bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating 3-omics data analyze rat lung tissue of COPD states and medical intervention by delineation of molecular and pathway alterations
Authors: Li Jiansheng , Zhao Peng , Yang Liping , Li Ya , Tian Yange , Li Suyun , Bai Yunping
Published: April 2017

Chronic obstructive pulmonary disease (COPD) is a serious health problem. However, the molecular pathogenesis of COPD remains unknown. Here, we explored the molecular effects of cigarette smoke and bacterial infection in lung tissues of COPD rats. We also investigated therapeutic effects of aminophylline (APL) on the COPD rats and integrated transcriptome, proteome, and metabolome data for a global view of molecular mechanisms of COPD progression. Using molecular function and pathway analyses, the genes and proteins regulated in COPD and APL-treated rats were mainly attributed to oxidoreductase, antioxidant activity, energy and fatty acid metabolism. Furthermore, we identified hub proteins such as Gapdh (glyceraldehyde-3-phosphate dehydrogenase), Pkm (pyruvate kinase isozymes M1/M2), and Sod1 (superoxide dismutase 1), included in energy metabolism and oxidative stress. Then, we identified the significantly regulated metabolic pathways in lung tissues of COPD- and APL-treated rats, such as arachidonic acid, linoleic acid, and α-linolenic acid metabolism, which belong to the lipid metabolism. In particular, we picked the arachidonic acid metabolism for a more detailed pathway analysis of transcripts, proteins, and metabolites. We could observe an increase in metabolites and genes involved in arachidonic acid metabolism in COPD rats and the decrease in these in APL-treated rats, suggesting that inflammatory responses were up-regulated in COPD rats and down-regulated in APL-treated rats. In conclusion, these system-wide results suggested that COPD progression and its treatment might be associated with oxidative stress, lipid and energy metabolism disturbance. Additionally, we demonstrated the power of integrated omics for the elucidation of genes, proteins, and metabolites’ changes and disorders that were associated with COPD.
Surveillance sanitaire estivale des populations piscicoles du Rhône au voisinage du Centre Nucléaire de Production d'Électricité (CNPE) du Tricastin. Synthèse 2008–2013
Authors: Girard P. , Brana J.-Y. , Fruget J.-F.
Published: April 2017

Une surveillance sanitaire des populations piscicoles du Rhône a été mise en place chaque été depuis 2005 en amont et en aval du CNPE du Tricastin dans le cadre de la surveillance préventive en cas d'aléa thermique impactant la production d'électricité. Elle s'appuie sur des descripteurs biologiques pertinents et validés (indice de condition, parasitisme) et sur deux outils méthodologiques originaux, les « codes pathologie » et « l'indice pathologique ». Une trentaine d'individus par station et par campagne sont capturés par pêche électrique à un rythme hebdomadaire durant la période estivale. Ils appartiennent essentiellement aux espèces suivantes : chevaine (Squalius cephalus) et gardon (Rutilus rutilus), puis perche fluviatile (Perca fluviatilis), barbeau fluviatile (Barbus barbus) et goujon (Gobio gobio). Bien qu'un écart moyen de température de l'eau de l'ordre de 1,3 °C soit observé pour la température tendancielle lors de nos campagnes d'échantillonnage au cours de la saison estivale (fin juin – début septembre) entre la station aval échauffée et la station amont (min 0,4 °C, max 2,3 °C), l'étude ne met pas en évidence de différence significative des indices de condition moyens (Icm) ainsi que des prévalences des lésions externes moyennes des poissons entre l'amont et l'aval après mélange. En revanche, l'effet combiné température et débit pourrait expliquer la variation interannuelle des prévalences de lésions observées au cours de l'étude. Le maximum de lésions est observé lors des années chaudes et à faible débit (2009) alors que les années froides et à fort débit sont caractérisées par des prévalences de lésions plus faibles (2013). Au final, aucun des effets constatés, directs ou indirects, n'est spécifique de l'action de la seule augmentation de température et ne démontre pas de manière significative une action de celle-ci sur les différents indices utilisés et, donc, sur l'état de santé des poissons. Le débit est également susceptible de représenter un facteur de stress majeur pour l'ichtyofaune et d'agir sur l'intégrité des individus. En revanche, la qualité physico-chimique standard et toxique ne semble pas être un facteur discriminant sur le Rhône. Les lésions observées dans le cadre de cette étude sont plus le fait d'atteintes pathologiques mineures, essentiellement provoquées par des bactéries opportunistes, que de problèmes toxicologiques. Dans le cadre de l'effet de plus en plus prégnant du changement climatique global sur les hydrosystèmes continentaux, une réflexion sur la prise en compte et le suivi des effets potentiels du réchauffement engendré sur le développement des maladies des poissons et sur le comportement des espèces résidentes et migratrices semble nécessaire, d'autant plus que d'autres descripteurs (hématologiques et histologiques) sont également susceptibles d'être intégrés dans ces outils de diagnostic et de surveillance de l'état de santé des populations piscicoles.
Leadership in Pediatric Surgery from a Senior's Perspective
Authors: Tovar Juan
Published: April 2017

Management of a pediatric surgical group involves organization, coordination, and direction of human resources in an attempt to achieve the best results in an efficient way. However, true leadership of such group should also involve inspiring it with a purpose. The superior interest of the patients and their families will be better served by achieving excellence at all levels of care, research, teaching, and diffusion of the results. These values are the core of the leader's action and may be difficult to develop in a hospital framework in which the main decisions are not always into his/her hands.

