bluuebunny/crossref_metadata_2025 huggingface dataset:
Type I interferons in tuberculosis: Foe and occasionally friend
Authors: Moreira-Teixeira Lúcia , Mayer-Barber Katrin , Sher Alan , O’Garra Anne
Published: April 2018

Tuberculosis remains one of the leading causes of mortality worldwide, and, despite its clinical significance, there are still significant gaps in our understanding of pathogenic and protective mechanisms triggered by Mycobacterium tuberculosis infection. Type I interferons (IFN) regulate a broad family of genes that either stimulate or inhibit immune function, having both host-protective and detrimental effects, and exhibit well-characterized antiviral activity. Transcriptional studies have uncovered a potential deleterious role for type I IFN in active tuberculosis. Since then, additional studies in human tuberculosis and experimental mouse models of M. tuberculosis infection support the concept that type I IFN promotes both bacterial expansion and disease pathogenesis. More recently, studies in a different setting have suggested a putative protective role for type I IFN. In this study, we discuss the mechanistic and contextual factors that determine the detrimental versus beneficial outcomes of type I IFN induction during M. tuberculosis infection, from human disease to experimental mouse models of tuberculosis.
Key comparison BIPM.RI(I)-K9 of the absorbed dose to water standards of the PTB, Germany and the BIPM in medium-energy x-rays
Authors: Burns D T , Kessler C , Büermann L , Ketelhut S
Published: April 2018

A key comparison has been made between the absorbed dose to water standards of the PTB, Germany and the BIPM in the medium-energy x-ray range. The results show the standards to be in general agreement at the level of the standard uncertainty of the comparison of 9 to 11 parts in 103. The results are combined with those of a EURAMET comparison and presented in terms of degrees of equivalence for entry in the BIPM key comparison database.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Earnings and Disposable Income of Farmers in Sweden, 1997–2012
Authors: Nordin Martin , Höjgård Sören
Published: April 2018

This study presents a comprehensive analysis of farmers’ income in Sweden. The results indicate that farm households in Sweden do well from a standard‐of‐living perspective, but that farming is still a low‐paid occupation from a return‐on‐skills perspective. Nevertheless, farm earnings increased faster over the study period than earnings in the general population, owing equally to higher farm earnings for operators and higher off‐farm earnings for their spouse. Since few female spouses make farm earnings, evaluating farm household earnings from mainly a household perspective fails to acknowledge the individual careers of farmer and spouse.
Ethanol Plant Location and Land Use: A Case Study of CRP and the Ethanol Mandate
Authors: Ifft Jennifer , Rajagopal Deepak , Weldzuis Ryan
Published: April 2018

This study uses a county‐level difference‐in‐difference framework to estimate the share of re‐enrollment into the Conservation Reserve Program (CRP) in response to local ethanol production capacity after the Renewable Fuels Standard (RFS). Relatively more land remained in CRP in ethanol‐intensive areas after the RFS. This seemingly counter‐intuitive result can be explained by post‐RFS changes to the CRP that favored ethanol‐intensive areas. Both CRP design changes and production trends correlated with ethanol plant location pose challenges for empirical strategies that use ethanol plant location to study production or land use decisions. Changes to CRP policies can play an important role in participation and land use decisions.
Financial Capability and Food Security in Extremely Vulnerable Households
Authors: Millimet Daniel L , McDonough Ian K , Fomby Thomas B
Published: April 2018

Food insecurity is among the most significant, nutrition‐related public health issues facing the United States. Unfortunately, little is known about the determinants of food insecurity except that it is not synonymous with poverty. Many households above the poverty line are food insecure; many below are not. We investigate a lack of financial capability as a potential salient determinant of household‐level food security. Using original survey data collected among food pantry clients in North Texas, we assess the impact of financial capacity on food security relying on family background as an exclusion restriction. Our results indicate a strikingly significant effect, both economically and statistically, of financial capability in general and financial behaviors in particular.
Agricultural Market Liberalization and Household Food Security in Rural China
Authors: Baylis Kathy , Fan Linlin , Nogueira Lia
Published: April 2018

In the 1990s, prior to its accession to the World Trade Organization, China dramatically reduced market distortions in agriculture. We use a panel of 6,770 rural households from 1989 to 2000 to ask whether agricultural market liberalization affected rural household food security as measured by the share of calories from non‐staples. Given that not all households may be able to take advantage of new market opportunities, we focus on the distributional effect of market liberalization. Unlike most previous research on the effects of liberalization, we consider the effects of liberalization on both farm and off‐farm income. We find that liberalization primarily improves household food security by increasing off‐farm income, and the effects vary greatly by initial food security status and producer types. While many households benefit from liberalization, some food‐insecure households producing import‐competing products have lower food security as a result of agricultural market liberalization.
SigMat: a classification scheme for gene signature matching
Authors: Xiao Jinfeng , Blatti Charles , Sinha Saurabh
Published: April 2018

