bluuebunny/crossref_metadata_2025 huggingface dataset:
Crop-damaging temperatures increase suicide rates in India
Authors: Carleton Tamma A.
Published: August 2017

Significance

Suicide is a stark indicator of human hardship, yet the causes of these deaths remain understudied, particularly in developing countries. This analysis of India, where one fifth of the world’s suicides occur, demonstrates that the climate, particularly temperature, has strong influence over a growing suicide epidemic. With 47 y of suicide records and climate data, I show that high temperatures increase suicide rates, but only during India’s growing season, when heat also reduces crop yields. My results are consistent with widely cited theories of economic suicide in India. Moreover, these findings have important implications for future climate change; I estimate that warming temperature trends over the last three decades have already been responsible for over 59,000 suicides throughout India.
Low-frequency hippocampal–cortical activity drives brain-wide resting-state functional MRI connectivity
Authors: Chan Russell W. , Leong Alex T. L. , Ho Leon C. , Gao Patrick P. , Wong Eddie C. , Dong Celia M. , Wang Xunda , He Jufang , Chan Ying-Shing , Lim Lee Wei , Wu Ed X.
Published: August 2017

Significance

The hippocampus with its dense reciprocal axonal projections to and from cortex is widely believed to mediate numerous cognitive functions. However, it is unknown whether and how specific hippocampal–cortical activity contributes to the brain-wide functional connectivity. Here, we use optogenetics and fMRI to examine how excitatory neural activity initiated in the dorsal dentate gyrus of the hippocampus propagates and modulates resting-state fMRI (rsfMRI) connectivity. We discover its robust propagation brain-wide at low frequency (1 Hz), which enhances interhemispheric rsfMRI connectivity and cortical and subcortical visual responses. Our findings highlight the important role of slow hippocampal–cortical oscillatory activity in driving brain-wide rsfMRI connectivity and mediating sensory processing.
Autonomous reciprocating migration of an active material
Authors: Ren Lin , Wang Meng , Pan Changwei , Gao Qingyu , Liu Yang , Epstein Irving R.
Published: August 2017

Significance

We analyze the reciprocating locomotion of a photosensitive gel undergoing an oscillating chemical reaction in a temporally constant gradient illumination environment to examine whether periodic migration can arise as an adaptive response of a system’s internal dynamics, analogous to biological functions like growth or breeding, to specific spatial variations in resource distribution, such as food, temperature, or light intensity, caused by geography or seasonal transition. Even in this relatively simple system, kinematic switching in the mode of locomotion under spatially varying illumination levels leads to reciprocating periodic motion, suggesting that such behavior may occur widely in organisms as a response to a variety of spatially distributed environmental stimuli to enhance their survival and reproduction.
Specific regulation of thermosensitive lipid droplet fusion by a nuclear hormone receptor pathway
Authors: Li Shiwei , Li Qi , Kong Yuanyuan , Wu Shuang , Cui Qingpo , Zhang Mingming , Zhang Shaobing O.
Published: August 2017

Significance

Human and animals store fat in the form of multiple small intracellular structures, called lipid droplets, in brown adipocytes, and in a single large lipid droplet in white adipocytes. When environmental temperature decreases, white adipocytes can convert into brown adipocytes, in which fat is more accessible for burning and thermogenesis, and vice versa. The mechanism underlying the interconversion between multiple and single lipid droplets is not clear. Here, we report that a nuclear hormone signaling pathway regulates similar conversions in the nematode
Caenorhabditis elegans
, and that components of this pathway have counterparts in humans.
Presumptive TRP channel CED-11 promotes cell volume decrease and facilitates degradation of apoptotic cells in
Caenorhabditis elegans
Authors: Driscoll Kaitlin , Stanfield Gillian M. , Droste Rita , Horvitz H. Robert
Published: August 2017

Significance

Apoptosis is required for normal animal development and homeostasis. Apoptosis is driven by caspases, cysteine proteases that cleave downstream targets and cause cell death and degradation. A classic hallmark of apoptosis is cell shrinkage. We identify a presumptive transient receptor potential (TRP) family cation channel, CED-11, that acts during apoptosis in
Caenorhabditis elegans
downstream of CED-3 caspase activation to promote a decrease in cell volume and facilitate the death and degradation of apoptotic cells. TRP channels can stimulate cell shrinkage in response to osmotic stress. Our results suggest that the mechanism of cell shrinkage during apoptosis might be similar to the regulatory volume decrease (RVD) that cells undergo after the cell swelling induced by hypoosmotic stress.
Ensemble modeling informs hypoxia management in the northern Gulf of Mexico
Authors: Scavia Donald , Bertani Isabella , Obenour Daniel R. , Turner R. Eugene , Forrest David R. , Katin Alexey
Published: August 2017

