bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamical quantum phase transitions (Review Article)
Authors: Zvyagin A. A.
Published: December 2016

During recent years the interest to dynamics of quantum systems has grown considerably. Quantum many body systems out of equilibrium often manifest behavior, different from the one predicted by standard statistical mechanics and thermodynamics in equilibrium. Since the dynamics of a many-body quantum system typically involve many excited eigenstates, with a non-thermal distribution, the time evolution of such a system provides an unique way for investigation of non-equilibrium quantum statistical mechanics. Last decade such new subjects like quantum quenches, thermalization, pre-thermalization, equilibration, generalized Gibbs ensemble, etc. are among the most attractive topics of investigation in modern quantum physics. One of the most interesting themes in the study of dynamics of quantum many-body systems out of equilibrium is connected with the recently proposed important concept of dynamical quantum phase transitions. During the last few years a great progress has been achieved in studying of those singularities in the time dependence of characteristics of quantum mechanical systems, in particular, in understanding how the quantum critical points of equilibrium thermodynamics affect their dynamical properties. Dynamical quantum phase transitions reveal universality, scaling, connection to the topology, and many other interesting features. Here we review the recent achievements of this quickly developing part of low-temperature quantum physics. The study of dynamical quantum phase transitions is especially important in context of their connection to the problem of the modern theory of quantum information, where namely non-equilibrium dynamics of many-body quantum system plays the major role.
Low-energy spectra of differential conductivity and shot noise in tunnel junctions based on superconductors with suppression of the order parameter at the S-N interface
Authors: Belogolovskii M. , Zhitlukhina E. , Egorov O.
Published: December 2016

The possibility of an anomalous structure in the differential conductivity of tunnel junctions based on high-temperature superconductors as a result of degradation of their surface layer is analyzed. This feature is in the form of two peaks near an energy gap separated by a region of suppressed conductivity. One peak is usually high and sharp, while the other is much more spread out. Differential conductivity and shot noise spectra in contacts of a normal injector with s- and d-type superconductors are calculated and compared. It is shown that combined measurements of these two characteristics can provide new information on the kinetics of transport processes in these structures.
The stress statistics of the first pop-in or discrete plastic event in crystal plasticity
Authors: Derlet P. M. , Maaß R.
Published: December 2016

The stress at which the first discrete plastic event occurs is investigated using extreme value statistics. It is found that the average of this critical stress is inversely related to the deforming volume, via an exponentially truncated power-law. This is demonstrated for the first pop–in event observed in experimental nano-indentation data as a function of the indenter volume, and for the first discrete plastic event seen in a dislocation dynamics simulation. When the underlying master distribution of critical stresses is assumed to be a power-law, it becomes possible to extract the density of discrete plastic events available to the crystal, and to understand the exponential truncation as a break-down of the asymptotic Weibull limit.
Performance and behaviour of Nellore steers on integrated systems
Authors: Domiciano L. F. , Mombach M. A. , Carvalho P. , da Silva N. M. F. , Pereira D. H. , Cabral L. S. , Lopes L. B. , Pedreira B. C.
Published: December 2016

This study aimed to evaluate performance and behaviour of Nellore steers (Bos taurus indicus) in integrated systems. Treatments consisted of three different systems: livestock; crop-livestock; and livestock-forestry, with triple rows of eucalyptus trees. The experiment was carried out in Sinop, MT, Brazil, in a randomised complete block design with four replicates, during two seasons (dry-rainy transition and rainy). The experimental period was from 19 September 2015 to 10 January 2016. Nellore steers used in the experiment had an average initial weight of 344 kg ± 11 kg, in continuous stocking and variable stocking rate. Forage mass accumulation rate was evaluated and, independently of the system, had the highest values recorded during the rainy season. Microclimate was evaluated through temperature and humidity index, black globe temperature and humidity index and radiant heat load. Highest values were obtained from 11:00 a.m. to 3:00 p.m. at the dry-rainy transition period for all systems. Animal behaviour was assessed every 10 min from 7:00 a.m. to 5:00 p.m., and averages were calculated for every 2 h. The longest grazing period was recorded from 9:00 a.m. to 1:00 p.m., and then after 3:00 p.m., regardless of the system. Rumination occurred more frequently from 1:00 p.m. to 3:00 p.m. during the rainy season, and also in the shade for the livestock-forestry system. Highest weight gains per area were recorded during the rainy season and for the crop-livestock system. It is concluded that the highest yields can be achieved with the inclusion of the crop component in livestock production systems, and that Nellore steers in silvopastoral systems prefer to ruminate and stay idle in the shade.
Accurate systematic frameworks are vital to advance ecological and evolutionary studies, with an example from Australian freshwater fish (Hypseleotris)
Authors: Page Timothy J. , Sternberg David , Adams Mark , Balcombe Stephen R. , Cook Benjamin D. , Hammer Michael P. , Hughes Jane M. , Woods Ryan J. , Unmack Peter J.
Published: December 2016

