bluuebunny/crossref_metadata_2025 huggingface dataset:
Robust error bounds for the Navier–Stokes equations
using implicit-explicit second-order BDF method with variable steps
Authors: García-Archilla Bosco , Novo Julia
Published: August 2022

This paper studies fully discrete finite element approximations to the Navier–Stokes equations using inf-sup stable elements and grad-div stabilization. For the time integration, two implicit–explicit second-order backward differentiation formulae (BDF2) schemes are applied. In both, the Laplacian is implicit while the nonlinear term is explicit, in the first one, and semiimplicit, in the second one. The grad-div stabilization allows us to prove error bounds in which the constants are independent of inverse powers of the viscosity. Error bounds of order $r$ in space are obtained for the $L^2$ error of the velocity using piecewise polynomials of degree $r$ to approximate the velocity together with second-order bounds in time, both for fixed time-step methods and for methods with variable time steps. A Courant Friedrichs Lewy (CFL)-type condition is needed for the method in which the nonlinear term is explicit relating time-step and spatial mesh-size parameters.
Relative Tense without Existential Quantification and Before
Authors: Ogihara Toshiyuki
Published: August 2022

This article discusses the semantics of tense morphemes in Japanese in temporal adverbial clauses as well as in relative clauses. We claim that they are non-pronominal higher order entities but do not carry existential quantifier meanings on their own. Specifically, we argue against the view that Japanese past tense sentences are necessarily existentially quantifying and that this is the reason why they cannot occur as mae ‘before’ clauses. This view is incompatible with the fact that Japanese ato ‘after’ clauses must occur in the past tense. By contrast, our own proposal about Japanese tense morphemes is based on the idea that the inherent meaning of ‘before’ (or ‘after’) agrees with the “relative” meaning of the tense morpheme in the temporal adverbial clause. That is, a ‘before’ clause must be in the future tense (conveyed by the non-past tense form) because it describes a situation that follows the matrix predication time, whereas an ‘after’ clause must be in the past tense because it describes a situation that precedes the matrix predication time. Choosing the wrong tense form would then result in a contradiction. We will make two separate compositional proposals within two major accounts of ‘before’ and ‘after’: Beaver and Condoravdi’s and Anscombe’s. This enables us to show that correct empirical predictions can be made about ‘before’ and ‘after’ clauses, including non-veridical ‘before’ clauses, regardless of which account of temporal connectives turns out to be optimal. Our proposal also covers ‘when’ clauses and (nominal) relative clauses. Japanese tense morphemes are higher order entities and are “quantifier-raised” to yield “simultaneous readings” for present tense relative clauses. From the viewpoint of natural language semantic theory, this article establishes that non-pronominal relative tense morphemes are not always existentially quantifying. When an existential quantifier interpretation is needed, it is supplied through independent means. This is a promising approach to the semantics of relative-tense languages such as Japanese.
Decompositions of stratified institutions
Authors: Diaconescu Răzvan
Published: August 2022

The theory of stratified institutions is a general axiomatic approach to model theories where the satisfaction is parameterized by states of the models. In this paper we further develop this theory by introducing a new technique for representing stratified institutions, which is based on projecting to such simpler structures. On the one hand this can be used for developing general results applicable to a wide variety of already existing model theories with states, such as those based on some form of Kripke semantics. On the other hand this may serve as a template for defining new such model theories. In this paper we emphasize the former application of this technique by developing general results on model amalgamation and on the existence diagrams for stratified institutions. These are two most useful properties to have in institution theoretic model theory.
Introduction
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

This chapter provides an overview of adolescent substance abuse and co-existing disorders in the United States, where such disorders are a major public health problem. The chapter underscores the importance of youth service providers having a foundational understanding of adolescent development. Such development is discussed from developmental, societal, legal, and brain maturation perspectives, all having a significant impact on clinical treatment and planning. Providers also need to understand the link between substance abuse and coexisting disorders. High-quality assessment and treatment depend on service providers having this knowledge. The chapter goes on to provide an overview of the book’s contents, which are organized by three sections addressing adolescent development, co-occurring disorders, and interventions and treatments. Internalizing and externalizing disorders, behavioral addictions, and various types of individual and family-based treatments are included in the book.
Internalizing and Related Disorders
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Internalizing disorders represent mental or behavioral conditions that are dominated by emotionality. Emotions are an adaptive tool to deal with life’s challenges. Adolescence is a developmental period when emotions can be extreme when elicited by both positive and negative experiences. The major internalizing disorders are depressive disorders and anxiety disorders; related ones in this domain include post-traumatic stress disorder (PTSD), bipolar disorder, and autism. Treatment effectiveness for teenagers with substance use disorder and a coexisting internalizing disorder is optimized when both domains are addressed. Behavioral-based treatment approaches with concurrent psychotropic medication are part of the treatment plan. One of the most common mental and behavioral disorders among adolescents in the United States is depression. For those suffering from a major depressive disorder, symptoms include a period of at least 2 weeks of a very persistent low mood accompanied with low self-esteem, loss of interest in normally enjoyable activities, and problems with sleep, energy, and concentration.
Continuum of Care and Treatment Planning
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

