bluuebunny/crossref_metadata_2025 huggingface dataset:
The Spy and the Saracen’s Secret
Authors: Öhrström Lars
Published: November 2020

The fifteenth of August 1754 was not a good day for the Swedish spy Reinhold Angerstein. After allegedly showing a very keen interest in Benjamin Huntsman’s Crucible Steel Works in Sheffield, he seems to have been promptly invited to take the next coach out of town, or something similar. In his diary he is only able to record some superficial information on how to make pocket-knives, and compared to the details given about other places, the lack of information about Sheffield is very suggestive of an early and speedy departure. However, a man of considerable social talents, as well as a gentleman, he did not need to despair. He apparently found lodgings for the night with the young Marquess of Rockingham, Charles Watson-Wentworth at Wentworth House. In passing, between technical and business-related notes in his diaries, we are told that the Marquess is married to ‘a daughter of a rich gentleman’. He does not let us know if she is pretty or not, but maybe old-time spies were more single-mindedly focused on their assignments. He had certainly not read Ian Fleming, and probably had no idea how we expect a gentleman-cum-spy to behave. We are, however, told that one of the Marquess’s ancestors was beheaded for supporting Charles I. He himself was apparently not bad looking, if the likeness of the portrait in Figure 9, still hanging in the head office of Jernkontoret (‘The Iron Bureau’, the Swedish Steel Producers’ Association) in central Stockholm is to be trusted. In 1754 he was 36 years old and, with some poetic licence, we could say that he was travelling in England and Wales in order to discover the Saracen’s secret. He was an industrial spy sent out by the Swedish government, and as such he used ‘all possible means, legal or otherwise’, to get to see what he wanted. In the mid-eighteenth century, the Swedish government and the country’s iron manufacturers wanted to know everything about British steelmaking.
The Emperor and Miss Smilla
Authors: Öhrström Lars
Published: November 2020

Biking south from Avignon, brief residence of the popes in southern France, towards Arles, town of bulls and van Gogh, should be a leisurely experience in the smiling Provencal landscape, making no undue demands on one’s physical abilities. That is, providing you stay away from the only obstacle on the way—the fortified hilltop village of Les Baux-de-Provence. An odd (some would say suspect) error of navigation brought us to the top one sunny day in September many years ago, but this detour proved to be well worth the effort. Both the village and the view are spectacular, and well justified claims to fame for Les Baux. However, Les Baux is, or should be, famous for another thing, the ore known as bauxite, discovered in the vicinity of the village by Pierre Berthier in 1821. Through the bauxite ore there is a curious connection between this sunny place of cicadas and pastis in the afternoon shade, and the Greenlandic adventures of Smilla Qaaviqaaq Jaspersen. These adventures that, told in the novel Miss Smilla’s Feeling for Snow, propelled Danish author Peter Høeg to international fame and fortune in 1992. In this bestselling novel, that can be described both as a thriller and as a ‘post-feminist’ critique of Danish colonialism, the mysterious doings of the Cryolite Company of Greenland plays a major role, as does Smilla’s profound knowledge of the solid-state properties of water. A former glaciologist of Danish–Greenlandic origins, she investigates the death of a neighbour’s six-year-old child after a fall from a snow-covered roof, which is dismissed by the police as an accident. She finds herself rummaging in the archives of the Cryolite Company in Copenhagen, examining forensic evidence, and finally joining the crew of an ill-fated expedition to a remote part of Greenland. At first sight, the common denominator between bauxite and cryolite is aluminium. As such, this is not so remarkable: aluminium, right under boron in the Periodic Table, is present in many minerals and ores, and is the third most abundant element in the earth’s crust.
Bonaparte’s Bursting Buttons: A Thin Story
Authors: Öhrström Lars
Published: November 2020

On my way to Vilnius, capital of Lithuania, one late November I realized that I had not packed any winter clothes. It turns out that I was not the first to make this blunder. None of the half a million or so Germans, French, Swiss, Poles, Italians, and other nationalities who passed through the town or in its vicinity in June 1812 had packed any winter clothes, something many of them were to later regret. They were on their way, although they did not know it at the time, to Moscow. What they also did not know was that they were going to make what was arguably the world’s worst aller-retour journey ever: Vilna to Moscow and back (at that time the town was known under its Polish name and had recently been acquired by the Russians in the process of the annihilation of the Polish state). It was June, and they were in a good mood, as the Russian Tsar had recently fled Vilna followed by his quarrelling generals, and they were under the command of possibly the most competent military leader since Alexander the Great: Napoleon Bonaparte. The lack of warm clothing was not going to bother me, however. By the morning the snow had melted, and luckily I was not on my way to Moscow on foot. I was in Vilnius to search for some buttons, preferably made of tin. The story of Napoleon’s buttons and their allegedly fateful role in the disastrous 1812 campaign is widespread among scientists and science teachers. This is partly due to the popular book with the same name by the chemists Penny LeCouteur and Jay Burreson, and I wanted to find out whether there could be any truth in it, or whether it was just another of the legends and rumours that has formed around this war. Briefly, the story goes like this: metallic tin is a dense material (lots of atoms per cubic centimetre) and was supposedly the material used for many of the buttons of what was known as la Grande Armée. Unfortunately, metallic tin has a nasty Mr Hyde variation, known as grey tin.
A Shiny Surface and a Tainted Past
Authors: Öhrström Lars
Published: November 2020

