bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspectives on COVID-19 vaccination among kidney and pancreas transplant recipients living in New York City
Authors: Tsapepas Demetra , Husain S Ali , King Kristen L , Burgos Yvonne , Cohen David J , Mohan Sumit
Published: June 2021

Purpose

Solid organ transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19), but limited vaccine access and vaccine hesitancy can complicate efforts for expanded vaccination. We report patient perspectives and outcomes from a vaccine outreach initiative for a vulnerable population of transplant recipients living in New York City.

Methods

This was a retrospective review of qualitative perspectives from a COVID-19 vaccine outreach initiative. In the outreach effort, kidney and pancreas transplant recipients under care at the transplant center at NewYork-Presbyterian Hospital were initially contacted electronically with educational material about vaccination followed by telephone outreach to eligible unvaccinated patients. Calls were used to schedule vaccine appointments for patients who agreed, answer questions, and assess attitudes and concerns for patients not yet ready to be vaccinated, with conversational themes recorded.

Results

Of the 1,078 patients living in the 5 New York City boroughs who had not reported receiving COVID-19 vaccination, 320 eligible patients were contacted by telephone. Of these, 210 patients were scheduled for vaccination at our vaccine site (including 13 who agreed to vaccination after initially declining), while 110 patients were either not ready or not interested in being vaccinated. The total number of patients willing to be vaccinated was 554 when also including those already vaccinated. Unwillingness to be vaccinated was associated with younger age (median age of 47 vs 60 years, P < 0.001), Black race (P = 0.004), and residence in Bronx or Brooklyn counties (P = 0.018) or a zip code with a medium level of poverty (P = 0.044). The most common issues raised by patients who were ambivalent or not interested in vaccination were regarding unknown safety of the vaccines in general, a belief that there was a lack of data about the vaccines in transplant recipients, and a lack of trust in the scientific process underlying vaccine development, with 34% of the patients contacted expressing vaccine hesitancy overall.

Conclusion

Our qualitative summary identifies determinants of COVID-19 vaccine hesitancy in a diverse transplant patient population, supporting the need for transplant centers to implement tailored interventions to increase vaccine acceptance in this vulnerable population.
Outcomes of preoperative real-time polymerase chain reaction testing for SARS CoV-2 in elective otolaryngology surgical patients during the pandemic: a prospective cohort study
Authors: Kavanagh F G , Brinkman D , James D L , O’Neill S , Murphy C , O’Riordan I , O’Flanagan G , Lang B , Keogh I , Lang E , Casserly P , Russell J , O’Brien D ,   ICE Collaborative Group, Sheahan P ,   the MERCyCAT Study Group, O’Shea R , Kang S J , O’Sullivan B , Kennedy C , Tiernan O , ó Murchú A , Urbaniak C , Hannon P , O’Sullivan H , Khan ; A , Dias D , Coakley R , Mehanna S , Hone S , Garry C , Heffernan E , Phelan S , Kieran A , O’Connor S , Cornyn S , Boyle M , Fitzsimons O , Young M , Thornton J , Lang P , Gormley T , Subramaniam M , Aly T , Zaman K , Majeed O , Fapohunda R , Byrne J , Cregg J , Cheema D , Thornton O , O’Domhaill M , Donnelly D , Smith L , Skinner B , Mahesh
Published: June 2021

Real-time polymerase chain reaction (RT-PCR) is used to rule out SARS-CoV-2 prior to surgery, however few studies have evaluated patients with negative testing after surgery. Some 499 patients with negative tests were followed for 14 days after surgery, 39 were retested but none developed positive RT-PCR after operation. The risk of developing a positive RT-PCR after surgery was 0.74 per cent.
Rapidly Increasing Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Limited Clinical Disease in 3 Malian Communities: A Prospective Cohort Study
Authors: Sagara Issaka , Woodford John , Kone Mamady , Assadou Mahamadoun Hamady , Katile Abdoulaye , Attaher Oumar , Zeguime Amatigue , Doucoure M’Bouye , Higbee Emily , Lane Jacquelyn , Mohan Rathy , Doritchamou Justin , Zaidi Irfan , Esposito Dominic , Kwan Jennifer , Sadtler Kaitlyn , Dicko Alassane , Duffy Patrick E
Published: June 2021

Background

The extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and transmission in Mali and the surrounding region is not well understood. We aimed to estimate the cumulative incidence of SARS-CoV-2 in 3 communities and understand factors associated with infection.

Methods

Between July 2020 and January 2021, we collected blood samples and demographic, social, medical, and self-reported symptoms information from residents aged 6 months and older over 2 study visits. SARS-CoV-2 antibodies were measured using a highly specific 2-antigen enzyme-linked immunosorbent assay optimized for use in Mali. We calculated cumulative adjusted seroprevalence for each community and evaluated factors associated with serostatus at each visit by univariate and multivariate analysis.

