bluuebunny/crossref_metadata_2025 huggingface dataset:
Food Selectivity in Autism Spectrum Disorder
Authors: Sharp William G. , Postorino Valentina
Published: October 2017

Children with autism spectrum disorder (ASD) have a fivefold increased risk of developing a feeding problem compared to peers. Food selectivity is the most widely documented feeding concern in ASD. However, it does not frequently correspond with compromised gross anthropometric parameters (i.e., height, weight, and body mass index) likely to trigger attention in pediatric settings. Poor dietary diversity is associated with increased risk of vitamin and mineral deficiencies and diet-related diseases. This chapter reviews the current state of the science regarding the prevalence, topography, consequences, and remediation of feeding problems in ASD. Food selectivity is differentiated from other eating disorders, with a specific focus on exploring the possible link between ASD and anorexia nervosa. A framework to guide the assessment and treatment process is provided, and current treatment approaches are reviewed. The chapter concludes with recommendations to enhance the evidence base to promote development of best standards of care.
Evidence-Based Treatment Approaches for Night Eating Disorders
Authors: Allison Kelly C. , Berner Laura A.
Published: October 2017

Night eating syndrome (NES) is characterized by evening hyperphagia and nocturnal ingestions. This chapter presents criteria for NES diagnosis, considerations for differential diagnosis, recommended diagnostic assessment tools, and current estimates of NES prevalence. Evidence in support of pharmacological interventions, behavioral stress management, behavioral weight loss treatment, and phototherapy for NES is reviewed. A clinical case example and detailed overview of cognitive–behavioral therapy for NES are also provided, and the potential impact of weight status on NES treatment outcome is discussed. Results from initial treatment outcome studies with small sample sizes are promising, but larger, randomized controlled trials of behavioral, pharmacological, and combination treatments for NES are needed.
Eating Disorders in Males
Authors: Brown Tiffany A. , Griffiths Scott , Murray Stuart B.
Published: October 2017

Eating disorders have been traditionally thought of as female disorders, with males representing a rare and atypical minority of presentations. As a result, males with eating disorders have been uniquely stigmatized. However, contemporary evidence has illustrated an increasing prevalence of male eating disorders, although males continue to be underrepresented in treatment studies and often go undetected in clinical practice. This chapter provides an overview of the prevalence of eating disorders in males, highlights distinct differences in clinical presentations, and provides recommendations for tailoring clinical treatment approaches. It also describes useful clinical resources related to males and eating disorders, including useful assessment measures and website resources.
Overview of Adaptations of IPT
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

Because of its success as a psychotherapeutic treatment for acute major depression, IPT has been adapted and tested in the treatment of patients with other disorders and in different formats. These modified treatments follow the general IPT principles outlined throughout this book. Key parameters to consider in these adapted versions are their time requirements (treatment duration), the clinical experience required, and any empirical support that exists for their effectiveness. Although different treatment durations have been suggested, it is important in IPT to set and hold to a time limit of some kind. The time limit provides structure so that the patient knows what to expect, and the pressure of time helps propel the acute therapy forward. Before using IPT for other disorders, therapists should review the DSM-5 diagnostic criteria for that disorder and have some clinical experience in treating that population.
Substance-Related and Addictive Disorders
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter includes an overview of the use of IPT for patients with substance abuse (e.g., alcohol, opiates, cocaine, and nicotine) and addictive disorders. The available data do not allow us to recommend IPT as a treatment for patients with a substance use disorder. There have been several negative IPT trials in this population, and in this setting IPT has been found to be no better than a control condition. However, some small studies in process are more optimistic for its use in narrowly defined samples. Based on the published literature, approaches other than IPT that focus on sobriety or relapse prevention may be preferable for patients with substance use disorders. IPT has never been intended as a treatment for all patients with all conditions, and substance abuse may be an area where its application has limited utility.
Group, Conjoint, Telephone, and Internet Formats
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

IPT was developed as an individual, face-to-face psychotherapy, but its principles are flexible enough to work in other formats. This chapter describes adaptations of IPT to four other formats: group IPT, conjoint (couples) IPT, telephone IPT, and Internet (self-guided) IPT. The research that has been done to evaluate each of these formats with various populations and in various settings is described. For instance, group IPT reduces interpersonal isolation; allows patients to see that others share their illness, validating the IPT sick role; and allows therapists to treat larger numbers of patients. However, patients receive less individual attention, difficulties in assembling adequate numbers of patients to form a group may delay treatment, and patients may present with different focal interpersonal problem areas. Recommendations for therapists who choose to use these adaptations are offered.
The Foundational Constructs of Goal Focused Positive Psychotherapy
Authors: Conoley Collie W. , Scheel Michael J.
Published: October 2017

