bluuebunny/crossref_metadata_2025 huggingface dataset:
Lobbying and Business Associations
Authors: Waterhouse Benjamin C.
Published: February 2019

Political lobbying has always played a key role in American governance, but the concept of paid influence peddling has been marked by a persistent tension throughout the country’s history. On the one hand, lobbying represents a democratic process by which citizens maintain open access to government. On the other, the outsized clout of certain groups engenders corruption and perpetuates inequality. The practice of lobbying itself has reflected broader social, political, and economic changes, particularly in the scope of state power and the scale of business organization. During the Gilded Age, associational activity flourished and lobbying became increasingly the province of organized trade associations. By the early 20th century, a wide range at political reforms worked to counter the political influence of corporations. Even after the Great Depression and New Deal recast the administrative and regulatory role of the federal government, business associations remained the primary vehicle through which corporations and their designated lobbyists influenced government policy. By the 1970s, corporate lobbyists had become more effective and better organized, and trade associations spurred a broad-based political mobilization of business. Business lobbying expanded in the latter decades of the 20th century; while the number of companies with a lobbying presence leveled off in the 1980s and 1990s, the number of lobbyists per company increased steadily and corporate lobbyists grew increasingly professionalized. A series of high-profile political scandals involving lobbyists in 2005 and 2006 sparked another effort at regulation. Yet despite popular disapproval of lobbying and distaste for politicians, efforts to substantially curtail the activities of lobbyists and trade associations did not achieve significant success.
underworld
Authors: Edmonds Radcliffe G.
Published: February 2019

Depictions of the underworld, in ancient Greek and Roman textual and visual sources, differ significantly from source to source, but they all draw on a common pool of traditional mythic motifs. These motifs, such as the realm of Hades and its denizens, the rivers of the underworld, the paradise of the blessed dead, and the places of punishment for the wicked, are developed and transformed through all their uses throughout the ages, depending upon the aims of the author or artist depicting the underworld. Some sources explore the relation of the world of the living to that of the dead through descriptions of the location of the underworld and the difficulties of entering it. By contrast, discussions of the regions within the underworld and existence therein often relate to ideas of afterlife as a continuation of or compensation for life in the world above. All of these depictions made use of the same basic set of elements, adapting them in their own ways to describe the location of, the entering into, and the regions within the underworld.
sexuality, textual representation of
Authors: Skinner Marilyn B.
Published: February 2019

The basic dominance-submission model of sexual relations, involving a hierarchical distinction between the active and passive roles, was the same in Greek and Roman cultures and remained unchanged throughout classical antiquity. However, we find subtle modifications reflected in the literary tradition from the Homeric age to imperial Rome. In Homer and Hesiod, heterosexual relations are the only recognized form of sexual congress, and consensual sex is mutually pleasurable. Forced sex, in the form of abduction and rape, also occurs in epic narrative. Pederasty became a literary theme in Greek lyric poetry of the archaic age. In classical Athens, discourses of sexuality were tied to political ideology, because self-control was a civic virtue enabling the free adult male householder to manage his estate correctly and serve the city-state in war and peace. Tragedy illustrates the dire impact of unbridled erōs, while comedy mocks those who trespass against moderation or violate gender norms, and forensic oratory seeks to disqualify such offenders from participating in government. Philosophical schools disagreed over the proper place of erōs in a virtuous life. While pederastic relations dominated discussions of love in philosophic works, romantic affairs between men and women received greater attention in Hellenistic poetry, in keeping with an increased emphasis on shared pleasure and reciprocal emotional satisfaction. During the late Republic and the Augustan age, Roman authors incorporated erotic motifs from archaic lyric and Hellenistic epigram into their own first-person love poems. The genre of love elegy, in which the poet-lover professes himself enslaved to a harsh mistress, became widely popular during Augustus’ reign but disappeared shortly thereafter. Meanwhile, Lucretius’ didactic epic On the Nature of Things, and Vergil’s Aeneid, a heroic account of the founding of Rome, both treat erotic obsession as destructive. In the Imperial period, elite anxieties were displaced onto concerns about gender deviance on the part of males and females alike: the figures of the cinaedus and the tribas were castigated in moralizing poetry, especially satire and satiric epigram. Roman novels focused upon the sexual escapades of marginal displaced types. Under Roman rule, on the other hand, Greek literature saw a new flowering in the Second Sophistic movement. While pederasty remained a favorite subject, hotly championed against heterosexual relations in prose treatises, the Greek novel explored a new model of heterosexuality in which premarital chastity and mutual fidelity appear to anticipate later Christian values.
conic sections
Authors: Fried Michael N.
Published: February 2019

The curves known as conic sections, the ellipse, hyperbola, and parabola, were investigated intensely in Greek mathematics. The most famous work on the subject was the Conics, in eight books by Apollonius of Perga, but conics were also studied earlier by Euclid and Archimedes, among others. Conic sections were important not only for purely mathematical endeavors such as the problem of doubling the cube, but also in other scientific matters such as burning mirrors and sundials. How the ancient theory of conics is to be understood also played a role in the general development of the historiography of Greek mathematics.
lex Oppia
Authors: Vuolanto Ville
Published: February 2019

