bluuebunny/crossref_metadata_2025 huggingface dataset:
Topological quantum computation based on chiral Majorana fermions
Authors: Lian Biao , Sun Xiao-Qi , Vaezi Abolhassan , Qi Xiao-Liang , Zhang Shou-Cheng
Published: October 2018

Significance

We propose a platform of quantum computation using the chiral Majorana fermions on the edges of topological materials. The quantum gates are naturally accomplished by the propagation of chiral Majorana fermions. If realized, its computation speed can be

1

0

3

faster than the currently existing quantum computation schemes.
Linguistic landscaping
Authors: Muth Sebastian
Published: October 2018

This paper will examine the uses of linguistic landscapes as a pedagogical tool in the fields of multilingualism and foreign language teaching and learning. In line with an increasing interest in sociolinguistic research of linguistically and culturally diverse communities, linguistic landscaping emerged as a methodological paradigm for the study of multilingualism in society. In particular, the field opened up towards the study of educational spaces and schools. In that respect, linguistic landscaping evolves into an educational tool to increase students’ awareness of both linguistically diverse classrooms as well as societal multilingualism as a whole. Based on recent research findings, this paper argues that LLs can contribute significantly to develop literacy skills, improve pragmatic competence, increase the possibility of incidental language learning, help in the acquisition of multimodal literacy skills, and enhance sensitivity to connotational aspects of language. Furthermore, I will argue that research in linguistic landscaping opens up the potential to transform students into sociolinguists, critically reflecting on multilingual practices both in school and beyond.
‘Obtained by peculiar favour, & much difficulty of the Singer’: Vincenzo Albrici and the Function of Charles II's Italian Ensemble at the English Restoration Court
Authors: Lebedinski Ester
Published: October 2018

This article discusses the function of Vincenzo Albrici and Charles II's Italian ensemble at the English Restoration court. The article cites newly discovered archival evidence to suggest that Albrici arrived at the English court in 1664 to become the leader of an exclusive ensemble performing Italian chamber music. The employment of the Italian ensemble imitated Mazarin's patronage of Italian music at the French court, arguably to rehabilitate the recently restored Stuart dynasty in the eyes of Continental courts. The article suggests that the ensemble performed chamber music privately at court, and also occasionally appeared in the queen's Catholic chapel after 1666. The recruitment of Albrici and the Italian ensemble shows that the English court participated in Continental musical fashions after the Restoration, and illustrates the complex webs of cultural exchange in mid-seventeenth-century Europe.
An Uncrossable Rubicon: Liszt’s Sardanapalo Revisited
Authors: Trippett David
Published: October 2018

In 1850, after five years of planning, Liszt began composing music for his Italian opera, Sardanapalo, after Byron. It was central to his ambition to attain status as a European composer, but he abandoned the project halfway through. La Mara (1911), Humphrey Searle (1954) and others declared the manuscript fragmentary and partially illegible, but in 2016 this verdict was categorically overturned when work began on an edition of what Liszt notated: almost the entirety of Act 1. This article draws on an array of sources – published and unpublished – significantly to update our knowledge of the circumstances surrounding Liszt’s composition and abandonment of Sardanapalo. In light of his inconsistently Italianate music and idiosyncratic treatment of the libretto, it also reinterprets Liszt’s mid-century aesthetic orientation, as a confidant of Wagner and would-be pillar of Franz Brendel’s future neudeutsche Schule. By contextualizing key aspects of the uncovered musical score and libretto within Liszt’s mid-century writings on aesthetics, it posits character, declamatory melody and the visuality of the stage as (initially) critical criteria in the communication of a literary narrative, and suggests that Liszt’s impulse towards symphonic poetry may first have been kindled within the aesthetic potential of opera.
Optimal Use Ratio of the Stromal Vascular Fraction (SVF): An Animal Experiment Based on Micro-CT Dynamic Detection After Large-Volume Fat Grafting
Authors: Li Fang-Wei , Wang Hai-Bin , Fang Jin-Ping , Zeng Li , Chen Chun-Lin , Luo Sheng-Kang
Published: October 2018

Background

The addition of the stromal vascular fraction (SVF) can enhance the postoperative survival rate of fat. However, a universal SVF application method is currently unavailable. Therefore, a simple and convenient guideline for SVF addition is needed for its clinical application.

Objectives

The authors sought to evaluate whether SVF can improve fat survival after large-volume fat grafting and to find a simple and convenient standard for the clinical use of SVF.

Methods

Patient fat samples were obtained after liposuction for SVF preparation and grafting. Four types of grafts were prepared with different SVF ratios: 0:1, 1:1, 2:1, and 4:1 SVF:fat. After intensive mixing, fat grafts (5 mL) were randomly injected into both sides of the backs of athymic rats (n = 15). At 24 hours and 1, 3, 6, and 9 months after the operation, microcomputed tomography scanning was performed to calculate the fat survival rate.

Results

Nine months after the operation, the survival rates of fat in the 4 groups were 8.89 ± 1.62% (0:1), 18.26 ± 3.85% (1:1), 8.83 ± 1.46% (2:1), and 7.96 ± 1.31% (4:1). The 1:1 group exhibited the greatest survival rate (P < 0.01), and the adipose tissue histological patterns and blood vessel quality were enhanced compared with those in the other groups.

