bluuebunny/crossref_metadata_2025 huggingface dataset:
THE BENEFICIAL ROLE OF PROBIOTIC AKKERMANSIA MUCINIPHILA IN INFLAMMATORY BOWEL DISEASE
Authors: Zheng Mengyu , Han Ran , Yuan Yali , Xing Yunqi , Zhang Wenji , Liu Yuyue , Li Junxiang , Mao Tangyou
Published: January 2023

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, is a chronic relapsing gastrointestinal inflammatory disease mediated by dysregulated immune responses to resident intestinal microbiota. Current conventional approaches including aminosalicylates, corticosteroids, immunosuppressive agents, and biological therapies are focused on reducing intestinal inflammation besides inducing and maintaining disease remission, and managing complications. However, these therapies are not curative and are associated with various limitations, such as drug resistance, low responsiveness and adverse events. Recent accumulated evidence has revealed the involvement of mucin-degrading bacterium Akkermansia muciniphila (A. muciniphila) in the regulation of host barrier function and immune response. Although the role of commensal A. muciniphila in IBD is controversial and needs further investigations, most clinical and experimental results still support the protective effect of A. muciniphila in the process and development of intestinal inflammation. Therefore, A. muciniphila-targeted and -based therapies is now considered a valuable therapeutic approach to treat IBD patients. However, how to selectively enrich the growth and colonization of A. muciniphila in the host intestine with direct or indirect interventions have not been clarified. This review reveals an interesting phenomenon that not only viable A. muciniphila, but pasteurised A. muciniphila, and its ingredients such as AmEVs, Amuc_1100 and P9 also can alleviate intestinal inflammation, suggesting a therapeutic potential of A. muciniphila in the treatment of IBD. More importantly, because of the natural characteristics individual strains grow, we believe that it is more promising weapon for the treatment of IBD to improve the intestinal microenvironment of A. muciniphila than to simply increase the number of individual bacteria itself. Therefore, it has become a research hotspot in recent years to improve intestinal microenvironment and indirectly promote the colonization of A. muciniphila through the supplementation of other probiotic or prebiotics, natural diets, drugs, and herbs, and achieved good progress, holds promise for A. muciniphila-targeted and -based therapies in the treatment of IBD.
THE GUT MICROBIOME REGULATES EFFICACY OF SULFASALAZINE THERAPY FOR SPONDYLOARTHRITIS IN INFLAMMATORY BOWEL DISEASE
Authors: Lima Svetlana , Rupert Amanda , Jin Wenbing , Viladomiu Monica , Pires Silvia , Woo Viola , Putzel Gregory , Marderstein Andrew , Funez-dePagnier1 Gabriela , Yang Wei , Guo Chun-Jun , Scherl Ellen , Longman Randy
Published: January 2023

Joint inflammation, or spondyloarthritis (SpA), is the most common extra-intestinal manifestation of inflammatory bowel disease (IBD), but the specific role for therapies targeting SpA is not well defined. One of the earliest medications used for the treatment of IBD is sulfasalazine (SAS). SAS is a prodrug composed of two chemical moieties, the anti-inflammatory 5-aminosalicilate and the antibiotic sulfapyridine. The efficacy of SAS in peripheral arthritis is thought to depend on its “antibacterial” properties, however the impact of SAS on the IBD-SpA microbiome and how it may improve extra-intestinal symptoms is unknown. Therefore, our study aims to diagnostically evaluate the role for the fecal microbiome in clinical response to SAS therapy and identify microbial and immunologic therapeutic targets associated with clinical response.

We have designed an observational study to longitudinally follow IBD patients with SpA who have a medical indication for SAS therapy. Clinical data and fecal samples from 22 patients were collected before initiation of SAS and at week 12 after initiation of SAS. Eleven IBD-SpA patients were concomitantly enrolled as controls and followed by 12 weeks. Metagenomic sequencing was used to define the effect of SAS on the IBD-SpA fecal microbiome and to evaluate its relationship with improvement in joint symptoms. Mouse models and in vitro assays were used to test the sufficiency of the SAS effect observed in patients.

The fecal microbiome of SAS-responders was distinct from that observed in non-responders and 6 pre-treatment microbial markers (including the short chain fatty acid (SCFA) producer Faecalibacterium prausnitzii) predicted SAS-response (AUC = 0.9). Fecal metabolome of SAS responders had lower thymine and higher deoxyuridine compared to non-responders consistent with evidence of a folate trap in response to SAS treatment. SAS therapy in SPF mouse-model of chemically-induced colitis alleviated colitis in GPR 109a-dependent fashion consistent with a synergistic role for SCFA. In vitro assays revealed SAS direct regulation of F. prausnitzii metabolic function and butyrate synthesis.

