bluuebunny/crossref_metadata_2025 huggingface dataset:
Redox and pH gradients drive amino acid synthesis in iron oxyhydroxide mineral systems
Authors: Barge Laura M. , Flores Erika , Baum Marc M. , VanderVelde David G. , Russell Michael J.
Published: February 2019

Significance

Amino acids are formed from simple organic precursors in iron oxyhydroxide mineral systems that contain geochemical gradients. Redox and pH gradients significantly impact reaction pathways: Amino acids only form when the mineral contains both oxidized and reduced iron, and when the surrounding solution is alkaline. This shows that aqueous, partially reducing iron mineral systems (which would have been common in early-Earth seafloor/vent environments) could have facilitated synthesis and concentration of prebiotic organic molecules relevant for the emergence of life. It also suggests that geochemical gradients in vent environments can drive product selectivity for prebiotic chemistry, perhaps leading to more complex organic reaction systems as these molecules continue to diffuse and react under different conditions within the gradients.
Insights into histidine kinase activation mechanisms from the monomeric blue light sensor EL346
Authors: Dikiy Igor , Edupuganti Uthama R. , Abzalimov Rinat R. , Borbat Peter P. , Srivastava Madhur , Freed Jack H. , Gardner Kevin H.
Published: February 2019

Significance

All living things must sense and react to their environment. Many single-celled organisms do so by using two-component systems, most simply consisting of a sensor histidine kinase and a response regulator. These systems are involved in pathogenicity pathways and can be targeted by new antibiotics. However, the molecular mechanisms used by histidine kinases to translate sensing into responses are not well understood. To probe this general question, we apply a combination of biophysical techniques to a monomeric histidine kinase that senses blue light to determine the structural changes occurring upon activation. We find these changes to be similar to those predicted for the common dimeric histidine kinases, illustrating that the mechanism of activation is conserved regardless of oligomeric state.
Nitrogen-fixing red alder trees tap rock-derived nutrients
Authors: Perakis Steven S. , Pett-Ridge Julie C.
Published: February 2019

Significance

Tree species that form symbioses with nitrogen-fixing bacteria can naturally fertilize forests by converting atmospheric nitrogen gas into plant-available forms. However, other mineral nutrients that plants require for growth are largely locked in bedrock, and are released only slowly into soil. We used strontium isotopes to trace nutrient sources for six common tree species in a temperate rainforest, including one species from a globally widespread genus known for high rates of biological nitrogen fixation. We found that trees capable of fixing atmospheric nitrogen gas were also best able to directly access mineral nutrients from bedrock. This gives nitrogen-fixing trees the unique ability to provide the full suite of essential nutrients required to fuel growth and carbon uptake in forest ecosystems.
Limits to the world’s green water resources for food, feed, fiber, timber, and bioenergy
Authors: Schyns Joep F. , Hoekstra Arjen Y. , Booij Martijn J. , Hogeboom Rick J. , Mekonnen Mesfin M.
Published: February 2019

Significance

Precipitation over land partitions into runoff via surface water and groundwater (blue water) and evapotranspiration (green water). We expand the traditional debate on water scarcity, which solely focuses on blue water, by assessing green water scarcity. The current debate on water scarcity is heavily skewed, since it leaves unnoticed the bulk of water availability––which is green––and the bulk of water use––which is also green. Green water is the main source of water to produce food, feed, fiber, timber, and bioenergy. Thus, to understand how freshwater scarcity constrains the production of these vital goods, explicating and including (limits to) green water use is imperative.
Recovery from tachyphylaxis of TRPV1 coincides with recycling to the surface membrane
Authors: Tian Quan , Hu Juan , Xie Chang , Mei Kaidi , Pham Cuong , Mo Xiaoyi , Hepp Régine , Soares Sylvia , Nothias Fatiha , Wang Yuanyuan , Liu Qiang , Cai Fen , Zhong Bo , Li Dongdong , Yao Jing
Published: February 2019

Significance

TRPV1 ion channel plays an important role in the transmission and modulation of pain. Desensitization of TRPV1 in nociceptors is adaptable for analgesic therapy. One type of desensitization is tachyphylaxis that reflects reduced TRPV1 responses to repetitive stimuli. To understand the mechanism underlying the whole-cell tachyphylaxis, here we used an orthogonal electro-optical approach integrating electrophysiology and light-sheet microscopy. We show that the intensity of tachyphylaxis is regulated by the strength of inducing stimulation, and that TRPV1 channels undergo activity-gated recycling to regulate their surface expression level thereby the degree of tachyphylaxis. This study provides real-time insights into the establishment of tachyphylaxis and helps to understand desensitization-based analgesics.
Vortex-induced dispersal of a plant pathogen by raindrop impact
Authors: Kim Seungho , Park Hyunggon , Gruszewski Hope A. , Schmale David G. , Jung Sunghwan
Published: February 2019

