bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Suspected COVID-19 Patients in a Pediatric Emergency Department
Authors: Akça Halise , Kurt Funda , Akça Çağlar Ayla , Güngör Ahmet Alptuğ , Kuruç Aylin Irmak , Gacal Esma Büşra , Gişi Simge , Kanık-Yüksek Saliha , Yakut Halil İbrahim , Dibek Mısırlıoğlu Emine , Şenel Emrah
Published: September 2021

Coronavirus disease 2019 (COVID-19) is now a global pandemic. The aim of this study was to investigate the prevalence of COVID-19 in pediatric patients and to compare the characteristics of positive and negative patients. This study conducted from March to May 2020 in a tertiary children's hospital. Patients were included if they were under 18 years old and a SARS-CoV-2 polymerase chain reaction test had been performed. Of the 1,812 patients included in the study, 365 (20.1%) were positive for COVID-19. The median age was 102 months in the positive group, 70 months in the negative group (p < 0.001). The sex distribution was almost equal. Nearly all positive patients had been in close contact with a COVID-19 infected family household member (p < 0.001). The most common symptoms were fever (54.4%) and cough (38.6%). The asymptomatic patient rate was higher in the positive group (p < 0.001). Lymphopenia (<1500/mm3) was found in 29.9% of the positive children (p = 0.005). When the groups were compared, white blood cell, neutrophil, lymphocyte, and platelet counts; neutrophil-to-lymphocyte ratio; and C-reactive protein level were lower in the positive group. Chest radiography was performed in 95.3% of the positive patients, and the results of 29.7% of them were interpreted as pathological (p < 0.001). Most of the pediatric patients had a history of contact with COVID-19 positive individuals, and therefore, the diagnosis is generally suspected from a history of household exposure to COVID-19. Lymphopenia can help predict positivity. Awareness, reinforcing infection control measures, and performing health management within families are important steps to manage these patients.
The asylum–child welfare paradox: unaccompanied minors in Austria
Authors: Dursun Ayse , Sauer Birgit
Published: September 2021

Existing research shows that right-wing populist imaginaries and discourses on “bogus asylum seekers” mobilise feelings of fear and panic and serve to legitimise increasingly restrictive asylum policies in Europe. In light of this ongoing development, this paper addresses a more intrinsic and structural aspect of asylum, which requires balancing the inclusion and exclusion of persecuted third-country nationals. This paradox is most evident with unaccompanied minors who are caught between state norms and practices that are both exclusionary and repressive (asylum) and inclusive and caring (child welfare). In order to tackle this dilemma, we explore how the asylum–child welfare paradox is organised and formalised by the state and how it affects unaccompanied minors. Based on interviews with unaccompanied minors in Austria and experts who work with them, the findings show that child and youth welfare norms and practices that are formalised as part of the asylum procedure improve unaccompanied minors’ living conditions without dismantling asylum norms and practices of surveillance, conditionality, and scarcity. Judging by their simultaneous implementation, the state preserves and reinforces exclusionary and repressive asylum norms not despite but through child welfare norms and practices.
Analysis of Ohmic loss due to non-ideal boundary in relativistic backward wave oscillator
Authors: Tan Nongchao , Wu Ping , Sun Jun , Hua Ye , Cao Yibing , Wang Dongyang , Song Zhimin , Zhu Meng , Huang Wenhui
Published: September 2021

Radio frequency Ohmic loss due to non-ideal conductor boundaries seriously limits the performance of electronic devices. In this paper, the Ohmic losses of two simple models are calculated by particle-in-cell (PIC) simulation, which is also verified by theoretical calculation. Thereafter, based on PIC simulation, we have studied the variation of the Ohmic losses of relativistic backward wave oscillators (RBWOs) with operating frequency and material conductivity. The PIC simulation results show that as the frequency advances, the Ohmic losses of RBWOs deteriorate sharply. The power loss becomes non-negligible when compared with the output power. The loss-power ratio of a V-band RBWO made of stainless steel is over 25%. The non-negligible Ohmic loss can explain to some extent that the difference between the simulated and the experimental output power of the RBWO becomes apparent as the working frequency increases.
Communicating communication
Authors: Fialkoff Yonatan , Pinchevski Amit
Published: September 2021

Recent years saw the rise of communication experts, operating in various contexts and enjoying high levels of popularity. The paper examines this expertise asking: What kind of expertise do communication experts hold? What is the communication they are expert in? And what can scholars of communication learn from experts who practice it professionally? Based on in-depth interviews with communication experts, we analyze what they believe are the components of their expertise and the reliance of this expertise on communication to communicate itself. We examine this recursive nature of expertise in communication by highlighting the relationship between these experts and laypeople, offering an explanation for the popularity of the former specifically in the era of “the death of expertise”.
Identity, agency and intercultural dialogic competencies in L2 ultimate attainment
Authors: Zubrzycki Kamil
Published: September 2021

