bluuebunny/crossref_metadata_2025 huggingface dataset:
The Testing Imperative: Why the US Ending the Human Immunodeficiency Virus (HIV) Epidemic Program Needs to Renew Efforts to Expand HIV Testing in Clinical and Community-Based Settings
Authors: Nosyk Bohdan , Fojo Anthony Todd , Kasaie Parastu , Enns Benjamin , Trigg Laura , Piske Micah , Hutchinson Angela B , DiNenno Elizabeth A , Zang Xiao , del Rio Carlos
Published: February 2023

Data from several modeling studies demonstrate that large-scale increases in human immunodeficiency virus (HIV) testing across settings with a high burden of HIV may produce the largest incidence reductions to support the US Ending the HIV Epidemic (EHE) initiative's goal of reducing new HIV infections 90% by 2030. Despite US Centers for Disease Control and Prevention's recommendations for routine HIV screening within clinical settings and at least yearly screening for individuals most at risk of acquiring HIV, fewer than half of US adults report ever receiving an HIV test. Furthermore, total domestic funding for HIV prevention has remained unchanged between 2013 and 2019. The authors describe the evidence supporting the value of expanded HIV testing, identify challenges in implementation, and present recommendations to address these barriers through approaches at local and federal levels to reach EHE targets.
CISG Exclusion during Legal Proceedings
Authors: Pohl-Michałek Małgorzata
Published: February 2023

In the contracting States of the Convention on Contracts for the International Sale of Goods (CISG), where the CISG applies via its Article 1, the courts have a duty under public international law to apply its rules automatically, regardless of the parties’ awareness in this respect. At the same time, the parties have a subsequent autonomy based on Article 6 of the CISG to exclude the application of the Convention, which may be done expressly or by implication. Such an exclusion may take place at various stages of the parties’ legal relationship, including during legal proceedings. Due to the fact that the legal representatives are often not aware of the CISG’s existence and its potential automatic application to the given case, when a dispute arises, they may fail to plead or base their arguments on the basis of its applicable rules. This article focuses on the adjudicator’s duty to apply the CISG ex officio, together with the possibility and requirements regarding its exclusions made during legal proceedings, given the example of two recent Chinese cases. In this contribution, it is advocated that the failure by the parties’ representatives to plead and base their arguments during litigation over the applicable CISG rules is not a sufficient indication of their intention to exclude the Convention.
Corticosteroids Increase the Risk of Invasive Fungal Infections More Than Tumor Necrosis Factor-Alpha Inhibitors in Patients With Inflammatory Bowel Disease
Authors: Gregory Martin H , Spec Andrej , Stwalley Dustin , Gremida Anas , Mejia-Chew Carlos , Nickel Katelin B , Ciorba Matthew A , Rood Richard P , Olsen Margaret A , Deepak Parakkal
Published: February 2023

Background

Invasive fungal infections are a devastating complication of inflammatory bowel disease (IBD) treatment. We aimed to determine the incidence of fungal infections in IBD patients and examine the risk with tumor necrosis factor-alpha inhibitors (anti-TNF) compared with corticosteroids.

Methods

In a retrospective cohort study using the IBM MarketScan Commercial Database we identified US patients with IBD and at least 6 months enrollment from 2006 to 2018. The primary outcome was a composite of invasive fungal infections, identified by ICD-9/10-CM codes plus antifungal treatment. Tuberculosis (TB) infections were a secondary outcome, with infections presented as cases/100 000 person-years (PY). A proportional hazards model was used to determine the association of IBD medications (as time-dependent variables) and invasive fungal infections, controlling for comorbidities and IBD severity.

Results

Among 652 920 patients with IBD, the rate of invasive fungal infections was 47.9 cases per 100 000 PY (95% CI 44.7–51.4), which was more than double the TB rate (22 cases [CI 20–24], per 100 000 PY). Histoplasmosis was the most common invasive fungal infection (12.0 cases [CI 10.4–13.8] per 100 000 PY). After controlling for comorbidities and IBD severity, corticosteroids (hazard ratio [HR] 5.4; CI 4.6–6.2) and anti-TNFs (HR 1.6; CI 1.3–2.1) were associated with invasive fungal infections.

Conclusions

Invasive fungal infections are more common than TB in patients with IBD. The risk of invasive fungal infections with corticosteroids is more than double that of anti-TNFs. Minimizing corticosteroid use in IBD patients may decrease the risk of fungal infections.
TNF
ΔARE
Pigs: A Translational Crohn’s Disease Model
Authors: Winogrodzki Thomas , Metwaly Amira , Grodziecki Alessandro , Liang Wei , Klinger Bernhard , Flisikowska Tatiana , Fischer Konrad , Flisikowski Krzysztof , Steiger Katja , Haller Dirk , Schnieke Angelika
Published: February 2023

Background and Aims

Crohn’s disease [CD] is a major subtype of inflammatory bowel diseases [IBD] with increasing incidence and prevalence. Results of studies using available small and large animal models are often poorly translatable to patients, and few CD models show small intestinal pathology. Due to its similarities to humans, the pig has emerged as a highly suitable translational disease model, particularly for testing novel nutritional and technological interventions. Our goal was to develop a physiologically relevant porcine CD model to facilitate translation of findings and interventions towards the clinic.