Significance

Understanding the spread of spores of plant pathogens, some of which may serve as potential human allergens, is of great importance to plant and animal health. Raindrop impact is known to be a mechanism for dispersing micron-sized pathogenic spores. However, previous studies have focused only on wet splash droplets formed by raindrop impact, which our results suggest are only a minor contributor to spore dispersal. Our experiments show the importance of air vortices resulting from the drop impacts to disperse spores beyond the laminar boundary layer, with the potential for transport over long distances.
Mitigation of thermal distortion in wire arc additively manufactured Ti6Al4V part using active interpass cooling
Authors: Wu Bintao , Pan Zengxi , Chen Guangyu , Ding Donghong , Yuan Lei , Cuiuri Dominic , Li Huijun
Published: February 2019

In this study, active interpass cooling using compressed CO2 was innovatively employed in the wire arc additively manufactured Ti6Al4V process with the aim of mitigating part distortion. A comparative analysis between simulation and experimental results was performed to explore the effects of active interpass cooling on the thermal behaviours, geometric features and distortion levels of deposit. The results show that active interpass cooling with CO2 gas is an effective means of reducing Wire arc additive manufacturing (WAAM)-part distortion by increasing heat dissipation and reducing heat accumulation within the deposition. It can contribute to a maximum reduction of 81% in longitudinal distortion and 69% in transverse distortion for the wall structures produced in this study. Compared to the cooling gas flow rate, cooling time alternation is more effective in mitigating WAAM-part distortion due to more effective heat dissipation per unit time. The findings reveal that using active interpass cooling in WAAM can offer significant cost and build-time savings, as well as providing conditions for the improvement of WAAM-part quality.
Mdm1 maintains endoplasmic reticulum homeostasis by spatially regulating lipid droplet biogenesis
Authors: Hariri Hanaa , Speer Natalie , Bowerman Jade , Rogers Sean , Fu Gang , Reetz Evan , Datta Sanchari , Feathers J. Ryan , Ugrankar Rupali , Nicastro Daniela , Henne W. Mike
Published: February 2019

Lipid droplets (LDs) serve as cytoplasmic reservoirs for energy-rich fatty acids (FAs) stored in the form of triacylglycerides (TAGs). During nutrient stress, yeast LDs cluster adjacent to the vacuole/lysosome, but how this LD accumulation is coordinated remains poorly understood. The ER protein Mdm1 is a molecular tether that plays a role in clustering LDs during nutrient depletion, but its mechanism of function remains unknown. Here, we show that Mdm1 associates with LDs through its hydrophobic N-terminal region, which is sufficient to demarcate sites for LD budding. Mdm1 binds FAs via its Phox-associated domain and coenriches with fatty acyl–coenzyme A ligase Faa1 at LD bud sites. Consistent with this, loss of MDM1 perturbs free FA activation and Dga1-dependent synthesis of TAGs, elevating the cellular FA level, which perturbs ER morphology and sensitizes yeast to FA-induced lipotoxicity. We propose that Mdm1 coordinates FA activation adjacent to the vacuole to promote LD production in response to stress, thus maintaining ER homeostasis.
Monte Carlo simulations of out-of-field surface doses due to the electron streaming effect in orthogonal magnetic fields
Authors: Malkov Victor N , Hackett Sara L , Wolthaus Jochem W H , Raaymakers Bas W , van Asselen Bram
Published: February 2019

The out-of-field surface dose contribution due to backscattered or ejected electrons, focused by the magnetic field, is evaluated in this work. This electron streaming effect (ESE) can contribute to out-of-field skin doses in orthogonal magnetic resonance guided radiation therapy machines.

Using the EGSnrc Monte Carlo package, a phantom is set-up along the central axis of an incident 10

10 cm2 7 MV FFF photon beam. The phantom exit or entry surface is inclined with respect to the magnetic field, and an out-of-field water panel is positioned 10 cm away from, and centered on, the isocenter. The doses from streaming backscattered or ejected electrons, for either a 0.35 T or 1.5 T magnetic field, are evaluated in the out-of-field water panel for surface inclines of 10, 30, and 45°.

The magnetic field focuses electrons emitted from the inclined phantom. Dose distributions at the surface of the out-of-field water panel are sharper in the 1.5 T magnetic field as compared to 0.35 T. The maximum doses for the 0.35 T simulations are 23.2%, 37.8%, and 39.0% for the respective 10, 30, and 45° simulations. For 1.5 T, for the same angles, the maximum values are 17.1%, 29.8%, and 35.8%. Dose values drop to below 2% within the first 1 cm of the out-of-field water phantom. The phantom thickness is an important variable in the magnitude of the ESE dose.

The ESE can produce large out-of-field skin doses and must be a consideration in treatment planning in the MRgRT work-flow. Treatments often include multiple beams which will serve to spread out the effect, and many beams, such as anterior–posterior, will reduce the skin dose due to the ESE. A 1 cm thick shielding of either a bolus placed on the patient or mounted on the present RF coils would greatly reduce the ESE dose contributions. Further exploration of the capabilities of treatment planning systems to screen for this effect is required.
A Primer on AmpC β-Lactamases: Necessary Knowledge for an Increasingly Multidrug-resistant World
Authors: Tamma Pranita D , Doi Yohei , Bonomo Robert A , Johnson J Kristie , Simner Patricia J ,   Antibacterial Resistance Leadership Group, Tamma P D , Doi Y , Bonomo R A
Published: February 2019

