bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in thyroid function parameters 3 months after allogeneic and autologous hematopoietic stem cell transplantation in children
Authors: Lebbink Chantal A , Bresters Dorine , Tersteeg Joni P B , van den Bos Cor , Dierselhuis Miranda P , Lentjes Eef G W M , Verrijn Stuart Annemarie A , Fiocco Marta , Tissing Wim J E , van Santen Hanneke M
Published: May 2023

Background

Thyroid dysfunction (hypo- and hyperthyroidism) has been reported as a late effect after hematopoietic stem cell transplantation (HSCT) in children. Short-term effects of HSCT on thyroid function parameters are, however, unclear.

Methods

We prospectively evaluated thyroid function parameters before and 3 months after HSCT in all children (<21 years) who underwent HSCT during a 2-year period in the Princess Máxima Center, the Netherlands.

Results

Among 72 children, none had thyroidal hypothyroidism or hyperthyroidism 3 months after HSCT. Changes in thyroid function parameters (either aberrant thyroid-stimulating hormone [TSH] or free thyroxine [FT4] concentrations) were found in 16% before and in 10% 3 months after HSCT. Reverse triiodothyronine (rT3) was found elevated in 9.3% before and in 37% 3 months after HSCT, which could be related to poor physical condition. An individual decline in FT4 concentration of ≥20% was found in 10.5% (6/57) 3 months after HSCT.

Conclusion

In conclusion, thyroidal hypo- and hyperthyroidism are very rare 3 months after HSCT. These results indicate that surveillance for hypo- and hyperthyroidism may start later in time. The changes in thyroid function parameters found 3 months after HSCT might reflect euthyroid sick syndrome.
COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden
Authors: Svallfors Signe , Larsson Elin C , Puranen Bi , Ekström Anna Mia
Published: May 2023

Background

In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity.

Methods

Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years.

Results

One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy.

Conclusions

The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.
Nothofagus pumilio regeneration failure following wildfire in the sub-Antarctic forests of Tierra del Fuego, Argentina
Authors: Ruggirello Matthew Joseph , Bustamante Gimena N , Soler Rosina M
Published: May 2023

Wildfires on the island of Tierra del Fuego in southern Argentina are not considered to have been a historic driver of forest dynamics. However, dramatic increases in the human population of the island over the last half-century have greatly increased fire ignition sources and thus the frequency of wildfires in the region. Lenga (Nothofagus pumilio (Poep. et Endl.) Krasser) forests support diverse ecosystem services by providing habitat for endemic flora and fauna and also represent a valuable timber resource for the forest industry of Tierra del Fuego. Evaluating the impact of forest fires on lenga regeneration is important not only because lenga is a native, slow-growing species that seems to lack adaptations that would allow it to recover rapidly after fire, but also because low tree species diversity on the island of Tierra del Fuego means lenga post-fire regeneration failure may lead to ecosystem state shifts. To determine how site characteristics and fire-impacted variables modulate post-fire regeneration densities and spatial patterns in lenga forests, we installed 192 plots (160 burned, 32 unburned) in which we measured site-characteristic (e.g. aspect, elevation) and fire-impacted (e.g. basal area, canopy cover) variables and tallied seedlings and saplings. Regeneration densities were significantly lower in burned than unburned plots. This was exacerbated with increasing distance from the unburned forest edge. Increasing distance to live trees that either survived fire or were outside the burned area negatively impacted regeneration as well. Time since fire negatively affected sapling, but not seedling counts. We concluded that lenga regeneration in the interior of burned areas is largely absent, delaying and potentially preventing forest recovery. These interior areas of burned lenga forests are unlikely to regenerate closed-canopy tree cover through passive restoration alone. Active restoration may be needed in these critical areas where live legacy trees are not present.
Self-contained Beta-with-Spikes approximation for inference under a Wright–Fisher model
Authors: Guerrero Montero Juan , Blythe Richard A
Published: May 2023

We construct a reliable estimation method for evolutionary parameters within the Wright–Fisher model, which describes changes in allele frequencies due to selection and genetic drift, from time-series data. Such data exist for biological populations, for example via artificial evolution experiments, and for the cultural evolution of behavior, such as linguistic corpora that document historical usage of different words with similar meanings. Our method of analysis builds on a Beta-with-Spikes approximation to the distribution of allele frequencies predicted by the Wright–Fisher model. We introduce a self-contained scheme for estimating parameters in the approximation, and demonstrate its robustness with synthetic data, especially in the strong-selection and near-extinction regimes where previous approaches fail. We further apply the method to allele frequency data for baker’s yeast (Saccharomyces cerevisiae), finding a significant signal of selection in cases where independent evidence supports such a conclusion. We further demonstrate the possibility of detecting time points at which evolutionary parameters change in the context of a historical spelling reform in the Spanish language.
Impact of pathogen genetics on clinical phenotypes in a population of Talaromyces marneffei from Vietnam
Authors: Sephton-Clark Poppy , Nguyen Thu , Hoa Ngo Thi , Ashton Philip , van Doorn H Rogier , Ly Vo Trieu , Le Thuy , Cuomo Christina A
Published: May 2023

