bluuebunny/crossref_metadata_2025 huggingface dataset:
From physiology to salt marsh management challenges with sea level rise: the case of native Spartina foliosa, invasive S. densiflora and their hybrid
Authors: Gallego-Tévar Blanca , Peinado-Torrubia Procopio , Álvarez Rosario , Grewell Brenda J , Castillo Jesús M
Published: May 2020

Sea level rise (SLR) imposes increasing salinity and inundation stresses in salt marshes which simultaneously face invasions by exotic plant species. We aimed to improve and apply knowledge on the ecophysiological responses of halophytes to SLR to conservation management of salt marshes. In a mesocosm experiment, we measured and compared phosphoenolpyruvate carboxylase (PEPC) activity and related functional traits of the California-native Spartina foliosa, invasive S. densiflora and their hybrid S. densiflora × foliosa in response to increasing levels of salinity and inundation. S. foliosa was moderately sensitive to salinity, showing a 57% reduction in PEPC specific activity from freshwater to hypersalinity. This native species compensated for the reduction of PEPC activity with increased salinity through 80% higher enzyme activation by phosphorylation. PEPC functional trait responses of S. foliosa were mostly independent of inundation depth. In view of these results, managers should conserve undeveloped lands for accommodation space above current high tide lines to facilitate colonization of stress-tolerant S. foliosa. Our results on functional responses of PEPC traits recorded high sensitivity to salinity for S. densiflora. This was reflected by 65% lower PEPC specific activity together with increasing accumulation of free proline (+96%) and total proteins (+23%) with elevated salinity. These results suggest prioritized eradication of S. densiflora populations in brackish habitats. Measured PEPC responses support the high stress tolerance of the S. densiflora × foliosa hybrid. PEPC traits for the hybrid were mostly independent of salinity and inundation. The hybrid showed higher PEPC-specific activity than S. foliosa (+70%) and S. densiflora (+15%) in freshwater under intermediate inundation. Results suggest that eradication of the hybrid should be the highest management priority. Our study shows that the responses of key functional physiological traits to environmental stresses serve as biological indicators that can guide ecosystem management practices in a scenario of climate change.
Genome-wide association studies of cardiac electrical phenotypes
Authors: Glinge Charlotte , Lahrouchi Najim , Jabbari Reza , Tfelt-Hansen Jacob , Bezzina Connie R
Published: May 2020

The genetic basis of cardiac electrical phenotypes has in the last 25 years been the subject of intense investigation. While in the first years, such efforts were dominated by the study of familial arrhythmia syndromes, in recent years, large consortia of investigators have successfully pursued genome-wide association studies (GWAS) for the identification of single-nucleotide polymorphisms that govern inter-individual variability in electrocardiographic parameters in the general population. We here provide a review of GWAS conducted on cardiac electrical phenotypes in the last 14 years and discuss the implications of these discoveries for our understanding of the genetic basis of disease susceptibility and variability in disease severity. Furthermore, we review functional follow-up studies that have been conducted on GWAS loci associated with cardiac electrical phenotypes and highlight the challenges and opportunities offered by such studies.
COVID-19: from epidemiology to treatment
Authors: Pericàs J M , Hernandez-Meneses M , Sheahan T P , Quintana E , Ambrosioni J , Sandoval E , Falces C , Marcos M A , Tuset M , Vilella A , Moreno A , Miro J M ,   Hospital Clínic Cardiovascular Infections Study Group, Miró Jose M , Ambrosioni Juan , Pericàs Juan M , Téllez Adrian , Hernandez-Meneses Marta , Garcia-Pares Delia , Moreno Asunción , de la Maria Cristina Garcia , Dahl Anders , Garcia-González Javier , Cañas-Pacheco María-Alejandra , Almela Manel , Casals Climent , Marco Francesc , Vila Jordi , Quintana Eduard , Sandoval Elena , Falces Carlos , Andrea Ruth , Pereda Daniel , Azqueta Manel , Castel Maria Angeles , Garcia Ana , Sitges Marta , Farrero Marta , Vidal Barbara , Pérez-Villa Felix , Pomar José L , Castella Manuel , Tolosana José M , Ortiz José , Fita Guillermina , Rovira Irene , Perissinotti Andrés , Fuster David , Ramírez Jose , Brunet Mercè , Soy Dolors , Castro Pedro , Llopis Jaume
Published: May 2020

The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an overview of COVID-19 and focuses on relevant aspects on prevention and management for specialists within the cardiovascular field.
Genome Assembly of the Ragweed Leaf Beetle: A Step Forward to Better Predict Rapid Evolution of a Weed Biocontrol Agent to Environmental Novelties
Authors: Bouchemousse Sarah , Falquet Laurent , Müller-Schärer Heinz
Published: May 2020