This chapter addresses treatment and treatment planning for youth with a substance use disorder. Youth who are using substances may benefit from some type of intervention or treatment response; some may require multiple interventions and treatments. It is advisable to assign a youth the appropriate level of care that is the least intensive and step up to a more intensive treatment if needed. Assessing placement or referral along the continuum of care for an adolescent suspected of drug involvement is complex. The American Society of Addiction Medicine (ASAM) provides a description of several levels of response along a continuum of care. The Comprehensive Adolescent Structured Interview (CASI) is one example of a tool to assess the extent of several problems that can help with determining level of care.
Autism Spectrum Disorder Versus Intellectual Disability
Authors: Blacher Jan , Baker Bruce L. , Moody Christine T.
Published: August 2022

Among individuals on the autism spectrum, intellectual disability (ID) is one of the most common co-occurring diagnoses. ID is a neurodevelopmental disorder characterized by impairments in intellectual and adaptive functioning. Such impairments can impact domains implicated in autism spectrum disorder (ASD), such as social communication. Thus, it is essential for diagnosing practictioners to be well-versed in the symptoms and assessment of both ASD and ID, especially in the context of one another. This chapter provides an overview of ID, outlines guiding considerations for differential diagnosis with ASD, and highlights additional needs in a diagnostic assessment when these diagnoses are being evaluated (e.g., evaluation of mental health and behavioral problems).
Autism Spectrum Disorder Versus Conduct Problems
Authors: Galán Chardée , Mazefsky Carla
Published: August 2022

Disruptive behaviors associated with conduct disorder (CD) and oppositional defiant disorder (ODD), such as aggression, noncompliance, and temper tantrums, are common in youth with autism spectrum disorder (ASD). A key consideration is whether such behavioral problems indicate a co-occurring diagnosis of ODD/CD and ASD or reflect an associated phenotype of ASD. The current chapter summarizes key considerations in the differential diagnosis of ASD and ODD/CD, including social and communication impairments, deficits in empathy, and the function of a child’s disruptive behavior. We conclude with a case example to illustrate the factors complicating the differential diagnosis of ASD and ODD/CD and provide validated assessments to guide this process.
Behavioral Health Services with High-Risk Infants and Families
Authors: Dempsey Allison G. , Cole Joanna C.M. , Saxton Sage N.
Published: August 2022

There is a growing need for integration of behavioral health providers within medical settings to address mental health concerns of expectant parents, high-risk infants and families, and the frontline medical staff who care for them. This book is designed to be a comprehensive, practical resource for providers working in perinatal and neonatal intensive care settings inclusive of fetal care centers, neonatal intensive care settings, and neonatal follow-up clinics. Contributors are leading experts in various aspects of care for expectant parents, infants, and their families, with backgrounds in medicine, psychology, social work, nursing, and parenting high-risk infants. The book is divided into five sections. Each section provides setting-specific information critical to behavioral health care practice, including an overview of common medical conditions and treatments, roles and activities of integrated health providers, and specific behavioral health issues pertaining to the setting. Case examples are presented throughout to highlight important concepts and application of clinical practice. Section I provides a broad overview of roles and practice issues, including the history of psychological services for high-risk infants, operational considerations, and systems-level approaches to improving care. Section II explores symptom presentation, risk assessment and treatment approaches for perinatal and infant mental health concerns, as well as strategies to support families (e.g., breastfeeding, decision-making, and peer support programs). Sections III–V address key components for clinicians within fetal care settings, neonatal intensive care settings, and neonatal follow-up settings, including an overview of common medical conditions and treatments, activities of integrated health providers, and multidisciplinary collaboration strategies to care for the unique needs of high-risk infants and families.
Regulation, Relationships, and Reflection
Authors: Talmi Ayelet , Browne Joy V.
Published: August 2022

Fragile infants who are born at risk for long-term developmental concerns often require specialized assessment and intervention services to promote regulation and provide neuroprotective care. Behavioral health interventions in the neonatal intensive care unit (NICU) include infant mental health services that promote infant–parent relationships, socioemotional competence, and nurturing relationships by providing developmentally supportive care and supporting parental mental health needs. Best practices for behavioral health providers in NICU settings include implementing specialized and evidence-based approaches spanning identification, evaluation, and intervention to enhance developmental, relational, and health outcomes. Reflection and reflective practice are core components of behavioral health professionals’ engagement with infants and their families. Consequently, behavioral health providers are uniquely positioned to support fragile infants, their families, and the professionals who serve them, promoting optimal development and healthy relationships well beyond the NICU.
A Brief History of Neonatal Follow-Up and Why It Is Done
Authors: Needelman Howard , Egboh Beatrice , Strong-Bak Whitney , Winningham Grace
Published: August 2022

