bluuebunny/crossref_metadata_2025 huggingface dataset:
Volumetric Analysis
Authors: Oriakhi Christopher O.
Published: November 2020

Volumetric analysis is a chemical analytical procedure based on measurement of volumes of reaction in solutions. It uses titration to determine the concentration of a solution by carefully measuring the volume of one solution needed to react with another. In this process, a measured volume of a standard solution, the titrant, is added from a burette to the solution of unknown concentration. When the two substances are present in exact stoichiometric ratio, the reaction is said to have reached the equivalence or stoichiometric point. In order to determine when this occurs, another substance, the indicator, is also added to the reaction mixture. This is an organic dye which changes color when the reaction is complete. This color change is known as the end point; ideally, it will coincide with the equivalence point. For various reasons, there is usually some difference between the two, though if the indicator is carefully chosen, the difference will be negligible. A typical titration is based on a reaction of the general type aA+bB → products where A is the titrant, B the substance titrated, and a:b is the stoichiometric ratio between the two. Some indicators include Litmus, Methyl Orange, Methyl Red, Phenolphthalein, and Thymol Blue. Titration can be applied to any of the following chemical reactions: • Acid–base • Complexation • Oxidation–reduction • Precipitation Only acid–base and oxidation–reduction titration will be treated here, though the fundamental principles are the same in all cases. Acid–base titration involves measuring the volume of a solution of the acid (or base) that is required to completely react with a known volume of a solution of a base (or acid). The relative amounts of acid and base required to reach the equivalence point depend on their stoichiometric coefficients. It is therefore critical to have a balanced equation before attempting calculations based on acid–base reactions. Below we define some of the common terms associated with acid–base reactions. A molar solution is one that contains one mole of the substance per liter of solution. For example, a molar solution of sodium hydroxide contains 40 g (NaOH=40 g/mol) of the solute per liter of solution. As described in chapter 13, the concentration of a solution expressed in moles per liter of solution is known as the molarity of the solution.
Chemical Equilibrium
Authors: Oriakhi Christopher O.
Published: November 2020

Many chemical reactions go to completion; i.e., all the reactants are converted to products. A good example is the reaction of calcium with cold water. . . Ca(s)+2 H2O(l) → Ca(OH)2(s)+ H2(g) . . . There is no evidence that the reverse reaction occurs. Such reactions are said to be irreversible. On the other hand, many reactions are reversible: the process can be made to go in the opposite direction. This means that both the reactants and products will be present at any given time. A reversible reaction is defined as one in which the products formed can react to give the original reactants. A double arrow is used to indicate that the reaction is reversible, as illustrated by the general equation:. . . aA+bB ⇌ cC +dD. . . At the start of the reaction, the reactants convert more quickly to products than products turn back to reactants because the reactants are present in much greater amount. Eventually the concentration of products is sufficient for the reverse reaction to become significant. The reaction is said to reach equilibrium when the net change in the products and reactants is zero, i.e., the rate of forward reaction equals the rate of reverse reaction. Chemical equilibria are dynamic equilibria because, although nothing appears to be happening, opposing reactions are occurring at the same rate. Figure 17-1 illustrates that for a reaction in chemical equilibrium, the rate of forward reaction equals the rate of reverse reaction. When a chemical reaction is at equilibrium, the concentrations of reactants and products are constant. The relationship between the concentrations of reactants and products is given by the equilibrium expression, also known as the law of mass action. For the general reaction:. . . aA+bB cC +dD. . . at a constant temperature, the equilibrium constant expression is written as: Kc = [C]c[D]d/[A]a[B]b where [A], [B], [C], and [D] are the molar concentrations or partial pressures of A,B,C, and D at equilibrium. The exponents a,b, c, and d in the equilibrium expression are the coefficients in the balanced equation; Kc is the equilibrium constant and is not given units. The subscript c shows that K is in terms of concentration. The numerical value for Kc is usually determined experimentally.
The Task of Higher Education
Authors: Fish Stanley
Published: November 2020

