bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Intracranial Vascular Lesions During Pregnancy
Authors: Renfrow Jaclyn J. , Zehri Aqib H. , Fargen Kyle M. , Singh Jasmeet , Wilson John A. , Wolfe Stacey Q.
Published: June 2018

Management of cerebral vascular lesions in pregnancy requires special consideration to an altered natural history in the pregnant patient, such as a higher rupture rate of arteriovenous malformations. Additionally, treatment challenges exist including radiation exposure, medication selection, optimal treatment timing, and modalities. If identified prior to a pregnancy most vascular lesions warrant a definitive treatment discussion to circumvent the risks associated with an intracranial hemorrhage during pregnancy. The treatment team consists of a multidisciplinary approach involving neurosurgeons, anesthesiologists, neurointensivists, and obstetricians.
Neurocutaneous Disorders in Pregnancy
Authors: Talati Asha N. , Hackney David N.
Published: June 2018

Neurocutaneous disorders are rare genetic conditions that can produce malformations of skin and various organ systems. During pregnancy, such conditions often require a specific course of management with coordinated care between neurology, obstetrics, and neonatology in order to promote best maternal and fetal outcomes. This chapter reviews the most common neurocutaneous conditions and best practices for management of these conditions in pregnancy. Neurocutaneous conditions discussed in this chapter include neurofibromatosis types I and II, Ehlers Danlos syndrome, Tuberous Sclerosis, Von Hippel Lindau syndrome, and Hereditary Hemorrhagic Telangiectasia. For each condition, brief overviews of disease manifestation followed by a summary of recommendations for pregnancy care path are provided.
Approach to Delivery in the Patient with Neurologic Disease
Authors: Link Heather M. , Pressman Eva K.
Published: June 2018

This chapter focuses on delivery considerations for patients with intracranial masses, spinal cord injuries, CNS vascular abnormalities, and neuromuscular disorders. Special attention is paid to issues regarding pre-delivery planning, optimal timing of delivery, preferred mode of delivery, initial assessment on labor and delivery, and postpartum considerations. For patients with neurologic disorders in pregnancy data regarding optimal mode of delivery is often limited due to the rare nature of some conditions. This chapter highlights the most recent evidence and strongly emphasizes the need for a multidisciplinary approach with close collaboration between anesthesiology, neurology, and neurosurgery to achieve optimal pregnancy outcomes.
Anesthetic Considerations for Neurologic Patients
Authors: Kreso Melissa , Gloff Marjorie , Wissler Richard
Published: June 2018

Women with neurologic conditions present unique challenges for the anesthesiologist during pregnancy and in the peripartum period. Many of these conditions have low prevalence, and many management decisions are guided by retrospective reviews and case reports. Although the details of management of each specific disease will be discussed elsewhere, by increasing understanding of anesthetic management issues for parturients with neurologic diseases, all providers can effectively optimize care plans and anticipate anesthetic considerations to assure safety during labor and delivery.
Perinatal Depression in Neurological Disease and Disability
Authors: Bjørk Marte Helene , Eberhard-Gran Malin
Published: June 2018

Women and men with neurological disease more often suffer from depression in relation to pregnancy and delivery than other parents. Perinatal depression may harm the parent-child relationship as well as the health of the child. Postnatal psychosis, suicide, and infanticide are rare but severe consequences of the disorder. Symptoms of perinatal depression may overlap with symptoms of neurological disease. Both disorders may aggravate each other. Side effects from neurological treatment could mimic symptoms of depression, and antidepressive drugs could worsen neurological symptoms and interact with other treatment. Neurological patients should be evaluated for risk factors for perinatal depression before delivery. These include previous psychiatric disease, sexual or psychical abuse, sleep problems, high neurological disease activity, and low social support. Pregnant women with previous psychotic episodes or bipolar disease should be referred for psychiatric evaluation before delivery. All patients should be screened for depressive symptoms during follow-up using a 3-step method.
Breastfeeding in the Context of Neurological Disorders
Authors: Lawrence Ruth A. , Rosen-Carole Casey
Published: June 2018

Lactation is the physiologic process of milk production and the completion of the pregnancy cycle. The goal for all pregnancies should be to support and encourage women to breastfeed, as the benefits to both mother and infant are well established. However, when managing pregnancy and lactation with a woman who also has a neurological disorder, it is essential to understand the impact on lactation of both the disease and the medications for treating the disease. Ideally disease control can be optimized and medications altered to reduce any negative influence on the mother or infant during lactation. Although neurologic disease does not typically interfere with breastfeeding, limited mobility, fatigue, decreased sensation, medications, and surgeries may add additional challenges for the breastfeeding woman with a neurologic condition. The goal of the neurologist, obstetrician, pediatrician, and lactation consultant should be to support and encourage breastfeeding, while minimizing the risk of medications for the infant.
Basic Clinical Syndromes and Definitions
Authors: Pendurthi Aparna , Mokin Maxim
Published: June 2018