Rapid evolution of weed biological control agents (BCAs) to new biotic and abiotic conditions is poorly understood and so far only little considered both in pre-release and post-release studies, despite potential major negative or positive implications for risks of nontargeted attacks or for colonizing yet unsuitable habitats, respectively. Provision of genetic resources, such as assembled and annotated genomes, is essential to assess potential adaptive processes by identifying underlying genetic mechanisms. Here, we provide the first sequenced genome of a phytophagous insect used as a BCA, that is, the leaf beetle Ophraella communa, a promising BCA of common ragweed, recently and accidentally introduced into Europe. A total 33.98 Gb of raw DNA sequences, representing ∼43-fold coverage, were obtained using the PacBio SMRT-Cell sequencing approach. Among the five different assemblers tested, the SMARTdenovo assembly displaying the best scores was then corrected with Illumina short reads. A final genome of 774 Mb containing 7,003 scaffolds was obtained. The reliability of the final assembly was then assessed by benchmarking universal single-copy orthologous genes (>96.0% of the 1,658 expected insect genes) and by remapping tests of Illumina short reads (average of 98.6 ± 0.7% without filtering). The number of protein-coding genes of 75,642, representing 82% of the published antennal transcriptome, and the phylogenetic analyses based on 825 orthologous genes placing O. communa in the monophyletic group of Chrysomelidae, confirm the relevance of our genome assembly. Overall, the genome provides a valuable resource for studying potential risks and benefits of this BCA facing environmental novelties.
Processing seismic ambient noise data with the continuous wavelet transform to obtain reliable empirical Green's functions
Authors: Yang Yang , Liu Chunyu , Langston Charles A
Published: May 2020

Obtaining reliable empirical Green's functions (EGFs) from ambient noise by seismic interferometry requires homogeneously distributed noise sources. However, it is difficult to attain this condition since ambient noise data usually contain highly correlated signals from earthquakes or other transient sources from human activities. Removing these transient signals is one of the most essential steps in the whole data processing flow to obtain EGFs. We propose to use a denoising method based on the continuous wavelet transform to achieve this goal. The noise level is estimated in the wavelet domain for each scale by determining the 99 per cent confidence level of the empirical probability density function of the noise wavelet coefficients. The correlated signals are then removed by an efficient soft thresholding method. The same denoising algorithm is also applied to remove the noise in the final stacked cross-correlogram. A complete data processing workflow is provided with the overall data processing procedure divided into four stages: (1) single station data preparation, (2) removal of earthquakes and other transient signals in the seismic record, (3) spectrum whitening, cross-correlation and temporal stacking and (4) remove the noise in the stacked cross-correlogram to deliver the final EGF. The whole process is automated to make it accessible for large data sets. Synthetic data constructed with a recorded earthquake and recorded ambient noise is used to test the denoising method. We then apply the new processing workflow to data recorded by the USArray Transportable Array stations near the New Madrid Seismic Zone where many seismic events and transient signals are observed. We compare the EGFs calculated from our workflow with commonly used time domain normalization method and our results show improved signal-to-noise ratios. The new workflow can deliver reliable EGFs for further studies.
A qualitative investigation of school age children, their parents and school staff on their participation in the Digital Education to LImit Salt in the Home (DELISH) program
Authors: Bouterakos M , Booth A , Khokhar D , West M , Margerison C , Campbell K J , Nowson C A , Grimes C A
Published: May 2020

This study explored the views of participants who completed a 5-week, online, interactive, family-based, salt reduction education program (Digital Education to LImit Salt in the Home). A secondary aim was to explore the views of school staff on the delivery of food and nutrition education in schools. Children aged 7–10 years, their parents and principals/teachers from participating schools located in Victoria, Australia, completed a semi-structured evaluation interview. Audio-recordings of interviews were transcribed verbatim and analysed using NVivo. Twenty-eight interviews (13 children; 11 parents; 4 school staff) were included. Thematic analysis revealed that the program was well received by all groups. Children reported that the interactivity of the education sessions helped them to learn. Parents thought the program was interesting and important, and reported learning skills to reduce salt in the family diet. School staff supported the delivery of nutrition education in schools but indicated difficulties in sourcing well-packed nutrition resources aligned with the curriculum. It appears that there is support from parents and teachers in the delivery of innovative, engaging, nutrition education in schools, however such programs need to be of high quality, aligned with the school curriculum and readily available for incorporation within the school’s teaching program.
Lincolnshire and the third crusade: the list of crusaders from the deanery of Holland*
Authors: Bass Ian L
Published: May 2020

Two lists of crusaders, dating from 1196 to 1201, survive in Canterbury Cathedral Archives. This article examines the list of Lincolnshire crusaders and the conduct of the inquiry established to discover those backsliding on their vows. Particular attention is paid to the palaeography and dating of the list, and the context in which it was compiled, thus providing a new appraisal of its contents. Based on the testimonies, the article concludes that the list was compiled in the 1196 inquiry. To provide wider access to the document, a new diplomatic transcription is included along with English translation and historical notes.
Endoscopic Activity and Serum TNF-α Level at Baseline Are Associated With Clinical Response to Ustekinumab in Crohn’s Disease Patients
Authors: Murate Kentaro , Maeda Keiko , Nakamura Masanao , Sugiyama Daisuke , Wada Hirotaka , Yamamura Takeshi , Sawada Tsunaki , Mizutani Yasuyuki , Ishikawa Takuya , Furukawa Kazuhiro , Ohno Eizaburo , Honda Takashi , Kawashima Hiroki , Miyahara Ryoji , Ishigami Masatoshi , Nishikawa Hiroyoshi , Fujishiro Mitsuhiro
Published: May 2020

Background and Aims

The therapeutic efficacy and safety of ustekinumab for Crohn’s disease (CD) have been reported from randomized controlled trials and real-world data. However, there are few studies describing the identification of patients most suitable for ustekinumab therapy. The aim of this study was to prospectively evaluate the patients receiving ustekinumab and identify predictors of the treatment efficacy.

