bluuebunny/crossref_metadata_2025 huggingface dataset:
The Performance of Computer-Aided Detection Digital Chest X-ray Reading Technologies for Triage of Active Tuberculosis Among Persons With a History of Previous Tuberculosis
Authors: Kagujje Mary , Kerkhoff Andrew D , Nteeni Mutinta , Dunn Ian , Mateyo Kondwelani , Muyoyeta Monde
Published: August 2022

Background

Digital chest X-ray (dCXR) computer-aided detection (CAD) technology uses lung shape and texture analysis to determine the probability of tuberculosis (TB). However, many patients with previously treated TB have sequelae, which also distort lung shape and texture. We evaluated the diagnostic performance of 2 CAD systems for triage of active TB in patients with previously treated TB.

Methods

We conducted a retrospective analysis of data from a cross-sectional active TB case finding study. Participants ≥15 years, with ≥1 current TB symptom and complete data on history of previous TB, dCXR, and TB microbiological reference (Xpert MTB/RIF) were included. dCXRs were evaluated using CAD4TB (v.7.0) and qXR (v.3.0). We determined the diagnostic accuracy of both systems, overall and stratified by history of TB, using a single threshold for each system that achieved 90% sensitivity and maximized specificity in the overall population.

Results

Of 1884 participants, 452 (24.0%) had a history of previous TB. Prevalence of microbiologically confirmed TB among those with and without history of previous TB was 12.4% and 16.9%, respectively. Using CAD4TB, sensitivity and specificity were 89.3% (95% CI: 78.1–96.0%) and 24.0% (19.9–28.5%) and 90.5% (86.1–93.3%) and 60.3% (57.4–63.0%) among those with and without previous TB, respectively. Using qXR, sensitivity and specificity were 94.6% (95% CI: 85.1–98.9%) and 22.2% (18.2–26.6%) and 89.7% (85.1–93.2%) and 61.8% (58.9–64.5%) among those with and without previous TB, respectively.

Conclusions

The performance of CAD systems as a TB triage tool is decreased among persons previously treated for TB.
Manual and mechanical stripping-induced enamel roughness and elemental composition in vivo
Authors: Katsigialou Niki , Sifakakis Iosif , Zinelis Spiros , Papageorgiou Spyridon N , Eliades Theodore
Published: August 2022

Objectives

Interproximal enamel reduction (IPR) is routinely used in orthodontics to generate small to moderate amounts of space within the dental arch. Aim of this ex vivo study was to evaluate the effect of two different IPR systems on the enamel surface’s waviness, roughness, and elemental composition after 6 months of intraoral exposure.

Materials and methods

Fifteen orthodontic extraction patients were included in the present study. The 39 healthy premolars, which were scheduled to be extracted, were subjected to IPR at least 6 months before their extraction. IPR was performed on their mesial side with two different methods: (1) instrumented method with the Ortho-Strips system (on handpiece) and (2) manually with the Intensiv ProxoStrip (strips)—each with four different grits for contouring, finishing, and polishing. The distal side of each premolar served as its own internal control. Treated and untreated tooth surfaces were evaluated by optical profilometry, Raman, and scanning electron microscope/X-ray energy-dispersive (EDX) analyses. Data were analysed with descriptive statistics and generalized linear models at alpha = 5%.

Results

Both IPR methods significantly reduced the waviness of the enamel surface (P < 0.001), with manual IPR leading to smaller waviness reductions than the instrumented IPR (P ≤ 0.001). On the other side, both IPR methods led to a significant increase in enamel surface roughness (P < 0.001), with no significant differences between IPR methods. EDX and Raman analyses did not demonstrate any alterations on elemental composition of enamel after at least 6 months of intraoral exposure.

Conclusions

Both stripping systems led to a flatter but rougher enamel surface. Further polishing is needed to restore the initial enamel smoothness. The elemental composition of the stripped enamel returns to the baseline level after 6 months of intraoral exposure.
Availability and implementation of guidelines in European child primary health care: how can we improve?
Authors: Kocken Paul L , van Kesteren Nicole M C , van Zoonen Renate , Reijneveld Sijmen A
Published: August 2022

Background

Clinical guidelines are important for providing high-quality child primary health care. We aimed to assess the availability, use and achieved delivery of guidelines in the European Union (EU).

Methods

We used a case study design to ascertain expert views on guidelines in six countries representing the EU. The experts completed an online questionnaire (response 49%), asking about their perception of guideline availability and implementation regarding three topics that represent prevention and care, i.e. vaccination, assessment of mental health and asthma care.

Results

According to the respondents all countries had guidelines available for asthma care. For vaccination and mental health assessment respondents agreed to a lesser degree that guidelines were available. Implementation of guidelines for vaccination was mostly perceived as intended, but implementation of the guidelines for mental health assessment and asthma care was limited. Notable barriers were complexity of performance, and lack of training of professionals and of financial resources. Important facilitators for guideline implementation were the fit with routine practice, knowledge and skills of professionals and policy support. We found no clear relationship of guideline availability and implementation with type of child primary health care system of countries, but strong governance and sufficient financial resources seemed important for guideline availability.

