bluuebunny/crossref_metadata_2025 huggingface dataset:
Public knowledge and awareness about mental illnesses
Authors: Jorm Anthony F.
Published: April 2012

For major physical health problems, like cancer and cardiovascular disease, members of the public typically have considerable knowledge about what they can do for prevention or early intervention, or have knowledge of treatments and services available. For example, in the area of cardiovascular disease, there is widespread knowledge about modifiable risk factors like smoking and exercise, people know the value of screening and treatment for hypertension and high cholesterol, many people have the first aid skills to apply cardiopulmonary resuscitation in an emergency, and some would know the warning signs of a stroke and the need to call an ambulance immediately.

Knowledge about mental disorders in the community has generally lagged behind that for major physical diseases. This is surprising given the high prevalence of mental disorders. Community surveys in many countries show high rates, with 1-year prevalence rates of 10 % to 19 % and lifetime prevalence rates of 18 % to 36 % being typical (Kessler et al., 2009). This high prevalence means that the whole population will either be personally affected by a mental disorder or have close contact with other people who are. Given the high exposure to mental disorders in the population, it can be argued that everyone needs some knowledge and skill to take action to improve community mental health.
Using information and evidence to improve mental health policy
Authors: Funk Michelle , Morris Jodi , Saxena Shekhar
Published: April 2012

A mental health policy is the official statement of a government about what they will do to improve the mental health situation in that country. Together with a mental health plan, which details concrete actions to implement the policy, they represent essential tools to improve the way mental health problems are addressed in countries. When well formulated, they can coordinate, through a common vision and plan, all programmes, services, and actions related to mental health. Without this type of organization, mental health problems are likely to be dealt with in an inefficient and fragmented manner. Mental health policies assist to maximize the effectiveness of mental health programmes, to ensure that funds are spent wisely, and to improve coordination among service providers in the community (Funk et al., 2005).

The World Health Organization (WHO) has argued for developing national policies on mental health that are information and evidence based. Though the broad objectives of the policy may remain the same across countries, the starting points are likely to be different across countries (even within the same income category) so much so that background and contextual information become essential for the development of policy and plans.
Methods for evaluating community treatments
Authors: Tyrer Peter
Published: April 2012

New treatments are constantly being introduced to all forms of psychiatry and for most of these the setting in which the treatment is administered is not of special importance. Thus the introduction of a new and effective drug for a mental disorder will require similar testing in hospital, community, or other settings and does not require special description here. However, all treatments given in the community have a common problem associated with them, compliance, or what is now more appropriately termed ‘concordance’ or ‘adherence’ (Mullen, 1997). Because treatment in the community can rarely be supervised satisfactorily, a great deal depends on the motivation of individual patients to continue whatever intervention is being given without the need to be closely monitored. Increasingly, therefore, the evaluation of community treatment is going to involve, 1) some check on whether the treatment is being given appropriately and 2) if not, whether additional treatments are able to be introduced to improve concordance and adherence. New treatments to improve compliance have now been introduced for the major psychoses and shown to be effective (Kemp et al., 1996; 1998; Perry et al., 1999) and these approaches are likely to impinge increasingly on those working in the community and be amongst the areas of competence being evaluated for such workers.

The word ‘evaluation’ is now being used increasingly to describe any type of description of an intervention, and more and more it is being used inappropriately with regard to community treatments. The word ‘evaluate’ is a mathematical expression originally used to give a numerical value to something which previously had no such value. It is still used in this sense in related expressions such as ‘evaluable’, but increasingly it has been broadened in use to describe any form of assessment, whether or not it is quantified accurately.
Developing evidence-based mental health practices
Authors: Mueser Kim T. , Drake Robert E.
Published: April 2012

Evidence-based mental health practices (EPBs) are scientifically validated interventions that help people with mental illnesses to achieve improvements in meaningful areas of their lives. Developing and establishing an EBP requires attention to scientific detail, considerable time, and multiple steps. We have described the major steps as: 1) articulation of the problem area, 2) identification of possible treatments, 3) pilot testing the intervention, and 4) controlled evaluation of the intervention.
Implementing guidelines
Authors: Cheung Amy , Whitty Paula , Eccles Martin P. , Grimshaw Jeremy
Published: April 2012

According to the Institute of Medicine, ‘Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.’ (Institute of Medicine, 1990). Guidelines provide a synthesis of what is known about a specific disorder or set of disorders whether it is regarding screening, diagnosis, or management. Compared to systematic reviews, they provide a broad overview of the management of a disorder or of an intervention.

This chapter will describe how mental health professionals and organizations can follow the steps to implement guidelines to improve clinical care. Resources to assist in this process are also listed at the end of the chapter in the appendix.
Overcoming impediments to community mental health in low- and middle-income countries
Authors: Saraceno Benedetto , Ommeren Mark van , Batniji Rajaie
Published: April 2012

As discussed in Chapter 6 by Wang and colleagues, the prevalence of mental disorders across the world — and across low- and middle-income countries (LAMIC) — is high. The median rate across the world of having at least one mental disorder in the last year is 10 % (WHO WMHS Consortium, 2004). The impact of these disorders on disability, other aspects of health, and development is substantial. Yet, the vast majority of people with a mental disorder are not in contact with services that offer mental health care (Wang et al., Chapter 6, this volume), Importantly, the association between severe mental disorder and human rights violations is strong (WHO, 2001). Even among people with severe mental disorders, few people receive adequate, humane care (WHO, 2001) and discrimination is pervasive (Thornicroft, 2006). It is clear that there is an urgent need to act.