The goal for neurological evaluation in the Emergency Department is to appropriately route potential acute stroke patients toward medical or surgical interventions in the most expedient manner possible. This chapter focuses on familiarizing the reader with main stroke subtypes and clinical manifestations associated with specific syndromes. Acute neurologic episodes being evaluated in the emergent setting for stroke workup can be divided into broad categories based on duration of symptoms, clinical presentation, and findings from basic imaging. This chapter explores the most common of these stroke syndromes and discusses the classification and clinical characteristics of transient ischemic attacks and ischemic and hemorrhagic strokes.
ADHD and substance misuse
Authors: Wilens Timothy , Carrellas Nicholas , Biederman Joseph
Published: June 2018

There has been great interest in the overlap between ADHD and substance use disorder (SUD). ADHD is a common neurobehavioural disorder of childhood that places the individual at elevated risk for later SUD. Studies have shown that 25–40% of adults and adolescents with SUD have ADHD. Although the exact link between the two disorders is still unclear, it appears their connection is complex, and involves the interplay between various biological, behavioural, and genetic factors. Early pharmacotherapy of ADHD does not increase SUD, and, in fact, appears to reduce cigarette smoking and SUD. In individuals with ADHD and SUD, stabilization of SUD is recommended initially, with consideration of adjunct non-stimulant and extended release stimulant medications. More research on the mechanisms of overlap between the disorders, preventative effects of early ADHD treatment on SUD, and concurrent treatments for ADHD and SUD are necessary.
Children and adolescents
Authors: Danckaerts Marina , Coghill David
Published: June 2018

ADHD is a common neurodevelopmental disorder that is underrecognized and underdiagnosed in many parts of the world but overdiagnosed in others. As there are presently no biological tests or markers available to support the diagnostic process, the cornerstone of case identification remains the clinical interview and assessment. Evidence suggests that a structured approach to assessment can foster good clinical practice and facilitate building a treatment plan that can be adequately monitored over time. Whilst there are several evidence-based clinical guidelines that describe the assessment process, these are not used in routine clinical practice as regularly as they should. This chapter describes the elements of a structured approach to assessment, including commentary on recognition, the clinical interview, observation, school information, questionnaires, diagnostic formulation, and cognitive and somatic examination. Special attention is needed to assess comorbidities and with special populations such as those in preschool and with intellectual impairments.
Behavioural therapy in adolescents and adults
Authors: Lam Alexandra Philomena , Philipsen Alexandra
Published: June 2018

Many different kinds of group or individual psychotherapeutic interventions, applied to the special needs of patients with ADHD, already exist (e.g. cognitive–behavioural therapy [CBT], coaching, problem-focused therapy, meta-cognitive training, mindfulness-based interventions, psychoeducation, and dialectical behaviour therapy [DBT]-based cognitive therapy). Most of these treatments are behaviourally orientated, and are predominantly modularly structured. CBT has been investigated most frequently and is regarded as the most effective psychological treatment option. The National Institute for Health and Care Excellence guidelines recommend CBT as appropriate for adolescents with moderate impairments and for adults, i.e. if drug treatment has proved to be only partially effective or ineffective. Interventions treating adolescents with ADHD are frequently based on CBT principles, behavioural therapy approaches, and cognitive and social skills training techniques addressing the patient, parents, or teachers. Unfortunately, interventions for adolescents have been investigated on a comparatively limited scale.
Neurofeedback
Authors: Holtmann Martin , Albrecht Björn , Brandeis Daniel
Published: June 2018

Neurofeedback of specific brain activity patterns allows perceiving and learning to gain control over these otherwise unaware neuronal processes. Neurofeedback may improve underlying neuronal deficits, and/or establish more general self-regulatory skills for compensating behavioural difficulties in other domains. Treating ADHD is the most common clinical neurofeedback application. Standard neurofeedback protocols based on electroencephalography train self-regulation of oscillatory activity in certain frequency bands (targeting theta/beta ratio) or slow cortical potential shifts. Both protocols have demonstrated promising outcomes, particularly in improving inattention symptoms, although controlled effects remain heterogeneous and often attenuated in blinded ratings. Further randomized controlled and (as far as possible) blinded evaluation studies are needed for better understanding of the mode of action and to establish robust standard training protocols for routine care. In the current state of evidence, neurofeedback can be recommended as part of a multimodal treatment of ADHD.
ADHD and school
Authors: Merrell Christine , Sayal Kapil
Published: June 2018

Within the school environment, teachers are well placed to identify children who exhibit ADHD symptoms. Universal school-based screening for ADHD is, however, not recommended. Teachers’ ratings of children’s behaviour at age 5 have been found to predict later academic outcomes. Longitudinal research suggests that inattention is substantively and significantly associated with poor academic outcomes whereas hyperactivity is not significantly related to later academic attainment, and impulsivity might be advantageous. Symptoms of inattention remain largely stable over time but symptoms of hyperactivity and impulsivity change. Whilst the school environment can present significant challenges for children with ADHD, advice and guidance to teachers about how to help children with inattentive, hyperactive, and impulsive behaviour to succeed in the classroom can facilitate more positive behavioural and academic outcomes. There is a need for research that assesses long-term outcomes and cost-effectiveness of school-based interventions as well as the impact of transition into secondary schooling.
Communicating concerns in healthcare
Authors: Flynn Maria , Mercer Dave
Published: June 2018

