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1
Phūangbāngphō, Suphak. Rāingān kānwičhai rư̄ang kāntrūatsō̜p hā ʻēnsai klaikhō̜sidēt nai malet phư̄t čhamphūak pǣng =: Screening of glycosidases in starch containing seeds. [Phitsanulok]: Phāk Wichā Chīwakhēmī, Khana Witthayāsāt, Mahāwitthayālai Narēsūan, 1995.
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Schröder, Fritz H. Screening for prostate cancer. Edited by James W. F. Catto. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0062.
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Screening for a disease must be clearly defined and differentiated from early detection. ‘Screening’ refers to the application of tests to the whole population or to defined segments such as males within certain defined high risk age groups. If applied in such a fashion ‘screening’ for prostate cancer may also be described epidemiologically as ‘secondary prevention’. While high-quality randomized studies show that screening reduces prostate cancer mortality by 21–44%, there is wide agreement that the introduction of population-based screening is at present premature because harms, mainly the high rate of overdiagnosis seen currently outweighs the benefits. This chapter attempts to put current knowledge into perspective with a set of recognized prerequirements for the application of screening, established by Wilson and Jungner in 1968.
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Safran, Meredith, ed. Screening the Golden Ages of the Classical Tradition. Edinburgh University Press, 2018. http://dx.doi.org/10.3366/edinburgh/9781474440844.001.0001.
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Screening the Golden Ages of the Classical Tradition explores how films and television programs have engaged with one of the most powerful myths in the Western classical tradition: that humans once lived under ideal conditions, as defined by proximity to the divine. We feel nostalgia for this imagined origin, regret at being born too late to enjoy it, and worry over why we lost it. We seek to recover that “golden age” by religious piety—or, by technological innovation, try to create our own utopia. The breach between this imagined world and lived reality renders these mythical constructs as powerful political tools. For the “golden age” concept influences how participants in the Western classical tradition view our own times by comparison, as an “iron age” whose degradation we lament and wish to escape. This “golden age” complex has manifested in the world-building activities of ancient Greek and Roman texts, from Hesiod to Suetonius, and in modernity’s hagiographic memory of certain historical societies: Periclean Athens, Thermopylae-era Sparta, and Augustan Rome. These fourteen collected essays discuss how golden age themes animate screen texts ranging from prestige projects like Gladiator and HBO’s Rome, to cult classics like Xanadu and Hercules: The Legendary Journeys, to films made by auteurs including Jules Dassin’s Phaedra and the Coen Brothers’ O Brother, Where Art Thou? Essays also examine the classical “golden age” tradition in fantasy (Game of Thrones), science fiction (Serenity), horror (The Walking Dead), war/combat (the 300 franchise, Centurion, The Eagle), and the American Western.
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Phillips, Katharine A. Assessment of Body Dysmorphic Disorder : Screening, Diagnosis, Severity, and Insight. Edited by Katharine A. Phillips. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190254131.003.0017.
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This chapter discusses assessment of body dysmorphic disorder (BDD), including diagnosis and screening as well as potential diagnostic pitfalls and how to avoid them. Measures used to screen for BDD, diagnose BDD, and assess BDD severity and BDD-related insight are reviewed, and guidelines for their use are provided. This chapter also discusses assessment of BDD in children and adolescents and assessment of patients who seek cosmetic procedures (such as surgery or dermatologic treatment) for appearance concerns. Because BDD is common, often severe, and usually missed in clinical settings, clinicians and researchers should routinely screen for BDD. Screening is especially recommended in mental health, substance abuse, dermatology, cosmetic surgery, and other cosmetic treatment settings. It is also important to screen for BDD when patients manifest clues suggesting a possible diagnosis of BDD (e.g., BDD rituals, camouflaging of disliked body areas, and social anxiety or avoidance).
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Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Gastrointestinal polyposis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0031.
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Hamartoms 220Adenomas 221Hyperplastic polyps 221Inflammatory polyps 222Polyps generally present with painless rectal bleeding or through genetic screening of affected families with polyposis syndromes. There are various types, as listed in Table 31.1. Juvenile polyps (hamartomas) are the most commonly seen and generally benign....
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Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Coeliac disease. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0033.
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Who to investigate 234How to investigate 236Diagnosis 238Treatment 240Follow-up and support 242Coeliac disease is an immune-mediated enteropathy caused by a permanent sensitivity to gluten which is present in wheat, barley, and rye. It occurs in genetically susceptible children and adults. The classical presentation is with chronic diarrhoea, abdominal distension, and failure to thrive. The widespread availability of antibody screening has considerably changed the clinical spectrum of cases seen. The testing of children with less classical symptoms and screening of children at high risk has brought increasing recognition of the varied presentation and increased prevalence of this now very common condition....
