bluuebunny/crossref_metadata_2025 huggingface dataset:
Electron mobility enhancement in solution-processed low-voltage In2O3 transistors via channel interface planarization
Authors: Mottram Alexander D. , Pattanasattayavong Pichaya , Isakov Ivan , Wyatt-Moon Gwen , Faber Hendrik , Lin Yen-Hung , Anthopoulos Thomas D.
Published: June 2018

The quality of the gate dielectric/semiconductor interface in thin-film transistors (TFTs) is known to determine the optimum operating characteristics attainable. As a result in recent years the development of methodologies that aim to improve the channel interface quality has become a priority. Herein, we study the impact of the surface morphology of three solution-processed high-k metal oxide dielectrics, namely AlOx, HfOx, and ZrOx, on the operating characteristics of In2O3 TFTs. Six different dielectric configurations were produced via single or double-step spin-casting of the various precursor formulations. All layers exhibited high areal capacitance in the range of 200 to 575 nF/cm2, hence proving suitable, for application in low-voltage n-channel In2O3 TFTs. Study of the surface topography of the various layers indicates that double spin-cast dielectrics exhibit consistently smoother layer surfaces and yield TFTs with improved operating characteristics manifested, primarily, as an increase in the electron mobility (µ). To this end, µ is found to increase from 1 to 2 cm2/Vs for AlOx, 1.8 to 6.4 cm2/Vs for HfOx, and 2.8 to 18.7 cm2/Vs for ZrOx-based In2O3 TFTs utilizing single and double-layer dielectric, respectively. The proposed method is simple and potentially applicable to other metal oxide dielectrics and semiconductors.
On the theory of the Schrödinger equation with the full set of relativistic corrections
Authors: Eremko A. A. , Brizhik L. S. , Loktev V. M.
Published: June 2018

All relativistic corrections to the Scrodinger equation which determine the interlink between spin and orbit of moving particles, are directly calculated from the Dirac equation using the spin invariant operators. It is shown that among the second order corrections there are not only the well-known Darwin and Thomas terms, but also the new ones. Only with the account of the latter corrections the energies found with the obtained spin-orbit interaction operator, coincide with the energies of the Dirac equation exact solution. The problem of electron spectrum in the quantum well type structures is studied in details and the physical reasons for the appearance of spin- orbit interaction operators in the Dresselhaus or Rashba form, are analyzed.
Evaluating the influence of dietary phytogenic blends on gestating and lactating sows and suckling piglets
Authors: Gheisar Mohsen Mohammadi , Cheong Jin Young , Zhao Pinyao , Kim In Ho
Published: June 2018

This experiment was conducted to determine the effect of dietary inclusion of phytogenic blends on the performance of sows during the gestating and lactating periods and suckling piglets. Fifty-one multiparous sows (Landrace × Yorkshire) were randomly distributed into three treatments (17 sows per treatment): T1 (basal diet); T2 (T1 + 0.05% AC blend (Astragalus membranaceus and Chinese Liquorice); T3 (T1 + 0.05% SL blend (Scutellaria baicalensis and Lonicera japonica). Feeding the sows with diets supplemented with AC and SL blends decreased (P < 0.05) bodyweight loss after farrowing to weanling. The number of piglets, average daily feed intake, backfat thickness, and oestrus interval was not influenced (P > 0.05) by diets. Suckling piglets of sows fed with AC and SL blends showed higher (P < 0.05) weanling bodyweight and average daily gain weight. Piglet survival rate and birthweight were not affected by treatments. Feeding sows with AC and/or SL blends did not significantly influence the composition of colostrum or milk. There was not any significant impact on faecal score of suckling piglets. These results indicated that supplementation of phytogenic blends to the diet of sows during gestating and lactating period led to a decline in bodyweight loss after farrowing and could improve litter performance.
Amino acid transporter expression in the endometrium and conceptus membranes during early equine pregnancy
Authors: Gibson Charlotte , de Ruijter-Villani Marta , Rietveld Jolanda , Stout Tom A. E.
Published: June 2018

Maternally derived amino acids (AA) are essential for early conceptus development, and specific transporters enhance histotrophic AA content during early ruminant pregnancy. In the present study we investigated AA transporter expression in early equine conceptuses and endometrium, during normal pregnancy and after induction of embryo–uterus asynchrony. ‘Normal’ conceptuses and endometrium were recovered on Days 7, 14, 21 and 28 after ovulation. To investigate asynchrony, Day 8 embryos were transferred to recipient mares on Day 8 or Day 3, and conceptuses were recovered 6 or 11 days later. Endometrial expression of AA transporters solute carrier family 38 member 2 (SLC38A2), solute carrier family 1 members 4 and 5 (SLC1A4 and SLC1A5) increased during early pregnancy, whereas solute carrier family 7 member 8 (SLC7A8), solute carrier family 43 member 2 (SLC43A2) and solute carrier family 7 member 1 (SLC7A1) SLC7A8, SLC43A2 and SLC7A1 expression decreased and the expression of solute carrier family 1 member 1(SLC1A1) and solute carrier family 7 member 2 (SLC7A2) was unaffected. In conceptus membranes, most transporters studied were upregulated, either after Day 14 (solute carrier family 7 member 5 – SLC7A5, SLC38A2, SLC1A4, SLC1A5 and SLC7A1) or Day 21 (SLC43A2 and SLC7A2). Asynchronous ET indicated that endometrial SLC1A5, SLC1A1 and SLC7A8 are primarily regulated by conceptus factors and/or longer exposure to progesterone. In conclusion, AA transporters are expressed in early equine conceptus membranes and endometrium in specific spatiotemporal patterns. Because conceptuses express a wider range of transporters than the endometrium, we speculate that the equine yolk sac has recruited AA transporters to ensure adequate nutrient provision during an unusually long preimplantation period.
Livestock depredation by large carnivores in the South Gobi, Mongolia
Authors: Mijiddorj Tserennadmid Nadia , Alexander Justine Shanti , Samelius Gustaf , Badola Ruchi , Rawat G. S. , Dutta Sutirtha
Published: June 2018