Every nurse is accountable for their decisions and actions. It is a professional responsibility, and statutory duty, to uphold the human rights of people for whom they care. This part of their role is often referred to in terms of ‘advocacy’ and ‘safeguarding’. On occasion, nurses will likely be faced with the need to express their concerns about aspects of care/treatment or suspected neglect/abuse of vulnerable people in a range of care settings. These might be in relation to perceived organizational shortcomings or failures, or specific to the circumstances of one person. In taking action, it is important that nurses adhere to local policies and follow appropriate channels of communication. This chapter focuses on two contemporary social and healthcare concerns where there is the potential for criminal justice involvement|—‘hate crime’ and ‘elder abuse’.
Neurological conditions
Authors: Flynn Maria , Mercer Dave
Published: June 2018

The nervous system’s central role in all human functions means that neurological disorders often directly impact on other body systems, so the management of neurological conditions is a complex and specialized area of nursing practice. People with neurological disorders will normally be cared for by specialist clinical teams working in neurological or neurosurgical units or spinal centres. However, general adult nurses will come into contact with people who have a collection of symptoms suggesting a neurological disorder, and they are highly likely to encounter people who are living with dementia. It is therefore important that general adult nurses can recognize neurological changes and communicate effectively with people who have disorders of the brain or nervous system. This chapter outlines key facts about neurological conditions which are likely to be useful to the general nurse. These include an overview of conditions, clinical examinations, and key nursing considerations. A summary of frequently prescribed medicines is also presented.
Pain
Authors: Flynn Maria , Mercer Dave
Published: June 2018

It is widely recognized that the experience of pain is unique to the individual, which makes caring for people in pain a challenge. The general hospital nurse is most likely to see people in pain due to an acute injury, an episode of ill health, following surgery, or at a wound dressing change. People living with chronic pain conditions will most often be in the care of community nurses or specialist pain management teams. In both acute and chronic pain conditions, it is important that general nurses can accurately assess, monitor, and treat pain. This chapter identifies the key features of acute and chronic pain and describes pain assessment tools which are in widespread use. It outlines common pharmacological and non-pharmacological approaches to pain management, along with a summary table of frequently prescribed pain medications. Key considerations in nursing practice and decision-making are outlined.
Teamwork
Authors: Flynn Maria , Mercer Dave
Published: June 2018

The importance of teamworking has been long established in healthcare, with nurses working both as part of a nursing team and as members of the wider multidisciplinary team. The effective organization and delivery of healthcare services depends upon a wide range of health professionals, patients, families, and carers working together to achieve the best health outcomes and quality of life. Whether healthcare is necessary for an acute illness episode, helping someone with a long-term health condition achieve an acceptable level of function, or supporting a person who is dying, placing people at the centre of care decisions demands effective teamworking. Understanding the nature and characteristics of teams can help nurses to work effectively and uphold professional caring values when working with people in any healthcare setting. This chapter outlines the key definitions and characteristics of teamworking.
Patient and public involvement in healthcare
Authors: Flynn Maria , Mercer Dave
Published: June 2018

The impulse for patient and public involvement (PPI) in health services reflects wider societal and policy concerns with citizenship and democratic participation. A consumerist turn in health policy has opened the door to advances in involvement initiatives, with nurses often playing a lead role. These involvement practices have developed in the interlinked areas of nursing practice, research, and education. Effective involvement is predicated upon emancipatory values and, as such, involvement practices are concerned with prevailing power relations. The actual form that involvement takes can be thorough, systematic, and empowering or partial, tokenistic, and subsumed under oppressive governance systems. Ultimately, involvement poses key questions for professional nursing identity, allowing for a re-imagining of professionalism that is essentially democratized and cooperative.
Overview
Authors: Cascarini Luke , Schilling Clare , Gurney Ben , Brennan Peter
Published: June 2018

This chapter discusses an overview of oral and maxillofacial surgery, including, UK Legal aspects, duties of an OMFS junior, the future of OMFS, and the Career pathways in OMFS
Behavioural Neurology of Anti-epileptic Drugs
Authors: Cavanna Andrea E.
Published: June 2018

The Behavioural Neurology of Antiepileptic Drugs is the first clinically oriented reference book on the use of antiepileptic drugs with a focus on their behavioural effects in both patients with epilepsy and patients with primary psychiatric conditions. This book provides a pocket-sized guide to assist neurologists in the use of antiepileptic drugs when treating patients with epilepsy and associated behavioural problems. Psychiatrists treating patients with affective, anxiety, and psychotic disorders will also find this compendium on the behavioural aspects of antiepileptic drugs as a useful tool for their clinical practice. The book is organized alphabetically by antiepileptic drug for easier information gathering, enabling physicians to use the text as a standalone reference in busy clinical settings, such as specialist epilepsy clinics or general psychiatry ward rounds. Particular care was taken in covering the breadth of medications used in modern epilepsy and psychiatry practice, including each drug’s indications, contra-indications, side-effects and important interactions. The underlying pharmacology is also presented to provide a quick refresher and background on the underlying mechanisms. Practical aspects related to prescribing and therapeutic drug monitoring are covered following the most up-to-date evidence based guidance. Each drug monograph closes with a section providing a visual rating in terms of antiepileptic indications, behavioural tolerability, interactions in polytherapy, and psychiatric use, again drawing on the existing evidence. A selected reference list is included to provide readers with the primary sources for clinically-relevant information presented in a concise way within each chapter.
Carbamazepine, oxcarbazepine, and eslicarbazepine
Authors: Cavanna Andrea E.
Published: June 2018

