bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal study on 3D ultrasound-based rupture risk assessment of abdominal aortic aneurysms
Authors: Nievergeld Arjet , Fonken Judith , Thirugnanasambandam Mirunalini , Maas Esther , van Sambeek Marc , Lopata Richard
Published: January 2025

Aims

Image-based, patient-specific rupture risk analysis of abdominal aortic aneurysms (AAAs) is promising but it is limited by invasive and costly imaging modalities. Ultrasound (US) offers a safe, more affordable alternative, allowing multiple assessments during follow-up and enabling longitudinal studies on AAA rupture risk.

Methods and results

This study used time-resolved 3D US to assess AAA rupture risk parameters over time, based on vessel and intraluminal thrombus (ILT) geometry. The locations and magnitude of peak wall rupture index (PWRI), peak wall stress (PWS), and maximum ILT thickness for varying AAA growth rates, and the correlation between PWRI, PWS, and geometric parameters were investigated. This study demonstrated that US-based biomechanical analysis is suitable for assessing rupture potential, providing insights into the evolution through various phases in AAA development. For the fast-growing AAAs, the location of PWRI moved closer to the locations of maximum ILT thickness, whereas the location of PWS moved further away. The newly introduced parameter, i.e. percentage of ILT expected for an aneurysm with a healthy lumen, showed a stronger correlation with PWS and PWRI and was less dependent on AAA size, indicating the potential for further research on ILT's impact on AAA rupture risk.

Conclusion

This study represents a step towards clinical introduction of US-based AAA rupture risk analysis. Further research and randomized trials are required to directly correlate PWRI with rupture risk. Further improvement of ILT visibility and personalization of the US-based models will be required to achieve clinical acceptance of model-based rupture risk predictions.
Segmental post-percutaneous coronary intervention physiological gradients using ultrasonic or optical flow ratio: insights from ASET JAPAN study
Authors: Revaiah Pruthvi C , Miyashita Kotaro , Tsai Tsung-Ying , Bajaj Retesh , Kotoku Nozomi , Tobe Akihiro , Muramatsu Takashi , Tanabe Kengo , Kozuma Ken , Ozaki Yukio , Garg Scot , Tu Shengxian , Dijkstra Jouke , Bourantas Christos V , Onuma Yoshinobu , Serruys Patrick W
Published: January 2025

Aims

Segmental pressure gradients post-percutaneous coronary intervention (PCI) can detect residual disease and optimization targets. Ultrasonic flow ratio (UFR) or optical flow ratio (OFR) offer simultaneous physiological and morphological assessment using a single imaging catheter. This study evaluated the utility of UFR and OFR in identifying residual disease post-PCI.

Methods and results

The study include patients from the Acetyl Salicylic Elimination Trial JAPAN Pilot study with complete intravascular imaging pullback data, where UFR or OFR was obtained post-PCI. Anatomical focal lesions distal and proximal to the stent were analysed in segments ≥5 mm long. UFR or OFR virtual pullback curves assessed intra-stent pressure gradients, defining physiological focal or diffuse by segmental pressure drops ≥0.05 over lengths <10 or ≥10 mm, respectively. The median post-PCI UFR/OFR was 0.93 (0.88–0.96) with 35.4% (69/195) vessels having a UFR/OFR < 0.91. There were significantly more focal lesions, both anatomical and physiological, proximal and distal to the stent in vessels with UFR/OFR < 0.91 compared with those ≥0.91. Agreement between anatomical and physiological focal lesions was moderate proximally (kappa = 0.553, P < 0.001) and fair distally (kappa = 0.219, P = 0.002). The in-stent gradient poorly predicted significant stent under-expansion. However, the virtual fractional flow reserve gradient performed well in detecting proximal or distal focal disease (area under the curve = 0.835 and 0.877, respectively).

Conclusion

UFR/OFR effectively identifies sub-optimal vessel physiology post-PCI and locates precise anatomical issues, validated by intravascular imaging.

Trial registration

The ASET JAPAN ClinicalTrials.gov reference: NCT05117866
Development of the fish invitrome for animal-free environmental risk assessment of chemicals
Authors: Revel Marion , Groh Ksenia , Bertoli Jessica , Degeratu Mihai-Ovidiu , Fischer Melanie , Fischer Stephan , Hoekman Jarno , Jozef Barbara , Li Roman , Mosimann Sven Lukas , vom Berg Colette , Županič Anže , Truffer Bernhard , Schirmer Kristin
Published: January 2025

