bluuebunny/crossref_metadata_2025 huggingface dataset:
Wrist
Authors: Warwick David , Dunn Roderick , Melikyan Erman , Vadher Jane
Published: November 2011

Anatomy 490

Biomechanics 494

Wrist pain 495

Investigations for wrist disorders 496

Crystal arthropathy 498

Carpal instability 499

Scapholunate instability 500

Mid-carpal instability 503

Wrist osteoarthritis 504

Swellings around the wrist 506

Avascular necrosis 508

Wrist operations 511

Tuberculosis 520

Distal radius–lunate fossa (quadrangular/spherical), scaphoid fossa (triangular/spoon-shaped) sigmoid notch (articulates with ulnar seat in DRUJ, variable concavity)....
Children
Authors: Warwick David , Dunn Roderick , Melikyan Erman , Vadher Jane
Published: November 2011

General considerations 522

Embryology 524

Ossification 526

Functional hand development 527

IFSSH classification of congenital limb malformation 528

Radial dysplasia (radial club hand) 530

Ulnar dysplasia (ulnar club hand) 536

Cleft hand 540

Symbrachydactyly 544

Arthrogryposis multiplex congenita (AMC) 546

Poland syndrome 548

Syndactyly 550...
Tumours
Authors: Warwick David , Dunn Roderick , Melikyan Erman , Vadher Jane
Published: November 2011

Types of tumour 574

Benign tumours of bone and cartilage 575

Ganglia 578

Benign tumours of soft tissue 582

Malignant tumours 584

Malignant tumours of bone and cartilage 585

Soft tissue sarcoma (STS) 586

Metastatic tumours 590

• Osteoid osteoma

• Osteoblastoma

• Chondroma (enchondroma, periosteal chondroma = ecchondroma)...
Vascular
Authors: Warwick David , Dunn Roderick , Melikyan Erman , Vadher Jane
Published: November 2011

Vascular anatomy 592

Vascular assessment 600

Hand–arm vibration syndrome (Vibration white finger) 604

Vascular anomalies 606

Acute vascular injury 612

Occlusion 614

Raynaud's disease 617

Compartment syndrome 618

• This is divided into three parts by the scalenus anterior muscle (this lies over the 2nd part)....
The normal heart
Authors: Archer Nick , Manning Nicky
Published: November 2011

Embryology 2

Anatomy (for echocardiography) 4

Fetal circulation 10

Physiology 12

Changes at birth 14

• In the first 20 days the human embryo has no cardiovascular structure and nutrition is achieved by diffusion.

• Development of the heart begins in the 3rd week after fertilization and is complete by the end of week 8; the heart starts to beat on about the 22...
Aetiology of structural congenital heart disease
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 18

Environmental factors 20

Genetic factors 26

Risk of associated non-cardiac anomalies 32

Prevention of congential heart disease 34

• The incidence of congenital heart disease (CHD) is approximately 8:1000 lives births but is higher in the prenatal population.

• The aetiology of CHD has been considered to be multifactorial—a combination of environmental factors and a genetic predisposition but increasing numbers of specific genetic causes are being identified....
Indications for fetal echocardiography
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 36

Indications for a detailed cardiac scan 38

• The incidence of structural CHD is 8:1000 live births, in practical counselling the figure often used is 1%.

• This figure is higher in the prenatal population and cardiac diagnoses are biased towards:

• More complicated lesions....
History and examination
Authors: Archer Nick , Manning Nicky
Published: November 2011

History 42

Examination 44

As in any area of medicine, assessment of the fetal cardiovascular system should begin with sufficient accurate information to allow a proper assessment and relevant counselling to be carried out. Aspects of the history are considered under 3 headings of information that should be available before investigation is performed and, in some cases, before referral to a fetal cardiac clinic. Much of the information should be available in maternity notes but some specific details often need clarifying....
Fetal echocardiography
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 46

Clinical application of relevant physics 48

Clinical principles of scanning 53

The basic cardiac scan 54

Detailed fetal echocardiography 68

There are different approaches to ultrasound examination of the fetal heart and it is a matter of choice as to which is adopted. However it is vital to have a systematic approach which allows for every relevant cardiac structure to be assessed, regardless of the position or well-being of the fetus....
Structural abnormalities
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 70

Classification of structural abnormalities 72

This chapter gives an overview of how structural cardiac anomalies—which are then described in detail in the following chapters—have been grouped. The following points apply throughout:

• It is essential to begin by establishing left and right sides of the fetus before going on to define the morphological features of each chamber and vessel and to demonstrate the cardiac connections (...
Left-sided anomalies
Authors: Archer Nick , Manning Nicky
Published: November 2011

Venoatrial junction 76

Atrioventricular junction 80

Ventricular-arterial junction 82

Arterial 88

• <1% of CHD.

• 1 or more of the 4 PVs, more frequently right sided, drain somewhere other than the LA, most commonly into the RA but otherwise IVC, SVC, left innominate vein, or coronary sinus....
Right-sided anomalies
Authors: Archer Nick , Manning Nicky
Published: November 2011

Venoatrial junction 100

Atrioventricular junction 102

Ventricular-arterial junction 108

• Abnormalities are rare in isolation and are usually seen:

• With disorders of laterality ( see Disorders of laterality, pp.144–145).

