bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypothalamic Hamartoma Causing Gelastic Seizures
Authors: Giridharan Nisha , Karas Patrick J. , Curry Daniel J.
Published: August 2022

Hypothalamic hamartomas are rare lesions that are highly epileptogenic. The lesions are benign, heterotopic masses that occur due to anomalies in neuronal migration. They usually present as a specific epileptic syndrome characterized by laughing spells, and the epileptic syndromes can further generalize. The hamartomas are often small lesions that can be missed on magnetic resonance imaging, and their epileptic syndromes may not be easily localizable by scalp electroencephalography. Their hypothalamic location renders the open or endoscopic surgical approach challenging, with a significant amount of morbidity associated with it. The advent of laser thermal interstitial therapy has allowed treatment of these lesions with minimal morbidity and reasonable seizure control rates.
Intractable Spinal Spastic Paraplegia
Authors: Kinsman Michael , Smith Kyle , Sami Mariah
Published: August 2022

Spasticity is a common medically refractory sequela of spinal cord injury. When medicines such as baclofen and tizanidine do not provide adequate benefit or when the side effects of these medications are impairing quality of life, surgical strategies can be considered. Percutaneous thoracolumbar radio-frequency rhizotomies and intrathecal baclofen delivery are two effective strategies for intractable spasticity. For patients being considered for intrathecal pump placement, an intrathecal trial of baclofen via lumbar puncture with pre- and postinjection assessment of spasticity is prudent. For patients with intrathecal baclofen pumps, baclofen withdrawal due to system failure is a serious complication that must be managed aggressively.
Allergic Diseases
Authors: Volcheck Gerald W.
Published: August 2022

Allergic diseases include atopic or immunoglobulin E (IgE)–mediated disorders that classically involve allergic rhinoconjunctivitis, allergic asthma, food and mediation allergy, and anaphylaxis. Although not mediated by IgE, certain diseases are often grouped with allergic diseases and include eosinophilic diseases, mast cell disease, nonallergic rhinitis, chronic rhinosinusitis, and primary immunodeficiency.
Arrhythmias and Syncope
Authors: Noseworthy Peter A.
Published: August 2022

Cardiac arrhythmias are due to disorders of impulse propagation (reentry) or impulse formation (abnormal automaticity or triggered activity). Reentry is the most common mechanism of arrhythmia and is further classified as macroreentrant or microreentrant. Macroreentrant arrhythmias have a discrete, definable circuit such as atrioventricular (AV) reentrant tachycardia (which are sustained as the impulse propagates across atrial, AV nodal, ventricular, accessory pathway, and back to the atrial tissue) or ventricular tachycardia (most often sustained around or through an area of myocardial scar). Microreentry occurs within a very small circuit and thus appears to arise from a single point in the myocardium.
Cardiac Manifestations of Systemic Diseases and Pregnancy
Authors: Blauwet Lori A. , Mankad Rekha , Phillips Sabrina D. , Klarich Kyle W.
Published: August 2022

This chapter covers varies systemic diseases and the ways they can affect the heart and how it works. It also covers how pregnancy can affect the heart.
Valvular and Congenital Heart Diseases
Authors: Klarich Kyle W. , Blauwet Lori A. , Phillips Sabrina D.
Published: August 2022

This chapter covers the types, symptoms, diagnosis, and treatment of valvular heart disease. Also covered are the possible defects that indicate congenital heart disease and their various treatments.
Gonadal and Adrenal Disorders
Authors: Shah Pankaj
Published: August 2022

This chapter discussed the various adrenal and gonadal disorders that can occur: adrenocortical failure, Cushing syndrome, primary aldosteronism, pheochromocytoma and paraganglioma, adrenal incidentaloma, male hypogonadism, gynecomastia, amenorrhea, polycystic ovary syndrome, and hyperprolactinemia.
Lipid Disorders
Authors: Kapoor Ekta
Published: August 2022

Lipid disorders result from genetic abnormalities in lipoprotein metabolism, other medical conditions (eg, type 2 diabetes mellitus, nephrotic syndrome, hypothyroidism, excessive alcohol use), and use of certain drugs (eg, corticosteroids, immunosuppressants). The most common disorders of genetic dyslipidemias are those of low-density lipoprotein (LDL) cholesterol (LDL-C), which often lead to premature atherosclerosis in persons and their family members.
Pituitary Disorders
Authors: Shah Pankaj
Published: August 2022

Hypopituitarism usually results from a deficiency of anterior pituitary hormones or, rarely, from tissue resistance to these hormones. Primary pituitary disease results from the loss of anterior pituitary cells and may be congenital or acquired. Hypothalamic hypopituitarism results from hypothalamic or pituitary stalk disease associated with the loss of hypophysiotropic regulatory hormones of the anterior pituitary cells. Functional hypothalamic disorders are common. Extrasellar disorders impinge on and impair the function of the hypothalamic-pituitary unit.
Esophageal and Gastric Disorders
Authors: Leggett Cadman L.
Published: August 2022

This chapter discusses esophagus function, normal action, and possible difficulties and diseases that can develop. Also covered is stomach and duodenum diseases, diagnoses, and possible management.
Liver and Biliary Disorders
Authors: Sanchez William
Published: August 2022