CONCLUSIONS: Collectively, these findings highlight the potential role for microbial diagnostics to improve SAS efficacy, and drug modulation of microbial markers to potentiate therapy for IBD patients with SpA.
ESTABLISHMENT AND TREATMENT OF MURINE COLONOIDS TO STUDY THE EPITHELIAL EFFECTS OF INTESTINAL INFLAMMATION IN VITRO
Authors: Crawford Erin , Mentrup Heather , Novak Elizabeth , Mollen Kevin
Published: January 2023

BACKGROUND

Disruption of the intestinal epithelial barrier is a hallmark of inflammatory bowel disease (IBD). The 3-dimensional colonoid culture system is a useful in vitro model to study intestinal stem cell dynamics and epithelial cell physiology in IBD pathogenesis. However, we have shown that in vivo epithelial changes are not necessarily retained in colonoids established from mice undergoing acute inflammation using a DSS model and primarily reflect stem cell physiology rather than that of terminally differentiated cells. We developed experimental methods to address this limitation. We terminally differentiate colonoids or create 2-D monolayers, and challenge them with a cocktail of inflammatory mediators that are typically elevated during IBD.

METHODS

Murine colonoids are established by isolating colonic crypts and plating them in basement membrane matrix. Over 3 to 5 days, crypt structures develop into spheroid colonoids 250 μm in diameter, forming a prominent lumen surrounded by a thin layer of epithelial stem cells. They are passaged a minimum of two times and then are either 1) terminally differentiated by incubating the colonoids with Differentiating Media or 2) used to establish intestinal epithelial monolayers. Inflammation is then induced by incubating cells with a cocktail of inflammatory mediators (TNFa, IL-1b, IFNg, H2O2). Protein is collected after 72 hours, and expression of proteins involved in mitochondrial biogenesis were assessed (n=3).

RESULTS

We found that changes in mitochondrial dynamics, reflective of key metabolic changes in the epithelium that are observed in colonic scrapings of DSS-treated mice are not recapitulated in traditional colonoids derived from mice on the same DSS regimen. We found that changes in expression and protein levels of peroxisome proliferator-activator receptor-gamma coactivator-1a (PGC1a), the master regulator protein of mitochondrial biogenesis, were not maintained in colonoids. After terminally differentiating colonoids and subsequently inducing inflammation, we were able to recapitulate a failure of mitochondrial biogenesis failure that is a hallmark of both human IBD and murine colitis. Protein expression of PGC1a as well as downstream transcription factor A, mitochondria (TFAM) were both decreased when assessed via western blot.

DISCUSSION

Colonoids are a useful tool for studying colonic physiology in vitro, however are limited in their ability to evaluate the effects of in vivo inflammation on the mitochondrial function and cellular metabolism. When removed from the intestinal milieu, crypt cells demonstrate a recovery of mitochondrial health and reflect stem primarily stem cell physiology. Our strategies provide opportunities for organoid manipulation which, when employed properly, can shed light on key aspects of intestinal epithelial mitochondrial function during inflammation.
THE EFFECT OF VEDOLIZUMAB ON CD8 T CELL REPERTOIRE HOMOGENEITY AND BLOOD-GUT TRAFFICKING IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Authors: Williams Kyle , Shows Donna , Kongala Ramya , Hindmarch Duncan , Clarke Astrid , Lord James
Published: January 2023

BACKGROUND

Inflammatory bowel disease (IBD) causes T cell infiltration of the intestinal mucosa, but the heterogeneity of these cells is not understood at a clonal level. The drug vedolizumab is believed to treat IBD by blocking the entry of circulating integrin α4β7+ T cells into the intestinal mucosa.

METHODS

We sought to understand the clonal distribution of T cells in IBD and how this is affected by vedolizumab by studying the T cell receptor (TCR) repertoire in CD8+ T cell subsets sorted from blood samples and colon mucosal biopsies via FACS. Inflamed or uninflamed colon segments from 15 ulcerative colitis and 13 Crohn’s disease patients were compared to colon biopsies from 11 people without IBD. In peripheral blood, we profiled purified α4β7+, α4β7- effector/memory, CD45RA+ terminal effector/memory (TEMRA) CD8 T cells, and mucosal-associated invariant T (MAIT) cells. In a separate cohort of 13 IBD patients, samples were obtained before and during vedolizumab therapy to determine its effect on the diversity and overlap of the TCR repertoires of blood and colon CD8+ T cells.

RESULTS

CD8 TCR diversity in the mucosa and peripheral blood did not correlate with inflammation. Repertoire overlap between any two anatomically distinct locations of a person’s colon was consistently high, though often lower between inflamed and uninflamed sites. CD8 TCR repertoire overlap was also seen between the colon and each peripheral blood subpopulation studied, with the highest overlap seen for integrin α4β7+ T cells and the lowest for MAIT cells. Inflamed tissue overlapped more than uninflamed with each blood subpopulation. Surprisingly, vedolizumab did not affect the degree of overlap between colon CD8+ T cells and circulating α4β7+ CD8 T cells, nor their TCR diversity, regardless of treatment efficacy. Indeed, flow cytometry revealed no relative depletion of effector/memory T cells in the colons of vedolizumab recipients. Instead, vedolizumab caused the depletion of rare naïve mucosal T cells and dendritic cells (DC) from the colonic mucosa.