The lex Oppia, decreed in 216 bce, regulated the use of wealth by the Roman women. There are different modern interpretative approaches to the law, dealing with its original contents and purpose (as a sumptuary law or as a wartime emergency measure), its abrogation in 195 bce with Cato the Elder’s speech and women’s demonstrations, and its uses in Livy and the debates in Rome in the late 1st century bce.
feminism and ancient literature
Authors: Morales Helen
Published: February 2019

Feminism does not refer to one coherent theory, doctrine, or political movement. The range of movements and ideologies that thrive under the term feminism, however, are all committed to political and social change. Feminism recognises that we live in a patriarchal world, that is to say a world in which women are, and have historically been, oppressed by and unequal to men. It opposes this, and strives to change existing power structures so that people of all genders and races have control over their own bodies, have equal opportunities and value, can participate fully in community life, and are allowed to live with dignity and freedom.

What has this to do with ancient literature? There are several significant ways in which feminism and ancient literature interact. Ancient literature, particularly ancient Greek tragedy and myth, has played a formative role in shaping feminist theory. Feminism encourages scholars to uncover and reevaluate a tradition of women’s writing. Feminism has provided the tools for us better to understand how ancient literature functioned to promote, and sometimes to challenge, the misogynist practices of ancient Greek and Roman societies. Scholars have detected feminism, or proto-feminism, in ancient writing. Queer theory and feminism join forces to mine ancient literature for alternatives to hetero, cisgender, and gender binary models of identity. Feminism has changed the field of ancient literary studies by valuing authors and genres that are sensitive to the perspectives of women of all ethnicities and statuses. Finally, ancient literature is used to serve contemporary activism: Greek and Latin texts are used by modern feminist authors who rewrite and creatively adapt ancient literature, and classicists resist the use of ancient literature to promote misogyny and white supremacy.
Citrus History, Taxonomy, Breeding, and Fruit Quality
Authors: Inglese Paolo , Sortino Giuseppe
Published: February 2019

In May, every year since 1857, in the great park of Sans-Souci in Potsdam just outside Berlin—a park begun in 1745 by Emperor Frederick II of Hohenzollern and expanded a century later by Frederick William IV—the doors of the great Orangerie open in and a Renaissance-style garden called Sizilianischer Garten is set up. On horse-drawn carriages, large olive and citrus trees are brought outdoors, and are then raised in masters.

For the young European who, in the second half of the 18th century and in the first decades of the following, traveled to Italy to see and study Renaissance culture and the remains of Greek civilization, the citrus species and fruits and groves of southern Italy became the ultimate symbol of beauty and a sort of status symbol of wealth, particularly that of landowners. Nothing is more expressive of the fascination of their fruit than Abu-l-Hasan Ali’s 12th-century writings: “Come on, enjoy your harvested orange: happiness is present when it is present. / Welcome the cheeks of the branches, and welcome the stars of the trees! / It seems that the sky has lavished gold and that the earth has formed some shiny spheres.”

Indeed, Citrus spp. are among the most important crops and consumed fruit worldwide. Their co-evolution due to a millennial agricultural utilization resulted in a complexity of species and cultivated varieties derived by natural or induced mutations, crossing and breeding the “original” species (Citrus medica, Citrus maxima, Citrus reticulate, Fortunella japonica) and their main progenies (C. aurantium, C. sinensis, Citrus limon, Citrus paradisi, Citrus clementina, etc.). Citrus spread from the original tropical and subtropical regions of southeast Asia toward the Mediterranean countries of Europe and North Africa and, after 1492, in the Americas, not to mention South Africa and Australia, where they still have a very important role. Citrus species, wherever they have been cultivated, quickly became the protagonists of the letters and the arts, as well as the markets and gastronomy, and can even be found in religious ceremonies, such as for Feast of Tabernacles (Sukkot). Studies on Citrus botany, cultivation, and utilization have been pursued since the early stages of the fruit’s domestication and grew following their introduction in Europe, the Americas, Africa, and Australia. Citrus research involves many different aspects: such as the study of citrus origin and botanical classification; citrus growing, propagation, and orchard management; citrus fruit quality, utilization and industry; citrus gardening and ornamentals; citrus in arts and manufacturing.
Agricultural Nitrogen and Phosphorus Pollution in Surface Waters
Authors: Bechmann Marianne , Stålnacke Per
Published: February 2019