Methods

We generated pigs bearing a 93-bp deletion of the adenosine–uracil-rich element [ARE] and a constitutive-decay element within the 3ʹ untranslated region of the TNF gene. Comparative analysis of physiological, molecular, histological and microbial characteristics was performed between wild-type, TNFΔARE/+ and TNFΔARE/ΔARE animals. Alterations in the microbiome were compared to the TNFΔARE mouse model and IBD patients.

Results

TNF ΔARE pigs recapitulate major characteristics of human CD, including ulcerative transmural ileocolitis, increased abundance of proinflammatory cytokines, immune cell infiltration and dysbiotic microbial communities. 16S rRNA gene amplicon sequencing revealed enrichment in members belonging to Megasphaera, Campylobacter, Desulfovibrio, Alistipes and Lachnoclostridum in faecal or mucosa-associated bacteria compared to wild-type littermates. Principal components analysis clustering with a subset of TNFΔARE/+ mice and human IBD patients suggests microbial similarity based on disease severity.

Conclusions

We demonstrate that the TNFΔARE pig resembles a CD-like ileocolitis pathophenotype recapitulating human disease. The ability to conduct long-term studies and test novel surgical procedures and dietary interventions in a physiologically relevant model will benefit future translational IBD research studies.
Benedicamus Domino as an expression of joy in Christmas songs of the Devotio moderna
Authors: Louviot Manon
Published: February 2023

Christmas, as the celebration of the birth of Jesus Christ, is a central and joyful feast of Christian worship. In medieval and early modern Europe, this translated into a rich musical tradition, of which Christmas songs were a significant part. Song collections from the Devotio moderna, a spiritual movement that spread in the Low Countries and Germany during the 15th and 16th centuries, are an important witness to this Christmas tradition. However, because of their wide dissemination and their simple musical style, these songs have presented an historiographical challenge: it has proved impossible to detail in full the ubiquitous circulation of the well-known songs adopted within the Devotio moderna, as well as to subject their music and texts to close analysis of the kind usually undertaken for more ‘complex’ polyphony. In this context, the Benedicamus Domino offers a new and productive perspective: not only was the Benedicamus Domino singled out for special permission to be sung in polyphony at Christmas, but many Christmas songs are in fact Benedicamus tropes. I trace the uses and functional implications of the Benedicamus Domino within a single and very widely transmitted song, Puer nobis nascitur. Based on an analysis of its polyphonic versions in Latin and of its transmissions with a mix of Latin and vernacular texts, I argue that the Benedicamus was one element deliberately used in Christmas songs to guide spiritual exercises and meditation, inspiring and expressing joy during the Christmas season.
‘With the base Viall placed between my Thighes’: musical instruments and sexual subtext in Titian’s Venus with musician series
Authors: Bandy Malachai Komanoff
Published: February 2023

Late in his career, Titian (and his workshop) treated the Venus with musician theme in a series of five similar paintings of unconfirmed patronage. All show the goddess in the same reclined pose, but the musician at her feet transmutes over the course of the series from organist to lutenist, and subtly changes position in the frame. Recently, the paintings and their thematic origins have elicited much debate among art historians McIver, Goffen, Falomir and others. But any mention of the painting’s musical instruments remains confined to discussion of the works’ composition, perspective, or implicit Neoplatonic or Petrarchan sensory discourse. In particular, conversation regarding Titian’s viol only highlights its crude form, as ‘proof’ of the series’ completion, after Titian’s death, by a less-skilled hand.

Despite its generally noble status throughout its lifespan, the viol became a widely sexualized object in Renaissance Italian literature; the first viol-centric sexual allusion comes from Straparola’s Le piacevoli notti, ii (Venice, 1553), which closely coincides in time and place with the viol’s appearance on Titian’s canvas. In particular, considering the wealth of viol-sexualizing English poetry and drama in the following century, connections between Titian’s Venus and Le piacevoli notti, with its ultimate vogue in English Transalpina culture, warrant recognition and investigation.
Building Ecosystem Resilience and Adaptive Capacity: a Systematic Review of Aspen Ecology and Management in the Southwest
Authors: Crouch Connor D , Rogers Paul C , Moore Margaret M , Waring Kristen M
Published: February 2023

