bluuebunny/crossref_metadata_2025 huggingface dataset:
Propylene oxide as a potential alternative to methyl bromide.
Authors: Isİkber A. A. , Navarro S. , Finkelman S. , Azrieli A. , Rindner M. , Dias R.
Published: November 2017

The relative effectiveness of propylene oxide (PPO) alone and in combination with vacuum (100 mm Hg) or 92% CO2 against all the life stages of Tribolium castaneum during short exposure times was evaluated. Sorption of PPO by wheat, cacao bean and maize at initial concentration of 82 mg/litre for a 4-h exposure was determined. The tests were carried out in desiccators at 30°C and 70% relative humidity. Exposures to vacuum or 92% CO2 alone, and an untreated control, were conducted in each test. The order of tolerance of the life stages to PPO was pupae > larvae > adults > eggs; these stages required a concentration of 147, 84, 55 and 30 mg/litre, respectively, to achieve LD99 for a 4-h exposure. PPO in combination with 100-mm Hg vacuum or 92% CO2 produced a significant decrease in the LD99 of the larvae, pupae and adults (6.2- to 7.1-fold) compared with exposure to PPO alone. A negligible mortality of all life stages except eggs was observed when these stages were exposed to 92% CO2 or vacuum (100 mm Hg) alone for 4 h. The results suggest that vacuum and CO2 have a synergistic effect on the insects when they are exposed to PPO. Sorption of PPO by wheat, cacao bean and maize after a 4-h exposure time varied between 57 and 79% of the initial concentration. This study suggests that combination of PPO with CO2 or vacuum could be a potential alternative to methyl bromide.
Naturally occurring acute selenium toxicosis in sheep.
Authors: Tiwary A. K. , Panter K. E. , Stegelmeier B. L. , James L. F. , Hall J. O.
Published: November 2017

The aim of this study was to investigate on the reported case of selenium poisoning in the Soda Spring in Idaho, USA by conducting an experiment which will imitate the conditions of the reported incident of selenium poisoning. Eight crossbred lambs (3 months old) were used in this study. Two of the eight lambs were administered 6 mg/kg organic Se as SeMeT while the other two lambs were given 8 mg/kg of organice selenium as SeMet the remaining four lambs served as control. Various plant samples (Grindelia spp., Aster eatonii and Medicago sativa) which were believed to be eaten by the animals were analyzed for selenium content using ICP/MS. Results showed that selenium content was quite variable between and within plant species, and all tested plant samples contained toxic selenium concentrations. Dietary Se concentration above 5 ppm is known to cause chronic Se poisoning in animals. Results also showed that most losses from acute Se poisoning occur within 1 to 3 days of intoxication and are characterized by depression, dyspnea, lesions of the liver and death. These findings were consistent with observations in the reported case and the SeMet dosed experimental lambs. The source of excessive Se in the field case was suspected to be the plant material that is known to predominantly contain organic selenium.
Leukoencephalomalacia in mules in Northern Brazil.
Authors: Riet-Correa G. , Duarte M. D. , Cerqueira V. D. , Oliveira C. M. C. , Riet-Correa F.
Published: November 2017

In June 2004, an outbreak of leukoencephalomalacia in mules from the state of Pará, northern Brazil, was reported. The disease affected 13 of the 80 mules in the farm. Until one week before the outbreak, the mules were supplemented daily with 60 kg of ground whole maize and 30 kg of African palm oil meal. One week before the outbreak, the amount of food was increased to 150 kg of the ground maize, 60 kg of African palm oil and 120 kg of poultry litter. The clinical signs in the affected mules were ataxia, muscular tremors, aggressiveness, absence of palpebral reflex, decreased tongue and upper and lower lip tone, decreased sensibility of the face and palate, and muscular slackening. All animals died with 10-24 h after manifestation of clinical signs. Postmortem examination revealed cavitations, haemorrhages and yellow discolouration in the thalamus and mesencephalon. Mild haemorrhagic lesions were also observed in the pons. Histopathologically, areas of malacia in the white matter were characterized by a vacuolated neutrophils with oedema and haemorrhages. No significant lesions were observed in other organs. The differences in clinical signs and location of the lesions in mules with those reported in horses and donkeys are discussed. To the authors' knowledge, this is the first report on leukoencephalomalacia in mules in Brazil.
Land reform in South Africa: an appraisal
Authors: Akinola Adeoye O.
Published: November 2017

