bluuebunny/crossref_metadata_2025 huggingface dataset:
Control electronics for semiconductor spin qubits
Authors: Geck Lotte , Kruth Andre , Bluhm Hendrik , Waasen Stefan van , Heinen Stefan
Published: December 2019

Future universal quantum computers solving problems of practical relevance are expected to require at least 106 qubits, which is a massive scale-up from the present numbers of less than 50 qubits operated together. Out of the different types of qubits, solid state qubits are considered to be viable candidates for this scale-up, but interfacing to and controlling such a large number of qubits is a complex challenge that has not been solved yet. One possibility to address this challenge is to use qubit control circuits located close to the qubits at cryogenic temperatures. In this work we evaluate the feasibility of this idea, taking as a reference the physical requirements of a two-electron spin qubit and the specifications of a standard 65 nm complementary metal-oxide-semiconductor process. Using principles and flows from electrical systems engineering we provide realistic estimates of the footprint and of the power consumption of a complete control-circuit architecture. Our results show that with further research it is possible to provide scalable electrical control in the vicinity of the qubit, with our concept.
Diminished Myoinositol in Ventromedial Prefrontal Cortex Modulates the Endophenotype of Impulsivity
Authors: Jupp Bianca , Sawiak Steve J , van der Veen Bastiaan , Lemstra Suzanne , Toschi Chiara , Barlow Rebecca L , Pekcec Anton , Bretschneider Tom , Nicholson Janet R , Robbins Trevor W , Dalley Jeffrey W
Published: November 2019

Maladaptive impulsivity manifests in a variety of disorders, including attention-deficit hyperactivity disorder (ADHD), depression, and substance use disorder. However, the etiological mechanisms of impulsivity remain poorly understood. In the present study, we used in-vivo proton magnetic resonance spectroscopy (1H-MRS) to investigate neurometabolite content in the prefrontal cortex (PFC) and striatum of rats exhibiting low- versus high-impulsive (LI, HI) behavior on a visual attentional task. We validated our 1H-MRS findings using regionally resolved ex-vivo mass spectroscopy, transcriptomics, and site-directed RNA interference in the ventromedial PFC. We report a significant reduction in myoinositol levels in the PFC but not the striatum of HI rats compared with LI rats. Reduced myoinositol content was localized to the infralimbic (IL) cortex, where significant reductions in transcript levels of key proteins involved in the synthesis and recycling of myoinositol (IMPase1) were also present. Knockdown of IMPase1in the IL cortex increased impulsivity in nonimpulsive rats when the demand on inhibitory response control was increased. We conclude that diminished myoinositol levels in ventromedial PFC causally mediate a specific form of impulsivity linked to vulnerability for stimulant addiction in rodents. Myoinositol and related signaling substrates may thus offer novel opportunities for treating neuropsychiatric disorders comorbid with impulsive symptomology.
Habitat transformation and climate change: Implications for the distribution, population status, and colony extinction of Southern Bald Ibis (Geronticus calvus) in southern Africa
Authors: Colyn Robin B , Henderson Catherine L , Altwegg Res , Smit-Robinson Hanneline A
Published: November 2019

Habitat transformation and loss is one of the greatest threats currently facing avian species. The cumulative impact of climate change on habitat loss is projected to produce disproportionate risk for endemic high-altitude species. The Southern Bald Ibis (Geronticus calvus) is an endemic high-altitude species found throughout highland grassland habitats in South Africa and Lesotho. The historical distribution has contracted notably and causal factors remain ambiguous. Furthermore, the historical population (1950–1970) was believed to be stable, but recent local surveys suggest colony declines and the current global population status remains largely unquantified. We assessed the current distribution and population status of the species through predictive modeling and trends in historical and recent colony counts across the species’ range. We examined climate and habitat change as potential causal factors contributing to the historical contraction in distribution, and projected the potential impact of future climate change predicted by global circulation models. Our study confirms that Southern Bald Ibis are of conservation concern. The loss of grasslands to expanding woody vegetation through bush encroachment was the most detrimental habitat transformation type associated with decreased colony growth and colony collapse. We recommend maintaining a minimum threshold of 50% or greater intact grassland habitat surrounding colonies to reduce colony extinction risk and promote colony persistence.
GHSR deficiency exacerbates cardiac fibrosis: role in macrophage inflammasome activation and myofibroblast differentiation
Authors: Wang Mo , Qian Lei , Li Jing , Ming Hao , Fang Li , Li Yingjia , Zhang Man , Xu Yaohua , Ban Yiqian , Zhang Weizhen , Zhang Youyi , Liu Yahan , Wang Nanping
Published: November 2019

Aims

Sustained activation of β-adrenergic signalling induces cardiac fibrosis, which marks progression to heart failure. GHSR (growth hormone secretagogue receptor) is the receptor for ghrelin, which is an orexigenic gastric hormone with newly defined cardiovascular effects. The present study determined the effects of GHSR deficiency in a mouse model of isoproterenol (ISO)-induced cardiac fibrosis and examined the underlying mechanism.