This review summarizes a theory on leadership at large and then analyzes in detail the peculiarities that distinguish surgical and pediatric surgical departments from a corporation in an attempt to extend the application of the principles of leadership to these structures.

Finally, the steps possibly taken by prospective leaders toward achieving that condition and some tips for the candidates based on the personal experience of the author are advanced.
Belastungen von Fachkräften in stationären Einrichtungen für Kinder und Jugendliche
Authors: Rau Thea , Ohlert Jeannine , Seidler Corinna , Fegert Jörg , Allroggen Marc
Published: April 2017

Psychische Belastungen von Fachkräften werden als zunehmend wichtiges Thema in stationären Einrichtungen für Kinder und Jugendliche betrachtet. Demgegenüber liegen nur wenige Studien vor, die Belastungserleben von pädagogischen Fachkräften allgemein und speziell in Jugendhilfeeinrichtungen untersuchen. Ziel der vorliegenden Studie war, Belastungserleben bei Fachkräften mittels des „Perceived Stress Questionnaire“ (PSQ) in Einrichtungen der Jugendhilfe zu erheben sowie dessen Zusammenhang mit Alter, Dauer der Tätigkeit im Arbeitsfeld und Geschlecht zu untersuchen. Insgesamt nahmen 426 Fachkräfte aus Jugendhilfeeinrichtungen an der Online-Studie teil. Die Ergebnisse zeigen tendenziell höhere Belastungswerte bei jüngeren Fachkräften und signifikant höhere Werte bei Anspannung im Vergleich zu älteren Mitarbeitenden, jedoch keinen Effekt von Geschlecht. Weiterhin besteht kein Zusammenhang zwischen Belastungserleben und Dauer der Tätigkeit im Arbeitsfeld, jedoch ein signifikanter Zusammenhang zwischen einem Gefühl von Sicherheit vor Gewalt in der Einrichtung und Belastung. Der Gesamtscore für Belastungserleben bei Fachkräften ist vergleichbar mit dem von gesunden Erwachsenen, während sich in den Subskalen im Vergleich zur Normstichprobe höhere Werte bei Anforderungen im Sinne von Termin- und Zeitdruck sowie bei Anspannung zeigen. Die Ergebnisse weisen auf eine hohe Vulnerabilität von jungen Fachkräften hin, der möglicherweise mit institutionellen Maßnahmen begegnet werden kann. Zur Klärung kausaler Zusammenhänge sind weitere Studien notwendig.
Coarse-graining strategy for molecular pair interactions: A reaction coordinate study for two- and three-dimensional systems
Authors: Heinemann Thomas , Klapp Sabine H. L.
Published: April 2017

We investigate and provide optimal sets of reaction coordinates for mixed pairs of molecules displaying polar, uniaxial, or spherical symmetry in two and three dimensions. These coordinates are non-redundant, i.e., they implicitly involve the molecules’ symmetries. By tabulating pair interactions in these coordinates, resulting tables are thus minimal in length and require a minimal memory space. The intended fields of application are computer simulations of large ensembles of molecules or colloids with rather complex interactions in a fluid or liquid crystalline phase at low densities. Using effective interactions directly in the form of tables can help bridging the time and length scales without introducing errors stemming from any modeling procedure. Finally, we outline an exemplary computational methodology for gaining an effective pair potential in these coordinates, based on the Boltzmann inversion principle, by providing a step-by-step recipe.
Wireless power transfer inspired by the modern trends in electromagnetics
Authors: Song Mingzhao , Belov Pavel , Kapitanova Polina
Published: April 2017

Since the beginning of the 20th century, researchers have been looking for an effective way to transfer power without wired connections, but the wireless power transfer technology started to attract extensive interest from the industry side only in 2007 when the first smartphone was released and a consumer electronics revolution was triggered. Currently, the modern technology of wireless power transfer already has a rich research and development history as well as outstanding advances in commercialization. This review is focused on the description of distinctive implementations of this technology inspired by the modern trends in electrodynamics. We compare the performances of the power transfer systems based on three kinds of resonators, i.e., metallic coil resonators, dielectric resonators, and cavity mode resonators. We argue that metamaterials and meta-atoms are powerful tools to improve the functionalities and to obtain novel properties of the systems. We review different approaches to enhance the functionality of the wireless power transfer systems including control of the power transfer path and increase of the operation range and efficiency. Various applications of wireless power transfer are discussed and currently available standards are reviewed.
Gain mechanism and carrier transport in high responsivity AlGaN-based solar blind metal semiconductor metal photodetectors
Authors: Rathkanthiwar Shashwat , Kalra Anisha , Solanke Swanand V. , Mohta Neha , Muralidharan Rangarajan , Raghavan Srinivasan , Nath Digbijoy N.
Published: April 2017

