bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating Telehealth Into Neurodevelopmental Assessment: A Model From the Cardiac Neurodevelopmental Outcome Collaborative
Authors: Cox Stephany M , Butcher Jennifer L , Sadhwani Anjali , Sananes Renee , Sanz Jacqueline H , Blumenfeld Elizabeth , Cassidy Adam R , Cowin Jessica C , Ilardi Dawn , Kasparian Nadine A , Kenowitz Joslyn , Kroll Kristin , Miller Thomas A , Wolfe Kelly R ,   from the Telehealth Task Force of the Cardiac Neurodevelopmental Outcome Collaborative
Published: January 2022

Objective

In the wake of the COVID-19 pandemic, psychologists were pushed to look beyond traditional in-person models of neurodevelopmental assessment to maintain continuity of care. A wealth of data demonstrates that telehealth is efficacious for pediatric behavioral intervention; however, best practices for incorporating telehealth into neurodevelopmental assessment are yet to be developed. In this topical review, we propose a conceptual model to demonstrate how telehealth can be incorporated into various components of neurodevelopmental assessment.

Methods

Harnessing existing literature and expertise from a multidisciplinary task force comprised of clinicians, researchers, and patient/parent representatives from the subspecialty of cardiac neurodevelopmental care, a conceptual framework for telehealth neurodevelopmental assessment was developed. Considerations for health equity and access to care are discussed, as well as general guidelines for clinical implementation and gaps in existing literature.

Results

There are opportunities to integrate telehealth within each stage of neurodevelopmental assessment, from intake to testing, through to follow-up care. Further research is needed to determine whether telehealth mitigates or exacerbates disparities in access to care for vulnerable populations as well as to provide evidence of validity for a wider range of neurodevelopmental measures to be administered via telehealth.

Conclusions

While many practices are returning to traditional, face-to-face neurodevelopmental assessment services, psychologists have a unique opportunity to harness the momentum for telehealth care initiated during the pandemic to optimize the use of clinical resources, broaden service delivery, and increase access to care for pediatric neurodevelopmental assessment.
Micronutrient homeostasis in plants for more sustainable agriculture and healthier human nutrition
Authors: Assunção Ana G L , Cakmak Ismail , Clemens Stephan , González-Guerrero Manuel , Nawrocki Adam , Thomine Sébastien
Published: January 2022

The provision of sustainable, sufficient, and nutritious food to the growing population is a major challenge for agriculture and the plant research community. In this respect, the mineral micronutrient content of food crops deserves particular attention. Micronutrient deficiencies in cultivated soils and plants are a global problem that adversely affects crop production and plant nutritional value, as well as human health and well-being. In this review, we call for awareness of the importance and relevance of micronutrients in crop production and quality. We stress the need for better micronutrient nutrition in human populations, not only in developing but also in developed nations, and describe strategies to identify and characterize new varieties with high micronutrient content. Furthermore, we explain how adequate nutrition of plants with micronutrients impacts metabolic functions and the capacity of plants to express tolerance mechanisms against abiotic and biotic constraints. Finally, we provide a brief overview and a critical discussion on current knowledge, future challenges, and specific technological needs for research on plant micronutrient homeostasis. Research in this area is expected to foster the sustainable development of nutritious and healthy food crops for human consumption.
Plasma LncRNA MALAT1 Expressions Are Negatively Associated with Disease Severity of Postmenopausal Osteoporosis
Authors: Qian Tie-Yong , Wan Hui , Huang Ci-You , Hu Xiao-Jing , Yao Wei-Feng
Published: January 2022

Background

Long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (LncRNA MALAT1) has been proven to promote osteogenesis in different health conditions. However, the role of plasma MALAT1 in postmenopausal osteoporosis (PMOP) has not been investigated.

Objective

To investigate whether plasma MALAT1 expressions are associated with severity of PMOP.

Methods

A total of 126 patients with PMOP and 126 healthy female control individuals were drafted into study participation. Plasma MALAT1 was detected using RT-PCR. Bone formation marker bone-specific alkaline phosphatase plasma concentration was determined using chemiluminescence immunoassay. Levels of bone absorption marker cross-linked N-telopeptidases of type I collagen were measured in duplicate using enzyme immunoassay. Bone mineral density (BMD) was examined in the total hips, femoral neck, and lumbar (L1–L4) spine using dual-energy x-ray absorptiometry. We used Genant semiquantitative (GSQ) criteria to assess the degree of vertebral deformity and fracture. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the potential diagnostic value of MALAT1 with regard to the GSQ grading. We used the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) to evaluate the symptomatic severity in and functional ability of the study participants.

Results

Plasma MALAT1 expressions were significantly lower in patients with PMOP, compared with healthy controls. Plasma MALAT1 expressions in patients with PMOP were positively associated with total hip, femoral neck, and lumbar (L1–L4) spine BMD. In total, 95 patients experienced vertebral deformity or fracture (VF), and 31 had no fractures. Plasma MALAT1 expressions were markedly decreased in patients with VF, compared with patients without fractures. Plasma MALAT1 expressions were negatively related to GSQ grading in patients with VF. ROC curve analysis demonstrated that decreased plasma MALAT1 expression exhibits decent diagnostic value with regard to GSQ grading. Finally, we discovered that plasma MALAT1 expression was also negatively associated with VAS and ODI.

