bluuebunny/crossref_metadata_2025 huggingface dataset:
Epilogue
Authors: Diener Alexander C. , Hagen Joshua
Published: March 2024

The Epilogue ties a number of the threads from the book’s varied chapters together and points to future avenues of research, as well as modes of thinking about borders and bordering. Calls for open borders, no borders, or the elimination of the state make claims to a moral high ground over the established geopolitical and social systems framed around bordered spaces. This Epilogue calls for readers to seriously consider these arguments but to also consider the consequences of open borders or no borders. The future is unlikely to depart aggressively from the patterns and structures of the past any time soon, but the fact that ideas of post-territoriality are emerging and borders are such a focus of ethical debate suggests that new paradigms of spatial organization are possible. This Very Short Introduction provides a foundation upon which readers may readily launch into further study of borders.
Being who you are
Authors: Schechtman Marya
Published: March 2024

This chapter further explores the idea of a true or deep self introduced in Chapter 2 and familiar from everyday life. It starts with two truisms. The first is that someone is often not themselves when they are inebriated or under extreme stress. The second is that someone often reveals who they truly are when inebriated or under extreme stress. Both are common views of when the true self emerges, yet they appear to be diametrically opposed. The chapter examines the picture of the true self each reveals. The first suggests that the true self is constituted by what we choose. In philosophical discussion, this idea is typically connected with discussions of the conditions of autonomous agency. The second suggests that the true self is a set of core traits to be discovered, accepted, and expressed. In philosophy and psychology, this view is often associated with questions of authenticity. Strengths and challenges of both approaches are discussed, revealing the complexity and nuance of our conception of the true self. The chapter concludes by introducing an alternative, narrative approach to understanding the true self, which is potentially in a better position to capture that complexity but faces challenges of its own.
Impact of pharmacist-driven referral to increase specialty pharmacy prescription capture
Authors: Elchehimi Sue’ad , Blackwell Joshua , Mohiuddin Saba , Bajaj Puneet
Published: March 2024

Purpose

To assess the impact of a clinical pharmacy specialist (CPS) embedded within a rheumatology clinic at a large academic medical center on the prescription capture rate at the health-system specialty pharmacy.

Methods

Initially low prescription capture rates for the health-system specialty pharmacy led to the integration of a CPS in the main campus rheumatology clinic. Benchmarking was completed by assessing the prior prescription capture rate using electronic medical record analytics and Loopback Analytics (a database of prescription capture for the health-system specialty pharmacy). The existing workflows for both the rheumatology clinic and specialty pharmacy were observed with regard to biologic medication ordering and processing. Strategies for an updated workflow for biologic ordering with the incorporation of an embedded CPS in the rheumatology clinic were designed. This new workflow was established with key stakeholders, including the CPS, rheumatology providers, clinic staff, and pharmacy technicians. Once the workflow was established, all parties were educated and updated, including rheumatology providers, nursing staff, and specialty pharmacy staff. Prescription capture rate was monitored on a monthly basis.

Results

Prescription capture increased from 13.16% before pharmacist implementation (October to December 2021) to 35.42% after pharmacist implementation (October to December 2022) (P = 0.019). During the same periods, the revenue generated increased from $43,222.89 to $135,198.70 (P = 0.224) and the proportion of prescriptions initially sent to the health-system specialty pharmacy compared to other specialty pharmacies increased from 37% to 79% (P < 0.001) with CPS implementation.

Conclusion

Expansion and implementation of pharmacy services by integrating a CPS in a rheumatology ambulatory clinic increased prescription capture and pharmacy revenue while optimizing patient care. We hope to expand similar CPS services to other clinics within the health system.
Successful Treatment of Noninflammatory CaHA Nodules Using Focused Mechanical Vibration
Authors: McCarthy Alec D , Berkowitz Shoham , Chernoff William Gregory
Published: March 2024

Noninflammatory nodules arising from the injection of biostimulatory fillers persist as an unwanted complication. Pathologically, noninflammatory nodules may arise from superficial injection, accidental boluses, or incorrect concentration of microparticles contained within the filler. This case report introduces a method for reversing calcium hydroxylapatite (CaHA) using focused mechanical vibration. An in situ hyperdilution was created by injecting saline into the nodule core to prepare it for resuspension. Topical microneedling was subsequently applied to generate vibrations, aiming to disperse the accumulated CaHA particles. The outcome demonstrated a significant reduction in the size and visibility of the nodule. This combined saline-microneedling approach offers a potential noninvasive, nonpharmacologic solution for managing superficial CaHA nodules.