Significance

The number of coastal hypoxia areas is spreading worldwide, with severe environmental and societal impacts. The second-largest hypoxic zone occurs in the northern Gulf of Mexico, where anthropogenic nutrient load is a key driving factor, as in many coastal waters. We address policy-relevant questions raised by Gulf stakeholders and decision-makers using an ensemble approach that integrates results from multiple models. Through development of a rigorous framework to propagate intramodel and intermodel uncertainty into the ensemble, we provide policymakers with the response of hypoxic area to a range of different nitrogen load reduction scenarios, with corresponding probabilistic statements that allow for quantitative risk assessment of alternative policy strategies.
Elevated IOP alters the space–time profiles in the center and surround of both ON and OFF RGCs in mouse
Authors: Sabharwal J. , Seilheimer R. L. , Tao X. , Cowan C. S. , Frankfort B. J. , Wu S. M.
Published: August 2017

Significance

Glaucoma is a leading cause of blindness worldwide and many patients with glaucoma do not realize they have the disease until a significant visual deficit occurs. Here we record from mouse retinal ganglion cells and determine how they properties change in a mouse model of experiment glaucoma. We identify multiple changes to retinal ganglion cell functional properties and potential circuits mediating these changes. The findings from this study will help glaucoma patients in two ways. The novel functional changes we see can help identify new diagnostic tests that could identify patients prior to gross vision loss. Additionally, identification of specific retinal pathways mediating glaucomatous injury will help develop new treatments that extend to retinal cells that are currently being ignored.
Deep evolutionary conservation of autism-related genes
Authors: Shpigler Hagai Y. , Saul Michael C. , Corona Frida , Block Lindsey , Cash Ahmed Amy , Zhao Sihai D. , Robinson Gene E.
Published: August 2017

Significance

Sociobiological theory proposed that similarities between human and animal societies reflect similar evolutionary origins. We used comparative genomics to test this controversial idea by determining whether superficial behavioral similarities between humans and honey bees reflect shared molecular mechanisms. We found unique and significant enrichment for autism spectrum disorder-related genes in the neurogenomic signatures of a high-level integration center of the insect brain in bees unresponsive to two different salient social stimuli. These results demonstrate deep conservation for genes implicated in autism spectrum disorder in humans and genes associated with social responsiveness in honey bees. Comparative genomics thus provides a means to test theory on the biology of social behavior.
Ten Years of Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT): Lessons Learned
Authors: Nunes Ana P. , Richmond Melissa K. , Marzano Kelly , Swenson Carolyn J. , Lockhart Jodi
Published: August 2017

The US Surgeon General recently issued a comprehensive report indicating that substance use is a major public health concern that must be addressed using a number of strategies. Screening, brief intervention, and referral to treatment (SBIRT) is one such strategy. SBIRT Colorado, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has implemented a statewide initiative for the past 10 years that has provided ample opportunities to identify key components for successful implementation. Successful implementation requires (1) strong clinical and management advocates; (2) full integration of services into practices’ workflow utilizing technology whenever possible; (3) interprofessional team approaches; (4) appropriate options for the small proportion of patients screening positive for a possible substance use disorder; (5) cannabis screening that accounts for legalization, and interventions that acknowledge differences between alcohol and cannabis use; (6) incorporating SBIRT into standard health care professionals’ training; and (7) addressing the significant issues regarding reimbursement through private and public payers for SBIRT services. Implementing and sustaining SBI as a standard of integrated care is essential to reduce the burden of substance use. Interdisciplinary approaches, technology, and training to increase practitioner confidence and skill are fundamental.
Saccades and smooth pursuit eye movements trigger equivalent gaze-cued orienting effects
Authors: Langton Stephen RH , McIntyre Alex H , Hancock Peter JB , Leder Helmut
Published: August 2017

Research has established that a perceived eye gaze produces a concomitant shift in a viewer’s spatial attention in the direction of that gaze. The two experiments reported here investigate the extent to which the nature of the eye movement made by the gazer contributes to this orienting effect. On each trial in these experiments, participants were asked to make a speeded response to a target that could appear in a location toward which a centrally presented face had just gazed (a cued target) or in a location that was not the recipient of a gaze (an uncued target). The gaze cues consisted of either fast saccadic eye movements or slower smooth pursuit movements. Cued targets were responded to faster than uncued targets, and this gaze-cued orienting effect was found to be equivalent for each type of gaze shift both when the gazes were un-predictive of target location (Experiment 1) and counterpredictive of target location (Experiment 2). The results offer no support for the hypothesis that motion speed modulates gaze-cued orienting. However, they do suggest that motion of the eyes per se, regardless of the type of movement, may be sufficient to trigger an orienting effect.
Correlations between zeros and critical points of random analytic functions
Authors: Feng Renjie
Published: August 2017

We study the two-point correlation

K
n
m

(
z
,
w
)

K^m_n(z,w)

between zeros and critical points of Gaussian random holomorphic sections

s
n

s_n

over Kähler manifolds. The critical points are points

∇

h
n

s
n

=
0

\nabla _{h^n} s_n=0

, where

∇

h
n

\nabla _{h^n}

is the smooth Chern connection with respect to the Hermitian metric

h
n

h^n

on line bundle

L
n

L^n

. The main result is that the rescaling limit of

K
n
m

(

z
0

+

u

n

,

z
0

+

v

n

)

