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1
author, Roberts Rachel 1970, ed. Vital signs for nurses: An introduction to clinical observations. Chichester, West Sussex, UK: Wiley-Blackwell, 2011.
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3
Rao, P. V. Krishna. Comparative study of the marmas. New Delhi: Rashtriya Sanskrit Sansthan, 2007.
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4
Vital Signs 2010: The trends that are shaping our future. Washington, D.C: Worldwatch Institute, 2010.
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5
The verse by the side of the road: The story of the Burma-Shave signs and jingles. New York, N.Y., U.S.A: S. Greene Press/Pelham Books, 1990.
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6
De Sio, Lorenzo, ed. La politica cambia, i valori restano? Una ricerca quantitativa e qualitativa sulla cultura politica in Toscana. Florence: Firenze University Press, 2011. http://dx.doi.org/10.36253/978-88-6655-020-4.
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How do Tuscans see politics? What is their relationship with it? Is there something different from the «red subculture» of the First Republic? Articulated answers to these questions emerge from this research commissioned by the Tuscan Regional Authority and conducted by the Centro Italiano Studi Elettorali with a mixed quantitative and qualitative approach. On the one hand, associative participation – expression of a deeply embedded tradition – is alive and kicking. On the other hand, we can see a decline in political participation, alongside elements of tension in the relation between citizens, parties and institutions. These are the inevitable signs of the great symbolic and organisational changes that have affected the mass parties; they must now address new challenges if they want to maintain the vital dialogue that the Tuscans demand from their political class.
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Reinhard and Florek. Le manuel des runes : Les mots et signes mystérieux qui apportent la connaissance et la force vitale. Médicis Entrelacs, 1994.
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8
Halpern, Ross. Psychosocial Aspects of Pain and Addiction (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0003.
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This chapter addresses the problem of assessing opiate use and psychological comorbidity, and discusses psychological strategies for coping with chronic pain. In 1995, the American Pain Society and others embraced pain as the fifth vital sign; yet pain differs from the other vital signs by being subjective, as opposed to being objectively measured, implying a psychological aspect. Psychological evaluation of a pain patient assesses underlying psychosocial aspects that play a role in reported pain symptoms. Early childhood abuse increases the likelihood of chronic pain later in life; pain may be precipitated by an emotional or physical trauma that reawakens anxiety from the original childhood experience. Precipitating traumas can include divorce, job loss, legal issues, grief, or death anniversaries. The earlier and more extensive the childhood trauma, the earlier and more extensive the physical report of pain in adulthood, and the greater the perceived need for opioid analgesia.
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Stewart, Joseph V. Vital Signs and Resuscitation (Landes Bioscience Medical Handbook (Vademecum)). Landes Bioscience, 2003.
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10
Berber, Stevan. Discrete Communication Systems. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780198860792.001.0001.
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The book present essential theory and practice of the discrete communication systems design, based on the theory of discrete time stochastic processes, and their relation to the existing theory of digital communication systems. Using the notion of stochastic linear time invariant systems, in addition to the orhogonality principles, a general structure of the discrete communication system is constructed in terms of mathematical operators. Based on this structure, the MPSK, MFSK, QAM, OFDM and CDMA systems, using discrete modulation methods, are deduced as special cases. The signals are processed in the time and frequency domain, which requires precise derivatives of their amplitude spectral density functions, correlation functions and related energy and pover spectral densities. The book is self-sufficient, because it uses the unified notation both in the main ten chapters explaining communications systems theory and nine supplementary chapters dealing with the continuous and discrete time signal processing for both the deterministic and stochastic signals. In this context, the indexing of vital signals and finctions makes obvious distinction beteween them. Having in mind the controversial nature of the continuous time white Gaussian noise process, a separate chapter is dedicated to the noise discretisation by introducing notions of noise entropy and trauncated Gaussian density function to avoid limitations in applying the Nyquist criterion. The text of the book is acompained by the solutions of problems for all chapters and a set of deign projects with the defined projects’ topics and tasks and offered solutions.
