bluuebunny/crossref_metadata_2025 huggingface dataset:
Delirium
Authors: Davis Daniel , Richardson Sarah , Sepulveda Esteban
Published: February 2021

Delirium is a common and severe neuropsychiatric syndrome of brain dysfunction characterized by acute and fluctuating inattention and other cognitive and perceptual deficits precipitated by acute illness. Despite being first described by Hippocrates more than two thousand years ago, there exists considerable uncertainty regarding the diagnosis of delirium due to our limited understanding of fundamental concepts, including its definition and pathophysiology. The ensuing lack of standardization results in delirium being frequently undiagnosed and significant misclassification bias in existing research. This chapter discusses the descriptive epidemiology of delirium, including methodological issues around case ascertainment in different population and clinical settings. There remains a lack of epidemiological research in the field, but we indicate the potential for observational longitudinal studies to address key questions on the population impact of delirium alongside fundamental questions of major importance to patients and their families regarding outcomes after delirium.
Infection, other than bacterial, including HIV
Authors: Yoro-Zohoun Inès , Luna Jaime , Amidou Salmane , Preux Pierre-Marie
Published: February 2021

This chapter is dedicated to the epidemiology of common non-bacterial central nervous system infections: parasitic, fungal, and viral infections. Non-bacterial central nervous system infections are public health challenges in developing and developed countries. Clinical manifestations and severity depend on pathogenic characteristics of the agents and of the patients (areas affected, age, immune status, etc.). These infections are an emerging problem with a poor prognosis if treatment is not adequate. Furthermore, these agents have been commonly implicated as risk factors to other neurological disorders and sequelae that impose a high burden on the healthcare resources.
Electromagnetic fields
Authors: Schüz Joachim , Feychting Maria
Published: February 2021

Exposures to extremely low-frequency electric and magnetic fields (ELF) related to the production, transmission, and use of electricity, as well as to radiofrequency electromagnetic fields (RF) mainly related to mobile communication and broadcasting are ubiquitous in modern times. Although protection limits prevent known biological effects, such as induction of electric currents and tissue heating, those guidelines are challenged by several decades of research of whether adverse effects exist below those protection limits, including studies on neurological diseases. Synthesizing the evidence shows little or inconsistent evidence for ELF and childhood and adult brain tumours, as well as for RF and neurodegenerative disease. Most studies show no association between mobile phone use and brain tumour risk, but a modestly increased risk with very heavy use for some subtypes cannot be excluded. Some indications of associations are seen between certain neurodegenerative diseases and occupational ELF exposures.
Harvesting conduits
Authors: Wang Alice , Smith Peter K.
Published: February 2021

The saphenous vein graft (SVG) remains the most commonly used conduit for circumflex, right coronary, and diagonal coronary grafts and is used in approximately 90% of patients undergoing coronary artery bypass grafting in the United States. Vein graft failure, however, remains a persistent disadvantage of the SVG compared to arterial conduits. Up to 15% of SVGs occlude within the first year and up to half are occluded by 10 years. Vein graft failure has serious clinical consequence as studies have found SVG occlusion to be associated with the need for repeat revascularization, myocardial infarction, and death. Consequently, much research has been dedicated to identifying causes of increased rates of vein graft failure, particularly whether the method of harvest affects SVG patency.
Respiratory assessment and care
Authors: Briscoe Daren
Published: February 2021

Respiratory conditions are a common complication for the acutely ill patient. Early recognition of the onset of a respiratory crisis is fundamental to prevent further deterioration of the acutely ill patient. This chapter provides a discussion of the respiratory system and the physiological mechanisms which control respiratory function with a useful overview of common respiratory symptoms. The principles of arterial blood gas analysis, respiratory support mechanisms, and tracheostomy care precedes a discussion of three commonly encountered respiratory disorders; asthma, COPD, and pneumonia, with focus upon nursing and medical support to support patients with these acute illnesses. A large proportion of emergency admissions to acute care wards are due to these diseases and thus a good understanding of the assessment and management of these conditions is essential.
Transfer of acutely ill patients
Authors: Gardner Emma
Published: February 2021

Transfers are undertaken to improve the management of the patient and therefore play a crucial part within a patient’s journey. It is therefore essential that the nurse has a clear understanding of the potential impact of moving critically ill patients and the problems that may occur during transfer. The transfer of patients, especially between hospital sites, is not without risk and adverse events that could have been prevented are well documented within the literature. The potential risks entailed in transferring an acutely ill patient within and between hospitals are explored in this chapter. There is a focus on pre-transfer preparation, the clinical skills and equipment required during transfer, and the importance of good communication skills to ensure patient safety.
Acute severe asthma
Authors: Nyman Andrew , Durward Andrew
Published: February 2021

