bluuebunny/crossref_metadata_2025 huggingface dataset:
Using PR tools for advocacy
Authors: Kofler Birgit
Published: April 2019

Advocacy in neurology, public education on the field of neurological diseases and care, and public relations as a means of supporting both advocacy and public education efforts, are closely interrelated. Advocacy activists are, in many instances, making use of public relations instruments—for the sake of public education campaigns as well as for awareness and mobilization purposes. PR tools play an important role in neurology advocacy. In some diseases, such as epilepsy, stroke, or dementia, awareness campaigns, public information, education, and advocating for an optimization of care can make a big difference with respect to prevention, early diagnosis, or access to therapies. Therefore, the question of how to best make use of the instruments in the PR toolbox for the purposes and aims of advocacy is of major practical relevance. In this chapter major PR instruments, particularly in the field of media relations and their practical use, will be described. Also, some critical issues with respect to the relationship between advocacy and the widespread efforts of the healthcare industry to integrate patients advocates and organizations of health professionals into their PR and lobbying strategies will also be mentioned.
Advocacy for movement disorders
Authors: Mancini Francesca , Colosimo Carlo
Published: April 2019

Movement disorders refer to several conditions caused by a pathophysiological alteration of the basal ganglia nuclei and/or cerebellum with heterogeneous features mainly regarding control of voluntary movements and the presence of involuntary movements. Currently available treatments are mainly symptomatic and most of the diseases are chronic, causing a progressive downturn in the quality of life of both patients and their caregivers. Our description of advocacy in movement disorders starts from what most patients and caregivers do when looking for advocacy, they use search engines on the web. There are several organizations committed to advocating for people affected by movement disorders. The most representative organizations for each disease are listed in the present chapter, describing the ones with particular and original characteristics, being impossible to itemize all the associations dealing with advocacy in movement disorders. In general, these organizations are associations for patients, with a meso level of action, and are primarily based in the United States and northern Europe.
Palliative care
Authors: Oliver David
Published: April 2019

Palliative care aims to provide holistic care for the person and their family, considering physical, psychosocial, and spiritual aspects of care. Advocacy is at the core of the care provided, in enabling people to be enabled to make decisions and be fully involved in their care. However, neurological disease may cause both communication and cognitive difficulties and care may need to be discussed and planned in advance, so that the person’s views are clear. As this chapter explores, the discussions are a challenge for all involved but are essential to enable the person and their family to be fully involved in their care.
Advocacy for patients with neuropathic pain
Authors: Onofrei Ligia , Smith A. Gordon
Published: April 2019

Pain is a nearly universal yet highly individual experience, with broad determinants including genetic factors, mechanism of injury, medical comorbidities, social aspects, and variations in coping styles and belief systems. In this chapter we examine how pain impacts individuals, healthcare providers who care for individuals with pain, and the overall health system with an emphasis on the importance of advocacy at each level. Key issues include the importance of continuing research in developing effective treatments with minimal side effects, improving access to and understanding of complementary and alternative treatment modalities such as cognitive behavioural therapy, developing continuing medical education programmes that empower physicians in the management of complex pain disorders, developing educational materials for patients that enable them to participate in the prevention and/or treatment of pain disorders, and integrating efforts within and across institutions and at a health system level.
Kenya
Authors: Ndetei David M , Nandoya Erick S , Musyimi Christine W , Kamau Lucy W , Mutiso Victoria N
Published: April 2019

There is very little research conducted in Kenya on the prevalence of dementia. Although there is no specific strategy on dementia care in Kenya, the government of Kenya has made several strides towards improving mental health service provision. In 1982, the Kenya government became one of the signatories to the International Plan of Action on Ageing in Vienna, Austria. Later on, it incorporated the rights of the elderly into the 2010 Constitution and recently launched a mental health policy to address mental health issues in Kenya. While something has been done by non-governmental organizations (NGOs) involved in mental health, there is still a huge gap in access to mental health services, particularly dementia. This can be overcome through massive research and collaboration between the government and NGOs to identify and treat dementia, as well as other mental disorders.
Maldives
Authors: Mansoor Shanooha , Rasheed Ahmed
Published: April 2019

Maldives is a developing, geographically dispersed small-island nation with a population of 344,023. With an annual population growth rate of 1.65%, Maldives is nearing the end of its demographic transition. Though universal healthcare is enshrined in law in Maldives, the healthcare sector is underdeveloped and there is a lack of awareness of mental illnesses, especially those related to old age such as dementia. There is also a lack of resources and necessary expertise to address the urgent problem of mental healthcare provision. The recently launched national Mental Health Policy (2015–2025) and Health Master Plan 2016–2025 acknowledge mental health conditions, including dementia and cognitive impairment, as those requiring long-term care—which is a step in the right direction. The government needs to demonstrate a more formal commitment to dementia care by developing a National Dementia Strategy to be incorporated into the Mental Health Policy or Health Master Plan, in order to achieve tangible progress in their efforts to address the challenges faced by Maldives in dementia care.
Italy
Authors: Palumbo Claudia , Volpe Umberto
Published: April 2019

