bluuebunny/crossref_metadata_2025 huggingface dataset:
The Meanie Club – Gendered violence and post-punk narratives of love in Miss Farkku-Suomi by Kauko Röyhkä and Dorfpunks by Rocko Schamoni
Authors: Gratzke Michael
Published: August 2019

This article examines love, relationships, intimacy and gendered violence in fictionalized punk biographies by authors and post-punk recording artists Kauko Röyhkä and Rocko Schamoni. Punk rock’s DIY aesthetic emphasizes self-fashioning and shock value. Where mainstream impression management, in the sense of Goffman’s micro-sociology, aims at hiding one’s ‘stigma’ in the presentation of the self, punk makes the individual’s ‘stigma’ the main feature of self-fashioning. This attitude is at odds with the ways in which the lover, in particular the Barthesian wretched lover, seeks to appear as attractive to the object of their affection. Miss Farkku-Suomi (‘Miss Denim Finland’, 2003) and Dorfpunks (‘Village Punks’, 2004) tell similar stories of transgressive self-fashioning leading to a re-instatement of hegemonic masculinity and heteronormative love narratives. This article contextualizes these findings regarding male punk writing by comparing them to the autobiography of female punk musician and writer Viv Albertine.
How Can We Explain Regime Type Differences If Citizens Don't Vote Based on Foreign Economic Policy?
Authors: Bearce David H , Velasco-Guachalla V Ximena
Published: August 2019

Political economy research shows that more democratic governments generally have more open trade policies with more flexible exchange rate regimes, yet political behavior theory argues that citizens do not think of foreign economic policy as salient and do not cast their votes considering such issues. This note investigates the puzzle about how democracies could have different foreign economic policies than autocracies if citizens do not vote based on these international issues. Using a political model with two possible ways for societal actors to influence state policy (electoral and/or special interest pressure), it first considers how voting based on salient domestic outcomes like inflation and unemployment may lead democratic governments towards more open trade and flexible exchange rates. Second, if more societal groups are able to lobby as special interests in more democratic regimes, then governments may also be pushed toward these same foreign economic policies. Thus, there is no fundamental contradiction between the political economy empirical results and the political behavior theory, although scholars need to adjust their theories to explain foreign economic policy differences across political regime type.
Rates of Adverse IBD-Related Outcomes for Patients With IBD and Concomitant Prostate Cancer Treated With Radiation Therapy
Authors: Feagins Linda A , Kim Jaehyun , Chandrakumaran Anchalia , Gandle Cassandra , Naik Katrina H , Cipher Daisha J , Hou Jason K , Yao Michael D , Gaidos Jill K J
Published: August 2019

Background

Patients with inflammatory bowel disease (IBD) may be at higher risk for complications from radiation treatment for prostate cancer. However, available data are limited, and controversy remains regarding the best treatment approach for IBD patients who develop prostate cancer.

Methods

A retrospective cohort study across 4 Department of Veterans Affairs hospital systems. Patients with established IBD who were diagnosed and treated for prostate cancer between 1996–2015 were included. We assessed for flares of IBD, IBD-related hospitalizations, and IBD-related surgeries within 6, 12, and 24 months of cancer diagnosis and survival at 1, 2, and 5 years. Flares of IBD were those documented as such by the treating physician, and treatment changed accordingly.

Results

One hundred patients with IBD and prostate cancer were identified. Forty-seven were treated with either treatment with external beam radiation or brachytherapy, and 53 were treated with nonradiation modalities. Comparing cohorts with or without radiation treatment, there were no differences in baseline IBD characteristics, Charlson comorbidity index, or prostate cancer stage. Inflammatory bowel disease flares were 2-fold higher for radiation-treated patients within 6 months (10.6% vs 5.7%) and 6–12 months (4.3% vs 1.9%) after cancer diagnosis. On multiple logistic regression analysis, radiation treatment (adjusted odds ratio, 4.82; 95% confidence interval, 1.15–20.26) was a significant predictor of flares. However, rates of IBD-related hospitalizations or surgeries were not significantly different.

Conclusions

In this retrospective, multicenter study, 2-fold higher rates of flare were found within the first year after prostate cancer diagnosis for patients treated with radiation, but there were no differences in IBD-related hospitalizations or surgeries. Although patients should be counseled of these risks, avoidance of radiation therapy in IBD patients with prostate cancer is likely not necessary.
Is Endoscopic Remission in Ulcerative Colitis Still Good Enough?
Authors: Bhattacharya Sumona , Cross Raymond K
Published: August 2019

Histology is a treatment target for investigational agents. Histologic activity predicts relapses and increased risk of colorectal neoplasia. Recent studies demonstrated that the proportion of patients achieving histologic improvement is low. Research is needed before providers treat to histologic remission.
A duty of care to prevent online exploitation of consumers? Digital dominance and special responsibility in EU competition law
Authors: Sauter Wolf
Published: August 2019