Methods and results

Histochemical studies showed that GHSR deficiency exacerbated cardiac fibrosis. Quantitative RT–PCR, western blotting, and immunofluorescence staining demonstrated that cardiac fibroblasts isolated from GHSR−/− mice exhibited increased expression of marker genes for myofibroblast trans-differentiation (α-SMA, SM22, and calponin) upon transforming growth factor-β treatment compared to wild-type mice. RNA-sequencing of heart transcriptomes revealed that differentially expressed genes in GHSR−/− hearts were enriched in such biological processes as extracellular matrix organization, inflammatory response, lipid metabolism, cell cycle, migration, and adhesion. Particularly, GHSR deficiency increased Wnt/β-catenin pathway activation in ISO-induced myocardial fibrosis. In addition, loss of GHSR in macrophages instigated inflammasome activation with increased cleavage and release of interleukin-18.

Conclusion

These results for the first time demonstrated that GHSR deficiency aggravated ISO-induced cardiac fibrosis, suggesting that GHSR was a potential target for the intervention of cardiac fibrosis.
Sex differences in heart failure
Authors: Lam Carolyn S P , Arnott Clare , Beale Anna L , Chandramouli Chanchal , Hilfiker-Kleiner Denise , Kaye David M , Ky Bonnie , Santema Bernadet T , Sliwa Karen , Voors Adriaan A
Published: November 2019

The overall lifetime risk of heart failure (HF) is similar between men and women, however, there are marked sex differences in the landscape of this condition that are both important and under-recognized. Men are predisposed to HF with reduced ejection fraction (HFrEF), whereas women predominate in HF with preserved ejection fraction (HFpEF). Sex differences are also notable in the penetrance of genetic cardiomyopathies, risk factors, e.g. breast cancer which may be associated with cancer treatment-induced cardiomyopathy, as well as sex-specific conditions such as peripartum cardiomyopathy (PPCM). This review outlines the key sex differences with respect to clinical characteristics, pathophysiology, and therapeutic responses to HF treatments. Finally, we address important differences in the prognosis of HF. A central hypothesis is that the higher risk of HFrEF in men compared to women may be attributable to their predisposition to macrovascular coronary artery disease and myocardial infarction, whereas coronary microvascular dysfunction/endothelial inflammation has been postulated to play a key role in HFpEF and maybe the common link among HF syndromes that women are predisposed to Takotsubo cardiomyopathy, PPCM, and breast cancer radiotherapy-induced cardiomyopathy. Under-pinning current sex disparities in HF, there is a paucity of women recruited to HF clinical trials (20–25% of cohorts) and thus treatment guidelines are predominantly based on male-derived data. Large gaps in knowledge exist in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy.
Intervention effectiveness by pharmacists integrated within an interdisciplinary health team on chronic complex patients
Authors: Acosta-García Hector , Alfaro-Lara Eva Rocío , Sánchez-Fidalgo Susana , Sevilla-Sánchez Daniel , Delgado-Silveira Eva , Juanes-Borrego Ana , Santos-Ramos Bernardo
Published: November 2019

Background

Nowadays, it is difficult to establish a specific method of intervention by the pharmacist and its clinical repercussions. Our aim was to identify interventions by pharmacists integrated within an interdisciplinary team for chronic complex patients (CCPs) and determine which of them produce the best results.

Methods

A systematic review (SR) was performed based on PICO(d) question (2008–18): (Population): CCPs; (Intervention): carried out by health system pharmacists in collaboration with an interdisciplinary team; (Comparator): any; (Outcome): clinical and health resources usage outcomes; (Design): meta-analysis, SR and randomized clinical trials.

Results

Nine articles were included: one SR and eight randomized clinical trials. The interventions consisted mainly in putting in order the pharmacotherapy and the review of the medication adequacy, medication reconciliation in transition of care and educational intervention for health professionals. Only one showed significant improvements in mortality (27.9% vs. 38.5%; HR = 1.49; P = 0.026), two in health-related quality of life [according to EQ-5D (European Quality of Life—5 Dimensions) and EQ-VAS (European Quality of Life—Visual Analog Scale) tests] and four in other health-related results (subjective self-assessment scales, falls or episodes of delirium and negative health outcomes associated with medication). Significant differences between groups were found in hospital stay and frequency of visits to the emergency department. No better results were observed in hospitalization rate. Otherwise, one study measured cost utility and found a cost of €45 987 per quality-adjusted life year gained due to the intervention.