The World Health Organization (WHO, 2003) developed a mental health policy and planning package to help countries to develop services that provide access to adequate care for people with mental disorder. This package was preceded and followed by evidence-informed and evidence-based advocacy through major publications — such as World Health Report 2001 on mental health (WHO, 2001), the World Mental Health Report (Desjarlais et al., 1995), Neurological, Psychiatric, and Developmental Disorders (Institute of Medicine, 2001), Disease Control Priorities related to Mental Neurological, Developmental and Substance Abuse Disorders (WHO and Disease Control Priorities Project, 2006), the 2007 Lancet Series on Global Mental Health, and the 2008 mental health Gap Action Plan (WHO, 2008 ). Although most research evidence on interventions comes from specialized care settings in high-income countries, fortunately there are good indications that much of this evidence generalizes to LAMIC (Patel, 2007).

A naïve observer would perhaps expect that with this amount of burden, human rights violations, high-level advocacy, technical guidance, and evidence for interventions, that mental health service development in LAMIC is flourishing. Indeed, it should be. Although it is true that some countries have made major strides, the reality however has been that mental health service development in most LAMIC has been a challenge. This chapter will address some key impediments in developing mental health services in LAMIC and will offer strategies to address these impediments.
The challenge of integrated care at the programme level
Authors: Torrey William C. , Brunette Mary F.
Published: April 2012

Adults with severe mental illnesses need integrated mental health and substance abuse treatment programming. The reasons are compelling: 1) approximately half of adults with severe mental illness also experience a co-occurring substance use disorder (Regier et al., 1990), 2) people with co -occurring disorders tend to have worse clinical outcomes, such as increased symptoms, more hospitalizations, and higher rates of infectious diseases, victimization, and homelessness (Dixon, 1999), and 3) separate or fragmented care is not effective (Ridgely et al., 1987). Despite growing awareness of the importance of these services, integrated programmes are still not widely available for people who need them (Epstein et al., 2004; Presidents’ New Freedom Commission on Mental Health, 2003).

Integrated dual disorders treatment (IDDT) is an integrated multidisciplinary team approach to care for adults with co-occurring substance use disorders and severe mental illnesses. The treatment programme grew out of experience with clinical programmes that are effective for this population and has been implemented widely (Mueser et al., 2003). IDDT offers a coordinated package of psychopharmacology, psychosocial interventions, and substance abuse counselling so that those needing the service experience a consistent approach, philosophy, and treatment recommendations.

Essential programme elements include a comprehensive, long-term, stage-wise approach to treatment; assertive outreach; motivational interventions; and strategies and supports to help people learn to manage both illnesses and to achieve their functional goals (Drake et al., 2001).

This chapter reviews the research on implementing IDDT services and provides practical recommendations for organizational leaders who would like to implement and offer integrated programming for people with co-occurring disorders.
Summing up: community mental health in the future
Authors: Graham Thornicroft
Published: April 2012

Several fundamental tenets inform our view of community mental health care. First is an understanding of a community’s needs for mental health services. Policy makers must appreciate epidemiological needs to implement services from a public health perspective. Second, mental health care must balance several opposing forces: population needs and local resources, hospital-based and community-based services, and human rights versus public safety concerns. Third, mental health services must align with basic human rights and health care values. Fourth, effective mental health care must incorporate evidence-based approaches. Fifth, putting intended services in place with high fidelity and cultural sensitivity must involve the complicated and poorly understood science of implementation. This step includes planning, organization, financing, workforce training, and quality assurance. Sixth, community mental health must address the community as well as mental health services. Addressing public attitudes, stigma, and community resources, as well as developing a consensus for good mental health care, are all critical. Finally, these systems of care must be flexible enough to evolve as our knowledge of needs, values, evidence-based practices, and implementation science changes over time. This final chapter addresses each of these tenets.
The epidemiology of heart failure
Authors: Guha Kaushik , McDonagh Theresa A.
Published: April 2012

