bluuebunny/crossref_metadata_2025 huggingface dataset:
Drugs of the Mind
Authors: Li Jie Jack
Published: November 2020

Alcohol produces a range of central-nervous-system-related biological effects, including anxiety reduction, euphoria, sedation, disinhibition, aggression, blackouts, tolerance, addiction, and withdrawal. The Chinese have used alcoholic drinks since 5000 B.C. Presumably, man ventured to drink the liquid from fermented grain, liked the intoxicating effect, and started to make it on purpose. Alcohol has been used as an anesthetic for millennia (see chapter 7). Alcohol is indispensable in medicine as a solvent. Laudanum, a staple of the medicine chest in the nineteenth century, was simply an alcoholic solution of opium. NyQuil, a cough syrup, and Listerine, an oral antiseptic, all contain copious amounts of ethanol. Alcohol has beneficial effects when consumed in moderate amounts. Research strongly suggests that moderate consumption of alcohol, especially red wine and dark beer, seems to have protective effects on the heart. The hallmarks of the Mediterranean diet are olive oil and red wine, and people from such countries have fewer cardiovascular events. Flavonoids, the active principle in red wine, are thought to exert beneficial cardiovascular effects. According to the Bible (Genesis 9:20–21), Noah was the first man who discovered wine: “Noah, a man of the soil, was the first to plant a vineyard. When he drank some of its wine, he became drunk and lay uncovered inside his tent.” The New Testament gives an account of Jesus performing his first miracle—turning water into wine. Despite the beneficial effects of moderate alcohol consumption, excessive use of alcohol damages the brain, heart, and liver. Even mild drunkenness can cause temporary loss of memory. The liver metabolizes alcohol with an enzyme called alcohol dehydrogenase, which turns alcohol into acetaldehyde. Because acetaldehyde is acutely toxic, people—including many Asians—who lack alcohol dehydrogenase cannot tolerate much alcohol. This is the reason that their faces become flush when they drink alcohol and that there are fewer incidents of alcoholism in Asians. Alcoholism is known to cause psychosis and alcoholic dementia. To fight the “demon rum,” on January 16, 1919, the U.S. Congress passed the Eighteenth Amendment, prohibiting “the manufacture, sale, or transportation of intoxicating liquors.” It was repealed 14 years later, the only amendment to the U.S. Constitution that has been repealed.
Rate Law and Mechanism
Authors: Jordan Robert B.
Published: November 2020

Once the experimental rate law has been established, the next step is to formulate a mechanism that is consistent with the rate law. The rate law will not uniquely define the mechanism but will limit the possibilities. The proposed mechanism will lead to predictions of trends in reactivity and other types of experiments that can be done to test the proposal. These aspects will be described in later chapters for specific types of reactions. Except for the simplest cases, the development of the rate law from the mechanism can be a messy exercise. The following sections describe some of the assumptions and tricks that can be used. Further discussions can be found in standard textbooks on kinetics. The problem is to determine the most reasonable mechanism(s) which will predict a rate law that is consistent with the observations. Very often this is done by analogy to previous studies on related systems, but there are some general guidelines that can be useful for writing a mechanism that will produce the desired form of the rate law. The mechanism is composed of elementary reactions whose rate laws are implied from the stoichiometry of each reaction. The elementary mechanistic steps are usually unimolecular or bimolecular reactions; termolecular reactions are very rare because of the improbability of bringing three species together. The form of the experimental rate law provides some guidelines for the construction of a mechanism. The following generalizations assume that the reaction is monophasic, but they may apply to individual steps in a multiphasic reaction. It also should be remembered that the experimental rate law may be incomplete because of experimental constraints. Then, the predicted rate law may contain terms not observed experimentally, but it should be possible to show that the extra terms are minor contributors under the conditions of the experiment. For the simplest cases, in which rate = kexp[A][B] or rate = kexp[A], the kinetics only requires a one step mechanism involving the species in the rate law. In the second case, the solvent also may be involved because its concentration will be constant and may be included in kexp .
Stereochemical Change
Authors: Jordan Robert B.
Published: November 2020

The kinetic and mechanistic aspects of this general area tend to be strongly dependent on the particular system. This makes general treatments and explanations impossible, at least at the current stage of understanding. Various aspects of this area have been summarized in some general reviews. Ligands bonded to a metal can undergo a number of structural changes that do not involve complete breaking of the metal-ligand bond(s). Such processes are the subject of the following sections. Many chelate ligands have conformers that can interconvert. For example, the conformers of ethylenediamine interchange by rotation about the carbon-carbon bond, as shown in the following structures: The Ha and Ha' protons are magnetically different from the Hb and Hb' protons, so their interconversion can, in principle, be studied by NMR. These protons may be referred to as exo and endo, respectively. In simple systems, their interconversion is too rapid (k >106 s-1) for this method. However, if there is some constraint (e.g., CH3 groups) or if the coordinating atoms are part of a larger chelate system, then interconversion is slow enough to be detected by NMR. In nonplanar Fe(III)- tetraphenylporphyrinates, the ring inversion rates vary widely, depending on the axial ligand and the substituents on the porphyrin.
Reaction Mechanisms of Organometallic Systems
Authors: Jordan Robert B.
Published: November 2020