Context
Livestock depredation is a major conservation challenge around the world, causing considerable economical losses to pastoral communities and often result in retaliatory killing. In Mongolia, livestock depredation rates are thought to be increasing due to changes in pastoral practices and the transformation of wild habitats into pasture lands. Few studies have examined the interactions between humans and carnivores and even fewer have considered how recent changes in pastoral practices may affect depredation rates.

Aim
This study aimed to assess the influence of herding practices on self-reported livestock losses to snow leopards and wolves in two communities in South Gobi, Mongolia.

Methods
In total, 144 herder households were interviewed and an information-theoretic approach was used to analyse the factors influencing self-reported livestock losses to snow leopards and wolves.

Key results
The majority of self-reported losses to both snow leopards and wolves occurred when herds were left unattended in the pastures. The economic loss associated with livestock losses to snow leopards and wolves amounted to an average loss of US$825 per herder and year. The number of livestock owned by a household and the frequency of shifting campsite had the strongest influence on livestock losses to snow leopards and wolves. Other determinants of livestock losses included frequency of visiting the soum (county) centre.

Implications
On the basis of the findings, we make recommendations for mitigating the conflict with large carnivores, with focus on guiding future herding practices.
Dissection of progenitor compartments resolves developmental trajectories in B-lymphopoiesis
Authors: Jensen Christina T. , Åhsberg Josefine , Sommarin Mikael N.E. , Strid Tobias , Somasundaram Rajesh , Okuyama Kazuki , Ungerbäck Jonas , Kupari Jussi , Airaksinen Matti S. , Lang Stefan , Bryder David , Soneji Shamit , Karlsson Göran , Sigvardsson Mikael
Published: June 2018

To understand the developmental trajectories in early lymphocyte differentiation, we identified differentially expressed surface markers on lineage-negative lymphoid progenitors (LPs). Single-cell polymerase chain reaction experiments allowed us to link surface marker expression to that of lineage-associated transcription factors (TFs) and identify GFRA2 and BST1 as markers of early B cells. Functional analyses in vitro and in vivo as well as single-cell gene expression analyses supported that surface expression of these proteins defined distinct subpopulations that include cells from both the classical common LPs (CLPs) and Fraction A compartments. The formation of the GFRA2-expressing stages of development depended on the TF EBF1, critical both for the activation of stage-specific target genes and modulation of the epigenetic landscape. Our data show that consecutive expression of Ly6D, GFRA2, and BST1 defines a developmental trajectory linking the CLP to the CD19+ progenitor compartment.
External K+ dependence of strong inward rectifier K+ channel conductance is caused not by K+ but by competitive pore blockade by external Na+
Authors: Ishihara Keiko
Published: June 2018

Strong inward rectifier K+ (sKir) channels determine the membrane potentials of many types of excitable and nonexcitable cells, most notably the resting potentials of cardiac myocytes. They show little outward current during membrane depolarization (i.e., strong inward rectification) because of the channel blockade by cytoplasmic polyamines, which depends on the deviation of the membrane potential from the K+ equilibrium potential (V – EK) when the extracellular K+ concentration ([K+]out) is changed. Because their open-channel conductance is apparently proportional to the “square root” of [K+]out, increases/decreases in [K+]out enhance/diminish outward currents through sKir channels at membrane potentials near their reversal potential, which also affects, for example, the repolarization and action-potential duration of cardiac myocytes. Despite its importance, however, the mechanism underlying the [K+]out dependence of the open sKir channel conductance has remained elusive. By studying Kir2.1, the canonical member of the sKir channel family, we first show that the outward currents of Kir2.1 are observed under the external K+-free condition when its inward rectification is reduced and that the complete inhibition of the currents at 0 [K+]out results solely from pore blockade caused by the polyamines. Moreover, the noted square-root proportionality of the open sKir channel conductance to [K+]out is mediated by the pore blockade by the external Na+, which is competitive with the external K+. Our results show that external K+ itself does not activate or facilitate K+ permeation through the open sKir channel to mediate the apparent external K+ dependence of its open channel conductance. The paradoxical increase/decrease in outward sKir channel currents during alternations in [K+]out, which is physiologically relevant, is caused by competition from impermeant extracellular Na+.
Anatomical resections are superior to wedge resections for overall survival in patients with Stage 1 typical carcinoids†
Authors: Filosso Pier Luigi , Guerrera Francesco , Falco Nicola Rosario , Thomas Pascal , Garcia Yuste Mariano , Rocco Gaetano , Welter Stefan , Moreno Casado Paula , Rendina Erino Angelo , Venuta Federico , Ampollini Luca , Nosotti Mario , Raveglia Federico , Rena Ottavio , Stella Franco , Larocca Valentina , Ardissone Francesco , Brunelli Alessandro , Margaritora Stefano , Travis William D , Sagan Dariusz , Sarkaria Inderpal , Evangelista Andrea ,   the ESTS NETs-WG steering committee, Yuste Mariano Garcia , Lim Eric , Papagiannopoulos Konstantinos , Asamura Hisao
Published: June 2018

