bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer survivorship and work
Authors: Wynn Philip , D’Sa Shirley
Published: May 2013

About 5 per cent of the overall UK cancer burden can be attributed to occupational exposures. However, occupational physicians in clinical practice are most likely to be called upon to support and advise employed patients with non-occupational cancers. Support services in the UK are being reconfigured to help the growing population of cancer survivors to live full and active lives for extended periods. Returning to the workplace is a part of this goal, and occupational physicians are likely to see increasing numbers of adults seeking still to work after treatment for conditions that in the past would have led to ill health-related retirement. Set against these improvements in clinical outcome, and the increasing emphasis on support for patients who achieve long-term survival, is evidence that many working-age adults treated for the common cancers subsequently encounter financial and occupational difficulties. People with cancer often experience a loss in income as a result of their condition. Thus, although most working adults diagnosed with primary cancer return to work, a significant minority do not. Cancer is increasingly seen as an illness that can be effectively treated, but functional outcomes vary considerably. Cancer survivorship is considered to encompass people who are undergoing primary treatment, in remission following treatment, show no symptoms of the disease following treatment, or are living with active or advanced cancer. Occupational physicians may be requested to assess work capability and provide advice on workplace support for cancer survivors in any of the survivorship states. In the UK, 98 per cent of public sector and 30 per cent of private sector employers have access to occupational health services. Employers will normally seek guidance from these services on how to manage employees who have developed a serious illness such as cancer. This means that occupational physicians can be in a key position to coordinate the vocational rehabilitation of cancer survivors. This chapter offers an overview of the evidence on work capability, rehabilitation, and occupational risk assessment that may apply to adults diagnosed with a range of cancers.
Viva 9
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 9 asks for an explanation of the dorsal compartments at the wrist joint in the image, and a definition of de Quervain's syndrome, including clinical signs and management options. It then asks about the adverse effects of local steroid injection, and the pitfalls of surgery.
Viva 10
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 10 asks for management protocol for this crush injury, and what would need explaining to the patient.
Viva 14
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 14 shows an x-ray of an 8-month old baby brought to casualty. Please give your thoughts, and offer your opinion about non-accidental injury and how to proceed if it is suspected. How should this fracture be treated?
Viva 15
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 15 shows an ultrasound scan of a right hip of a 3-year-old child referred from casualty with a 24-h history of fever, malaise, and reluctance to bear weight on his right leg. How should this patient be approached, considering that the casualty officer has sent some routine bloods along with the scan? How should the child be assessed and, based on the hip scan, what is the best management?
Viva 18
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 18 shows a radiograph. Offer diagnosis. This patient presents with new-onset pain in the upper thigh. What is the opinion of what has happened, and how should this patient be managed now? The patient has been treated expectantly, but unfortunately the lesion remains – what is the best way to proceed?
Viva 19
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 19 shows a radiograph of a 6-year-old child who fell out of a tree onto their left arm. Describe the radiograph and offer management protocols. After reducing and pinning the fracture under anaesthetic, on post-operative review in recovery a pulse cannot be located. What should be done now?
Viva 22
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 22 asks how bones unite after a fracture, the difference between intramembranous and endochondral ossification, and how do bones get wider?
Viva 25
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 25 shows an image, a graph, and a table. Describe the investigation illustrated, osteoporosis and list its risk factors, the numerical results that are given by this test and how to interpret them, followed by a description of the treatment of osteoporosis, the drugs, and how they act.
Viva 28
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 28 asks for an identification of the material shown in the image, how it is manufactured, and how its material properties can be manipulated.
Viva 30
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 30 shows two images of devices and asks what they are, their characteristic features, their design philosophy, how they work, and how they can fail.
Viva 33
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 33 asks what the diagram shown represents, and what the pathological process is behind aseptic loosening.
Viva 47
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 47 shows a 26-year-old skier who crashed. What does this radiograph show and what are the immediate concerns about the patient? How is an initial assessment of this patient carried out, and how are these injuries classified? This patient has an arterial injury — what should be done? Which nerve is most commonly damaged and how would this be managed? What is the definitive treatment for an unstable knee?
Viva 55
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 55 shows a 30-year-old man who fell off his mountain bike and presented to the emergency department complaining of shoulder pain. Describe the radiograph and offer any classifications for such an injury? How should this patient be managed, and describe any recent papers on the management of clavicular fractures?
Viva 56
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 56 shows a radiograph of a child who has fallen off a swing. Describe the injury and classify it. How can this child's age be estimated from the radiograph? This is an isolated closed injury — how would this be managed definitively? What are some of the complications of this particular injury?
Viva 57
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 57 asks what is seen in the image, how does it evolve, and what are the principles of treating this condition?
Viva 58
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 58 asks for a description of what is seen in the image and what the stages are of this condition and how they are managed.
Viva 59
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 59 asks for identification of the condition in the image, what should be looked at on the X-ray, and the treatment options.
Viva 63
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 63 shows a patient 6 months following a right TKR. She is complaining of pain. What are the commonest causes of pain following a TKR? How should this patient be investigated and managed? The blood tests show raised CRP and ESR, and the aspirate grows coagulase-negative, Gram-positive cocci after 5 days. How should this be managed?
Viva 65
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 65 shows a picture of a 67-year-old woman with a painful left knee. The pain has been increasing over the last 3 years. She is otherwise fit and well and has had previous joint replacements as shown. How should this patient be managed? How should the patient be consented for a TKR? Describe the plan for surgery in this case.
Viva 67
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 67 asks What considerations need to be taken into account prior to performing a hip arthrodesis? What position should be chosen to arthrodese a hip? What are the indications and pre-operative investigations needed prior to ‘taking-down’ an arthrodesed hip and converting to a total hip arthroplasty?
Viva 69
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 69 asks what dislocation rate is quoted when consenting a patient for a total hip replacement? What causes a hip to dislocate? What measures can be taken to prevent re-dislocation?
Viva 76
Authors: Davies Nev , Jackson Will , Price Andrew , Rees Jonathan , Lavy Chris
Published: May 2013

