bluuebunny/crossref_metadata_2025 huggingface dataset:
Analytical comparison of two or more graphical representations
Authors: Krzanowski W J
Published: November 2023

In this final chapter dealing with graphical representations, we shall concentrate on techniques that fall under either the projection or the optimization categories introduced in Chapter 1. In the former category, the input data are thought of as a swarm of points (representing sample individuals) in a high-dimensional space. and we obtain a pictorial representation by projecting this swarm into a low-dimensional subspace of the original space. Principal component analysis is a typical example of such a technique. In the latter category, no explicit high-dimensional geometrical model exists for the data, but instead we construct directly a low-dimensional space in which points represent the sample individuals, by optimizing some suitable criterion function. Multidimensional scaling is an example of such a technique. Both approaches yield low-dimensional spaces in which sample individuals are represented by points, but the projection approach additionally enables an interpretation of the derived subspace to be made in terms of the dimensions of the original space.
Data inspection or data analysis?
Authors: Krzanowski W J
Published: November 2023

The material in Part I of this book has been concerned exclusively with data inspection: given a multivariate data set, are there any interesting patterns that can be observed in the numbers themselves? We have seen that inspection of a large data matrix is not an easy task, and the whole of Part I was therefore concerned with methods of constructing pictorial representations of such matrices, in the hope that any such interesting patterns in the data might be highlighted more easily. In order to construct these pictorial representations, an initial connection had to be made between the elements of the data matrix and points, lines, or shapes in Euclidean space. This connection enabled a geometrical model of the data to be set up, and many concepts familiar in geometry could then be used to achieve simplification of the initial data representation. The important aspect of all the techniques of Part I, however, is that in no case was any structure imposed on the data representation. Clearly some information always has to be lost when a high-dimensional set of data is represented in relatively few dimensions, but in no case was any of the lost information directly attributable to the imposition of external constraints acting on the elements of the data matrix. In other words, no preconceived ideas about the behaviour of the system governed the type of output observed in each technique. Rather, the data were able to speak for themselves, and the pictorial representations attempted to display the resulting message as faithfully as possible.
Measuring and interpreting association
Authors: Krzanowski W J
Published: November 2023

This produces the familiar geometrical representation of the sample that we have used throughout the book when dealing with quantitative data. In the present case, of course, the data matrix has just two columns so the representation is exactly two-dimensional, and no dimensionality reduction is needed.
Conclusion: some general multivariate problems
Authors: Krzanowski W J
Published: November 2023

The development of multivariate analysis in this book has been through a problem-orientated, rather than technique-orientated, approach, and the division of the material into five main parts has stemmed from this approach. However, a few general problems cut across such categorization, in the sense that they can arise irrespective of the form of data and in a variety of circumstances. We therefore conclude the book by discussing these problems briefly, and outlining the main ways in which they can be tackled. Detailed consideration of each would require a major portion of the book, so we do no more than convey their general flavour and present relevant references from which the reader can obtain full technical and practical details.
Sundials: how to tell the time without a digital watch
Authors: Budd C J , Sangwin C J
Published: November 2023

Ok, so you have just got the latest in digital watches, with a stop watch, date, times from all over the world, and the ability to function at 4000 fathoms. Just one small problem, the batteries have gone flat. If the sun is shining, however, you don’t need to use a watch at all, because the sun makes an excellent clock which (fortunately) doesn’t need batteries that can run down. This masterclass is all about how we use sundials to tell the time, and contains real-life construction projects, including a splendid garden ornament and the perfect way to decorate the school playground. With some care, and using some interesting mathematics, we can end up building a very accurate sundial. If you find the mathematics in the first sections heavy going then rush on to the later sections where you will see how to construct a variety of different types of sundial. However, we hope that you will enjoy the mathematics as well. Although we often take the problems of telling the time or of finding the day’s date for granted, finding solutions to these are vital to our civilization. Early men and women needed to have an accurate notion of the seasons in order to know when to plant and harvest their crops. As civilization developed it became important to know the time of the day. Two times were obvious, as everyone was aware of when the sun rose (dawn) and when it set (dusk). More accurate observations of the sun then showed that having risen in the east it climbed to its highest point in the sky, which is due south (in the northern hemisphere), before descending towards its setting point in the west. The time when the sun is at its highest point (which is when the shadows are shortest) is called noon. Knowing dawn, noon and dusk separated the day into morning, afternoon, and night.
Castles: mathematics in defence and attack
Authors: Budd C J , Sangwin C J
Published: November 2023