Chapter 2 presents the theory behind Goal Focused Positive Psychotherapy (GFPP), a technique that facilitates clients’ thriving by creating a happier, meaningful life. Psychotherapy can help clients to enjoy a lifetime of well-being and growth toward their meaningful, virtuous goals through positive emotions. The Broaden-and-Build Theory of positive emotions serves as the change mechanism for GFPP. It is important to select goals for therapy based upon client values and personal meaning (approach goals and intrinsic goals). Using clients’ personal strengths (including their culture) is of central importance, as is the promotion of hope in usually demoralized clients. The implicit theory of personal change or the growth mindset includes the belief in neural or brain plasticity. Self Determination Theory sets out competence, relatedness, and autonomy as the three determinants of motivation and the fundamental psychological needs.
Conclusion and Future Directions
Authors: Conoley Collie W. , Scheel Michael J.
Published: October 2017

The final chapter presents empirical support for Goal Focused Positive Psychotherapy (GFPP) in comparison to cognitive-behavioral therapy and short-term psychodynamic therapy. Topics for future research and development are addressed. The GFPP orientation toward the client and skills to enact the orientation are discussed. The three primary pathways of the Contextual Model, a meta-theory of psychotherapy, are used to outline future research. Pathway 1 describes the importance of forming a real relationship between the therapist and client. Pathway 2 consists of the client’s expectations of benefit that are created through therapeutic techniques. The final pathway is the client’s change through participating in the therapy interventions. Treatment model validity issues are reviewed by examining therapists’ therapy model allegiance versus treatment integrity. Assessing the therapist’s competence as an ability to facilitate GFPP experiences for the client is examined. Finally, areas of growth for GFPP are discussed, including a better integration of systems theory.
Active Planning: Mapping the territory and navigational skills for AMBIT-influenced work
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

This chapter, comprising three sections, is the first of two (with Chapter 4) covering the work with clients. The first section covers planning and the maintenance of purpose and progress in work that take place in chaotic, changing, and confusing territory. The second section covers the phases of AMBIT work, laying out a broadly generic “map of the journey” with key processes and challenges (initial engagement, assessment, formulation, and goal-setting, followed by a second phase of active intervention and reviewing, then phases of work on sustaining and consolidating gains, in preparation for ending). The final section describes how a mentalizing stance can be held in relation to goal-setting and planning, explicitly balancing this rather concrete, task-focused work with the two other processes of “broadcasting intentions” (to evoke support and collaboration) and “sustaining sensitive attunement” (to maintain engagement and trust). Tools to support these activities are offered.
Enhancing Attention and Organization in Adolescents
Authors: Spiel Craig F. , Harrison Judith R. , State Talida M.
Published: October 2017

The chapter “Enhancing Attention and Organization in Adolescents,” in School Mental Health for Adolescents, describes the constructs and importance of attention and organization in secondary schools and their relationship to attention-deficit/hyperactivity disorder. Difficulties attending in classroom settings can lead to serious academic impairment, which in turn can lead to a host of negative outcomes for adults. Attempts to alter the negative effects of inattention and disorganization have resulted in the development of interventions and services to address these issues. The authors begin by describing methods of identifying risk and the effects of developmental changes associated with assessment. Next, the authors describe school-based services, including services frequently provided in schools, and evidence-based services. Finally, the authors describe a service delivery model for implementing services in schools.
Regulating Emotions
Authors: Mychailyszyn Matthew P. , Manning Maureen A. , Petrick Catherine T.
Published: October 2017

The chapter “Regulating Emotions,” in School Mental Health Services for Adolescents, examines various aspects related to emotion regulation, including its identification, assessment, and intervention, according to evidence-based practice. Internalizing disorders represent an area of marked concern for youth, particularly during the developmental stage of adolescence. Particularly troublesome is empirical evidence that suggests an increasing prevalence rate of depression among youth. In the chapter, prevalence of disorders is examined, as well as different modalities by which psychopathology in the schools can be screened for and more formally evaluated. Various forms of cognitive-behavioral prevention and intervention are discussed and considered for appropriateness within a particular school context. Obstacles to implementation are considered and recommendations for a model of service delivery are offered.
Screening and Progress Monitoring in Secondary Schools
Authors: Soares Denise A. , George Catherine C. , Vannest Kimberly J.
Published: October 2017

The chapter “Screening and Progress Monitoring in Secondary Schools,” in School Mental Health Services for Adolescents, examines social, emotional, and behavioral screening in secondary schools. Mental health disorders in adolescence are known to be associated with poor school and life outcomes, including academic underachievement, school dropout, drug use, and physical aggression. This chapter reviews universal screening at the secondary level, which provides evidence to help assess instruction in the school and identifies those students who may not be making expected progress. In addition, the authors describe barriers to screening. They present data on types of common problems, justification for engaging in screening, and methods for screening and progress monitoring, including guiding principles and time lines.
Prevention of Depression and Bipolar Disorder
Authors: Craighead W. Edward , Beardslee William , Johnson Robert
Published: October 2017