Land-related issues have taken centre stage in socio-political and economic discourse in post-apartheid South Africa. As in other societies, access to land is vital for social–cultural sustainability, improved livelihoods and economic development; hence, the sensitivity of the land reform projects initiated by successive governments. While the South African state has made strides in correcting the unequal ownership patterns inherited from the previous regime, the skewed pattern of land distribution persists, and conflict over land and poverty prevail. Stakeholders in the land reform project have different perspectives. While some advocate for accelerated ‘return’ of land to the original black owners, there are compelling reasons to question the unproductive utility of land that has already been transferred. This article interrogates government performance in the land restitution and redistribution project, assesses the utility of land re-allocated to new owners, and explores the convergence between land reform and persistent poverty. In so doing, it identifies many flaws in the land reform scheme.
Standardization of (higher) education in Europe – policy coordination 2.0?
Authors: Elken Mari
Published: November 2017

The European educational landscape is changing. Education remains formally under the sphere of the nation states and has traditionally been resistant towards EU involvement. Several recent initiatives from joint policy-making point towards increased standardization as a key element of European integration in education and higher education. The article builds on the notion of standards-based governance and outlines this as a distinct mode for policy-making in the EU, emphasizing incentives and voluntary implementation, the use of expertise and technical calibration, their quasi-regulatory nature of the process. The article draws on a number of empirical examples to show how standards have been used for higher education policy on EU level.
Stakeholder organizations in the European higher education area: exploring transnational policy dynamic
Authors: Vukasovic Martina
Published: November 2017

The study focuses on multi-level and multi-actor characteristics of European governance, concentrating on six European stakeholder organizations in the area of higher education (HE) and research. It analyses how policy positions change over time and how such changes can be accounted for, juxtaposing (1) environmental influence linked to structuration of the European HE policy arena as an organizational field and (2) internal organizational dynamic. Policy positions are seen to comprise three elements – policy issues, policy preferences and normative basis. Theoretically, the study is grounded in policy analysis, interest groups and neo-institutionalism. The empirical material consists of policy documents, subjected to both quantitative and qualitative content analysis. The study identifies changes in policy positions of stakeholder organizations, resulting in both differences and similarities, though the latter do not emerge over time in a way that suggests straightforward convergence. Thus, further research into specificities of policy-making processes within these organizations is necessary.
U.S. state higher education appropriations: assessing the relationships between agency politicization, centralization, and volatility
Authors: Lacy T Austin , Fowles Jacob , Tandberg David A , Hu Shouping
Published: November 2017

Research into state appropriations across the United States frequently examines the influence of socio-demographic characteristics and political characteristics on particular levels of funding. We extend this literature to examine the year-to-year volatility of funding in order to test hypotheses surrounding the interlocks among multiple actors in the political stage. Our findings suggest that, when state higher education leaders are politically close to governors and have no formal budgetary power they capture more revenue volatility.
Policy learning, motivated scepticism, and the politics of shale gas development in British Columbia and Quebec
Authors: Montpetit Éric , Lachapelle Erick
Published: November 2017

What is policy learning and how do we know when we observe it? This article develops an original way of operationalizing policy learning at the individual and subsystem level. First, it juxtaposes four types of opinion change at the individual level – opinion shifting; opinion softening; position-taking and opinion hardening. This last change, we argue is indicative of motivated scepticism, a non-learning process that we borrow from public opinion studies. Second, we identify factors associated with opinion change and argue that some of them indicate policy learning, while others point to motivated scepticism. Lastly, we examine learning and motivated scepticism against patterns of opinion convergence (the expected outcome of learning) and polarization (the expected outcome of motivated scepticism) at the subsystem level. We illustrate the use of this approach to study policy learning with the case of shale gas development in two Canadian provinces, British Columbia and Quebec. While, we find clear signs of individual learning and motivated scepticism in both provinces, we find that policy learning is more prevalent in Quebec than in British Columbia at the subsystem level.
Cognition and policy change: the consistency of policy learning in the advocacy coalition framework
Authors: Moyson Stéphane
Published: November 2017

Policy actors involved in decision-making processes interact and gradually accumulate evidence about policy problems and solutions. As a result, they update their policy beliefs and preferences over time. This process of policy learning is consistent if policy preferences are aligned with any adaptations in beliefs about policy outcomes – a crucial condition of learning-induced policy changes. This article examines whether and when policy learning is consistent based on regression analyses conducted on data from a 2012 survey of 293 Belgian actors involved in the European liberalization policy process for the rail and electricity sectors. In line with the advocacy coalition framework, existing research has suggested that motivated modes of reasoning, such as selective exposure and biased assimilation, influence policy actors’ attitudes and behaviours. This study isolates the effect of biased assimilation on policy learning by demonstrating that when policy actors adapt their beliefs about policy outcomes, they do not necessarily align their policy preferences with those adaptations. Furthermore, biased assimilation is higher among politically curious actors, but their degree of commitment to the policy process does not appear to play a role. The theoretical and practical implications of these findings are discussed.
Policy learning and policy change: theorizing their relations from different perspectives
Authors: Moyson Stéphane , Scholten Peter , Weible Christopher M
Published: November 2017

