bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Upconversion Nanoparticles in Biomedical Field
Authors: Cai Zhihan
Published: November 2023

Upconversion nanoparticles (UCNPs) are currently one of the most concerned detection technologies. UCNPs are a new kind of luminescent material based on the anti-Stokes reaction of rare-earth ions. Their advantages lie in the doping of rare-earth ions in the luminescent material, which has a high signal to noise ratio and strong fluorescence intensity, has a long fluorescence lifetime of approximately 100 milliseconds, good bio-compatibility and low toxicity. The emission band is narrow and has high penetration power and there is less damage to the matrix and interface. Nowadays, detection technologies based on UCNPs and interdisciplinary integration have laid a solid foundation for the development of new detection methods and instruments in fields such as bioanalysis, bioengineering, and materials, and have been widely applied in various fields. To this end, this research will explain the basic principle of UCNPs and the influence of lanthanide factors. This research also discussed the practical applications of UCNPs in magnetic resonance imaging (MRI), photodynamic therapy (PDT), biomarkers, and immunoassays in biomedical field, and looked forward to future research on UCNPs.
Theoretical identification of key structural factors for strong magnetic anisotropy in Ni(II) complexes
Authors: Yang Longqing , Cao Jiaan , Li Xiangyang , Ye Lyuzhou , Yan Yi Jing , Zheng Xiao
Published: November 2023

Single-molecule magnets (SMMs) possess a crucial property called magnetic anisotropy (MA), which has an exceedingly delicate correlation with their structures. In recent years, the study on magneto-structural correlations has emerged as a challenging area in singlemolecule science. Understanding the fundamental physical mechanisms underlying the magneto-structural correlations is essential for building excellent high-temperature SMMs. In this work, we screened various four-coordinated nickel(II) SMMs and studied several key structural factors, such as the lengths and angles of the coordination bonds that may be closely associated with MA. Following that, we developed simple molecular models to deduce the evolution trends of MA with coordination bond angles and lengths. The findings on the magneto-structural correlations stimulated our interest to further explore the crystal structure database. We revealed that the magneto-structural correlation can be well described by a logarithmic function. Guided by such a relationship, we discovered a nickel(II) complex with the strongest MA to date among the tetrahedral-coordinated ones. Our work may be helpful for the empirical synthesis of exceptional high-temperature SMMs.
Lebanese EMI instructors’ role identity and teaching practices
Authors: Abouzeid Reema , Liardét Cassi , Khachan Victor
Published: November 2023

English-medium instruction (EMI) typically requires disciplinary instructors to deliver content in a language
other than their students’ and their own first language. While this practice is growing alongside related approaches (e.g., content and
language integrated learning) EMI is distinct in that the primary objective is teaching the disciplinary content, with English
merely playing an instrumental role. This has implications for how lecturers view their role in EMI classrooms and how this is
enacted through their teaching and marking practices. The present study examines instructors’ beliefs about EMI instruction in a
context where EMI has long been adopted but only minimally researched: Lebanon. Sixty-three instructors from two Lebanese
universities were surveyed about their experiences teaching EMI, their views about the role of language, and their marking
practices. Eight instructors were further interviewed to elaborate on these responses. Findings reveal that the majority of the
surveyed instructors recognise that teaching English is at least part of their role as content instructors whereas the interviewed
instructors distanced themselves from this dual-focused responsibility, despite reporting several examples of teaching English
alongside the content. These findings highlight the ambiguity around instructors’ role(s) in EMI classrooms and raises the need
for greater definition and clarity to ensure that EMI’s full potential is reached.
Citrus Huanglongbing (Greening) Disease
Authors: Boa Eric
Published: November 2023

Huanglongbing disease (HLB), also known as citrus greening disease, is the most important and damaging disease of citrus fruits worldwide. The disease is caused by three closely related bacteria belonging to the genus
Candidatus Liberibacter
. The bacteria are spread over short distances by sucking insects known as psyllids and by the movement of infected (yet often undetected) planting material between countries and continents. Citrus is a general category of fruits which includes oranges, lemons, grapefruits and tangerines. All types are susceptible to infection and researchers have yet to develop resistant or tolerant varieties. The leading growers of citrus fruits are China, Brazil and India, which collectively produced 75 million tonnes in 2021. All three are affected by the disease; in total around 65 countries have confirmed the disease. HLB is not present in Europe, where Spain and Italy are leading citrus producers. Climate change poses a significant threat to the expansion of the disease. The arrival of HLB in the USA in the early 2000s, at around the same time as Brazil, marked a significant stage in the continuing battle to manage the disease. The USA is a major producer of citrus fruits, which was primarily from Florida before the arrival of HLB. Research efforts were intensified and over $100 million was allocated in the USA from 2007 to 2016 to develop effective ways to reduce damaging losses. Despite major advances in knowledge of the pathogen and insect vector, and how they interact with citrus hosts, it is clear that much more needs to be done to achieve long-lasting success in managing a challenging disease.

