bluuebunny/crossref_metadata_2025 huggingface dataset:
Akutes Koronarsyndrom und Schlaganfall – interdisziplinäres Management
Authors: Zeus Tobias , Jander Sebastian
Published: December 2017

Das akute Koronarsyndrom folgt in Diagnostik und Therapie europäischen Leitlinien. Die interventionelle Therapie steht in der Akutphase im Vordergrund. Ziel ist die Wiederherstellung der Myokardperfusion durch Wiedereröffnung eines verschlossenen oder stenosierten Koronargefäßes. Analog hierzu ist der wesentliche Eckpunkt der Behandlung des akuten Hirninfarkts die zerebrale Rekanalisation. In Abhängigkeit vom zeitlichen Verlauf und der Lokalisation wird dies durch Thrombolyse und/oder endovaskuläre Thrombektomie erreicht. Eine besondere Herausforderung ist das gleichzeitige Auftreten von Schlaganfall und akutem Koronarsyndrom. Da eine Troponinerhöhung in diesem Zusammenhang sowohl eine Dysbalance zwischen Sauerstoffangebot und -bedarf als auch Zeichen einer koronaren Plaqueruptur darstellen kann, sind Anamnese, EKG und Bildgebung besonders wichtig, um die Indikation zur Herzkatheterdiagnostik sicher stellen zu können. Die periinterventionelle und postinterventionelle Gerinnungstherapie sollte interdisziplinär abgestimmt werden und das intrazerebrale Blutungsrisiko berücksichtigen.
Das akute Scrotum im Kindesalter – Juristische Fallstricke
Authors: Bader Pia , Hugemann Christoph , Frohneberg Detlef
Published: December 2017

Das akute Scrotum im Kindesalter ist ein Notfall.

Da verschiedene Erkrankungen für plötzliche Scrotalschmerzen verantwortlich sein können, sind die gezielte Anamnese, die Abwägung der DD, eine schnelle Entscheidung und rasches Handeln, zum Beispiel bei einer Hodentorsion, erforderlich.

Bei fehlender Einwilligungsfähigkeit des Minderjährigen ist die Einwilligung der Erziehungsberechtigten zwingend erforderlich. Andererseits bereitet deren Einholung im akuten Notfall häufig organisatorische Probleme. Es ergeben sich im täglichen Routinebetrieb durchaus Situationen, in denen gegebenenfalls eine Therapie entschieden werden muss, ohne eine ausreichende Rechtssicherheit durch die rechtzeitige Einwilligung der Erziehungsberechtigten gewährleisten zu können.

Je nach Alter und Entwicklung des Kindes u. U. ist auch die Einwilligung des Patienten selbst zu berücksichtigen.

Die juristische Bewertung des jeweiligen Einzelfalles und die Erzielung von Rechtssicherheit ist für den behandelnden Arzt und Operateur von wesentlicher Bedeutung.
S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma
Authors:   Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V., Buhl R. , Bals R. , Baur X. , Berdel D. , Criée C.-P. , Gappa M. , Gillissen A. , Greulich T. , Haidl P. , Hamelmann E. , Kardos P. , Kenn K. , Klimek L. , Korn S. , Lommatzsch M. , Magnussen H. , Nicolai T. , Nowak D. , Pfaar O. , Rabe K. , Riedler J. , Ritz T. , Schultz K. , Schuster A. , Spindler T. , Taube R. , Taube K. , Vogelmeier C. , von Leupold A. , Wantke F. , Weise S. , Wildhaber J. , Worth H. , Zacharasiewicz A. ,   Deutsche Gesellschaft für Rehabilitationswissenschaften e.V.,   und Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V.;
Published: December 2017

Die vorliegende Leitlinie ist eine Neufassung und Aktualisierung der Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma, welche die bisher für den deutschen Sprachraum gültige Version aus dem Jahr 2006 ablöst. Die Fülle an neuen Erkenntnissen zur Pathophysiologie und zu den Phänotypen von Asthma und das erweiterte Spektrum an diagnostischen und therapeutischen Möglichkeiten bei dieser Erkrankung machte eine Neufassung und Aktualisierung notwendig. Es werden sowohl für Kinder und Jugendliche als auch für Erwachsene mit Asthma die aktuellen, Evidenz-basierten diagnostischen und therapeutischen Empfehlungen dargelegt.
Endoscopic pancreatic balloon sphincteroplasty for difficult to treat pancreatic stones and strictures: experience in 80 patients
Authors: Bansal Rinkesh , Patil Gaurav , Puri Rajesh , Choudhary Narendra , Patle Saurabh , Sharma Zubin , Sud Randhir
Published: December 2017

Background and aim There is paucity of data about endoscopic pancreatic sphincteroplasty (EPS) after endoscopic pancreatic sphincterotomy (EPST) in the treatment of chronic pancreatitis. The aim of this study was to establish the indications for EPS, complications related to it, and to examine its effectiveness in managing chronic pancreatitis after a year of follow-up.

Methods We evaluated the safety and efficacy of pancreatic balloon dilation coupled with sphincterotomy for the treatment of chronic pancreatitis. The technical success rate of balloon dilation, stone clearance, frequency of pancreatic stenting, and procedure-related adverse events were recorded.

