bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and Construction of Density Based Traffic Control System
Authors: Usikalu M. R. , Okere A. , Ayanbisi O. , Adagunodo T. A. , Babarimisa I. O.
Published: October 2019

Congestion is a serious issue due to vechicular traffic. One of the known causes of traffic congestion is the amount of time spend waiting for the red light to change to green. The changing of traffic light is hard-coded and it is not reliant on traffic volume. There is therefore need to simulate and optimize traffic control to better accommodate density based traffic rather than time based. This system attempts to lessen possibilities of traffic jams brought about by traffic lights to a reasonable degree. This project, a density based traffic control system is been implemented to solve this problem. The system entails programming an Arduino using Arduino integrated development environment (IDE) to enable traffic lights give the right of access to the road by selecting the lane with the high number of cars. The traffic lights are modified to chip away at an auspicious premise until there is a signal identified by the infrared sensors. The sensor identifies an object (i.e. a vehicle, a motorcycle etc) and signals the Arduino to control the traffic lights for its individual path. Once there is no sign identified by any of the four sensors the traffic lights keep on dealing with an auspicious premise. The mean response time of the sensor was found to be 0.39 seconds. Further research is recommended to produce the device on a large scale to be deployed to all roads in the country.
Corporate Social Responsibility & Brand Loyalty in The Nigerian Telecommunication Industry
Authors: Akhigbe J O , Olokoyo F O
Published: October 2019

The existing literature on Corporate Social Responsibility with regards to consumer responsiveness towards the organization is currently split and filled with inconsistencies. This reality makes theory building quite difficult. Therefore, further studies will be necessary to build theory consensus and update the existing literature. This study attempts to evaluate the effects of corporate social responsibility on brand loyalty in a developing nation such as Nigeria, with special focus on its telecommunication industry. Data gathering was carried out through the distribution of 386 questionnaires to the customers of the four largest mobile telecommunication firms in Nigeria. Simple linear regression was used in testing the formulated hypothesis. Findings from the hypothesis testing reveals there is no significant relationship between corporate social responsibility and brand loyalty in the Nigerian telecommunication sector. However, favorable price point, good quality service and good customer care were some of the attributes the customers emphasized on as regards to what determines their brand loyalty. Based on the findings from this study, firms are recommended to integrate CSR policies into their core operations. CSR should be focused on providing solutions to Nigeria’s social economic challenges. A concise policy should be initiated to ensure clear information and reporting channels are duly released to every stakeholder group. Without diligent reporting of CSR activities, customers can easily assume the firms do not engage in CSR practices.
Research of hydraulic reliability of water supply network based on the simulation of EPANET
Authors: Duan Xiaolong , Zong Yongchen , Hao Kaiyue , Huang Decai , Li Yuanwei
Published: October 2019

Based on cascading failure, the model of EPANET is used to analyze the system reliability of water supply network and node impact evaluation and pipeline evaluation. Then three conclusions are obtained by calculation. The first conclusion is the hydraulic reliability of the water supply pipe network is related to the node and the pipe section. And the results of the analysis can correspond to the consequences of pipeline failure which can be used as a basis for evaluating pipeline. The second conclusion is the node can be divided into the failure node and the influence node based on node impact evaluation of the water supply network. And the failure node can be set to monitor the water supply system focus because of the sensitivity of these two types of nodes to cascading failure. The third conclusion is the pipeline evaluation is a comprehensive evaluation of pipeline operation and node influence, and pipeline can be divided into key sections, the main pipe, the general pipe, and the key pipe and the main pipe are the greatest threats to the hydraulic reliability of the water supply pipe network, so they should be considered as the key part of system optimization and system monitoring.
Research on Machining Fixture of Near-Net-Shaped Jet Engine Blade
Authors: Wu Dongbo , Chen Yunhai , Zhen Xuesong , Zhang Kaiyao
Published: October 2019

This paper focus on the design and verification of the machining fixture on the background of the adaptive processing technology. Firstly, the positioning and clamping scheme of near-net-shaped jet engine blades are introduced and analyzed, especially the new materials (Polyetheretherketone (PEEK-GF30)) and new structure are applied to fixture, and corresponding fixture is designed, manufactured and applied to engineering. Secondly, the relationship between the blade clamping deformation and clamping force is analyzed by finite element method (FEA). Thirdly, blade cutting deformation is analyzed by cutting experiment. The results show that this new material and structure fixture combined with CNC adaptive processing technology can achieve the precision machining of near-net-shaped jet engine blades Tenon root.
Extremal eigenvalues of the Dirichlet biharmonic operator on rectangles
Authors: Buoso D. , Freitas P.
Published: October 2019

We study the behaviour of extremal eigenvalues of the Dirichlet biharmonic operator over rectangles with a given fixed area. We begin by proving that the principal eigenvalue is minimal for a rectangle for which the ratio between the longest and the shortest side lengths does not exceed