Over the last 30 years we have gone from famine to feast in terms ofthe epidemiological data now published for heart failure (HF). The field started with the seminal publication on the natural history ofHF from the Framingham study in 1971 showing a prevalence of HF of 0.8% in those aged between 50 and 59, rising to 9.1% inthose over 80 years with incidence rates of 0.2% at age 54 and 0.4% at age 85. This was followed by a large European study,‘The men born in 1913’, which gave similar figures of a prevalenceof 2.1% at age 50 and 13% at age 67 and incidence rates of 0.15% and 1% respectively at ages 50 and 67. These landmarkstudies relied on a clinical diagnosis of HF, basedon symptoms, signs, and scoring systems to identify cases. Moremodern epidemiological studies have used definitions of HF whichinclude objective measures of cardiac function in their definition,in keeping with current European and United States guidelines forthe diagnosis of HF. Initial studies focused on systolic dysfunctionbecause they reported at much the same time as the HF treatmenttrials which also enrolled patients with systolic HF. More recentlyattention has turned to describing the epidemiology of HF withpreserved systolic function, in addition.When describing the epidemiology of HF, it is worth bearing inmind that estimates of incidence and prevalence will vary according to the definition of HF used and the type of cohort being studied.This is especially important when assessing work which hasobjectively measured left ventricular systolic function. Variablessuch as left ventricular ejection fraction are normally distributed,so the cut point chosen is a critical determinant of the eventualresults.The present chapter aims to outline the contemporary epidemiologyof HF by describing its prevalence, incidence, aetiology andmortality as well as describing the trends which are occurring in thearea. It will discuss hospitalization rates, prognosis and economicburden in both Europe and the United States.
Myocardial energetics
Authors: Sugden Peter H. , Fuller Stephen J.
Published: April 2012

The heart is an example of a specialized type I (‘red’) striated muscle in that it is continuously active and reliant principally on aerobic metabolism for its energy supply. Although much of the myocyte volume is taken up by myofibrils, the mitochondria constitute about 30%. In the heart, these subcellular organelles regenerate the bulk of ATP from ADP and inorganic phosphate. ATP is an ‘energy transducing molecule’ which couples the energy available from fuel metabolism into external work (principally myofibrillar contraction). In order to maintain fuel oxidation, ATP regeneration, and muscle contraction, a highly developed coronary circulation and uninterrupted coronary blood flow are necessary to ensure adequate delivery of O2 and fuels, and to remove the product of aerobic metabolism, CO2. The heart is omnivorous and utilizes any metabolic fuel presented to it, within the constraints of metabolic regulation. The major substrates for oxidation in humans are lipid-derived fuels (principally long-chain fatty acids (LCFAs) such as palmitate, but also triglycerides and ketone bodies (acetoacetate and its reduction product, 3-hydroxybutyrate) in specialized circumstances) and the carbohydrate-derived fuels (glucose, lactate, and pyruvate).

Although the heart can oxidize amino acids, these are of minor importance. The accepted dogma is that the human heart relies predominantly (70% ) on lipid-derived fuels for its energy supply, but the majority of investigations have involved postabsorptive subjects where lipid metabolism is generally more favoured than in the immediately postprandial state. The role of cardiac energetics and ‘metabolic remodelling’ are discussed with regards to the transition of the healthy heart into failure.
The failing cardiomyocyte
Authors: Lyon Alexander , Harding Sian
Published: April 2012

The human myocardium consists of a variety of different cell types. The cell that has been most extensively studied is the cardiomyocyte, which represents the single contracting unit of the myocardium. It has been estimated that there are 3 billion cardiomyocytes in the human ventricular myocardium, organized into the complex three-dimensional architecture of the ventricular myocardial tissue. Conceptually there are two underlying pathophysiological problems at the level of the cardiomyocyte which drive the functional deterioration of the failing heart. The first is numerical loss of cardiomyocytes, due both to the underlying causal disease process, such as acute myocardial infarction or chemotherapy, and to further loss secondary to apoptosis and necrosis triggered by theneurohormonal and inflammatory activation in the failing myocardium irrespective of the initial injury. Secondly, the remaining viable cardiomyocytes are required to provide sufficient contractile force to maintain an adequate cardiac output, despite loss of significant numbers and abnormal stress–strain relationships resulting from altered chamber geometry and extracellular matrix remodelling. The surviving cardiomyocytes compensate temporarily via transition to an adaptive hypertrophic state, which is associated with activation of fetal gene expression patterns. However, the persistent drive from the neurohormonal activation to maintain cardiac output, and activation of systemic inflammatory systems secondary to tissue hypoperfusion and congestion, combined with reduced metabolic efficiency in the hypertrophied cardiomyocytes, results in the development of contractile dysfunction of the hypertrophied cardiomyocyte. This is independent of the underlying cause of heart failure (HF), some of which cause further continuing impairment of cardiomyocyte function, such as familial dilated cardiomyopathy due to mutations in the cytoskeletal or sarcomeric proteins. The common endpoint for the failing heart, irrespective of underlying aetiology, is characterized at a cellular and molecular level by a distinctive failing signature. Cardiomyocytes isolated from failing human and animal hearts demonstrate impairment of both contraction (inotropy) and relaxation (lusitropy). Mechanical dysfunction of failing cardiomyocytes is amplified at higher beating frequencies, increased calcium concentration or during catecholamine stimulation. The loss of the force-frequency response (the Treppe or Bowditch effect) is a hallmark characteristic of HF. A variety of different pathophysiological factors have been proposed to underlie these mechanical alterations, including abnormal morphological and structural remodelling, and functional changes in signalling pathways, ionic fluxes, organelle function, and gene expression. It is becoming increasingly apparent that these are not independent processes; rather, crosstalk and interplay between the different pathophysiological processes serve to amplify the abnormalities and drive the deterioration of the failing cardiomyocyte phenotype.
Echocardiography
Authors: Duncan Alison
Published: April 2012

