bluuebunny/crossref_metadata_2025 huggingface dataset:
Education and Cognitive Decline: An Integrative Analysis of Global Longitudinal Studies of Cognitive Aging
Authors: Clouston Sean A P , Smith Dylan M , Mukherjee Soumyadeep , Zhang Yun , Hou Wei , Link Bruce G , Richards Marcus
Published: May 2019

Background

The objective of this study was to examine the association between education and incidence of accelerated cognitive decline.

Methods

Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N = 28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer’s disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister studies. Life expectancy ratios (LER) and 95% confidence intervals (CIs) were reported.

Results

This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER = 1.031 95% CI = [1.013–1.015], p < 1E-06). Replication analyses using data from 14 countries identified similar results.

Conclusions

These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania
Authors: Hackett Kristy , Kazemi Mina , Lafleur Curtis , Nyella Peter , Godfrey Lawelu , Sellen Daniel
Published: May 2019

Mobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.
Canadian men’s health stigma, masculine role norms and lifestyle behaviors
Authors: McCreary Donald R , Oliffe John L , Black Nick , Flannigan Ryan , Rachert Joe , Goldenberg S Larry
Published: May 2019

Men are at high risk for both morbidity and premature mortality from several of the most common serious diseases. Although numerous factors have been identified to explain men’s risk, this study focused on the relationship between lifestyle behaviors, health-related self-stigma and masculine role norms. An age and location stratified sample of 2000 Canadian men completed measures assessing five lifestyle behaviors (smoking, alcohol use, sleep, diet and exercise), a screen for depression, and measures of self-stigma and masculine role norms. The results showed that elements of both health-related self-stigma and masculine role norms were associated with increased risk for being above the clinical threshold for four of the lifestyle behaviors and depression. The most frequent and largest relationships were associated with exercise and depression. The total number of lifestyle behaviors for which participants were above the clinical cut-points was also associated with self-stigma and masculine role norms. These findings demonstrate the importance of health-related self-stigma and masculine role norms as potential barriers to men’s health and well-being.
Quantitative RyR1 reduction and loss of calcium sensitivity of RyR1Q1970fsX16+A4329D cause cores and loss of muscle strength
Authors: Elbaz Moran , Ruiz Alexis , Bachmann Christoph , Eckhardt Jan , Pelczar Pawel , Venturi Elisa , Lindsay Chris , Wilson Abigail D , Alhussni Ahmed , Humberstone Thomas , Pietrangelo Laura , Boncompagni Simona , Sitsapesan Rebecca , Treves Susan , Zorzato Francesco
Published: May 2019

Recessive ryanodine receptor 1 (RYR1) mutations cause congenital myopathies including multiminicore disease (MmD), congenital fiber-type disproportion and centronuclear myopathy. We created a mouse model knocked-in for the Q1970fsX16+A4329D RYR1 mutations, which are isogenic with those identified in a severely affected child with MmD. During the first 20 weeks after birth the body weight and the spontaneous running distance of the mutant mice were 20% and 50% lower compared to wild-type littermates. Skeletal muscles from mutant mice contained ‘cores’ characterized by severe myofibrillar disorganization associated with misplacement of mitochondria. Furthermore, their muscles developed less force and had smaller electrically evoked calcium transients. Mutant RyR1 channels incorporated into lipid bilayers were less sensitive to calcium and caffeine, but no change in single-channel conductance was observed. Our results demonstrate that the phenotype of the RyR1Q1970fsX16+A4329D compound heterozygous mice recapitulates the clinical picture of multiminicore patients and provide evidence of the molecular mechanisms responsible for skeletal muscle defects.
Monetary valuation of recreational fishing in a restored estuary and implications for future management measures
Authors: Pouso Sarai , Ferrini Silvia , Turner R Kerry , Borja Ángel , Uyarra María C
Published: May 2019

Recreational fishing is considered a cultural ecosystem service, important in terms of the socio-economic benefits that it provides. In the Nerbioi estuary (northern Spain), investments in water treatment and the closure of polluting industries have led to several benefits such as improvements in water quality, fish abundance and richness, and recreational fishing activity. Currently, this activity is performed along the whole estuary including areas that previously were severely polluted. Valuing the benefits of recreational fishing is crucial to support the management of the estuary. The economic valuation is performed using a multi-site travel cost analysis. In addition, the effect on welfare measures of future scenarios where environmental conditions and accessibility change is analysed. Results indicate that each recreational trip in Nerbioi has a use value of 14.98€, with an aggregate value of 1.12 M€year−1 for the whole recreational fishers’ community. The simulated scenarios suggest that further environmental improvements would have a positive effect in the activity, increasing the current welfare by 7.5–11.5%. In contrast, worsening of environmental conditions and accessibility could translate into a welfare reduction up to 71%. The monetary use value of recreational fishing partially covers (4.7%) the costs of maintaining the environmental quality of the estuary.
Improving antibacterial prescribing safety in the management of COPD exacerbations: systematic review of observational and clinical studies on potential drug interactions associated with frequently prescribed antibacterials among COPD patients
Authors: Wang Yuanyuan , Bahar Muh Akbar , Jansen Anouk M E , Kocks Janwillem W H , Alffenaar Jan-Willem C , Hak Eelko , Wilffert Bob , Borgsteede Sander D
Published: May 2019

