bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical management of tumours of the orbit
Authors: Chabot Joseph D , Stefko S. Tonya , Gardner Paul
Published: October 2019

The orbit can harbour a variety of lesions and their approach and treatment should be dictated by anatomical location and pathology. The proximity of the orbit to the sinonasal cavity and anterior and middle cranial fossae make it an ideal location for collaboration among neurosurgeons, otolaryngologists, and ophthalmologists. Traditional orbitotomy, microsurgical transcranial, and endoscopic endonasal approaches (EEA) provide 360-degree access for biopsy or resection of both primary intraorbital lesions and those involving the structures surrounding the orbits. The most appropriate surgical corridor will avoid crossing the vertical plane of the optic nerve and will also avoid excess retraction of the globe. A multidisciplinary team with all available specialties is therefore ideal for management of orbital lesions. This chapter outlines the anatomy, clinical presentation, and techniques that guide surgeons in management of these lesions.
Skull lesions
Authors: Gioffre Giorgio , Timofeev Ivan
Published: October 2019

Skull vault lesions are rare and represent 1–2% of all bone masses. They are commonly an incidental finding or may be discovered during staging work-up for other diseases. Different classification systems can be employed in order to categorize such lesions: primary (benign and malignant) or secondary as well as neoplastic and non-neoplastic (inflammatory and proliferative). For many of these lesions the clinical and radiological features are often non-specific making the diagnosis cumbersome. Rather than being defined clinical entities, they frequently form part of a spectrum of disease where ruling out an unfavourable progression is of paramount importance. Combining a basic knowledge of the epidemiology, clinical presentation, imaging findings, and histopathology is essential to differentiate these pathologies. The aim of this chapter is to define the important features of each lesion, to offer an overview of the investigations and treatment, and to provide guidance for the differential diagnosis based on imaging. Therefore, pathological entities with similar radiological appearances are grouped together.
Surgical management of anterolateral skull base lesions
Authors: Cusimano Michael , Meier Michael P.
Published: October 2019

The following section outlines major considerations in the treatment of anterolateral skull base lesions. The essential anatomy, including the nasosinal region as well as the anterior fossa, is presented and the related challenge of defining the appropriate surgical approach is highlighted. We report on our principles of preoperative investigations and demonstrate the cornerstones of the perisurgical treatment for patients with lesions of the anterolateral skull base in our department. The chapter focuses on surgical decision-making and surgical techniques, it covers the most relevant approaches in managing anterolateral lesions. Detailed descriptions of the anterior interhemispheric approach, the supraorbital craniotomy, and minicraniotomy, the extended endoscopic endonasal approach, the orbitozygomatic approach, and the Fisch approaches are provided. Finally, we present and discuss the surgically relevant nuances of four selected cases to highlight and discuss the controversies for and against the choice of a particular approach.
Schwannomas
Authors: Mathiesen Tiit , Förander Petter , Pettersson David
Published: October 2019

Sporadic vestibular schwannoma (VS) is the commonest tumour of the cerebellopontine angle and comprise 6–8% of all intracranial tumours. The incidence varies between 12 and 20 cases per million inhabitants and years in different reports; a large minority of these tumours grow during follow-up. Treatment options include wait and scan, microsurgery, radiosurgery, and radiotherapy. Micro- and radiosurgery are well validated to offer long-term tumour control, but patients may suffer from hearing deficit and facial nerve paresis. Unexpectedly, long-term life quality is more affected by vertigo and headaches. Other cranial nerve schwannomas cause symptoms depending on the affected nerves and respond to the same therapies when treatment is indicated.
Craniopharyngioma and Rathke’s cleft cysts
Authors: Fahlbusch Rudolf , Gerganov V. , Metwali H.
Published: October 2019

Both craniopharyngiomas and Rathke’s cysts are rare pituitary lesions of dysembryogenic origin. Their radiological differentiation may be sometimes difficult due to their occasionally similar imaging characteristics. The surgical management of these lesions, especially of craniopharyngiomas, may be very challenging. Gross total removal of a craniopharyngioma is associated with longer recurrence-free survival but could be associated with higher rate of surgery-related morbidities and pituitary insufficiency. Craniopharyngiomas are considered in the majority of cases to be a ‘chronic disease’. A principle difference in the operative management of these two lesions is that in craniopharyngiomas, resection of their thicker capsule is mandatory in order to achieve complete removal, whereas it is nearly impossible and not recommended to attempt such cyst wall removal in Rathke’s cysts. Emptying of the cyst content is usually sufficient to provide cure in the majority of these patients. Recurrences in Rathke’s cyst are only rarely observed in contrast to craniopharyngiomas.
Intraventricular tumours
Authors: Grundy Paul , Apostolopoulos Vasileios
Published: October 2019

