bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of food concentration on the life table demography and morphology of three Keratella quadrata morphotypes
Authors: Ge Ya-Li , Zhan Rong , Yu Jin-Hang , Xi Yi-Long , Ma Jie , Xu Dan-Dan
Published: April 2018

Keratella quadrata with two (2PS), one (1PS) and none posteolateral (0PS) spines were cultured under four food levels (0.75 × 106, 1.5 × 106, 3.0 × 106 and 6.0 × 106 cells·mL−1 of Scenedesmus obliquus) to test the differences in the life table demography and the morphological characteristics among these three morphotypes. The results showed that each K. quadrata morphotype could produce 2PS, 1PS and 0PS offsprings. The frequencies of 0PS were extremely low (<5%) and could be considered as a small probability event, suggesting that the 0PS morphotype might be an abnormal status. The following life table demographic tests suggested that 0PS morphotype had a relatively lower intrinsic rate of population growth at high food concentrations and a relatively lower average lifespan, in comparison to 2PS rotifers. These results further supported that the 0PS K. quadrata might be an abnormal development. Along with the elevating food concentration, 1PS morphotype reproduced more 2PS offsprings, suggesting that high energy input might be helpful to grow more posterolateral spines. However, in response to the increasing food concentration, 0PS rotifers produced more 1PS offsprings. The underlying mechanisms required further investigations. The posterolateral spine length of offsprings of 0PS K. quadrata was significantly longer than those of 2PS and 1PS rotifer parents at the four food concentrations, which probably help the offsprings of 0PS rotifer parents to survive in natural environments, since long and more posterolateral spines offer rotifers high ability to compete with other rotifers and cladocerans for food or to resist predators.
Multi-station investigation of spread F over Europe during low to high solar activity
Authors: Paul Krishnendu Sekhar , Haralambous Haris , Oikonomou Christina , Paul Ashik , Belehaki Anna , Ioanna Tsagouri , Kouba Daniel , Buresova Dalia
Published: April 2018

Spread F is an ionospheric phenomenon which has been reported and analyzed extensively over equatorial regions on the basis of the Rayleigh-Taylor (R-T) instability. It has also been investigated over midlatitude regions, mostly over the Southern Hemisphere with its generation attributed to the Perkins instability mechanism. Over midlatitudes it has also been correlated with geomagnetic storms through the excitation of travelling ionospheric disturbances (TIDs) and subsequent F region uplifts. The present study deals with the occurrence rate of nighttime spread F events and their diurnal, seasonal and solar cycle variation observed over three stations in the European longitude sector namely Nicosia (geographic Lat: 35.29 °N, Long: 33.38 °E geographic: geomagnetic Lat: 29.38 °N), Athens (geographic Lat: 37.98 °N, Long: 23.73 °E geographic: geomagnetic Lat: 34.61 °N) and Pruhonice (geographic Lat: 50.05 °N, Long: 14.41 °E geographic: geomagnetic Lat: 47.7 °N) during 2009, 2015 and 2016 encompassing periods of low, medium and high solar activity, respectively. The latitudinal and longitudinal variation of spread F occurrence was examined by considering different instability triggering mechanisms and precursors which past literature identified as critical to the generation of spread F events. The main findings of this investigation is an inverse solar cycle and annual temporal dependence of the spread F occurrence rate and a different dominant spread F type between low and high European midlatitudes.
Entwicklungsstand von klinischer Ethikberatung in der Psychiatrie
Authors: Gather Jakov , Kaufmann Sarah , Otte Ina , Juckel Georg , Schildmann Jan , Vollmann Jochen
Published: April 2018

Ziel der Studie Erhebung von Daten zur Verbreitung und zum Entwicklungsstand von klinischer Ethikberatung in psychiatrischen Institutionen in Nordrhein-Westfalen.

Methodik Umfrage unter Ärztlichen Direktoren, Pflege- und Verwaltungsdirektoren aller psychiatrischen Akutkrankenhäuser und Maßregelvollzugskliniken in Nordrhein-Westfalen.

Ergebnisse Aus 89 % aller psychiatrischen Akutkrankenhäuser und 100 % aller Maßregelvollzugskliniken liegt mindestens ein Fragebogen vor. 92 % der antwortenden psychiatrischen Akutkrankenhäuser und 29 % der Maßregelvollzugskliniken halten Strukturen der klinischen Ethikberatung vor.

Schlussfolgerung Strukturen der klinischen Ethikberatung sind in psychiatrischen Institutionen weiter verbreitet als bislang in der Forschung angenommen.
Kriteriumsvalidität der deutschsprachigen Version der CES-D in der Allgemeinbevölkerung
Authors: Jahn Rebecca , Baumgartner Josef , van den Nest Miriam , Friedrich Fabian , Alexandrowicz Rainer , Wancata Johannes
Published: April 2018

Ziel der Studie Bisher gibt es keine Studien zur Kriteriumsvalidität der deutschen Version der CES-D in der Allgemeinbevölkerung.

Methodik Für 508 Personen aus Österreich wurden die CES-D mit ICD-Diagnosen basierend auf einem SCAN-Interview verglichen.

Ergebnisse Die gesamte Diskriminationsfähigkeit für beide Geschlechter betrug 0,836 (Receiver Operating Characteristics). Bei einem optimalen Cut-off (9/10) fand sich eine Sensitivität von 81,1 % und eine Spezifität von 74,3 %.