Nutrient pollution can have a negative impact on the aquatic environment, with loss of biodiversity, toxic algal blooms, and a deficiency in dissolved oxygen in surface waters. Agricultural production is one of the main contributors to these problems; this article provides an overview of and background for the main biogeochemical processes causing agricultural nutrient pollution of surface waters. It discusses the main features of the agricultural impact on nutrient loads to surface waters, focusing on nitrogen and phosphorus, and describes some of the main characteristics of agricultural management, including processes and pathways from soil to surface waters. An overview of mitigation measures to reduce pollution, retention in the landscape, and challenges regarding quantification of nutrient losses are also dealt with. Examples are presented from different spatial scales, from field and catchment to river basin scale.
Seed Banking as Future Insurance Against Crop Collapses
Authors: Hay Fiona
Published: February 2019

Food security is dependent on the work of plant scientists and breeders who develop new varieties of crops that are high yielding, nutritious, and tolerate a range of biotic and abiotic stresses. These scientists and breeders need access to novel genetic material to evaluate and to use in their breeding programs; seed- (gene-)banks are the main source of novel genetic material. There are more than 1,750 genebanks around the world that are storing the orthodox (desiccation tolerant) seeds of crops and their wild relatives. These seeds are stored at low moisture content and low temperature to extend their longevity and ensure that seeds with high viability can be distributed to end-users. Thus, seed genebanks serve two purposes: the long-term conservation of plant genetic resources, and the distribution of seed samples.

Globally, there are more than 7,400,000 accessions held in genebanks; an accession is a supposedly distinct, uniquely identifiable germplasm sample which represents a particular landrace, variety, breeding line, or population. Genebank staff manage their collections to ensure that suitable material is available and that the viability of the seeds remains high. Accessions are regenerated if viability declines or if stocks run low due to distribution. Many crops come under the auspices of the International Treaty on Plant Genetic Resources for Food and Agriculture and germplasm is shared using the Standard Material Transfer Agreement. The Treaty collates information on the sharing of germplasm with a view to ensuring that farmers ultimately benefit from making their agrobiodiversity available.

Ongoing research related to genebanks covers a range of disciplines, including botany, seed and plant physiology, genetics, geographic information science, and law.
Islam and Social Work
Authors: Husain Altaf
Published: February 2019

During the 21st century, professional organizations such as the National Association of Social Workers have sanctioned standards for religious competence in social work practice and education. Social work practitioners and students are expected to receive training and education in spirituality. While content on Islam and Muslims is emerging in the professional literature, this is the first article in the Encyclopedia to explore the relatedness between the teachings of the Islamic faith and the social work profession. The Muslim population in the world, and in the United States specifically, is described briefly, along with an overview of intra-faith diversity. Social work practice with Muslims can be enhanced substantially when practitioners are aware of the worldview of Muslims and core Islamic values. In addition, practitioners should be familiar with Islamic teachings within a historical and professional context. Micro and macro level practice strategies and approaches are presented with a special emphasis on social work values and ethics. Lastly, practice principles for religion-sensitive practice with clients who self-identify as Muslims are delineated.
Age at Immigration, Generational Status, and Death Among Children of Immigrant Mothers: A Longitudinal Analysis of Siblings
Authors: Mehta Neil K , Martikainen Pekka , Cederström Agneta
Published: February 2019

Studies have documented that age at immigration and generational status are important predictors of socioeconomic outcomes among children of immigrants. Whether these characteristics are related to long-term risk of death is unknown. Leveraging variation within sibships, we evaluated the association of age at immigration and generational status (i.e., first or second generation) with death among children of immigrant mothers to Sweden. Data included 272,429 individuals (126,701 sibships) aged 15 or more years from the total Swedish population followed between 1990 and 2009. Population-average and sibling fixed-effect regressions were estimated, with the latter controlling for unobserved factors shared by siblings. The foreign-born children of immigrants experienced a 17% higher risk of death than the Swedish-born children of immigrants. This excess risk was evident for external and nonexternal causes of death. In general, a graded association was not detected between age at immigration and death among the foreign-born individuals; however, those arriving during primary school ages appeared especially vulnerable. This study provides robust evidence that among children of immigrants, being foreign born was associated with a long-term death penalty compared with being born in the host country.
Electrophysiological and transcriptomic correlates of neuropathic pain in human dorsal root ganglion neurons
Authors: North Robert Y , Li Yan , Ray Pradipta , Rhines Laurence D , Tatsui Claudio Esteves , Rao Ganesh , Johansson Caj A , Zhang Hongmei , Kim Yeun Hee , Zhang Bo , Dussor Gregory , Kim Tae Hoon , Price Theodore J , Dougherty Patrick M
Published: February 2019