K^m_n(z_0+\frac u{\sqrt n}, z_0+\frac v{\sqrt n})

for any

z
0

∈
M

z_0\in M

is universal as

n
n

tends to infinity. In fact, the universal rescaling limit is the two-point correlation between zeros and critical points of Gaussian analytic functions for the Bargmann–Fock space of level

1
1

. Furthermore, in the length scale of order

n

−

1
2

n^{-\frac 12}

, there is a “repulsion" between zeros and critical points for the short range, and a “neutrality" for the long range.
Geometry of the moduli of parabolic bundles on elliptic curves
Authors: Fernández Vargas Néstor
Published: August 2017

The goal of this paper is the study of simple rank 2 parabolic vector bundles over a

2
2

-punctured elliptic curve

C
C

. We show that the moduli space of these bundles is a non-separated gluing of two charts isomorphic to

P

1

×

P

1

\mathbb {P}^1 \times \mathbb {P}^1

. We also showcase a special curve

Γ
\Gamma

isomorphic to

C
C

embedded in this space, and this way we prove a Torelli theorem. This moduli space is related to the moduli space of semistable parabolic bundles over

P

1

\mathbb {P}^1

via a modular map which turns out to be the 2:1 cover ramified in

Γ
\Gamma

. We recover the geometry of del Pezzo surfaces of degree 4 and we reconstruct all their automorphisms via elementary transformations of parabolic vector bundles.
Wild solenoids
Authors: Hurder Steven , Lukina Olga
Published: August 2017

A weak solenoid is a foliated space defined as the inverse limit of finite coverings of a closed compact manifold

M
M

. The monodromy of a weak solenoid defines an equicontinuous minimal action on a Cantor space

X
X

by the fundamental group

G
G

of

M
M

. The discriminant group of this action is an obstruction to this action being homogeneous. The discriminant vanishes if the group

G
G

is abelian, but there are examples of actions of nilpotent groups for which the discriminant is non-trivial. The action is said to be stable if the discriminant group remains unchanged for the induced action on sufficiently small clopen neighborhoods in

X
X

. If the discriminant group never stabilizes as the diameter of the clopen set

U
U

tends to zero, then we say that the action is unstable, and the weak solenoid which defines it is said to be wild. In this work, we show two main results in the course of our study of the properties of the discriminant group for Cantor actions. First, the tail equivalence class of the sequence of discriminant groups obtained for the restricted action on a neighborhood basis system of a point in

X
X

defines an invariant of the return equivalence class of the action, called the asymptotic discriminant, which is consequently an invariant of the homeomorphism class of the weak solenoid. Second, we construct uncountable collections of wild solenoids with pairwise distinct asymptotic discriminant invariants for a fixed base manifold

M
M

, and hence fixed finitely-presented group

G
G

, which are thus pairwise non-homeomorphic. The study in this work is the continuation of the seminal works on homeomorphisms of weak solenoids by Rogers and Tollefson in 1971 and is dedicated to the memory of Jim Rogers.
Chern classes of crystals
Authors: Esnault Hélène , Shiho Atsushi
Published: August 2017

The crystalline Chern classes of the value of a locally free crystal vanish on a smooth variety defined over a perfect field. Out of this we conclude new cases of de Jong’s conjecture relating the geometric étale fundamental group of a smooth projective variety defined over an algebraically closed field and the constancy of its category of isocrystals. We also discuss the case of the Gauß–Manin convergent isocrystal.
The Riemann theta function solutions for the hierarchy of Bogoyavlensky lattices
Authors: Wei Jiao , Geng Xianguo , Zeng Xin
Published: August 2017

Starting with a discrete

3
×
3

3\times 3

matrix spectral problem, the hierarchy of Bogoyavlensky lattices which are pure differential-difference equations are derived with the aid of the Lenard recursion equations and the stationary discrete zero-curvature equation. By using the characteristic polynomial of Lax matrix for the hierarchy of stationary Bogoyavlensky lattices, we introduce a trigonal curve

K

m
−
1

\mathcal {K}_{m-1}

of arithmetic genus

m
−
1

m-1

and a basis of holomorphic differentials on it, from which we construct the Riemann theta function of the trigonal curve, the related Baker–Akhiezer function, and an algebraic function carrying the data of the divisor. Based on the theory of trigonal curves, the Riemann theta function representations of the Baker–Akhiezer function, the meromorphic function, and in particular, that of solutions of the hierarchy of Bogoyavlensky lattices are obtained.
A persistent homological analysis of network data flow malfunctions
Authors: Scoville Nicholas A , Yegnesh Karthik
Published: August 2017

Persistent homology has recently emerged as a powerful technique in topological data analysis for analysing the emergence and disappearance of topological features throughout a filtered space, shown via persistence diagrams. In this article, we develop an application of ideas from the theory of persistent homology and persistence diagrams to the study of data flow malfunctions in networks with a certain hierarchical structure. In particular, we formulate an algorithmic construction of persistence diagrams that parameterize network data flow errors, thus enabling novel applications of statistical methods that are traditionally used to assess the stability of persistence diagrams corresponding to homological data to the study of data flow malfunctions. We conclude with an application to network packet delivery systems.
Free-swimming swordfish, Xiphias gladius, alter the rate of whole body heat transfer: morphological and physiological specializations for thermoregulation
Authors: Stoehr Ashley , St. Martin Joshua , Aalbers Scott , Sepulveda Chugey , Bernal Diego
Published: August 2017