Intraventricular tumours are relatively rare, histologically diverse, and commonly low grade. The location of the tumour, MRI features, associated conditions, and the age of the patient help to narrow the radiological differential diagnosis. The management of intraventricular tumours needs to be tailored to the presumed nature of the tumour, its location, size, and the general state of the patient. The management of hydrocephalus is often the first priority. Radical excision of intraventricular tumours is usually favoured for younger patients, whereas subtotal excisions or even just cerebrospinal fluid (CSF) diversion is favoured for older patients with tumours which are less accessible. Excision of tumours, usually ependymomas originating from the floor of the fourth ventricle may be associated with significantly disabling postoperative deficit with can frequently but not always improve over a period of time. As always in brain tumour surgery, balancing radical excision and overall well-being of patients requires careful consideration.
Pineal tumours
Authors: Waqar Mueez , Mills Samantha , Mallucci Conor L , Jenkinson Michael D
Published: October 2019

Tumours of the pineal are very rare, tend to be more common in children and while there are a wide variety of pathologies the majority are germ cell tumours and pineal parenchymal tumours. These tumours usually present with hydrocephalus and endoscopic third ventriculostomy is the operation of choice. It is important to test for tumour markers in the blood and cerebrospinal fluid, since the diagnosis of a secreting germ cell tumour precludes the need for surgery. Surgical biopsy can be performed by endoscopy or with frame-based stereotaxy. For germ cell tumours chemotherapy and radiotherapy are the mainstay of treatment, but surgery has a role in the management of residual disease. For primary parenchymal tumours, maximum surgical resection is the first-line treatment and can be curative for pineocytoma. Pineoblastoma require adjuvant radiotherapy and for intermediate grade pineal tumours the role of radiotherapy is still being evaluated.
Uncommon brain lesions
Authors: Wan Yizhou , Marcus Hani J , Santarius Thomas
Published: October 2019

In this chapter we discuss neurosurgical tumours, which are uncommon and have not been covered elsewhere. Due to their rarity this chapter reviews what is known about these conditions and primarily discusses their diagnosis. The description of management is derived largely from published case series. Uncommon brain lesions vary in their clinical presentation and radiological findings, making a timely and accurate diagnosis challenging. A timely and accurate diagnosis is a guiding principle in the management of patients with brain tumours. Making the diagnosis of uncommon brain lesions is inherently challenging, but this chapter highlights several elements that are important when investigating such lesions.
Concussion and sports-related head injury
Authors: Wilson Mark
Published: October 2019

Interest in concussion and sports-related injury has intensified in recent years for three main reasons: (1) it is a preventable form of brain injury; (2) there is increasing evidence that repeated injury can result in long-term neurocognitive loss; and (3) as a result there are potential medicolegal costs to organizations that, possibly inadvertently, allow this form of brain injury to occur within their sport. The long-term effects of boxing resulting in dementia pugilistica have been appreciated for some time, however the results of repeated mild head injury in other sports is now under focus. Concussion, increasingly termed mild traumatic brain injury, should be graded. Imaging, removal from, and return to sport are all discussed in this chapter.
The pathophysiology of aneurysms
Authors: Cagnazzo Federico , Lanzino Giuseppe , Kassell Neal F.
Published: October 2019

Intracranial aneurysms (IAs) are pathological dilatations of the arterial wall. With widespread utilization of non-invasive imaging, unruptured IAs are diagnosed with increased frequency. Approximately 80–90% are saccular or berry aneurysms. Their pathophysiology is still controversial, but most likely multifactorial and related to interaction between modifiable (smoking and hypertension) and unmodifiable (haemodynamic, genetics, and wall biology) factors. A small group of IAs presents a different aetiology and pathophysiology (traumatic, dissecting, blister, fusiform, and mycotic aneurysms). Although there is no controversy about the indication for treatment of ruptured IAs, management of unruptured IAs is very controversial. While the vast majority of small IAs will remain quiescent for life, a very small number will go on to rupture. Size, location, shape, and other risk factors for aneurysm rupture, must be taken into account when deciding between invasive or conservative management.
Carotid artery disease and cerebral ischaemia
Authors: Sweeney Kieron , O’Hare A. , Javadpour Mohsen
Published: October 2019

