bluuebunny/crossref_metadata_2025 huggingface dataset:
Comorbidity and Personality in Body Dysmorphic Disorder
Authors: Hart Ashley S. , Niemiec Martha A.
Published: August 2017

Comorbidity is common in body dysmorphic disorder (BDD). Major depressive disorder, social anxiety disorder (social phobia), obsessive-compulsive disorder, and substance use disorders are the most frequently co-occurring Axis I conditions. Except for eating disorders (more common in women) and substance use disorders (more common in men), Axis I comorbidity rates in BDD appear similar across genders. Axis I comorbidity is associated with greater functional impairment and morbidity. Rates of comorbid personality disorders in BDD are high. Disorders from cluster C occur most frequently, with avoidant personality disorder the most common. Associated traits include low self-esteem and high levels of neuroticism, introversion, unassertiveness, social anxiety and inhibition, rejection sensitivity, and perfectionism. Research is needed on the relationship between BDD and psychiatric comorbidity, the causes and consequences of comorbidity in BDD, and the relationship between BDD and associated personality traits.
Challenges in Assessing and Treating Patients with Body Dysmorphic Disorder and Recommended Approaches
Authors: Veale David , Phillips Katharine A , Neziroglu Fugen
Published: August 2017

Clinicians commonly encounter multiple challenges when assessing and treating individuals with body dysmorphic disorder (BDD). Some of the major challenges include poor insight and low motivation for appropriate treatment, delay in seeking treatment, desire for usually ineffective cosmetic treatment (e.g., surgery or dermatologic treatment) instead of mental health treatment, co-occurring substance use disorders, and frequent and sometimes severe suicidality. This chapter discusses recommended approaches to these challenges that clinicians can implement when assessing and treating patients with BDD. Strategies for engaging patients in cognitive-behavioral treatment and pharmacotherapy, and for disengaging patients from cosmetic treatment, are reviewed. Suggestions for treating patients with comorbid substance use disorders and suicidal patients are offered.
Treating a Patient with Body Dysmorphic Disorder Using Medication and Cognitive-Behavioral Therapy: An Illustrative Case Example
Authors: Phillips Katharine A. , Simmons Rachel A.
Published: August 2017

This chapter illustrates how the authors treated a representative patient with body dysmorphic disorder (BDD) using both medication and cognitive-behavioral therapy (CBT). The case example illustrates engagement strategies, treatment selection, implementation of recommended treatment strategies, approaches to some commonly encountered decision points, and possible solutions to frequently encountered treatment challenges. Following the case example, the authors comment on these issues. The chapter discusses approaches to patients who desire cosmetic treatment rather than mental health treatment. Factors involved in the decision to use CBT, pharmacotherapy, or both treatment modalities for BDD are also covered.
Cosmetic Medical and Surgical Treatments and Body Dysmorphic Disorder
Authors: Crerand Canice E. , Sarwer David B. , Ryan Margaret
Published: August 2017

This chapter reviews the topic of body dysmorphic disorder (BDD) and cosmetic medical (including surgical) treatments. One of the most concerning aspects of BDD from a clinical perspective is these individuals’ pursuit of non-mental health treatments—such as surgery, dermatologic treatment, and dental treatment—for a mental health problem. The prevalence of BDD among individuals who seek cosmetic surgical and nonsurgical treatments—especially rhinoplasty—is consistently higher than BDD’s estimated prevalence in the general population. Conversely, a high proportion of persons with BDD seek aesthetic procedures to improve their perceived appearance defects. The limited literature on changes in BDD symptoms and psychosocial functioning after these treatments suggest that outcomes appear to often be poor. BDD symptom improvement is rare and, at best, temporary; there also is risk for symptom exacerbation. Provision of cosmetic treatment for BDD concerns may also involve risks for both patients and clinicians. Taken together, these findings suggest that BDD is a contraindication for cosmetic procedures. The chapter concludes with directions for future research.
Integrating Physical and Mental Health Care in the Veterans Health Administration
Authors: Rubenstein Lisa V.
Published: August 2017

The Veterans Health Administration, part of the U.S. Department of Veterans Affairs (VA), is responsible for the largest integrated health care system in the United States and is committed historically and by statute to provide mental and physical health care for veterans. The evolution of integrated mental and physical health care in the VA serves as an in-depth, real-world example of large-scale implementation of integrated care models. The VA’s ongoing national primary care/mental health care integration initiative is the foundation for the system’s efforts in this regard. The challenges and opportunities VA implementers faced in promoting integrated mental health care show the feasibility and importance of providing integrated care and the fundamental changes required for achievement. This chapter discusses the drivers and resources, as well as the barriers, involved in the development of an integrated physical and mental health care model.
Treating Depression and Bipolar Disorder in Integrated Care Settings
Authors: Schneck Christopher
Published: August 2017