Swordfish (Xiphias gladius) are large, highly-migratory pelagic, fishes that make diel, vertical excursions from the warm, surface layer (e.g. 18–24 °C) to the cold waters (∼8 °C) below the thermocline (300–600 m). They possess anatomical traits [e.g. medial red muscle (RM) position and an associated vascular rete] that could enable metabolic heat-retention and result in RM temperature elevation above ambient, or RM endothermy. We herein provide: (i) expanded anatomical descriptions of the RM-associated vasculature (i.e. central rete and lateral blood vessels), (ii) new measurements of in vivo temperature, and (iii) heat transfer models to assess the capacities for RM endothermy and physiological thermoregulation during vertical movements. Despite the presence of a medial RM and two associated blood-flow pathways (one of which forms a rete), swordfish exhibited a limited capacity for RM endothermy, with muscle temperatures approaching ambient during prolonged periods above or below the thermocline. Our heat transfer models suggest, however, that swordfish may control rates of heat loss or gain during vertical movements, possibly by altering the route of blood flow supplying the RM. Such physiological thermoregulation likely contributes to the ability of swordfish to capitalize on food resources below the thermocline, which are out of range for most other active, pelagic fishes.
Memory
Authors: Carrión Victor G. , Turner John A. , Weems Carl F.
Published: August 2017

One of the most prominent symptoms of PTSD is the persistence of troubling trauma-memories that appear resistant to extinction. To understand the key role that memory plays in the development of PTSD, the current chapter presents a review of theoretical models for memory encoding, processing, learning, and extinction. The preclinical literature that has informed our understanding of the toxic relationship between chronic elevation of stress hormones such as glucocorticoids and memory is examined. Consideration of cognitive and neuroimaging studies on adults and children illustrates the long-term consequences of traumatic stress on the neurofunctional structures involved in memory, such as the hippocampus and LHPA axis. The variance in these effects, attributable to their timing and context, is discussed, and suggests that stress may preprogram subsequent memory performance when it is experienced during the critical period of brain development.
Treatment Outcomes
Authors: Carrión Victor G. , Turner John A. , Weems Carl F.
Published: August 2017

The phenomenology of PTSD has been established in the previous chapters to be an already broad domain that encompasses a myriad of interactions between brain systems. As our understanding of the disorder expands and yields new questions, so do the available options for treatment. The current chapter reviews the cognitive and behavioral interventions for PTSD and other anxiety disorders that have demonstrated efficacy in clinical trials, as well as a variety of emerging pharmacological interventions and the preclinical literature that has informed their development. The identification of biomarkers for PTSD is discussed in terms of their potential application as both potential predictors of the development of PTSD and of the outcome of interventions designed to treat it.
Brain Function in Pediatric PTSD
Authors: Carrión Victor G. , Turner John A. , Weems Carl F.
Published: August 2017

Previous chapters established that many of the symptoms of PTSD in children and adolescents are associated with structural and functional abnormalities of fronto-limbic pathways. The current chapter reviews the scope of the book and discusses general implications that result from these findings, suggests other areas of investigation, and discusses applicability of this neuroscience research to treatment and policy. This includes a survey of current research into critical periods of brain development that may affect the trajectory of PTSD’s development, research into whole-brain networks exhibiting vulnerability to traumatic stress, and innovative treatment strategies based on these emerging theoretical frameworks. Future directions for the ever-growing field of traumatic stress science, as well as miscellaneous findings not otherwise included within this book’s framework, are discussed.
Age at Onset and Clinical Course of Body Dysmorphic Disorder
Authors: Bjornsson Andri S.
Published: August 2017

This chapter reviews studies that have been conducted to determine the age at onset and course of illness of body dysmorphic disorder (BDD). Age at onset has been examined in two large samples, and the mean age at onset was the same in both studies (16.7 years). About two thirds of people had onset of BDD before age 18. There were more similarities than differences between the early-onset group (before age 18) and the later-onset group, although the early-onset group had a higher prevalence of attempted suicide than the late-onset group in both samples. The clinical course of BDD is often chronic unless appropriate treatment is received. These findings point to the need for early education on healthy body image and treatment interventions for BDD, especially among adolescents.
Suicidality and Aggressive Behavior in Body Dysmorphic Disorder
Authors: Phillips Katharine A.
Published: August 2017

