bluuebunny/crossref_metadata_2025 huggingface dataset:
Football, history, and the nation in Southeastern Europe
Authors: Baker Catherine
Published: December 2016

In October 2014, Serbia's European Championships qualifying match against Albania was abandoned after a drone flew onto the pitch in Belgrade with a banner showing Kosovo as part of a Greater Albania, provoking a fight between both teams and their fans. While the flight of the drone was a technologically novel reminder that the nation's territorial space is not two-dimensional but three-dimensional, the subject of a politics of verticality and volume (Weizman 2012,12; Elden 2013), the imagery of its invasive entry and violent ejection from the symbolic territory, and the battlefield of the nation underlined a point that could have been made at any point since the institutionalization of international sporting competition in the late nineteenth and early twentieth centuries: that controversies over sports, between and within nations, reveal the deeper conflicts about territorial and cultural boundaries that are the very process of constructing national identity. Yet all this has taken place within a framework of supposed internationalism and sporting fraternity; indeed, it is the very structure of organized, scheduled competition between nations that makes these sporting encounters regular and possible.
Novel regulatory roles of Mff and Drp1 in E3 ubiquitin ligase MARCH5–dependent degradation of MiD49 and Mcl1 and control of mitochondrial dynamics
Authors: Cherok Edward , Xu Shan , Li Sunan , Das Shweta , Meltzer W. Alex , Zalzman Michal , Wang Chunxin , Karbowski Mariusz
Published: December 2016

MARCH5, an OMM-associated E3 ubiquitin ligase, controls mitochondrial function. Despite its importance, the mechanism and factors controlling MARCH5 activity are largely unknown. Here we report that the MARCH5 C-terminal domain plays a critical role in degradation of MARCH5 substrates, likely by facilitating release of ubiquitinated proteins from the OMM. We also found that the mitochondrial fission proteins Drp1 and Mff negatively regulate MARCH5’s activity toward MiD49 and Mcl1. Knockouts of either Drp1 or Mff led to reduced expression, shorter half-lives, and increased ubiquitination of MiD49 and Mcl1. Effects of Mff and Drp1 depletion on degradation rates and ubiquitination of Mcl1 and MiD49 were eliminated in Drp1−/−/MARCH5−/− and Mff−/−/MARCH5−/− cells. Our data show that it is not mitochondrial morphology per se but rather Mff and Drp1 that directly control MARCH5. Consistently, we find that Mff is an integral component of the MARCH5/p97/Npl4 complex, which is also controlled by MARCH5’s C-terminal domain. Furthermore, not only mitochondrial fission but also fusion is regulated through Mff and Drp1 protein activities. Thus, in addition to their canonical roles in mitochondrial fission, Mff and Drp1 also act as regulatory factors that control mitochondrial fission and fusion.
Consumer Research with Big Data: Applications from the Food Demand Survey (FooDS)
Authors: Lusk Jayson L.
Published: December 2016

In three separate studies based on data from the Food Demand Survey (FooDS), which has been conducted monthly for over three years, this paper explores heterogeneity in preference across consumers in traditional demand systems, heterogeneity in preferences over time in choice experiments, and the tail of the distribution for a particular food consumption pattern—vegetarianism. Results show that elasticities of demand for food at home and food away from home vary widely across different groups of consumers defined by a priori cluster analysis based on demographic and attitudinal variables. Results from a choice experiment are found to depend on when the experiment was conducted and on the market prices prevailing at the time of the survey. Given the large sample of consumers observed over time, there is sufficient data to demographically characterize a small portion of the population—vegetarians—using traditional logit models and a machine learning method ‐ a classifications tree.
Improved orthology inference with Hieranoid 2
Authors: Kaduk Mateusz , Sonnhammer Erik
Published: December 2016

Motivation

The initial step in many orthology inference methods is the computationally demanding establishment of all pairwise protein similarities across all analysed proteomes. The quadratic scaling with proteomes has become a major bottleneck. A remedy is offered by the Hieranoid algorithm which reduces the complexity to linear by hierarchically aggregating ortholog groups from InParanoid along a species tree.

Results

We have further developed the Hieranoid algorithm in many ways. Major improvements have been made to the construction of multiple sequence alignments and consensus sequences. Hieranoid version 2 was evaluated with standard benchmarks that reveal a dramatic increase in the coverage/accuracy tradeoff over version 1, such that it now compares favourably with the best methods. The new parallelized cluster mode allows Hieranoid to be run on large data sets in a much shorter timespan than InParanoid, yet at similar accuracy.

Availability and Implementation

Perl code freely available at http://hieranoid.sbc.su.se/.