The day Erin Brockovich was driving in Reno and got hit by another driver, brought her in close contact not only with the bumper of the other car, but eventually also with the US legal system, and this would change her life completely. The day Steven Soderbergh asked Julia Roberts to play the part of Erin Brockovich in the film with the same name didn’t really change her life, one presumes, but it would show the world’s moviegoers and critics that the star and Academy Award winning actress of 1990 was really back on the right track. What is the link between these events? The answer is the element chromium. It was chromium that made law-firm clerk Brockovich start a David-against-Goliath struggle with the California energy conglomerate Pacific Gas and Electric Company, that made director Soderbergh make the blockbuster movie that gave Roberts an Oscar for best female actress in 2000 and revitalized her career. I will try not to spoil the picture for those who have not seen it, because it is well worth watching, but the fact that the good guys win in the end is probably not a surprise anyway. However, the role of chromium in this play is not at all evident. And are the good guys really the good guys? There is usually a proper amount of, and a proper place for, everything, and this includes the elements of the periodic table. The main component in steel, a material which has a role to play in this story, is iron, and while we sometimes have too low a level of this element in our bodies, too much of it will kill us. The same goes for chromium: we can’t live without it. Or so it was thought until very recently. It was supposed to help us to break down and metabolize sugars, and thus ‘chromium deficiency’ could possibly be related to diabetes. Now, while low levels seems to do no harm, there are still possibilities of a therapeutic window—that is, concentrations where it may do some good—but it does not any longer seem to be considered an essential element, although official consensus on this has not yet been proclaimed.
The Actress and the Spin Doctor
Authors: Öhrström Lars
Published: November 2020

This story could begin with a fictional horse named Velvet, or perhaps behind the keyboards in a smoky bar in Halmstad, and it might have had a very different ending were it not for the unlikely excursion of a few medicinal chemists to the exotic southern part of the periodic table into the realm of the Lanthanoids. One or two generations of movie aficionados and the celebrity-hungry populace were upset, intrigued, or just plain nosey when another chapter in what seemed to be the never-ending story of Elizabeth Taylor, last of the great Hollywood divas, was revealed in February 1997. Dame Elizabeth had been diagnosed with a brain tumour just before her 65th birthday and was due for an operation in a few weeks. As it turned out, this non-malignant tumour, which was easily removed by surgery, was probably the least of her medical problems, but when singer Marie Fredriksson fainted in her home in 2002 and the causes were revealed to be a potentially deadly cancer tumour, the situation was radically different. The fate of the 44-year-old, half of the immensely successful pop duo Roxette, affected a different generation to those who had been following the career of Elizabeth Taylor since the 1940s, and was also deeply unsettling since the victim was a woman in the prime of her life with young children. Brain tumours are difficult to deal with—you cannot just break open the skull and poke around until you find them, there far too many sensitive connections and devices that may be broken. Their precise location is a key issue, and for that you need to look inside the head without opening it. The most powerful method is what scientists call Nuclear Magnetic Resonance Imaging, known to the public simply as MRI as the little word ‘nuclear’ may have associations that would be unhelpful in situations in which calm and composure may be necessary, both for the patient and relatives. Looking inside human bodies has been of tremendous importance for medicine, but has also meant business opportunities, both for the unscrupulous and the upstanding.
To Take Back the Future
Authors: Öhrström Lars
Published: November 2020