Conclusions

An appropriate SVF ratio can increase the fat survival rate after large-volume fat grafting, but no linear relationship exists between the SVF ratio and fat survival. The optimal SVF:fat ratio for grafting is 1:1.
High-Expanding Regions in Primate Cortical Brain Evolution Support Supramodal Cognitive Flexibility
Authors: Sneve Markus H , Grydeland Håkon , Rosa Marcello G P , Paus Tomáš , Chaplin Tristan , Walhovd Kristine , Fjell Anders M
Published: October 2018

Primate cortical evolution has been characterized by massive and disproportionate expansion of a set of specific regions in the neocortex. The associated increase in neocortical neurons comes with a high metabolic cost, thus the functions served by these regions must have conferred significant evolutionary advantage. In the present series of analyses, we show that evolutionary high-expanding cortex – as estimated from patterns of surface growth from several primate species – shares functional connections with different brain networks in a context-dependent manner. Specifically, we demonstrate that high-expanding cortex is characterized by high internetwork functional connectivity; is recruited flexibly over many different cognitive tasks; and changes its functional coupling pattern between rest and a multimodal task-state. The capacity of high-expanding cortex to connect flexibly with various specialized brain networks depending on particular cognitive requirements suggests that its selective growth and sustainment in evolution may have been linked to an involvement in supramodal cognition. In accordance with an evolutionary-developmental view, we find that this observed ability of high-expanding regions – to flexibly modulate functional connections as a function of cognitive state – emerges gradually through childhood, with a prolonged developmental trajectory plateauing in young adulthood.
Demand drives growth all the way: Goodwin, Kaldor, Pasinetti and the Steady State
Authors: Taylor Lance , Foley Duncan K , Rezai Armon
Published: October 2018

A demand-driven alternative to the conventional Solow–Swan growth model is analysed. Its medium run is built around Marx–Goodwin cycles of demand and distribution. Long-run income and wealth distributions follow rules of accumulation stated by Pasinetti in combination with a technical progress function for labour productivity growth incorporating a Kaldor effect and induced innovation. An explicit steady state solution is presented along with analysis of dynamics. When wage income of capitalist households is introduced, the Samuelson–Modigliani steady state ‘dual’ to Pasinetti’s cannot be stable. Numerical simulation loosely based on US data suggests that the long-run growth rate is around 2% per year and that the capitalist share of wealth may rise from about 40 to 70% due to positive medium-term feedback of higher wealth inequality into its own growth.
Diversifying ICA: Identity, Difference, and the Politics of Transformation
Authors: Gardner Paula M
Published: October 2018

The outgoing President of the International Communication Association (ICA) reflects on the ongoing lack of ethnic and gender diversity reflected in our organization, at our conferences, and in our publications. Referencing past communication scholarship, specifically the constitutive approach, and postcolonial feminist approaches, the essay challenges communication scholars to seek out, read, and cite diverse research, and tackle our shared #Communicationsowhite problem. In so doing, we will expand our research networks, ensuring a rich ICA future whereby our membership, research networks, and publications reflect the diverse communication research that exists globally.
Antibody Therapeutics for Ovarian Carcinoma and Translation to the Clinic
Authors: Josephs Debra H. , Bax Heather J. , Pellizzari Giulia , Spicer James F. , Montes Ana , Karagiannis Sophia N.
Published: October 2018

Despite improvements over the past decade in the treatment of ovarian cancer, many patients are at risk of recurrent disease and emerging drug resistance. The increased selectivity and reduced toxicity of molecularly targeted anti-cancer agents renders them attractive for development in ovarian cancer, and monoclonal antibodies targeting ovarian cancer-specific tumor antigens represent the largest such group investigated in this clinical setting. This chapter describes examples of monoclonal antibodies clinically evaluated for efficacy in ovarian cancer. These agents recognize molecular targets expressed on tumors or within tumor microenvironments that may be essential for tumor cell survival and proliferation. Recently, antibodies targeting checkpoint molecules on immune cells have shown efficacy in modulating anti-tumor immunity, and applications in ovarian carcinomas are evaluated. The chapter focuses on therapeutic agents’ attributes on targeting key cancer growth and progression pathways, and propensity to engender effector functions by activating immune effector cells in tumors and the circulation.
Ovarian Tumor Microenvironment and Innate Immune Recognition
Authors: Reader Jocelyn , Lynam Sarah , Harper Amy , Rao Gautam , Matheny Maya , Roque Dana M.
Published: October 2018

