bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Health Messages about Perinatal Marijuana use in an Evolving Policy Context
Authors: Jarlenski Marian , Zank Jennifer , Tarr Jill , Chang Judy C.
Published: December 2016

Background: Marijuana is a commonly used substance in pregnancy in the United States. It is unknown what public health messages about perinatal marijuana use are being disseminated in the changing policy landscape. Methods: The authors systematically searched 51 state and 5 federal public health agencies’ Web sites in February 2016 for information about perinatal marijuana use. Of these, 1 federal agency and 10 state agencies had published information about perinatal marijuana use. Content analysis was performed by 2 investigators, with excellent interrater reliability (mean κ = 0.87). Results: Most content was targeted to the public, although 3 agencies had content targeted to health care providers. Common messages about health effects included adverse outcomes in infants and children exposed in utero and that marijuana can be passed via breast milk to infants. Eight sites mentioned health effects of marijuana use during breastfeeding, 5 included resources to stop using marijuana, 5 mentioned implications of marijuana use for infant safety, and 3 mentioned potential legal consequences. Conclusions: The volume of public health messages about perinatal marijuana use is low, content of messages differs across state agencies, and perinatal marijuana is seldom addressed in content published by federal agencies.
Effects of mushroom extract on textural properties and muscle protein degradation of bovine longissimus dorsi muscle
Authors: Lee Kyung-Ha , Kim Ho-Kyoung , Kim Sae-Hun , Kim Kyoung-Hwan , Choi Young-Min , Jin Hyun-Hee , Lee Seung-Joo , Ryu Youn-Chul
Published: December 2016

We investigated the effects of Sarcodon aspratus, Agaricus bisporus, and Lentinula edodes aqueous extracts on the tenderization of bovine longissimus dorsi muscle. Meat quality and muscle protein degradation were examined as well. Beef chunks were marinated in distilled water (control), 5% S. aspratus (SA), 5% A. bisporus (AB), or 5% L. edodes (LE) extracts. SA was shown to have a higher enzymatic activity (p < 0.001) and water-holding capacity than LE (p < 0.01). SA and AB extracts exhibited lower shear force values compared with the control (p < 0.05). SA, AB, and LE showed superior muscle proteolytic effects compared with the control. SA demonstrated the ability to degrade myosin heavy chains and actin, which was not observed after AB and LE extract treatments. This suggests that SA extract may affect tenderization. Taken together, our results show that aqueous extract of S. aspratus affects the tenderness of the bovine longissimus dorsi muscle.
Use of thermodilution cardiac output overestimates diagnoses of exercise‐induced pulmonary hypertension
Authors: Hsu Steven , Brusca Samuel B. , Rhodes Parker S. , Kolb Todd M. , Mathai Stephen C. , Tedford Ryan J.
Published: December 2016

Two new definitions of exercise‐induced pulmonary hypertension (EIPH) have emerged. Both rely on measuring cardiac output (CO), yet this remains unstandardized. In our cohort of patients undergoing invasive cardiopulmonary exercise testing, we found that using thermodilution CO rather than direct Fick CO led to a significant excess of EIPH diagnoses.
Report of the CCQM-K97: measurement of arsenobetaine standard solution and arsenobetaine content in fish tissue (tunafish)
Authors: Ma L D , Wang J , WEI C , Kuroiwa T , Narukawa T , Ito N , HIOKI A , CHIBA K , Yim Y H , Lee K S , Lim Y R , Turk G C , Davis C W , Mester Z , Yang L , McCooeye M , Maxwell P , Cankur O , Tokman N , Coskun F G
Published: December 2016

The CCQM-K97 key comparison was organized by the inorganic analysis working group (IAWG) of CCQM as a follow-up to completed pilot study CCQM-P96 and P96.1 to test the abilities of the national metrology institutes to accurately quantitate the mass fraction of arsenobetaine (AsB) in standard solution and in fish tissue. A pilot study CCQM-P133 was parallelized with this key comparison. National Institute of Metrology (NIM), China and National Metrology Institute of Japan (NMIJ) acted as the coordinating laboratories.

Six NMIs participated in CCQM-K97 and two institutes participated in CCQM-P133, and all of them submitted the results. Some NMIs submitted more than one results by different methods. The results were in excellent agreement with each other, and obviously better than those of previous P96 and P96.1. Therefore the calibrant which each NMI used was comparable. It shows that the capabilities of some of the participants have been improved after the previous pilot studies.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
On the construction of semisimple Lie algebras and Chevalley groups
Authors: Geck Meinolf
Published: December 2016

Let

g

\mathfrak {g}

be a semisimple complex Lie algebra. Recently, Lusztig simplified the traditional construction of the corresponding Chevalley groups (of adjoint type) using the “canonical basis” of the adjoint representation of 

g

\mathfrak {g}

. Here, we present a variation of this idea which leads to a new, and quite elementary, construction of

g

\mathfrak {g}

itself from its root system. An additional feature of this set-up is that it also gives rise to explicit Chevalley bases of

g

\mathfrak {g}

.
MetaDCN: meta-analysis framework for differential co-expression network detection with an application in breast cancer
Authors: Zhu Li , Ding Ying , Chen Cho-Yi , Wang Lin , Huo Zhiguang , Kim SungHwan , Sotiriou Christos , Oesterreich Steffi , Tseng George C
Published: December 2016