Children with acute severe asthma requiring invasive ventilation are among the most difficult to manage in the Intensive Care Unit (ICU). This chapter begins by explaining the pathophysiology of asthma before examining the approaches to its management on the ICU—starting with the evidence for the use of non-invasive ventilation and bronchodilators. Indications for invasive ventilation in acute severe asthma are discussed and important considerations in the conduct of induction of anaesthesia and intubation in this patient group. Ventilation strategies are explored, with particular reference to the concepts of airway resistance, driving pressure, inspiratory flow limitation, and auto-positive end expiratory pressure (PEEP). The use of the mucolytic therapy intratracheal DNAse is discussed, and indications for the use of extracorporeal membrane oxygenation in refractory cases. Finally, the chapter reports on outcomes for children with acute severe asthma and factors associated with higher risk of mortality.
Traumatic brain injury
Authors: DelSignore Lisa A. , Tasker Robert C.
Published: February 2021

Chapter 7 covers the definition, epidemiology, pathophysiology, and management of traumatic brain injury (TBI). It explains the fundamental concepts of brain physiology: intracranial compliance; intracranial hypertension; cerebral perfusion pressure; cerebral blood flow; and autoregulation. Medical management of TBI is detailed, including hyperosmolar therapy and nutritional support. Neuromonitoring of patients with TBI in the intensive care unit is discussed, including the evidence base for seizure monitoring and antiepileptic drug prophylaxis. Patients with severe TBI and refractory intracranial hypertension may need escalation to second-tier therapies, which are evaluated, including the evidence for decompressive craniectomy. A concise summary of the different therapies is included.
Late Effects of Therapy and Survivorship Issues
Authors: Hjorth Lars , Haupt Riccardo , Michel Gisela , Garrè Maria Luisa , Kremer Leontien C.M. , Skinner Rod
Published: February 2021

This chapter presents an overview of late complications of therapy for childhood cancer with a focus on organ systems at risk. First comes an introductory overview of previous and current studies on late complications of treatment for childhood cancer, followed by data on epidemiology. Serious late complications such as late mortality (i.e. premature death), second malignant neoplasms, and cardiac disease, as well as neurological and neuropsychological toxicities, are described in more detail. Endocrine problems (both gonadal and non-gonadal) are presented, including information on the metabolic syndrome. Toxicities of other organ systems follow (i.e. lung, kidney, vision, hearing, face and teeth, gut and liver, skin, skeleton, and the immune system), as does specific information on survivors of haematopoietic stem-cell transplantation (HSCT) and central nervous system (CNS) tumours, as well as surgical complications. Finally, the chapter presents information on psychosocial outcomes regarding long-term follow-up care, with an outlook to the future and recommendations for further reading.
Childhood Histiocytoses
Authors: Aricò Maurizio , van den Bos Cor , Weitzman Sheila
Published: February 2021

This chapter summarizes the clinical spectrum of the histiocytic disorders—Langerhans cell histiocytosis (LCH), haemophagocytic lymphohistiocytosis (HLH), and some uncommon histiocytic disorders, including juvenile xanthogranuloma (JXG) and Rosai–Dorfman disease—as well as the current diagnostic and therapeutic approaches in these diseases. Multiple activating mutations in the RAS–RAF–MEK–ERK pathway have recently been described in LCH. Their role in the pathophysiology of the disorder and in targeted therapy is reviewed. This chapter explains the differences between primary and secondary HLH, and reviews the genetic abnormalities playing a role in both forms of HLH.
The ageing brain
Authors: Woulfe John , Gray Doug , Proctor Carole
Published: February 2021

Ageing is accompanied by loss of cognitive function, but the effects, pattern, and extent of this are highly variable among individuals. At one end of the spectrum, symptoms of neurodegenerative disorders, such as memory loss in Alzheimer’s disease, are observed. While the underlying cellular mechanisms have been studied extensively, less is known about the mechanisms leading to brain ageing per se. It is believed that there is a continuum between ageing and classical neurodegeneration. However, there is evidence of neuronal and glial changes at the cellular and molecular levels that are unrelated to the pathological changes observed in disease. These age-related changes may lower the threshold for neurodegeneration pathologies. The underlying mechanisms are complex and also involve stochastic events such as random molecular damage leading to inter-individual variability in the rate of cognitive decline.
The sociology of ageing
Authors: Edmondson Ricca
Published: February 2021

This chapter begins with an overview of the contrasting phenomena that need to be reconciled within the sociology of ageing. It stresses respects in which ageing itself is a social phenomenon, arguing that they reveal deep social ambiguities and contestations in connection with the human life-course. It then examines both threats and resources associated with globalized aspects of contemporary ageing, before interrogating contributions by successive theoretical analyses of what ageing involves. The chapter explores the decisive impacts of welfare states on the circumstances of ageing and their connections with the social distribution of family and caring roles. It continues with a discussion of generational and gender relations before examining wider environments for life-course development and their connections with familial and other forms of mutual care. Lastly, it addresses issues relating to social exclusion and ageism, before exploring aspects of social meaning connected with later life and their potential for enhancement.
Epidemiology of old age psychiatry
Authors: Minett Thais , Brayne Carol , Stephan Blossom C.M
Published: February 2021