There are different ways to be propelled into stardom. In 1953 Audrey Hepburn used a scooter in the William Wyler film Roman Holiday. The unsteady ride ends at a police station, and with Hepburn earning an Academy Award for best actress. A rather different approach was taken by Michael Douglas and friends in Romancing the Stone (Robert Zemeckis 1984, also produced by Douglas), where Douglas and Kathleen Turner are chased throughout most of the film by Danny DeVito in a white Renault 4L. These more modest modes of transport were not quite the style of Michael J. Fox in Zemeckis’ next movie Back to the Future — Fox’s vehicle to international fame is a plutonium-powered DeLorean sports car. While Piaggio (the makers of the Vespa used by Hepburn) and Renault are large companies that still exist, the DeLorean Motor Company was already bankrupt in 1982, too early to profit from the success of the movie—a worldwide blockbuster sensation in 1985. But even if you could find a used DeLorean DMC-12, the only model ever built by the company, don’t expect it to take you back to the 1950s even if you fuel it up with plutonium. In the movie, Fox’s character Marty McFly gets caught up in a time paradox and literally needs to save his own future. In real life, six years later, at the age of 29, Fox was diagnosed with Parkinson’s disease, beginning a very real life fight to take back his own future by battling the disease at all levels. Parkinson’s disease is what is known as degenerative neurological disorder. It is chronic, and there is at present no cure, but treatment to combat the symptoms exists. It was first described in detail by English physician James Parkinson, and named after him by the influential Jean-Martin Charcot whom we met briefly in Chapter 12. The classical symptoms are tremors, rigidity, slowness of movements, and balance problems. The problems for doctors, and consequently for their patients, is that there is no simple chemical or biochemical test for Parkinson’s disease, sometimes making the diagnosis a complicated affair.
Vaccines
Authors: Colbert Dom
Published: November 2020

A working knowledge of vaccinology is essential for anyone involved in travel medicine. This includes the storage, indications, scheduling, common side effects, usefulness, technique of administration and management of acute adverse reactions to any vaccine one gives. Those who administer vaccines should also be fully aware of the type of vaccine they are giving, should know exactly what is in the vaccine in question, should know its expected efficacy, and be able to roughly estimate a BCR. Giving unnecessary vaccines is reprehensible and unworthy of any doctor or nurse. In travel medicine, the ‘patient’, who is normally a healthy person, must be informed of the pros and cons of any proposed vaccine. Giving vaccines is only a part of the pre-travel consultation and is certainly not the most important part.
Adventure Travellers
Authors: Colbert Dom
Published: November 2020

There has been a remarkable increase in adventure and extreme travel in recent years. This includes travel in remote areas, mountain climbing, e.g. Kilamanjaro, living in rough and dangerous situations, and working in slums and shanty towns. Young adults, students, and backpackers constitute the majority of adventure travellers. They also constitute a group that is the most careless about health and most loathe spending money on a pre-travel consultation. Chapter 10 is devoted to special activities, which is a natural continuation of adventure travel.
Specific Medical Risks for the Traveller
Authors: Colbert Dom
Published: November 2020

The next two chapters deal with specific and general medical risks for the traveller. The topics covered are not exhaustive nor are they always exclusive to the traveller. However, they do focus on the problems most likely to be encountered when travelling and, as such, the responsible travel health advisor must be familiar with them.
Symptoms of Psychiatric Illness
Authors: Sloan Peter , Bell Joy
Published: November 2020

Few physical signs or investigative tools are available to psychiatrists to aid them in making their diagnosis. An ability to understand the patient’s mental state is therefore of vital importance in categorizing and precisely communicating their mental disorder. The MSE is the psychiatrist’s most used and useful resource. It elicits psychopathology in particular pat­terns, enabling diagnoses to be made. Psychopathology can therefore be defined as the scientific study of abnormal experience, cognition, and behaviour (Sims, 2002) and was first described by Karl Jaspers in the early 900s. More specifically, descriptive psychopathology is the subjective description of abnormal experience as related by patients and the objective observation of their behaviour. It has facilitated the creation of diagnostic systems, for example ICD-10 and DSM-IV, grouping symptom clusters and classifying which signs and symptoms indicate a particular diagnosis. In this chapter, you will be presented with a number of clinical sce­narios, which will enable you to familiarize yourself with some of the important phenomenological terms used by clinicians to help classify experience and illness. We have attempted to incorporate signs encoun­tered in all elements of the MSE and have used clinical examples from the main diagnostic groups.
Community psychiatry
Authors: Watson Andrew , Myers Gil
Published: November 2020