Talaromycosis, a severe and invasive fungal infection caused by Talaromyces marneffei, is difficult to treat and impacts those living in endemic regions of Southeast Asia, India, and China. While 30% of infections result in mortality, our understanding of the genetic basis of pathogenesis for this fungus is limited. To address this, we apply population genomics and genome-wide association study approaches to a cohort of 336 T. marneffei isolates collected from patients who enrolled in the Itraconazole vs Amphotericin B for Talaromycosis trial in Vietnam. We find that isolates from northern and southern Vietnam form two distinct geographical clades, with isolates from southern Vietnam associated with increased disease severity. Leveraging longitudinal isolates, we identify multiple instances of disease relapse linked to unrelated strains, highlighting the potential for multistrain infections. In more frequent cases of persistent talaromycosis caused by the same strain, we identify variants arising over the course of patient infections that impact genes predicted to function in the regulation of gene expression and secondary metabolite production. By combining genetic variant data with patient metadata for all 336 isolates, we identify pathogen variants significantly associated with multiple clinical phenotypes. In addition, we identify genes and genomic regions under selection across both clades, highlighting loci undergoing rapid evolution, potentially in response to external pressures. With this combination of approaches, we identify links between pathogen genetics and patient outcomes and identify genomic regions that are altered during T. marneffei infection, providing an initial view of how pathogen genetics affects disease outcomes.
Control of cellularization, nuclear localization, and antipodal cell cluster development in maize embryo sacs
Authors: Chettoor Antony M , Yang Bing , Evans Matthew M S
Published: May 2023

The maize female gametophyte contains four cell types: two synergids, an egg cell, a central cell, and a variable number of antipodal cells. In maize, these cells are produced after three rounds of free-nuclear divisions followed by cellularization, differentiation, and proliferation of the antipodal cells. Cellularization of the eight-nucleate syncytium produces seven cells with two polar nuclei in the central cell. Nuclear localization is tightly controlled in the embryo sac. This leads to precise allocation of the nuclei into the cells upon cellularization. Nuclear positioning within the syncytium is highly correlated with their identity after cellularization. Two mutants are described with extra polar nuclei, abnormal antipodal cell morphology, and reduced antipodal cell number, as well as frequent loss of antipodal cell marker expression. Mutations in one of these genes, indeterminate gametophyte2 encoding a MICROTUBULE ASSOCIATED PROTEIN65-3 homolog, shows a requirement for MAP65-3 in cellularization of the syncytial embryo sac as well as for normal seed development. The timing of the effects of ig2 suggests that the identity of the nuclei in the syncytial female gametophyte can be changed very late before cellularization.
Daily Life of Ukrainian Jewish Children in the Zhmerinka Ghetto during the Holocaust in Transnistria
Authors: Tomchuk Lilia
Published: May 2023

Established at the end of August 1941 in the region then known as Transnistria, the Zhmerinka ghetto was exceptional for several reasons. Though historians have portrayed it as a “model ghetto” or “miniature state” given its organization, maintenance of Jewish community life, and higher survival rate, the individual experiences of the ghetto inmates, particularly those of children, have been largely excluded from historical scholarship. Drawing on survivor accounts, this article addresses the everyday lives of Ukrainian-Jewish children in Zhmerinka’s unique environment. By examining family dynamics and gender roles in various settings, this study explores how the artificial “normality” of the ghetto included for children new roles and responsibilities, forced labor and violence, and survival strategies that helped them cope with these distorted realities.
Outside In: challenges for evolutionary studies on entry
Authors: Capone Gianluca
Published: May 2023

This short note reviews the evolutionary modeling literature focusing on the specific topic of entry of new firms. A large variety of choices have been employed to model entry, often motivated by the need to keep the model simple and comprehensible. Entry is more subject to simplification pressures than other elements of industrial dynamics because a deeper treatment of the phenomenon requires the specification of details external to the focal industry. Starting from more recent and elaborate models of entry, some proposals for further advancement are put forth.
Unsexing citation: Closing the gender gap in global public law
Authors: Dixon Rosalind , Versteeg Mila
Published: May 2023

