bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hand Hygiene and Infection Control
Authors: Lovegrove Jane 
Published: November 2020

Abstract
Each year hundreds of millions of people contract an infection while in the receipt of heath care. At any time 1.4 million people worldwide are suffering from an infectious complication associated with health care (WHO 2005). Health care acquired infections not only lead to pain discomfort, disability, and possible death for the recipient but also place a huge emotional and physical burden on relatives and carers. In England and Wales an average of one in 11,000 people die of a hospital acquired infection (HAI) each year; this figure rises to 1 in 300 for patients over the age of 80 (Bandolier 2006). Hospital admission is now a major risk factor for health care related infection (Gould 2009). In 2007 around 9,000 people in England died with an MRSA bloodstream infection or related Clostridium difficile infection (National Audit Office 2009). These figures do not include deaths from other HAIs so in fact the number of deaths from HAIs could be greater. In addition, it is also believed that many people die from a health care acquired infection which is not identified on the death certificate. In England, health care related infections have been estimated to cost a billion pounds annually (WHO 2005). The World Health Organization has identified hand hygiene as the primary measure to reduce infections (WHO 2009). Everyone involved in the provision of health care must be trained in effective hand decontamination (NICE 2003). Unclean hands move microorganisms from one place to another. Transmission of infection by hands has been identified with recent hospital outbreaks of MRSA and Clostridium difficile. Good hand hygiene is one of the most effective methods of reducing hospital acquired infections. Hand decontamination removes transient bacteria acquired from recent contact with an infected item or person. While hand decontamination is advocated before contact with every patient regardless of setting, patients in hospital are at greatest risk of acquiring an infection. In the UK 7.6% of patients admitted to hospital become infected. In England the figure is even higher at 8.19% (Nazarko 2008). It is essential for health care students to not only be able to perform effective hand washing, but also understand the principles of the procedure, as well as the possible physical, emotional and financial consequences of failing to perform hand hygiene.
Food for Thought: Enzyme Action
Authors: Atkins Peter 
Published: November 2020

Abstract
Nature makes use of the tools that I have been developing, and does so in the most extraordinary and subtle manner. After all, she has had about four billion years to come up with solutions to problems with which human chemists have striven seriously for only a century or so. Most of the reactions that go on in organisms—including you—are controlled by the proteins called ‘enzymes’ (a name derived from the Greek words for ‘in leaven’, as in yeast). Enzymes are biological catalysts (Reaction 11) that are extraordinarily specific and highly effective in their role. One of these complex molecules might serve as the merest foot soldier in the army of reactions going on inside you, with a role such as severing the bond between two specific groups of atoms in a target molecule. Because their function may be highly specific, enzyme molecules need to be large: they have to recognize the molecule they act on, act on it, then release it so that they can act again. Thus, they have to have several functions built into them. As you will see, enzymes are the ultimate in functional blindness: they feel around in their surroundings in order to identify their substrate, the species they can act on. Life is ultimately blind chemical progress guided by touch. I am going to introduce you to one particular group of enzymes, the ‘proteases’, and focus on one example from this group, namely chymotrypsin. A protease is a traitor to its kind: it is a protein that breaks down other proteins. It plays a role in digestion, of course, but its range is much wider. One protease enables a lucky sperm to eat through the cell wall of an egg and ensure its at least temporary immortality. Another facilitates the clotting of blood to terminate possibly fatal bleeding. Chymotrypsin itself is an enzyme that is secreted from the pancreas into the intestine, and makes an essential contribution to the process of digestion. Its name is derived slightly circuitously from the Greek words for animal fluid, a bodily ‘humour’, and rubbing, as it was obtained as a fluid by rubbing the pancreas.
Grand Designs: Synthesis
Authors: Atkins Peter 
Published: November 2020

Abstract
In this final reaction I am going to show you in the broadest of outlines how chemists build the equivalent of a cathedral. That is, how they synthesize a complicated molecule from scratch. The aim of a synthesis is to take a reasonably readily available laboratory chemical and process it—add bits on, take things off, close rings of atoms, open rings, build flying buttresses, and so on—until the target compound has been made. You could take the view that you should really start from absolute scratch, from the elements themselves, typically hydrogen, carbon, nitrogen, and oxygen, and build the molecule from those. However, that would be a waste of time and not crucial to the demonstration of the synthetic route because it is possible to argue that there are already plenty of methods for synthesizing the simple starting materials from scratch, and the real challenge is to build the intricate molecule. That is rather like accepting that a contractor can supply windows, bricks, and beams when constructing a real house and that it isn’t necessary to go all the way back to the sand, clay, and iron ore from which they are made to demonstrate that the house can be built literally from the ground up. Of course, the starting materials in a modern chemical synthesis might seem a bit recondite, but be assured that they are reasonably acceptable and purchasable from suppliers of laboratory reagents or easily made from what they do supply. Now for the particular cathedral on which I intend to focus. That scourge of humanity, malaria (‘bad air’), was introduced into the New World in the fifteenth century and soon wrought the havoc that had for long, and still, afflicts millions. The natives there found that an extract of the bark of the quina-quina tree, in due course to be classified as Cinchona Officinalis, was an effective cure, in particular having saved the life of the Countess of Cinchona. In due course the active component, quinine, was identified and extracted.
Understanding Dementia
Authors: Dewing Jan 
Published: November 2020

