bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the beliefs and experiences with regard to COVID-19 vaccine hesitancy and acceptance in a slum of Karachi, Pakistan
Authors: Qasim Rubina , Shah Hakim , Sultan Aqsa , Yaqoob Muhammad , Haroon Rukhsana , Mistry Sabuj Kanti , Bestman Amy , Yousafzai Mohammad Tahir , Yadav Uday Narayan
Published: October 2022

The COVID-19-related misinformation and vaccine hesitancy is a widespread global concern and a recognized public health problem in Pakistan. The current research sought to explore the beliefs and experiences with regard to COVID-19, including vaccine hesitancy and acceptance, in a slum of Karachi, Pakistan. This study used an interpretivist epistemological approach for data collection and employed in-depth interviews (IDIs) and focus group discussions (FGDs) to explore the themes of interest. IDIs and FDGs were conducted in the local language (Pashtu) and Urdu, using semi-structured interview guides. A hybrid thematic analysis approach (use of both inductive and deductive coding) was used to analyze the data. We identified two key themes: the first related to vaccine hesitancy and refusal and included the role of personal belief systems, vaccine mistrust and public perceptions in hesitancy; the second related to vaccine acceptance and included knowledge and awareness about the vaccine and trusted sources of information. Religious beliefs and cultural norms influenced attitudes toward COVID-19 and vaccination. This study also found that awareness about the COVID-19 vaccine in this sample was influenced by sex, educational status and socioeconomic status. Participants with good health literacy and those from healthcare backgrounds were more likely to share views that indicated vaccine acceptance. The findings of this study are being used to co-design a comprehensive intervention to dispel COVID-19 misinformation and vaccine hesitancy across a range of stakeholders such as youths, community leaders, family members, faith leaders, schools and community-based local organizations in Pakistan.
Spatial and temporal evolution of total factor productivity of low-carbon tourism industry based on DEA–Malmquist Index model
Authors: Tang Zi , Huang Tianyue , Si Xiaopeng , Wang Weili
Published: October 2022

The energy consumption and carbon dioxide emissions of tourism industry in China have become issues that cannot be ignored, putting pressure on the natural environment. This study uses Data Envelopment Analysis–Malmquist Index (MI) model to analyze the temporal and spatial evolution process of low-carbon tourism industry efficiency in Heilongjiang Province from 2010 to 2019. The results show that from 2010 to 2019, the technical efficiency (TE) of low-carbon tourism industry in 12 regions of Heilongjiang Province was significantly different and shows a growth trend. The pure technical efficiency (PTE) in Qiqihar, Jixi and Yichun had a more significant impact on the TE, and PTE had a greater impact on the development of low-carbon tourism economy in these regions. Hegang, Daqing, Shuangyashan, Kiamusze, Heihe and Suihua have a higher MI, and the TE has maintained a stable growth state overall.
A Special Tribunal for the Crime of Aggression?
Authors: Dannenbaum Tom
Published: October 2022

The Russian Federation is currently in the second phase of what appears to be a war of aggression against Ukraine. While Russia’s invasion is widely thought to satisfy the threshold of the crime of aggression, the routes to accountability for this crime are unclear: The International Criminal Court lacks jurisdiction and domestic courts offer an uncertain alternative. Therefore, Ukraine and a chorus of others are advocating the creation of a special tribunal. This piece explores the options as well as the arguments that speak in favour and against establishing such a special tribunal for the crime of aggression.
Demographic and environmental correlates of home ranges and long-distance movements of Mohave ground squirrels
Authors: Poessel Sharon A , Leitner Philip , Inman Richard D , Esque Todd C , Katzner Todd E
Published: October 2022

Space use by mammals can differ among age-classes, sexes, or seasons, and these processes are recognized as adaptive behavioral strategies. Semi-fossorial ground squirrels, in particular, have shown age- and sex-specific patterns in their aboveground movement behaviors. We studied space use of Mohave ground squirrels (Xerospermophilus mohavensis) at the Freeman Gulch study site in the central region of their range in the Mojave Desert, California. We documented the timing of their full annual cycle, investigated correlates of size of home ranges of adults and distance of long-distance movements by juveniles, and evaluated whether juvenile body masses and movements were related to interannual climatic variation. Adult males emerged from burrows and entered hibernation sooner than did adult females. Home ranges were larger for males (x¯ ± SD = 0.50 ± 0.40 km2) than females (0.05 ± 0.03 km2), especially during the mating season. Maximum distances moved by juveniles did not differ significantly between males (1.6 ± 2.3 km) and females (1.0 ± 1.8 km), and both sexes were equally likely to travel long distances from natal sites. The longest-distance movement we documented was 7.7 km by a juvenile male. Juveniles born in a year of low vegetation productivity gained significantly less mass (97 ± 7 g) and traveled shorter distances than those born in a year of higher vegetation productivity (177 ± 20 g). Our findings were similar to those documented in the Coso Range study site in the northern region of the geographic range of the species, indicating that movement patterns are similar range-wide. Mohave ground squirrels responded strongly to climate variation, and global climate change will likely result in a northward shift in suitable habitats. Informed conservation planning, therefore, will be essential for this rare, declining species.
Temporal rate of postmortem DNA degradation in archived tissue samples: evidence from liver and muscle
Authors: Amarilla-Stevens Heidi N , Stevens Richard D , Phillips Caleb D , Bradley Robert D
Published: October 2022