Neuropathic pain encompasses a diverse array of clinical entities affecting 7–10% of the population, which is challenging to adequately treat. Several promising therapeutics derived from molecular discoveries in animal models of neuropathic pain have failed to translate following unsuccessful clinical trials suggesting the possibility of important cellular-level and molecular differences between animals and humans. Establishing the extent of potential differences between laboratory animals and humans, through direct study of human tissues and/or cells, is likely important in facilitating translation of preclinical discoveries to meaningful treatments. Patch-clamp electrophysiology and RNA-sequencing was performed on dorsal root ganglia taken from patients with variable presence of radicular/neuropathic pain. Findings establish that spontaneous action potential generation in dorsal root ganglion neurons is associated with radicular/neuropathic pain and radiographic nerve root compression. Transcriptome analysis suggests presence of sex-specific differences and reveals gene modules and signalling pathways in immune response and neuronal plasticity related to radicular/neuropathic pain that may suggest therapeutic avenues and that has the potential to predict neuropathic pain in future cohorts.
Faecal Microbiota Dynamics and their Relation to Disease Course in Crohn’s Disease
Authors: Galazzo Gianluca , Tedjo Danyta I , Wintjens Dion S J , Savelkoul Paul H M , Masclee Ad A M , Bodelier Alexander G L , Pierik Marie J , Jonkers Daisy M A E , Penders John
Published: February 2019

Background

Microbial shifts have been associated with disease activity in Crohn’s disease [CD], but findings on specific taxa are inconsistent. This may be due to differences in applied methods and cross-sectional study designs. We prospectively examined the faecal microbiota in adult CD patients with changing or stable disease course over time.

Methods

Faeces were collected at two time-points from 15 healthy control individuals [HCs], 35 CD patients who were in remission and who maintained remission [RRs], and 22 CD patients during remission and also during subsequent exacerbation [RAs]. The microbial composition was assessed by 16S rRNA [V4] gene sequencing.

Results

Compared with HCs, patients with CD had a lower microbial richness [p = 0.0002] and diversity [p = 0.005]. Moreover, the microbial community structure of a subset of patients, clustered apart from HCs, was characterized by low microbial diversity and Faecalibacterium abundance. Patients within this cluster did not differ with respect to long-term disease course compared with patients with a ‘healthy-appearing’ microbiota.

Over time, microbial richness and diversity did not change in RR versus RA patients. Although the microbial community structure of both RR and RA patients was less stable over time compared with that of HCs, no differences were observed between the patient groups [p = 0.17]; nor was the stability impacted by Montreal classification, medication use, or surgery.

Conclusion

The altered microbiota composition and stability in CD was neither associated with disease activity nor long-term disease course, questioning its involvement in the development of an exacerbation. The aberrant microbiota composition in a subset of CD patients warrants further exploration of a more microbiota-driven etiology in this group.
Hybrid positron emission tomography-magnetic resonance imaging for assessing different stages of cardiac impairment in patients with Anderson–Fabry disease: AFFINITY study group
Authors: Imbriaco Massimo , Nappi Carmela , Ponsiglione Andrea , Pisani Antonio , Dell’Aversana Serena , Nicolai Emanuele , Spinelli Letizia , Aiello Marco , Diomiaiuti Claudio Tommaso , Riccio Eleonora , Esposito Roberta , Galderisi Maurizio , Losi Mariangela , Greiser Andreas , Chow Kelvin , Cuocolo Alberto
Published: February 2019

Aims

Anderson–Fabry disease (AFD) is an X-linked lysosomal storage disorder associated with multi-organ dysfunction. While native myocardial T1 mapping by magnetic resonance (MR) allow non-invasive measurement of myocyte sphingolipid accumulation, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and MR are able to identify different pathological patterns of disease progression. We investigated the relationship between T1 mapping and 18F-FDG uptake by hybrid PET-MR cardiac imaging in AFD female patients.

Methods and results

Twenty AFD females without cardiac symptoms underwent cardiac PET-MR using 18F-FDG for glucose uptake. In all patients and in seven age- and sex-matched control subjects, T1 mapping was performed using native T1 Modified Look-Locker Inversion-recovery prototype sequences. 18F-FDG myocardial uptake was quantified by measuring the coefficient of variation (COV) of the standardized uptake value using a 17-segment model. T1 values of AFD patients were lower compared with control subjects (1236 ± 49 ms vs. 1334 ± 27 ms, P < 0.0001). Focal 18F-FDG uptake with COV >0.17 was detected in seven patients. COV was 0.32 ± 0.1 in patients with focal 18F-FDG uptake and 0.12 ± 0.04 in those without (P < 0.001). Patients with COV >0.17 had higher T1 values of lateral segments of the mid ventricular wall, compared with those with COV ≤0.17 (1216 ± 22 ms vs. 1160 ± 59 ms, P < 0.05).

