bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival rate of cemented versus cementless tibial component in primary total knee arthroplasty over 5 years of follow-up: comparative study of 109 prostheses
Authors: Pacoret Victor , Kalk Etienne , Labattut Ludovic , Girardot Guillaume , Baulot Emmanuel , Martz Pierre
Published: September 2020

Introduction: Knee osteoarthritis is the main indication for primary total knee arthroplasty (TKA). It is now accepted that cementless implantation of the femoral component provides equivalent results to cemented one, however, the optimal fixation method of the tibial component remains controversial. The purpose of this study was to compare the survivorship of cemented versus cementless tibial baseplate in primary total knee arthroplasty.Materials and methods: We carried out a retrospective, monocentric study, including 109 TKA (Zimmer®Natural Knee II ultra-congruent mobile-bearing) implanted between 2004 and 2010 for primary osteoarthritis, comparing 2 groups depending on tibial component fixation method, one cemented (n = 68) and one cementless (n = 41). Clinical (Knee Society Rating System (KSS), Hospital for Special Surgery (HSS) scores, range of motion) and radiodiological outcomes were assessed at last follow-up with a minimal follow-up of 5 years.Results: Mean follow-up were 8.14 [5.31–12.7] and 8.06 [5.22–12.02] years, respectively, in cemented and cementless groups. The tibial component survival rate was 100% [95CI: 91.4–100] in the cementless group and 97.1% [95CI: 89.78–99.42] in the cemented group (2 aseptic loosenings) (p = 0.27). Radiolucent lines were present in 31.7% (n = 13) of the cementless and 44.1% (n = 30) of the cemented baseplates (p = 0.2). The postoperative KSS knee score was higher in the cementless group (99 ± 3 vs. 97 ± 7.5;p = 0.02), but there was no significant difference in KSS function, global KSS and HSS scores. Mean range of flexion was 120 ± 10° in the cementless group and 122.5 ± 15° in the cemented group (p = 0.37). No significant differences were found on the radiographic data or on complications.Conclusion: In this study, the survival rate of the tibial component is not influenced by its fixation method at a mean follow-up of 8 years in osteoarthritis, which confirms the reliability of cementless fixation in primary TKA.
Engineering photonics solutions for COVID-19
Authors: Soler Maria , Scholtz Alexis , Zeto Rene , Armani Andrea M.
Published: September 2020

As the impact of COVID-19 on society became apparent, the engineering and scientific community recognized the need for innovative solutions. Two potential roadmaps emerged: developing short-term solutions to address the immediate needs of the healthcare communities and developing mid/long-term solutions to eliminate the over-arching threat. However, in a truly global effort, researchers from all backgrounds came together in tackling this challenge. Short-term efforts have focused on re-purposing existing technologies and leveraging additive manufacturing techniques to address shortages in personal protective equipment and disinfection. More basic research efforts with mid-term and long-term impact have emphasized developing novel diagnostics and accelerating vaccines. As a foundational technology, photonics has contributed directly and indirectly to all efforts. This perspective will provide an overview of the critical role that the photonics field has played in efforts to combat the immediate COVID-19 pandemic as well as how the photonics community could anticipate contributing to future pandemics of this nature.
Clean environments as a social norm: a field experiment on cigarette littering
Authors: Sagebiel Julian , Karok Lukas , Grund Julian , Rommel Jens
Published: September 2020

Cigarette littering in public spaces is an environmental and aesthetic problem. Broken windows theory posits that visible signs of anti-social behavior such as littering create the perception of a social norm in built environments. Cigarette butts on the ground then encourage people to drop theirs as well. We test this theory on benches of a university campus in a field experiment with two treatments: (1) a clean environment with no cigarette butts on the ground and (2) a dirty environment with 25 cigarette butts on the ground. Our outcome variable is the number of additional cigarette butts on the ground after two hours. We find a small effect of approximately 0.5 butts less per 2-hour period on clean grounds. Increased cleaning efforts can thus reduce littering, but the effect is probably too small to justify additional cleaning costs.
Nanometric behaviour of monocrystalline silicon when single point diamond turned—a molecular dynamics and response surface methodology analysis
Authors: Abdulkadir Lukman N , Bello Ademola A , Bawa Mohammad A , Abioye Adekunle M
Published: September 2020

