bluuebunny/crossref_metadata_2025 huggingface dataset:
RealityConvert: a tool for preparing 3D models of biochemical structures for augmented and virtual reality
Authors: Borrel Alexandre , Fourches Denis
Published: August 2017

Motivation

There is a growing interest for the broad use of Augmented Reality (AR) and Virtual Reality (VR) in the fields of bioinformatics and cheminformatics to visualize complex biological and chemical structures. AR and VR technologies allow for stunning and immersive experiences, offering untapped opportunities for both research and education purposes. However, preparing 3D models ready to use for AR and VR is time-consuming and requires a technical expertise that severely limits the development of new contents of potential interest for structural biologists, medicinal chemists, molecular modellers and teachers.

Results

Herein we present the RealityConvert software tool and associated website, which allow users to easily convert molecular objects to high quality 3D models directly compatible for AR and VR applications. For chemical structures, in addition to the 3D model generation, RealityConvert also generates image trackers, useful to universally call and anchor that particular 3D model when used in AR applications. The ultimate goal of RealityConvert is to facilitate and boost the development and accessibility of AR and VR contents for bioinformatics and cheminformatics applications.

Availability and implementation

http://www.realityconvert.com

Supplementary information

Supplementary data are available at Bioinformatics online.
Self-Injurious Behaviors
Authors: Carrión Victor G. , Turner John A. , Weems Carl F.
Published: August 2017

Self-injurious behaviors represent a heterogeneous group of behaviors that affect the individual negatively either in a physiological, physical, and/or emotional manner. Many children who have survived a traumatic event engage in nonsuicidal self-injury (NSSI) as a diversely expressed, maladaptive coping mechanism that has been associated with a variety of negative outcomes across the lifespan. The current chapter discusses the preclinical literature that informs our understanding of these behaviors, the various instruments used to assess them, and research on adults and children who engage in self-injurious behaviors (SIB). Several theoretical models for the neurological substrates of SIB are compared, suggesting that SIB use several parts of the brain to manage otherwise uncontrollable cascades of negative affect in PTSD. Challenges, such as the stigma surrounding SIB engagement and its strong association with borderline personality disorder, as well as future directions, including potential SIB directed pharmacological interventions, are discussed.
Three Patients with Body Dysmorphic Disorder : Cases and Commentary
Authors: Phillips Katharine A. , Simmons Rachel A. , Donahue Joseph
Published: August 2017

This chapter provides three representative case descriptions of individuals with body dysmorphic disorder (BDD). These cases convey BDD’s core, universal features: appearance preoccupations, resulting repetitive behaviors (rituals, compulsions), and resulting distress or impairment in functioning. The cases also convey the broader range of symptoms that patients experience and the different ways in which BDD can manifest in patients’ lives. We additionally illustrate two variants of BDD: muscle dysmorphia and BDD by proxy. We follow each case with a commentary in which we discuss some key aspects of each patient’s presentation.
Insight and Delusional Beliefs in Body Dysmorphic Disorder
Authors: Phillips Katharine A.
Published: August 2017

This chapter discusses insight (“delusionality”) in body dysmorphic disorder (BDD). BDD beliefs span a broad range of insight, from good to absent insight (i.e., delusional beliefs). About 70% of patients have poor or absent insight. Early emerging clues suggest possible neurobiologic bases of poorer insight in BDD. BDD’s delusional form (characterized by the absence of insight) appears to be the same disorder as its nondelusional form rather than a separate psychotic disorder. Consistent with this, serotonin-reuptake inhibitor (SRI) monotherapy is efficacious for delusional BDD as well as nondelusional BDD. Neuroleptic (antipsychotic) monotherapy is not currently recommended for delusional BDD. Cognitive-behavioral therapy (CBT) appears efficacious for both delusional and nondelusional BDD, but research is needed to determine whether a somewhat modified approach may be helpful for delusional beliefs. Insight often improves with SRIs and CBT.
Neurobiology of Body Dysmorphic Disorder : Heritability/Genetics, Brain Circuitry, and Visual Processing
Authors: McCurdy-McKinnon Danyale , Feusner Jamie D.
Published: August 2017

This chapter covers studies addressing neurobiologic factors that may contribute to body dysmorphic disorder (BDD). There are indications that neurobiologic abnormalities are associated with symptoms in BDD. This includes evidence that the susceptibility for BDD may be partly heritable and that there may be shared genetic factors among the obsessive-compulsive and related disorders (of which BDD is a member) as a group. In addition, studies of brain circuitry in BDD implicate white matter and structural connectivity abnormalities as playing possible roles in the pathophysiology of BDD. Furthermore, studies of visual processing suggest that disturbances in visual perception and visuospatial information processing, characterized by heightened attention to detail and impairment in holistic and global assessment, are also contributory.
Environmental Factors in Body Dysmorphic Disorder
Authors: Neziroglu Fugen , Barile Nicole
Published: August 2017