Results Out of 580 patients who underwent pancreatic endotherapy between July 2014 and February 2016, 80 patients underwent EPS. The mean age of these 80 patients was 34 ± 11 years, and 80 % (n = 64) were males. The common indications were removal of large radiolucent stones in 31 patients; unyielding radiopaque stones post extracorporeal shock wave lithotripsy (ESWL) in 20 patients, and pancreatic duct stricture combined with stones in 29 patients. EPS could be successfully completed in 98.75 % of patients. Complete ductal clearance in a single session was achieved in only 25 patients, while 26 patients required two sessions. There were two adverse events of pain requiring admission for more than 24 hours and one procedure related bleeding, all of which were managed conservatively. The patients had an average follow-up of 8 months (6 – 12 months) and all the patients were pain free.

Conclusions Endoscopic pancreatic sphincteroplasty is a relatively safe procedure with a low incidence of complications and a high rate of treatment success.
Entwicklungsräume
Authors: Vollmer Tanja C. , Koppen Gemma , Vraetz Thomas , Niemeyer Charlotte
Published: December 2017

Vom Heilungserfolg wissenschaftsbasierter Architektur für Kinder- und Jugendkliniken Kann man Heilungs- und Entwicklungschancen
hospitalisierter Kinder und Jugendlicher mittels Architektur verbessern? Noch nie wurde der Frage so konsequent nachgegangen wie in der
neuen Kinder- und Jugendklinik der Universität Freiburg. Seit 2013 arbeiten dort Pflegende, Pädagogen, Psychologen und Ärzte gemeinsam
daran, im zukünftigen Klinikbau die Krankenversorgung und Krankenhausumgebung besser als bisher aufeinander abzustimmen. Sie werden dabei
maßgeblich von einer Architekturpsychologie unterstützt, die sich auf die Entwicklung von sogenannten Qualitativen Raumkonzepten
spezialisiert hat.
Kardiologische Rehabilitation
Authors: Schwaab Bernhard
Published: December 2017

Die Rehabilitation kardiovaskulärer Erkrankungen stellt eine multimodale Intervention auf somatischer, psychologischer, edukativer und sozialer Ebene durch ein interdisziplinäres Team dar und beinhaltet neben der Optimierung der medizinischen Sekundärprävention zur Reduktion von Morbidität und Mortalität auch die Verbesserung der körperlichen Leistungsfähigkeit und der Lebensqualität sowie die Wiedereingliederung in das soziale und Erwerbsleben. In 5 kontrollierten Kohortenstudien an 12 556 Patienten aus Deutschland konnte gezeigt werden, dass eine Anschlussrehabilitation nach akutem Myokardinfarkt und nach Bypass-Operation die Gesamtmortalität, die Reinfarktrate und die Hospitalisierung im Verlauf von 1–2 Jahren signifikant senkte. Diese Ereignisreduktion gelang zusätzlich zu einer interventionellen Akuttherapie und einer evidenzbasierten medikamentösen Sekundärprävention. 3 internationale Metaanalysen bestätigen diese nationalen Ergebnisse für Patienten mit Koronarer Herzkrankheit. Eine kardiologische Rehabilitation wird in nationalen und internationalen Leitlinien auch empfohlen für Patienten nach Herzklappenoperation und -intervention, nach dekompensierter Herzinsuffizienz, nach Herztransplantation sowie nach ICD-, CRT- und VAD-Implantation. Die Absicherung der Evidenz der kardiologischen Rehabilitation in Deutschland durch einen RCT wäre wünschenswert. Darüber hinaus sollten die multimodalen Interventionen noch individueller auf spezifische Patientengruppen (Hochbetagte, Gebrechliche), Indikationen (TAVI, VAD) sowie Komorbiditäten (pAVK, T2DM) ausgerichtet und besondere berufliche Problemlagen konsequent berücksichtigt werden. Die kardiologische Rehabilitation sollte integraler Bestandteil jeder Versorgung sein, die sich am dauerhaften Therapieerfolg orientiert.
Vorhofflimmern als Risikofaktor für eine Demenz
Authors: Dietzel Joanna , Endres Matthias , Häusler Karl
Published: December 2017

Sowohl Vorhofflimmern als auch eine Demenz weisen eine hohe Prävalenz in der älteren Bevölkerung auf und werden in einem relevanten Ausmaß durch vergleichbare kardiovaskuläre Risikofaktoren bedingt. Vorhofflimmern ist bekanntermaßen ein unabhängiger Risikofaktor für den ischämischen Schlaganfall und zudem ein Risikofaktor für die Entwicklung einer Demenz, wie bevölkerungsbasierte Untersuchungen und systematische Übersichtsarbeiten belegen. Unabhängig von durch Vorhofflimmern bedingten zerebralen Ischämien scheint eine durch Vorhofflimmern induzierte chronische zerebrale Hypoperfusion und eine systemische Entzündungsreaktion der Entwicklung kognitiver Defizite Vorschub zu leisten. Obwohl bei bekanntem Vorhofflimmern bisher weder eine rhythmuserhaltende Therapie noch eine Gerinnungshemmung im Sinne einer medikamentösen Schlaganfallprävention nachweislich förderlich für die Prävention einer Demenz ist, stellt eine individualisierte und leitliniengerechte Therapie des Vorhofflimmerns sicher einen vielversprechenden Ansatz klinischer Studien dar. Die kognitive Funktion von Patienten mit Vorhofflimmern sollte zudem in der klinischen Praxis Beachtung finden.
Quantum interference in multi-branched molecules: The exact transfer matrix solutions
Authors: Jiang Yu
Published: December 2017