Hard and brittle materials such as silicon and silicon carbide are widely used in aerospace and integrated circuit. They are often poorly machined owing to non-linearity in machining process and complexities in selecting suitable machining parameters and tool geometry. The experimental difficulty involved in observing nanoscale physical phenomena (i.e. in-process measurement problems, inaccessible contact area of tool and workpiece, and the difficulty of surface analysis) has led to the use of molecular dynamics (MD) and response surface methodology (RSM) to investigate effect of tool edge radius, rake and clearance angles on monocrystalline silicon in this research. The response of subsurface deformation depth (SSD), tool temperature, kinetic friction cutting and thrust forces to tool edge radius, rake and clearance angles showed that SSD increased as the rake angle, edge radius and clearance angle increased while kinetic friction reduced as they increased. The increase in SSD as the clearance angle increased as observed in this study can be associated to the interactive/combined influence of the effects of both edge radius and rake angle.
The personalized antithrombotic management of atrial fibrillation with intermediate thromboembolic risk: a case report
Authors: Hammer Andreas , Schnaubelt Sebastian , Niessner Alexander , Sulzgruber Patrick
Published: September 2020

Background

So far there has been little evidence on the antithrombotic treatment of patients presenting with atrial fibrillation (AF) and a CHA2DS2-VASc score of 1 in men (2 in women). However, a recently published position paper suggests a personalized approach in weighing individual risk factors and considering additional patient characteristics and biomarkers for the decision for or against antithrombotic treatment in this intermediate-risk AF population.

Case summary

A 63-year-old male patient with a CHA2DS2-VASc score of 1 due to hypertension presents with a first episode of paroxysmal AF. The European Society of Cardiology (ESC) guidelines on the management of AF do not recommend a general antithrombotic therapy in those patients. Therefore, the decision for or against the initiation of oral anticoagulation (OAC) in the presented case is based on recent treatment recommendations of the ESC, that aim to guide clinicals through the question whether to anticoagulate or not.

Discussion

Oral anticoagulation in patients presenting with a CHA2DS2-VASc of 1 remains a challenging approach in clinical practice and physicians need to carefully balance the individual benefit of reducing thromboembolic risk with OAC against the potential harm due to an increase in bleeding risk in this patient population. The ESC provided an easily applicable approach for decision-making in patients with AF and a CHA2DS2-VASc score of 1 via consideration of additional risk factors, scoring tools, and established biomarkers. Of note, if an antithrombotic therapy is offered, non-vitamin K antagonist oral anticoagulants should be preferred over vitamin K antagonists based on the beneficial net clinical benefit.
Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices
Authors: Ahmed Fozia Zahir , Crosbie Carol , Kahn Matthew , Motwani Manish
Published: September 2020

Background

Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic.

Case summary

An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner.

Discussion

The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.
Case report: A fatal case of aortic and mitral valve endocarditis caused by Streptobacillus moniliformis
Authors: Winther Mette , Jensen Hanne Sortsøe , Harder Tarpgaard Irene , Nielsen Hans Linde
Published: September 2020

Background

Infective endocarditis (IE) secondary to rat-bite fever (RBF) is rare but potentially lethal. Rapid diagnosis is of utmost prognostic importance. However, the diagnosis of RBF is challenging because Streptobacillus moniliformis does not grow under conventional culture conditions.

Case summary

A 65-year-old male without previous cardiac history presented with sudden onset of balance problems and facial palsy. For 2 weeks, he had experienced intermittent fever and myalgia. Transoesophageal echocardiography (TOE) revealed severe mitral and aortic valve IE with aortic root abscess. The patient underwent a double biological valve replacement. Blood cultures remained negative after 9 days of incubation. However, sub-cultivation on solid media demonstrated the growth of pleomorphic Gram-negative rods, identified as S. moniliformis. After 4 weeks of antibiotic therapy, he was discharged. One month later, control TOE showed valve excrescences and aortic annular aneurysm. Despite comprehensive surgery, antibiotic treatment, and intensive care, the patient died 1 week after reoperation.

Discussion

A fatal outcome of S. moniliformis IE is rare. The majority of previous cases describe underlying valvular abnormalities or death due to insufficient antimicrobial therapy. Here, the patient had no prehistory of valvular heart disease and despite appropriate antibiotics, the outcome was fatal. Rapid diagnosis of RBF IE has prognostic implications. Identification of S. moniliformis is, however, difficult, because the bacterium is fastidious and does not grow under standard laboratory conditions. Therefore, diagnosis often relies on clinical symptoms or a history of rodent exposure. Close attention to this disease by clinicians, in addition to, dialogue with clinical microbiologists is essential.
FRAGILE: FRench Attitude reGistry in case of ICD LEad replacement
Authors: Alonso Christine , Marquie Christelle , Defaye Pascal , Clementy Nicolas , Mondoly Pierre , Sadoul Nicolas , Boveda Serge , Hidden-Lucet Françoise , Dompnier Antoine , Da Costa Antoine , Marijon Eloi , Leclercq Christophe , Caudron Guillaume , Piot Olivier , DEHARO Jean-Claude ,   “groupe Rythmologie—Stimulation cardiaque de la société française de cardiologie”
Published: September 2020

Aims

FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups.