1.066459
1.066459

. We then consider the sequence formed by the minimal

k
k

th eigenvalue and show that the corresponding sequence of minimising rectangles converges to the square as

k
k

goes to infinity.
𝛼∼𝑙 relatively dense sets and weighted pseudo almost periodic phenomenon
Authors: Liang Jin , N’Guérékata G. , Xiao Ti-Jun
Published: October 2019

In this paper, we propose a new idea of studying the weighted pseudo almost periodic phenomenon. We introduce a new mathematical concept of

α
∼
l

\alpha \sim l

relatively dense set and show that the

α
∼
l

\alpha \sim l

relatively dense set is more useful than the classical relatively dense set due to Bohr or Bochner in treating the weighted pseudo almost periodic phenomenon. We prove the uniqueness of decomposition of the weighted pseudo almost periodic functions with values in Banach spaces and with weights in a new weight function set, and show that the new weight set is larger than all the existing weight function sets which ensures the uniqueness of such decomposition in literature. Moreover, we reveal several properties of the vector-valued weighted pseudo almost periodic functions, and provide a series of concrete examples and remarks for illustrating our theoretical results.
Activity of a ubiquitin ligase adaptor is regulated by disordered insertions in its arrestin domain
Authors: Baile Matthew G. , Guiney Evan L. , Sanford Ethan J. , MacGurn Jason A. , Smolka Marcus B. , Emr Scott D.
Published: October 2019

The protein composition of the plasma membrane is rapidly remodeled in response to changes in nutrient availability or cellular stress. This occurs, in part, through the selective ubiquitylation and endocytosis of plasma membrane proteins, which in the yeast Saccharomyces cerevisiae is mediated by the HECT E3 ubiquitin ligase Rsp5 and arrestin-­related trafficking (ART) adaptors. Here, we provide evidence that the ART protein family members are composed of an arrestin fold with interspersed disordered loops. Using Art1 as a model, we show that these loop and tail regions, while not strictly required for function, regulate its activity through two separate mechanisms. Disruption of one loop mediates Art1 substrate specificity. Other loops are subjected to phosphorylation in a manner dependent on the Pho85 cyclins Clg1 and Pho80. Phosphorylation of the loops controls Art1’s localization to the plasma membrane, which promotes cargo ubiquitylation and endocytosis, demonstrating a mechanism through which Art1 activity is regulated.
The French Mandate in Lebanon
Authors: Hakim Carol
Published: October 2019

A century after the victorious Allied powers distributed their spoils of victory in 1919, the world still lives with the geopolitical consequences of the mandates system established by the League of Nations. The Covenant article authorizing the new imperial dispensation came cloaked in the old civilizationist discourse, entrusting sovereignty over “peoples not yet able to stand by themselves under the strenuous conditions of the modern world” to the “advanced nations” of Belgium, England, France, Japan, and South Africa. In this series of “reflections” on the mandates, ten scholars of Europe, Africa, the Middle East, Asia, and the international order consider the consequences of the new geopolitical order birthed by World War I. How did the reshuffling of imperial power in the immediate postwar period configure long-term struggles over minority rights, decolonization, and the shape of nation-states when the colonial era finally came to a close? How did the alleged beneficiaries—more often the victims—of this “sacred trust” grasp their own fates in a world that simultaneously promised and denied them the possibility of self-determination? From Palestine, to Namibia, to Kurdistan, and beyond, the legacies of the mandatory moment remain pressing questions today.
Comparing Interstate and European Conflict of Laws from a Constitutional Perspective: Can the United States Inspire the European Union?
Authors: Meeusen Johan
Published: October 2019

The still-recent process of Europeanization and constitutionalization of conflict of laws in the European Union can benefit in some respects from a comparison, from a constitutional perspective, with interstate conflict of laws in the United States. The quasi-absence of federal choice-of-law rules, the Supreme Court’s approach of minimal constitutional constraints to choice of law and the focus of U.S. interstate conflicts law on substantive policies and interests stand out as three major differences from the development of EU conflict of laws. Learning from the American experience and taking into account the case law of the Court of Justice of the European Union and the requirements of subsidiarity and proportionality, the EU legislature should be open, in particularly sensitive areas, to the recognition method as an alternative to the unification of choice-of-law rules. Neither the Supreme Court’s minimal constraints doctrine nor its prioritization of individual-fairness concerns over federal interests should be followed in Europe. Although it recognizes that conflict of laws can contribute in different ways to the European general interest, the Treaty of Lisbon has set up a rather disappointing framework to that effect. Amendments and clarifications are needed to enable EU conflict of laws to fulfill its ambitions and really contribute to the EU’s quasi-federal integration process.
The Anatomy and Clinical Application of Preorbital Septum Fiber
Authors: Zhao Jingyi , Guo Xiaoshuang , Lai Chenzhi , Zhang Dong , Du Hong , Yang Changsheng , Yue Yingying , Jin Xiaolei
Published: October 2019

Background

In patients with mild superior sulcus deformity, pseudoptosis, or multiple eyelid folds, several bulky fibers can be found anterior to the orbital septum. These fibers, called preorbital septum fibers, may constrict protrusion of the fat pad and movement of the levator palpebrae muscle.