Motivation

Several large-scale efforts have been made to collect gene expression signatures from a variety of biological conditions, such as response of cell lines to treatment with drugs, or tumor samples with different characteristics. These gene signature collections are utilized through bioinformatics tools for ‘signature matching’, whereby a researcher studying an expression profile can identify previously cataloged biological conditions most related to their profile. Signature matching tools typically retrieve from the collection the signature that has highest similarity to the user-provided profile. Alternatively, classification models may be applied where each biological condition in the signature collection is a class label; however, such models are trained on the collection of available signatures and may not generalize to the novel cellular context or cell line of the researcher’s expression profile.

Results

We present an advanced multi-way classification algorithm for signature matching, called SigMat, that is trained on a large signature collection from a well-studied cellular context, but can also classify signatures from other cell types by relying on an additional, small collection of signatures representing the target cell type. It uses these ‘tuning data’ to learn two additional parameters that help adapt its predictions for other cellular contexts. SigMat outperforms other similarity scores and classification methods in identifying the correct label of a query expression profile from as many as 244 or 500 candidate classes (drug treatments) cataloged by the LINCS L1000 project. SigMat retains its high accuracy in cross-cell line applications even when the amount of tuning data is severely limited.

Availability and implementation

SigMat is available on GitHub at https://github.com/JinfengXiao/SigMat.

Supplementary information

Supplementary data are available at Bioinformatics online.
Integrative Sexual Health
Authors: Weil Andrew
Published: April 2018

Integrative Sexual Health explores beyond the standard topics in men’s and women’s health, drawing on a very rich and diverse research literature. Books on sexuality typically are for the clinical specialist and cite only focally relevant research, or are geared to lay knowledge and cite almost no research. Integrative Sexual Health provides an overview of sexual biology and sexual dysfunction, diverse lifespan, lifestyle, and environmental impacts on sexual function, applies complementary and integrative medicine solutions to sexual problems, and offers traditional Eastern and Western treatment approaches to resolving sexual difficulties. Written by diverse integratively trained experts in sexuality, psychology, psychiatry, and other medical specialties. Integrative Sexual Health includes clinical vignettes, detailed treatment strategies for mitigating the side effects of medications, and sexual dysfunction associated with medical illness and poor lifestyle habits, as well as citing extensive research and further resources. Integrative treatment modalities not typically consulted in mainstream sexual medicine, such as traditional Chinese medicine, Ayurvedic medicine, aromatherapy, and botanical medicine are presented with the best available evidence, in a clinically relevant manner. This volume in the Weil Integrative Medicine Library will be valuable to the specialist and non-specialist alike, who seek to understand and treat sexual problems using an integrative medicine approach, and acquire tools to help patients maintain lifetime optimal general health and vitality that supports healthy sexuality.
Midlife and Beyond (DRAFT)
Authors: Espinosa Geovanni , Esposito Ralph
Published: April 2018

Androgen deficiency, low testosterone, or, its newest name, andropause, is becoming a common issue among men, with estimates suggesting 6% to 12% of men experiencing this syndrome. Aside from low androgen levels, men may present with significant symptoms including sexual dysfunction, low libido, infertility, muscle loss, and overall malaise. The causes of andropause are multifactorial, ranging from physiological dysfunction to lifestyle, nutritional, environmental, and emotional influences. Given that the conventional treatment for andropause is exogenous testosterone replacement, the underlying causes may not fully be addressed. This chapter exposes the underlying causes of andropause, identifying not only the biochemical and biophysiological aspects but also the various insufficiencies and functional imbalances that may contribute. Further, precise therapeutic botanicals, nutrients, exercise, and dietary modifications are discussed specific to improving male hormone status and its effect on sexual health.
Optimum Macronutrition for Sexual Health (DRAFT)
Authors: Hoffman Ronald L. , Muedin Leyla
Published: April 2018

The importance of nutrition in sexual health cannot be overemphasized. Given the prevalence of obesity in America and its associated morbidities such as metabolic syndrome, type 2 diabetes, and cardiovascular disease, sadly, sexual dysfunction is on the rise. Some—usually men —confronting a sexual problem may seek to consume commercial supplements or specific foods traditionally believed to improve sexual performance. However, the scientific evidence makes it clear that oysters, asparagus, or supplements are far less relevant than optimizing one's daily diet. Macronutrition impacts sexual function in many ways and as a consequence of specific dietary regimens, habits, and health practices. Nutritional patterns negatively affect testosterone, nitric oxide, cortisol, and inflammatory pathways and have other impacts. This chapter sets out what science says about macronutrition's key role in sexual function and dysfunction and advocates the best nutritional strategies for improved sexual function, vitality, and overall health.
Sexual Dysfunction Secondary to Micronutrient Deficiency (DRAFT)
Authors: Bartlik Barbara , Mindes Janet , Haas Sheila Sperber
Published: April 2018