Despite its prevalence, the etiology and pathogenesis of body dysmorphic disorder (BDD) has yet to be fully elucidated due to this disorder’s complexity. Research into causal and contributory factors has been limited, yet there is emerging evidence that environmental factors play an important role and, furthermore, that specific environmental factors may be characteristic of BDD and possibly contribute to the development and maintenance of the disorder. Sociocultural pressures to achieve physical perfection; factors such as teasing/bullying, abuse, and perceived childhood maltreatment; heighted aesthetic sensitivity; and possibly certain personality traits may all be important. Factors such as these, coupled with biologic factors that include genetic heritability and deficits in visual processing, may significantly contribute to both the development and maintenance of the disorder. More research is needed to understand the specific factors that lead to this disorder to better assist with the development of evidence-based psychological treatment.
Cognitive-Behavioral Therapy for Body Dysmorphic Disorder
Authors: Rasmussen Jessica , Gómez Angelina F. , Wilhelm Sabine
Published: August 2017

Cognitive-behavioral therapy (CBT) that is tailored to the unique clinical features of body dysmorphic disorder (BDD) is currently the psychosocial treatment of choice for BDD. Researchers have made great strides in understanding the cognitive-behavioral processes that contribute to the development and maintenance of BDD. CBT for BDD is based on this theoretical understanding and has been shown to be highly effective in reducing BDD symptom severity and associated symptoms. The key components of CBT include identifying and rationally disputing maladaptive appearance-related thoughts, and exposure with response prevention for feared and avoided situations. CBT for BDD also integrates educating the patient on the mental and behavioral processes involved in the BDD experience with mindfulness/perceptual retraining (e.g., techniques aimed at helping patients to view their appearance with a neutral, global, and aware perspective) to augment the therapeutic process. Advanced cognitive strategies are used to address negative core beliefs. Because BDD is typically characterized by poor or absent insight, motivational interviewing is often needed to overcome ambivalence towards treatment.
The Relationship Between Body Dysmorphic Disorder and Social Anxiety Disorder
Authors: Kelly Megan M. , Kent Mark
Published: August 2017

Body dysmorphic disorder (BDD) and social anxiety disorder (SAD) are highly comorbid disorders that share high levels of social anxiety, social avoidance, and rejection sensitivity. In addition, in emotional processing studies, patients with BDD and SAD both show a heightened sensitivity to hostility. However, BDD and SAD differ in many important ways, including key phenomenologic and clinical differences as well as treatment approaches. This chapter reviews similarities and differences between BDD and SAD across demographic, clinical, biologic, and other domains. Future research directions for work that may further elucidate the relationship between these two disorders are also discussed.
Introduction to Disruptive Behavior Disorders
Authors: Hans Steiner , Whitney Daniels , Michael Kelly , Christina Stadler
Published: August 2017

This chapter introduces the history of disruptive behavior disorders. The achievements of the Chicago Reformers, who introduced the idea that juveniles should be granted exceptions before the law based on their immaturity, began the process of bringing the world of development, psychiatry, and medicine to delinquents. August Aichhorn, the director of the Vienna Reform School system, is primarily responsible for the idea that abnormal development underlies crime, and, as such, psychoeducational approaches can be helpful in restoring the youth. The concepts of treatment and rehabilitation factor in to this view. The chapter ends by introducing the complexities of diagnosing antisocial and aggressive behavior.
Taxonomy, Classification, and Diagnosis of Disruptive Behavior Disorders
Authors: Hans Steiner , Whitney Daniels , Michael Kelly , Christina Stadler
Published: August 2017

This chapter traces the development of diagnoses attempting to capture antisocial and aggressive behavior. The chapter provides a careful discussion of the advantages of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases systems and their diagnostic grouping. Tracing the processes by which these diagnoses were created, the hidden and obvious problems in the current taxonomy are laid bare. The model of developmental psychopathology, of which disruptive behavior disorders arguably have been called a model disorder, provides concluding comments, which point to the advantages of another taxonomy that hold the promise of improving the state of the current descriptive systems.
Epidemiology of Disruptive Behavior Disorders
Authors: Hans Steiner , Whitney Daniels , Michael Kelly , Christina Stadler
Published: August 2017

This chapter summarizes the available epidemiological evidence supporting the current diagnoses grouped in the disruptive behavior disorder (DBD) cluster. It seems DBDs are common disorders, but although researchers have made great strides in capturing the prevalence of these disorders in normal and clinical populations, and although there are some very solid longitudinal findings, there are still many unknowns that need to be corrected. Most of the difficulties encountered in epidemiology are a function of the ongoing changes in the descriptive diagnostic criteria and the lack of a truly state-of-the-art three-level epidemiological design. This chapter discusses these issues including implications for clinical practice.
Comprehensive and Integrated Treatment of Disruptive Behavior Disorders
Authors: Hans Steiner , Whitney Daniels , Michael Kelly , Christina Stadler
Published: August 2017

