bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: McFarlane Ben
Published: June 2020

This introductory chapter sets out the law of proprietary estoppel through the principle applied in Thorner v Major (2009). Peter Thorner, a farmer from Somerset, had indicated to David, whose father was a cousin of Peter, that David would inherit Peter’s farm. As a result, David had continued to work on that farm, for very low pay, for a further fifteen years. When Peter died without having made a valid will, the statutory intestacy rules imposed a duty on Peter’s administrators to hold the farm for the benefit not of David but of other relatives of Peter, closer to him in blood if not in life. The House of Lords confirmed, however, that proprietary estoppel operated to impose a duty on Peter (and now on his administrators) to transfer to David the farm and associated assets. The decision meant not only that David was around £2.1 million better off than he would have been had no estoppel claim been possible, but also that, in the words of the Supreme Court’s exhibition’s display: ‘if a verbal promise is made to someone who subsequently relies on that promise to their own detriment, that promise can be enforced under the principles of fairness and equity’.
Acquiescence, Representation, or Promise
Authors: McFarlane Ben
Published: June 2020

This chapter is concerned with the conduct of a person, A. Each of the acquiescence-, representation-, and promise-based strands is considered separately. The chapter therefore sets out the particular conduct of A that may give rise to a proprietary estoppel. The need to distinguish between these three forms is particularly evident when considering the notion that a proprietary estoppel claim requires a representation or assurance by A. Whilst the formulation in Thorner describes the first element of proprietary estoppel as consisting of a ‘representation or assurance’, it is submitted here that it is more accurate to describe that element as capable of being satisfied by A’s acquiescence, representation, or promise.
Third Parties
Authors: McFarlane Ben
Published: June 2020

This chapter examines how B’s ability to establish a proprietary estoppel as a result of A’s conduct may affect third parties such as C. First, there may be a question as to the burden of B’s pre-existing proprietary estoppel on a third party. This question will arise where, after the occurrence of facts that would allow B to establish a claimed proprietary estoppel against A, a third party deals with the property to which B’s claim relates. Secondly, there may be a question as to the benefit of B’s pre-existing proprietary estoppel. This question will arise where, after the occurrence of facts that would allow B to establish a claimed proprietary estoppel against A, B2 then acquires, or purports to acquire, a right from B that relates to B’s claim. Thirdly, there may be other circumstances in which third parties may be affected, concerned with neither the benefit nor the burden of B’s proprietary estoppel.
Remedies
Authors: McFarlane Ben
Published: June 2020

This chapter deals with remedies and so looks at how a court will enforce B’s rights, whether against A or any other party bound by those rights. The practical remedial question of how best to enforce B’s rights arises irrespective of the means by which those rights have been acquired, and so this chapter makes no distinction between the three strands of proprietary estoppel. Here, a court has a wide discretion when deciding how best to protect and enforce B’s right. Whenever a court has to answer the remedial question, and thus must decide how best to protect and enforce a right of B, it will need to have the flexibility to mould its order to the facts before it. This is true whether or not B’s right has arisen through proprietary estoppel.
A Short History of Crimes Against Humanity
Authors: Mettraux Guénaël
Published: June 2020

This introductory chapter provides a background of crimes against humanity. The first formal acknowledgement of crimes against humanity as a separate category of international crimes can be found in the Charter of the Nuremberg Tribunal. However, the view that there are overarching legal principles, sometimes referred to as the laws of humanity, that regulate the conduct of men above and beyond the laws of individual nations long pre-dated this instrument. During the First World War, references to the laws of humanity became increasingly frequent. The notion was generally used to describe a category of violent actions that disturbed the international order and that could be directly imputed not only to people but also to states. Significant to the development of the law of crimes against humanity was the work of the Inter-Allied Commission on the Responsibility of the Authors of the War and Enforcement of Penalties. The chapter then details the drafting of the Charter of the Nuremberg Tribunal as well as its legacy.
Underlying Offences
Authors: Mettraux Guénaël
Published: June 2020

This chapter explores the underlying offences which can constitute crimes against humanity. Crimes against humanity are composed of two core elements: a chapeau or contextual element and an underlying crime committed in and sufficiently linked to the chapeau. The list of underlying crimes that could, in theory, qualify as crimes against humanity is limited in nature and has not significantly evolved since Nuremberg. The Nuremberg Charter provided for six categories of crimes against humanity: murder; extermination; enslavement; deportation; other inhumane acts; and persecutions on political, racial, or religious grounds. Control Council Law No. 10, which regulated the subsequent prosecution of Nazi war criminals in occupied Germany, provided for the same six categories and added three other crimes to the list: imprisonment, rape, and torture. The chapter then assesses which crimes against humanity form part of customary international law.
Do Race, Ethnicity, and Culture Shape the Experience and Disclosure of Child Sexual Abuse?
Authors: Malloy Lindsay C. , Sutherland Jessica E. , Rodriguez Steen Lillian , Quas Jodi A.
Published: June 2020