Level of Evidence: 5
Cranium morphology prevalence among digging habits in Thomomys species
Authors: Álvarez-Castañeda Sergio Ticul , Monroy-Gamboa Alina Gabriela
Published: March 2024

Species of the Thomomys subgenera of pocket gophers dig tunnels differentially; Thomomys are mainly claw-diggers while Megascapheus are tooth-diggers. Specific skull analyses could help in differentiating species in the bottae–umbrinus complex. This study revealed that Megascapheus shows similarity in cranium morphometry but that rostrum shape should show modifications associated with tooth-digging habits. We analysed cranium variation between Megascapheus species to identify interspecific variation. The variation in cranial morphometry within and between eight Megascapheus species was quantified through a two-dimensional geometric morphometry analysis based on 19 dorsal and 19 lateral reference points of 1172 specimens from different localities. Sample shape diversity and discrimination were analysed using principal component analysis (PCA) and canonical variable analysis (CVA). Sexual dimorphism tests were performed on cranium shape and size. A Student’s t-test was performed to explore differences between groups previously evaluated by CVA. PCA revealed considerable overlap across species in terms of view and sexes, with significant differences in Procrustes distances (shape) and centroid distances (size). The analyses showed that species in the subgenus Megascapheus have two main cranium morphotypes associated with the ecosystem that they inhabit. The analyses contribute to confirm the species level for T. fulvus and T. nigricans.
Explicit and implicit motor simulations are impaired in individuals with aphantasia
Authors: Dupont William , Papaxanthis Charalambos , Madden-Lombardi Carol , Lebon Florent
Published: March 2024

Individuals with aphantasia report having difficulties or an inability to generate visual images of objects or events. So far, there is no evidence showing that this condition also impacts the motor system and the generation of motor simulations. We probed the neurophysiological marker of aphantasia during explicit and implicit forms of motor simulation, i.e. motor imagery and action observation, respectively. We tested a group of individuals without any reported imagery deficits (phantasics) as well as a group of individuals self-reporting the inability to mentally simulate images or movements (aphantasics). We instructed the participants to explicitly imagine a maximal pinch movement in the visual and kinaesthetic modalities and to observe a video showing a pinch movement. By means of transcranial magnetic stimulation, we triggered motor-evoked potentials in the target right index finger. As expected, the amplitude of motor-evoked potentials, a marker of corticospinal excitability, increased for phantasics during kinaesthetic motor imagery and action observation relative to rest but not during visual motor imagery. Interestingly, the amplitude of motor-evoked potentials did not increase in any of the conditions for the group of aphantasics. This result provides neurophysiological evidence that individuals living with aphantasia have a real deficit in activating the motor system during motor simulations.
Drivers of Geographic Patterns in Outpatient Antibiotic Prescribing in the United States
Authors: Kissler Stephen M , Oliveira Roster Kirstin I , Petherbridge Rachel , Mehrotra Ateev , Barnett Michael L , Grad Yonatan H
Published: March 2024

In a retrospective, ecological analysis of US medical claims, visit rates explained more of the geographic variation in outpatient antibiotic prescribing rates than per-visit prescribing. Efforts to reduce antibiotic use may benefit from addressing the factors that drive higher rates of outpatient visits, in addition to continued focus on stewardship.
How Institution-Building Shapes Great Power Alignment: An Institutional Perspective on the China–Russia Partnership
Authors: Düben Björn Alexander
Published: March 2024

Sino-Russian relations have thrived in the post–Cold War era. While the relationship has attracted ample academic attention, many of the underlying factors contributing to the bilateral rapprochement over the past three decades remain un(der)explored. This article examines the role played by one of the factors involved in this process: the development of institutional links between the two states. Bilateral institutions, which were largely absent until the mid-1990s, have rapidly proliferated into a dense network of commissions and subcommissions, working groups, and other institutionalised exchanges, encompassing virtually all sectors of interaction between China and Russia. The article employs analytical concepts borrowed from Institutionalist theory and develops criteria of analysis to assess the extent to which the process of bilateral institution-building has contributed to promoting and perpetuating Sino-Russian rapprochement, enabling the two states to forge a closer working relationship with each other. The article also examines what the limits of this process have been. It concludes that the practical impact of bilateral institution-building on policy-making has been modest; however, the institutions have come to constitute important forums to secure a regular exchange and familiarisation between senior decision-makers and stakeholders, allowing for an active communication of important information and mutual assurances regarding each country’s policy choices, intentions, and concerns.
Prognostic factors and validation of the histologic chronicity score for C3 glomerulopathy: a registry analysis
Authors: Mirioglu Safak , Cebeci Egemen , Yazici Halil , Derici Ulver , Sahin Gulizar , Coban Ganime , Eren Necmi , Gungor Ozkan , Dede Fatih , Dincer Tamer , Turkmen Kultigin , Basturk Taner , Duranay Murat , Arikan Hakki , Tunca Onur , Elcioglu Omer Celal , Tatar Erhan , Aydin Zeki , Oygar Deren , Demir Serap , Tanrisev Mehmet , Kurultak Ilhan , Oruc Aysegul , Turkmen Aydin , Akcay Omer Faruk , Cetinkaya Hakki , Ozturk Savas ,   the Glomerular Diseases Working Group of the Turkish Society of Nephrology (TSN-GOLD), Ozluk Yasemin , Gonul Ipek Isik , Gumrukcu Gulistan , Vural Cigdem , Gunay Emine Kilinc , Colak Aysel , Gurses Iclal , Esen Haci Hasan , Ozagari Ayse Aysim , Kiremitci Saba , Kaya Handan , Ozdemir Cigdem , Tasli Funda , Ayhan Arzu Saglam , Karabulut Yasemin Yuyucu , Guney Neslihan , Usta Ufuk , Vuruskan Berna Aytac
Published: March 2024

Background

Data on the prognostic factors for C3 glomerulopathy (C3G) are limited, and validation of the new C3G histologic index (C3G-HI) in different settings is still needed. We aimed to evaluate the chronicity score of C3G-HI and probable prognostic factors in our population.