Usually in a workshop we aim to work with each other, to do things in teams, and to generally make friends. This chapter is an exception as we consider how people can be seriously nasty to one another and how a mathematician can help them to do it. However, although the class involves some practical experiments, no loss of blood will be involved - at least not on purpose. What we will do is to use mathematics to understand how and why castles were constructed the way they were, and how a bit of mathematics can help us both to design them to be easier to defend and also make them easier to attack. So you thought that castles were just to be studied in history lessons? Well read on! The business of building fortifications to protect you and your family from the next person and their family is as old as human civilization. It is a sad fact that often the main mark that remains of a civilized society are the fortifications that they erect to defend themselves from another civilization! Indeed, it has been said that the only man-made object that can be seen from space is the Great Wall of China, which was built around 240 BC to defend the Chinese people. Thus, at first glance, an alien might only be able to tell that we were civilized by looking at one of our defences. When excavating an ancient city often the first thing that you look for is evidence of the fortifications that were used to defend it. One of the oldest known fortified cities is Jericho, and the fortifications around Jericho are described in the Old Testament in the sixth chapter of the book of Joshua. In this story, Joshua breached the walls by using trumpets and the help of God. In this chapter we will consider more conventional means of attack.
Basic concepts
Authors: Lindsey J K
Published: November 2023

Nonlinear modelling is one of the more sophisticated areas of modem statistics. It involves advanced statistical concepts from a wide variety of areas, from inference to repeated measurements. In this chapter, I shall review some of the most important ones. Those for stochastic dependencies are outlined in Appendix B. Still others will be introduced throughout the following chapters, as required.

Statisticians often seem most fascinated by inference: how to draw general conclusions from specific, limited observations. Here, I concentrate on a different aspect of the statistical approach: how best to represent the ‘reality’ of what has been observed, both its systematic and its random aspects.
Families of nonlinear regression functions
Authors: Lindsey J K
Published: November 2023

In this chapter, I shall review briefly some of the basic classes of nonlinear regression functions that are important in medical research.

One of the most common types of studies where nonlinear regression functions are usually necessary involves the analysis of growth curves. As the name indicates, they are usually associated with studies over time.
Molecular basis of signal transduction
Authors: Helmreich Ernst J M
Published: November 2023

In this chapter, the signals, the growth factors, and the receptors receiving the signals are introduced. Receptor–ligand interactions at the cell surface are the first step in cellular signalling. This introduction will acquaint the reader with some of the major players in cellular signalling.
Signal transduction pathways through heterotrimeric G proteins: transmission of hormonal and sensory signals
Authors: Helmreich Ernst J M
Published: November 2023

G-protein-coupled receptors (GPCRs) are expressed in eukaryotes, from yeast to humans. Many hormones bind to GPCRs. Targets of hormonal signals, transmitted by GPCRs, are often enzymes, synthesizing second messengers such as cAMP. Through second messengers, G-protein-coupled receptors regulate many metabolic and cellular functions, including ion channels. GPCRs also transmit signals to cellular phosphorylation cascades, such as the MAP kinase pathway. Sensory signals, light, smell, and taste signals are also received by receptors with seven transmembrane helices and transmitted and amplified by heterotrimeric G proteins.
Control of signalling by phosphorylation dephosphorylation
Authors: Helmreich Ernst J M
Published: November 2023

Chapter 7 will sum up the facts concerning phosphorylation dephosphorylation, a mechanism involved in nearly all cellular regulatory processes. As example of the role of phosphorylation dephosphorylation the response of the body to insulin will be examined in Chapter 8.
Regulation of cell death
Authors: Helmreich Ernst J M
Published: November 2023

The cell cycle is complemented by a programme controlling cell death. This programme orders cells to destroy themselves when they are no longer needed or when they are damaged and dysfunctional. Cell death is characterized by blebbing and vacuole formation, chromatin condensation, and DNA fragmentation. To survive, cells from multicellular organisms (metazoans) must keep the suicide programme under control and prevent its activation. The signalling pathways receiving and transmitting ‘death signals’ involve cell–cell interactions. The first appearance of programmed cell death (PCD) may go back to the emergence of multicellular, metazoan organisms. An example is stalk formation in the slime mould, Dictyostelium discoideum, where kind of a CD programme directs the assembly of aggregated cells, slugs and stalk formation.
Transformation of normal cells to tumour cells
Authors: Helmreich Ernst J M
Published: November 2023

By now the reader should have gained a perception of the basic design of cellular signal transduction pathways. In the following chapters he or she will find out how helpful this information is for understanding carcinogenesis because, in principle, malignancy is caused by a failure of the genetic programme controlling cell growth, proliferation, and differentiation. Genes encoding nearly every regulatory protein are normal, constitutive, cellular protooncogenes. They may become oncogenes by mutation and cause cancer. They may also cause cancer when their transcription is out of control and they are overexpressed. Keeping in mind the role of proto-oncogenes in cellular regulation, it is not surprising that mutation or overexpression of the key components of signal-transduction chains cause regulatory chaos and lead to uncontrolled proliferation and de-differentiation of cells.
Renal cell carcinoma in dialysis and transplantation
Authors: Tebyani Neyssan , Gritsch H Albin
Published: November 2023

