bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo measurements of interindividual differences in DNA glycosylases and APE1 activities
Authors: Chaim Isaac A. , Nagel Zachary D. , Jordan Jennifer J. , Mazzucato Patrizia , Ngo Le P. , Samson Leona D.
Published: November 2017

Significance

The DNA in each cell is damaged thousands of times daily. Consequently, a battery of DNA repair pathways exist that allow repair of this damage. Failure to repair can lead to devastating diseases, including cancer and neurodegeneration. Each individual’s DNA repair capacity (DRC) is inherently different. Being able to measure an individual’s DRC could contribute to a personalized approach to prevent and treat disease. Here we present powerful tools for measuring in vivo base excision repair capacity for five distinct DNA lesions. We use these methods to predict the cellular responses to a variety of DNA damaging agents, and to monitor differences in DRC in primary human lymphocytes. Additionally, we unveil previously unknown transcriptional mutagenesis induced by DNA lesions.
Higher education governance in France, Germany, and Italy: Change and variation in the impact of transnational soft governance
Authors: Dobbins Michael , Knill Christoph
Published: November 2017

There is a consensus that transnational soft governance has unleashed the forces of change in higher education. However, individual national HE systems are still anchored in country-specific regulatory regimes, which reflect national-historical, institutional, and cultural developments. Against this background, three crucial questions guide our study: How does the state react to transnational pressures for change? How is transnationally inspired policy change ‘digested’ by the preexisting country-specific governance structures? And to what extent have national HE systems converged on a common governance model? To address these questions, we conduct a multi-level comparative analysis of developments in Germany, France, and Italy. We first break down the concept of higher education governance into sub-dimensions and derive concrete policy indicators for three historically embedded governance ideal types. Drawing on historical institutionalism and institutional isomorphism, we explore how historical legacies and transnational communication have impacted policy pathways over the past 30 years. We graphically illustrate the policy trajectories using our ‘governance triangles’, which encompass the balance of power between multiple actors, including the state and universities, university management and the academic profession, and external stakeholders.
Governance change and governance learning in Europe: stakeholder participation in environmental policy implementation
Authors: Challies Edward , Newig Jens , Kochskämper Elisa , Jager Nicolas W
Published: November 2017

Current European Union (EU) policies require policy-makers on different levels of government to engage with new forms of governance such as participatory planning, aiming to improve environmental policy delivery. We address the central issue of how policy-makers learn about the appropriateness of different modes of governance. By way of example, we examine recent innovations in EU water governance – primarily through the enactment of the Water Framework Directive (2000) and the Floods Directive (2007), and their requirements for stakeholder participation in the planning process. We discuss scope for policy-induced ‘governance learning’, wherein policy-makers draw on evidence and experience to learn about how to design and execute effective participatory planning and decision-making. In doing so, we aim to extend work on policy learning by focusing on the procedural dimensions of governance, and make a case for more coordinated and systematic approaches to gathering evidence and learning from ongoing EU environmental policy implementation.
How does policy learning occur? The case of Belgian mental health care reforms
Authors: Thunus Sophie , Schoenaers Frédéric
Published: November 2017

This article asks how policy learning is achieved and whether and how it impacts on policy change. By drawing on the empirical case of Belgian mental health reforms, it shows that policy learning occurs through the very practice of policy-making. In-depth analyses of the process of preparing and devising, a current reform of mental health care delivery, called Reform 107, evidence that the transformation of policy learning – through verbal expression, inscription in documents or enactment in social situations such as meetings – is crucial to its impact on policy change. A phenomenological approach to knowledge in policy helps to perceive and describe the transformation of policy learning through practical actions and interactions involved in devising policy change. Analytically, looking at this transformation entails shifting the focus from big and visible changes in policy objectives and instruments to micro policy practices such as meeting and writing documents. Placing the focus on micro policy practices should not lead, however, to a disregard for the social context in which they develop. The interactionist concept of linked ecologies provides the means to consider social regulations influencing policy learning without underestimating their very ephemeral and contingent nature.
Wicked and less wicked problems: a typology and a contingency framework
Authors: Alford John , Head Brian W
Published: November 2017