Italy is among countries in the world with the highest population of older people, with Italian elderly people accounting for over 20% of the total population of the country, and ranks second in Europe in terms of the ‘ageing index’ (i.e. the number of people aged 65 and above per 100 youths under the age of 15). In Italy, over 1 million people suffer from dementia, including approximately 600,000 cases of Alzheimer’s disease. Since 2000, a specific National Dementia Plan was initiated and Alzheimer’s Evaluation Units (UVAs) were introduced in all Italian regions to coordinate systematically the complex care process for dementia. Some Italian regions have recently deemed appropriate to change the denomination of UVAs to ‘Evaluation Units of Dementia’ (UVDs) and/or ‘Centres for Cognitive Impairment’. More recently, the Italian Ministry of Health launched an initiative aimed at improving the essential levels of assistance/care (LEA). The LEA represent all activities and services deemed essential to all Italian citizens and that the Italian national health system has to ensure are available, either on a free basis or by paying a participation fee, depending on patients’ situations.
Turkey
Authors: Tunçel Özlem Kuman , Elbi Hayriye
Published: April 2019

Turkey has a rapidly ageing population, the issues of which are new to the country. To date, there is no National Dementia Strategy. The strong tradition of family caregiving in Turkey has perhaps influenced the demand for access to formal care services. Informal care provided by families, which includes living together with the elders and providing the most comfort, is one of the strongest aspects of dementia care in Turkey. Another positive aspect is new legal regulation of the social security system for the elderly. Moreover, there is an increasing awareness of dementia and dementia care, which will hopefully give new impetus to further advancements in dementia care. The future of dementia care in Turkey should ideally include: (1) the development of a National Dementia Strategy, (2) improvement of informal care, including support for caregivers, and (3) an increase in the number, as well as improved quality, of in-hospital geriatric services.
Community-based health care
Authors: Lankester Ted
Published: April 2019

This chapter sets the background and context for the rest of the book. It talks about the history and progress of community-based health care (CBHC), and the many emerging challenges we now face. These challenges include a lack of trained health workers, poor planning and capacity at the national level, and weak or non-existent health systems. It tackles the question of how CBHC can help meet these challenges. It describes the special features of CHBC, and explains how CBHC is an integral part of well-functioning health systems, including primary health care. In the context of the Sustainable Development Goals (SDGs), it shows how CBHC can tackle poverty, a root cause of ill health. The chapter discusses how we can focus on strengthening and scaling up existing programmes, aim for long-term development, and identify some ‘quick wins’.
Health screening in occupational health
Authors: Koh David , Aw Tar-Ching
Published: April 2019

This chapter on health screening in occupational health describes common screening procedures in occupational health practice, such as pre-placement examination, health surveillance, and examinations prior to job reassignments. It covers biological monitoring and biological effects monitoring and discusses examples of specific screening tests such as executive health screening, genetic screening, and screening for drugs and alcohol. This chapter also reviews theoretical and technical issues in screening such as the characteristics of a screening test, for example, sensitivity, specificity, predictive value, likelihood ratios, and receiver operating characteristic (ROC) curves. The advantages and disadvantages of screening, practical and ethical aspects of screening, and finally the evaluation of screening programmes are discussed.
Drugs and alcohol in the workplace
Authors: Brown David , Rhinds David
Published: April 2019

However it presents, drug and alcohol misuse is a particularly challenging issue for employers, managers, and occupational health professionals. This includes the effects of drugs and alcohol on health and well-being and the direct and indirect impact on output, performance, and behaviour at work. There are legal implications if employees are under the influence of alcohol or drugs or in possession of illegal drugs where there may be a degree of vicarious liability for the employer. A lack of understanding and stigmatization may lead to limited tolerance towards such individuals, and there may be significant issues regarding public confidence towards those working in safety-critical industries. While awareness of alcohol-related problems in society and the workplace appears to be increasing, the distinction between what is social drinking and problematic drinking is often blurred.
International travel
Authors: Patel Dipti
Published: April 2019

International travel is a common feature of employment, and organizations that send employees overseas owe them a legal and moral duty of care regardless of where in the world they work. Those that travel internationally for work are a diverse group comprising a range of professions, and as diverse as their backgrounds are the strategies for preparation and health risk management and reduction in relation to overseas assignments. The health and safety of this group of workers is therefore critically important for the employee, employer, and also for the success of the assignment. This chapter provides an overview of the factors to consider when preparing employees for international assignments including ensuring that they are fit and adequately prepared, and that appropriate procedures are in place to take care of them if they become ill or injured.
Health effects of vibration
Authors: Lawson Ian , Cooke Roger
Published: April 2019

Hand–arm vibration syndrome (HAVS) is one of the commonest occupational diseases and occupational health professionals are often called upon to give advice on health surveillance and fitness for work in workers exposed to hand-transmitted vibration. There are many potential sources of HTV, the common feature being tools and equipment capable of transmitting an external source of vibrational energy to the hand–arm system. This chapter covers the clinical features, case assessment, and management of HAVS cases that will assist in providing such advice. It also covers other regional vibration disorders including carpal tunnel syndrome, Dupuytren’s contracture, musculoskeletal effects, hypothenar and thenar hammer syndromes, and some less commonly reported and putative vibration disorders.
Gastrointestinal and liver disorders
Authors: Madan Ira , Hellier Simon
Published: April 2019

