By O. Rocko. University of Tennessee Health Science Center.
Acute pulmonary oedema A 12-lead electrocardiogram should be performed if it will alter Identiﬁcation your immediate management/choice of destination or you work in Respiratory distress discount 120mg xenical fast delivery, wheeze with ﬁne crackles at the lung bases with a region with a prehospital thrombolysis policy purchase xenical 120 mg overnight delivery. Clinical tip: Check for signiﬁcant blood pressure differences in either arm that occurs with thoracic aortic dissection purchase generic xenical on line. Intravenous furosemide is probably not as effective as ﬁrst as they may not respond as well to adrenaline and steroids. Intubation may management easier – this information needs to be sought from be required depending on transfer time. Non-invasive ventilatory collateral history and presence of medical alert bracelets/cards. Oxylog 3000)butbewareofhighﬂowsrequired – carefuloxygencalculation Transport considerations isamust. Airway is likely to be difﬁcult to manage – allow the patient to position Arrhythmias themselves if possible. Destination considerations Clinical tip: Get a print off of the rhythm strip to analyse, as well Nearest hospital with emergency facilities and intensive care. Differential/concurrent diagnosis Treatment Beware of atrial ﬁbrillation with a coexisting bundle branch block. If airway obstructs be prepared to perform prompt surgical cricothyroido- Transport considerations tomy. Repeat commended – transcutaneous pacing may become necessary or doses as needed (0. Destination considerations Local resources and the availability of a dedicated coronary care Neurological emergencies unit will dictate destination. The ﬁtting patient Identiﬁcation Treatment Many seizure types and presentations exist. Self-limiting seizures Treatmentshouldbeadministeredaccordingtothelocaladaptation do not require emergency prehospital intervention. Use of speciﬁc cus (including tonic–clonic, tonic, clonic, myoclonic and absence treatments such as adenosine or amiodarone will depend on the seizures)andfocalstatusepilepticus(alsoknownaspartialseizures). Patients are at risk of traumatic injuries as a result of the cardioversion should only be attempted if you have the skill set for seizure. Severetonic–clonicseizurescanresultinposteriorshoulder safe sedation, in the presence of severe adverse signs and prolonged dislocation. Transport considerations • Skin: Oedema – typically facial and associated ﬂushing. Intravenous phenytoin may be adminis- tered during a prolonged transfer/on scene time (but not if seizures Treatment are associate with tricyclic overdose). Rapid sequence induc- appropriate with prolonged prehospital times and when the potas- tion with thiopentone should be considered for those who do not sium level can be measured. Clinical tip: Midazolam can be given via the buccal or intranasal Hypoglycaemia routes. Respiratory support may Identiﬁcation be needed following treatment with benzodiazepines. Be aware of purposeful insulin professionals and lay-people to identify potential cerebrovascu- overdose. Transport considerations In the case of agitated and confused patients correct this before Differential/concurrent diagnosis transporting them. Recovery position is appropriate for those that Arrhythmias, hypoglycaemia and other causes of seizures are com- can protect their own airway. Destination considerations Transport considerations A hospital with appropriate facilities. Treatment Oral glucose followed by complex carbohydrate if conscious and Destination considerations compliant. Block excision of the injection embolectomy within the locally deﬁned time window is crucial. Clinicaltip:Thoughtemptingtodischargeonscenethesepatients Treatment have a high relapse rate so are best transferred to hospital for The development of point of care testing which accurately distin- observation. Treatment currently consists of support- Poisoning ive management and rapid transfer. Identiﬁcation In the absence of a reliable and/or collaborative history, poison- ing may be a difﬁcult diagnosis. Consider in all patients with Metabolic emergencies altered levels of consciousness, unexplained arrhythmia or unusual High blood sugar including diabetic ketoacidosis clinical manifestations. Combinations of toxidromes can further and hyperosmolar states complicate identiﬁcation (Table 23. Identiﬁcation A high blood sugar on point of care testing accompanied by Differential/concurrent diagnosis autonomic symptoms: tachycardia, Kussmauls respiration, sweet Need to consider both alternative causes of the clinical presentation smelling/pear drop breath (ketones). Differential/concurrent diagnosis Transport considerations Attempt to ﬁnd and treat trigger, e. Destination considerations Transport considerations Rare poisonings and those requiring specialist intervention may Monitor for arrhythmias. Careful Opioid Opioid receptor Sedation, miosis, decreased communication and non-threatening body language are essential. Anticholinergic muscurinic acetylcholine Altered mental status, receptors sedation, hallucinations, Cases may include deliberate self harm or attempted suicide, with mydriasis, dry skin, dry associated trauma or overdose. Sympathomimetic alpha and beta agitation, mydriasis, adrenergic receptors tachycardia, hypertension, Transport considerations