bluuebunny/crossref_metadata_2025 huggingface dataset:
On the effect of hyperaldosteronism-inducing mutations in Na/K pumps
Authors: Meyer Dylan J. , Gatto Craig , Artigas Pablo
Published: October 2017

Primary aldosteronism, a condition in which too much aldosterone is produced and that leads to hypertension, is often initiated by an aldosterone-producing adenoma within the zona glomerulosa of the adrenal cortex. Somatic mutations of ATP1A1, encoding the Na/K pump α1 subunit, have been found in these adenomas. It has been proposed that a passive inward current transported by several of these mutant pumps is a "gain-of-function" activity that produces membrane depolarization and concomitant increases in aldosterone production. Here, we investigate whether the inward current through mutant Na/K pumps is large enough to induce depolarization of the cells that harbor them. We first investigate inward currents induced by these mutations in Xenopus Na/K pumps expressed in Xenopus oocytes and find that these inward currents are similar in amplitude to wild-type outward Na/K pump currents. Subsequently, we perform a detailed functional evaluation of the human Na/K pump mutants L104R, delF100-L104, V332G, and EETA963S expressed in Xenopus oocytes. By combining two-electrode voltage clamp with [3H]ouabain binding, we measure the turnover rate of these inward currents and compare it to the turnover rate for outward current through wild-type pumps. We find that the turnover rate of the inward current through two of these mutants (EETA963S and L104R) is too small to induce significant cell depolarization. Electrophysiological characterization of another hyperaldosteronism-inducing mutation, G99R, reveals the absence of inward currents under many different conditions, including in the presence of the regulator FXYD1 as well as with mammalian ionic concentrations and body temperatures. Instead, we observe robust outward currents, but with significantly reduced affinities for intracellular Na+ and extracellular K+. Collectively, our results point to loss-of-function as the common mechanism for the hyperaldosteronism induced by these Na/K pump mutants.
Deregulation and Productivity: Empirical Evidence on Dairy Production
Authors: Frick Fabian , Sauer Johannes
Published: October 2017

We investigate productivity development and its relation to resource reallocation effects in the dairy sector in southeast Germany during the phasing‐out of the European Union milk quota. We hypothesize that both extreme output price levels and market deregulation fostered efficient reallocation of production resources. We use a farm‐level dataset containing financial accounting data for a period of 15 years. Farm‐level productivity is estimated by a proxy variable approach that is robust to endogenous input choice. We compare this approach to other estimation techniques as well as an index‐based analysis. After aggregation we decompose sector productivity into unweighted mean productivity and a covariance term measuring the allocation of resources toward more productive farms. We observe an increase in the covariance term coinciding with a period of deregulation efforts and volatile milk prices. We seek to find support for our hypotheses by a regression analysis linking the measure for the potential covariance between resource reallocation and productivity on the one hand, and deregulation as well as price variability on the other. In this analysis we find some empirical evidence for the hypotheses.
The Unified Protocol for Anxiety Disorders
Authors: Conklin Laren R. , Farchione Todd J. , Dufour Steven
Published: October 2017

Of any cluster of illnesses outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), none is more prevalent, likely to serve as a comorbid diagnosis, or costly in the United States than anxiety disorders. This chapter outlines the applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) for the treatment of such disorders. First, we briefly review the background research that provides context for the use of transdiagnostic treatment for anxiety disorders. The UP, with its intent to target comorbidity, is an approach that can be especially helpful for therapists who want to use an evidence-based treatment, prefer the structure of a manualized protocol, and value the benefits that a workbook can bring to patients. We then present two clinical case studies to demonstrate how each individual module of the UP maps onto typical cases of principal and comorbid anxiety. Recommendations for specific methods of protocol implementation are also described.
Group Treatment Applications of the Unified Protocol
Authors: Bullis Jacqueline R. , Bentley Kate H. , Kennedy Katherine A.
Published: October 2017

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated promising results among patients with heterogeneous anxiety and comorbid depressive disorders when delivered on an individual basis, but greater efficiencies may be achieved with group-based applications. This chapter will provide a rationale for utilizing a transdiagnostic approach in a group format, including cost-effectiveness and efficiency for patients and practitioners alike. It will illustrate a recent application of the UP with patients who completed 12 sessions in a group, offer guidelines on how to successfully implement the UP in a group of patients with a range of anxiety, depressive, and related disorders, and discuss the challenges that arose during treatment. We will then present data on the treatment response for each patient, as well as patients’ perceptions of the acceptability and feasibility of the UP in a group format, and conclude with our thoughts on future research priorities.
The Unified Protocol
Authors: Cassiello-Robbins Clair , Latin Heather Murray , Sauer-Zavala Shannon
Published: October 2017