Understanding the nuances of AmpC β-lactamase–mediated resistance can be challenging, even for the infectious diseases specialist. AmpC resistance can be classified into 3 categories: (1) inducible chromosomal resistance that emerges in the setting of a β-lactam compound, (2) stable derepression due to mutations in ampC regulatory genes, or (3) the presence of plasmid-mediated ampC genes. This review will mainly focus on inducible AmpC resistance in Enterobacteriaceae. Although several observational studies have explored optimal treatment for AmpC producers, few provide reliable insights into effective management approaches. Heterogeneity within the data and inherent selection bias make inferences on effective β-lactam choices problematic. Most experts agree it is prudent to avoid expanded-spectrum (ie, third-generation) cephalosporins for the treatment of organisms posing the greatest risk of ampC induction, which has best been described in the context of Enterobacter cloacae infections. The role of other broad-spectrum β-lactams and the likelihood of ampC induction by other Enterobacteriaceae are less clear. We will review the mechanisms of resistance and triggers resulting in AmpC expression, the species-specific epidemiology of AmpC production, approaches to the detection of AmpC production, and treatment options for AmpC-producing infections.
Tick-borne Encephalitis Vaccine Failures: A 10-year Retrospective Study Supporting the Rationale for Adding an Extra Priming Dose in Individuals Starting at Age 50 Years
Authors: Hansson Karin E , Rosdahl Anja , Insulander Mona , Vene Sirkka , Lindquist Lars , Gredmark-Russ Sara , Askling Helena H
Published: February 2019

Background

Southern Sweden is endemic for tick-borne encephalitis (TBE), with Stockholm County as one of the high-risk areas. Our aim in this study was to describe cases of vaccine failures and to optimize future vaccination recommendations.

Methods

Patients with TBE were identified in the notification database at the Department of Communicable Disease Control and Prevention in Stockholm County during 2006–2015. Vaccine failure was defined as TBE despite adherence to the recommended vaccination schedule with at least 2 doses. Clinical data were extracted from medical records.

Results

A total of 1004 TBE cases were identified, 53 (5%) were defined as vaccine failures. In this latter group, the median age was 62 years (6–83). Forty-three (81%) patients were aged >50 years and 2 were children. Approximately half of the patients had comorbidities, with diseases affecting the immune system accounting for 26% of all cases. Vaccine failures following the third or fourth vaccine dose accounted for 36 (68%) of the patients. Severe and moderate TBE disease affected 81% of the cases.

Conclusions

To our knowledge, this is the largest documented cohort of TBE vaccine failures. Vaccine failure after 5 TBE vaccine doses is rare. Our data provide rationale for adding an extra priming dose to those aged ≥50 years.
Deriving Specifications of Control Programs for Cyber Physical Systems
Authors: Burns Alan , Hayes Ian J , Jones Cliff B
Published: February 2019

Cyber physical systems (CPS) exist in a physical environment and comprise both physical components and a control program. Physical components are inherently liable to failure and yet an overall CPS is required to operate safely, reliably and cost effectively. This paper proposes a framework for deriving the specification of the software control component of a CPS from an understanding of the behaviour required of the overall system in its physical environment. The two key elements of this framework are (i) an extension to the use of rely/guarantee conditions to allow specifications to be obtained systematically from requirements (as expressed in terms of the required behaviour in the environment) and nested assumptions (about the physical components of the CPS); and (ii) the use of time bands to record the temporal properties required of the CPS at a number of different granularities. The key contribution is in combining these ideas; using time bands overcomes a significant drawback in earlier work. The paper also addresses the means by which the reliability of a CPS can be addressed by challenging each rely condition in the derived specification and, where appropriate, improve robustness and/or define weaker guarantees that can be delivered with respect to the corresponding weaker rely conditions.
Quantitative estimation of extravascular lung water volume and preload by dynamic 15O-water positron emission tomography
Authors: Nielsen Roni Ranghøj , Sörensen Jens , Tolbod Lars , Alstrup Aage Kristian Olsen , Iversen Peter , Frederiksen Christian Alcaraz , Wiggers Henrik , Jorsal Anders , Frøkier Jørgen , Harms Hendrik Johannes
Published: February 2019

Aims

Left ventricular filling pressure (preload) can be assessed by pulmonary capillary wedge pressure (PCWP) during pulmonary arterial catheterization (PAC). An emerging method [pulse indexed contour cardiac output (PICCO)] can estimate preload by global end-diastolic volume (GEDV) and congestion as extravascular lung water (EVLW) content. However, no reliable quantitative non-invasive methods are available. Hence, in a porcine model of pulmonary congestion, we evaluated EVLW and GEDV by positron emission tomography (PET). The method was applied in 35 heart failure (HF) patients and 9 healthy volunteers.