The practice of modern evolutionary and ecological research is interdisciplinary, with the process of evolution underpinning the diversity on display. However, the inference of evolutionary patterns can be difficult owing to their historical nature. When the biological units and evolutionary relationships involved are unclear, interpreting any ecological and biological data can be problematic. Herein we explore resulting issues when evolutionary theories rely on an unclear or incomplete biological framework, using some Australian freshwater fish (carp gudgeons: Hypseleotris, Eleotridae) as an example. Specifically, recent theories regarding the role of developmental plasticity on ontogeny and speciation have focused on this group. However, carp gudgeons have complex, and as yet incompletely understood, species boundaries and reproductive biology. Even basic data for the recognised taxa, relating to their phylogenetic relationships, life histories and species distributions, are unclear, have often been misinterpreted and are still in the process of being assembled. Combined, these factors make carp gudgeons a relatively poor group on which to apply more advanced evolutionary theories at the moment, such as the role of developmental plasticity in diversification.
Development of an Index of Biotic Integrity for the Sand Hills Ecoregion of the Southeastern United States
Authors: Paller Michael H. , Kosnicki Ely , Prusha Blair A. , Fletcher Dean E. , Sefick Stephen A. , Feminella Jack W.
Published: December 2016

We developed an index of biotic integrity (IBI) for the Sand Hills ecoregion within the upper Coastal Plain of the southeastern United States. This ecoregion exhibits differences in species composition among river basins and possesses a relatively depauperate fish fauna that has been affected by faunal homogenization. We also investigated whether this IBI could be improved by adding benthic macroinvertebrate information. Data collected from 70 wadeable stream sites were used to calculate 45 fish assemblage metrics. Twelve metrics within the categories of species richness, species composition, habitat guild, trophic guild, tolerance level, alien/invasive species, and individual fish condition were retained after screening all metrics for sensitivity to disturbance, redundancy, and ecological content. Heterogeneity of species composition among basins led to a greater reliance on richness, indicator species, trophic guild, and habitat guild metrics rather than on more geographically variable species composition metrics. Characteristic headwater assemblages provided the basis for some metrics, and invader species metrics were included to address faunal homogenization. The Sand Hills IBI (SHIBI) was more accurate ecoregion‐wide than IBIs that were developed for portions of the Sand Hills, correctly classifying about 60% of the disturbed sites compared with less than 30% for the other IBIs. However, the SHIBI was not highly responsive to gradients in site quality, as indicated by an R2 of 0.30 between SHIBI scores and instream habitat quality scores. This R2 value was improved to 0.49 by supplementing the SHIBI with a benthic macroinvertebrate index (the Ephemeroptera, Plecoptera, and Trichoptera index). We conclude that ecoregion‐wide IBIs should (1) be based on ecoregion‐wide data that characterize responses to disturbance and natural habitat gradients, (2) maintain a substantial ecological basis by including several metric classes, and (3) include metrics that address faunal homogenization where disturbance has increased the dispersion of nonnative species and native generalist species. In addition, combining information from different assemblages can enhance IBI responsiveness to disturbance and improve performance.

Received May 5, 2016; accepted September 19, 2016 Published online December 8, 2016
“Down with the Monarchy”: Iran’s Republican Moment of August 1953
Authors: Randjbar-Daemi Siavush
Published: December 2016

The purpose of this article is to explore and analyze Iran’s “Republican Moment” of 16‒19 August 1953, arguably the last concerted effort to abolish the monarchy and establish a republican order in the county prior to the Revolution of 1978‒79. By drawing on a broad range of primary source materials that have thus far remained relatively understudied by existing scholarship, such as the political press of those crucial days, the essay will attempt to shed light on a number of significant domestic developments which impacted the outcome of the actual coup of 19 August 1953. A further attempt will be made to explain the importance of calls in favor of the Republic and the premier Mohammad Mosaddeq’s refusal to take heed of them. The paper will also explore the diverse origins of the Republican platform and its impact on both the urban crowd and the political elite.
Rusty Gage: A plastic approach to neuroscience
Authors: Siletti Kimberly
Published: December 2016

Gage’s work focuses on neurogenesis and plasticity in the adult central nervous system.
A mechanism for acetylcholine receptor gating based on structure, coupling, phi, and flip
Authors: Gupta Shaweta , Chakraborty Srirupa , Vij Ridhima , Auerbach Anthony
Published: December 2016