Supplementary information

Supplementary data are available at Bioinformatics online.
AnglerFish: a webserver for defining the geometry of α-helices in membrane proteins
Authors: Colledge Matthew , Wallace B A
Published: December 2016

Integral membrane proteins that form helical pores and bundles constitute major drug targets, and many of their structures have been defined by crystallography and cryo-electron microscopy. The gating of channels and ligand binding of transporters generally involve changes in orientation of one or more the constituent helices in the structures. At present there is no standard easily accessible means for defining the orientation of a helix in a membrane protein structure. AnglerFish is a web-based tool for parameterising the angles of transmembrane helices based on PDB coordinates, with the helical orientations defined by the angles ‘tilt’ and ‘swing’. AnglerFish is particularly useful for defining changes in structure between different states, including both symmetric and asymmetric transitions, and can be used to quantitate differences between related structures or different subunits within the same structure.

Availability and Implementation

AnglerFish is freely available at http://anglerfish.cryst.bbk.ac.uk. The website is implemented in Perl-cgi and Apache and operation in all major browsers is supported. The source code is available at GitHub.

Supplementary information

Supplementary data are available at Bioinformatics online.
Analyzing user-generated online content for drug discovery: development and use of MedCrawler
Authors: Helfenstein Andreas , Tammela Päivi
Published: December 2016

Motivation

Ethnopharmacology, or the scientific validation of traditional medicine, is a respected starting point in drug discovery. Home remedies and traditional use of plants are still widespread, also in Western societies. Instead of perusing ancient pharmacopeias, we developed MedCrawler, which we used to analyze blog posts for mentions of home remedies and their applications. This method is free and accessible from the office computer.

Results

We developed MedCrawler, a data mining tool for analyzing user-generated blog posts aiming to find modern ‘traditional’ medicine or home remedies. It searches user-generated blog posts and analyzes them for correlations between medically relevant terms. We also present examples and show that this method is capable of delivering both scientifically validated uses as well as not so well documented applications, which might serve as a starting point for follow-up research.

Availability and Implementation

Source code is available on GitHub at {{https://github.com/a-hel/medcrawler}}

Supplementary information

Supplementary data are available at Bioinformatics online.
ACTG: novel peptide mapping onto gene models
Authors: Choi Seunghyuk , Kim Hyunwoo , Paek Eunok
Published: December 2016

In many proteogenomic applications, mapping peptide sequences onto genome sequences can be very useful, because it allows us to understand origins of the gene products. Existing software tools either take the genomic position of a peptide start site as an input or assume that the peptide sequence exactly matches the coding sequence of a given gene model. In case of novel peptides resulting from genomic variations, especially structural variations such as alternative splicing, these existing tools cannot be directly applied unless users supply information about the variant, either its genomic position or its transcription model. Mapping potentially novel peptides to genome sequences, while allowing certain genomic variations, requires introducing novel gene models when aligning peptide sequences to gene structures. We have developed a new tool called ACTG (Amino aCids To Genome), which maps peptides to genome, assuming all possible single exon skipping, junction variation allowing three edit distances from the original splice sites, exon extension and frame shift. In addition, it can also consider SNVs (single nucleotide variations) during mapping phase if a user provides the VCF (variant call format) file as an input.

Availability and Implementation

Available at http://prix.hanyang.ac.kr/ACTG/search.jsp.

Supplementary information

Supplementary data are available at Bioinformatics online.
Intraseason Waning of Influenza Vaccine Protection: Evidence From the US Influenza Vaccine Effectiveness Network, 2011–2012 Through 2014–2015
Authors: Ferdinands Jill M. , Fry Alicia M. , Reynolds Sue , Petrie Joshua G. , Flannery Brendan , Jackson Michael L. , Belongia Edward A.
Published: December 2016

Background.

Recent studies suggest that influenza vaccine effectiveness (VE) may wane over the course of an influenza season, leading to suboptimal VE during late influenza seasons.

Methods.

We examined the association between influenza VE and time since vaccination among patients ≥9 years old with medically attended acute respiratory illness in the US Influenza Vaccine Effectiveness Network using data pooled from the 2011–2012 through 2014–2015 influenza seasons. We used multivariate logistic regression with polymerase chain reaction–confirmed influenza infection as the outcome and vaccination status defined by days between vaccination and symptom onset as the predictor. Models were adjusted for calendar time and other potential confounding factors.

Results.

We observed decreasing VE with increasing time since vaccination for influenza A(H3N2) (P = .004), influenza A(H1N1)pdm09 (P = .01), and influenza B viruses (P = .04). Maximum VE was observed shortly after vaccination, followed by a decline in VE of about 7% (absolute) per month for influenza A(H3N2) and influenza B and 6%–11% per month for influenza A(H1N1)pdm09 viruses. VE remained greater than zero for at least 6 months for influenza A(H1N1)pdm09 and influenza B and at least 5 months for influenza A(H3N2) viruses. Decline in VE was more pronounced among patients with prior-season influenza vaccination. A similar pattern of increasing influenza risk with increasing time since vaccination was seen in analyses limited to vaccinees.

Conclusions.