Given the need to reduce animal testing for environmental risk assessment, we aim to develop a fish invitrome, an alternative fish modular framework capable of predicting chemical toxicity in fish without the use of animals. The central module of the framework is the validated RTgill-W1 cell line assay that predicts fish acute toxicity of chemicals (Organisation for Economic Co-operation and Development test guideline 249). Expanding towards prediction of chronic toxicity, the fish invitrome includes two other well-advanced modules for chemical bioaccumulation/biotransformation and inhibition of fish growth. This framework is expected to continuously evolve with the development of modules that predict, for instance, neurotoxicity and reproductive toxicity. We envisage the fish invitrome framework becoming part of the broader academic field of new approach methodologies (NAMs), where it will remain flexible and open to integration of new developments from research groups around the world. To accelerate the development and uptake of this framework, we strive for transdisciplinarity, integrating both natural and social sciences, along with broader stakeholder interactions. A stepwise socio-technical approach was chosen, where mainstreaming the fish invitrome involves progressive adoption across various ecotoxicological contexts. The framework will be codesigned with stakeholders from academia, industry, and regulatory bodies. Rather than aiming for immediate regulatory acceptance, this approach aims to build trust and familiarity with fish cell line–based testing among stakeholders. By doing so, it encourages broader use of the framework in practical applications while gradually overcoming institutional, cultural, and technical barriers. Additionally, establishing a clear roadmap for mainstreaming the fish invitrome will help identify and address challenges to its uptake, ensuring a smoother transition to nonorganismal testing methodologies.
Influence of cutting attachment on work efficiency, fuel consumption and environmental pollution from plastic wire during tending of young forests with brush cutters
Authors: Naskrent Bartłomiej , Grzywiński Witold , Polowy Krzysztof , Jelonek Tomasz , Tomczak Arkadiusz , Naskrent Ewelina , Szwed Tomasz
Published: January 2025

Petrol brush cutters are among the most widely used devices for tending young forests. During this work, environmental pollution is generated by the combustion of fuel and by the discarding of pieces of the plastic cutting line. The aim of this study was to compare operating parameters and the degree of plastic pollution from the cutting line, and to determine fuel consumption during tending of young forest with the use of a petrol brush cutter equipped with different cutting attachments: a plastic wire head, and 2-, 3-, and 24-tooth cutting blades. Measurements were made in the course of work on 2–3-year-old oak plantations containing two vegetation types (herbaceous and mixed). It was found that the most efficient cutting attachment was the wire head, but its use was associated with significant wire and fuel consumption. In the mixed vegetation case, wire consumption was 575.89 g*ha−1, which is comparable to eighteen polyethylene terephthalate (PET) bottles. Similar performance and significantly lower fuel consumption were obtained with the 2-tooth blade. In addition, when using cutting blades, there was no wire consumption and thus no plastic pollution of the environment. It was concluded that, in order to eliminate plastic pollution and reduce fuel consumption while achieving satisfactory working efficiency, the use of wire heads should be abandoned in favor of metal cutting blades.
Waveform tomography of the Antarctic Plate
Authors: Chua Ee Liang , Lebedev Sergei
Published: January 2025

We present a new seismic shear wave velocity model of the upper mantle of the Antarctic Plate region, AP2024. It includes the lithosphere and underlying mantle down to 660 km depth beneath both the continental and oceanic portions of the plate. To augment the limited seismic station coverage of Antarctica, we assemble very large regional and global data sets, comprising all publicly available broad-band seismic data. The model is built using 785 thousand seismograms from over 27 thousand events and 8.7 thousand stations. It is constrained by both body and Rayleigh surface waves, ensuring the dense data sampling of the entire upper mantle depth range. The tomographic inversion is global but focused on the Antarctic Plate, with the data sampling maximized in the Southern Hemisphere, with elaborate automated and manual outlier analysis and removal performed on the regional data, and with the regularization tuned for the region. The upper mantle of the Antarctic continent exhibits a bimodal nature. The sharp boundary along the trans-Antarctic mountains separates the cratonic eastern from tectonic western Antarctica and shows a shear-velocity contrast of up to 17 per cent at $\sim$100 km depth. The bimodal pattern is also seen in the oceanic part of the plate, with the older oceanic lithosphere beneath the Indian sector of the Southern Ocean showing higher shear velocities. The continental lithosphere in East Antarctica shows high velocity anomalies similar to those beneath stable cratons elsewhere around the world. It is laterally heterogeneous and exhibits significant thinning in the near-coastal parts of Dronning Maud Land and Wilkes Land. A low velocity channel is observed along the southern front of the West Antarctic Rift System and is probably related to Cenozoic rifting. High seismic velocity anomalies are detected beneath the Antarctic Peninsula and are likely to indicate fragments of the recently subducted Phoenix Plate Slab. Low velocity anomalies beneath Marie Byrd Land extend into the deep upper mantle and are consistent with a deep mantle upwelling feeding West Antarctica intraplate magmatism.
Nutraceutical potential of modified Thai red curry paste: antioxidant, anti-inflammatory, and gut microbiota modulation
Authors: Detarun Preeyabhorn , Wichienchot Santad , Siripongvutikorn Sunisa , Utaipan Tanyarath , Samakradhamrongthai Rajnibhas Sukeaw , Wittaya Thawien , Punvichai Teerasak , Naher Jasmin
Published: January 2025