Objectives

In this study, the authors illustrated the anatomy of these fibers and described the double-eyelid procedure to correct pseudoptosis, mild superior sulcus deformity, and multiple eyelid folds, which may be caused by these fibers.

Methods

The bulky preorbital septum fibers were dissected and severed during upper blepharoplasty to release the orbital septum fat pad and levator palpebrae muscle. This procedure was performed between January 2016 and January 2018 in 56 patients with distinct preorbital septum fibers.

Results

Of the 56 patients, 38 displayed mild to moderate upper eyelid depression and multiple eyelids, and 18 displayed pseudoptosis. Bulky fibers that existed in the superficial layer of the orbital septum were all dissected and removed. After 6 months’ recovery, the superior sulcus deformity improved in all patients. No recurrence of multiple eyelids was observed. Patients with pseudoptosis showed a notable release of their upper eyelids.

Conclusions

This is the first time to our knowledge that the preorbital septum fibers are described as a distinct anatomical structure. They are clinically important in upper eyelid anatomy and the improvement of sunken upper eyelids or pseudoptosis. The combination of blepharoplasty with release of these fibers is easy to perform and promote.

Level of Evidence: 4
High Definition Liposculpture in Male Patients Using Reciprocating Power-Assisted Liposuction Technology: Techniques and Results in a Prospective Study
Authors: Saad Ahmad N , Pablo Arbelaez Juan , De Benito Javier
Published: October 2019

Background

High-definition liposculpture (HDL) consists of techniques developed to emulate an athletic and attractive surface anatomy.

Objectives

The aim of this study was to describe our experience, including techniques and postoperative outcomes, when performing HDL with power-assisted liposuction (PAL) technology in male patients.

Methods

In this prospective study PAL was used for fat extraction and to perform HDL. Intraoperative data were collected and the techniques used were recorded. Postoperatively, photographs were taken, and data were collected regarding the use of compression garments and pain medication, return to work and full activity, and satisfaction levels.

Results

All patients were males, with an average age of 32.3 years and a body mass index of 26.45 kg/m2; the follow-up period averaged 7.6 months. Intraoperatively, all patients received HDL of the chest, abdomen, back, and upper arms, and fat transfer to the chest. The average operative time was 3.4 hours. None of patients had drains left intraoperatively. Postoperatively, all patients were completely off their pain medications by postoperative day 9. They received, on average, 3.7 sessions of lymphatic massage and wore compression garments for an average of 3 weeks. They returned to work 6.1 days after surgery and were back to full activity in 3.2 weeks. Minor complications were reported in 2 patients. Patient satisfaction was on average 9.8 (on a scale of 1-10) at 6 months.

Conclusions

HDL with PAL technology is a safe procedure that delivers reproducible natural-looking results with high patient satisfaction rates, low risk of complications, and a relatively short and tolerable recovery process.

Level of Evidence: 4
The Dissolution of the Hong Kong National Party: Constitutionality under the ‘Militant Democracy’ Theory
Authors: Jing Qin , Qingfeng Zhou
Published: October 2019

The unprecedented dissolution of the Hong Kong National Party, a localist political party advocating the independence of Hong Kong from China, has given rise to a constitutional dispute over the competing principles of protecting national security and upholding freedom of association. This article first analyses the theory of ‘militant democracy’, which refers to a form of constitutional democracy authorized to protect civil and political freedom by pre-emptively restricting the exercise of such freedoms, as applied in the case law of the European Court of Human Rights. It argues that a pre-emptive ban on a party can be justified by a government if the party pursues undemocratic aims or employs violence or incitement to violence to achieve its political goals. This article then assesses the constitutionality of the dissolution of the Hong Kong National Party in light of the theory of ‘militant democracy’ and submits that such a theory should equally apply to Hong Kong, allowing the government to act in a militant manner to dissolve any political parties such as the Hong Kong National Party if they have incited or resorted to violence to pursue their political agenda.
Closing the Broadband Gap: A Technology-Based Student and Family Engagement Program
Authors: Ball Annahita , Skrzypek Candra
Published: October 2019

This pilot study explored a technology-based intervention aimed at increasing student and family engagement in school, using a quasi-experimental pretest–posttest design. All fourth- and fifth-grade students participated in a classroom-based one-to-one program; some students also received take-home tablets and broadband access. Student surveys assessed behavioral, cognitive, and affective engagement and academic motivation. Parent surveys assessed perceptions of school support, empowerment in schools, and overall experiences in schools. Teachers participated in a focus group to share their impressions of the program. Results showed that affective engagement and academic motivation decreased for all students, with no differences between the intervention and comparison groups. Parents in the intervention group reported greater perceptions of school support but no significant differences or changes in empowerment or overall school experiences. Students, parents, and teachers all reported positive experiences with the program. Findings point to the ways varying contexts may influence engagement in school.
Next-generation technologies for studying host–pathogen interactions: a focus on dual transcriptomics, CRISPR/Cas9 screening and organs-on-chips
Authors: Baddal Buket
Published: October 2019