An inpatient admission to a psychiatry ward has a high cost both eco­nomically and psychologically. While it is necessary at times to treat someone in hospital, the majority of the work in maintaining good men­tal health is done while the patient is living their usual life with its highs, lows, and challenges. Community psychiatry aims to manage people with mental illness in their own environment. There are many benefits to this, including promoting a sense of normality, allowing for continued support from family and friends, and helping to bridge the change between ill­ness and recovery. Because of this, community psychiatry covers almost everything in psychiatry and is as much a speciality of exclusion as a spe­cific group: no under 18s (child and adolescent), over 65s (psychiatry of old age), addictions (substance misuse), or the law (forensic psychiatry). But a community psychiatrist can’t be too exclusive because local differ­ences, based on what other dedicated services are available, and sub­threshold presentations mean that a good working knowledge of most conditions is essential. In many ways, community psychiatrists are the GPs of the speciality. The only way to manage such a large and varied workload is to make good use of the multidisciplinary team (MDT): community psychiatric nurses (CPNs), occupational therapists (OTs), speech and language therapists (SALTs)—the list of acronyms is endless but essential. A good community psychiatrist has a team they can rely on to help keep a watch­ful eye over their clinical population; managing their day-to-day care and anticipating problems before a relapse develops. The balance between giving space for recovery and monitoring to ensure efficient treatment is hard to achieve but gratifying when it occurs. Part of the skill set of a good community psychiatrist is an understand­ing of the research statistics: prevalence of disorders, treatment rates, and prognosis. These allow for faster diagnosis and evidence-based treatments to speed up recuperation. The minutiae of these facts aren’t needed, but a broad understanding helps shape assessment and management.
Substance Misuse Psychiatry
Authors: Lydall Greg , Clarke Kelly
Published: November 2020

Clinicians in all areas of medicine are likely to encounter people with substance misuse issues, so an understanding of the key issues is essen­tial. Human beings have used intoxicating substances, such as alcohol, nicotine, cannabis, and heroin, for millennia. Motivations might include experimentation, pleasure, social enhancement, or for physical or psy­chological pain management. Some people who use these legal and illegal substances experience problems related to their use, including loss of control, adverse consequences, withdrawals or cravings, damaged end organs, risky behaviour, and premature death. Substance misuse impacts not only on individual physical and mental health but also upon families and wider society by increased healthcare, criminal justice, social ser­vices, and unemployment costs. Drug and alcohol problems affect between 10% and 25% of the popu­lation each year, and up to 35% of people have ever used illicit drugs. Alcohol, an intoxicating sedative, is the most commonly used drug, with 25% of the UK population drinking above ‘low-risk’ limits. In England in 2010 there were an estimated 300 000 opiate, crack-cocaine, and inject­ing drug users, and only half were in treatment. Substance misuse is commonly associated with physical and mental health co-morbidity. The prevalence of co-existing mental health and substance use problems (termed ‘dual diagnosis’) may affect between 30% and 70% of those presenting to healthcare and social care settings. In general, four interrelationships in dual diagnosis are recognized: • substance use leading to social problems and psychological symptoms not amounting to a diagnosis • substance use leading to social dysfunction and secondary psychiatric and physical illness • substance use exacerbating an existing mental or physical health prob­lem and associated social functioning • primary psychiatric illness precipitating substance misuse which may also be associated with physical illness and affect social ability. Given the array of substance misuse problems, an individual treat­ment approach is essential and may involve psychological, pharmaco­logical, and social intervention. An empathic, non-judgemental clinical approach is essential to engage people with substance misuse problems. Motivational interviewing is an evidence-based talking therapy to help people in denial about their problems make changes for themselves and avoids imposing change prematurely.
Associations between prenatal stress, anxiety and depression and child behavioural and cognitive development. Is it causal?
Authors: Glover Vivette , O’Connor Thomas G.
Published: November 2020

I (V.G.) first got to know Channi at the inaugural Indian Biological Psychiatry meeting In Bombay over 20 years ago. I was working on monoamine oxidase at the time. It was my first trip to India and his first to Bombay for several decades. We spent much time talking together, and by the end of it, as well as visiting temples, the Gateway of India, and the Elephanta Caves. Channi had persuaded me to carry out research on maternal mood in the perinatal period, the effects on the child, and the underlying biological mechanisms. This I have been doing ever since. Thus for me, like many others, Channi changed the direction of my career. His infectious enthusiasm, and very wide range of interests, have directed and inspired world research in perinatal psychiatry. There is now considerable evidence from both human and animal studies that the children of stressed, anxious, or depressed mothers are more likely to experience a range of neurodevelopmental problems than the children of unstressed mothers. (Glover 2011; O’Donnell et al. 2009; Talge et al. 2007; Van den Bergh et al. 2007,). With animal studies it is much easier to establish that these associations are causal. Newborn rat pups of prenatally stressed mothers can be cross-fostered to non-stressed mothers on the first day after birth, with control pups of unstressed mothers cross-fostered also. This can establish that any differences in outcome are caused by stress in the prenatal period. Many such studies have shown that there are definite fetal programming effects of prenatal stress on behaviour, cognitive development, the hypothalamuspituitaryadrenal (HPA) axis, and brain structure and function of the offspring (e.g. Henry et al. 1994; Weinstock 2001, 2008; Afadlal et al. 2010). The nature of the effects can be affected by the timing of the exposure in gestation, the type of the stress, the strain of the animal, the age at which the offspring was tested, and the sex of the offspring (Weinstock 2008), The effects of prenatal stress on the offspring can often be mimicked by giving the stress hormone corticosterone, or a synthetic glucocorticoid, to the pregnant animal (Matthews 2000; Afadlal et al. 2009).
Evidence-based practice
Authors: Daly Blánaid , Batchelor Paul , Treasure Elizabeth , Watt Richard
Published: November 2020