Quaking aspen (Populus tremuloides Michx.) has high conservation value on the southwestern edge of its range, which extends from the southwestern United States (i.e., Arizona, New Mexico, and Texas) to central Mexico. This value is driven by aspen’s ecological importance, positive impact on local economies, and aesthetic and cultural values. Generally, the scant aspen populations that remain in the Southwest lack resilience and adaptive capacity, and managers are unsure how best to maintain the species in an uncertain future. This systematic review seeks to address that need by reviewing existing literature from the Southwest on which biotic and abiotic factors influence aspen forest dynamics and by synthesizing that literature with a discussion of how management can promote aspen ecosystem resilience and adaptive capacity. We found that fire and silvicultural treatments promote aspen regeneration, but chronic ungulate browse inhibits recruitment. Moreover, drought is a driver of overstory mortality and has a negative influence on recruitment. In the second half of this review, we propose three management objectives for increasing aspen resilience and adaptive capacity: (1) promote diversity in age structure, (2) mitigate ungulate impacts, and (3) enhance complexity. We consider how various management strategies could meet these objectives and highlight potential threats to aspen forest health and resilience.
Constituting the negative globality of fear
Authors: Frankenberg Günter
Published: February 2023

This Editorial Reflection traces the global proliferation of pandemic fears and follows them through psychological theories as well as legal measures of infection control. Pandemic fears are included in the controversial discussion on how laws and constitutions (should) protect freedom in a pandemic and how the fear of contagion and the insecurity triggered by infection protection measures reinforce each other and contribute to the negativity of a pandemic. In closing, the article presents different forms of fear denial such as conspiracy myths, stimulated by anti-COVID-19 regimes of law and politics.
Surveillance for Multisystem Inflammatory Syndrome in US Children Aged 5–11 Years Who Received Pfizer-BioNTech COVID-19 Vaccine, November 2021 through March 2022
Authors: Cortese Margaret M , Taylor Allan W , Akinbami Lara J , Thames-Allen Andrea , Yousaf Anna R , Campbell Angela P , Maloney Susan A , Harrington Theresa A , Anyalechi E Gloria , Munshi Datta , Kamidani Satoshi , Curtis C Robinette , McCormick David W , Staat Mary A , Edwards Kathryn M , Creech C Buddy , Museru Oidda , Marquez Paige , Thompson Deborah , Su John R , Schlaudecker Elizabeth P , Broder Karen R
Published: February 2023

Multisystem inflammatory syndrome in children (MIS-C) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; in the United States, reporting of MIS-C after coronavirus disease 2019 (COVID-19) vaccination is required for vaccine safety monitoring. Pfizer-BioNTech COVID-19 vaccine was authorized for children aged 5−11 years on 29 October 2021. Covering a period when approximately 7 million children received vaccine, surveillance for MIS-C ≤ 90 days postvaccination using passive systems identified 58 children with MIS-C and laboratory evidence of past/recent SARS-CoV-2 infection, and 4 without evidence. During a period with extensive SARS-CoV-2 circulation, MIS-C illness in children after COVID-19 vaccination who lacked evidence of SARS-CoV-2 infection was rare (<1 per million vaccinated children).
Comparison of an advanced automated ultrasonic scanner (AutoFom III) and a handheld optical probe (Destron PG-100) to determine lean yield in pork carcasses
Authors: Dorleku Justice B , Wormsbecher Lisa , Christensen Mette , Campbell Cheryl P , Mandell Ira B , Bohrer Benjamin M
Published: February 2023

This study compared the accuracy of two methods for predicting carcass leanness (i.e., predicted lean yield) with fat-free lean yields obtained by manual carcass side cut-out and dissection of lean, fat, and bone components. The two prediction methods evaluated in this study estimated lean yield by measuring fat thickness and muscle depth at one location with an optical grading probe (Destron PG-100) or by scanning the entire carcass with advanced ultrasound technology (AutoFom III). Pork carcasses (166 barrows and 171 gilts; head-on hot carcass weights (HCWs) ranging from 89.4 to 138.0 kg) were selected based on their fit within desired HCW ranges, their fit within specific backfat thickness ranges, and sex (barrow or gilt). Data (n = 337 carcasses) were analyzed using a 3 × 2 factorial arrangement in a randomized complete block design including the fixed effects of the method for predicting lean yield, sex, and their interaction, and random effects of producer (i.e., farm) and slaughter date. Linear regression analysis was then used to examine the accuracy of the Destron PG-100 and AutoFom III data for measuring backfat thickness, muscle depth, and predicted lean yield when compared with fat-free lean yields obtained with manual carcass side cut-outs and dissections. Partial least squares regression analysis was used to predict the measured traits from image parameters generated by the AutoFom III software. There were method differences (P < 0.01) for determining muscle depth and lean yield with no method differences (P = 0.27) for measuring backfat thickness. Both optical probe and ultrasound technologies strongly predicted backfat thickness (R2 ≥ 0.81) and lean yield (R2 ≥ 0.66), but poorly predicted muscle depth (R2 ≤ 0.33). The AutoFom III improved accuracy [R2 = 0.77, root mean square error (RMSE) = 1.82] for the determination of predicted lean yield vs. the Destron PG-100 (R2 = 0.66, RMSE = 2.22). The AutoFom III was also used to predict bone-in/boneless primal weights, which is not possible with the Destron PG-100. The cross-validated prediction accuracy for the prediction of primal weights ranged from 0.71 to 0.84 for bone-in cuts and 0.59 to 0.82 for boneless cut lean yield. The AutoFom III was moderately (r ≤ 0.67) accurate for the determination of predicted lean yield in the picnic, belly, and ham primal cuts and highly (r ≥ 0.68) accurate for the determination of predicted lean yield in the whole shoulder, butt, and loin primal cuts.
Using natural strata when examining unmeasured biases in an observational study of neurological side effects of antibiotics
Authors: Brumberg Katherine , Ellis Darcy E , Small Dylan S , Hennessy Sean , Rosenbaum Paul R
Published: February 2023