Thai red curry paste (TRCP) is a traditional product used for health benefits, although its potential use as a nutraceutical product has not yet been explored. Therefore, this study investigated the effectiveness of traditional (CON) and modified TRCP (M1-TRCP and M2-TRCP) by assessing antioxidants, anti-inflammation, cytotoxicity and gut microbial diversity. The results showed that antioxidant activities were higher in M2-TRCP than in M1-TRCP and CON samples. The major phytochemical constituents present in TRCP have been identified as citric acid, feluric acid and various glycosidic derivatives. The anti-inflammatory effect was found that the 2.5 mg mL−1 CON, M1-TRCP and M2-TRCP could reduce NO2 by 21.24, 11.01 and 10.72 μM without cytotoxicity, respectively. In gut simulation models, it was found that the production of SCFAs viz. acetic acid was increased tremendously by 5 times in CON, where increased values observed 6 and 8 times in M1-TRCP and M2-TRCP (p < 0.05). The 16 s rRNA results elucidated that in the M2-TRCP sample, gut microflora was dominated by phyla Actinobacteria and genus Bifidobacterium. This study highlights the potential of nutrient uptake in the gut and enhances bioavailability by reducing oxidation and inflammation. Additionally, the knowledge gained benefits the further development of TRCP into functional or nutraceutical products.
Typical Ranks of Random Order-Three Tensors
Authors: Breiding Paul , Eggleston Sarah , Rosana Andrea
Published: January 2025

In this paper we study typical ranks of real $m\times n \times \ell $ tensors. In the case $ (m-1)(n-1)+1 \leq \ell \leq mn$ the typical ranks are contained in $\{\ell , \ell +1\}$, and $\ell $ is always a typical rank. We provide a geometric proof of this fact. We express the probabilities of these ranks in terms of the probabilities of the numbers of intersection points of a random linear space with the Segre variety. In addition, we give some heuristics to understand how the probabilities of these ranks behave, based on asymptotic results on the average number of real points in a random linear slice of a Segre variety with a subspace of complementary dimension. The typical ranks of real $3\times 3\times 5$ tensors are $5$ and $6$. We link the rank probabilities of a $3\times 3 \times 5$ tensor with i.i.d. Gaussian entries to the probability of a random cubic surface in ${\mathbb{R}}\textrm{P}^{3}$ having real lines. As a consequence, we get a bound on the expected number of real lines on such a surface.
Conceptually accurate signed English transliteration: Effects of speaking rate and lag time on production accuracy
Authors: Krause Jean C , Smith Andrea A , Surrency Steven F
Published: January 2025

This paper is the fifth in a series concerned with factors affecting the level of access that educational interpreters provide to deaf and hard-of-hearing students. In previous papers, we have examined accuracy and intelligibility of educational interpreters who use Cued Speech (CS) and Signing Exact English (SEE). In this study, accuracy, or the proportion of the message correctly produced by the interpreter, was evaluated in 12 Conceptually Accurate Signed English (CASE) transliterators with varying degrees of experience at 3 different speaking rates (slow, normal, fast). Results were similar to previously reported data for CS and SEE transliterators: (a) speaking rate had a large negative effect on accuracy, primarily due to increased frequency of omissions, and (b) lag time had a very small negative effect on accuracy, accounting for just 3% of the variance. A small difference from previous studies was that increased experience level was not associated with increased accuracy; rather, all experience groups performed similarly. Finally, like their CS and SEE counterparts, the overall accuracy of the CASE transliterators (61% on average) was relatively low, which continues to raise concerns about the quality of transliteration services that (at least some) children receive in educational settings.
Introduction
Authors: Beck J. Gayle
Published: January 2025

This introductory chapter provides an overview of group cognitive behavioral therapy for the treatment of posttraumatic stress disorder (PTSD). Group treatments for PTSD like this one are widely used in clinical practice. One role of the therapists conducting this program is to facilitate cohesion among group members to establish a culture of collaboration and mutual support. The chapter outlines the four symptom clusters of PTSD: intrusion symptoms, avoidance symptoms, negative thoughts and feelings, and heightened arousal and reactivity. It also integratess issues involving group processes during Group CBT and the parameters of Group CBT for PTSD.
Welcome to Group CBT for PTSD
Authors: Beck J. Gayle
Published: January 2025

This chapter introduces the key concepts surrounding group cognitive behavioral therapy (CBT) treatment, particularly focused on the symptoms of posttraumatic stress disorder (PTSD). It discusses how group CBT can help people learn skills to manage the symptoms of PTSD. Working on these skills in a group with other Veterans can be rewarding and helpful, and also valuable to recovery. The chapter explains that psychological science developed tools to help people reclaim some of the parts of their lives surrendered to PTSD. It looks into how therapists will develop an understanding of each person's circumstances and work to help everyone connect during Group CBT.
Session 2: Understanding Avoidance, Mindfulness (Part I)
Authors: Beck J. Gayle
Published: January 2025