In the last 40 years, the needs of and demands for health care both in the UK and worldwide have increased dramatically. These increases are related to the population ageing, the development of new technologies and knowledge, rising patient expectations, and associated increases in professional expectations about the possibilities and potential of health care (Muir Gray 1997 ). In this period, the key policy concerns of the international health care community have been about containing costs and enabling equitable access to high quality health care, while also ensuring greater accountability, patient satisfaction, and improved public health (Lohr et al. 1998). Health care resources are finite and must be shared equitably on the basis of need, capacity to benefit, and effectiveness. The use of high quality research evidence and guidelines to inform individual patient care and population health care have become central to this process. In the mid-1970s, various writers began to question the effectiveness of medicine and the increasingly wider influence exerted by the medical profession on society. For example, McKeown (1976) mapped mortality rates for the main killer airborne diseases (tuberculosis, whooping cough, scarlet fever, diptheria, and smallpox) against contemporary advances in medicine from the mid-19th century to the early 1970s. He found that the declines in the incidence and prevalence of communicable diseases had occurred before their microbial cause had been identified and before an effective clinical intervention had been developed. McKeown concluded that the declines in mortality rates were not attributable to immunization and therapy and suggested the declines could more reasonably be attributed to better nutrition and improved housing conditions which had occurred over the period. Allied to McKeown’s historical analysis was the work of Archie Cochrane who evaluated contemporary clinical practice in the 1970s. In his seminal work Effectiveness and Efficiency , Cochrane (1972) showed that many medical treatments provided in the NHS were ineffective, inefficient, and founded on medical opinion rather than on a rigorous assessment of efficacy and effectiveness. Box 7.1 defines the terms efficacy, effective, and efficiency.
Public health approaches to the prevention of traumatic dental injuries
Authors: Daly Blánaid , Batchelor Paul , Treasure Elizabeth , Watt Richard
Published: November 2020

Injuries are a major cause of morbidity and mortality in both developed and developing countries around the world. It is estimated that, of the total burden of global disease, just over 12% is attributable to injuries (WHO 2008). Depending on the cause, injuries can be divided into unintentional and intentional. Two-thirds of the global burden of injury is classified as unintentional and these are mainly caused by road traffic injuries and falls. Intentional injuries are caused by violence. The term ‘accident’ is discouraged, as this suggests that chance or bad luck are the main causes of the harmful event (Davis and Pless 2001). Injuries are in fact predictable and preventable in most cases. The multiple and interacting causes of injury provide a good example of the broader determinants of health. Injuries are not solely caused by the behaviour of individuals. Instead, the underlying influences and causes of the behaviour, the broader context, need to be understood. Hanson et al. (2005) have proposed an ecological approach that describes three key dimensions: the individual, the physical environment, and the social environment. A better understanding of the true causes of this major global public health issue will help to inform more effective intervention strategies. In dentistry, increasing clinical and public health interest has focused on the issue of traumatic dental injury (TDI). This chapter will present an overview of the epidemiology of TDI. The impact of the condition will be highlighted and the key aetiological factors identified. A critical appraisal of treatment and preventive approaches will be presented and an alternative public health approach will be outlined. Data on the extent and severity of TDIs are rather limited in comparison to the amount of information available in relation to dental caries and periodontal diseases. Comparisons between populations is also hampered, as surveys often use different methods to measure and assess TDIs. A recent review of the global literature indicated that amongst pre-school children approximately one-third had suffered TDI in the primary dentition (Glendor 2008 ). It was estimated that a quarter of all school children and almost a third of adults had suffered trauma to the permanent dentition, although significant variations existed both between and within countries.
Fundamentals of crystallography
Authors: Giacovazzo Carmelo
Published: November 2020