OBJECTIVES

Typical carcinoids (TCs) are rare, slow-growing neoplasms, usually characterized by satisfactory surgical outcomes. Due to the rarity of TCs, international guidelines for the management of particular clinical presentations currently do not exist. In particular, non-anatomical resections (wedges) are sometimes advocated for Stage 1 TCs because of their indolent behaviour. The aim of this paper was to evaluate the most effective type of surgery for Stage 1 TCs, using the European Society of Thoracic Surgeons retrospective database of the Neuroendocrine Tumors of the Lung Working Group.

METHODS

We analysed the effect of surgical procedure on the survival of patients with Stage 1 TCs. Overall survival (OS) was calculated from the date of intervention. The cumulative incidence of cause-specific death (tumour- and non-tumour-related) was also estimated. The impact of the surgical procedure (i.e. lobectomy vs segmentectomy vs wedge resection) on survival was investigated using the Cox model with shared frailty (for OS, accounting for the within-centre correlation) and the Fine and Gray model (for cause-specific mortality) using the approach based on the multinomial propensity score. Effects were estimated including in the model the logit-transformed propensity scores of segmentectomy and wedge resection as covariates.

RESULTS

A total of 876 patients with Stage 1 TCs (569 women, 65%) were included in this study. The median age was 60 years (interquartile range 47–69). At the last follow-up, 66 patients had died: The 5-year OS rate was 94.3% [95% confidence interval (CI) 92.2–95.9]. The 5-year cumulative incidences of tumour- and non-tumour-related deaths were 2.4% (95% CI 1.4–3.9) and 3.9% (95% CI 2.5–5.6%), respectively. The analysis performed using the multinomial propensity score approach confirmed the significantly worse survival of patients treated with a wedge resection compared to those treated with a lobectomy (hazard ratio 2.01, 95% CI 1.09–3.69; P = 0.024). Similar effects of wedge resection are detectable for cause-specific deaths: tumour-related (hazard ratio 2.28, 95% CI 0.86–6.02; P = 0.096) and non-tumour-related (hazard ratio 1.74, 95% CI 0.89–3.40; P = 0.105).

CONCLUSIONS

In a large cohort of patients, we were able to demonstrate the superiority of anatomical surgical resection in Stage 1 TCs in terms of OS. This result should therefore be considered for future clinical guidelines for the management of TCs.
Gaps in health information exchange between hospitals that treat many shared patients
Authors: Everson Jordan , Adler-Milstein Julia
Published: June 2018

Objective

Hospitals that routinely share patients are those that most critically need to engage in electronic health information exchange (HIE) with each other to ensure clinical information is available to inform treatment decisions. We surveyed pairs of hospitals in a nationwide sample to describe whether and how hospitals within each hospital referral region (HRR) that have the highest shared patient (HSP) volume engaged in HIE with each other.

Methods

We used Medicare’s Physician Shared Patient Patterns data to identify hospital pairs with the highest shared patient volume in each hospital referral region. We surveyed a purposeful sample of pairs and then calculated descriptive statistics to compare: (1) HIE with the HSP hospital vs HIE with other hospitals, and (2) HIE with the HSP hospital versus federal measures of HIE engagement that are not partner-specific.

Results

We received responses from 25.5% of contacted hospitals and 33.5% of contacted pairs, allowing us to examine information sharing among 68 hospitals in 63 pairs. 23% of respondents reported worse information sharing with their HSP hospital than with other hospitals while 17% indicated better sharing with their HSP hospital and 48% indicated no difference. Our HSP-specific measures of HIE differed from federal measures of HIE engagement: while 97% of respondents are classified as routinely sending information electronically in federal measures, in our data only 63% did so with their HSP hospital.