This chapter starts by explaining why it is so important to prevent the initial episode of depression and other mood disorders. Experiencing such a condition is devastating for the individual but there is also a global cost associated. Prevention of mood disorders and depression is an urgent and timely topic. However, empirical work regarding prevention is difficult and has been slow to progress. More work has been carried out on how to prevent a second and subsequent episodes. However, we need to focus on finding out how better to prevent the initial episode. The chapter ends with some thoughts on future directions and recommendations. It states that attention needs to be directed to disseminating cognitive behavioral therapy and family-based programs as a major public health initiative.
Defining Schizophrenia
Authors: Gur Raquel E. , Gur Ruben C. , Keshavan Matcheri S. , Kohler Christian , Walker Elaine
Published: October 2017

This chapter begins by describing exactly what schizophrenia is. It also defines what is meant by adolescent and adult in terms of this condition. It goes on to look at the diagnostic criteria for schizophrenia. It then considers the relationship of phenomenology to neural mechanisms. Finally, it looks at the use of phenomenology to assist in identifying the phenotype for genetic studies. Research into this area is continuous. However, some early trends are noteworthy. Some potential gene discoveries have now been replicated enough times that it is increasingly unlikely that they are false positive findings. We can also expect that the biochemical pathways represented by these genes will be explored at the level of basic cell biology and new leads about pathogenesis and potential new targets for prevention and treatment will be found. In addition, we should expect a number of studies to emerge that will try to understand whether expression of these genes are changed in the brains of schizophrenia patients. Also, efforts are already underway to try to understand how these genes influence psychological functions such as attention, sensory gating, and memory that are disturbed in schizophrenia. Finally, intense efforts will be made to try to determine whether these different genes are acting through a common pathway as, for example, has been postulated for the known genes for Alzheimer's disease.
Prevention of Anxiety Disorders
Authors: Foa Edna B. , Franklin Martin , McNally Richard J. , McLean Carmen , Pine Daniel
Published: October 2017

This chapter begins by introducing current thinking on the rationale for preventing anxiety disorders in youth. It explains risk and protective factors in youth and examines symptoms exhibited. An important set of impediments to developing successful prevention intervention is the lack of knowledge about the complex interrelations among the various risk and protective factors for the development of anxiety disorders. Much is known about some specific factors but little is known about how they interact, which leaves the field bereft of a strong theoretical foundation upon which to build prevention programs. This may be why prevention research has continued to languish relative to treatment. There are a number of practical considerations that have stunted the development of prevention programs as well. The chapter outlines these. Therefore, new sources of funding must be identified to generate knowledge that will inform the development of anxiety disorder prevention programs.
Research Agenda for Substance Use Disorders
Authors: O’Brien Charles , Romer Daniel
Published: October 2017

The chapter starts by looking at the limited research that has been carried out among adolescents with substance dependence. The data gathered from studies for adults is often used when studying adolescents. However, there are critical differences. The chapter then goes through what we know and what we don' know about substance use in adolescents. It asks: how can we improve the treatment system and gives a number of crucial areas in which treatment can be improved upon. The chapter asks a final important question: how can political initiatives secure appropriate resource allocation?
Universal Approaches to Youth Suicide Prevention
Authors: Mortali Maggie G.
Published: October 2017

This chapter focuses on suicide prevention programs that have taken a universal approach, targeting whole populations of adolescents regardless of individual risk factors. The aim of universal suicide prevention programs is to reduce risk factors or enhance protective factors across the entire population. One particularly widespread approach targets youth where they are most accessible—in the schools. Four types of universal prevention programs are especially common and continue to be the most widely used approach in schools: school-based screening programs, adult and peer gatekeeper training programs, skills training programs, and comprehensive or “whole school” programs. This chapter describes and critiques each type, gives examples, and discusses the assumptions under which these programs operate.
Adolescent Gambling
Authors: Derevensky Jeffrey L. , Gilbeau Lynette
Published: October 2017

As a result of gambling’s general social acceptability, increased availability, and new online accessibility, and gambling has increased among youth. Adolescents represent a high-risk, vulnerable group for developing gambling problems. While youth with gambling problems typically do not present in the same way as adults, they nevertheless experience a host of negative consequences associated with excessive gambling. This chapter reviews risk and protective factors, screening, and treatment strategies for gambling problems among adolescents and highlights the importance of harm minimization through prevention strategies. Education and social policy implications are provided.
Emotion Regulation and Anxiety
Authors: Hannesdóttir Dagmar Kr. , Ollendick Thomas H.
Published: October 2017