It is important to consider the potential effects of race, ethnicity, and culture (REC) on how children experience and disclose childhood sexual abuse, and how their disclosures are received by caregivers and state institutions. This chapter reviews the evidence for differences in rates of childhood sexual abuse across REC groups and for how and why children from different REC groups disclose childhood sexual abuse. Findings suggest that, while REC may not influence abuse or disclosure characteristics directly, REC are related to a number of factors that can alter children’s motivation to disclose, their willingness to provide detailed accounts in interviews, and how others react to their disclosures. This chapter highlights the importance of REC sensitivity in relation to childhood sexual abuse for professionals and lay persons, including teachers, lawyers, and child welfare staff who work with victimized children, to whom children may disclose and who must at times evaluate those disclosures.
Transracial Adoption
Authors: Farr Rachel H. , Hrapczynski Katie M.
Published: June 2020

Historically, transracial adoption has been controversial in the United States. Even with legislation supporting the adoption of children who are not the same race or ethnicity as their parents, debate has continued about the well-being and racial socialization of transracially adopted children. Transracial adoptions comprise close to half of adoptions in the United States and most frequently involve White parents raising children of color. This chapter reviews what is known from the social sciences about family dynamics and child outcomes among transracial adoptive families in the United States. It also highlights pivotal court cases in custody battles related to transracial adoption, including recent controversy surrounding the Indian Child Welfare Act (1978). An intersectionality framework is used to represent diversity among transracial adoptive families, including those with sexual minority parents and formed through different pathways (i.e., international, private domestic, public child welfare). Finally, the chapter discusses evidence-based recommendations informing relevant laws and policies.
The Impact of Parental Criminal Justice Involvement on Children of Color
Authors: Miller Keva M. , Crain Crystallee
Published: June 2020

Over the past five decades, arrest, incarceration, and correctional supervisory rates have risen dramatically. One collateral consequence of the upward trend concerns the millions of children who are deeply impacted by the effects of parental criminal justice involvement and the associated risks, yet remain relatively hidden from society and underserved by support systems. Of great concern is the extent to which children of color, who are significantly overrepresented, experience increased vulnerability to adversity and poor outcomes. The need and opportunity exist to examine contributors to racial disproportionality and disparity among this population and to identify policies and practices that counteract contributing factors. This chapter discusses the scope of the problem, the impact that parental criminal justice involvement and the associated risks have on youth, and policies and practices that contribute to overrepresentation of children of color. Policy and practice recommendations that advocate for culturally informed responses and child-centered approaches are provided.
Racial Minority Youths’ Perceptions of the Justice System
Authors: Woolard Jennifer L. , Henning Kristin
Published: June 2020

Both explicit and implicit racial biases shape police and civilian perceptions of and responses to adolescent offending. In turn, Black youths’ contemporary and historical personal and vicarious experiences with racism and policing shape their perceptions of and responses to the police. Although youth of all races generally exhibit the same developmental trajectories of cognitive and psychosocial capacities, minority youth are treated more harshly than their peers. This chapter highlights the attitudes, expectations, and experiences that youth and law enforcement bring to a shared encounter and examines how they play out in the interaction itself. The chapter also discusses the implications for justice policies and practices and for training. Reform should focus on school-based police presence and enhanced police training that involves youth. Research should foreground multiple methodologies using an intersectionality lens. Only when racial minority youth experience fair treatment and outcomes within the legal system will their attitudes toward it improve.
Children, Race, and Psychology
Authors: Goodman Gail S. , Harris LaTonya S. , Goldfarb Deborah , Wang Yan
Published: June 2020

This book, The Legacy of Racism for Children, focuses on an extremely important but understudied topic in the psychological literature: the legacy of racial discrimination for children of color. The authors develop this theme by introducing many related and timely issues, such as sex trafficking, physical punishment, child maltreatment, education, transracial adoption, juvenile court, criminal court, and immigration. Here, we consider each chapter in the book and summarize its main points, discuss future directions, and provide some relevant research findings. Our chapter highlights the importance of the home and the education system as contexts for intervention. This chapter concludes with a poignant example to discuss the assumption of free will as applied to adolescents or adults who have experienced racial discrimination and other traumas in childhood.
Do We Need Another Eating Disorder?
Authors: Keel Pamela K.
Published: June 2020

Most people know about anorexia and some know about bulimia, but very few have ever heard of purging disorder. Purging disorder is an eating disorder characterized by self-induced vomiting or misuse of laxatives, diuretics, or other medications to influence weight or shape in individuals who are not underweight and who do not have large binges. This chapter describes how and when purging disorder was first identified, placing it in the context of the identification of other eating disorders and the factors that determine whether a condition should be considered a new mental disorder. It describes how purging disorder came to be included as an “other specified feeding or eating disorder” in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
Medical Consequences of Purging
Authors: Keel Pamela K.
Published: June 2020