Methods and results

Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.

Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient’s age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications.

Conclusion

In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient’s age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
Periods of Abelian Differentials With Prescribed Singularities
Authors: Le Fils Thomas
Published: September 2020

We give a necessary and sufficient condition for a representation of the fundamental group of a closed surface of genus at least $2$ to ${\mathbb{C}}$ to be the holonomy of a translation surface with a prescribed list of conical singularities. Equivalently, we determine the period maps of abelian differentials with prescribed list of multiplicities of zeros. Our main result was also obtained, independently, by Bainbridge, Johnson, Judge, and Park.
Residual Malaria: Limitations of Current Vector Control Strategies to Eliminate Transmission in Residual Foci
Authors: Rodriguez Mario H
Published: September 2020

The transmission of Plasmodium parasites in residual foci is currently a major roadblock for malaria elimination. Human activities and behavior, along with outdoor biting mosquitoes with opportunistic feeding preferences are the main causes of the inefficacy of the main vector control interventions, long lasting insecticide-impregnated nets and insecticide residual spraying. Several strategies to abate or repel outdoor biting mosquito vectors are currently being researched, but the impact of insecticide resistance on the efficacy of these and current indoor-applied insecticides requires further assessment. Understanding the human, ecological and vector factors, determining transmission in residual foci is necessary for the design and implementation of novel control strategies. Vector control alone is insufficient without adequate epidemiological surveillance and prompt treatment of malaria cases, the participation of endemic communities in prevention and control is required. In addition, malaria control programs should optimize their structure and organization, and their coordination with other government sectors.
Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID 19 healthcare workers
Authors: McKeeby Jon W , Siwy Christopher M , Revoir Josanne , Carlson Seth D , Joyce Maria D , Bailin Heike , Frank Karen M , Krumlauf Mike , Matlock Ann Marie , Lee Laura M , Sparks Mary , Barnes Tony , Liu Yenshei , Row Chung-Hee , Schmitt James M , Smith Danielle , Zelazny Adrian M , Lonnerdal Daniel , Coffey Patricia S
Published: September 2020

Assuring the safety of both patients and healthcare workers (HCWs) in hospitals has been the primary focus of every healthcare organization during the COVID 19 pandemic. This article discusses the NIH Clinical Center’s interdisciplinary approach to deploying an organizational Asymptomatic Staff Testing System.
The Family Caregiving Imperative
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Parnell Terri Ann
Published: September 2020

The majority of adults will develop or contract one or more chronic illnesses in the latter third of their lives. They will live protractedly with illness for years before death. About one in six Americans (adult aged, as there are no reliable numbers on caregivers under the age of 18) provide an estimated 37 billion hours of unpaid care to family or friends. This population of caregivers shoulders a heavy load with little support, putting their own health in peril. A description of the caregiving population, their tasks, and financial costs are detailed. The four most common chronic illnesses of dementia, cancer, diabetes, and heart disease are specifically examined from a caregiving perspective. An argument is presented that situates the patient and caregiver as one unit of care, prioritizing family communication as a key part of health communication and decision-making. The summative force of perceived, experienced, and anticipated communication for the caregiver with patient, providers, family, and system is described. Caregiver effectiveness and well-being can be improved through better communication and improved health literacy, which also improves patient outcomes. The integration of family illness narratives that situate the informal caregiver’s experiences are presented. Four featured caregiver stories are detailed and set the stage for a typology of caregivers, which will unfold across the volume.
Hallucinogens and Dissociatives
Authors: Rastegar Darius A.
Published: September 2020

Hallucinogens, also referred to as psychedelics, are a broad range of agents that alter perception in different ways. An estimated 1.3 million Americans are current (past month) users of hallucinogens. Hallucinogen use is highest among young adults; 3,4-methylenedioxymethamphetamine (MDMA) is the most commonly used agent, followed by lysergic acid diethylamide (LSD) and phencyclidine (PCP). Hallucinogens alter sensory perception and change the qualities of thought or emotion. PCP, MDMA, and LSD can be detected in urine drug tests. There appear to be few serious lasting complications associated with hallucinogen use. There are few data on the treatment of individuals who use hallucinogens or dissociatives.
Medical Care for Patients with Substance Use Disorders
Authors: Buresh Megan , Rastegar Darius A.
Published: September 2020