Chapter 8 reviews anxiety disorders of childhood and adolescence, investigating the role of emotion regulation in onset, maintenance and propagation. Based on DSM-5 criteria anxiety disorders have the following core features: Excessive, persisting anxious arousal and clinically significant symptoms causing distress or dysfunction in social, academic or other domains of functioning. Currently, CBT interventions have been created for school-aged children with anxiety including the Coping Cat and the Cool Kids programs. Despite relatively high success rates, children remaining symptomatic after treatment may benefit from emotion-focused approaches, such as Emotion-Focused Cognitive-Behavioral Therapy and the Unified Protocol for the Treatment of Emotional Disorders in Youth. In addition, novel therapies have been devised targeting parents and their emotion regulation deficits like the Supportive Parenting for Anxious Childhood Emotions (SPACE) program. Future research should employ randomized control trials comparing the novel treatment approaches, treatment as usual, and standard CBT determining best practice protocols.
Children’s and Adolescents’ Emotion Regulation in the Context of Parental Incarceration
Authors: Zeman Janice , Dallaire Danielle
Published: October 2017

This chapter discusses children’s emotion regulation and adjustment in relation to parental incarceration. Parental incarceration may contribute to psychological maladjustment by disrupting the attachment bond between the parent and child and by influencing the development and deployment of maladaptive emotion regulation competencies. A nascent body of research indicates children of incarcerated parents are at risk for negative socio-emotional, psychological, educational, and health outcomes. Limited studies have investigated the impact incarceration has on emotion regulation; preliminary findings demonstrate children who manifest stronger emotion regulation skills have fewer negative psychological outcomes. Thus, a more comprehensive investigation of emotion regulation competencies fostering resilience is warranted. Additionally, future research investigating the impact of modeling and emotion coaching by key socializing figures is warranted. Training children and caregivers to manage affect during emotionally-provocative situations during the incarceration period (e.g., visitations, family reunification) may promote healthy adjustment.
Children Exposed to Traumatic Stress
Authors: Scott Brandon G. , Weems Carl F.
Published: October 2017

This chapter discusses children exposed to traumatic stress, which is often associated with persisting, negative outcomes such as anxiety, depression, aggression, grief, somatic complaints, poor academic achievement, social problems, and sleep problems. Research demonstrates that contextual factors, such as parenting behaviors and temperament may influence whether youth continue to have problems following the trauma. Severe and prolonged stress related symptoms may lead to posttraumatic stress disorder (PTSD), a multifaceted disorder involving persistent, chronic, heightened emotional reactivity, arousal to trauma cues, maladaptive emotion regulation (e.g., cognitive or behavioral avoidance), intrusive thoughts, and negative cognitions and mood states. Theoretical research posits that an integral component of PTSD is emotion dysregulation, involving deficits across cognitive, neurobiological, and behavioral systems. From a treatment perspective, empirical evidence supports trauma focused-CBT, school-based interventions, like Cognitive Behavioral Intervention for Trauma in Schools and Grief and Trauma Intervention, Eye Movement Desensitization and Reprocessing are auspicious, and nascent treatments.
Assessment of Career Interests
Authors: Leong Frederick T. L. , Fan Weiqiao , Zhou Xiaolu
Published: October 2017

The work of career interest assessment bridges various career interest theories and their applications in practice. However, the interface between theory and application in career interests has often been challenged in terms of cross-cultural validity and the role in explaining and predicting behaviors for specific groups such as different genders in a cultural setting. Based on measures of career interests, the construct validity of the important theoretical models for career interests is first reviewed in this chapter. The predictive validities of career interest are then examined in terms of career development, human resources and organizational behaviors, and academic achievement. Some interesting interactions between cultures and gender on career interests are reviewed in terms of the factor structure of interests. Finally, future research directions of career interest assessment are discussed in terms of cultural validity and cultural specificity.
Multiwavelength observations of nova SMCN 2016-10a – one of the brightest novae ever observed
Authors: Aydi E , Page K L , Kuin N P M , Darnley M J , Walter F M , Mróz P , Buckley D A H , Mohamed S , Whitelock P , Woudt P , Williams S C , Orio M , Williams R E , Beardmore A P , Osborne J P , Kniazev A , Ribeiro V A R M , Udalski A , Strader J , Chomiuk L
Published: October 2017

