bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning “About” Versus Learning “From”Other Minds
Authors: Gergely Gyorgy
Published: November 2023

One of the species-unique characteristics of human cultures is that they create, maintain, transmit, and retain across generations many cultural forms, skills, and knowledge whose relevant aspects are often cognitively opaque to their users and learners. In this chapter I’ll first characterize the concept of cognitive opacity, outline the nature of the learnability problem it represents for mechanisms of cultural learning, and speculate about its evolutionary origins. It will be argued that during hominid evolution, a new type of social learning system has been selected that is specialized to ensure efficient intergenerational transfer of cognitively opaque cultural contents from knowledgeable to nai”ve conspecifics. The design structure of this cue-driven cognitive adaptation of mutual design, which we call natural pedagogy (Csibra and Gergely, 2006; Gergely and Csibra, 2006; Gergely et al., 2007), will then be described. Pedagogical knowledge transfer is triggered by specific ostensive and referential cues to which infants show special and early sensitivity and which involve the selective communicative manifestation of relevant and generalizable cultural knowledge about referent kinds for the infant to fast-learn. I shall then critically contrast pedagogy theory with currently dominant alternative approaches to cultural learning that are based on simulation and identification processes by comparing how these respective models can account for recent evidence on early relevance-guided selective imitative learning, on the one hand, and on young infants’ interpretation of others’ referential emotion expressions in ostensive versus incidental observation contexts, on the other hand.
Of Pigeons, Humans, Language, and the Mind
Authors: Bonatti Luca L
Published: November 2023

Humans and pigeons don’t appear to have much in common. Humans have never been good at flying even short distances, nor have pigeons ever developed extensive civilizations. However, appearances are deceiving. For starters, they both seem to love crowded places, where they hang out and like to be photographed, possibly together, frequently with utter disregard for the artistic masterpieces therein. Also, as Woody Allen observed, they are among the few species in the animal kingdom that value monogamy, at least as a Kantian ideal of reason. In this chapter, I want to explore the hypothesis that humans and pigeons are alike in another aspect; a potentially fruitful trait of high-level cognition, exploited very differently in the two species.
Innate Constraints on Judgment and Decision-Making?
Authors: Santos Laurie R , lakshminarayanan venkat
Published: November 2023

In this chapter, we explore the possibility that human judgment and decision-making heuristics may have an innate component. We first provide a brief review of this heuristic approach, exploring what little is known about the role of experience in the emergence of these biases over the course of human development. We then review how a comparative-developmental approach allows us to directly address which aspects of our heuristics are innate, universal, and evolutionarily ancient. We then adopt insights from comparative cognition to investigate origins of two classic judgmental biases-loss aversion and reference dependence. We present evidence that humans and nonhumans exhibit analogous judgmental biases previously thought to be uniquely human, and further argue that these shared behaviors result from a common and possibly innate ancestry. We end by postulating that examining the innateness of seemingly maladaptive behaviors such as reference dependence and loss aversion may provide insight into the psychological machinery that drives both accurate and biased decision-making.
Structure of the Speech
Authors: Wooten Cecil
Published: November 2023

I. Proemium: D explains why he has risen to speak before the older orators and asks for the audience ‘s indulgence (§1).

II. Preliminary Arguments (§§2–12).

A. First Topic: The Athenians should not be discouraged by the difficult situation, since they have done nothing to make it better, but should be encouraged by the examples of their ancestors and of Philip himself, who overcame formidable foes by taking vigorous action (§§2–7).

B. Second Topic: Philip ‘s position is not as sure as it seems, since his allies and subjects resent his arrogance; the Athenians should take advantage of their animosity toward him (§§8–9).

C. Third Topic: Philip has grown great only because of Athenian negligence and carelessness; they will never be able to defeat him if they are unorganized and unprepared (§§10–12).

III. Specific Proposals (§§13–30).
From Rocking to B-Boying: History and Mystery
Authors: Schloss Joseph G
Published: November 2023

The early development of the dance took place among small groups of work-ing-class black and Latino teenagers, many of whom did not even know about each other at the time. As New York City was abandoned by the federal gov-ernment and working-class neighborhoods were abandoned by New York City, youth in those neighbour hoods were, in turn, abandoned by traditional institu-tions that were supposed to care for them. As a forgotten minority of a forgotten minority of a forgotten minority, their culture was almost totally ignored.
Differentiating the Diagnostic Considerations
Authors: Dimario Francis J
Published: November 2023

The approach to establishing a correct diagnosis when confronted with a child who appears to be experiencing events that could be epileptic in nature but are indeed non-epileptic is challenging. The appropriate identification will depend upon a careful extraction of the clinical history, confirmation of a supportive examination, observation of the critical events, and generally less reliance upon laboratory testing. These non-epileptic events by definition conform to a paroxysmal or intermittent character and are defined by key characteristics that allow identification. Unfortunately, not all entities are sufficiently well characterized at the outset to be confidently recognized.
Sleep-Related Phenomena
Authors: Dimario Francis J
Published: November 2023