We present a transfer matrix formalism for studying quantum interference in a single molecule electronic system with internal branched structures. Based on the Schrödinger equation with the Bethe ansatz and employing Kirchhoff’s rule for quantum wires, we derive a general closed-form expression for the transmission and reflection amplitudes of a two-port quantum network. We show that the transport through a molecule with complex internal structures can be reduced to that of a single two-port scattering unit, which contains all the information of the original composite molecule. Our method allows for the calculation of the transmission coefficient for various types of individual molecular modules giving rise to different resonant transport behaviors such as the Breit-Wigner, Fano, and Mach-Zehnder resonances. As an illustration, we first re-derive the transmittance of the Aharonov-Bohm ring, and then we apply our formulation to N identical parity-time (PT)-symmetric potentials, connected in series as well as in parallel. It is shown that the spectral singularities and PT-symmetric transitions of single scattering cells may be observed in coupled systems. Such transitions may occur at the same or distinct values of the critical parameters, depending on the connection modes under which the scattering objects are coupled.
Hydrogen-dependent low frequency noise and its physical mechanism of HfO2 resistance change random access memory
Authors: Chen Y. Q. , Liu X. , Liu Y. , Peng C. , Fang W. X. , En Y. F. , Huang Y.
Published: December 2017

The effect of hydrogen on low frequency noise characteristics of HfO2 resistance change random access memories (RRAMs) was investigated in this paper. The experimental results show that HfO2 RRAMs after hydrogen treatment take on the better uniformity of switch characteristics and the conduction enhancement behavior. Furthermore, it was found that the low frequency noise characteristics of the HfO2 RRAMs was significantly impacted by the hydrogen treatment, and at three kinds of typical resistance states, the low frequency noises of the HfO2 RRAMs after hydrogen treatment are larger than those of the fresh HfO2 RRAMs. The mechanism could be attributed to H induced oxygen vacancies, which serve as the additional traps for conduction due to the trap-assisted tunneling process. This will result in more random trap/detrap processes in the conducting filament, which gives rise to the larger low frequency noise in the HfO2 RRAMs. The results of this study may be useful in the design and application of HfO2 RRAMs.
Effect of interleaved Si layer on the magnetotransport and semiconducting properties of n-Si/Fe Schottky junctions
Authors: Das Sudhansu Sekhar , Kumar M. Senthil
Published: December 2017

Heterostructure films of the form n-Si/Si(tSi)/Fe(800 Å) were prepared by DC magnetron sputtering. In these films, the Si and Fe (800 Å) films were deposited onto n-Si(100) substrates. Substrates with different doping concentration ND were used. The thickness tSi of the interleaved Si layer is varied. For tSi = 0, the heterostructures form n-Si/Fe Schottky junctions. Structural studies on the samples as performed through XRD indicate the polycrystalline nature of the films. The magnetization data showed that the samples have in-plane easy axis of magnetization. The coercivity of the samples is of the order of 90 Oe. The I-V measurements on the samples showed nonlinear behavior. The diode ideality factor η = 2.6 is observed for the junction with ND = 1018 cm-3. The leakage current I0 increases with the increase of ND. Magnetic field has less effect on the electrical properties of the junctions. A positive magnetoresistance in the range 1 – 10 % was observed for the Si/Fe Schottky junctions in the presence of magnetic field of strength 2 T. The origin of the MR is analyzed using a model where the ratio of the currents across the junctions with and without the applied magnetic field, IH=2T/IH=0 is studied as a function of the bias voltage Vbias. The ratio IH=2T/IH=0 shows a decreasing trend with the Vbias, suggesting that the contribution to the MR in our n-Si/Fe Schottky junctions due to the spin dependent scattering is very less as compared to that due to the suppression of the impact ionization process.
Properties of dynamic magnetic loss of ferrite
Authors: Saotome Hideo , Azuma Keisuke , Kizuka Hiroki , Tanaka Takuma
Published: December 2017

The B-H loop of ferrite becomes narrower with a decrease in the excitation frequency. However, even at frequencies lower than 1 kHz, the B-H loop exhibits a certain minimum width, which is referred to as the (DC) hysteresis loop, and its area corresponds to the hysteresis loss. The dynamic magnetic loss is obtained by subtracting the hysteresis loss from the B-H loop area measured at a frequency above 1–10 kHz. The temperature characteristics of the hysteresis and dynamic magnetic losses are determined to be experimentally different, which suggests that the mechanism for the generation of dynamic magnetic loss is not exactly the same as that for the hysteresis loss. The dynamic magnetic loss is expressed using the dynamic magnetic loss parameter, which is a function of B and its time derivative, dB/dt. The dynamic magnetic loss parameter is measured under excitation with a rectangular waveform voltage. A ferrite core of TDK PC47 was used and the maximum magnetic flux density Bm, was set to 350 mT. The measured dynamic magnetic loss parameter was experimentally verified to be one of the intrinsic characteristics of ferrite and was also validated for cases of excitation with sinusoidal waveform voltages.
Ferromagnetic resonance and spin-wave resonances in GaMnAsP films
Authors: Liu Xinyu , Li Xiang , Bac Seul-Ki , Zhang Xucheng , Dong Sining , Lee Sanghoon , Dobrowolska Margaret , Furdyna Jacek K.
Published: December 2017

