bluuebunny/crossref_metadata_2025 huggingface dataset:
Alternative oxidase is an important player in the regulation of nitric oxide levels under normoxic and hypoxic conditions in plants
Authors: Kumari Aprajita , Pathak Pradeep Kumar , Bulle Mallesham , Igamberdiev Abir U , Gupta Kapuganti Jagadis
Published: April 2019

Plant mitochondria possess two different pathways for electron transport from ubiquinol: the cytochrome pathway and the alternative oxidase (AOX) pathway. The AOX pathway plays an important role in stress tolerance and is induced by various metabolites and signals. Previously, several lines of evidence indicated that the AOX pathway prevents overproduction of superoxide and other reactive oxygen species. More recent evidence suggests that AOX also plays a role in regulation of nitric oxide (NO) production and signalling. The AOX pathway is induced under low phosphate, hypoxia, pathogen infections, and elicitor treatments. The induction of AOX under aerobic conditions in response to various stresses can reduce electron transfer through complexes III and IV and thus prevents the leakage of electrons to nitrite and the subsequent accumulation of NO. Excess NO under various stresses can inhibit complex IV; thus, the AOX pathway minimizes nitrite-dependent NO synthesis that would arise from enhanced electron leakage in the cytochrome pathway. By preventing NO generation, AOX can reduce peroxynitrite formation and tyrosine nitration. In contrast to its function under normoxia, AOX has a specific role under hypoxia, where AOX can facilitate nitrite-dependent NO production. This reaction drives the phytoglobin–NO cycle to increase energy efficiency under hypoxia.
Hierarchical clustering reveals unique features in the diel dynamics of metabolites in the CAM orchid Phalaenopsis
Authors: Ceusters Nathalie , Luca Stijn , Feil Regina , Claes Johan E , Lunn John E , Van den Ende Wim , Ceusters Johan
Published: April 2019

Crassulacean acid metabolism (CAM) is a major adaptation of photosynthesis that involves temporally separated phases of CO2 fixation and accumulation of organic acids at night, followed by decarboxylation and refixation of CO2 by the classical C3 pathway during the day. Transitory reserves such as soluble sugars or starch are degraded at night to provide the phosphoenolpyruvate (PEP) and energy needed for initial carboxylation by PEP carboxylase. The primary photosynthetic pathways in CAM species are well known, but their integration with other pathways of central C metabolism during different phases of the diel light–dark cycle is poorly understood. Gas exchange was measured in leaves of the CAM orchid Phalaenopsis ‘Edessa’ and leaves were sampled every 2 h during a complete 12-h light–12-h dark cycle for metabolite analysis. A hierarchical agglomerative clustering approach was employed to explore the diel dynamics and relationships of metabolites in this CAM species, and compare these with those in model C3 species. High levels of 3-phosphoglycerate (3PGA) in the light activated ADP-glucose pyrophosphorylase, thereby enhancing production of ADP-glucose, the substrate for starch synthesis. Trehalose 6-phosphate (T6P), a sugar signalling metabolite, was also correlated with ADP-glucose, 3PGA and PEP, but not sucrose, over the diel cycle. Whether or not this indicates a different function of T6P in CAM plants is discussed. T6P levels were low at night, suggesting that starch degradation is regulated primarily by circadian clock-dependent mechanisms. During the lag in starch degradation at dusk, carbon and energy could be supplied by rapid consumption of a large pool of aconitate that accumulates in the light. Our study showed similarities in the diel dynamics and relationships between many photosynthetic metabolites in CAM and C3 plants, but also revealed some major differences reflecting the specialized metabolic fluxes in CAM plants, especially during light–dark transitions and at night.
Jasmonate action in plant defense against insects
Authors: Wang Jiaojiao , Wu Dewei , Wang Youping , Xie Daoxin
Published: April 2019

Herbivorous insects represent one of the major threats to sessile plants. To cope with herbivore challenges, plants have evolved sophisticated defense systems, in which the lipid-derived phytohormone jasmonate plays a crucial role. Perception of insect attack locally and systemically elicits rapid synthesis of jasmonate, which is perceived by the F-box protein COI1 to further recruit JAZ repressors for ubiquitination and degradation, thereby releasing transcription factors that subsequently activate plant defense against insect attack. Here, we review recent progress in understanding the molecular basis of jasmonate action in plant defense against insects.
Psychiatry and Its Checkered Past
Authors: Puckett Judith , Shumway Jones David
Published: April 2019

This chapter examines the history of critiques that have been made of psychiatric practice in specific times and specific places. Though psychiatry is well-established as part of the medical profession and requires completion of a medical education all doctors receive, psychiatrists are often viewed as distinct from other doctors, and psychiatry continues to be viewed negatively in the public eye. Psychiatrists themselves have been partly to blame for this; the profession originally spent decades attempting to differentiate itself from the other medical professions. Since it is not possible to cover every aspect of the history of critiques of psychiatry, the chapter focuses on two major problems that continue to influence how psychiatry is practiced and perceived today: the development of asylums as a form of confinement for those who are mentally ill, and the development of psychiatric nosology and diagnosis. By exploring the continuum of mental illness and the idea of “normal versus abnormal,” the chapter offers psychiatrists a framework for how they can think about their work going forward.
Navigating Cultural Challenges in Patient–Clinician Dyads
Authors: Immanuel Josepha A. , Joey Cheung Chun-Yi , Trinh Nhi-Ha T.
Published: April 2019