Information

© The Author 2023
Home care in Europe: background and aims
Authors: Jamieson Anne
Published: November 2023

This book forms part of a major study into care delivery systems in Europe, known as ‘Age Care Research Europe’. The study has been funded by the European Community as a concerted action programme, in which research teams from nine countries have participated: Belgium, Denmark, France, Greece, Germany, Ireland, Italy, the Netherlands, and the UK. The study resulted from a research proposal and a research design formulated by Professor Illsley of the UK (who subsequently became Project Leader) and Dr Robert van Zonneveld of the Netherlands. The design is described in some detail elsewhere (Illsley 1987) and will only be briefly summarized here. From earlier discussions with policy makers and research workers, Illsley and van Zonneveld were aware that all countries were encountering difficulties in adapting the pattern of services and the distribution of resources to meet the increased demand on health and social services in a period of limited growth, and in the face of resistance from other service sectors.
The home-help service in England and Wales
Authors: Lawson Robin , Davies, Bleddyn
Published: November 2023

Services for elderly people have come under increasing scrutiny in the UK in the 1980s because of the increasing numbers of frail elderly people in the population, constraints on resources, and the national policy of caring for vulnerable people in their own homes for as long as possible. If the home-help/care service is to be the cornerstone of community care, as the Social Services Inspectorate (SSI) (1988) proposed, a number of changes will be required, including the provision of more personal care, more flexible provision, and co-ordination with other services both within and outside social services departments (SSI 1987, 1988).
Home-care services in the Federal Republic of Germany
Authors: Dieck Margret , Garms-Homolová Vjenka
Published: November 2023

Within today's health services, this hierarchy of services is abundantly clear. Thus, as far as health insurance coverage is concerned, only the need of specialized nursing allows for provision of basic nursing as well as home help, if required. This is because nursing services at home are defined as adjuncts to medical treatment within health insurance, i.e., within the service system that offers either services in kind or full-cost insurance coverage for those deemed ill. Nursing services alone are not provided by health insurance but only if medical treatment is needed. However, within the means-tested, social welfare system, nursing services and home help can be provided to frail elderly people, even if they are not undergoing medical treatment.
The prevention of infections
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

Infectious diseases are still a major cause of mortality and morbidity in the modern developed world. The changing picture is complicated by frequent international travel for business and pleasure and population movements a people seek better conditions for themselves and their families. The advent of antibiotics and good public health practice (Appendix I) have had a major impact but their use is only a part of the approach which should be adopted in general practice where most infections present and are managed. In this chapter the strategies of health education, immunization, and prophylaxis are examined with practical suggestions to enable the primary health care team to maximize their impact on the incidence of infection.
The investigation of infection
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

Infection, potentially one of the most serious and life-threatening of presen tations, is also a common complaint resulting in significant morbidity and loss of productivity. The general practitioner must, therefore, on the one hand recognize and manage infections such as meningitis or septicaemia which present acutely and often dramatically and on the other, cope with less serious complaints related to sore throats, ear infections, chest problems, urinary tract infections, and pelvic infections. One of the important tash of general practice is to assess the severity of the complaint and decide which merit investigation, referral or treatment. In the context of a cash-limited health service, resources must be well used and each clinician should develop clear ideas about the criteria for investigation and referral.
Infections of the lower respiratory tract
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

This chapter deals with common and important lower re piratory tract infections {LRTis) which principally manifest beyond the trachea and discusses their epi demiology, aetiology, clinical features, investigation, and management. Although GPs play a major part in dealing with these problems, one of their most important roles is to encourage patients to stop smoking thereby substantially reducing the impact of these infections on individuals and families.
Infections of the genital tract
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

The infections of men and women are considered separately in this chapter, with the infections of the male genital tract, which are inevitably associated with urinary tracl infections, discussed in Chapter 10.
Skin and soft tissue infections
Authors: Southgate Lesley , Lockie Cameron , Heard Shelley , Wood Martin
Published: November 2023

Skin and soft tissue infections are caused by a variety of bacteria, viruses, and fungi and are commonly seen in general practice. The average GP will see about 30 new cases per 1000 patients in any year. Patients also present with infestations some of which are secondarily infected. Many patients present directly to, or are followed up, by the practice nurse. The diagnosis and management of these conditions should form part of multidisciplinary continuing education and a practice clinical meeting on the subject would present an ideal opportunity to invite the local microbiologist and infection control nurse.
Nosocomial pathogens
Authors: Mehtar Shaheen
Published: November 2023

