bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing Stress, Coping, and Communicating Effectively: Tips for Family Members and Patients
Authors: Compton Michael T , Broussard Beth
Published: November 2020

As discussed in previous chapters, psychosis often first begins in late adolescence or young adulthood. Thus, many people who experience a first episode of psychosis live with and rely on their families for support. In addition to providing a place to live and other basic support, families are key in the recovery process because they love and care for the person with the illness and they want to help. Family members may need to provide emotional support, arrange for treatment, and find new ways to cope with the signs and symptoms of psychosis or other problems that result from the illness. Families are a very important part of the team that is necessary to properly manage psychosis. In fact, now that more effective antipsychotic medicines and psychosocial treatments are available, many people with psychosis often can receive treatment in the community and with their families rather than having extended stays in the hospital. Families play a major role in helping their loved ones manage their illness. As a result, it is vital to create a supportive family environment by reducing stress, coping, and communicating effectively. This chapter focuses on three essential domains of a supportive family environment: reducing stress, enhancing coping, and ensuring effective communication. First, we begin by defining …Families play a major role in helping their loved ones manage their illness. As a result, it is vital to create a supportive family environment by reducing stress, coping, and communicating effectively.… stress and the ways that the early stages of psychosis can lead to stress. We discuss three ways to reduce stress in the family as well as three related ways the family can help the patient to reduce stress. Second, we define coping and talk about the importance of coping with a stressful event, like an episode of psychosis in a family member. We offer three ways of coping effectively for family members as well as three ways that patients can practice effective coping. Third, we address the value of good communication and how the symptoms of psychosis can sometimes interfere with productive communication patterns. We then provide eight points of advice for effective communication within the family.
Finding Specialized Programs for Early Psychosis
Authors: Compton Michael T , Broussard Beth
Published: November 2020

Most of the time, people of all different ages and with all sorts of mental illnesses go to the same place to see a doctor, get medicines, or participate in counseling. That is, they go to mental health clinics or the office of a mental health professional that provides treatments for a number of different illnesses. Most young people who have psychosis get their medical care and treatment in a hospital, clinic, or doctor’s office. In these places, the doctors and other mental health professionals may have taken special classes about how to help young people with psychosis, but that may not be their only focus. They may see people with other illnesses too. However, in some places around the world, there are special clinics that are for people in the early stages of psychosis. These types of specialized programs have been developed recently, since the 1990s. These programs have a number of different types of mental health professionals, including psychiatrists, psychologists, nurses, social workers, counselors, and others. In some programs, mental health professionals and doctors in training may rotate through the clinic spending several months at a time training in the clinic. Some programs, like the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Victoria, Australia, operate within the framework of a youth health service. Such youth services treat all sorts of mental health issues in young people. Other programs are located primarily in adult mental health facilities. Such programs may offer classes or group meetings just for people who recently developed psychosis and other classes or group meetings especially for the families of these young people. Typically, these programs provide someone with 2–3 years of treatment. They usually do a full evaluation of the patient every few months and keep track of how he or she is doing. If the patient needs more care afterwards, they help him or her find another program for longer-term care. In this chapter, we list some of these clinics located in various parts of the world and describe what these specialized early psychosis programs provide.
Settings and Models of AIDS Psychiatric Care
Authors: Goforth Harold W. , Khalife Sami
Published: November 2020

From primary prevention to end-of-life care, AIDS psychiatry can make significant contributions to preventing risk behaviors and HIV transmission, mitigating suffering, and improving adherence to risk reduction and medical care. Early in the epidemic, stigma and discrimination magnified suffering and excluded persons known to have HIV and AIDS from many settings in the United States and throughout the world. Such treatment of persons with AIDS was described (Cohen, 1989) as a new form of discrimination called “AIDSism.” As we approach the end of the third decade of the HIV pandemic, in most countries education, training, and experience have mitigated AIDSism, and persons with HIV and AIDS are now seen in varieties of medical and nonmedical settings. The multimorbid medical and psychiatric illnesses associated with HIV infection have complicated the care of persons with HIV and AIDS. A primary care guideline for the care of persons with HIV is available in print (Aberg et al., 2009) and online and is updated regularly at: http://www.journals.uchicago.edu/page/cid/IDSAguidelines.html. AIDS psychiatrists, psychosomatic medicine psychiatrists, as well as child, adult, and geriatric psychiatrists and other mental health professionals are in a unique position to intervene and provide both preventive and treatment interventions for children, adolescents, and adults who are vulnerable to, infected with, or affected by HIV infection. Psychiatrists generally make long-term and trusting relationships with their patients and take complete histories including sexual histories and substance use histories. Primary physicians, pediatricians, obstetricians, and HIV specialists as well as parents and teachers may also have unique opportunities to intervene throughout the life cycle. In this chapter, we provide a list of settings where educational opportunities abound and can lead to an improved understanding of how to prevent HIV transmission. These settings are summarized in Table 1.1. Since a full description of every setting with potential for intervention is beyond the scope of this chapter, we provide more specific descriptions of settings where providing education and easy access to testing, condoms, and drug and alcohol treatment can be therapeutic and lifesaving.
HIV through the Life Cycle
Authors: Batista Sharon M. , Soffer Jocelyn
Published: November 2020