• In sinus venosus type ASDs (rarely recognized in fetal life).

• Absence of the portal vein is very rare; the umbilical vein joins directly to the IVC....
Septal anomalies
Authors: Archer Nick , Manning Nicky
Published: November 2011

Atrial septal defects 122

Ventricular septal defects 124

Atrioventricular septal defects 134

• The presence of a patent foramen ovale (PFO) is essential for right-to-left flow of oxygenated blood returning from the placenta to reach vital organs.

• Distinguishing between PFO and an ASD is difficult and the diagnosis can only be made with certainty if the atrial septum is virtually absent. It is suggested that if the size of the gap in the atrial septum is greater than the diameter of the AA then the possibility of a significant ASD postnatally should be considered....
Miscellaneous structural anomalies
Authors: Archer Nick , Manning Nicky
Published: November 2011

Double inlet left ventricle 140

Disorders of laterality 144

• <1% of CHD.

• Both AV valves open into the morphological LV.

• Double inlet RV is exceedingly rare.

• RV is small and often rudimentary.

• VSD.

• Arterial connections vary:

• Normally connected, may have pulmonary outflow obstruction....
Abnormal ventricular-arterial connections
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 148

Transposition of the great arteries 150

Congenitally corrected transposition of the great arteries 154

Truncus arteriosus (common arterial trunk) 156

A normal 4-chamber view of the heart identifies the atria and ventricles and demonstrates normal AV connections but extended views are necessary to identify the great arteries as they leave the heart, thus defining ventricular-arterial connections. Abnormal ventricular-arterial connections that are part of complex lesions are considered with the relevant lesion in other parts of this book....
Cardiac position
Authors: Archer Nick , Manning Nicky
Published: November 2011

Normal cardiac position and axis 160

Abnormalities of cardiac position 162

• This is the normal arrangement. The heart:

• Lies in the left side of the chest—laevocardia.

• Apex points to the left at an angle of 45° to a perpendicular anteroposterior line through the spine....
Fetal cardiac rhythm
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 166

Identification of cardiac rhythm 168

Normal rhythms 172

Fast abnormal rhythms 184

Slow abnormal rhythms 194

Irregular rhythms 200

Normal cardiac rhythm originates in the sinus node, a RA structure. Atrial electrical depolarization is manifest on the electrocardiogram (ECG) by a P wave and is followed by atrial contraction....
Cardiac function
Authors: Archer Nick , Manning Nicky
Published: November 2011

Assessment 202

Treatment 218

Cardiac function, if severely compromised, will cause general markers of ill health such as:

• Pericardial effusion larger than physiological ( see Table 5.1, p.56).

• Hydrops.

• Reduced movement.

The purpose of the assessments discussed here is to identify the stressed or failing fetal heart at an earlier stage and to provide ways of monitoring changes objectively....
Heart muscle disease
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 220

Types of heart muscle disease 222

Assessment 228

Treatment 230

Heart muscle disease in the fetus can be a 1° (often genetically determined) abnormality or 2° to another disease process in the fetus or the mother. These functional types of heart muscle disease are discussed in this chapter....
Abnormalities at a glance
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 232

Abnormal appearances of the cardiac chambers 234

Abnormal appearances of the great arteries 236

Abnormal cardiac rhythms 238

Abnormalities of cardiac position 240

• Although defining a precise cardiac anomaly can be difficult, it is sometimes immediately obvious that there is something wrong with the cardiac anatomy or rhythm and that further assessment is needed....
Other investigations
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 244

Invasive testing 246

Examination of sample 248

Parental blood sampling 250

Fetal electrocardiography 250

Fetal magnetic resonance imaging 250

• It is important to determine whether a cardiac lesion is:

• Isolated or

• Associated with non-cardiac abnormalities or

• Part of a syndrome....
Cardiac tumours
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 252

Echogenic foci 254

Rhabdomyoma 258

Teratoma 260

Fibroma 262

Haemangioma 262

Myxoma 262

• Cardiac tumours are rare.

• Identification requires subsequent monitoring for:

• Fetal well-being.

• Growth of the tumour.

• Planning management of delivery and neonatal period.

• It is important to consider the possibility of non-cardiac problems....
Nuchal translucency and the heart
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 264

The nuchal scan 266

Management 268

Nuchal translucency describes sonolucent tissue in the posterior aspect of the fetal neck; the size can be measured with accuracy during the 1st trimester of pregnancy and an increase in the measurement is associated with an increased risk of chromosomal abnormality. If fetal karyotype is normal:
...
Fetal hydrops and the heart
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 270

Pathophysiology 275

Aetiology 276

Assessment and monitoring 278

Management 279

Hydrops fetalis refers to the pathological condition where fluid collects in 2 or more body cavities; it represents excessive accumulation of interstitial fluid, initially in the serous spaces (pericardial, pleural, and peritoneal cavities—...
Twins and the heart
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 282

Types of twin 284

Cardiac complications of monochorionic twins 286

Twin-to-twin transfusion syndrome and the heart 288

Management of cardiac issues in twin pregnancies 290

• Twins account for approximately 2% of all pregnancies.

