bluuebunny/crossref_metadata_2025 huggingface dataset:
Qafzeh Cave in a Broader Perspective
Authors: Hovers Erella
Published: October 2023

The previous chapters have described how Middle Paleolithic hominins who occupied Qafzeh Cave produced and modified stone tools. The fluctuations in tactics of technological organization were then examined against the distribution of various resources that the occupants seem to have used. This set of analyses revealed variability within what at Erst glance appeared to be quite uniform technological behaviors. The diversity discerned among the Qafzeh assemblages does not stem from shifts in the application of particular chaînes opératoires (although there are some specific examples of this type of variability). Rather, it is expressed mainly in organizational tactics that occasionally shifted against the background of a stable lithic reduction strategy. The complexity of observed behaviors was explained as depicting the dominant role of technological tradition in shaping the lithic assemblages. It was further asserted that the lithic tradition might have emerged initially as a functional response to specific needs, complementing particular mobility and seasonality patterns, but then evolved into a traditional behavior that survived through time without necessarily being dependent on the conditions that enhanced its initial occurrence. Finally, it was argued that independent lines of evidence are consistent with the development of other technological and social traditions, and thus support the suggested interpretation of the lithic Ends.
Population Dynamics during the Middle Paleolithic Period in the Levant
Authors: Hovers Erella
Published: October 2023

The issue of Moderns and Neanderthals in the Levant is not the focus of the current work. Yet it is this issue that has long captivated the attention, not to say the imagination, of paleoanthropologists (chapter 1). As the “home” of one of the most important diagnostic groups of skeletal remains, Qafzeh Cave has been at the heart of some of the prolonged and sometimes heated debates on Neanderthal–Modern interactions. It is therefore worthwhile to examine the implications of the lithic assemblages of Qafzeh (chapters 4–7) and their meaning in a broader Levantine context (chapter 8) with regard to the issue of interactions—or lack thereof—between Moderns and Neanderthals in the Levant. In the following discussion, I attempt to re-address, on the basis of current information and recent theoretical advances on the part of both ecologists and archaeologists, some of the premises and assumptions underlying inVuential models of such relationships.
Winning Re-election
Authors: GILLON STEVEN M
Published: October 2023

By the Winter of 1996, the relationship between Gingrich and Clinton had hit bottom. In addition to the bad feeling created by the budget battles, both had grown weary of the constant stream of investigation and invective hurled at each other. As Clinton had feared, Republicans used their oversight function to investigate every aspect of his presidency. The strategy was developed by the Speaker’s closest advisor, Joe Gaylord, who suggested that Republicans engage in an orchestrated effort to “indict the Clinton administration.” Specifically, he recommended that the Republicans use their “oversight function” to keep the administration on the defensive. “Change the battlefield to one where Democrats are on the defensive by attacking personal ethics, attacking individual legislative records, forcing Dems to defend Clinton administration.” Part of the plan was to put pressure on the White House to get House Democrats to back off their investigations of Gingrich. “Get the Clinton administration under special prosecutor problems and have the Clinton administration get the House Dems to back down.”
14
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

One Saturday last September is a day I will never forget. I was getting ready to go to work with my dad in our family business, when suddenly I blacked out and collapsed. I barely remember trying to regain consciousness and struggling to pull myself up. A while later, my dad found me lying in the middle of the floor and thought I had fallen asleep there. He walked me back to bed and later had me get ready to leave. I was very tired and slept most of the day.
16
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

I mostly still have my seizures once a month. This is despite the fact that I’ve had my ovaries and uterus removed—and I don’t have any more actual periods. Even so, when the date comes up that I would have usually expected my period, I still have seizures! It’s very hard trying to get a job when you have seizures. If you have one on the job, they send you home. I was out of work for 4 weeks and was put on another medicine and felt better. I was told to go back to work, but that they would only accept me 3 days a week.
23
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

I have had epilepsy all my life, so I know what it is like to have seizures. In the beginning, it was hard for me because no one understood what epilepsy was, including me. As I grew up and tried unsuccessfully to go to work, the seizures got worse. People still did not seem to understand. Even the doctors. I got married and became pregnant. The doctors did not give me any special instructions or guidance, even though they knew I had seizures. My daughter was born with a heart defect and now has attention-deficit disorder.
31
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

Growing up, I had a hard time in school with the other students and trouble making friends because they were afraid of getting near me. They thought they could ‘‘catch’’ epilepsy. Now that I have children, I find that explaining all about my seizures to them and repeatedly saying that I’ll be fine if I have a seizure makes it easier for them to accept my epilepsy.
32
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

Here are the burning questions about my epilepsy that I have struggled with throughout my life: It is very hard to me to face the reality that I am 19 years old and yet do not have the right to drive. Whenever I watch my 16-year-old brother drive, I think to myself, ‘‘It’s just not fair!’’ I think that’s the hardest thing for me to deal with.