Conclusions

Availability and implementation of clinical guidelines in child primary health care vary between EU countries. Implementation conditions can be strongly improved by adequate training of professionals, stronger governance and sufficient financial resources as facilitating factors. This can yield major gains in child health across Europe.
A reciprocal translocation involving Aspergillus nidulans snxAHrb1/Gbp2 and gyfA uncovers a new regulator of the G2–M transition and reveals a role in transcriptional repression for the setBSet2 histone H3-lysine-36 methyltransferase
Authors: James Steven W , Palmer Jonathan , Keller Nancy P , Brown Morgan L , Dunworth Matthew R , Francisco Sarah G , Watson Katherine G , Titchen Breanna , Achimovich Alecia , Mahoney Andrew , Artemiou Joseph P , Buettner Kyra G , Class Madelyn , Sydenstricker Andrew L , Anglin Sarah Lea
Published: August 2022

Aspergillus nidulans snxA, an ortholog of Saccharomyces cerevisiae Hrb1/Gbp2 messenger RNA shuttle proteins, is—in contrast to budding yeast—involved in cell cycle regulation, in which snxA1 and snxA2 mutations as well as a snxA deletion specifically suppress the heat sensitivity of mutations in regulators of the CDK1 mitotic induction pathway. snxA mutations are strongly cold sensitive, and at permissive temperature snxA mRNA and protein expression are strongly repressed. Initial attempts to identify the causative snxA mutations revealed no defects in the SNXA protein. Here, we show that snxA1/A2 mutations resulted from an identical chromosome I–II reciprocal translocation with breakpoints in the snxA first intron and the fourth exon of a GYF-domain gene, gyfA. Surprisingly, a gyfA deletion and a reconstructed gyfA translocation allele suppressed the heat sensitivity of CDK1 pathway mutants in a snxA+ background, demonstrating that 2 unrelated genes, snxA and gyfA, act through the CDK1–CyclinB axis to restrain the G2–M transition, and for the first time identifying a role in G2–M regulation for a GYF-domain protein. To better understand snxA1/A2-reduced expression, we generated suppressors of snxA cold sensitivity in 2 genes: (1) loss of the abundant nucleolar protein Nsr1/nucleolin bypassed the requirement for snxA and (2) loss of the Set2 histone H3 lysine36 (H3K36) methyltransferase or a nonmethylatable histone H3K36L mutant rescued hypomorphic snxA mutants by restoring full transcriptional proficiency, indicating that methylation of H3K36 acts normally to repress snxA transcription. These observations are in line with known Set2 functions in preventing excessive and cryptic transcription of active genes.
Research Centers Collaborative Network Workshop on Sex and Gender Differences in Aging
Authors: Brinkley Tina E , Stites Shana D , Hunsberger Holly C , Karvonen-Gutierrez Carrie A , Li Mengting , Shaaban C Elizabeth , Thorpe Roland J , Kritchevsky Stephen B
Published: August 2022

Aging affects men and women differently; however, the impact of sex and gender on the aging process is not well understood. Moreover, these 2 concepts are often conflated, which further contributes to a lack of clarity on this important issue. In an effort to better understand the relevance of sex and gender in aging research, the Research Centers Collaborative Network sponsored a 1.5-day conference on sex and gender differences in aging that brought together key thought leaders from the 6 National Institute on Aging center programs. The meeting included sessions on comparing males and females, pathophysiological differences, sex/gender in clinical care, and gender and health in the social context. Presenters from a wide array of disciplines identified opportunities for multidisciplinary research to address current gaps in the field and highlighted the need for a more systematic approach to understanding the how and why of sex/gender differences, as well as the health implications of these differences and the sex/gender biases that affect clinical treatment and outcomes. This article summarizes the proceedings of the workshop and provides several recommendations to move the field forward, such as better data collection tools to assess the intersection of sex and gender in epidemiological research; a life course perspective with attention to fetal/developmental origins and key life stages; innovative animal models to distinguish contributions from sex hormones versus sex chromosomes; and integration of sex/gender into teaching and clinical practice. Ultimately, successful implementation of these recommendations will require thoughtful investigations across the translational spectrum and increased collaborations among those with expertise in sex and gender differences.
Mutual influence in support seeking and provision behaviors during comforting conversations: a turn-level analysis
Authors: Rains Stephen A , Bonito Joseph A , Lutovsky Bethany R , Nemcova Katerina , Tsetsi Eric , Ashtaputre Anjali , Pavlich Corey A , Akers Chelsie
Published: August 2022