The general principles discussed in Chapter 3 also apply to reactions of organometallic complexes. Because these systems do not have a wide range of structurally similar complexes with different metal atoms for comparative studies across the Periodic Table, comparisons are usually made down a particular group. However, there is a wide range of ligands available for studies of entering and leaving group effects. This area has been the subject of several recent reviews. A major difference from the systems discussed in Chapter 3 is that many of these complexes are soluble in organic solvents, including hydrocarbons. This can minimize the complicating factor of solvent coordination, but these solvents often have quite low dielectric constants so that various types of preassociation are more probable. The metal carbonyl family of compounds is typical of the range of structures and reactivities of organometallic complexes. The rate of CO exchange was examined in early studies, and this work is the subject of a recent review. The order of reaction rates is as follows: Where the rate law has been determined, the reaction is first-order in [M(CO)R] and zero-order in [CO]. This implies a D mechanism, since a solvent intermediate is unlikely for the "noncoordinating" solvents. This mechanism also is probable for other ligand substitutions. The main mechanistic exception to the above generalizations is V(CO)6, which has an Ia mechanism for PR3 substitution reactions. This compound is unique in that it is the only 17-electron metal carbonyl and also is by far the most labile. Some kinetic results for substitution on V(CO)6 in hexane are given in Table 5.1. The substitution rates have rather low ΔH* values, and the negative ΔS* values are typical of an associative process. The rates for various entering groups correlate with the basicity rather than the size, as measured by the cone angle. It has been suggested that formation of a 19-electron associative intermediate from a 17-electron reactant is much more favorable than a 20-electron intermediate from an 18-electron reactant.
Inorganic Photochemistry
Authors: Jordan Robert B.
Published: November 2020

Electromagnetic radiation in the form of UV and visible light has long been used as a reactant in inorganic reactions. The energy of light in the 200- to 800-nm region varies between 143 and 36 kcal mol-1, so it is not surprising that chemical bonds can be affected when a system absorbs light in this readily accessible region. Systematic mechanistic studies in this area have benefited greatly from the development of lasers that provided intense monochromatic light sources and from improvements in actinometers to measure the light intensity. Prior to the laser era, it was necessary to use filters to limit the energy of the light used to a moderately narrow region or to just cut off light below a certain wavelength. Pulsed-laser systems also allow much faster monitoring of the early stages of the reaction and the detection of primary photolysis intermediates. The systems discussed in this chapter have been chosen because of their relationship to substitution reaction systems discussed previously. For a broader assessment of this area, various books and review articles should be consulted. Mechanistic photochemistry incorporates features of both electron-transfer and substitution reactions, but the field has some of its own terminology, which is summarized as follows: The quantum yield,F , is the number of defined events, in terms of reactant or product, that occur per photon absorbed by the system. An einstein, E, is defined as a mole of photons, and if n is the moles of reactant consumed or product formed, then F = n/E. For simple reactions F£ 1 but can be >1 for chain reactions. An actinometer is a device used to measure the number of einsteins emitted at a particular wavelength by a particular light source. Photon-counting devices are now available and secondary chemical actinometers have been developed, such as that based on the Reineckate ion, Cr(NH3)2(NCS)4-, as well as the traditional iron(III)-oxalate and uranyl-oxalate actinometers. An early problem in this field was the lack of an actinometer covering the 450- to 600-nm range and the Reineckate actinometer solved this problem.
A Practical Guide to Recovery-Oriented Practice
Authors: Davidson Larry , Rowe Michael , Tondora Janis , O'Connell Maria J. , Lawless Martha Staeheli
Published: November 2020

This book takes a lofty vision of "recovery" and of "a life in the community" for every adult with a serious mental illness promised by the U.S. President's 2003 New Freedom Commission on Mental Health and shows the reader what is entailed in making this vision a reality. Beginning with the historical context of the recovery movement and its recent emergence on the center stage of mental health policy around the world, the authors then clarify various definitions of mental health recovery and address the most common misconceptions of recovery held by skeptical practitioners and worried families. With this framework in place, the authors suggest fundamental principles for recovery-oriented care, a set of concrete practice guidelines developed in and for the field, a recovery guide model of practice as an alternative to clinical case management, and tools to self-assess the recovery orientation of practices and practitioners. In doing so, this volume represents the first book to go beyond the rhetoric of recovery to its implementation in everyday practice. Much of this work was developed with the State of Connecticut's Department of Mental Health and Addiction Services, helping the state to win a #1 ranking in the recent NAMI report card on state mental health authorities. Since initial development of these principles, guidelines, and tools in Connecticut, the authors have become increasingly involved in refining and tailoring this approach for other systems of care around the globe as more and more governments, ministry leaders, system managers, practitioners, and people with serious mental illnesses and their families embrace the need to transform mental health services to promote recovery and community inclusion. If you've wondered what all of the recent to-do has been about with the notion of "recovery" in mental health, this book explains it. In addition, it gives you an insider's view of the challenges and strategies involved in transforming to recovery and a road map to follow on the first few steps down this exciting, promising, and perhaps long overdue path.
Stroke
Authors: Lee Hochang Ben , Lipsey John R.
Published: November 2020