Epileptic seizures may manifest a host of behavioral, motor, and perceptual alterations due to abnormal cortical electrical discharges. All epileptic seizure types can be electrically evident and often clinically manifest during sleep. In fact, sleep may serve as an activator of both epileptic discharges and epileptic seizures through the induction of brain-activated electrographic changes. Sleep itself, however, is a state where an orderly evolution of electrical brain wave patterns induces and reflect the clinical stages and physiologic responses we observe as sleep.
Factitious Disorders
Authors: Dimario Francis J
Published: November 2023

Factitious epilepsy is one of the most difficult, potentially sinister, and often difficult to conclusively prove conditions mimicking epileptic seizures. By the very nature of the disorder, the individual perpetrator engages in a medical pretense of volitional deception. Non-epileptic seizures are but one of a myriad of other medical conditions, symptoms, and signs frequently intentionally feigned. In the context of children, parents and guardians may perpetuate a feigned illness in their child by the commission of pediatric condition falsification.
Further Considerations
Authors: Dimario Francis J
Published: November 2023

In the previous chapters an organization and description of the clinical conditions and epidemiology of non-epileptic paroxysmal childhood disorders was presented. These entities individually and as a group can in many instances be mistakenly considered diagnostically for epileptic seizures. An emphasis has been placed upon phenomenon that display variations in normal childhood behavior and physiologic functioning with special consideration to other pathological conditions that require additional identification, further investigation, and treatment.
Justice in Community Care
Authors: Capitman John A
Published: November 2023

In the United States, other established market economies, and some countries within Asia, Latin America, and the Caribbean, the epidemiological transition and associated changes in population age composition and causes of death had occurred to varying degrees by the 1990s. The accelerating graying of the population expected in coming years stands out as a striking demographic force inLuencing individuals’ lived experience in these countries. As populations age, policies and programs that promote public health and well-being face rapid growth in total demand (because of absolute and relative growth in the number of elders) and the need to direct services to managing co-occurring chronic disease and sociocultural challenges. This rapidly changing medical and demographic context for elder-care practice has stimulated debate in many countries about social goals and the needed service systems, processes, and resource commitments. This chapter explores a central theme in these debates: fairness in 0nancing and provision of community-oriented supportive health services for elders. In this context, “supportive health services” references health and social services offered to elders to extend the period of active engagement in the community by preventing the progress of chronic disease and providing needed supports throughout the disablement process.
Community-Based Care for the Elderly
Authors: Friedland Seymour J
Published: November 2023

Ask most elderly people how they would like to live out their lives and you will typically get a response that indicates a preference for remaining at home. In a recent national study, 64% indicated that in the event of a serious illness they would prefer to live at home, 3% preferred to move to an institution such as a nursing home, and only 15% preferred moving in with family. Yet, 72% of the $98 billion spent in 2000 on long-term care for the elderly was directed toward institutional care. Clearly, then, we continue to have service systems that are geared toward institutional models and are only now beginning to look at community alternatives. The purpose of this chapter is to explore a number of new models of community care, issues involved in developing and sustaining community approaches, and implications for the interdisciplinary model.
Interdisciplinary Health Management for Older Adults
Authors: Satin David G , Armstrong Kimberly , Bard Terry R , Boyle Kathleen , Broverman Shannon , Brown Peggy , Burack Jeanette , Drevins Joan R , Maramaldi Peter , Pritchard Jennifer , Raine Erica , Salinger Julie , Sauder Kimberly , Vaughn Melanie
Published: November 2023

david g. satin: What do you know now that you didn’t know before? What kind of thinking or what kind of ideas did this material stimulate?

shannon broverman/Elder Care Administration: I think that we learned about the meaning of interdisciplinary approach to care, which is a unique concept. It’s not something that you have to learn through trial and error; you learn through role-plays and through in-depth group projects.

jennifer prichard/Nursing/Health Care Administration: One of the things that I was really struck by was the number of creative individuals who are putting together very innovative programs to improve the quality of life for elders. I have a much greater appreciation of the multitude of initiatives currently in place and being developed. It is very concerning how truly underresourced we really are to care for our older adults in the future as this age group continues to grow. It will require continued ingenuity and creativity on the part of policy makers and providers to meet their needs.
Morality Without God?
Authors: Sinnott-Armstrong Walter
Published: November 2023

Some argue that atheism must be false, since without God, no values are possible, and thus “everything is permitted.” Walter Sinnott-Armstrong argues that God is not only not essential to morality, but that our moral behavior should be utterly independent of religion. He attacks several core ideas: that atheists are inherently immoral people; that any society will sink into chaos if it is becomes too secular; that without morality, we have no reason to be moral; that absolute moral standards require the existence of God; and that without religion, we simply couldn’t know what is wrong and what is right. Sinnott-Armstrong brings to bear convincing examples and data, as well as a lucid, elegant, and easy to understand writing style. This book should fit well with the debates raging over issues like evolution and intelligent design, atheism, and religion and public life as an example of a pithy, tightly-constructed argument on an issue of great social importance.
What’s So Divine About Commands?
Authors: Sinnott-Armstrong Walter
Published: November 2023