Article 102 Treaty on the Functioning of the European Union imposes a special responsibility on undertakings with a dominant position. Digital dominance based on data but also on network effects, platforms, and first user advantage can lead to extreme inequality in bargaining positions with regard to online services, which can result in unfair treatment of competitors, suppliers, and consumers—such as exploitation and discrimination. Online consumers are the focus of this article. In order to tackle competition issues regarding online consumers, I propose interpreting the special responsibility of digitally dominant undertakings as a duty of care in their regard. Digitally dominant undertakings may not just be burdened by but also benefit from this approach, which increases predictability and trust in online markets. It resembles treating online undertakings as information fiduciaries as has been proposed in the USA, but is different because privacy is not the driving concern here and the context is that of antitrust. I look at standards for triggering the duty of care and make proposals for the application of this norm, but both remain to be specified further.
Saving Your Self: How Identity Relevance Influences Product Usage
Authors: Sheehan Daniel , Dommer Sara Loughran
Published: August 2019

Although research has consistently demonstrated that people prefer to purchase products and brands that represent their identity, relatively little research has examined how this identity relevance influences product usage. Drawing from work on intertemporal choice, the present work proposes a conceptual framework for the influence of identity on product usage. The authors theorize and demonstrate an identity conservation effect, in that consumers are less likely to use nondurable identity products compared to nonidentity products because the tradeoff between possession value and in-use value is larger for identity products. Six studies demonstrate the identity conservation effect and provide support for the value tradeoff framework through both mediation and theoretically supported moderation.
Geography and State Fragmentation
Authors: Kitamura Shuhei , Lagerlöf Nils-Petter
Published: August 2019

Some of the richest places in the world have very high historical border presence, and are often located in particular geographic environments. In this paper we compile grid-cell level data on borders between sovereign states in Europe and surrounding areas from 1500 until today to document that state borders tend to be located in rugged and mountainous terrain, by rivers, and where it rains a lot. Moreover, two commonly used measures of economic activity—night lights and population density—are higher in cells with more borders, in particular more stable borders. This result holds also when controlling for geography. However, by the same metric, cells with more borders than neighboring cells are less developed than those neighbors. These patterns are consistent with a theory in which state competition benefits long-run development, but these benefits accrue more to the center than the periphery of states.
Independent Validation of EarlyR Gene Signature in BIG 1-98: A Randomized, Double-Blind, Phase III Trial Comparing Letrozole and Tamoxifen as Adjuvant Endocrine Therapy for Postmenopausal Women With Hormone Receptor–Positive, Early Breast Cancer
Authors: Buechler Steven A , Gray Kathryn P , Gökmen-Polar Yesim , Willis Scooter , Thürlimann Beat , Kammler Rosita , Viale Giuseppe , Leyland-Jones Brian , Badve Sunil S , Regan Meredith M
Published: August 2019

Background

EarlyR gene signature in estrogen receptor–positive (ER+) breast cancer is computed from the expression values of ESPL1, SPAG5, MKI67, PLK1, and PGR. EarlyR has been validated in multiple cohorts profiled using microarrays. This study sought to verify the prognostic features of EarlyR in a case-cohort sample from BIG 1–98, a randomized clinical trial of ER+ postmenopausal breast cancer patients treated with adjuvant endocrine therapy (letrozole or tamoxifen).

Methods

Expression of EarlyR gene signature was estimated by Illumina cDNA-mediated Annealing, Selection, and Ligation assay of RNA from formalin-fixed, paraffin-embedded primary breast cancer tissues in a case-cohort subset of ER+ women (N = 1174; 216 cases of recurrence within 8 years) from BIG 1–98. EarlyR score and prespecified risk strata (≤25 = low, 26–75 = intermediate, >75 = high) were “blindly” computed. Analysis endpoints included distant recurrence–free interval and breast cancer–free interval at 8 years after randomization. Hazard ratios (HRs) and test statistics were estimated with weighted analysis methods.

Results

The distribution of the EarlyR risk groups was 67% low, 19% intermediate, and 14% high risk in this ER+ cohort. EarlyR was prognostic for distant recurrence–free interval; EarlyR high-risk patients had statistically increased risk of distant recurrence within 8 years (HR = 1.73, 95% confidence interval = 1.14 to 2.64) compared with EarlyR low-risk patients. EarlyR was also prognostic of breast cancer–free interval (HR = 1.74, 95% confidence interval = 1.21 to 2.62).

