bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review of Molecular Autopsy Studies in Sudden Infant Death Cases
Authors: Martin Lorna , Ramesar Raj , Heathfield Laura
Published: August 2018

Sudden unexpected death is an upsetting event, which can remain unexplained even after post-mortem investigation. Internationally, molecular autopsies have shown to resolve up to 44% of unexplained cases; however, it is currently unclear how many of these were infants. This systematic literature review showed that significantly fewer infant cases were resolved (median: 4%) compared with cohorts of 1 to 45 years old (median: 32%). Further, no study involving indigenous African participants has yet been published. Overall, molecular autopsies hold immense value to living family members and is motivation to explore new avenues in infant cohorts.
Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome
Authors: Sherbiny Magdy , Kamal Nehal , Ghoneimy Ahmed
Published: August 2018

Background Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft.

Methods Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome.

Results The mean follow-up period was 48.7 months (12–104 months). The mean age at presentation was 10.3 years (5–17 years). The average length of the resected femoral shaft was 19.2 cm (15–24 cm) and the average length of the harvested fibula was 17.4 cm (15–21 cm). The mean time to union was 4.8 months (1–6 months) and the mean hypertrophy index was 78% (15.5–184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56–100%) and the mean limb length inequality was 4.75 cm (3–11 cm).

Conclusion Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting.

Level of Evidence IV.
Microsurgery Training Resource Variation among US Integrated Plastic Surgery Residency Programs
Authors: Mueller Melissa , Pourtaheri Navid , Evans Gregory
Published: August 2018

Background Given emerging focus on competency-based surgical training and work-hour limitations, surgical skills laboratories play an increasingly important role in resident education. This study was designed to investigate educational opportunities in microsurgery across integrated residency programs.

Methods Senior residents (PGY 4–6) at integrated plastic surgery programs were surveyed during the 2016 to 2017 academic year to determine each program's access to: training microscopes and anastomosis models, video-based skills assessment, pre-requisite skills exams, flap courses, or a formal microsurgical training curriculum. Programs were stratified based on large size (>18 residents) and presence of microsurgery fellows. Chi-squared analysis was performed with p < 0.05 to assess statistical significance.

Results Survey responses were collected from 32 of 60 eligible programs (53% response rate). Sixty-nine percent provide access to one to two training microscopes, 25% provide three or more, and 6% provide none. Sixty-nine percent of programs train anastomosis with nonliving prosthetics, 66% with living biologics, and 50% with nonliving biologics. Large program size or having microsurgical fellows was not associated with increased access to training microscopes or specific anastomosis models. Programs without microsurgery fellows reported more often that a formal microsurgery curriculum would be helpful (90 vs. 58% of programs with fellows, p = 0.0003). Respondents who indicated that creating a formal curriculum would not be helpful elaborated that their program already has a formal curriculum or a high volume of microsurgery cases.

Conclusion This study demonstrates the current variation in microsurgery training at integrated plastic surgery residency programs. A formal microsurgical training curriculum is commonly viewed as being helpful, particularly at programs without microsurgery fellows.
Enzymatic characterization of an extracellular glucoamylase from Tricholoma matsutake and its cloning and secretory expression in Pichia pastoris
Authors: Onuma Hiroki , Uchiyama Hiroto , Hara Kento , Fukuta Yasuhisa , Shirasaka Norifumi
Published: August 2018

A glucoamylase from the ectomycorrhizal fungus Tricholoma matsutake (TmGLA) was purified 33.2-fold to homogeneity as a single monomeric glycoprotein with a molecular mass of 63.9 kDa. Maximum activity was observed at 60°C and pH 5.0. The enzyme is active down to 50°C and in the pH range of 4.0–6.0, and its activity is strongly inhibited by Ag+. It degrades α-1,4- and α-1,6-glycosidic linkages in various polysaccharides. Its gene (TmGlu1) was cloned using information from the enzyme’s internal amino acid sequences and the whole genome sequence of T. matsutake NBRC 30605. The deduced amino acid sequence showed clear homology with those of GH family 15 proteins. Pichia pastoris transformed with TmGlu1 secreted the active enzyme in a glycosylated form, and its characteristics were the same as the native enzyme.
Responses of the chloroplast glyoxalase system to high CO2 concentrations
Authors: Shimakawa Ginga , Ifuku Kentaro , Suzuki Yuji , Makino Amane , Ishizaki Kimitsune , Fukayama Hiroshi , Morita Ryutaro , Sakamoto Katsuhiko , Nishi Akiko , Miyake Chikahiro
Published: August 2018