Fluoroquinolones are widely prescribed antibiotics that carry a US Food and Drug Administration warning about possible side-effects on the central and peripheral nervous system. We compare 436,891 patients with sinusitis treated with fluoroquinolones to two control groups treated with azithromycin or amoxicillin. In addition to looking for nervous system complications, we look for evidence of bias using outcomes for which an effect was not anticipated. The comparison uses ‘natural strata’ that form control groups proportional in size to the treated group and balance many covariates beyond those that define the strata. The main technical contribution is a new method for near-optimal construction of natural strata with multiple groups. The online supplement material contains proofs, details, and information about the R package natstrat and replication.
Understanding Self-Injury
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

Self-injury, the purposeful damaging of one’s own body tissue without suicidal intent represents a common and significant mental health concern across the globe. Notwithstanding the major strides made in our understanding of self-injury over the past twenty years, it remains enveloped by substantial stigma and misunderstanding. Unfortunately, this foments profound shame, isolation, and hopelessness for many people with lived experience of self-injury. As such, how we think about self-injury and support people who self-injure requires an approach grounded in understanding people’s unique stories and experiences. This involves explicit recognition of the many strengths and underlying resilience that all people with lived experience possess. Hence, this book is the first to offer a person-centered understanding of self-injury, with particular emphasis on several areas often overlooked in the literature, including: stigma, the language used to talk about self-injury, and recovery, among many others. Given its applied nature, the content of this book has relevance for mental health professionals and trainees, school professionals, families, and researchers. Moreover, by virtue of applying the content in this book, readers will not only develop a deeper and more compassionate understanding of self-injury but will be ideally positioned to work appropriately and effectively with individuals who have lived experience of self-injury.
Self-Injury and Suicidal Thoughts and Behaviors
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

Although, by definition, self-injury is not enacted with active suicidal intent, it would be inaccurate to say there is no association with suicidal thoughts and behaviors. Yet, the exact nature of this relation is complex. In some cases, people may engage in self-injury and never experience suicidal thoughts and behaviors. Other individuals may experience suicidal thoughts and behaviors, but never engage in self-injury. Still others may engage in both suicidal and nonsuicidal behaviors at different times in their life. This chapter outlines some of the factors that may contribute to the confusion regarding the relation between self-injury and suicidal thoughts and behaviors, presents the current state of knowledge regarding this association, and offers suggestions for a person-centered approach to enquiring about suicidal thoughts and behaviors.
Rethinking and Addressing Contagion
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

One of the most feared aspects of self-injury is the potential for self-injury “contagion” or the idea that self-injury can “spread” from one person to another. There is also concern that people can gain the idea to self-injure from popular or social media. This chapter summarizes the evidence for this socialization effect, and offers theoretical explanations for how people may model or adopt behavior exhibited by someone else. It also explores the potential for intervention or research settings, where self-injury is the topic of interest, to increase risk of self-injury among individuals engaging in treatment or participating in research. Finally, consistent with the person-centered themes that are the core of this book, it offers an alternative view of “contagion” that allows a broader consideration of the social causes and consequences of self-injury.
Self-Injury Recovery
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

Traditional approaches used to conceptualize recovery in the context of self-injury often place emphasis on cessation of the behavior. While this can represent an important facet of recovery, a broader and multipronged approach better captures the complexity of people’s recovery experiences. Thus, drawing on recent empirical evidence, lived experience voices, as well as calls from the field, the current chapter presents a novel, person-centered framework of self-injury recovery. In doing so, it also addresses how prior models may not be as well-suited to frame recovery. The subsequent chapter builds on the model outlined here and discusses its application in clinical settings.
Supporting People With Lived Experience
Authors: Lewis Stephen P. , Hasking Penelope A.
Published: February 2023

Given the significant stigma and numerous misconceptions often associated with self-injury, many individuals who self-injure are understandably reluctant to disclose their experience or talk about it once the topic is broached by someone in their life. Hence, this chapter highlights the importance of adopting a person-centered approach when interacting with people who have lived experience. This includes practical guidance for both initial and ongoing conversations. Additionally, the present chapter addresses specific concerns that people with lived experience of self-injury may have (e.g., scarring) and how to support people in this regard. Finally, it ends by discussing the importance of one’s own self-care.
An introduction to AMBIT
Authors: Cracknell Liz , Bevington Dickon
Published: February 2023