Conclusion

Plasma MALAT1 expressions are negatively associated with severity of PMOP.
A Pregnant Pause
Authors: Marcelin Jasmine R. , Yao Joseph D.
Published: January 2022

Current guidelines recommend universal HIV screening of all patients aged 13 to 65 years. The risk of perinatal transmission of HIV has decreased with the implementation of universal screening during pregnancy. The current fourth-generation HIV-1 antibody and antigen screening tests are highly sensitive and specific. Early HIV infection can be asymptomatic, and acute retroviral syndrome can present with fever, viral respiratory-like symptoms, lymphadenopathy, and multiple nonspecific symptoms. Viral load testing should be pursued if the screening and supplemental serologic assays show discordant results.
What a Headache!
Authors: Tan Eugene M. , Marcelin Jasmine R. , Temesgen Zelalem
Published: January 2022

Cryptococcus neoformans is a facultative, intracellular yeast that when inhaled, can cause a primary pulmonary infection; the infection can remain latent but may be activated when the host becomes immunocompromised. C neoformans then disseminates and traverses the blood-brain barrier to cause cryptococcal meningitis. Typical symptoms include fever, weight loss, night sweats, headache, and altered mental status. Cryptococcosis tends to occur in immunocompromised patients with HIV/AIDS, solid-organ transplant, or hematologic malignancy. Treatment regimens for patients can differ, depending on whether they have HIV/AIDS, are receiving immunosuppressive medications, or are immunocompetent.
Kidney Disease and HIV
Authors: Tan Eugene M. , Marcelin Jasmine R. , Rizza Stacey A.
Published: January 2022

Patients are considered to have chronic kidney disease (CKD) when markers of kidney damage are present for longer than 3 months. HIV is a risk factor for CKD. The 2 major categories of HIV-related kidney disease include HIV-associated nephropathy and HIV-associated immune complex kidney disease. Various antiretroviral therapy (ART) regimens may affect renal function. Patients with HIV should be monitored with a creatinine-based estimated glomerular filtration rate, urinalysis, and quantitative measure of albuminuria or proteinuria whenever ART is initiated or changed. In patients with stable HIV, serum creatinine should be obtained twice yearly and urinalysis should be obtained annually.
Acute Respiratory Failure in a Patient With a Methicillin-Resistant Staphylococcus aureus Bloodstream Infection
Authors: Lin Erica , Abu Saleh Omar M. , O’Connor Christina G.
Published: January 2022

Acute eosinophilic pneumonia (AEP) is characterized by pulmonary infiltrates and an excess of eosinophils with a bronchoalveolar lavage differential cell count or lung biopsy. The pathophysiology of medication-induced AEP is still unknown. Diagnosis of AEP is established on the basis of the following criteria: acute onset of febrile illness with respiratory manifestations, hypoxemia, diffuse infiltrates on imaging, an excess of eosinophilia with either greater than 25% eosinophils with a bronchoalveolar lavage differential cell count, or eosinophilic pneumonia on biopsy, in the absence of other causes. Management includes withdrawal of the inciting agent and close observation.
Raised, Purplish, Papular Mass in the Oral Cavity of a Patient Receiving Therapy for HIV/AIDS
Authors: Abeykoon Jithma P. , Abu Saleh Omar M. , Sanchez Jose J.
Published: January 2022

Kaposi sarcoma (KS) is an angioproliferative disease that requires human herpes virus 8 infection (HHV-8). The development of KS appears to depend on the viral homologs of human genes that are carried by HHV-8. Skin lesions such as angiomas, hematomas, pyogenic granuloma, and nevi should also be considered in the differential diagnosis. Biopsy of the lesion should be performed when possible. The diagnosis of KS is confirmed if the biopsy specimen shows the HHV-8 latency-associated nuclear antigen. The main treatment for AIDS-associated KS is combination antiretroviral therapy.
Complicated Urinary Tract Infection With a Multidrug-Resistant Organism
Authors: Narayanan Prasanna P. , Abu Saleh Omar M. , O’Horo John C.
Published: January 2022

In the early 2000s, carbapenem-resistant Enterobacteriaceae (CRE) emerged as a new public health threat. The most common types often are resistant to carbapenems and multiple additional antibiotic classes. Outcomes of these infections are poor, with mortality rates approaching 44%. Carbapenemase-producing bacteria are generally identified through cultures and susceptibility testing. Current antimicrobial options for CRE infections are limited. Aminoglycosides, colistin, polymyxin B, and tigecycline are commonly used when in vitro testing shows susceptibility. Combination therapy may be used, although high-quality data about treatment outcomes are lacking. Newer antibiotics are in development to combat CRE infections: ceftazidime-avibactam, aztreonam-avibactam, cefiderocol, and cefepime-zidebactam.
When Transplant Goes Viral: The Perils of Overimmunosuppression
Authors: Abad Cybele L. , Razonable Raymund R.
Published: January 2022