With an annual incidence of more than 600,000 cases, thromboembolic stroke is the third leading cause of death in the United States after heart disease and cancer (Kochanek et al., 2004). The number of stroke survivors has increased to 4.5 million adults nationally as the management of acute stroke continues to improve (AHA, 2002). Psychiatric syndromes are common complications of stroke and are associated with psychologic distress, increased impairment, poor rehabilitation outcomes, and excess morbidity. The purpose of this chapter is to describe clinically important poststroke psychiatric disorders and suggest appropriate treatment. Cognitive deficits are the most common psychiatric complication of stroke and affect nearly all stroke survivors. The type of cognitive disturbance depends on the location of the brain injury. Left hemisphere strokes frequently cause aphasia. Right hemisphere strokes cause substantial (but often underrecognized) cognitive impairments such as diminished insight, decreased attention, impaired spatial reasoning, and neglect syndromes. Furthermore, depending on the location of a stroke, other functions such as motivation, memory, judgment, and impulse control may also be affected. A large stroke or a series of small strokes affecting both hemispheres may lead to the global cognitive impairment of dementia. When a series of strokes is involved, the cognitive decline develops in a stepwise manner. This vascular dementia or multi-infarct dementia may be difficult to distinguish from Alzheimer’s disease. Autopsy studies of patients diagnosed with vascular dementia have often demonstrated the presence of Alzheimer’s disease pathology. As many as 25% of all dementia cases are attributable to a combined neuropathology of Alzheimer’s disease and multiple infarcts (Massoud et al., 1999). In addition to strategies such as speech and language therapy, physical and occupational therapy, and cognitive rehabilitation, pharmacologic treatment may improve cognitive deficits in some stroke patients. The parallels between vascular dementia and Alzheimer’s disease, as well as the evidence that reduced cholinergic function may play a role in both (Gottfries et al., 1994) have encouraged the use of acetylcholinesterase inhibitors (eg, donepezil) in vascular dementia. These drugs have shown modest benefits in such patients (Roman et al., 2005), and their use is described in Chapter 20.
Nonpharmacologic Interventions Other Than Psychotherapy
Authors: Lyketsos Constantine G.
Published: November 2020

Several nonpharmacologic interventions are available to the physician for the management of psychiatric disturbances in patients with neurologic disease. These include education, providing day-to-day structure, and caregiver interventions. They are discussed individually in this chapter. Patient education is a critical aspect of management that can reassure patients, help them better understand what is happening to them, reduce distress, promote a stronger clinician– patient relationship, and enhance adherence to treatment.When treating psychiatric symptoms in a patient with neurologic disease, it is important to set aside time to provide such education. Several approaches to patient education might be incorporated. For the patient who has limited insight into his or her psychiatric symptoms, it is important to approach education delicately and nonjudgmentally, emphasizing treatment options without directly confronting the patient about the lack of insight. For example, a man might be told that his symptoms of anxiety, irritability, and trouble sleeping represent a ‘‘mood disorder’’ for which effective treatment is available to reduce his suffering. By focusing on doing something to help, the physician avoids conflict and preserves the clinician–patient relationship while asking the patient to keep an open mind about diagnosis and therapy. For the patient who has better insight, education involves more detailed explanation of the psychiatric diagnosis and the physician’s best judgment about its cause. For example, ‘‘you are seeing things that are very real to you but that others do not see. I have no doubt that these are real to you, and that they are troubling. Many patients with Parkinson’s disease develop such symptoms that we call hallucinations. They may be caused by some of the medication you take for your condition or by the brain damage caused by the Parkinson’s disease. I think we might be able to make them better.’’ Sometimes, and commonly in the context of dementia care, a patient’s condition precludes constructive discussion of diagnosis. The patient may be incapable of understanding or may not even recognize that anything is wrong with him. In some cases, the patient may become upset and agitated if a diagnosis is discussed.
Reflections
Authors: Li Jie Jack
Published: November 2020

