bluuebunny/crossref_metadata_2025 huggingface dataset:
Does isolation of the left atrial posterior wall using cryoballoon ablation improve clinical outcomes in patients with persistent atrial fibrillation? A prospective randomized controlled trial
Authors: Ahn Jinhee , Shin Dong Geum , Han Sang Jin , Lim Hong Euy
Published: January 2022

Aims

Posterior wall isolation (PWI) of the left atrium (LA) adjunct to pulmonary vein isolation (PVI) by radiofrequency catheter ablation has shown favourable outcomes in patients with persistent atrial fibrillation (PeAF). This study was sought to investigate the efficacy and safety of additional PWI by cryoballoon ablation (CBA) alone in patients with PeAF.

Methods and results

Patients who underwent de novo CBA for PeAF (n = 100) were randomly assigned (1 : 1) to the PVI only group and PVI combined with PWI (PVI+PWI) group. Procedural and clinical outcomes were prospectively compared over a 12-month follow-up.

 

Baseline characteristics, including mean AF duration (56.2 ± 43.2 months) and LA size (48.2 ± 7.7 mm), were well-balanced between the groups. Successful PVI was achieved in all patients. In the PVI+PWI group, complete PWI by CBA was achieved in 31 (62%) patients. The LA indwelling and procedure times were significantly longer in the PVI+PWI group. The complication rates were not different between groups. During a mean follow-up of 457.9 ± 61.8 days, the recurrence rate of atrial tachyarrhythmia was significantly lower in the PVI+PWI group than in the PVI only group (24% vs. 46%; P = 0.035). The recurrence-free survival rate was significantly higher in the PVI+PWI group compared with the PVI only group, irrespective of complete PWI (log-rank P = 0.013). Multivariate analysis showed that adjunctive PWI [hazard ratio (HR) 0.255; P = 0.003] and LA size (HR 1.079; P = 0.014) were independent predictors of clinical recurrence.

Conclusion

Compared with PVI only, adjunctive PWI achieved exclusively by CBA resulted in better clinical outcomes without increasing complications in patients with PeAF.
Electrical markers and arrhythmic risk associated with myocardial fibrosis in mitral valve prolapse
Authors: Chivulescu Monica , Aabel Eivind W , Gjertsen Erik , Hopp Einar , Scheirlynck Esther , Cosyns Bernard , Lyseggen Erik , Edvardsen Thor , Lie Øyvind H , Dejgaard Lars A , Haugaa Kristina H
Published: January 2022

Aims

We aimed to characterize the substrate of T-wave inversion (TWI) using cardiac magnetic resonance (CMR) and the association between diffuse fibrosis and ventricular arrhythmias (VA) in patients with mitral valve prolapse (MVP).

Methods and results

TWI was defined as negative T-wave ≥0.1 mV in ≥2 adjacent ECG leads. Diffuse myocardial fibrosis was assessed by T1 relaxation time and extracellular volume (ECV) fraction by T1-mapping CMR. We included 162 patients with MVP (58% females, age 50 ± 16 years), of which 16 (10%) patients had severe VA (aborted cardiac arrest or sustained ventricular tachycardia). TWI was found in 34 (21%) patients. Risk of severe VA increased with increasing number of ECG leads displaying TWI [OR 1.91, 95% CI (1.04–3.52), P = 0.04]. The number of ECG leads displaying TWI increased with increasing lateral ECV (26 ± 3% for TWI 0-1leads, 28 ± 4% for TWI 2leads, 29 ± 5% for TWI ≥3leads, P = 0.04). Patients with VA (sustained and non-sustained ventricular tachycardia) had increased lateral T1 (P = 0.004), also in the absence of late gadolinium enhancement (LGE) (P = 0.008).

Conclusions

Greater number of ECG leads with TWI reflected a higher arrhythmic risk and higher degree of lateral diffuse fibrosis by CMR. Lateral diffuse fibrosis was associated with VA, also in the absence of LGE. These results suggest that TWI may reflect diffuse myocardial fibrosis associated with VA in patients with MVP. T1-mapping CMR may help risk stratification for VA.
Geosocial Features and Loss of Biodiversity Underlie Variable Rates of Inflammatory Bowel Disease in a Large Developing Country: A Population-Based Study
Authors: da Luz Moreira Andre , de Campos Lobato Luiz Felipe , de Lima Moreira Jessica Pronestino , Luiz Ronir Raggio , Elia Celeste , Fiocchi Claudio , de Souza Heitor Siffert Pereira
Published: January 2022

Background

The epidemiology of inflammatory bowel disease (IBD) in developing countries may uncover etiopathogenic factors. We investigated IBD prevalence in Brazil by investigating its geographic, spatial, and temporal distribution, and attempted to identify factors associated with its recent increase.

Methods

A drug prescription database was queried longitudinally to identify patients and verify population distribution and density, race, urbanicity, sanitation, and Human Development Index. Prevalence was calculated using the number of IBD patients and the population estimated during the same decade. Data were matched to indices using linear regression analyses.