Results

Overall, 94.8% (2533/2672) of participants completed both study visits. A total of 31.3% (837/2672) were aged <10 years, 27.6% (737/2672) were aged 10–17 years, and 41.1% (1098/2572) were aged ≥18 years. The cumulative SARS-CoV-2 exposure rate was 58.5% (95% confidence interval, 47.5–69.4). This varied between sites and was 73.4% in the urban community of Sotuba, 53.2% in the rural town of Bancoumana, and 37.1% in the rural village of Donéguébougou. Study site and increased age were associated with serostatus at both study visits. There was minimal difference in reported symptoms based on serostatus.

Conclusions

The true extent of SARS-CoV-2 exposure in Mali is greater than previously reported and may now approach hypothetical “herd immunity” in urban areas. The epidemiology of the pandemic in the region may be primarily subclinical and within background illness rates.
Evaluation of the Infectious Diseases Society of America’s Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows
Authors: Spicer Jennifer O , Armstrong Wendy S , Schwartz Brian S , Abbo Lilian M , Advani Sonali D , Barsoumian Alice E , Beeler Cole , Bennani Kenza , Holubar Marisa , Huang Misha , Ince Dilek , Justo Julie Ann , Lee Matthew S L , Logan Ashleigh , MacDougall Conan , Nori Priya , Ohl Christopher , Patel Payal K , Pottinger Paul S , Shnekendorf Rachel , Stack Conor , Van Schooneveld Trevor C , Willis Zachary I , Zhou Yuan , Luther Vera P
Published: June 2021

Background

Antimicrobial stewardship (AS) programs are required by Centers for Medicare and Medicaid Services and should ideally have infectious diseases (ID) physician involvement; however, only 50% of ID fellowship programs have formal AS curricula. The Infectious Diseases Society of America (IDSA) formed a workgroup to develop a core AS curriculum for ID fellows. Here we study its impact.

Methods

ID program directors and fellows in 56 fellowship programs were surveyed regarding the content and effectiveness of their AS training before and after implementation of the IDSA curriculum. Fellows’ knowledge was assessed using multiple-choice questions. Fellows completing their first year of fellowship were surveyed before curriculum implementation (“pre-curriculum”) and compared to first-year fellows who complete the curriculum the following year (“post-curriculum”).

Results

Forty-nine (88%) program directors and 105 (67%) fellows completed the pre-curriculum surveys; 35 (64%) program directors and 79 (50%) fellows completed the post-curriculum surveys. Prior to IDSA curriculum implementation, only 51% of programs had a “formal” curriculum. After implementation, satisfaction with AS training increased among program directors (16% to 68%) and fellows (51% to 68%). Fellows’ confidence increased in 7/10 AS content areas. Knowledge scores improved from a mean of 4.6 to 5.1 correct answers of 9 questions (P = .028). The major hurdle to curriculum implementation was time, both for formal teaching and for e-learning.

Conclusions

Effective AS training is a critical component of ID fellowship training. The IDSA Core AS Curriculum can enhance AS training, increase fellow confidence, and improve overall satisfaction of fellows and program directors.
Transmural Response and Transmural Healing Defined by Intestinal Ultrasound: New Potential Therapeutic Targets?
Authors: Helwig Ulf , Fischer Imma , Hammer Leonie , Kolterer Stefanie , Rath Stefan , Maaser Christian , Kucharzik Torsten
Published: June 2021

Background and Aims

Intestinal ultrasound [IUS] is a useful modality to monitor patients with inflammatory bowel disease [IBD]. Little is known about the use of IUS and appropriate definitions for transmural response [TR] and healing [TH]. We aimed to establish the use of IUS in monitoring TH as a potential target in routine medical practice.

Methods

Based on the prospective, non-interventional, multicentre studies TRUST and TRUST&UC, we conducted a post-hoc analysis of 351 IBD patients with increased bowel wall thickness [BWT]. We analysed the rates of patients achieving TR and TH, comparing three definitions of TH. In 137 Crohn’s disease [CD] patients, the predictive value of TR and TH was investigated for the clinical and sonographic outcome at week 52.

Results

Within 12 weeks of treatment intensification, 65.6% [n = 118] of CD patients and 76.6% [n = 131] of ulcerative colitis [UC] patients showed a TR. Depending on the definition, 23.9–37.2% [n = 58/67/43] of CD patients and 45.0–61.4% [n = 90/105/77] of UC patients had TH at week 12. CD patients with TH were more likely to reach clinical remission at week 12 (odds ratio [OR] 3.33 [1.09–10.2]; p = 0.044) and a favourable sonographic outcome (OR 5.59 [1.97–15.8]; p = 0.001) at week 52 compared with patients without TH.