This chapter will help Veterans to understand avoidance and mindfulness so that group cognitive behavioral therapy (CBT) treatment will more effective. It explains how trauma-related memories can lead to avoidance. Group CBT begins with discussing avoidance and other forms of unhealthy coping. The one-step-at-a-time approach to exposure used throughout this program gives clients the chance to test their predictions about danger and safety using their specific trauma cues. The chapter then explains how mindfulness can help people learn to live in the present. It also notes the importance of learning how to focus attention on one thing to encourage mindfulness.
Session 5: Written Exposure (Part II) and Learning Progressive Muscle Relaxation (Seven Muscle)
Authors: Beck J. Gayle
Published: January 2025

This chapter builds on the information and skills introduced in the prior one, providing more information about written exposure and progressive muscle relaxation. Written exposure gives Veterans a chance to tell their story of trauma from their own perspective, thus providing a chance to process the feelings that were happening at the time. . The chapter provides a shortened version of progressive muscle relaxation, condensing the 16 muscle groups into seven. It emphasizes how techniques such as progressive muscle relaxation can help to alleviate the physical symptoms of posttraumatic stress disorder and can be helpful to use following written exposure.
Functions of the Hippocampal Formation, Its Biological Characteristics, and Its Use as a Neurobiological Model
Authors: Morris Richard , Amaral David , Bliss Tim , Duff Karen , O’Keefe John
Published: January 2025

This history of studies of the hippocampus is a glorious one, with contributions from anatomists, physiologists, molecular biologists and, in the modern era, computational neuroscientists. This chapter summarizes key concepts and discoveries in hippocampal neurobiology up to the modern era characterized by integrative neuroscience. The striking organization of the hippocampus has long attracted the attention of many investigators of the central nervous system. The chapter considers historical concepts such as a possible role in olfaction, emotion, attention control, before embracing the contemporary idea of a key role in memory. The hippocampus has, moreover, served as a test bench for the development of a variety of general neuroscientific analyses and experimental techniques, leading on to current interest in its role in several types of neural dysfunction and neuropathology.
Molecular Mechanisms of Synaptic Function in the Hippocampus
Authors: Donlin-Asp Paul G. , Hafner Anne-Sophie , Schuman Erin M.
Published: January 2025

This chapter details the molecular mechanisms of synaptic function in the hippocampus. Proteins are the main effectors of cellular functions in all cells, including neurons. In neurons, the proteome present in a synaptic compartment reflects the type of synapse and history. The chapter then elaborates on the cellular mechanisms currently known to target proteins to synaptic compartments before discussing local protein synthesis and its role within both dendrites and axon. It also considers the unresolved issues revolving around the key concepts of mRNA targeting, mRNA half-lives and local versus global proteome remodeling in axons and dendrites. It ends with a discussion of what is known about the dysregulation of protein synthesis in disease states.
The Entorhinal Cortex
Authors: Kanter Benjamin R. , Moser Edvard I. , Witter Menno P.
Published: January 2025

This chapter begins with an historical overview of the definition of the entorhinal cortex, its relationship with the hippocampus, and why a separate chapter is deemed relevant. Subsequent sections review the neurostructural and connectional organization of the entorhinal cortex. This is followed by a description of the functional relevance of these various components, including some of the current main theoretical underpinnings of these various functions. Finally, the dysfunctions that contribute to neurodegenerative, neurodevelopmental, and psychiatric disorders, such as Alzheimer’s Disease, medial temporal lobe epilepsy, and schizophrenia, are briefly summarized.
Theories of Hippocampal Function
Authors: McKenzie Sam , Gobbo Francesco , Morris Richard G. M.
Published: January 2025

This chapter outlines theories of hippocampal function from the perspective of their computational role, algorithms and neurobiological implementation. It begins with two foundational theories focusing on spatial representations and navigation, and on declarative memory, together with the varied lines of evidence held to support these very distinct perspectives. It discusses other theories that sought to unify these different approaches, culminating in the contemporary view that the hippocampal formation plays a vital role in the encoding of new episodic memory traces and the binding of events to spatial contexts. It examines current interest in engrams using state of the art opto- and chemogenetic technology, and ends with a discussion of the role of the hippocampus in systems consolidation and the creation of schemas in cortex for the assimilation of new knowledge.
Picturing Depression: Faces, Backgrounds, and Foregrounds
Authors: Fogel Barry S. , Jiang Xiaoling
Published: January 2025

Depression takes diverse forms, each with distinctive epidemiology, phenomenology, and optimal treatments. In each case of depression, culture is background; unique individual circumstances are foreground. Exemplary cases are described. In historical and contemporary Japan, older people often are devalued and socially excluded; this can lead to “lonely deaths” from self-neglect or unnatural deaths including suicides. China’s long-standing tradition of authoritarian parenting and burdensome filial obligation often underlies depression in younger adults. American regions have depression-relevant cultural differences as large as those between nations. In Utah, high gender inequality is associated with a high prevalence of depression in young women. In Connecticut high income and wealth inequality entail a high prevalence of depression and problematic substance use among people of lower socioeconomic class. Cultural awareness, including knowledge of different communication styles, can empower clinicians to make more accurate diagnoses of depression and build therapeutic relationships.
Cultural Correlates and Clinical Consequences
Authors: Fogel Barry S. , Jiang Xiaoling
Published: January 2025