hyperthermia, diaphoresis Team safety. If not do Cholinergic nicotinic and muscurinic altered mental status, you require a police escort? Patients unwilling to travel to hospital acetylcholine seizures, miosis, are likely to require sectioning under the Mental Health act (or receptors lacrimation, diaphoresis, bronchospasm, local equivalent). The police may intervene to protect the general bronchorrhea, vomiting, public or the patient themselves. It is not safe to transport acutely diarrhoea, bradycardia disturbed patients by air. Serotonin serotonin receptors altered mental status, syndrome tachycardia, hypertension, hyperreﬂexia, clonus, Destination considerations hyperthermia If the patient is known to a psychiatric facility it is best to take them to the associated hospital for continuity of care where feasible. Treatment Awareness of the availability of rarely stocked antidotes may dictate You may have to assess the patient’s capacity to consent to or destination. If sedation is necessary, then this must be safe, and never so deep that the airway becomes compromised. The patient Treatment should be fully monitored: end tidal carbon dioxide monitoring Rapidly remove the patient from any potential further contam- is strongly advised. Some poisons have speciﬁc antidotes – these are rarely presentation and practitioner familiarity. Activated charcoal can be administered in most cases of poisoning with a few exclu- sions (Box 23. The mainstay of prehospital treatment consists of Infection/sepsis symptomatic treatment and safe transfer. Contraindications • Decreased level of consciousness • Differential/concurrent diagnosis Acids • Alkalis Consider likely source and type of infection. Remember to collect any ‘evidence’ of potential sources of poisoning at the scene – this may be the only opportunity to gather this valuable information.
According to Bowker and Hawkins (2006: 87) many avail- able resources on medical terminology do include variants; although relevant buy xenical 60 mg mastercard, this information can sometimes be misleading for users because they should be provided with the different circumstances in which those variants should or could be used and why discount 60 mg xenical visa. The selection of the appropriate lexis in each context is essential as it is one of the conventions that facilitate the construction of textual models: textual genres purchase xenical cheap. Formation Patterns of Denominative Variants in Biomedicine 77 With the help of different subcorpora, it has been possible to find variants for terms in different registers. Each context provided by concordance lines has been the source for identifying explicit variants, that is variants linked to terms by means of reformulative discourse markers (cf. As opposed to Daille (2005: 183) who considers that term variants are noun phrases composed of a head noun and a nominal or adjectival modifier, in this study all nominal syntagmatic units, including acro- nyms, have been taken into account. Furthermore, as can be observed in Table 5, each term has a different number of variants: terms in S1 have from 1 to 5 variants while terms in S2 have from 1 to 8 variants. Syntactically, the majority of Formation Patterns of Denominative Variants in Biomedicine 79 variants in S2 have been formed by composition (90%) and only a few 1 by truncation (10%). It should be highlighted that all the compound variants – bone-marrow stromal stem cell, bone marrow stromal cell, skeletal stem cell, bone marrow-derived stromal cell – in S1 are assigned to the same term mesenchymal stem cell. The main dif- ference between the truncated forms in S1 and in S2 is that most trun- cated forms in S2 belong to most known types of cells as they are hy- peronyms of many other specific types (e. All the compounds from the resulting data have been further subclassified according to the process terms have gone through to result in alternative denominations. The greatest number of compounds has been found in S2 (47), and there- fore they have been described in the first place: ● 18 variants out of 52 (34%) reproduce compounds built from Greek or Latin roots in the English language (e. Different words are 1 In this study, truncation is understood as a formal means by which a lexematic unit is reduced to an acronym or an abbreviated form. Discussion In agreement with already cited authors such as Gaudin (1990), Sager (1990), Bowker and Hawkins (2006), neither terms nor their variants are context free. Specifically, variants in these registers are trig- gered by the intention of the writers and the level of knowledge of the recipients in each situation type. Based on the results extracted from our corpus it seems to be possible to infer regular patterns of variation and the specific motiva- tions behind term choice. Scientific popularization implies a reformulation pro- cess in which most Greco-Latin terms have at least an alternative Formation Patterns of Denominative Variants in Biomedicine 81 expression. In this sense, Gotti (2014: 19) states that popula- rization “does not alter the disciplinary content […] as much as its lan- guage, which needs to be remodeled to suit a new target audience”. The aim of experts and semi-experts writing for a lay audience is that recipients can continue reading without finding conceptual barriers and that they overall understand the