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This chapter addresses the question of the constitutionalization of the EU. It shows that similarities and dissimilarities between the constitutionalism of the EU and that of America, along three levels of analysis. It discusses in detail the features of the CT signed in Rome in October 2004, stressing its coherence with the compound nature of the EU. Finally, the chapter deals with the contested process of its ratification.

Imaging modalities have evolved over the last century and different modalities, such as plain X-ray, air or contrast ventriculography, pneumo-encephalography, cerebral angiography, CT scan, MRI, SPECT and PET scanning all have significantly contributed to the diagnosis and management of epilepsy. Whereas some of the initial imaging modalities, such as X-ray, ventriculography and conventional nuclear medicine imaging have become almost redundant and obsolete, the advent and evolution of various high-resolution tomographic neuroimaging during the past several decades has had a significant impact on the understanding, classification and treatment of patients with epilepsy. Cerebral imaging became almost routine following the development and widespread availability of CT scanning, which quickly became the standard of care in the evaluation of patients with epilepsy until outperformed by much higher resolution and greater structural details of MRI. This chapter briefly reviews the historical aspects and evolution of neuroimaging in epilepsy.

Magnetic resonance imaging (MRI) has opened up the way to diagnose dementia in vivo. It provides clear evidence for hippocampal atrophy in Alzheimer's disease (AD), lobar atrophy in frontotemporal lobar degeneration (FTLD), vascular changes in VaD, and specific findings in some rare forms of dementia. In addition, the traditional role of excluding space-occupying lesions has been kept and the combination of both aspects has rendered MRI indispensable in the diagnostic work-up.

In this chapter, Clark describes his love for the flugelhorn Clark would talk about his love for flugelhorn to his friend, Keith Ecker. During one of such conversations, Clark and Keith came up with the idea for a rehash of an old flugelhorn. Clark was thrilled to see an old flugelhorn revamped into a new one, with the help of Keith Ecker. The flugelhorn was welcomed by Duke Ellington for the band and Duke even wrote a tune entitled “Juniflip on the Flugelhorn.” Eventually, the flugelhorn was developed into a better one by an olds company, which was called the CT model. However, to his great disappointment, Clark found out that the company went kaput. That left Clark with few CT models to hold on to, which he guarded with his life.

This chapter considers the case for an ontology of real dispositions replacing the so-called laws of nature as the basic building blocks of explanation. It considers how one might explain the phenomenon of change. The first section presents two world views: the laws view and the dispositionalist view. The second section examines the events as explained by laws of nature. The third section examines the events as explained by dispositions. The fourth section examines the problem with laws. The fifth section discusses prescriptive and descriptive laws. The sixth section considers an explanatory ontology superior to that of the covering law model and is without reference to general laws. The seventh section discusses one benefit that laws can provide that capacities cannot — generality. The last section proposes a contingency thesis (CT): the laws of nature are logically contingent.

This chapter discusses the tomographic analysis of the Daka calvaria. It presents observations made on distortion, subcortical structures, and endocranial features through the use of computed tomographic (CT) imagery of the Daka calvaria. The chapter provides descriptions of individual cranial vaults bones and of the endocast, and presents cranial metrics and vault thicknesses, which were derived from micro-CT data.

This chapter is comprised of 25 clinically based and also knowledge based questions and answers. The corresponding answers to the questions can be found at the end of the chapter, each of which has a short explanation and at least one reference.

Over the last fifty years, the hospital has been technologized, corporatized, and bureaucratized due to demographic, political, economic, and scientific developments. The demographic shift has led to the greying of the population, with an associated increase in chronic disease, resulting in hospitalized patients becoming sicker and more complex. Legislative changes such as the introduction of Medicare led to a surge in the number of hospitalizations of older individuals; the subsequent move to prospective payment led to shorter hospital stays—and increased reliance on the skilled nursing facility. A change in the economic climate produced consolidation, with the resulting growth of hospital chains and hospital systems. Scientific advances, fuelled in many cases by generous research grants from the National Institutes of Health, led to new, non-invasive imaging techniques such as computerized tomography and magnetic resonance imaging. Advances in biology and epidemiology led to new approaches to the hospital’s management of diseases as disparate as heart attacks and cancer.

This chapter provides a brief introduction to a variety of neuroscience techniques other than MRI and fMRI. We first discuss standard anatomical and physiological techniques for studying neurons and their connections. We then provide brief explanations of non-MRI large-scale neuroimaging techniques used in studying humans, including EEG, MEG, CT, PET and SPECT, as well as some interventional techniques such as TMS. Because of their inferior spatial and temporal resolution, these techniques are likely to appear less often in the courtroom than is MRI and fMRI, but they still provide evidence that may be legally relevant. We conclude the chapter with a brief discussion of advances in genetics that tell us about the brain. Neurogenetics and behavioral genetics are beginning to provide interesting insights into the genetic bases of brain function and of behavioral traits.