• 2/3 are dizygotic (DZ)—non-identical twins resulting from fertilization of 2 separate oocytes....
The heart in the sick fetus
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 292

Maternal causes 294

Fetal causes 298

• The fetus is vulnerable to a changing environment including any factors brought about by compromised maternal well-being.

• Major factors determining cardiac output are discussed in other chapters ( see Chapter 13, Fetal cardiac rhythm, pp.165...
Management of fetal structural cardiac disease in pregnancy
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 304

Diagnosis 306

Counselling 308

Management of pregnancy 310

Fetal intervention 312

Management of delivery 314

Place of delivery 316

Future pregnancies 318

Cardiac abnormalities account for approximately 20% of neonatal deaths and in some the cardiac cause is only identified at post-mortem; a significant proportion of CHD remains undetected during pregnancy and thus does not influence management of the pregnancy or delivery. However, there are some lesions whose early postnatal management may be altered in the light of prior knowledge and thus prenatal diagnosis may improve postnatal outcome both in terms of mortality and morbidity....
Postnatal evaluation
Authors: Archer Nick , Manning Nicky
Published: November 2011

Introduction 320

History and examination 320

Echocardiography 322

Radiology 322

Magnetic resonance imaging 322

Electrocardiography 324

Chromosome analysis and gene testing 324

Metabolic testing 326

Autopsy examination 328

There are differences between fetal and postnatal investigations for a variety of reasons. Members of the fetal team need to be aware of the scope of post-delivery tests so that prenatal management including counselling is consistent with later approaches. Ways in which tests are similar or differ post-delivery are outlined in the rest of this chapter....
Conclusion
Authors: Archer Nick , Manning Nicky
Published: November 2011

Conclusion 330

Fetal cardiology is progressing extremely rapidly. It is certain that by the time this book is published some new information will be threatening to alter some aspects of diagnosis or management. We have deliberately not speculated about details of possible new approaches. The clinical role of 3D and 4D scanning, of some of the newer Doppler techniques, and of fetal ECG for example, will become clearer in time, particularly with respect to assessing fetal cardiac function. Indications for and value of fetal cardiac interventions are being actively evaluated. Drug therapy for fetal conditions in addition to arrhythmias is only in its infancy with no clear consensus at present—this will change....
Growth (including short stature and tall stature)
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Introduction 2

Measurement techniques 6

Physiology 10

Growth disorders 12

Causes of short stature 14

Investigation of short stature 22

Therapy for short stature 24

Introduction to tall stature 28

Constitutional tall stature 30

Exogenous obesity 31

Syndromic tall stature 32

Endocrine causes of tall stature ...
Puberty and its disorders
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Definition 44

Physiology of normal puberty 46

Pubertal staging 48

Timing of puberty 52

Premature sexual maturation 53

Central precocious puberty (CPP) (gonadotropin-dependent precocious puberty) 54

Abnormal patterns of gonadotropin secretion 56

Gonadotropin-independent precocious puberty (GIPP) 57

Virilization 58

Delayed puberty 60

Central causes of delayed puberty (both sexes) ...
The pituitary and hypopituitarism
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Embryology 72

Anatomy 73

Physiology 74

Growth hormone deficiency (GHD) 76

Diagnosis of GHD 78

Treatment of GHD 81

Adult GHD 82

ACTH deficiency 84

CHARGE syndrome 86

Gonadotropin deficiency 86

Thyroid-stimulating hormone deficiency (central hypothyroidism) 90

Prolactin deficiency 92

Posterior pituitary 94

Further reading ...
Diabetes mellitus
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Introduction to diabetes mellitus 116

Type 1 diabetes (T1DM) 118

Pathophysiology of type 1 diabetes 120

Risks of developing type 1 diabetes 124

Clinical features and development of type 1 diabetes 126

Therapy of type 1 diabetes 128

Insulins 130

Diabetes monitoring 138

Hypoglycaemia 142...
Obesity
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Introduction 192

Assessment 196

Classification 197

Aetiology 198

Simple obesity 198

Identified syndromes 200

Complications 204

Investigation 208

Treatment 210

Guidelines for management of obesity 214

Further reading 216

Obesity is often defined as ‘an excess of body fat frequently resulting in a significant impairment of health and longevity’....
Hypoglycaemia
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Physiology 218

Aetiology 219

Decreased glucose 220

Increased glucose utilization 222

Symptoms 228

Investigation 230

Further reading 234

Under normal circumstances blood glucose in children and adults is tightly maintained at ∼3.5–6.0mmol/L during fasting and following feeding and exercise.