High-risk newborns are known to have various sequelae to the problems they encounter while in the neonatal intensive care unit (NICU). To address problems in these patients, and learn how to care for future high-risk patients, NICU follow-up clinics have been developed. Although most large NICUs have a follow-up clinic, there is little standardization of these programs. These programs seek to address and put in place the best interventions, both in the nursery and post-discharge, for newborns with conditions such as cerebral palsy, bronchopulmonary dysplasia, vision impairment, and others. Both the field of medicine and society at large have been fascinated with the outcome for infants born at risk for death and neurodevelopmental disabilities. Physicians skilled in these infant diseases have made great progress in treating them.
After the NICU
Authors: Serrano Verenea J. , Schulz Jonna H. von , Buchholz Melissa , Malik Kristina , Wrenn Amy , Talmi Ayelet
Published: August 2022

After hospital discharge, neonatal intensive care unit (NICU) graduates often have special health care needs that can persist into childhood. Primary care is a universal care setting that presents the opportunity for these needs to be addressed. Behavioral health services integrated into the primary care setting allow for early identification of concerns through screening, addressing of concerns through consultation and intervention, and increased care coordination through collaboration with various care team members. Given the special health care needs of NICU graduates and the increased risk for behavioral health concerns among NICU graduates and their families, it is important to adapt behavioral health practices to meet the specific needs of NICU graduates and their families. This chapter discusses adaptations and considerations for providing integrated behavioral health services in primary care for NICU graduates over the course of their childhood.
Let’s Get Started!
Authors: Meuret Alicia E. , Dour Halina J. , Guinyard Amanda G. Loerinc , Craske Michelle G.
Published: August 2022

This chapter discusses how the Positive Affect Treatment (PAT) program begins. According to science and clinical experience, regular homework practice has a clear effect on treatment success, especially with written and behavioral components. Practicing skills at home is essential to make gains in therapy. The skills introduced in session are intended to be practiced daily for a recommended time. Time and energy are vital when it comes to the PAT program. On the other hand, fear and lack of motivation could be reasons to avoid therapy. The chapter also teaches participants how to fill in exercise forms to be used during the treatment.
The Triad of Feelings, Thoughts, and Actions
Authors: Meuret Alicia E. , Dour Halina J. , Guinyard Amanda G. Loerinc , Craske Michelle G.
Published: August 2022

This chapter focuses on the mood cycle. It explains how the triad of thoughts, behavior, and physical sensations could impact mood and vice versa. While therapy cannot help with turning off feelings, people can still change the way they think and behave, and this in turn impacts their emotions. The chapter discusses the difference between downward spirals and upward spirals. One of the goals of Positive Affect Treatment (PAT) is achieving an upward spiral by changing behavior and working on thoughts. The chapter also highlights the importance of labeling positive emotions in an effort to improve one’s ability to recognize and communicate feelings.
Brief Supportive Psychotherapy
Authors: Markowitz John C.
Published: August 2022

Supportive psychotherapy is widely practiced but poorly defined, often misunderstood, and unfairly disparaged. Dr. Markowitz and his colleagues manualized Brief Supportive Psychotherapy (BSP) years ago as a time-limited control treatment to compare to “more active” established psychotherapies like Cognitive Behavioral Therapy and Interpersonal Psychotherapy in research studies. In fact, BSP, an emotion-focused, bare-bones treatment based on Carl Rogers’s Client-Centered Therapy, has since proven to be a robust treatment in multiple randomized controlled treatment trials. It has generally kept pace with the brand-name treatments in treating patients with difficult disorders like chronic depression. It deserves a place among evidence-based treatments in depression treatment guidelines. Some therapists previously trained in cognitive and behavioral approaches have found this affect-focused approach adds a new dimension to their thinking and to patients’ lives. This book is both an elaboration of the now well-tested research treatment manual for BSP and a primer for clinicians. It illustrates how BSP helps patients with mood and anxiety disorders to tolerate rather than avoid their powerful negative emotions. It describes the key elements of supportive psychotherapy, covering the crucial “common factors” that help make all evidence-based psychotherapies effective (e.g., affective arousal, helping the patient to feel understood, realistic optimism for improvement, a therapeutic ritual, clinical poise, and success experiences). BSP maximizes patient autonomy, letting the patient lead sessions, and prescribes no homework. It is an elemental, relatively simple approach for a psychotherapy, yet no psychotherapy is easy to do well. Its affect-focused approach enhances the application of all psychotherapeutic approaches.
Affect Focus
Authors: Markowitz John C.
Published: August 2022