The overall AMBIT approach is described in this chapter, explaining the centrality of the concepts of mentalizing and epistemic trust. The four quadrants of the AMBIT wheel—‘Working with your Client’, ‘Working with your Team’, ‘Working with your Network’, and ‘Learning at Work’—are covered. For each quadrant, the role of mentalizing in this area of work is described, as well as the features of the stance, basic practice, and specific tools and techniques found to be helpful by workers who have applied them in a wide range of work settings and tasks.
Connecting psychotherapy to the streets
Authors: Dahlquist Ernst
Published: February 2023

This chapter describes the application of AMBIT principles to a well-established existing mental health service for young people in Malmö, Sweden. Using the AMBIT framework, the authors describe the development of an integrated model combining intensive outreach work and psychotherapy to enable young people who would never have considered having psychotherapy as a way of addressing their needs to enter into conversations where this type of help becomes accessible to them. The approach described is a highly relational one, in which existing relationships of trust are used to support young people in engaging in other helping relationships. The following key aspects of the Working with your Client quadrant are described: creating contact and establishing epistemic trust, care planning and linking to the network, concrete targeted support, emotional support, coexistence, reflective conversations, parent work, and psychological assessment.
AMBIT for adults with severe personality disorders
Authors: Knapen Saskia , van Duursen Rozemarijn
Published: February 2023

This chapter describes the adoption of the AMBIT framework by a team working with adults with a personality disorder diagnosis, in Utrecht, the Netherlands. The implementation of the AMBIT model in this service context is explained with reference to the four quadrants of the AMBIT wheel. In the first quadrant, Working with your Client, the challenge of establishing epistemic trust and the significance of scaffolding healthy existing relationships is explained. In Working with your Team, the importance of a well-connected team in in supporting individual workers’ mentalizing capacity is covered, and the use of daily team briefings and weekly or two-weekly intervision sessions. The AMBIT model was particularly relevant in highlighting to the service the importance of the third quadrant, Working with your Network, and building awareness of the prevalence of network dis-integration and the value of using the dis-integration grid. The fourth quadrant, Learning at Work, was implemented by creating a learning space via regular meetings to discuss progress and practice, manualizing, local trainings, and sharing practice with other mental healthcare organizations.
Applying AMBIT principles to the training process
Authors: Talbot Laura , Smith Rebecca , Wheeler James , Fuggle Peter
Published: February 2023

The AMBIT training process involves the application of AMBIT principles, as well as training in them. Learning is central to the AMBIT approach, and the learning principles that are used in the practice of AMBIT are also used in training, starting with close attention to the relationship between trainer and trainee and the requirement to generate epistemic trust for learning to take place. The principles of Active Planning are particularly salient to training, and the elements of sensitive attunement and broadcasting intentions are described in the training context. In addition to the relationship between trainer and trainee, the role of training in strengthening and supporting relationships in both teams and networks is covered.
Itch and Herpes Zoster
Authors: Rowbotham Michael C.
Published: February 2023

This chapter presents the case of an 85-year-old woman who suffers from chronic postherpetic neuralgia (PHN) after ophthalmic zoster characterized by intractable itch at the face. She reports severe daily pain described as burning, lancinating, and sensitive to touch and wind, despite 30 mg of hydrocodone per day, which induces somnolence and constipation. She had not received the zoster vaccine. Weak opioids are generally ineffective for neuropathic pain, but they have a place for acute herpes zoster when pain is both inflammatory and neuropathic. In this case, the first step is to try a gabapentinoid (either pregabalin or gabapentin), an antidepressant (either tricyclic or duloxetine), or a topical agent, although the latter have a more limited role for facial pain. However, the best treatment for PHN is prevention of shingles, and all eligible persons should be vaccinated.
Painful Legs and Diabetes (1)
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of a 48-year-old man with type II diabetes and alcoholism who reports bilateral and symmetrical at both feet described as neuropathic. Blood tests show chronic hepatitis. He satisfies criteria for diabetic and/or alcoholic painful neuropathy. Diabetic painful neuropathy affects 15–35% of patients with diabetes and is more prevalent in type II diabetes. Risks may be enhanced by alcohol. Initial management focuses on glycemic control and lifestyle measures, whereas neuropathic pain requires specific antineuropathic treatments. Since this patient had contraindications or did not tolerate first line recommended drugs for painful diabetic neuropathies (e.g., duloxetine, gabapentin, pregabalin) and his pain area was limited and well circumscribed, second line topical treatments including off label 5% lidocaine plasters (US Food and Drug Administration and European Medical Agency approved for postherpetic neuralgia) and high-concentration capsaicin patches (US Food and Drug Administration approved for diabetic painful neuropathies and postherpetic neuralgia) were proposed.
Painful Legs and Diabetes (2)
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of a 58-year-old woman with a past history of smoking and type II diabetes necessitating insulin therapy who complains of pain in the lower limbs. Electromyography shows an axonal neuropathy of the lower limbs. However, her pain is not due to diabetic neuropathy but, rather, to severe peripheral arterial disease. This woman finally underwent surgical revascularization. Recovery was total, and duloxetine could be stopped. This case reminds that many patients with diabetic neuropathy have pain in the feet, but their pain is not necessarily related to their neuropathy, and other frequent causes include nociceptive pains due to ulcers, infections, bedsores, arthropathy, and peripheral arterial disease.
Orofacial Pain
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents a case of a young woman who suffers from chronic orofacial pain, which appeared after left mandibular third molar avulsion. Pain is continuous, described as hot/burning and aching, without pain paroxysms and involving the whole hemiface. Clinical examination is normal. This case is compatible with persistent idiopathic orofacial pain (formerly atypical facial pain), which may be triggered by minor trauma or surgery particularly involving the dental nerves. There is a continuum between idiopathic orofacial pain and post-traumatic trigeminal neuropathic pain. The management is similar to that of peripheral neuropathic pain and includes psychological therapy because this pain is often associated with psychological or psychiatric comorbidities.
Brachial Plexus Avulsion
Authors: de Andrade Daniel Ciampi
Published: February 2023