HIV infection can occur at any time in the life cycle from the newborn period, through childhood and adolescence to adulthood, older age. The unique issues and special vulnerabilities involved with each aspect of the life cycle, from family planning to pregnancy and the newborn to older aged person with HIV, are addressed from the biopsychosocial standpoint. While some features of HIV illness are common to any age group, specific challenges arise at various stages of the life cycle, as well as different patterns of transmission, clinical course, and service needs. This chapter will consider such differences at various stages of the life cycle. At the beginning of the AIDS epidemic almost 30 years ago, infected blood products represented a common mode of transmission, with many children diagnosed with HIV infection after receiving transfusions for hemophilia and blood disorders. Because of current practices of screening blood products prior to transfusion, the face of neonatal and early-childhood HIV has changed considerably, to one of children who are infected mostly perinatally through vertical transmission, rather than through exposure to blood products. While the incidence of perinatally acquired infections is decreasing in areas of the world where there is access to HIV care and antiretroviral medication, some transmission of HIV from mother to child remains, both in the United States and throughout the world. In 2007, approximately 79 infants were born with HIV in the United States, compared with 330 in 1994 (CDC, 2007). The primary means of HIV infection of a newborn is vertical transmission during gestation, birth, or breastfeeding of an infant by an HIV-positive mother. It is strongly recommended that all pregnant women be screened for HIV infection as part of routine prenatal care. Such screening is not legally mandatory, however, and may not be performed without the mother’s consent. It is advantageous to obtain HIV testing as early as possible in the course of a pregnancy so that preparation can be made to reduce the risk of transmission to the infant. Without preventive care during gestation or delivery, the risk of transmission from mother to child is 15%–35% (Newell, 1991; Gabiano et al., 1992).
Palliative and Spiritual Care of Persons with HIV and AIDS
Authors: Cohen Mary Ann , Lux Joseph Z.
Published: November 2020

Palliative care of persons with HIV and AIDS has changed over the course of the first three decades of the pandemic. The most radical shifts occurred in the second decade with the introduction of combination antiretroviral therapy and other advances in HIV care. In the United States and throughout the world, progress in prevention of HIV transmission has not kept pace with progress in treatment, thus the population of persons living with AIDS continues to grow. Furthermore, economic, psychiatric, social, and political barriers leave many persons without access to adequate HIV care. As a result, persons who lack access to care may need palliative care for late-stage AIDS while persons with access to AIDS treatments are more likely to need palliative care for multimorbid medical illnesses such as cardiovascular disease, cancer, pulmonary disease, and renal disease. Palliative care of persons with HIV and AIDS cannot be confined to the end of life. We present palliative care on a continuum as part of an effort to alleviate suffering and attend to pain, emotional distress, and existential anxiety during the course of the illness. We will provide guidelines for psychiatric and palliative care and pain management to help persons with AIDS cope better with their illnesses and live their lives to the fullest extent, and minimize pain and suffering for them and their loved ones. This chapter reviews basic concepts and definitions of palliative and spiritual care, as well as the distinct challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, cultural sensitivity, communication, and psychiatric contributions to common physical symptom control are reviewed. The terms palliative care and palliative medicine are often used interchangeably. Modern palliative care has evolved from the hospice movement into a more expansive network of clinical care delivery systems with components of home care and hospital-based services (Butler et al., 1996; Stjernsward and Papallona, 1998). Palliative care must meet the needs of the “whole person,” including the physical, psychological, social, and spiritual aspects of suffering (World Health Organization, 1990).
Our Planet
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