Due to the high incidence carotid artery disease and cerebral ischaemia, accurate and timely diagnosis and treatment is required to reduce the significant morbidity and mortality associated with these conditions. This chapter discusses the epidemiology, pathophysiology, clinical presentation, investigation, and treatment of these conditions. Cerebral ischaemia and stroke can occur due to a heterogeneous number of pathological processes. These pathological processes can affect either large or small vessels and can be broadly classified into thrombotic, embolic, or occlusive causes. The most common cause of thrombotic ischaemic is atherosclerosis. The most common cause of embolic ischaemia is cardiogenic due to atrial fibrillation followed by extracranial atherosclerosis of the aorta or carotids. Both of these causes can affect both the large and small vessels. This chapter explores the current evidence for medical, interventional, and surgical treatment options.
Cavernomata and angiographically occult lesions
Authors: Patel Hiren , van Beijnum Janneke
Published: October 2019

Cerebral cavernous malformations (CCMs), known in addition as cavernomata or cavernous (haem)angiomata, are vascular malformations consisting of abnormally enlarged capillary cavities without intervening parenchyma (see section on capillary telangiectasia, this chapter) or arterial feeders with venous drainage (see arteriovenous malformations, Chapter 50). About 10–20% of CCMs are associated with a developmental venous anomaly (DVA), which is an extreme variation of the normal venous anatomy. CCMs can occur as result of an underlying genetic disorder, and genetic analysis is recommended in patients with a positive family history or multiple lesions. A conservative approach for asymptomatic CCMs seems justified in the large majority of cases and follow-up imaging is only needed if patients become symptomatic. Indications for surgical treatment are multiples haemorrhages, CCMs with mass effect causing symptoms, and patients with intractable epilepsy with an identified epileptogenic focus. Stereotactic radiosurgery can be considered in exceptional cases with a very high surgical risk.
Spinal physiology
Authors: Khan Sadaquate , Tsang Kevin , Nayeb Lamia
Published: October 2019

The spinal column in addition to its mechanical and structural role in bipedal primates also plays an important role in three physiological processes: motor control, sensory perception, and autonomic function. This chapter aims to describe the role of the spinal cord in these physiological processes and the patterns of deficit that result from injuries to the spinal cord. The initial section will cover spinal tract anatomy of transmission of pain, proprioception, motor function, and coordination. This will be followed by a description of autonomic control of bladder, bowel, sexual function, and blood pressure. The final segment will describe the patterns of neurological deficit resulting from spinal cord injury.
Medical pathologies of the spinal cord
Authors: McGuigan Chris , O’Connell Karen , McGovern Eavan , McGurgan Iain
Published: October 2019

Spinal cord presentations commonly seen by neurosurgeons suggestive of surgical pathology can be mimicked by many medical conditions. The most common presentations of medical, neurological conditions seen by neurosurgeons include conditions causing acute spastic paraparesis, such as transverse myelitis, and acute flaccid paralysis, such as Guillain–Barré syndrome. Other medical conditions such as motor neuron disease, neuropathy pain syndromes can also mimic radiculopathies and may be referred for a neurosurgical outpatient review. Therefore, a knowledge of these conditions and recognition of some of the key questions to ask during a history is beneficial. Key findings to look for on examination will also help with a timely diagnosis and involvement of the relevant specialist without unnecessary investigations or interventions.
Lumbar spinal disease
Authors: Kellett Christopher G , Crocker Matthew J
Published: October 2019

Spinal pathology comprises greater than 50% of the neurosurgeon’s workload. Therefore, a comprehensive understanding of spinal pathophysiology is of paramount importance. The spine has three principal biomechanical roles; namely load bearing, mobility, and protection of the neural elements. With obesity on the rise and the ageing population, lumbar spinal disease is set to become increasingly prevalent. This chapter outlines the three key pathophysiological concepts underpinning lumbar spinal disease: spinal function, the motion segment, and spinopelvic balance. In addition, the clinical features pertaining to these common pathological processes are described and the best available evidence guiding treatment is discussed.
Spinal tumours
Authors: Brecknell John , Leong Quah Boon
Published: October 2019