This chapter covers the common gastrointestinal and liver disorders which occur in the working age population. Disorders affecting the bowel may result in frequency and urgency of defaecation, excess flatulence, and faecal leakage, which necessitate rapid and frequent access to lavatory facilities, but workers often find it embarrassing to disclose their symptoms or their needs to their managers. Other disorders, such as gastrointestinal infections in food handlers, may pose a risk to the general population; in addition, hepatitis A may pose a risk to co-workers. Finally, the prevalence of obesity in the working age population is rapidly increasing and the role of occupational health practitioners and the workplace in its prevention and management is discussed.
Blood-borne viruses
Authors: Grime Paul , Conlon Christopher
Published: April 2019

Hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infections have particular implications for fitness for work. These include the impact of symptoms and disease, the transmissibility of infection in the course of specific work activities, and, in the case of HIV, vulnerability to other infections arising from immune deficiency. This chapter focuses on HBV, HCV, and HIV because these are the most common blood-borne viruses that have particular implications for work. Blood-borne viral infections can affect people of any age. In the UK, HIV infection is specifically mentioned and automatically considered as a disability, from the point of diagnosis, by the Equality Act 2010. HBV and HCV infections may also qualify as disabilities, if associated disease causes impairment. There are therefore practical, legal, and ethical issues to consider when assessing fitness for work in people with blood-borne viral infections.
Haematological disorders
Authors: Smedley Julia , Kaczmarski Richard S.
Published: April 2019

In recent years, there have been major advances in the management of many haematological conditions. As a result, there have been real improvements in long-term survival and workability, particularly among patients with haemoglobinopathies and haematological malignancies. Work is often not possible for many months during major treatments such as chemotherapy or haematological stem cell transplantation. However, more of these patients will return to the employment market after treatment than previously. With the exception of a few jobs that are contraindicated (including some in heavy or dangerous industries and commercial aviation), adjustments to work will enable most patients with haematological disorders to work efficiently and safely. Generic issues that should be considered for work adjustments include fatigue, impaired immunity, and bleeding tendency.
International Schedule for Integrated Assessment and Staging of Care for Dementia (IDEAL schedule)
Authors: Semrau Maya , Burns Alistair , Lobo Antonio , Rikkert Marcel Olde , Robert Philippe , Schepens Mirjam , Stoppe Gabriela , Sartorius Norman
Published: April 2019

This chapter includes a complete copy of the IDEAL schedule, including its seven dimensions: 1) activities of daily living; 2) physical health; 3) cognitive functioning; 4) behavioural and psychological symptoms; 5) social support; 6) informal care, (which includes two sub-dimensions: time spent on care by informal carer and carer stress); and 7) formal professional care (which includes three sub-dimensions: total number of hours of formal professional care received, total number of hours of formal professional care needed, and additional dementia-related care needed). Each dimension has a set of anchor points, which assist the user of the schedule in rating the different dimensions appropriately. Information is also provided on how to calculate the total sum score on the IDEAL schedule.
The thrifty phenotype and related developmental hypotheses
Authors: Bhopal Raj S.
Published: April 2019

The developmental origins of health and disease (DOHAD) hypothesis proposes that impairment of fetal and infant development leads to lasting, perhaps permanent, changes in organ structure, body composition, and metabolism. The critical factor, however, is thought to be dysadaptation, whereby the environmental circumstances in later life do not match those the person is programmed for. This kind of mismatch is particularly likely in migrant populations leaving rural parts of South Asia (where nutrition is sometimes limited) and settling in affluent, nutrition-rich countries. South Asian babies are born small but with relatively well-preserved fat depots, especially on the torso and intra-abdominally. This relative central preservation of fat is a characteristic that remains through life. The thrifty phenotype and related hypotheses attribute it to fetal and early life growth and development. The empirical evidence suggests, however, a modest role for these ideas in explaining disease outcomes in South Asians in adulthood.
Pathophysiological response to burns
Authors: Mabvuure Nigel Tapiwa , Munson Christopher F. , Pleat Jonathon
Published: April 2019

Greater understanding of the pathophysiological response to burns has advanced both the care and outcomes of afflicted patients. Locally, three zones are described by the Jackson burn zone model: the inner coagulation zone (maximal damage), middle dynamic stasis zone (salvageable with first aid and resuscitation) and the, usually, recoverably outer zone of hyperaemia due to increased tissue perfusion. Systemic, multi-organ changes can follow burns affecting greater than 20% total body surface area due to the release of various neurohormonal mediators including cytokines, hormones, catecholamines among others. In the immediate post-burn resuscitation phase, ‘burn shock’ and the resultant end-organ dysfunction negatively affects outcomes. Further, the systemic inflammatory response to large burns is typically hypercatabolic and can last for 2–3 years. This chapter summarizes current understanding of the pathophysiological response to resuscitation and non-resuscitation burns wounds and introduces broad measures aimed at ameliorating its deleterious results.
Hypermetabolic response to burns
Authors: Herndon David N. , Finnerty Celeste C. , Przkora Rene
Published: April 2019