This paper addresses shortcomings in the scholarship about ‘wicked problems’, and suggests ways of tackling them. Firstly, accounts of these problems tend to ‘totalise’, regarding them as intractable masses of complexity, so conflict-prone and/or intractable that they defy definition and solution. By contrast, we put forward a more nuanced analysis, arguing that complex problems vary in the extent of their wickedness, via such dimensions as their cognitive complexity or the diversity and irreconcilability of the actors or institutions involved. We propose a typology of different forms of wicked problems. A second shortcoming, linked to intractability, is that the favoured means of tackling wicked problems has tended towards ‘one best way’ approaches, most commonly collaboration with key stakeholders. Moreover, particular forms of collaboration tend to be routinely applied in ‘one-size-fits-all’ fashion to a variety of situations – notably with a plethora of actors, and a focus on governance rather than implementation management. We put forward a contingency framework, based on our typology, proposing which types of collaboration are suitable for which types of problem. Finally, we argue for a more realistic standard of success in dealing with wicked problems, especially the most difficult ones. To call for the ‘solving’ of these problems is to set up a standard which is not only impossible but also perhaps unnecessary. We argue that we do not so much ‘solve’ wicked problems as make progress towards improvement or towards better managing them. We spell out a more realistic version of ‘progress’.
Institutional entrepreneurship and change in consumer protection policy in the telecommunications sector: innovations in the text-based analysis approach
Authors: Righettini Maria Stella , Sbalchiero Stefano
Published: November 2017

This article analyses the institutional entrepreneurship within independent regulatory agencies (IRAs) as a variable explaining policy change over time and seeks to offer new insight for the identification and analysis of structure-agency relationships. The article contributes to the institutional entrepreneurship research agenda by connecting changes in IRA consumer protection policy to changes in agency leadership (specifically, agency presidents). The method used relies upon a quantitative and qualitative text analysis approach to connect and pinpoint structure-agency dynamics over time. The empirical sections compare and contrast the results obtained through the content analysis of the annual reports issued between 2000 and 2015 by the Italian Communications Authority (Agcom), and illustrate variations between periodic changes to Agcom’s presidency and changes in ideas, strategies and tools in the field of consumer protection in the telecommunications sector.
Contextualising the context in policy entrepreneurship and institutional change
Authors: Bakir Caner , Jarvis Darryl S L
Published: November 2017

While there is a considerable literature concerning policy entrepreneurship and institutional isomorphism, significantly less literature has emerged addressing the impact of context on policy and institutional entrepreneurship and of the interactions between various contexts and agency. In this article, we demonstrate that the actions of entrepreneurs in the public sector are most likely to generate policy and institutional changes when they are reinforced by complementarities arising from context-dependent, dynamic interactions among interdependent structures, institutions and agency-level enabling conditions.
The structural basis of ryanodine receptor ion channel function
Authors: Meissner Gerhard
Published: November 2017

Large-conductance Ca2+ release channels known as ryanodine receptors (RyRs) mediate the release of Ca2+ from an intracellular membrane compartment, the endo/sarcoplasmic reticulum. There are three mammalian RyR isoforms: RyR1 is present in skeletal muscle; RyR2 is in heart muscle; and RyR3 is expressed at low levels in many tissues including brain, smooth muscle, and slow-twitch skeletal muscle. RyRs form large protein complexes comprising four 560-kD RyR subunits, four ∼12-kD FK506-binding proteins, and various accessory proteins including calmodulin, protein kinases, and protein phosphatases. RyRs share ∼70% sequence identity, with the greatest sequence similarity in the C-terminal region that forms the transmembrane, ion-conducting domain comprising ∼500 amino acids. The remaining ∼4,500 amino acids form the large regulatory cytoplasmic “foot” structure. Experimental evidence for Ca2+, ATP, phosphorylation, and redox-sensitive sites in the cytoplasmic structure have been described. Exogenous effectors include the two Ca2+ releasing agents caffeine and ryanodine. Recent work describing the near atomic structures of mammalian skeletal and cardiac muscle RyRs provides a structural basis for the regulation of the RyRs by their multiple effectors.
High-temperature thermodynamics of silver: Semi-empirical approach*
Authors: Joshi R H , Thakore B Y , Vyas P R , Jani A R , Bhatt N K
Published: November 2017

We report high-temperature thermodynamics for fcc silver by combining ab initio phonon dynamics to empirical quadratic temperature-dependent term for anharmonic part of Helmholtz free energy. The electronic free energy is added through an interpolation scheme, which connects ambient condition free electron gas model to Thomas–Fermi results. The present study shows good agreement with experimental and reported findings for several thermal properties, and the discrepancy observed in some caloric properties is addressed. The decreases in the product of volume thermal expansion coefficient and isothermal bulk modulus and in the constant volume anharmonic lattice specific heat at high temperature are the clear evidences of proper account of anharmonicity. The present study also reveals that T
2–dependent anharmonic free energy is sufficient for correct evaluation of thermal pressure and conventional Grüneisen parameter. We observe that the intrinsic phonon anharmonicity starts dominating above characteristic temperature, which is attributed to higher order anharmonicity and can be related to higher order potential derivatives. We conclude that the uncorrelated and largeamplitude lattice vibrations at high temperature raise dominating intrinsic thermal stress mechanism, which surpasses the phonon-anharmonism and requires future consideration.
Predicting loop conformational ensembles
Authors: Marks Claire , Shi Jiye , Deane Charlotte M
Published: November 2017

Motivation

Protein function is often facilitated by the existence of multiple stable conformations. Structure prediction algorithms need to be able to model these different conformations accurately and produce an ensemble of structures that represent a target’s conformational diversity rather than just a single state. Here, we investigate whether current loop prediction algorithms are capable of this. We use the algorithms to predict the structures of loops with multiple experimentally determined conformations, and the structures of loops with only one conformation, and assess their ability to generate and select decoys that are close to any, or all, of the observed structures.