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Gotman, Kélina. Translatio. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190840419.003.0004.
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Renegade physician Paracelsus compared St. John’s Day dances to earthquakes, epileptic tremors, and tics. This ecosophical and vitalist concept, according to which all sorts of bodies echo one another’s shaking motions, countered long-held academic prejudice against witchcraft; neither choreomaniacs nor witches were subject to supernatural forces. Rather, the ‘vital spirits’ caused limbs, like branches, to shake. What’s more, dancing was now thought to cure dancing, and municipal authorities keen to keep a Strasbourg dancing mania in check employed guards to help wear dancers out—while exorcism associated religious, municipal, and medical experts. The translatio or passage from collective to individual disorder, epitomized in St. Vitus, now patron saint of all dance maniacs, continued throughout the eighteenth and nineteenth centuries, as neurologists’ theories of chorea, epilepsy and insanity aligned popular carousing with individual quaking motions. Choreomania came to signal the epidemic proliferation of what Giorgio Agamben has styled purposeless gesture.
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Dillon, Marta. Vivir con virus. Editorial de la Universidad Nacional de La Plata (EDULP), 2016. http://dx.doi.org/10.35537/10915/91956.
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Este libro empezó a escribirse hace más de veinte años. El punto final del texto que sigue fue puesto hace más de diez. En el medio, la rutina de escribir cada domingo la columna que saldría publicada en el suplemento No, del diario <i>Página/12</i>. Una enorme ternura me envuelve frente a la nueva puesta en papel de esta red de palabras que una vez me salvaron la vida. Ternura por esa que fui, por la ingenuidad que sobrevive entre líneas, por las comas y los puntos que sobran por todos lados, por esa heterosexualidad convencida de la que me fugué con tanto placer. Todo está dicho en las páginas que siguen, conservé el prólogo de la edición original, del año 2004, en honor a esa sucesión de presentes que hilvanan una trayectoria vital. Muchas cosas han cambiado desde entonces, ahora sabemos que los tratamientos para el vih-sida son realmente efectivos, que el estigma se ha morigerado al mismo tiempo que se aplazó la amenaza de muerte y que hasta se puede prescindir de los condones cuando la carga viral permanece indetectable. Otras siguen igual, hay cuerpos que importan y otros que no, quienes mueren por causas relacionadas al vih sida son en su enorme mayoría pobres, personas trans, indi*s, negr*s; excluid*s. Pero no tengo intenciones de hablar sobre sida, aunque ahí está el origen de esta trama.
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Marx, Gernot, and Michael Fries. Acute illness in the postoperative period. Edited by Neil Soni and Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0089.
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As more complex and risky surgical procedures are carried out in industrialized countries, anaesthetists are confronted with higher incidences of acute life-threatening conditions during the perioperative period. This is especially true for older patients with concomitant morbidities. Sepsis, cardiovascular complications including myocardial infarction, pulmonary embolism, and stroke, as well as massive bleeding are among the most severe complications that may arise during any time in the postoperative period starting as early as in the post-anaesthesia care unit. Early identification along with rapid stabilization of vital signs are key to improving outcomes in these patients.
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Jianliang, Wu, ed. Shen ti de jian kang di tu: Yi mu le ran de shen ti jian kang xiao xuan ji. Taibei Shi: Tai shi wen hua shi ye gu fen you xian gong si, 2004.
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15
O’Neal, Jason B., and Andrew Shaw. Introduction to Perioperative Cardiac Urgencies and Emergencies. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0004.
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Cardiac arrest in the perioperative period is distinct from cardiac arrest in other scenarios, given that the event is typically witnessed and real-time vital signs are often being monitored. Additionally, having a mental framework by which to consider and refine the differential diagnosis is paramount, as this then guides the selection of a suitable treatment plan. However, in order to establish the correct diagnosis, one must have an adequate understanding of normal cardiac physiology, of cardiovascular pathology, and the ways in which this may adversely affect cardiac function. This chapter provides an overview of how to approach the patient with cardiovascular instability. Subsequent chapters in this section discuss specific treatment plans for the major life-threatening pathophysiologies one could encounter.
