.
Accurate numerical simulation of electrodiffusion and water movement in brain tissue
Authors: Ellingsrud Ada J , Boullé Nicolas , Farrell Patrick E , Rognes Marie E
Published: November 2021

Mathematical modelling of ionic electrodiffusion and water movement is emerging as a powerful avenue of investigation to provide a new physiological insight into brain homeostasis. However, in order to provide solid answers and resolve controversies, the accuracy of the predictions is essential. Ionic electrodiffusion models typically comprise non-trivial systems of non-linear and highly coupled partial and ordinary differential equations that govern phenomena on disparate time scales. Here, we study numerical challenges related to approximating these systems. We consider a homogenized model for electrodiffusion and osmosis in brain tissue and present and evaluate different associated finite element-based splitting schemes in terms of their numerical properties, including accuracy, convergence and computational efficiency for both idealized scenarios and for the physiologically relevant setting of cortical spreading depression (CSD). We find that the schemes display optimal convergence rates in space for problems with smooth manufactured solutions. However, the physiological CSD setting is challenging: we find that the accurate computation of CSD wave characteristics (wave speed and wave width) requires a very fine spatial and fine temporal resolution.
Social Group Size and Shelter Availability Influence Individual Metabolic Traits in a Social Fish
Authors: Chrétien Emmanuelle , Boisclair Daniel , Cooke Steven J , Killen Shaun S
Published: November 2021

Synopsis

Group living is widespread among animal species and yields both costs and benefits. Presence of conspecifics can restrict or enhance the expression of individual behavior, and the recent social environment is thought to affect behavioral responses in later contexts, even when individuals are alone. However, little is known about how social group size influences the expression of individual physiological traits, including metabolic rates. There is some evidence that shoaling can reduce fish metabolic rates but this variable may be affected by habitat conditions such as shelter availability via density-dependent processes. We investigated how social group size and shelter availability influence Eurasian minnow (Phoxinus phoxinus) metabolic rates estimated by respirometry. Respirometry trials were conducted on fish in isolation before and after they were housed for 3 weeks in a social treatment consisting in a specific group size (n = 4 or 8) and shelter availability (presence or absence of plant shelter in the experimental tank). Plant shelter was placed over respirometers for half of the duration of the respirometry trials, allowing estimation of minimum daytime and nighttime metabolic rates in both conditions (in the presence or absence of plant shelter). Standard metabolic rate (SMR), maximum metabolic rate (MMR), and aerobic scope were also estimated over the entire trial. Minimum daytime and nighttime metabolic rates estimated while in presence of plant shelter were lower than when estimated in absence of plant shelter, both before and after individuals were housed in their social treatment. After the social treatment, SMRs were higher for fish that were held in groups of 4 as compared with those of fish held in groups of 8, while MMR showed no difference. Plant shelter availability during the social treatments did not influence SMR or MMR. Our results suggest that social group size may directly influence energy demands of individuals, highlighting the importance of understanding the role of group size on variations in physiological traits associated with energy expenditure.
Preserving Jewish heritage
Authors: Klein Michele
Published: November 2021

The family heirlooms and Jewish ritual objects owned by Frankfurt-born Solomon David Schloss (1815–1911), an ardent Jew, who was much affected by the death of his young wife, shed light on how one man participated in the growing trend for preserving Jewish heritage in the late nineteenth century. The story of his collection, spanning a century and a half, coincides with the modern history of collecting Jewish ceremonial art. This account reveals, as with other types of art collection, a variety of motives, changes in meaning and challenges of provenance research. Schloss’s purchase of Jewish ritual items from needy Jews has added moral value to the collection, most of which has remained, as he wished, in the family. Although frequently loaned for didactic public display, the personal sense of ancestry that his objects embody distinguishes them from those in museums.
Specnuezhenide reduces carbon tetrachloride-induced liver injury in mice through inhibition of oxidative stress and hepatocyte apoptosis
Authors: Hu Dongmei , Huang Shaojie , Ding Yi , Zhao Xian , Zhang Wei , Chen Haixia , Wang Jingwen
Published: November 2021

Objectives

This study aimed to investigate the hepatoprotective effects of specnuezhenide against carbon tetrachloride (CCl4)-induced liver injury in mice.