Excess glucose is stored as glycogen in the liver under the influence of insulin, and released at times of need to maintain blood glucose in response to the counter-regulatory hormones:
...
Adrenal gland disorders
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Physiology 236

Adrenal insufficiency 238

Adrenal steroid excess 246

Further reading 247

The adrenal cortex, which produces steroid hormones, is under the control of both the hypothalamo–pituitary–adrenal (HPA) endocrine axis, which regulates cortisol secretion, and the renin–angiotensin system, which regulates aldosterone secretion (Figs 8.1 and ...
Thyroid gland disorders
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

The thyroid 250

Congenital hypothyroidism (CH) 254

Transient neonatal hypothyroidism 258

Neonatal hyperthyroidism 258

Acquired hypothyroidism 260

Hyperthyroidism 262

Thyroid cancer in childhood 266

Further reading 269

• The thyroid gland develops from endoderm in the floor of the pharynx at 3–4 weeks gestation and travels caudally to leave the thyroglossal tract in the neck (which may persist as a thyroglossal cyst)....
Calcium, vitamin D, and bone disorders
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Physiology of calcium regulation 272

Bone mineralization 274

Causes of loss of bone mass 276

Hypocalcaemia 278

Hypercalcaemia 282

Rickets 284

Further reading 287

The control of calcium metabolism is complex and depends on several systems—parathyroid hormone, calcitonin, and vitamin D3—which have an interdependence which is not yet fully understood (...
Disorders of sex development
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Embryology of sex development 290

Definitions 292

46, XY DSD (incomplete masculinization of a male fetus) 294

46, XX DSD (masculinization of a female fetus) 296

Ovotesticular DSD (true hermaphroditism) 296

Other conditions associated with DSD 297

Management of the infant with DSD 298

Further reading 302...
Endocrine emergencies
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

Introduction 304

Diabetic ketoacidosis 306

Hypoglycaemia 314

Adrenal insufficiency–adrenal crisis 316

Hypocalcaemia 318

Hypercalcaemia 320

Acute diabetes insipidus 322

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 324

Hyperthyroid crisis 326

Hypothyroid coma 327

Unclear sex–ambiguous genitalia (Disorder of Sex Development) (DSD) 328

This section is intended to be brief, with readily accessible information that is needed in an endocrine emergency in an infant, child, or adolescent. Endocrine emergencies are rare, but because of this they are usually unexpected. Always take a few moments to assess the situation....
Endocrine investigations and laboratory reference ranges
Authors: Butler Gary , Kirk Jeremy
Published: November 2011

General guidelines 330

GH provocation tests 331

Tests for GH secretion 332

IGF-1 generation test 334

Oral glucose tolerance test for investigating excess GH secretion 335

TRH test 336

LHRH/GnRH (gonadotropin-releasing hormone) stimulation test 337

Triple pituitary stimulation test 338

Water deprivation test (WDT) 340...
Introduction
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

An approach to the oncology consultation 2

It is important to have a good structure for the oncological consultation to ensure holistic care for the patient and efficient completion of administrative tasks.

Patients may have been seen already by other healthcare professionals and have undergone a number of investigations. They may or may not have received the results of these. They may have some knowledge of the diagnosis, prognosis, and treatment options. Following appropriate introductions it is important to assess the patient's current understanding of the situation....
Clinical approach to suspected cancer
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Lung cancer 4

Breast cancer 5

Urological cancer 6

Nervous system tumours 7

Upper gastrointestinal cancer 8

Lower gastrointestinal cancer 9

Gynaecological cancer 10

Haematological cancer 11

Head and neck cancer 12

Thyroid cancer 13

Bone cancer and sarcoma 14

Skin cancer—melanoma 15

Skin cancer—non-melanoma ...
Concepts of multidisciplinary management
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Cancer prevention 18

Cancer screening 22

Cancer genetics 24

Genetic counselling 28

Principles of cancer diagnosis and management 32

Principles of surgical oncology 38

Radiotherapy 42

Principles of systemic therapy 46

Carcinogenesis is a multistep process consisting of progressive molecular and cellular changes leading to early invasive cancer and finally to distant metastasis and death. The initiation and progression of cancer usually takes years. Attempts are being made to reverse the molecular and cellular changes at an early state of cancer initiation or progression. The World Health Organization (WHO) estimates that at least one-third of all cancers are preventable and cancer prevention is the most cost-effective long-term strategy for the control of cancer....
Oncological emergencies
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Tumour lysis syndrome 568

Hypercalcaemia 569

Hyponatraemia 570

Hyperkalaemia 571

Hypoglycaemia 572

Hyperuricaemia 573

Febrile neutropenia 574

Thrombocytopenia 578

Catheter associated infections 580

Raised intracranial tension 582

Spinal cord compression 584

Cardiac arrest: introduction 585

Cardiac tamponade 586

Venous thromboembolism (deep venous thrombosis and pulmonary embolism) ...
Special situations in oncology
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Cancer in the elderly 602

Cancer in pregnant women 604

Fertility and cancer 608

Late effects 610

Cancer survivorship 614

Travel 616

Insurance 618

Vaccination 620

Lifestyle choices after cancer 624

The internet and oncology 628

Negligence and risk management in oncology 630

Complementary therapies ...
Palliative care
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Pain management 640

Nausea and vomiting 646

Malignant bowel obstruction 649

Constipation 650

Diarrhoea 651

Hiccups 652

Depression 654

Delirium 656

Oral care 657

Cancer-related fatigue 658

Cancer cachexia 659

Breathlessness 660

Cough 661

Haemoptysis 662

Symptom clusters 663

End of life care 664

In general, cancer pain management should be focused on the three-step WHO analgesic ladder for cancer pain relief (Ventafridda et al. ...
Clinical management of cancer: flowcharts
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Bladder cancer 670