Diverse micronutrient deficiencies can impair sexual function. The many recognized factors that can result in depleted vitamins and minerals include suboptimal diet, aging, toxins, malabsorption, and depleted soil. This chapter focuses on the generally unrecognized depleting effects due to a large and diverse variety of common pharmaceutical medications. Nearly half of all Americans take prescription drugs, frequently more than one, and many of them fall within this category and are discussed here. This chapter provides a detailed summary of clinical experience and research evidence for the depletion of those micronutrients with the greatest negative impact on healthy sexual functioning, and for the drugs involved, and includes guidance on identifying and then resolving each of these deficiencies. The standard of care for patients with sexual dysfunction is psychotherapy or medication, both of which are often only minimally or partially effective. Yet identifying and correcting drug-induced micronutrient depletion often resolves sexual dysfunction.
The Obesity Epidemic and Sexual Health (DRAFT)
Authors: Lamm Steven , Bekisz Jonathan
Published: April 2018

There are few conditions that have such wide-ranging effects on sexual function as obesity. Though many of the exact mechanisms are yet to be elucidated, its impacts on the cardiovascular, endocrine, and nervous systems, among others, bestow upon obesity an almost unrivaled ability to devastate the human sexual response. Further, the effects of obesity extend beyond the purely physiologic into the psychologic and have the ability to impair both males and females alike. The downstream sequelae of sexual dysfunction secondary to obesity can significantly impair an individual’s quality of life, affecting his or her self-esteem, opportunity to form and maintain meaningful relationships, and ability to reproduce if desired, all of which can further promote pro-obesogenic attitudes and behaviors. Thus there is tremendous incentive for appreciation and understanding of the complex interplay between obesity and sexual function, as well as their relation to an individual’s overall physical and mental health.
Integrative Treatment of Depression and Anxiety (DRAFT)
Authors: Falk Katherine
Published: April 2018

An integrative approach to the understanding and treatment of mood, anxiety, and sexual disorders is different from a conventional allopathic approach. Rather than merely identifying and treating symptoms, integrative psychiatry looks at the whole person and provides a unique treatment plan for each person, which might also include psychotropic medications when appropriate. Integrative psychiatry addresses the root causes of the problem, considers all factors that influence an individual’s physical and mental health, and, whenever possible, uses less toxic interventions. Many individuals seek integrative care because the conventional approaches have failed to help them. This chapter provides a road map for treating depression and anxiety from an evidenced-based integrative perspective: micronutrients, fish oil, herbs, amino acids, other treatments such as light therapy, and of course lifestyle changes. The integrative approach to mental health treatment has the added benefit of doing less to disrupt sexual function and more to heal it.
The Pharmacology of Opioids
Authors: Cavacuiti Christopher
Published: April 2018

This chapter focuses on the attributes of and component medications within the class of opioids, emphasizing kinetics, dynamics, and therapeutic and adverse effects. To help patients make informed decisions about opioid use, the clinicians prescribing these medications must be able to explain when opioids are likely to help and when they are likely to do harm. Subclasses of opioids include phenanthrenes, benzomorphans, phenylpiperidines, and diphenylheptanes; examples are given of each, with respective utilities and limitations. A discussion then follows of pharmacodynamics, pharmacokinetics, opioid receptor affinity, metabolism, and drug interactions. Tables and figures amplifying the text include: opioid class by synthetic method (Table 8.1); common physiological effects by opioid receptor subtypes (Table 8.2); opioid activity (Table 8.3); and a listing of figures and tables located in Appendix B (opioid receptor affinity, respiratory depression with opioids, adverse effects, metabolism, pharmacogenetics, extended release/long-acting opioids, abuse deterrent formulations). A text box provides supplemental resources.
Understanding and Preventing Opioid Misuse and Abuse
Authors: DuPont Robert L. , Parran Theodore V. , Wilford Bonnie B.
Published: April 2018

This chapter describes the dynamics of opioid misuse and abuse, and of opioid use disorder, as a basis for choosing risk mitigation strategies. Its opening words capture the dichotomy confronting the physician, describing opioids’ virtues and simultaneous risks. Factors contributing to the misuse and compulsive use of opioids preface a review of the best practices in prevention: prescription drug monitoring programs (PDMPs), consultation and collateral source interrogation, lost prescription replacement policies, and development of and mutual adherence to formal monitoring plans. The chapter is directed to all physicians in clinical practice. Included is a table describing appropriate and inappropriate opioid use, with clinical examples. A second table distinguishes medical from nonmedical uses of opioids according to intent, effect, pattern, control, and legality. A final table distinguishes between the physician’s and the patient’s responsibilities.
Diagnosing Patients and Initiating Treatment
Authors: Parran Theodore V. , Hopper John A. , Wilford Bonnie B.
Published: April 2018