Heart failure (HF) is a complex syndrome that can result from anystructural or functional cardiac disorder that impairs the ability ofthe heart to function as a pump to support a physiological circulation.The most common cause of HF in the United Kingdom iscoronary artery disease (CAD); other aetiologies include hypertension, atrial fibrillation, cardiomyopathies, valvular heart disease,pericardial disease, and intracardiac shunts. Transthoracicechocardiography has a decisive role in the diagnosis, treatment,and follow-up of patients with HF. Indeed, its importance wasunderscored in the UK 2003 NICE Guidelines for Heart Failure, and more recently in the American College of Cardiology/AmericanHeart Association (ACC/AHA) guidelines for the diagnosis andmanagement of HF, where echocardiography was endorsed as ‘thesingle most useful diagnostic test in the evaluation of patients with heart failure…’. Echocardiography utilizes ultrasound which hasno known adverse biological effects, is noninvasive, and is a relativelylow-cost imaging modality. The use of echocardiography inthe diagnosis, therapeutic management, and serial follow-up of theincreasing number of patients with HF has therefore potentially large health benefits with relatively low patient cost.
Invasive investigation
Authors: Gardner Roy S.
Published: April 2012

Despite advances in noninvasive imaging, there are frequent occasions when invasive investigation is required. This chapter aims to summarize these techniques and demonstrate how both right and left heart catheterization can offer valuable information about the patient. The technique for human cardiac catheterization was first developed by Werner Forssmann. In 1929, he inserted a cannula into his own antecubital vein, through which he passed a catheter for 65 cm and then walked to the X-ray department, where a photograph was taken of the catheter lying in his right atrium. The Seldinger technique is now used to place catheters in a variety of locations including veins, arteries, or body cavities such as pleural or pericardial spaces. Obtaining central venous access is a key skill in the management of an ill patient, allowing invasive pressure monitoring, infusion of therapy, and access for procedures such as temporary pacing, pulmonary artery catheterization, and endomyocardial biopsy. The three routes commonly employed are the internal jugular vein, thesubclavian vein, and the femoral vein. Complications include bleeding, inadvertentarterial puncture, vascular damage including late vesselstenosis, pneumothorax (particularly with subclavian access),infection (especially femoral vein access), arrhythmia, and airembolism.The pulmonary artery flotation catheter (PAC) can be used to measure pressures in the right heart (right atrium, right ventricle, pulmonary artery and pulmonary capillary wedge pressure), cardiac output (usingthermodilution), and to assess pulmonary and systemic vascular resistance. It can also be used to detect intracardiac shunts (e.g. VSDs), as well as measure mixed venous oxygen saturation. Left heart catheterization can also be used in the measurement of left ventricular end-diastolic pressure.

Coronaryangiography(which can help to clarify underlying aetiology and offer useful prognostic information), Contrast left ventriculography (which can provide important information regarding global and regional cardiac function and mitral regurgitation),endomyocardial biopsies (which are commonly taken after heart transplantation to assess allograft rejection) and other invasive investigations are also described.
Anaemia
Authors: Meer Peter van der , Veldhuisen Dirk J. van
Published: April 2012

In patients with chronic heart failure (HF), anaemia is frequentlydiagnosed. The prevalence of anaemia depends on the severity ofheart failure and the diagnostic criteria used to define it. The criteriaof the World Health Organization (haemoglobin <12 g/dL(7.5 mmol/L) in women, haemoglobin <13 g/dL (8.1 mmol/L) inmen) are most commonly used in the majority of studies appearingon the topic. Recently a study was performed in 2653 patientsrandomized in the CHARM Program. This substudy revealed thatanaemia was equally common in patients with CHF and preserved (27% ) or reduced (25% ) left ventricular ejection fraction (LVEF).The presence of anaemia was associated with diabetes, low bodymass index, higher systolic and lower diastolic blood pressure, andrecent heart failure (HF) hospitalization. In the study, more thanone-half of the anaemic patients had impaired renal function(glomerular filtration rate <60 mL/min), compared with less than30% of the nonanaemic chronic HF patients. In 2008, a meta-analysiswas conducted to address the relationship between anaemiaand mortality in patients with chronic HF. In this analysis,examining more than 150 000 patients, anaemia was frequentlyobserved, being found in over one-third of the chronic HF patients.The presence of anaemia was associated with a doubled mortalityrisk in patients with systolic as well as diastolic HF.When assessing the mortality risk by using multivariate analyses,anaemia remained an independent risk factor for mortality in chronic HF patients. The incidence of anaemia is much more difficult to determinethan the prevalence. Data from the OPTIMAAL trial suggest,though, that in a population without anaemia at baseline who hada heart attack complicated by the development of HF, the incidence of anaemia was 10% in the first year.
Sleep-disordered breathing
Authors: Simonds Anita K.
Published: April 2012

