bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview Of Quantum Electrodynamics And Matter–Radiation Field Interaction
Authors: Nitzan Abraham
Published: November 2020

Many dynamical processes of interest are either initiated or probed by light, and their understanding requires some knowledge of this subject. This chapter is included in order to make this text self contained by providing an overview of subjects that are used in various applications later in the text. In particular, it aims to supplement the elementary view of radiation–matter interaction as a time-dependent perturbation in the Hamiltonian, by describing some aspects of the quantum nature of the radiation field. This is done on two levels: The main body of this chapter is an essentially qualitative overview that ends with a treatment of spontaneous emission as an example. The Appendix gives some more details on the mathematical structure of the theory. In elementary treatments of the interaction of atoms and molecules with light, the radiation field is taken as a classical phenomenon.
Martin-Löf ’s type theory
Authors: Nördstrom B. , Petersson K.
Published: November 2020

The type theory described in this chapter has been developed by Martin-Löf with the original aim of being a clarification of constructive mathematics. Unlike most other formalizations of mathematics, type theory is not based on predicate logic. Instead, the logical constants are interpreted within type theory through the Curry-Howard correspondence between propositions and sets [Curry and Feys, 1958; Howard, 1980]: a proposition is interpreted as a set whose elements represent the proofs of the proposition. It is also possible to view a set as a problem description in a way similar to Kolmogorov’s explanation of the intuitionistic propositional calculus [Kolmogorov, 1932]. In particular, a set can be seen as a specification of a programming problem; the elements of the set are then the programs that satisfy the specification. An advantage of using type theory for program construction is that it is possible to express both specifications and programs within the same formalism. Furthermore, the proof rules can be used to derive a correct program from a specification as well as to verify that a given program has a certain property. As a programming language, type theory is similar to typed functional languages such as ML [Gordon et al., 1979; Milner et al., 1990] and Haskell [Hudak et al, 1992], but a major difference is that the evaluation of a well-typed program always terminates. The notion of constructive proof is closely related to the notion of computer program. To prove a proposition ("x Î A)($yÎB)P(x,y) constructively means to give a function f which when applied to an element a in A gives an element b in B such that P(a, b) holds. So if the proposition ("xÎ A)($yÎB)P(x,y) expresses a specification, then the function f obtained from the proof is a program satisfying the specification. A constructive proof could therefore itself be seen as a computer program and the process of computing the value of a program corresponds to the process of normalizing a proof. It is by this computational content of a constructive proof that type theory can be used as a programming language; and since the program is obtained from a proof of its specification, type theory can be used as a programming logic.
Higher-Order Logic Programming
Authors: Nadathur Gopalan , Miller Dale
Published: November 2020

Modern programming languages such as Lisp, Scheme and ML permit procedures to be encapsulated within data in such a way that they can subsequently be retrieved and used to guide computations. The languages that provide this kind of an ability are usually based on the functional programming paradigm, and the procedures that can be encapsulated in them correspond to functions. The objects that are encapsulated are, therefore, of higher-order type and so also are the functions that manipulate them. For this reason, these languages are said to allow for higher-order programming. This form of programming is popular among the users of these languages and its theory is well developed. The success of this style of encapsulation in functional programming makes is natural to ask if similar ideas can be supported within the logic programming setting. Noting that procedures are implemented by predicates in logic programming, higher-order programming in this setting would correspond to mechanisms for encapsulating predicate expressions within terms and for later retrieving and invoking such stored predicates. At least some devices supporting such an ability have been seen to be useful in practice. Attempts have therefore been made to integrate such features into Prolog (see, for example, [Warren, 1982]), and many existing implementations of Prolog provide for some aspects of higher-order programming. These attempts, however, are unsatisfactory in two respects. First, they have relied on the use of ad hoc mechanisms that are at variance with the declarative foundations of logic programming. Second, they have largely imported the notion of higher-order programming as it is understood within functional programming and have not examined a notion that is intrinsic to logic programming. In this chapter, we develop the idea of higher-order logic programming by utilizing a higher-order logic as the basis for computing. There are, of course, many choices for the higher-order logic that might be used in such a study. If the desire is only to emulate the higher-order features found in functional programming languages, it is possible to adopt a “minimalist” approach, i.e., to consider extending the logic of first-order Horn clauses— the logical basis of Prolog—in as small a way as possible to realize the additional functionality.
An Introduction to Text Analysis in Genomics
Authors: Raychaudhuri Soumya
Published: November 2020