This chapter reviews suicidality and aggressive/violent behavior in body dysmorphic disorder (BDD) and presents clinical cases, which reflect the extreme suffering that BDD often causes. Suicidal ideation and suicide attempts are common in BDD. This has been found in both clinical and epidemiologic samples and in adults as well as youth. More severe BDD symptoms are independently associated with an increased risk of suicidal ideation and suicide attempts. Suicidality appears more common in BDD than in obsessive-compulsive disorder and other clinical samples with which BDD has been directly compared. Although data are limited, the rate of completed suicide appears markedly elevated; indeed, individuals with BDD have many risk factors for completed suicide. Physical aggression and violence are less well studied but appear to commonly occur as a consequence of BDD. Surgeons, dermatologists, and other clinicians who provide cosmetic treatment may be at particular risk. Additional studies designed to investigate these topics are urgently needed.
Gender and Body Dysmorphic Disorder
Authors: Gazzarrini Denise , Perugi Giulio
Published: August 2017

Body dysmorphic disorder (BDD) in females and males appears to have more similarities than differences; however, gender-related factors appear to influence some aspects of BDD’s clinical expression and prevalence. In epidemiologic studies, BDD is slightly more common in females than in males, but in clinical samples and samples of convenience, the gender ratio is more variable. Gender seems to influence some specific body parts of concern (e.g., men are more likely to be concerned about their genitals, women their breasts and legs). Women appear more likely than men to use certain camouflaging techniques and to pick their skin in response to skin concerns. Differences in comorbidity have also been reported, with substance use disorders more common in males and eating disorders more common in females. Men and women are equally likely to seek cosmetic treatment for BDD, which differs from the general population, but women are more likely to receive it. The possible influence of gender on treatment response deserves further research.
Cognitive and Emotional Processing in Body Dysmorphic Disorder
Authors: Buhlmann Ulrike , Hartmann Andrea S.
Published: August 2017

According to current cognitive-behavioral models, body dysmorphic disorder (BDD) is characterized by a vicious cycle between maladaptive appearance-related thoughts and information-processing biases, as well as maladaptive behaviors and negative emotions such as feelings of shame, disgust, anxiety, and depression. This chapter provides an overview of findings on cognitive characteristics such as dysfunctional beliefs, information-processing biases for threat (e.g., selective attention, interpretation), and implicit associations (e.g., low self-esteem, strong physical attractiveness stereotype, and high importance of attractiveness). The chapter also reviews face recognition abnormalities and emotion recognition deficits and biases (e.g., misinterpreting neutral faces as angry) as well as facial discrimination ability. These studies suggest that BDD is associated with dysfunctional beliefs about one’s own appearance, information-processing biases, emotion recognition deficits and biases, and selective processing of appearance-related information. Future steps to stimulate more research and clinical implications are discussed.
The Self as an Aesthetic Object : Body Image, Beliefs About the Self, and Shame in a Cognitive-Behavioral Model of Body Dysmorphic Disorder
Authors: Baldock Emma , Veale David
Published: August 2017

This chapter describes a cognitive-behavioral model of body dysmorphic disorder (BDD), focusing on a core concept of “processing of the self as an aesthetic object.” This concept refers to the experience of being intensely self-focused on a distorted and negative “felt sense” of how one appears to others, and of anticipating or experiencing negative evaluation and rejection because of how one looks. The model proposes that this “felt sense” is informed by intrusive imagery derived from aversive memories, which many individuals with BDD experience. Appearance may become an “idealized value” (i.e., something of primary importance in defining the self and its worth). According to the model, the negative “felt sense” of how the person looks is interpreted in terms of a threat to the self as a whole (e.g., being unacceptable or unlovable). Behavioral responses designed to minimize the threat to the self (e.g., having cosmetic surgery, checking disliked features in the mirror, and avoiding being seen by others) are postulated to instead exaggerate the sense of threat and reinforce the processing of the self as an aesthetic object. Implications for therapeutic intervention are discussed.
Treating Children and Adolescents with Body Dysmorphic Disorder
Authors: Greenberg Jennifer L. , Sullivan Alexandra , Wilhelm Sabine
Published: August 2017

Body dysmorphic disorder (BDD) is a common and severe disorder that typically has its onset during adolescence. Youth with BDD appear more severely ill than adults in terms of having poorer insight and a higher likelihood of having attempted suicide. Despite BDD’s severity and early onset, there is only limited research on its treatment in youth. Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are the first-line treatments for BDD in adults and appear to be effective for adolescents with BDD. This chapter provides an overview of the treatment of BDD in youth, including cognitive-behavioral and pharmacologic approaches, and an illustrative case example. The chapter also addresses cosmetic treatment for BDD in children and adolescents, which appear to be ineffective.
The Family and Body Dysmorphic Disorder : Impact, Responses, and a Suggested Family-Based Treatment Approach
Authors: van Noppen Barbara , Sassano-Higgins Sean
Published: August 2017

This chapter focuses on the impact of body dysmorphic disorder (BDD) on the family; possible responses by the family (Expressed Emotion and Family Accommodation); and family-based treatment that may be helpful for BDD, as well as approaches to challenges that therapists may encounter. Although research on BDD and families has not been done, the disorder often has a devastating impact on families. This impact may include the financial costs of caring for the patient with BDD, paying for cosmetic procedures, and psychological costs in the unfortunate event of patient suicide. Although family treatment of BDD has not yet been developed or tested, the authors of this chapter make recommendations, based on clinical experience, for clinicians who are attempting to implement family-based treatment for BDD. This includes a discussion of behavioral contracting and other cognitive-behavioral therapy techniques. Several cases that illustrate these concepts are presented.
A Surgeon’s Perspective on Body Dysmorphic Disorder and Recommendations for Surgeons and Mental Health Clinicians
Authors: Naini Farhad B.
Published: August 2017