Mahatma Gandhi supposedly once said: “It took Britain half the resources of the planet to achieve its prosperity. How many planets will a country like India require?” Translated to the world order of today, his question would be: “What if China would aspire to the standards of living of the United States?” Our planet is certainly flexible. A quarter of its surface has been plowed up, and its atmosphere, soil, and water have been fundamentally altered in many places. Humanity now extracts more nitrogen from the air than nature does, and we use more water than all the rivers put together. It’s a miracle that Earth’s systems have been able to withstand these interventions as effectively as they have. Many parts of the world are cleaner than they were a century ago. Pollutants like sulphur, nitrogen, and small particles are now routinely filtered from exhaust pipes and chimneys. We’ve mastered the problems of acidification and smog. But those were the easy tasks. The fact that we dealt with bad things in the past is no guarantee of a rosy future. Interference in our environment is too great for that. Humanity continues its assault on the planet. The toughest problems remain unsolved. The truth is that we are already consuming more than one Earth can support. Just as a company can spend more than it earns by selling its assets, we are eating into Earth’s capital, which was accumulated during thousands of years. In a report published by a group of leading scientists, it was concluded that we already have transgressed safe planetary boundaries in many respects. We already have surpassed the carrying capacity of Earth’s climate with a factor of 1.5, we are at a tenfold rate of bearable biodiversity loss, we extract four times more nitrogen from natural cycles than can be considered sustainable, and we are at the tolerable thresholds of the phosphorus cycle, ocean acidification, and stratospheric ozone depletion. Human civilization is out of kilter with the natural environment. We are using considerably more than one Earth. Many subsystems of Earth react in a nonlinear, often abrupt, way.
Searching for New Energy
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

We looked in the previous chapter at the prospects for our current energy infrastructure and asked how we can make it more flexible and sustainable. In this chapter, we fast-forward to the new energy economy after the oil era. The quantity of available energy is not the main worry in the postcarbon era. We’re surrounded by tremendous amounts of energy. The power of the sun’s rays was there long before we started to discover fossil energy sources, and on Earth’s surface, we can harness wind and water. Another vast amount of energy is encapsulated in our planet in the form of heat. As yet, we only tap small fractions of these natural energy supplies. Evaluating our long-term options, we have to ask ourselves: How can we harness these energy sources in such a way that they may serve us without a serious regress in our human civilization? Only then may we hope for a gradual transition to a new energy era. In the course of our history, we have used ever more concentrated forms of energy. In the era when we warmed ourselves by a wood fire and ate the grains of the field, we needed about 1 square meter of land for each watt of energy that came available. When we tamed wind and water power, the energy yield of a square meter of land rose by a factor of ten. The advent of coal, oil, and gas accounted for another factor of hundred improvement. This is calculated by summing up the amount of land you need for excavating the energy carriers and converting them to a useful form of energy. A similar calculus can be made using the energy content of the energy carriers themselves. Society has evolved with each subsequent energy innovation. More concentrated forms of energy allowed for a more concentrated community with a more complex division of labor. Now we don’t have to search large areas of land for some useful calories for ourselves; we can devote our time to comfort and complicated products.
Managing Failures
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

Computers are the engines that drive our society. We get paid via computer, and we use them to vote in elections; computers decide whether to deploy the airbags in our car; and doctors use them to help identify a patient’s injuries. Computers are embedded in all sorts of processes nowadays, and that can make us vulnerable. Because of a single computer glitch, large payment systems can grind to a halt. When computers malfunction, we risk losing our power supply, our railway links, and our communications. Worst of all, we habitually shift responsibility to computers and blindly follow their advice. This is why patients occasionally receive ridiculously high doses of a powerful drug or a car driver who blindly follows his satnav may end up in a ditch. Ubiquitous computer use can cause otherwise responsible people to leave their common sense at home. We’re all too familiar with poorly designed software, computer errors, or—worse still—programs that flatly refuse to function properly no matter what we do. It is hardly surprising then that computer failures cost the world hundreds of billions of dollars a year. In the United States alone, failed computer projects are believed to waste $55 billion annually. And the media only report the tip of the iceberg— the foul-ups that cost millions or result in fatalities. For instance, in the 1980s, several cancer patients were killed by a programming error that caused the Therac 25 radiotherapy unit to deliver excessive doses of radiation. In 1996, Europe’s first Ariane 5 rocket had to be blown up a mere 37 seconds after launch in what might be the costliest software failure in history. In 2007, six F-22 aircraft experienced multiple computer crashes as they crossed the date line, disabling all navigation and communication systems. The list can be extended endlessly, and there are many more failures that we never hear about. Only about a third of all computer projects can be described as successful, and even these are hardly error-free. Why can’t we prevent programming mistakes? Could we improve computers and their software to protect society from the “moods”’ of its digital machines?
Advanced Machines
Authors: van Santen Rutger , Khoe Djan , Vermeer Bram
Published: November 2020

