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1
McElligott, Alan G. Fighting, vocal activity, annual mating success and lifetime mating success of Fallow bucks (Dama dama L.): Short-term investment and long-term cost. Dublin: University College Dublin, 1997.
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2
Association, American Medical Directors. Falls and fall risk: Clinical practice guideline, 1998. [Columbia, Md.?]: American Medical Directors Association, 1998.
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3
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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4
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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5
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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6
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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7
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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8
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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9
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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10
Schneider, Barbara. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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11
Evans, Brenda. Accidental Falls: Risk Factors, Prevention Strategies and Long-Term Outcomes. Nova Science Publishers, Incorporated, 2015.
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12
Emily, Amerman, Philadelphia Corporation for Aging, and United States. Administration on Aging, eds. Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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13
Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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14
Clinical protocol series for care managers in community based long-term care. Philadelphia, PA (642 North Broad St., Philadelphia 19130-3409): Philadelphia Corporation for Aging, 1995.
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15
Costello, Kathleen, and Scott D. Newsome. Symptoms of Multiple Sclerosis. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0085.
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Symptoms of MS can be categorized as primary, secondary, or tertiary. Primary symptoms are those that are a direct result of CNS damage, such as fatigue, bladder dysfunction, visual disturbances, incoordination or imbalance, etc. Secondary symptoms are complications arising from these symptoms such as falls due to imbalance, spasticity or weakness, or UTI due to bladder retention. Tertiary symptoms are the social and vocational consequences of primary and secondary symptoms and can include divorce, job loss, financial hardship, and social isolation. Careful evaluation of these symptoms along with appropriate treatment and long-term follow-up can contribute to the quality of life for patients with MS.
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Bell, Ruth Greenspan. Protecting the Environment during and after Resource Extraction. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198817369.003.0016.
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Natural resources extraction inevitably imposes environmental damage including diversion of scarce water away from pressing local needs, disruption of fragile ecosystems, and longer-range and often irreparable harm. These fall most forcefully on the local populations at or near the extraction sites but also beyond. Effective regulation of extractive industries is critical to balance immediate needs with longer-term considerations. Unfortunately, much extraction takes place in countries with weak institutions and poor success rates in addressing any of their environmental challenges and often rampant corruption undercutting fair application of rules. This chapter concludes that improving practices requires a long and sustained commitment from everyone involved—the countries and industry.
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Popova, Svetlana, Shannon Lange, Larry Burd, and Jürgen Rehm. Burden and Social Cost of Fetal Alcohol Spectrum Disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199935291.013.78.
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Damage to the central nervous system is a unifying concept for nearly all of the diagnoses that fall under the Fetal Alcohol Spectrum Disorders (FASD) umbrella. Thus, FASD are an important public health and social problem worldwide that consumes a large amount of resources, both economic and societal by imparting a large burden on society through such sectors as the healthcare system, mental health and substance abuse treatment services, foster care, the criminal justice system, and the long-term care of individuals with intellectual and physical disabilities. Existing estimates of the economic impact of FASD demonstrate significant cost implications on the individual, the family and society. Many of the costs associated with FASD can be reduced with the implementation of effective social policies and intervention programs.
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Pollack, Detlef, and Gergely Rosta. East Germany. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198801665.003.0012.
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The case of East Germany raises the question of why religion and church, which had fallen to an unprecedentedly low level after four decades of suppression, have not recovered since 1989. The repressive church politics of the SED were undoubtedly the decisive factor in the unique process of minoritizing churches in the GDR. However, other external factors such as increasing prosperity, socio-structural transformation, and the expansion of the leisure and entertainment sector played an important role, too. In addition, church activity itself probably also helped to weaken the social position of churches. The absence of a church renaissance after 1990 can be explained by several factors, such as the long-term effects of the break with tradition caused by the GDR system, the political and moral discrediting of the church by the state security service, and people’s dwindling confidence in the church, which was suddenly seen as a non-representative Western institution.
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Maffini, Maricel V., and Sarah Vogel. Food Additives. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190490911.003.0011.