Spinal tumours in adults, although usually presenting with pain and neurological dysfunction, are often incidental findings. For the spinal neurosurgeon, the range of pathologies, clinical presentations, and required surgical techniques included within the management of spinal neoplasia is vast, from benign lesions unchanged over a decade of observation to malignant disease that progresses over a few hours to paraplegia, and from the finest microsurgery to instrumentation over multiple spinal segments. Surgery has a key role to play in the management of many of these, both to decompress the neurological elements of the spine and, when necessary, to reconstruct the mechanical integrity of the spine. This chapter highlights some of the challenges facing the contemporary spinal tumour surgeon.
Cervical spine injuries
Authors: Mathieson Calan , Barrett Chris , Alakandy Likhith
Published: October 2019

The management of cervical spine fractures is a complex and fascinating topic. A multitude of descriptive terminologies and classification systems have been developed over the years in an attempt to better understand this heterogenous group of patients. Despite this however, there is often little consensus with regards to the best way to manage this population. This chapter will predominantly discuss the decision-making process involved in the management of cervical spine fractures. The goal of the spine surgeon in managing patients with acute cervical spine injury is to prevent secondary neurological injury, deformity, and pain by re-establishing stability if necessary. Assessing how to achieve this goal can be very challenging. The surgeon will be faced with many questions. Which patients should undergo surgical intervention? Which operation will best stabilize the spine? Which patients should be treated with a collar or a halo vest? Does the injury require reduction with traction initially? There are also questions of timing. When should the surgeon plan the proposed procedure?
Electrodiagnostics
Authors: Forster Alan , Morris Robert
Published: October 2019

Clinical neurophysiology provides valuable information in neurosurgery, serving as: a diagnostic tool that can quantify type and severity of damage to the central and peripheral nervous system, a means of monitoring the safety of structures within and around the surgical site, and a method to map structures. As such it aides in identifying structures (e.g. finding sacral nerve roots within a spinal lipoma or nuclei within the thalamus), assessing functional integrity (e.g. motor pathways from cortex to any relevant accessible muscle), and monitoring their function while surgery occurs near to structures (e.g. VII while retraction during trigeminal microvascular decompression, and in scoliosis surgery) and provide guidance to technical operative steps (e.g. for selective dorsal rhizotomy). Intraoperative monitoring is not new, though the advances in equipment and technique of recent years have seen an explosion in the useful ways that neurophysiology can aid the neurosurgeon and protect the patient. The development of techniques to localize epileptic foci and map eloquent cerebral cortex in the 1950s produced major scientific advances as well as revolutionizing epilepsy surgery. Since the 1960s Tasker in Toronto, and Gillingham in Edinburgh, were recording from microelectrodes in the human thalamus to guide movement disorder surgery. Pioneers such as Møller have extended the applications of neurophysiological monitoring in skull base surgery. This chapter describes neurophysiological mapping and monitoring, and the different tools that are useful in different situations.
Movement disorders
Authors: Ashkan Keyoumars , Ughratdar Ismail
Published: October 2019

Merely having the technical ability to perform functional neurosurgery is not sufficient. An understanding of key clinical concepts surrounding movement disorders lies at the heart of becoming a competent functional neurosurgeon in order to ensure correct patient selection and perioperative management. This chapter provides a thorough medical overview of the fundamental clinical aspects, including pathophysiology, diagnosis and medical therapy for the commonest movement disorders encountered in neurosurgical practice: Parkinson’s disease, essential tremor, and dystonia. A brief overview of the surgical management options and outcomes from surgery is discussed. Finally, some of the controversies related to the surgical aspects of movement disorders are examined.
Neurosurgical interventions for psychiatric disorders
Authors: Bervoets Chris , Nuttin Bart , Gabriëls Loes
Published: October 2019

Psychiatric disorders are among the most prevalent illnesses worldwide. Both medication and psychotherapy (alone or in combination) are evidence-based therapeutic steps in the treatment algorithm. In the past decades neurosurgical interventions for psychiatric disorders have attracted research interest and are sparsely introduced in the clinical field. The efficacy of these neurosurgical interventions (i.e. deep brain stimulation (DBS) and lesional neurosurgery) however remains under debate. We lack a full understanding of the pathophysiological basis of many psychiatric disorders. Researchers study multiple neuroanatomical targets within one psychiatric indication and multiple indications for electrical stimulation of one brain target. Stimulation parameter selection can still be improved.
Surgical management of epilepsy
Authors: Schramm Johannes
Published: October 2019