Schlussfolgerung Die CES-D zeigt eine ausreichende Kriteriumsvalidität sowohl für Männer als auch Frauen.
Schulterendoprothetik
Authors: Krukenberg Anna , Imiolczyk Jan-Philipp , Moroder Philipp , Scheibel Markus
Published: April 2018

Zusammmenfassung

Die Schulterendoprothetik hat in den letzten Jahren zunehmend an Aufmerksamkeit gewonnen. So können mittlerweile nicht nur bessere klinische und radiologische Ergebnisse erzielt werden, sondern auch das Indikationsspektrum konnte erweitert werden. Der folgende Artikel gibt einen Überblick über die Historie, die Indikationen, die aktuellen Konzepte und Ergebnisse und Komplikationen der Schulterendoprothetik.
Kortison-Injektionen an der Wirbelsäule (periartikulär, nervennah, epidural)
Authors: Jablawi Fidaa , Schöller Karsten
Published: April 2018

Wirbelsäulennahe Kortison-Injektionen gehören zu den heutzutage am weitesten verbreiteten medizinischen Prozeduren überhaupt. Durch die epidurale, intra- und periartikuläre Applikation der Steroide sollen inflammatorisch getriggerte, therapieresistente Schmerzen von nozizeptivem und neuropathischem Charakter beeinflusst werden.

Auch wenn das Risiko der Infiltrationen insgesamt gering ist, wurden Fälle mit schweren neurologischen Komplikationen wie z. B. nach zervikalen, epiduralen transforaminalen Injektionen beschrieben. Insgesamt scheint das Risikoprofil nicht kristalliner Steroide wie dem Dexamethason bei allenfalls geringgradig niedrigerer Effektivität im Vergleich mit den häufig gebrauchten kristallinen Steroiden günstiger zu sein.

Die wissenschaftliche Evidenz zur Effektivität der verschiedenen wirbelsäulennahen Steroidinfiltrationen steht in einem starken Kontrast zu deren häufigen Anwendungen. Sämtliche Techniken der Steroid-Applikation haben einen limitierten Nutzen bei lokalen Schmerzen, die beste Evidenz für eine kurzfristige Schmerzlinderung besteht für die epidurale Steroidinfiltration bei radikulären Schmerzen.
Differences in Segmental Speeds as a Function of Maturation in Youth Baseball Pitchers
Authors: Washington Jessica , Gilmer Gabrielle , Barfield Jeff , Gascon Sarah , Saper Michael , Dugas Jeffrey , Andrews James , Oliver Gretchen
Published: April 2018

The purpose of this study was to determine how stride length, segmental sequencing of the pelvis, trunk, humerus, and forearm velocities and accelerations, and the timing of these values change as youth mature. Thirteen youth baseball pitchers participated at three consecutive time points: visit 1 (10.7±1.3 years; 151.8±10.7 cm; 45.0±9.65 kg), visit 2 (11.5±1.6 years; 155.5±11.1 cm; 50.4±10.0 kg), and visit 3 (12.4±1.7 years; 161.5±11.7 cm; 56.4±10.8 kg). Participants executed three pitches for a strike to a catcher. The maximum value of stride length and segmental speeds and accelerations was recorded. The point at which these maximum values occurred during the throw was calculated as a percentage from hand separation to maximum internal rotation of the shoulder. Repeated measures ANOVAs and Friedman Tests revealed no statistically significant differences between stride length, segmental speeds and accelerations, and their percentage of the pitch between the three visits. However, there was a significant increase in ball velocity across visits. No significant changes occurred in pitching mechanics between the ages of 10–12. The authors speculate the lack of differences can be accounted for because these ages are prior to any significant pubescent changes. Future research should consider pre- and post- pubescent age groups.
Improving particle beam acceleration in plasmas
Authors: C. de Sousa M. , L. Caldas I.
Published: April 2018

The dynamics of wave-particle interactions in magnetized plasmas restricts the wave amplitude to moderate values for particle beam acceleration from rest energy. We analyze how a perturbing invariant robust barrier modifies the phase space of the system and enlarges the wave amplitude interval for particle acceleration. For low values of the wave amplitude, the acceleration becomes effective for particles with initial energy close to the rest energy. For higher values of the wave amplitude, the robust barrier controls chaos in the system and restores the acceleration process. We also determine the best position for the perturbing barrier in phase space in order to increase the final energy of the particles.
Effect of optical damage resistant dopants on the dielectric properties of LiNbO3: Insight from broadband impedance spectroscopy and Raman scattering
Authors: Cochard Charlotte , Guennou Mael , Spielmann Thiemo , van Hoof Niels , Halpin Alexei , Granzow Torsten
Published: April 2018

Optical damage limits the application range of congruent LiNbO3. This problem is commonly overcome by adding optical-damage-resistant cations. Here, the influence of doping with optical-damage-resistant Mg and Zn on the ionic and piezoelectric contributions to the dielectric permittivity is investigated in a broad frequency range (1 mHz–2 THz). It is shown that the two dopants have radically different influences on the variation of ionic permittivity with doping, in spite of their similarities with respect to the crystallographic structure. Raman spectroscopy reveals that the difference in permittivity can be traced to the effect of Mg and Zn doping on the susceptibility of the phonon modes. Both observations point to differences in the defect incorporation mechanisms.
Determination of true ileal phosphorus digestibility of maize and soybean meal and true ileal calcium digestibility of soybean meal for broiler chickens
Authors: Trairatapiwan T. , Ruangpanit Y. , Songserm O. , Attamangkune S.
Published: April 2018