Pathogens constantly interact with their hosts and the environment, and therefore have evolved unique virulence mechanisms to target and breach host defense barriers and manipulate host immune response to establish an infection. Advances in technologies that allow genome mining, gene editing such as CRISPR/Cas9, genomic, epigenomic and transcriptomic studies such as dual RNA-seq, coupled with bioinformatics, have accelerated the field of host–pathogen interactions within a broad range of infection models. Underpinning of the molecular changes that accompany invasion of eukaryotic cells with pathogenic microorganisms at the intersection of host, pathogen and their local environment has provided a better understanding of infectious disease mechanisms and antimicrobial strategies. The recent evolution of physiologically relevant three-dimensional (3-D) tissue/organ models and microfluidic organ-on-chip devices also provided a window to a more predictive framework of infectious disease processes. These approaches combined hold the potential to highly impact discovery of novel drug targets and vaccine candidates of the future. Here, we review three of the available and emerging technologies—dual RNA-seq, CRISPR/Cas9 screening and organs-on-chips, applicable to the high throughput study and deciphering of interaction networks between pathogens and their hosts that are critical for the development of novel therapeutics.
Archives, Museums and Sacred Storage: Dealing with the Afterlife of the Truth and Reconciliation Commission of Canada
Authors: Milton Cynthia E , Reynaud Anne-Marie
Published: October 2019

Abstract∞

The Canadian Truth and Reconciliation Commission (TRC) acquired over 1,200 material submissions through the gifts it received at its events. Though other TRCs mention objects in their records, the gift-giving practice that became central to TRC events in Canada was unprecedented, and so is its large collection of TRC-gifted objects today. The Canadian TRC is thus unique and faces the challenges of categorizing, preserving, displaying and honouring these material artefacts. What has been the post-TRC life of these objects and art pieces? What is their role in creating a collective memory of residential schools and how might they promote reconciliation? This article shows that the post-TRC life of the objects opens up new museological spaces and practices through the ways the objects are curated (or not) for remembering and learning about residential schools according to Indigenous protocols and ways of thinking and feeling.
Reply – 313 Dermatome-Induced Lacerations: Incidence, Management and Preventative Measures. April 2018, Volume 39, Issue Suppl 1, Page S126
Authors: Nassar Mahmoud K , Jordan Daniel J , Quaba Omar
Published: October 2019

We would like to suggest the use of a simple and relevant mnemonic (‘STSG’) for the safe use of powered dermatomes to harvest split thickness skin grafts. Safety checklists have been shown to be effective tools for improving patient safety in various clinical settings by improving compliance with good practice and reducing the incidence of adverse events.
The influence of Geant4-DNA toolkit parameters on electron microdosimetric track structure
Authors: Wang Yidi , Li Zhanpeng , Zhang Shuyuan , Tang Wei , Li Xiang , Chen Dandan , Sun Liang
Published: October 2019

The influence of different physical process factors on tracks of low-energy electrons in liquid water was analyzed and evaluated based on the Geant4-DNA toolkit of Geant4 version 10.4, and it provides theoretical support for obtaining the basic parameters of microdosimetry concerned with radiotherapy and radiation protection. According to the characteristics of different models, five physics constructors of Geant4-DNA toolkit were selected to simulate monoenergetic electrons in microscopic scale. Details of track structure of different Geant4-DNA physics constructors were compared, including total number of interaction processes, number and energy percentage of excitation and ionization; analyzing the impacts of mean lineal energy of several factors, including Geant4-DNA physics constructors, initial energy, radius of scoring spheres, interaction processes and cut-off energy. Firstly, ‘G4EmDNAPhysics’ (hereinafter referred to as ‘dna’) is well consistent with ‘G4EmDNAPhysics_option 2’ (hereinafter referred to as ‘option 2’), and ‘G4EmDNAPhysics_option 4’ (hereinafter referred to as ‘option 4’) is well consistent with ‘G4EmDNAPhysics_option 5’ (hereinafter referred to as ‘option 5’); secondly, there are differences for the information of track structure and mean lineal energy between ‘option 2’ ‘option 4’ and ‘G4EmDNAPhysics_option 6’ (hereinafter referred to as ‘option 6’); thirdly, the influence of the model on the mean lineal energy decreases with the increase of the radius of the scoring spheres, whereas mean lineal energy increases as the tracking cut increases. Several alternative discrete physics constructors of Geant4-DNA are comprehensively discussed overlaying multiple perspectives under different conditions in this work.
Isolated pneumomediastinum following laparoscopic cholecystectomy: a rare complication
Authors: Kostis Minas , Patriarcheas Vasileios , Apergis Stamatios , Leontis Michail , Panayiotakopoulos George
Published: October 2019

