bluuebunny/crossref_metadata_2025 huggingface dataset:
Studying the fire hazard properties of multi-walled carbon nanotubes by the method of synchronous thermal analysis
Authors: Dan V , Barbin N , Bezzaponnaya O , Terentiev D , Alexeev S
Published: November 2019

The present paper considers oxidation of multi-walled carbon nanotubes at different heating rates and temperatures to ensure the process in the kinetic region. The nanotubes were analyzed by the method of synchronous thermal analysis. Experiments were carried out at different heating rates: 5, 10 and 20 °C/min. As a result, the character of thermogravimetric and differential thermogravimetric curves was determined, and thermograms were constructed, thereby allowing to define weight loss stages and establish exact weight loss values at a programmed temperature increase. Besides, the temperature characterized by the maximum weight loss rate was established. Differential scanning calorimetry revealed the maximum temperature of endothermic and exothermic peaks, as well as changes in thermal effects (enthalpy changes). The most important indicators of fire hazard of the multi-walled carbon nanotubes – ignition and self-ignition temperature – were determined. The ignition temperature was approximately equal to the temperature of the beginning of the thermal distortion of the sample in the air – 553.7, 578.6 and 584.3 °C for the heating rates of 5, 10 and 20 °C/min, respectively. The self-ignition temperature corresponded to the temperature of the maximum yield of volatiles – 627.5, 651.9 and 670.8 °C for the heating rates of 5, 10 and 20 °C/min, respectively.
The use of concrete and epoxy resin, modified with few-layer graphene for the production, repairs, and strengthening of concrete beams
Authors: Pershin V , Al-Shiblawi K A , Al-Mashhadani A M R , Pasko A , Melekhin D
Published: November 2019

The paper deals with the modification of concrete and epoxy resin with a 2D carbon material (2DCM) obtained by liquid-phase shear exfoliation of graphite. It was experimentally established that the three-point bending strength of graphene-modified samples (0.05 wt.% of graphene in cement) in 1.5 times greater than that of pristine (unmodified) concrete. The water absorption of concrete modified with the 2DCM was found to decrease by 3 times. A method, differing from the known ones where few-layered graphene is obtained directly in the hardener through shear exfoliation of graphite, was developed for modifying the ED-20 epoxy resin using the 2DCM. It allowed us to increase the Charpy impact strength by 25-30 %. The tensile and bending strength were increased by 10 %. The test results of the restored beams after breaking at three-point bending, as well as on the adhesion of the reinforcing fabric to concrete, revealed a synergistic effect while using the concrete and epoxy resin modified with the 2DCM.
Vortex mode transformation interferometry
Authors: Damzen Michael J , Kerridge-Johns William R , Geberbauer J W T
Published: November 2019

Whilst many techniques exist for generation of an optical vortex, there remains a need for new devices and methods that can also provide vortex generation with higher powers, greater flexibility of wavelength, and generation beyond the lowest-order Laguerre–Gaussian

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mode to address a broader range of practical applications. This work reveals how an all-mirror based interferometric mode transformation system can provide these properties including revealing, for the first time, the generation of a much richer set of vortex mode patterns than might have been thought possible previously. A new developed theoretical formulation, confirmed with excellent agreement by experimental demonstrations in an imbalanced Sagnac interferometer, shows interferometric transformation is possible for all orders of Laguerre–Gaussian

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modes into a rich set of high quality higher-order vortex and vortex superposition. The interferometric approach is shown to be configurable to increase or decrease vorticity. The new mathematical formulation provides the ability to perform a full modal power analysis of both the mode-transformed transmitted vortex and the complementary reflected beam at the Sagnac beamsplitter (BS) port. A discussion is made on the origin of the orbital angular momentum transferred to the vortex output from the Sagnac BS.
Generation of mixed mode I/II failure criteria from MMB specimens: an experimental study
Authors: Alfred Franklin  , Christopher T
Published: November 2019

Characterization of resistance to delamination is of great importance in selection of composite material. Mixed mode delamination is one of the most serious failure modes in aerospace composites. This article examines the delamination behaviour of mixed mode bending (MMB) test specimens made of glass/epoxy and carbon/epoxy composites. Literature published test data on different composites have been utilzed to identify the best suited failure criterion. Benzeggagh-Kenane (B-K) criterion as well as the polynomial criteria are used to generate failure envelopes from the fracture toughness data of composite specimens. Experiments were conducted on unidirectional fiber reinforced epoxy MMB specimens to analyze the failure trend of laminated composites and to validate the proposed polynomial criteria. Present investigations reveal that both B-K and polynomial criteria fit well for unidirectional specimens and cubic polynomial criterion fits well for angle-ply specimens.
Corrosion performance of hydroxyapaite and hydroxyapaite/titania bond coating for biomedical applications
Authors: Bedi Tejpreet Singh , Kumar Santosh , Kumar Rakesh
Published: November 2019