Epidemiology is the foundation of public health and rational planning of services. In the field of old age psychiatry, the information provided by epidemiological research has been highly influential. As the world older population is growing proportionally faster than the other age segments, there is a continuous need for further epidemiological research in old age psychiatry. Neuropsychiatric conditions, such as depression and dementia, cognitive impairment, and behavioural and functional decline, place a considerable onus on the health, social, and economic systems. This chapter presents some of the world demographic data and basic epidemiological concepts, discusses some methodological issues in the epidemiology of mental disorders in old age, and presents a summary of many of the most important studies in this field.
Molecular genetics and biology of dementia
Authors: Hye Abdul , Velayudhan Latha
Published: February 2021

Dementia is caused by an interplay between genes and lifestyle and environmental factors. Recent advances in genetic and molecular biology have provided valuable insights into the pathogenesis of underlying dementia for not only in those with clear genetic aetiology, but also in those with no familial basis. The advent of large-scale genome-wide association studies (GWAS) and the more recent next-generation sequencing has unravelled some great insight into the possible underlying mechanisms involved in neurodegenerative disorders such as Alzheimer’s disease, vascular dementia, frontotemporal lobar degeneration, and Lewy body disease. Interestingly, there is a common theme and these studies have outlined several pathways such as immune regulation, lipid metabolism, protein folding, and protein transport. This brings hope for future treatment strategies and therapeutic targets. Finally, most dementias are multifactorial and not only caused by genetic factors. Therefore, more research is needed, particularly investigations of epistasis and gene-by-environment interaction.
Psychiatric assessment of older people
Authors: Huntley Jonathan , Thomas Alan , Stewart Rob
Published: February 2021

The venue for psychiatric assessment varies, but given the choice, there are substantial advantages in the first assessment being conducted at home. The aims of assessment are to do more than achieve a diagnosis, though this is crucial; the aim should also be to produce a holistic assessment of all needs, leading to the involvement of a range of appropriate professionals in health and social care services to address these needs and carry out their own specialist assessments. Information from informants will supplement that of the patient and enable completion of all the important domains in the psychiatric history. The mental state examination will include a special emphasis on cognitive assessment, and a brief physical examination looking for neurological signs is important.
Psychopharmacology
Authors: Bishara Delia
Published: February 2021

The use of pharmacological agents in older adults is one of the most complex aspects of patient care. Clinicians must display expert knowledge on and careful consideration of the various factors involved. Older people exhibit an unexpected or exaggerated response to drug therapy when compared to their younger counterparts of the same body weight and gender. Often this response is explained through pharmacokinetic or pharmacodynamic changes. Understanding the common physiological changes seen in ageing is helpful in anticipating the changes expected in pharmacokinetic parameters. The pharmacodynamic variations seen in older patients may also increase or decrease sensitivity to a drug independently of the pharmacokinetic changes. In addition, age is known to be associated with increased prevalence of multiple chronic illnesses frequently requiring the use of complex therapeutic regimens, thus increasing the risk for adverse drug reactions and drug interactions in older people.
Primary care management of older people with mental health problems
Authors: Robinson Louise , Chew-Graham Carolyn A
Published: February 2021

This chapter discusses the presentation and primary care management of the commonest mental health problems in older people; delirium, delusions, depression and anxiety, and dementia. Primary care is on the front line in dealing with older people who have mental health problems, supporting their families to care for them, and managing people with complex comorbidities in addition to mental health issues. Older people consult their GP almost twice as often as other age groups and up to 40% of older people may have a mental health problem. The chapter presents cases drawn from the authors’ real-life practice, first, to represent clinical presentations and management within primary care; and second, to demonstrate how primary care links with secondary care and the wider services. It discusses the management of patients largely within reference to UK primary care systems and policy, but the international readership should find parallels within their own healthcare systems.
Liaison old age psychiatry
Authors: Thompson Fiona , Baker-Glenn Elena
Published: February 2021

Liaison psychiatry is a sub-specialty of psychiatry that specializes in the interface between physical and mental health, and involves treating patients who are attending general hospitals. This chapter provides an overview of the development of old age liaison psychiatry with consideration of the commissioning and funding of services. It discusses the importance of liaison psychiatry services being integrated within the general hospital team. It outlines different models of liaison psychiatry and provides examples of different services in the UK. It describes common conditions seen within older adult liaison psychiatry and considers screening tools and outcomes. Finally, it covers other aspects of the role of liaison psychiatry, such as teaching, training, governance and accreditation of services and considers interfaces with other services and the future of liaison psychiatry.
Mild cognitive impairment
Authors: Marchment Deepti , Chan Dennis
Published: February 2021

