bluuebunny/crossref_metadata_2025 huggingface dataset:
The Trials (and Tribulations) of Complementary and Alternative Medicine in Oncology
Authors: Ludmir Ethan B , Jethanandani Amit , Mainwaring Walker , Miller Austin B , Lin Timothy A , Espinoza Andres F , Verma Vivek , VanderWalde Noam A , Grossberg Aaron J , Guadagnolo B Ashleigh , Koong Albert C , Jagsi Reshma , Thomas Charles R , Fuller C David
Published: May 2019

Two decades following the creation of the Office of Cancer Complementary and Alternative Medicine at the National Cancer Institute, the status of complementary and alternative medicine (CAM) research within oncology remains opaque. To better understand the landscape of CAM studies in oncology, we identified CAM-related phase III randomized controlled trials (RCTs) through ClinicalTrials.gov and compared these CAM trials to all non-CAM oncologic RCTs. Pearson χ2 testing was used to compare proportions across groups; all tests were two-sided. Comparing the 25 identified CAM RCTs with 739 non-CAM RCTs, CAM studies were more likely to be sponsored by a cooperative group (64.0% vs 28.6%, P < .001) and less likely to be industry funded (8.0% vs 76.5%, P < .001). CAM trials disproportionately excluded disease-related outcomes as endpoints (8.0% vs 84.6%, P < .001), were unsupported by prior early-phase data (55.0% vs 96.1%, P < .001), and did not meet the primary endpoint (8.7% vs 53.0%, P < .001). Given the observed relationship between encouraging pilot data and subsequent phase III trial success, we contend that future CAM RCTs may yield more promising findings if better supported by appropriately designed and well-characterized early-phase signals.
Severe yellow fever in Brazil: clinical characteristics and management
Authors: Ho Yeh-Li , Joelsons Daniel , Leite Gabriel F C , Malbouisson Luiz M S , Song Alice T W , Perondi Beatriz , Andrade Lucia C , Pinto Lécio F , D’Albuquerque Luiz A C , Segurado Aluisio A C ,   Hospital das Clínicas Yellow Fever Assistance Group
Published: May 2019

Background

Little is known about clinical characteristics and management of severe yellow fever as previous yellow fever epidemics often occurred in times or areas with little access to intensive care units (ICU). We aim to describe the clinical characteristics of severe yellow fever cases requiring admission to the ICU during the 2018 yellow fever outbreak in São Paulo, Brazil. Furthermore, we report on preliminary lessons learnt regarding clinical management of severe yellow fever.

Methods

Retrospective descriptive cohort study. Demographic data, laboratory test results on admission, clinical follow-up, and clinical outcomes were evaluated.

Results

From 10 January to 11 March 2018, 79 patients with laboratory confirmed yellow fever were admitted to the ICU in a tertiary hospital in Sao Paolo because of rapid clinical deterioration. On admission, the median AST was 7,000 IU/L, ALT 3,936 IU/L, total bilirubin 5.3 ml/dL, platelet 74 × 103/mm3, INR 2.24 and factor V 37%. Seizures occurred in 24% of patients, even without substantial intracranial hypertension. The high frequency of pancreatitis and rapidly progressive severe metabolic acidosis were notable findings. 73% of patients required renal replacement therapy. The in-hospital fatality rate was 67%. Patients with diabetes mellitus had a higher case fatality rate (CFR) of 80%, while patients without diabetes had a CFR of 65%. Leading causes of death were severe gastrointestinal bleeding, epileptic status, severe metabolic acidosis, necrohemorrhagic pancreatitis, and multi-organ failure.

Conclusions

Severe yellow fever is associated with a high CFR. The following management lessons were learnt: Anticonvulsant drugs in patients with any symptoms of hepatic encephalopathy or arterial ammonia levels >70 μmol/L was commenced which reduced the frequency of seizures from 28% to 17%. Other new therapy strategies included early institution of plasma exchange. Due to the high frequency of gastric bleeding, therapeutic doses of intravenous proton pump inhibitors should be administered.
Empathy
Authors: Elliott Robert , Bohart Arthur C. , Watson Jeanne C. , Murphy David
Published: May 2019

Empathy refers to understanding what another person is experiencing or trying to express. The chapter begins by discussing definitional issues and presenting an integrative definition. It then reviews measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. Clinical examples illustrating different forms of therapist empathy and empathic response modes are then presented. The core of the review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .28 (equivalent of d = .58) for 82 independent samples and 6,138 clients. In general, the empathy–outcome relation held for different theoretical orientations and client presenting problems. The chapter considers the limitations of the current data and concludes with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy.
Promoting Treatment Credibility
Authors: Constantino Michael J. , Coyne Alice E. , Boswell James F. , Iles Brittany R. , Vîslă Andreea
Published: May 2019