Conclusions

IUS response and TH in a relevant proportion of patients suggests that IUS is a useful method to assess transmural inflammatory activity in daily clinical practice. TR and TH are predictive for the sonographic outcome at week 52.
Interactions in Public Policies: Spousal Responses and Program Spillovers of Welfare Reforms
Authors: Johnsen Julian Vedeler , Vaage Kjell , Willén Alexander
Published: June 2021

In this paper we exploit the introduction of an early retirement reform in Norway to provide new evidence on interactions in public policies across programs and household members. The analysis generates four results. First, the reform decreased the employment of the directly affected individuals. Second, the introduction of the early retirement option caused program substitution away from alternative welfare programs. Third, it reduced employment among spouses of directly affected individuals. Finally, the reduction in spousal employment was driven by take-up of disability insurance. These results demonstrate that interactions in public policies can have a substantial impact on the effect of welfare reforms.
Socioeconomic Background and Gene–Environment Interplay in Social Stratification across the Early Life Course
Authors: Erola Jani , Lehti Hannu , Baier Tina , Karhula Aleksi
Published: June 2021

To what extent are differences in education, occupational standing, and income attributable to genes, and do genetic influences differ by parents’ socioeconomic standing? When in a children’s life course does parents’ socioeconomic standing matter for genetic influences, and for which of the outcomes, fixed at the different stages of the attainment process, do they matter most? We studied these research questions using Finnish register-based data on 6,529 pairs of twins born between 1975 and 1986. We applied genetically sensitive variance decompositions and took gene–environment interactions into account. Since zygosity was unknown, we compared same-sex and opposite-sex twins to estimate the proportion of genetic variation. Genetic influences were strongest in education and weakest in income, and always strongest among those with the most advantaged socioeconomic background, independent of the socioeconomic indicator used. We found that the shared environment influences were negligible for all outcomes. Parental social background measured early during childhood was associated with weaker interactions with genetic influences. Genetic influences on children’s occupation were largely mediated through their education, whereas for genetic influences on income, mediation through education and occupational standing made little difference. Interestingly, we found that non-shared environment influences were greater among the advantaged families and that this pattern was consistent across outcomes. Stratification scholars should therefore emphasize the importance of the non-shared environment as one of the drivers of the intergenerational transmission of social inequalities.
Marriage, the Risk of Overeducation, and Selection into Both: Evidence from Germany
Authors: Hamjediers Maik , Schmelzer Paul
Published: June 2021

Two competing theories of social support and role specialization have been invoked to explain how marital status affects labour market outcomes. Whereas evidence of beneficial labour market outcomes among married men and employed married women favours a social support perspective, evidence of married women’s reduced labour market participation corresponds to a role specialization perspective. We make two contributions to this literature. First, we apply both theories to first jobs in positions for which the employee is overeducated (educational attainment exceeding job requirements). Second, we employ preference theory to show how selection into marriage shapes its association with being in a position of overeducation. To account for potential selection, we model the probability of being married and the risk of starting a career in overeducation simultaneously based on retrospective data from the German National Educational Panel Study. In line with the theory of role specialization, married women seem to be more likely to start in overeducation than unmarried women. However, adjusting for selection into marriage yields lower risks of overeducation for married women and men in comparison to their unmarried counterparts. This supports the social support perspective on overqualification and highlights how selection into marriage shapes its association with labour market outcomes.
Truth Beyond the ‘Trigger Puller’: Moral Accountability, Transitional (In)Justice and the Limitations of Legal Truth
Authors: Hearty Kevin
Published: June 2021

This article critically examines how existing truth recovery processes have, and how proposed truth recovery processes might, address the issue of shoot-to-kill in Northern Ireland. In contrast to ongoing legacy case prosecutions of British Army veterans, it argues that truth recovery processes should adopt a maximalist conceptualization of truth and responsibility. This, it is argued, necessitates differentiating between legal truth and structural truth, and between legal, political and moral responsibility. It is further submitted that such an approach would reflect the importance of identifying and understanding patterns (looking at similar cases collectively) and context (looking at the socio-political-legal backdrop to them) when establishing the ‘broad circumstances’ around disputed killings. This approach would allow truth recovery to advance beyond low-level ‘trigger pullers’ to ensure ‘moral accountability’ for the complicity of other actors within the state apparatus.
Early Changes in Interferon Gene Expression and Antibody Responses Following Influenza Vaccination in Pregnant Women
Authors: Giacomelli Cao Raquel , Christian Lisa , Xu Zhaohui , Jaramillo Lisa , Smith Bennett , Karlsson Erik A , Schultz-Cherry Stacey , Mejias Asuncion , Ramilo Octavio
Published: June 2021

Background

Influenza immunization during pregnancy provides protection to the mother and the infant. Studies in adults and children with inactivated influenza vaccine have identified changes in immune gene expression that were correlated with antibody responses. The current study was performed to define baseline blood transcriptional profiles and changes induced by inactivated influenza vaccine in pregnant women and to identify correlates with antibody responses.

Methods

Pregnant women were immunized with inactivated influenza vaccine during the 2013–2014 and 2014–2015 seasons. Blood samples were collected on day 0 (before vaccination) and on days 1 and 7 after vaccination for transcriptional profile analyses, and on days 0 and 30, along with delivery and cord blood samples, to measure antibody titers.