This chapter covers various tests to check if the liver is working properly. Several liver disorders are described as well as liver diseases. Possible liver injuries are discussed.
Clinical Epidemiology
Authors: Litin Scott C. , Bundrick John B.
Published: August 2022

Diagnostic tests are tools that either increase or decrease the likelihood of disease in a specific patient. When a diagnostic test is applied to a population at risk for a particular disease, patients in the studied population can be assigned to 1 of 4 groups on the basis of disease status and the test result.
Genetics
Authors: Collins C. Scott , Wittich Christopher M.
Published: August 2022

Chromosome abnormalities occur in 1 in 180 live births. One-third of these abnormalities are due to autosomal aneuploidy—an abnormal number of chromosomes. Risk factors for autosomal aneuploidy are maternal age 35 years or older and a previous birth of an affected child. The most common autosomal aneuploidy syndrome of full-term infants is Down syndrome.
Geriatrics
Authors: Tung Ericka E.
Published: August 2022

The overarching goal of the geriatric assessment is to develop a holistic understanding of the older patient as a means to identify emerging problems and individual capabilities. This information guides treatment, care coordination, and evaluation of long-term care needs. Assessment of the older adult requires a multifaceted approach that encompasses physical, cognitive, and psychosocial domains. The comprehensive geriatric assessment takes this approach a step further. It is targeted toward the frail older adult and involves an interdisciplinary team of geriatric care providers. Both the general assessment and the comprehensive assessment aim to enhance quality of life and optimize function. Given the time constraints placed on practicing physicians, a strategy of rapid screening of key geriatric domains, followed by a more in-depth assessment of worrisome areas, is an effective approach.
Otolaryngology and Ophthalmology
Authors: Collins Nerissa M.
Published: August 2022

This chapter covers various ear and eye problems, and their causes and treatments.
Physician Well-Being and Burnout
Authors: Vaa Stelling Brianna E. , West Colin P.
Published: August 2022

Physician burnout represents a public health crisis because of its high prevalence and serious consequences at all levels of the health care system. Physicians cannot provide optimal patient care when they are not well. Fortunately, the drivers of burnout and attendant solutions to reduce it and promote well-being are increasingly understood. With collaboration among individual physicians, health care organizations, and regulatory bodies, the field of medicine can achieve the desired goal of delivering outstanding patient care in a system where physicians experience joy in practice.
Preventive Medicine
Authors: Bonnes Sara L. , Adusumalli Jayanth , Stephenson Christopher R.
Published: August 2022

Preventive medicine focuses on preventing disease and keeping patients healthy. It has primary, secondary, and tertiary levels. In the primary level, disease is prevented before it occurs (eg, immunization, use of condoms to prevent sexually transmitted diseases), in part through use of health counseling.
Bleeding Disorders
Authors: Pruthi Rajiv K.
Published: August 2022

Bleeding disorders consist of clotting factor deficiencies or inhibitors, vascular bleeding disorders, and platelet disorders (quantitative and qualitative). Each of these is broadly classified into congenital disorders and acquired disorders. The best screening tool to evaluate for a bleeding disorder is a thorough clinical evaluation (personal and family bleeding history and physical examination). The presence of a bleeding disorder may be suggested from inquiry into the presence and age at onset of spontaneous bleeding (eg, epistaxis, easy bruising, or joint bleeding), unusual or unexpected posttraumatic or surgical bleeding (including from dental extractions), and family history. A thorough clinical evaluation should also include review of medications and coexisting medical problems to identify clinical risk factors for bleeding.
Thrombotic Disorders
Authors: Pruthi Rajiv K.
Published: August 2022

This chapter describes the types of thrombotic disorders, risk factors, diagnosis, possible prevention, and treatment of these disorders. Venous thromboembolism, deep vein thrombosis, and pulmonary embolism are discussed, as well as abnormalities of the procoagulant and anticoagulant systems.
HIV Infection
Authors: Kasten Mary J. , Temesgen Zelalem
Published: August 2022

This chapter describes the transmission, diagnosis, disease history, care, associated infections and conditions, possible treatments, and lifestyle adjustments for living with an HIV infection.
Immunocompromised Hosts
Authors: Beam Elena , Tosh Pritish K. , Sohail M. Rizwan
Published: August 2022

Infections in immunocompromised patients may occur in the clinical setting of neutropenia, B-cell and T-cell deficiencies, immunoglobulin deficiencies, complement deficiencies, and leukocyte dysfunction. Some patients have multiple defects due to both the underlying disease and its treatment.
Microorganism-Specific Syndromes
Authors: Beam Elena , Tosh Pritish K. , Sohail M. Rizwan
Published: August 2022

There are several human pathogens for which the microorganism is, in many ways, synonymous with the syndrome it causes. This chapter briefly reviews the microbiology, associated clinical syndromes, testing, and treatment for some of the most clinically significant pathogens, grouped by organism type.
Pulmonary and Mycobacterial Infections
Authors: Whitaker Jennifer A. , Tosh Pritish K.
Published: August 2022

