bluuebunny/crossref_metadata_2025 huggingface dataset:
The Concept of Infection Control in Prevention and Treatment of Periodontal Disease
Authors: Ramberg Per , Wennstrom Jan
Published: November 2012

Periodontal disease is an infectious disease affecting more than 50% of the adult
population, and epidemiological studies reveal an increased risk for cardiovascular disease
and stroke among individuals with periodontal disease. Hence, prevention and treatment of
periodontal diseases through the control of periodontal infections are import issues not only
for the oral health but also the general health of the individual. In this chapter current
concepts regarding treatment approaches for establishing and maintaining periodontal
infection control are discussed.
When Risk Factor Patterns Change Due to New Scientific Evidence - Ethical Dilemmas
Authors: Hofmann Bjørn
Published: November 2012

If oral infection causes CVD, there is a moral imperative to avoid CVD by
reducing oral infections. But what if it is not clear whether oral infection causes CVD? Then
we are faced with conceptual, methodological and moral challenges. The literature, as the rest
of this book, is focusing on methodological challenges, trying to show that and how oral
infections cause CVD. However, there has been little or no attention on the conceptual and
moral challenges, which are the topics for this chapter. A closer analysis of the scientific
basis for claiming that oral infection causes CVD reveals a series of moral issues. These stem
from a) how to choose between the many conceptions of causality, and from b) the moral
challenge of preventing harm when there is an unclear or weak causal relationship between
oral infection and CVD or c) when various kinds of uncertainty prevail. The challenge of
how to act under uncertain circumstances comes out as questions of resource allocation and
prioritization, but it also poses issues of medicalization and not causing unnecessary health
anxiety. Hence, although the literature is void of discussing moral challenges with the
relationship between oral infection and CVD, the challenges are ample.
Potential Effect of Ethanol on the U.S. Economy: A General Equilibrium Approach
Authors: B. Moss Charles , G. Schmitz Troy
Published: November 2012

Several studies have analyzed the effect of bioenergy tax credits on agriculture and energy markets
using a partial equilibrium framework. Most of these studies focus on a detailed description of the effects of
bioenergy in specific commodity markets such as corn. An alternative approach used here is to analyze the effect
of these policies on the economy using a general equilibrium model that directly accounts for feedback effects in
the economy. These feedback effects reduce the production possibilities in the overall economy.
Hidden Ethanol Subsidies in Brazil Revisited
Authors: G. Schmitz Troy , L. Seale James
Published: November 2012

Brazil is the world’s largest sugar producer and exporter of ethanol, and the world’s second largest
ethanol producer. Hidden subsidies such as government blend ratios have added to Brazil’s ability to produce
sugar and ethanol. The blend ratio has remained relatively stable over the last several years, but it likely will be
changed to promote more sugar production, relative to ethanol, given the high price of sugar in 2009.
Impacts of Future Energy Price and Biofuel Production Scenarios on International Crop Prices, Production, and Trade
Authors: Schwarz Gerald , von Witzke Harald , Noleppa Steffen
Published: November 2012

We discuss the impacts of future energy prices and biofuel production levels on agricultural market prices,
production, and trade, and present the results of a partial equilibrium model of international agricultural trade with
interconnected markets. The results of the model suggest that the long-term trend of declining real agricultural
commodity prices has been reversed. A key result in this regard is that the price of energy has become a major driving
force of agricultural world market prices. For instance, until 2016/18 the price of wheat is expected to increase by about
16 percent, 35 percent, and 91 percent based on oil prices of US$45, US$70 and US$102 per barrel, respectively. The
2016/18 baseline projection shows an increase in total world production from 10 percent for wheat to 30 percent for
oilseeds. Variations in energy cost have the biggest impact on sugar production in the European Union, corn production
in North America, other grains production in Brazil and Australia, sugar production in China, and corn production in the
Commonwealth of Independent States (CIS). Increased bioenergy demand has the biggest impact on corn production,
followed by sugar and oilseeds production. The impacts and importance of energy prices and biofuel production for
agricultural trade varies between commodities and regions. Future long-term biofuel scenarios could change
considerably, depending on technology and bioenergy production pathways.
Alternative Domestic and Trade Policies for Biofuels and Market Variability in the United States
Authors: Yano Yuki , Blandford David , Surry Yves
Published: November 2012