Primary care clinicians commonly encounter patients with substance use disorders and can provide effective treatment for their problems. Many of the medical complications associated with drug use are due to the use of needles; these include transmission of HIV and hepatitis C, soft tissue infections, and endocarditis. Harm reduction strategies reduce the harms associated with drug use without targeting use itself; these include syringe distribution, safe consumption facilities, naloxone distribution, and pre-exposure HIV prophylaxis. Patients on opioid agonist treatment may develop a number of problems, including hypogonadism, constipation, and psychomotor impairment; those on methadone may develop prolonged QT syndrome. Other issues include drug interactions, treatment of acute pain, and perioperative care. Treating pain in patients with substance use disorder can be complicated; for many, especially those with opioid use disorder, treatment with buprenorphine or enrollment in methadone maintenance is the best option.
Special Populations
Authors: Fingerhood Michael I.
Published: September 2020

There are a number of issues regarding substance use disorders (SUD) that are particular to certain populations. Adolescents tend to lack insight into problems that result from substance use. CRAFFT is a simple and reliable screening tool for SUD in adolescents. Treatment generally consists of counseling. Intimate partner violence is more common among women with SUD and those whose partners have SUD. During pregnancy, alcohol is the drug most damaging to the fetus. Treatment programs developed specifically for women may be beneficial. Most SUD in older adults are related to alcohol, but opioid use is increasing, with associated risk of overdose fatality. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals appear to be at increased risk for SUD. LGBTQ youth in particular have high rates of physical and sexual abuse, leading to high rates of opioid use disorder. Few programs specifically deliver LGBTQ-sensitive substance use treatment. At the time of incarceration, many arrestees test positive for illicit drugs or alcohol and perceive a need for treatment, but few receive it. Without medication for opioid use disorder while incarcerated, the risk of fatal opioid overdose soon after release is high. With regard to health professionals, the prevalence of alcohol use disorder is similar to that for the general population, although illicit drug use is less common. Medical societies have implemented programs to address SUD in the health professions.
Ethical and Legal Considerations
Authors: Fingerhood Michael I.
Published: September 2020

Providing care to individuals with substance use disorders raises legal and ethical issues. The two major legal issues are regulation of scheduled drugs and patient confidentiality. Many patients make poor choices; nevertheless, all deserve medical care incorporating the principles of ethical care. General ethical principles apply to the treatment of substance use disorders. These include autonomy, beneficence, nonmaleficence, justice, fidelity, and futility. Treatment of individuals with substance use disorders may create situations in which there is conflict or disagreement with clinicians. Effective strategies can help avoid or mitigate dilemmas. Drug testing, employment, and pregnancy raise specific legal and ethical issues.
Stimulants and Other ADHD Medicines
Authors: Ansari Arash , Osser David N.
Published: September 2020

The chapter on adult attention-deficit/hyperactivity disorder (ADHD) medicines discusses and reviews the use of psychostimulants (such as methylphenidate and amphetamines), and nonstimulants (such as atomoxetine, guanfacine, and clonidine). It reviews their mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects. It further reviews stimulants’ risk of misuse and dependence. The chapter also briefly discusses complementary and alternative pharmacotherapies. It includes an in-depth review of the clinical use of these medications for ADHD (particularly in college students) and for other psychiatric disorders (such as binge-eating disorder) and other medical disorders. It also discusses the use of ADHD medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of ADHD medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.
Phenomenology: a neuropsychiatric perspective
Authors: Trimble Michael
Published: September 2020

To understand the development of phenomenology, one must also understand the Kantian influence on pre-nineteenth-century continental philosophy, namely his distinction between the noumenon (the thing itself) and the phenomenon (the thing as it appears to us). This chapter explores the effects of phenomenology’s evolution on the field of psychiatry and then neuropsychiatry, following the pari passu shifts in Western culture and its prevailing philosophies. By examining the intellectual trajectories of philosophers, such as Edmund Husserl and Karl Jaspers, it traces the development of our understanding of consciousness, arguing Jasper’s ‘method-based psychiatry’, heavily reliant on the patient’s description of their experience, to be the best fit for neuropsychiatry, neither tied entirely to empirical neurology or the ‘Cartesian freely floating ego’ of conventional psychiatry.
Basic neuroanatomy review
Authors: Hart Jr John
Published: September 2020