Conclusion

In females with AFD, focal 18F-FDG uptake with a trend towards a pseudo-normalization of abnormal T1 mapping values, may represent an intermediate stage before the development of myocardial fibrosis. These findings suggest a potential relationship between progressive myocyte sphingolipid accumulation and inflammation.
Medicare Access and Children’s Health Insurance Program Reauthorization Act: The Basics for the Breast Imaging Radiologist
Authors: Golding Lauren Parks , Nicola Gregory N
Published: February 2019

Breast imaging radiologists are considered by many to be leaders among diagnostic radiologists in the transition to value-based care. Many strategies for success in the changing healthcare landscape are exemplified by the day-to-day practice of breast imaging, including well-developed quality measures, standardized accepted best practices and terminology, and a prominent role in communicating with patients and coordinating care. Further development of these strategies will be important for continued success in both the Merit-Based Incentive Payment System and in alternative payment models.
Spermatological Morphology of Triatoma Species (Hemiptera: Reduviidae: Triatominae)
Authors: Oliveira Maria Luiza Ribeiro de , Camara Daniel Cardoso Portela , Freitas Simone Patrícia Carneiro , Santos-Mallet Jacenir Reis
Published: February 2019

Spermatozoa are among the most diverse cell types, and their morphologies often provide data that can be used to reliably evaluate phylogenetic relationships. They can also help to clarify the nature of ‘specific complexes’, which are common among triatomines. In the present study, we evaluated the copulation behavior of Triatoma rubrovaria Blanchard 1843 (Hemiptera: Reduviidae: Triatominae) and the structural morphology of sperm from T. carcavalloi Jurberg Rocha & Lent, 1998, T. infestans Klug, 1834, T. pintodiasi Jurberg Cunha & Rocha, 2013, and T. rubrovaria. Copulatory behavior was described from the moment males and females genitalia joined until they separated. Insemination was confirmed by the presence of a spermatophore in the female’s bursa copulatrix. To measure their sperm, males were dissected and their seminal vesicles were removed, squashed on glass slides, and then spread, fixed, and observed under a photomicroscope. The images obtained were analyzed to measure the sperm. Seminal vesicles were also prepared for transmission electron microscopy. We performed K-means clustering separately for each species to group their sperm based on morphology. The differences in spermatozoa length among species of Triatominae, sperm types, and the interaction between species and sperm type were assessed with a two-way analysis of variance (ANOVA). The copulation time in T. rubrovaria was 3 to 5 min, which was sufficiently long for spermatophore transfer. All taxa showed polymorphic (short and long) sperm, with significant differences in the lengths of sperm among taxa. Using electron microscopy, the sperm cells of the four taxa examined were found to have similar ultrastructural morphology, confirming the hypothesized synapomorphies of sperm within the suborder Heteroptera (Hemiptera).
Senescence of the Kidney
Authors: O’Sullivan Eoin D. , Ferenbach David A.
Published: February 2019

Senescence is a state of terminal growth arrest, with associated structural and functional changes in the affected cell. Cellular senescence can be induced in embryogenesis and in response to stimuli including aging, DNA damage, and cell stress. There is great interest in the physiological function and pathological role of senescent cells in the progression of the renal aging phenotype and chronic kidney disease. This chapter will explore the incomplete but evolving knowledge of the roles for senescence in the developing, injured, aged, and scarred kidneys. The potential for senescent cells to be targeted to maximize renal protection in the face of aging and injury will also be summarized.
Nephron-Sparing Surgery
Authors: Puliatti Stefano , Ferrari Nancy , Rocco Bernardo , Bianchi Giampaolo , Micali Salvatore
Published: February 2019

Exceptional advances in diagnostic imaging has resulted in an increased diagnosis of mass at early stages. Currently, more than half of the renal tumors are characterized by their small size at the time of diagnosis. Thus, we no longer consider the removal of the entire kidney as an appropriate treatment for these small-sized renal tumors. Thanks to the new technologies and the anatomic-functional studies, the management of small-sized renal tumors has changed from open surgery, with complete removal of the kidney, to a minimal invasive surgery that aims to resect only the mass, saving healthy renal parenchyma and residual kidney function. Although, healthy parenchyma preservation is of a huge benefit for the patient, it makes surgery more complex. This chapter addresses the development pathway that led to nephron-sparing surgery. Moreover, its indications, possible benefits, complications and the intervention techniques will be discussed.
Hepatorenal Syndrome
Authors: Durand François , Francoz Claire , DiNorcia Joseph , Genyk Yuri S. , Nadim Mitra K.
Published: February 2019

Hepatorenal syndrome (HRS) occurs in patients with end-stage liver disease and results from the complex circulatory changes associated with cirrhosis, where splanchnic vasodilatation and effective hypovolemia play central roles. Although related to hypovolemia, HRS is not reversed by volume expansion. In theory, HRS is not associated with structural changes in the kidney and, thus, is fully reversible with liver transplantation. Improvement may be observed with vasoconstrictors such as terlipressin in combination with albumin. However, in the absence of transplantation, HRS is associated with an extremely poor prognosis, even in patients who respond to vasoconstrictors. It is important to differentiate HRS from acute tubular necrosis because the therapeutic approach to each is different. Recent biomarkers are helpful but do not allow a clear distinction.
Hospital-Based Palliative Care
Authors: Maani-Fogelman Patricia
Published: February 2019