Since the 1960s the number of patients with end-stage renal disease treated with renal replacement therapy has increased steadily. According to the 2001 United States Renal Data system (USRS) annual report, approximately 340 000 patients were being treated for end-stage renal disease (ESRD) at the end of 1999 and 88 000 new patients started treatment in 1999. The estimated rate of growth of new ESRD patients is 7.3 per cent per year for 1995–1999. Renal replacement therapy is comprised of hemodialysis, peritoneal dialysis, and kidney transplantation.
Antigens recognized by T lymphocytes on renal cell carcinoma
Authors: Eynde Benoît J Van den , Probst-Kepper Michael
Published: November 2023

The study of tumor antigens recognized by T cells was made possible about 15 years ago when cytolytic T lymphocytes (CTL) capable of killing the autologous tumor cells were isolated from the lymphocytes of cancer patients. Human melanoma cells can be grown relatively easily in vitro, and the first CTL were obtained from blood lymphocytes of melanoma patients. Melanoma there- fore has become the paradigmatic tumor for human tumor immunology (Boon et al. 1994). Anti-melanoma CTL have also been isolated from tumor-infiltrating lymphocytes (TIL), and in some cases homogeneous CTL clones were obtained by limiting dilution cloning of CTL lines. In a few cases it has been possible to test the recognition of some normal cells by the CTL clones, and thereby determine the specificity with which they are able to kill the tumor cells.
Monoclonal antibodies to renal cancer antigens
Authors: Divgi C , Oosterwijk E , Steffens, M , Bander N
Published: November 2023

Cancer immunologists continued to attempt to define recognized tumor antigens and discern the reasons why immune surveillance sometimes fails and allows cancer development. The occasional spontaneous regression in renal cancer (Everson and Cole 1966; Freed et al. 1977; Snow and Schellhammer 1982; Vogelzang et al. 1992) provides indirect evidence implying a role of the immune system in the natural history of renal cancer. Oliver et al. (1989) observed a series of 73 patients with metastatic renal cancer without therapy until disease progression. This study provided data on the natural history of metastatic renal cancer as well as a baseline for comparison to therapy trials. Oliver et al.
Therapeutic options for localized disease
Authors: Montie James E , Beduschi Ricardo
Published: November 2023

Renal cell carcinoma (RCC) is the most common malignancy of the kidney and constitutes approximately 85 per cent of all primary renal cancers and roughly 3 per cent of all adult malignancies. Radical nephrectomy, as described by Robson et al. (1969), has been the standard treatment for clinically localized RCC for the past 30 years. Nevertheless, management of clinically localized RCC has evolved considerably in the last few years. Radical nephrectomy is no longer regarded as the only curative therapy available, and surgical removal of the entire organ is no longer required in all cases of RCC. The widespread use of ultra- sound, computerized tomography (CT), and magnetic resonance imaging (MRI) as diagnostic tools in patients with symptoms unrelated to the urinary tract has permitted detection of solid renal tumors, many of which ultimately prove to be renal cancers.
Inferior vena caval tumors
Authors: Sorcini Andrea , Libertino John A
Published: November 2023

Renal cell carcinoma (RCC) has the propensity to infiltrate the surrounding parenchyma, to penetrate the capsule and extend into the perirenal adipose tissue and adjacent structures, and, in particular, to infiltrate the venous system and propagate into the inferior vena cava (IVC). Electron microscopy reveals renal tumor cells around thin-walled vessels and small fenestrations with the neoplastic process prolapsing into the lumen. These characteristics are consistent with RCC, but they have been described in con- junction with adrenocortical carcinomas and Wilms’ tumors.
Surveillance strategies following surgery for renal cell carcinoma
Authors: Uzzo Robert G , Novick Andrew C
Published: November 2023

Epithelial tumors of the kidney account for approximately 3 per cent of all solid neoplasms (Parker et al. 1997). Adenocarcinoma or renal cell carcinoma (RCC) represent nearly 85 per cent of newly diagnosed malignancies of the kidney occurring at an estimated rate of 4.4–11.1 per 100 000 person-years in the US (Chow et al. 2000). Recent data from the US Surveillance, Epidemiology, and End Results (SEER) program demonstrate a steady increase in RCC of 2.3–4.3 per cent annually between 1975 and 1995 (Chow et al. 2000). This rise can be attributed in part to early detection through the widespread use of non-invasive imaging techniques (Rodriguez et al. 1995), although this reason alone cannot fully explain the upward trend (Chow et al. 2000).
Adjuvant therapy for renal cell carcinoma
Authors: Baar Joseph , L.Trump Donald
Published: November 2023