Breast cancer 671

Cervical cancer 672

Colon cancer 673

Endometrial cancer 674

Epithelial ovarian cancer 675

Hepatocellular cancer 676

Small-cell lung cancer 677

Non-small cell lung cancer 678

Oesophageal cancer 679

Pancreatic cancer 680

Prostate cancer 681

Rectal cancer 682

Stomach cancer ...
Appendix
Authors: Ajithkumar Thankamma , Barrett Ann , Hatcher Helen , Cook Natalie
Published: November 2011

Systemic therapy regimens 692

Radiotherapy fractionation 695

Glomerular filtration rate 701

Anatomical diagrams 702

• Cisplatin 80–100mg/m2 IV infusion Day 1

• 5-FU 1g/m2 24-hour infusion Days 1–5

• 3-week cycle

• 75mg/m2 for 42 days starting on the first day of radiotherapy. Give 1 hour prior to radiotherapy and morning at weekend...
Normal pregnancy
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Complications of early pregnancy
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Care of the fetus
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Maternal medicine and infections
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Obstetric conditions
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Care in labour
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Common obstetric techniques, procedures, and surgery
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Reproduction
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Benign and urogynaecology
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Benign, premalignant, and malignant tumours in gynaecology
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Common gynaecological procedures and surgery
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2011

Abstracts and keywords to be supplied.
Top-down causation regarding the chemistry–physics interface: a sceptical view
Authors: Scerri Eric R.
Published: November 2011

This article examines two influential authors who have addressed the interface between the fields of chemistry and physics and have reached opposite conclusions about whether or not emergence and downward causation represent genuine phenomena. While McLaughlin concludes that emergence is impossible in the light of quantum mechanics, Hendry regards issues connected with the status of molecular structure as supporting emergence. The present author suggests that one should not be persuaded by either of these arguments and pleads for a form of agnosticism over the reality of emergence and downward causation until further studies might be carried out.
Family‐centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology
Authors: Watt L. , Dix D. , Gulati S. , Sung L. , Klaassen R. J. , Shaw N. T. , Klassen A. F.
Published: November 2011

Background  Over the past two decades, there is increasing emphasis being placed upon providing family‐centred care (FCC) in paediatric oncology settings. However, there is a lack of knowledge of FCC in paediatric oncology from the perspectives of immigrant parents. The purpose of this paper is to describe Chinese and South Asian immigrant parents' experiences of FCC in paediatric oncology settings in Canada.

Methods  This study adopted a constructivist grounded theory approach. Fifty first generation Chinese and South Asian parents of children with cancer who were at least 6 months post‐diagnosis were recruited from six Canadian paediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi, and transcribed into English. Analysis involved line‐by‐line, focused and theoretical coding, and the use of the constant comparison method.

Results  Findings indicated that overall parents were highly satisfied with the care and services they received, and their experiences were reflective of the key elements of FCC. However, there were some areas of concern identified by participants: parents not perceiving themselves as a member of the medical team; inconsistency in the quality and co‐ordination of services among healthcare providers; disrespectful and mechanical manner of a few healthcare providers; and parents' discomfort with healthcare providers communicating sensitive health‐related information directly with their child.

Conclusions  In order to successfully provide family‐centred services to immigrant parents of children with cancer, better communication of the elements of FCC between healthcare staff and families is needed to negotiate a clear role for the parents as partners of the healthcare team. Moreover, a better understanding of how family relationships are structured in immigrant families will assist healthcare providers to balance the best interests of the child with that of the family as a unit.
Microencapsulation of β‐carotene using native pinhão starch, modified pinhão starch and gelatin by freeze‐drying
Authors: Spada Jordana Corralo , Marczak Ligia Damasceno Ferreira , Tessaro Isabel Cristina , Noreña Caciano Pelayo Zapata
Published: November 2011

Beta‐carotene was microencapsulated by freeze‐drying using native pinhão starch, hydrolysed pinhão starch 6 dextrose equivalent (DE), hydrolysed pinhão starch 12 DE and the mixture of these materials with gelatin as coating material. The purpose of this research was to produce and characterize these microcapsules. The capsules’ efficiency, surface content, moisture, morphology, solubility, particle size and glass transition temperature were analysed. The hydrolysed pinhão starch 12 DE showed the highest total β‐carotene content and the lowest surface β‐carotene content, unlike the native starch. Using scanning electron microscopy, it was observed that all microcapsules presented undefined shapes. The samples with gelatin had wider particle size distribution, higher diameters, lower solubility and higher glass transition temperature when compared with other the samples. Results obtained suggest that the modified pinhão starch can be considered as potential wall material for encapsulation of β‐carotene.
Meeting Principles and Lifeworlds Halfway: Jürgen Habermas on the Future of Europe
Authors: Verovšek Peter J.
Published: November 2011

