bluuebunny/crossref_metadata_2025 huggingface dataset:
Crafting and Implementing a Career Development Course in Psychology
Authors: Goedereis Eric A. , Cohen Stanley H.
Published: October 2017

The purpose of this chapter is to present one method of crafting and implementing a career development course in psychology that has proven valuable to students at West Virginia University (WVU). The WVU model serves botha career development and an orientation to the major function consistent withAPA’s Guidelines for the Undergraduate Psychology Major by incorporatingseveral key components of successful career interventions that have been identified in major reviews of the careerdevelopment literature.
History of Psychology as a Capstone Course
Authors: Benjamin Ludy T.
Published: October 2017

This chapter discusses history of psychology as a capstone course, including the importance of history of psychology as a course and an introduction to psychology itself, as well as presenting the opportunity for students to practice communication skills, critical thinking, contextual emphasis, and lifelong learning.
Teaching Psychology’s Endings
Authors: Lutsky Neil
Published: October 2017

In this chapter argues that there is a generalized psychology of endings that provides insights and guides for pedagogical endings. Generalizing the concept of endings further implies that a prototypic teaching topic—the construction of courses—can be applied to other pedagogical challenges, such as crafting individual class sessions or structuring an entire psychology curriculum. The chapter also addresses teaching as the responsible conveyance of purpose and meaning.
Introduction
Authors: Miller Mark D.
Published: October 2017

This chapter presents an introduction to interpersonal therapy for cognitive impairment (IPT-ci). It discusses the purpose of this manual, research using IPT in older individuals, and the use of IPT with depressed elders in a research setting.
A Concise Review of Gerontology/Geriatric Medicine
Authors: Miller Mark D.
Published: October 2017

Chapter 3 reviews of gerontology and geriatric medicine. It presents background information on gerontology (physiologic changes of aging, the aging process), polypharmacy, the effects of medication in the elderly, sleep problems, and other issues related to older age. The importance of social support for the elderly is also discussed.
Overview of Late-Life Depression
Authors: Miller Mark D.
Published: October 2017

Chapter 4 outlines late-life depression. It explores the causes of depression (including medical conditions, medication, and alcohol), treatments for depression, and other diagnoses (bipolar disorder, co-occuring anxiety, and personality disorders), depression and cognitive impairment, and collaborative care.
Juggling Porcupines
Authors: Johnson W. Brad , Koocher Gerald P.
Published: October 2017

This chapter presents an introduction to the title, and discusses the difficulties in being ethical in challenging roles and work settings. It explores the rationale for the title, and presents an overview of the structure that the individual case studies will take.
Everyone I Know Knows Everyone I Know
Authors: Brown Laura S.
Published: October 2017

This case discusses boundaries and confidentiality. Keeping that boundary and doing no harm when the lives of clients overlap, and the communities of the therapist and the client lead to unavoidable multiple roles, constitute the key ethical issues in this case. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
An Affair to Remember
Authors: Ann McCabe Mary
Published: October 2017

This case explores the protection of vulnerable clients and confidentiality in the situation of a cheating spouse. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
Trapped by Trauma
Authors: Peteet John
Published: October 2017

This case explores the situation of clients that cannot or will not protect themselves from harm. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
Is That What I Said?
Authors: Deutsch Robin M.
Published: October 2017

This case describes a situation where a child client's parents divorced during treatment and the subsequent difficulties that were caused to the treatment process. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
The Siren Song of Silence
Authors: Kinscherff Robert
Published: October 2017

This case explores the bases for professional judgements when advocating for a child in an abuse case. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
When Boundaries Intersect in Cyberspace
Authors: El-Ghoroury Nabil Hassan
Published: October 2017

This case discusses intersection of boundaries that can occur over social media websites such as Facebook, and the complications of relationships and confidentiality. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
When Bad Things Happen to People Who Try Really Hard
Authors: Tippins Nancy T.
Published: October 2017

This case describes a situation involving the interpretation of validity evidence, and confidentiality in research. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
A Near Fall
Authors: Etzel Edward F.
Published: October 2017

This case explores the challenges involved in working with intercollegiate athletes and sport psychology. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
The Wink
Authors: Behnke Stephen H.
Published: October 2017

This case explores issues when a therapist's private and professional lives intersect unexpectedly and clients are encountered outside of the treatment situation. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
So, How Exactly Did You Get Interested in Eating Disorders?
Authors: Derenne Jennifer L.
Published: October 2017

This case explores beneficence and nonmaleficence, autonomy and privacy, professional boundaries, and the problem of overlapping roles when a colleague displays unhealthy behaviors. The chapter presents a discussion of the key ethical issues, a summary of the primary ethical conundrums prevalent in the work setting, and a final reflection in retrospect regarding how the ethical quandary was handled.
The Dissemination of Evidence-Based Practices by Federal and State Mental Health Agencies
Authors: Rivard Jeanne C. , Ganju Vijay K. , Roberts Kristin A. , Lane G. Michael
Published: October 2017