Erratic breathing during sleep in heart failure (HF) patients hasbeen observed for centuries, with Cheyne–Stokes respiration (CSR)being the classic example. A rapid increase of knowledge in sleepmedicine over the last few decades has identified a range of sleep-disorderedbreathing conditions, all of which have relevance to thecardiac patient. Sleep-disordered breathing (SDB) is a generic termused to cover the respiratory disturbances during sleep that includeobstructive sleep apnoea (OSA), central sleep apnoea (CSA), CSR/periodic breathing, and obstructive and central hypoventilation. In adults, an apnoea is defined by 10 s of cessation in airflow; obstructiveapnoeas are accompanied by respiratory effort; and in centralevents, effort is absent. Hypopnoeas are partial events and are variously defined: most definitions include a reduction ofmore than 30% in respiratory airflow or thoracoabdominal excursiontogether with arterial desaturation of 2–4%, or more than 50% reduction in airflow without desaturation. The syndrome of OSA is defined by the presence of more than15 obstructive apnoeas and hyponoeas an hour; or more than 5obstructive apnoeas and hyponoeas an hour associated with symptomssuch as daytime sleepiness and fatigue, nocturnal choking, orunrefreshing sleep. The apnoea–hyponoea index (AHI) is the totalnumber of these events per hour of sleep. Severe SDB is consideredto be present if there are more than 30 apnoea and hyponoeas perhour. The respiratory disturbance index (RDI) is used to expressthe total number of respiratory events per hour of study time andtherefore may differ from the AHI as any episodes of wakefulnessduring the monitoring period will be included in the RDI.
Arthritis
Authors: Walker Nicola L. , McEntegart Anne
Published: April 2012

Heart failure (HF) and arthritis are both common in adults,increasing in prevalence with age. The term arthritis covers a widespectrum of disease which may involve the cartilage,bone, tensile structures (ligaments, tendons, and muscles), or synovialtissue, and pathological processes can impact on any of thesestructures.
Angiotensin receptor blockers
Authors: McMurray John J.V.
Published: April 2012

Angiotensin receptor blockers (ARBs) were developed to providean alternative approach to interrupting the renin–angiotensin system(RAS), which was pharmacologically distinct from that ofangiotensin converting enzyme (ACE) inhibitors. By selectivelyblocking the angiotensin II type 1 (AT1) receptor, ARBs werethought to offer the potential for more complete blockade of theRAS. Evidence had accumulated that angiotensin II could be generatedthrough enzymes other than ACE (e.g. chymase) and ARBsblock the action of angiotensin II, regardless of its source, at thereceptor level. Another fundamental difference betweenthe two approaches is the lack of effect of ARBs on bradykininwhich is metabolized by ACE (also known as kininase II).Accumulation of bradykinin with ACE inhibitors is responsible forcough and angioedema. Consequently, it was hoped that ARBswould be better tolerated than ACE inhibitors. Bradykinin, however, may also have beneficial effects, including vasodilatation,antithrombotic activity, and inhibition of pathological tissueremodelling. This latter perspective, that bradykinin might have beneficial actions, underpinned the hypothesis that the combinationof an ACE inhibitor and ARB might be better than an ACEinhibitor alone in heart failure (HF). In other words, the ARBwould maximize RAS inhibition and the ACE inhibitor wouldaugment bradykinin.
Nonpharmacological management
Authors: Blue Lynda , Millerick Yvonne
Published: April 2012

Managing heart failure (HF) is not an easy task: the numbers of patients are large and increasing, and many patients have complex needs. This presents a challenge not only to patients and their caregivers but also to health care systems and health care professionals. Patients are asked to take multiple pharmacological agents that often require adjustment; are expected to make lifestyle changes; and a growing number of patients are now being considered for device therapy. At hospital discharge, few patients receive lifestyle and self-management advice in written form and it is therefore not surprising that many patients with HF have poor knowledge about their condition and its management.

Over the last decade, various guidelines have been published on the management of chronic HF. The guidelines have primarily concentrated on pharmacological treatment (and more recently, device therapy) and only briefly address lifestyle advice and self-care management strategies.

Several trials of specialist HF management programmes which adopt a multidisciplinary approach have shown that self-management strategies lead to an improved quality of life. A multidisciplinary approach has also been shown to reduce hospitalizations and mortality.

Optimal management of HF requires not only best practice in pharmacological management but also appropriate education strategies, practical advice, and caring support to enable patients and their caregivers to achieve the best possible quality of life, without offering unrealistic expectations of cure. It is important not only that patients and their caregivers are given the opportunity to take greater control of managing their condition, but also that health care professionals should not underestimate the critical role they have in empowering their patients. Much of the present chapter is based on expert advice, rather than robust evidence.
Cardiac resynchronization therapy
Authors: Chandrasekaran Badrinathan , Cowburn Peter J.
Published: April 2012