Results

We find that while loops with only one known conformation are predicted well, conformationally diverse loops are modelled poorly, and in most cases the predictions returned by the methods do not resemble any of the known conformers. Our results contradict the often-held assumption that multiple native conformations will be present in the decoy set, making the production of accurate conformational ensembles impossible, and hence indicating that current methodologies are not well suited to prediction of conformationally diverse, often functionally important protein regions.

Supplementary information

Supplementary data are available at Bioinformatics online.
Perverse Schobers and Wall Crossing
Authors: Donovan W
Published: November 2017

For a balanced wall crossing in geometric invariant theory (GIT), there exist derived equivalences between the corresponding GIT quotients if certain numerical conditions are satisfied. Given such a wall crossing, I construct a perverse sheaf of categories on a disk, singular at a point, with half-monodromies recovering these equivalences, and with behaviour at the singular point controlled by a GIT quotient stack associated to the wall. Taking complexified Grothendieck groups gives a perverse sheaf of vector spaces: I characterize when this is an intersection cohomology complex of a local system on the punctured disk.
Integrated Neuroscience for the Clinician
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

Neurologic disorders are common, and all clinicians must be capable of recognizing and managing them. Many steps are required to solve a neurologic problem. Patients seldom present to their physician with a well-defined diagnosis for which appropriate therapy can be readily dispensed. Instead, they present with an array of symptoms and signs that constitute a clinical problem the physician must attempt to resolve.
Neuroembryology and Development of the Nervous System
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The study of neuroscience begins with a survey of the embryonic development of the nervous system because it provides a framework and background for understanding the anatomy and function of the nervous system in the adult. The eventual location and connectivity of the structures in the brain, spinal cord, and peripheral nervous system reflect the orderly development of the nervous system.
Neurochemistry
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

Communication between neurons occurs primarily at the level of synapses. The most common form of communication in the nervous system is through chemical synapses, which consist of presynaptic and postsynaptic components separated by a synaptic cleft. The presynaptic terminals contain synaptic vesicles, which are involved in the storage and release of neurotransmitters by the process of exocytosis. Complex mechanisms control the synthesis, vesicular storage, and release of neurotransmitters and regulate the availability of neurotransmitter at the level of the synaptic cleft. The effects of the neurochemical transmitter on its target are mediated by neurotransmitter receptors. Specific neurotransmitter systems are responsible for fast neuronal excitation or inhibition, while other neurotransmitter systems regulate the excitability of neurons in the nervous system. Abnormalities in neurochemical transmission are responsible for many disorders, including acute neuronal death, seizures, neurodegenerative disorders, and psychiatric diseases. Most importantly, neurochemical systems provide the target for pharmacologic treatment of these disorders. The aims of this chapter are to review the basis of neurochemical transmission and the distribution, biochemistry, and function of specific neurotransmitter systems.
Autonomic Nervous System
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The autonomic nervous system is a critical effector of an internal regulation system that controls functions necessary for survival. Autonomic outputs regulate the activity of the heart; the smooth muscle of the blood vessels, pupil, and visceral organs; and the exocrine glands. The autonomic nervous system includes 3 subdivisions: the sympathetic, parasympathetic, and enteric nervous systems. Autonomic disorders may be prominent manifestations of several neurologic diseases and, in some cases, may be valuable in localizing lesions in the nervous system.
Peripheral Level
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

Precise anatomical localization is a main goal of neurologic diagnosis. Knowledge of the major longitudinal systems and the manifestations of diseases within each system permits localization of a lesion within 1 or more systems. present the patterns of disease at each of the 4 major levels. The combination of signs and symptoms resulting from damage to the systems at each major level often allows highly specific localization of the underlying disorder. This chapter focuses on the peripheral level, which includes all neuromuscular structures outside the skull and spinal column. This includes spinal and peripheral nerves, nerve plexuses, sensory receptors, neuromuscular junctions, muscles, and the portions of cranial nerves outside the cranial vault. Diseases at the peripheral level are among the most common neurologic diseases and are encountered by physicians in all medical specialties.
Supratentorial Level
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