Methods

Patients with moderate to severe active CD scheduled to receive ustekinumab were enrolled. The responders and nonresponders were compared at weeks 0, 8, 24, and 48 by evaluating patient demographics, simple endoscopic scores (SES-CD), ustekinumab and cytokine concentrations, and cellular fractions.

Results

The clinical response and clinical remission rates in the 22 enrolled patients were 59.1% and 31. 8% at week 8, 68.2% and 45.5% at week 24, and 54.4% and 40.9% at week 48, respectively. There were no significant differences in patients’ demographic and disease characteristics at baseline between responders and nonresponders. A combination of low SES-CD and high serum TNF-α concentration at baseline showed a good correlation with the clinical response. Serum TNF-α concentration was decreased because of the therapy. The ratio of CD4+TNF-α cells at baseline was significantly higher in responders than in nonresponders; however, the ratios of CD45+CD11b+TNF-α and CD45+CD11c+TNF-α cells were not different. The ratio of CD4+ TNF-α cells decreased with the treatment in the responders but not in the nonresponders.

Conclusions

The combination of 2 factors, namely higher serum TNF-α concentration and lower SES-CD at baseline, may assist clinicians in selecting the appropriate therapy for patients with moderate to severe CD.
Optimal power distribution method for energy storage system based on available capacity
Authors: Gege Liu
Published: May 2020

In order to eliminate the difference of the state of charge (SOC) among parallel battery energy storage systems, an optimization method of power distribution based on available capacity is proposed in this paper. The objective function and constraints are established to realize the optimal power allocation of battery energy storage and to improve the stability of the energy storage system. The simulation and experimental results are presented. The results have proved the corrective and effective of the method.
Correlations Among mRNA Expression Levels of ATP7A, Serum Ceruloplasmin Levels, and Neuronal Metabolism in Unmedicated Major Depressive Disorder
Authors: Liu Xuanjun , Zhong Shuming , Yan Lan , Zhao Hui , Wang Ying , Hu Yilei , Jia Yanbin
Published: May 2020

Background

Previous studies have found that elevated copper levels induce oxidation, which correlates with the occurrence of major depressive disorder (MDD). However, the mechanism of abnormal cerebral metabolism of MDD patients remains ambiguous. The main function of the enzyme ATPase copper-transporting alpha (ATP7A) is to transport copper across the membrane to retain copper homeostasis, which is closely associated with the onset of mental disorders and cognitive impairment. However, less is known regarding the association of ATP7A expression in MDD patients.

Methods

A total of 31 MDD patients and 21 healthy controls were recruited in the present study. Proton magnetic resonance spectroscopy was used to assess the concentration levels of N-acetylaspartate, choline (Cho), and creatine (Cr) in brain regions of interest, including prefrontal white matter (PWM), anterior cingulate cortex (ACC), thalamus, lentiform nucleus, and cerebellum. The mRNA expression levels of ATP7A were measured using polymerase chain reaction (SYBR Green method). The correlations between mRNA expression levels of ATP7A and/or ceruloplasmin levels and neuronal biochemical metabolite ratio in the brain regions of interest were evaluated.

Results

The decline in the mRNA expression levels of ATP7A and the increase in ceruloplasmin levels exhibited a significant correlation in MDD patients. In addition, negative correlations were noted between the decline in mRNA expression levels of ATP7A and the increased Cho/Cr ratios of the left PWM, right PWM, and right ACC in MDD patients. A positive correlation between elevated ceruloplasmin levels and increased Cho/Cr ratio of the left PWM was noted in MDD patients.

Conclusions

The findings suggested that the decline in the mRNA expression levels of ATP7A and the elevated ceruloplasmin levels induced oxidation that led to the disturbance of neuronal metabolism in the brain, which played important roles in the pathophysiology of MDD. The decline in the mRNA expression levels of ATP7A and the elevated ceruloplasmin levels affected neuronal membrane metabolic impairment in the left PWM, right PWM, and right ACC of MDD patients.
The Influence of Feed and Drinking Water on Terrestrial Animal Research and Study Replicability
Authors: Kurtz David M , Feeney William P
Published: May 2020