Large burns are one of the most disastrous injuries today. The survivor experiences a tremendous metabolic response that does not resolve with burn wound healing. This response is seen in patients with burns over more than 30% of the total body surface area (TBSA). Two phases are observed: the 'ebb' phase starts immediately after a burn, lasts for 2–3 days, and is characterized by a “shock state” with decreases in cardiac output and metabolism; the ‘flow’ phase starts approximately 5 days after a burn. This phase can last up to 3 years in paediatric patients with >30% TBSA. The flow phase is characterized by persistent hypermetabolic and inflammatory responses, leading to catabolism and loss of function. Early interventions, including excision and grafting of wounds, enteral feeding, treatment of infections, pharmacological interventions (eg. anabolic hormones, adrenergic receptor antagonists), and exercise, can successfully attenuate this deleterious response.
Burns surgery
Authors: Bache Sarah , Dziewulski Peter George
Published: April 2019

This chapter summarizes common methods of surgical management of acute burn injuries in the modern era. It discusses the rationale for surgical excision and the considerations that must be taken into account before embarking on an operation. Descriptions of equipment commonly used, and the techniques employed are detailed, with an emphasis on those used for burn excision and wound closure. As the commonest method of wound closure following excision is with skin grafts, these are examined in further detail. Finally, a brief guide to the surgical management of specific burns of varying sizes and depths is given.
Electrical injuries
Authors: Lee Jong , Herndon David N. , Finnerty Celeste C.
Published: April 2019

Electrical injuries extend deep into tissues and are characterized by high mortality and complications. This chapter will discuss classification of electrical injuries and the major mechanisms of electrical injury. It will describe clinical features of these injuries, concentrating on the integumentary, neurological, cardiovascular, respiratory, musculoskeletal, and renal systems. It will then describe investigation and treatment of these injuries, with a discussion of immediate care and inpatient care. The chapter will conclude with a list of complications commonly seen after electrical injury.
Radiation burns
Authors: Yip Christina , Mabvuure Nigel Tapiwa , Bodansky David
Published: April 2019

Radiation burns are caused by electromagnetic radiation (X-rays or gamma rays) or particle (alpha or beta) ionizing radiation. Ionization produces free radicals which cause DNA damage, cell death and malignant change. Burns may occur as a consequence of radiotherapy or medical imaging using beam energy. Radiation burns are generally rare and most commonly caused by isotopes (192Iridium or 60Cobolt) used for brachytherapy. Industrial accidents such as Fukushima can have catastrophic short and long-term sequelae but are rare. However, due to the constant threat of terror attacks, knowledge of the approach to a patient with radiation burns is important. This chapter discusses wound and general patient assessment as well as immediate treatment measures for a patient with radiation burns.
Hand burns
Authors: Goverman Jeremy , Fagan Shawn , Dargan Dallan
Published: April 2019

Hand burns are extremely common. Morbidity from such burns can be significant and overall quality of life post injury relies heavily on appropriate hand function. It is important to identify and treat burns of the hands in order to minimize morbidity. Appropriate assessment of burn wound depth and hand function is critical with particular attention to prevention of vascular compromise via procedures for decompression of pressure.
Skin substitutes
Authors: Tadiparthi Sujatha
Published: April 2019

Skin substitutes are a heterogeneous group of wound coverage materials that aid in would closure and replace the functions of the skin. They were developed as an adjunct or alternative to autografts. They are available in large quantities, they can provide a mechanical barrier to infection and fluid loss, and enable a neo-dermal base that may help minimize scar contraction. However, they can be expensive, difficult to store with a short half-life and there is a learning curve for their clinical application and use. Skin substitutes can provide either temporary wound cover (eg. Biobrane, TansCyte) or permanent wound cover (eg. Intergra, Matriderm, Alloderm). The features, advantages and disadvantages of the main types of skin substitutes currently in common use are described in this chapter.
Nutritional requirements in the burn patients
Authors: Munson Christopher F. , Mabvuure Nigel Tapiwa , Dheansa Baljit
Published: April 2019

Burns are associated with significant changes to the metabolic rates of affected patients, raising calorific requirements by up to 200%. Energy requirements can be calculated using several different equations depending on patient group. The majority of administered nutrients should be supplied as simple carbohydrates with judicious supplementation with lipids. Protein replacement is key due to the negative balance resulting from proteolysis. Consideration should also be given to vitamin and trace element supplementation with evidence supporting zinc, selenium, copper and select vitamin replacement. Any replacement or supplementation programme requires regular monitoring in order to avoid over or under feeding.
Tetanus
Authors: Lindsay Karen J
Published: April 2019

This chapter discusses Clostridium tetani infection and its relation to burns including presentation, immunization, tetanus-prone injuries, prophylaxis, and treatment.
Military burns
Authors: Bisarya Kamal , Cubison Tania
Published: April 2019