Influenza causes annual, seasonal epidemics that lead to tens of thousands of deaths each year in the United States. Community-acquired pneumonia causes substantial morbidity and mortality among adults, the highest rates being in persons older than 65 years. CAP and influenza combine to be the seventh leading cause of death in the United States. Worldwide, Mycobacterium tuberculosis causes the most common type of human-to-human chronic infection due to mycobacteria. Parasitic infections of the lung are less common in the United States than in many other parts of the world.
Acid-Base Disorders
Authors: Qian Qi
Published: August 2022

Simple acid-base disorders are defined by changes in pH and the initial change in 1 of 2 variables: serum bicarbonate (HCO3−) concentration and partial pressure of CO2 (Pco2). Low pH indicates acidosis, and high pH indicates alkalosis. The Henderson-Hasselbalch equation describes the 4 acid-base disorders and their compensatory changes. Mixed acid-base disorders are the presence of 2 primary acid-base disorders—specifically, one primary disorder with a compensation that is out of proportion to the expected estimation. There are 5 steps to analyzing acid-base status in a patient.
Acute Kidney Injury
Authors: Norby Suzanne M. , Kashani Kianoush B.
Published: August 2022

Acute kidney injury (AKI) denotes a rapid deterioration of kidney function within 1 week of an insult to the kidney. AKI results in the accumulation of nitrogenous metabolites, along with fluid, electrolyte, and acid-base imbalances. The traditional classification system subdivides AKI into prerenal, intrinsic renal, and postrenal categories. Although AKI has a dominant cause in some patients, multiple factors usually contribute to its development. The management of AKI is mostly supportive because no therapeutic options are currently available. Determining and managing the risk factors associated with AKI are essential steps to decrease the extent of the injury.
Chronic Kidney Disease
Authors: Schinstock Carrie A.
Published: August 2022

Chronic kidney disease (CKD) is a worldwide public health problem. In the United States, the prevalence of end-stage renal disease (ESRD) is increasing, especially among persons older than 65 years. More than 20 million people in the United States are thought to have CKD, and this population uses a disproportionate amount of health care resources. CKD is also associated with an increased risk of death, particularly from cardiovascular causes. Referral to a nephrologist should be considered when patients have AKI, stage 4 CKD, substantial proteinuria, unexplained hematuria or red blood cell casts, resistant hypertension, hereditary kidney disease, electrolyte abnormalities, or recurrent nephrolithiasis.
Cerebrovascular Diseases
Authors: Klaas James P. , Brown Robert D.
Published: August 2022

The causes of ischemic cerebrovascular disorders and cerebral infarction can be classified according to the site of the source for the arterial blockage within the vascular system, from most proximal to distal: cardiac source, large-vessel disorders, small-vessel occlusive disease, and hematologic disorders.
Inflammatory and Autoimmune Central Nervous System Diseases and the Neurology of Sepsis
Authors: McKeon Andrew
Published: August 2022

This chapter discusses the symptoms, diagnosis, and therapy for inflammatory central nervous system diseases and autoimmune central nervous system diseases. It also describes the neurology of sepsis.
Neoplastic Diseases
Authors: Porter Alyx B.
Published: August 2022

Neoplastic diseases include tumors in the brain and central nervous system, primary central nervous system lymphoma, and systemic cancer. Brain metastases are the most common brain tumors. Epidural spinal cord compression is the most common cause of spinal cord dysfunction in patients with cancer and is frequently preceded by vertebral metastasis. Paraneoplastic disorders are associated with increased levels of circulating antibodies that are directed against neoplastic cells and attack membrane ion channels or intracellular proteins in neurons. Treatment of cancer with chemotherapeutic and biologic agents is frequently complicated by the development of neurotoxicity.
Cancer of Unknown Primary Origin and Paraneoplastic Syndromes
Authors: Wittich Michelle A. Neben
Published: August 2022

Carcinoma of unknown primary origin (CUP) describes a metastatic disease for which the primary cancer cannot be identified. Of all invasive cancers, 2% to 6% are CUP. When a pathologic diagnosis is established, additional evaluation should be tailored according to the patient’s risk factors (eg, smoking and breast cancer risk), symptoms and signs, sites of metastasis, and the histologic diagnosis. Paraneoplastic syndromes are caused by factors other than direct tumor invasion or compression. They do not necessarily indicate metastatic disease. Paraneoplastic syndromes can be classified as endocrine, neurologic, dermatologic, or rheumatologic.
Gynecologic Cancers: Cervical, Uterine, and Ovarian Cancers
Authors: Hendrickson Andrea E. Wahner
Published: August 2022

Globally, cervical cancer is the fourth most common type of cancer and the fourth leading cause of cancer death among women. In recent decades, the incidence of cervical cancer, along with the mortality rate associated with the disease, have markedly decreased. Uterine cancers are the most common type of gynecologic cancer in developed countries. Overall, endometrial cancer carries a more favorable prognosis than other types of cancer because symptoms often arise early. Epithelial ovarian cancer is the most lethal of the gynecologic cancers and is the fifth leading cause of cancer deaths among US women.
Colorectal Cancer
Authors: Hubbard Joleen M.
Published: August 2022