Pick up the mission statement of almost any college or university, and you will find claims and ambitions that will lead you to think that it is the job of an institution of higher learning to cure every ill the world has ever known: not only illiteracy and cultural ignorance, which are at least in the ball-park, but poverty, war, racism, gender bias, bad character, discrimination, intolerance, environmental pollution, rampant capitalism, American imperialism, and the hegemony of Wal-Mart; and of course the list could be much longer. Wesleyan University starts well by pledging to “cultivate a campus environment where students think critically, participate in constructive dialogue and engage in meaningful contemplation” (although I’m not sure what meaningful contemplation is); but then we read of the intention to “foster awareness, respect, and appreciation for a diversity of experiences, interests, beliefs and identities.” Awareness is okay; it’s important to know what’s out there. But why should students be taught to “respect” a diversity of interests, beliefs, and identities in advance of assessing them and taking their measure? The missing word here is “evaluate.” That’s what intellectual work is all about, the evaluation, not the celebration, of interests, beliefs, and identities; after all, interests can be base, beliefs can be wrong, and identities are often irrelevant to an inquiry. Yale College’s statement also starts well by promising to seek students “of all backgrounds” and “to educate them through mental discipline,” but then mental discipline turns out to be instrumental to something even more valuable, the development of students’ “moral, civic and creative capacities to the fullest.” I’m all for moral, civic, and creative capacities, but I’m not sure that there is much I or anyone else could do as a teacher to develop them. Moral capacities (or their absence) have no relationship whatsoever to the reading of novels, or the running of statistical programs, or the execution of laboratory procedures, all of which can produce certain skills, but not moral states.
Follow-up and Sticking with Treatment
Authors: Compton Michael T , Broussard Beth
Published: November 2020

When someone is diagnosed with a first episode of psychosis, it can be easy to want to forget about the diagnosis after leaving the hospital or clinic. Symptoms may even appear to go away. However, the likely reason the person’s symptoms have improved is that he or she has been taking medicine and getting treatment. It is important for the patient to stick to this treatment plan to continue to feel better, have decreasing symptoms, and eventually return to normal functioning. At the hospital or clinic, patients work with mental health professionals on a plan for their treatment. Adherence or compliance is when patients stick with their treatment plan and include this plan into their daily life. Mental health professionals use the words adherence and compliance to mean the same thing. In this book, we use the word adherence. Adherence includes: attending follow-up appointments with mental health professionals, taking medicine regularly, and completing therapy exercises given at appointments. We discuss each of these in the following pages. Before the patient leaves the hospital or clinic, the mental health professional and patient will discuss or plan future follow-up appointments. Patients may need to go to these appointments every other week, or even more frequently, when just leaving the hospital. Those who have stayed well for a longer period may be able to go to appointments less often. They may go every month and eventually, only every three months. If available in the community, other choices may include appointments in the home or in the community with case managers or treating professionals (See Chapter 7 on Psychosocial Treatments for Early Psychosis). Appointments may be at a clinic or hospital and usually last 30 to 45 minutes. They may be with a doctor for a checkup. The patient also may have to go to appointments for counseling, therapy, or other types of psychosocial treatments. The number of appointments the patient has to go to will depend on his or her specific needs. Knowing that they have to go to many sessions may be disappointing for patients. Most people do not like going to the doctor! This is true for many people with psychosis as well.
Fighting Stigma
Authors: Compton Michael T , Broussard Beth
Published: November 2020

Mental health professionals now understand more about mental illnesses than ever before. Effective treatments are available that support many people with mental illnesses living full and productive lives. Despite this and the general public’s broader understanding of mental illnesses, negative and incorrect beliefs about these disorders continue. These incorrect beliefs include that mental illnesses are moral failures and that people with mental illnesses are dangerous, incompetent, and unable to function in the community. This can cause persons with mental illnesses and their families to delay seeking treatment in an attempt to avoid being labeled with a mental illness diagnosis. Once diagnosed, they may worry about people finding out and treating them differently. They may experience discrimination in various parts of their lives. This is due to the stigma of mental illness. The traditional definition of stigma is a mark of shame that usually lasts forever. Stigma can have negative effects on both the affected person and his or her family. The stigma related to mental illnesses often begins when doctors diagnose the patient with a mental illness. This diagnosis, or label, sometimes links the patient to stereotypes, or negative ideas, about people with a mental illness. However, stigma can also begin even before a diagnosis, when the affected person begins to display signs and symptoms of an illness. These signs and symptoms (such as talking to oneself or having unusual beliefs) may link the person to negative ideas about those with a mental illness. The stereotypes that society holds about people with mental illnesses are usually wrong. Examples of such ideas are that a person with a mental illness is dangerous, not very intelligent, and unable to work. Other false ideas are that the person has no self-control and will never recover. Stereotypes can cause others to view people with mental illnesses as different and less human. Not understanding these disorders, others may look down upon or think less of those with a mental illness. As a result, patients and their families may feel that they are less important, or they may feel discriminated against. They also may feel that the stereotypes about those with a mental illness are in some way true.
A Biopsychosocial Approach to Psychiatric Consultation in Persons with HIV and AIDS
Authors: Batista Sharon M. , Lux Joseph Z.
Published: November 2020