Nosocomial pathogens (alert organisms) are bacteria or viruses that cause or spread hospital outbreaks. The Infection Control (IC) team must investigate every occurrence of nosocomial infection. Nosocomial pathogens may arise, de nova, in a hospital unit or be brought in by staff or patients admitted to the hospital.
The infected patient
Authors: Mehtar Shaheen
Published: November 2023

All specimens for bacteriological examination should be fresh and sent in sterile containers to the Microbiology Department as soon as possible after collection. The results of bacteriological examination depend on the quality of the specimen. If specimens are taken in non-sterile containers, or after antibiotic therapy has been started, the results may be inaccurate and/or inconclusive. A specimen collection system exists in most hospitals and usually takes place twice a day. It is often worthwhile taking urgent specimens directly to the laboratory and speaking to the laboratory staff.
Introduction and summary
Authors: Banta H David , Luce Bryan R
Published: November 2023

The field of technology assessment has developed as an aid to policy-making with regard to technology (35,492). Technology is applied knowledge. It is this applied knowledge that allows prevention, diagnosis, and treatment of disease and rehabilitation from its consequences. The goal of health care is a healthier population. Health care technology assessment is also aimed at this overall goal. Thus, the main purpose of health care technology assessment is to help ensure that medical technologies are safe, efficacious, and appropriately used.
Historical perspective on technology in health care
Authors: Banta H David , Luce Bryan R
Published: November 2023

Historically speaking, the health care system has had little effective technology. The health care system was not designed to provide effective technology to sick people. The system instead provided care to people with problems. Gradually, effective technology did begin to enter practice, but even today many possibly ineffective practices remain common. This chapter will consider some of the historical forces that led to the present situation. Although the history of evaluation and assessment is relatively short, it too will be presented.
The adoption of health care technology
Authors: Banta H David , Luce Bryan R
Published: November 2023

Figure 3 illustrates the processes of development and diffusion by the well-known sigmoid curve. This curve relates the percentage of potential to actual adopters. This curve does not convey the dynamism of the diffusion process, and thus may not give sufficient insights into diffusion itself. It is particularly useful, however, in visualizing the policy framework affecting technology. Policies have been developed that deal with several stages in the life cycle of any health care technology.
Assessing social implications of health care technology
Authors: Banta H David , Luce Bryan R
Published: November 2023

The social implications of a new or existing health care technology can be the most challenging and difficult aspects of evaluation. Any decision to develop or use a health care technology inevitably rests on value judgements. Social and cultural factors are completely intertwined in questions concerning the place of technology in health care. At the same time, the methods for assessing social implications of health care technology are relatively undeveloped and few mechanisms exist to take action based on the results of such evaluations. Society does not seem to have enough confidence in social scientists and others dealing with social issues 10 insure that results of this type of assessment are used in policy-making.
Assuring the quality of health care
Authors: Banta H David , Luce Bryan R
Published: November 2023

The quality of medical and health care is becoming an increasingly visible public issue in a number of countries (17,425,428,469,475,553,642,618). While the overall results of advances in health care seem relatively clear, there is considerable evidence that optimal care is not being given, based on available studies. This book focuses on technology assessment and the information it provides on benefits, risks, costs, and social implications of health care technology. Focusing on technology assessment has a risk; the risk is implying that examining a situation is enough. In fact, information from assessment must be used. One of the most important purposes of technology assessment is to improve quality of health care (296,428).
The assessment of medical lmaging
Authors: Banta H David , Luce Bryan R
Published: November 2023

Diagnostic imaging has been subjected to intense scrutiny since the introduction of the CT scanner in 1972. At that time, relatively few assessments of diagnostic imaging had been done aside from assessments related to safety, especially in minimizing doses of ionizing radiation. Assessing diagnostic imaging was also seen as difficult from the beginning, because the impact of an image on health cannot be direct. The diagnosis must change therapy, and the therapy must be effective.
Picture archiving and communications systems (PACS): an example of the computer revolution
Authors: Banta H David , Luce Bryan R
Published: November 2023

The experience with technology assessment in medical informatics is quite limited, but interest is growing (345). Informatics groups such as the International Society for Optical Engineering (SPIE) frequently hold sessions on this subject (344). In 1990, a conference was held in Montpellier. France, on the subject of ‘medical technology assessment, with special emphasis on informatics applied to medicine and health’ (245).
Health care technology in Sweden
Authors: Werkö Lars
Published: November 2023

Sweden has a population of about eight million people. Largely urban and highly industrialized, Sweden has one of the world’s highest per capita incomes. The country’s economy is a mixture of capitalism and socialism. Sweden has a government-owned and operated health care system. The system is highly regionalized, with four levels: health centres, district hospitals, central general hospitals, and regional hospitals (274).
Assessment of health care technology in The Netherlands
Authors: Rigter Henk
Published: November 2023

