bluuebunny/crossref_metadata_2025 huggingface dataset:
Response of a laminar separation bubble to impulsive forcing
Authors: Michelis Theodoros , Yarusevych Serhiy , Kotsonis Marios
Published: May 2017

The spatial and temporal response characteristics of a laminar separation bubble to impulsive forcing are investigated by means of time-resolved particle image velocimetry and linear stability theory. A two-dimensional impulsive disturbance is introduced with an alternating current dielectric barrier discharge plasma actuator, exciting pertinent instability modes and ensuring flow development under environmental disturbances. Phase-averaged velocity measurements are employed to analyse the effect of imposed disturbances at different amplitudes on the laminar separation bubble. The impulsive disturbance develops into a wave packet that causes rapid shrinkage of the bubble in both upstream and downstream directions. This is followed by bubble bursting, during which the bubble elongates significantly, while vortex shedding in the aft part ceases. Duration of recovery of the bubble to its unforced state is independent of the forcing amplitude. Quasi-steady linear stability analysis is performed at each individual phase, demonstrating reduction of growth rate and frequency of the most unstable modes with increasing forcing amplitude. Throughout the recovery, amplification rates are directly proportional to the shape factor. This indicates that bursting and flapping mechanisms are driven by altered stability characteristics due to variations in incoming disturbances. The emerging wave packet is characterised in terms of frequency, convective speed and growth rate, with remarkable agreement between linear stability theory predictions and measurements. The wave packet assumes a frequency close to the natural shedding frequency, while its convective speed remains invariant for all forcing amplitudes. The stability of the flow changes only when disturbances interact with the shear layer breakdown and reattachment processes, supporting the notion of a closed feedback loop. The results of this study shed light on the response of laminar separation bubbles to impulsive forcing, providing insight into the attendant changes of flow dynamics and the underlying stability mechanisms.
Evangelist of Fragments: Doing Mite-Box Capitalism in the Late Nineteenth Century
Authors: Kaell Hillary
Published: May 2017

A century ago, the mite box (penny collection box) was ubiquitous in North America as a religious fundraising tool, especially for women and children. Using the Methodist Woman's Foreign Missionary Society as a case study, I ask what these boxes reveal about the intersection of gender, consumerism, and capitalism from circa 1870–1930. By cutting across traditional Weberian and Marxist analyses, the discussion engages a more complex understanding of religion and capital that includes emotional attachments and material sensations. In particular, I argue that mite boxes clarify how systematic giving was institutionalized through practices that created an imaginative bridge between the immediacy of a sensory experience and the projections of social policies and prayers. They also demonstrate how objects became physical points of connection that materialized relationships that were meant to be present, but were not tangible. Last, they demonstrate the continued salience of older Christian ideas about blessings and sacrifice, even in an era normally associated with the secularization of market capitalism and philanthropy.
From dispassionate law to compassionate outcomes in health-care law, or not
Authors: Biggs Hazel
Published: May 2017

Health-care law presents numerous challenges to the conception of the law as a dispassionate arbiter of disputes or protector of rights. Issues relating to end-of-life care, the assessment of mental capacity and decision-making for those who lack capacity, amongst others, epitomise the complex nature of health-care law. They also raise globally applicable questions about discrimination, or equal protection, as well as concerns for relief of suffering, the assessment of best interests and the exercise of individual autonomy. This paper will evaluate the extent to which law's traditional objectivity (dispassion) is undermined by the introduction of concerns about compassion into judicial and executive decisions. Focusing primarily on the law in England and Wales, but with reference to multi-jurisdictional case-law and international instruments, it will consider whether the law provides compassionate approaches and outcomes in end-of-life decision-making, and the implications of compassion for legal certainty.
Explaining Moral Behavior
Authors: Osman Magda , Wiegmann Alex
Published: May 2017

Abstract. In this review we make a simple theoretical argument which is that for theory development, computational modeling, and general frameworks for understanding moral psychology researchers should build on domain-general principles from reasoning, judgment, and decision-making research. Our approach is radical with respect to typical models that exist in moral psychology that tend to propose complex innate moral grammars and even evolutionarily guided moral principles. In support of our argument we show that by using a simple value-based decision model we can capture a range of core moral behaviors. Crucially, the argument we propose is that moral situations per se do not require anything specialized or different from other situations in which we have to make decisions, inferences, and judgments in order to figure out how to act.
Moral Hindsight
Authors: Fleischhut Nadine , Meder Björn , Gigerenzer Gerd
Published: May 2017

Abstract. How are judgments in moral dilemmas affected by uncertainty, as opposed to certainty? We tested the predictions of a consequentialist and deontological account using a hindsight paradigm. The key result is a hindsight effect in moral judgment. Participants in foresight, for whom the occurrence of negative side effects was uncertain, judged actions to be morally more permissible than participants in hindsight, who knew that negative side effects occurred. Conversely, when hindsight participants knew that no negative side effects occurred, they judged actions to be more permissible than participants in foresight. The second finding was a classical hindsight effect in probability estimates and a systematic relation between moral judgments and probability estimates. Importantly, while the hindsight effect in probability estimates was always present, a corresponding hindsight effect in moral judgments was only observed among “consequentialist” participants who indicated a cost-benefit trade-off as most important for their moral evaluation.
Autonomous Floats Shed New Light on the Ocean’s Many Hues
Authors: Stanley Sarah
Published: May 2017