Methods and results

Eight pigs were studied. Pulmonary congestion was induced by a combination of beta-blockers, angiotensin-2 agonist and saline infusion. PAC, PICCO, computerized tomography, and 15O-H2O-PET were performed. EVLW increased from 521 ± 76 to 973 ± 325 mL (P < 0.001) and GEDV from 1068 ± 170 to 1254 ± 85 mL (P < 0.001). 15O-H2O-PET measures of EVLW increased from 566 ± 151 to 797 ± 231 mL (P < 0.001) and GEDV from 364 ± 60 to 524 ± 92 mL (P < 0.001). Both EVLW and GEDV measured with PICCO and 15O-H2O-PET correlated (r2 = 0.40, P < 0.001; r2 = 0.40, P < 0.001, respectively). EVLW correlated with Hounsfield units (HU; PICCO: r2 = 0.36, P < 0.001, PET: r2 = 0.46, P < 0.001) and GEDV with PCWP (PICCO: r2 = 0.20, P = 0.01, PET: r2 = 0.29, P = 0.002). In human subjects, measurements were indexed (I) for body surface area. Neither EVLWI nor HU differed between chronic stable HF patients and healthy volunteers (P = 0.11, P = 0.29) whereas GEDVI was increased in HF patients (336 ± 66 mL/m2 vs. 276 ± 44 mL/m2, P = 0.01).

Conclusion

The present study demonstrates that 15O-H2O-PET can assess pulmonary congestion and preload quantitatively. Hence, prognostic information from 15O-H2O-PET examinations should be evaluated in clinical trials.
NLRP7 and KHDC3L variants in Chinese patients with recurrent hydatidiform moles
Authors: Ji Mingliang , Shi Xiaohua , Xiang Yang , Cui Quancai , Zhao Jun
Published: February 2019

Objective

Recurrent hydatidiform moles are reportedly biparental complete moles and related to mutated NLRP7 and KHDC3L. This study was designed to identify mutations of gene NLRP7 and KHDC3L in biparental complete moles.

Methods

In this study, we have screened NLRP7 and KHDC3L mutations in five patients with recurrent moles and five with sporadic moles. Molar tissues and blood samples were collected from patients and their partners. Genotypes of the molar tissues were determined based on short tandem repeat polymorphism. The coding exons of NLRP7 and KHDC3L were sequenced.

Results

Two patients with recurrent moles had biparental complete moles, while all other patients had androgenetic complete moles. Three non-synonymous variants in NLRP7 (c.955 G>A, c.1280 T>C and c.1441 G>A) and one in KHDC3L (c.602 C>G) were identified in patients with recurrent moles. NLRP7 c.1441 G>A and c.1280 T>C were mutations found in the Chinese population, while c.1441 G>A was only detected in patients with biparental complete moles in this study.

Conclusions

Genotyping can be used to differentiate biparental complete moles from androgenetic moles and to predict the risk of recurrent moles in future pregnancies. NLRP7 c.1441 G>A may associate with biparental complete moles. Biparental complete moles exhibit genetic heterogeneity.
‘Mirages of an Intellectual Dreamland’? Ratio, Obiter and the Textualization of International Precedent
Authors: Ridi Niccolò
Published: February 2019

In recent years, various actors—states, judges and commentators alike—have taken issue with the way international adjudicators have approached precedent. Criticism has been levelled, in particular, to the phenomenon of ‘obiter dicta’ (observations that, though not necessary for the decision, are nonetheless included in it), which have been found to amount to a symptom of bad decision-making or, from the perspective of the adjudicator using them, bad precedent following. This article addresses this debate by resituating the issue within a more grounded discussion of the theory of precedent in international adjudication, providing an in-depth theoretical and empirical analysis of the practice, and seeks to frame it within in the broader phenomenon of ‘textualization’. By doing so, it strives to clarify the use, authority and ultimate function of obiter dicta, as well as of precedent in general, in international adjudication.
Pathogenesis of Acute Kidney Injury
Authors: Basile David P. , Padanilam Babu J.
Published: February 2019

Acute kidney injury represents a significant clinical disorder associated with a rapid loss of renal function following a variety of potential insults. This chapter reviews multiple issues related to the pathophysiology of AKI with an emphasis on studies from animal models. Early responses following kidney injury include impaired hemodynamic and bioenergetic responses. Reductions in renal ATP levels occur as a result of compromised fatty acid oxidation and impaired compensation by glycolysis. Sustained reductions in perfusion contribute to extension of AKI characterized by complex inflammatory and cellular injury responses, often leading to cell death. Concurrently, the kidney displays an elegant repair response, leading to successful recovery in most cases, characterized in part by epithelial cell growth, while maladaptive or incomplete recovery of tubules or capillaries can predispose the development of interstitial fibrosis and CKD progression.
Imaging of the Kidney
Authors: Wymer David C. , Wymer David T. G.
Published: February 2019

The focus of this chapter is the use of imaging in providing the information necessary to protect the kidney from insults (metabolic and physical) and when needed to evaluate effects of age related renal changes, drugs, treatments, and trauma on renal function. Imaging is an integral part in the evaluation of the renal patient. Radiology has a mandate to help provide a diagnosis while balancing the benefits of imaging against any potential adverse effect encountered in the imaging process. Major considerations in deciding on how to best image a given patient include radiation exposure, contrast allergies, potential contrast toxicity (including systemic effects such as NSF), psychological effects (such as claustrophobia), and renal trauma secondary to interventional procedures.
Slowing Progression of Chronic Kidney Disease
Authors: Pollack-Zollman Martine , Vassalotti Joseph A.
Published: February 2019