Ovarian adenocarcinoma is typified by detection at late stages with dissemination of cancer cells into the peritoneal cavity and frequent acquisition of chemoresistance. A number of studies show the importance of the tumor microenvironment and innate immune recognition in tumor progression. Ovarian cancer cells can regulate the composition of their stroma to promote the formation of ascitic fluid rich in cytokines and bioactive lipids such as PGE2, and to stimulate the differentiation of stromal cells into a pro-tumoral phenotype. In response, cancer-associated fibroblasts, cancer-associated mesenchymal stem cells, tumor-associated macrophages, and other peritoneal cells can act through direct and indirect mechanisms to regulate tumor growth, chemoresistance via alteration of class III β‎ tubulin, angiogenesis and dissemination. This chapter deciphers the current knowledge about the role of stromal cells, associated secreted factors, and the immune system on tumor progression. This suggests that targeting the microenvironment holds great potential to improve the prognosis of patients with ovarian adenocarcinoma.
Adoptive Cell Immunotherapy for Epithelial Ovarian Cancer
Authors: Farghaly Samir A.
Published: October 2018

The standard management for epithelial ovarian cancer (EOC) is a combination of aggressive debulking surgery with residual tumor of less than 1 cm and platinum-based chemotherapy. However, a high percentage of patients experience disease recurrence. Extensive efforts to find new therapeutic options have been made, albeit cancer cells develop drug resistance and malignant progression occurs. Novel therapeutic strategies are needed to enhance progression-free survival and overall survival of patients with advanced EOC. Several preclinical and clinical studies investigated feasibility and efficacy of adoptive cell therapy (ACT) in EOC. The aim of this chapter is to present an overview of ACT in EOC, focusing on Human Leukocyte Antigen (HLA)-restricted tumor infiltrating lymphocytes and MHC-independent immune effectors such as natural killer and cytokine-induced killer. The available data suggest that ACT may provide the best outcome in patients with low tumor burden, minimal residual disease, or maintenance therapy. Further preclinical studies and clinical trials are needed.
Heat Shock Protein Vaccine Therapy for Ovarian Cancer
Authors: Abe Hiroyuki , Sasada Amane , Tabata Shigeki , Abe Minako
Published: October 2018

Despite advances in chemotherapeutic regimens, ovarian cancer has a poor prognosis. Therefore important effective treatments are urgently needed. Many studies have reported that the immune system plays a critical role in disease progression and overall survival. One known effective immunotherapy is the dendritic cell (DC)-based vaccine pulsed with tumor-associated antigens. This chapter reports on a method of production of a novel DC-based vaccine. The key technologies are (a) monocyte collection without leukapheresis, (b) monocyte expansion, (c) production of dendritic cells, (d) multiple overlapping long peptides with heat shock protein 70, and (e) combination immunotherapy approach. The next generation of immunotherapy for ovarian cancer will be focused on combination approaches that simultaneously augment immunity while preventing local immune suppression. Possible combinations which might be useful to help patients with ovarian cancer are summarized in this chapter.
Clinical Trials of Ovarian Cancer Immunotherapy and Future Directions
Authors: Drerup Justin M. , Clark Curtis A. , Curiel Tyler J.
Published: October 2018

Ovarian cancer (OC) is an immunogenic tumor and among the first where measures of anti-tumor immunity correlated with improved survival. Thus, immunotherapy could be a viable OC treatment modality. Nonetheless, clinical OC immunotherapy trials have demonstrated only modest successes at best, and there is currently no Food and Drug Administration (FDA)approved OC immune therapy despite recent successes in other carcinomas and lymphomas and FDA-approved immunotherapy agents for them. New data suggest specific impediments to effective de novo and treatment-induced anti-OC immunity and support the concept that effective, tolerable OC immunotherapy could be developed based on these newer insights. This chapter reviews the history of OC immunotherapy, highlights important discoveries in OC-related immune dysfunction, covers promising recent developments, highlights newer and ongoing clinical trials, and speculates on future directions that could lead to improved OC immunotherapy approaches.
Conceptual History of Post-Traumatic Stress Disorder
Authors: Shalev Arieh Y. , Marmar Charles R.
Published: October 2018

This chapter illustrates the conceptual and historical background of our current understanding of post-traumatic stress disorder (PTSD) and the implication of that history for current and future research and practice. It follows two parallel paths, conceptual and chronological, showing a progression in defining, recognizing, and diagnosing PTSD, The chapter discusses a stable conceptual space within which key clinical features of PTSD are conserved across time and cultures. The chapter also considers recent conceptual and definitional challenges emanating from new computational tools and advances in neurobehavioral research.
Measures of PTSD Symptom Severity
Authors: Parker-Guilbert Kelly S. , Moshier Samantha J. , Marx Brian P. , Keane Terence M.
Published: October 2018

Assessment of post-traumatic stress disorder (PTSD) symptom severity serves a variety of important clinical and research purposes and may be able to more accurately represent the nature of posttraumatic stress when compared with traditional categorical diagnosis. Numerous measures that assess PTSD symptom severity are available and choosing measures with strong psychometric properties that meet one’s clinical or research needs is essential to accurate assessment. This task is made more complex by the recent update to the PTSD symptom criteria from DSM-IV-TR to DSM-5. This chapter discusses available clinician-rated and self-report methods for evaluating PTSD symptom severity and makes recommendations for clinicians and researchers across a range of contexts and patient populations.
Post-Traumatic Stress Disorder Associated with Disaster
Authors: North Carol S.
Published: October 2018