Studies have proposed that background concordance of the patient and clinician increases the likelihood of a “good fit” and strengthens the patient–clinician relationship, especially in groups who typically do not seek psychiatric care. There are, however, limitations and challenges to the presumed benefit of patient–clinician matching. In this chapter we explore these challenges using three in-depth case vignettes and discuss the effects of over-identification on therapeutic progress, background concordance on rapport-building, and self-disclosure on therapeutic outcome. We briefly describe a workshop for trainees aimed to introduce and to practice interviewing techniques with patients of “similar” versus “different” backgrounds from their own.
Classification of Patterns and Syndromes on Autonomic Testing
Authors: Novak Peter
Published: April 2019

This chapter lists the main syndromes and patterns seen during autonomic testing, based on classification according to physiology and/or functional anatomy. Although the classification is arbitrary, it is useful in that it allows the diagnostician to see classify patterns in test results that assist in the correct interpretation of the results. Presented in a series of easy to access lists, the most common patterns are autonomic failure, autonomic overactivity, paroxysmal dysautonomia orthostatic hypotension syncope, hyperventilation, cerebral hypoperfusion, cerebral blood flow velocity, and cerebral autoregulation disorders.
Case 1: Normal Example
Authors: Novak Peter
Published: April 2019

This chapter shows normal patterns of cardiovascular and cerebrovascular responses to tilt, deep breathing, the Valsalva maneuver, and skin biopsy.
Case 12: Postural Tachycardia Syndrome with Presyncope and Syncope
Authors: Novak Peter
Published: April 2019

The patient became dizzy at the beginning of the tilt and continued to be dizzy and anxious. She had a presyncopal reaction that preceded neurally medicated syncope later during the tilt. Syncope and presyncope may occur in postural tachycardia syndrome.
Case 17: Paroxysmal Dizziness in Postural Tachycardia Syndrome
Authors: Novak Peter
Published: April 2019

Paroxysmal dysautonomia can be responsible for transient dizziness and postural tachycardia syndrome (POTS).
Case 21: Orthostatic Cerebral Hypoperfusion Syndrome, Intermittent
Authors: Novak Peter
Published: April 2019

The tilt test showed mild orthostatic cerebral hypoperfusion syndrome (OCHOS) with intermittent reduction in cerebral blood flow velocity. OCHOS is associated with reduced orthostatic cerebral blood flow velocity without orthostatic hypotension or arrhythmia. Calcium channel blockers may be helpful in OCHOS.
Case 39: Hypothermia in Frontotemporal Dementia
Authors: Novak Peter
Published: April 2019

This case illustrates severe generalized autonomic failure associated with frontotemporal dementia (FTD) and hypothermia. The tilt test provoked severe sustained orthostatic hypotension associated with reduced heart rate response and a decline in cerebral blood flow velocity. Thermoregulation is a vital function of autonomic nervous system.
Case 44: Multiple System Atrophy
Authors: Novak Peter
Published: April 2019

Multiple system atrophy (MSA) is associated with severe autonomic failure of the central nervous system. Autonomic testing showed a typical MSA pattern including severe sympathetic adrenergic and parasympathetic failure with orthostatic hypotension and cerebral hypoperfusion.
Case 47: Moebius Syndrome
Authors: Novak Peter
Published: April 2019

This case illustrates patient with Moebius syndrome with autonomic symptoms of intermittent dizziness and breathing difficulties that were present since birth. Testing provoked transient orthostatic hypotension twice at the beginning of the tilt. On both occasions, blood pressure recovered, but there was no compensatory tachycardia during the hypotensive episodes. The spells were associated with a cerebral vasodilation pattern in cerebral vasculature and hypoperfusion (OCHOS). Paroxysmal hypertension, orthostatic hypotension, and autonomic symptoms are described in Moebius syndrome.
Case 48: Dyspnea
Authors: Novak Peter
Published: April 2019

A 62-year-old man, a life-long nonsmoker with no known chronic pulmonary disease, presented with slowly progressive chronic exertional dyspnea. Autonomic testing showed severe autonomic abnormalities in several domains (the total QASAT score was 37), likely due to small fiber neuropathy. Cerebral blood flow velocity was reduced in supine position and during the tilt due to hypocapnia.
Case 55: Small Fiber Neuropathy with Autonomic Failure
Authors: Novak Peter
Published: April 2019