This chapter provides an overview of state efforts initiated at both the federal and state levels to improve access to evidence-based psychological interventions (EBPIs). Several novel strategies for facilitating implementation, such as university-state mental health system collaborations, as well as the importance of the development of financial infrastructure for the initiation and maintenance of these efforts are described.
Sustaining Hawaii’s Evidence-Based Service System in Children’s Mental Health
Authors: Nakamura Brad J. , Higa-McMillan Charmaine K. , Chorpita Bruce F.
Published: October 2017

Chapter 9 describes the impetus for and implementation of these efforts with a particular focus on sustaining and maintaining the significant advances achieved in recent years in improving access to care for children and adolescents in Hawaii.
Dissemination and Implementation of Dialectical Behavior Therapy
Authors: Landes Sara J. , Linehan Marsha M.
Published: October 2017

This chapter describes the implementation of the dialectical behavior therapy (DBT) Intensive Training Model developed in response to the lack of effectiveness of standard training workshops. The dissemination and implementation of the Positive Parenting Program (Triple P) is unique relative to the other interventions in this volume given the population-based approach taken by its developers.
Dissemination and Implementation of Evidence-Based Psychological Interventions
Authors: McHugh R. Kathryn , Barlow David H.
Published: October 2017

Chapter 13 explores the current status of research and future directions for the dissemination and implementation of evidence-based psychological interventions, including further emphasis on dissemination and implementation science, standardization of procedures for outcomes assessment, better collaboration between research and practice, transdiagnostic treatments, stepped-care models, integration of mental health care in primary care, and use of information technology.
Introduction
Authors: Russell James
Published: October 2017

This chapter presents an introduction to the title as a whole. It outlines ‘theory of mind’ mechanism (ToMM) and ‘the theory theory’ within an executive-deficit approach, practical implications of the research the title explores, and discusses the structure and content of the title itself.
Pretend play in autism: executive explanations
Authors: Jarrold Christopher
Published: October 2017

This chapter discusses executive explanations of pretend play in autism. This includes problems with the metarepresentational-deficit account, if an executive dysfunction explanation is plausible, evidence for the role of executive deficits (failures to inhibit and to generate), generativity deficits, and how a generativity deficit fits with notions of executive dysfunction.
Components of executive function in autism and other disorders
Authors: Ozonoff Sally
Published: October 2017

This chapter discusses components of executive function in autism. It explores the discriminant validity problem, methodological issues, and the information processing approach. It also considers the evidence for executive dysfunction in several other disorders (including attention deficit hyperactivity disorder (ADHD), schizophrenia, Tourette syndrome (TS), and obsessive-compulsive disorder (OCD).
How executive disorders can bring about an inadequate ‘theory of mind’
Authors: Russell James
Published: October 2017

This chapter discusses how executive disorders can bring about an inadequate ‘theory of mind’. It describes a conceptual linkage between agency and self-awareness, and gives reasons for the suggestion that disorders of agency will give rise to disorders of self-awareness. It reviews the evidence for this view that has emerged from experimental studies of autism, concentrating on the process of action-monitoring.
Thinking about research
Authors: Gilbert Paul , Irons Chris
Published: October 2017

This chapter discusses the issues and dilemmas encountered when considering and beginning to engage the research process. They look at why we should value research as a special way of answering questions, how a research question is formulated, and the many different ways our questions can be answered. The chapter explores evidence, reliability and validity, efficacy and effectiveness.
Sampling in health and clinical psychology research
Authors: Buchanan Heather , Coulson Neil
Published: October 2017

This chapter focuses on gaining access to samples in psychology research and how this impacts on sampling. It considers the reality of gaining access to a sample, as this is often fraught with practical difficulties that may not be immediately obvious even at the planning stage of research, and offers advice on how to make the process of gaining access to samples as problem-free as possible. It also outlines guidelines for how samples should be taken and different research settings.
The measurement of physiological outcomes in health and clinical psychology
Authors: Wetherel Mark A. , Vedhara Kav
Published: October 2017

This chapter details techniques that allow for the measurement of the major physiological systems that react to psychological stimuli, i.e., the nervous, endocrine and immune systems. These core systems are discussed in relation to their function in response to psychological stimuli, and appropriate measurement techniques for each of the systems are explained.
The use of diary methodologies in health and clinical psychology
Authors: Ferguson Eamonn
Published: October 2017

This chapter examines the methodological and statistical issues as well as problems associated with diary research and conclude with examples of how diaries can be used in health/clinical research and practice. Issues include compliance, data analysis and multilevel modelling (MLM).
Analysing categorical data
Authors: Fife-Schaw Chris
Published: October 2017

This chapter explores the analysis of categorical data and the chi-squared test. This includes logistic regression (how it works, and goodness of fit), the importance of predictors, and cautionary notes about the use of regression analysis. The chapter also discusses the prediction of multi-category outcome variables (multinomial logistic regression, and configural frequency analysis (CFA)).
Behaviour
Authors: Harvey Allison G. , Watkins Edward , Mansell Warren , Shafran Roz
Published: October 2017