We report on the highest responsivity for III-nitride Metal Semiconductor Metal solar-blind photodetectors on sapphire. Devices on unintentionally doped AlGaN epilayers grown by Metal Organic Chemical Vapor Deposition exhibited sharp absorption cut-off in the range of 245–290 nm. Very high responsivity >5 A/W at 10 V bias was achieved with visible rejection exceeding three orders of magnitude for front illumination. Compared to the responsivity values reported in the literature for state-of-the-art solar-blind photodetectors, this work presents the highest values of responsivity at a given bias and up to sub-250 nm detection threshold. The high responsivity is attributed to an internal gain mechanism operating on these devices. The reverse-bias leakage current across these samples was found to be dominated by thermionic field emission at low biases and Poole-Frenkel emission from a deep trap level (0.7 eV from the conduction band-edge for Al0.50Ga0.50 N) at high biases.
Interatomic potential to study plastic deformation in tungsten-rhenium alloys
Authors: Bonny G. , Bakaev A. , Terentyev D. , Mastrikov Yu. A.
Published: April 2017

In this work, an interatomic potential for the W-Re system is fitted and benchmarked against experimental and density functional theory (DFT) data, of which part are generated in this work. Having in mind studies related to the plasticity of W-Re alloys under irradiation, emphasis is put on fitting point-defect properties, elastic constants, and dislocation properties. The developed potential can reproduce the mechanisms responsible for the experimentally observed softening, i.e., decreasing shear moduli, decreasing Peierls barrier, and asymmetric screw dislocation core structure with increasing Re content in W-Re solid solutions. In addition, the potential predicts elastic constants in reasonable agreement with DFT data for the phases forming non-coherent precipitates (σ- and χ-phases) in W-Re alloys. In addition, the mechanical stability of the different experimentally observed phases is verified in the temperature range of interest (700–1500 K). As a conclusion, the presented potential provides an excellent tool to study plasticity in W-Re alloys at the atomic level.
Effect of nonlinear energy transport on neoclassical tearing mode stability in tokamak plasmas
Authors: Fitzpatrick Richard
Published: April 2017

An investigation is made into the effect of the reduction in anomalous perpendicular electron heat transport inside the separatrix of a magnetic island chain associated with a neoclassical tearing mode in a tokamak plasma, due to the flattening of the electron temperature profile in this region, on the overall stability of the mode. The onset of the neoclassical tearing mode is governed by the ratio of the divergences of the parallel and perpendicular electron heat fluxes in the vicinity of the island chain. By increasing the degree of transport reduction, the onset of the mode, as the divergence ratio is gradually increased, can be made more and more abrupt. Eventually, when the degree of transport reduction passes a certain critical value, the onset of the neoclassical tearing mode becomes discontinuous. In other words, when some critical value of the divergence ratio is reached, there is a sudden bifurcation to a branch of neoclassical tearing mode solutions. Moreover, once this bifurcation has been triggered, the divergence ratio must be reduced by a substantial factor to trigger the inverse bifurcation.
Quantifying self-organization in fusion plasmas
Authors: Rajković M. , Milovanović M. , Škorić M. M.
Published: April 2017

A multifaceted framework for understanding self-organization in fusion plasma dynamics is presented which concurrently manages several important issues related to the nonlinear and multiscale phenomena involved, namely,(1) it chooses the optimal template wavelet for the analysis of temporal or spatio-temporal plasma dynamics, (2) it detects parameter values at which bifurcations occur, (3) it quantifies complexity and self-organization, (4) it enables short-term prediction of nonlinear dynamics, and (5) it extracts coherent structures in turbulence by separating them from the incoherent component. The first two aspects including the detection of changes in the dynamics of a nonlinear system are illustrated by analyzing Stimulated Raman Scattering in a bounded, weakly dissipative plasma. Self-organization in the fusion plasma is quantitatively analyzed based on the numerical simulations of the Gyrokinetic-Vlasov (GKV) model of plasma dynamics. The parameters for the standard and inward shifted magnetic configurations, relevant for the Large Helical Device, were used in order to quantitatively compare self-organization and complexity in the two configurations. Finally, self-organization is analyzed for three different confinement regimes of the MAST device.
Mixed farming diversification may be costly: southern Queensland case study
Authors: Zull A. F. , Owens J. , Bourgault M. , Johnson B. , Peck G. , Christodoulou N.
Published: April 2017

