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1
Sheikh, Abdul Jawad. Individual psychotherapy (client centered) of psychogeriatric patients: A controlled trial in a day hospital setting. Birmingham: University of Birmingham, 1996.
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2
Integrating total quality management in a library setting. New York: Haworth Press, 1993.
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3
Bauman, Kristy A., and Robert C. Hyzy. Volume-controlled mechanical ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0095.
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The goal of mechanical ventilation is to achieve adequate gas exchange while minimizing haemodynamic compromise and ventilator-associated lung injury. Volume-controlled ventilation can be delivered via several modes, including controlled mechanical ventilation, assist control (AC) and synchronized intermittent mandatory ventilation (SIMV). .In volume-controlled modes, the clinician sets the flow pattern, flow rate, trigger sensitivity, tidal volume, respiratory rate, positive end-expiratory pressure, and fraction of inspired oxygen. Patient ventilator synchrony can be enhanced by setting appropriate trigger sensitivity and inspiratory flow rate. I:E ratio can be adjusted to improve oxygenation, avoid air trapping and enhance patient comfort. There is little data regarding the benefits of one volume-controlled mode over another. In acute respiratory distress syndrome, low tidal volume ventilation in conjunction with plateau pressure limitation should be employed as there is a reduction in mortality with this strategy. This chapter addresses respiratory mechanics, modes and settings, clinical applications, and limitations of volume-controlled ventilation.
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Wiffen, Philip, Marc Mitchell, Melanie Snelling, and Nicola Stoner. Controlled drugs. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198735823.003.0006.
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This chapter is aimed at hospital pharmacists and technicians and provides a helpful overview on dealing with instances when controlled drugs are reported as missing. It provides a framework on dealing with such situations and differentiates between the pharmacy department and clinical areas. The chapter also discusses patients’ own controlled drugs in a hospital setting, including the use, return, disposal, and destruction of patients’ own controlled drugs.
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Li, Ingrid, Arthur Brewer, and Rusty Reeves. Hypnotic agents and controlled substances. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0029.
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Sleep medications are among the most frequently prescribed medications in the community. Many other Class II controlled substances, such as benzodiazepines and opiate medications, have become a major public health concern through overuse and abuse. Within correctional settings, these concerns are heightened and special considerations must be included in any treatment decision. Inmates abuse drugs at a prevalence many times higher than in the general population. A survey of practitioners in jails and prisons in the United States expresses the concern that sleep, opiate, and benzodiazepine medications can be abused or diverted. There has been little published as to the best correctional practice for the prescription of these medications. In general, sleep medications and controlled substances should be prescribed cautiously in a correctional setting, and wherever possible should be avoided as first-line treatment or as long-term treatment. Sleep medications are the most difficult to control since the quest for medications to treat sleep complaints is ubiquitous in corrections. Guidelines, thoughtful use of formulary controls, and a measure of flexibility will assist in the appropriate prescription of these medications. This chapter evaluates best practices in this arena of prescription practice.
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Zinberg, Norman. Drug, Set, and Setting: The Basis for Controlled Intoxicant Use. Yale University Press, 1986.
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7
Krawatzek, Félix. Setting, Concepts, and Theory. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198826842.003.0001.
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Youth can play a central role for understanding political developments during crises. The introductory chapter suggests combining the discursive and the physical mobilization of youth to understand its relevance in moments of crisis. Conceptual clarification is provided on the book’s key terms: ‘crisis’ as a category of experience which conveys contingency and possibilities; ‘youth’ as a political and cultural symbol; and ‘generation’ as combining experiences and expectations. The comparative historical frame starts from the contemporary Russian case and gradually adds variation in a controlled manner. A subsequent section develops a theory of the entwined processes of the political mobilization of young people and changing discourses about youth in moments of crisis in distinct political settings. The discussion of the theoretical processes leads to the formulation of the three guiding hypotheses on the symbolic and physical mobilization of youth and the relationship between youth and society at large.
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Schatman, Michael E., Ronald J. Kulich, and David A. Keith. Controlled Substance Risk Mitigation in the Dental Setting, an Issue of Dental Clinics of North America. Elsevier, 2020.
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Frass, Michael. The difficult intubation in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0081.