The story of statins is a success story for science (both basic and applied) and scientists (in both academia and industry). It contains one of the classic scientific and marketing battles in the history of the pharmaceutical industry. More important, it has been a great boon for the millions of patients who have benefited from statins in preventing coronary heart disease. The story of the statins is a triumph of the heart. Statins, a class of cholesterol-lowering drugs, have revolutionized the landscape of coronary heart disease treatment. Since Merck’s marketing of Mevacor in 1987, the world has benefited from statins in numerous ways. As a class of drugs, statins have set standards on numerous fronts in helping manage LDL cholesterol, one of the major risk factors for coronary heart disease. Statins set a high standard in efficacy, a high standard in safety, and a high standard in financial success for the patients, payers, and the pharmaceutical industry. Not only do statins greatly reduce cholesterol and lower mortality in people at risk for heart attacks, but some studies also suggest that they might help prevent or treat a wide range of ailments, including Alzheimer’s disease, multiple sclerosis, bone fractures, some types of cancer, macular degeneration, and glaucoma. The world has already benefited from the statins in many ways. Low is good, but lower is even better. Fifty years ago, the connection between cholesterol and coronary heart disease was still in question. Twenty years ago, the merit of lowering LDL cholesterol was not even unanimously agreed upon. Cholesterol drugs before the statins, such as resins, niacin, and fibrates, worked to some extent but were also seriously limited by their side effects. Thanks to the emergence of the statins, with Mevacor as the first on the market in 1987, all these questions on the relationship between cholesterol and coronary heart disease are answered beyond any shadow of doubt. Today, the statins have annual sales of more than $20 billion. Hundreds of millions of patients have benefited from statins by delaying and even preventing coronary heart disease.
Energy Needs to 2050
Authors: Crane Hewitt , Kinderman Edwin , Malhotra Ripudaman
Published: November 2020

Having looked at the evolution of energy use and the current state of the energy industry in the previous chapters, we are now ready to make some projections for the future. As the famous Danish physicist Niels Bohr once said, “Prediction is very difficult, especially about the future.” Forecasts of human activity are fraught with uncertainty. This is clearly true of energy forecasts, given that regional and national economic, political, and social trends can change world energy use, as can scientific discoveries and engineering developments unanticipated when the forecast was made. Among the technological changes that have had the largest impact on our pattern of energy consumption, perhaps foremost is the development of the internal combustion engine in transportation, and the accompanying enormous increase in the use of petroleum. The mobility afforded to individuals by automobiles, trains, and later by airplanes greatly shrunk the world, bringing people and economies closer together but also in many cases, unfortunately, helping precipitate international conflicts. Perhaps equally important has been the rise in the use of electricity. The development of the electric power system and its extension beyond urban areas profoundly influenced the daily lives of everyone touched by it. Likewise, the discovery of semiconductors and their application in information technologies, including computers, the Internet, wireless personal communication, and space-based global communication, have altered the way we interact with one another and our surroundings. While the use of these technologies has increased the demand for energy—particularly electricity—it has also contributed immensely to our productivity and thus at the same time helped mitigate the increase. The discovery of atomic fission and its uses in peace and in war have had ramifications in the technological and geopolitical realm. Following the Second World War, great optimism prevailed as exemplified by the statement in 1954 attributed to Lewis Strauss, then chairman of the U.S. Atomic Energy Commission, that nuclear power will be “too cheap to meter.” The ability of nuclear power to deliver electricity abundantly and cheaply helped it become a significant contributor to global primary energy within 20 years.
Our Energy Inheritance: Fossil Fuels
Authors: Crane Hewitt , Kinderman Edwin , Malhotra Ripudaman
Published: November 2020

The use of fossil fuels—petroleum, natural gas, and coal—is ubiquitous today and has made possible the advances of modern civilization. These fuels are capable of providing energy for a variety of applications—from very small to very large—and touch our lives in many ways. A small gas-fired heater uses about 50,000 Btu/hr (1 standard cubic foot [scf] of gas/min) and keeps our homes warm. A 200-horsepower gasoline engine in a family car consumes around 2 gal/hr of oil and can carry a load of five passengers a distance of 60 miles on a level highway. An 1,800-ton/hr cement plant consumes 900 MBtu/hr (about 0.9 million scf gas/hr) when in full operation and produces the building material widely used for constructing homes, offices, industries, roads, and bridges. A large, coal-fired electric power station (1,000 MW rating) requires between 300 and 500 tons of coal per hour and produces enough electricity to power half a million homes. The range of power that fossil fuels, particularly oil, can deliver is truly amazing: the same basic fuel that powers jet aircraft also powers children’s model aircraft engines. It is unlikely that aircraft will ever be powered by solar panels mounted on the wings or by on-board nuclear reactors. The importance of fossil fuels in our lives cannot be overemphasized. It took millions of years to accumulate them, and their potential exhaustion in just a few centuries should seriously concern all of us. In this chapter, we briefly review the circumstances that led to formation of our fossil fuels and then discuss how much of each of them is available. This discussion requires clarifying the special meanings ascribed to such terms as reserves and resources. For all three fuels, we look at the global distribution of our resources. We also present estimates of possible resource lifetimes under varying conditions of use and indicate the nominal equipment and infrastructure requirements for producing these inherited resources at a rate of 1 CMO/yr. As we shall see, our conventional reserves are somewhat limited, but our resource base is large, and unconventional oil and gas resources offer a substantially greater potential. Nonetheless, exploiting unconventional resources is certain to be more expensive and, in most cases, potentially more damaging to the environment.
Management of Blepharoptosis
Authors: Lucarelli Mark J.
Published: November 2020