Many farmers in Australia and in other countries have a choice of crop or livestock production, and many choose a mixture of both, based on risk preference, personal interests, markets, land resources and local climate. Mixed farming can be a risk-spreading strategy, especially in highly variable climates, but the right scales of each enterprise within the mix may be critical to farm profitability.
To investigate expected farm profits, the probability of breaking even, as well as the worst and best case scenarios, we used farm data and APSIM (Agricultural Production Systems Simulator) to simulate the production of a typical, semi-arid, mixed-farm in southern Queensland. Three farming system scenarios were investigated: I, livestock and more intensive cropping; II, current production system of livestock and minimal cropping; and III, livestock only. We found that the expected profits were in the order system I > system III > system II. The key reason for the lower profits of system II was the high overhead cost of capital to continue some cropping, with low annual cropping income. Under the worst case scenario, in years with low rainfall, system I had the greatest downside risk with far greater financial losses. Systems I and III had similar probabilities of breaking even, and higher than system II, which incurs cropping overheads and limited cropping returns. Therefore, system II was less desirable than either system I or III. This case study helps farmers and advisors of semi-arid mixed farming enterprises to be better informed when making decisions at the paddock and whole-farm level, in both the short and long term, with respect to profit and risk. The method used in this paper can be applied to other mixed farms, in Australia and elsewhere.
Clitic climbing in the speech of Braga and Lisbon
Authors: Barbosa Pilar , de Paiva Maria da Conceição , Martins Kellen Cozine
Published: April 2017

In European Portuguese, clitic pronouns can be attached to the highest verb in certain verbal clusters, a process known as clitic climbing (CC). According to some authors (Magro, 2005), CC is more productive in the Northern varieties of European Portuguese. In this chapter, we present and discuss the findings of a comparative analysis of Braga and Lisbon oral speech. Our main claim is that CC is a stable variation phenomenon. By means of a multivariate analysis, we show that CC is more frequent than attachment of the clitic to the infinitive in the two varieties. Moreover, we discuss evidence in favor of the claim that this syntactic variation presents the same configuration in both varieties: it is lexically constrained and not socially marked.
Sortilin and retromer mediate retrograde transport of Glut4 in 3T3-L1 adipocytes
Authors: Pan Xiang , Zaarur Nava , Singh Maneet , Morin Peter , Kandror Konstantin V.
Published: April 2017

Sortilin is a multiligand sorting receptor responsible for the anterograde transport of lysosomal enzymes and substrates. Here we demonstrate that sortilin is also involved in retrograde protein traffic. In cultured 3T3-L1 adipocytes, sortilin together with retromer rescues Glut4 from degradation in lysosomes and retrieves it to the TGN, where insulin-­responsive vesicles are formed. Mechanistically, the luminal Vps10p domain of sortilin interacts with the first luminal loop of Glut4, and the cytoplasmic tail of sortilin binds to retromer. Ablation of the retromer does not affect insulin signaling but decreases the stability of sortilin and Glut4 and blocks their entry into the small vesicular carriers. As a result, Glut4 cannot reach the insulin-responsive compartment, and insulin-stimulated glucose uptake in adipocytes is suppressed. We suggest that sortilin- and retromer-mediated Glut4 retrieval from endosomes may represent a step in the Glut4 pathway vulnerable to the development of insulin resistance and diabetes.
Ambulatory Presentations in Adults and Children
Authors: O’Neal Mary Angela , Caplan Rochelle
Published: April 2017

Psychogenic nonepileptic seizures (PNES) present in a myriad of ways to multiple different providers, making it a challenging diagnosis. Furthermore, patients with PNES are frequently misdiagnosed as having epilepsy and treated with anticonvulsants. The purpose of this chapter is to describe some of the common outpatient presentations for both adults and children with PNES, how patients may present to different providers, and the differential diagnoses associated with their presentation. The chapter then presents adult and child cases to illustrate these presentations and underscore some of the common pitfalls and difficulties in diagnosing PNES.
Neurological and Medical Factors
Authors: Wong Victoria S. S. , Salinsky Martin
Published: April 2017

This chapter addresses the neurological and medical factors associated with psychogenic nonepileptic seizures (PNES). PNES can occur concurrently with epilepsy in 5 to 20% of patients. Traumatic brain injury (TBI) is a major cause of epilepsy, but it is also commonly cited by patients with PNES as the primary cause of their seizures. PNES are also overrepresented in patients with intellectual and learning disabilities. Patients with PNES usually have additional subjective neurological and medical complaints. Pain complaints are overrepresented in patients with PNES and are a major contributor to health care use. Cognitive complaints are also common, with a patient’s mood playing a larger role than objective cognitive dysfunction. Medically unexplained symptoms such as fibromyalgia and chronic fatigue syndrome are overrepresented in patients with PNES. Their occurrence increases the likelihood of diagnosing PNES over epilepsy. These observations reveal a complex pattern of susceptibility to the development of PNES. PNES are thus best viewed as only one symptom of a heterogeneous disorder characterized by multiple physical symptoms used to express psychological distress.
Diagnostic Challenges for the Mental Health Team and Psychiatrist
Authors: Myers Lorna , Barry John J.
Published: April 2017