Viva 76 asks what tennis elbow is, and what is the differential diagnosis? What are the histopathological findings in this condition? How can this condition be managed, and describe the surgical procedure that could be performed.
Families and patients with mental illness: on the recovery road
Authors: Shamir Eliahu
Published: May 2013

The onset of severe mental illness typically occurs at a young age, of around 15–30 years. It generates for all of the parties involved—individuals with mental illnesses, their families, and healthcare providers—acute stresses, confrontations, and strong internal and external pressures. This chapter focuses in particular on families. Social stigma, unfounded fears, shame, accusations, and denial all contribute to a dismal situation. Beyond medical treatment, intensive cognitive education and behavioural as well as emotional training are essential for survival, and to avoid crisis and collapse. These approaches facilitate the parties’ psychosocial alliance for effective caregiving, rehabilitation and recovery. The cognitive program described in this chapter consists of “know thy enemy” (the dangers and threats, and learning to use tools and resources to defeat them) and behavioural training (how to handle and negotiate the vastly increased problems and needs among the parties involved, and when and how to control expressed emotion and where to discharge it, using support groups and cognitive behavioral therapy). Education during the early stages of illness is essential in order to avoid serious mistakes and irreversible damage over a period of many years. A list of topics and courses is suggested, tailored for families and also adaptable for professionals and patients. Psychosocial reform of the ways in which societies organize and appropriate mental health services is crucial. An Israeli story and situation is conveyed via the author's 30 years of experience as a father of a mentally ill person, as the chair-person of and public speaker for the NGO of the families of mentally ill people in Israel, as a researcher of health systems, and as a delegate to the 2009 World Association for Psychosocial Rehabilitation Congress in Bangalore, India.
Benevolence and discipline: the concept of recovery in early nineteenth-century moral treatment
Authors: Charland Louis C.
Published: May 2013

This is a chapter on the history of ideas related to recovery. Moral treatment was a novel approach to caring for mentally ill patients that arose towards the end of the eighteenth century in Europe, and then spread to North America. It is most famously associated with the names of William Tuke in York, and Philippe Pinel in Paris. These two very different men—Tuke was a wealthy English Quaker businessman and philanthropist, and Pinel was a famous French medical author and doctor—formulated two quite different approaches to the care of the mentally ill. Yet there are also important similarities in their approaches. The concept of “recovery” plays a fundamental role in both Tuke's and Pinel's conceptions of the care and treatment of mental illness. It is interesting, and important, to consider the underlying premises of their respective clinical approaches as we consider the nature and origins of the concept of “recovery” today.
Contrasting conceptualizations of recovery imply a distinct research methodology
Authors: Gill Kenneth
Published: May 2013