Sugar metabolism pathways such as photosynthesis produce dicarbonyls, e.g. methylglyoxal (MG), which can cause cellular damage. The glyoxalase (GLX) system comprises two enzymes GLX1 and GLX2, and detoxifies MG; however, this system is poorly understood in the chloroplast, compared with the cytosol. In the present study, we determined GLX1 and GLX2 activities in spinach chloroplasts, which constituted 40% and 10%, respectively, of the total leaf glyoxalase activity. In Arabidopsis thaliana, five GFP-fusion GLXs were present in the chloroplasts. Under high CO2 concentrations, where increased photosynthesis promotes the MG production, GLX1 and GLX2 activities in A. thaliana increased and the expression of AtGLX1-2 and AtGLX2-5 was enhanced. On the basis of these findings and the phylogeny of GLX in oxygenic phototrophs, we propose that the GLX system scavenges MG produced in chloroplasts during photosynthesis.
Plasmid copy number mutation in repA gene encoding RepA replication initiator of cryptic plasmid pHM1519 in Corynebacterium glutamicum
Authors: Hashiro Shuhei , Yasueda Hisashi
Published: August 2018

Cryptic plasmid pHM1519 is a rolling-circular replication mode plasmid of the pCG1 plasmid family in coryneform bacteria. The derived shuttle vector pPK4 is maintained at about 40–50 copies per chromosome in Corynebacterium glutamicum 2256 (ATCC 13869). We found that a mutation (designated copA1) within the repA gene encoding essential initiator protein RepA of the pHM1519-replicon increased the copy number of the mutant plasmid to about 800 copies per chromosome. The mutation was a single G to A base transition, which changed Gly to Glu at position 429 of the amino acid sequence of RepA. In silico secondary structure prediction of RepA suggested that Gly429 is situated in a disordered region in a helix-turn-helix motif, which is a typical DNA-binding domain. This study shows the first example of a high copy number of a C. glutamicum cryptic plasmid caused by an altered replication initiator protein.
Predictive cluster level surrogacy in the presence of interference
Authors: Gabriel Erin E , Follmann Dean A
Published: August 2018

Surrogate evaluation is a difficult problem that is made more so by the presence of interference. Our proposed procedure can allow for relatively easy evaluation of surrogates for indirect or spill-over clinical effects at the cluster level. Our definition of surrogacy is based on the causal-association paradigm (Joffe and Greene, 2009. Related causal frameworks for surrogate outcomes. Biometrics65, 530–538), under which surrogates are evaluated by the strength of the association between a causal treatment effect on the clinical outcome and a causal treatment effect on the candidate surrogate. Hudgens and Halloran (2008, Toward causal inference with interference. Journal of the American Statistical Association103, 832–842) introduced estimators that can be used for many of the marginal causal estimands of interest in the presence of interference. We extend these to consider surrogates for not just direct effects, but indirect and total effects at the cluster level. We suggest existing estimators that can be used to evaluate biomarkers under our proposed definition of surrogacy. In our motivating setting of a transmission blocking malaria vaccine, there is expected to be no direct protection to those vaccinated and predictive surrogates are urgently needed. We use a set of simulated data examples based on the proposed Phase IIb/III trial design of transmission blocking malaria vaccine to demonstrate how our definition, proposed criteria and procedure can be used to identify biomarkers as predictive cluster level surrogates in the presence of interference on the clinical outcome.
Establishment of a Macaca fascicularis gut microbiome gene catalog and comparison with the human, pig, and mouse gut microbiomes
Authors: Li Xiaoping , Liang Suisha , Xia Zhongkui , Qu Jing , Liu Huan , Liu Chuan , Yang Huanming , Wang Jian , Madsen Lise , Hou Yong , Li Junhua , Jia Huijue , Kristiansen Karsten , Xiao Liang
Published: August 2018

Macaca fascicularis, the cynomolgus macaque, is a widely used model in biomedical research and drug development as its genetics and physiology are close to those of humans. Detailed information on the cynomolgus macaque gut microbiota, the functional interplay between the gut microbiota and host physiology, and possible similarities to humans and other mammalians is very limited. The aim of this study was to construct the first cynomolgus macaque gut microbial gene catalog and compare this catalog to the human, pig, and mouse gut microbial gene catalogs. We performed metagenomic sequencing on fecal samples from 20 cynomolgus macaques and identified 1.9 million non-redundant bacterial genes of which 39.49% and 25.45% are present in the human and pig gut bacterial gene catalogs, respectively, whereas only 0.6% of the genes are present in the mouse gut bacterial gene catalog. By contrast, at the functional levels, more than 76% Kyoto Encyclopedia of Genes and Genomes orthologies are shared between the gut microbiota of all four mammalians. Thirty-two highly abundant bacterial genera could be defined as core genera of these mammalians. We demonstrated significant differences in the composition and functional potential of the gut microbiota as well as in the distribution of predicted bacterial phage sequences in cynomolgus macaques fed either a low-fat/high-fiber diet or a high-fat/low-fiber diet. Interestingly, the gut microbiota of cynomolgus macaques fed the high-fat/low-fiber diet became more similar to the gut microbiota of humans.
Opening of the Norway pout box: will it change the ecological impacts of the North Sea Norway pout fishery?
Authors: Bigné Matthieu , Nielsen J Rasmus , Bastardie François
Published: August 2018