CKD progression is introduced broadly, including definitions to distinguish related conditions (such as rapid CKD progression from AKI), common pathways for loss of kidney function, as well as validated ESRD prediction models to risk stratify patients and populations. Interventions to slow CKD progression are hypertension control in the context of current blood pressure target controversies, use of RAAS blockade for hypertension with albuminuria (A3) or proteinuria, glycemic control in diabetes, diabetic kidney disease therapy with a focus on recent and ongoing interventional trials and alkali therapy for CKD metabolic acidosis. Other less evidenced-based treatments (retrospective and observational trials, as well as secondary outcomes of RCT) to slow CKD progression are also discussed. These include the folic acid supplementation in the deficient population, SGLT-2 inhibitors for type-2 diabetes, intervention for obstructive sleep apnea, prevention of AKI, early nephrology referral and implementation of the multi-disciplinary approach to slowing CKD progression.
Obstructive Uropathies
Authors: Deshpande Priya , Sharma Shuchita
Published: February 2019

Obstructive Uropathy remains an important cause of acute kidney injury. The etiology of obstructive uropathy can be very variable ranging from extrinsic compression of the urinary tract by tumors or surrounding structures to intraluminal obstruction by crystals and stones. Patients with obstructive uropathy manifest symptoms based on the area of obstruction within the urinary tract. Flank pain, hematuria, and suprapubic discomfort are some of the associated symptoms. The diagnosis of obstructive uropathy requires a high index of suspicion and, depending on its nature, can be confirmed clinically and/or with an imaging modality. Prompt diagnosis and treatment with effective relief of obstruction is important in preventing long-term and permanent damage to the kidneys.
Acute Kidney Injury from Therapeutic Agents
Authors: Knicely Daphne , Choi Michael J. , Thavarajah Sumeska
Published: February 2019

Many agents, which are crucial for diagnostic and therapeutic purposes, are associated with nephrotoxicity and acute kidney injury. The nephrotoxicity often becomes the limiting factor for use of these agents, and, in some cases, there are no alternative agents. This chapter reviews the common classes of agents that are associated with nephrotoxicity (contrast, intravenous immunoglobulin, aminoglycosides, vancomycin, amphotericin, and nonsteroidal anti-inflammatory drugs). The mechanisms of nephrotoxicity from these agents as well various patient risk factors associated with nephrotoxicity are examined, and potential strategies to try to prevent acute kidney injury are reviewed. There are many therapeutic agents that cause renal toxicity that often become the limiting factor in the agent’s use. Often, there are no alternative agents available, so recognition of the risk factors for nephrotoxicity and incorporation of preventative measures are critical.
Immunological Agents in the Treatment of Glomerulonephritis
Authors: Farouk Samira , Winston Jonathan
Published: February 2019

Glomerulonephritis is an important cause of end-stage renal disease worldwide, and treatment strategies have evolved over the past several decades. Immunosuppressive therapies compromise the majority of available therapeutic options. Glucocorticoids, first studied in glomerular disease patients in 1957, remains a first-line therapy for most glomerular diseases. The decision of which cocktail of immunosuppressive therapies to prescribe is not only driven by data but also by patient characteristics and adverse effect profiles. Though the majority of current therapeutic options are globally immunosuppressive therapies, more targeted and less toxic therapies are being developed and tested in clinical trials. An understanding of the mechanisms and efficacy of each of these immunological agents in various glomerular diseases is critical for the nephrologist.
NSAIDs and the Kidney
Authors: Chan Lili , Kim Tonia
Published: February 2019

NSAIDs are among the most commonly prescribed medications in the United States. NSAID associated kidney disease presents in various ways including ischemic acute kidney injury, nephrotic syndrome, and analgesic nephropathy. Elderly patients and patients who are also on diuretics and/or renin angiotensin aldosterone system blockade are at higher risk of developing NSAIDs associated kidney disease. Additionally, NSAIDs negatively impact blood pressure. Unfortunately, there is no currently effective therapy for the prevention of NSAIDS associated kidney disease. Proposed preventative strategies are discussed.
Chemotherapeutic Agents and the Kidney
Authors: Selamet Umut , Hanna Ramy M. , Rastogi Anjay , Abudayyeh Ala
Published: February 2019

Chemotherapeutic agents have toxicities that extend beyond their therapeutic effect on malignant cells, and the kidneys are involved in the metabolism of these agents. Kidney toxicity delay the elimination of anticancer drugs from the body and increase the risk of systemic toxicity. Conventional chemotherapeutics generally cause direct renal tubular injury and electrolyte wasting syndromes. Newer cancer treatments include targeted therapy and immunotherapy. Targeted therapy, especially the drugs that target vascular endothelial growth factor, disrupt the crosstalk between podocytes and endothelial cells of the glomerulus resulting in a spectrum of glomerular diseases. On the other hand, immune checkpoint inhibitors release the break on the immune system and can cause immune-mediated tubulointerstitial nephritis and glomerulonephritis similar to autoimmune diseases. This chapter summarizes nephrotoxicity profiles of some of the common conventional chemotherapeutics as well as newer anticancer agents.
Thrombotic Microangiopathies
Authors: Kaufman Lewis
Published: February 2019