We observed decreasing influenza vaccine protection with increasing time since vaccination across influenza types/subtypes. This association is consistent with intraseason waning of host immunity, but bias or residual confounding could explain these findings.
Combatting Global Infectious Diseases: A Network Effect of Specimen Referral Systems
Authors: Fonjungo Peter N. , Alemnji George A. , Kebede Yenew , Opio Alex , Mwangi Christina , Spira Thomas J. , Beard R. Suzanne , Nkengasong John N.
Published: December 2016

The recent Ebola virus outbreak in West Africa clearly demonstrated the critical role of laboratory systems and networks in responding to epidemics. Because of the huge challenges in establishing functional laboratories at all tiers of health systems in developing countries, strengthening specimen referral networks is critical. In this review article, we propose a platform strategy for developing specimen referral networks based on 2 models: centralized and decentralized laboratory specimen referral networks. These models have been shown to be effective in patient management in programs in resource-limited settings. Both models lead to reduced turnaround time and retain flexibility for integrating different specimen types. In Haiti, decentralized specimen referral systems resulted in a 182% increase in patients enrolling in human immunodeficiency virus treatment programs within 6 months. In Uganda, cost savings of up to 62% were observed with a centralized model. A platform strategy will create a network effect that will benefit multiple disease programs.
HLA-B*57 and IFNL4-Related Polymorphisms Are Associated With Protection Against HIV-1 Disease Progression in Controllers
Authors: Dominguez-Molina Beatriz , Tarancon-Diez Laura , Hua Stephane , Abad-Molina Cristina , Rodriguez-Gallego Esther , Machmach Kawthar , Vidal Francesc , Tural Cristina , Moreno Santiago , Goñi María José , Ramírez de Arellano Elena , del Val Margarita , Gonzalez-Escribano María Francisca , Del Romero Jorge , Rodriguez Carmen , Capa Laura , Viciana Pompeyo , Alcamí José , Yu Xu G. , Walker Bruce D. , Leal Manuel , Lichterfeld Mathias , Ruiz-Mateos Ezequiel ,   for the Spanish AIDS Research Network HIV-Controllers Cohort integrated in the Spanish AIDS Research Network
Published: December 2016

Background.

Human immunodeficiency virus type 1 (HIV-1) controllers maintain HIV-1 viremia at low levels (normally <2000 HIV-RNA copies/mL) without antiretroviral treatment. However, some HIV-1 controllers have evidence of immunologic progression with marked CD4+ T-cell decline. We investigated host genetic factors associated with protection against CD4+ T-cell loss in HIV-1 controllers.

Methods.

We analyzed the association of interferon-lambda 4 (IFNL4)–related polymorphisms and human leukocyte antigen (HLA)-B haplotypes within long-term nonprogressor HIV-1 controllers (LTNP-Cs; defined by maintaining CD4+ T-cells counts >500 cells/mm3 for more than 7 years after HIV-1 diagnosis) vs non-LTNP-Cs who developed CD4+ T-cell counts <500 cells/mm3. Both a Spanish study cohort (n = 140) and an international validation cohort (n = 914) were examined. Additionally, in a subgroup of individuals, HIV-1–specific T-cell responses and soluble cytokines were analyzed.

Results.

HLA-B*57 was independently associated with the LTNP-C phenotype (odds ratio [OR], 3.056 [1.029–9.069]; P = .044 and OR, 1.924 [1.252–2.957]; P = .003) while IFNL4 genotypes represented independent factors for becoming non-LTNP-C (TT/TT, ss469415590; OR, 0.401 [0.171–0.942]; P = .036 or A/A, rs12980275; OR, 0.637 [0.434–0.934]; P = .021) in the Spanish and validation cohorts, respectively, after adjusting for sex, age at HIV-1 diagnosis, IFNL4-related polymorphisms, and different HLA-B haplotypes. LTNP-Cs showed lower plasma induced protein 10 (P = .019) and higher IFN-γ (P = .02) levels than the HIV-1 controllers with diminished CD4+ T-cell numbers. Moreover, LTNP-Cs exhibited higher quantities of interleukin (IL)2+CD57- and IFN-γ +CD57- HIV-1–specific CD8+ T cells (P = .002 and .041, respectively) than non-LTNP-Cs.

Conclusions.

We defined genetic markers able to segregate stable HIV-1 controllers from those who experience CD4+ T-cell decline. These findings allow for identification of HIV-1 controllers at risk for immunologic progression and provide avenues for personalized therapeutic interventions and precision medicine for optimizing clinical care of these individuals.
Diabetes Mellitus and Latent Tuberculosis Infection: A Systemic Review and Metaanalysis
Authors: Lee Meng-Rui , Huang Ya-Ping , Kuo Yu-Ting , Luo Chen-Hao , Shih Yun-Ju , Shu Chin-Chung , Wang Jann-Yuan , Ko Jen-Chung , Yu Chong-Jen , Lin Hsien-Ho
Published: December 2016

Background.

Despite the well-documented association between diabetes and active tuberculosis, evidence of the association between diabetes and latent tuberculosis infection (LTBI) remains limited and inconsistent.

Methods.

We included observational studies that applied either the tuberculin skin test or the interferon gamma release assay for diagnosis of LTBI and that provided adjusted effect estimate for the association between diabetes and LTBI. We searched PubMed and EMBASE through 31 January 2016. The risk of bias of included studies was assessed using a quality assessment tool modified from the Newcastle-Ottawa scale.