Development of postoperative pneumomediastinum is one of the most infrequent complications of laparoscopic procedures. We report a case of a 47-year-old woman who developed pneumomediastinum consequently to laparoscopic cholecystectomy. The patient was treated conservatively and was discharged on the fifth postoperative day. Early detection of this condition, differential diagnosis and careful monitoring of the patient are important, as it may lead to severe consequences, including the life-threatening tension pneumomediastinum.
Choosing Eggs
Authors: Klitzman Robert L.
Published: October 2019

Women who fail to get pregnant using their own oocytes (or eggs) can try using another woman’s but then face challenges. Potential parents who decide to use someone else’s eggs must determine whose to use—family members’, friends’, or strangers’. In the United States, one of only three countries that legally permit individuals to buy and sell human eggs, most prospective parents who use other people’s eggs buy them from strangers, fueling a proliferation of egg donor agencies. Women and agencies selling eggs can earn relatively large fees—up to $50,000 for an egg. Yet young women selling their eggs do so primarily for money and may not sufficiently grasp the risks, especially ovarian hyperstimulation syndrome, raising ethical concerns. Many patients also grapple with whether to tell others that an outsider’s egg was used. To avoid needing others’ eggs in the future, young women also face dilemmas of whether to freeze their own eggs. Providers and patients often wrestle with uncertainties and dilemmas.
Choosing Embryos to Avoid Disease
Authors: Klitzman Robert L.
Published: October 2019

Preimplantation genetic diagnosis (PGD) lets patients reject embryos with certain genes (e.g., for breast cancer, cystic fibrosis, or Down syndrome). Increasingly, researchers are also using whole-genome and whole-exome sequencing to identify genetic markers associated with other diseases. Doctors and patients can also choose embryos with certain immune system markers or human leukocyte antigens to enable the future child to donate stem cells or other tissues to an existing child with a severe disease and be a so-called savior sibling. This procedure has been used for sickle-cell anemia and beta-thalassemia. In the near future, CRISPR (clustered regularly interspaced short palindromic repeats) also will let doctors insert desired genes into embryos. But providers and patients struggle with when to use PGD, for which conditions, how to decide, how many times to attempt PGD if it fails, whether to select embryos to create savior siblings, whether patients should always be told the results of genetic tests on embryos, whether to test the fetus to confirm the results, and what to do with leftover embryos—whether to freeze, discard, or donate them.
Choosing Supports
Authors: Klitzman Robert L.
Published: October 2019

Patients struggle to cope with ethical, social, and psychological challenges in several ways, from trying to manage expectations to seeking various forms of support from family, friends, and others. Shame, stigma, and disappointment lead many patients to disclose their infertility and treatment to few, if any, family members; and consequently, they derive little support from them. Abortion or embryo screening due to a mutation, for instance, can be difficult to reveal because outsiders may be pro-life. Patients respond to perceived shortcomings of families and friends in several ways—from trying to educate these individuals or limit interactions to seeking new supports, whether from fellow patients or psychotherapists. Patients frequently seek new social supports—from formal to informal, from in person to online, and from individual psychotherapy to support groups and large organizations. Many prospective parents, who might benefit from mental health treatment, resent the cost as insurance commonly covers little, if any, of the expense. Face-to-face and online groups each offer pros and cons.
Choosing Education
Authors: Klitzman Robert L.
Published: October 2019

Physicians in several fields, patients, families, and the public at large would benefit from more education and understanding regarding infertility and its treatment—from information about basic biology and causes of infertility to specific procedures and the ethical, legal, social, and psychological issues that can arise. Patients must comprehend myriad new facts, which can take considerable effort, struggling to grasp important aspects of statistics and genetics, including recessive genes and variants of unknown significance. Many physicians in and outside of the field of infertility also have knowledge gaps about these medical (e.g., genetic), psychological, and ethical issues and vary in how well they educate patients.
Choosing Policies
Authors: Klitzman Robert L.
Published: October 2019