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Dierdorf, Stephen F. Hypocalcemia/Hypercalcemia. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0038.
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Calcium is critical to many vital physiologic functions. These functions include cardiac rhythm and contractility, neuromuscular transmission, and skeletal muscle contractility. 45% of the calcium in the blood is ionized, which is more revalent to the physiologic function of calcium as opposed to the fraction that is bound. Serum ionized calcium levels are closely regulated by the parathyroid gland via calcium-sensing receptors and parathormone secretion. Low or high levels of calcium can result in life-threatening cardiac dysrhythmias and skeletal muscle weakness leading to respiratory failure. The anesthesiologist must be aware of the clinical conditions that place patients at risk for calcium abnormalities. This will allow for early recognition of the signs and symptoms, so that measurements can take place and rapid treatment can be given.
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Luzzi, Joseph. The Task of Italian Romanticism. Edited by Paul Hamilton. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199696383.013.20.
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This chapter revisits the heated controversies over Italian Romanticism to show that they actually represent a vital literarymode. In short, the debates led to the creation of literary masterpieces that carry within themselves the signs of the age’s literary polemics. The public debate about the relation between literary and national identity made authors aware of their political responsibilities toward the yet-to-be-born Italian nation. Foscolo, Leopardi, and Manzoni avoided direct alignment with mainstream Romantic thought, but enjoyed a greater literary and artistic freedom than their more doctrinaire (and less talented) contemporaries. Italy’s isolation from much of European intellectual life gave the nation’s controversies over Romanticism a dramatic, almost desperate air, as the subtext over whether Italy would become ‘Romantic’ was equal to asking whether it could become ‘modern’.
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Medforth, Janet, Linda Ball, Angela Walker, Sue Battersby, and Sarah Stables. Normal labour: first stage. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754787.003.0014.
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This chapter covers the first stage of labour, from onset through to latent and active phases. It describes the physiology and diagnosis of the first stage of labour and gives the definitions of low- and high-risk women. It considers birth in both hospital and home settings and the current recommendations for the place of birth. The basic care and support of low-risk women during both the latent and active first stage of labour are described for both home and hospital settings. Mobility and optimum positions during the first stage, labouring in water, and current guidance regarding maternal nutrition and monitoring vital signs are discussed. Guidance on the assessment of progress by observation, abdominal and vaginal examination, monitoring fetal well-being, and record-keeping on the partogram are also considered.
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Morgan, David. Chance and the Work of Enchantment. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190272111.003.0007.
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One of the most fundamental features of the universe is randomness or chance, even if some religions have sought to deny its existence by attributing every unexpected turn of events to the mystery of divine will. Turning randomness into purpose is one of the primary tasks of enchantment. This chapter explores the history of material devices and ideas about chance from the ancient world to the present. It shows how chance is a vital ingredient in enchantment, whether it is overtly used in casting lots or the random opening of a book, or staunchly denied in the narrative work of resolving the mysteries of providence. The agency of images in the process propels the interpretation of tarot cards or reveals divine will in apparitions. Marks become signs in the practices of enchantment, and images at work make the world go one’s way.
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Thiry, Steven, and Luc Duerloo, eds. Heraldic Hierarchies. Leuven University Press, 2021. http://dx.doi.org/10.11116/9789461663467.
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Early modern heraldry was far from a nostalgic remnant from a feudal past. From the Reformation to the French Revolution, aspiring men seized on these signs to position themselves in a changing society, imbuing heraldic tradition with fresh meaning. Whereas post-medieval developments are all too often described in terms of decadence and stifling formality, recent studies rightly stress the dynamic capacity of bearing arms. Heraldic Hierarchies aims to correct former misconceptions. Contributing authors rethink the influence of shifting notions of nobility on armorial display and expand this topic to heraldry’s share in shaping and contesting status. Moreover, addressing a common thread, the volume explores how emerging states turned the heraldic experience into an instrument of power and policy. Contributing to debates on social and noble identity, Heraldic Hierarchies uncovers a vital and surprising aspect of the pre-modern hierarchical world.