Results.

Thirteen studies (1 cohort study and 12 cross-sectional studies) were included, involving 38263 participants. The cohort study revealed an increased but nonsignificant risk of LTBI among diabetics (risk ratio, 4.40; 95% confidence interval [CI], 0.50–38.55). For the cross-sectional studies, the pooled odds ratio from the random-effects model was 1.18 (95% CI, 1.06–1.30), with a small statistical heterogeneity across studies (I2, 3.5%). The risk of bias assessment revealed several methodological issues, but the overall direction of biases would reduce the positive causal association between diabetes and LTBI.

Conclusions.

Diabetes was associated with a small but statistically significant risk for LTBI. Findings from this review could be used to inform future cost-effectiveness analysis on the impact of LTBI screening programs among diabetics.
Costly Curves: How Human-Like Shapes Can Increase Spending
Authors: Romero Marisabel , Craig Adam W
Published: December 2016

Can exposure to body shapes affect spending preferences? Because Western society associates thinness with economic value, we argue that a shape resembling thin human body types activates concepts related to positive financial outcomes, such as responsibility and hard work. The results of five experiments show that exposure to thin, human-like shapes influences consumer self-efficacy judgments and spending outcomes, depending on the perceiver’s weight. In line with social comparison, we demonstrate that seeing a thin (vs. wide) human-like shape leads consumers with a high body mass index to make more indulgent decisions. Financial self-efficacy is highlighted as the underlying mechanism, and high resemblance to the human form is identified as a critical moderator. The findings of this research acknowledge visual similarity’s role in stereotype knowledge activation and weight stereotypes’ broad scope of influence.
The Dreams of Santiago Ramón y Cajal
Authors: Ehrlich Benjamin
Published: December 2016

This book contains the first English translation of the lost dream diary of Santiago Ramón y Cajal (1852–1934), the Nobel Prize-winning “father of modern neuroscience.” In the late nineteenth century, while scientific psychologists searched the inner world of human beings for suitable objects of study, Cajal discovered that the nervous system, including the brain, is composed of distinctly independent cells, later termed neurons. “The mysterious butterflies of the soul,” he romantically called them, “whose beating of wings may one day reveal to us the secrets of the mind.” Cajal was contemporary with Sigmund Freud (1856–1939), whose “secrets of the mind” radically influenced a century of thought. Although the two men never met, their lives and works were intimately related, and each is identified with the foundation of a modern intellectual discipline—neurobiology and psychoanalysis—still in conversation and conflict today. In personal letters, Cajal insulted Freud and dismissed his theories as lies. In order to disprove his rival, Cajal returned to an old research project and started recording his own dreams. For the last five years of his life, he abandoned his own neurobiological research and concentrated on psychological manuscripts, including a new “dream book.” Although his intention was to publish, the project was never released. The unfinished work was thought to be lost, until recently, when a Spanish book appeared claiming to feature the dreams of Cajal, along with the untold story of their complex journey into print.
Cajal and Dream Research
Authors: Ehrlich Benjamin
Published: December 2016

Cajal published a total of about three hundred and fifty scientific articles. The majority of these are concerned with the structure of the nervous system, six of them are on the subject of psychology, and only a single one is on dreaming. Although he did not value the content of dreams, Cajal was fascinated by their neurobiological mechanisms. During sleep, the cells throughout the brain that are hyperactive during daytime operations—especially those responsible for “the critical faculty”—are exhausted and rest; meanwhile, the fresh cells that store unused impressions are free to perform their gymnastics, randomly synthesizing their impulses. Through analysis of thousands of dreams through visual dreaming in a technique he referred to as “the introspective method,” he concluded that there was no involvement from any cells in the retina. This avant-garde finding reflects our contemporary thinking about dreaming.
Cajal and Freudianism in Spain
Authors: Ehrlich Benjamin
Published: December 2016

Spain was among the countries most receptive to Freud and psychoanalysis. Cajal was trying to make biology lead into psychophysiology; thus, the two neurologists were moving toward the same aim from opposite directions. Cajal’s research at that time addressed the most pressing questions of contemporary neuroanatomy: How do neurons recover from damage and what kind of damage can they recover from? Despite Cajal’s more absolutist doctrine, his students were willing to reconcile psychoanalysis with traditional biology, seizing on the more positivistic and evolutionary elements of the theory. In the aftermath of Einsteinian relativity, this younger cohort was far more comfortable with the role of subjectivity in science than Cajal, who was devoted to the facts. Cajal was always outwardly respectful of Freud’s work but never enthusiastic and at times harshly critical..
Comparing the Lives of Cajal and Freud
Authors: Ehrlich Benjamin
Published: December 2016