Hospital-based palliative care (HBPC) is often the primary contact between patients and the field of palliative care. As such, HBPC programs must be built to withstand the challenges and demands of the changing healthcare landscape and the shifting, often complex needs of the inpatient consultation. Time, energy, strong interpersonal communication skills, and dedication are key elements to building a successful HBPC program. Attention to detail and attentiveness to patient wishes round out the foundation of the continuum. HBPC is a forum for expansion of palliative care services into the medical clinics, outreach facilities, community-based practices, and home care venues. The role of nursing across this spectrum of care amid advancing chronic illness is a vital aspect of programmatic success. Ongoing education and research must be offered and resourced for HBPC and palliative care in general to remain steadfast and successful against the background of national healthcare reform.
Fatigue
Authors: O’Neil-Page Edith , Dean Grace E. , Anderson Paula R.
Published: February 2019

Individuals suffering from chronic or malignant disease may experience overwhelming and debilitating symptoms of extensive tiredness or sleepiness or an inability to meet daily self-care requirements and maintain personal interaction with significant others. However, they may be unable to verbalize the impact of fatigue on their daily activities. Fatigue is both personal and communal, affecting all aspects of life. Fatigue is often unrecognized by family and healthcare providers or is accepted as a “side effect” of disease and treatment. Cancer-related fatigue affects all aspects of life, at all ages, and may remain unacknowledged by healthcare providers. Yet with recognition and intervention, fatigue can be successfully managed throughout the course of disease, recovery, or through end of life.
Nausea and Vomiting
Authors: Collett David , Chow Kimberly
Published: February 2019

Nausea and vomiting are highly prevalent and distressing symptoms experienced by patients in both the cancer and noncancer palliative care population. Nausea and vomiting, although often occurring together, are two distinct symptoms and should be assessed and managed as such. The cause of these symptoms is often multifactorial and may be directly related to the disease itself and/or disease-specific treatments. A comprehensive assessment of the patient includes a thorough history and physical exam, with the consideration of diagnostic tests if this is in line with the patient’s goals and the results can help guide treatment decisions. The skilled palliative care nurse understands that the management of symptoms such as nausea and vomiting can improve the overall quality of life for patients and requires a holistic, patient-centered approach that includes both pharmacologic and nonpharmacologic methods.
Dysphagia, Hiccups, and Other Oral Symptoms
Authors: Klinedinst Rachel , Kurash Cohen Audrey , Dahlin Constance M.
Published: February 2019

Dysphagia, hiccups, and other oral symptoms, including sialorrhea, xerostomia, and dysgeusia, are commonly experienced in patients with terminal illnesses and are symptoms of many diseases and health conditions in patients receiving palliative care. These symptoms often occur concurrently and not only impact a patient’s safety and ability to sustain adequate nutrition and hydration, but also physical comfort, social well-being, and quality of life. Consideration of any intervention should be aligned closely with the patient’s overall goals of care and treatment plan. Management of swallowing difficulties and oral complications in patients with serious illness focuses on preventing functional decline, maximizing quality of life and comfort, and supporting the patient’s wishes. Nurses must identify the presence of these symptoms and understand their negative impact on quality of life. A multidisciplinary team-based approach will promote successful treatment with better outcomes and improved relief of symptoms.
Insomnia
Authors: Schroeder Karla
Published: February 2019

Insomnia is prevalent in people with serious illness and can adversely affect quality of life. The presence of insomnia in advanced disease is often correlated with comorbid conditions and symptomatology. Poorly managed insomnia is reported as one of the most frequent complaints for patients with serious illness. Management of insomnia requires a comprehensive assessment of the multidimensional components of the syndrome, which includes the physical, emotional, psychosocial, and spiritual aspects of care. Treatment for insomnia varies based on the contributing factors and often involves pharmacological and nonpharmacological interventions. This chapter provides a model for assessment and intervention, using a holistic approach to care for those who suffer from insomnia due to a serious illness.
Withdrawal of Invasive Mechanical Ventilation
Authors: Campbell Margaret L.
Published: February 2019

The withdrawal of invasive mechanical ventilation is done to allow a natural death. Families may or may not be at the bedside according to their preference. Patients dependent on mechanical ventilation may be at high risk for experiencing respiratory distress during and after withdrawal. Close attention to assessing for respiratory distress is integral to the procedure. A number of processes constitute this palliative procedure, including pre-medication for anticipatory respiratory distress, assessing for respiratory distress, treating any respiratory distress with morphine, reducing the ventilatory support, and removing the endotracheal tube. Estimations of duration of survival will contribute to post-withdrawal triage decisions.
Planning for the Actual Death
Authors: Berry Patricia , Griffie Julie
Published: February 2019