In the last decade, the use of cardiac resynchronization therapy(CRT), also known as biventricular pacing (BVP), has emerged as anew therapeutic option for selected patients with heart failure (HF)and ongoing symptoms despite optimal medical therapy who alsohave a prolonged QRS interval. CRT, by retiming the failing heart,improves symptoms, reduces hospitalization, and prolongs survivalin patients with left ventricular dysfunction and a broad QRScomplex. CRT improves electromechanical dyssynchrony and maximizes the efficiency of the cardiac contraction sequence, leading to an acute haemodynamic benefit and, over time, a reductionin left ventricular volumes and an improvement in left ventricularejection fraction (LVEF). A prolonged QRS width (> 120 ms) is a marker of benefit from CRT, with approximately 70% of suchpatients having symptomatic improvement following CRT. Cardiacresynchronization therapy can be delivered on its own as a pacemaker(CRT-P) or in addition to an internal cardiac defibrillator,where it is referred to as CRT-D. Advances in device technologyand telecommunications now enable remote monitoring of surrogatemarkers of HF, offering the ability to predict subclinical deterioration,and thereby potentially preventing HF hospitalization.
Ventricular assist devices, including intra-aortic balloon pumps
Authors: Birks Emma J. , Slaughter Mark S.
Published: April 2012

Heart failure (HF) is a major problem associated with high morbidityand mortality, and the prognosis from heart failure is worse thanthat for myocardial infarction or carcinoma of the bowel, breast, or prostate. Medical therapy with ACE inhibitors, β‎ -blockers, angiotensin2 inhibitors, and aldosterone antagonists, together withresynchronization therapy, has improved the survival of many withHF, but there remain a large group of patients who, despite optimalmedical therapy, are in NYHA class III/IV HF with a very poorprognosis. Unfortunately the numbers of useable donor heartsavailable to perform heart transplantation for these patients has significantly decreased over recent years and the number is totallyinadequate for the population who require heart transplantation.Left ventricular assist devices (LVADs) are rapidly evolving andare being increasingly used to treat patients with advanced HF. They are very efficient artificial hearts that assist the circulation andthey are being inserted into an increasing number of patients withadvanced HF. The LVAD technology itself is also evolving veryquickly. They were initially inserted as a bridge to transplantationin patients with advanced HF with deteriorating clinical status whowere unable to wait any longer for heart transplantation. They weremostly inserted into patients who, despite inotropic ± intra-aorticballoon pump (IABP) support, had deteriorating NYHA class IVHF and usually also end-organ dysfunction. Not only are LVADslife saving in these deteriorating patients who might otherwise diebefore a donor heart becomes available, but they also improve secondaryorgan function prior to transplantation, reduce pulmonaryhypertension, and allow for improvement of nutritional status. Thedecrease in donors means that an increasing number of patientshave been requiring support with a LVAD for survival when theirclinical status deteriorates.
Monitoring
Authors: Riley Jillian P. , Cowie Martin R.
Published: April 2012

Heart failure (HF) is a chronic condition with the risk of episodicdeterioration (‘decompensation’). Aims of therapy include stabilizationof the syndrome, improvement in the prognosis and qualityof life, and the avoidance of hospitalization. Early detection ofdeterioration is a key component of HF management programmes,with the goal of adjusting therapy to restabilize the syndrome rapidlyand to avoid the need for emergency hospitalization.HF management programmes were developed to help ensurepatients received appropriate multiprofessional input to their treatment,education, and monitoring. They were designed to help fillthe gap that often existed between discharge from hospital and thetraditional outpatient clinic review. Many patients decompensatedduring this high-risk period, resulting in readmission to hospital.However, despite such programmes becoming more widespread,perhaps as many as 30% of patients are still readmitted within12 months of hospital discharge, with some of the admissionspreventable with better monitoring.This chapter discusses the key elements of monitoring of patientswith HF, including what and who should be monitored, the frequencyof monitoring, and the different methods of monitoring.
Sensitivity of Kansas Isolates of Sclerotinia homoeocarpa to Boscalid
Authors: Gonzalez Brandon R. , Kennelly Megan M.
Published: April 2012

Seventy-one isolates of Sclerotinia homoeocarpa from 12 sites in Kansas were evaluated in vitro for sensitivity to boscalid using four-fold dilutions ranging from 0.00024 to 4.0 μg/ml to determine the effective concentration that inhibited growth by 50% (EC50). The range of EC50 values was from 0.09 to 3.90 μg/ml with a mean of 0.77 μg/ml, and the log values were distributed normally. A subset of 26 isolates was also tested for boscalid sensitivity on fungicide-treated plants in a greenhouse assay. Higher in vitro EC50 values for boscalid were not correlated with higher percent relative disease severity on boscalid-treated plants. These results provide a starting point for further monitoring of boscalid sensitivity.

Accepted for publication 20 January 2012. Published 2 April 2012.
Histological Evidence that Microsclerotia Play a Significant Role in Disease Cycle of the Boxwood Blight Pathogen in Southeastern United States and Implications for Disease Mitigation
Authors: Weeda Sarah M. , Dart Norman L.
Published: April 2012

Cylindrocladium pseudonaviculatum, the causal agent of box blight, has been shown to survive in soil for at least 5 years. The occurrence of microsclerotia in host tissue remains undocumented, making the mechanism for long term survival of this pathogen unclear. If the boxwood blight pathogen has indeed lost or never evolved the ability to produce microslerotia in tissues, one could infer that the pathogen is either less equipped for long term survival in soil than other Cylindrocladium species or the pathogen has evolved another mechanism to enable it to persist in soil. Based on these assumptions, we conducted a histological study to determine the potential role, if any, of microsclerotia in the lifecycle of C. pseudonaviculatum.