Methods

In this registry study, 74 patients from 20 centers with adequate follow-up data were included. Total chronicity score (TCS) was calculated according to percentages of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and presence of arterio- and arteriolosclerosis. Primary composite outcome was defined as doubling of serum creatinine from baseline, undergoing dialysis or transplantation, development of stage 5 chronic kidney disease, or death.

Results

Median age was 34 [interquartile range (IQR) 24–46] years, and 39 patients (52.7%) were male. Median follow-up duration was 36 (IQR 12–60) months, and median TCS was 3 (IQR 1–5). Overall, 19 patients (25.7%) experienced primary composite outcome. Multivariate Cox regression model showed that only hemoglobin [adjusted HR (aHR) 0.67, 95% confidence interval 0.46–0.97, P = .035] predicted primary composite outcome, and TCS fell short of the statistical significance (aHR 1.26, 0.97–1.64, P = .08). Receiver operating characteristic analysis demonstrated that TCS showed an area under the curve value of 0.68 (0.56–0.78, P = .028) in discriminating primary composite outcome at 3 years, and 3-year kidney survival was lower in patients with TCS ≥4 (72.4%) compared with TCS <4 (91.1%) in Kaplan–Meier analysis (P = .036).

Conclusions

Low hemoglobin levels predicted dismal outcomes in patients with C3G. TCS ≥4 was associated with a worse 3-year kidney survival, which validated the 3-year prognostic value of the TCS of C3G-HI in our population.
Recurrent angina and cardiac ischaemia as a presentation of pheochromocytoma: a case report
Authors: van de Bovenkamp Arno A , Kalkman Deborah N , Beijk Marcel A M , van de Veerdonk Mariëlle C
Published: March 2024

Background

We present a case of a pregnant patient with recurrent angina, in which her symptoms were initially attributed to coronary artery spasm. However, during follow-up, she was diagnosed as having pheochromocytoma, a rare neuroendocrine tumour.

Case summary

The 35-year-old patient was admitted to the hospital because of chest pain and elevated cardiac troponins after the use of MDMA. Physical examination, electrocardiogram, echocardiography, coronary angiogram, and cardiac MRI were normal. Symptoms were attributed to coronary spasm, and a calcium antagonist was started. Ten months later, when 36 weeks pregnant, her symptoms returned. One week later, the patient was readmitted to the hospital with signs of acute left ventricular (LV) failure, highly elevated troponins, and severe global LV dysfunction. Urgent section caesarean was performed due to maternal morbidity and foetal tachycardia. During section, flushes and marked variability in blood pressure were noted. Laboratory metanephrines testing was performed. LV function recovered within 3 days without any therapeutic intervention. However, chest pain reoccurred, now accompanied with headaches, malignant hypertension, and accelerated idiopathic ventricular rhythms. (Nor)metanephrines tests were positive. A solid lesion in the right adrenal on CT scan confirmed the diagnosis of pheochromocytoma. Fluid repletion and alpha-blocker therapy were started. Due to persistent symptoms, urgent laparoscopic adrenalectomy was performed. Hereafter, the patient remained without symptoms.

Discussion

A pheochromocytoma may present with recurrent angina and can result in a catecholamine-induced cardiomyopathy. It is important to timely recognize this diagnosis in order to minimize morbidity and mortality.
Transthoracic and transoesophageal echocardiography for tricuspid transcatheter edge-to-edge repair: a step-by-step protocol
Authors: Mazzola Matteo , Giannini Cristina , Sticchi Alessandro , Spontoni Paolo , Pugliese Nicola Riccardo , Gargani Luna , De Carlo Marco
Published: March 2024

Tricuspid regurgitation (TR) carries an unfavourable prognosis and often leads to progressive right ventricular (RV) failure. Secondary TR accounts for over 90% of cases and is caused by RV and/or tricuspid annulus dilation, in the setting of left heart disease or pulmonary hypertension. Surgical treatment for isolated TR entails a high operative risk and is seldom performed. Recently, transcatheter edge-to-edge repair (TEER) has emerged as a low-risk alternative treatment in selected patients. Although the experience gained from mitral TEER has paved the way for the technique’s adaptation to the tricuspid valve (TV), its anatomical complexity necessitates precise imaging. To this end, a comprehensive protocol integrating 2D and 3D imaging from both transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) plays a crucial role. TTE allows for an initial morphological assessment of the TV, quantification of TR severity, evaluation of biventricular function, and non-invasive haemodynamic evaluation of pulmonary circulation. TOE, conversely, provides a detailed evaluation of TV morphology, enabling precise assessment of TR mechanism and severity, and represents the primary method for determining eligibility for TEER. Once a patient is considered eligible for TEER, TOE, alongside fluoroscopy, will guide the procedure in the catheterization lab. High-quality TOE imaging is crucial for patient selection and to achieve procedural success. The present review examines the roles of TTE and TOE in managing patients with severe TR eligible for TEER, proposing the step-by-step protocol successfully adopted in our centre.
Spatial inequality in higher education: a growing urban–rural educational gap?
Authors: Zahl-Thanem Alexander , Rye Johan Fredrik
Published: March 2024