CONCLUSIONS

CD8 T cell clones are spread homogenously throughout the colon. Although TCR repertoire overlap is greater within than between inflamed and uninflamed colon segments, a similar diversity of TCRs in both argues against local clonal expansion being the main source of excess T cells in inflamed mucosa. Rather, our data reveal increased TCR overlap between blood and inflamed mucosa to support the significance of T cell trafficking in IBD pathogenesis, particularly concerning experienced α4β7+ T cell populations. However, we surprisingly found neither gross nor clonal evidence that blockade of this trafficking is the mechanism by which vedolizumab treats IBD, instead finding only naïve T cells and DC to be depleted from the colonic mucosa in response to vedolizumab.
Analytical and Biological Variability of a Commercial Modified Aptamer Assay in Plasma Samples of Patients with Chronic Kidney Disease
Authors: Dubin Ruth F , Deo Rajat , Ren Yue , Lee Hongzhe , Shou Haochang , Feldman Harold , Kimmel Paul , Waikar Sushrut S , Rhee Eugene P , Tin Adrienne , Chen Jingsha , Coresh Joseph , Go Alan S , Kelly Tanika , Rao Paduranga S , Chen Teresa K , Segal Mark R , Ganz Peter
Published: January 2023

Background

We carried out a study of the aptamer proteomic assay, SomaScan V4, to evaluate the analytical and biological variability of the assay in plasma samples of patients with moderate to severe chronic kidney disease (CKD).

Methods

Plasma samples were selected from 2 sources: (a) 24 participants from the Chronic Renal Insufficiency Cohort (CRIC) and (b) 49 patients from the Brigham and Women’s Hospital–Kidney/Renal Clinic. We calculated intra-assay variability from both sources and examined short-term biological variability in samples from the Brigham clinic. We also measured correlations of aptamer measurements with traditional biomarker assays.

Results

A total of 4656 unique proteins (4849 total aptamer measures) were analyzed in all samples. Median (interquartile range [IQR] intra-assay CV) was 3.7% (2.8–5.3) in CRIC and 5.0% (3.8–7.0) in Brigham samples. Median (IQR) biological CV among Brigham samples drawn from one individual on 2 occasions separated by median (IQR) 7 (4–14) days was 8.7% (6.2–14). CVs were independent of CKD stage, diabetes, or albuminuria but were higher in patients with systemic lupus erythematosus. Rho correlations between aptamer and traditional assays for biomarkers of interest were cystatin C = 0.942, kidney injury model-1 = 0.905, fibroblast growth factor-23 = 0.541, tumor necrosis factor receptors 1 = 0.781 and 2 = 0.843, P < 10−100 for all.

Conclusions

Intra-assay and within-subject variability for SomaScan in the CKD setting was low and similar to assay variability reported from individuals without CKD. Intra-assay precision was excellent whether samples were collected in an optimal research protocol, as were CRIC samples, or in the clinical setting, as were the Brigham samples.
Intradural extramedullary meningeal melanocytoma: a case report and literature review
Authors: Parwez Rabeeia , Ahmed Razna , Baig Arsalan , Ruiz Fernanda , Baig Mirza Asfand , Sadek Ahmed-Ramadan , Arvin Babak , Qureshi Anjum
Published: January 2023

Primary meningeal melanocytomas are extremely rare, benign tumours arising from the leptomeninges. While they are considered to be benign lesions, there is potential for their growth and transformation into malignant melanomas. They are commonly found in the cervical spine, with a decreased incidence in the thoracic and lumbar regions. We present a case report of a 56-year-old man who presented to our unit with a 4-month history of lower limb weakness and a sensory level at T6. Magnetic resonance imaging shows an intradural extramedullary tumour. The patient underwent a thoracic debulking of the lesion with neurophysiological monitoring. Histopathology confirmed the diagnosis of melanocytoma of meningeal origin, with a low mitotic count. Our patient recovered well post-operatively with no complications. Surgical resection is an effective method to manage this tumour; however, adjuvant radiotherapy is advised due to the risk of recurrence and malignant transformation.
Developing and Sustaining a Culturally Responsive and Positive School Climate
Authors: Goforth Anisa N. , Pham Andy V.
Published: January 2023

This chapter provides an overview of school climate, which is defined broadly as the students’, teachers’, and staff’s feelings, attitudes, and experiences of their school life. Further, there are a number of dimensions of school climate, including safety, relationships (student–student as well as student–teacher), teaching and learning, institutional environment, school improvement, and social media. Next, one specific framework, the cultural-ecological model of school climate, is introduced, which can be helpful in developing and sustaining a safe and positive school climate. Mental health professionals should take the lead in developing, adapting, and delivering effective violence prevention and intervention programs based on data to ensure that they make a difference in developing a positive school climate and promoting safety. School climate data can also contribute to the development of refined policies to that ensure procedures, processes, and positive outcomes are sustained.
Culturally Responsive Multi-Tiered Systems of Support and Evidence-Based Interventions
Authors: Goforth Anisa N. , Pham Andy V.
Published: January 2023