It is estimated that there will be 31 200 new cases of renal cell carcinoma (RCC) diagnosed in the US in 2000, and 11 900 people will die from this disease (American Cancer Society). Approximately 70 per cent of patients present with localized or locally advanced disease (Golimbu et al. 1986) and are potentially curable by nephectomy alone. However, relapse rates are high in such patients, with 5-year survival rates of 56–100, 47–100, and 34–80 per cent in patients with stage I (that is, T1N0), stage II (that is, T2 N0), and stage III disease (that is, T1N1M0 to T3cN1M0), respectively.
Cell-based therapy in the treatment of renal cell carcinoma
Authors: Gitlitz Barbara J , Belldegrun, Arie S , Figlin Robert A
Published: November 2023

Over the last 50 years, considerable advances have been made in our knowledge of tumor immunology. This encompasses concepts such as antigen processing and presentation via the major histocompatability complex (MHC) (Bjorkman and Parham 1990; Bjorkman et al. 1987); regulation of the immune response by cytokines, the influence of secondary signals such as co-stimulatory molecules, any, most notably, the characterization of a variety of genes encoding tumor-associated antigens (TAA). For many tumor types, the DNA and amino acid sequences of TAA have been elucidated including MHC-restricted immunodominant peptide sequences. This basic research has formed the basis for the exploration of more targeted clinical immunotherapies.
Laparoscopic adrenalectomy by the posterior lumbar approach
Authors: Baba Shiro , Iwamura Masatsugu
Published: November 2023

Laparoscopy today is a procedure well past its learning curve and a standard part of the urologic armamentarium. Since laparoscopic adrenalectomy by transperitoneal anterior (Go 1993; Higashihara et al. 1993) and lateral approaches (Gagner et al. 1993) was reported in 1993, this procedure has gradually become the primary treatment option for benign adrenal diseases. Its success is due primarily to improvements in instrumentation and the rapid acquiring of laparoscopic anatomy by urologists. Operating in the retroperitoneum across the peritoneal cavity, however, necessitates considerable retraction of intraperitoneal organs.
Learning theory perspectives on early reactions to traumatic events
Authors: Perrin Sean
Published: November 2023

The term ‘learning theory’ as used in this chapter refers to classical and operant conditioning theo ries. Both approaches view reinforcement as the central process by which the environment acts upon the organism to produce complex behaviour patterns (Donahoe, 1998). The differences between the two theories are evident in the procedures used to demonstrate learning. In the classical conditioning procedure (Pavlov, 1927) a reflex-eliciting stimulus (e.g. food) is presented to the animal following an environmental event (e.g. a tone). In the operant procedure (Thorndike, 1911), the elic iting stimulus is presented following a particular behaviour (e.g. pressing a lever). In both cases, the eliciting stimulus acts as a reinforcer because it changes the way the environment guides behaviour.
Cognitive perspectives on early reactions to traumatic events
Authors: Pilgrim Hazel
Published: November 2023

Cognitive theory has inspired and informed a number of distinct forms of psychological inter ventions generically referred to as cognitive therapy. In recent years they have been subjected to systematic evaluation with encouraging results for clinically significant expressions of anxiety, phobias, depression and obsessive-compulsive disorders. It has also been demonstrated as a valid therapy for PTSD (Marks et al., 1998; Tarrier et al., 1999). Development of cognitive theories has often followed clinical observations in such a way that the theory, in tum, engenders suggestions as to which types of interventions may be useful in therapeutic practice. This being the case, cognitive therapies and theories are in a process of continuous evolution.
Systemic approaches to early interventions in a community affected by organized violence
Authors: Ajdukovic Dean , Ajdukovic Marina
Published: November 2023

Reviews of the literature on the effectiveness of early interventions with individuals and groups show the importance of the social context in which healing should progress. When describing the initial stage of psychological first aid Freeman et al. (2000) list activities that involve active, organized and supporting environments. This includes forms of practical help, provisions of food and shelter, protection from further threat, immediate care for physical needs, etc. Herman (1992) maintains that restoring connections with the environment, which emphasizes the importance of the social network of a victim, is among the critical points of trauma recovery.
Early intervention strategies applied following rape
Authors: Resnick Heidi , Acierno Ron , Stafford, Jane , Minhinnett Robin
Published: November 2023

In this chapter we provide a brief review of the literature related to development and implementation of early intervention strategies following completed rape of women by men. Most, if not all, of the principles in this chapter may be applicable to sexual assault more broadly defined including, but not limited to attempted sexual assault, contact sexual molestation, sexual assault of girls, boys and men, same-gender sexual assault and sexual harassment. However, the large majority of controlled studies of sexual assault have been conducted with women raped by men.
A brief early intervention service for accident and assault victims
Authors: Bisson Jonathan I
Published: November 2023