Having seizures scares me, but dealing with my lack of driving makes me depressed. When I look at all the people on the road driving their own cars, like my friends, I feel different.
44
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

When I first sat down to write this, I believed I had nothing to contribute. I have always tried to live my life as though epilepsy wasn’t part of the equation. But I found myself saying ‘‘except for’’ a lot. I see epilepsy from two perspectives. My cousin, Mary Anne, had a very severe case, worse than me. I hate to admit that before my own epilepsy surfaced, I would see my cousin go into seizures and I looked upon her with pity and some indifference, believing that somehow she had caused this to happen, and after all, God punished the evil. Although I believed she had been punished enough, she died of an attack at the age of 33, after falling into a bathtub full of water.
45
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

I started having seizures when I was 24 years old. I had just returned home from work and the phone rang. It was my friend, Denise. She asked me how I was feeling. I said, ‘‘Fine. Why?’’ Then she dropped a bomb on me. She asked, ‘‘Are you on drugs?’’ I said, ‘‘No! What are you talking about?’’ She explained, ‘‘You were acting very strange today at work when I was talking to you. You didn’t hear a word I said—you just kept staring for about 7 minutes.’’ I started to cry and called my parents to tell them what happened. They took me to the hospital, where I had all kinds of tests.
47
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

Fortunately, having epilepsy has not affected my family relationships. My family has always been supportive and sensitive to my medical, emotional, and physical needs. Accepting that I have wait until the last minute to write that 20-page paper. Some people can pull an all-nighter; my body shuts down whether I want it to or not. Sometimes, I take on too many things with school, work, and social life, and I burn the candle at both ends. If I do not get 8 hours of sleep a day, my body does not function at its optimum level.
50
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

I have never really just sat down to contemplate being a woman with epilepsy. I was not diagnosed until I was in my 40s. Until that time, I just thought I occasionally fainted, though I did also feel something was ‘‘wrong’’ with me. I was fortunate. My cousin who, coincidentally, is a nurse who specializes in epilepsy, assisted me. She took over and got me to the best doctors and helped me to obtain the best medical care. I cannot imagine what would have happened without her presence. I could say that epilepsy does not affect me. That would be wrong, though. Epilepsy does affect me. I have to be cautious driving, and I have to be sure I get enough sleep and eat properly—all things that are beneficial, anyway.
62
Authors: Schachter Steven C , Krishnamurthy Kaarkuzhali Babu , Cantrell Deborah T Combs
Published: October 2023

I’ve had seizures since birth. From what I understand, the first seizure I had was a grand mal seizure. Nearly all the seizures I had after that were petit mal. I’m not really sure how many seizures I had each month up until the eighth grade because I didn’t personally keep track of them. When I was a freshman in high school, I tried to keep track of my seizures. During my 4 years of high school, I usually had four to five seizures a month, though there were a few months I had eight to ten seizures. On some of the days that I had seizures, I was able to stay at school and do what I had planned to do because I felt OK.
Epilepsy in Our View
Authors: Schachter Steven C
Published: October 2023

Epilepsy in our View is a collection of personal stories from friends, family members, and co-workers of people with epilepsy, in which they describe their observations and feelings about witnessing seizures and about the person with epilepsy. It helps to shed light on the social consequences of epilepsy while increasing understanding of what's happening when a person has a seizure. ABOUT THE SERIES: With the Brainstorms series, one of the world's leading authorities on epilepsy, Dr Steven C. Schachter, has gathered together the personal testimonies of patients, family members, and caregivers to create a poignant and gripping series of books on this misunderstood and often devastating disorder.
Management of Diabetic Retinopathy: Evidence-based Systematic Review
Authors: mohamed, Quresh , Wong tien y.
Published: October 2023

There are 200 million persons with diabetes mellitus worldwide [1], with 20 million in the United States alone [2]. The most speciEc microvascular complication of diabetes is diabetic retinopathy, the leading cause of visual impairment in working-age persons. The prevalence of diabetic retinopathy increases with disease duration [3], so that after 20 years, nearly all persons with type 1 diabetes and 60% of those with type 2 have some retinopathy. The major risk factors for diabetic retinopathy include hyperglycemia, hypertension, and hyperlipidemia [3,4], and have been summarized in Chapter 5.
C
Authors: Campbell Robert Jean
Published: October 2023

CA 1. Abbreviation for chronological age.

2. Catecholamine (q.v.). See epinephrine.

CAA Cerebral amyloid angiopathy; a Mendelian variant of small vessel disease, characterized by the deposition of amyloid in the walls of leptomeningeal and cerebral cortical blood vessels. Clinical manifestations include recurrent or multiple lobar hemorrhages, cognitive deterioration, and ischemic strokes. Rupture of structurally weakened arteries results in cerebral hemorrhage. Several autosomal dominantly inherited forms are due to mutations in the amyloid precursor protein. The ε4 allele of APOE is associated with enhanced beta-amyloid deposition in the cerebral vasculature and earlier disease onset. Patients with CAA-related hemorrhage show an excess of the ε2 allele, which may predispose to rupture of amyloid-laden vessels. See VaD.