Motivation

Gene co-expression network analysis from transcriptomic studies can elucidate gene–gene interactions and regulatory mechanisms. Differential co-expression analysis helps further detect alterations of regulatory activities in case/control comparison. Co-expression networks estimated from single transcriptomic study is often unstable and not generalizable due to cohort bias and limited sample size. With the rapid accumulation of publicly available transcriptomic studies, co-expression analysis combining multiple transcriptomic studies can provide more accurate and robust results.

Results

In this paper, we propose a meta-analytic framework for detecting differentially co-expressed networks (MetaDCN). Differentially co-expressed seed modules are first detected by optimizing an energy function via simulated annealing. Basic modules sharing common pathways are merged into pathway-centric supermodules and a Cytoscape plug-in (MetaDCNExplorer) is developed to visualize and explore the findings. We applied MetaDCN to two breast cancer applications: ER+/ER- comparison using five training and three testing studies, and ILC/IDC comparison with two training and two testing studies. We identified 20 and 4 supermodules for ER+/ER- and ILC/IDC comparisons, respectively. Ranking atop are ‘immune response pathway’ and ‘complement cascades pathway’ for ER comparison, and ‘extracellular matrix pathway’ for ILC/IDC comparison. Without the need for prior information, the results from MetaDCN confirm existing as well as discover novel disease mechanisms in a systems manner.

Availability and Implementation

R package ‘MetaDCN’ and Cytoscape App ‘MetaDCNExplorer’ are available at http://tsenglab.biostat.pitt.edu/software.htm.

Supplementary information

Supplementary data are available at Bioinformatics online.
Dosing Guidance for Intravenous Colistin in Critically Ill Patients
Authors: Nation Roger L. , Garonzik Samira M. , Thamlikitkul Visanu , Giamarellos-Bourboulis Evangelos J. , Forrest Alan , Paterson David L. , Li Jian , Silveira Fernanda P.
Published: December 2016

Background.

Intravenous colistin is difficult to use because plasma concentrations for antibacterial effect overlap those causing nephrotoxicity, and there is large interpatient variability in pharmacokinetics. The aim was to develop dosing algorithms for achievement of a clinically desirable average steady-state plasma colistin concentration (Css,avg) of 2 mg/L.

Methods.

Plasma concentration-time data from 214 adult critically ill patients (creatinine clearance, 0–236 mL/min; 29 receiving renal replacement therapy [RRT]) were subjected to population pharmacokinetic analysis. Development of an algorithm for patients not receiving RRT was based on the relationship between the dose of colistimethate that would be needed to achieve a desired Css,avg and creatinine clearance. The increase in colistin clearance when patients were receiving RRT was determined from the population analysis and guided the supplemental dosing needed. To balance potential antibacterial benefit against risk of nephrotoxicity the algorithms were designed to achieve target attainment rates of >80% for Css,avg ≥2 and <30% for Css,avg ≥4 mg/L.

Results.

When algorithm doses were applied back to individual patients not receiving RRT (including those prescribed intermittent dialysis on a nondialysis day), >80% of patients with creatinine clearance <80 mL/min achieved Css,avg ≥2 mg/L, but for patients with creatinine clearance ≥80 mL/min, the target attainment was <40%, even with the maximum allowed daily dose of 360 mg colistin base activity. For patients receiving RRT, target attainment rates were >80% with the proposed supplemental dosing. In all categories of patients, <30% of patients attained Css,avg ≥4 mg/L.

Conclusions.

The project has generated clinician-friendly dosing algorithms and pointed to circumstances in which intravenous monotherapy may be inadequate.
Partner Bereavement and Risk of Herpes Zoster: Results from Two Population-Based Case-Control Studies in Denmark and the United Kingdom
Authors: Schmidt Sigrun A. J. , Vestergaard Mogens , Pedersen Henrik S. , Schønheyder Henrik C. , Thomas Sara L. , Smeeth Liam , Mansfield Kathryn E. , Sørensen Henrik T. , Forbes Harriet J. , Langan Sinéad M.
Published: December 2016

Background.

Psychological stress is commonly thought to increase the risk of herpes zoster by causing immunosuppression. However, epidemiological studies on the topic are sparse and inconsistent. We conducted 2 parallel case-control studies of the association between partner bereavement and risk of zoster using electronic healthcare data covering the entire Danish population and general practices in the UK Clinical Practice Research Datalink.

Methods.

We included patients with a zoster diagnosis from the primary care or hospital-based setting in 1997–2013 in Denmark (n = 190671) and 2000–2013 in the United Kingdom (n = 150207). We matched up to 4 controls to each case patient by age, sex, and general practice (United Kingdom only) using risk-set sampling. The date of diagnosis was the index date for case patients and their controls. We computed adjusted odds ratios with 99% confidence intervals for previous bereavement among case patients versus controls using conditional logistic regression with results from the 2 settings pooled using random-effects meta-analysis.