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Freer, Phoebe E. Skin Calcifications. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0049.
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Dermal and epidermal calcifications in the breast are extremely common and are typically benign, of no clinical significance, and are unrelated to breast cancer. If the radiologist attempts to do a mammographically guided needle localization for surgical excisional biopsy of calcifications that are not recognized to be in the dermis, it is possible that the patient may proceed to surgical biopsy with no calcifications seen in the excised specimen. Therefore, it is important to recognize dermal calcifications as such at the time of screening or diagnostic imaging. This chapter reviews the key imaging and clinical features of skin calcifications that may be encountered either incidentally on breast imaging or on diagnostic imaging when a patient has been recalled from screening for grouped calcifications. Topics discussed include obtaining tangent views to accurately diagnose skin calcifications, as well as how to recognize calcifications on tomosynthesis.
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Prince, Erin L., and Heidi R. Umphrey. Multiple Circumscribed Masses. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0019.
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A circumscribed mass is a mass with margins demonstrating a sharp demarcation between the lesion and surrounding tissue. On mammography, at least 75% of the margin must be well defined in order for the mass to qualify as circumscribed. Multiple circumscribed masses may be seen unilaterally or bilaterally and can be seen on up to 1.7% of screening mammograms. After mammography, these masses may need to be further evaluated with ultrasound and correlated with clinical information. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple circumscribed masses. Topics discussed include cysts, fibroadenomas, oil cysts, metastases, lymph nodes, and neurofibromas.
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Loving, Vilert A. Pre-Operative Localization. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0059.
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Non-palpable, surgical breast lesions require image guidance to direct the site of excision. With the widespread adoption of screening mammography and increased identification of non-palpable breast cancers, image guidance is critical to support the surgeon in successful breast-conserving surgery. Pre-operative localization procedures are typically performed under mammography guidance or ultrasound guidance, and less commonly under magnetic resonance imaging (MRI) guidance. This chapter, appearing in the section on interventions and surgical changes, reviews protocols and pitfalls, pre-/peri-/post-procedure clinical management, and imaging follow-up of pre-operative localization procedures. Topics discussed include mammography-guided, ultrasound-guided, and MRI-guided localization procedures. This chapter also introduces the radioactive seed and radiofrequency identification localization procedures and discusses post-operative specimen radiographs.
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McShane, Tony, Peter Clayton, Michael Donaghy, and Robert Surtees. Neurometabolic disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0213.
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Various disorders result from genetically determined abnormalities of enzymes, the metabolic consequences of which affect the development or functioning of the nervous system. The range of metabolic disturbances is wide, as is the resultant range of clinical syndromes. Although most occur in children, some can present in adult life, and increasing numbers of affected children survive into adult life. In some, specific treatments are possible or are being developed. The last 20 years has seen a considerable expansion in our understanding of the genetic and metabolic basis for many neurological conditions. Particular clinical presentations of neurometabolic disorders include ataxias, movement disorders, childhood epilepsies, or peripheral neuropathy. Detailed coverage of the entire range of inherited metabolic diseases of the nervous system is available in other texts (Brett 1997; Scriver et al. 2001; Menkes et al. 2005).Treatment is possible for some metabolic diseases. For instance, the devastating neurological effects of phenylketonuria have been recognized for many years. Neonatal screening for this disorder and dietary modification in the developed world has removed phenylketonuria from the list of important causes of serious neurological disability in children. This success has led to new challenges in the management of the adult with phenylketonuria and unexpected and devastating effect of the disorder on the unborn child of an untreated Phenylketonuria mother. More recently Biotinidase deficiency has been recognized as an important and easily treatable cause of serious neurological disease usually presenting with early onset drug resistant seizures. This and some other neurometabolic diseases can be identified on neonatal blood screening although a full range of screening is not yet routine in the United Kingdom. More disorders are likely to be picked up at an earlier asymptomatic stage as the sophistication of screening tests increases (Wilcken et al. 2003; Bodamer et al. 2007).Although individual metabolic disorders are rare, collectively such disorders are relatively common. In reality most clinicians will see an individual condition only rarely in a career. Furthermore, patients with certain rare conditions are often concentrated in specialist referral centres, further reducing the exposure of general and paediatric neurologists to these disorders. A recent study into progressive intellectual and neurological deterioration, PIND, gives some information about the relative frequency and distribution of some childhood neurodegenerative diseases in the United Kingdom (Verity et al. 2000; Devereux et al. 2004). Although primarily designed to identify any childhood cases of variant Creutzfeldt- Jakob disease, the study also provided much information about the distribution of neurometabolic disease in children in the United Kingdom. The commonest five causes of progressive intellectual and neurological deterioration over 5 years were Sanfilippo syndrome, 41 cases, adrenoleukodystrophy, 32 cases, late infantile neuronal ceroid lipofuschinosis, 32 cases, mitochondrial cytopathy, 30 cases, and Rett syndrome, 29 cases. Notably, geographical foci of these disorders were also found and correlate with high rate of consanguinity in some local populations.