This chapter maps evidence-based interventions on the biopsychosocial model of causation suggested by the current evidence. Medications and biological treatments are still second-line interventions, which should be considered only if there is insufficient progress with psychological and social-familial treatments. There is very little progress in the past decade in testing medication interventions. New findings from neuroscience suggest another subtype of disruptive behavior disorders (DBDs), which holds considerable promise to improve outcomes in this treatment category. Psychological treatments are best supported by the evidence, especially when delivered in manualized form with a high degree of treatment fidelity. Familial and community-based interventions are also well supported, especially in complex, severe and chronic cases. There is a dearth of intervention studies targeting the different phenotypes of antisocial and aggressive behavior and studies of integrated treatment However, many studies are now available that approach treatment from a medical evidence–based rather than criminological perspective.
Team-Based Integrated Primary Care
Authors: Rosenberg Tziporah , Fogarty Colleen T. , Privitera Michael R , McDaniel Susan H.
Published: August 2017

With the advent of major reform in health care delivery systems, team-based approaches to primary care are becoming standard, inviting expansion of the role of the psychiatrist as part of those teams. Teams of interdisciplinary professionals expand access to primary care and the connection to specialty care for those who need the most support. This chapter describes the typical roles in integrated primary care teams, including those filled by a psychiatrist. The authors discuss the differences between traditional mental health and primary care cultures and adapting to the needs of primary care through transdisciplinary collaboration. An overview of the potential levels of collaboration is provided. The authors describe their own long-term experience with integrated primary care in the Department of Family Medicine at the University of Rochester. The chapter concludes with a discussion about the future of psychiatric care within primary care teams as well as population management for those with comorbid illness.
The Patient-Centered Medical Home
Authors: Conry Colleen , Levy Shandra Brown , Jortberg Bonnie T.
Published: August 2017

The Patient-Centered Medical Home (PCMH) involves an organizing set of principles for the delivery of primary care that has become widely accepted by primary care medical associations, policymakers, businesses, and insurance companies. The PCMH places the patient at the center of the delivery of care. One physician directs the patient’s care. The PCMH emphasizes a whole-person orientation and coordinated care, including integration of physical health with behavioral health. Care is coordinated across the health care system. Use of a PCMH enhances access to medical care and ensures quality and safety. This chapter reviews the history of the PCMH and discusses joint principles of the PCMH; models of care, space, and payment; and the newer concept of the “medical neighborhood.”
Financing Integrated Care Models
Authors: Schwartz Bruce J. , Stein Gillian , Wetzler Scott
Published: August 2017

The idea that addressing behavioral health issues will generate sufficient cost savings in the general medical sector to reduce overall health care spending is a poignant argument for integrating primary care and behavioral health care programs. The enactment of recent health care legislation, particularly the Mental Health Parity and Addiction Equity Act (2008) and the Affordable Care Act (2010), affords a unique opportunity to transform the way in which care is funded. This transformation is vital to the integrated care project. This chapter outlines the history of integrated care financing and the separation of mental and physical health care systems and discusses reimbursement strategies that have been suggested to replace fee-for-service models. The authors argue that the success of the medical cost offset hypothesis depends on targeting high-cost patients, as well as moving away from siloed reimbursement toward global budgeting.
Aging Brain Care
Authors: Alder Catherine A. , Austrom Mary Guerriero , LaMantia Michael A. , Boustani Malaz A.
Published: August 2017

While fragmented care is a problem across the entire health care delivery system, it is especially problematic for vulnerable older adults with dementia and late-life depression. Most older adults have multiple chronic conditions. Cognitive impairment and mood disorders complicate the management of these comorbid conditions by interfering with the patient’s ability to monitor and report symptoms and comply with the care plan. To reduce fragmentation and promote integrated care, each medical provider must adopt a more holistic view of health care, recognizing the importance of communication and collaboration among all providers and the potential impact of any one action on the patient’s overall health. The Aging Brain Care (ABC) model provides a structure for integrating evidence-based interventions for dementia and depression into the primary care environment. By extending the delivery of care beyond the clinic, ABC offers patient-centered services aimed at coordinating care across multiple providers, settings, and community resources.
Telehealth in an Integrated Care Environment
Authors: Voyles Debbie , Waugh Maryann , Shore James H. , Lippolis L. Charolette , Lyon Corey
Published: August 2017

The health care industry is evolving in response to increasing costs, poor health outcomes, and consumer dissatisfaction. Integrated care is a critical component of health care evolution, recognizing the particular burden of untreated behavioral health issues on both physical and behavioral health care outcomes and costs. Telehealth, the use of technology to provide care at a distance, is a flexible process adaptable to a variety of integrated care applications and models. Telehealth (telepsychiatry, telebehavioral health, telemental health) can help maximize limited resources and expand the reach of psychiatrists and other limited specialty providers. As evidenced in a strong and growing research base, telehealth can support integrated care, as well as forward its application in new and innovative ways across the integration continuum. This chapter provides examples of current telehealth supported care integration models along the Substance Abuse and Mental Health Services Administration (SAMHSA)’s articulated integration continuum.
Automated Mental Health Assessment for Integrated Care
Authors: Shedler Jonathan
Published: August 2017