Results.

Overall, the adjusted odds ratios for the association between partner bereavement and zoster were 1.05 (99% confidence interval, 1.03–1.07) in Denmark and 1.01 (.98–1.05) in the United Kingdom. The pooled estimates were 0.72, 0.90, 1.10, 1.08, 1.02, 1.04, and 1.03 for bereavement within 0–7, 8–14, 15–30, 31–90, 91–365, 366–1095, and >1095 days before the index date, respectively.

Conclusions.

We found no consistent evidence of an increased risk of zoster after partner death. Initial fluctuations in estimates may be explained by delayed healthcare contact due to the loss.
Viral Shedding and Transmission Potential of Asymptomatic and Paucisymptomatic Influenza Virus Infections in the Community
Authors: Ip Dennis K. M. , Lau Lincoln L. H. , Leung Nancy H. L. , Fang Vicky J. , Chan Kwok-Hung , Chu Daniel K. W. , Leung Gabriel M. , Peiris J. S. Malik , Uyeki Timothy M. , Cowling Benjamin J.
Published: December 2016

Background.

Influenza virus infections are associated with a wide spectrum of disease. However, few studies have investigated in detail the epidemiological and virological characteristics of asymptomatic and mild illness with influenza virus infections.

Methods.

In a community-based study in Hong Kong from 2008 to 2014, we followed up initially healthy individuals who were household contacts of symptomatic persons with laboratory-confirmed influenza, to identify secondary infections. Information from daily symptom diaries was used to classify infections as symptomatic (≥2 signs/symptoms, including fever ≥37.8°C, headache, myalgia, cough, sore throat, runny nose and sputum), paucisymptomatic (1 symptom only), or asymptomatic (none of these symptoms). We compared the patterns of influenza viral shedding between these groups.

Results.

We identified 235 virologically confirmed secondary cases of influenza virus infection in the household setting, including 31 (13%) paucisymptomatic and 25 (11%) asymptomatic cases. The duration of viral RNA shedding was shorter and declined more rapidly in paucisymptomatic and asymptomatic than in symptomatic cases. The mean levels of influenza viral RNA shedding in asymptomatic and paucisymptomatic cases were approximately 1–2 log10 copies lower than in symptomatic cases.

Conclusions.

The presence of influenza viral shedding in patients with influenza who have very few or no symptoms reflects their potential for transmitting the virus to close contacts. These findings suggest that further research is needed to investigate the contribution of persons with asymptomatic or clinically mild influenza virus infections to influenza virus transmission in household, institutional, and community settings.
Penile Immune Activation and Risk of HIV Shedding: A Prospective Cohort Study
Authors: Patel Eshan U. , Kirkpatrick Allison R. , Grabowski Mary Kate , Kigozi Godfrey , Gray Ronald H. , Prodger Jessica L. , Redd Andrew D. , Nalugoda Fred , Serwadda David , Wawer Maria J. , Quinn Thomas C. , Tobian Aaron A. R.
Published: December 2016

Background.

Genital immune activation is suspected to modulate local human immunodeficiency virus (HIV) RNA levels and the risk of sexual HIV transmission.

Methods.

A prospective, observational cohort study of 221 HIV-infected men undergoing male circumcision (MC) was conducted in Rakai, Uganda. Penile lavage samples collected from the coronal sulcus at baseline and 4 weekly visits after MC were assayed for pro-inflammatory cytokines and HIV RNA. The main analysis was limited to 175 men with detectable HIV plasma viral load (VL > 400 copies/mL; n = 808 visits). The primary exposures of interest were individual and total cytokine detection at the previous postoperative visit. Adjusted prevalence risk ratios (adjPRR) of detectable HIV shedding (VL > 40 copies/mL) were estimated by Poisson regression models with generalized estimating equations and robust variance estimators and included adjustment for plasma HIV VL.

Findings.

Among men with a detectable plasma VL, penile HIV shedding was detected at 136 visits (16.8%). Detectable interleukin (IL)-1β (adjPRR = 2.14; 95% confidence interval (CI) = 1.02–4.48), IL-6 (adjPRR = 2.24; 95% CI = 1.28–3.90), IL-8 (adjPRR = 2.42; 95% CI = 1.15–5.08), IL-10 (adjPRR = 2.51; 95% CI = 1.67–3.80), and IL-13 (adjPRR = 1.87; 95% CI = 1.15–3.03) were associated with penile HIV shedding at the subsequent visit. Men with 2–4 (adjPRR = 2.36; 95% CI = 1.08–5.14) and 5–7 (adjPRR = 3.00; 95% CI = 1.28–7.01) detectable cytokines had a greater likelihood of detectable penile HIV shedding at the subsequent visit, compared to men with ≤ 1 detectable cytokine. The total number of detectable cytokines was also associated with a higher penile log10 HIV VL at the subsequent visit among HIV shedders.