The small-mesh Norway pout (Trisopterus esmarkii) fishery intensified in the northern North Sea during the 1970s. Concerns about juvenile gadoid bycatch led to the “Norway pout box” closure along the Scottish coast in 1977. To assess the justification of the box today and the potential current impacts of opening the box, we evaluate the closure effects on selected fish stocks by analysing high-resolution research survey and commercial fishery data. The species- and size-specific distribution patterns in relation to environmental influencing factors are analysed for Norway pout and important bycatch species inside and outside the box. Relative distribution of benthic habitats is compared between inside–outside areas according to fish occurrence and fishery spatial footprint. No area differences in fish size composition are observed. However, species abundance depends significantly on habitat and depth whose area distribution is not homogenous. The current fishery is mainly in deeper, muddy seabeds. Haddock (Melanogrammus aeglefinus) and whiting (Merlangius merlangus) density is higher in shallow and sandy habitats, with a relatively larger area coverage inside the box. If a box opening implies relatively more fishery in those habitats, then increased bycatch can be expected. Consequently, closure of certain benthic habitats may instead be better management, opening new fishing opportunities without risk.
Dredging-induced turbid plumes affect bio-irrigation and biogeochemistry in sediments inhabited by Lanice conchilega (Pallas, 1766)
Authors: Mestdagh Sebastiaan , Ysebaert Tom , Moens Tom , Van Colen Carl
Published: August 2018

Building man-made structures in coastal seas are often preceded by dredging operations, inducing turbid plumes of suspended sediment. To study the effects of such high-concentration sediment plumes on the suspension-feeding polychaete Lanice conchilega, a laboratory experiment was performed, in which individuals of L. conchilega were exposed to natural seawater with a suspended sediment concentration (SSC) of ∼ 0.3 g l−1 and treatments with elevated SSC of 5 and 1 g l−1, representing concentrations in a dredging plume at the moment of sediment release and after initial dilution, respectively. We measured clearance rates of sediment particles, biogeochemical fluxes, and bio-irrigation. While clearance rates and nitrite efflux significantly increased in both treatments with elevated SSC compared with the control, bio-irrigation increased at 1 g l−1 but was lowest at 5 g l−1. It is suggested that piston pumping is intensified under intermediate concentrations to remove sediment, but ceases under high concentrations are due to sediment ingestion. By transporting oxygen into the sediment, bio-irrigation enhances aerobic microbial processes, among which nitrification. We conclude that short-term extreme suspended sediment concentrations can have a significant impact on the biogeochemistry of the seabed through changes in behaviour of L. conchilega.
The Intersection of Body Image and Oncology
Authors: Fingeret Michelle Cororve , Teo Irene
Published: August 2018

This chapter introduces the framework for the rest of the book, which reviews best practices of body image care for a multidisciplinary team of oncologists, psychiatrists, psychologists, nurses, social workers, rehabilitation specialists, speech and language pathologists, and other allied healthcare professionals. The book provides a comprehensive overview of available literature on body image outcomes with cancer populations, integrates scientific findings from the general body image literature that can be applied to the oncology setting, and provides readers with a comprehensive theoretical foundation along with practical recommendations for assessment tools and intervention approaches that can be utilized by a range of healthcare professionals. It is relevant for emerging as well as established healthcare professionals internationally and can be used in training and other educational settings.
Theoretical Foundations of Body Image
Authors: Rhoten Bethany
Published: August 2018

Abstract: The purpose of this chapter is to review the theoretical foundations of body image. Neurological, psychoanalytic, psychological, nursing, contextual, fear-avoidance, information-processing, feminist, evolutionary, genetic, and positivist viewpoints have all influenced the conceptualization of body image. Body image in the context of oncology is a multidimensional experience influenced by a variety of factors. By understanding the origin and history of body image conceptualization, researchers and clinicians in cancer care can build upon the existing knowledge base to develop appropriate and timely assessments of body image, train oncology healthcare providers to include body image in holistic survivorship care, and design interventions that appropriately address the body image needs of this population.
Body Image Issues Across Cancer Types
Authors: Lehmann Vicky , Tuinman Marrit A.
Published: August 2018

Abstract: This chapter provides a broad overview of body image challenges experienced by cancer patients and survivors, first focusing on patient characteristics and common treatment side effects that can affect body image and then summarizing findings specific to certain clusters of diagnoses. Research in the area of body image and cancer has largely focused on patients with breast cancer. A growing body of research also recognizes the negative impact of altered appearance and functioning on body image outcomes of patients with sexual organ-related, gastrointestinal, head and neck, skin, and other cancers. Body image is typically evaluated within the context of a single type of cancer and rarely compared across different types. This chapter proposes a visibility-stability model as a conceptual framework to facilitate understanding of the impact of cancer on body image across cancer types. This framework further considers functional body changes and survivors’ subjective evaluations as core components.
Body Image and the Cancer Treatment Trajectory
Authors: Sherman Kerry A. , Shaw Laura-Kate E.
Published: August 2018