This case demonstrates severe autonomic failure with orthostatic hypotension affecting cardiovagal and sympathetic adrenergic fibers and associated with small fiber neuropathy. Small fiber neuropathy is severe, mixed, and affecting sensory and autonomic fibers, non–length-dependent. Orthostatic cerebral blood flow velocity was reduced throughout the tilt, indicative of autoregulation failure.
Case 59: Small Fiber Neuropathy and Autonomic Failure with Elevated Voltage-Gated Potassium Channel Antibodies
Authors: Novak Peter
Published: April 2019

This case demonstrates severe autonomic failure associated with autoimmune small fiber neuropathy that was positive for elevated voltage-gated potassium channel (VGKC) antibodies. Adrenergic autonomic failure is associated with orthostatic hypotension. Low cerebral blood flow velocity during the tilt was associated with cerebral vasoconstriction.
Case 64: Ehlers-Danlos Syndrome and Small Fiber Neuropathy
Authors: Novak Peter
Published: April 2019

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. This patient had severe small fiber neuropathy, likely contributing to her pain complaints. Tilt test was negative, except for anxiety symptoms. There was no evidence of autonomic failure.
Case 69: Small Fiber Neuropathy, Hypocapnic Cerebral Hypoperfusion, and Generalized Hypermobility Spectrum Disorder
Authors: Novak Peter
Published: April 2019

Autonomic testing showed mixed small fiber neuropathy, which can be responsible for both sensory complaints and dysautonomia. Dysautonomia was generalized, but mild and was associated with mild orthostatic intolerance. The patient has generalized hypermobility spectrum disorder (GHSD).
Case 71: Small Fiber Neuropathy, Postural Tachycardia, and Mast Cell Activation Syndrome
Authors: Novak Peter
Published: April 2019

The patient has history of mast cell activation syndrome (MCAS) in which mast cells inappropriately release active substances including leukotriene and histamines, triggering symptoms of flushing and orthostatic intolerance. Small fiber neuropathy was length-dependent, mild, affecting predominantly sensory fibers. Tilt test showed postural tachycardia syndrome (POTS).
Case 72: Postural Tachycardia, Mast Cell Activation SYNDROME, and Ehlers-Danlos Syndrome
Authors: Novak Peter
Published: April 2019

The patient has history of mast cell activation syndrome (MCAS), as well as Ehlers-Danlos (EDS) syndrome. This study was indicative of mild postural tachycardia syndrome (POTS), most likely a hyperadrenergic variant which is associated with elevated orthostatic catecholamines. Both EDS and MCAS syndromes are clustered with dysautonomia.
Case 83: Small Fiber Neuropathy and Preload Failure
Authors: Novak Peter
Published: April 2019

Preload failure can be associated with small fiber neuropathy, hypocapnic cerebral hypoperfusion, and dysautonomia.
Case 92: Anxiety
Authors: Novak Peter
Published: April 2019

The tilt test can be useful in the evaluation of anxiety and to differentiate anxiety from orthostatic intolerance.
Case 93: Anxiety Mimicking Postural Tachycardia Syndrome
Authors: Novak Peter
Published: April 2019

The tilt test provoked this patient’s typical waxing and waning spells associated with palpitations and dizziness. Testing showed mild adrenergic dysfunction of unclear clinical significance and small fiber neuropathy. Anxiety can mimic and exaggerate symptoms of orthostatic intolerance.
Case 95: Fluctuating Psychogenic Dizziness
Authors: Novak Peter
Published: April 2019

Autonomic testing with cerebral blood flow velocity monitoring can be useful to evaluate psychogenic dizziness.
Case 96: Functional Neurologic Disorder and Postural Tachycardia Syndrome
Authors: Novak Peter
Published: April 2019

Cerebral blood flow velocity monitoring can be useful to diagnose psychogenic unresponsiveness.
Laboratory Tests
Authors: Bartlett John G. , Redfield Robert R. , Pham Paul A.
Published: April 2019

This chapter covers the following topics: HIV viruses including viral variants (group O and group N); immune responses to HIV and detection markers; HIV serologic tests; initial tests to detect HIV antibody; confirmatory tests to detect antibody, antigen, or RNA; false-negative and false-positive results; testing strategies and algorithms; alternative testing strategies for resource-limited countries; home tests; tests that use oral fluids; molecular tests to detect and monitor HIV infection; kinetics of viral nucleic acid production (including qualitative and quantitative RNA tests); HIV DNA assessment; uses of viral load tests; rapid molecular tests; resistance testing (including purpose and scope); resistance test methods; tests for sexually transmitted infections (STIs); screening tests for other infectious agents; and recommended reading.
Weaver Syndrome and EZH2-Related Overgrowth Syndromes
Authors: Weaver David D.
Published: April 2019

Comprehensive details on Weaver syndrome, one of the best recognized of the overgrowth syndromes, are presented in this chapter. The syndrome is characterized by overgrowth of prenatal onset, a distinctive craniofacial appearance, camptodactyly, widened metaphysis, accelerated bone age, and developmental delay. Like other overgrowth syndromes, Weaver syndrome is accompanied by an increased risk of malignancies, neuroblastoma, leukemia, and lymphoma in particular. The diagnosis relied on clinical evaluation alone until 2012 when the causative gene, EZH2, was discovered. The gene product joins with other related proteins to form a polycomb repressive complex that functions as an epigenetic signal that compacts chromatin and silences genes by histone modifications.
Artefacts
Authors: Barber Russell , Fletcher Nick
Published: April 2019