Two experiments were conducted, using the regression method, to determine the true ileal phosphorus (P) digestibility of maize and soybean meal (SBM), and true ileal calcium (Ca) digestibility of SBM for broiler chickens. The aim of Experiment 1 was to determine true ileal P digestibility of maize and SBM. The experimental diets were formulated with four inclusion levels of each test ingredient to achieve graded concentrations of total P (2.5, 3.0, 3.5 and 4.0 g/kg, respectively). The P concentrations in maize-based diets were adjusted by the inclusion of monosodium phosphate. The Ca:total P ratio in all diets was maintained at 1.35 by the addition of limestone. Experiment 2 was conducted to determine true ileal Ca digestibility of SBM. Experimental diets were formulated to contain four levels of SBM to achieve graded concentrations of Ca (2.5, 3.0, 3.5 and 4.0 g/kg, respectively). Because of the low concentration of Ca in SBM, all diets were supplemented with a similar level of limestone to prevent any Ca deficiency. The Ca:total P ratio in all diets was adjusted to be equal by the addition of monosodium phosphate. In both experiments, titanium dioxide (3 g/kg) was used as the indigestible marker. One-day-old male broiler chicks were fed a commercial starter diet from 1 to 21 days of age. On Day 22, a total of 240 and 120 birds were assigned to eight and four dietary treatments in Experiments 1 and 2, respectively, with five replicate cages and six birds per cage. Birds were fed the experimental diets for 7 days. On Day 29, ileal digesta were collected from the posterior half of ileum, and the true P and Ca digestibility of test ingredients were calculated by linear regression analysis. True P digestibility of maize and SBM were determined to be 33.8% and 42.3%, respectively. True Ca digestibility of SBM was determined to be 45.9%.
Tunable cytotoxic aptamer–drug conjugates for the treatment of prostate cancer
Authors: Powell Gray Bethany , Kelly Linsley , Ahrens Douglas P. , Barry Ashley P. , Kratschmer Christina , Levy Matthew , Sullenger Bruce A.
Published: April 2018

Significance

As prostate cancer is the second leading cause of cancer-related death among men in the United States, an unmet medical need exists for therapies that eliminate prostate tumors while preventing toxicity in normal tissue. Recently, such tumor-targeting therapies have gained Food and Drug Administration approval in the form of antibody drug conjugates. However, a need exists for new tumor-targeting therapies that are easier to manipulate and synthesize. By selecting for RNA ligands that internalize into prostate cancer cells but not normal prostate cells, we developed another class of targeted agents. We demonstrate that the E3 RNA selectively internalizes into prostate cancer cells and that E3 highly toxic drug conjugates are potent anti-tumor agents.
DNA methylation and transcriptome aberrations mediated by ERα in mouse seminal vesicles following developmental DES exposure
Authors: Li Yin , Hamilton Katherine J. , Wang Tianyuan , Coons Laurel A. , Jefferson Wendy N. , Li Ruifang , Wang Yu , Grimm Sara A. , Ramsey J. Tyler , Liu Liwen , Gerrish Kevin E. , Williams Carmen J. , Wade Paul A. , Korach Kenneth S.
Published: April 2018

Significance

Early developmental exposure to endocrine active compounds causes late-stage effects and alterations in the reproductive tract of adult mice. Unexpectedly, estrogen receptor alpha (ERα) plays a pivotal role in mediating these developmental effects. As a model outcome from these developmental effects, we present transcriptome and DNA methylation profiling of the seminal vesicles (SVs) following neonatal diethylstilbestrol (DES) exposure. ERα mediates transcriptome aberrations in SVs of adult mice that impact developmental reprogramming at adulthood. DNA methylation dynamically changes during development, and methylation is greater in ERα knockout mice compared with wild type. Expression levels of DES-altered genes are associated with their DNA methylation status. These findings provide unique evidence for understanding the developmental actions and mechanisms of endocrine-disrupting chemicals in human health.
Large SOD1 aggregates, unlike trimeric SOD1, do not impact cell viability in a model of amyotrophic lateral sclerosis
Authors: Zhu Cheng , Beck Matthew V. , Griffith Jack D. , Deshmukh Mohanish , Dokholyan Nikolay V.
Published: April 2018

Significance

Amyotrophic lateral sclerosis (ALS) is an invariably fatal neurodegenerative disease. Autosomal dominant mutations in the SOD1 gene are responsible for 12% of familial ALS cases and 1.5% of sporadic cases. However, it remains unknown whether the large fibrillar aggregates formed by misfolded SOD1 are a causative agent in disease progression. By designing mutations that specifically stabilize SOD1 fibrils or nonnative oligomers, we found that the assembly into insoluble fibrils mitigated the neurotoxic effects caused by aberrant conformation of trimers. We also demonstrated with electron microscopy that toxic SOD1 trimers displayed heterogeneous structures, in concert with computational studies. Our findings suggest a protective role of fibrils and a plausible pharmaceutical strategy, as promoting SOD1 fibrillogenesis reduces the population of neurotoxic species.
Evolution of Anthroponyms in an Area of Linguistic Transition: A Socio-Onomastic Study
Authors: Fernández Juncal Carmen
Published: April 2018