Results

We identified 162 894 IBD patients, 59% with ulcerative colitis (UC) and 41% with Crohn’s disease (CD). The overall prevalence of IBD was 80 per 100 000, with 46 per 100 000 for UC and 36 per 100 000 for CD. Estimated rates adjusted to total population showed that IBD more than triplicated from 2008 to 2017. The distribution of IBD demonstrated a South-to-North gradient that generally followed population apportionment. However, marked regional differences and disease clusters were identified that did not fit with conventionally accepted IBD epidemiological associations, revealing that the rise of IBD was variable. In some areas, loss of biodiversity was associated with high IBD prevalence.

Conclusions

When distribution is considered in the context of IBD prevalence, marked regional differences become evident. Despite a background of Westernization, hotspots of IBD are recognized that are not explained by population density, urbanicity, sanitation, or other indices but apparently are explained by biodiversity loss. Thus, the rise of IBD in developing countries is not uniform, but rather is one that varies depending on yet unexplored factors like geoecological conditions.
SARS-CoV-2 Infectivity and Antibody Titer Reduction for 6 Months After Second Dose of BNT162b2 mRNA Vaccine in Health Care Workers: A Prospective Cohort Study
Authors: Kim Namhee , Shin Sue , Minn Dohsik , Park Seungman , An Dongheui , Park Jae Hyeon , Roh Eun Youn , Yoon Jong Hyun , Park Hyunwoong
Published: January 2022

Several studies reported that severe acute respiratory syndrome coronavirus-2 antibody levels change over 6 months in participants receiving the vaccination. From the enrolled 272 health care workers (HCWs), blood samples were obtained at 2, 16, and 24 weeks after the second vaccination dose. In the 267 noninfected HCWs, the neutralizing antibodies decreased by 23.9%, and the anti-spike/receptor binding domain antibody decreased by 53.8% at 24 weeks. We observed no significant difference in antibody reduction between the sexes; however, in younger individuals, there was higher antibody formation and lower reduction rates of the neutralizing antibody. In 3 HCWs with breakthrough infections, the antibody levels were relatively low just before the coronavirus disease 2019 infection. In conclusion, as antibody titers decrease over time after the second vaccination dose and HCWs with low antibody titers tend to have a high probability of breakthrough infection, an additional dose should be considered after several months.

Blood samples were obtained from health care workers at 2, 16, and 24 weeks after a second vaccination dose. Antibody titers decreased over time and the participants with low antibody titers tended to have a high probability of breakthrough infection.
World Travelers: Parthenogenesis and Ecological Tolerance Enable Multiple Colonization Events by the Widespread Short-Tailed Whipscorpion, Stenochrus portoricensis (Schizomida: Hubbardiidae)
Authors: Monjaraz-Ruedas Rodrigo , Francke Oscar F , Prendini Lorenzo
Published: January 2022

Whereas morphology remains a powerful tool for the diagnosis and description of short-tailed whip scorpions, or schizomids (Order Schizomida Petrunkevitch, 1945), especially when adults of both sexes are available, the systematics of some schizomid taxa is difficult to resolve due to a lack of characters in these morphologically conserved arachnids. Stenochrus portoricensis Chamberlin, 1922, defined on a single character of the female spermathecae, is the most widespread schizomid in the New World. Numerous records in the Neotropics, from the southern United States to Brazil, throughout the Caribbean, and further afield, including the Galapagos Islands and Europe, raise the question as to whether S. portoricensis is indeed a single widespread species or a complex of multiple species with conserved morphology? The present study uses a multilocus dataset and the broadest geographical sample currently available to address the phylogeography of S. portoricensis with molecular divergence dating and ancestral area reconstruction of all currently known species of Stenochrus Chamberlin, 1922. Analyses recovered S. portoricensis as paraphyletic. Two species previously synonymized are revalidated and transferred to Stenochrus. Population structure analyses recovered the remaining samples of S. portoricensis as a single monophyletic species with low genetic divergence and comprising two subclades. Ancestral area reconstruction suggests a Mesoamerican origin for Stenochrus, which contains a widespread species, recently introduced to multiple localities. Introductions to Europe and the Caribbean occurred from a single clade in the Yucatán Peninsula, Mexico, within which genetic divergence is minimal, confirming the hypothesis of multiple independent introductions with successful colonization facilitated by parthenogenetic reproduction.
“It’s a mess sometimes”: patient perspectives on provider responses to healthcare costs, and how informatics interventions can help support cost-sensitive care decisions
Authors: Richards Olivia K , Iott Bradley E , Toscos Tammy R , Pater Jessica A , Wagner Shauna R , Veinot Tiffany C
Published: January 2022

Objective

We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions.

Materials and Methods

We conducted 18 semistructured interviews with diverse patients (ages 24–81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding.

Results

Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not always occur when patients felt they were needed. Consequently, patients faced a “cascade of work” to address affordability challenges. To prevent this, collaborative informatics tools could facilitate cost conversations and shared decision-making by providing information about a patient’s financial constraints, enabling comparisons of medication/testing options, and addressing transportation logistics to facilitate patient follow-through.