Scholars have consistently found that inequalities in educational attainment are most pronounced along social origin and gender dimensions, but urban–rural inequalities have also been evident in recent years. A spatial gradient in educational attainment reflects how rural students are consistently less likely to gain higher education (HE) credentials than their urban peers. By drawing on full-population administrative data on the Norwegian birth cohorts from 1965 to 1989 (n = 1,419,406), followed from age 16 to 30, this article analyses how urban–rural differences in HE have changed over the last 25 years, and furthermore, whether urban–rural disparities have developed in distinct ways based on students’ social origin and gender. The results show that urban–rural disparities in higher educational attainment have become more pronounced for recent birth cohorts and particularly evident for post-1980 cohorts. This applies to students originating from both privileged and less privileged families. However, urban–rural inequalities are more evident for men than women, which over time has led gender differences to become considerably greater in rural areas. The results demonstrate that spatial inequality requires further attention in educational and stratification research, as the outcomes suggest that the urban–rural educational gap is not necessarily consistent over time.
A proxy implementation of thermal pressurization for earthquake cycle modelling on rate-and-state faults
Authors: Herrera Marco T , Ampuero Jean P , Crempien Jorge G F
Published: March 2024

The reduction of effective normal stress during earthquake slip due to thermal pressurization of fault zone pore fluids is a significant fault weakening mechanism. Explicit incorporation of this process into frictional fault models involves solving the diffusion equations for fluid pressure and temperature outside the fault at each time step, which significantly increases the computational complexity. Here, we propose a proxy for thermal pressurization implemented through a modification of the rate-and-state friction law. This approach is designed to emulate the fault weakening and the relationship between breakdown energy and slip resulting from thermal pressurization and is appropriate for fully dynamic simulations of multiple earthquake cycles. It preserves the computational efficiency of conventional rate-and-state friction models, which in turn can enable systematic studies to advance our understanding of the effects of fault weakening on earthquake mechanics. In 2.5-D simulations of pulse-like ruptures on faults with finite seismogenic width, based on our thermal pressurization proxy, we find that the spatial distribution of slip velocity near the rupture front is consistent with the conventional square-root singularity, despite continued slip-weakening within the pulse, once the rupture has propagated a distance larger than the rupture width. An unconventional singularity appears only at shorter rupture distances. We further derive and verify numerically a theoretical estimate of the breakdown energy dissipated by our implementation of thermal pressurization. These results support the use of fracture mechanics theory to understand the propagation and arrest of very large earthquakes.
Convergence and error estimates of a penalization finite volume method for the compressible Navier–Stokes system
Authors: Lukáčová-Medviďová Mária , She Bangwei , Yuan Yuhuan
Published: March 2024

In numerical simulations a smooth domain occupied by a fluid has to be approximated by a computational domain that typically does not coincide with a physical domain. Consequently, in order to study convergence and error estimates of a numerical method domain-related discretization errors, the so-called variational crimes, need to be taken into account. In this paper we apply the penalty approach to control domain-related discretization errors. We embed the physical domain into a large enough cubed domain and study the convergence of a finite volume method for the corresponding domain-penalized problem. We show that numerical solutions of the penalized problem converge to a generalized, the so-called dissipative weak, solution of the original problem. If a strong solution exists, the dissipative weak solution emanating from the same initial data coincides with the strong solution. In this case, we apply a novel tool of the relative energy and derive the error estimates between the numerical solution and the strong solution. Extensive numerical experiments that confirm theoretical results are presented.
Optimal Conformal Prediction for Small Areas
Authors: Bersson Elizabeth , Hoff Peter D
Published: March 2024

Existing methods for small-area data involve a trade-off between maintaining area-level frequentist coverage rates and improving precision via the incorporation of indirect information. In this article, we develop an area-level prediction region procedure that mitigates this trade-off. The method takes a conformal prediction approach in which the conformity measure is the posterior predictive density of a working model that incorporates indirect information. The resulting prediction region has guaranteed within-area frequentist coverage regardless of the working model, and, if the working model assumptions are accurate, the region has smaller expected volume compared to other regions with the same coverage rate. For a normal working model, we prove such a prediction region is an interval and construct a straightforward algorithm to obtain its endpoints. We illustrate the performance of our method through simulation studies and an application to EPA radon survey data.
Anxiety and Related Disorders Interview Schedule for DSM-5, Child and Parent Version
Authors: Albano Anne Marie , Silverman Wendy K.
Published: March 2024

