bluuebunny/crossref_metadata_2025 huggingface dataset:
pH: a promising indicator of feed waste in piggery effluent?
Authors: Pratt Chris , Hill Jaye , Skerman Alan , Redding Matthew
Published: April 2018

Feed waste in pork production sheds can amount to substantial economic losses. No simple methods exist to quantify this waste, which commonly ends up in the effluent stream. Monitoring piggery effluent might offer producers a practical alert solution for feed waste losses. We investigated piggery effluent pH as a potential marker of feed waste, given that most feed substrates and breakdown products are acidic whereas effluent is alkaline. To explore this prospective relationship, we constructed simulated effluent streams comprising faeces, urine and feed. These waste components were acquired from a commercial batch grower shed, at four different times over the 12-week growth cycle. In laboratory settings (25°C) we used the collected wastes to simulate the two stages of typical flushing piggery effluent systems: (1) Faeces + urine + feed waste accumulation in flushing channels, and (2) flush water mixing with these wastes in an effluent collection sump. We repeated the exercise for a one-off sampling event at a sow facility. For all events, at the grower and sow facility, the pH of the simulated effluents yielded exponentially decreasing relationships with increasing feed waste level (P < 0.05). For the grower facility we applied each of the four laboratory-derived relationships to the farm’s sump effluent pH, which was measured during each of these sampling events. The predicted feed waste levels were commensurate with estimates of feed waste for the same facility derived from alternative, time intensive approaches reported in other studies. Further work is needed to transition the promising results uncovered here into an alert system to help farmers improve profitability and minimise waste.
Patterns of plant carbon, nitrogen, and phosphorus concentration in relation to productivity in China’s terrestrial ecosystems
Authors: Tang Zhiyao , Xu Wenting , Zhou Guoyi , Bai Yongfei , Li Jiaxiang , Tang Xuli , Chen Dima , Liu Qing , Ma Wenhong , Xiong Gaoming , He Honglin , He Nianpeng , Guo Yanpei , Guo Qiang , Zhu Jiangling , Han Wenxuan , Hu Huifeng , Fang Jingyun , Xie Zongqiang
Published: April 2018

Significance

Estimates of nutrient allocation in different plant tissues and the relationships between the nutrient contents and photosynthetic capacity are critical to predicting ecosystem carbon sequestration under global change. Here, we provide an assessment of large-scale patterns of community-level nitrogen and phosphorus concentrations in different plant tissues and then examine how nutrient allocations are coupled with plant productivity. The results show that nutrient concentrations in leaves are less responsive to abiotic environments than those in woody stems and roots (stable leaf nutrient concentration hypothesis); the relationships between vegetation primary productivity and leaf nutrient contents are stronger when less nutrients are allocated to the woody tissues (productivity–nutrient allocation hypothesis) and are stronger in deciduous than in evergreen vegetation (productivity–leaf lifespan hypothesis).
Worldwide distribution of theDCDC2READ1 regulatory element and its relationship with phoneme variation across languages
Authors: DeMille Mellissa M. C. , Tang Kevin , Mehta Chintan M. , Geissler Christopher , Malins Jeffrey G. , Powers Natalie R. , Bowen Beatrice M. , Adams Andrew K. , Truong Dongnhu T. , Frijters Jan C. , Gruen Jeffrey R.
Published: April 2018

Significance

Languages evolve rapidly due to an interaction between sociocultural factors and underlying phonological processes that are influenced by genetic factors.DCDC2has been strongly associated with core components of the phonological processing system in animal models and multiple independent studies of populations and languages. To characterize subtle language differences arising from genetic variants associated with phonological processes, we examined the relationship between READ1, a regulatory element inDCDC2, and phonemes in languages of 43 populations across five continents. Variation in READ1 was significantly correlated with the number of consonants. Our results suggest that subtle cognitive biases conferred by different READ1 alleles are amplified through cultural transmission that shape consonant use by populations over time.
Urbanization prolongs hantavirus epidemics in cities
Authors: Tian Huaiyu , Hu Shixiong , Cazelles Bernard , Chowell Gerardo , Gao Lidong , Laine Marko , Li Yapin , Yang Huisuo , Li Yidan , Yang Qiqi , Tong Xin , Huang Ru , Bjornstad Ottar N. , Xiao Hong , Stenseth Nils Chr.
Published: April 2018

Significance

Urbanization reduces exposure risk to many wildlife parasites and in general, improves overall health. However, our study importantly shows the complicated relationship between the diffusion of zoonotic pathogens and urbanization. Here, we reveal an unexpected relationship between hemorrhagic fever with renal syndrome incidence caused by a severe rodent-borne zoonotic pathogen worldwide and the process of urbanization in developing China. Our findings show that the number of urban immigrants is highly correlated with human incidence over time and also explain how the endemic turning points are associated with economic growth during the urbanization process. Our study shows that urbanizing regions of the developing world should focus their attention on zoonotic diseases.
Synthetically engineered
Medea
gene drive system in the worldwide crop pest
Drosophila suzukii
Authors: Buchman Anna , Marshall John M. , Ostrovski Dennis , Yang Ting , Akbari Omar S.
Published: April 2018