This chapter provides an overview of disaster-related post-traumatic stress disorder (PTSD). The chapter begins by examining the special role that disasters have in contributing to our general understanding of PTSD. It further explores the critical roles played by both disaster trauma and exposure to it toward the development of PTSD, by applying nosology of the disorder and understanding the construction of criteria for its diagnosis. The chapter explains procedures and methods for assessment of disaster-related PTSD in individuals and in populations, reviews risk factors for PTSD after disasters, and describes the post-disaster course of PTSD. Finally, the chapter provides an operational approach with a mental health framework to address PTSD associated with exposure to disaster.
Child Abuse and Neglect as Risk Factors for Post-Traumatic Stress Disorder
Authors: Westfall Nils C. , Nemeroff Charles B.
Published: October 2018

Child abuse and neglect confer substantially increased risks of developing post-traumatic stress disorder (PTSD) for the victims and possibly even their offspring. Furthermore, they are associated with more severe and treatment-resistant PTSD and common comorbid conditions, such as major depressive disorder. This chapter begins by discussing the epidemiology of child abuse, neglect, and maltreatment-associated PTSD to provide a sense of the nature and scope of these major public health problems, then describes the major ways in which child abuse and neglect may contribute to increased liability to PTSD: maltreatment, victim, and environmental factors; neurobiological changes, including neuroendocrine, neurotransmitter system, structural and functional neuroimaging, inflammatory, and epigenetic changes; interactions with risk gene alleles; and cognitive, psychological, and behavioral changes. A discussion of the implications of this knowledge for future research and the development of new treatments for child maltreatment–associated PTSD follows.
Genetic Approaches to Post-Traumatic Stress Disorder
Authors: Guffanti Guia , Kaufman Milissa L. , Lebois Lauren A. M. , Ressler Kerry J.
Published: October 2018

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder with an estimated genetic component accounting for 30%–40% of the variance contributing to risk for the disease. This chapter starts with a review of the biological hypotheses and related genetic mechanisms currently proposed to be associated with PTSD and trauma-related disorders. It will follow with a description of the state-of-the-art on the methodologies and their application to map genetic loci and identify biomarkers associated with PTSD. Finally, we will review the latest results from genome-wide association studies of genetic variants as well as those derived from the emerging fields of epigenetics and gene expression.
Race and Ethnicity
Authors: Pole Nnamdi
Published: October 2018

Empirical evidence shows consistent elevations in post-traumatic stress disorder (PTSD) prevalence for Black and Native American (and, to some extent, Latino American) trauma survivors in comparison to their White and Asian American counterparts. Certain subgroups within these larger groups (e.g., Caribbean Blacks and Latinos, Southeast Asians, sexual minorities) appear to show greater risk than the rest of their group members. Ethnoracial disparities in PTSD appear to be partially accounted for by disparities in trauma exposure, racial discrimination, coping style, and cultural expressive style. Ethnoracial minorities also show lower utilization of professional PTSD treatment, even though most evidence suggests that these therapies can be equally effective for all ethnoracial groups. Culturally adapted PTSD therapies have been proposed that may encourage greater utilization of evidence-based trauma treatments and thereby reduce ethnoracial disparities in PTSD.
Prolonged Exposure Therapy for Post-Traumatic Stress Disorder
Authors: Brown Lily A. , Yusko David , Tannahill Hallie , Foa Edna B.
Published: October 2018

This chapter presents an overview of prolonged exposure therapy (PE), a highly efficacious and effective treatment for post-traumatic stress disorder (PTSD). First, emotional processing theory is reviewed, which provides the theoretical basis for PE and the key mechanisms underlying PTSD symptom reduction. Next, a synthesis of the robust evidence for the efficacy and effectiveness of PE is provided. The chapter reviews evidence that in addition to ameliorating PTSD symptoms, PE reduces secondary symptoms such as depression, suicidal ideation, anger, and substance use disorders. The chapter describes evidence supporting the extension of PE with unique samples, including individuals with psychosis, persons with self-injurious behavior, and war veterans. The chapter concludes with a review of the status of PE dissemination and implementation efforts.
Psychotherapy: Cognitive Processing Therapy (CPT)
Authors: Dillon Kirsten H. , Resick Patricia A. , Monson Candice M.
Published: October 2018

This chapter discusses cognitive processing therapy (CPT), a trauma-focused, cognitive-behavioral treatment for post-traumatic stress disorder (PTSD). CPT focuses primarily on identifying and challenging maladaptive beliefs that have developed about and as a result of the trauma, in order to help the client adopt a more balanced set of beliefs. Based on its long history of research support, CPT is one of the leading evidence-based treatments for PTSD. The chapter covers the theoretical background for CPT, describes the therapy, and presents a summary of research findings. Studies of CPT across multiple populations, settings, cultures, and countries are discussed. Research on the efficacy of CPT for individuals with comorbid conditions (e.g., brain injury, personality disorders, depression) and the impact of CPT on health-related outcomes and psychosocial functioning is also presented.
Group Therapy
Authors: Sloan Denise M. , Schnurr Paula P.
Published: October 2018