This chapter argues that there are a number of contrasting views of recovery from serious mental illness. One possible view conceives of recovery solely from an idiographic perspective—that is, each individual's personal journey. This perspective on recovery as personal experience is understood as meaningful to an individual, but is also understood as not necessarily generalizable to others. Thus, according to this viewpoint, recovery is best understood from a phenomenological perspective. A contrasting view conceives of recovery from a more nomothetic perspective, not solely an individual's experience, but as measurable processes that are applicable to individuals with similar characteristics in similar circumstances. Thus an understanding of recovery can be derived by traditional methods of empirical inquiry. Of course, these two archetypal views may in fact be contrasting views of the same phenomena. Nevertheless, given contrasting epistemological views of recovery, distinct research methods are necessary. A solely phenomenological approach suggests that qualitative methods, such as personal narrative analysis, are most useful. A traditional empirical approach might seek to establish the presence of steps or stages, validated by multiple raters or convergent measures. One methodology that potentially integrates both approaches is participatory action research. Driven primarily by the premise that the participants who are the object of the study data should participate in every step of the research, from the conceptualization of the problem to interpretation of the findings, participatory action research may be particularly suited to the subject matter of recovery. This chapter reviews the contrasting methodological approaches and their application to the study of recovery. Examples of research studies that illustrate each of the approaches will be reviewed. In instances where relevant examples are not available from the literature, a program of future research will be outlined to illustrate the implications of that perspective.
Recovery and hope in relation to schizophrenia
Authors: Schrank Beate , Wally Johannes , Schmidt Burghart
Published: May 2013

This chapter discusses how philosophy provides a basis for the societal exclusion or inclusion of people with mental health abnormalities and how hope, as a central element of recovery, can be regarded as a prerequisite for the re-establishment of the personally valued social roles of these individuals. The authors look at how different philosophical approaches have understood human nature over time. In their attempt to determine what is normal and what is true, philosophers have always—at least implicitly—also defined what is abnormal; furthermore, they have addressed the relationship between truth and subjective experience, usually allowing for a certain amount of freedom with regard to truth in subjective experience. These various definitions of normality and truth, or abnormality and non-truth, respectively, are relevant background considerations; they impact on what is perceived as psychotic experience within a given society and what is to be done with those who are seen as suffering from a mental condition (i.e. to assign them a place in society or relegate them to the margins). By addressing this, the authors also introduce a philosophical approach to the contemporary concept of personal recovery in mental health. They then proceed to provide a real world example of how the recovery idea can thrive in a societal niche, together with the obstacles and constraints attached to this idea, from a practical as well as from a philosophical perspective. Lastly, the authors illustrate why hope is important for the recovery process. Taking a second look at the example provided in Part 2, they argue that the crucial motivation for hope is not so much the achievement of goals but rather the approximation of goals which might very well change during the process. Hope enables us to take risks and to keep striving even if goals are not achieved. Hope then helps us to adapt, to redefine goals and to continue on the way to recovery. Thus it initiates and sustains recovery
From being subjected to being a subject: recovery in relation to schizophrenia
Authors: Lysaker Paul , Lysaker John
Published: May 2013

Increasingly, recovery from severe mental illness is understood as not merely a matter of the remission of symptoms, but also the recovery of those capacities that enable one to be a meaningful agent in one's life, even if that life remains challenged by mental illness. This chapter explores one dimension of that kind of recovery, namely a rejuvenated sense of self. It explores from a dialogical perspective the processes implicated in both the diminishment and then the recapture of rich self experience among individuals with severe mental illnesses such as schizophrenia, and closes by exploring the connections of sense of self with meaningful agency. Implications for treatment are discussed.
Miscellaneous urological diseases of the kidney
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Simple and complex renal cysts 396

Calyceal diverticulum 399

Medullary sponge kidney (MSK) 400

Acquired renal cystic disease (ARCD) 402

Autosomal dominant polycystic kidney disease (ADPKD) 404

Vesicoureteric reflux in adults 408

Pelviureteric junction obstruction in adults 412

Anomalies of renal fusion and ascent: horseshoe kidney, ectopic kidney ...
Stone disease
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Kidney stones: epidemiology 428

Kidney stones: types and predisposing factors 432

Kidney stones: mechanisms of formation 434

Factors predisposing to specific stone types 436

Evaluation of the stone former 440

Kidney stones: presentation and diagnosis 442

Kidney stone treatment options: watchful waiting and the natural history of stones ...
Upper tract obstruction, loin pain, hydronephrosis
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Hydronephrosis 492

Management of ureteric strictures (other than PUJO) 496

Pathophysiology of urinary tract obstruction 498

Physiology of urine flow from kidneys to bladder 499

Ureter innervation 500

Retroperitoneal fibrosis 502

Dilatation of the renal pelvis and calyces (Fig. 10.1). When combined with dilatation of the ureters, known as hydroureteronephrosis....
Urological eponyms
Authors: Reynard John , Brewster Simon , Biers Suzanne
Published: May 2013

Alcock’s canal: canal for the internal pudendal vessels and nerve in the ischiorectal fossa.

Benjamin Alcock (b 1801). Professor of Anatomy, Physiology, and Pathology (1837) at the Apothecaries Hall in Dublin.

Anderson–Hynes pyeloplasty: dismembered pyeloplasty for PUJO.