Previous chapters in this book have been dedicated to exploring the use of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) with a variety of emotional disorders, and those chapters present compelling evidence for the efficacy of the UP across the range of these disorders. This evidence has now inspired further research efforts to better understand the contribution of individual treatment components, as well as to evaluate new methods of treatment delivery with the goal of furthering dissemination. The purpose of this chapter is to describe future directions and projects related to the UP, including dismantling studies, dissemination efforts, and the development of an Internet-delivered form of the intervention. Further, we discuss how these projects will enhance our understanding of the UP and how these endeavors will further a clinician’s ability to provide efficient, effective care.
Self-Management of Cardiac-Related Health Issues
Authors: Vilchinsky Noa
Published: October 2017

One of the strongest means by which to reduce the risk of cardiac events’ recurrence and mortality is via restructuring major lifestyle habits and self-management of one’s risk factors. The therapeutic recommendations consists of smoking cessation, changing dietary choices, exercising on a regular basis, taking medication, and managing one’s psychological distress. Yet many individuals with cardiac impairments find it extremely difficult to manage them. Most barriers for self-management can be organized under the following coordinates: systemic and sociocultural barriers, gender-related barriers, and psychologically related barriers. The demanding task of improving individuals’ self-management is not inherently of individuals and their family members only. Health systems and health providers within them should develop and apply novel and effective procedures to support individuals to self-manage their life situation, thus transforming it from crisis to challenge.
Self-Management of Vision Impairments
Authors: Drury Vicki Blair , Aw Ai Tee , Lim Priscilla Shiow Huey
Published: October 2017

Many of the eye conditions that lead to vision loss are long-term conditions that require ongoing management. Vision loss has a profound impact on an individual’s life: occupational, social, and recreational. Most vision loss is degenerative and progressive. Yet self-management of the consequences of the condition can empower individuals to maintain independence and to continue doing chosen activities. This chapter initially describes the prevalence of vision loss and the most common conditions causing vision loss in adults. It then describes functional limitations of vision loss and barriers and challenges to self-management. Finally, an overview of coping strategies and evidence-based interventions is provided.
RAINBOW
Authors: West Amy E. , Weinstein Sally M. , Pavuluri Mani N.
Published: October 2017

RAINBOW: A Child- and Family-Focused Cognitive-Behavioral Treatment for Pediatric Bipolar Disorder is a comprehensive, evidence-based treatment manual designed specifically for children ages 7–13 with bipolar spectrum disorders and their families. Developed by experts in pediatric mood disorders and tested in a randomized clinical trial (RCT), RAINBOW integrates psychoeducation and cognitive-behavioral therapy (CBT) with complementary techniques from mindfulness-based intervention, positive psychology, and interpersonal therapy to address the range of therapeutic needs of families affected by this disorder. Guided by the evidence on the neurobiological and psychosocial difficulties accompanying pediatric bipolar disorder, this treatment targets the child and family across seven core components: Routine, Affect Regulation, I Can Do It, No Negative Thoughts and Live in the Now, Be a Good Friend/Balanced Lifestyle for Parents, Oh How Do We Solve This Problem, and Ways to Get Support. Throughout the treatment, the child and family will learn how to identify mood states and triggers of mood dysregulation, and develop cognitive and behavioral strategies for improving mood stability. Children will build social skills, and caregivers will develop greater balance and self-care in their own lives. The family will learn ways to use routines, problem-solving, and social support to improve overall family functioning. Intended for qualified child-focused mental health professionals, this manual includes the conceptual background of the treatment and user-friendly step-by-step instruction in delivering RAINBOW with families, including handy session outlines and engaging worksheets for the child and caregiver(s).
Affect Regulation Skills for Parents
Authors: West Amy E. , Weinstein Sally M. , Pavuluri Mani N.
Published: October 2017

Session 3 of the RAINBOW treatment protocol focuses on developing routines (ingredient R: Routine of RAINBOW) and improving affect regulation (ingredient A: Affect regulation of RAINBOW), and is conducted individually with the parent/caregiver(s). After a review of the previous week’s work by the therapist and parents, the parents are first engaged in a task to help establish predictable routines at home to minimize their child’s emotional reactivity. Parents are then encouraged to share their own feelings surrounding parenting a child with bipolar disorder. Last, the therapist and the parents develop ways to improve the identification, communication, and management of difficult feelings.
Affect Regulation Skills for Children
Authors: West Amy E. , Weinstein Sally M. , Pavuluri Mani N.
Published: October 2017