A series of Ga1-xMnxAs1-yPy films grown by MBE on GaAs (100) substrates was systematically studied by ferromagnetic resonance (FMR). Magnetic anisotropy parameters were obtained by analyzing the angular dependence of the FMR data. The results clearly show that the easy axis of the films shifts from the in-plane [100] direction to the out-of-plane [001], indicating the emergence of a strong tensile-strain-induced perpendicular anisotropy when the P content exceeds y ≈ 0.07. Multiple resonances were observed in Ga1-xMnxAs1-yPy films with thicknesses over 48 nm, demonstrating the existence of exchange-dominated non-propagating spin-wave modes governed by surface anisotropy.
Microstructure evolution and coercivity enhancement in Nd-Fe-B thin films diffusion-processed by R-Al alloys (R=Nd, Pr)
Authors: Xie Yigao , Yang Yang , Zhang Tongbo , Fu Yanqing , Jiang Qingzheng , Ma Shengcan , Zhong Zhenchen , Cui Weibin , Wang Qiang
Published: December 2017

Diffusion process by Nd-Al and Pr-Al alloys was compared and investigated in Nd-Fe-B thin films. Enhanced coercivity 2.06T and good squareness was obtained by using Pr85Al15 and Nd85Al15 alloys as diffusion sources. But the coercivity of diffusion-processed thin films by Pr70Al30 and Pr55Al45 alloys decreased to 2.04T and 1.82T. High ambient coercivity of 2.26T was achieved in diffusion-processed thin film by Nd70Al30 leading to an improved coercivity thermal stability because Nd2Fe14B grains were enveloped by Nd-rich phase as seen by transmission electron microscopy Nd-loss image. Meanwhile, microstructure-dependent parameters α and Neff were improved. However, high content of Al in diffusion-processed thin film by Nd55Al45 lead to degraded texture and coercivity.
Extreme multistability analysis of memristor-based chaotic system and its application in image decryption
Authors: Li Chuang , Min Fuhong , Jin Qiusen , Ma Hanyuan
Published: December 2017

An active charge-controlled memristive Chua’s circuit is implemented, and its basic properties are analyzed. Firstly, with the system trajectory starting from an equilibrium point, the dynamic behavior of multiple coexisting attractors depending on the memristor initial value and the system parameter is studied, which shows the coexisting behaviors of point, period, chaos, and quasic-period. Secondly, with the system motion starting from a non-equilibrium point, the dynamics of extreme multistability in a wide initial value domain are easily conformed by new analytical methods. Furthermore, the simulation results indicate that some strange chaotic attractors like multi-wing type and multi-scroll type are observed when the observed signals are extended from voltage and current to power and energy, respectively. Specially, when different initial conditions are taken, the coexisting strange chaotic attractors between the power and energy signals are exhibited. Finally, the chaotic sequences of the new system are used for encrypting color image to protect image information security. The encryption performance is analyzed by statistic histogram, correlation, key spaces and key sensitivity. Simulation results show that the new memristive chaotic system has high security in color image encryption.
Antimicrobial drug usage and poultry production: case study in Ghana
Authors: Johnson Sherry , Bugyei Kwasi , Nortey Priscillia , Tasiame William
Published: December 2017

Antimicrobial use in food animal production could lead to the occurrence of antimicrobial residues in the animal products. In Ghana, there is no monitoring program for antimicrobial residue in foods of animal origin. We determined the types of antimicrobial drugs used in poultry production in Dormaa municipality and the levels of residue found in poultry products. Performing a cross-sectional study, a structured questionnaire and direct observation methods were used to assess antimicrobial usage, knowledge of and adherence to withdrawal periods in randomly selected poultry farms. Eggs and ready-for-sale broilers were purchased from selected respondents’ farms for detection and quantification of residues using the microbial inhibition plate assay. A total of 132 farmers were interviewed from 115 farms. Farms (86%) administered drugs to birds for prophylactic purposes. A total of 28 (24.3%) farms had tetracycline residue in eggs, 25 (21.7%) in kidney and 14 (12.2%) in liver. Mean (±s.d.) tetracycline concentration (μg/g) found were: eggs 0.02 ± 0.003; kidneys 0.02 ± 0.01; and liver 0.01 ± 0.008. Twenty-six farms (92.9%; ρ > 0.05) that had residues in eggs had sold eggs during treatment of the laying birds. A disinfectant and two antibiotics in human formulations were administered to birds in 44.3%, 17.4% and 2.6% farms respectively on an extra-label basis. Tetracyclines were the main antimicrobial drugs used in poultry farming in the study area with little or no regard to withdrawal periods. Tetracycline residue was found in poultry but below the Maximum Residue Level set by Codex Alimentarius. Extra-label use of disinfectant to water-medicate birds poses a health hazard to farmers and consumers alike.
Superoxide Anion Biosensor Based on Bionic-Enzyme Hyperbranched Polyester Particles
Authors: Niu Yanlian , Hu Sisheng , Zhou Qian , Liu Yang , Liu Yuhong , Zhao Jing , Wan Mimi , Zhao Wenbo , Shen Jian
Published: December 2017

Self-assembly techniques have been demonstrated to be a useful approach to developing new functional nanomaterials. In this study, a novel method to fabricate a manganese phosphate self-assembly monolayer (SAM) on a hyperbranched polyester (HBPE-OH) nanoparticle surface is described. First, the second-generation aliphatic HBPE-OH was carboxy-terminated, phosphorylated, and then ionized with manganese by a three-step modification process. The final product of HBPE-AMPA-Mn2+ particles was obtained and characterised by FT-IR spectroscopy, 1H NMR spectroscopy, transmission electron microscopy (TEM), Zeta potential, and energy dispersive spectroscopy (EDS). Moreover, the HBPE-AMPA-Mn2+ particles were used to construct a novel biosensor for detection of superoxide anions (O2•−) released from HeLa cells. Results showed that the response currents of this biosensor were proportional to the O2•− concentration ranging from 0.79 to 16.6 μM, and provided an extremely low detection limit of 0.026 μM (S/N = 3). The results indicate that the particle-decorated electrode surface, which involved a hyperbranched structure and a surface self-assembly technology, proposed here will offer the ideal catalytic system for electrochemical enzymatic sensors.
The effect of simulated microgravity on the Brassica napus seedling proteome
Authors: Frolov Andrej , Didio Anna , Ihling Christian , Chantzeva Veronika , Grishina Tatyana , Hoehenwarter Wolfgang , Sinz Andrea , Smolikova Galina , Bilova Tatiana , Medvedev Sergei
Published: December 2017