This book outlines the Anxiety Disorders Interview Schedule for DSM-5, Child and Parent Versions. These are considered the gold standard semi-structured interviews used in clinical research and services to assess and diagnose the major mental health conditions affecting children, adolescents, and young adults. These interviews cover the range of conditions identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), while also providing information for careful case formulation in treatment planning and evaluation of outcomes. Evaluators are able to quantify the severity of illness using a Clinician Severity Rating (CSR), as well as level of severity of symptoms and associated avoidance behavior. Decision rules for combining parent and youth report, examples of CSR levels for the child anxiety triad of separation anxiety disorder, social anxiety disorder, and generalized anxiety disorder are included in the Clinician Guide, as well as detailed information on use of the Autism Supplement.
Oncology and palliative care
Authors: Furmedge Dan
Published: March 2024

The importance of palliative and end-of-life care cannot be underestimated, as all doctors will come into contact with patients approaching the end of their life. As such, all doctors should have a working understanding of the principles of palliative care, as well as how to recognize terminal illness and how to manage symptoms at the end of life. This chapter contains 17 questions that encompass important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Medicine to track revision progress and revise effectively.
Clinical chemistry
Authors: Furmedge Dan
Published: March 2024

The aim of this chapter is to help you with your working practical knowledge of clinical chemistry. With so many tests available and increasingly fast laboratory processors, there is a growing temptation to request large numbers of blood tests for every patient. Investigations should be used as an adjunct to the history and clinical examination. Test results should reinforce the likely diagnosis and rule out our differentials, rather than be used to try and make the diagnosis per se. This chapter contains 22 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Medicine to track revision progress and revise effectively.
Radiology
Authors: Sinharay Rudy
Published: March 2024

The aim of this chapter is to help you with your preparation with your medical school exams, and raise awareness and your working practical knowledge of radiology. From the ubiquitous chest X-ray for diagnosing community-acquired pneumonia or congestive cardiac failure to an urgent computed tomography (CT) scan of the brain to confirm a suspected subarachnoid haemorrhage, radiological investigations are an essential (if sometimes overused) resource for diagnosing disease. This chapter contains 23 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Medicine to track revision progress and revise effectively.
Organization
Authors: Orosz Judit , McGoughlin Steve
Published: March 2024

Summary

Intensive care units (ICUs) care for patients who have or at risk of developing life-threatening organ dysfunction. ICUs require specialized infrastructure and equipment and a multi-disciplinary team who are trained to care for critically ill patients. There are several organizational factors that can influence patient outcomes and staff satisfaction, which need to be considered in the function of an ICU. Examples of these factors include the designation of responsibility of patient care within the ICU, the cohorting of critically ill patients, and the approach to staffing ICUs out of hours. COVID-19 has further emphasized the impact of organizational factors on patient outcomes as ICUs globally have had to develop and implement pandemic plans to cope with a surge of critically ill patients.
Mechanical Ventilation: How to Set Up the Ventilator
Authors: Boesing Christoph , Luecke Thomas , Krebs Joerg
Published: March 2024

Summary

Mechanical ventilation is a key component in the management of critically ill patients. Therefore, the attending physician needs a comprehensive understanding of the indications, aims, and underlying physiology when treating mechanically ventilated patients to avoid potentially detrimental consequences like ventilator-induced lung injury. A structured approach includes an assessment of the respiratory system, the clinical situation of the patient, and choosing the correct ventilatory mode that avoids patient–ventilator asynchrony. This chapter outlines essential features of respiratory mechanics, their effect on different ventilator strategies, and key components of mechanical ventilation.
Advanced Respiratory Therapies: Inhaled Therapies, Heliox, ECMO and ECCO2-R, and Non-conventional Ventilatory Modes
Authors: Ehrmann Stephan , Juffermans Nicole P , Schultz Marcus J , Patroniti Nicolò , Molin Alex , Scharffenberg Martin , Nabecker Sabine , Abreu Marcelo Gama de
Published: March 2024

Summary

This chapter discusses diverse and some esoteric aspects of respiratory critical care support, yet important to certain patient groups. Section 22.1 covers the indications, delivery, and practical aspects of inhaled therapies used for therapeutics such as bronchodilators, mucolytics, and antibiotics. The differences between circuits, non-invasive versus invasive mechanical ventilation, and particle delivery technologies are addressed. In Section 22.2, heliox, a gaseous mixture of helium and oxygen, is evaluated from a theoretical basis and in its implementation as a therapy for acute respiratory failure. It can reduce airway resistance and work of breathing. Heliox may be suitable for certain situations where upper airway flow is compromised despite conventional therapies. Clinical outcome studies in asthma, chronic obstructive pulmonary disease (COPD), and airways stenoses are described. Section 22.3 covers extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal for respiratory failure. From their history, through technical and practical aspects of set-up, clinical indications, evidence, and future developments, this provides a comprehensive succinct understanding of its role in contemporary respiratory critical care. Finally, Section 22.4 describes non-conventional modes of ventilation, which aim to address the limitations of conventional modes, specifically monotonous respiratory patterns or non-ideal triggering. Airway pressure release ventilation, variable ventilation, high-frequency oscillatory ventilation, proportional assist ventilation, neurally adjusted ventilatory assist, and flow-controlled ventilation are discussed. The theoretical benefits of these types of ventilation, and patient cohorts to select for further clinical studies, allow a glimpse into further advances likely to emerge.
Fluid Balance
Authors: Aya Hollmann D , Cecconi Maurizio
Published: March 2024