All politics and policy issues involve the accumulation of data about problems and solutions in context of social interactions. Drawing on these data, policy actors acquire, translate, and disseminate new information and knowledge toward achieving political endeavors and for revising or strengthening their policy-related beliefs over time. ‘Policy learning’ is a concept that refers to this cognitive and social dynamic. Articles in this special issue examine the relationship between policy learning and policy change from different theoretical perspectives. In this introduction to the special issue, we describe the current approaches that structure the field and gaps in knowledge separating policy learning and policy change. We introduce a refined conceptual framework to outline and compare the articles in the issue. These articles point to several facets of the learning phenomenon. First, the articles focus on the nature and consequences of learning by specific groups of society, such as advocacy coalitions, epistemic communities, citizens, street-level bureaucrats, and policy brokers. Second, they present learning processes in which information and experience are used to acquire new knowledge on policy objectives to substantiate and legitimize them or to change or form beliefs. Third, they identify several cognitive and social processes to strengthen the connection between policy learning and policy change. Finally, the articles point to several psychological, social, and institutional factors fostering or impeding these cognitive and social processes. This introduction concludes with avenues for future research.
Three competing interpretations of policy problems: tame and wicked problems through the lenses of population aging
Authors: Marier Patrik , Van Pevenage Isabelle
Published: November 2017

This contribution presents competing lenses of population aging as policy problems and it compares their impact on the treatment of policy problems. Three lenses are analysed: intergenerational, biomedical and social gerontological. The intergenerational lens treats population aging as a new form of class conflict along age groups. The social gerontological lens claims that population aging is first and foremost a social issue and it stands in opposition to the dominance of biomedical approaches that treat aging as a pathology. The presence of these three alternative conceptions of the policy problem is indicative of the complexity surrounding population aging and the importance of having divergent definitions of policy problems. Via an analysis of informal care giving in the Canadian context, this contribution also presents a comparison of the three lenses with a focus on the roots of these conceptualisations in various disciplines, their prevalence in various public organisations, and the policy consequences of their strength or weakness.
Using the MMPI-2-RF to Characterize Defendants Evaluated for Competency to Stand Trial and Criminal Responsibility
Authors: Sellbom Martin
Published: November 2017

This study sought to provide more specific comparison groups for examiners using the MMPI-2-RF in criminal forensic evaluations, as well as to expand upon the existing literature by comparing defendants evaluated for Competency to Stand Trial (CST) and Criminal Responsibility (CR) on psychological functioning. In a large pre-trial criminal defendant sample ( n = 486), significant differences were observed between defendants evaluated for CST and those evaluated for CR on scales reflecting emotional and externalizing dysfunction, but not thought dysfunction. Moreover, those opined competent to stand trial by forensic examiners scored lower than those opined incompetent on measures of psychoticism/paranoia, whereas those opined not criminally responsible were less likely to exhibit externalizing psychopathology relative to those opined to be criminally responsible. Implications for forensic psychology practice are discussed.
Energy landscape differences among integrins establish the framework for understanding activation
Authors: Li Jing , Springer Timothy A.
Published: November 2017

Why do integrins differ in basal activity, and how does affinity for soluble ligand correlate with cellular adhesiveness? We show that basal conformational equilibrium set points for integrin α4β1 are cell type specific and differ from integrin α5β1 when the two integrins are coexpressed on the same cell. Although α4β1 is easier to activate, its high-affinity state binds vascular cell adhesion molecule and fibronectin 100- to 1,000-fold more weakly than α5β1 binds fibronectin. Furthermore, the difference in affinity between the high- and low-affinity states is more compressed in α4β1 (600- to 800-fold) than in α5β1 (4,000- to 6,000-fold). α4β1 basal conformational equilibria differ among three cell types, define affinity for soluble ligand and readiness for priming, and may reflect differences in interactions with intracellular adaptors but do not predict cellular adhesiveness for immobilized ligand. The measurements here provide a necessary framework for understanding integrin activation in intact cells, including activation of integrin adhesiveness by application of tensile force by the cytoskeleton, across ligand–integrin–adaptor complexes.
Sensory System
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The sensory system provides information to the central nervous system about the external world (exteroceptive) and the internal environment (interoceptive). Impulses traveling toward the central nervous system are called afferent impulses. Afferent information may be transmitted as conscious data that are perceived by the organism and then used to modify behavior; as unconscious data that, although used to modify behavior, remain unperceived by the organism; or as both conscious and unconscious data. Afferent impulses are functionally subdivided into 4 categories: general somatic afferent impulses (from skin, striated muscles, and joints), general visceral afferent impulses (largely unconscious, from serosal and mucosal surfaces, smooth muscle of the viscera, and baroreceptors), special somatic afferent impulses (relating to vision, hearing, and equilibrium), and special visceral afferent impulses (relating to taste and smell).
Motor System
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