The development of first-generation biofuels has strengthened the linkage between agricultural
commodity markets and energy markets. This chapter analyzes the implications of U.S. domestic and trade
policies for ethanol in the face of year-to-year fluctuations in the domestic supply of feedstock (corn) and
petroleum prices. The current U.S. policy mix involves a prohibitive tariff on imported ethanol, a fixed subsidy
for blending ethanol with gasoline, and a blending or consumption mandate. We find that as the likelihood that
the mandate is binding increases, the variability of ethanol use declines; the impact of corn supply variations on
corn prices is increased due to greater inelasticity in demand, but the impact of oil price variations on corn prices
is reduced. Tariffs could be reduced to allow ethanol imports, given a modification of the subsidy mechanism,
which would reduce the impact of corn supply fluctuations on corn prices. But, if the minimum supply-inducing
price for imported ethanol is sensitive to petroleum prices, corn prices could be affected by petroleum price
fluctuations even when the U.S. mandate is binding. With freer trade, the impact of U.S. domestic and trade
policies for ethanol on the variability of domestic corn prices depends on the relative magnitude of external
shocks as well as on ethanol policies in supplying countries. In addition to examining a reduction in the current
specific tariff, the implications of using an ad valorem tariff or a variable tariff are assessed.
U.S. Biofuel Policy Effects on Agricultural Commodity Exports
Authors: Thompson Wyatt , Meyer Seth , Westhoff Pat
Published: November 2012

Key U.S. biofuel policies mostly target domestic use but indirectly affect agricultural markets. Biofuel
support increases demand for U.S. agricultural commodity feedstocks, particularly corn and soybean oil given current
practices, and consequently increases prices for these commodities. Unintended global responses may include higher
food prices and greater land conversion to agricultural uses. However, past research is uncertain about the magnitude of
effects of different U.S. biofuel policies and suggests that their effects depend on market conditions. Our contribution is
to test systematically the link between petroleum prices and the effects of biofuel policies on U.S. agricultural
commodity prices and exports. Using a partial equilibrium model of U.S. agricultural and biofuel sectors, we vary
petroleum prices and other external factors over hundreds of combinations during a ten-year projection period.
Comparing results with and without U.S. biofuel support programs to identify how these policies affect markets, we find
that removing these policies reduces corn and soybean oil prices and exports substantially when petroleum prices are
low, but have less pronounced effects when petroleum prices are high. The effects on other commodity markets follow a
similar pattern for directly complementary or substituting goods, but are more attenuated for goods that are less directly
related to the main biofuel feedstocks in the medium-term future. Our results highlight the sensitivity of U.S. minimum
biofuel use mandates, particularly for petroleum prices, and the interaction of mandates and other biofuel policies.
Long-Term Effects of Increasing Ethanol Production on Agricultural Markets and Trade, Land Use, and Food Security
Authors: L. Bryant Henry , Lu Jiamin , W. Richardson James , L. Outlaw Joe
Published: November 2012

We examine the long-run effects of increased U.S. ethanol production on the agricultural economy and
worldwide food insecurity. Overall, we find that moderate increases in ethanol production would result in relatively
modest changes after a (potentially lengthy) adjustment period. Significant improvements in cellulosic ethanol
production technology would substantially reduce the magnitude of such changes, as increases in ethanol production
could be fueled by previously unutilized agricultural wastes. Changes in food insecurity caused by increasing ethanol
production would tend to be most painful in Africa, the Far East, and Central and South America (excluding Brazil).
Global Biofuel Expansion under Different Energy Price Environments
Authors: M. Peters May
Published: November 2012

This chapter examines the impact of varying energy price paths (reference, low, and high petroleum
prices) on continued biofuel expansion and the implications on global agricultural commodity markets. It uses
PEATSim, a dynamic, partial equilibrium, multi-commodity, multi-region global trade model of the agriculture
sector. Continued biofuel expansion spurred by alternative energy programs will lead to higher agricultural
commodity prices and to changes in the trade patterns in biofuel feedstocks. The ability of countries to achieve
their alternative energy goals are largely determined by the future path of energy prices. With low energy prices,
biofuel demand will fall (absent mandates), which means reduced biofuel production costs to keep biofuel
competitive with petroleum-based fuel. If energy prices increase, biofuel use likely will exceed country-specific
energy targets and will result in much higher agricultural commodity prices. In either event, technological
innovation (which lowers biofuel feedstock production cost and increases biofuel conversion efficiency) will be
key in achieving biofuel expansion while mitigating impacts on agricultural commodity markets.
Food Crisis: Did Agricultural Prices Rise Faster than they Fell?
Authors: Stigler Matthieu , Tortora Piera
Published: November 2012

International agricultural markets have experienced important price fluctuations recently, with prices
spiking in 2007-2008 and then declining sharply in 2008. While domestic prices generally followed these
increases, there is concern that they remained at high levels despite decreases in international prices. This issue of
asymmetry between downward and upward price transmission has been widely discussed in economic literature,
and some authors have argued that such asymmetry is the rule rather than the exception. With its sustained price
increase followed by a large decrease, the food price spike provides an ideal case to test this hypothesis. We
assess this question empirically by investigating a sample of small wheat importing countries. We use time series
models which allow for asymmetries - namely regime switching cointegration techniques - to examine whether
the international price spike and its subsequent decline have been transmitted to domestic markets to the same
extent. Out of the four countries we investigate, we find a clear case of a downward asymmetry, a clear case of
upward asymmetry, the remaining two countries yield less definitive results.
New Trends in Consumer Needs: Functional Foods in the European Market
Authors: Annunziata Azzurra , Vecchio Riccardo
Published: November 2012