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Airway management in the intensive care unit differs from conventional controlled settings such as general anaesthesia in the operating room (OR). Due to adequate patient preparation and positioning in the OR, endotracheal intubation is usually easy to perform. However, in the intensive care setting, endotracheal intubation is often difficult or impossible because patients are not prepared and intubation is immediately necessary without sufficient time for putting together technical and pharmaceutical equipment. As an alternative, non-invasive alternate airway management may be performed. Besides non-invasive ventilation via mask or helmet, the use of Combitube®, EasyTubeTM, and different types of laryngeal mask airway are described, in order to alleviate decision-making in emergency situations such as difficult intubation, vomiting and bleeding patients, small interincisor distance, etc.
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McDaid, David. Economic modelling for global mental health. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199680467.003.0015.
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This chapter sets out the case for making use of economic modelling techniques to help inform decisions on effective and cost-effective actions for global mental health. Models potentially can be used to augment information obtained from controlled trials, for instance to look at the potential cost-effectiveness of actions over time periods beyond trial duration, to help adapt evidence obtained in one context to likely scenarios in other settings where infrastructure, costs, and current treatment options may be very different, or to help identify priority areas for research. The strengths and limitations of different modelling approaches are discussed and examples of how they have been used to inform policy making highlighted. The chapter ends by setting out key steps that should be taken when both planning and presenting the findings from a modelling study.
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Grant, Jon E., and Brian L. Odlaug. Assessment and Treatment of Pyromania. Edited by Jon E. Grant and Marc N. Potenza. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195389715.013.0101.
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Pyromania, also referred to as pathological fire setting, is a disorder defined by the deliberate and purposeful fire setting that has occurred on more than one occasion and that cannot be attributed to another psychiatric disorder. Although juvenile or adolescent fire-setting behavior or match play is a fairly common occurrence, clinical pyromania is a rare disorder associated with shame and embarrassment, significant psychosocial dysfunction, and legal consequences. Case reports and small controlled clinical trials have reported the successful treatment of fire-setting behavior through both pharmacotherapeutic and psychotherapeutic means. Pyromania, however, is a largely misunderstood, unrecognized, and untreated disorder.
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Weiss, Helen. Design issues in global mental health trials in low-resource settings. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199680467.003.0004.
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In this chapter we outline the key principles in design and analysis of trials for mental health. The chapter focuses on randomized controlled trials as these are the gold-standard trial design, which minimizes confounding due to other factors and enables us to draw conclusions about the effectiveness of the intervention. Other key principles of trial design discussed in the chapter include methods to develop a clearly stated, testable research hypothesis, definition of well-defined outcomes, appropriate choice of the control condition, masking of providers and participants where possible, realistic sample size estimates, and appropriate data monitoring and statistical analysis plans. The chapter also outlines alternatives to the parallel arm superiority trial design, such as equivalence and non-inferiority trials, cross-over, stepped wedge, fixed adaptive, and patient preference trial designs.
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Patel, Nihar. Acute Pain Management. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0064.
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Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.
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Ness, Immanuel. Political Economy of Migrant Labor in U.S. History. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252036279.003.0003.
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This chapter provides a historical comparative analysis of U.S. migration policy and examines why foreign migrant labor is growing at a rapid pace. In 1993, the Washington Consensus, the World Trade Organization (WTO), the International Monetary Fund (IMF), and the World Bank—multilateral financial institutions controlled by corporations in North America and Western Europe—established a new policy that would impose harsh penalties on any country that closed its borders to foreign trade, thereby setting the stage for monetary crises and high unemployment. That labor has no control over these organizations more than suggests the dire predicament that workers and unions confront today.
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Myers, Sara P., and Matthew D. Neal. Management of Exsanguinating Hemorrhage: Hemostasis and Resuscitation (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0022.
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This chapter describes the approach to massive bleeding in a patient within the setting of rapid response team (RRT) calls. Emphasis is placed on identifying peripheral sources of bleeding that can be controlled with compression. Military experience has aided in the understanding of how zeolite and clay can be used as chemical adjuncts. Resuscitative strategies and transfusion practices that promote hemodynamic stability are reviewed. Concurrent coagulopathy that can exacerbate hemorrhage is addressed and a brief overview is provided demonstrating how commonly prescribed anticoagulants can be monitored and reversed. To illustrate that multimodal therapy is often necessary to control hemorrhage, the chapter closes with surgical and minimally invasive techniques for definitive hemostasis.