For anyone purging in pursuit of a “healthy” weight, the medical complications of purging eliminate the notion that this could make anyone healthier. All purging methods cause severe loss of bodily fluid because water is the primary component of matter expelled from the body. Dehydration contributes to low blood pressure, slow and irregular heartbeat, and kidney problems. Purging also contributes to electrolyte imbalances, which negatively impact heart and kidney function and can trigger seizures, muscle weakness, and breakdown of muscle tissue. Stomach acid from vomit causes sores in the mouth and erodes teeth. Laxative misuse can trigger uncontrollable diarrhea and constipation. In insulin-dependent diabetics, reducing or omitting insulin increases blood sugar concentrations, which can lead to blindness, kidney failure, nerve damage, cardiovascular disease, amputation, coma, and death. Individuals who purge should seek medical care, and physicians should follow published guidelines for evaluating medical status.
What Happens in Treatment
Authors: Keel Pamela K.
Published: June 2020

Effective treatment requires a team of health professionals working together. Team members should include, at minimum, a physician, a dietitian, and a therapist. Many treatments begin with psychoeducation to explain what maintains purging disorder, the consequences of the illness, and why a chosen therapy facilitates recovery. This chapter describes therapies that have been used to treat patients with purging disorder, including family-based treatment in adolescents, cognitive-behavioral therapy in adolescents and adults, and integrated cognitive affective therapy in adults. Most treatments require adaptation to effectively address purging as a primary symptom rather than as a response to binge eating. At this time, there are no randomized controlled trials focused on treatment for purging disorder. This means clinicians bear the responsibility of identifying a first line of treatment for their patients with purging disorder and evaluating the treatment’s effectiveness.
Foundations of Prolonged Exposure
Authors: Rauch Sheila A. M. , Rothbaum Barbara O. , Smith Erin R. , Foa Edna B.
Published: June 2020

This chapter presents the foundations for prolonged exposure (PE) therapy as they have been developed in emotional processing theory to immerse the provider in theory that will guide all decisions during PE, whether they are using the intensive outpatient program (PE-IOP) in this manual or another model (e.g., PE-Primary Care, or standard PE). The authors present a discussion on how PE works and on the research supporting the theorized mechanisms of change. In addition, alternative treatments are described, including medication and considerations for patients who are already on medications when they are engaged in PE-IOP. The chapter ends with a discussion of why this PE-IOP model was developed and when it may be indicated for patient care.
Exposure in PE-IOP
Authors: Rauch Sheila A. M. , Rothbaum Barbara O. , Smith Erin R. , Foa Edna B.
Published: June 2020

This chapter presents in-depth details of how to implement the exposure component of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), including places where variation is acceptable and why. The authors present the logistics and rationale for individual sessions that include imaginal exposure and individualized trauma emotional processing. In addition, the authors present in vivo group exposure session logistics and rationale. The in vivo group includes the general psychoeducation components of PE, the in vivo exposure hierarchy creation, and the practice of in vivo exposure. The exposures may occur in a group or individually, escorted or non-escorted, as clinically indicated for the individual patient.
Integrative Interventions
Authors: Rauch Sheila A. M. , Rothbaum Barbara O. , Smith Erin R. , Foa Edna B.
Published: June 2020

In addition to the core of prolonged exposure in the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), the program also includes integrative interventions designed to encourage positive coping, wellness, and maintenance of gains from PE-IOP. These integrative interventions can vary based on availability, cost, patient population, etc. While they can vary, program implementers should be cautious that the chosen interventions have a general rationale that fits the overall PE-IOP milieu by supporting approaching and not avoiding trauma memories and reminders and that emotions are not dangerous but a normal part of life. The authors discuss the rationale for inclusion of interactive interventions as well as how to decide what interventions to use.
Communication Skills
Authors: Landau Carol
Published: June 2020

This chapter is an in-depth exploration of communication between parents and teens. This foundation becomes important when difficult topics like depression, substance use, or family conflict need to be discussed. Communication strategies, including open-ended questioning, validation, empathy, and optimal timing, are detailed. The chapter illustrates why lecturing and immediate problem-solving are not helpful. Assertive communication within the family is discussed as well as cultural barriers to effective communication. The skills of motivational interviewing are applied to parent–child interactions about decisions. The family dinner is examined as an opportunity for shared communication and connection. Divorce is seen as a severe breakdown in communication, with 25–30% of children suffering negative effects. Arizona State University’s New Beginning Program for parents going through a divorce is presented as a proactive model that has reduced psychological problems in children and emerging adults.
Distress Tolerance, Distraction, and Mindfulness Matters
Authors: Landau Carol
Published: June 2020