Although Jürgen Habermas is widely recognized as a philosopher and social theorist, his political philosophy is often accused of excessive formalism. Habermas has not only responded to these critiques in his theoretical writings, but also by showing how his critical theory can be applied to concrete situations in his Short Political Writings ( Kleine politische Schriften). Using his political commentaries on the future of Europe and the European Union (EU), I explore Habermas' melding of abstract principles with concrete political developments. The case of Europe reveals an ongoing process of adjustment, where Habermas' theoretical insights and the place of the EU in his political thought have to respond to political developments. I argue that this process of ‘meeting halfway’ ( Entgegenkommen), a concept I borrow from Habermas' social theory, demonstrates how the formalism of his theoretical commitments may be applied to politics. This approach also allows me to critique Habermas when he does not go far enough in adjusting his theory to account for concrete developments in European politics.
A Clinical Study to Evaluate Denture Adhesive Use in Well‐Fitting Dentures
Authors: Munoz Carlos A. , Gendreau Linda , Shanga Gilbert , Magnuszewski Tabetha , Fernandez Patricia , Durocher John
Published: November 2011

Purpose: The objective of this study was the assessment of retention and stability and functional benefits of denture adhesive applied to well‐fitting and well‐made dentures.

Materials and Methods: This was a randomized, crossover study to compare two marketed denture adhesives (test cream, Super Poligrip® Free, and test strip, Super Poligrip® Comfort Seal Strips) and an unmarketed cream adhesive (GlaxoSmith Kline Consumer Healthcare) with no adhesive as the negative control. Thirty‐six subjects completed the study. One hour after the application of denture adhesive, retention and stability were measured using the Kapur Index and maxillary incisal bite force. Two hours after application, functional tests were used to assess denture movement and peanut particle migration under the denture. Subjects also rated confidence, comfort, satisfaction with dentures, and denture wobble in conjunction with the functional tests.

Results: Denture adhesives significantly (p < 0.05) improved retention and stability of well‐fitting dentures. Subjects experienced significantly (p < 0.05) fewer dislodgements while eating an apple after adhesive was applied to dentures. Significant (p < 0.05) increases in subjective ratings of confidence and comfort as well as decreases in denture wobble were associated with the use of adhesive. There was significant (p < 0.05) improvement in satisfaction ratings for cream adhesives. A single application of each denture adhesive was well tolerated.

Conclusion: The results of this study provide evidence that use of Super Poligrip® denture adhesives can enhance aspects of performance of complete well‐fitting dentures as well as provide increased comfort, confidence, and satisfaction with dentures.
The Influence of Mapped Hazards on Risk Beliefs: A Proximity‐Based Modeling Approach
Authors: Severtson Dolores J. , Burt James E.
Published: November 2011

Interview findings suggest perceived proximity to mapped hazards influences risk beliefs when people view environmental hazard maps. For dot maps, four attributes of mapped hazards influenced beliefs: hazard value, proximity, prevalence, and dot patterns. In order to quantify the collective influence of these attributes for viewers’ perceived or actual map locations, we present a model to estimate proximity‐based hazard or risk (PBH) and share study results that indicate how modeled PBH and map attributes influenced risk beliefs. The randomized survey study among 447 university students assessed risk beliefs for 24 dot maps that systematically varied by the four attributes. Maps depicted water test results for a fictitious hazardous substance in private residential wells and included a designated “you live here” location. Of the nine variables that assessed risk beliefs, the numerical susceptibility variable was most consistently and strongly related to map attributes and PBH. Hazard value, location in or out of a clustered dot pattern, and distance had the largest effects on susceptibility. Sometimes, hazard value interacted with other attributes, for example, distance had stronger effects on susceptibility for larger than smaller hazard values. For all combined maps, PBH explained about the same amount of variance in susceptibility as did attributes. Modeled PBH may have utility for studying the influence of proximity to mapped hazards on risk beliefs, protective behavior, and other dependent variables. Further work is needed to examine these influences for more realistic maps and representative study samples.
Event‐Tree Analysis with Imprecise Probabilities
Authors: You Xiaomin , Tonon Fulvio
Published: November 2011

Novel methods are proposed for dealing with event‐tree analysis under imprecise probabilities, where one could measure chance or uncertainty without sharp numerical probabilities and express available evidence as upper and lower previsions (or expectations) of gambles (or bounded real functions). Sets of upper and lower previsions generate a convex set of probability distributions (or measures). Any probability distribution in this convex set should be considered in the event‐tree analysis. This article focuses on the calculation of upper and lower bounds of the prevision (or the probability) of some outcome at the bottom of the event‐tree. Three cases of given information/judgments on probabilities of outcomes are considered: (1) probabilities conditional to the occurrence of the event at the upper level; (2) total probabilities of occurrences, that is, not conditional to other events; (3) the combination of the previous two cases. Corresponding algorithms with imprecise probabilities under the three cases are explained and illustrated by simple examples.
Structured Expert Elicitation About Listeria monocytogenes Cross‐Contamination in the Environment of Retail Deli Operations in the United States
Authors: Hoelzer Karin , Oliver Haley F. , Kohl Larry R. , Hollingsworth Jill , Wells Martin T. , Wiedmann Martin
Published: November 2011