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Hoyles, Rachel K., and Athol U. Wells. Respiratory system. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0020.
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Pulmonary involvement is common in the connective tissue diseases (CTDs) and is associated with significant morbidity and mortality. Improved management of systemic disease has led to increasing numbers of surviving patients with clinically significant pulmonary disease. Screening for pulmonary complications highlights the frequency of subclinical involvement. In this chapter, the pulmonary manifestations of the more common CTDs are detailed, including rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), polymyositis/dermatomyositis (PM/DM), Sjögren's syndrome (SS), and, more briefly, ankylosing spondylitis (AS). A broad spectrum of pulmonary disorders are seen in association with the CTDs or the drugs used to treat the underlying disorder, including interstitial lung disease, pulmonary infections, airways disease, pulmonary nodules, pleural disease, chest wall pathology and pulmonary vascular disease; the discussion is stratified by pulmonary complication. In many cases, two or more pulmonary manifestations of CTD coexist or there are other concurrent diseases such as asthma and lung cancer, resulting in potentially confusing mixed imaging and pulmonary function abnormalities. This chapter presents a comprehensive approach to the investigation, screening, prognostic evaluation, and treatment decisions in pulmonary disease associated with the CTDs.
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Thomson, C. Claire. A Free Hand: The Art Film versus the Art of Documentary. Edinburgh University Press, 2018. http://dx.doi.org/10.3366/edinburgh/9781474424134.003.0009.
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This chapter focuses on the short art film, a genre which emerged around 1950 to mediate the visual and plastic arts, often for international exchange. Danish films about national cultural heritage and the applied arts were the focus for state-sponsored film. These often circulated very widely: the production and distribution of Shaped by Danish Hands (Hagen Hasselbalch, 1948) and Thorvaldsen (Carl Th. Dreyer, 1949) are detailed as examples of Danish films seen by millions of international viewers. The chapter also highlights the artistry of the informational filmmakers themselves, as institutional practice: the principle that the director should have a ‘free hand’ to interpret the brief. An example of an alternative circuit for the screening of art films in Denmark is detailed: art film screening series at Thorvaldsen’s Museum. Debate about the extent to which state-sponsored filmmaking should pursue art and to what extent documentary itself was an art form marks the late 1950s, as changes in leadership and funding shift practice and priorities within Dansk Kulturfilm. The chapter ends with a discussion of one of the agency’s final productions, Herning 65, which captures a site-specific artwork in a factory in the town of Herning.
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Waldek, Stephen. Fabry disease. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0337.
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Fabry disease is a rare X-linked lysosomal storage disorder in which deficiency of alpha-galactosidase A leads to accumulation of substrate, mostly globotriaosylceramide, which causes a progressive, multiorgan disease affecting predominantly the kidneys, skin, heart, and nervous system. Painful peripheral (‘acral’) neuropathy is characteristic.Key clinical signs are angiokeratoma found by close examination of skin; characteristic eye lesions may be seen; lipid deposits may be seen in urine. Renal biopsy appearances are characteristic and this is commonly where the diagnosis is first made. Increasingly, cardiologists are suspecting the condition in adults with echocardiographic appearances of left ventricular hypertrophy. Diagnosis in men is usually made by measurement of alpha-galactosidase in either white cells or plasma (or using blood spots). Unfortunately, many female patients can have normal enzyme levels so that genetic testing is the only way to confirm a diagnosis. Non-selective screening strategies (e.g. males on renal replacement therapy with uncertain renal diagnoses) have had low yields.
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McClellan, Moana, and Ian Davies. The thin ice of simplicity in environmental and conservation assessments. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198808978.003.0002.