Mild cognitive impairment (MCI) is a descriptive term that in essence refers to the presence of cognitive impairment out of keeping with normal ageing but of insufficient severity to constitute dementia. Debate continues as to whether MCI represents a discrete syndrome, a transitional state, or a prodrome for a variety of neurodegenerative diseases: it is at present considered to be heterogeneous both in terms of clinical presentation and aetiology. This chapter outlines how the concept of MCI has evolved to its current form and summarizes its diagnostic criteria, epidemiology, prognosis, underlying aetiologies, and pathophysiology. It briefly covers related phenomena such as subjective cognitive decline and mild behavioural impairment. It explores the role of biomarkers and neuroimaging in investigating MCI in clinical and research settings and finally concludes with a proposed clinician’s approach to the diagnosis and management of MCI.
Management of dementia
Authors: Cullum Sarah , Taye Tesema
Published: February 2021

The cornerstone of dementia care is social care, and much of this is delivered by the families and carers of people with dementia. The management of dementia should therefore focus on supporting and developing the care provided by family members and carers in the community, because their education and enablement will help to optimize the quality of life for all people living with dementia. This chapter concentrates on the assessment and management of people with dementia in the early and later stages of the disorder. At both stages we consider engagement, autonomy, respect, protection, and ethical issues, as well as describing the clinical and psychosocial aspects of treatment. The emphasis is on the broader principles of management, which apply to people with dementia of any aetiology, their families, carers, and communities, and take into account the different settings in which they may present.
Older people as victims and perpetrators of crime
Authors: Lorito Claudio Di , Vӧllm Birgit
Published: February 2021

Older people are at a higher risk of becoming the victims of crime than of being the perpetrators of it, given the added vulnerability that comes with aging. This chapter examines crime in relation to old age. The first section presents data around older people as victims of crime, and further discusses different types of abuse against older people, which, in the presence of intensive care needs and carer burden, may be perpetrated within the family or in residential and institutional settings. The second section of the chapter examines older people as the perpetrators of crime. In particular, it describes how older offenders are dealt within the justice system. It presents data on the growing population of older offenders in prisons and in forensic psychiatric services and reports on whether the unique needs of older offenders are being met in these settings.
Driving and psychiatric illness in later life
Authors: O’Neill Desmond , Rapoport Mark J.
Published: February 2021

Access to transportation, and in particular to driving, is possibly more important in later life for the maintenance of health and wellbeing than at earlier stages of life. Those involved with the care of older people with psychiatric illness need to routinely inquire about driving and transportation, and to develop routines of assessment and care that appropriately balance transportation needs and public safety. The increasing research evidence base favours a functional approach with emphasis on behaviour and judgment, collateral history, a broad view of cognitive function, and a low-threshold for on-road testing for those with the early stages of dementia. In addition, initiating planning for transportation for when driving is no longer possible is recommended.
Ophthalmology
Authors: Denniston Alastair , Mathewson Priscilla
Published: February 2021

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of ophthalmology. Starting with an ophthalmic glossary, it describes in depth how to assess the eyes and flags some key points to remember. Eye conditions such as acute glaucoma, acute anterior uveitis, episcleritis, corneal ulcers, ophthalmic shingles, conjunctivitis, and allergic eye disease are investigated. Tears and lacrimation are explored, along with blepharospasm, hemifacial spasm, and orbital swelling. Retinal problems such as retinoblastoma, loss of vision, primary open-angle glaucoma, cataract, macular degeneration, and retinal detachment are described, moving on to visual field defects, squint, and pupil problems. Systemic disease and diabetes mellitus are explored, as well as ocular disease in pregnancy, the effect of drugs on the eye, and tropical eye disease. A look at vision rounds off the chapter, with refraction, contact lenses, refractive procedures, and blindness, before a glimpse of the possible future for the eye.
Anaesthesia
Authors: Hjelde Nina
Published: February 2021

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of anaesthesia. It reviews preoperative assessment, sedation, drugs used to induce anaesthesia, inhalational anaesthetic agents, intravenous anaesthetic agents, and muscle relaxants. It explores the practical conduct of anaesthesia, Difficult Airway Society (DAS) guidelines, maintaining and monitoring, rapid sequence induction aspiration, and intubation technique. It examines some complications of anaesthesia, end of anaesthesia, recovery, pain, and postoperative nausea and vomiting, and describes regional anaesthesia, including peripheral nerve blocks and neuraxial anaesthesia.
Political and institutional determinants of migration policies
Authors: Ricciardi Toni , Cattacin Sandro
Published: February 2021