The aim of current investigation is to access in-vitro corrosion performance of flame sprayed titania (TiO2) coated 316L stainless steel, hydroxyapatite (HAp) coated, hydroxyapatite/titania bond coated (HAp/TiO2) 316L stainless steel and plasma sprayed zirconia (ZrO2) coated 316L stainless steel. In HAp/TiO2 bond coatings, TiO2 was utilize as a bond coat between the 316L stainless steel substrate and HAp top coat. The different characterization methods such as SEM, EDS, XRD and electrochemical methods were used to analyse the electrochemical characteristics as well as microstructural morphology phases of the coatings. In addition the corrosion behavior of the coated and uncoated samples was performed in simulated body fluid. The tests were carried out for potentio-dynamic polarization and open circuit potential. The experimental results reveal that after the deposition of bond coatings (HAp, TiO2, ZrO2 and HAp/TiO2) the corrosion resistance of the steel was observed to increase.
Law and Inclusive Urban Development: Lessons from Chile’s Enabling Markets Housing Policy Regime
Authors: Mc Cawley Diego Gil
Published: November 2019

This Article addresses the recent international trend in development theory and practice towards an “enabling markets” approach in housing policy. This approach delegates to housing markets the responsibility of providing affordable housing and therefore limits the role of government to stimulating the private sector through targeted subsidies. I ask whether an enabling markets policy constitutes an adequate regulatory strategy for the provision of sustainable housing solutions for the urban poor. I explore this question through an in-depth case study of Chile’s housing policy regime, which was a pioneer in the implementation of an enabling markets strategy; for over four decades, successive governments have been able to provide access to housing to a vast portion of low-income residents, in the context of a regulatory framework that favors private real estate development. However, this success story is marred by an important failure. Through its market-based regime, Chile has routinely clustered low-income families on cheap land, usually located at the periphery of the country’s urban centers, and often in areas with poor public and private services. The main argument I present in this Article is that Chile’s commitment towards an enabling markets regulatory regime has helped to reinforce the pattern of urban exclusion, and has prevented the government from experimenting with alternative policy strategies that may be more effective in promoting inclusionary housing. The main limitation of the enabling markets strategy is that it assumes that the delivery of targeted subsidies will generate an adequate supply of affordable housing for the low-income sector. The Chilean experience shows that this assumption is false, because subsidies are rarely sufficient to enable beneficiaries to compete for well-located housing, while private companies have strong incentives to agglomerate low-income housing in the least desirable urban areas. I argue that, in order to promote urban inclusion, governments need to experiment with an alternative policy strategy that I call a “planning housing markets” approach, which involves using land-use governance mechanisms to ensure that low-income housing is fairly distributed within cities.
Point-group symmetry detection in three-dimensional charge density of biomolecules
Authors: Reboul Cyril F , Kiesewetter Simon , Elmlund Dominika , Elmlund Hans
Published: November 2019

Motivation

No rigorous statistical tests for detecting point-group symmetry in three-dimensional (3D) charge density maps obtained by electron microscopy (EM) and related techniques have been developed.

Results

We propose a method for determining the point-group symmetry of 3D charge density maps obtained by EM and related techniques. Our ab initio algorithm does not depend on atomic coordinates but utilizes the density map directly. We validate the approach for a range of publicly available single-particle cryo-EM datasets. In straightforward cases, our method enables fully automated single-particle 3D reconstruction without having to input an arbitrarily selected point-group symmetry. When pseudo-symmetry is present, our method provides statistics quantifying the degree to which the 3D density agrees with the different point-groups tested.

Availability and implementation

The software is freely available at https://github.com/hael/SIMPLE3.0.
Efficient, D-glucose insensitive, growth on D-xylose by an evolutionary engineered Saccharomyces cerevisiae strain
Authors: Nijland Jeroen G , Li Xiang , Shin Hyun Yong , de Waal Paul P , Driessen Arnold J M
Published: November 2019

Optimizing D-xylose consumption in Saccharomyces cerevisiae is essential for cost-efficient cellulosic bioethanol production. An evolutionary engineering approach was used to elevate D-xylose consumption in a xylose-fermenting S. cerevisiae strain carrying the D-xylose-specific N367I mutation in the endogenous chimeric Hxt36 hexose transporter. This strain carries a quadruple hexokinase deletion that prevents glucose utilization, and allows for selection of improved growth rates on D-xylose in the presence of high D-glucose concentrations. Evolutionary engineering resulted in D-glucose-insensitive growth and consumption of D-xylose, which could be attributed to glucose insensitive D-xylose uptake via a novel chimeric Hxt37 N367I transporter that emerged from a fusion of the HXT36 and HXT7 genes, and a down regulation of a set of Hxt transporters that mediate glucose sensitive xylose transport. RNA sequencing revealed the downregulation of HXT1 and HXT2 which, together with the deletion of HXT7, resulted in a 21% reduction of the expression of all plasma membrane transporters genes. Morphological analysis showed an increased cell size and corresponding increased cell surface area of the evolved strain, which could be attributed to genome duplication. Mixed strain fermentation of the D-xylose-consuming strain DS71054-evo6 with the D-glucose consuming CEN.PK113–7D strain resulted in decreased residual sugar concentrations and improved ethanol production yields compared to a strain which sequentially consumes D-glucose and D-xylose.
Father of the Bride, or the Biologization of Social Animosity in Nazi Germany, 1937–1941*
Authors: Teicher Amir
Published: November 2019