This chapter presents the case of a young man who suffers from neuropathic pain at the left hand since a traumatic brachial plexus avulsion while driving a motorcycle. Pain is mainly paroxysmal, with intense spontaneous electric shock-like discharges. At examination, the patient has complete paralysis and extended anesthesia of the left arm. This case is compatible with brachial plexus avulsion (BPA) caused by high-energy traction to the brachial plexus, usually during a motorcycle accident. BPA commonly causes neuropathic (mainly paroxysmal) pain and musculoskeletal pain. Neuropathic pain and musculoskeletal pain may be difficult to differentiate in these patients, and this may be helped by screening questionnaires.
Pain and Paraplegia
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of a young patient with T10 paraplegia who suffers from several types of pain: neuropathic below-level pain at the lower limbs; musculoskeletal pain at the shoulder; and lower pain, visceral abdominal pain, and peripheral neuropathic pain due to ulnar compression at the upper limbs. Pain after spinal cord injury (SCI) is frequent and is often neuropathic, but other types of pain often coexist. Screening questionnaires are helpful to discriminate neuropathic SCI pains from other types of pain. Management should be multimodal and depend on pain mechanisms. For below-level neuropathic pain, oral antineuropathic drugs and physical therapies may be proposed. For at-level or above-level SCI, additional treatments may include topical agents and transcutaneous electrical nerve stimulation.
Opioids
Authors: Rowbotham Michael C.
Published: February 2023

This chapter presents the case of a man with failed back surgery syndrome and neuropathic pain in the leg who has a past history of psychoactive drug and alcohol abuse. He received strong opioids soon after his injury and continues to use oxycodone and hydromorphone for breakthrough pain; he never received first-line antineuropathic drug. Strong opioids are not recommended as first line for chronic neuropathic pain but, rather, only as last choice. Current or past alcohol or psychoactive drug abuse are red flags for problematic opioid use, Opioid tolerance develops very soon after opioid initiation, but opioid-induced hyperalgesia is not yet proven to be a common clinically relevant phenomenon.
Complementary Medicine
Authors: Tosti Grégory
Published: February 2023

This chapter presents the case of a man with alcoholic neuropathy who has refractory pain to several lines of treatments. Given the refractory nature of the pain and the severity and impact on his daily life, he was encouraged to start hypnosis. Although hypnosis has been shown to be effective for acute pain, evidence is weaker for chronic pain. There are no clear predictive factors of the response, but there are virtually no side effect and very few contraindications. Other complementary techniques for chronic neuropathic pain include mindfulness, acupuncture, relaxation, yoga, and biofeedback. The level of evidence for their efficacy, specifically with regard to neuropathic pain, is limited and better documented for mindfulness.
Management of High-Risk Patients
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of a woman scheduled for total knee arthroplasty for osteoarthritis who has severe baseline anxiety, sleep disorders, catastrophizing, and depression and overuses opioids for migraine with chronic headache. This case illustrates the risk factors for chronic postsurgical pain, including neuropathic postsurgical pain. Risk factors include preoperative pain, postoperative pain, and opioid use but also many psychological factors, particularly state or trait anxiety, catastrophizing, and depression, as well as lack of cognitive flexibility. Patients with these risk factors should be carefully assessed, undergo psychotherapy before and/or after surgery, and be carefully managed for their pain as soon as possible after surgery to avoid long-term pain chronicization.
Management of Patients with Comorbidities
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of a patient with chronic postsurgical pain who has serious psychiatric comorbidity, which contributes to enhance his pain and disability, reduce his coping abilities, and reduce the chance of therapeutic success. This case illustrates the importance of detecting psychiatric comorbidities in patients with neuropathic pain and working in close collaboration with psychologists and psychiatrists. Neuropathic pain tends to impair quality of life more than any other type of pain and is often associated with disability, anxiety, depression, disturbed sleep, or catastrophizing. Questionnaires may be helpful in identifying these PROs. The management of psychiatric comorbidities should precede or be associated with the management of pain.
Management of Neuropathic Pain: Patient-Reported Outcome Measures
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter discusses the case of a man with postherpetic neuralgia who presents with multiple neuropathic symptoms, such as burning pain, electric shocks, and allodynia, and has difficulty rating his average pain intensity on a simple scale. Hence, he has difficulty reporting the efficacy of drug treatments, with a contradiction between his apparently constant pain intensity and his improved disability. This case shows the potential relevance of specific neuropathic pain questionnaires even in routine use to facilitate treatment adaptation. Most treatments of neuropathic pain have an incomplete effect on pain symptoms. Thus, the use of specific neuropathic assessment questionnaires in routine may facilitate treatment adaptation.
Management of Neuropathic Pain: Quantitative Sensory Testing
Authors: Kersebaum Dilara , Baron Ralf
Published: February 2023

