bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on Happening and Extincting Mechanism of a Squall Line along the Eastern Helan Mountain
Authors: Wei Li , Guoping Hong , Jianhua Mu , Jia He , Jun Yan , Hejiang Zuo
Published: June 2021

In the afternoon of June 17, 2020, a squall line occurred over the eastern region of Helan Mountain in Ningxia, accompanied by lightning, strong wind and short-term heavy precipitation, which affected north and middle part of Ningxia and Wuhai of Inner Mongolia. Basing on the Doppler radar data and conventional meteorological observation data, the weather process was analyzed. the results show that: (1) the cold air from the middle and high latitudes intersected with the near surface warming air in Alashan of Inner Mongolia, which promoted the development of convection and induced the formation of squall line; (2) the temperature and pressure field at high and low level were asymmetrical and the weather system presented a forward tilting structure, which was conducive to the occurrence of strong convective weathers such as squall line; (3) the squall line strengthened when moving across Helan Mountain due to the topographic uplifting and the strong vertical wind shear;(4) After moving into north and middle part of Ningxia, the convergence and divergence configuration of the squall line weakened, the circulation energy faded and the convective structure and circulation field became incomplete gradually, the inclined sinking airflow in the back of the squall line gradually weakened due to the precipitation.
Research on the Influence of Smoke Vents on the Smoke Temperature in the Dormitory Corridor
Authors: Zhang Yujin
Published: June 2021

A simplified dormitory corridor model was established in this paper to simulate the fire in the dormitory and its corridor with Fire Dynamics Simulator (FDS). By exploring the distribution and change law of temperature and smoke in the dormitory and corridor, the author found out the development characteristics of dormitory fire and the influence of different natural smoke vent heights on the change of smoke temperature, which can provide a certain theoretical basis for dormitory construction design, effective control of dormitory fire smoke, personnel evacuation and fire suppression.
Experimental investigation into the influences of water loss on the exothermic process of alum-based phase change materials
Authors: Zhong Dong
Published: June 2021

Zero-emission solar heating is one of the most promising path to solve the energy crisis, Increasing conversion efficiency of thermal energy is the kernel of the problem. Herein, to this day, efficiency of solar heating system is seriously restricted by the randomness, dispersion and intermittency of solar energy. In modern energy science, efficient storage and release of thermal energy is the major way to overcome the fluctuation of energy source. Alum-based phase change materials (AHS) have large phase change enthalpy and material density, especially for aluminum ammonium sulfate dodecahydrate (NAS), but its application is restricted by instability in thermal storage and release cycles. However the key factors affecting their stability are still unclear. In this paper, by studying and comparing the effect of heating duration near the boiling point of water on the crystallization process of NAS/aluminum potassium sulfate dodecahydrate (KAS), we consider that water loss is the main reason for their poor reproducibility, which determines the concentration of nucleation basic units. With detailed analysis, it’s suggested that difference between K+ and NH4+ in polarization is primarily accounted for obvious distinction between NAS and KAS on crystallization with water loss. This work may provide a powerful guidance to the thermal performance of AHS in solar thermal conversion and promote its application in future.
In-depth analysis reveals complex molecular aetiology in a cohort of idiopathic cerebral palsy
Authors: Li Na , Zhou Pei , Tang Hongmei , He Lu , Fang Xiang , Zhao Jinxiang , Wang Xin , Qi Yifei , Sun Chuanbo , Lin Yunting , Qin Fengying , Yang Miaomiao , Zhang Zhan , Liao Caihua , Zheng Shuxin , Peng Xiaofang , Xue Ting , Zhu Qianying , Li Hong , Li Yan , Liu Liru , Huang Jingyu , Liu Li , Peng Changgeng , Kaindl Angela M , Gecz Jozef , Han Dingding , Liu Dong , Xu Kaishou , Hu Hao
Published: June 2021

Cerebral palsy is the most prevalent physical disability in children; however, its inherent molecular mechanisms remain unclear. In the present study, we performed in-depth clinical and molecular analysis on 120 idiopathic cerebral palsy families, and identified underlying detrimental genetic variants in 45% of these patients. In addition to germline variants, we found disease-related postzygotic mutations in ∼6.7% of cerebral palsy patients. We found that patients with more severe motor impairments or a comorbidity of intellectual disability had a significantly higher chance of harbouring disease-related variants. By a compilation of 114 known cerebral-palsy-related genes, we identified characteristic features in terms of inheritance and function, from which we proposed a dichotomous classification system according to the expression patterns of these genes and associated cognitive impairments. In two patients with both cerebral palsy and intellectual disability, we revealed that the defective TYW1, a tRNA hypermodification enzyme, caused primary microcephaly and problems in motion and cognition by hindering neuronal proliferation and migration. Furthermore, we developed an algorithm and demonstrated in mouse brains that this malfunctioning hypermodification specifically perturbed the translation of a subset of proteins involved in cell cycling. This finding provided a novel and interesting mechanism for congenital microcephaly. In another cerebral palsy patient with normal intelligence, we identified a mitochondrial enzyme GPAM, the hypomorphic form of which led to hypomyelination of the corticospinal tract in both human and mouse models. In addition, we confirmed that the aberrant Gpam in mice perturbed the lipid metabolism in astrocytes, resulting in suppressed astrocytic proliferation and a shortage of lipid contents supplied for oligodendrocytic myelination. Taken together, our findings elucidate novel aspects of the aetiology of cerebral palsy and provide insights for future therapeutic strategies.
Social Network Analysis of the Panama Papers Concentrating on the MENA Region
Authors: Al shboul Bashar , Rabab’ah Abdullateef , Al-Ayyoub Mahmoud , Jararweh Yaser , Baker Thar
Published: June 2021

