bluuebunny/crossref_metadata_2025_split huggingface dataset:
Testing topics
Authors: Ford Michael J 
Published: November 2023

Abstract
At least one-third of all patients referring themselves to a general practitioner or presenting to a general medical clinic have no evidence of underlying organic disease to account for their symptoms. They do not have frank psychiatric illness, and are conventionally considered to have functional disorders. The term ‘functional disorder’ is, unfortunately, sometimes used in a pejorative or dismissive manner, as biomedical science has become the focus of medical attention.
Altered emotional states are commonly associated with physical symptoms, and most people will have experienced (say) urinary frequency before an interview or an examination. Some individuals do not find it easy to admit to, much less to express, the emotions which are disturbing them; others lack the insight and emotional vocabulary which would help them to associate their physical symptoms with an emotional problem. As Balint [124] has said, some illnesses allow patients to complain of a problem.
Planning and acceptance testing of megavoltage therapy installations
Authors: Almond P R , Horton J L 
Published: November 2023

Abstract
Planning and acceptance testing of a megavoltage therapy installation is a major undertaking whatever the size of the institution or department. Because the equipment and site preparation are expensive, and most of the machines are complex and can be supplied by several different manufacturers, it is imperative that a great deal of thought and care go into the decision, with the aim being that the specification of the machine that is installed meets the need of the institution at that time and for the projected lifetime of the equipment. In this chapter, the various types of equipment that are available and their general specification are described. Criteria for machine selection are then presented, followed by a discussion of treatment-room design and protection considerations. Finally, acceptance test procedures, which ensure that the institution obtains the equipment that was planned, are presented.
Absolute dose determination for high-energy photon and electron beams
Authors: Mijnheer B J , Thwaites D I , Williams J R 
Published: November 2023

Abstract
The principal aim of absolute dose determination is to enable an ionization chamber to be used at a reference point in a phantom and, with the use of appropriate conversion and correction factors, to yield the absorbed dose to water at that point for the situation in which the chamber is replaced by water. Ideally chamber calibration factors need to be available for every radiation quality used in the radiotherapy centre. The objective is achieved through the use of an ionization chamber calibrated at an accredited standards laboratory and the application of an appropriate protocol.
Simulation and imaging for radiation therapy planning
Authors: Dyk J Van , Mah K 
Published: November 2023

Abstract
The process of radiation therapy for malignant disease is complex and involves many steps, as is shown in the block diagram of Figure 7.1. It begins with patient diagnosis, contains a number of steps to patient treatment, and carries through with on-going follow-up. One crucial step in this process is the determination of the location and extent of disease relative to adjacent critical normal tissues. This can be done in a variety of ways, ranging from simple clinical examination to the use of complex imaging modalities, sometimes aided by contrast agents. Another step of the process is the selection of the necessary radiation beams to provide an adequate coverage of the tissues at risk, while minimizing the dose to healthy normal tissues. Before treatment is initiated, this treatment plan needs to be confirmed by an imaging procedure to ensure that the beams traverse the desired anatomical volume and correlate accurately with respect to critical structures.
Treatment planning for external beam therapy: advanced techniques
Authors: Redpath A T , McNee S G 
Published: November 2023

Abstract
It is now accepted that computerized tomography (CT) has a major role in treatment planning. Its diagnostic worth in the detection of malignant disease is significant, and the assessment of the extent of the disease may be vital in determining the choice of treatment. The specification of the anatomy of the patient in three dimensions, as a map of electron density values, allows accurate calculation of the dose distribution. It also permits accurate localization of the planning target volume and of critical normal structures.
Electron beam treatment-planning techniques
Authors: Thwaites D I 
Published: November 2023