Primary care clinics are the de facto treatment settings for patients with major depression and bipolar disorder. Primary care patients with mood disorders are more difficult to assess and treat than patients without such disorders, often have comorbid medical and psychiatric conditions, and require greater practice resources for optimal management. Because current treatment of mood disorder patients in primary care settings is often minimally adequate, changes in overall management strategies are needed to improve outcomes. This chapter describes pathways by which primary care providers can implement an integrated care and collaborative model likely to improve patient outcomes. It describes the epidemiology and costs of mood disorders, as well as basic pharmacologic and psychosocial approaches useful in primary care settings. Depressed patients who are refractory to treatment and patients with bipolar disorder are more complicated to manage and almost always require collaboration with a behavioral health specialist and a consulting psychiatrist.
Assessing and Treating Sexual Problems in an Integrated Care Environment
Authors: Pollock Kenneth M. , Altman Alan M.
Published: August 2017

Sexual problems often remain untreated due to a number of barriers that exist in the primary care environment. Working in integrated teams and under the upcoming changes in reimbursement, primary care providers will be able to screen for, assess, treat, and/or refer sexual problems to colleagues within and outside of their practice. This requires a small but significant increase in the team’s level of knowledge about sex. Sexual problems have multiple etiologies: physical, including hormonal and structural, individual/psychological, and relationship-based. These causes interact with one another and require concurrent, rather than sequential, interventions. Major sexual problem areas include low and/or discrepant desire levels, difficulty becoming aroused (erectile dysfunction in men, low excitement in women), difficulty in achieving orgasm in women and men, premature ejaculation, and sexual pain in women. Working through integrated, multidisciplinary teams, much more can be done for patients in this important area of health.
Classifications
Authors: Laureno Robert
Published: August 2017

This chapter on “Classification” examines neurological classifications. Considered are classifications of neuropathology, and psychiatry. Discussed are multiple sclerosis, cranial nerves, DSM-5, and other topics. Although “eventually every system of classification breaks down,” we must classify. We classify to aid research, education, and clinical thinking. We classify anatomic structures, and we classify diseases. The basic problem is that many natural phenomena fail to fit into neat categories, and some diseases defy classification. Superimposed on the problem of nature’s complexity is the problem of the experts. Doctors disagree about classification, sometimes vehemently. We can best use our evolving classifications if we remember that nature is prone to ignore our divisions.
Current context and aims
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter addresses the current context of mental health care for outreach practice. It covers the rise of consumerism, the increased emphasis on audit and clinical governance, plus the need to demonstrate both the evidence base of practice and its benefits for patients. It sets practice in the context of the changing nature of professional roles and claims that clinical judgement can be exercised despite the increased prescription by service commissioners and the attendant bureaucracy.
Access: Office hours, shifts, or 24/7 availability?
Authors: Burns Tom , Firn Mike
Published: August 2017

Crisis intervention is an important component of community outreach, so the arrangements for flexible and timely access have always been important. The original ACT model stressed 24/7 availability, but this has proven difficult to sustain. This chapter critically examines the need for such availability, and describes a series of less resource-intense alternatives. These include shift working, flexible evening and weekend working, and shared access arrangements. With the development of crisis resolution/home treatment (CRHT) teams in the UK, outreach out of hours has increasingly been restricted to them. We examine the differences between reality and rhetoric in the benefits of extended working and note the costs, both in terms of manpower, but also of information exchange, in some of these over-elaborate systems. We a also examine effective contingency arrangements to ensure patient safety out of hours.
Self-neglect
Authors: Burns Tom , Firn Mike
Published: August 2017

The chapter describes ways of managing self-neglect in psychotic patients living in their own homes. Incidence in the general and mentally ill populations is poorly reported in the literature. The impact of the negative symptoms often found in schizophrenia on behaviour and activities of daily living, as well as consequences for physical health and social inclusion, are presented. The case study in this chapter illustrates ways to document assessed risk and to formulate interventions. Interventions need to be presented practically and sensitively within established relationships.
Schizophrenia and delusional disorders
Authors: Burns Tom , Firn Mike
Published: August 2017

Schizophrenia is the iconic mental illness. This chapter describes the evolution of the concept by doctors in the early mental hospitals through to modern classifications of its subtypes. The nature/nurture controversy has been particularly fraught in schizophrenia and the possible role of the family in its genesis is considered in detail. Explanatory models such as the ‘schizophrenogenic mother’ and the ‘double bind’, although now only historical, are described because of their hold on the popular imagination. Family factors (‘expressed emotion’) in the maintenance of the disorder are also considered. The role of maintenance medication, clozapine, the identification of relapse signatures, early intervention, and psychosocial interventions are also described.
Training
Authors: Burns Tom , Firn Mike
Published: August 2017