International migration is an especially important interpretive key through which to understand the long history of globalization. Over the last 20 years, an increasing number of countries have experienced a prolonged transition in the nature of the migration to which they are subject: countries that were historically lands of emigration are becoming lands of immigration. This chapter describes how migration and migration policies have changed over the last two centuries, especially in Europe. Until the French Revolution, Europe had considered immigration a resource and not a scourge, and European imperialism has probably sown the seeds of distrust and racism that continue to pervade the world today. European states have alternated between policies favouring the restriction and promotion of migration, depending on their own perceived economic and geopolitical needs. Paradoxically, periods of restriction, intended to protect the domestic economy, preceded economic crises. It is possible to trace a cause-and-effect relationship between restrictive policies and subsequent economic crises.
Urbanization and its impact on migrant mental health
Authors: McCay Layla , Banulescu-Bogdan Natalia
Published: February 2021

The urban environment plays an important role in the mental health of migrant populations. One in five international migrants lives in the top 20 ‘global cities’ and over 90% of immigrants in traditional countries of immigration live in urban areas. Cities have the potential to exert a positive impact on migrants’ mental health, through opportunities including education, employment, cultural diversity, and ready-made social networks. However, rates of many mental disorders are higher in cities. Migrants interact with cities in specific ways that can trigger or create mental health problems such as disparities and segregation; economic stress; pressures to integrate; and reduced access to nature. Many also face the bureaucratic hurdles and uncertainty of living in cities while applying for legal status; and encounter the gap between aspirations and reality. Urban impact on mental health can be particularly pronounced for asylum seekers and refugees.
General health needs of migrants and refugees
Authors: Pavli Androula , Tsiodras Sotirios
Published: February 2021

General health needs of migrants and refugees describes health problems while they are ‘on the move’, on arrival, and during their early settlement. The process of migration may increase their vulnerability to physical, mental, and social health issues. This chapter reviews common health problems on arrival in migrants and refugees usually related to situations in their country of origin, the journey, and during early settlement, including communicable and non-communicable diseases. The chapter also discusses barriers to access of health care, such as a lack of awareness of legal entitlements, socio-economic conditions, linguistic and cultural differences, and challenges confronted by healthcare professionals. Recommendations are also included regarding the provision of primary health care services by well-trained interdisciplinary teams, screening and immunization.
The role of mass media in suicide prevention
Authors: Westerlund Michael , Niederkrotenthaler Thomas
Published: February 2021

Most researchers in the field of suicide and mass media nowadays agree that the studies carried out to date have substantiated the existence, under certain circumstances, of genuine suicidal ‘contagion’ from suicide reports in the media. The fact that many studies have demonstrated an association between media reporting of suicide and actual suicidal behaviour has also prompted the issue of various types of recommendations on how the media should report on the subject of suicide to avoid imitative behaviour. In addition to harmful media effects, protective potentials of media reporting have emerged as a major research field in suicide prevention in the last decade, with high relevance to public mental health. The purpose of this text is to discuss and identify the problems associated with research on suicide and the media, with a number of seminal articles published over the years serving as examples.
Introduction
Authors: Cookson Richard , Griffin Susan , Norheim Ole F. , Culyer Anthony J.
Published: February 2021

Distributional cost-effectiveness analysis (DCEA) aims to help healthcare and public health organizations make fairer decisions with better outcomes. Standard cost-effectiveness analysis provides information about total costs and effects. DCEA provides additional information about fairness in the distribution of costs and effects—who gains, who loses, and by how much. It can also provide information about the trade-offs that sometimes occur between efficiency objectives: improving total health and equity objectives, such as reducing unfair inequality in health. This chapter introduces DCEA and provides an overview of the book contents. After summarizing the motivation, aims, and scope of the book, it concludes with a section on how to use the book and which chapters are likely to be useful for which audiences. Chapters 1, 2, 3, and 4 introduce the basic concepts and are likely to be useful to research producers and research users alike, so we recommend reading these first before turning to specific methods chapters.
Costs and health effects
Authors: Angus Colin
Published: February 2021

This chapter shows how to model the distribution of costs and health effects of a health programme by equity-relevant characteristics. We introduce the ‘staircase of inequality’, a framework for thinking about the main steps in the causal pathway leading to differences in costs and effects by equity-relevant characteristics. We then illustrate the application of this framework with the example of public funding options for nicotine replacement therapy (NRT) in England. In this case, the main steps along the staircase of inequality are: need (who smokes), receipt (which smokers use smoking cessation services and how delivery costs vary), short-term effect (which service users succeed in quitting), and long-term effect (which short-term quitters become long-term quitters and how many healthy years they gain). At each step, we model differences in costs and effects by socioeconomic status and geography. We then combine this information to simulate the distribution of lifetime costs and health effects. The framework can also be applied to other equity-relevant variables, such as ethnicity or gender, other concepts of health, and other time horizons. We discuss the key assumptions and data requirements for implementing this approach, highlighting potential data sources and providing guidance for setting these parameters when evidence is scarce.
Rank-dependent equity weights
Authors: O’Donnell Owen , Ourti Tom Van
Published: February 2021