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The American diet is dramatically different today than in 1958, when Congress passed the Food Additives Amendment. Innovations in processing, preserving, and packaging have made food more affordable and convenient but added thousands of new chemicals to our diet. More than 10,000 additives are allowed in food, but most have not been tested, and their long-term, chronic effects have rarely been studied. The regulatory system has fallen short of being fully implemented and has been weakened by decades of limited resources. A legal loophole allows new chemicals in food without notice to or review by the Food and Drug Administration, and the outdated safety assessment process fails to adequately address public health concerns. The result is that consumers bear the burden of deciding what is safe to eat, with limited information to do so. Without robust review of the safety of chemicals in food, there is little insight into the extent to which they may be contributing to chronic diseases.
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Williams, Arthur Robin, and Olivera J. Bogunovic. Benzodiazepines and Other Sedative-Hypnotics in the Older Adult. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0007.
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Sedative-hypnotic-use disorder is a serious problem in the elderly and is a growing concern in the United States. The American Geriatrics Society’s “Choosing Wisely” initiative cautions against the use of any benzodiazepines or other sedative-hypnotics as initial treatment in older adults, yet benzodiazepines are the most frequently prescribed drugs in the elderly for both insomnia and anxiety. Other classes of medication (e.g., serotoninergic antidepressants) may be substituted for benzodiazepines based on diagnosis. With advancing age, the elderly are more sensitive to the potential side effects of benzodiazepines because of altered pharmacokinetics and pharmacodynamics Increasingly, studies have indicated that older patients disproportionately experience adverse events with benzodiazepines such as falls and cognitive deficits and have difficulty reducing or stopping long-term use without experiencing rebound effects such as anxiety and insomnia. Sedative-hypnotic-use disorders among older adults are increasing in prevalence and warrant heightened clinical attention, thoughtful assessment, and active management.
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Mody, Ashoka. The Final Act. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780199351381.003.0010.
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This chapter discusses Eurozone's decline in the global economic leagues. On top of the historically low productivity growth, insufficient monetary and fiscal stimulus through 2014 did material damage not just at the time but also to future growth potential. Eurozone economies will grow at a significantly slower average pace over the next decade than they did in the decade before the global financial crisis began. In combination, reinforcement of the long-term productivity growth lag by the setback of the prolonged crisis practically ensures that Eurozone economies will fall further behind the world's most dynamic economies. These economic and financial vulnerabilities are especially serious in the Eurozone's south. As the economic disparities between the south and the north have increased, political tensions between the leaders of these two groups of countries have grown. These tensions will limit the prospect of finding collective solutions to Europe's problems.
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Smith, Jad. Raising the Noise Level, 1951–66. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252037337.003.0002.
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This chapter details the early life of John Brunner. Brunner had first meaningful encounter with science fiction (SF) when grandfather's rare 1898 Heinemann edition of H. G. Wells' The War of the Worlds (1898) ended up misshelved in his playroom. At six and a half years old, Brunner read it, adorned its endpapers with Martian fighting-machines, and that was that. By nine, Brunner was a full-fledged SF addict. During his final term at Cheltenham College in the fall of 1951, Brunner's first printed story appeared alongside fiction by A. Bertram Chandler, Kenneth Bulmer, and Manly Banister in Walt Willis' celebrated fanzine Slant. Though only a page long, “The Watchers” (1951) leaves little doubt that the seventeen-year-old Brunner began his career as a devoted idealist. In April 1966, Brunner became the first recipient of the British Science Fiction Association's Fantasy Award.
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Torrington, Matthew. Addiction: Definition, Epidemiology, and Neurobiology. Edited by Shahla J. Modir and George E. Muñoz. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190275334.003.0001.
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This chapter discusses the DSM-5 diagnostic criteria for substance use disorders and identifies addiction as a disease of reward, motivation, and memory rooted in complex biologic changes. It explains the epidemiology of addiction and identifies the rise and fall of specific drug use and behaviors. It then moves to the neurobiology of addiction, naming the numerous survival systems that are intertwined with addiction’s genetics, early brain development, and learning pathways. Finally, it looks at why some people become addicts, describing it as a pro-inflammatory, bio-psycho-social-environmental-spiritual disease state. Addicted persons often engage in this behavior, no longer to obtain pleasure, but to relieve discomfort created by withdrawal from the drug and the negative life consequences of addiction. The chapter concludes by addressing what needs to be done in both the short- and long-term, noting that applying the disease model to addiction has been the most effective method of saving lives.
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Pinheiro, Armando Castelar. The Rise and Fall of State Enterprises. Edited by Edmund Amann, Carlos R. Azzoni, and Werner Baer. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190499983.013.35.