James Anderson and Wilfred Hynes. Surgeons, Sheffield United Hospitals....
Breast
Authors: Donovan Ellen , Coles Charlotte , Westbury Charlotte , Yarnold John
Published: May 2013

Chapter 4 discusses evidence on radiotherapy effects in early breast cancer.
Rectal cancer
Authors: Glynne-Jones Rob , Harrison Mark , Sebag-Montefiore David
Published: May 2013

Chapter 7 assesses the role of radiation therapy in rectal cancer, with emphasis on preoperative imaging, patient selection for preoperative chemoradiotherapy (CRT) and short-course preoperative radiotherapy (SCPRT), and postoperative chemoradiation. We describe the various available planning techniques. More conformal techniques such as intensity-modulated radiotherapy (IMRT), volume-modulated arc therapy (VMAT), and brachytherapy are also described. In addition, chemoradiation and radiotherapy as an adjunct to local excision and endoluminal irradiation are also reviewed.
External beam radiotherapy for prostate cancer
Authors: Hafeez Shaista , Creak Antonia , Dearnaley David P
Published: May 2013

Chapter 8 discusses urology and external beam radiotherapy in prostate cancer, bladder cancer, cancer of the testis, and cancer of the penis.
Testis
Authors: Hoskin Peter
Published: May 2013

Chapter 8c discusses the role of radiotherapy in testicular cancer and how it is becoming less prominent. The mainstay of treatment is radical orchidectomy and, where there is a risk of metastatic disease, combination chemotherapy. Radiotherapy may be indicated in the following situations: 1) Stage I testicular seminoma delivering prophylactic para-aortic lymph nodes irradiation, and 2) Palliative treatment in the management of chemotherapy resistant disease.
Penis
Authors: Hoskin Peter
Published: May 2013

Chapter 8d discusses carcinoma of the penis, which is typically a squamous carcinoma arising on the penile shaft or glands in an uncircumcised patient. Management may be by primary surgery, either total amputation or partial amputation with reconstruction, or primary radiotherapy. Primary radiotherapy is indicated for those patients with T1 and T2 tumours <4 cm in diameter, particularly in those unfit for surgery, those with locally advanced disease and fixed inguinal lymph nodes, and for patients in whom surgical treatment may require total amputation and where they choose to have organ preservation by radiotherapy as an alternative. No randomized trial comparison is available to give accurate figures for the relative efficacy of either treatment. Brachytherapy is an alternative means of delivering high-dose radiotherapy to the penis and may be considered where there is local expertise for this instead of external beam treatment.
Central nervous system tumours
Authors: Burnet Neil G , Harris Fiona , Jena Raj , Burton Kate E , Jefferies Sarah J
Published: May 2013

Chapter 11 discusses central nervous system (CNS) tumours, including principles, planning volumes, dose distribution, high- and low-grade glioma, Ependymoma, Medulloblastoma, Germ cell tumours —germinoma and teratoma, Vestibular (acoustic) schwannoma, Pituitary tumours (including craniopharyngioma), Meningioma, and primary spinal cord tumours.
Principles of paediatric radiation oncology
Authors: Taylor Roger E
Published: May 2013

Chapter 15 discusses the principles of paediatric radiation oncology, and addresses quality assurance, chemotherapy/radiotherapy interactions, Leukaemia, Hodgkin lymphoma, Non-Hodgkin lymphoma, Neuroblastoma, Rhabdomyosarcoma, Ewing’s sarcoma/peripheral primitive neuroectodermal tumour, Osteosarcoma, central nervous system tumours, Intensity-modulated radiotherapy, and proton therapy for paediatric tumours.
Radiotherapy planning for metastatic disease
Authors: Hoskin Peter
Published: May 2013

Chapter 16 discusses radiotherapy planning for metastatic disease, predominantly for patients with bone metastasis, spinal cord compression, and brain metastasis. The techniques for such treatments are specific to this indication rather than the primary tumour site.
Good surgical practice
Authors: McLatchie Greg , Borley Neil
Published: May 2013

Duties of a doctor 2

Communication skills 4

Evidence-based surgery 6

Critical appraisal 10

Audit 12

Consent 14

Death 16

End-of-life issues 18

Clinical governance 20

The General Medical Council (GMC) lists the duties of a doctor in its document Good medical practice.1 The duties can be thought of under three headings (the 3 Cs): competency, communication, correctness (or probity)....
Breast and endocrine surgery
Authors: McLatchie Greg , Borley Neil
Published: May 2013

Breast cancer 240

Surgical treatment of breast cancer 242

Breast cancer screening 244

Benign breast disease 246

Acute breast pain 248

Goitre 250

Thyrotoxicosis 252

Thyroid tumours—types and features 254

Thyroid tumours—diagnosis and treatment 256

Post-thyroid surgery emergencies 258

Primary hyperparathyroidism 260

Multiple endocrine neoplasia ...
Urology
Authors: McLatchie Greg , Borley Neil
Published: May 2013