This chapter sets out training frameworks and key skills and competencies that underpin comprehensive care in community outreach in mental health. A framework of core and advanced competencies for multidisciplinary teams is presented capable of supporting evidence-based clinical practice. Safe non-clinical operations are also supported by a schedule of mandatory staff training in areas such as equality, diversity, and information governance.
Vascular pathology
Authors: Carton James
Published: August 2017

This chapter covers vascular pathology, including common arterial and venous diseases including atherosclerosis and its complications, hypertension, shock, chronic lower limb ischaemia, acute lower limb ischaemia, aortic dissection, abdominal aortic aneurysm, deep vein thrombosis, and varicose veins.
Introduction
Authors: Lei Yuan
Published: August 2017

The ‘Introduction’ chapter presents the concept of the entire ventilator system, whose understanding is crucial for the clinician performing mechanical ventilation. Mechanical ventilation is a risky, expensive, and error-prone therapy, the author asserts, which is why it is so important to understand not just the clinical application of ventilation, but also the equipment used in ventilation therapy. Furthermore, the ventilator must be viewed within the context of the larger ventilation system. This chapter defines the book’s audiences and discusses its value to them.
Essential Variables and Breath Types
Authors: Lei Yuan
Published: August 2017

‘Essential Variables and Breath Types’ describes the eight types of mechanical breath in terms of their five essential variables: triggering, cycling, controlling, targeting, and baseline pressure. This chapter begins with detailed descriptions of these variables, including their definitions, mechanisms, and options. It ends by defining the eight mechanical breath types as different combinations of these variables. The author describes how these variables are used to define such breath types as volume control or pressure support. The author incorporates into the discussion abnormalities of each of these variables.
Alarms and Safety Mechanisms
Authors: Lei Yuan
Published: August 2017

‘Alarms and Safety Mechanisms’ breaks that puzzling black box, which includes those critical functions designed to safeguard the ventilated patient. It describes the categories of alarms, including application alarms (also called clinical alarms), which may indicate problems with the patient; a leak or occlusion in the breathing circuit; or an improper ventilator setting. It goes on to describe technical alarms that point to an actual malfunction within the ventilator system. It also discusses alarm priorities and alarm settings or alarm limits. The chapter details each common alarm, listing alternative alarm messages as they appear on different ventilators, and describing what the alarm means and how to troubleshoot it. Finally, the chapter discusses a ventilator’s emergency states, such as the ambient state or the safety valve open state, and the ventilator inoperative alarm.
Oxford Manual of Major Incident Management
Authors: Hunt Paul , Greaves Ian
Published: August 2017

Regrettably, no year passes without some form of major incident occurring somewhere in the United Kingdom. To the traditional threats of transport, industrial, and natural disasters has been added the possibility of a major terrorist atrocity such as the London bombings of 7 July 2005 or the recent marauding gun attacks in Paris. The international situation continues to suggest that the likelihood of further similar attacks is a question of when, rather than if. That said, for most professional responders, a transport incident such as the GNER crash at Great Heck, a chemical incident such as Flixborough, or an environmental catastrophe like Boscastle is probably the most likely type of incident that they will be involved in. The key to a successful response lies in preparedness and effective planning built upon up-to-date knowledge and a full awareness of relevant policy and procedures. The recent enquiry into the emergency services response to ‘7/7’ highlighted a number of failings while also complementing the individuals from all services and specialities who offered aid. Although, due to the nature of this incident being especially sensitive, it is clear that the emergency services response to any incident will be subject to intense public scrutiny—both official and via the media. There is a clear need to establish a core knowledge base which extends beyond individual professional boundaries and hence the need for this manual. The Oxford Manual of Major Incident Management will, for the first time, bring together and integrate the key facts for potential emergency responders to, or who may be involved in the planning and preparation for, a major incident of any type or scale.
Conventional Weapons: Explosives and Ballistics
Authors: Greaves Ian , Hunt Paul
Published: August 2017

Chapter 11 covers information on injury from bullets, types of weapon, bombs and blast injury, suicide bombers, managing the scene of a shooting, managing the scene of an explosion, preservation of evidence, and human remains.
Acute dyspnoea in the emergency department
Authors: Mueller Christian
Published: August 2017