Background

Guidelines advise the use of antibacterials (ABs) in the management of COPD exacerbations. COPD patients often have multiple comorbidities, such as diabetes mellitus and cardiac diseases, leading to polypharmacy. Consequently, drug–drug interactions (DDIs) may frequently occur, and may cause serious adverse events and treatment failure.

Objectives

(i) To review DDIs related to frequently prescribed ABs among COPD patients from observational and clinical studies. (ii) To improve AB prescribing safety in clinical practice by structuring DDIs according to comorbidities of COPD.

Methods

We conducted a systematic review by searching PubMed and Embase up to 8 February 2018 for clinical trials, cohort and case–control studies reporting DDIs of ABs used for COPD. Study design, subjects, sample size, pharmacological mechanism of DDI and effect of interaction were extracted. We evaluated levels of DDIs and quality of evidence according to established criteria and structured the data by possible comorbidities.

Results

In all, 318 articles were eligible for review, describing a wide range of drugs used for comorbidities and their potential DDIs with ABs. DDIs between ABs and co-administered drugs could be subdivided into: (i) co-administered drugs altering the pharmacokinetics of ABs; and (ii) ABs interfering with the pharmacokinetics of co-administered drugs. The DDIs could lead to therapeutic failures or toxicities.

Conclusions

DDIs related to ABs with clinical significance may involve a wide range of indicated drugs to treat comorbidities in COPD. The evidence presented can support (computer-supported) decision-making by health practitioners when prescribing ABs during COPD exacerbations in the case of co-medication.
Global production network dis/articulations in Zanzibar: practices and conjunctures of exclusionary development in the tourism industry
Authors: Murphy James T
Published: May 2019

Recent assessments of economic geographers’ work on global production stress the need for improved understandings of the immanent, structural and contingent drivers of disarticulations—uneven and exclusionary development outcomes that often occur when places become connected to global production networks (GPN). Some argue that a productive approach is to view the places or regions linked to GPN as ‘conjunctures’ of context-specific and multi-scalar processes, social formations, power relations, histories and structures that shape the quality of GPN couplings and help to produce disarticulations. This article argues that an epistemological focus on the practices of firms connected to GPN can yield insights into industry-specific processes (e.g. value creation, upgrading) and region- or place-specific conjunctural factors that produce disarticulations. The approach is elaborated on and applied illustratively to the case of Zanzibar’s (Tanzania) tourism industry, a sector that has grown rapidly but in a manner that has excluded many of the archipelago’s residents from the benefits of increasing integration into GPN. The practices of Zanzibari enterprises and foreign-owned resorts show how local enterprises are increasingly marginal in tourism GPN, while large-scale resorts and non-local firms capture and subsequently offshore much of the value generated by the industry. A qualitative analysis of these practices highlights how they are shaped in part by the conjuncture of several structural factors and processes—political, economic, racial and technological—that help to produce disarticulations in Zanzibar.
A prospective evaluation of liquid biopsy for detecting MYCN amplification in neuroblastoma patients
Authors: Iehara Tomoko , Yagyu Shigeki , Gotoh Takahiro , Ouchi Kazutaka , Yoshida Hideki , Miyachi Mitsuru , Kikuchi Ken , Sugimoto Tohru , Hosoi Hajime
Published: May 2019

Background

Our previous study reported a method for determining MYCN gene amplification (MNA) status using cell-free DNA in serum. We prospectively analyzed the serum MNA status using sera obtained before the initial diagnosis from patients with neuroblastoma and evaluated the utility of this method.

Methods

Eighty patients were enrolled in the study. The serum MYCN/NAGK ratio was assessed for all cases.

Results

Fifteen cases showed serum MNA, while 65 did not. Of the 80 total patients, tumor samples for a genetic analysis were not obtained from 27 due to the patients’ condition or other reasons. For the 43 of 80 cases that had both serum and tumor samples analyzed, the serum-based MNA status matched to tumor-based MNA status (P < 0.001). The sensitivity and the specificity were 100%, respectively. Seven of 15 cases who diagnosed as MNA by serum-based MNA status were <18 months of age, and tumor samples were not obtained from 4 of these cases. Based on the serum MNA status, these cases were able to start treatment immediately. The 4-year event-free survival rates of cases with and without MNA in sera were 37.5% and 84.8%, respectively (P < 0.001).