Patients’ perception of treatment credibility represents their belief about a treatment’s personal logicality, suitability, and efficaciousness. Although long considered an important common factor bearing on clinical outcome, there have been no systematic reviews of the credibility–outcome association. In this chapter, the authors first discuss the definitions of credibility and similar constructs, common measures of credibility, clinical examples of treatment credibility perception, and several landmark studies. The chapter then presents a meta-analysis of the association between patients’ credibility perception and their posttreatment outcomes. The meta-analysis was conducted on 24 independent samples with 1,504 patients. The overall weighted effect size was r = .12, or d = .24. Next, the authors present moderators and mediators of the treatment credibility–outcome link (the former in the context of the meta-analysis), evidence supporting causality in the association, patient factors contributing to their treatment credibility perception, and limitations of the research base. Finally, the chapter reviews diversity considerations, training implications, and therapeutic practices with regard to patient-perceived treatment credibility and its association with therapy outcome.
Evidence-Based Psychotherapy Responsiveness: The Third Task Force
Authors: Norcross John C. , Wampold Bruce E.
Published: May 2019

This chapter introduces the second volume of Psychotherapy Relationships That Work and frames its work within the Interdivisional APA Task Force on Evidence-Based Relationships and Responsiveness. The book presents clinical examples, original meta-analyses, diversity considerations, training implications, and research-infused practice recommendations for nine methods of adapting or tailoring psychotherapy to clients’ transdiagnostic characteristics (attachment style, coping style, racial/ethnic culture, gender identity, therapy preferences, reactance level, religion/spiritual identity, sexual orientation, and stages of change). The chapter outlines the purpose and history of the interdivisional task force and its relation to previous efforts to identify evidence-based practices in psychotherapy. The chapter also presents the key limitations of the work.
Preferences
Authors: Swift Joshua K. , Callahan Jennifer L. , Cooper Mick , Parkin Susannah R.
Published: May 2019

Client preferences in psychotherapy reflect specific conditions and activities that clients desire in their treatment, with increasing evidence pointing to preference accommodation as facilitating psychotherapy outcomes. This updated meta-analysis establishes the magnitude of the effect of client preference accommodation in psychotherapy. Based on data from 53 studies and over 16,000 clients, preference accommodation was associated with fewer treatment dropouts (odds ratio = 1.79) and more positive treatment outcomes (d = .28). The chapter provides case examples of preference accommodation, limitations of the research, diversity considerations, and practice recommendations for working with client preferences.
Reactance Level
Authors: Edwards Christopher J. , Beutler Larry E. , Someah Kathleen
Published: May 2019

Resistance and its extreme variation, reactance, are uniformly observed across varieties of psychotherapy. This chapter provides definitions of reactance, reviews its frequent measures, and offers a clinical example. A meta-analysis of 13 controlled studies (1,208 patients) examined the degree to which treatment outcomes are enhanced when therapists offer less directive treatments to high reactance patients. The results revealed a large effect size (d = .79), confirming that highly reactant individuals did better in psychotherapy when the therapist assumed a reflective and nondirective stance. To a lesser degree, the opposite was also true. Limitations of the research and diversity considerations are noted. Practice recommendations are provided to minimize a patient’s reactant behavior.
Religion and Spirituality
Authors: Hook Joshua N. , Captari Laura E. , Hoyt William , Davis Don E. , McElroy Stacey E. , Worthington Everett L.
Published: May 2019

Some religious or spiritual (R/S) clients seek psychotherapy that integrates R/S values, while others may be reticent to disclose R/S-related aspects of struggles in a presumably secular setting. The authors meta-analyzed 97 outcome studies (N = 7,181) examining the efficacy of tailoring treatment to patients’ R/S beliefs and values. They compared the effectiveness of R/S-tailored psychotherapy with no-treatment controls, alternate secular treatments, and additive secular treatments. R/S-adapted psychotherapy resulted in greater improvement in clients’ psychological (g = .74) and spiritual (g = .74) functioning compared with no treatment and non-R/S psychotherapies (psychological g = .33; spiritual g = .43). In more rigorous additive studies, R/S-accommodated psychotherapies were equally effective to standard approaches in reducing psychological distress (g = .13) but resulted in greater spiritual well-being (g = .34). The chapter features several clinical examples and concludes with evidence-based therapeutic practices.
Sexual Orientation
Authors: Moradi Bonnie , Budge Stephanie L.
Published: May 2019

The clinical need for lesbian, gay, bisexual, and queer (LGBQ+) affirmative psychotherapies has been widely recognized; however, empirical research on the outcomes of such psychotherapies is limited. This chapter begins by offering definitions and delineating four key themes of LGBQ+ affirmative psychotherapies. The authors conceptualize LGBQ+ affirmative psychotherapies not as sexual orientation group specific but rather as considerations and practices that can be applied with all clients. The chapter then summarizes a search for studies to attempt a meta-analysis and discusses limitations and directions for research based on this search. The chapter ends by delineating diversity considerations and recommending therapeutic practices for advancing affirmative psychotherapy with clients of all sexual orientations.
Stages of Change
Authors: Krebs Paul , Norcross John C. , Nicholson Joseph M. , Prochaska James O.
Published: May 2019