Results

Transcriptional analysis demonstrated overexpression of interferon-stimulated genes (ISGs) on day 1 and of plasma cell genes on day 7. Prevaccination ISG expression and ISGs overexpressed on day 1 were significantly correlated with increased H3N2, B Yamagata, and B Victoria antibody titers. Plasma cell gene expression on day 7 was correlated with increased B Yamagata and B Victoria antibody titers. Compared with women who were vaccinated during the previous influenza season, those who were not showed more frequent significant correlations between ISGs and antibody titers.

Conclusions

Influenza vaccination in pregnant women resulted in enhanced expression of ISGs and plasma cell genes correlated with antibody responses.

Brief summary: This study identified gene expression profiles of interferon-stimulated genes and plasma cells before vaccination and early after vaccination that were correlated with antibody responses in pregnant women vaccinated for influenza.
Embodied Conversational Agents in eHealth: How Facial and Textual Expressions of Positive and Neutral Emotions Influence Perceptions of Mutual Understanding
Authors: ter Stal Silke , Jongbloed Gerbrich , Tabak Monique
Published: June 2021

Embodied conversational agents (ECAs) could engage users in eHealth by building mutual understanding (i.e. rapport) via emotional expressions. We compared an ECA’s emotions expressed in text with an ECA’s emotions in facial expressions on users’ perceptions of rapport. We used a $2 \times 2$ design, combining a happy or neutral facial expression with a happy or neutral textual expression. Sixty-three participants (mean, 48$ \pm $22 years) had a dialogue with an ECA on healthy living and rated multiple rapport items. Results show that participants’ perceived rapport for an ECA with a happy facial expression and neutral textual expression and an ECA with a neutral facial expression and happy textual expression was significantly higher than the neutral value of the rapport scale ($P = 0.049$ and $P = 0.008$, respectively). Furthermore, results show no significant difference in overall rapport between the conditions ($P = 0.062$), but a happy textual expression for an ECA with a neutral facial expression shows higher ratings of the individual rapport items helpfulness ($P = 0.019$) and enjoyableness ($P = 0.028$). Future research should investigate users’ rapport towards an ECA with different emotions in long-term interaction and how a user’s age and personality and an ECA’s animations affect rapport building. Optimizing rapport building between a user and an ECA could contribute to achieving long-term interaction with eHealth.
Recurrent solitary fibrous tumor of the pleura with malignant transformation: a case report
Authors: Sakamoto Risa , Hamahiro Tomoka , Maeda Ryo , Ayabe Takanori , Tomita Masaki , Tanaka Hiroyuki
Published: June 2021

We report a rare case of recurrent solitary fibrous tumor (SFT) of the pleura with suspicious malignant transformation. A 78-year-old man had undergone prior surgical resection of the primary and recurrent SFT tumors at 11 and 2 years before the current presentation. Although his primary tumor had a round shape and did not show invasive growth, the current recurrent tumor extended through the neural foramen and had an osteoclastic progression into the thoracic spine. A computed tomography (CT) guided needle biopsy was performed and the pathological diagnosis of the tumor was confirmed as the recurrence of SFT. Immunohistochemically, the MIB-1 proliferation index (Ki-67) of the primary tumor and the current tumor was 1.74 and 30.00%, respectively. These clinical and immunohistochemical findings were strongly suspected the malignant transformation of SFT from benign. He was treated with radiotherapy, and a response was observed.
A case of seat belt-induced small bowel rupture and Chance fracture accompanied by elevated serum amylase
Authors: Tatekawa Yukihiro
Published: June 2021

We report herein our experience with a 10-year-old girl who incurred injuries consistent with seat belt syndrome. The patient was involved in a low-speed motor vehicle accident while restrained in a three-point belt (shoulder and lap belts). She complained of abdominal pain and developed tenderness and abdominal guarding. On admission, enhanced computed tomography (CT) demonstrated a fluid collection in the pelvis and a fractured vertebra in the lumbar spine. The following day, her C-reactive protein and serum amylase levels were elevated and plain CT demonstrated free air in the left side of the abdominal cavity. A ruptured jejunum was detected on laparoscopy. The involved segment of intestine was resected and an end-to-end anastomosis performed. She had an uneventful post-operative course. On post-operative day 14, she was transferred to another facility to undergo therapy for her spinal fracture. After completing conservative therapy, she was discharged 5 weeks after the initial injury.
Migrants in the Middle East and North Africa during the COVID-19 pandemic
Authors: Wickramage Kolitha , Ito Chiaki , Hilali Mahmoud , Hargreaves Sally , Requena-Méndez Ana
Published: June 2021

As COVID-19 vaccine roll-out begins in the MENA region, ensuring that migrant populations have equitable access to the vaccine, designing innovative and specific mechanisms for vaccine roll-out in these areas and monitoring vaccine uptake in migrant groups are now imminent challenges.
On the evolution of plant thermomorphogenesis
Authors: Ludwig Wenke , Hayes Scott , Trenner Jana , Delker Carolin , Quint Marcel
Published: June 2021