Mutual influence is central to prominent supportive communication theories but remains understudied. We conduct a turn-level analysis to investigate mutual influence in the unfolding nature of conversations among 334 stranger dyads discussing a personal problem. We examine how the types of messages produced by support seekers influence the immediate response from providers, and how that provider response impacts the next message produced by support seekers. Seeker use of approach behaviors and exonerating justifications were associated with higher levels of person centeredness in provider responses, and avoidance behaviors were associated with lower levels of provider person centeredness. Higher levels of provider person centeredness were associated with a greater likelihood of approach behaviors, exonerating justifications, and incriminating justifications and lower likelihood of avoidance behaviors from seekers. The results collectively suggest virtuous and vicious cycles in the messages produced by seekers and providers during supportive conversations.
The chromosome-level genome of Gypsophila paniculata reveals the molecular mechanism of floral development and ethylene insensitivity
Authors: Li Fan , Gao Yuan , Jin Chunlian , Wen Xiaohui , Geng Huaiting , Cheng Ying , Qu Haoyue , Liu Xing , Feng Shan , Zhang Fan , Ruan Jiwei , Yang Chunmei , Zhang Liangsheng , Wang Jihua
Published: August 2022

Gypsophila paniculata, belonging to the Caryophyllaceae of the Caryophyllales, is one of the most famous worldwide cut flowers. It is commonly used as dried flowers, whereas the underlying mechanism of flower senescence has not yet been addressed. Here, we present a chromosome-scale genome assembly for G. paniculata with a total size of 749.58 Mb. Whole-genome duplication signatures unveil two major duplication events in its evolutionary history: an ancient one occurring before the divergence of Caryophyllaceae and a more recent one shared with Dianthus caryophyllus. The integrative analyses combining genomic and transcriptomic data reveal the mechanisms regulating floral development and ethylene response of G. paniculata. The reduction of AGAMOUS expression probably caused by sequence polymorphism and the mutation in miR172 binding site of PETALOSA are associated with the double flower formation in G. paniculata. The low expression of ETHYLENE RESPONSE SENSOR (ERS) and the reduction of downstream ETHYLENE RESPONSE FACTOR (ERF) gene copy number collectively lead to the ethylene insensitivity of G. paniculata, affecting flower senescence and making it capable of making dried flowers. This study provides a cornerstone for understanding the underlying principles governing floral development and flower senescence, which could accelerate the molecular breeding of the Caryophyllaceae species.
FLOWERING LOCUS Tindel variants confer vernalization-independent and photoperiod-insensitive flowering of yellow lupin (Lupinus luteusL.)
Authors: Plewiński Piotr , Rychel-Bielska Sandra , Kozak Bartosz , Maureira-Butler Iván J , Iqbal Muhammad Munir , Nelson Matthew N , Książkiewicz Michał
Published: August 2022

Ongoing climate change has considerably reduced the seasonal window for crop vernalization, concurrently expanding cultivation area into northern latitudes with long-day photoperiod. To address these changes, cool season legume breeders need to understand molecular control of vernalization and photoperiod. A key floral transition gene integrating signals from these pathways is the Flowering locus T (FT). Here, a recently domesticated grain legume, yellow lupin (Lupinus luteus L.), was explored for potential involvement of FT homologues in abolition of vernalization and photoperiod requirements. Two FTa (LlutFTa1a and LlutFTa1b) and FTc (LlutFTc1 and LlutFTc2) homologues were identified and sequenced for two contrasting parents of a reference recombinant inbred line (RIL) population, an early-flowering cultivar Wodjil and a late-flowering wild-type P28213. Large deletions were detected in the 5′ promoter regions of three FT homologues. Quantitative trait loci were identified for flowering time and vernalization response in the RIL population and in a diverse panel of wild and domesticated accessions. A 2227 bp deletion found in the LlutFTc1 promoter was linked with early phenology and vernalization independence, whereas LlutFTa1a and LlutFTc2 indels with photoperiod responsiveness. Comparative mapping highlighted convergence of FTc1 indel evolution in two Old World lupin species, addressing both artificial selection during domestication and natural adaptation to short season environmental conditions. We concluded that rapid flowering in yellow lupin is associated with the de-repression of the LlutFTc1 homologue from the juvenile phase, putatively due to the elimination of all binding sites in the promoter region for the AGAMOUS-like 15 transcription factor.
Investigation ofBrassicaand its relative genomes in the post-genomics era
Authors: Wu Jian , Liang Jianli , Lin Runmao , Cai Xu , Zhang Lei , Guo Xinlei , Wang Tianpeng , Chen Haixu , Wang Xiaowu
Published: August 2022

The Brassicaceae family includes many economically important crop species, as well as cosmopolitan agricultural weed species. In addition, Arabidopsis thaliana, a member of this family, is used as a molecular model plant species. The genus Brassica is mesopolyploid, and the genus comprises comparatively recently originated tetrapolyploid species. With these characteristics, Brassicas have achieved the commonly accepted status of model organisms for genomic studies. This paper reviews the rapid research progress in the Brassicaceae family from diverse omics studies, including genomics, transcriptomics, epigenomics, and three-dimensional (3D) genomics, with a focus on cultivated crops. The morphological plasticity of Brassicaceae crops is largely due to their highly variable genomes. The origin of several important Brassicaceae crops has been established. Genes or loci domesticated or contributing to important traits are summarized. Epigenetic alterations and 3D structures have been found to play roles in subgenome dominance, either in tetraploid Brassica species or their diploid ancestors. Based on this progress, we propose future directions and prospects for the genomic investigation of Brassicaceae crops.
High throughput saliency-based quantification of grape powdery mildew at the microscopic level for disease resistance breeding
Authors: Qiu Tian , Underhill Anna , Sapkota Surya , Cadle-Davidson Lance , Jiang Yu
Published: August 2022