Conclusions

This study confirmed the prognostic significance of EarlyR using RNA from formalin-fixed, paraffin-embedded tissues from a case-cohort sample of BIG 1–98. EarlyR identifies a set of high-risk patients with relatively poor prognosis who may be considered for additional treatment. Further studies will focus on analyzing the predictive value of EarlyR signature.
Part I How Section 4 Works, 1 Section 4 Basics
Authors: Brian C Kalt
Published: August 2019

The text of Section 4 of the Twenty-Fifth Amendment is dense and requires careful unpacking. Section 4 allows a president to be displaced from power if the Vice President and a majority of the Cabinet declare that he is unable to discharge his powers and duties. The text then provides for the President to return to power. If the Vice President and Cabinet oppose his attempt, Congress is empowered to resolve any disputes. All of this is subject to specific procedural requirements and time limits. This chapter presents all of these details in both bullet-point form and with a comprehensive flowchart.
Introduction
Authors: Green Ronald M. , Little George A.
Published: August 2019

There is evidence that religious beliefs strongly influence families’ treatment decisions about their loved ones, especially when difficult life-and-death choices must be made. This becomes important in the context of neonatal intensive care units (NICUs) committed to family-centered care because families’ beliefs will influence their decision making. To assist NICU professionals, families, and students of bioethics, the chapters in this book seek to address the question, “What are the teachings of the world’s major religious traditions about the status and care of the newborn?” This introduction presents six “take-home” insights derived from the discussions that follow.
Muslim Biomedical Ethics of Neonatal Care
Authors: Ayubi Zahra
Published: August 2019

This chapter outlines Muslim ethics and practices surrounding the birth, care, and death of neonates, with special attention to gender dynamics in Muslim families. In the absence of unified Islamic law-making bodies that decide on issues of biomedical ethics, it is crucial to explore questions of authority over decision making, which is often a highly gendered issue. The central questions that arise in neonatal cases are: When is it appropriate to withdraw treatment? What rituals surround the births and deaths of neonates? and Who has the authority to make decisions? The author divides Muslim practices into two main paradigms: those based on scripturally dependent beliefs and those based on ritually dependent beliefs. It is important for medical practitioners to be aware of gendered concerns and differences between ethicolegal theory and ethical praxis in decision making in neonatal care. Muslim beliefs and practices cannot be reduced to texts.
How Age-Old Cultural Tenets Complicate the Care of Premature or Sick Navajo Newborns
Authors: Schwarz Maureen Trudelle
Published: August 2019

Each of the hundreds of indigenous groups in Native North America has its own beliefs about the body, personhood, health, and illness, which directly influence care and treatment of premature and sick newborns. This chapter is limited to how members of the Diné Nation (more commonly known as the Navajo) think about these issues. Differences of opinion invariably exist between biomedical practitioners’ and Navajo family members’ understandings of the causes, treatments, and appropriate care for the child. Several factors will be at play: among them are differences acknowledged between Navajo and non-Navajo people; notions of contamination; and medical and religious pluralism. Also relevant are numerous age-old Navajo tenets on the body and personhood, including relational notions of personhood; beliefs about how detached body parts retain lifelong influence; assumptions regarding the malleability of a newborn’s body; prohibitions against cardiopulmonary resuscitation and blood transfusions; and convictions about the power of language.
Seventh-Day Adventists and Care for the Newborn
Authors: Winslow Gerald R.
Published: August 2019

As a practical expression of their faith, Seventh-day Adventists have established healthcare institutions, including facilities for the intensive care of newborn infants. This chapter provides a brief history of Adventist engagement in health care and seeks to explain how core Adventist convictions provide the motivation for providing such care and shape the way it is given. The chapter also describes how Adventist beliefs may affect the ways in which Adventists or their family members receive health care. This includes beliefs in divine creation, human wholeness, freedom of conscience, spiritual commitment to health, and worldwide mission. Adventists believe that, by the Creator’s design, each person is a spiritual and physical unity. Using the example of a specific case of neonatal intensive care, the chapter explores how Adventist convictions are likely to support and inform caregiving and care receiving. Also described are Adventist principles for end-of-life care.
Renal Function in Critically Ill Patients
Authors: Guru Pramod K.
Published: August 2019

Renal function serves as a window into the homeostasis of internal organs, and multiple organ system failure can occur in critically ill patients irrespective of the initial site of insult. Therefore, essential knowledge of renal pathophysiology is crucial in the diagnostic approach and management of critically ill patients. Close interaction between the kidney and other vital organs such as the heart, lungs, and brain is primarily responsible for the morbidity and mortality among critically ill patients. Pathologic renal changes can manifest in various conditions, such as acute kidney injury (AKI), chronic kidney disease, glomerulonephritis, fluid-electrolyte imbalances, and nephrotic syndrome.
Consequences of Acute Metabolic Changes to the Brain
Authors: Braksick Sherri A. , Hocker Sara E.
Published: August 2019

Acute hypertension is a common clinical problem that accounts for almost 25% of emergency department visits in the United States. It can occur in patients who have preexisting hypertension or in patients who were previously normotensive. This chapter provides an overview of cerebral autoregulation and the mechanisms of action and side effect profiles of different antihypertensive medications used to treat acute hypertension.
Consequences of Acute Hypertension to the Brain
Authors: Oshel Katherine M. , Wadei Hani M.
Published: August 2019

The components of consciousness are classically separated into 2 major groups: level of alertness (being awake) and content of thinking (being aware). Major acute neurologic disorders affect both components. These 2 components are interrelated but sometimes dissociated. Coma is often due to an extensive structural (anoxic-ischemic) injury or to diffuse physiologic dysfunction (eg, intoxication, seizures, or acute metabolic derangement).
Coma and Other Altered States of Consciousness
Authors: Wijdicks Eelco F. M.
Published: August 2019