This chapter explains how to evaluate the distributional consequences of health programmes by comparing inequality penalized measures of population health. The approach taken is founded on use of rank-dependent social welfare functions (SWFs) that evaluate population health outcomes in terms of equity-weighted average health, using weights that depend only on rank in the distribution of health. The underlying ethical principles and resource allocation implications are compared with those of the level-dependent welfare function approach introduced in the next chapter. Conditions under which quantitative results derived from a rank-dependent SWF are consistent with the preference ordering of programmes established by dominance analysis are identified. The approach is easily extended to allow for aversion to health inequality in relation to an equity-relevant variable, such as socioeconomic status.
Level-dependent equity weights
Authors: Norheim Ole F. , Asaria Miqdad , Johansson Kjell Arne , Ottersen Trygve , Tsuchiya Aki
Published: February 2021

This chapter explains how you can use level-dependent social welfare functions (SWFs) to evaluate health distributions in a manner that is founded on explicit, challengeable, and consistent ethical principles. A level-dependent social welfare function (SWF) weights health gains for one person or group relative to another as a function of their absolute health levels. By contrast, a rank-dependent SWF weights health gains for one person or group relative to another as a function of their health ranks in the wider population. A level-dependent SWF is also called a prioritarian SWF. The basic prioritarian principle is a specific value judgment giving priority to the worse-off based on their absolute level of health. The aim of this chapter is to describe level-dependent SWFs and how they can be used to conduct equity-efficiency trade-off analysis. A SWF can be consistent with many different sets of weights, which vary according to the chosen value of an equity parameter. We show how level-dependent equity parameters can be used to perform a systematic sensitivity analysis of how different degrees of concern for the worse-off have different policy implications.
Uncertainty about facts and heterogeneity in values
Authors: Griffin Susan
Published: February 2021

This chapter covers methods for describing how lack of knowledge impacts on the conduct and findings of distributional cost-effectiveness analysis (DCEA). It also sets out methods for describing how different value judgments can alter the findings. It explains why and how to distinguish uncertainty about facts from heterogeneity in values, and the role of each in informing decisions. It shows how the standard tools of uncertainty analysis in economic evaluation—including deterministic and probabilistic sensitivity analysis, and value of information analysis—can be applied to DCEA to provide information about uncertainty in the estimated health distributions and summary measures of equity impact. The chapter also shows how to use deterministic sensitivity analyses to investigate the implications of alternative value judgments and inequality metrics for DCEA findings and recommendations.
Forensic psychiatry
Authors: Candilis Philip , Martinez Richard
Published: February 2021

Forensic psychiatry derives the ethics of the subspecialty from a review of its historical evolution. From its early origins in community psychiatry to its contemporary applications in cultural narrative and human rights, forensic ethics has come to recognize multiple perspectives in its theory and practice. Tools like narrative, cultural assessment, and self-reflection now characterize a professional ethics that adopts an integrative approach to the intersection of two very different value systems, those of Law and Medicine. As practitioners recognize the vulnerability of persons and values caught at this junction, innovative thinking about social justice and human rights enhances the ethical understanding of the profession’s goals and purpose.
Spectropolarimetry of low redshift quasars: origin of the polarization and implications for black hole mass estimates
Authors: Capetti Alessandro , Laor Ari , Baldi Ranieri D , Robinson Andrew , Marconi Alessandro
Published: February 2021

We present the results of high signal-to-noise ratio VLT spectropolarimetry of a representative sample of 25 bright type 1 AGN at z < 0.37, of which nine are radio-loud. The sample covers uniformly the 5100 Å optical luminosity at L5100 ∼ 1044−1046 erg s−1, and H α width at FWHM ∼ 1000−10 000 $\rm {\, km \, s}^{-1}$. We derive the continuum and the H α polarization amplitude, polarization angle, and angle swing across the line, together with the radio properties. We find the following: (1) The broad line region (BLR) and continuum polarization are both produced by a single scattering medium. (2) The scattering medium is equatorial and at right angle to the system axis. (3) The scattering medium is located at or just outside the BLR. The continuum polarization and the H α polarization angle swing, can both serve as an inclination indicator. The observed line width is found to be affected by inclination, which can lead to an underestimate of the black hole mass by a factor of ∼5 for a close-to face-on view. The line width measured in the polarized flux overcomes the inclination bias and provides a close-to equatorial view of the BLR in all AGN, which allows to reduce the inclination bias in the BLR based black hole mass estimates.
Top1-PARP1 association and beyond: from DNA topology to break repair
Authors: Chowdhuri Srijita Paul , Das Benu Brata
Published: February 2021