Technology assessment in The Netherlands is based on decision cycles, which have in common four major steps (see Chapter 6): (I) identifying and selecting the existing and emerging technologie that need to be addressed; (2) collecting the necessary information; (3) decision-making; and (4) providing follow-up by disseminating the results and monitoring what happens with the technology in practice. These steps will return later in this chapter in the discussion of pharmaceuticals, medical devices, and other health care technologies.
Medical technology assessment the USA 1
Authors: Banta H David , Luce Bryan R
Published: November 2023

The USA has an open, private health care system that does not do well at controlling technological change (587). None the less, the system is innovative and dynamic. Because of the lack of controls on technology, this chapter will concentrate on technology assessment programmes. Today a number of organizations in government and the private sector have assumed responsibilities for assessing health care technologies in the USA. As a rule, these organizations have been created over time as a response to the perceived needs of society.
Conclusions
Authors: Banta H David , Luce Bryan R
Published: November 2023

All countries are faced with rapid technological change in the health care field. In addition, all countries have limited resources for health care. Health care technology has become an increasingly visible issue in almost all countries in the world. The very successes of health care have made it a policy issue.
Alcohol
Authors: Anderson Peter
Published: November 2023

There is evidence for a dose-response relationship between alcohol consumption and risk of liver cirrhosis, cancers of the oropharynx, larynx, oesophagus, rectum (beer only), liver, and female breast, and violent death, but the relationship between alcohol consumption and cardiovascular disease is more complex. It is now recognized that alcohol may reduce the risk of coronary heart disease (CHD), despite its adverse effect on blood pressure and the association with an increased risk of stroke.
Individual interventions and behaviour change
Authors: Schofield Theo
Published: November 2023

The essential final step in any programme to prevent cardiovascular disease is for people to change their behaviour. This may be by adopting healthier habits and life-styles, reducing their known risk factors or adhering to any therapy that is advised. Unless behaviour changes, nothing will change. This chapter is therefore concerned with the ways that people change their behaviour and the methods that can be used to help them to do so.
Issues in measurement: Smoking
Authors: Fowler Godfrey
Published: November 2023

Measurement of tobacco consumption relies heavily on self-reported information. Such information includes the number and type of manufactured cigarettes or cigars smoked daily, or the amount of ‘roll your own’ cigarette tobacco, or of pipe tobacco used. There is no reliable way of validating this self-reported information and it is generally felt that people underestimate the amount they smoke. Blood nicotine (or cotinine) levels vary widely and are not simply related to the amount smoked but to the way smoking is carried out as well as to quantity. Various questionnaires are available to measure tobacco consumption and an example is provided in Table 19.1.
Basic pattern of notes
Authors: Guly H R
Published: November 2023

The time a patient waits to be seen or waits on a trolley before admission is a measure of quality of care and it should be possible to identify these times for each patient. Accurate times are clearly important if a patient makes a complaint of having to wait an excessive length of time. Timings are also important for audit, planning, and the generation of statistics. Accurate waiting time statistics are becoming essential to satisfy the purchasers of A& E services, that agreed standards are being achieved.
Examination
Authors: Guly H R
Published: November 2023

In many branches of medicine physical examination of a patient may concentrate on the symptomatic area but will involve an examination of the whole body. InA& E, examination will usually be more restricted and the aim of this book is to state what examination should be performed for each part of the body. One of the important reasons for junior doctors working in A& E is to learn and practice the skills of examination of the musculoskeletal system and to learn to differentiate the normal from the pathological at all ages.
Advice to patients and follow-up
Authors: Guly H R
Published: November 2023

A patient’s refusal of treatment should be noted and where this might have serious consequences, the refusal should be confirmed by the patient’s signature on the appropriate form. If they refuse even to sign the form, this must be confirmed by the signature of a witness on the records.
Non-traumatic problems
Authors: Guly H R
Published: November 2023

Patients with acute musculoskeletal pains commonly present to the A& E department as do patients with less acute problems. It is not the function of this book to give advice on whether these patients should be seen or treated in an emergency department but if they are seen (even if referred back to their general practitioner for treatment) it is important that their problems are assessed and documented properly.
Knee injury
Authors: Guly H R
Published: November 2023

Many of the important injuries of the knee are of the soft tissues and not visible on plain X-rays. Most diagnoses can be made clinically but even for those diagnoses requiring more specialized or invasive procedures (e.g. Magnetic resonance imaging or arthroscopy), good clinical skills are needed to select the patients who require further investigation.
Computers and genetic diseases
Authors: Elmslie Frances V , Winter Robin M
Published: November 2023