All bodily movements, including those of internal organs, are the result of muscle contraction, which is under neural control. The muscles of the limbs, trunk, neck, and eyes are derived from somites. The muscles involved in facial expression, mastication, phonation, and swallowing are derived from the branchial arches. Somatic and limbic motor pathways arising from the cerebral cortex and brainstem control the activity of the motor neurons innervating all these muscles. The motor system, like the sensory system, includes a complex network of structures and pathways at all levels of the nervous system. This network mediates many types of motor activity. An understanding of its organization and the integration of the motor system with the sensory system is necessary for accurate localization and diagnosis of neurologic disease.
Vascular System
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The blood vessels to an organ provide it with a relatively constant supply of oxygen and other nutrients and a means for removal of metabolic waste. Failure to meet these vital requirements results in disease in that organ. Because of the unique structure and organization of the nervous system, localized abnormalities in its blood supply may produce devastating alterations in neural function. This chapter describes the normal anatomy and physiology of the vascular supply to neural tissue and the clinical manifestations of pathologic processes affecting this system.
Spinal Level
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The spinal level includes the vertebral column and its contents. The spinal canal within the vertebral column is the passage formed by the vertebrae. It extends from the foramen magnum of the skull through the sacrum of the spinal column and contains the spinal cord, nerve roots, spinal nerves, meninges, and vascular supply of the spinal cord. Five of the major systems are represented in the spinal canal: the sensory, motor, autonomic, vascular, and cerebrospinal fluid systems. The vascular and cerebrospinal fluid structures are the support systems of the spinal cord. Diseases of the spinal canal involve 1 or more of these systems and produce patterns of disease distinctive to this level. The anatomical and physiologic characteristics of the spinal cord and spinal nerves that permit the identification and localization of diseases in the spinal canal are presented in this chapter.
Posterior Fossa Level: Brainstem and Cranial Nerve Nuclei
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The posterior fossa level contains all the structures located within the skull below the tentorium cerebelli and above the foramen magnum. These structures are derivatives of the embryonic mesencephalon, metencephalon, and myelencephalon and include portions of all the systems discussed in other chapters. The major structures of this level are the brainstem, cerebellum, and segments of cranial nerves III-XII before their emergence from the skull. The brainstem, the core of the posterior fossa level, is a specialized rostral extension of the embryonic neural tube that preserves, even in the mature state, many of the longitudinal features of the spinal cord and provides for segmental functions of the head. This chapter describes the general anatomy of the posterior fossa, the anatomy and functions of cranial nerves III-XII, and the internal anatomy of the medulla, pons, and midbrain.
Posterior Fossa Level
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The focus of this chapter is on the anatomy of the cerebellum and the 3 systems characteristic of the posterior fossa level: the ocular motor, auditory, and vestibular systems. The clinical examination and clinical correlations at the level of the posterior fossa are also discussed in this chapter.
Diencephalon
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The supratentorial level includes all structures located within the skull and above the tentorium cerebelli. These structures develop from the embryonic prosencephalon and, therefore, include derivatives of the diencephalon and telencephalon. The visual system, a derivative of the diencephalon, provides input to the cerebral cortex for image formation and to subcortical structures to trigger the light reflex and entrain the circadian rhythm. This chapter discusses the anatomy, physiology, and clinical correlates of the diencephalic components of systems at the supratentorial level.
Biophysical Aspects of EEG and MEG Generation
Authors: Wadman Wytse J. , Lopes da Silva Fernando H.
Published: November 2017

This chapter reviews the essential physical principles involved in the generation of electroencephalographic (EEG) and magnetoencephalographic (MEG) signals. The general laws governing the electrophysiology of neuronal activity are analyzed within the formalism of the Maxwell equations that constitute the basis for understanding electromagnetic fields in general. Three main topics are discussed. The first is the forward problem: How can one calculate the electrical field that results from a known configuration of neuronal sources? The second is the inverse problem: Given an electrical field as a function of space and time mostly recorded at the scalp (EEG/MEG), how can one reconstruct the underlying generators at the brain level? The third is the reverse problem: How can brain activity be modulated by external electromagnetic fields with diagnostic and/or therapeutic objectives? The chapter emphasizes the importance of understanding the common biophysical framework concerning these three main topics of brain electrical and magnetic activities.
EEG in Metabolic Disorders, Intoxications, and Epileptic Encephalopathies
Authors: Sutter Raoul , Pang Trudy , Kaplan Peter W.
Published: November 2017