Chapter 6 reviews the literature on behavioural processes and draws conclusions about the extent to which they are transdiagnostic. Three behavioural processes considered are escape/avoidance, within-situation safety-seeking behaviours, and ineffective safety-signals. These processes are considered in the context of anxiety disorders and obsessive-compulsive disorder (OCD), somatoform disorders, eating disorders, sleep disorders, and substance-related disorders).
Remediable or preventable psychological factors in the aetiology and prognosis of medical disorders
Authors: Steptoe Andrew
Published: October 2017

This chapter outlines recent developments in understanding how psychological factors contribute to medical disorders. Traditional clinical and epidemiological studies in which psychological constructs are measures in population samples of diagnosed patient groups have been supplemented by more direct investigations on the effects of psychological stimulation on pathophysiology.
The biopsychosocial approach
Authors: Smith George Davey
Published: October 2017

This chapter provides a critique of whether the biopsychosocial model is useful in understanding aetiological factors in chronic diseases. It illustrates the arguments by referring to studies on peptic ulcer and ischaemic heart diseases, and shows that bias and confounding can generate spurious findings and associations, especially in observational studies.
Are the patient-centred and biopsychosocial approaches compatible?
Authors: Creed Francis
Published: October 2017

This chapter addresses the question of whether patient-centred and biopsychosocial approaches are compatible. It first outlines the patient-centred approaches, before considering whether this affects outcome, and explores why the biopsychosocial approach is not used more widely. It considers if particular individual interviewing skills should be encouraged independently of their overall models.
Motivational basis of cognitive determinants of addiction
Authors: Cox W. Miles , Klinger Eric , Fadardi Javad Salehi
Published: October 2017

Chapter 4 discusses motivational basis of cognitive determinants of addiction. It explores a motivational model of alcohol and other drug use, the Motivational Structure Questionnaire (MSQ) and Personal Concerns Inventory (PCI), the effect on substance use of having attractive non-substance incentives, the effects of current concerns on cognitive processing, and cognitive-motivational interventions.
Nonpharmacologic Treatments for Childhood Attention-Deficit/Hyperactivity Disorder and Their Combination with Medication
Authors: Pfiffner Linda J. , Haack Lauren M.
Published: October 2017

Of the nonpharmacological treatments for childhood attention-deficit/hyperactivity disorder (ADHD), behavioral interventions have the largest evidence base. Current behavioral interventions include behavioral parent training, behavioral classroom management, child skills training, behavioral multicomponent interventions, and multimodal treatment, which combines behavioral interventions and medication. This updated review of studies reveals significant behavioral treatment effects from randomized controlled trials on a wide range of child outcomes including ADHD and oppositional defiant disorder symptoms as well as areas of functional impairment such as homework, organizational, and social behaviors. Combined behavioral and medication treatments appear to reduce the needed dose or intensity of each intervention.
Psychosocial Treatments for Conduct Disorder in Children and Adolescents
Authors: Kazdin Alan E.
Published: October 2017

Significant advances have been made in the treatment of antisocial and aggressive behavior (conduct disorder), a severe source of impairment among children and adolescents. Several psychosocial interventions with strong evidence in their behalf with children and adolescents are highlighted in the chapter. They include parent management training, multisystemic therapy, multidimensional treatment foster care, cognitively based treatments, functional family therapy, brief strategic family therapy, and the Good Behavior Game. The treatments have been very well studied, with multiple replications. There remain questions about the long-term impact of treatments, the persons for whom one or more of these treatments are well suited, and how to optimize therapeutic change.
Pharmacological Treatments for Unipolar Depression
Authors: Prendes-Alvarez Stefania , Schatzberg Alan F. , Nemeroff Charles B.
Published: October 2017

Major depressive disorder is a chronic syndrome associated with high mortality (secondary to suicide and increased risk for heart disease, stroke, and other serious diseases). It is one of the most common medical disorders affecting adults in the world today. In the United States, the lifetime prevalence of major depression is 16.7% for adults. The average age of onset is 32 years, and women are 70% more likely to develop depression than men. Neither the core requisite symptoms for the diagnosis of a major depressive episode nor the required duration of at least 2 weeks has changed from DSM-IV to DSM-5. This chapter discusses the main issues surrounding the treatment of major depressive disorder, such as suicidality and goals of treatment, and provides information about all treatment options approved by the U.S. Food & Drug Administration. Drugs are categorized by their mechanisms of action.
Treatments for Eating Disorders
Authors: Pike Kathleen M. , Gianini Loren M. , Loeb Katharine L. , Le Grange Daniel
Published: October 2017