This chapter will describe the technical assumptions that produce artefacts and explain acoustic shadowing, enhancement, and reverberation, including the origin of A- and B-lines. It will also describe near-field, side lobe, and mirror image artefacts and how to avoid them. Finally, it will introduce the concept of foreshortening and how off-axis imaging can produce false images.
Right ventricular assessment
Authors: Hendron David
Published: April 2019

This chapter will outline how the right ventricle differs from the left ventricle, in terms of anatomy and physiology, and will describe the concepts of right ventricular pressure, volume overload, and ventricular interdependence. It will describe how two-dimensional echo can be used to detect right ventricular enlargement and systolic impairment, and distinguish between acute and chronic pathophysiology. The advanced section will introduce how to recognize pulmonary hypertension and use tissue Doppler analysis to assess right ventricular systolic function.
Abdominal assessment
Authors: Kirk-Bayley Justin , Doyle James
Published: April 2019

The role of focused abdominal scanning includes its use during the initial assessment of severe trauma and to guide safe drainage of ascites. Knowledge of the normal abdominal appearance is essential for the safe interpretation of focused abdominal scanning. Assessment of the sub-diaphragmatic structures is also integral to undertaking lung ultrasound. This chapter describes the technique of abdominal scanning, the ultrasonographic features of the major intra-abdominal organs, and the appearances of some common pathology.
Acute kidney injury
Authors: Harrison Alex
Published: April 2019

Ultrasound assessment of the urinary tract is frequently undertaken to identify post-renal or obstructive causes of renal failure. This chapter describes the normal renal sonoanatomy and the technique for scanning the renal tract, including the bladder. The sonographic features of the common pathology that may be identified are described, including the classification of hydronephrosis. The advanced section introduces the role of ultrasound in assessing renal perfusion.
Acute respiratory distress syndrome
Authors: Victor Kelly , Kirk-Bayley Justin , Ioannou Nicholas
Published: April 2019

This chapter will review the targets for ultrasound assessment, including biventricular function, extravascular water, and systemic volume assessment. Importantly, it will discuss how to differentiate cardiogenic from non-cardiogenic pulmonary oedema, how to recognize acute cor pulmonale, and when to look for a patent foramen ovale. The advanced section will introduce Doppler-based methods to evaluate right ventricular systolic function and pulmonary arterial systolic pressure, which can both become compromised in acute respiratory distress syndrome.
Percutaneous tracheostomy
Authors: Labib Ahmed , Bodenham Andrew R
Published: April 2019

Percutaneous tracheostomy is a common procedure in the intensive care unit, and ultrasound can be used to improve the safety and success of the procedure. This chapter reviews the role of a pre-procedural ultrasound examination and describes the technique and the normal sonoanatomy. The use of ultrasound to guide tracheal cannulation during percutaneous tracheostomy and crycothyrotomy is also described.
Lumbar puncture
Authors: Margetts Paul
Published: April 2019

Undertaking lumbar puncture in the intensive care patient can be technically challenging due to patient positioning and body habitus. Ultrasound guidance can improve the success rate and is relatively easy to learn. This chapter describes the normal sonoanatomy of the lumbar spine and how to use ultrasound to guide lumbar puncture.
The athlete’s heart in children and adolescents
Authors: Stuart Graham , Pieles Guido E.
Published: April 2019

Athlete’s heart occurs in childhood but is less well understood than in adults. In children, exercise-related cardiac remodelling occurs but with more heterogeneity than in adults. It can be difficult to distinguish age-related cardiac maturation, exercise-related adaptation, and the early manifestation of cardiac disease such as cardiomyopathy. The initial assessment of a child with possible athlete’s heart includes a detailed history (medical, family, and exercise), comprehensive physical examination, ECG, and echocardiography. Congenital and structural heart disease should be excluded and the pubertal stage should be considered when interpreting findings. Investigations should be interpreted according to somatic size (using centiles) and pubertal stage rather than chronological age. Ethnic variations in physiology should be identified. If in doubt, child athletes with possible ethnically related changes should be followed up until maturity. T-wave inversion in anteroseptal leads is usually normal before puberty but abnormal after puberty. Lateral T-wave inversion is usually abnormal at any age. Voltage criteria for left ventricular hypertrophy are common in healthy child athletes. The presence of pathological Q waves, T-wave inversion, and ST-segment depression requires exclusion of cardiomyopathy. Most child athletes’ heart chamber size is within the normal reference ranges for age/gender, but hypertrophic cardiomyopathy should be considered in adolescent athletes with wall thickness >12mm (girls >11mm).
The electrocardiogram in the athlete
Authors: Alessandro Zorzi , Corrado Domenico
Published: April 2019