The February 16th, 2001 issue of Science magazine announced the completion of the human genome project—making the entire nucleotide sequence of the genome available (Venter, Adams et al. 2001). For the first time a comprehensive data set was available with nucleotide sequences for every gene. This marked the beginning of a new era, the ‘‘genomics’’ era, where molecular biological science began a shift from the investigation of single genes towards the investigation of all genes in an organism simultaneously. Alongside the completion of the genome project came the introduction of new high throughput experimental approaches such as gene expression microarrays, rapid single nucleotide polymorphism detection, and proteomics methods such as yeast two hybrid screens (Brown and Botstein 1999; Kwok and Chen 2003; Sharff and Jhoti 2003; Zhu, Bilgin et al. 2003). These methods permitted the investigation of hundreds if not thousands of genes simultaneously. With these high throughput methods, the limiting step in the study of biology began shifting from data collection to data interpretation. To interpret traditional experimental results that addressed the function of only a single or handful of genes, investigators needed to understand only those few genes addressed in the study in detail and perhaps a handful of other related genes. These investigators needed to be familiar with a comparatively small collection of peer-reviewed publications and prior results. Today, new genomics experimental assays, such as gene expression microarrays, are generating data for thousands of genes simultaneously. The increasing complexity and sophistication of these methods makes them extremely unwieldy for manual analysis since the number and diversity of genes involved exceed the expertise of any single investigator. The only practical solution to analyzing these types of data sets is using computational methods that are unhindered by the volume of modern data. Bioinformatics is a new field that emphasizes computational methods to analyze such data sets (Lesk 2002). Bioinformatics combines the algorithms and approaches employed in computer science and statistics to analyze, understand, and hypothesize about the large repositories of collected biological data and knowledge.
Protein Interaction Networks
Authors: Raychaudhuri Soumya
Published: November 2020

Genes and proteins interact with each other in many complicated ways. For example, proteins can interact directly with each other to form complexes or to modify each other so that their function is altered. Gene expression can be repressed or induced by transcription factor proteins. In addition there are countless other types of interactions. They constitute the key physiological steps in regulating or initiating biological responses. For example the binding of transcription factors to DNA triggers the assembly of the RNA assembly machinery that transcribes the mRNA that then is used as the template for protein production. Interactions such as these have been carefully elucidated and have been described in great detail in the scientific literature. Modern assays such as yeast-2-hybrid screens offer rapid means to ascertain many of the potential protein–protein interactions in an organism in a large-scale approach. In addition, other experimental modalities such as gene-expression array assays offer indirect clues about possible genetic interactions. One area that has been greatly explored in the bioinformatics literature is the possibility of learning genetic or protein networks, both from the scientific literature and from large-scale experimental data. Indeed, as we get to know more and more genes, it will become increasingly important to appreciate their interactions with each other. An understanding of the interactions between genes and proteins in a network allows for a meaningful global view of the organism and its physiology and is necessary to better understand biology. In this chapter we will explore methods to either (1) mine the scientific literature to identify documented genetic interactions and build networks of genes or (2) to confirm protein interactions that have been proposed experimentally. Our focus here is on direct physical protein–protein interactions, though the techniques described could be extended to any type of biological interaction between genes or proteins. There are multiple steps that must be addressed in identifying genetic interaction information contained within the text. After compiling the necessary documents and text, the first step is to identify gene and protein names in the text.
Long-term astrophysical processes
Authors: Adams Fred C.
Published: November 2020

As we take a longer-term view of our future, a host of astrophysical processes are waiting to unfold as the Earth, the Sun, the Galaxy, and the Universe grow increasingly older. The basic astronomical parameters that describe our universe have now been measured with compelling precision. Recent observations of the cosmic microwave background radiation show that the spatial geometry of our universe is flat (Spergel et al., 2003). Independent measurements of the red-shift versus distance relation using Type Ia supernovae indicate that the universe is accelerating and apparently contains a substantial component of dark vacuum energy (Garnavich et al., 1998; Perlmutter et al., 1999; Riess et al., 1998). This newly consolidated cosmological model represents an important milestone in our understanding of the cosmos. With the cosmological parameters relatively well known, the future evolution of our universe can now be predicted with some degree of confidence (Adams and Laughlin, 1997). Our best astronomical data imply that our universe will expand forever or at least live long enough for a diverse collection of astronomical events to play themselves out. Other chapters in this book have discussed some sources of cosmic intervention that can affect life on our planet, including asteroid and comet impacts (Chapter 11, this volume) and nearby supernova explosions with their accompanying gamma-rays (Chapter 12, this volume). In the longerterm future, the chances of these types of catastrophic events will increase. In addition, taking an even longer-term view, we find that even more fantastic events could happen in our cosmological future. This chapter outlines some of the astrophysical events that can affect life, on our planet and perhaps elsewhere, over extremely long time scales, including those that vastly exceed the current age of the universe. These projections are based on our current understanding of astronomy and the laws of physics, which offer a firm and developing framework for understanding the future of the physical universe (this topic is sometimes called Physical Eschatology – see the review of ćirković, 2003). Notice that as we delve deeper into the future, the uncertainties of our projections must necessarily grow.
Evolution theory and the future of humanity
Authors: Wills Christopher
Published: November 2020