Schools have repeatedly struggled to address racial or ethnic disproportionality, particularly related to overrepresentation in exclusionary discipline practices and identification for special education services. Culturally responsive approaches in the provision of academic and behavior supports can increase student belonging and improve student outcomes in schools. This chapter discusses cultural issues when delivering instructional and behavioral supports using a multi-tiered system of support, including pedagogical considerations. Schools are responsible for implementing culturally responsive evidence-based interventions, supporting knowledge and skills for professional educator and staff behavior, and fostering culturally valid data-based decision-making, with the goal of attaining equitable academic, social, and behavioral outcomes. Recommendations are provided for adapting and evaluating effectiveness of interventions for those students who need additional individualized support.
Counseling and Psychotherapy to Support Diverse Students
Authors: Goforth Anisa N. , Pham Andy V.
Published: January 2023

This chapter presents an overview of the culturally responsive approaches to providing counseling and psychotherapy to culturally and linguistically diverse students. Practitioners should consider the ecological perspectives of mental health and well-being. In particular, they should ensure that the counseling is from a strengths-based, and not deficit-based, perspective. Practitioners should (1) engage in critical reflexivity of their knowledge and skills, (2) build relationships, develop goals, and create a culturally affirming space, (3) consider the salient sociocultural factors and cultural dimensions that may be relevant in the case, (4) examine how to incorporate sociocultural factors or cultural dimensions into the counseling, (5) review the potential counseling approaches and understand the cultural assumptions of each, and (6) implement the treatment using cultural strengths. Finally, the chapter highlights some key professional, ethical, and legal considerations for providing counseling to culturally and linguistically diverse students.
Engaging With Couples
Authors: Starks Tyrel J.
Published: January 2023

This chapter reviews concepts and novel skills uniquely relevant to establishing rapport and a working alliance with couples. The concept of relational orientation is reviewed along with its implications for considering the use of first-, second-, and third-person pronouns in session dialogue. Factors unique to understanding the social context in which couples are embedded (e.g., social network overlap, couple-level discrimination, and relationship marginalization) are also discussed. The task of balancing attention along the dialectic of focus—shifting between attending to the individual partners and the couple as a whole—is demonstrated. Following this, the use of opening statements to establish norms in couples Motivational Interviewing as well as new active listening skills—dyadic reflections and relationship affirmations—are introduced, and their function in session is reviewed.
Facilitating Dyadic Functioning
Authors: Starks Tyrel J.
Published: January 2023

This chapter introduces the novel process of facilitating dyadic functioning to the traditional four-process Motivational Interviewing framework. Like all Motivational Interviewing processes, facilitating is relevant throughout the course of treatment; however, it emerges prototypically as most salient after the initial engaging process, and some attention to facilitating is warranted to prepare the couple before focusing on the target behavior moves to the foreground. The chapter begins with an overview of research linking relationship functioning to physical and mental health. Common approaches to conceptualizing key domains of relationship functioning (including satisfaction, commitment, and emotional investment) are reviewed before discussing how these domains might emerge in a Motivational Interview with a couple. Finally, strategies for facilitating dyadic functioning in couples Motivational Interviewing are discussed.
Integration, Future Directions, and Limitations
Authors: Sauermilch Daniel , Starks Tyrel J.
Published: January 2023

This chapter looks ahead to the ongoing development of couples Motivational Interviewing. First, it examines the potential for practice integration. Examples of how the principles, processes, and practices articulated in this text may be integrated with existing intervention strategies from individual cognitive behavioral or couples counseling practice (e.g., social and problem skills training, behavioral activation, contingency management, values clarification) are reviewed. Special issues relevant to the informed consent process and intervention practices relevant to relationship dissolution are discussed. Finally, there is speculation on the potential to generalize the practice of couples Motivational Interviewing to other populations. While sexual minority men, substance use, and HIV-related sexual health have been the focus of this text, the history of Motivational Interviewing development—and in some instances formative data—would suggest couples Motivational Interviewing may have applications well beyond this narrow initial focus.
Session 5: Acceptance of Pulling-Related Inner Experiences
Authors: Woods Douglas W. , Twohig Michael P.
Published: January 2023