Session 4 of the RAINBOW treatment protocol is primarily conducted with the child and focuses on developing affect-regulation skills (ingredient A: Affect regulation of RAINBOW). Key skills developed in this session include recognizing and labeling emotions, identifying physiological cues of anger and other feelings, and recognizing triggers of anger. These skills are taught in order to help the child to normalize the experience of intense emotion, and to teach the child how to cope with intense negative emotion. In addition, the child’s completed mood charts are reviewed, and mood monitoring is assigned again as a between-session task for the child and the family.
Eating Disorders and Borderline Personality Disorder
Authors: Wisniewski Lucene , Anderson Leslie K.
Published: October 2017

Individuals with eating disorders (EDs) tend to have elevated rates of comorbid borderline personality disorder (BPD). A number of studies have found that individuals with both ED and BPD present with a more complicated clinical picture compared to individuals with ED alone, both in terms of eating pathology and in terms of more severe problems with depression, anxiety, impulse control, and affect dysregulation. Therapists are often faced with clinical dilemmas with regard to limiting therapy-interfering behaviors and attending to health-threatening or self-destructive behaviors without reinforcing them while ensuring that these behaviors do not supersede the therapeutic focus on ED symptoms, potentially reinforcing self-destructive behaviors. This chapter offers guidelines for responding to therapy-interfering behaviors in this population from the perspective of dialectical behavior therapy, with a case example to illustrate these principles.
Considerations in the Treatment of Eating Disorders Among Ethnic Minorities
Authors: Ramirez Ana L. , Trujillo-ChiVacuán Eva , Perez Marisol
Published: October 2017

Although once thought of as a White upper socioeconomic status illness, eating disorders are now known to occur among ethnic minority individuals. Unfortunately, because there have been no treatment trials specifically for ethnic minority individuals with eating disorders, very little is known about the efficacy and generalizability of current existing treatments for these individuals. Therapists face a clinical dilemma in attempting to maintain evidence-based practice while being culturally sensitive and adapting research-supported treatments for ethnic minority individuals. This chapter provides a review of the literature on prevalence rates and how the clinical presentation of ethnic minorities (Latinos, African Americans, and Asian American) differs from that of White individuals. In addition, it provides information on how evidence-based treatments have been adapted for ethnic minority groups and other important considerations when providing eating disorder treatment for ethnic minority individuals.
Midlife-Onset Eating Disorders
Authors: Runfola Cristin D. , Baker Jessica H. , Bulik Cynthia M.
Published: October 2017

It is not infrequent to see older adults present with eating disorder behaviors or diagnoses. This chapter reviews the prevalence, incidence, and clinical presentation of eating disorders at midlife. Following characterization of midlife eating disorders, evidence-based treatments for these disorders at midlife are discussed. Reviewed data suggest that eating disorders exist at midlife but that research is inadequate to state definitively the frequency with which they occur and how they differ from presentations earlier in life. Existing research on mid- and late-life eating disorders suggests that providers must consider the eating disturbances within the developmental context of the individuals under study. Similarly, treatment for individuals with eating disorders at midlife should consider enlisting family support and must be tailored to address the impact of aging and responsibilities on the individual because they may serve as very different triggering and maintaining factors than those seen in youth.
Beginning IPT
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter describes the tasks of the first few IPT sessions. The therapist’s tasks in the opening sessions are to review the depressive symptoms and make a diagnosis; explain depression as a medical illness and describe treatment options; evaluate the need for medication; review the patient’s “interpersonal inventory”; present a formulation, linking the patient’s illness to an interpersonal focus; make a treatment contract based on the formulation, and explain what to expect in treatment; define the framework and structure of treatment; and give the patient the “sick role.” After this, the work of IPT begins on the defined problem area. In these sessions the therapist focuses consistently on mood and interpersonal interaction. The therapist helps the patient to see the link between them, reinforces adaptive interpersonal functioning, and helps the patient to explore and gain comfort with new options where old strategies have not been working.
Peripartum Depression
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