This chapter reviews distress tolerance and strategies for developing them in students. Distress tolerance skills were developed in dialectical behavior therapy, particularly relevant to students who have great amounts of difficulty modulating negative emotions. Although parents may be tempted to jump in with problem-solving for their teens, a better approach is to assist teens in developing the ability to tolerate distress. Modeling distress tolerance is one strategy, as is incorporating mindfulness into the family. Meditation is also discussed as a possibility for detaching from negative emotions. Exercises for breathing, meditation, mindful observation, and muscle relaxation are included. A case is discussed––an overwhelmed student whose parents consistently protected her from distress; subsequently, she self-medicated with marijuana and alcohol.
Social Power
Authors: Landau Carol
Published: June 2020

Social forces affect all of us in positive and negative ways, and adolescents and emerging adults are especially sensitive to them. Positive social support forces include close relationships with family members and friends. Social isolation is a risk factor for depression. The power of the media is examined through a study that was done in Fiji with young women before and after the introduction of television. The role of social media and its negative impact on the mood of teenagers and young adults is documented, yet one reason it may be difficult to limit social media in students is that parents are over-involved in digital media as well. A final set of negative social forces are bullying, cyberbullying, body shaming, and harassment of people who are different from the perceived norm. Included in the chapter are strategies for limiting social media and responding to bullying.
How the Principles of Cognitive Behavior Therapy (CBT) and Other Evidence-Based Therapies Can Help Your Family
Authors: Landau Carol
Published: June 2020

Several evidence-based types of therapy discussed in this chapter have been shown to be effective treatments for depression. These include cognitive behavior therapy, interpersonal therapy, and behavioral activation therapy. Third-wave forms of therapy are also detailed, including dialectical behavior therapy and acceptance and commitment therapy. These have less evidence for their effectiveness but show promise. Mindfulness-based cognitive therapy has been shown to prevent relapse of depression. The techniques from all of these schools can be used in plans for the prevention of depression. Detailed attention is given to such techniques from cognitive behavior therapy as decatastrophizing; challenging negative assumptions, all-or none thinking, and overgeneralizations; and cognitive reframing and restructuring. Knowledge of these techniques can make parents better informed consumers when arranging treatment for their children. as well as identify ways they might be directly helpful to a distressed teen.
Transforming Malignant Perfectionism and Encouraging Flexibility
Authors: Landau Carol
Published: June 2020

People with perfectionism are vulnerable to depression. If a student believes they must be perfect and has a harsh, ruminating type of self-criticism, they will develop a negative mood. This chapter centers on a perfectionistic teen and how cognitive behavior therapy was used to help her and her parents. Perfectionism also leads to procrastination, and both can create major problems in college. There are two types of perfectionism, maladaptive and adaptive. Adaptive perfectionism involves keeping high standards but having less pressure, self-criticism, and rigid rules. The concept of the growth mindset is introduced, with the goal of seeing education as an opportunity rather than an all-or-none road to individual success.
College as a Land of Challenges
Authors: Landau Carol
Published: June 2020

The college experience presents numerous challenges. Everything from living with a roommate for the first time to severe substance abuse can be found on college campuses. Some of the challenges described in this chapter are roommates, romantic break-ups, binge drinking, drunkorexia, chronic marijuana use, other recreational drugs, parties, the hookup culture, and sexual assault. A student’s need to self-regulate becomes critically important. At the same time, a college student may also need to deal with family stress, loss or divorce. During family crises communication becomes even more important because of the distance that may be involved. A family’s struggle with their daughter’s academic and alcohol problems are detailed with a discussion of the decision about whether she should leave college.
Is Taking Time Off from College a Good Idea?
Authors: Landau Carol
Published: June 2020

Is it a good idea to take time off from college? Or take time off before college? This question is examined in depth in this chapter. Two types of taking time off are a medical leave of absence or taking a gap year before college. A process is described of how to communicate about and understand college policies on taking time off. The advantages of a gap year are also described. A case of a minority student who wanted to and did take time off is discussed. He wasn’t sure what to do and needed to arrange productive activities and therapy while he was away, as well as consider how he would communicate with family and friends about his decision. The chapter ends with suggestions for how to best plan for a student taking time off from college.
Introduction
Authors: Eyal Nir , Hurst Samia A. , Murray Christopher J. L. , Schroeder S. Andrew , Wikler Daniel
Published: June 2020

This introductory chapter provides a brief history of philosophers’ involvement with the Global Burden of Disease Study, from its origins in the 1990s through the present, showing how the researchers leading the GBD have consistently sought out the advice of philosophers, and how their input has shaped several important aspects of the study. It then goes on to summarize some of the key conclusions defended in the volume’s remaining chapters, on philosophical issues raised by the GBD as a whole, on whether studies like the GBD should aim to measure health or well-being, on the GBD’s use of causation, on values built into the GBD’s measures, and on the uses of GBD data.
Years of Good Life Based on Consumption and Health
Authors: Cookson Richard , Cotton-Barratt Owen , Adler Matthew D. , Asaria Miqdad , Ord Toby
Published: June 2020