Guidelines identifying best practices for harvesting tissues that lead to optimal DNA preservation are few but are important curatorial concerns for genetic resource collections. We conducted a temporal study to establish rate of DNA degradation of tissue samples extracted from field-caught museum specimens. Five individuals of Sigmodon hispidus were collected and their liver and muscle tissues were harvested. Each tissue type was sectioned into 15 subsamples, and each was preserved in liquid nitrogen at different time intervals (2, 4, 8, 16, and 32 min; 1, 2, 4, 8, and 16 h; and 1, 2, 4, 8, and 16 days) following death. DNA was extracted using an automated robotic instrument and molecular mass profiles were determined fluorometrically. Postmortem DNA degradation was continuous and dependent on time, but also was significantly affected by differences among individual cotton rats. DNA fragments of ≥10,000 base pairs in length were present in muscle samples across all time intervals, whereas DNA fragments of this size in liver samples were no longer present after 8–16 h postmortem. DNA molecular mass profiles showed that muscle samples retained 80% of their longest fragments (≥10,000 base pairs) until 1 day postmortem, whereas liver samples retained the same percentage only until 8 min after death. Although rates of decay were measured from samples in a laboratory (not field) setting, rates of decay presented here can guide field and museum workers in best practices. Results suggest that opportunistic samples, such as those from roadkill specimens, are more likely to be of use for a variety of molecular methods when muscle is preserved. Considerations of differences in rates of degradation may also guide selection of tissue types housed in genetic resource collections, especially under space-limited circumstances.
National online survey of Filipinos’ knowledge, attitude and awareness of antibiotic use and resistance: a cross-sectional study
Authors: Berdida Daniel Joseph E , Grande Rizal Angelo N , Lopez Violeta , Ramirez Sheryl H , Manting Muhmin Michael E , Berdida Marc Matthew E , Bañas Christopher B
Published: October 2022

Objectives

Globally, the number of cases and deaths associated with antibiotic resistance increases yearly. In the Philippines, studies on antibiotic resistance remain underreported. Thus, this study examined Filipinos’ knowledge, attitude and awareness and the associated predictive variables to their antibiotic use and resistance.

Methods

A population-based, cross-sectional and predictive approach guided this study. Convenience sampling of 3767 participants was recruited through social media and completed the Eurobarometer survey on antibiotic resistance from July 2021 to January 2022. Chi-square test and regression analysis were used to analyze the data.

Key findings

A relatively average number of the participants have a general idea about the common types of antibiotics available. Males and health care workers had a higher percentage of correct responses on antibiotic resistance knowledge. Most participants had low knowledge levels of antibiotic resistance (n = 1911, 50.7%). Age, educational attainment, profession, antibiotic use within the last 12 months, and having household members taking antibiotics were significant predictors of the level of knowledge on antibiotic resistance (P-value < 0.05). There was a significant difference in participants’ gender, age and educational status in their attitudes on the acquisition, hygienic practices and role of health professionals in antibiotic resistance (P-value < 0.05).

Conclusions

Government agencies and policymakers should consider the identified predictors when establishing policies on antibiotic resistance. This will ensure that antibiotic use is both safe and effective.
Ephedra sinica polysaccharide alleviates airway inflammations of mouse asthma-like induced by PM2.5 and ovalbumin via the regulation of gut microbiota and short chain fatty acid
Authors: Liu Jun-Xi , Yuan Hong-Yu , Li Ya-Nan , Wei Zhen , Liu Yang , Liang Jun
Published: October 2022

Objectives

Epidemiological investigations show that long-term exposure to PM2.5 is directly related to asthma-like and other respiratory diseases. This study aims to further explore the pharmacological effect of Ephedra sinica polysaccharide (ESP) on lung injury caused by atmospheric PM2.5.

Methods

To achieve the aim, we explored the therapeutic effect of ESP on an aggravated asthma-like mouse induced by PM2.5 combined with ovalbumin (OVA), and explored mechanisms underlying the connection between gut microbiota and lung function.

Key findings

Preliminary results showed that ESP alleviated the symptoms of aggravated allergic asthma-like in mice; reduced the number of eosinophils in BALF; reduced the levels of serum Ig-E, IL-6, TNF-α, and IL-1β. Further qRT-PCR detected that ESP inhibited the NF-κB pathway. The final analysis detected by 16S rRNA and short chain fatty acid (SCFA) confirmed that ESP increased relative proportions of Bacteroides, Lactobacillus, Prevotella, Butyricicoccus and Paraprevotella, but decreased that of Enterococcus and Ruminococcus; increased acetic acid, propionic acid, butyric acid, isobutyric acid, valeric acid, isovaleric acid, and isohexanic acid in the meanwhile.