Gender equality matters in the global public law academy for at least three reasons: the production of diverse scholarship, and substantive equality of opportunity for, and the equal exercise of social power by, female-identifying scholars. And while the global public law academy is in many ways becoming more diverse and inclusive, a great deal of work remains to be done to achieve true gender equality, especially after COVID-19, given its impact on geographic and gender (in)equality. In this article, we examine one important dimension to gender equality in the global public law academy: the degree to which articles by female-identifying scholars are cited at rates comparable to those authored by male-identifying scholars. To do so, we construct a unique database of articles published and cited within I•CON itself and use a variety of empirical techniques to analyze this data. Doing so, we find a clear pattern of gendered citation in global public law: while 37% of I•CON articles are authored by at least one female, only 25% of citations include at least one female author. We explore a variety of gendered and non-gendered explanations for the pattern. Perhaps our most striking finding is that male-author teams cite female authors at lower rates than author teams that have at least one female author, an effect that persists even when we account for self-citation, time trends, and the reputation of the cited authors. Notably, female authors cite female scholars at about the same rate as which they are published; the gender citation gap appears to be driven by the citation practices of male scholars alone. This finding suggests that implicit bias in citation, especially by male authors, cannot be ruled out. We therefore explore potential gender-conscious responses to the phenomenon.
From hierarchical to panoptic control: The Chinese solution in monitoring judges
Authors: He Xin
Published: May 2023

In the wake of the 2014 judicial reforms, are Chinese judges in most circumstances free in their decision-making? Based primarily on interviews with judges, this article argues that although a truncated hierarchy has led to increased judicial autonomy, the state maintains its tight grip over judges. In its new form, the state’s control is more indirect, external, ex post, diffused, and ideological. It allows the state to closely monitor judges’ entire handling of cases (hence the designation “panoptic”). It has some similarities with, yet fundamentally differs from, existing patterns in authoritarian states. While judges’ accountability continues to be largely a bureaucratic matter, this Chinese form of control has nonetheless been effective at a time of soaring caseloads, a slimmed-down judiciary, and increasing insistence on legitimacy. This article seeks to deepen understanding of developments in Chinese courts and, more widely, judicial politics in authoritarian states.
Watch out for lung tissue trapped by fractured ribs
Authors: Jiang Jipeng , Wang Linghui , Liu Yang , Xia Hui
Published: May 2023

A 52-year-old woman was injured in an accident. Emergency tests showed rib fractures and pleural effusion. However, lung incarceration was found during the thoracic exploration that was not detected in the preoperative images. Although this occurrence is rare, clinicians should be careful of this possible pitfall, which may bring about a poor prognosis after a rib fracture.
Risk of type 2 diabetes after diagnosed gestational diabetes is enhanced by exposure to PM2.5
Authors: Pan Shih-Chun , Huang Ching-Chun , Chen Bing-Yu , Chin Wei-Shan , Guo Yue Leon
Published: May 2023

Background

Air pollution and gestational diabetes mellitus (GDM) are both associated with increased diabetes mellitus (DM) occurrence. However, whether air pollutants modify the effects of GDM on the occurrence of DM has been unknown. This study aims to determine whether the effect of GDM on DM development can be modified by exposure to ambient air pollutants.

Methods

Women with one singleton birth delivery during 2004–14 according to the Taiwan Birth Certificate Database (TBCD) were included as the study cohort. Those newly diagnosed as having DM 1 year or later after childbirth were identified as DM cases. Controls were selected among women without DM diagnosis during follow-up. Personal residence was geocoded and linked with interpolated concentrations of air pollutants into township levels. Conditional logistic regression was used to determine the odds ratio (OR) of pollutant exposure and GDM, adjusting for age, smoking and meteorological variables.

Results

There were 9846 women who were newly diagnosed as having DM over a mean follow-up period of 10.2 years. We involved them and the 10-fold matching controls involved in our final analysis. The OR (odds ratio) (95% confidence interval, 95% CI) of DM occurrence per interquartile range increased in particulate matter (PM) smaller than or equal to 2.5 µm (PM2.5) and ozone (O3) was 1.31 (1.22–1.41) and 1.20 (1.16–1.25), respectively. The effects of PM exposure on DM development were significantly higher in the GDM group (OR: 2.46, 95% CI: 1.84–3.30) than in the non-GDM group (OR: 1.30, 95% CI: 1.21–1.40).

Conclusions

Exposure to high levels of PM2.5 and O3 elevates the risk of DM. GDM acted synergistically in DM development with exposure to PM2.5 but not with that to O3.
Exergoeconomic evaluation of a new carbon-free hydrogen and freshwater production system based on biomass gasification process
Authors: Zhang Xinhua , Li Hong , Taghavi Mohammad
Published: May 2023