There are a number of effective treatments for PTSD; however, the most highly recommended treatments are individually delivered. The literature on group treatment for PTSD has lagged considerably behind that of individual treatment. As a result, much less is known about group treatment for PTSD. This is unfortunate, as group approaches can offer a number of advantages, such as decreasing social isolation and normalizing PTSD symptoms. Moreover, despite the lack of evidence-based group therapy protocols for PTSD, group treatment is frequently used in mental healthcare settings. This chapter provides an overview of the literature on group interventions for PTSD. Characteristics of group treatment are described along with methodological considerations unique to the group format. The chapter also reviews the available efficacy data and provides clinical and research recommendations.
The Use of Antipsychotics in PTSD
Authors: Nasrallah Henry A. , Sarihan Priyanka
Published: October 2018

Psychosis is one of the manifestations of the post-traumatic stress Disorder (PTSD) syndrome. Several controlled and uncontrolled trials have been published about the efficacy and safety of second-generation antipsychotic drugs in PTSD. In this chapter, we review the various studies and provide data related to the management of psychotic symptoms in the context of PTSD. Most second-generation antipsychotic agents exert efficacy in PTSD, with varying degrees of tolerability and safety. In many cases, they may be used in combination with other medications targeting depression and anxiety, the most common symptom clusters in PTSD.
Prevention of Post-Traumatic Stress Disorder
Authors: Shalev Arieh Y. , Barbano Anna C. , Qi Wei , Marmar Charles R.
Published: October 2018

Post-traumatic stress disorder (PTSD) follows an exposure to traumatic events and as such its onset and early development are better charted then those of most other mental disorders. It is not surprising, therefore, that major efforts have been dedicated to preventing its occurrence before, during and after trauma exposure. This chapter discusses the rationale, desirability, feasibility and outcome of interventions designed to prevent PTSD. Several efficient interventions have been documented. Barriers to their early implementations, however, greatly reduce their effectiveness and require urgent attention.
Integrative Approach to Alcohol Use Disorder
Authors: Wilkens Jeff , Modir Shahla J.
Published: October 2018

Integrative medicine has the potential to augment traditional medical treatment of alcohol use disorders (as defined by the DSM-5), while also providing a basis for primary and secondary prevention of alcohol-use disorders (AUD). The chapter provides the reader with a review of the effects of alcohol on the human brain and body—including how chronic heavy alcohol use produces disproportionate changes throughout the brain that may result in the development of AUD, the influence of genetics on an individual’s sensitivity or insensitivity to alcohol, how traditional medicine balances medications that reduce craving for alcohol with psychosocial therapies, and how exercise, healthy diet, meditation, yoga, mindfulness, acupuncture, and neurofeedback may augment traditional medical treatment and contribute to primary and secondary prevention of AUD.
Integrative Approach to Stimulant-Use Disorder
Authors: Mitton Andrew , Mooney Larissa J.
Published: October 2018

SUD remains a significant public health problem with limited evidence-based treatment options available for many individuals. This chapter provides a review of integrative treatment approaches for stimulant use disorder, including current literature on evidence-based behavioral interventions, pharmacotherapy, and complementary and alternative treatments (CAM) for both cocaine and amphetamine use. Current epidemiology, physical and mental health effects, and public health impacts, of these disorders is also discussed. The chapter provides an overview of current mainstream treatments for these disorders and challenges that have been faced in developing effective treatment modalities. With the relative paucity of available traditional treatments, the chapter seeks to explore the evidence for the use of such CAM treatments as acupuncture, exercise, yoga, transmagnetic cranial stimulation (TMS), meditation, and N-acetylcysteine (NAC).
Integrative Approach to Nicotine Use Disorder
Authors: Martarano David
Published: October 2018

Smoking (tobacco use) is a the costliest and deadliest of the substance-use disorders. Smoking cessation is an industry unto itself. Alternative approaches to smoking cessation pre-date pharmacologic approaches (buproprion, varenicline, nicotine replacement) including: hypnosis, CBT, yoga, supplements, and acupuncture have been clinically validated. Other approaches, including energy healing and diet, have not demonstrated efficacy. This chapter focuses on genetics, pharmacology, physiology, and the aforementioned approaches and the relevant research of this long-standing epidemic.
Hallucinogens: Spiritual and Therapeutic Use, Overuse, and Complications
Authors: Grob Charles S.
Published: October 2018

A fascinating class of psychoactive substances possessing a long and mysterious history of human use are the classic hallucinogens. Forming a vital component of prehistorical and aboriginal culture and belief systems, hallucinogens were ultimately condemned and repressed by evolving civilizations, only to the “rediscovered” in the 20th century. Of compelling interest to anthropologists, ethnobotanists, pharmacologists, medical scientists, and mental health clinicians, their use was diverted to the general culture, particularly among youth during the politically tumultuous 1960s: it was determined to be the cause of a period of cultural upheaval associated with a perceived public health crisis. After decades of quiescence, however, the careful examination of hallucinogens under rigorous and approved research conditions has resumed. This chapter will explore the historical background, neuropharmacology, cultural use, risks of adverse events/addiction, recent renaissance of controlled research, and models for optimal use and implications for the future.
Ayurvedic Approach to Addiction
Authors: Modir Shahla J.
Published: October 2018