No field of science has cast more light on both the past and the future of our species than evolutionary biology. Recently, the pace of new discoveries about how we have evolved has increased (Culotta and Pennisi, 2005). It is now clear that we are less unique than we used to think. Genetic and palaeontological evidence is now accumulating that hominids with a high level of intelligence, tool-making ability, and probably communication skills have evolved independently more than once. They evolved in Africa (our own ancestors), in Europe (the ancestors of the Neanderthals) and in Southeast Asia (the remarkable ‘hobbits’, who may be miniaturized and highly acculturated Homo erectus). It is also becoming clear that the genes that contribute to the characteristics of our species can be found and that the histories of these genes can be understood. Comparisons of entire genomes have shown that genes involved in brain function have evolved more quickly in hominids than in more distantly related primates. The genetic differences among human groups can now be investigated. Characters that we tend to think of as extremely important markers enabling us to distinguish among different human groups now turn out to be understandable at the genetic level, and their genetic history can be traced. Recently a single allelic difference between Europeans and Africans has been found (Lamason et al., 2005). This functional allelic difference accounts for about a third of the differences in skin pigmentation in these groups. Skin colour differences, in spite of the great importance they have assumed in human societies, are the result of natural selection acting on a small number of genes that are likely to have no effects beyond their influence on skin colour itself. How do these and other recent findings from fields ranging from palaeontology to molecular biology fit into present-day evolution theory, and what light do they cast on how our species is likely to evolve in the future? I will introduce this question by examining briefly how evolutionary change takes place.
Catastrophes and insurance
Authors: Taylor Peter
Published: November 2020

This chapter explores the way financial losses associated with catastrophes can be mitigated by insurance. It covers what insurers mean by catastrophe and risk, and how computer modelling techniques have tamed the problem of quantitative estimation of many hitherto intractable extreme risks. Having assessed where these techniques work well, it explains why they can be expected to fall short in describing emerging global catastrophic risks such as threats from biotechnology. The chapter ends with some pointers to new techniques, which offer some promise in assessing such emerging risks. Catastrophic risks annually cause tens of thousands of deaths and tens of billions of dollars worth of losses. The figures available from the insurance industry (see, for instance, the Swiss Re [2007] Sigma report) show that mortality has been fairly consistent, whilst the number of recognized catastrophic events, and even more, the size of financial losses, has increased. The excessive rise in financial losses, and with this the number of recognized ‘catastrophes’, primarily comes from the increase in asset values in areas exposed to natural catastrophe. However, the figures disguise the size of losses affecting those unable to buy insurance and the relative size of losses in developing countries. For instance, Swiss Re estimated that of the estimated $46 billion losses due to catastrophe in 2006, which was a very mild year for catastrophe losses, only some $16 billion was covered by insurance. In 2005, a much heavier year for losses, Swiss Re estimated catastrophe losses at $230 billion, of which $83 billion was insured. Of the $230 billion, Swiss Re estimated that $210 billion was due to natural catastrophes and, of this, some $173 billion was due to the US hurricanes, notably Katrina ($135 billion). The huge damage from the Pakistan earthquake, though, caused relatively low losses in monetary terms (around $5 billion mostly uninsured), reflecting the low asset values in less-developed countries. In capitalist economies, insurance is the principal method of mitigating potential financial loss from external events in capitalist economies. However, in most cases, insurance does not directly mitigate the underlying causes and risks themselves, unlike, say, a flood prevention scheme.
Artificial Intelligence as a positive and negative factor in global risk
Authors: Yudkowsky Eliezer
Published: November 2020

By far the greatest danger of Artificial Intelligence (AI) is that people conclude too early that they understand it. Of course, this problem is not limited to the field of AI. Jacques Monod wrote: ‘A curious aspect of the theory of evolution is that everybody thinks he understands it’ (Monod, 1974). The problem seems to be unusually acute in Artificial Intelligence. The field of AI has a reputation for making huge promises and then failing to deliver on them. Most observers conclude that AI is hard, as indeed it is. But the embarrassment does not stem from the difficulty. It is difficult to build a star from hydrogen, but the field of stellar astronomy does not have a terrible reputation for promising to build stars and then failing. The critical inference is not that AI is hard, but that, for some reason, it is very easy for people to think they know far more about AI than they actually do. It may be tempting to ignore Artificial Intelligence because, of all the global risks discussed in this book, AI is probably hardest to discuss. We cannot consult actuarial statistics to assign small annual probabilities of catastrophe, as with asteroid strikes. We cannot use calculations from a precise, precisely confirmed model to rule out events or place infinitesimal upper bounds on their probability, as with proposed physics disasters. But this makes AI catastrophes more worrisome, not less. The effect of many cognitive biases has been found to increase with time pressure, cognitive busyness, or sparse information. Which is to say that the more difficult the analytic challenge, the more important it is to avoid or reduce bias. Therefore I strongly recommend reading my other chapter (Chapter 5) in this book before continuing with this chapter. When something is universal enough in our everyday lives, we take it for granted to the point of forgetting it exists. Imagine a complex biological adaptation with ten necessary parts. If each of the ten genes is independently at 50% frequency in the gene pool – each gene possessed by only half the organisms in that species – then, on average, only 1 in 1024 organisms will possess the full, functioning adaptation.
Some Elements of Functional Analysis
Authors: Chemin Jean-Yves , Desjardins Benoit , Gallagher Isabelle , Grenier Emmanuel
Published: November 2020