Summary

Fluid balance refers to the volume of fluid held in the body during a defined period of time. Management of fluid balance is important in patients with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and sepsis. In this chapter, we examine the evidence that supports the goal of a negative fluid balance goal and the potential confounders related to the fluid balance measurements. We also review the physiological background for the homeostasis of water and the upcoming technology to estimate intravascular fluid status in critically ill patients. We propose to use fluid balance in context with other clinical and biochemical observations, particularly those that can be surrogates of tissue or organ perfusion.
Delirium and Sleep
Authors: Al-Hindawi Ahmed , Rogers Eli , Vizcaychipi Marcela P
Published: March 2024

Summary

Delirium, an acute dysfunction of cognition and memory, can occur at any age and is associated with increased mortality, worse cognitive function following discharge, and increased length and cost of stay. Its development is likely as a result of multiple intertwined mechanisms of neuroinflammation, neuronal hypoxia, and neurotransmitter imbalance that trigger a final common pathway. Two phenotypes of delirium occur: hypoactive and hyperactive, with the former occurring in the vast majority of patients, yet is the most difficult to clinically detect. Sleep plays an important role in the development of delirium although no causal link has yet been identified. Multiple mechanisms that are present in patients with delirium have been hypothesized to result in poor sleep quality and the development of delirium, but evidence is lacking. The diagnosis of delirium is operationalized by bedside scoring systems; the CAM-ICU score is sensitive, reproducible, and easy to perform. Identifying any modifiable risk factors is the treatment of choice as there is no specific treatment for this syndrome.
Fungal Respiratory Infections
Authors: Bassetti Matteo , Carnelutti Alessia , Righi Elda
Published: March 2024

Summary

Invasive fungal infections are life-threatening diseases characterized by high mortality rates, especially among critically ill and immunocompromised patients. The impairment of defence mechanisms (e.g. lymphocyte dysfunction, drug-induced immunosuppression, and presence of invasive devices such as intravascular catheters), along with prolonged hospitalizations and broad-spectrum antimicrobial therapies, are potential risk factors for invasive fungal infections. The increasing complexity of medical care, the advent of more potent chemotherapeutic regimens, and more solid organ and haematopoietic stem cell transplant recipients have contributed to the progressive rise of invasive fungal infections. Candida spp. and Aspergillus spp. are the most common pathogens causing invasive fungal infections. Aspergillosis and Pneumocystis jiroveci pneumonia represent severe forms of lung infections. Less commonly, Cryptococcus neoformans may cause pneumonia with disseminated infection of bone, skin, and brain seen in profoundly immunocompromised patients. Candida are not usually pulmonary pathogens, but systemic Candida infection and candidemia can complicate the care of critically ill patients. The clinical diagnosis of invasive fungal infections is challenging, and nonculture-based methods can facilitate the management of high-risk patients. Conventional culture techniques are imperfect and slow whereas a range of antigen and nucleic acid/PCR-based tests are faster and more sensitive. Timely and appropriate antifungal treatment is paramount in the management of invasive fungal infections. Relatively new antifungals (e.g. triazoles and echinocandins) are available and promising in clinical practice for the treatment of invasive fungal infections. In this chapter, the clinical diagnosis and personalized pharmacological treatment of invasive fungal infections in critically ill patients are reviewed and discussed.
Burns Inhalation Injury
Authors: Soussi Sabri , Legrand Matthieu , Singh Suveer
Published: March 2024

Summary

Burn-related inhalation injury refers to damage to the respiratory tract and/or lung parenchyma by heat, smoke, or chemical irritants. Burn inhalation injury also causes systemic toxicity by toxic gases (particularly carbon monoxide, CO; and hydrogen cyanide, HCN). Anything more than mild injury is associated with increased mortality in critically ill burn patients. Bronchoscopy confirms diagnosis, defines the severity, and aids therapeutic airway clearance. Treatment of inhalation injury is mainly supportive: securing a definitive airway early, protective mechanical ventilation, airway clearance strategies, surveillance for pulmonary infection, inhalation strategies of 4-hourly inhaled heparin, and N-acetylcysteine plus bronchodilators. Post-recovery respiratory sequelae require follow-up. Future therapeutic strategies may address the complex pathophysiology that involves control of the inflammatory, oxidative stress and coagulation pathways, and their effects on the respiratory tract at the molecular level. A simple, validated prognostic tool that incorporates standardized grades of bronchoscopic images would be desirable in the future.
Poisoning
Authors: Singh Omender , Garg Suneel Kumar , Juneja Deven
Published: March 2024

Summary

Critical care physicians frequently manage poisoning and drug overdose. Poisoning and overdose may cause respiratory failure by compromising respiratory pump function and/or by causing direct injury to the lung parenchyma. Respiratory failure may also develop from central nervous system depression. In poisonings associated with respiratory failure, arterial blood gas should always be done with co-oximetry. Airway, Breathing, Circulation, Disability, Exposure (ABCDE) remains the mainstay of initial approach but may need to be modified in certain poisoning and overdoses where oxygen therapy may aggravate toxicity or where specific therapy, that is, antidote, may improve respiratory failure dramatically. Decontamination and supportive measures remain the main focus of treatment.
Lung Transplantation
Authors: Bein Thomas , Pfeifer Michael
Published: March 2024