IPT is based on the hypothesis that patients who experience social disruptions face an increased risk for depression. Thus, IPT is an interesting potential treatment for addressing symptoms that develop during the perinatal period. This chapter covers the use of IPT during pregnancy, miscarriage, the postpartum period, and infertility treatment. Adequate treatment of depression is important for the health not only of the mother but of the infant and other children in the family. IPT adaptations that have been proposed for use in these settings are reviewed. Research studies on the use of IPT during pregnancy and the postpartum period are summarized. The usual problem areas of the IPT framework (grief, role disputes, role transitions, and deficits) aptly apply to pregnancy, miscarriage, postpartum depression, and depression associated with infertility, with a fifth one (complicated pregnancy) added.
Training and Resources
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

Evidence-based psychotherapies like IPT are increasingly being offered to patients, and patients are requesting them as information filters into the popular press and social media. While some training programs are incorporating IPT, progress is slow, and the status of certification varies by country. This chapter outlines how clinicians can learn IPT, a process that involves three key elements: read the IPT manual, attend an IPT training workshop, and obtain clinical supervision on training cases. Learning IPT involves discovering how to take your basic psychotherapy training and modify it for use with a specific set of strategies. The authors recommend conducting at least two time-limited, diagnosis-focused IPT cases to gain comfort with the structure and techniques of the treatment. A list of resources is provided at the end of the chapter, including translations of seminal IPT manuals.
Introducing Goal Focused Positive Psychotherapy
Authors: Conoley Collie W. , Scheel Michael J.
Published: October 2017

This chapter provides an overview of the philosophy and foundational premises of Goal Focused Positive Psychotherapy. Goal Focused Positive Psychotherapy is described as a comprehensive psychotherapy model built primarily upon positive psychology principles to optimize well-being, which diminishes the effects of psychological distress. The theory of change is the Broaden-and-Build Theory of positive emotions. The therapeutic process promotes client strengths, hope, and positive emotions in order to assist the client in attaining goals, making growth toward goals in psychotherapy and life more enjoyable. Issues of ethics, psychological metaphor, therapeutic alliance, client context, and a case example of a client with posttraumatic stress disorder are presented.
Goal Focused Positive Psychotherapy Case Examples
Authors: Plumb Evelyn Winter , Byrom Robert , Bartholomew Theodore T. , Hawley Kate
Published: October 2017

This chapter presents four case examples that illustrate the key principles of Goal Focused Positive Psychotherapy (GFPP). The formation of the therapist–client relationship is highlighted. Strengths are identified in the midst of the client describing problems. Approach goals are identified and positive emotions elicited based upon client readiness. Each therapist’s approach fits the client’s concerns and strengths. The client’s initial concerns form the beginning for the strength-oriented journey. Techniques such as positive empathy are used to identify the client’s desires. Client desires are understood to be in juxtaposition with client difficulties. GFPP is used within the context unique to each client. Client contexts can be conceptualized as comprising client problems, complaints, and difficulties, along with client strengths, assets, and culture. At the end of the chapter a synthesis statement assesses the common threads and distinctive qualities of the four cases.
Adaptive Mentalization-Based Integrative Treatment
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

This book is for youth workers, social workers, mental health staff, specialist teachers, family support workers, and so on, whose clients present with comorbidity, risk, and difficulty accessing mainstream services. It describes inevitably stressful, unsettling work, providing effective help in complex helping systems. An innovative response emerges, building on adaptive (evidence-based) mentalization-based theory and practice. Uniquely, AMBIT applies mentalizing not only directly, in work with clients, but also in work: (a) with the team, (b) with wider (often “dis-integrated”) networks, and (c) creating cultures of learning and radical transparency. AMBIT is as much an improvement system for teams as a “therapy”—strengthening team identity and coherence, and supporting a wider community of practice. Linking evidence-based practice to practice-based evidence, the book concludes with impact descriptions from some of the nearly 200 AMBIT-trained teams, a client’s perspective, and a challenging analysis of systems of care pointing toward the need to create more mentalizing systems.
The History and Future of School Mental Health
Authors: Weist Mark D. , Flaherty Lois , Lever Nancy , Stephan Sharon , Van Eck Kathryn , Bode Abby
Published: October 2017

Beginning in the 1980s, mental health programs in schools began to expand beyond those delivered solely by schools and school employees. This was related to growing recognition of the limitations of separate community and school mental health efforts, and of the benefits of working together. These “expanded” school mental health (SMH) programs began to gain momentum in the 1990s and are now a major national force. This chapter reviews key milestones in the history of the field and the critical policy themes (e.g., federalism, school decision-making, healthcare reform, financing) that are being confronted. It concludes with a review of major opportunities for the further growth and development of the field, including embedding programs within multi-tiered systems of support, improving training and workforce development, improving interdisciplinary and cross-system collaboration, enhancing high-quality and evidence-based practice, and developing effective systems of implementation support. A brief review of international developments concludes the chapter.
Engaging Adolescents in Secondary Schools
Authors: Reschly Amy L. , Pohl Angie J. , Christenson Sandra L. , Appleton James J.
Published: October 2017