This article is based on the conceptual-thermodynamic design and exergoeconomic investigation of a new poly-generation system driven by a biomass fuel (i.e. wood). In the proposed energy system, a Rankine power process, a gasification process, a desalination process (i.e. multi-effect desalination, MED) and a water electrolyzer (i.e. solid oxide electrolyzer cell, SOEC) are installed in a hybrid form. Electric energy, fresh water and hydrogen gas are the useful output products of the proposed energy system. The proposed energy system indicates an innovative framework for the carbon-free production of these products, which introduces an environmentally friendly and efficient schematic. The findings of the research indicated that the proposed energy system is capable of producing more than 1.8 MW of electric power. Other useful output products of the proposed energy system include hydrogen fuel and fresh water, which were calculated as 0.0036 kg/s and 9.92 m3/h, respectively. It was also calculated that the proposed energy system can achieve energetic and exergetic efficiencies equal to 37.1% and 17.8%, respectively. The total unit exergy cost of the products and the exergy destruction rate of the proposed energy system were equal to 15.9$/GJ and 8640 kW, respectively. Parametric analysis is also presented in order to identify the input variables affecting the performance of the energy system. Further, the behavior of the system under four different types of biomass was evaluated and compared.
Computer model of IL-6-dependent rheumatoid arthritis in F759 mice
Authors: Yamamoto Reiji , Yamada Satoshi , Atsumi Toru , Murakami Kaoru , Hashimoto Ari , Naito Seiichiro , Tanaka Yuki , Ohki Izuru , Shinohara Yuta , Iwasaki Norimasa , Yoshimura Akihiko , Jiang Jing-Jing , Kamimura Daisuke , Hojyo Shintaro , Kubota Shimpei I , Hashimoto Shigeru , Murakami Masaaki
Published: May 2023

The interleukin-6 (IL-6) amplifier, which describes the simultaneous activation of signal transducer and activator of transcription 3 (STAT3) and NF-κb nuclear factor kappa B (NF-κB), in synovial fibroblasts causes the infiltration of immune cells into the joints of F759 mice. The result is a disease that resembles human rheumatoid arthritis. However, the kinetics and regulatory mechanisms of how augmented transcriptional activation by STAT3 and NF-κB leads to F759 arthritis is unknown. We here show that the STAT3-NF-κB complex is present in the cytoplasm and nucleus and accumulates around NF-κB binding sites of the IL-6 promoter region and established a computer model that shows IL-6 and IL-17 (interleukin 17) signaling promotes the formation of the STAT3-NF-κB complex followed by its binding on promoter regions of NF-κB target genes to accelerate inflammatory responses, including the production of IL-6, epiregulin, and C-C motif chemokine ligand 2 (CCL2), phenotypes consistent with in vitro experiments. The binding also promoted cell growth in the synovium and the recruitment of T helper 17 (Th17) cells and macrophages in the joints. Anti-IL-6 blocking antibody treatment inhibited inflammatory responses even at the late phase, but anti-IL-17 and anti-TNFα antibodies did not. However, anti-IL-17 antibody at the early phase showed inhibitory effects, suggesting that the IL-6 amplifier is dependent on IL-6 and IL-17 stimulation at the early phase, but only on IL-6 at the late phase. These findings demonstrate the molecular mechanism of F759 arthritis can be recapitulated in silico and identify a possible therapeutic strategy for IL-6 amplifier-dependent chronic inflammatory diseases.
Oral Endotracheal Tube Stabilization for Facial Burns in Infants—Report of Two Techniques
Authors: Dillon Jasjit K , Bhat Aparna , Barnes Christopher , Stewart Barclay , Burke Andrea B
Published: May 2023

Establishing a secure airway is critical in the acute phase of facial burns. This case report involving a 9-month-old infant with facial burns describes two techniques of securing an oral airway—trans-alveolar wiring and the application of an intermaxillary fixation (IMF) screw. The use of an IMF screw was more reliable than trans-alveolar wiring, as it allowed a secure airway through the patient’s hospitalization, which involved seven additional surgical interventions including five separate facial skin grafts over a 3-month period.
Identity, Information, and Situations
Authors: Pennesi Daniele
Published: May 2023

This paper introduces a model of individual behavior based on identity, a person’s sense of self. The individual evaluates situations, that is, sets of available actions given a belief about the actions’ uncertain payoffs. In some situations, a psychological cost arises because the individual’s identity prescribes an action that differs from the one maximizing material benefits. The model shows that a common process of weighing psychological costs and material benefits drives the choice of both information and future opportunities. As a result, information avoidance is akin to preferring fewer opportunities, such as crossing the street to avoid a fundraiser. The model provides a coherent rationalization for diverse behaviors, including willful ignorance, opting out of social dilemmas, and excess entry into competitive environments. The psychological cost varies non-monotonically with the quality of information or with having more opportunities. Non-monotonicity complicates the identification of prescriptions from behavior, a difficulty that is partially resolvable by observing specific choices.
Cost-effectiveness analysis of pembrolizumab in patients with treatment-refractory metastatic colorectal cancer in Japan
Authors: Sugiura Kiyoaki , Hiratsuka Hiroki , Oshima Go , Aiko Satoshi
Published: May 2023

Objective

The immune checkpoint inhibitor pembrolizumab has recently been recognized as a standard treatment regimen for patients with metastatic colorectal cancer and the microsatellite-instability-high/mismatch repair-deficient mutation. However, its cost-effectiveness in late-line treatment remains unclear. The aim of this study was to assess the cost-effectiveness of pembrolizumab for patients with microsatellite-instability-high/mismatch repair-deficient metastatic colorectal cancer.