Discussion

Like providers, patients want informatics tools that address patient out-of-pocket costs. They want to discuss healthcare costs to reduce the frequency of unaffordable costs and obtain proactive assistance. Informatics interventions could minimize the cascade of patient work through shared decision-making and preventative actions. Such tools might integrate information about efficacy, costs, and side effects to support decisions, present patient decision aids, facilitate coordination among healthcare units, and eventually improve patient outcomes.

Conclusion

To prevent a burdensome cascade of work for patients, informatics tools could be designed to support cost conversations and decisions between patients and providers.
Mechanical fault detection based on machine learning for robotic RV reducer using electrical current signature analysis: a data-driven approach
Authors: Raouf Izaz , Lee Hyewon , Kim Heung Soo
Published: January 2022

Recently, prognostic and health management (PHM) has become a prominent field in modern industry. The rotate vector (RV) reducer is one of the widely used mechanical components in industrial systems, specifically in robots. The RV reducer is known for its unique characteristics of small size, efficient speed transmission, and high torsion. The RV reducer is prone to several kinds of faults, due to its continuous operation in an industrial robot. To keep the operation smooth and steady, timely PHM of the RV reducer has become essential. Previously, the RV reducer fault was diagnosed via various techniques, such as ferrography analysis, vibration analysis, and acoustic emission analysis. However, these conventional techniques have various issues. To resolve those issues, we introduce a novel approach to use the embedded electrical current system for the fault detection of the RV reducer. However, this is quite complicated to investigate mechanical fault using an electrical current signature, since the RV reducer is not an integral part of the electric motor, and finding a fault pattern in faulty components needs thorough examination. We therefore focus on the application of machine learning (ML) for fault classifications. We present an approach for feature extraction, feature selection, and feature reduction using the information obtained from the motor current signature analysis to create an ML-based fault classification system with distinguishable prominent features. Finally, the authenticity of the presented approach is justified via the improved values of evaluating parameters, such as accuracy, specificity, and sensitivity, for ML classifiers.
A finite-element algorithm with a perfectly matched layer boundary condition for seismic modelling in a diffusive-viscous medium
Authors: Zhao Haixia , Xu Wenhao , Gao Jinghuai , Zhang Yijie , Yan Wenjing
Published: January 2022

Seismic numerical modelling involved in each stage of seismic exploration process is aimed at predicting seismograms in an assumed subsurface medium. The energies and phases of waves vary with the presence of fluids, while the frequency-dependent seismic reflections in a reservoir with hydrocarbons was explained using the diffusive-viscous wave (DVW) equation. We proposed a Galerkin finite-element method (FEM) to numerically study the propagation properties of the DVW in fluid-filled media to ascertain the influences of saturated fluids on characteristics of the wavefield. We also theoretically analysed the numerical dispersion and stability condition of the FEM algorithm, which indicated that a minimum of six nodes per wavelength is recommended to achieve more accurate results. In numerical simulation, we presented a non-split perfectly matched layer (NPML) boundary condition for the DVW equation to absorb the artificial reflections in finite-element modelling, using a homogeneous model to demonstrate the effectiveness of the NPML boundary condition through comparisons with the results without the PML condition. Moreover, we modelled the DVW propagation in a fluid-saturated (gas, oil and water) medium with sharp edges and curved interfaces using the proposed method and compared the results with those pertaining to acoustic waves. The numerical results indicated significant amplitude damping and phase variation in the DVW when it propagates across the fluid-saturated layers compared with those of acoustic waves. Furthermore, we compared the numerical results in the fluid-saturated model calculated via the FEM with those calculated via FCT-FDM (flux corrected transport-finite-difference method) to demonstrate the validity of the former.
Avian Introgression Patterns are Consistent With Haldane’s Rule
Authors: Ottenburghs Jente
Published: January 2022

According to Haldane’s Rule, the heterogametic sex will show the greatest fitness reduction in a hybrid cross. In birds, where sex is determined by a ZW system, female hybrids are expected to experience lower fitness compared to male hybrids. This pattern has indeed been observed in several bird groups, but it is unknown whether the generality of Haldane’s Rule also extends to the molecular level. First, given the lower fitness of female hybrids, we can expect maternally inherited loci (i.e., mitochondrial and W-linked loci) to show lower introgression rates than biparentally inherited loci (i.e., autosomal loci) in females. Second, the faster evolution of Z-linked loci compared to autosomal loci and the hemizygosity of the Z-chromosome in females might speed up the accumulation of incompatible alleles on this sex chromosome, resulting in lower introgression rates for Z-linked loci than for autosomal loci. I tested these expectations by conducting a literature review which focused on studies that directly quantified introgression rates for autosomal, sex-linked, and mitochondrial loci. Although most studies reported introgression rates in line with Haldane’s Rule, it remains important to validate these genetic patterns with estimates of hybrid fitness and supporting field observations to rule out alternative explanations. Genomic data provide exciting opportunities to obtain a more fine-grained picture of introgression rates across the genome, which can consequently be linked to ecological and behavioral observations, potentially leading to novel insights into the genetic mechanisms underpinning Haldane’s Rule.
Estimating deer density and abundance using spatial mark–resight models with camera trap data
Authors: Bengsen Andrew J , Forsyth David M , Ramsey Dave S L , Amos Matt , Brennan Michael , Pople Anthony R , Comte Sebastien , Crittle Troy
Published: January 2022