Imaging-based high throughput phenotyping (HTP) systems have demonstrated promising solutions to enhance genetic understanding of grapevine powdery mildew (PM) resistance and have accelerated PM-resistant cultivar breeding. The accuracy and throughput of extracting phenotypic traits from images are still the bottleneck of modern HTP systems, especially at the microscopic level. The goal of this study was to develop a saliency-based processing pipeline for the quantification of PM infection in microscopic images and comprehensively evaluate its performance for genetic analyses. An input image was segregated into subimages that were classified as infected or healthy by a pretrained CNN classifier. Saliency maps from the classification were generated post-hoc and used for the quantification of PM infection in the input image at the pixel level without the use of mask annotations. A total of seven phenotypic traits were extracted from images collected for a biparental population. Experimental results showed that optimal combinations of convolutional neural network and saliency methods achieved strong measurement correlations (r = 0.74 to 0.75) with human assessments at the image patch level, and the traits calculated by the saliency-based processing pipeline were highly correlated (r = 0.87 to 0.88) with reference PM infection ratings at the leaf image level. The high quantification accuracy of the saliency-based pipeline led to the increased explanation of phenotypic variance and reliable identification of quantitative trait loci. Therefore, the saliency-based processing pipeline can be used as an effective and efficient analysis tool for PM disease research and breeding programs in the future, especially agricultural and life science studies requiring microscopic image analysis.
“We Are Not Taking a Backseat”: Health Social Workers’ Perspectives on COVID-19 Response and Recovery
Authors: Ross Abigail M , Schneider Samantha , Boskey Elizabeth
Published: August 2022

The COVID-19 pandemic has wrought widespread devastation across the United States, exacerbating existing health inequities rooted in the social determinants of health. Social work is the key workforce tasked with providing social care in healthcare settings. In September 2019, the National Academies of Science, Engineering, and Medicine released a landmark Consensus Study Report, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. The report describes a framework for addressing key care needs that articulates five “As for action” (5As)—awareness, alignment, assistance, adjustment, and advocacy—that are critical to social care. Drawing from a series of focus groups conducted with 55 social workers employed in a large urban pediatric quaternary hospital, this study qualitatively examines the utility of this framework in characterizing social care activities during the pandemic response and recovery efforts. Findings suggest that the 5As framework is both applicable to pandemic social work practice and an accurate encapsulation of the core elements of hospital social work practice, even if social workers themselves may not necessarily be aware of that conceptualization. Future implications for social work practice in arenas of awareness, adjustment, assistance, alignment, and advocacy are also discussed.
Time-Dependent Moments From the Heat Equation and a Transport Equation
Authors: Curto Raúl E , di Dio Philipp J
Published: August 2022

We present a new connection between the classical theory of full and truncated moment problems and the theory of partial differential equations, as follows. For the classical heat equation $\partial _t u = {\nu } \Delta u$, with initial data $u_0 \in {\mathcal {S}}(\mathbb {R}^n)$, we first compute the moments $s_{\alpha }(t)$ of the unique solution $u \in {\mathcal {S}}(\mathbb {R}^n)$. These moments are polynomials in the time variable, of degree comparable to $\alpha $, and with coefficients satisfying a recursive relation. This allows us to define the polynomials for any sequence, and prove that they preserve some of the features of the heat kernel. In the case of moment sequences, the polynomials trace a curve (which we call the heat curve), which remains in the moment cone for positive time, but may wander outside the moment cone for negative time. This provides a description of the boundary points of the moment cone, which are also moment sequences. We also study how the determinacy of a moment sequence behaves along the heat curve. Next, we consider the transport equation $\partial _t u = ax \cdot \nabla u$ and conduct a similar analysis. Along the way we incorporate several illustrating examples. We show that while $\partial _t u = {\nu }\Delta u + ax\cdot \nabla u$ has no explicit solution, the time-dependent moments can be explicitly calculated.
Psychometric properties of the person-centred coordinated care experience questionnaire (P3CEQ) in a Norwegian radiotherapy setting
Authors: Sollid May ingvild volungholen , Slaaen Marit , Danielsen Signe , Kirkevold Øyvind
Published: August 2022

Background

The number of older adults with cancer is increasing. Radiotherapy is an important treatment modality for cancer and may cause side effects and distress. Patient-reported experience measures aim to measure patients’ experiences with health care. This can help healthcare services to improve in line with patients’ needs. To assess how Norwegian patients receiving radiotherapy experience their care, a valid and reliable tool is required. We selected the person-centred coordinated care experience questionnaire as a tool.

Objective

The aim of the study is to validate the Norwegian version of the person-centred coordinated care experience questionnaire in a radiotherapy setting.