This study analyses the evolution of the anthroponymical repertoire of a municipal council located in the west of the province of Vizcaya, in the Spanish Basque Country. It has traditionally been a Spanish-speaking area, although it is now clearly influenced by the language policies of the Basque Autonomous Community to which it belongs, where recent years have witnessed a major expansion in the use of the Basque language in different ambits. This study examines the evolution of onomastic usages over a period that includes the transition from the Franco era to democracy in the 1970s, with the ensuing quantitative and qualitative shift in the choice of children’s names. This period records an abrupt change in tendencies from the traditional Spanish onomastic sources to a new repertoire, somewhat alien to local usages, but with considerable identifying strength, a positive stereotype, and a stratification of the phenomenon according to the gender variable.
Seeing the insulin receptor in action
Authors: Short Ben
Published: April 2018

Researchers use single-particle electron microscopy to visualize an insulin-induced conformational shift that leads to receptor activation.
Choosing Certifiers: Evidence from the British Retail Consortium Food Safety Standard
Authors: Bar Talia , Zheng Yuqing
Published: April 2018

Standards play a vital role in promoting food safety, and in many countries third‐party certification bodies carry out audits to determine if food manufacturers comply with a particular standard. Using data from the British Retail Consortium global standards program, we study manufacturers’ choices of certification bodies. We take a certification body's share of high audit grades in the months preceding an audit as a measure of perceived leniency, and find that manufacturers are more likely to choose certification bodies that they perceive to be more lenient. Manufactures are also more likely to choose geographically closer certification bodies, and to return to the same certifier that audited their site in the previous year.
Evaluating statistical approaches to leverage large clinical datasets for uncovering therapeutic and adverse medication effects
Authors: Choi Leena , Carroll Robert J , Beck Cole , Mosley Jonathan D , Roden Dan M , Denny Joshua C , Van Driest Sara L
Published: April 2018

Motivation

Phenome-wide association studies (PheWAS) have been used to discover many genotype-phenotype relationships and have the potential to identify therapeutic and adverse drug outcomes using longitudinal data within electronic health records (EHRs). However, the statistical methods for PheWAS applied to longitudinal EHR medication data have not been established.

Results

In this study, we developed methods to address two challenges faced with reuse of EHR for this purpose: confounding by indication, and low exposure and event rates. We used Monte Carlo simulation to assess propensity score (PS) methods, focusing on two of the most commonly used methods, PS matching and PS adjustment, to address confounding by indication. We also compared two logistic regression approaches (the default of Wald versus Firth’s penalized maximum likelihood, PML) to address complete separation due to sparse data with low exposure and event rates. PS adjustment resulted in greater power than PS matching, while controlling Type I error at 0.05. The PML method provided reasonable P-values, even in cases with complete separation, with well controlled Type I error rates. Using PS adjustment and the PML method, we identify novel latent drug effects in pediatric patients exposed to two common antibiotic drugs, ampicillin and gentamicin.

Availability and implementation

R packages PheWAS and EHR are available at https://github.com/PheWAS/PheWAS and at CRAN (https://www.r-project.org/), respectively. The R script for data processing and the main analysis is available at https://github.com/choileena/EHR.

Supplementary information

Supplementary data are available at Bioinformatics online.
On the Isotypic Decomposition of Cohomology Modules of Symmetric Semi-algebraic Sets: Polynomial Bounds on Multiplicities
Authors: Basu Saugata , Riener Cordian
Published: April 2018

We consider symmetric (under the action of products of finite symmetric groups) real algebraic varieties and semi-algebraic sets, as well as symmetric complex varieties in affine and projective spaces, defined by polynomials of degrees bounded by a fixed constant d. We prove that if a Specht module, $\mathbb{S}^{\lambda }$, appears with positive multiplicity in the isotypic decomposition of the cohomology modules of such sets, then the rank of the partition $\lambda$ is bounded by O(d). This implies a polynomial (in the dimension of the ambient space) bound on the number of such modules. Furthermore, we prove a polynomial bound on the multiplicities of those that do appear with positive multiplicity in the isotypic decomposition of the abovementioned cohomology modules. We give some applications of our methods in proving lower bounds on the degrees of defining polynomials of certain symmetric semi-algebraic sets, as well as improved bounds on the Betti numbers of the images under projections of (not necessarily symmetric) bounded real algebraic sets, improving in certain situations prior results of Gabrielov, Vorobjov, and Zell.
Midlife and Beyond (DRAFT)
Authors: Blackman Janine A.
Published: April 2018

This chapter discusses the varying changes in female hormones that begin 20 to 30 years prior to a woman’s final menstrual period (FMP), commonly around 50 years of age. Both testosterone and progesterone begin declining in a woman’s 20s and 30s, respectively, and antral follicle count in her ovaries also declines. In contrast, estrogen levels remain relatively stable from puberty until a woman’s early 40s This chapter discusses the changes that occur in a woman’s sexual health and overall health and well-being as her hormones change throughout her lifespan. It also discusses the controversy and misleading information about conventional hormone replacement therapies and presents case examples of postmenopausal women’s sexual health and overall health and well-being being restored with an integrative approach using custom-compounded bioidentical hormone replacement. A relatively new (nonsurgical) radiofrequency treatment for vulvo-vaginal rejuvenation for vaginal atrophy and urinary leakage problems in older women is also discussed.
Integrative Treatment of Female Sexual Dysfunction (DRAFT)
Authors: Paykel Jacquelyn M.
Published: April 2018