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This chapter asks whether environmental and human health are well served by the creation and use of simple indices, such as the California Communities Environmental Health Screening Tool and the Environmental Performance Index. Reducing vast complexity to a single number offers the possibility of helping to communicate complex science to the public and to decision-makers. Indices are appealing because they are quantitative, have the appearance of being data-based, and seem objective. However, the biases and potential errors inherent in simplifying multidimensional data can result in misleading or incorrect conclusions. This chapter details some problems inherent to environmental indices, examines how these issues have led wellintentioned studies astray, and offers solutions to navigate the indices landscape.
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Guglielmi, Valeria, Judith Souget, Wouter van Elzelingen, Ingo Willuhn, and Nienke Vulink. Influence of Sex Hormones on OCD. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0027.
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OCD symptoms often seem to correlate with hormonal changes. For example, onset during puberty or in the postpartum period is common, and some female patients report monthly fluctuations in their symptoms. This chapter reviews available evidence about the interaction between the sex hormones estrogen, progesterone, and testosterone, and the neuropeptide oxytocin, and the initiation, amelioration, or exacerbation of OCD symptoms. Human studies as well as animal studies are reviewed. Furthermore, suggestions for clinical practice are provided, including: patient education, screening and treatment of perinatal OCD, cognitive behavioral therapy, and pharmacotherapy. The chapter concludes with suggestions on future research into the onset and exacerbation of OCD in women relative to reproductive cycle events.
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Patel, Nilay, David Cranston, and Mark Sullivan. The aetiology, epidemiology, clinical features, and investigation of kidney cancer. Edited by James W. F. Catto. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0083.
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Over 270,000 patients worldwide are diagnosed with renal cancer every year. It is the most lethal of all urological malignancies, with 33–44% of patients dying as a result of the disease. The past three decades has seen the incidence of renal cancer increasing by approximately 2% per year. This increased incidence has predominantly been within localized tumours, detected incidentally due to the increased use of cross-sectional imaging in medical practice. Despite an increase in the number of patients undergoing surgery for renal cancer, mortality rates have continued to rise. There is some evidence to suggest this may be a consequence of the overdiagnosis and overtreatment of small renal masses. At present, there is no justification for national screening programmes for renal cancer.
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Horvath, Laura J. Reduction Mammoplasty. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0061.
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Reduction mammoplasty is a surgical procedure performed to decrease breast size. Breast parenchyma and skin are resected, and the nipple is repositioned to a more superior location on the smaller breast mound. The goals of the procedure are to alleviate a variety of physical and psychological complaints. Because women with a history of reduction surgery are commonly seen for screening mammography and other breast imaging studies, it is important to be aware of the normal post-operative appearance. This chapter, appearing in the section on intervention and surgical change, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for reduction mammoplasty. Topics discussed include clinical indications, surgical technique, and benign post-operative changes, including scars, oil cysts, fat necrosis, and calcifications.
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Sullivan, Maria, and Frances Levin, eds. Addiction in the Older Patient. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.001.0001.
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Addictive disorders in older adults are underdiagnosed and undertreated. An important reason for this lack of recognition of a serious health problem is a paucity of clinical knowledge about how such disorders present in this population. The presentation for alcohol and substance use disorders in the elderly can be confusing, given the metabolic changes and concurrent conditions associated with aging, together with interactions between alcohol and prescribed psychoactive drugs. Further, screening instruments have not been validated for this population. Brief interventions may be effective but should take into account contextual needs such as medical conditions, cognitive decline, and mobility limitations. Treatment strategies, including detoxification regimens, need to be modified for older patients and - in the case of opioid dependence - must address the management of chronic pain in this population. Ironically, benzodiazepines are the most frequently prescribed psychoactive medication in the elderly, despite older individuals' greater sensitivity to side effects and toxicity. Older women are at particularly heightened vulnerability for iatrogenic dependence on sedatives and hypnotics. More clinical research data are needed to inform screening and referral strategies, behavioral therapies, and pharmacological treatment. At the same time, emerging technologies such as communication tools and monitoring devices offer important opportunities to advance addiction treatment and recovery management in older adults. Although research to date has been limited in this population, recent data suggest that treatment outcomes are equal or better to those seen in younger cohorts.
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Freer, Phoebe E. Skin Lesions. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0050.
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Skin lesions are commonly seen on breast imaging. Often, a raised skin lesion is encountered incidentally during screening mammography and can be mistaken for a mass within the breast parenchyma. In most cases, lesions confined within the dermis are benign. Occasionally, focal skin involvement may be the presenting sign of a breast cancer that is either locally extensive to the skin or has an inflammatory component. This chapter reviews the key imaging and clinical features of skin lesions that may be encountered either incidentally on breast imaging or on diagnostic imaging as an area of patient concern. Imaging features of skin lesions, the differential diagnoses, and further management will be reviewed. Topics discussed include benign epithelial cysts (i.e., sebaceous cyst and epidermal inclusion cysts), seborrheic keratosis, keloid and dermal nevi, cellulitis, and inflammatory and locally advanced breast cancers.