Methods

A feasibility study of the person-centred coordinated care experience questionnaire and a cross-sectional study—testing psychometric properties of the questionnaire in a Norwegian radiotherapy setting—were conducted. Participants were recruited from two different hospitals in Norway. Patient characteristics and item scores are described using descriptive statistics. We performed an exploratory factor analysis and applied principal component analysis with a varimax rotation. Cronbach’s α was used to assess internal consistency.

Results

In total, 24 patients participated in the feasibility test, and 176 were included in the cross-sectional study where we explored the psychometric properties of the person-centred coordinated care experience questionnaire. Three factors were identified. Internal consistency was established for the 10-item scale, with Cronbach’s α = 0.698.

Conclusions

Conclusions must consider the Norwegian setting and healthcare context. We found that the Norwegian version of the person-centred coordinated care experience questionnaire is a relevant, valid and reliable tool to provide insight into different areas of patients’ experiences upon receiving radiotherapy. However, further testing on a larger sample is necessitated.
Sensitive and Rapid Detection of Escherichia coli O157:H7 From Beef Samples Based on Recombinase Aided Amplification Assisted CRISPR/Cas12a System
Authors: Fang Taisong , Shen Jinling , Xue Junxin , Jiang Yuan , Guo Dehua , Yang Jielin , Kong Xiangxiang , Xu Xuebin , Wang Xiang
Published: August 2022

Background

Escherichia coli O157:H7, being the cause of hemorrhagic colitis in humans, is recognized as one of the most dangerous and widespread foodborne pathogens. A highly specific, sensitive, and rapid E. coli O157:H7 detection method needs to be developed since the traditional detection methods are complex, costly, and time-consuming.

Objective

In this study, a recombinase aided amplification (RAA) assisted CRISPR/Cas12a (RAA-CRISPR/Cas12a) fluorescence platform for specific, sensitive, and rapid nucleic acid detection of E. coli O157:H7 was introduced.

Methods

First, the feasibility (components of CRISPR/Cas12a system) of the developed method was evaluated. Then a total of 34 bacterial strains were used for the specificity test, and gradient dilutions of extracted DNA and bacterial solutions of E. coli O157:H7 were prepared for the sensitivity test. Third, a real-time PCR assay for detection of the specific wzy gene of E. coli O157:H7 (FDA’s Bacteriological Analytical Manual) was used for sensitivity comparison. Finally, analysis of RAA-CRISPR/Cas12a detection in spiked and 93 real ground beef samples was carried out.

Results

The developed RAA-CRISPR/Cas12a method showed high specificity, and the detection could be completed within 30 min (after 4 h enrichment in spiked ground beef samples). The limit of detection (LOD) of bacterial concentrations and genomic DNA was 5.4 × 102 CFU/mL and 7.5 × 10−4 ng/μL, respectively, which exhibited higher sensitivity than the RAA-gel electrophoresis and RT-PCR methods. Furthermore, it was shown that E. coli O157:H7 in ground beef samples could be positively detected after 4 h enrichment when the initial bacterial inoculum was 9.0  CFU/25 g. The detection results of the RAA-CRISPR/Cas12a method were 100% consistent with those of the RT-PCR and traditional culture-based methods while screening the E. coli O157:H7 from 93 local collected ground beef samples.

Conclusions

The developed RAA-CRISPR/Cas12a method showed high specificity, high sensitivity, and rapid positive detection of E. coli O157:H7 from ground beef samples.

Highlights

The RAA-CRISPR/Cas12a system proposed in this study provided an alternative molecular tool for quick, specific, sensitive, and accurate detection of E. coli O157:H7 in foods.
The Law and Economics of Tying in Digital Platforms: Comparing Tencent and Android
Authors: Wu Qian , Philipsen Niels J
Published: August 2022

Tying has become a common practice in digital platforms. It may generate both pro-competitive effects and anti-competitive effects, which makes it difficult to distinguish between lawful and unlawful tying practices. The cases of Tencent and Android both involve tying conducts, but interestingly, the cases have different outcomes. This article explores reasons for these different case outcomes from a comparative law and economics perspective. By assessing the facts and legal rulings in Tencent and Android, we find that the different case outcomes result, on the one hand, from the different case facts, and on the other hand, from the different approaches used by the EU Commission and the Chinese Supreme People’s Court. The Court scores better in terms of ensuring legal certainty; nevertheless, it may face difficulties when it has to apply economic analysis. The Commission seemingly uses more economics, but the application is not full-fledged, as it disregards important case facts when assessing competition foreclosure, and employs asymmetric legal tests and evidence standards for anti/pro-competitive effects of tying. From a law and economics perspective, we provide suggestions for China and the EU, taking the recent Anti-Monopoly Guidelines on Platforms in China and the forthcoming Digital Markets Act in the EU into account.
Aboveground net primary productivity was not limited by phosphorus in a temperate typical steppe in Inner Mongolia
Authors: Guo Yumeng , Zhou Meng , Sheng Jun , Yuan Yujia , Yuan Guangyuan , Zhang Wen-Hao , Bai Wenming
Published: August 2022