This chapter proposes a practical measure of individual well-being to facilitate the economic evaluation of public policies. The authors propose to evaluate policies in terms of years of good life gained, in a practical and flexible way that complements and builds upon the standard outcome measures used in cost-effectiveness and cost–benefit analysis. The authors show how to do this by adjusting years of life lived for consumption-related quality of life—that is, the material standard of living—as well as health-related quality of life. This is a straightforward extension of the quality-adjusted life year metric used in health economics for measuring years of healthy life. The authors’ approach allows for differences between people in the marginal value of money. It also permits distributional impact analysis in terms of lifetime well-being—that is, how many good years of life different people can expect over the course of their lives. The authors aim to show how years of good life could be measured in practice by harnessing readily available data on three important elements of individual well-being: consumption, health-related quality of life, and mortality. They also aim to identify the main ethical assumptions needed to use this measure.
Values, Politics, and Health Measurement
Authors: Kingma Elselijn
Published: June 2020

What is the role of values in health measurements, such as the disability-adjusted life years (DALYs) employed in the Global Burden of Disease Study? And what should that role be? These questions can be illuminated by considering what the role of values is in the concepts of health and disease themselves. This chapter argues in favor of a limited role of values in our accounts of health and disease both on conceptual and pragmatic grounds. The author then argues that the role of values in the DALY health measurement system employed by the Global Burden of Disease Study is generally aligned with the general role for values in accounts of health and disease that the author advocates—and therefore correct.
Age and Time in the Measurement of the Burden of Disease
Authors: Bognar Greg
Published: June 2020

A basic principle of the Global Burden of Disease (GBD) studies is that all units of health loss have the same value. However, in earlier iterations of the GBD studies this principle had some qualifications. One was that the value of the same health loss may differ between individuals of different ages; that is, DALYs were age-weighted. Age-weighting has now been removed for ethical reasons. A year of healthy life has the same value regardless of the age of the person living it. Contrary to this claim, however, the author argues that a form of implicit age-weighting is still implied by the GBD methodology. But the author also argues that this kind of age-weighting can be defended on moral grounds.
The Uses of Burden-of-Disease Data for Priority Setting
Authors: Ottersen Trygve , Norheim Ole F.
Published: June 2020

The generation of burden-of-disease (BOD) data has been driven by a desire to inform policy making and priority setting. This chapter examines the uses of BOD data for priority setting. The authors first introduce the most relevant BOD metrics and describe how these have been linked to priority setting. They next discuss the problems with using BOD data to directly guide priorities. They stress that BOD data are about problems, while priority setting is about solutions, and describe how priority setting based on BOD fails to capture cost-effectiveness and fairness in the distribution of benefits. Against this background, the authors argue that BOD can play many important roles in priority setting, but that these are all indirect. They outline multiple indirect roles, with illustrations from a recent priority setting proposal in Norway. They conclude with general recommendations for how BOD-related data can be made more useful for priority setting.
Toronto University and Medical School and Internship in Detroit
Authors: Caplan Louis R.
Published: June 2020

Abstract: Fisher’s medical school experience and training are described in this chapter. Medical education and medicine in general at the time of Fisher’s matriculation seem quite primitive and undisciplined by today’s standards. A very brief review of the history of medicine and medical education up to that time places the situation during the 1930s when Fisher matriculated into perspective. William Osler’s career, which predated but influenced Fisher, is described. Fisher’s medical internship at Henry Ford Hospital in Detroit, Michigan, is also briefly discussed. During his entire medical career, Fisher maintained a strong commitment to accurate measurement and quantification of physical signs and observations, a discipline he first learned in Toronto as a student.
World War II and Experience as a British Naval Officer
Authors: Caplan Louis R.
Published: June 2020

Abstract: In this chapter, Fisher’s marriage and brief experience in Montreal during the pre-World War II years are discussed. The bulk of this chapter concerns his induction into the Canadian Navy and his experiences on ships during the early portion of World War II. The sinking of one of the ships on which he served and his capture by the Germans are also discussed. Fisher enlisted in the Canadian Navy in 1940 and was commissioned as a Surgeon Lieutenant. In April 1941, the Germans sank the ship on which Fisher served, and he was captured and sent to Germany as a prisoner of war.
Neurological Examination of the Stuporous Patient, Lacunar Infarction, Intracerebral Hemorrhage, and Aneurysmal Subarachnoid Hemorrhage
Authors: Caplan Louis R.
Published: June 2020