This preliminary study seeks to examine the role of agency and bilinguals’ identity negotiated in the processes of acculturation as key factors in attaining a very high or near-native L2 proficiency. Since these aspects appear to have been underestimated in research on L2 ultimate attainment, interviews were carried out with eight L2 speakers of Polish (four near-native and four highly advanced bilinguals) in order to obtain qualitative data on participants’ self-identity and acculturation. The results show that the near-native subjects identified themselves very strongly with the receiving society, whereas highly proficient L2 speakers retained a much stronger sense of L1-related identity. It is hypothesized that bilinguals’ acculturation strategies and intercultural dialogic competencies may be decisive factors in determining L2 near-nativeness.
Translation policy
Authors: Jazini Alireza
Published: September 2021

The translation policy model by González Núñez (2013, 475) comprises three elements, namely “translation management”, “translation practices”, and “translation beliefs”. While the first two elements of this model are straightforward and easy to study in top-down approaches, translation beliefs can relate both to policymakers and policy receivers. However, the distinction has not been clearly made in this model and the element of translation beliefs has been chiefly treated in the literature as though it comes from the top levels of policymaking, hence overlooking the bottom-up aspects of it (seeGonzález Núñez 2014,2016;Li et al. 2017). In order to improve this model, the present paper draws on the audience reception theory (Hall 1973), and shows that the current translation policy model requires a fourth element that I would call ‘translation reception’. The paper draws on the findings of a reception-oriented case study on translation policies in provincial broadcasting in Iran. This study argues that a more inclusive model of translation policy should not only include the authority-level elements of translation management, translation practices, and translation beliefs, but also the element of translation reception on the part of policy receivers. This way, I hope, the end users’ involvement in and contribution to the translation policy network will not be overlooked in subsequent research.
Systematic study of two-proton radioactivity half-lives using the two-potential and Skyrme-Hartree-Fock approaches *
Authors: Pan Xiao , Zou You-Tian , Liu Hong-Ming , He Biao , Li Xiao-Hua , Wu Xi-Jun , Zhang Zhen
Published: September 2021

In this work, we systematically study the two-proton (

) radioactivity half-lives using the two-potential approach, and the nuclear potential is obtained using the Skyrme-Hartree-Fock approach and the Skyrme effective interaction of SLy8. For true

radioactivity (

0 and

0, where

and

are the released energies of the one-proton and two-proton radioactivity, respectively), the standard deviation between the experimental half-lives and our theoretical calculations is 0.701. In addition, we extend this model to predict the half-lives of 15 possible

radioactivity candidates with

0 obtained from the evaluated atomic mass table AME2016. The calculated results indicate a clear linear relationship between the logarithmic

radioactivity half-lives (

) and coulomb parameters [(

+

)

] considering the effect of orbital angular momentum proposed by Liu

[Chin. Phys. C 45, 024108 (2021)]. For comparison, the generalized liquid drop model (GLDM), effective liquid drop model (ELDM), and Gamow-like model are also used. Our predicted results are consistent with those obtained using other relevant models.
Retraction: Global Stability Analysis of Dengue Transmission Model with Awareness, Vector Control and Time Delays (J. Phys.: Conf. Ser.
1899 012104)
Authors: De Lara-Tuprio Elvira P. , Teng Timothy Robin Y. , Macalalag Jay Michael R.
Published: September 2021

This article has been retracted by IOP Publishing on 7 September 2021 at the request of the authors and conference organising committee. This article was not part of the Workshop on Engineering, Education, Applied Sciences and Technology (WEAST, Makassar, Indonesia), and was submitted in error by the conference organisers. The organisers apologise for this error.

Retraction published: 07 September 2021
River pollution and social inequalities in Dhaka, Bangladesh
Authors: Hoque Sonia Ferdous , Peters Rebecca , Whitehead Paul , Hope Robert , Hossain Mohammed Abed
Published: September 2021

River pollution through the discharge of untreated sewage and industrial effluent is a perverse outcome of rapid urbanisation and economic growth across Asia. To understand the socio-spatial and seasonal inequalities in pollution risks, we designed a direct observation method to record people’s daily river use activities across dry and wet seasons, complemented by monthly monitoring of river water quality, heavy metal and biotoxicity assessment a large-scale household survey along a 25km stretch of the Turag River and Tongi Khal in Dhaka, Bangladesh. We found very high ammonia and almost zero dissolved oxygen during the low flow season, further exacerbated by heavy metals from the annual Bishwa Ijtema gathering and downstream industrial zones. Pollution exposure through domestic activities prevailed throughout the year, particularly for women and girls along low-income settlements lacking adequate water and sanitation facilities. Swimming peaked among men and children in the monsoon, risking exposure to pathogen pollution. Recognising the social inequalities in risk can support the sequencing of policy action involving short-term adaptation (improved services, education, advocacy) and long-term mitigation (effluent treatment, regulation and enforcement) responses.
High-output heart failure associated with primary plasma cell leukaemia due to arteriovenous shunting: a case report
Authors: Sudo Yuta , Inagaki Hiroshi
Published: September 2021

Background

Primary plasma cell leukaemia is rarely associated with high-output heart failure, and the underlying mechanism is not well understood. We encountered a rare case of high-output heart failure caused by primary plasma cell leukaemia. Its underlying mechanism was clarified through imaging studies.