Interpretation of the athlete’s 12-lead electrocardiogram (ECG) should be based on specific criteria because changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiological and benign consequence of the heart’s adaptation to exercise. ECG abnormalities in athletes are classified into two groups—‘common and training-related’ (Group 1) and ‘uncommon and training-unrelated’ (Group 2)—based on their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations. The present chapter reviews the abnormalities that may be found in an athlete ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment to exclude an underlying cardiac disease.
Cardiac magnetic resonance imaging
Authors: Claessen Guido , La Gerche André
Published: April 2019

Cardiac magnetic resonance imaging (CMR) has become an extremely valuable tool in the detection of cardiac pathology because of its accuracy in assessing cardiac structure and function, and its ability to provide tissue characterization. In this chapter we discuss the role of CMR in the evaluation of athletes, in whom it can be challenging to differentiate physiological changes from underlying myocardial pathology. It is fundamental to distinguish athletes undergoing CMR because of concerning symptoms from athletes evaluated for screening purposes with little pre-test probability for disease. We will briefly highlight state-of-the-art imaging sequences and post-processing techniques that are being used to assess cardiac morphology, function, and viability in athletes. Finally, we will discuss CMR findings present in inherited and acquired cardiomyopathies and how to distinguish these from physiological changes observed in highly trained athletes.
Nuclear imaging
Authors: Möhlenkamp Stefan
Published: April 2019

Myocardial perfusion imaging using single photon emission computed tomography (SPECT) by means of scintigraphy is an established non-invasive method for detecting coronary artery disease (CAD) and improving risk stratification in symptomatic individuals. Data on its diagnostic and prognostic role and value in athletes are sparse. Possibly in part due to exercise-induced improved myocardial microvascular morphology and function, a mismatch between advanced coronary atherosclerosis burden and comparatively small myocardial perfusion defects has been reported in athletes. Because of radiation exposure and the costs of the test a careful risk–benefit assessment is necessary, particularly in asymptomatic athletes with risk factors and young athletes.
Congenital coronary artery anomalies
Authors: Basso Cristina , Frescura Carla , Rizzo Stefania , Thiene Gaetano
Published: April 2019

Despite the low prevalence in the general population, congenital coronary artery anomalies (CAAs) are well recognized as a major cause of sudden cardiac death (SCD). Not all CAAs have the same prognostic impact and each of them should be discussed individually. Apart from anomalous origin of a coronary artery (CA) from the pulmonary artery, the anomalous origin from the wrong aortic sinus, either the left main CA from the right sinus or the right CA from the left sinus, are traditionally considered as the highest risk of SCD. CAAs with an inter-arterial course carry the highest risk of ischaemia, particularly during exercise. Several pathophysiological mechanisms have been postulated, including compression of the anomalous CA between the aorta and the pulmonary artery, the acute angle take-off, the proximal intra-mural aortic course, and a superimposed CA spasm. The diagnostic work-up, including ischaemia provocation test imaging tools, and current management strategies, from sport restriction to surgical intervention, are discussed.
Mitral valve prolapse in relation to sport
Authors: Schmied Christian , Sharma Sanjay
Published: April 2019

Depending on the definition of the disease and diagnostic criteria mitral valve prolapse (MVP) is one of the commonest structural abnormalities of the heart. The condition is characterized by myxoid degeneration of the mitral valve and appears to be more common in females. Trans-thoracic echocardiography is the primary diagnostic tool for diagnosing MVP and provides information about the structure and function of the valve, but also allows comprehensive evaluation of the subvalvular complex. Additional trans-oesophageal echocardiography and 3D echocardiography provide excellent further assessment of the mitral valve complex. The vast majority of patients have a relatively benign natural history. However, a small proportion may develop severe mitral regurgitation due to degenerative disease or chordal rupture, infective endocarditis, embolic cerebrovascular accident, supraventricular and ventricular arrhythmias, and sudden cardiac death. Athletic training has the potential for expediting the degenerative process and a propensity for arrhythmias or even sudden death.
Physical activity and leisure-time exercise prescription for sedentary/untrained individuals
Authors: Piepoli Massimo F. , Dellborg Mikael , Börjesson Mats
Published: April 2019

Modern life is associated with limited physical demands. Societal change has made travel, work, and free time physically less demanding. Sedentary/untrained individuals are an increasing group in modern society, and they are also considered to be at higher risk of cardiovascular complications. Thus this group should benefit from an increased level of physical activity (PA) as both primaryand secondary prevention. Advice on lifestyle should include guidance on smoking, eating, and physical activity, each complementary and additive to the other. The prescription of exercise to sedentary individuals is recommended to all, but should include an individual risk–benefit analysis to achieve the maximum potential health benefits at the lowest possible risk. However, there are also some absolute contraindications for PA in sedentary individuals. The final prescription should be followed up, and it should include assessment of the PA level and/or fitness, and must be adjusted when indicated.
Urinary tract infection
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Urinary tract infections are important because they may be caused by a structural renal abnormality, diagnosis of which may prevent further renal damage. The importance of collection of the sample and its analysis is vital to prevent unnecessary invasive investigations.
Enuresis
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Enuresis is common and it is important to know whether the cause is benign or pathological.
Tubular disorders
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Tubular function is critical for the maintenance of electrolyte and acid–base balance. Consequently, acid–base disorders typically manifest with alterations in plasma electrolyte concentrations and/or pH. Tubular handling of the various electrolytes is often linked on a molecular level. For example, secretion of potassium and protons in the collecting duct is dependent on sodium reabsorption. Consequently, tubular disorders typically present with characteristic patterns of electrolyte and acid–base abnormalities, which can serve as biochemical ‘fingerprints’ for the accurate diagnosis of the underlying disorder. Recognition of these ‘fingerprints’ is critical as correct identification of the underlying disorder is key for appropriate treatment.
Peritoneal dialysis in end-stage kidney disease
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