We report on multiwavelength observations of nova Small Magellanic Cloud Nova 2016-10a. The present observational set is one of the most comprehensive for any nova in the Small Magellanic Cloud, including low-, medium-, and high-resolution optical spectroscopy and spectropolarimetry from Southern African Large Telescope, Folded Low-Order Yte-Pupil Double-Dispersed Spectrograph, and Southern Astrophysical Research; long-term Optical Gravitational Lensing Experiment V- and I-bands photometry dating back to 6 yr before eruption; Small and Moderate Aperture Research Telescope System optical and near-IR photometry from ∼11 d until over 280 d post-eruption; Swift satellite X-ray and ultraviolet observations from ∼6 d until 319 d post-eruption. The progenitor system contains a bright disc and a main sequence or a sub-giant secondary. The nova is very fast with t2 ≃ 4.0 ± 1.0 d and t3 ≃ 7.8 ± 2.0 d in the V band. If the nova is in the SMC, at a distance of ∼61 ± 10 kpc, we derive MV, max ≃ −10.5 ± 0.5, making it the brightest nova ever discovered in the SMC and one of the brightest on record. At day 5 post-eruption the spectral lines show a He/N spectroscopic class and an Full Width at Half Maximum of ∼3500 km s−1, indicating moderately high ejection velocities. The nova entered the nebular phase ∼20 d post-eruption, predicting the imminent super-soft source turn-on in the X-rays, which started ∼28 d post-eruption. The super-soft source properties indicate a white dwarf mass between 1.2  and 1.3 M⊙ in good agreement with the optical conclusions.
Time-scales of stellar rotational variability and starspot diagnostics
Authors: Arkhypov Oleksiy V , Khodachenko Maxim L , Lammer Helmut , Güdel Manuel , Lüftinger Teresa , Johnstone Colin P
Published: October 2017

The difference in stability of starspot distribution on the global and hemispherical scales is studied in the rotational spot variability of 1998 main-sequence stars observed by Kepler mission. It is found that the largest patterns are much more stable than smaller ones for cool, slow rotators, whereas the difference is less pronounced for hotter stars and/or faster rotators. This distinction is interpreted in terms of two mechanisms: (1) the diffusive decay of long-living spots in activity complexes of stars with saturated magnetic dynamos, and (2) the spot emergence, which is modulated by gigantic turbulent flows in convection zones of stars with a weaker magnetism. This opens a way for investigation of stellar deep convection, which is yet inaccessible for asteroseismology. Moreover, a subdiffusion in stellar photospheres was revealed from observations for the first time. A diagnostic diagram was proposed that allows differentiation and selection of stars for more detailed studies of these phenomena.
Frequent Shifts inAspergillus flavusPopulations Associated with Maize Production in Sonora, Mexico
Authors: Ortega-Beltran A. , Cotty P. J.
Published: October 2017

Aspergillus flavus frequently contaminates maize, a critical staple for billions of people, with aflatoxins. Diversity among A. flavus L morphotype populations associated with maize in Sonora, Mexico was assessed and, in total, 869 isolates from 83 fields were placed into 136 vegetative compatibility groups (VCGs) using nitrate-nonutilizing mutants. VCG diversity indices did not differ in four agroecosystems (AES) but diversity significantly differed among years. Frequencies of certain VCGs changed manyfold over single years in both multiple fields and multiple AES. Certain VCGs were highly frequent (>1%) in 2006 but frequencies declined repeatedly in each of the two subsequent years. Other VCGs that had low frequencies in 2006 increased in 2007 and subsequently declined. None of the VCGs were consistently associated with any AES. Fourteen VCGs were considered dominant in at least a single year. However, frequencies often varied significantly among years. Only 9% of VCGs were detected all 3 years whereas 66% were detected in only 1 year. Results suggest that the most realistic measurements of both genetic diversity and the frequency of A. flavus VCGs are obtained by sampling multiple locations in multiple years. Single-season sampling in many locations should not be substituted for sampling over multiple years.
American Society of Clinical Oncology Position Statement: Strategies for Reducing Cancer Health Disparities Among Sexual and Gender Minority Populations
Authors: Griggs Jennifer , Maingi Shail , Blinder Victoria , Denduluri Neelima , Khorana Alok A. , Norton Larry , Francisco Michael , Wollins Dana S. , Rowland Julia H.
Published: October 2017

(Abstracted from J Clin Oncol 2017;35:2203–2208)

Sexual and gender minorities (SGMs) include individuals who are lesbian, gay, bisexual, transgender (LGBT), and intersex. These individuals bear a disproportionate cancer burden.
Blocking FSH Induces Thermogenic Adipose Tissue and Reduces Body Fat
Authors: Liu Peng , Ji Yaoting , Yuen Tony , Rendina-Ruedy Elizabeth , DeMambro Victoria E. , Dhawan Samarth , Abu-Amer Wahid , Izadmehr Sudeh , Zhou Bin , Shin Andrew C. , Latif Rauf , Thangeswaran Priyanthan , Gupta Animesh , Li Jianhua , Shnayder Valeria , Robinson Samuel T. , Yu Yue Eric , Zhang Xingjian , Yang Feiran , Lu Ping , Zhou Yu , Zhu Ling-Ling , Oberlin Douglas J. , Davies Terry F. , Reagan Michaela R. , Brown Aaron , Kumar T. Rajendra , Epstein Solomon , Iqbal Jameel , Avadhani Narayan G. , New Maria I. , Molina Henrik , van Klinken Jan B. , Guo Edward X. , Buettner Christoph , Haider Shozeb , Bian Zhuan , Sun Li , Rosen Clifford J. , Zaidi Mone
Published: October 2017