Conclusions

It was not possible to determine with certainty which interventions produce the best results in CCPs. The clinical heterogeneity of the studies and the short follow-up of most studies probably contributed to this uncertainty.
Fish and fish side streams are valuable sources of high-value components
Authors: Välimaa Anna-Liisa , Mäkinen Sari , Mattila Pirjo , Marnila Pertti , Pihlanto Anne , Mäki Maarit , Hiidenhovi Jaakko
Published: December 2019

The current practice of fish processing generates increasing quantities of side streams and waste, such as skin, heads, frames, viscera, and fillet cut offs. These may account for up to 70% of the fish used in industrial processing. Low-value fish catches, and under-utilized fish species comprise another source of side streams. These side streams have been discarded in the environment leading to environmental problems or they have ended up as low commercial value products, such as feed for fur animals and aquaculture. However, several studies have shown that fish side streams contain valuable bioactive ingredients and fractions, such as fish oils, proteins and peptides, collagen, gelatin, enzymes, chitin, and minerals. These compounds and fractions may provide the opportunity to develop novel applications in health promoting foods, special feeds, nutraceuticals, pharmaceuticals, and cosmetic products. Better utilization of side streams and low-value fish would simultaneously improve both the environmental and ecological sustainability of production. This review summarizes the current knowledge on fish and fish side streams as sources of high-value components such as peptides with antimicrobial, antioxidative, antihypertensive, and antihyperglycemic properties, proteins such as fish collagen and gelatin, fish enzymes, fish oils and fatty acids, polysaccharides like glucosaminoglycans, chitin and chitosan, vitamin D, and minerals. Production technologies for recovering the high-value fractions and potential product applications are discussed. Furthermore, safety aspects related to the raw material, technologies, and fractions are considered.
Decision space and participation of primary healthcare facility managers in the Ideal Clinic Realisation and Maintenance programme in two South African provinces
Authors: Muthathi Immaculate Sabelile , Levin Jonathan , Rispel Laetitia C
Published: November 2019

In South Africa, the introduction of a national health insurance (NHI) system is the most prominent health sector reform planned to achieve universal health coverage in the country. Primary health care (PHC) is the foundation of the proposed NHI system. This study draws on policy implementation theory and Bossert’s notion of decision space to analyse PHC facility managers’ decision space and their participation in the implementation of the Ideal Clinic Realisation and Maintenance (ICRM) programme. We conducted a cross-sectional survey among 127 PHC facility managers in two districts in Gauteng and Mpumalanga provinces. A self-administered questionnaire elicited socio-demographic information, the PHC managers’ participation in the conceptualization and implementation of the ICRM programme, their decision space and an optional open-ended question for further comments. We obtained a 100% response rate. The study found that PHC facility managers reported lack of involvement in the conceptualization of the ICRM programme, high levels of participation in implementation [mean score 5.77 (SD ±0.90), and overall decision space mean score of 2.54 (SD ±0.34)]. However, 17 and 21% of participants reported narrow decision space on the critical areas of the availability of essential medicines and on basic resuscitation equipment respectively. The qualitative data revealed the unintended negative consequences of striving for ‘ideal clinic status’, namely that of creating an illusion of compliance with the ICRM standards. The study findings suggest the need for greater investment in the health workforce, special efforts to involve frontline managers and staff in health reforms, as well as provision of adequate resources, and an enabling practice environment.
Should we still perform fresh embryo transfers in ART?
Authors: Blockeel Christophe , Campbell Alison , Coticchio Giovanni , Esler John , Garcia-Velasco Juan A , Santulli Pietro , Pinborg Anja
Published: November 2019

An increasing number of researchers have alluded to the potential benefit of deferring the transfer of embryos produced during assisted reproductive technologies (ARTs) away from ovarian stimulation, using cryopreservation to enable this. The scientific evidence that may justify this recent trend in the use of the so-called ‘freeze-all strategy’ includes early, mostly small randomised controlled trials that have demonstrated an increase in live birth rates after elective embryo cryopreservation in certain patient populations, as well as evidence from cohort studies and retrospective analyses. What are the risks and benefits of freeze-all strategies in ART, who are the patients in whom it is likely to be advantageous, and does the current evidence allow us to identify situations when deciding that a fresh embryo transfer would be counter-productive? ART professionals are often faced with challenging clinical decisions regarding the best course of treatment for their patient. The purpose of this opinion paper is to provide a clinical guide for whether to perform a fresh embryo transfer or to opt for freezing all embryos in specific situations.
Mass Transference Principle: From Balls to Arbitrary Shapes
Authors: Koivusalo Henna , Rams Michał
Published: November 2019

The mass transference principle, proved by Beresnevich and Velani in 2006, is a strong result that gives lower bounds for the Hausdorff dimension of limsup sets of balls. We present a version for limsup sets of open sets of arbitrary shape.
Liver X Receptor Activation Impairs Neutrophil Functions and Aggravates Sepsis
Authors: Souto Fabrício O , Castanheira Fernanda V S , Trevelin Silvia C , Lima Braulio H F , Cebinelli Guilherme Cesar Martelossi , Turato Walter M , Auxiliadora-Martins Maria , Basile-Filho Anibal , Alves-Filho Jose Carlos , Cunha Fernando Q
Published: November 2019

Background

Liver X receptors (LXRs) are nuclear receptors activated by oxidized lipids and were previously implicated in several metabolic development and inflammatory disorders. Although neutrophils express both LXR-α and LXR-β, the consequences of their activation, particularly during sepsis, remain unknown.

Methods

We used the model of cecal ligation and puncture (CLP) to investigate the role of LXR activation during sepsis.