What looks like a cake tin on wheels is working its way around the room. The robot vacuum cleaner is just as noisy as a normal one, but there’s an important difference: You don’t have to lift a finger to clean your floor. The dirt collects inside the robot’s body, swept up industriously by the rotating brushes and sucked in by the motor. The machine’s sensor flickers over the spot where some bread crumbs just fell, telling it that this is an especially dirty place, which requires an extra sweep for good measure. At the edge of the stairs, the cake tin detects the drop and changes course in the nick of time. Having surveyed the room three times, the robot concludes that its job is done. Everything is clean. No more arguing over who has to vacuum the floor. Let the machine do the work while you sit in a comfortable chair, maybe with another robot for a pet. You can already buy devices like this for a couple of hundred dollars. In fact, much of the Industrial Revolution is about machines working for us. That has dramatically changed productivity and labor. In our households, too, we have a number of machines that do the work for us. Examples are our washing machines and dryers. But for as long as machines have existed, we have dreamed of robots that could take over more tedious chores—metal people who would obey our every order and do our work for us—open the door, boil the potatoes, fix the car. It’s no coincidence that robot derives from the word for “work” in most of the Slavic languages. Robots spark fantasies of large factories full of metal workers lifting boxes, toiling on the production line, and designing new products at their drawing boards. These are some serious toys. They extend our human capacities in much the same way as all the other tools we have developed in the course of our history. Some are already in use in our daily lives, including ones that make independent and crucial decisions without seeking our input.
Is the Syndrome of Depression a Valid Concept?
Authors: Mitchell Alex J. , Zimmerman Mark
Published: November 2020

Depression is an everyday term, but if clinical management is to be empirically based, there needs to be a valid and reliable definition of the disorder that is distinct from normal sadness. The validity of the concept and all studies of screening for depression are hampered by the absence of a gold standard. Nevertheless, various thorough methods of assessment may help to improve the clinical utility of our concept of depression. This book is built around the premise that major depressive disorder (MDD) exists in a way that is recognizable time and again by clinicians around the world. Considerable effort has been expended in developing and refining methods to measure depression. This chapter takes a step back and asks whether this effort is built upon a solid foundation. This begins with an important question: What is the purpose of making a meaningful diagnosis in any field of medicine? We suggest it is primarily to gain consensus and knowledge that may help individuals and populations who have healthrelated ‘‘meetable unmet needs.’’ A medical diagnosis (spurious or not) has several other benefits (Textbox 1.1). It facilitates agreement with colleagues, it lends confidence to patients, it adds legitimacy to treatments, and it may allow the development of targeted interventions. Because many conditions can be successfully treated without knowing the true etiology or the precise diagnosis, the lack of gold standard should not be a cause of therapeutic nihilism. Consider neurologists attempting to treat a midlife inherited chorea in 1862. Meticulous clinical method could bring some success despite the absence of a name and a description for another 10 years and the absence of a known etiology for another 110 years. Although many early treatments were based largely on placebo effects or environmental manipulation, once a definitive cause is found and the pathophysiologic mechanism is revealed, the potential for treatment becomes vast, whereas once it was small. Yet there is an even more fundamental issue. Kraepelin believed the major psychiatric disorders were ‘‘natural disease entities’’ simply awaiting a discovery of a specific medical cause. After intensive effort the search for fundamental causes was resigned and nosology underwritten by internal cohesion of symptoms and signs.
Overview of Depression Scales and Tools
Authors: Mitchell Alex J.
Published: November 2020

There have been a large number of depression tools published for the purposes of detecting depression or rating its severity. Choosing between them is difficult without adequate information on their validity, reliability, and acceptability. Recently, ever-shorter-version mood measures have been released. Is a shorter scale a better scale? It is important to study each method against our best standard and ideally compare scales head to head to judge the optimal scale for each situation. Clinicians and researchers have developed a bewildering number of tools for the assessment of depression. These are most often questionnaires designed to help elicit symptoms of depression for the purpose of screening, diagnosis, and monitoring progress (Textbox 2.1). Although we often use the terms screening, diagnosis, and case-finding interchangeably, in an epidemiologic sense screening refers to the attempted detection of disorder in those who had not sought testing or did not suspect they had a particular condition. Often a screening test is not usually intended to be diagnostic, in that those with suspicious findings may be referred for more definitive examination. The latter is perhaps better known as case-finding. This means a screening tool can favor negative predictive value (NPV) over positive predictive value (PPV) (see Chapter 5). In both screening and case-finding the test may be applied ‘‘routinely’’ to all cases, or selectively to those thought to be at high risk. A screening test applied to many individuals should be as simple as possible to retain high uptake, and positive results must be paired with an acceptable next step. A case-finding measure may be more involved but should still consider acceptability. Adoption of a test in clinical practice probably depends more on acceptability than accuracy. During the past five decades there has been a considerable effort to improve the methods used to detect and quantify depression (Textbox 2.2). Some scales, such as theCronholm-Ottosson Depression Scale, have fallen into obscurity,while others, such as the Hamilton Depression Rating Scale and the Beck Depression Inventory, have each been cited over 10,000 times. Given that there are so many similar depression scales, it is not surprising that clinicians have trouble choosing between them.
Conjunctival Buttonholes
Authors: Syed Misha F.
Published: November 2020