Conclusions

The study showed that ESP has a potential for future therapeutical applications in the prevention and treatment of asthma-like disease induced by PM2.5 and OVA via regulation of gut microbiota and SCFA.
Troubleshooting
Authors: Mercado Alfonso , Venta Amanda
Published: October 2022

This chapter highlights troubleshooting considerations when working with Latinx groups. For example, the authors discuss linguistic considerations when working with interpreters, and the possible barriers to treatment and alliance, including dealing with microaggressions in the assessment process. As well, the fact that some Latinx clients do not speak Spanish is also discussed, and the importance of discerning the client’s preferred language is emphasized. Rather than making assumptions about a client’s preferred language, cultural humility is demonstrated in asking the client their preferred language and making efforts to accommodate that preference. The chapter also discusses the unique considerations needed when testing undocumented clients and in the assessment of undocumented children. A conclusion on cultural adaptions is also presented.
Basics of Neurophysiology
Authors: Rubin Devon I.
Published: October 2022

The physiology of resting membrane potentials, action potentials, and transmission of the electrical signals along neurons and between different cells forms the basis of clinical neurophysiology. The transmission of information in the nervous system depends on the generation of a resting potential through variable permeability of ions across cell membranes controlled by the ionic concentration gradients. Propagated action potentials arise when local potentials reach threshold, allowing for information to move from one area to another within the nervous system. The information is integrated in neurons by the interaction of local potentials generated in response to the neurotransmitters released from depolarized nerve terminals. In this system, information can be coded either as the rate of discharge in individual cells or axons or as the number and combination of active cells. While the physiology and activity of the nervous system can be described in terms of the electrical activity of single cells, the combined activity of large numbers of cells and axons determines the behavior of the organism. Each type of alteration in neuronal or muscle cell physiology can produce symptoms. The particular findings in a patient depend on which cells are altered and the length of alteration. These may include loss or abnormal sensory symptoms, such as tingling or visual obscurations, loss of strength, decrease in consciousness, or abnormal movements. These physiological alterations are not specific and may be the result of many different pathologic mechanisms and diseases. This chapter reviews the basic principles underlying the activity of excitable cells as they apply to the basic neurophysiology of neurons and myocytes.
Long-Term Video-EEG Monitoring in the Epilepsy Monitoring Unit
Authors: Burkholder David B. , Shin Cheolsu
Published: October 2022

Long-term video electroencephalographic (EEG) monitoring (LTM) in the epilepsy monitoring unit (EMU) is a valuable clinical tool. It has utility in diagnosing various types of seizures and other episodic events, classifying epilepsies, and monitoring therapeutic responses. It is a necessary test for assessing drug-resistant patients who may benefit from epilepsy surgery. Due to the sensitive nature of EMU monitoring, certain technical standards, staffing, and hospital environmental considerations are important. Patient safety is particularly important as seizures and other unpredictable types of events often create injury risks that may be mitigated when appropriately anticipated. LTM in the EMU is an essential instrument for any neurologist.
Technical Problems and Potential Complications of Needle EMG
Authors: Rubin Devon I.
Published: October 2022

Needle electromyography (EMG) is a routine technique used during a routine electrodiagnostic examination that provides information about muscle and nerve function in the evaluation of patients with suspected neuromuscular disorders. Needle EMG is performed by inserting a small needle electrode through the skin and into a muscle, moving the electrode through multiple portions of the muscle, and recording the electrical signals generated from the muscle fibers at rest and during voluntary activation at each of these sites. Technical problems may be encountered during the needle examination that can interfere with accurate and efficient collection and interpretation of the data. Needle EMG is generally a safe procedure. However, since it involves inserting and moving a needle into and through muscle tissue, there are potential risks in certain situations. This chapter reviews technical problems and the risks that may be encountered during needle EMG.
Brainstem Auditory Evoked Potentials
Authors: Carter Jonathan L.
Published: October 2022

Brainstem auditory evoked potentials (BAEPs) assess peripheral and central auditory conduction pathways and are helpful in diagnosing both peripheral and central disorders affecting these pathways. They are commonly used to screen infants for hearing loss. In central disorders, BAEPs may provide evidence for asymptomatic lesions in the brainstem or help to localize symptomatic lesions. While the findings are not specific for pathology, slowing of interpeak latencies suggests a demyelinating disorder, while loss of one or more waveforms may suggest other etiologies, such as stroke or tumor. In the era before high-resolution magnetic resonance imaging (MRI), BAEPs were important tools for detection of acoustic neuromas, and they may still be useful in patients who cannot undergo MRI imaging. The greatest technical challenge is recording a reproducible wave I, especially in individuals with peripheral hearing loss. If wave I cannot be successfully recorded, conclusions regarding subsequent waveforms must be made with caution. Because BAEPs are resistant to anesthesia, they have assumed an important role in intraoperative monitoring of surgical cases involving cranial nerves or brainstem structures. They are also useful in assessing prognosis in nontraumatic coma and in the determination of brain death.
Autonomic Physiology
Authors: Cheshire William P.
Published: October 2022