Cultural identity is associated with diet, activities, sleeping habits, and patterns of substance use. All directly relate to the risk and expressions of depression and the bipolar spectrum. Related structural factors include housing quality; environmental hazards; quality of food, healthcare, and public education; and availability of highly lethal means of self-harm. It influences the prevalence of depression phenotypes: melancholic, anxious, primarily somatic, or highly externalized “masculine depression.” External stigma of depression is universal, but its details are culture-dependent. The acceptability and feasibility of specific treatments vary by culture. Before prescribing against a patient’s culturally based biases, a clinician should consider not only medication and psychotherapy but also lifestyle or environmental changes; complementary, alternative, and integrative medicine; antidepressant smartphone apps; light therapy; and non-invasive brain stimulation. Depression biomarkers soon may have a role in selection of treatments that are both culturally compatible and likely to work.
Flying High, Feeling Low: Depression in Airline Pilots
Authors: Fogel Barry S. , Jiang Xiaoling
Published: January 2025

The rare but extremely disturbing phenomenon of intentional crashes of passenger flights draws attention to the problem of untreated depression and bipolar illness among airline pilots. Surveys suggest that pilots have a high prevalence of depressive symptoms, though they rarely seek clinical care for them. Risk factors include chronobiologic stress; frequent exposure to hypoxia, noise, and polluted air; high rates of obesity and sleep apnea; loneliness in long-haul pilots; and work–family conflict. The highly masculine composition and culture of the profession entails denial and externalization of depression and a high rate of sexual harassment of female pilots. Severe institutional stigma combines with pilots’ working conditions to impede standard treatments of depression. Mental health education, lifestyle modification, peer support, and non-pharmacologic treatments can help pilots with subsyndromal depressive symptoms within the constraints of their working conditions and occupational culture.
Perioperative Surgical Home Care Model
Authors: Campbell Eileen , Limoncelli Janine
Published: January 2025

The perioperative surgical home (PSH) is a system used to coordinate and organize patient care that is patient-centered and physician-led. This system is a team-based approach to medical management that spans the entire time frame of the patient’s surgical experience from the initial decision to proceed with a surgical intervention to final discharge to home, an acute care facility, or skilled nursing facility. The team consists of all healthcare professionals who will play a part in the patient’s surgical experience. The emergence of the PSH occurred in 2011, with the proposal of the surgical home draft submitted to the American Society of Anesthesiologists House of Delegates. There have since been numerous summits, panels, and symposiums dedicated to the growth and improvement of the surgical home concept. In addition, there has been a steady effort to educate medical caregivers about the development and advantages of a PSH within different hospital systems.
Perioperative Management of Medications for Substance Use Disorders
Authors: Hickey Thomas R. , Boyaji Shafik
Published: January 2025

Substance use disorders are treatable, chronic conditions, and opioids remain the most lethal drugs per the UN 2022 World Drug Report. Risky use of substances and addiction are the largest and most preventable cause of morbidity in the United States, accounting for one-third of hospital inpatient costs and one-fourth of deaths. Data from Centers for Disease Control show that the opioid crisis causes approximately 80,000 deaths annually in the United States, with staggering downstream costs. As opioid use disorder has increased, so, too, has the use of medications for opioid use disorder: buprenorphine, methadone, and naltrexone. Substance use disorder and its treatments present unique perioperative challenges, particularly in pain management. Effective care of these patients requires knowledge of the nature of the disorder, the basic pharmacology of the substances themselves and of the medicines used to treat these disorders, and an understanding of best practices for perioperative management.
Indications for Preoperative C-Spine Imaging for Elective Procedures
Authors: Richman Deborah C.
Published: January 2025

This chapter discusses the importance of airway assessment and management during the perioperative period. These essentials are the responsibility of the anesthesiologist; a careful medical history and physical examination are the key elements of airway assessment. Occasionally cervical spine (c-spine) imaging is required for safe care of the patient perioperatively. Trauma is the obvious example, but elective patients who have certain diseases or syndromes also may require imaging. Rheumatoid arthritis, as an example, is briefly reviewed. It is important for the clinician to choose tests and imaging wisely and be mindful of the value of the test—only ordering when it may change perioperative management or outcomes.
AHA Guidelines Application
Authors: Papke Samuel , Benson Michael , Zimmerman Joshua
Published: January 2025