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Obando Cabezas, Lucely, Alonso Tejada Zabaleta, María Ceila Galeano Bautista, Marinella Rivera Escobar, Carolina Piragauta Álvarez, Lina Fernanda Vélez Botero, Jéssica López Peláez, Ángela Patricia Acosta Pulido, and Andrea Valeria Viveros Balanta. Aportes de la psicología en el ámbito hospitalario: la humanización en los servicios de salud como objetivo prioritario. Editorial Universidad Santiago de Cali, 2020. http://dx.doi.org/10.35985/9789585147164.
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En ese sentido, un psicólogo puede ser requerido para intervenir en una sala de visitas a una familia que acaba de recibir la noticia del fallecimiento un ser querido, o para responder a una interconsulta en una sala general de hospitalización, para persuadir ante todos los presentes a un paciente que se niega a que se le realice un procedimiento médico de vital importancia para su salud. Y aún en los casos en que se programa con la debida antelación la atención a una persona, es frecuente observar que el encuadre de atención clínica se desdibuja. Por ejemplo, en algunos casos en que se le debe transmitir a un paciente el resultado positivo que obtuvo en una prueba de VIH/SIDA, el tiempo programado de 20 minutos de atención puede terminar siendo de dos horas ante la percepción en el sujeto de signos clínicos de ideación suicida activados por los resultados de la prueba.
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Schott, Christopher K., and Jessica A. Fozard. Hypotension and Shock (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0008.
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Hypotension is a common cause of rapid response team (RRT) activation. It is critical to be able to rapidly identify the etiology of hypotension. In the setting of a rapid response team call, there is often limited time and information available when first encountering a hypotensive patient. With attention to key elements in the patient’s history of present illness, physical exam, and findings of predominant changes in systolic, diastolic, and pulse pressures, RRTs can rapidly narrow their differential diagnosis. We will discuss the initial evaluation and treatment recommendations based on the etiology of hypotension and shock. Resuscitation should continue until circulatory homeostasis occurs, as guided by a patient’s exam, vital signs, and trends in laboratory values. This chapter provides a framework on how to quickly differentiate between the causes of hypotension or shock when evaluating patients during a rapid response scenario to most accurately guide therapy.
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Borron, Stephen W. Management of cyanide poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0326.
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Acute cyanide poisoning poses vital diagnostic and therapeutic challenges for emergency physicians and intensivists. While it presents certain unique clinical features, cyanide poisoning may be confused with other entities. Definitive, contemporaneous diagnosis at the bedside is impossible in most hospitals. A thorough anamnesis, rapid physical assessment, and evaluation of key laboratory indicators often point the clinician in the right direction. Smoke inhalation from structure fires represents the most frequent source of cyanide poisoning. Symptom onset may be gradual in the case of skin exposures to cyanide or ingestion of compounds that are metabolized to cyanide. However, acute cyanide poisoning presents as a syndrome of rapidly evolving and deteriorating vital signs, profound neurological and cardiovascular dysfunction, and if therapeutic interventions are not timely and adapted, death. There is little time for diagnostic testing: one must act! The sine qua non of treatment is excellent supportive care, with aggressive airway management, support of blood pressure, and correction of acidosis. Treatment of acidosis is particularly relevant in the case of cyanide. Rapid administration of specific cyanide antidotes may be lifesaving. While geographic variations exist in antidote availability, most commercially available antidotes have been demonstrated to be effective. Hydroxocobalamin and sodium thiosulphate, both safe in the setting of smoke inhalation, offer the highest therapeutic index, a critical consideration when the diagnosis is uncertain.
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O'Hara, Alexander. Drinking with Woden. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190857967.003.0011.
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In a widely known passage of the Vita Columbani (I.27), Jonas of Bobbio introduces the god Woden. This is the oldest mention of the deity in a narrative source. In a very brief chronological arc, two further attestations suggest the new significance assumed by the god in the seventh century. This chapter explores the evolving meaning of Woden up to the the Carolingian period. It suggests that Woden and other markers of barbarism and paganism were not a simple reflection of actual barbarism and non-Christian belief. They were part of a wider repertory of signs and habits used by military elites for self-representation. Following the rise and fall of Woden’s suitability for the barbarian aristocracies from the seventh to the ninth centuries, the chapter frames these evolving strategies of representation in the social and political landscape of Europe.