Interpretation.

Pro-inflammatory cytokine production had a dose-dependent and temporal association with penile HIV shedding, suggesting that genital immune activation may increase the risk of sexual HIV transmission by driving local HIV replication.
A slip wave solution in antiplane elasticity
Authors: Ranjith K.
Published: December 2016

It is shown that a slip wave solution exists for antiplane sliding of an elastic layer on an elastic half-space. It is a companion solution to the well-known Love wave solution.
Mental models, communication, and engagement in marine projects
Authors: Boschetti Fabio , Andreotta Matthew
Published: December 2016

In a hypothetical decision-making situation in which a unique truth exists and each party’s aim in acquiring knowledge is to approach the truth, argumentation would be unnecessary because the best scientific theory would win the argument. Likewise, if truth is irrelevant and a perfect persuasion method is available, argumentation would also be pointless, because arguing parties, each possessing the perfect recipe, would lead a third party to switch sides endlessly. In the real world, argumentation matters because a unique truth rarely exists, information can be uncertain or vague, aims are often ambiguous if not contradictory, and acquiring knowledge can have other purposes besides approaching the truth. Marine scientists are increasingly expected to contribute to complex decision-making by providing not only scientific evidence, but also impact in the form of effective communication and persuasion. Here we review insights from different disciplines on how humans organise knowledge, beliefs, opinions, assumptions and worldviews, how these interrelate and how they affect decision-making as well as the reception of information. By focussing on the theory of mental models and the Causal Layered Analysis we also show how the structure underlying the organisation of scientific and non-scientific knowledge can be reduced to a fairly common framework. We conclude by reviewing some tools a marine scientist can employ in a stakeholder engagement process in order to better understand the audience to which scientific information needs to be delivered.
Health-Related Quality of Life as a Goal for Clinical Care
Authors: Sullivan Mark D.
Published: December 2016

The importance of chronic illness has brought a new focus on patient-reported outcomes of clinical care. Health-Related Qualify of Life (HRQL) is a new goal for clinical care that combines a physician’s view of health as an objective biological fact and the patient’s view of health as a subjective experiential state. The diagnosis of an impersonal and objective disease separable from the patient arose after the French Revolution and helped to delimit the new right to health care. But objective mortality and morbidity metrics are not adequate for capturing the burden of chronic illness. HRQL was invented to capture the burden of chronic illness, but has not been successfully incorporated into clinical trials or clinical care. Chronic low back pain is presented as an example where both objective and subjective metrics of treatment success have failed. We need an openly patient-centered definition of health that is not just a supplement to objective disease diagnosis.
Deformation echocardiography
Authors: Cameli Matteo , Sengupta Partho , Edvardsen Thor
Published: December 2016

Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional and global myocardial function. First introduced as a post-processing feature of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from speckle tracking analysis. Tissue Doppler imaging yields velocity information from which strain and strain rate are mathematically derived whereas two-dimensional speckle tracking yields strain information from which strain rate and velocity data are derived. Data obtained from these two different techniques may not be equivalent due to limitations inherent with each technique. Speckle tracking analysis can generate longitudinal, circumferential, and radial strain measurements and left ventricular twist. Although potentially useful, these measurements are also complicated and frequently displayed as difficult-to-interpret waveforms. Strain imaging is now considered a robust research tool and has great potential to play many roles in routine clinical practice. This chapter explains the fundamental concepts of deformation imaging, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, and the strengths and weaknesses of these methods.
Stress echocardiography: introduction and pathophysiology
Authors: Sicari Rosa , Dulgheru Raluca
Published: December 2016

Stress echocardiography is the combination of two-dimensional echocardiography with a physical, pharmacological, or electrical stress. The diagnostic end point for the detection of myocardial ischaemia is the induction of a transient worsening in left ventricular regional function during stress. Among different stress modalities of comparable diagnostic and prognostic accuracy available, semisupine exercise is the most frequently used; dobutamine-the best test for viability assessment; dipyridamole-the safest and simplest pharmacological stress test; and the most suitable for combined wall motion-coronary flow reserve assessment. Identification of viable myocardium and evaluation of severity of valvular heart disease are additional recognized applications of stress echocardiography. In spite of its dependence upon operators’ training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging modality to achieve the still elusive target of sustainable cardiac imaging in the field of non-invasive diagnosis of coronary artery disease.
Stress echocardiography: diagnostic and prognostic values and specific clinical subsets
Authors: Pierard Luc A. , Cortigiani Lauro
Published: December 2016