Plants have a remarkable capacity to acclimate to their environment. Acclimation is enabled to a large degree by phenotypic plasticity, the extent of which confers a selective advantage, especially in natural habitats. Certain key events in evolution triggered adaptive bursts necessary to cope with drastic environmental changes. One such event was the colonization of land 400–500 million years ago. Compared with most aquatic habitats, fluctuations in abiotic parameters became more pronounced, generating significant selection pressure. To endure these harsh conditions, plants needed to adapt their physiology and morphology and to increase the range of phenotypic plasticity. In addition to drought stress and high light, high temperatures and fluctuations thereof were among the biggest challenges faced by terrestrial plants. Thermomorphogenesis research has emerged as a new sub-discipline of the plant sciences and aims to understand how plants acclimate to elevated ambient temperatures through changes in architecture. While we have begun to understand how angiosperms sense and respond to elevated ambient temperature, very little is known about thermomorphogenesis in plant lineages with less complex body plans. It is unclear when thermomorphogenesis initially evolved and how this depended on morphological complexity. In this review, we take an evolutionary–physiological perspective and generate hypotheses about the emergence of thermomorphogenesis.
Lung Ultrasound to Detect Pneumothorax or Mainstem Intubation
Authors: Roberts J. Devin , Clebone Anna
Published: June 2021

Chapter 2 covers the use of lung ultrasound to detect pneumothorax and mainstem intubation. In healthy patients, a layer of visceral pleura will slide on the parietal pleura with every breath. This can be readily imaged with a handheld ultrasound probe at the point of care, and this information can be used for diagnosis of pneumothorax or mainstem intubation. Lung ultrasound can also help the clinician to visualize pleural effusions or pulmonary edema. When trying to diagnose pneumothorax by imaging, lung ultrasound is more accurate for ruling pneumothorax in (level B evidence) or out (level A evidence) than supine anterior chest radiograph.
Gastric Ultrasound and Assessment of Gastric Contents in Incompletely Fasted Patients
Authors: Clebone Anna
Published: June 2021

Chapter 3 discusses the use of gastric ultrasound and assessment of gastric contents in incompletely fasted patients. In children, fasting status can be difficult to ascertain because children may have eaten on the morning of surgery without their parent’s knowledge. In addition, children with disorders such as gastroparesis or incomplete gastric emptying may have increased stomach contents. Although rare, aspiration of gastric contents can occur with general anesthesia or sedation in children, potentially leading to morbidity. Gastric ultrasound can be used preoperatively to assess stomach contents in children when there is a suspicion for gastroparesis, incomplete gastric emptying, or incorrectly reported fasting times.
Ilioinguinal and Iliohypogastric Nerve Blocks
Authors: Lawrence Ann , Sheahan Corey
Published: June 2021

Chapter 8 covers ilioinguinal and iliohypogastric nerve blocks. These techniques involve the injection of local anesthetic into the facial layer between the internal oblique and transversus abdominis muscles, with the goal of anesthetizing the nerves that originate from the L1 spinal root. This block provides analgesia to the skin over the lower abdomen where it joins with the upper pelvis, to the upper pelvis, and along the middle portion of the thigh. Historically, a blind technique was utilized, during which the needle was inserted until a palpable “fascial click” was felt. This approach had an estimated 20 to 30% failure rate as well as a higher risk for iatrogenic small bowel and colonic puncture. An ultrasound guided approach reduces the risk for complications and has been shown to be successful, reducing postoperative analgesia requirements as well as reducing the volume of local anesthetic required.
Pediatric Pulmonary Radiology
Authors: Finkle Joshua H.
Published: June 2021

Chapter 11 examines radiologic images for common and uncommon pediatric pulmonary disorders. These include neonatal problems such as meconium aspiration, transient tachypnea of the newborn, respiratory distress syndrome, pulmonary interstitial emphysema, bronchopulmonary dysplasia, persistent pulmonary hypertension, neonatal pneumonia, and congenital diaphragmatic hernia. The chapter goes on to look at congenital lung anomalies such as congenital lobar overinflation, bronchopulmonary sequestration, and congenital pulmonary airway malformation. The lung tumor pleuropulmonary blastoma is described. Infections reviewed include pneumonia and viral bronchiolitis, and genetic disorders examined include acute chest syndrome, cystic fibrosis, and primary ciliary dyskinesia. The chapter covers the clinical features and anatomy associated with these disorders as well as their diagnosis based on the radiologic imaging.
Pediatric Neurologic Radiology
Authors: Johnson Christopher
Published: June 2021

Chapter 15 examines radiologic images for common pediatric neurologic disorders. These include head and neck disorders such as choanal atresia and congenital piriform aperture stenosis, branchial cleft cysts, thyroglossal duct cyst, fibromatosis colli, and retinoblastoma. The chapter goes on to look at spine diseases such as tethered cord, spinal dysraphism, caudal regression, pars interarticularis defect, and ventriculus terminalis. Brain abnormalities examined include germinal matrix hemorrhage, periventricular leukomalacia, craniosynostosis, and TORCH infection. Intracranial tumors looked at include posterior fossa neoplasms and supratentorial, intraventricular, and suprasellar tumors. Other brain abnormalities include those from trauma, vascular malformations, Dandy-Walker malformation, and migration and proliferation anomalies.
Phase 1 (Continued)
Authors: Busch Fredric N. , Milrod Barbara L. , Chen Cory K. , Singer Meriamne B.
Published: June 2021