For persons with HIV and AIDS, a thorough and comprehensive assessment has far-reaching implications not only for compassionate, competent, and coordinated care but also for adherence to medical treatment and risk reduction, as well as public health. Primary physicians, HIV specialists, as well as psychiatrists and other mental health professionals can play an important role in preventing the spread of HIV infection. Psychiatric disorders are associated with inadequate adherence to risk reduction, medical care, and antiretroviral therapy. While adherence to medical care for most medical illnesses has major meaning to patients, loved ones, and families, adherence to medical care for HIV and AIDS has major implications for reduction of HIV transmission and prevention of emergence of drug-resistant HIV viral strains (Cohen and Chao, 2008). Many persons with HIV and AIDS have psychiatric disorders (Stoff et al., 2004) and can benefit from psychiatric consultation and care. The rates of HIV infection are also higher among persons with serious mental illness (Blank et al., 2002), indicating a bidirectional relationship. Some persons with HIV and AIDS have no psychiatric disorder, while others have a multiplicity of complex psychiatric disorders that are responses to illness or treatments or are associated with HIV/AIDS (such as HIV-associated dementia) or multimorbid medical illnesses and treatments (such as hepatitis C, cirrhosis, end-stage liver disease, HIV nephropathy, end-stage renal disease, anemia, coronary artery disease, and cancer). Persons with HIV and AIDS may also have multimorbid psychiatric disorders that are co-occurring and may be unrelated to HIV (such as posttraumatic stress disorder, or PTSD, schizophrenia, and bipolar disorder). The complexity of AIDS psychiatric consultation is illustrated in an article (Freedman et al., 1994) with the title “Depression, HIV Dementia, Delirium, Posttraumatic Stress Disorder (or All of the Above).” Comprehensive psychiatric evaluations can provide diagnoses, inform treatment, and mitigate anguish, distress, depression, anxiety, and substance use in persons with HIV and AIDS. Furthermore, thorough and comprehensive assessment is crucial because HIV has an affinity for brain and neural tissue and can cause central nervous system (CNS) complications even in healthy seropositive individuals. Because of potential CNS complications as well as the multiplicity of other severe and complex medical illnesses in persons with HIV and AIDS (Huang et al., 2006), every person who is referred for a psychiatric consultation needs a full biopsychosocial evaluation.
Psychotherapeutic Treatment of Psychiatric Disorders
Authors: Soffer Jocelyn , Cohen Mary Ann
Published: November 2020

Persons living with HIV and AIDS face a complex array of stresses and challenges, as discussed throughout this book, which may overwhelm psychological functioning. This leads to considerable distress and suffering (Cohen et al., 2002), manifests in a multitude of psychiatric symptoms, and increases nonadherence to risk reduction and medical care. The aim of psychotherapeutic care for persons with HIV is to mitigate such distress through a combination of psychosocial interventions. Goals of such therapies may include enhancing adaptive coping strategies, facilitating adjustment to living with HIV, increasing social supports, and improving a patient’s sense of purpose, self-esteem, and overall well-being. Goals may also include improving adherence to risk reduction and medical care, as well as preventing HIV transmission. Psychological distress in persons with HIV infection is associated with decreased quality of life, disease progression, and mortality (Leserman, 2008). Considering the biopsychosocial model, emotional distress in HIV can be viewed as resulting from a combination of medical, psychological, and social factors related to the illness (see Table 8.1). In some studies, improved social support and active coping styles in response to illness and stress have correlated with improved immunological parameters. Studies have also linked depressed mood and stressful life events to worsened immunological status, including decreased CD4 cell counts. Nonetheless, randomized controlled data demonstrating the ability of behavioral and social interventions to improve immune status remain conflicted; further evidence-based research is needed. While improving immunological status is a potential benefit of psychosocial treatment for people with HIV infection, it is relieving the suffering inherent to psychiatric illness and improving patients’ quality of life that remain the primary goals. A variety of psychosocial interventions are available to persons with HIV, from individual to group-based formats. Such treatments span a spectrum of psychotherapeutic approaches, including supportive, psychodynamic, interpersonal, and cognitive-behavioral. This chapter will consider the benefits of such psychosocial interventions by summarizing the current state of research and findings for each of these treatment approaches, addressing both individual and group settings.
Resources for Persons with AIDS and their Caregivers
Authors: Batista Sharon M. , Cozza Kelly L.
Published: November 2020

This chapter was developed as a basic reference list of resources for HIV clinicians to help them meet the various needs of persons with AIDS throughout the lifespan. The resources listed are by no means exhaustive or comprehensive, as there is a plethora of relevant literature, Web sites, and interest groups—too many to fit into a single chapter! Instead, this is a set of resources that the authors have found particularly useful when seeking answers to treatment-and social services–related questions at the bedside as well as in ambulatory and community settings. At the time of publication, these resources had been updated regularly and consistently; technology related to HIV evolves on an almost daily basis. A mixture of print and Internet-based resources is provided here—some will be useful to keep in the office setting for perusal or for patients, and some can be obtained on the Internet at a moment’s notice when the need arises. Many of the listings are for Web sites that can aid clinicians in accessing the most current information available on the Internet, which can change almost daily. The sites listed were current as of April 28, 2009. The resources in this section are intended primarily to aid health-care providers in accessing up-to-date answers to questions regarding diagnoses and treatments as well as ethical and legal issues. There are also several sources for patient education materials. While many of these resources are from U.S.-based organizations, much of the information contained within them is applicable in international practice settings. There is also a section related exclusively to population-based and international resources, pertaining to specific ethnic groups or areas outside of the United States. A primary care guideline for the care of persons with HIV is available in print (Aberg et al., 2009) and online and is updated regularly at: http://www.journals.uchicago.edu/page/cid/IDSAguidelines.html. National AIDS Treatment Advocacy Project: http://www.natap.org/ This organization lists upcoming conference and events, articles, and publications.
Past as Prologue
Authors: Newman Richard S.
Published: November 2020