Military burns can be accidental or due to combat and are generated by a wide variety of mechanisms including explosives (main), incendiary, chemical and nuclear weapons. Explosives give rise to a blast wave or a blast wind which cause primary (eg. barotrauma) to quaternary (eg. burn) effects on multiple organs. Blast injury secondary effects (penetrating injuries) are the leading cause of death in military attacks. Infection associated mortality occurs at higher rates in combat burns. Polytrauma management follows ATLS/EMSB guidelines. Outcomes are similar to civilians but can lead to long term physical and psychological morbidity. Prevention is via pre-deployment education and protective equipment.
Laser management of scars
Authors: Lindsay Karen J , Shokrollahi Kayvan
Published: April 2019

This chapter provides an overview of laser as applied to burns and scar management.
Using gamma ray monitoring to avoid missing the next Milky Way Type Ia supernova
Authors: Wang (王夕露) Xilu , Fields Brian D , Lien (連雅琳) Amy Yarleen
Published: April 2019

A Milky Way Type Ia supernova (SNIa) could be unidentified or even initially unnoticed, being dim in radio, X-rays, and neutrinos, and suffering large optical/IR extinction in the Galactic plane. But SNIa emit nuclear gamma-ray lines from 56Ni → 56Co → 56Fe radioactive decays. These lines fall within the Fermi/GBM energy range, and the 56Ni 158 keV line is detectable by Swift/BAT. Both instruments frequently monitor the Galactic plane, which is transparent to gamma rays. Thus GBM and BAT are ideal Galactic SNIa early warning systems. We simulate SNIa MeV light curves and spectra to show that GBM and BAT could confirm a Galactic SNIa explosion, followed by Swift localization and observation in X-rays and UVOIR band. The time of detection depends sensitively on the 56Ni distribution, and can be as early as a few days if ${\gtrsim } 10{{\ \rm per\ cent}}$ of the 56Ni is present in the surface as suggested by SN2014J gamma data.
The distances to star clusters hosting Red Supergiants: χ Per, NGC 7419, and Westerlund 1
Authors: Davies Ben , Beasor Emma R
Published: April 2019

Galactic, young massive star clusters are approximately coeval aggregates of stars, close enough to resolve the individual stars, massive enough to have produced large numbers of massive stars, and young enough for these stars to be in a pre-supernova state. As such these objects represent powerful natural laboratories in which to study the evolution of massive stars. To be used in this way, it is crucial that accurate and precise distances are known, since this affects both the inferred luminosities of the cluster members and the age estimate for the cluster itself. Here we present distance estimates for three star clusters rich in Red Supergiants (χ Per, NGC 7419, and Westerlund 1) based on their average astrometric parallaxes $\bar{\pi }$ in Gaia Data Release 2, where the measurement of $\bar{\pi }$ is obtained from a proper-motion screened sample of spectroscopically confirmed cluster members. We determine distances of $d=2.25^{+0.16}_{-0.14}$ kpc, $d=3.00^{+0.35}_{-0.29}$ kpc, and $d=3.87^{+0.95}_{-0.64}$ kpc for the three clusters, respectively. We find that the dominant source of error is that in Gaia’s zero-point parallax offset πZP, and we argue that more precise distances cannot be determined without an improved characterization of this quantity.
Association between hippocampal dose and memory in survivors of childhood or adolescent low-grade glioma: a 10-year neurocognitive longitudinal study
Authors: Acharya Sahaja , Wu Shengjie , Ashford Jason M , Tinkle Christopher L , Lucas John T , Qaddoumi Ibrahim , Gajjar Amar , Krasin Matthew J , Conklin Heather M , Merchant Thomas E
Published: April 2019

Background

Hippocampal avoidance has been suggested as a strategy to reduce short-term memory decline in adults receiving whole-brain radiation therapy (RT). The purpose of this study was to determine whether the hippocampal dose in children and adolescents undergoing RT for low-grade glioma was associated with memory, as measured by verbal recall.

Methods

Eighty patients aged at least 6 years but less than 21 years with low-grade glioma were treated with RT to 54 Gy on a phase II protocol. Patients underwent age-appropriate cognitive testing at baseline, 6 months posttreatment, yearly through 5 years posttreatment, year 7 or 8, and year 10 posttreatment. Random coefficient models were used to estimate the longitudinal trends in cognitive assessment scores.

Results

Median neurocognitive follow-up was 9.8 years. There was a significant decline in short-delay recall (slope = −0.01 standard deviation [SD]/year, P < 0.001), total recall (slope = −0.09 SD/y, P = 0.005), and long-delay recall (slope = −0.01 SD/y, P  = 0.002). On multivariate regression, after accounting for hydrocephalus, decline in short-delay recall was associated with the volume of right (slope = −0.001 SD/y, P = 0.019) or left hippocampus (slope = −0.001 SD/y, P = 0.025) receiving 40 Gy (V40 Gy). On univariate regression, decline in total recall was only associated with right hippocampal dosimetry (V40 Gy slope = −0.002, P = 0.025). In children <12 years, on univariate regression, decline in long-delay recall was only associated with right (V40 Gy slope = −0.002, P = 0.013) and left (V40 Gy slope = −0.002, P = 0.014) hippocampal dosimetry.