Abstract
This chapter presents a comprehensive understanding of dementia as a commonly encountered condition/syndrome in the nursing care of older adults and offers insights into the health challenges faced by people living with dementia. It will provide nurses with the knowledge to be able to assess, manage, and care for people with dementia in an evidence-based and person-centred way. After a comprehensive overview of the causes, risk factors, and impact of dementia, it will outline best practice to deliver care, as well as to prevent or minimize further ill-health. Nursing assessments and priorities are highlighted throughout, and the nursing management of the symptoms and common health problems associated with dementia can be found in Chapters 14 and 17, respectively. In the past, dementia was most often described in terms of mental disability. However, it is now more often described in terms of neurological disability (i.e. changes in the brain). For example, the Mental Health Foundation describes dementia as:…A decline in mental ability which affects memory, thinking, problem-solving, concentration and perception….The NHS Choices website states:…Dementia describes the effects of certain conditions and diseases on a person’s mental ability, personality and behaviour….Dementia is generally classified according to two international classification systems: the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV); and the International Classification of Diseases tenth edition (ICD-10). Dementia can be defined as a syndrome whereby there is gradual death of brain cells, resulting in a loss of brain ability that is severe enough to interfere with normal activities of living for more than 6 months. Problems with brain function should not have been present at birth and it is not associated with a loss or alteration of consciousness. This latter point distinguishes dementia from delirium, which is a state of mental disorientation that can happen if you become medically unwell, also known as an ‘ acute confusional state’ (Royal College of Psychiatrists, 2009). (See Chapter 11). It is vital that nurses hold central what dementia means for people living with it. For example, people will commonly experience changes to their perception, senses, memory, and the range of skills they need to carry out everyday activities.
Managing Anxiety
Authors: Kendal Sarah , Baker John 
Published: November 2020

Abstract
This chapter explores anxiety, providing a clinical description of its impact on patients with guidance for evidence-based assessment and management. Anxiety has a defined physiological mechanism and merits a planned management approach. Every nurse should possess the knowledge and skills to identify patients with and/or at risk of anxiety, to select and implement evidence-based strategies to manage anxiety, and to review the effectiveness of these to inform any necessary changes in care. It can be useful to think of most mental and emotional phenomena as being a combination of four systems: autonomic, behavioural, cognitive, and environmental (Box 14.1). Emotions that we experience, such as happiness, sadness, anxiety, and anger, depend on how the systems interact with each other. These four systems combine to form a common model in mental health, known as the ABC-E model of emotion (Briddon et al., 2008) (also see Chapter 8), which will be used as a framework for the chapter. An ABC-E-based assessment helps to clarify nursing interventions in each one of these four areas. An intervention in one of these systems can often help to alleviate distressing emotions. A commonly used classification system for mental disorders is the International Classification of Diseases version 10 (ICD-10) (World Health Organization (WHO), 2010). An alternative classification system is the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1994). The main types of anxiety are listed in Box 14.2. Many features of anxiety disorder also present in the patient who is agitated. Agitation is a form of anxiety that can raise particular concerns about safety. As illustrated in Table 14.1, the main difference is in the cognitive and behavioural domains, i.e. what the person is thinking and doing. The descriptions in Table 14.1 apply to anxiety as a clinical problem, as in the case of David, whose story is described in Case study 14.1. The difference between non-clinical and clinical anxiety is explained in the ‘Making a clinical assessment’ section. There are other approaches to defining anxiety.
Diagnosis of oral disease
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip 
Published: November 2020