The supratentorial level consists of 2 main anatomical regions: the diencephalon and the telencephalon. The anatomy, physiology, and clinical correlations of lesions affecting the diencephalon and visual pathways are described in another chapter. The telencephalon forms the cerebral hemispheres, which consist of the cerebral cortex, basal ganglia, and subcortical white matter tracts that interconnect areas of the cerebral cortex with one another and with the basal ganglia, thalamus, brainstem, and spinal cord. The medial portion of the cerebral hemispheres includes the amygdala, hippocampal formation, and cingulate cortex. These areas are involved in emotional and memory processing. The olfactory system is intimately related to these structures. The lateral and inferior aspects of the cerebral hemispheres include most of the frontal, insular, parietal, temporal, and occipital lobes. Neurons distributed in several cortical areas interact, forming functional networks that control different cognitive functions.
Clinical Problems
Authors: Benarroch Eduardo E. , Cutsforth-Gregory Jeremy K. , Flemming Kelly D.
Published: November 2017

Clinical cases are presented with questions and answers to allow the reader to assess knowledge and identify areas for additional study. A small number of questions in this chapter address details of pharmacology that are not included in the text of previous chapters. We have included these questions because they are representative of clerkship shelf, residency in-training, or American Board of Psychiatry and Neurology examinations.
Anterotemporal, Basal Temporal, Nasopharyngeal, and Sphenoidal Electrodes and High-Density Arrays
Authors: Schomer Andrew , Seeck Margitta , Kanner Andres M. , Schomer Donald L.
Published: November 2017

Temporal lobe epilepsy is the most frequent type of epilepsy of focal origin in adults. Electroencephalographic evaluation for surgical treatment requires accurate localization of epileptic foci. The yield of detection with scalp electrodes depends on three variables: source and extent of the epileptogenic area relative to the scalp electrodes’ position; electric field generated by the epileptiform activity and the electric vectors’ orientation; and extent of propagation of the epileptiform activity from mesial to temporal lateral regions. Recordings of epileptiform activity of presumed mesial-temporal origin should include additional electrodes such as anterior temporal or basal temporal electrodes or a subtemporal chain. Nasopharyngeal electrodes appear to yield no advantage over anterior temporal or basal temporal electrodes or a subtemporal chain and are associated with discomfort. Sphenoidal electrodes should be considered in special circumstances; reliability is improved if placed under fluoroscopy. High-density scalp recordings allow for even greater resolution and improved spatial sampling.
Normal EEG in Wakefulness and Sleep
Authors: Krishnan Vaishnav , Chang Bernard S. , Schomer Donald L.
Published: November 2017

The normal adult electroencephalogram (EEG) is not a singular entity, and recognizing and appreciating the various expressions of a normal EEG is vital for any electroencephalographer. During wakefulness, the posterior dominant rhythm (PDR) must display a frequency within the alpha band, although an absent PDR is not abnormal. A symmetrically slowed PDR, excessive theta activity, or any delta activity during wakefulness is abnormal and a biomarker of encephalopathy. Low-voltage EEGs have been associated with a variety of neuropathological states but are themselves not abnormal. During non-rapid eye movement sleep, a normal EEG will display progressively greater degrees of background slowing and amplitude enhancement, which may or may not be associated with specific sleep-related transients. In contrast, the EEG during rapid eye movement sleep more closely resembles a waking EEG (“desynchronized”) in amplitude and background frequencies. Across both wakefulness and sleep, significant asymmetries in background frequencies and amplitude are abnormal.
Convulsive Status Epilepticus
Authors: Drislane Frank W , Herman Susan T , Kaplan Peter W
Published: November 2017

Generalized convulsive status epilepticus (GCSE) is a serious neurologic illness causing unresponsiveness, major physiologic disturbances, risk of injury and, if prolonged enough, neuronal damage. Causes are many, and the outcome often depends as much on the etiology as on the epileptic seizure itself. Several anti-seizure medications are used in treatment of GCSE, but some cases continue electrographically when clinical convulsions cease (nonconvulsive SE), and EEG is essential in their diagnosis. About 20% of cases become refractory to initial treatment, and the EEG becomes even more crucial in diagnosis and management. This chapter also covers other forms of SE with significant motor manifestations including: focal motor status (including epilepsia partialis continua); myoclonic status, which includes some relatively benign forms as well as some with a very poor prognosis; and clonic and tonic status. It reviews the many different EEG findings in those forms of status, and the use of EEG in their treatment and management, especially in prolonged cases.
Intracranial EEG Monitoring
Authors: Seeck Margitta , Schomer Donald L.
Published: November 2017