Theists often assert that atheists can’t really believe in objective morality. These theists are not talking about what is psychologically possible. Their claim is that a certain combination of views is incoherent and indefensible. They think that objective moral values, facts, or truths could not exist if God did not exist; so, if I really followed out the implications of my views on God, then I would have to give up my views on morality in Chapter Four and, instead, become a moral nihilist or subjectivist.
What Do You Know?
Authors: Sinnott-Armstrong Walter
Published: November 2023

Imagine that you heard a voice in your head commanding you to murder your son. In 1976 in New York City, David Berkowitz responded to such a voice by killing six people. How would you know whether it was a delusion or God speaking to you? This question raises difficulties for the divine command theory, according to secular moral theorists.

On the other side, theists sometimes claim that atheists and agnostics cannot know which acts are morally right or wrong without guidance from God. It is too easy to say that we ought not to cause harm without an adequate reason. What is hard is to figure out whether we have an adequate reason.
Melancholy and Melancholia
Authors: Radden Jennifer
Published: November 2023

Foucault’s dense and brilliant “archacological” analyses of the structures of insanity reveal suggestions of a sixteenth-and seventeenth-century understanding of that condition as “unreason” (déraison). The notion of insanity as unreason invites some interesting comparisons with its later medical understanding, the ascendency of which Foucault so closely documented.
Is This Dame Melancholy?: Equating Today’s Depression and Past Melancholia
Authors: Radden Jennifer
Published: November 2023

A superficial continuity links today’s clinicaldepressionwith melancholyand melancholia(the latter two terms were used interchangeably until the nineteenth century). Indeed, an equation between the two is often assumed. The relationship between today’s depression and melancholic states of old is an ambiguous and problematic one, however. Twentieth-century descriptions of depression and pre-nineteenth-century accounts of melancholia show some surprising similarities, but they also differ tellingly. Moreover, whether we see them as the same condition under different guises—reflecting differing cultural idioms of distress, perhaps—is itself a complex methodological and even ontological question.
My Symptoms, Myself: Reading Mental Illness Memoirs for Identity Assumptions
Authors: Radden Jennifer
Published: November 2023

Portrayals of the relationship between self and psychological symptoms in first person narratives about psychiatric illness and recovery are conspicuously varied.1 Much of this variation will obviously be attributable to the symptoms themselves—not only their degree of disabling severity but also their nature more generally. Some of these states and traits are more abhorrent and painful than others, for example, and some affect moods, capabilities, and responses more central to self and self identity than others—as, I shall argue, does depression.
Optimizing pharmacologic outcomes: Individualization of therapy
Authors: Smith Howard S
Published: November 2023

An “analgesic ladder” approach to the selection of analgesic drugs for cancer pain has been popularized by the World Health Organization and is now widely accepted as a broad guideline and educational tool (World Health Organization, 1996). No such universally accepted and validated simplistic guideline or stepwise algorithm exists for persistent noncancer pain; however, similar principles of therapy exist, including initiating treatment conservatively with progressive titration of doses and the addition of more aggressive strategies in the face of a lack of responsiveness.
Potential documentation tools in long-term opioid therapy
Authors: Smith Howard S , Kirsh Kenneth L
Published: November 2023

When opioids are used for long-term therapy, the clinician must be skilled in opioid prescribing, know the principles of addiction medicine, and be committed to performing and documenting a comprehensive assessment repeatedly over time. Inadequate assessment can lead to undertreatment, compromise the effectiveness of therapy, and prevent an appropriate response when problematidrug-related behaviors occur.
The Evolutionary Biology of Human Female Sexuality
Authors: Thornhill Randy , Gangestad Steven W
Published: November 2023

Research conducted over the last fifteen years has placed in question many of the traditional conclusions about the evolution of human female sexuality. Women have not lost estrus, as earlier researchers thought, but it is simply concealed, resulting in two functionally distinct sexualities with markedly different ends in each phase. At the fertile phase of the cycle, women prefer male traits that may mark superior genetic quality, and at infertile phases, they prefer men willing to invest resources in a mate. Thus, women’s peri-ovulatory sexuality functions to obtain a sire of superior genetic quality, and is homologous with estrus in other vertebrates. This model sheds light on male human sexuality as well: men perceive and respond to women’s estrus, including by increased mate guarding. Men’s response is limited, compared to other vertebrate males, implying coevolutionary history of selection on females to conceal estrus from men and selection on men to detect it. Research indicates that women’s concealed estrus is an adaptation to copulate conditionally with men other than the pair-bond partner. Women’s sexual ornaments-the estrogen-facilitated features of face and body-are honest signals of individual quality pertaining to future reproductive value.
Extended Female Sexuality
Authors: Thornhill Randy , Gangestad Steven W
Published: November 2023