Before introducing the concept of Leray’s weak solutions to the incompressible Navier–Stokes equations, classical definitions of Sobolev spaces are required. In particular, when it comes to the analysis of the Stokes operator, suitable functional spaces of incompressible vector fields have to be defined. Several issues regarding the associated dual spaces, embedding properties, and the mathematical way of considering the pressure field are also discussed. Let us first recall the definition of some functional spaces that we shall use throughout this book. In the framework of weak solutions of the Navier– Stokes equations, incompressible vector fields with finite viscous dissipation and the no-slip property on the boundary are considered. Such H1-type spaces of incompressible vector fields, and the corresponding dual spaces, are important ingredients in the analysis of the Stokes operator.
Weak Solutions of the Navier–Stokes Equations
Authors: Chemin Jean-Yves , Desjardins Benoit , Gallagher Isabelle , Grenier Emmanuel
Published: November 2020

The mathematical analysis of the incompressible Stokes and Navier–Stokes equations in a possibly unbounded domain Ω of Rd (d = 2 or 3) is the purpose of this chapter. Notice that no regularity assumptions will be required on the domain Ω. Because of the compactness result stated in Theorem 1.3, page 27, the case of bounded domains will be different (in fact slightly simpler) than the case of general domains. The study of the spectral properties of the Stokes operator previously defined relies on the study of its inverse, which is in fact much easier. We shall restrict ourselves here to the case of the homogeneous Stokes operator which is adapted to the case of a bounded domain.
The Full Extent
Authors: Weiner J. S. , Stringer Chris
Published: November 2020

Almost any single one of the techniques employed in the investigations suffices to reveal the elaborateness of the deception which was perpetrated at Piltdown. The anatomical examination, the tests for fluorine and nitrogen bear particularly good witness to this; even the radio-activity results taken alone, led the physicists to remark on the ‘great range of activity shown by specimens from this one little site’; ‘it is difficult to avoid the conclusion that the different bones in the Piltdown assemblage have had very different geological and chemical histories’. We have merely to take account of the stained condition of the whole assemblage, to realize the thoroughness of the fraud. From the Vandyke brown colour of the unnaturally abraded canine we infer with certainty that it was deliberately ‘planted’. The superficiality of the iron impregnation, combined with the chromium, tells as much as regards the orang jaw. And it is this iron-staining which finally shows that the rest, human and animal, was without doubt, all ‘planted’. The iron-staining has two peculiar features. It seems probable that ferric ammonium sulphate (iron alum) was the salt employed. This salt is slightly acid. The peculiarity of this salt (and, indeed, of any acid sulphate) is that in bone which contains little organic matter such as the cranium of Piltdown I, or Piltdown II, the beaver bones and hippo teeth, it brings about a detectable change in the crystal structure of the bone. In the apatite in which the calcium of the bone is held, the phosphate is replaced by sulphate to form gypsum. This change is quite unnatural, for neither gypsum nor sufficient sulphate occur in the gravels at Piltdown to bring it about. So the iron-sulphate-staining is an integral part of the forger’s necessary technique. He also used chromium compounds to aid the iron-staining probably because he thought it would assist the production of iron oxide. Chromium compounds are oxidizing. The basic strategy underlying the Piltdown series of forgeries now seems reasonably clear. Two main elements in the plan taken together explain nearly all the features of the affair quite satisfactorily.
Introduction
Authors: Susskind Richard , Susskind Daniel
Published: November 2020