Significance

Here we describe a fully functional gene drive system constructed in a major worldwide crop pest,
Drosophila suzukii
. This system is composed of a synthetic
Medea
drive with a maternal miRNA “toxin” and a zygotic “antidote,” and we demonstrate that it can bias inheritance with 100% efficiency and can persist in a population given high release frequencies. We discuss how such a system may be used to suppress
D. suzukii
populations or render them harmless to target crops.
Global peatland initiation driven by regionally asynchronous warming
Authors: Morris Paul J. , Swindles Graeme T. , Valdes Paul J. , Ivanovic Ruza F. , Gregoire Lauren J. , Smith Mark W. , Tarasov Lev , Haywood Alan M. , Bacon Karen L.
Published: April 2018

Significance

Peatlands are organic-rich wetlands that have acted as globally important carbon sinks since the Last Glacial Maximum. However, the drivers of peat initiation are poorly understood. Using a catalog of radiocarbon dates combined with simulations of past climates, we demonstrate that peat initiation in the deglaciated landscapes of North America, northern Europe, and Patagonia was driven primarily by warming growing seasons rather than by any increase in effective precipitation. In Western Siberia, which was not glaciated, climatic wetting was required to convert existing ecosystems into peatlands. Our findings explain the genesis of one of the world’s most important ecosystem types and its potentially fragile, distributed carbon store, with implications for understanding potential changes in peatland distribution in response to future warming.
Spatial determinants of quorum signaling in a
Pseudomonas aeruginosa
infection model
Authors: Darch Sophie E. , Simoska Olja , Fitzpatrick Mignon , Barraza Juan P. , Stevenson Keith J. , Bonnecaze Roger T. , Shear Jason B. , Whiteley Marvin
Published: April 2018

Significance

Quorum sensing is a communication system that allows bacteria to coordinate their activities, and these systems are critical for virulence in several bacteria, including
Pseudomonas aeruginosa
. There is a significant gap in knowledge about how quorum sensing proceeds during infection, particularly how spatial organization of the infecting microbial community impacts signaling. Using a model that recapitulates the biogeographical properties of
P. aeruginosa
infection of the cystic fibrosis lung, we discovered that communication primarily occurs within
P. aeruginosa
aggregates and that communication between aggregates is only observed for very large aggregates containing ≥5,000 cells. This study identifies a critical role for spatial distribution and bacterial phenotypic heterogeneity in bacterial signaling during infection, and provides a platform for future ecological and evolutionary studies.
Discovery of recombinases enables genome mining of cryptic biosynthetic gene clusters in Burkholderiales species
Authors: Wang Xue , Zhou Haibo , Chen Hanna , Jing Xiaoshu , Zheng Wentao , Li Ruijuan , Sun Tao , Liu Jiaqi , Fu Jun , Huo Liujie , Li Yue-zhong , Shen Yuemao , Ding Xiaoming , Müller Rolf , Bian Xiaoying , Zhang Youming
Published: April 2018

Significance

Natural products biosynthesized by cryptic gene clusters represent a largely untapped source for drug discovery. However, mining of these products by promoter engineering is restricted by the lack of streamlined genetic tools, especially in nonmodel biosynthetic gene cluster (BGC)-rich bacteria. Here, we describe the discovery of a pair of bacteriophage recombinases and application of recombinase-assisted promoter engineering to rapidly identify and activate several cryptic biosynthetic gene clusters in two Burkholderiales strains that currently lack effective genetic tools. Construction of an efficient genome engineering platform in a natural product producer expedites mining of cryptic BGCs in their native backgrounds, and host melioration for yield or structure optimization. This strategy enables potentially scalable discovery of novel metabolites with intriguing bioactivities from many other bacteria.
Dynamic activation and regulation of the mitogen-activated protein kinase p38
Authors: Kumar Ganesan Senthil , Clarkson Michael W. , Kunze Micha B. A. , Granata Daniele , Wand A. Joshua , Lindorff-Larsen Kresten , Page Rebecca , Peti Wolfgang
Published: April 2018

Significance

The physical basis for the regulation of protein MAP kinases is key to understanding their role in cellular signaling in human biology and disease. However, the biochemical events that lead to MAPK activation are not well understood. Here, using biomolecular NMR dynamics measurements, we show that kinase activation is not due simply to phosphorylation of the activation loop. Rather, we show that phosphorylation and substrate binding cause the dynamics of p38 to change from a state in which they are uncoordinated to one that is uniform across the entire molecule. That is, synchronized dynamics coordinates enzyme activity, which leads to a shift in the energy landscape and ultimately drives enzyme function. This makes essential elements of allostery and activation dynamically accessible.
Formate rescues neural tube defects caused by mutations in
Slc25a32
Authors: Kim Jimi , Lei Yunping , Guo Jin , Kim Sung-Eun , Wlodarczyk Bogdan J. , Cabrera Robert M. , Lin Ying Linda , Nilsson Torbjorn K. , Zhang Ting , Ren Aiguo , Wang Linlin , Yuan Zhengwei , Zheng Yu-Fang , Wang Hong-Yan , Finnell Richard H.
Published: April 2018