Symptoms and signs in urology 354

Investigations of urinary tract disease 356

Urinary tract stones 358

Obstruction of the ureter 360

Benign prostatic hyperplasia 362

Stricture of the urethra 364

Scrotal swellings 366

Disorders of the foreskin 368

Common conditions of the penis 370

Erectile dysfunction ...
Colorectal surgery
Authors: McLatchie Greg , Borley Neil
Published: May 2013

Ulcerative colitis 392

Crohn's disease 394

Other forms of colitis 396

Colorectal polyps 398

Colorectal cancer 400

Restorative pelvic surgery 402

Minimally-invasive colorectal surgery 403

Diverticular disease of the colon 404

Rectal prolapse 406

Pilonidal sinus disease 408

Fistula-in-ano 410

Haemorrhoids 412

Acute anorectal pain ...
Paediatric orthopaedic
Authors: McLatchie Greg , Borley Neil
Published: May 2013

Developmental dysplasia of the hip (DDH) 458

Slipped upper femoral epiphysis (SUFE) 460

The limping child 462

The child with a fracture 464

Non-accidental injury (NAI) 466

Legg–Calvé–Perthes disease 468

Motor development 470

Club foot or congenital talipes equinovarus (CTEV) 471

Flat feet (pes planus) ...
Orthopaedic surgery
Authors: McLatchie Greg , Borley Neil
Published: May 2013

Examination of a joint 490

Examination of the limbs and trunk 492

Fracture healing 494

Reduction and fixation of fractures 498

The skeletal radiograph 502

Injuries of the phalanges and metacarpals 504

Wrist injuries 508

Fractures of the distal radius and ulna 510

Fractures of the radius and ulnar shaft ...
Neuroimmunology
Authors: Miller Aaron E. , DeAngelis Tracy M.
Published: May 2013

Neuroimmunology is a practical and accessible guide for both common and not-so-common neuroimmunological syndromes. Comprised of a collection of thirty short case vignettes, the information is presented in an easily digestible format that consists of a discussion highlighting the topic in question as well as an answer and advice section. These discussions are followed by a brief 'take home' message emphasizing the clinical, diagnostic, and therapeutic pearls of the case.
Transverse Myelitis
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

The differential diagnosis of transverse myelitis is lengthy and can present a daunting challenge to the evaluating physician. Emphasizing the critical importance of an initial exclusion of spinal cord compressive causes, we then present several clinical red flags, which can assist in narrowing the potential etiologies and discuss available therapeutic options.
Neuromyelitis Optica
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Neuromyelitis optica (NMO), a chronic inflammatory, demyelinating autoimmune disorder of the central nervous system with a predilection for the optic nerves and spinal cord, has long been confused with classical multiple sclerosis. In this chapter, we review the important clinical and radiographic distinctions of NMO and NMO spectrum disorders, and summarize promising new concepts in pathophysiology and therapeutic approaches.
Neuroborreliosis
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Neuroborreliosis, an infection of the nervous system by the spirochete Borrelia burgdorferi, is a controversial entity both in its proper diagnosis and management. In this chapter, we review the common presentations of Lyme infection affecting the central and peripheral nervous systems, the utility of diagnostic screening and confirmatory tests, and the recommended course of antibiotic treatment.
Varicella Zoster Myelopathy
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Varicella zoster virus (VZV) myelopathy is a rare cause of infectious myelitis and can present in both immunocompetent as well as immunocompromised individuals. In this chapter, we review the two most common presentations of VZV myelopathy, the optimal diagnostic testing and current therapeutic approaches.
Neurosarcoidosis
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Sarcoidosis is a multi-systemic, inflammatory, granulomatous disorder of unknown etiology, characterized pathologically by the presence of noncaseating granulomas and multinucleated giant cells. Involvement of the nervous system is estimated in 5% of patients with systemic sarcoidosis, and rarely occurs as an isolated phenomenon. In this chapter, we review the most common peripheral and central presentations of neurosarcoidosis.
Susac’s Syndrome
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Susac’s syndrome, also known as retinocochleocerebral vasculopathy, involves the triad of encephalopathy, vision, and hearing loss. In this chapter, we review the typical ophthalmological and auditory findings, the pathognomonic radiographic features, and the general clinical course of Susac’s syndrome. In addition, we discuss the role of empiric therapeutic approaches involving corticosteroids and immunosuppressants.
Hashimoto’s Encephalopathy
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Hashimoto’s encephalopathy (HE) is a rare but potentially corticosteroid responsive disorder, which should be considered in cases of encephalopathy of unclear etiology. Hashimoto’s thyroiditis usually does not accompany HE and thyroid function is generally clinically normal. In this chapter, we review the differential diagnostic suspicions for a case of encephalopathy of unclear etiology and respective aspects that raise concern for HE. In addition, we discuss the utility of diagnostic testing and options for therapeutic management.
Polyarteritis Nodosa
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Polyarteritis nodosa (PAN) is a systemic illness that most often involves the peripheral nervous system, skin, kidneys, and gastrointestinal tract. In this chapter, we review the diagnostic criteria for PAN, its most common neurological manifestations affecting the peripheral nervous system as well as central nervous system presentations, and discuss general treatment recommendations.
Rassmussen’s Encephalitis
Authors: Miller Aaron E. , DeAngelis Teresa M.
Published: May 2013