Psychological sequelae to accidents and assaults are common. Breslau et al. (1991) interviewed 1007 American adults aged between 21 and 30. Almost 40% had been exposed to a major traumatic event of which accidents and assaults were the most common. Kessler et al. (1995) in their large epidemiological survey in the USA found lifetime prevalence of PTSD following serious accident to be 20.7% in men and 23.6% in women. For physical attack the rates were 12.4% in men and 30.8% in women, and for rape 65% in men and 45.9% in women. In Breslau et al.’s (1991) study 11.6% of those who had suffered a sudden injury or serious accident and 22.6% of those physically assaulted developed PTSD compared to 80% of women who reported rape. The presence of high levels of psychological morbidity following accidents and assaults has major implications for hospital trauma services including orthopaedic surgery, general surgery, accident and emergency medicine, ophthalmology and maxillo-facial surgery in addition to primary care and mental health services.
Demyelinating Disease
Authors: Formaglio Fabio , (Sandy) Macleod A D
Published: November 2023

Demyelinating diseases share the common pathologic feature of foci of degeneration, involving the myelin sheath of nervous tissue. Multiple sclerosis (MS) is the commonest demyelinating disease and this chapter will focus on the palliative management of MS.
Muscular Dystrophy and Related Myopathies
Authors: Maddocks Ian , Stern Leon
Published: November 2023

The management of muscular dystrophy and the various related myopathies presents particular challenges in the maintenance of effective professional oversight during the transition from adolescent to adult (which often entails a change in institutional and professional relationships) and in assisting caring family members face the inevitability of deterioration and death after long years of intense loving effort in the promotion of positive attitudes and optimal function. Some of the skills learnt in the more usual settings of palliative care can be appropriate to this situation, but sensitivity will be necessary if, in introducing them, they are regarded as appropriate only to the terminal phase. A broad coalition of professional skills will best meet the complex physical and emotional needs of patient and family as the terminal period draws on.
Quadriplegia and Paraplegia
Authors: Ceranski Walter A
Published: November 2023

Since palliative care in the individual with quadriplegia or paraplegia involves a person with a stable deficit and a nearly normal life expectancy, it requires an understanding of the relationship between a variety of factors (such as level and mechanism of injury) and preserved function. To this end, this chapter begins with a review of those relationships. This is followed by an overview of complications of quadriplegia and paraplegia (along with comments regarding their potential impact on quality of life and productivity). This knowledge can assist in making informed decisions on how (and how aggressively) to treat these complications. Finally, some suggestions are made for areas of research which could contribute to the effectiveness of treatment. The hope remains that advances in research will lead to such restoration of function that the need for palliative care in the person with quadriplegia or paraplegia will no longer exist.
Locked-in Syndrome
Authors: Grisold Heinz Lahrmann Wolfgang
Published: November 2023

In this chapter the neurologic symptoms, the neuroanatomical and pathophysiological background, and the palliative management of patients with locked-in syndrome (LIS) is presented. Most often LIS is caused by basilar artery thrombosis. The patient becomes completely paralysed with only vertical eye and upper lid movements spared. Consciousness, sensation, and hearing are most often intact. Emphasis is put on the explanation of the diagnosis and its implications to the patient, the relatives, and the caring team. Of major importance is to establish a sufficient mode of communication with the LIS patient. Different methods and technical solutions are presented. The ethical point of this condition, which belongs to the nightmares of human beings, is discussed.
Spasticity
Authors: Noth Johannes Gereon R , Fink Gereon R
Published: November 2023

Spasticity-an increased stretch resistance of the passive skeletal muscle with exaggerated tendon jerks-is a common neurologic symptom in palliative care and can result from any lesion (e.g. due to a stroke or a brain tumor) of the long corticospinal tract. The clinical variety of spastic syndromes results from the topology of the CNS lesion and the subsequent differential involvement of the descending pathways. The overall approach to the management of spasticity includes reversing any noxious stimulus, using physical interventions before adding pharmacotherapy, and reserving more invasive techniques (e.g. nerve blocks, orthopedic or neurosurgical procedures) to a few exceptional situations. The aim of the treatment is to prevent joint contractures, decubiti, and orthostatic hypotension. Current pharmacological treatment is based on substances that act as muscle relax-ants including baclofen, tizanidine, diazepam, and botolinum toxin.
Dysphagia
Authors: Borasio Mario Prosiege Edith Wagner-Sonntag Gian Domenico
Published: November 2023

Dysphagia is a major problem in neurological patients requiring palliative care. An accurate assessment of swallowing problems and of dysphagia-related symptoms based on clinical, videofluoroscopic, and videoendoscopic evaluation is a prerequisite for appropriate treatment. Management of dysphagia in palliative patients comprises many pharmacological and non-pharmacological interventions. It should be performed on a team basis and should include the patient and his/her relatives in all important decisions such as augmented feeding techniques.
Communication Impairment
Authors: Foulsum Amanda Scott Margaret
Published: November 2023

This chapter examines the nature of communication impairment frequently encountered in palliative care settings and the role of the speech and language therapist in the assessment and management of these problems. The specific components of communicationcognition, speech, language and pragmatics-are examined. The focus of intervention for this clinical population is one of informational counselling and the provision of compensatory management strategies. This intervention involves the patient and their key communication partners and should take into consideration changes in the patient’s functional and emotional states.
Epileptic Seizures and Myoclonus
Authors: Noachtar Sabine We l Soheyl
Published: November 2023