A thorough understanding of upper eyelid anatomy is essential for the ptosis surgeon. The upper eyelid consists of skin, orbicularis, septum, tarsus, levator, Muller’s muscle, and conjunctiva. The skin and orbicularis form the anterior lamella. Conceptually, the orbicularis may be subdivided according to its topography into pretarsal, preseptal, and orbital components (over the orbital rim and extending to the frontalis muscle superiorly). The orbital septum is a fibrous lamellar structure arising from the periosteum over the superior and inferior orbital rims. In the upper eyelid, the orbital septum fuses with the levator aponeurosis approximately 2 to 5 mm above the superior tarsal border in Caucasians. In Asian patients, the septum extends further inferiorly into the eyelid. Preaponeurotic orbital fat is normally located behind the orbital septum in the preaponeurotic space. The preaponeurotic fat is an important landmark for surgeons as it lies immediately anterior to the levator aponeurosis. The tarsus of the upper eyelid is a firm, dense connective-tissue plate that provides rigidity to the eyelid. The upper tarsal plate measures approximately 10 mm vertically in the center of the eyelid. The tarsal plate is usually 1 mm thick. The levator complex originates from the periorbita of the lesser wing of the sphenoid at the annulus of Zinn. The muscular portion of the levator in adults is approximately 36 mm long, while the aponeurosis is 14 to 20 mm long. The bony attachments of the aponeurosis are via its horizontal expansions, the medial and lateral horns. The lateral horn, which is much stronger than the medial horn, passes through the lacrimal gland and divides it into the palpebral and orbital lobes. The lateral horn attaches to the periorbita of the orbital tubercle and to the lateral canthal tendon. The medial horn is a thin, delicate structure. It attaches loosely with the posterior portion of the medial canthal tendon and curves medially and posteriorly to insert at the posterior lacrimal crest and the adjacent periorbita of the medial orbital wall. Whitnall’s superior transverse ligament (Whitnall’s ligament) is a condensation of the fascial sheaths of the levator muscle located superior to the area of transition of the levator muscle to the levator aponeurosis (musculoaponeurotic junction).
Management of Eyelid Retraction
Authors: Taich Alexander , Hassan Adam S.
Published: November 2020

Eyelid retraction has numerous causes. Most notably eyelid retraction is caused by thyroid eye disease (TED), trauma, and postsurgical changes. The upper eyelid margin is typically measured at 3.5 to 4.5 mm above the center of the cornea. The lower eyelid margin is typically situated at the inferior border of the limbus. Eyelid retraction is a condition in which the upper eyelid margin is displaced superiorly or the lower eyelid margin is displaced inferiorly. Eyelid retraction may result in exposure keratopathy and disturbing ocular symptoms, including blurred vision, photophobia, foreign body sensation, burning, and reactive tearing. Eyelid retraction in TED is thought to be due to a combination of inflammation, fibrosis, and adrenergic stimulation of the eyelid retractors. Proptosis can also contribute to eyelid retraction. In the upper eyelid, factors responsible for eyelid retraction include (1) inflammation and fibrosis of the levator and Müller’s muscles, (2) adrenergic stimulation of Müller’s muscle, and (3) inflammation and fibrosis of the inferior rectus muscle, causing hypodeviation of the globe and compensatory overaction of the superior rectus–levator complex. In the lower eyelid, factors responsible for eyelid retraction include (1) inflammation and fibrosis of the inferior rectus muscle with consequent traction on its anterior extension, the capsulopalpebral fascia, which is the main lower lid retractor, and (2) adrenergic stimulation of the smooth muscle fibers within the lower lid retractor complex. A combination of eyelid retraction and proptosis in TED may result in ocular exposure with symptoms of ocular irritation, an undesirable cosmetic appearance, corneal erosion and infection, or (rarely) globe luxation. Mild exposure problems can be managed with topical lubricants. Guanethidine, a topical sympatholytic agent, is of limited usefulness in the management of eyelid retraction due to its variable efficacy and frequent ocular side effects, including irritation, hyperemia, photophobia, pain, edema, burning sensation, and punctate keratitis. It may be more tolerable if used in lower concentrations. Exposure problems in the inflammatory phase of the condition present a special challenge as surgical correction of eyelid retraction is best performed in the pos-tinflammatory, stable phase. Several reports have described using Botulinum toxin injections, 2.5 to 15 U, either subconjunctivally or percutaneously, just above the superior border of the tarsus.
Surgery of the Lacrimal System
Authors: Dailey Roger A. , Chavez Mauricio R.
Published: November 2020