Despite their many social and cultural differences, Santiago Ramón y Cajal and Sigmund Freud had more in common than one might naturally assume. Both attended and excelled in anatomy and medical courses in University. Freud even studied histology and contributed important discoveries to that field. However, Cajal entered the army between his schooling and his discovery of histology. Cajal’s brush with tuberculosis led to his first direct encounter with psychology. Experimenting with himself as a subject, he learned the transformative power of what is called “autosuggestion.” Although known for his purely anatomical research of the nervous system, Cajal initially was drawn to study the brain by an emotional attachment to his experience with psychology and the mind’s potential for personal improvement, in addition to his intellectual and artistic connection with the material itself.
The Effects of Hypnosis and Suggestion
Authors: Ehrlich Benjamin
Published: December 2016

Although Cajal was devoted to “the religion of the cell,” there was an apocryphal strain of thought running through his research. Before studying the brain, Cajal had explored hypnotism through his science fiction, and he confirmed the real effects of suggestibility in his psychological research. Cajal sided with the Nancy doctrine of universal suggestibility, whereas Freud was persuaded by Charcot’s demonstration that hypnosis was both a sign of illness and a treatment modality for mental illness. The career paths of Cajal and Freud would diverge permanently. Despite his interest in experimental psychology and his personal experience with hypnosis and suggestion, Cajal experienced a conversion to neurohistology that resembled an awakening. However, he never lost his interest in the workings of the mind.
On the Divergence of Psychology and Neuroanatomy
Authors: Ehrlich Benjamin
Published: December 2016

Freud’s career in neurohistology effectively ended in 1888, the “year of fortune” in which Cajal’s career auspiciously began. However, on the subject of his relationship to Cajal, one might ask, “How did Freud respond to Cajal’s new discoveries?” Freud was among the later adopters of the neuron theory, after he realized that the new facts might help support his grandiose theory of the psyche. Although the two men never met, the relationship between Cajal and Freud, defined by both proximity and distance, seems to reflect the subsequent disconnect between neurobiology and psychoanalysis. Although there have been collaborative and conciliatory efforts between the two disciplines, considerable philosophical and methodological differences remain. One of the current battlefronts for their ideological conflict happens to be the science of dreams.
Patient-Centered Care or Patient-Centered Health?
Authors: Sullivan Mark D.
Published: December 2016

The history of proposals for patient-centered medicine begins with Michael Balint’s proposal for patient-centered medicine as an alternative to illness-centered medicine. This has been weakened in more recent calls for patient-centered care from clinicians, foundations, and professional organizations. It is argued that patient-centeredness consists of both taking the patient’s perspective and activating the patient. Taking the patient’s perspective involves communication skills and may involve developing a “shared mind” with the patient. Two programs for activating patients are contrasted, 1) the Expert Patient program based on the Chronic Disease Self-Management Program of Lorig and Holman and 2) the Patient-Centered Medical Home based on the Chronic Care Model developed by Wagner and colleagues. Patient empowerment involves activating patients on their own behalf and in service of their own goals. A truly patient-centered chronic care model aims not only for patient empowerment, but also for patient capability to pursue health and other vital goals.
On the Role of Health Behavior in 21st-Century Health
Authors: Sullivan Mark D.
Published: December 2016

Patient health behavior is crucially important in the care of chronic disease. Medication adherence and lifestyle health behaviors both make major contributions to individual and population health. Clinical interventions to improve adherence and lifestyle are contrasted with their natural determinants. The Chronic Care Model shifts our attention from promoting patient obedience to developing skills for self-management of chronic illness. We need to ask whether treatment of chronic illness, like diabetes, should be accomplished through or around patient. Two recent diabetes treatment trials, ACCORD and TEAMCARE, provide contrasting approaches to the nature of therapeutic action. The Diabetes Prevention Project demonstrated that it is possible to prevent the development of diabetes through exercise and diet or medication. Adherence to treatment appears to improve health outcomes, even if the treatment is inactive, through the “healthy adherer effect.” This suggests that an active approach to health may have intrinsic benefits.
Vagueness in psychiatry: An overview
Authors: Keil Geert , Keuck Lara , Hauswald Rico
Published: December 2016

In psychiatry there is no sharp boundary between the normal and the pathological. Although clear cases abound, it is often indeterminate whether a particular condition does or does not qualify as a mental disorder. For example, definitions of ‘subthreshold disorders’ and of the ‘prodromal stages’ of diseases are notoriously contentious. Philosophers and linguists call concepts that lack sharp boundaries, and thus admit of borderline cases, ‘vague’. This overview chapter reviews current debates about demarcation in psychiatry against the backdrop of key issues within the philosophical discussion of vagueness: are there various kinds of vagueness? Is all vagueness representational? How does vagueness relate to epistemic uncertainty? What is the value of vagueness? Given the immense social, moral, and legal importance of demarcating the normal from the pathological in psychiatry, what are the pros and cons of gradualist approaches to mental disorders, that is, of construing boundaries as matters of degree?
Mental and physical gradualism in Graeco-Roman medicine
Authors: Lewis Orly , Thumiger Chiara , van der Eijk Philip
Published: December 2016