Donor cytomegalovirus (CMV) seropositivity and recipient seronegativivty status and overimmunosuppression are interrelated factors that predispose patients who have undergone transplant to CMV disease. Antiviral prophylaxis is one of the recommended methods of preventing CMV disease in recipients of solid organ transplants. The standard treatment recommendation for CMV disease is intravenous ganciclovir; for mild to moderate cases, oral valganciclovir is appropriate. Foscarnet is the main choice for treating CMV disease due to a UL97-variant virus. Cidofovir is another option for ganciclovir-resistant CMV. Treatment options for drug-resistant CMV are limited. Novel drugs such as maribavir and letermovir are currently under clinical investigation.
Patient With Diplopia and Thoracic Pain
Authors: Higgins Alexandra S. , Hoversten Patrick S. , Enzler Mark J.
Published: January 2022

Lyme disease is caused most frequently by Borrelia burgdorferi. The nervous system is the third most common site of involvement for Borrelia infections, and 10% to 15% of patients with Lyme disease have neurologic involvement. Lyme disease that is associated with the triad of lymphocytic meningitis, cranial neuropathy, and radiculoneuritis is termed Bannwarth syndrome. Lyme disease serologic testing consists of 2-tiered antibody testing that starts with an enzyme immunoassay and, if positive or indeterminate, is followed by a confirmatory immunoglobulin M and G Western blot for antibodies against B burgdorferi to increase the specificity of initial testing. Treatment consists of intravenous ceftriaxone or doxycycline.
Integrating Resistance
Authors: Zeuli John D.
Published: January 2022

First-generation integrase strand transfer inhibitors (INSTIs) have a lower genetic barrier to resistance than second-generation INSTIs. Primary resistance against raltegravir usually develops via 3 mutually exclusive pathways (N155, Q148, Y143). Elvitegravir often develops primary resistance via T66, E92, N155, or Q148 mutation development. First-generation INSTIs share a high level of cross-resistance. Second-generation INSTIs have in vitro activity against many first-generation INSTI mutations, with bictegravir and dolutegravir showing comparable activities and cabotegravir having less activity for some combinations. Dolutegravir at an increased dose has clinical data to support its use in a combination regimen for patients with first-generation INSTI failure and resistance.
Questions
Authors: Challener Douglas W. , Marcelin Jasmine R. , Cawcutt Kelly A.
Published: January 2022

This section consist of question and answers for the section
The New and Changing Landscape of Children Receiving Pediatric Palliative Care in the US
Authors: Sisk Bryan , Widger Kimberley , Feudtner Chris
Published: January 2022

Pediatric palliative and hospice care (PPC) is now firmly established as a clinical discipline across multiple countries. The evidence base to support PPC practice has grown considerably over the past two decades, but many gaps in knowledge persist. In this chapter, the authors briefly review the history of foundational PPC research that began more than 50 years ago. They then discuss the current state of PPC research related to the patient experience, the family experience, communication studies, symptom-directed interventions, outcome measure development, and systems of care. The chapter ends by highlighting areas in need of further study.
Children’s Voices
Authors: Muriel Anna C. , Rosenberg Abby R. , Sourkes Barbara M.
Published: January 2022

A child’s understanding and psychological experience of their illness must be attended to as distinct from that of their parents and siblings throughout the illness trajectory. This chapter uses vignettes and children’s words and art to highlight the importance of eliciting and observing a child’s experience in order to effectively assess and alleviate suffering. A summary of developmental considerations frames the discussion of the impact of the illness, the children’s awareness of their (or their sibling’s) condition, and anticipatory grief. A child’s modes of expression may reflect individual and family psychology, cognitive function, and cultural background. There is also a discussion of the voice of the child in medical decision-making and the impact of the family and sociocultural context. The contributions of mental health professions such as child psychology, psychiatry, and social work, as well as others who provide other therapeutic supportive care, such as child life and art/music therapy, are described as integral to interdisciplinary pediatric palliative care.
Cultural Humility, Social Determinants, and Disparities in Pediatric Palliative Care
Authors: Jonas Danielle , Morvant Alexis , Munoz-Blanco Sara
Published: January 2022

Access and receipt of pediatric palliative care (PPC) services are influenced in part by social factors such as race and ethnicity, cultural values and norms, religious or spiritual beliefs, cumulative personal or familial experiences, and social environment. Many of these social factors are known contributors to disparities in healthcare. PPC strives to be inclusive and equitable but disparities within this specialty exist. Cultural humility is a life-long approach that invites us to reflect on our beliefs and biases, thus allowing an encompassing experience of humility within the context that all human beings are unable to fully grasp all complex nuances of all cultures. As we incorporate cultural humility into an approach to caring for diverse individuals, we also exercise genuine curiosity to learn about “the other” within the culture of medicine. This chapter offers suggestions for how to assess communication preferences of pediatric patients and families, a framework on how to be culturally humble and curious, practical tips regarding the PPC provider role, factors that contribute to disparities in PPC access, and an exploration of the concept of cultural humility within the social context of PPC.
Family Experience and Relationships
Authors: Mooney-Doyle Kim , Marsac Meghan L. , Miller Elissa G. , Deatrick Janet A. , Alderfer Melissa A.
Published: January 2022