The Autonomic Physiology chapter explains the function of the various components of the autonomic nervous system that are relevant to neurologic practice and the scientific basis for clinical autonomic testing. It provides an overview of the general neuroanatomical organization of the autonomic nervous system and reviews the neurophysiology of arterial baroreflexes and muscle sympathetic activity in maintaining blood pressure and in orthostatic hypotension. It also reviews sudomotor and vasomotor skin sympathetic activity, which are important in thermoregulation. With this background, the chapter reviews the role of clinical autonomic testing in the diagnosis of small-fiber neuropathies and alpha-synucleinopathies and surveys the range of autonomic diseases that may be encountered in patients with neurologic disease. The content is written for general and neuromuscular neurologists as much as for autonomic specialists.
Volume Conduction in Clinical Neurophysiology
Authors: Lagerlund Terrence D. , Rubin Devon I.
Published: October 2022

Volume Conduction reviews the theory describing the spread of electrical current throughout the body. The types and polarities of cortically generated potentials and the relationship to excitatory and inhibitory postsynaptic potentials are discussed. Influences of the volume conductor on peripheral nerve and muscle potentials are described. Specific current sources, including monopoles, dipoles, and quadrupoles and the spread of current through the body from each type of source, are described, together with how these influence the spatial distributions of potentials recorded from referential and bipolar montages. The effects of resistive-capacitive properties of the volume conductor medium are discussed, together with how these effects can cause erroneous latency measurements of propagating action potentials. Applications to evoked potentials, electroencephalography (EEG), nerve conduction studies, and needle electromyography are described. Dipole source localization by EEG and magnetoencephalography is also discussed. An Appendix gives formulas for calculating potentials in homogeneous media and discusses how these potentials change in nonhomogeneous volume conductors.
Instrumentation and Electricity for Clinical Neurophysiology
Authors: Lagerlund Terrence D.
Published: October 2022

This chapter reviews the basic principles of electricity and how they apply to electrical circuits. Electrical properties such as electric field, electric potential, electromotive force, electric current, current density, resistance, conductance, resistivity, conductivity, capacitance, inductance, frequency, reactance, and impedance are defined, along with their measurement units and formulas for calculation. Electrical circuit components such as seats of electromotive force (batteries and generators), resistors, capacitors, coils (inductors), diodes, and transistors are described, as well as example circuits containing these components. Key concepts of electrical circuits such as direct current and alternating current, root mean square measurements, time constant, cutoff frequency, resonance, forward and reverse biasing, gain (amplification), and common mode rejection ratio are discussed. High-pass and low-pass filter circuits and differential amplifier circuits are also described and their usage is illustrated.
Injury to the liver, pancreas, spleen, gallbladder, and extra-hepatic bile duct
Authors: Mirza Ahmad , Filobbos Rafik , Kausar Ambareen , O’Reilly Derek A.
Published: October 2022

Abdominal trauma can cause significant injury to the liver, pancreas, gallbladder, and spleen. In recent decades, there has been a paradigm shift from surgical treatment of these injuries to a conservative, non-operative approach, including angioembolization. When laparotomy is performed for liver trauma, damage control manoeuvres, including peri-hepatic packing, form the mainstay of the initial strategy. For pancreatic trauma, the key distinction for clinical purposes is whether a main pancreatic ductal injury is present. A non-operative approach is preferred when the main pancreatic duct is not involved. A conventional distal pancreatectomy is usually required for a complete transection of the pancreas. The management of splenic trauma has also changed significantly over the past few decades with non-operative management (NOM) becoming the mainstay of treatment. Biliary tract injuries can be difficult to diagnose and require either an endoscopic stent or an operative approach.
Peritoneum
Authors: Pagadala Nitesh Naga Balaji , Pottakkat Biju
Published: October 2022

The peritoneum is the most widespread membrane with unique functional capabilities. This chapter highlights the anatomy of peritoneum and its blood supply with special mention to surgical importance of all the peritoneal folds or membrane. All the intriguing aspects of peritoneal physiology in maintaining intraabdominal homeostasis are elucidated. All the possible primary peritoneal diseases are explained. Approach and evaluation to a patient with ascites and management are also elaborated.
Current concepts in intra-abdominal adhesions
Authors: Bedford Matthew R. , Karandikar Sharad
Published: October 2022

Adhesions remain one of the more challenging issues in surgical practice. This is in part due to the fact that the density of their formation, time interval to subsequent development of symptoms, and severity of clinical presentation are variable. Although the majority of adhesions are clinically silent, the consequences of adhesion formation can represent a life-long problem including chronic abdominal pain, recurrent intestinal obstruction, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and without effective therapy. The aim of this chapter is to review the aetiology and pathophysiology behind adhesion formation, with particular emphasis on post-operative adhesions. The spectrum of clinical presentations will also be discussed, along with strategies for their management. Finally, an overview of recent advances in prevention strategies for development of post-operative adhesions will be discussed.
Tumours of the retroperitoneum and management of retroperitoneal sarcomas
Authors: Cairncross Lydia , Malherbe Francois , Strauss Dirk
Published: October 2022