Abstract
The attractive feature of electron beams for a variety of clinical applications is the shape of the depth-dose curve, characterized by a relatively steep fall-off and a finite range. This enables reasonably uniform doses to be delivered to a well-defined region extending from the surface, whilst at the same time sparing underlying tissue. Above about 20 MeV the fall-off of the curve becomes progressively less steep with energy, and the separation of the high-dose and spared regions becomes increasingly blurred. Energies higher than this can be used for deeper-seated tumours in a manner similar to megavoltage photons. However, the majority of linear accelerators that provide clinical electron beams provide energies within the range 4-20 MeV and this chapter is mainly concerned with their use. Discussion is limited to the parameters affecting either the dose distribution or the link between monitor units (mu) and dose. Calculation methods are considered, where appropriate, but no detailed discussion is given of more complex algorithms.
Developing primary care services for older people
Authors: Iliffe Steve , Drennan Vari 
Published: November 2023

Abstract
In this final section of the book we return to, and expand upon, the earlier themes explored in the first four chapters. We examine the potential for improvement and change in services for older people by considering issues which focus beyond the care of an individual and beyond the activities of an individual primary care professional. This chapter includes a discussion of: Most primary care practitioners experience their work as dealing with the individual person - whether as a consultation or a referral because that is how the ‘work’ arrives. During the nineties primary care professionals have experienced major service changes imposed from without through legislative and fiscal changes, the possible exception to this imposition being fundholding, which was not only voluntary but also inspired some practices to think in innovative ways. Most notably this external imposition included the introduction of:
Skin cancer
Authors: Atkinson Ronnie J 
Published: November 2023

Abstract
The skin is unique in three ways. First, it is a living covering for the body to pro- tect it from loss of water and injury from light, heat, chemicals, and infectious organisms. Second, it is the main organ for regulating body temperature. Last, apart from the eye, it is the only organ easily visible, making it an excellent model for early diagnosis treatment and prevention.
Head and neck cancer
Authors: Eakin Ruth 
Published: November 2023

Abstract
The impact of these cancers on psychological, physical, and social functioning cannot be understated. The disfigurement from the disease or treatment can be enormous, although continuing improvements in surgical techniques and prostheses are resulting in better cosmetic results. It is hoped that improvements in radiotherapy, such as altered fractionation and 3-D conformal therapy, will also help to reduce treatment related morbidity.
Gastrointestinal cancer
Authors: McAleer James J A 
Published: November 2023

Abstract
Gastrointestinal tumours are relatively common and account for almost 25% of all tumours. Since these tumours arise in a distensible hollow tube, they tend to have a relatively late presentation. Clinical vigilance and willingness to investigate patients with minimal gastrointestinal symptoms are required to detect early- stage disease and improve outcome. The tumour types occurring along the gastro- intestinal tract are quite different in terms of aetiological factors, anatomy, therapeutic options, and outcome, and accordingly they will be considered under separate headings.
Genitourinary malignancy
Authors: Keane Patrick F , McAleer John D Kelly,James J A 
Published: November 2023

Abstract
The incidence of all types of genitourinary malignancy is increasing. This is part- ly due to the increased numbers of elderly people in the population and improvements in diagnostic techniques, but there has been a significant real increase in the incidence of renal, prostate, and testicular cancer. Environmental exposure to carcinogens is thought to account for the increase in testicular cancer. Prostate cancer is the second biggest killer in males and will overtake lung cancer as male smoking habits change. Haematuria is the presenting sign of renal and urothelial malignancy and yet many patients delay in coming to their doctor for medical advice. Similarly, patients with testicular lumps and lesions on the penis often delay coming forward. Clearly there is a need for improved awareness in the population at large regarding the significance of these symptoms.
Statistical Questions in Evidence-Based Medicine
Authors: Bland Martin , Peacock Janet 
Published: November 2023