Conclusion

The serum-based MNA status was useful for precisely predicting the MNA status in tumor and it has clinical benefits for predicting risk stratification in patients for whom obtaining tumor samples is difficult.
Histochemical examination on principal collagen fibers in periodontal ligaments of ascorbic acid-deficient ODS-od/od rats
Authors: Hasegawa Tomoka , Miyamoto-Takasaki Yukina , Abe Miki , Qiu Zixuan , Yamamoto Tomomaya , Yimin  , Yoshida Taiji , Yoshino Hirona , Hongo Hiromi , Yokoyama Ayako , Sasaki Muneteru , Kuroshima Shinichiro , Hara Kuniko , Kobayashi Masatoshi , Akiyama Yasuhiro , Maeda Takeyasu , Luiz de Freitas Paulo Henrique , Li Minqi , Amizuka Norio
Published: May 2019

In this study, we aimed to clarify the role of ascorbic acid in collagen synthesis in periodontal ligaments using osteogenic disorder Shionogi (ODS)/ShiJcl-od/od rats lacking L-gulonolactone oxidase. These rats cannot synthesize ascorbic acid in vivo. Eight-week-old ODS/ShiJcl-od/od male rats were administered ascorbic acid solution at a concentration of 200 mg/dL (control group, n = 6) or ascorbic acid solution at concentration of 0.3 mg/dL (insufficient group, n = 12). Six rats of the insufficient group were then given with ascorbic acid solution at concentration of 200 mg/dL for additional 3 weeks (rescued group, n = 6), and then, their mandibles were histochemically examined. Consequently, the insufficient group specimens were seen to possess fewer collagen fibers, and silver impregnation revealed numerous fine, reticular fiber-like fibrils branching off from collagen in the periodontal ligaments. In control group, faint immunoreactivities for matrix metalloproteinase (MMP)2 and cathepsin H were seen in the periphery of blood vessels and throughout the ligament, respectively. In contrast, in the insufficient group, intense MMP2-immunoreactivity was observed to be associated with collagen fibrils in the periodontal ligaments, and cathepsin H-immunopositivity was seen in ligamentous cells. The rescued group showed abundant collagen fibers filling the periodontal ligament space. Under transmission electron microscopy, ligamentous fibroblasts incorporated collagen fibrils into tubular endosomes/lysosomes while simultaneously synthesizing collagen fibril bundles. Thus, ascorbic acid insufficiency affected the immunolocalization of cathepsin H and MMP2; however, ligamentous fibroblasts appear to possess the potential to synthesize collagen fibers when supplied with ascorbic acid.
Image Content Analysis of US Natural Resources-Related Professional Society Websites with Respect to Gender and Racial/Ethnic Diversity
Authors: Bal Tara L , Sharik Terry L
Published: May 2019

In 2018, a web image content analysis was conducted to assess the perceived gender and race/ethnicity diversity and representativeness of 11 natural resources-related, professional society websites. Results highlight the lack of inclusivity of women and minorities in images most frequently seen at the top of these organizations’ home webpages. More gender and race/ethnicity diversity is present on the main landing page or home page for these organizations, but much less diversity is found on other webpages within the websites. Women and minorities are also less likely to be portrayed in images in the field, or actively engaging with natural resources (more likely to be included in posed, passive images indoors). Representative diversity in images is important to influence the perceived fit and consequential decisionmaking for potential students and professionals entering natural resource-related fields.
Determinants of Viral Resuppression or Persistent Virologic Failure After Initial Failure With Second-Line Antiretroviral Treatment Among Asian Children and Adolescents With HIV
Authors: Teeraananchai Sirinya , Kerr Stephen J , Gandhi Monica , Do Viet Chau , Van Nguyen Lam , Tran Dan Ngoc Hanh , Kosalaraksa Pope , Singtoroj Thida , Thammajaruk Narukjaporn , Jupimai Thidarat , Sohn Annette H
Published: May 2019

Of 56 children with perinatally acquired human immunodeficiency virus (HIV) who had been prescribed second-line protease inhibitor–based antiretroviral therapy and had ≥1 previous episode of viral failure (HIV RNA, ≥1000 copies/mL), 46% had ≥1, 34% had ≥2, and 23% had ≥3 consecutive episodes of viral failure during the 2 years of follow-up. Two of these children experienced a major protease inhibitor mutation.
Does Rotavirus Vaccination Affect Longer-Term Intussusception Risk in US Infants?
Authors: Burke Rachel M , Tate Jacqueline E , Dahl Rebecca M , Aliabadi Negar , Parashar Umesh D
Published: May 2019