This book is about the professions and the systems and people that will replace them. Our focus is on doctors, lawyers, teachers, accountants, tax advisers, management consultants, architects, journalists, and the clergy (amongst others), on the organizations in which they work, and the institutions that govern their conduct. Our main claim is that we are on the brink of a period of fundamental and irreversible change in the way that the expertise of these specialists is made available in society. Technology will be the main driver of this change. And, in the long run, we will neither need nor want professionals to work in the way that they did in the twentieth century and before. There is growing evidence that a transformation is already under way. More people signed up for Harvard’s online courses in a single year, for example, than have attended the actual university in its 377 years of existence. In the same spirit, there are a greater number of unique visits each month to the WebMD network, a collection of health websites, than to all the doctors working in the United States. In the legal world, three times as many disagreements each year amongst eBay traders are resolved using ‘online dispute resolution’ than there are lawsuits filed in the entire US court system. On its sixth birthday, the Huffington Post had more unique monthly visitors than the website of the New York Times, which is almost 164 years of age. The British tax authorities use a fraud-detection system that holds more data than the British Library (which has copies of every book ever published in the UK). In 2014 the US tax authorities received electronic tax returns from almost 48 million people who had used online tax preparation software rather than a tax professional to help them. At WikiHouse, an online community designed a house that could be ‘printed’ and assembled for less than £50,000 (built successfully in London during September 2014). The architectural firm Gramazio & Kohler used a group of autonomous flying robots to assemble a structure out of 1,500 bricks.
Information and Technology
Authors: Susskind Richard , Susskind Daniel
Published: November 2020

In Part I of this book, by reporting on our own research and reflecting on the writings of others, we offer evidence of the changes that the professions are facing. In these opening chapters, however, we do not provide an explanation of why this transformation is taking place. That is our purpose now, in Part II of the book. Our aim is to provide a more general and systematic account of what is going on. We advance a variety of theories and models that explain the evidence we have uncovered and suggest how these may help us predict what is yet to unfold. Our initial focus in this chapter is on what we call the ‘information substructure’ of society, and how this influences the way that human beings have shared practical expertise in the past and are likely to do so in the future. Then we turn to technology, and talk about the worth of making predictions. Our conclusions here help us to identify what we regard as the four most important sets of future developments in technology. In concluding this chapter, we present a fifty-year overview of the changing impact of technology on the professions. This then sets us up for Chapter 5, where we discuss the nature of knowledge, the evolution of professional work, and the models for the production and distribution of practical expertise that will displace the traditional working practices of professionals. In everyday conversation, people often now use the terms ‘technology’ or ‘tech’ more often than ‘information technology’ and ‘IT’. This emphasis on the technical angle is understandable, because the technological accomplishments that underpin our everyday devices are remarkable. The technology can be mesmerizing, both in its power and design, and we justifiably marvel at the genius and ingenuity of those who contribute to its development. But to focus exclusively on the ‘T’ rather than on the ‘I’, to neglect the ‘information’ in our wonder at the ‘technology’, runs the risk of failing to grasp the role and value of information—in our world generally, and especially in the professions.
Objections and Anxieties
Authors: Susskind Richard , Susskind Daniel
Published: November 2020

We surface now from our theorizing in Part II to address more practical matters. Roughly speaking, the story so far is this—the professions are our current solution to a pervasive problem, namely, that none of us has sufficient specialist knowledge to allow us to cope with all the challenges that life throws at us. We have limited understanding, and so we turn to doctors, lawyers, teachers, architects, and other professionals because they have ‘practical expertise’ that we need to bring to bear in our daily lives. In a print-based industrial society, we have interposed the professions, as gatekeepers, between individuals and organizations and the knowledge and experience to which they need access. In the first two parts of the book we describe the changes taking place within the professions, and we develop various theories (largely technological and economic) that lead us to conclude that, in the future—in the fully fledged, technology-based Internet society—increasingly capable machines, autonomously or with non-specialist users, will take on many of the tasks that currently are the exclusive realm of the professions. While we do not anticipate an overnight, big-bang revolution, equally we do not expect a leisurely evolutionary progression into the post-professional society. Instead, we predict what we call an ‘incremental transformation’ in the way in which we organize and share expertise in society, a displacement of the traditional professions in a staggered series of steps and bounds. Although the change will come in increments, its eventual impact will be radical and pervasive. Our personal inclination, articulated at greater length in the Conclusion, is to be strongly sympathetic to this transformation. Our professions are creaking—they are increasingly unaffordable and inaccessible, and suffer from numerous other defects besides, as we describe in section 1.7. Change is long overdue. In conversation with mainstream professionals, in response to our thinking, two words in juxtaposition are uttered again and again—‘yes but . . . ’. Sometimes, what then follows is the special pleading that we note in section 1.9—professionals argue that our thinking applies to all professions other than their own.
Cough
Authors: Farne Hugo , Norris-Cervetto Edward , Warbrick-Smith James
Published: November 2020