Neuropathic pain of various origins manifests clinically through typical signs and symptoms. Sensory gain and loss can be assessed with quantitative sensory testing (QST) through the application of standardized thermal and mechanical stimuli. Thus, a sensory phenotype for each patient is created and compared to reference values of healthy controls. Individualized, sensory profiles are relevant for the identification of treatment responders in clinical practice and pharmaceutical trials. To pursue the goal of a targeted pharmacological therapy, clinical trials with patient stratification at baseline are needed. The approach of sensory profiling and subgrouping is recommended by the European Medicines Agency for exploratory trials on neuropathic pain. It is important to consider that the assessment through QST is limited to evoked sensations, whereas ongoing or spontaneously occurring symptoms are missed. Patient-reported outcome measures are promising complementary tools to survey both spontaneously occurring sensory symptoms and evoked sensations, also allowing the stratification of patients.
The Case of Cannabinoids
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of a woman who suffers from central pain associated with multiple sclerosis. Pain is paroxysmal with very severe and frequent electric shocks. She smokes cannabis to relieve her pain paroxysms but has no signs of craving. She appears to be a good candidate for oral or sublingual cannabinoids (oral tetrahydrocannabinol or nabiximols). Contrary to painful spasticity, the efficacy of cannabinoids is still unclear in neuropathic pain based on randomized controlled trials, but a subgroup of patients may likely benefit from these drugs, which seem to be more effective on pain paroxysms. Cannabinoids have been more studied in neuropathic pain than in other types of chronic pain.
Nerve Blocks and Drug Infusions
Authors: Portal Benjamin , Bhullar Ravneet , Argoff Charles
Published: February 2023

This chapter presents the case of a patient with complex regional pain syndrome (CRPS) who had difficulty undergoing physiotherapy due to pain. For this patient, regional somatic nerve blocks using local anesthetics may be proposed because they may have at least short-term benefit and facilitate physiotherapy. They may also be useful for diagnostic purposes. Sympathetic nerve blocks are routinely used for CRPS, but evidence based on adequate studies is lacking. Infusion techniques for neuropathic pain include intravenous infusions of ketamine or lidocaine, which may be beneficial for a short period and may be envisaged after concertation to relieve severe pain exacerbations for patients with refractory neuropathic pain.
Noninvasive Brain Stimulation
Authors: Attal Nadine , Bouhassira Didier
Published: February 2023

This chapter presents the case of an elderly woman who suffers from trigeminal neuropathy with severe facial pain secondary to brainstem lesion, refractory to first-, second-, and third-line treatments of neuropathic pain. In this case, noninvasive central brain stimulation may be considered in specialized centers. These techniques encompass repeated high-frequency (≥10 Hz) repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Their efficacy has been mainly established for motor cortex rTMS in peripheral and central refractory neuropathic pain. Best procedures include robot-assisted neuronavigation. Safety is good and main side effects include headache. The efficacy of tDCS of the motor cortex is less established for neuropathic pain.
Walking and Wheezing
Authors: Krishnamurthy Rajesh , Bubolz Beth
Published: February 2023

This chapter discusses a case of myocarditis and pericardial effusion in a pediatric patient. It addresses a notoriously difficult diagnosis to make, which can result in significant morbidity and mortality if missed. This case highlights the departure from presentation in pediatric cardiac failure compared to the adult population. Herein, pediatric heart failure is explored in the context of a subtle history with few abnormal physical findings and elusive radiographic evidence. A high index of suspicion is required to entertain the diagnosis in adolescents. Lessons in careful history taking and attention to detail demonstrated in this case will aid the clinician in making this potentially fatal diagnosis, which might otherwise be overlooked.
What’s That in the Diaper?
Authors: Reynolds Maegan S. , Jadcherla Yamini , Vogelius Esben
Published: February 2023