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Thornicroft, Graham, and Vikram Patel, eds. Global Mental Health Trials. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199680467.001.0001.
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Global mental health is a dynamic field of global health; a core aspect of the story which has led to its emergence has been the conduct of randomised controlled trials (RCTs) evaluating innovative delivery systems of packages of care for mental disorders in low-resource settings. Global Mental Health Trials brings together many of the world's leading researchers active in the fields of RCTs in low- and medium-resource countries and settings related to improving mental health care. It presents clear and practical information about how to conduct such trials in these settings, along with critical methodological and ethical issues related to such trials, learning from the positive and negative experiences of expert scientists in many countries worldwide who have completed such trials. This online resource serves as a valuable resource for practitioners in mental health, including psychiatrists, psychiatric nurses nursing, psychologists, social workers, and occupational therapists, as well as researchers in the areas of psycho-social treatments in mental health, mental health services research, and programme and systems evaluation.
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Greenberg, Benjamin, and Sarah H. Lisanby. TMS in the study and treatment of anxiety disorders. Edited by Charles M. Epstein, Eric M. Wassermann, and Ulf Ziemann. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780198568926.013.0043.
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A few studies of transcranial magnetic stimulation (TMS) as an anxiety disorder treatment have been reported. In treatment studies, the focal application of TMS in the treatment of anxiety disorders has been guided by the present understanding of the neurocircuitry underlying these disorders. This article reviews the current state of the literature on the uses of TMS in the study and treatment of anxiety disorders, and discusses the implications for understanding their patho-etiology. Investigation of the possible therapeutic effects of repetitive TMS in obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or any anxiety disorder remains at a preliminary stage. There have been promising initial observations in OCD, which require systematic testing in controlled studies. As far as PTSD is concerned, the available data suggest that additional TMS work is required. The observations need to be replicated in controlled settings to determine whether this approach will have value in treating anxiety disorders.
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Kreit, John W. Patient–Ventilator Interactions and Asynchrony. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0011.
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Patient–Ventilator Interactions and Asynchrony describes what happens when the patient and the ventilator do not work together in an effective, coordinated manner. Effective mechanical ventilation requires the synchronized function of two pumps: The mechanical ventilator is governed by the settings chosen by the clinician; the patient’s respiratory system is controlled by groups of neurons in the brain stem. Ideally, the ventilator simply augments and amplifies the activity of the respiratory system. Asynchrony between the ventilator and the patient reduces patient comfort, increases work of breathing, predisposes to respiratory muscle fatigue, and may even impair oxygenation and ventilation. The chapter describes the causes and consequences of patient–ventilator asynchrony during ventilator triggering and the inspiratory phase of the respiratory cycle and explains how to adjust ventilator settings to improve patient comfort and reduce the work of breathing.
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Karlan, Dean, and Jacob Appel. Failing in the Field. Princeton University Press, 2018. http://dx.doi.org/10.23943/princeton/9780691183138.001.0001.
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All across the social sciences, from development economics to political science departments, researchers are going into the field to collect data and learn about the world. While much has been gained from the successes of randomized controlled trials, stories of failed projects often do not get told. This book delves into the common causes of failure in field research, so that researchers might avoid similar pitfalls in future work. Drawing on the experiences of top social scientists working in developing countries, the book investigates failed projects and helps guide practitioners as they embark on their research. From experimental design and implementation to analysis and partnership agreements, the book shows that there are important lessons to be learned from failures at every stage. The book describes five common categories of failures, reviews six case studies in detail, and concludes with some reflections on best (and worst) practices for designing and running field projects, with an emphasis on randomized controlled trials. There is much to be gained from investigating what has previously not worked, from misunderstandings by staff to errors in data collection. Cracking open the taboo subject of the stumbles that can take place in the implementation of research studies, this is a valuable ‘how-not-to’ handbook for conducting fieldwork and running randomized controlled trials in development settings.
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Stammen, Katherine, Harish Siddaiah, Cody Brechtel, Elyse M. Cornett, Charles J. Fox, and Alan D. Kaye. Pain Management for General Surgery. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457006.003.0006.