Sexual satisfaction in women is associated with general well-being. Meanwhile, female sexual dysfunction (FSD) is strongly associated with feelings of physical and emotional dissatisfaction, decreased happiness, reduced quality of life, and impaired interpersonal relationships. While each woman has her own definition of “normal sexual function,” research demonstrates that approximately 40% of US women have experienced sexual difficulties at least once in their life, the most distressing of which across all age groups is decreased sexual desire. The author reviews the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) classification of FSD, differing models of female sexual response, the multifactorial potential of the pathophysiology of FSD, and the standard clinical evaluation of a woman who presents with sexual dysfunction. Treatment modalities are reviewed for various forms of FSD including education, lifestyle modification, psychological therapies, supplements, botanicals, mind-body medicine, manual medicine, conventional medications (hormonal and nonhormonal), and surgical interventions.
Birth Control Pills and Hormonal Contraception (DRAFT)
Authors: Bartlik Barbara , Kaur Amandeep , Schoen Chelsea , Kolzet Julie
Published: April 2018

This chapter reviews the existing literature on the use of hormonal contraception (HC) and sexual functioning. In the cases where HC has been shown to lead to a decrease in sexual functioning, the chapter presents several hypotheses for the mechanisms that could be responsible for those changes, such as micronutrient depletion and elevations in sex hormone binding globulin with consequent reductions in free testosterone. Throughout this chapter, the authors make a case for clinicians to take care to inform patients of the potential sexual side effects of hormonal contraceptives, bearing in mind that it may be advisable for women who use them to supplement with certain vitamins and minerals. This may be an especially important consideration for women with genetic polymorphisms in methylation. The chapter concludes with a clinical case study.
Toxins (DRAFT)
Authors: Sprouse Adrienne
Published: April 2018

This chapter describes the categories of 300+ environmental chemicals measured in the blood and urine of Americans by the US Centers for Disease Control and Prevention. Some are endocrine-disrupting chemicals (EDCs) and substitute for endogenous hormones in a variety of metabolic processes affecting sexual health, obesity, diabetes, and behavior. The Monotonic Dose-Response (linear dose-response) is inappropriate when evaluating the health consequences of EDCs. Nonmonotonic Dose-Response Curves are better for considering the affinity of the ligand for the receptor, receptor saturation, ligand specificity, and tissue specificity of the receptor distribution. These factors combine to explain why ambient levels of many environmental chemicals cause damage to tissues or development and why low-level exposures can create disease different from higher level exposures. Exposure during critical stages of fetal development may cause permanent changes not apparent until adulthood. Environmental chemicals that are not EDCs may harm by altering genetic material and causing apoptosis.
Inflammation and the Gut–Brain–Mood Connection (DRAFT)
Authors: Falk Katherine , Bartlik Barbara , Mindes Janet
Published: April 2018

Inflammation, oxidative stress, dysbiosis, and increased gut permeability (leaky gut) are now understood to be among the causative factors in depression, other psychiatric illnesses, and sexual dysfunction. This new appreciation of psychiatric illness as a systemic illness, occurring in the body as well as in the brain, offers new ways to understand and treat sexual problems such as polycystic ovary syndrome and erectile dysfunction. Leaky gut can be caused by medications such as antibiotics, NSAIDS, or aspirin; drinking alcohol; or the proinflammatory standard American diet. As conventional treatments for these conditions do not address sources of systemic inflammation, this integrative medicine approach is of great value for clinicians and can help relieve the suffering of patients and their loved ones.
Healing Sexual Problems in the Ayurvedic Tradition of India (DRAFT)
Authors: Ewers Keesha
Published: April 2018

This chapter summarizes the essential principles and approach of India’s traditional medicine, Ayurveda, to healing sexual problems. In Ayurveda there is no one-size-fits-all solution; rather, it defines constitutional types (doshas) according to the balance of elements and gives guidelines for sexual activity for each dosha. Health is said to begin with digestion, and Ayurveda offers a nuanced theory of how digestion may create either toxins (ama) or life force (ojas). Ojas is the basis of cellular reproduction, vitality, and sexual health. This chapter also offers gender- and dosha-specific herbal prescriptions for treating such sexual problems as low libido, premature ejaculation, vaginal dryness, erectile dysfunction, and anorgasmia.
Healing Male Sexual Function Concerns in Traditional Asian Medicine (DRAFT)
Authors: Capodice Jillian
Published: April 2018

Traditional Asian medical systems and, in particular, traditional Chinese medicine (TCM), is a whole, or holistic, medical system that evaluates, diagnoses, and treats common health conditions. TCM is unique with regard to its fundamental physiologic and pathophysiology; its medical theory is vastly different from Western biomedicine. This chapter provides a background on basic TCM physiology and pathophysiology as it relates to the male genitourinary system and sexual function. The biomedical diseases of male sexual function, including disorders of arousal, ejaculation, and libido, are also defined. Discussion includes how both TCM and classical Chinese medicine theories might be used to treat common traditional medical patterns of male sexual function. Finally current research on acupuncture, moxibustion, herbal medicine, and other related modalities of traditional Asian medicine are summarized as it pertains to biomedical disorders of male sexual function.
Botanicals (Adaptogens and Others) that Support or Stimulate Desire (DRAFT)
Authors: Yarnell Eric
Published: April 2018