Argo float data reveal regional deviations from existing models of the relationship between ocean color and biogeochemistry.
NOAA Officials Stress Hurricane Danger and Storm Safety
Authors: Showstack Randy
Published: May 2017

Agency scientists on a Hurricane Awareness Tour showcase NOAA research capabilities and warn that although winds can cause severe damage, the biggest killers are storm surges and inland flooding.
Effects of replacing Leymus chinensis with whole-crop wheat hay on Holstein bull apparent digestibility, plasma parameters, rumen fermentation, and microbiota
Authors: Niu Wenjing , He Yang , Xia Chuanqi , Rahman Muhammad Aziz Ur , Qiu Qinghua , Shao Taoqi , Liang Yixun , Ji Linbao , Wang Haibo , Cao Binghai
Published: May 2017

Twelve Holstein bulls were used in a 4 × 4 Latin square design to investigate the effects of using whole-crop wheat hay (WCWH) as a substitute for Leymus chinensis (LC) on apparent digestibility, plasma parameters, ruminal fermentation, and microbial communities. Experimental treatments were four proportions of WCWH, 0, 33, 67, and 100%, as a substitute for LC (WCWH0, WCWH33, WCWH67, and WCWH100, respectively). The WCWH100 group showed a higher nutritional intake of crude protein (CP) and higher apparent digestibility of organic matter (OM), CP, and ether extract (EE) than the WCWH0 group (P < 0.05). Urea N, NH3-N, isobutyrate and isovalerate levels were higher (P < 0.05) in the WCWH100 group than in the WCWH0 group. 16S rRNA high-throughput sequencing analysis revealed similarities in the community composition, species diversity and relative abundance of dominant bacteria at the phylum and genus levels among the four groups. Collectively, our data indicated that WCWH can be used to replace LC in the diet of finishing dairy bulls without having a negative impact on apparent digestibility, plasma parameters, and ruminal bacteria composition. These results offer the first deep insight into the effects of replacing LC with WCWH on the performance parameters and rumen microbiota in Holstein bulls, and may aid in ruminant farming.
Quantitative inheritance of volatile pheromones and darcin and their interaction in olfactory preferences of female mice
Authors: Liu Ying-Juan , Guo Hui-Fen , Zhang Jian-Xu , Zhang Yao-Hua
Published: May 2017

In this study, we examined how urine-borne volatile compounds (UVCs) and darcin of male mice are inherited from parents and interact to modulate the olfactory preferences of females using two inbred strains of mice, C57Bl/6 (C57) and BALB/c (BALB), and their reciprocal hybrids (BC = BALB♀× C57♂; CB = C57♀ × BALB♂). Chemical analysis revealed that the UVCs of C57BL/6 males were quantitatively distinguishable from those of BALB/c males. Darcin was detected in C57 urine, but not in BALB urine. The levels of UVCs and darcin in both BC and CB were intermediate between those of C57 and BALB. Behaviourally, C57 females consistently preferred BALB male urine over C57 or CB males despite that there are trace amounts of darcin in BALB urine. However, the preference for BALB urine disappeared in contact two-choice tests of BALB vs. BC pairs, and restored when recombinant darcin was added to BALB male urine. Our results suggested that both UVCs and darcin in male mice are quantitatively inherited and interact to affect the olfactory preferences of females.
Efficient all p-type heterojunction photocathodes for photoelectrochemical water splitting
Authors: Lu Xue , Liu Zhifeng
Published: May 2017

Co3O4 nanostructures with different morphologies are directly grown on an ITO substrate and Sb2S3 is loaded onto these to construct a Co3O4/Sb2S3 heterojunction, which is used as an all p-type photocathode for PEC water splitting for the first time.
Synthesis of bis(trithio)phosphines by oxidative transfer of phosphorus(i)
Authors: Kosnik Stephanie C. , Nascimento Maxemilian C. , Rawson Jeremy M. , Macdonald Charles L. B.
Published: May 2017

We report the oxidative transfer of the phosphorus(i) centre in [PIdppe][Br] to tetrathiocin and disulfide ligands. Characterization of the resulting bis(trithio)phosphines and mechanistic insight into the formation of these products is provided.
Two tartratoborates with hybrid anionic groups from unusual condensation reactions
Authors: Yan Dong , Mao Fei-Fei , Ruan Ting-Ting , Mao Jiang-Gao
Published: May 2017

Two different tartrate–borate motifs obtained from different condensation reactions are presented.
SO2 and SO3 reactions with [(C5Me5)2Sm-O-Sm(C5Me5)2]: a DFT investigation and comparison with CO2 reactivity
Authors: Louyriac Elisa , Roesky Peter W. , Maron Laurent
Published: May 2017