Abstract
Statistical Questions in Evidence-based Medicine is a book of questions and answers about the statistical principles and methods used in medical research. Based entirely on material published in the medical literature and popular media, it will prove invaluable to medical students, doctors, nurses, medical researchers and others concerned with medical data. This book is a companion volume to the new 3rd edition of An Introduction to Medical Statistics but can also be used in conjunction with the 2nd edition or with other good texts. Short excerpts of material from published papers or summaries of their results are presented with questions. These test and develop the reader's understanding and interpretation of statistics and extend the reader's research and critical appraisal skills, thus encouraging an evidence-based approach. Questions are presented on the left-hand page with detailed answers on the right-hand page. Answers include references to core material in An Introduction to Medical Statistics. The book is intended as a series of examples for self-teaching but could also be read as a series of case studies with detailed commentaries. The questions are clearly graded, using icons, in terms of difficulty and undergraduate or postgraduate level. The book is easy to use and a model of clarity for the reader.
Presenting data
Authors: Bland Martin , Peacock Janet 
Published: November 2023

Abstract
Tables and graphs must convey information clearly and quickly. They should not mislead the reader. They should be clearly titled and labelled. Bar charts and line graphs should show the zero value on the axis if possible. Although graphs can convey a lot of information quickly, they can also be very misleading. Sometimes graphs use a logarithmic scale. The effect is to compress the scale for high values and stretch the scale for low values. This may make positively skew distributions symmetrical. It makes multiplicative relationships additive and may straighten curved relationships. The values 1 and 10 and 10 and 100 are equal distances apart on a logarithmic scale, because they share the same ratio.
Estimation
Authors: Bland Martin , Peacock Janet 
Published: November 2023

Abstract
We often denote the mean of a population by p and the standard deviation by o. We use a sample to estimate quantities such as these in the whole population. We can use a single number, such as the mean, calculated from the sample as an estimate. This is called a point estimate. It will not be exactly the same as the population value (e.g. mean). It is useful in addition to find an interval estimate, a range of values which we hope will include the population value. This is usually a 95% confidence interval. A 95% confidence interval is a range of values chosen so that the population value would lie within the confidence intervals calculated from 95% of possible samples. It therefore reflects the amount by which population estimates vary from sample to sample. Other probabilities can be used, e.g. 90% or 99%' A bigger probability leads to a wider interval, a smaller probability to a narrower interval with more risk of being wrong. Standard errors are often used to calculate confidence intervals.
The analysis of cross-tabulations
Authors: Bland Martin , Peacock Janet 
Published: November 2023

Abstract
To investigate the relationship between two qualitative variables, we tabulate one variable by the other to get a table of frequencies. This is a contingency table. We can use a chi-squared test to test the null hypothesis that in the population there is no relationship between the two variables. This compares the observed frequencies with those expected if the null hypothesis were true. This is a test for large samples; a guide to the validity for small samples is that at least 80% of the expected frequencies should exceed 5.0, all expected frequencies should exceed 1.0.
Recurrence
Authors: Ebrahim Shah , Harwood Rowan 
Published: November 2023

Abstract
‘Will it happen again, doctor?’ The stroke patient is asking one of the most difficult questions to answer clearly, and is expecting a straight ‘yes’ or ‘no’. The clinician may toss a mental coin, and say ‘no’, realizing that this answer will be wrong some of the time but right most of the time. The response may be justified by the paternalistic notion that the patient really does not need negative ideas to ponder during the difficult period of recovery. An alternative is to give a probability of a further stroke.
Rhabdomyosarcoma
Authors: Leuschner Iva 
Published: November 2023

Abstract
Rhabdomyosarcoma is a heterogeneous group of tumors. The tumors are composed of cells that histologically resemble fetal muscle cells at 10-12 weeks of gestation (8). By the early 1950s it was realized that the rhabdomyosarcoma had at least two distinct morphological subtypes which were named embryonal and alveolar rhabdomyosarcoma. Molecular genetic studies of the last decade have shown that these different histological patterns are caused by different genetic changes. Today, the two basic subtypes of rhabdomyosarcoma are regarded as probably distinct sarcoma entities sharing myogenic differentiation. A different biological behavior of the two subtypes of rhabdomyosarcoma has been shown in large clinical oncology studies (9-11), that demonstrated that the alveolar rhabdomyosarcoma is associated with a less favorable prognosis compared to the embryonal type. This resulted in development of treatment protocols with regard to the variable aggressiveness of the different subtypes of RMS.
Malignant soft tissue tumors of childhood
Authors: Thomas J Robert , Parham David M 
Published: November 2023