Acute dyspnoea is a very common symptom in the acute cardiac care setting. In contrast to current beliefs, acute dyspnoea, as the leading symptom in the emergency department, is associated with about twice the mortality risk, compared to acute chest pain. Rapid and accurate identification of the cause of dyspnoea is critical to the initiation of specific and effective treatment. In most patients, a rapid and accurate diagnosis in the emergency department can be achieved by a combination of vital signs, including pulse oximetry, detailed patient history, physical examination, blood tests (including natriuretic peptides—BNP, NT-proBNP, or MR-proANP), venous blood gases, and C-reactive protein in all patients, and D-dimers in selected patients, electrocardiograms, chest X-ray, and more recently also lung ultrasound. It is key to remember that the prevalence of acute heart failure in unselected patients with acute dyspnoea is about 50%. Therefore, a high awareness for the presence of acute heart failure is mandatory. Acute heart failure, pneumonia, obstructive pulmonary diseases (chronic obstructive pulmonary disease and asthma), pulmonary embolism, and anxiety disorders represent more than 90% of all cases with acute dyspnoea in the emergency department. In about 10–15%, two acute causes (e.g. acute heart failure and pneumonia) may be present and require combined treatment. Transthoracic echocardiography should be immediately performed in all patients with acute dyspnoea and shock, and in those patients in whom the diagnosis remains uncertain, even after initial work-up.
Coronary artery bypass graft surgery
Authors: Davierwala Piroze M , Mohr Friedrich W
Published: August 2017

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.
Acute heart failure: heart failure surgery and transplantation
Authors: Visouli Aikaterini N , Pitsis Antonis A
Published: August 2017

Cardiac surgery should be considered in all cases of acute heart failure (AHF) or acutely decompensated chronic heart failure (ADCHF) caused, precipitated, or aggravated by surgically correctable causes. Mechanical circulatory support (MCS) and heart transplantation (HTx) may be considered when all conventional measures have failed.
Myocarditis and pericarditis
Authors: Noutsias Michel , Maisch Bernhard
Published: August 2017

Transition of acute myocarditis to dilated cardiomyopathy occurs in approximately 20% of patients within a follow-up period of 33 months. Recent research has revealed the adverse prognostic impact of several clinical parameters for this scenario. Acute myocarditis and its sequelae dilated cardiomyopathy and inflammatory cardiomyopathy are often caused by viral infections. Histological evaluation of endomyocardial biopsies is critical for the diagnosis of the cardiomyopathy entity and for the clinical management of around 20% of the patients. Additionally, contemporary diagnostic procedures of endomyocardial biopsies are indispensable for the selection of inflammatory cardiomyopathy patients who will likely benefit from immunosuppression or antiviral (interferon) treatment. Immunoadsorption, with subsequent immunoglobulin substitution, is a further promising immunomodulatory treatment option for dilated cardiomyopathy patients, targeting primarily the anticardiac autoantibodies. Cardiac magnetic resonance has emerged as a valuable diagnostic approach for myocarditis and pericarditis. Myocardial late gadolinium enhancement has been associated with adverse outcome and sudden cardiac death. Bridging of the first 3 months with a wearable cardioverter–defibrillator, until a definitive decision on the implantation of an implantable cardioverter–defibrillator, is a growingly recognized cornerstone in the clinical management of patients with acute myocarditis with depressed left ventricular ejection fraction of <40% and new-onset dilated cardiomyopathy, respectively. Acute pericarditis is labelled idiopathic or suspected viral without adequate proof of the respective aetiology. Non-steroidal anti-inflammatory drugs and colchicine are proven and safe therapeutic mainstays for pericarditis, including the first attack. Pericardiocentesis is a lifesaving treatment of cardiac tamponade. Pericardioscopy and epicardial biopsies can contribute to the aetiological differentiation of pericardial effusions.
Pulmonary embolism
Authors: Torbicki Adam , Kurzyna Marcin , Konstantinides Stavros
Published: August 2017

Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
Infection, sepsis, and multiorgan dysfunction syndrome
Authors: Favory Raphaël , Vincent Jean-Louis
Published: August 2017

Sepsis is the main cause of multiple organ failure and remains a concern because of the associated high morbidity and mortality. In recent years, important advances have been made in the understanding of the pathophysiology of sepsis. Sepsis and septic shock are the end result of complex interactions between infecting organisms and various elements of the host response. A key feature of the common sequence of organ failure is dysfunction of the cardiovascular system, including microcirculatory elements. Outcome improvement in sepsis is based on recognizing the process early and instituting effective therapies. The time window for intervention is relatively short, and treatment must promptly control the source of infection, restore haemodynamic homoeostasis, and support failing organ systems.
Perioperative management of the high-risk surgical patient: cardiac surgery
Authors: Ranucci Marco , Castelvecchio Serenella , Ballotta Andrea
Published: August 2017

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.
First trans-Neptunian object in polar resonance with Neptune
Authors: Morais M. H. M. , Namouni F.
Published: August 2017