Methods

Male C57BL/6 mice were intraperitoneally injected with 10 ml/kg body weight of CCl4 (0.5% diluted in arachis oil) for acute liver injury after oral administration of specnuezhenide for 7 days. Twenty-four hours after the final CCl4 injection, mice were euthanized and plasma and liver samples were collected.

Key findings

The results showed that specnuezhenide markedly and dose-dependently reduced serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) activity and relative liver weight, as well as ameliorated histopathological damage caused by CCl4 and decreased malondialdehyde (MDA) levels, and increased the activity of antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). Moreover, specnuezhenide promoted the expression and nuclear translocation of the nuclear factor erythroid 2-related factor 2 (Nrf2) and increased the mRNA and protein expression of Nrf2 signalling-related genes heme oxygenase-1 (HO-1), glutamate-cysteine ligase catalytic subunit (GCLC) and NAD(P)H:quinone oxidoreductase 1 (NQO1). Finally, TUNEL staining and immunohistochemistry indicated that specnuezhenide prevented CCl4-induced hepatocytic apoptosis by up-regulating B-cell lymphoma 2 (Bcl-2) expression and downregulating Bcl-2-associated X (Bax) expression.

Conclusions

Specnuezhenide reduced CCl4-induced liver injury in mice by inhibiting oxidative stress via activation of Nrf2 signalling and decreasing hepatocyte apoptosis.
Metal crossroads in plants: modulation of nutrient acquisition and root development by essential trace metals
Authors: Lešková Alexandra , Javot Hélène , Giehl Ricardo F H
Published: November 2021

The metals iron, zinc, manganese, copper, molybdenum, and nickel are essential for the growth and development of virtually all plant species. Although these elements are required at relatively low amounts, natural factors and anthropogenic activities can significantly affect their availability in soils, inducing deficiencies or toxicities in plants. Because essential trace metals can shape root systems and interfere with the uptake and signaling mechanisms of other nutrients, the non-optimal availability of any of them can induce multi-element changes in plants. Interference by one essential trace metal with the acquisition of another metal or a non-metal nutrient can occur prior to or during root uptake. Essential trace metals can also indirectly impact the plant’s ability to capture soil nutrients by targeting distinct root developmental programs and hormone-related processes, consequently inducing largely metal-specific changes in root systems. The presence of metal binding domains in many regulatory proteins also enables essential trace metals to coordinate nutrient uptake by acting at high levels in hierarchical signaling cascades. Here, we summarize the known molecular and cellular mechanisms underlying trace metal-dependent modulation of nutrient acquisition and root development, and highlight the importance of considering multi-element interactions to breed crops better adapted to non-optimal trace metal availabilities.
The Nell Dialogues
Authors: McQuellon Richard P
Published: November 2021

Nell M. came to her therapist with an unusual problem: She was disappointed that her metastatic breast cancer, with the promise of ending her life, was not progressing on her hoped-for schedule. She had hoped her death would prevent her from witnessing her spouse’s mental deterioration from Alzheimer’s disease. This is how Nell’s story began and proceeded for a period of 40 weeks of counseling meetings, including 12 recorded sessions. This book consists of 12 illness narratives created in the presence of her therapist. These dialogues explore the challenges of managing the physical and emotional demands of cancer, relationship issues with family and healthcare professionals, and disturbing, anxiety-provoking thoughts and the mourning that accompanies the end of life. Nell’s vibrant voice is a beacon throughout the narratives, sometimes sad, yet always hopeful for a good death. Her ability to navigate the difficult territory of mortal time and dying informs readers about how they might approach their own ending with grace and dignity.
Introduction
Authors: McQuellon Richard P.
Published: November 2021

This book tells the story of Nell M. and the author, her therapist, as they encounter mortal time. When Nell was diagnosed with metastatic breast cancer, she sought counseling because she wasn’t dying soon enough. The text consists of a compilation of 12 illness narratives in conversation with the author. Nell was disappointed that her breast cancer would not prevent her from seeing her husband deteriorate due to Alzheimer’s disease. She had hoped breast cancer would give her an easy exit. Her journey was guided by conversation in psychotherapy, a circle of family and friends, as well as her spiritual community, where she gained strength and sustenance. The narratives include commentary and reflections by the author/therapist as well as a section on coping with three important areas of a patient’s life: the disease of cancer and treatment-related symptoms, personal and professional relationships, and intrusive thoughts and troubling feelings. The therapeutic approach is supportive-expressive counseling with deep empathic listening and compassionate responding at its core. The dialogues include poetry readings and use of music, both comforting elements that inform the art of dying.
February 16, 2005—Seeking Witness
Authors: McQuellon Richard P.
Published: November 2021