Families are crucial to the development, well-being, and health of children. When a child is diagnosed with a serious medical condition, all members of the family, as well as the ways in which the family functions, are affected. Parents may need to make life-altering medical decisions and must incorporate the illness and treatment into ongoing family life. Parents may also need to learn how to prioritize critical child-rearing responsibilities for both their ill child and their well children, possibly renegotiating their roles and responsibilities with their partners and others in the family system. This chapter describes the experiences of families throughout their pediatric palliative care journey and outlines the implications of these experiences for the delivery of pediatric palliative care. Conceptual frameworks include the social ecological model, family systems theory, and traumatic stress model.
Pediatric Delirium in the Palliative Care Setting
Authors: Tran Paula , Moss Jeffrey , Koh Eunice , Ort Katherine , Shaw Richard J. , Goldsmith Michelle
Published: January 2022

Pediatric delirium is an often underrecognized and reversible complication of illness; it is a clinical emergency demanding immediate management. Pediatric delirium requires prompt identification, medical investigation, and treatment of the symptoms and the underlying cause, when possible. Alterations in brain function co-occur with complex medical illness in compromised patients leading to significant negative outcomes. These include higher morbidity and mortality, lengthened hospital stay, and negative psychological sequelae for patients and their families, as well as for clinical caregivers. This chapter highlights the importance of screening, early assessment, treatment, education, and psychological support for patients, families, and clinicians from all disciplines.
Sleep and Circadian Rhythms
Authors: Ajayi Toluwalase A. , Zhou Eric S. , Rogers Valerie E.
Published: January 2022

Sleep and circadian disruptions negatively impact health outcomes and quality of life for children and their families. Children and adolescents with serious, life-threatening illnesses are at increased risk of sleep and circadian disorders due to their disease and its medical treatment, and this at a time when they are at greatest need of care that supports their health and quality of life. This chapter discusses common pediatric sleep and circadian disorders, current research on these disorders among children living with a variety of life-threatening illnesses, and environmental and psychosocial factors contributing to sleep disorders (and vice-versa). Finally, assessment and pharmacological and nonpharmacological management of sleep and circadian disturbances is reviewed. While effective treatments are lacking for many aspects of palliative care, sleep and circadian disorders are largely treatable and have tremendous potential to improve the health and quality of life of these children.
Prenatal and Neonatal Palliative Care
Authors: Cummings Christy , Sullivan Anne , Cramer Lauren , Boss Renee
Published: January 2022

The needs of families anticipating the birth of a baby with a life-threatening condition offers unique opportunities to implement palliative care measures throughout the prenatal and neonatal periods. Families may learn that their baby has a life-threatening diagnosis early in pregnancy, in the prenatal period just prior to delivery, or in the neonatal period after birth. They then bear the difficult task of shifting from joyful welcoming of a healthy newborn to comprehending the ramifications of their baby’s diagnosis. Palliative care in each scenario is targeted to families’ unique needs after diagnosis. This chapter addresses the palliative care for neonates in four distinct periods: early prenatal, late prenatal, early neonatal, and late neonatal, and describes how interdisciplinary team (IDT) clinicians can deliver integrated, compassionate, and evidence-based services for these infants and families.
Children with Complex Chronic Conditions
Authors: Bogetz Jori , Collura Christopher A. , Torkildson Christy
Published: January 2022

Children with complex chronic conditions (CCCs) have lifelong care needs that benefit from the support of specialty pediatric palliative care (PPC) teams. These needs extend beyond expert medical care and care coordination. They also include helping families to share their values, compassionate communication about the tradeoffs regarding medical interventions, attentive multimodal symptom management, and a measure of comfort with uncertainty. Parents of children with CCCs can also utilize PPC teams to advocate for unmet needs, support them through emotions that come from ongoing grief/loss, and celebrate the milestones and joys of having a child with special needs. Integration of PPC with other ongoing services in the hospital and in the community can improve care for these children and their families.
Advanced Heart Disease
Authors: Cousino Melissa K. , Heneghan Chelsea , Blume Elizabeth D.
Published: January 2022

Due to surgical and medical advancements, survival of children with congenital and acquired heart diseases has significantly increased. There are two primary etiologies of pediatric AHD: cardiomyopathy and congenital heart disease. Advanced heart disease resulting from congenital defects or cardiomyopathy remains a rare condition among children; however, morbidity and mortality is high among this population. Hospital-based deaths with invasive interventions at end of life are common. To improve quality of life, reduce suffering, and support patient and family medical decision-making, there is growing attention being paid to the role of palliative care within pediatric AHD.
Cystic Fibrosis and Other Childhood Lung Diseases
Authors: Dellon Elisabeth Potts , Goggin Jessica , Rabinowitz Elliot
Published: January 2022