Retroperitoneal sarcomas (RPS) are rare tumours representing less than 0.3 per cent of all adult malignancies. Although rare, a knowledge of their presentation, workup and principles of management is important for primary care clinicians, radiologists and general surgeons, as early diagnosis and treatment is critical to the successful management of these complex and aggressive malignancies. Primary retroperitoneal tumours (RPT) arise separate from the organs of the retroperitoneum i.e. the kidneys, adrenals, pancreas and retroperitoneal colon. They may be benign or malignant and represent a wide range of pathologies with sarcomas accounting for one third of the total number. Retroperitoneal sarcomas (RPS) usually occur sporadically with few described risk factors. Histopathologically, these tumours arise from mesenchymal derived tissues with over 70 different histological subtypes though 50 per cent arise from the three commonest subtypes: liposarcoma, leiomyosarcoma, and undifferentiated pleomorphic sarcoma. The clinical presentation is usually with a large abdominal mass or as an incidental finding on radiology for other conditions. Diagnostic workup includes a contrast CT scan and often a core biopsy if a liposarcoma is not confidently diagnosed on radiological features. Multidisciplinary discussion is critical to the management of these rare tumours and, though there is a role for radiotherapy and chemotherapy, complete surgical resection is the key to successful management. However, many patients with RPS will present late with incurable disease, or recur either locally or systemically after surgery, and therefore good palliative care and support systems are important in providing holistic care for these patients.
Anatomy, diseases, and surgical applications of omentum
Authors: Singh Anand Narayan , Sahni Peush
Published: October 2022

Omentum, the policeman of the abdomen, develops from dorsal mesogastrium. It has a rich vascular supply and abundant store of adipocytes. The omentum functions as a site of fat storage, regeneration, immune regulation and infection control. For these properties, omentum has been used surgically for reinforcement of gastrointestinal perforations, reinforcement of anastomoses, omentoplasty in hydatid cyst and in various extra-abdominal applications. Various benign and malignant diseases are rare but remain a diagnostic and management challenge.
Mesentery—Anatomy, diseases, and internal hernias
Authors: Bharathan Anand , Priyanga Rohini , Muthusamy Satheesh Kumar , Balaraman Kesavan
Published: October 2022

Mesentery is a composite tissue composed of blood vessels, lymphatics, lymph nodes, and autonomic innervation of the midgut and hindgut that is covered by variable number of layers of peritoneum and represents the hilum of these portions of intestine. Derived from mesodermal tissues during embryogenesis, mesentery elongates and eviscerates from the coelomic cavity during elongation of gut and attains its adult disposition after return of gut to the developing coelomic cavity. This chapter discusses the various regions of the mesentery, their anatomic importance, and embryologic abnormalities that result in various internal hernias and principles of their treatment in this chapter. Infections, benign and malignant disease processes arise in mesentery from its various tissue components like lymph nodes, blood, and vessels and this chapter deals with the most important of them.
Abdominal tuberculosis
Authors: Ibrarullah Mohammad , Kapoor Vinay K.
Published: October 2022

Tuberculosis continues to be a global disease. Abdominal tuberculosis is a not uncommon form of extrapulmonary tuberculosis and includes involvement of the gastrointestinal tract, peritoneum, lymph nodes, and solid organs. Its clinical picture depends on the site of involvement and the type of pathology. Abdominal tuberculosis can mimic several other diseases. Radiology and endoscopy play an important role in the diagnosis of abdominal tuberculosis and the polymerase chain reaction (PCR) -based XpertR test provides rapid results for confirmation. Treatment is with antitubercular therapy; complications, for example perforation and obstruction may require surgical intervention. Surgical procedures for abdominal tuberculosis are conservative. The mortality of abdominal tuberculosis, especially with acute presentation, remains high.
Surgery in the time of a pandemic
Authors: Satwik Ambarish , Pawar Pranay , Sharma Abhishek , George Christina
Published: October 2022

The SARS-CoV-2 pandemic since its onset in late December 2019 has over 213 million cases and 4.4 million deaths reported globally (August 2021). Health services everywhere in the world have been running to augmented capacity during COVID surges. They have been learning on the fly how to become COVID-compliant. In many instances, hospitals were asked to suddenly convert 80 per cent of their inpatient services into COVID care facilities. That meant not just mobilizing and training human resources for COVID care but also structural and infrastructural changes. Cordon sanitaires had to be set up and reinforced. Air handling and ventilation had to be reformatted on short notice to make it COVID compliant. It was an arduous undertaking that was necessary for the safety of healthcare workers and non-COVID patients. Discussed herein are the particularities of these changes, particularly in the surgical setting, which have now found their way into the standard operating protocols of most hospitals. They will remain a lasting legacy of this pandemic. Also discussed are the minutiae of surgery on a COVID positive patient.
Mesenteric ischaemia
Authors: Kühn Florian , Schiergens Tobias S. , Klar Ernst
Published: October 2022