Epileptic seizures and myoclonus are bothersome for both patients and relatives. They occur in a variety of syndromes and different diseases. Myoclonus can be of epileptic origin, but there are a lot of other etiologies also involved. Non-epileptic myoclonus and epilepsy have to be distinguished because therapy and prognosis are different.
Pain
Authors: Daniela hord Eugenia , Portenoy Hord Russell K
Published: November 2023

Pain usually can be relieved through the systematic application of guidelines adapted from extensive experience in the population with cancer pain. These guidelines are predicated on a comprehensive assessment, which clarifies the nature of the pain, determines whether there is a primarily treatable cause, clarifies the most effective pain management strategies, and provides insight into the degree to which pain is accompanied by other problems that together undermine quality of life. Opioid pharmacotherapy is the mainstay analgesic approach and the most important principle of prescribing is individualization of the dose based on repeated dose titration. The high prevalence of pain in patients with neurologic illnesses warrants controlled trials to help better understand the clinical profile of these syndromes and find the best treatment options.
Fatigue
Authors: Doninger Lynne I Wagner David Cella Nicholas A
Published: November 2023

Fatigue is one of the most commonly reported symptoms among medically ill populations and adversely impacts quality of life. In clinical settings, fatigue is often not assessed and, consequently, inadequately treated. Causative factors are likely to be multifactorial in nature, and the underlying pathophysiology of fatigue is poorly understood. Principles for the clinical management of fatigue are similar across medically ill populations for whom fatigue is a prominent feature (e.g. multiple sclerosis, cancer, HIV/AIDS). Comprehensive assessment of fatigue should include an evaluation of fatigue characteristics to understand its functional impact and provide insight into potential etiologies. Treatment of fatigue should address causative factors that are commonly observed in medically ill populations and are easily detected and treated (e.g. anemia). Pharmacological and non-pharmacological interventions have been utilized for the management of fatigue; however, few randomized clinical trials have been conducted.
Urological Symptoms
Authors: Badlani Darshan K Shah Gopal H
Published: November 2023

In order to best manage a neurologically impaired patient, it is important to consider the patient’s age, sex, level of lesion, and degree of ambulation, manual dexterity, and independence. The concerns of the urologist are primarily the preservation of the upper urinary tract or renal function and avoidance of urinary tract infection. This translates to ensuring adequate bladder storage and emptying at low intravesical pressures. The patient’s concern, conversely, has to do with social mores such as preservation of continence. The patient needs a solution that is both socially acceptable and easily adopted.
Psychiatric Symptoms
Authors: Stiefel AlIexandre Berney Friedrich
Published: November 2023

This chapter focuses on the main diagnostic and treatment issues related to patients presenting with psychiatric symptoms in the palliative care setting. Specific pharmacological treatments and general aspects such as coping, defenses, and communication skills are discussed. A supportive attitude towards the patient’s own efforts to cope with a severe illness, as well as a proactive attitude, intended to integrate major biographical and contextual aspects in the patient’s treatment plan are proposed here.
Personal Identity and Palliative Care
Authors: Defanti Carlo A
Published: November 2023

This chapter explores the issue of personal identity and its possible alterations due to brain diseases. Impairment of cognition and other higher nervous functions can be severe enough to alter the personality of affected people to such a degree that the question of their personal identity is raised. Even though this philosophical problem may appear to be far removed from the reality of hospital wards, in fact it is relevant for the clinical decision-making process, especially during the advanced stages of dementia, in, for instance, challenging the authority of advance directives for health care. Moreover, personal identity and its preservation can and should be a therapeutic goal for palliative care of demented people.
Informed Consent
Authors: Bernat James L
Published: November 2023

All patients have the ethical right of informed consent and refusal that requires physicians, except in emergency treatment, to seek their permission before proceeding with medical care. This right is transferred to a legally authorized surrogate decision maker to exercise on their behalf when patients lose the capacity to make health-care decisions. Patients and surrogates require adequate information and the absence of coercion. Ideally, patients and physicians will practice shared decision making so the decision is patient-centered. Surrogates for incompetent patients should attempt to follow the explicit or implicit preferences of the patients they represent and decide in their best interest when they lack knowledge of their treatment preferences. Child patients should be included in the consent process to the extent they are capable of understanding. Consent is a process and not an event. It is a communication process that evolves over time. Consent for participation as a human research subject imposes even stricter standards of information exchange and lack of coercion than consent for treatment.
Physical separations of elements: compartments and zones in biology
Authors: Fraústo da Silva J J R , Williams R J P
Published: November 2023