Nicotinic acetylcholine receptors are allosteric proteins that generate membrane currents by isomerizing (“gating”) between resting and active conformations under the influence of neurotransmitters. Here, to explore the mechanisms that link the transmitter-binding sites (TBSs) with the distant gate, we use mutant cycle analyses to measure coupling between residue pairs, phi value analyses to sequence domain rearrangements, and current simulations to reproduce a microsecond shut component (“flip”) apparent in single-channel recordings. Significant interactions between amino acids separated by >15 Å are rare; an exception is between the αM2–M3 linkers and the TBSs that are ∼30 Å apart. Linker residues also make significant, local interactions within and between subunits. Phi value analyses indicate that without agonists, the linker is the first region in the protein to reach the gating transition state. Together, the phi pattern and flip component suggest that a complete, resting↔active allosteric transition involves passage through four brief intermediate states, with brief shut events arising from sojourns in all or a subset. We derive energy landscapes for gating with and without agonists, and propose a structure-based model in which resting→active starts with spontaneous rearrangements of the M2–M3 linkers and TBSs. These conformational changes stabilize a twisted extracellular domain to promote transmembrane helix tilting, gate dilation, and the formation of a “bubble” that collapses to initiate ion conduction. The energy landscapes suggest that twisting is the most energetically unfavorable step in the resting→active conformational change and that the rate-limiting step in the reverse process is bubble formation.
MTN-017: A Rectal Phase 2 Extended Safety and Acceptability Study of Tenofovir Reduced-Glycerin 1% Gel
Authors: Cranston Ross D. , Lama Javier R. , Richardson Barbra A. , Carballo-Diéguez Alex , Kunjara Na Ayudhya Ratiya Pamela , Liu Karen , Patterson Karen B. , Leu Cheng-Shiun , Galaska Beth , Jacobson Cindy E. , Parikh Urvi M. , Marzinke Mark A. , Hendrix Craig W. , Johnson Sherri , Piper Jeanna M. , Grossman Cynthia , Ho Ken S. , Lucas Jonathan , Pickett Jim , Bekker Linda-Gail , Chariyalertsak Suwat , Chitwarakorn Anupong , Gonzales Pedro , Holtz Timothy H. , Liu Albert Y. , Mayer Kenneth H. , Zorrilla Carmen , Schwartz Jill L. , Rooney James , McGowan Ian ,   for the MTN-017 Protocol Team
Published: December 2016

Background.

Human immunodeficiency virus (HIV) disproportionately affects men who have sex with men (MSM) and transgender women (TGW). Safe and acceptable topical HIV prevention methods that target the rectum are needed.

Methods.

MTN-017 was a phase 2, 3-period, randomized sequence, open-label, expanded safety and acceptability crossover study comparing rectally applied reduced-glycerin (RG) 1% tenofovir (TFV) and oral emtricitabine/TFV disoproxil fumarate (FTC/TDF). In each 8-week study period participants were randomized to RG-TFV rectal gel daily, or RG-TFV rectal gel before and after receptive anal intercourse (RAI; or at least twice weekly in the event of no RAI), or daily oral FTC/TDF.

Results.

MSM and TGW (n = 195) were enrolled from 8 sites in the United States, Thailand, Peru, and South Africa with mean age of 31.1 years (range 18-64). There were no differences in ≥grade 2 adverse event rates between daily gel (incidence rate ratio [IRR], 1.09; P = .59) or RAI gel (IRR, 0.90; P = .51) compared to FTC/TDF. High adherence (≥80% of prescribed doses assessed by unused product return and Short Message System reports) was less likely in the daily gel regimen (odds ratio [OR], 0.35; P < .001), and participants reported less likelihood of future daily gel use for HIV protection compared to FTC/TDF (OR, 0.38; P < .001).

Conclusions.

Rectal application of RG TFV gel was safe in MSM and TGW. Adherence and product use likelihood were similar for the intermittent gel and daily oral FTC/TDF regimens, but lower for the daily gel regimen.

Clinical Trials Registration:

NCT01687218.
Using electronic monitoring to record catches of sole (Solea solea) in a bottom trawl fishery
Authors: van Helmond Aloysius T. M. , Chen Chun , Poos Jan Jaap
Published: December 2016

Electronic monitoring (EM) is often presented as a solution to document all catches through video observations under the EU landing obligation. However, identifying small fish on video in large volumes of catch is challenging. In this study, logbook records were compared with video observations for catches to test efficacy of EM for different size classes of sole (Solea solea) on board bottom trawlers. Comparisons were based on: (i) systematic differences (paired t-test), (ii) linear correlation (Pearson’s r), and (iii) absolute agreement (ICC). Results suggest that EM of small individuals in mixed fisheries is not as effective as it is for large individuals. To improve efficiency for estimating quantities of small fish, additional methods are required to enhance video review. One possible method for enhancing video review is using a protocol where crew arranged the individual fish in front of the cameras. Indeed, this study suggests that such a protocol substantially improves EM of the complete catch. However, the protocol requires an additional three minutes of processing time per haul for a single species. Given the large number of quota species under the landing obligation for this fishery, implementing the protocol thus comes with a cost for the fishing industry; the extra time needed to conduct a simple protocol probably would exceed 12 h per fishing trip.
Long-term exposure to elevated pCO2 more than warming modifies early-life shell growth in a temperate gastropod
Authors: Rühl Saskia , Calosi Piero , Faulwetter Sarah , Keklikoglou Kleoniki , Widdicombe Stephen , Queirós Ana M.
Published: December 2016