Mental health conditions are prevalent in primary care and general medical settings. Health care policy organizations recommend routine mental health screening, but the screening tools most often used in medical settings do not meet medical providers’ clinical needs and have had little impact on patient outcomes. The Quick PsychoDiagnostics Panel (QPD Panel) is a computerized, fully automated mental health assessment test designed to meet the specific real-world needs of busy medical providers. It screens for 11 common mental health conditions and provides actionable information for treatment decisions. The QPD Panel is self-administered by patients, typically in the clinic waiting room using a tablet device. Providers immediately receive a computer-generated, chart-ready assessment report. The QPD Panel achieves high physician and patient acceptance in real-world clinical use. This chapter describes the benefits of the QPD Panel in primary and integrated care medical settings and discusses its rationale and development.
Integrated Care for Anxiety Disorders
Authors: Davies Robert D. , Guillemet Isabelle , Trosterman Adam
Published: August 2017

Anxiety disorders are among the most common psychiatric disorders in the general population and among patients in primary care settings. However, the majority of anxiety disorders go unrecognized and untreated in primary care practices. The most common anxiety disorders in primary care settings are panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. These disorders are readily treated with medications and/or evidence-based therapies once accurately identified and diagnosed. This chapter will describe targeted, high-yield screening practices for anxiety disorders, as well as collaborative, integrated treatment pathways for primary care settings and integrated health care environments.
The Treatment of Schizophrenia Spectrum and Other Psychotic Disorders in Integrated Primary Care
Authors: Lowdermilk Elizabeth , Joseph Nicole , Feinstein Robert E
Published: August 2017

Many patients with psychotic disorders, for systemic and personal reasons, are treated in primary care, even though there currently are no evidence-based integrated care models supporting this practice. This chapter describes the screening and salient clinical features of schizophrenia and psychotic disorders, management of emergencies, the biopsychosocial-cultural evaluation, differential diagnosis (medical and psychiatric), and medications and other treatments that can be delivered by an integrated multidisciplinary team. Psychiatric specialty services are also described, so that primary care referrals to specialty psychiatric services can be offered. Special considerations are outlined for the care and treatment of psychotic women and psychotic geriatric populations. The Denver Health Medical Center’s model of integrated care is introduced, including lessons learned during its development and implementation. An integrated care model for the treatment of psychotic disorders in primary care is proposed that unites best practices of specialty psychiatric care with the fundamentals of integrated care.
Treating Substance Use Disorders in Integrated Care Settings
Authors: Pade Patricia , Martin Laura , Collins Sophie
Published: August 2017

Addiction and substance use disorders (SUDs) are extremely prevalent and are commonly encountered in the primary care setting. The traditional separation of SUD treatment from mainstream medicine has not been an optimal model of effective patient care. Primary care providers can play a crucial role in the recognition, intervention, and treatment of SUDs. This chapter provides an overview of the assessment process, intervention strategies, and pharmacologic and nonpharmacologic treatments that can be effectively implemented in an integrated care environment or primary care setting for a variety of SUDs. The integration of SUD treatment into integrated care environments holds the promise of improving acceptability to patients, decreasing the stigmatization of SUDs, enhancing satisfaction for providers, and improving outcomes for patients.
Treating Somatic Symptom Disorder and Illness Anxiety in Integrated Care Settings
Authors: Landa Alla , Makous Marina , Fallon Brian A.
Published: August 2017

Somatic symptom and illness anxiety disorders are highly prevalent conditions that are not adequately recognized and treated in many countries around the world. This chapter reviews the best world practices in diagnosing and treating these conditions in integrated care settings. The authors suggest that a paradigm shift in the health care culture and organizational structure toward the abandonment of mind–body dualism and establishment of a biopsychosocial model of care is essential for successful identification and treatment of these challenging disorders. This includes the integration of medical, psychiatric, and special psychosomatic treatments; a multidisciplinary team approach; and stepped organization of care. Targeting the multidisciplinary teams of clinicians and health care organizations and using a systems approach to health care reorganization, this chapter highlights treatment approaches and care pathways for these conditions that have been shown to be clinically effective and to reduce costs and inefficient use of health care resources.
Death and Dying
Authors: Brewer Anne A. , Connelly Joseph V.
Published: August 2017

