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This chapter presents a review of research concerning multisensory processing impairments in three developmental disorders: developmental coordination disorder (DCD), autism spectrum disorder (ASD), and developmental dyslexia (DD). By comparing multisensory processes across these three disorders, a number of similarities in sensory responses were noted (e.g., hypo- and hyper-sensitivity to sensory information, sensorimotor impairments). This chapter discusses whether multisensory processing abnormalities could represent a particular vulnerability or, perhaps more importantly, a particular risk factor in atypical development. Within and across disorders, possible developmental trajectories that may have led to such impairments are examined. Finally, the need for further multisensory research in developmental disorders is highlighted, and avenues for future research explored.

As a sensory and emotional experience generally associated with tissue-damaging or nearly tissue-damaging stimuli, pain might be considered to be a unitary physiological and pathological process. However, a wealth of evidence indicates that multiple mechanisms contribute to pain, each of which is subject to or an expression of neural plasticity (i.e. the capacity of neurons to change their function, chemical profile, or structure). Three principal categories of pain have been identified: physiological, inflammatory, and neuropathic. This chapter discusses these categories of pain and the mechanisms of pain hypersensitivity using the concepts of activation, modulation, and modification as applied to integration and processing of sensory inputs by the network of nociceptive neurons in the dorsal horn.

Occupational diseases are illnesses that are associated with a particular occupational or industry and result from hazards in the workplace. They are entirely preventable if hazards in the workplace are eliminated or controlled. Many occupational diseases are unique to the hazards encountered in certain workplaces and do not, or rarely, exist apart from workers. Silicosis, for example, simply does not occur unless the patient has been exposed to silica dust and this almost never occurs except in the workplace. Other occupational diseases are familiar diseases, seen in the general population, that have an occupational cause in the particular case. For example, occupational lung cancer is identical to lung cancer from smoking but may be caused by many occupational exposures, including asbestos, arsenic and polycyclic aromatic hydrocarbons. Occupational skin disorders can be broadly divided into three groups: dermatitis, skin damage, and skin cancers. Occupational lung diseases are also varied. They include occupational asthma, airway irritation, toxic inhalation, infections, hypersensitivity pneumonitis, fume fevers, pneumoconiosis, and cancer. Noise-induced hearing loss is a form of progressive deafness caused by exposure to noise. Reproductive disorders include many causes of infertility, most of which affect men more than women. Because of concern for the fetus, pregnant women should be protected from many physical and chemical exposures but are generally otherwise able to do what work they have been doing until late in the pregnancy.

The postural syndromes observed after unilateral global and selective lesions of the vestibular apparatus are discussed in the first part of this chapter. The second part includes the results that suggest that N-methyl-D-aspartate (NMDA) receptors contribute to the resting discharge of the vestibular neurons in normal guinea pigs in vivo. The third part contains the recommendation to increase the number and/or sensitivity of NMDA receptors on deafferented neurons in order to create denervation hypersensitivity. This could contribute to the functional recovery of the static reflexes in hemilabyrinthectomized guinea pigs.

This chapter examines environmental conditions and stimuli that naturally produce or facilitate aggression. The findings reveal that the stimulus classes that have the most influence on aggressive behaviour are those producing painful responses and those resulting from the withdrawal of, or reduction in, reinforcing stimuli. The result also suggests that isolation and sensory deprivation can produce increased irritability and hypersensitivity to new stimuli, resulting in aggression.

Most believe that it is worse for a person to die than to continue to exist with a good life. At the same time, many believe that it is not worse for a merely possible person never to exist than to exist with a good life. I argue that if the underlying properties that make us the sort of thing we essentially are can come in small degrees, then to maintain this commonly held pair of beliefs we will have to embrace an implausible sort of evaluative hypersensitivity to slight nonevaluative differences. Avoidance of such hypersensitivity pressures us to accept that it can be worse for merely possible people never to exist. If this conclusion is correct, then the standard basis for giving no or less priority to merely possible persons would disappear (i.e., that things cannot be better or worse for them). Though defenders of Person-Affecting Views and their opponents may still disagree in theory, they could arrive at the same answers to many monumentally important practical questions.

This chapter describes the clinical presentation of commonly-encountered occupational and environmental respiratory disorders, including principles regarding disease recognition and prevention. Where appropriate, clinical cases are included to illustrate specific diseases. The chapter begins with a general introduction to the evaluation of individuals and populations, including important considerations from the history and physical examination as well as common findings on typical diagnostic tests such as chest X-rays and other imaging studies, and pulmonary function testing. Specific disease topics covered include (a) disorders due to irritant exposures (high-, moderate-, and low-solubility irritants); (b) disorders due to nonirritant exposures (carbon monoxide and indoor and ambient air pollution); (c) occupational airways diseases (work-related asthma and occupational chronic obstructive pulmonary disease); (d) hypersensitivity pneumonitis, byssinosis, and other diseases due to organic dust exposure; and (e) pneumoconiosis (including asbestosis, silicosis, and coal workers’ pneuconiosis). Childhood asthma is discussed as a risk factor for occupationally-related lung disease.