This chapter covers the fifth session of the Acceptance and Commitment Therapy (ACT) Enhanced Behavior Therapy for Trichotillomania (AEBT-T) treatment package. It discusses how to work with a client on an alternative way of responding to hair-pulling urges, pulling-related cognitions, cravings for specific sensory experiences, and emotions that have commonly led to pulling. It also describes the “paper in shoe” exercise; the therapist can equate the tactile sensations generated by the paper in the shoe to the private event the client uses pulling to control. The chapter reviews activities that present acceptance or willingness to have pulling-related inner experiences and highlights how attempting to control those inner experiences works. It mentions behavioral commitment to reduce hair pulling. The basis for using acceptance in AEBT-T is that urges and other inner experiences ultimately cannot be controlled and attempts at controlling them can be harmful.
Case 3
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 28-year-old woman with no known medical problems presented with a 9-day history of a non-productive cough, shortness of breath, fever, headache, and loss of smell and taste. She was 35 weeks into her first pregnancy. She had not been abroad recently. She lived with her husband and his parents, and all had developed similar symptoms in the preceding few days. Her booking BP was 110/80 mmHg and BMI was 30 kg/m2. She was not on any regular medication, there was no family history of medical problems, and she had never smoked. She was of Indian ethnicity and had decided not to be vaccinated against SARS-CoV2 whilst she was pregnant.
Case 7
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 22-year-old woman in her first pregnancy presented at 24 weeks of gestation with acute shortness of breath, which had developed over the preceding 24 hours. She described chest tightness, but no associated palpitations, cough, fever, or coryzal symptoms. She had had no previous similar episodes. Past medical history was notable for allergic rhinitis and childhood eczema and asthma. She was taking antacids when required for heartburn and was not on any regular medication. She had no family history of significant illnesses and had never smoked. On examination she was wheezy and her peak flow rate was reduced compared to that expected for her age and height.
Case 19
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 33-year-old woman was referred for pre-conception counselling because of cystic fibrosis. The diagnosis was made after she developed meconium ileus as a neonate, requiring surgical intervention at 3 days of age. She had continued to experience constipation into adulthood, requiring intermittent use of gastrograffin. Her weight was stable (BMI 21 kg/m2). She had experienced a great improvement in her condition since she started a combination CFTR protein modulator treatment. The latest forced expiratory volume (FEV1) was 62%. Her medications included triple combination therapy (tezacaftor, ivacaftor, elexacaftor), DNAse nebulizer, salbutamol inhaler, tiotropium inhaler, colomycin nebulizer, steroid nasal spray, steroid inhaler, azithromycin, pancrealipase capsules, multivitamins, folic acid, macrogol, and omeprazole.
Case 21
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 35-year-old woman in her first pregnancy was referred to the maternal assessment unit at 36 weeks of gestation. During a routine midwifery appointment, her left eye had been noted to be red. She had noticed a gritty and irritated sensation. This had started 24 hours previously, and was not associated with any discharge, pain, or visual disturbance. There was no photophobia and no history or sensation suggestive of a foreign body. There was no history of injury, and she did not wear contact lenses.
Case 44
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 36-year-old woman attended antenatal clinic at 22 weeks of gestation in her first pregnancy. She had a history of severe rheumatoid arthritis and had required high-dose oral and intra-articular steroids 18 months previously. Prior to pregnancy she was taking methotrexate and a biosimilar TNF-alpha inhibitor. The methotrexate was stopped 2 months prior to conception. Her arthritis had remained quiescent during pregnancy, and she was keen to discuss whether she could stop her TNF-alpha inhibitor.
Case 50
Authors: Frise Charlotte , Bhalsod Krupa , Scott Rebecca , Gibson Harry
Published: January 2023

A 32-year-old woman with multiple sclerosis was referred from a fertility clinic for pre-conception counselling. She had been trying to conceive for 18 months and had regular periods. She had never been pregnant. She was diagnosed with multiple sclerosis 4 years ago, and initially treated with glatiramer acetate but was switched to natalizumab 2 years ago. She had no relapses in that time. In addition to monthly natalizumab infusions, she took 4000 units vitamin D daily. She had no other medical conditions.
Introduction
Authors: Boyles Tom
Published: January 2023

This chapter begins with the story of a professor who befuddles her medical team by requesting a simple pregnancy test to solve a seemingly complex medical problem. It goes on to describe what medical tests are, when they are needed, and answers the deliberately naïve question of why we perform tests at all. It concludes that tests answer patient-relevant questions, which must be formulated before any test is requested. These questions must have a ‘What?’ and a ‘Why?’ component. The chapter explains why it is important to learn about tests given their potential side effects and huge financial costs.
Prognostic Understanding in the Terminally Ill
Authors: Polacek Laura C. , Walsh Leah E. , Duva Melissa M. , George Login S. , Applebaum Allison J.
Published: January 2023

Prognostic understanding is a multifaceted construct that has garnered increased attention among palliative care professionals, particularly for its role in medical decision-making, the provision of care, and patient psychological well-being at end of life. This chapter provides an overview of the current state of research and clinical care surrounding prognostic understanding in patients with terminal illness. Specifically, how prognostic understanding has been defined and measured both historically and in the present is discussed. Particular attention is paid to the importance of prognostic understanding for the provision of goal-concordant end-of-life care as well as its association with psychosocial outcomes. Prognostic information preferences, patient–provider communication, and interventions to improve prognostic understanding are also reviewed. Cultural variations in prognostic information preferences and understanding are also discussed, in addition to future directions for research and clinical practice.
Compassion
Authors: Harris Daranne , Sinclair Shane
Published: January 2023

Compassion in palliative care is both a guiding principle and a patient need. This chapter provides an evidence-based and clinically informed conceptualization of compassion for healthcare providers in palliative care. First, compassion is defined and delineated from related concepts of sympathy and empathy. Next, the Healthcare Provider Compassion Model is presented, illustrating the flow and relationship between the key components of compassion. An exploration of the workplace, relational, and personal inhibitors and facilitators affecting the provision of compassion are then identified, including addressing the myth of compassion fatigue. Finally, the authors emphasize the need to integrate compassion competencies into healthcare training and the necessity of routinely assessing patients’ experiences of compassion to improve the delivery of compassion in clinical care.
Demoralization in Palliative Care
Authors: Kissane David W. , Bobevski Irene , Grassi Luigi
Published: January 2023