In 1978, Love Canal resident Anne Hillis sarcastically explained the “recipe” for the chemical disaster taking shape in her neighborhood: take “approximately 16 acres” of land, add “22,000 tons of toxic wastes, mix with spring water, snow, etc …” Then, she wrote, add “human beings.” The “yield” would be “miscarriage … birth defects … suicide and death.” For people wondering just how the chemicals ended up in Love Canal in the first place, Hillis wrote that the whole saga began not in the recent past but in “the late 1800s, [when] a canal had been dug” by a starry-eyed industrialist who then abandoned the altered landscape. The groove of earth he left behind was “filled in with chemicals in the … 1940s,” covered over and forgotten. Only later would “these chemicals” migrate from the dump into the local environment. For Hillis, as for other residents, Love Canal’s troubled environmental present was a product of its toxic past. But how far back did that troubled past go? New York State health officials asserted that the “seeds” of Love Canal were sown in Niagara’s “highly industrialized” history, which stretched from the late 19th century onward. Similarly, the Niagara Gazette created a “Love Canal Chronology” that began in 1894, when entrepreneur William Love began excavating a power canal that never materialized but whose remains formed a perfect burial pit later on. An activist group pushed Love Canal’s chronology back further. Although “Love Canal became a household word in 1978,” the group claimed, “the idea for the place that was to carry the name originated in 1836,” when an engineer stamped out the route of an artificial river that would be even grander than the Erie Canal. No matter how far back they went, all of these commentators saw history as a key lens through which to view the modern Love Canal disaster. Yet few traced the area’s toxic history back to colonial times.
Quality of Life
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

How old will our children live to be? 120? 150? The average human life span continues to lengthen, and more and more of us will enjoy a long life. A substantial proportion of today’s children will one day celebrate their 100th birthday, whereas back in 1900, half of all human beings were dead by the age of 37. Life expectancy in the Western world has advanced with remarkable speed, which means the number of old people is also increasing rapidly. A century ago, a mere 1 percent of the world’s population was aged older than 65. By 2050, that figure will be about 20 percent. Babies born in 2010 will live an average of 20 years longer than those born in 1950. Life expectancy increases 3 years for each decade that passes, reflecting ongoing progress in technology. The necessities of life are provided more efficiently than they were a century ago, certainly in the West. There is enough to eat, and we are well clothed and sheltered. Advances in medical science mean we can live longer without falling victim to disease. And if we do get sick, we can survive longer. Chronic illness, heart conditions, and cancer are no longer necessarily a death sentence. People in the developed world now live so long that the main causes of death for those under 50—violence and suicide—lie beyond the reach of medical technology. We only become dependent on medical intervention later in our lives, as the age at which we begin to “break down” has risen progressively over the past century. Today’s old people are much sprightlier than their counterparts in the past. A person now aged 75 frequently has a similar level of health, vitality, and joie de vivre as a 65-year-old two generations ago. We wear out less, our living conditions are better, and prompt action is taken if something goes wrong. Most important, many people believe it is worthwhile to live longer as we can enjoy the extra years in good health and pleasant circumstances.
Engineering Society
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

A storm blew up in Berlin in 1989 not far from the spot where much of this book was written. It all began in a small way with people attending weekly services at the local church to pray for peace. When the communist East German regime used violence to break up a demonstration, the church became a refuge for hundreds, and later thousands, of people. The society in question had grown rigid. To express it in the language of complexity, the social network became so tautly stretched that any shock was readily propagated throughout the system. The police repeatedly beat up the churchgoers, but the multitude failed to respond in the expected way. Instead of kicking and punching, they prayed and sang. They didn’t display the anticipated logic of action and reaction, eventually causing the police to withdraw in confusion. The demonstrators created positive feedback, and as a result, the mass of people grew even bigger. “We were prepared for everything but not for candles,” a police commander later commented. The protests also confused the GDR’s inflexible leaders. At the peak of the protests, an East German minister declared that citizens would be permitted to travel to the West. The chaos that ensued was so great that historians are still trying to unravel the precise sequence of events. On the brink of a critical transition, old forces dissipate and unpredictable movements can occur. This is a typical example of a small movement that can lead to much greater things, as we have also seen in other complex systems. Tens of thousands of people laid siege to the Wall. Exactly who eventually decided to raise the barriers has been lost in the fog of history. It was most likely a low-ranking officer at a border crossing who was no longer able to cope with the mass of people. To ease the pressure, he allowed a few citizens through the barrier. The effect was to throw gasoline onto the fire or, to put it another way, to create positive feedback that tipped the situation into transition. Within minutes, the crowd could no longer be restrained.
How Do We Know When a Screening Test is Clinically Useful?
Authors: Mitchell Alex J.
Published: November 2020