CAC Chemical aversive conditioning; the use of sensitizing agents such as disulfiram in the treatment of alcoholism. See aversion therapy. cacergasia Obs. Inadequate functioning of body or mind.

cachectin See cachexia.

cachexia A chronic catabolic state, associated with certain infections and malignancies, characterized by weight loss that continues despite consumption of an adequate diet. A factor or factors—termed cachectin—produced by endotoxin-stimulated macrophages, inhibits the activity of lipogenic (fat-producing) enzymes, and triglycerides are mobilized from adipose tissue with resultant weight loss. See anorexia nervosa; hypophysial cachexia.
K
Authors: Campbell Robert Jean
Published: October 2023

K+ channel See ion channel; action potential; resting membrane potential.

Kahlbaum, Karl Ludwig (1828–1899) German psychiatrist; catatonia.

Kahlbaum syndrome Nonmalignant catatonia(q.v.).

Kahlbaum-Wernicke syndrome Presbyophrenia(q.v.).

kayak gene See clock, biological.

kaif, kif Pleasure or feeling of contentment and ease, as in a dream or state of ecstasy. The term is used in Morocco to refer to hashish or marijuana (q.v.).

kainate An activator of the kainate subtype of EAA (q.v.). See AMPA.

Kalinowsky, Lothar B. (1899–1992) German-born neuropsychiatrist; in United States after 1940; electroconvulsive and other somatic treatments.

Kallmann, Franz J. (1897–1965) German-born psychoanalyst and geneticist; genetics of human behavior, especially schizophrenia, manic-depressive psychosis.

Kalmuk idiocy Obs. (Kalmuk, member of a nomad Tartar tribe) Down syndrome (q.v.).

Kandinsky-Clérambault complex See Clérambault-Kandinsky complex.

Kanner, Leo (1894–1981) Austrian-born psychiatrist; emigrated to United States in 1924; founded Johns Hopkins Children ‘s Psychiatric Clinic (1930); wrote first text in Child Psychiatry (1935); early infantile autism.

Kardiner, Abraham (1891–1981) Cofounder of first psychoanalytic training school in the United States (1930); The Individual and His Society (1939); Psychological Frontiers of Society (1945).

Karpman Drama Triangle A conceptualization of traumatic experiences in terms of victim, rescuer, and persecutor. Originally suggested as one way of viewing intrafamilial dynamics of alcoholics and their families, it has since been extended to other disorders, such as dissociative identity disorder (DID).
Q
Authors: Campbell Robert Jean
Published: October 2023

QALY Quality-adjusted life year, a measure of disease burden used particularly in treatment outcomes researchin schizophrenia. See DALY.

QEB Quantitative Electrophysiological Battery (q.v.).

QI Quality improvement; overall, an effort to achieve the best results for any clinical intervention(s). QI uses statistical tools to measure such elements as process stability, variability, and outcomes and a management approach that encourages each participant in the treatment process to identify ways in which the process and its outcome might be improved. QI generally addresses populations rather than individual patients. QI programs aim to improve care on a systemic level; they must continually assess not only the services provided to identified patients but also needs for services that have not yet been developed within a community. It is not enough to find that practitioners have followed clinical guidelines appropriately and effectively; questions about prevention of illness in the first place, the effects of illness and its sequellae on patients, caretakers, and others in the community, and patient (and family) satisfaction must also be addressed. See quality assurance.

qi-gong psychosis A brief psychotic reaction

with dissociative or paranoid symptoms associated with overinvolvement in the Chinese folk practice of enhancing vital energy (qi-gong).
Figuring Out What’s Wrong
Authors: Lehman Thomas J A
Published: October 2023

When a child has muscle, bone, or joint pain, it is important to understand that each of the conditions that may be responsible has a typical set of problems it causes (symptoms), a typical age group in which it occurs, and other typical findings that usually make it easy for an experienced physician to diagnose. At the same time, if a child does not have the typical problems or is not the typical age, it’s much less likely that the suspected condition is the proper explanation. This is why your physician should always start the evaluation by asking you (and your child, if he or she is old enough) questions about the problem.
Systemic Lupus Erythematosus
Authors: Lehman Thomas J A
Published: October 2023

Systemic lupus erythematosus (SLE) is a complex autoimmune disease that most often affects teenage girls and young adult women. Less frequently, SLE occurs in both older and younger individuals and in boys. SLE often begins with fevers, rash, joint pains, and fatigue. Although these symptoms are worrisome, it is the ability of SLE to affect many different internal organs (brain, heart, lungs, muscles, kidneys, skin, joints, liver, or intestine) that makes this a serious illness. It is important that children who have SLE be promptly recognized so that they can be treated and internal organ damage prevented whenever possible.
Scleroderma
Authors: Lehman Thomas J A
Published: October 2023