Globally, many wild deer populations are actively studied or managed for conservation, hunting, or damage mitigation purposes. These studies require reliable estimates of population state parameters, such as density or abundance, with a level of precision that is fit for purpose. Such estimates can be difficult to attain for many populations that occur in situations that are poorly suited to common survey methods. We evaluated the utility of combining camera trap survey data, in which a small proportion of the sample is individually recognizable using natural markings, with spatial mark–resight (SMR) models to estimate deer density in a variety of situations. We surveyed 13 deer populations comprising four deer species (Cervus unicolor, C. timorensis, C. elaphus, Dama dama) at nine widely separated sites, and used Bayesian SMR models to estimate population densities and abundances. Twelve surveys provided sufficient data for analysis and seven produced density estimates with coefficients of variation (CVs) ≤ 0.25. Estimated densities ranged from 0.3 to 24.6 deer km−2. Camera trap surveys and SMR models provided a powerful and flexible approach for estimating deer densities in populations in which many detections were not individually identifiable, and they should provide useful density estimates under a wide range of conditions that are not amenable to more widely used methods. In the absence of specific local information on deer detectability and movement patterns, we recommend that at least 30 cameras be spaced at 500–1,000 m and set for 90 days. This approach could also be applied to large mammals other than deer.
Modeling the suitability of Texas karst regions for infection by Pseudogymnoascus destructans in bats
Authors: Wolf Lilianna K , Meierhofer Melissa B , Morrison Michael L , Cairns David M , Lacher Thomas E
Published: January 2022

White-nose syndrome (WNS) is caused by the fungus Pseudogymnoascus destructans and has led to the deaths of millions of North American bats since it was first documented in New York in 2006. Since the first cases were recorded, WNS has spread rapidly across North America and is now confirmed or suspected in 40 US states and seven Canadian provinces. Often, the presence of P. destructans is detected in a cave or hibernaculum before signs of WNS manifest in the resident bat population, making presence of the fungus a more reliable assessment of potential epidemic spread than expansion of manifested WNS. An analysis of 43 cave internal climates across the state of Texas revealed a pattern of thermal suitability for P. destructans that correlated significantly with landscape (elevation, lithology) and external climate (mean surface temperature and precipitation). We generated a predictive model to assess the potential spread of P. destructans through Texas karst systems based on external features that correlate with suitable internal climates for fungal growth. Applications of this model to external climatic variables from 2019 showed seasonally varying patterns of suitability for fungal growth in select regions of Texas karst systems. Results from these surveys and models showed that internal climates of Texas caves are likely able to sustain the growth of P. destructans and could cause disease and resulting declines in Texas bats, and act as stepping-stones for the fungus, allowing it to travel southward into Mexican and Central American cave systems. The resulting work will inform researchers and natural resource managers of areas of significant concern to monitor for the spread of WNS.
Proofs of the Divine: Luke’s Use of Tekmhpion in Acts 1:3 in Light of Herodotus’ Description of the Battle of Mycale (Hist. 9.100.2)
Authors: Morgan James M
Published: January 2022

In Acts 1:3, the author claims that Jesus had shown himself alive ‘by many proofs’ (ἐν πολλοῖς τεκμηρίοις). Phrases containing τεκμήριον (a NT hapax) qualified by πολύς have a long textual history. Reference works, however, do not discuss the closest rhetorical and theological parallel to the occurrence of τεκμήριον in Acts, which is found in Herodotus’ description of the battle of Mycale (Histories 9.100.2) in a metaleptic aside about proofs of divine intervention in human history: Δῆλα δὴ πολλοῖσι τεκμηρίοισι ἐστὶ τὰ θεῖα τῶν πρηγμάτων. Given the theologically charged nature of Luke–Acts and the Histories, this rich parallel illustrates well both projects and evinces plausible Herodotean influence on Luke’s historiographical erudition.
Quality in Pediatric Palliative Care
Authors: Williams IV Conrad , Thompson Amanda L. , Kobler Kathie
Published: January 2022

As the pediatric palliative care (PPC) field matures, interdisciplinary PPC teams are called to draw from the growing evidence base to deepen their efforts to optimize care for children with serious illness and their families. Quality PPC provision depends on an awareness of the experiences and perspectives of all involved in the child’s care, followed by a willingness to tailor care to meet the preferences and goals of each family. This chapter explores the current state of quality in PPC, including a summary of national quality-focused organizations, initiatives, and standards of care. A family’s perspective on what it means to receive quality PPC is offered, along with practical strategies from an interdisciplinary perspective to encourage teams to collaborate on incorporating quality initiatives in their daily practice.
Existential Suffering and Distress
Authors: Waldman Elisha , Bartel Mark
Published: January 2022