message. In order to achieve their aim, they use above all paraphrases; secondly they use English coun- terparts which sometimes strictly follow the order of Greco-Latin roots of terms, and others are reduced forms. The description of variants in this study shows hints of the appropriateness of variants in certain settings characterized by different users and a particular purpose. The methodology carried out in this study can be applied to other specialized languages and the resulting variants can contribute to the improvement of terminology-oriented applications: 82 Paula De Santiago González specialized dictionaries, computer-assisted translations, etc. In Cabré, María Teresa / Feliu, Judit (eds) La ter- minología científico-técnica: reconocimiento, análisis y extrac- ción de información formal y semántica. Introduction In the last decades, several studies have been concerned with the analysis of the discourse of popularization (see for example Shinn/ Whitley 1985; Gregory/Miller 1998; Myers 1997, 2003; Ciapuscio 2003; Calsamiglia/Van Dijk 2004). Many scholars have been interest- ed in the language adopted by journalists and media professionals when dealing with scientific research articles and have focused in particular on the linguistic features of popularizing texts. This line of research has often analysed journalists’ products in comparison with the original research articles in scientific journals, pointing out several differences at various levels, such as textual, syntactic and rhetorical levels (Myers 1990, 1991, 1994; Calsamiglia 2003). Furthermore, par- ticular interest has been placed on those linguistic strategies enacted in order to enhance lay readers’ comprehension such as the use of meta- phors (Gülich 2003) and other expressive functions (e. As far as the definition of popularization is concerned, this pro- cess has often been identified as a ‘social operation’ aimed at commu- nicating lay versions of scientific knowledge among the public at large (Jacobi 1999; Calsamiglia/Van Dijk 2004). The discourse of populari- zation is a pluricode discourse in which text, images, stylesheets and colours semantically interact (Lemke 1998; Miller 1998) through a multimodal approach (Gotti 2013). As Bontems (2013: 103) argues, images are fundamental to the construction of scientific knowledge for a lay audience since they influence the reader’s sensitivity, thus 88 Silvia Cavalieri enhancing comprehension. The journalist is the mediator between science and its popularization and he/she chooses the right images and, in the case of complex technical ones, he/she adapts them to the supposed background knowledge of their public (Jacobi 1999; Bontems 2013). Even though in the last years many studies have claimed the im- portance of images in the field of science popularization (see among others Jacobi 1999; Bontems 2013; Dondero 2013; Lathene-Da Cunha 2013), little attention has been paid to the role of captions in the pro- cess of conveying specialist knowledge for a wider audience of non- specialists (Myers 1997). In order to fill this gap in the literature, the present work aims at providing an introductory description of captions in the discourse of medicine through the media, focusing in particular on three comparable corpora of news collected from the medicine sec- tions of French, English and Italian online magazines of science popu- larization. To be more specific, the study deals with the popularizing strategies used in the captions and their relation with the news and the image they refer to. Moreover, the use of captions is compared in the three languages to highlight similarities or differences in their use in order to see what strategies are typical of popularization discourse in different cultures As for the organization of the chapter, the first part will focus on the materials and methods used for the analysis, the second will deal with the findings deriving from an in-depth observation of corpus data and, in the final section, results will be discussed and conclusions will be drawn in the light of the previous analysis. Materials and Methods The present study has focused on scientific popularization discourse (Calsamiglia/Van Dijk 2004; Desmet 2005) aimed at transferring gen- eral medical information to a target public of educated laymen inter- ested in the latest science news. The articles chosen are texts adapted Popularizing Medical Discourse: The Role of Captions 89 to the editorial board policies by journalists, in which the presence of graphs, images and illustrations is pervasive. More specifically, the analysis was carried out on three comparable corpora of science news articles collected from the medicine sections of six online magazines of science popularization, namely Futura-Sciences and Science et ave- nir for the French corpus, Le Scienze and Focus for the Italian corpus, and Scientific American and Science Daily for the English corpus. As for the number of articles published, data show a sharp difference among the various online magazines and, in particular, between the Italian ones and the others. Moreover, it is worth noting a difference in the number of images used: English magazines tend to use one image per article while in French and Italian magazines we find an average of two images. The images found in the corpus are mainly of two types: 1) direct representations