The definition of extended female sexuality is straightforward: Extended female sexuality is female receptivity to sex or proceptivity for sex (through which females seek to copulate with males) during periods other than when females are fertile—sex when they cannot conceive (see also Rodríguez-Gironés & Enquist, 2001). By de0nition, then, extended female sexuality involves sex with no direct reproductive bene0ts via conception. By another name, extended sexuality is nonreproductive sexuality. We prefer the term extended sexuality, partly so as not to imply that it lacks reproductive bene0ts. (That is, we wish to avoid the implication that sex that is not about “procreation” is merely about “recreation.”) Sex has costs, and these costs must be offset by bene0ts for sex to evolve. We hence adopt the working assumption that extended female sexuality itself does indeed result in net reproductive bene0ts for females who engage in it or is an incidental effect of other features that enhance reproductive success. (As well, some forms of sexuality that are nonconceptive are not extended sexuality; see our discussion of polyandrous sex later.) This chapter focuses on the question of what selection pressures directly or indirectly lead to extended female sexuality.
Age-Related Pharmacology
Authors: Weber Wendell W
Published: November 2023

Life in healthy individuals begins with a period of rapid growth and development followed by a prolonged period of maturity that slowly and progressively declines into senescence. For treatment of specific diseases, physicians strive to prescribe drugs appropriate for a patient’s age and health on the premise that they will bring about favorable, reproducible responses. But young children and elderly persons differ in many ways from mature adults in their middle years, including their capacity to handle and respond to intrinsic and extrinsic stimuli. Aging dominates both the structure and function of cells and organs over a much lengthier period of life than processes involved in growing and development, but knowledge of the mechanisms associated with aging is still very limited and generally less well understood than those that regulate growth and functional advancement.
Drug Discovery
Authors: Weber Wendell W
Published: November 2023

This chapter describes how genomics is involved in the discovery of new drugs for medical therapy. For at least a decade after numerous molecular benchmarks in enzyme and receptor pharmacogenetics had been established, the pharmaceutical industry did not vigorously pursue a gene-based approach to drug discovery. Such an approach was initially viewed with skepticism, but in the 1990s genomics created a whole new direction for drug development, and the elucidation of genetic diversity came to be regarded as an essential component of new drug discovery. By providing a better drug at the outset, genomics could improve safety and efficacy, and diminish costly drug failures.
Kinetics and Mechanisms of Reactions of Cl, O(3P), NO3, and O3 with Alkanes
Authors: Calvert Jack G , Derwent Richard G , Orlando John J , Tyndall Geoffrey S , Wallington Timothy J
Published: November 2023

In this chapter, kinetic data for the reactions of alkanes with Cl-atoms, O(3P), NO3, and O3 will be presented. As was noted in chapter I-C, reaction with OH is clearly the major loss process for the alkanes under most atmospheric conditions. However, reaction with Cl, O(3P), and NO3 can play a role in certain circumstances. For example, although ambient concentrations of Cl-atoms have not been firmly established and tropospheric average concentrations are likely to be less than 103 molecule cm-3 (Rudolph et al., 1996), elevated concentrations (104 molecule cm-3 or more) may be present in the marine boundary layer (MBL) (Jobson et al., 1994; Wingenter et al., 1996; 2005), in coastal areas (Spicer et al., 1998), and/or in urban regions (Tanaka et al., 2003). Reaction of O(3P) with the alkanes may play some role in polluted areas, especially in the early morning when photolysis of NO2 [a source of O(3P)] is maximized relative to O3 photolysis (a major OH source). NO3 is most abundant at night and, in fact, is the most important night time oxidant for the alkanes, although the rate at which this night time chemistry occurs cannot compete with daytime OH-initiated oxidation rates. As will be summarized in section III-E, the occurrence of any reaction between ozone and the alkanes has not been established, and these processes can certainly be ignored for any atmospheric conditions (Atkinson and Carter, 1984). Table III-A-1 presents atmospheric lifetimes for a representative set of alkanes against various oxidation pathways (OH, Cl, O(3P), NO3) for conditions found in various regions of the lower atmosphere.
Berlin, 1855–1864 I: A City of Mingled Chimes
Authors: Walker Alan
Published: November 2023

Bülow’s appointment as head of the piano department at the Stern Con- servatory was the first secure position he had enjoyed. Although he looked forward with trepidation to the routine of institutionalized teaching, it was an important situation and he knew that it would bring him to prominence in the Prussian capital. Shortly before taking up his duties, he wrote to his mother, telling her that if he was going to be condemned to waste his life in Berlin as a piano teacher, the least she could do for him would be to move to Berlin in order to look after him. ‘You must make this sacrifice for me’, he told her.Whether the remark was made half in jest, or whether it was made in all sincerity, even Bülow himself may not have known. Franziska did not require a second invitation; she closed down her home in Dresden, and joined her son in his bachelor’s apartment at no. 4 Behrenstrasse.
The Last Days and Death of Bülow, 1893–1894
Authors: Walker Alan
Published: November 2023