The United States regulates assisted reproductive technologies far less than do other Western countries, most of which have more nationalized health insurance. US states vary widely in whether they have any laws and, if so, what. Governmental agencies (e.g., Food and Drug Administration, Centers for Disease Control and Prevention) and professional organizations (e.g., American Medical Association, American Society of Reproductive Medicine) have begun addressing several areas but could potentially do more. Improved national and professional policies are needed regarding several areas, including egg and sperm donation, egg donor agencies, numbers of embryos transferred into wombs, gestational surrogacy, oversight of providers, insurance coverage, and data collection. Doctors generally perceive problems in the field but argue that industry self-regulation, rather than government policy, is adequate. Yet many providers fail to follow current guidelines and regulations. Moreover, new technologies continue to develop, including gene editing of embryos through CRISPR and mitochondrial replacement therapy (so-called three-parent babies). More data and research are crucial on current use of procedures and long-term medical and psychological follow-up of patients, egg donors, gestational surrogates, and offspring, to evaluate, for instance, the effectiveness of egg freezing and longitudinal follow-up of children born through these procedures.
The Paraphilias
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: This book examines current and past perspectives concerning unconventional sexual interests. Extensively referenced, it challenges the dogma that sexual interests are immutably determined during a single critical period and are thereafter unchangeable. It critically reviews the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD) diagnostic criteria for paraphilic disorders. It provides assessment and treatment recommendations for each of the paraphilias listed in the DSM-5 and ICD-10. The book provides extensive case histories and tables summarizing more than 100 paraphilias and the latest research. It is written for mental health clinicians and specialists in the fields of sexology, forensic psychology, and psychiatry.
Assessment, Treatment, and Management of Paraphilic Disorders
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: Many books, chapters, and articles concerning the assessment and treatment of the paraphilias have been published. Most are limited due to a lack of clarity about what is being treated and a failure to fully recognize the heterogeneity of the treatment population(s). This chapter provides a review of the assessment methods and treatments that have been recommended for paraphilic disorders in general. They are presented together because assessments and treatments can be generalized across different paraphilic disorders and many assessment and treatment approaches are complementary. Treatment approaches specific to individual paraphilias are discussed in the chapters dealing with the specific paraphilias.
Transvestic Disorder
Authors: Fedoroff J. Paul
Published: October 2019

Abstract: Transvestic disorder is defined as a condition in which there is persistent (at least 6 months), recurrent, and intense sexual arousal from wearing clothes associated with the opposite gender as evidenced by fantasies, urges, or behaviors. The condition causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The term “transvestism” is used in this chapter in recognition that most people with transvestic interests never seek or require psychiatric care. This chapter discusses the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for transvestic disorder, along with the diagnosis, treatment, and prognosis. The recent literature on these topics is reviewed.
Shared Decision-Making and Goals-of-Care Discussion in the Preoperative Visit
Authors: Kunac Anastasia
Published: October 2019

Utilizing shared decision-making and a structured goals of care discussion in the context of a preoperative visit is a mechanism by which surgeons may optimize patient-centered care. Goals-of-care conversations involve first exploring a person’s illness experience, values, and preferences and then information about their medical condition so that physician and patient arrive at a decision that guides medical care. In the field of surgery, this is an evolutionary step beyond informed consent when surgeon and patient are considering surgical therapy for a serious illness. The conversation ultimately includes a medical recommendation integrating the current clinical situation with the patient’s values and wishes. The discussion and subsequent decision(s) are translated into a plan of care.
Palliative Care for the Emergency Surgery Patient
Authors: Berlin Ana
Published: October 2019

Emergency surgery in seriously ill patients is associated with a high burden of morbidity, mortality, and healthcare utilization. Palliative care as a concurrent and integrated facet of high-quality acute surgical care has the potential to improve quality of life and reduce unwanted and nonbeneficial treatment. Despite this, the palliative care needs of patients facing emergency surgical problems are frequently unmet owing to a complex array of real and perceived barriers, including time, systemic pressures, knowledge gaps, and cultural factors. Achieving a high standard of surgical palliative care for emergency surgery patients requires maximizing the accuracy of prognostic evaluation and risk assessment, improving communication and decision-making according to established frameworks, and aggressively managing symptoms using balanced therapeutic approaches tailored to the goals and values of the patient. This chapter presents the latest evidence base for these core components of emergency surgical care, along with important considerations relevant to academic research, education and curriculum development, and programmatic innovations aimed at more optimally meeting the palliative care needs of emergency surgery patients.
Communicating Serious News
Authors: Fiorentino Michele , Lamba Sangeeta
Published: October 2019

This chapter discusses the key points of communicating serious news to patients and their family members in the surgical settings. Surgeons deliver serious news in a variety of settings, such as the outpatient, inpatient, intensive care unit, and perioperative areas as well as the emergency trauma bay setting. Each setting presents some unique challenges and needs. We describe some of the best practices when delivering serious news to a patient in these situations. We also address the impact of these conversations on the surgeon, including coping with emotions and moral distress. Though effective communication skills are highly valued by surgeons, surgery training places less emphasis on building such skills as compared to teaching of procedural or technical skills. Therefore, some key knowledge, skills, and attitudes related to teaching effective communication skills to future surgeons are outlined.
The Feeding Access Consult
Authors: Toevs Christine
Published: October 2019