Results

In this study, we verified that LXR activation reduces neutrophil chemotactic and killing abilities in vitro. Mice treated with LXR agonists showed higher sepsis-induced mortality, which could be associated with reduced neutrophil infiltration at the infectious foci, increased bacteremia, systemic inflammatory response, and multiorgan failure. In contrast, septic mice treated with LXR antagonist showed increased number of neutrophils in the peritoneal cavity, reduced bacterial load, and multiorgan dysfunction. More important, neutrophils from septic patients showed increased ABCA1 messenger ribonucleic acid levels (a marker of LXR activation) and impaired chemotactic response toward CXCL8 compared with cells from healthy individuals.

Conclusions

Therefore, our findings suggest that LXR activation impairs neutrophil functions, which might contribute to poor sepsis outcome.
Blind Spots of Traditional Microbiological Tests for Severe Community-Acquired Pneumonia in Adults and Availability of Nonculture Techniques: A Nationwide Survey of Physicians in China
Authors: Zhang Jing , Hu Weiping , Huang Yi , Qu Jieming ,   the Infection Assembly of the Chinese Thoracic Society
Published: November 2019

Background

In China, no national survey has been conducted to evaluate physicians’ attitudes and compliance with guidelines in the management of adult patients with community-acquired pneumonia (CAP). Therefore, this study aimed to evaluate physicians’ awareness of the use of microbiological tests in the management of severe CAP (SCAP) and to investigate the availability of nonculture tests in China.

Methods

A nationwide electronic questionnaire survey was conducted among Chinese physicians between March and July 2018, which assessed their viewpoints concerning the issues in the management of SCAP.

Results

A total of 6333 physicians completed this survey, evenly covering all career stages. Among these, 3208 (50.6%) and 1936 (30.6%) had blind spots in the application of blood and sputum cultures in the management of SCAP, respectively. Nonteaching hospital, nonrespirologists, and junior career stage were independently associated with misunderstandings. Regarding nonculture methods, 52.7% of the facilities had no access to polymerase chain reaction-based pathogen detection tests. The accessibility of urinary antigen tests for Streptococcus pneumoniae (42.5%) and Legionella pneumophila (38.5%) was also low. The main barriers were inland and remote region, lower hospital level, and nonteaching hospital.

Conclusions

Insufficient use of sputum and blood cultures, together with low accessibility of major nonculture techniques, were noticeable barriers to achieving microbiological diagnosis of SCAP in China. To help curb the overuse of broad-spectrum antibiotics, further measures should be taken to raise awareness among nonspecialists and promote rapid nonculture tests, especially in nonteaching hospitals and developing regions.
The Politics of Twitter: Emotions and the Power of Social Media
Authors: Duncombe Constance
Published: November 2019

Social media is becoming a key medium through which we communicate with each other: it is at the center of the very structures of our daily interactions. Yet this infiltration is not unique to interpersonal relations. Political leaders, governments, and states operate within this social media environment, wherein they continually address crises and institute damage control through platforms such as Twitter. A question arises here as to what the turn to Twitter means for conventional structures of power and different levels of communication. This article analyses the emotional dynamics of Twitter, illustrating how emotion is implicated in the power of this social media platform. I argue that Twitter can both represent emotions and provoke emotions, which can play an important role in the escalation or de-escalation of conflict. The emotional conditions Twitter facilitates are implicated in how shifts in temporality and functionality of communication have shaped political discourse so significantly.
Minority Family Forest Owners in the United States
Authors: Butler Sarah M , Schelhas John , Butler Brett J
Published: December 2019

Family forest owners own more forestland in the United States than any other group. There have been no national studies of racial and ethnic minority family forest owners in the United States, in spite of increasing attention to diversity in forestry. Using the US Forest Service’s National Woodland Owner Survey data, we sought to better understand minority owners by looking at their characteristics, attitudes, and behaviors. Of the over 4 million family forest ownerships with 10+ ac in the United States, minorities comprise 6.6 percent of the ownerships and own 5.1 percent of the 265 million ac. Although many similarities exist between minority and nonminority owners, such as reasons for owning land and concerns, minority landowners tend to be more regionally located, have smaller forest holdings, are less likely to manage their forests, and are less likely to have participated in assistance programs. Broad insight into the attitudes and behaviors of minority family forest owners can help policymakers, program directors, and outreach coordinators begin to understand the needs of minority landowners, providing this historically underserved group with tools they need to attain their forest management and land-use goals. By increasing minority landowner engagement, we can hopefully slow the loss of land by minority landowners.
Seasonal variation in native hydraulic conductivity between two deciduous oak species
Authors: Mota-Gutiérrez Dilia , Arreola-González Guadalupe , Aguilar-Romero Rafael , Paz Horacio , Cavender-Bares Jeannine , Oyama Ken , Gonzalez-Rodriguez Antonio , Pineda-García Fernando
Published: November 2019

Aims

Mechanisms of plant drought resistance include both tolerance and avoidance. Xylem vulnerability to embolism and turgor loss point are considered traits that confer tolerance, while leaf abscission and deciduousness characterizes the avoidance strategy. While these mechanisms are thought to trade-off expressing a continuum among species, little is known on how variation in the timing and duration of leaf shedding in response to drought affect the relationship between xylem and leaf tolerance. In the present study, we explored the extent to which drought tolerance differs between two oak (Quercus) species that exhibit different leaf shedding behaviours. Particularly, we predicted that Q. deserticola Trel., which loses leaves at the end of the dry season (late-deciduous) and is thus exposed to a greater risk of cavitation, would be more drought tolerant and more conservative in its water use than Q. laeta Liebm., which loses its leaves for only a short period of time in the middle of the dry season (brevideciduous).