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Allen, Shelley J. Pathophysiology of Alzheimer’s disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198779803.003.0002.
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We now know that the onset of the pathological processes leading to Alzheimer’s disease (AD) may be 15–20 years before symptoms appear. This focuses attention on synaptic changes and the early role of tau, and less on the hallmark amyloid plaques (Aβ) and neurofibrillary tau tangles. Sensitive biomarkers to allow early screening will be essential. Familial autosomal AD is the result of mutations in one of three genes (APP, PSEN1, or PSEN2), each directly related to increased Aβ, and informs pathological mechanisms in common sporadic cases, but are also subject to influence by many risk genes and environmental factors. The essential role of apolipoprotein E in neuronal repair and Aβ clearance provides a therapeutic target but also a challenge in carriers of the risk gene APOE4. Current treatments are symptomatic, derived from neurotransmitter deficits seen; particularly cholinergic, but emerging data suggest alternative targets which may prove more productive.
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van Spronsen, Francjan J., and Robin H. Lachmann. Phenylketonuria and Hyperphenylalaninemia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0012.
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Phenylketonuria (PKU) is the prototype treatable genetic disorder and most advanced countries have been performing newborn screening for more than 40 years. Institution of a low-protein diet early in life can reduce the concentration of phenylalanine in the blood and the brain, and prevent the severe learning and behavioral difficulties that were historically associated with PKU. Interestingly, as the brain matures it becomes resistant to the toxic effects of phenylalanine. The effects of high phenylalanine levels on the adult brain are a subject of active research, but, unlike the effects on IQ seen in the first decade of life, they appear to be reversible. The most important effect of high phenylalanine levels in adults is teratogenicity, and in many ways the maternal PKU syndrome is a more devastating disease than PKU itself. Fortunately, maternal PKU syndrome is preventable if women with PKU maintain strict control of phenylalanine levels throughout pregnancy.
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Kulkarni, Kunal, James Harrison, Mohamed Baguneid, and Bernard Prendergast, eds. Geriatric medicine. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198729426.003.0010.
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Geriatric medicine is a complex specialty often complicated by factors such as multiple causation, chronic fluctuating course, and attendant functional and social factors. Such complex aetiology mandates multifactorial assessments and multifactorial interventions. Not all older people need the skills of a specialist geriatric team, but appropriate skills must either be embedded within systems managing older people, or else effective screening tools developed that enable non-specialists to recognize patients who benefit from more specialist assessment. Older people, as a group, face the greatest burden of disease and stand to benefit most from quality research—yet there is less of it. Determining the effect of complex interventions on heterogeneous populations afflicted by complex disease is inherently difficult and is made more so by high fatality, difficult follow-up, and cognitive impairment. Such patients are routinely excluded from trials that seek answers to simpler—but less common and less important—clinical questions.
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Brown, David W. G. Herpes B virus (Cercopithecine Herpes 1). Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0036.
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Herpes B virus or Cercopithecine herpes 1 as it is formally classified causes a persistent infection of monkeys of the Macaca genus. In monkey colonies and social groups, it is transmitted by close contact and sexually. Human infection is rare with less than 50 human cases described it has been seen in monkey handlers exposed to infected monkeys following bites, scratches and abraded skin. Infection has also been recognized in two cases following exposure through laboratory work. Following an incubation period of 9-59 days typically an ascending encephalomyelitis develops which is fatal in 80% of cases. Prevention and control of the risk of B virus is based on avoiding direct contact with infected animals by screening, following handling guidelines for monkeys used in biomedical research and rigorous laboratory safety precautions. Treatment with acyclovir has been successful and halved mortality in recent cases. It is also recommended for prophylaxis in potential exposures.
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Coates, Laura C., and Philip S. Helliwell. Psoriatic arthritis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0114.