This chapter provides a systematic overview of the diagnostic and prognostic value of electroencephalography (EEG) in adult patients with different types of encephalopathies in association with metabolic, toxic, and epileptic disorders. Most encephalopathies present with a fluctuating course characterized by typical but not pathognomonic symptoms such as cognitive impairment, altered mental status or confusion, lethargy, decreased or rarely increased motor activity, and disturbed sleep/wake cycles. EEG enables rapid, bedside electrophysiological monitoring, providing dynamic real-time information on the integrity of neocortical brain activity. Hence, EEG complements clinical and neuroimaging assessments of encephalopathic patients. Progressive slowing of EEG background activity with increasing cerebral dysfunction, emergence of intermittent transients, electrographic seizures, and impaired background reactivity to external stimuli all provide important diagnostic and prognostic information to guide medical management.
Combination of Brain Functional Imaging Techniques
Authors: Seeck Margitta , Spinelli L , Gotman Jean , Lopes da Silva Fernando H.
Published: November 2017

Several tools are available to map brain electrical activity. Clinical applications focus on epileptic activity, although electric source imaging (ESI) and electroencephalography-coupled functional magnetic resonance imaging (EEG–fMRI) are also used to investigate non-epileptic processes in healthy subjects. While positron-emission tomography (PET) reflects glucose metabolism, strongly linked with synaptic activity, and single-photon-emission computed tomography (SPECT) reflects blood flow, fMRI (BOLD) signals have a hemodynamic component that is a surrogate signal of neuronal (synaptic) activity. The exact interpretation of BOLD signals is not completely understood; even in unifocal epilepsy, more than one region of positive or negative BOLD is often observed. Co-registration of medical images is essential to answer clinical questions, particularly for presurgical epilepsy evaluations. Multimodal imaging can yield information about epileptic foci and underlying networks. Co-registering MRI, PET, SPECT, fMRI, and ESI (or magnetic source imaging) provides information to estimate the epileptogenic zone and can help optimize surgical results.
Adolescence
Authors: Mandel Rachel , Gerson Ruth
Published: November 2017

Adolescence is a time of remarkable change—a time of physical and emotional growth with many potential problems. It is a turbulent yet universal stage of life, and mental health providers can be flummoxed in approaching, diagnosing, and treating adolescents, with the ongoing question of “What is normal adolescent behavior?” Providers sometimes lose sight of central issues in adolescent life, such as school, family, trauma, foster care, and burgeoning responsibilities. This chapter provides a case example of a typical teen presentation in the emergency department and uses it to illustrate the complexity of adolescent mental health issues. Favorable outcomes are possible when clinicians are mindful of the special needs of this age group, including risky behavior, the impact of bullying, and academic stress, and when clinicians can navigate the corresponding systems of care.
Transition-Age Youth
Authors: Tse Jeanie , Lai Larissa , Sorrentino Sharon
Published: November 2017

As young people become adults and establish their independence, they make critical choices about relationships, education, and vocation. This transition is even more challenging for young people with histories of trauma, mental illness, and poor social supports, such as many youth aging out of the foster care system. Dishearteningly high rates of school dropout, homelessness, incarceration, and suicide in the 15- to 25-year-old age group have focused increasing attention on the needs of this population. This chapter presents strategies to engage these transition-age youth. Flexible but reliable, youth-led and future-oriented care breaks down treatment barriers so that youth can develop and achieve personal goals. Attention to the housing, vocational, and social support needs of these young people is crucial to their survival and success.
Families
Authors: Guo Yu-Heng , Heru Alison M.
Published: November 2017

Mental illness can deeply impact a family’s dynamic, sometimes leading to its breakdown. At the same time, family support can make or break the recovery trajectory of a person with mental illness. When traditional individual treatments are not effective, it is often an indicator that the family should be included. Observing family interactions can help determine a family’s and individual’s needs. In this chapter, a family’s story is used to illustrate how public psychiatrists can work with families to preserve attachments, develop understanding and support for the affected individual, and prevent caregiver burnout. The case illustrates how a genogram, family inclusion, and family psychoeducation can be used create a broader narrative and build empathy for the family system.
State Psychiatric Hospitals
Authors: Barber Mary , Casoy Flavio , Zinns Rachel
Published: November 2017

State hospitals have represented an increasingly small piece of the public mental health system due to deinstitutionalization and ongoing hospital downsizing and closure. However, state hospitals continue to treat people with the most serious and complex mental illnesses. Freedom from the need to produce revenue and the luxury of time are two factors that leave state hospitals vulnerable to cuts but are also clinical assets. In this chapter, two cases illustrating histories common to patients treated in the state hospital are discussed—a patient with complex trauma and a patient with schizophrenia—exploring how state hospital systems can be designed to support individuals in their pursuit of recovery.
Homelessness
Authors: Fried Joanna , Morinis Leora
Published: November 2017