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Pain is multidimensional and subjective, which makes it difficult to treat. Newer treatment modalities have been under development with a better understanding of pain pathways in recent years. These treatments take advantage of the multifactorial components of pain, including agents such as ketamine, capsaicin, gabapentin, pregabalin, long-acting opioids, peripheral nerve blockade, and patient-controlled analgesia. Numerous studies have revealed not only efficacy but additive and/or synergistic effects when multiple agents are utilized for pain management. Overall, adequate perioperative pain control is important both in an acute setting and in preventing the development of a chronic pain condition, which causes significant short- and long-term negative consequences. Best practice strategies are being utilized based on clinical studies to reduce pain and improve patient needs after surgery.
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Meftahi, Ida. Dancing Angels and Princesses. Edited by Anthony Shay and Barbara Sellers-Young. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199754281.013.002.
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Linking twentieth-century discourse on dance to the staged body, this chapter presents a genealogy of Iranian “national dance” (raqs-i milli) in light of the biopolitics of the national(ist) stage of the Pahlavi era (1925–1979) in Iran. Through the process of heteronormalization of the stage, the transvestite bachchah raqqas and zanpush of the preexisting popular minstrel setting (mutribi) was eliminated from the early twentieth-century modernist-nationalist stage because it embodied an ambiguous sexuality that did not match the ideals of “modern” Iran. Instead, an educated and professionalized female national dancer with balletic moves and a controlled performance of sexuality performed the ego-ideal of modern Iranian women onstage. Often depicted as an angel or a Persian princess, this new female construct enacted the narratives of the nation on the prestigious “national(ist)” stage of the Pahlavi period.
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Brady, Peter A. Evaluation and Treatment of Arrhythmias. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199755691.003.0043.
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Abnormal cardiac arrhythmias may be due to reentry, abnormal automaticity, or triggered activity. Reentrant rhythms may be microreentrant or macroreentrant. Ambulatory (Holter) monitoring is useful for the evaluation of both symptomatic and asymptomatic rhythm disturbances and their relationship to daily activity. Treadmill exercise testing is very useful in the evaluation of patients who present with bradycardia and symptoms of palpitations because it allows both documentation of the adequacy of heart rate response to exercise and the recording of the cardiac rhythm during exercise in a controlled setting with ECG monitoring. An electrophysiologic study is useful for assessing sinus node function and the cardiac conduction system and for attempting to induce atrial or ventricular arrhythmias that could explain the clinical presentation. Electrophysiologic study requires placement of electrode catheters in the heart to record and to stimulate heart rhythm. Several therapeutic options are available for heart rhythm disorders, including drug therapy, radiofrequency ablation, and device therapy.
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Li Bassi, Gianluigi, and Carles Agusti. Toilet bronchoscopy in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0122.
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Critically-ill patients retain respiratory secretions. Toilet bronchoscopy is applied to aspirate retained secretions and revert lung atelectasis. Toilet bronchoscopy is particularly indicated when retained secretions are visible during the procedureand air-bronchograms are not present at the chest radiograph. Yet, toilet bronchoscopy should only be applied when other less invasive methods of secretion removal have failed. Ventilatory settings during the intervention, the inspiratory fraction of oxygen should be increased to 100%. In volume control ventilation, the pressure limit alarm needs to be increased; during pressure-controlled ventilation, the set inspiratory pressure should be increased. The external PEEP should be decreased to at least 50% of the baseline values, to prevent barotrauma. The use of sedatives, analgesics, and topical anaesthetics is mandatory to achieve favourable procedural condition. Toilet bronchoscopy is also feasible and safe in critically-ill patients undergoing non-invasive ventilation.
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Appelbaum, Kenneth L., and Kevin R. Murphy. Attention deficit disorders. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0037.
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The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in correctional settings is in itself problematic and quite contentious; treating the disorder more so. Community prevalence studies estimate that 2.5% to 4% of adults in the United States and worldwide meet diagnostic criteria for ADHD. Some research findings suggest that ADHD occurs at far greater prevalence rates among criminal justice populations than in the population at large. The nature of the condition, its assessment, and its management combine to create a perfect storm of potentially vexing challenges for the prison psychiatrist. This chapter reviews those diagnostic and treatment challenges, including the risk of diversion and misuse of controlled substances among inmates. An assessment and treatment model is presented that takes into account and minimizes risk while helping ensure access to care in appropriately selected cases. Some inmates have a compelling need for treatment, potentially including stimulant medications. Neither unbridled use nor complete elimination of stimulants makes good clinical or administrative sense for correctional systems. An approach that relies on current impairment in significant functional areas, meaningful involvement in treatment, and absence of active misuse of substances will allow access to medication for those with verifiable need while lessening the risks associated with prescription of controlled substances in jails and prisons. The issues of differential diagnosis in a population with epidemic substance abuse, the challenges of appropriate management, and an evidence-based treatment model are discussed in this chapter.