Regardless of its cause, acute neuromuscular respiratory weakness leads to alveolar hypoventilation. Additional features that complicate the clinical presentation are upper airway muscle weakness and pulmonary complications (mostly due to aspiration). Having an understanding of basic ventilatory physiology and the pathophysiologic mechanisms underlying mechanical neuromuscular respiratory failure is essential for early recognition, initial evaluation, and further etiologic investigation of neuromuscular respiratory failure. Besides allowing for targeted treatment, identifying the cause has prognostic implications.
Neuromuscular Respiratory Failure
Authors: Hawkes Maximiliano A. , Wijdicks Eelco F. M.
Published: August 2019

Breathing is a continuous, rhythmic, to-and-fro movement that requires a close interplay between arterial PCO2, oxygen, and respiratory centers. Certain thresholds exist for respiratory drive, and these thresholds change with acute neurologic disease. Primary structural lesions to the brainstem are most common, but decreased levels of consciousness frequently trigger episodic breathing. This chapter discusses the essentials of the respiratory pacemaker and neurologic breathing patterns.
Neurogenic Breathing Patterns
Authors: Wijdicks Eelco F. M.
Published: August 2019

Abnormalities of cardiac function and cardiac electrophysiology are not uncommon in patients with acute injury to the central nervous system, and cardiac abnormalities may be the initial signs when these patients are first evaluated. Some patients have findings that suggest an acute coronary syndrome but disappear after the intracranial pressure surge subsides. The clinician must consider underlying neurologic disease when a patient presents with cardiac arrhythmias, new-onset pulmonary edema, hypotension, or cardiogenic shock with characteristics atypical for a primary cardiac event if the patient is in an otherwise unexplained comatose state.
Vascular Emergencies of the Aorta
Authors: Almerey Tariq , Moore January F. , Farres Houssam
Published: August 2019

Many serious conditions require emergent vascular intervention, but the most challenging conditions that typically require admission to an intensive care unit are ruptured abdominal aortic aneurysm (AAA) and acute aortic syndrome (ie, aortic dissection, intramural hematoma, and penetrating ulcers).
Pituitary Apoplexy
Authors: Braksick Sherri A.
Published: August 2019

Pituitary apoplexy is infarction of the pituitary gland by hemorrhage or ischemia. Although pituitary apoplexy is rare, it is a neurologic emergency and sometimes a neurosurgical and endocrine emergency that require rapid intervention to prevent severe and potentially life-threatening adrenal insufficiency, hydrocephalus, intracranial hemorrhage, or ischemic stroke.
Adrenal Insufficiency in Neurocritically Ill Patients
Authors: Venegas-Borsellino Carla P. , Naranjo-Sierra Santiago
Published: August 2019

The hypothalamic-pituitary-adrenal (HPA) axis is a complex system that equilibrates blood levels of glucocorticoid hormones. Cortisol levels are dynamic and normally fluctuate in response to constant feedback; functional deficiency in this system results in adrenal insufficiency (AI). An elevated corticosteroid level is needed as a protective response to stress during acute illness or major surgery, but corticosteroid secretion can be altered by splanchnic and central nervous system influence, fever, acidosis, and proinflammatory cytokines. Critical illness–related corticosteroid insufficiency (CIRCI) is a relatively insufficient HPA response; often encountered in critical care patients, it can worsen outcomes.
Disseminated Intravascular Coagulation: Clinical Diagnosis and Management
Authors: Vishnu Prakash , Ailawadhi Sikander
Published: August 2019

Disseminated intravascular coagulation (DIC) is a phenomenon with the potential for causing thrombosis and bleeding. DIC, typically occurring in patients with critical illness, can manifest as an acute, life-threatening emergency or as a chronic, subclinical process depending on the influence of morbidity from the underlying cause. The presence of DIC increases the risk of mortality by twofold in patients with trauma and severe sepsis and is an independent predictor of mortality. The pathogenesis of DIC is not only related to abnormal coagulation activation and platelet consumption but also involves multiple mechanisms of the inflammatory system and innate immunity.
Sepsis and Septic Shock
Authors: Sims Charles R. , Comfere Thomas B.
Published: August 2019

Sepsis is the most common cause of admission to the intensive care unit (ICU). Although its incidence has increased during the past decade, its short-term mortality has decreased. Furthermore, organ dysfunction caused by dysregulated host immune response to infection resulting in systemic hypoperfusion and end-organ dysfunction is associated with long-term outcomes including frequent morbidity (secondary infections, hospital readmission, decreased quality of life) and mortality in the ICU.
Carotid Artery Disease
Authors: Mbabuike Nnenna , Tawk Rabih G.
Published: August 2019