In order to understand the observed binding of the chemical elements, metals and non-metals, to particular chemical sites in biological systems, we have discussed three factors: (1) the limitations on the concentration of chemical elements imposed by their abundance and availability in the environment; (2) the possibility of adjusting this availability in a cell by pumping an element or compound across a single membrane into or out of its inner aqueous phase; (3) the intrinsic stability, thermodynamic and kinetic, of the association of the chemical elements with particular ‘ligand’ frameworks which have ‘designed’ structures, either in solution or in a condensed phase.
Phosphate, Silica, and Chloride: Acid-base Non-metals
Authors: Fraústo da Silva J J R , Williams R J P
Published: November 2023

It is not warranted to give in this book anything but passing reference to the non-metal chemistry of H, C, N, and O since these four elements form the central part of organic biochemistry and there are excellent volumes dealing with this subject. At the same time, it is pertinent to give a summary table (Table 18.1) of the involvement of metal ions with virtually all the small molecules which are the available precursors of biological organic chemistry.
The seven elements of a highly effective bowel habit
Authors: Levitt Michael
Published: November 2023

Most people believe that it is the number of bowel actions per day or per week that determines whether or not their bowel habit is normal. This is simply not so. Although a large majority of individuals do have their bowels open from between three times daily to every third day, there are, amongst these, many who are dissatisfied with their lot. What is more, many perfectly ‘normal’ people have their bowels open less frequently than every third day.

As it is, nearly all of us experience daily, though subtle, fluctuations of varying degrees in our bowel habit. None of us produce an identical stool two days in a row! There is also a marked difference between men and women: on average, men have their bowels open more often, produce softer faeces, and much more gas than do women, even when eating a similar diet. A large majority of (heterosexual) couples will have made this observation already!
Urgency and incontinence of faeces
Authors: Levitt Michael
Published: November 2023

Inability to control one’s bowels is amongst the most humiliating experiences an adult is ever likely to encounter. Whilst this is a rare event for most of us— usually only experienced in the course of a bout of food poisoning or gastroenteritis—it may be a recurring nightmare for some.

There are many different causes of anal incontinence, reflecting the interplay of stool frequency and consistency, anal sphincter muscle strength, and the efficiency of rectal emptying. Most sufferers—and very often their doctors—focus on the anal sphincter as the likely culprit: ‘My muscles are too weak’; ‘I can’t seem to shut off my back passage’. Although these highly specialized muscles may be weakened or torn by childbirth, surgery, or trauma, they are often not to blame.
Pain, bleeding, piles, and prolapse
Authors: Levitt Michael
Published: November 2023

Anal pain. Rectal bleeding. Perianal prolapse and swelling. These are amongst the most common human physical complaints. And why not? Almost everyone on earth has an anus and each of us uses it, often on numerous occasions every day. Luckily for doctors working in this field, the range of possible causes for these complaints is small making diagnosis relatively easy. Even luckier, for the sufferers of anal pain, bleeding, piles, and prolapse, their causes are rarely serious.

Yet the vast majority of people prefer to suffer in silence rather than disclose this most private part of their anatomy. Home remedies, expensive over-the-counter creams or suppositories and horror stories about surgical treatment abound. Doctors themselves have little training in the diagnosis and treatment of these conditions, and misdiagnosis, though rarely serious, is common. Almost all of these anal complaints tend, at some stage to be labelled ‘haemorrhoids’, resulting in unnecessary prolongation of symptoms and undue expense.
Recap: When bowel motions get too soft
Authors: Levitt Michael
Published: November 2023

There is no doubt that constipation because of slow colonic transit and bowel motions that have become too hard is a common problem. Yet, we have never been better informed about the benefits of increasing our dietary fibre and have been well and truly brainwashed into believing that we must all strive to achieve a consistently soft bowel motion.

For the record, dietary fibre does play an important role in providing us with essential vitamins not available from other dietary sources. What is more, fibre can help lower blood cholesterol levels and appears to have a protective effect against the development of bowel cancer and, probably, breast cancer. So it’s true: fibre is good for you. But where is it written that if a little of something is good for you, then a whole bucketful is necessarily better? And why should it be true that if more fibre is good for some of us, then it just has to be good for everyone else too?
Practice building – relationships around the patient
Authors: Trevor Burke F J , Freeman Ruth
Published: November 2023

Despite the acknowledgement of the need for understanding and the provision of appropriate health care, recent research has shown that a ‘gap’ exists between the treatment actions of the dentist and the treatment wishes of the patient (Newsome et al. 2000). The ‘gap’ is exacerbated by the dentist’ s apparent lack of effective communication skills which is further compounded by his/her use of technical terms and jargon. Rather than being the centre of attention, some patients, according to Newsome et al. (2000), feel that they are relegated to the periphery with their treatment wishes remaining unfulfilled.
Essential business principles of dental practice
Authors: Trevor Burke F J , Freeman Ruth
Published: November 2023

Two of these, the balance sheet and the profit and loss accounts, are traditionally prepared by an accountant for the purpose of taxation, and thus known as the ‘accounts’ The others (cash flow forecast and budget) are useful in the management of the business but are not required by the Inland Revenue. Because they are not legally required, this often means the business owner does not prepare them, which is a pity as they can be both useful and valuable documents.
Pathological mutations affecting mitochondrial protein synthesis
Authors: Jacobs Howard T
Published: November 2023