Substantial progress in advancing evidence-based treatments for eating disorders has been made. Many well-designed studies provide cumulative support for cognitive-behavioral therapy (CBT) as the treatment of choice for bulimia nervosa. Interpersonal psychotherapy (IPT) and pharmacotherapy are considered appropriate alternative treatments for bulimia nervosa. While CBT, IPT and pharmacotherapy often produce significant reductions in binge eating and compensatory behaviors, these treatment options need to be improved to help more individuals achieve full and lasting recovery. In the treatment of binge eating disorder, CBT and IPT have been shown to be the most efficacious in reducing symptoms and improving psychological outcomes. Weight loss is often an additional goal of those entering treatment for binge eating disorder; however, existing treatments have generally been unsuccessful in producing significant maintainable weight loss. Initial studies suggest that CBT may be associated with improved outcome both in the acute and maintenance phases of treatment for anorexia nervosa.
Psychopharmacological Treatments for Substance Use Disorders
Authors: McKay James R. , Kranzler Henry R. , Kampman Kyle M. , Ashare Rebecca L. , Schnoll Robert A.
Published: October 2017

The treatment of substance use disorders with medications is well established, although most experts agree that pharmacological interventions must be combined with psychosocial therapies. Many type 1 and type 2 controlled trials have shown that the use of nicotine replacement therapy significantly increases abstinence rates. Non-nicotine treatments, such as bupropion and varenicline, have been found in controlled trials to significantly increase abstinence rates. The treatment of alcohol use disorder can be enhanced by three approved medications with different mechanisms of action: disulfiram, naltrexone, and acamprosate. Methadone maintenance treatment has consistently shown efficacy in the treatment of opioid dependence, and buprenorphine has substantially expanded the options for treating the disorder. Although double-blind, placebo-controlled clinical trials of several medications have provided initial evidence of efficacy for cocaine use disorder, efficacy has not yet been shown in multisite trials.
Psychological Treatments for Personality Disorders
Authors: Crits-Christoph Paul , Barber Jacques P.
Published: October 2017

For the treatment of borderline personality disorder, a meta-analysis found statistically significant effects indicating a beneficial effect of dialectical behavior therapy (DBT) over treatment as usual for reduction in anger, parasuicidality, and mental health. All of these effects were moderate to large. However, DBT is not uniquely effective for borderline personality disorder. Two type 1 randomized controlled trials found equal effects for versions of psychodynamic therapy. Single type 1 studies have also supported the efficacy, compared to treatment as usual, of cognitive therapy, schema therapy, and Systems Training for Emotional Predictability and Problem Solving (STEPPS, a therapy that combines cognitive-behavioral techniques and skills training with a systems component) as treatments for borderline personality disorder.
Psychopharmacological Treatment of Personality Disorders
Authors: Perez-Rodriguez M. Mercedes , Siever Larry J.
Published: October 2017

Despite the lack of approval by the U.S. Food & Drug Administration, drugs are used widely to treat personality disorders, particularly borderline personality disorder, based on their effects known from clinical trials in other psychiatric disorders (off-label use). The role of medications in personality disorders is limited to moderate effects on some but not all of the symptom domains. There are no medications available that improve the global severity of any personality disorder as a whole. In borderline personality disorder, evidence is strongest for second-generation antipsychotics and mood stabilizers, while dietary supplements like omega-3 fatty acids hold some promise. However, medications have limited effectiveness and are still viewed as adjunctive to other forms of treatment, particularly psychotherapy.
Introducing Dynamic “Forms of Vitality”
Authors: Stern Daniel N.
Published: October 2017

This chapter introduces the dynamic forms of vitality. Vitality is a manifestation of life, and it takes on many dynamic forms and permeates daily life, psychology, psychotherapy, and the arts. It considers why forms of vitality should be explored further
The Nature and Theoretical Framework of Dynamic “Forms of Vitality”
Authors: Stern Daniel N.
Published: October 2017

This chapter explores the basic concepts essential to forms of vitality, namely the primacy of movement, the nature of the forces involved, the temporal contouring of movements, space and directionality/intentionality, the emergent property of aliveness, the separation of form from content, and the disentangling of vitality forms from emotions and sensations.
Generalist psychiatric treatments for borderline personality disorder: the evidence base and common factors
Authors: Bateman Anthony W. , Krawitz Roy
Published: October 2017

Chapter 2 discusses generalist psychiatric treatments for borderline personality disorder (BPD). It introduces the rationale for seeking common factors in treatment and provide a brief overview of some relevant literature, outlines the four generalist treatments that have been shown to be effective (structured clinical management (SCM), general psychiatric management (GPM), good clinical care (GCC), and supportive psychotherapy (SP)), describes the outcome studies of the four treatments, and reviews commonalities of the treatments.
Structured clinical management: core treatment strategies
Authors: Bateman Anthony W. , Krawitz Roy
Published: October 2017