This chapter describes the principles of peritoneal dialysis, the insertion of the peritoneal dialysis catheter, prevention and treatment of infection, the peritoneal dialysis prescription, and assessment of the dialysis provision.
Neuroprogression and accelerated ageing in severe psychiatric disorders
Authors: Brietzke Elisa , Yamagata Ana S. , Maurya Pawan K. , Rizzo Lucas B.
Published: April 2019

A convergent body of evidence suggests an overlap between neural, molecular, and functional findings in patients with severe mental illnesses and normative ageing. Patients in late stages of mood disorders and psychosis present brain changes and cognitive decline consistent with a pattern of accelerated ageing. In addition, replicated but heterogeneous findings support the notion that individuals with major depressive disorder, bipolar disorder, and schizophrenia have shorter telomeres compared to age-matched healthy controls. The recognition that severe mental illnesses are associated with premature or accelerated ageing offers new avenues of investigation for really novel therapeutic approaches. The hope is that these interventions will not only treat symptoms but be able to modify the course of these psychiatric conditions.
Neuroprogression in anxiety disorders
Authors: Perna Giampaolo , Mingotto Elisa , Alciati Alessandra , Caldirola Daniela
Published: April 2019

Anxiety disorders (AnxDs) are highly prevalent and may have detrimental effects on somatic health and cognitive functioning. An emerging perspective suggests that patients with AnxDs may manifest more medical comorbidities and/or decreased cognitive performances as a result of accelerated cellular ageing and neuroprogression, which entails the pathological reorganization of the brain along the course of severe mental disorders. In this chapter, we focus on the hallmarks of neuroprogression by reviewing preclinical and human findings that suggest an overlap between the processes of impaired neurogenesis, neurodegeneration, structural, functional, molecular, and cellular modifications occurring both in AnxDs and ageing. Although this research is in its early stages, the literature suggests a link between anxiety and accelerated ageing in the processes involved in neuroprogression. Structural, functional, and molecular changes in the brain that accompany normal ageing, including telomere shortening, beta-amyloid accumulation, immune-inflammatory, and oxidative/nitrosative stress were overrepresented in subjects with AnxDs compared to controls without AnxDs.
Neuropsychological functioning and neuroimaging in bipolar disorder: Evidence of neuroprogression
Authors: Bora Emre
Published: April 2019

This chapter reviews the evidence of neuroprogresssion in bipolar disorder (BD) based on available neurocognitive and neuroimaging studies. It discusses the alternative versions of neuroprogression in patients with BD, including pronounced and subtle forms of neurodegeneration and functional reorganization in brain activity. It reviews the evidence for time-related alterations in structural brain imaging studies in patients with BD. It also reviews the outcome of longitudinal and cross-sectional studies investigating cognitive decline over time in patients with BD. Also discussed is the importance of distinguishing illness-related neuroprogressive changes from changes in developmental trajectories, state-related changes, and non-illness-related progressive changes, including metabolic syndrome.
Lifestyle and neuroprogression: Diet, sleep, and exercise
Authors: Lopresti Adrian L. , Drummond Peter D.
Published: April 2019

Diet, sleep, and exercise are lifestyle factors important for the prevention and treatment of psychiatric disorders, including major depressive disorder, anxiety disorders, bipolar disorder, and schizophrenia. These lifestyle factors can contribute to dysregulation in important physiological mechanisms associated with psychiatric disorders and influence neuroprogression. We review research highlighting the important role of these lifestyle factors for different psychiatric conditions, and examine the potential mechanisms behind their therapeutic effects, with a particular emphasis on how they may each influence neuroprogression.
Tobacco, alcohol, and substance use in the perinatal period
Authors: Barlow Jane , Axford Nick
Published: April 2019

This chapter summarizes evidence on (i) the prevalence and effects on the unborn and newborn infant of exposure to teratogenic substances such as tobacco, alcohol, or substances during pregnancy, and (ii) what works during the perinatal period in terms of universal and targeted interventions for smoking cessation, and preventing and treating alcohol and drug misuse. It concludes with recommendations for practice, drawing on the evidence presented and best practice guidance, and focusing on strategies for identification and intervention.
Opportunistic surveillance in primary care
Authors: Wilson Philip , Kirkham Jackie
Published: April 2019