The main theme of this dialogue is Nell’s slow movement toward death and her frustration at the delay. Her physical status is declining and she is visibly deteriorating. Since it is difficult for her to travel by car, we decided to meet in her home. She is frightened by her appearance changes and declares she looks like a beetle, with a bloated body and sticklike appendages. She longs for a witness to her bodily changes and yet is reluctant to ask her spouse Al to look at her. She is disappointed there is nowhere she can find the comfort of someone’s witness to her physical changes. She has met with her medical oncologist and come away frustrated because he has said death is not imminent and yet she is ready. Even so, Nell’s sense of humor is intact and she laughs about completing her income taxes: “Now I can die!” She has had an initial negative encounter with hospice and expresses her concern about their competence. She finds comfort in guided imagery introduced to her by her dear friend Mary, geographically distant but regularly present via phone call.
June 7, 2005—Grief and Sadness
Authors: McQuellon Richard P.
Published: November 2021

Nell’s tumor is expanding noticeably; her abdomen is grossly distended. She speaks sadly of losing 20 years of expected lifespan and her tears flow. Her disease trajectory is accelerating and accompanied by grief. She is weary, yet her conversational energy is strong and her spirits are high. She finds consolation in Buddhism, a bodhisattva and faith in a God who helps her accept fate. She now has a hospital bed provided by hospice. It allows her to get up and down more easily. Her legs are swollen, and her walking is limited. She eats very little. Nonetheless, she continues to live well as she approaches death, and our dialogue reflects experiences of both mourning and cheer. Her sense of humor is very much alive.
June 21–22, 2005—Departure
Authors: McQuellon Richard P.
Published: November 2021

These two meetings are dramatic and intense as Nell is entering her last hours. On June 21, she feels her energy “drop out of the bottom” and asks for a transfusion. Previously, it helped restore her vitality and made a big difference in her mood. Her physician feels it is not indicated, a very distressing answer for Nell. However, she realizes she is too weak to travel to the clinic and accepts that her body is shutting down. She is actively dying. She discusses objects she wants to give away and occasionally closes her eyes to rest, summoning the last of her energy to reenter our conversation. She is fading as she has predicted, just like Tinker Bell leaving this world for the next. Nevertheless, the life in her eyes ignites when we discuss her beloved tennis and the upcoming Wimbledon tennis match. On June 22, Al summons me to the bedside, where Nell is barely conscious. We both say goodbye as she takes her last breath. Together with her hospice nurse, we say a prayer. Nell has let go, not picking and choosing but rather accepting her ending.
Afterword—Therapist Reflections
Authors: McQuellon Richard P.
Published: November 2021

This is the story of Nell embracing her life in the weeks prior to her death and the author’s part in witnessing and assisting her safe passage. She died peacefully as she had wished and prepared for these many months. The idea of mortal time engaged her and opened up a new period of discovery at the end. The constant presence of her spouse Al as well as her beloved cat Amber was a comfort on the journey. Walking with Nell was an invitation for me to cultivate self-knowledge by not only witnessing her narrative but also living in it with her. Suffering, sadness, and grief were all part of the journey as well as the gestures of kindness and appreciation to me, including naming me her bodhisattva, her guide on the road to eternity. Music and poetry helped ease the way. It was fitting to end our work together by giving the eulogy in the church she attended. The work of seeing Nell and being with her is complete. The heart-work continues, fueled by the images of Nell in mortal time.
Consciousness
Authors: Johnson L. Syd M
Published: November 2021

Consciousness is notoriously difficult to define. Several things are meant by consciousness: sentience, self-awareness, wakefulness, phenomenal consciousness, and more. There are also several consciousness-related ontological, epistemological, and ethical questions, including questions about what consciousness is, what creatures are conscious, how we can know who is conscious, and, importantly, questions about the ethical significance of consciousness. This chapter provides a sketch of several philosophical and scientific theories of consciousness as an introduction to medical, scientific, and philosophical inquiries into consciousness and unconsciousness.
Practical Epidemiology
Authors: Vaughan J Patrick , Victora Cesar , Chowdhury A Mushtaque R
Published: November 2021