The transtheoretical model and the stages of change are often used to adapt treatment to the individual client. This chapter aims to review the stages of change and popular measures of change readiness in psychotherapy and to conduct a meta-analysis of the relation between readiness measures and psychotherapy outcomes. This chapter reports data from 76 studies, encompassing 25,917 patients. Moderate-sized effects (d =.41) were found for the association between stages and psychotherapy success. Outcomes were a function of pretreatment stage of change; that is, the farther a patient is along the stages, the better the treatment outcomes. The chapter concludes with limitations of the research, diversity considerations, and therapeutic practices for stage matching in psychotherapy specifically and behavioral health more generally.
Which Problems Do You Address First?
Authors: Brody David L.
Published: May 2019

Concussion patients often have a lot of things going on at the same time. Consider these three principles: (1) Ask the patient what’s bothering him the most. Often it is pain. Migraine headaches, for example, can be terrible. Try to deeply understand the patient’s life to figure out what matters most. (2) Ask the collateral source what’s causing the most problems in the patient’s life? Often it is mood instability. “He’s not the same person” is a common complaint. Sometimes, the most important problems following concussion are not immediately apparent to the patient. (3) Look for the “top of the cascade”: one single problem that is the root cause of one or more additional problems. For example, sleep disruption can in turn worsen memory, attention, pain, mood disorders and many other symptoms. Major depression can impair virtually every aspect of life, including energy, sleep, pain, attention, and memory.
Headaches
Authors: Brody David L.
Published: May 2019

First Rule: Triage is more important than diagnosis. Take a careful history by asking specific hypothesis-testing questions. Examine the patient. This is important. You can’t do it over the phone. Second rule: Migraines are really common after concussion; an atypical presentation of migraine is still more likely than most other types of headaches. Consider nonpharmacological measures, triptans, over-the-counter analgesics, and good prophylaxis as for regular migraine. Third rule: Patients can have more than one type of headache at the same time. Fourth Rule: Patients with medication overuse headache aren’t going to get better from anything you do until the medication overuse is addressed. Consider admitting patients with medication overuse headaches to the hospital.
Sleep Disruption
Authors: Brody David L.
Published: May 2019

Patients will get worse over time, not better, if they accumulate sleep deficit from chronic insomnia.

The hierarchy for sleep is as follows: Best is good-quality natural sleep, second best is pharmacologically enhanced good-quality sleep, worst is insufficient or poor-quality sleep.

The main tools are cognitive behavioral therapy for insomnia and pain control. Sleep medications such as Melatonin, zolpidem (Ambien), Eszopiclone (Lunesta), and trazodone are helpful and relatively safe for short-term use in concussion patients. Avoid whenever possible medications that can impair recovery and cognitive function, such as benzodiazepines, anticholinergics, and antipsychotics; avoid use of alcohol as a sleep aide. Consider using a quantitative tool such as the Insomnia Severity Index. If there are concerns, refer to a sleep medicine clinic for consultation and a formal sleep study; patients may not be reliable historians with regard to their sleep habits. Obstructive sleep apnea is very common in concussion patients.
Anxiety and Depression
Authors: Brody David L.
Published: May 2019

First, assess safety. Severe anxiety and depression can lead to suicide. Second, distinguish between reactive anxiety and depressive symptoms vs. an impairing mood disorder. The ‘treatment’ for reactive anxiety and depressive symptoms is education, reassurance, and a good plan to get the patient’s life back on track. If the patient has an impairing (but not immediately dangerous) mood disorder, it can be treated for the most part just like a mood disorder in the absence of concussion. The optimal approach usually involves both non-pharmacological and pharmacological interventions: exercise, treat sleep disturbances, psychological counseling, avoid substances that worsen mood overall such as alcohol and street drugs, consider appropriate long-term antidepressant /antianxiety medications. There are many options, and side effects can be the limiting factor. There has been recent interest in repetitive transcranial magnetic stimulation (rTMS) treatment for depression in concussion patients.
Post-traumatic Stress Disorder
Authors: Brody David L.
Published: May 2019

In many contexts, the trauma that caused the concussion can also trigger a strong stress response. Take a focused history from the patient and collateral source for hyperarousal, nightmares, avoidance, emotional numbing, dissociation, and prior diagnosis of post-traumatic stress disorder (PTSD). Assess safety. Severe PTSD can lead to suicide. Refer to a psychologist or counselor with specific expertise in PTSD for prolonged exposure therapy or cognitive behavioral therapy. Optimize sleep. Start an anxiolytic antidepressant. Prescribe prazosin for nightmares. Ideally, use short-acting benzodiazepines only for emergencies. Advise the patient to stop drinking alcohol. Treat chronic pain aggressively if present. Consider a second-line mood stabilizer if necessary. Don’t be afraid to use stimulants if the patient also has impairing attention deficit once the PTSD symptoms are under reasonable control. Consider using a quantitative scale such as the PTSD Checklist (PCL-5).
Sexual Dysfunction
Authors: Brody David L.
Published: May 2019