Colorectal cancer is diagnosed in approximately 137,000 Americans annually and causes 50,000 deaths each year. It is the third most common cause of cancer death in North America and Europe. The incidence of colorectal cancer has decreased since the early 2000s, after it peaked in the late 1990s. The decrease in colon cancer incidence and mortality rate is attributed to improved screening methods, consisting mainly of endoscopic surveillance.
Genitourinary Cancer
Authors: Costello Brian A.
Published: August 2022

Approximately 165,000 new cases of prostate cancer occur annually in the United States. In US men, it is the most common cancer and is the second leading cause of cancer death. Testicular cancer is diagnosed in approximately 9,000 men annually. It is the most common solid cancer in males aged 15 to 35 years. Approximately 81,000 new cases of bladder cancer are diagnosed in the US annually. Approximately 17,000 people die each year of bladder cancer. Each year in the US, 65,000 new cases of kidney cancer are diagnosed. Approximately 15,000 people die of kidney cancer annually.
Lung Cancer and Head and Neck Cancer
Authors: Leventakos Konstantinos , Wittich Michelle A. Neben , Price Katharine A.
Published: August 2022

Each year in the United States, approximately 220,000 new cases of lung cancer are diagnosed and approximately 158,000 people die of lung cancer. Lung cancer accounts for approximately 27% of all cancer deaths. Lung cancer is classified histologically into small cell and non–small cell types. The most common head and neck cancer is squamous cell carcinoma of the upper aerodigestive tract. Head and neck squamous cell carcinoma can occur in the nasopharynx, oropharynx, larynx or hypopharynx, oral cavity, and paranasal sinuses. Uncommon cancers of the head and neck include salivary gland cancers, esthesioneuroblastoma, melanoma, lymphoma, sarcoma, and paraganglioma.
Mood and Anxiety Disorders
Authors: Kolla Bhanuprakash , Palmer Brian A.
Published: August 2022

Since 30% to 40% of ambulatory primary care visits have a psychiatric component, successful patient care often hinges on successful treatment of comorbid psychiatric illness. The key concept when assessing psychiatric symptoms is whether a symptom interferes with a patient’s functioning or causes distress, or both.
Psychotic and Somatic Symptom and Related Disorders
Authors: Kolla Bhanuprakash , Palmer Brian A.
Published: August 2022

Psychosis is a generic term used to describe altered thought and behavior, in which the patient is incapable of interpreting their situation rationally and accurately. Psychotic symptoms can occur in various medical, neurologic, and psychiatric disorders. Many psychotic reactions seen in medical settings are either associated with the use of recreational or prescription drugs or occur in the context of delirium. Some of these drug-induced psychotic reactions are nearly indistinguishable from schizophrenia in terms of hallucinations and paranoid delusions (eg, amphetamine and phencyclidine [PCP] psychoses).
Critical Care Medicine
Authors: Kennedy Cassie C. , Baqir Misbah
Published: August 2022

Effective functioning of the respiratory system requires 1) normal central nervous system control, 2) intact neuromuscular transmission and bellows function, 3) patent airways, and 4) normal gas exchange at the alveolar-capillary level. Shock is defined as the inadequate provision of oxygen and metabolic substrate to the tissues. Sepsis is a dysregulated response by the host to an infection that causes life-threatening organ dysfunction.
Obstructive Lung Diseases
Authors: Iyer Vivek N.
Published: August 2022

Obstructive lung diseases include chronic obstructive pulmonary disease (COPD) (eg, chronic bronchitis and emphysema), asthma, bronchiectasis, cystic fibrosis, obliterative bronchiolitis, α1-antitrypsin deficiency, airway stenosis, and diffuse panbronchiolitis. The 2 most prevalent obstructive lung diseases are COPD and asthma.
Pulmonary Vascular Disease
Authors: Cartin-Ceba Rodrigo
Published: August 2022

This chapter describes the presentation, diagnoses, and treatments for various pulmonary vascular diseases, including pulmonary hypertension, pulmonary vasculitides, alveolar hemorrhage syndrome, pulmonary arteriovenous malformation, hepatopulmonary syndrome, pulmonary artery aneurysm, pulmonary capillary hemangiomatosis, pulmonary vascular tumors, superior vena cava syndrome, and pulmonary lymphatic disorers.
The Origin, Evolution, and Epidemiology of HIV-1 and HIV-2
Authors: Kirchner Jeffrey T.
Published: August 2022

This chapter reviews the origin of HIV and its entry into humans as well as the different strains and subtypes of HIV. A section of the chapter is dedicated to examining the spread of HIV throughout Africa and the rest of the world. The diversity of HIV is discussed in detail along with treatments and vaccine developments. The chapter concludes with a brief discussion about the future of HIV regional and global genetic diversity.
Immunology
Authors: Hartigan-O’Connor Dennis J. , Brander Christian
Published: August 2022

The immunology chapter covers how HIV affects the immune system as whole. Mechanisms of chronic inflammation in HIV are discussed as well as pathogenesis of immune reconstitution inflammatory syndromes (IRIS). Immunologic effects of antiretroviral therapy and the role of persistent immune dysfunction during therapy on clinical outcomes is examined in this chapter. The chapter concludes with a review of the future of immune-based therapeutics in HIV disease.
Health Maintenance
Authors: Kseri Ramiz
Published: August 2022