First, ask open questions about the cough itself: • Acute or chronic? The British Thoracic Society (BTS) defines acute as <3 weeks and chronic as >8 weeks. Between 3 and 8 weeks the cough may be due to recovering acute illness or developing chronic illness. • Constant or intermittent? A cough that is intermittent may suggest an extrinsic trigger (e.g. if the patient only coughs at work there may be an allergy to something in the workplace). A cough that is constant suggests an intrinsic cause. • Productive or dry? The presence of sputum indicates inflammation and/or infection. Patients with chronic obstructive pulmonary disease (COPD) have chronically inflamed airways and often produce white or clear sputum. Patients with infection have yellow or green sputum. Particularly large volumes of sputum, often green or rusty coloured, may be coughed up in bronchiectasis and lung abscesses. • Blood? More specifically: ■ Blood-streaked sputum? Suggests infection or bronchiectasis. ■ Pink and frothy sputum? Suggests pulmonary oedema. ■ Frank blood (haemoptysis)? See Chapter 8. Suggests tuberculosis (TB), lung cancer, pulmonary embolus, bronchiectasis, or other rarer causes (e.g. granulomatosis with polyangiitis (GPA, formerly known as Wegener’s granulomatosis), or Goodpasture’s syndrome). • Timing? Asthma is classically worse at night and early hours of the morning. Pulmonary oedema or gastro-oesophageal reflux disease (GORD) can also be worse at night due to the positional effects of lying flat. Patients often report sleeping propped up on pillows to mitigate these effects. Trigger factors such as pets, cold weather, or exercise indicate asthma, as does a worsening in spring/summer. • Character? A wheezy cough suggests airway obstruction due to asthma or COPD. A bovine cough (breathy) is characteristic of vocal cord paralysis. A dry cough is suggestive of a bronchitis (usually viral) or interstitial lung disease. A gurgling/wet cough is suggestive of bronchiectasis. Pertussis infection causes a ‘whooping’ cough. Second, ask directed questions about factors that might be triggering the cough: • Environmental irritants: Smoking? Occupation? Pets? Change of house, office, etc? • Past medical history: Asthma? GORD? Rhinitis/sinusitis? Heart failure? Recent chest infection? • Drug history? Angiotensin-converting enzyme (ACE) inhibitors in particular can cause a cough.
Epigastric pain
Authors: Farne Hugo , Norris-Cervetto Edward , Warbrick-Smith James
Published: November 2020

We have arranged the differential diagnosis in order of likelihood in a man of this age with more likely diagnoses in larger font and less likely diagnoses in smaller font in Figure 12.1. Pathologies that should be excluded at the earliest possible opportunity are shown in bold. Bear in mind that this differential diagnosis refers to epigastric pain as a presentation of ‘acute abdomen’ and thus differs markedly from epigastric pain presenting as outpatient dyspepsia. Note that although we have adopted a standard approach of history, examination, and investigations over the course of the following pages, you should use clinical judgement to deviate from this path if one of the ‘must exclude’ diagnoses is suspected, or if there is a need for urgent resuscitation. For example, if a 69-year-old male diabetic patient with known unstable angina presents with exercise-induced epigastric pain, you would be wise to perform an electrocardiogram (ECG) and obtain baseline observations at the earliest opportunity. Various characteristics of the pain will help to narrow our differential diagnosis of epigastric pain: Site: • Pain that has spread from the epigastrium to involve the rest of the abdomen may suggest peritonitis from a perforated GI tract (e.g. perforated gastric ulcer, which causes epigastric pain because the stomach is embryologically a foregut structure). • Pain that has spread from the epigastrium to involve the chest may be cardiac. • Biliary disease, although anatomically located in the right upper quadrant, may present with purely epigastric symptoms. Onset: • Pain that is of very sudden onset suggests perforation of a viscus (e.g. a perforated duodenal ulcer or Boerhaave’s perforation) or myocardial infarction. • Pain from acute pancreatitis and biliary colic develops maximal intensity over 10–20 minutes. • Inflammatory processes such as acute cholecystitis or pneumonia typically take hours to reach their peak. Character: • ‘Crushing’ or ‘tightness’ qualities are typical of cardiac pathology. • Sharp, ‘burning’ pain is typical of peptic ulcers, gastritis, and duodenitis. • Deep, ‘boring’ pain is typical of pancreatitis. Radiation: • Back pain is classically associated with pancreatitis, leaking abdominal aortic aneurysms, and sometimes seen with peptic ulcers.
Flank pain
Authors: Farne Hugo , Norris-Cervetto Edward , Warbrick-Smith James
Published: November 2020