The delivery of anesthesia for major noncardiac surgery to patients with significant cardiovascular disease is a common clinical scenario, particularly given the aging population and the rising prevalence of cardiovascular comorbidities. These patients present a unique set of anesthetic and perioperative challenges requiring in-depth discussions with the patient, the surgeon, and other subspecialists. As perioperative physicians, anesthesiologists often must advise on the perioperative management of medications, the quantification of surgical risk, the necessity in pursuing further testing, and even the diagnosis of cardiovascular disease. While these considerations can be complex, there are multiple published guidelines to assist with the management of these patients.
Perioperative Atrial Fibrillation and Anticoagulation Management
Authors: Tao Jing , Oprea Adriana D.
Published: January 2025

Atrial fibrillation (AF) is a cardiac arrhythmia commonly encountered during the preoperative evaluation of surgical patients. Many patients with AF will be chronically anticoagulated to reduce the risk of cerebral vascular accident (CVA). Currently, two major classes of oral anticoagulants exist: vitamin K antagonists and direct oral anticoagulants. Although perioperative anticoagulation management can prove challenging, knowledge of their pharmacokinetics along with advanced planning can successfully minimize the risk of surgical bleeding as well as the patient’s risk of thrombosis.
COPD
Authors: Rajaleelan Wesley , Wong Jean
Published: January 2025

The perioperative management of patients with chronic obstructive pulmonary disease (COPD) who are currently still smoking is a challenging task for the perioperative physician. The risks for postoperative complications, increased morbidity, and mortality are high in these patients. In this chapter, the authors review the physiologic changes of COPD, preoperative assessment, and optimization of a patient with COPD prior to spine surgery. The profound impact of smoking on adverse perioperative outcomes, particularly in the context of spine surgery is highlighted. The chapter also discusses behavioral and pharmacological smoking cessation interventions that have been shown to increase abstinence and can reduce surgical complications.
Cirrhosis and Truly Elective Major Surgery
Authors: Jakab Sofia S. , Oprea Adriana D.
Published: January 2025

The prevalence of chronic liver diseases and cirrhosis is increasing but so is the availability and efficacy of therapies for these patients. As a result, patients with cirrhosis live longer and undergo a variety of surgical procedures. In addition, many patients and their surgical team are not aware of the presence of cirrhosis, which is mostly asymptomatic in the early stages, leading to intra- and postoperative complications. Perioperative management of patients with cirrhosis requires special considerations depending on the stage and complications of cirrhosis and the degree of liver synthetic dysfunction and portal hypertension, as well as the type of surgery (urgency, complexity) and the patient’s comorbidities, overall prognosis, and eligibility for liver transplantation. Anesthesia clinicians need to be familiar with diagnosing cirrhosis, applying the scoring systems for preoperative risk evaluation, and optimizing these patients before surgery.
Pregnant Patient for Non-Obstetric Surgery
Authors: Salimi Nayema K. , Fardelmann Kristen L.
Published: January 2025

Non-obstetric surgery occurs in up to 2% of all pregnancies in the United States and most commonly involves abdominal and orthopedic procedures. A multidisciplinary approach to care including experts in surgery, obstetrics, anesthesia, and neonatology provides the framework to optimize maternal and fetal outcomes. Medically necessary surgery in the pregnant patient should never be delayed because delaying care is associated with significant maternal and fetal morbidity and mortality. Although significant concern regarding anesthetic exposure in pregnancy and the potential for adverse fetal outcomes exists, no commonly used anesthetic agent has been shown to have negative effects on neurocognitive development or teratogenicity at any gestational age. While specific challenges exist when caring for the pregnant patient, the application of general ethical principles will help guide counseling and shared decision-making.
When DNR Stands in the OR
Authors: Kras Joseph F.
Published: January 2025

The Do Not Resuscitate (DNR) order (also referred to variously as DNAR [Do Not Attempt Resuscitation] and AND [Allow Natural Death]) is one of the most controversial orders in medicine and, not infrequently, a subject of contention between the patient/family and the medical staff. Autonomy of the patient is nearly sacrosanct in Western (and especially American) medicine. What the patient wants, the patient gets. Yet physicians are dedicated and sworn to provide the best medical treatment possible to their patients. These precepts may come into direct conflict when the patient dictates that resuscitation not be provided to them, especially if the need for resuscitation has been precipitated by the actions of the physicians taking care of that patient.
Perioperative Care of the Cancer Patient
Authors: Helder Cory W. , Pedoto Alessia
Published: January 2025

With advances in oncological care, an increasing population of cancer survivors continue to live with the toxicities of those treatments. Knowledge of prior treatments and neoadjuvant therapy is important for the perioperative planning for both patients undergoing treatment and those in remission. Many of the treatments have short-term toxicities and latent effects with the potential to negatively impact the heart, lung, endocrine, hematologic systems and increase future malignancy risk. The optimization of a patient’s health prior to treatment is vital since often there is limited recovery time between therapies. Additionally, new families of medications are being developed for maintenance therapy that harness the native immune system to attack malignancies: these same cells can target susceptible healthy cells. Familiarity with treatments, strategies for prehabilitation, and methods for reducing risk are important during the short preoperative window before surgery in this increasingly large surgical population.
My Patient in the PACU Is Not Making Any Sense
Authors: Steadman Joy
Published: January 2025