The magnitude and the direction of the gravitational field represent an important environmental factor affecting plant development. In this context, the absence or frequent alterations of the gravity field (i.e. microgravity conditions) might compromise extraterrestrial agriculture and hence space inhabitation by humans. To overcome the deleterious effects of microgravity, a complete understanding of the underlying changes on the macromolecular level is necessary. However, although microgravity-related changes in gene expression are well characterised on the transcriptome level, proteomic data are limited. Moreover, information about the microgravity-induced changes in the seedling proteome during seed germination and the first steps of seedling development is completely missing. One of the valuable tools to assess gravity-related issues is 3D clinorotation (i.e. rotation in two axes). Therefore, here we address the effects of microgravity, simulated by a two-axial clinostat, on the proteome of 24- and 48-h-old seedlings of oilseed rape (Brassica napus L.). The liquid chromatography-MS-based proteomic analysis and database search revealed 95 up- and 38 downregulated proteins in the tryptic digests obtained from the seedlings subjected to simulated microgravity, with 42 and 52 annotations detected as being unique for 24- and 48-h treatment times, respectively. The polypeptides involved in protein metabolism, transport and signalling were annotated as the functional groups most strongly affected by 3-D clinorotation.
Corrigendum to: Changes in smoking, drinking, overweight and physical inactivity in young Australian women 1996–2013
Authors: Powers Jennifer R. , Loxton Deborah , Anderson Amy E. , Dobson Annette J. , Mishra Gita D. , Hockey Richard , Brown Wendy J.
Published: December 2017

Issue addressed: Smoking, risky drinking, overweight and obesity, and physical inactivity are health‐risk factors (HRFs) that contribute significantly to morbidity worldwide. Several initiatives have been introduced over the past two decades to reduce these HRFs. This paper examines changes in the prevalence of HRFs in young women (aged 18–23 years) between 1996 and 2013, overall and within demographic groups.

Methods: Data from two cohorts of the Australian Longitudinal Study on Women's Health, born in 1973–78 (n=14247) and 1989–95 (n=17012) were weighted to provide national estimates. Prevalence ratios were used to compare HRFs in 2013 relative to 1996.

Results: In 1996, 32% were current smokers, 38% were risky drinkers, 22% were overweight or obese and 7% were physically inactive. In 2013, corresponding estimates were 19%, 35%, 33% and 6%. Between 1996 and 2013, overall smoking prevalence decreased, but remained over 43% among least educated women. Overweight and obesity increased in all demographic groups.

Conclusions: The findings suggest that only smoking, which has been the subject of changes in taxation, legislation and regulation, declined significantly, in all except the least educated women. In contrast, the prevalence of overweight and obesity, which has largely been addressed through awareness campaigns and voluntary actions by the food industry, increased markedly in all demographic sub‐groups.

So what?: The findings show that comprehensive health promotion interventions, such as those for tobacco control, are successful (but may still be ineffective among less educated women). In contrast the measures to control population weight gain among young women have been futile so far.
Comparisons of vaginal flora patterns among sexual behaviour groups of women: implications for the pathogenesis of bacterial vaginosis
Authors: Olson Kristin M. , Boohaker Louis J. , Schwebke Jane R. , Aslibekyan Stella , Muzny Christina A.
Published: December 2017

Background
Bacterial vaginosis (BV) is the most common cause of vaginal discharge. The objective was to compare the prevalence of BV by Nugent score among African-American women who have sex with women (WSW) and women who have sex with women and men (WSWM) compared with an age-matched group of women who have sex with men (WSM). Secondary objectives were to correlate low versus high Nugent scores with vaginal symptoms among women with BV and to correlate BV diagnosis with sexual practices. Methods: A secondary analysis of clinical and laboratory data from African-American WSW (n = 73) and WSWM (n = 68) participating in the Women’s Sexual Health Project (August 2011–October 2013) and a 3 : 1 age-matched group of African-American WSM participating in the Longitudinal Study of Vaginal Flora (August 1999–February 2002) at a sexually transmissible infection clinic (n = 423) was performed. Results:Compared with WSM, WSW and WSWM were significantly more likely to have BV based on the Nugent score (OR 2.63; 95% CI 1.55–4.48; P < 0.01 and OR 3.67; 95% CI 2.17–6.21; P < 0.01 respectively). WSW and WSWM with BV were not significantly more likely to have higher Nugent scores than WSM with BV. Among women with BV reporting symptoms, there was no significant difference in the proportion of women with low-positive versus high-positive Nugent scores. Women who participated in receptive vaginal sex (penile or digital) within the 30 days preceding study enrolment were significantly more likely to have BV (OR 2.50; 95% CI 1.57–3.63; P < 0.01). Conclusions: WSW and WSWM were significantly more likely to have BV than WSM. Further analysis of sexual practices among sexual behaviour groups of women is needed to determine their potential impact on BV rates.
Concordance between monetary and sexual delay discounting in men who have sex with men
Authors: Jones Jeb , Guest Jodie L. , Sullivan Patrick S. , Kramer Michael R. , Jenness Samuel M. , Sales Jessica M.
Published: December 2017