Demoralization is a mental state of low morale and poor coping, with key symptoms of discouragement, hopelessness, entrapment, loss of role, and pointlessness culminating in a desire to die. Systematic reviews have identified a prevalence of demoralization among 13–18% of patients receiving palliative care. When mood and anxiety disorders have been controlled for, demoralization has been associated with a three-fold increased risk of the development of suicidal thinking. Demoralization is an apt specifier for forms of adjustment disorder and major depression. Latent class analysis has revealed a high likelihood of moderate demoralization being associated with poor adjustment and severe demoralization being associated with mental states of anhedonia and anxiety. Network analyses have confirmed that anhedonic depression constitutes a separate community of symptoms from demoralized symptoms that cluster around loss of meaning and hope, entrapment, and loss of control/isolation. Central symptoms in these communities provide important therapeutic targets and include hopelessness, pointlessness, loss of role, and entrapment. The measurement of the symptoms of demoralization has been strengthened with validated instruments to aid assessment and clarification of the differential diagnoses the clinician must consider. Existentially oriented and meaning-centered therapies underpin the treatment of demoralization, as the clinician seeks to shift each person from postures of existential vulnerability to more constructive and resilient approaches to coping.
Introduction to Supervision Theory and Practice
Authors: Veach Patricia McCarthy
Published: January 2023

This chapter provides select definitions of clinical supervision from different human services professions, including genetic counseling. It summarizes common themes in these definitions, such as processes and functions of supervision. It also describes the tenets, goals, and strategies of the Reciprocal-Engagement Model of Supervision developed to characterize genetic counseling supervision, and it lists empirically derived genetic counseling supervisor competencies. It explains the importance of genetic counselors taking on the role of supervising students, identifies benefits of being in a supervisory role, and offers suggestions for intentionality in the use of one’s supervisory power. This chapter concludes with experiential learning activities to promote self-reflection and deliberate supervision practice.
Supervision for Self-Reflective Practice
Authors: Veach Patricia McCarthy
Published: January 2023

This chapter defines self-reflective practice, describes self-reflection as a key component of deliberate practice, and presents strategies for promoting student self-reflective skills. It identifies supervision as an ideal environment for the intentional cultivation of self-reflective skills because as students are encouraged to discuss their genetic counseling experiences, they do so with the support of more experienced practitioners. It presents a variety of evocative strategies ranging from setting expectations for self-reflection to building students’ self-reflective skills throughout a rotation. The chapter emphasizes supervisor development and modeling of their own self-reflection as influential strategies. Stimulus questions and illustrative examples encourage the reader’s self-reflection, and learning activities provide opportunities to practice self-reflection using different models and approaches.
Common Clinical Supervision Challenges
Authors: Veach Patricia McCarthy
Published: January 2023

This chapter describes three prevalent supervision challenges: conflict in supervision relationships, supervisor countertransference, and student anxiety. It highlights the importance of addressing each challenge to promote professional development. It identifies possible sources of each challenge; gives examples of behaviors related to each one; and presents general strategies for recognizing relationship conflict, supervisor countertransference, and student anxiety. It illustrates each common challenge with discussion of a specific situation (e.g., student autonomy versus imitation, and student anxiety due to having multiple supervisors) and ways a supervisor can address the situation. Experiential activities provide practice in recognizing and managing these common challenges in genetic counseling supervision.
A Decade of Excellent Outcomes After Surgical Intervention in 538 Patients with Thoracic Outlet Syndrome
Authors: Al Shakarchi Julien
Published: January 2023

This chapter provides a summary of a landmark study in vascular surgery reporting the long-term results in patients undergoing surgical intervention for thoracic outlet syndrome. The study demonstrated excellent outcomes for patients who underwent surgery (first rib resection) for neurogenic thoracic outlet syndrome, venous thoracic outlet syndrome, and arterial thoracic outlet syndrome. This chapter describes the basics of the study, including funding, study location, inclusion and exclusion criteria, how many patients were recruited, study design, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary, and concludes with a relevant clinical case.
Growing teratoma syndrome in testis cancer
Authors: Clark Jennifer , Lee Thomas A. , Ramani Vijay A.C.
Published: January 2023

The growing teratoma syndrome is a rare syndrome that can occur during or after standard chemotherapy treatment for non-seminomatous or mixed (non-seminoma and seminomatous) germ cell tumours. The challenging surgical case of a young man presenting with a massive 10 kg retroperitoneal and abdominal mass following systemic treatment for metastatic testis cancer is described. The clinical details of his presentation and principles of treatment in metastatic testis cancer are discussed with emphasis on the following aspects of this particular case: preoperative care/preparation, chemotherapy, decision-making regarding management of residual masses following completion of chemotherapy for metastatic testis cancer, planning and performing a bilateral RetroPeritoneal Lymph Node Dissection (RPLND) and postoperative care. The patient himself faced multiple challenges throughout his treatment, highlighting the need for specialist care at expert centres when managing young people with testis cancer.
Female urinary retention
Authors: Ravindra Pravisha , Thiruchelvam Nikesh
Published: January 2023