A key outcome in medical education is the training of doctors to acquire the knowledge and understanding of the basic science that underpins clinical practice. The graduate will be able to apply to medical practice biomedical scientific principles, method and knowledge relating to: anatomy, biochemistry, cell biology, genetics, immunology, microbiology, molecular biology, nutrition, pathology, pharmacology and physiology .’ (Tomorrow’s Doctors 2009, GMC, UK). In this, the last of the themed chapters of questions that map to the Oxford Handbook of Medical Sciences, we will test knowledge of infectious diseases and the host immune responses that counteract them. Despite the shift of the world health problem to non-communicable diseases in recent times (Global status report on non-communicable diseases 2010, World Health Organization), infectious diseases remain a major health problem in many parts of the world. Even in developed countries, epidemics and outbreaks of infections are not infrequent events, pandemics sporadically crop up at the least expected times. In addition, microorganisms constantly evolve to escape the host immune response and to develop resistance to treatments that have been developed. Therefore, we have no choice but to keep up our knowledge and to develop new treatments.

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52-year-old man presents to the clinic for review some six weeks after starting phenytoin for complex partial seizures. He is very concerned as he has a rash which began on his face but quickly spread over the upper body. It begins as large,...

Pharmacology is defined as the study of the effects of drugs on the function of a living organism. It is an inte­grative discipline that tackles drug/ compound behaviours in varied physiological systems and links these to cellular and molecular mechanisms of action. As a scientific endeavour, pharmacology evolved from the early identification of therapeutic properties of nat­ural compounds, with herbal medicines and relatively complex pharmacopoeias widely used in early cultures. Despite this, lack of understanding of the physio­logical, pathological, and chemical processes governing the human body prevented the early establishment of pharmacology as a scientific discipline. Since then, pharmacology has progressed to be considered a fully developed integrative science that employs techniques and theories from various disciplines, such as chemistry, biochemistry, genomics, medicinal chemistry, physi­ology, and cellular and molecular biology. Collectively, these are applied to study disease causality and the rele­vant mechanistic action of compounds, to establish new treatments. In the last 100 years, the importance of clinical pharmacology has increased in line with the scientific and technological advances in biomedical research. Benefits gained from molecular and cellular approaches have enabled a more comprehensive analysis of drugs and their actions in functional context. Now, clinical pharmacology and therapeutics encompass the dis­covery, development, regulation, and application of drugs in a process that integrates scientific research with clinical practice to better treat illness and preserve health. Within this textbook the principles of pharmacology are discussed by therapeutic area so that the reader can link disease pathophysiology, drug mechanism, and modern prescribing behaviours for conditions commonly seen in clinical practice. There are, however, fundamental concepts that are universal in understanding the interaction between drugs and their ‘targets’, including receptor pharmacology, genomic pharmacology, and pharmacokinetics. The pharmacological receptor models preceded by many years the knowledge of the receptor as an entity. It was not until the last 150 years that a series of contributions from many notable biologists and chemists established the principles that founded modern day pharmacology. They produced a significant paradigm shift in therapeutics, where empirical descriptors of the activities observed (heating, cooling, moistening, emetic, etc.) were replaced by the concept of a ‘target’. After more than a century, the basic receptor concept is still the foundation of biomed­ical research and drug discovery.

Ethics in the tradition of Derek Parfit’s Reasons and Persons is riddled with sorites-like arguments, which lead us by what seem innocent steps to seemingly false conclusions. Take, for example, spectrum arguments for the Repugnant Conclusion that appeal to slight differences in quality of life. Several authors have taken the view that, since spectrum arguments are structurally analogous to sorites arguments, the correct response to spectrum arguments is structurally analogous to the correct response to sorites arguments. This sorites analogy is here argued against. There are potential structural disanalogies between spectrum arguments and sorites arguments. But even if these arguments are relevantly structurally analogous, they differ in their content in ways that show the sorites analogy to be implausible. Two content-based disanalogies are here explored—one is inspired by Parfit’s work on reductionism, and the other involves hypersensitivity. The chapter concludes with a methodological lesson.

Intuitively there are many things that non-derivatively contribute to well-being: pleasure, desire satisfaction, knowledge, friendship, love, rationality, freedom, moral virtue, and appreciation of beauty. According to pluralism, at least two different types of things non-derivatively contribute to well-being. Lopsided lives score very low in terms of some types of things that putatively non-derivatively contribute to well-being, but very high in terms of other such types of things. This chapter argues that pluralists essentially face a trilemma about lopsided lives: they must either make implausible claims about how they compare in terms of overall well-being with more balanced lives, allow overall well-being to be implausibly hypersensitive to very slight nonevaluative differences, or adopt implausible seeming limits on what things lives can contain or how much they can contribute to overall well-being. Such problems about lopsided lives push us away from pluralism and toward simpler theories of well-being, toward hedonism in particular.