One of the key differences between TFPP and more open-ended psychodynamic psychotherapy is its specific focus on symptoms of PTSD throughout the treatment. This chapter outlines ways in which the therapist can focus psychodynamic psychotherapy on specific PTSD symptoms. These include difficulties with trust and paranoia, symptoms of re-experiencing the trauma(s), dissociation and avoidance, and guilt and a sense of “badness.” Approaches for fostering insight into these symptoms through a psychodynamic lens are all accompanied by illustrative clinical examples. Development of a psychodynamic formulation for the patient with PTSD is then articulated by linking symptoms, their precipitants, their meanings in the context of early and more recent relationships understood through the lens of the transference, and their defensive functions. The clinical vignettes show how the evolution of a more cohesive and positive self-narrative permits further self-exploration and access to memories, and the possibility of more flexibility in the patients’ life choices.
Phase 3
Authors: Busch Fredric N. , Milrod Barbara L. , Chen Cory K. , Singer Meriamne B.
Published: June 2021

This chapter highlights the importance of the termination phase to the practice of TFPP. Attachment dysregulation and feelings of abandonment and rage come to the fore within the therapeutic relationship during termination. Careful handling of this process is crucial in helping the PTSD patient move past symptoms to effect therapeutic change. Issues that commonly arise during termination are feelings of loss and mourning, anxiety surrounding separations, aggravation of mistrust and anger, and fantasies and fears of helplessness. Feelings of pride and gratitude may also emerge. Termination is a challenging time in TFPP, and this chapter also focuses on common countertransference concerns and ways of avoiding pitfalls. Clinical vignettes of TFPP terminations are provided.
Extended Example of TFPP Treatment
Authors: Busch Fredric N. , Milrod Barbara L. , Chen Cory K. , Singer Meriamne B.
Published: June 2021

This chapter provides an extended case example of a 21 session treatment of a patient with TFPP. Pablo, a 27-year-old mixed Latino male Army Veteran who served in Afghanistan, presented with generalized anxiety, severe separation anxiety, and PTSD. In addition to his severe anxiety, panic attacks, hypervigilance, nightmares, and intrusive memories, Pablo complained of being in a “fog.” Symptoms began when a Humvee exploded next to Pablo. The therapist noted the patient’s description of feeling “trapped in a foxhole” with his painful memories of abuse and neglect in childhood and anger in current relationships. The therapist helped Pablo understand that he directed this anger toward himself, seeing himself as bad or inadequate, accepting his attackers’ view of him. The therapist linked the emotional impact of the Humvee explosion to a familiar set of anxieties and concerns following certain childhood experiences, and helped Pablo see how the pain of his early relationships and losses shaped his current fears and relationship choices. In the course of TFPP, Pablo became more comfortable expressing his anger and fears about his childhood, his military trauma and his current relationships. Symptoms and defenses and their origins and meanings were understood in the context of the relationship Pablo’s with his therapist (the transference). At termination Pablo was significantly improved; he no longer met DSM criteria for PTSD or other anxiety disorders. He felt much less affected by the “fog” and more capable of addressing problems in his life and moving forward with his goals and desires.
History of pain in children
Authors: Unruh Anita M. , McGrath Patrick J.
Published: June 2021

The problem of pain has always concerned humankind, as pain is a compelling call for attention and a signal to escape. Early efforts to understand pain, and its origins, features, and treatment reflected the duality between spiritual conceptualizations of pain and physiological explanations depending on the predominance of such views in a given culture. When spiritual perspectives dominated, prayer, amulets, supplication, and religious rites controlled approaches to pain treatment. Herbal remedies were often part of such strategies and might themselves been physiologically effective. In ancient writings about pain and disease, treatments for children were often given alongside discussions about the health of women. In this chapter, we trace early approaches to pain in children to the modern era, highlighting points of transition and improvements in pediatric pain management.
Prevention of the development and maintenance of pediatric chronic pain and disability
Authors: Rosenbloom Brittany N. , Pagé M. Gabrielle , Huguet Anna , Katz Joel
Published: June 2021

Understanding the predisposing factors that confer a greater or lesser risk of developing chronic, or persistent, pain is an essential step in chronic pain prevention and management. This chapter focuses on current theoretical models that can inform prevention of pediatric pain and disability. We review the literature on known risk/protective factors, markers, correlates, and prognostic factors for the transition to chronic pain and disability across a variety of pain conditions. We distinguish between primary, secondary, and tertiary levels of pain prevention and discuss the clinical implications of this distinction.
Nociceptive signaling in the periphery and spinal cord
Authors: Hathway Gareth , Greenspon Charles M. , Baccei Mark L.
Published: June 2021