Samarocene oxide [Cp*2Sm-O-SmCp*2] with Cp* = C5Me5, often seen as an undesirable product resulting from the oxidation of samarocene, has been reported to react with organic and inorganic anhydrides.
Divergent synthesis of biflavonoids yields novel inhibitors of the aggregation of amyloid β (1–42)
Authors: Sum Tze Han , Sum Tze Jing , Collins Súil , Galloway Warren R. J. D. , Twigg David G. , Hollfelder Florian , Spring David R.
Published: May 2017

Biflavonoids inhibit the aggregation of Aβ42, the pathological hallmark of Alzheimer's disease, with an IC50 of 16 μM.
Synthesis of benzil-o-carboxylate derivatives and isocoumarins through neighboring ester-participating bromocyclizations of o-alkynylbenzoates
Authors: Yuan Si-Tian , Zhou Hongwei , Zhang Lianpeng , Liu Jin-Biao , Qiu Guanyinsheng
Published: May 2017

Neighboring ester-participating bromocyclizations of o-alkynylbenzoates are developed for the switchable synthesis of benzil-o-carboxylate derivatives and isocoumarins.
1060 nm single‐mode vertical‐cavity surface‐emitting laser operating at 50 Gbit/s data rate
Authors: Simpanen E. , Gustavsson J.S. , Haglund E. , Haglund E.P. , Larsson A. , Sorin W.V. , Mathai S. , Tan M.R.
Published: May 2017

An energy efficient 1060 nm GaAs‐based oxide‐confined vertical‐cavity surface‐emitting laser designed for high‐speed modulation and single‐mode emission has been developed. A record data rate of 50 Gbit/s at an energy dissipation of 100 fJ/bit is demonstrated for a device with >50 dB side‐mode‐suppression and 0.2 mA threshold current, making this laser a promising light source for long‐reach optical interconnects.
Bit error floor of multi‐level phase modulation with noisy phase reference
Authors: Lee J. , Jang Y. , Yoon D.
Published: May 2017

A simple method is proposed for the derivation of bit error floor (BEF) expressions of multi‐level phase modulations with noisy phase reference based on the geometric features of constellations. To validate the result, average BEF expressions of 8 + 8 and 4 + 12 amplitude and phase‐shift keyings adopted in digital video broadcasting‐satellite 2 extensions are derived and consultative committee for space data systems, and analyse the results.
Secrecy outage performance of transmit antenna selection for cognitive radio systems
Authors: Yan Peishun , Zou Yulong , Zhu Jia
Published: May 2017

In this study, the authors investigate the employment of transmit antenna selection (TAS) against eavesdropping in cognitive radio systems, where a cognitive source (CS) node transmits to a cognitive destination (CD) node in the face of an eavesdropper, each equipped with multiple antennas. The authors derive a closed‐form expression of secrecy outage probability for the proposed TAS scheme. For the purpose of comparison, the authors also study the random antenna selection (RAS) as a baseline. Moreover, the secrecy diversity orders of TAS and RAS are analysed to provide an intuitive insight into the effect of the number of antennas on the secrecy outage performance. It is of interest to observe that the secrecy diversity order of TAS is the product of number of transmit antennas at CS and receive antennas at CD and the secrecy diversity order achieved by RAS scheme is the number of receive antennas at CD, which both have nothing to do with the number of antennas at eavesdropper. Finally, the simulation results validate the authors’ theoretical results and the proposed TAS outperforms the conventional RAS in terms of secrecy outage probability.
Caractérisation par nanoindentation du GaN irradié par des ions uranium de grande énergie
Authors: Eve Sophie , Moisy Florent , Germanicus Rosine Coq , Grygiel Clara , Hug Eric , Monnet Isabelle
Published: May 2017

Le comportement mécanique de films minces de nitrure de gallium GaN irradiés par des ions uranium accélérés a été étudié par nanoindentation. Les résultats montrent une décroissance des propriétés mécaniques du matériau par irradiation, corrélée à l’augmentation de la fluence des ions U utilisés. La perturbation croissante du réseau cristallin du GaN par irradiation conduit à une modification des mécanismes de déformation du matériau, les zones fortement désordonnées gênant le mouvement des dislocations et résultant en leur accumulation au niveau de l’interface, et à une augmentation de la dureté. Au-delà d’une fluence de 1013 ions/cm2, le recouvrement des traces latentes créées par le passage des ions lourds conduit à une chute significative des caractéristiques mécaniques des films, et une uniformisation du comportement des matériaux irradiés aux fortes fluences.
Microwave-Assisted Synthesis of Benzo[4,5]imidazo[1,2-a]pyrimidines from β-Bromo-α,β-unsaturated Aldehydes and 2-Aminobenzimidazoles
Authors: Ho Son , Dao Pham , Cho Chan
Published: May 2017

β-Bromo-α,β-unsaturated aldehydes react with 2-aminobenzimidazoles by microwave irradiation in the presence of a base and magnesium sulfate to give the corresponding benzo[4,5]imidazo[1,2-a]pyrimidines in moderate to good yields.
Brachial Plexus Injuries with Ulnar Musculocutaneous Transfer: 78 Cases Study Focused on Possible Postoperative Complications
Authors: Corrêa Márcio , Cardoso Márcio , Gepp Ricardo , Quiroga Marco , Beraldo Paulo
Published: May 2017

Objective To analyze 78 cases of brachial plexus injury submitted to the Oberlin technique between 2003 and 2012. The potential complications of this technique were analyzed, especially motor damage or hypoesthesia of the hand.