Word quickly spread that Bülow was seeking treatment as an occasional patient at the Pankow Hospital for Nervous Diseases, where his doctors were conducting some exploratory tests. This led to speculation on the part of the general public that Bülow had lost his reason, and that he had been incarcerated in an asylum for the mentally insane.It has been well said that a lie can make its way around the world at once, while truth is still putting on its boots. Pankow was, in fact, an advanced centre for the treatment of neurological disorders, with a medical faculty which was among the best in the field.
Laboratory and imaging abnormalities
Authors: Wallace Daniel J
Published: November 2023

A typical primary care physician’s clinical laboratory and imaging center allows him or her to successfully diagnose, stage, and monitor response to therapy in lupus patients. The complete blood count screens for anemia, autoimmune hemolytic anemia, leucopenia, lymphopenia, leukocytosis, and thrombocytopenias. A comprehensive metabolic panel along with lipid and thyroid testing evaluates liver, renal, and metabolic functions. A routine urinalysis shows sediment, casts, or protein excretion in individuals with renal involvement. Muscle enzymes are elevated with myositis. The partial thromboplastin time is prolonged in many patients with the lupus anticoagulant. Acute-phase reactants such as erythrocyte sedimentation rate and C-reactive protein are elevated with active disease. Chest radiographs reveal pleural effusions, pleural scarring, and interstitial or alveolar changes, while electrocardiograms may suggest pericarditis or myocarditis as well as screen for infarction, strain patterns, or arrhythmias. Joint imaging screens for erosions, calcinosis, and avascular necrosis.
Differential diagnosis and disease associations
Authors: Wallace Daniel J
Published: November 2023

Lupus has many similarities to the “great mimicker,” as Sir William Osler termed syphilis. It can present with symptoms, signs, and laboratory abnormalities affecting every organ system in the body. Twenty percent of patients with one autoimmune disease (including lupus) have a second autoimmune disorder. As a result, there is often a great degree of confusion when lupus is part of the differential diagnosis. This chapter addresses these issues.
Important subsets and special considerations
Authors: Wallace Daniel J
Published: November 2023

When antibodies to Ro (SSA) cross the placenta, they infrequently settle in fetal tissue. Anti-SSB and anti-RNP may do this as well. Neonatal lupus occurs when the infant is born with a discoid or subacute cutaneous rash that disappears within weeks, often without treatment.This occurs in 7% of infants born to anti-Ro-positive mothers. Two percent of the time, this antibody settles in other tissues. Of those with pathology, 54% have varying degrees of myocardial dysfunction, and 7% have hepatic, hematologic, or neurologic complications. Pregnant mothers with anti-Ro should undergo serial fetal echocardiograms between weeks 18 and 24; dexamethasone or intravenous immunoglobulin may be advised to prevent or ameliorate congenital heart block.
Experimental and innovative therapies
Authors: Wallace Daniel J
Published: November 2023

As of this writing, no biologic interventions have been approved for systemic lupus erythematosus (SLE).Numerous agents are in clinical trials and are summarized here. The landscape is continuously changing. The reader is referred to the Web site for up-to-date information. Therapies targeting T/B/antigen-presenting cell interactions in clinical trials include abatacept (already approved for rheumatoid arthritis [RA]). Agents targeting the activation of complement include eculizumab (approved for paroxysmal nocturnal hemoglobinuria). The induction of immune tolerance can be effectuated by abetimus (an anti-anti-DNA B-cell toleragen) and edratide (an anti-DNA peptide toleragen), which are in phase III trials. B cells are targeted by rituximab (an anti-CD20 approved for RA), epratuzumab (an anti-CD22), and anti-BlyS/BAFF/APRIL precursors of anti-CD20 (e.g., belimumab, atacicept). A variety of cytokine targets are being studied: anakinra (anti-interleukin [IL]-1 receptor antagonist available for RA), anti-IL-6R, and anti-IL-10, among several others that are promising in animal models.
The central dogma of molecular biology and protein synthesis
Authors: Cordes Eugene H
Published: November 2023

Suppose for a moment that you are the publisher of J. K. Rowling’s series of Harry Potter novels (don’t spend the money yet; we are just supposing). You have a single copy of her latest manuscript, say Harry Potter and the Deathly Hallows, the final book in the series. Basically, you have two tasks. The first is to replicate the manuscript in the English language several million times. The second is to translate the English- language manuscript into a number of other languages and then replicate those copies. Now suppose that you are a cell in possession of one copy of your genome, a small collection of DNA molecules. When you sense a round of cell division about to happen, you have two related tasks. The first is to replicate your DNA molecules exactly, so as to have two copies, one for each daughter cell. Unlike the publisher of Rowling’s books, you need only one new copy, not millions, but you will need to continue to replicate the DNA molecules at each round of cell division. The second task is to translate the DNA molecule language into that of RNA and then into that of proteins. A new complement of RNA and protein molecules is required for the new cell and for the process of cell division. So the task of a cell facing cell division is not unlike that of a book publisher in some basic ways.
Vitamins Molecules of life
Authors: Cordes Eugene H
Published: November 2023