Case summary

A 49-year-old man with no specific medical history was admitted to our hospital because of heart failure that did not improve with diuretic therapy. His condition was diagnosed as high-output heart failure and primary plasma cell leukaemia after admission. Extensive bone involvement in primary plasma cell leukaemia and arteriovenous shunts in the same lesion were suspected after various imaging studies. The first cycle of chemotherapy with bortezomib, adriamycin, and dexamethasone led to remission of primary plasma cell leukaemia and improved heart failure symptoms. The patient received further chemotherapy in addition to autologous peripheral blood stem cell transplantation and maintenance therapy and had no recurrence of pPCL or heart failure for 1 year to date.

Discussion

Primary plasma cell leukaemia can be associated with high-output heart failure, which is caused by arteriovenous shunting at the lesion site with diffuse bone involvement. Imaging studies may lead to the early diagnosis of aetiology and treatment of patients with high-output heart failure associated with primary plasma cell leukaemia.
Physical Disability and Older Adults’ Perceived Food and Economic Insecurity During the COVID-19 Pandemic
Authors: Choi Shinae L , Carr Deborah , Namkung Eun Ha
Published: September 2021

Objectives

We examined whether older adults with physical disability were vulnerable to three types of perceived economic insecurity (difficulty paying regular bills, difficulty paying medical bills, and income loss) and two types of perceived food insecurity (economic obstacles and logistical obstacles) during the early months of the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, and race/ethnicity) and two pandemic-specific risk factors (job loss and COVID-19 diagnosis).

Method

Data are from a random 25% subsample of Health and Retirement Study participants who completed a COVID-19 module introduced in June 2020. We estimated logistic regression models to predict each of five self-reported hardships during the pandemic.

Results

Bivariate analyses showed that persons with three or more functional limitations were more likely to report both types of food insecurity, and difficulty paying regular and medical bills since the start of the pandemic, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Job loss substantially increased the risk of economic insecurity but not food insecurity.

Discussion

Older adults with more functional limitations were vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by COVID-19. Supports for older adults with disability should focus on logistical as well as financial support for ensuring their food security.
Platform mergers and antitrust
Authors: Parker Geoffrey , Petropoulos Georgios , Van Alstyne Marshall
Published: September 2021

Should internet era merger policy differ from industrial era merger policy? Platform ecosystems rely on economies of scale, data-driven economies of scope, high-quality algorithmic systems, and strong network effects that frequently promote winner-take-most markets. Their market dominance has generated competition concerns that appear difficult to assess with traditional merger policy tools. This paper examines the acquisition strategies of the five major U.S. platforms—Google, Amazon, Facebook, Apple, and Microsoft—since their inception. We discuss the main merger and acquisition theories of harm and how these operate differently than in the past. To address merger and acquisition concerns of multi-sided platforms, we develop four proposals that incorporate (i) a new ex ante regulatory framework, (ii) an update of the conditions under which the notification of mergers should be compulsory and the burden of proof should be reversed, (iii) differential regulatory priorities in investigating horizontal versus vertical acquisitions, and (iv) an update of competition enforcement tools to increase visibility into market data and trends.
“Rule of law” with Chinese characteristics: Evolution and manipulation
Authors: Cohen Jerome A
Published: September 2021

Government under law or law under government? Rule of law or rule by law? That was the hotly debated constitutional law topic in China during the last two decades of the twentieth century. In her article, “Shifting Meanings of Fazhi and China’s Journey toward Socialist Rule of Law”, Professor Ye gives us a careful and thoughtful analysis of relevant developments that includes the decisive outcome reinforced by current Communist Party chief Xi Jinping. Drawing upon China’s imperial traditions and dictatorial Legalist philosophy, Xi wields law as an instrument of comprehensive official power, although in practice his repression strays into Communist lawlessness.
Broadly Distributed but Genetically Fragmented: Demographic Consequences of Pleistocene Climatic Oscillations in a Common Iberian Grasshopper
Authors: Ortego Joaquín , Noguerales Víctor , Tonzo Vanina , González-Serna María José , Cordero Pedro J
Published: September 2021