Abstract: The chapter “Body Image and the Cancer Treatment Trajectory” provides an overview of body image–related concerns and challenges that can arise throughout the cancer journey, from cancer detection and diagnosis through to active treatment and cancer survivorship. The chapter examines how body image concerns can serve as a significant barrier to cancer detection, including self- and physician examination, routine screening, and diagnostic tests. It then reviews the impact of cancer surgery and treatment-related side effects (such as physical disfigurement, hair loss, skin irritations, weight loss or gain, changes to bodily functions, premature menopause, and lymphedema) on an individual’s body image, self-concept, and overall psychosocial well-being in both the short and longer term. Finally, the chapter discusses body image concerns arising from risk-reducing or prophylactic surgery to minimize hereditary risk of cancer occurrence.
Body Image and Functional Loss
Authors: Henry Melissa , Alias Ali
Published: August 2018

Abstract: The implications of functional loss following cancer is an area of psychosocial oncology that is rarely ventured. This is especially true in the context of limb and sensory losses, which have important repercussions on the patient’s well-being, namely as the individual is required to reassess and redefine his or her identity in face of these adversities. This chapter explores the implications of these losses via the intersection of the World Health Organization’s International Classification of Functioning, Disability, and Health with key oncological attributes of body image disturbances that seek to render explicit psychological mechanisms underlying impairments, limitations, and restrictions. Emphasizing the use of a standard framework for the assessment of functioning is essential, especially in understudied areas. Through this perspective, further insight is provided for the methodological and biopsychosocial assessment of functioning and body, and implications for clinical inquiry and practice are proposed for the advancement of cancer survivor care.
Lymphedema and Body Image Disturbance
Authors: DeSnyder Sarah M. , Shaitelman Simona F. , Schaverien Mark V.
Published: August 2018

Abstract: Lymphedema is a dreaded side effect of cancer treatments. Studies within the field of psychosocial oncology have shed light on the profound effect of lymphedema secondary to treatment of cancer on quality of life, body image, activities of daily living, and financial stress. Patients who develop lymphedema are at risk for body image disturbances. It is critical for healthcare providers to recognize and treat lymphedema at its earliest stages not only to control lymphedema but to mitigate the detrimental downstream effects of lymphedema including body image disturbance, social anxiety, and depression, all of which affect health-related quality of life. For those who experience diminished health-related quality of life due to lymphedema, healthcare providers must intervene with psychosocial support.
Speech and Swallowing Impairment
Authors: Lewin Jan S. , Fingeret Michelle Cororve , Hutcheson Kate A.
Published: August 2018

Abstract: Patients with head and neck cancer face multiple, often severe psychological and functional problems associated with the diagnosis and treatment of their disease including alterations in or loss of human voice, disruptions in speech production, and deterioration of swallowing ability. These functional changes significantly compromise a patient’s body image and can occur as a result of the disease as well as its primary treatment, whether surgery, radiation therapy (RT), or both. Adjuvant treatments that include RT generally increase functional deficits and associated body image disturbance. Therefore, a thorough understanding of the functional effects associated with the given treatment modality or combination of modalities must be conveyed adequately to the patient. A multidisciplinary team approach and ongoing communication among clinicians is critical to successful outcomes. This approach includes the delivery of psychosocial interventions to facilitate coping with functional changes during active treatment and into cancer survivorship.
Body Image in Children and Adolescents with Cancer
Authors: Thompson Amanda L. , Wiener Lori
Published: August 2018

Abstract: A diagnosis of cancer in childhood or adolescence has the potential to influence body image development and may have a lasting impact on self-perception and self-esteem. This chapter first describes existing research about body image in children and adolescents with cancer and then outlines key principles of clinical care of pediatric patients. Clinical assessment of precancer body image is discussed, followed by a review of the impact of treatment on appearance and perception of physical differences over the illness trajectory. Strategies to address body altering side effects of cancer, including the role of social support, are reviewed, and the chapter concludes by describing clinical interventions for more persistent and intrusive body image concerns that interfere with social functioning or cause significant emotional distress. A case study is presented throughout to illustrate key concepts and principles.
Men, Body Image, and Cancer
Authors: Drummond Murray , Gough Brendan
Published: August 2018