There is a high prevalence of serious mental illness and substance use disorders in people who are experiencing homelessness. Many individuals without housing are not well served within the existing outpatient mental health services system, and without tailored interventions, many cannot or do not access ongoing psychiatric care. Team-based and integrated approaches that address housing, mental and physical health, substance use, and benefits and entitlements are recommended to engage and support these individuals. Services spanning an individual’s trajectory from street to shelter to housing can help foster recovery. This chapter illustrates the importance of specialized clinical approaches for this population and discusses both evidence-based practices and unique best practice interventions for clinicians working with people experiencing homelessness.
Individuals with Developmental Disabilities
Authors: Stratigos Katharine , Tioleco Nina , Silberman Anna , Whitaker Agnes
Published: November 2017

Persons with developmental disabilities (DD), such as autism spectrum disorder and intellectual disability, are at substantially greater risk of having comorbid mental illness compared to the general population. Their mental health care needs, however, are vastly undertreated. Contributors to this situation include the challenges of evaluating mental illness in individuals with DD; stigma associated with and systematic barriers against people with DD; communication barriers; inadequate training of health care workers; insufficient availability of community mental health services; and the complexity of the available social services and legal systems at the federal, state, and community levels. This chapter uses a case to review the different factors that contribute to irritability and problem behavior in a person who has autism spectrum disorder with intellectual and language impairment. Also reviewed is the complicated system of services and statutes that may be of assistance when working with this population.
Veterans
Authors: Quitangon Gertie
Published: November 2017

The US Department of Veterans Affairs (VA) has the largest nationally integrated, publicly funded health care system in the country, providing care to approximately 8 million military veterans. It is a training ground for a majority of medical, nursing, and allied health professionals in the United States and has a record of more than 90 years of health care research and innovation. Mental health care for veterans has evolved considerably from World War I to the post-9/11 era, and lessons learned from veterans of Vietnam and more recent wars have been informing changes in practices and procedures. Improvement of mental health care has been a VA institutional priority, and the VA has led in the implementation of integrated care and recovery-oriented services. It is a pioneer in post-traumatic stress disorder and traumatic brain injury research. This chapter introduces the VA structures and programs developed to enhance access to services and delivery of evidence-based best practices.
Introduction
Authors: Cavanaugh T.A.
Published: November 2017

The Introduction explains the relevance of the cover art, “the bas-relief of Telephus,” to the book’s theme—that doctoring must exclude deliberate wounding. The relief depicts Achilles’ healing of Telephus, whom Achilles had wounded. Telephus’ wound festered; the Delphic oracle told him that “the wounder heals.” This pithy truth points to an allied, more worrisome phenomenon. Namely, just as the wounder heals, so too does the healer wound—the problem of a doctor wounding (iatrogenic harm). The Hippocratic Oath addresses this salient problem, especially as found in a physician deliberately injuring a patient, e.g., euthanizing a patient, even at that patient’s request. The Introduction summarizes how each chapter addresses the Oath—the need for the Oath, the Oath and associated contract, iatrogenic harm as the fundamental medical-ethical issue paradigmatically illustrated by a physician’s involvement in killing, and, finally, medicine as involving a profession of an ethic internal to itself.
Snake?
Authors: Cavanaugh T.A.
Published: November 2017

Chapter 1 (Snake?) reflects on Asclepius’ snake (symbolic of the healing profession) as indicative of the need for Hippocrates’ Oath. Chapter 1 proposes that this ancient medical symbol reveals medicine’s vexing ethical problem, iatrogenic harm—wounds caused by a physician. Such wounds take three forms: wounds ineliminable from therapy (e.g., cauterizing), harmful errors committed while caregiving (e.g., wrong drug dose), and, last of all, but most ethically problematic, wounds of role-conflation, such as euthanizing a patient or assisting suicide (at the patient’s request). By the last type of wound, a physician takes on the role of wounder and deliberately injures, thereby abandoning the practice of medicine as an exclusively therapeutic activity. Chapter 1 argues that Hippocrates’ Oath responds to this vexing medical-ethical problem of role conflation by having physicians forswear the role of wounder, especially as instanced by killing.
Treatment and management of personality-disordered offenders in the community
Authors: Jeffcote Nikki , Craissati Jackie
Published: November 2017

This chapter describes the research and clinical evidence on which recent developments in services for personality disordered offenders have been based, and it offers practical guidance for both mental health and criminal justice practitioners. Drawing on 20 years of experience working with this group in community settings, the chapter highlights the need to adapt traditional assessment and treatment approaches if the historical tendency to exclude these individuals from services is to be overcome. Integrating psychologically informed management and social-inclusion approaches into models of community service provision allows psychological wellbeing and effective risk management to be addressed in an effective and defensible way.
Renal and retroperitoneal abscess
Authors: Hartley Alice E. , Page Toby
Published: November 2017