Just as in yeast, mitochondrial DNA mutations in humans can be classified into three broad categories: point mutations affecting protein-coding genes (designated mit  − in yeast), point mutations affecting the protein synthetic apparatus (syn  − in yeast), and large deletions. Large deletions in yeast, a class of mtDNA mutants designated ρ−, are represented as long, tandem repeats of the non-deleted segment of mtDNA.
Mitochondrial dysfunction in neurodegenerative disease
Authors: Cooper JM
Published: November 2023

Mitochondria are recognized for their key role in supplying ATP for normal cell function, which is particularly important for high-energy requiring cells such as neurones. However, the generation of free radicals by the respiratory chain and the involvement of the mitochondrion in cellular calcium buffering and regulation of apoptosis may also contribute to the involvement of mitochondrial dysfunction in disease. The first section of the chapter focuses on various factors that may influence mitochondrial function, and their relationship to pathogenesis.
Gene therapy for mitochondrial DNA disorders
Authors: Bigger B , Taylor RW , Turnbull, DM , Lightowlers RN
Published: November 2023

Mutations of the mitochondrial genome (mtDNA) cause a variety of progressive clinical disorders for which there is no effective treatment. Consequently, novel therapeutic approaches are being considered. Mitochondrial genetics is complex, with single cells containing many hundreds or thousands of mtDNA molecules and in the disease state there are often populations of mutated and wild type mtDNA coexisting in the same cell or tissue. As the defective genome is expressed within the mitochondrial matrix surrounded by two membranes, any therapeutic molecule must reach this compartment.
The practice as an organization
Authors: Launer John
Published: November 2023

Practices lie at the heart of family medicine in Britain. They are the physical and emotional homes for GPs and primary care teams for most of our working lives. Yet almost everything that is written about general practice ignores the work setting itself. There is a British Journal of General Practice, but no Journal of General Practices. This focus on the content of our work, with a selective inattention to the working context, is telling. It invites comparison with theories of mind that focus on the individual ‘s inner life, while studiously ignoring any background of biographical history or family interaction. In both cases, the narrowness of view leads to an impoverished approach, even a disturbed one.
Management of serious mental illness
Authors: Wright Christine , Burns Tom
Published: November 2023

Serious mental illness is rarely an isolated episode. A diagnosis of schizophrenia, bipolar affective disorder, or recurrent severe depressive illness, is, at best, a lifelong vulnerability and, at worst, a continuous chronic condition with serious associated disabilities. Like many physical chronic diseases, such an illness demands of the individual and those closest to them acceptance of a highly unpalatable diagnosis, adjustments in lifestyle and life expectations, and the often unwelcome realities of long-term treatment and service involvement— if relapse and long-term disability are to be minimized. As with other chronic diseases, the organization of care needs to include a greater emphasis on certain key elements.
Suicide, deliberate self-harm and severe depressive illness
Authors: Evans Jonathan
Published: November 2023

Those who work in primary care could be forgiven for thinking that suicide is a rare event, which is difficult to predict and therefore difficult to prevent. It might be thought that those who are going to kill themselves do not consult their GP before doing so and that if they do they will be unlikely to disclose their intent. It is difficult enough to predict suicide amongst high-risk groups within secondary care (Pokorny 1983) and so the challenge in primary care should not be under-estimated.
A significant digression
Authors: Ulfstrand Staffan
Published: November 2023

Charles Darwin (1809–1882) wrote these words in the introduction to his book about the origin of species through natural selection, published in 1859. The conclusions he drew were based primarily on impressions gathered during a five-year voyage around the world on board HMS Beagle. What he saw during that long voyage caused him to question the concept of the immutability of species. He adopted the budding idea that, with certain modifications, species currently living (very probably our own species as well) had evolved from other species and—most importantly—he suggested a mechanism which could explain how these modifications originated and why their designs were so well adapted to their purposes. It is difficult to think of any other book that has had such a comprehensive and lasting influence on human thought as Darwin’s On the Origin of Species.
Savannah ruminants: five different lifestyles
Authors: Ulfstrand Staffan
Published: November 2023

About 80 million years ago a group of archaic mammals roamed the earth, mammals that would in turn give rise to many of today’s large savannah herbivores. As early as the beginning of the Tertiary (65 million years ago), one species within this enigmatic group divided and produced two evolutionary lines. Of these, one evolved into two of the orders of mammals alive today, namely, the artiodactyls (aardvark, swine, giraffes, camels, and the hollow-horned bovines) and whales, while the other lineage is represented today by perissodactyls (horses, rhinoceroses, and tapirs), sea cows, hyraxes, and elephants. Thus, a cow is actually more closely related to a whale than to a horse.