Conclusion

In this 10-year longitudinal study, greater hippocampal dose was associated with a greater decline in delayed recall. Such findings might be informative for radiation therapy planning, warranting prospective evaluation.
Extended star-forming regions within galaxies in a dense proto-cluster core at z = 2.53
Authors: Suzuki Tomoko L , Minowa Yosuke , Koyama Yusei , Kodama Tadayuki , Hayashi Masao , Shimakawa Rhythm , Tanaka Ichi , Tadaki Ken-ichi
Published: April 2019

At z ∼ 2, star formation activity is thought to be high even in high-density environments such as galaxy clusters and proto-clusters. One of the critical but outstanding issues is if the structural growth of star-forming galaxies can differ depending on their surrounding environments. In order to investigate how galaxies grow their structures and what physical processes are involved in the evolution of galaxies, one requires spatially resolved images of not only stellar components but also star-forming regions within galaxies. We conducted (Adaptive Optics) AO-assisted imaging observations for star-forming galaxies in a dense proto-cluster core at z = 2.53 with IRCS and AO188 mounted on the Subaru Telescope. A combination of AO and narrow-band filters allows us to obtain resolved maps of Hα-emitting regions with an angular resolution of ${0{^{\prime\prime}_{.}}1}$–${0{^{\prime\prime}_{.}}2}$, which corresponds to ∼1 kpc at z ∼ 2.5. Based on stacking analyses, we compare radial profiles of star-forming regions and stellar components and find that the star-forming region of a sub-sample with log (M*/$M_\odot$) ∼ 10–11 is more extended than the stellar component, indicating the inside-out growth of the structure. This trend is similar to the one for star-forming galaxies in general fields at z = 2–2.5 obtained with the same observational technique. Our results suggest that the structural evolution of star-forming galaxies at z = 2–2.5 is mainly driven by internal secular processes irrespective of surrounding environments.
Attitudes Toward Asylum Seekers: Evidence from Germany
Authors: Hager Anselm , Veit Susanne
Published: April 2019

What theories explain variation in public opinion toward asylum seekers? We implement a survey experiment in which a representative sample of German residents evaluates vignettes of asylum seekers, which randomly vary attributes that speak to deservingness, economic and religious threat, and gender considerations of attitude formation. We find strong support for deservingness theories. Economic and religious threat theories also receive empirical support. Gender plays a negligible role. Importantly, we also document that economic and—to a lesser extent—religious threat considerations only matter when respondents evaluate economic refugees. By contrast, political refugees are welcomed nearly unconditionally. Our paper thus replicates key findings from Bansak, Hainmueller, and Hangartner (2016) and Czymara and Schmidt-Catran (2016) using a representative sample and points to an important interaction effect in public opinion formation toward asylum seekers: economic threat only gets activated when refugees’ deservingness is in doubt.
Distribution of Cereal Cyst Nematodes (Heterodera avenae and H. filipjevi) in Eastern Washington State
Authors: Wen Nuan , Manning-Thompson Yvonne , Garland-Campbell Kimberly , Paulitz Timothy
Published: April 2019

Cereal cyst nematodes (CCN; Heterodera avenae and H. filipjevi), cause substantial worldwide yield loss in small grain cereals such as wheat, barley, and oat. H. avenae was first detected in the United States in western Oregon in 1974 and had spread to northeast Oregon by the mid-1980s. Although H. avenae was detected in eastern Washington in 1984, extensive infestations were not recognized until 2010. H. filipjevi, first detected in Oregon in 2008, was found in eastern Washington in 2014. To gain more information about the distribution of these two species, an extensive survey was undertaken in eastern Washington, and methods were developed to distinguish species using DNA sequencing of single cysts. In this study, we surveyed 356 wheat and barley fields in eastern Washington from 2007 to 2017. CCN from the infested locations were identified to species level by sequencing the ribosomal internal transcribed spacers (ITS) and/or 28S ribosomal RNA (rRNA) genes. The sequences were compared in the GenBank database in the National Center for Biotechnology Information (NCBI) to identify species. The results show that H. filipjevi is primarily confined to southern Whitman County, WA; and H. avenae has a wider distribution across the higher precipitation annual cropping area of eastern Whitman County. Knowledge of species identification is critical for deployment of host resistance as an effective means of management, since resistance genes for one species of CCN may not be effective against the other.
Functional Variation of Plant–Pathogen Interactions: New Concept and Methods for Virulence Data Analyses
Authors: Kosman E. , Chen X. , Dreiseitl A. , McCallum B. , Lebeda A. , Ben-Yehuda P. , Gultyaeva E. , Manisterski J.
Published: April 2019