Significance

Periconceptional supplementation with folic acid (FA) has reduced the prevalence of neural tube defects (NTDs) in numerous global populations; however, more than 30% of NTDs remain FA resistant. Previous in vitro studies identified
Slc25a32
-encoding mitochondrial folate transporter that delivers tetrahydrofolate across the mitochondrial membrane. Herein, we provide the original description of transgenic
Slc25a32
gene trapped (Slc25a32
gt/gt
) knockout mice, who present with 100% penetrant NTDs. We demonstrate that formate supplementation rescues normal neural tube closure in the majority (78%) of
Slc25a32

gt/gt

embryos, whereas 5-methyltetrahydrofolate was not effective. Additionally, biallelic
SLC25A32
loss-of-function mutations were identified in a human NTD case. Our findings add an NTD mouse model to several others that benefit developmentally from maternal formate supplementation.
Next-generation CRISPR/Cas9 transcriptional activation in
Drosophila
using flySAM
Authors: Jia Yu , Xu Rong-Gang , Ren Xingjie , Ewen-Campen Ben , Rajakumar Rajendhran , Zirin Jonathan , Yang-Zhou Donghui , Zhu Ruibao , Wang Fang , Mao Decai , Peng Ping , Qiao Huan-Huan , Wang Xia , Liu Lu-Ping , Xu Bowen , Ji Jun-Yuan , Liu Qingfei , Sun Jin , Perrimon Norbert , Ni Jian-Quan
Published: April 2018

Significance

We present flySAM, a potent system for Cas9-based transcriptional activation (CRISPRa) in
Drosophila
. flySAM greatly improves on existing in vivo CRISPRa techniques in terms of potency, scalability, and ease of use, and provides a simple and general method for conducting overexpression experiments and screens. flySAM will now serve as the basis for our growing collection of publicly available CRISPRa transgenic fly lines.
Shewanella oneidensisas a living electrode for controlled radical polymerization
Authors: Fan Gang , Dundas Christopher M. , Graham Austin J. , Lynd Nathaniel A. , Keitz Benjamin K.
Published: April 2018

Significance

Metabolic engineering benefits from the tunable and tightly controlled transformations afforded by biological systems. However, these reactions have generally been limited to naturally occurring pathways and products. In this work, we coopt metabolic electron transfer fromShewanella oneidensisto control the activity of an exogenous metal catalyst in an abiotic reaction scheme: atom-transfer radical polymerization. In the presence ofS. oneidensis, polymerizations exhibited well-defined kinetics and yielded polymers with controlled molecular weights and low polydispersities. Additionally, polymerization activity was dependent on electroactive metabolism and specific electron transport proteins, both of which provide handles to control material synthesis. This work serves as a proof-of-principle toward expanding the scope of reactions available to metabolic engineers to include previously discovered transition-metal–catalyzed reactions.
Thermally stable, highly efficient, ultraflexible organic photovoltaics
Authors: Xu Xiaomin , Fukuda Kenjiro , Karki Akchheta , Park Sungjun , Kimura Hiroki , Jinno Hiroaki , Watanabe Nobuhiro , Yamamoto Shuhei , Shimomura Satoru , Kitazawa Daisuke , Yokota Tomoyuki , Umezu Shinjiro , Nguyen Thuc-Quyen , Someya Takao
Published: April 2018

Significance

We have developed an ultraflexible organic photovoltaic (OPV) that achieves sufficient thermal stability of up to 120 °C and a high power conversion efficiency of 10% with a total thickness of 3 μm. By combining an inherently stable donor:acceptor blend as the active layer and ultrathin substrate and barriers with excellent thermal capability, we were able to overcome the trade-offs between efficiency, stability, and device thickness. The ultraflexible and thermally stable OPV can be easily integrated into textiles through the commercially available hot-melt process without causing performance degradation, thereby presenting great potential as a ubiquitous and wearable power source in daily life.
Deep learning improves prediction of drug–drug and drug–food interactions
Authors: Ryu Jae Yong , Kim Hyun Uk , Lee Sang Yup
Published: April 2018

Significance

Drug interactions, including drug–drug interactions (DDIs) and drug–food constituent interactions, can trigger unexpected pharmacological effects such as adverse drug events (ADEs). Several existing methods predict drug interactions, but require detailed, but often unavailable drug information as inputs, such as drug targets. To this end, we present a computational framework DeepDDI that accurately predicts DDI types for given drug pairs and drug–food constituent pairs using only name and structural information as inputs. We show four applications of DeepDDI to better understand drug interactions, including prediction of DDI mechanisms causing ADEs, suggestion of alternative drug members for the intended pharmacological effects without negative health effects, prediction of the effects of food constituents on interacting drugs, and prediction of bioactivities of food constituents.
The ins and outs of vesicular monoamine transporters
Authors: Yaffe Dana , Forrest Lucy R. , Schuldiner Shimon
Published: April 2018