Ayurveda is one of the oldest systems of natural medicine in the world. Originating over 4,000 years ago, it is the root of several other branches of traditional medicine including the Chinese and Greek medical systems. The word “veda” means knowledge or science and the term “ayus” means life in Sanskrit. Thus, the term “ayurveda” means the knowledge or “science of life.” In this chapter, we review the basic principles and pathophysiology of illness from an Ayurvedic medicine perspective. We also discuss in depth the disease treatment model from an Ayurvedic perspective. Additionally, we explore the Ayurvedic view of addiction and discuss treatment approaches. Included is the use of the Ayurvedic model to describe and treat three different types of alcoholism as an illustration of varying doshic imbalances.
Traditional Chinese Medicine (TCM) and Acupuncture Approach to Addiction
Authors: Modir Shahla J. , Morris Joel
Published: October 2018

The first half of this chapter paints a broad overview of TCM (traditional Chinese medicine) with a focus on addiction. The second half details the Western studies, which address specific addictive substances. A glimpse of TCM’s history in the context of the medical models is discussed. The Western medical model is compared to and differentiated from TCM. Yin-yang and 5-element theory are detailed. The Zang Fu patterns are examined along with the principles of treatment and recognition of patterns. The 3 treasures (jing, qi, and shen) are discussed. Acupuncture was serendipitously found to be an addiction treatment with EA (electro acupuncture) and auricular points in 1972, which suggested a neuroendocrinological basis. Animal studies pointed toward involvement of different neurotransmitters in the basic mechanism of acupuncture, which are: the dopamine, GABAeric, and serotonergic systems. Most of the quality Western studies use the NADA (National Acupuncture Detoxification Association) protocols, which use 5 auricular points: shen men, kidney, liver, and lung. This protocol treats opiates, cocaine, nicotine, and AUDs. Regarding opiate detoxification, addicts assigned to the treatment groups were more consistent and more frequently attended treatment. Regarding alcohol, female participants (N = 185) who received acupuncture reported a decrease in cravings, depression, and anxiety with an increase in problem solving, when compared to controls (N = 101). There is less evidence that acupuncture is helpful for cocaine and nicotine. Acupuncture appears most helpful as an adjunct therapy, which keeps people more engaged in therapy longer, resulting in better outcomes.
Ibogaine: History, Pharmacology, Spirituality, & Clinical Data
Authors: Shapiro Benjamin
Published: October 2018

Ibogaine is an indole alkaloid derived from the African shrub Tabernathe iboga with broad anti-addictive, anti-depressant, and central nervous system stimulating effects. It is categorized as an oneriogen (or atypical hallucinogen) and has been used in West African tribal rituals for centuries. It was identified by French explorers in the early 1900s, came to the United States in the 1960s, and became marginalized in the mid-1990s after adverse outcomes halted federally funded human trials. Since then legal ibogaine treatment clinics have been established in countries without use restrictions. Ibogaine is a σ1 and σ2 receptor and μ and κ opioid receptor agonist and a α3β4 nicotinic and NMDA receptor antagonist. Decades of trials have demonstrated ibogaine’s potential. Human trials of ibogaine consistently demonstrate rapid remission of acute withdrawal symptoms but differ in their findings with regard to abstinence and toxicity. While ibogaine is not a “magic bullet,” considerable abstinence may result after multiple treatments, however QT prolongation can produce lethal ventricular tachyarrhythmias.18 MC is in pre-clinical investigation.
Integrative Approaches to Healing
Authors: Scott E. Hitchcock , Muñoz George E.
Published: October 2018

Emotional balance and stability are important aspects of long-term abstinence from non-prescribed mood altering chemicals. Labiality (extreme mood swings) can contribute to relapse. This chapter challenges the traditional concept of healing, defined as a return to prior levels of functioning. Adverse childhood experiences, with their long-term contribution to adolescent and adult mood problems are noted. Interventions for adverse childhood experiences are recommended as part of the healing journey for emotional wellness. The limitations of traditional addiction treatment are discussed, as well as various possible detractors to good emotional health and sobriety. Interventions, processes, and various counseling theoretical practices are suggested for improving mood, emotional well-being, and sobriety. Ongoing assessment and monitoring of emotional well-being and relapse risk are critical. The quality of the relationship between the practitioner and patient is crucial in order to co-create a viable, individualized, holistic treatment plan.
Integrative Approaches to the Management of Chronic Pain and Substance Abuse
Authors: Pujol Lynette M. , Herbert Bettina , Geppert Cynthia M. A. , Cardon Karen E.
Published: October 2018

The complexity of pain and addiction is a challenging clinical problem to address. Approaching the treatment of addiction and pain requires a holistic interpretation of a patient, understanding the psychological as well as biological mechanisms involved in both conditions. Given these facts, an interface has been created in this chapter of 2 phenomenal approaches to pain focused in both the psychiatric and mechanistic pain models. The result is a well-rounded and comprehensive view on how to approach pain in the integrative format for patients with addiction. When to consider different conventional and integrative modalities is reviewed including their evidence base. The role of personality, pain perception, and cognitions are all examined. The full array of integrative approaches including mind-body interventions, guided imagery, CBT, hypnosis, spirituality, mindfulness and postural techniques, manipulation, yoga, Tai chi and TCM are all discussed.
The Future of Addiction and Recovery Healing Arts
Authors: Modir Shahla J. , Muñoz George E.
Published: October 2018