Although the genetic consequences of contemporary landscape composition and range shifts driven Pleistocene climatic oscillations have been studied fairly well in alpine organisms, we know much less about how these factors have shaped the demography of taxa with broader climatic niches and distributions. Here, we use high-throughput sequencing data to study the processes underlying spatial patterns of genomic variation in Omocestus panteli (Bolívar, 1887) (Orthoptera: Acrididae), a common Iberian grasshopper distributed across numerous habitat types and a wide elevational range (from sea level to >2,000 m). Although the species is broadly distributed, our analyses support that its contemporary populations show significant genetic fragmentation that dates back to the last glacial period. Accordingly, spatially explicit testing of alternative gene flow scenarios and demographic inference analyses revealed that genetic differentiation between populations and their long-term effective population sizes are best explained by the spatial configuration of environmentally suitable habitats during the last glacial maximum (ca. 21 ka). At that time, the species experienced net demographic expansions but interspersed unsuitable areas might have disrupted gene flow and created opportunity for geographical diversification. Collectively, our analyses indicate that the genetic makeup of contemporary populations is not well explained by current environmental factors or geographical barriers to dispersal but mostly reflects genetic fragmentation during the last glacial period followed by postglacial admixture among previously isolated gene pools. Taken together, these results support that the Pleistocene ‘species pump’ model might be also useful in explaining demographic dynamics and geographical diversification in taxa characterized by broad climatic niches.
Phylogenomic Variation at the Population-Species Interface and Assessment of Gigantism in a Model Wolf Spider Genus (Lycosidae, Schizocosa)
Authors: Starrett James , Bui Ashley , McGinley Rowan , Hebets Eileen A , Bond Jason E
Published: September 2021

Animal body size has important evolutionary implications. The wolf spider genus Schizocosa Chamberlin, 1904 has developed as a model for studies on courtship, with visual and vibratory signals receiving attention; however, body size has never been carefully evaluated. Although species of Schizocosa can be distinguished from their close relatives by differences in genitalic structures, male ornamentation, and behavior, some species are morphologically similar, making diagnosis, and identification difficult. Evaluation of species boundaries using genetic data across Schizocosa is limited. The similar species S. maxima Dondale & Redner, 1978 and S. mccooki (Montgomery, 1904) are separated predominantly on the basis of size differences, with S. maxima being larger. We evaluate the evolution of size in these two Schizocosa species distributed in western North America, where gigantism of S. maxima is hypothesized to occur, particularly in California. We sampled subgenomic data (RADseq) and inferred the phylogeny of S. mccooki, S. maxima, and relatives. We apply a variational autoencoder machine learning approach to visualize population structuring within widespread S. mccooki and evaluate size within the context of a comparative phylogenetic framework to test the hypotheses related to genetic clustering of populations and gigantism. Our data show S. mccooki populations are not genealogically exclusive with respect to S. maxima. Likewise, S. maxima individuals are not recovered as a lineage and do not form an isolated genetic cluster, suggesting that the observed differences in size cannot be used to accurately delimit species. The cause of gigantism in S. maxima remains unexplained, but provides a framework for future studies of size variation and speciation.
Is Phylogeographic Congruence Predicted by Historical Habitat Stability, or Ecological Co-associations?
Authors: Garrick Ryan C , Hyseni Chaz , Arantes Ísis C , Zachos Louis G , Zee Peter C , Oliver Jeffrey C
Published: September 2021

Comparative phylogeographic studies can distinguish between idiosyncratic and community-wide responses to past environmental change. However, to date, the impacts of species interactions have been largely overlooked. Here we used non-genetic data to characterize two competing scenarios about expected levels of congruence among five deadwood-associated (saproxylic) invertebrate species (i.e., a wood-feeding cockroach, termite, and beetle; a predatory centipede, and a detritivorous millipede) from the southern Appalachian Mountains—a globally recognized center of endemism. Under one scenario, abiotic factors primarily drove species’ responses, with predicted congruence based on the spatial overlap of climatically stable habitat areas estimated for each species via ecological niche modeling. The second scenario considered biotic factors to be most influential, with proxies for species interactions used to predict congruence. Analyses of mitochondrial and nuclear DNA sequences focused on four axes of comparison: the number and geographic distribution of distinct spatial-genetic clusters, phylogeographic structure, changes in effective population size, and historical gene flow dynamics. Overall, we found stronger support for the ecological co-associations scenario, suggesting an important influence of biotic factors in constraining or facilitating species’ responses to Pleistocene climatic cycles. However, there was an imperfect fit between predictions and outcomes of genetic data analyses. Thus, while thought-provoking, conclusions remain tentative until additional data on species interactions becomes available. Ultimately, the approaches presented here advance comparative phylogeography by expanding the scope of inferences beyond solely considering abiotic drivers, which we believe is too simplistic. This work also provides conservation-relevant insights into the evolutionary history of a functionally important ecological community.
Cryo-electron microscopy of the giant viruses
Authors: Burton-Smith Raymond N , Murata Kazuyoshi
Published: September 2021