The H+-coupled vesicular monoamine transporter (VMAT) is a transporter essential for life. VMAT mediates packaging of the monoamines serotonin, dopamine, norepinephrine, and histamine from the neuronal cytoplasm into presynaptic vesicles, which is a key step in the regulated release of neurotransmitters. However, a detailed understanding of the mechanism of VMAT function has been limited by the lack of availability of high-resolution structural data. In recent years, a series of studies guided by homology models has revealed significant insights into VMAT function, identifying residues that contribute to the binding site and to specific steps in the transport cycle. Moreover, to characterize the conformational transitions that occur upon binding of the substrate and coupling ion, we have taken advantage of the unique and powerful pharmacology of VMAT as well as of mutants that affect the conformational equilibrium of the protein and shift it toward defined conformations. This has allowed us to identify an important role for the proton gradient in driving a shift from lumen-facing to cytoplasm-facing conformations.
CCQM K6.2 determination of total cholesterol in human serum
Authors: Wise Stephen A , Phinney Karen W , Duewer David L , Sniegoski Lorna T , Welch Michael J , Pabello Guiomar , Caldero Marco A Avila , Qinde Liu , Kooi Lee Tong , Rego Eliane , Garrido Bruno , Allegri Gabriella , Cruz Marcia de La , Barrabin Juliana , Puglisi Celia , Lopez Eduardo , Lee Hwashim , Kim Byungjoo , Delatour Vincent , Heuillet Maud , Nammoonnoy Jintana , Gören Ahmet Ceyhan , Bilsel Gokhan , Konopelko L , Krylov A , Lopushanskaya E
Published: April 2018

Cholesterol is one of the most frequently measured substances in human blood/serum to assist in assessing the health status of individuals. Because of its clinical significance, CCQM-K6 determination of cholesterol in serum was completed in 2000 as one of the first key comparison (KC) studies performed within the Organic Analysis Working Group (OAWG). The first subsequent KC for cholesterol, CCQM-K6.1, was completed in 2001. Measurements for this second subsequent, CCQM-K6.2, were completed in 2012. These subsequent comparisons were conducted to enable CCQM members that had not participated in earlier studies to demonstrate their capabilities to measure a nonpolar (pKow < −2), low molecular mass (100 g/mol to 500 g/mol) metabolite in human serum at relatively high concentrations (1 mg/g to 3 mg/g) found in normal populations. Successful participation in CCQM-K6.2 demonstrated capabilities in analysis of complex biological matrices including sample preparation (extraction, derivatization), LC or GC separation, and quantification using an isotope dilution mass spectrometry approach.

Normally in a subsequent KC, no key comparison reference value (KCRV) would be established and assessment of performance would be via the deviation of participants' results to the anchor institute's results, adjusted to account for the anchor's performance in the original comparison versus its KCRV. Due to the very long-time period since the original key comparison, the OAWG decided that this did not represent the best approach to assess performance in what is a relatively complex measurement. Given the excellent agreement between the anchor institute's results and robust consensus summary of the participants' values, the reference value for this study was taken as the anchor institute's result and treated as a 'KCRV'. Seven of the nine participants demonstrated agreement with the reference value.

Main text

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

The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Long-term variation in numbers and biomass of silver eels being produced in two European river systems
Authors: Poole W Russell , Diserud Ola H , Thorstad Eva B , Durif Caroline M , Dolan Conor , Sandlund Odd Terje , Bergesen Knut , Rogan Gerard , Kelly Sean , Vøllestad Leif Asbjørn
Published: April 2018

The European eel (Anguilla anguilla) population has been in decline at least since the 1960s and reliable regional information, particularly on the spawner production and escapement (i.e. the silver eel life stage), is a requirement of the EU stock recovery regulation. Two comparable time series exist in Burrishoole (Ireland) and Imsa (Norway), with monitoring of total silver eel production since the early 1970s. Numbers of emigrating silver eels fell significantly (p < 0.0001) in the 1980s (breakpoints: Burrishoole 1982; Imsa 1988), in both catchments from >4000 eels per annum to ∼2000 eels per annum. The proportion of male eels dropped and the average size of female eels increased. Biomass of silver eels escaping has remained similar in Burrishoole (1.1/1.2 kg/ha), but not in Imsa (2.1/0.9 kg/ha) between the early period and the 2000s. Factors that govern the onset of eel maturation (silvering) and the annual production of silver eels are little understood. In this paper, the influence of time-lagged environmental variables on silver eel production is examined. Annual variation in the time series was partly (r2 Burrishoole = 0.43, Imsa = 0.46) explained by variation in water temperature and water level. Annual number of migrating eels in both catchments was positively related to summer temperature and summer water flow, negatively related to summer temperatures in the previous year, and in the Burrishoole, also negatively related to high water levels in September/October. The models did not transfer well between catchments, indicating likely catchment specific environmental factors impacting on eel production. The reduction in eel numbers observed in both catchments, accompanied by the change in sex ratio and mean weight of females that contribute to maintain biomass production, calls into question the advisability of basing a spawner escapement recovery target on biomass alone, while numbers and proportions of males decline.
From magnets to bears: is a career studying salmon narrow or broad?†
Authors: Quinn Thomas P
Published: April 2018