Over the last decade foods have not been intended only to satisfy hunger and provide necessary
nutrients but also to prevent nutrition-related diseases and improve the physical and mental well-being of
consumers. Hence healthier food products have entered the global markets with force in the past few years and
rapidly gained market shares. The food industry has reacted to this trend by developing a growing variety of new
products with health-related claims and images. However, due to limited consumer knowledge and awareness of
the health effects of newly developed functional ingredients, there are strong needs for communication activities.
The role of information is crucial since consumers cannot perceive the benefit directly from the product, unlike
taste and other sensory characteristics. The type of information and trust in it regarding the effect of a particular
product on health represent additional factors behind the success of functional foods. Based on these
considerations this chapter offers an overview of the functional food (FF) market in Europe and ascertains the
opportunities for further expansion of this segment. Consumer behaviour towards FFs was analyzed through a
quantitative survey conducted on 400 Italian food shoppers. Our findings reveal that respondents are confused
due to the ambiguity of what FF products are, and that consumers perceive products that are intrinsically healthy
such as yogurt, cereals and juice, as preferable and credible carriers of FFs. Moreover, use of principal
components analysis highlighted the key role played by the perception of healthiness in determining shoppers’
attitudes towards FF.
Territory Image and Notoriety as Sources of Equity in the Wine Market
Authors: Calvo Dopico Domingo
Published: November 2012

The world wine market is mature, together with an increasingly global, open and very competitive
environment. Companies have to face the challenge of achieving differentiated quality based on the creation of
equity. One of the mechanisms to build this differentiation is the creation of strong brands. The objective of this
paper is to find out which sources of brand equity could endow the product with a higher differentiation. To
respond to this objective, we carried out a study with five Spanish collective brands: Rioja, Valdeorras, Ribeiro,
Rias Baixas, and Ribera de Duero. A panel of 296 consumers assessed the dimensions of brand equity for each of
them. Results reveal that the most important source of equity, from the consumer’s point of view, in explaining
the formation of brand equity, is territory image. Territory image is a differentiating factor used by consumers to
identify and recognise a specific brand among the many alternatives, as well as shaping an excellent source to
equity in the consumer’s mind. Another important source of equity is notoriety. Individual or collective efforts in
investments to create notoriety and territory image would be very important in creating a strong brand. This is an
excellent way to build authentic brand equity. Regarding wineries, the procurement of authenticity will be critical
in commanding price premiums and obtaining an advantage against potential competitors.
Contributors
Authors: N. Rezitis Anthony
Published: November 2012

Full text available.
Pachyosteosclerosis in Archaic Homo: Heavy Skulls for Diving, Heavy Legs for Wading?
Authors: Stephen Munro  , Marc Verhaegen
Published: November 2012

Compared to the skeletons of all other primates, including Homo sapiens, the crania and postcrania of Homo erectus were typically massive, displaying extremely thick bones with compact cortices and narrow medullary canals. Even outside the primate order, examples of animals displaying such massive bones are rare. Although this feature is sometimes seen as diagnostic of H. erectus, few convincing hypotheses have been put forward to explain its functional and adaptive significance.

Here, we present data showing that unusually heavy bones were a typical, although not exclusive nor indispensable, characteristic of H. erectus populations through the early, middle and late Pleistocene in areas of Asia, Africa and Europe. A comparative review of the occurrence of massive skeletons in other mammals suggests that they have an important buoyancy control function in shallow diving aquatic and semi-aquatic species, and are part of a set of adaptations that allow for the more efficient collection of slow, sessile and immobile foods such as aquatic vegetation and hard-shelled invertebrates. We therefore consider the possibility that part-time shoreline collection of aquatic foods might have been a typical element of the lifestyle of H. erectus populations. We discuss the alternative explanations for heavy bones from the literature, as well as apparent exceptions to the rule, such as thin-boned H. erectus and thick-boned Homo sapiens fossils. A review of the palaeo-ecological data shows that most, if not all, H. erectus fossils and tools are associated with water-dependent molluscs and large bodies of permanent water. Since fresh and salt water habitats have different densities, we hypothesize that in H. erectus as well as in some Homo sapiens populations, there might have been a positive correlation between massive bones and dwelling along sea or salt lake shores.
Human Breath-Hold Diving Ability Suggests a Selective Pressure for Diving During Human Evolution
Authors: Erika Schagatay
Published: November 2012

Modern humans are generally considered to be fully terrestrial, yet display a range of activities involving breath-hold (apneic) diving, including sustained harvest diving, spear-fishing, recreational free-diving and competitive apnea for duration, distance or depth. Via harvest diving, involving repeated diving with half of the time submerged for several hours per day, groups in South East Asia obtain a considerable amount of catch. The physiological basis for such repeated diving involves i) conscious breath control, ii) an efficient diving response, diverting stored oxygen to the heart and brain, and iii) adequate thermal insulation. Another contribution to the human diving ability comes from the spleen, which - by ejecting extra red blood cells into circulation - can enhance blood gas storage and carbon dioxide buffering capacity, a response typically found in seals.