High-resolution study of the giant viruses presents one of the latest challenges in cryo-electron microscopy (EM) of viruses. Too small for light microscopy but too large for easy study at high resolution by EM, they range in size from ∼0.2 to 2 μm from high-symmetry icosahedral viruses, such as Paramecium burseria Chlorella virus 1, to asymmetric forms like Tupanvirus or Pithovirus. To attain high resolution, two strategies exist to study these large viruses by cryo-EM: first, increasing the acceleration voltage of the electron microscope to improve sample penetration and overcome the limitations imposed by electro-optical physics at lower voltages, and, second, the method of ‘block-based reconstruction’ pioneered by Michael G. Rossmann and his collaborators, which resolves the latter limitation through an elegant leveraging of high symmetry but cannot overcome sample penetration limitations. In addition, more recent advances in both computational capacity and image processing also yield assistance in studying the giant viruses. Especially, the inclusion of Ewald sphere correction can provide large improvements in attainable resolutions for 300 kV electron microscopes. Despite this, the study of giant viruses remains a significant challenge.
Hoarding Disorder
Authors: Worden Blaise , Tolin David F.
Published: September 2021

This chapter discusses the nature and clinical characteristics of hoarding disorder, a debilitating condition that runs a chronic course without treatment and can lead to significant functional impairment and cost to society. Prevalence estimates for hoarding disorder range from 1.5% to 6% of the general population, and it tends to co-occur with depressive and anxiety disorders. In the DSM-5, hoarding disorder was differentiated from obsessive-compulsive disorder, primarily because of the pronounced differences from OCD in terms of treatment response and phenotype. However, HD remains classified as an obsessive-compulsive and related disorder. This chapter covers the etiology of hoarding disorder across biological and psychological determinants. In addition to the nature of symptoms, contemporary approaches to assessment and treatment are highlighted. The chapter concludes with a discussion of future directions for research.
Sensory Processing and Intolerance in Obsessive-Compulsive Disorder
Authors: Collins Katherine A. , Grimaldi Stephanie J. , Stern Emily R.
Published: September 2021

Patients with obsessive-compulsive disorder often exhibit abnormal sensitivity to sensory stimuli and a reduced ability to screen out stimuli that most do not find bothersome. This chapter reviews the literature to date investigating these sensory experiences, first describing studies examining behavioral and psychophysiological responses to external sensory stimuli (exteroception) that use neuroscience and clinical frameworks. Results from these studies suggest that patients with obsessive-compulsive disorder show greater sensory sensitivity than healthy controls. In addition to abnormal exteroception, many patients with obsessive-compulsive disorder experience abnormal sensations that appear to be “internally generated,” including not-just-right experiences, incompleteness, and physical urges. These sensations, termed “sensory phenomena,” cause significant distress and impairment in daily functioning and may require different treatments than fear-based obsessions. The chapter discusses the clinical phenomenology of these sensory phenomena and describes the literature on their epidemiology and neural correlates, concluding with a brief discussion of directions for future research that may provide further insight into the nature of sensory symptoms in obsessive-compulsive disorder as well as potential treatments.
The Hunt for “Perfect” Jolly Green (Cannabis)
Authors: Minaya Charlene , McKay Dean
Published: September 2021

Obsessive-compulsive disorder (OCD) and substance use disorders (SUDs) are clinically distinct disorders that share key features such as impulsivity, obsessive thoughts, compulsive behavior, and impaired attentional distraction. OCD sufferers may turn to substance use as a maladaptive coping strategy to reduce OCD-related distress, although research also suggests that varying substances may have differential effects on OCD symptoms (i.e., mitigating or even aggravating these symptoms). As individuals with comorbid OCD and SUDs demonstrate higher rates of suicidality and distress and lower treatment adherence compared to individuals with OCD alone, treatment considerations for this population are critical. Exposure and response prevention, the gold standard of OCD treatment, intentionally provokes OCD-related distress, which could inadvertently lead to an increased desire to use substances. While substance use and stress management may serve as beneficial precursors to exposure, further research is warranted on the interactions between OCD and SUDs and strategies to manage substance use in the context of OCD treatment.
Tourette’s Disorder
Authors: Ramsey Kesley , McGuire Joseph F.
Published: September 2021

Tourette’s disorder and persistent tic disorders, collectively referred to as TD, are relatively common diagnoses that are associated with functional impairment and a poor quality of life. Over the past two decades, original research has advanced the field’s understanding of the neurobiological underpinnings and clinical correlates of TD. This progress has contributed to the development and validation of key assessment tools and interventions for individuals with TD. Innovative research continues to expand our evolving conceptualization and treatment of TD. This chapter provides a brief historical overview of TD prior to outlining recent research advancements. The current genetic and neurophysiological framework on TD is reviewed and research exploring the phenomenology associated with TD is summarized. The state of evidence-based assessment and treatment of tics is outlined. The chapter concludes with a discussion of current gaps in the literature, as well as promising new directions for future TD research.
Pediatric Acute-Onset Neuropsychiatric Syndrome
Authors: Saxena Kirti , Kurian Sherin , Saxena Johanna , Muscal Eyal
Published: September 2021