Phosphorus (P) is an essential element for plant growth, however, whether the aboveground net primary productivity (ANPP) of typical steppe was limited by P remains obscure. To detect the effects of P addition on primary productivity and aboveground biomass of different plant functional groups both under ambient and N addition conditions, ANPP and aboveground biomass of grasses and forbs were measured from 2016 to 2020 on a 16-year N and P addition experiment platform in a temperate typical steppe in Inner Mongolia. The soil available N and P concentrations were also determined to test the relationship between ANPP and the availability of soil nutrients. We found that P addition under ambient condition had no significant effect on ANPP and the aboveground biomass of grasses and forbs. However, under N addition, P addition significantly increased ANPP and the aboveground biomass of forbs. Furthermore, soil available N and P concentrations were increased significantly by N and P addition, respectively. Moreover, there was no significant correlation between ANPP and soil available P concentration, while ANPP was positively correlated with soil available N concentration. These results suggest that P is not the key factor limiting the primary productivity of the temperate typical steppe in Inner Mongolia. However, under N addition, P addition can promote ANPP and alter the community composition. These findings provide valuable information for the management of the temperate typical steppe.
Cognitive Behavior and Dialectic Behavior Therapies
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Cognitive-behavioral therapy (CBT) strategies take the view that clinical problems, such as substance use disorder and other behavioral problems, are learned behaviors. These learned behaviors are hypothesized to be the result of environmental factors. CBT techniques address underlying cognitions and behaviors that are unduly influenced by these environmental factors. CBT approaches are organized around three learning principles that are typically combined into a multicomponent program: classical conditioning (the role of environmental stimuli that contribute to behaviors), operant conditioning (how rewards and punishment influence behaviors), and social learning theory (the power that influential role models have on a person’s behaviors). Dialectical behavior therapy (DBT), originally developed by Marsha Linehan to treat her female patients diagnosed with borderline personality disorder, focuses on client skills for identifying and transforming negative thinking patterns and learning ways to effectively cope with stress and to regulate emotions. DBT encompasses components of CBT.
Actions Toward Feeling Better
Authors: Craske Michelle G. , Dour Halina J. , Treanor Michael , Meuret Alicia E.
Published: August 2022

This chapter discusses the importance of monitoring one’s daily activity and mood. It introduces the concept of positive activities, which will help clients appreciate the direct link between their behaviors, thoughts, and feelings. Engaging in positive activities is expected to produce a positive mood cycle and an upward spiral. Because reactivation of positive behaviors is thought to be effective in treating depression, the focus of Positive Affect Treatment (PAT) is on activities that are likely to generate positive emotions. Additionally, memory specificity training will help prevent clients from dismissing positive activities as irrelevant or unimportant. By monitoring their activities, clients will be able to identify which daily activities improve their mood.
Positive Affect Treatment for Depression and Anxiety
Authors: Meuret Alicia E. , Dour Halina , Loerinc Guinyard Amanda , Craske Michelle G.
Published: August 2022

Positive Affect Treatment for Depression and Anxiety: Workbook discusses the process and advantages of the Positive Affect Treatment (PAT), which is a program specifically designed to increase interest or joy in usual activities for individuals with depression or anxiety. The program has three main sets of exercises: Actions Toward Feeling Better, Attending to the Positive, and Building Positivity. The title highlights how PAT will be an indispensable resource for individuals with depression or anxiety who are struggling to find enjoyment in life. It also tackles the concept of anhedonia, which refers to the loss of interest or joy in usual activities.
Module 3: Understanding and Tracking LGBTQ-Related Stress and Emotional Experiences
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter focuses on educating the client about the components of emotional experiences and exploring how these emotional experiences may be shaped by LGBTQ-related stress. It discusses how to review the client’s home practice, in which they identified emotional triggers related to LGBTQ-related stress. It also introduces the idea that emotions are functional, adaptive responses to LGBTQ-related stress. The chapter outlines how to help the client develop greater awareness of their own patterns of emotional responding and explore maintaining factors, such as LGBTQ-related stress. It describes the session, in which the therapist focuses more on psychoeducational aspects and some initial personal examples and goes into more detail in reviewing personal examples of the client’s sequence of emotions.
Module 9: Recognizing Accomplishments and Looking to the Future
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter concentrates on consolidating treatment gains and planning for the future, including long-term goal setting and planning for coping with LGBTQ-related stress. It reviews a client’s home practice, which involves an emotion exposure, as well as the client’s overall experience with home practice throughout treatment. It also examines treatment skills for coping with negative emotions in the context of LGBTQ-related stress. The chapter emphasizes that treatment progress is a continuing process, and that with continued practice of the skills learned in treatment, clients can expect to see continued changes in their symptoms over time. It considers the end of treatment as a new “phase” of treatment, where the client can continue practicing the skills learned in treatment to see further treatment gains or troubleshoot challenges to treatment progress to determine the appropriate next steps.
Emotional Difficulties and LGBTQ-Related Stress
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter talks about difficult, distressing emotions and how negative reactions to strong emotions can actually make them worse. It explores new ways to respond to emotions that can ultimately help a patient feel better and reviews the ways that LGBTQ-related stress can contribute to distressing emotions. It also explains the components of LGBTQ-affirmative cognitive behavioral therapy, which will be the focus of this treatment. The chapter analyzes how LGBTQ-related stress contributes to distressing emotions and introduces the STAIRCaSE model of LGBTQ-related stress and emotional disorders. It mentions the development of the treatment program in order to help LGBTQ people who are struggling with distressing emotions, such as anxiety, sadness, anger, or even shame.
Module 1: Setting Goals and Building Motivation for LGBTQ-Affirmative Cognitive-Behavioral Therapy
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter highlights the importance of building motivation and setting goals so that a patient can get the most out of the program. A patient can start by thinking about their motivations for engaging in behavioral health care, as well as the pros and cons of making changes to their life. It reviews progress monitoring, which involves completing questionnaires regarding a patient’s symptoms of anxiety, depression, and any other symptoms that may be important to keep track of. The chapter describes how people who seek this treatment often hope to improve the way they feel, stop behaving in unhelpful ways, and generally improve their life. It assesses two factors that affect how much a person ends up benefiting from therapy: how much the person engages in the treatment and how motivated and committed the person is to changing.
Low intensity psychological interventions for children and young people: the economic case thus far
Authors: Knapp Martin , Wong Gloria
Published: August 2022