Accepted for publication 17 February 2012. Published 3 April 2012.
Compatibility of Foliar Insecticides and Soybean Cyst Nematode Bioassays
Authors: Brady Chad R. , Li Jiarui , Todd Timothy C. , Oakley Thomas R. , Trick Harold N.
Published: April 2012

The objective of this study was to investigate the effect of foliar-applied insecticides on soybean cyst nematode reproduction in greenhouse bioassays. In two independent trials, a total of eight different insecticides were evaluated for their non-target effects on soybean cyst nematodes.

Accepted for publication 20 January 2012. Published 9 April 2012.
Transcriptome sequencing of black grouse (
Tetrao tetrix
) for immune gene discovery and microsatellite development
Authors: Wang Biao , Ekblom Robert , Castoe Todd A. , Jones Eleanor P. , Kozma Radoslav , Bongcam-Rudloff Erik , Pollock David D. , Höglund Jacob
Published: April 2012

The black grouse (
Tetrao tetrix
) is a galliform bird species that is important for both ecological studies and conservation genetics. Here, we report the sequencing of the spleen transcriptome of black grouse using 454 GS FLX Titanium sequencing. We performed a large-scale gene discovery analysis with a focus on genes that might be related to fitness in this species and also identified a large set of microsatellites. In total, we obtained 182 179 quality-filtered sequencing reads that we assembled into 9035 contigs. Using these contigs and 15 794 length-filtered (greater than 200 bp) singletons, we identified 7762 transcripts that appear to be homologues of chicken genes. A specific BLAST search with an emphasis on immune genes found 308 homologous chicken genes that have immune function, including ten major histocompatibility complex-related genes located on chicken chromosome 16. We also identified 1300 expressed sequence tag microsatellites and were able to design suitable flanking primers for 526 of these. A preliminary test of the polymorphism of the microsatellites found 10 polymorphic microsatellites of the 102 tested. Genomic resources generated in this study should greatly benefit future ecological, evolutionary and conservation genetic studies on this species.
Prognostic Significance of Serum Proangiogenic Molecules in Patients withDe NovoNon-Hodgkin Lymphomas
Authors: Rujirojindakul Pairaya , Lekhakula Arnuparp
Published: April 2012

This study was aimed to assess the clinical significances of the serum VEGF and bFGF in Thai patients withde novoNHL. Serum VEGF and bFGF concentrations were measured from 79 adult patients with newly diagnosed stage 2–4 non-Hodgkin lymphomas by quantitative sandwich enzyme immunoassay. At the time of diagnosis, the serum VEGF concentrations from 79 patients ranged from 72.0 to 2919.4 pg/mL, with a mean of 668.0 pg/dL. The serum bFGF concentrations ranged from undetectable to 2919.4 pg/mL, with a mean of 12.15 pg/dL. Multivariate analysis identified higher than the mean of serum VEGF, B symptoms, bulky diseases, anemia, and treatment with CHOP or R-CHOP as independent variables influencing the complete remission rate. From a Cox proportional hazards model, variables independently associated with overall survival were bone marrow involvement, more extranodal involvement, poor performance status, anemia, and higher than the mean of serum bFGF.
A Histological Study of Ovarian Development in the Giant Red ShrimpAristaeomorpha foliacea(Crustacea: Decapoda: Aristeidae) from the Southern Tyrrhenian Sea (Western Mediterranean)
Authors: Perdichizzi Anna , Pirrera Laura , Micale Valeria , Muglia Ugo , Rinelli Paola
Published: April 2012

The reproductive features of the giant red shrimp,Aristaeomorpha foliacea, were investigated in the southern Tyrrhenian sea by experimental trawl sampling. The annual length-frequency distribution showed a multimodal trend in females, ranging between 16 and 67 mm carapace length (CL), and a unimodal trend in males (18–45 mm CL). Mature males occurred in different proportions all year round, while females displayed seasonal maturity (June—September), with a peak in July. Six oocyte developmental stages were identified, the most advanced of which (Pv, postvitellogenic) had never been described before in this species. Ovary development followed a group-synchronous pattern, with the yolked oocyte stock clearly separated from the reservoir of unyolked oocytes, suggesting thatA. foliaceais a total spawner, with determinate fecundity. Based upon histological findings, a revision of macroscopic maturity staging employed in Mediterranean bottom trawl surveys (MEDITS) is proposed.
Phytophthora capsiciEpidemic Dispersion on Commercial Pepper Fields in Aguascalientes, Mexico
Authors: Zapata-Vázquez Adrián , Sánchez-Sánchez Mario , del-Río-Robledo Alicia , Silos-Espino Héctor , Perales-Segovia Catarino , Flores-Benítez Silvia , González-Chavira Mario Martín , Valera-Montero Luis Lorenzo
Published: April 2012