Cystic fibrosis (CF) and other life-threatening childhood lung diseases offer many opportunities for integration of palliative care into routine care management throughout the life span. This chapter focuses on CF, with much of the content also applying to other childhood lung diseases, which are briefly reviewed. A summary of CF care delivery is described, with an emphasis on the unique aspects of the lived experience of individuals with CF. A model of collaborative primary and specialty palliative care, integrated into routine CF care, demonstrates how clinicians on CF care teams and palliative care specialists can work together throughout each phase of life to provide high-quality, comprehensive, and compassionate palliative care along the illness trajectory.
Hematologic Symptoms
Authors: Speller-Brown Barbara , Campbell Jillian , Abraham Allistair , Patel Priyal , Humphrey Lisa , Webb Jennifer
Published: January 2022

Hematologic conditions have a significant impact on feelings of wellness and overall health. Blood conditions including anemia, thrombocytopenia, and bleeding or clotting disorders have the potential to significantly impact quality of life. These conditions may be primary and lifelong or may be secondary to other conditions or therapies. This chapter reviews common causes of hematologic conditions, as well as ways to manage symptoms and improve outcomes. Interdisciplinary care throughout the lifetime of a patient with a hematologic condition is critical, especially as multiple organ systems may be affected by any disorder that affects the blood. Treatment options including disease-modifying therapies, transfusion, blood and marrow transplant, and gene therapy will be discussed. Patients and families need information, support, and guidance as they traverse multifaceted and complex systems of care, and an interdisciplinary team can be beneficial to optimize quality of life.
Perspectives on Sex and Normality
Authors: Burton Barbara , Fagan Peter J. , Saleh Fabian M.
Published: January 2022

This chapter discusses different perspectives on sex and normality. The Internet with its instantaneous sharing of sexual fantasies, the migration of peoples across traditional national boundaries, and a growing awareness of cultural diversity forces people to recognize that the evaluation of sexual behaviors by different groups and cultures and by different individuals within the same society is varied, sometimes extremely so. Frequently, the clashing of views about sexual behaviors, including those classified as sexual offenses by a jurisdiction, is framed in terms of normality versus non-normality. The structure of the chapter is that of the four perspectives of psychiatry, which were later applied to sexual disorders. The four perspectives of disease, dimension, behavior, and life story provide a methodological framework for discussing and hopefully advancing the answer to the questions about normality and sexual behaviors.
Sexual Offender Recidivism
Authors: Bradford John M. , Chaimowitz Gary , Levin Giovana , Olagunju Andrew
Published: January 2022

This chapter evaluates sexual offender recidivism. Recidivism in sexual offenders is critical for two reasons. The first reason is that based on studies of recidivism, risk assessment instruments are used to predict future recidivism. Second, recidivism is used as a measure of treatment outcome and rehabilitation of the sexual offender. The understanding of sexual offense recidivism is vital for anyone who is engaged in the assessment and treatment of sexual offenders. In more recent years, the focus on sexual offense recidivism appropriately has been directed by the impact on individuals of their victimization by sexual offenders. All of this supports efforts on treatment and rehabilitation to reduce recidivism. When considering sexual offense recidivism and treatment outcome studies from an empirical standpoint, there are some critical considerations to evaluate. There is a consensus that sexual offenses are underreported, and this may affect the statistical estimates in recidivism and treatment outcome studies. To compensate for underreporting, the definition of an act of recidivism includes rearrest as well as reconviction.
Visual Reaction Time
Authors: Abel Gene G. , Wiegel Markus , Bradford John M.
Published: January 2022

This chapter discusses the theoretical foundations for, development of, empirical evidence for, and continued development of visual reaction time (VRT) as a measure of sexual interest. The evaluation of paraphilic sexual interests must adapt to scientific and technical advances, as well as to the cultural and societal attitudes, sociopolitical context, and legal environment in which these advances occur. The thorough evaluation of individuals with possible paraphilias must include assessment of their sexual interest patterns, especially evaluation of any sexual interest in children. The chapter then details the formation of the Behavioral Medicine Institute of Atlanta to research VRT as a potential psychological test to assist clinicians in determining the sexual interests of individuals with potential paraphilias. The most critical objective of the research was to determine whether a brief, valid screening instrument could be developed to identify those with sexual interests in children who were applying to organizations that work with youths.
The Role of Personality Disorder in Sexual Offending
Authors: O’Shaughnessy Roy J. , Levin Giovana
Published: January 2022

This chapter addresses the role of personality traits and disorders in sexual offending behavior. The ability to identify specific traits related to target antisocial behaviors has specific value in forensic psychiatry, especially in risk assessment and in planning and implementing treatment and management programs for violent persons, including sexual offenders. Increasing knowledge regarding genesis of personality traits related to subsequent antisocial behavior and sexual offending also carries great potential for the implementation of early treatment and prevention programs for youth at risk. When one looks at many of the empirically proven risk factors for sexual abuse, one is struck that there are substantial shared factors associated with the genesis of juvenile delinquency and general antisocial functioning as well as substance abuse. It is probable that multiple risk factors are required and that no single risk factor is sufficient to explain the genesis of sexual offending behavior.
Empirically Based Psychological Approaches to the Treatment of Sex Offenders
Authors: Marshall William L. , Marshall Liam E.
Published: January 2022