Bloody stools in a neonate can be from a variety of etiologies such as benign anal fissures or milk protein allergy, or from more life-threatening etiologies such as volvulus, infectious colitis, or necrotizing enterocolitis (NEC). Older children may have bloody stools associated with intussusception, usually diagnosed with ultrasound, and treated with contrast enema or Meckel’s diverticulum diagnosed with a technetium scintigraphy. NEC is most commonly seen in premature infants but must be excluded in infants presenting to the Emergency Department with bloody stools. An abdominal radiograph is the initial imaging modality of choice for the diagnosis of NEC. Pathognomonic features of NEC seen on x-ray include pneumatosis intestinalis (air within the bowel wall), portal vein air, or pneumoperitoneum from intestinal perforation. NEC should be managed with IV fluids, bowel rest with gastric decompression, IV antibiotics, and surgical consultation.
Torticollis in a Child with Down Syndrome
Authors: Williamson Kristy , Goldfisher Rachelle
Published: February 2023

Down syndrome is associated with many orthopedic conditions. One of the most common is atlantoaxial instability, which is due to the laxity of ligaments supporting C1 and C2 vertebrae. Atlantoaxial instability can lead to subluxation or fixation and potentially, spinal cord compression. Patients may present with neck pain, torticollis, or neurologic dysfunction. Any Down syndrome patient with new weakness or sensory deficit should prompt urgent evaluation and imaging. Providers should immobilize the c-spine, then first obtain plain radiographs to evaluate the cervical spine alignment. CT scan is generally performed for better vertebral imaging, followed by MR to assess the ligaments and spinal cord. Neurosurgical evaluation and stabilization are warranted for symptomatic instability.
Why Is This Infant So Fussy?
Authors: Greene Michelle , Thomas Anna , Bennett Berkeley
Published: February 2023

This chapter explores the vast differential diagnosis for an infant with vomiting from the most common benign etiologies to more serious pathology, such as pyloric stenosis and focuses on one of the most devastating etiologies: abusive head trauma. The normal anatomy present on an infants CT are reviewed and the pathophysiology and classification of subdural hemorrhage, epidural hemorrhage, and subarachnoid hemorrhage are described, as well as findings on computerized tomography. Details regarding the variable presentation of abusive head trauma, medical management in the acute phase, differential diagnosis, and recommended workup for non-accidental trauma are included. Guidance on mandated reporting are discussed, as well as pearls for management and common pitfalls.
Ripping Apart My Heart
Authors: Conway Thomas P. , Koberlein George C. , Bullaro Francesca M.
Published: February 2023

The presentation and imaging assessment for pediatric blunt thoracic trauma differs from their adult counterparts. The majority of thoracic trauma is blunt in children and typically can be assessed with a screening chest radiograph, without further need for advanced imaging. Vascular injuries should be suspected in children with mediastinal widening, indistinct aortic knob, left pleural effusion, thickening of the paratracheal stripe, or tracheal deviation on a chest radiograph. When vascular injury is suspected, advanced imaging is critical for identification and classification of the injury, with anything other than a Grade I injury requiring intervention, with TEVAR as the current intervention of choice. Early identification of these injuries is critical to optimize outcome.
The Unlucky Hit!
Authors: Montana McKenzie , Gates Robert L. , Burroughs Zachary
Published: February 2023

Blunt abdominal trauma is the number three cause of traumatic death in children over 1 year of age in the United States and the most common unrecognized fatal injury. Vague symptoms and nonverbal pediatric patients make effective triage difficult in this population. In addition, there is limited utility in abdominal ultrasound, and early laboratory results may be misleading in the diagnostic assessment. Often, this leads to unnecessary computed tomography (CT) imaging, which results in radiation exposure, cancer risk, and excessive cost to the family. It is important to risk-stratify the stable patients using a proven algorithm to guide clinical decision-making. This chapter discusses the diagnosis, management, and disposition of both stable and unstable pediatric patients presenting with blunt abdominal trauma.
Drugs in Palliative Care
Authors: Dickman Andrew
Published: February 2023

While palliative care has adopted a holistic approach to treatment, medication-driven symptom management ostensibly forms the critical aspect of care. Prescribing in palliative care can be extremely complex because the patient may often have comorbidity, or occasionally multimorbidity. The associated polypharmacy further complicates the pharmacological management of symptoms being caused by the palliative condition. This can be daunting for healthcare professionals and can negatively impact upon the effectiveness of care provided. Fully revised and updated, the third edition of Drugs in Palliative Care provides a detailed, yet concise overview of topics that are encountered in palliative care clinical practice. The book will appeal to a variety of healthcare professionals involved in the provision of palliative care and medicines information.
Prescribing guidance
Authors: Dickman Andrew
Published: February 2023

The second chapter provides detailed prescribing advice for a range of different common conditions encountered in palliative care.
Monographs A–Z
Authors: Dickman Andrew
Published: February 2023

The third chapter comprises drug monographs for medications commonly used for symptom control in an easy-to-access A–Z format.
B
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter B
D
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter D
F
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter F
I
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter I
L
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter L
N
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter N
W
Authors: Dickman Andrew
Published: February 2023

This chapter includes drugs beginning with the letter W