Most striking among human aquatic activities is competitive apnea, with records of a period of 11 min 35 s in duration, the distance of 265 m in underwater swimming with fins, and a depth of 124 m in deep-diving with fins. Without fins, the distance of 218 m and depth of 101 m have been achieved, performances in the range of marine mammals. This requires additional mechanisms to maximize gas storage, minimize energy expenditure, and enhance conscious tolerance to asphyxia, involving e.g. increase lung volume, baseline hematocrit and spleen volume, and means to cope with the increased pressure. While it takes both inherent predisposition and training to achieve such record results, most healthy humans can, after some practice, make voluntary apneas of 3-4 min, swim a distance of 50 m under water and reach depths of 20-30 m, which may be unique among terrestrial mammals.

Human superior harvest diving and competitive diving capacity may suggest a selective pressure for diving during some time period of human evolution.
Marine Adaptations in Human Kidneys
Authors: Marcel F. Williams
Published: November 2012

Humans possess kidneys that are normally multi-pyramidal in their morphology, a characteristic that is unique to Homo sapiens amongst primates. While uni-pyramidal kidneys predominate in terrestrial mammals, kidneys with multiple medullary pyramids are nearly universal in marine mammals. In salt water environments, renal medullary pyramids appear to function as a means to increases the rate of salt and nitrogenous waste excretion by increasing the surface area between the cortex and medulla. While renal medullary pyramids seem to have no functional value in freshwater environments, most freshwater aquatic mammals with renal pyramids can be phylogenetically traced to either marine ancestors or aquatic ancestors that frequented marine environments. Terrestrial mammals with multi-pyramidal kidneys such as elephants, bears, and rhinoceroses also appear to have had semi-aquatic ancestors that frequented marine environments. However, the multi-pyramidal kidneys of the Bactrian camel and Arabian camel (dromedary) were apparently convergently evolved as adaptations to high salt consumption in xeric terrestrial environments where camels consume halophytic plants and drink water from brine pools with natural salinities higher than seawater. The numerous vestiges of aquatic adaptations in the human body in addition to the abundant distribution of corporeal salt excreting eccrine sweat glands and the excretion of salt tears in humans, strongly suggest that the multiple medullary pyramids of the human kidneys probably evolved as an adaptation to a coastal marine ecology rather than to a xeric terrestrial environment.
Obstetrical Implications of the Aquatic Ape Hypothesis
Authors: Michel Odent
Published: November 2012

The aquatic ape hypothesis (AAH) offers the possibility to re-interpret several aspects of the human pre- and perinatal periods. We introduced the concept of birthing pools in the 1970s in order to treat labor pain, particularly lumbar pain in the middle of cervical dilation associated with failure to progress. We assumed that immersion in water at body temperature would be a way to reduce the level of stress hormones, facilitating the release of oxytocin. We first learned that the dilation of the cervix could progress dramatically in an aquatic environment before water immersion, and that it was associated with behavior suggestive of a reduction in neocortical control. The release of inhibitors of neocortical control in an aquatic environment was an opportunity to phrase new questions about the relationship of Homo sapiens with water. We also learned that occasionally some women did not want nor had the time to get out of the pool for the birth itself. They behaved in a way suggesting that, while in a particular state of consciousness, they knew that a birth under water was safe for the baby. The origin of this knowledge, and the strong attraction towards water that some women experience during labor, should be looked at in the light of the AAH.

By raising questions about the development of the human brain from an evolutionary perspective, the AAH enables to pose similar questions from an ontogenetic perspective. Today the focus is on the needs in iodine, docosahexaenoic acid, vitamin D, and other nutrients that are essential for brain development, and that happen to be abundant in seafood. This led us to reconsider (pre-)eclampsia as a multi-factorial syndrome, related to a maternalfetal conflict, whereby inadequate maternal nutrition is prioritized as a factor that can independently increase the probability of conflict, challenging the current belief that reduced utero-placental perfusion is the unique pathophysiological process in this human pregnancy disease. In other words, we present (pre-)eclampsia as the price some humans have to pay for having a large brain, while the specific nutritional needs are not ideally satisfied.

Other puzzling and unexplained human particularities in the perinatal period, such as human neonatal vernix caseosa and of the absence of human maternal placentophagy, can be re-interpreted in the light of the AAH.
Superior Underwater Vision Shows Unexpected Adaptability of the Human Eye
Authors: Anna Gislen  , Erika Schagatay
Published: November 2012