Chili pepper blight observed on pepper farms from north Aguascalientes was monitored for the presence ofPhytophthora capsiciduring 2008–2010. Initially, ELISA tests were directed to plant samples from greenhouses and rustic nurseries, showing an 86% of positive samples. Later, samples of wilted plants from the farms during the first survey were tested with ELISA. The subsequent survey on soil samples included mycelia isolation and PCR amplification of a 560 bp fragment of ITS-specific DNA sequence ofP. capsici. Data was analyzed according to four geographical areas defined by coordinates to ease the dispersal assessment. In general, one-third of the samples from surveyed fields containedP. capsici, inferring that this may be the pathogen responsible of the observed wilt. Nevertheless, only five sites from a total of 92 were consistently negative toP. capsici. The presence of this pathogen was detected through ELISA and confirmed through PCR. The other two-thirds of the negative samples may be attributable toFusariumandRhizoctonia, both isolated instead ofPhytophthorain these areas. Due to these striking results, this information would be of interest for local plant protection committees and farmers to avoid further dispersal of pathogens to new lands.
Perceiving Numbers Affects the Internal Random Movements Generator
Authors: Vicario Carmelo Mario
Published: April 2012

According to the evidence of direct relationships among space, numbers, and finger representations, a random movement generation (RMG) task was employed in order to investigate whether numerical exposure can influence the finger selection of healthy humans. To this purpose a group of participants were asked to generate random finger movements during the exposure to several numerical cues. Although participants were explicitly asked to move finger as random as possible, results showed that left-hand fingers were moved more frequently than right-hand fingers when low numerical cues (from 1 to 3) were presented, and,vice versa, right-hand fingers were moved more frequently than left-hand fingers when high numerical cues (ranged from 7 to 9) were presented. The current result suggests that spontaneous actions can be affected by abstract information, providing an evidence that numerical concepts can influence low-level, non-goal-directed behaviours.
A Comparitive Assessement of Cytokine Expression in Human-Derived Cell Lines Exposed to Alpha Particles and X-Rays
Authors: Chauhan Vinita , Howland Matthew , Wilkins Ruth
Published: April 2012

Alpha- (α-) particle radiation exposure has been linked to the development of lung cancer and has been identified as a radiation type likely to be employed in radiological dispersal devices. Currently, there exists a knowledge gap concerning cytokine modulations associated with exposure toα-particles. Bio-plex technology was employed to investigate changes in proinflammatory cytokines in two human-derived cell lines. Cells were irradiated at a dose of 1.5 Gy to eitherα-particles or X-rays at equivalent dose rates. The two cell lines exhibited a unique pattern of cytokine expression and the response varied with radiation type. Of the 27 cytokines assessed, only vascular endothelin growth factor (VEGF) was observed to be modulated in both cell lines solely afterα-particle exposure, and the expression of VEGF was shown to be dose responsive. These results suggest that certain proinflammatory cytokines may be involved in the biological effects related toα- particle exposure and the responses are cell type and radiation type specific.
Acute and Chronic Toxicity of Soluble Fractions of Industrial Solid Wastes onDaphnia magnaandVibrio fischeri
Authors: Flohr Letícia , Castilhos Júnior Armando Borges de , Matias William Gerson
Published: April 2012

Industrial wastes may produce leachates that can contaminate the aquatic ecosystem. Toxicity testing in acute and chronic levels is essential to assess environmental risks from the soluble fractions of these wastes, since only chemical analysis may not be adequate to classify the hazard of an industrial waste. In this study, ten samples of solid wastes from textile, metal-mechanic, and pulp and paper industries were analyzed by acute and chronic toxicity tests withDaphnia magnaandVibrio fischeri. A metal-mechanic waste (sample MM3) induced the highest toxicity level toDaphnia magna(CE50,48 h=2.21%). A textile waste induced the highest toxicity level toVibrio fischeri(sample TX2,CE50,30 min=12.08%). All samples of pulp and paper wastes, and a textile waste (sample TX2) induced chronic effects on reproduction, length, and longevity ofDaphnia magna. These results could serve as an alert about the environmental risks of an inadequate waste classification method.
Kinetic Analysis for Macrocyclizations Involving Anionic Template at the Transition State
Authors: Martí-Centelles Vicente , Burguete M. Isabel , Luis Santiago V.
Published: April 2012

Several kinetic models for the macrocyclization of aC2pseudopeptide with a dihalide through aSN2reaction have been developed. These models not only focus on the kinetic analysis of the main macrocyclization reaction, but also consider the competitive oligomerization/polymerization processes yielding undesired oligomeric/polymeric byproducts. The effect of anions has also been included in the kinetic models, as they can act as catalytic templates in the transition state reducing and stabilizing the transition state. The corresponding differential equation systems for each kinetic model can be solved numerically. Through a comprehensive analysis of these results, it is possible to obtain a better understanding of the different parameters that are involved in the macrocyclization reaction mechanism and to develop strategies for the optimization of the desired processes.