Intracranial electroencephalography (iEEG) is used to localize the focus of seizures and determine vital adjacent cortex before epilepsy surgery. The two most commonly used electrode types are subdural and depth electrodes. Foramen ovale electrodes are less often used. Combinations of electrode types are possible. The choice depends on the presumed focus site. Careful planning is needed before implantation, taking into account the results of noninvasive studies. While subdural recordings allow better mapping of functional cortex, depth electrodes can reach deep structures. There are no guidelines on how to read ictal intracranial EEG recordings, but a focal onset (<5 contacts) and a high-frequency onset herald a good prognosis. High-frequency oscillations have been described as a potential biomarker of the seizure onset zone. Intracranial recordings provide a focal but magnified view of the brain, which is also exemplified by the use of microelectrodes, which allow the recording of single-unit or multi-unit activity.
High-Frequency EEG Activity
Authors: Gotman Jean , Crone Nathan E.
Published: November 2017

Activities with frequencies between 60 and 80 Hz and approximately 500 Hz are labeled here as high-frequency activities. They were largely ignored until the beginning of the millennium, but their importance is now well recognized. They can be divided into activities occurring in the healthy brain in relation to sensory, motor, and cognitive or memory activity and activities occurring in the epileptic brain in the form of brief events (high-frequency oscillations), which appear to be an important marker of the brain regions that are able to generate seizures of focal origin. In humans, most of the work related to these activities has been done in intracerebral electrodes, where they are relatively frequent and easy to identify. They have been recorded in scalp electroencephalograms in some circumstances, however. This chapter reviews the recording methods, the circumstances in which they occur, their mechanism of generation, and their clinical significance.
Magnetoencephalography
Authors: Hari Riitta
Published: November 2017

This chapter introduces magnetoencephalography (MEG), a tool to study brain dynamics in basic and clinical neuroscience. MEG picks up brain signals with millisecond resolution, as does electroencephalography, but without distortion by skull and scalp. The chapter describes current instrumentation based on superconducting quantum interference devices (SQUIDs). It delineates basic characteristics of measured signals: (1) brain rhythms and their reactivity during sensory processing and various tasks and (2) evoked responses elicited by sensory stimuli, and the dependence of these responses on various stimulus characteristics. Signals are described from healthy and diseased brains. The chapter presents studies of the brain basis of cognition and social interaction studied in dual-MEG setups and describes how MEG applications can be broadened by innovative setups, including frequency tagging. Progress in the field is predicted regarding sensor technology, data analysis, and multimodal brain imaging, all of which could strengthen MEG’s role in the study of brain dynamics.
EEG Mapping and Source Imaging
Authors: Michel Christoph M. , He Bin
Published: November 2017

This chapter describes methods to analyze the scalp electric field recorded with multichannel electroencephalography (EEG). With advances in high-density EEG, systems now allow fast and easy recording from 64 to 256 channels simultaneously. Pattern-recognition algorithms can characterize the topography of scalp electric fields and detect changes in topography over time and between experimental or clinical conditions. Methods for estimating the sources underlying the recorded scalp potential maps have increased the spatial resolution of EEG. The use of anatomical information in EEG source reconstruction has increased the precision of EEG source localization. Algorithms of functional connectivity applied to the source space allow determination of communication between large-scale brain networks in certain frequencies and identification of the directionality of this information flow and detection of crucial drivers in these networks. These methods have boosted the use of EEG as a functional neuroimaging method in experimental and clinical applications.
The Suicidal Crisis
Authors: Galynker Igor
Published: November 2017

One of the most difficult determinations a psychiatrist makes is whether the chronically suicidal patient is at risk for suicide in the immediate future. The Suicidal Narrative is the first book to help clinicians evaluate the risk of imminent suicidal behavior. The book describes a theoretical framework for a systematic and comprehensive assessment of short-term suicide risk and also describes practical ways of conducting risk assessment interviews in different settings. The book is based on the narrative crisis model of suicide, which posits that individuals with trait vulnerability for suicide attempt suicide after they develop the suicide crisis syndrome when they feel that their life narrative has no acceptable future. This book first reviews current models of suicidal behavior and introduces the narrative crisis model of suicide. Next, it provides a comprehensive description of trait vulnerabilities followed by a discussion of stressful life events that may increase short-term suicide risk. The book’s core introduces the key concepts of the narrative crisis model of suicide—the suicidal narrative and suicide crisis syndrome—and addresses the clinical value of clinicians’ emotional responses to suicidal patients. Finally, the book provides practical guidance for conducting short-term suicide risk assessment and introduces current approaches to suicide risk reduction. The Suicidal Narrative is designed as a textbook and reference guide. The book contains more than 50 clinical case vignettes, detailed examples of risk assessment interviews, as well as test cases for self-assessment.
Introduction
Authors: Galynker Igor
Published: November 2017