Methods

The study was conducted in central Mexico in a single population of each of the two oak species, separated from each other by a distance of 1.58 km, and by an altitudinal difference of 191 m. Quercus deserticola (late deciduous) is more frequent down slope, while Q. laeta (brevideciduous) tends to occur at higher elevations along the gradient. We assessed seasonal differences (rainy versus dry season) in native stem hydraulic conductivity, and tested for variation in xylem vulnerability to cavitation, leaf water use and leaf turgor loss point between the two species.

Important Findings

The two oak species did not differ in traits conferring drought tolerance, including xylem vulnerability to embolism, leaf turgor loss point, or stomatal conductance. However, both species had different performance during the dry season; the brevideciduous species had lower negative impact in the xylem function than the late-deciduous species. Overall, seasonal changes in plant physiological performance between the two oak species were determined by a reduction in the canopy leaf area.
ATBS1-INTERACTING FACTOR 2 negatively regulates dark- and brassinosteroid-induced leaf senescence through interactions with INDUCER OF CBF EXPRESSION 1
Authors: Kim Yoon , Park Seon-U , Shin Dong-Min , Pham Giang , Jeong You Seung , Kim Soo-Hwan
Published: November 2019

ATBS1-INTERACTING FACTOR 2 (AIF2) is a non-DNA-binding basic helix–loop–helix (bHLH) transcription factor. We demonstrated that AIF2 retards dark-triggered and brassinosteroid (BR)-induced leaf senescence in Arabidopsis thaliana. Dark-triggered BR synthesis and the subsequent activation of BRASSINAZOLE RESISTANT 1 (BZR1), a BR signaling positive regulator, result in BZR1 binding to the AIF2 promoter in a dark-dependent manner, reducing AIF2 transcript levels and accelerating senescence. BR-induced down-regulation of AIF2 protein stability partly contributes to the progression of dark-induced leaf senescence. Furthermore, AIF2 interacts with INDUCER OF CBF EXPRESSION 1 (ICE1) via their C-termini. Formation of the AIF2–ICE1 complex and subsequent up-regulation of C-REPEAT BINDING FACTORs (CBFs) negatively regulates dark-triggered, BR-induced leaf senescence. This involves antagonistic down-regulation of PHYTOCHROME INTERACTING FACTOR 4 (PIF4), modulated through AIF2-dependent inhibition of ICE1’s binding to the promoter. PIF4-dependent activities respond to dark-induced early senescence and may promote BR synthesis and BZR1 activation to suppress AIF2 and accelerate dark-induced senescence. Taken together, these findings suggest a coordination of AIF2 and ICE1 functions in maintaining stay-green traits.
Decrosslinking enables visualization of RNA-guided endonuclease–in situ labeling signals for DNA sequences in plant tissues
Authors: Nagaki K , Yamaji N
Published: November 2019

Information about the positioning of individual loci in the nucleus and the status of epigenetic modifications at these loci in each cell contained in plant tissue increases our understanding of how cells in a tissue coordinate gene expression. To obtain such information, a less damaging method of visualizing DNA in tissue that can be used with immunohistochemistry is required. Recently, a less damaging DNA visualization method using the CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/associated caspase 9) system, named RNA-guided endonuclease–in situ labeling (RGEN-ISL), was reported. This system made it possible to visualize a target DNA locus in a nucleus fixed on a glass slide with a set of simple operations, but it could not be applied to cells in plant tissues. In this work, we have developed a modified RGEN-ISL method with decrosslinking that made it possible to simultaneously detect the DNA loci and immunohistochemistry signals, including histone modification, in various types of plant tissues and species.
Weighing and Weight Exposure
Authors: Becker Carolyn Black , Farrell Nicholas R. , Waller Glenn
Published: November 2019

Regular, open weighing is a critical component of evidence-based treatments for eating disorders. Weight provides critical information for violating patients’ harm expectancies, and weighing offers a powerful learning opportunity for coping with anxiety. However, many clinicians collude with their patients in avoiding open weighing. The clinician’s job is to tolerate their own anxiety about things such as patient dropout while asking their patients to do likewise with their anxiety about knowing their weight. Therefore, clinician and patient need to learn the same thing—tolerance of uncertainty. This chapter details the rationale and methods for using exposure in the form of open weighing, so that the patient can overcome their fear of uncontrollable weight gain.
Novel Ways to Use Exposure for Eating Disorders
Authors: Becker Carolyn Black , Farrell Nicholas R. , Waller Glenn
Published: November 2019