Adaptability of the eye is a key feature in a semi-aquatic mammal and several optical and physiological strategies can be used to allow functioning of the eye in the two media, i.e., air and water. Human eyes are considered to be adapted to vision in air as more than two-thirds of the refractive power is derived from the curved cornea, an effect that is lost under water. It was observed that children of Sea Nomad groups in South East Asia appeared to have much better underwater vision than expected, allowing efficient collection of small shells from a non-contrasting background without visual aids. Studies on the visual acuity of such groups were carried out, followed by studies to reveal how the observed adaptability of the eye was achieved. Standardized optical methods were adopted to field conditions and used to reveal how the Sea Nomad children see under water. Results showed a high adaptability of the human eye to the underwater environment, with the visual acuity of the Sea Nomad children being twice that found in a European control group. Training in non-diving children was found to evoke the same adaptive responses as those observed in Sea Nomads. The mechanisms responsible for this superior underwater vision were heavy accommodation and concurrent pupil constriction, features previously observed in semi-aquatic mammals and birds. This may be an interesting example of convergent evolution. The human eye proved to be flexible and adaptable enough to function under water with an uncompromised function in air. An explanation for this surprising adaptation in a terrestrial mammal could be that it has evolved during a phase with selective pressure for foraging under water.
Human Aquatic Color Vision
Authors: Wang-Chak Chan
Published: November 2012

Many human physiological and behavioral features could possibly be explained as semi-aquatic adaptations in the remote past. However, aspects of human perception and cognition have rarely been considered in this light. In this chapter, human color vision will be discussed at two levels.

At the physiological level, visual pigments of retinal cone/rod cells, being essential to color vision, are compared among humans, their closest primate relatives, and terrestrial as well as aquatic mammals. Also the cause of human color blindness is discussed.

At the cultural level, the mystery of ‘fuzzy’ color terms like grue (green-or-blue) in many world languages is discussed, and we propose a new model based on two arguments: each color term actually corresponds to a naturally occurring color, and the ‘ fuzzy’ terms were produced in a semi-aquatic primitive life since the dawn of human language.
Aquagenesis: Alister Hardy, Elaine Morgan and the Aquatic Ape Hypothesis
Authors: Richard Ellis
Published: November 2012

This paper gives an overview of the beginnings and the scientific acceptance of the so-called aquatic ape hypothesis of human evolution (AAH), especially the work of Alister Hardy and Elaine Morgan. In 1960, marine biologist Sir Alister Hardy, in a notorious article in The New Scientist, entitled Was Man more aquatic in the past?, suggested that “a branch of the primitive ape-stock was forced by competition from life in the trees to feed on the sea shores, and to hunt for food, shell fish, sea urchins, etc., in the shallow waters off the coast … ”, and that “these semiaquatic creatures were soon wading into deeper water, and eventually began to swim and dive for food at even greater depths.” [1]. His hypothesis was based on observations such as human swimming and diving skills, our furlessness and subcutaneous fat tissues, and our streamlined shape “compared with the clumsy form of the ape.” Hardy's littoral hypothesis was brought into the attention of the great public by the books and papers of tv writer Elaine Morgan, beginning with her bestseller The descent of woman [2], and followed by The aquatic ape [3], The scars of evolution [4] and The aquatic ape hypothesis [5], in which she discussed the waterside theory in much greater detail, e.g., with regard to the origin of human bipedality and laryngeal descent and in which she made comparisons to the fossil swamp ape Oreopithecus and to living animals such as the mangrove-dwelling proboscis monkeys (Nasalis larvatus) and the arguably ex-aquatic elephants. This paper further discusses relevant work of Desmond Morris and Christian de Muizon, as well as diverse reactions of palaeo-anthropologists, such as professor Phillip Tobias's dismissal of the savannah hypothesis.
Just Add Water: The Aquatic Ape Story in Science
Authors: Tess Williams
Published: November 2012

Science theory argues that all ideas are contextualized in their disciplines and also reflect historical and current cultural and social values. This chapter looks at the origins of the aquatic ape hypothesis (AAH) and its development over fifty years, focusing on the particular contributions of Elaine Morgan. The hypothesis had its genesis in a gendered debate on human difference and has connections with anthropology, primatology, palaeontology and other disciplines. More radically, it has a complex relationship with scientific method, gene-centered neo- Darwinism and theories that advocate multiple agents of biological change. Analysis of the AAH reveals much about the history of various genres in science writing, and constructions of scientific authority and knowledge.
Genetic, Molecular, Neuroanatomic, and Electrophysiologic Mechanisms of Chemically Induced Seizures
Authors: Lee Ernest C. , Kales Stefanos N.
Published: November 2012