There are many unscheduled contacts between children and clinicians, and therefore many opportunities for clinicians to identify previously unsuspected problems that parents may not already have suspected. There are three distinct foci during assessment, namely the child, the parent(s), and the parent–child relationship. Any of these can alert the practitioner to potential concerns, regardless of the presenting issue. Practitioners need to be aware of, and alert to, concerns about physical and social/emotional development, as well as signs of maltreatment and neglect. In addition, it is important to be able to evaluate the quality of parenting a child experiences, as this is a strong predictor of future mental and physical health. While this is an area in which clinicians may feel less confident or skilled, there is evidence to suggest that continuity of care and a trusting parent–clinician relationship provide an arena in which problems can be raised, aired, and more satisfactorily addressed.
Gypsy/Traveller, migrant, and refugee children
Authors: Condon Louise , Mytton Julie
Published: April 2019

Children living in special circumstances due to migration or refugee status, or being of Gypsy, Roma, or Traveller ethnicity, have extra health needs and difficulty in accessing universal and specialist health services. Migrant, refugee, and Traveller children belong to diverse ethnic and social groups, but share characteristics which increase their need for targeted health promotion. All groups are subsections of the population with poor self-reported health and access to health services, and higher numbers of dependent children. It is well recognized that they experience discrimination and social exclusion which adversely impacts health. There is overlap between groups, for example, refugees are migrants who have left their country of origin to avoid persecution, and Roma are migrants who are of Gypsy ethnicity. This chapter identifies the reasons why children from these groups require focused health promotion; it summarizes their health needs, describes interventions to improve their physical and mental health through the child health programmes, and discusses factors that influence their ability to access preventive services.
Enhancements to child health programmes in the UK
Authors: Emond Alan , Haynes Alice
Published: April 2019

Five programmes which offer additional services to enhance the child health programmes for families at risk of poorer maternal and child health and development outcomes are being evaluated. Flying Start is a community-based programme targeted on families with children under 4 years of age living in deprived neighbourhoods in Wales. A Better Start is a place-based programme implemented by local partnerships in English wards with high levels of economic deprivation, providing services and support for all families living in the target wards from pregnancy until a child’s fourth birthday. The Family Nurse Partnership is a structured programme of home visits for first-time young mothers. The Maternal Early Childhood Sustained Home-visiting programme is a structured programme of sustained home visiting delivered by health visitors in pregnancy and the first 2 years. The Trial of Healthy Relationship Initiatives for the Very Early-years is comparing two parenting programmes for women with additional mental health or social support needs in pregnancy with outcomes up to 18 months. Early published results are reviewed and links given to the websites to signpost the reader to up-to-date information on the effectiveness of each programme.
Quality assurance and data requirements of the child health programme
Authors: Blair Mitch , Spencer Andy
Published: April 2019

This chapter outlines how the child health programme should be appraised and the issues of classification and coding, staff awareness of information systems, and data flows are highlighted. Sentinel event analysis is used to describe how safety and effectiveness of the programme might be enhanced. Various international examples of quality dashboards are also described including how they are used for information feedback to parents, health and other professionals, as well as policymakers in the pursuit of continuous quality improvement.
Women’s, children’s, and adolescents’ health in a changing world
Authors: Rowson Mike
Published: April 2019

There have been huge improvements in women’s and children's health over the past five decades, resulting from rising living standards, increased health expenditures, and donor investments. However, large inequalities remain and, driven by epidemiological, economic, political, and environmental transitions, new challenges have emerged. Global health and women’s and children’s health specifically have been evolving to recognise the broader determinants of health, and away from more targeted interventions. The vision of Universal Health Coverage and the Sustainable Development Goals are the broader visions put forward by the international community. But there remain questions about whether they will achieve the cross-sectoral action required to improve women’s and children's health still further.
Economic evaluation in global health
Authors: Pitt Catherine , Borghi Josephine , Hanson Kara
Published: April 2019

This chapter sets out the key steps in undertaking an economic evaluation: framing the study; measuring and valuing the costs and effects of the chosen interventions; and key elements within analysis, such as adjusting for differential timing, estimating the impact of uncertainty through sensitivity analysis, and modelling. The chapter also discusses the use of economic evaluation for decision making, the presentation of findings, and challenges with economic evaluations, and provides some key references. The chapter concludes by looking at future priorities, outlining how increased conduct and use of economic evaluation in low- and middle-income countries will help optimise the use of limited resources to improve health.
Adolescent injuries
Authors: Li Qingfeng , Hyder Adnan A
Published: April 2019