Abstract: Despite a growing body of literature around men’s bodies and body image, there is a paucity of research surrounding men and body image within the cancer literature. This chapter considers a range of issues including men’s body image and masculinities as well as illness-induced body dissatisfaction in men. It draws on literature and research to identify key issues so that health professionals can be informed about particular body image issues relevant to male cancer patients. The way in which the chapter is set out is designed to guide the reader through information that will highlight the broader issues facing men with respect to body image. It provides evidence to emphasize the need to understand men and their bodies in contemporary Western society generally and in the context of illness such as prostate cancer, which is the leading gender-specific cancer in men.
Body Image and Couples
Authors: Hansen Esther , Reese Jennifer Barsky , Grayer Justin
Published: August 2018

Abstract: Body image concerns can create challenges in a cancer survivor’s partnered relationship, and aspects of this relationship can influence how a survivor copes with body image concerns. This chapter describes both research and clinical interventions focusing on couples experiencing body image distress associated with cancer and its treatment. First, the chapter reviews observational and couple-based intervention research relevant to the problem of body image distress and the partnered relationship. Next, it offers an overview of conceptual principles relevant to couple-based clinical approaches, focusing on the key concepts of mentalization and attachment narratives. Then it provides detailed guidance on approaches for the assessment, case formulation, and management of body image distress in a relational framework through case examples. Finally, it offers a summary and introduces questions to stimulate future work in this area, including how to best optimize, expand, and disseminate couple-based interventions addressing cancer-related body image concerns.
Cultural Considerations in Body Image and Cancer
Authors: Harper Kristina , Konradsen Hanne
Published: August 2018

Abstract: This chapter discusses the Western cultural perspective of the body ideal and how cultural norms may influence the body image experiences of patients with cancer. The chapter begins with an overview of the sociocultural standards of appearance embraced in Western society, including the body-ideal shift throughout the 20th and 21st centuries, and how this specifically relates to physical changes that can co-occur with cancer, followed by a broader look at additional facets of Western culture (e.g., consumerism, surgical enhancement, media) that may shape the body image experience and ultimately treatment decisions of cancer patients. Specific research findings are discussed primarily in relation to body image in breast cancer with brief discussion of other cancers that impact one’s appearance. Finally, current interventions for working within the Western cultural framework are discussed, as well as clinical considerations for health care providers working with patients on body image issues in the oncology setting.
Cultural Considerations in Body Image and Cancer
Authors: Lee Geok Ling , Teo Irene
Published: August 2018

Abstract: This chapter discusses the Asian cultural perspective based on Confucian concepts and how they can influence the body image experiences of patients with cancer. The chapter begins with a brief description of key Confucian concepts, such as relationship dominance, relational self, and self-cultivation. The connection between these concepts and the body image experience of patients with cancer is discussed, with illustrative examples. This is followed by a review of the research findings on body image in psycho-oncology studies conducted in Asia. Although limited, there are studies that examine body image changes in breast, gynecologic, head and neck, as well as gastrointestinal cancers. Clinical considerations are offered for health care providers who are interested in working with Asian patients with body image issues in an oncology setting. In conclusion, more efforts are needed to examine body image and cultural-specific themes in the context of oncology in Asia.
Synthesis
Authors: Fingeret Michelle Cororve , Teo Irene
Published: August 2018

Abstract: This chapter is dedicated to summarizing key findings on what is known about body image care for cancer patients, and offering suggestions for future directions in the field of oncology. In this concluding chapter, the goal is to emphasize broad ideas related to body image theory, research, and interventions particularly as it relates to cancer-specific treatment sequelae. Further attention is given to special populations such as children, older adults, men, and in acknowledging important cultural considerations.
Why Are the Health Humanities Relevant (and Vital) in Postgraduate Medical Education?
Authors: Skorzewska Anna , Peterkin Allan D.
Published: August 2018

This introductory chapter provides a short history of medical humanities and continues on to give an overview of the limits of medical practice, evidence-based medicine (EBM), successes and failures, curricula, and the current state of medical humanities. The medical and health humanities have become a widespread discipline, with journals, institutes, and associations worldwide. Throughout undergraduate medical education, new courses, electives, programs, and research are proliferating. Yet there is very little officially documented about relevance and efficacy in postgraduate medical education. The chapters that follow provide both a rigorous argument for using the arts and humanities in postgraduate medical education and a practical “how-to” that will guide readers in developing arts and humanities initiatives in their own program or medical school. Each chapter provides ideas, hands-on lesson plans, and resources to pave the way forward.
Redirecting the Clinical Gaze
Authors: Leonard Elysse , Tau Michael
Published: August 2018