Knowledge of basic neuroanatomic organization is essential to understanding cognitive anatomic correlations. This chapter provides a descriptive overview of the basic neuroanatomic structures in the human brain, with a particular emphasis on the structures that are associated with cognitive and behavioural functions. These structures include the lobes of the brain (frontal, parietal, occipital, and temporal), the subcortical nuclei (basal ganglia and thalamus), the white matter, and the limbic system. A conceptual framework is presented that can be utilized to organize the anatomical locations, as well as the interconnections between regions. It is noted that neuroanatomy is not easily learnt by reading a text because it is a three-dimensional set of relationships.
Structural imaging in neuropsychiatry
Authors: Kandasamy Naga , Niry Dana
Published: September 2020

This chapter looks into the imaging modalities available in clinical practice, with a brief note on the evolution of the commonly used imaging modalities and their clinical applications. Indications for imaging in neuropsychiatry, with typical examples of some commonly seen clinical conditions, are discussed, including imaging pitfalls and diagnostic dilemmas.
Neuropsychiatry of demyelinating disorders
Authors: Feinstein Anthony , Pavisian Bennis
Published: September 2020

Multiple sclerosis (MS) is the commonest cause of neurological disability in young and middle-aged adults. Given there is no cure, treatment is even more essential and all behavioural difficulties associated with MS are responsive to treatment, with the exception of euphoria. This chapter focuses predominantly on the behavioural syndromes known to present with MS, broaching them under two categories: cognition and mood/behaviour. For cognition, methods of detection and treatment are discussed, while the mood section is divided further by condition, exploring depression, bipolar affective disorder, euphoria, and the pseudobulbar affect. The chapter also makes reference to other, less common demyelinating disorders, such as neuromyelitis optica, central pontine myelosis, and Marchiava-Bignami syndrome.
Memory disorders and dementias
Authors: Cope Thomas E. , Isaacs Jeremy D. , Kopelman Michael D.
Published: September 2020

Memory disorders can be classified either as transient or persistent. This chapter provides a brief overview of transient neurological amnesias such as transient global amnesia (TGA) and transient epileptic amnesia (TEA), before moving on to persistent memory disorders, using vignettes to demonstrate the cognitive effects of conditions like Korsakoff syndrome and herpes encephalitis. The remainder of the chapter focuses on various forms of dementia, beginning with an exploration of the various types of Alzheimer’s disease and moving on to less common dementias, such as vascular cognitive disorder and variant Creutzfeldt–Jakob disease, with vignettes and sub-sections on management and prognosis. Dementias associated with movement disorders, such as corticobasal syndrome and spinocerebellar ataxia (SCA), are explored, followed lastly by various transient psychogenic amnesias, the basis of which is not neurological, but psychological.
Neuropsychiatry of alcohol-related brain damage
Authors: Wilson Ken
Published: September 2020

Like the liver, the brain is commonly affected by long-term alcohol misuse. While neurocognitive dysfunctions are widely known in their most extreme presentations, such as Korsakoff’s syndrome and Wernicke’s encephalopathy (WE), there are other less explicit manifestations of neurocognitive damage which occur more frequently. This chapter explores these conditions under the umbrella term ‘alcohol-related brain damage’ (ARBD), more specifically employing the term Wernicke–Korsakoff’s syndrome (WK) when referring to the acute and chronic effects of thiamine deficiency. The correlation between excessive alcohol consumption and thiamine intake is explored, along with the body’s response of boosting gamma-aminobutyric acid (GABA)–benzodiazepine and NMDA receptors. In acute and non-acute cases of ARBD, prompt diagnosis and treatment are essential due to the risk of long-term cognitive and intellectual damage it can yield. As such, psychosocial treatment in the aftermath of the clinical phase is equally important, focusing on assessment, therapeutic intervention, adjustment, and social integration.
ADHD in adults
Authors: Maltezos Stefanos , Whitwell Susannah , Asherson Philip
Published: September 2020

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by pervasive or impairing levels of inattention or hyperactivity. It is most comprehensively defined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria, which recognizes its clinical heterogeneity by grouping it according to three presentations: predominantly inattentive, predominantly hyperactive–impulsive, and combined subtypes. However, ADHD presentations can change significantly over time, most often presenting predominantly as hyperactive–impulsive in infants, with combined symptoms for children, and predominantly inattentive in the case of adults. This chapter focuses on the presentation of ADHD in adults, discussing the detrimental effects its various presentations can have on economic, educational, and social outcomes, before examining the systemic limitations of its recognition and treatment in certain countries. Finally, management and treatment methods are explored, for instance the administering of dopamine and noradrenaline reuptake inhibitors such as methylphenidate and atomoxetine, respectively, and the lack of data on their effectiveness in tackling ADHD comorbidities such as bipolar disorder and schizophrenia.
Catatonia
Authors: Fink Max
Published: September 2020