One of the most difficult determinations a psychiatrist makes is whether the chronically suicidal patient is at risk for imminent suicide. The Introduction presents the challenges of the imminent risk assessment and explains the purpose of The Suicidal Narrative—the first clinical guide to such an assessment. It introduces the distinction between long-term and short-term suicide risk, highlights the lack of structured instruments for imminent risk assessment, and discusses the advantages of multimodal and multi-informant assessment methods. It then describes intended uses of the guide, lists its inherent limitations, and identifies possible areas of unintended misuse. The Introduction concludes by naming the main intended use of The Suicidal Narrative: as a roadmap for a comprehensive assessment of imminent suicide risk in diverse clinical settings.
Suicide Crisis Syndrome
Authors: Galynker Igor
Published: November 2017

Research has shown that the suicide crisis syndrome (SCS) is a suicide-specific diagnosable condition that is associated with imminent suicidal behavior. This chapter proposes Diagnostic and Statistical Manual of Mental Disorders criteria for SCS and provides a detailed description of its proposed structure and symptoms. Discussion of long-term versus short-term suicide risk and of suicide warning signs is followed by a discussion of the lack of predictive validity of self-reported suicidal ideation and intent with regard to imminent suicidal behavior. The core of the chapter consists of detailed description of the SCS main components: entrapment, affective disturbance in its many forms (emotional pain, anhedonia, frantic anxiety, and depressive turmoil), loss of cognitive control in several forms (ruminations, cognitive rigidity, thought suppression, and ruminative flooding), and altered arousal. The chapter concludes with the SCS assessment algorithm, representative case descriptions, and a test case.
Harm Reduction
Authors: Batra Sonal , Villegas Noah , Zerbo Erin
Published: November 2017

Harm reduction is defined as a set of policies, programs, and practices aimed at reducing the negative health, social, and economic consequences associated with various behaviors. Although classically applied to the treatment of substance use disorders, its scope has broadened over time to include high-risk sexual activity, nonadherence to treatment, and other behaviors that may lead to negative consequences. In addition to providing relevant historical context for scenarios encountered, this chapter uses a case to demonstrate how a provider might take a nonjudgmental and humanistic approach to identifying maladaptive behaviors and apply evidence-based, realistic interventions to reduce associated harms. Specific topics discussed include opioid use disorder, tobacco use disorder, female sex work, and nonadherence to psychotropic medications.
Financing Care
Authors: Everett Anita
Published: November 2017

Persons with serious mental illnesses are much more likely to have government-sponsored insurance, such as Medicaid and Medicare, compared to persons with general medical conditions. Often, state, city, or county government programs are needed to close gaps in services funding. Learning to navigate the health care financing system to access needed treatment and rehabilitative services is an essential part of a public psychiatrist’s work, and psychiatrists have a valuable role in advocating for better access to care. The pieces of the complex financing puzzle come together to provide, at the very least, a safety net and, at optimum, a high-quality delivery system that promotes resilience, recovery, and well-being.
The Elderly
Authors: Popeo Dennis
Published: November 2017

Every day, approximately 20,000 Americans turn age 65 years. If the current prevalence of mental illness and substance abuse continues, in 2040 more than 15 million adults older than age 65 years will need services that are specifically tailored to older adults. As it is, the current population of older adults is underserved—a service gap to which public psychiatrists must respond. By presenting one representative case, this chapter addresses some of the specific needs of this cohort of patients, including complex and comorbid health issues, cognitive impairment, caregiver burden, elder abuse, and the unfortunate prevalence of homelessness among the elderly. Age-appropriate mental health treatment is discussed, with the goal of educating mental health practitioners to better serve this diverse and heterogeneous population.
Correctional Settings
Authors: Ford Elizabeth
Published: November 2017

Correctional settings could represent an opportunity to provide treatment and rehabilitation for the disproportionately large numbers of people with mental illness who are incarcerated. Public psychiatrists have developed compassionate models of care for these individuals in prisons throughout North America, and they have worked to prevent victimization of individuals in these contexts. Risks including substance use, violence, and suicide are among the challenges that psychiatrists manage in these settings, and continuity of care following release into the community presents broad systemic challenges as well. The forensic psychiatry chapter’s discussion of diversion and fitness restoration dovetails with the focus on care provision within correctional settings explored in this chapter.
Co-occurring Substance Use Disorders
Authors: Soule Michael , Connery Hilary S.
Published: November 2017