This chapter peers into the future of addiction treatment. It begins with an exploration of repetitive transcranial magnetic brain stimulation or rTMS as a treatment for SUD. The evidence and clinical data is reviewed. Findings include outcome data on the use of rTMS. Furthermore, important brain regions central to the development of SUD are examined: the ventral tegmental area and ventral striatum appear to play a central role in the binge/intoxication stage, the extended amygdala in the withdrawal/negative affect stage, and the orbitofrontal cortex-dorsal striatum, prefrontal cortex, basolateral amygdala, hippocampus, and insula in craving. The role of genomics and gene-wide associations to deliver future personalized addiction treatments is discussed as is advanced functional neural imaging. Technology for patients and consumers, including relapse prevention apps and bidirectional biometric reading is mentioned. Breakthroughs in addiction immunology, both generalized and substance specific, are discussed as potential points of future study and interventions.
NMDA Receptor Antagonists, Gabapentinoids, Alpha-2 Agonists, and Dexamethasone
Authors: Feng Alexander J. , Chien George C. Chang , Kaye Alan D.
Published: October 2018

Surgical pain is a major obstacle in the recovery of patients. Effective pain management is of upmost importance to optimize a patient’s recovery, decrease medical complications, and increase patient satisfaction. Traditional pain management with opioids and nonsteroidal anti-inflammatory drugs have significant side effect profiles leading to medical complications or insufficient pain management from reluctance of use. Adjuvant analgesic can provide improved pain management with significantly less side effect profile. In addition, the clinician can, with synergistic effects of adjuvant medications, lower the total dosages used, thus lessening the likelihood of the side effects that occur when medications are used alone at a higher dosage. This chapter presents several adjuvant analgesics—NMDA receptor antagonists, gabapentinoids, alpha-2 agonists, and dexamethasone—and evidence for their use. Ultimately, through the use of traditional pain management options along with adjuvant analgesics, the effectiveness of acute pain management can be increased while adverse outcomes are reduced and functional recovery and quality of life improved.
Pain Management in Breast Surgery
Authors: Bogue Jarrod T. , Rohde Christine H.
Published: October 2018

Plastic surgeons frequently perform surgery on the breasts, for both cosmetic and reconstructive purposes. Pain after breast surgery can be a significant issue and is often a source of great concern for patients. Conventional pain control methods rely on opioid pain medications. These medications are plagued by side effects and contribute to opioid misuse, addiction, and abuse. Novel pain control regimens utilizing nonopioid alternatives are paramount to stemming the use of opioids while providing adequate postoperative pain control. Choices for pain control in patients undergoing breast surgery include, but are not limited to, local analgesia, regional blocks, nonpharmacologic options, enhanced recovery protocols, tumescent techniques, and cognitive-behavioral therapies. Multimodal approaches taking advantage of these nonopioid analgesic options are available and evidence-based.
Postoperative Pain Management
Authors: Chen Q. Cece , Zou Shengping
Published: October 2018

Postoperative pain management is an important aspect of caring for a surgical patient as inadequate pain control can be associated with increased morbidity and mortality. Failure to effectively control postoperative pain is often due to poor communication and poorly coordinated care between the care teams, poor communication with the patient, insufficient education, unrealistic expectations, fear of complications from the pain regimen, inaccurate pain assessment, and limited effective pain treatment modalities. An effective pain management can therefore lead to improved patient comfort, satisfaction, earlier ambulation, faster recovery time, decreased hospital stay and cost of care, and reduced postoperative complications.
Prevention of Adverse Effects in Perioperative Pain Management for General and Plastic Surgeons
Authors: Krashin Daniel , Murinova Natalia , Kaye Alan D.
Published: October 2018

Postoperative pain management is a key part of perioperative care. Inadequately controlled pain contributes to poor outcomes and patient satisfaction. Overmedication with opioids for postoperative pain also leads to complications and slows recovery. Perioperative pain care starts with thorough evaluation at the preoperative visit. Multimodal pain treatment reduces the reliance on opioids and tends to improve outcomes. Many complicating factors, including pregnancy, comorbid psychological and medical conditions, addiction, and chronic opioid therapy need to be identified and addressed in a personalized pain plan. Complications including delirium and opioid-induced respiratory suppression are also discussed.
New Vistas in Perioperative Pain Management
Authors: Furnish Timothy , Said Engy
Published: October 2018

The chapter “New Vistas in Perioperative Pain Management” provides an overview of analgesics for acute pain that have been recently introduced and that are in development as well as a discussion of enhanced recovery after surgery (ERAS) programs that make use of multimodal analgesic regimens. It reviews the innovation in analgesics that has focused on new formulations and uses of older compounds including oral, intravenous, and transmucosal agents. It describes the potential role of mu-opioid g-protein modulators as novel opioids with an improved adverse effect profile as well as a novel opioid with the potential for lower abuse potential. It also explains the use of analgesic regimens and pathways in ERAS programs to reduce recovery times and length of hospital stays.
Challenges of Anesthesia Outside of the Operating Room
Authors: Gross Wendy L. , Urman Richard D.
Published: October 2018