Chapter 11 provides an organized approach to diagnosis and to the initial treatment plan, focusing on substance use disorders. The elements of pharmacological and behavioral approaches to treatment, including the management of withdrawal, are addressed separately (Sections III and IV). It begins with directions on initiation of the patient relationship, with the object of eliciting cooperation. The sources of information that should be interrogated are listed, including the history, screening tools, physical examination, laboratory studies, and collateral information (e.g., the prescription drug monitoring program or PDMP). A discussion of diagnosis includes the principles underlying the ICD-10 and the DSM-5. The process of enlisting the patient in a treatment agreement and in the formulation of a collaborative treatment plan is described; the practical elements of patient education in medication accountability and dosing are included. The chapter concludes with a treatment planning checklist to facilitate orderly transition to the treatment itself.
Opioid Pharmacotherapies for Chronic Pain
Authors: Pham Thien C. , Kominek Courtney , Brooks Abigail , Fudin Jeffrey
Published: April 2018

Chronic pain management employing opioids is divided into subtopics, including: risk–benefit balance; a review of the mode of action of opioid analgesics (Chap. 8); the suitability of synthetic opioids for neuropathic pain; endocrinopathy proceeding from opioid use; the use of the morphine-equivalent daily dose as a conversion tool for managing multiple opioids; the place of extended-release and long-acting opioids; current technology in abuse deterrence; and an overview of the challenges entailed in prescribing. This last section details the complex components of a decision to prescribe opioids for chronic pain. A table is provided of the classification of common opioid analgesics and their duration of activity. A text box gives the table of contents of Appendix B, supportive tables and figures therein for this chapter; there is also a text box listing additional resources.
Preventing Avoidable Work Disability
Authors: Cloeren Marianne , Colameco Stephen
Published: April 2018

Addiction professionals often are called upon to provide opinions or coordinate the treatment of substance abuse, dependence, or addiction in patients who are enmeshed in complicated benefits or compensation systems, including workers’ compensation. Recovery is often compromised by system hurdles, such as insurer resistance to addiction treatment, and secondary gain issues, such as attorney advice for maximal benefit based on profound disability. Disability beliefs and other potentially modifiable risk factors for unnecessary work disability are also common in patients with chronic pain and addiction. These risk factors include fear/avoidance, pain catastrophization, perceived injustice, childhood trauma, and psychiatric illness. Excessive and inappropriate medical care, often including unnecessary procedures and medication, contributes to disability beliefs, which are usually entrenched by the time a patient presents to an addiction professional. This chapter provides information about recognizing disability risk factors, assessing work capacity, and developing treatment strategies that promote optimal return to function.
Revising the Treatment Plan and/or Ending Addiction Treatment
Authors: Hopper John A. , Parran Theodore V.
Published: April 2018

Where Chapter 18 discusses revision of the treatment plan and ending of pain treatment, Chapter 23 focuses on the conclusion of addiction treatment. It closes the loop to Chapter 11, Initiating Treatment and Monitoring Patient Progress. The authors describe the conditions which will oblige a revision of the treatment plan; such as alterations in prescription medications with cross-metabolism, pregnancy or menopause, liver disease, or aging. There are also behavioral conditions that will oblige plan modification, whether dysfunctional or hostile behaviors or other psychiatric instability. Consequently, a significant portion of the chapter is dedicated to the identification of relapse, its psychodynamic and developmental meanings, and the appropriate interventions for it. Voluntary and involuntary terminations and the therapeutic steps taken with both are discussed as logical continuations of any treatment plan.
Pain and Addiction in Military Personnel and Veterans
Authors: Robeck Ilene R. , Hunt Stephen C. , Burgo-Black Lucile , McKelvey Jeremiah , Siddiqui Afreen , Mariano Anthony J.
Published: April 2018

Veterans of military service pose a special case both in their susceptibility to addiction and their risk for a co-occurring disorder, posttraumatic stress disorder. The elements of a military history are provided; this is not intuitive, and is salient both for determining entitlement status and to assess the cumulative injury. Numerous pain syndromes can occur as the result of both long-term wear and tear and abrupt injury, requiring consideration for disability compensation. PTSD and traumatic brain injury are more common here than perhaps among any other occupational group. Unique risks and concerns accompany the experience of warfare in different theaters; special sections are devoted to Iraq and Afghanistan; the first and second Gulf wars; and to Vietnam. Women constitute a newly enfranchised military group as subject to injury as their male cohorts. Several pain care innovations have been championed by the Veterans Administration, and these are described.
Theoretical Perspectives on Gender and Gender-Related Processes in Adjustment to Cancer (DRAFT)
Authors: Bright Emma E. , Stanton Annette L.
Published: April 2018