The mortality of acute mesenteric ischaemia has remained high for decades despite improvements in diagnostic, interventional, and surgical techniques. The time to diagnosis of acute mesenteric ischaemia is the most important modifiable predictor of the outcome of the patient. Hence, focus on the specific history and recognition of predisposing factors set the course for time-saving and efficient diagnosis. The initial clinical stage of acute mesenteric ischaemia is characterized by the sudden onset of severe abdominal pain followed by a painless interval. The symptoms of non-occlusive mesenteric ischaemia and intestinal venous thrombosis are different and less specific than those of acute arterial occlusive ischaemia. Biphasic contrast-enhanced computed tomography is the diagnostic tool of choice for diagnosis of arterial and venous occlusion. A central occlusion of the superior mesenteric artery or signs of peritonitis require immediate surgery. However, endovascular techniques for arterial occlusion have taken on a greater importance today. In case of a peripheral embolism in patients with no signs of peritonitis, interventional pharmacotherapy with local fibrinolytic agents should be conducted. The accompanying intensive care management includes volume replacement, systemic anticoagulation, and antibiotic therapy, as well as close patient monitoring to exclude secondary organ failure.
The small bowel in acute and critical illness
Authors: Reintam Blaser Annika , Jakob Stephan M. , Windsor John A. , Preiser Jean-Charles
Published: October 2022

The pathophysiology of small bowel dysfunction in critical illness includes perfusion abnormalities, tissue oedema, metabolic response to stress, alterations in endocrine and immunological functions, and gut barrier alterations. Several of these aspects are related to critical illness, others are the result of treatments or an interaction between the two. The small bowel can become hypoperfused, oedematous, and distended with changes in microbiome, all of which can have consequences for gastrointestinal surgery during critical illness, and its clinical outcome. Specific monitoring tools for small bowel (dys)function in critically ill patients are lacking and management options are largely supportive, aiming at restoration of tissue perfusion and minimizing factors causing bowel dysmotility.
Duodenal adenomas and small bowel polyps, including familial adenomatous polyposis
Authors: Latchford Andrew , Backman Ann-Sofie , Spigelman Allan
Published: October 2022

Small bowel and duodenal polyps are commonly seen in the rare polyposis syndromes, where they may be a major clinical problem and may be a cause of significant morbidity and indeed mortality. Sporadic polyps at these sites, however, are uncommon. This chapter reviews the current level of understanding of such polyps and outlines current approaches to surveillance, as well as endoscopic and surgical interventions used to treat them. Data are reviewed according to polyp subtype and then by the syndromes in which such polyps occur. The best data are available for familial adenomatous polyposis and so there is a focus on this syndrome which, given its incidence, will be the condition to which clinicians are most likely to be exposed.
Lymphomas of the small bowel and duodenum
Authors: Cirocchi Roberto , Tondo Annalisa , Morabito Antonino
Published: October 2022

Gastrointestinal tract lymphomas are rare and affect both adults and children, with differences in epidemiology and histological prevalence. A diagnosis is made after a biopsy of the lesions. Medical and surgical treatments are available, and their use depends on the type of tumour, its site, extension, and the patient’s age.
Phenomenology of Tics and Sensory Urges
Authors: Leckman James F. , Bloch Michael H. , Sukhodolsky Denis G. , Artukoğlu Bekir B. , Scahill Lawrence , King Robert A.
Published: October 2022

The origin of tics may be related to a heightened and selective sensitivity to cues from within the body or from the outside world, possibly as a result of a reduced ability to suppress irrelevant information in sensory, motor, and cognitive domains. The temporal pattern of tics, which are known to occur in bouts and wax and wane in severity, and their long-term outcome might represent important clues to the neurobiology of tics. Moreover, the role played by the environmental context in modulating tic expression may be key to developing and refining novel behavioral interventions. The association of tics with comorbid behavioral problems has a very strong impact on social, emotional, and academic outcomes in adulthood. This chapter introduces the reader to the wide phenomenological spectrum of Tourette syndrome and other tic disorders. The key phenomenological features of Tourette syndrome and related disorders represent crucial educational objectives for clinicians, teachers, parents, and peers that may lead to better clinical, social, and academic outcomes.
Comprehensive Assessment Strategies
Authors: King Robert A. , Landeros-Weisenberger Angeli
Published: October 2022