Abstract
Other than rhabdomyosarcoma and peripheral primitive neuroectodermal tumor (PNET), malignant neoplasms arising within extraskeletal soft tissue comprise a small percentage of childhood tumors (1). Their relatively infrequent occurrence can contribute to difficulty in clinical recognition and correct classification. Another factor that hinders our understanding, especially in light of their rarity, is their wide diversity in tumor types, as partially listed in Table 11.1, which also gives data related to relative incidence in a large prospective multiinstitutional study (2, 3). Recent developments in the basic biological understanding of some of these entities will hopefully aid in alleviating some problems in their diagnosis and classification.
Pediatric renal neoplasms
Authors: Argani Pedram , Perlman Elizabeth J 
Published: November 2023

Abstract
Primary renal tumors account for 6% of cancers in children, surpassed in frequency by leukemias, brain tumors, lymphomas, sarcomas, and neuroblastomas (1). Approximately 500 new pediatric renal neoplasms are diagnosed each year in the United States, over 80% of which are enrolled on a National Wilms Tumor Study (NWTS) clinical protocol (2). The NWTS was started in 1969 with the goal of optimizing therapy for children with renal neoplasms, and has met with great success. Much of this success can be attributed to the accurate subclassification of tumors on the basis of clinical and pathologic features into high- and low-risk types, allowing the intensity of therapy to be modified
appropriately.
Bone tumors (excluding Ewing’s sarcoma)
Authors: Bell Walter C , Siegal Gene P 
Published: November 2023

Abstract
Osteosarcoma is the most common primary malignant tumor of bone (excluding hematopoietic malignancies such as myeloma) and is the most common malignant tumor of childhood. Approximately 1000 new cases are diagnosed per year in the United States with a slight male predominance. The peak incidence of osteosarcoma is in the second decade of life with a second smaller peak in individuals over the age of 50 (1). This second peak in older individuals may be largely attributed to secondary forms of osteosarcoma arising, for example, in Paget’s disease or post irradiation, or to unusual subtypes such as osteosarcoma of the jaw, which occurs in older individuals (1, 2). The most common sites for the development of osteosarcoma are the metaphyseal regions of the long bones with the distal femur, proximal tibia, and proximal humerus, in that order, representing the three most common sites affected (3-5).
Carcinoma
Authors: Cullinane Catherine J 
Published: November 2023

Abstract
In childhood carcinomas are rare, with an annual incidence for most sites nearly always under 1/1 million (1). In a US study the annual age adjusted rate for all carcinomas in adults was about 434 per 100,000 but only 1.4 per 100,000 in children (2). In their review of paediatric cancer during a 10-year period in the United Kingdom, McWhirter and colleagues found that carcinoma represented about 2% of all childhood malignancies (3). Another UK study estimated the age standardized rate as 2.4 per million per year. However, over the 30-year study period the incidence increased from 1.5 to 3.3 per million (4). The incidence and type of carcinoma in children differs from that in adults, where skin, lung, colon, and breast are the most common. In children the types of carcinoma most frequently seen include thyroid, colon, nasopharyngeal, adrenocortical, melanoma, salivary, liver, and renal, although the incidence varies throughout the world (1-3).
Tendon and Ligament Biochemistry and Pathology
Authors: Riley Graham 
Published: November 2023

Abstract
Tendon and ligament pathologies are often seen by general practitioners, rheumatologists, and specialists in musculoskeletal medicine. Increased participation in recreational exercise and sport, although beneficial for general health and well-being, has led to a substantial rise in their incidence. However, only belatedly are these conditions receiving the attention they deserve from the research community.
Personality disorders
Authors: McGuffin Peter , Moffitt Terrie , Thapar Anita 
Published: November 2023