Background Delay discounting has been found to be associated with numerous health-related outcomes, including risky sexual behaviour. To date, it is unclear whether delay discounting measured in different domains is associated within individuals. The goal of this study was to assess the concordance of monetary and sexual delay discounting in men who have sex with men. Methods: Participants completed an online survey, including the Monetary Choice Questionnaire and the Sexual Discounting Task. Linear regression models were used to assess the association between monetary and sexual discount rates. Results: Sexual discount rates did not predict monetary discount rates. There was a substantial amount of clustering of sexual discount rates, requiring sexual discounting data to be categorised. Conclusions: Monetary and sexual delay discounting are distinct processes that are not necessarily associated within individuals, and monetary delay discounting is not an appropriate proxy measure for sexual impulsivity. Data from the Sexual Discounting Task are typically rank-transformed for analysis. These data suggest that this might be an invalid method of analysis. Future studies should investigate the distribution of their data to determine if it is appropriate to analyse sexual discounting data as a continuous measure.
The Role of Family and Community in Integrative Preventive Medicine
Authors: Marvasti Farshad Fani
Published: December 2017

The role of family and community in integrative preventive medicine (IPM) is to leverage primary care as the chief means for disseminating and implementing a new integrative model of prevention. Thus IPM provides a shift from acute to chronic disease treatment and prevention with the goal of morbidity compression to extend the period of disease-free high-quality life. This shift results in a new focus for family and community medicine. Integrative preventive medicine realigns primary care with primary prevention, from reactive “sick” acute care to proactive preventive “health” care. It recreates “routine” physical exams as opportunities for primary prevention and patient health education. It empowers physicians to go beyond simply screening for secondary prevention and waiting for a disease to be diagnosed in favor of proactively engaging patients with an evidence-based lifestyle regimen to prevent the onset of disease and maintain optimal health for as long as possible.
The Role of Complementary and Alternative Medicine in Integrative Preventive Medicine
Authors: Marvasti Farshad Fani
Published: December 2017

Integrative preventive medicine (IPM) identifies complementary and alternative medicine (CAM) as a key contributor to the goal of extending disease-free high-quality life; CAM provides therapeutic approaches that are amenable to self-care, are cost-effective, are minimally invasive, and have minimal potential for side effects. Using CAM in IPM results in a shift away from passive screenings and treatment-centered approaches to prevention-focused care. Integrative preventive medicine redefines and expands the levels of prevention to include evidence-based CAM at each level of prevention alongside conventional approaches. And CAM reemphasizes the value of primary prevention as an underused level of prevention in our current approach to healthcare. Integrative preventive medicine affirms the value of evidence-based CAM in treating the major risk factors for morbidity and mortality and encourages physicians to actively discuss the diverse array of CAM therapies with their patients and to incorporate evidence-based CAM into their treatment plans.
Heterogeneity
Authors: Ferraro Kenneth F.
Published: December 2017

Gerontologists are intrigued by the astonishing degree of heterogeneity in later life and seek to identify the mechanisms that create or reduce it. Oddly, some fields of recent inquiry emphasize diversity associated with race, sex, and class, while giving scant attention to diversity by age. Gerontologists, by contrast, are vigilant to explore diversity between and within age groups. This chapter delineates some of the sources of heterogeneity in later life, including interindividual and intercohort differences, intraindividual change, non-normative events, and stochastic processes. It also considers processes that may reduce heterogeneity. To illustrate the axiom of heterogeneity, it identifies age and cohort differences in the consequences of environmental exposures.
Discontinuing Mechanical Ventilation
Authors: Kreit John W.
Published: December 2017

Discontinuing Mechanical Ventilation provides clear, step-by step instructions on how to liberate or “wean” the patient from the ventilator. It explains how to determine when the patient is ready to begin the weaning process, how to perform a spontaneous breathing trial, and how to determine if the patient is ready for extubation, including such considerations as whether the patient is at risk for post-extubation laryngeal edema; whether the patient will be able to effectively clear secretions from the airways following extubation; and determining if the patient has a “difficult airway” should the need for re-intubation arise. The chapter also provides a step-by-step approach to the difficult-to-wean patient, covering topics such as how to assess ventilatory ability and demand; determine the cause(s) of increased demand, impaired ability, or both; treat the causes of increased demand and impaired ability; and determine when to perform a tracheostomy.
Magnetic Resonance Methodologies
Authors: Bandettini Peter A. , Lu Hanzhang
Published: December 2017

Magnetic resonance imaging is a noninvasive tool for assessing brain anatomy, perfusion, metabolism, and function with precision. In this chapter, the basics and the most cutting edge examples of MRI-based measures are described. The first is measurement of cerebral perfusion, including the latest techniques involving spin-labelling as well as the tracking of exogenous contrast agents. Functional MRI is then discussed, along with some of the cutting edge methodology that has yet to make it into routine clinical practice. Next, resting state fMRI is described, a powerful technique whereby the entire brain connectivity can be established. Diffusion-based MRI techniques are useful for diagnosing brain trauma as well as understanding the structural connections in healthy and pathological brains. Spectroscopy is able to make spatially specific and metabolite-specific assessment of brain metabolism. The chapter ends with an overview of structural imaging with MRI, highlighting the developing field of morphometry and its potential for differentially assessing individual brains.
Diagnosis and Epidemiology of Psychotic Disorders
Authors: Meyer Emma , Walsh-Messinger Julie , Malaspina Dolores
Published: December 2017