The aim of this chapter is to explore how ancient medical ideas offer relevant parallels to the modern notions of degree vagueness and combinatorial vagueness with respect to mental health and its management. By closely examining several key examples, this chapter argues that Graeco-Roman physicians recognized physical and mental health as states that admit of gradation and were aware of the nuances, variations, and even the relativity of the distinction between ‘healthy’ and ‘ill’. When it comes to notions of physical and mental health, these nuances are both quantitative and qualitative. One of the characteristics of Graeco-Roman medicine is the consideration given to a body–mind continuum as something that is subject to health and disease and can be the object of medical attention. Section 2 introduces ancient conceptions of physical health and demonstrates the relevance of degree and combinatorial vagueness in this domain. Section 3 focuses on mental health.
Disease entities and the borderline between health and disease: Where is the place of gradations?
Authors: Hucklenbroich Peter
Published: December 2016

The chapter discusses the demarcation of health and disease by considering ‘disease entity’ as the most fundamental notion in the theory of medicine. First, it provides an analysis of the conceptual structure of the medical theory of disease and nosology. It demonstrates that the most central theoretical tool of fully developed medical disciplines is the concept of disease entity. Second, the chapter demonstrates that individual cases of disease entities differ typically according to their stages and degrees of severity. Third, the chapter argues that psychiatry is not yet a fully developed medical discipline and is lacking a mature nosological structure. The conclusion is that, for diagnostic and practical purposes, psychiatry is not in need of gradations between health and disease in general, but rather of empirically sound and validated gradations that address the kind, stage, and severity of its nosological entities, including its provisional surrogates for proper disease entities.
Indeterminacy in medical classification: On continuity, uncertainty, and vagueness
Authors: Hauswald Rico , Keuck Lara
Published: December 2016

This chapter aims to clarify the terminology of and relations between ontological, epistemological, and semantic aspects of indeterminacy in medical classification systems. Although classifications of diseases and mental disorders are often characterized as having blurred boundaries, there is no consensus on what exactly this means. The following clarification may remedy this shortcoming: from an ontological point of view, disease entities are found to be discrete or continuous, depending on whether realisation gaps occur. From an epistemological perspective, the certainty of a classification depends on how controversial the assessment of its validity is throughout contexts and how much different legitimate interests of classification users vary. Finally, as semantic categories, medical classifications can be defined precisely or vaguely. The chapter analyses how the ontological, epistemological, and semantic levels are interrelated and how the proposed terminological clarifications may help to disentangle discussions about the validity of medical classifications.
Fuzzy boundaries and tough decisions in psychiatry
Authors: Helmchen Hanfried
Published: December 2016

In the field of mental disorders the boundaries between mental normality and disease are often blurred. Psychiatrists, being aware of the instrumental nature of psychiatric diagnoses, try to deal with these blurred boundaries by stipulating strict definitions of clinical categories, by operationalizing diagnoses, and by using evidence-based methods of production and algorithmic application of medical knowledge. However, the clinical uncertainties can only partially be reduced by these means, because the physician always has to consider the individuality of the patient as well as to find a helpful solution to the dilemma of not treating a treatable but only probable or even only possible disease condition versus treating a variation of normal behavior against the risk of obtaining unwanted side effects of drug therapy or stigmatization. As is shown in the chapter, subthreshold mental disorders provide illuminating illustrations of these limits of medical standardization.
Moral and legal implications of the continuity between delusional and non-delusional beliefs
Authors: Sullivan-Bissett Ema , Bortolotti Lisa , Broome Matthew , Mameli Matteo
Published: December 2016

This chapter explores two aspects of gradualism as they apply to delusion: the acknowledgement that it is difficult to distinguish pathological from non-pathological beliefs; and the view that there is considerable continuity between delusional and other epistemically faulty beliefs. The chapter identifies implications of these two aspects of gradualism for questions about one’s moral and legal responsibility for actions motivated by delusions. Section 2 argues that an effective demarcation between pathological and non-pathological beliefs cannot be successfully achieved on mere epistemic grounds. Some reasons are offered for endorsing the thesis that delusional beliefs are continuous with other epistemically faulty beliefs. Section 3 examines the implications of the continuity thesis for the association between being diagnosed with a psychiatric disorder featuring delusions and having reduced responsibility for actions motivated by delusions. Some interesting cases of agents who committed crimes related to the content of their epistemically faulty beliefs are considered.
General principles of echocardiography
Authors: Garbi Madalina , D’hooge Jan , Shkolnik Evgeny
Published: December 2016

Echocardiography uses ultrasound waves to generate images of cardiovascular structures and to display information regarding the blood flow through these structures. Knowledge of basic ultrasound principles and current technology is essential for image interpretation and for optimal use of equipment during image acquisition and post-processing. This chapter starts by presenting the physics of ultrasound and the construction and function of instruments. Image formation, optimization, display, presentation, storage, and communication are explained. Advantages and disadvantages of available imaging modes (M-mode, two-dimensional, and three-dimensional) are detailed and imaging artefacts are illustrated. The potential biologic effects of ultrasound and the need for quality assurance are discussed.
Three-dimensional echocardiography
Authors: Badano Luigi P. , Lang Roberto M. , Goncalves Alexandra
Published: December 2016