Retroperitoneal infections are often difficult to diagnose as their clinical presentation is often non-specific. They generally occur in people with anatomical abnormalities, malignancy, injury, or infection of the retroperitoneal organs, but may result from lymphatic or haematogenous spread. Delayed diagnosis can lead to abscess formation with associated high morbidity and risk of mortality. The retroperitoneum can be divided into anterior, perinephric, and posterior compartments and an understanding of this anatomy can help localize the source of infection. Both aerobic and anaerobic organisms can be responsible; the cause of the infection should be identified and treated. In patients who fail to respond to antibiotics, surgical abscess drainage or removal of the infected tissue may need to be performed. Early diagnosis and treatment is critical in preventing subsequent abscess formation and organ damage and to reduce the risk of morbidity.
Evaluation of stone formers
Authors: Iqbal Muhammad Waqas , Jibara Ghalib , Lipkin Michael E. , Preminger Glenn M.
Published: November 2017

Urolithiasis is among the most common urologic disorders with high incidence and recurrence rates. High environmental temperatures, prevalence of the Western diet, obesity, age, gender, and race are among the common risk factors associated with this disease. The primary goal of evaluating these patients is to provide a simple, economic, and effective workup, which yields information that is directly applicable to providing relevant medical preventative measures. The management of urolithiasis requires a relevant history, targeted physical exam, appropriate chemistry, urinary and stone analyses results, radiological imaging to accurately identify number, location, and size of stones, as well as a metabolic evaluation. All stone formers whether single or recurrent should have a basic evaluation to identify any factors that may predispose to recurrent stone formation. Comprehensive metabolic evaluations are offered to patients at increased risk of recurrence or morbidity from stone disease, or have difficult to treat stones.
Watchful waiting for stone disease
Authors: Reynard John , Turney Ben
Published: November 2017

Renal stones are highly prevalent and while many cause symptoms or are of a size that requires treatment even if asymptomatic, the natural history of stones suggests that treatment may not be necessary in all cases. Stone size, position, and number are related, to a degree, to the likelihood of a subsequent stone event such as stone migration causing ureteric colic or increase in stone size, but the predictive power of ‘natural history’ studies is limited by the small number of patients in these studies. In this chapter, the evidence for watchful and waiting for asymptomatic stone disease is explored, and situations in which it is reasonable and conversely unreasonable are discussed.
Retrograde intrarenal surgery
Authors: Astroza Gaston M. , Lipkin Michael E. , Preminger Glen M.
Published: November 2017

Retrograde intrarenal surgery (RIRS), also known as flexible ureterorenoscopy (fURS) is an effective and safe method for the management of intrarenal stones. Its use has increased in recent years with several reports showing stone-free rates as high as shock wave lithotripsy (SWL) for intrarenal stones. This improvement in efficacy of retrograde intrarenal surgery (RIRS) is related to technological advances and improvements in endoscopic techniques that have made retrograde stone removal easier. The main advantage of RIRS compared to open operative or percutaneous intervention is a decrease in operative morbidity for the patient, as well as a faster recovery. RIRS should be considered in patients with kidney stones if they have a contraindication for SWL or percutaneous nephrolithotomy (PCNL), such as the presence of a bleeding diathesis, some cases of morbid obesity, musculoskeletal deformities, or infundibular stenosis.
Open stone surgery for kidney stones
Authors: Astroza Gastón M. , Jibara Ghalib , Lipkin Michael E. , Preminger Glenn M.
Published: November 2017

The open approach for stone surgery is currently used infrequently in patients undergoing stone removal. Currently an associated anatomic abnormality, a failure of or a contraindication to minimally invasive therapy, or a large and complex stone are the infrequent indications for open surgery. For these indications, laparoscopic or robotic approaches have almost completely replaced open procedures in the hands of skilled laparoscopic surgeons. Pyelolithotomy was supplanted almost 20 years ago by the advent of percutaneous and shock wave technology. Currently, the only indications for this procedure are a failure of or contraindication to other techniques, or the presence of an associated abnormality such as ureteropelvic junction obstruction, which could then be managed simultaneously.
Ureteric stones
Authors: Turney Ben , Reynard John
Published: November 2017

This chapter summarizes the variety of ways in which ureteric stones can present together with non-radiological and radiological diagnostic tests used to identify them. Ureteric stones classically present with sudden onset, severe loin pain with or without radiation to the groin, testis, or labia majora. The urgent desire to pass urine, combined with increased urinary frequency and the passage of small voided volumes of urine is suggestive of a vesicoureteric junction stone. Haematuria as a presenting symptom of a ureteric stone is rare. Magnetic resonance (MR) urography is an accurate imaging test for identifying ureteric stones. However, at the present time, cost, restricted availability and limited experience in interpretation of the images by radiologists and urologists limit its usefulness as a routine diagnostic method of imaging in cases of acute flank pain.
Assessment of urinary incontinence
Authors: Drake Marcus
Published: November 2017