In private, ask specifically about sexual dysfunction, and if appropriate, ask the collateral source separately. Assess for depression, severe fatigue or hypersomnia, untreated pain, and alcohol or drug abuse (especially marijuana). Check medications for sexual side effects; serotonin specific reuptake inhibitors are the most common culprits. Test for hormonal imbalances and unrecognized cauda equina or lower spinal cord injury. Consider a trial of a phosphodiesterase type 5 (PDE5) inhibitor, and refer to urology for more advanced options.
Return to School
Authors: Brody David L.
Published: May 2019

Consider a graded stepwise approach to return to school, analogous to the strategy for return to play. This requires coordination with teachers, administrators, school nursing/medical providers, parents, and often classmates. The steps include mental rest, light cognitive activity (e.g., reading familiar material), moderate cognitive activity (e.g., new material in the student’s strongest subject), back to school with accommodations and extra rest, back to school without accommodations, catch up on missed work, then resume extracurricular activities. For complex concussions, reduce barriers to optimal cognitive performance, such as sleep disorders, headache, depression, and anxiety. There is no point in trying to return to school when any of these are substantially impairing. Reduced cognitive activity is associated with faster resolution of concussion-related symptoms, but complete cognitive rest is not necessary. Patients do not have to be completely symptom-free to return to school and to light exercise. Consider using a quantitative measure such as the Behavior Rating Inventory of Executive Function (BRIEF).
Medico-legal Aspects of Concussion
Authors: Brody David L.
Published: May 2019

When medico-legal issues such as lawsuits, criminal actions, or worker’s compensation cases are involved, reliable and unbiased collateral source information is critical. Often, coworkers, neighbors, or community leaders are good choices. It is worth reiterating here that no scan or test can “rule in” or “rule out” concussion. However, a very high-quality magnetic resonance imaging (MRI) scan performed as early as possible after injury can be helpful in some cases. Concussion and other brain injuries put criminals at higher risk of rearrest after they have been released from custody.
Special Topics in Contact Sport Athletes and Others Who Have Had Multiple Concussions and Subconcussive Impacts
Authors: Brody David L.
Published: May 2019

When to retire from contact sports? Help the patient, family, and peers think through the decision carefully. Educate them about the risk of serious and currently untreatable long-term problems, such as chronic traumatic encephalopathy. Discuss potential for a future professional sports career versus other career, interpersonal, and family aspirations.

Does the patient have Chronic Traumatic Encephalopathy (CTE)? There is no way to tell for sure while the patient is alive. High-risk features may include progressive worsening over time, prominent mood and behavioral abnormalities, parkinsonism, and a cavum septum pellucidum on magnetic resonance imaging (MRI) scan. At present, treatment is entirely based on relieving symptoms and keeping the patient safe.
Concussion in Military Personnel
Authors: Brody David L.
Published: May 2019

Consider treating acute blast-related concussion patients with N-acetyl cysteine (NAC) when starting within 72 hours after injury. For more chronic issues, in addition to family members, the best collateral source may be another service member with whom the patient has served. Evaluate carefully for post-traumatic stress disorder (PTSD), chronic pain, sleep disorders, balance, and hearing loss given that these are especially common in military personnel with concussion. Maintain confidentiality; if the patient has been using drugs and/or alcohol, it may be wise to refer them for rehabilitation discretely, because active duty military personnel do not have the same privacy protections that civilians have, and this can jeopardize their future careers. Return-to-duty decision-making is best done in collaboration with military physicians and occupational therapists. Refer to community resources specifically dedicated to wounded warriors.
Canonical Cortical Circuits
Authors: Douglas Rodney J. , Martin Kevan A. C.
Published: May 2019

The neural representations of the sensory, motor, and cognitive systems are mapped systematically across the sheet of the neocortex. This organization of the neocortical sheet may have great significance for the organization of behavior, not least because nearest neighbouring areas are more strongly connected than more distant areas. The local circuits within each cortical area are also systematically organized: the different types of excitatory and inhibitory cells are connected in simple motifs that form the elements of canonical computational operations across the entire cortical sheet.
The Cortical Microcircuit as a Recurrent Neural Network
Authors: Yuste Rafael
Published: May 2019

The mammalian neocortex has distributed excitatory and inhibitory connectivity that, together with the integrative properties of pyramidal cells and their strong synaptic plasticity, make it ideally suited to implement a neural network design. This chapter summarizes results from the author’s research, consistent with the hypothesis that the neocortical microcircuit is a recurrent neural network that builds dynamical attractors. According to this paradigm, the units of function of the cortex would be groups of neurons forming ensembles or assemblies through Hebbian synaptic plasticity. The canonical cortical microcircuit would thus be a general-purpose neural network, fine-tuned by experience to solve any optimization problem.
The Cholinergic Multicompartmental Basal Forebrain Microcircuit
Authors: Zaborszky Laszlo , Gombkoto Peter
Published: May 2019