The chapter “Engaging Adolescents in Secondary Schools,” from the volume School Mental Health Services for Adolescents, covers the topics of student engagement, connections between engagement/disengagement and mental health, and interventions to enhance engagement. Student engagement is a construct with wide appeal to scholars and practitioners who study and work with school-age youth. Engagement interventions have the potential to enhance students’ functioning across academic, behavioral, and social-emotional domains. Tables of student engagement interventions, organized by type (academic, behavioral, cognitive, affective) and level of intensity (universal, targeted), in accordance with response-to-intervention (RTI)/multi-tiered system of support (MTSS) service-delivery models, are included, along with general implementation recommendations.
Addressing Adolescent Drug Abuse
Authors: Winters Ken C. , Wagner Eric , Krepps Walker
Published: October 2017

The chapter “Addressing Adolescent Drug Abuse,” in School Mental Health Services for Adolescents, examines several topics related to adolescent substance use: brain development and its implications for mental health services, evidence-based prevention and intervention programs, and the utility of clinical services adapted for school settings. Substance use by adolescents continues to be a public health concern. Not only does recent research show relatively high rates of use, but the onset of substance use during the teenage years has been linked to subsequent substance use disorders and is associated with a wide range of social, learning, and psychological consequences. The need is great for schools to address this public health issue by utilizing the growing number of existing evidence-based prevention and intervention programs.
Research Agenda for Anxiety Disorders
Authors: Foa Edna B. , Franklin Martin , McNally Richard J. , McLean Carmen , Pine Daniel
Published: October 2017

The chapter starts by outlining what is already known about the ecology of adolescent development and culture and how it relates to the development of anxiety disorders in individuals. Identifying which young people are most at risk to develop anxiety disorders after experiencing negative life events, the chapter argues, is an important next step toward developing selective treatment and prevention intervention programs. The chapter then goes on to explain what is not currently known about what factors are linked specifically to anxiety disorders, as opposed to what might cause a general likelihood of development of a disorder. It is critical, therefore, that more research be conducted on obtaining basic knowledge about specific risk and protective factors of pathological anxiety in adolescents. This research must carefully consider the context of adolescent development and culture in trying to discern the particular factors and the manner in which these factors interact.
Treatment of Eating Disorders
Authors: Attia Evelyn , Becker Anne E. , Bulik Cynthia M. , Field Alison E. , Golden Neville H. , Kreipe Richard E. , Le Grange Daniel , Mitchell James E. , Pike Kathleen M. , Sysko Robyn , Taylor C. Barr , Walsh B. Timothy
Published: October 2017

This chapter focuses on treatments for adolescents with eating disorders, using information derived from randomized controlled trials and evidence-based treatments for eating disorders in adults. Available data provide some guidance in selecting treatments, but there are significant limitations in research on psychological and pharmacological interventions. Family-based treatment is effective for adolescents with anorexia nervosa, especially for those with a short duration of illness. For adolescents with bulimia nervosa, both family-based treatment and guided self-help based on cognitive-behavioral therapy are empirically supported interventions. At this time, there are no randomized controlled trials on the treatment of adolescents with binge-eating disorder, and, despite the widespread use of psychotropic medications, there is little empirical information about the utility and safety of such interventions for adolescents. Additional large well-controlled systematic studies with adolescents are needed to inform best care practices.
Research Agenda for Eating Disorders
Authors: Attia Evelyn , Becker Anne E. , Bulik Cynthia M. , Field Alison E. , Golden Neville H. , Kreipe Richard E. , Le Grange Daniel , Mitchell James E. , Pike Kathleen M. , Sysko Robyn , Taylor C. Barr , Walsh B. Timothy
Published: October 2017

The concluding chapter of this section outlines several gaps in current knowledge that will be critical to address in future research. DSM-5 introduced a number of changes in diagnostic criteria for eating disorders, and it is crucial to determine the utility of these revised criteria in addressing the needs of adolescents with clinically significant eating problems. More large studies are needed to understand the frequencies of eating disorders and disordered eating in the general population, and risk factors for their development, including psychological and biological factors. It will be important to improve knowledge of the benefits and risks of psychological and pharmacological treatment interventions, and to clarify the most effective methods of involving the family. Continued research on prevention is critical to understand how efforts to prevent eating disorders can be integrated with interventions to prevent other psychological disorders and obesity.
Stigma
Authors: Jamieson Patrick E. , Romer Daniel
Published: October 2017