Computers have become essential tools in the day-to-day life of the clinical geneticist. Research into genetic disorders has expanded rapidly in the last few years and it has become impossible to keep up to date with new genetic information without the aid of centralized databases. In addition, the calculations involved in mapping and isolating genes are complex and require the aid of a computer. As more diseases are tackled so the computer scientists have risen to the challenge of producing an increasing range of software capable of analysing these problems. In this chapter we will give a broad overview of the ways in which computers are used, together with specific examples of recent, successful applications of the programs described.
Familial and genetic aspects of primary vesicoureteric reflux
Authors: Bailel Ross R
Published: November 2023

Reflux nephropathy is the cause of about 10% of all cases of end-stage renal failure, and up to 50% of those presenting in childhood (Disney 1991; Bailey 1992; Bailey et al. 1993, 1994). Reflux nephropathy is therefore comparable in frequency to autosomal dominant adult polycystic kidney disease as a cause of end-stage renal failure. Reflux nephropathy is associated with the severer degrees of primary vesicoureteric reflux (Bailey 1973, 1992; Bailey et al. 1993). The latter is due to a congenital anomaly (McGovern et al. 1960; Hutch 1961), which in some instances is familial and inherited. This chapter will review the familial and genetic data so far reported in patients with primary vesicoureteric reflux or reflux nephropathy.
Congenital nephrotic syndrome
Authors: Gubler Marie-Claire
Published: November 2023

The term ‘congenital nephrotic syndrome’ (CNS) is used to designate nephrotic syndrome (NS) which is present at birth or, by extension, detected within the first three months oflife, whereas ‘infantile nephrotic syndrome’ applies to NS of later onset, up to one year of age. Most have a genetic basis and a poor outcome. The best example of CNS was initially observed and described in Finland by Hallman and Hjelt (1959) and is now called congenital nephrotic syndrome of Finnish type.
Fabry’s disease and the lipidoses
Authors: Desnick Robert J , Eng Christine M
Published: November 2023

Originally described as a dermatologic curiosity by Fabry (1898), and independently by Anderson in the same year (1898), Fabry’s disease is now recognized as an inborn error of metabolism resulting from the defective activity of the lysosomal enzyme, cx-galactosidase A. The enzymatic defect, transmitted by an X-linked recessive gene, leads to the progressive deposition of neutral glycosphingolipids with terminal cx-galactosyl moieties in the plasma and lysosomes of endotheli al, perithelial, and smooth-muscle cells of the cardiovascular-renal system and, to a lesser extent, in reticuloendothelial, myocardial, and connective-tissue cells. Epithelial cells in the kidney, cornea, and other tissues contain the lysosomal glycolipid deposits, as do ganglion and perineural cells of the autonomic nervous system.
Nephropathic cystinosis: growing into adulthood
Authors: Gallo Linda K , Gahl William A
Published: November 2023

Although nephropathic cystinosis has long been considered a renal disease of childhood, two major therapeutic interventions have transformed it into an adult disorder as well. First, renal transplantation has prolonged the lives of many cystinosis patients into the third and fourth decades. In particular, the 70-80 North American patients who had received a renal allograft prior to 1985 (Gahl et al. 1986) have now reached adulthood. Second, the cystine-depleting agent, cysteamine, has so favourably altered the natural course of cystinosis that many patients are now approaching adulthood without requiring a renal allograft (Gahl et al. 1987; Clark et al. 1992; Markello et al. 1993). Consequently, adult nephrologists and other physicians are increas ingly called upon to manage the many renal and non-renal complications of long-standing cystinosis. These will be discussed below, but first it is helpful to become familiar with the disease in children.
The amyloidoses and familial Mediterranean fever
Authors: Nelson S R , Pras M
Published: November 2023

The understanding of’amyloid’ is advancing on several fronts, particularly the molecular genet ics of the inherited forms of this condition. These inherited forms of amyloid may have their prodrome in childhood but most have their clinical manifestations in adolescent and adult life. Rokitansky (1842) and others described physical deposits of a waxy, lard-like substance before Virchow (1854) termed them ‘amyloid’. But it is Virchow who is recognized as the discoverer of the disease entity ‘amyloidosis’ because of his clinical description and observation that the deposits take up iodine in a manner similar to starch or cellulose. On the basis of this staining, Virchow concluded that they were made up of carbohydrate. A few years later, the chemists Kekule and Schmidt (1858) noted that they contained so much nitrogen that they were albumi nous in nature. For many years the protein component has been the focus of amyloid research but recently the presence of the carbohydrate and glycosaminoglycan components has been re examined. Manipulation of the latter may offer therapeutic options for the future in addition to present therapies.
Legal Problems in Emergency Medicine
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Legal Problems in Emergency Medicine is a small, practical book which covers a large, complex subject. It is the first book to offer practical guidance specifically for the doctor, nurse, manager, or lawyer faced with legal difficulties arising out of a medical emergency. 'Ignorance of the law is no excuse', and all professionals now require a working knowledge of the law relating to their subject. Those practising Emergency Medicine are no exception, whether casualty officers, hospital specialists, general practitioners, or nursing or paramedical staff. The first part of this book offers guidance, with examples, for those 'on the spot' in difficult situations, whilst the second part consists of a condensed but authoritative summary of the various legal topics comprising emergency medicine law. Written in plain language, it makes several complex and difficult areas of the law accessible to the legal layman-yet it does not avoid more complicated issues and is fully reference so that the truth of each statement can be validated. Readers will benefit from the extensive working knowledge of a unique team of authors: an emergency physician who has practised at the English Bar, and a practising solicitor.
Officialdom
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Enquiries from patients’ relatives and friends as to their well-being seldom present difficulty. A patient will usually give his consent but, if he cannot, and it is in his best interests, it is fairly easily implied. On the other hand, when officials make enquiries the culture of helpfulness may predominate with the risk of improper disclosure.
Local difficulties
Authors: Montague Alan , Hopper Andrew
Published: November 2023