Conclusions

Despite increased HIE engagement, our descriptive results indicate that HIE is not developing in a way that facilitates information exchange where it might benefit the most patients. New policy efforts, particularly those emerging from the 21st Century Cures Act, need to explicitly pursue strategies that ensure that HSP providers engage in exchange with each other.
History and Evolution of the Trauma- and Stressor-Related Disorders
Authors: Stoddard Jr Frederick J. , Benedek David M. , Milad Mohammed R. , Ursano Robert J.
Published: June 2018

This introductory chapter provides the historical context leading to our present conceptualization of trauma- and stressor-related disorders. As an introduction to the rest of the book, it describes examples of the range of traumatic experience through history and depicted in literature and art. This chapter reviews the manner in which the cognitive, emotional, and behavioral effects of traumatic experience have been subsequently classified in global medical nosology. Additionally, it provides an overview of changes in the classification of trauma- and stressor-related disorders in the three major diagnostic systems used in the United States, with a particular focus on the increasing recognition of these disorders’ dimensionality.
Acute Stress Disorder
Authors: Bryant Richard A.
Published: June 2018

Acute stress disorder (ASD) was introduced as a new diagnosis in 1994 in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. This diagnosis has led to much new research into the nature of acute psychological reactions to trauma, as well as considerable developments in how acute traumatic stress is assessed and treated. This chapter reviews the current diagnostic criteria, the nature of trajectories of traumatic stress responses, known mechanisms of ASD, and prevailing assessment and treatment procedures. This review highlights that the predictive utility of the ASD diagnosis has been challenged by longitudinal research, which has led to marked changes in the definition and goals of the diagnosis in DSM-5. Despite the problems associated with initial conceptualizations of the ASD diagnosis, its introduction has led to novel early intervention strategies for trauma survivors.
Trauma in Late Life
Authors: Sakauye Kenneth , Nininger James E.
Published: June 2018

This chapter focuses on the prevalence of trauma exposure and posttraumatic problems in the elderly and reviews information on resilience and suggested treatment approaches. While posttraumatic stress disorder in the elderly has been studied, less is known about other common trauma- and stressor-related disorders including adjustment disorder, acute stress disorder, and traumatic grief. The Diagnostic and Statistical Manual of Mental Disorders (fifth edition) defines trauma as “exposure or actual or threatened death, serious injury, or sexual violence.” It must be directly experienced, witnessed, or occur to a family member or friend, or it could be a repeated or extreme exposure to aversive details of a traumatic event. No event is always traumatic, and, conversely, even a seemingly mild negative event can be traumatic to some individuals. Two presumed variables are (a) appraisal of the situation (whether a person feels in control) and (b) individual biological differences in responsiveness.
Population Trauma
Authors: Stoddard Jr. Frederick J. , Ursano Robert J. , Cozza Stephen J.
Published: June 2018

This chapter reviews trauma- and stressor-related disorders (TSRDs) as they relate to disaster, defined by the World Health Organization as “a severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community.” Some are human-made such as a terrorist event or shooting, while others are due to natural events such as earthquake or hurricane. Humanitarian emergencies are also a class of disasters. Since most but not all people and communities are resilient, the prevalence of TSRDs after disaster and what interventions are optimal is highly relevant to disaster recovery. The chapter discusses the impact of disaster preparedness, factors that influence how communities cope with disaster, and the effect of trauma and stress on populations. It goes on to review factors that influence susceptibility and resilience to disaster trauma, the range of psychological consequences of disaster, and early interventions for TSRDs in response to disaster.
The Role of Stress in the Etiology of PTSD
Authors: Pace-Schott Edward F. , Gazecki Samuel
Published: June 2018

This chapter reviews the biological features of stress and their correlation to symptoms of posttraumatic stress disorder (PTSD). Over the past 15 years, advances in understanding the neurobiology of stress and anxiety have revealed underlying neural abnormalities that might help explain why posttraumatic symptoms—intrusive memories or nightmares, avoidance of situations or stimuli associated with the event, persistent negativity of mood and cognition, and hyperarousal—persist in patients with PTSD. This chapter focuses on research that has discovered how abnormal hypothalamic-pituitary-adrenal axis activity, abnormalities of the catecholamingergic/autonomic system, and atypical physiologic and neural circuit responses during fear extinction recall may be important biological factors in the etiology and maintenance of PTSD symptoms.
The Neurochemistry and Epigenetics of PTSD
Authors: Post Robert M.
Published: June 2018

This chapter reviews the neurochemistry and epigenetics of posttraumatic stress disorder (PTSD). Traditional views of the neurochemistry of PTSD focus on alterations in classical central nervous system neurotransmitters serotonin and norepinephrine and pathological reactivity in the hypothalamic-pituitary-adrenal axis, and these are only briefly noted here. Instead, the chapter emphasizes a series of new conceptualizations and neurochemical data that have recently been elucidated. One is the recognition of the symptoms and neurobiology of PTSD as a moving target, being very different in different stages of illness evolution. Differences are apparent in the neurochemistry involved in early life stressor-related vulnerabilities to PTSD, the acute stress reaction, compensation and resolution phases, or ongoing chronicity with sleep disturbance, nightmares, flashbacks, hyperarousal, and dulling and depression. The neurochemical abnormalities vary as a function of this temporal unfolding and the common acquisition and progression of comorbid syndromes of alcohol and substance abuse.
Genetics and Gene–Environment Interaction
Authors: Klengel Torsten , Lebois Lauren A. M. , Gaynor Sheila , Guffanti Guia
Published: June 2018

Trauma and stress-related disorders make an excellent case for gene-environment interactions because although exposure to trauma and stress is a well-established risk factors toward their development, such factors alone are not sufficient to explain etiopathogenesis. Exposure to traumatic events is a prerequisite of posttraumatic stress disorder (PTSD) diagnosis, but the majority of individuals who are exposed to even a severe traumatic event do not develop PTSD. Why some individuals are vulnerable and others are resilient remains an open question. While genetic factors may play a significant role, it is conceivable that the complex interplay between genetic and environmental factors contribute to the observed interindividual variability.
Trauma in the Medical-Surgical Patient
Authors: Quijije Nadia
Published: June 2018