(Abstracted from Nature 2017;546:107–112)

Osteoporosis is common in postmenopausal women because of cessation of menstruation. Bone loss occurs most rapidly during late perimenopause—a period characterized by relatively stable estrogen and rising follicle-stimulating hormone (FSH) levels as a result of ovarian failure.
A family with two cases of melanocytic tumors and fragile X syndrome
Authors: Lesage Candice , Coupier Isabelle , Guillot Bernard
Published: October 2017

Fragile X syndrome (FXS), a leading cause of inherited intellectual disability, most commonly results from an expansion of the CGG trinucleotide repeat in the fragile X mental retardation 1 (FMR1) gene to more than 200 copies (full mutation). The FXS phenotype differs by sex and is associated with intellectual and cognitive impairment, characteristic physical features, epilepsy, and/or behavioral challenges including autism spectrum disorder. In this patient population, tumors involving blood cells, digestive organs, the central nervous system, and testes have been described, but melanocytic tumors have not been reported. Here, we describe two maternal cousins with FXS, one of whom has melanoma and the other has atypical nevus syndrome. We discuss possible mechanisms leading to this unusual or possibly coincidental association and the difficulties in the optimal treatment of FXS patients.
Minimally Invasive Redo Mitral Valve Replacement using a Robotic-Assisted Approach
Authors: Patel Hetal , Lewis T. P. Clifton , Stephens Richard L. , Angelillo Margaret , Sibley David H.
Published: October 2017

Minimally invasive, robotic-assisted cardiac surgery has been shown to decrease transfusion rates, decrease wound infection rates, shorten hospital length of stay, and allow for a faster return to full activity compared with traditional sternotomy approaches. However, its application has chiefly been limited to primary, isolated procedures such as primary mitral valve repair or replacement. We describe the first reported use of a robotic surgery platform to perform reoperative mitral valve replacement using a minimally invasive, totally endoscopic, port-access approach.
Use of Blood Biomarkers in the Assessment of Sports-Related Concussion—A Systematic Review in the Context of Their Biological Significance
Authors: O'Connell Brendan , Kelly Áine M. , Mockler David , Orešič Matej , Denvir Karl , Farrell Garreth , Janigro Damir , Wilson Fiona
Published: October 2017

Objectives:

To critically review current knowledge on the positive and negative predictive value of blood biomarkers for concussion; to illustrate the clinical and biological contexts that help evaluate the use of these markers in sport-related traumatic brain injuries (TBIs).

Methods:

This systematic review was performed in accordance with PRISMA guidelines. We reviewed the measurement, clinical utility, endpoint, and biological significance of blood biomarkers in concussion.

Results:

A total of 4352 publications were identified. Twenty-six articles relating to blood biomarkers were included in the review. Four common blood biomarkers, namely S100B, tau, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), were examined. Overall, the studies showed S100B measurement and use, either acutely or at several time points, can distinguish injured from noninjured patients with an uncertain degree of utility in predicting mortality. At present, S100B has largely become an acceptable biomarker of TBI; however, studies have begun to highlight the need to incorporate clinical symptoms instead of S100B concentration in isolation on the basis of inconsistent results and lack of specificity across published studies. Further research is needed to evaluate and validate the use of tau, NSE, and GFAP as a diagnostic aid in the management of concussion and TBI.

Conclusions:

At present, blood biomarkers have only a limited role in the evaluation and management of concussion. Although several biomarkers of brain injury have been identified, continued research is required. S100B holds promise as the most clinically useful diagnostic biomarker. Blood biomarkers, in combination with other clinical data, such as head computed tomography, would maximize the diagnostic accuracy. The methodological limitations evident in blood biomarker research results in the need for the clinical utility of blood biomarker use in concussion to be further explored.
Clinical Utility of Oculomotor and Electrophysiological Measures in Identifying Concussion History
Authors: Ledwidge Patrick S. , Patterson Jessie N. , Molfese Dennis L. , Honaker Julie A.
Published: October 2017

Objective:

To examine whether oculomotor and electrophysiological measures improve the clinical performance of the typical concussion protocol for classifying collegiate athletes with a history of concussion.

Design:

Cross-sectional.

Setting:

University Athletic Medicine and Research Facility.

Participants:

Forty-five varsity collegiate athletes.

Independent Variables:

Collegiate varsity athletes with or without a history of a diagnosed concussion.

Main Outcome Measures:

Multivariate receiver operating curve and area under the curve (AUC) analyses tested the clinical performance of the typical concussion protocol (symptoms, postural control, neuropsychological abilities). We examined differences in clinical performance between this protocol and after adding reflexive saccade and event-related potential (ERP) indices. Hypotheses were formed after data collection.