Carbamazepine is a first-generation antiepileptic drug characterized by a good range of antiepileptic indications, with acceptable risk of interactions in polytherapy. Carbamazepine has a very good behavioural tolerability profile and is in widespread psychiatric use (indication for bipolar disorder—acute mania). Oxcarbazepine and eslicarbazepine are carbamazepine derivatives. Oxcarbazepine is a second-generation antiepileptic drug characterized by a good range of antiepileptic indications, with acceptable risk of interactions in polytherapy. Like carbamazepine, oxcarbazepine has a very good behavioural tolerability profile and potential for widespread psychiatric use. Eslicarbazepine is a third-generation antiepileptic drug for which clinical experience is still limited. Little is known about its positive and negative psychotropic properties and their implications for the management of behavioural symptoms in patients with epilepsy.
Gabapentin
Authors: Cavanna Andrea E.
Published: June 2018

Gabapentin is a second-generation antiepileptic drug characterized by few antiepileptic indications, with very good interaction profile in polytherapy. The therapeutic indications of gabapentin for the treatment of epileptic seizures have been largely overshadowed by its widespread use for the treatment of neuropathic pain (especially post-herpetic neuralgia, diabetic neuropathy, and pain caused by a spinal cord injury). Gabapentin has a good behavioural tolerability profile and a good range of psychiatric uses (unlicensed indications for anxiety disorders and alcohol withdrawal symptoms). Despite the widespread use of gabapentin for behavioural conditions, its potential usefulness as adjunctive treatment of bipolar affective disorder is still controversial.
Phenytoin
Authors: Cavanna Andrea E.
Published: June 2018

Phenytoin is a first-generation antiepileptic drug characterized by a good range of antiepileptic indications, with an acceptable interaction profile in polytherapy. The reasons for the decreased use of phenytoin in patients with epilepsy include its narrow therapeutic index and potential for long-term toxicity, as well as the development of other antiepileptic drugs throughout the second half of the twentieth century. Phenytoin has a good behavioural tolerability profile and a restricted range of psychiatric uses. Despite occasional reports of adverse behavioural effects (especially at higher doses), there is some weak evidence for its potential usefulness as mood stabilizer and in the pharmacological management of impulsive aggression.
Comparative evidence and clinical scenarios
Authors: Cavanna Andrea E.
Published: June 2018

By bringing together the available information from the use of individual antiepileptic drugs in patients with epilepsy, it is possible to derive some preliminary comparative evidence about their positive and negative psychotropic properties, as well as their implications for the management of behavioural symptoms in this patient population. These findings often match the available evidence supporting the use of antiepileptic drugs for the treatment of patients with primary psychiatric symptoms. Expertise on the relative advantages/disadvantages of each antiepileptic drug in different clinical situations requires up-to-date knowledge about the behavioural and cognitive effects of these medications (a task made increasingly more difficult by the rapid expansion of the field) .
Clinical Imaging of the Spine
Authors: Safriel Yair
Published: June 2018

Spinal conditions are one of the most common situations necessitating a referral for imaging. As spine therapies advance, there is a greater need for accurate spine imaging. There are four primary modalities used to image the spine: radiography, magnetic resonance imaging, computed tomography, and nuclear imaging. The most important fact to remember is that these modalities are often complementary rather than mutually exclusive. The appropriate use of spine imaging is an evolving topic. Imaging that involves ionizing radiation should be used judiciously. Understanding the intricacies of imaging may allow the physician to make an optimal choice.
Cervical Facet Dysfunction
Authors: Amin Sandeep
Published: June 2018

Cervical facet dysfunction poses a diagnostic and therapeutic dilemma in patients with axial neck pain due to either degenerative changes or whiplash injuries as it presents with a paucity of diagnostic radiologic or examination findings. The specific orientation of the cervical facet joints renders them particularly vulnerable to whiplash injury. This chapter examines the clinically relevant anatomy with nuances unique to the cervical spine, etiology of the structural changes, diagnostic tools, and treatment of cervical facet dysfunction. Understanding the relevant anatomy and referral patterns of cervical facet joints allows for more targeted diagnosis and treatment. There are strong evidence-based options in the treatment of cervical facet joint dysfunction.
Thoracic Facet Dysfunction/Costotransverse Joint Pathology
Authors: Young Brian A. , Sizer Phillip S. , Day Miles
Published: June 2018