This chapter reviews psychiatric consultation for trauma and stress in medical-surgical patients. Hospitalization can induce psychologic or psychiatric disturbance and worsen the clinical condition of patients who are suffering from medical and surgical comorbidities. Some medical conditions can be related to stress related disorders indirectly, while others, such as critical illness/intensive care unit treatment or direct physical injury, are themselves traumatic stressors that can promote trauma and stressor-related disorders (TSRDs). Given the negative impact of stress-related disorders on quality of life, mental health clinicians should diagnose TSRDs to ensure patients receive appropriate care. Treatment and management can be provided in multiple forms of psychological therapies and psychopharmacology, and within a multidisciplinary team, particularly for the medical surgical patient. Psychiatrists, psychologists, and social workers must assist patients with terminal illnesses by optimizing end-of-life care, supporting patients and their families, and encouraging approaches to allow the transformative process of dying to be meaningful.
Pharmacologic Treatment of Adults with Trauma- and Stressor-Related Disorders
Authors: Benedek David M. , Wynn Gary H.
Published: June 2018

This chapter reviews evidence-based pharmacological treatments for posttraumatic stress disorder, acute stress disorder, and adjustment disorder in adults. Emphasis is given to treatments that have received the strongest recommendations in published practice guidelines, clinical trials, and meta-analyses. Mention is also made of pharmacological interventions introduced subsequent to changes in diagnostic definitions that occurred with the shift to the category trauma- and stress-related disorders in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Medications covered in this chapter are across a broad range of classes and include serotonin specific reuptake inhibitors (SSRIs), antipsychotics, anticonvulsants, and benzodiazepines. The discussion addresses medications used as monotherapy and as medication augmentation.
Complementary and Alternative Medicine for Trauma- and Stressor-Related Disorders
Authors: Wynn Gary H. , Benedek David M.
Published: June 2018

The use of complementary and alternative medicine (CAM) throughout the United States and abroad has significantly increased in the past decade. CAM is relevant to trauma and stressor-related disorders given the frequency of use, but there is very limited evidence to support these treatment options. There is also currently no generally accepted list of what treatments constitute CAM, but only a number of generalized definitions that attempt to provide structure to the concept; therefore, a challenge facing providers will be familiarization with the broad range of modalities potentially considered CAM. This chapter uses a clinician focused definition of CAM: dividing CAM in to “complementary”, “alternative”, and “alternative delivery methods”. The first section, on complementary medicine, covers animal therapy, recreational therapy, yoga, creative arts therapy, and meditation. The second, on alternative therapies, describes alternative pharmacology and acupuncture. The last section provides a brief overview recent developments in alternative care delivery methods.
Family-Based Interventions for PTSD
Authors: Cozza Stephen J.
Published: June 2018

Posttraumatic stress disorder (PTSD) is associated with negative health and mental health effects in those it afflicts but also has been shown to have negative effects on relationships with intimate partners and close relatives. Although different types of trauma require tailored approaches to family intervention, PTSD broadly affects interpersonal relationships, communication, and family functioning. Most of the existing literature has focused on military and veteran families affected by combat-related PTSD. This military perspective is used to structure this chapter and to highlight several areas important to an understanding of PTSD and its effect on families with children: framing PTSD from a family systems perspective and recognizing its impact on relationships and family functioning, reviewing child developmental considerations, describing unique challenges of childhood traumatic bereavement, and summarizing the developing literature examining family interventions for PTSD. Six strategies are highlighted that can mitigate risk in families affected by PTSD.
Evaluating Bariatric Surgical Risk Using Risk-Scoring Systems
Authors: DeMaria Eric J. , Kim Claudia Jin
Published: June 2018

Surgical risk assessment is a critical aspect of delivering safe bariatric and metabolic surgery care today. Years ago, there were no useful methodologies to differentiate morbidly obese patients based on surgical risk stratification. Today there are numerous available strategies that can identify patients at higher risk for complications and for otherwise poor results, such as insufficient weight loss and suboptimal resolution of comorbid medical conditions. These strategies can guide the preoperative evaluation, allow the provider to better inform the patient regarding risk, and allow for more aggressive perioperative care to be instituted on a selective basis, thus lowering overall costs of care. Identification of low-risk patients undergoing low-risk procedures has allowed for surgical treatment of some patients in free-standing surgical centers. In this chapter, we review available risk-stratification strategies that can be useful in the preoperative assessment of risk in the obese population undergoing bariatric surgery.
Application of Statistical Methods in Bariatric Surgery
Authors: Janik Michał Robert
Published: June 2018

It is very important to learn from surgical complications. For this reason, research is vital in surgical practice. Clinical epidemiology and statistics provide the methodology for analyzing data and drawing conclusions. Thus, every surgeon should understand the basics of clinical epidemiology in order to know how to improve his or her practice. This chapter provides a background in epidemiology and the basic statistical methods that are commonly use in bariatric surgical research. A thorough knowledge of the different types of clinical studies and commonly used statistical tests is imperative for the clinician to have in order to interpret data accurately. If necessary the help of a biostatistician will ensure appropriate statistical tests are applied and results and conclusions of studies are credible.
Medical Management of Endocrine Disorders after Bariatric Surgery
Authors: Kashyap Sangeeta
Published: June 2018