For more than 50 years, the research community has made strides to better determine the nutrient requirements for many common laboratory animal species. This work has resulted in high-quality animal feeds that can optimize growth, maintenance, and reproduction in most species. We have a much better understanding of the role that individual nutrients play in physiological responses. Today, diet is often considered as an independent variable in experimental design, and specialized diet formulations for experimental purposes are widely used. In contrast, drinking water provided to laboratory animals has rarely been a consideration in experimental design except in studies of specific water-borne microbial or chemical contaminants. As we advance in the precision of scientific measurements, we are constantly discovering previously unrecognized sources of experimental variability. This is the nature of science. However, science is suffering from a lack of experimental reproducibility or replicability that undermines public trust. The issue of reproducibility/replicability is especially sensitive when laboratory animals are involved since we have the ethical responsibility to assure that laboratory animals are used wisely. One way to reduce problems with reproducibility/replicability is to have a strong understanding of potential sources of inherent variability in the system under study and to provide “…a clear, specific, and complete description of how the reported results were reached [1].” A primary intent of this review is to provide the reader with a high-level overview of some basic elements of laboratory animal nutrition, methods used in the manufacturing of feeds, sources of drinking water, and general methods of water purification. The goal is to provide background on contemporary issues regarding how diet and drinking water might serve as a source of extrinsic variability that can impact animal health, study design, and experimental outcomes and provide suggestions on how to mitigate these effects.
HIV-DNA undetectability during chronic HIV infection: frequency and predictive factors
Authors: Nozza Silvia , Galli Laura , Gianotti Nicola , Parisi Mariarita , Poli Andrea , Cinque Paola , Spagnuolo Vincenzo , Bruzzesi Elena , Mastrangelo Andrea , Castagna Antonella
Published: May 2020

Background

HIV-DNA is a marker of HIV reservoirs. Objectives of the study were to determine prevalence of HIV-DNA < 100 copies/106 PBMCs in blood and to identify factors associated with this in a cohort of HIV-1-infected subjects treated with ART and with undetectable viral load (VL).

Methods

This was a cross-sectional study on chronic HIV-1-infected people living with HIV (PLWH) followed up at the Department of Infectious Diseases of San Raffaele Scientific Institute on current ART without change for 12 months, with available pre-ART HIV-RNA and with undetectable VL for ≥12 months. HIV-DNA was amplified and quantified by real-time PCR (ABI Prism 7900); limit of detectability was 100 copies/106 PBMCs. Logistic regression was used to identify predictive factors for HIV-DNA < 100 copies/106 PBMCs.

Results

Four hundred and sixty-eight PLWH were considered in the analyses, 119 (25%) with HIV-DNA < 100 copies/106 PBMCs. At multivariate analysis, we found that PLWH with lower zenith HIV-RNA, higher nadir CD4 and a shorter time between HIV diagnosis and ART start were more likely to have HIV-DNA < 100 copies/106 PBMCs, after adjustment for age, gender, calendar year of ART start, type of current ART regimen, percentage time spent with undetectable VL since ART start, current CD4 and CD4/CD8 ratio.

Conclusions

In our chronic PLWH on virological suppression for 4 years, the prevalence of HIV-DNA < 100  copies/106 PBMCs was found to be 25%. Lower zenith HIV-RNA, shorter time between HIV diagnosis and starting ART and higher CD4 nadir were independently associated with low HIV-DNA.
Influence of Sorghum Cultivar, Nitrogen Fertilization, and Insecticides on Infestations of the Sugarcane Aphid (Hemiptera: Aphididae) in the Southern United States
Authors: Wilson B E , Reay-Jones F P F , Lama L , Mulcahy M , Reagan T E , Davis J A , Yang Y , Wilson L T
Published: May 2020

The sugarcane aphid, Melanaphis sacchari Zehntner, is an economically damaging pest of sorghum, Sorghum bicolor (L.), across the southern United States. Field experiments investigated impacts of sorghum cultivar, nitrogen fertilization, and insecticides on M. sacchari infestations and sorghum yields in Louisiana and South Carolina in 2017 and 2018. In South Carolina, M. sacchari densities in unprotected plots peaked on 30–31 July of both years before declining by early- to mid-August. In Louisiana, infestations peaked on 26 and 12 July for 2017 and 2018, respectively, and declined by mid-August. Nitrogen fertilization influenced M. sacchari densities in Louisiana in 2018 with the highest-level infestations recorded from plots that received high N rates. Densities of M. sacchari on susceptible sorghum cultivar, DKS 38-88, were 1.5- to 2.3-fold greater than on DKS 37-07 in both years in Louisiana and in 2018 in South Carolina. Nitrogen fertilization was associated with improved sorghum yields in Louisiana experiments. Sorghum yields across experiments were 2- to 4-fold greater in plots protected with multiple insecticide applications than in unprotected plots. Yield from plots with insecticides sprayed once at currently used action thresholds differed from unprotected plots only in the 2018 Louisiana experiment. Results from these experiments indicate insecticidal protection of susceptible sorghum cultivars remains critical throughout much of the southern United States. Further research is needed to develop integrated management programs that incorporate fertilization manipulation, cultivar resistance, and insecticidal control.
Research ethics in a pandemic: considerations for the use of research infrastructure and resources for public health activities
Authors: Doerr Megan , Wagner Jennifer K
Published: May 2020