The chapter describes procedures for surgical management of drug-resistant epilepsy. The presurgical evaluation is outlined including the use of MRI, and functional imaging with PET and single photon emission computed tomography (SPECT). The importance of electroencephalographic recordings of seizures in split-screen video technique is underlined. The spectrum of interventions includes temporal lobe procedures (selective amygdalohippocampectomy, two-thirds temporal lobectomy, and tailored lateral resections), in addition to extratemporal lobe resections consisting of lesionectomies, extended lesionectomies, but also lobectomies and multilobectomies. Hemispherectomies/hemispherotomies of various types are described and a second disconnective procedure: callosotomy. Vagal nerve stimulator implantation as a palliative procedure is detailed, and other operations are briefly touched (such as hypothalamic hamartoma disconnection, deep brain stimulation, and responsive cortical stimulator implantation). The chapter is concluded by briefly discussing outcome of epilepsy surgery and management of complications. The controversy concerning small temporal lobe resections versus classic lobe resections is outlined.
Spinal development and spinal dysraphism
Authors: Thompson Dominic
Published: October 2019

The term spinal dysraphism encompasses a group of congenital disorders of spinal cord development. This potentially confusing array of conditions is best understood from an embryological perspective, and a unifying method of classification is presented. Spinal dysraphism is associated with neurological, urological, and orthopaedic deficits, these may be present at birth or may evolve over time due to the effects of spinal cord tethering. Precise diagnosis is essential to formulating an appropriate surgical management plan in order to optimize long-term neurological outcome. Contemporary and controversial surgical advances in the field are discussed including electrophysiology directed radical resection for spinal lipomas and antenatal surgery for myelomeningocele.
Spinal infection
Authors: Haden Nicholas , White Edward
Published: October 2019

This chapter provides a comprehensive review of the presentation, investigation, and management of patients presenting with a spinal infection. Particular attention is given to discitis and osteomyelitis (collectively referred to as spondylodiscitis), spinal epidural abscesses, and postoperative infections following spine surgery, although in practice there is considerable overlap between these conditions. These forms of spinal infection are rare, but are associated with significant morbidity and mortality, often due to diagnostic delays related to their non-specific presenting symptoms. The relevant literature is reviewed and summarized to provide guidance on the prompt diagnosis and management of these conditions in clinical medical practice.
A brief history of suicidal behaviour
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter places suicide and suicidal behaviour in a European historical context. Although suicide has been documented throughout history, its meaning and functions have varied over time. In the Middle Ages, suicide was regarded as sinful but, subsequently, was conceptualized in terms of social influences or mental illness. Systematic research into suicidal behaviour has been undertaken for more than two centuries. The contributions of Morselli, using statistical and epidemiological techniques, were particularly notable. Many of the accepted social and psychiatric antecedents of suicide we talk about today were well described by the nineteenth century.
What causes suicidal behaviour?
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses some of the causes of suicidal behaviour and some of the risk and protective factors. Psychological autopsy studies (which collect information from family members and other sources following suicide) suggest that as many as 80–90 per cent of people may have a psychiatric illness at the time of death. However, the causes of suicide are multiple and complex. Previous suicidal behaviour is also a very important risk factor. A number of models seek to bring together risk factors to further our understanding. One example is the stress diathesis model which highlights the interaction between individual vulnerability and later stressors. The Haddon Matrix on the other hand takes a public health perspective. The presence of even multiple risk factors is not sufficient to explain suicide and an individualized approach is needed when assessing patients.
Psychiatric disorders and biological factors
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses the role of psychiatric disorders, biological factors, and genetic factors in suicidal behaviour. These increase risk and the susceptibility of some individuals to react more severely to stress but do not inevitably lead to suicide. All psychiatric disorders are associated with a higher risk of suicide, particularly mood disorders, schizophrenia, and drug and alcohol misuse. Comorbidity (multiple psychiatric disorders at the same time or psychiatric and physical disorders together) is common. The vulnerability to suicidal behaviour is partly inherited. The serotonin and hypothalamic–pituitary–adrenal systems are associated with suicide; however biological factors lack specificity. There is an important interaction between genetic susceptibility and the environment—stressors may have more of an impact in individuals who carry particular genes.
Psychosocial and societal influences on suicidal behaviour
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses psychosocial and broader societal influences on suicidal behaviour. Social factors such as unemployment, deprivation, social integration, and religion are important. A number of developmental factors have also been associated with suicide, as have adverse life events either in early childhood or later in the life course. Interpersonal conflict is a common antecedent of suicidal behaviour. Situational factors such as the media, other people having engaged in suicidal behaviour, and access to means of suicide also contribute. Psychological theories, particularly the concept of ‘entrapment’, can help our understanding of aetiology of suicidal behaviour.
Bereavement after suicide
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter discusses the central role of bereavement after suicide. Supporting people bereaved by suicide should be a key component of suicide prevention strategies. People bereaved by suicide may be at increased risk of suicidal behaviour themselves but are less likely to obtain support than other bereaved groups. There may be qualitative differences in the issues or grief themes which arise when someone is bereaved through suicide compared to those which arise after death from other causes. Clinicians are vulnerable to similar feelings as well as concerns about their professional competence. Information resources, psychological interventions, and support groups may be helpful for people bereaved by suicide.
Frequently asked questions
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter attempts to answer some common questions about suicide and suicidal behaviour based on the available research evidence. These questions include: whether asking about suicidal behaviour increases risk; whether suicide is contagious; whether suicide can be rational (with particular reference to assisted suicide and euthanasia); whether people of different ages warrant different management; what research about suicide terrorism tells us; whether no-harm contracts are of value; whether harm minimization or harm reduction is a useful strategy; whether the closure of psychiatric beds has contributed to suicide; and the usefulness of individual inquiries about suicide.
Clinical examples
Authors: Kapur Navneet , Goldney Robert
Published: October 2019