Urinary retention in a woman is uncommon and can have a diverse aetiology. Causes can be classified into acute (transient) or chronic (recurrent). Initial management consists of bladder drainage either urethrally (intermittent or indwelling) or suprapubically. Careful history taking and examination will allow possible causes to be considered. Further investigations such as video urodynamics and flexible cystoscopy are indicated if the retention cannot be resolved despite correction of any suspected causes. Patient ideas, concerns, and expectations should be elicited with longer-term management, as what may be acceptable to one patient may not be to the next. Symptoms may change with time and management strategies should change to accommodate this. A multidisciplinary approach is key and clinical nurse specialist support is vital.
Neurogenic bladder
Authors: Ecclestone Hazel , Hamid Rizwan , Shah Julian
Published: January 2023

This case discusses the urological management of a 49-year-old man with spina bifida who was referred to a specialist reconstructive unit. The gentleman presented with complex upper and lower urinary tract dysfunction. He underwent baseline and specialized investigations. The rationales for these diagnostic tests along with their findings are discussed. The various management options are then outlined with an explanation of the advantages and disadvantages of each. The selected operative option is then detailed, in addition to long-term follow-up both in this gentleman as well as surveillance of the neurourological population in general. Expert comments are outlined throughout the case.
Penile fracture
Authors: Garrod Huw , Moore Sacha , Shergill Iqbal , Seipp Christian
Published: January 2023

Penile fracture is a rare urological emergency that is almost always the result of an injury sustained during sexual intercourse. It has a very characteristic clinical presentation with immediate loss of erection, penile swelling and bruising, and a pop or cracking sound. Prompt surgical repair is essential to reduce the likelihood of complications including erectile dysfunction and penile curvature.
Recurrent urinary tract infections and non-neurogenic neurogenic bladder in children
Authors: Skott Martin , Mushtaq Imran
Published: January 2023

A case is presented of recurrent urinary tract infections (UTIs) with frequent findings of post-void residuals in a 5-year-old potty-trained girl. Despite prophylactic antibiotics, breakthrough lower UTIs occurred, and investigations showed upper urinary tract dilatation, bladder wall thickening, but no significant renal parenchymal damage. Urodynamic studies revealed impaired bladder compliance, dysfunctional voiding, and incomplete bladder emptying. A magnetic resonance imaging scan of her spine revealed no intraspinal abnormality. Clean intermittent catheterization was attempted on several occasions, but the patient was very resistant and fearful. Therefore, a suprapubic tube was placed temporarily, with clamp and release during daytime and on overnight free drainage. Following placement of the suprapubic tube, complete resolution of upper urinary tract dilatation and episodes of UTIs occurred. This case illustrates that a simple case of recurrent UTIs turned out to be the most severe form of bladder dysfunction without any clear know pathology.
Haemorrhagic eschar of the glans: a case study in the myriad manifestations of urethral pathology
Authors: Decker Emily , Cao Kevin , Cuckow Peter
Published: January 2023

Urethral and preputial pathology is common yet often misunderstood, leading to undertreatment of morbidity in both boys and men. Through illustration of an unusual clinical situation, this case describes both the common and uncommon pathologies of the penis, provides an overview of the epidemiology, reviews the literature, and finally presents a paradigm for safe and effective care.
Confucianism and “Confucianism”
Authors: Richey Jeffrey L.
Published: January 2023

The modern encounter with Confucianism, both in China and the West, has been shaped by the legacies of Western missionary and imperialist contacts with Chinese culture. In order to extricate the meanings of “Confucius,” “Confucian,” and “Confucianism” from their original colonialist frameworks, attention must be paid to both emic (cultural insiders’) and etic (cultural outsiders’) perspectives on these cultural phenomena, including the scholastic, ritual, textual, and political dimensions of the Confucian tradition as well as the costs and benefits of approaching Confucianism as both a cultural system and as a cultural repertoire. The essay argues that understanding Confucianism as a cultural repertoire—a toolkit of images, institutions, practices, and texts that may be used to situate an audience within a given story and effect changes in both the mindset of that audience and the audience’s world itself—is the most effective way to see how Confucianism’s performative and narrative power is at work in the world.
Confucianism in Singapore, Malaysia, and Indonesia
Authors: Kuo Eddie C. Y. , Sun Qingjuan
Published: January 2023