This chapter focuses on the crucial topic of emotion in psychotherapy. It reviews key negative affects patients tend to avoid: anger, sadness, and anxiety. It asks the therapist to assess how aware the patient is of his or her emotional life and how he or she handles those emotions. It then addresses how to elicit affect, encourage the patient to tolerate it, and validate the patient’s emotions. Doing so raises the implicit question: What can the patient do with those feelings? A discussion follows on the distinction between expectable painful emotions and symptomatic feelings. The chapter describes drawing affects from and linking emotions to the particulars of a patient’s life. The chapter further describes the appropriate therapeutic stance in Brief Supportive Psychotherapy and discusses the need for therapists to be able to tolerate strong affects themselves.
Adjusting Brief Supportive Psychotherapy to Different Disorders
Authors: Markowitz John C.
Published: August 2022

This brief chapter describes the adaptation of Brief Supportive Psychotherapy for non-mood disorders, mainly anxiety disorders. Because Brief Supportive Psychotherapy is so elemental, it might not need dramatic adaptation for other disorders. The chapter describes the need to test any further adaptations in outcome trials. The chapter also discusses using Brief Supportive Psychotherapy in the context of comorbid psychiatric disorders.
History, Basic Principles, and Outline of LGBTQ-Affirmative Cognitive-Behavioral Therapy
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter begins with the main premise of the Unified Protocol (UP), which is that individuals experiencing depression, anxiety, or other stress-related symptoms use maladaptive emotion regulation strategies that attempt to avoid or dampen the intensity of uncomfortable emotions. UP teaches clients to confront and experience stress and respond to their emotions in more adaptive ways. It highlights how UP reduces the intensity and incidence of interfering and overwhelming emotional experiences and improves functioning. The chapter outlines the basic principles that guide the successful delivery of the original UP, the cognitive-behavioral treatment upon which the LGBTQ-affirmative adaptations are based. It also covers other principles that identify ways that cognitive-behavioral treatment principles can be enhanced to address the impact of LGBTQ-related stress on LGBTQ people’s mental and behavioral health.
Session 1: Functional Analysis and Introduction to Treatment
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter demonstrates an initial treatment session that is designed to provide a review of the client’s presenting problems and diagnoses within the context of the LGBTQ-related stress cognitive-behavioral case formulation. It talks about the sessions that focus on psychoeducation about LGBTQ-related stress and the rationale behind the treatment and conduct the functional analysis by assessing each of the components of the STAIRCaSE Model. It also recommends the short assessment of the client’s symptoms to track changes over time and build motivation throughout treatment. The chapter refers to the Overall Depression Severity & Impairment Scale (ODSIS) and Overall Anxiety Severity & Impairment Scale (OASIS), which are short assessments of the anxious and depressive symptoms over the prior week. It highlights suggested discussion points for the therapist to go over with the client about what treatment will entail and how the treatment program was developed.
Module 1: Setting Goals and Building Motivation for LGBTQ-Affirmative Cognitive-Behavioral Therapy
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter focuses on the client’s readiness and motivation for change and fosters self-efficacy for engaging in LGBTQ-affirmative cognitive-behavioral therapy. It demonstrates how to do the sessions for reviewing all module content and agreeing on setting three major treatment goals and for breaking down the client’s treatment goals. It emphasizes the use of a progress record to see how the client’s symptoms are changing from session to session based on the week’s assessments. The chapter highlights the importance of motivation and commitment when starting mental health treatment. The more motivated a client is, the more likely they are to fully engage with sessions and to practice skills in between sessions, which yields better treatment outcomes.
Module 2: Understanding the Nature and Emotional Impact of LGBTQ-Related Stress
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter raises awareness about the potential influence of LGBTQ-related stress on the client’s experience of depression and anxiety. It discusses how to provide psychoeducation about the nature and emotional impact of LGBTQ-related stress, beginning with how LGBTQ-related stress contributes to the client’s daily life. It also shows how a therapist must explore how LGBTQ-related stress contributes to the client’s daily life and well-being. The chapter is designed to help therapists make LGBTQ clients understand how early and ongoing LGBTQ-related stress might contribute to their experiences of anxiety and depression, the nature of their emotional responses to LGBTQ-related stress, and unhelpful coping behaviors in the face of LGBTQ-related stress. It notes that LGBTQ people are more than twice as likely to experience major depression, panic disorder, and social anxiety disorder compared to their heterosexual peers.
Module 3: Understanding and Tracking LGBTQ-Related Stress and Emotional Experiences
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter describes how emotions work and how they are relevant to a patient as an LGBTQ person. It explains how patients can understand and manage their emotions better and considers patients’ experiences with LGBTQ-related stress to understand how it impacts their emotions. It reviews different kinds of LGBTQ-related stress so that patients can start to figure out how it might be affecting their emotions and behaviors, particularly the ones they want to change through this program. The chapter talks about the before, during, and after of a patient’s LGBTQ-related stress experiences, and patients are asked to practice identifying some triggering situations that lead to LGBTQ-related stress. It points out that emotions themselves are not bad as they tell which events and situations patients should pay attention to so that they can take action.
Brief and low intensity cognitive behavioural therapy for children and young people
Authors: Myles-Hooton Pamela
Published: August 2022