The basal forebrain (BF) is composed of an affiliation of structures, including the medial septum, ventral pallidum (VP), vertical diagonal band (VDB) and horizontal diagonal band (HDB) nuclei, substantia innominata/extended amygdala (SI/EA), and peripallidal regions. Together, they constitute one of the most extensive multicompartmental microcircuits in the brain. A prominent feature of the mammalian BF is the presence of aggregated and nonaggregated, large, cholinergic neurons, which project to the cerebral cortex, the hippocampal complex, and the amygdala. This highly complex system has been implicated in cortical activation, attention, motivation, and memory, as well as neuropsychiatric disorders such as Alzheimer’s disease, Parkinson’s disease, schizophrenia, and drug abuse. Advances in modern tracing, genetic, and refined pharmacological techniques have dramatically increased the understanding of how the BF cholinergic system can support both phasic acetylcholine (ACh) release in attention, memory, and sensory processing and tonic ACh release over broad cortical areas as part of a general arousal effect.
Hippocampus: Network Physiology
Authors: Buzsáki György , Fernández-Ruiz Antonio
Published: May 2019

Information in the entorhinal-hippocampal system is transferred through alternating layers of recurrent excitatory and largely parallel-organized networks, allowing the iterative integration and segregation of messages. Local computations require time, and the speed of layer-to-layer transfer of information is largely determined by the dynamics of network oscillations. Temporal integration within coherent theta oscillation sets constraints on the resolution of both spatial and nonspatial information. Theta and high-frequency oscillatory dynamics can generate self-organized assembly sequences that reflect a compressed version of experienced firing patterns during exploration and learning. The strength and theta phase preference of upstream drivers cooperate with local circuit mechanisms in controlling the timing of spikes in hippocampal circuits in the service of memory and spatial navigation.
Implications from Microcircuits of a Moth’s Antennal Lobe for Olfactory Information Processing
Authors: Lei Hong , Oland Lynne A. , Riffell Jeffery A. , Beyerlein Aaron , Hildebrand John G.
Published: May 2019

Olfactory circuits of all animals face a common challenge of extracting meaningful odor cues from background odors. This chapter summarizes what the authors have learned from their ongoing work toward the goal of understanding how the neural circuits in a moth’s antennal lobe (AL) determine diverse physiological responses that ultimately mediate the animal’s natural behavior. The text describes the different types of cellular elements that participate in the glomerular circuitry, focuses on the functional organization of these elements, and attempts to explain observed physiological responses in the context of behavior using the understood operating principles of the AL circuits. For convenience, the connections from the perspective of the main output neurons of the circuitry, uniglomerular projection neurons (uPNs), are described.
Antennal Lobe of the Honeybee
Authors: Rybak Jürgen , Menzel Randolf
Published: May 2019

The antennal lobe (AL) of an insect is the functional analog of the olfactory bulb in mammals. The first-level synaptic interaction of large numbers of multiple types of olfactory receptor neurons (OSNs) with AL interneurons serves the function of reliably coding a vast range of odorants and their mixtures and the separation between odor identity and odor concentration. Honeybees learn and discriminate among a seemingly unlimited number of odors (natural and artificial), categorize odor mixtures as unique stimuli, identify odors within 250 ms and odor sequences within 6 ms, and generalize odors according to the respective combinatorial glomerulus activity patterns in the AL. Therefore, the AL is the first-order neuropil serving basic functions of odor discrimination, categorization, generalization, and learning. This chapter first describes the internal organization of the AL, its inputs, and its outputs, and then analyzes the local circuit of a prototypical glomerulus.
Mushroom Body of the Honeybee
Authors: Rybak Jürgen , Menzel Randolf
Published: May 2019

The mushroom body (MB) in the insect brain is composed of a large number of densely packed neurons called Kenyon cells (KCs) (Drosophila, 2200; honeybee, 170,000). In most insect species, the MB consists of two caplike dorsal structures, the calyces, which contain the dendrites of KCs, and two to four lobes formed by collaterals of branching KC axons. Although the MB receives input and provides output throughout its whole structure, the neuropil part of the calyx receives predominantly multimodal input from sensory projection neurons (PNs) of second or a higher order, and the lobes send output neurons to many other parts of the brain, including recurrent neurons to the MB calyx. Widely branching, supposedly modulatory neurons (serotonergic, octopaminergic) innervate the MB at all levels (calyx, peduncle, and lobes), including the somata of KCs in the calyx (dopamine).
Microcircuitry of the Rostral Nucleus of the Solitary Tract
Authors: Travers Joseph B. , Travers Susan P.
Published: May 2019

Gustatory and somatosensory information from the oral cavity is carried by afferent fibers in the fifth, seventh, and ninth cranial nerves to synapse in the rostral nucleus of the solitary tract (rNST). Incoming taste afferents from the three cranial nerves follow a rostral-caudal gradient within the nucleus, characterized by a gradual transition from neurons with anterior-to-posterior mouth receptive fields. This organization predisposes a pattern of convergence onto second-order neurons of afferents innervating adjacent or apposing receptors, while maintaining an orotopic representation. Although evidence for convergence between the seventh and ninth nerves is relatively infrequent in extracellular recordings, high-magnification confocal microscopy and patch recordings suggest the potential for considerable interaction between these cranial nerves. Overall, the convergence of afferent input functions to increase the overall firing rate, receptive field size, and responsiveness to a wider range of taste stimuli of second-order neurons than peripheral fibers.
The Mammalian Brainstem Chewing Circuitry
Authors: Kolta Arlette , Lund James P.
Published: May 2019