The service of an emergency department can only be as good as its hospital will allow. Overtired or over-confident junior members of in-patient teams may be tempted to take advantage of the inexperience of a casualty officer. He may be dissuaded from making a formal referral against his better judgement or the reluctant response may be unacceptably slow.
The system
Authors: Montague Alan , Hopper Andrew
Published: November 2023

Medicine is practised within the infinitely complex machine of human society. It is subject to many influences including the super-vision by professional bodies as well as the activity of government and its agents such as hospital management, social workers, and police forces. The most potent influence is the law.
Medical negligence and vicarious liability
Authors: Montague Alan , Hopper Andrew
Published: November 2023

The civil law exists to redress wrongs, not to punish wrongdoers. It is principally concerned with parties who fall out over business agreements, children and property of families who fall apart, and with those who commit and those who suffer civil wrongs (or torts). In National Health Service work there are no contracts between doctors and patients and so the bulk of medical litigation is in the realm of tort.
Confidentiality
Authors: Montague Alan , Hopper Andrew
Published: November 2023

The doctor’s obligation of secrecy is ancient, and embedded in the Hippocratic Oath: ‘I will keep silence thereon, counting such things to be as sacred secrets’. It is essential to the trust between doctors and patients. It is a legal as well as an ethical obligation and can be enforced by the courts.
Police powers
Authors: Montague Alan , Hopper Andrew
Published: November 2023

The law of England and the British Constitution developed with traditions of the rights of man and the liberty of the subject. These have been eroded as governments have sought to protect us from antisocial and lawless elements, in part by conferring special powers on police constables. It is fundamental that a constable has no general or inherent power to enter premises, detain people, seize things, or obtain answers to his questions.
In vitro models in the study of renal cystogenesis
Authors: Mangoo-Karim Roberto , Sullivan Lawrence P , Ye Min , Grantham Jared J
Published: November 2023

Epithelial cyst configuration is a physiological design in the function of certain organs such as ovarian follicles, thyroid follicles, and blastocysts. Similarly, the cylindrical design of nephrons and collecting ducts and the juxtaposition of renal tubules and microvessels are essential for proper renal function. In the kidney, however, the cyst phenotype deriving from tubules is distinctly abnormal. These pathological structures distort the functional, vascular, and structural integrity of the kidney, and are associated in many instances with the progressive deterioration of renal function. Polycystic kidney disease encompasses a spectrum of clinical conditions that have renal enlargement secondary to cyst expansion as a common feature.
Pathogenesis of polycystic kidney disease: altered cellular function
Authors: Wilson Patricia D
Published: November 2023

There may be several different mechanisms leading to the formation of cysts in kidneys, which can be broadly divided into those of genetic and non-genetic in origin. Within the genetic group, to date, no exact animal model has been shown to reflect a human genetic polycystic kidney disease (PKD) as judged by chromosome assignment, inheritance trait or rate of disease progression. Nevertheless, animal models have been of value in analysing cellular mechanisms involved in renal cyst formation (Table 6.1), and are particularly useful when viewed in comparison to findings in human tissues (Table 6.2).
Hypertension in polycystic disease
Authors: Watson .A1ichael L
Published: November 2023

Reports of hypertension in associatton with polycystic kidney disease (PKD) began to appear in the literature in the early part of the twentieth century (Braasch 1916; Schacht 1931). Most of these reports related to patients who had chronic renal failure as a consequence of cystic kidney disease (Braasch and Schacht 1933; Rall and Odell 1949; Higgins 1952), and it was noted that in these patients the incidence of hypertension was very much higher than in age- and sex-matched controls with end-stage renal disease secondary to pyelonephritis (Schacht 1931).
Miscellaneous renal and systemic complications of autosomal dominant polycystic kidney disease including infection
Authors: Elzinga Lawrence W , Bennett William M
Published: November 2023