Chronic diseases are the leading causes of mortality worldwide. Their prevalence and disruptive potential warrant an understanding of the factors that influence adjustment to chronic illness. Gender and gender-related processes play an important role in psychosocial and physical adjustment to chronic disease. In this chapter, the authors summarize theoretical frameworks relevant to the role of gender in adjustment to chronic illness, with a particular focus on the experience of cancer. Although theoretically guided research is limited, theoretical frameworks suggest promising avenues of inquiry for characterizing the role of gender and adjustment to cancer and the development of associated interventions.
Female Caregivers of Male Cancer Patients (DRAFT)
Authors: Badger Terry , Segrin Chris
Published: April 2018

The diagnosis and treatment of cancer is a relationship, rather than an individual problem, because there is a patient and often an informal caregiver. In terms of male cancer patients and their female caregivers, this is most often studied in the context of prostate cancer patients and their female caregivers. Concepts from the stress process model are used to organize research findings on the women caring for their male partners with cancer. This review illustrates how different contexts of care, primary objective stressors, and resources can all contribute to the primary subjective stressors (e.g., quality of life, relationship problems, role demands) experienced by dyads in this context. Interventions to help caregivers as well as directions for clinical practice and future research are discussed.
The Integration of Aging and Gender to Understand the Cancer Experience Among Older Adults (DRAFT)
Authors: Bellizzi Keith M. , Dibble Kate E.
Published: April 2018

Central to understanding the experience of cancer in older adults is to recognize human behavior and the role of gender and age. The goal of this chapter is to present a general description of what is known about cancer and aging, briefly describe the literature on gender and aging, and offer suggestions for the integration of these disparate fields to answer important clinical and research questions for older adults with cancer. Analyzing gender and age in psycho-oncology studies, not as a factor to stratify on but as a lens to view and understand the cancer experience, will allow for a richer understanding of the experience of cancer in older adults.
Gender Considerations in Adolescents and Young Adults with Cancer (DRAFT)
Authors: Thompson Amanda L. , Gardner Molly A.
Published: April 2018

Literature on adolescents and young adults (AYA) with cancer has largely focused on the biopsychosocial challenges of this developmental period, with limited attention paid to the role of gender or to gender differences in adjustment and outcomes. Differences have been found in the self-reported needs of AYA patients both during and after treatment, as well as in the information received regarding fertility preservation, psychological distress, positive growth, and benefit-finding and the role of social support in adjustment. Methodological limitations, however, impact our ability to draw robust conclusions about the role of gender in psychosocial adjustment and outcomes among AYAs with cancer. We present the limited research on gender in AYA patients and survivors, highlight significant gaps in the literature, provide recommendations for future research, and suggest early implications for clinical care.
Exploring Gender and Cultural, Socioecological Considerations in Psycho-Oncology (DRAFT)
Authors: Ashing Kimlin Tam , Wang Judy Huei-yu , George Marshalee , Gwede Clement K.
Published: April 2018

The field of psychosocial oncology must respond to the needs of increasingly diverse cancer patient and survivor populations. Taking a health equity approach, this chapter reviews the intersectionality of the gender, culture, and socioecological contexts relevant to psychosocial oncology and survivorship. The authors propose five initiatives to (1) ensure gender consideration in the way forward so that psychosocial oncology is more patient responsive in treatment and healing, (2) increase the diversity and capacity of psychosocial oncology providers by training health care providers and professionals from underrepresented groups, (3) expand the reach of psychosocial care beyond the confines of academic research institutes and cancer centers into community hospitals and settings, (4) increase participation of advocates and survivors in peer-based supportive care, and (5) encourage collaboration among psychosocial oncology professionals and organizations, advocates, and policy-makers to promote access to and availability of psychosocial supportive care for ethnic minority and underserved communities.
When the Invisible Screen Becomes Visible (DRAFT)
Authors: Loscalzo Matthew J. , Clark Karen L. , Bitz Courtney , Yopp Justin M. , Rosenstein Donald L.
Published: April 2018

This chapter outlines two innovative sex- and gender-based biopsychosocial interventions: Couples Coping with Cancer Together and Single Fathers Due to Cancer. The foundation of each intervention is based on strengths inherent to the participants’ gender. Couples Coping with Cancer Together focuses on patients and partners during both active treatment and survivorship. Single Fathers Due to Cancer engages widowed fathers and their children. These two programs illustrate the relevance of sex (a one-time biological event determined at conception: male, female, intersex) and gender (how individuals defines themselves and their lives) differences in coping with the challenges of cancer. Future research is essential to empirically explore interventional studies that focus on gender-related strengths.
Next Steps in Gender-Oriented Psycho-Oncology Research and Practices (DRAFT)
Authors: Kim Youngmee , Loscalzo Matthew J.
Published: April 2018

This chapter summarizes previous chapters in this book and provides suggestions for future directions of gender-oriented psycho-oncology research.