Traditionally, chemically-induced seizures have received little detailed emphasis in general neurology literature. The few articles that describe correlations between seizures and chemical exposure(s) usually focus on clinical effects rather than underlying pathophysiological mechanisms. Conclusions of studies from various biological disciplines are discussed in order to convey a global understanding of chemically-induced seizure mechanisms. Theoretical mechanisms underlying the progression from a seizure occurring only with external induction to a seizure occurring spontaneously (epilepsy) are also discussed. A generally accepted model of epileptogensis is that of kindling, in which the clinical manifestations of seizures increase as seizures are repeatedly induced. Recent studies are beginning to reveal just how this kindling phenomenon might occur through permanent genetic and microneuroanatomic alterations induced by aberrant excessive electrical impulse activity, via direct physiologic injury, or through unintended adverse consequences of repair mechanisms. Largescale genomic studies are beginning to reveal that many genes likely contribute to seizure induction and the loss of synaptic plasticity observed in epilepsy. Examples of mechanisms underlying specific chemically-induced seizures are discussed including those caused by cyanide, carbon monoxide, and chemical nerve agents. Further research and understanding of fundamental seizure mechanisms will likely lead to the discovery of novel and more effective methods by which to treat and ultimately prevent seizure or epilepsy development. To this end, a review of the basic principles of relevant microscopic neuroanatomy, neuroelectrophysiology, neurotoxicology, and molecular genetics, is presented along with specific examples of chemicals known to elicit seizures.
Seizures Associated with Warfare Nerve Agents: Pathophysiology, Clinical Symptoms and Supportive Interventions
Authors: Dolkart Oleg , Ben-Abraham Ron , Weinbroum Avi A
Published: November 2012

Until more recently, the effects of exposure to chemical warfare agents were a remote area of clinical practice, which concerned military specialists, microbiologists, and toxicologists. Since the World Trade Center attack in New York City in September 2001, there has been real concern about the possible impact of nerve agents (NA) released by terrorists on civilian population. In the pre- and intra-hospital settings, anesthesiologists have since become more involved in the preparedness of such potential mass casualty events together with administrative officials. The former create protocols to improve casualty rescue, management, and outcome, while the latter building up medical contingents, drilling interventional and logistic protocols and provide early and late medical and psychological life support to the care providers and the population.

Exposure to warfare NA intoxicants can cause brain damage, long-term cognitive and behavioral deficits, and even death. In the acute phase of the intoxication, brain damage is primarily caused by intense seizure activity induced by these agents. Also, hypoxia and asphyxia are associated with seizures; however, these may be pre-terminal conditions.

This review will elaborate in detail pre-hospital and intra-hospital management of NA in terms of seizures. Other aspects of medical and administrative attendance associated with these chaotic situations are reviewed elsewhere and will be refereed accordingly. Pathophysiology and clinical management of current trends of life support will be addressed.
Seizures and Other Neurological Symptoms Induced by Organophosphates,Including Warfare Nerve Agents
Authors: Feiner Adam-Scott , Yersin Bertrand , Stettbacher Andreas , Bankoul Sergei , Baumberger Christophe , Carron Pierre-Nicolas
Published: November 2012

Acute organophosphate (OP) intoxication is associated with many symptoms and clinical signs, including potentially life-threatening seizures and status epilepticus. Instead of being linked to the direct cholinergic toxidrome, OP-related seizures are more probably linked to the interaction of OPs with acetylcholineindependent neuromodulation pathways, such as GABA and NMDA. The importance of preventing, or recognizing and treating OP-related seizures lies in that, the central nervous system (CNS) damage from OP poisoning is thought to be due to the excitotoxicity of the seizure activity itself rather than a direct toxic effect. Muscular weakness and paralysis occurring 1-4 days after the resolution of an acute cholinergic toxidrome, the intermediate syndrome is usually not diagnosed until significant respiratory insufficiency has occurred; it is nevertheless a major cause of OP-induced morbidity and mortality and requires aggressive supportive treatment. The condition usually resolves spontaneously in 1-2 weeks.

Treatment of OP intoxication relies on prompt diagnosis, and specific and immediate treatment of the lifethreatening symptoms. Since patients suffering from OP poisoning can secondarily expose care providers via contaminated skin, clothing, hair, or body fluids. EMS and hospital caregivers should be prepared to protect themselves with appropriate protective equipment, isolate such patients, and decontaminate them. After prompt decontamination, the initial priority of patient management is an immediate ABCDE (A : airway, B : breathing, C : circulation, D : dysfunction or disability of the central nervous system, and E : exposure) resuscitation approach, including aggressive respiratory support, since respiratory failure is the usual ultimate cause of death. The subsequent priority is initiating atropine therapy to oppose the muscarinic symptoms and diazepam to prevent or control seizures, with oximes added to enhance acetylcholinesterase (AChE) activity recovery. Large doses of atropine and oximes may be necessary for poisoning due to suicidal ingestions of OP pesticides.
Organophosphate Toxicity Relating to Exposure Route and Type of Agent
Authors: J.A. Joosen Marloes , J. van der Schans Marcel , B. Smit August , P.M. van Helden Herman
Published: November 2012

The current medical countermeasures for organophosphate (OP) poisoning are effective to a reasonable extent, yet, there is room for improvement. In this review, suspected causes of acute and long term-effects of OPexposure and possible interventions will be discussed, in relation to the type of nerve agent and different exposure routes. Inhibition of AChE by organophosphates leads to excessive buildup of released acetylcholine (ACh) at cholinergic synapses resulting in a failure of neuromuscular transmission and leads to seizures followed by status epilepticus. Eventually, poisoning with OPs is likely to result in death or long-term neuronal deficits.