Stigma occurs when a person or group is negatively stereotyped and is treated as socially unacceptable. The stigma surrounding mental disorders poses significant barriers to identification, treatment, and recovery from these conditions. Stigmatizing beliefs about mental illness emerge prior to adolescence and are reinforced by both entertainment and news media. These widespread beliefs can promote self-stigma in persons with symptoms of mental illness. This chapter reviews the community and psychological processes that contribute to stigma and strategies that seek to reduce its harms in adolescents. It also highlights examples of successful stigma-reduction programs that emphasize the efficacy of treatment, correction of negative stereotypes, and exposure to persons with mental illness who have been successfully treated.
Attentiveness and Responsibility
Authors: Freitag Lisa
Published: October 2017

This chapter begins to evaluate caregiving for children with multiple special needs through the lens of Joan Tronto’s first two phases of care. Multiple narratives written by parents of children with a variety of disabilities or health care needs are examined for depictions of attentiveness and responsibility. The child’s multiple needs create for the parents multiple new areas in which they must be acutely attentive and responsible. Parents also must learn to live with the emotional uncertainty and moral ambivalence of caring for a child whose health is fragile. They must advocate for the child on both a systemic and personal level. Morally, they must become the sort of person who can perform difficult tasks and make difficult medical decisions, despite the fact that, for the most part, they had no choice but to take on an enormous caregiving task.
Introduction and Historical Perspective
Authors: Lippmann Morton , Schlesinger Richard B.
Published: October 2017

Literature relevant to chemical contamination, especially to the adverse effects of occupational exposures, extends back to ancient Greece, Middle Age Europe and Japan, and the dawn of the industrial age. For air pollution, the adverse effects of coal burning effluents were recognized in London in the thirteenth century and became acute over 150 years ago. The feasibility of control of drinking water pollution due to communicable diseases agents was not adequately demonstrated until early in the twentieth century. By the middle of the twentieth century, it became apparent that chemical contamination of community air, drinking water, and foods was having serious adverse effects on the health of infants, the elderly, and more susceptible members of the general population, as well as effects on environmental quality and public safety, and this recognition led to legislation that addressed the need to control the emissions of hazardous chemicals.
Environmental Sampling and Exposure Assessment
Authors: Lippmann Morton , Schlesinger Richard B.
Published: October 2017

This chapter describes the characterization of occupational exposures of workers to chemicals at their job sites, and exposures of general populations to chemicals in the environmental for individuals and population groups. It also discusses: approaches to risk assessment; the determination of whether exposures exceed established exposure limits or standards; and the methodologies used to determine and/or model the concentrations of chemicals in environmental media that are used to determine the nature and extent of exposures, and of biomarkers of exposure, to individuals and populations of humans and other receptors.
Cognitive Assessment for Clinicians
Authors: Hodges John R.
Published: October 2017

This book provides clinicians with a theoretically motivated guide to the assessment of patients with cognitive complaints. Its main goal is to teach physicians, psychiatrists, and psychologists how to assess cognition in the clinic or at the bedside based around the instrument, the Addenbrooke’s Cognitive Examination (ACE), developed in Cambridge over many years and subsequently refined and modified. The latest version is the ACE-III, which is freely available and has been translated into many languages. The early chapters provide a framework in which aspects of cognition are considered as those with a distributed representation in the brain (such as attention and memory) versus those with more focal representation (such as language, praxis, and spatial abilities). There are descriptions of the major syndromes encountered in clinical practice, notably delirium and dementia, which have been updated to incorporate recent discoveries. There follows the all-important section on history taking and the ‘meat of the book’: how to perform bedside cognitive testing. The ACE-III is contrasted to other commonly used brief standardized mental test schedules (such as the Montreal Cognitive Examination). Sixteen cases with a full range of cognitive disorders illustrate the method recommended. Finally, there is an appendix outlining the range of formal tests commonly used in neuropsychological practice.
The subspecialty practice of critical care echocardiography
Authors: Colebourn Claire , Newton Jim
Published: October 2017