For more than a century, catatonia has been considered a marker of the Kraepelin/Bleuler concept of schizophrenia. However, over the past half-century, it has been increasingly recognized as a separate entity, independently diagnosable and treatable. This chapter explores the diagnosis, treatment, and biological underpinnings of catatonia. Initially, it lists certain motor behaviours whose presentation might indicate catatonia, according to the Catatonia Rating Scale (CRS) such as mutism, delirium, and repetitive rhythmic acts. Through the intravenous administration of certain drugs, such as benzodiazepines, barbiturates, or gamma-aminobutyric acid (GABA) agonists, the effect on the patient’s CRS score is used to confirm the diagnosis. The treatment history of catatonia prior to the discovery of the efficacy of benzodiazepines and induced grand mal seizures (electroconvulsive therapy) is broached, such as chemically induced seizures and amobarbital. Finally, its different presentations are discussed, along with its consideration as a biological fear response.
Apathy in neuropsychiatric conditions
Authors: Pahissa Jaime , Starkstein Sergio
Published: September 2020

Apathy is a frequent finding in both acute and chronic neurological conditions, and it is defined as a general reduction in motivation, as manifested by reduced goal-directed behaviours, cognitions, and emotions. This chapter reviews the frequency, diagnostic process, clinical correlates, and treatment of apathy in Alzheimer’s disease and traumatic brain injury, as examples of relevant chronic neurodegenerative and acute conditions, respectively.
Focal brain syndromes in neuropsychiatry
Authors: Shotbolt Paul
Published: September 2020

The idea that the brain’s different regions are responsible for specific functions was first described by François Chaussier in the eighteenth century, leading to the neuroscientific delineation of the lobes. This chapter goes on to describe the functions of different regions of the brain, before listing the neurological conditions which can result from damage to each region, such as spasticity and hyperreflexia from lesions on the medial prefrontal cortex, or Parkinson’s disease and Wilson’s disease from damage to the basal ganglia. Case studies are used to show the behavioural changes which can arise from such lesions and to demonstrate that similar groupings of psychiatric responses to lesions in different areas, paired with the rarity of truly focal brain lesions, make the process of anatomical localization more complicated with psychiatric conditions than neurological ones.
Neuropsychiatry services in Japan
Authors: Miyoshi Koho
Published: September 2020

This chapter deals with the neuropsychiatric service provision, training, career opportunities, particular issues in aged society, and scientific activities for understanding the situation of neuropsychiatry in Japan. The proportion of people aged 65 years and older in Japan reached the world’s highest at 21.0% in 2006. The elderly population has since increased persistently and is estimated at 27.1% of the total population. In addition to this, the ratios of people aged 75 years and over and those aged 85 years and over are estimated at 13.2% and 4.1%, respectively. The ‘oldest old ’ group has contributed to the increasing prevalence of dementia. According to the governmental survey, the estimated number of elderly persons with dementia was 2.80 million in 2010 and 3.45 million in 2015. It is predicted to increase to 4.1 million by 2020 and 4.7 million by 2035. The number of patients with major neuropsychiatric disorders, especially Alzheimer’s disease, vascular dementia, and Parkinson’s disease, has been increasing for the last two decades, and the needs for neuropsychiatric services are also rapidly increasing. Neuropsychiatric services consist mainly of provision of clinical diagnosis, based on clinical examination, and medical treatment for neuropsychiatric symptoms, i.e. psychiatric symptoms of neurological disorders. Neuropsychiatric services should be provided by neuropsychiatry specialists. There are approximately 13,000 psychiatrists and 8000 neurologists working in psychiatric hospitals, general hospitals, medical schools, and private clinics. However, the number of neuropsychiatry specialists is quite limited. Therefore, there is urgency for the Japanese Neuropsychiatric Association (JNA) to set up an appropriate training system for clinicians in order to remediate the shortage of neuropsychiatrists.
Neuropsychiatry services in Central, Southern, and Eastern Europe
Authors: Vargas Martín L. , Guekht Alla , Priller Josef
Published: September 2020

In order to promote international homogeneity of neuropsychiatric services and standards of practice, one must consider local historical perspectives. This chapter focuses on the variety of historical perspectives on neuropsychiatry between countries in Central, Southern, and Eastern Europe, focusing first on Central Europe, from its initial understanding with Hippocrates, through the inter- to post-war disciplinary fracture of neurology and psychiatry, to the eventual influence of the Anglo-American tradition in the latter half of the twentieth century that saw the fracture mended. Further connections between different cultural perspectives on neuropsychiatry are explored, such as the German tradition’s influence on neuropsychiatry in Franco’s Spain, and the impact of Pinel and Charcot’s nineteenth-century advances in the French school on Europe as a whole. Given the advance of globalization, an international paradigm is now needed for neuropsychiatry, which could help define the discipline and incorporate new integrative perspectives such as neurophenomenology and neuropsychoanalysis.
Finding and appraising evidence
Authors: Brice Anne , Burls Amanda , Hill Alison
Published: September 2020