Abstract
The most common oral diseases are dental caries and periodontal dis­ease. The diagnosis and treatment of these diseases are the focus of the majority of dentists, dental therapists, and dental hygien­ists. Nevertheless, it is the responsibility of the dental healthcare pro­fessional to provide a holistic approach to management that ensures both good oral and general health for their patients. A broad knowledge of the range of diseases that affect the oral cavity is essential and also an appreciation that oral disease may be the first sign of an underlying systemic disease. Before this knowledge can be applied, the clinician must obtain an accurate patient history and undertake a systematic clinical examination. These key clinical skills underpin both medicine and dentistry, and are an absolute requirement to formulate a differ­ential diagnosis. The use of imaging modalities and laboratory tests are often required to reach a definitive diagnosis, and it is the justification and informed choice of these additional investigations that will facili­tate a timely and accurate diagnosis. Following diagnosis, appropriate treatment can be instituted, the ideal outcome being a return to health or control of the patient’s symptoms in recalcitrant chronic diseases. Obtaining a clear and precise clinical history is essential. The clinician must listen carefully to the information conveyed by the patient and then use direct questioning to collect additional data to construct an accurate picture of the patient’s problem. This can be a significant challenge and requires excellent communication skills to build a good patient–clinician relationship. The most common presenting problems relate to pain or the development of a lesion: swelling, lump, ulcer, or white/red patch. To establish a comprehensive pain history, the features listed in Table 1.1 should be addressed. Obtaining an accurate history for a lesion is dependent on the patient noticing the abnormality in the first instance and, as a consequence, the information may be rather vague; however, it is important to ascertain the key points listed in Table 1.2. A comprehensive medical history (Box 1.1) will identify any concur­rent disease that may be relevant to the presenting oral condition (Chapter 10) and highlight any issues relating to proposed medical or surgical interventions.
Disorders of bone
Authors: Robinson Max , Hunter Keith , Pemberton Michael , Sloan Philip 
Published: November 2020

Abstract
Most invasive dental procedures involving removal of teeth or bone are followed by uneventful healing. However, dentists should be aware that generalized abnormalities of bone, such as osteoporosis and Paget’s dis­ease of bone, may complicate these procedures and, rarely, can lead to ongoing clinical problems. The effects of radiotherapy to the jaws and bisphosphonate treatment are well-described causes of osteonecrosis and delayed healing. Diagnosis of bone disorders often depends on integrating the results of clinical, imaging, pathological, genetic, and biochemical investigations. Although the bony skeleton is often thought of as forming just a rigid framework, it should be remembered that bone is a living, responsive tissue that plays an important role in metabolism. During development, some bones develop from a cartilaginous template and others, such as most of the craniofacial bones, form in fibrous membranes. Bone matrix is laid down by osteoblasts that are derived from the extensive meshwork of bone-lining cells that cover the bone surfaces. The bone matrix contains osteocytes that are responsive to mechanical stresses. Bone matrix is removed by osteoclasts that move over the bone sur­face, resulting in scalloped pits termed Howship’s lacunae. Bone mat­rix can be woven or lamellar in pattern. Pathologists often examine sections of bony lesions in polarized light to determine whether the pattern of the collagenous matrix is woven or lamellar, because it can be pivotal for diagnosis. It is also important for clinicians to be aware that, in order to produce a histological section of bone, the tissue must first be fixed and then demineralized to soften the matrix. When a bone biopsy is performed, the patient should be made aware that additional time will be needed to process the biopsy. Following extraction of a tooth, the socket rapidly fills with blood, which then clots. Granulation tissue, which consists of proliferating endothelial cells and fibroblasts derived from remnants of the periodontal ligament and surrounding alveolar bone, grows into the clot and organization commences. Osteoclasts begin to remodel the crestal bone and remove any small spicules of bone detached during the extraction.
Predictors of hypertension detection in English general practices: a cross sectional study
Authors: Levene Louis S , Coles Briana D , Gillies Clare L , Shabnam Sharmin , Zaccardi Francesco , Khunti Kamlesh 
Published: November 2020

Abstract

Background
Worldwide, high systolic blood pressure is the leading risk factor for deaths and disability-adjusted life-years but has been historically under-detected. This study aimed to quantify differences between estimated and practice-detected prevalences of hypertension across English general practices, and to determine how variations in detected prevalence could be explained by population-level and service-level factors.

Methods
Descriptive statistics, pair wise correlations between the independent variables and a multivariable regression analysis were undertaken. In the regression model, the outcome was detected hypertension prevalence, adjusted for estimated prevalence, person-related and disease-related determinants of illness and characteristics of general practices.

Results
Detected prevalence was substantially lower than estimated prevalence (mean difference 16.23%; standard deviation 2.88%). Higher detected prevalence was associated with increased deprivation, increased non-white ethnicity and urban location. Lower detected prevalence was associated with larger list sizes, more general practitioners and being located in the South outside London. The final multivariable model’s adjusted R2 value was 0.75.