In this chapter we summarize the basic concepts, formulas and tables which constitute the essence of general crystallography. In Sections 1.2 to 1.5 we recall, without examples, definitions for unit cells, lattices, crystals, space groups, diffraction conditions, etc. and their main properties: reading these may constitute a useful reminder and support for daily work. In Section 1.6 we establish and discuss the basic postulate of structural crystallography: this was never formulated, but during any practical phasing process it is simply assumed to be true by default. We will also consider the consequences of such a postulate and the caution necessary in its use. We recall the main concepts and definitions concerning crystals and crystallographic symmetry. Crystal. This is the periodic repetition of a motif (e.g. a collection of molecules, see Fig. 1.1). An equivalent mathematical definition is: the crystal is the convolution between a lattice and the unit cell content (for this definition see (1.4) below in this section). Unit cell. This is the parallelepiped containing the motif periodically repeated in the crystal. It is defined by the unit vectors a, b, c, or, by the six scalar parameters a, b, c, α, β, γ (see Fig. 1.1). The generic point into the unit cell is defined by the vector . . . r = x a + y b + z c, . . . where x, y, z are fractional coordinates (dimensionless and lying between 0 and 1). The volume of the unit cell is given by (see Fig. 1.2) . . . V = a ∧ b · c = b ∧ c · a = c ∧ a · b. (1.1). . .
Interpersonal Communication
Authors: Sully Sue
Published: November 2020

Nursing is an interpersonal profession (Ellis and Whittington 1981) which is to say that the majority of the goals of the profession are met through the quality and nature of relationships the nurse is able to form. Effective interpersonal communication which underpins the therapeutic relationship is a complex set of skills which require the nurse to understand the context and purpose of the interactions, in addition to being aware of their own agendas and factors which might form a barrier to effective working relationships. Historically, interpersonal communication was implicit within nursing care and by the 1980s writers such as Morrison and Burnard (1991) and Porritt (1990) had identified and explored the nature of the therapeutic relationship and interpersonal skills within nursing care. Now authors such as Stein-Parbury (2009), Burnard and Gill (2008), Maben and Griffiths (2008), Freshwater (2005) and Greenhalgh and Heath (2005) have studied and written about this area in great depth. Both the Department of Health (DOH) (2010) and the Nursing and Midwifery Council (2008) have identified the centrality of patient-led care and the nurses’ ability to develop effective working relationships that enhance dignity and treat the person with compassion and care. A therapeutic relationship is significantly different from relationships that are formed socially amongst colleagues and friends. In order to establish a relationship which is helpful it is necessary to be aware of the assumptions, expectations and feelings you carry into each new professional relationship. Without this awareness there is a real danger that your own ‘noise’ will make it difficult for you to be present and experience the other person as they are. In order to understand the emotional needs and concerns of the person it is necessary for you to try to understand the world of the person that you are caring for—from that person’s own perspective. The nearer you can come to this the more effective will be the relationship, and the assessed needs of the patient will be more accurate and relevant. Learning about interpersonal communication within the context of nursing and the therapeutic relationship means that you will have the opportunity to develop your skills and adapt them for the purpose of caring for others.
Assessment of Medication Calculation Skills
Authors: Stubbings Terry
Published: November 2020

Accuracy with medication dosage calculation is key to safe practice for a nurse. However, errors are not uncommon and seem to be increasing in frequency and some of them lead to harm or death to patients (NPSA 2009). The NMC (2010), in its essential skills clusters, requires baseline skills for calculating medicines, nutrition and fluids. It also requires that, by completion of a nursing course, an individual will be competent in the process of medication related calculation involving tablets and capsules, liquid medicines, injections and IV infusions. Part of this competence is making judgements about what calculations to use, how to do them, what degree of accuracy is appropriate and what the answer means in relation to the context. Passing an assessment of medication dosage calculation skills should be seen as only one aspect of developing the competence to practise safely. There are three possible approaches to assessment on nursing courses: If this is how medication related calculation skills are assessed on your course, you should feel confident that it has a high degree of validity (that is, the assessment is very real, since it is done in a real clinical environment). However, the many variables in a clinical setting mean that the assessment can be considered low in reliability (that is, that the same level of medication related calculation skill would be assessed each time). If your course requires this sort of assessment, ensure you find out exactly what is being assessed. Is the assessment just about calculation of medication dosages, or are other aspects of medication administration also being tested (e.g. assessment of patient prior to administration, interpersonal skills with patients, administration, documentation)? Documentation of medication administered is very important in nursing practice, so this aspect is likely to be included. If this is how medication related calculation skills are assessed on your course, you should feel confident that it has a high degree of reliability (that is, assessment can be carried out in the same way with each student) and the level of validity is quite high too (that is, it will be set up like a real clinical environment).
Introduction
Authors: Bentley Peter J.
Published: November 2020