This chapter overviews the aims of this book, and what the editors hope that readers will gain from it, serving to introduce the concept of low intensity (LI) cognitive behavioural therapy (CBT). It first reviews the prevalence of mental health disorders in children and young people, including how rates and severity levels have changed in recent decades, and associated needs for efficient, effective treatment options. It then provides a brief historical overview of LI CBT and presents a working definition of LI CBT and how it differs from brief CBT for the purposes of this book. Hereafter, the terms LI CBT and LI interventions will be used throughout the book.
Efficacy of low intensity interventions for mental health problems in children and young people
Authors: Bennett Sophie D.
Published: August 2022

There is an increasing evidence base for the use of low intensity interventions in children and young people. A recent meta-analysis, pulling together the results of existing studies of self-help for children and young people, found that self-help (both guided and unguided) was associated with significant medium-to-large effects on symptoms of anxiety, depression, and disruptive behaviour in children and young people. Larger effect sizes indicate bigger differences between groups, so a medium-to-large effect size suggests that there is a ‘medium-to-large sized’ difference between scores for the low intensity intervention groups and the control groups. This suggests that the low intensity intervention works better than the control intervention. This chapter considers the results of the 50 studies included in this meta-analysis. ‘Self-help’ is used to mean both clinician-guided and self-guided interventions.
Low intensity assessment
Authors: Vickery (née Whitney) Hannah
Published: August 2022

The range of organizations which deliver low intensity interventions for children and young people means that assessment processes are sometimes variable. Some children and young people may experience a brief ‘screening/triage assessment’ and others may undergo a more comprehensive child and adolescent mental health service assessment, before presenting to a low intensity service. For the purposes of this chapter, the focus is on how to conduct a low intensity assessment. Elements including information gathering, risk assessment, and creating problem statements will be explored. Common challenges and potential solutions will also be covered to support readers in their real clinical practice. It is encouraged that this chapter is read in conjunction with Chapter 8 on routine outcome measures.
Low intensity interventions for autistic children and young people
Authors: Libsack Erin J. , McNair Morgan L. , Giacomantonio Joseph , Felsman Peter , Lerner Matthew D.
Published: August 2022

Autism spectrum disorder is a lifelong neurodevelopmental disorder estimated to affect 1 in 54 children. Although interest in low intensity (LI) interventions for autistic youth has increased recently, most published research remains limited to small sample sizes and pilot methodology. Evidence-based research collected from large-scale randomized controlled trials, inclusion of active control groups, and replication studies are largely still lacking. This chapter offers a window into the growing field of LI intervention research within the extant autism spectrum disorder literature. It highlights the use of technology (e.g. virtual reality and computer-based interventions), alternate treatment providers and settings (e.g. peers or teachers; classrooms or summer camps), as well as brief and truncated interventions (e.g. growth mindset interventions and romantic relationship workshops) for autistic youth. It also notes key challenges, such as the typical time-intensive interventions for autistic individuals, and potential solutions, such as the distilling and matching model, for successfully implementing LI interventions for autistic individuals. Finally, it discusses what we expect the future to hold for LI interventions for autistic youth.
Apps for mental health problems in children and young people
Authors: Stallard Paul
Published: August 2022

Improving the mental health of children and adolescents is a global priority. While effective psychotherapeutic interventions are available, child and adolescent mental health services have limited capacity resulting in many children failing to seek, or receive, the help they require. Alternative approaches to delivering evidence-based mental health interventions at scale are required with technologically delivered interventions offering a potential way of bridging the mental health treatment gap. Smartphone apps are the most accessible of all the technologically delivered interventions and yet the evidence for their impact on mental health is scant. Given their widespread use, professionals should routinely ask what apps a young person has used, highlight any limitations, and correct any inaccuracies of content. Apps can be integrated within traditional clinical practice and are particularly useful for sharing information and introducing skills.
FIRST
Authors: Fitzpatrick Olivia , Bailin Abby , Venturo-Conerly Katherine , Wei Melissa , Weisz John
Published: August 2022

Most youths receiving community-based mental healthcare have multiple difficulties and will terminate treatment early. Thus, interventions that can efficiently target several, frequently fluctuating treatment needs might be appropriate for these youths. One such approach is FIRST, an efficient, transdiagnostic intervention grounded in evidence-based principles of therapeutic change. This chapter outlines some benefits, challenges, and potential solutions to the challenges of delivering FIRST.
The Acute Respiratory Distress Syndrome
Authors: Maben Sarah , Gosling Andre F. , Shaefi Shahzad
Published: August 2022