Existential suffering encompasses a broad set of experiences and concerns. These are often difficult to define but generally involve a sense of loss of anchoring in the world and a loss of meaning, along with a sense of threatened personal identity. Often the idea of existential suffering overlaps with ideas of spiritual distress, psychological distress, psychosocial distress, and physical suffering. Existential suffering may be experienced by children, parents, and siblings as well as by staff members involved in the care of children with serious illness. Addressing existential suffering in any context requires an interdisciplinary approach, highlighting the importance of the interdisciplinary pediatric palliative care team and allied partners.
Easing Distress When Death Is Near
Authors: Lotstein Debra , Rusch Rachel
Published: January 2022

The death of a child is an intense, deeply personal experience for the child and his or her family and for everyone involved. Anticipatory guidance regarding the various aspects of end-of-life care can be helpful for families but requires compassion and exquisite communication skills to match the appropriate level of information with the patient and family’s state of coping. This chapter provides guidance on how to manage and address both common and special symptoms and circumstances that may arise during the dying process. Clinician efforts to optimize a child’s comfort at end of life relieves suffering and may also have long-lasting effects for grieving family members. Thoughtful attention to actions after a child’s death can promote both family and staff resilience.
Mental Illness and Sex Offending
Authors: Saleh Fabian M. , Berlin Fred S. , Malin H. Martin
Published: January 2022

This chapter assesses the relationship between mental illness and sex offending. The terms “sex offending” and “mental illness” are sometimes inextricably linked, often in improper ways. The notion that all civilly committed sex offenders have a mental disorder does not withstand clinical scrutiny. To qualify for civil commitment as a sexually violent predator (SVP), an individual must have (1) one or more prior “violent” sex offense convictions, (2) a mental abnormality or personality disorder, and (3) a mental abnormality that makes that individual likely to commit a future “violent” sexual offense. Colloquially, “mental abnormalities” are often collectively referred to as major mental illnesses or, more formally, serious mental illnesses (SMIs). Strictly speaking, personality disorders are considered to be mental disorders. However, in practice, many use the term “mental disorder” to refer only to SMIs, as opposed to personality disorders or intellectual disabilities. This chapter focuses on sex offending by individuals who are not personality disordered, but also includes some discussion of those individuals who engage in sex offending behaviors related to medical conditions.
Pharmacological Treatment of Paraphilic Sex Offenders
Authors: Bradford John M. , Saleh Fabian M.
Published: January 2022

This chapter explores the pharmacological treatment of paraphilic sex offenders. The World Federation of Societies of Biological Psychiatry (WFSBP) established a task force to evaluate the evidence-based treatment of the paraphilic disorders for both adults and adolescents. The primary aim of WFSBP guidelines for the biological treatment of the paraphilias was to evaluate the role of pharmacological agents in the treatment and management of paraphilias with a focus on the treatment of adult males. These guidelines were intended for use in clinical practice by clinicians who diagnose and treat paraphilia, now known as paraphilic disorders. The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners. A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.
Female Sexual Offenders
Authors: Berner Wolfgang , Briken Peer , Hill Andreas , Tozdan Safiye
Published: January 2022

About 1% of sentenced sexual offenders are female. Investigations on victims of child molestation reveal at least a participation of female perpetrators in one-fourth of cases of male victims and in 13% of female victims. The spectrum of offenses of female offenders reaches from minor forms of indecency, exhibitionism, different forms of child molestation, and incest to all forms of aggressive acts, including rape and murder. Male and female children are the most prominent victims. In a high percentage of offenses, the female offender acts together with a male accomplice. Only in rare cases is the diagnosis of paraphilia reported; far more frequent are different forms of depression, alcohol and drug abuse, and personality disorders (borderline, antisocial, dependent). Most authors agree that a high percentage (more than 50%) of female sexual offenders were themselves victims of sexual and/or physical abuse. Conflicts with the mother and resulting problems with women—especially mother identity—are reported by psychodynamic-oriented authors. Only a few case reports exist on effective medical treatment with selective serotonin reuptake inhibitors and antiandrogens. A carefully differentiated psychotherapeutic treatment program, including group, individual, and social therapeutic strategies, should take into consideration the good lives model (GLM), but also specific factors of female offending: The importance of female identity problems, the higher importance of relationship aspects, and the victim–victimizer circle.
Sexual Abuse by Clergy
Authors: Glancy Graham , Saini Michael , Hardy Kate
Published: January 2022

This chapter examines sexual abuse by clergy, which has received a great deal of media attention and has generated immense public outcry toward the perpetrators and the church. The Catholic Church has been criticized for protecting child molesters and for concealing the widespread problem of clergy sexual abuse within the Church. Perpetrators of child sexual abuse, however, can be found among clergy of various denominations and across the globe. Moreover, allegations of child sexual abuse have been made in almost every type of community institution serving children, including schools, sports, and voluntary organizations. The chapter focuses on etiological factors comprising intrapersonal, interpersonal, and systemic levels of analysis, and presents current clergy offender typologies that have attained general acceptance within the scientific community. It also offers some suggestions regarding prevention, training, and treatment.
Persons With Intellectual Disabilities Who Sexually Offend
Authors: Griffiths Dorothy , Fedoroff J. Paul
Published: January 2022