Capture in mean motion resonance has been observed in the Solar system for small objects with prograde as well as retrograde orbits of moderate inclinations. However, no example of an object with a nearly polar orbit was known to be in resonance with a planet. In this Letter, we report that the nearly-polar trans-Neptunian object (471325), nicknamed Niku, is in a 7:9 resonance with Neptune, with a mean lifetime in resonance of 16 ± 11 million years. While entrance and exit in the 7:9 resonance is caused by close encounters with Neptune, the resonant configuration provides a temporary protection mechanism against disruptive close encounters with this planet. The other nearly polar trans-Neptunian objects do not seem to be in resonance with the planets with the possible exception of 2008 KV42, also known as Drac, that has a small chance of being in the 8:13 resonance with Neptune.
The nature of H α-selected galaxies along the large-scale structure at z = 0.4 revealed by Subaru Hyper Suprime-Cam survey
Authors: Koyama Yusei , Hayashi Masao , Tanaka Masayuki , Kodama Tadayuki , Shimakawa Rhythm , Yamamoto Moegi , Nakata Fumiaki , Tanaka Ichi , Suzuki Tomoko L , Tadaki Ken-ichi , Nishizawa Atsushi J , Yabe Kiyoto , Toba Yoshiki , Lin Lihwai , Jian Hung-Yu , Komiyama Yutaka
Published: August 2017

We present the environmental dependence of color, stellar mass, and star formation (SF) activity in Hα-selected galaxies along the large-scale structure at z = 0.4 hosting twin clusters in the DEEP2-3 field, discovered by the Subaru Strategic Program of Hyper Suprime-Cam (HSC SSP). By combining photo-z-selected galaxies and Hα emitters selected with broadband and narrowband (NB) data from the recent data release of HSC SSP (DR1), we confirm that galaxies in higher-density environments or galaxies in cluster central regions show redder colors. We find that there still remains a possible color–density and color–radius correlation even if we restrict the sample to Hα-selected galaxies, probably due to the presence of massive Hα emitters in denser regions. We also find a hint of increased star formation rates (SFR) amongst Hα emitters toward the highest-density environment, again primarily driven by the excess of red/massive Hα emitters in high-density environments, while their specific SFRs do not significantly change with environment. This work demonstrates the power of the HSC SSP NB data for studying SF galaxies across environments in the distant universe.
Machine-learning-based real–bogus system for the HSC-SSP moving object detection pipeline
Authors: Lin Hsing-Wen , Chen Ying-Tung , Wang Jen-Hung , Wang Shiang-Yu , Yoshida Fumi , Ip Wing-Huen , Miyazaki Satoshi , Terai Tsuyoshi
Published: August 2017

Machine-learning techniques are widely applied in many modern optical sky surveys, e.g., Pan-STARRS1, PTF/iPTF, and the Subaru/Hyper Suprime-Cam survey, to reduce human intervention in data verification. In this study, we have established a machine-learning-based real–bogus system to reject false detections in the Subaru/Hyper-Suprime-Cam Strategic Survey Program (HSC-SSP) source catalog. Therefore, the HSC-SSP moving object detection pipeline can operate more effectively due to the reduction of false positives. To train the real–bogus system, we use stationary sources as the real training set and “flagged” data as the bogus set. The training set contains 47 features, most of which are photometric measurements and shape moments generated from the HSC image reduction pipeline (hscPipe). Our system can reach a true positive rate (tpr) ∼96% with a false positive rate (fpr) ∼1% or tpr ∼99% at fpr ∼5%. Therefore, we conclude that stationary sources are decent real training samples, and using photometry measurements and shape moments can reject false positives effectively.
Injury and Liability Associated With Spine Surgery
Authors: Kutteruf Rachel , Wells Deva , Stephens Linda , Posner Karen L. , Lee Lorri A. , Domino Karen B.
Published: August 2017

Background:

Although spine surgery is associated with significant morbidity, the anesthesia liability profile for spine surgery is not known. We examined claims for spine procedures in the Anesthesia Closed Claims Project database to evaluate patterns of injury and liability.

Materials and Methods:

A retrospective cohort study was performed. Inclusion criteria were anesthesia claims provided for surgical procedures in 2000 to 2014. We compared mechanisms of injury for cervical spine to thoracic or lumbar spine procedures using χ2 and the Fisher exact test. Univariate and multivariate logistic regression analyses were used to determine factors associated with permanent disabling injury in spine surgery claims.

Results:

The 207 spine procedure (73% thoracic/lumbar; 27% cervical) claims comprised >10% of claims. Permanent disabling injuries to nerves, the spinal cord, and the eyes or visual pathways were more common with spine procedures than in nonspine procedures. Hemorrhage and positioning injuries were more common in thoracic/lumbar spine claims, whereas difficult intubation was more common in cervical spine claims. Multiple logistic regression demonstrated prone positioning (odds ratio=3.50; 95% confidence interval, 1.30-9.43) and surgical duration of ≥4 hours increased the odds of severe permanent injury in spine claims (odds ratio=2.73; 95% confidence interval, 1.11-6.72).