Stress echocardiography is a widely used method for assessing coronary artery disease, due to its high diagnostic and prognostic value. While inducible ischaemia predicts an unfavourable outcome, its absence is associated with a low risk of future cardiac events. The method provides superior diagnostic and prognostic information than standard exercise electrocardiography and perfusion myocardial imaging in specific clinical subsets, such as women, hypertensive patients, and patients with left bundle branch block. Stress echocardiography allows effective risk assessment also in the diabetic population. The evaluation of coronary flow reserve of the left anterior descending artery by transthoracic Doppler adds diagnostic and prognostic information to that of standard stress test. Stress echocardiography is indicated in the cases when exercise electrocardiography is unfeasible, uninterpretable or gives ambiguous result, and when ischaemia during the test is frequently a false-positive response, as in hypertensive patients, women, and patients with left ventricular hypertrophy. Viability detection represents another application of stress echocardiography. The documentation of a large amount of viable myocardium predicts improved ejection fraction, reverse remodelling, and improved outcome following revascularization in patients with ischaemic cardiomyopathy. Moreover, stress echocardiography can aid significantly in clinical decision-making in patients with valvular heart disease through dynamic assessment of primary or secondary mitral regurgitation, transvalvular gradients, and pulmonary artery systolic pressure, as well as before vascular surgery due to the excellent negative predictive value. Finally, stress echocardiography allows effective risk stratification in patients with hypertrophic cardiomyopathy through evaluation of inducible ischaemia, coronary flow reserve, and intraventricular gradient.
Lung ultrasound
Authors: Gargani Luna , Miglioranza Marcelo-Haertel
Published: December 2016

The lung is a relatively new site for the application of ultrasound. Beyond the more established assessment of pleural effusion, this organ has been traditionally considered off limits for sonographic investigation, since air is a well-known foe of the ultrasound beam. However, in recent years it has been shown that this apparent physical limitation can be overcome when the air content decreases, as happens in a diseased pulmonary parenchyma. The most useful lung ultrasound sign for cardiologists is the presence of B-lines, the sonographic hallmark of pulmonary interstitial syndrome, including interstitial pulmonary oedema. Bilateral multiple B-lines are present in patients with pulmonary congestion and may help assess and semiquantify the extent of extravascular lung water in patients with heart failure. This sign is low cost, easy to perform, can be repeated at bedside, and does not employ ionizing radiation. Lung ultrasound is also useful for detecting other pulmonary conditions such as pneumothorax, and lung consolidations such as pneumonia or pulmonary infarction.
Ischaemic heart disease: acute coronary syndrome
Authors: Alonso Salinas Gonzalo Luis , Izco Marina Pascual , Fernández-Golfín Covadonga , Badano Luigi P. , Zamorano José Luis
Published: December 2016

Transthoracic echocardiography (TTE) is a non-invasive and accessible tool that should be widely used in the evaluation of patients with suspected or known acute coronary syndrome (ACS). Its role is crucial in the management of patients with suspected ACS without electrocardiographic changes or elevation of cardiac markers, allowing the formulation of differential diagnosis between cardiac and extracardiac aetiologies. If the ACS is confirmed, initial assessment of regional and global left and right ventricle contractile function is fundamental in establishing the management strategy and may help in the risk stratification of these patients. TTE can also characterize the ischaemic myocardium in the acute phase, exposing any myocardial regional wall motion abnormalities. Furthermore, TTE is an excellent tool for the initial assessment of the aetiology of cardiogenic shock. It provides additional information regarding the haemodynamic status of the patient, including filling pressures and stroke volume, and it may rule out other causes of shock; thus, immediate TTE, or transoesophageal echocardiography if necessary, should be performed when cardiogenic shock is suspected. In the chronic phase, TTE plays an important role in characterizing myocardial infarction scar and its extent. TTE can accurately differentiate viable myocardium from scar tissue, and may guide revascularization if needed, improving patient care.
Heart valve disease (mitral valve disease): mitral stenosis
Authors: Popescu Bogdan A. , Sengupta Shantanu P. , Samiei Niloufar , Mateescu Anca D.
Published: December 2016

The most common cause of mitral stenosis (MS) is rheumatic fever followed by degenerative MS. Echocardiography is the key method to diagnose and evaluate MS. Echocardiographic findings are closely related to aetiology. In rheumatic disease echocardiography shows thickening of leaflet tips with restricted opening caused by commissural fusion resulting in ‘doming’ of the mitral valve in diastole. Quantitation of MS severity includes measuring mitral valve area (MVA) by planimetry (anatomical area, by two-/three-dimensional echo), or by the pressure half-time (PHT) method (functional area, by Doppler), and the mean pressure gradient. Planimetry is considered the reference method to determine MVA as it is relatively load independent. The PHT method is widely used due to its simplicity, but different factors influence the relationship between PHT and MVA. Other indices of MS severity are rarely used in clinical practice. Echocardiography also helps in the assessment of consequences of MS, and of associated valvular lesions. Exercise Doppler is recommended when there is discrepancy between the resting echocardiography findings and the clinical picture. Echocardiography is crucial in determining the timing and type of intervention in patients with MS. When considering percutaneous mitral commissurotomy (PMC) valve morphology should be comprehensively evaluated for mobility, thickness, calcifications, and subvalvular apparatus. The echo findings may determine the suitability for PMC, guide the procedure, and assess its results.
Heart valve disease: pulmonary valve disease
Authors: Miller Owen I. , Budts Werner
Published: December 2016