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We can divide the history of Brazilian state-owned enterprise (SOEs) into two periods. In the first (1930s to late 1970s), SOEs were a policy instrument in state-led industrialization. They produced manufactured goods, supplied cheap inputs to private manufacturing firms, and financed those companies with long-term, subsidized loans. In the second period (1980s to the early 2000s), Brazil privatized several of its main SOEs. Privatization was mainly seen as an answer to macroeconomic problems and did not result from a national ideological about-face; indeed, most Brazilians continued to trust the state to lead development. Thus, the fall of SOEs was relative. Large companies such as Petrobrás and Eletrobrás continue in state hands. Moreover, the Lula and Rousseff administrations created several SOEs and strengthened others. And the state developed new channels to influence private investment, through a network of equity participations in private companies, held by BNDES and SOE pension funds.
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Stewart, Frances, Gustav Ranis, and Emma Samman. Achievements, Challenges, and the Way Forward. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198794455.003.0009.
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The chapter reviews progress across countries on human development over forty years in many dimensions. As shown earlier, there was general progress on basic human development, measured by the Human Development Index. This chapter also shows progress on many other dimensions, including a rising number of countries with broadly democratic political systems, a decline in crime in many countries, and a fall in gender gaps in education and earnings. Despite a recent upsurge of violent conflict, this was mostly on a downward trend at a global level. There was a more mixed situation in some other dimensions—for example, homicides and inequalities rose while trust fell in many countries. The most pervasive failure was on environmental sustainability. The chapter concludes with a discussion of areas that the human development approach has not adequately incorporated, including social institutions, macroeconomics, and above all environmental conditions which may threaten long-term achievements on human development.
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Fachard, Sylvian, and Edward M. Harris, eds. The Destruction of Cities in the Ancient Greek World. Cambridge University Press, 2021. http://dx.doi.org/10.1017/9781108850292.
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From the Trojan War to the sack of Rome, from the fall of Constantinople to the bombings of World War II and the recent devastation of Syrian towns, the destruction of cities and the slaughter of civilian populations are among the most dramatic events in world history. But how reliable are literary sources for these events? Did ancient authors exaggerate the scale of destruction to create sensational narratives? This volume reassesses the impact of physical destruction on ancient Greek cities and its demographic and economic implications. Addressing methodological issues of interpreting the archaeological evidence for destructions, the volume examines the evidence for the destruction, survival, and recovery of Greek cities. The studies, written by an international group of specialists in archaeology, ancient history, and numismatic, range from Sicily to Asia Minor and Aegean Thrace, and include Athens, Corinth, and Eretria. They highlight the resilience of ancient populations and the recovery of cities in the long term.
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Hainline, Brian, Lindsey J. Gurin, and Daniel M. Torres. Concussion. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190937447.001.0001.
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Concussion is a type of mild traumatic brain injury, is common, and occurs both in sport and as a result of falls or accidents. Concussion has become an increasingly recognized public health concern, largely driven by prominent media coverage of athletes who have sustained concussion. Although much has been written about this condition, its natural history is still not well understood, and practitioners are only now beginning to recognize that concussion often manifests in different clinical domains. These may require targeted treatment in and of themselves; otherwise, persistent post-concussive symptoms may develop. Although most individuals who sustain a concussion recover, and although concussion is a treatable condition, it is important that concussion be managed early and comprehensively to avoid a more prolonged clinical trajectory. A relatively recent term often used in the setting of concussion is repetitive head impact exposure—a biomechanical force applied to the head that does not generate a clinical manifestation of concussion, but may result in structural brain changes. Although it is often assumed that repetitive head impact exposure leads to long-term neurological sequelae, the science to document this assumption is in its infancy. Repeated concussions may lead to depression or cognitive impairment later in life, and there is an emerging literature that repeated concussion and repetitive head impact exposure are associated with chronic traumatic encephalopathy or other neurodegenerative diseases. Currently there is no known causal connection between concussion, repetitive head impact exposure, and neurodegeneration, although this research is also still in its infancy.
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Finfer, Simon, and Oliver Flower. Assessment and immediate management of spinal cord injury. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0344.