Listeria monocytogenes is among the foodborne pathogens with the highest death toll in the United States. Ready‐to‐eat foods contaminated at retail are an important source of infection. Environmental sites in retail deli operations can be contaminated. However, commonly contaminated sites are unlikely to come into direct contact with food and the public health relevance of environmental contamination has remained unclear. To identify environmental sites that may pose a considerable cross‐contamination risk, to elucidate potential transmission pathways, and to identify knowledge gaps, we performed a structured expert elicitation of 41 experts from state regulatory agencies and the food retail industry with practical experience in retail deli operations. Following the “Delphi” method, the elicitation was performed in three consecutive steps: questionnaire, review and discussion of results, second questionnaire. Hands and gloves were identified as important potential contamination sources. However, bacterial transfers to and from hands or gloves represented a major data gap. Experts agreed about transfer probabilities from cutting boards, scales, deli cases, and deli preparation sinks to product, and about transfer probabilities from floor drains, walk‐in cooler floors, and knife racks to food contact surfaces. Comparison of experts' opinions to observational data revealed a tendency among experts with certain demographic characteristics and professional opinions to overestimate prevalence. Experts’ votes clearly clustered into separate groups not defined by place of employment, even though industry experts may have been somewhat overrepresented in one cluster. Overall, our study demonstrates the value and caveats of expert elicitation to identify data gaps and prioritize research efforts.
Rates of Upgrade of ICD Recipients to CRT in Clinical Practice and the Potential Impact of the More Liberal Use of CRT at Initial Implant
Authors: SCOTT PAUL A. , WHITTAKER ANDREW , ZEB MEHMOOD , WATTS EDD , YUE ARTHUR M. , ROBERTS PAUL R. , MORGAN JOHN M.
Published: November 2011

Background:
 Many implantable cardioverter defibrillator (ICD) recipients may develop indications for cardiac resynchronization therapy (CRT) during follow‐up. However, the actual upgrade rate during follow‐up in clinical practice is not known.

Methods:
 We performed a single center retrospective observational study of all new ICD implants over 5 years (2003–2007). The rate of CRT upgrade of patients initially implanted with a single‐/dual‐chamber ICD during follow‐up was assessed. The impact of using alternative criteria on the need for CRT in ICD recipients at initial implant was also evaluated.

Results:
 During the study period, there were 549 new ICD implants. The initial implant was a single/dual‐chamber ICD in 73% (n = 399) and a CRT‐D in 27% (n = 150). During follow‐up (48±20 months) of the 399 ICD recipients, 70 (17.5%) died and 15 (3.8%) were upgraded to CRT, including eight cases where left ventricular lead implant had been initially unsuccessful. Upgrade rates at 1, 3, and 5 years were 0.03%, 2.4%, and 5.1%, respectively. Using alternative CRT criteria (left ventricular ejection fraction [LVEF]≤30%, QRS ≥130 ms, New York Heart Association I‐IV) 42.6% (n = 234) of ICD recipients met criteria for CRT at initial implant.

Conclusion:
 In this retrospective single center study, rates of CRT upgrade in ICD recipients over the medium term were low, which may reflect underuse in otherwise appropriate candidates. The more liberal use of CRT at initial implant in patients with a reduced LVEF, a broad QRS, but only mild heart failure symptoms would require approximately 50% increase in CRT use in ICD recipients at initial implant, and may help address some of the suggested underutilization. (PACE 2012; 35:73–80)
Early Recurrence of Atrial Tachyarrhythmias Following Radiofrequency Catheter Ablation of Atrial Fibrillation
Authors: ANDRADE JASON G. , KHAIRY PAUL , VERMA ATUL , GUERRA PETER G. , DUBUC MARC , RIVARD LENA , DEYELL MARC W. , MONDESERT BLANDINE , THIBAULT BERNARD , TALAJIC MARIO , ROY DENIS , MACLE LAURENT
Published: November 2011

The use of blanking periods, the immediate period postablation during which transient tachyarrhythmia episodes are not considered recurrences, has been predicated on the assumption that not all early recurrences of atrial tachyarrhythmias (ERAT) will lead to later recurrences and, as such, does not necessarily represent treatment failure. While ERAT can be expected to occur in approximately 38% of patients within the first 3 months of atrial fibrillation (AF) ablation, only half of these patients will manifest later recurrences. Clinical features related to the patient's history of AF, the index ablation procedure, and particularities of the ERAT can help identify patients at higher risk of later recurrence in whom aggressive attempts to control rhythm, including early cardioversion and reintervention, may be justified. (PACE 2012; 35:106–116)
Application of the Seattle Heart Failure Model in Patients on Cardiac Resynchronization Therapy
Authors: PERROTTA LAURA , RICCIARDI GIUSEPPE , PIERAGNOLI PAOLO , CHIOSTRI MARCO , PONTECORBOLI GIULIA , DE SANTO TIZIANA , BELLOCCI FULVIO , VITULANO NICOLA , EMDIN MICHELE , MASCIOLI GIOSUÈ , RICCERI ILARIA , PORCIANI MARIA CRISTINA , MICHELUCCI ANTONIO , PADELETTI LUIGI
Published: November 2011

Background:
The Seattle Heart Failure Model (SHFM) is a multimarker risk assessment tool able to predict outcome in heart failure (HF) patients.

Aim:
To assess whether the SHFM can be used to risk‐stratify HF patients who underwent cardiac resynchronization therapy with (CRT‐D) or without (CRT) an implantable defibrillator.