A variety of different diseases are grouped together under the diagnosis of scleroderma. The focal (or localized) forms of scleroderma are often mild and may not require any treatment. In contrast, progressive systemic sclerosis (also called diffuse scleroderma) is a life-threatening disease typically involving the heart, lungs, and other organs. Fortunately, the mild forms of scleroderma are far more common than the severe ones.
Alternative Medicine: Vitamins, Supplements, and Other Treatments
Authors: Lehman Thomas J A
Published: October 2023

You cannot treat illness without the risk of side effects. Whether you take the prescribed medications, buy over-the-counter medications, ignore the problem and hope it will go away, buy a supplement in a health food store, or try a “cure” from some other source, there are risks associated with every choice. The only difference is whether or not those risks are clearly explained to you. The physician is required to tell you about potential side effects for medications, and warnings are printed on the labels of over-the-counter medications for you to read, but for any other substance you’re on your own.
Growing Pains?
Authors: Lehman Thomas J A
Published: October 2023

Little Jennifer S. was fourteen months old when her mother noticed that she did not want to put her left foot firmly on the floor when she was taken out of her crib one morning. She did not walk correctly for a few minutes, but an hour later she seemed fine. This did not happen again until a couple of weeks later. After six weeks, Jennifer’s mother noticed that it was happening more frequently. She mentioned this to the pediatrician when she brought in Jennifer for her immunizations one afternoon. The pediatrician wiggled Jennifer’s leg around, watched her walk a few feet, and reassured Jennifer’s mother that she was fine. When Mrs. S. called the pediatrician a month later to discuss bringing her in, she was told that the problem was probably just “growing pains.” By the time Jennifer was seen in the pediatric rheumatology clinic at the age of two years, her left knee was markedly swollen, she could not straighten her left leg all the way, and the muscles of her left leg were much weaker than those of her right leg. Jennifer had obvious arthritis. Reassured by what the pediatrician had told her, her mother had continued to believe that Jennifer just had growing pains until Jennifer screamed when the nurse tried to straighten her leg at her two-year-old checkup.
Why Do Children Get Rheumatic Disease?
Authors: Lehman Thomas J A
Published: October 2023

Fill a football stadium with 100,000 random children, and the rheumatic diseases are rare. Fill that same football stadium with 100,000 children who have relatives with rheumatic disease, and children with rheumatic disease will be ten or twenty times as common. Researchers believe there is a genetic contribution here. While most of the rheumatic diseases clearly occur more frequently in relatives of people with rheumatic disease, not all parents with a family history of rheumatic disease need to worry. But these diseases occur in relatives often enough that investigators have to notice.
Juvenile Arthritis Juvenile Rheumatoid Arthritis, Juvenile Chronic Arthritis, Juvenile I diopathic Arthritis
Authors: Lehman Thomas J A
Published: October 2023

Whenever the diagnosis of juvenile arthritis is considered, two important points must be remembered. First, fever and rash should not be present in children with juvenile arthritis except in those with systemic-onset arthritis. If a child with arthritis has fever or a rash, a strong effort must be made to exclude infectious causes. Fever, rash, and arthritis may be present in Lyme disease, reactive arthritis, and a variety of other diseases that are not juvenile arthritis, including sarcoid, lupus, and IBD.
Lyme Disease
Authors: Lehman Thomas J A
Published: October 2023

Frankie was a delightful twelve-year-old who loved to play sports. Halfway through football season, he began to complain of knee pains. When his symptoms didn’t improve, he was taken to his pediatrician. At first, the pediatrician thought that Frankie had simply twisted the knee. When Frankie was unable to continue football because the knee was swollen and painful, he was referred to an orthopedist. Three months later, Frankie continued to have pain in the knee that prevented him from playing. With activity the knee often became swollen but then improved over a week to ten days. He was sent to me to treat his “JRA.” The father was sure that he had been tested for Lyme disease, but careful review of the records revealed that the test had never been done. The orthopedist was sure that the pediatrician had checked, and the pediatrician was sure that the orthopedist had done so. When I did the Lyme test it was strongly positive, and Frankie improved dramatically when we treated him with antibiotics.
Scleroderma
Authors: Lehman Thomas J A
Published: October 2023

Scleroderma is a broad term that simply means “hard skin.” A variety of different diseases are grouped together under this diagnosis. The focal (or localized) forms of scleroderma are often mild and may not require treatment. In contrast, progressive systemic sclerosis (also called diffuse scleroderma) is a life-threatening disease typically involving the heart, lungs, and other organs. Fortunately, the mild forms of scleroderma are far more common than the severe ones.
Family Issues
Authors: Lehman Thomas J A
Published: October 2023

In one of my families there were three children; the oldest was a twelve-year-old boy with severe arthritis. It was decided that he would have a hip replacement after the end of the school year. Both parents were very concerned, and everyone knew that Johnny was expected to be in the hospital for five days after the surgery. All of us would have the same initial response: Ask a sitter or a relative to care for Sally and Timmy (eight and ten years old) so that Mom and Dad can be at Johnny’s bedside for the five days. Summer travel plans are off, because Johnny will need a lot of physical therapy to recover and will not be able to travel. This all sounds reasonable, but it’s the wrong answer.
Perceptual Fading during Voluntary and Involuntary Eye Movements
Authors: Proudlock Frank A , Jorgensen, Astrid Y , Gottlob Irene
Published: October 2023