Results:

Significant AUCs were demonstrated for the typical concussion protocol (model 1: AUC = 0.75, P = 0.007), after adding reflexive saccade eye excursion gain (model 2: AUC = 0.80, P = 0.001), and ERPs (model 3: AUC = 0.79, P = 0.002). The AUC for reflexive saccades and ERPs was significant (model 4: AUC = 0.70, P = 0.030). Model 2's increased clinical performance compared with model 1 was nonsignificant, χ2(2) = 1.871, P = 0.171.

Conclusions:

All 4 models demonstrated adequate sensitivity and specificity for classifying athletes with a previous concussion. Adding reflexive saccades and ERPs did not significantly increase clinical performance of the typical concussion protocol. Future research should determine the clinical utility of saccades and ERPs for acute postconcussion assessments.
Incidence of Symptomatic Pulmonary Embolus and Deep Vein Thrombosis After Knee Arthroscopy in the Pediatric and Adolescent Population
Authors: Lau Brian C. , Jagodzinski Jason , Pandya Nirav K.
Published: October 2017

Objective:

The incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) after pediatric knee arthroscopy is unknown. The purpose of this study was to determine the incidence of venous thromboembolism (VTE) after knee arthroscopy in the pediatric and adolescent population in a high-volume center.

Design:

Retrospective cohort study.

Setting:

Tertiary care children's hospital.

Patients:

All patients who underwent arthroscopy of the knee for a sports-related injury by 2 surgeons were reviewed. Chief complaint, past medical/surgical history, medications, procedure performed, intraoperative findings, intraoperative complications, and postoperative recovery were reviewed. The incidences of postoperative VTE within 30 days after the procedure were reviewed.

Results:

Seven hundred forty-six (358 male and 388 female patients) knee arthroscopies performed from September 2011 to October 2016 by 2 pediatric orthopedic surgeons specializing in sports-related injuries were included. The average age was 15.2 ± 2.72 years. Five patients were suspected to have either DVT or PE postoperatively (0.67%). The overall incidence of symptomatic confirmed VTE after knee arthroscopic procedures was 0.27% (one DVT after a partial lateral meniscectomy and one PE after fixation of an osteochondral lesion).

Conclusions:

The incidence of VTE after pediatric sports medicine knee arthroscopies is low, 0.27%. Patients who present with calf swelling or pain, chest pain, or shortness of breath after arthroscopic surgery should be examined closely.

Level of Evidence:

Level III.
QT Corrections for Long QT Risk Assessment: Implications for the Preparticipation Examination
Authors: Hadley David , Hsu David , Pickham David , Drezner Jonathan A. , Froelicher Victor F.
Published: October 2017

Background:

Because sudden cardiac death (SCD) in the young mainly occurs in individuals with structurally normal hearts, improved screening techniques for detecting inherited arrhythmic diseases are needed. The QT interval is an important screening measurement; however, the criteria for detecting an abnormal QT interval are based on Bazett formula and older populations.

Objective:

To define the normal upper limits for QT interval from the electrocardiograms (ECGs) of healthy young individuals, compare the major correction formula and propose new QT interval thresholds for detecting those at risk of SCD.

Methods:

Young active individuals underwent ECGs as part of routine preparticipation physical examinations for competitive sports or community screening. This was a nonfunded study using de-identified data with no follow-up.

Results:

There were 31 558 subjects: 2174 grade school (7%), 18 547 high school (59%), and 10 822 college (34%). Mean age was 17 (12-35 years), 45% were female, 67% white, and 11% of African descent. Bazett performed least favorably for removing the effect of heart rate (HR), whereas Fridericia performed the best. Fridericia correction also closely fit the raw data best (R2 of 0.65), and at percentile values applicable to screening. The recommended risk cut points using Bazetts correction identified less than half of the athletes in the 99th or 99.5th percentiles of the uncorrected QT by HR range. Use of Fridericia correction increased capture rates by over 50%.

Conclusion:

Our results support the application of the Fridericia-corrected threshold of 460 for men and 470 milliseconds for women (and 485 milliseconds for marked prolongation) rather than Bazett correction for the preparticipation examination.
Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders
Authors: Gondolini Giorgio , Schiavi Paolo , Pogliacomi Francesco , Ceccarelli Francesco , Antonetti Tommaso , Zasa Michele
Published: October 2017

Objective:

To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years).

Design:

Case series. Level of evidence: IV.

Setting:

University Hospital/Private Practice.

Patients:

Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years.

Interventions:

A MOF to obtain decompression of all compartments was performed in all patients.

Main Outcome Measures:

Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation.

Results:

A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week.

Conclusions:

Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery.