Every morning I begin my day by taking a multivitamin/mineral pill. It serves me as a kind of insurance policy: whatever my diet may be on a given day, I am reasonably assured of fulfilling all my needs for vitamins. This by no means the same as saying that it does not matter what I eat once I have taken my vitamin pill; it surely does. Taking vitamin pills does not excuse one from consuming a sensible diet, rich in vegetables and fruits and sparing in high fat foods. At the same time, vitamin pills are inexpensive and are, in my mind at least, a sensible insurance policy.
Sciatic Nerve
Authors: Fisch Adam
Published: November 2023

The L4–S3 Nerve roots form the sciatic nerve, which comprises both the peroneal and tibial nerves. The sciatic nerve is responsible for knee flexion and the actions of the lower extremity. As well, it provides sensory coverage to the posterior thigh, most of the lower leg, and the foot. Now, trace the course of your sciatic nerve.
Cranial And Spinal Nerve Overview
Authors: Fisch Adam
Published: November 2023

In This Chapter, we will learn the organization of the cranial and spinal nerves. In order to do so, we will first review the embryogenesis of cranial and spinal nerve development, which will require us to establish the anatomical landscape of the developing embryo. This approach requires extra work at the outset and, therefore, is often met with resistance. However, bear with this teaching method. Knowing the embryogenesis of these nerve groups will allow us to infer their anatomical positions and functions, long after we forget them. Moreover, the information we learn here about the neural plate and folding of the neural tube is of great clinical importance, and is a common board topic in its own right. At the end of the chapter, the highlights of this material are simplified and consolidated for use at the bedside. We must know the global topography of the cranial nuclei to practice neurology; the rest of the details are secondary.
Somatomotor Cranial Nerves
Authors: Fisch Adam
Published: November 2023

The Somatomotor Cranial nerves comprise cranial nerves 3, 4, 6, 12, and 11. It is called “somatomotor” because these nerves innervate somite muscle derivatives. All of the somatomotor cranial nerves originate in midline and innervate midline musculature, and they are all general somatomotor nerves, except for cranial nerve 3, which has an additional general visceral motor cell column component. We discuss the visceral component of cranial nerve 3, the Edinger–Westphal nucleus, in the “Eye Movements” chapter in association with the pupillary light reflex.
White Matter Pathways
Authors: Fisch Adam
Published: November 2023

White Matter Pathways are the train-tracks of the nervous system. If they are interrupted, impulses stagnate. Historically, the number of publications on white matter has paled in comparison to that on gray matter. However, now, with diffusion tensor imaging and other radiographic techniques dedicated to imaging the white matter pathways, much is being learned about their anatomy. Recent attempts to clarify white matter anatomy using audiographic and diffusion spectrum imaging techniques were compiled in a remarkable book entitled Fiber Pathways of the Brain, by Jeremy Schmahmann and Deepak Pandya. Images from that book are included at the start of this chapter.
Olfactory System
Authors: Fisch Adam
Published: November 2023

The Olfactory System is a less important sensory system in humans than in many other animal classes but its anatomy has been well studied and, as discussed in the preceding chapter, it has important secondary connections to memory and behavioral brain regions. In Parkinson’s disease and Alzheimer’s dementia, loss of olfactory function is an early symptom of disease, and research is ongoing to use olfactory testing to help diagnose these clinical disorders in their early stages.
Apraxia
Authors: Fisch Adam
Published: November 2023

Apraxias Are notoriously difficult to conceptualize and, unfortunately, inconsistently defined throughout the literature. In some ways trying to imagine them is like looking at a three-dimensional painting: let your mind go and the image will become clear, but if you focus on any particular element within it, the image will fragment into numerous, insubstantial pieces. In this chapter, we will first establish the common definitions of frequently discussed apraxias, so we will be able to look for them at the bedside and answer board questions about them. Then, we will disassemble these definitions in order to understand their limitations. If you just want a simple mental construct for the apraxias, it is better to accept the imaginary, three-dimensional painting than to analyze its fragments; however, to do so, you need to accept that what you are viewing is unreal.
Etiology of Parkinson’s disease
Authors: Dalvi Arif , Walsh Ryan
Published: November 2023

Sir James Parkinson considered “indulgence in spirituous liquors” and “long lying on the damp ground” as possible etiologies of Parkinson’s disease (PD).1 Eighty years later, Gower reported that 15% of his patients with PD had a family history.2 More recently, initial impressions from a twin study on World War II veterans suggested a minor role for genetic factors, as similar concordance rates were observed in monozygotic and dizygotic twins.3 However, following the discovery of the α-synuclein gene4 and the subsequent discovery of a number of PARK genes, the debate between supporters of genetic or environmental causes has been renewed. The assumptions of Sir James Parkinson have not held up, but a number of alternative environmental factors have been brought into the limelight. This review is focused on “idiopathic” PD, although causes of atypical parkinsonism are reviewed where they offer relevant insights. Current understanding of the etiology of PD points to a multifactorial disorder with gene–environment interactions leading to neuronal cell death (Fig. 5.1).
Management of motor disability in advanced Parkinson’s disease
Authors: Lyons Kelly E , Pahwa Rajesh
Published: November 2023