A multidisciplinary team can be most effective when dealing with issues of death and dying. This chapter describes how an integrated practice, using resources both within the practice and in the larger community, can best manage a patient during this challenging time. When done well, integrated care can have a profoundly positive effect on both the patient and the patient’s family. This chapter describes how an integrated multidisciplinary team, in a primary care practice, manages key issues in caring for the dying patient. Such issues include advance care planning; communicating bad news; managing medical, emotional, and spiritual issues; palliative care; hospice; and bereavement care.
Health Coaching in Integrated Care
Authors: Feinstein Marilyn S , Feinstein Robert E.
Published: August 2017

Health care in the United States is in transition. Facilitating individual patient and population-based lifestyle change is critical for creating a healthier country. Fostering prevention, promoting lifestyle change, and dealing with the high incidence and prevalence of chronic disease is within the purview of health coaching, a new health discipline. This chapter describes the emergence, theories and methodologies, and efficacy of health coaching. We describe health coaching in practice, as primary care and integrated care environments begin to incorporate health coaching within multidisciplinary health care teams. Five major coaching approaches are discussed: the transtheoretical model (stages of change), motivational interviewing, solution-focused coaching, cognitive-behavioral coaching, and mindfulness-based stress reduction. An example of a brief coaching session is presented.
Crisis Intervention in Integrated Care
Authors: Simpson Scott A. , Feinstein Robert E.
Published: August 2017

A crisis occurs when a life stressor overwhelms a person’s ability to cope with a problematic life situation. Crises often become evident in the primary care setting. People in crisis feel distressed and alone; they experience a psychological disorganization that affects their mood and functioning. Most patients can benefit from a brief crisis intervention treatment delivered in an integrated care environment. Behavioral health specialists can lead crisis intervention therapy with the support of the primary care provider, nurses, staff, and a consulting psychiatrist. Crisis intervention treatment includes identifying the life stressor, understanding the patient’s response to stress, assessing the patient’s social system, listing possible solutions to the crisis, and working to implement those solutions. As the crisis resolves, the integrated team provides anticipatory guidance for the patient and primary provider.
Best Practice for Family-Centered Health Care
Authors: Stratton Joanna Sturhahn , Buck Katherine , Heru Allison M.
Published: August 2017

The patient-centered medical home is a strong model of care that can be improved by harnessing the power of the patient’s family. This chapter highlights a three-step model of family involvement in patient care: (1) family inclusion, (2) family education and support, and (3) family systems therapy. The model is grounded in evidence-based research and incorporates the essential components of integrated care. A clinical case example illustrates how to involve the family in a stepwise progression. This model of family-centered care is applicable in any health care setting.
Group Interventions in Integrated Care Settings
Authors: Rothberg Brian , Lum Hillary D.
Published: August 2017

Group interventions offer effective and efficient ways to educate patients, treat illnesses, and facilitate healing and support for a variety of physical, emotional, and social challenges. Patients feel vulnerable and fearful when ill and value the opportunity to tell their narratives in cohesive groups. Group interventions can target specific diseases, symptoms, skill-building strategies, life stages, or vulnerable patient populations to help improve patient, disease, and health care outcomes within integrated health care settings and other specialty practices. In integrated care settings, group interventions inherently use multidisciplinary teams to deliver care at the highest level of each staff member’s training. When restructuring medical practices to include group medical visits, important considerations include thorough training of group facilitators, strong administrative support, adequate clinical space, and a navigable billing structure. In addition to professionally led groups, peer-led support groups can empower patients to adopt healthy behaviors.
Foundations for Clinical Neurology
Authors: Laureno Robert
Published: August 2017

Part 1 of this book deals with the practice of neurology. It comments on neurologic history-taking, including observations of patient gestures. It also discusses the neurologic examination and its quantification. Magnetic resonance and computerized tomographic brain imaging are compared and contrasted. The importance of gravity, timing of scans, and plane of section of scans are emphasized. Neurologic diagnosis and its pitfalls are discussed. Neurologic treatment, empirical approaches to therapy, and the provision of hope and reassurance are emphasized. In Part 2, symmetry in neurologic disease as a clue to metabolic cause is a major topic. Selective vulnerability of brain areas to trauma, anoxia, toxins, and other diseases are discussed. Diseases of rapid normalization including myelinolysis are described. Carotid stenosis, berry aneurysm, arteriovenous malformations and other examples of asymptomatic disease comprise a final chapter in this section. Part 3 comments on special topics in neurology. Major attention is given to neurologic terminology, its origins, evolution, eponyms, and politics. The rise, fall, and evolution of neurologic concepts are described. Consideration is given to classifications and causation in neurology. The phenomena of decussation and asymmetry in neurology are discussed.
At the Bedside
Authors: Laureno Robert
Published: August 2017

The chapter “At the Bedside” examines neurologic history-taking with special attention paid to the importance of clarifying the use of terms between physician and patient, the use of gestures and demonstration in eliciting accurate symptom recall, evaluating input from witnesses and family members, and observing patient demeanor and emotional status. The chapter also describes and evaluates popular neurologic examination methods with comments on quantification, selection, and appropriate application of various standardized tests. Helpful guidance on performing examinations of strength, sensory perception, mental status, and memory is also provided. The physician is encouraged to develop his or her own succinct, quickly applied, and easily replicated tests to aid in the diagnosis of neurologic disorders.
Imaging
Authors: Laureno Robert
Published: August 2017