Although, the OP nerve agents soman and VX act via a similar mechanism, that is inhibition of AChE, the toxicological impact following exposure shows to be quite different. Whereas, toxic signs upon sc exposure to soman in general develop very rapidly with the presence of seizures, pc exposure to VX animals shows delayed development of clinical signs compared to sc soman exposure. Such differences in agent behavior put special demands on treatment.

Another important conclusion of the present study is that an effective life-saving treatment at short term, may not be sufficient to prevent long term cognition deficits. This implies that a more thorough understanding of the cause of such deficits is needed to design improved treatment strategies. Suppression of the inflammatory processes in seizure initiation and continuation and restoring impaired neurogenesis, the latter proposed as a cause of cognition deficits following soman exposure, could be starting points for improved treatment.
Therapeutic Effects of Drug Combinations Targeting Muscarinic and Adrenoreceptors during Soman Poisoning
Authors: Loke, Weng Keong , Ho Lai Kwan
Published: November 2012

Soman, a potent acetylcholinesterase inhibitor, induces accumulation of acetylcholine at the neural synapses resulting in overstimulation of the cholinergic system. At lethal concentrations, Soman-induced seizures progress rapidly into status epilepticus, which if not terminated, will lead to eventual death or profound brain damage amongst survivors. The current diazepam anticonvulsant could stop seizures when administrated early but its efficacy diminishes rapidly when applied late post seizures. Increasing diazepam dosage to compensate for reduction in anticonvulsant potency enhances nerve agent-induced respiratory depression. Research is on-going to identify alternate neuroprotection options for managing established and refractory status epilepticus without increasing respiratory difficulties amongst nerve agent casualties. In this chapter, a review of the various neuroprotection options that have been investigated as alternatives to diazepam in the last decade is presented. In addition, we have also provided a comprehensive report on neuroprotective actions achieved with a combined administration of clonidine and atropine sulfate in Soman poisoned animals with status epilepticus. Clonidine, an α2-adrenergic agonist, acts on post-synaptic heteroreceptors to exert pre-synaptic inhibition on release of acetylcholine while atropine sulphate, as a muscarinic antagonist, blocks cholinergic activation of post-synaptic muscarinic receptors. By targeting the central cholinergic system with this synergistic drug combination, besides enhancing animal survival, rapid seizure arrest was achieved with early administration while functional neuroprotection was observed in animals undergoing established status epilepticus. Interestingly, neuroprotection was achieved despite the continued presence of seizures, when it was applied during established status epilepticus and its effect was much higher than that afforded by diazepam. Inclusion of clonidine was vital for preventing atropine induced lethal ventricular arrhythmias in hypoxic animals when treatment was given late. This finding may be useful for reviewing the current perceived roles of central cholinergic and glutamatergic systems in maintaining established status epilepticus, which has directed much of current research for new neuroprotection options towards the glutamate system.
Pilocarpine and Nerve Agents Induced Seizures: Similarities and Differences
Authors: Tang Feng Ru , Kato Koichi , Loke Weng Keong
Published: November 2012

Cholinergic nerve agents remain a realistic terrorist threat due to its combination of high lethality, demonstrated use and relative abundance of un-destroyed stockpiles around the world. While current fielded antidotes are able to mitigate acute poisoning, effective neuroprotection in the field remains a challenge amongst subjects with established status epilepticus (SE) following nerve agent intoxication. Due to ethical, safety and chemical security related issues, extensive preclinical and clinical research on cholinergic nerve agents is not possible. This may have been a contributory factor for the slow progress in uncovering uncovering new neuroprotectants for nerve agent casualties with established status epilepticus. To overcome this challenge, comparative research with surrogate chemicals that produce similar hypercholinergic toxicity but with less security concerns would be a useful approach forward. In this paper, we will systemically compare the mechanism of seizure generation, neuropathological, Genomic and neurobehavioral changes reported with pilocarpine, soman, and sarin challenged animal models. This review will be an important first step in closing this knowledge gap between two closely related models of neurotoxicity. Hopefully, it will spur further efforts in using surrogate cholinergic models by the wider scientific community to expedite the development of a new generation of antidotes that are better able to protect against delayed neurological effects inflicted by nerve agents.
Solutions to Problems of Controlling Long Waves with the Help of Micro-Structure Tools
Authors: V. Arabadzhi Vladimir
Published: November 2012

In recent times the idea of cloaking has become very popular. After radar and sonar were discovered, problems of "visibility" reduction for physical bodies in air (by electromagnetic waves) or in water (by acoustical waves) have immediately become serious areas of research in physics. New technologies (sensors, actuators) of high spatial-temporal resolution, metamaterials and new computers with fast and accurate calculations, in combination with nontraditional versions of solutions to these boundary problems, have allowed physicists to obtain successful results in some cases. This e-book presents a rare attempt to understand the cloaking problem as a whole. The book should be useful for readers with a strong interest in contemporary problem solving approaches in the physics of waves.
The Mad: Being Positioned as ‘Mad’ and Counteracting that Positioning
Authors: Davies Bronwyn , Laws Cath
Published: November 2012

As detailed in Chapter 1, Researching special schools: a poststructuralist approach, this
work explores the capacity to apply poststructuralism, in theory and in practice, in a setting where other
discourses are dominant. I focus on my own work as principal in the context of a special education
school where I worked with students categorised as ‘emotionally/behaviourally disordered’. I analyse
the discourses that inform this kind of work, both from the position of one who inevitably took them up,
even becoming expert in them, and from a Foucauldian position of critique which sets out to render
these discourses less able to be taken up.