Chapter 4 explores the core treatment strategies of structured clinical management (SCM) as a treatment for borderline personality disorder (BPD). It includes nonspecific interventions (interviewing, clinician attitude, authenticity and openness, empathy, validation, positive regard, advocacy) and specific interventions (problem-solving skills, tolerance of emotions, mood regulation, impulse control, sensitivity and interpersonal problems, self-harm).
Structured clinical management: inpatient treatment and prescribing
Authors: Bateman Anthony W. , Krawitz Roy
Published: October 2017

Chapter 5 discusses inpatient treatment for borderline personality disorder (BPD), and prescribing, including iatrogenesis, indicators for hospital admission, review of medication, and hospital admission. Prescribing in clinical practice is also outlined, including a summary of pharmacotherapy in BPD, clinical cautions, prescribing guidance, crisis, maintenance prescribing, time on medication, and comorbid conditions.
Family and friends
Authors: Bateman Anthony W. , Krawitz Roy
Published: October 2017

This chapter provides an introduction and sections on level of involvement of family and friends in treatment for BPD, guiding suggestions for short two-session interventions for time-restricted clinicians, comments for multisession interventions where resources exist, and a summary of the research data.
Top ten additional resource-efficient treatment strategies
Authors: Bateman Anthony W. , Krawitz Roy
Published: October 2017

This chapter describes ten strategies that are additional to those previously described. The effective specialist BPD treatments that have been drawn mostly from in this chapter are DBT and mentalization-based therapy as these are the two BPD treatments with the most robust evidence base. Strategies include mentalizing and mindfulness; valued action irrespective of emotions; self-acceptance; accepting thoughts and valued action; changing thoughts; decreasing hyperarousal; chain analysis; structure; DBT skills and clinical feedback of treatment outcomes.
Abstraction
Authors: MacPherson Sarah E. , Sala Sergio Della , Cox Simon R. , Girardi Alessandra , Iveson Matthew H.
Published: October 2017

The frontal tests available in the literature for assessment of abstraction abilities are discussed. For each test, the evidence for localization of abstraction processes within the various frontal subregions is considered, including the findings from patient and lesion studies as well as neuroimaging studies. The effects of healthy adult aging on tests tapping abstraction abilities are also discussed.
Initiation and inhibition
Authors: MacPherson Sarah E. , Sala Sergio Della , Cox Simon R. , Girardi Alessandra , Iveson Matthew H.
Published: October 2017

Two types of frontal tests are available in the literature: those that assess initiation and those that assess inhibition. For each test, the evidence for localization of these processes within the various frontal subregions is considered, including the findings from patient and lesion studies as well as neuroimaging studies. Age effects on tests tapping initiation and inhibition are also discussed.
Multi-tasking
Authors: MacPherson Sarah E. , Sala Sergio Della , Cox Simon R. , Girardi Alessandra , Iveson Matthew H.
Published: October 2017

Localization of the processes associated with the Multiple Errands Task and the Six Elements Task are discussed. Evidence includes the findings from patient and lesion studies as well as neuroimaging studies. Age effects on the performance of both of these tasks is also discussed.
Social decision-making
Authors: MacPherson Sarah E. , Sala Sergio Della , Cox Simon R. , Girardi Alessandra , Iveson Matthew H.
Published: October 2017

Tests to assess social decision-making are discussed in relation to localization of social decision-making processes within frontal subregions. The findings from patient and lesion studies and from neuroimaging studies are considered. In addition, studies examining the effects of healthy adult aging on performance on these social decision-making tests are reviewed.
Supplier strategy in global value chains: shaping governance and profiting from upgrading
Authors: Sako Mari , Zylberberg Ezequiel
Published: October 2017

The growth of emerging market firms with a global presence highlights the need to better understand how supplier strategy influences global value chains (GVCs). We respond to this need by applying corporate strategy and technology strategy to improve the predictive and prescriptive power of GVC theory. Under what circumstances can suppliers in GVCs shape governance and profit from upgrading? Using corporate strategy, we argue that supplier strategy concerning make-or-buy decisions and buyer diversification can effect a change in governance mode. Using technology strategy, we identify appropriability regimes and complementary assets as essential preconditions for suppliers to capture value from upgrading. Our central contribution is in developing an integrative theoretical framework for analyzing how suppliers alter governance over time, and how they capture the value they create by upgrading, resulting in shifts in value chain polarity. This framework has significant implications for economic development.
Sydowia polyspora is both a Foliar Endophyte and a Preemergent Seed Pathogen in Pinus ponderosa
Authors: Ridout Mary , Newcombe George
Published: October 2017