The diagnoses shown in bold in Figure 18.1 are all surgical emergencies that you must exclude as you clerk the patient. In women, you should consider gynaecological causes, e.g. ectopic pregnancy, ovarian torsion (you can of course narrow these down depending on whether the woman is of childbearing age or not). Also, bear in mind that other abdominal pathology can occasionally present as flank pain (e.g. pancreatitis, diverticulitis, appendicitis). You should ask the standard array of questions about the pain—remember the mnemonic SOCRATES: Site: Where is the pain, and has it always been there? Is it unilateral or bilateral? Kidney stones are almost always unilateral, but the location of the pain may radiate from loin to groin. Often they start with a vague discomfort that is ignored until it becomes a severe pain. Onset: Any trauma or other trigger, or spontaneous? Gradual or sudden? Trauma may lead to musculoskeletal pain or internal bleeding. Character: Is the pain colicky or constant? Is it sharp or dull? Ureteric stones give a colicky (waxing and waning) pain because of periodic spasms of the ureteric smooth muscle walls trying to dislodge the blockage. A constant pain is more consistent with a stone lodged in the kidney, which does not periodically contract (‘vermiculate’) like the ureters, or an inflammatory cause. Musculoskeletal pain is more typically an ache, while nerve impingement causes shooting pains. Radiation: Does the pain radiate to the groin (typical of ureteric pain)? Does it radiate down the leg (typical of lumbar nerve root pain)? Alleviating factors: Does anything make the pain better, e.g. a given posture, eating/drinking, any medications, etc.? Timing: How long has the pain been present? Musculoskeletal back pain can last many weeks, whereas a leaking abdominal aortic aneurysm (AAA) is unlikely to persist for more than a day without resolution, one way or another. Exacerbating factors: Does anything make the pain worse? Patients with peritonitis (e.g. due to a perforated peptic ulcer) are very sensitive to movement. Severity: How severe is the pain (e.g. on a scale of 1–10)? Kidney stones are said to be excruciatingly painful, comparable to childbirth.
Acute joint pain
Authors: Farne Hugo , Norris-Cervetto Edward , Warbrick-Smith James
Published: November 2020

The ‘must exclude’ diagnosis is septic arthritis. Not only can it destroy articular cartilage within days if not treated (hence permanently reducing joint function), but it is also associated with a mortality of about 10% due to underlying bacteraemia. Remember that pain may be referred from elsewhere. For example, hip pathology may present as knee pain, and lumbar spine pathology may present as hip pain. The causes of a single, acutely painful joint include those shown in Figure 27.1, with larger font size highlighting those that are more common. • Pain. You should characterize the pain as for any other pain along the lines of SOCRATES (see Chapter 1). Pain that worsens with movement and improves with rest is likely to be non-inflammatory. An acute onset (hours) is consistent with septic arthritis, gout/pseudogout, and trauma. A more insidious onset is more common in conditions like bursitis and tendonitis, where the relevant anatomical structure becomes inflamed with overuse. Chronic onset suggests osteoarthritis (note that some rheumatologists prefer the term osteoarthrosis to reflect the fact that the inflammation is not the primary pathology). The severity of pain can usefully be assessed by asking about joint function—for example, can the patient weight bear? • Trauma. Mr Sullivan has already said he does not remember there being any trauma, but you must always ask and make sure. Even the slightest of knocks can cause significant pain. However, this does not exclude other diagnoses—trauma can precipitate infection or gout, for example. • Common risk factors for gout. There are many potential causes of gout, but the more common ones that you should ask about include use of thiazide diuretics, recent heavy alcohol intake, chronic renal failure, and chemotherapy (high cell apoptosis, leading to degradation of DNA and excess urate). A history of renal stones or previous episodes of gout also makes gout more likely. • Common risk factors for septic arthritis. Again there are many possible risk factors, but the key ones are immunosuppression (e.g. diabetes, HIV, steroid use) and any prosthetic joints. • Risk factors for haemarthrosis. Typically due to a coagulopathy (e.g. classically haemophilia), anticoagulant use (typically warfarin) or trauma (e.g. a ruptured anterior cruciate ligament in the knee).
Shakespeare in Prison
Authors: Rose Jonathan
Published: November 2020