Conclusions:

Anesthesia claims related to spine surgery were associated with severe permanent disability primarily from nerve and eye injuries. Prone positioning and surgical duration of ≥4 hours were associated with permanent disabling injuries. Attention to positioning, resuscitation during blood loss, and reducing length of surgery may reduce these complications.
A Simple Technique to Position the Image Intensifier During Anterolateral Approaches to Shoulder Surgery: The Sydney Harbour Bridge Position
Authors: Richardson Martin , Stevens Jarrad , Sobol Tony
Published: August 2017

We describe a simple technique for positioning the image intensifier (II) during shoulder procedures that can both reduce II positioning time and decrease the risk of inadvertent desterilization of the equipment. For the shoulder surgeon who uses II while operating in the lateral position, this technical pearl is worth considering.
Understanding the complex relationships underlying hot flashes: a Bayesian network approach
Authors: Smith Rebecca L. , Gallicchio Lisa M. , Flaws Jodi A.
Published: August 2017

Objective:

The mechanism underlying hot flashes is not well-understood, primarily because of complex relationships between and among hot flashes and their risk factors.

Methods:

We explored those relationships using a Bayesian network approach based on a 2006 to 2015 cohort study of hot flashes among 776 female residents, 45 to 54 years old, in the Baltimore area. Bayesian networks were fit for each outcome (current hot flashes, hot flashes before the end of the study, hot flash severity, hot flash frequency, and age at first hot flashes) separately and together with a list of risk factors (estrogen, progesterone, testosterone, body mass index and obesity, race, income level, education level, smoking history, drinking history, and activity level). Each fitting was conducted separately on all women and only perimenopausal women, at enrollment and 4 years after enrollment.

Results:

Hormone levels, almost always interrelated, were the most common variable linked to hot flashes; hormone levels were sometimes related to body mass index, but were not directly related to any other risk factors. Smoking was also frequently associated with increased likelihood of severe symptoms, but not through an antiestrogenic pathway. The age at first hot flashes was related only to race. All other factors were either not related to outcomes or were mediated entirely by race, hormone levels, or smoking.

Conclusions:

These models can serve as a guide for design of studies into the causal network underlying hot flashes.
Frequency of Acute Otitis Media in Children Under 24 Months of Age Before and After the Introduction of the 10-valent Pneumococcal Conjugate Vaccine Into the National Immunization Program in Chile
Authors: Rosenblut Andrés , Rosenblut Macarena , García Karen , Maul Ximena , Santolaya María E.
Published: August 2017

Background:

Streptococcus pneumoniae is the leading cause of acute otitis media (AOM). Ten-valent pneumococcal conjugated vaccine (PCV-10) was introduced to the Chilean National Immunization Program (NIP) in 2011. The aim of this study was to estimate the frequency of AOM in children <24 months of age attending the emergency department (ED) of Hospital Sótero del Río (HSR) 4 years before and 4 years after the introduction of PCV-10 in the Chilean NIP.

Methods:

Register-based nested case-control study. Cases (n = 1907) were all children <24 months of age with a clinical diagnosis discharge of AOM at the ED of HSR, and controls (n = 244,334) were all other children <24 months of age attended at the same ED in the same time period, with any other discharge diagnosis. The data were obtained through HSR Statistical Service.

Results:

In the study period, there was a mean of 30,695 children <24 months managed each year at the ED of HSR. The percentage with AOM in the prevaccine period was 0.94% and in the postvaccine period was 0.62%, respectively (P = 0.026). Exposure to the PCV-10 was associated with a decreased risk to develop AOM in children <24 months, with an odds ratio of 0.659 (95% confidence interval: 0.60–0.72).

Conclusions:

Our study showed a significant decrease in the percentage and risk of AOM in children <24 months of age who visited the ED of HSR after implementation of PCV-10 in the NIP in Chile.
Protein kinase A regulates inflammatory pain sensitization by modulating HCN2 channel activity in nociceptive sensory neurons
Authors: Herrmann Stefan , Rajab Hamsa , Christ Irina , Schirdewahn Christoph , Höfler Daniel , Fischer Michael J.M. , Bruno Ariane , Fenske Stefanie , Gruner Christian , Kramer Felix , Wachsmann Tassilo , Wahl-Schott Christian , Stieber Juliane , Biel Martin , Ludwig Andreas
Published: August 2017