Rasmussen’s encephalitis is a rare autoimmune encephalitis that generally manifests in the pediatric population with refractory focal motor seizures followed by insidiously progressive cognitive decline and hemispheric dysfunction. In this chapter, we review the current pathophysiological concepts of RE, its typical clinical and pathognomonic radiographic features, and the medical and surgical therapeutic approaches.
Beliefs and Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2013

Chapter 3 presents a general overview of religious and cultural beliefs and how they may pertain to the acceptance of brain death and organ donation. It also touches on the role of the clergy in the intensive care unit.
Critics and Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2013

Chapter 4 concentrates on the viewpoints and motivations of physicians who oppose the concept of brain death and may be involved in these determinations.
Research Priorities in Late-Life Mood Disorders
Authors: Dow Briony , Lin Xiaoping , Tinney Jean , Harambous Betty , Ames David
Published: May 2013

This chapter presents a summary of research priorities for international researchers in the area of late life mood disorders. After a brief discussion on important issues that underlie future research in this area, including sociodemographic changes and advances in technology, it presents a snapshot of current research in late life mood disorders and identifies important gaps. The chapter concludes with recommendations on research priority areas likely to create the most exciting opportunities for the late life mood disorder field in the next 5-10 years. These include more cross disciplinary research, including psycho-social, behavioral and biological approaches; more targeted research into anxiety, including neurological aspects of anxiety advanced through neuroimaging; and translational research that evaluates the effectiveness, cost, and feasibility of treatments for anxiety in a range of settings but particularly primary health settings.
the diagnosis and treatment of unipolar depression in late life
Authors: Snowdon John , Almeida Osvaldo P.
Published: May 2013

Development of a depressive disorder is commonly attributable to a complexity of factors, though with differences between age-groups. The pattern of losses experienced in old age differs from that encountered earlier in life; notably, increasingly prevalent physical illness and brain changes may cause psychological stress additional to their neurophysiological impact. DSM-IV diagnostic decisions have proved relatively unhelpful when planning interventions in cases of late-life unipolar depression. Relapse following remission is common, especially if culpable factors (e.g. vascular change or persisting effects of losses) remain in evidence. Understanding how different factors have contributed to diminution of self-esteem, as well as biological depressive features, allows planning of appropriate therapeutic strategies.
Bipolar Disorder
Authors: Young Robert C. , Mahgoub Nahla A.
Published: May 2013

Older adults with bipolar (BP)disorder present a heterogeneous group of patients who have diverse clinical characteristics, and comorbidities and presumably differing pathophysiology and etiology. Age-related factors including age at onset of illness and age-associated neurobiological and psychosocial factors may contribute to these extents of heterogeneity. Relevant neurobiological changes may include vascular and degenerative processes. This chapter provides an overview of the limited evidence base. Investigation of this subgroup of BP patients presents both challengers and important opportunities for investigation. Opportunities include studies of markers of vulnerability, of how heterogeneity may be associated with differences in outcomes and may guide development of novel treatments, and of the nature of clinical features shared with other geriatric disorders.
Anxious Depression
Authors: Andrew J. Petkus, Eric J. Lenze, , Wetherell Julie Loebach
Published: May 2013

The majority of depressed older adults also suffer from clinically significant symptoms of anxiety. In this chapter we will describe the prevalence rates of co-occurring depression and anxiety in older adulthood; as well as the negative outcomes associated with these disorders. Anxiety and depression share many similarities and we review the biological, psychological, and emotional similarities between these disorders. Recently developed transdiagnostic models that conceptualize depressive and anxiety disorders as “emotional disorders” are reviewed. Lastly, we provide pharmacological and psychosocial treatment recommendations for older adults suffering from depression and anxiety.
Complementary and Alternative Medicine Approaches for Treatment and Prevention of Late-Life Mood Disorders
Authors: Merrill David , Payne Martha , Lavretsky Helen
Published: May 2013