Abstract: This chapter describes some of Fisher’s major contributions in neurology, stroke, and cerebrovascular disease. The main areas are the neurological examination, especially in patients with decreased consciousness; the pathology of penetrating artery disease and lacunar infarction and the associated clinical findings; the pathology and clinical features of intracerebral hemorrhage and description of the findings in cerebellar hemorrhage; and the presence and clinical features of delayed cerebral infarction and arterial vasoconstriction in patients with aneurysmal subarachnoid hemorrhage. His contributions were often made over time. He often worked on different areas of interest concurrently. When he prepared a list in 1998 of his own contributions for a Canadian Medical Hall of Fame biographer, he listed 101 separate contributions.
Carotid Artery and Cerebral Atherosclerosis, Transient Ischemic Attacks, Symptoms and Signs Correlated with Lesions at Various Brain Locations, Cervical and Cranial Arterial Dissections, and Hydrocephalus and Gait Abnormalities
Authors: Caplan Louis R.
Published: June 2020

Abstract: This chapter describes Fisher’s contributions in regard to the presence, nature, and severity of carotid artery and cerebral atherosclerosis and the symptoms and signs in patients with brain ischemia and infarction; transient ischemic attacks; the nature and symptoms related to dissection of brain-supplying arteries; and hydrocephalus and gait abnormalities in older adults. Fisher made many contributions to medicine. Arguably his major contribution to the care of patients with cerebrovascular disease and brain ischemia and strokes was his lengthy descriptions and diagrams of the symptoms and signs in patients with occlusive cerebrovascular disease that appeared in textbooks of internal medicine and neurology.
Atrial Fibrillation, Memory, Timing and Quantity of Behavior, Randomized Therapeutic Trials and Anticoagulation of Brain Ischemia Patients, and Headache and Migraine
Authors: Caplan Louis R.
Published: June 2020

Abstract: This chapter describes Fisher’s contributions in regard to atrial fibrillation as a common cause of brain embolism; the brain anatomy of memory and persistent and temporary amnesia; the brain anatomy related to the timing and quantity of behavior; randomized therapeutic trials and anticoagulation treatment of patients with brain ischemia; and headache and migraine. Fisher and colleagues made important contributions to knowledge concerning the acquisition and retention of memories. Fisher recognized that strokes offered an opportunity to learn how various areas in the brain functioned. He became avidly interested in all aspects of cognition and behavior. In addition, Fisher had a career-long interest in headache, and he cared for many patients in whom headache was the predominant symptom and health problem.
Retirement and Beyond
Authors: Caplan Louis R.
Published: June 2020

Abstract: Fisher’s retirement and his life, activities, and accomplishments during retirement are discussed in this chapter. He received many awards, including entrance into the Canadian Medical Hall of Fame. During his last years, his wife developed a dementing illness and died, and he had a myocardial infarction and became nearly blind due to glaucoma. His 90s were spent in assisted living and nursing home facilities in Albany, New York, near his youngest son. He died at age 98 years. He witnessed remarkable changes during his near century of life. Much of the change in the care of patients with stroke and cerebrovascular disease could be directly attributable to his research, writings, and teachings and to the physicians he had mentored lovingly during his long and fruitful career.
Using Deep Brain Stimulation to Improve Orthostatic Tremor
Authors: Hassan Anhar
Published: June 2020

A 79-year-old woman with medication-refractory disabling orthostatic tremor (OT) of 15 years’ duration was referred for deep brain stimulation (DBS). She reported leg tremor within seconds of standing that spread to the trunk and upper limbs within 30 seconds, requiring her to sit down. She carried a stool everywhere to compensate for inability to stand. She had failed several medications, including clonazepam. Clinical exam showed visible and palpable leg tremor within seconds of standing. Surface electrophysiology confirmed a 15- to 16-Hz tremor on standing that transmitted to the arms with load-bearing. She was approved for bilateral ventral intermediate thalamic DBS. A microlesional effect was observed on standing up in the operating room following bilateral lead placement. Outpatient DBS programming resulted in further tremor suppression clinically, confirmed by movement electrophysiology with DBS turned off and on. At 3-year follow-up, the patient could stand for 10 to 15 minutes, with only minor shifts in stance, and no longer needed a stool. There was an observed difference in tremor severity and standing time with DBS turned on and off. This case adds to the growing body of literature on the benefit of bilateral thalamic DBS for medication-refractory OT. However, whether there is a more optimal DBS target is not yet known.
Bilateral Ventral Intermediate Thalamic Deep Brain Stimulation for Medication-Refractory Orthostatic Tremor
Authors: Afshari Mitra , Starr Philip A. , Ostrem Jill L.
Published: June 2020

In this case, a 61-year-old right-handed woman presented with a 20-year history of mild bilateral kinetic hand tremor and a 10-year history of progressive gait imbalance on standing. The unsteadiness was relieved with walking. She was diagnosed with essential tremor (ET) and orthostatic tremor (OT). Her hand tremor initially responded to treatment with propranolol, but later worsened despite dose optimization. Bilateral Vim stimulation provided tremor relief and an increase in “standing time.” The chapter discusses some of the common physiology between ET and OT, which has been a longtime topic of investigation. It also introduces the new concept of preoperative, postoperative, and even intraoperative use of EMG of the legs to help quantify tremor more objectively in addition to measuring “standing time.”
Medication-Refractory Parkinsonian Tremor Requiring Dual Lead Implantation for Tremor Control
Authors: Hassan Anhar
Published: June 2020