This chapter presents a detailed outline of tuberculosis screening and assessment methods as well as discussing testing frequency. The importance of routine dental care for people with HIV and immunization schedules for people with HIV is highlighted.
The Pharmacist’s Role in HIV Care
Authors: Cocohoba Jennifer
Published: August 2022

This chapter provides an extensive overview of the role HIV pharmacist specialists play in HIV care. Settings in which pharmacists provide care are discussed as well as the specific skills pharmacists retain that contribute to HIV care.
Palliative Care and End-of-Life Support
Authors: DenOuden Paul W.
Published: August 2022

Both hospice and palliative care are reviewed in depth in this chapter. The different options available to the patient are discussed as well as when each option may be most appropriate. The reader is also provided a variety of common symptoms to be aware of when providing palliative care.
Select Topics in the Care of Women with HIV
Authors: Christensen Theresa , Schafer Jason J. , Short William R.
Published: August 2022

The importance of family planning and preconception care are reviewed in detail in this chapter. Counseling and assessment about childbearing and contraception are covered as well as care for women wishing to conceive. The reader is presented information regarding the recommended frequency and specimen collection technique for cervical Pap smears in HIV-infected women, the role of human papillomavirus (HPV) testing, and indications for specialist referral for colposcopy. The chapter concludes with an overview of the clinical management of HIV-positive pregnant women, including recommendations for use of antiretroviral agents and drug disposition.
Antiretroviral Therapy for Children and Newborns
Authors: Nielsen-Saines Karin
Published: August 2022

This chapter discusses advances in antiretroviral therapy for the prevention of mother-to-child HIV transmission. Pediatric-specific issues of early HIV diagnosis, timing and pathogenesis of HIV disease, and use of surrogate markers of HIV infection in this population are reviewed in the text. The difference between the concepts of HIV exposure and HIV infection is highlighted. The chapter concludes with a brief discussion citing the benefits of antiretroviral therapy in children.
Substance Use in HIV Populations
Authors: David Elizabeth H. , Truong Thanh Thuy
Published: August 2022

This chapter discusses issues, implications, diagnosis, and treatment of substance use disorders in HIV-positive individuals. The learner will be able to describe the bidirectional interactions between HIV and unhealthy substance use, recognize unhealthy substance use in people with HIV, and provide an initial outline of possible approaches to the treatment of substance use disorders among people with HIV.
Caring for Older People with HIV
Authors: Sangarlangkarn Aroonsiri , Zeuli John D. , Avihingsanon Anchalee
Published: August 2022

This chapter describes the differences in HIV care and management for persons with HIV who are 50 years old or older compared to their younger counterparts. Importantly, older patients with HIV present unique and complex cases and disease-centric guidelines do not apply to every patient. Management of diseases in older patients with HIV should be individualized based on aging phenotypes identified by the Veterans Aging Cohort Study (VACS) index, interactions with multiple morbidities, and patient preferences. Learners will understand how to conduct a comprehensive geriatric assessment to assess for function, mobility/fall risk, frailty, cognition, mood, and issues related to polypharmacy. Learners will also discuss a comprehensive medication assessment, nutrition and weight changes, social and monetary issues impacting care, symptom burdens and pain, and advance planning. Lastly, learners will be presented with specific coexisting conditions common to aging that are impacted by HIV, including diabetes mellitus, hypertension, bone disease, peripheral neuropathy, certain cancers, and recommended vaccinations.
Non-opportunistic Infections
Authors: Chakrabarti Priyanka
Published: August 2022

This chapter covers the diagnosis and treatment of respiratory complications in people with HIV. These complications include nonspecific interstitial pneumonitis, lymphocytic interstitial pneumonitis, diffuse infiltrative CD8+ lymphocyte syndrome, and pulmonary arterial hypertension. Learners will be able to diagnose, differentiate, and treat respiratory complications associated with HIV and antiretroviral use.
Neurologic Effects of HIV Infection
Authors: Hasbun Rodrigo , Kass Joseph S.
Published: August 2022

This chapter delineates the clinical features, differential diagnosis, and management of HIV-associated neurocognitive disorders (HAND). Learners will understand the high prevalence of HAND in antiretroviral-naive patients and among patents with virologic suppression. Information is given about how to use rapid screening tools such as the Montreal Cognitive Assessment (MOCA) test and Frontal Assessment Battery (FAB) test to diagnose HAND in the clinic. The learner will also examine other significant cognitive, behavioral, and motor abnormalities that impact HIV compliance, retention in care for older individuals, and quality of life.
The COVID-19 Pandemic and HIV
Authors: Prokesch Richard C.
Published: August 2022

This chapter provides a summary overview of the COVID-19 pandemic and how it impacts people with HIV and special considerations for healthcare providers. It summarizes the findings of investigations aimed to determine if people with HIV are more susceptible to COVID-19 compared to non-HIV-infected populations. Lastly it provides guidance and best practices on healthcare delivery during a pandemic.
HIV-Associated Lipodystrophy and Lipoatrophy
Authors: Sekhar Rajagopal V.
Published: August 2022