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Spinal cord injury is a potentially devastating injury, which may occur in isolation, but more commonly occurs in the setting of multiple injuries. Motor vehicle accidents and falls are the most common causes. Depending on the level of the injury and its completeness, patients may be left with paraplegia or tetraplegia. The injury may be immediately obvious based on history and clinical examination, but may have to be actively excluded in multiply-injured patients. Thoracolumbar spine fractures are almost always evident on plain X-rays, whereas computed tomography (CT) or magnetic resonance imaging (MRI) is frequently required to exclude cervical spine injuries. Immediate management should be directed at the detection and treatment of life-threatening injuries. Patients should be transferred to a facility specializing in the management of spinal cord injury as soon as feasible. Acute management of the spinal injury itself is largely supportive and aimed at avoiding preventable secondary injury. Respiratory complications are common, and high thoracic or cervical injuries may lead to neurogenic shock. Early identification of the injury and appropriate management results in improved outcome, reducing disability and costs of long-term management.
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Meddings, Jennifer, Vineet Chopra, and Sanjay Saint. Preventing Hospital Infections. 2nd ed. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197509159.001.0001.
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This book provides a detailed, step-by-step description of a model quality improvement intervention for hospitals, pinpointing the obstacles and showing how to surmount them. This second edition has been carefully updated, with new material describing some technical aspects of infection prevention, new tools for use by front-line providers, and results of recent large collaborative infection prevention studies. In easy-to-read, user-friendly language, it explains why clinicians neglect or actively oppose quality changes—from physicians who distrust change, to nurses who want to protect their turf, to infection preventionists who avoid the wards. The book also sheds light on how and why hospitals embark on quality improvements, the role of the hospital’s leadership cadre, the selection and training of the project team, and how to sustain quality gains long term. The intervention framework described in the book focuses on the prevention of hospital-associated infections—in particular, catheter-associated urinary tract infection (CAUTI)—but it is directly applicable to a variety of other hospital issues, such as falls, pressure sores, and Clostridioides difficile infection (CDI). In fact, the book includes a chapter applying this framework to a CDI prevention initiative. In addition, for hospitals having trouble with staff adherence to a quality initiative, we provide three infection-specific questionnaires (for CAUTI, CLABSI, and CDI) to help pinpoint individual problems, and provide a link to a website offering advice tailored to their specific circumstances.
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Ornebring, Henrik, ed. The Oxford Encyclopedia of Journalism Studies. Oxford University Press, 2020. http://dx.doi.org/10.1093/acref/9780190694166.001.0001.
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104 scholarly articles Scholarly, public, practitioner, and policymaker interest in journalism is both long-standing and on the rise. It is a field in tremendous flux: social, cultural, economic and technological change is transforming every aspect of news production and consumption. And journalism is facing increased threats around the world today, even in places it once seemed well protected. This collection takes stock of this evolving field, summarizes the development of major themes of research, revisits key concepts and traditional forms and genres of journalism in light of contemporary developments, and to sets out directions for future research. The 104 essays in this encyclopedia fall into six main categories: Key Concepts; Theories and Research Perspectives; the Practice of Journalism; Forms, Genres, and Types of Journalism; Systems and Structures of Journalism; and the Reception of Journalism. The essays in this compendium: • reflect the breadth and depth of contemporary journalism studies and acknowledges the rich history of the field • recognize the global diversity in and around journalism in term of practices, normative frameworks, epistemologies, and others, and takes a globally comparative perspective throughout the volume • trace histories, summarizes state-of-the-art research, and points to avenues for future research • are written to the highest international standards and at the same time is accessible for practitioners, advanced students, and other stakeholders with a particular interest in journalism and journalism research.
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Abdulkader, Rita, and Richard A. Watts. Mycobacterial diseases. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0103.
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The main diseases caused by mycobacterial infection are tuberculosis (TB) and leprosy. Despite a fall in the prevalence of these diseases over the last decade, they are still significant causes of morbidity and mortality worldwide. Atypical mycobacterial infections are encountered less frequently. Immigration patterns, the frequency of human immunodeficiency infection, and the increased numbers of patients on immunosuppressive treatments render mycobacterial infections relevant not only to physicians in the developing world where they traditionally occurred but also in the developed world. Skeletal TB occurs in 1–3% of cases of TB infection, and is more frequently encountered in the immunocompromised. A high index of suspicion is required, diagnosis relies on a combination of clinical features and radiological, histological, and microbiological tests. Multidrug regimens are required for treatment with surgery in selected cases. Leprosy is caused by M. leprae infection. The disease is still a leading cause of disability worldwide. Diagnosis is usually clinical. The course of the disease is indolent but may be interrupted by acute inflammatory reactions, which contribute to nerve damage and disability. Treatment aims at eliminating the mycobacteria using multidrug regimens, and management of complications including leprosy reactions and long-term nerve damage. Atypical mycobacterial infections affecting bone and joints are uncommon; they usually follow direct inoculation of the pathogen. Haematogenous dissemination is encountered in immunocompromised patients. These microorganisms are not usually susceptible to the same drug regimens used in the treatment of tuberculosis.