Parkinson’s disease (PD) is a progressive neurodegenerative disorder with increasing disability as the disease progresses. Motor disability in advanced disease can be related to either complications of antiparkinsonian therapy or to the progression of the disease. Motor complications related to levodopa therapy include motor fluctuations and dyskinesia. Disease progression often results in the development of postural instability and freezing.1
Nonpharmacological management of Parkinson’s disease
Authors: Videnovic Aleksandar
Published: November 2023

Parkinson’s disease (PD) is a progressive neurodegenerative disorder associated with significant disability in both motor and nonmotor functional domains. Pharmacological and surgical treatments have significantly improved the symptomatic burden of PD. However, due to the progressive nature of PD, these therapies often become ineffective with time, and may cause intolerable adverse events. There is therefore a tremendous need to optimize the utilization of nonpharmacological rehabilitative therapies with the aim of improving function and quality of life in the PD population. This chapter summarizes the role of nonpharmacological therapies in the management of PD patients.
Parkinson’s Disease Treatment Guide for Physicians
Authors: Ahlskog J Eric
Published: November 2023

Roughly 1.9 million people are afflicted with Parkinson’s disease and, according to the Parkinson’s Disease Foundation, that number is on the rise! Parkinson’s Disease Treatment Guide for Physicians will comprehensively cover Parkinson’s disease (PD), including diagnosis, testing, prognosis, and possible causes. Its primary focus will be on treatment, specifying appropriate drugs, doses, and common side effects. It will address not only the treatment of motor problems (tremor, gait, etc.), but everything else that routinely arises in a PD practice, including osteoporosis prevention, blood pressure, sexual, bowel, or bladder dysfunction, dementia, depression, common skin rashes, and more. This book will mirror Dr. Ahlskog’s earlier book, The Parkinson’s Treatment Book: Partnering with Your Doctor to Get the Most from Your Medications (2005). Each chapter in the current book will follow the same outline and cover nearly the same material as in each chapter of the earlier patient book, but it will be more succint and direct, with many teaching points summarized wtih bullet points or in small tables. In effect, the clinician and patient can both be reading, or have read, the same material.
Conditions Mistaken for Parkinson’s Disease
Authors: Ahlskog J Eric
Published: November 2023

Common things being common, most cases of parkinsonism represent Parkinson’s disease (PD). However, there are other disorders to consider during the diagnostic evaluation. This chapter will not provide an exhaustive list of parkinsonian disorders but focuses on those conditions likely to surface in practice.
Parkinsonism-Plus Syndromes, Levodopa Failures, and Refractory Tremor: Treatment Options
Authors: Ahlskog J Eric
Published: November 2023

In chapter 6, we discussed a number of disorders that may masquerade as Parkinson’s disease (PD) but have other origins. This includes the so-called parkinsonism-plus syndromes. Sometimes, these conditions are not recognized until they fail levodopa treatment. In this chapter, we will address what medications are available for these conditions, as well as levodopa-refractory tremor.
Levodopa Adjustments to Treat Motor Instability: Motor Fluctuations and Dyskinesias
Authors: Ahlskog J Eric
Published: November 2023

The progressive loss of nigrostriatal dopaminergic terminals ultimately results in altered levodopa pharmacodynamics, as discussed in chapters 5 and 10–12. The initial stable levodopa benefit, termed the “long-duration response,” begins to give way to responses increasingly tied to each dose, the so-called “short-duration response.” During the initial treatment years when long duration responses predominate, the timing of the doses is not important, except for taking them without food; doses can be missed without a decline in benefit. However, after several years or longer, the benefit begins to fluctuate; the response develops within an hour or so after each dose, persists for a few hours or less, and then declines. This concept is graphically depicted in figure 17.1. Occasional patients with long-standing Parkinson’s disease (PD) will experience responses lasting only 1–2 hours, which mirrors the plasma levodopa half-life of 1.5–2 hours.
Nonmotor Symptoms Requiring Dopamine Replacement Therapy
Authors: Ahlskog J Eric
Published: November 2023

The purpose of this chapter is to highlight nonmotor symptoms that can be effectively treated with carbidopa/levodopa and other dopaminergic medications, much like motor symptoms. There are a variety of such symptoms, which often go unrecognized as potentially levodopa responsive.
Insomnia, Somnolence, and Other Sleep Disorders
Authors: Ahlskog J Eric
Published: November 2023

Insomnia is a major problem for many with Parkinson’s disease (PD) and the most common cause is nocturnal parkinsonism. Untreated or undertreated parkinsonism is associated with a variety of symptoms that prevent PD patients from becoming comfortable in bed, such as akathisia, stiffness, difficulty in turning over, tremor, and dystonic cramping. Obviously, insomnia is common in the general population and other nonparkinsonism-related factors may also be operative in PD. However, clinical experience suggests that the majority of PD patients with insomnia have parkinsonism as the primary cause.
Constipation and Delayed Gastric Emptying
Authors: Ahlskog J Eric
Published: November 2023