Classical virulence analysis is based on discovering virulence phenotypes of isolates with regard to a composition of resistance genes in a differential set of host genotypes. With such a vision, virulence phenotypes are usually treated in a genetic manner as one of two possible alleles, either virulence or avirulence in a binary locus. Therefore, population genetics metrics and methods have become prevailing tools for analyzing virulence data at multiple loci. However, a basis for resolving binary virulence phenotypes is infection type (IT) data of host–pathogen interaction that express functional traits of each specific isolate in a given situation (particular host, environmental conditions, cultivation practice, and so on). IT is determined by symptoms and signs observed (e.g., lesion type, lesion size, coverage of leaf or leaf segments by mycelium, spore production and so on), and assessed by IT scores at a generally accepted scale for each plant–pathogen system. Thus, multiple IT profiles of isolates are obtained and can be subjected to analysis of functional variation within and among operational units of a pathogen. Such an approach may allow better utilization of the information available in the raw data, and reveal a functional (e.g., environmental) component of pathogen variation in addition to the genetic one. New methods for measuring functional variation of plant–pathogen interaction with IT data were developed. The methods need an appropriate assessment scale and expert estimations of dissimilarity between IT scores for each plant–pathogen system (an example is presented). Analyses of a few data sets at different hierarchical levels demonstrated discrepancies in results obtained with IT phenotypes versus binary virulence phenotypes. The ability to measure functional IT-based variation offers promise as an effective tool in the study of epidemics caused by plant pathogens.
Assessing Hereditary Colorectal Cancer Referral Patterns to a Tertiary Care Center: A Novel Approach Using Geographic Information System Mapping
Authors: Ford Molly M. , Camp Janey V. , Geiger Timothy M. , Hopkins M. Benjamin , Muldoon Roberta L. , Prestwich Anna , LaNeve David C. , Hawkins Alexander T.
Published: April 2019

BACKGROUND:

Patients and their family members with hereditary colorectal cancer require longitudinal follow-up that is best achieved through a dedicated program with a registry. However, referrals for these conditions remain poor. Geographic information systems technology is a novel method to evaluate geographic variation in multiple realms but is being used more in health care.

OBJECTIVE:

The purpose of this study was to evaluate referral patterns with geographic information systems technology to better target efforts for improving overall referrals. We hypothesized that marked variation would exist as to the geospatial locations of referrals and that gastroenterologists would be the dominant referral source.

DESIGN:

This was a retrospective cross-sectional study.

SETTINGS:

The study was conducted at Vanderbilt University Medical Center.

PATIENTS:

The hereditary colorectal cancer registry was queried from June 2007 to August 2016 for demographics, distance to center, genetic mutations, and the specialty of the referring providers. Geospatial data on both patient and referring specialist were collected.

MAIN OUTCOME MEASURES:

We analyzed patient and referral data with geographic information systems technology to look for gaps and patterns.

RESULTS:

A total of 676 patients were entered into the registry during this period. Fifty-six percent were women, and the median age was 50 years (interquartile range, 42–60 y). The median distance from the center was 60 miles (interquartile range, 22–120 miles), and 31% carried an identified germline mutation. Gastroenterology represented the overall largest source of referrals and, when broken down by syndrome, they represented the top referral specialty for familial adenomatous polyposis. Surgeons were the largest referral source for Lynch syndrome.

LIMITATIONS:

The study was limited by covariates in the database.

CONCLUSIONS:

Our hereditary colorectal cancer registry serves a large geographic area, with the largest group of referrals coming from gastroenterologists. Performing this analysis with geographic information systems technology mapping allowed us to identify clustering of patients and providers throughout the region as well as gaps. This information will help to target outreach and distribution of educational materials for providers and their patients to increase registry enrollment. See Video Abstract at http://links.lww.com/DCR/A950.
Case–Control Study of Tumor Stage–Dependent Outcomes for Cutaneous Squamous Cell Carcinoma in Immunosuppressed and Immunocompetent Patients
Authors: Gonzalez Jessica L. , Cunningham Kiera , Silverman Rebecca , Madan Elena , Nguyen Bichchau Michelle
Published: April 2019

BACKGROUND

Immunosuppressed patients have worse outcomes from cutaneous squamous cell carcinomas (cSCCs), although unclear whether it is due to the development of more high-stage tumors or worse outcomes for a given stage.

OBJECTIVE

Analyze the impact of immunosuppression on the development of cSCCs and tumor stage–dependent outcomes.

MATERIALS AND METHODS

Single-institution 1:2 case–control study of primary invasive cSCCs from 2005 to 2015 in 106 mixed-cause immunosuppressed patients and 212 control subjects matched to age, gender, and race.

RESULTS

Four hundred twelve cSCCs from 106 immunosuppressed patients and 291 tumors from 212 matched immunocompetent patients were included. Both cohorts had similar T-stage distribution, with <5% high-stage tumors, that is, AJCC-7 T2, AJCC-8 T3, and BWH T2b/T3. Immunosuppression significantly increased the likelihood of poor outcomes (POs) (aggregate of local recurrence (LR), nodal and distant metastasis, and squamous cell carcinoma–related deaths) for low-stage tumors, that is, AJCC-7 T1 (odds ratio [OR], 4.29), AJCC-8 T1 (OR, 3.45), AJCC-8 T2 (OR, 3.75), BWH T1 (OR, 3.53), and BWH T2a (OR, 3.41) tumors. There was no significant difference in the treatment: most tumors were treated with Mohs (71% vs 75%) or excision (21% vs 20%) in both cohorts.

CONCLUSION

Immunosuppressed patients have an increased risk of POs, specifically LRs, from low-stage cSCCs. Definitive treatment of cSCCs is recommended.
Gender, Depression, and Blue-collar Work
Authors: Elser Holly , Rehkopf David H. , Meausoone Valerie , Jewell Nicholas P. , Eisen Ellen A. , Cullen Mark R.
Published: April 2019

Background:

Industrial blue-collar workers face multiple work-related stressors, but evidence regarding the burden of mental illness among today’s blue-collar men and women remains limited.