This chapter is concerned with access. It is the natural starting point for consideration of administrative law doctrine. The chapter begins with a discussion on the jurisprudence of the European Court of Justice (ECJ) and Court of First Instance (CFI) concerning the right to take part in the initial determination. It then considers political initiatives to foster consultation in the Community legislative process. It also discusses the possible impact of the Charter of Rights and considers the reform that would have been made by the Constitutional Treaty (CT).

This chapter applies a Bayesian formulation of the Partial Volume (PV) effect, based on the Benford distribution, to the statistical classification of nuclear medicine imaging data: specifically Positron Emission Tomography (PET) acquired as part of a PET-CT phantom imaging procedure. The Benford distribution is a discrete probability distribution of great interest for medical imaging, because it describes the probabilities of occurrence of single digits in many sources of data. The chapter thus describes the PET-CT imaging and post-processing process to derive a gold standard. Moreover, this chapter uses it as a ground truth for the assessment of a Benford classifier formulation. The use of this gold standard shows that the classification of both the simulated and real phantom imaging data is well described by the Benford distribution.

Dementia implies problems with cognition (thinking), and this is a fundamental component of DLB and PDD. Dementia also implies that the cognitive problems are sufficiently troublesome to affect activities of daily living. Less severe impairment of memory or thinking that does not interfere with daily activities is classified as mild cognitive impairment (MCI). MCI may be a prelude to dementia. If MCI accompanies parkinsonism, then the treatment strategies outlined in this text are appropriate. Dementia does not necessarily mean that a rapid progression to an advanced state is inevitable. Dementia may be relatively mild and well compensated, especially with the help of the spouse and family; it may remain that way for years. The cognitive profile of DLB and PDD was described in Chapter 4. To review, this impairment affects several major components of intellect. This includes executive function, localized to the frontal lobes of the brain. Visuospatial conceptualization is similarly affected, which reflects problems in the posterior brain (i.e., parietal and occipital lobes). Memory declines in DLB and PDD, but less than in Alzheimer’s disease. Fluctuations in mental clarity are often noted in these Lewy disorders, where near-normal thinking may be followed hours later by confusion. In Chapter 4, the process of diagnosing DLB and PDD was also discussed. Before clinicians consider such a diagnosis, however, they must be certain that they have not overlooked any other treatable causes or contributors. Sometimes the DLB or PDD diagnosis is correct but the dementia is exacerbated by some other factor. In this chapter, those factors and the appropriate workup are considered. One should not arrive at the final diagnosis of a neurodegenerative dementia before considering treatable factors, including medical conditions, brain lesions (e.g., bleeds), and medication effects. This is especially relevant if there has been a rapid decline or recent onset. Prescription drugs are a common cause of cognitive impairment. Before ordering tests, it is appropriate to go over all medications that the patient is taking. Commonly prescribed drugs that can impair cognition include those shown in Table 12.1. This is not an exhaustive list. The primary clinician should decide what, if any, medication should be eliminated.

A crucial question for the growing field of affective touch neuroscience is: Could affective touch be a special kind of touch, complete with its own neural mechanisms? This chapter summarizes recent research in psychology and neuroscience relevant to this question. If affective touch really is special, we would expect it to have particular effects on social behavior, which might even be underpinned by distinct neural pathways not shared by other kinds of touch. Findings from developmental and social psychology suggest that touch in social interactions does indeed influence feelings and evaluations. On the neural level, evidence that affective touch may indeed rely on neural pathways—distinct from other kinds of touch information—is provided by the recent discovery of a special type of nerve in mammalian skin, the C tactile afferent. Neuroimaging research also points to distinct networks for affective touch. The chapter concludes with the proposition that affective touch is not just nice for its own sake but also does something. Functional roles of affective touch may be in strengthening and maintaining social bonds, and possibly in buffering the autonomic nervous system effects of minor, day-to-day stressors.

The term “neuroimaging” includes the use of various technologies to either directly or indirectly image the structure or function of the brain and its response to normal and abnormal processes. Structural neuroimaging attempts to noninvasively visualize gross pathology in the brain and can be used for the diagnosis of gross (large-scale) intracranial diseases, such as tumors. The most common structural imaging techniques are X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Functional neuroimaging techniques are primarily based on regional cerebral blood flow, regional cerebral metabolic rate of glucose consumption, or neuroreceptor signaling. They are most commonly used to quantify neuroreceptor status, diagnose diseases that cause metabolic derangement, and study the neurobiology and cognitive psychology associated with various neurological and neuropsychiatric disorders, such as major depression. The most common functional neuroimaging techniques are positron emission tomography (PET), single-photon emission tomography (SPECT), and functional magnetic resonance imaging (fMRI).