Acute respiratory distress syndrome (ARDS) defines a clinical entity involving respiratory failure, hypoxemia, and bilateral pulmonary infiltrates on chest X-ray secondary to noncardiogenic pulmonary edema. Pathogenesis requires an initial insult that triggers a systemic inflammatory response, ultimately damaging lung parenchyma. Management is multifaceted, including treatment of the underlying disease process, lung-protective ventilation strategies, methods to prevent patient–ventilator dysynchrony, and strategies to improve ventilator:perfusion matching. Escalation to extracorporeal membrane oxygenation may even be required. Several therapies have not been shown to reduce mortality, including inhaled nitric oxide and high-frequency oscillatory ventilation. The mortality rate is high, and recovery is prolonged. There are many significant areas of ongoing research to better delineate patient, disease, and treatment-related factors that reduce morbidity and mortality in ARDS.
Anti-NMDA Receptor Encephalitis
Authors: McDonald Jennifer , Miller Steven E.
Published: August 2022

Initially recognized in young women with teratoma who presented with psychosis and/or memory problems, anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis can rapidly progress to severe neurologically mediated illness requiring intensive care. NMDAR encephalitis appears to have the most frequent incidence of paraneoplastic encephalitis. However, while most presentations of paraneoplastic encephalitis are poorly responsive to treatment, patients with antibody-mediated NMDAR encephalitis (first identified 2007) are more likely to respond to treatment. This chapter presents a case study and then discusses the symptoms, diagnosis, and treatment of NMDAR encephalitis. While the majority of patients recover, roughly one-fourth of patients suffer long-lasting disabilities or mortality.
Elevated ICP With a Sella Turcica Tumor With Diplopia and Panhypopituitarism
Authors: Boss Payal , Diwan Murtaza
Published: August 2022

Sella turcica tumors present unique challenges to intensivists as they involve a unique interplay between both endocrinology and neurology. They usually present after the third decade of life, and patients can have neurological symptoms secondary to compression or abnormalities related to pituitary hormone secretion. The most common symptoms include visual field deficits, diplopia, headache, and pituitary hormone deficiency or excess. In rare instances, patients can present with acute neuro-ophthalmologic symptoms in the setting of hemodynamic instability. These cases may be secondary to hemorrhage into an existing sellar tumor and the development of pituitary apoplexy. This condition can present similarly to subarachnoid hemorrhage or sepsis from bacterial meningitis. Prompt diagnosis should be made from a constellation of clinical symptoms, and imaging, as well as lab findings of panhypopituitarism. Treatment includes hormone replacement with glucocorticoids or urgent neurosurgical resection.
Hypertrophic Obstructive Cardiomyopathy With Systolic Anterior Motion of the Mitral Valve
Authors: Daniels Justin
Published: August 2022

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease, affecting 1 in 500 people. It’s a disease with hypertrophic myocytes in disarray, leading to either diffuse or focal ventricular wall thickening and associated with the development of fibrosis. The penetrance and presentation of the disease spans a wide spectrum. The most concerning sequalae is the occurrence of sudden cardiac death (SCD) in young patients. Besides SCD, HCM is associated with left ventricular outflow tract obstruction, systolic anterior motion of the mitral valve, diastolic heart failure, atrial fibrillation, cardiac ischemia, and end-stage systolic heart failure. The goals of treatment for acute symptoms include volume replacement, vasoconstrictors, and controlling tachycardia. Long-term treatment is centered around negative inotropes, negative chronotropes, and invasive interventions to reduce obstruction.
Refractory VT/VF to ECLS/ECMO
Authors: Barta Brent , Staab Jared
Published: August 2022

Refractory ventricular tachycardia and ventricular fibrillation is a condition with multiple underlying causes and a range of clinical acuity that varies from an urgent medical condition to the cause of sudden cardiac death. The initial treatment will depend on the severity of the presenting signs and symptoms, and the definitive treatment can be very complex with several modalities being utilized. Like all other diseases, the most appropriate treatment regimen depends on the specific nature of the pathology. This condition requires immediate attention to stabilize the patient and an in-depth knowledge of the disease process and available treatment options if the patient survives the initial presentation. There is an increasing body of literature that suggests mechanical circulatory support may have a role in the initial resuscitation and continued management of these patients. Despite its increased usage, the decision to initiate mechanical support for this condition is complex, and there are no concise guidelines for the appropriate use of this costly and resource-intense modality as a bridge to definitive treatment.
Anaphylaxis Presenting From Home
Authors: Staab Jared , Barta Brent
Published: August 2022