Obstruction of the tear outflow system can occur anywhere along its course from the tear lake to the inferior meatus of the nose. Surgical techniques designed to relieve this functional or complete obstruction have been available for a long time. Toti of Italy described the dacryocystorhinostomy (DCR) procedure in 1908 as a treatment modality for obstruction of the nasolacrimal duct. His technique did not make use of mucosal flaps. Dupuy-Dutemps of France, on the other hand, encouraged the use of flaps. He recommended suturing together the nasal mucosal and lacrimal sac flaps. The success rate of the operation improved dramatically. Today the external DCR procedure makes use of modifications of both of these historically described procedures. In recent years, intranasal DCR has enjoyed renewed popularity. This procedure had been performed by Lester Jones and others for years but was dropped because the success rate was 80% at best. Although the use of endoscopic techniques and laser technology has been advocated by some authorities, the success rate (approximately 70%) with relatively short-term follow-up has limited its acceptance. More recently, Javate and associates reported a series of patients undergoing endoscopic DCR with the radiofrequency Ellman unit. Their reported success rate of 90% compared favorably with a 94% success rate in 50 age-matched patients undergoing external DCR with a follow-up of 9 months. This rate also compares favorably to the present authors’ success rate of approximately 95% in uncomplicated cases undergoing external DCR and a similar rate with the endoscopic approach without use of a laser. Therefore, the laser does not appear to offer any significant advantage over more traditional intranasal approaches, and the cost may actually be a financial disincentive to its use. The benefit of mitomycin continues to be debated. You and associates performed a prospective study showing favorable long-term success rates with the use of mitomycin. On the other hand, Liu and associates performed a prospective study that demonstrated no benefit. While the DCR works well for lacrimal sac or nasolacrimal duct obstruction, it does not address obstructions of the puncta and canaliculi.
Orbital Exenteration
Authors: Hsu Adam , Esmaeli Bita
Published: November 2020

Orbital exenteration is a surgical procedure that removes varying degrees of the orbital contents and periorbital soft tissue, including periorbital skin, the globe, extraocular muscles, optic nerve, the periorbita, and the orbital fat. In some instances, the disease process may necessitate removal of the bony orbital walls as well. Orbital exenteration is reserved for highly malignant and potentially fatal neoplasms originating from the ocular adnexal structures; ocular tumors with extension to the orbital soft tissue; orbital extension of tumors of the paranasal sinuses or nasal cavity; and orbital extension from intracranial processes. Tumors necessitating orbital exenteration may include squamous cell carcinoma, basal cell carcinoma, sebaceous carcinoma, melanoma of the conjunctiva, uveal melanoma with extrascleral or orbital extension, epithelial cancers such as adenoid cystic carcinoma of the lacrimal gland, rhabdomyosarcoma, and other rare tumors. The indications for orbital exenteration in a number of previously published series are summarized in Table 23-1. In addition to cancers, nonmalignant neoplasms—such as neurofibromatosis causing severe orbital displacement, immobility, and blindness or extensive lymphangioma compromising function and cosmesis—may also lead to orbital exenteration. Nonneoplastic diseases of rapidly infiltrative nature, either inflammatory or infectious, and nonneoplastic diseases associated with refractory orbital pain may also be indications for orbital exenteration. Examples include invasive fungal infections of the orbit such as mucormycosis; orbital socket contracture after enucleation causing severe pain; and extreme cases of Graves orbitopathy unresponsive to other treatment modalities. Orbital exenteration results in complete loss of vision in the affected eye as well as significant disfigurement of the upper face; thus, counseling of the patient prior to surgery and understanding of the patient’s expectations are important to minimize the patient’s distress. During the preoperative interview, the patient’s past medical and surgical history, current medications, coagulation status, and allergies should be ascertained; there should also be a review of systems, with a focus on symptoms of cancer and metastasis. The physical examination should include careful inspection for signs of local or regional extension of disease. Regional lymph node and distant-organ metastasis must be ruled out prior to the decision to proceed with an orbital exenteration.
Manic Mood Disorders
Authors: Fink MD Max
Published: November 2020

Patients suffering from mania are overactive, intrusive, excited, and belligerent. They may believe that they have special powers, are related to public figures, and can read the minds of others. They spend money lavishly. Voices on the radio or television are sometimes understood as personal communications. They speak rapidly, with illogical and confused thoughts, move constantly, and write page after page of nonsense. They typically sleep and eat poorly, have little interest in work, friends, or family, and often require restraint or seclusion. Suicide is a perpetual threat. Some manic patients are likable, while others are angry and frightening. Psychosis is a frequent feature. Manic patients believe that their parents are not their real parents, asserting that they have royal blood. They believe that they can predict the future. They know that others are watching or talking about them, and they hear voices when no one is present. Delusional mania requires more intensive treatment and almost always hospital care. In older classifications of psychiatric illnesses, these patients were considered to be suffering from a manic-depressive illness. In modern classification, this term has been discarded and the illness is now conceived as bipolar disorder for patients with manic and depressive features and major depression for those with depressive symptoms only. Bipolar disorders, ranging from mild to severe, are divided into numerous subtypes. The variety of symptoms that admit the diagnosis of bipolar disorder has led to a virtual epidemic of diagnoses of the condition. Many patients so labeled do not exhibit the sleep difficulty, loss of appetite, and loss of weight, or the severity of illness, that were the criteria for manic-depressive illness. In manic-depressive illness, the manic episode persists for hours, days, weeks, or months and interferes with normal living. Once the episode resolves, it may suddenly recur; or manic episodes may alternate with periods of depression, or occur as simultaneous mixed episodes of depression and mania. When the shift in mood from mania to depression takes place within one or a few days, the condition is labeled rapid cycling, a particularly malignant form of the illness. In manic-depressive illness, the manic episode persists for hours, days, weeks, or months and interferes with normal living.
Writing the Introduction Section
Authors: Robinson Marin S , Stoller Fredricka L , Constanza-Robinson Molly , Jones James K
Published: November 2020