In 1937, to his great dismay, Nazi ethnologist Otto Reche discovered that his daughter’s suitor came from a family ‘hereditarily burdened’ with mental diseases. A strong proponent of eugenics, Reche was determined to thwart the looming wedding. He turned to the highest authority on such matters, genetic-psychiatrist Ernst Rüdin, and asked him to furnish the evidence that the planned marriage was biologically undesirable. Reche’s daughter, however, was resolute in her choice, and the familial dispute soon escalated to involve the highest echelons of the Nazi state. A detailed micro-historical reconstruction of the affair exposes the way in which racial-hygienic doctrine, class resentment, inter-generational conflict and personal animosity became interwoven in the daily lives—and loves—of Germans under the Nazi regime.
‘Everyone knows grandma’. Pathways to gambling venues in regional Australia
Authors: Bestman Amy , Thomas Samantha L , Randle Melanie , Pitt Hannah , Cassidy Rebecca , Daube Mike
Published: November 2019

In regional Australia, families (including children), attend community venues that contain gambling products, such as electronic gambling machines (EGMs), for a range of non-gambling reasons. However, there is a gap in research that seeks to understand how these venues may become embedded into family social practices. Drawing on Bourdieu’s concepts of habitus and cultural capital, this paper aimed to explore factors that influence family decisions to attend venues and perceptions of risk associated with children’s exposure to gambling products. Face-to-face qualitative interviews were conducted with 31 parents who attended community gambling venues with their children, in New South Wales, Australia. Families attended venues for three key reasons, first because of the influence of others in their social networks, second for regular social activities and third because of structural factors such as a lack of alternative, affordable, family friendly environments in their local area. Despite recognizing the harm associated with EGMs, parents distanced themselves from EGM harm with all parents perceiving venues to be an appropriate space for families. Research in this study indicates that family social practices within venues affect perceptions of risk associated with community gambling venues. The impact of these practices on longer-term health requires more investigation by public health and health promotion researchers and practitioners. Health promotion initiatives should consider identifying alternative sources of support and/or developing alternative social spaces for families in regional communities that do not contain gambling products.
Intent-to-cure surgery for small-cell lung cancer in the era of contemporary screening and staging methods
Authors: Chenesseau Joséphine , Bourlard Donatienne , Cluzel Armand , Trousse Delphine , D’Journo Xavier-Benoît , Thomas Pascal Alexandre
Published: November 2019

OBJECTIVES

Our goal was to report on the contemporaneous single-centre experience of patients with small-cell lung cancer (SCLC) who had lung resection with curative intent.

METHODS

Between 2005 and 2018, 31 patients were operated on for SCLC with curative intent. There were 11 women and 20 men whose ages averaged 63 ± 10 years. The clinical diagnosis was incidental in 16 patients (51.6%). All patients were screened with high-resolution computed tomography, positron emission tomography and brain imaging. Eight patients (25.8%) had invasive mediastinal lymph node staging.

RESULTS

Preoperative tissue diagnosis was unknown or erroneous in 26 patients (83.9%). Lung resections comprised mainly lobectomies (n = 23; 74.2%). Lymphadenectomies harvested a mean of 16.3 ± 3 lymph nodes, leading to upstaging in 38.7% of the cases. An R0 resection was achieved in 28 patients (90.3%). Pathological analysis disclosed pure small cell histological specimens in 24 patients (77.4%). There were no 90-day deaths. Perioperative platinum-based chemotherapy was performed in 27 patients (87.1%); adjuvant thoracic irradiation, in 7 (50%) of the 14 N+ patients; and prophylactic cranial irradiation, in 8 (29.6%) of the 27 potential candidates. Overall, disease-free and disease-specific survival rates at 5 years were 32.9 ± 10%, 35.2 ± 10% and 44.1 ± 11.3%, respectively.

CONCLUSIONS

Despite the use of contemporary screening and staging methods, selection of SCLC candidates for surgery remained haphazard, surgery was typically performed in ignorance of the actual histological and adherence to treatment guidelines was inconsistent. Nevertheless, one-third of patients with SCLC who were operated on were cured, even in cases of regional or oligometastatic disease.
Spatially Explicit Changes in Potato Psyllid (Hemiptera: Triozidae) Populations in Three South Texas Potato Fields
Authors: Henne Don C , Thinakaran Jenita
Published: November 2019