Rotavirus vaccination has been associated with a short-term increased risk of intussusception. Our analysis of insurance claims for 1 858 827 US children with 544 recorded cases of intussusception found a nonsignificant decrease in intussusception (hazard ratio, 0.79 [95% confidence interval, 0.57–1.09]) in fully rotavirus-vaccinated children followed up to the age of 2 years.
The fixed point property and a technique to harness double fixed point combinators
Authors: Manzonetto Giulio , Polonsky Andrew , Saurin Alexis , Simonsen Jakob Grue
Published: May 2019

The ${\lambda }$-calculus enjoys the property that each ${\lambda }$-term has at least one fixed point, which is due to the existence of a fixed point combinator. It is unknown whether it enjoys the ‘fixed point property’ stating that each ${\lambda }$-term has either one or infinitely many pairwise distinct fixed points. We show that the fixed point property holds when considering possibly open fixed points. The problem of counting fixed points in the closed setting remains open, but we provide sufficient conditions for a ${\lambda }$-term to have either one or infinitely many fixed points. In the main result of this paper we prove that in every sensible ${\lambda }$-theory there exists a ${\lambda }$-term that violates the fixed point property.

We then study the open problem concerning the existence of a double fixed point combinator and propose a proof technique that could lead towards a negative solution. We consider interpretations of the ${\lambda } {\mathtt{Y}}$-calculus into the ${\lambda }$-calculus together with two reduction extension properties, whose validity would entail the non-existence of any double fixed point combinators. We conjecture that both properties hold when typed ${\lambda } {\mathtt{Y}}$-terms are interpreted by arbitrary fixed point combinators. We prove reduction extension property I for a large class of fixed point combinators.

Finally, we prove that the ${\lambda }{\mathtt{Y}}$-theory generated by the equation characterizing double fixed point combinators is a conservative extension of the ${\lambda }$-calculus.
Internuclear Ophthalmoplegia
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Internuclear ophthalmoplegia is characterized by an ipsilateral adduction deficit that can be overcome with convergence. It is caused by a lesion affecting the medial longitudinal fasciculus in the brainstem tegmentum. In this chapter, we begin by reviewing the clinical features of internuclear ophthalmoplegia. We next list the common causes of internuclear ophthalmoplegia, which include demyelination, stroke, tumors, and congenital hindbrain anomalies. We then discuss other potential causes of an adduction deficit that can mimic internuclear ophthalmoplegia, which include ocular myasthenia and chronic progressive external ophthalmoplegia, and describe strategies to help diagnose these at the bedside. Lastly, we briefly discuss the treatment approach for internuclear ophthalmoplegia.
Downbeat Nystagmus
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Downbeat nystagmus is a common type of central vestibular nystagmus that often produces oscillopsia or blurred vision. It is a vertical jerk-waveform nystagmus with upward slow phases and downward quick phases. In this chapter, we begin by reviewing the clinical features of downbeat nystagmus. We next list the common causes for downbeat nystagmus, which include inherited cerebellar degenerations, acquired cerebellar degenerations, congenital hindbrain anomalies, stroke, tumors, and medications. We then discuss the workup and management of paraneoplastic cerebellar degeneration, which is most commonly associated with cancers of the lung, ovary, and breast. Lastly, we review medical treatment options for downbeat nystagmus.
Pendular Nystagmus
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Pendular nystagmus often occurs in the setting of multiple sclerosis, but it can also occur in the syndrome of oculopalatal tremor. It has a sinusoidal waveform such that there are slow phases in both directions without corrective quick phases. Because it can cause disabling oscillopsia, many affected patients request treatment. In this chapter, we begin by reviewing the clinical features and pathogenesis of pendular nystagmus occurring in the setting of multiple sclerosis. We next review the clinical features and pathogenesis of oculopalatal tremor, which is most commonly a delayed consequence of brainstem tegmentum or cerebellar stroke. Lastly, we review the medical treatment options for pendular nystagmus, which include gabapentin and memantine.
Eyelid Ptosis
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Upper-eyelid ptosis is frequently encountered in clinical practice but has a broad differential diagnosis. It can produce visual symptoms when the pupil is encroached by the upper eyelid. In this chapter, we begin by reviewing the clinical features that help with localization of the lesion responsible for upper-eyelid ptosis. We next describe the components of the eyelid examination that help to quantify and characterize upper-eyelid ptosis. We then discuss the features of levator dehiscence and list its common causes, which include involutional changes in orbital connective tissues, long-term use of contact lenses, and iatrogenic trauma. Lastly, we review the treatment options for levator dehiscence.
Benign Essential Blepharospasm
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Blepharospasm is an involuntary closure of the eyes that is caused by spasm of the orbicularis oculi. It can be isolated or associated with certain ophthalmic and neurologic disorders, such as progressive supranuclear palsy. In this chapter, we begin by reviewing the clinical features of benign essential blepharospasm and oromandibular dystonia (Meige syndrome). We next review the clinical features of apraxia of eyelid opening and hemifacial spasm, since these disorders can occasionally be confused with benign essential blepharospasm. Lastly, we discuss management options for benign essential blepharospasm, which include injections of botulinum toxin A into the orbicularis oculi and surrounding muscles.
Carotid-Cavernous Fistula
Authors: Thurtell Matthew J. , Tomsak Robert L.
Published: May 2019