The thrombotic microangioapathy (TMA) syndromes are characterized by concomitant occurrence of severe thrombocytopenia, microangiopathic hemolytic anemia, and ischemic end organ dysfunction often of the kidneys. While several of their features overlap in terms of clinical presentation, the pathophysiology and underlying causes of each form of primary TMA are quite unique. Over the last decade, researchers’ understanding of these underlying causes has accelerated dramatically, providing transformative approaches to the way patients with these disorders are diagnosed, followed, stratified, and treated. These targeted approaches have led to rapidly evolving patient outcomes including the development of novel therapeutic approaches to prevent and treat kidney disease in these patients.
Kidney Disease in HIV Infection and Treatment
Authors: Wyatt Christina M.
Published: February 2019

HIV-positive individuals are at increased risk of kidney disease as a result of HIV-related kidney disease, toxicity of antiretroviral therapy, and accelerated progression of comorbid kidney disease. Because of the broad spectrum of disease, kidney biopsy should be considered in all HIV-positive individuals who present with kidney disease. While an effective combination antiretroviral therapy has substantially reduced the incidence of HIV-associated nephropathy, antiretroviral therapy appears to have less impact on immune-complex kidney disease and comorbid kidney diseases. The management of kidney disease in HIV-positive individuals is complicated by unique drug–drug interactions and drug effects on creatinine-based estimates of kidney function.
Visual and Perceptual Science and Radiology
Authors: Bruno Michael A.
Published: February 2019

This chapter discusses the science of human visual perception, including recently published experimental results that directly explore the underlying visual perceptual processes involved in diagnostic radiology. The amazing properties of human visual perception have been found to involve a (perhaps unexpectedly) complex interplay between the eye and brain and can be affected by a large number of factors in surprising and unexpected ways. We will discuss what is different about a radiologist’s brain in this regard, compared to the brains of people who are not similarly trained and experienced. The chapter reviews the most common radiologist errors, as these may yield key insights into the process and lead to more effective strategies for error prevention.
Reducing Error in Radiology
Authors: Bruno Michael A.
Published: February 2019

This chapter reviews a new “theory of error,” which is a way of classifying errors based on three principal types of error causes. Mechanisms and solutions are proposed for each of these major error types. The strategies for error reduction that we discuss include those aimed at systems factors, those aimed at individual and cognitive factors, and those aimed at overcoming the flaws that are inherent to the basic neurobiological makeup of human beings and that predispose us to making certain types of error in this setting. We conclude by outlining a “roadmap” for reducing error in radiology in the future.
Introduction to Palliative Care
Authors: Ferrell Betty Rolling
Published: February 2019

This chapter serves as an introduction to the 5th edition of the Oxford Textbook of Palliative Care, designed to be an evidence-based resource for nurses to assist with the real challenges they face at the patient’s bedside. At a time when our population is aging, the healthcare payment system is uncertain, healthcare costs are escalating, and more people are faced with chronic illnesses, there is a pressing need to extend palliative care into an increasing range of settings. It is the intent of the authors and the editors to provide concise and practical information to assist nurses as they address the palliative care needs of the seriously ill and the dying and their families.
National Consensus Project for Quality Palliative Care
Authors: Dahlin Constance M.
Published: February 2019

Hospice in the United States has been delineated by Medicare Conditions of Participation. Without specific palliative care financing, there are no federal standards or payments for palliative care. The National Consensus Project for Quality Palliative Care was originally a collaborative entity composed of six organizations and now comprises ten organizations. Its purpose is to create national standards for comprehensive quality palliative care. The Clinical Practice Guidelines delineate eight domains of quality care reflecting patient-centered care with an interdisciplinary approach across all settings. Over the course of 17 years, each edition of the guidelines has reflected the growth and maturity of palliative care and its movement from care for people with life-threatening illness to care for patients upon a diagnosis of a serious illness.
Principles of Patient and Family Assessment
Authors: Chovan John D.
Published: February 2019

Nursing assessment comprising physical, psychosocial, and spiritual domains is essential for planning palliative care. Such assessment involves input from the patient, family, and all members of the interdisciplinary team, with information shared verbally as well as in the patient’s health records. Ongoing, detailed, and comprehensive assessment is requisite to identifying the complex and changing needs and goals of patients facing chronic or life-threatening illness and those of their families. In this chapter, goals, techniques, and tools are discussed for assessing patients and families during four timeframes occurring during chronic and life-threatening illnesses: diagnosis, during treatments, when treatment is over, and during active dying. A case study threads through the chapter to illustrate the application of these principles and techniques in culturally appropriate ways.
Bowel Management
Authors: Mooney Stefanie N. , Patel Purvi , Buga Sorin
Published: February 2019