There are three main themes in this self-reflective essay, and I hope they are thought-provoking without being pretentious. The first is the topic of scientific specialization. How do we steer a course between being a dilettante on one hand, dabbling in everything without making major contributions in any field, and on the other hand being a specialist who digs deeply but too narrowly? The second theme is the concept of specialization with respect to place, and the study of natural history. It can be incredibly rewarding, both personally and professionally, to develop a rich ecological understanding of a particular place such as a field station. However, this requires a great commitment of time, and it reduces mobility and experience elsewhere. The third theme is the importance of mentoring and the transfer of encouragement and opportunity from one cohort to the next. I will address these three themes in this order but they are closely linked to each other, making the separation somewhat artificial.
Socioeconomic Factors and Ninth Grade School Performance in Childhood Leukemia and CNS Tumor Survivors
Authors: Lindahl Merete , Addington Silas Victor , Winther Jeanette Falck , Schmiegelow Kjeld , Andersen Klaus Kaae
Published: April 2018

Background

Childhood cancer survivors can experience deficits in school performance in adolescence. Few studies have investigated how social and socioeconomic factors influence and modify school performance. This study investigates the hypothesis that social and parental socioeconomic factors influence ninth grade school performance in childhood leukemia and central nervous system (CNS) tumor survivors and that the effect is different from that in healthy peers.

Methods

We analyzed data from nationwide Danish registers on school grades for children who finished ninth grade during 2002–2015 in Denmark. Using a unique within-school matched design, we compared grades from childhood cancer survivors with grades from healthy peers. Social factors were maternal/paternal civil status, immigrant status, and country of origin. Parental socioeconomic factors were measured by education and income. The study consisted of 36 426 children, of whom 460 and 289 were leukemia and CNS tumor survivors, respectively.

Results

School grades varied considerably across social strata. However, the grades among CNS tumor survivors varied notably less in the following effect modifiers: parental educational attainment, income, and immigrant status. On the contrary, no significant effect modifiers were found among leukemia survivors as compared with healthy peers.

Conclusion

There is a strong effect of social and parental socioeconomic factors on school performance in healthy adolescence in Denmark. The same pattern is seen in survivors of leukemia, but a different pattern is seen in survivors of CNS tumors. This finding suggests that impairment of school-related functions differ between leukemia and CNS tumor survivors. This study contributes to knowledge on learning in adolescence in childhood cancer survivors by investigating several social and socioeconomic effect modifiers with nationwide register data and a unique statistical method particularly suitable for comparing school grades. Improved insight could make it possible to identify high-risk groups that may need different means of help.
Relationship Between Anthropometric Factors and Risk of Second Breast Cancer Among Women With a History of Ductal Carcinoma In Situ
Authors: Flanagan Meghan R , Tang Mei-Tzu C , Baglia Michelle L , Porter Peggy L , Malone Kathleen E , Li Christopher I
Published: April 2018

Background

Women with ductal carcinoma in situ (DCIS) have an elevated risk of a second breast cancer, but few data are available regarding the impact of modifiable lifestyle factors on this risk.

Methods

In a population-based case–control patient study of women with a history of DCIS in western Washington diagnosed between 1996 and 2013, 497 patients diagnosed with DCIS and a second ipsilateral or contralateral invasive or in situ breast cancer were enrolled. There were 965 matched control patients with one DCIS diagnosis. Associations between anthropometric factors and risk of an invasive or in situ second breast cancer event were evaluated using conditional logistic regression. Statistical tests were two-sided.

Results

Obesity (body mass index [BMI] ≥ 30 kg/m2) at initial DCIS diagnosis was associated with a 1.6-fold (95% confidence interval [CI] = 1.2 to 2.2) increased risk of any second breast cancer and a 2.2-fold increased risk of a contralateral second breast cancer (95% CI = 1.4 to 3.3) compared with normal weight women (BMI < 25 kg/m2). BMI and weight, both at initial DCIS diagnosis and at the time of the second breast cancer diagnosis, were positively associated with risk of any second and second invasive breast cancers (odds ratio = 1.01–1.04, all P ≤ .03).

Conclusions

Although additional confirmatory studies are needed, obesity appears to be an important contributor to the risk of second breast cancers within the growing population of women with DCIS. This has potential clinical relevance with respect to identifying which women with a history of DCIS may require more careful monitoring and who may benefit from lifestyle modifications.
Female Sexual Biochemistry (DRAFT)
Authors: Castellanos Madeleine M.
Published: April 2018

“Female Sexual Biochemistry” reviews the key hormones and neurotransmitters that have a major role in female sexuality. Estrogens—estradiol, estrone, and estriol—as well as major androgens, such as testosterone and dihydrotestosterone (DHT), are presented with a discussion of their role in the support of the reproductive organs and genitals as well as their actions on the central nervous system to affect sexual desire, arousal, and responsiveness. The interaction and regulation of estrogen by progesterone and thyroid hormone is included. A review of the dual-control model of sexual responsiveness is presented, including excitatory and inhibitory factors, as well as a summary of major neurotransmitters that work to enhance sexual arousal or inhibit it. The sexual response cycle is reviewed and relevant changes in pregnancy, childbirth, perimenopause, and menopause are presented. Finally, there is mention of how synthetic hormones and environmental toxins with hormone activity may alter a woman’s sexual response.
Sexual Dysfunction and Exercise (DRAFT)
Authors: Teta Keoni (John) , Esposito Ralph , Teta Jade
Published: April 2018