Carotid-cavernous fistulas are abnormal vascular communications between the carotid artery or its branches and the cavernous sinus. They often present with visual symptoms and signs, such as proptosis, chemosis, diplopia, or conjunctival injection. In this chapter, we begin by reviewing the types of carotid-cavernous fistula and their respective causes. We next discuss the symptoms, signs, and potential complications of carotid-cavernous fistula. We then discuss noninvasive imaging approaches for the diagnostic evaluation of carotid-cavernous fistula, although digital subtraction cerebral angiography is necessary for definitive diagnosis. Lastly, we review the management options for carotid cavernous fistula, including approaches that can minimize or address potential visual complications.
Recognizing Family
Authors: McLaughlin Janice
Published: May 2019

This chapter seeks to explore some of the complexities involved in recognizing family and draws from a range of work interrogating what is meant by the term. It does so to support the bioethical concern with the importance of relationships to selfhood, of which family is a key form, while also attesting to the politics and risks of such a move. The overall argument is that we need to take care around the recognition dynamics involved in advocating that particular kinds of relationships are important to acknowledge in healthcare. This argument is worked through by exploring two important terms in the debates on family, vulnerability and value, and by layering a sociological account of both into their role in validating a relational/family approach to selfhood and healthcare ethics.
Young Caregivers
Authors: Calder Gideon
Published: May 2019

This case study illustrates the experiences of a young caregiver. The case is emblematic of wider questions of distributive justice: the sharing of resources and caring responsibilities in society, and the impact of this on the life chances of children (and indeed their parents). To what extent, for example, should the situations in the case be regarded as the responsibility of outside agencies, and if those agencies intervene, how should they do this, and with what ends in view? It also raises questions about the agency of caregivers, and the extent to which family members have the right to take on roles even when this is detrimental to their well-being.
Device-Associated Infections (Outside of the Neonatal Intensive Care Unit)
Authors: Karandikar Manjiree V. , Lee Grace M. , Holzmann-Pazgal Galit , Coffin Susan
Published: May 2019

Device-associated infections cause substantial morbidity in children. These healthcare-associated infections (HAI) can increase length of stay and healthcare costs. The strategies used to prevent device-associated infections in children can vary, depending on many patient-specific factors, including the child’s age and physical location when receiving inpatient pediatric care. In addition, infection prevention strategies in children are not always the same as adult prevention strategies. This chapter reviews practical, evidence-based strategies to prevent pediatric ventilator-associated events (VAE), central line–associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). The recommendations focus on patients outside the neonatal intensive care unit (NICU) setting.
Management of Hospital Visitors
Authors: Mehrotra Preeti , Shane Andi L.
Published: May 2019

Policies and practices regarding management of visitors vary by hospital system. Current guidance from the Society for Healthcare Epidemiology (SHEA) suggests that practices should be based on (a) the pathogen suspected or confirmed, (b) the underlying medical condition of the patient and the visitor, and (c) the endemicity of that pathogen in the hospital and surrounding community—distinguishing between outbreak and non-outbreak settings. Pediatric infection prevention strategies should strive to balance family centered care with policies that minimize the risk of acquiring or transmitting pathogens. This chapter provides guidance on managing hospital visitors when a child’s infection requires isolation precautions. Age-based visitor restriction policies are reviewed. This chapter also includes discussion about high-consequence pathogens such as Ebola virus.
Pertussis and Influenza Cocooning Immunization Strategies
Authors: Varman Meera , Pietruszka Sarah Turner , Lehan Karen
Published: May 2019

This chapter discusses the adult immunization strategy called “cocooning” to protect young infants from vaccine-preventable disease. Cocooning focuses on immunizing all close contacts of infants and high-risk children, thereby decreasing their exposure to these infectious diseases. The cocooning strategy is frequently recommended as a strategy to prevent transmission of influenza and pertussis. Cocooning may include the vaccination not only of mothers but also of fathers, grandparents, siblings, extended family members, daycare providers, healthcare workers, and other caregivers in contact with the infant. This chapter provides suggestions for implementing an adult immunization program in both ambulatory and inpatient pediatric settings.
Women’s Healthcare Through a Feminist Ethics Lens
Authors: d’Agincourt-Canning Lori , Ells Carolyn
Published: May 2019