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Schneider, Antoine G., Neil J. Glassford, and Rinaldo Bellomo. Choice of Renal Replacement Therapy and Renal Recovery. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0038.
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Acute kidney injury (AKI) is a major complication of critical illness, associated with increased mortality and morbidity. Among survivors of AKI, a subset will develop the need for chronic dialysis. Chronic dialysis imposes a major physical, emotional, economic, and social burden on ICU survivors and their caregivers. Evidence suggests that the type of renal replacement therapy used in the acute setting may affect renal recovery differently. For example, intermittent haemodialysis (IHD) increases the risk of hypotension and acute volume and solute fluctuations, and such physiological events have been associated with fresh renal injury. In contrast, continuous renal replacement therapy (CRRT) does not carry such risks. Consistent with such physiological and experimental observations and differences, several observational studies and some randomized controlled trials suggest that using IHD, instead of CRRT, as the preferred form of RRT increases the risk of patients entering a chronic dialysis programme. A recent meta-analysis confirmed these findings. Clinicians making decisions about the choice of RRT modality in ICU patients should carefully consider these observations.
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Sternbach, Marion. Apheresis in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0268.
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This chapter describes therapeutic plasma exchange, as well as cytapheresis for hyperleukocytosis and essential thrombocythemia, as well as harvesting haematological stem cells (HSC) for transplantation. Instrumentation and techniques are mostly density centrifugation, much less column adsorption for antibodies or membrane filtration for noxious molecules. Pathophysiology of apheresis is dealt with in great detail with emphasis on prevention and treatment of side effects, much more critical in the intensive care unit (ICU) setting. Main manifestations are: hypocalcaemia due to chelation by anticoagulants, hypo- and less hypervolaemia, allergic reactions to sedimenting and volume replacement starches or plasma, depletion of coagulation factors, vitamin K, immunoglobulins, lymphocytes with long lifespan and platelets. Wash-out of drugs for comorbid or underlying conditions occurs inadvertently. Main indications for plasma exchange are thrombotic thrombocytopenic purpura (TTP)/haemolytic uraemic syndrome (HUS) with plasma or cryo-poor supernatant (based on RCT), hyperviscosity syndromes, post-transfusion purpura (PTP) and auto-immune haemolytic anaemia (AIHA), where all other treatments have failed. In cold agglutinin disease, cryoglobulinaemia, coagulation factor inhibitors and ABO incompatible HSC transplants, plasmapheresis has proven useful. Myeloma with renal failure does not seem to benefit significantly from plasma exchange (randomized controlled trials proven).
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Fuglestad, Finn. Slave Traders by Invitation. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190876104.001.0001.
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The small Slave Coast between the river Volta and Lagos, and especially its central part around Ouidah, was the epicentre of the slave trade in West Africa. But it was also an inhospitable, surf-ridden coastline, subject to crashing breakers and devoid of permanent human settlement. Nor was it easily accessible from the interior due to a lagoon which ran parallel to the coast. The local inhabitants were not only sheltered against incursions from the sea, but were also locked off from it. Yet, paradoxically, this small coastline witnessed a thriving long-term commercial relationship between Europeans and Africans, based on the trans-Atlantic slave trade. How did it come about? How was it all organized? Dahomey is usually cited as the Slave Coast's archetypical slave raiding and slave trading polity. An originally inland realm, it was a latecomer to the slave trade, and simply incorporated a pre-existing system by dint of military prowess, which ultimately was to prove radically counterproductive. Dahomey, which never controlled more than half of the region we call the Slave Coast, represented an anomaly in the local setting, an anomaly the author seeks to define and to explain.
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Irani, Ayesha A. The Muhammad Avatāra. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780190089221.001.0001.