Establishing a positive therapeutic alliance during the initial psychiatric interview allows the clinician to collect the necessary diagnostic information and can have a significant impact on a patient’s decision to follow up with treatment recommendations once the diagnosis of psychogenic nonepileptic seizures (PNES) is determined. When evaluating a patient with suspected PNES in an out- or inpatient setting, there are a variety of clinician behaviors that can support or obstruct the establishment of a positive therapeutic alliance. Similarly, a number of typical patient characteristics in PNES can affect the psychiatric assessment. In this chapter, these characteristics and behaviors are discussed, a clinician checklist is provided, and dialogue boxes illustrate a few common patient–clinician interactions, hypothetical challenges, and clinician responses. Distinctive challenges, including interaction with specific PNES subtypes (i.e., developmentally delayed, malingering, or hostile patients) and patients who are effectively incapacitated by high event frequency and systemic barriers, are presented.
Clinicians’ Response to the Diagnosis
Authors: Plioplys Sigita , Abbas Shan , Smith Brien
Published: April 2017

This chapter explores clinicians’ attitudes toward the diagnosis and treatment of psychogenic nonepileptic seizures (PNES). Across medical specialties, many clinicians report misconceptions about the nature of PNES, which contributes to a negative attitude toward this disorder and difficulties interacting with PNES patients. When working with PNES patients, clinicians often experience feelings of professional incompetency, frustration, and anxiety, which can negatively impact the clinician–patient relationship and treatment outcome. Recommendations to increase clinicians’ knowledge about PNES, promote more positive attitudes toward the disorder, and improve the clinician–patient relationship are provided.
Models of Care
Authors: Sawchuk Tyson , Austin Joan K. , Terry Debbie
Published: April 2017

This chapter addresses common barriers to care delivery in psychogenic nonepileptic seizures (PNES) and limitations of current approaches. Theoretical and practical considerations in delivering PNES care are discussed. These include a stepped-care approach, which offers a strategy for efficiently managing health care resources and has promise in treatment of PNES. Patient-centered care, a general approach to providing health care services in a manner that takes into consideration the patients’ expressed needs, desires, and preferences, is also considered. Examples of care models are presented, including a pediatric model for PNES recently developed and being tested in a Canadian hospital setting. Future directions for the development of care models in PNES are discussed and a list of recommendations is provided.
The Roles of the Patient and Family
Authors: Doss Julia L. , Robbins Jeffrey Mark
Published: April 2017

Psychogenic nonepileptic seizures (PNES) is a complicated disorder to both diagnose and treat. While challenging to manage, the physical symptoms represent only a part of the treatment of PNES. This chapter addresses how to approach the family and the patient from the first diagnostic encounter to the evolving process of outpatient treatment. In addition, working with pediatric and adult patients differs significantly. Pediatric patients with PNES must develop tools for improved management of their symptoms first and then proceed to working on underlying stressors. For adult patients, making the connection between symptoms and underlying stressors is an ongoing process that is woven throughout the course of treatment. Both an adult and a child case are presented to further illustrate these dynamics.
Toward the Integration of Care
Authors: Baslet Gaston , Dworetzky Barbara A.
Published: April 2017

Patients with psychogenic nonepileptic seizures (PNES), a subtype of functional neurological symptom disorder (FNSD), receive suboptimal care owing to a number of factors, including the poorly understood nature of the disorder, limited evidence-based treatments, limited education within training programs, and a divided healthcare system. This chapter reviews the impact that such factors have in the delivery of care and attitude toward patients with PNES and FNSD. The chapter constructively proposes how recent advances can be turned into therapeutic opportunities from the point of view of clinical care and education and training, by using an integrated care approach. The specific components and goals of the integrated care model are discussed. The ultimate goal is that all aspects of the patient’s life are aligned toward maximum recovery and optimized functioning. Finally, the positive impact that such a model can have in training programs is emphasized. A change in the delivery of care for FNSD patients represents an opportunity to integrate these disorders within the realm of modern medicine with a compassionate and empathic professional attitude.
Facilitating Treatment Adherence in Pain Medicine
Authors: Cheatle Martin D. , Fine Perry G.
Published: April 2017

Almost daily, we seem to be witnessing astonishing innovations in diagnostic technologies and the development of novel therapeutics. In spite of these advancements and other time-tested interventions to mange the major diseases including intractable pain, patient nonadherence continues to undermine efforts to optimize individual and population health. The World Health Organization defines adherence as “The extent to which a person’s behavior taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare provider.” This definition implies that the patient-clinician relationship is based on a model of collaboration and patient-centeredness requiring time and resources which are scarce commodities in current practice. With these constraints in mind, acquiring skills to facilitate adherence to prescribed therapies and healthy lifestyle behaviors is critical to improving clinical outcomes.