Sexual dysfunction often is multifactorial, with contributing etiologies ranging from cardiometabolic, neuronal, hormonal to psychological in origin. Whatever the origin, there is one very productive, often overlooked intervention for sexual dysfunction: exercise. Both female and male sexual dysfunction can be indicators of poor general health and may be linked to multiple conditions that respond exceptionally well to precise and tailored therapeutic exercises. Major contributing risk factors to sexual dysfunction include obesity, diabetes, hormonal imbalances, nerve damage, pharmaceutical side effects, cardiometabolic dysregulation, psychoemotional imbalance, menopause, pregnancy, and childbirth. A “go hard and rest hard” approach creates an intricate balance between high-intensity training and restorative exercise designed to address the underlying causes and risk factors of sexual dysfunction. This chapter discusses therapeutic exercise for sexual dysfunction and provides tailored exercises, detailed routines, and key practitioner-patient tools to provide a framework for a successful response to treat, reverse, and prevent sexual dysfunction.
Complementary and Alternative Treatments for Female Sexual Pain (DRAFT)
Authors: Spadt Susan Kellogg , Fariello Jennifer Yonaitis
Published: April 2018

An estimated 17–19% of women in the United States suffer from chronic sexual pain and dyspareunia of vulvovaginal origin. The majority will see several health care providers in an effort to comprehensively diagnose, evaluate, and decide on a management strategy for the condition. As a result of countless encounters with health care providers, and after trying numerous unsuccessful traditional medical interventions woman can feel frustrated and look to the use of complementary and alternative solutions to “solve their sexual health mystery.” According to the 2007 National Health Interview Survey, an estimated 83 million adults in the United States spent $33.9 billion dollars on complementary and alternative medicine. Complementary therapies, including psychotherapy, physical therapy, and behavioral modification strategies, are becoming increasingly popular for women who are seeking treatment of chronic sexual pain either as a first-line therapy monotherapy or as cotherapies added to traditional medical pharmacotherapy.
Aromatherapy in the Treatment of Sexual Dysfunction and Relationship Problems (DRAFT)
Authors: Green Mindy
Published: April 2018

Aromatherapy and its tools, essential oils, can be useful adjuncts to any other type of treatment for sexual dysfunction and relationship problems. Functional fragrance naturally derived from pure plant distillation (essential oils) can affect the emotions, mood, and anxiety and be an adjunct in treating behavior disorders. This chapter briefly examines the role of olfaction—the process of smelling that occurs in the same area of the brain (the limbic system) that processes memory and emotion. Essential oils are employed through inhalation or dermal application. The wide-ranging array of aromatic constituents found in essential oils can have a diverse effect on neurochemicals that are released into the body, resulting in a variety of actions: stress reduction, relaxation, mental or sexual stimulation, memory recall, and engendering intimacy.
The Neuroscience of Pain and Addiction
Authors: Waller R. Corey
Published: April 2018

This chapter addresses the neurological architecture of both pain and addiction. The components of the relationship between the two are manifold, and include substances ingested; neurotransmitters and their receptor sites; cells, tissues, and organs and their integrated function. The author focuses on the basic neuroscience. The opening discussion (“Progress in Understanding Pain and Addiction”) maps our present understanding of both the plasticity of brain circuits and the fixity of drug effects. There follows a review of the anatomical structure of the brain, integrated with the known addiction and pain sensation processing pathways; an anatomical figure of the brain is provided. These descriptions lead to a scenario-based discussion of the implications for treatment of both pain and addiction: a patient with high pain tolerance experiencing pain, a patient with low pain tolerance experiencing pain, and the consequences of administering opioids. It concludes with therapeutic recommendations for management.
Psychosocial Aspects of Pain and Addiction
Authors: Halpern Ross
Published: April 2018

This chapter addresses the problem of assessing opiate use and psychological comorbidity, and discusses psychological strategies for coping with chronic pain. In 1995, the American Pain Society and others embraced pain as the fifth vital sign; yet pain differs from the other vital signs by being subjective, as opposed to being objectively measured, implying a psychological aspect. Psychological evaluation of a pain patient assesses underlying psychosocial aspects that play a role in reported pain symptoms. Early childhood abuse increases the likelihood of chronic pain later in life; pain may be precipitated by an emotional or physical trauma that reawakens anxiety from the original childhood experience. Precipitating traumas can include divorce, job loss, legal issues, grief, or death anniversaries. The earlier and more extensive the childhood trauma, the earlier and more extensive the physical report of pain in adulthood, and the greater the perceived need for opioid analgesia.
The Language of Pain and Addiction
Authors: Miller Michael M.
Published: April 2018

The language employed in managing coexisting pain and addiction affects the management itself. Clinicians working with such patients may not realize that the two disorders share a terminology that can be confusing, imprecise, overlapping and/or stigmatizing. This chapter has two components:

1. A description of Pain Medicine as a specialized area of practice, research, and education, whose leaders try to clarify concepts and terminology to improve patient care, professional standards, and public policy.