Summary

Lung transplantation (LT) is an established treatment for end-stage pulmonary diseases, a worldwide organ shortage notwithstanding. Recent advances in operative techniques as well as significant improvements in immunosuppressive management have led to better survival rates, but the careful evaluation of candidates is of particular importance for the success of LT. Post-transplant intensive care requires specific organ and pharmaceutical support to avoid or reduce typical complications in the early period (infection, rejection, ischaemia-reperfusion injury, anastomotic damage, and early graft dysfunction). Bilateral transplants when feasible have better outcomes than single-lung transplants. Quality of life is generally higher post transplantation. The survival rate following LT is ≈50% after 5 years. Successful long-term outcome is strongly associated with a balanced immunosuppression, careful prophylaxis of infection, and the avoidance of chronic allograft dysfunction. Extracorporeal lung support with avoidance of mechanical ventilation is an increasingly preferred bridge to transplantation, especially in those patients who deteriorate while listed. Improving ex vivo perfusion techniques in human donor lungs is the subject of active research.
Liberation from Mechanical Ventilation
Authors: Murphy Patrick B , Jones Andrew , Camporota Luigi
Published: March 2024

Summary

Prolonged mechanical ventilation accounts for an important number of intensive care unit bed days. Weaning is the process of moving towards liberation from mechanical ventilation following resolution of the acute physiological insult that resulted in intensive care admission. Weaning is not simply the reduction of ventilator pressure support but is the global process of progressing a ventilator-dependent patient to return to spontaneous breathing and subsequent extubation or decannulation from tracheostomy. While readiness testing and simple weaning can be protocol driven, patients who progress from difficult weaning to prolonged mechanical ventilation will often require detailed physiological assessment in order to identify the reason for weaning failure. Complex weaning involves not just attention to the respiratory physiological impairment but a multi-disciplinary approach involving physical rehabilitation and psychological support to tackle the invariably present co-morbidities that will halt weaning. This appears to be most cost-effectively delivered in specialist centres.
Endocrinology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Hateley Peter , Kelly Dearbhla , McGurgan Iain
Published: March 2024

This chapter discusses endocrinology, including endocrine physiology, diabetes mellitus (DM) classification, treatment, and complications, diabetic neuropathy and foot care, hypoglycaemia, insulinoma, thyroid function tests (TFTS), thyrotoxicosis, hypothyroidism (myxoedema), parathyroid hormone and hyperparathyroidism, hypoparathyroidism, adrenal cortex and Cushing’s syndrome, Addison’s disease (adrenal insufficiency), hyperaldosteronism, phaeochromocytoma, hirsutism, virilism, gynaecomastia, impotence, hypopituitarism, pituitary tumours, hyperprolactinaemia, acromegaly, and diabetes insipidus (DI).
Oncology and palliative care
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Hateley Peter , Kelly Dearbhla , McGurgan Iain
Published: March 2024

This chapter discusses oncology and palliative care, including looking after people with cancer, cancer signs and symptoms, chemotherapy and targeted treatment, radiotherapy and interventional oncology, multidisciplinary cancer care, oncology emergencies, paraneoplastic syndromes, tumour markers, and palliative care principles, pain, and care in the last days of life.
The thesan project: public data release of radiation-hydrodynamic simulations matching reionization-era JWST observations
Authors: Garaldi Enrico , Kannan Rahul , Smith Aaron , Borrow Josh , Vogelsberger Mark , Pakmor Rüdiger , Springel Volker , Hernquist Lars , Galárraga-Espinosa Daniela , Yeh Jessica Y -C , Shen Xuejian , Xu Clara , Neyer Meredith , Spina Benedetta , Almualla Mouza , Zhao Yu
Published: March 2024

Cosmological simulations serve as invaluable tools for understanding the Universe. However, the technical complexity and substantial computational resources required to generate such simulations often limit their accessibility within the broader research community. Notable exceptions exist, but most are not suited for simultaneously studying the physics of galaxy formation and cosmic reionization during the first billion years of cosmic history. This is especially relevant now that a fleet of advanced observatories (e.g. James Webb Space Telescope, Nancy Grace Roman Space Telescope, SPHEREx, ELT, SKA) will soon provide an holistic picture of this defining epoch. To bridge this gap, we publicly release all simulation outputs and post-processing products generated within the thesan simulation project at www.thesan-project.com. This project focuses on the z ≥ 5.5 Universe, combining a radiation-hydrodynamics solver (arepo-rt), a well-tested galaxy formation model (IllustrisTNG) and cosmic dust physics to provide a comprehensive view of the Epoch of Reionization. The thesan suite includes 16 distinct simulations, each varying in volume, resolution, and underlying physical models. This paper outlines the unique features of these new simulations, the production and detailed format of the wide range of derived data products, and the process for data retrieval. Finally, as a case study, we compare our simulation data with a number of recent observations from the James Webb Space Telescope, affirming the accuracy and applicability of thesan. The examples also serve as prototypes for how to utilize the released data set to perform comparisons between predictions and observations.
Advancing noninvasive glioma classification with diffusion radiomics: Exploring the impact of signal intensity normalization
Authors: Foltyn-Dumitru Martha , Schell Marianne , Sahm Felix , Kessler Tobias , Wick Wolfgang , Bendszus Martin , Rastogi Aditya , Brugnara Gianluca , Vollmuth Philipp
Published: March 2024

Background

This study investigates the influence of diffusion-weighted Magnetic Resonance Imaging (DWI-MRI) on radiomic-based prediction of glioma types according to molecular status and assesses the impact of DWI intensity normalization on model generalizability.