This chapter discusses the nature and clinical characteristics associated with both pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). Clinical features, etiology and course, and appropriate diagnosis and assessment approaches are discussed. Common comorbid conditions, both psychiatric and medical, associated with PANS are also described. Syndromal features that uniquely characterize PANS presentations of OCD are illustrated. Extent data on immune-focused and psychiatric treatments are discussed, including means for addressing complex presentations and multiply comorbid cases, and interventions in multiple settings (such as school, clinic, and community). The chapter concludes with a discussion of future research.
Perinatal and Postpartum Obsessive-Compulsive Disorder
Authors: Fairbrother Nichole , Challacombe Fiona L. , Collardeau Fanie , Truong Thanh Thuy
Published: September 2021

Postpartum obsessive-compulsive disorder can occur as a new disorder, as a preexisting condition, or can represent the exacerbation or recurrence of a prior condition. The presentation of postpartum OCD is often characterized by a rapid onset, and commonly includes obsessions of harm related to the newborn, typically around the time of birth. Symptoms of postpartum OCD can, however, persist long after the delivery of a baby. This chapter discusses the nature and clinical characteristics associated with perinatal and postpartum obsessive-compulsive disorder. Clinical features and appropriate diagnosis and assessment approaches are discussed. Data on psychiatric treatments are provided. The chapter concludes with a discussion of future research.
The Inhibitory Learning Approach to Exposure and Response Prevention for Obsessive-Compulsive Disorder
Authors: Hellberg Samantha N. , Ojalehto Heidi J. , Buchholz Jennifer L. , Abramowitz Jonathan S.
Published: September 2021

Exposure and response prevention (ERP) is the most effective treatment for obsessive-compulsive disorder (OCD), with robust symptom gains consistently observed. Yet, both research and clinical practice indicate ERP is not equally efficacious for all individuals with OCD, and a considerable portion fail to achieve full symptom remission or experience relapse despite substantial short-term gains. To this end, inhibitory learning theory (ILT) has emerged as an empirically driven conceptual framework for implementing ERP with the goal of optimizing the efficiency and durability of treatment gains. This chapter reviews the conceptual framework for ERP, illustrates ERP through a case example in which common pitfalls were encountered, defines ILT, and illustrates the use of ILT to address these pitfalls.
Technology-Based Psychotherapies for Obsessive-Compulsive Disorder
Authors: Fletcher Terri L. , Ecker Anthony H. , Boykin Derrecka M. , Dawson Darius B. , Rassu Fenan , Hundt Natalie E.
Published: September 2021

Access to exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) continues to be challenging for many individuals around the world, particularly those living in rural and underserved areas. Innovative technological solutions including mobile applications, internet-based programs, and video telehealth have the potential to expand access to mental health care for OCD. This chapter covers the use of technology in delivering ERP for OCD. First, an overview is provided of the various technology-based solutions that exist and the supporting evidence for each. Then, as video telehealth delivery is the most commonly used and has the most empirical support, the rest of the chapter discusses the benefits and challenges of video telehealth delivery of ERP; covers clinical, ethical, and legal considerations in the delivery of ERP via video telehealth; and provides two case studies illustrating relevant issues.
Distress Tolerance
Authors: Blakey Shannon M. , Lanier Megan K.
Published: September 2021

Distress tolerance, sometimes referred to as “psychological distress tolerance” or “emotional distress tolerance,” is the perceived or actual capacity to withstand aversive emotional states. Distress tolerance is a trait-like transdiagnostic characteristic that varies within and across individuals with obsessive-compulsive and related disorders (OCRDs). From a cognitive-behavioral formulation, distress tolerance influences an individual’s anticipatory predictions regarding how distressing a stressor may be, an individual’s actual experience of distress in response to a stressor, and how an individual copes in response to a stressor. Using illustrative case examples, this chapter discusses the relevance of distress tolerance to the development and maintenance of OCRDs, the assessment of distress tolerance, as well as therapeutic interventions that may be used to address this phenomenon when it is observed in clinical settings.
Prevention of Obsessive-Compulsive Disorder
Authors: Wong Shiu F. , Riskind John H. , Aardema Frederick
Published: September 2021

Because obsessive-compulsive disorder (OCD) interferes with social and occupational functioning, and affects up to 3% of the population, it is important to consider strategies for how to prevent this condition. Although there is some evidence that OCD has biological or genetic components, at this time these are not well understood and therefore not malleable. Accordingly, prevention strategies are built around the growing body of research on psychological risk and protective factors related to OCD. Research on OCD prevention is very limited, and this chapter aims to inspire further developments in this area. In doing so, the chapter provides a framework for understanding prevention in mental health. This will be followed by a consideration of the factors relevant to OCD. Recommendations are provided regarding specific preventive interventions borrowed from prevention research on other mental disorders and for future research.
Delivery of Standard UP-C and UP-A Treatment for Youth with Emotional Disorders
Authors: Gruen Rinatte , Braun Dylan
Published: September 2021