Insect abundance is commonly recorded in the form of discrete counts taken from plants. Analyses of these counts provide information about spatial distributions and population structure. A study was conducted in the Lower Rio Grande Valley of Texas during April and May 2014 to determine how populations of potato psyllids [Bactericera cockerelli (Šulc)] within three potato fields change over time. It was found that potato psyllid populations in these potato fields frequently changed both spatially and temporally. Chi-square goodness of fit tests and Akaike’s Information Criterion indicated that the frequency distributions of potato psyllid counts conformed to a negative binomial distribution, implying an aggregated spatial pattern. Variance–mean ratios were always much larger than one, also implying spatially clumped populations. However, with a few exceptions, a Spatial Analysis by Distance IndicEs analysis showed that potato psyllid counts were mostly random in space, the clumping generally occurring on individual potato plants and rarely involving groups of potato plants in close proximity. Trends in proportions of plants infested by at least one potato psyllid and the clumping parameter k were similar for all three potato fields. Potato psyllid spatial population structure is a dynamic process that involves continuous adult movements leading to substantial redistribution of potato psyllids over limited time spans of 2 to 3 d. By capturing elements of their spatial and temporal patterns of redistribution, the study reported here is a step towards a better understanding of the population dynamics and movement of potato psyllids.
Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes
Authors: Gaudiani Michael A , Samuel Linsen T , Mahmood Bilal , Sultan Assem A , Kamath Atul F
Published: November 2019

Subchondral insufficiency fractures of the femoral head (SIFFH) are a cause of femoral head collapse leading to degenerative hip disease. SIFFH is often mistaken for osteonecrosis given similar clinical and radiographic features. These similarities often lead to missed or delayed diagnosis which can often delay or change management. The purpose of this article is to systematically review the spectrum of demographics, diagnostic and treatment options, including hip preservation in young patient populations. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All related peer-reviewed publications from January 1999 to January 2019 were reviewed using the following databases: Medline, EMBASE, Scopus and Web of Science. The systematic review identified 54 articles, encompassing 482 patients (504 hips) diagnosed with SIFFH. One hundred and seventy-six (35%) males and 306 (63%) females were included, with a mean age of 53.6 ± 17.5 years and mean body mass index of 23.4 ± 4.0 kg/m2. Mean follow-up was 23.4 ± 15.9 months. Treatment decisions were 256 (55%) non-operative, 157 (34%) total hip arthroplasty (THA), 24 (5%) transtrochanteric anterior rotational osteotomy, 9 (2%) hip arthroscopy, 7 (2%) hip resurfacing, 3 (1%) bone grafting, 3 (1%) hemiarthroplasty and 1 (1%) tantalum rod insertion. Overall, 35% of SIFFH hips were converted to THA at latest follow-up. A majority of SIFFH patients had symptom resolution with non-operative management. Failure most often resulted in THA. In younger patients, hip preservation techniques have shown promising early results and should be considered as an alternative.
Palliative fenestration for a symptomatic subcarinal bronchogenic cyst by the prone position approach
Authors: Nakamura Toru , Fujikawa Ryo , Arai Yoshifumi , Otsuki Yoshiro , Funai Kazuhito
Published: November 2019

A complete excision is the most reliable therapy for bronchogenic cysts (BC) but is often accompanied by technical difficulties due to severe adhesions. An 83-year-old-woman with poorly controlled diabetes noted worsening upper abdominal pain after meals and paroxysmal atrial fibrillation. Magnetic resonance imaging revealed a cystic mass in the subcarinal region, and she underwent a thoracoscopic prone position surgery. The cyst wall was found to have strictly adhered to the adjacent organs, and the lesion was not amenable to a complete excision. We performed a fenestration of the cyst wall with the aspiration of an yellowish mucus content. After opening the cavity wide enough, the remnant luminal epithelium was ablated by electrocautery. Her clinical symptoms disappeared immediately after the surgery without any surgical morbidity. A prone-position thoracoscopic palliative fenestration is a feasible option for a symptomatic subcarinal BC.
Functional Assessment of Eating Disorders and Their Maintenance
Authors: Becker Carolyn Black , Farrell Nicholas R. , Waller Glenn
Published: November 2019

One shared feature between eating disorders and anxiety-based disorders is the functional relationship between fears and associated avoidance and safety behaviors. Patients with eating disorders are individuals; thus, they will experience different symptoms. The clinician’s task is to understand those symptoms and plan treatment accordingly. That understanding is much easier when clinicians’ focus their assessment on both the short- and long-term functions that eating disorder behaviors serve. Identifying those functions allows clinicians to engage their patients and their family in making changes, because patients and families will understand that their existing responses are not working and are worsening the ED symptoms.
Cue Exposure for Binge Eating
Authors: Becker Carolyn Black , Farrell Nicholas R. , Waller Glenn
Published: November 2019

Many patients who have experienced difficulties with binge eating continue to do so even after nutritional stabilization. This can happen because they experience learned cues that trigger strong food cravings. Cue exposure can be useful to address such binge eating. This technique involves confronting the cues that typically elicit heightened food cue reactivity (i.e., cravings), while preventing the subsequent response of bingeing. In this process, patients learn that their binge cues are no longer predictive of an actual episode of binge eating. That learning has the effect of substantially weakening cravings that occur in association with exposure to binge eating cues.
Emotion-Focused and Interpersonal Exposure
Authors: Becker Carolyn Black , Farrell Nicholas R. , Waller Glenn
Published: November 2019