Botanical medicines can play an important role in helping men and women with sexual dysfunction. Marketing hype has distorted their role, and illegal adulteration of herbal products with unlabeled phosphodiesterase type 5-inhibiting drugs is a rampant problem in the marketplace. Research most validates the traditional use of Panax ginseng (Asian ginseng) root, Pausinystalia yohimbe (yohimbe) bark, Epimedium spp (horny goat weed) leaf and stem, and Crocus sativus (saffron) stamen for enhancing libido and erectile function. Withania somnifera (ashwagandha) root, Turnera diffusa (damiana) leaf, and Tribulus terrestris (caltrop vine) fruit are less well studied but still have a strong reputation in traditional medicine as aphrodisiacs. Clinical use of these herbs is discussed with case examples. The problem with biopiracy of traditional aphrodisiacs from the Global South is also reviewed.
Opioid Overdose Education, Prevention, and Management
Authors: Wollschlaeger Bernd
Published: April 2018

In reviewing the elements of opioid overdose education, prevention, and management, this chapter focuses particularly on practical interventions that are available and deserve advocacy; e.g., provision of naloxone to those with opioid use disorder and to possible first responders. It moves from a discussion of the epidemiology of opioid deaths to the more individual topic of patient risk for overdose. Prophylactic interventions in the form of education of the patient’s family and friends, and agreements for treatment with informed consent are described. There follows a discussion of management of the opioid poisoning itself, including use/distribution of naloxone injection. Two figures are included: drug overdose death rates in the United States (2014); a map describing the current states with naloxone or “good Samaritan” laws impacting opioid overdose management. A text box with resources includes directions for initiation of community overdose prevention and intervention schemes.
Non-Opioid Pharmacotherapies for Chronic Pain
Authors: Otis James A. D.
Published: April 2018

The objective of chapter 15 is to describe analgesic approaches to chronic pain, excluding opioids. As such, it emphasizes, first, the available pharmacotherapies; and then procedures. The pharmacotherapies divide into analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs); adjuvant analgesics, such as tricyclic antidepressants and anticonvulsants; oral anesthetic agents (cardiotropics); adrenergic agonists; topical agents such as capsaicin and local anesthetic solutions and ointments; and muscle relaxants such as cyclobenzaprine, tizanidine, and baclofen. Interventions include many best administered by anesthesiologists such as infusions of anesthetic agents; trigger point injections; local and regional blockade, spinal injections including corticosteroids; and electrical spinal cord stimulation. A text box is provided with additional resources.
Self-Directed Non-Pharmacological Management of Chronic Pain
Authors: Colameco Stephen
Published: April 2018

This chapter supplements Chapter 16 by emphasizing non-medication pain management techniques that have no need of a facilitator or intercessor beyond education and initiation. The successful management of chronic pain most often requires comprehensive approaches that include self-care and psychological, functional-restorative, and alternative-integrative approaches to complement medical treatments. Many patients with chronic pain lack access to integrated multidisciplinary care; under these circumstances, patient education and pain self-management may play a critical role in recovery, especially in the context of substance use disorders. Self-management or self-directed approaches may include psychological self-help, behavioral approaches, online support, group support, nutrition, graded exercise, the use of OTC devices (e.g., TENS), self-guided movement therapies, and other approaches. Sections on spirituality, sleep, and nutrition complete the foundation of self-directed therapies. The authors note that it is crucial to motivate patients and their families to become active participants in their own treatment process.
Opioid Pharmacotherapies for Substance Use Disorders and Addiction
Authors: Fields Jason Baker , Haning William F. , Olsen Yngvild
Published: April 2018

This chapter is about patient selection criteria and the dosing recommendations for methadone, buprenorphine, and naltrexone. It also addresses the legal and documentation issues uniquely associated with the former two medications, and specific complicating circumstances such as hepatic impairment, pregnancy, breast-feeding, and respiratory compromise. Risk factors including concurrent use of benzodiazepines and alcohol are addressed, as well as the intrinsic risks of the medications themselves (e.g., seizures for buprenorphine, respiratory arrest with methadone). The objective of the chapter is to orient the primary care provider to available pharmacotherapies in the outpatient setting; the need for parallel or integrated psychosocial treatment is implicit. Accompanying text boxes include additional resources and a discussion of the changing federal regulations regarding patient population limits for buprenorphine prescribers.
Pain and Addiction in Patients with Co-Occurring Medical Disorders
Authors: Colameco Stephen
Published: April 2018

Distinct from Chapter 24, on co-occurring psychiatric disorders, this chapter addresses common physical comorbidities that give rise to chronic pain and are notorious for associated substance use disorders. The concept of “pseudo-addiction” is explored as one of several contributors to common misperceptions of the analgesic needs of such patients. Examples of entities discussed are chronic low back pain, sleep apnea, chronic pancreatitis, cirrhosis, and HIV infection or AIDS-related pain. While not intrinsically painful, sleep apnea merits inclusion as it arises in conjunction with sedative-hypnotic, opioid, or nicotine use. Cirrhosis likewise creates obstacles to successful pain or addiction management resulting from altered metabolism of medications and enhanced susceptibility to potentially lethal syndromes (hepato-renal syndrome, gastric hemorrhage, etc.). The management of neuropathic pain in HIV infection (Chapter 15) is amplified here.
Pain and Addiction in Patients Who Smoke Cigarettes
Authors: Karan Lori D.
Published: April 2018