Music can and does exist without notation. In fact, its existence predates what we have come to accept as traditional music notation. Many musical traditions have thrived for centuries without any kind of formal codified symbol system to make musical replication easier. Music has existed, and often still exists, as an aurally transmitted art form. The same can’t be said for computers. Though the tongue-in-cheek Hart and Lieberman quote at the beginning of the chapter gets to the heart of the aural and intuitive nature of music’s origins, computer code relies on complex mathematics built, amazingly, on the seemingly simple 1s and 0s of binary arithmetic. Yet just as with music, there are tools and applications that your students can use to express themselves without even thinking about the underlying mathematics. For many of your students, the act of creating, whether it’s making music or developing web content, is accomplished intuitively, without formal training and knowledge of the “tools of the trade”: musical notation and computer code. Sherry Turkle asserts that “today’s children are growing up in the computer culture; all the rest of us are at best its naturalized citizens”. Following that line of reasoning a bit further, let’s assume for a moment that for your students music and computers are ingrained components of their culture. As is sometimes the case, however, the formal acquisition of these tools can often serve as a barrier to further understanding rather than the gateway this knowledge is meant to serve: impeding rather than enabling the creative process. Gardner feels that formal musical training can “be the beginning of the end of most children’s musical development” (p. 38). He believes “the challenge of musical education is to respect and build upon the young child’s own skills and understanding of music rather than impose a curriculum designed largely for adults” (p. 38). Bamberger’s research with college students suggests that students of any age possess musical instincts that, in the proper environment, can be developed and nurtured.

Visitors to the Lawrence Room, Girton College, Cambridge University, on Thursday afternoons (when the small one room museum is open to the public) will find a dead body on display. The body is that of an Egyptian mummy from the Coptic period with a painted face mask and inscription ‘Hermione Grammatike’. It was this inscription that attracted Girton College to acquire this ancient body. A loose translation suggests this was a woman scholar, and therefore the first recorded woman scholar in history and as such an appropriate ‘mascot’ for one of the early great champions for formal female education. The mummy was purchased from Egyptologist Flinders Petrie who had excavated it in 1910–11 (Imogen Gunn and Dorothy Thompson, pers. comm.). The case of Hermione is both particular and general. Across all of the UK and indeed the Western world, human remains from all ages and all parts of the world can be found in all types of museums of all sizes apparently isolated and insulated from society’s normal relationships with the dead: grief, morbidity, respect, invisibility. Context would appear to be everything in terms of attitudes to the display of the human dead. This paper reviews this concept of context, and offers some commentary on the origins, constraints, and boundaries for the display of human remains. To begin with an Egyptian mummy as an example is also appropriate, as this particular category has an almost ubiquitous and overpowering place in Western museums. It has been accepted practice to include human remains in displays since the widespread establishment of public museums in the nineteenth century. These are normally associated with archaeological discoveries but can also be found in physical and social anthropological displays, medical and history of medicine displays, and occasionally in other contexts. Museum practice is very much a creation of Western, primarily Enlightenment, values and the inclusion of human remains in displays can be traced in these values (for example, the anatomical drawings of Leonardo da Vinci and the public anatomy demonstrations of the nascent Royal Society in London) and in the Christian European culture from which this derived (for example, the display in churches of saints’ relics: Weiss-Krejci this volume).

Visitors to the Hull and East Riding Museum used to reach the climax of the Iron Age exhibition, Celtic World, by coming face-to-face with the extraordinary funerary offerings from three chariot burials at Wetwang Slack (Dent 1985). Now removed for urgent conservation, the iron swords from two male burials, their scabbards decorated with intricate, incised Celtic art, and the corroded iron mirror and sealed bronze container from the female burial, were displayed in Perspex cases. Beads of red glass ‘enamel’ adorned both swords and box, and a slender iron pin shone with a thin strip of glowing gold, entwined around a coral bead. These artefacts are marvellous testimonies to Iron Age craft skill, speaking of the repertoire of decorated objects through which power amongst these communities was underpinned and reproduced (Giles 2008). Behind these cases, setting the scene for these personal possessions or funerary gifts, is an oversized image—now the focus of that section of the museum: a reproduction of Peter Connolly’s impressive and moving reconstruction of a chariot burial (Fig. 19.1), loosely modelled on the Kirkburn K5 inhumation (see Stead 1991) and painted in the late 1980s. The image shows a tableau of mourners surrounding a grave, in which has been interred the body of an adult male (Fig. 19.1). He is lying over the wheels of a dismantled chariot, with a shield placed over his chest, and forequarters of pig lain on top. The box of the chariot (still attached to the pole shaft) is being lowered over the body like a coffin, before the grave is back-filled. The participants in this ceremony are predominantly male, with one woman at the edge in an apparent state of grief: two others are in the background, one keeping a pair of children at a distance from the proceedings. Two ponies are being led away from the scene, tossing their heads as if perturbed by the event. Such images have a powerful, instantaneous impact: ‘act[ing] at a distance, across the gallery, in a way a block of text cannot’ (James 1999a: 121).