This chapter focuses on persons with intellectual disabilities who sexually offend. Persons with intellectual disabilities present many similar and some unique features that can contribute to the development of sexually offending behavior. The chapter reviews the history of sexuality of persons with intellectual disabilities; the prevalence of sexually offending behavior; methods of comprehensive assessment strategies to identify risk factors, vulnerabilities, and central processing challenges; and methods to develop an integrated model of intervention. Neither the criteria for sexual offense under the criminal code nor the diagnostic criteria for paraphilic sexual disorders currently explicitly include provisions for individuals with intellectual disabilities. Yet this group poses special challenges not only to the judicial system but also to those with the responsibility of providing for their care.
Keratitis
Authors: Tu Elmer Y. , Mah Francis S. , Baum Jules
Published: January 2022

This chapter highlights keratitis, an ocular emergency that can lead to severe visual disability and requires prompt diagnosis and treatment. Sequelae can vary in severity from little or no visual loss to corneal scarring, perforation, endophthalmitis, and loss of the eye. Although the corneal surface is awash with microorganisms of the normal flora, an intact corneal epithelium and ocular defense mechanism serve to prevent infection in the normal eye. While some organisms such as Neisseria gonorrhoeae, Neisseria meningitidis, Corynebacterium diphtheriae, Listeria, and Shigella can penetrate an intact epithelium, all others require damage to the epithelial layer to invade the cornea. The chapter identifies several risk factors that predispose the cornea to infection. Although the clinical manifestations of corneal infections may be characteristic of certain pathogens, further laboratory evaluation with cultures and antibiotic susceptibility testing provides a definitive diagnosis and more focused treatment after empirical therapy has been initiated.
Retinitis
Authors: Stiefel Hillary C. , Albert Daniel M.
Published: January 2022

This chapter examines the most clinically important forms of infectious retinitis: cytomegalovirus retinitis (CMVR), acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), ocular toxoplasmosis, and syphilitic retinitis. CMVR is the most common and clinically significant opportunistic ocular infection seen in immunocompromised patients, including those with AIDS, as well as in patients with compromised immunity following organ transplantation or chemotherapy for systemic malignancy. It usually begins as a unilateral condition but progresses to involve the contralateral eye in approximately 20% of cases. Successful treatment of CMVR depends on the restoration of immune function. In HIV/AIDS patients, the use of highly active antiretroviral therapy (HAART) lowers the progression of CMV retinitis and incidence of vision loss.
Periocular and retro-orbital infections
Authors: Barshak Miriam B. , Durand Marlene L.
Published: January 2022

This chapter focuses on periocular and retro-orbital infections. Periocular infections are infections of the soft tissues surrounding the globe of the eye. These include infections of the eyelids, lacrimal system, and orbit. Dacryocystitis, or infection of the lacrimal sac, is the most common infection of the lacrimal system and results from obstruction of the lacrimal duct. Although both preseptal and orbital infections may present with a similar external appearance of swollen, red eyelids, the distinction is important because orbital infections are usually much more serious. Cavernous sinus thrombophlebitis is a very rare complication of orbital infections or of infections in the midface “danger triangle” (upper lip to root of the nose).
Skin ulcer and pyoderma
Authors: Maffei Joanne T.
Published: January 2022

This chapter describes skin ulcers and pyoderma. Skin lesions are important clues to systemic diseases, and, conversely, host factors make patients susceptible to skin infections caused by certain organisms. The skin has a limited response to insults from the microbial world, forming vesicles and pustules that eventually rupture and leave exposed dermis. Accurate diagnosis and appropriate treatment depend on a detailed history that includes systemic complaints, history of exposure and travel, and the initial appearance of the skin lesions. Sound diagnosis of difficult cases also depends on appropriate cultures and histopathology. Most superficial skin infections and ulcers can be treated empirically according to the typical clinical presentation of the lesions. A workup is required for lesions that do not respond to routine therapy, that are rapidly progressive, or that occur in an immunocompromised host.
Chronic viral hepatitis
Authors: Freshman Michelle E. , Friedman Lawrence S.
Published: January 2022

This chapter describes chronic viral hepatitis, which is defined as necroinflammation of the liver of more than 3 to 6 months’ duration, demonstrated by persistently elevated serum aminotransferase levels and associated with characteristic histologic findings. The causes of chronic hepatitis include hepatitis B, C, and D viruses as well as noninfectious disorders, including nonalcoholic steatohepatitis, autoimmune hepatitis, hepatitis following alcohol or medication exposure, Wilson disease, and, rarely, celiac disease. Chronic hepatitis is characterized on the basis of etiology; grade of portal, periportal, and lobular inflammation (minimal, mild, moderate, or severe); and stage of fibrosis (none, mild, moderate, severe, cirrhosis). In the absence of advanced cirrhosis, patients are often asymptomatic or have mild, nonspecific symptoms. Patients with chronic hepatitis B and active viral replication may be treated with a nucleoside or nucleotide analog or with pegylated interferon for hepatitis B, although interferon is rarely used now. Those with chronic hepatitis C may be treated with direct-acting antiviral agents.
Clostridioides (Clostridium) difficile
Authors: Cunha Cheston B. , Cunha Burke A.
Published: January 2022