As a multiorgan genetic disease, autosomal dominant polycystic kidney disease (ADPKD) has protean manifestations. Many of the more common and better understood complications and issues are covered separately in this monograph, including hypertension, renal failure, cystic liver disease, and cerebral aneurysms. This chapter addresses miscellaneous additional topics, including the very important subject of renal and hepatic infection.
Particular problems in childhood and adolescence in autosomal dominant polycystic kidney disease
Authors: Chapman Arlene B
Published: November 2023

The original nomenclature for Autosomal dominant polycystic kidney disease (ADPKD) was ‘adult polycystic kidney disease’ due to the usual age of presentation. However, the disease is autosomal dominantly inherited and the number of neonates, infants, and children diagnosed with ADPKD has increased dramatically during the past 20 years. The increased recognition of ADPKD in the paediatric age group is due to a number of factors.
Counselling and ethical considerations in autosomal dominant polycystic kidney disease
Authors: Macnicol Anne M , Wright Alan F
Published: November 2023

Autosomal dominant polycystic kidney disease (ADPKD) is a common and serious genetic disorder with onset of symptoms generally after the reproductive age resulting in the propagation of the disease over many generations. It there fore presents an important opportunity to genetic counsellors to inform affected and ‘at-risk’ family members about the nature of the disorder and the treatment options, the recurrence risks to offspring and the advantages and disadvantages of pre-symptomatic testing. Advances in treatment have gradually led to an improved prognosis. Specific treatment is not available in ADPKD but early diagnosis leading to the prevention of hypertension is beneficial.
What causes kidney failure? Causes as yet without a specific treatment
Authors: Cameron Stewart
Published: November 2023

Fortunately, we already know from Chapter 3 that not all forms of glomemlonephritis lead to kidney failure, and that of those types that do, not everyone affected takes this course. However, in all groups of young adults with kidney failure who have been studied, the commonest single cause of kidney de .. struction are one or another of the group of conditions known collectively as glomerulonephritis. This is not true of children, or of the elderly, as we have noted above.
People with special needs: diabetics, paraplegics, children, and the elderly
Authors: Cameron Stewart
Published: November 2023

Facing up to kidney failure is bad enough, but is doubly difficult if, in addition, you have a condition which affects other parts of your body and may have been creating problems for you during many years. In addition, people at the extremes of life—the very young and the very old-have their own special problems.
An overview of treatments for kidney failure
Authors: Cameron Stewart
Published: November 2023

There were, at the end of 1992, just under 600 000 people being maintained by some form of dialysis, and about 200 000 people with functioning transplanted kidneys. Thus in the next year or two the number of people alive who would otherwise have died will exceed one million. Which form of treatment is best? Of course there is no answer to this question, because it depends entirely upon what individual people want, and what may be best for them medically.
The development of new drugs
Authors: Hobbs Richard , Millson David
Published: November 2023

The main objectives of clinical novel therapeutic research are to demonstrate the efficacy, safety, and metabolism of a drug or device in defined clinical indications, with the dosage range and proposed market formulation defined, and culminating in a successful approval from drug regulatory authorities. More recently, there has been a greater expectation that novel drugs will demonstrate efficacy over and above that seen in existing therapies and also provide some evidence on cost-effectiveness.
Licensing and marketing of drugs
Authors: Langman Michael , Wells, Frank , Leach Frank
Published: November 2023

One inevitable consequence of drugs being developed by a commercial pharmaceutical industry is that, like other commodities, they are bought and sold for profit. However, they are a commodity with some very special features which make the market for drugs unique, in particular with regard to the extent to which it is stringently regulated. There are good reasons for the stringent regulation of the market in drugs.
Impact of the UK healthcare reforms on prescribing
Authors: Walley Tom , Ferguson, John , Carter Yvonne
Published: November 2023

Prescribing by GPs has come in for extensive attention in recent years, because of the rising costs, concerns about the quality of much prescribing, and value for money. This increased attention must, however, be seen in the context of extensive reforms in the NHS over the same period, the biggest upheaval since its inception in the 1940s.
Non-prescription or over-the-counter medicines and the role of the pharmacist
Authors: Bond Christine , Bradley Colin
Published: November 2023

In the UK, the retail and wholesale dealings of all medicines and poisons are regulated primarily by the Medicines Act 1968, together with the Poisons Act 1972 and the Misuse of Drugs Act 1971. Sale and supply of medicines (by which is meant ‘medicinal products’ and includes any substance or article sold or supplied for administration to human beings or animals for a medicinal purpose) is controlled by the Part III of the Medicines Act 1968, and by orders made under it.
Introduction
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