This chapter begins with brief comments on the history of psychological treatment and then describes the principles upon which effective treatment relies. These empirically derived principles specify the approach to the allocation of resources according to each client’s risk to reoffend (the Risk principle), the issues that need to be targeted (the Needs principle), and the way in which treatment should be delivered (the Responsivity principle). The specific application of these principles in the treatment of sex offenders is then described. The limited evidence on the rate of entry into treatment and on treatment completion is outlined followed by a consideration of the inconsistencies in the application of these principles that is evident in the literature. Evidence supporting a limited number of treatment targets is noted followed by a consideration of the evidence on treatment effectiveness. Finally an alternative empirically-based treatment approach derived from the “positive psychology” literature is outlined followed by a review of the effectiveness of treatment.
Orchiectomy
Authors: Krueger Richard B.
Published: January 2022

This chapter presents the historical data supporting bilateral orchiectomy as a possible treatment modality for individuals who have committed sexual crimes or who have paraphilic disorders. Although the idea of orchiectomy, or surgical castration, evokes strongly negative emotional responses in many individuals, several reviews of biological treatments for sex offenders examining recidivism data from European studies have concluded that castration had very significant positive effects on recidivism. Castration for control, domination, punishment, mutilation, social advancement, and political reasons has been practiced since antiquity and has been the subject of several reviews. Some of the literature refers to “medical castration” or “pharmacological castration,” by which is meant the use of hormonal or gonadotropin-releasing hormone agonist therapy to reduce testosterone to castrate levels. Some of the literature on the treatment of prostate cancer also refers to androgen deprivation therapy, which has the aim of reducing testosterone to castrate levels, and which can be accomplished by surgical or medical castration.
Sexually Offending Behaviors in the Elderly
Authors: Davidow Jennie B. , Hucker Stephen J.
Published: January 2022

This chapter assesses sexually offending behaviors in the elderly. Research has consistently shown that older offenders are affected by significant medical and psychiatric problems not commonly seen in younger offenders. Given the extent of these problems, it has been suggested that use of specialized geriatric and psychogeriatric services for assessment and treatment is desirable. Although prisons and other correctional facilities are usually ill-equipped to provide the necessary care for such offenders, incarceration offers the opportunity to assess and treat conditions that may not have been possible in the outside community. Improvement in the health of prisoners may also reduce the burden of their chronic conditions both while incarcerated and after release.
Forensic Considerations
Authors: Reeves Rusty , Rosner Richard
Published: January 2022

This chapter addresses forensic considerations of sex offenders. All forensic psychiatric and psychological evaluations require the rational organization and analysis of data. A sex offender evaluation is no different, especially because this evaluation often involves forensic considerations beyond a sex offender evaluation. A four-step method devised by Richard Rosner stands the test of time and allows such rational organization and analysis. This method is simple, profound, and most importantly, useful—one the authors use themselves and teach their fellows in forensic psychiatry. The four steps are issue, legal criteria, data, and reasoning. The chapter describes these steps and illustrates their use by applying them to both forensic sex offender evaluations and non–sex offender evaluations.
Fever of unknown origin
Authors: Cunha Cheston B. , Cunha Burke A.
Published: January 2022

This chapter discusses fever of unknown origin (FUO). FUO describes prolonged fevers greater than 38°C/101°F lasting for 3 or more weeks that remain undiagnosed after a focused FUO outpatient/inpatient workup. The causes of FUO include infectious and noninfectious disorders. A variety of infectious, malignant, and rheumatic/inflammatory disorders may be associated with prolonged fevers, but relatively few persist undiagnosed for sufficient duration to be classified as FUOs. Because the appropriateness of therapy is based on a correct diagnosis, the main focus of the clinical approach to FUOs is diagnostic rather than therapeutic. The diagnostic workup should be focused on signs, symptoms, and nonspecific laboratory abnormalities that may either enhance or diminish particular diagnostic possibilities. Empiric therapy is rarely justifiable unless a potentially treatable life-threatening disease is a definite/highly probable diagnosis.
Salivary and lacrimal gland infections
Authors: Malek Alexandre E. , Fares Johny , Raad Issam I.
Published: January 2022

This chapter describes salivary gland infection or inflammation, also known as sialadenitis, which occurs in different age groups ranging from neonates to elderly people. It involves mainly the parotid, submandibular, and, to a lesser extent, the sublingual glands. Infections can be related to a variety of organisms including bacterial, viral, or mycobacterial. The cause of sialadenitis may be secondary to a variety of local or systemic factors affecting salivary output either by decreasing production or outflow. Bacterial sialadenitis is divided into two major subgroups: acute and chronic sialadenitis. Chronic sialadenitis is defined as repeated episodes of acute bacterial sialadenitis that are separated by periods of remission. Viral diseases of the salivary glands mainly affect the parotid glands, mumps being the most common infection. Other miscellaneous infectious causes of sialadenitis have been reported. Lacrimal gland infections usually affect the canaliculi and lacrimal sac. The three main types of infections are canaliculitis, dacryocystitis, and dacryoadenitis. Usually treatment involves systemic antibiotic therapy and surgical intervention.
Deep neck infections
Authors: Gradon Jeremy D.
Published: January 2022