The release of millions of financial documents, which has been known as the ‘WikiLeaks’ of the financial world (a.k.a. ‘Panama Papers’), has dragged global attention in how highly structured means applied by some of the elite to conceal their financial assets. Consequently, significant financial corruption allegations were raised. We concentrate on a somewhat overlooked region, the Middle East and North Africa (MENA) region. This study aims to use social network analytics to study the information contained in these documents. We are checking the major players in the MENA’s trends and patterns to determine if it matches the known economic powers. The analysis reveals that while the constructed network enjoys some typical characteristics, many interesting observations and properties are worth discussing. Specifically, using the extracted network consisting of 62 987 nodes and 84 692 edges, our social network analysis finding shows that, perhaps surprisingly, the nodes or the social network are not necessarily directly correlated with perceived economic influence.
Long-Term Safety and Efficacy of Risankizumab Treatment in Patients with Crohn’s Disease: Results from the Phase 2 Open-Label Extension Study
Authors: Ferrante Marc , Feagan Brian G , Panés Julián , Baert Filip , Louis Edouard , Dewit Olivier , Kaser Arthur , Duan W Rachel , Pang Yinuo , Lee Wan-Ju , Gustafson Dawn , Liao Xiaomei , Wallace Kori , Kalabic Jasmina , D’Haens Geert R
Published: June 2021

Background and Aims

Risankizumab, an interleukin-23 antibody, demonstrated efficacy and acceptable safety in a phase 2 study of patients with moderate-to-severe refractory Crohn’s disease. This open-label extension investigated the long-term safety, pharmacokinetics, immunogenicity and efficacy of risankizumab in responders to risankizumab in the parent phase 2 study.

Methods

Enrolled patients had achieved clinical response [decrease in Crohn’s Disease Activity Index from baseline ≥100] without clinical remission [Crohn’s Disease Activity Index <150] at Week 26, or clinical response and/or remission at Week 52 in the parent phase 2 study and received open-label subcutaneous risankizumab 180 mg every 8 weeks.

Results

Sixty-five patients were enrolled, including four who had lost response in the parent study and were first reinduced with risankizumab 600 mg every 4 weeks [three infusions]. Patients received risankizumab for a median of 33 months [total: 167.0 patient-years]. The rate of serious adverse events was 24.6 events/100 patient-years; the majority were gastrointestinal in nature. Rates of serious infections, opportunistic infections and fungal infections were 4.2, 1.8, and 6.6 events/100 patient-years, respectively. No deaths, malignancies, adjudicated major adverse cardiovascular events, latent/active tuberculosis or herpes zoster were reported. Treatment-emergent anti-drug antibodies developed in eight patients [12.3%]; none were neutralizing. Efficacy outcomes were maintained during the study, including the proportions of patients [observed analysis] with clinical remission [>71%] and endoscopic remission [>42%].

Conclusions

Long-term maintenance treatment with subcutaneous risankizumab 180 mg every 8 weeks was well tolerated by patients with Crohn’s disease, with no new safety signals.

Clinical trial registration number: NCT02513459
PBP4-mediated β-lactam resistance among clinical strains of Staphylococcus aureus
Authors: Satishkumar Nidhi , Alexander J Andrew N , Poon Raymond , Buggeln Emma , Argudín Maria A , Strynadka Natalie C J , Chatterjee Som S
Published: June 2021

Background

PBP4, a low-molecular-weight PBP in Staphylococcus aureus, is not considered to be a classical mediator of β-lactam resistance. Previous studies carried out by our group with laboratory strains of S. aureus demonstrated the ability of PBP4 to produce β-lactam resistance through mutations associated with the pbp4 promoter and/or gene. Recent studies of β-lactam-resistant clinical isolates of S. aureus have reported similar mutations associated with pbp4.

Objectives

To determine if pbp4-associated mutations reported among clinical strains of S. aureus mediate β-lactam resistance.