This essay describes the development of Confucianism in Singapore, supplemented by the cases of two other Southeast Asian countries, Malaysia and Indonesia. There are some pertinent studies carried out mainly in Chinese but few in English. This essay offers a comprehensive overview of Confucianism in these regions to the English world. The case of Singapore features two peak periods of Confucian movements: one in the 1910s, led by local intellectual elites; and the second, a government-led revitalization movement, which occurred in the 1980s. The development of Confucianism in Malaysia and Indonesia are also outlined with key events and organizations. The essay points out that in all three cases, Confucianism was transplanted into these regions by early Chinese immigrants and that each went through similar pattern during colonial times. Post–World War II and after the three states had gained independence, the development of Confucianism diverged in response to the different social and political situations in each country.
Confucianism and Literature
Authors: Fuller Michael A. , Huang Martin W.
Published: January 2023

Throughout the premodern era, the Confucian governance based on a civil (wen文) ordering of society required ritual and official writing that imparted to wenzhang 文章 (literature) a moral and political seriousness while the humaneness central to Confucian thought also required that writing engage the serious realities of human experience. These core commitments did not change, but the philosophical basis grounding the Confucian order grew more complex, and the literary forms through which writers explored human experience evolved to meet these shifts in the Confucian worldview. During the late imperial period, the complicated relationship between literature and examination culture in particular had a profound impact on the life of almost every educated man in late imperial China.
Confucianism and Modern Culture
Authors: Jochim Christian
Published: January 2023

Confucian traditions have interacted with modern cultures, coming under their influence and reacting to them. In addition, as part of East Asian culture, these religious and philosophical traditions have themselves evolved, producing modern reinterpretations of the Confucian heritage. They have become “modern” through changes similar to the developments that have brought us modern Buddhism, modern Christianity, and so forth. This article will begin with reflections on historical developments that governed interactions between Confucian traditions and modern cultures in three East Asian countries. Later, it will consider whether there are common themes in the modernizing of Confucian traditions across East Asia.
Youth Cultures of Activism and Politics
Authors: Maksudyan Nazan
Published: January 2023

Youth cultures’ engagement with activism and politics, through which young people attempt “to initiate and resist change in the social order,” has produced a sizable literature. A discussion of this topic traces this engagement and its changes over time. First, nationalist youth cultures of the early twentieth century stressed duty, responsibility, and idealism. Later, the anti-establishment youth cultures of the 1960s and 1970s aspired to change the world on a global scale. Anarchistic and nonconformist youth subcultures of the 1980s and 1990s cultivated apathy toward traditional politics. Finally, globally dissenting millennials focus their concerns on democratic governance, ecology, and global social justice.
Race and Election Law
Authors: Ross Bertrall L.
Published: January 2023

At the core of election law in the United States are contestations over the rights of African Americans to participate and be represented in the democratic process. Consistent with Derrick Bell’s interest-convergence thesis, the outcome of the Black struggle for full citizenship has depended, at particular moments in time, on whether enough White Americans understand African American voting and representation to be in their own interest. The result has been halting progress toward a still-incomplete multiracial democracy. In this chapter, the author provides a history of the racial struggle for political inclusion with a focus on the South, where the intensity of the struggle has been the greatest. The author emphasizes African Americans’ agency in attaining political rights from legislatures and courts and the role of White partisans as facilitators of, and checks on, America’s progress toward a multiracial democracy.
Models of Governance in Cameroon’s Public Administration
Authors: Ondoua Biwolé Viviane
Published: January 2023

How can one build a prosperous economy in a fragile, even inoperative administrative environment? That is the concern underlying the present chapter whose objective is to question the pertinence of the governance model of the Cameroon’s public administration where free-market levers do not necessarily correspond to the values that Cameroonian society identifies with; hence the necessity to re-think another governance model that would promote an endogenous social imaginary.
The Economy of Humanitarianism
Authors: Kemedjio Cilas
Published: January 2023

The asymmetry between the donors and the beneficiaries makes it almost impossible to engage in a meaningful conversation about egalitarian relationships in the field of humanitarian intervention. Most of the misunderstandings are not unrelated to this lopsided configuration. This chapter analyzes the contradictions of humanitarianism as a benevolent approach to nation-building in Cameroon and beyond. Section 2 focuses on the globalization of humanitarianism and the relationship between the two notions. It starts with Homi Bhabha’s interrogations on the pertinence of theories of decolonization in the era of economic globalization, and discusses the works of Mongo Beti and Imbole Mbue, two major literary figures from Cameroon. I consider the adverse impact of humanitarian interventions in the nation-building process. The disruptive role played by the forces of globalization, I argue, does not necessary lead to better outcomes as far as the welfare of distressed populations is concerned. Humanitarians move in by redirecting marginalized groups away from the unfulfilled promises of the State and into the hands of the mighty power of NGOs.
Early Human Capital Accumulation and Decentralization
Authors: Tchuente Guy
Published: January 2023

Decentralization is a centerpiece in Cameroonian’s government institutions’ design. This chapter elaborates a simple hierarchy model for the analysis of the effects of power devolution. The model predicts overall positive effects of decentralization with larger effects when the local authority processes useful information on how to better allocate the resources. The estimation of the effects of the 2010’s power devolution to municipalities in Cameroon suggests a positive impact of decentralization on early human capital accumulation. The value added by decentralization is the same for Anglophone and Francophone municipalities; the effects of decentralization are larger for advanced levels of primary school.