Film has been used in medical education for many years to teach both medical students and residents. This has taken many forms, from informal “movie clubs” to organized seminars embedded into curricula. This chapter reviews the literature on the use of film in medical education. It then presents a unique model for how films can augment postgraduate training. Using an example of a close reading of the film Son frère (2003), the chapter suggests that film can be used to provoke reflection on certain characteristics of clinical work, including the unpredictability and irrationality of illness and the experience of not-knowing. Experimental and nonlinear narratives can amplify these themes by challenging viewers’ expectations. The chapter then discusses various practical considerations for teaching using cinema, including film and venue selection, screening rights, and community partnerships. Lastly, sample lesson plans and suggested resources are provided as examples to aid curriculum development.
Narrative Medicine in Postgraduate Medical Education
Authors: Arntfield Shannon , Hynes Kathryn
Published: August 2018

This chapter presents a practically minded conceptualization of the field of narrative medicine (NM) as it relates to postgraduate educators. To assist educators implement and deliver NM education to residents, the practices, principles, and paradoxes of NM are reviewed. The practices of NM are made explicit because educators have a fundamental responsibility to understand them when offering training in this discipline. Practices include sharing a narrative, close reading, and reflective writing. The principles of NM are discussed because, when applied, they fortify the practices and enable more success and enjoyment. The principles of NM stipulate the work should be experiential, relational, and programmatic. The paradoxes of NM are identified and explored because they can stymie the efforts of educators to teach and can have major consequences to the outcomes of the work. The implementation paradox, the credibility paradox, and the legitimacy paradox are discussed.
The Visible Curriculum
Authors: Stern Eva-Marie , Wall Shelley
Published: August 2018

The visible curriculum is a term for engagement with the visual arts in medical education. The purposes of having medical trainees view and respond to artworks have been framed in various ways: to sharpen technical abilities, to foster cognitive and interpersonal skills, and to promote personal growth. Art-making, as an embodied practice, activates skills essential to medical care which go beyond words and beyond cognitive work. This chapter summarizes current visual teaching/learning modalities used in medical training, considers the importance of art-making in addition to art observation, suggests differences in approach between undergraduate and residency training, and offers some practical examples of visual arts-based sessions for training and reflection.
Teaching the Social Sciences in Residency
Authors: Feilchenfeld Zac , Kuper Ayelet , Friesen Farah , Chen Amanda , Whitehead Cynthia
Published: August 2018

Social sciences are only rarely integrated into graduate medical curricula, though there have been several calls for increasing social sciences in medical education. The usual approaches to teaching the social sciences in graduate medical education in the current literature include basing curricula on the Behavioral and Social Sciences model or the Social Determinants of Health model. One further approach attempts to teach competencies that suggest intersections between the social sciences and competency frameworks. A foundation of social science knowledge, analogous to the foundational basic science and clinical science knowledge learned by trainees to support medical expertise, could support the broader competencies required for trainees to become competent physicians. This chapter describes a model of foundational social science knowledge, developed from research findings. The chapter provides curricular ideas, practical tips, discussion questions, and helpful links for program directors looking to incorporate social science teaching in their programs.
Promoting Collaborative Competencies
Authors: Langlois Sylvia , Gold Karen
Published: August 2018

This chapter explores the role of arts and humanities in promoting interprofessional learning and patient-centered collaborative practice. This chapter addresses the importance of collaborative competencies in postgraduate training and healthcare practice as situated within the principles of relational-centered care. Case studies of learning activities which can be adapted for use in postgraduate medical education and specific consideration for interprofessional facilitation provide a practical guide on how to incorporate the arts into postgraduate education. Additionally, components of a certificate program for learners focusing on the development of collaborative competencies through engagement in the arts and humanities are discussed.
Teaching History of Medicine/Healthcare in Residency
Authors: Shorter Edward , Bélanger Susan E.
Published: August 2018

The history of medicine has an important role to play in a medical humanities program. Those who lead the history portion of such programs should see their role as building bridges from history to medical practice. One often distinguishes between the “art” and the “science” of medicine. Both are important today, and the art of medicine comes into play in particular in managing patients who have symptoms without lesions. Here there are clear historical lessons, and such greats as William Osler at Johns Hopkins University thought of history as providing guidance in the therapeutic use of the doctor-patient relationship. These lessons are still relevant today: History can open the eyes of medical students and residents to ways of interacting with patients that they do not otherwise learn about.
How to Fund and Promote Arts-Based Initiatives in Postgraduate Medical Education
Authors: Tomas Robert Pierre
Published: August 2018