In this chapter we will review the evolution of the concept of adherence, the incidence of nonadherence, factors influencing adherence behavior and provider and nonprovider enhancement of adherence.
Adherence in Pharmacotherapy
Authors: Martel Marc O. , Jamison Robert N.
Published: April 2017

This chapter summarizes the factors that have been found to be associated with an increased risk of pharmacotherapy adherence problems among patients with chronic pain. An overview of screening instruments and strategies that can be used for the assessment and management of patients at risk of medication nonadherence is also addressed. Given that research on pharmacotherapy adherence among patients with pain has predominantly been conducted in the context of opioid therapy, a particular emphasis is placed on opioids. However, issues associated with adherence to nonopioid pharmacotherapies are also addressed throughout the various sections of this chapter. Recommendations regarding pharmacotherapy for chronic pain are provided.
Adherence in Pain Medicine
Authors: Schatman Michael E. , Benitez Oscar J.
Published: April 2017

This chapter reviews adherence to treatment options in pain medicine from the clinician’s point of view. Adherence is discussed in the context of principle-based ethics through the four tenets of autonomy, nonmaleficence, beneficence, and justice. Treatment adherence for pain medicine on the part of the clinician transcends mere compliance with opioid prescriptions and policies. Adherence is addressed as a broad-based approach that can be clinically appropriate when principle-based ethics are followed. The shortage of clinical therapists and the corresponding role of clinical psychologists are discussed. Ways to find a balance between the issues of abuse and underprescribing are also addressed.
Clinical pharmacy skills
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines the skills relevant to clinical pharmacists and covers a variety of topics to support newly qualified pharmacists working in clinical areas. In particular, this chapter covers pharmacist endorsing of drug charts and writing in medical notes, how to deal with a variety of situations such as distressed or dying patients, and issues that pharmacists will come across during their daily work on the ward. It also covers a variety of skills such as communication, presentation, time management, and prioritization.
Controlled drugs
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at hospital pharmacists and technicians and provides a helpful overview on dealing with instances when controlled drugs are reported as missing. It provides a framework on dealing with such situations and differentiates between the pharmacy department and clinical areas. The chapter also discusses patients’ own controlled drugs in a hospital setting, including the use, return, disposal, and destruction of patients’ own controlled drugs.
Herbal medicines
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at all healthcare professionals, patients, and the general public to provide a brief insight to the importance of herbal medicines. The six sections provide a summary into the efficacy, general information relating to commonly used herbal medicines and Chinese herbs, including side effects and potential interactions with other medicines and surgical considerations that should improve patient safety. New to this edition is a section aimed at healthcare providers on sourcing evidence for herbal medicines enquiries from patients and the public.
Therapy-related issues: gastrointestinal
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at pharmacists and provides information on certain gastroenterology issues and is designed to complement the British National Formulary, Chapter 1. The individual sections cover diagnosis, symptoms, and treatment for diarrhoea, constipation, nausea and vomiting, dyspepsia, peptic ulcer disease, and reflux conditions. There is also a section concerning pharmaceutical issues for patients who have stomas.
Therapy-related issues: cardiovascular system
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter is aimed at junior hospital pharmacists and community pharmacists and is loosely based on the British National Formulary, Chapter 2. It covers diagnosis, symptoms, and treatment management plans for a variety of cardiovascular topics including hypertension, heart failure, and angina, and additional topics that cover issues related to anticoagulation, acute coronary syndromes, ST-segment elevation myocardial infarction, and cardiopulmonary resuscitation.
Therapy-related issues: skin
Authors: Wiffen Philip , Mitchell Marc , Snelling Melanie , Stoner Nicola
Published: April 2017

This chapter outlines information relevant to pharmacists and other healthcare professionals related to selected skin conditions. The review of wound care includes classification of wounds, selection of wound dressings, and a discussion of other wound care products and practices including topical antimicrobials, honey, larval therapy, and vacuum-assisted closure. Management of eczema covers the use of emollients, corticosteroids, and topical calcineurin inhibitors. The different treatments available to treat psoriasis are discussed, ranging from older agents such as coal tar to the role of biologics.
Growth and maturation
Authors: Baxter-Jones Adam DG
Published: April 2017

As children grow they increase in size and maturity. While growth refers to changes in size and complexity of tissue composition, maturation is the progressive achievement of adult status. A child’s growth status is an important determinant of current and lifelong health. Regular physical activity is required to obtain optimal growth. Normal healthy children show the same patterns of growth in terms of attainment of size and changes in proportionality. However, growth is not a linear process; the speed of statural growth decreases during infancy, is relatively constant during childhood, and accelerates during adolescence before slowing down in emerging adulthood. Although the patterns of growth are similar in all individuals, the timing and tempo of growth shows vast variability both within and between sexes. Thus it is important to remember that the effects of growth and maturation may mask or be greater than the effects of exercise.
Motor development
Authors: Sugden David , Soucie Helen
Published: April 2017

The development of motor skills in the first two years of life are dramatic, and then become more subtle with time. Chapter 4 describes these changes, and explains how these changes take place. Analysis is done via neuro-maturational theories, information processing, and cognitive terms as well as more recent ecological and dynamical systems viewpoints. The bidirectional influence of other faculties like embodied cognition and movement show that motor development does not occur in isolation. Movement skills are essential to daily life and influence our social, emotional, and cognitive being. This process of evolution and refinement is a complex, dynamic, self-organizing system. Theoretical explanations of motor development involve the transaction of children’s resources, the environmental context, and the task at hand. Not all children develop typically, although the influencing parameters are the same for all; rather, it is the metrics within the parameters that differ.
Muscle strength
Authors: De Ste Croix Mark BA
Published: April 2017