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LaZella, Andrew T. The Singular Voice of Being. Fordham University Press, 2019. http://dx.doi.org/10.5422/fordham/9780823284573.001.0001.
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The Singular Voice of Being: John Duns Scotus and Ultimate Difference reconsiders John Duns Scotus’s well-covered theory of the univocity of being in light of his less explored discussions of ultimate difference. Ultimate difference is a notion introduced by Aristotle and known by the Aristotelian tradition, but one that, the book argues, Scotus radically retrofits to buttress his doctrine of univocity. Ultimate difference for Aristotle meant the last difference in a line of specific differences whereby all the preceding differences would be united into a single substance rather than remain a heapish multiplicity. Scotus both broadens and deepens the term such that, in the end, it comes to resemble its Aristotelian ancestor more in name than in substance. This is because Scotus broadens ultimate difference to include not only specific differences, but also intrinsic modes of being (e.g., finite/infinite) and principles of individuation (i.e., haecceitates). Furthermore, he deepens it by divorcing it from anything with categorial classification, such as substantial form. Rather, by linking ultimate difference to primary diversity irreducible to opposition, privation, or contradiction, Scotus responds to the long-standing Parmenidean arguments against the division of being. Differentiation is not a fall from the perfect unity of being. Rather, ultimate difference divides being by perfective determination of this otherwise indifferent concept. The division of being culminates in individuation as the final degree of perfection, which constitutes indivisible (i.e., singular) degrees of being.
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Allen-Meares, Paula, Tina R. Shanks, Larry M. Gant, Leslie Hollingsworth, and Patricia L. Miller. A Twenty-First Century Approach to Community Change. Oxford University Press, 2017. http://dx.doi.org/10.1093/acprof:oso/9780190463311.001.0001.
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Urban renewal has been the dominant approach to revitalizing industrialized communities that fall into decline. Detroit, with its vast majority Black population and struggling auto industry, encountered such decline. The Skillman Foundation sought to engage in a joint effort to bring Detroit back to its position of strength. With its mission of enhancing the development and well-being of children, Skillman entered partnerships with six Detroit neighborhoods with the largest concentrations of children whose well-being and development was at risk. The Foundation solicited the technical assistance of the University of Michigan School of Social Work. This book introduces readers to the environment within which the work of technical assistance began. The work is placed within a theoretical and practice context. This includes conducting needs assessments at multiple levels, engaging community members in identifying strategies for problem-solving, assistance in developing community goals for immediate and long-term success, and implementing social work field instruction opportunities. Lessons learned and challenges are described as they played out in the process of creating partnerships for the Foundation with community leaders, engaging and maintaining youth involvement, managing roles and relationships with multiple partners recruited by the Foundation for their specialized expertise, and conducting the work of technical assistance within a context of increasing influence of the city’s surrounding systems (political, economic, educational, and social). Readers will note the role of technical assistance in an evolving theory of change. Case vignettes, case-based discussion questions, and additional resources in each chapter provide an excellent opportunity for classroom use.
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Fieldhouse, Edward, Jane Green, Geoffrey Evans, Jonathan Mellon, Christopher Prosser, Hermann Schmitt, and Cees van der Eijk. Electoral Shocks. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198800583.001.0001.