Twenty percent to 30% of all Sjögren’s patients have some form of pulmonary symptoms. The most common ones involve dry trachea, pleuritic discomfort, cough, and shortness of breath (dyspnea). Over time, approximately 10% of patients develop interstitial changes that may progress to scarring, increased pulmonary pressure, and bronchiectasis. A variety of interstitial lung disease (ILD) have been identified in the context of Sjögren’s. Infrequently, some Sjögren’s patients present with vasculitis or thromboembolic or lymphoproliferative changes. Evaluating the lungs in Sjögren’s includes pulmonary function testing, high-resolution CT scanning, 2-D echocardiography, and sleep studies. Supportive measures such as humidification are useful. If there is evidence for systemic inflammation, disease-modifying agents such as cyclophosphamide, mycophenolate mofetil, antifibrotic agents, or azathioprine are prescribed.

All traditional neuropsychological assessment techniques emerged in an era prior to modern neuroimaging. In fact, question-answer/paper-and-pencil test origins that gained traction with Alfred Binet in 1905 remain the same core techniques today. Indeed, Binet’s efforts began the era of standardized human metrics designed to assess a broad spectrum of cognitive, emotional, and behavioral functions and abilities. During the early part of the 20th century, the concept of an intellectual quotient expressed as a standard score with a mean of 100 and a standard deviation of 15 also initiated the era of quantitative descriptions of mental and emotional functioning (Anastasi, 1968; Stern, 1912). Other descriptive statistical metrics were applied to human measurement, including scaled, percentile, T-score, and z-score statistics. Statistical measures became part of the assessment lexicon and each possessed strength as well as weakness for descriptive purposes, but together proved to be immensely effective for communicating test findings and inferring average and above or below the norm performances. In turn, descriptive statistical methods became the cornerstone for describing neuropsychological findings, typically reported by domain of functioning (memory, excutive, language, etc.; Cipolotti & Warrington, 1995; Lezak, Howieson, Bigler, & Tranel, 2012). As much as psychology and medicine have incorporated descriptive statistics into research and clinical application, a major focus of both disciplines also has been binary classification—normal versus abnormal. This dichotomization recognizes some variability and individual differences within a test score or laboratory procedure, but at some point the clinician makes the binary decision of normal or abnormal. In the beginnings of neuroimaging, which are discussed more thoroughly below, interpretation of computed tomographic (CT) or magnetic resonance imaging (MRI) scans mostly was approached in this manner. Although lots of information was available from CT and MRI images, if nothing obviously abnormal was seen, the radiological conclusion merely stated in the Impression section, “Normal CT (or MRI) of the brain,” with no other qualification (or quantification) of why the findings were deemed normal other than the image appeared that way. Until recently, quantification of information in an image required hand editing and was excruciatingly time consuming.

The MRCP PACES respiratory station offers an opportunity to demonstrate a slick examination technique that is performed on practically all patients. Respiratory diseases, after cardiovascular and musculoskeletal complaints, are the third most common cause for presentation to either the Emergency Department or the general practitioner (GP) and remains proof of the concept that ‘common things are common’. Respiratory disease can be generally divided into 3 major categories: airways, parenchymal and pleural disease. We have aimed to structure the following chapter to reflect this. Certain ‘high-yield’ or ‘favourites’ that recur in the PACES examination are covered in this section. During PACES, examiners assess your ability to both elicit and then correctly interpret physical signs. A general sense exists that a decision to pass or fail a candidate rests on an aura of competence (or incompetence!) during the clinical performance. In essence, the examiners are looking for you to demonstrate correct techniques whilst eliciting the signs and logical thinking when interpreting them. Therefore, eliciting the physical signs is only the first step; the interpretation and presentation are equally, if not more, important. With this in mind, the following useful general points should be considered: • The respiratory examination does not need to be a lengthy one. Start at the peripheries with the hands and then move to the back (unless specifically advised otherwise by your examiners). Traditionally the physical examination starts with the anterior chest but it is perfectly acceptable to do the back first then return to the front (most signs and clues to the diagnosis e.g. scars, will be detected by examining the posterior chest). • A 6-minute period is allowed for the examination portion of the station and it is our advice to spend the first 2 minutes examining the patient from a general perspective (including full inspection, hands and face) then the second 2 minutes on the posterior chest and the final 2 minutes on the anterior chest. As time is limited, palpate for features of pulmonary hypertension or right-sided heart failure at the anterior chest, before moving to the respiratory signs.