Methods

The pbp4 promoters and genes bearing mutations from clinical isolates were cloned into a heterologous host. Reporter, growth and Bocillin assays were performed to assess their role in β-lactam resistance. X-ray crystallography was used to obtain acyl-enzyme intermediate structures of the WT and mutant PBP4 with nafcillin and cefoxitin.

Results

Of the five strains that contained pbp4 promoter mutations, three strains exhibited enhanced expression of PBP4. The R200L mutation in pbp4 resulted in increased survival in the presence of the β-lactams nafcillin and cefoxitin. Further, introduction of either a promoter or a gene mutation into the genome of a WT host increased the ability of the strains to resist the action of β-lactams. The four high-resolution X-ray structures presented demonstrate the binding pose of the β-lactams tested and provide hints for further drug development.

Conclusions

Mutations associated with the pbp4 promoter and pbp4 gene altered protein activity and mediated β-lactam resistance among the clinically isolated strains that were studied.
Clinical Value of Consensus Molecular Subtypes in Colorectal Cancer: A Systematic Review and Meta-Analysis
Authors: ten Hoorn Sanne , de Back Tim R , Sommeijer Dirkje W , Vermeulen Louis
Published: June 2021

Background

The consensus molecular subtypes (CMSs) of colorectal cancer (CRC) capture tumor heterogeneity at the gene-expression level. Currently, a restricted number of molecular features are used to guide treatment for CRC. We summarize the evidence on the clinical value of the CMSs.

Methods

We systematically identified studies in Medline and Embase that evaluated the prognostic and predictive value of CMSs in CRC patients. A random-effect meta-analysis was performed on prognostic data. Predictive data were summarized.

Results

In local disease, CMS4 tumors were associated with worse overall survival (OS) compared with CMS1 (hazard ratio [HR] = 3.28, 95% confidence interval = 1.27 to 8.47) and CMS2 cancers (HR = 2.60, 95% confidence interval = 1.93 to 3.50). In metastatic disease, CMS1 consistently had worse survival than CMS2-4 (OS HR range = 0.33-0.55; progression-free survival HR range = 0.53-0.89). Adjuvant chemotherapy in stage II and III CRC was most beneficial for OS in CMS2 and CMS3 (HR range = 0.16-0.45) and not effective in CMS4 tumors. In metastatic CMS4 cancers, an irinotecan-based regimen improved outcome compared with oxaliplatin (HR range = 0.31-0.72). The addition of bevacizumab seemed beneficial in CMS1, and anti-epidermal growth factor receptor therapy improved outcome for KRAS wild-type CMS2 patients.

Conclusions

The CMS classification holds clear potential for clinical use in predicting both prognosis and response to systemic therapy, which seems to be independent of the classifier used. Prospective studies are warranted to support implementation of the CMS taxonomy in clinical practice.
Exploiting genotype × management interactions to increase rainfed crop production: a case study from south-eastern Australia
Authors: Hunt James R , Kirkegaard John A , Harris Felicity A , Porker Kenton D , Rattey Allan R , Collins Marisa J , Celestina Corinne , Cann David J , Hochman Zvi , Lilley Julianne M , Flohr Bonnie M
Published: June 2021

Crop yield must increase to keep pace with growing global demand. Past increases in crop production have rarely been attributable to an individual innovation but have occurred when technologies and practices combine to form improved farming systems. Inevitably this has involved synergy between genotypic and management improvements. We argue that research focused on developing synergistic systems that overcome clear production constraints will accelerate increases in yield. This offers the opportunity to better focus and multiply the impact of discipline-focused research. Here we use the rainfed grain production systems of south-eastern Australia as a case study of how transformational change in water productivity can be achieved with research focused on genotype × management synergies. In this region, rainfall is low and variable and has declined since 1990. Despite this, growers have maintained yields by implementing synergistic systems combining innovations in (i) soil water conservation, (ii) crop diversity, (iii) earlier sowing, and (iv) matching nitrogen fertilizer to water-limited demand. Further increases are emerging from synergies between genetic improvements to deliver flowering time stability, adjusted sowing times, and potential dual-purpose use. Collaboration between agronomists, physiologists, and crop breeders has led to development of commercial genotypes with stable flowering time that are in early phases of testing and adoption.
Six Steps to Managing Alzheimer's Disease and Dementia
Authors: Budson Andrew E. , O'Connor Maureen K.
Published: June 2021

Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families explains everything that a family member or other caregiver needs to care for their loved one with Alzheimer’s disease or another dementia, all the way from the mild stage through death—and beyond. It begins by explaining Alzheimer’s and dementia, and how to manage problems with memory, language, vision, emotion, behavior, sleep, and bodily functions. Next discussed are which medications help—and which make things worse. Caring for yourself and building a care team are then covered, as well as how to sustain your relationship. Final chapters discuss the progression of dementia, the eventual death, and how to plan for life afterward. It is written in an easy-to-read style, featuring clinical vignettes and character-based stories that provide real-life examples of how to successfully manage Alzheimer’s disease and dementia.
What is Alzheimer’s disease?
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