A 52-year-old man with Parkinson disease (PD) of 9 years’ duration was referred to the DBS clinic for medication-refractory severe unilateral rest and re-emergent tremor and frequent motor fluctuations. He was approved for DBS, with debate over the optimal target to treat severe tremor and fluctuations (subthalamic nucleus [STN] plus/minus the ventral intermediate [Vim] thalamus) and unilateral versus bilateral implantation. The committee decided to perform unilateral STN lead placement first, to provide benefit for both motor fluctuation and tremor, with the option of adding Vim concurrently if required. Intraoperatively, there was incomplete tremor capture, so a second lead was placed in Vim with success. Subsequent DBS programming achieved marked improvement of tremor and fluctuations at low stimulation, although side effects necessitated bipolar configurations in both leads. The patient reported excellent sustained tremor suppression at 2-year follow-up, although motor fluctuations recurred. This case illustrates that for intraoperative stimulation-refractory PD tremor, consideration can be given to adding a second Vim DBS target (dual DBS targets).
Use of Constant Current Mode to Allow Both Monopolar and Bipolar Interleaving at a Single Contact
Authors: Spindler Meredith , Chahine Lana
Published: June 2020

A 56-year-old woman with advanced Parkinson disease underwent implantation of bilateral subthalamic nucleus (STN) deep brain stimulation with bilateral single-channel internal pulse generators (IPGs; Activa SC). Initial monopolar review suggested that ventral placement of the right STN lead and sufficient motor control could not be achieved without stimulation-induced side effects. She eventually underwent revision of the right STN lead. Subsequently, achieving the best balance between tremor control and dysarthria required interleaving of contacts 1 and 2 on the right. When she was due for battery replacement, she opted for a single, dual-channel, rechargeable IPG (Activa RC). Because her right STN lead used interleaving, at 125 Hz per program, and her left STN was programmed at 185 Hz without interleaving, the new dual-channel IPG required reprogramming of her left STN to be used for interleaving. However, the addition of any contact other than the most effective contact reduced her benefit, and thus it was decided to interleave two programs stimulating this contact in monopolar and bipolar mode. To achieve this, a change to constant current mode was required. Tremor control was re-established with this setting.
Management of Stimulation-Induced Dyskinesia in Parkinson Disease With Interleaving Programming Settings
Authors: Sharma Vibhash D. , Lyons Kelly E. , Pahwa Rajesh
Published: June 2020

Deep brain stimulation (DBS) of subthalamic nucleus (STN) can effectively control motor complications in Parkinson disease (PD). The outcome of DBS therapy depends on lead placement in the dorsolateral aspect of STN, as well as post-DBS programming. Effective DBS programming requires knowledge of side effects/complications related to stimulation. One of the infrequent complications of STN DBS is stimulation-induced dyskinesia, which can present similar to levodopa-induced dyskinesia with choreiform, ballistic, or dystonic movements. Stimulation-induced dyskinesia can be bothersome and can interfere with effective control of motor symptoms because typically the contact causing dyskinesia is the most effective in improving motor symptoms. This chapter discusses clinical presentation and management strategies in a patient with tremor-predominant PD who developed stimulation-induced dyskinesia. After trying multiple programming parameters, patient tremor and dyskinesia were effectively controlled on interleaved programming settings. The authors conclude that interleaving DBS programming can be a potential option for management of stimulation-induced dyskinesia.
Freezing of Gait After Bilateral Globus Pallidus Interna Deep Brain Stimulation in Generalized Dystonia
Authors: Moscovich Mariana
Published: June 2020

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a safe and long-term effective treatment for medication-refractory dystonia. However, complications and side effects may occur. Freezing of gait (FOG) is a rare phenomenon in patients with dystonia, although very frequently this complication is observed in patients with Parkinson disease (PD). FOG can be disabling and may severely impair quality of life, even when episodic. This chapter reports on a case of a 49-year-old left-handed man presenting with FOG, impairment in balance, and walking difficulty. These issues emerged 3 years after successful bilateral GPi DBS for primary generalized dystonia.
Rescue Ventral Intermediate Thalamus Deep Brain Stimulation to Address Refractory Tremor Following Subthalamic Nucleus Deep Brain Stimulation With Brittle Dyskinesia
Authors: Afshari Mitra , Ostrem Jill L. , Luciano Marta San , Larson Paul S.
Published: June 2020