They obey our instructions with unlimited patience. They store the world’s knowledge and make it accessible in a split second. They are the backbone of modern society. Yet they are largely ignored. Computers. They comprise our crowning achievements to date, the pinnacle of all tools. Computer processors and software represent the most complex designs humans have ever created. The science of computers has enabled one of the most extraordinary transformations of our societies in human history. . . . You switch on your computer and launch the Internet browser. A one-word search for ‘pizza’ finds a list of pizza restaurants in your area. One click with the mouse and you are typing in your address to see if this restaurant delivers. They do! And they also allow you to order online. You choose the type of pizza you feel like, adding your favourite toppings. The restaurant even allows you to pay online, so you type in your credit card number, your address, and the time you’d like the delivery. You choose ‘as soon as possible’ and click ‘pay’. Just thirty-five minutes later there is a knock on your door. The pizza is here, smelling delicious. You tip the delivery guy and take the pizza to your table to eat. Ordering pizza is nothing unusual for many of us around the world. Although it may seem surprising, this increasingly common scenario with cheap prices, fast delivery, and access to such variety of food for millions of customers is only possible because of computers. In the situation above you might have spotted just one computer. If we take a look behind the scenes, the number of computers involved in bringing your pizza is astonishing. When you switched on your computer, you actually powered up many computers that all work together to make the display, mouse, keyboard, broadband, and main computer operate. Your computer linked itself to the Internet—which is a worldwide network of computers— with the help of computers of the phone company and Internet service provider. When you searched for ‘pizza’ the request was routed between several computers before reaching the search engine computers.
Renal medicine
Authors: Emmett Stevan R. , Hill Nicola , Dajas-Bailador Federico
Published: November 2020

The kidneys are of fundamental importance in the regu­lation of fluid and electrolytes, maintaining permissive extracellular fluid composition (salts and water), pH, and volume, while also mediating the removal of waste prod­ucts. Based on the anatomy of the nephron, three main processes occur in order to deliver this balance: glom­erular filtration, tubular secretion, and tubular resorption. Drugs can act at different sites within this system, so that functional equilibrium can be restored in various disease states (e.g. hypertension, heart failure, liver failure, neph­rotic syndrome). CKD is a long- term condition that lasts more than 3 months and affects the function of both kidneys. It results from any pathology that reduces renal functional capacity and produces a decrease in GFR to less than 60 mL/ min/ 1.73 m2. Prevalence within the UK is high, particularly in the elderly and affects 6– 8% of the population. The most common cause of CKD is idiopathic (unknown, usually with small kidneys), then diabetes mellitus. In both, glom­erular damage and mesangial injury (causing metabolic and haemodynamic effects) occur. Mild- moderate essen­tial hypertension does not cause CKD. Knowledge of the functional anatomy of the proximal tubule and loop of Henle is essential in understanding therapeutic targets and treatment of pathologies, as each region and transporter system has a key role. In brief, the journey of solutes from the blood to the production of urine occurs at five main anatomical sites— the glom­erulus, the proximal tubule, the loop of Henle, the distal tubule (proximal part and distal part), and the collecting ducts (Figures 5.1 and 5.2). The glomerulus is a network of capillaries (like a ball of string), which merge with the nephron via Bowman’s cap­sule. It is the first site of filtration and the place where solutes, toxins, and small proteins are removed from the wider circulatory system, after delivery by the renal ar­teries (via an afferent arteriole). Blood and larger proteins remain in the arteriole and leave via an efferent branch, while the filtrate enters the proximal convoluted tubule. The afferent:efferent system ensures that a constant filtration pressure is maintained irrespective of variations in arterial pressure. The capillary bed is very large, so that permeability and filtration rates are high. A normal glomerular filtration rate (GFR) i.e. 90– 120 mL/ min/ 1.73 m2, depends on hydrostatic pressure, the colloid osmotic pressure and hydraulic per¬meability.
Inside and Outside of Hillforts
Authors: Harding Dennis
Published: November 2020

By the 1960s, a greater interest in the social and economic role of hillforts demanded more extensive excavation of their interiors. Whilst fieldwork was still dependent on volunteer labour and limited research funds, the expense of large-scale stripping by hand would have been prohibitive, and only with public funding of ‘rescue’ or ‘salvage’ excavation in advance of development was it practical to contemplate large-scale area excavation. Hillforts that were extensively excavated included Balksbury (Wainwright 1969; Wainwright and Davies 1995; Ellis and Rawlings 2001) and Winklebury (Smith 1977; Robertson-Mackay 1977; Fisher 1985) in Hampshire. Whilst large-scale examination of hillfort interiors is plainly essential to an understanding of their economic and social functions, there is a high probability that ephemeral features, the foundations of which did not penetrate into subsoil or bedrock, will be destroyed by mechanical stripping, if they have not already been damaged beyond retrieval by ploughing. So the question remains: how partial and therefore potentially misleading are the surviving plans of hillfort interiors thus exposed? Hillfort exteriors, arguably equally important to an understanding of the role of the enclosure as its interior, have been even more neglected, first because of an implicit assumption that the earthworks defined the area of the ‘site’, and second, because the logistical problems of excavating outside the limits of the ramparts increased exponentially with distance from the enclosure. The possibility, indeed probability, of activity contemporary with the occupation of the hillfort having extended beyond the limits of the rampart need not necessarily imply a social division between acropolis and polis on the eastern Mediterranean model. It simply requires a redefinition of the concept of what constituted the ‘site’ in which the enclosure earthworks are not the definitive criterion. The issue was identified more than thirty years ago (Harding 1979; Hingley 1980), and excavation and survey at Battlesbury Camp, Wiltshire (Ellis and Powell 2008) and Castle Hill, Little Wittenham (Allen et al. 2011), has shown its importance for future research. There are three principal, non-intrusive ways of investigating hillfort interiors and immediate exteriors. The first is by surface survey, not in itself as simple as may appear at first sight, since detecting and meaningfully depicting the highly fugitive traces of prehistoric occupation requires an experienced eye, sensitive to the residual surface signs of constructional activity.
Head and neck surgery
Authors: Conn Gemma
Published: November 2020