A conjunctival buttonhole is a defect in the conjunctival tissue that occurs during manipulation of the conjunctival flap where the underlying Tenon’s capsule may or may not remain intact. Buttonholes during glaucoma filtering surgery have been reported in 3% of fornix-based conjunctival flaps and approximately 1% of limbus-based conjunctival flaps. Recognition of conjunctival defects is important since infections can occur if the microbial surface flora get into the bleb, and hypotony can result from excessive egress of filtered aqueous. Furthermore, if the bleb flattens, fibrous adhesions may compromise filtration. A conjunctival buttonhole presents a unique challenge intraoperatively during trabeculectomy surgery because the usual surgical approach must be revised, and the repair strategy depends on the location of the buttonhole. Conjunctival buttonholes are well-documented potential intraoperative complications during glaucoma surgery. Sugar was among the first to report their occurrence in the 1960s, when he described a conjunctival hood procedure for repairing buttonholes in a fornix-based flap. A conjunctival flap was dissected from Tenon’s capsule after opening the conjunctiva at the limbal margin and then pulled down onto the peripheral cornea and sutured into place. Tincture of iodine was applied to the bleb surface, and the corneal margin was abraded. Grady and Forbes, among others, began reporting the use of tissue adhesive in the closure of ophthalmic surgical wounds. They suggested the novel use of alkyl 2-cyanoacrylate glue because the temporary nature of the adhesive was particularly well suited to repairing conjunctival buttonholes: “Tissue adhesives serve to stop the continuous external flow of aqueous humor, thereby allowing the conjunctival wound to heal; after healing has occurred, the persistence of adhesive is no longer necessary or desirable.” These authors also mentioned other popular surgical repair options common at that time, including the rolling of a conjunctival flap over the buttonhole, suturing of the torn edge of conjunctiva into a corneal groove, or closing the buttonhole with a tissue patch of conjunctiva harvested from another area. Interestingly, many of these same options are used today. In the late 1970s, a new “atraumatic” needle emerged and was reported to improve treatment of intraoperative conjunctival buttonholes.
Choroidal Effusion and Hemorrhage
Authors: Fellman Ronald L.
Published: November 2020

Every intraocular surgery carries risk of a serious complication. One of the most worrisome is an intraoperative suprachoroidal hemorrhage. For a variety of reasons, especially hypotony, these hemorrhages occur more frequently in glaucoma patients, may develop at any time during the perioperative period, and may cause considerable visual loss. When a severe choroidal hemorrhage does occur, it can be visually devastating and may be very painful. A large perioperative choroidal effusion is also worrisome because it may be the initiating factor that precipitates a choroidal hemorrhage. Even after a “simple bleb needling” or postoperative suture lysis for uncontrolled intraocular pressure (IOP), a suprachoroidal hemorrhage may develop, leading to catastrophic visual loss. In spite of best efforts, choroidal events will still occur and should be managed in a highly expeditious fashion. Proper prevention and management of a choroidal event is the best chance for saving vision. An intraoperative choroidal event is typically a spontaneous collection of either fluid and/or blood in the suprachoroidal space. This potential space is located between the choroid and the sclera. The fluid within a chronic choroidal effusion typically has a straw color due to the accumulation of proteins. Choroidal events are most common following glaucoma surgery, and choroidal hemorrhage or effusion may lead to complicated surgery with resulting visual loss. A spontaneous intraoperative choroidal effusion may initiate a shallow anterior chamber and a firm eye. The mechanisms are complex and variable. A spontaneous collection of blood into the suprachoroidal space may occur when the IOP is low, as seen during filtration surgery. Severe bleeding that breaks through into the vitreous is typically associated with a poor prognosis, as are bleeds that reach the optic nerve head. These eyes commonly end up with a pale optic disc and poor visual function. Every attempt is made to avoid these situations (see Table 6.1); nevertheless, the surgeon must remain calm during such an event and immediately close the eye to minimize visual harm.
Elevated IOP with a Deep Anterior Chamber
Authors: Baik Annie K. , Brandt James D.
Published: November 2020