Co-occurring global change drivers, such as ocean warming and acidification, can have large impacts on the behaviour, physiology, and health of marine organisms. However, whilst early-life stages are thought to be most sensitive to these impacts, little is known about the individual level processes by which such impacts take place. Here, using mesocosm experiments simulating ocean warming (OW) and ocean acidification (OA) conditions expected for the NE Atlantic region by 2100 using a variety of treatments of elevated pCO2 and temperature. We investigated their impacts on bio-mineralization, microstructure, and ontogeny of Nucella lapillus (L.) juveniles, a common gastropod predator that exerts important top-down controls on biodiversity patterns in temperate rocky shores. The shell of juveniles hatched in mesocosms during a 14 month long experiment were analysed using micro-CT scanning, 3D geometric morphometrics, and scanning-electron microscopy. Elevated temperature and age determined shell density, length, width, thickness, elemental chemistry, shape, and shell surface damages. However, co-occurring elevated pCO2 modified the impacts of elevated temperature, in line with expected changes in carbonate chemistry driven by temperature. Young N. lapillus from acidified treatments had weaker shells and were therefore expected to be more vulnerable to predation and environmental pressures such as wave action. However, in some instances, the effects of both higher CO2 content and elevated temperature appeared to have reversed as the individuals aged. This study suggests that compensatory development may therefore occur, and that expected increases in juvenile mortality under OA and OW may be counteracted, to some degree, by high plasticity in shell formation in this species. This feature may prove advantageous for N. lapillus community dynamics in near-future conditions.
‘Individualism’ and ‘Collectivism’ in Collective Labour Law
Authors: Bogg Alan
Published: December 2016

This article examines the concepts of ‘individualism’ and ‘collectivism’ in collective labour law. A popular critique of freedom of association norms characterises such norms as ‘individualist’ or ‘individualistic’. This individualist bias undermines the institutions of collective labour relations. The ‘individualist’ critique is often coupled with the development of an alternative positive account of collective labour law that is based upon a foundation of ‘collectivism’. ‘Collectivist’ labour law encompasses a concern for collective or group rights, rather than rights for individuals; it affirms collective values; and the metric of legitimacy of a legal regime of freedom of association is the extent to which it supports collective bargaining through independent trade unions. On this conventional approach, ‘individualism’ and ‘collectivism’ stand in opposition to each other. This article argues against this dichotomous understanding of ‘individualism’ and ‘collectivism’. A comparative perspective on the ‘right to organise’ supports the view that individual and collective rights can stand in a complementary relation to each other. Furthermore, the union’s right to exclude may sometimes legitimately yield to competing individual rights, such as the right not to be subjected to unjust discriminatory treatment. The important task for labour lawyers is to identify an effective combination of collective and individual rights in order to promote just and decent outcomes in the workplace.
Activities of Digestive Enzymes in the Omnivorous Pest Apolygus lucorum (Hemiptera: Miridae)
Authors: Li Wenjing , Zhao Xincheng , Yuan Wei , Wu Kongming
Published: December 2016

The mirid bug Apolygus lucorum Meyer-Dür, 1843, an omnivorous species that feeds on plants and animals, has become a major pest in China as production of Bt-cotton has grown to such a large scale. Its omnivory is likely to be critical for its success, but the digestive mechanism(s) underlying processing and adsorption of such diverse foods is relatively unknown. Here, we examined the activities of digestive enzymes of A. lucorum in the salivary gland complex and midgut and the effect of sex, age, and food source on these activities. Amylase and protease were present in the salivary gland complex and the midgut, but were higher in the salivary gland complex. Trypsin-like enzyme was also present in both organs, but chymotrypsin-like enzyme was present only in the midgut. Sex, age, and food source affected the activities of these digestive enzymes. In general, the activities of these enzymes peaked at 10 d after emergence, and amylase and protease activities were higher in female adults than in males. Of the food sources tested, green bean pods (Gb) induced the highest amylase activity, whereas Helicoverpa armigera Hübner, 1809 eggs (He) and a mixture of Gb and He induced higher activities of the trypsin-like and chymotrypsin-like enzymes. The results from food switching experiments confirmed that amylase activity could be induced by plant sources, and animal sources induced protease activity. Thus, the types and activities of digestive enzymes in A. lucorum provide the physiological basis of the pest’s omnivory.
Modeling cell survival and change in amount of DNA during protracted irradiation
Authors: Matsuya Yusuke , Tsutsumi Kaori , Sasaki Kohei , Yoshii Yuji , Kimura Takaaki , Date Hiroyuki
Published: December 2016