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Psoriasis is a chronic skin condition affecting about 3% of Europeans and North Americans. About 15% of people afflicted with psoriasis will develop psoriatic arthritis—cutaneous risk factors for this are psoriasis of the nails, scalp, and flexures. Since most cases of arthritis develop in people with psoriasis, new screening tools, both clinical and imaging, are available. Some genetic factors may also explain susceptibility and severity. Historically, five clinical subgroups have been described but these may be simplified to axial and peripheral involvement, the latter dividing into oligo- and polyarticular patterns. The importance of these clinical subdivisions is still under debate and research but it is clear that there is marked heterogeneity in all manifestations of this disease. In recent times the importance of extra-articular features has gained prominence such that the metabolic syndrome and cardiovascular morbidity are now seen as important features of 'psoriatic disease'. The diverse changes seen in bone on imaging reflect both the underlying pathogenic mechanisms and the ways in which the disease progresses. Recent work with animal models and immunohistochemistry has further advanced our understanding of these features. In the biologic era renewed interest in psoriatic arthritis has stimulated research into outcome assessment and permitted clearer understanding of how these new drugs work on the different aspects of the disease. In addition, improved recognition of the impact of the disease on the person has stimulated the development of new patient-reported outcome tools.
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Coates, Laura C., and Philip S. Helliwell. Psoriatic arthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0114_update_003.
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Psoriasis is a chronic skin condition affecting about 3% of Europeans and North Americans. About 15% of people afflicted with psoriasis will develop psoriatic arthritis—cutaneous risk factors for this are psoriasis of the nails, scalp, and flexures. Since most cases of arthritis develop in people with psoriasis, new screening tools, both clinical and imaging, are available. Some genetic factors may also explain susceptibility and severity. Historically, five clinical subgroups have been described but these may be simplified to axial and peripheral involvement, the latter dividing into oligo- and polyarticular patterns. The importance of these clinical subdivisions is still under debate and research but it is clear that there is marked heterogeneity in all manifestations of this disease. In recent times the importance of extra-articular features has gained prominence such that the metabolic syndrome and cardiovascular morbidity are now seen as important features of ’psoriatic disease’. The diverse changes seen in bone on imaging reflect both the underlying pathogenic mechanisms and the ways in which the disease progresses. Recent work with animal models and immunohistochemistry has further advanced our understanding of these features. In the biologic era renewed interest in psoriatic arthritis has stimulated research into outcome assessment and permitted clearer understanding of how these new drugs work on the different aspects of the disease. In addition, improved recognition of the impact of the disease on the person has stimulated the development of new patient-reported outcome tools.
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Nava, Stefano, and Luca Fasano. Ventilator Liberation Strategies. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0039.
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The weaning process should ideally begin as soon as the patient is intubated and continue through the treatment of the cause inducing acute respiratory failure. Weaning includes the assessment of readiness to extubate, extubation, and post-extubation monitoring; it also includes consideration of non-invasive ventilation which has been shown to reduce the duration of invasive mechanical ventilation in selected patients. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation and should be achieved rapidly, since prolonged mechanical ventilation is associated with increased risk of complications and mortality and with increased costs. During mechanical ventilation, medical management should seek to correct the imbalance between respiratory load and ventilatory capacity (reducing the respiratory and cardiac workload, improving gas exchange and the ventilatory pump power). Ventilator settings delivering partial ventilatory pump support may help prevent ventilator-induced respiratory muscles dysfunction. Daily interruption of sedation has been associated with earlier extubation. Critically ill patients should be repeatedly and carefully screened for readiness to wean and readiness to extubate, and objective screening variables should be fully integrated in clinical decision making.
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Rodríguez-Iturbe, Bernardo, and Mark Haas. Post-streptococcal glomerulonephritis. Edited by Neil Turner. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0077_update_001.
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Post-streptococcal glomerulonephritis is a complication of Streptococcal infections that is responsible for classic acute nephritic syndrome, mostly seen in children. This is an acute nephritis associated with prominent fluid retention and oedema, hypertension and haematuria. Serum complement levels are diagnostically helpful as C3 levels are characteristically very low. However, many cases are much less severe and may pass unrecognized, only being identified by screening for dipstick haematuria. In children recovery is the rule but in adults, often with comorbid conditions, the prognosis is significantly worse. Management centres on loop diuretics plus treatment of the infection if still present, and additional hypotensive agents if required. Severe cases may require dialysis. High-dose corticosteroids have often been given in severe crescentic disease but there is no evidence that they are effective. In children, recovery of renal function is often excellent, though long-term studies now suggest that it may represent a risk factor for the development of chronic kidney disease. When it occurs in developed societies it is often in older patients with comorbid conditions and atypical presentations. Resolution may be less complete than in children.
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Roessler, Philip, and Harry Verhoeven. Back Against the Wall. Oxford University Press, 2017. http://dx.doi.org/10.1093/acprof:oso/9780190611354.003.0010.