This chapter describes the development and current status of the subspecialty practice of critical care echocardiography. The available accreditation processes are discussed, including tips for success. The interactions between training and service elements of critical care echocardiography are explored. Proposed quality standards for in-house critical care echocardiography practice are given to guide service development.
The left ventricle in critical illness
Authors: Colebourn Claire , Newton Jim
Published: October 2017

This chapter reviews the structure and physiology of the left ventricle and details assessment methods and their safe usage. It looks in detail at the effects of critical illness on left ventricular function, specifically including the effect of sepsis, ischaemia, and drug toxicity.
Volume assessment and fluid responsiveness
Authors: Colebourn Claire , Newton Jim
Published: October 2017

This chapter looks in detail at the assessment of fluid responsiveness using transthoracic echocardiography. It includes an explanation of static and dynamic markers of fluid responsiveness and a description of the importance of heart–lung interaction in understanding fluid responsiveness. It provides a step-by-step guide to the different techniques available for assessment and looks closely at how this assessment varies according to whether the patient is spontaneously breathing or mechanically ventilated.
Signs and symptoms
Authors: Forsyth Rob , Newton Richard
Published: October 2017

This chapter addresses the diagnostic approach to the patterns of symptoms and signs commonly seen in the paediatric neurology clinic. It encourages pattern recognition. The presentations considered are: altered mental state (agitation/confusion); motor disorders (exercise limitation and muscle pain; eye or facial movement abnormalities; the floppy infant; a funny gait; weakness; unsteadiness or falls; toe-walking; disordered sensation, numbness, pain, dysaesthesia; deafness, loss or disturbance of hearing or vision; paroxysmal disorders (funny turns, loss of awareness, epilepsy, headache, movement disorders); developmental delay, impairment or regression, school failure; speech disturbance; behaviour disorder; symptoms that might suggest a spinal disorder such as back pain, incontinence, or scoliosis; other skeletal abnormality including abnormal skull size or shape, foot deformity; sleep disturbance.
Specific conditions
Authors: Forsyth Rob , Newton Richard
Published: October 2017

This chapter adopts a systematic approach to common diagnoses in paediatric neurology, aetiologies, management to include investigation and treatment, and outcome. For each condition current knowledge on cause and underlying biology is summarized. A rational approach to investigation and treatment is summarized for each topic. These include: acquired brain injury; autoimmune and autoinflammatory disease of the CNS; cerebral palsy and neurodisability which covers feeding, communication, special senses, and respiratory disease; demyelinating disease; epilepsy including its impact on daily life; non-epileptic paroxysmal phenomena; functional illness, illness behaviour; headache; hydrocephalus; spina bifida and related disorders; idiopathic intracranial hypertension; infection of the CNS; congenital infection; mitochondrial disease; movement disorders; neuromuscular disease which covers neuropathy, anterior horn cell disease, and myasthenic syndromes; neurocutaneous syndromes; neurodegenerative conditions; late presentations of metabolic disease; neurotransmitter disorders; sleep disorders; stroke and intracerebral haemorrhage; tumours of the CNS; and vitamin-responsive disorders.
Consultation with other services
Authors: Forsyth Rob , Newton Richard
Published: October 2017

This chapter discusses the common task of being asked by another paediatric specialty to review a child with neurological symptoms. It addresses common clinical scenarios and presents the principles of good practice. The specialties considered are cardiology, endocrinology, gastroenterology, neonatology, neurosurgery, oncology, intensive care, child psychiatry, nephrology, respiratory medicine, and rheumatology. Advice on causation and patterns of presentation is given along with cross-reference to information on investigation, treatment and outcome.
Physical Health and Schizophrenia (Oxford Psychiatry Library)
Authors: Castle David J. , Buckley Peter F. , Gaughran Fiona P.
Published: October 2017

The association between mental health and physical health forms the core of this book. While it is recognized that serious mental illnesses such as schizophrenia carry a reduced life expectancy, it is often assumed that suicide is the main cause of this disparity. But in actuality, suicide accounts for no more than a third of the early mortality associated with schizophrenia: the vast majority is due to cardiovascular factors. This book seeks to put this stark fact in context, detailing the extent of cardiovascular risk, sharing information regarding reasons for this excess, and outlining approved approaches for screening for and treatment of such risk factors in people with schizophrenia. As such, this book seeks to inform those caring for people with schizophrenia of these parameters and suggests ways in which they may be addressed, using a holistic model which embraces shared decision-making and which is compatible with the recovery framework. It provides guidance regarding monitoring as well as information about focused interventions that can help ameliorate risk. It also addresses those physical health factors apart from cardiovascular, that add to the burden of ill health amongst people with schizophrenia: pulmonary health, bone health, sexual health, and cancer risk are just some of these. In addition, the book provides patient and carer information material that can be used to try to ensure that all involved have a truly informed role in decision-making about their treatment and that both psychiatric and physical health issues are taken seriously.
Reasons for excess medical morbidity in schizophrenia
Authors: Castle David J. , Buckley Peter F. , Gaughran Fiona P.
Published: October 2017