This chapter on “Imaging” examines the relative advantages and disadvantages of computed tomography (CT) and magnetic resonance imaging (MRI) scans. It compares the modalities to each other and to gross neuropathology. For several decades, neurologists have been able to view cross-sectional images of living patients. Analogous to gross neuropathology, cross-sectional imaging displays the brain as an entire organ but does not demonstrate microscopic tissue or cellular pathology. By allowing practitioners to view sections of brain and spinal cord in vivo, imaging has improved neurologic practice and facilitated clinical research. This chapter deals with imaging topics that are important to the neurologist. The timing of scans, the effects of gravity, and the importance of plane of section are considered. Imaging is compared to gross neuropathology, and MRI is compared to CT.
Normalization
Authors: Laureno Robert
Published: August 2017

This chapter on “Normalization” examines neurologic diseases due to rapid normalization of systemic medical problems. Hyperglycemia, acidosis, hyponatremia, hypernatremia, uremia, and arterial hypertension are considered. Rapid normalization of a systemic medical disorder can cause neurologic disturbance and disease. Treatment of diabetes, uremia, and certain electrolyte disorders are examples. Stopping regular use of a medication would seem to bring the body to a more normal (unmedicated) state, but, in some cases, there are neurologic complications to rapid cessation. Likewise, a withdrawal syndrome can follow sudden cessation of a regularly used nonmedicinal chemical, causing neurologic withdrawal phenomena. Not all normalization disorders are chemical or metabolic. Rapid correction of increased intracranial pressure or rapid lowering of severe arterial hypertension are examples.
Asymmetry
Authors: Laureno Robert
Published: August 2017

This chapter on “Asymmetry” examines the topic of normal neurological asymmetries and their implications for disease states. Neurologists encounter asymmetry daily. They regularly see asymmetry of pupil diameter, and alpha rhythm amplitude differences are frequently found between the right and left sides on a scalp recording. Not all of the asymmetries are important. However, neurologists must be aware of the anatomic asymmetries that occur. Within limited ranges, these asymmetries are “physiologic.” Asymptomatic developmental asymmetries can become important when disease is superimposed on congenital vascular variants. This chapter comprises discussion of several topics about central nervous system asymmetries and their importance to the neurologist.
Lowly Origins
Authors: Laureno Robert
Published: August 2017

This chapter, “Lowly Origins,” examines the evolution of the nervous system and its implications for clinical neurology. Topics include peripheral nerve anatomy, extraocular muscles, and physiologic circuits related to respiration. Human neuroanatomy and neurologic disease carry a record of our vertebrate ancestors, and neurology is more understandable when the clinician is attuned to our ancient neurological circuits. The extraocular muscles are a prime example. Although the extraocular muscles have changed their orientation to the axis of the eye, and although not all of these muscles are as important as they once were, these muscles of the human eye have otherwise changed little from those of the shark. They remain similar in appearance and consistent in innervation. They are the best conserved muscles in all of vertebrate evolution. The development of limbs, loss of gills, assumption of bipedal locomotion, and development of a huge brain has had virtually no effect on them.
Outreach in Community Mental Health Care
Authors: Burns Tom , Firn Mike
Published: August 2017

The last 50 years has witnessed a radical change in the care of the severely mentally ill as asylums have closed and care has moved to the community. Two developments have marked this transition. The first is the development of multidisciplinary community mental health teams (CMHTs). The second is an increasing reliance on outreach to engage and support the most seriously ill patients. This book is a guide for those, whatever their professional background, who work in CMHTs. It focuses on the practicalities of the job—what they all need to know, whether coming to it from social work, nursing, or psychology. It is based on our decade of working together in an assertive outreach team and our backgrounds in nursing and psychiatry in a range of CMHTs.The book is in three parts. The first addresses the underlying principles of the practice and its variations. It explores the themes that are common to all outreach work and the specific thinking and practice characterizing different teams and settings. The second section addresses the range of problems faced by the outreach worker. These include the challenges presented by different diagnoses, plus those of hostility, homelessness, suicidality, and the omnipresent complications of drug and alcohol abuse. Psychosocial interventions aimed to promote employment and social stability are outlined with clinical examples. The third section explores the structural issues of managing the team, providing effective supervision, and conducting research. We draw on relevant research when appropriate, but the style of the book is practical, based primarily on accumulated experience.
Who is assertive outreach for? Referrals and discharges
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter examines the characteristics of patients who need community outreach. It identifies those who most often receive it and those for whom it seems to add little extra. It considers dual diagnosis patients, offender patients, ethnic minority patients, and patients with co-occurring learning disabilities. It also considers the balance between positive and negative symptoms in psychosis and also its suitability for first-onset psychosis. It discusses the value of explicit criteria for both acceptance and discharge and the nature of step-down where that is an option. The processes of acceptance and discharge, with their necessary collaboration, are outlined.
Model variance and model fidelity: The lessons from ACT
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter takes the assertive community treatment (ACT) model of community outreach as a starting point and examines what can and what cannot be varied and still achieve good results. ACT has a special place in community outreach as it was the first model of care confirmed by research, and controversy has raged about the need, or otherwise, for ‘model fidelity’. The chapter identifies the core ingredients—small caseloads, in vivo psychosocial treatments, mainstreaming, flexibility, 24/7 availability—and examines the evidence for and against them. It pays particular attention to the roles of support workers and the medical member of the team. Later developments such as flexible assertive outreach (FACT) are also described.
Compulsion and freedom
Authors: Burns Tom , Firn Mike
Published: August 2017