This chapter provides the book’s rationale, reviews themes that are central to the book, and presents an overview of its chapters. The collection aims to bring insights from healthcare providers, clinical ethicists, scholars, and community together as a way of broadening feminist bioethics and being responsive to ethical issues in women’s healthcare. A starting premise is that gender is central to the evaluation of healthcare and healthcare practices. Several feminist themes that are pertinent to the ethics analyses throughout the book are described. These include relational components of moral life, justice and oppression, women-centered care, implications of sex and gender distinctions, and examining issues through an ethics lens. The overview of chapters highlights the specific gaps in the literature each one fills, along with how they fit together as a collection.
Caring for Refugees, New Immigrants, and Uninsured Women
Authors: Caulford Paul , Rahunathan Sumathy
Published: May 2019

This chapter considers ethical issues related to care of immigrant women and refugees. Even in a country like Canada with a “universal” public healthcare system and a humanitarian history of opening its doors to refugees and immigrants, inconsistent and fragmented policies leave large gaps in healthcare access for refugees and immigrant women. These, in turn, result in harms to the health, safety, and potential life opportunities and trajectories for women and girls new to the country. This chapter identifies these gaps and insists that healthcare access must become a central part of the broader conversation on social responsibility to refugees, women, and their families. The issues raised in the Canadian context have applicability to international jurisdictions.
Data, Information, and Knowledge
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Informatics begins with organized data. This consists of creation of a structured approach to data classification and management. The implications of the terms data, information, and knowledge are understood to be a hierarchy of data complexity and interrelationships. Knowledge management is a key component of the information system. Knowledge management has multiple potential pitfalls. Errant and obsolete data are the most common issues. Guidelines change, and for a busy clinician, it is hard to keep track of the new changes. New indications for medications and procedures may be found. This new knowledge ultimately triggers changes to protocols and order sets, and these changes have to be made with appropriate speed as well as caution. Those in informatics make every decision on the basis of the best and most accurate information available at the time. Knowledge management needs to keep up.
Representation and Organization of Health Information
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Data must be represented and organized in ways that improve individual care and support databases designed to improve care delivery, reporting, and research. There are innumerable potential data sources, but discussed in this chapter are some of the most important data sources for healthcare. Clinical data include all of the locally stored, clinically relevant data. These include demographics as well as actual medical data. If a health information exchange is functioning, then data from that exchange may be included to a variable extent. Different applications require different ways of modeling and storing data. These tasks require trade-offs between computable data representations and less structured elements.
Basics of Computers
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Foundational knowledge of informatics includes a basic understanding of the operation of computers. This includes hardware design and function, programming, and networking basics. Although few clinical informatics professionals will personally design computers or write large programs, every professional should have an understanding of the capabilities and limitations of current information technology. Informatics professionals need basic familiarity with computer structure and function. Also, understanding programming and aspects of computer control and query language gives foundational knowledge of what is doable and what is not doable. Computers are composed of hardware and software. Hardware is the physical devices, and software is the operating instructions.
Data Science
Authors: Misulis Karl E. , Frisse Mark E.
Published: May 2019

Data science is the study of how analytics techniques can be applied to large and diverse data sets. This field is emerging because of the availability of massive data sets in both consumer and health sectors, new machine learning and other analytics requiring large-scale computation, and the vital need to identify risk factors, trends, and other relationships not apparent when applying traditional analytics methods to smaller structured data sets. In some organizations, the primary role of a clinical informatics professional no longer is focused on how electronic health records are used in healthcare delivery but instead is focused on how patient encounter information can be collected efficiently, aggregated with information from other encounters or sources, and analyzed to improve our understanding of how population studies can improve the care of individuals. Such an understanding is critical to improving care quality and lowering healthcare costs.
Aortic Valve Surgery
Authors: Reed Heather , Lombaard Stefan , Arzillo Samantha
Published: May 2019

Aortic valve stenosis is the most common primary valvular disease today. The natural history of aortic valve stenosis is most commonly described as a long latent period without symptoms as the disease progresses from mild to severe, followed by a shorter period with symptoms; ultimately, death will result if the stenosis is left untreated. Today, severe aortic stenosis is a class 1 indication for surgery. Classic symptoms include dyspnea, syncope, and angina. Diagnostic options include echocardiography, cardiac catheterization, computed tomography, and magnetic resonance imaging. Perioperative transesophageal echocardiography is necessary for preoperative and postoperative assessment of the patient who has severe aortic stenosis.
Robotic CABG
Authors: Dhawan Richa
Published: May 2019