Carotid artery disease is a common source of ischemic stroke due to ulcerated or hemorrhagic plaque. Risk factors for carotid artery disease include typical atherosclerotic disease risk factors, such as smoking, hyperlipidemia, and diabetes mellitus. This chapter reviews the diagnostic approach to symptomatic carotid artery disease (including stroke and transient ischemic attacks), the overall management approach for symptomatic carotid artery disease (including endovascular and open carotid endartectomy), and medical management options for asymptomatic carotid artery disease. Perioperative management after carotid artery intervention is discussed.
Traumatic Brain Injury and Spinal Cord Injury
Authors: Babu Maya A.
Published: August 2019

Traumatic brain injury (TBI) is one of the most common global disorders leading to neurologic morbidity, especially in the young. Spinal cord injury (SCI) can also occur with trauma and lead to paraparesis, tetraparesis, or paralysis with lifelong disability. This chapter reviews TBI and SCI risk factors, the initial approach to management and stabilization, and recent guidelines.
Guillain-Barré Syndrome
Authors: Wijdicks Eelco F. M.
Published: August 2019

The incidence of Guillain-Barré syndrome (GBS) is about 1 case per 100,000 per year, but it is twice that in elderly persons. Multiple antecedent events have been reported. GBS can become a major neurocritical illness. Admission to the intensive care unit is expected in 1 of 5 patients with GBS. Rapidly progressive limb weakness may extend to the oropharyngeal muscles or diaphragm, an effect that often leads to intubation and mechanical ventilation. Outcome in GBS is nearly always good, and severe disability remains in only a minority of affected patients.
Status Epilepticus
Authors: Robinson Christopher P. , Hocker Sara E.
Published: August 2019

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting longer than 5 minutes or recurrent seizure activity without return to baseline between events. Several classifications exist. The Neurocritical Care Society recommends a simplified classification in which SE is dichotomized as convulsive or nonconvulsive, with nonconvulsive status epilepticus further stratified as focal or generalized.
Demyelinating Disorders of the Central Nervous System
Authors: Smith Aurelia A. , Weinshenker Brian G.
Published: August 2019

Patients with central nervous system (CNS) inflammatory demyelinating disease (IDD) usually have acute relapses of neurologic symptoms that frequently remit spontaneously or after corticosteroid administration; they may also present with a progressive neurodegenerative condition, either de novo or after 1 or more acute relapses. Most patients with acute relapses of demyelinating disease do not have severe disability and can be treated as outpatients. Most hospitalizations for patients with multiple sclerosis (MS), for instance, are for reasons unrelated to MS, such as infection. However, patients with CNS IDD occasionally present with serious, emergent complications caused directly by CNS inflammation or indirectly by secondary complications, either of which can require critical care management.
Autoimmune Encephalitis
Authors: Shosha Eslam , Pittock Sean J.
Published: August 2019

Autoimmune encephalitis is an increasingly recognized, life-threatening disorder that, because of its variable clinical presentations, poses a diagnostic challenge in the intensive care setting. Patients with autoimmune encephalitis often need to be in an intensive care unit for management of life-threatening complications commonly related to multifocal nervous system involvement that includes status epilepticus, cognitive decline and behavioral changes, psychosis, and autonomic instability.
Intensive Care After Spinal Surgery
Authors: Watridge Clarence B.
Published: August 2019

Spinal surgery is a relatively common surgical procedure in the United States. More than 600,000 spinal operations are performed each year, and many are performed as outpatient procedures. Although only a small percentage of spinal surgery patients require intensive care unit (ICU) admission, spinal surgery does carry a risk of death. In addition, the neurologic recovery is often limited by the nature of the condition, and surgical outcomes can be adversely affected postoperatively.
Ultrasonography
Authors: Naranjo-Sierra Santiago , Ng Tucker Lauren K.
Published: August 2019

Ultrasonography is the use of sound waves to create images and is used mainly for diagnostic purposes and for real-time guidance during procedures. Point-of-care ultrasonography is widely used in fields such as anesthesia, critical care, and emergency medicine, in which it is becoming an important part of the current standard of care because of its ability to provide accurate visual information about a patient, either to rapidly evaluate clinical status or to provide guidance for procedures, without requiring transfers to other areas. For patients in an intensive care unit, focused ultrasonography has been reported to result in management changes in more than 50%.
Transesophageal Echocardiography
Authors: Craner Ryan C. , Mookadam Farouk , Ramakrishna Harish
Published: August 2019

The use of ultrasound has revolutionized care in the intensive care unit (ICU). The use of critical care echocardiography, including transthoracic echocardiography (TTE), has become commonplace in ICUs worldwide. In North America, however, intensivists rarely perform transesophageal echocardiography (TEE) unless they have anesthesiology training or have received specialized training to be competent in TEE. In many centers, neurology critical care is provided within the general ICU, and many tertiary-care centers have a dedicated ICU for specialized cases that require advanced and intensive neurologic care.
Diagnostic and Interventional Bronchoscopy in the Intensive Care Unit
Authors: Keller Cesar A.
Published: August 2019