The act of mastication requires the coordinated activity of jaw, facial, and tongue muscles. The form of movements varies between foods and changes gradually during a single masticatory sequence, in parallel with the physical properties of the food bolus. The basic pattern of mastication is produced by a brainstem central pattern generator (CPG) when tonically activated by inputs from sensory afferents, higher brain regions, or both. Although not required to produce the basic pattern, sensory feedback is largely responsible for adjusting the motor output to changes in food properties, while cortical inputs are thought to play a role in anticipation and determination of the initial patterns of movements.
Spinal Circuit for Escape in Goldfish and Zebrafish
Authors: Fetcho Joseph R.
Published: May 2019

Escape or startle responses are vital to organisms. In fishes, escape behavior is a rapid bend of the body and tail away from a potential threat that occurs within milliseconds after a stimulus. When properly executed, it is a fast, powerful body bend to only one side that takes precedence over any other movements. The behavior is initiated by the firing of one of a bilateral pair of hindbrain reticulospinal neurons (RSNs) called Mauthner cells (M-cells). The output of each cell occurs via an axon that crosses in the brain and extends the length of the spinal cord on the opposite side of the body. The circuit of the M-cell in spinal cord is based upon studies of goldfish and zebrafish. This circuit, repeated along the spinal cord, has several features that are well matched to the behavioral demands of escape movements.
Tadpole Swimming Network
Authors: Sillar Keith T. , Li Wen-Chang
Published: May 2019

Xenopus laevis frog tadpoles near the time of hatching have proved to be an excellent model system in which to explore the neural mechanisms responsible for the initiation, maintenance, sensory adaptation, and termination of rhythmic locomotor activity in vertebrates. The underlying neural network is one of the most completely understood in any vertebrate. Detailed knowledge has accrued over the last 40 years, highlighting conserved operational features of vertebrate rhythm generators and serving as an invaluable platform from which to investigate associated issues of fundamental importance in neuroscience, such as motor program switching, transmitter corelease, network development, neuromodulation, and metamodulation of network operation. There are many advantages of this simple model system, including the presence of a well-defined network output that relates directly to the behavior of the animal under study (namely, swimming locomotion).
The Tritonia Swim Central Pattern Generator
Authors: Katz Paul S.
Published: May 2019

Tritonia diomedea is a sea slug that escapes from predatory starfish by rhythmically flexing its entire body in the dorsal and ventral directions. This escape swim behavior is produced by a central pattern generator (CPG), without needing sensory feedback. There are several features of the neural basis for this response that make it of particular interest for neuroscientists. One is that the CPG is a network oscillator; bursting arises as an emergent property of the neurons and their connectivity. Another interesting feature is that the CPG contains state-dependent, intrinsic neuromodulation: one of the CPG neurons uses the neurotransmitter serotonin (5-HT) to modulate the strength of synapses made by the other CPG neurons under certain conditions. This CPG seems to have evolved from a nonoscillatory network. Finally, there are novel mechanisms for plasticity during learning and in response to injury.
Preparing International Travelers
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

The Pretravel Consultation

Lin H. Chen, Natasha S. Hochberg

Travelers’ Perception of Risk

David R. Shlim

Last-Minute Travelers

Gail A. Rosselot

Complementary & Integrative Health Approaches

David Shurtleff, Kathleen Meister, Catherine Law

Prioritizing Care for the Resource-Limited Traveler

Zoon Wangu, Elizabeth D. Barnett

Telemedicine

Taylan Bozkurt...
Environmental Hazards & Other Noninfectious Health Risks
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

Injury & Trauma

Erin M. Parker, Erin K. Sauber-Schatz, David A. Sleet, Michael F. Ballesteros

Mental Health

Thomas H. Valk

Safety & Security Overseas

Uzma Javed

Mosquitoes, Ticks & Other Arthropods

John-Paul Mutebi, John E. Gimnig

Sun Exposure

Karolyn A. Wanat, Scott A. Norton

Extremes of Temperature...
Travel for Work & Other Reasons
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

The Business Traveler

William B. Bunn

Advice for Aircrews

Phyllis E. Kozarsky

Health Care Workers, Including Public Health Researchers & Medical Laboratorians

Henry M. Wu, Alan G. Czarkowski, Eric J. Nilles

Humanitarian aid Workers

Eric J. Nilles, Brian D. Gushulak, Stephanie Kayden

US Military Deployments...
Posttravel Evaluation
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