In almost no other surgical specialty does use of a diagnostic screen have such prominence than when considering the diagnosis of a lump in the head or neck. Is the lump neoplastic and if so, is it likely to be of benign, malignant, or of mixed malignant potential? Does the mass have features of a developmental condition or could it represent sequelae of acute or chronic infection? Are there associated signs suggesting endocrine or metabolic dysfunction in association with the mass? Is there a traumatic origin or are there features of degenerative disease? Enlarged lymph nodes may be reactive due to inflammation, acute or chronic infection, or may represent primary or secondary neoplastic dis­ease. Anatomical knowledge of lymph drainage patterns provides clues as to the region of primary pathology. Developmental abnormalities such as thyroglossal cyst, dermoid inclu­sion cyst, and brachial fistula exhibit specific clinical signs and are found in characteristic anatomical locations. Systemic clinical signs may occur in endocrine abnormalities asso­ciated with hyper- or hypothyroidism and, for instance, in primary hyperparathyroidism. Bimanual examination will assist localization of sialolithiasis and the alert examiner will search for clinical involvement of the facial nerve which may help to suggest the nature of the neoplastic pathology involv­ing a pre-auricular mass. CT scan and fibre-endoscopy are powerful diagnostic tools in inves­tigation of the oro- and nasopharynx and of the pathologies that may lie therein. Head and neck pathologies may be treated by ENT, head & neck, or general surgical specialists. Irrespective of which specialty eventually manages the patient, it behoves the medical student and surgical trainee to ensure that he or she is conversant with the common clinical mani­festations and anatomical features of conditions that occur in this region. This chapter will help you to revise distinct features of some of the most common clinical pathologies affecting the head and neck, and should remind you of rationales for specific diagnostic and therapeutic avenues.
Understanding Diabetes Mellitus
Authors: Phillips Anne , Gadsby Roger
Published: November 2020

The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with type 1 and type 2 diabetes mellitus in an evidence-based and person-centred way. Diabetes mellitus is a long-term condition that can affect people of all ages; consequently, people with diabetes mellitus can be found in every healthcare environment, from hospitals to care homes. The chapter will provide a comprehensive overview of the classifications, causes, and risk factors of diabetes. The key principles of patient assessment are established, before exploring best practice to deliver care, prevent acute complications, and minimize long-term complications. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with diabetes can be found in Chapters 19, 22, 24, 25, 26, and 28, respectively. Diabetes mellitus is a group of metabolic conditions with hyperglycaemia occurring as the main feature. It is characterized by chronic increased blood glucose (hyperglycaemia), with disturbance of carbohydrate, protein, and fat metabolism, which results from defects in insulin secretion, insulin action, or both (World Health Organization (WHO), 1999). The hormone insulin, produced by the beta cells in the pancreas, controls blood glucose levels, keeping them within a narrow range in normal health (4舑6 mmol/l before food). When blood glucose levels rise (for example, after a meal containing carbohydrates has been consumed), glucose enters the beta cells, eventually resulting in the release of insulin into the portal circulation. The classifications of diabetes mellitus (World Health Organization, 2006) are as follows….● Type 1 diabetes mellitus, previously known as insulin-dependent diabetes mellitus (IDDM) ● Type 2 diabetes mellitus, previously known as non-insulin-dependent diabetes mellitus (NIDDM) ● Gestational diabetes mellitus ● Others, such as disorders affecting the pancreas, and endocrine conditions…The features of type 1 and type 2 diabetes mellitus are outlined in Table 9.1. Gestational diabetes is carbohydrate intolerance, resulting in hyperglycaemia with onset or recognition during pregnancy (World Health Organization, 2006). However, the condition may have been present prior to pregnancy, but not been diagnosed. Diabetes mellitus may occur for other reasons, including genetic defects and diseases affecting the pancreas.