This chapter discusses a case in which a “rescue” deep brain stimulation (DBS) lead was implanted to address suboptimal tremor control. The patient was a 52-year-old woman with disabling bilateral postural and action hand tremor who also had mild parkinsonian signs. An essential tremor (ET)–Parkinson disease (PD) syndrome was suspected, and subthalamic nucleus (STN) DBS was pursued. Attempts at optimizing tremor control by reprogramming were limited by the induction of brittle dyskinesia even with small amounts of stimulation. Bilateral ventral intermediate thalamus DBS leads were then implanted, and the tremors improved significantly. Troubleshooting strategies for optimizing tremor control and reducing STN DBS–induced brittle dyskinesia are discussed. The chapter reviews important learning points on DBS target selection for ET, PD, and ET-PD spectrum syndromes.
Postural Instability and Gait Disorder After Subthalamic Nucleus Deep Brain Stimulation
Authors: Kurtis Mónica M. , Pérez-Sánchez Javier R.
Published: June 2020

Parkinson disease (PD) patients who have undergone surgery and develop festinating gait and postural instability are challenging to diagnose and treat. This chapter describes the case of an early-onset PD patient who underwent deep brain stimulation (DBS) 4 years after disease onset due to motor and nonmotor fluctuations and medication side effects (impulse control disorder). A year after surgery, the patient developed gait and balance problems in the on-medication/on-stimulation states that resolved after turning stimulation off or withdrawing medication for 12 hours. However, other symptoms, including as bradykinesia, rigidity, and tremor, reappeared. Troubleshooting involved magnetic resonance imaging to evaluate electrode placement and complete screening of all contacts with successful reprogramming and medication adjustments. The pathophysiology of balance problems is discussed, including the synergistic effects of subthalamic nucleus DBS and dopaminergic treatment, which may lead to increased postural sway and lower limb dystonia.
Nonsurgical Management of an Exposed Deep Brain Stimulation Lead
Authors: Brown Ethan G. , Volz Monica , Heath Susan , Galifianakis Nicholas B. , Ostrem Jill L.
Published: June 2020

Erosion of the skin overlying a deep brain stimulator (DBS) lead can occur in between 1 and 10% of cases. This complication increases the risk for subsequent infection, and full explantation of the lead is almost always necessary. In some specific cases, however, nonoperative management may be possible. This chapter describes a case of a patient with Parkinson disease (PD) and implantation of bilateral subthalamic nuclei (STN) DBS leads with a complicated postoperative course, requiring lead revision and extensive reprogramming to achieve therapeutic benefit. The patient later developed a skin erosion and eventual exposure of his brain lead, which recurred after skin graft placement. Because of the sterile appearance of his erosion and his willingness to be closely monitored, he was managed nonsurgically with only topical antibiotics. After 3 years of DBS therapy with an exposed lead, the erosion site became infected, requiring surgical movement of the system, but the patient experienced improved quality of life with DBS up until this point in time. Temporary nonoperative management of some low-infection-risk chronic lead erosions may be well-tolerated and allow for continued benefit from DBS. This conservative and controversial management choice may be helpful in rare cases in which a patient is benefiting greatly from DBS and would not be considered a candidate for DBS reimplantation.
Steroid-Responsive Edema Interfering With Deep Brain Stimulation Programming
Authors: Khemani Pravin , Chitnis Shilpa
Published: June 2020

Deep brain stimulation (DBS) surgery–associated complications are most commonly due to infections and issues with surgical hardware. An uncommon postsurgical complication hindering effective programming is noninfectious edema appearing as an abnormal peri-electrode T2 signal hyperintensity on brain magnetic resonance imaging (MRI). A 72-year-old woman with Parkinson disease underwent bilateral subthalamic nucleus (STN) implantation for medication-refractory motor symptoms. Worsening balance shortly after surgery and suboptimal response to DBS programming prompted brain MRI, which showed an abnormal T2 hyperintensity around the left STN electrode. Although intravenous antibiotics were considered, the absence of clinical signs and lack of postcontrast T2 signal enhancement argued against infection. Suspecting vasogenic edema, a short course of oral dexamethasone steroids was initiated, with gradual improvement in balance and resolution of the abnormal MRI signal. The mechanism of steroid-responsive vasogenic edema after DBS surgery is not well-understood. This case underscores the importance of being vigilant about this rare complication, differentiating it from infection based on clinical presentation and radiographic characteristics, and treating it appropriately.
Improved Outcome on Interleaved Deep Brain Stimulation Settings
Authors: Miocinovic Svjetlana , Khemani Pravin , Whiddon Rebecca , Chitnis Shilpa
Published: June 2020

Interleaving is a DBS programming method whereby two sets of stimulation parameters are applied interchangeably (on a millisecond level). This chapter describes a patient with Parkinson disease who was implanted with subthalamic nucleus deep brain stimulation but achieved suboptimal tremor control with conventional programming (monopolar, double monopolar, or bipolar settings). Interleaving allowed the dorsal contact to be set to a higher setting, while the contact below was set to a tolerable lower setting. Together, the two contacts provided complete tremor resolution without side effects. It is unknown whether interleaving provides any additional advantage over simply allowing use of different amplitudes at different contacts, but potential mechanisms are discussed.