The thoracic facet and costotransverse joints are often implicated as the source of thoracic pain, yet definitive diagnostic and treatment guidance is significantly limited. This chapter reviews the anatomy, innervation, and biomechanics of these joints, as well as associated pathology. Definitive innervation of the posterior primary rami has yet to be established, and significant pain pattern overlap between the thoracic facet joint, costotransverse joints, and visceral referral patterns, as well as the limitations of current biomechanics, challenge the clinician’s ability to examine pain of suspected thoracic origin. The use of clinical reasoning in the absence of definitive diagnostic and treatment approaches is necessary to optimize outcomes in patients with pain of suspected thoracic musculoskeletal origin. A progression from noninvasive to minimally invasive to interventional techniques may be warranted based on the patient’s response to treatment.
Surgical Approaches for Degenerative Lumbar Stenosis
Authors: Drazin Doniel , Lagman Carlito , Piper Christine , Kappel Ari , Kim Terrence T.
Published: June 2018

This chapter discusses the evaluation of patients presenting with low back pain and the surgical management of three common causes of low back pain in adults: stenosis, spondylolisthesis, and scoliosis. Components of the history and physical examination, diagnostic imaging, and ancillary studies are reviewed. Surgical management includes decompression including laminectomy or laminotomy, and instrumented fusion. Indications, contraindications, general procedural steps, and potential complications are covered. Recent published literature is reviewed when appropriate.
Pelvic Pain and Floor Dysfunction
Authors: Sarno Danielle , Hameed Farah
Published: June 2018

Chronic pelvic pain is defined as persistent pain perceived in structures related to the anatomic pelvis (lower abdomen below the umbilicus) of either women or men for greater than 6 months. The etiology may be related to gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic causes. Pelvic pain and floor dysfunction often are associated with a musculoskeletal disorder related to the pelvic girdle, spine, or hip. Myofascial pelvic pain may be related to other diagnoses, such as depression, irritable bowel syndrome, endometriosis, constipation, painful bladder syndrome, and chronic urinary tract infections. A thorough history and clinical examination, including an internal pelvic floor musculoskeletal examination, can help identify the underlying etiology. A multidisciplinary approach to management is essential. Pelvic floor physical therapy plays an integral role. Other treatments, such as medications, complementary therapies, and injections, may be used in conjunction with physical therapy to facilitate a comprehensive rehabilitation program and manage symptoms.
Spinal Cord Stimulation
Authors: Petersen Erika A.
Published: June 2018

Spinal cord stimulation is an effective strategy for managing chronic neuropathic pain that is refractory to other medical treatment. Proper patient selection and fastidious technique are essential to good outcomes. Electrodes can be placed through both percutaneous and laminotomy approaches. Care should be taken to minimize the risks of spinal electrode implantation: infection, neurologic injury, device migration, and device malfunction. Technological innovation and applications continue to improve rapidly, affording more options for treatment.
A Novel Approach Using Computed Tomography Angiograms to Predict Sternotomy Or Complicated Anastomosis in Patients Undergoing Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass
Authors: Cook Richard C. , Fung Anthony Y. , Percy Edward D. , Mayo John R.
Published: June 2018

Objective

Robotically assisted minimally invasive direct coronary artery bypass is an alternative to sternotomy-based surgery in properly selected patients. Identifying the left anterior descending artery when it is deep in the epicardial fat can be particularly challenging through a 5- to 6-cm mini-thoracotomy incision. The objective of this study was to evaluate a technique for predicting conversion to sternotomy or complicated left anterior descending artery anastomosis using preoperative cardiac-gated computed tomography angiograms.

Methods

Retrospective review of 75 patients who underwent robotically assisted minimally invasive direct coronary artery bypass for whom a preoperative computed tomography angiogram was available. The distance from the left anterior descending artery to the myocardium was measured on a standardized “5-chamber” axial computed tomography view. The relative risk of sternotomy or complicated anastomosis was compared between patients whose left anterior descending artery was resting directly on the myocardium (left anterior descending artery to the myocardium distance = 0 mm) with those whose left anterior descending artery was resting above (left anterior descending artery to the myocardium distance > 0 mm).

Results

The average left anterior descending artery to the myocardium distance was 3.2 ± 2.6 mm (range = 0–11.5 mm). Fourteen patients (18.7%) had an left anterior descending artery to the myocardium distance of 0 mm. Of the entire group of 75 patients, 6 (8.0%) required conversion to sternotomy. Four others (5.3%) were reported to have a complication with the anastomosis intraoperatively. For patients with left anterior descending artery to the myocardium distance of 0 mm, the relative risk of sternotomy or complicated anastomosis was 18.0 (95% confidence interval = 4.3–75.6, P = 0.0001).

Conclusions

In our experience, patients with left anterior descending artery to the myocardium distance of 0 mm were at significantly higher risk of either conversion to sternotomy or technically challenging anastomosis, with 8 (57.1%) of 14 patients in this group experiencing either end point. This novel measurement may be useful to identify patients who may have anatomy, which is not well suited to the robotically assisted minimally invasive direct coronary artery bypass approach.
Adjunct Aripiprazole Reduces Prolactin and Prolactin-Related Adverse Effects in Premenopausal Women With Psychosis
Authors: Kelly Deanna L. , Powell Megan M. , Wehring Heidi J. , Sayer MacKenzie A. , Kearns Ann Marie , Hackman Ann L. , Buchanan Robert W. , Nichols Rebecca B. , Adams Heather A. , Richardson Charles M. , Vyas Gopal , McMahon Robert P. , Earl Amber K. , Sullivan Kelli M. , Liu Fang , Luttrell Sarah E. , Dickerson Faith B. , Feldman Stephanie M. , Narang Supriya , Koola Maju M. , Buckley Peter F. , RachBeisel Jill A. , McEvoy Joseph P.
Published: June 2018

Purpose/Background

Prolactin-related adverse effects contribute to nonadherence and adverse health consequences, particularly in women with severe mental illness. Treating these adverse effects may improve treatment acceptability, adherence, and long-term outcomes.