We focus on the importance of using epidemiological concepts and skills needed to investigate, plan and deliver primary health care services and to strengthen district level public health programmes. We illustrate these with examples from LMICs and for a hypothetical district population of 200,000 people.
Health Quantitative Studies
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Observational health studies look for associations between exposures and possible subsequent health outcomes. To test hypotheses, case-control studies look backward in time to earlier exposures while cohort studies observe exposed and non-exposed groups forward in time to record outcome incidence data. Both designs test hypotheses for associations while cohorts can also identify causality. Interventions are best tested using randomized controlled trials for efficacy and community trials for effectiveness. These studies utilize complicated methods and require specialist expertise.
Organizing Investigations and Surveys
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Organizing investigations and surveys can be complicated and they require careful planning. Hand-held portable devices and mobile phones are commonly used today. All questionnaires require careful design, preparation, and piloting. Survey objectives can be reviewed if they are too ambitious and survey design may require changes, such as a reduction in sample size, omission of particular questions, or fewer clinical and laboratory procedures. A pilot trial is essential to test all the methods, fieldwork plans and logistic support. A full survey check list is provided.
Communicating Health Information
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Sharing and dissemination of health information needs careful planning to inform both the public and local health staff, local government departments, and the Ministry of Health, as well as other health-related sectors like agriculture, education, water, and environment, and non-governmental health organizations. Local radio and social media are very important for active communications between district teams, health workers, and the wider public. Policy briefs can be used to disseminated and circulate health news, reports and plans. The importance of making power-point presentations and presenting written reports and papers is emphasised.
Epidemiology for Monitoring and Evaluation
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Monitoring involves continuous observation to see if plans are on track and evaluation determines the effectiveness of planned health interventions delivered by the health services and programmes. The systems approach uses indicators to measure delivery, access, quality, and coverage of services and programmes and their impact on health status indicators. Efficacy measures the impact of interventions in individual people. Measuring effectiveness in whole communities utilizes quasi-experimental population-based study designs with community controls. The importance of ethical principles and monitoring equity in health planning is presented and emphasised.
Using Ethical Principles
Authors: Vaughan J Patrick , Victora Cesar , R Chowdhury A Mushtaque
Published: November 2021

Ethical practice is important for all health workers in public, non-government, and private health services that aim to strengthen primary health care. Four general principles are important: respect for the right of individuals to practice informed choices (autonomy), a fair distribution of benefits and risks (justice), benefits that should far outweigh risks (beneficence), and do no harm or injury (non-maleficence). Local health teams should use these principles together with national guidelines to organise a fair and just approach to district health planning, data collection, and local research studies.
Anatomy of the sacroiliac joint
Authors: Malinowski Mark N. , Swain Anshuman R. , Kim Chong H.
Published: November 2021

The sacroiliac joint, a multiplanar joint located in the dorsal complex of the pelvis, is one of the most important joints in the human to ensure upright and bipedal stability. The joint has been the subject of study for many years, but due to the presence of anatomic variability, challenges remain when analyzing its biomechanics in both normal and pathologic states. The joint is well vascularized and heavily innervated, making it a clinically significant structure with respect to primary, autoimmune, and traumatic disease processes. The chapter describes the gross anatomy of this joint as well as its embryologic origins, variability, and proposed movements as it relates to the joint’s potential for pathogenicity. This information will be useful to clinicians during diagnosis and radiographic evaluation of the patient with low back pain.
Sacroiliac joint conditions
Authors: Swain Anshuman R. , Kim Chong H. , Malinowski Mark N.
Published: November 2021

The sacroiliac joint is a common source of chronic low back pain. Multiple conditions can result in the development of pain within this axial joint. These conditions may be both pathologic or nonpathologic. Pain may result from injury from an intraarticular as well as an extraarticular source. Pain in the sacroiliac joint may result from degenerative, traumatic, and inflammatory conditions. Conditions covered in this chapter are osteoarthritis, sacroiliac joint dysfunction, infection (pyogenic or granulomatous), crystalline-induced sacroiliitis (found in gout and calcium pyrophosphate dihydrate deposition disease), spondyloarthropathies, reactive arthritis, malignancy (primary and secondary), trauma. The impact of pregnancy on the sacroiliac joint is also discussed.
Types of anesthesia for different sacroiliac joint interventions
Authors: Habibi Behnum A. , Malinowski Mark N. , Kim Chong H.
Published: November 2021