The number and size of existing research studies with massive databases and biosample repositories that could be leveraged for public health response against SARS-CoV-2 (or other infectious disease pathogens) are unparalleled in history. What risks are posed by coopting research infrastructure—not just data and samples but also participant recruitment and contact networks, communications, and coordination functions—for public health activities? The case of the Seattle Flu Study highlights the general challenges associated with utilizing research infrastructure for public health response, including the legal and ethical considerations for research data use, the return of the results of public health activities relying upon research resources to unwitting research participants, and the possible impacts of public health reporting mandates on future research participation. While research, including public health research, is essential during a pandemic, careful consideration should be given to distinguishing and balancing the ethical mandates of public health activities against the existing ethical responsibilities of biomedical researchers.
Mental Health Trajectories of Fathers Following Very Preterm Birth: Associations With Parenting
Authors: McMahon Grace E , Anderson Peter J , Giallo Rebecca , Pace Carmen C , Cheong Jeanie L , Doyle Lex W , Spittle Alicia J , Spencer-Smith Megan M , Treyvaud Karli
Published: May 2020

Objective

Mothers of infants born very preterm (VPT) are at high risk of mental health difficulties. However, less is known about the course of fathers’ depressive and anxiety symptoms over time, and the implications this may have for early parenting behaviors.

Methods

In total, 100 fathers of 125 infants born VPT (<30 weeks’ gestation) completed questionnaires assessing depressive and anxiety symptoms shortly after their infant’s birth, and when their infant reached term-equivalent age, 3 months, 6 months, and 12 months’ corrected age. At 12 months’ corrected age, fathers’ parenting behaviors were assessed using the Emotional Availability Scales. Longitudinal latent class analysis was used to identify trajectories of fathers’ depressive and anxiety symptoms, and linear regression equations examined relationships between these trajectories and fathers’ parenting behaviors.

Results

For both depressive and anxiety symptoms, two distinct trajectories were identified. For depression, most fathers were assigned to the persistently low symptom trajectory (82%), while the remainder were assigned to the persistently high symptom trajectory (18%). For anxiety, 49% of fathers were assigned to the persistently low symptom trajectory, while 51% were assigned to the trajectory characterized by moderate symptoms over the first postnatal year. There were no significant differences in parenting behaviors between fathers assigned to the different depressive and anxiety symptom trajectories.

Conclusions

Fathers of infants born VPT are at risk of chronic depressive and anxiety symptoms over the first postnatal year, highlighting the need for screening and ongoing support.
Pancreatic neuroendocrine tumor featuring growth into the main pancreatic duct and tumor thrombus within the splenic vein: a case report
Authors: Miyata Takashi , Takamura Hiroyuki , Kin Ryosuke , Nishiki Hisashi , Hashimoto Akifumi , Fujii Yoritaka , Miura Seiko , Fujita Jun , Kaida Daisuke , Tomita Yasuto , Nakamura Naohiko , Fujita Hideto , Kinami Shinichi , Ueda Nobuhiko , Kosaka Takeo
Published: May 2020

A 48-year-old woman was admitted to our hospital because of upper abdominal pain. Computer tomography showed an enhancing mass in the pancreatic body, dilation of the main pancreatic duct (MPD) and a filling defect within the splenic vein. On the basis of the preoperative diagnosis of pancreatic body cancer, distal pancreatectomy was scheduled. The pancreas was divided along the left edge of the gastroduodenal artery; however, frozen pathological examination of the pancreatic stump was tumor positive, and therefore a total pancreatectomy was performed. The lesion was a white expansive nodular mass that had spread into the MPD and protruded into the splenic vein. A pathological diagnosis of non-functioning neuroendocrine tumor (NET) was made. In general, imaging findings of disruption of the MPD and tumor vein thrombus are characteristics of pancreatic ductal adenocarcinoma, but are uncommon in NET. However, NET should be included in the differential diagnosis for such patients.
“Send Me the Pictures”: Patient Confidentiality in a Digital World
Authors: Marco Catherine A.
Published: May 2020

Emergency physicians have a duty to protect patient confidentiality, within the constraints of the law. It is an ethical and legal duty and serves to maintain patient trust and protects patients’ relationships, employment, and personal desire for confidentiality of medical information. There are specific circumstances where confidentiality should appropriately be breached, including judicial proceedings, public reporting statutes, and in cases where patients or other parties are endangered. Emergency physicians should avoid using social media for posting patient information, including de-identified images and comments. Transmission of patient information may be performed over secure electronic servers, for the purposes of patient treatment, with the patient’s consent. Protected health information may be appropriately used for educational purposes.
Assessment of Decision-Making Capacity
Authors: Iserson Kenneth V.
Published: May 2020

Decision-making capacity (rather than “competence,” a legal term) is the ability to make decisions about one’s own medical care. Having decision-making capacity rests on the patient’s understanding their healthcare options and choosing an option consistent with their stable value system. Capacity is decision relative, meaning that the criteria to have decisional capacity depend on the complexity of the decision and the seriousness of possible outcomes. Individuals can have fluctuating decision-making capacity.
Hide and Seek
Authors: Grover Purva
Published: May 2020