First three chapters provide comprehensive overview and theories on the role of gender in the individual’s and in the patient-caregiver pair’s adjustment when dealing with cancer. Next four chapters illustrate how one’s gender plays a role in the adjustment processes of a patient versus a family caregiver whose gender is the same or opposite of one’s own, which are followed by additional three chapters that take consideration of age, generation, and sociocultural influence on the role of gender. Last two chapters present psychosocial interventions and programs that are focused on gender and cancer. Given the inherently complex biopsychosocial nature of gender, we strongly encourage future studies that are theory-driven and hypothesis-testing, which will help distinguishing the gender issue from that of patient-caregiver roles, lifespan/developmental phases, treatment phases, or culture and social movement.
Evolution and Evidence for Rapid Response Teams (DRAFT)
Authors: Tahseen Muhammad , Simmons Richard L.
Published: April 2018

A rapid response system (RRS) is a program designed to respond in a timely, organized, and comprehensive manner to a patient’s urgent unmet medical need within a healthcare facility. The goals of the rapid response team (RRT) are to restore homeostasis, prevent further physiologic deterioration, and establish an optimal environment of care. RRTs are now in widespread use in the US because of the Joint Commission’s national patient safety goals, which required that healthcare organizations improve recognition and response to changes in a patient’s condition. Recent meta-analyses have now concluded that RRT is effective in reducing the incidence of cardiac arrests within hospitals. There is still controversy, however, on the impact of RRT on ultimate clinical outcomes, including mortality. In this chapter, we review the history and evolution of RRTs, rationale for its existence, its impact on patient outcomes, and current controversies.
Rapid Response Team Organization and Activation (DRAFT)
Authors: Scholle Carol Curio
Published: April 2018

The Rapid Response System (RRS) is organized into four basic components. These components include an activation limb, a response limb, a quality assurance infrastructure, and an administrative component. These components remain consistent despite campus size, physical layout, patient population, available technical resources, and personnel. Oversight of the RRS is provided by the patient safety, risk management experts, as well as clinical experts to maintain high quality of care delivered to acutely ill patients. Administrative support in the development of policy, allocation of resources, and communicating a strong and clear message regarding the mission and vision of the RRS is invaluable. In this chapter, we review each element of the RRS.
In-Hospital Cardiac Arrest (DRAFT)
Authors: Elmer Jonathan , Freyer Abhishek
Published: April 2018

In-hospital cardiac arrest (IHCA) is a major public health problem. Despite its prevalence, there remains a paucity of high-level evidence to guide patient management during and after resuscitation from IHCA and most guidelines are extrapolated from studies of out-of-hospital cardiac arrest. This chapter reviews the cornerstones of IHCA management: early recognition, provision of high quality compressions, and early defibrillation of shockable rhythms. It also summarizes key actions in early post-resuscitation care, including multiple system organ support to prevent rearrest and restore hemodynamic stability and prevention of secondary brain injury. Finally, brief attention is given to adjuncts to traditional IHCA resuscitation including thrombolysis, corticosteroids, and extracorporeal circulatory support.
Hypotension and Shock (DRAFT)
Authors: Schott Christopher K. , Fozard Jessica A.
Published: April 2018

Hypotension is a common cause of rapid response team (RRT) activation. It is critical to be able to rapidly identify the etiology of hypotension. In the setting of a rapid response team call, there is often limited time and information available when first encountering a hypotensive patient. With attention to key elements in the patient’s history of present illness, physical exam, and findings of predominant changes in systolic, diastolic, and pulse pressures, RRTs can rapidly narrow their differential diagnosis. We will discuss the initial evaluation and treatment recommendations based on the etiology of hypotension and shock. Resuscitation should continue until circulatory homeostasis occurs, as guided by a patient’s exam, vital signs, and trends in laboratory values. This chapter provides a framework on how to quickly differentiate between the causes of hypotension or shock when evaluating patients during a rapid response scenario to most accurately guide therapy.
Hypertensive Emergencies (DRAFT)
Authors: Gidwani Hitesh , Donadee Chenell
Published: April 2018