This chapter includes three clinical vignettes which highlight some of the basic principles of assessment and management. The case studies describe a young person with interpersonal issues, a person with a long history of behaviours that might fit the criteria for borderline personality disorder, and a man in mid-life with a severe psychiatric illness. All those who present with suicidal thoughts and behaviour warrant a full assessment. The treatment offered depends on the presence and nature of any psychiatric and physical illness identified, as well as wider patient needs. Older people may have more prominent mental disorders. Some form of follow-up should be offered wherever possible.
Introduction to a Model for Disaster Evaluation
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

In this chapter we move to a discussion of the determination of objectives for a disaster evaluation study and the rationale behind the design and use of a logic model. Logic models are now widely used throughout the domain of public health as a tool for both designing and evaluating health programs (typically referred to as ‘interventions’). This chapter is offered as a general introduction to the detailed discussion of eight steps for conducting a disaster evaluation as presented in Part 2 of this Field Manual. The selection of two key components of our general evaluation framework, ‘evaluation objectives’ and ‘program theory/logic model’ for further discussion, is to highlight the centrality and importance of these ideas and concepts for scientific evaluations.
Formulate Evaluation Questions (Step 2)
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

In this chapter we define the five basic categories of evaluation, namely structure (resources), process (activities), outcomes, adequacy, and costs associated with the response(s). Structure refers to the equipment and personnel and the way in which these resources were organized for use in the medical response. Process refers to the activities carried out during the disaster response. Outcome assessment concerns the results of the care provided on the patients served, usually measured over time. Adequacy describes the extent to which the search-and-rescue, pre-hospital and hospital, and public health responses were able to meet the needs of the community during the disaster response. In general, these categories are consistent with the design of a typical logic model. Following the discussion of ‘evaluation categories’ we suggest questions that the evaluation team might consider for inclusion in the evaluation study. For each category we suggest questions which could be addressed in any disaster evaluation study which focuses on the medical and public health response. The stakeholder group should be fully involved in the selection of questions to be addressed by the evaluation team.
Ethical Considerations in Disaster Evaluation Studies
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