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The Muhammad Avatāra: Salvation History, Translation, and the Making of Bengali Islam reveals the powerful role of vernacular translation in the Islamization of Bengal. Its focus is on the magnificent seventeenth-century Nabīvaṃśa of Saiyad Sultān, who lived in Arakanese-controlled Chittagong. Drawing upon the Arabo-Persian Tales of the Prophets genre, the Nabīvaṃśa (“Lineage of the Prophet”) retells the life of the Prophet Muhammad for the first time to Bengalis in their mother-tongue. This book delineates the challenges faced by the author in articulating the pre-eminence of Islam and its Arabian prophet in a land where multiple religious affiliations were common, and when Gauṛīya Vaiṣṇava missionary activity was at its zenith. Sultān played a pioneering role in setting into motion various lexical, literary, performative, theological, and, ultimately, ideological processes that led to the establishment of a distinctively Bengali Islam in east Bengal. At the heart of this transformation lay the persuasiveness of translation on a new Islamic frontier. The Nabīvaṃśa not only kindled a veritable translation movement of Arabo-Persian Islamic literature into Bangla, but established the grammar of creative translation that was to become canonical for this regional tradition. This text-critical study lays bare the sophisticated strategies of translation used by a prominent early modern Muslim Bengali intellectual to invite others to his faith.
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Brunero, John. Instrumental Rationality. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780198746935.001.0001.
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Rationality requires that we intend the means we believe are necessary for achieving our ends. This book explores several interrelated issues regarding the formulation and status of this requirement of means–ends coherence. I argue that means–ends coherence is a genuine requirement of rationality, and cannot be explained away as a myth, confused with a disjunction of requirements to have, or not have, specific attitudes. But nor, I argue, is means–ends coherence strongly normative in that we always ought to be means–ends coherent. Why is this requirement in place? One popular strategy looks to the connection between intention and belief, and aims to explain means–ends coherence by appealing to the requirements of theoretical rationality. I argue that this strategy is unpromising. I instead propose that we look to the constitutive aim of intention. Just as belief has a constitutive aim (truth) that can explain some of the theoretical requirements of consistency and coherence governing beliefs, intention has a constitutive aim (what I call “controlled action”) that can explain some of the requirements of consistency and coherence governing intentions. In particular, I argue that we can understand means–ends coherence by understanding the constitutive aims of both of the attitudes governed by the requirement, intention and belief. In being means–ends incoherent, you are setting yourself up to fail, assuring that you either have a false instrumental belief or your intention won’t issue in action.
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Tatlisumak, Turgut, and Lars Thomassen, eds. Ischaemic Stroke in the Young. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.001.0001.
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Stroke in the young is different, complex, and challenging. This book delivers a comprehensive review of the different aspects of young ischaemic stroke. Incidence, risk factors, and aetiology differ notably from those seen in the elderly. There is an increased prevalence of traditional risk factors already at a young age, but the book also focuses on special risk factors in young stroke patients. In many young stroke patients, aetiology remains unclear. The book outlines an extensive diagnostic workup and a stroke subtype classification adapted for young strokes. Gender differences are prevalent in young stroke. The book describes risk factors that are either unique or more prevalent in women and the importance of treating them aggressively. Stroke symptoms in children are comparable to those in adults, but there is a dramatic bystander delay in diagnosing the stroke. The text therefore also deals with rapid stroke recognition and adaption to the special needs in children. Young stroke patients are under-represented in randomized controlled treatment trials. In the emergency setting, unusual clinical findings and off-label situations may be faced and the decision-making process may be challenging. Recommendations for secondary prevention are also mainly extrapolated from studies in older individuals. The authors extrapolate data and draw conclusions on the acute and prophylactic treatment of young stroke. Prognosis after young stroke is poor. Even minor stroke may have devastating life-long consequences for quality of life, education, and working capacity. The book points to the opportunity for lifelong prevention of vascular events.
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Raghunathan, Karthik, and Andrew Shaw. Crystalloids in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0057.