Altered mental status in the postoperative period is a serious medical problem that needs to be diagnosed and treated promptly. The differential diagnosis for altered mental status can be linked to individual patient characteristics such as frailty, age, preoperative organic brain pathology, medication interactions, thromboembolic phenomena, surgical or positioning complications, withdrawal from substances, and physiologic insults such as prolonged hypotension or hypoxia. Altered mental status from delirium is more frequent in the elderly after surgery and has tremendous implications as regards length of stay, morbidity, and mortality. Methods reliably preventing delirium do not yet exist, and treatment of altered mental status postoperatively depends on contributing factors. Management of delirium requires an interdisciplinary approach.
The HR Monitor Is Alarming in the PACU
Authors: Dobrusin Avi , Kanakaraj Muthuraj
Published: January 2025

All patients arriving at PACU should have standard American Society of Anesthesiologists (ASA) monitoring including continuous ECG. Handoff from the intraoperative clinical staff to the PACU staff is vital. At-risk patients may develop any arrhythmias from bradycardia to tachyarrhythmias (including torsades de pointes), symptomatic or asymptomatic. A high index of clinical suspicion and prompt management is critical. Focused history, clinical examination, resuscitation, and appropriate management of specific arrhythmias should be instituted. Simultaneously, any underlying pathology precipitating the arrhythmias should be evaluated and treated. A multidisciplinary intervention by the anesthesiologists, nurses, surgeons, and the resuscitation team should be done at the earliest. PACU should have immediate access to the resuscitation equipment. All staff should be certified and updated in the Advanced Cardiac Life Support guidelines.
Assessment and challenges of the use of assessment tools across cultures
Authors: Saraf Gayatri , Chaturvedi Santosh K.
Published: January 2025

Somatization is highly prevalent and disabling, and leads to high primary care utilization. The number, diversity, and expression of somatic symptoms are highly influenced by culture. Measurement of somatic symptoms can be very challenging because of the lack of a universally agreed-upon definition, the qualitative and subjective nature of symptoms, and difficulties in quantifying the pattern, attribution, and frequency. Currently available instruments for assessment vary widely in their focus and time frame of assessments, and have several limitations. While several clinician-rated, self-report, and diagnostic instruments are available to assess somatic symptoms, there is a dearth of instruments that will lend themselves to culturally informed and sensitive assessment. This chapter aims to delve into the challenges in assessment of somatization and limitations of currently available instruments. This chapter discusses and examines some commonly used instruments with a cultural lens, summarizes the findings, and provides future directions.
Somatization disorders in incarcerated populations
Authors: Vajawat Bhavika , Venkataramu N. Vyjayanthi , Varshney Prateek , Math Suresh Bada
Published: January 2025

An incarceration is a complex event that holds various implications for the mental health of the individual. It leads to changes in the psychosocial environment, diminution of human rights, attitudinal barriers such as stigma, and poor social support in an individual who might already be vulnerable, biologically and developmentally. Consequently, and intuitively, the prevalence of mental illness is several folds higher among prisoners compared to the general population. Research related to somatization among prisoners, in particular, is sporadic. However, available research on incarcerated populations indicates a wide range of prevalence of somatization, possibly due to variations in defining somatization disorders and the methodology used in identifying them. Unique considerations such as simulation of symptoms for primary or secondary gain, a higher prevalence of comorbid personality disorders such as antisocial and borderline personality disorders, and a paucity of human resources in prisons have a myriad of implications on the assessment and management of somatization in prisoners, thereby warranting the need for these to be addressed. These sparse, yet important, findings have also provided a framework for further research in this area.
Somatization in Russia: Historical research aspects and their influence on clinical practice
Authors: Chumakov Egor , Petrova Nataliia
Published: January 2025

Somatization is a tendency to experience and communicate somatic distress and symptoms unaccounted for by pathological findings, to attribute them to physical illness, and to seek medical help for them, in response to psychosocial stress. In the multicentre, cross-sectional epidemiological study SYNTHESIS from Russia conducted in 2007–9 (n = 1849), somatoform/hypochondriac disorders were found in 28.1% of patients in oncology, cardiology, dermatology, rheumatology, and pulmonology practices. Physical symptoms are especially prevalent in people who have mental health problems such as depressive and anxiety disorders. A well-known phrase by the Soviet psychiatrist D. D. Pletnev (1927) states: ‘There are no somatic diseases without resulting mental abnormalities, just as there are no mental diseases isolated from somatic symptoms.’ This chapter presents data on theoretical and practical approaches to defining somatization in patients with mental disorders in Russia.
Somatization in Paraguay
Authors: Gonzalez-Urbieta Israel , Melgarejo Osvaldo , Torales Julio
Published: January 2025