This chapter focuses on the Introduction, the first formal section of the journal article. The Introduction is often the first section to be read (by readers) but the last section to be written (by writers). This is because the Introduction must tell readers “where the article is going and why”, a mission that is most easily accomplished after the rest of the sections have been completed. By the end of this chapter, you should be able to do following: Write an Introduction following its conventional organizational ■ structure ■ Compose the all-important opening sentence of an Introduction ■ Cite and summarize others’ works in concise and appropriate ways ■ Conclude your Introduction in an effective manner As you work through the chapter, you will write an Introduction section for your own paper. The Writing on Your Own tasks throughout the chapter guide you step-by step as you do the following: 6A Read and paraphrase the literature 6B Prepare to write 6C Draft your opening paragraph 6D Identify a gap 6E Draft your full Introduction 6F Practice peer review 6G Fine-tune your Introduction The Introduction, as its name implies, sets the stage for the rest of the journal article by introducing the research area, describing its importance, and hinting at what new knowledge and insights the authors have gained. The Introduction is also where authors summarize others’ works; this involves several important writing skills such as paraphrasing, writing concisely, and correctly citing the literature. Paraphrasing and writing concisely are addressed in this chapter; citing the literature is addressed in chapter 17. At long last, we ask you to read the Introduction to the aldehydes-in-beer article (excerpt 6A). If you have progressed through these textbook chapters sequentially, you have already read the Methods, Results, and Discussion sections. Admittedly, this order may seem a bit unusual. Remember, however, we want you to read the Introduction through the eyes of the writer, not the reader. As authors write their Introduction, they already know what unfolds in the rest of their paper; now you, too, have this perspective.
Writing the Experimental Approach Section
Authors: Robinson Marin S , Stoller Fredricka L , Constanza-Robinson Molly , Jones James K
Published: November 2020

This chapter focuses on writing the experimental section of the Project Description, the section in which you tell readers how you will conduct the proposed work. Unlike the experimental section of a journal article, which is written largely after a work has been completed, here you describe proposed methodology. Reviewers, after reading this section, should be convinced that the work is plausible and that the investigator has the background and expertise necessary to carry out the proposed work. By the end of this chapter, you should be able to do the following: ■ Know ways to establish your expertise as a researcher ■ Be able to share and build on preliminary results ■ Present your proposed research in a logical order ■ Identify obstacles in your proposed research plan This chapter covers what is normally presented in the second main section of the Project Description. Common headings in this section are EXPERIMENTAL APPROACH (level 1) Prior Accomplishments (level 2) Preliminary Results (level 2) Proposed Methodology (level 2) Objective 1. (level 3) Objective 2. (level 3) As you work through the chapter, you will write the Experimental Approach section of your own proposal. The Writing on Your Own tasks throughout the chapter guide you step by step as you do the following: 13A Share prior accomplishments 13B Share preliminary results 13C Describe your proposed methods 13D Complete the Experimental Approach section We begin with excerpt 13A, part of an Experimental Approach section that you can read and analyze on your own. Excerpt 13A is a continuation of excerpt 12A, where Aga makes the case that we need to better understand the stereochemistry of metolachlor, a widely used herbicide and potential carcinogen, as it degrades in soil. In excerpt 13A, she describes two specific research objectives needed to accomplish this task.
Chemical Equations
Authors: Oriakhi Christopher O.
Published: November 2020