This chapter examines and addresses the critical role that nursing has in facilitating a “good death”—however the patient and family define it—including care before and after the death. As death nears, there is only one chance to “get it right.” In addition to summarizing the symptoms that are common and intensify as death nears, the chapter presents a nursing framework for working with patients and families during this stressful yet meaningful time. The chapter also revisits and discusses, in the context of approaching death, issues related to advance care planning, a family goals of care conference, vital signs, medically administered fluids, cardiopulmonary resuscitation, and discontinuing dialysis. Signs and symptoms of impending death and postmortem changes are summarized to enable the nurse to interpret and normalize these changes to those present before and after the death. The chapter concludes with a discussion of how the nurse can facilitate the early grieving process.
Palliative Care for Patients with Mental Illness
Authors: Chovan John D. , Morgan Betty D.
Published: February 2019

This chapter describes the challenges and special needs for persons living with severe and persistent mental illness as they face chronic and life-threatening illnesses. Healthcare providers, especially those working on palliative care interdisciplinary teams, will learn the magnitude of this underserved population; their circumstances; the special needs of the persons with schizophrenia, bipolar disorder, and personality disorders; and those aspects of their mental illness that limit access to and delivery of appropriate healthcare throughout the trajectory of their illnesses. Techniques for caring for and communicating with patients and their families are offered, as are ethical decision-making advice regarding refusal of treatment, capacity and competence, advance directives, and interpersonal issues.
Long-Term Care
Authors: Carpenter Joan , Ersek Mary
Published: February 2019

This chapter examines palliative care across residential care settings with a focus on nursing homes. It reviews the environment of nursing homes, describes the residents who live there, and provides details about the interdisciplinary team providers who care for the residents. It also discusses the challenges and opportunities for delivering palliative care services to nursing home residents with life-limiting illness. Quality end-of-life care in nursing homes is important because more than 1.4 million Americans live in nursing homes, and more than half of these residents require extensive assistance with bathing, dressing, toileting, and mobility. Of those nursing home residents over 65 years of age, 80% are 75 years or older. Despite the efforts to keep frail elders in the community, the nursing home population is expected to increase as the numbers of older persons in the United States and other developed countries increase. The chapter concludes with a description of models for delivering palliative care in nursing homes.
The Role of PT, OT, and Other Therapies in Palliative Care for Seriously Ill Patients
Authors: Lin Dennis , Borjan Megan , San Andres Seanell D. , Kelly Christina
Published: February 2019

This chapter describes the roles of physical therapy, occupational therapy, speech language pathology, and recreation therapy in providing rehabilitation for patients receiving palliative care. Palliative rehabilitation should be included as part of a comprehensive interdisciplinary effort to support patients who experience functional impairments or symptoms that impact daily life and that result from terminal illness. Palliative rehabilitation focuses on creating collaborative goals that address disability and easing symptom burden to maximize or maintain function throughout every stage of disease. Patients receiving the appropriate rehabilitative interventions can adapt to the changes and foster an optimal quality of life. Nurses collaborate with the rehabilitation team so that patients and their caregivers can achieve a greater benefit from their palliative care.
Grief and Bereavement in Perinatal and Pediatric Palliative Care
Authors: Limbo Rana , Kobler Kathie , Davies Betty
Published: February 2019

The diagnosis of a life-threatening condition in a young child (including the unborn) brings staggering grief when the prognosis predicts the likelihood of an early death. The diagnoses range from genetic or chromosomal disorders that will cause death either during pregnancy or shortly after birth to malignancy, severe prematurity, and trauma, among others. Perinatal and pediatric palliative care are discussed from the standpoint of relationship, highlighting nursing care that focuses on a theory of teaching and learning—guided participation. As family members learn to deal with their own and their child’s suffering and physical condition, the nurse joins with them in identifying how relational, task-related, and emotional competencies can be attained and maintained by establishing new goals (regoaling) and hopes. The purpose of this chapter is to discuss grief as a life-long, relational process. The trajectory of grief reflects how survivors of loving relationships maintain closeness and connection, cherishing dear ones who are no longer physically present. The authors highlight grief theory and provide examples of clinical application. Chapter content also includes practical strategies for grief assessment and supporting bereaved parents and children. Finally, the authors focus on how healthcare providers are affected by the intensity of bearing witness to the child’s, family’s, and other team members’ suffering.
Self-Care
Authors: Kravits Kathy G.
Published: February 2019

Self-care is growing as a topic for scientific inquiry. In this chapter, the biological basis of the stress response and the recent evidence of the consequences of persistent and ongoing stressors overwhelming the individual’s resources will be discussed. Secondary to the growing awareness of the destructive consequences of persistent stress, palliative care providers are affected by both stress inherent in the emotional labor of the work and lack of self-care. The result is risk for the development of compassion fatigue, burnout, and secondary traumatic stress symptoms. Martin Seligman’s work in positive psychology and Happiness Theory will be used to explore well-being and the intentional creation of greater life satisfaction.
Ethical Considerations in Palliative Care
Authors: Prince-Paul Maryjo , Daly Barbara J.
Published: February 2019