This chapter explores infections of the deep spaces of the neck, which are becoming more common. Patients with deep neck infections are frequently either diabetic, HIV-infected (irrespective of antiretroviral therapy status), or immunocompromised in some other way. In addition, a history of injection drug use (IDU), neutropenia, or exogenous steroid therapy is common. A dental source is frequently present. Deep neck infections are usually polymicrobial, reflecting the oral cavity source of most of these infections. When associated with IDU, community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most likely organism encountered. Attempts to devise an algorithm-based approach to help with clinical decision-making have been made. Factors considered important include the presence/absence of airway obstruction, depth of neck involvement, ability to open mouth, ability to swallow, and any recent antibiotic usage.
Eumycetoma
Authors: Dlova Ncoza C. , Mosam Anisa , Chateau Antoinette
Published: January 2022

Mycetoma refers to a chronic subcutaneous granulomatous infection found predominantly in India, South America, and Africa. It is characterized by subcutaneous nodules, draining sinuses, and grains. It usually involves the feet and may result in disfigurement. Although mycetoma can be clinically diagnosed, effective therapy requires etiological characterization of the causative organism by pathology and culture. Where the causative agents are bacterial, mycetoma is subclassified as actinomycetoma; and where the organisms are fungal, it is termed eumycetoma. This chapter focuses on eumycetoma, which is difficult to treat and requires a combined approach for the best results. A combination of debulking surgery and antifungals is used, with azoles as first-line (itraconazole) followed by allylamines until clinical cure is obtained. In resistant cases, second-line azoles (posaconazole and voriconazole) or a combination of azoles and allylamines are used. Greater awareness and health worker education is necessary to diagnose and treat eumycetoma early and effectively. This, together with community awareness, is imperative to preventing chronic and disfiguring eumycetoma.
Croup, supraglottitis, and laryngitis
Authors: Behlau Irmgard
Published: January 2022

This chapter assesses acute supraglottitis (epiglottitis), croup, and laryngitis. Croup is a clinical syndrome characterized by a seal-like barking cough, hoarseness, inspiratory stridor, and often some degree of respiratory distress. It is primarily a disease of children between the ages of 1 to 6 with peak incidence between 6 months and 3 years. Rapid, objective, and calm assessment of severity must be done to determine management and without respiratory compromise. Meanwhile, supraglottitis is characterized by inflammation and edema of the supraglottic structures, including the epiglottis, arytenoepiglottic folds, arytenoids, and false vocal cords. Treatment of acute supraglottitis is directed at establishing an airway and administering appropriate antibiotics. Finally, acute laryngitis often presents with hoarseness, odynophagia, and localized pain, which may also be referred and manifests as otalgia. Because most cases of acute laryngitis are viral in etiology and self-limited, treatment usually consists of resting the voice and inhaling moistened air.
Community-acquired pneumonia
Authors: Vyas Keyur S.
Published: January 2022

This chapter describes community-acquired pneumonia (CAP), which continues to cause significant morbidity and mortality worldwide. In developed countries, most episodes occur in the elderly with one or more chronic underlying disease. Children are more commonly affected in the developing world. Morbidity and mortality from CAP remain high worldwide despite advances in antibiotic and intensive care therapy. Making the clinical diagnosis of pneumonia is usually not difficult. Pneumonia is suspected when one or more of the following is present: cough, purulent sputum, dyspnea, pleuritic pain, fever, chest auscultation findings consistent with pneumonia, leukocytosis, or a new pulmonary infiltrate on imaging. Once the diagnosis is suspected, the physician must decide whether hospitalization is necessary and if so, whether intensive care unit (ICU) admission is appropriate.
Infections of cardiovascular implantable devices
Authors: Sohail M. Rizwan , DeSimone Daniel C. , Steckelberg James M.
Published: January 2022

This chapter assesses infections of cardiovascular implantable devices. Cardiovascular implantable electronic devices (CIED) include permanent pacemakers (PPM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices. The reported risk of CIED infection depends on the complexity of the device and host comorbid conditions. Once infected, complete device removal and systemic antibiotic therapy are necessary to achieve cure. Earlier versions of CIEDs required surgical placement of epicardial leads, which was facilitated by sternotomy, and generators were mostly placed in the abdominal area. However, in contemporary practice, most device leads are placed percutaneously via the subclavian vein, and the device generator resides in a subcutaneous pocket in the pectoral area. Use of epicardial leads is now reserved for special situations where transvenous lead placement is not possible or deemed high risk due to active or recent bloodstream infection.
Acute appendicitis
Authors: Wu Bian , Maa John
Published: January 2022

This chapter looks at acute appendicitis, which is one of the most common surgical emergencies. It can occur in males and females of all ages but is most common in older children and young adults. The diagnosis is often delayed in younger children and the elderly due to atypical presentations. The pathophysiology of acute appendicitis begins with obstruction of the appendicular lumen. The obstruction is commonly caused by a fecalith (impacted stool) in adults and lymphoid hyperplasia in children, but can also result from foreign bodies (undigested seeds), infections (especially parasitic), and tumors (most commonly adenocarcinoma, followed by carcinoid tumors). A classic presentation of acute appendicitis includes periumbilical pain that migrates to the right lower quadrant, representing a progression from visceral pain to parietal pain that may occur within a few hours or a few days. The mainstay of treatment for simple acute appendicitis is prompt surgical removal of the appendix. To prevent progression leading to perforation, it is important to achieve timely and proper source control.
Diverticulitis
Authors: Zelhart Matthew D. , Nichols Ronald L.
Published: January 2022