Several studies implicated cyclic adenosine monophosphate (cAMP) as an important second messenger for regulating nociceptor sensitization, but downstream targets of this signaling pathway which contribute to neuronal plasticity are not well understood. We used a Cre/loxP-based strategy to disable the function of either HCN2 or PKA selectively in a subset of peripheral nociceptive neurons and analyzed the nociceptive responses in both transgenic lines. A near-complete lack of sensitization was observed in both mutant strains when peripheral inflammation was induced by an intradermal injection of 8br-cAMP. The lack of HCN2 as well as the inhibition of PKA eliminated the cAMP-mediated increase of calcium transients in dorsal root ganglion neurons. Facilitation of Ih via cAMP, a hallmark of the Ih current, was abolished in neurons without PKA activity. Collectively, these results show a significant contribution of both genes to inflammatory pain and suggest that PKA-dependent activation of HCN2 underlies cAMP-triggered neuronal sensitization.
Dissecting the role of the CRMP2–neurofibromin complex on pain behaviors
Authors: Moutal Aubin , Wang Yue , Yang Xiaofang , Ji Yingshi , Luo Shizhen , Dorame Angie , Bellampalli Shreya S. , Chew Lindsey A. , Cai Song , Dustrude Erik T. , Keener James E. , Marty Michael T. , Vanderah Todd W. , Khanna Rajesh
Published: August 2017

Neurofibromatosis type 1 (NF1), a genetic disorder linked to inactivating mutations or a homozygous deletion of the Nf1 gene, is characterized by tumorigenesis, cognitive dysfunction, seizures, migraine, and pain. Omic studies on human NF1 tissues identified an increase in the expression of collapsin response mediator protein 2 (CRMP2), a cytosolic protein reported to regulate the trafficking and activity of presynaptic N-type voltage-gated calcium (Cav2.2) channels. Because neurofibromin, the protein product of the Nf1 gene, binds to and inhibits CRMP2, the neurofibromin–CRMP2 signaling cascade will likely affect Ca2+ channel activity and regulate nociceptive neurotransmission and in vivo responses to noxious stimulation. Here, we investigated the function of neurofibromin–CRMP2 interaction on Cav2.2. Mapping of >275 peptides between neurofibromin and CRMP2 identified a 15-amino acid CRMP2–derived peptide that, when fused to the tat transduction domain of HIV-1, inhibited Ca2+ influx in dorsal root ganglion neurons. This peptide mimics the negative regulation of CRMP2 activity by neurofibromin. Neurons treated with tat-CRMP2/neurofibromin regulating peptide 1 (t-CNRP1) exhibited a decreased Cav2.2 membrane localization, and uncoupling of neurofibromin–CRMP2 and CRMP2–Cav2.2 interactions. Proteomic analysis of a nanodisc-solubilized membrane protein library identified syntaxin 1A as a novel CRMP2-binding protein whose interaction with CRMP2 was strengthened in neurofibromin-depleted cells and reduced by t-CNRP1. Stimulus-evoked release of calcitonin gene–related peptide from lumbar spinal cord slices was inhibited by t-CNRP1. Intrathecal administration of t-CNRP1 was antinociceptive in experimental models of inflammatory, postsurgical, and neuropathic pain. Our results demonstrate the utility of t-CNRP1 to inhibit CRMP2 protein–protein interactions for the potential treatment of pain.
The role of spatial frequency information in the decoding of facial expressions of pain: a novel hybrid task
Authors: Wang Shan , Eccleston Christopher , Keogh Edmund
Published: August 2017

Spatial frequency (SF) information contributes to the recognition of facial expressions, including pain. Low-SF encodes facial configuration and structure and often dominates over high-SF information, which encodes fine details in facial features. This low-SF preference has not been investigated within the context of pain. In this study, we investigated whether perpetual preference differences exist for low-SF and high-SF pain information. A novel hybrid expression paradigm was used in which 2 different expressions, one containing low-SF information and the other high-SF information, were combined in a facial hybrid. Participants are instructed to identify the core expression contained within the hybrid, allowing for the measurement of SF information preference. Three experiments were conducted (46 participants in each) that varied the expressions within the hybrid faces: respectively pain-neutral, pain-fear, and pain-happiness. In order to measure the temporal aspects of image processing, each hybrid image was presented for 33, 67, 150, and 300 ms. As expected, identification of pain and other expressions was dominated by low-SF information across the 3 experiments. The low-SF preference was largest when the presentation of hybrid faces was brief and reduced as the presentation duration increased. A sex difference was also found in experiment 1. For women, the low-SF preference was dampened by high-SF pain information, when viewing low-SF neutral expressions. These results not only confirm the role that SF information has in the recognition of pain in facial expressions but suggests that in some situations, there may be sex differences in how pain is communicated.
Efficacy and Safety of Simeprevir or Daclatasvir in Combination With Sofosbuvir for the Treatment of Hepatitis C Genotype 4 Infection
Authors: Babatin Mohammed A. , Alghamdi Abdullah S. , Albenmousa Ali , Alaseeri Abdulla , Aljarodi Mahdi , Albiladi Haziz , Alsahafi Ashwaq , Almugharbal Mohammed , Alothmani Hammad S. , Sanai Faisal M. , Bzeizi Khalid I.
Published: August 2017

Introduction:

The combination of sofosbuvir (SOF) with simeprevir (SMV) or daclatasvir (DCV) is very effective in treating hepatitis C virus (HCV) infection, particularly genotype (GT) 1. However, the data on GT4 are very limited. We aimed to determine the efficacy and safety of SOF in combination with either SMV or DCV in GT4-infected patients.