of the object described in the article, in which the similarity between the representamen and the object relies on simple qualities or properties (Lathene-Da Cunha 2013); 90 Silvia Cavalieri 2) diagrams and graphs, i. According to Myers (1997: 98) in scientific popularization articles “the text directs us to the picture, which leads us back to the caption, which leads to the picture, which leads back to the text”. So, first of all, we decided to consider the rela- tionship between the captions, the image and the article and we identi- fied what part of the article the caption anchors to. Thirdly, we analysed the most frequent popularizing strategies employed in the captions in order to enhance readers’ comprehension of the scientific knowledge reported following the framework pro- posed by Garzone (2006). Finally, a contrastive analysis of the use of captions in the three languages selected is provided and differences and similarities are outlined and discussed. A classification of captions in comparable corpora of science popularization news Considering the quantitative presence of captions in comparable cor- pora, a first interesting observation that can be made concerns the fact that only 28 images out of 448 do not present captions. As regards the typology outlined in Section 2, data show that the most frequent category of captions found in the three corpora is the summa- rizing one (197 out of 448). Des études suggèrent par ex- emple […]; More than 8,000 different phenolic compounds have been Popularizing Medical Discourse: The Role of Captions 93 identified […]). The Italian caption of Focus is the most summarized one, since it begins with a nominalization (allattamento) to introduce the main topic and then gives only the main gist of what the text is about (il latte materno […] è pericoloso) The second most frequent category of captions identified in the three corpora is that of descriptive captions (109 out of 448). Descrip- tive captions are directly linked to the picture they refer to and they provide a description of the element depicted in the picture or of the data represented in a graph. The following extracts, taken from the three corpora, are representative examples of this type of captions in the different languages: (4) Ce schéma explique les mécanismes en jeu dans cette expérience. Massa/Yale, Science Daily) As we can see in the examples above, the captions signal the relation with the described picture through textual metadiscursive devices (‘endophoric markers’, Hyland 2005) such as ce schema (Futura- Sciences), miniature (Le Scienze), microscope image (Science Daily).
The patient’s problem buy 120 mg xenical with mastercard, then buy xenical overnight delivery, described with the greatest degree of specificity generic xenical 120mg visa, is glomerulonephritis. The clini- cian’s task at this point is to consider the differential diagnosis of glomeru- lonephritis rather than that of pedal edema. This means the features of the illness, which by their presence or their absence narrow the differential diagnosis. This is often difficult for junior learners because it requires a well-developed knowledge base of the typical features of disease, so the diagnostician can judge how much weight to assign to the various clinical clues present. For example, in the diagnosis of a patient with a fever and productive cough, the finding by chest x-ray of bilateral apical infiltrates with cavitation is highly discriminatory. There are few illnesses besides tuberculosis that are likely to produce that radi- ographic pattern. A negatively predictive example is a patient with exuda- tive pharyngitis who also has rhinorrhea and cough. The presence of these features makes the diagnosis of streptococcal infection unlikely as the cause of the pharyngitis. Once the differential diagnosis has been con- structed, the clinician uses the presence of discriminating features, knowl- edge of patient risk factors, and the epidemiology of diseases to decide which potential diagnoses are most likely. Looking for discriminating features to narrow the differential diagnosis Once the most specific problem has been identified, and a differential diag- nosis of that problem is considered using discriminating features to order the possibilities, the next step is to consider using diagnostic testing, such as labo- ratory, radiologic, or pathologic data, to confirm the diagnosis. Quantitative reasoning in the use and interpretation of tests were discussed in Part 1. Clinically, the timing and effort with which one pursues a definitive diagnosis using objective data depends on several factors: the potential gravity of the diagnosis in question, the clinical state of the patient, the potential risks of diagnostic testing, and the potential benefits or harms of empiric treatment. For example, if a young man is admitted to the hospital with bilateral pul- monary nodules on chest X-ray, there are many possibilities including metastatic malignancy, and aggressive pursuit of a diagnosis is necessary, perhaps includ- ing a thoracotomy with an open-lung biopsy. The same radiographic findings in an elderly bed-bound woman with advanced Alzheimer dementia who would not be a good candidate for chemotherapy might be best left alone with- out any diagnostic testing. Decisions like this are difficult, require solid med- ical knowledge, as