There is no shortage of suggested methods to screen for depression, including clinical interviews. Assuming these are applied to a group containing patients with depression and patients without depression, how do we decide which are the optimal methods? In addition, how can tests be compared and how can tests be combined? This chapter discusses the methods used to compared scales and tools. The terms diagnosis and screening both refer to the application of an agreed method to confirm those with a condition and to exclude those without the condition (for discussion see Chapter 2). When attempting to separate depressed versus non-depressed individuals there is always an overlap of symptoms (or biological markers) (see Chapter 1, Fig. 1); therefore, a perfect test based on current tests is unobtainable. Testing may be focused on those at high risk of the condition (such as screening for depression after myocardial infarction) or applied to a wider population (screening for depression in all primary care patients). The former is a high-prevalence setting, which favors the ability to confirm a condition, whereas the latter is a low-prevalence setting, which favors the ability to refute a condition. It is often forgotten that the clinical process of making a diagnosis is a form of screening itself. Here the tool is the clinician’s clinical skill and the sample is all patients seen by the clinician. If a clinician is attuned to the concept of depression, has a high index of suspicion, and asks the right questions, then it is likely he or she will have high personal diagnostic accuracy. If the clinician is unconfident, inexperienced, and untrained, it is less likely that he or she will be able to make a correct diagnosis (see Table 5.1 and Chapter 3). Some literature suggests that the added value of screening tools for depression is apparent only in the latter situation. A diagnostic test for depression is designed to help the clinician elicit and weigh symptoms and signs to make a diagnosis. How, then, is this achieved, and how does a screening test work in scientific terms?
Screening for Depression in Perinatal Settings
Authors: Barton Jodi , Boyce Philip
Published: November 2020

Implementing screening in perinatal settings poses a potentially complex set of issues, but screening is nonetheless increasingly being recommended and even mandated. When should screening occur—during pregnancy, postpartum, or both? What instrument should be used? How acceptable is screening to mothers? What difference does screening make to the management of postpartum depression? This chapter presents an evidence-based approach to all aspects of perinatal screening. Over the past 20 years there has been considerable interest in psychiatric disorders arising during the course of pregnancy and following childbirth. Most of the attention has been focused on depressive disorders arising within the first 3 months to 1 year after childbirth, commonly referred to as postnatal or postpartum depression. Pregnancy was once thought to be protective against depressive symptoms; however, women are just as likely to experience depressive symptoms while pregnant as they are during the postpartum period. The mean prevalence of antenatal depression is between 10.7% and 12%, with increasing prevalence and severity through the second and third trimesters. This is comparable with the 10% to 15% of women who develop postpartum depression. While the DSM-IV official recognition of postpartum depression arising after childbirth is confined to a postpartum specifier for those episodes of major depression that have an onset within 4 weeks after delivery, increasing knowledge of depression during the antenatal period has given rise to its equally important early recognition and treatment. Whatever the specifier of postpartum depression in the DSM-IV, depression at this time has been granted considerable importance because of its potential adverse impacts upon child development and maternal morbidity and mortality; and because of the treatment challenges inherent in pregnant and breastfeeding women. Even though the consequences of postpartum depression have been recognized, the illness itself is frequently not identified; it has been estimated that between 50% and 75% of the women suffering from postpartum depression will have it identified and potentially treated. More recent work has focused attention on depression during the course of pregnancy, so-called antenatal depression. However, the validity of measuring depression during pregnancy and in the postpartum period is not clear, especially the boundary between depressive symptoms and clinically significant depressive disorder.
Late Bleb Leaks
Authors: Khator Parul , Myers Jonathan S.
Published: November 2020