Making good public health decisions requires integrating relevant local knowledge about your population with national guidance and best research evidence. However, public health research evidence is more diverse than clinical research and needs to be sought in a much wider range of information sources. Furthermore, evidence comes from a range of different study types, which adds a further challenge when assessing the quality of the research. This chapter has two aims. The first is to help you find research evidence efficiently, so that you can access the best, most relevant research evidence for your research query. The second is to help you make sense of research through the technique of critical appraisal, which is the systematic assessment of research evidence. Finding and appraising evidence is an essential skill in the process of improving the health of the population.
Disasters
Authors: Bolton Paul , Burkle Jr Frederick M.
Published: September 2020

After reading this chapter you will be familiar with a basic public health approach to disasters and other crises.
Media advocacy for policy influence
Authors: Chapman Simon , Freeman Becky
Published: September 2020

Many public health interventions are controversial or potentially controversial. The way the media handle such issues can strongly influence public and policy-maker attitudes towards them, and effective media advocacy can be a powerful way of taking forward public health initiatives. After reading this chapter, you should have a better understanding of: how the media deal with public health issues; how the framing of an issue influences whether and how it leads to changes in policy; what you can do when a public health issue is framed in an adverse or harmful way.
Controlling expenditures
Authors: Rice Thomas , Griffiths Chris
Published: September 2020

This chapter will help you understand: why controlling healthcare expenditures is key to achieving other public health goals; the primary reasons for rising expenditures; how rising expenditures have been addressed at national and subnational levels; ways in which controlling expenditures can fit into your professional role.
Health technology assessment
Authors: de Waure Chiara , Favaretti Carlo
Published: September 2020

The aim of this chapter is to help the public health practitioner to: learn what health technology assessment (HTA) is in healthcare and in public health domains; understand that HTA is a powerful tool for the governance of the healthcare systems at all their levels: macro (national and regional), meso (hospitals and healthcare services organizations), and micro (healthcare professionals); understand that HTA is a multidisciplinary, multidimensional and multistakeholder process; gain knowledge about how to develop an HTA report to support decision makers in taking the best possible decisions; know the main sources of data to base the assessment contents on evidence; recognize the role of HTA in public health
Effective negotiating
Authors: Marcus Leonard
Published: September 2020

The work of public health requires frequent decision making, problem solving, and transactions among people who have different stakes in the outcome. When authority is distributed among those people—such that no one stakeholder can make a unilateral and binding decision upon others— then that outcome is negotiated. Those negotiations involve exchanges in which the parties both contribute and glean expertise, resources, and information through the process. The tenor of the negotiation is often determined by the temperament, strategies, and desired outcomes that each of the stakeholders bring to the process. Are the negotiations collaborative or contentious? How are the parties framing the questions and issues to be resolved? What is each hoping to achieve, and might there be opportunities to reap mutual benefits?
Modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors
Authors: Hansen Dominique , Halle Martin
Published: September 2020

Physical activity (PA) and exercise training (ET) are highly effective in the prevention of cardiovascular disease (CVD) via improvement of cardiovascular risk factors (CV RFs), such as blood pressure (BP), lipid profile, glycaemic control, body fat mass, and inflammation. In the first part of this chapter, we describe the currently observed effects of PA and exercise intervention on these RFs. In the second part, we explain which exercise modalities should be selected to optimize these CVD RFs, especially for those patients with multiple CVD RFs.
Intervention for depression, anxiety, and stress in cardiovascular patients
Authors: Abreu Manuela
Published: September 2020

The strong influence of depression on adherence to treatment and the prognosis of coronary artery disease (CAD) is emphasized in the 2016 European Guidelines on the prevention of cardiovascular disease (CVD) in clinical practice and in the 2019 European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes. Therefore it is important that health professionals working in cardiac rehabilitation (CR) are aware of (a) the importance of depression on cardiac mortality, (b) the tools for diagnosis, and (c) the principles of treatment and their impact on prognosis in depressed cardiac patients. Treating depression has the potential to improve CV outcomes, and selective serotonin reuptake inhibitors (SSRIs) are the first-line antidepressants in coronary heart disease patients. However, it is essential to educate patients about side effects, to monitor them closely, and to be aware of interactions with other medications.
Classifying topological charge in SU(3) Yang–Mills theory with machine learning
Authors: Matsumoto Takuya , Kitazawa Masakiyo , Kohno Yasuhiro
Published: September 2020