Methods

Radiomic features, compliant with image biomarker standardization initiative standards, were extracted from preoperative MRI of 549 patients with diffuse glioma, known IDH, and 1p19q-status. Anatomical sequences (T1, T1c, T2, FLAIR) underwent N4-Bias Field Correction (N4) and WhiteStripe normalization (N4/WS). Apparent diffusion coefficient (ADC) maps were normalized using N4 or N4/z-score. Nine machine-learning algorithms were trained for multiclass prediction of glioma types (IDH-mutant 1p/19q codeleted, IDH-mutant 1p/19q non-codeleted, IDH-wild type). Four approaches were compared: Anatomical, anatomical + ADC naive, anatomical + ADC N4, and anatomical + ADC N4/z-score. The University of California San Francisco (UCSF)-glioma dataset (n = 409) was used for external validation.

Results

Naïve-Bayes algorithms yielded overall the best performance on the internal test set. Adding ADC radiomics significantly improved AUC from 0.79 to 0.86 (P = .011) for the IDH-wild-type subgroup, but not for the other 2 glioma subgroups (P > .05). In the external UCSF dataset, the addition of ADC radiomics yielded a significantly higher AUC for the IDH-wild-type subgroup (P ≤ .001): 0.80 (N4/WS anatomical alone), 0.81 (anatomical + ADC naive), 0.81 (anatomical + ADC N4), and 0.88 (anatomical + ADC N4/z-score) as well as for the IDH-mutant 1p/19q non-codeleted subgroup (P < .012 each).

Conclusions

ADC radiomics can enhance the performance of conventional MRI-based radiomic models, particularly for IDH-wild-type glioma. The benefit of intensity normalization of ADC maps depends on the type and context of the used data.
Criminal Jurisdiction in Indian Country
Authors: Pevar Stephen L.
Published: March 2024

Criminal jurisdiction is the authority a government possesses to create rules of conduct and to punish those who violate the rules. Three governments—federal, state, and tribal—have some degree of criminal jurisdiction on each Indian reservation. Few areas of federal Indian law are as confusing as criminal jurisdiction. Determining which government can exercise jurisdiction over a crime often depends on the nature of the crime, the race of the victim, the race of the perpetrator, and on whether Congress has passed a law conferring jurisdiction to a particular government in this circumstance. This chapter discusses the authority of the tribe, the state, and the federal government to enforce their criminal laws in Indian country.
Indian Hunting and Fishing Rights
Authors: Pevar Stephen L.
Published: March 2024

Access to fish and game, the U.S. Supreme Court stated in 1905, was as important to the Native peoples of North America as “the atmosphere they breathed.” For many Native Americans, it remains that important today. This chapter discusses what power Indian tribes have to regulate hunting and fishing on the reservation. It also includes what rights Indians and tribes have to engage in off-reservation hunting and fishing under federal treaties and statutes. Great controversy surrounds these tribal hunting and fishing rights, especially off-reservation rights, due to the shortage of fish and game and the desire of non-Indians to limit tribal access to these resources.
The Unique Status of Certain Native American Groups
Authors: Pevar Stephen L.
Published: March 2024

Certain Native American groups have a unique status under federal law, including the Pueblos of New Mexico, Alaska Natives, Oklahoma tribes, New York tribes, and the non-federally recognized tribes. Congress has passed laws or issued policies that apply only to each of these tribal groups, and mistakes can be made unless these individual differences are taken into account. For instance, although there are 229 federally recognized tribes in Alaska, only one of them has a reservation. And in New Mexico, the nineteen Pueblos own their land, unlike the situation that exists for every other tribe, where tribal land has been placed in trust status and title is held by the United States. This chapter discusses the federal government’s unique relationship with each of these groups.
Indian Gaming
Authors: Pevar Stephen L.
Published: March 2024

Gaming has become the single greatest source of income for Indian tribes. The cumulative revenue made by gaming tribes is ten times greater than the amount of money the U.S. Department of the Interior distributes through its Indian affairs programs, and thirty times greater than what tribes earn from selling their natural resources, such as oil, gas, and coal. In addition to generating income for tribes, in 2018 Indian gaming also generated some 676,000 jobs, $36.2 billion in wages, and $13.4 billion in federal, state, and local taxes, and resulted in $1.83 billion in revenue sharing to federal, state, and local governments. This chapter discusses the origin of Indian gaming, the efforts by the states and by Congress to regulate it, the Indian Gaming Regulatory Act, and the impact of Indian gaming.