2. The language of Addiction Medicine; arguably, even more complex than that of pain medicine because of the emotions, stigma, and discrimination attached to substance use disorders labels.

All physicians’ concern must be that the patient adheres to the treatment plan by using prescription medications in only safe and healthy ways. This requires counseling, and monitoring treatment adherence and the safety of prescriptions, even in the absence of a diagnosable substance use disorder.
Providing Integrated Care for Pain and Addiction
Authors: Wartenberg Alan A.
Published: April 2018

The central premise of this chapter on providing integrated care for both pain and addiction is that all patients presenting with pain are at risk for development of substance use disorders. Assessment and treatment of the complex interplay between pain syndromes and substance use disorders proceed most productively by employing an integrated model, with a multidisciplinary approach and with employment of multiple diagnostic instruments. The author describes an integrated care model as it applies to each of the common substances of use: opioids, tobacco, alcohol, benzodiazepines, cannabinoids, barbiturates, and stimulants. The basis for a decision to refer for evaluation or treatment is described. The chapter concludes with an argument for collaboration between disciplines, notably pain medicine and addiction medicine, as being the current standard of acceptable care for patients whose illnesses dwell in both camps. A separate text box provides additional information and resources bearing on this chapter’s topics.
Legal Issues in Treating Pain and Addiction
Authors: Salsitz Edwin A.
Published: April 2018

Competent treatment of both pain and addiction requires an understanding of applicable federal, state, and local laws and regulations. Key requirements of federal laws and regulations are outlined in this chapter; the authors emphasize the need for an understanding of local and regional laws and precedents, which goes beyond the scope of the chapter, and a separate text box is provided with resources. Also provided is a text box analyzing 2017 changes to the federal Rule 42, CFR, relating to confidentiality and re-disclosure of information specific to treatment of substance use disorders. Areas of chapter focus include: HIPAA, confidentiality, general medical recordkeeping principles and obligations, federal audits (DATA 2000 and buprenorphine), medication storage, reporting requirements and the duty to warn, reports to employers, and the management of an office closure.
Screening Patients for Opioid Risk
Authors: Fudin Jeffrey , Cleary Jacqueline , Kominek Courtney , Brooks Abigail , Pham Thien C.
Published: April 2018

The narrow therapeutic index associated with most analgesic opioids creates a high degree of risk, obliging caution in patient selection; this chapter describes screening practices. More attention is due to the use of opioid therapy for chronic non-cancer pain as episodes of respiratory arrest increase. Universal precautions are recommended for all patients. Before and throughout treatment, selected tools assessing risk and misuse should be employed. Increased access to the opioid antagonist naloxone has followed the increase in opioid poisoning deaths; the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD) helps determine the likelihood of an opioid overdose, serving to select candidates for at-home naloxone access. Urine drug testing aids treatment plan adherence. Tables include: a comparison of screening tools for risk stratification; a comparison of tools for assessment of opioid misuse; the scoring procedure for the RIOSORD; and a list of risk classes with predicted probabilities.
Drug Testing and Other Tools for Patient Monitoring
Authors: Baxter Louis E.
Published: April 2018

Chapter 12 describes patient monitoring in the setting of addiction or addiction risk, and pain management, to include drug testing. The advantages, disadvantages, and types of available testing for drug use are described, with a discussion of their limitations. Body fluids and tissues for sampling include hair, blood, saliva, sweat, and urine; all yield information regarding drug use within unique limitations and at different levels of convenience. The test methodology imposes a need to know respective sensitivities and specificities, particularly in a forensic setting. Breath testing (alcohol) is not within the scope of this chapter. Recommended frequencies of urine testing are addressed. The utility of other forms of monitoring (self-report, collateral sources, PDMP) is assessed in the final section. Two tables are provided, (1) urine drug detection times, and (2) sources of false positive tests in urine immunoassay studies. Supplemental information sources are cited in a text box.
Mindfulness as a Component of Addiction Treatment
Authors: Abramowitz Sharone
Published: April 2018

This compact chapter addresses patient selection and general principles of mindfulness-based interventions, specifically mindfulness-based stress reduction (MBSR). It describes mindfulness-oriented recovery enhancement (MORE) as a combination of mindfulness intervention and cognitive behavioral therapy, suggesting its effectiveness in reducing the perception of pain in more than half of the participants who complete training. While focusing principally on the patient, the chapter argues for the utility of mindfulness-based interventions in preserving the serenity and enhancing the effectiveness of the therapist. It also notes that while the therapeutic outcome may be modest, there is generally little cost and very little risk to initiation of mindfulness meditation and similar interventions. A text box is given with additional resources.
Pain and Addiction in Patients with Co-Occurring Psychiatric Disorders
Authors: Ziegler Penelope P.
Published: April 2018

Addressed equally to psychiatrists and to primary care providers, this chapter is intended to explore non–substance use disorder psychiatric diagnoses as they impact the perception of pain and the treatment of substance use disorders. A screening checklist emphasizing basic principles of psychiatric history-taking is provided to help identify the patient’s requirements. The author reviews the classes of psychiatric diagnoses most likely to be present in the pain/addiction and other comorbidly-ill patients, and reviews suicide risks. Similarly, the classes of medications employed in psychiatry and their capacity for alleviation or aggravation of substance use disorders are reviewed, with notations of drug–drug interactions. A final section addresses the role of emotions and psychiatric symptoms in the perception and management of pain.
Pain and Addiction in Patients with Post-Traumatic Stress Disorder
Authors: Eraker Steven A.
Published: April 2018