Methods

Markov decision modeling using treatment costs, disease-free survival and overall survival was performed to examine the cost-effectiveness of pembrolizumab monotherapy compared with chemotherapy, and best supportive care. The Japanese healthcare payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The primary outcome was the incremental cost-effectiveness ratio between the strategies. Sensitivity analyses were performed and the effects of uncertainty on the model parameters were investigated.

Results

Pembrolizumab monotherapy had incremental cost-effectiveness ratios of $408204.3 per quality-adjusted life-year gained compared with best supportive care and $489123.4 per quality-adjusted life-year gained compared with chemotherapy. Given a Japanese willingness-to-pay threshold of $69560.38 per quality-adjusted life-year, the base case results suggested that pembrolizumab monotherapy was not cost-effective. The sensitivity analysis results were in line with the base case results.

Conclusion

Pembrolizumab monotherapy is not a cost-effective option in late-line treatment for patients with metastatic colorectal cancer and microsatellite-instability-high/mismatch repair-deficient mutation in the Japanese healthcare system. Further studies on its cost-effectiveness in first-line treatment are warranted.
New Options for the Prevention and Treatment of Malaria: Focus on the Role of Atovaquone and Proguanil Hydrochloride
Authors: Shanks G. Dennis
Published: May 2023

The opinions and assertions herein are those of the author and are not to be construed as official or reflecting the views of the US Department of Defense.
Uncovering plant epigenetics: new insights into cytosine methylation in rye genomes
Authors: Kaur Navneet , Nayakoti Swapna , Brock Natasha , Halford Nigel G
Published: May 2023

This article comments on:

Kalinka A, Starczak M, Gackowski D, Stępień E, Achrem M. 2023. Global DNA 5-hydroxymethylcytosine level and its chromosomal distribution in four rye species. Journal of Experimental Botany 74, 3488–3502.
Combination of in vivo proximity labeling and co-immunoprecipitation identifies the host target network of a tumor-inducing effector in the fungal maize pathogen Ustilago maydis
Authors: Shi Wei , Stolze Sara C , Nakagami Hirofumi , Misas Villamil Johana C , Saur Isabel M L , Doehlemann Gunther
Published: May 2023

Plant pathogens secrete effectors, which target host proteins to facilitate infection. The Ustilago maydis effector UmSee1 is required for tumor formation in the leaf during infection of maize. UmSee1 interacts with maize SGT1 (suppressor of G2 allele of skp1) and blocks its phosphorylation in vivo. In the absence of UmSee1, U. maydis cannot trigger tumor formation in the bundle sheath. However, it remains unclear which host processes are manipulated by UmSee1 and the UmSee1–SGT1 interaction to cause the observed phenotype. Proximity-dependent protein labeling involving the turbo biotin ligase tag (TurboID) for proximal labeling of proteins is a powerful tool for identifying the protein interactome. We have generated transgenic U. maydis that secretes biotin ligase-fused See1 effector (UmSee1–TurboID-3HA) directly into maize cells. This approach, in combination with conventional co-immunoprecipitation, allowed the identification of additional UmSee1 interactors in maize cells. Collectively, our data identified three ubiquitin–proteasome pathway-related proteins (ZmSIP1, ZmSIP2, and ZmSIP3) that either interact with or are close to UmSee1 during host infection of maize with U. maydis. ZmSIP3 represents a cell cycle regulator whose degradation appears to be promoted in the presence of UmSee1. Our data provide a possible explanation of the requirement for UmSee1 in tumor formation during U. maydis–Zea mays interaction.
Oesophageal diverticula
Authors: Kapp Joshua , Müller Philip , Gutschow Christian A.
Published: May 2023

Oesophageal diverticula are rare entities that are often caused by motility disorders. Diverticular outpouchings may be observed over the entire length of the oesophagus, with a predilection (80% of cases) of the pharyngo-oesophageal region. The risk of malignancy is slightly increased compared with the standard population. Therapeutic management should be tailored to the location, size, symptomatology, and individual perioperative risk of the patient. It can be summarized that asymptomatic diverticula need no therapy; small (<1 cm) diverticula usually need not be resected; and medium (1–3 cm) and large (>4 cm) diverticula should be treated by resection, diverticulopexy, invagination, or (in case of Zenker’s diverticulum) by transoral diverticulo-oesophagostomy. In addition, a myotomy or (in the case of epiphrenic diverticula) alternatively a preoperative balloon dilatation of the sphincter region should be performed. Because of the rarity of oesophageal diverticula and due to the wide range of therapeutic options, expert experience is usually limited even in large hospitals. Therefore, management by an experienced multidisciplinary team using the complete spectrum of today’s endoscopic and surgical options is a prerequisite for effective treatment of this rare disease.
Gastro-oesophageal reflux disease
Authors: Stüben Björn-Ole , Duprée Anna , Mann Oliver
Published: May 2023