Perceptual fading (PF) is a phenomenon in which a target in the visual field fades from view after a certain fading time (FT). PF is reset by microsaccadic eye movements; however, PF has not been investigated during nonfixation eye movements. We compared PF during voluntary eye movements in healthy volunteers and in patients with involuntary eye oscillations caused by nystagmus. Twelve healthy volunteers performed a PF task consisting of following an oscillating fixation cross moving with either a sine wave (pursuit task) or a square wave (saccadic task) profile while viewing a static peripheral spot of low contrast (1.5x threshold). This was compared to FT during a static fixation cross with peripheral spot moving and also when both were moving. FT was also compared in 4 volunteers with nystagmus.
Effect of Eye Exercise on Clinical Outcome of Noncompressive Ocular Motor Nerve Palsy
Authors: Poonyathalang Anuchit , Preechawat, Pisit , Janvimaluang Vitoo
Published: October 2023

Patients with extraocular muscle paralysis are often frustrated by double vision and related functional problems. Some patients are also distressed with dizziness and nausea. Occlusion of one eye, spectacle prisms, and injection of botulinum toxin have been used to reduce diplopia during the recovery period. Usually, occlusion of the paralytic eye is recommended, but without stereopsis patients may encounter difficulties in daily activities. Rehabilitation of extraocular muscle palsy has involved exercises that emphasize maximal ocular motor effortor invoking the vestibulo-ocular reflex.However, there is little evidence-based support for such rehabilitation programs. In patients with noncompressive ocular motor nerve palsies, complete recovery of eye movement usually occurs within six months, but in patients with severe nerve injury, recovery is more variable. Training using the patient’s finger provides strong visual and somatosensory feedback, along with the corollary discharge of the motor command (efference copy), thereby providing a strong cue for the patient to make an appropriate eye movement in the correct direction.It has been proposed that eye movement exercise can assist not only in promoting movement on the affected side but also in decreasing hyperactivity on the unaffected side that might contribute to a muscular contracture.One goal of such eye movement exercises is to reduce recovery time.
Neuromuscular Junction Dysfunction in Miller Fisher Syndrome
Authors: Rucker Janet C
Published: October 2023

Miller Fisher syndrome (MFS) is considered a variant of acute inflammatory demyelinating polyneuropathy (AIDP), otherwise known as Guillain-Barré syndrome, and classically consists of a triad of bilateral ophthalmoplegia, ataxia, and areflexia.Anti-GQ1b antibodies are present in up to 90% of patients. The precise location, mechanism, and extent of neurological insult are not completely understood. Peripheral nerve demyelination is regarded as the hallmark of pathological involvement, given the clinical overlap of the syndrome with AIDP and direct pathological evidence,but extensive clinical and radiographic evidence of central nervous system involvement exists.3-6 In addition, evidence of direct neuromuscular junction (NMJxn) involvement is mounting in a mouse diaphragm/ phrenic nerve model and in human cases of MFS.7-10 A patient with recurrent MFS and a decremental response to repetitive stimulation on electromyography (EMG) in the absence of electrophysiological evidence of demyelinating peripheral neuropathy is described.
The Neuro-ophthalmologic Complications of Chiropractic Manipulation
Authors: Devereaux Michael w.
Published: October 2023

Cervical manipulation, specifi cally chiropractic manipulation, is an important cause of vertebral basilar and, rarely, carotid artery distribution strokes. The mechanism of action of vertebral artery distribu-tion strokes is vertebral artery dissection at the level of the atlas as a result of rotation and extension of the head, which can occur in association with chi-ropractic manipulation
Japan: E-Commerce and Taxation in Japan
Authors: Rhee MIaji Christine
Published: October 2023

This chapter introduces Japan’s current business laws and their relationship to e-commerce, and analyzes Japan’s effort to craft tax laws—specifically, a definition of permanent establishment (PE) that will accommodate the distinguishing characteristics of e-commerce. A question central to this discussion will be whether an Internet server qualifies as a PE, because double taxation and direct income tax law are based on the concept of a PE.
Mexico: Electronic Commerce and the Concept of Permanent Establishment
Authors: Diedrich Graciela M
Published: October 2023

International commerce has spread in multiple forms, booming particularly through the Internet, where is widely known as electronic commerce, or e-commerce. This new form of conducting cross-border business activities presents the question of whether or not the income derived from said activities should be taxed by the source country. This chapter explores the different circumstances under which e-commerce activities lead to the existence of a permanent establishment.
Bounce
Authors: Wicks Robert J
Published: October 2023