Technological advances and increased experience in robotic coronary artery bypass surgery in the last 15 years have expanded and changed the field. Totally endoscopic coronary artery bypass surgery has become more prevalent and innovative. These cardiac cases require proficiency in skills such as management of one-lung ventilation, insertion of specialized catheters, intraoperative monitoring, and transesophageal echocardiography. Anesthesiologists must be familiar with different methods of lung isolation, including management of episodes of hypoxemia, hypercarbia, and sequelae of increased pulmonary vascular resistance during lung isolation. Procedures with arrested heart on cardiopulmonary bypass require expertise in insertion of a percutaneous coronary sinus catheter for administration of retrograde cardioplegia, in addition to insertion of a pulmonary artery vent for left ventricular decompression. Transesophageal echocardiography is essential for placement of specialized cannulas for cardiopulmonary bypass, such as the endoaortic occlusion balloon clamp and remote access perfusion lines. In certain cases, anesthetic technique should facilitate intraoperative extubation and management of postoperative pain.
Aortic Stenosis in Noncardiac Surgery
Authors: Perkins Blake , Dupont Frank
Published: May 2019

Aortic stenosis is the most common valvular lesion in patients older than 65 years, occurring in 2%–9% of patients. It is estimated that the number of patients with aortic stenosis who will need surgery will increase dramatically as the world’s population ages. Treatment of aortic stenosis includes surgical aortic valve replacement, transcatheter aortic valve replacement, balloon valvuloplasty, or medical management. Aortic stenosis is associated with significant perioperative risk in noncardiac surgery. Hemodynamic changes from anesthesia medications and the surgical procedure can result in decreased coronary perfusion, myocardial ischemia, arrhythmias, heart failure, or even death. General or regional anesthesia can be administered safely to asymptomatic patients with significant aortic stenosis if hemodynamics are maintained in the perioperative period.
Anesthetic Management for Patients With Left Ventricular Assist Devices Undergoing Noncardiac Surgery
Authors: Kleiman Amanda M. , Spencer Christopher , Huffmyer Julie L.
Published: May 2019

The incidence and prevalence of chronic heart failure is increasing in the United States, and end-stage heart failure is associated with high mortality. While medical management is often the first-line treatment of heart failure, mechanical circulatory support and ventricular assist device therapies are being increasingly employed to improve symptoms and end-organ dysfunction from heart failure. Patients with left ventricular assist devices (LVADs) are not only surviving with their disease, but also thriving as a result of LVAD support, and many return to normal activities of daily life. Thus, these patients present to hospitals for noncardiac surgeries, both elective and urgent, with increasing frequency. This chapter explores some commonly used ventricular assist devices, the altered physiology that accompanies LVAD therapy with continuous flow devices, as well as some of the anesthetic considerations that are vital for patients presenting for both elective and urgent surgeries.
The Dreaded Bring Backs
Authors: Zaky Ahmed
Published: May 2019

The postoperative care of the cardiac surgical patient continues to be an ongoing challenge. An aging population coupled with increasing comorbidities results in sicker patients now undergoing open-heart surgery. Moreover, those patients with high operative risk are undergoing minimally invasive cardiac procedures that are associated with their own newly recognized inherent risks. Anesthesiologists and intensivists caring for cardiac surgical patients should be aware of the challenges imposed by the population and by the procedures. Their scope of skills should expand to encompass fluency in bedside echocardiography, electrophysiology, and bedside extracorporeal and balloon pump insertion techniques. In so doing, cardiac anesthesiologists/intensivists not only will be able to make critical abstract plans that are implemented by other personnel, but also will be able to pursue lifesaving prompt diagnostic and therapeutic procedures frequently needed in this acutely critically ill patient population. This chapter discusses some of the frequently encountered life-threatening complications that occur in the postoperative cardiac surgical patient that may lead to surgical reexploration. The chapter focus is on the definitive and supportive management of these complications and their underlying mechanisms with more specific attention on postoperative bleeding and coagulopathy.
Electrophysiology Procedures
Authors: Disque Andrew , Patel Komal
Published: May 2019