General Approach to the Returned Traveler

Jessica K. Fairley

Screening Asymptomatic Returned Travelers

Michael Libman, Sapha Barkati

Fever

Mary Elizabeth Wilson

Rapid Diagnostic Tests for Infectious Diseases

Elizabeth Rabold, Jesse Waggoner

Antimicrobial Resistance

D. Cal Ham, Joseph Lutgring, Aditya Sharma

Sexually Transmitted Infections

Jodie Dionne-Odom...
Headache
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter enumerates various features that are reassuring and do not point to serious disease. Several Red Flags are given that indicate the need for investigation. Clues for cluster headache, orthostatic headache, and several other headache syndromes are mentioned. Also listed are a few specific headaches that respond to indomethacin.
Epilepsy and Sleep Disorders
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter lists Handles that would allow identification of various disorders associated with seizures by inspection alone, such as tuberous sclerosis, Sturge-Weber syndrome, lipoid proteinosis, Angelman’s syndrome, and Rett syndrome. Other diagnoses require further detail from the history and examination. Guides to localization and lateralization are provided, and the main causes of refractory seizures are detailed. The problem of non-epileptic attacks is addressed and characteristic EEG patterns are illustrated. Handles for the major sleep-related disorders are exemplified.
Peripheral Neuropathy
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter divides peripheral neuropathy into mononeuropathy, radiculopathy, and polyneuropathy. Disorders of major peripheral nerves are highlighted: namely, median, ulnar, radial, sciatic, and femoral nerves, and how their associated dysfunction may be identified speedily. Polyneuropathy is subdivided according to pattern of onset; accompanying pain; axonal or demyelinating; length- or non–length-dependent; inherited or acquired; presence of nerve thickening; occurrence of tremor; skin, hair, or nail changes; deafness; ophthalmoplegia; anosmia; ageusia, or cataract.
Dementia and Cognition
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter emphasizes the value of preliminary observations in making a provisional diagnosis of dementia. Significant aspects of the history are detailed, such as head injury or brain hemorrhage that could lead to hydrocephalus or superficial siderosis. Handles are given that facilitate identification of Alzheimer’s disease and its mimics, such as the posterior cortical variant. The importance of temporal pattern of disease is emphasized. Further Handles are outlined for frontotemporal dementia variants. The value of physical examination is stressed as it may disclose an underlying structural lesion.
The Practical Playbook in Action: Improving Health Through Cross-Sector Partnerships
Authors: Auerbach John , DeSalvo Karen B.
Published: May 2019

Chapters 3 examines the challenges of addressing broad health issues which face communities now. It argues that these are effectively achieved only through partnerships across sectors, which create conditions in which everyone can be healthy. The underpinning for this approach lies in recognising that the most crucial factors influencing the public's health are not in the health sector per se, but are rather a result of the influence of a multitude of factors at family, community, city, state, and federal levels. These include social and economic factors (such as poverty, racism, and other forms of discrimination), social isolation, and policies governing the the social determinants of health. The sectors that influence these factors, the chapter states, include housing, education, transportation, economic development, city and county planning, and public safety. The chapter goes on to express how these partnerships can be formed and what they can do.
Partnering with Transportation Sector Actors and Advocates to Improve Health Outcomes
Authors: Wilke Teresa , Leight Shawn
Published: May 2019

Chapter 6 argues that where people live and work (and play) has an impact on health and how they interact in communities. Good transport links, it states, are crucial. The chapter looks at the various stakeholders, actors, and influencers of transporation policies and systems in a community. It provides a number of questions for readers to consider with this issue. It concludes that transportation sector planning, investment, maintenance, and governance directly influence population mobility, which can promote or inhibit reliable access to social determinants of health and opportunities to thrive across the lifespan.
Business and Public Health: Why Corporate America Will Soon Help Lead the Public Health Charge
Authors: Hall Scott
Published: May 2019

This chapter is concerned with the influence of business on public health. It argues that it makes sense that business should be concerned with public health for it is in the best interest of that sector that workers are healthy. It illustrates this with “The Widget Story”. A growing body of data is accumulating that is beginning to demonstrate the principles behind this theoretical story. The chapter then asks: what role can business play in promoting public health?
The Path Forward: The Role of Hospitals and Health Systems in Advancing Health and Well-Being for Individuals and Communities
Authors: Bhatt Jay , Jagar Andrew
Published: May 2019

This chapter starts by explaining a current trend in the transformation of the role of hospitals in advancing health in the community. The change is the result of demographic change and disease burden shifts which are moving away from acute to chronic. And hospitals and health systems are, as a result, leading an unprecedented transformation to re-envision their role and extend their impact beyond the clinic walls. They are working to create new models of care that prioritize teaming and partnership with the aim of engaging in true population health: advancing health and well-being by bridging care and community. The key, the chapter argues, is to promote affordability while enhancing value. The chapter concludes by stating that hospitals and health systems play an important role in the health of communities across the United States. While that role is changing and will likely continue to evolve, the importance of these institutions as anchors in their communities is likely to increase in coming years.
Taking Collaborations to Scale
Authors: Calvo Ahmed
Published: May 2019