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Hillman, Ken, and Jack Chen. Rapid response teams for the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0003.
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There is a high incidence of potentially preventable deaths and serious adverse events in acute hospitals. Most of these events occur on the general wards of the hospital. The concept of rapid response systems was developed as a way of identifying seriously-ill and at-risk patients in acute hospitals at an early stage in order to improve outcomes. The system has two major components—criteria to define the deteriorating patient linked to a rapid response. The criteria are based on a combination of abnormal vital signs and observations, and the response is based on matching the patient with staff with the appropriate skills. Implementing and evaluating hospital-wide systems present new challenges that are different to our approach to a new drug or procedure. As well as agreeing to the appropriate criteria and response, the system needs leadership and support across the whole hospital, including education programmes and, monitoring with appropriate quality assurance activities. Increasingly, the specialty of intensive care is designed around the needs of the seriously ill, rather than being geographically confined within the four walls of an intensive care unit. The concept of rapid response systems is part of that process.
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Odeberg-Wernerman, Suzanne, and Margareta Mure. Anaesthesia for urological surgery and for robotic surgery in urology and gynaecology. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0062.
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Laparoscopic and robot-assisted laparoscopic surgical procedures are commonly used in both urology and gynaecology. These minimally invasive techniques result in early mobilization and short hospital stay and robot-assisted operations are increasingly favoured by patients and surgeons. A complex physiological response is created by the combined effects of carbon dioxide pneumoperitoneum, elevated intra-abdominal pressure, and sometimes a profound Trendelenburg position. Healthy patients tolerate this situation well, but compromised patients are at risk of developing heart failure, ischaemia, or both. Correct interpretation of vital signs can be challenging in this situation. This chapter gives an overview of the physiology during laparoscopic and robot-assisted laparoscopic surgery and gives recommendations for anaesthesia and monitoring. The field of urology and gynaecology also includes major open surgery as well as transurethral surgery and techniques for the management of urinary tract stones. The anaesthetic management and perioperative care of major open surgery, including the increasingly adopted ‘enhanced recovery after surgery’ concept, are also covered. The syndrome of transurethral resection of the prostate can still place patients at risk despite increased knowledge and improved selection of irrigation fluid.
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Doder, Dusko, and Louise Branson. The Inconvenient Journalist. Cornell University Press, 2021. http://dx.doi.org/10.7591/cornell/9781501759093.001.0001.
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This book describes how one February night crystalized the values and personal risks that shaped the life of the author of this book. The frigid Moscow night in question was in 1984, and the author, a Washington Post correspondent, reported signs that Soviet leader Yuri Andropov had died. The CIA at first dismissed the reporting, saying that “Doder must be smoking pot.” When Soviet authorities confirmed Andropov's death, journalists and intelligence officials questioned how a lone reporter could scoop the multibillion-dollar US spy agency. The stage was set for Cold War-style revenge against the journalist. After emigrating to the United States from Yugoslavia in 1956, the author committed himself to the journalist's mission. He knew that reporting the truth could come at a price, something driven home by his years of covering Soviet dissidents and watching his Washington Post colleagues break the Watergate story. Still, he was not prepared for a cloaked act of reprisal from the CIA. Taking aim at the author, the CIA insinuated a story into Time magazine suggesting that he had been co-opted by the KGB. His professional world collapsed and his personal life was shaken as he fought Time in court. In this book, the author reflects on this attempt to destroy his reputation, his dedication to reporting the truth, and the vital but precarious role of the free press today.
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Macauley, Robert C. Pain and Symptom Management at the End of Life (DRAFT). Edited by Robert C. Macauley. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199313945.003.0007.