The advent of fully-sampled matrix array transthoracic transducers has enabled advanced digital processing and improved image formation algorithms and brought three-dimensional echocardiography (3DE) technology into clinical practice. Currently, 3DE is recognized as an important echocardiographic technique, demonstrated to be superior to two-dimensional echocardiography in various clinical scenarios. This chapter focuses on the technology of 3DE matrix transducers, physics of 3D imaging, data set acquisition (multiplane, real-time, full-volume, zoom, and colour), and display (volume rendering, surface rendering and multislice) modalities. The chapter also addresses the issues of training in 3DE, and main clinical indications and reporting of transthoracic and transoesophageal 3DE.
Stress echocardiography: image acquisition and modalities
Authors: Sicari Rosa , Płońska-Gościniak Edyta , Lowenstein Jorge
Published: December 2016

Stress echocardiography has evolved over the last 30 years but image interpretation remains subjective and burdened by the operator’s experience. The objective operator-independent assessment of myocardial ischaemia during stress echocardiography remains a technological challenge. Still, adequate quality of two-dimensional images remains a prerequisite to successful quantitative analysis, even using Doppler and non-Doppler based techniques. No new technology has proved to have a higher diagnostic accuracy than conventional visual wall motion analysis. Tissue Doppler imaging and derivatives may reduce inter-observer variability, but still require a dedicated learning curve and special expertise. The development of contrast media in echocardiography has been slow. In the past decade, transpulmonary contrast agents have become commercially available for clinical use. The approved indication for the use of contrast echocardiography currently lies in improving endocardial border delineation in patients in whom adequate imaging is difficult or suboptimal. Real-time three-dimensional echocardiography is potentially useful but limited by low spatial and temporal resolution. It is possible that these technologies may serve as an adjunct to expert visual assessment of wall motion. At present, these quantitative methods require further validation and simplification of analysis techniques.
Heart failure: left ventricular systolic dysfunction
Authors: Donal Erwan , Galli Elena
Published: December 2016

Heart failure (HF) is a growing problem worldwide and poses an especially large public health burden. It represents a new epidemic of cardiovascular disease, affecting nearly 5.8 million people in the United States, and over 23 million worldwide. Nevertheless, in Europe, fears of an impending HF ‘epidemic’ could not be confirmed in this analysis of trends in prevalence for the period 1990-2007 in patients hospitalized with HF in Sweden. An overall slight decrease in age-adjusted prevalence was observed from 2002. The prevalence in patients under 65 years increased markedly. In absolute numbers, there was a substantial increase among the very old, consistent with demographic changes. The complexity of left ventricular function(s) assessment in HF patients is related to the complexity of heart anatomy, but also to the complexity of electromechanical interaction, and to the load dependency of all the parameters that could be applied in clinical practice.
Heart failure: risk stratification and follow-up
Authors: Moonen Marie , Van de Veire Nico , Donal Erwan
Published: December 2016

An increasing number of two- and three-dimensional echocardiographic, Doppler, and speckle imaging-derived parameters and values can be related to prognosis in heart failure with left ventricular (LV) systolic dysfunction. This chapter discusses both conventional and new indices, including their advantages and potential limitations. There is increasing evidence for the use of new indices, including three-dimensional LV ejection fraction and global longitudinal strain. The follow-up and monitoring of heart failure patients using two-dimensional transthoracic echocardiography is also discussed in this chapter, including how to estimate the LV filling pressures and quantify LV reverse remodelling.
Heart valve disease: tricuspid valve disease
Authors: Muraru Denisa , Anwar Ashraf M. , Song Jae-Kwan
Published: December 2016

The tricuspid valve is currently the subject of much interest from echocardiographers and surgeons. Functional tricuspid regurgitation is the most frequent aetiology of tricuspid valve pathology, is characterized by structurally normal leaflets, and is due to annular dilation and/or leaflet tethering. A primary cause of tricuspid regurgitation with/without stenosis can be identified only in a minority of cases. Echocardiography is the imaging modality of choice for assessing tricuspid valve diseases. It enables the cause to be identified, assesses the severity of valve dysfunction, monitors the right heart remodelling and haemodynamics, and helps decide the timing for surgery. The severity assessment requires the integration of multiple qualitative and quantitative parameters. The recent insights from three-dimensional echocardiography have greatly increased our understanding about the tricuspid valve and its peculiarities with respect to the mitral valve, showing promise to solve many of the current problems of conventional two-dimensional imaging. This chapter provides an overview of the current state-of-the-art assessment of tricuspid valve pathology by echocardiography, including the specific indications, strengths, and limitations of each method for diagnosis and therapeutic planning.
Cardiac transplant patients
Authors: Torres Río Aguilar , Badano Luigi P. , Tsiapras Dimitrios
Published: December 2016