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Through the testimonies of civil administrators and security hawks, this chapter demonstrates the repatriation of nearly a million Rwandans from the camps was not the exorcism Paul Kagame had hoped for, but rather how the opposite was true. The failure to organize screening at the border meant that within months of the return of the refugees the RPF had to confront an insurgency that engulfed the country. With thousands of soldiers deployed in Congo, it could barely stave off the existential menace of the resurgent génocidaires. This context informed how the RPF responded to Kabila’s Katangization. For Kigali, its shrinking influence in Kinshasa was a disaster, as it came just when Kabarebe needed his authority as chief of staff to send Congolese troops to destroy the resurfaced rear bases of the génocidaires in North and South Kivu. The actual divorce was accelerated when intelligence reports began showing the unthinkable was happening: in Kabila’s attempts at escaping Kabarebe’s embrace, his advisors forged links with the génocidaires and supplied them with weapons. This was a point of no return in the security dilemma facing the liberation coalition. Paul Kagame gave the green light to proceed with a regime change strategy in Congo.
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McDermott, Barbara E. Developmental disabilities. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0052.
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While the purpose of the correctional system is multi-faceted, including punishment and removal of the offender from society, one component is rehabilitation. With no offender does this seem more relevant than those with developmental disabilities. Although the research is inconsistent, most studies suggest that offenders with developmental delays commit less serious offenses, yet serve more time in prison than offenders without such delays. Opinions are mixed on whether appropriate services for such individuals should be provided on specialized units. Proponents of this approach cite the vulnerabilities of these offenders. However, all agree that specialized services must include appropriate assessment that takes into account culture and individualized approaches to habilitation. It cannot be presumed that services designed for the individual with mental illness will be appropriate for inmates with developmental disabilities. Little research has been conducted on the efficacy of specialized services for offenders with developmental disabilities. As such, correctional facilities must necessarily take guidance from research based on non-offender samples. An active collaboration between departments of corrections and agencies providing services for individuals with developmental disabilities can enhance service delivery and improve the integration of the offender into the community. This chapter outlines the progress that has been made in the identification and habilitation of individuals with developmental disabilities in the criminal justice system. Definitions, legal issues, and prevalence rates will be discussed, as well as the vulnerabilities individuals with developmental delays present to the criminal justice system. Finally, screening, management, and habilitation in corrections arising directly from these vulnerabilities are discussed.
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Diamond, Pamela M. Traumatic brain injury. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0053.
Full textAbstract:
During the past decade, traumatic brain injury (TBI) has become a frequent topic in the media. It has been a decade of expanding awareness, increased research, and growing concern about TBI of all severity levels. Consistent with this increased attention, researchers and policymakers have made strides toward greater understanding of the risks of TBI, the scope and complexity of the symptom profiles seen after TBI, and the types of treatments that optimize recovery. Recent studies have confirmed a 50 to 60% prevalence of TBI among prisoners. Most have experienced multiple injuries and experienced their first TBI in their mid-teens. Routine screening for TBI is rarely done in these settings in spite of there being a number of tested instruments available. The cognitive deficits associated with mild to moderate TBI are often indistinguishable from those associated with many mental illnesses and substance abuse. Etiology is difficult to establish; nevertheless, the common symptom patterns often make adjustment to jail or prison difficult. Educational interventions designed to improve staff knowledge of the prevalence of TBI and frequent symptom patterns are important first steps. Training staff how to modify their behavior and facilitate communication with inmates expressing these symptoms may reduce episodes of misunderstanding and potential aggression. Similarly, current programming may be modified to accommodate the cognitive deficits suffered by inmates with TBI as well as other disorders. This chapter reviews the prevalence of TBI in correctional settings, its impact on co-occurring mental illness and substance use, and opportunities to recognize, intervene, and treat patients with TBI.
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Grant, Warren, and Martin Scott-Brown. Prevention of cancer. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0350.