Addressed equally to psychiatrists and to primary care providers, this chapter is intended to explore non–substance use disorder psychiatric diagnoses as they impact the perception of pain and the treatment of substance use disorders. A screening checklist emphasizing basic principles of psychiatric history-taking is provided to help identify the patient’s requirements. The author reviews the classes of psychiatric diagnoses most likely to be present in the pain/addiction and other comorbidly-ill patients, and reviews suicide risks. Similarly, the classes of medications employed in psychiatry and their capacity for alleviation or aggravation of substance use disorders are reviewed, with notations of drug–drug interactions. A final section addresses the role of emotions and psychiatric symptoms in the perception and management of pain.
Pain and Addiction in Older Adults
Authors: Buckalew Nelly A.
Published: April 2018

Addressing unique effects of both addiction and analgesia on older adults, this chapter defines the geriatric population and proceeds to discuss the recognition of addiction or substance misuse in it. There is little argument that the elderly have special diagnostic concerns and management needs that are imposed upon those of younger adults. The concept of the pain signature is introduced as a measure of the functions with which the individual’s pain interferes. Four instruments serving as diagnostic aids are included in tabular format: the pain signature elements; a list of recommended patient history queries; suggested components of the review of systems; and special components of the physical examination. The tables are geared specifically toward geriatric patients. The two central themes of the chapter are treatment of pain, and the treatment of opioid misuse and addiction.
Introduction to Gender in Psycho-Oncology (DRAFT)
Authors: Loscalzo Matthew J.
Published: April 2018

Sex and gender are emotionally charged concepts in society. Never before has there been more interest in the sciences of sex and gender. In the past, sex and gender were primarily the domain of the humanities, especially literature, painting, and music. Greater political and sociological expectations for the rights of women and the emergence of increased tolerance for alternative lifestyles have reverberated throughout societies globally—with mixed results. Women, in particular, have suffered from lack of appreciation for the inescapable, well-documented biopsychosocial sexual dimorphisms that are all too often overshadowed by politics, fear, and ignorance. Without a more evolved understanding of and engagement in the unique characteristics and potentials of women and men, from cell to society, cancer science would have remained a “hidden hostage” to societal ignorance. The emergence of strategic or tailored cancer medicine cannot exist without integrating sex into prevention, diagnosis, and the development of new treatments.
Theories of Gender in Adjustment to Medical Illness (DRAFT)
Authors: Kim Youngmee , Mitchell Hannah-Rose , Ting Amanda
Published: April 2018

Caregiving has historically been considered the role of women, yet the number of male caregivers has increased substantially in recent years. Such changes call for systematic understanding of the role of gender in caregiving processes. This chapter summarizes theoretical perspectives pertaining to gender issues in caregiving and then evaluates their adequacy for the cancer caregiver population. Despite lack of gender theory–driven research in cancer caregiving, studies support the adequacy of gender theories in identifying subgroups of caregivers who are vulnerable to adverse effects of cancer in the family and in developing evidence-based interventions. Integration of the issues related to the medical trajectory of the patients, lifespan stage of the caregivers, sociocultural resources, and risk factors in this emerging area of gender-oriented research and practice in cancer caregiver is highly encouraged.
Male Patients and Their Male Caregivers (DRAFT)
Authors: Blank Thomas O. , Descartes Lara , Asencio Marysol
Published: April 2018

There is a dearth of literature on male-to-male caregiving relationships generally and almost none specific to cancer. Some prior studies have included male caregivers and/or male care recipients, but they have rarely separated out male–male dyads for analysis. Thus, without access to much research specific to male–male caregiving for cancer, this chapter draws on related and relevant literature, such as that on men caring for men with AIDS and interactions within prostate cancer support groups. These findings are used to describe what male–male caregiving may look like. A consideration of how female caregiving is typically foregrounded and valued in the caregiving literature is used to critique the current state of knowledge of male caregiving, and the large research gap in this field is identified.
Leadership and Crisis Management (DRAFT)
Authors: Butcher Brad W.
Published: April 2018

Medical errors were recently identified as the third leading cause of death in the United States. Many of these errors result from deficiencies in nontechnical skills (NTS), including effective communication and appropriate task delegation. Rapid response teams (RRTs) operate in error-prone, high-stakes environments where elevated clinical risk, substantial time pressure, and the need to perform multiple actions in parallel coexist. Borrowing from the aviation industry and the military, medicine is placing a growing emphasis on instructing healthcare providers, particularly members of teams, in the NTS of crisis management. Barriers to developing these skills can be overcome through encouraging standardization and practice using realistic simulation. When directing a team in the care of a deteriorating patient, RRT leaders must introduce team members and their roles, maintain an assertive yet inclusive tone, practice closed loop communication, control the crowd, maintain situational awareness, promote a flattened hierarchy, and perform regular debriefing sessions.