Early postoperative elevation of intraocular pressure (IOP) in the setting of a deep anterior chamber following trabeculectomy can generally be attributed to either mechanical obstruction or underfiltration. A careful clinical exam will almost always reveal the cause of elevated IOP and guide the clinician to logical, step-wise management. First, one should confirm that the anterior chamber is deep and the conjunctival wound is intact. Further investigation is directed by clinical signs, such as blood or fibrin in the anterior chamber, the pupil configuration, the appearance of the filtering bleb, internal obstruction of the sclerostomy, blood under the scleral flap, or subconjunctival hemorrhage. In the absence of such findings, underfiltration is most likely due to an inadequately sized sclerostomy, tight sutures on the scleral flap, or early fibrosis of the external sclerostomy site. Gonioscopy, in conjunction with anterior segment slit-lamp examination, is crucial in the evaluation of elevated IOP in the early postoperative period. Although adequate flow may have been established at the time of surgery, continued patency of the trabeculectomy should be confirmed to distinguish between underfiltration and obstruction. Obstruction of the sclerostomy site by blood, fibrin, vitreous, iris tissue, or fragments of Descemet’s membrane should be visible on gonioscopy examination. If the trabeculectomy site appears internally patent, examination of the scleral flap may further demonstrate causes for elevated IOP. Intraoperative or postoperative bleeding may lead to development of subconjunctival hemorrhage. Even in the absence of subconjunctival hemorrhage, blood and fibrin can occlude the trabeculectomy flap. If there is no evidence of physical obstruction, intrinsic properties of the trabeculectomy itself (such as ostium size and/or tension on the scleral flap sutures) may be contributing to elevated IOP. Gentle massage or digital manipulation serves both diagnostic and therapeutic purposes. If gonioscopy has not yet been performed and the bleb is unresponsive to digital manipulation, an internal obstruction may be present. Since internal obstruction of the ostium may not be readily apparent on routine slit-lamp examination, the threshold for gonioscopy should be low.
Early Vision Loss After Trabeculectomy
Authors: Fechtner Robert D. , Khouri Albert S.
Published: November 2020

“This surgery is designed to help you preserve the vision you have. If we are completely successful, you will not see worse once we are done.” Hardly an encouraging message we give to patients needing glaucoma surgery. An experienced glaucoma surgeon knows that aqueous diversion procedures are fraught with complications, including the ever terrifying loss of vision. Early complications of trabeculectomy that can lead to vision loss can be categorized as refractive, inflammatory/infectious, hemorrhagic, and other. It is important to recognize these complications promptly and understand the appropriate time to intervene. Thoughtful preoperative planning, meticulous technique, and a dose of good luck can help prevent these complications. It is the ability to anticipate, avoid, and manage complications that distinguishes the successful and satisfied glaucoma surgeon from a frustrated one. Trabeculectomy may induce new spherical and cylindrical aberrations. When intraocular pressure (IOP) is reduced, and particularly if there is overfiltration, the lens-iris diaphragm moves forward, and the anterior chamber shallows. These combined actions usually induce a spherical refractive error (myopic shift). The clinical signs of a myopic shift will be a shallow anterior chamber and visual acuity that will improve with a pinhole occluder or refraction. Interestingly, should the overfiltration be accompanied by macular edema, the myopic effect may be counteracted by a hyperopic shift due to macular elevation and shortening of axial length, and the patient may not have any change in refraction or may even have a hyperopic shift. For more information about axial length and changes in refraction, including after trabeculectomy, see Chapter 41. Astigmatic shift can have several origins. If a trabeculectomy flap is dissected too far anteriorly into the peripheral cornea and not sutured securely back to its origin, “against the rule” astigmatism can be induced. If a superiorly located flap is sutured with too much tension, astigmatism can be induced along the axis of the tightest suture(s), usually “with the rule.” (See Chapter 26.) Additionally, uneven suture tension in the conjunctival closure (whether limbus- or fornix-based) can affect the degree of postoperative astigmatism.
Aniridia, WAGR Syndrome, and Associated Conditions
Authors: Al-Aswad Lama A. , Riansuwan Lookjan
Published: November 2020