Patients and Methods:

In this real life, prospective, observational study, HCV (GT4) patients (n=96) were evaluated in 2 groups on the basis of the 12-week treatment regimen they received. Group 1 (n=56) patients were treated with SOF and SMV±ribavirin (RBV), whereas group 2 patients were treated with SOF and DCV±RBV (n=40). The primary efficacy endpoint was sustained virologic response 12, whereas the primary safety endpoint was drug discontinuation or occurrence of grade 3/4 adverse events.

Results:

The mean age was 49±14.6 years (59.4% men). Cirrhosis was present in 53.6% and 35.0% of groups 1 and 2, respectively, whereas 27 patients (48.2%) in group 1 and 21 patients (52.5%) in group 2 had failed prior interferon-based treatment. The median pretreatment HCV-RNA log10 was 6.1 (3.6 to 7.0) and 6.0 (3.6 to 7.2) IU/mL in groups 1 and 2, respectively. RBV was given to 17 patients (30.4%) in group 1 and 2 patients (5%) in group 2. All patients achieved sustained virologic response 12 (100%). Adverse events occurred in 32% of patients (grade 1 and 2), but none discontinued treatment. One patient died in the SMV group (not related to treatment).

Conclusions:

SMV/SOF or DCV/SOF combinations are safe and highly effective in HCV-GT4 treatment. Cirrhosis and failure of prior interferon-based treatment did not influence treatment response.
Inter-rater reliability of two paediatric early warning score tools
Authors: Jensen Claus S. , Aagaard Hanne , Olesen Hanne V. , Kirkegaard Hans
Published: August 2017

Background

Paediatric early warning score (PEWS) assessment tools can assist healthcare providers in the timely detection and recognition of subtle patient condition changes signalling clinical deterioration. However, PEWS tools instrument data are only as reliable and accurate as the caregivers who obtain and document the parameters.

Objective

The aim of this study is to evaluate inter-rater reliability among nurses using PEWS systems.

Design

The study was carried out in five paediatrics departments in the Central Denmark Region. Inter-rater reliability was investigated through parallel observations. A total of 108 children and 69 nurses participated. Two nurses simultaneously performed a PEWS assessment on the same patient. Before the assessment, the two participating nurses drew lots to decide who would be the active observer. Intraclass correlation coefficient, Fleiss’ κ and Bland–Altman limits of agreement were used to determine inter-rater reliability.

Results

The intraclass correlation coefficients for the aggregated PEWS score of the two PEWS models were 0.98 and 0.95, respectively. The κ value on the individual PEWS measurements ranged from 0.70 to 1.0, indicating good to very good agreement. The nurses assigned the exact same aggregated score for both PEWS models in 76% of the cases. In 98% of the PEWS assessments, the aggregated PEWS scores assigned by the nurses were equal to or below 1 point in both models.

Conclusion

The study showed good to very good inter-rater reliability in the two PEWS models used in the Central Denmark Region.
Innovative Approach to Reconstruct Bedside Handoff
Authors: Anthony Mary K. , Kloos Janet , Beam Patricia , Vidal Kathleen
Published: August 2017

When nurses integrate patient expertise, nurse-to-nurse handoff becomes patient-centered (nurse and patient), and the weak link between quality and safety is mitigated. The existing paradigm for handoff is an ineffective measure to minimize errors. This article describes a reimagined bedside handoff—transitioning handoff from its prescriptive nurse-centered interaction to a patient-centered partnership using the principles of complex adaptive systems, simple rules, and partnerships that address the uniqueness of each patient and nurse interaction.
Improving Patient Care Outcomes Through Better Delegation-Communication Between Nurses and Assistive Personnel
Authors: Wagner Elissa A.
Published: August 2017

In acute care settings, registered nurses need to delegate effectively to unlicensed assistive personnel to provide safe care. This project explored the impact of improved delegation-communication between nurses and unlicensed assistive personnel on pressure injury rates, falls, patient satisfaction, and delegation practices. Findings revealed a tendency for nurses to delay the decision to delegate. However, nurses' ability to explain performance appraisals, facilitate clearer communication, and seek feedback improved. Patient outcomes revealed decreased falls and improved patient satisfaction.