well as a thorough understanding of one’s patient and the patient’s background and inclinations, and constitute the art of medicine. Some diseases, such as congestive heart failure, may be designated as mild, moderate, or severe based on the patient’s functional status, that is, their ability to exercise before becoming dyspneic. With some infections, such as syphilis, the staging depends on the duration and extent of the infection, and follows along the natural history of the infection (ie, primary syphilis, secondary, latent period, and tertiary/neurosyphilis). If neither the prognosis nor the treat- ment was affected by the stage of the disease process, there would not be a reason to subcategorize as mild or severe. In making decisions regarding treatment, it is also essential that the clinician identify the therapeutic objectives. When patients seek medical attention, it is generally because they are bothered by a symptom and want it to go away. When physicians institute therapy, they often have several other goals besides symptom relief, such as prevention of short- or long-term complications or a reduction in mortality. For example, patients with congestive heart failure are bothered by the symptoms of edema and dyspnea. Salt restriction, loop diuretics, and bed rest are effective at reducing these symptoms. It is essential that the clinician know what the thera- peutic objective is, so that one can monitor and guide therapy. Clinical Pearl ➤ The clinician needs to identify the objectives of therapy: symptom relief, prevention of complications, or reduction in mortality. Some responses are clinical, such as the patient’s abdominal pain, or temper- ature, or pulmonary examination. Obviously, the student must work on being more skilled in eliciting the data in an unbiased and standardized manner. The stu- dent must be prepared to know what to do if the measured marker does not respond according to what is expected. Is the next step to retreat, or to repeat the metastatic workup, or to follow up with another more specific test? Approach to Reading The clinical problem–oriented approach to reading is different from the clas- sic “systematic” research of a disease. Patients rarely present with a clear diag- nosis; hence, the student must become skilled in applying the textbook information to the clinical setting. In other words, the student should read with the goal of answering specific questions. Clinical Pearl ➤ Reading with the purpose of answering the seven fundamental clinical questions improves retention of information and facilitates the application of “book knowledge”to “clinical knowledge. One way of attacking this problem is to develop standard “approaches” to com- mon clinical problems. It is helpful to understand the most common causes of various presentations, such as “the most common causes of pancreatitis are gallstones and alcohol. With no other information to go on, the student would note that this woman has a clinical diagnosis of pancreatitis. Using the “most common cause” information, the student would make an educated guess that the patient has gallstones, because being female and pregnant are risk factors. If, instead, cholelithiasis is removed from the equation of this scenario, a phrase may be added such as: “The ultrasonogram of the gallbladder shows no stones. Now, the student would use the phrase “patients without gallstones who have pancreatitis most likely abuse alcohol. This question is difficult because the next step may be more diagnostic infor- mation, or staging, or therapy. It may be more challenging than “the most likely diagnosis,” because there may be insufficient information to make a diagnosis and the next step may be to pursue more diagnostic information. Another pos- sibility is that there is enough information for a probable diagnosis, and the next step is to stage the disease. Hence, from clinical data, a judgment needs to be rendered regarding how far along one is on the road of: Make a Dx → Stage the disease → Treat based on stage → Follow response Frequently, the student is “taught” to regurgitate the same information that someone has written about a particular disease, but is not skilled at giving the next step. This talent is learned optimally at the bedside, in a supportive envi- ronment, with freedom to make educated guesses, and with constructive feed- back. Smith has stable angina because he has retrosternal chest pain when he walks three blocks, but it is relieved within minutes by rest and with sub- lingual nitroglycerin. Stage the disease: “I don’t believe that this is severe disease because he does not have pain lasting for more than 5 minutes, angina at rest, or conges- tive heart failure. Treat based on stage: “Therefore, my next step is to treat with aspirin, beta- blockers, and sublingual nitroglycerin as needed, as well as lifestyle changes. Follow response: “I want to follow the treatment by assessing his pain (I will ask him about the degree of exercise he is able to perform without chest pain), performing a cardiac stress test, and reassessing him after the test is done. This question goes further than making the diagnosis, but also requires the student to understand the underlying mechanism for the process. The student is advised to learn the mechanisms for each disease process, and not merely memorize a constellation of symptoms.