This chapter asks why it is that people with schizophrenia are at such high risk for so many physical health maladies. The answers are complex and multidimensional, encompassing shared aetiological factors, schizophrenia-related factors, personal issues, and system issues. Research into these causes and their associations with each other is advancing and is able to inform appropriate therapeutic interventions. At an individual patient level, it is important for clinicians to appreciate how these factors can interact with each other in increasing risk, so that person-specific factors can be addressed. There is also potential for system-level changes to be informed by these understandings: such changes require an appreciation of the breadth of these issues and of the barriers that act to exacerbate underlying vulnerabilities.
Classification of Surgical Complications
Authors: Gonzalez Andrew , Kuy SreyRam
Published: October 2017

This landmark paper proposed a graded classification model for surgical complications and determined that there is a direct correlation between complication grade and patient length of stay. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.
Multivariable Predictors of Postoperative Surgical Site Infection after General and Vascular Surgery
Authors: Thompson Norris B , Kuy SreyRam
Published: October 2017

This landmark study proposed a model for predicting surgical site infections (SSI). Using logistic regression analysis, variables independently associated with increased risk of SSI were identified, which included smoking, alcohol use, comorbidities, disseminated cancer, weight loss greater than 10%, emergency surgery, and length of operative time. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.
Proving the Value of Simulation in Laparoscopic Surgery
Authors: McLean Kelly , Kuy SreyRam
Published: October 2017

This landmark study examined the value of simulation training in laparoscopic surgery. This study examining the MISTELS training program showed that inanimate laparoscopic simulators can be used to teach, practice, and assess basic laparoscopic skills prior to entering the operating room and performing surgery on live patients. The MISTELS simulation training program is the basis for the Fundamentals of Laparoscopic Surgery (FLS) program administered by Society of American Gastrointestinal and Endoscopic Surgeons. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.
Watchful Waiting versus Surgery for Inguinal Hernia
Authors: Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark study in hernia surgery. For men with minimally symptomatic inguinal hernias, does deferring surgical repair until symptoms develop lead to worse outcomes with respect to pain and physical function? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving inguinal hernia repair.
Minimally Invasive Approach to Infected Pancreatic Necrosis
Authors: Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark study in abdominal surgery. Does a minimally invasive, “step-up” approach to necrotizing pancreatitis reduce mortality and major complications as compared to open necrosectomy? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving a patient with infected pancreatic necrosis.
Bile Duct Injury in Laparoscopic Cholecystectomy
Authors: Steggerda Justin , Simms Eric , Burch Miguel
Published: October 2017

This chapter provides a summary of a landmark study in performance of laparoscopic cholecystectomy. Can we improve safety and reduce the risk of bile duct injury during laparoscopic cholecystectomy? Starting with that question, it provides information including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter reviews identified risk factors and describes technical aspects the authors identified to increase safety, notably defining the critical view of safety. The chapter also provides a brief critique, review of other notable studies, and concludes with a relevant clinical case regarding possible treatment of a patient with ERCP.
Minimally Invasive Parathyroidectomy versus Conventional Surgery for Primary Hyperparathyroidism
Authors: Kwon Rachel J.
Published: October 2017

This chapter provides a summary of a landmark study in endocrine surgery. Is minimally invasive parathyroidectomy better than conventional bilateral cervical exploration for the treatment of primary hyperparathyroidism with respect to cure rates and complication rates? Starting with that question, it describes the basics of the study, including year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case on minimally invasive parathyroidectomy.
Ranson’s Criteria for Acute Pancreatitis
Authors: Catanzaro Michael P.
Published: October 2017

This chapter provides a summary of a landmark historical study in surgery. It describes the history of pancreatitis, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: clinical decision rules. The management of pancreatitis has evolved from primarily a surgical disease to one in which operation is rarely undertaken, in part because stratification tools such as Ranson’s criteria have enabled more conservative management of those likely to have favorable outcomes. The development of Ranson’s criteria also paved the way for newer clinical scores that may have more discriminatory power.