Stress is a fact of modern life. And as more and more people face greater financial insecurity, longer work hours, and the increasingly complex personal and social demands of our fast-paced, multi-tasking, high-tech lifestyle, finding healthy ways to handle stress is more important than ever. In Bounce: Living the Resilient Life, Robert Wicks shows you not just how to manage stress, but how to transform stressful situations into opportunities to live a more meaningful, self-aware, and compassionate life. Wicks makes available to everyone techniques he has used for over 30 years in helping physicians, nurses, psychotherapists, educators, social workers, ministers, and relief workers not only survive but flourish in highly stressful occupations. You'll learn a wide range of methods--normally reserved for those in helping and healing professions--to help you bounce back from stress and live life to the fullest. Bounce shows you how to: BL Recognize the insidious nature of denial and avoidance as responses to stress BL Employ psychologically powerful approaches to self-awareness BL Improve self-talk through the use of cognitive behavioral principles BL Apply daily-debriefing techniques BL Utilize a structured reflection guide to uncover areas that require special attention BL Incorporate silence, solitude, and mindfulness into daily life BL Stop the drain of valuable emotional energy caused by toxic life situations and unexamined attitudes and beliefs BL And much more Most important, Bounce helps you develop your own self-care protocol and personal renewal program, based on an honest assessment of your needs, life situation, and habitual ways of dealing--or failing to deal--with stress. Insightful, practical, and filled with wise guidance, Bounce shows us all how to live with greater resilience in a world that grows more stressful by the day.
Epidemiology of ankylosing spondylitis and related spondyloarthropathies
Authors: Khan Muhammad Asim
Published: October 2023

Physicians’ perceptions regarding the epidemiology of AS are slowly changing, but numerous misconceptions about AS remain that may contribute to the delay in its diagnosis and effective treatment, including the misperceptions that it is a rare disease and that it is a mild disease that is easy to diagnose.1–5 According to one study, approximately 5% of chronic back pain sufferers being seen at general practice/primary care practice offices in England “may have a mild form of AS that may never progress to definite ankylosis, but for whom treatment as if they had AS may be of benefit. “6 Early diagnosis of AS is crucial now that more effective therapies are available to suppress disease activity and improve functional ability.
Causes of ankylosing spondylitis
Authors: Khan Muhammad Asim
Published: October 2023

The precise cause of AS remains unknown, but there is strong evidence that genetic factors play a pivotal role in disease susceptibility, and that they interact with nongenetic (environmental) factors to lead to immune-mediated mechanisms that result in the release of proinflammatory cytokines such as TNF-α.1–9 More than 90% of the risk of developing AS is determined genetically, indicating the highly heritable nature of this disease.1–5 There is a strong association with the genetic marker HLA-B27, which lies in the major histocompatibility complex (MHC) region on the short arm of chromosome 6 (6p21 region). However, HLA-B27 is not a prerequisite for AS, as the disease also affects individuals who do not possess HLA-B27.
Physical findings
Authors: Khan Muhammad Asim
Published: October 2023

Clinical signs are sometimes minimal in the early stages of the disease. Examination of the sacroiliac joints and the spine (including the neck), measurement of chest expansion and range of motion of the hip and shoulder joints, and a search for signs of enthesitis are critical in making an early diagnosis of AS.1–7 Important physical findings due to enthesitis that are present in many patients but are often overlooked include tenderness over vertebral spinal processes, iliac crest, anterior chest wall, calcaneus (plantar fasciitis and/or Achilles tendinitis), ischial tuberosities, greater trochanters, and sometimes tibial tubercles.
Descriptions of related diseases: Thespondyloarthropathies
Authors: Khan Muhammad Asim
Published: October 2023

The spondyloarthropathies (SpA) form a group of overlapping inflammatory rheumatologic diseases that show a tendency for involvement of the axial skeleton, entheses (bony insertions of ligaments and tendons; singular is “enthesis “), and peripheral joints (Fig. 1.4, Table 9.1). They may also show involvement of extraskeletal structures such as the eyes, skin, gut, and genitourinary tract.1,2 Predominantly conjunctivitis in reactive and psoriatic arthritis, and acute anterior uveitis in the other three disorders listed.
The new treatment: Remarkable efficacy of TNF-a antagonists
Authors: Khan Muhammad Asim
Published: October 2023

TNF-α inhibitors have transformed the management of AS and related SpA.1–10 Patients who do not respond to conventional therapies can now be offered treatment with these agents. Etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) are now approved by the U.S. Food and Drug Administration (FDA) for the treatment of AS and PsA, in addition to RA and psoriasis. (A fourth TNF-α antagonist, golimumab, is expected to be approved by the FDA by time this book is published). These TNF-α inhibitors are highly and equally effective as monotherapy (without the need for concomitant methotrexate [MTX]) for treating musculoskeletal manifestations in patients with active AS unresponsive to conventional therapy. They lead to rapid and remarkable improvement in the symptoms and signs, including back pain and stiffness, peripheral arthritis, enthesitis, and dactylitis, and they have maintained long-term effectiveness.11–16 Clinical improvement is accompanied by a significant decrease in inflammation, as evidenced by a dramatic reduction in CRP and ESR. The improvement also may be shown on MRI, but it is too early to say whether these medications will slow or prevent progressive bony ankylosis.
Other aspects of disease management
Authors: Khan Muhammad Asim
Published: October 2023