Aniridia (Greek) literally means “absence of iris” (the colored part of the eye); however, this is a misnomer because patients with aniridia always have irises that are rudimentary or not fully developed. Years ago when this eye condition was given the name “aniridia,” it was not known that the name would come to only describe the most physically noticeable aspect of the condition. Today it is known that the lack of iris is only a minor aspect of aniridia, and it does not reflect the more important aspects of aniridia that can cause even more vision loss. Aniridia has been and still is referred to as a “rare” eye condition, even though the eye conditions that make up aniridia are common ones such as glaucoma, cataract, corneal degeneration, and low vision. The “rare” aspect of aniridia is having the combination of these conditions in one individual, affecting his or her vision. Aniridia is a genetic eye condition that is congenital—that is, it is present from birth—and affects various structures of the eye. It occurs when the gene responsible for eye development, the PAX6 gene (located on the eleventh chromosome), does not function correctly. The result is developmental disorders not only of the iris, but also of the cornea, the angle of the eye, the lens, the retina (sensory part of the eye), and the optic nerve (nerve that carries visual impulse to the brain). The degree of maldevelopment differs from one patient to another. Aniridia is a bilateral disease. The incidence of this condition ranges from one in 40,000 to one in 50,000 births. It occurs equally in males and females, and has no racial predilection. Aniridia can be familial or sporadic (occurs spontaneously, not inherited). Familial Aniridia (87%): The Ocular Manifestations Occur in Isolation 85% autosomal dominant 2%autosomal recessive has been observed in the rare Gillespie’s syndrome, in which aniridia is associated with cerebellar ataxia, structural defects in the cerebellum and other parts of the brain, and mental retardation. Patients with Gillespie syndrome are not predisposed to the development of Wilms’ tumor.
Aniridia—Epidemiology and Genetics
Authors: Mandal Anil K. , Rao Harsha B. L.
Published: November 2020

Aniridia literally means “without iris.” The iris is the part of the eye that gives color to the eye. But the term aniridia encompasses more than its literal meaning and includes abnormalities of almost all the structures of the eye, from the cornea up to the optic nerve and including the angle of the anterior chamber, the lens, and the fovea. This is why aniridia is often called a “panocular disease.” The cornea is normally an avascular (lacking blood vessels), transparent tissue on the front part of the eye. In individuals with aniridia, it becomes vascularised. A bunch of blood vessels grows over the cornea: this growth is called a pannus. The angle of the anterior chamber is that part of the eye between the cornea and the iris that drains the fluid within the eye out of the eye and maintains the pressure within the eye at normal levels. Aniridia affects this part and hampers the fluid flow out of the eye, thereby increasing the pressure within the eye, leading to a condition called glaucoma. The lens is a biconvex structure behind the iris that focuses light rays entering into the eye onto the retina, which converts these light signals into electric signals that are carried through the optic nerve to the brain. In aniridia there may be displacement of the lens from its normal position, which is called subluxation or dislocation, or the normally clear lens may turn opaque, which is called a cataract. The fovea is the area of the retina that is responsible for clear vision. It may be underdeveloped; this is called foveal hypoplasia and affects vision. Similarly, the optic nerve that carries the visual sensations may also be underdeveloped, affecting vision. Besides these anatomical abnormalities, functional problems in addition to decreased vision include nystagmus (involuntary wobbling movement of the eye), squinting, and intolerance to light (photophobia). In this chapter we will discuss mainly the epidemiology (incidence and distribution of diseases) and genetic aspects of aniridia.
Parents’ and Families’ Guide
Authors: Otis Jessica J. , Lauderdale James D.
Published: November 2020

When your child is first diagnosed with aniridia or WAGR syndrome, you will have several questions for your child’s ophthalmologist. To be prepared for the first appointment, the best thing to do is make a list of questions. Some questions other parents have had are listed at the end of this chapter. If you choose to, you can use these as a starting point and add more questions to the list as you think of them. At the appointment, be sure to have your list of questions to ask the doctor. Be sure to repeat what the doctor has told you to make sure you understand him or her. If you’re not sure, then ask the doctor to try to explain it in a different way so you can understand. It is your child, and you should be as informed as possible, and the only way to do that is to ask questions and to have a good relationship with your child’s ophthalmologist. Other questions parents have had that you do not necessarily need to ask an ophthalmologist will be discussed in this chapter. When a child is first diagnosed, a question asked by many parents, especially mothers, is, “Was this my fault?” No, it was not. Do not ever blame yourself for your child having aniridia or WAGR syndrome. It is a genetic disorder that you could not have done anything about, unless you do have it yourself. There is no reason for you to feel guilty or to put blame on yourself for something you had no control over. One way to help get over any of these feelings is to join Aniridia Foundation International, where you can meet many other parents and people with aniridia. From meeting and speaking with them, you can get the support you need. . On AFI’s members’ area website, I asked parents, “What questions did you have when your child was diagnosed?” One mother responded, “Mainly I wish someone had told us that he would be able to see at least a little bit and that the disastrous picture that was painted for us at the start was not actually representative of what he would turn out to be.”
Jill Nerby and Aniridia Foundation International
Authors: Otis Jessica J.
Published: November 2020