Congenital abnormalities of the pulmonary valve (PV) are common either as a single lesion or in the context of more complex congenital lesions where abnormalities of the PV play a major role in the cardiac physiology. Transthoracic echocardiographic (TTE) imaging of the PV is relatively straightforward in the normally connected heart due to its anterior position close to common sonographic windows. Imaging of the abnormally positioned PV requires modifications to standard projections and may be better demonstrated by a transoesophageal (TOE) or three-dimensional (3D) echocardiographic approach. Standard 3D TTE may offer advantages in surgical planning for an abnormally positioned pulmonary valve in complex congenital anatomy and 3D TOE may add value to the demonstration of abnormalities of the subpulmonary right ventricular outflow tract.
Takotsubo syndrome
Authors: Citro Rodolfo , Davin Laurent , Muñoz Daniel Rodriguez
Published: December 2016

Owing to its dynamic and unique nature, standard echocardiography plays a key role in the diagnostic work-up of patients suspected of takotsubo cardiomyopathy (TTC), providing distinctive features of this peculiar syndrome. Useful information for the early recognition of TTC can be derived from the discrepancy between extensive myocardial dysfunction and a modest increase in troponin levels; the detection of a ‘circumferential pattern’ of left ventricular (LV) wall motion abnormalities, which typically extend beyond the distribution of a single coronary artery; coronary flow assessment in the distal tract of the left anterior descending artery; and right ventricular (RV) involvement (biventricular ballooning). Advanced echocardiographic techniques, including speckle tracking, myocardial contrast and coronary flow studies, are providing further mechanistic and pathophysiological insights. Additionally, evaluation of both LV systolic and diastolic function along with early identification of any potential complications are crucial for clinical management and risk stratification. Comprehensive serial echocardiographic examinations should be systematically performed during the follow-up of TTC patients to monitor myocardial function recovery.
Cardiac rhythm disorders
Authors: Haugaa Kristina H. , Faletra Francesco , Cavalcante João L.
Published: December 2016

Cardiac rhythm disorders require diagnostic, prognostic, and guidance of therapeutic procedures by echocardiography. The most common sustained cardiac arrhythmia is atrial fibrillation (AF) leading to an increased risk for mortality, heart failure, and thromboembolic events. Echocardiography is performed to assess the aetiology of AF which most commonly is associated with diseases leading to enlarged atria. Furthermore, echocardiography is crucial to evaluate thromboembolic risk by assessing the morphology and function of the left atrial appendage among other parameters. Non-invasive imaging modalities including two-dimensional transthoracic (TTE) and transoesophageal echocardiography (TOE) with three-dimensional imaging are often indicated. Finally, TOE can help in the preprocedural planning and providing guidance for interventions such as pulmonary vein ablation and percutaneous left atrial appendage closure. In patients with ventricular arrhythmias, TTE is the first-line diagnostic tool for assessing the aetiology of ventricular arrhythmias. Ischaemic heart disease, either acute or chronic fibrosis, is the most common causes of ventricular tachycardias. Left ventricular ejection fraction remains the most important parameter for indication of an implantable cardioverter defibrillator for primary prevention therapy, although newer strain echocardiographic measures may add incremental prognostic information.
Interventional echocardiography
Authors: San Román Alejandra Carbonell , Zamorano José Luis
Published: December 2016

Multimodality imaging is vital in any percutaneous cardiac procedure, increasing the precision and accuracy of the procedure to optimize results and reduce complications to a minimum. Three-dimensional transoesophageal echocardiography has progressively become essential, as it provides supportive and precise image information, additive to that obtained by conventional two-dimensional imaging. The rapidly evolving technology to improve visualization and image resolution is aiding the development and performance of these techniques with an increasing need of qualified imaging expertise. This chapter describes the use of transthoracic, transoesophageal, and intracardiac echocardiography approaches in a variety of interventional echocardiography procedures, including valvular heart disease, transcatheter aortic valve implantation, MitraClip® therapy for mitral valve repair, percutaneous closure of paravalvular leaks, and intracardiac shunts.
Mouth care, feeding, and hydration
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Feeding one’s child is a basic parental instinct, so a situation where this is causing problems is very distressing not only for the child, but also for the family. This chapter examines the management of feeding problems, including nutritional assessment and factors that may help with feeding. Types of enteral feeding are also covered, including nasogastric tube and gastrostomy, with details given on factors that would influence the need for enteral feeding. This chapter includes a section on hydration and mouth care, an often overlooked area of symptom management.
Palliative care emergencies
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

A palliative care emergency describes a symptom situation that is serious and demands immediate and skilled specialist attention, but is also unusual enough for there to be a possibility that the specialist has not often encountered it. In a palliative care emergency, the patient experiences sudden and severe distress that can only be relieved by prompt and confident intervention by the palliative care team. There is little time to prepare for it, and, to the specialist in paediatric palliative medicine, an emergency is defined by the importance of already having a clear strategy for dealing with it. That can be challenging for those working in paediatric palliative care, because most are rare. This chapter covers the six main emergencies encountered in paediatric palliative medicine: cord compression, catastrophic haemorrhage, severe uncontrolled pain, superior vena cava obstruction, intestinal obstruction, and hypercalcaemia.
Practicalities around time of death
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