Shigeto Ikeda in Japan developed fiberoptic bronchoscopy (FOB), beginning a revolution in the diagnosis and treatment of diverse pulmonary conditions. FOB evolved with additional diagnostic and interventional tools. FOB has become an essential bedside tool for diagnosis and management in critically ill patients. FOB is safe, even in patients with respiratory failure and, if done cautiously, in patients with increased intracranial pressure.
Electroencephalography
Authors: Crepeau Amy Z.
Published: August 2019

Electroencephalography (EEG) in critically ill patients allows for monitoring of cerebral function when a clinical examination is limited because of altered mental status or coma. Continuous EEG (cEEG) has increasingly been used to monitor critically ill patients in the intensive care unit (ICU). Implementation of cEEG in the ICU presents a unique set of challenges, requiring special expertise and a multidisciplinary approach.
Effects of Targeted Temperature Management on Drugs
Authors: Ng Tucker Lauren K.
Published: August 2019

Hypothermia therapy, better known as targeted temperature management (TTM), has increased in popularity in the past several years and has only proven benefits in the setting of cardiac arrest. It has been unsuccessful or not sufficiently proven in traumatic brain injury,bacterial meningitis, cerebral hemorrhage and ischemic stroke. TTM has been shown to decrease intracranial pressure and is used in the management of refractory intracranial pressure despite recent evidence suggesting harm.
Communicating With Families
Authors: Ingram Cory
Published: August 2019

Professionalism guides how intensivists provide care, and communicating effectively is a core principle of professionalism. Communicating with families is common in intensive care units because patients may be in extremis or unable to understand their critical illness. Interpersonal and communication skills are core competency areas at all levels of medical training and practice. The Accreditation Council for Graduate Medical Education included interpersonal and communication skills as a general competence, and the American Board of Medical Specialties endorsed the same competencies for practicing physicians. Nonetheless, a physician must rely on experience to recommend certain options to patients’ families, guide them toward understanding, and proceed with the best professional choice.
Ethical Concerns and Care Before Organ Donation
Authors: McLaughlin Diane C. , Ng Tucker Lauren K.
Published: August 2019

Organ donation usually proceeds smoothly and compassionately without raising any ethical concerns, and the involved family members are usually very satisfied. When concerns do arise, they typically involve 3 issues: consent for organ donation, critical care of the potential organ donor with brain death, and donation after cardiac death.
Traditional Media
Authors: Schraeder Terry L.
Published: August 2019

Physicians who participate in the media may perform an important public health service for their communities. Physicians who understand the media (and their influence) may decide to engage and work with the press to inform society on a variety of issues in medicine. Physicians have access to information and knowledge as well as experience, a perspective and a point of view valuable to the public. They have something to say and something to teach the public because they do it every day in their practice, in their profession, and with their patients. Improving their understanding of reporters’ roles, responsibilities, and professional guidelines, along with an overview of the world of medical journalism, may help reduce physicians’ anxiety and potentially help them relate to journalists and interact with the press. Physicians will want to learn important guidelines from the American Medical Association and other organizations regarding their involvement with the media, whether writing a news article or being interviewed on television. This chapter includes the “what, why, how, when, and where” regarding all of the information and advice physicians need before working with or in traditional media.
Medical Management of Patients with Subarachnoid or Intracranial Hemorrhage and Increased Intracranial Pressure
Authors: Sweid Ahmad , Jabbour Pascal M. , Rahm Sage P. , Tjoumakaris Stavropoula , Gooch M. Reid , Rosenwasser Robert H.
Published: August 2019

Intracranial hemorrhage requires an understanding of etiology and prompt management for an improved outcome. Intracranial hemorrhage is classified into four subcategories: epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and intracerebral or intraparenchymal hemorrhage, according to the anatomical localization of the bleed. If it occurs in the space between the dura and the skull, then this is epidural hemorrhage, which usually traumatic and requires emergent surgical intervention. A subdural hematoma is localized between the dura and the arachnoid membrane. Usually, this entity occurs in elderly patients following trauma or a tear of a cortico-dural bridging vein. Hematoma evacuation in specific indications is the treatment of choice. Both epidural and subdural hematomas have a minimal role for medical intervention; thus this chapter focuses on the other two entities; subarachnoid hemorrhage and intracerebral hemorrhage. Studies have shown that early and specialized multidisciplinary management improves outcomes. This chapter discusses the etiology, presentation, and medical management of both subarachnoid and intracerebral hemorrhages.
Palliative Care in the Neurosurgical Patient
Authors: Liquori Michael , Mechler Kathleen , Liantonio John , Pennarola Adam
Published: August 2019

Palliative care is specialized medical care for people living with serious illness. It focuses on improving quality of life of the patient. Many neurosurgical patients have a life-altering, serious illness and benefit from palliative care expertise. This chapter describes key roles for palliative care, including understanding the difference between palliative care and hospice care and when and how to identify appropriate patients for palliative care referral. A framework for the effective communication of difficult information is discussed. An approach to symptom management for both pain and nonpain symptoms, like nausea, constipation, and delirium, is provided. Finally, identification of patients appropriate for hospice referral is reviewed.
Denotation and Connotation
Authors: Pamboukian Sylvia A.
Published: August 2019