Through a discussion of the effects of cigarette smoking on both pain perception and other substance use, this chapter outlines the presentation of the benefits to the patient and reviews smoking cessation strategies. It begins with an epidemiological review of the higher prevalence of smoking among those with chronic pain syndromes, such as fibromyalgia, headache, and low back pain. The many adverse consequences of cigarette smoking for general health are identified, from enhanced osteoporosis to prolonged wound repair. Most strikingly, smoking is demonstrated to both exacerbate the experience of pain and lead to a heightened requirement for opioid analgesia. Its overlap with other substance use disorders has long been recognized, including an association with higher relapse rates to alcohol and other drugs. A table is provided detailing the physiological improvements seen upon smoking cessation.
Pain and Addiction in Adolescents and Young Adults
Authors: Weaver Michael F.
Published: April 2018

Distinguishing between the needs of adults and those of adolescents, this chapter concentrates on practical operational approaches to both addiction and pain in the ephebiatric population. The susceptibility of this group to substance use disorders, and the profound impact on the developing brain and body of substances of misuse, is complicated further by their high level of physical activity and vulnerability to trauma. Data are provided from the Monitoring the Future project to profile the substance use risk of this population; a summary table is included giving the prevalence of various substances of misuse among youths. Unique requirements in their treatment are addressed, with emphasis placed on a network therapy, enlistment of family cooperation, and neighborhood resources. Noting that this is a population for whom physicians may be reluctant to initially consider medication, safety profiles are examined.
Men Caring for Women in the Cancer Context (DRAFT)
Authors: Hagedoorn Mariët , Revenson Tracey A.
Published: April 2018

This chapter provides an overview of the consequences of a cancer diagnosis for female patients and their male caregivers, mostly partners or spouses. The majority of the couples adjust well; only a minority shows elevated levels of psychological distress a year or more after diagnosis. Nevertheless, the literature shows that cancer and its treatment may have a considerable impact on sexual functioning, fertility, and other aspects of the relationship. Communication between patients and partners and between couples and health care professionals plays a key role in solutions to these problems. Psychosocial interventions that may ameliorate the stresses these couples face are presented throughout the chapter. The authors also address issues of gender and caregiving.
Female Caregivers to Female Cancer Survivors (DRAFT)
Authors: Boehmer Ulrike , Clark Melissa A. , Fredman Lisa
Published: April 2018

In this chapter, the authors focus on adult female caregivers performing informal caregiving tasks to adult females diagnosed with cancer. The authors limit discussion to a binary definition of gender, whereas Chapter 11 addresses gender minorities, including transwomen caregivers and transgender care recipients. The authors present national data on adult caregivers and describe the characteristics of female-to-female caregivers. They present a theoretical model for evaluating the impact of female-to-female cancer caregiving and review interventions that are relevant to this group of caregivers. While female caregiver to female patient is the most prevalent caregiver–patient combination, there is mostly an absence of same-gender effects on cancer caregiving and interventions.
Rapid Response System
Authors: Kellum John A.
Published: April 2018

This handbook provides a practical approach to the evaluation, differential diagnosis, and management of common medical and surgical emergencies such as cardiac arrest, acute respiratory failure, seizures, and hemorrhagic shock occurring in hospitalized patients. Less common and special circumstances such as pediatric, obstetric, oncologic, neurologic, and behavioral emergencies as well as palliative care for terminally ill patients encountered in the context of rapid response team (RRT) events are also discussed. An overview of commonly performed bedside emergency procedures by rapid response team members complements the clinical resources that may need to be brought to bear during the course of the rapid response team event. Finally, an overview of organization, leadership, communication, quality, and patient safety surrounding rapid response team events is provided. This book is written with medical students, junior physicians, and nursing staff in mind working in both academic and community hospital settings. Both a novice and an experienced healthcare provider involved in a rapid response system (RRS) will find this handbook to be a valuable supplement to the clinical experiences gained through active engagement in the system. Hospital administrators and senior management staff will also find this book to be useful in the evaluation of quality and performance of the rapid response system, management of staff attitudes and behavior, performance of peer review, care for second victims, and implementation of countermeasures for patient safety problems discovered in the course of rapid response system reviews.
Atrial Fibrillation and Other Cardiac Arrhythmias (DRAFT)
Authors: Schneider Antoine , Bellomo Rinaldo
Published: April 2018

Cardiac arrhythmias are common in hospitalized patients, with their incidence increasing in older patients and those with comorbidities. Cardiac arrhythmias represent a trigger for approximately 10% of rapid response team (RRT) activations. Of those, atrial fibrillation (AF) is the most commonly observed. Other common cardiac arrhythmias in the in-hospital setting include supraventricular tachycardia, atrial flutter, ventricular tachycardia, and bradycardias. Members of the RRT should be skilled in the diagnosis and management of these common arrhythmias. This chapter presents an overview of cardiac arrhythmias that RRT members are likely to encounter, discussing their incidence and significance, as well as their immediate management.
Respiratory Failure and Hypoxemia (DRAFT)
Authors: Javed Jeffrey K. , Moore Jason E.
Published: April 2018

