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In the eighteenth century's burgeoning culture of travel and "Grand Tours," Rome was the essential destination. From all over Europe, artists jostled with art lovers and collectors of antiquities, each influencing the other in their respective ambitions. The cult of Rome was particularly strong in France, and this volume looks at more than 100 works by artists such as Hubert Robert, Jean-Honoré Fragonard and Jacques-Louis David, who made pilgrimages to the "Eternal City" and who were decisively influenced by their time there. The works are contextualized across five different sections: the first focuses on the tradition of academic training in Rome; the second explores the depiction of the city's landscape and surrounding countryside; the third looks at Rome and Paris' cultures of art lovers, patrons and artists; the fourth section examines the eighteenth-century conception of antiques; and the final section looks at Rome's annual festivals, and their influence on French artists.
This innovative book investigates the roots of contemporary experiences of stigma, throwing new light on the phenomenon by examining a variety of long-term conditions. Behaviour, lifestyle and identity are no longer the results of mass-production by social class and nation, but increasingly the quirky and unique eccentricities of the individual as consumer, reflexive citizen and free agent. But if the hallmark of the post-modern world is endless variety and unlimited sub-cultural freedom, should we not be witnessing "The End of Stigma"? The book takes Fukuyama’s notion of "The End of History" and examines contemporary challenges to the stigma associated with chronic illness. Award-winning author Gill Green examines cases of HIV, mental illness and substance misuse, to provide new insights into stigma in health. She demonstrates that people with long-term conditions refuse to be defined by their condition and highlights their increasingly powerful voice. The End of Stigma? will be of interest to a wide range of students and health professionals in medical sociology, health studies and social care.
Biointegration of Medical Implant Materials, Second Edition, provides a unique and comprehensive review of recent techniques and research into material and tissue interaction and integration. New sections discuss soft tissue integration, with chapters on the biocompatibility of engineered stem cells, corneal tissue engineering, and vascular grafts. Other sections review tissue regeneration, inorganic nanoparticles for targeted drug delivery, alginate based drug delivery devices, and design considerations, with coverage of the biocompatibility of materials and their relevance to drug delivery and tissue engineering. With its distinguished editor and team of international contributors, this book is ideal for medical materials scientists and engineers in industry and academia. - Provides a unique and comprehensive review of recent techniques and research into material and tissue interaction and integration - Discusses soft tissue biointegration, with chapters on the biocompatibility of engineered stem cells, corneal tissue engineering, vascular grafts and replacement materials for facial reconstruction - Includes new information on a variety of tissue regeneration techniques and applications
Background Irritable bowel syndrome (IBS) is a common, chronic, relapsing, and sometimes disabling, symptombased disorder of gut brain interactions. It has got a female predominance and occurs in all ages, with a slight decrease among elderly. The IBS symptoms can affect everyday work and social life in addition to an increased use of health care resources. Most IBS patients are diagnosed and helped in primary health care (PHC). For many patients, available treatment is insufficient. It is known that both extraintestinal symptoms such as fatigue, as well as comorbidities such as mood disorders, chronic pain syndromes, and insomnia contribute to the illness burden, often to a larger extent than the gastrointestinal symptoms as such. Even though the pathophysiology of IBS is not completely known, it is now conceptualized as a disorder of altered brain-gut interactions, where a biopsychosocial model helps in understanding the symptoms. Exposure