Method Medical records from patients with brachial plexus injuries at the levels of the C5-C6 and C5-C6-C7 vertebrae were retrospectively analyzed. Cases submitted to the Oberlin procedure with or without concomitant brachial plexus procedures between 2003 and 2012 were evaluated. The minimum follow-up period was of 1 year. In addition to the clinical examination, electromyography and magnetic resonance imaging (MRI) of the brachial plexus were used to diagnose and locate the nerve damage.

Results A total of 78 surgical patients met the inclusion criteria. Postoperative neurological changes, mostly transient, were observed in 18 patients. Hypoesthesia in the ulnar side of the hand was observed in seven cases; neuropathic pain in five cases; allodynia in four cases, and hand motor loss in two cases.

Conclusion Based on the results of the present case series, we conclude that there are few sequelae in the donor nerve territory compared with the benefit of the Oberlin technique on the recovery of elbow flexion after brachial plexus injuries.
Esperanto linguistics
Authors: Pereltsvaig Asya
Published: May 2017

Esperanto is an unusual language in many ways. First, it was originally created artificially, in a highly multilingual environment. Secondly, it was designed with the express purpose of becoming a language of interlingual communication, a language easy to learn for people from the widest range of linguistic backgrounds. Although it never became auniversal lingua franca, Esperanto now has up to 2 million users and a sizeable number of native speakers. Yet even for such native speakers, Esperanto is never their only language. Its use is limited to certain domains, and for the overwhelming majority of its speakers, including native ones, Esperanto is not their dominant language. These facts may make Esperanto and Esperanto speakers useful in tests of the robustness of generalizations about linguistic typology, Universal Grammar, first and second language acquisition, language contact and creolization, variation and change. This article provides an overview of work that has been done to date on these topics.
Report on the bilateral comparison between BIM (Bulgaria) and VSL (The Netherlands)
Authors: Dekker Paul , Kunova Angela , Dierikx Erik
Published: May 2017

A bilateral comparison has been organized between VSL, The Netherlands and BIM, Bulgaria in the field of spectral regular transmittance measurements. This comparison is registered as EURAMET project nr. 1073 and EURAMET.PR-K6.2 in the BIPM key comparison database.

The aim of the comparison is to demonstrate the improvement of calibration measurement capabilities of BIM in this working field. If this comparison is successful, i.e. the results support the claimed improvement in uncertainties, the improved CMC's for BIM will be included in Appendix C of the CIPM mutual recognition arrangement (MRA).

The results of this comparison are linked to key comparison CCPR K6.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCPR, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Motivic Serre invariants modulo the square of 𝕃-1
Authors: Yasuda Takehiko
Published: May 2017

Motivic Serre invariants defined by Loeser and Sebag are elements of the Grothendieck ring of varieties modulo

L

−
1

\mathbb {L}-1

. In this paper, we show that we can lift these invariants to modulo the square of

L

−
1

\mathbb {L}-1

after tensoring the Grothendieck ring with

Q

\mathbb {Q}

under certain assumptions.
Business of Hospital Neurology
Authors: Misulis Karl E. , Baňez Monico Peter
Published: May 2017

Business and organizational issues are critical to success of a hospital neurology program. Most hospital neurologists will participate in or institute stroke services. This will be accompanied by a set of expectations and metrics which require continued vigilance. Other organizational decisions include whether to participate in Teleneurology services. Billing, coding, and risk management are just some of the other issues which have to be addressed as part of the program.
Hypoxic-Ischemic Encephalopathy
Authors: Misulis Karl E. , Murray E. Lee
Published: May 2017

Hypoxic-ischemic encephalopathy (HIE) is one of the most common reasons for hospital neurology consultation. The reasons for neurologic consultations are usually medical management, evaluation and management of myoclonus and seizure activity, and prognosis.
Infectious Diseases
Authors: Misulis Karl E. , Murray E. Lee
Published: May 2017

Infectious diseases are a common cause of hospital neurology consultation either because infection has directly involved nervous structures or patients with infection have developed a neurologic condition. This chapter discusses the presentation, diagnosis, and management of a variety of infectious diseases encountered in hospital neurology practice.
Neuro-Oncology
Authors: Anderson Mark D. , Misulis Karl E.
Published: May 2017

Cancers require neurologic care for multiple facets of evaluation and diagnosis. Among the most common are diagnosis of a CNS mass lesion, localization and diagnosis of new focal deficits, seizures or encephalopathy in cancer patients, suspected paraneoplastic disorders, and neurologic complications of cancer treatment. This chapter discusses common and important disorders likely to be encountered in a hospital neurology practice.
Toolkit
Authors: Misulis Karl E. , Murray E. Lee
Published: May 2017

This section is a toolkit contains some key reference information for hospital neurologists. This chapter concerns studies.
What Psychiatrists Do Not Know About Psychotherapy
Authors: Paris Joel
Published: May 2017