The system of mandatory reporting was created in response to a growing recognition of devastation that child abuse was causing in the United States. All states designate people in certain professions as “mandated reporters.” This has led to discussion regarding unintended consequences or negative effects of mandatory reporting. What are our obligations toward adult patients who confide that they were abused as a child but are unsure if they want to report this now? Are we still the mandated reporters? How does patient autonomy factor into this? These laws and statutes are complex, and our legal obligations must be weighed against various ethical and practical considerations.
No Country for Sick Men
Authors: Gorgas Diane L. , Li-Sauerwine Simiao
Published: May 2020

Caring for undocumented immigrants in the emergency setting brings legal and ethical challenges. This chapter discusses the spectrum of these challenges, including duty to report to immigration authorities, the restrictions placed by the Health Insurance Portability and Accountability Act (HIPAA) on ability to report, and the ethical perspective on duty to provide compassionate care for undocumented persons. Providing emergency care is mandated under the Emergency Medical Treatment and Active Labor Act (EMTALA), but coordinating care for chronic medical conditions requiring high-resource treatments may fall under the venue of emergency medicine. This chapter reviews strategies for providing chronic treatment of end-stage renal disease (ESRD) among undocumented persons, and discusses the legal and ethical questions involving this patient population.
Everyday J.
Authors: Kraus Chadd K.
Published: May 2020

Commonly defined as having greater than four emergency department (ED) visits in a year, patients who are frequent users of the ED make up an estimated 3.5% to 10% of all ED visits and have been reported to account for nearly a third of all ED use. Frequent ED users have higher mortality, higher hospital admission rates, and higher use of all health care services, both specialty and primary care, compared to other patients using the ED. These patients should have the autonomy to access ED evaluation and care if he or she believes he or she has a medical emergency. This principle has been codified into both federal and many state laws protecting the “prudent layperson standard.” These patients should not be coerced to not seek ED care if the person believes he or she has an emergent condition.
Risky Behavior
Authors: Marco Catherine A.
Published: May 2020

Patients may present to the emergency department (ED) for various complaints and requests related to risky sexual behavior. Such concerns may include pregnancy or infectious disease transmission, including urethritis, cervicitis, HIV, hepatitis, or others. Emergency physicians should test for pregnancy and infectious diseases, treat empirically for appropriate patients, and refer patients for counseling to reduce risky sexual behavior. Following a significant potential HIV exposure, postexposure prophylaxis (PEP) should be considered. The decision to administer PEP should be based on shared decision-making with the patient and should include assessment of the risk of the exposure and HIV status of the source patient. If the HIV status of the source patient is unknown, the source should be tested following informed consent and counseling. Patients should be referred to outpatient follow-up, including primary care, infectious disease, and if indicated, social services.
Introduction and Overview
Authors: Strakowski Stephen M.
Published: May 2020

Bipolar disorder is a common psychiatric condition that is one of the leading causes of disability worldwide. As a dynamic, recurrent, and chronic illness, it can be complex to identify and manage. In this Primer on text, leading international authors explore aspects of clinical presentation epidemiology, etiology, neurobiology, and treatment of bipolar disorder. The text provides a readable but comprehensive overview of this common illness. The book has been organized into three major sections describing different aspects of bipolar disorder: Clinical Presentation and Epidemiology; Etiology and Neurobiology; and Treatment. This organization is not intended to imply that these various components are truly distinct but rather allows readers to quickly locate specific areas of interest. Treating bipolar disorder is challenging but is ultimately rewarding because good care can make it possible for these individuals to succeed in all aspects of life.
Course of Bipolar Disorders
Authors: Duran Luis R. Patino , DelBello Melissa P.
Published: May 2020

Bipolar disorder is a lifelong condition in most individuals, with a complex and dynamic course of illness that consists of recurrent affective episodes complicated by other psychiatric and behavioral symptoms. Before illness onset, at-risk individuals demonstrate nonspecific psychiatric symptoms that evolve into, usually, depressive episodes and ultimately mania or hypomania during adolescence. Recovery after a first manic episode is typical, but recurrences are common, and with more episodes, the risk for recurrences increases. A number of clinical factors are associated with recurrences, including co-occurring psychiatric and medical problems. Suicide is a major concern in the course of illness, so understanding risk factors may help mollify the likelihood of this outcome. Similarly, cardiovascular disease rates are elevated and associated with premature death. This chapter provides a review of the factors affecting and associated with bipolar disorder across the life span.
Cognitive Behavioral Models of Emotional Dysregulation in Bipolar Disorder
Authors: Fleck David E. , Nery Fabiano G. , Adler Caleb M.
Published: May 2020