Conclusions
Substantial under-detection of hypertension is widespread across England. Independent of estimated prevalence, factors associated with greater morbidity and population density predicted higher detected prevalence. Identifying patients with undetected hypertension and coordinating care for these patients will require further resources and logistical support in community settings.
Selective Disclosure as a Self-Protective Process: Navigating Friendships as Asian and Latino Undocumented Young Adults
Authors: Cho Esther Yoona 
Published: November 2020

Abstract
Drawing on in-depth interviews with sixty-three undocumented, 1.5-generation Korean-origin and Mexican-origin young adults in the United States, I bring attention to the deep-seated effects of immigration status that extend into the most intimate aspects of undocumented immigrants’ lives. Findings show that the stigma of being undocumented leads undocumented young adults to be selective about whom they befriend and to whom they decide to disclose their status, feeling safer with those of shared immigrant descent. Furthermore, ethnoracial background shapes pathways of selective disclosure. Korean undocumented young adults in the study were more likely to be prompted to disclose their status to justify another personal circumstance, whereas Mexican respondents primarily sought empathy and community in times of distress. Moreover, Korean respondents more often created a distinction between individuals with whom they discussed the intimate details of their legal situation and those they deemed close but from whom they hid their status. This work demonstrates the ways in which undocumented immigrants engage in selective status disclosure as one of myriad strategies to mitigate the harmful affective and material effects of undocumented immigration status. By using a comparative qualitative approach, this study points to the nuanced and very personal ways in which ethnoracial background shapes everyday experiences of illegality.
Cytotoxicity and Genotoxicity of E-Cigarette Generated Aerosols Containing Diverse Flavoring Products and Nicotine in Oral Epithelial Cell Lines
Authors: Tellez Carmen S , Juri Daniel E , Phillips Loryn M , Do Kieu , Yingling Christin M , Thomas Cindy L , Dye Wendy W , Wu Guodong , Kishida Shosei , Kiyono Tohru , Belinsky Steven A 
Published: November 2020

Abstract
Electronic cigarettes are the most commonly used nicotine containing product among teenagers. The oral epithelium is the first site of exposure and our recent work revealed considerable diversity among e-liquids for composition and level of chemical constituents that impact nicotine deposition in a human oral-trachea cast and affect the formation of reactive carbonyls. Here, we evaluate the dose response for cytotoxicity and genotoxicity of e-cigarette-generated aerosols from 10 diverse flavored e-liquid products with and without nicotine compared with unflavored in 3 immortalized oral epithelial cell lines. Three e-liquids, Blue Pucker, Love Potion, and Jamestown caused ≥20% cell toxicity assessed by the neutral red uptake assay. Nine products induced significant levels of oxidative stress up to 2.4-fold quantified by the ROS-Glo assay in at least 1 cell line, with dose response seen for Love Potion with and without nicotine across all cell lines. Lipid peroxidation detected by the thiobarbituric acid reactive substances assay was less common among products; however, dose response increases up to 12-fold were seen for individual cell lines. Micronuclei formation indicative of genotoxicity was increased up to 5-fold for some products. Blue Pucker was the most genotoxic e-liquid, inducing micronuclei across all cell lines irrespective of nicotine status. A potency score derived from all assays identified Blue Pucker and Love Potion as the most hazardous e-liquids. These in vitro acute exposure studies provide new insight about the potential for some flavored vaping products to induce significant levels of oxidative stress and genotoxicity.
Correlation of Hounsfield Unit Measurements on Computed Tomography of the Shoulder With Dual-Energy X-ray Absorptiometry Scans and Fracture Risk Assessment Tool Scores: A Potential for Opportunistic Screening
Authors: Earp Brandon E. , Kallini Jennifer R. , Collins Jamie E. , Benavent Kyra A. , Tintle Scott M. , Rozental Tamara D. 
Published: November 2020

Background:
The diagnosis of bone mineral density (BMD) abnormalities involves dual-energy x-ray absorptiometry (DXA), but few patients complete this after a fragility fracture. The assessment of BMD using Hounsfield unit (HU) measurements from computed tomography (CT) scans has been correlated with DXA results in previous studies. We aimed to evaluate the correlation between shoulder CT HU and DXA scores.

Methods:
Billing databases of 3 academic institutions were queried for patients who underwent both DXA and CT scan of the upper extremity within 1 year of each other. DXA T-scores for spine, hip, and femoral neck were recorded. BMD status was defined based on composite T-scores, using the lowest T-score in the spine, hip, or proximal femur. CT scans were measured for HU over 4 slices, recorded to create a bone column, then averaged. The patients' risks of major osteoporosis-related fracture and hip fracture were calculated using the Fracture Risk Assessment Tool.

Results:
In total, 300 patients were included. A positive correlation was found between composite T-scores and HU for glenoid and proximal humerus (0.36; 0.17). The proximal humerus HU was significantly associated with the BMD T-score for the hip (P = 0.01); the glenoid HU was significantly associated with BMD T-scores for the hip, spine, and femoral neck (P = 0.002; P = 0.001; P = 0.002). A 10-year risk of hip fracture >3% was associated with lower proximal humerus HU.

Conclusions:
Our study is the first to discover significant correlations between HU at the glenoid and proximal humerus and risk factors as established by the Fracture Risk Assessment Tool scoring system.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.