Injuries are the leading cause of mortality and morbidity for children 10–19 years old globally. Low and middle-income countries account for a burden of injuries disproportionate to their population, vehicle possession, and economic activities. Common types of unintentional injuries include road traffic crashes, drowning, burns, and falls. Self-harm is the most common type of intentional injury globally. Major barriers to injury prevention are lack of quality data on injury epidemiology, misperception of injuries as ‘accidents’, insufficient funding, and the multi-sectorial nature of injury prevention. Previous studies and experience, mostly from high-income countries, have identified a set of effective and cost-effective interventions to prevent child injuries. Evidence-based and well-enforced legislation is a highly effective tool in preventing injuries. Enhanced multi-sectorial effort is required to achieve development goals on injuries, including the sustainable development goal (SDG) target 3.6: by 2020, halve the number of global deaths and injuries from road traffic injuries.
Indirect maternal deaths
Authors: Lytle Heather , Chikaphonya-Phiri Beatrice , Merriel Abi
Published: April 2019

Indirect maternal deaths account for over a quarter of maternal deaths worldwide. Deaths from indirect causes include communicable and non-communicable diseases, as well as pre-existing and new conditions. Prevention of indirect maternal deaths has received less attention than direct causes of death, where interventions can be targeted around the time of delivery. Indirect deaths can be more complex to address as pregnancy brings unique health challenges due to the changing physiology of a pregnant woman. These physiological changes are summarised alongside the impact of some communicable (e.g. malaria) and non-communicable diseases (e.g. cardiovascular disease) on indirect deaths. The challenges in diagnosing, and therefore measuring, indirect deaths are discussed, as are challenges in deciding whether these deaths are incidental or exacerbated by pregnancy. A focus on improving both research and health policy is needed to address the challenges brought about by the increasing burden of indirect deaths.
Stillbirths
Authors: Blencowe Hannah , Sadoo Samantha , Lawn Joy
Published: April 2019

An estimated 2.6 million stillbirths occur annually, 98% in low and middle-income countries. Stillbirths have received significantly less policy attention than other maternal and child health outcomes. Inadequate data and a lack of standardised definitions impedes our understanding of the true burden and ability to track progress. Contrary to widespread fatalism, half of all stillbirths occur during labour and birth, and can be prevented through high quality obstetric care. Many result from other preventable conditions, such as maternal syphilis, malaria, and non-communicable diseases. Stillbirths are associated with significant direct, indirect, psychological, and social costs to families and society, which needs to be better appreciated and addressed.
Ethics and rights
Authors: Kelley Maureen
Published: April 2019

This chapter discusses the importance of considering clinical obligations, public health ethics, and human rights when evaluating treatment decisions or programmes in reproductive, maternal, newborn, and child health (RMNCH). Healthy communities and populations depend on strong commitments to the value of women’s and children’s health, and the lives of women and children often depend upon a strong defence of their equal human rights. Ethical arguments offer an important rationale for best practices in clinical settings and support evidence-based policies and programmes aimed at improving RMNCH regionally and globally. The chapter considers how different types of ethical challenges arise across domains, from patient bedside to policy, and which ethical principles can guide decisions and solutions. It also encourages critical thinking and debate around evidence-based messaging and advocacy in RMNCH, considering possible unintended consequences such as stigma or inadvertent harms. The chapter includes a multi-level ethical dilemma for consideration and discussion.
Patient and caregiver advocacy
Authors: Bulbeck Helen
Published: April 2019

This chapter, ‘Patient and caregiver advocacy’, examines the context for advocacy for people who are living with a brain tumour, why it is different, how it manifests itself, and what advocacy looks like. It explores the challenges that come with living with a brain tumour and how advocacy can alleviate these challenges. The different advocacy roles are reviewed, including an exploration of how some patients can become advocates for others, while others do not. Underpinning this however is a need to be responsive and agile throughout what can be a very fluid, dynamic, and complex journey. Anyone who finds themselves supporting someone who is living with a brain tumour will find this chapter useful.
SOS Children’s Villages: Rediscovering advocacy to increase relevance and impact. A high-level case study
Authors: Pichler Richard
Published: April 2019

SOS Children’s Village had engaged in advocacy in the very early days (1950s) but later began to focus on service provision, largely disconnecting it from the professional discourse. By the late 1990s, the organization expanded into over 100 countries. Despite doing excellent work as service provider, the organization felt the threat of being of little relevance, losing support and recognition. The organization had to rediscover how to engage in advocacy as integral part of its mission. Missing elements in the UN Convention on the Rights of the Child offered the chance to convince internal and external public of the need of SOS Children’s Villages to engage in advocacy. Today, SOS Children’s Villages are an essential advocate for 550,000 children directly and 220 million children indirectly.
International advocacy: Case studies and lessons learnt
Authors: Grisold Wolfgang , Klicpera Anna , Grisold Thomas
Published: April 2019

This chapter takes an international perspective on advocacy. It focuses on the question of how international advocacy projects can look like and what makes them successful. In doing so, we turn to the practical and applied sides of advocacy. Advocacy activities aim at taking the voice of patients to inform, protect, and support them. In the first part of this chapter, we will present successful cases of advocacy activities in neurology. In the second part, we will reflect on personal experiences where advocacy activities were or should have been implemented. Reflecting on these cases, we present some lessons learnt that advocates may want to consider when they plan and implement international advocacy activities.