Psychiatrists usually make an effort to keep current on the latest developments in psychopharmacology. However, many (if not most) know little about psychotherapy research. Yet the evidence is very strong that talking therapies are highly effective. In common mental disorders, psychotherapy usually yields equivalent results to medication and, in many cases, provides unique “added value” that drug treatment cannot offer. Its value is firmly established in the most common problems that psychiatrists treat—anxiety disorders, mild to moderate major depression, substance abuse, and personality disorders. It is also not widely known that psychotherapy need not be lengthy but, rather, can be conducted effectively with a time frame of a few months. A vast body of research shows that therapy lasting 3–6 months helps most patients; there is almost no evidence supporting longer courses of treatment.
Seizures Occurring Once a Month
Authors: O’Neal M. Angela
Published: May 2017

In this chapter, the hormonal influences on epilepsy are discussed. Catamenial epilepsy is defined when seizure frequency increases correlated with certain phases of the menstrual cycle. The most common type as demonstrated by this patient is the perimenstrual exacerbation, C1. This corresponds to a progesterone decline. The next most common pattern is the periovulatory exacerbation, C2. This is characterized by an increase in seizure frequency associated with ovulation and the associated surge in estrogen. The luteal pattern, C3, is the least frequent. In this pattern, seizure frequency increases in the luteal phase of the menstrual cycle. An approach to treatment of catamenial epilepsy is reviewed.
A Lady with a Headache in the First Trimester
Authors: O’Neal M. Angela
Published: May 2017

This case is illustrative of migraine during pregnancy. In pregnancy, due to changes in the level of estrogen, migraines are often more frequent in the first trimester. The natural history for migraine, especially migraine without aura, is that 70% get better by the second trimester. A general strategy for management of migraines during pregnancy is illustrated. In general, prophylactic medications are not used during pregnancy, and migraines are treated symptomatically. Tables of the usual migraine medications to treat both the acute headache and to prevent migraine are included, along with their pregnancy classification and breast feeding safety. The chapter is meant to be a practical guide to migraine management during pregnancy and postpartum.
Ringing in the Ears and Pain in the Head
Authors: O’Neal M. Angela
Published: May 2017

The case illustrates the classic clinical features of a low-pressure headache. The pathophysiology results from the loss of cerebrospinal fluid (CSF). This causes sagging of the brain, stretching of the bridging veins, and venodilatation. The clinical history is of a headache that is worse in the upright position and remits when the patient is supine. Due to the connection of the perilymphatic fluid and CSF, postural tinnitus is a frequent symptom. Risk factors for low-pressure headache include those that are patient-specific: female sex, low body mass index, prior history of a low-pressure headache, and an underlying headache disorder. Operator-specific factors that decrease the risk of a postdural puncture headache (PDPH) include greater operator experience and the use of a smaller-gauge, non-cutting lumbar puncture needle. The best treatment for low-pressure headache is a blood patch with resolution in over 90% of low-pressure headaches.
Acute Headache in Pregnancy
Authors: O’Neal M. Angela
Published: May 2017

The case illustrates the characteristics of pituitary apoplexy. This anatomy of the pituitary, which predisposes to the condition, is described. The most common clinical feature is headache. Visual disturbance related to optic chiasm or optic nerve involvement is also common. Pituitary apoplexy is a neuroendocrine emergency. The most important hormone involved is adrenocorticotropic hormone, ACTH. However, there are often multiple hormonal deficiencies: growth hormone, hypothyroidism, and hypogonadotropic deficiency. A high prolactin level may reflect a prolactinoma or be due to hypothalamic inhibition. Diabetes insipidus (DI) is also common. The most urgent issue in treating pituitary apoplexy is prompt assessment of fluid and electrolyte imbalance and the replacement of corticosteroids.
Multiple Sclerosis
Authors: Kaplan Tamara B. , Matiello Marcelo
Published: May 2017

Multiple sclerosis (MS) often affects women of childbearing age. There are many issues to consider when counseling women about their disease and treatment during this time. The Pregnancy in Multiple Sclerosis (PRIMS) study, published in 1998, is the best large-scale prospective study published to date. Based on this trial, and those that followed, it is recognized that the rate of relapse in MS decreases during pregnancy, especially during the third trimester, but there is a significant increase in relapse rate in the first three months postpartum. If relapses do occur during pregnancy, women are often treated with methylprednisolone, but this is generally avoided in the first trimester. Disease-modifying therapies (DMTs) are usually discontinued during preconception, pregnancy, and while breast-feeding. DMTs are classified under different FDA pregnancy categories based on human and animal data. Breast-feeding may influence postpartum relapse rate, but the true effect continues to be debated.
A 27-Year-Old Woman with Epilepsy Planning for Pregnancy
Authors: Voinescu P. Emanuela
Published: May 2017