The feeding access consult is often the bane of every surgeon. We are either a technician or someone who delays the discharge for a goals-of-care discussion. This chapter gives the surgeon the resources necessary to understand when a feeding tube may be beneficial for the patient and when it is not indicated. This chapter reviews the complications of feeding tube placement and its role in dementia and cancer. This chapter also discusses comfort feeds, financial costs, and the role of palliative medicine in the feeding access consult. The information presented is useful for the surgeon for understanding the short- and long-term outcomes of placement of a feeding tube and guiding discussions with colleagues, patients, and families about the realities of feeding access.
Surgical Palliative Care Education and Training
Authors: Sadler Erin M. , Easson Alexandra M.
Published: October 2019

Palliative care in surgery is a growing area of interest as it has been recognized that there is great benefit to surgical patients when palliative principles are integrated into their care. Despite efforts to improve surgeons’ competencies in this area, evidence of practice change remains limited. This chapter establishes the current state of education and training in surgical palliative care, reviews the literature regarding novel tools and models for palliative care instruction across all levels of surgical training, and outlines key pillars of surgical palliative care educational endeavors that can serve as a framework for future curriculum development and learning objectives throughout surgical training.
Low-grade glioma
Authors: Santarius Thomas , Bello Lorenzo , Duffau Hugues
Published: October 2019

Diffuse low-grade glioma affect young people in their twenties to forties. The management of this disease is tailored to the needs of each individual patient, taking into account their immediate, medium-, and long-term social and professional roles, personal aspirations, and interests, aiming to achieve optimum onco-functional balance. This starts with measurement of velocity of growth, for which a minimum of two scans with an interval of 2–3 months are obtained. The aim of surgery is resection to predefined functional boundary as this achieves most accurate histological diagnosis, best oncological outcome (prolonged time to anaplastic transformation and overall survival) and preserves function. Awake surgery with electrical brain stimulation mapping allows maximizing the degree of resection and minimize the risk of neurological deficit. Value of repeated surgeries as well as radiotherapy, chemotherapy, and molecular markers, such as IDH1 in the management of diffuse low-grade gliomas, is discussed.
Radiotherapy and radiosurgery for brain tumours
Authors: Short Susan
Published: October 2019

Following surgery fractionated radiotherapy is standard treatment for high-grade gliomas. The place for radiotherapy in low-grade gliomas is more open to debate.

Radiotherapy works by causing double stranded DNA breaks, there are two DNA repair pathways in mammalian cells, tumour cells are less able to repair DNA damage caused by radiotherapy than normal cells, thus radiotherapy is usually delivered in fractions. Conformal beam and intensity-modulated radiotherapy techniques can be used to optimize the distribution of the radiation and protect organs at risk. Brachytherapy, gamma knife, boron neutron capture, and proton beam therapy are other techniques in development or with indications for use in certain situations. The side effects of radiotherapy include fatigue, hair loss, pseudoprogression, which can be difficult to distinguish from tumour recurrence and induced secondary tumours.
Meningiomas and haemangiopericytoma (HPC)
Authors: Birk Harjus S , Han Seunggu J. , Kirollos Ramez , Santarius Thomas , McDermott Michael W.
Published: October 2019

Meningiomas are the most common primary brain tumours and account for 36.7% of all primary intracranial neoplasms. Taking into account population increases in the United States, 150 000 people currently may have a diagnosis of meningioma, with an incidence rate of 3–3.5 per 100 000. General management principles of meningiomas and location-specific treatment considerations are discussed. Surgery is the primary and main treatment for most meningiomas with radiotherapy used in biologically and clinically aggressive meningiomas. Not all meningiomas require urgent treatment and many meningiomas are be best managed with radiological follow-up. The most recent biological and genetics literature is reviewed.
Epidemiology of head injury and outcome after head injury
Authors: Alshafai Nabeel , Maas Andrew
Published: October 2019

Traumatic brain injury (TBI) constitutes a major cause of death and disability, and the World Health Organization (WHO) has projected that traumatic brain injury will be one of the leading causes of mortality and morbidity by 2020. In low- and middle-income countries the incidence of TBI is increasing, subsequent to increased motorization. It is, however, particularly vulnerable road users (pedestrians, cyclists) where the risk is greatest. In higher income countries, children, young adults, and elderly patients have the highest rate of TBI and a substantial increase in incidence of TBI in elderly patients as a result of falls has been noted. Nevertheless, TBI is a disease that affects the population of all ages and is referred to as ‘a silent epidemic’. Knowledge of the epidemiology of TBI is essential to inform healthcare planning and to target prevention campaigns appropriately. In this chapter we will summarize global TBI epidemiological perspectives and reflect on the burden that TBI imposes on health economics and society. We will review current classification systems, outcome measures, and prognostic models for TBI.
Pathophysiology of traumatic brain injury
Authors: Manley Geoffrey T. , Yue John K. , Deng Hansen , Winkler Ethan A. , Burke John F. , Suen Catherine
Published: October 2019