In the assessment of a potential new or established case of tic disorder, the clinician has several goals that extend beyond confirming or clarifying the presence and severity of tics and the diagnosis of tic disorder. These include assessing the impact of the disorder on the patient and family, identifying the factors that exacerbate or mitigate the symptoms, determining the extent of comorbid conditions, clarifying the patient’s and the family’s understanding of the disorder, and developing an alliance and shared perspective on the patient’s problems in order to pursue the treatment goals and priorities that emerge from the assessment. Clinicians, teachers, parents, and peers should be educated regarding the key phenomenological features and natural course of Tourette syndrome and related disorders. For children, the clinician needs to place the tics into the context of overall development so that the child’s development is kept on track. This often involves refocusing the family’s attention away from the tics and helping them find ways to build on the child’s strengths and abilities. Social, emotional, and academic outcomes in adulthood do not always reflect tic outcomes given the chronic course, the negative impact on peer and family relationships, and the variable number of co-occurring conditions. Helping a child or an adult become a “self-advocate” rather than being ashamed of their tics is often a helpful approach. A comprehensive assessment of each of these domains will ensure that a consensus can be reached concerning treatment priorities.
Evoked Potentials
Authors: Misulis Karl E.
Published: October 2022

This chapter looks into evoked potentials, which are the electrical responses to stimulation. EPs gradually became more popular when the diagnosis of central disorders was partnered with more therapeutic options. However, EPs are less used to evaluate physiological processes of the brain and spine when the MRI could not. The chapter clarifies the types of evoked potential to be considered such as visual EP, somatosensory EP, auditory EP, and motor EP. Additionally, EPs are averaged to allow being beyond electrical and physiological noise. The analysis is often a combination of automatic and manual as most modern acquisition devices make good estimates of where the measurement markers should be.
Frances Legendre
Authors: Towers Anna
Published: October 2022

Frances Legendre was accustomed to being in control. When she came to the Palliative Care Unit suffering from advanced ovarian cancer, she was prepared to die. She exuded acceptance and calm, and she drew her family and the palliative care staff into her plans and images of eternity. But Mrs. Legendre did not die then and, a few weeks later, convinced that it was not yet her time, she launched into a relentless effort to find a cure. She insisted that her oncologists enroll her—against their own judgment—in high-risk experimental treatments, and the palliative care team found itself advocating more aggressive care for their patient. When all the treatments failed, Mrs. Legendre again came back to the Palliative Care Unit to die. This time she and her family wanted the end to come quickly, peacefully, now.
Victor Sloski
Authors: Boston Patricia
Published: October 2022

Victor Sloski learned that he had lung cancer when he was 57. The news was hard to take. He had lived happily with Shirley, his live-in companion, for 20 years. Still, when experimental treatments failed, he was prepared to die, hoping the end would come soon. It didn’t. His cancer metastasized from his lungs to his stomach, spleen, colon, and finally, to his brain, causing him to go blind. The palliative care team offered to arrange an admission to the inpatient unit, but Mr. Sloski insisted that he wanted home care. He wanted to die at home regardless of how ill he became. Victor Sloski did die at home. Afterward, Shirley said, “Caring for a dying husband was the biggest challenge of my life. But if I had to do it all over again, I would do it.” Getting to that point had been very hard. At times Shirley felt that she was too exhausted, emotionally and physically, to go on.
Miriam Lambert
Authors: Towers Anna
Published: October 2022

It happens on occasion in palliative care that a person’s pain remains uncontrolled despite the best efforts of the team. Miriam Lambert was referred to our study because of the difficulty of her case. She had not had an easy life, and emotional issues compounded her situation. The palliative care team tried to control her pain with a full spectrum of medications, as well as with anesthetic blocks. They tried supportive nonmedical and psychological interventions, such as art therapy, music therapy, and massage, to reach her in any way they could. Nonetheless, the pain persisted.
Jenny Doyle
Authors: Lambrinidou Yanna
Published: October 2022

Jenny Doyle, a 47-year-old White American woman with inflammatory breast cancer, received end-of-life care for eight-and-a-half months, much longer than is typical for a US hospice program. Her time with hospice was tumultuous, marked by periods of anger and resentment amid others of gratitude and affection. She fought her disease bitterly to the very end. Her struggle led her to a series of doctors and created serious tensions for the hospice team. Throughout this journey, the legacy of early years of strife with her children created additional stresses and strains, which persisted in the bereavement period. “At least let the moment of her death be peaceful,” her family prayed. But even that was not to be.
Paula Ferrari
Authors: Boston Patricia
Published: October 2022

Paula Ferrari was diagnosed with amyotrophic lateral sclerosis (ALS), an incurable degenerative motor neuron disease that leads to progressive weakness of the muscles in the extremities and trunk. For the next three years, Paula lived with ALS. When she was admitted to the Palliative Care Unit, she was no longer able to eat or swallow on her own. Paula knew that these changes would take place and that her disease would progress until she wouldn’t be able to breathe alone. She knew that many others suffering with ALS would have given up and tried to seek physician-assisted suicide if it were legal and available (as it was not in Canada at that time). But for Paula Ferrari, to seek help to hasten one’s death was an act of total self-deprivation. Death, she insisted, is an integral part of our being and existence. To undergo the experience of dying, regardless of the physical suffering it entails, is our ultimate lesson of life. Experiencing suffering offers a unique opportunity to know about ourselves and who we are in our spiritual existence. Paula did suffer physically. But she stood firmly by her beliefs and never wavered. For her caregivers on the Palliative Care Unit, Paula Ferrari seemed to have mastered the extremes of living with a fatal illness.
Difficult airway
Authors: Lyons Craig , O’Sullivan Ellen P.
Published: October 2022