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The pendulum of pain treatment has swung from stoic acceptance before the widespread availability of opioids, to embrace of opioids as pain became the “fifth vital sign,” to significant concern in light of the current opioid epidemic. The use of opioids for chronic pain should be differentiated from their use in palliative care, where there still exists significant concern for hastened death when high doses are used (i.e., opiophobia). While clinicians should be familiar with the Rule of Double Effect to justify such use, the rule is not truly needed because of the rarity of respiratory depression when opioids are used appropriately. Appropriate pain treatment is a human right, and as such surrogates should not be able to refuse it based on their own views, and global inequities prompt significant justice concerns.
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Pirani, Tasneem, and Tony Rahman. Diagnosis and management of upper gastrointestinal haemorrhage in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0177.
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Upper gastrointestinal haemorrhage is a medical emergency that may present with haematemesis and/or melena. An exhaustive history and careful examination aids in identifying the cause of bleeding and directing appropriate management. Validated scoring systems exist to guide the urgency of endoscopic therapy, although these should not be used in isolation, but in conjunction with complete patient assessment. The initial priority should be to resuscitate and stabilize the patient using the airway, breathing, circulation, and disability framework. Resuscitation should be guided by clinical and physiological parameters. Patients should be managed in an environment where vital signs such as heart rate, blood pressure, respiratory rate, conscious level, and urine output are monitored at least hourly. Attempts should be made to correct coagulopathy. Specialist advice should be sought from haematologists for guidance on the most appropriate use of packed red cells and blood products. Over-transfusion should be avoided. Initiation of pre-endoscopy proton pump inhibitor therapy, in particular to avoid definitive endoscopic therapy, is not recommended. Diagnostic endoscopy and therapy should be conducted within 24 hours of presentation. Numerous endoscopic therapies exist—when epinephrine is used for local tamponade and vasoconstriction, application of dual modality treatment is recommended. In cases where endoscopic therapy fails or is not possible, radiological diagnosis, and embolization may become necessary. Occasionally, surgery is required for definitive treatment—close liaison with surgeons is therefore necessary, especially where initial endoscopy is considered suboptimal or re-bleeding occurs.
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Mueller, Christian. Acute dyspnoea in the emergency department. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0009.
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Acute dyspnoea is a very common symptom in the acute cardiac care setting. In contrast to current beliefs, acute dyspnoea, as the leading symptom in the emergency department, is associated with about twice the mortality risk, compared to acute chest pain. Rapid and accurate identification of the cause of dyspnoea is critical to the initiation of specific and effective treatment. In most patients, a rapid and accurate diagnosis in the emergency department can be achieved by a combination of vital signs, including pulse oximetry, detailed patient history, physical examination, blood tests (including natriuretic peptides—BNP, NT-proBNP, or MR-proANP), venous blood gases, and C-reactive protein in all patients, and D-dimers in selected patients, electrocardiograms, and chest X-ray. It is key to remember that the prevalence of acute heart failure in unselected patients with acute dyspnoea is about 50%. Therefore, a high awareness for the presence of acute heart failure is mandatory. Acute heart failure, pneumonia, obstructive pulmonary diseases (chronic obstructive pulmonary disease and asthma), pulmonary embolism, and anxiety disorders represent more than 90% of all cases with acute dyspnoea in the emergency department. In about 10–15%, two acute causes (e.g. acute heart failure and pneumonia) may be present and require combined treatment. Transthoracic echocardiography should be immediately performed in all patients with acute dyspnoea and shock, and in those patients in whom the diagnosis remains uncertain, even after initial work-up.
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Mueller, Christian. Acute dyspnoea in the emergency department. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0009_update_001.