Complementary and alternative medicine (CAM) approaches for treatment of late life mood disorders are reviewed and discussed. Widespread use of CAM therapies by the aging population necessitates that clinicians have familiarity in regards to the efficacy and safety of a wide variety of CAM treatments. The major domains of CAM therapies are defined and relevant approaches are discussed, including biologically based therapies (omega-3 fatty acids, S-adenosyl-Lmethionine, St. John’s wort), mind-body medicine (yoga, tai chi, exercise, mindfulness meditation), alternative medical systems (acupuncture, Ayurveda), and other CAM practices (religion and spirituality, expressive therapies).
Depression in Older Adults Receiving Hospice Care
Authors: Desai Abhilash K. , Lo Daphne , Grossberg George T.
Published: May 2013

Depression (both major and minor depression) is prevalent in terminally ill older adults, and is under-diagnosed and undertreated in this population. Depression in older adults receiving hospice care has not been rigorously studied and most of the existing research in this area has been conducted in patients terminally ill due to cancer. Only a few of these studies involve older adults receiving hospice care. Depression in terminally ill older adults may reduce quality of life, increase stress in family members, impair decision making capacity and may shorten survival. Depression is often mistaken for normal grief and although differentiating between them is challenging, a systematic assessment allows for accurate diagnosis. Clinical experience and limited research data indicate that depression responds to a combination of psychosocial and psychopharmacological interventions in older adults who are terminally ill.
Functional Neuroimaging in Late-Life Mood Disorders
Authors: Patel Meenal J. , Aizenstein Howard J. , Smith Gwenn S.
Published: May 2013

Structural and functional neuroimaging modalities have identified changes in neural circuitries in patients with mood disorders in late life, including major depression and bipolar disorder. The most widely used imaging modalities include functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). The major findings will be reviewed regarding the functional neuroanatomy of late life depression, changes in neural circuitry under conditions of affective and cognitive activation, changes in neural circuitry associated with antidepressant treatment, and molecular imaging studies of specific neurochemical markers and neuropathology. The potential for the neuroimaging measure to serve as neurobiological markers of treatment response, as well as future directions for fMRI and PET imaging, are discussed.
Psychoneuroimmunology of Depressive Disorders
Authors: Irwin Michael R.
Published: May 2013

Many exciting developments have occurred regarding the relationship between depression and the immune system, putting the field of psychoneuroimmunology into a clinical context with important translational implications for late-life depression. Initial studies focused on the impact of depression on relatively narrowly defined immunologic endpoints, which were ultimately relevant to infectious illnesses, autoimmune disorders, cancer as well as cardiovascular disease. More recently, the reciprocal influences of the immune system on the brain and behavior including depression have taken center stage. Increasing data now indicate that activated inflammatory processes can influence multiple aspects of CNS function including neurotransmitter metabolism, neuroendocrine function, and information processing leading to behavioral changes in humans. Together, these findings have provided insight into the identification of inflammatory mediators of depression risk and the development of novel anti-inflammatory, behavioral and pharmacologic treatments for late-life depression.
Brain Imaging Techniques and Their Application to Bipolar Disorder
Authors: Adler Caleb M. , Cerullo Michael A.
Published: May 2013

Recent technological advances have radically changed the nature of brain imaging, allowing significant advances in the understanding of psychiatric disorders and the neural substrates underlying affective and psychotic symptoms. A number of techniques have been used to study the structure and function of the bipolar brain, including computed tomography (CT), positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Increasingly however, brain imaging is being dominated by magnetic resonance imaging (MRI) techniques that allow examination of brain anatomy (both gray and white matter), functional activity, and neurochemistry. Each of these imaging methodologies allow examination of different aspects of neuroanatomy and physiology, and have both strengths and weaknesses that must be considered when designing studies and interpreting findings. As neuroimaging techniques continue to proliferate and advance, it is likely that these methodologies will play a major role in improving our understanding of bipolar neurophysiology, as well as in the development of novel, more effective treatments.
Neurochemical and Metabolic Imaging in Bipolar Disorder
Authors: Kim Jieun E. , Lyoo In Kyoon , Renshaw Perry F.
Published: May 2013

Magnetic resonance spectroscopy (MRS) is an important neuroimaging technique offering the promise of revolutionizing how we study human brain function by allowing the examination of molecular processes in the live human brain. This chapter reviews both proton (1H) and phosphorus (31P) MRS studies in bipolar disorder and proposes a neurochemical model of this illness. Integration of the MRS findings including alterations in cerebral levels of N-acetyl aspartate, glutamate/glutamine, choline-containing compounds, myo-inositol, and lactate, measured using 1H MRS and alterations in cerebral levels of phosphocreatine, phosphomonoesters, and intracellular pH, measured using 31P MRS, leads to a well-supported hypothesis of an underlying mitochondrial impairment in bipolar disorder.
Neuroimaging Studies of Bipolar and Unipolar Depression
Authors: Versace Amelia , Almeida Jorge R. C. , Phillips Mary L.
Published: May 2013