Responses to painful or noxious stimuli are functional at birth. However, postnatal changes in the transmitters, receptors, and pathways involved in nociceptive signaling result in significant age-related changes in the nature and degree of response. Noxious mechanical, thermal, and chemical stimuli are detected by peripheral nociceptors, transduced into electrical stimuli, and transmitted to the spinal cord. Within the spinal cord, there are significant postnatal changes in the balance of inhibitory and excitatory signaling, that not only influence the acute response to afferent input, but can also underlie long-term alterations in sensory processing following tissue injury in early life. Evaluating age-related changes in nociceptive signaling is essential not only for understanding acute behavioral responses to noxious stimuli, but also for identifying the most appropriate and effective pain-management interventions at different developmental ages.
Theoretical basis of pain
Authors: Goubert Liesbet , Pillai Riddell Rebecca , Simons Laura , Borsook David
Published: June 2021

Pain experiences, both acute and chronic, are common in infants, children, and adolescents. The aim of this chapter is to give an overview of different biopsychosocial pediatric pain models that address acute or chronic pain. Recent insights in neural processes are discussed, as well as psychosocial mechanisms across a child’s development. The crucial role of parents in different theoretical conceptualizations is highlighted. We emphasize that both risk factors for the development of chronic pain-related disability and resilience mechanisms for adaptive child functioning should be considered. Finally, clinical implications are outlined ensuing from the different theoretical models discussed in this chapter.
Pain in the cultural context
Authors: Latimer Margot , Bombay Amy , VanEvery Rachel
Published: June 2021

Pain and culture are complex and multifactorial phenomena. The concepts are difficult to define and measure since they intersect with the biological, psychological, and social realms. Considering the intrinsic multidimensionality of each phenomenon, we are only beginning to understand the myriad ways in which culture may influence pain. Consequently, (1) the study of the relationship between culture and pain has been fraught with methodological and theoretical challenges; and (2) there is little evidence to support specific guidelines on how to assess and treat pain of specific cultural groups. Therefore, researchers face challenges in conducting research on pain with indigenous populations.
Pain, social relationships, and school
Authors: Forgeron Paula , King Sara , Fales Jessica
Published: June 2021

Social consequences of chronic pain for youth have only been a focus of research in the past decade. Research suggests that peer relationships, including close friendships, of children and adolescents with chronic pain may be negatively affected by pain. It has also been suggested that social reactions from others can negatively affect the child or adolescent’s pain experience. School functioning (i.e., academic performance and social engagement at school) may also be impaired as a result of chronic pain. Clinicians should understand the many challenges experienced by youth with chronic pain and should attend to the social consequences of pain when working with youth and their families. Research investigating interventions to manage the effects of chronic pain on school and social functioning is needed. However, there are some strategies that may be helpful in mitigating the negative consequences to social and school functioning associated with chronic pain.
Neuropathic pain in children
Authors: Verriotis Madeleine A. , Walker Suellen M.
Published: June 2021

Lesions or disease of the somatosensory nervous system can produce neuropathic pain (NP). Typical features include spontaneous or paroxysmal pain, often described as burning, shooting, like electric shocks, or pins and needles. NP does occur in childhood, but age at the time of injury may influence the risk of NP following traumatic nerve injuries. Whilst conditions commonly associated with NP in adults may be less common in childhood (e.g., trigeminal neuralgia), other conditions (e.g., Fabry’s disease and erythromelalgia), may present with pain in childhood and present a diagnostic challenge for paediatric practitioners.
Persisting pain in childhood medical illness
Authors: Mherekumombe Martha , Collins John J.
Published: June 2021

Persistent pain in childhood and medical illness can be challenging to manage. The chapter has been revised to give a brief overview of the approach to pain management in some childhood diseases. Better understanding of the etiology of pain mechanisms guide the management of pain. In addition, an understanding of the pathophysiology of the underlying processes and utilizing a stepwise assessment and treatment approach is important. Discussion around the multifaceted approach to childhood pain management incorporating the understanding of the role and place of analgesics in managing these medical illnesses is outline. In addition, appropriate medication or analgesia prescription and the role of nonpharmacological approaches has been considered in this revision.
Behavioral measures of pain
Authors: Chorney Jill M. , McMurtry C. Meghan
Published: June 2021

Though self-report has historically been considered the “gold-standard” measure of pain, behavioral observations are an important source of information and can address a number of limitations of self-report. In this chapter, we will review the current state of evidence on behavioral measures of pain in children and adolescents, including a brief discussion of future directions. We focus on measures that are considered to be well-established or have been included in recent systematic reviews, and provide an overview of the contexts of use (population, settings) and scoring method of each measure. We highlight areas of special consideration, including cross-cultural considerations, automaticity of behavior, and similarities and differences between behavioral conceptualizations of pain, fear, anxiety, and distress. To demonstrate the utility of behavioral scales, we also include a case study.
Biomarkers of pain in infants and children
Authors: Rotem-Kohavi Naama , Brummelte Susanne , Craig Kenneth D. , Oberlander Tim F.
Published: June 2021