Methods/Procedures

Premenopausal women with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder were recruited for a randomized, double-blind, placebo-controlled 16-week trial of adjunct aripiprazole (5–15 mg/d). Participants had elevated prolactin (>24 ng/mL) and were experiencing galactorrhea, amenorrhea, oligomenorrhea, or sexual dysfunction on a prolactin-elevating antipsychotic. Participants were evaluated biweekly for prolactin elevation and galactorrhea and completed a menstrual diary review. Psychiatric symptoms and adverse effects were closely monitored.

Findings/Results

Forty-six women were randomized (n = 25 aripiprazole, n = 21 placebo). Thirty-seven completed at least 8 weeks of the study (n = 20 [80%] aripiprazole and n = 17 [81%] placebo). Aripiprazole (mean dose, 11.7 ± 2.4 mg/d) was effective for lowering prolactin relative to placebo (P = 0.04). In addition, 45% (9/20) of the aripiprazole group had a normalized prolactin (<24 mg/mL) compared with 12% (2/17) of the placebo group (P = 0.028). Galactorrhea resolved in 77% (10/13) of the aripiprazole-treated participants compared with 33% (4/12) in the placebo group (P = 0.028). Normalization of sexual function (<16 on the Arizona Sexual Experience Scale) occurred in 50% on aripiprazole (7/14) versus 9% (1/11) on placebo (P = 0.030). No differences between groups in symptoms or adverse effects were noted. Overall, women rated a mean score of 4.6 ± 0.6 on a 5-point Likert scale for sexual function improvement, suggesting their particular satisfaction with improvement in this domain.

Implications/Conclusions

Building upon prior studies, this rigorous evaluation confirms the utility of adjunctive aripiprazole as a strategy for improving prolactin and managing prolactin-related adverse effects in premenopausal women with psychosis.
A Preliminary Examination of the Effects of Transdiagnostic Versus Single Diagnosis Protocols on Anger During the Treatment of Anxiety Disorders
Authors: Cassiello-Robbins Clair , Sauer-Zavala Shannon , Wilner Julianne G. , Bentley Kate H. , Conklin Laren R. , Farchione Todd J. , Barlow David H.
Published: June 2018

Dysregulated anger is often present in the emotional (i.e., anxiety, mood, and related) disorders; however, it is rarely targeted in treatment. Transdiagnostic treatments, which focus on processes that contribute to dysregulated emotions across the range of psychopathology, might represent an efficient way to treat this anger. Using a subset of data from a recently completed equivalency trial comparing the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to single diagnosis protocols (SDPs) for specific disorders, this study began exploring whether the UP led to great reductions in anger compared with the SDPs. Results indicated that there was a small, nonsignificant, decrease in anger in the UP condition, whereas there was a moderate, nonsignificant increase in anger in the SDP condition. At posttreatment, UP patients had significantly lower anger scores than patients who received an SDP. These preliminary results suggest that transdiagnostic treatments may be well poised to target dyregulated anger in the context of emotional disorders.
Vestibular Rehabilitation Is Associated With Visuovestibular Improvement in Pediatric Concussion
Authors: Storey Eileen P. , Wiebe Douglas J. , D'Alonzo Bernadette A. , Nixon-Cave Kim , Jackson-Coty Janet , Goodman Arlene M. , Grady Matthew F. , Master Christina L.
Published: June 2018

Background and Purpose:

Vision and vestibular-related deficits are common after concussion and are associated with prolonged recovery times, substantially impacting the quality of life for children. The utility of targeted vestibular rehabilitation for these deficits in children after concussion is unknown. The purpose of this study was to determine whether active vestibular rehabilitation is associated with an improvement in visuovestibular signs and symptoms in children with concussion.

Methods:

A retrospective cohort study of children diagnosed with concussion and referred to vestibular rehabilitation between 2012 and 2014 was conducted. Patient-reported symptoms and visuovestibular performance measures were assessed in the medical practice and physical therapy settings.

Results:

One hundred nine children were included in the study with a mean age of 11.8 (3.4) years. Among this group, 59 (54%) were male and 48 (44%) had a sports-related concussion. Children presented to a pediatric sports medicine office and physical therapy a median of 24 (interquartile range [IQR], 14-42) and 55 (IQR, 39-94) days after injury, respectively. Concussion symptoms decreased from a median of 9 (IQR, 5-13) symptoms at initial evaluation to a median of 0 (IQR, 0-2) symptoms at final assessment. Performance on all visuovestibular tasks improved significantly over the course of therapy except for near point of convergence. For the 45 children who completed the Balance Error Scoring System at both initial and final therapy visits, there was a significant improvement in mean level of performance (P< 0.0001). Characteristics between those who completed a full versus partial course of physical therapy were similar.