Methods:

In this retrospective cohort study, we examined health and employment records for 37,183 blue- and white-collar workers employed by a single US aluminum manufacturer from 2003 to 2013. Using Cox proportional hazards regression, we modeled time to first episode of treated depression by gender and occupational class. Among cases, we modeled rates of depression-related service utilization with generalized gamma regression.

Results:

Compared with their white-collar counterparts, blue-collar men were more likely to be treated for depression (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) as were blue-collar women (HR = 1.4; 1.2, 1.6). Blue-collar women were most likely to be treated for depression as compared with white-collar men (HR = 3.2; 95% CI = 2.1, 5.0). However, blue-collar workers used depression-related services less frequently than their white-collar counterparts among both men (rate ratio = 0.91; 95% CI = 0.84, 0.98) and women (rate ratio = 0.82; 95% CI = 0.77, 0.88).

Conclusions:

Blue-collar women were more likely to be treated for depression than white-collar workers, and blue-collar women were most likely to be treated for depression compared with white-collar men. However, blue-collar men and women used depression-related healthcare services less frequently than white-collar workers. These findings underscore that blue-collar women may be uniquely susceptible to depression, and suggest that blue-collar workers may encounter barriers to care-seeking related mental illness other than their insurance status.
Long-Term Follow-up of Intrastromal Corneal Ring Segment Implantation in Pediatric Keratoconus
Authors: Alfonso José F. , Fernández-Vega-Cueto Luis , Lisa Carlos , Monteiro Tiago , Madrid-Costa David
Published: April 2019

Purpose:

To evaluate efficacy, safety, and stability of Ferrara-type intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation in pediatric patients with keratoconus.

Methods:

This study included patients with keratoconus aged 18 years or younger who had received Ferrara-type ICRS implantation. The uncorrected and corrected distance visual acuities, residual refractive errors, and root mean square for coma-like aberration were recorded preoperatively and at 6 months, 1, 3, and 5 years postoperatively.

Results:

One hundred eighteen eyes of 88 patients (mean age 16.1 ± 1.89; range 10–18) were studied. All patients were examined at a 6-month follow-up after ICRS implantation, and at the 12-, 36-, and 60-month follow-ups, 97, 71, and 23 eyes were evaluated, respectively. Mean uncorrected distance visual acuity (logarithm of minimum angle of resolution) changed from 0.67 ± 0.37 preoperatively to 0.37 ± 0.30, 6 months after ICRS implantation (P < 0.0001). Mean corrected distance visual acuity increased in turn from 0.19 ± 0.15 to 0.10 ± 0.12 (P < 0.0001). The percentage of eyes with a refractive cylinder ≤2.00 D increased from 30.5% before surgery to 70.3% 6 months later, and the root mean square for corneal coma-like aberration showed a statistically significant decrease (P < 0.001). At the follow-up visits, refractive and visual values remained stable compared with those of the 6-month visit.

Conclusions:

Our long-term results suggest that Ferrara-type ICRS implantation is a safe, effective, and stable procedure for restoring vision in pediatric patients with keratoconus.
Parallels between lumbosacral radiculopathy and complex regional pain syndrome: α1-adrenoceptor upregulation, reduced dermal nerve fibre density, and hemisensory disturbances in postsurgical sciatica
Authors: Drummond Peter D. , Morellini Natalie , Visser Eric , Finch Philip M.
Published: April 2019

Residual lower-limb pain after low back surgery (postsurgical sciatica) and complex regional pain syndrome (CRPS) involving a lower limb are separate conditions but may share some mechanisms (eg, tissue inflammation, neuroimmune disturbances, and central neuroplasticity). As adrenergically evoked pain contributes, in part, to CRPS, whether an adrenergic mechanism also contributes to postsurgical sciatica was investigated in this study. Immunohistochemistry was used to identify α1-adrenoceptors (α1-AR) on nerve fibres and other targets in the affected and contralateral skin of 25 patients with postsurgical sciatica, and α1-AR expression was investigated in relation to pain and pinprick hyperalgesia after intradermal injection of the α1-AR agonist phenylephrine. In addition, quantitative sensory testing was performed on all 4 limbs and on each side of the forehead. α1-AR expression was greater in keratinocytes (but not blood vessels or nerve fibres) in the symptomatic than contralateral leg, and dermal nerve fibre density was reduced in both legs. However, distal adrenergic involvement in pain in postsurgical sciatica seems unlikely, as neither heightened α1-AR expression in keratinocytes nor reduced dermal nerve fibre density were associated with pain or hyperalgesia to intradermal phenylephrine injection. Sensitivity to pressure-pain, pinprick, and cold-pain was greater in the ipsilateral than contralateral forehead of the entire cohort, but sensory disturbances were most pronounced in patients with additional CRPS-like features. Together, these findings suggest that bilateral distal neuropathy and central neuroplastic changes are involved not only in the pathophysiology of CRPS but also in postsurgical sciatica. This may have treatment implications for patients with postsurgical sciatica.