This chapter reviews palliative considerations for bowel management in a patient with advanced disease such as cancer, liver failure, AIDS, or general debility. In particular, it discusses the definition, prevalence, pathophysiology, assessment, and management of gastrointestinal symptoms common in the palliative population, including constipation and diarrhea. It also reviews malignant bowel obstruction and ascites and how these may impact quality of life for patients with life-limiting illness. The discussion of management includes both pharmacologic approaches and supportive care options. This information is designed to help guide nursing assessment and treatment of bowel management, as well as provide useful insight to any clinical provider encountering these conditions.
Bladder Management in Palliative Care
Authors: Farrington Naomi , Murphy Catherine
Published: February 2019

Management of urinary difficulties in palliative care should be as much a priority for nursing care as symptoms such as pain and nausea, as these, too, can cause great distress and discomfort. This chapter discusses the urinary and bladder difficulties that may occur in a patient approaching the end of life and the options for nursing care that can be considered with personalized, holistic care in mind. Potential problems for patients in receipt of palliative care can include voiding dysfunctions such as urinary retention, toileting issues such as incontinence, and painful bladder difficulties such as spasm and infection. Priorities for nursing care are detailed, taking into account the patient’s clinical situation and personal preferences.
Palliative Wound, Ostomy, and Continence Care
Authors: Tilley Charles P. , Fu Mei R. , Lipson Jana M.
Published: February 2019

Palliative wound, ostomy, and continence care is a nascent area of palliative care nursing, with little research and few evidence-based guidelines to guide practice. The majority of patients at end of life will suffer from a wound, ostomy, or continence malady, requiring specialist-level consultation with a wound, ostomy, and continence nurse (WOC nurse). Palliative wound, ostomy, and continence care emphasizes an interprofessional, patient-centered approach to alleviate suffering and promote well-being and quality of life through the preservation or restoration of functional performance. A combination of evidence-based wound, ostomy, and continence nursing interventions and advanced symptom management science is the hallmark of this nursing specialty.
Pruritus, Fever, and Sweats
Authors: Smothers Angel
Published: February 2019

The key to successful symptom management with pruritus, fever, and sweats rests on identifying common underlying causes for the symptoms and using evidence-based nonpharmacological and pharmacological treatments to improve quality of life. Pruritus is explained by those who experience it as an itching sensation where the location of the itch usually cannot be identified. Pruritus can accompany different serious chronic illnesses with the underlying pathophysiology not well understood. Fever and sweats can accompany pruritus or can occur as isolated symptoms. Fever can be related to an infection but also can be related to other physiological issues including neurological ones. Sweating can occur as a physical response or an emotional one.
Delirium, Confusion, and Agitation
Authors: Goldberg Wendy , Mahr Greg , Williams Amy M. , Ryan Michael
Published: February 2019

Delirium is a serious and common complication of the medical care of the seriously or terminally ill. Patients present as confused, agitated, abstracted, or withdrawn. Delirium, though challenging to diagnose, is important to recognize and treat. Medical complications, length of stay, cost of care, and caregiver burden are all adversely affected by the presence of delirium. The authors review diagnostic issues, including commonly used screening tools. Pharmacological and nonpharmacological interventions are described in detail. Such interventions have been shown to both prevent and effectively treat delirium. Delirium, and the agitation and confusion that can accompany the disorder, is very frustrating for families and caregivers. Nursing management and family interventions are particularly important in the management of this complex disorder.
Sedation for Refractory Symptoms
Authors: Banerjee Chandana , Freeman Bonnie
Published: February 2019

Palliative sedation is an end-of-life comfort measure often misunderstood by both families and healthcare providers. Its use can vary from a short respite from pain to a continuous and deep sedation that is maintained until death. Either way, it involves an elective choice. This chapter focuses on deep sedation that does not cause respiratory arrest but that renders a patient unresponsive to verbal and tactile stimuli. With deep sedation, the patient is prevented from eating, drinking, and interacting with loved ones. As a result, deep sedation can become an ethical, social, and moral issue for both family and healthcare staff, as it may accelerate the dying process by causing dehydration, starvation, and overmedication. It is for these reasons that some individuals believe palliative sedation to be nothing more than “slow euthanasia.” This chapter will address the ethical and symptomatic issues associated with deep sedation for the dying.
The Meaning of Hope in the Dying
Authors: Cotter Valerie T. , Foxwell Anessa M.
Published: February 2019

This chapter explores the many dimensions of hope and identifies its possible influence on health and quality of life. Hope is a key factor in coping with and finding meaning in the experience of life-threatening illness. Hope is integrally entwined with spiritual and psychosocial well-being. Although terminal illness can challenge and even temporarily diminish hope, the dying process does not inevitably bring despair. The human spirit, manifesting its creativity and resiliency, can forge new and deeper hopes at the end of life. Palliative care nurses play important roles in supporting patients and families with this process by providing expert physical, psychosocial, and spiritual care. Sensitive, skillful attention to maintaining hope can enhance quality of life and contribute significantly to a “good death,” as defined by the patient and family. Fostering hope is a primary means by which palliative care nurses accompany patients and families on the journey through terminal illness. In this chapter, nursing assessment and strategies to nurture and respect individual variations in hope are described. Specific issues such as “unrealistic hopefulness” and cultural considerations in the expression and maintenance of hope are discussed. The goals of the chapter are to provide the reader with an understanding about this complex but vital phenomenon; to offer guidance in the clinical application of this concept to palliative nursing care; and to explore some of the controversies about hope that challenge clinicians.
Supporting Families and Family Caregivers in Palliative Care
Authors: Stajduhar Kelli I. , Dionne-Odom J. Nicholas
Published: February 2019