Three relatively novel approaches to the use of exposure for eating disorders are considered. Each is relatively experimental in treating eating disorders but is well established in treating anxiety-based disorders. Interoceptive exposure can be used to treat distress over bodily cues (e.g., fullness). Imaginal exposure can be used to elevate and treat anxiety as a prelude to in vivo exposure, although it should be used only when necessary. Finally, exposure can be used to address “magical thinking,” such as thought–shape fusion. These methods show promise with eating disorder treatment but are in the early stages of conceptualization and development. Their use should be treated as experimental at present, and clinicians should be alert to their impact in clinical practice.
Involving Friends, Family, and Other Loved Ones
Authors: Becker Carolyn Black , Farrell Nicholas R. , Waller Glenn
Published: November 2019

Although exposure-based treatments are most commonly implemented in an individual therapy format, involving families in exposure can boost the likelihood of a successful treatment outcome. Many families will need instruction and careful guidance from clinicians in sidestepping the common pitfalls of accommodating their loved one’s eating disorder symptoms and/or engaging in patterns of highly emotionally charged and critical responding toward their loved one (i.e., expressed emotion). There are several useful options that clinicians have for involving family members directly in patients’ exposure activities. Examples of those options include training family members to be supportive “exposure coaches,” as well as utilizing family as exposure stimuli when appropriate. Employing these options effectively will help to instill a collective “exposure mindset,” in which the family are all on the same page in confronting anxiety-evoking stimuli and eliminating use of safety behaviors.
Delivering Mental Health Assistance in the Wake of Natural and Manmade Disasters
Authors: Cecil Alec
Published: November 2019

Disasters, both natural and manmade, seem to be occurring with increasing frequency in the United States and around the world. A single incident may affect many thousands of people. Collectively, many millions feel the impact of disaster every year. Addressing the psychological elements of such events has become recognized as a vital component of preparation, immediate response, and long-term recovery. This chapter reviews the major psychological aspects of disasters and disaster mental health (DMH) and highlights the importance of psychosocial assistance to survivors, responders, and others. DMH is designed to comfort and stabilize those affected, to promote effective coping, and to help maintain and restore inherent functioning. Factors that inhibit greater provision and utilization of these services are discussed, as is the importance of responding appropriately within the cultural environment of affected populations.
Serving the Underserved
Authors: Duan Changming
Published: November 2019

Eliminating disparities in racial/ethnic mental health care is an ethical mandate and a tall order for the field of psychotherapy. There are significant obstacles that pose challenges, and at the same time point out directions for the field to address. This chapter provides arguments and narratives illustrating that increasing racial/ethnic parity requires all practicing psychotherapists and those in training to devote themselves to personal and professional multicultural identity/competence development, continuous knowledge renewal, and expansion and improvement of interventions in and outside of counseling rooms. Some of the possible and concrete paths toward meeting such demands are discussed to aid practitioners in their pursuit of the course of racial /ethnic mental health care parity.
Out of the Shadows
Authors: Haldeman Douglas C.
Published: November 2019

Sexual minority and gender-diverse (SM/GD) persons experience depression, anxiety, suicidality, and substance use issues at a disproportionate rate when compared with heterosexuals. Stigma, minority stress, and prejudicial social attitudes and institutional policies are viewed as the reason for this. The disparities in access to health care for SM/GD persons is significant and is perceived as due to lack of access to competent care as well as mistrust of health care professionals on the part of SM/GD persons. SM/GD teens and elders, as well as individuals with low socioeconomic status, those living in rural areas, and those with disabilities, are particularly vulnerable. Recommendations for changes in health care policy, as well as strategies for improving the cultural competence of health care providers and evidence-based treatments, are discussed. Additionally, further research, standardizing health care training to include SM/GD persons, prevention, and inter-organizational advocacy are recommended.
Providing Psychotherapy in Rural Areas
Authors: Cohn Tracy J. , Tsai Pei-Chun
Published: November 2019

Residents in rural communities experience unique challenges in accessing and utilizing mental health care services. Providing services to members of rural communities is a social justice concern. Rural areas have a distinct culture with specific contextual stressors. This chapter highlights structural and systemic stressors and challenges that rural residents encounter, including the barriers to care that characterize rural residents’ help-seeking attitudes and behaviors, clinical work, as well as training and supervision. The authors illustrate ways that psychotherapists can increase their rural cultural competence in knowledge, awareness, and skills to help overcome these barriers. Innovative and empirically supported solutions for working in rural communities are provided. Recommendations are made for future research, clinical work, training programs, and models for rural mental health care.
From Exploratory to Experimental
Authors: Williams Elizabeth Nutt
Published: November 2019