This chapter discusses taking collaborations to scale. In other words, those aiming at enlargement of the number of partners on a scale that requires collaboration over a larger distance. These distances could include a region, a whole state, a nation, or they might have international dimensions, as opposed to only having a partnership at the local community level. The chapter looks at the importance of data in large collaborations. Other issues it looks at include the importance of everyone being aware of their teaching role, the importance of trust building, the importance of considering the end goal from the beginning, and, finally, the importance of starting small but keeping in mind the bigger picture.
Sustainability Through Accountability: The Accountable Community for Health Model
Authors: Standish Marion , Midura Bonnie , Masters Barbara , Powers Patricia , Hogan Laura
Published: May 2019

This chapter opens by posing the issue that public and private funders have long supported community collaboratives to address a wide range of health issues. Although these collaboratives accomplish important goals, they rarely continue beyond the funding stage or yield lasting systems change. The chapter describes the Accountable Community for Health Model as a model for sustaining community collaborations. The chapter identifies seven key elements for success. The Wellness Fund is a unique component, though many of the success factors and lessons learned are in alignment with other models.
All In: How and Why Communities Are Using Data to Drive Community Health Improvement
Authors: Tanner Clare , Eckart Peter
Published: May 2019

This chapter opens by explaining that developing a shared data system is a natural extension of multi-sector work, though it is both an accelerator and a pain point for many initiatives. As multi-sector initiatives proliferate, the chapter argues, lessons of what works and what doesn't are being learned, and those lessons have much to offer to communities in the earlier stages of sharing data. As a result, several national initiatives and funders have joined together to form All In: Data for Community Health, a learning network of communities across the United States that are testing and evaluating new ways to transform health through multi-sector partnerships to share data. The chapter presents advice from this experience.
Digital Data Exchange Between Health Care and Public Health: Lessening the Burden
Authors: Engel Jeffrey P. , Hammond W. Edward
Published: May 2019

This chapter seeks to provide an overview of automated data exchange between public health and health care, highlighting cases which use electronic laboratory reporting (ELR) and electronic case reporting (ECR) and how health data is standardized and messaged. It also provides the example of the West Nile Virus (WNV). This example demonstrates how health data can be used to lessen the burden of mandated disease reporting for health care and improve timeliness, completeness, and accuracy of surveillance for public health. The Digital Bridge project is also introduced, as a national single and scalable solution emphasizing the importance of the public-private partnership. Challenges facing the Digital Bridge approach include ensuring ongoing investments in all sectors for automation and data exchange, especially information technology infrastructure maintenance and a prepared workforce of engineers, epidemiologists, and data scientists.
Practical Lessons Learned from Baltimore’s B’FRIEND Initiative
Authors: Phelan-Emrick Darcy F. , Fried Michael , Tan Heang , Martin Molly , Wen Leana S.
Published: May 2019

This chapter presents a case study from the Baltimore City Health Department called the Baltimore Falls Reduction Initiative Engaging Neighborhoods and Data (B'FRIEND). The initiative aimed at improving the issue of falls among older adults (65 years and over). B'FRIEND seeks to reduce falls-related emergency department visits and hospitalizations among older adults in Baltimore City. It does this by implementing a falls surveillance system with data from the state's health information exchange (HIE) and then using those data to target interventions. The chapter looks at how this initiative came about, the key groups involved, and the lessons learned.
Community-Centered Health Homes: Bridging Health Care Services and Community Prevention
Authors: Mikkelsen Leslie , Pañares Rea , Cohen Larry
Published: May 2019

This chapter looks at prevention and public health. Preventing illness and injury in the first place has the potential to be a powerful component of a country's strategy to improve population health while strengthening access to quality health care and reducing costs. The chapter looks at the Community-Centered Health Home (CCHH) term, which is used to describe health care organizations that take an active role, in partnership, to improve community conditions that impact patients' health (for example, supporting rental housing code enforcement, building septic systems, and improving community access to healthy food and places for physical activity). The chapter looks at ways to test the CCHH initiative. The chapter concludes by stating that CCHH contributes to the US's journey toward a system of health by highlighting the value of health care in partnering with its surrounding community and offering a systematic approach to partnering with community groups to improve community conditions, while continuing to meet the daily priority of delivering high-quality health care.
Braiding, Blending, or Block Granting?: How to Sustainably Fund Public Health and Prevention in States
Authors: Clary Amy , Riley Trish
Published: May 2019

This chapter presents innovative funding strategies to help state Medicaid and public health decision-makers plan for possible changes to the structure and levels of federal funding for public health. Four scenarios are presented that represent a range of responses to possible changes and reductions in federal funding. Creating greater flexibility in funding is a central component of their strategy to support and sustain cross-agency work. Blended, braided, and block grant strategies are discussed as well as state-based examples of these strategies have been adopted to safeguard and promote the health of their communities. The chapter also presents a rural case study on sustainability of a mental health initiative to strengthen social support and leadership development. Led by a Federal Qualified Health Center, this multi-sector partnership includes public health, health care, and community support partners. Through this collaborative, partners share ideas, pool resources, share meeting space, and provide peer-to-peer training to develop a sustainable workforce capable of providing social support services and needed job skills to youth and veterans.