Echocardiography has a pivotal role in the care of heart transplant (HT) recipients. This chapter discusses the use of echocardiographic techniques for the assessment of HT patients. In the early post-transplant period, echocardiography has demonstrated its utility to assess the normal and abnormal structural and physiological changes of the transplanted heart, as well as to detect complications such as graft failure. During follow-up, development of acute/chronic graft rejection and cardiac allograft vasculopathy remains the leading causes of mortality in HT recipients and the role of conventional and new echocardiographic techniques in detecting these complications is discussed. Finally, the role of stress echocardiography, which provides additional functional information to the anatomical data obtained with invasive coronary angiography and intravascular ultrasound, is highlighted. The last sections of the chapter are dedicated to the echocardiographic monitoring of endomyocardial biopsies and how to schedule serial echocardiograms during the follow-up of HT recipients.
Cardiac oncology
Authors: Galderisi Maurizio , Plana Juan Carlos , Edvardsen Thor , Di Bello Vitantonio , Lancellotti Patrizio
Published: December 2016

Cancer therapeutics may induce cardiac damage in the left and the right ventricle. Radiotherapy most frequently induces valvular damage, carotid stenosis, and coronary artery disease. Pericardial disease may be due to both chemo- and radiotherapy. The manifestations of both chemo- and radiotherapy can develop acutely but also become overt years after their performance, in particular after radiotherapy. The main cardiac damage of cancer therapeutics-related cardiac dysfunction (CTRCD) corresponds to the reduction of left ventricular (LV) systolic function. The Expert Consensus document from ASE and EACVI has defined CTRCD as a decrease in LV ejection fraction (LVEF) of greater than 10 percentage points, to a value less than 53%. The accurate calculation of LVEF at baseline and during follow-up is extremely important. The assessment of LV longitudinal function, in particular of speckle tracking-derived global longitudinal strain (GLS), can provide additional information, allowing early, subclinical detection of CTRCD. The ideal strategy could be to compare the measurements of GLS obtained during chemotherapy, with the one obtained at baseline. An integrated approach with the use of echocardiography at standardized, clinical preselected intervals with biomarker (ultrasensitive troponin) assessment prior to each chemotherapy cycle could be suggested in patients at high risk of CTRCD. Follow-up after therapy should depend on the type of chemotherapy/radiotherapy and the presence/absence of on-therapy CTRCD. Long-term follow-up should be planned after radiotherapy.
Paediatric palliative medicine: philosophy and practice
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

This chapter will consider a brief history of palliative care in children, a definition of palliative care in children, and how that might need to be worked out in the practical care of children with life-limiting conditions. It focuses on the underlying principles that should always inform management of paediatric palliative cases, including the need to balance harm and benefit, the need for a rational approach, and a need for a multidimensional approach.
Ethics in palliative care
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Ethical principles are the same in palliative medicine as they are in other medical disciplines. Clinical decisions at the end of life, however, may involve ethical considerations and judgements that are particularly complex and on whose outcome much may depend. This chapter reviews basic ethical principles, including beneficence, non-maleficence, respect for autonomy, and justice as fairness, as well as ethical principles specific to palliative care. It evaluates the principle of double effect and the ethical considerations when withholding and withdrawing treatment, alongside a discussion of euthanasia.
Gastrointestinal symptoms
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

A number of gastrointestinal symptoms are encountered in paediatric palliative care. This chapter covers commonly occurring symptoms, including constipation, diarrhoea, sialorrhoea, visceral hyperalgesia, anorexia, cachexia, and hiccough. Details on definitions, causes, and management are covered in most instances, and a section on blended feeds is also included.
Palliative care in intensive care environments
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

A significant proportion of deaths in childhood, even those from life-limiting conditions, happen in an intensive care environment. An effective interface between palliative care services and the neonatal or paediatric intensive care unit is important but also presents certain specific challenges. This chapter looks at some of these challenges. It covers advance emergency care planning and compassionate extubation, examining the practicalities, symptom management, and parallel planning involved in this stage of care. Significant attention is also given to the ethics of compassionate extubation and symptoms during compassionate extubation.
Religion and ritual
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Religion and ritual have featured in human society for many thousands of years. The complexity of the rituals of different religions and their diversity can seem overwhelming at times, but interestingly all religions appear to follow many similar themes. Even though each culture has its own approach to death, in almost all faiths, death is seen as a time of transition. This chapter covers approaches to death found in the major UK religions and cultures. Examining the main features of Christianity, Islam, Hinduism, Sikhism, Judaism, Buddhism, and traditional African cultures, this chapter covers both the general aspects of these faiths and cultures, and the main beliefs and practicalities that these groups associate with the death of a child. As well as providing information on specific issues, this chapter covers usual procedures before and after death, funeral rituals, and typical rituals on the anniversary of death.
Communication amongst professionals
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Communication skills amongst professionals all centre on the basic ideology of teamworking. The World Health Organization affirms that primary health should involve all related sectors working together, including education and social services, in addition to health care, and that efforts should be made to coordinate these sectors. This chapter explores how best to ensure effective communication in the care of a terminally ill child through team theory and by examining the challenges of teamwork. General guidance for establishing successful teamwork is also given.