There are a variety of anesthetic techniques commonly used for sacroiliac joint (SIJ) procedures. For example, diagnostic SIJ injections do not necessitate anesthesia, while open SIJ fusions require general anesthesia. This chapter, targeted to practitioners performing SIJ procedures, covers the basic elements of these techniques. After a brief discussion of the history of anesthesia in relation to SIJ procedures, each common anesthetic technique is discussed, in order of increasing sedation. Local anesthesia is discussed for intraarticular joint injections, blocks of the nerves innervating the SIJ, and radiofrequency ablations of these same nerves. Monitored anesthesia care is discussed for procedures such as minimally invasive SIJ fusions and the Simplicity radiofrequency ablation technique. The use of neuraxial anesthesia, via either spinal or epidural blocks, is considered for lateral SIJ fusions. Finally, the use of general anesthesia for lateral and open fusions is reviewed.
Intraarticular injections (ultrasound-guided and fluoroscopic-guided approaches)
Authors: Mrad Luay , Gargya Akshat , Abdallah Rany T.
Published: November 2021

Intraarticular injection of the sacroiliac joint is a commonly performed procedure in interventional pain practice for the management of chronic low back pain due to sacroiliac joint inflammation or dysfunction. It can also be done as a diagnostic procedure to detect the source of low back pain. It is preferred to perform this procedure under image guidance using either fluoroscopy or ultrasound. Ultrasound-guided injection of the sacroiliac joint is preferred in pregnant patients to avoid exposure and risk of complications from radiation. Ultrasound is also beneficial in avoiding vascular injury; however, this imaging modality has less accuracy than fluoroscopy. This chapter describes the steps used to successfully perform two approaches, providing information about the necessary equipment, patient positioning, and anesthesia.
Radiofrequency ablation of the sacroiliac joint
Authors: Ali Haider M. , Eshraghi Yashar , Guirguis Maged
Published: November 2021

Radiofrequency ablation (RFA) is a revolutionary procedure in the practice of pain management that can be used in the treatment of sacroiliac joint pain syndromes. It is a technology that uses radiofrequency needle probes to create lesions by way of localized tissue destruction. It is indicated for patients with chronic sacroiliac joint pain who have had a positive response to a lateral branch block. This procedure typically provides at least 6 and up to 12 months of significant pain relief and can be repeated. Practitioners should be well versed in the different evolving methods for RFA as well as its evidence, relevant anatomy, the technology used in RFA, and the complications that may occur with this procedure and how to prevent them. This chapter explores these principles and presents the relevant findings from the literature for this innovative procedure for sacroiliac joint pain.
Regenerative medicine therapies for sacroiliac joint disease
Authors: Strand Natalie H. , Maloney Jillian , Hunt Christine L.
Published: November 2021

The sacroiliac joint is a common cause of low back pain, and techniques to reduce pain and improve function are of utmost interest to the pain medicine practitioner. As regenerative medicine continues to expand, a thorough understanding of the types of therapies that make up the regenerative medicine toolkit is imperative. This chapter reviews prolotherapy and injections of mesenchymal stem cells, platelet-rich plasma, autologous whole blood, and hyaluronic acid for the treatment of sacroiliac joint–mediated pain. Information on background, mechanisms of action, pharmacology, safety and efficacy, possible side effects, and preparation and administration is provided for each of these regenerative injectants, along with a brief review of clinical trials and published data.
Oxford Handbook of Head and Neck Anatomy
Authors: van Gijn Daniel R. , Dunne Jonathan
Published: November 2021