Hypertensive emergencies may be encountered by rapid response teams (RRTs). Various forms of acute organ dysfunction separate hypertensive urgency from hypertensive emergency. These include acute heart failure, acute coronary syndrome, acute aortic dissection, ischemic stroke, hemorrhagic stroke, hypertensive encephalopathy, sympathetic crisis, postoperative hypertension, and hypertensive emergencies in pregnancy. RRTs must be able to rapidly assess the patient’s condition, initiate treatment, and triage the patient to the appropriate level of care. This chapter summarizes the initial evaluation and triage of the patient as well as the blood pressure reduction goals in the acute period for the various conditions associated with hypertensive emergencies, discussing suggested drugs with the dosages, and looking at common pitfalls.
Chest Pain and Acute Coronary Syndrome (DRAFT)
Authors: D’Auria Stephen , Ramani Ravi
Published: April 2018

Chest pain is a common presenting complaint faced by the rapid response team (RRT), and can herald a serious process such as acute coronary syndrome or aortic dissection, or be secondary to a minor muscle strain. A methodical approach to chest pain is necessary to avoid premature diagnostic closure. One of the most feared diagnoses is a myocardial infarction. Fortunately, there are well-established guidelines describing the necessary steps for treatment of both ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). This chapter will address the differential for chest pain as well as established guidelines for treatment of acute coronary syndrome.
Management of Exsanguinating Hemorrhage: Hemostasis and Resuscitation (DRAFT)
Authors: Myers Sara P. , Neal Matthew D.
Published: April 2018

This chapter describes the approach to massive bleeding in a patient within the setting of rapid response team (RRT) calls. Emphasis is placed on identifying peripheral sources of bleeding that can be controlled with compression. Military experience has aided in the understanding of how zeolite and clay can be used as chemical adjuncts. Resuscitative strategies and transfusion practices that promote hemodynamic stability are reviewed. Concurrent coagulopathy that can exacerbate hemorrhage is addressed and a brief overview is provided demonstrating how commonly prescribed anticoagulants can be monitored and reversed. To illustrate that multimodal therapy is often necessary to control hemorrhage, the chapter closes with surgical and minimally invasive techniques for definitive hemostasis.
Palliative Care Interventions: Role in Rapid Response Team Events (DRAFT)
Authors: Lincoln Taylor , Haliko Shannon , Schell Jane
Published: April 2018

Rapid response team (RRT) activation identifies hospitalized patients with acute illness who have a high symptom burden and are at increased risk for mortality and psychosocial distress. For many patients, the rapid response event presents itself as a final opportunity to avoid aggressive therapies that are unlikely to achieve patient-centered goals. Accumulating evidence supports an important role of the RRT in end-of-life care and the potential benefits of palliative care interventions by identifying at-risk patients who may benefit from readdressing goals of care (GOC) and facilitating a transition toward care that is most consistent with their preferences. This chapter outlines key palliative care skills that can be employed in the context of the RRT event including GOC discussion, patient/family support, and symptom management.
Airway Equipment (DRAFT)
Authors: Emlet Lillian L. , Dargin James M.
Published: April 2018

Patients frequently require airway management during rapid response team (RRT) activations. Airway management during RRT activations frequently occurs in locations that are not well equipped or prepared to perform airway procedures. Therefore, it is important that RRTs arrive with the proper equipment and medications to safely secure the airway whenever necessary. An “airway bag” that is stocked by a hospital’s central supply department and carried by RRTs ensures the availability of functioning equipment and helps to standardize the process of airway management during RRT activation. In this chapter, we will review recommendations for equipment required in emergency airway management, including portable routine and difficult airway equipment and medications.
Communication and Coordination of Care (DRAFT)
Authors: DiNella Jeannine , Kress Terri
Published: April 2018