Jill Nerby was the first to welcome me to Aniridia Foundation International (AFI) when I joined. Shortly after beginning to volunteer for AFI’s members’ newsletter, I approached Jill about doing this book. Instantly she approved of my idea and told me if I needed anything to let her know. She has been instrumental in shaping the book’s content and eliciting the participation of all the doctors and professionals. Her support and wisdom have helped create this informative book for you, and they have meant a great deal to me. She is caring and friendly to all. Jill inspires us to strive towards goals for AFI and in our own lives. Here is her inspiring personal life story and the tale of how she began Aniridia Foundation International (formally the USA Aniridia Network). Jill Ann Nerby was born in Milwaukee, Wisconsin, in 1961 to her parents, Dennis and Sullen Nerby. She was officially diagnosed with aniridia when she went for her three-week check-up. Jill’s parents were told that she was only the second person in the state of Wisconsin to be diagnosed with aniridia. Dr. George Worm realized something was wrong with her eyes and sent her to a well-known ophthalmologist in Chicago, Illinois, with experience in aniridia. This doctor tested Jill for glaucoma and found that she had been born with it. She was then put on eye drops, since the doctor felt Jill was too young to have surgery. Jill’s parents were devastated, since she was their first child and the family’s first grandchild. They did not even know if she could see and thought she might be blind already. They asked many people and sisters at the Catholic convent to pray for Jill. Today Jill has a younger sister, Marybeth, and a younger brother, Jeff; they do not have aniridia. Jill says growing up was challenging at times. Kids would sometimes tease her, leave her out, or pick her last.
From Dalton to the Discovery of the Periodic System
Authors: Scerri Eric
Published: November 2020

Our story begins, somewhat arbitrarily, in the English city of Manchester around the turn of the nineteenth century. There, a child prodigy by the name of John Dalton, at the tender age of fifteen is teaching in a school with his older brother. Within a few years, John Dalton’s interests have developed to encompass meteorology, physics, and chemistry. Among the questions that puzzle him is why the various component gases in the air such as oxygen, nitrogen, and carbon dioxide do not separate from each other. Why does the mixture of gases in the air remain as a homogeneous mixture? As a result of pursuing this question, Dalton develops what is to become modern atomic theory. The ultimate constituents of all substances, he supposes, are hard microscopic spheres or atoms that were first discussed by the ancient Greek philosophers and taken up again by modern scientists like Newton, Gassendi, and Boscovich. But Dalton goes a good deal further than all of these thinkers in establishing one all-important quantitative characteristic for each kind of atom, namely its weight. This he does by considering quantitative data on chemical experiments. For example, he finds that the ratio for the weight in which hydrogen and oxygen combine together is one to eight. Dalton assumes that water consists of one atom of each of these two elements. He takes a hydrogen atom to have a weight of 1 unit and therefore reasons that oxygen must have a weight of 8 units. Similarly, he deduces the weights for a number of other atoms and even molecules as we now call them. For the first time the elements acquire a quantitative property, by means of which they may be compared. This feature will eventually lead to an accurate classification of all the elements in the form of the periodic system, but this is yet to come. Before that can happen the notion of atoms provokes tremendous debates and disagreements among the experts of Dalton’s day.
Element 72—Hafnium
Authors: Scerri Eric
Published: November 2020

The story concerning the discovery and isolation of element 72 bears all the characteristics of controversy and nationalistic overtones that seems to characterize many of our seven elements. On one hand, it seems odd that there should be so much controversy associated with these elements given that Moseley’s method had apparently provided an unequivocal means through which elements could be identified as well as a way of knowing just how many elements remained to be discovered. On the other hand, perhaps it was precisely because the problem of the missing elements became so clearly focused on a few elements, with known atomic numbers, that the stakes became higher than they would have been if the number of elements remaining to be discovered had been uncertain, as they were in pre-Moseley times. Element 72 (fig. 4.1) was clearly anticipated, although not as such, even in Mendeleev’s earliest table of 1869. As fig. 4.2 shows, Mendeleev considered that an as yet undiscovered element with an atomic weight of 180 should be a homologue of zirconium (The modern accepted value is 178.50). This fact may not seem very significant and yet we will see, as the story of this chapter unfolds, that it amounts to Mendeleev predicting that this element would be a transition metal rather than a rare earth. But Mendeleev was not really in a position to make such a statement since the nature and number of rare earth elements was unknown in his day. Indeed, the problem of the rare earths was one of the most acute challenges to his periodic system and one that he personally never resolved. Sometime later, Julius Thomsen, a chemistry professor at the University of Copenhagen and incidentally the chemistry instructor to the physicist Niels Bohr, published a periodic table in which he too included a missing element that was a homologue of zirconium (fi g. 4.3). Suffice it to say that there was a general consensus among chemists that on the basis of the periodic table there should exist an element before tantalum that would be a homologue of zirconium.