Hyper-radiosensitivity (HRS) is a well-known bioresponse under low-dose or low-dose-rate exposures. Although disorder of the DNA repair function, non-targeted effects and accumulation of cells in G2 have been experimentally observed, the mechanism for inducing HRS by long-term irradiation is still unclear. On the basis of biological experiments and a theoretical study, we have shown that change in the amount of DNA associated with accumulation of cells in G2 enhances radiosensitivity. To demonstrate continuous irradiation with 250 kVp X-rays, we adopted a fractionated regimen of 0.186 or 1.00 Gy per fraction at intervals of 1 h (i.e. 0.186 Gy/h, 1.00 Gy/h on average) to Chinese Hamster Ovary (CHO)-K1 cells. The change in the amount of DNA during irradiation was quantified by flow cytometric analysis with propidium iodide (PI). Concurrently, we attempted a theoretical evaluation of the DNA damage by using a microdosimetric-kinetic (MK) model that was modified to incorporate the change in the amount of DNA. Our experimental results showed that the fraction of the cells in G2/M phase increased by 6.7% with 0.186 Gy/h and by 22.1% with 1.00 Gy/h after the 12th irradiation. The MK model considering the change in amount of DNA during the irradiation exhibited a higher radiosensitivity at a high dose range, which could account for the experimental clonogenic survival. The theoretical results suggest that HRS in the high dose range is associated with an increase in the total amount of DNA during irradiation.
Cajal’s Legacy
Authors: Ehrlich Benjamin
Published: December 2016

This chapter looks into the legacy of Santiago Ramón y Cajal. Historians rank Cajal alongside more recognizable names such as Darwin and Pasteur among the greatest biologists of the nineteenth century and Copernicus, Galileo, and Isaac Newton among the greatest scientists of all time. In his final testament to the neuron theory, Neuron Theory or Reticular Theory? Cajal reported to have seen more than a million neurons. Cajal’s drawings of these neurons are much like portraits. “Only true artists are attracted to science,” he once said. Although the majority of his work concerns the nervous system, Cajal was a physician who contributed to many other fields. To pathology, he contributed studies on tuberculosis, leprosy, syphilis, rabies, Alzheimer’s disease, and cancer. He also published science fiction and wrote one of the earlier manuals on color photography. Cajal was a true polymath and a national hero in his home country of Spain.
From Patient to Agent
Authors: Sullivan MD, PhD Mark
Published: December 2016

In the 21st century, the primary challenge for health care is chronic illness. To meet this challenge, we need to think anew about the role of the patient in health and health care. There have been widespread calls for patient-centered care, but this model of care does not question deeply enough the goals of health care, the nature of the clinical problem, and the definition of health itself. We must instead pursue patient-centered health, which is a health perceived and produced by patients. We should not only respect, but promote patient autonomy as an essential component of this health. Objective health measures cannot capture the burden of chronic illness, so we need to draw on the patient's perspective to help define the clinical problem. We require a new definition of health as the capacity for meaningful action. It is recognized that patients play a central role in chronic illness care, but the concept of health behavior retards innovation. We seek not just an activated patient, but an autonomous patient who sets and pursues her own vital goals. To fully enlist patients, we must bridge the gap between impersonal disease processes and personal processes. This requires understanding how the roots of patient autonomy lie in the biological autonomy that allows organisms to carve their biological niche. It is time for us to recognize the patient as the primary customer for health care and the primary producer of health. Patient agency is both the primary means and primary end of health care.
Escaping the Autonomy Versus Objectivity Trap by Repersonalizing the Clinical Problem
Authors: Sullivan Mark D.
Published: December 2016

Respect for patient autonomy has been sought as the antidote to the depersonalization that ails modern medicine. It serves as a challenge to the dominance of impersonal disease diagnosis in treatment choice. We now repersonalize treatment at a late stage through the informed consent process. If we are to find another way to repersonalize health care, we need to understand the historical roots of the patient autonomy versus objective disease dynamic in which we are trapped. The same disengaged self that sees ethics in terms of autonomy also sees disease as an observable tissue lesion within the body at autopsy. Clinico-pathological correlation offers a gold standard for clinical diagnosis and a completely objective access to disease. This ability to diagnose objective disease is the source of physician paternalism. It can be countered by incorporating the patient’s view of the clinical problem back into the diagnostic process.
Advancing from Activated Patient to Autonomous Patient
Authors: Sullivan Mark D.
Published: December 2016

Patient action in chronic disease care may not be best understood as “behavior.” Healthy patients do not just emit healthy behaviors but act as agents in their own lives. Bandura revolutionized health psychology through his “agentic” approach that emphasized patient confidence or self-efficacy. Now, the personal importance of behavior change is elicited using techniques like motivational interviewing. These and other approaches that include personal goals and identity shift our focus from behavior to action. Health action includes not just management of a disease separate from the self, but self-transformation. Achieving lasting change in health actions requires attention to the autonomous quality of patient motivation. Self-determination theory offers a useful theory of intrinsic motivation and an understanding of the process of internalization of motivation. This helps us understand the promise of shared decision-making and its difference from informed consent. Ultimately, patient empowerment must be understood as fostering patient autonomy.
Seeking the Roots of Health and Action in Biological Autonomy
Authors: Sullivan Mark D.
Published: December 2016