Treatment for women with epilepsy (WWE) of childbearing age should be cautiously selected, given that the benefits of treatment during potential future pregnancies have to be weighed against the adverse effects on the developing fetus. The number of antiepileptic drugs (AEDs) has increased significantly in the last 20 years, and remarkable progress has been made in characterizing their teratogenicity, adverse neonatal outcomes, and neurodevelopmental problems. Not only the AED choice, but the number of AEDs used and their dose are also important. This chapter aims to introduce some of the basic guidelines for preconception counseling.
Telemental Health in India
Authors: Thara Rangaswamy , John Sujit , Rao Kotteswara
Published: May 2017

India, with its large rural population and limited mental health resources, must identify alternative strategies to deliver services. Telepsychiatry offers a pragmatic solution to redistribute sparse resources concentrated in urban pockets. Information available about telepsychiatry practice in India is largely anecdotal with limited literature available in the public domain with regard to technology used, processes undertaken, utilization patterns, or outcomes. The experience of the Schizophrenia Research Foundation (SCARF) in running a telepsychiatry network under its SCARF Telepsychiatry in Pudukottai (STEP) program is described in this chapter. This includes an account of the background to this initiative, description of the program methodology, the technology used, and the required infrastructure to establish mobile telepsychiatry clinics and fixed-line clinics in rural communities. The reach of the program, its coverage, major achievements, and challenges faced are described in detail.
Cross-Cultural Telemental Health
Authors: Pape Niklas Skov , Jørgensen Rasmus Christian , Kofoed Rune Weise
Published: May 2017

This chapter discusses previous experiences with telemental health, the importance of a cross-cultural understanding of mental health, and the potential psychological barriers to cross-cultural telepsychiatric treatment in low- and middle-income countries. The cross-cultural aspect of the patient–therapist relationship is almost absent in recent research on telemental health. The majority of studies regarding telemental health have been conducted in Western countries. This is an obvious worry, because patients’ health beliefs, attitudes, and behaviors are rooted in their specific cultural setting, and failure to consider this can have negative consequences for patients. A sociotechnical approach to developing a dynamic, iterative, and flexible system for telemental health could increase its sufficiency, applicability, and utility by striving to include social, human, cultural, and technological aspects, and ultimately could provide a much needed framework for development and implementation of telemental heath.
History of Brain Death
Authors: Wijdicks Eelco F.M.
Published: May 2017

The ability to diagnose brain death is linked to the ability to support catastrophic neurological injury and, thus, linked to the development of critical care. A new comatose state was noted with loss of all brainstem reflexes, absent respiratory drive, and loss of vascular tone leading to progressive hypotension and cardiac arrest. This chapter describes the evolution of thought and refinement of brain death criteria in the United States, from the Harvard criteria in 1968 to the American Academy of Neurology practice guidelines in 2010 and more recent pediatric guidelines.
Clinical Problems in Brain Death Determination and Organ Donation
Authors: Wijdicks Eelco F.M.
Published: May 2017

There are clear guiding principles in the determination of brain death and subsequent discussion about organ donation. In most situations, brain death is straightforward to diagnose, consent is obtained for organ donation, and—for the endlessly waiting recipients—all goes well. But questions can arise, and occasionally physicians encounter problems. Advances in medical practice have also changed the way physicians approach catastrophic neurological illness, and the consequences of therapeutic interventions must be considered. The number of available ancillary tests also has increased over the years, creating difficulties with interpretation when the validity of the tests is insufficiently known. The diagnosis of brain death also may generate moral dilemmas. This chapter seeks to address solutions to common clinical problems in practice.
Teaching Medicine
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

Medical schools in the United States now graduate some 18,000 students a year, and most of them will continue their medical education at one of the more than 1,000 teaching hospitals. Time constraints, complex patients, and the involvement of multiple disciplines in the care of patients have necessitated changes in medical education on the units. Unlike prior research, this project focused on the context in which learning happens and designated the team as the focus of research. The authors spent time with 12 outstanding attendings and their teams in order to provide detailed descriptions of the specific strategies, methods, and even language that the attendings use to teach their learners not only about medicine but also about how to care for patients.
Bedside and Beyond
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

The attendings made bedside teaching (or the teaching that occurs just outside of a patient’s room) a mainstay of their approach. They felt that the best way to learn was from the patients themselves. They combined their physical examination and questioning of the patient with the presentation of relevant teaching points. Attendings taught that information learned from a current patient should be applied to the next patient. In this way, what is taught builds on itself, creating a solid foundation of knowledge. Attendings would not only teach to the team but would be alert to any need to provide individual instruction. They recognized that team members have different learning capacities and sought to prevent knowledge gaps from developing in every level of learner.
Role Models
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: May 2017

Attendings understand that their behavior, as physicians, as instructors, as human beings, will most likely be internalized and emulated by some of their learners. As a result, they continually monitor themselves, striving to make sure that they are living up to their personal and professional standards. Attendings often hold themselves to a higher standard than they do their learners. Role modeling is an important part of the teaching process and includes demonstrating how to be a lifelong learner, maintaining professionalism in the face of adversity, and acknowledging the emotional toll that caring for patients can have on oneself. Humor with both learners and patients was common among the attendings, as was expressing the joys of being a doctor.
Practice and Malpractice in the Evaluation of Suicidal Patients
Authors: Jacobson Gary
Published: May 2017