This chapter discusses abnormal fat distribution (lipodystrophy) associated with HIV and antiretroviral therapy by describing what is currently know about HIV-associated lipodystrophy, the current clinical implications of lipodystrophy in persons with HIV, and the therapeutic interventions that can be used to treat and improve the health status of persons with HIV and lipodystrophy. The learner will also understand the different manifestations of lipodystrophy, including fat loss (lipoatrophy), fat gain (lipohypertrophy), or mixed patterns and the associated increased risk of developing dyslipidemia, insulin resistance, diabetes mellitus, cardiovascular disease, fatty liver disease, renal disease, and metabolic syndrome. Associated treatments are also discussed.
US Healthcare Systems, HIV Programs, and Coverage Policy Issues
Authors: Packett Bruce J.
Published: August 2022

This chapter reviews the broad landscape of the US healthcare systems and payers as they pertain to the provision of care for persons with HIV. The learner will be able to describe the assortment of federal, state, and local programs and private and charitable organizations that provide healthcare to people with HIV who do not have adequate health insurance coverage. Topics such as the Affordable Care Act, Medicare, Medicaid, the Ryan White HIV/AIDS Program, private health insurance, and state insurance exchanges are discussed. Other topics covered are provider reimbursement and billing and coding issues related to the care of persons with HIV.
Legal Issues
Authors: Schouten Jeffrey T.
Published: August 2022

This chapter covers legal issues surrounding HIV healthcare. Legal topics include recommendations for routine HIV testing in various health care settings, recommended frequency of testing for at-risk populations, consent, and allowable circumstances for HIV testing without consent. The learner will also be able to describe disease reporting requirements, surveillance, molecular surveillance, and reportable associated diseases. Issues related to confidentiality such as partner notification requirements, disclosure issues, perinatal and adolescent disclosure concerns, HIV criminalization, and stigma are also discussed. Additional topics include treatment of minors, confidentiality, HIPAA requirements, and end-of-life issues such as durable power of attorney, advance directives, wills, and physician orders for life-sustaining treatment.
Research Design and Analysis
Authors: Rojas Sarah A. , Ramers Christian B.
Published: August 2022

This chapter helps the learner differentiate between per-protocol and intent-to-treat statistical analyses. It also helps the learner to differentiate between the U.S. Food and Drug Administration’s algorithms that assess virologic response to antiretroviral therapies and when noninferiority analysis may be considered. The learner will also understand the difficulties of drawing cause-and-effect conclusions about associations identified in research studies, including the limitations of observational studies and cross-study comparisons.
Probing the z ≳ 6 quasars in a universe with IllustrisTNG physics: impact of gas-based black hole seeding models
Authors: Bhowmick Aklant K , Blecha Laura , Ni Yueying , Matteo Tiziana Di , Torrey Paul , Kelley Luke Zoltan , Vogelsberger Mark , Weinberger Rainer , Hernquist Lars
Published: August 2022

We explore implications of a range of black hole (BH) seeding prescriptions on the formation of the brightest $z$ ≳ 6 quasars in cosmological hydrodynamic simulations. The underlying galaxy formation model is the same as in the IllustrisTNG simulations. Using constrained initial conditions, we study the growth of BHs in rare overdense regions (forming $\gtrsim 10^{12}\, {\rm M}_{\odot }\,h^{-1}$ haloes by $z$ = 7) using a  (9 Mpc h−1)3 simulated volume. BH growth is maximal within haloes that are compact and have a low tidal field. For these haloes, we consider an array of gas-based seeding prescriptions wherein $M_{\mathrm{seed}}=10^4\!-\!10^6\, {\rm M}_{\odot }\,h^{-1}$ seeds are inserted in haloes above critical thresholds for halo mass and dense, metal-poor gas mass (defined as $\tilde{M}_{\mathrm{h}}$ and $\tilde{M}_{\mathrm{sf,mp}}$, respectively, in units of Mseed). We find that a seed model with $\tilde{M}_{\mathrm{sf,mp}}=5$ and $\tilde{M}_{\mathrm{h}}=3000$ successfully produces a $z$ ∼ 6 quasar with $\sim 10^9\, {\rm M}_{\odot }$ mass and ∼1047 erg s−1 luminosity. BH mergers play a crucial role at $z$ ≳ 9, causing an early boost in BH mass at a time when accretion-driven BH growth is negligible. With more stringent seeding conditions (e.g. $\tilde{M}_{\mathrm{sf,mp}}=1000$), the relative paucity of BH seeds results in a much lower merger rate. In this case, $z$ ≳ 6 quasars can only be formed if we enhance the maximum allowed BH accretion rates (by factors ≳10) compared to the accretion model used in IllustrisTNG. This can be achieved either by allowing for super-Eddington accretion, or by reducing the radiative efficiency. Our results demonstrate that progenitors of $z$ ∼ 6 quasars have distinct BH merger histories for different seeding models, which will be distinguishable with Laser Interferometer Space Antenna observations.
Photometric and dynamic characterization of active asteroid (248370) 2005QN173
Authors: Novaković Bojan , Pavela Debora , Hsieh Henry H , Marčeta Dušan
Published: August 2022