Outreach is particularly needed for patients with limited insight into their need for treatment. This chapter examines the concept of insight and the practices used to support it and to ensure treatment despite its limitations. Balancing individual liberty and recovery against the need for effective treatment is a constant challenge for outreach workers. Internationally, levels of compulsion are increasing. Compulsion has expanded beyond the hospital into the community despite the absence of evidence that such community treatment orders (CTOs) have any significant benefits for patients. Different forms of informal coercion, including leverage, are described along with practices to protect the therapeutic relationship when compulsion has to be used. The power imbalance in the therapeutic relationship is explored and the risks for unwitting abuse noted.
Medication compliance
Authors: Burns Tom , Firn Mike
Published: August 2017

Differing terms are used for compliance, including concordance and adherence. This chapter examines the range of obstacles to compliance, including side effects, lack of insight, lack of effectiveness, and resistance to being reminded of the illness. The influence of family and friends is also considered. We believe it is often best to avoid complex explanations, and just accept that it is difficult to remember to take medicines regularly for months and years. Several strategies exist to improve compliance, including depot preparations, psycho-education, and efforts to strengthen the therapeutic relationship. Compliance therapy, based on motivational interviewing, is described in detail. The outreach worker is also uniquely able to rely on prompting and support as well as careful monitoring and structuring the clinical interview to ensure that compliance is regularly assessed. Supporting compliance is a long-term commitment, not a once-off intervention.
Hostility
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter discusses the politics, incidence, assessment, and management of challenging, hostile, and violent behaviour from the perspective of practising community outreach with people with more severe and enduring mental health problems. As a way of establishing risk factors, data are presented on incidence of hostility in both community and inpatient settings along with the research evidence on associations between severe mental illnesses, such as psychosis, substance misuse, and violence. Methods and frameworks for risk assessment are presented and critiqued. Risk management techniques with individuals are demonstrated and illustrated through case studies. Community team training, policies, procedures, support, and supervision are presented as examples of best practice.
Finance and appointeeship
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter describes the broad sweep of benefits, other sources of help, and practical interventions such as appointeeship, also known as representative payeeship, to help people with more severe mental health problems manage their money and keep their community tenure. The challenges of access to financial help and complex eligibility rules for patients and carers are covered. Legal frameworks are described for people deemed incapable of managing their own affairs, including the Court of Protection and Lasting Power of Attorney.
Housing and homelessness
Authors: Burns Tom , Firn Mike
Published: August 2017

Mental illness is both a cause and sometimes a consequence of homelessness. The prevalence of mental illness in the homeless is greater than for the population as a whole. The chapter considers the evidence for whether the closure of long-stay psychiatric hospitals has added to the problem, and to what extent other factors are at play. Types of social housing and residential support are presented together with the legal framework for entitlement to housing. Programmes aimed at people with long-term homelessness and severe mental illnesses, such as Housing First, are presented with evidence for effectiveness.
Head and neck pathology
Authors: Carton James
Published: August 2017

This chapter discusses head and neck pathology and covers benign oral cavity diseases, oral/oropharyngeal carcinoma, benign sinonasal diseases, sinonasal malignancies, nasopharyngeal diseases, benign laryngeal diseases, laryngeal carcinoma, odontogenic cysts, jaw bone neoplasms, and neck lumps.
Renal pathology
Authors: Carton James
Published: August 2017

This chapter discusses renal pathology, including acute kidney injury (AKI), chronic kidney disease (CKD), nephrotic syndrome, hereditary renal diseases, Alport’s syndrome and thin basement membrane lesion, hypertensive nephropathy, diabetic nephropathy, minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous glomerulopathy, glomerulonephritis, IgA nephropathy, post-infectious glomerulonephritis, C3 glomerulopathy, anti-glomerular basement membrane disease, monoclonal gammopathy-associated kidney disease, acute tubular injury, acute tubulointerstitial nephritis, reflux nephropathy, and obstructive nephropathy.
Urological pathology
Authors: Carton James
Published: August 2017