There are any number of inspirational accounts of prison reading (such as Malcolm X), so let’s begin with what doesn’t work. Larry E. Sullivan, the leading scholar of this small but enthralling literary subfield, has concluded that probably the favorite author behind bars is Friedrich Nietzsche, and most frequently quoted sentence, “What does not kill me makes me stronger.” Convicts also devour crime and escapist literature, but few read Plato, Boethius, Bunyan, or Dostoevsky. And the reason should be obvious. Typically, prison systems work relentlessly to crush the individuality of their inmates. Physical resistance only brings ever-more brutal punishment, so prisoners resort to the one form of rebellion they can get away with, which is to read the most extreme forms of antisocial philosophy: Schopenhauer, Herbert Spencer, Nietzsche. If you are caged like an animal, these ideologies offer some psychological compensation: you can imagine yourself radically free, infinitely superior to your jailers in terms of intelligence, courage, and authenticity. It all sounds romantically transgressive, but that’s a very costly illusion, because it locks the prisoner into a battle with authority that he cannot win, and amplifies the behavior that got him incarcerated in the first place. Among black female inmates, the counterpart to Nietzsche is “urban fiction,” a new genre where the ubermenschen are inner-city crime lords, as wealthy as they are sadistic. Their women are consistently beautiful, expensively dressed, and obscenely abused. The demand for these novels knows no limit, and they are smuggled in faster than wardens can confiscate them. Their fans want to know why these black-authored books are banned while the equally gruesome thrillers of James Patterson are allowed in, and they have a point. But whereas Patterson is clearly on the side of law and order, urban fiction glamorizes drugs and thugs—and all too many readers admit that they fall for it: . . . “It excites me to read them. I look at all this money they’re making. I can’t wait to see the dollar signs . . . I like how they’re hustlers. How they con someone. It gives me a feeling of oh man, is it that easy? I coulda tried that!” . . .
Myth, Memento, and Memory: Avebury (Wiltshire, England)
Authors: Wheatley David
Published: November 2020

In Christopher Nolan’s film Memento (Nolan 2000), Leonard Shelby— played by Guy Pearce—suffers from anterograde amnesia, which prevents him from generating any new memories. To deal with this, he creates material traces such as Polaroid photographs and notes and he tattoos the most significant facts onto his body. Each time he awakes, he encounters these mementos (notes, images, and tattoos) and must interpret them in order to decide what to do next. He sometimes leaves messages for himself, intended to constrain his future behaviour, but while these messages effect his actions, some of the notes or photos may be lost or destroyed, or he may fail to realize that they have been manipulated or altered. Further, he may not interpret them correctly, so that his actions are not what he intended. Despite his amnesia, however, the past is always implicated in Leonard’s story and it is always changing his future. In some sense, the way that Leonard leaves mementos for himself is a more interesting model for the way that successive human communities encounter the remains of the past than the idea of biographies. Just as on Leonard’s tattooed body, traces of the past such as earthworks and monuments are inscribed onto the landscape, yet oral tradition cannot transmit the detailed meanings of those traces or the intentions of their creators through long sequences of time so that human communities encountering them later are, metaphorically, amnesiacs. Sometimes earthworks and monuments are built with the intention of projecting a particular world-view, constraining future generations to act in particular (‘correct’) ways. Over long periods, however, oral traditions distort, people move away and areas are occupied by new inhabitants with no cultural memory of those intentions or meanings. Just as with Leonard’s tattoos, monuments become mementos that have to be interpreted and situated within a contemporary understanding of the world before meaningful action is possible. If we think of both Leonard’s tattoos and the physical traces of the past as mementos, then it’s worth thinking how these differ from memories.
“These places know him no more”: Surveys, Panoramas, and the Landscape of Ancient America
Authors: Snead James E.
Published: November 2020

Around 1850 an image of a mysterious cavern in the western country was painted on a vast stretch of canvas. It depicts an elaborate, subterranean realm with colorful stalactites, exotic mineral formations, and an enigmatic hieroglyphic inscription. The darkness is illumined by the flaming brands of a party of explorers, who move about in active curiosity. In the shadows beyond the torchlight a trio of mummies can be seen, propped up against the rocks. The Kentucky Mummy—and a few of her peers—patiently await the attention of Investigators. The description attached to the painting, however, suggests that its object is not Mammoth Cave, but another western grotto, located in a bluff alongside the Ohio known as Cave-in-Rock. In actuality there were no stalactites at this particular location, and no evidence for antiquities either. Early in the era of western exploration the cavern had been used as shelter by travelers: the walls were indeed inscribed, but—like the trees that had once risen atop the Grave Creek Mound—with the signatures of those passing through rather than with those of the ancient inhabitants. More infamously, the cave had been used by river pirates as a base for attacks on flatboat passengers. Eastern newspapers had carried accounts of the banditti of Cave-in-Rock. Thomas Ashe included the cave among his bone-filled catacombs, and a newspaper article of a few years later described the place as a “dark mansion of the murdered.” John Egan’s romanticized depiction of Cave-in-Rock—executed on behalf of Montroville Dickeson—illustrates the complex accretion of historicized landscapes in the American West in the era prior to the Civil War. For the mid-nineteenth-century audience such palimpests were relatively commonplace, representing the increasing time depth of settlement and the progressive integration of different types of historical experience. That the painter had apparently never seen the place itself was irrelevant: his canvas artfully joined the ancient dead with the casualties of more recent times, connecting past and present in equal degree, within a mythicized western setting. The nature of Egan’s work itself indicated that visual imagery was a potentially powerful strategy for engaging the material past in the antebellum United States.