Patients with AS should be followed on a regular basis to monitor disease activity, response to treatment, and medication side effects, even if their illness seems to be inactive.1–3 The frequency of monitoring should be based on the clinical presentation and the drug therapy being used. Monitoring should comprise symptoms and signs, laboratory testing, and imaging studies. Specific skeletal elements to be monitored include duration of morning stiffness, severity of pain, mobility of the lumbar and cervical spine, chest expansion, and clinical evidence of enthesitis and changes in joint inflammation as well as range of motion. Measures to evaluate disease activity, such as BASDAI, BASMI, BASFI, and HAQ, may be used to monitor response to therapy.
Socioeconomic aspects and prognosis
Authors: Khan Muhammad Asim
Published: October 2023

Patients with AS experience reduced vitality and quality of life. Compared with the general population, they are more likely to experience progressive functional impairment over time as well as work disability and possible job loss. Many patients cannot maintain the level of employment that they had before the onset of their disease. Patients with physically demanding jobs are more likely to change their type of work, decrease their work hours, or experience temporary or permanent work disability in contrast to patients who have jobs that are less physically demanding. AS patients leave the labor force at a two-to three-fold higher rate than the general population, and they report similar pain and functional disability as those with RA.1–4
Before Prozac
Authors: Shorter Edward
Published: October 2023

Psychiatry today is a barren tundra, writes medical historian Edward Shorter, where drugs that don't work are used to treat diseases that don't exist. In this provocative volume, Shorter illuminates this dismal landscape, in a revealing account of why psychiatry is "losing ground" in the struggle to treat depression. Naturally, the book looks at such culprits as the pharmaceutical industry, which is not inclined to market drugs once the patent expires, leading to the endless introduction of new--but not necessarily better--drugs. But the heart of the book focuses on an unexpected villain: the FDA, the very agency charged with ensuring drug safety and effectiveness. Shorter describes how the FDA permits companies to test new products only against placebo. If you can beat sugar pills, you get your drug licensed, whether or not it is actually better than (or even as good as) current medications, thus sweeping from the shelves drugs that may be superior but have lost patent protection. The book also examines the FDA's early power struggles against the drug industry, an influence-grab that had little to do with science, and which left barbiturates, opiates, and amphetamines all underprescribed, despite the fact that under careful supervision they are better at treating depression, with fewer side effects, than the newer drugs in the Prozac family. Shorter also castigates academia, showing how two forms of depression, melancholia and nonmelancholia--"as different from each other as chalk and cheese"--became squeezed into one dubious classification, major depression, which was essentially a political artifact born of academic infighting. An astonishing and troubling look at modern psychiatry, Losing Ground is a book that is sure to spark controversy for years to come.
Power Play
Authors: Shorter Edward
Published: October 2023

What happened to these successful members of the first drug set? They had various fates, through all of which runs the common thread of in- difference to science, the playing up of anecdotal risks rather than bal- ancing the risk-benefit ratio for public health, and the willingness to use the regulator’s awesome power for political purposes. The Food and Drug Administration had been more or less a one- horse operation when in the 1950s and especially in the 1960s it vastly expanded to become eventually the major regulatory agency we know today. It solidified its authority largely by taking on the most popular drugs and beating their manufacturers as a way of expanding agency power. Not that there were any real problems with most of the drugs themselves, which tended to be safe, effective, and widely prescribed. It was rather that the agency aspired to emerge as the tough “new” kid on the regulatory block by knocking down some of the industry heavy- weights. This is the story of how a federal agency won the power to dictate medical indications—meaning diagnoses—to the pharmaceutical industry.
Death Sentences
Authors: Shorter Edward
Published: October 2023

Of the first drug set of the 1950s, little remains 60 years later. How did it happen that these important agents were relegated to the sidelines? Part of the story is that they were forcefully sidelined, by the very au- thorities who are supposed to safeguard the public health and ensure that the remedies in the marketplace are optimal. That effort began to gain traction with such events as the 1966 hearings on meprobamate, Librium, and Valium, but the outcomes of those proceedings were small potatoes compared to the results of a larger government initiative that was then just getting underway for a wide variety of medications. Right up front, the class of drugs now formally called antidepres- sants triumphed over all other drug classes—and depression over all other competing diagnoses—partly because they were federally man- dated through broadly sweeping FDA activities from the late 1960s to the early 1980s. During this period, the FDA came to believe in the pu- rity of the concept of “antidepressants,” and the agency was able to im- pose its views on the pharmaceutical industry, which in turn responded by producing scads of antidepressants for the suffering public. It was also helpful that, in tilting the table toward depression, the agency si- multaneously wiped out about half of the existing drugs competing for the neurosis market. This portentous chapter in the history of psychiatry and psychopharmacology is almost unknown. It is called DESI.
American Medicine: Science, Competence, and Ethics
Authors: Jonsen Albert R
Published: October 2023