Patients undergoing oromaxillofacial and head and neck surgery can have pathologies that threaten the reliability of oxygen delivery under anaesthesia. Airway management requires a patient-specific and procedure-specific focus, working within the skillset of the anaesthesia and surgical services of the day. This chapter on difficult airway management focuses upon airway assessment and the formation of an airway management plan. Core airway management techniques are discussed, including bag mask ventilation, use of supraglottic airway devices, and laryngoscopy by direct and video-based means. The importance of positioning, preoxygenation, and neuromuscular blockade is explained. Awake airway management techniques (awake fibreoptic intubation, awake videolaryngoscopy, and awake tracheostomy) are discussed, being viewed as essential components of anaesthetists’ armamentarium. Airway management for maxillomandibular fixation is afforded special attention due to the requirement for specific knowledge and skills. The extubation process is explored, with pre-emptive and rescue techniques that may reduce the likelihood of airway compromise during this period identified. Finally, the contribution of human factors to difficult airway management is considered, with task fixation and cognitive overload highlighted as potential threats that must be overcome by anaesthetists in order to prioritize reliable patient oxygenation.
Orofacial pain
Authors: Wong Stanley Sau Ching , Cheung Chi Wai
Published: October 2022

Orofacial pain describes pain that is experienced in the face and/or oral cavity. Many of these patients suffer from chronic orofacial pain, which refers to pain lasting more than 3 months. Both acute and chronic orofacial pain are important clinical problems. In particular, chronic orofacial pain can be severe and result in long-term physical and psychosocial impairment. A detailed assessment through history, physical examination, and investigations is needed to delineate the underlying pain pathology, rule out red flag pathologies, and identify psychosocial barriers to pain relief. Since orofacial pain is complex and often challenging to treat, a holistic biopsychosocial approach using a combination of different types of treatment strategies is often needed. Pharmacological treatment remains the mainstay for managing most orofacial pain conditions. However, non-pharmacological therapies such as psychological interventions, behavioural therapy, and physical therapy are useful depending on the specific pain condition. Interventional pain procedures may be effective and should be considered in those who have not responded satisfactorily to conservative treatment. This chapter discusses the epidemiology of orofacial pain, assessment approach, and classification of chronic orofacial pain disorders. The epidemiology, aetiology, clinical features, and management of specific orofacial pain conditions will also be discussed. These include trigeminal neuralgia, persistent idiopathic facial pain, herpes zoster-related pain, and temporomandibular disorders.
Secondary hypertension
Authors: Singh Gurbhej , Wander Gurpreet Singh
Published: October 2022

Hypertension is a major risk factor for cardiovascular disease. Primary hypertension with no identifiable cause is seen in the majority of patients. When a specific aetiology can be identified, which, most of the times, may be correctable, it is labelled as secondary hypertension. Common causes for secondary hypertension include renal parenchymal disease, renovascular disease, primary hyperaldosteronism, phaeochromocytoma, obstructive sleep apnoea, and substance/drug-induced. Diagnostic work-up for secondary hypertension is guided by history, clinical examination, and clinical clues pointing to specific diagnosis. The cost-effectiveness of diagnostic work-up, treatment, and outcome must be weighed against the pretest probability. This chapter discusses various causes for secondary hypertension, with the clinical clues and their pathophysiology.
Diagnosis and investigation of hypertension
Authors: Wolley Martin , Stowasser Michael
Published: October 2022

Establishing the diagnosis of hypertension requires repeated measurements over time, and consideration should be given in many patients to obtaining out-of-office readings with ambulatory or home blood pressure monitoring to rule out the white coat effect. New methods such as unobserved automated office blood pressure measurement give different information to standard office blood pressure measurement, and care needs to be taken to take note of the different blood pressure cut-offs for different measurement techniques. Clinical investigations in newly diagnosed hypertensive patients should be undertaken to seek evidence of end-organ damage, and appropriate patients should be screened for secondary causes. Patients should also be assessed for other cardiovascular risk factors to form an overall risk profile and help plan appropriate and holistic cardiovascular treatment.
Blockers of the renin–angiotensin–aldosterone system in hypertension
Authors: Mordi Ify R. , Lang Chim C.
Published: October 2022

The renin–angiotensin–aldosterone system (RAAS) is pivotal to the pathophysiology of hypertension and its associated end-organ damage. This chapter briefly discusses the role of the RAAS in hypertension before subsequently describing the current pharmacological strategies targeting this pathway for treatment of hypertension (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, angiotensin receptor–neprilysin inhibitors, and direct renin inhibitors), including indications and important clinical considerations. The chapter will summarize the relevant literature on the effects of RAAS blockers on both blood pressure and cardiovascular outcomes. Finally, the chapter will summarize the current position of RAAS blockers in hypertension management and clinical practice guidelines.