Strength increases in boys and girls until about the age of 14 years where it begins to plateau in girls and a spurt is evident in boys. By 18 years there are few overlaps in strength between boys and girls. The exact age in which gender differences become apparent is both muscle group- and muscle action-specific. There are few well controlled longitudinal studies that have concurrently examined the influence of known variables using appropriate statistical techniques. Most studies have shown that maturation does not exert an independent effect when other factors, such as stature and body mass, are accounted for. Additionally, the assumption that muscle cross-sectional area is the most important parameter in strength production does not hold when examined with other known variables. Consistently, stature appears to play a key role in strength development and this may be attributed to changes in the muscle moment arm.
Physical activity and bone health
Authors: Kemper Han CG , Fernandes Rômulo A
Published: April 2017

The growth and development of the skeleton during childhood and adolescence is an important determinant of the development of osteoporosis in later life. Therefore healthy behaviours adopted in early life are crucial in the promotion of bone health in adulthood. In the last decades, the available technology to monitor bone growth parameters has become more accurate and cheaper, improving the quality of longitudinal studies undertaken over the last few years. In childhood, the engagement in daily physical activities has a relevant impact on bone formation, mainly if weight-bearing activities are incorporated into it. The physical exercise-related osteogenic effects improve the bone health of boys and girls in different maturational stages. Moreover, the practice of organized sport incorporates osteogenic aspects, while well-structured physical education classes also seem relevant to improving bone health.
The assessment of physical activity
Authors: Hildebrand Maria , Ekelund Ulf
Published: April 2017

Physical activity (PA) is a complex human behaviour that comprises several dimensions, including intensity, frequency, duration, type/mode, and domain. PA outcomes can be divided into two main categories: the estimation of energy expenditure, and other quantifying metrics of PA. Subjective methods, including questionnaires and diaries, are often easy to use, cost-effective and are able to assess type of PA and to rank PA levels. However, they are prone to several limitations and are not able to provide accurate estimates of PA, energy expenditure, or intensity. Objective methods, including accelerometers and heart rate monitors, provide a reasonably accurate quantification of intensity, frequency, duration, and PA energy expenditure. When choosing a method for assessing PA several factors need to be considered, including validity, reliability, accuracy, and responsiveness, as well as the purpose of the study, the population being studied, and the outcome of interest.
Exercise, physical activity, and cerebral palsy
Authors: Dallmeijer Annet J , Balemans Astrid CJ , Verschuren Olaf
Published: April 2017

Children with cerebral palsy have major motor impairments that lead to reduced fitness and physical activity levels. Increased energy cost of walking in combination with reduced aerobic fitness induces high levels of physical strain that can lead to fatigue complaints and limited physical activity. To assess fitness, adapted laboratory and field exercise tests with good reliability and validity are available for both ambulant and wheelchair-using children with cerebral palsy. Children with cerebral palsy show increased sedentary time and low physical activity levels which relate to increased risks for health issues and loss of functional abilities at older age. Reducing sedentary time and increasing physical activity are important to counteract the increased health risks and loss of functional abilities. Fitness training of sufficient frequency, intensity, and duration is required to maintain and optimize long-term health and functional ability in children with cerebral palsy.
Protecting child athletes
Authors: Mountjoy Margo , Kirby Sandi , Tiivas Anne
Published: April 2017

Members of the athlete medical/sport science support team must be confident that athletes are benefitting from treatment, and that they are not victims of medical mismanagement. Athletes must not be treated differently to any other patient in society. This chapter discusses why protection of the child athlete is necessary, and how child athletes can be subjected to psychological abuse, which may form the gateway to other types of abuse. These can include physical abuse, sexual abuse, and neglect, all of which are prevalent in all sports and at all levels. It also covers particularly vulnerable groups of child athletes, including the elite, the disabled, and the LGB (lesbian, gay, bisexual) athlete populations. It covers the many sport organizations working in the field of child athlete protection, as well as the existing statutes governing the rights and freedoms of children in sport.
Paracoccidioidomycosis
Authors: Shikanai-Yasuda M.A.
Published: April 2017

Paracoccidioidomycosis is a systemic mycosis caused by dimorphic fungus of the complex Paracoccidioides brasiliensis, which is found in soil and in a variety of animals, and transmitted to humans by inhalation. It is restricted geographically to Central and South America, where it is the commonest endemic chronic human mycosis, acquired in rural and periurban areas, equally distributed among prepubescent boys and girls, but more frequent in men than women (10:1)....
The acute phase response and C-reactive protein
Authors: Pepys M.B.
Published: April 2017

The acute phase response—trauma, tissue necrosis, infection, inflammation, and malignant neoplasia induce a complex series of nonspecific systemic, physiological, and metabolic responses including fever, leucocytosis, catabolism of muscle proteins, greatly increased de novo synthesis and secretion of a number of ‘acute phase’ plasma proteins, and decreased synthesis of albumin, transthyretin, and high- and low-density lipoproteins. The altered plasma protein concentration profile is called the acute phase response. All endothermic animals mount a similar response, suggesting that it may have survival value, and increased availability of proteinase inhibitors, complement, clotting, and transport proteins presumably enhances host resistance, minimizes tissue injury, and promotes regeneration and repair....
Hereditary periodic fever syndromes
Authors: Lachmann Helen J. , Hawkins Philip N.
Published: April 2017

The hereditary periodic fever syndromes are autoinflammatory diseases that mostly present in childhood and are characterized by recurrent, self-limiting, seemingly unprovoked episodes of fever and systemic inflammation that occur in the absence of autoantibody production or identifiable infection.