The roots of biological autonomy and health are the same. Goals make biology distinct as a science, for without goals, we cannot understand why a biological trait exists. Organisms are autonomous biological entities because they define what is inside and what is outside themselves. This boundary between inner and outer gives the organism a self-referential purpose. Claude Bernard made experimental physiology possible with his concept of the internal environment, but he was unable to explain how the organism established the boundary between itself and its environment. Hence, homeostasis portrays the organism as reactive not active. Autopoiesis is an alternative defining characteristic of living beings. It generates biological autonomy through additional biological constraint on chemical processes, not through a special vital force. Healthy organisms can construct their own environmental niche. For humans, this niche is social and is constructed with a social physiology. Both exercise and education increase health by increasing capacity for niche construction.
Make the Patient the True Customer for Health Care
Authors: Sullivan Mark D.
Published: December 2016

Despite accelerating expenditures on health care, the United States is falling behind peer countries in population health. The mismatch between dollars spent on health care and health achieved raises the question of the value of health services. How should we value these? The Affordable Care act expands access to care but does not question expert valuation of health states and health services. Rather than beginning with health insurance, a more productive path for our thinking proceeds from the nature of health to the nature of health care to the nature of health insurance. If we are to keep health care costs from rising no faster than GDP, we must make the patient the true customer for health care. Health policy should not aim to minimize objective disease or maximize subjective well-being, but to foster health capability. This encompasses the ability to enjoy health and to pursue it.
Psychiatric diagnosis, tacit knowledge, and criteria
Authors: Thornton Tim
Published: December 2016

The two main psychiatric taxonomies set out codifications of psychiatric diagnoses via lists of symptoms with the aim of maximizing the reliability of diagnostic judgements. This approach has been criticized, however, for failing to capture the precise connection between diagnostic judgements and symptoms as detected by skilled clinicians. Assuming that this criticism is correct, this chapter offers two related accounts of why this might be so. First, skilled diagnostic judgement may be an exercise of tacit knowledge: a practical skill the exercise of which requires the presence of the patient. Second, the conception of criteria implicit in the DSM and ICD is based on a mistaken view of how what people say and do connects to their mental states. On an alternative account, in an overall gestalt diagnostic judgement the various criteria are abstractions from a whole that directly expresses the underlying psychopathological state of patients or clients.
Reflections on what is normal, what is not, and fuzzy boundaries in psychiatric classifications
Authors: Keuck Lara , Frances Allen
Published: December 2016

This chapter takes the need to save ‘normal’ and avoid diagnostic inflation as a point of departure to reflect on what is normal, what is not, and what is in-between. It argues that ‘normal’ is a fallible and vulnerable comparative class to define mental disorders. Mental disorders must be distinguished from behaviours and mental states that reflect individual difference but not clinically significant psychopathology. Risk conditions, mild symptoms, and prodromal stages signify that a person is not yet or not severely diseased. Such notions of unclear cases and in-between states exhibit both vagueness and ambiguity. These considerations are used to suggest ways of limiting the (mis)uses of DSM in fields other than clinical psychiatry.
Vagueness, the sorites paradox, and posttraumatic stress disorder
Authors: Zachar Peter , McNally Richard J.
Published: December 2016

This chapter explores the vagueness inherent in the conceptual structure of posttraumatic stress disorder (PTSD). Although psychopathologists have developed precise diagnostic criteria for PTSD, concepts such as traumatic, severe, and impaired generate borderline cases. As in the sorites paradox, where difficult to distinguish but successively smaller piles of sand may be called heaps, in PTSD similar but successively milder traumatic events may produce PTSD symptoms. The vagueness that bedevils PTSD is of two sorts: the degree vagueness manifested in gradual transitions between subtraumatic and traumatic stressors; and vagueness between normal and abnormal reactions. Also discussed here is an alternative causal systems approach in which the symptoms of PTSD are causally related parts of PTSD. Such mereological structures produce combinatorial vagueness in which there are borderline cases between PTSD and other psychiatric syndromes.
Doppler echocardiography
Authors: Kasprzak Jaroslaw D. , Sadeghpour Anita , Jurcut Ruxandra
Published: December 2016

Doppler examination is an integral part of the echocardiogram. Current systems are equipped with spectral Doppler in continuous wave mode (offering measurements of high velocities with limited spatial specificity due to integration of signal along the scan line), pulsed wave mode (high spatial specificity with maximal recordable velocity reduced by the Nyquist limit), and colour Doppler flow mapping (allowing rapid identification of flow pattern within a cross-sectional B-mode sector). Tissue Doppler echocardiography emerged as a basic tool for sampling regional myocardial velocities, in pulsed wave or colour velocity mapping mode. Finally, three-dimensional systems improve spatial presentation of flow phenomena by integrating Doppler-derived flow patterns in three-dimensional datasets.
Stress echocardiography: methodology
Authors: Andrade Maria João , Varga Albert
Published: December 2016