It is only within the recent past that bioethicists and legal scholars have begun to address the highly complex domain of ethical and legal issues related to the conduct of research in the context of disaster conditions. Since the year 2000, several national and international committees and organizations have developed guidelines for the ethical conduct of research under disaster conditions. These guidelines focus upon three unique characteristics of the disaster situation that researchers must consider: (1) the unique vulnerability of disaster victims; (2) the complications related to obtaining ‘ethics review’ during and immediately after a disaster impact; and (3) threats to research team members, victims and rescue workers during the data collection period. Suggestions for managing these threats and their associated risks are offered in this chapter. The framework and suggestions are drawn from reviews prepared by the World Health Organization and by a team of bioethics and legal scholars who have carefully reviewed and summarized the relevant national and international guideline statements.
Epilogue
Authors: Ricci Edmund M. , Pretto Ernesto A. , Ole Sundnes Knut
Published: October 2019

This is the epilogue for the book Disaster Evaluation Research.
Abdominal Surgery
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on abdominal surgery contains eight clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible causes and accompanying symptoms of abdominal pain that may present in the emergency department include appendicitis, cholecystitis, cholangitis, ingested foreign body, rectal bleeding, gastric or sigmoid volvulus and post-laparoscopy complications.. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The materials in this chapter will greatly aid revision for the Final FRCEM examination.
Dermatology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on dermatology contains six clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Rashes (which may be itchy or painful, or both), swelling of the lips (e.g. angioedema), cellulitis of the lower limb, and erythroderma may be indicative of potentially serious conditions, and it will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Endocrinology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on endocrinology contains six clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of endocrine origin that may present in the emergency department include hypoglycaemia, diabetic ketoacidosis, and thyroid storm, among others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
ENT Surgery
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on ear, nose, and throat (ENT) surgery contains seven clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of ENT origin that may present in the emergency department include epistaxis, vertigo, peritonsillar abscess, nasal fracture, foreign bodies, and otitis externa. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Haematology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on haematology contains seven clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of haematological origin that may present in the emergency department include Henoch–Schönlein purpura, immune thrombocytopenia, sickle cell crisis, and haemolytic transfusion reaction. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Musculoskeletal Conditions
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on musculoskeletal disorders contains 15 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of musculoskeletal origin that may present in the emergency department include back pain, septic arthritis, fractures, joint dislocations, and chest injuries, among others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Neurology and Psychiatry
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on neurology and psychiatry contains 17 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of neurological or psychological origin that may present in the emergency department include stroke, seizures, transient ischaemic attacks, and herpes zoster ophthalmicus, among many others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Obstetrics and Gynaecology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on obstetrics and gynaecology contains 13 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of gynaecological origin that may present in the emergency department include ectopic pregnancy, pelvic inflammatory disease, and ovarian hyperstimulation syndrome, among others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Ophthalmology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on general opthalmology contains 12 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of ophthalmologicall origin that may present in the emergency department include intraocular foreign bodies, glaucoma, Horner’s syndrome, vitreous haemorrhage, and orbital fractures, among many others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Respiratory Medicine
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on respiratory medicine contains 12 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and their accompanying symptoms of respiratory origin that may present in the emergency department include asthma, chronic obstructive pulmonary disease, pneumonia, and massive haemoptysis. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Urology
Authors: Banerjee Ashis , Jafar Anisa J. N. , Mukherjee Angshuman , Solomonides Christian , Witt Erik
Published: October 2019

This chapter on urology contains nine clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of urological origin that may present in the emergency department include haematuria, ureteric stones, acute urinary retention, acute kidney injury, and priapism. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.
Alleviating tension in ΛCDM and the local distance ladder from first principles with no free parameters
Authors: van Putten Maurice H P M
Published: October 2019

At increasing levels of confidence, Λ cold dark matter (ΛCDM) is challenged by tension in the Hubble parameter H0 with respect to the local distance ladder. We introduce a new approach to alleviating H0 tension by accelerated expansion leading up to an unstable de Sitter state (UdS) in the distant future. It shares the same parameters H0 and ΩM, 0 of late-time ΛCDM, wherein dS is assumed to be stable. For the matter density ΩM, 0, we test this by estimates over running inner intervals [0, zmax ] in the Pantheon data of 1048 supernovae supported by simulations over a common distribution of redshift data. We zoom in to the intermediate redshift interval [0.1, 0.4] well covered by data. For UdS, uncertainties in matter density in UdS are about one-half of those in ΛCDM and constancy exceeds that in ΛCDM by a factor greater than 2 as their estimates gradually diverge with z up to a significance of 2.5σ. UdS points to ΩM, 0 ≃ 0.3707 ± 0.015 that may be tested by future high-z observations on H(z).
Expression Atlas update: from tissues to single cells
Authors: Papatheodorou Irene , Moreno Pablo , Manning Jonathan , Fuentes Alfonso Muñoz-Pomer , George Nancy , Fexova Silvie , Fonseca Nuno A , Füllgrabe Anja , Green Matthew , Huang Ni , Huerta Laura , Iqbal Haider , Jianu Monica , Mohammed Suhaib , Zhao Lingyun , Jarnuczak Andrew F , Jupp Simon , Marioni John , Meyer Kerstin , Petryszak Robert , Prada Medina Cesar Augusto , Talavera-López Carlos , Teichmann Sarah , Vizcaino Juan Antonio , Brazma Alvis
Published: October 2019