Eating disordered behaviors are often still present when starvation has been reduced because they are used to reduce emotional states and to block the impact of interpersonal triggers. Exposure can be used to address both the emotional and the related interpersonal triggers to eating disordered behaviors. The Newton’s cradle model is used to formulate such events, using behavioral chain analysis to understand behaviors that are commonly described as “just a habit.” This understanding allows clinicians to break open the steps in such behavioral chains to intervene. While there are several potential points and methods that can be used for such an intervention, the use of exposure to address the emotional states directly is a powerful tool, giving the maximum effect in a relatively short time by preventing avoidant and safety behaviors.
Health Systems Issues and the Underserved
Authors: Herz Gordon I. , Gaba Charles
Published: November 2019

A number of factors endemic to the U.S. health system contribute to barriers to meeting the mental health needs of the underserved. Important variables include the economic barrier of continued gaps in affordable third-party coverage for care, perceived and actual costs of care, insufficient numbers of clinicians relative to the number of individuals in need of mental health services, and training and workforce gaps to meet specific needs (e.g., culture, disability, geographical) of the population. Approaches being developed to counter the limited-access problem include increasing economic support for coverage of services, expanding the workforce, incorporating ethics and cultural competence in clinical training, educating consumers about real costs of care, and developing volunteer and charitable models of service provision. Future developments to decrease health system barriers are likely to include technological advances.
Delivering Psychological Services to Military Members
Authors: Kalmbach K. C. , Moore Bret A.
Published: November 2019

Military members are immersed in an all-encompassing culture and required to make countless personal sacrifices, often experiencing trauma or other stressors that most civilians will never face. Over the past two decades, a grateful nation has provided unprecedented levels of support for the many brave servicemen and women who choose this career path. It may therefore come as a surprise to some that, despite this support, many military members remain underserved in the area of mental health. Challenges include system and access barriers; health providers’ lack of familiarity with military injuries, needs, and culture; and military members’ own stigma-related reluctance to seek treatment. This chapter provides mental health clinicians with suggestions for practice. We outline the challenges and detail the qualities necessary to work effectively with psychotherapy clients who are military members.
Bringing Psychotherapy to People Living in Poverty
Authors: Campbell Linda F. , Selby-Nelson Emily M.
Published: November 2019

The “problem of the poor” is typically discussed as a client/patient problem. However, interviews of poor people, and those with whom they work, consistently reveal the role of the environment in maintaining the intractability of this status, as well as the role of the mental health professional who unknowingly contributes to the cycle. The barriers to mental health services for the poor are complex and interdependent; a domino effect ensues that results in ongoing stressors. Classism and the failure of our standards of care to include class competency in cultural competency training, research, and practice are profound. These omissions and the models available for evidence-based practice through continuing education and graduate training are described. Empirically supported treatments and qualitative research are reviewed, demonstrating more effective outcome expectations than were possible with traditional approaches. Settings and systems that hold promise for a path toward the future are identified.
Responding to the Mental Health Needs of Underserved Latin Americans
Authors: Fernández-Álvarez Héctor , Grazioso Maria del Pilar , Kirszman Diana , Lubina Meri , Goodyear Rodney
Published: November 2019

Latin Americans experience an especially large gap between their mental health needs and treatment availability. Access to treatment is limited by attitudes and stigma, the lack of substantial treatment infrastructures, and shortages of mental health professionals. The treatments that underserved populations do obtain are often informed by models imported from North America and Europe, without sufficient cultural adaptation. This chapter describes the work that Fundación Aiglé is doing to address this treatment gap. This includes its graduate training programs and supervision networks that extend regionally, beyond Argentina; its publications; and its treatment model, the integrative model of psychotherapy. The chapter also describes Aiglé’s Therapeutic Assistance Program for People with Limited Resources (PATER) as one approach to providing treatment to underserved populations. The work that Aiglé is doing provides a model for other nongovernmental agencies to adapt to their own circumstances.
Palliative Care Needs of People Affected by Natural Hazards, Political or Ethnic Conflict, Epidemics of Life-Threatening Infections, and Other Humanitarian Crises
Authors: Krakauer Eric L. , Daubman Bethany-Rose , Aloudat Tammam , Bhadelia Nahid , Black Lynn , Janjanin Sanja , Khan Farzana
Published: November 2019

The principles of humanitarianism explicitly require both saving lives and prevention and alleviation of human suffering as essential parts of a humanitarian healthcare response. The consequences of humanitarian crises vary greatly depending on the causes, location, and vulnerability of the population they affect, but the consequences often include extensive loss of life and physical, psychological, social, and spiritual suffering on a massive scale. The poor, the displaced (refugees and internally displaced persons), and those living in low-income settings generally are most vulnerable to unnecessary suffering and death. Palliative care must be provided for all dying patients and should be integrated with life-saving treatment for patients with acute life-threatening conditions. This chapter discusses a range of humanitarian crises, the needs of people affected by and living in such crises, and components of effective palliative care.
Delirium and Acute Anxiety
Authors: Bezanson Kevin , Rogers Stephanie
Published: November 2019

This chapter reviews the assessment and management of patients presenting with acute confusion and agitation in humanitarian crises. The first section focuses on delirium, its distinguishing characteristics, and its diagnosis. The chapter then describes a contextually appropriate process for identifying and treating potentially reversible causes. Finally, it recommends management strategies for associated distressing symptoms with a priority on behavioral over pharmacological interventions. The second section addresses acute anxiety in the context of collective and personal trauma. Distinguishing features and manifestations are described. Approaches to management emphasizing behavioral and psychosocial care, with a limited role for pharmacological support, are outlined. The potential relationship of acute anxiety to other mental health conditions is also referenced.
Communicating Bad News
Authors: Weaver Meaghann S. , Ibach Michaela
Published: November 2019