Alzheimer’s is a disease in which amyloid plaques build up in the brain. The plaques damage brain cells, the cells develop tangles, and the tangles destroy the cells. Alzheimer’s disease begins silently and progresses through very mild, mild, moderate, and severe stages. Age, being a woman, and family history are risk factors for the disease. Tests using a lumbar puncture or PET scan can help to confirm the diagnosis of Alzheimer’s disease, but they are only used in special circumstances. Lastly, you can reduce your risk of developing Alzheimer’s disease by eating a Mediterranean-style diet, engaging in aerobic exercise, and staying socially active.
How to manage memory problems
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

There are many way to help manage your loved one’s memory problems. If their dementia is fairly mild, memory strategies and aids can often help. Using a pillbox or another method to ensure that medications are being taken correctly is critical. Pictures are more easily learned than words. Don’t tell a person with dementia what not to do; tell them what they should do. Habits and routines are generally preserved in dementia, and new ones can be learned. Use methods to make sure the stove is not left on and the water is not left running. Work to eliminate wandering and write a plan in case it occurs. Take advantage of technological solutions to memory problems. Use reminders of the past to make your loved one feel more at home. Don’t fight false memories. Lastly, reminding your loved one that they have memory problems is rarely helpful.
How to manage vision problems
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

Whether caused by dementia or an eye disease, problems with vision can disrupt your loved one’s function, create hallucinations, and even lead them to think you are an imposter. There are, however, many things you can do to help. Start with an eye examination to make sure their eyeglasses prescription is correct and to look for treatable diseases. Ensure adequate lighting in and around their home and increase visual cues in potentially hazardous areas, such as stairs. Adjust for difficulty seeing or paying attention on one side. Increase visual contrast and size of numbers and letters for their daily activities. Use navigation systems with audible directions. Reduce the impact of hallucinations. Lastly, manage difficulties when your loved one does not recognize you, thinks you are someone else, or believes that you have been replaced by an imposter.
Which medications can worsen thinking, memory, behavior, or function?
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

Many medications may cause memory impairment, drowsiness, and confusion. Make sure that you know and keep track of all the medications your loved one is taking, including prescriptions, over-the-counter medications, vitamins, herbs, and supplements. Review these medications with their doctor. When possible, stop or lower the dose of medications that are causing problems. There are a variety of medications that can produce impairments in thinking and memory, including anticholinergic medications; antidepressants; antihistamines; antipsychotics; anxiety medications (benzodiazepines); dizziness and vertigo medications; incontinence medications (antispasmodics); migraine medications; muscle relaxants; narcotics (opioids); nausea, stomach, and bowel medications; seizure medications (anticonvulsants); sleeping medications; tremor medications; and herbal remedies. Consider anesthesia and cancer treatments carefully. Lastly, note that cholesterol-lowering medications do not cause memory problems.
Which medications can improve thinking, memory, behavior, or function?
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

Dementia disrupts a number of brain chemicals, and medications may be helpful to restore the balance of these neurotransmitters. When considering a new medication, it is important to set clear, measurable goals; start with a low dose; and track the effects over time. Cholinesterase inhibitors help with memory, mood, behavioral problems, and hallucinations; memantine helps with attention, alertness, mood, and behavioral problems; selective serotonin reuptake inhibitors (SSRIs) help with mood, anxiety, and behavioral problems; dextromethorphan/quinidine helps with inappropriate laughing or crying as well as behavioral problems; melatonin and acetaminophen help with sleep; atypical neuroleptics help with agitation, aggression, delusions, hallucinations, and picking; carbidopa/levodopa helps with walking, movement, and parkinsonian tremors; and beta blockers help with essential tremor. Clinical trials of new medications being developed may be available for those who are looking for better treatments for their loved one and for the next generation.
How to plan for the progression of dementia
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