Abstract
Personality can be defined as the individual’s entire repertoire of relatively stable and enduring behaviours (genetic aspects of normal personality are considered in Chapter 4). By the same token, personality disorders are usually seen as reflecting enduring traits, and not as transient or alterable states that may change greatly over time. Hence they are considered to be different from those forms of mental illness that have a definable onset and may later show remissions and relapses. The difference between personality disorders and other types of psychiatric disorder is recognized in the Diagnostic and Statistical Manual 4th edition (DSM-IV) (American Psychiatric Association 1993) whereby axis I diagnoses consist of clinical disorders and ‘other conditions that may be a focus of clinical attention’ and disorders of personality are included separately under axis II. Although the other main psychiatric classification scheme contained in the International Classification of Diseases 10th edition (ICD-10) does not include axial separation, the difference between personality disorder and other types of clinical condition is implicitly recognized. In most other respects the DSM-IV and ICD-10 definition and classification of personality disorders is very similar.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
Authors: Chabriat H , Bousser M G 
Published: November 2023

Abstract
CADASIL (cerebral .autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) (Tournier-Lasserve et al.1993) is a systemic smaIl artery disease which was identified during the past decade, using clinical, magnetic resonance imaging (MRI), pathological, and genetic tools (Tournier-Lasserve et al.1993). The disease is due to mutations of the Notch3 gene on chromosome 19 (Joutel et al.1996). The identification of the CADASIL gene was crucial to determine precisely the different aspects of the clinical phenotype and to understand better the natural history of this new cause of dementia of both subcortical type and pure vascular origin. This was also an essential step to obtain a genetic test which is now used routinely to confirm the diagnosis of the disease.
MRI and other neuroimaging modalities for subcortical stroke
Authors: Davis S M , Parsons M W 
Published: November 2023

Abstract
The widespread introduction of computed tomographic (CT) imaging in the 1970s allowed non-invasive diagnosis of lacunar infarcts, previously identified as clinical syndromes and confirmed only via autopsy studies (Fisher 1965a, Caplan 1980, Nelson et al. 1980). However, it was evident that CT scanning was frequently insensitive, particularly with acute infarcts. By the late 1980s, magnetic resonance imaging (MRI) had become widely available and this modality allowed more sensitive detection of lacunar infarcts, particularly those in the brainstem (Arboix et al. 1990a, Hommel et al. 1980). However, as with CT scanning, the diagnostic sensitivity with MRI was greater when it was performed a few days after stroke onset, rather than at the hyperacute stage (Table 10.1).
Electroencephalography in patients with small, deep infarcts
Authors: Kappelle L J , Huffelen A C van 
Published: November 2023

Abstract
When Fisher (1965a) revitalized the concept of the small deep (‘lacunar’) infarction in the 1960s, there were no brain imaging techniques to confirm this diagnosis during life. Since lesions were limited to subcortical structures and spared the cortex, specific clinical features in conjunction with a normal electroencephalogram (EEG) were obligatory for the diagnosis (Fisher and Curry 1965,Caplan and Young 1972, Caplan 1976, Haferkamp 1977).
Writing up the research
Authors: Armstrong David , Grace John 
Published: November 2023

Abstract
The chapters so far have described in detail the various stages of the research process, beginning with defining a question for research and developing a research design, through to analysing the data collected in the study using a range of statistical techniques. This chapter now focuses on describing the various questions and issues that need to be tackled in writing up the research. Dr Greatman has had a long-standing interest in the salaries of health service managers. Eventually he gets around to a survey of the salaries of different grades of manager compared with the pay of health care professionals. He is ‘shocked’ to discover that some health services managers are paid more. This is news the world has been waiting for. Now to get the key findings into print.