This chapter discusses urological pathology and covers diseases of the urinary tract managed by urologists. This includes genitourinary malformations, urinary tract infection, urinary tract obstruction, urinary calculi, cystic renal diseases, benign renal tumours, renal cell carcinoma (RCC), childhood renal tumours, urothelial carcinoma, benign prostatic hyperplasia (BPH), prostate carcinoma, testicular germ cell tumours, testicular non-germ cell tumours, paratesticular diseases, urethral diseases, penile diseases, and scrotal diseases.
Gynaecological pathology
Authors: Carton James
Published: August 2017

This chapter covers gynaecological pathology and includes vulval skin diseases, benign vulval tumours, vulval carcinoma, vaginal infections, vaginal tumours, cervical carcinoma, cervical screening, endometriosis, endometrial carcinoma, uterine leiomyomas (fibroids), uterine leiomyosarcoma, functional ovarian cysts, benign non-epithelial ovarian tumours, benign epithelial ovarian tumours, borderline epithelial ovarian tumours, ovarian carcinomas, pelvic inflammatory disease, ectopic pregnancy, polycystic ovarian syndrome, hydatidiform mole, and pre-eclampsia.
Haematopathology
Authors: Carton James
Published: August 2017

This chapter discusses haematopathology, including iron deficiency anaemia, anaemia of chronic disease, megaloblastic anaemias, hereditary spherocytosis, glucose-6-phosphate dehydrogenase deficiency, thalassaemias, sickle-cell disorders, idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), von Willebrand disease, haemophilia, thrombophilia, acute B-lymphoblastic leukaemia, acute myeloid leukaemias, chronic lymphocytic leukaemia (CLL), chronic myelogenous leukaemia, polycythaemia vera (PV), essential thrombocythaemia (ET), primary myelofibrosis (PMF), myelodysplastic syndromes (MDS), follicular lymphoma, diffuse large B-cell lymphoma, Burkitt’s lymphoma (BL), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), mantle cell lymphoma, classical Hodgkin’s lymphoma (cHL), lymphoplasmacytic lymphoma (LPL), plasma cell myeloma, primary amyloidosis, and mature T-cell non-Hodgkin’s lymphomas.
Multisystem diseases
Authors: Carton James
Published: August 2017

This chapter discusses multisystem diseases, including systemic lupus erythematosus, systemic sclerosis, sarcoidosis, and vasculitis.
Medical Ventilator System Basics: A clinical guide
Authors: Lei Yuan
Published: August 2017

Medical Ventilator System Basics: A clinical guide—unlike books that focus on clinical applications, or that provide specifics about individual ventilator models, this is a practical guide about the equipment used for positive pressure mechanical ventilation. This book provides the information a clinician needs every day: how to assemble a ventilator system, how to determine appropriate ventilator settings, how to make sense of monitored data, how to respond to alarms, and how to troubleshoot ventilation problems. The book applies to all ventilators based on the intermittent positive pressure ventilation (IPPV) operating principle. In a systematic and comprehensive way, the book steps the user through the ventilator system, starting with its pneumatic principles to an explanation of the anatomy and physiology of respiration. It describes the system components, including the ventilator, breathing circuit, humidifier, and nebulizer. The book then introduces ventilation modes, starting with an explanation of the building blocks of breath variables and breath types. It describes the major ventilator functions, including control parameters, monitoring, and alarms. Along the way the book provides much practical troubleshooting information. Clearly written and generously illustrated, the book is a handy reference for anyone involved with mechanical ventilation, clinicians and non-clinicians alike. It is suitable as a teaching aid for respiratory therapy education and as a practical handbook in clinical practice.
Basic Concepts
Authors: Lei Yuan
Published: August 2017

‘Basic Concepts’ explains seven important physical concepts that are required to understand how a positive pressure ventilator system works: pressure, volume, flow, time, resistance, compliance, and time constant. A positive pressure ventilator system is a pneumatic device based on the operating principle of intermittent positive pressure ventilation (IPPV).
Humidification, Nebulization, and Gas Filtering
Authors: Lei Yuan
Published: August 2017

‘Humidification, Nebulization, and Gas Filtering’ describes the therapies, which, while not essential to ventilation, are frequently applied together with it. This chapter provides a comprehensive discussion of these devices, including the clinical needs for them and their operating principles, options, and common complications. It describes the composition and operating principle of active heated humidifiers. Artificial humidification brings with it the additional issue of circuit rainout, which may require that heated wires be added to the breathing circuit. The chapter includes a table for troubleshooting issues related to active humidification. Heat and moisture exchangers or HMEs, an alternative to humidifiers, are also discussed. Finally, the chapter turns to the use of in-line nebulizers or aerosol therapy. The chapter ends with a discussion of respiratory gas filtering, which, for all the benefit a bacteria filter brings, also introduce the risk of occlusion.