Discussion and Conclusions:

Vestibular rehabilitation in children with concussion is associated with improvement in symptoms as well as visuovestibular performance. This active intervention may benefit children with persistent symptoms after concussion. Future prospective studies are needed to determine the efficacy and optimal postinjury timing of vestibular rehabilitation.

Video Abstract availablefor more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A208).
Cyclical Abdominal Pain in an Adolescent Female
Authors: Kelly Geoffrey S. , Baluyot Mariju F. , Anders Jennifer F.
Published: June 2018

Congenital agenesis of the lower vagina is a rare disorder characterized by separation between the unaffected proximal vagina and the distal vagina by a band of fibrous tissue. The typical presentation is an early adolescent female with chronic, cyclic abdominal pain and primary amenorrhea. In this case report, we describe an adolescent who presented to the pediatric emergency department on 2 occasions with a chief complaint of lower abdominal pain.
Auguste Renoir, Sculptor With Hired Hands
Authors: Zeidler Henning K.
Published: June 2018

The coping with rheumatoid arthritis of the famous French impressionist painter Pierre-Auguste Renoir (1841–1919) is described in former publications. The heavily handicapped painter has in his last years created sculptures in cooperation with the sculptor Richard Guino (1890–1973). The extraordinary genesis of the sculptures through a masterful artistic cooperation, as well as the resulting legal issues and shameful copyright infringements, is reported. Renoir's decision to create sculptures with the help of Guido can be attributed to his remarkable artistic vision, vitality, optimistic nature, and strong will and is also a further testimonial of creative coping of an artist overcoming the physical handicap due to rheumatoid arthritis of his final years, so far not described in detail in the medical literature.
Untargeted Mass Spectrometry-Based Metabolomics Tracks Molecular Changes in Raw and Processed Foods and Beverages
Authors: Gauglitz Julia M. , Aceves Christine M. , Aksenov Alexander A. , Aleti Gajender , Almaliti Jehad , Bouslimani Amina , Brown Elizabeth A. , Campeau Anaamika , Caraballo-Rodriguez Andres Mauricio , Chaar Rama , da Silva Ricardo R. , Demko Alyssa M. , Di Ottavio Francesca , Elijah Emmanuel , Ernst Madeleine , Ferguson L. Paige , Holmes Xavier , van der Hooft Justin J.J. , Jarmusch Alan K. , Jiang Lingjing , Kang Kyo Bin , Koester Irina , Kwan Brian , Ni Bohan , Li Jie , Li Yueying , Melnik Alexey V. , Molina-Santiago Carlos , Oom Aaron L. , Panitchpakdi Morgan W. , Petras Daniel , Quinn Robert , Sikora Nicole C. , Spengler Katharina , Teke Bahar , Tripathi Anupriya , Ul-Hasan Sabah , Vargas Fernando , Vrbanac Alison , Vu Anthony Q. , Wang Steven C. , Weldon Kelly , Wilson Kayla , Wozniak Jacob M. , Yoon Michael , Bandeira Nuno , Dorrestein Pieter C.
Published: June 2018

A major aspect of our daily lives is the need to acquire, store and prepare our food. Storage and preparation can have drastic effects on the compositional chemistry of our foods, but we have a limited understanding of the temporal nature of processes such as storage, spoilage, fermentation and brewing on the chemistry of the foods we eat. Here, we performed a temporal analysis of the chemical changes in foods during common household preparations using untargeted mass spectrometry and novel data analysis approaches. Common treatments of foods such as home fermentation of yogurt, brewing of tea, spoilage of meats and ripening of tomatoes altered the chemical makeup through time, through both chemical and biological processes. For example, brewing tea altered its composition by increasing the diversity of molecules, but this change was halted after 4 min of brewing. The results indicate that this is largely due to differential extraction of the material from the tea and not modification of the molecules during the brewing process. This is in contrast to the preparation of yogurt from milk, spoilage of meat and the ripening of tomatoes where biological transformations directly altered the foods molecular composition. Comprehensive assessment of chemical changes using multivariate statistics showed the varied impacts of the different food treatments, while analysis of individual chemical changes show specific alterations of chemical families in the different food types. The methods developed here represent novel approaches to studying the changes in food chemistry that can reveal global alterations in chemical profiles and specific transformations at the chemical level.
Repeated inversions at thepannierintron drive diversification of intraspecific colour patterns of ladybird beetles
Authors: Ando Toshiya , Matsuda Takeshi , Goto Kumiko , Hara Kimiko , Ito Akinori , Hirata Junya , Yatomi Joichiro , Kajitani Rei , Okuno Miki , Yamaguchi Katsushi , Kobayashi Masaaki , Takano Tomoyuki , Minakuchi Yohei , Seki Masahide , Suzuki Yutaka , Yano Kentaro , Itoh Takehiko , Shigenobu Shuji , Toyoda Atsushi , Niimi Teruyuki
Published: June 2018