As your loved one begins to experience more problems with thinking and memory, they will need help managing their health care, finances, and other aspects of daily living. They may need to leave their home in order to receive the amount or type of care they require. Preparing legal documents such as a will, power of attorney, and health care proxy is an important step in planning for the future. Having conversations with your loved one early after a diagnosis ensures that they can participate in future planning as much as possible, easing your burden as increased care is required. Even if they don’t want to participate, you can still explore options so you will be ready when a crisis occurs.
The Management of Terror
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter addresses the psychological impact of life-threatening disease of acute onset. Anxiety may be profound in this circumstance, with the severity of symptoms often meeting criteria for acute stress disorder (ASD) or posttraumatic stress disorder (PTSD) in both patients and family caregivers. The nature of traumatic stress and the ways in which it may be alleviated by Managing Cancer and Living Meaningfully (CALM) therapy are described here. Terror management theory (TMT), including the psychological pillars that protect individuals from the fear of death, is introduced as a model to understand how death anxiety is managed when mortality salience is heightened. The influence of TMT in formulating our research and in developing the CALM intervention is described here.
Attachment Security
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter provides an overview of the construct of attachment security and describes the threat to this security that may arise in response to the diagnosis or progression of advanced disease. The heightened mortality salience that occurs in this context activates the attachment system, and increased dependency and caregiving needs frequently require an adjustment or renegotiation of attachment security. Attachment security protects from death anxiety and other forms of distress, and so the renegotiation of attachment relationships is often an urgent task that is needed to maintain or restore emotional equilibrium. This chapter explains the central role of attachment security in the Managing Cancer and Living Meaningfully (CALM) intervention, in which the therapeutic relationship can provide a secure base to process distressing thoughts and feelings and to face the challenges that inevitably occur.
The Pearl in the Oyster
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter considers the phenomenon of posttraumatic growth (PTG) in the context of advanced cancer, drawing upon both theory and empirical research. The concept of PTG refers to improvements that have been postulated to occur in psychological, interpersonal, and spiritual domains as a result of successful coping with trauma. Various theoretical models of PTG are described and compared and the controversy as to whether PTG is a real, observable phenomenon is explored. The chapter specifically considers the unique emergence of PTG in advanced cancer, the measurement tools that have been used, and the methodological challenges of research examining this relationship. Finally, the potential of Managing Cancer and Living Meaningfully (CALM) to promote psychological growth in patients with advanced cancer is explored.
The Context of CALM
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter provides an overview of the range of psychotherapeutic interventions that have been applied to patients with advanced and metastatic cancer and the relationship of Managing Cancer and Living Meaningfully (CALM) to the field. Approaches to alleviate distress at the time of diagnosis of advanced or life-threatening cancer, those for patients near the end of life, and those for patients living with metastatic and advanced cancer are discussed. The latter include supportive-expressive, meaning-centered, cognitive-behavioural, mindfulness-based, and grief therapies tailored for individuals, groups, and families. Interventions tailored for the end of life, including Dignity Therapy, Short-Term Life Review, and narrative interventions, are reviewed. The barriers to the optimal delivery of psychosocial interventions for patients with advanced disease are also explored.
The CALM Domains
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter describes the four domains of Managing Cancer and Living Meaningfully (CALM), which represent the general content themes that patients are given the opportunity to address over the course of CALM therapy. These domains—namely, symptom management and communication with healthcare providers; changes in self and relations with close others; spirituality or sense of meaning and purpose; and thinking about the future, hope, and mortality—are discussed here in detail. The general therapeutic goals of exploration in each domain are outlined, with suggested probes to initiate discussion. Case examples, which include potential therapeutic responses and non-CALM responses, are provided to enhance understanding of therapeutic intent within each domain.
CALM Therapy Cases
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter contains case summaries and brief case examples, based on actual patients treated with Managing Cancer and Living Meaningfully (CALM), to illustrate the process of CALM therapy and the common issues that may arise. The case summaries, which include individual and couples-based cases, elucidate the process of CALM as it unfolds from the initial session to the final meeting. Brief case examples are also presented to highlight potential CALM challenges.
Introduction
Authors: Gross Michael L.
Published: June 2021

“Can military medicine be ethical?” is one question that may puzzle readers whose knowledge of medical ethics since 9/11 is colored by the prisons of Abu Ghraib and Guantanamo Bay. To address these and other challenges, Military Medical Ethics in Contemporary Armed Conflict explores controversial topics that include preferential care for compatriot warfighters, force feeding detainees, weaponizing medicine to wage war, medical experimentation, and neural enhancement for warfighters. Less controversial but no less compelling concerns direct our attention to postwar justice: the duty to rebuild war-torn nations and the obligation to care for war-torn veterans.
Moral Reasoning in Military Medical Ethics
Authors: Gross Michael L.
Published: June 2021

Applied ethics must resolve moral dilemmas, because, at the end of the day, medical personnel and military commanders must act. Reaching a defensible ethical decision requires moral agents to define the military and medical mission clearly and answer the following questions. Is the proposed operation or policy an effective and necessary means to attain the mission’s goals? Are the costs proportionate, keeping in mind that costs include military, medical, and moral costs? Finally, is the deliberative forum appropriate? Military medical ethics entails private (doctor-patient) and public discourse. Public discourse or deliberation engages the political community and its institutions. It requires widespread participation, well-reasoned arguments, reasonable pluralism, and, ultimately, responsive public policy.
Military Medicine in Contemporary Armed Conflict
Authors: Gross Michael L.
Published: June 2021