The autonomic nervous system is affected early in Parkinson’s disease (PD) and this especially includes the gastrointestinal (GI) myenteric plexuses, as well as autonomic spinal neurons. As a consequence, GI motility is impaired, with slowed transit and consequent constipation and delayed gastric emptying. In fact, constipation may be one of the earliest symptoms, predating the motor symptoms of PD by a decade.
Societal and Occupational Issues; Caregivers
Authors: Ahlskog J Eric
Published: November 2023

The clinician is an invaluable resource not only to the patient with Parkinson’s disease (PD), but also to the family. As an ally in the battle against PD, the clinician’s advice may be sought when confronting certain life-altering decisions. These decisions obviously must be individualized, and we will discuss only general principles. However, it all starts with the primary treatment goal that has been reiterated many times in the book: The goal of the clinician is to do everything possible to maintain patients in the mainstreams of their lives, including optimum use of PD medications. However, if and when insurmountable problems surface, life changes may be necessary.
Factors Involved in Causing Multiple Sclerosis
Authors: Birnbaum Gary
Published: November 2023

MS occurs worldwide, but its incidence varies greatly. MS is most common in temperate climates, both above and below the equator, with diminishing frequency as one approaches the equator. The reasons for this uneven distribution are not clear, but one important factor must be environmental exposure. There are major differences in exposures to viral, bacterial, and parasitic agents in different geographic areas, as well as differences in the ages at which individuals are exposed to these agents. Migration studies of populations moving from higher-risk to lower-risk regions, or vice versa, have convincingly shown that living in a particular risk area before puberty establishes the risk for that individual; moving subsequently does not change the risk. Thus, an early environmental event, possibly infectious, is important in determining susceptibility to disease. Many factors have been implicated; among them are exposure to Epstein-Barr virus and exposure to, or lack of exposure to, sunlight and vitamin D.
Complementary Therapies for Multiple Sclerosis
Authors: Birnbaum Gary
Published: November 2023

Providing truly comprehensive care to persons with MS requires the services of health professionals other than physicians. There are multiple aspects of disease management that cannot be addressed as part of an individual’s visit to the physician’s office, and these additional aspects of disease management are the subject of this chapter. Individual needs will vary greatly depending on the phase of the person’s illness (e.g., newly diagnosed, or entering the secondary-progressive phase of their disease), their degree of disability, and the support available from family and friends. Availability of services and financial resources also vary greatly, potentially putting more burden on caregivers and necessitating compromises. In an ideal world, all services described below would be readily available, easily accessed, and financially feasible.
How the Physician’s Ethics and Goals Determine the Content and Techniques of the Clinical History
Authors: DeMyer William E
Published: November 2023

The ethical code of the medical model (Table 4–1) requires the physician to act always for the patient’s benefit (Wynia et al., 1999). This key ethic is the foundation for the entire the physician–patient relationship (Li, 1996). Most of the major medical organizations worldwide and most ethicists either explicitly accept this ethic and the derivative ethics listed in Table 4–1 or do not contradict them (Ahronheim et al., 2000; Beauchamp and Walters, 2003; Bernat, 2002; Hope, 2004; Weinberg, 2000).
Ending the Clinical History, Recording It, and Integrating It with the Physical Examination
Authors: DeMyer William E
Published: November 2023

The first question is “What do you think may have caused your symptoms?” or “Are you worried about any particular disease causing your symptoms?” Such questions may disclose fears of specific disorders such as cancer, heart disease, and AIDS. The patient’s symptoms may imitate those of a relative or friend who died of these diseases. From the patient’s answers, you plan a workup that will exclude the feared disease, or you will know how best to present the unwelcome news if the patient has the feared disease (Creagan, 1994). I had a compelling experience with the father of the next patient. Pt 30: The parents brought their 3-year-old son to the Riley Hospital emergency room because he had just had a brief febrile convulsion. As the father narrated the history, his voice quavered and his hands shook visibly. Convulsions in a child always upset parents, but the father’s reaction far exceeded the usual. I stopped the progression of questions and said, “I see that something has made you extremely upset. Can you tell me about it?” He said, “When I was 9 years old, I had a puppy that had convulsions, and he died one day, in my arms, having a convulsion.”
The Clinical History of the Medical Model Compared to Alternative Models
Authors: DeMyer William E
Published: November 2023

Why practitioners of alternative medicine cannot use the history and thought processes of the medical model By design, the clinical history discloses symptoms that relate to a scientific understanding of brain and body functions and disease. The clinical history searches for scientifically verifiable causes of disease, such as exposure to microbes or toxins, heredity, autoimmune reactions, and stress. Beyond the science, the art of the clinical history explores the essence of the patient. Because alternative practitioners reject scientific explanations of causality and pathogenesis, they couch their histories in terms that sell their belief system and their products.