Endocrine complications after bariatric surgery include persistent hyperglycemia in patients with type 2 diabetes who experience initial success with weight loss. This complication occurs in those with a prolonged duration of diabetes (> 8 years) and is related to poor residual pancreatic beta-cell function. Often, weight regain is associated with recurrent diabetes, and strategies that target both weight loss and glycemic control are required. New diabetes agents, such as the SGLT2 inhibitor drug class, offer advantages to diabetes treatment after bariatric surgery. On the other end of the glycemic spectrum, hyperinsulinemic hypoglycemia occurs in patients with and without diabetes prior to surgery and often presents with little or no symptoms (i.e., neuroglycopenia). Treatment strategies involve careful monitoring of blood glucose levels and the use of low-glycemic/high-fiber diets as well as drugs that lower glucose absorption and insulin secretion. Glycemic management after bariatric surgery requires close observation.
Bariatric Surgery in the Elderly
Authors: Marcotte Eric
Published: June 2018

The U.S. census revealed that, in 2010, the “older population,” age 65 and older, represented 13% of the population (40.2 million people). The percentage will increase with time and will be 19.3% (72.1 million people) by 2030 and 20.2% (88.5 million people) by 2050, largely due to the aging baby boomer generation. Data from the Centers for Disease Control and Prevention showed that 14% of the general population age 60 had a BMI ≥ 35, with the higher-risk groups of Hispanic and non-Hispanic black communities reaching 16.7% and 20.1%, respectively. It is recognized that elderly obese patients present with a higher frequency of comorbidities than their younger counterparts, most likely related to the duration of their disease. Although initial studies demonstrated an increased risk in elderly patients, bariatric surgery has since been demonstrated to be a safe and efficient treatment option, as long as older patients undergo complete medical optimization prior to undergoing surgery.
Weight Regain after Bariatric Surgery
Authors: Burguera Bartolome , Hag Amani Mohamed , Heinberg Leslie J.
Published: June 2018

Bariatric surgery is the most effective therapy for morbid obesity. Unfortunately, a significant number of patients experience significant postoperative weight regain, which undermines the metabolic and cardiovascular benefits of weight loss associated with surgery. When revisional procedures are not indicated and/or when behavioral factors are present (e.g., nonadherence, eating pathology), bariatric programs currently do not have any empirically evaluated treatment options to offer those burdened with less favorable outcomes. This chapter reviews the definition of successful weight loss after bariatric surgery, as well as some biologic and behavioral factors that could be implicated in weight regain after surgery. Finally, we outline the scientific evidence supporting the use of behavioral and medical therapies to prevent weight regain after surgery. Bariatric programs need to determine from clinical experience, as well as through clinical trials, what behavioral/medical therapies are the most effective for managing weight gain after bariatric surgery.
Radiologic Assessment and Management of Complications
Authors: Federle Michael P. , Griffin Michael O.
Published: June 2018

Radiology plays and important role in the evaluation of patients who have undergone a bariatric surgical procedure. This chapter discusses the imaging appearance of complications after the most common bariatric surgeries, Roux-en-Y gastric bypass, gastric banding, and sleeve gastrectomy. The fluoroscopic upper GI examination and computed tomography (CT) are the most commonly used imaging modalities for evaluating these patients. For each surgical procedure, fluoroscopic and/or CT images are used to illustrate the normal postoperative anatomy and to provide examples of common and uncommon complications seen in the early and late postoperative periods. Appropriate imaging technique is highlighted. A role for interventional radiology in the minimally invasive management of some of these complications is also briefly discussed.
Cognitive Changes in Pregnancy
Authors: Weber Miriam T.
Published: June 2018

Subjective memory complaints are commonly reported in pregnancy and the postpartum period. Given the frequency of such complaints, there is great interest in understanding the effects of pregnancy and the postpartum period on objectively measured cognitive function in healthy women, as well as the potential clinical significance of subjective memory complaints (SMC) in this population. In this chapter, we review the literature examining objective cognitive function in pregnant and postpartum women. We focus on studies that employed neuropsychological tests of memory and other domains of cognitive function, discuss the literature on contributions to cognitive changes in pregnancy and postpartum, and outline a care pathway for practitioners encountering pregnant women with cognitive concerns.
Principles of Reproductive Healthcare in Chronic Neurologic Disease
Authors: Drennan Kathryn J. , Vanushkina Maria
Published: June 2018

Neurologic illness and injury account for a subset of women who are pregnant with disability. The care of these women is hampered by inadequate education of health-care workers, negative attitudes toward women with disability, assumptions about the sex lives of women with disability, and structural barriers that decrease accessibility to medical care for women. Additionally, systemic barriers as well as a lack of emphasis on multidisciplinary approach expose women to inadequate care. Appropriate education, the elimination of structural barriers and negative attitudes as well as emphasis on patient centered and multidisciplinary care can help to optimize patient outcome and experience.
Traumatic Brain Injury and Pregnancy
Authors: Thompson Karla L. , Filer William , Harris Matthew , Lee Michael Y.
Published: June 2018