to stress is thought to play an important role overall in the pathology of IBS, as well as immune activation at least in a subgroup of patients. This thesis aimed to gain deeper understanding of the biopsychosocial mechanisms of IBS and its associations with stress, comorbidities, and fatigue. Methods Study I and II are based on the Twin cities IBS study population, which included IBS patients and a control group of other patients without gastrointestinal complaints from ten PHC centres in the county of Östergötland. Alongside demographics, psychosocial questionnaires and a GI symptom diary, it included analyses of hair cortisol concentrations (HCC) evaluated in study I, and data on self-rated health as well as diagnoses of comorbidities, and number of health care contacts from a regional registry, evaluated for study II. Study III of this thesis is based on the Brain-Gut study with a population of secondary care IBS patients, and healthy controls (HC). It included self-rated measures of fatigue impact on the daily life and early adverse life events, as well as measures of circulating TNF-α, and analyses of resting-state functional magnetic resonance imaging of brain areas within a mesocorticolimbic circuitry of known relevance for fatigue. Results Study I: Perceived stress was higher in the IBS group while a considerable portion of IBS patients had low levels of HCC. No association between perceived stress and HCC was seen in either group. Study II: IBS patients had lower self-rated health and more PHC utilization than the non-IBS patients. Good self-rated health was independently associated with younger age, higher sense of coherence and less gastrointestinal pain in both groups. In IBS, PHC utilization was associated with comorbidities in general, and sleep disorders in particular. Study III: Fatigue impact on daily life, and TNF- α were higher in IBS patients than in HC. In IBS, further an association was seen between fatigue impact on the one hand, and TNF- α, emotional abuse in childhood, as well as altered mesocorticolimbic connectivity on the other. Conclusion In conclusion this thesis firstly emphasizes that IBS patients in many ways, including health outcomes, consists a vulnerable group of PHC patients. We add evidence for a possible suppression of the stress response system in a substantial portion of IBS patients. Further, comorbid sleep disorders seem to be particularly associated with excess PHC utilization in IBS and could possibly be a target for treatment interventions. Moreover, alongside treating gastrointestinal pain, efforts to improve the individuals’ sense of coherence could be one way to achieve better self-rated health in both IBS and non-IBS patients. Finally, we suggest that fatigue in IBS is associated with immune activation, central alterations and to some extend also previous childhood trauma. IBS (Irritable Bowel Syndrome) är en vanlig, kronisk tarmsjukdom med återkommande symtom av buksmärta tillsammans med ändrade avföringsvanor. Den drabbar cirka 10% av befolkningen och är vanligast hos kvinnor samt något mindre vanlig hos äldre. För många innebär IBS ett stort lidande, försämrad livskvalitet och ökad sjukvårdskonsumtion. De flesta IBS-patienter tas om hand i primärvården. Nuvarande, tillgänglig behandling är ofta otillräcklig. En del IBS-patienter har också andra symtom, så som muskelsmärta och uttalad trötthet, som inte går över vid vila, så kallad fatigue. Det är också vanligt förekommande med andra sjukdomstillstånd såsom depression och andra smärtsyndrom. Det är visat att den typen av symtom och samsjuklighet många gånger är värre för IBS-patienten än de faktiska magtarmsymptomen. Numera tror man att symtomen vid IBS beror på störningar i det ömsesidiga samspelet mellan tarm och hjärna, men de bakomliggande mekanismerna är inte helt klarlagda. För att förstå IBS-patientens symtom är en så kallad biopsykosocial förklaringsmodell till stor hjälp, då symtomen inte bara beror av biologiska mekanismer, utan individens sociala miljö samt psykologiska reaktioner spelar också stor roll. Stress är centralt för så väl utveckling av, som symtom vid IBS och även för förståelsen av den biopsykosociala förklaringsmodellen generellt. Tidigare forskning visar också att immunsystemet är påverkat hos åtminstone en andel av