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‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to crystalloids in critically-ill patients. A revised Starling model describes a central role for the endothelial glycocalyx in determining fluid disposition. This model supports crystalloid utilization in most critical care settings where the endothelial surface layer is disrupted and lower capillary pressures (hypovolaemia) make volume expansion with crystalloids effective, since transvascular filtration decreases, intravascular retention increases and clearance is significantly reduced. There are important negative consequences of both inadequate and excessive crystalloid resuscitation. Precise dosing may be titrated based on functional measures of preload responsiveness like pulse pressure variation or responses to manoeuvres such as passive leg raising. Crystalloids have variable electrolyte concentrations, volumes of distribution, and, consequently variable effects on plasma pH. Choosing balanced crystalloid solutions for resuscitation may be potentially advantageous versus ‘normal’ (isotonic, 0.9%) saline solutions. When used as the primary fluid for resuscitation, saline solutions may have adverse effects in critically-ill patients secondary to a reduction in the strong ion difference and hyperchloraemic, metabolic acidosis. Significant negative effects on immune and renal function may result as well.
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Sanetti, Lisa, Melissa A. Collier-Meek, and Lindsay Fallon. Fidelity with Flexibility. Edited by Sara Maltzman. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199739134.013.25.
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Research has linked the use of evidence-supported treatments to effective, efficient therapeutic outcomes. Questions related to the best way to disseminate and implement evidence-supported treatments in the field has led to discussions about transportability of treatments from controlled to applied settings. Specifically, scholars have focused on issues related to treatment fidelity, acceptability, and adoption versus adaptation of evidence-based treatments in practice. Treatment fidelity, a multidimensional construct, pertains to how extensively a treatment is delivered to a client, and it may be affected by several variables. Although the relationship is complex, treatment fidelity is considered an important moderator of client outcomes. Furthermore, the acceptability of a treatment appears to be of importance. Simply, if a treatment is perceived to be acceptable, it is more likely to be implemented with high levels of fidelity, increasing the chances that successful therapeutic outcomes will result. Nevertheless data indicate that some clinicians are wary of using evidence-supported treatments; their chief concern is feasibility of implementation, which could affect treatment fidelity and acceptability. Thus, there is a debate about whether evidence-supported treatments should be adopted strictly as developed or whether they might be adapted to improve implementation and acceptability. In adaptation of a treatment, relevant clinician variables (e.g., training received, availability of resources) and client factors (e.g., cultural fit) might be considered to promote therapeutic outcomes. This chapter describes how the key to treatment success may be to strike a balance between fidelity and adaptation of evidence-based treatments and fidelity with flexibility.
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Simpson, A., E. Aarons, and R. Hewson. Marburg and Ebola viruses. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0038.
Full textAbstract:
Infection with Marburg and Ebola viruses cause haemorrhagic fevers that are characterized by organ malfunction, bleeding complications, and high mortality. The viruses are members of the family Filoviridae, a group of membrane-enveloped filamentous RNA viruses. Five distinct species of the genus Ebolavirus have been reported; the genus Marburgvirus contains only one species. Both Marburg and Ebola virus diseases are zoonotic infections whose primary hosts are thought to be bats. The initial human infection is acquired from wildlife and subsequent person-to-person spread propagates the outbreak until it is brought under control. Ebola and Marburg viruses are classified as hazard or risk group 4 pathogens because of the very high case fatality rates observed for Ebola and Marburg virus diseases, the frequency of person-to-person transmission and community spread, and the lack of an approved vaccine or antiviral therapy. This mandates that infectious materials are handled and studied in maximum containment laboratory facilities. Epidemics have occurred sporadically since the discovery of Marburg in 1967 and Ebola virus in 1976. While some of these outbreaks have been relatively large, infecting a few hundreds of individuals, they have generally occurred in rural settings and have been controlled relatively easily. However, the 2013–2016 epidemic of Ebola virus disease in West Africa was different, representing the first emergence of the Zaire species of Ebola in a high-density urban location. Consequently, this has been the largest recorded filovirus outbreak in both the number of people infected and the range of geographical spread. Many of the reported and confirmed cases were among people living in high-density and impoverished urban environments. The chapter summarizes the most up-to-date taxonomic status of the family Filoviridae. It focuses on Marburg and Ebola viruses in a historical context, culminating in the 2013–2016 outbreak of Ebola virus in West Africa. Virus biology of the most well-studied member is described, with details of the viral genome and the protein machinery necessary to propagate viruses at the molecular and cellular level. This information is used to build a wider-scale virus–host perspective with detail on the pathology and pathogenesis of Ebola virus disease. The consequences of cell infection are examined, together with our current understanding of the immune response to Ebola virus, leading to a broader description of the clinical features of disease. The chapter closes by drawing information together in a section on diagnosis, ecology, prevention, and control.