This chapter provides a characterization of cognitive impairment in bipolar disorder and how emotions affect cognition and lead to cognitive biases. The Behavioral Approach System and Interactive Cognitive Model of bipolar disorder are reviewed, along with the newer Interactive Influence Model of Emotion and Cognition, which holds promise in future applications to mood disorders. These models provide a framework for the development and expansion of neurobiological models and psychotherapeutic interventions for bipolar disorder. The authors conclude by noting that, while models of bipolar disorder still need to be expanded to account for cognitive and behavioral influences beyond simple correlations with symptom outcomes, their importance is clearly demonstrated in the development of cognitive behavioral therapies, cognitive remediation therapies, and mindfulness-based cognitive therapies for bipolar disorder. The ability to test the efficacy of these, and other, cognitive behavioral therapeutics in controlled trials based on the predictions of well-characterized models of bipolar disorder will undoubtedly lead to advances in patient care.
Integrative Medicine and Lifestyle Management in the Treatment of Bipolar Disorder
Authors: Salem Taban , Fristad Mary A.
Published: May 2020

The circadian disruption associated with bipolar disorder and the success of social rhythm therapies in ameliorating distress and improving functioning make it clear that “healthy habits”—sufficient sleep, nutritious eating, and plentiful exercise—are important components of successful outcomes for persons with bipolar spectrum disorders. Additionally, evidence for the benefits of nutritional interventions and phototherapy is growing. Finally, mood charting and other self-help strategies are increasingly recognized as important components of recovery. Given that 20 to 50% of adults with bipolar disorder use some form of nonconventional therapy, it is important for mental health providers of all disciplines to be familiar with the literature in this area. This chapter provides an overview of integrative interventions and reviews evidence supporting their use.
The economic benefits of rehabilitation for neurological conditions
Authors: O’Connor Rory J.
Published: May 2020

Rehabilitation programmes are highly cost-effective interventions that restore people’s independence, dignity, and quality of life. In the past there was an impression that they appeared expensive, which resulted in a lack of enthusiasm to develop them by funding bodies and commissioners. However, the evidence demonstrating the long-term cost-effectiveness of rehabilitation is robust. Many people with long-term neurological conditions will live for many years after the onset of the condition and investment in their physical and psychological functioning early on will, over that person’s lifetime, will result in substantial savings. Nevertheless, calculating economic evaluations can be complicated and the correct measure must be chosen to identify the change produced by the rehabilitation intervention. These data must then be handled appropriately, and any ancillary costs included. The economic impact of the rehabilitation programme is wider than a purely healthcare intervention and will include potential earnings and reduced costs to social care. The economic analyses will also include housing, education, and vocational outcomes, and the effect of the long-term condition on family members who may have a caring role.
Spinal neuronal dysfunction after deprivation of supraspinal input
Authors: Hubli Michèle , Dietz Volker
Published: May 2020

A central nervous system lesion can lead to remote structural and functional changes which may limit functional recovery. For example, after a spinal cord injury (SCI) structural and functional alterations of spinal neuronal networks take place: in the first weeks after an SCI, neither locomotor nor spinal reflex (SR) activity can be evoked. Once spinal shock has resolved, an early SR component can be re-evoked and locomotor electromyography (EMG) activity re-appears when appropriate proprioceptive input is provided. In a more chronic stage of SCI alterations in SR components are accompanied by a decline of EMG amplitude in the leg muscles during assisted locomotion. According to rodent experiments it is assumed that the deprivation of supraspinal input and the lack of meaningful proprioceptive input to spinal neuronal networks account for such alterations. A critical combination of sensory cues through physiological training strategies might prevent the development of an undirected neural plasticity.
Secondary changes after damage of the central nervous system Significance of spastic muscle tone in rehabilitation
Authors: Dietz Volker , Sinkjaer Thomas
Published: May 2020

The relationship between clinical spasticity and spastic movement disorder in human adults is covered in this chapter. Exaggerated tendon tap reflexes associated with muscle hypertonia are the clinical signs of central nervous system lesions. Therefore, most antispastic treatments are directed at the reduction of reflex activity. However, a discrepancy exists between spasticity as measured in the clinic and movement disorder. Central motor lesions are associated with a loss of supraspinal drive and defective use of afferent input. These changes lead to paresis and maladaptation of the movement pattern. Secondary changes in mechanical muscle fibre and collagen tissue result in spastic muscle tone, which in part compensates for paresis and allows functional movements on a simpler level of organization. In mobile patients, functional training should be applied to improve both function and spasticity. Antispastic drugs can accentuate paresis and should primarily only be applied in non-ambulatory subjects.
Stem cell application in neurorehabilitation
Authors: Jessberger Sebastian , Curt Armin , Barker Roger A.
Published: May 2020

A number of diseases of the brain and spinal cord are associated with substantial neural cell death and/or disruption of correct and functional neural networks. In the past, a variety of therapeutic strategies to rescue these systems have been proposed along with agents to induce functional plasticity within the remaining central nervous system (CNS) structures. In the case of injury or neurodegenerative disease these approaches have only met with limited success, indicating the need for novel approaches to treat diseases of the adult CNS. Recently, the idea of recruiting endogenous or transplanting stem cells to replace lost structures within the adult brain or spinal cord has gained significant attention, along with in situ reprogramming, and opened up novel therapeutic avenues in the context of regenerative medicine. Here we review recent advances in our understanding of how endogenous stem cells may be a part of pathological processes in certain neuropsychiatric diseases and summarize recent clinical and preclinical data suggesting that stem cell-based therapies hold great promise as a future treatment option in a number of diseases disrupting the proper function of the adult CNS.
Self-management strategies in neurorehabilitation
Authors: Jones Fiona , Demain Sara
Published: May 2020