A sound knowledge of anatomy forms the scientific backbone of medicine and surgery – equipping the owner with the tools necessary to understand, remember and ultimately manage the clinical scenarios encountered throughout ones career. The Oxford Handbook of clinical head and neck anatomy is a novel venture for the Oxford Handbook series into the field of anatomy. It tackles the notoriously difficult three-dimensional anatomy of the head and neck and provides clinically relevant correlates, etymology and a brief insight into the people behind the commonly encountered eponymous structures and syndromes. Traditional anatomy texts and atlases can be overwhelming in terms of volume, descriptions and accompanying images. The Oxford Handbook of clinical Head and neck anatomy offers a succinct yet comprehensive, portable and quick reference guide with over 400 colour and grey-scale illustrations. The schematic nature of the illustrations makes them readily reproducible on the operating theatre whiteboard, outpatient clinic or ward, making it a true bedside companion. It is written and illustrated by a trainee in oral and maxillofacial surgery, with an awareness of the needs of those in a similar position, combined with firsthand insight into the difficulties faced by those attempting to learn and link the anatomy taught in pre-clinical years with cases seen in day to day clinical practice thereafter. This book is aimed at medical and dental students, trainees at all levels in Oral and Maxillofacial surgery, ENT surgery and plastic and reconstructive surgery, and radiologists and anaesthetists with an interest in head and neck. Furthermore, it provides an authoritative source for those preparing for the Member of the Royal College of Surgeons and Member of the Faculty of Dental Surgeons exams.
A Brief History of Body Shape
Authors: Denton Nathan
Published: November 2021

Like the vast numbers of other organisms that roam, or have roamed, the earth, the modern human represents a finely honed tool—one forged through millennia as it struggled to survive and thrive in more or less unaccommodating environments. Displaying the battle scars and winning strategies of its brutal, but ultimately triumphant battle against the elements, our bodies hold vast amounts of encrypted information that describe our biological lineage. In addition to the countless mechanisms that have evolved to support our existence, however, the human body is somewhat unique in that it exhibits striking permanent physiological differences that identify and define the sexes. The biology that arises from, and the social meanings attributed to, these physical features penetrate deep into the heart of what it means to be human, as well as a man or a woman. Before delving into the biology of fat, we must first therefore consider the history of body shape. This chapter begins by discussing several explanations for why the modern human body might have evolved the shape it has, and why the body differs between the sexes. Building from this foundation, it examines how societal attitudes toward body shape are ascribed and their shift over time.
What Shape Is Healthy? Body Composition, Body Shape, and Health
Authors: Denton Nathan
Published: November 2021

Fat is one of the privileged few organs that has earned sufficient historic recognition for its importance to our well-being to be subject to routine inspection at home, in the clinic, and even the gym. We also tend to be very aware of how and where our clothes feel tight, whether we can squeeze comfortably into that economy seat on a plane or through that turnstile at the train station. But what do these feelings say about our health? Are we more in jeopardy if our gut is spilling over our belt, our bum is threatening to shred the seam of our trousers, or the scales are groaning under our weight? To obtain answers to such burning questions—answers which have implications that reach far beyond wardrobe malfunctions and uncomfortable travel—we must first understand techniques used to measure body composition and regional fat mass. Historically the preserve of a handful of enthusiastic experts, the colossal global burden of obesity and associated diseases has made accurate measurement of body composition and fat distribution a key research tool in the scientific and clinical arenas. This chapter reviews the various measurement techniques before examining the data they’ve generated on the striking yet complex relationship between body composition and fat distribution with health outcomes.
Same but Different
Authors: Denton Nathan
Published: November 2021