We present the physical and dynamical properties of the recently discovered active asteroid (248370) 2005QN173 (aka 433P). From our observations, we derived two possible rotation period solutions of 2.7 ± 0.1 and 4.1 ± 0.1 h. The corresponding light-curve amplitudes computed after correcting for the effect of coma are 0.28 and 0.58 mag, respectively. Both period solutions are shorter than the critical rotation limit computed for a strengthless triaxial ellipsoid, suggesting that rotation mass shedding should at least partly be responsible for the observed activity. We confirm that the activity level is fading further, but at a very modest rate of only 0.006 mag d−1, still also compatible with sublimation-driven activity. We found that 248370 likely belongs to the Themis asteroid family, making it a fourth main-belt comet associated with this group. Orbital characteristics of 248370 are also consistent with its origin in the young 288P cluster of asteroids. The 288P cluster is associated with its namesake main-belt comet, providing an exciting possibility for a comparative analysis of intriguing main-belt comets 248370 and 288P.
Two can play at that game: constraining the role of supernova and AGN feedback in dwarf galaxies with cosmological zoom-in simulations
Authors: Koudmani Sophie , Sijacki Debora , Smith Matthew C
Published: August 2022

There is growing observational evidence for dwarf galaxies hosting active galactic nuclei (AGN), including hints of AGN-driven outflows in dwarfs. However, in the common theoretical model of galaxy formation, efficient supernova (SN) feedback is the tool of choice for regulating star formation in the low-mass regime. In this paper, we present a suite of high-resolution cosmological dwarf zoom-in simulations relaxing the assumption of strong SN feedback, with the goal to determine whether more moderate SN feedback in combination with an efficient AGN could be a suitable alternative. Importantly, we find that there are sufficient amounts of gas to power brief Eddington-limited accretion episodes in dwarfs. This leads to a variety of outcomes depending on the AGN accretion model: from no additional suppression to moderate regulation of star formation to catastrophic quenching. Efficient AGN can drive powerful outflows, depleting the gas reservoir of their hosts via ejective feedback and then maintaining a quiescent state through heating the circumgalactic medium. Moderate AGN outflows can be as efficient as the strong SN feedback commonly employed, leading to star formation regulation and H i gas masses in agreement with observations of field dwarfs. All efficient AGN set-ups are associated with overmassive black holes (BHs) compared to the (heavily extrapolated) observed BH mass–stellar mass scaling relations, with future direct observational constraints in this mass regime being crucially needed. Efficient AGN activity is mostly restricted to high redshifts, with hot, accelerated outflows and high X-ray luminosities being the clearest tell-tale signs for future observational campaigns.
Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group
Authors: Karschnia Philipp , Young Jacob S , Dono Antonio , Häni Levin , Sciortino Tommaso , Bruno Francesco , Juenger Stephanie T , Teske Nico , Morshed Ramin A , Haddad Alexander F , Zhang Yalan , Stoecklein Sophia , Weller Michael , Vogelbaum Michael A , Beck Juergen , Tandon Nitin , Hervey-Jumper Shawn , Molinaro Annette M , Rudà Roberta , Bello Lorenzo , Schnell Oliver , Esquenazi Yoshua , Ruge Maximilian I , Grau Stefan J , Berger Mitchel S , Chang Susan M , van den Bent Martin , Tonn Joerg-Christian
Published: August 2022

Background

Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (1) explore the prognostic utility of the classification system and (2) define how much removed non-CE tumor translates into a survival benefit.

Methods

The international RANO resect group retrospectively searched previously compiled databases from 7 neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and postoperative MRI were collected.

Results

We collected 1,008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC-26981/22981 (TMZ/RT→TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm3) were favorably associated with outcome: patients with “maximal CE resection” (class 2) had superior outcome compared to patients with “submaximal CE resection” (class 3) or “biopsy” (class 4). Extensive resection of non-CE tumor (≤5 cm3 residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 (“supramaximal CE resection”). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers.

Conclusions

The proposed “RANO categories for extent of resection in glioblastoma” are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such “supramaximal CE resection.”
Effects of anthocyanin-rich supplementation on cognition of the cognitively healthy middle-aged and older adults: a systematic review and meta-analysis of randomized controlled trials
Authors: Feng Ruo Chen , Dong Yan Hong , Hong Xian Li , Su Ya , Wu Xi Vivien
Published: August 2022

Context

The prevalence of age-related cognitive decline has been on the rise as the global population age, putting the independence and quality of life of elderly at risk. Anthocyanin, as a subclass of dietary flavonoids, may have a beneficial impact on cognitive outcomes.

Objectives

To examine the effects of dietary anthocyanin supplementation on cognition of the cognitively healthy middle-aged and older adults.

Data Sources

PubMed, ScienceDirect, CINAHL, EMBASE, ProQuest and Cochrane databases were searched.

Data Extraction and Analysis

Thirteen studies were included in this meta-analysis. Anthocyanin-rich supplementation was found to significantly improve the processing speed of the older adults (95%CI 0.08, 0.44; P = 0.004). No significant differences were observed between intervention and control groups on memory, attention, executive function and psychomotor performance. Current neuroimaging studies have found promising effects of anthocyanin supplementation on brain activation and cerebral perfusion.