Expression Atlas is EMBL-EBI’s resource for gene and protein expression. It sources and compiles data on the abundance and localisation of RNA and proteins in various biological systems and contexts and provides open access to this data for the research community. With the increased availability of single cell RNA-Seq datasets in the public archives, we have now extended Expression Atlas with a new added-value service to display gene expression in single cells. Single Cell Expression Atlas was launched in 2018 and currently includes 123 single cell RNA-Seq studies from 12 species. The website can be searched by genes within or across species to reveal experiments, tissues and cell types where this gene is expressed or under which conditions it is a marker gene. Within each study, cells can be visualized using a pre-calculated t-SNE plot and can be coloured by different features or by cell clusters based on gene expression. Within each experiment, there are links to downloadable files, such as RNA quantification matrices, clustering results, reports on protocols and associated metadata, such as assigned cell types.
The Race to the Bottom Revisited: International Labour Law, Global Trade and Evolutionary Game Theory
Authors: Menashe Maayan
Published: October 2019

This article revisits the ‘race to the bottom’ in international labour law, in light of new developments in evolutionary and epistemic game theory and considering new empirical findings on the economic effects of labour rights. Accordingly, it explores two solutions to this collective action problem not previously analysed in labour law literature—‘indeterminate play’ and the ‘correlating device’—and it shows how these solutions relate to international trade law and international labour law. Moreover, a new perspective is offered, according to which international labour law and international trade law can be complementary in fostering global co-operation on labour regulation and in supporting development efforts. Through a novel characterisation of global labour governance according to three game theoretical models, this study ultimately highlights the importance of freedom of association and collective bargaining in enhancing co-operation among states and promoting processes by which countries’ social and economic development can be incrementally raised.
Arabidopsis FLYING SAUCER 2 Functions Redundantly with FLY1 to Establish Normal Seed Coat Mucilage
Authors: Kunieda Tadashi , Hara-Nishimura Ikuko , Demura Taku , Haughn George W
Published: October 2019

Following exposure to water, mature Arabidopsis seeds are surrounded by a gelatinous capsule, termed mucilage. The mucilage consists of pectin-rich polysaccharides, which are produced in epidermal cells of the seed coat. Although pectin is a major component of plant cell walls, its biosynthesis and biological functions are not fully understood. Previously, we reported that a transmembrane RING E3 ubiquitin ligase, FLYING SAUCER 1 (FLY1) regulates the degree of pectin methyl esterification for mucilage capsule formation. The Arabidopsis thaliana genome has a single FLY1 homolog, FLY2. In this study, we show that the FLY2 protein functions in mucilage modification together with FLY1. FLY2 was expressed in seed coat epidermal cells during mucilage synthesis, but its expression level was much lower than that of FLY1. While fly2 showed no obvious difference in mucilage capsule formation from wild type, the fly1 fly2 double mutants showed more severe defects in mucilage than fly1 alone. FLY2-EYFP that was expressed under the control of the FLY1 promoter rescued fly1 mucilage, showing that FLY2 has the same molecular function as FLY1. FLY2-EYFP colocalized with marker proteins of Golgi apparatus (sialyltransferase-mRFP) and late endosome (mRFP-ARA7), indicating that as FLY1, FLY2 controls pectin modification by functioning in these endomembrane organelles. Furthermore, phylogenetic analysis suggests that FLY1 and FLY2 originated from a common ancestral gene by gene duplication prior to the emergence of Brassicaceae. Taken together, our findings suggest that FLY2 functions in the Golgi apparatus and/or the late endosome of seed coat epidermal cells in a manner similar to FLY1.