Poor seedling performance and reduced seed emergence are often ascribed to known pathogens that cause low seedling recruitment and poor seed emergence in forest nurseries and regeneration plantings. On the other hand, foliar endophytes are often overlooked as a source of poor emergence or tree seedling disease. Here, we show that an endophytic fungus common to the foliar microbiome of Pinus ponderosa acts as a cryptic pathogen in delaying emergence. In a series of experiments, we inoculated seed of P. ponderosa with a suspension of Sydowia polyspora 12 h prior to sowing. S. polyspora reduced seed emergence of its host, P. ponderosa, by as much as 30%. A tetrazolium chloride viability assay showed that S. polyspora reduces emergence by preventing germination; seed remained viable. In sum, pathogens affecting tree seed emergence and seedling recruitment may be endophytic as well as in seed and soil and deserve greater attention in studies of natural regeneration.
Validating a Method to Assess Lipreading, Audiovisual Gain, and Integration During Speech Reception With Cochlear-Implanted and Normal-Hearing Subjects Using a Talking Head
Authors: Schreitmüller Stefan , Frenken Miriam , Bentz Lüder , Ortmann Magdalene , Walger Martin , Meister Hartmut
Published: October 2017

Objectives:

Watching a talker’s mouth is beneficial for speech reception (SR) in many communication settings, especially in noise and when hearing is impaired. Measures for audiovisual (AV) SR can be valuable in the framework of diagnosing or treating hearing disorders. This study addresses the lack of standardized methods in many languages for assessing lipreading, AV gain, and integration. A new method is validated that supplements a German speech audiometric test with visualizations of the synthetic articulation of an avatar that was used, for it is feasible to lip-sync auditory speech in a highly standardized way. Three hypotheses were formed according to the literature on AV SR that used live or filmed talkers. It was tested whether respective effects could be reproduced with synthetic articulation: (1) cochlear implant (CI) users have a higher visual-only SR than normal-hearing (NH) individuals, and younger individuals obtain higher lipreading scores than older persons. (2) Both CI and NH gain from presenting AV over unimodal (auditory or visual) sentences in noise. (3) Both CI and NH listeners efficiently integrate complementary auditory and visual speech features.

Design:

In a controlled, cross-sectional study with 14 experienced CI users (mean age 47.4) and 14 NH individuals (mean age 46.3, similar broad age distribution), lipreading, AV gain, and integration of a German matrix sentence test were assessed. Visual speech stimuli were synthesized by the articulation of the Talking Head system “MASSY” (Modular Audiovisual Speech Synthesizer), which displayed standardized articulation with respect to the visibility of German phones.

Results:

In line with the hypotheses and previous literature, CI users had a higher mean visual-only SR than NH individuals (CI, 38%; NH, 12%; p < 0.001). Age was correlated with lipreading such that within each group, younger individuals obtained higher visual-only scores than older persons (rCI = −0.54; p = 0.046; rNH = −0.78; p < 0.001). Both CI and NH benefitted by AV over unimodal speech as indexed by calculations of the measures visual enhancement and auditory enhancement (each p < 0.001). Both groups efficiently integrated complementary auditory and visual speech features as indexed by calculations of the measure integration enhancement (each p < 0.005).

Conclusions:

Given the good agreement between results from literature and the outcome of supplementing an existing validated auditory test with synthetic visual cues, the introduced method can be considered an interesting candidate for clinical and scientific applications to assess measures important for AV SR in a standardized manner. This could be beneficial for optimizing the diagnosis and treatment of individual listening and communication disorders, such as cochlear implantation.
Biomechanical Comparison of Intrapelvic and Extrapelvic Fixation for Acetabular Fractures Involving the Quadrilateral Plate
Authors: Gillispie Gregory J. , Babcock Sharon N. , McNamara Kyle P. , Dimoff Michaela E. , Aneja Arun , Brown Philip J. , Carroll Eben A.
Published: October 2017

Objectives:

Elderly patients represent the fastest growing and most difficult to treat population sustaining acetabular fractures. When treated surgically, isolated extrapelvic or combined intrapelvic–extrapelvic constructs may be used. No biomechanical or clinical study has compared the merits of these 2 techniques in cadaveric models. This research aims to biomechanically quantify the additional benefit of intrapelvic fixation to a standard extrapelvic fixation construct.

Methods:

Ten cadaveric pelves underwent standardized anterior column and quadrilateral plate fracture creation. One hemipelvis from each subject received isolated extrapelvic fixation, whereas the other received adjunctive intrapelvic fixation. Specimens were then subjected to a 50% of body weight (BW) nondestructive stiffness test followed by loading to failure. For the 50% BW test, displacement at 50% BW and stiffness were calculated. For the load to failure test, stiffness, elastic energy, and plastic energy were calculated. Yield point, force at clinical failure (defined at 2 mm of displacement), and maximum force were also identified. A Wilcoxon matched-pairs t test was used to compare fixation groups.

Results:

The addition of an intrapelvic plate improved construct performance for all test parameters. A statistically significant difference (P < 0.05) was reached for yield force, maximum force, and plastic energy.