Given the complexity of the healthcare system and individual patients who have a serious illness, nurses often are uncertain about the right or most ethically sound action. The nurse who identifies ethical issues or questions will need to use a systematic process to examine the situation and reach a decision about what action to take. Although moral questions can arise about any aspect of nursing practice, including informed consent and duties to colleagues, the issues most frequently encountered in palliative care center around end-of-life decisions. These include withholding and withdrawing treatment (e.g., mechanical ventilation, medically administered nutrition and hydration, cardiopulmonary resuscitation, cardiac assist devices) and concerns about requests for hastened death, nonbeneficial interventions, and palliative sedation. These discussions will be most helpful when they focus on values and goals of care rather than on specific treatments. Although it is increasingly recognized that clinicians have not only the right but the professional duty to refrain from interventions that are harmful, it is essential to be cautious in judging interventions as “futile” or medically inappropriate. Decisions regarding ethical dilemmas and the choices that are necessary require thoughtful discussion and critical communication skills.
The Ethos of Palliative Nursing
Authors: Lazenby Mark , Moore Michael Anthony
Published: February 2019

The moral character of palliative nursing can be defined by the qualities inherent in a caring relationship. Trustworthiness is the quality of being competent, reliable, and honest, all of which guide nurses in building caring relationships with their patients. Imagination aids nurses in identifying creative ways to meet patients’ desires and needs within the confines of illness. Beauty is honoring patients’ humanity and personhood by seeing patients as separate from their illnesses and seeing their aliveness through active listening. In the context of the impersonal medical industrial complex, space is creating and opening physical and spiritual spaces in which patients can still be themselves. Presence is not imposing nurses’ desires upon their patients, nor is presence imposing the impersonality of treating patients as case numbers; it is, rather, being with them as human beings. Through these five qualities of a caring relationship, palliative nurses can help see the humanity of their patients and also the humanity within themselves. The patient-to-nurse relationship is a human-to-human relationship built on trust, imagination, beauty, space, and presence, which leads to honoring the patient and aids patient and nurse in mutual spiritual and emotional growth.
Psychoeducational Interventions for Cancer Family Caregivers
Authors: Dionne-Odom J. Nicholas , Bakitas Marie A. , Ferrell Betty
Published: February 2019

The term psychoeducation, first employed by Anderson et al., was used to describe an approach to psychotherapy that included helping individuals better understand their illness and acquire basic skills in problem-solving, communication, and coping. This chapter first provides an overview of the components of psychoeducation in the context of cancer caregiving, then describes therapeutic goals and the counseling techniques employed to reach these goals. A recent literature review of cancer family caregiver interventions is then presented with particular focus on the dose, content, format, and reported effectiveness of tested psychoeducational interventions. Finally, an overview of one psychoeducational intervention for cancer caregivers, ENABLE (Educate, Nurture, Advise, Before Life Ends), is detailed with an accompanying case example.
Paediatric urology
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter covers paediatric urology, and the fourth edition includes the latest guidelines and recommendations (National Institute for Health and Care Excellence 2013, British Association of Paediatric Urologists 2015). The embryology of the urinary and genital tracts is detailed. The presentation of undescended testes, vesicoureteric reflux, and urinary tract infection and their current management recommendations are included. New sections in the fourth edition include paediatric trauma, nephrolithiasis, uro-physiology, and the foreskin. Megaureter, ectopic ureter, and ureterocele are also covered in detail. Hypospadias and epispadias are covered. This chapter also includes the assessment and management of children with urinary incontinence and nocturnal enuresis.
Basic science and renal transplant
Authors: Reynard John , Brewster Simon F , Biers Suzanne , Neal Naomi Laura
Published: February 2019

This chapter covers the basic physiological functions of the kidney, bladder, and urethra. Renal anatomy is detailed, including the anatomical relations of the kidney. Renal physiology is covered in detail, including the regulation of renal blood flow and regulation of water, acid–base, sodium, and potassium balance. It includes the principles of renal replacement therapy and the principles of renal transplantation, including assessment of both the recipient and the donor. Transplant surgery is outlined, including commonly used drugs and complications and their management and common complications of renal transplant surgery. The different types of organ rejection are discussed, including their treatments.
The concept of recognition and the problem of freedom
Authors: Rashed Mohammed Abouelleil
Published: February 2019

This chapter, “The concept of recognition and the problem of freedom,” reconstructs the concept of recognition by tracing its dialectical development in Hegel’s Phenomenology of Spirit. The chapter offers a reading of the dialectic in which the central animating problem is the nature of freedom: how can a subject affirm its independence in the midst of other subjects; can it do so alone without taking account of anyone outside of it, or is dependence on the recognition of others a condition of its freedom? In addressing this question, the chapter contrasts Kant’s and Hegel’s views on autonomy and freedom. It explores various interpretations of Hegel’s idealism in the course of seeking an account of the concept of recognition that can be acceptable for us today. It argues that recognition is a concept that we ought to employ in thinking about freedom and social relations.