Schizophrenia spectrum disorders and affective psychoses are jointly considered in this chapter in light of the ongoing controversy concerning the diagnostic boundary between these conditions. Emil Kraepelin first separated schizophrenia (which he named dementia praecox) from manic-depressive insanity based on the deteriorating course of illness in schizophrenia, and the convention is still upheld in the DSM-5. A wealth of evidence suggests that this dichotomy does not mirror clinical reality. This chapter reviews the history of the diagnostic concepts underlying the grouping and separation of “the psychoses,” focusing on schizophrenia, schizoaffective disorder, and bipolar disorder.
Synaptic Mechanisms of Psychotic Disorders
Authors: Grant Seth G. N.
Published: December 2017

Synapses are the hallmark of the neuroanatomy of the brain. The million billion synapses of the human brain connect the nerve cells into the networks that underpin all behavior. The molecular anatomy of synapses is also remarkably complicated with ~2000 proteins in the synapse proteome. The proteins are physically organized into a hierarchy of molecular machines that control synapse biology. These proteins integrate and compute the information in patterns of nerve cell activity. Mutations in hundreds of genes that encode synaptic proteins contribute to over one hundred brain diseases, including common mental disorders. The synapse proteome is of fundamental importance to mental illness.
Cellular Mechanisms of Psychotic Disorders
Authors: Dienel Samuel J. , Lewis David A.
Published: December 2017

Cognitive dysfunction in schizophrenia, including disturbances in working memory, is a core feature of the illness and the best predictor of long-term functional outcome. Working memory relies on neural network oscillations in the prefrontal cortex. Gamma-aminobutyric acid (GABA) neurons in the prefrontal cortex, which are crucial for this oscillatory activity, exhibit a number of alterations in individuals diagnosed with schizophrenia. These GABA neuron disturbances may be secondary to upstream alterations in excitatory pyramidal cells in the prefrontal cortex. Together, these findings suggest both a neural substrate for working memory impairments in schizophrenia and therapeutic targets for improving functional outcomes in this patient population.
Current Treatments for Psychotic Disorders
Authors: Sarpal Deepak K. , Malhotra Anil K.
Published: December 2017

Over the past several decades, considerable work has established our current repertoire of approaches to treatment of psychosis. This chapter provides an overview of current treatments for psychotic disorders with a focus on schizophrenia. Diagnostic considerations will be introduced, followed by discussions of first generation and second generation antipsychotic drugs, our current mainstay for treatment. Adverse effects of medications will be examined, as well as approaches to treatment refractory illness and nonpharmacologic treatment modalities. Finally, in light of recent advances in our understanding of the neurobiology of psychotic disorders, we will briefly discuss treatment-related biomarkers, and novel treatment targets under development.
Neurotrophic Mechanisms of Depression
Authors: Duman Ronald S.
Published: December 2017

Early theories of depression and treatment response were centered on the monoamine neurotransmitters, but more recent work has focused on functional and structural synaptic plasticity and the role of neurotrophic factors, particularly brain derived neurotrophic factor (BDNF). Neurotrophic factors regulate all aspects of neuronal function, including adaptive plasticity, synapse formation, and neuronal survival. Chronic stress and depression cause reductions in levels of BDNF and other key factors, including vascular endothelial growth factor (VEGF) and fibroblast growth factor 2 (FGF2), in cortical regions that contribute to atrophy and loss of neurons observed in depressed patients and rodent stress models. In contrast, these neurotrophic factors are upregulated by chronic administration of typical antidepressants and are required for antidepressant responses. Moreover, fast acting, highly efficacious antidepressant agents such as ketamine rapidly increase BDNF release and synapse formation, paving the way for a new generation of medications for the treatment of depression.
Current and Experimental Treatments for Anxiety Disorders
Authors: Guastella Adam J. , Norton Alice , Alvares Gail A. , Song Yun Ju Christine
Published: December 2017

There are currently a range of treatments available for anxiety disorders, including pharmacological and behavior-based therapies. The most widely used medications, for which there is considerable evidence of efficacy across a range of anxiety disorders, are the serotonin-selective reuptake inhibitor antidepressants. Benzodiazepines are also widely prescribed and show efficacy for acute anxiety, but their use in the treatment of chronic anxiety syndromes is more problematic. Many patients are not adequately covered by the available range of medications, which is driving interest in potentially new pharmacological approaches. The best established non-pharmacological treatment of anxiety is cognitive behavioral therapy and several related behavioral approaches, which have been shown to be efficacious in a range of anxiety disorders. One of these related approaches is called cognitive bias modification, which aims to alter an individual’s responses to anxiety-provoking stimuli.
Epidemiology of Substance use Disorders
Authors: Kandel Denise B. , Hu Mei-Chen , Griesler Pamela C. , Kerridge Bradley T. , Grant Bridget F.
Published: December 2017

The epidemiology of drug use in the general population includes two distinct streams of research. The more common stream measures consumption patterns by asking individuals whether (and how frequently) they have ever used specific classes of drugs. The second stream measures the extent of problematic drug use by asking individuals about behaviors and symptoms that would meet the criteria for a substance use disorder. This chapter presents data on the epidemiology and phenomenology of substance use disorders from comparative and developmental perspectives, focusing on DSM-5 definitions, prevalence for types of drugs and by age, gender, and race/ethnicity, comorbidity with psychiatric disorders, and developmental stages.
The Genetic Basis of Addictive Disorders
Authors: Goldman David , Zhou Zhifeng , Hodgkinson Colin
Published: December 2017