Traumatic brain injury (TBI) is a leading cause of death and disability throughout the world, particularly among young adults, affecting untold numbers of women of childbearing age. TBIs can disrupt almost any aspect of physical, cognitive, and/or emotional functioning, potentially complicating a woman’s ability to conceive, carry, and deliver a healthy child. For women who are already pregnant and sustain a TBI, medical stabilization of the mother and management of risk of further injury to the fetus are priorities. For women with a previous history of TBI, comprehensive assessment and optimal management of common sequelae of TBI (eg, seizures, endocrine dysfunction, physical and cognitive impairments, and neuropsychiatric symptoms) are essential to maximizing outcomes for both mother and child. Consultation with physiatry and neuropsychology, utilization of rehabilitation therapies to maximize the mother’s functional recovery, and consistent communication among all medical team members throughout pregnancy are essential.
Charcot-Marie-Tooth Disease and Pregnancy
Authors: Creigh Peter D. , Herrmann David N.
Published: June 2018

Charcot-Marie-Tooth neuropathies (CMT) represent the most common hereditary neuropathies and can affect men and women from infancy to adulthood. There are no effective or FDA approved pharmacologic treatments aimed at disease modification for any form of CMT, so the primary focus of clinical care is on symptomatic treatment, maintaining functionality, and limiting secondary injury. CMT does not in general appear to affect a woman’s ability to carry a pregnancy. However, having CMT does increase the risk of delivery related complications (operative delivery, fetal presentation anomalies and postpartum bleeding) and exacerbation of neurologic symptoms during pregnancy is possible. Therefore, understanding the risks and planning appropriately are crucial for all women with CMT considering pregnancy and their health care providers. Overall, with the appropriate medical care, most women with CMT who choose to become pregnant will have an uncomplicated pregnancy and deliver a healthy infant.
Inherited Metabolic Diseases (IMDs) and Pregnancy
Authors: Ahmed Ahmed I. , Aldhaheri Sarah , Bannick Allison
Published: June 2018

Inherited metabolic diseases (IMDs) are rare genetic disorders: clinically heterogeneous, and they can present at any age. With the expanded newborn screening panels, many of the IMDs have been successfully screened. Early diagnosis and treatment of these conditions have led to improved neurological outcomes and overall survival of these individuals, and now many of them are reaching childbearing age. Despite treatment, the potential presence of preexisting organ involvement may not only impact their fertility potentials but also may impose a higher risk of adverse maternal and fetal outcomes. Pregnancy leads to an extra strain on maternal metabolism; this may result in the manifestation of symptoms of a previously unknown disease or a progression of a known disease. This chapter will address the possible complications of some inherited disorders of metabolism that are associated with maternal or fetal neurological manifestations such as disorders of energy metabolism (eg, mitochondrial disorders, adult onset urea cycle disorders, ornithine transcarbamylase (OTC) deficiency, amino acidopathies, phenylketonuria (PKU), and impaired fatty acid oxidation disorders). We will provide special emphasis on the available potential treatments and plan of care during pregnancy and postpartum periods.
Neurologic Complications in Obstetric Anesthesia
Authors: Gloff Marjorie , Kreso Melissa , Wissler Richard
Published: June 2018

Neuraxial analgesia and anesthesia is routinely requested for women in the peripartum and postpartum period. Given that there is widespread knowledge of the benefits of obstetricians, mainstream media, and word-of-mouth communication, many patients expect to receive some form of neuaxial anesthesia during their peripartum experience. Neuraxial anesthesia can provide both pain relief during induction and labor and can provide surgical anesthesia for a variety of surgical procedures in the peripartum and postpartum period. While generally considered safe, neuraxial anesthesia is not without risk. This chapter discusses the most common neurologic complications associated with neuraxial anesthesia in the obstetric population.
Brain volumes and intrinsic brain connectivity in ADHD
Authors: Konrad Kerstin , Di Martino Adriana , Aoki Yuta
Published: June 2018

Neuroimaging studies have increased our understanding of the neurobiological underpinnings of ADHD. Structural brain imaging studies demonstrate widespread changes in brain volumes, in particular in frontal-striatal-cerebellar networks. Based on the widespread nature of structural and functional brain abnormalities, approaches able to capture the organizing principles of large-scale neural systems have been used in ADHD. These include diffusion magnetic resonance imaging (MRI) and resting state functional MRI (R-fMRI). Complementary to findings of volumetric studies, diffusion investigations have reported structural connectivity abnormalities in frontal-striatal-cerebellar networks. In parallel, R-fMRI studies point towards abnormalities in the interaction of multiple networks, extending the functional territory of explorations beyond cognitive and motor control. In the future, a deep phenotypic characterization beyond diagnostic categories combined with longitudinal study designs and novel analytical approaches will accelerate the pace towards clinical translations of neuroimaging to improve the detection and prediction of neural trajectories and treatment response in ADHD.
Cognitive functioning in ADHD
Authors: Coghill David , Toplak Maggie , Rhodes Sinead , Adamo Nicoletta
Published: June 2018