The founders of the AMA hoped to encourage the education of physicians “in anatomy, physiology, pathology and organic chemistry.” In 1847 these medical sciences were, as one medical historian says, in “transition to a physiological synthesis.” That physiological synthesis was the convergence of descriptive anatomy with chemistry and physiology. Exciting work was being done in Europe. In Germany, Justus von Liebig was inventing organic chemistry, Johannes Miiller was creating neurophysiology, and his student Theodor Schwann was formulating the cell theory.
Abortion
Authors: Farber Daniel A , Sherry Suzanna
Published: October 2023

Perhaps the most important—or at least the best-known—case that the Supreme Court has decided in the past forty years is Roe v. Wade, in, which it recognized a constitutional right to abortion. Few cases in the Court’s history have given rise to such controversy. For almost twenty years after Roe, the Court expanded and then contracted the right it had recognized in Roe, the justices argued among themselves about its validity, and scholars often predicted that it would soon be overruled. But in 1992, in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court surprisingly reaffirmed the existence of the constitutional right but altered the structure of its analysis. Both cases can be evaluated under our standards.
Epilepsy: A Problem With The Brain
Authors: Reuber Markus , Schachter Steven C , Elger Christian E , Altrup Ulrich
Published: October 2023

Anyone can develop epilepsy, and about one in a hundred people does. This makes epilepsy as common as diabetes or rheumatoid arthritis. However, people talk much less about epilepsy than about these other conditions.

This picture shows 120 people. If they were typical of the whole population, one or two should have epilepsy. Most people with epilepsy would lead a normal life if only people without epilepsy would let them. Unfortunately, many are prejudiced about epilepsy. This book is for people with epilepsy and for people who live or work with them. It is written to inform people about epilepsy. It is meant to explain the causes and treatment of epilepsy. It is meant to be understood by everyone.

Other medical conditions, tuberculosis for instance, particularly affect poor people. There are also diseases that are more common in rich people. Epilepsy affects rich and poor alike. A person can develop epilepsy when he or she is a baby, a young adult, or in older age.
Politics
Authors: Mcgeough Kevin M
Published: October 2023

The evidence that can be used to reconstruct the government of the Roman monarchy is meager at best. Archaeological data can reveal the existence of public structures, population and site size, and the spread of material culture. However, this evidence is very open to interpretation. Unlike the multitude of contemporary sources available for the Republican and Imperial periods, there is a lack of historical records contemporary with the period of the monarchy. Much later accounts of the monarchy have survived, but it is often difficult to untangle the historical facts from the blend of mythical accounts and contemporary political polemic.
Asthma
Authors: Berger William E , Currie Graeme P
Published: October 2023

Asthma is a common chronic inflammatory condition affecting the airways and displays a varied phenotypic picture. It is becoming increasingly recognized by healthcare workers and epidemiological studies suggest that along with other atopic diseases, its prevalence is rising. The precise etiology of asthma remains uncertain, but genetic and environmental factors such as viruses, country of origin, allergen exposure, early use of antibiotics, and numbers of siblings have all been implicated in its inception and development. Pathologically it is characterized by inflammation, physiologically by airway hyper-responsiveness (or hyper-reactivity) resulting in reversible airflow obstruction, and clinically by wheeze, chest tightness, breathlessness and cough. It can present in early childhood as well as adulthood, and varies markedly in severity, clinical course, subsequent disability and response to treatment. Exacerbations and symptoms of asthma are the final manifestation of a complex interplay between an array of inflammatory cells and mediators, which cause airway smooth muscle to intermittently relax and contract. Despite greater knowledge surrounding the immunopathological origins of asthma and considerable advances in its management, it remains one of the most important chronic diseases in young adults and poses a significant degree of morbidity throughout all age groups. A minority of patients experience difficulty in controlling asthma and pose significant therapeutic difficulties in specialist clinics. Exacerbations of asthma contribute to significant costs for healthcare systems and are implicated in adversely affecting the quality of life of individuals and their families. Moreover, although asthma deaths have decreased over the past few decades, an appreciable number of deaths still occur each year. Regular anti-inflammatory therapy with inhaled corticosteroids is required in all but the mildest of disease and attenuates underlying airway inflammation and hyper-responsiveness, while bronchodilators are designed to relax airway smooth muscle and prevent bronchoconstriction on exposure to bronchoconstrictor stimuli. Other forms of treatment are required in individuals with persistent symptoms and exacerbations. In recent years several potentially exciting treatments have emerged and are in varying degrees of development. Part of the new Oxford American Respiratory Library, this concise, portable guide provides an essential reference on current, evidence-based medical approaches to diagnosing and managing asthma. This practical volume features chapters on the pathophysiology of the disease with information on the common symptoms and potential triggers. In addition, the text includes discussions of new and emerging pharmacotherapies and complementary treatment therapies, with guidelines for symptom prevention.