Conclusions:

These findings demonstrate that the addition of intrapelvic plating may offer distinct advantages in prevention of catastrophic construct failure in situations in which significant lateral to medial force is applied to the greater trochanter such as patient falling.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Phalangeal Fracture Pearls and Pitfalls
Authors: Abzug Joshua M. , Mehlman Charles T.
Published: October 2017

Pediatric phalangeal fractures are extremely common, especially among toddlers and older children/adolescents involved in sporting activities. The physical examination must include an assessment for deviation and malrotation. In addition, concomitant injuries must be assessed for such as tendon and/or neurovascular injuries. Plain radiographs are typically sufficient to make the diagnosis and determine the treatment. The majority of pediatric and adolescent phalangeal fractures can be treated with immobilization. Substantial deviation and malrotation must be addressed with closed reduction techniques with or without percutaneous pinning. Open reduction is reserved for cases with concomitant injuries, open fractures, older adolescents, and patients in whom an adequate closed reduction cannot be obtained. When diagnosed and treated appropriately, pediatric and adolescent phalangeal fractures typically result in excellent outcomes.
The Correlation Between the OTA/AO Classification System and Compartment Syndrome in Both Bone Forearm Fractures
Authors: Auld Thomas S. , Hwang John S. , Stekas Nicholas , Gibson Peter D. , Sirkin Michael S. , Reilly Mark C. , Adams Mark R.
Published: October 2017

Objective:

To evaluate the efficacy of using the Orthopaedic Trauma Association (OTA/AO) classification for both bone forearm fractures in predicting compartment syndrome.

Design:

Retrospective cohort.

Setting:

Level 1 Academic Trauma Center.

Patients/Participants:

One hundred fifty-one patients 18 years of age and older, with both bone forearm fractures diagnosed from 2001 to 2016 were categorized based on the OTA/AO classification. Patients with both bone fractures caused by gunshot wounds were excluded.

Main Outcome Measurements:

The endpoint for our study was whether forearm fasciotomies were performed based on the presence of compartment syndrome.

Results:

Of a total of 151 both bone forearm fractures, 15% underwent fasciotomy. Six of 80 (7.5%) grouped 22-A3, 8 of 44 (18%) grouped 22-B3, and 9 of 27 (33%) grouped 22-C underwent fasciotomies for compartment syndrome (P = 0.004). The relative risks of developing compartment syndrome for group 22-B3 versus 22-A3 was 2.42 (P = 0.08), 22-C versus 22-B3 was 1.83 (P = 0.15), and 22-C versus 22-A3 was 4.44 (P = 0.002).

Conclusions:

There is a significant correlation between the OTA/AO classification and the need for fasciotomies, with group C fractures representing the highest risk. Clinicians can use this information to have a higher index of suspicion for compartment syndrome based on OTA/AO classification to help minimize the risk of a missed diagnosis.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Increased Incidence of Vascular Injury in Obese Patients With Knee Dislocations
Authors: Johnson Joey P. , Kleiner Justin , Klinge Stephen A. , McClure Philip K. , Hayda Roman A. , Born Christopher T.
Published: October 2017

Objectives:

With rising rates of obesity in the United States, the burden of knee dislocations in this population remains unknown. This national epidemiologic study was designed to analyze the association of obesity with closed knee dislocation and vascular complications.

Design:

Retrospective cohort study.

Setting:

The deidentified Nationwide Inpatient Sample database was used to access the US inpatient data from 2000 to 2012.

Patients/Participants:

Patients with noncongenital closed knee dislocations were included. Examined variables included patient age, sex, vascular injury, and obesity status.

Main Outcome Measures:

Outcome measures included hospital length of stay, amputation, and inpatient hospitalization charge.

Results:

From 2000 to 2012, a total of 19,087 knee dislocations were identified, including 2265 in overweight/obese patients (11.9%). The annual incidence of knee dislocations reported in patients diagnosed as either obese or morbidly obese increased over the 13-year period (P < 0.0001). The overall average rate of vascular injury requiring intervention was 5.63%, whereas 7.2% of obese patients and 11.3% of morbidly obese patients with knee dislocations (P < 0.0001) sustained a vascular injury requiring intervention. The average length of stay and amputation rate for obese and morbidly obese patients who sustained a knee dislocation was not statistically different from nonobese patients when vascular injury was controlled. When patients with a vascular injury were excluded, obese and morbidly obese patients who sustained a knee dislocation had higher average cost of hospital stay than nonobese patients (P = 0.0262).

Conclusions:

This study demonstrates significant increases in costs of stay with obese patients sustaining knee dislocations when compared with normal weight knee dislocation patients. Vascular injuries were found to be far more common in obese and morbidly obese patient groups than nonobese patients. Providers should be on high alert when managing knee dislocations in obese patients because a significant number require prompt vascular intervention.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Is S3 a Viable Osseous Fixation Pathway?
Authors: Eastman Jonathan G. , Adams Mark R. , Frisoli Kendall , Chip Routt Milton L.
Published: October 2017

Objectives:

To report the incidence of patients with a third sacral segment (S3) osseous fixation pathway (OFP) that could accommodate a transiliac-transsacral screw.

Design:

Retrospective case series.

Setting:

Regional Level 1 Trauma Center.

Patients/Participants:

A total of 250 patients without pelvic trauma from January 2017 to February 2017 were included.