This chapter discusses practice and malpractice in the evaluation of suicidal patients. Contemporary standards of care require a comprehensive assessment of suicide risk. Risk factors include ideation about suicide, death, or self-harm; a history of attempted suicide and a family history of suicide or a serious suicide attempt; diagnoses and symptoms that are correlated with an increased suicide risk; and stressors correlated with an increased risk of suicide in the short term. Protective factors include the presence of young children at home and religious beliefs. Hospitalization of a suicidal person does not necessarily eliminate the risk. Constant observation is usually required during the initial treatment period. Transferring care requires the transfer of explicit documentation, including the patient’s history of suicide risk, treatment efforts and their results, and plans for ensuring the patient’s safety during the transitional period between providers.
Treatment Refusal
Authors: Nesbit Ariana , Hoge Steven K. , Pinals Debra A.
Published: May 2017

Management of treatment refusal can be legally and ethically complicated. Patients may refuse various types of treatment, including medications, group and individual psychotherapy, electroconvulsive therapy (ECT), and surgical procedures. Historically, patients with mental illness have had limited rights to refuse treatment. This chapter explores the factors that led to an increased recognition of these rights and provides an overview of current legal approaches to the adjudication of treatment refusal. It focuses primarily on the refusal of antipsychotic medications in inpatient settings, because many of the original court cases and much of the literature and research pertain to this issue. However, restrictions on the administration of antipsychotic medication over the patient’s objection extend beyond inpatient settings to nursing homes, medical and surgical inpatient services, and psychiatric outpatient settings. The chapter also discusses refusal of ECT and presents recommendations for the clinical care of a patient who refuses treatment.
Evaluation of Child Abuse and Neglect
Authors: Soulier Matthew , Ayoub Catherine
Published: May 2017

Child abuse and neglect constitute a long-standing worldwide epidemic. Millions of cases of abuse and neglect are reported every year. As mandated reporters, clinicians are legally bound to recognize and report, but not prove, suspected acts of child maltreatment. Child protection agencies investigate the validity of the allegations. Only trained professionals should explore and gather evidence for suspected abuse or neglect of a child, while the clinician who has fulfilled his or her duty as a mandated reporter continues to provide clinical care for the child. Young children also benefit from forensic examinations by interviewers who are trained in early childhood development and age-appropriate interview techniques, such as open-ended questions, that minimize suggestion and allow children to freely recall the alleged offender’s behavior. A clear understanding of professional duties and responsibilities will promote the just adjudication of offenders and the well-being of children.
Disability Evaluations
Authors: Price Marilyn
Published: May 2017

Mental health professionals frequently participate in the disability application process. Standards and requirements for a finding of disability may vary considerably from one context to another. A disability carrier may request that a mental health professional perform an independent medical examination. This chapter discusses the concepts of work capacity, functional impairment, and disability as they apply to disability evaluations performed for the most common types of disability insurers (Social Security, workers’ compensation, and private insurers), as well as work-related evaluations involving the Americans with Disabilities Act, fitness for duty and return to work, and disability in the context of litigation. Ethical issues in performing disability evaluations are addressed, including differences in the roles of the treating clinician and the independent forensic evaluator and management of situations where the evaluator’s opinion differs from that of the claimant and the claimant’s attorney.
Ethics at the Intersection of Mental Health and the Law
Authors: Candilis Philip J. , Sidhu Navneet
Published: May 2017

Clinicians regularly face ethical dilemmas that challenge their personal and professional boundaries, such as accepting gifts, interacting with patients or evaluees in social settings, and managing differing expectations of patients and evaluees. This chapter describes how various ethical theories and models, such as principlism, virtue theory, deontology, consequentialism, communitarian ethics, narrative ethics, and boundary models, can be applied to assist physicians, therapists, social workers, and other clinicians whose practice brings them to the interface of mental health and the law. It addresses some aspects of clinical practice in which the expectations of the evaluee or clinician may not coincide with the expectations of the law. It describes a modern professionalism that integrates the various ethical approaches and offers the greatest likelihood of success in negotiating the complex issues arising at the interface of mental health practice and the law while incorporating sensitivity to culture, language, gender, and prior experiences.
Family Response to Critical Illness
Authors: Davidson Judy E. , Netzer Giora
Published: May 2017

Family members of ICU patients can have mental, physical, and social responses to critical illness. These responses can begin when their loved ones are in the ICU and persist after discharge. Interventions in the ICU could have long-term effects on family members. Communication, proximity, engagement, maintaining family integrity, optimizing sleep, and conflict resolution may all play a role in family health following the discharge or death of the patient. Research is needed to further quantify the epidemiology, mechanisms of action, and efficacy of interventions to optimize the health of this large group of people. While waiting for research results to definitively point us towards effective preventive measures and early interventions, it is prudent to optimize communication, encourage proximity and engagement, and support the health of family members while caring for the critically ill and injured. As patients and their families move into the home environment, it is important to consider their long-term health as well.
Vascular surgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter covers vascular operations. Treatments described for varicose veins are high tie and multiple avulsions, radio-frequency ablation, and foam sclerotherapy. Repair of elective and ruptured abdominal aortic aneurysm and endovascular repair are described. Operations like aortobifemoral bypass, femoral popliteal above- and below-knee bypass graft, and femoro-distal bypass are included. Urgent operations like femoral and brachial embolectomy, lower limb fasciotomy are also described. In addition, above- and below-knee amputations and vascular access are included.
Neurosurgery
Authors: Agarwal Anil , Borley Neil , McLatchie Greg
Published: May 2017