Research using denotation and connotation explores how words convey meaning to various audiences and illuminates phenomena such as patient resistance, structural barriers to healthcare, and the evolution of specific medical practices. Words such as cancer, natural, narcotic, botanical, palliative, consent, and many others, are ripe for such analysis because each has many denotations (definitions) and connotations (cultural associations). For example, the word digitalis may connote a pretty foxglove flower, a heart drug, or a poison. What might this mean for patients prescribed digitalis? For those who see foxglove as a safer alternative? Denotation and connotation explore how concepts in healthcare emerge, propagate, evolve, or decline within specific communities, at particular historical moments, or across eras and cultures. This chapter offers a theoretical background in literary analysis regarding denotation and connotation and describes how such analyses offer fruitful avenues for research in health humanities.
Analyzing Metaphors
Authors: Wohlmann Anita
Published: August 2019

Metaphors are handy tools. They help describe and explain a complex and abstract “thing” by referring to something else. Metaphors, however, are not neutral or innocent instruments to convey information: they can be stigmatizing, entail harmful mystification, and evoke ethical problems. Thus, metaphors operate between two poles: on the one hand, they are the result of an endeavor to narrow down and render more precise, and, on the other hand, they unfold ambiguous meanings and harbor a potential for multiple forms of engagement. The chapter presents two approaches to metaphors: one based in cognitive metaphor theory and the other informed by narrative theory. The chapter specifies concrete methods that help identify, understand, and contextualize metaphors. It will also present examples of how metaphors can be used as powerful resources by caregivers, patients, and researchers to better understand the complexities involved in dealing with health and illness.
Ethnography
Authors: Anderson-Fye Eileen , Hildebrand Vanessa M.
Published: August 2019

Ethnography is a powerful qualitative research method used to understand research informants’ perspectives on a health-related topic. Developed and pioneered by anthropologists, this method has become an important tool across disciplines and industries. This chapter explains the utility of the method for use in the health humanities and offers step-by-step instructions to teach the reader to conduct ethnographic research. Concrete examples from long-term research projects demonstrate not only how this method is used to answer “why” and “how” questions, but also how this type of research pairs with other research methods. Many tools are offered to the reader to assist in the development of ethnographic research skills including resources, references, and an exercise to teach the method.
Surveys
Authors: Klugman Craig M.
Published: August 2019

Surveys collect descriptive data about the behaviors or opinions of a population. The power of surveys comes from applying the same questions and the same response choices to a large number of people. In the health humanities, surveys have most often been used for course or program evaluations, to learn about patient experiences, and to collect data on opinions. A good survey has a defined research question and respondent population, and it asks carefully crafted questions including yes/no, multiple choice, ratings, rankings, sliders, pull-downs, and text entry. Surveys require Institutional Review Board review and a knowledge of basic statistics. While a good survey can provide generalizable perspectives, one of their main limitations is that they do not explain why people answer as they do.
Preoperative Optimization of the Chronic Pain Patient
Authors: McAnally Heath B. , Freeman Lynda Welton , Darnall Beth
Published: August 2019

Elective surgery on poorly prepared patients suffering with chronic pain and comorbid substance dependence is increasingly shown to confer suboptimal outcomes—both clinical and economic. Achieving biopsychosocial “fitness for surgery” for these patients often requires a process similar to preoperative optimization of cardiac and other chronic diseases, with modification/elimination of risk factors (in many cases shared with those diseases). These risk factors are not so much genetic or uncontrollable, but rather behavioral, and comprise toxic thoughts and toxic habits. The preoperative optimization program for chronic pain patients presented in this book focuses on high-yield modifiable targets that are supported by the literature and the authors’ clinical experience. These comprise tobacco cessation, preoperative opioid reduction or elimination, slow-wave sleep enhancement, nutritional and exercise “prehabilitation,” and reduction of anxiety and pain catastrophization.
Rationale and Process Overview for Preoperative Optimization of Chronic Pain
Authors: McAnally Heath B.
Published: August 2019

The previous chapter demonstrated that preoperative chronic pain and its many associated comorbidities pose significant risk of suboptimal and adverse outcomes after surgery. Morbidity and economic data clearly indicate room for improvement in the arena of preoperative preparation/optimization of these factors prior to elective surgery. Many have called for a better system of identifying patients at risk and intervening at various stages (preoperative, intraoperative, and postoperative) with multidisciplinary/multimodal approaches in an attempt to mitigate this growing problem. Principles of evidence-based standards of care and wise allocation of resources/fiscal responsibility require that in high-impact and high-prevalence conditions such as chronic pain, benefits clearly outweigh risks and justify the costs. The federal government is increasingly implementing drastic overhaul to the reimbursement system and one of those changes particularly relevant to the perioperative arena is the advent of bundled and capitated payments which further incentivizes quality care with minimization of both postoperative complications and costs involved in preventing and treating them.
The Primacy of Motivation in Preoperative Optimization
Authors: McAnally Heath B. , Darnall Beth
Published: August 2019