This chapter examines several strategies for conveying bad or challenging health-related news in a variety of situations. Principles discussed in this chapter are applicable to healthcare workers across all disciplines but are especially useful for palliative care providers and those working in humanitarian crises or emergencies. The SPIKES protocol and the Ask-Tell-Ask method communication tools are reviewed in detail with both positive and negative examples provided to aid the reader in application. Recommendations for setting up a family meeting, exploring patients’ goals, arranging follow-up, and responding to emotion are also included.
Surgical Treatment of Raised Intracranial Pressure
Authors: Zaazoue Mohamed A. , Rodgers Richard B.
Published: November 2019

Traumatic brain injury (TBI) is a common problem encountered in the emergency department, and neurosurgeons are typically involved early in the management. Prompt physical examination and head CT are crucial to assess TBI patients and determine their management plan. Intracranial pressure (ICP) monitoring is indicated for patients with altered mental status and abnormal imaging. ICP management is a tiered approach, with early tiers involving nonsurgical, and medical interventions. For patients with uncontrolled elevation of ICP, there are three possible surgical interventions: external ventricular drain placement, evacuation of mass lesion, and/or decompressive craniectomy (unilateral or bilateral). Finally, when patients who underwent craniectomy recover from the acute phase of TBI, cranioplasty is performed for cosmetic purposes and potential neurological benefit.
Injury to the Dural Venous Sinuses
Authors: El Ahmadieh Tarek Y. , Madden Christopher J. , Timmons Shelly D.
Published: November 2019

This chapter presents the case of a large surgically evacuated occipital/suboccipital epidural hematoma, caused by traumatic injury to the left transverse sinus. It reviews the guidelines for surgical evacuation of epidural hematomas, as well as the incidence, initial assessment, surgical planning, and management of dural venous sinus injuries. Further addressed are the surgical techniques and nuances used for intraoperative control of dural venous sinus bleeding and strategies used for dural venous sinus repair. Finally, the potential complications associated with dural venous sinus surgery, including rebleeding and air embolism, and their management in the intraoperative and postoperative settings are discussed.
Traumatic Intracerebral Contusions
Authors: Eli Ilyas , Couldwell Mitchell , Rabb Craig H.
Published: November 2019

Cerebral contusions are a subtype of traumatic brain injury that classically result from coup or contrecoup injuries. Common locations for these injuries are the inferior frontal, temporal, and occipital lobes. Mass effect from edema and hemorrhagic progression are frequent with contusions. Depending on the clinical examination results and radiographic findings, treatment may be nonsurgical or surgical. A Glasgow Coma Scale (GCS) score of 8 or less warrants placement of an intracranial pressure (ICP) monitoring device. Surgery is indicated in patients with deterioration of neurological examination findings, ICP that is refractory to exhaustive medical management, or imaging findings of severe mass effect. Patients with moderate or severe traumatic brain injury (GCS <13) are typically admitted to intensive care units for close monitoring of neurological examination changes, hyponatremia, hemorrhagic progression, and postsurgical complications. Recovery varies widely, and outcomes depend on age, initial GCS score, size, and location of the contusion.
Management of Temporal Bone Fractures
Authors: Ji Hongzhao , Isaacson Brandon
Published: November 2019

Temporal bone fractures can present with a variety of symptoms and physical exam findings. Facial paralysis, hearing loss, spinal fluid leak, vestibular dysfunction, and vascular injuries are all potential issues that may occur in the setting of skull base trauma. The indications and interpretation of facial nerve electrophysiology studies with respect to the need for surgical decompression or repair are reviewed. Injuries to the middle and inner ear may result in conductive, mixed, or pure sensorineural hearing loss depending on the location of the fracture. Surgical repair of conductive or mixed hearing loss should be delayed because spontaneous improvement often occurs. CSF leakage presents with clear or serosanguineous aural discharge and typically resolves with conservative measures. Occasionally spinal fluids leaks require lumbar subarachnoid drainage or surgical exploration and repair. Evaluation and management of other issues arising as a result of temporal bone trauma will also be reviewed.
Blunt Cervical Vascular Injury
Authors: Plitt Aaron R. , Kafka Benjamin , Rickert Kim
Published: November 2019

Cervical cerebrovascular injury occurs in approximately 1% of patients presenting with blunt trauma, but it carries a high morbidity (80%) and mortality (40%) when left undiagnosed. Cervical spine fractures, especially between C1 and C6, are at higher risk for injury to the cervical cerebrovasculature. These injuries are graded I–V in order of ascending severity. The diagnosis is established using a vascular imaging study, predominantly CT angiography. Once diagnosed, the treatment is predominantly medical with antiplatelet or anticoagulation therapy, and its presence should not preclude reduction of a fractured or subluxed vertebrae. The medical therapy should be continued for 3–6 months with regular follow-up vascular imaging to assess for progression of the injury. Overall, blunt cervical vascular injury should be suspected in patients with cervical spine fractures or trauma to the head and neck region, and it should be treated medically.
Management of Gunshot Wounds to the Head
Authors: Aarabi Bizhan
Published: November 2019