Cost-effectiveness, or good value for money in producing goods and benefits at an acceptable cost, is intricately linked with funding decisions and service access. It is thus a key rationale for low intensity psychotherapies, one that is of particular pertinence in relation to children and young people: demand for mental healthcare in this age group is great, and economic impacts of poor mental health are wide and enduring. While evidence of clinical non-inferiority compared with standard treatment is now accumulating, as noted in other chapters, the cost-effectiveness of low intensity alternatives sometimes appears just to be assumed on the basis that they involve lower costs. After explaining what economic evaluation entails, this chapter describes a few key examples of economic evaluation of low intensity psychological interventions in children and young people to illustrate the necessity and usefulness of economic evidence, particularly its relevance in informing policy and practice decisions.
Negative effects of low intensity interventions in children and young people
Authors: Rozental Alexander
Published: August 2022

Previous chapters have demonstrated that low intensity interventions are seen by patients to be important, effective, and may be cost-effective. However, just as in medicine, effective psychological treatments may also have side effects. While the evidence for such side effects, or ‘negative effects’ is limited for low intensity therapies in children and young people, they are nonetheless important to consider. This chapter looks at the evidence for negative effects in psychological therapies across adults and children in general, before summarizing the evidence in low intensity treatments and in children and adolescents specifically.
Low intensity interventions for anxiety disorders in children and adolescents
Authors: Creswell Cathy , Chessell Chloe , Hill Claire , Waite Polly
Published: August 2022

Anxiety disorders in children and young people are common and cause significant short- and potentially long-term impairment. For preadolescent children with anxiety disorders, there is good evidence that brief, therapist-guided, parent-led treatments are effective and cost-effective. There is also promising initial evidence for online interventions for both preadolescents and adolescents. Beyond the trials of online interventions, there has been limited evaluation of low intensity treatments specifically for adolescents with anxiety disorders, and this is a clear priority for innovation and evaluation; however, the wider literature highlights the potential of exposure-based interventions.
Low intensity interventions for sleep problems in children and adolescents
Authors: Gavriloff Dimitri , Waite Felicity , Espie Colin A.
Published: August 2022

Sleep problems in children and young people are common and varied. They are also often poorly understood and result in significant disruption to the lives of those affected, including to the lives of parents and family members. However, the majority of these problems can be treated using well-evidenced cognitive behavioural approaches. This is particularly important as the effective treatment of sleep problems not only improves sleep itself but also reduces the risk of other mental health problems and improves the ability of the child or young person and their family to function optimally during the day.
Practical applications of implementation science to low intensity cognitive behavioural therapy interventions
Authors: Schriger Simone , Beidas Rinad
Published: August 2022

As demonstrated in prior chapters, low intensity cognitive behavioural therapy interventions (henceforth referred to as low intensity interventions) for youth can be used to treat a diverse set of psychological disorders. Broadly, these interventions require less time, cost, and complexity and offer more flexibility and adaptability compared to traditional high intensity interventions. Despite their tremendous potential, few low intensity interventions have been implemented in routine practice outside of the context of research. This chapter discusses how to implement these interventions in community settings so that their public health potential can be realized.
Playing anxiety and depression away
Authors: Lucassen Mathijs F. G. , Fleming Theresa M. , Shepherd Matthew J. , Stasiak Karolina , Merry Sally N.
Published: August 2022