In the Iraq and Afghanistan wars (2001 and ongoing), military medicine saved more wounded than in any previous conflict. Improvised explosive devices (IEDs) injured tens of thousands of the more than three million warfighters deployed. Prominent wounds included multisystem injuries, traumatic brain injuries, limb loss, and post-traumatic stress (PTSD). To care for wounded service personnel, multinational forces established in-theater facilities for lightly and moderately wounded, while evacuating the critically injured to Europe and the United States. Coalition facilities could not offer comprehensive medical attention to host-nation allies or civilians. As the fighting progressed, multinational forces teamed up with local government agencies to slowly rebuild local medical infrastructures through Medical Civic Action Programs (MEDCAP) and Provincial Reconstruction Teams (PRT). As the conflicts wind down, Coalition nations face their responsibility to rebuild each country and to tend discharged veterans at home. Both tasks prove daunting.
Combat Casualty Care
Authors: Gross Michael L.
Published: June 2021

To deliver combat casualty care to warfighters, multinational forces deploy medical units to provide immediate front-line treatment, transfer the injured to in-theater combat hospitals, and evacuate the critically wounded to Europe and the United States. With bed space limited, Coalition medical facilities developed medical rules of eligibility to regulate the flow of multinational patients, host-nation allies, detainees, and local civilians. While multinational patients received unreserved medical attention, local nationals were, at best, only eligible for emergency care before transfer to poorly equipped local facilities. Despite legal provisions that stipulate impartial care based solely on urgent medical need, medical personnel attended to patients based on national identity and military status. Military necessity sometimes permits treating moderately injured warfighters before the critically ill to return the former to duty. Appealing to associative duties, however, allows military medical providers to deliver preferential care to compatriots despite urgent medical need elsewhere.
Postwar Healthcare Reconstruction
Authors: Gross Michael L.
Published: June 2021

Following humanitarian wars, multinational forces incur an obligation to rebuild. As international donors and local authorities rebuilt healthcare services in Iraq and Afghanistan, life expectancy and vaccination rates increased while infant and maternal mortality decreased. Using health to enhance state-building, however, was less successful. State-building is an ambitious undertaking that requires legitimacy, governance, essential services, and human security. Although health care can foster trust between the government and its citizens, Iraq and Afghanistan show only slight progress toward constructing secure, stable nations. War-torn countries, however, are not the only eligible recipients for reconstruction aid. Any severely fragile and destitute state has a claim for assistance and healthcare aid against the international community. To get the most of their resources, therefore, donor states must apportion aid to those states with the best chances of providing their citizens with a decent and dignified life.
Conclusion
Authors: Gross Michael L.
Published: June 2021

Rounding out Military Medical Ethics in Contemporary Armed Conflict, the conclusion first highlights the signposts that lead the reader to understand how the ethics of war is inseparable from the ethics of military medicine. Military medicine must serve just war. Historically, just wars are defensive or humanitarian. But things may change. So next, we look to the future. Past wars do not necessarily predict coming conflicts. Future wars will see novel weapons and new adversaries drawing from nation-states, nonstates, criminals, and unknown assailants. Nevertheless, the experience of recent wars, particularly those in Iraq and Afghanistan, offers important lessons to guide military medicine as war evolves into ways we can anticipate and in ways we cannot.
Sleep Through the Ages: Adults and Older Adults
Authors: Dzierzewski Joseph M. , Raldiris Tarah , Ravyts Scott
Published: June 2021

Sleep is essential for optimal physical and mental health, particularly in late-life. Thus, knowledge regarding age-related changes in sleep are of particular importance. This chapter begins by synthesizing existing research regarding the normative changes in sleep architecture, timing, and duration which occur from middle age to late-life. These normative changes are characterized by less N3 sleep, earlier bed and wake times, and shorter overall nocturnal sleep duration. The chapter concludes by providing an overview of common sleep disorders in older adulthood, including circadian rhythm disorder, sleep disordered breathing, and insomnia. These sleep disorders become more prevalent with age and are frequently associated with declines in functioning. Overall, though changes in sleep in late-life are common, they tend to occur gradually, with a significant portion of older adults able to maintain adequate sleep as they age.
Light and Sleep
Authors: Reid Morgan P. , Dautovich Natalie D. , Dzierzewski Joseph M.
Published: June 2021

Sleep has been consistently demonstrated as a key component of overall health, and poor sleep is associated with various negative physical, cognitive, and mental health outcomes. Optimal sleep requires the sleep–wake circadian rhythm to be synchronized to a 24-hour period. Light is a key determinant in the synchronization of the circadian rhythm to this period. Exposure to bright light in the morning can advance the sleep period, while bright light in the evening can delay the sleep period and lead to negative sleep outcomes. The home environment should make appropriate use of light so as to optimize sleep and eliminate environmental light pollution. Light can also be utilized to treat circadian phase sleep disorders.
Sleep: A Traditional Chinese Medicine Perspective
Authors: Holland Alex
Published: June 2021