This chapter describes the standard delivery of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A). It is intended to help therapists understand how the flexible modules within each treatment are typically presented, and serves to supplement the existing UP-C/A therapist guide. This chapter outlines the core transdiagnostic treatment components that are common to the UP-C and UP-A while also highlighting key differences in treatment presentation for different developmental levels to help therapists select the most appropriate intervention for their clients. While this chapter focuses on the delivery of UP-C and UP-A for youth with depression, anxiety, and related concerns, it also provides greater context for treatment adaptations for other presenting problems that are described later in this book.
Current Evidence Base for the UP-C and UP-A
Authors: Tonarely Niza , Phillips Dominique
Published: September 2021

This chapter summarizes current research support for Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A), which have been found to be efficacious for children and adolescents with a range of emotional concerns. The UP-A has been investigated in randomized controlled trials and has demonstrated efficacy in treating anxiety and depressive symptoms, with significant decreases in symptoms during treatment and maintenance of gains following treatment. The UP-C has been investigated using open and randomized controlled trial designs and was found to be as efficacious as an established anxiety protocol. This chapter also presents research on patterns of change across symptoms and individuals in response to the UP-C and UP-A, including response trajectories, the timing of change, and comparisons of rates of change by symptom and reporter.
Pediatric Illnesses and Pediatric Settings
Authors: Landoll Ryan R. , Thornton Kade B. , Elmore Corinne A.
Published: September 2021

Transdiagnostic treatments such as the Unified Protocol are uniquely situated to support health issues that present in childhood as well as in pediatric medical settings. In particular, the high comorbidity between anxiety and somatic concerns makes transdiagnostic approaches important to utilize in medical settings where they may first appear. There is limited literature on adapting the Unified Protocol for the Treatment of Emotional Disorders in Children (UP-C) in these settings, but some promising initial work has been done in the area of chronic pain. Clinicians are encouraged to consider adapting the UP-C to work with both health conditions and settings in childhood, given the likelihood of comorbid physical and mental health challenges in pediatrics. In addition, adaptations to a health care setting should focus on decreasing the frequency and duration of UP-C encounters while also working to address symptoms before they become more acute.
Enhanced Communication Skills
Authors: Glajchen Myra , Wilkins Christine
Published: September 2021

Good communication is considered fundamental to high-quality palliative care. Communication includes serious illness conversations with patients and family caregivers, collaborative communication across teams and disciplines, and communication with community providers. This chapter explores definitions, evidence-based research, training, and best clinical practices in three areas of enhanced communication. Narrative medicine promotes empathy, patient-centered listening, and life review through reflective journaling, writing, and self-reflection. Goals-of-care discussions, which may include advance care planning, ensure that providers align care with what matters most to the patient. The family meeting is used to facilitate communication, discuss the illness experience, present treatment choices, and facilitate end-of-life decision-making. Quality healthcare mandates training for healthcare clinicians in communication using a systematic approach.
Patients With Substance Use Disorder
Authors: Woodall Hunter
Published: September 2021

Palliative care providers, including physician assistants, frequently encounter substance use disorder (SUD) in patients or their families. Many of these patients with SUD remain undiagnosed at the time of palliative care referral, with most patients with these issues having preexisting conditions. Management of these patients requires proper screening and diagnosis, and teams must establish clear expectations. This chapter teaches palliative care teams to detect SUD and differentiate addiction behaviors from incompletely managed symptoms; diagnose and manage associated psychosocial issues; communicate clear expectations regarding treatment; safely prescribe controlled medications; manage intoxication or withdrawal; and develop plans to deal with drug diversion. Ongoing timely multidisciplinary communication is paramount in managing these challenging illnesses.
Veteran Population
Authors: Pilewski Holly
Published: September 2021

The Department of Veterans Affairs is a large, multilayered administration providing veterans healthcare, numerous medical and caregiver benefits, and cemetery and burial services. Veterans account for a large portion of the population and have unique physical, psychological, spiritual, and social needs that are shaped by veterans’ perceptions of military experience and injuries or medical conditions related to their service. Many veterans receive their care outside the VA. This makes it imperative for everyone to have a basic understanding of the VA, military culture, and veterans’ multifaceted needs. Hospice and palliative care in and outside the VA setting are essential in order to provide veterans with improved quality of life and high-quality end-of-life care.
Transitions in Palliative and End-of-Life Care
Authors: Steinberg Karl , Fratkin Michael
Published: September 2021

In palliative and end-of-life care, people with serious illness and their families experience a number of transitions—in functional status, physical location, cognitive abilities, and goals of care. This chapter focuses on care transitions in location and treatment preferences and discusses some pitfalls of transitions, along with telemedicine as a palliative care tool to reduce the burden of transitions. Medication reconciliation between sites of care and interprofessional coordination of care among various clinicians and teams are important elements of safe, effective care transitions. Respecting a patient’s autonomy while optimizing safety can be a challenge, and care decisions in times of transition should be person centered, holistic, and compassionate.
An action-oriented perspective on space and affordances
Authors: Arbib Michael A.
Published: September 2021