This chapter is a practical how-to for funding strategies for arts-based and health humanities teaching in postgraduate medical education. Ideas contained here are suggestions and not meant to be an exhaustive manual, however they may direct the reader towards resources not previously considered. From support for specific activities and workshops to seeking major gifts for the creation of faculty-wide humanities programs, it is a broad-based fundraising how-to, suggesting both, small, incremental changes as well as broad, dramatic ways in which such programs can be transformed and provided with badly—needed resources. The main objective is not necessarily to answer all the question, but rather to overcome the inherent bias against fundraising that the academics experience in their careers.
Child and Adolescent Anxiety Psychodynamic Psychotherapy
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Child and adolescent anxiety psychodynamic psychotherapy (CAPP) is a new, manualized, tested, 24-session psychotherapy articulating psychodynamic treatment for youths with anxiety disorders. The book describes how clinicians intervene by collaboratively identifying the meanings of anxiety symptoms and maladaptive behaviors and communicating the emotional meanings of these symptoms to the child. The treatment is conducted from a developmental perspective, and the book contains clinical examples of how to approach youth of varying ages. The authors demonstrate that CAPP can help children and adolescents: • Reduce anxiety symptoms by developing an understanding of the emotional meanings of symptoms • Enhance the skill of reflection and self-observation of one’s own and others’ feelings and motivations (improvement in symptom-specific reflective functioning) • Diminish use of avoidance, dependence, and rigidity by recognizing how underlying emotions (e.g., guilt, shame, anger), as well as conflicted wishes can be tolerated and understood • Understand fantasies and personal emotional significance surrounding the anxiety symptoms to reduce symptoms’ magical, compelling qualities and impact on the child The manual provides a description of psychodynamic treatment principles and techniques and offers a guide to the opening, middle, and termination phases of this psychotherapy. The book contains chapters on the historical background of child psychodynamic psychotherapy, on developmental aspects of child psychotherapy, and on the nature of parent involvement in the treatment. This manual is intended to be used by clinicians from diverse therapy backgrounds, and it will appeal to the student reader as well as to the experienced clinician.
Introduction
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Chapter 1 acquaints the reader with child and adolescent anxiety psychodynamic psychotherapy (CAPP), a novel time-limited psychodynamic psychotherapy for children with anxiety disorders, which has undergone preliminary studies. CAPP’s unique feature is that it is focused on the individual meanings of the symptoms, rather than solely on behavioral and symptomatic change. CAPP works to help to reveal the meaning of the symptoms, increases the capacity to reflect, and actively engages the child patient in bringing about change. The literature is reviewed regarding the impact of anxiety disorders on the child and family, as well as the societal burden in terms of the significant health care costs. The authors elucidate the historical background of child psychodynamic psychotherapy and explain the background of CAPP as a developmentally modified version of panic-focused psychodynamic psychotherapy (PFPP), the only psychodynamic psychotherapy to meet evidence-based criteria for adults with anxiety disorders. Two patients, Marie and Tom, who will be followed throughout the book, are introduced. Chapter 1 concludes with an overview of the three phases of treatment.
Time-Limited Psychodynamic Psychotherapy
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Child and adolescent anxiety psychodynamic psychotherapy (CAPP) follows psychoanalytic principles by addressing the unconscious meaning of the child’s symptoms, while employing a time-limited, twice-weekly frame, which affects technique. In Chapter 2, the authors illustrate how the therapist establishes a collaborative and empathic relationship with the child, identifies a central psychological dynamism early, and consistently refocuses on the presenting anxiety symptoms and the jointly identified psychological dynamisms. The authors describe variations in psychotherapeutic technique necessitated by the age-related capacities of the young patient. Important psychodynamic principles, such as transference, are described. Reflective functioning, which is the capacity to be reflective about one’s own mind and to envision mental states in others, is explained. Selective attention is paid to symptom-specific reflective functioning, which refers to the capacity to reflect on the specific anxiety symptoms and their meanings as an important mediator of change.
Including Parents of Children and Adolescents in Dynamic Psychotherapy of Anxiety
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Chapter 5 focuses on the nature and meaning of parent involvement in child and adolescent anxiety psychodynamic psychotherapy (CAPP). Most of CAPP is conducted with the therapist and child or teen alone. The importance of parent participation relates to the practical and natural developmental dependence of the child on the parent, as well as the importance of a solid therapeutic alliance with the parents, which is essential to sustain and maintain the treatment of the youngster. Separation anxious parents are sometimes conflicted about letting go of the child and allowing a relationship to develop with the therapist that largely excludes the parent. It is important for the therapist to be aware of such tendencies in parents so that they can be addressed when they occur and will not interfere with treatment. Specific guidelines are described regarding working with younger children and working with parents of teens.
The Anxiety Disorders
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Chapter 6 consists of six subsections, describing the anxiety disorders treated with child and adolescent anxiety psychodynamic psychotherapy (CAPP). These include generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, panic disorder, agoraphobia and phobic avoidance, and (comorbid) posttraumatic stress disorder. Each section is organized as follows: the authors describe the phenomenology and diagnostic criteria, followed by the salient psychodynamic factors and conflicts. Each section concludes with treatment considerations, addressing transdiagnostic techniques, which apply to all anxiety disorders, and diagnosis-specific adaptations. Clinical vignettes are given for each anxiety disorder. A detailed table summarizes psychodynamic theory, target symptoms, and treatment strategies, followed by specific clinical approaches, rounding out variations of core fantasies and changes in techniques expected for each variant of the anxiety disorders.
Course of Marie’s Treatment
Authors: Preter Sabina E. , Shapiro Theodore , Milrod Barbara
Published: August 2018