The associations between overall and regional fat mass with numerous health outcomes seem to transcend age, sex, and ethnicity, suggesting that they are underpinned by some common mechanisms. This chapter aims to make sense of these striking relationships by considering the macroscopic, cellular, and molecular processes operating within various anatomically distinct fat depots to help rationalize the complex relationship between regional fat accumulation and various aspects of metabolic, cardiovascular, and reproductive health. After outlining how fat depots around the body behave differently, the following section examines why this may be the case. This involves considering various phenomena, namely adipogenesis, gene expression, and epigenetics, that underpin the biological properties of adipocytes which aggregate to inform the behaviour of fat as a multi-cellular tissue.
Consequentialism
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explains the consequentialist approach to ethical analysis. It distinguishes act utilitarianism and rule utilitarianism. It also considers different possibilities as to which outcomes should be considered relevant for consequentialists. It considers a number of challenges and objections to consequentialist ethics.
The four principles
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the four principles developed in the seminal book by Beauchamp and Childress. The four principles (autonomy, beneficence, non-malfeasance and justice) are explained and examples provided of how they operate in principle. There is a discussion of the difficulties faced when these principles appear to clash with each other.
Care ethics
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores care ethics. This approach emphasises the importance of supporting caring relationships. The ethical response to a situation is informed by the relationships between the people involved. This means that care ethics tends to avoid hard rules and advocates an approach that takes into account the specifics of the situation.
Moral relativism and subjectivism
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the claim that ethics is subjective or relative. In other words that there are no moral absolutes and that moral claims always vary depending on the dominant norms at the time. The chapter explains the difficulties with claims of this kind. It also considers how ethics can appreciate diversity within society and be tolerant, while holding on to moral absolutes.
Introduction to the legal system
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter provides a general introduction to the legal system. It explains the court structure in England. It sets out the primary sources of law: statute and common law. It also explores the difference between civil law and criminal law, and how different kinds of cases can be brought arising from the same set of facts. It also considers the status of European Law following Brexit.
Negligence
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the law of negligence. It explains the concepts of a duty of care and what amounts to a breach of that duty. It also considers the importance of causation in the law and the need to prove that the negligent act caused the loss to the claimant. The chapter also explains how damages are assessed under the tort of negligence.
Resource allocation
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores the issues around the rationing of medical resources. It considers the different ways in which restrictions are imposed on what treatments are available and the ethical basis on which these assessments are based. This includes the controversial 'quality adjusted life years' method which is used to determine a cost/benefit analysis of different treatments. The chapter also examines how rationing is consistent with broader themes of justice.
Issues in the doctor–patient relationship
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter explores a range of legal and ethical issues involved in the doctor-patient relationship. It emphasises the need to ensure a doctor has consent before treatment. The law on the test for mental capacity and the meaning of consent is set out. Doctor’ duties to disclose risks associated with treatment are described. The legal and ethical treatment of advance directives are explained. The chapter also explains how medical professionals should treat patients who cannot consent and how a best interests assessment should be performed. It also addresses the question of when a child can give effective consent and the law regarding children who refuse treatment.
Mental Health Act 1983
Authors: Smajdor Anna , Herring Jonathan , Wheeler Robert
Published: November 2021

This chapter covers the Mental Health Act 1983 and includes topics on The definition of mental disorder under the Mental Health Act, Criteria for admission under s.2 Mental Health Act, Criteria for Admission under section 3, Criteria for Emergency Admission under section 4 Mental Health Act, Brain Tissue Treatment under Mental Health Act, Electro-convulsive Therapy.
A simple numerical experiment on the dust temperature bias for Lyman break galaxies at z ≳ 5
Authors: Chen Yung Ying , Hirashita Hiroyuki , Wang Wei-Hao , Nakai Naomasa
Published: November 2021

Some studies suggest that the dust temperatures (Td) in high-redshift (z ≳ 5) Lyman break galaxies (LBGs) are high. However, possible observational bias in Td is yet to be understood. Thus, we perform a simple test using random realizations of LBGs with various stellar masses, dust temperatures, and dust-to-stellar mass ratios, and examine how the sample detected by ALMA is biased in terms of Td. We show that ALMA tends to miss high-Td objects even at total dust luminosity LIR > 1011 L⊙. LBGs are, however, basically selected by the stellar UV luminosity. The dust-temperature bias in a UV-selected sample is complicated because of the competing effects between high Td and low dust abundance. For ALMA Band 6, there is no tendency of high-Td LBGs being more easily detected in our experiment. Thus, we suggest that the observed trend of high Td in z ≳ 5 LBGs is real. We also propose that the 450 $\rm {\mu m}$ band is useful in further clarifying the dust temperatures. To overcome the current shallowness of 450 $\rm {\mu m}$ observations, we examine a future Antarctic 30-m class telescope with a suitable atmospheric condition for wavelengths $\lesssim 450~\rm {\mu m}$, where the detection is not confusion-limited. We find that, with this telescope, an LIR-selected sample with log (LIR/L⊙) > 11 is constructed for z ≳ 5, and detection in the intermediate-M⋆ (stellar mass) range [9 < log (M⋆/M⊙) < 9.5] is much improved, especially at high Td.