In helping children to have a ‘good death’, it is vitally important to understand the practical issues around death. Parents often have little or no understanding of this and will look to the health-care professional for guidance. When done well, the parents are left unaware of the complexities involved. However, when done badly, the parents can be left feeling very upset. Predicting the time of death for a child is notoriously difficult, and this issue is addressed by this chapter. A detailed overview of practicalities around the time of death is provided, with information on the correct procedure before death, certifying and registering a death, cremation, organ and tissue donation, and transporting and looking after the body. Further practicalities, including the post-mortem, the role of the coroner, and the role of the Child Death Overview Panel, are also covered.
Communication skills
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

The medical care of children is characterized by the extent to which it relies on collaboration with family. In effect, the family of a child is expected to behave as colleagues with the paediatric or primary care team. The goal of communication with patients and families is to ensure the families feel confident and competent in this collegiate relationship. This chapter looks at the aim of communication factors that can complicate effective communication. A structured approach to facilitate the aims of communication is provided, with details on each stage.
Coping skills
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Working within health care induces different levels of stress in professionals. When dealing with life-limited children, these stresses can be immense and, if not managed correctly, can lead to burnout. This chapter addresses specific issues that health-care professionals may face, with specific attention paid to how to effectively manage these issues.
Prologue
Authors: Stanghellini Giovanni
Published: December 2016

The Introduction explains the overall project and focuses on the question ‘What is it to be human?’. Rationality, language, self-awareness, self-knowledge, and moral sense have been indicated as the distinctive features of being human. In this book, I will build on and develop the assumption that to be human means to be in dialogue. Dialogue is a unitary concept that will guide me in attempting to address in a coherent way three essential issues for clinical practice: ‘What is a human being?’, ‘What is mental pathology?’, and ‘What is care?’. I will argue that to be human means to be in dialogue with alterity, that mental pathology is the outcome of a crisis of one’s dialogue with alterity, and that care is a method wherein dialogues take place whose aim is to re-enact interrupted dialogue with alterity within oneself and with the external world.
The Uncanny and the secretly familiar double
Authors: Stanghellini Giovanni
Published: December 2016

This chapter explains the second paradox of alterity: alterity is felt as extraneous and familiar at the same time. It comes as a surprise from the most intimate and proper region of the Self. What is experienced as most extraneous is also what is most proper to the Self. These are the two sides of a fold: a zone of continuity rather than discontinuity. This is the topos of the Double and the Uncanny. Alterity does not coincide with the Freudian Unconscious. This impersonal and not individuated part is not repressed. It is the obscure side of my own existence as it manifests itself in front of myself. From this stems a further paradox: if alterity is our own life in as much as it does not belong to us, then we must respond for something for which we are not responsible.
Habitus: the emergence of alterity in social situations
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that my habits seem to be what is most distant from alterity as they pertain to order and regularity. Yet, habits exonerate me from reflecting each time about the proper way to act under given circumstances. Thus, acting on the basis of habit means to act unreflectively and involuntarily. The ‘habitual self’ is opposed to the ‘reflecting self’. Habit actually is the power of forgetting. It is not unconscious in a psychodynamic sense; rather it is a form of unreflecting, inattentive, practical Cogito. As such, it is another form of dissociated spontaneity, next to drive and emotion, which may surprise me, especially when it prescribes me a given action that is inappropriate to the circumstances. Habit is what lets me discover alterity as repetition in the course of my intersubjective life.
A logic for recognition: heterology
Authors: Stanghellini Giovanni
Published: December 2016