Bipolar disorder is defined by the occurrence of mania, but affected individuals spend most of their time when ill struggling with depression. Consequently, understanding the neurobiology of depression might clarify the neural substrates of bipolar disorder. Moreover, contrasting the neurobiology of unipolar and bipolar depression might identify specific features of bipolar illness that result in mood cycling and might aid in diagnosis. Despite the significant promise in these considerations, relatively few neuroimaging studies have directly compared bipolar and unipolar depression. Nonetheless, white matter neuroimaging (e.g., diffusion tensor imaging, DTI) findings suggest that depression in bipolar and unipolar disorder may be distinguished by different abnormalities in right uncinate fasciculus. Moreover, these findings support a hypothesis that unipolar depression demonstrates left- but not right-sided abnormalities in amygdala-orbitomedial prefrontal cortical structural connectivity. Functional connectivity studies report corresponding differences between bipolar and unipolar depressed subjects in right-sided bottom-up amygdala-medial prefrontal effective connectivity. More studies comparing these depressive disorders are clearly needed to extend this model of bipolar depression.
Understanding life through unwanted childlessness: Ethnography and fiction from Ghana, Bangladesh and ‘dystopia’ (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: van der Geest Sjaak , Nahar Papreen
Published: May 2013

Drawing on ethnographic work in Ghana and Bangladesh, and on a British dystopian novel, we sketch the social, emotional, and existential consequences of childlessness for women who desperately want a child, as is still common in the two countries where the authors carried out research. For these women, childlessness leads to loneliness and a sense of uselessness. Underlying these emotions is the notion that children constitute and personify continuity; childlessness thus stands for the discontinuation of life.
Insights from Cameroon: Five years after the Declaration on the Rights of Indigenous Peoples (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: Pelican Michaela
Published: May 2013

In September 2007, after 23 years of negotiation between nation states and indigenous peoples' organizations, the United Nations (UN) General Assembly finally adopted the Declaration on the Rights of Indigenous Peoples. Among its most significant assertions were indigenous peoples' rights to self‐determination; to lands, territories, and natural resources; and to free, prior, and informed consent. Activists and organizations concerned with human and minority rights saw the adoption of the declaration as an important step toward the improvement of the precarious situation of many minority groups. Today, five years have passed since the declaration's adoption. What difference has it made? Have the activists' expectations materialized? How has the declaration been implemented? Which are the responses of governmental and civil society actors? Drawing on institutional developments at the United Nations as well as the case of Cameroon and the Mbororo as a national minority group, I aim to provide some answers to these questions.
FGM or FGMo? Cross‐cultural dialogue in an Italian minefield (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: Mabilia Mara
Published: May 2013

On 20 December 2012 the United General Assembly unanimously passed a resolution banning the practice of Female Genital Mutilation (FGM). In this article, Mara Mabilia aims to draw attention to the lives of immigrant women in Europe, and more specifically Italy, from some of the 30 or so chiefly Islamic countries of Africa, where what she prefers to call ‘female genital modification’ (FGMo) is practised. Her aim is neither to advocate the practice, nor to challenge the bans instituted in the West. Rather, her aim is, more broadly, to probe how women, having undergone these practices, live in host societies that interpret these chiefly as human rights violations through the prism of unacceptable violence. To condemn FGM should not imply condemnation also of the 100–140 million women that the World Health Organization (WHO) estimates have undergone this practice.
Mitochondrial DNA analyses show that Zambia's South Luangwa Valley giraffe (Giraffa camelopardalis thornicrofti) are genetically isolated
Authors: Fennessy Julian , Bock Friederike , Tutchings Andy , Brenneman Rick , Janke Axel
Published: May 2013

Thornicroft's giraffe, Giraffa camelopardalis thornicrofti, is a geographically isolated subspecies of giraffe found only in north‐east Zambia. The population only occurs in Zambia's South Luangwa Valley, an area which interestingly places it between the current distribution of Masai (G. c. tippelskirchi) giraffe to the north, and the Angolan (G. c. angolensis) and South African (G. c. giraffa) giraffe in the south‐west and south, respectively. Specific studies have been undertaken on the ecology of this subspecies, but their population genetics remains unknown. We studied 34 individuals from the South Luangwa National Park and adjacent Lupande Game Management Area and seven individuals from northern Botswana. The complete cytochrome b and control region sequences of the mitochondrial genome were sequenced and analysed together with database data by maximum likelihood tree reconstruction and maximum parsimony network analyses. The giraffe from Zambia's South Luangwa Valley are most closely related to the subspecies G. c. tippelskirchi and part of their radiation. However, they form a unique population that would benefit from increased research and conservation management.