In recent years the road toll has tended to edge downward in developed countries perhaps because of an increasing awareness of the need to build safety features into motor vehicles, and perhaps due to an improvement in the education of drivers and law enforcers. The hidden road toll, the effect on the drivers, passengers, and pedestrians who suffer head injuries in traffic accidents, has also edged downward. Unfortunately there is still a horrendously high number of head injuries overall. People are still head injured in falls, in sports, particularly contact sports, in industry, and in violence on the streets. Young men still make up the majority of these cases, with small children and the elderly also at risk.
Some specific consequences
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

Some or all of the after-effects which we talked about in the last chapter can be seen in anyone who has had a closed head injury, whether it was mild or severe. You will remember that in Chapter Z we described how in this sort of injury damage occurs to widespread areas of the brain because of the distortion and twisting which occurs. Penetrating injuries or blood clots on the other hand cause more localized damage, with different effects. These often look like the results of a stroke, perhaps with paralysis of one side of the body or loss of speech. Often both sorts of damage are present at the same time, which makes them more difficult to deal with.
Providing a head-injury service
Authors: Gronwall Dorothy , Wrightson, Philip , Waddel Peter
Published: November 2023

Up to now we have been talking about the effects of head injury and how the problems are dealt with. We have agreed that many of the problems are very difficult to solve. Though nowadays the standard of acute medical care is usually good, we have also suggested that the other services that the authorities provide are often inadequate, both because they have not understood what is needed and because they have not given the requirements of head-injured people enough priority in their budgets.
Autoantibodies and lupus nephritis
Authors: Rahman M A Anisur , Isenberg David A
Published: November 2023

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease with an incidence of approximately four cases per 10 people per year in the UK. The peak age of onset is between the ages of 20 and 40 and women are affected approximately 10 times more often than men. The condition is commoner in some racial groups than others. In Birmingham (UK) the prevalence of SLE in women is 206 per 10 in Afro-Caribbeans, 91 per lOS in Asians, and 36 per 10 in Caucasians. For men the corresponding figures are 9.3 per 105, 2.6 per 10, and 3.4 per 10 for these three ethnic groups, respectively.
Clinical manifestations of lupus nephritis
Authors: Cameron J Stewar
Published: November 2023

Lupus is an archetypcal multisystem disease, and almost every tissue or organ may be affected. Indeed, its diagnosis conventionally depends upon multisystem involvement, as well as the presence of antibodies directed against various nuclear antigens. Thus it is best regarded as a syndrome—the lupus syndrome—rather than a disease entity. Although clinical renal disease, when present, is a major determinant of prognosis it must be seen in the context of this multisystem involvement. Renal disease is rarely the first manifestation of lupus, even when it may come later to dominate the clinical picture.
Pregnancy in women with lupus nephritis
Authors: Hou SusanH
Published: November 2023

Pregnancy in a woman with lupus nephritis is fraught with hazards: she has a disease which is immunologically mediated and modulated by changes in sex hormones; there are major hormonal and immunologic changes during pregnancy; her illness may affect her kidneys and heart which ordinarily function at increased levels during pregnancy; and she may require treatment which carries added risks during pregnancy. The fetus is at risk from the direct effects of the disease, the effects of the medications used to treat it, and the infectious complications of these medications. To move from conception to birth with two healthy individuals requires traversing a medical minefield filled with sudden and unpredictable dangers for both mother and child.
Gender Issues: Freudian and feminist stories
Authors: Sayers Janet
Published: November 2023

Freud notoriously narrated both sexes’ psychology in terms of the male-centred myths of Oedipus and Narcissus. He rejected the suggestion that women’s psychology might be better encompassed by the female-centred myth of Elektra. And he tended to focus on individual and intrapsychic issues to the relative neglect of interrelational and interpersonal issues now recognized by post-Freudian and feminist theorists to be crucial in shaping our adult lives and loves. In this chapter, I seek to highlight the latter issues, and the rather different stories women and men often tell about themselves, with examples from culturally shared myths; published autobiography and fiction; dream stories anonymously written by pupils attending two parallel, single-sex, state secondary schools; and from the stories patients have told me in therapy.
Sacred tales
Authors: Sims Andrew
Published: November 2023

In this chapter we will look at some of the stories behind the sources of energy in modern British health care. I see us, like the observers at an old-fashioned battle, standing on a hillside looking at and recognizing the prominent individuals as they approach us. We have difficulty identifying them as they leap into our view, and we may only be able to recognize them by their tails as they disappear once again. So, as the new National Health Service was unveiled before us in the early 1990s, we knew that we were to be confronted with purchasers and providers but it was not so easy to see at that stage how market forces would come to distort certain services. We have come to realize that it is ‘only by their tails that ye shall know them’.