Surgical patients with chronic pain frequently neglect basic health behaviors (e.g., maintenance of appropriate diet, sleep hygiene, exercise patterns) while engaging in harmful ones (e.g., tobacco use, alcohol excess, chronic opioid consumption) all of which have been shown to confer poor postoperative outcomes. Effective preoperative optimization of patients suffering with chronic pain requires at least a basic understanding of the complex and heterogeneous motivation behind deliberative (and subconscious) behaviors, and the application of interventions supporting self-determined elimination of toxic cognitive-behavioral patterns and their replacement with healthy ones. This chapter begins with an overview of motivational interviewing and select positive literature reviews addressing the utility of the method in modifying behaviors pertinent to this program. A survey of the development of our understanding of core common elements of human motivation is presented, followed by a biopsychosocial-spiritual framework for considering interpersonal variance; the chapter concludes with a brief consideration of dynamic intrapersonal variables affecting motivation within the individual.
The Pragmatism of Habit in Preoperative Optimization
Authors: McAnally Heath B. , Darnall Beth
Published: August 2019

As stated in the previous chapter’s introduction, effective preoperative optimization of patients suffering with chronic pain depends on behavioral modification. Chronic pain is largely influenced if not mediated by omission of healthy biopsychosocial-spiritual behaviors (e.g., healthy diet, sleep, exercise, and stress management patterns) and commission of unhealthy ones (e.g., pro-inflammatory diet, toxin consumption). This chapter explores the critical role of habit in directing behavior in general and, in particular, health behaviors. It examines what is currently known about the psychology and neurobiology of habit formation and maintenance. It then turns to a brief overview of the application of these concepts to the perioperative optimization of patients with chronic pain.
Sleep Optimization
Authors: Freeman Lyn
Published: August 2019

Sleep deprivation is arguably the single most compromising event that prevents pain patients from changing behavior. To get the sleep-deprived patient to take action to improve their sleep and become more capable of healthy change, healthcare practitioners must approach the patient with the evidence of “what works,” but on his or her own terms, in a language that he or she can understand and cognitively retain, and in a psychological manner that will inspire hope and increase motivation. This chapter endeavors to accomplish the following: (1) review the scope of the problem; (2) clarify the frame of reference of the author; (3) explain how humans function as living rhythm machines; (4) define circadian rhythms, chronobiology, and clock genes; (5) describe the challenges of improving sleep hygiene in a patient population; and (6) identify the methods of change used clinically, including motivational interviewing.
Concepts of rehabilitation
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

In healthcare, rehabilitation has been defined as ‘a general health strategy with the aim of enabling persons with health conditions experiencing, or likely to experience, disability to achieve and maintain optimal functioning’. This chapter covers models of disability, including clinical, social, and biopsychosocial models; describes the use of correct terminology, and the importance of avoiding terminology that implies dependency or terminology which just categorizes all people with disabilities; and introduces approaches to rehabilitation, illustrated by a case study. Goal planning, habit forming, and outcome measurement are all described, and the benefits of rehabilitation are outlined. It summarizes the basic tasks of rehabilitation, and introduces the rationale for the rest of the book.
Swallowing
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

Dysphagia is the over-arching term referring to disorders of swallowing. Dysphagia is a common complication of many acute and chronic neurological conditions. Dysphagia is important in the rehabilitation setting as it can produce common and potentially avoidable complications, morbidity, and death. This chapter defines the normal physiology of swallowing, the assessment of dysphagia (a multidisciplinary process), and management strategies. These include examples for dysphagia originating from anatomical, physiological, and behavioural causes. Clinical indicators for assessment are listed, and various methods such as taking a detailed history, cognitive communication screening, behavioural observation, oromotor assessment, bedside swallowing assessment, instrumental assessment of swallowing (where indicated), and nutritional assessment are described.
Personal factors in rehabilitation
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

A patient’s perception of their journey through rehabilitation is based on their personal aspirations and expectations as filtered through the value and belief systems within which they live. From these internal constructs, the uniqueness of an individual’s lived experience emerges and explains how two individuals with the same health condition or health state may respond to their situation very differently. This chapter covers contextual factors within the International Classification of Functioning, Disability and Health model, personality factors, attitudes, skills, and behaviour patterns in the context of how an individual will react to rehabilitation.
Cerebral palsy
Authors: Sivan Manoj , Phillips Margaret , Baguley Ian , Nott Melissa
Published: August 2019

This chapter concerns rehabilitation for adults with cerebral palsy (CP). It begins with aspects of CP in childhood as the definition, aetiology, and classification of CP are all based on its origins preterm or in infancy. Adolescence is a time of great change for any person as they develop an autonomous existence and learn to take responsibility for various aspects of life. Having a disability such as CP brings additional challenges. Describing the dominant challenges of CP at different stages of life, including the transition to adulthood and during adult life, the chapter gives practical rehabilitation advice.