This chapter describes the implications of diagnosing, or not diagnosing, and managing patients with body dysmorphic disorder (BDD) from a surgeon’s point of view. BDD is common among patients seeking cosmetic surgery, and surgical outcomes are usually poor. This chapter offers recommendations for surgeons about the importance of preoperative diagnosis, how to inform patients of the need for mental health evaluation, and how to handle a patient when the diagnosis becomes evident only after surgery. Some recommendations for mental health clinicians are discussed from the surgeon’s perspective. A case example is offered.
The Relationship of Body Dysmorphic Disorder to Obsessive-Compulsive Disorder and the Concept of the Obsessive-Compulsive Spectrum
Authors: Simberlund Jessica , Hollander Eric
Published: August 2017

This chapter describes the relationship of body dysmorphic disorder (BDD) to obsessive-compulsive disorder (OCD) and the concept of the obsessive-compulsive spectrum. BDD is proposed to be part of an obsessive-compulsive spectrum of disorders, given its many similarities to OCD. OCD and BDD are both characterized by obsessions and compulsions, although in BDD individuals focus specifically on body image concerns, whereas in OCD they typically focus on concerns such as contamination, harm, and aggression. Distress that results from obsessions usually generates compulsive behaviors intended to reduce emotional discomfort. Individuals with BDD are more likely to have delusional beliefs and significantly poorer insight. Individuals with BDD report higher rates of major depressive disorder, substance use disorders, suicidal thoughts, and suicide attempts. OCD and BDD demonstrate familiality, indicating that they are likely related conditions. OCD and BDD are thought to be heterogeneous disorders that result from both genetic and environmental factors, some of which appear to be shared; for example, they appear to share some abnormalities involving the basal ganglia and limbic system (specifically the caudate nucleus).
The Relationship Between Body Dysmorphic Disorder and Eating Disorders
Authors: Grant Jon E. , Leppink Eric W. , Redden Sarah A.
Published: August 2017

This chapter discusses research findings regarding body dysmorphic disorder (BDD) and eating disorders, and it provides guidelines for distinguishing between them. BDD and eating disorders show many similarities, including negative and distorted body image, decreased quality of life, compensatory behaviors such as dieting, and abnormalities in visual processing. Patients with BDD express specific concerns with different parts of their bodies and physical appearance; common examples are complexion, nose, breasts/genitals, and hair. In patients who have prominent concerns about weight and body fat and shape, however, the diagnosis of BDD can be complicated because such concerns can occur as a symptom of BDD but also overlap with those in eating disorders such as anorexia nervosa and bulimia nervosa. BDD and eating disorders are often comorbid, which is accompanied by notably higher rates of suicidality and psychiatric hospitalization than occur in patients with either disorder alone. BDD and eating disorders represent distinct pathologies, and it is important to distinguish between them, particularly given the increased risk of suicidality when the disorders are comorbid.
Etiology of Disruptive Behavior Disorders
Authors: Hans Steiner , Whitney Daniels , Michael Kelly , Christina Stadler
Published: August 2017

This chapter discusses the growing data base examining the biological, psychological, and social factors causing disruptive behavior disorders (DBDs). Some of the most intriguing findings are derived from the clinical and preclinical studies of psychopathy, the most extreme and pathological variant of antisocial and aggressive behavior. The existing data are best accommodated in a risk/resilience model informed by developmental psychopathology, rather that a reductionist biological model. The most likely model of causation of DBDs will be multifactorial rather than unifactorial. It is also likely that different syndromes within the DBD grouping will be informed by very different admixtures of biological, psychological, and social factors, which in turn have important implications for effective treatments. The current descriptive diagnoses are inadequate for a sophisticated empirical understanding of DBDs.
Canadian Approach to Integrated Care
Authors: Kates Nick , Anderson Ellen
Published: August 2017

This chapter describes the evolution of collaborative mental health care in Canada over the past 15 years, and the ways in which integrated care is becoming an increasingly integral part of Canada’s provincial and territorial healthcare services. It explores the underlying principles and models that can be found across the country. There is a particular emphasis on three things: (1) changes any mental health service can make to improve collaboration, (2) programs to increase the mental health skills and capacity of primary care, and (3) the integration of mental health services within primary care.