In this chapter, the use of Traditional Chinese Medicine (TCM) for the treatment of insomnia and other sleep-related conditions is explored. The language of TCM often appears impenetrable to Western researchers, but TCM represents a centuries-old complete, viable, and integrated medical system. The author provides a review of the language of TCM that allows the reader to come to an understanding of the mechanisms for why insomnia occurs, why acupuncture is used in its treatment, and how insomnia is diagnosed in terms of pattern identification using signs and symptoms for differential diagnosis. In addition, sample treatment protocols for both acupuncture and Chinese herbal medicine are presented.
Diagnosis and Treatment of the Central Disorders of Hypersomnolence
Authors: Maness Caroline , Marie Trotti Lynn
Published: June 2021

The central disorders of hypersomnolence (CDH) are lifelong conditions that cause an irrepressible need for sleep during waking hours. Some of these disorders are due to medications or other conditions, but narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) occur as primary conditions. In each disorder excessive daytime sleepiness (EDS) may be accompanied by ancillary features such as sleep paralysis, hypnagogic/hypnopompic hallucinations, sleep drunkenness, or, in the case of NT1, cataplexy. Polysomnography and a multiple sleep latency test are used for diagnosis. Diagnostic lumbar puncture may be performed to differentiate NT1 from NT2. Although the mainstay of treatment for CDH is currently pharmacotherapy, management may also involve behavioral approaches such as sleep and nap scheduling, dietary modifications, and cognitive-behavioral therapy. Pharmacologic treatment can include traditional medications such as modafinil, methylphenidate, or sodium oxybate. Novel therapeutic agents such as pitolisant, clarithromycin, flumazenil, and melatonin may be useful in relieving EDS and associated symptoms.
Introduction to Sleep-Disordered Breathing and Treatment
Authors: Martires Joanne S. , Ram Reuben , Wallace Jeanne
Published: June 2021

Sleep-related breathing disorders encompass a wide range of problems that occur during sleep. The most common sleep-related breathing disorder is obstructive sleep apnea syndrome (OSAS). OSAS is increasingly prevalent, underdiagnosed and can lead to significant daytime sleepiness and disability. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS but lack of adherence to CPAP is rampant. Supportive care, education, and motivational enhancement programs do show promise in improving compliance. Alternatives to CPAP such as oral appliances, hypoglossal nerve stimulation, and myofunctional therapy have not been proved as efficacious but may provide some benefit. In the future, personalized treatment may be the best way to approach this condition. Central sleep apnea and hypoventilation are other forms of sleep-related breathing disorders. Treatment largely depends on the underlying condition but may require the use of advanced modes of noninvasive ventilation such as adaptive servo-ventilation, bilevel positive airway pressure, and volume-assured pressure support. Treatment of sleep-related breathing disorders is complex and includes seeking patient input, understanding barriers to treatment, and reevaluating patients after treatment is initiated. Successful treatment of sleep-disordered breathing can lead to improvements in daytime function, quality of life, and overall health.
Technology and Sleep: Wearable Sleep Devices, Apps, and Consumer Products
Authors: Grigsby-Toussaint Diana , Parab Kaustubh Vijay , Shin Jong Cheol
Published: June 2021

The proliferation of various forms of technology has made defining, measuring, and evaluating sleep both exciting and daunting at the same time. In this chapter, the authors summarize both old and new technology used to study sleep, and they highlight its clinical implications. Specifically, the authors discuss white noise machines which have been well-established for nonpharmacological interventions for sleep, as well as more recent technologies such as apps, sleep trackers, deep sleep headbands, and virtual reality games. In all these newer arenas of technology, additional studies are needed to fully assess their impact on sleep outcomes and their applicability to sleep science.
Distal Transradial “Snuffbox” Approach
Authors: Brunet Marie-Christine , Chen Stephanie H. , Jabbour Pascal M. , Peterson Eric C.
Published: June 2021

The distal radial or “snuffbox” approach is a modification of the traditional radial approach that uses a more distal location of the radial artery for puncture. The radial artery at this location is beyond the palmer arch thus puncturing has a theoretically lower risk of hand or thumb ischemia. In addition, the hand is positioned in the neutral position so it is more comfortable for the patient. Finally, the compression times are shorter so the patient can be discharged earlier after diagnostic procedures. This was originally an interventional cardiology innovation because of the frequent use of left radial access in interventional cardiology, but the approach has benefits for right radial access in neurointervention as well. The patient positioning and technical nuances of the snuffbox approach are reviewed.
Left Transradial Approach
Authors: Sweid Ahmad , Peterson Eric C. , Jabbour Pascal M.
Published: June 2021

The left transradial access has an essential role in the cerebrovascular armamentarium in limited indications. Access to the posterior circulation via the left vertebral artery is one of the main indications, in addition to cases that require bilateral access. It has several advantages such as using the non-dominant hand, ergonomic when accessing through the anatomical snuffbox, and overcomes certain anatomical variations. This chapter will delve the advantages, limitations, and technical nuances of the left transradial approach.
Intraoperative Transradial Angiogram
Authors: Sweid Ahmad , Peterson Eric C. , Jabbour Pascal M.
Published: June 2021