Substance use disorders are frequently comorbid with mood, anxiety, and psychotic disorders, and they commonly present in tandem in both primary care and psychiatric settings. Unfortunately, in the past, individuals with co-occurring substance use and mental health disorders would receive treatment in community mental health clinics only after their substance use disorder was “stabilized.” There has been increasing recognition that integrated treatment is necessary for these individuals to fully succeed and achieve recovery. This chapter uses a common presentation to illustrate up-to-date screening and treatment recommendations. Motivational interviewing, contingency management, cognitive–behavioral therapy, and medication-assisted treatment are explored. A discussion of the continuum of community-based services and systems challenges follows.
Refugees and Immigrants
Authors: How Poh Choo , Lo Pachida , Westervelt Marjorie , Ton Hendry
Published: November 2017

The number of refugees and immigrants continues to increase each year. These populations may experience migration-related trauma and stress that increase the risk for mental illness(es). Perspectives about mental illness, its expression, and treatments often differ significantly between immigrants/refugees and their providers. Therefore, psychiatric evaluation requires sensitivity to the patients’ cultural context and perspectives, including the specific stressors associated with being a migrant. Interpreters can be helpful as cultural brokers in the process of forming a collaborative explanatory model and treatment plan. The latter should include psychosocial approaches to help patients identify areas of resiliency and foster post-traumatic growth, as well as social integration and acculturation to the dominant culture while maintaining affiliation with their original culture. This will increase the probability of positive mental health outcomes.
Hippocrates' Oath and Asclepius' Snake
Authors: Cavanaugh T.A.
Published: November 2017

Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession—a practice incorporating an internal, uniquely medical ethic that particularly prohibits doctors from killing. In its most basic and least controvertible form, this ethic mandates that physicians try to help while not trying to harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical code arises from reflection on the most vexing medical-ethical problem: iatrogenic harm, injury caused by a physician. The book argues that deliberate iatrogenic harm—especially the harm of a doctor choosing to kill (physician-assisted suicide, euthanasia, abortion, and involvement in capital punishment)—amounts to an abandonment of medicine as an exclusively therapeutic profession. Since electively killing a patient always injures (even when done at the patient’s request), the Oath excludes killing (along with other salient harms such as sexual exploitation and the violation of patient confidentiality) from medicine as a profession. The work argues that medicine as a profession necessarily involves stating before others what one stands for: the goods one seeks and the bads one seeks to avoid on behalf of the sick. The book considers and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes by noting that medical promising (as found in the White Coat Ceremony by which US medical students matriculate) implicates medical autonomy, which merits respect, including the honoring of professional conscientious objection.
Wounding
Authors: Cavanaugh T.A.
Published: November 2017

Chapter 3 (Wounding) considers the wounds forsworn in the Oath. It focuses particularly upon the killing of one’s patient as the paradigmatic instance of wounding, while also considering sexual exploitation and violations of confidentiality. Chapter 3 argues on behalf of the Oath, especially for its contention (found in the oath-proper) that a physician electively killing a patient, even at the request of that patient, instances harm and injustice. It advances numerous reasons for regarding a doctor’s involvement in killing as a profound error that entirely disorients medicine as an exclusively therapeutic practice. Further, it argues for the Oath’s implicit claim that iatrogenic harm (especially in the form of role-conflation as instanced by Dr. Guillotin, whose example serves as a cautionary tale) amounts to the foundational medical-ethical problem the answer to which (found in the Oath) inaugurates medicine as a profession (in contrast to, e.g., conflicts of interest).
US outpatient commitment in context: When is it ethical and how can we tell?
Authors: Swanson Jeffrey W. , Swartz Marvin S. , Moseley Daniel D.
Published: November 2017

Outpatient commitment is the legal practice of using civil court orders to mandate mental health treatment in the community for certain adults with serious and chronic mental illnesses. In this chapter, we examine the historical context in which the practice of outpatient commitment emerged in the United States. We discuss the controversial nature of outpatient commitment, examining the assumptions and perspectives of those on either side of ongoing arguments about whether the practice is legitimate, fair, and effective. In the final section of the chapter, we discuss whether, and under what conditions, outpatient commitment may be ethical. We discuss a useful conceptual framework for disentangling the various types of considerations involved in determining whether public policies are ethical. The framework identifies four principles relevant to ethical decision making in the context of outpatient commitment: (1) respect for autonomy, (2) non-maleficence, (3) beneficence, and (4) justice.
Psychiatric disorder and individual violence: Evidence and perceptions
Authors: Busfield Joan
Published: November 2017