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This book offers a novel perspective on British elections, focusing on the importance of increasing electoral volatility in British elections, and the role of electoral shocks in the context of increasing volatility. It demonstrates how shocks have contributed to the level of electoral volatility, and also which parties have benefited from the ensuing volatility. It follows in the tradition of British Election Study books, providing a comprehensive account of specific election outcomes—the General Elections of 2015 and 2017—and a more general approach to understanding electoral change.We examine five electoral shocks that affected the elections of 2015 and 2017: the rise in EU immigration after 2004, particularly from Eastern Europe; the Global Financial Crisis prior to 2010; the coalition government of the Conservatives and the Liberal Democrats between 2010 and 2015; the Scottish Independence Referendum in 2014; and the European Union Referendum in 2016.Our focus on electoral shocks offers an overarching explanation for the volatility in British elections, alongside the long-term trends that have led us to this point. It offers a way to understand the rise and fall of the UK Independence Party (UKIP), Labour’s disappointing 2015 performance and its later unexpected gains, the collapse in support for the Liberal Democrats, the dramatic gains of the Scottish National Party (SNP) in 2015, and the continuing period of tumultuous politics that has followed the EU Referendum and the General Election of 2017. It provides a new way of understanding electoral choice in Britain, and beyond, and a better understanding of the outcomes of recent elections.
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Giannitsis, Evangelos, and Hugo A. Katus. Biomarkers in acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0036.
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Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among troponin-negative subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.
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Giannitsis, Evangelos, and Hugo A. Katus. Biomarkers in acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0036_update_001.
Full textAbstract:
Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among normal-troponin subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.
37
Giannitsis, Evangelos, and Hugo A. Katus. Biomarkers in acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0036_update_002.
Full textAbstract:
Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among normal-troponin subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.
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Nash, David. Changes in Precipitation Over Southern Africa During Recent Centuries. Oxford University Press, 2017. http://dx.doi.org/10.1093/acrefore/9780190228620.013.539.
Full textAbstract:
Precipitation levels in southern Africa exhibit a marked east–west gradient and are characterized by strong seasonality and high interannual variability. Much of the mainland south of 15°S exhibits a semiarid to dry subhumid climate. More than 66 percent of rainfall in the extreme southwest of the subcontinent occurs between April and September. Rainfall in this region—termed the winter rainfall zone (WRZ)—is most commonly associated with the passage of midlatitude frontal systems embedded in the austral westerlies. In contrast, more than 66 percent of mean annual precipitation over much of the remainder of the subcontinent falls between October and March. Climates in this summer rainfall zone (SRZ) are dictated by the seasonal interplay between subtropical high-pressure systems and the migration of easterly flows associated with the Intertropical Convergence Zone. Fluctuations in both SRZ and WRZ rainfall are linked to the variability of sea-surface temperatures in the oceans surrounding southern Africa and are modulated by the interplay of large-scale modes of climate variability, including the El Niño-Southern Oscillation (ENSO), Southern Indian Ocean Dipole, and Southern Annular Mode.Ideas about long-term rainfall variability in southern Africa have shifted over time. During the early to mid-19th century, the prevailing narrative was that the climate was progressively desiccating. By the late 19th to early 20th century, when gauged precipitation data became more readily available, debate shifted toward the identification of cyclical rainfall variation. The integration of gauge data, evidence from historical documents, and information from natural proxies such as tree rings during the late 20th and early 21st centuries, has allowed the nature of precipitation variability since ~1800 to be more fully explored.Drought episodes affecting large areas of the SRZ occurred during the first decade of the 19th century, in the early and late 1820s, late 1850s–mid-1860s, mid-late 1870s, earlymid-1880s, and mid-late 1890s. Of these episodes, the drought during the early 1860s was the most severe of the 19th century, with those of the 1820s and 1890s the most protracted. Many of these droughts correspond with more extreme ENSO warm phases.Widespread wetter conditions are less easily identified. The year 1816 appears to have been relatively wet across the Kalahari and other areas of south central Africa. Other wetter episodes were centered on the late 1830s–early 1840s, 1855, 1870, and 1890. In the WRZ, drier conditions occurred during the first decade of the 19th century, for much of the mid-late 1830s through to the mid-1840s, during the late 1850s and early 1860s, and in the early-mid-1880s and mid-late 1890s. As for the SRZ, markedly wetter years are less easily identified, although the periods around 1815, the early 1830s, mid-1840s, mid-late 1870s, and early 1890s saw enhanced rainfall. Reconstructed rainfall anomalies for the SRZ suggest that, on average, the region was significantly wetter during the 19th century than the 20th and that there appears to have been a drying trend during the 20th century that has continued into the early 21st. In the WRZ, average annual rainfall levels appear to have been relatively consistent between the 19th and 20th centuries, although rainfall variability increased during the 20th century compared to the 19th.