Rapid response teams (RRTs) are complex with various team members and thus accurate communication is important to minimize error. The concept of team effort and delegation/sharing of responsibilities during a medical crisis should be present from the onset. As more responders arrive at the scene, the situation has the potential to become disorganized without consistent communication and leadership. By identifying specific roles and responsibilities, promoting use of good communication skills during crisis and practicing effective team work will help to minimize error. In this chapter, we review the communication and coordination skills required before, during, and after the activation of an RRT.
Dizziness and Vertigo (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter explores dizziness and vertigo, including different types of dizziness (lightheadedness, disequilibrium, anxiety, and vertigo), peripheral causes of vertigo (paroxysmal positional vertigo (BPPV), labyrinthitis, Meniere disease, and schwannoma), the Dix-Halpike maneuver and Epley maneuver, and central causes of vertigo (lesions in the posterior fossa (strokes, tumors, demyelinating disease), migraine, and seizures).
Headache and Facial Pain (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter discusses headache and facial pain, including headaches due to another underlying cause (secondary headaches), migraine and its typical features (nausea, vomiting, photophobia, phonophobia, visual aura), trigeminal autonomic cephalgias (such as cluster headaches), and trigeminal neuralgia.
Infections of the CNS: Meningitis and Encephalitis (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter discusses infections of the central nervous system (CNS), meningitis including its symptoms (fever, headache, nuchal rigidity, altered level of consciousness), its causes (bacterial, fungal, viral, or aseptic), and how the CSF profile provides clues to the etiology. The chapter also discusses encephalitis, its symptoms (seizures, other focal neurologic symptoms). Patients with Herpes Simplex Encephalitis may show T2 hyperintensities in the anterior temporal lobes and limbic structures on MRI. CSF may show xanthochromia and positive PCR for HSV1 or HSV2.
Dementia 2: CJD, NPH, and Summary (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter explores dementia, and focuses on Creutzfeldt Jakob Disease (CJD), and Normal Pressure Hydrocephalus (NPH). It outlines the causes and symptoms of CJD, as well as diagnostic tests (MRI, CSF presence of protein 14-3-3, EEG, and biopsy). It also discusses NPH, including its characteristics and treatment.
Demyelinating Diseases 1: Multiple Sclerosis (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter explores demyelinating diseases, and focuses on multiple sclerosis (MS). It discusses the causes of MS, its etiology, symptoms (optic neuritis, sensory changes, weakness, spasticity, and bowel and bladder dysfunction), and subtypes (relapsing remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS)).
Demyelinating Diseases 2: NMO, ADEM, GBS, CIDP (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter explores demyelinating diseases, and focuses on neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), including their symptoms, causes, and diagnostic tests.
Neoplasms of the CNS (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter discusses neoplasms of the central nervous system (CNS), including metastatic tumors, common primary brain tumors (pediatric astrocytoma, pediatric medulloblastoma, adult meningioma, and adult glioblastoma), as well as pituitary adenoma, and pineal tumors, which can present with Parinaud syndrome.
Myopathy (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter discusses myopathy, including its symptoms (pain, stiffness, cramps, exertional fatigue, myoglobinuria, shortness of breath, rash), muscular dystrophy and dystrophinopathies (Becker with reduced dystrophin and Duchenne with no dystrophin), polymyositis, dermatomyositis, and inclusion body myositis.
Peripheral Nervous System 2: Radiculopathy (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter explores the peripheral nervous system (PNS) and focuses on radiculopathy, including causes of radiculopathy (herniated disc, spondylolisthesis, osteoarthritis), common locations for radiculopathies, and the result of disruption of the distal end of the spinal cord (conus medullaris syndrome, cauda equine syndrome).
Spinal Cord Syndromes (DRAFT)
Authors: Kaplan Tamara , Milligan Tracey
Published: April 2018

The video in this chapter discusses spinal cord syndromes, including Brown Sequard syndrome (presenting with ipsilateral loss of vibration/proprioception, spastic weakness, flaccid weakenss, and contralateral loss of pain and temperature), central cord syndrome (presenting with loss of pain and temperature in a cape-like distribution), and vitamin B12 deficiency (may present as subacute combined degeneration).
Early Palliative Care for Patients with Metastatic Non-Small Cell Lung Cancer (DRAFT)
Authors: Gray Nathan A. , LeBlanc Thomas W.
Published: April 2018

This chapter provides an overview and commentary on the 2010 study by Temel and colleagues regarding early palliative care for patients with non-small cell lung cancer. It describes the trial design and findings while also providing a concise critique of the study and a brief review of relevant subsequent studies. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.
Benefits of Early Palliative Care to Informal Family Caregivers (DRAFT)
Authors: Martin Emily J. , Roeland Eric J.
Published: April 2018

This chapter summarizes the Dionne-Odom et al. randomized controlled trial evaluating the benefits of an early, nurse-led palliative care intervention to caregivers of patients with advanced cancer. The study examined the impact of early (at diagnosis) versus delayed (12 weeks later) intervention on caregiver quality of life, depressed mood, and burden. The study showed that early intervention caregivers had lower depression scores at three months compared to the delayed group caregivers. Terminal decline analyses also showed lower depression and stress burden scores in the caregivers who received the early intervention. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a clinical case.
Availability and Integration of Palliative Care at US Cancer Centers (DRAFT)
Authors: Pérez-Cruz Pedro , Rodríguez-Núñez Alfredo
Published: April 2018

The aim of this survey study was to characterize the availability and degree of integration of palliative care (PC) services in US cancer centers in 2010. Executives and PC program leaders from 71 National Cancer Institute (NCI)-designated cancer centers and a random sample of 71 out of 1,411 non-NCI-designated cancer centers were surveyed. Cancer center executives rated their current pain and PC services favorably and reported a significant improvement in the availability of these services between 2005 and 2010. The availability of PC programs was 98% for NCI and 78% for non-NCI cancer centers. The inpatient consultation teams, outpatient clinics, and PC units were generally larger and served more patients at NCI than at non-NCI centers. This study revealed the existing gap in PC services among US cancer centers and addressed the need to consolidate infrastructure, increase training, improve research, and advocate for public health challenges in the field.