This chapter examines self-management in a way that introduces evidence, ideas, and concepts which illustrate the benefits of a personalized collaborative approach to neurorehabilitation. It reviews constructions of self-management from the chronic disease literature and the relevance to neurology and overlapping methods such as shared decision-making, health coaching, and motivational interviewing. It also reviews the benefits of integrating key self-management strategies into clinical encounters and current methods of measuring outcomes. It has been written for any healthcare professional who seeks to understand how to support and enable self-management within neurorehabilitation.
Recognition and management of functional symptoms after traumatic brain injury
Authors: Ricciardi Lucia , Carson Alan J. , Edwards Mark J.
Published: May 2020

Traumatic brain injury (TBI) is a common and disabling disorder. Most TBIs are ‘mild’, but in such patients a small proportion of people develop persistent, sometimes severe, symptoms. Here we present evidence that at least a proportion of these people, often labelled as having ‘post-concussion syndrome’, in fact have a functional neurological disorder. Psychiatric (e.g. anxiety, depression) and medical (migraine, side effects of medication) comorbidities are common and can complicate the clinical picture in such patients. Symptoms relating to an actual TBI and functional symptoms can also co-occur, a situation usually described as ‘functional overlay’. This chapter discusses the diagnosis and management of this common clinical scenario.
Technology to enhance locomotor function
Authors: Rupp Rüdiger , Schließmann Daniel , Schuld Christian , Weidner Norbert
Published: May 2020

Technology plays an important role in the rehabilitation of patients with impairments of the lower extremity due to disease or trauma of the central nervous system (CNS). In gait rehabilitation, compensatory or restorative strategies are applied depending on the time after trauma and the severity of impairment. Advances in the understanding of CNS plasticity led to the establishment of task-oriented restorative therapies, first of all body weight supported treadmill training, either manually or robotically assisted. Although robotic therapies have not been shown to be superior, they relieve therapists from the exhaustive work of assisting the stepping movements. At this point, locomotion robots provide advanced therapeutic options like intensive gait training also at home and improvement of training quality through the integration of real-time movement feedback. For enhancement of mobility in individuals with severe sensorimotor impairments and the associated limited potential for recovery, compensatory strategies including wheelchairs and more recently active exoskeletons need to be considered. It will be exciting to see whether technological progress in mechatronics, energy storage, and intuitive control will result in exoskeletons capable of replacing traditional walking aids in everyday life conditions.
The principles of a national diabetic eye screening programme
Authors: Galsworthy Paul
Published: May 2020

Screening identifies apparently healthy people who may be at increased risk of a disease or condition, enabling earlier treatment or better-informed decisions. The NHS diabetic eye screening (DES) programme is one of the young person and adult NHS population screening programmes in the UK. The UK National Screening Committee (UK NSC), which makes independent, evidence-based recommendations to ministers in the four UK nations about the 11 population-based screening programmes. Public Health England (PHE)—Screening Quality Assurance Service (SQAS) ensures programmes are safe and effective by ensuring national standards are met.
Ophthalmic treatment of diabetic retinopathy
Authors: Sivaraj Ramesh R. , Gibson Jonathan M.
Published: May 2020

The ophthalmic treatment of diabetic retinopathy is aimed at preserving vision and requires an interdisciplinary approach. The main treatments used for proliferative retinopathy and diabetic maculopathy include laser photocoagulation, intra-vitreal, and peri-ocular drug injections, or a combination of both. In advanced cases of diabetic retinopathy (DR), vitrectomy and retinal surgery may help preserve vision. Cataract surgery in diabetic patients is extremely successful, but overall these patients are usually considered to be at risk of more complications than the general population. Those patients with pre-existing DR at the time of surgery should be regarded as a high risk group and will require careful pre-operative assessment and post-operative review. In this group, intervention with laser photocoagulation and intra-vitreal pharmacotherapy may be necessary.
The Failure to Give
Authors: Childress James F.
Published: May 2020

After considering the huge and persistent gap between the supply of deceased donor organs for transplantation and the number of patients on the waiting list for a transplant, this chapter considers different ethical frameworks for evaluating first-person failures to donate organs after death and then assesses selected public policies designed to overcome these failures. Policies to facilitate first-person deceased organ donation often seek to alter the individual’s risk/cost-benefit calculations in deciding whether to register as a donor (for instance, by providing financial incentives); financial incentives can be ethically justifiable under some circumstances if they encourage and facilitate donation but do not implicate the sale of organs. Other proposed policies seek to nudge the individual’s declaration of organ donation through mandated choice or required response or through opt-out policies, often called “presumed consent,” under which not opting out counts as a donative decision. Available evidence suggests that mandated choice, required response, and presumed consent would probably be ineffective and perhaps even counterproductive in the United States at this time, but that some carefully designed combination could possibly be both ethically acceptable and effective.