Paraguayans tend to be quiet, reserved, and of few words, so it can be difficult for them to express their feelings. They prefer balance and moderation, and dislike outbursts. In the Paraguayan culture, somatic ailments are usually treated first in the local community, through interventions based on the patient’s (or family members’) previous experience with similar ailments. Phytotherapy, generally known and passed down from generation to generation, is more accepted and ritualistic in nature, and its efficacy is conditional on compliance with the indication. If it does not work or if the discomfort persists, the family physician is consulted, regardless of the specialty. It is the family physician who solves the problem or refers the person to a higher level of complexity of care. This chapter focuses on these characteristics of somatization in Paraguay, from its cultural characteristics to its clinical features.
Somatization in Africa
Authors: Ojeahere Margaret , Gaffaz Rwanda , Handuleh Jibril I. M.
Published: January 2025

This chapter introduces somatisation disorder (somatic symptom disorders) in Africa and relates it to both physical and mental health. Somatisation disorder was previously considered to be more common in non-western societies and rare in developed countries, however, recent findings suggest the contrary. Accumulating evidence demonstrates that somatisation disorder among Africans can be expressions of mental distress. Idioms of expression are indicators that Africans have their unique way of manifesting mental distress. The subsequent parts of this chapter explore the aetiology and presentations of somatisation disorders in Africa. Several studies from Africa have shown disparities in the presentation of somatisation disorder along lines of age, gender, socioeconomic status, and history of traumatic experiences. Interestingly, demonstrable similarities occur despite unique patterns of somatisation disorder across regions of Africa. The mainstay of management of somatisation disorder is to improve outcomes and the quality of life of affected individuals, their families and to reduce the burden of care. Increased research and collaborative activities across Africa and other countries will ameliorate the burden of care. Adoption of local and culturally appropriate interventions which consider the complex interplay of biological, psychological, and social factors is essential for the effective management of somatisation disorder.
General principles of management of somatization
Authors: Orsolini Laura , Cicolini Angelica , Salvi Virginio , Volpe Umberto
Published: January 2025

Somatic symptoms are often the most common reasons for a medical consultation, considerably placing huge demands on health and financial resources by mainly being subject to several, often inappropriate and unhelpful, investigations. They may determine distress to patients and their clinicians and family members, representing a challenge for all health professionals including primary care physicians and psychiatrists. Treatment of somatic symptoms and related disorders (SSRDs) comprises a multimodal approach. The most evidence-based and effective treatments include cognitive behavioural therapy (CBT) and, in some cases, pharmacotherapy. In clinical practice, serotonin reuptake inhibitors and tricyclic antidepressants are routinely prescribed in SSRDs. This chapter discusses the fundamental steps to be followed for correct management of SSRDs, by providing an overview of the current updated literature regarding both non-pharmacological and pharmacological strategies.
Self-Harm
Authors: Quarshie Emmanuel Nii-Boye , House Allan
Published: January 2025

‘Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self-harm—how common it is, who is at risk, what methods are used, and how severity is judged, as well as what forms self-harm can take. A final chapter reviews what is known about reasons for self-harm, moving beyond the idea that it is solely a symptom of mental disorder. The second section reviews approaches to prevention of self-harm and its treatment in clinical and non-clinical settings. The third section takes a person-centred approach, reviewing approaches to self-management and to approaching the personal encounter for professionals and others likely to meet self-harm in their working lives. A final chapter considers some of the challenges remaining in understanding and responding to self-harm. There is a list of resources written, as is the rest of the book, with an international readership in mind, including readers from low- and middle-income countries.
Care at the end of life
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter discusses medical care at the end of life. It covers thinking about death, symptom control in palliative care, care in the last days of life, verification of death, and what happens after the death of a patient.
Gastroenterology
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter discusses gastroenterology. It covers emergency treatment of abdominal pain, gastrointestinal bleeding, and liver failure. The chapter also discusses abdominal pain, acute upper GI bleeds, acute lower GI bleeds, nausea and vomiting, diarrhoea, constipation, liver failure, and jaundice.
Primary care
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter covers issues in the context of primary care. It discusses chronic disease prevention and management, chronic limb pain, limb swelling, joint pain, neck lumps, ENT, groin lumps, and breast lumps. It outlines the warning signs for recognizing the sick child. It then covers gynaecological issues such as vaginal bleeding, gynaecological causes of pain, contraception, early pregnancy (1st trimester), later pregnancy (2nd and 3rd trimester), delivery, and postpartum, and finishes on breast lumps
Evidence-based mental health nursing practice
Authors: Callaghan Patrick , Crawford Paul
Published: January 2025

Evidence-based practice is an important part of a mental health nurse’s role. Using the best possible, and the best available, evidence will enhance mental health nursing practice, provide an empirical justification for that practice, and assure people receiving mental health nursing care that the care they receive is up to date. This chapter examines evidence-based mental health nursing and shows how mental health nurses can use the best available evidence for their practice. The chapter examines the origins of evidence-based practice, describes contested issues on the topic, and discusses how mental health nurses can evaluate evidence to use in their practice.