Glaucoma filtering surgery is an effective method to lower intraocular pressure (IOP).However, as is the case with any interventional procedure, filtering surgery poses risks to the eye. At a reported incidence of 4.2%–10%, late leakage of filtering blebs is one of the most common and challenging complications encountered by glaucoma surgeons Bleb leaks pose many sight-threatening risks to the eye, including inflammation, blebitis, endophthalmitis, hypotony with its attendant risk of choroidal effusions and maculopathy, flat chamber with corneal decompensation, cataractous changes, and suprachoroidal hemorrhage. Additionally, allowing bleb leaks to persist risks failure of the filtration surgery. Leaks can occur at any point in the life of the bleb, from months to years after surgery, and late bleb leaks are commonly referred to as those occurring at least 2 months after surgery. Unlike early bleb leaks, which are frequently located at incisions and suture tracks or are secondary to intraoperative surgical trauma (buttonholes), late bleb leaks can often be seen at the apex of a cystic, avascular bleb (Figure 16.1). These leaks arise from focal epithelial thinning, which eventually culminates in a conjunctival defect in the wall of the bleb. Bleb leaks occur for a variety of reasons, including trauma to the conjunctival bleb wall. Thin-walled, focal, cystic blebs are at a much greater risk of leaking than diffuse, vascular blebs. One important risk factor for development of thin-walled blebs is the use of antifibrotic agents, such as 5-fluorouracil and mitomycin-C (see Chapter 27). Mechanical factors, such as eye rubbing, contact lenses, and giant papillary conjunctivitis, also increase the risk of bleb leaks by causing trauma to a focal area of susceptible conjunctiva. Although digital ocular compression is frequently performed and prescribed by ophthalmologists for management of encapsulated filtering blebs, one study from Japan showed that there is an increased risk of leak (3.1%–5.6%) with digital ocular bleb compression. This risk was especially increased in blebs with a larger avascular area or a longer intraoperative duration of mitomycin-C. In addition, conditions that cause conjunctival exposure, such as thyroid ophthalmopathy or a large overhanging bleb, can also increase the chances of leakage.
Bleb-Related Vision Loss
Authors: Bar-Sela Shai M.
Published: November 2020

Trabeculectomy is an effective procedure to control intraocular pressure (IOP) and to prevent progression of vision loss. One of the risks associated with this procedure is oversized and exuberant blebs, which may result in reduction of visual acuity. Understanding the mechanisms and prognosis of this complication is important for evaluating and selecting the proper treatment. Large blebs overhanging the cornea may cause visual acuity loss if they directly obstruct the visual axis, but they can also be problematic due to their effect on lid movements and resultant drying of the cornea. Furthermore, the overhanging, “beer-belly” bleb can also induce corneal dryness as well as irregular astigmatism. The trabeculectomy surgical technique itself may also affect the development of oversized blebs. Some authors believe that fornix-based conjunctival flaps result in more diffuse and less elevated blebs that are less likely to encroach on the limbus, compared to limbus-based conjunctival flaps. Limbusbased conjunctival flaps are limited by scar formation at the conjunctival wound site, preventing posterior movement of aqueous and forcing bleb elevation toward the limbus. The use of antifibrotics, such as mitomycin-C and 5-fluorouracil, during filtering procedures may predispose to the development of larger ischemic blebs. Thin-walled ischemic blebs may continue to enlarge months to years postoperatively as the bleb wall constantly remodels. Various laser treatments can be used to contract oversized blebs. Fink et al used argon laser photocoagulation to shrink large blebs in 4 eyes; however 2 eyes developed leaks. Sony et al treated 3 eyes with large blebs using frequency-doubled Nd:YAG photocoagulation after painting the area of the blebs with gentian violet to enhance the laser absorption. Several treatment sessions resulted in bleb shrinkage and remodeling. Lynch et al applied a continuous wave multimode Nd:YAG laser in 4 eyes with symptomatic large blebs, 3 of which had undergone previous trabeculectomy with antifibrotic agents. Two eyes required retreatment, and one eye developed a bleb leak afterward. These reports indicate that laser application success has been limited, and bleb leaks may occur.
Complications Common to Nonpenetrating Surgeries
Authors: Crichton Andrew C.
Published: November 2020

Nonpenetrating glaucoma surgery encompasses techniques that involve a deep dissection to the level of Descemet’s membrane, allowing aqueous seepage. The major techniques covered by the term “nonpenetrating surgery” are deep sclerectomy with or without implant and viscocanalostomy. In large meta-analyses comparing nonpenetrating procedures to trabeculectomy, trabeculectomy resulted in lower intraocular pressures (IOP) but a higher risk of postoperative complications. Although nonpenetrating surgery is successful in lowering IOP, the amount of IOP lowering is typically not as low as can be achieved with trabeculectomy. Consequently, patient selection with regard to the target IOP is important in the decision of whether or not to perform a nonpenetrating procedure. The goal of nonpenetrating procedures is to lower IOP with fewer complications than are seen with trabeculectomy. The complications that can occur can be easily understood and predicted by an understanding of the techniques and modifications, as well as knowledge and mechanisms of the adjustments that can be used postoperatively to enhance success. After appropriate anesthetic, the techniques involve a deep dissection in the sclera to the limbus. In the case of deep sclerectomy, after the initial half-thickness flap is fashioned, a second deeper flap is created and excised. This dissection is taken to the level of Descemet’s membrane, allowing controlled flow of aqueous. A fine forceps may be used to strip the outer wall of Schlemm’s canal, further enhancing the flow. The space created by the excision can then be filled with an implant, such as collagen (AquaFlow™ Collagen Glaucoma Drainage Device; STAAR® Surgical Company, Monrovia, California) or hyaluronate (SK Gel®; Corneal Laboratories, Paris, France). For viscocanalostomy, Schlemm’s canal is identified and dilated by using viscoelastic. With deep sclerectomy, intraoperative or postoperative antimetabolites may be used to try to increase success rates by limiting the inflammatory response. Goniopuncture to the Descemet’s window is often required postoperatively (in up to 67% of cases) to enhance flow and lower IOP. The available evidence on complications of nonpenetrating glaucoma surgery is relatively sparse and may be challenging to interpret. Comparative studies between trabeculectomy and nonpenetrating surgery would seem to show fewer complications in the nonpenetrating group.
Introduction The City That Lost Its Soul
Authors: Zukin Sharon
Published: November 2020