Computer games are utilized for a range of serious reasons, including for educational purposes and to support the mental health of children and adolescents. Applied games such as serious games (i.e. computerized games for serious purposes) and gamification (i.e. gaming elements used outside of commercial games) have the ability to increase treatment adherence by making learning in a therapeutic context enjoyable. This chapter briefly outlines the potential benefits of serious games in relation to child and adolescent depression and anxiety. It draws on the case study of SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) to help illustrate the strengths of serious games, as well as their associated challenges.
The power of peer support
Authors: Bennett Sophie D. , Croucher Lauren , Hagell Ann , Mertan Elif , Minhinnett Wendy , Shafran Roz
Published: August 2022

There is a clear need for support for families outside of traditional formal mental health services, given significant problems accessing interventions and navigating provision. Peer support groups, where families can help each other, may have a number of advantages. They can be used for emotional support and expression as well as places to receive and provide advice. This chapter aims to consider the advantages and limitations of peer support for families of children and young people with mental health difficulties. It considers specific examples relating to internet-delivered peer support for parents of children and young people with mental health difficulties.
Refractory Asthma in the Pediatric Patient
Authors: Salant Jennifer A. , Biagas Katherine V.
Published: August 2022

Asthma is the most common chronic disease of childhood. Acute exacerbations of asthma, including the persistent presentation status asthmaticus, account for many pediatric hospitalizations that result in pediatric intensive care unit (ICU) admissions in the setting of respiratory failure and arrest. Inhaled beta-agonists and systemic corticosteroids are the mainstays of treatment, but adjunct inhaled and systemic therapies are often required in the setting of status asthmaticus that does not resolve quickly. Ventilation strategies, including noninvasive and invasive modes, are often indicated and require an understanding of cardiopulmonary interactions. ICU providers must be prepared to treat the spectrum of asthma presentations in the pediatric population.
The Failing Fontan
Authors: Ankola Ashish A. , Choudhury Tarif A.
Published: August 2022

Congestive heart failure in the Fontan circulation (“Fontan failure”) can be due to different causes. Presentations can vary from having symptoms of congestive heart failure to demonstrating additional cyanosis in the presence of right to left shunts. A knowledge of the patient’s anatomy and physiology, both past and present, is critical in discerning the clinical urgency of this presentation. A critical assessment of respiratory and cardiac causes is necessary. If a primary respiratory process contributes to a patient’s altered hemodynamics, weighing the need for positive pressure support for ventilation must be carefully balanced against the deleterious it has on Fontan physiology. A suspected cardiac process can be evaluated using a combination of echocardiography and cardiac catheterization to identify anatomic and pathophysiologic causes of Fontan failure. Cardiac catheterization can also provide a means for therapeutic intervention to address residual anatomic defects. With a confirmed diagnosis, maximization of medical therapies to treat elevated pulmonary vascular resistance, diastolic dysfunction, and increased afterload can help to maintain Fontan physiology over the long term.
Obstructive Sleep Apnea With Hypercarpnia and Hypoxia After Laparoscopic Gastric Bypass Surgery
Authors: Sutherland Lauren
Published: August 2022

Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder that is characterized by episodes of upper airway collapse leading to apnea or hypopnea while sleeping. OSA is associated with increasing age, BMI, and neck circumference as well as male gender. Diagnosis is made by polysomnography demonstrating 5 or more episodes of apnea or hypopnea per hour, and treatment involves weight loss and positive airway pressure devices. OSA is associated with many cardiovascular, cerebrovascular, and metabolic comorbidities. Patients undergoing surgical procedures should be assessed for risk of OSA, and those with a diagnosis or high suspicion should be managed with special precautions throughout the perioperative period.
Introduction
Authors: Forstein Marshall
Published: August 2022

The introduction to this book, Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals, identifies intensely personal narratives from doctors and other healthcare professionals who usually remain less visible and vulnerable in the care of others. Especially daunting over the past few years has been the inescapable impact of the COVID pandemic, intensifying for health professionals the fatigue, unending loss, and change in the public’s faith in the healthcare system. The stories distinguish loss and grief as two different but closely related experiences in the process of letting in, letting go, and moving forward when possible. “Loss is that which is gone forever as it was. Grief is what we do with the loss; how and where we feel it, and how we try, sometimes more successfully than others, to move through that loss to regain some footing in our life remaining.” The editors worked closely with each other and the contributing authors to provide some insight into the suffering and courage as each faced sometimes insurmountable odds of managing unremitting heartbreak professionally while facing powerful personal losses that challenge the best of coping mechanisms.
An Oncologist Reflects on Loss and the Culture of Medicine
Authors: Schapira Lidia
Published: August 2022

Dr. Schapira, a medical oncologist, offers a candid account of the intersection of personal and professional experiences of loss. In this chapter the author explores the basic question of what a patient wants and needs from their doctor when confronted with a life-threatening illness. She takes the reader on a quick tour of medical training and reflects on how she handled personal and professional losses at various moments during her career. The interwoven threads of the narrator’s growth and professional development are presented against the backdrop of the prevailing culture of medicine. The author reflects that stoicism as a personal attribute was highly valued during her training and describes how it affected her emotional response to suffering and loss.