Inhibition, memory, temporal discounting, decision-making, timing, and intraindividual variability in reaction time have emerged as key cognitive domains for understanding neurocognitive deficits in individuals with ADHD. In the domain of inhibition, motor inhibition has been studied most extensively, with deficits demonstrated in both restraint and cancellation. Working memory difficulties have been identified using a broad range of tasks. Decision-making has been less well studied, but risky decision-making and temporal discounting have displayed relatively consistent effects. Motor timing, duration discrimination, duration reproduction, and variability on all of these tasks have also been implicated in ADHD. From a clinical perspective, whilst ADHD is clearly associated with a broad range of neuropsychological deficits, there is considerable heterogeneity and none of these deficits is required or necessary for a diagnosis. However, neuropsychological measures may help define cognitive subgroups within ADHD and these may in turn be useful in predicting course, outcome, and treatment response.
Adult ADHD
Authors: Asherson Philip , Ramos-Quiroga Josep Antoni , Young Susan
Published: June 2018

ADHD is a neurodevelopmental disorder with symptoms that start during childhood or early adolescence and commonly persist into adulthood. In adults, similar symptoms and impairments are seen as in children, although overt levels of hyperactivity-impulsivity tend to decrease, inattention tends to persist, and age-appropriate presentation of symptoms needs to be considered. Emotional self-regulation, sleep problems, excessive spontaneous mind wandering and behavioural self-regulation often co-occur with adult ADHD and are independent sources of impairment. In establishing the diagnosis of adult ADHD it is important to be aware of potential symptom overlap with other common mental health disorders such as anxiety, depression, and personality disorder. There is a risk that ADHD is mistaken for these other disorders. In most cases ADHD can be accurately assessed and diagnosed in adults through the use of diagnostic interview assessments that provide a detailed clinical assessment of the diagnostic criteria for ADHD.
Intellectual impairment and neurogenetic disorders
Authors: Simonoff Emily
Published: June 2018

Intellectual disability (ID) is a neurodevelopmental disorder commencing in early life in which both learning, typically measured with IQ tests, and adaptive functioning are impaired. Prevalence rates of ID vary widely, but converge around 3%. ID is associated with increased rates of all mental disorders but most with other neurodevelopmental disorders; hyperkinetic disorder is estimated to be increased 10-fold in ID, and rates of ADHD have been estimated to be approximately 5%. The full explanation for this association is uncertain, but shared genetic influences play an important role. Co-occurring ID should be considered when undertaking assessments for ADHD. The limited evidence base for treatment of ADHD with ID shows methylphenidate to be effective in randomized controlled trials (RCTs), but the effect sizes are about half those reported for children with average intellectual ability and with higher rates of non-serious adverse effects. No non-pharmacological interventions have been evaluated in RCTs.
Influence of tics and/or obsessive-compulsive behaviour on the phenomenology of coexisting ADHD
Authors: Rothenberger Aribert , Becker Andreas , Brüni Lillian Geza , Roessner Veit
Published: June 2018

The coexistence of ADHD, tic disorders (TD) and obsessive-compulsive behaviour (OCB) can appear in any combination as a ‘clinical dyad or triad’. The possible combinations are well above what would be expected by chance alone. Overlap and relationship, specifically in the long-term course, between these problem areas creates different psychopathological profiles at different time points along the lifetime. In this chapter we explore the phenomenology of the possible co-occurrences of ADHD, TD, and OCB. Specifically, the impact of TD and/or OCB on the clinical presentation of ADHD will be described. The co-occurrence of ADHD with TD and/or OCB and their multifaceted interactions are a challenge for clinical assessment and treatment having a developmental psychopathological view in mind.
Developmental coordination disorder
Authors: Gillberg Christopher , Fernell Elisabeth , Gillberg I. Carina , Kadesjö Björn
Published: June 2018

ADHD is often comorbid with other psychiatric/neurodevelopmental disorders, and is associated with developmental coordination disorder (DCD) in about half of all cases. Therefore, clinicians who are working with patients with ADHD need to be aware of the very strong association with motor impairment and should be able to diagnose motor control problems. There are evidence-based interventions for DCD, which makes it important for clinicians to be able to provide adequate assessment and early diagnosis. Several well-researched screening instruments are available, in particular the test of motor impairment, the movement assessment battery for children, and the screening devices designed by a Swedish group.
Oxford Handbook of Oral and Maxillofacial Surgery
Authors: Cascarini Luke , Schilling Clare , Gurney Ben , Brennan Peter
Published: June 2018

This new edition of Oxford Handbook of Oral and Maxillofacial Surgery has been fully updated to cover the current guidelines and research in the field of OMFS. Splitting vital knowledge into sections based on clinical areas, this handbook uses bulleted lists and summary boxes to make the information easily searchable. Chapters on ‘in the clinic’, ‘in the theatre’, and ‘on the ward’ cover all common complaints and presentations that the reader can expect to encounter in their daily activities, and a dedicated section to emergencies provides clear advice. Common drugs and dental materials are covered as a quick reference guide. With OMFS now part of the Core Training programme for surgical trainees, the handbook ensures a solid grasp of the basics and fundamentals to help support decision making for junior doctors, dental foundation trainees, specialist nurses, and medical and dental students.