Gastro-oesophageal reflux disease, hiatal hernia, and Barrett’s oesophagus are conditions with a high, and in some parts of the world increasing, prevalence which cause high socioeconomic costs. The treatment of these conditions requires unique interdisciplinary cooperation, and failure to adequately treat these conditions leads to seriously impaired quality of life for the patients affected. For Barrett’s oesophagus, knowledge of the aetiology as well as the treatment of the condition is vital for physicians, and adequate surveillance of patients with Barrett’s disease according to the current literature can save lives by identifying progression to oesophageal cancer at an early stage. This chapter gives a current, evidence-based overview of these conditions as well as the current treatment standards for each of these conditions.
Gastric cancer
Authors: Borgstein Alexander B.J. , Gisbertz Suzanne S. , van Berge Henegouwen Mark I.
Published: May 2023

The treatment of gastric cancer is influenced by the stage of the gastric tumour. Treatment options may target early-stage, advanced, or metastatic gastric cancer. In this chapter, future treatment options for each of the different stages of gastric cancer are discussed. First, the current curative treatment of gastric cancer is summarized. Then new surgical techniques for early-stage gastric cancer are investigated, followed by a discussion on the use of the sentinel node principle in gastric cancer. New surgical treatments for advanced gastric cancer are then covered. The last section of the chapter discusses new non-surgical treatment for advanced gastric cancer and metastatic disease.
Palliative APRN Practice and Leadership
Authors: Dahlin Constance , Coyne Patrick J.
Published: May 2023

Chapter 1 delves into the evolution of the palliative advanced practice registered nurse (APRN). Important historical milestones in palliative care and palliative nursing are highlighted. Palliative APRNs promote access to palliative care, facilitate evidence-based palliative practices, and deliver safe, quality palliative care across settings and populations. Overall, the emphasis is on the roles of the palliative APRN as a leader in clinical practice, program administration, palliative care–related advocacy and policy, palliative care education, and research in palliative care. The chapter offers a wealth of resources for professional development and addresses specialization, roles, mentorship, and leadership. The authors discuss how APRNs can influence the future of the specialty.
The Palliative APRN in Residential Facilities
Authors: McClean Melissa , Nalls Victoria
Published: May 2023

This chapter discusses the role of the advanced practice registered nurse (APRN) in delivering palliative care to patients in two residential facility settings: assisted living facilities and nursing homes. Most often, residents in these settings are living with and dying from advanced chronic and progressive illnesses. There is growing evidence that APRNs in facility settings can improve clinical outcomes for residents with these advanced illnesses. APRNs with specialized training in palliative care are uniquely suited to elevate the quality of care for facility-dwelling individuals by aiding with advance care planning, providing expert symptom management, and coordinating care during transitions. Implementing and sustaining APRN-led care models in these settings can be challenging for multiple reasons, which are discussed. This chapter also provides a case study describing APRN-led evaluation and management in a nursing home setting.
Economically Disadvantaged Urban Dwellers
Authors: Curry Natasha
Published: May 2023

One in 10 of the US population lives in poverty, and half of these individuals live in cities. Many studies have uncovered the fact that the poor are more likely to get sick, become seriously sick, and die younger. Palliative care is a vital discipline to help the urban poor, yet, sadly, few have access to it. Providing quality palliative care for the urban poor requires a diverse set of skills and competencies and comes with its own unique challenges. Advanced practice registered nurses (APRNs) working in this setting must wear many hats: clinician, social worker, therapist, and advocate. Palliative APRNs also have a mandate to lead and transform palliative care in practice, education, research, administration, and policy.
Communication in Pediatric Palliative Care
Authors: Fossa Mallory , McBee Julia , Rusch Rachel
Published: May 2023

The heart of high-quality pediatric palliative care (PPC) is communication. Major palliative organization have guidelines for effective palliative care communication. The National Consensus Project, American Academy of Pediatrics, National Hospice and Palliative Care Organization, and Hospice and Palliative Nurses Association have set standards and guidelines emphasizing the importance of effective, compassionate, and developmentally appropriate communication between the PPC team, child, and family. The palliative care advanced practice nurse registered nurse (PP APRN) works collaboratively with the interdisciplinary team, drawing on each member’s strength and expertise to establish rapport and trust with the young person and their family. Together, the team works to understand their collective perception of the serious illness, eliciting values and then integrating the family’s care preferences with medical recommendations to create an individualized care plan.
Culturally Respectful Palliative Care
Authors: Foley Helen , Mazanec Polly
Published: May 2023