The research findings to date are clear: Health disparities exist and are persistent. This chapter explores current research strategies and considers additional, less often employed methodologies in the area of mental health disparities. In particular, previous correlational and survey studies examining barriers to treatment are reviewed. In addition to understanding barriers to treatment, however, we need to focus on what works for underserved populations. Additional experimental studies of treatment modalities (e.g., telehealth), the impact of integrated care and geographic access, and the use of culture- and language-sensitive programs seem timely. Additional qualitative studies of individual experiences within various underserved populations will also help us devise innovative treatment approaches. By matching method to need, we will be able to find new ways to help underserved populations decide to seek help, access the care they need, and receive the best psychotherapeutic treatments available.
Gastrointestinal Symptom Management
Authors: Hsin Gary
Published: November 2019

This chapter looks at the most commonly encountered gastrointestinal symptoms in palliative care, including diarrhea, constipation, nausea, vomiting, anorexia, cachexia, and malignant bowel obstruction (MBO). The chapter gives an overview of these symptoms along with recommendations for both pharmacological and nonpharmacological treatment options. It also provides helpful tips and general principles to help guide the clinician practicing in the field.
Skin Conditions in Crisis Areas
Authors: Glass Marcia , Kovarik Carrie , Haseltine Mara , Freiwald Sandra L. , Barbour Susan
Published: November 2019

This chapter describes the most common and urgent skin issues facing palliative-medicine providers working in conflict zones, epidemics, and natural disasters. The first section focuses on exposure-related skin conditions, including burns, firearm injuries, frostbite, and snake bites. The second section describes lethal bacteria commonly found in floodwaters. The third section explores common skin conditions facing terminally and severely ill patients in crisis areas. The fourth section explains noninfectious yet potentially life-threatening skin diseases in these settings. The final section describes the opportunistic infections which could target patients with HIV anywhere.
Pediatric Palliative Care in the Context of Humanitarian Crises
Authors: Waldman Elisha , Baker Justin N.
Published: November 2019

Children represent a particularly vulnerable population in any humanitarian crisis. This chapter draws attention to some of the special vulnerabilities children experience so that clinicians may be more aware in addressing them. In addition, this chapter focuses on a number of aspects of pediatric care that practitioners more familiar with the care of adults may be less familiar with, including communicating with children (especially difficult news), evaluating pain and symptoms in children (who may be nonverbal or noncommunicative), and guidelines around medical management of pain and symptoms, especially in care of the dying child. A number of other chapters are cross-referenced where relevant.
Houston: 1970–1989
Authors: Miller Craig A.
Published: November 2019

Amid ongoing efforts at understanding atherosclerosis, Baylor becomes research “Supercenter.” Diana DeBakey, the wife of Michael E. DeBakey dies. DeBakey travels to China and Soviet Union, and communicates with President Nixon. Celebrities and nobility come to Houston to be treated by DeBakey. DeBakey meets and marries German actress Katrin Fehlhaber. His book, The Living Heart, is published. DeBakey becomes Chancellor of the college, and later he operates on the deposed Shah of Iran. DeBakey is instrumental in the founding of the Journal of Vascular Surgery. Investigations are begun into infection as a possible cause of atherosclerosis, and the period sees the beginnings of Baylor’s collaboration with NASA in the development of a left ventricular assist device (LVAD).
A Biological Century
Authors: Horwitz Allan V.
Published: November 2019

At the outset of the 19th century, mental illnesses were few in number, loosely defined, explained through many diverse and often competing theories, and treated by a wide variety of healers. As the century progressed, theological views faded as understandings coalesced around a medical model that understood mental disturbances as comparable to organic diseases. They were brain malfunctions that were often transmitted through hereditarian processes and that should be specified and distinguished from each other through their etiology, course, and outcome. The most seriously ill often entered mental institutions that were run by superintendents affiliated with the new medical specialty of psychiatry. The more numerous classes of nervous patients came to seek help from somatically oriented doctors. Although explanations of mental disturbances still encompassed both internal and external factors, the balance had tilted sharply toward the former.
Orbital Trauma
Authors: Plitt Aaron R. , Kafka Benjamin , El Ahmadieh Tarek Y. , Madden Christopher J.
Published: November 2019

Orbital and ocular trauma occurs in 10–17% of all cases of trauma. There should be a high suspicion for orbital injury in patients with blunt trauma to the head and neck region, especially in the setting of periorbital ecchymosis. CT of the face should be performed to assess for fractures. Signs of globe rupture or entrapment of an extraocular muscle are indications for emergent surgical treatment. In the absence of those signs, surgery can be delayed to allow for resolution of edema. Surgical indications are primarily cosmetic. After an orbital fracture is diagnosed, the patient should be monitored with serial ophthalmologic exams to assess for cosmetic deformity, visual decline, or diplopia. The most common symptom after surgical repair of a fracture is diplopia, which often resolves with time. Overall, in the absence of emergent signs (i.e., globe rupture and entrapment), orbital trauma should be treated symptomatically with surgical intervention for cosmesis.
Management of Complex Scalp Injuries
Authors: Theofanis Thana N. , Greaney Patrick
Published: November 2019