Anaphylaxis is a medical emergency that affects individuals of all ages with a higher incidence among younger people. Geography appears to play a role with increased incidence the further one moves from the equator as well as in rural areas. Due to lack of standardized diagnostic criteria the incidence of anaphylaxis is challenging to define but appears to be increasing. Anaphylaxis may present with an acute onset of rash, hives, angioedema, or pruritis leading to wheezing, dyspnea, hypotension, and vasodilatory shock. Lat manifestations may include nausea, vomiting, and diarrhea. Common triggers for anaphylaxis include food, venom, drugs, and exercise. The diagnosis of anaphylaxis is made based on physical exam findings and the exclusion of other conditions that may mimic anaphylaxis. Epinephrine remains the mainstay of treatment, while education and avoidance of triggers assists in prevention.
Severe Thermal Burn Injury, Greater Than 80% Total Body Surface Area
Authors: Trester Joshua
Published: August 2022

Injuries from fires are the fourth most common traumatic injury worldwide behind traffic incidents, falls, and intentional violent injuries per data from the World Health Organization. In the United States, the age-corrected death rate from fires and burn injures was 1.2 per 100,000 in 2006. Lower socioeconomic status has been associated with a significantly higher risk of burn injury in communities in the United States and approximately 90% of burn-related deaths occur in low or middle-income countries. Large total body surface area thermal burns are associated with high morbidity and mortality as well as prolonged stays in the intensive care unit, need for aggressive support, severe pain, and associated complications. The initial and subsequent critical care management of these unstable patients necessitates continuous involvement of the intensive care team, ideally as part of a multidisciplinary approach to managing these patients’ complex injury.
Mesenteric Ischemia With Dead Bowel After Major Abdominal Surgery
Authors: Bowen Robert , Shen Liang
Published: August 2022

Mesenteric ischemia is a constellation of disease processes that ultimately result in decreased blood supply to the mesentery, intestinal necrosis, perforation, and sepsis. Patients tend to be older and presentations can be variable, both due to the range of etiologies that lead to ischemia and the decreased symptom reporting reliability. Imaging, particularly computed tomography angiography, is of great value in diagnosing this condition and helps guide further therapy. The diagnosis is often time-sensitive, as delayed diagnosis leads to decreased gut viability and significantly worse prognosis. Treatment options often include surgical intervention, and long-term outcomes depend heavily on patient comorbidities, patient acuity, and length of remaining viable bowel.
Sepsis
Authors: Foley Edward D. , Castresana Manuel R.
Published: August 2022

Sepsis is often a fatal disease process depending on the severity of the critical illness. Conventionally, sepsis has been regarded as a systemic inflammatory response caused by infection, but is now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It can be difficult to determine whether infection is present and when it is, whether it is the cause of critical illness and organ failure. However, when sepsis is suspected, it is crucial to look for the source of infection, as the rapid and effective treatment of infection improves outcome. A successful approach to clinical management needs timely recognition and early resuscitative measures with concurrent diagnosis and specific therapy, including source control, where indicated. A collaborative and multidisciplinary approach to multisystem organ support is often required to achieve the best outcome.
Cardiac Tamponade
Authors: Freeman Rachel Maldonado , Vail Emily Anne
Published: August 2022

Cardiac tamponade is an emergency caused by fluid accumulation in the pericardial sac, leading to compression of the heart, impaired ventricular filling, and hemodynamic compromise. Cardiac tamponade after cardiac surgery is a rare but serious complication that has a high morbidity and mortality if not diagnosed and evacuated promptly. Depending on the procedure performed, the incidence of tamponade is between 0.2% and 8%. Clinical presentation can be nonspecific; no single bedside exam or test is adequately sensitive to definitively detect tamponade. To prevent cardiovascular compromise and arrest, diagnosis and treatment must be prompt. Medical treatment of tamponade focuses on maintaining preload, afterload and elevated heart rate until definitive treatment by pericardiocentesis, pericardial window or surgical exploration may be performed.
Ethics in Critical Care
Authors: Weyker Paul D. , DeCamilli Alessandro R.
Published: August 2022

There are four guiding principles of medical ethics. These include autonomy, beneficence, nonmaleficence, and justice. Autonomy respects an individual’s right to make decisions about their treatment. Beneficence states that a physician should act in the patient’s best interest. Nonmaleficence requires that physicians do not cause harm to a patient. Justice implies that healthcare is distributed in a fair and equitable manner. In the intensive care unit, there often can be a contradiction between autonomy and nonmaleficence. This can leave the critical care physician in a precarious situation stuck between a rock and a hard place. This is especially true in the case of patients who are unwilling to accept potentially life-saving transfusions of blood products on religious grounds.
“Will You Take Me In?”
Authors: Madison Damon
Published: August 2022

When I was in first grade, my elementary school had a Father–Student Day. I fantasized that my father was going to attend. He never communicated to me that he would, but I had hope he knew about it and would surprise me. He never made it. I was devastated and embarrassed because all the other students had their fathers. After school, I sat on the schoolhouse stoop, waiting, hoping he would show up. The teacher parking lot began to empty. A kind teacher came up to me and asked, “Damon, are you ok? Is your parent coming?” “Yes,” I lied. “Ok, get home safe,” she replied and went on her way. I waited two hours for my father not to show up.
Losing Them
Authors: Ship Amy N.
Published: August 2022