This chapter defines culturally respectful palliative care and discusses how the advanced practice registered nurse can integrate principles into clinical practice. The chapter emphasizes the importance of first reflecting on one’s own values, practices, and beliefs and recognizing their influence on the delivery of culturally appropriate care. Communication strategies for performing a cultural assessment of the patient and family are presented. Cultural communication considerations such as language differences, health literacy, and access to technology are addressed, and strategies to deal with these issues are offered. Special considerations in the delivery of culturally respectful palliative care (addressing disparities in quality palliative care, supporting beliefs regarding disclosure of prognosis and medical decision-making, recognizing cultural implications of pain and symptom management, integrating cultural rituals and practices into clinical care, and dealing with cultural clashes) are reviewed.
Pain
Authors: Paice Judith A.
Published: May 2023

To provide safe and effective pain relief, the palliative advanced practice registered nurse (APRN) must possess exceptional pain assessment skills, including keen history-taking and physical examination. Biological, psychological, social, and spiritual factors should be considered part of a complete assessment and serve as a guide for development of a comprehensive plan of care. APRNs must have comprehensive knowledge of pain management options including appropriate pharmacologic and nonpharmacologic therapies. The APRN consults colleagues who provide interventions such as physical therapy, interventional techniques, and cognitive-behavioral strategies. APRNs must practice universal precautions to detect aberrant behavior with pain medications. Finally, APRNs must implement safe prescribing practices.
Respiratory Symptoms
Authors: Moore Ember S. , Broglio Kathleen
Published: May 2023

Dyspnea and cough are two distinct symptoms that may occur together and cause significant symptom distress. Both symptoms are not completely understood, and treatment has not been well-defined for individuals with serious illness in the context of palliative care. The advanced practice registered nurse (APRN) should possess the skills to assess these symptoms and, when possible and appropriate, treat or refer for the treatment of underlying pathologies that may be causative factors. In advancing disease and at the end of life, the APRN can utilize multiple strategies to decrease the distress associated with cough and dyspnea. The APRN can acknowledge these prevalent symptoms and raise awareness of the quality of life burden they pose to individuals and their caregivers. The APRN can be an educator on best practice in symptom assessment and treatment and should participate in education and research to further ensure that individuals receive appropriate treatment of these distressing symptoms.
Delirium
Authors: Evans Bonnie D. , Hickey Erica J.
Published: May 2023

In the palliative care population, delirium is a common syndrome, and the incidence increases at the end of life. It is a complex phenomenon, and multiple theories are postulated to explain the underlying pathophysiology that causes acute changes primarily in attention and awareness. Factors contributing to the development of delirium are categorized as predisposing or unmodifiable factors such as older age and precipitating or potentially modifiable factors such as medications or infection. Delirium can cause significant caregiver distress, poses an immediate risk to patient safety, and can also be life-threatening. It is associated with an increase in inpatient mortality that can continue post-discharge, and some studies support persistent cognitive and functional impairment. Assessment requires information regarding the patient’s baseline cognitive status, familiarity with delirium risk factors, and validated delirium assessment tools. The hallmark for diagnosis is the presence of one or more underlying medical conditions, in palliative care, typically multifactorial. Primary prevention that targets known delirium risk factors with multicomponent, nonpharmacological interventions is preferable. Early recognition of symptoms and addressing any precipitating factors can limit the severity and duration of evolving delirium. The extent of any diagnostic workup and intervention must be based on the goals of care, particularly in the palliative care population. There is no consensus to guide current pharmacological management of delirium. In severe, refractory, or terminal delirium, the risk and benefit of any medication being considered must be carefully evaluated.
Palliative Sedation
Authors: Collett David , Baxter Kelly
Published: May 2023

This chapter examines palliative sedation, a therapy used for patients with intractable symptoms, and the advance practice registered nurse’s role in caring for the patient as well as the family and the interdisciplinary team. It discusses definitions of palliative sedation, indications, and settings, and reviews medication management and administration. An overview of identification and evaluation of intractable suffering is provided. There is a review of medications appropriate for palliative sedation, as well as guidelines and best practices for delivering team-based and patient-centered palliative care when palliative sedation is used. Ethical and legal aspects and national position statements from nursing and medical professional societies are reviewed. A case study is included to illustrate the nurse’s and the interdisciplinary team’s responsibilities to the patient, the family, and each other during the provision of palliative sedation.
Anxiety, Post-Traumatic Stress Disorder, and Other Trauma-Related Disorders
Authors: McDowell Anna K. , Simpson Scott A.
Published: May 2023

Anxiety is a universal experience, and impairing anxiety-related disorders are the most common psychiatric illnesses. Presentations of anxiety are common in emergency settings. Although anxiety may portend serious medical illness, it is more common that anxiety is a symptom that complicates the assessment and management of other illnesses. A brief history identifying the key sources of a patient’s anxiety is invaluable for developing a quick psychiatric differential, assessing suicide risk, and ascertaining the need for further treatment. This chapter reviews common anxiety syndromes, including generalized anxiety disorder, panic disorder, and adjustment disorders related to medical illness. The effects of trauma, including acute stress disorder and post-traumatic stress disorder, are also reviewed for their complex impacts on patients’ care.
Perinatal Patients and Related Illnesses, Symptoms, and Complications Related to Pregnancy
Authors: Slocum Sarah
Published: May 2023