Addictive disorders are moderately to highly heritable, indicating that alleles transmitted from parents are protective, or enhance risk by whatever mechanisms. However, the inheritance of addictive disorders is complex, involving hundreds of genes and variants that are both common and rare, and that vary in effect size and context of action. Genes altering risk for addictions have been identified by pathway and candidate gene studies in humans and model organisms, and genomic approaches including genome-wide association, meiotic linkage, and sequencing. Genes responsible for shared liability to different addictive disorders have been identified, as well as genes that are relatively specific in altering risk of addiction to one agent. An impediment to overarching conclusions is that most of the heritability of addictions is unexplained at the level of gene or functional locus. However, new analytic approaches and tools have created new potentials for resolution of the “missing heritability.”
Molecular Neuroimaging in Addictive Disorders
Authors: London Edythe D. , Robertson Chelsea L.
Published: December 2017

Molecular neuroimaging, using nuclear medicine procedures to evaluate brain function and markers for specific neurochemical systems, has substantially advanced the understanding of brain dysfunction linked to addictive disorders. Neuroimaging studies of human subjects and animal models has provided fundamental information on the neurobiology of vulnerability to addiction as well as the acute effects of drugs of abuse and the sequelae of chronic use, including the persistent states that maintain addiction and lead to relapse in those who initiate drug abstinence. A common theme that has emerged from decades of brain imaging points to frontostriatal dysfunction, which is a therapeutic target.
Brain Development and the Risk for Substance Abuse
Authors: Heitzeg Mary M. , Casey B.J.
Published: December 2017

Addiction affects millions of people each year in the United States, with adolescence being a particularly vulnerable period of risk. This chapter provides an overview of recent human imaging and animal studies of adolescent brain development to further elucidate who may be most at risk for developing a substance abuse problem and when they may be most vulnerable. Emphasis on how brain circuitry underlying impulse control and sensitivity to rewards changes across development and how individual variation in this development may contribute to risk for addiction are highlighted. Understanding risk factors and how they change with exposure across development may enhance early detection, management, treatment, and ultimately prevention of substance use disorders.
Novel Approaches for Treating Addiction
Authors: Acri Jane B. , Skolnick Phil
Published: December 2017

Despite remarkable progress in our understanding of the neurobiological bases of drug abuse, no novel pharmacotherapies have recently been approved to treat substance use disorders (SUDs). Thus, while reformulations of established treatments have either been approved or are currently in late stage development (e.g., sustained release formulations of naltrexone (Vivitrol®) and buprenorphine), the development of medications to treat SUDs has lagged well behind other areas of psychiatry. In this chapter, we review some of the factors that have contributed to this dearth of innovative pharmacotherapies. We also review evidence that supports clinical testing of late stage molecules (developed for other indications) acting at promising targets, as well as novel biological approaches to the treatment of SUDs.
Current Approved Pharmacotherapies for Substance Use Disorders
Authors: Hammond Alexis S. , Strain Eric C.
Published: December 2017

About 3%–6% of the US population (an estimated 17 million people) were diagnosed with a substance use disorder (SUD) in 2014. This significant problem requires continued development of appropriate and effective therapies. Current treatments often include a combination of both pharmacologic and psychosocial modalities, tailored to an individual’s needs. This chapter provides a general overview of the pharmacotherapies that are currently approved by the US Food and Drug Administration for particular SUD indications. Those SUDs for which there are approved treatments include opioids, nicotine, and alcohol use disorders. Promising non-approved or investigational drugs are also briefly reviewed.
Genetics of Dementia
Authors: Renton Alan E. , Goate Alison M.
Published: December 2017

The genetic architecture of dementia is polygenic and complex, with risk alleles spanning frequency–effect size space. Despite significant progress, most genes influencing these disorders await discovery. Known risk loci implicate perturbed pathways that coalesce around recurring mechanistic themes, notably the autophagosome-lysosome system, the cytoskeleton, endocytosis, innate immunity, lipid metabolism, mitochondria, and the ubiquitin-proteasome system. Phenotypic and pathophysiological pleiotropy suggests some conditions form continuous clinicopathogenetic disease spectra blurring classical diagnoses. Future large-scale genome sequencing of global populations will significantly elucidate etiopathogenesis and is likely to reframe nosology. Furthermore integrative prospective cohort studies have the potential to revolutionize our understanding of dementia.
Neurobiology of Lewy Body Dementias
Authors: Galvin James E. , Bras Jose Tomas
Published: December 2017

Lewy body dementia (LBD) is the second most common form of neurocognitive disorder after Alzheimer’s disease and covers two related diagnoses: Dementia with Lewy Bodies and Parkinson’s Disease Dementia. Despite being a common disorder, diagnosis outside expert academic centers remains a significant challenge. The core pathological feature of LBD is the cortical Lewy body; however, many cases will have coexistent Alzheimer disease pathology. Genetic risk factors for LBD include mutations in genes for alpha-synuclein (SNCA) and galactocerbrosidase (GBA). Dopamine transporter imaging remains the most sensitive but platforms for measuring alpha-synuclein are being developed. Current therapies focus on symptomatic relief but experimental cell and animal models are providing new insights for the development of disease-modifying therapeutics.