As health care bears the simultaneous burdens of rapid technological development and increasing financial constraints, there has been significant increase in the number and types of procedures performed outside of the operating room. The broadening scope and complexity of noninvasive procedures, along with increasing acuity of patients, often make deeper sedation, general anesthesia, and robust hemodynamic monitoring both necessary and challenging. Anesthesiologists are more frequently called upon to provide care for medically complex patients undergoing novel, unfamiliar procedures in nontraditional locations. As technology advances, the number of procedure areas and the need for anesthesia services proliferates. The landscape of anesthesiology, therefore, is changing; new challenges and opportunities have emerged. This chapter provides an overview of these challenges, including assessing locations, equipment considerations, integrating care teams, safety guidelines, preprocedural patient evaluation and postprocedure care, commonly encountered problems, and financial considerations.
Anesthetic Techniques
Authors: Grech Dennis , Hausman Laurence M.
Published: October 2018

Anesthetic techniques for procedures performed outside the traditional operating room are varied. General anesthesia, sedation, and regional anesthesia can all be delivered in this venue. The choice of technique is based on safety considerations and patient comorbidities. Perioperative monitoring such as pulse oximetry, end-tidal carbon dioxide monitoring, and electrocardiography and blood pressure monitoring protocols must be consistent with American Society of Anesthesiologists guidelines. Common procedures include elective office-based anesthetics, emergency room sedations, endoscopic retrograde cholangiopancreatographies in the gastroenterology suite, and minimally invasive interventions in the radiology department. Because most of these locations have limited postanesthesia care unit capabilities, the patient’s rapid return to baseline functioning and the ability to be discharged quickly, safely, and comfortably are important goals. Thus, anesthetic technique and the pharmacokinetics and pharmacodynamics of the anesthetics, analgesics, antiemetics, and local anesthetics are of utmost importance.
Anesthesia Information Management Systems (AIMS) for the OOOR Setting
Authors: Ruskin Keith J. , Gottlieb Ori
Published: October 2018

Anesthesia information management systems (AIMS) offer significant benefits to an anesthesiologist who practices beyond the operating room. AIMS systems have the potential to improve patient care because they deliver a customized, legible anesthesia record while storing the patient’s physiologic data in an easily searchable database. An electronic workflow allows the anesthesiologist to focus on patient care while facilitating tasks such as quality assurance, compliance, research, and billing.
Outcomes, Regulation, and Quality Improvement
Authors: Metzner Julia , Domino Karen B.
Published: October 2018

To improve the safety of patients undergoing procedures in remote locations, practitioners should be familiar with rigorous continuous quality improvement systems, national and regulatory patient safety efforts, as well as complications related to anesthesia/sedation in out of the operating room (OOOR) settings. This chapter discusses severe outcomes and mechanisms of injury in OOOR locations, national patient safety and regulatory efforts that may be adapted to the OOOR setting, and quality improvement efforts essential to track outcomes and improve patient safety. Patient safety can be improved by adherence to respiratory monitoring (e.g., pulse oximetry and capnography), sedation standards/guidelines and national patient safety and regulatory efforts, and development of vigorous quality improvement systems to measure outcomes and make changes.
Gastrointestinal Endoscopy Procedures
Authors: Gromski Mark A. , Matthes Kai
Published: October 2018

A vast array of gastrointestinal endoscopic procedures are performed routinely that vary from the very common screening colonoscopy to such highly specialized procedures as endoscopic submucosal dissection or per oral endoscopic myotomy. Gastrointestinal endoscopic procedures may be performed in various settings, including outpatient endoscopy/surgery centers, the emergency room, intensive care units, or hospital operating rooms. It is essential to be aware of the components of each procedure, the stimulating components of each procedure (which will interplay with the need for a plan for sedation), and the potential complications of each procedure. This chapter provides essential background information for most of the routinely encountered endoscopic procedures that may be useful to help plan for safe care of the patient during and after the procedure.
Anesthesia for Gastrointestinal Endoscopic Procedures
Authors: Barton Lori Kral , Fragneto Regina Y.
Published: October 2018

As the population ages, patients presenting for endoscopic procedures are more likely to have significant comorbidities. In addition, endoscopic procedures of increasing complexity are being performed. While there are significant differences among geographic regions in the United States, anesthesia care providers are providing sedation or general anesthesia for a greater proportion of procedures performed in the endoscopy suite. A variety of drugs and anesthetic techniques have been used successfully. Propofol remains the most commonly used drug when sedation is provided by an anesthesia professional, sometimes as a sole agent and sometimes in combination with other medications. Dexmedetomine and ketamine have also been used successfully. Patient characteristics and the specific needs of the endoscopist based on the procedure being performed will determine the most appropriate anesthetic regimen for each patient. For more complex endoscopic techniques, general anesthesia may be preferred, with some data indicating improved success of the procedure.