I am the mother of three sons, but only one lives. Every component of my life as a mother was a shock: I never could have imagined that my first son would be born with profound brain damage; never could dream that my second would as well. I could never have conceived that my eldest would die, and couldn’t have ever considered that my second one would, too. I could never imagine the life I’d lead as their mother, and how I’d go forward after their deaths. I could never apprehend how many losses I’d experience before I lost them forever. I am the mother of three sons but travel the world with only one, carrying the absence of my other two with me as I step into my future.
Five Decades
Authors: Rosen Steven T.
Published: August 2022

Poem by Steven T. Rosen
Good Times, Brother
Authors: Halporn John
Published: August 2022

The story of my younger brother Doug’s cancer divides my life into a “time before” and a “time after,” both as a person and as a physician. My brother was a healthy thirty-three-year-old medical student when he developed an aggressive stomach cancer. This story describes the course of his illness through the end of his life and catalogues the losses he and our family experienced. I reflect on my experience as a brother and caregiver and how I struggle to reconcile this loss and my professional identity as a physician. This writing has helped me understand and accept myself a little better—I have pain in the recalling and describing, but when I finish a draft there is relief and a bit more distance from the hurt. I recognize the two angles I have focused on: what happened and how I reacted and adapted. The first is an effort to accurately record and honor our life-changing experience. The second is the work of accepting how I was and how I am.
Clinical Classification of Tremor Syndromes
Authors: Becktepe Jos , Deuschl Günther
Published: August 2022

Tremor is the most common movement disorder, and the diagnosis of most tremor syndromes relies solely on the clinical classification. The 2018 updated consensus criteria on the classification of tremors apply a two-axis approach: Axis 1 comprises the clinical phenomenology and is the basis for the syndromic categorization. The clinical assessment of a tremor patient includes the patient’s history; the tremor characteristics in terms of localization, activation conditions and tremor frequency; the examination of additional neurological or systemic signs; and, possibly, additional laboratory tests. On Axis 2, the etiology is described; this can be acquired, genetic, or idiopathic. In most patients with isolated tremor syndromes, the etiology remains idiopathic. The tremor classification is currently the basis for physicians to communicate about tremor diagnoses, and for selecting treatments. It reflects the status of knowledge about tremors; further development in the future is likely.
Neuroimaging of Tremors
Authors: Helmich Rick C.
Published: August 2022

Most clinical tremor syndromes are associated with changes in the central nervous system, and neuroimaging can help to make these changes visible. This chapter discusses how neuroimaging can be used during the clinical workup of a patient presenting with tremor, and in fundamental research. The value of different neuroimaging techniques will be discussed, and this chapter will also clarify different analytical approaches. Studies differ as to whether tremor is viewed as a trait (which differs between individuals) or a state (which differs between contexts). Converging evidence shows that tremor-related activity (a state characteristic) in the cerebello-thalamo-cortical circuit plays a key role in many clinical tremor syndromes. In addition, there are also findings that are specific to a tremor syndrome. Essential tremor is characterized by increased tremor-related activity in the cerebellum, possibly driven by functional (GABAergic) and/or structural (gray matter atrophy) changes. Rest tremor in Parkinson disease is associated with abnormal activity in both the basal ganglia and the cerebello-thalamo-cortical circuit, influenced by altered dopaminergic and noradrenergic influences onto the thalamus, and also involving serotonergic changes. Dystonic tremor syndromes involve multiple brain circuits, including cerebellum, basal ganglia, and cortex. Orthostatic tremor is linked to structural and functional changes in the cerebellum and medial frontal cortex. Challenges for the future are to develop neuroimaging biomarkers that can help to identify and explain the phenotypical convergence and divergence between clinical tremor syndromes, and which may be used to predict treatment response.
Voice Tremor
Authors: Xavier Laura de Lima , Simonyan Kristina
Published: August 2022

Voice tremor is one of the most common and arguably most socially debilitating forms of tremor as it significantly impairs daily communication and social interactions of an affected individual. It is, however, clinically under-evaluated, partially due to unclear voice tremor classification and challenges with its differential diagnosis. While the understanding of the voice tremor is still being developed, in this chapter we define it as a symptom present in a spectrum of neurological disorders. We focus on essential tremor and laryngeal dystonia where voice tremor represents one of the common symptoms and briefly discuss voice tremor presentations in other neurological disorders. Our goal is to summarize the most recent interdisciplinary developments in voice tremor classification, pathophysiology, and treatment, as well as outline the prospective diagnostic and therapeutic horizons for those who suffer from it.