This chapter explores the links commonly made between psychiatric disorder and individual violence. To this end it: first, looks at the evidence concerning the relationship between psychiatric disorder and violent behaviour, examining a range of empirical data, including the issue of whether it is possible to predict violence in those with mental illness; second, it draws on a range of ideas to explore how we can best understand the continuing, often exaggerated, assumptions of a close link between the two; and third and finally, it considers the implications of both the empirical data and the explanatory ideas for mental health policy.
Recovery and recidivism reduction for offenders with mental illness
Authors: Rotter Merrill , Barber-Rioja Virginia , Schombs Faith
Published: November 2017

Treatment of individuals with mental illness who have justice involvement has the same goals as the treatment of those without justice involvement: ameliorating symptoms, minimizing disability, maximizing community functioning, and supporting individualized recovery goals. The attainment of these goals are challenged, if not precluded, when a person is incarcerated, making the overrepresentation of individuals with mental illness all the more tragic, and decreasing criminal justice activity all the more important for both clinical success and public safety. Understanding and addressing the risk of criminal recidivism (i.e., re-arrest and return to jail for offenders with mental illness) is, therefore, a critical skill for the forensic clinician. In this chapter, we review risk factors for recidivism with specific focus on those relevant for offenders with mental illness, and present a holistic approach that incorporates both traditional treatment and recidivism-focused psychosocial interventions.
Treatment with medication: Side effects, adherence, and risk
Authors: Tracy Derek K. , Gaughran Fiona
Published: November 2017

Antipsychotic medications revolutionized the care of psychosis, but they have brought with them significant side effects and issues around adherence; these latter factors, and informed co-working with patients, are primary drivers for specific medication choices. The data remain limited for polypharmacy and above-maximum dose prescribing, though there may be individuals for whom this is considered. Long-acting injectables (LAIs or ‘depots’) have a good evidence base, and are probably underutilized, though clozapine remains our drug of choice in refractory illness. Forensic-population data show that medications significantly reduce recidivism, including of violent crime. Whilst side effect data are disheartening for both patient and clinician, there are rational management strategies for them all. Novel future therapies being evaluated include acetylcholinergic and glutamatergic enhancers, anti-inflammatory drugs, and the neural peptide oxytocin, to improve negative and cognitive functioning; neuromodulation through rTMS and tDCS are also showing early promise.
Outpatient psychotherapeutic approaches with mentally disordered offenders
Authors: Velsen Cleo Van , Norton Kingsley
Published: November 2017

In the last 30 years, there has been an upsurge of interest in developing and refining psychological approaches to the treatment and management of offenders. This chapter focuses on outpatient interventions with those identified as suffering from forensic personality disorder. The potential range of treatments is vast; therefore, we examine general treatment principles. We describe the concept of forensic personality disorder and outline theoretical and evidence-based approaches to aetiology and therapy. Attention is paid to the establishment and maintenance of a therapeutic alliance, including the importance of boundaries, which can easily become distorted. Offender patients are usually seen in the context of the criminal justice system and risk, which means understanding the balance between confidentiality and information sharing. The effect on individuals and teams and the need to explore disagreements and conflicts in the treatment service are highlighted. Clinical vignettes are included to illustrate the concepts described.
Violence risk in community settings
Authors: Buchanan Alec , Norko Michael A.
Published: November 2017

Managing the risk of harm to others is an essential aspect of the care of hospital patients and mentally disordered people in prisons. As these people move to the community, the responsibility to assess risk remains, but the circumstances and the resources available change. This chapter reviews violence risk-assessment principles described in previous chapters, and applies them to the management of risk in community settings. Those principles continue to require the obtaining of information from a range of sources and the collation of that information, a task complicated by the coexistence of correlation-based and causation-based approaches in the literature. Managing risk in community settings requires particular attention to a range of concerns, including the appropriateness of residential placements, the monitoring of people’s mental states, and the ethics of sharing information. It also requires the integration of risk-management strategies with other tools of rehabilitation, such as vocational services and substance-abuse services.
Kidney stones
Authors: Turney Ben , Reynard John
Published: November 2017

The composition of kidney stones is variable and the predisposing factors multifactorial. Consequently, a detailed evaluation of the patient’s lifestyle, diet, fluid intake, medical history, drug history, urinary tract anatomy, blood, and urine biochemistry and stone composition is required determine predisposing factors for stone formation in an individual patient. Combinatorial subtle variants in biochemistry may act synergistically to increase risk of stone formation/recurrence. Many medications may alter blood and/or urine biochemistry and predispose to stone formation. Corticosteroids increase absorption of calcium from the gut and cause hypercalciuria. Topirimate (for seizures or migraines), sulphasalazine (for rheumatoid arthritis), diuretics containing triamterene, acetazolamide (for myotonia), antacids containing trisilicate, calcium supplements, vitamin D supplements, vitamin C in high doses, indinavir (for HIV), and some herbal medicines (containing ephedrine) all increase stone risk.