A program in Hamilton, Ontario, has successfully integrated mental health counselors and psychiatrists into the offices of 170 family physicians across a city of 500,000 people for the past 20 years. The authors present data from the program’s evaluation, as well as key lessons learned and advice for other programs looking to set up similar models.
Working with Personality Disorders in an Integrated Care Setting
Authors: Feinstein Robert E. , Connelly Joseph V.
Published: August 2017

Patients with personality disorders are common in primary care and medical settings. They can elicit intense problematic reactions from the members of an integrated care team, which can affect the team’s evaluation, diagnoses, diagnostic testing, medical orders, medications, laboratory tests, treatments, recommendations, and referrals. The four most common and challenging personality disorders are borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, and obsessive-compulsive personality disorder. This chapter reviews the classification, epidemiology, biological basis, psychosocial formulation, and co-occurring mental health disorders associated with these personality disorders. A personality disorder schema is presented for managing these difficult patients. The impact these patients can have on the integrated care team is described. A care pathway is outlined that can be used for management, brief treatment, and referral for treatment to a personality disorder specialist.
Violence and Suicide
Authors: Feinstein Robert E.
Published: August 2017

Patients exhibiting violent or suicidal behavior have psychiatric symptoms varying along a spectrum of risk, from minimal to fatal. Evidence supports screening patients for intimate partner violence and suicide risk. Clinical care focuses on establishing a team and a working alliance, determining the “Why now?” of dangerousness, and using clinical judgments, risk assessment tools, a critical pathway, and a risk registry. Clinical care includes assessment of (1) violent or suicidal ideation, (2) recent dangerous behaviors, (3) past history of risky behaviors, (4) support system, (5) substance use, (6) cooperation with treatment, and (7) clinician reactions (8) diagnosis of medical and neurologic comorbidities. A multidisciplinary team can optimally manage these patients by deciding on the level of care needed for each problem or episode. Care can be delivered by using a practice registry and a critical pathway and focusing care on psychotherapy, with medications as needed. Steps are outlined for managing intimate partner violence.
Symmetry
Authors: Laureno Robert
Published: August 2017

This chapter examines the causes of symmetric neurologic lesions in toxic and metabolic disease, trauma, neoplastic disease, vascular disease, and infectious disease. The importance of symmetry in diagnosis is emphasized. Symmetry can be a problem for the neurologist; especially on computed tomography (CT) scans, symmetric disease can be difficult to notice on the background of symmetric brain anatomy because the eye more quickly detects a one-sided lesion or multifocal asymmetric lesions than symmetric lesions. Symmetry of brain lesions is important to the clinician because it suggests a toxic, metabolic, or other chemically based cause. Diseases with symmetric pathology but unknown cause probably are chemically based; the clue of symmetry gives investigators an opportunity to pursue various avenues of research.
Learning Neurology
Authors: Laureno Robert
Published: August 2017

This chapter on “Learning Neurology” examines methods of visual display as an effective way of enhancing learning, and it discusses teaching approaches to help others learn neurology. In learning neurology, memorizing “normal” anatomy is initially helpful, but the advanced learner or practicing neurologist must be always aware of and sensitive to the normal variations that occur in neurological anatomy. In teaching, one cannot anticipate which statements will hit home with a student; one can only hope that something one utters will affect the student’s future thinking or put him on a path of study. Repetition is the fundamental pedagogical principle, and the neurologic educator must remember its importance.
The role of medication
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter focuses mainly on the importance of maintenance antipsychotic medication and mood stabilizers. It examines procedures to support persistence with these drugs and maintain engagement. The techniques for initiating and monitoring clozapine therapy in the community for patients with resistant schizophrenia are outlined. The practical processes for ensuring and conducting regular structured reviews of long-term medication, both to assess progress and to identify side effects, are described in detail. In addition, the judicious use of antidepressants and benzodiazepines is outlined.
Engagement
Authors: Burns Tom , Firn Mike
Published: August 2017

Engagement is defined and a classification of engagement-related activity presented, underlining the centrality of individual and team relationships in delivering health and social care to individuals. Case studies provide practical illustration of differing approaches in the hierarchy of engaging individuals in treatment, from mutually constructive strategies to more restrictive tactics for people who avoid services. Throughout, the patient and service perspective is compared, for example, when does conscientious follow-up become perceived as harassment? Critique and evidence from research and patient testimony is provided. The value of engagement measures are discussed, including patient reported attachment and proxy measures of missed appointments and dropout.
Suicidality
Authors: Burns Tom , Firn Mike
Published: August 2017

The chapter describes ways of understanding, predicting, and managing suicidality and self-harm in people with severe and enduring mental illness in contact with community outreach teams. Data on incidence are presented with evidence on associations with factors such as demographics, diagnosis, co-morbidity, and life events as a way of identifying risk factors. Validated tools and frameworks for assessment are presented and critiqued with research evidence for the effectiveness of interventions. The chapter concludes with a case study, care plan, and risk management plan of a man whose life has been devastated by psychotic illness.
Depression, anxiety, and situational disorders
Authors: Burns Tom , Firn Mike
Published: August 2017