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Acute dyspnoea is a very common symptom in the acute cardiac care setting. In contrast to current beliefs, acute dyspnoea, as the leading symptom in the emergency department, is associated with about twice the mortality risk, compared to acute chest pain. Rapid and accurate identification of the cause of dyspnoea is critical to the initiation of specific and effective treatment. In most patients, a rapid and accurate diagnosis in the emergency department can be achieved by a combination of vital signs, including pulse oximetry, detailed patient history, physical examination, blood tests (including natriuretic peptides—BNP, NT-proBNP, or MR-proANP), venous blood gases, and C-reactive protein in all patients, and D-dimers in selected patients, electrocardiograms, chest X-ray, and more recently also lung ultrasound. It is key to remember that the prevalence of acute heart failure in unselected patients with acute dyspnoea is about 50%. Therefore, a high awareness for the presence of acute heart failure is mandatory. Acute heart failure, pneumonia, obstructive pulmonary diseases (chronic obstructive pulmonary disease and asthma), pulmonary embolism, and anxiety disorders represent more than 90% of all cases with acute dyspnoea in the emergency department. In about 10–15%, two acute causes (e.g. acute heart failure and pneumonia) may be present and require combined treatment. Transthoracic echocardiography should be immediately performed in all patients with acute dyspnoea and shock, and in those patients in whom the diagnosis remains uncertain, even after initial work-up.
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Kissane, David W., and Matthew Doolittle. Depression, demoralization, and suicidality. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0173.
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The development of clinical depression is common during palliative care, adversely affects quality of life and adherence to medical treatments, yet regrettably can pass unrecognized. Screening for distress as the sixth vital sign is therefore highly recommended. Demoralization is another form of distress where the apparent pointlessness of continued life may lead to suicidal thinking. As the mental condition deteriorates, co-morbid states of anxiety, depression, and demoralization become more likely. Rates of suicide are increased with advanced cancer and poor symptom control. Fortunately, combined treatment with medication and counselling is effective in ameliorating depression, demoralization, and suicidality. Meta-analyses of psychotherapy trials confirm clear benefits, with behavioural activation, supportive, interpersonal, and cognitive behavioural therapies all making contributions. Group, couple, and family therapies optimize support for all involved. All members of the multidisciplinary team contribute to the active treatment of depression, demoralization, and the prevention of suicide.
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Supp-Montgomerie, Jenna. When the Medium Was the Mission. NYU Press, 2021. http://dx.doi.org/10.18574/nyu/9781479801480.001.0001.
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When the Medium Was the Mission traces the shaping influence of religion—particularly US Protestantism—on network culture through the story of the Atlantic Telegraph Cable of 1858. In the middle of the nineteenth century, this medium was emphatically the mission of Protestant missionaries to “civilize” non-Protestants, public figures who used the telegraph to establish an implicitly Christian national culture, of utopianists who understood this new technology to herald the advent of global and divine accord, and of all the many who passionately believed the cable would connect the world. People acting in the name of religion—from US Protestant missionaries to the Ottoman sultan—spread Samuel Morse’s telegraph machine around the world and linked the telegraph to an emerging discourse of global unity. Christian tropes infused enthusiasm into fantastical public discourse about telegraphs’ capacity to connect, new religious communities in the United States indelibly affiliated networks with promises of perfect harmony, and Protestant-inflected religious affect charged essentially meaningless signals with profound cultural significance. In all of these activities, religion forged imaginaries of networks as connective, so much so that connection now defines networks, despite networks’ regular reliance on disconnection. The book analyzes documentary evidence of US enthusiasm for telegraph infrastructure—including missionary accounts, public speeches, celebratory memorabilia, religious publications, and telegrams—to demonstrate the vital ways religion helped to establish communication networks and produce an abiding sense of what networks are and what they can do.
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Scadding, John. Neuropathic pain. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0386.