A chemical equation is a shorthand way of describing a chemical reaction. It uses symbols of elements and formulas of compounds in place of words to describe a chemical change or reaction. 1. The formulas and symbols of reactants are written on the left side of the equation. 2. The formulas and symbols of products are written on the right side of the equation. 3. A plus sign (+) is placed between different reactants and different products. 4. The reactants are separated from the products by an arrow (→) pointing in the direction of the reaction. For a reversible reaction, double arrow (⇄) is used. 5. The physical states of substances may be indicated by the symbols (s) for solid, (l) for liquid, (aq) for aqueous solution, and (g) for gases. 6. The equation is then balanced by inserting appropriate coefficients for the products and reactants. For the word equation Sulfur trioxide+Water → Sulfuric acid we can substitute the formulas for reactants and products, following the above rules, and obtain a chemical equation for the reaction as: SO3(g)+H2O(l) −→ H2SO4(aq) A chemical equation is balanced when it has the same number of atoms of each element on either side of the equation. Thus, a balanced equation obeys the law of conservation of mass. That is, atoms are not ‘created’ or ‘destroyed’ in writing a chemical equation. 1. Formulate and write a word equation if necessary from experiment or problem. 2. Write the unbalanced equation using the rules for writing chemical formulas. 3. Balance the equation to make sure the law of conservation of mass is observed. (a) Inspect both sides of the equation to identify atoms that need to be balanced. (b) Balance one element at a time by placing a suitable coefficient to the left of the formula containing the element. Note that a coefficient placed in front of the formula affects all the atoms in the formula. For example, 2 H2O implies 2 molecules of water containing 4 atoms of hydrogen and 2 atoms of oxygen. (c) Never attempt to balance an equation by changing subscripts because this will change the formulas of the compounds.
Fundamentals of Electrochemistry
Authors: Oriakhi Christopher O.
Published: November 2020

Electrochemistry is the branch of chemistry that deals with the interconversion of chemical and electrical energy. A galvanic (or voltaic) cell is a chemical system that uses an oxidation–reduction reaction to convert chemical energy into electrical energy (hence it is also known as an electrochemical cell). This process is the opposite of electrolysis (explained in section 23.10), wherein electrical energy is used to bring about chemical changes. The two systems are similar in that both are redox processes; in both, the oxidation takes place at one electrode, the anode, while reduction occurs at the cathode. Figure 23-1 shows a galvanic cell, indicating the half-reactions at the two electrodes. Electrons flow through the external circuit from the anode (Zn) to the cathode (Cu). The overall reaction, which is obtained by adding the anodic and cathodic half-cell reactions, is: . . .Zn(s)+Cu2+(aq) → Zn2+(aq)+Cu(s). . . This cell has a potential of 1.10 V (see next section). The potential energy of electrons at the anode is higher than at the cathode. This difference in potential is the driving force that propels electrons through the external circuit. The cell potential (Ecell) is a measure of the potential difference between the two half-cells. It is also known as the electromotive force (emf) of the cell, or, since it is measured in volts, the cell voltage. An electrochemical cell consists of two half-reactions at different potentials, which are known as electrode potentials. The electrode potential for the oxidation half-reaction is called the oxidation potential. Similarly, for the reduction half-reaction, we have the reduction potential. The potential of a galvanic cell is determined by the concentrations of the species in solution, the partial pressures of any gaseous reactants or products, and the reaction temperature. When the electrochemical measurement is carried out under standard-state conditions, the cell potential is called the standard electrode potential and is given the symbol E0. The standard conditions include a concentration of 1 M, gaseous partial pressure of 1 atm, and a temperature of 25°C. It is impossible to measure the absolute potential value of a single electrode, since every oxidation is accompanied by a reduction. Therefore any measurement is carried out against a reference electrode.
The Initial Evaluation of Psychosis
Authors: Compton Michael T , Broussard Beth
Published: November 2020

People experiencing a first episode of psychosis and their families sometimes hesitate in seeking mental health evaluation and treatment. One reason may be that they do not know what to expect. In addition, old wives’ tales, stories from the media, or other ideas about what happens to people with psychosis may be frightening. This chapter explains the evaluation provided in a health-care setting when people seek help for a first psychotic episode. A thorough evaluation is the first step for mental health professionals to help people experiencing a first psychotic episode. The main reason for evaluation is to better understand what people with psychosis are experiencing. Just like medical illnesses, early psychosis differs greatly across individuals. It can include many different types of signs and symptoms that are caused by a number of different disorders. So, a thorough evaluation allows the mental health professional to compile all sorts of information, from different perspectives, to arrive at the most appropriate diagnosis and develop the most effective treatment plan. As described in Chapter 3, a thorough evaluation assesses three types of possible causes of psychosis. Are the psychotic symptoms a result of a medical condition that requires treatment? Are they stemming from a substance of abuse? Or, do they indicate a psychiatric illness, such as major depression, bipolar disorder, or a primary psychotic disorder? Importantly, the evaluation can provide families with an explanation for what their loved one is experiencing. It also may help the person with psychosis to feel better understood. This chapter describes the typical evaluation that is provided when someone first comes into a mental health facility with psychosis. Most importantly, interviews and observations allow the mental health professional to understand the nature of the psychotic symptoms, including when they started, how they progressed, etc. In addition to gathering information from the patient, the mental health professional will want to collect any other records that may be helpful and to contact others who know the patient to get their perspectives. The mental health professional will usually do a number of medical and psychological exams, including a physical exam, cognitive assessments, lab tests, and perhaps an electroencephalogram and an imaging study.