Biomarkers are commonly used in clinical care and research as indicators of diseases and physiological states. Preferably, a biomarker should be readily accessible, low in cost, easy to interpret, highly specific, and sensitive to health and disease. Owing to the complexity of the pain system, no unidimensional reliable biomarker for pain has been identified that meets all of these criteria to date. In children, neurologically dependent developmental changes, maturation of physiological stress reactivity systems, and life experience add additional layers of complexity to the use of biomarkers of pain. Nevertheless, readily available and reliable biomarkers reflecting function of the pain system would greatly enhance timely and appropriate understanding and treatment of pain, especially in infants and children with communication, cognitive, and motor disabilities. This chapter examines currently available pain-related biomarkers, their use, and limitations.
Measurement of health-related quality of life and physical function
Authors: Tham See Wan , Wilson Anna C. , Murphy Lexa K. , Palermo Tonya M.
Published: June 2021

This chapter reviews the measurement of health-related quality of life (HRQoL) and physical function in pediatric pain populations, including details about questionnaire and performance-based measures, and recommendations for their use. Because many children and adolescents with pain report impairment in participation in physical activities, physical functioning is a core target and intervention outcome. The domain of physical functioning encompasses a number of constructs such as physical fitness, physical activity, and disability, which are interrelated, but represent distinct aspects of functioning. Moreover, HRQoL is a broader concept that subsumes physical and psychosocial function. There are a wide variety of measurement tools, but no established guidelines for measurement. Better understanding of assessment of HRQoL and physical function may enable clinicians and researchers to track functional performance and changes over time, and improve the design and testing of effective interventions for children with pain.
Interventional pain-management techniques for chronic pain
Authors: Sethna Navil F. , Alrayashi Walid , Dinakar Pradeep , Boretsky Karen R.
Published: June 2021

As part of the multidisciplinary management of pediatric chronic pain, interventional pain-management (IPM) techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in pediatric populations is limited. Interventions range from injection techniques with local anesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. In selected patients, IPM procedures can serve as useful adjuncts in multidisciplinary management of chronic pain disorders.
Sucrose and sweet taste
Authors: Harrison Denise , Yamada Janet , Bueno Mariana
Published: June 2021

Abundant published evidence demonstrates the pain-reducing effects of sweet solutions in human infants and animals. Analgesic effects persist up to around 1 year of age in human infants, though there is less research to support analgesic effects in older infants and, for the existing research, effects are more moderate than seen in the neonatal period. Though the exact mechanisms are unclear, analgesic effects are believed to be due to the relationship between sweet taste and the endogenous opiate system. Based on the extensive evidence to support sweet solutions, their use can be recommended prior to commonly performed short-lasting minor painful procedures in newborn and young infants. Despite extensive research, knowledge gaps and controversies remain relating to the mechanisms of analgesia; the effectiveness and safety of sweet solutions when given over prolonged periods to preterm and sick infants; the effectiveness in sick infants receiving concomitant analgesics; and the effectiveness in children older than 12 months of age.
Cannabis
Authors: Ware Mark A. , Pitt Rebecca , Ingelmo Pablo
Published: June 2021

There is relatively little evidence around the role of cannabis and cannabinoids in the treatment of pediatric pain, leading to a reliance on limited adult research that may or may not be relevant. In this chapter, we discuss the science behind cannabinoid receptors, current indications for cannabis and cannabinoid use and associated risks, evolving evidence around their use in pain medicine, and particular considerations of treatment in children. We present a hypothetical clinical scenario to more clearly set the stage for addressing these considerations in adolescents. Finally, we discuss important points for researchers and clinicians to examine as they weigh the risk and benefit of treatment in a world where cannabis and its derivatives are available, evidence-based, and sought-after options for various conditions related to pediatric chronic pain.
Psychosocial interventions for pediatric pain management
Authors: Uhl Kristen , Wright Laura A. , Coakley Rachael M. , Logan Deirdre E.
Published: June 2021

Cognitive behavior therapy (CBT) is the most commonly researched and empirically supported psychotherapy treatment for the management of pediatric pain. CBT is a brief, goal-oriented psychotherapy treatment using a hands-on, practical problem-solving approach. It is based on the concept that thoughts, feelings, and behaviors are causally interrelated. This chapter offers an overview of CBT and its application to pain management, describes specific cognitive behavior strategies commonly used for pediatric acute and chronic pain problems, presents the empirical evidence supporting these approaches, and highlights key considerations and emerging directions in the use of CBT and related treatments for pediatric pain.
Complementary therapy in pediatric pain
Authors: Martin Sarah R. , Zeltzer Lonnie K.
Published: June 2021

There is increasing pediatric use of complementary therapies, especially for pediatric pain. This chapter reviews the key literature on studies that pertain to the use of complementary therapy in pediatric pain management. Though limited evidence exists for many complementary therapy modalities, initial evidence is promising. Currently, the strongest evidence supports the use of hypnotherapy, which will have its own chapter, and biofeedback for headaches. Acupuncture research is growing, but there are few well-designed studies in children. Most data indicate that complementary therapy use is safe in children when administered by a trained practitioner using good clinical judgment (e.g., avoiding massage in children aversive to touch).