Conclusion

Anthocyanin-rich supplementation may preserve cognitive processing speed and neuro-activities in older adults, which improves their daily functioning and quality of life. This review provides useful insights to guide direction and methodological designs for future studies to explore the underlying mechanisms of anthocyanins.

Systematic Review and Meta-analysis Registration

PROSPERO registration No. CRD42021228007.
Cardiorespiratory fitness is associated with sickness absence and work ability
Authors: Kolu P , Raitanen J , Sievänen H , Tokola K , Vähä-Ypyä H , Nieminen E , Vasankari T
Published: August 2022

Background

Physical activity may sustain the physical aspect of work ability despite health problems such as musculoskeletal disorders and anxiety, which are the most prevalent work-related health problem in Europe.

Aims

To evaluate the association of Finnish municipal workers’ accelerometer-measured physical activity, sedentary behaviour, and cardiorespiratory and muscular fitness with their sickness absence levels, perceived work ability and health-related quality of life.

Methods

In connection with a randomized controlled trial recruiting 185 municipal workers, the authors performed baseline data analysis utilizing quantile regression to examine relationships between the outcome variables (all-cause sickness absence for 6 months, perceived work ability and health-related quality of life) and cardiorespiratory fitness, muscular fitness, and physical activity, and sedentary behaviour. All results were adjusted for age, sex and education level.

Results

The median duration of all-cause sickness absence over the preceding 6 months was lowest among participants with high cardiorespiratory fitness relative to the lowest tertile (2.0 versus 6.0 days; P < 0.05), and the highest perceived work ability was found among those with high or moderate cardiorespiratory fitness as compared to the lowest tertile (8.0 versus 7.0; P < 0.001). Moderate-to-vigorous physical activity correlated positively with the physical component of health-related quality of life (P < 0.01) and with a high cardiorespiratory-fitness level (P < 0.05).

Conclusions

High cardiorespiratory fitness was associated with decreased all-cause sickness absence days and improved work ability among municipal workers.
Building Professional Capability
Authors: American Association for the Advancement of Science
Published: August 2022

The professional preparation of new teachers concentrates on getting them ready to teach certain subjects and grades in the existing curriculum, not on how to go about changing the curriculum they have inherited (let alone learning of the need to do so). Consequently, professional development of employed teachers tends to focus on improving their content background and instructional techniques. Similarly, the preparation of school administrators focuses largely on matters of school management, with little attention paid to the details of curriculum design. If school districts are to achieve curriculum reform, therefore, it is essential that they build a professional capability for undertaking curriculum change. This chapter suggests how school districts can make headway in developing such a capability while at the same time beginning to make substantial improvements in some aspects of the curriculum itself. It calls upon educators in school districts to raise their collective level of science literacy, to become knowledgeable about the science, mathematics, and technology learning goals appropriate for all students, and to familiarize themselves with what is reliably known about student learning related to those goals. The chapter also calls for educators to increase their ability to make sound judgments about the quality of curriculum materials and to employ a variety of different curriculum formats that have particular instructional advantages. Building professional capability for curriculum improvement in a school district calls for teachers to acquire certain knowledge and skills regarding science itself, how it is represented in literacy goals, how students learn challenging ideas, and how materials for instruction and assessment serve students’ learning. It does not follow, however, that every teacher and administrator in a school district must attain the same level of expertise in every one of these matters. If one thinks of the faculty as a large team of professionals engaged in a shared endeavor, then it is the collective capability that counts—as long as there is sufficient collaboration among the members of the team. Teamwork is not common enough in the area of curriculum reform, but it is an aspect of professionalism that can be learned, if there is a will to do so.
Unburdening the Curriculum
Authors: American Association for the Advancement of Science
Published: August 2022

Time in school for teaching and learning is not limitless. Yet many textbooks and course syllabi seem to assume otherwise. They include a great abundance of topics, many of which are treated in superficial detail and employ technical language that far exceeds most students’ understanding. And even as new content is added to the curriculum— little is ever subtracted—students are being asked to learn with greater depth. Rarely is more time made available for accomplishing this. Coverage almost always wins out over student understanding, quantity takes precedence over quality. Many decades of overload have shaped curriculum, textbooks, tests, and teacher expectations into an industry of superficiality. Many teachers know, or at least suspect, how little their students understand, but do not know how to transform the system. Lengthening the school day and year and reducing the number of different subjects students study are obvious though apparently unpopular remedies for the mismatch between curricular time and content, but in any event would not by themselves solve the problem. Another remedy sometimes proposed is to move concepts lower in the grade sequence, thereby leaving time free in high school for students to learn better what they study. That would be a tenable ambition if high-school students were learning those ideas well now. Because they are not, however, it is no more than wishful thinking to believe that younger children will be able to learn what older children apparently do not. Improvements in teaching methods and curriculum design may eventually make it possible for students to learn more than they do now, hour for hour, but the current and critical need is for them to acquire at least some important knowledge and skills better, even at the price of covering fewer topics overall. This chapter describes four strategies aimed at reallocating time—time to focus on understanding important facts, principles, and applications in science, mathematics, and technology, not time to enable still more material to be superficially covered. The underlying purpose is to realize a better cost-to-benefit ratio, using time and resources in ways that will maximize students’ eventual science literacy.