In civilian life, gunshot wounds to the head are deadly. Almost 90% of patients will die at the scene, and only 10% have a chance to be seen and treated in a trauma center. The neurosurgeon must first examine the patient and look for overall outcome. Patients with Glasgow Coma Scale (GCS) scores of 5 and less, fix and dilated pupils, and with a slug traversing the sagittal or coronal planes and closed ambient cisterns have a very high chance of death and disability. Patients with good GCS scores and injuries involving air sinuses need special care during surgery and need watertight dural closure. Extensive convexity wounds may need superficial debridement and/or decompressive craniectomy in association with intracranial pressure monitoring. Small BB gun fragments are innocuous and pose very little chance of infection. Fragments involving the orbits, face, and pterion upon entering the brain, crossing the midline, and associated with intracerebral hematomas must have CT angiography to rule out traumatic intracranial aneurysms. Almost 50% of patients with penetrating head injury will eventually become epileptic.
Oxford Handbook of ENT and Head and Neck Surgery
Authors: Corbridge Rogan , Steventon Nicholas
Published: November 2019

This book, like all the other Oxford Handbooks, aims to provide a compact, but comprehensive, guide to medical practice. It has been designed to slip inside the pocket of a white coat and to be rapidly retrieved for reference. There are many blank facing pages for notes and for amending or annotating the text to fit in with local practice. The core text is based on an anatomical list of ear, nose, and throat (ENT) diseases. There are separate sections on ENT examinations, investigations, common operations, ward care, and emergencies. There is also a separate section on the work of other ENT health professionals. Chapter 3 on ‘common methods of presentation’ is unique for this type of book. This chapter is a guide for dealing with patients as they present in clinical practice. It also provides a convenient way of accessing the relevant chapter in the anatomical list.
New to this edition is an overview of ENT conditions and their management in other parts of the world.
Common operations
Authors: Corbridge Rogan , Steventon Nicholas
Published: November 2019

This chapter discusses common ear, nose, and throat (ENT) operations. The general and specific consent issues around surgery, specific complications of ENT surgery, and the use of the World Health Organization (WHO) surgical checklist are outlined. Common operations include descriptions of indications, preoperative checks, the procedure, post-operative care, complications, length of stay, and discharge advice are provided.
ENT emergencies
Authors: Corbridge Rogan , Steventon Nicholas
Published: November 2019

This chapter outlines the management of common ear, nose, and throat (ENT) emergencies. The assessment of blood loss and its treatment in the context of severe epistaxis or post-tonsillectomy haemorrhage are detailed. Protocols for dealing with fractured noses, sudden hearing loss, sudden facial palsy, and foreign bodies are discussed.
Acute Pain
Authors: Zinboonyahgoon Nantthasorn , Schreiber Kristin
Published: November 2019

Chapter 14 covers the essentials of acute pain care in the hospital and procedural setting. The chapter begins with an overview of the negative physiologic impacts of uncontrolled acute pain. Based on a foundational understanding of pain pathways and nociceptive signaling, it is possible to construct an acute pain management plan incorporating nonpharmacologic, systemic, and focal pharmacologic elements for an effective multimodal treatment plan. Acute opioid management, including analgesic equivalence, is discussed in detail. Benefits, precautions, side effects, and toxicities of opioids are addressed. Naloxone administration is described in detail. Obstetric, regional, nerve blockade, and multimodal analgesia are described. Adjustments to therapy for patients with substance use disorder are addressed in detail.
Large dipole moment induced efficient bismuth chromate photocatalysts for wide-spectrum driven water oxidation and complete mineralization of pollutants
Authors: Chen Xianjie , Xu Yuan , Ma Xinguo , Zhu Yongfa
Published: November 2019

Herein, a wide-spectrum (∼678 nm) responsive Bi8(CrO4)O11 photocatalyst with a theoretical solar spectrum efficiency of 42.0% was successfully constructed. Bi8(CrO4)O11 showed highly efficient and stable photocatalytic water oxidation activity with a notable apparent quantum efficiency of 2.87% (420 nm), superior to many reported wide-spectrum driven photocatalysts. Most remarkably, its strong oxidation ability also enables the simultaneous degradation and complete mineralization for phenol, and its excellent performance is about 23.0 and 2.9 times higher than CdS and P25-TiO2, respectively. Its high activity is ascribed to the giant internal electric field induced by its large crystal dipole, which accelerates the rapid separation of photogenerated electron–hole pairs. Briefly, the discovery of wide-spectrum bismuth chromate and the mechanism of exponentially enhanced photocatalytic performance by increasing the crystal dipole throw light on improving solar energy conversion.
Measurement of Pectoralis Minor Muscle Length in Women Diagnosed With Breast Cancer: Reliability, Validity, and Clinical Application
Authors: Harrington Shana E , Hoffman Julie , Katsavelis Dimitrios
Published: November 2019

Background

Decreased pectoralis minor muscle length is common after primary breast cancer treatment and can result in an abnormal position of the scapula. This position can contribute to shoulder pain and pathomechanics and can lead to problems such as impingement syndrome, rotator cuff tears, and frozen shoulder. Currently, there are limited reliable methods for measuring pectoralis minor length.