Selective trapping of human topoisomerase 1 (Top1) on the DNA (Top1 cleavage complexes; Top1cc) by specific Top1-poisons triggers DNA breaks and cell death. Poly(ADP-ribose) polymerase 1 (PARP1) is an early nick sensor for trapped Top1cc. New mechanistic insights have been developed in recent years to rationalize the importance of PARP1 beyond the repair of Top1-induced DNA breaks. This review summarizes the progress in the molecular mechanisms of trapped Top1cc-induced DNA damage, PARP1 activation at DNA damage sites, PAR-dependent regulation of Top1 nuclear dynamics, and PARP1-associated molecular network for Top1cc repair. Finally, we have discussed the rationale behind the synergy between the combination of Top1 poison and PARP inhibitors in cancer chemotherapies, which is independent of the ‘PARP trapping’ phenomenon.
ClipSV: improving structural variation detection by read extension, spliced alignment and tree-based decision rules
Authors: Xu Peng , chen Yu , Gao Min , Chong Zechen
Published: February 2021

Structural variation (SV), which consists of genomic variation from 50 to millions of base pairs, confers considerable impacts on human diseases, complex traits and evolution. Accurately detecting SV is a fundamental step to characterize the features of individual genomes. Currently, several methods have been proposed to detect SVs using the next-generation sequencing (NGS) platform. However, due to the short length of sequencing reads and the complexity of SV content, the SV-detecting tools are still limited by low sensitivity, especially for insertion detection. In this study, we developed a novel tool, ClipSV, to improve SV discovery. ClipSV utilizes a read extension and spliced alignment approach to overcoming the limitation of read length. By reconstructing long sequences from SV-associated short reads, ClipSV discovers deletions and short insertions from the long sequence alignments. To comprehensively characterize insertions, ClipSV implements tree-based decision rules that can efficiently utilize SV-containing reads. Based on the evaluations of both simulated and real sequencing data, ClipSV exhibited an overall better performance compared to currently popular tools, especially for insertion detection. As NGS platform represents the mainstream sequencing capacity for routine genomic applications, we anticipate ClipSV will serve as an important tool for SV characterization in future genomic studies.
Interpretable detection of novel human viruses from genome sequencing data
Authors: Bartoszewicz Jakub M , Seidel Anja , Renard Bernhard Y
Published: February 2021

Viruses evolve extremely quickly, so reliable methods for viral host prediction are necessary to safeguard biosecurity and biosafety alike. Novel human-infecting viruses are difficult to detect with standard bioinformatics workflows. Here, we predict whether a virus can infect humans directly from next-generation sequencing reads. We show that deep neural architectures significantly outperform both shallow machine learning and standard, homology-based algorithms, cutting the error rates in half and generalizing to taxonomic units distant from those presented during training. Further, we develop a suite of interpretability tools and show that it can be applied also to other models beyond the host prediction task. We propose a new approach for convolutional filter visualization to disentangle the information content of each nucleotide from its contribution to the final classification decision. Nucleotide-resolution maps of the learned associations between pathogen genomes and the infectious phenotype can be used to detect regions of interest in novel agents, for example, the SARS-CoV-2 coronavirus, unknown before it caused a COVID-19 pandemic in 2020. All methods presented here are implemented as easy-to-install packages not only enabling analysis of NGS datasets without requiring any deep learning skills, but also allowing advanced users to easily train and explain new models for genomics.
Bi-directional electron transfer between H2 and NADPH mitigates light fluctuation responses in green algae
Authors: Milrad Yuval , Schweitzer Shira , Feldman Yael , Yacoby Iftach
Published: February 2021

The metabolism of green algae has been the focus of much research over the last century. These photosynthetic organisms can thrive under various conditions and adapt quickly to changing environments by concomitant usage of several metabolic apparatuses. The main electron coordinator in their chloroplasts, nicotinamide adenine dinucleotide phosphate (NADPH), participates in many enzymatic activities and is also responsible for inter-organellar communication. Under anaerobic conditions, green algae also accumulate molecular hydrogen (H2), a promising alternative for fossil fuels. However, to scale-up its accumulation, a firm understanding of its integration in the photosynthetic apparatus is still required. While it is generally accepted that NADPH metabolism correlates to H2 accumulation, the mechanism of this collaboration is still vague and relies on indirect measurements. Here, we investigated this connection in Chlamydomonas reinhardtii using simultaneous measurements of both dissolved gases concentration, NADPH fluorescence and electrochromic shifts at 520–546 nm. Our results indicate that energy transfer between H2 and NADPH is bi-directional and crucial for the maintenance of redox balance under light fluctuations. At light onset, NADPH consumption initially eventuates in H2 evolution, which initiates the photosynthetic electron flow. Later on, as illumination continues the majority of NADPH is diverted to the Calvin–Benson–Bassham cycle. Dark onset triggers re-assimilation of H2, which produces NADPH and so, enables initiation of dark fermentative metabolism.
A Systematic Review of Clinical Practice Guidelines for Physical Therapist Management of Patellofemoral Pain
Authors: Wallis Jason A , Roddy Leanne , Bottrell Judy , Parslow Sue , Taylor Nicholas F
Published: February 2021