This chapter answers the question: on which kind of logic is recognition based? The other is not like me (empirical dissymmetry) and at the same time is like me (transcendental symmetry), as he is aware of the space that separates him from the Other as he is about to cross it. Heterology is the logic that posits the Other as radically other, in contrast to a conception of the relationship with the Other based on the category of analogy. The Other is not knowable to me as analogous to me. The Other’s experiences are not grasped if I rely on my own experiences under similar circumstances as the way to understand what happens to her. Rather, as radically different from me, the Other remains unknowable to me. The Other’s logos—that is, the ordering principle behind the meaningfulness of the Other’s world—is not reducible to mine. The Other is ‘hetero-logos’.
First steps towards the person-centred, dialectical model of mental disorders
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that mental symptoms are the interruption of this dialogue through which we strive to build and maintain our personal identity and our position in the world. The person is engaged in trying to cope with, solve, and make sense of the basic disturbing experiences stemming from her clash with alterity. When a symptom emerges, the line of the pathogenic trajectory is the following: (1) a disproportion of alterity and the person’s resources for understanding, of emotions and rationality, of pathos and logos, of otherness and selfhood, bringing about a disturbing metamorphosis of self and world experience; (2) a miscarried auto-hermeneutics or self-interpretation of one’s abnormal experiences and of the transformations of the life-world that they bring about; (3) the fixation in a psychopathological structure in which the dialectics between the person and alterity gets lost.
The trauma of non-recognition
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that human existence is stained by the tragic experience of our failed encounter with the Other. Mental pathology is a miscarried attempt to deal with the suffering that stems from the intolerability of the awareness of the Other’s radical alterity. Our incapacity to recognize the Other is the mark of being human, not a subjective inability. In our tending towards the Other we experience the Other as unattainable. The essence of the Other is its otherness: the Other can never be fully appropriated, but only approximated, as a frustrating limitation for our desire and of our capacity for understanding. This failure in encountering the Other leads to a state of suffering such as to generate defensive shelters that develop into fixed forms of miscarried existence and become part of the spectrum of what we regard as mental pathology.
Erotomania and idolatrous desire
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that our desire seeks an idolatrous satisfaction. Erotomania is paradigmatic of the importance of the teleology of love in human affairs and its pathogenetic importance. Is our love for an image, a shelter from the suffering generated by the failed encounter with the Other? Or is it the ultimate obstacle that obstructs our leap to the Other? Narcissus and Pygmalion, as well as de Clérambault’s erotomanic patients, are in love with an image. Their desire is directed to an idol fabricated by their mind. This idol impedes their relation to ‘real’ people and brings about a ‘phantasmatic’ satisfaction of their desire. The image of the Other stands between ourselves and the Other. Our focusing on this phantasm, rather than on the flesh-and-blood Other, disregards the Other’s freedom not to correspond to our own desire, and our incapacity to tolerate this.
The P.H.D. method
Authors: Stanghellini Giovanni
Published: December 2016

This chapter reports the main principles of the P.H.D. method:

Phenomenological unfolding (P): unfolding means to open up and lay bare the pleats of the patient’s experiences. Unfolding enriches understanding by providing further resources in addition to those that are immediately visible. The main aim is to rescue the logos of the phenomena in themselves, the implicit, automatic, forgotten sources that make phenomena appear as they appear to the patient.

Hermeneutic analysis of the person’s position-taking towards her experience (H): rescuing from the implicit the active role that the patient has in shaping her symptoms, helping her to recalibrate her miscarried position-taking and, finally, to recover her sense of responsibility and agency.

Dynamic analysis of the life-history in which experiences and position-taking are embedded (D): making sense of a given phenomenon is finally to posit it in a meaningful context, and this context includes the personal history of the patient.
Empathy and beyond
Authors: Stanghellini Giovanni
Published: December 2016

This chapter discusses previous characterizations of empathy. It argues that understanding severe aberrations of experience requires a kind of training that goes beyond a conception of spontaneous empathic skills, and at the same time avoids the pitfalls of empathy based on the clinician’s personal experiences and common-sense categories. To achieve this kind of second-order empathy I need to acknowledge the autonomy of the other person, and consequently that the life-world of the other person is not like my own. The supposition that the other lives in a world just like my own—i.e. he experiences time, space, his own body, others, the materiality of objects, etc., just as I do—is often the source of serious misunderstandings.
Second-order empathy
Authors: Stanghellini Giovanni
Published: December 2016

This chapter reports a case study of ‘manipulation’. It argues that the case study of manipulation confirms that the supposition that the Other lives in a world just like my own is often the cause of serious misunderstandings—the source of negative emotions and of misleading value judgements and stigmatization that interfere with one’s capacity to care for other persons and to make sense of their behaviour. In order to empathize with these persons and make sense of their behaviour we need to acknowledge the existential difference, the particular autonomy, which separates us from their way of being in the world. Any forgetting of this difference—for instance between my own world and that of a person who ‘manipulates’ the others—will be an obstacle to empathic understanding, since these people live in a life-world of which the structure is (at least in part) different from my own.
Intimacy
Authors: Stanghellini Giovanni
Published: December 2016

This chapter argues that where narrativity ends, intimacy may begin. The clinical encounter is an aesthetic experience. One must dodge the scientific rationalism in order to preserve the phenomenological understanding and achieve an understanding of the meaning of a clinical situation as felt, rather than simply assessing objective signs and symptoms. The acceptance of atmospheres as clinically relevant phenomena is ultimately related to the acknowledgement of the ambiguous nature of the clinical encounter. The clinical encounter is an event suspended between the pathic and the linguistic domains of experience, an open event that invites participation, and must remain so in order to preserve the phenomenological precision. Intimacy is an atmosphere in which both partners feel a sense of connectedness and a shared understanding. It can be encapsulated in the formula ‘aloneness–togetherness’—sharing one’s own aloneness with another person. Intimacy is the meeting of two solitudes. This relatedness is transformational.
Disorders of peripheral nerves and motor neuron disease
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the clinical features and evidence-based drug treatment regimens of polyneuropathies (Guillain–Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy, paraproteinaemic neuropathies, and vasculitic neuropathies), mononeuropathies (Bell’s palsy), systemic conditions with peripheral nerve involvement (Sjögren’s and sarcoidosis), and motor neuron disease (MND).
I
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [I]