This chapter evaluates Clostridioides (Clostridium) difficile, a gram-positive anaerobic spore-forming bacillus found in colon flora. When C. difficile is induced to produce exotoxins (A/B) symptomatic disease (i.e., diarrhea/colitis) follows. The clinical spectrum of infection ranges from watery toxigenic diarrhea to invasive transmural colitis. C. difficile diarrhea is primarily an infection of adults. The chapter then considers the differences in pathophysiology and severity between C. difficile diarrhea and C. difficile colitis, which may be acquired in the community or hospital. Because with C. difficile diarrhea the process is intraluminal and limited to colon mucosa, the aim of therapy is to deliver high intraluminal concentrations of effective anti-C. difficile drugs. With C. difficile colitis, the pharmacokinetic aim of therapy is to achieve therapeutic colon wall levels.
Peritonitis
Authors: Slavoski Linda A. , Levison Matthew E.
Published: January 2022

This chapter explores peritonitis, which is inflammation within the peritoneal cavity. It considers infectious causes of peritonitis. Two major types include: (1) primary (spontaneous or idiopathic) and (2) secondary. Primary peritonitis, also called spontaneous bacterial peritonitis (SBP), is defined as infection within the peritoneal cavity without an evident intra-abdominal source. Meanwhile, secondary peritonitis is associated with a predisposing intra-abdominal lesion. When signs of peritonitis and sepsis persist or recur after treatment for secondary peritonitis, the clinical entity has been termed tertiary peritonitis. In comparison with patients with other forms of peritonitis, tertiary peritonitis has significantly longer intensive care unit (ICU) and hospital stays, higher organ dysfunction scores, and higher mortality rates.
Focal renal infections and papillary necrosis
Authors: Fisher Ann F. , Dembry Louise M.
Published: January 2022

This chapter addresses focal renal infections and papillary necrosis. Focal infections of the kidney can be divided into intrarenal and perirenal pathology. The classification of intrarenal abscess encompasses renal cortical abscess and renal corticomedullary abscess; the latter includes acute focal bacterial nephritis (AFBN), acute multifocal bacterial nephritis, and xanthogranulomatous pyelonephritis (XGP). Perirenal abscesses are found in the perinephric fascia external to the capsule of the kidney, generally occurring from extension of an intrarenal abscess. Meanwhile, papillary necrosis is a clinicopathologic syndrome that develops during the course of a variety of syndromes, including pyelonephritis, affecting the renal medullary vasculature, leading to ischemic necrosis of the renal medulla. The resultant sloughing of papillae may lead to urinary tract obstruction and potentially further renal impairment.
Reye syndrome
Authors: Weiner Debra L. , Kritzer Amy
Published: January 2022

This chapter describes Reye syndrome, which is an acute noninflammatory encephalopathy with fatty degenerative liver failure. Decrease in aspirin use in children, in response to its association with Reye syndrome, and the identification of medications, toxins, and inborn errors of metabolism (IEMs) that present with Reye-like syndrome manifestations have made Reye syndrome exceedingly rare. While recognizing the rarity of Reye syndrome, the diagnosis should be considered in any child with vomiting, altered mental status, and classic laboratory findings, but must be a diagnosis of exclusion. Early recognition and treatment of Reye and Reye-like syndromes, including possible IEMs, is essential to prevent death and optimize the potential for recovery without neurologic impairment. Support of airway, breathing, circulation, minimizing metabolic demands, avoiding catabolism, promoting anabolic state, correction of metabolic derangements and coagulopathy, ammonia detoxification, and prevention/treatment of increased intracranial pressure (ICP) are the mainstays of treatment
Corticosteroids, cytotoxic agents
Authors: Taiwo Babafemi O. , Nam Hannah
Published: January 2022

This chapter investigates how iatrogenic alteration of the immune system occurs with use of corticosteroids or noncorticosteroid immunosuppressants. Although there is overlap, noncorticosteroid immunosuppressants can be broadly divided into cytotoxic antineoplastic drugs and immunosuppressants used in transplantation. Because some of the cells or biologic pathways targeted by therapeutic immunosuppressive agents are essential for the body's defenses against pathogenic microorganisms, the use of immunosuppressants involves walking a fine line between therapy and iatrogenic harm. The mechanism of action of the immunosuppressant, the dosage used, the length of therapy, and underlying disease(s) all affect the type and severity of subsequent infections. These factors also inform decisions on immunization, prophylaxis, or empirical therapy in high-risk patients.
Infection in the elderly
Authors: Crossley Kent
Published: January 2022