Objective

The objective of this study was to examine the reliability and validity of measuring pectoralis minor length in women diagnosed with breast cancer.

Design

This was a cross-sectional reliability and validity study.

Methods

Bilateral pectoralis minor length (in centimeters) was assessed using a palpation meter in women (N = 29) diagnosed with breast cancer by 2 licensed physical therapists who were masked to the measures. Bilateral pectoralis minor length was also measured using a motion capture system to assess validity.

Results

Intratester reliability (intraclass correlation coefficient, ICC [3,k] = 0.971; 95% confidence interval [CI] = 0.939–0.986; standard error of measurement [SEM] = 0.16 cm) and intertester reliability (ICC[3,k] = 0.915; 95% CI = 0.81–0.962; SEM = 0.31 cm) were excellent for the palpation meter on the affected side and the unaffected side (intratester reliability: ICC[3,k] = 0.951; 95% CI = 0.897–0.977; SEM = 0.19 cm; intertester reliability: ICC[3,k] = 0.945; 95% CI = 0.877–0.975; SEM = 0.22 cm). Significant correlations were found between the motion capture system and the palpation meter on the affected side (r = 0.87) and the unaffected side (r = 0.81). Bland-Altman plots between the palpation meter and the motion capture system demonstrated that all the measures fell within the limits of agreement.

Limitations

This study encountered possible errors with the accuracy of the motion capture system tracking because of the proximity of the markers and inherent volumetric restrictions.

Conclusions

The palpation meter is a reliable, valid, easily administered, and cost-effective tool for assessing pectoralis minor length in women with breast cancer.
Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis
Authors: Carpenter Lewis , Nikiphorou Elena , Kiely Patrick D W , Walsh David A , Young Adam , Norton Sam
Published: November 2019

Objectives

To examine secular trends in the progression of clinical and patient-reported outcomes in early RA.

Methods

A total of 2701 patients recruited to the Early Rheumatoid Arthritis Study or Early Rheumatoid Arthritis Network with year of diagnosis from 1986 to 2011. The 5-year progression rates for patients diagnosed at different points in time were modelled using mixed-effects regression; 1990, 2002 and 2010, were compared. Clinical markers of disease included the 28-joint count DAS and the ESR. Patient-reported markers included the HAQ, visual analogue scale of pain and global health, and the Short-Form 36.

Results

Statistically significant improvements in both 28-joint count DAS and ESR were seen over the 5 years in patients diagnosed with RA compared with those diagnosed earlier. By 5 years, 59% of patients with diagnosis in 2010 were estimated to reach low disease activity compared with 48% with diagnosis in 2002 and 32% with diagnosis in 1990. Whilst HAQ demonstrated statistically significant improvements, these improvements were small, with similar proportions of patients achieving HAQ scores of ≤1.0 by 5 years with a diagnosis in 1990 compared with 2010. Levels of the visual analogue scale and the Mental Component Scores of the Short-Form 36 indicated similar, statistically non-significant levels over the 5 years, irrespective of year diagnosed.

Conclusion

This study demonstrates improvements in inflammatory markers over time in early RA, in line with improved treatment strategies. These have not translated into similar improvements in patient-reported outcomes relating to either physical or mental health.
Women’s Family and Employment Life Courses Across Twentieth-Century Europe: The Role of Policies and Norms
Authors: Zagel Hannah , Van Winkle Zachary
Published: November 2019

This article examines longitudinal patterns of work–family reconciliation across Europe and whether the influence of defamilizing policies on those patterns is contingent on the normative context. Data from the Survey of Health, Ageing and Retirement and sequence analysis are used to reconstruct and analyze women’s family and employment life courses from age fifteen to fifty years, born in the period between 1924 and 1966 from fourteen countries. Historic family policy data and gender attitudes collected in the International Social Survey Programme are included in multinomial regressions. Results suggest that defamilization and gender egalitarianism increase the labor market attachment of women with traditional family life courses independently.
The Impact of Geriatric-Specific Triage Tools Among Older Adults in the Emergency Department
Authors: Pham Khue D. , Lim Fidelindo A.
Published: November 2019

As the aging population grows, emergency department (ED) service utilization among those 65 years and older is expected to rise. In 2017, it was estimated that approximately 49 million Americans were 65 years and older. Not surprisingly, the number of ED visits by older adults is also increasing, given that this population is more likely to have multiple comorbidities. Emergency department visits by older adults pose specific challenges in risk stratification and optimizing their care based on the use of geriatric-specific triage tools. The aim of this integrative review is to appraise the impact of geriatric-specific triage tolls used in the ED and offer meaningful discussion on how to best address older adults in the ED setting. Findings from this review will help inform the efforts of clinicians, educators, researchers, and public health policy stakeholders charged in the care and advocacy for vulnerable older adults.