This chapter explores the discourses and practices used with children at a special school who come to
be read as/perform as ‘mad’. Using Foucault’s work on madness and civilisation, I examine the
everyday educational practices through which these children are constituted, and tease out the dangers
and chances created for teachers and students working at the margins. Through exploring the practices
around ‘mad’ adults, as detailed by Foucault, I examine how these same practices are used with
children in covert and complex ways, and I explore the dominant and marginalising discourses
positioning children and young people as ‘mad’.
The Sad: Being Positioned as ‘Sad’ and Counteracting that Positioning
Authors: Davies Bronwyn , Laws Cath
Published: November 2012

As detailed in Chapter 1, Researching special schools: a poststructuralist approach, this
work explores the capacity to apply poststructuralism, in theory and in practice, in a setting where other
discourses are dominant. I focus on my own work as principal in the context of a special education
school where I worked with students categorised as ‘emotionally/behaviourally disordered’. I analyse
the discourses that inform this kind of work, both from the position of one who inevitably took them up,
even becoming expert in them, and from a Foucauldian position of critique which sets out to render
these discourses less able to be taken up.

In this chapter I examine the discourses that have informed the way we think about children living in out-ofhome
care who do not fit into the normal school system. I explore my own embeddedness in those
discourses when I work with these children, and I subject the discourses to critique—to make them visible
and analysable, showing the (often negative) effects they have on the children’s lives. These are powerful
discourses with powerful effects, and what I set out to do here is show how we are inevitably constituted by
them and constitute the children with them, even while learning to distance ourselves from them and no
longer hold them as revealing ‘the truth’ about the individual children we work with.
Acknowledgement
Authors: Davies Bronwyn , Laws Cath
Published: November 2012

I sincerely thank the students and staff at the special school described in this book. Their humour,
friendship and conversations provided great sustenance throughout the research. In particular, I am indebted
to all the students with whom I have ever worked. I hope I can remember to learn from all they taught me
about themselves and about myself.

There are many people to whom I am intellectually indebted—people whose work I have read, people with
whom I have talked and people with whom I have engaged in many critical discussions. In particular, I
thank the students of Professor Bronwyn Davies who share amazing insights; I am privileged to be a
member of such a talented group of writers and thinkers.

Special thanks to Professor Bronwyn Davies, my editor and mentor, for her guidance and support.
I appreciate the support of the Australian Catholic University, particularly Professor Marea Nicholson for
her insights and support.

I wish to thank all my friends, particularly Lee, Alicia, Susan and Julie. Their patience, advice and humour
provided great support throughout this journey.

To my sisters, Madeline and Patricia, I offer this work as a tribute to our lives.

To Ian, I offer my gratitude and my love—your support and partnership sustain me in so many ways.
A Simple Risk Stratification for Time to Development of Sight-Threatening Diabetic Retinopathy
Authors: Stratton Irene M. , Aldington Stephen J. , Taylor David J. , Adler Amanda I. , Scanlon Peter H.
Published: November 2012

OBJECTIVE

The American Diabetes Association and the English NHS Diabetic Eye Screening Program recommend annual screening for diabetic retinopathy (DR) with referral to ophthalmology clinics of patients with sight-threatening DR (STDR). Using only longitudinal data from retinal photographs in the population-based NHS Diabetic Eye Screening Program in Gloucestershire, we developed a simple means to estimate risk of STDR.

RESEARCH DESIGN AND METHODS

From 2005, 14,554 patients with no DR or mild nonproliferative DR only at two consecutive annual digital photographic screenings were categorized by the presence of DR in neither, one, or both eyes at each screening and were followed for a further median 2.8 years.

RESULTS

Of 7,246 with no DR at either screening, 120 progressed to STDR, equivalent to an annual rate of 0.7%. Of 1,778 with no DR in either eye at first screening and in one eye at second screening, 80 progressed to STDR, equivalent to an annual rate of 1.9% and to a hazard ratio (HR) of 2.9 (95% CI 2.2–3.8) compared with those with no DR. Of 1,159 with background DR in both eyes at both screenings, 299 progressed to STDR equivalent to an annual rate of 11% and an HR of 18.2 (14.7–22.5) compared with individuals with no DR.

CONCLUSIONS

Combining the results from 2 consecutive years of photographic screening enables estimation of the risk of future development of STDR. In countries with systematic screening programs, these results could inform decisions about screening frequency.