This chapter provides summative information on the biomechanics, classification, and metabolism of traumatic brain injury (TBI). Impact, impulse, static/quasistatic loading, and related biomechanical sequelae following rotational shear and strain are discussed. Morphological classifications across extradural, acute/chronic subdural, subarachnoid, and intraventricular haemorrhages, as well as cerebral contusions and axonal injuries, are characterized and correlated with injury severity. Management options and implications for penetrating TBI and mild TBI/concussion are described. Cerebral metabolism including pressure/viscosity, CO2 reactivity, and autoregulation are explained in detail to provide for in-depth exploration of a spectrum of secondary injury cascades, encompassing glutamatergic excitotoxicity, autoregulatory loss, and the pressure reactivity index, flow disturbances, elevated intracranial pressure, cortical spreading depression and seizures/epilepsy. Beta-amyloid deposition in response to TBI, and genetic susceptibilities to poor recovery are covered. Current developments to standardize TBI classification systems, establish evidentiary benchmarks for quality of care, and accelerate advances in diagnosis and prognosis are highlighted.
Normal cerebrovascular physiology and vascular anatomy
Authors: Bulters Diederik O. , Durnford Andrew
Published: October 2019

The first part of this chapter describes normal neurovascular anatomy including its embryology, histology, and normal arterial variants. It includes angiographic arterial anatomy and also the structures and territories supplied by specific vessels. The anatomy of the venous sinuses and both the superficial and deep cerebral veins are described. The second part details normal cerebral neurophysiology, including autoregulation and the control of cerebral perfusion. It covers the myogenic, metabolic, and neurogenic mechanisms of cerebral blood flow and vessel diameter regulation. Finally, the role and influence of mannitol on cerebral blood flow is described, and how although it acutely reduces cerebral volume and intracranial pressure, its exact mechanism of action remains unclear.
Cerebral arteriovenous malformations and dural arteriovenous fistulae
Authors: Morgan Michael
Published: October 2019

This chapter on bAVM, DAVF, and CCF describes their development, management, and anticipated outcomes. Arteriovenous malformations (AVM) of the brain are diagnosed annually in 1 per 100 000 population, are acquired early in life and can present with intracerebral haemorrhage (ICH), seizure, headache, or neurological disorders. They rupture for the first time at 1–2% per year. Rate of rerupture is 4–6% per year. Spetzler-Ponce classes A, B, and C allow stratification of most likely treatment options into surgery, radiosurgery, and no intervention, respectively. The less frequent DAVF and CCF are discussed with the management pathways of conservative, embolization, and surgery. Because of the diversity of clinical scenario, decision-making is highly nuanced. CCF constitutes both DAVF involving the cavernous sinus (indirect fistulae) and direct fistula between ICA and sinus. Where multiple treatment pathways are reasonable, treatment is presented to facilitate comparison between modalities as well as providing advantages and disadvantages of each path.
Thoracic spinal disease
Authors: Sweeney Kieron , Moran Catherine , Bolger Ciaran
Published: October 2019

The thoracic spine occupies a unique position with respect to anatomical, biomechanical, pathological, and surgical considerations. The kyphosis of the thoracic spine is offset by the lordosis in the mobile cervical spine and the principal load bearing lumbar spine maintaining a sagittal balanced posture. Due to the biomechanical properties of the thoracic spine, the incidence of thoracic disc prolapse is low. However, the anatomical features of the thoracic spine make appropriate surgical planning imperative. This chapter will cover the management and operative approaches to thoracic disc disease, including open and minimally invasive techniques. Operative approaches can be broadly divided into two groups, anterior and posterior-lateral. Each approach is discussed with respect to technique, anatomy, closure, and common complications. It will also discuss pathogenesis, diagnosis, and management of osteoporotic fractures.
Special considerations in paediatric head and spinal trauma
Authors: Kay Andrew , Rodrigues Desiderio , Sharp Melanie , Solanki Guirish
Published: October 2019

This chapter focuses on the special considerations in paediatric head and spinal trauma. Anatomical, physiological, and mechanical differences in the developing paediatric brain create a unique pattern and epidemiology of traumatic brain injury and spinal injury. Management needs to be adapted to allow for such differences. Traumatic brain injury management tailored to the paediatric population will be covered. In this chapter, injuries unique to the paediatric population will be outlined including non-accidental injuries, growing fractures, and ping pong fractures. Spinal injury considerations including craniocervical and axial trauma, as well as SCIWORA in the paediatric population will also be covered here.
Paediatric brain tumours
Authors: Roth Jonathan , Constantini Shlomi
Published: October 2019

Paediatric brain tumours (PBT) are a unique entity, in children and in the overall general brain tumour population. They are distinct from adult brain tumours for several reasons, including patient-related factors (size, blood volume), location of the tumours, histological and genetic factors, treatment factors, and prognosis. Even technical surgical aspects may differ from those applied in the adult population. This chapter reviews the main aspects of PBT and their treatment in relation to the aforementioned factors. This text has pinpointed the most important topics of PBT but due to the breadth of the subject, this text cannot be a comprehensive account of every aspect of these pathologies or their treatments.