Full textAbstract:
In the UK, the four commonest cancers—lung cancer, breast cancer, colon cancer, and prostate cancer—result in around 62 000 deaths every year. Although deaths from cancer have fallen in the UK over the last 20 years, the UK still suffers from higher cancer death rates than many other countries in Western Europe. In 1999, the UK government produced a White Paper called Saving Lives: Our Healthier Nation that outlined a national target to reduce the death rate from cancer by at least 20% in people under 75 by 2010. The subsequent NHS Cancer Plan of 2000 designed a framework by which to achieve this target through effective prevention, screening, and treatment programmes as well as restructuring and developing new diagnostic and treatment facilities. But do we know enough about the biology of the development of cancer for government health policies alone to force dramatic changes in survival? The science behind the causes of cancer tells us that its origin lies in acquired or inherited genetic abnormalities. Inherited gene mutation syndromes and exposure to environmental mutagens cause cancer, largely through abnormalities in DNA repair mechanisms, leading to uncontrolled cell proliferation. Although screening those thought to be at highest risk, and regulating exposure to environmental carcinogens such as tobacco or ionizing radiation, have reduced, and will continue to reduce, cancer deaths, there are many other environmental factors that have been shown to increase the population risk of cancer. These will be outlined in this chapter. However, the available evidence is largely from retrospective and cross-sectional population-based studies and therefore limits the ability to apply this knowledge to the risk of the individual patient who may been seen in clinic. Although we may be able to put him or her into a high-, intermediate-, or low-risk category, the question ‘will I get cancer, doc?’ is one that we cannot answer with certainty. The NHS Cancer Plan of 2000, designed to reduce cancer deaths in this country and to bring UK treatment results in line with those other countries in Europe, focuses on preventing malignancy as part of its comprehensive cancer management strategy. It highlights that the rich are less likely to develop cancer, and will survive longer if they are diagnosed than those who live in poverty. This may reflect available treatment options, but is more likely to be related to the lifestyle of those with regular work, as they may be more health aware. The Cancer Plan, however, suggests that relieving poverty may be more labour intensive and less rewarding than encouraging positive risk-reducing behaviour in all members of the population. Eating well can reduce the risk of developing many cancers, particularly of the stomach and bowel. The Cancer Plan outlines the ‘Five-a-Day’ programme which was rolled out in 2002 and encouraged people to eat at least five portions of fruit and vegetables per day. Obese people are also at higher risk of cancers, in particular endometrial cancer. A good diet and regular exercise not only reduce obesity but are also independent risk-reducing factors. Alcohol misuse is thought to be a major risk factor in around 3% of all cancers, with the highest risk for cancers of the mouth and throat. As part of the Cancer Plan, the Department of Health promotes physical activity and general health programmes, as well as alcohol and smoking programmes, particularly in deprived areas. Focusing on these healthy lifestyle points can potentially reduce an individual lifetime risk of all cancers. However, our knowledge of the biology of four cancers in particular has led to the development of specific life-saving interventions. Outlined in this chapter are details regarding ongoing prevention strategies for carcinomas of the lung, the breast, the bowel, and the cervix.
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Schofield, C. J. American trypanosomosis (Chagas disease). Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0050.
Full textAbstract:
American trypanosomosis is due to infection with Trypanosoma cruzi (Protozoa, Kinetoplastidae). This is a widespread parasite of small mammals and marsupials throughout most of the Americas, roughly from the Great Lakes of North America (approx. 42 ° N) to southern Argentina (approx. 46 ° S). It is mainly transmitted by blood-sucking bugs of the subfamily Triatominae (Hemiptera, Reduviidae) which are widespread in the Americas, but rare in the Old World. Except in some research laboratories, and infected immigrants from Latin America, T.cruzi has not been reported from the Old World, although closely-related trypanosome species are commonly found in Old and New World bats.Human infection with T.cruzi is generally known as Chagas disease, taking the name of Brasilian clinician Carlos Justiniano das Chagas who first described it from patients in central Brasil (Chagas 1909). Chagas isolated and described the parasite, correctly deduced most of its life-cycle and clinical symptoms associated with the infection, identified the insect vectors and some of the reservoir hosts, and also trialed initial attempts to control it. He was nominated at least twice for the Nobel prize in medicine (Coutinho and Dias 2000; Lewinsohn 2003).Although difficult to treat, Chagas disease can be controlled by measures to halt transmission, primarily by eliminating domestic populations of the insect vectors, together with serological screening to avoid transmission by blood donation from infected donors. Since 1991, a series of multinational initiatives have used this approach to halt transmission over vast regions of the areas previously endemic for the human infection. Estimated prevalence of the human infection has declined from the 1990 estimate of 16–18 million people infected, to the current estimate of just over 7 million infected (OPS 2006; Schofield & Kabayo 2008). Prevalence is expected to decline further, and control strategies are now being adjusted to develop a sustainable system of disease surveillance, focal vector control, and specific treatment for any new cases (Schofield et al. 2006; WHO 2007). Guidance for diagnosis and treatment is also required for non-endemic countries, where recent years have seen increasing migration from Latin America such that cases of chronic Chagas disease have now been reported from amongst Latin American migrants in Europe, USA and Canada, and Japan, together with some congenital cases and transmission from infected blood donors and by organ transplant.