Architects design spaces that offer perceptual cues, affordances, for our various effectivities. Lina Bo Bardi’s São Paulo Museum demonstrates how praxic and contemplative actions are interleaved—space is effective and affective. Navigation often extends beyond wayfinding to support ongoing behavior. Scripts set out the general rules for a particular kind of behavior, and may suggest places that a building must provide. Cognitive maps support wayfinding. Other maps in the brain represent sensory or motor patterns of activity. Juhani Pallasmaa’s reflections on The Thinking Hand lead into a view of how the brain mediates that thinking, modeling hand–eye coordination at two levels. The first coordinates perceptual and motor schemas. The body schema is an adaptable collage of perceptual and motor skills. The second coordinates the ventral “what” pathway that can support planning of actions, and the dorsal “how” pathway that links affordance-related details to motor control. A complementary challenge is understanding how schemas in the head relate to social schemas. Finally, the chapter compares the cognitive challenges in designing a building and in developing a computational brain model of cognitive processes.
From empathy to mirror neurons and back to aesthetics
Authors: Arbib Michael A.
Published: September 2021

This chapter approaches aesthetics anew by considering empathy and Einfühlung, “feeling ourselves into” a work of art or architecture. The key neuroscience is the discovery of mirror neurons in monkeys that inspired the discovery of mirror systems in humans. Unsupervised, supervised, and reinforcement learning, each based on a different rule for synaptic plasticity, are presented as background for a computational model of how mirror neuron wiring is learned. Mirror neurons may serve social interaction, but they also self-monitor in acquiring new behaviors. This is exemplified in modeling how adaptive sequences of behavior may be mastered through learning the desirability and executability of actions. Such opportunistic scheduling complements the role of scripts. Empathy is linked to mirror systems but also depends on systems beyond the mirror. Returning to Einfühlung, we explore how a motor component may enrich our aesthetic appreciation by recognizing the actions and emotions of protagonists in a representational painting, or by gaining some feeling for the actions of the artist, sculptor, or architect in creating the work. Finally, case studies are sampled, including those in neuroaesthetics seeking neural correlates for aesthetic appreciation, that contribute to a tool kit for assessing the experience of buildings to enrich future design.
Sources of the Military Metaphors of Medicine
Authors: Fuks Abraham
Published: September 2021

Chapter 5 traces the historical origins of military metaphors and seeks to understand their cultural roots. Some scholars point to Pasteur’s germ theory and the development of immunology in the late nineteenth century as the beginnings of the linguistic wars against bacteria and disease. Yet, physicians of an earlier era prior to any knowledge of bacteria postulated a human body engaged in life-and-death battles, and the earliest depiction of fever as evidence of a war within the body appears in the work of an Italian friar in 1635. The chapter postulates an earlier cultural origin for these metaphoric battles in ancient theological sources in which disease is understood as retribution for sins and an evil that must be fought with contrition and prayer. The Psychomachia, an allegorical work of the fifth century, relates the mythic battles between good and evil that are later readily evident in Puritan writings of England and early America.
Resilience of Military Metaphors
Authors: Fuks Abraham
Published: September 2021

Military metaphors have been ubiquitous in medicine for centuries. This indicates that tropes of battle may be helpful to some persons in coping with illness. This chapter examines pathographies, that is, stories of illness written by patients, and the words that describe their experiences. A powerful example of a war correspondent and historian of battles of WWII illustrates how military language offers a sense of control and self-reliance for a person who values action and engagement. Thus, for some, figures of war and victory are especially resonant and may counter the loss of dignity and fear that accompany illness. However, this demands bravado, stoicism, and even denial. Further, the words may shift to heroism in the face of defeat as the illness worsens. This chapter notes the particular responsibilities of the physician caring for the “warrior” patient and the imperative for an adaptable and nuanced stance as the illness evolves.
A Pharmacology of Words
Authors: Fuks Abraham
Published: September 2021

This chapter proposes that placebos are best understood as a metaphor in which words (and doctors) are drugs and can thereby alleviate symptoms and promote healing. Placebos may be chemically inert, yet they possess clinical potency. Various explanations for the placebo effect have been proposed, including conditioning, expectancy, meaning response, and ritual, and the relevant causal neural mechanisms are reviewed. The chapter examines the paradox of the widespread use of placebos and the mistrust they often elicit, while reviewing the importance of the patient’s and physician’s belief in the impact of words and ritual. The various types are noted, including hidden or covert placebos, open-label placebos, and socially transmitted placebos. The chapter emphasizes the importance of context and the clinical relationship in the benefits provided by this long-underappreciated clinical phenomenon.