In the early years of the twenty-first century, New York City lost its soul. Some people doubt that the city ever had a soul, because New York has always grown by shedding its past, tearing down old neighborhoods and erecting new ones in their place, usually in a bare-faced struggle for financial gain. Others just shrug because, today, all big cities are erasing their gritty, bricks-and-mortar history to build a shiny vision of the future. Beijing, Shanghai, and other Chinese cities are clearing out the narrow, rundown alleys in their center, removing longtime residents to the distant edges of town, and replacing small, old houses with expensive apartments and new skyscrapers of spectacular design. Liverpool and Bilbao have torn down their abandoned waterfronts and turned aging docks and warehouses into modern art museums. In London, Paris, and New York artists and gentrifiers move into old immigrant areas, praising the working-class bars and take-out joints but overwhelming them with new cafés and boutiques, which are soon followed by brand-name chain stores. A universal rhetoric of upscale growth, based on both the economic power of capital and the state and the cultural power of the media and consumer tastes, is driving these changes and exposing a conflict between city dwellers’ desire for authentic origins—a traditional, mythical desire for roots—and their new beginnings: the continuous reinvention of communities. To speak of a city being authentic at all may seem absurd. Especially in a global capital like New York, neither people nor buildings have a chance to accumulate the patina of age. Most residents are not born there, neither do they live in the same house for generations, and the physical fabric of the city is constantly changing around them. In fact, all over the world, “Manhattanization” signifies everything in a city that is not thought to be authentic: high-rise buildings that grow taller every year, dense crowds where no one knows your name, high prices for inferior living conditions, and intense competition to be in style.
Conclusion Destination Culture and the Crisis of Authenticity
Authors: Zukin Sharon
Published: November 2020

When Jane Jacobs wrote The Death and Life of Great American Cities in 1960, death was all too evident around her. New York City’s port was shutting down, factories and neighborhoods hadn’t altered their look since the beginning of the century, and middle-class families were fleeing from declining public services and expanding dark ghettos to the suburbs. The city, it was clear, lay in the grip of two malevolent forces, government and developers, though Jacobs directed her ire at architects and bureaucrats, whose plans, she said, destroyed lively neighborhoods and extinguished all sparks of social life. In Jacobs’s view the monolithic office towers, large public housing projects, intrusive highways, and monumental cultural centers that marked postwar cities brought on a “great blight of dullness” and reduced residents to passive pawns. Followed to a logical extreme, these were not plans for growth; they were a design for catastrophe. The city’s life, on the other hand, required preserving the old streets, buildings, and blocks that seemed so old-fashioned, for these sustained the delicate fabric of social uses and cultural meanings that wove people together. On this authenticity the city’s future would depend. “Authenticity” was not a word in Jacobs’s vocabulary. She talked instead about density and diversity, about “character and liveliness,” and how to “avoid the ravages of apathetic and helpless neighborhoods.” For the most part, she advocated resisting overscale development and permitting good design of urban spaces to encourage community involvement. It is not clear that following her suggestions would have allowed cities to avoid the lack of investment in public institutions and the miscarriage of racial and social equality that depressed so many neighborhoods in the next generation. By now, though, we have enough critical distance from those neighborhoods to see them as “authentic,” and we can use our Jacobs-influenced vision to transform their authenticity into equity for all. We already use the streets and buildings to create a physical fiction of our common origins; now we need to tap deeper into the aesthetic of new beginnings that inspires our emotions.
Inspirations
Authors: Otis Jessica J
Published: November 2020