We apply a machine learning technique for identifying the topological charge of quantum gauge configurations in four-dimensional SU(3) Yang–Mills theory. The topological charge density measured on the original and smoothed gauge configurations with and without dimensional reduction is used as inputs for neural networks (NNs) with and without convolutional layers. The gradient flow is used for the smoothing of the gauge field. We find that the topological charge determined at a large flow time can be predicted with high accuracy from the data at small flow times by the trained NN; for example, the accuracy exceeds $99\%$ with the data at $t/a^2\le0.3$. High robustness against the change of simulation parameters is also confirmed with a fixed physical volume. We find that the best performance is obtained when the spatial coordinates of the topological charge density are fully integrated out in preprocessing, which implies that our convolutional NN does not find characteristic structures in multi-dimensional space relevant for the determination of the topological charge.
E. MISHAN & SONS, INC (T/A EMSON) v HOZELOCK LTD
Authors:   Patents Court
Published: September 2020

Patents – European Patents – Expandable garden hoses – Infringement – Validity – Person skilled in the art – Common general knowledge – Construction – Whether tubes “unattached” between “couplers” – Meaning of “non-elastic” – Equivalents – Obviousness – Prior user – Inventor working in front garden – Whether what was visible was made available to the public – Commercial success – Burden of proof – Priority – “Formstein” defences
Association of Obesity With Maternal and Cord Blood Penicillin Levels in Women With Group B Streptococcus Colonization
Authors: McCoy Jennifer A. , Elovitz Michal A. , Alby Kevin , Koelper Nathanael C. , Nissim Itzhak , Levine Lisa D.
Published: September 2020

OBJECTIVE:

To compare maternal and cord blood penicillin concentrations in women with and without obesity who are receiving intrapartum group B streptococcus (GBS) prophylaxis.

METHODS:

We performed a prospective cohort study of term women receiving intrapartum penicillin prophylaxis for GBS colonization (determined by antenatal rectovaginal culture). The following outcomes were compared between obese (body mass index [BMI] 35 or higher at delivery) and nonobese (BMI less than 30 at delivery) groups: penicillin concentration in maternal blood (after two penicillin doses) and umbilical cord blood, GBS rectovaginal colonization status on admission and after two completed doses, and neonatal GBS colonization (using a postnatal ear swab). Fifty-five women were needed to detect a 0.75 SD difference in cord blood penicillin concentrations.

RESULTS:

Fifty-five women were enrolled and had all specimens collected; 49 had complete data for analysis (obese n=25, nonobese n=24). There was no difference in the median maternal penicillin concentration between groups (obese 4.2 micrograms/mL vs nonobese 4.0 micrograms/mL, P=.58). There was, however, a 60% lower median cord blood penicillin concentration in the obese compared with the nonobese group (2.7 micrograms/mL vs 6.7 micrograms/mL, respectively, P<.01), with no significant difference in time from last penicillin dose to delivery (obese 2.9 hours vs nonobese 1.7 hours, P=.07). The difference in cord blood concentrations remained significant after adjustment for nulliparity, hypertensive disorders, and time from last penicillin dose to delivery. Only 59.6% of women tested positive for GBS by rectovaginal culture on admission (obese 60.9% vs nonobese 58.3%, P=.86).

CONCLUSION:

The median cord blood penicillin concentration was 60% lower in neonates born to women with obesity compared with those born to women without obesity. However, all concentrations exceeded the minimum inhibitory concentration. Maternal penicillin levels were not significantly different between groups. More than 40% of women who previously tested positive for GBS by antenatal culture tested negative for GBS on admission for delivery.
Management of Fecal Incontinence
Authors: Brown Heidi W. , Dyer Keisha Y. , Rogers Rebecca G.
Published: September 2020

Nine percent of adult women experience episodes of fecal incontinence at least monthly. Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence. Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Fewer than 30% of women with fecal incontinence seek care, and lack of information about effective solutions is an important barrier for both patients and health care professionals. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low. This article provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician–gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons. The initial clinical evaluation of fecal incontinence requires a focused history and physical examination. Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment. Invasive diagnostic testing and imaging generally are not needed to initiate treatment but may be considered in complex cases. Most women have mild symptoms that will improve with optimized stool consistency and medications. Additional treatment options include pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and, for severely affected individuals for whom other interventions fail, colonic diversion.