IBS-patienterna. Syftet med den här avhandlingen var att nå en djupare förståelse av biopsykosociala mekanismer vid IBS med fokus på stress, samsjuklighet och fatigue. Delstudie I och II jämförde IBS-patienter och en kontrollgrupp med andra primärvårdspatienter, utan magtarmsymtom på 10 vårdcentraler i Östergötland. Delstudie III undersökte IBS-patienter på magtarmkliniken i Linköping i jämförelse med friska kontroller. I delstudie I undersökte vi kortisol i hår-nivåer, som ett mått på hur stresshormonnivåerna varit över tid. Trots att IBS-patienterna som grupp beskrev en större självupplevd stress än icke-IBS-patienterna hade en andel förhållandevis låga nivåer av kortisol i håret. I delstudie II undersökte vi hur samsjuklighet i form av totalt antal registrerade diagnoser, samt vissa specifika diagnoser och psykologiska aspekter samt magtarmsymtom, påverkade självskattad hälsa och primärvårdskonsumtion hos IBS- och icke-IBS-patienterna. I båda grupperna var lägre ålder, större känsla av sammanhang, och lägre grad av buksmärta oberoende associerat med bättre självskattad hälsa. Hos IBS-patienterna fann vi närmast en femfaldigt ökad risk att ha många kontakter med primärvården vid samtidigt diagnostiserad sömnstörning. Den kopplingen sågs inte hos patienterna utan IBS. Däremot var det totala antalet diagnoser också en faktor av betydelse för vårdkonsumtionen i båda grupperna. I delstudie III belyste vi fatigue och eventuella kopplingar till nivåer av en proinflammatorisk signalmolekyl (TNF-α) samt till självrapporterade missförhållanden under uppväxten hos IBS patienter och friska kontroller. Med funktionell magnetkameraundersökning av hjärnan undersökte vi också kopplingen mellan aktivitetsmönster i områden som är relaterade till emotionella, kognitiva och motivationsrelaterade aspekter av fatigue hos IBS patienter och friska kontroller. Vi fann att IBS-patienterna upplevde fyrfaldigt mer påverkan av fatigue på sina dagliga liv än kontrollerna. Den ökade trötthetsupplevelsen var också relaterad till högre nivåer av TNF-α i blodet hos IBS-patienterna, liksom i viss mån till missförhållanden under uppväxten. Slutligen såg vi att högre grad av upplevd fatigue hos IBS-patienterna ledde till minskad samtida aktivitet (konnektivitet) i de undersökta hjärnområdena som representerade de motivationsrelaterade och kognitiva aspekterna av trötthetsupplevelsen. Någon liknande koppling mellan TNF-α och förändringar i hjärnaktiviteten sågs ej. Sammanfattningsvis pekar våra resultat gällande samsjuklighet, självskattad hälsa, psykosociala faktorer samt fatigue på att IBS-patienterna är en sårbar patientgrupp som bör uppmärksammas. Våra resultat från delstudie I pekar vidare mot att stressaxeln kan vara uttröttad hos vissa IBS-patienter. Enligt resultaten i delstudie II är känsla av sammanhang jämte buksmärta faktorer, som bör tas i beaktande för att om möjligt uppnå bättre självskattad hälsa både hos IBS- och andra primärvårdspatienter. Vidare synes IBS-patienternas förhållandevis stora vårdkonsumtion vara särskilt avhängig av samtidig sömnstörning, vilket också det torde vara av betydelse i klinisk praxis och av intresse för framtida forskning. Delstudie III, visar ett samband mellan fatigue, som bisymtom vid IBS, och så väl barndomstrauman som möjlig immunaktivering. Vi fann även att IBS patienter som upplevde stor påverkan av fatigue på sina dagliga liv, också hade en minskad konnektivitet mellan hjärnstrukturer av betydelse för kognition och motivation.
Skin Biopsy - Diagnosis and Treatment is a collection of six chapters that includes an initial chapter on the site selection of a skin biopsy that optimizes diagnosis of various dermatological diseases and in many instances it is a therapeutic intervention and is useful in monitoring the response to therapy. The following five chapters encompass the application and role of skin biopsy to the overall diagnosis of certain conditions such as non-scarring and scarring alopecia, Langerhan cell neoplasms, severe cutaneous adverse reactions, pemphigus vulgaris and foliaceus, and oral lichen planus. An accurate diagnosis allows for an up to date discussion on the treatment of these complex conditions as the pathogenesis and the histologic findings are evolving and the therapeutic options are concomitantly emerging.