This chapter stresses the unique aspects of infection in the elderly, who are defined as those older than 65 years of age, and discusses infections that occur in long-term care institutions. It explains how infections in the aged are an important area of concern for medicine. It also points out that the number of individuals who are older than 65 is increasing dramatically and is disproportionate because of lower birth rates. The chapter emphasizes how age alone is seen as a relatively unimportant risk factor for infection-related death or serious morbidity, although mortality associated with many infections is increased in the elderly. It outlines the variety of comorbid conditions that are increasingly common with advancing age and that appear to be closely associated with greater morbidity and mortality from infection.
Immune reconstitution inflammatory syndrome
Authors: Marais Suzaan , Meintjes Graeme
Published: January 2022

This chapter examines how treatment with antiretroviral therapy (ART) results in a decreased HIV viral load for the majority of patients with HIV disease. It talks about the early stages of immune recovery on ART, in which a subset of patients may experience clinical deterioration due to the immune reconstitution inflammatory syndrome (IRIS). It also discusses how IRIS typically occurs during the initial 3 months of ART as the result of a dysregulated immune response directed at infective or noninfective antigens. The chapter highlights the majority of IRIS cases that are associated with mycobacterial, fungal, or viral infections. It describes two forms of infective IRIS that are recognized as IRIS (p-IRIS) and IRIS (u-IRIS).
Percutaneous injury
Authors: Kuhar David , Powell Krista
Published: January 2022

This chapter discusses how healthcare personnel (HCP) are at risk of occupational exposure to bloodborne pathogens. It examines the risk factors for transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV from needlesticks and injuries from sharp objects. It also mentions percutaneous exposures as the most common mechanism for transmission of bloodborne pathogens in healthcare settings. The chapter investigates data from several surveillance systems that reported injuries that occur in medical floors, operating rooms, and intensive care units. It discusses the prevention of bloodborne pathogen transmission through exposure prevention, which requires a diversified approach to the occupational health and safety hierarchy of controls.
Nonsurgical antimicrobial prophylaxis
Authors: Rouphael Nadine G. , Dretler Alexandra Wolcott
Published: January 2022

This chapter focuses on chemoprophylaxis, the use of an antimicrobial agent to prevent infection that is often administered after exposure to a virulent pathogen or before a procedure associated with risk of infection. It discusses how chronic chemoprophylaxis is sometimes administered to persons with underlying conditions that predispose to recurrent or severe infection. It discusses the use of antibiotics as preemptive therapy to prevent clinical disease in persons infected with a microorganism, such as Mycobacterium tuberculosis. The chapter explains immunization as another excellent means of preventing infection. It examines the recommendation of prophylaxis when the risk of infection is high or the consequences significant.
Immunizations
Authors: Jong Elaine C.
Published: January 2022

This chapter examines the long-lasting immunity against many serious infectious diseases that can be elicited through active immunization by the administration of specific antigens that stimulate the recipient host's production of protective antibodies. Protective levels of specific antibodies usually develop within 2 to 4 weeks after completion of the primary immunization regimen. The vaccine doses may be given orally, administered as mucosal vaccines, or given by injection using intradermal, subcutaneous, or intramuscular routes. The chapter also discusses passive immunization as the process by which protective immunity is obtained through transfer of preformed antibodies from an immune host to a nonimmune recipient, either as immunoglobulin or antibody-specific immunoglobulin. The chapter highlights host factors that influence protective efficacy resulting from active immunization. Vaccines used for recommended immunization coverage of children, adolescents, and adults are reviewed, along with relevant contraindications.
Advice for travelers
Authors: Wu Henry M. , Fairley Jessica K.
Published: January 2022

This chapter discusses individuals who travel around the world for business, tourism, study, or aid work. The World Tourism Organization estimates that, in 2015, there were 1.2 billion international tourist arrivals worldwide. The chapter covers common health problems associated with travel, especially in low-income countries where travelers frequently self-report a travel-associated health problem and often seek healthcare while traveling or after return. Healthcare providers can play a critical role in minimizing the risk of illness and injury during travel, and the administration of travel-related vaccinations and malaria prophylaxis remain cornerstones of the pre-travel consultation. The chapter highlights noninfectious causes of morbidity and mortality, such as injury and exacerbation of chronic illness, that are typically the most common health issues travelers encounter.
Fever in the returning traveler
Authors: Zumla Alimuddin
Published: January 2022

This chapter explores fever as a frequent problem in travelers returned from holidays, business trips, or employment outside their country of residence. It analyzes the wide range of infectious and parasitic diseases that can cause fever, some of which can be rapidly fatal if not detected and treated early. It cites plasmodium falciparum malaria as a medical emergency that prompts essential diagnosis and treatment. The chapter emphasizes how all patients should be assessed for risk of malaria, viral hemorrhagic fever, dengue, and antibiotic-resistant urinary, gastrointestinal, or respiratory infections. It focuses on fever related to more “imported” diseases acquired during travel to which the physician practicing in the West may be unfamiliar.