Stress echocardiography is the combination of echocardiography with a physical, pharmacological, or electrical stress. Good quality images are absolutely necessary and a quad-screen format should be applied for comparative analysis. Different stress echo protocols can be used in different pathologies. Exercise echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of various cardiac conditions. The most usual pathologies are suspected or known ischaemic heart disease, mitral and aortic valve diseases, hypertrophic cardiomyopathy, and pulmonary hypertension. Among exercise-independent stresses, dobutamine and dipyridamole are the most frequently used. Dobutamine is widely accepted for the evaluation of myocardial viability. The two tests have comparable accuracy for the detection of coronary artery disease. Ergonovine echo is highly feasible, accurate, and safe for the diagnosis of coronary vasospasm. High-rate pacing is especially appropriate in patients with a permanent pacemaker because non-invasive diagnosis of coronary artery disease in these patients is an extremely difficult task.
Right ventricle and pulmonary arterial pressure
Authors: van den Bosch Annemien E. , Badano Luigi P. , Grapsa Julia
Published: December 2016

Right ventricular (RV) performance plays an important role in the morbidity and mortality of patients with left ventricular dysfunction, congenital heart disease, and pulmonary hypertension. Assessment of RV size, function, and haemodynamics has been challenging because of its complex geometry. Conventional two-dimensional echocardiography is the modality of choice for assessment of RV function in clinical practice. Recent developments in echocardiography have provided several new techniques for assessment of RV dimensions and function, include tissue Doppler imaging, speckle-tracking imaging, and volumetric three-dimensional imaging. However, specific training, expensive dedicated equipment, and extensive clinical validation are still required. Doppler methods interrogating tricuspid inflow and pulmonary artery flow velocities, which are influenced by changes in pre- and afterload conditions, may not provide robust prognostic information for clinical decision-making. This chapter addresses the role of the various echocardiographic modalities used to assess the RV and pulmonary circulation. Special emphasis has been placed on technical considerations, limitations, and pitfalls of image acquisition and analysis.
Right atrium
Authors: Tourneau Thierry Le , Caballero Luis , Wei-Chuan Tsai
Published: December 2016

The right atrium (RA) is located on the upper right-hand side of the heart and has relatively thin walls. From an anatomical point of view, the RA comprises three basic parts, the appendage, the vestibule of the tricuspid valve, and the venous component (superior and inferior vena cava, and the coronary sinus) receiving the deoxygenated blood. The RA is a dynamic structure dedicated to receive blood and to assist right ventricular (RV) filling. The three components of atrial function are the reservoir function during ventricular systole, the conduit function which consists in passive blood transfer from veins to the RV in diastole, and the booster pump function in relation to atrial contraction in late diastole to complete ventricular filling. Right atrial function depends on cardiac rhythm (sinus or atrial fibrillation), pericardial integrity, RV load and function, and tricuspid function. Right atrial dimension assessment is limited in two-dimensional (2D) echocardiography. Right atrial planimetry in the apical four-chamber view is commonly used with an upper normal value of 18-20 cm2. Minor and major diameters can also be measured. Three-dimensional (3D) echocardiography could overcome the limitation of conventional echocardiography in assessing RA size. Right atrial function has been poorly explored by echocardiography both in physiological and pathological contexts. Although tricuspid inflow and tissue Doppler imaging of tricuspid annulus can be used in the exploration of RA function, 2D speckle tracking and 3D echocardiography appear promising tools to dissect RA function and to overcome the limitations of standard echocardiography.
Heart valve disease: mixed valve disease, multiple valve disease, and others
Authors: Unger Philippe , Maurer Gerald
Published: December 2016

Multiple and mixed heart valve disease are highly prevalent. Echocardiography is the cornerstone technique for imaging these patients. As with patients with single-valve stenosis or regurgitation, one should aim to evaluate the aetiology, the mechanism(s) of dysfunction, as well as the consequences and the possibility of repair. There are, however, specific issues, which include the followings: (1) the lack of published data; (2) most indices of valvular regurgitation and of stenosis severity have been validated in patients with single-valve/single-lesion disease; and (3) the haemodynamic interactions that may affect the severity and the diagnosis of these lesions. A global assessment of the consequences of the lesions is of the utmost importance in the decision-making process: whereas only severe regurgitation or stenosis is usually considered for surgery by current guidelines in a single-valve lesion, the combination of two or more less-than-severe lesions causing symptoms, left ventricular dysfunction, and/or pulmonary pressure increase may warrant surgery. This chapter focuses on the echocardiographic assessment of these sometimes complex lesions, emphasizing some pitfalls and tips to take into account when managing these patients.
Replacement heart valves
Authors: Chambers John B. , Pibarot Phillipe , Rosenhek Raphael
Published: December 2016

Echocardiography is the mainstay investigation for assessing replacement valve function and detecting pathology. Transthoracic echocardiography is sufficient for assessing patients routinely with no evidence of pathology. However, in patients with suspected dysfunction, the addition of transoesophageal echocardiography is usually necessary. Stress echocardiography may also be necessary in patients with exertional symptoms unexplained by the resting transthoracic echocardiography. New modalities, notably computed tomography and magnetic resonance, provide complementary information in selected cases. This chapter summarizes the normal appearance of replacement valves by position and also describes the diagnosis of pathology.
Diseases of the aorta
Authors: Evangelista Arturo , Bossone Eduardo , Nchimi Alain
Published: December 2016

Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases. Evaluation of the aorta is a routine part of the standard echocardiographic examination. Transthoracic echocardiography (TTE) permits adequate assessment of several aortic segments, particularly the aortic root and proximal ascending aorta. Transoesophageal echocardiography (TOE) overcomes the limitations of TTE in thoracic aorta assessment. TTE and TOE should be used in a complementary manner. Echocardiography is useful for assessing aorta size, biophysical properties, and atherosclerotic involvement of the thoracic aorta. TTE appears to suffice for aortic root assessment. TOE is the gold standard in thoracic aorta assessment. It provides excellent morphological information on aortic dissection and is superior to TTE in the diagnosis of intramural haematomas and aortic ulcers. TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TOE should define entry tear location, mechanisms and severity of aortic regurgitation, and true lumen compression. In addition, echocardiography is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications. Although other imaging techniques have a greater field of view and may yield complementary information, echocardiography is portable, rapid, accurate and cost-effective in the diagnosis and follow-up of most aortic diseases.
Cardiac involvement in systemic diseases
Authors: Płońska-Gościniak Edyta , Ciurzynski Michal , Fijalkowski Marcin , Gosciniak Piotr , Szymanski Piotr , Pasierski Tomasz , Muñoz Daniel Rodriguez , Zamorano José Luis
Published: December 2016

Cardiovascular features in systemic diseases are common. Transthoracic echocardiography represents a first-line diagnostic tool among these patients. Pericarditis is the most frequent cardiac complication of rheumatoid arthritis. In systemic lupus erythematosus, echocardiography shows usually small or moderate pericardial effusion in up to 55% of patients. In this group, Libman-Sacks vegetations develop mainly on the mitral valve but also can be seen on other valves. Pulmonary hypertension is one of the most important complications adversely influencing survival of systemic sclerosis patients. In antiphospholipid syndrome, the most common echocardiographic abnormality is diffuse or focal leaflet thickening, seen in 40-60% of subjects. Among Marfan syndrome patients, aortic root aneurysm is the most dangerous complication. In this chapter the authors also report the echocardiographic abnormalities occurring in rare systemic diseases including carcinoid, haemochromatosis, sarcoidosis, and amyloidosis. Moreover, echocardiographic changes in neoplastic disease and in patients undergoing chemotherapy and/or radiotherapy are also described.
Diseases with a main influence on pericardium
Authors: Hagendorff Andreas , Ernande Laura
Published: December 2016

The high spatial and temporal resolution, widespread availability, and non-invasive nature of echocardiography make it the imaging modality of choice for assessment of cardiac valvular disease. Echocardiography allows not only detailed evaluation of valve morphology, but also makes possible assessment of the haemodynamic consequences and impact on left and right ventricular size and function. Based on this data, a more informed decision may be made on the nature and timing of surgical or percutaneous intervention. A wide variety of diseases may afflict the cardiac valves. In some such as rheumatic heart disease and degenerative disease, abnormality of valve function is the most important manifestation. Many systemic diseases, however, may affect the cardiac valves and not infrequently, echocardiography may be the first clue to a systemic illness. The salient points of diseases affecting mainly the cardiac valves are discussed in this chapter.
Adult congenital heart disease
Authors: Di Salvo Giovanni , Budts Werner , Miller Owen I.
Published: December 2016

Echocardiography has a well-established role in the assessment of adults with congenital heart disease. It provides accurate anatomical and functional information and is a bedside, low-cost, and easily repeatable technique. Although some lesions may be diagnosed for the first time in adulthood or may not need a surgical repair, in most cases the typical scenario is to evaluate an adult patient with a known congenital heart disease who has already undergone one (or more) previous surgical or catheter interventions, often during childhood. This chapter provides the basic anatomical concepts for the most frequent diseases, together with a brief presentation of the most used surgical techniques and the haemodynamic patterns seen after these corrections. However, the chapter is only an overview due to the variety of congenital heart disease and the complexity of its imaging.
Perioperative echocardiography
Authors: Wouters Patrick F. , Guarracino Fabio , Seeberger Manfred
Published: December 2016

Perioperative echocardiography is one of the fastest growing areas of echocardiography. Transthoracic imaging is increasingly being used in postoperative patients, in critical care settings, and in emergency medicine. Intraoperative imaging remains the exclusive domain of transoesophageal echocardiography (TOE) where cardiac surgery is the primary field of application. However, the use of intraoperative TOE is gradually expanding towards non-cardiac surgery. The indications for perioperative echo have recently been re-evaluated, resulting in recognition of the ubiquitous benefit in patients undergoing surgery. Although TOE is safe, there may be a greater risk of traumatic damage to the soft tissues in anaesthetized patients who cannot complain of pain nor resist during probe insertion. Perioperative imaging in cardiac surgery should be used to confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anaesthetic and surgical plan, and assess the results of surgical intervention. Using imaging to optimize myocardial function is a constantly developing technique to ensure that patients leave the operating room in the best possible condition.