Intraoperative angiogram (IOA) is a valuable tool for cerebrovascular surgery. It confirms surgical outcomes for a variety of pathologies. It allows early identification of any residue or compromise of a parent vessel. This chapter will delve into the advantages, limitations, and technical nuances of IOA via a radial approach. IOA is a valuable tool for cerebrovascular surgery. IOA allows early diagnosis and identification of any residue and obviates the need for postoperative diagnostic angiogram. It confirms surgical outcomes for a variety of pathologies such as aneurysm occlusion and parent vessel patency, arteriovenous malformation resection, dural fistula ligation, bypass patency, and adequate carotid revascularization after endarterectomy. Though there are alternatives, such as indocyanine green fluorescence (ICGA) angiography, formal angiography remains the gold standard as it overcomes the limitations of ICGA. Femoral access has been the main approach for IOA with an excellent safety profile. Recently the radial approach has been gaining wide interest among neurointerventionalists, and there are several advantages for the radial approach over the femoral approach in IOA.
Scope and Principles of Neuropsychiatry in the Young
Authors: Taylor Eric
Published: June 2021

This chapter introduces the concept of neurodevelopmental disorders, a group of conditions characterized by onset in early childhood, persistence into adult life, and high rates of altered cognitive and neurological function. Genetic influences are strong and male gender predominates. Such disorders are frequent reasons for referral to psychiatry, paediatrics, and clinical psychology and often require team approaches to meet a variety of needs for service. They used to be regarded as distinct categories of disturbance, but a modern understanding has established them as common conditions, frequently present together and having continuous distribution in the population. Attention disorders, the spectrum of autism, intellectual and learning deficits, language disorders, and abnormalities of movement all figure and commonly account for difficulties in education and the development of problems in personal relationships.
Attention Deficit Hyperactivity Disorder
Authors: Taylor Eric
Published: June 2021

This chapter describes the recognition and associations of the syndrome of attention deficit hyperactivity disorder (ADHD), with special reference to the multitude of associated problems. Inattentiveness, overactivity, and impulsiveness are behaviour styles that predict later disadvantage in education, employment, physical health, substance use, mental health, and personal relationships. They very often coexist with features of oppositional disorders, anxiety, and the autism spectrum. These are considered both as differential diagnoses and as multiple morbidities needing to be recognized. Several cognitive limitations, including in executive function, can be identified by psychological testing. Genetic inheritance is a powerful influence. Neuroimaging is detecting an increasing number of changes in brain structure and function. The problems are widespread, but recognition of the syndrome varies between countries. The diagnosis is increasing in frequency over time. Treatment with stimulant medication is often helpful, but there is considerable controversy about how widely to apply it.
Genetic and Environmental Influences on Early Development
Authors: Taylor Eric
Published: June 2021

This chapter considers the genetic and environmental influences that may lead to the appearance of neurodevelopmental changes in early life. Behavioural genetics considers similarities between individuals in the light of their degree of biological relatedness, and has established high levels of heritability for several problems. Molecular genetics has therefore progressed to identifying individual genes. Single environmental risk factors can be identified and aggregated into a concept of adversity. Defined chromosome and single-gene changes are described for conditions such as Down and fragile-X. They emphasize the power and the complexity of genetic influences. Most complex psychiatric disorders are the result of large numbers of genes of small effect considered individually, but large effect in interactions with each other and with the environment. Environmental influences are considered in this chapter both from the perspectives of gene–environment correlation and interaction, and as known associations that can be causes. Infections, toxins, and deficiencies are described. Challenges from psychosocial adversity are included, together with their possible modes of action.
Conventional echocardiography—basic principles
Authors: Hagendorff Andreas , Stobe Stephan , Tayal Bhupendar
Published: June 2021

Echocardiography is an imaging technique that enables accurate assessment of cardiac structures and cardiac function. Conventional echocardiography involves different modalities—especially the M-mode, the 2D, and colour Doppler, as well as the pulsed-wave and continuous wave Doppler. The M-mode illustrates the reflections of a single sound beam plotted against time. 2D echocardiography enables the documentation of views, which represent characteristic sectional planes of the moving heart during one heart cycle. Colour Doppler echocardiography adds the information of blood flow to the 2D cineloop. Pulsed-wave Doppler is the acquisition of a local blood flow spectrum of a defined region represented by the dimension of the sample volume, whereas continuous wave Doppler displays the blood flow spectrum of all measured blood flow velocities along a straight line sound beam from its beginning to the end. The handling of the transducer has to be target-oriented, stable with respect to the imaging targets, and coordinated with respect to angle differences between the defined views to use all these modalities correctly to get optimal image quality of the cineloops and spectra. Thus, the focus of this chapter will be a mainly practically oriented description of scanning technique in transthoracic and transoesophageal echocardiography.