This chapter assesses diverticulitis. Diverticulosis coli is an anatomic abnormality of mucosal outpouchings in the colonic wall. Colonic diverticula are often asymptomatic, and the prevalence varies greatly with such factors as geographic location, dietary habits, race, and age. The diagnosis of diverticulosis is often made incidentally in otherwise asymptomatic patients at the time of routine surveillance endoscopy or on imaging for other reasons. Most of these patients require only counseling about the need for prophylactic measures such as a fiber-rich diet, adequate fluid consumption, and the prevention of constipation. Meanwhile, symptomatic diverticulosis presents as two categories. The first is bleeding, in the form of lower gastrointestinal hemorrhage. The second is inflammation in the form of diverticulitis. Even when clinical manifestations of diverticulosis occur, emergent surgical intervention is necessary in only a minority of patients. During such life-threatening emergencies, the physician must be prepared to resuscitate the patient quickly and proceed to surgical intervention without benefit of a definite diagnosis.
Whipple’s disease and sprue
Authors: Mojtahed Amirkaveh , Afshar Payam
Published: January 2022

This chapter examines Whipple’s disease and tropical sprue. Whipple’s disease is primarily a disease of the gastrointestinal tract with extra-intestinal symptoms of arthralgia, fever, and neurologic syndromes. The nonspecific clinical presentation of the condition creates confusion for the clinician and latency in the diagnosis that can span many years. However, its diagnosis may be expedited with iatrogenic immunosuppression. Appropriate treatment of Whipple’s disease with antibiotics is essential to avoid the inevitable mortality of the condition. Tropical sprue is an acquired malabsorptive and likely infectious disease of unknown etiology that may affect locals and travelers in the tropics. Patients suffer from chronic diarrhea related to malabsorption of fatty acids and carbohydrates, as well as bile salt-induced diarrhea from terminal ileal (TI) involvement. The chapter also looks at small intestinal bacterial overgrowth (SIBO), characterized by an increased number of bacteria residing in the small bowel.
Vaginitis and cervicitis
Authors: Faro Sebastian
Published: January 2022

This chapter discusses vaginitis and cervicitis, which are undoubtedly linked in many instances, to some degree. Vaginitis can be divided into two broad categories: infectious and noninfectious, and either can lead to cervicitis. The most common noninfectious cause of vaginitis is bacterial vaginosis (BV), which has been shown not to be simply an alteration in the indigenous vaginal microbiota but perhaps should be considered as a subclinical infection. Many women with vaginitis are asymptomatic and do not seek treatment until they develop symptoms. Patients with vaginitis and cervicitis who undergo pelvic surgery are at risk for post-operative pelvic infection. BV has also been associated with complex pelvic inflammatory disease. Therefore, a simple evaluation of the vagina and cervicitis can lead to proper management, resolution of vaginitis and cervicitis, and improve the patient's quality of life.
Prostatitis
Authors: Cunha Cheston B. , Cunha Burke A.
Published: January 2022

This chapter evaluates prostatitis. The most common types of prostatitis are acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). ABP must be differentiated from urinary tract infections (UTIs) and CBP must be differentiated from non-bacterial (NBP) prostatitis and recurrent cystitis. Patients with ABP are acutely ill with fever and chills, and ABP may be complicated by urosepsis or prostatic abscess. In contrast, CBP is an indolent relapsing UTI with plus or minus perineal, genital, or low back pain usually accompanied by frequency, urgency, dysuria, or dysuria. CBP patients are usually referred to infectious diseases physicians for antibiotic treatment of persistent/relapsing infection. Repeated treatment failures are most often due to suboptimal (selection and duration) antibiotic therapy for CBP.
Acute and chronic osteomyelitis
Authors: Kronig Ilona , Vaudaux Pierre , Suvà Domizio , Lew Daniel , Uçkay Ilker
Published: January 2022

This chapter studies acute and chronic osteomyelitis. Osteomyelitis is a common term for bone infection, although noninfectious inflammation of bones and adherent structures exist. Strictly speaking, osteomyelitis implicates affection of bone and marrow. As for any infection, physicians like to create big groups of disease headed as acute (AO) and chronic osteomyelitis (CO), although this distinction does not much determine daily clinical practice. AO is a hematogenous infection that occurs mostly in prepubertal children and in the elderly and is usually located in the metaphyseal area of long bones (children) or in the spine (elderly). It is the result of a local proliferation of bacteria within bone after a septicemic storm. Alternatively, AO can originate locally following trauma or orthopedic surgery (surgical site infection). In contrast, CO has two origins. It may result from either a neglected sequel of AO, or from the continuous spreading of chronic ulcers in paraplegics, bedridden patients, or diabetic patients with foot problems. Epidemiology of osteomyelitis is heterogeneous with variability among involved bones, pathogens, and settings.