Complex scalp wounds require an understanding of basic anatomy and a broad knowledge of options for surgical repair. The scalp is comprised of five layers: skin, subcutaneous fat, galea aponeurotica, loose areolar tissue, and pericranium. The vascular supply is provided from vessels branching primarily off the external carotid artery. Sensation is provided by the trigeminal and C2–C3 nerves. A surgical team should evaluate all full-thickness and complex scalp lacerations, especially those associated with underlying skull fractures. Complications include wound dehiscence and infection. Clinicians must remain extremely vigilant in following these patients because an infection can lead to underlying osteomyelitis of the skull, meningitis, or subdural empyema. Often, multiple surgical teams may be involved, and a planned stepwise approach may provide the best outcome for the patient.
Occipital Condyle Fractures
Authors: Fitchett Evan , Alsaiegh Fadi , Jallo Jack
Published: November 2019

Occipital condyle fractures are a rare entity most commonly associated with traumatic injuries. Head CT is the most sensitive method for detecting such fractures, and follow-up MRI to identify ligamentous injury is necessary to determine if the fracture is unstable or if there is compression of neural elements. Surgical intervention with either a Halo device or internal fixation is only necessary in the setting of unstable fractures or when there is evidence of bilateral fractures or avulsed fragments causing neural compression. Most patients recover with little to no lasting symptoms, though it is important to watch for a delayed presentation of lower cranial nerve deficits.
Multimodality Monitoring in Severe Traumatic Brain Injury
Authors: Khellaf Abdelhakim , Hutchinson Peter J. A. , Helmy Adel
Published: November 2019

The central aspects of severe traumatic brain injury (sTBI) management are control of intracranial pressure (ICP) and maintenance of adequate delivery of glucose and oxygen to the brain. Brain multimodality monitoring (MMM) is an important tool defined by the concurrent use of multiple brain monitors, typically ICP monitoring, cerebral perfusion pressure (CPP) monitoring (via ICP and invasive arterial monitoring), brain tissue oxygen tension (PbtO2) monitoring, and cerebral microdialysis for brain biochemistry. The aim of brain MMM in patients with sTBI is to help optimize conditions for brain recovery within the neurocritical care unit, prevent secondary injury, and provide individualized therapeutic targets. In this chapter, the authors further elaborate on these concepts and current guidelines with application to a case example.
Paediatric ENT problems
Authors: Corbridge Rogan , Steventon Nicholas
Published: November 2019

This chapter looks at paediatric ear, nose, and throat (ENT) problems. It outlines the difficulty assessing the paediatric patient and the necessity to have a team approach to care. Approaches to airway problems, feeding difficulties, speech problems, and sleep-disordered breathing are described. Age-specific language development is tabulated.
Allied health professionals
Authors: Corbridge Rogan , Steventon Nicholas
Published: November 2019

This chapter describes the roles of allied health professionals who provide specialist treatment to the ear, nose, and throat (ENT) patient. The role of each practitioner and the specific problems with which they deal are outlined. The roles of the audiologist, hearing therapist, speech and language therapist, aural care nurse, dietician, and specialist head and neck nurse are documented.
Nociceptive Processing
Authors: Renn Cynthia L. , Dorsey Susan G.
Published: November 2019

Chapter 2 describes the molecular events associated with pain signaling. The mechanisms associated with chemical, thermal, and mechanical pain signaling in the peripheral nerve endings are detailed. Molecular signaling mechanisms occurring in the spinal dorsal horn, including the primary afferent nociceptor, the inhibitory interneurons, and the descending on-cells and off-cells projecting from the nucleus raphe magnocellularis are described. Persistent increases in pain signaling resulting from inflammatory mediators are explained with reference to specific molecules. Signaling events at supraspinal levels, such as the thalamus, cortex, periaqueductal gray, and nucleus raphe magnus, including cannabinoids, opioids, and noradrenergic and serotonergic neurotransmitter events, are described as critical to pain pathways with relevance to potential pain therapies.
Pain Psychology
Authors: Jackson Valerie
Published: November 2019

Chapter 5 covers the foundations of pain clinical care in the biopsychosocial model, demonstrates how this model is applied in psychological assessment and treatment planning for patients with chronic pain, and introduces the reader to the foundational concepts in pain psychology and the major categories of psychological treatments for pain. The biopsychosocial model is examined and explained in detail with application to the case scenario that opens the chapter. The assessment of patients with chronic pain is described, and the benefits and potential risks of psychological assessment are characterized. Pain psychology concepts, including pain catastrophizing, pain anxiety, and passive coping, are explained. The major treatment paradigms, including psychoeducation, cognitive behavioral therapy (CBT), acceptance commitment therapy, relaxation strategies, mindfulness-based therapies, biofeedback, and treatment responses, are described in detail. An application of CBT is presented, explaining to the reader the process of feeding forward through automatic thoughts, feelings, and behaviors and illustrating how this is changed positively by CBT to reduce the negative impacts of chronic pain on thoughts, feelings, and behaviors, leading ultimately to less pain and less pain interference. Pain psychology is introduced in this chapter in the context of collaborative interprofessional care models.