Chapter 7 concludes the manual with the case presentation of Marie’s treatment. Marie, who was introduced at the beginning of the manual, is a 14-year-old ninth-grader with anxious inhibitions arising from her history of being bullied. She presented with a two-and-a-half-year history of severe primary social anxiety disorder, with comorbid posttraumatic stress disorder, agoraphobia, and separation anxiety disorder, with episodes of dizziness and crying and inability to speak in any situation outside of her home or school classes. The authors describe how Marie’s treatment unfolded, the salient developments during the three phases of treatment, and how the particular use of understanding recurrent nightmares became a turning point in her treatment.
Introduction
Authors: Gladman Dafna , Fitzgerald Oliver
Published: August 2018

Owing to recent advances in the recognition of psoriatic arthritis, its outcomes, its pathogenesis, and the development of several novel therapeutic approaches, it is believed that a comprehensive textbook on psoriatic arthritis was necessary. This book will provide the most up-to-date information in the advances in the field of psoriatic arthritis, its classification criteria, and mechanisms of bone destruction and formation. This chapter provides an overview of the scope of the textbook, the rationale behind writing a volume on this subject, and advice to clinicians.
Epidemiology of psoriasis
Authors: Takeshita Junko , Gelfand Joel M.
Published: August 2018

Psoriasis is a common chronic inflammatory disorder of the skin that is associated with multisystem effects. Approximately 125 million people worldwide are affected by psoriasis, nearly one quarter of whom have moderate to severe disease. The majority of patients with psoriasis have a waxing and waning course with variable periods of spontaneous disease improvement or clearance. A rapidly expanding body of epidemiologic literature suggests psoriasis to be associated with a greater comorbid disease burden than patients without psoriasis. In addition to psoriatic arthritis, cardiometabolic diseases, including metabolic syndrome and its component disorders, as well as major adverse cardiovascular events are the most common comorbidities of psoriasis; together they are the primary cause of premature mortality among moderate to severe psoriasis patients. Continued efforts to better understand currently known and identify other emerging comorbidities of psoriasis are critical.
Epidemiology of psoriatic arthritis
Authors: Husni Elaine , Michael Madonna
Published: August 2018

The epidemiological studies of psoriatic arthritis (PsA) is quite challenging as our understanding of the disease is evolving. A wide range of incidence and prevalence is reported among different countries suggesting genetic and environmental factors influencing the epidemiology of PsA. Other contributing factors accounting for the wide range and variation of PsA epidemiology include age and gender variations, ethnicity, lack of precise case definition, and small sample size. A high level of suspicion in patients with pre-existing psoriasis, and collaborative efforts shared between primary care physicians (PCP), dermatologist, and rheumatologist, will enhance early detection and management of PsA, subsequently improving overall patient outcomes, and quality of life.
Overview of psoriatic arthritis pathogenesis
Authors: de Vlam Kurt
Published: August 2018

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis occurring in patients with psoriasis. Some consider it as part of the heterogeneous group of diseases unified in the concept of spondyloarthritis (SpA). At least some subtypes, such as the oligoarticular and axial subtypes, can be classified as SpA. The aetiology and pathogenesis are poorly understood. An enthesitis-based model was proposed to unify skin and joint manifestation and to differentiate PsA from other rheumatic diseases such as rheumatoid arthritis and osteoarthritis. The development of PsA results from the interplay of genes, the immune response, and interaction with environmental factors. The fact that more than 80% of patients with PsA have precedent or simultaneous psoriasis suggests that the skin disease is almost a ‘condicio sine qua non’ for the development of PsA.
Genetics of psoriasis
Authors: Stuart Philip E. , Tsoi Lam C. , Hambro Caely A. , Elder James T.
Published: August 2018

Psoriasis is an immune-mediated inflammatory disease (IMID) characterized by skin inflammation, epidermal hyperplasia, increased risk of arthritis, and cardiovascular morbidity. Substantial evidence indicates that psoriasis is driven by abnormal interactions between cells of the innate and adaptive host defence systems, including keratinocytes, dendritic cells, and T-cells, resulting in a dysregulated immune response and markedly increased epidermal proliferation. The precise aetiology of psoriasis remains unknown. Here, we review how innate and adaptive host defence responses are regulated by genetic factors that modulate the overall risk of psoriasis and dictate whether the disease affects the skin and/or the joints. Specifically, we review the epidemiologic basis for considering psoriasis as a genodermatosis, summarize knowledge derived from linkage and association studies of cutaneous psoriasis (PsC) and psoriatic arthritis (PsA), and attempt to relate genetic and immunologic discoveries in a pathogenetic framework that may eventually allow prediction of the development of PsA in psoriatic individuals.