Involuntary loss of urine is subdivided primarily into stress, urgency, or mixed urinary incontinence. The history and examination aim to identify underlying mechanisms, and indicators of more complex causes, or serious medical conditions. Associated lower urinary tract symptoms (LUTS) should be catalogued in detail. History should also cover symptom bother, as this is the prime driver of therapy. Validated questionnaires are the most effective way to capture aspects of incontinence and associated LUTS. Wider pelvic symptoms, such as pelvic organ prolapse, sexual function, and anal symptoms should also be evaluated. Physical examination needs to cover general aspects, including occult neurological disease. Abdominal and pelvic examination evaluates the genitalia, pelvic floor muscle function, and pelvic masses, along with urethral hypermobility in women and the prostate in men.
Lower urinary tract reconstruction
Authors: Mundy Anthony R. , Andrich Daniela E.
Published: November 2017

In clinical practice, most reconstructive urological procedures performed are for urethral strictures and otherwise on the lower urinary tract. Bladder augmentation and substitution are widely used by urologists and increasingly so in other subspecialties across the spectrum of urology for what used to be reconstructive problems, but new problems have developed to challenge reconstructive urologists, requiring a different approach but based on the same general principles. Thus, as augmentation and substitution cystoplasty become increasingly part of ‘general urology’, so reconstructive urologists are adapting these principles to deal with the complications of the treatment of prostate cancer, gynaecological cancer and rectal cancer.
Molecular biology of prostate cancer
Authors: Alves Ines Teles , Trapman Jan , Jenster Guido
Published: November 2017

Prostate cancer is a heterogeneous disease that arises through the acquisition of key malignant hallmarks. At the molecular level, prostate tumours are dependent upon the androgen receptor pathway, which affects cell function, growth, and behaviour through downstream androgen-regulated genes. Prostate cancer requires this activity and manipulates the AR pathway to maintain signalling. For example, mutation of the AR (to bind ligands other than androgens) or amplification/duplication of the AR allows signalling to continue in the absence of testosterone. Around 50% of prostate cancers have a gene fusion between the androgen-regulated component of the TMPRSS2 gene and a transcription factor (e.g. ETS family members ERG and ETV1). This results in aberrant androgen stimulated cell growth. Current research is using molecular knowledge to identify biomarkers, such as PCA3, and new therapies, such as enzalutamide or abiraterone acetate.
Prostate-specific antigen and biomarkers for prostate cancer
Authors: Lilja Hans
Published: November 2017

Prostate-specific antigen (PSA) is a kallikrein serine protease secreted by the prostate to liquefy the ejaculatory coagulum. Changes in the blood/prostate barrier allows PSA to enter the circulation in men with prostate cancer and other inflammatory prostatic diseases. The commonest method for detection of men at risk of prostate cancer is PSA testing, which is typically used in an opportunistic screening setting. The widespread use of PSA testing leads to overdiagnosis and overtreatment of many men with low-risk prostate cancer, but can allow the identification of those with significant disease requiring radical treatment. This lack of specificity for high-risk prostate cancer has led to the need for more accurate biomarkers or methods to improve the use of PSA testing.
Metastatic disease in prostate cancer
Authors: Clarke Noel W
Published: November 2017

Metastases are the predominant cause of morbidity and death from prostate cancer (CaP). The tendency for cells to migrate from the primary site, enter the vascular/lymphatic circulation, and implant/grow at secondary sites is the principal discriminator of aggressive form indolent disease. But this process is poorly understood. Cells enter the circulation in increasing number as the disease progresses, impinging on endothelial surfaces, particularly in red bone marrow where they bind and transmigrate, forming early cell colonies. This requires chemo-attractants and nutrients enabling cellular survival. Established metastases thrive independently, disrupting local tissue, as characterized by progressive replacement of red bone marrow and disruption of skeletal architecture. Bone disruption includes massive overstimulation of both osteoblasts and osteoclasts, inducing synchronous over-production of abnormal bone and gross osteolysis.
Screening for bladder cancer
Authors: Brinkman Maree , Zeegars Maurice
Published: November 2017

Bladder cancer (BC) is one of the most common urological malignancies and ranks ninth among all cancers worldwide. While screening has the potential to detect early cases of BC and reduce disease specific mortality, to date there are no routine screening programmes of asymptomatic individuals conducted anywhere in the world. There are however, a range of tests and procedures available for the detection and subsequent diagnosis of BC for select individuals presenting with urological symptoms and who are at increased risk of the disease.This chapter provides an overview of the traditional screening tools used for the detection of BC, such as urinalysis for haematuria and urinary cytology, as well as a brief description of follow-up procedures including cystoscopy, imaging, and treatment modalities.