This chapter investigates best practices for nurses who are involved in supporting families and family caregivers in palliative care. It views the family as a specialized unit of care which contributes to the healthcare system in a substantive way. There are significant implications for families and family caregivers in taking on these responsibilities, and nurses play a vital part in maintaining the integrity and health of the family and family caregiver. With a focus on palliative care, specific suggestions are made for nurses’ assessments in identifying needs and providing subsequent interventions. Particular sites of care (home, acute, etc.) and implications arising from a range of disease categories are discussed. The chapter concludes with recommendations for identifying community resources.
Spiritual Care Intervention
Authors: Rosa William
Published: February 2019

Spirituality is one of the primary unifying forces of the human experience. It inextricably links us as human beings of the global village across cultures, continents, faith traditions, genders, socioeconomic differences, and the continuum of wellness–illness. Spiritual care addresses the suffering inherent to the human experience and seeks to mitigate the deeply painful consequences of loss (of autonomy, relationships, health, etc.), hopelessness and/or isolation, recognizing one’s mortality, or feeling unseen, unheard, unacknowledged, or voiceless. Effective spiritual care intervention requires a level of awareness and attention beyond the clinical data and rote nature of traditional nursing tasks. Through compassion in action and the intelligent use of a broad spectrum of modalities and communication methods, the nurse can create a healing environment that alleviates spiritual distress and promotes spiritual well-being. Love is the ultimate spiritual care intervention—the moral/ethical foundation of nursing: the holy work of touching bodies and spirits and souls.
Palliative Care for People Living with HIV
Authors: Slomka Jacquelyn
Published: February 2019

This chapter discusses the palliative care needs of people living with HIV (PLWH). Now considered a chronic condition, HIV presents specific challenges both for individuals who are long-term survivors and for those adults who are recently diagnosed. The initial diagnosis of a chronic condition can be devastating for anyone, but a diagnosis of HIV may be especially stressful and challenging due to the social stigma and history associated with it. For PLWH whose condition is well-controlled, the development of comorbidities associated with disease characteristics, medication, or the aging process speaks to the need for palliative care throughout the disease trajectory. This chapter focuses on the social context impinging on those needs. It provides palliative care content that can facilitate nurses’ collaborations with patients, as well as with physicians and other healthcare team members who care for adults with HIV.
Cancer Survivorship
Authors: Reb Anne , Economou Denice
Published: February 2019

Cancer survivors are living longer as a result of treatment advances, and, for those with advanced cancer, there is more uncertainty regarding prognosis and future needs. Survivors will need support to manage long-term side effects including physical and emotional concerns such as fear of recurrence and uncertainty. The palliative care approach to cancer survivors includes assessment of physical, psychological, social, family, and spiritual concerns. Psychosocial, emotional, and spiritual concerns may contribute to physical symptoms, a fact that supports the importance of a holistic and comprehensive approach to symptom management. Referrals to palliative or supportive care should be based on patient and caregiver needs rather than on prognosis. Survivors with advanced cancer or high symptom burden should be referred to interdisciplinary palliative care teams. Survivors in transition from active treatment and those in remission may benefit from early referrals to rehabilitation services to help improve function and manage common symptoms. A comprehensive geriatric assessment can help to identify health concerns and the need for supportive care interventions. This chapter will discuss considerations for incorporating palliative care during the cancer survivorship trajectory; common symptoms and assessment strategies; communication challenges; and a brief overview of nonpharmacologic approaches to symptom management.
Organ Donation
Authors: Hansen Lissi , Dunn Lauren F.
Published: February 2019

This chapter examines the organ donation process from the time the bedside nurse recognizes that a patient should be referred for organ donation until organ procurement has been completed. It also discusses when to speak with families about organ donation, how to address family concerns, the clinical triggers for organ donation, differences between brain death donation and donation after circulatory death (DCD), and palliative care for patients who are candidates for DCD. State and federal regulations related to prospective donors and safeguarding standards that are in place for organ procurement organizations (OPO) and hospitals are also included.
Pulmonary Palliative Care
Authors: Maani-Fogelman Patricia A. , Weller Ruby A.
Published: February 2019

People with advanced lung disease have physical, psychological, social, and spiritual issues that reduce their quality of life. While they may receive life-prolonging treatment, this usually does not address these other essential components. Symptom management is essential and should address air hunger, exertional dyspnea, chest tightness, anxiety/panic, increased work of breathing as evidenced by increased accessory muscle use, and increased oxygen needs, along with concomitant spiritual or existential distress and grief. Early identification and intervention of pulmonary function, frequency of exacerbations, need for oxygen, and functional status are crucial. A particular challenge in managing the care of those with advanced lung disease is the unpredictability of their illness and difficulty in prognostication. Earlier involvement of palliative care in those with advanced lung disease leads to improved quality of life for patients and families, as well as a more efficient utilization of medical resources that are consistent with the patient’s wishes.