Disorders include (1) familial Mediterranean fever (FMF), due to mutation in the gene encoding pyrin; (2) tumour necrosis factor (TNF) receptor associated periodic syndrome (TRAPS), due to mutation in a gene for a TNF receptor; (3) Mevalonate kinase deficiency and period fever (MKD), caused by mutations in the mevalonate kinase gene; and (4) the cryopyrin associated periodic syndromes (CAPS), which include (a) familial cold urticarial syndrome, (b) Muckle–Wells syndrome, and (c) chronic infantile neurological, cutaneous and articular syndrome. Understanding of the molecular pathogenesis of these disorders provides unique insights into the regulation of innate immunity and inflammation....
Viral hepatitis—clinical aspects
Authors: Hodgson H.J.F.
Published: April 2017

There are five major hepatitis viruses—A, B, C, D, and E—with the clinical picture depending on the severity of the inflammation induced in the liver, and on whether the virus is cleared from the liver or persists long-term.

Acute icteric hepatitis, characterized by jaundice and right upper quadrant abdominal tenderness, is the commonest clinically recognized consequence of infection. This is generally a self-limited condition with low mortality and complete recovery: only hepatitis B and C have the propensity to cause chronic viral hepatitis. Typically, hepatocellular enzyme levels in blood are prominently raised at the time of the onset of symptoms, whilst the serum alkaline phosphatase level is only slightly increased. Specific diagnosis is made by serological testing for particular viruses. Uncomplicated cases recover spontaneously; there is no proven therapy to enhance recovery, but alcohol and potentially hepatotoxic drugs should be withdrawn. Fulminant hepatic failure caused by viral hepatitis has 80% mortality and should be treated (if possible) by orthotopic liver transplantation....
Cardiac catheterization and angiography
Authors: Folland Edward D.
Published: April 2017

Cardiac catheterization/angiography is indicated for evaluation of patients with coronary, valvular, and congenital heart disease in whom diagnostic or therapeutic decisions cannot be made on the basis of noninvasive tests. Most patients presenting for cardiac catheterization have coronary artery disease: catheterization and coronary angiography are integral parts of interventional treatments for patients experiencing ischaemic coronary syndromes....
Cardiovascular syphilis
Authors: Somers Krishna
Published: April 2017

Clinicians need to be aware of cardiovascular syphilis in patients at risk of infection, with the time taken from initial infection to clinical manifestation ranging from 10 to 25 years, although this is accelerated in patients with HIV infection. Inadequate or interrupted antibiotic therapy may confound the development of cardiovascular syphilis and make diagnosis difficult....
Coronary heart disease: epidemiology and prevention
Authors: Danaei Goodarz , Rahimi Kazem
Published: April 2017

Coronary heart disease (CHD) is now the leading cause of death and disability in almost all regions of the world. Despite recent declines in age-standardized death rates from CHD globally, the number of CHD deaths have been increasing due to a combination of growth in population numbers and their longevity. In addition, manifestation and outcome of CHD varies substantially between and within countries....
Management of stable angina
Authors: Timmis Adam D.
Published: April 2017

Angina—the pain provoked by myocardial ischaemia—is usually caused by obstructive coronary artery disease that is sufficiently severe to restrict oxygen delivery to the cardiac myocytes. Quality of life is impaired in direct proportion to the severity of symptoms.

Clinical history remains the most useful basis for diagnosis and referral decisions to specialist services, the commonest indications being (1) new-onset angina, (2) exclusion of angina in high-risk individuals with atypical symptoms, (3) worsening angina in a patient with previously stable symptoms, (4) new or recurrent angina in a patient with history of myocardial infarction or coronary revascularization, (5) assessment of occupational fitness (e.g. airline pilots)....
Percutaneous interventional cardiac procedures
Authors: Folland Edward D.
Published: April 2017

Percutaneous coronary intervention (PCI) is the term applied to a variety of percutaneous, catheter-based procedures that accomplish revascularization by angioplasty (enlargement of a vessel lumen by modification of plaque structure), stenting (deployment of an internal armature or stent), atherectomy (removal or ablation of plaque), or thrombectomy (removal of thrombus)....
The impact of coronary heart disease on life and work
Authors: Petch Michael C.
Published: April 2017

Coronary heart disease is common and lethal: these facts are well known and have a profound influence on attitudes of victims and others—their families, friends, and employers.

The presence of heart failure and/or significant areas of cardiac ischaemia is the principal determinant of prognosis, and can be best judged by history, examination, and noninvasive testing, with common sense and experience being the best tools for assessing an individual’s fitness to resume life and work following the development of coronary heart disease....