Clinical Relevance:

Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.
The Relationship of Anxiety, Depression, and Quality of Life in Adults With Left Ventricular Assist Devices
Authors: Casida Jesus M. , Abshire Martha , Ghosh Bidisha , Yang James J.
Published: October 2017

Psychological distress, including anxiety and depression, is commonly reported by patients with implantable left ventricular assist devices (LVADs). Still, the influence of anxiety and depression on global quality of life (QOL) is unknown. Moreover, the empirical data of LVAD patients’ QOL is limited to 24 months. This study examined the differences in anxiety, depression, and QOL based on 3 LVAD implant duration groups (≤12, 13–24, and ≥25 months). We also examined the influence of anxiety and depression on QOL. An observational cross-sectional study design was employed using self-administered demographics, anxiety, depression, and global QOL questionnaires. A total of 100 patients (mean age 52 ± 13.3 years) across the United States completed the study. In the 3 implant duration groups, we found no significant differences in anxiety and depression, but the global QOL scores of patients with LVADs ≥ 13 months were significantly worse than those of patients with LVADs ≤ 12 months. Also, the correlations between QOL and either anxiety or depression were significant: Pearson’s r ranged from −0.44 to −0.65 with all p values <0.0001. Compared with anxiety, depression is a stronger predictor of QOL. Our data showed that when depression is increased by 1 unit, the average QOL decreased by 0.76 units, assuming anxiety is held constant. This study uncovered relationships among anxiety, depression, and QOL in patients with long-term LVADs. Longitudinal research is needed to confirm our findings and explore factors that may contribute to worse QOL, particularly, those patients supported with LVADs beyond 13 months.
Breath Hydrogen Testing in East and Southeast Asia
Authors: Yao Chu Kion , Chu Natural Hoi Sing , Tan Victoria Ping Yi
Published: October 2017

Breath hydrogen tests are popular, noninvasive tests for the assessment of carbohydrate fermentation in patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). There is limited information regarding the utility of breath hydrogen and methane tests in IBS and FD patients in East and Southeast Asia. This review aims to summarize current literature about common indications of breath testing in this region, the genesis of functional gastrointestinal symptoms by provocative breath testing and provide suggestions for correct use. The most common testing indication is the assessment of lactose intolerance, followed by small intestinal bacterial overgrowth (SIBO) and differentiation of intestinal gas profiles in research setting. Studies in this region not only documented a high prevalence of lactose malabsorption but a population, both healthy and IBS, that is highly symptomatic to typical lactose intakes. Breath hydrogen assessment of other fermentable carbohydrates (FODMAPs) are fairly uncommon, whereas methane breath testing is almost nonexistent. Cumulative hydrogen production following lactulose was also not excessive in IBS patients compared with controls. The evidence however, for the detection of SIBO suggests limited reliability in the use of lactulose or glucose breath testing alone and inconclusive data on its correlation with symptoms. Conversely, little has been carried out in FD. In conclusion, breath testing should be limited in the predicting patients with SIBO for directing clinical management but can be considered in the objective assessment of lactose malabsorption within a low FODMAP diet. Recommendations to improve the interpretation of breath testing in research were also provided.
New predictive factors of poor response to therapy in autoimmune hepatitis: role of mean platelet volume
Authors: Abdel-Razik Ahmed , Mousa Nasser , Zakaria Sahar , Elhelaly Rania , Elzehery Rasha , Zalata Khaled , Awad Mahmoud , Eldeeb Ahmed A. , Abdelsalam Mostafa
Published: October 2017

Background and objectives

The response to immunosuppressive therapy in autoimmune hepatitis (AIH) is a matter of debate. The aim of this work is to identify the histological, biochemical, and clinical predictive factors of incomplete response/treatment failure to the standard treatment (prednisone with or without azathioprine) in a well-characterized series of AIH Egyptian patients.

Patients and methods

Of 49 AIH patients, only 36 patients completed this retrospective cohort study. The immunological, biochemical, histopathological, and clinical characteristics of patients were evaluated at diagnosis and during follow-up.

Results

Patients were classified into two groups; group A showed a complete response to therapy (n=22; 61%) and group B showed partial response/treatment failure (n=14; 39%). In a multivariate analysis, we observed that age at diagnosis up to 22 years [odds ratio (OR): 23.22; confidence interval (CI): 3.978–135.549; P<0.001], serum albumin up to 3.2 g/dl (OR: 5.36; CI: 1.237–23.209; P=0.025), mean platelet volume (MPV) of at least 10.75 fl (OR: 16.5; CI: 3.093–88.037; P<0.001), and presence of cirrhosis at diagnosis (OR: 8.44; CI: 1.682–42.392; P=0.001) were independent variables that can predict partial response/treatment failure. MPV correlated positively with stages of fibrosis/cirrhosis and grades of activity in liver biopsy at diagnosis and correlated inversely with serum albumin and age at presentation. During therapy, group B showed a fluctuation in MPV levels, however, group A showed a progressive decline until the end point.

Conclusion

Our study confirmed that younger age, hypoalbuminemia, increased MPV, and cirrhosis at diagnosis were all independent predictors of incomplete response/treatment failure in AIH patients. MPV may reflect the response to therapy.