Objective

The purpose of this study was to conduct a systematic review to evaluate clinical practice guidelines for the physical therapist management of patellofemoral pain.

Methods

Five electronic databases (CINAHL, Embase, Medline, Psychinfo, Cochrane Library) were searched from January 2013 to October 2019. Additional search methods included searching websites that publish clinical practice guidelines containing recommendations for physical therapist management of patellofemoral pain. Characteristics of the guidelines were extracted, including recommendations for examination, interventions, and evaluation applicable to physical therapist practice. Quality assessment was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, applicability of recommendations to physical therapist practice was examined using the AGREE Recommendation Excellence instrument, and convergence of recommendations across guidelines was assessed.

Results

Four clinical practice guidelines were included. One guideline evaluated as higher quality provided the most clinically applicable set of recommendations for examination, interventions, and evaluation processes to assess the effectiveness of interventions. Guideline-recommended interventions were consistent for exercise therapy, foot orthoses, patellar taping, patient education, and combined interventions and did not recommend the use of electrotherapeutic modalities. Two guidelines evaluated as higher quality did not recommend using manual therapy (in isolation), dry needling, and patellar bracing.

Conclusion

Recommendations from higher-quality clinical practice guidelines may conflict with routine physical therapist management of patellofemoral pain. This review provides guidance for clinicians to deliver high-value physical therapist management of patellofemoral pain.

Impact

This review addresses an important gap between evidence and practice in the physical therapist management of patellofemoral pain.

Lay Summary

If you have kneecap pain, this review offers guidance for your physical therapist to provide examination processes, treatments, and evaluation processes that are recommended by high-quality guidelines.
Historical Development of the Puccinia triticina Population in South Africa
Authors: Labuschagne Rinette , Venter Eduard , Boshoff Willem H. P. , Pretorius Zacharias A. , Terefe Tarekegn , Visser Botma
Published: February 2021

In contrast to many other countries, the virulence and genetic diversity of the South African Puccinia triticina population before 1980 is unknown, because of the absence of regular and systematic race analysis data and viable rust cultures. Herbarium specimens housed at the National Collection of Fungi, Biosystematics Unit, Plant Health and Protection, Agricultural Research Council, Pretoria, South Africa (SA), provided the opportunity to investigate the genetic development of the population using isolates collected between 1906 and 2010. Five subpopulations that survived between 21 and 82 years in the field were found. While three of these could represent the original races that entered SA during European settlement, two appear to be recent exotic introductions into SA, most probably from other African countries. The demise of the three oldest subpopulations might be from the release of resistant wheat cultivars. The population is clonal, where new virulence develops through single step mutations and selection for virulence. Although a possible case of somatic hybridization was found, sexual reproduction appears to be absent in SA. This study confirmed the importance of annual surveys in SA and its neighboring countries for the timely detection of new virulent races that could threaten wheat production in SA.
Effect of Chemical Seed Treatment on Rice False Smut Control in Field
Authors: Song Jie-Hui , Wang Yu-Fu , Yin Wei-Xiao , Huang Jun-Bin , Luo Chao-Xi
Published: February 2021

Rice false smut, caused by the pathogen Ustilaginoidea virens, is a severe emerging disease in China. It affects not only the quality of rice but also yields of rice production. To make clear the effect of chemical seed treatment on the rice false smut control in fields, during 2014 to 2017, four fungicides with different modes of action were used to treat rice seeds contaminated by false smut balls. In rice-growing seasons, samples of rice tissues were taken for detection of U. virens by using a specific nested PCR method at different rice-growing stages. In addition, the occurrence of rice false smut was investigated at maturation stage. Results showed that U. virens in plant tissues decreased significantly at the seedling stage upon chemical seed treatment. Four chemical treatments decreased the detection rate significantly (P < 0.01) compared with the water treatment, but no significant difference was observed among four chemical treatments. However, the detection rate did not decease significantly at the tillering and booting stages. Similarly, the final occurrence of rice false smut did not show significant difference between each chemical and water treatment. These results suggested that chemical seed treatment had only limited efficacy in preventing occurrence of rice false smut; application of fungicides at the booting stage or integrated use of fungicides and agricultural practices might give a better control for this disease.