How genetic information is modified to generate phenotypic variation within a species is one of the central questions in evolutionary biology. Here we focus on the striking intraspecific diversity of more than 200 aposematic elytral (forewing) colour patterns of the multicoloured Asian ladybird beetle,Harmonia axyridis, which is regulated by a tightly linked genetic locush. Our loss-of-function analyses, genetic association studies,de novogenome assemblies, and gene expression data reveal that the GATA transcription factor genepannieris the major regulatory gene located at thehlocus, and suggest that repeated inversions and cis-regulatory modifications atpannierled to the expansion of colour pattern variation inH. axyridis. Moreover, we show that the colour patterning function ofpannieris conserved in the seven spotted ladybird beetle,Coccinella septempunctata, suggesting thatH. axyridis’extraordinary intra-specific variation may have arisen from ancient modifications in a conserved elytral colour patterning mechanisms in ladybird beetles.
Cell boundary confinement sets the size and position of theE. colichromosome
Authors: Wu Fabai , Swain Pinaki , Kuijpers Louis , Zheng Xuan , Felter Kevin , Guurink Margot , Chaudhuri Debasish , Mulder Bela , Dekker Cees
Published: June 2018

While the spatiotemporal structure of the genome is crucial to its biological function, many basic questions remain unanswered on the morphology and segregation of chromosomes. Here, we experimentally show inEscherichia colithat spatial confinement plays a dominant role in determining both the chromosome size and position. In non-dividing cells with lengths up to 10 times normal, single chromosomes are observed to expand more than 4 fold in size, an effect only modestly influenced by deletions of various nucleoid-associated proteins. Chromosomes show pronounced internal dynamics but exhibit a robust positioning where single nucleoids reside strictly at mid-cell, while two nucleoids self-organize at ¼ and ¾ cell positions. Molecular dynamics simulations of model chromosomes recapitulate these phenomena and indicate that these observations can be attributed to depletion effects induced by cytosolic crowders. These findings highlight boundary confinement as a key causal factor that needs to be considered for understanding chromosome organization.
Evaluation of the capacity of Pediatricians in Nigeria to conduct of research: A nationwide Survey
Authors: Ughasoro Maduka D. , Jalo Iliya , Okolo Angela , Adejiyugbe Ebun , Murktah Mariya , Omogberare Austin , Onankpa Ben , Ibeziako Ngozi , Ubesie Agozie , Nwaneri Damian , Ezechukwu Clement , Stephen Oguche
Published: June 2018

Background

Quality health care service delivery to children and adolescents is enhanced by continuous research into the health challenges of this subpopulation led by paediatricians with tremendous capacity to investigate and proffer solutions to the myriads of childhood illnesses. Understanding the health issues therefore is the foundation for implementation of viable interventions that assure optimum service delivery. In view of this background, the Paediatric Association of Nigeria (PAN) directed that research into children’s health challenges in Nigeria should be brought to the front burner in the country. Pursuant to this laudable goal this study was conceived to evaluate the research capacity and capability of paediatricians in Nigeria and the institutions they represent. In view of above needs, this study aimed at evaluating the research capacities and challenges among paediatricians.

Methods

The survey used a cross-sectional nationwide design to enroll paediatricians into the study. The study was a combination of both online and face-to-face survey using questionnaire developed from Research Capacity Assessment Framework. Information on previous research work, challenges encountered, existing capacity and utilization of research outcome were obtained. The SPSS version 20 was used for data entry and analysis. For qualitative variables, similar responses were grouped under thematic heading.

Results

The response rates for online (via email survey, group-administered in a conference and individual face-to-face (at workshops) were 32 (3.2%), 75 (13.6%) and 15 (60%) respectively. The majority, 87(85.5%) of the participants had conducted prevalence studies, compared to 9 (8.8%) that had done experimental studies. Those who have ever received grant funding for their studies were 21 (19.4%), while the proportion whose research outcome had informed policy update and practice were policy 20 (18.2%). More than 55% of the participants had challenges on some of the seven aspects of research: research topic, proposal, funding, fieldwork, analysis, utilizing findings and collaboration. Less than 40% of the participants had received training on some of the tested 14 research capacity areas except for the area of ethics where 78 (70.9%) reported having received training. For 51 (46.4%) this ethics training included the Good Clinical Practice Guidelines.

Conclusion

Nigerian Academic Paediatricians need to be stimulated to develop interest in research by building their presently low research capacity if future paediatric practice is to be driven significantly by evidence.
Interpreting turbidity measurements for vesicle studies
Authors: Wang Anna , Miller Christopher Chan , Szostak Jack W.
Published: June 2018

Spectrophotometers are routinely used to assess the turbidity of vesicle solutions. Here we provide guidelines for interpreting turbidity measurements of vesicle samples, and highlight potential pitfalls of the approach. We use an exact solution for core-shell scatterers to model and calculate how samples of vesicles scatter light, and provide a comprehensive overview of how the turbidity of vesicle samples can change with vesicle size, contents, and composition. Surprisingly, we find that vesicle lamellarity has a large effect on sample turbidity, while unilamellar vesicles of different sizes have similar turbidity. We use our model in conjunction with experimental data to measure the thickness of oleic acid vesicle membranes and find excellent agreement with values determined by cryo-TEM. We also calculate the effects of potential errors in measurement from forward scattering and multiple scattering.