This chapter on neurosurgery covers such operations as lumbar puncture, lumbar drain insertion, burrhole access to the cranial cavity, evacuation of chronic subdural haematoma, insertion of ventricular drain, ventriculoperitoneal shunt and intracranial pressure monitor, craniotomy, decompressive craniectomy, elevation of depressed skull fracture, anterior cervical discectomy, lumbar microdiscectomy, laminectomy, carpal tunnel decompression, and ulnar nerve decompression.
Minimally Invasive Transpalpebral ‘‘Eyelid’’ Approach to Unruptured Middle Cerebral Artery Aneurysms
Authors: Mandel Mauricio , Tutihashi Rafael , Mandel Suzana Abramovicz , Teixeira Manoel Jacobsen , Figueiredo Eberval Gadelha
Published: May 2017

BACKGROUND: Although recent technological advances have led to successful endovascular treatment, middle cerebral artery (MCA) aneurysms are still prone to surgery. Because minimally invasive options are limited and possess several functional and cosmetic drawbacks, a transpalpebral approach is proposed as a new alternative.

OBJECTIVES: To describe and assess surgical results of the minimally invasive transpalpebral approach in patients with MCA aneurysms.

METHODS: The data of 25 patients with unruptured MCA aneurysms from 2013 to 2016 were included in a cohort prospective database. We describe modifications of the approach and technique for MCA aneurysm clipping, in a step-by-step manner. The outcome was based on complications, procedural morbidity and mortality, and clinical and angiographic outcomes.

RESULTS: All procedures were successfully performed in a standardized way, and no major complications related to the new approach were observed. Twenty-two patients were discharged the day after surgery (88%). The majority of aneurysms were 5 to 6 mm in diameter (mean, 7 mm; range 4-21 mm). All patients underwent postoperative angiographic control, which showed no significant residual neck. A 3-mo follow-up was sufficient to show no visible scars with excellent cosmetic results. The mean duration of follow-up was 16 mo.

CONCLUSION: The transpalpebral approach comes as a minimally invasive, safe, definitive, and cosmetically adequate solution for MCA aneurysms at the present time.
Development of a Perfusion-Based Cadaveric Simulation Model Integrated into Neurosurgical Training: Feasibility Based On Reconstitution of Vascular and Cerebrospinal Fluid Systems
Authors: Zada Gabriel , Bakhsheshian Joshua , Pham Martin , Minneti Mike , Christian Eisha , Winer Jesse , Robison Aaron , Wrobel Bozena , Russin Jonathan , Mack William J , Giannotta Steven
Published: May 2017

BACKGROUND

Novel methodologies providing realistic simulation of the neurosurgical operating room environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills.

OBJECTIVE

To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a “Mock Operating Room” for neurosurgical procedures.

METHODS

At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012 and 2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system. Models were used to train neurosurgical residents in various procedures. Self-assessment of pre- and postprocedure trainee confidence (Likert) scores was compared for each module.

RESULTS

The following novel procedural training methodologies were successfully established: management of an injury to the carotid artery during an endoscopic endonasal approach (n = 12), endoscopic endonasal CSF leak repair (n = 6) with fluorescein perfusion, carotid endarterectomy (n = 4), extracranial-to-intracranial bypass (n = 2), insertion of ventriculostomy catheter (n = 7), spinal laminectomy with durotomy repair (n = 9), and intraventricular neuro-endoscopy with septum pellucidotomy and third ventriculostomy (n = 12). In all instances, trainees reported improvement in their postprocedural confidence scores, with mean pre- and postprocedural Likert scores being 2.85 ± 1.09 and 4.14 ± 0.93 (P < .05).

CONCLUSION

Augmentation of fresh cadaveric specimens via reconstitution of vascular and CSF pathways is a feasible methodology for complimenting surgical training in numerous neurosurgical procedures, and may hold implications in the future of neurosurgical resident education.
Congenital Deafness Alters Sensory Weighting for Postural Control
Authors: Maheu Maxime , Sharp Andréanne , Pagé Sara , Champoux François
Published: May 2017

Objectives:

The aim of this study was to examine sensory reweighting for postural control in congenitally deaf individuals.

Design:

We studied 14 controls and 14 deaf age-matched individuals using a force platform and the modified clinical test of sensory interaction and balance protocol. Both groups performed the postural tasks without auditory cues (with hearing protectors for controls or without hearing devices for the deaf).

Results:

The results confirmed poorer postural stability in the deaf. More importantly, the data suggest that congenitally deaf individuals rely more on somatosensory information for postural control than controls.

Conclusions:

This increased somatosensory reliance may increase postural sway when it comes to more challenging postural conditions.