Respiratory failure and hypoxemia are among the most common problems encountered by the rapid response team (RRT) and can lead to rapid patient deterioration and arrest. A brief, systematic approach focusing on treatment priorities such as airway patency, correcting hypoxemia, and supporting work of breathing, allows RRT responders to quickly provide the appropriate level of supportive care and narrow the complex differential diagnosis of acute respiratory failure. This chapter reviews a logical and efficient clinical diagnostic evaluation, therapeutic modalities including rescue treatments and mechanical ventilation, and transport considerations for this patient group. The pragmatic, problem-based clinical approach discussed in this chapter will help RRTs provide effective care for this group of patients.
Major Trauma (DRAFT)
Authors: Varley Patrick R. , Alarcon Louis H.
Published: April 2018

Trauma is a leading cause of death and disability in the United States. Although it is generally considered to occur mostly outside of the hospital, traumatic injuries may occur anywhere. Outcomes for patients experiencing major trauma are closely linked to the healthcare response. Appropriate responses to traumatic injuries have been developed over the past 50 years, and are now considered to involve the care of a well-trained trauma team. This team utilizes established protocols to rapidly evaluate and treat injured patients. This chapter discusses the evolution of trauma teams, equipment and supplies, and the primary, secondary, and tertiary surveys used in trauma team response.
Obstetric Emergencies (DRAFT)
Authors: Shamshirsaz Amir , Muigai David
Published: April 2018

An obstetric rapid response team (RRT) should ideally include the readily available presence of an obstetrician and a well-established system for escalation of care and management of the fetus where applicable. During the evaluation of an obstetric patient, the RRT team should be familiar with the unique changes in maternal pregnant physiology and their influence on the presentation and management of common maternal emergencies. Postpartum hemorrhage, pre-eclampsia related complications, and sepsis together form the bulk of causes for maternal RRT calls. The knowledge of, and competence with, left lateral displacement of the uterus and the timing and execution of perimortem cesarean section are essential during maternal cardiopulmonary resuscitation. In this chapter, we review common maternal emergencies during RRT activation and their management.
Oncologic Emergencies (DRAFT)
Authors: Rafkin Harry S.
Published: April 2018

Oncologic emergencies are potentially life-threatening syndromes that occur in patients with cancer, and are either directly or indirectly related to the patient’s tumor. The clinical progression of these syndromes is rapid and the initial assessment of the patient must be done quickly, as without immediate therapy, high morbidity and mortality results. The oncologic emergency may be due to the tumor, the treatment given to control the tumor, or it may be due to a previously existing condition. This chapter reviews the clinical presentation, treatment, and management of tumor lysis syndrome, hypercalcemia, hyponatremia, disseminated intravascular coagulation, hyperviscosity syndrome, spinal cord compression, and superior vena cava syndrome.
The Difficult Airway (DRAFT)
Authors: Phillips Dennis , Knight Joshua
Published: April 2018

The difficult airway invariably presents itself to all airway managers and is mostly unpredictable in the context of rapid response team (RRT) calls. A multiprofessional difficult airway team (DAT) that could be called for airway emergencies is likely to reduce complications and death. The DAT is organized with predefined roles for each member so that rapid intervention occurs during the emergency. Priority is given to oxygenation throughout the airway response. The anticipated and unanticipated difficult airways should be approached differently and often require medication adjuncts that should be carefully chosen. Airway devices such as the video laryngoscope and the laryngeal mask airway (LMA) have dramatically improved the ability to secure an airway quickly. Finally, it is important to recognize when a surgical airway is needed in the setting of the RRT calls.
Acute Stroke (DRAFT)
Authors: Steinberg Alexis , Molyneaux Bradley J.
Published: April 2018

The development of a stroke is an acute neurologic emergency that requires rapid evaluation as any delay in treatment worsens outcome. There are two main types of strokes, hemorrhagic and ischemic, each requiring specific rapid assessment and interventions. If an acute ischemic stroke is suspected, then a decision regarding thrombolytic therapy and endovascular thrombectomy has to be made quickly. A hemorrhagic stroke demands rapid medical management of blood pressure, reversal of coagulopathy, and early neurosurgical consult for possible external ventricular drain (EVD) placement and hemorrhage evacuation. This chapter expands on the indicated work-up in a suspected stroke patient in the setting of the rapid response team (RRT) calls, different imaging modalities, management options in the acute and subacute periods, and post-stroke complications.
Ventricular Assist Devices (DRAFT)
Authors: Padmanabhan Rajagopala , Sappington Penny
Published: April 2018

Ventricular assist devices (VADs) have become a cornerstone of therapy in the management of end-stage heart failure, both as a means of bridging to cardiac transplantation and as destination therapy for long-term quality of life improvement. Responding to medical emergencies in patients with VADs poses numerous challenges to rapid response team (RRT) providers. Managing these patients requires basic understanding of VAD function and physiology and the multitude of complications that follow their implantation. Most healthcare professionals lack exposure to VADs, and although it may seem daunting, this chapter will provide a systematic approach of how to identify, troubleshoot, diagnose, and manage VAD-associated complications and provide emergency care for the VAD patient.