Intervention:

The axial and sagittal reconstruction images of each patient's computed abdomen and pelvis tomography (CT) scans were reviewed.

Main Outcome Measurements:

Each CT was evaluated for the presence of sacral dysmorphism and whether an S3 OFP that could accommodate an intraosseous transiliac-transsacral screw exists.

Results:

There were 130 of the 250 patients (52%) with sacral dysmorphism. Overall, 38 of the 250 patients (15.2%) had an S3 OFP that could accommodate a 7.0-mm transiliac-transsacral style screw. When narrowed to patients who had an S3 OFP, 38 of 153 patients (24.8%) could accommodate a 7.0-mm transiliac-transsacral screw. Specific to the 38 patients with an adequate S3 OFP, 34 of 38 patients (89.5%) were noted to have sacral dysmorphism.

Conclusions:

Our study demonstrates that 15.2% of patients have an S3 OFP large enough to accommodate an intraosseous implant. Patients who have sacral dysmorphism are more likely to have an adequate S3 OFP. Additional studies are needed to quantify the S3 OFP, understand the bone quality of the S3 segment and accompanying biomechanical implications, and investigate the anatomical concerns associated with S3 screw placement.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Early Surgery Confers 1-Year Mortality Benefit in Hip-Fracture Patients
Authors: Maheshwari Kamal , Planchard Jeffrey , You Jing , Sakr Wael Ali , George Jaiben , Higuera-Rueda Carlos A. , Saager Leif , Turan Alparslan , Kurz Andrea
Published: October 2017

Background:

To evaluate the relationship between surgical timing and 1-year mortality in patients requiring hip fracture repair.

Methods:

We analyzed all 720 patients (>65 years) who had hip fracture surgery between March 2005 and February 2015, identifying patients by ICD-9 diagnosis and procedure codes using electronic data query. Mortality data were obtained from the institutional database, state and Social Security Death Indices. The relationship between surgical timing (defined as the interval from admission to the start of surgery) and 1-year mortality was assessed using a multivariable logistic regression, adjusting for baseline clinical status and surgical factors.

Results:

Among the 720 patients, 159 patients (22%) died within 1 year. The median time from admission to surgery was 30 hours. A linear relationship between the surgical timing and 1-year mortality was demonstrated. Delaying surgery was significantly associated with increased 1-year mortality, odds ratio 1.05 (95% CI: 1.02–1.08) per 10-hour delay (P = 0.001).

Conclusions:

A linear relationship was observed between surgical timing and 1-year mortality. Each 10-hour delay from admission to surgery was associated with an estimated 5% higher odds of 1-year mortality. Therefore, we suggest that hip fractures should be treated urgently similar to other time-sensitive pathology such as stroke and myocardial ischemia.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implant Density at the Apex Is More Important Than Overall Implant Density for 3D Correction in Thoracic Adolescent Idiopathic Scoliosis Using Rod Derotation and En Bloc Vertebral Derotation Technique
Authors: Delikaris Alexandre , Wang Xiaoyu , Boyer Laure , Larson A. Noelle , Ledonio Charles G.T. , Aubin Carl-Eric
Published: October 2017

Study Design.

Biomechanical analysis of 3D correction and bone–screw forces through numerical simulations of scoliosis instrumentation with different pedicle screw patterns.

Objective.

To analyze the effect of different screw densities and distributions on 3D correction and bone–screw forces in adolescent idiopathic scoliosis (AIS) instrumentation.

Summary of Background Data.

Instrumentation constructs with various numbers of pedicle screws and patterns have been proposed for thoracic AIS instrumentation. However, systematic biomechanical studies have not yet been completed on the appropriate screw patterns for optimal 3D correction.

Methods.

Patient-specific biomechanical models of the spine were created for 10 AIS cases (Lenke 1). For each case, surgical instrumentation patterns were computationally simulated using respectively a reference screw pattern (two screws per level fused) and six alternative screw patterns with fewer screws. Simulated surgical maneuvers and model definition were unchanged between simulations except the number and distribution of screws. 3D correction and bone–screw forces were compared.

Results.

A total of 140 posterior instrumentations were computationally simulated. Mean corrections in the coronal and sagittal planes with alternative screw patterns were within 4° to the reference pattern. Increasing screw density in the apical region from one to two screws per level improved percent apical vertebral rotation (AVR) correction (r = 0.887, P < 0.05). Average bone–screw force associated with the reference screw pattern was 243N ± 54N and those with the alternative screw patterns were 11% to 48% lower.

Conclusion.

Compared with the reference maximal screw density pattern, alternative screw patterns allowed similar corrections in the coronal and sagittal planes. AVR correction was strongly correlated with screw density in the apical region; AVR correction varied significantly with screw patterns of the same overall screw density when an en bloc vertebral derotation technique was simulated. High screw density tended to overconstrain the instrumented spine and resulted in higher forces at the bone–screw interface.

Level of Evidence: N/A