This chapter is a collection of stories from those who do not let anything keep them from achieving their goals and who inspire us. These individuals show us there is hope and that anything is possible. My name is Eric, and I am 27 years old. I was born with familial (hereditary) aniridia. I also have nystagmus, beginnings of a cataract in my right eye, lens implant in my left eye, and corneal keratopathy in both eyes (but it is worse in my left eye). I am married to my lovely wife, Amber, and we have four children. They are: Joseph (ten years old), Sarah (seven years old), Aniston (four years old), and Christopher (two years old). The two oldest have normal vision and the two youngest have aniridia (how’s that for the law of randomization?). Currently, I work as a research assistant at the University of Florida as part of my doctoral degree. I also own my own company where I work as an occupational therapist with blind and low-vision individuals of all ages. Initially when I went to occupational therapy school, I was not interested in working with people who have vision impairments. Instead, I specialized in working with older adults. After working in the field for several years with older adults, I began to notice that many of my elderly patients had vision problems. Although I grew up with a visual impairment, I did not feel professionally qualified to address their vision issues because learning how to adapt to a visual impairment is different for someone born with a visual impairment than someone who acquires a visual impairment later in life. So I went back to school to gain additional training in working with people who have visual impairments. Part of my job as an occupational therapist is to evaluate patients for specific assistive-technology needs, recommend products that would increase their independence, and to teach patients with multiple disabilities how to use these devices.
Psychological Support
Authors: Pishotta Mark , Krangel Alison
Published: November 2020

Stress is an everyday experience that no one is exempt from experiencing, whether the stressor is positive or negative. Combine that reality with a medical condition, and there is a noticeable increase in the stress level that can easily become overwhelming. Like other diagnoses, aniridia has an impact on those living with the condition and their families. One of the reasons this condition is so complex is the lack of knowledge about it in both the public and medical communities. Too often people respond with a “What?” when they hear the word aniridia, and that leaves the families to be the educators, when they are the ones who still need to be educated. Their frustration can easily build. There is frustration with the diagnosis, with the life changes, and with the frustration itself. Without recognition or acceptance of this frustration, and an appropriate outlet to help ease the situation, negative effects are likely. It is vital for those touched by aniridia to prepare for the inevitable stress. Parents must identify and accept themselves as the supporting structures of their families. If they are weakened, they will be less likely to support their children. Individuals with aniridia have enough barriers to overcome and must learn to prevent future obstacles such as stress from affecting their lives. Although stress is unavoidable, it is at times preventable and, most often, manageable. By and large, there are three types of stress: acute, episodic, and chronic. Acute stress is defined as short-term stress that does not result in any permanent damage. One can describe this as the daily stress that can be lived with and is experienced by all individuals (such as taking tests and driving in heavy traffic). The second stress, episodic stress, is more intense because it is the frequent suffering of acute stress. The sufferer views life as chaotic and constantly in crisis, epitomized by the expression “if something can go wrong, it will.”
Acquired Optic Nerve Diseases
Authors: Quiros Peter A. , Sadun Alfredo A.
Published: November 2020

This chapter focuses on the most frequently acquired optic nerve diseases: their signs and symptoms, visual field findings, and the required basic workup and management. Acquired optic nerve diseases are often vision threatening and sometimes even life threatening. There is a need for accurate and timely diagnosis. Therefore, it is incumbent on the clinician to identify optic neuropathies, separate them from chronic congenital and hereditary problems, and aggressively pursue the diagnosis and treatment as necessary. In the workup of optic neuropathies, the visual field is extremely helpful. All patients with suspected optic neuropathies require careful examination of the visual fields for detection, characterization, and monitoring. Acquired optic neuropathies include inflammatory, ischemic, compressive, metabolic, and central nervous system–reflected pathology (papilledema). Inflammatory optic neuropathies include optic neuritis and its various etiologies such as demyelination, infective, immune-mediated (atypical), and slowly progressive/ chronic. Ischemic optic neuropathies include nonarteritic ischemic optic neuropathy (NAION) and arteritic ischemic optic neuropathy (AAION). Metabolic optic neuropathies include nutritional and/or toxic etiologies. Compressive optic neuropathies can occur due to mass effect on the disc optic, gliomas, and perioptic meningiomas. Papilledema may be primary (pseudotumor cerebri) or secondary to central nervous system mass effect. Optic neuritis is defined as a primary inflammation of the optic nerve. It is characterized by central visual loss that worsens over days and usually peaks about 1 to 2 weeks after the onset. It is usually unilateral but may be bilateral, especially in children, following viral infections like measles, mumps, and chickenpox. It occurs most commonly in adults (18-45 years old). Orbital or periocular pain may be present or precede the visual loss and is exacerbated with eye movements. Etiologies include demyelinating diseases/multiple sclerosis;, idiopathic, viral, or bacterial infections (syphilis); contiguous inflammation of the meninges, orbit, or sinuses,; granulomatous inflammation (tuberculosis, sarcoidosis, and cryptococosis); and autoimmune diseases. It is the most common cause of acute visual loss from optic nerve disease in the young and middle-aged adult group.