Methods and Results:
The SHFM was applied to 342 New York Heart Association class III‐IV patients who received a CRT (23%) or CRT‐D (77%) device. Discrimination and calibration of SHFM were evaluated through c‐statistics and Hosmer‐Lemeshow (H‐L) goodness‐of‐fit test. Primary endpoint was a composite of death from any cause/cardiac transplantation. During a median follow‐up of 24 months (25th–75th percentile [pct]: 12–37 months), 78 of 342 (22.8%) patients died; seven patients underwent urgent transplantation. Median SHFM score for patients with endpoint was 5.8 years (25th–75th pct: 4.25–8.7 years) versus 8.9 years (25th–75th pct: 6.6–11.8 years) for those without (P < 0.001). Discrimination of SHFM was adequate for the endpoint (c‐statistic always ranged around 0.7). The SHFM was a good fit of death from any cause/cardiac transplantation, without significant differences between observed and SHFM‐predicted survival.

Conclusion:
The SHFM successfully stratifies HF patients on CRT/CRT‐D and can be reliably applied to help clinicians in predicting survival in this clinical setting. (PACE 2012; 35:88–94)
Real‐Time Dominant Frequency Analysis of the Pulmonary Vein in Patients with Paroxysmal Atrial Fibrillation
Authors: MATSUO SEIICHIRO , YAMANE TEIICHI , DATE TARO , TOKUTAKE KEN‐ICHI , HIOKI MIKA , ITO KEIICHI , NARUI RYOHSUKE , TANIGAWA SHIN‐ICHI , TOKUDA MICHIFUMI , YAMASHITA SEIGO , INADA KEIICHI , MINAI KOSUKE , KOMUKAI KIMIAKI , SUGIMOTO KEN‐ICHI , YOSHIMURA MICHIHIRO
Published: November 2011

Background:
 Paroxysmal atrial fibrillation (PAF) can be treated with pulmonary vein isolation (PVI). A spectral analysis can identify sites of high‐frequency activity during atrial fibrillation (AF). We investigated the role of the PVs on AF perpetuation by dominant frequency (DF) analysis.

Methods:
 Thirty‐one consecutive patients with PAF who underwent PVI were included in the prospective study. DF was calculated in each of the PVs, 16, five, and five sites in the left atrium, the coronary sinus, and the right atrium, respectively. In patients presenting sinus rhythm at the baseline, AF was induced by pacing. The PVs were then divided into two groups; PVs demonstrated the highest DF (HDF‐PV) and others.

Results:
 One patient was excluded from the analysis because sustained AF could not be induced. AF was terminated in 43.3% (13/30) of patients during ablation. Of 92 PVs isolated during AF, 30 and 62 PVs were classified into the HDF‐PV and others, respectively. PAF was more frequently terminated by the HDF‐PV isolation compared to the others (33.3%[10/30] vs 4.8%[3/62], P = 0.0004). Interestingly, nine of the 30 HDF‐PVs showing the highest DF among all 30 regions, including extra PVs, led to AF termination in 88.9% (eight out of nine) of cases. Moreover, the HDF‐PVs isolation resulted in a greater AF cycle length prolongation than the other PVs isolation (12.1±5.0 vs 2.7±7.6 ms, P = 0.007).

Conclusion:
 Termination of PAF was more frequently observed during ablation of the PVs with the highest DF. The PV showing high DF played an important role in the maintenance of PAF. (PACE 2012; 35:28–37)
Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation
Authors: WUTZLER ALEXANDER , ROLF SASCHA , HUEMER MARTIN , PARWANI ABDUL SHOKOR , BOLDT LEIF‐HENDRIK , HERBERGER ERIK , HOHENBICHLER KATHARINA , DIETZ RAINER , HAVERKAMP WILHELM
Published: November 2011

Background:
 The combination of intravenous propofol and midazolam is frequently used to provide unconscious sedation during catheter ablation of atrial fibrillation (AF), but only a very few reports are available on the influence of prolonged propofol infusion on arterial blood gas, blood pressure, and anesthesia‐associated complications during ablation of AF. The purpose of this study was to assess tolerance and safety of unconscious sedation with intravenous propofol and midazolam during catheter ablation of AF.

Methods:
 A total of 316 consecutive patients (age 59 ± 10 years, 68% men) presenting to our center for catheter ablation of symptomatic AF were enrolled prospectively. A total number of 424 procedures were performed under unconscious sedation with propofol and midazolam. SaO2, electrocardiogram, arterial blood pressure, and arterial blood gases were monitored throughout the procedure.

Results:
 Mean procedure duration was 235 ± 48 minutes. Patients received 1.125 ± 684 mg propofol, 9.5 ± 3 midazolam, and 1.963 ± 813 mL NaCl infusion. Complications during the procedure were identified in eight patients (2.5%, one × coronary air embolization, one × myocardial infarction, four × pericardial effusion, two × pericardial tamponade). All eight patients were symptomatic (distress, report of pain); none of the complications was attributable to unconscious sedation itself.

Conclusion:
 Unconscious sedation with propofol and midazolam in AF ablation procedures lasting 3–5 hours did not result in severe changes of vital parameters or serum electrolytes. Anesthesia‐associated problems were not observed. Propofol and midazolam can be safely used during catheter ablation of AF. (PACE 2012; 35:38–43)