Emergency psychiatrists and trainees often encounter women who are pregnant, postpartum, or of reproductive age. As physicians, emergency psychiatrists must improve counseling for patients who are or may become pregnant. Psychotropic medication management in pregnancy is underemphasized in training programs and clinical work. With 50% of pregnancies in the United States being unplanned, it is imperative that all clinicians gain a basic comfort level with this population. This chapter discusses the use of medication for acute agitation, psychotic and affective disorders, anxiety, substance use, and trauma-related disorders, in addition to special topics such as pregnancy loss, personality disorders, suicidality, gender identity and sexual orientation, and considerations for lactation.
Tool, Constraint, Liability, Context
Authors: Rozel John S. , Soliman Layla
Published: May 2023

The everyday practice of emergency psychiatry involves a blend of clinical skills and legal knowledge. Perhaps more than any other clinical specialty, emergency psychiatry is beholden to the use of legal processes as a fundamental tool for ensuring that people in need of care are helped and that their civil rights are protected. Significant variation in rules and standards across jurisdictions complicates an already perilous balance between autonomy and beneficence. In addition to primary tools such as voluntary and involuntary commitment, emergency psychiatrists routinely work with important standards relating to confidentiality and duties to third parties. Furthermore, although psychiatry and emergency medicine are not frequently sued specialties per se, the psychiatric emergency service poses special risks for malpractice liability.
Quality Improvement in Psychiatric Emergency Settings
Authors: Balfour Margaret E. , Rhoads Richard
Published: May 2023

This chapter provides an overview of basic quality improvement concepts for those interested in improving clinical care in emergency psychiatric settings. Quality improvement is anything that improves the delivery, consistency, or outcome of care, ranging from large, multistep projects (e.g., changing the entire process for suicide assessment and triage) to small, seemingly minor improvements (e.g., updating a form or streamlining a process to make it more efficient). Frontline staff—including residents—are critical to successful quality improvement efforts because they are often the first to notice processes that need improvement and can help develop practical solutions based on their real-world experience. The chapter begins with an overview of the history of quality improvement in health care and some of the frameworks commonly applied in health care settings. Next, it discusses the importance of quality measurement and provides practical guidance on choosing what to measure and how to measure it. Then, the chapter presents a real-world example to illustrate how quality improvement concepts can be applied to improve care in an emergency psychiatric setting using the FOCUS-PDSA framework.
Models of Well-Being
Authors: Thomas Larissa R.
Published: May 2023

A shared mental model for how to conceptualize well-being is foundational to approaching and addressing well-being challenges. Such a framework helps to guide priorities and ensure that the entire organization is speaking the same language when discussing well-being. As with other major thought discourses, conceptual models of clinician well-being have evolved as studies on drivers and interventions have emerged. Today’s models incorporate an understanding of well-being as a complex problem that requires interventions to address systems and the culture of medicine while supporting individuals. This chapter includes a summary of the evolution of thought on models for well-being, describes several common models used for understanding drivers and intervention frameworks, and addresses the value of commitments to aspirational states.
What’s Causing the Problem?
Authors: Orrange Susan M. , Adragna Michael S. , Jeanlus Ashley
Published: May 2023

Numerous drivers of burnout have been explored in students and GME trainees; some at the individual level and others at the broader institutional level. Institutional supports for students shown to promote well-being include pass–fail curricula, decreased class hours, greater flexibility, supportive relationships with faculty and staff, and support for diversity. At the individual level, medical student well-being is influenced by self-care, social cohesion, stress perception, educational debt, and help-seeking behaviors. Meanwhile, among residents and fellows, well-being is influenced by both demands placed on individuals by institutions and programs and resources provided to them. Resident well-being is also driven by personal factors such as self-care, social support, and stress coping, empathy, emotional intelligence, and personality. This chapter concludes by contextualizing these findings within existing driver models of burnout and engagement. Exploring these drivers can guide educators and leaders to create changes that positively impact future physician well-being.
Making the Case for Institutional Commitment to Well-Being
Authors: Harry Elizabeth , Morrison Katherine , Lawrence Elizabeth
Published: May 2023

In this chapter, the authors describe five major reasons why health care institutions must embrace the need to improve and support the well-being of their physicians. These five reasons include the moral imperative to reduce distress, mental illness, and suicide in physicians; the need to avert tragedies; regulatory requirements; the quality and safety of patient care; and the economic cost associated with physician burnout. The authors explore each of these reasons in detail, providing the evidence behind their contentions. The chapter includes two practice boxes that help the reader identify what data and strategies are needed to make and present the case for institutional leadership to prioritize physician well-being.