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Pain signalled by a normal sensory system, nociceptive pain, serves a vital protective function. The peripheral and central nervous somatosensory systems permit rapid localization and identification of the nature of painful stimuli, prior to appropriate action to minimize or avoid potentially tissue damaging events. A reduction or absence of pain resulting from neurological disease emphasizes the importance of this normal protective function of pain. For example, tissue destruction occurs frequently in peripheral nerve diseases which cause severe sensory loss such as leprosy, and in central disorders such as syringomyelia. Neuropathic pain results from damage to somatosensory pathways and serves no protective function. This chapter provides an overview of neuropathic pain, considering its context, clinical features, pathophysiology, and treatment.In the peripheral nervous system, neuropathic pain is caused by conditions affecting small nerve fibres, and in the central nervous system by lesions of the spinothalamic tract and thalamus, and rarely by subcortical and cortical lesions. The clinical feature common to virtually all conditions leading to the development of neuropathic pain is the perception of pain in an area of sensory impairment, an apparently paradoxical situation. The exception is trigeminal neuralgia.Neuropathic pain is heterogeneous clinically, aetiologically, and pathophysiologically. Within a given diagnostic category, whether defined clinically or aetiologically, there are wide variations in reports of pain by patients. This heterogeneity poses one of the greatest challenges in understanding the mechanisms of neuropathic pain. Knowledge of the pathophysiology is an obvious pre-requisite to the development of effective treatments. The goal of a pathophysiologically based understanding of the symptoms and signs of neuropathic pain is, of course, just such a rational and specific approach to treatment. While this is not yet achievable, clinical-pathophysiological correlations have led to some recent advances in treatment.
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Copeland, B. J., ed. The Essential Turing. Oxford University Press, 2004. http://dx.doi.org/10.1093/oso/9780198250791.001.0001.
Full textAbstract:
Alan Turing was one of the most influential thinkers of the 20th century. In 1935, aged 22, he developed the mathematical theory upon which all subsequent stored-program digital computers are modeled. At the outbreak of hostilities with Germany in September 1939, he joined the Government Codebreaking team at Bletchley Park, Buckinghamshire and played a crucial role in deciphering Engima, the code used by the German armed forces to protect their radio communications. Turing's work on the version of Enigma used by the German navy was vital to the battle for supremacy in the North Atlantic. He also contributed to the attack on the cyphers known as "Fish," which were used by the German High Command for the encryption of signals during the latter part of the war. His contribution helped to shorten the war in Europe by an estimated two years. After the war, his theoretical work led to the development of Britain's first computers at the National Physical Laboratory and the Royal Society Computing Machine Laboratory at Manchester University. Turing was also a founding father of modern cognitive science, theorizing that the cortex at birth is an "unorganized machine" which through "training" becomes organized "into a universal machine or something like it." He went on to develop the use of computers to model biological growth, launching the discipline now referred to as Artificial Life. The papers in this book are the key works for understanding Turing's phenomenal contribution across all these fields. The collection includes Turing's declassified wartime "Treatise on the Enigma"; letters from Turing to Churchill and to codebreakers; lectures, papers, and broadcasts which opened up the concept of AI and its implications; and the paper which formed the genesis of the investigation of Artifical Life.
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Arena, Ross, Dejana Popovic, Marco Guazzi, Amy McNeil, and Michael Sagner. Cardiovascular response to exercise. Edited by Guido Grassi. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0026.
Full textAbstract:
The body’s response to an exertional stimulus, if performed adequately to meet the imposed demand, is an orchestrated response predominantly among the cardiovascular, pulmonary, and skeletal systems. These physiological systems work together to ensure that up-titrated energy and force production demands are met. The magnitude of the exertional stimulus these systems are able to respond to, when an individual is in a true state of physiological health, is influenced by multiple factors including age, sex, biomechanics, genomics, and exercise training history. When one or more of these systems suffers from dysfunction, as is the case when an individual is at risk for (i.e. unhealthy lifestyle history) or diagnosed with a chronic disease, the response to a physical stimulus ultimately fails and exertional capacity is limited. There is a clear and well-established clinical relevance to the cardiovascular response to an exertional stimulus, commonly assessed through a graded aerobic exercise test on a treadmill or cycle ergometer. In fact, aerobic capacity has been referred to a key vital sign. We are also gaining an appreciation of how communication and presentation of information between health professionals and individuals receiving care significantly impacts comprehension and adherence to a plan of care. This chapter addresses these areas, beginning with a brief granular description of exertional cardiovascular physiology, transitioning to practical clinical implications of this information for health professionals, and ending with how the individuals seeking healthcare receive, process, and comprehend this information with the ultimate goal being real-world application and improved health outcomes.