Cardiac arrhythmias are a common cause of patient morbidity and mortality. Modern electrophysiology (EP) procedures, including placement of permanent pacemakers and implantable cardioverter-defibrillators and catheter ablation of cardiac arrhythmias, have been shown to reduce mortality and improve quality of life and symptoms. These procedures can also reduce the need for antiarrhythmic medications and hence reduce side effects related to these medicines. The procedures performed in the EP laboratory can be protracted and painful and therefore frequently require the assistance of an anesthesia team for patient comfort. Additionally, this patient population often presents with complicated comorbid conditions and hemodynamic instability. Frequently, the anesthetic management can be complicated and difficult, requiring a thorough understanding of these patients and the procedures they choose to undergo.
Extracorporeal Membrane Oxygenation
Authors: Lowe Michael E. , Roberts Joseph D. , Chaney Mark A.
Published: May 2019

Percutaneous mechanical devices are used in the treatment of severe cardiac or respiratory disease. These devices include extracorporeal membrane oxygenation, intra-aortic balloon pump, TandemHeart™, and Impella®. The use of these devices has increased over time as their clinical efficacy has been established and technological advancements have made their use more practical and accessible. Technological advancements have helped improve the morbidity of ECMO. Two of the major improvements have been to the oxygenator and to the pump system. As these devices become more commonplace, it is important to have a thorough understanding of how each device works, their indications, and potential complications.
Aortic Arch Repair (Circulatory Arrest)
Authors: Asher Shyamal
Published: May 2019

Aortic arch repair is a technically challenging surgery that requires collaboration between the anesthesiology, cardiac surgery, and perfusion teams. To accomplish a total aortic arch repair, blood flow to the brain and the rest of the body has to be interrupted. The most common aortic arch pathologies encountered for surgery are aortic arch aneurysms followed by aortic dissections. The need for hypothermia and circulatory arrest during aortic arch surgeries leads to unique implications for anesthetic management. Therefore, adequate knowledge of the planned surgery and specific surgical and nonsurgical cerebral protection techniques are necessary. Furthermore, an understanding of intraoperative neurophysiologic and temperature monitoring at deep hypothermia as well as postbypass coagulopathy management are needed in these challenging cases.
Mediastinal Mass Excision
Authors: Schurle Alan , Nizamuddin Junaid
Published: May 2019

Mediastinal masses are rare tumors of the thoracic cavity. Although not all types require surgical intervention, resection of these masses provides a clinical challenge for the anesthesiologist due to both local mass effects, such as airway and vascular compression, and systemic effects, including paraneoplastic syndromes. A common example includes myasthenia gravis associated with thymoma. Preoperative assessment includes viewing imaging, obtaining a thorough history, performing a focused physical examination, and reviewing laboratory values. Medically optimizing comorbid conditions prior to excision, if possible, may reduce perioperative morbidity and mortality. Intraoperative considerations include planning for postoperative analgesia, establishing an airway, selection of invasive and noninvasive monitors, choosing intravenous access sites commensurate with tumor size and location, judicious fluid administration, and ventilator management. Postoperative considerations include intensive care unit transport, analgesia, and airway maintenance.
Evaluation and Anesthetic Management for Patients With Cardiac Trauma
Authors: Smith Daniel , Ness Eric , Kleiman Amanda M.
Published: May 2019

Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.
ICU Management of the Cardiac Patient
Authors: Patel Vijal , Nizamuddin Junaid
Published: May 2019

Management of the cardiac surgery patient continues in the intensive care unit, necessitating an understanding of the underlying disease process, operative procedure, and potential complications. Complications in cardiac surgery patients span virtually every organ system and manifest at different times in the postoperative period. As such, successful outcomes in cardiac surgery require a multidisciplinary approach, with postoperative care tailored to the pathophysiology present. This chapter discusses the commonly encountered postoperative concerns and overarching management pearls, beginning from intensive care unit handoff to weaning circulatory support and extubation. Also discussed are the postoperative implications of specific interventions utilized in cardiac surgery.
Radiotherapy
Authors: Brown Richard , Horne Paula
Published: May 2019

This chapter examines the manner in which radiotherapy is employed to treat cancers and the general principles which govern its use. Radiotherapy can be used in a curative or palliative setting and is frequently combined with surgery or chemotherapy to produce an optimum treatment plan. The underpining radiobiology to treatment fractionation is briefly explored, before the differing modalities by which radiotherapy can be delivered are outlined. The principles of radiotherapy planning are laid out, before recent advances in radiotherapy treatment are also covered. Radiotherapy toxicities and side effects and the management of these are analysed in some detail.
Allogeneic haematopoietic stem cell transplantation
Authors: Eyre Toby
Published: May 2019

This chapter explores the principles and uses of allogeneic haematopoietic stem cell transplantation, including its main uses in poor-risk acute leukaemia and chronic myeloid leukaemia. It discusses the principle of graft-versus-malignancy, and human leucocyte antigen matching and donor sources are described. Complications, including graft-versus-host disease, veno-occlusive disease, and opportunistic infections, such as cytomegalovirus, are covered. This includes nursing care of these complex problems.