Outreach workers, even if mainly concerned with severe psychoses, must regularly deal with depression, anxiety, and situational disorders. This chapter summarizes the practical approaches to these problems. In depression, the value of general support, regular structured assessments, and the use of CBT are proposed. The overlap of situational depression with bipolar depression is explored. CBT is equally indicated with anxiety disorders, but outreach workers can have a particular role in graded exposure. The judicious use of medication should not be overlooked. The two situational disorders described are post-traumatic stress disorder (PTSD) and bereavement. The chapter ends with a brief review of what used to be loosely called ‘neurotic disorders’ such as OCD and eating disorders. The successful care of psychotic individuals is often dependent on close attention to these more general problems.
Physical health care
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter deals with an increasingly important topic: the recognition that individuals with severe mental illness die nearly 20 years before they should. The situational factors contributing to this excess mortality are outlined—failure to register with a GP, homelessness, and dysfunctional help-seeking behaviour. Individual risks, including self-neglect, co-morbid conditions, and the impact of treatments (e.g. metabolic syndrome caused by novel antipsychotics), are also outlined. The role of the outreach worker can involve building liaison with the GP and, on occasions, taking direct responsibility for the physical care of some of the more severely ill patients. There are risks of blurred confidentiality, marginalization, and withdrawal by GP services in this approach, but sometimes it is inevitable.
Psychosocial interventions with families, carers, and patients
Authors: Burns Tom , Firn Mike
Published: August 2017

The three broad areas of activity usually implied by psychosocial interventions in psychosis—psycho-education, behavioural family management, and cognitive behaviour therapy—are presented with their relative evidence base and strategies for delivering them through community outreach. Psychosocial interventions require a well-trained and resourced workforce, and the gap between best practice and routine delivery is manifest. Barriers and enablers are presented to show how this gap can be closed in a well-organized community outreach service.
Research and development
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter covers the spectrum of routine monitoring, audit, service evaluation, and formal research. Routine monitoring is an essential task for all mental health professionals, and techniques to make it more palatable are explored, including using routine data for clinical supervision and monitoring team targets. Regular audit is described as an essential tool for logical service development and quality improvement. In the discussion of research, the importance of choosing the correct methodology and of paying attention to detail are stressed. In community psychiatry, sampling bias, regression to the mean, and the Hawthorne effect pose important risks. The hierarchy of research methods is outlined with randomized controlled trials (RCTs) at the top, preferably with either single- or double-blinding. Careful statistics and systematic reviews support evidence-based practice. In addition to experimental quantitative trials, there is a place for cohort and case control trials, as well as for qualitative trials to generate hypotheses.
Infectious diseases
Authors: Carton James
Published: August 2017

This chapter describes infectious diseases, including common types of microbes (bacteria, viruses, fungi, protozoa, helminths) and antimicrobial agents (antibacterial, antiviral, and antifungal agents), as well as some common systemic infectious diseases such as human immunodeficiency virus (HIV), tuberculosis (TB), infectious mononucleosis, malaria, syphilis, Lyme disease, and leishmaniasis.
Gastrointestinal pathology
Authors: Carton James
Published: August 2017

This chapter discusses gastrointestinal pathology, including gastrointestinal malformations, oesophagitis, oesophageal polyps and nodules, oesophageal carcinoma, gastritis, gastric polyps, gastric carcinoma, gastrointestinal stromal tumours, peptic duodenitis, coeliac disease, small bowel infarction, intestinal infections, intestinal obstruction, acute appendicitis, Crohn’s disease, ulcerative colitis, colorectal polyps, colorectal carcinoma, diverticular disease, and anal pathology.
Pancreatic pathology
Authors: Carton James
Published: August 2017

This chapter discusses pancreatic pathology and covers pancreatic malformations, acute pancreatitis, chronic pancreatitis, pancreatic ductal carcinoma, pancreatic neuroendocrine tumours, pancreatic cystic tumours, and acinar cell carcinoma.
Breast pathology
Authors: Carton James
Published: August 2017

This chapter discusses breast pathology, including duct ectasia, granulomatous mastitis, fat necrosis, fibrocystic change, fibroadenoma, phyllodes tumour, intraductal papilloma, radial scar, proliferative breast diseases with and without atypia, ductal carcinoma in situ (DCIS), invasive breast carcinomas, breast screening, and male breast diseases.
Neuropathology
Authors: Carton James
Published: August 2017

This chapter discusses neuropathology, including nervous system malformations, epilepsy, head injury, cerebral infarction, intracerebral haemorrhage, subarachnoid haemorrhage, meningitis, cerebral infections, multiple sclerosis, Guillain–Barré syndrome, myasthenia gravis, Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, Parkinson’s disease, Huntington’s disease, motor neurone disease, Creutzfeldt–Jacob disease, astrocytomas (including glioblastoma), oligodendroglioma, ependymoma, meningioma, medulloblastoma, primary CNS lymphomas, and cerebral metastases.
Lung Ventilation: Natural and Mechanical
Authors: Lei Yuan
Published: August 2017

‘Lung Ventilation: Natural and Mechanical’ describes the processes of respiration and lung ventilation, focusing on those issues related directly to mechanical ventilation. The chapter starts by discussing the anatomy and physiology of respiration, and the involvement of the lungs and the entire respiratory system. It continues by introducing the three operating principles of mechanical ventilation. It then narrows its focus to intermittent positive pressure ventilation (IPPV), the operating principle of most modern critical care ventilators, explaining the pneumatic process of IPPV. The chapter ends by comparing natural and mechanical/artificial lung ventilation.