bluuebunny/crossref_metadata_2025 huggingface dataset:
Paradigm 10: Mental Illnesses Are Like Any Other Illnesses
Authors: Stuart Heather , Arboleda-Flórez Julio , Sartorius Norman
Published: November 2017

Many anti-stigma programs are built on the premise that mental illnesses are like any other illnesses, and once the public realizes the similarities between mental illnesses and other physical conditions, they will adopt a more benevolent view. However, mental illnesses are not like other illnesses. Historical and political realities have made them different. Also, the way in which they express themselves is different in that, above all, they affect social relations and functioning. To overlook these fundamental facts is to deeply misunderstand the nature and effects of stigma attached to mental illnesses.
Identifying Program Priorities
Authors: Stuart Heather , Arboleda-Flórez Julio , Sartorius Norman
Published: November 2017

A clear understanding of local conditions—particularly the priorities of people who experience stigma—is required in order to target a program and set meaningful objectives. This chapter discusses selected qualitative and quantitative approaches that can be used to assess local priorities and needs.
Leg Edema Woes
Authors: Pereira Edwin C.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Alimentary Antimicrobial Apocalypse
Authors: Mullane Kathleen M.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Lung Mass in a Neutropenic Patient With Leukemia
Authors: Satlin Michael J. , Castro Stephen , Walsh Thomas J.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Upper Respiratory Symptoms During Febrile Neutropenia
Authors: Ison Michael G.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Multiple Skin Lesions in a Neutropenic Patient With Leukemia
Authors: McCarthy Matthew , Schuetz Audrey N. , Walsh Thomas J.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
To Accept or Not To Accept?
Authors: Echenique Ignacio A. , Ison Michael G.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain the state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlight the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Beware the Fish Tank
Authors: Ince Dilek
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
When the Dust Settles
Authors: Babik Jennifer M.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
A Tough Pill to Swallow
Authors: Whitson Matthew , Khungar Vandana
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Take One’s Breath Away
Authors: Byrne Dana D. , Rosenbach Misha A. , Hamilton Keith W.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each case highlights the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Introduction
Authors: Limaye Ajit P. , Strasfeld Lynne
Published: November 2017

Chapter 2 focuses on the solid organ transplantation (SOT). The Solid organ transplantation (SOT) is undertaken to restore organ function for patients with failing or end-stage disease of the liver, heart, lung, kidneys, and/or pancreas or to re-establish function in patients with short gut or other disorders of the intestinal tract. Organ transplantation requires lifelong maintenance immune suppression to prevent organ rejection. Infection can be related to donor transmission, reactivation from latency in the recipient, or acquisition de novo post-transplant. The evaluation of suspected infection in SOT recipients is guided by the clinical presentation, with likelihood shaped by prophylaxis strategies, host factors, and exposure history. Prompt evaluation is critical, often requiring multimodality imaging, microbiologic testing with cultures and molecular diagnostics, and invasive diagnostics or biopsy. The chapter concludes that, through use of biomarkers and indicators of pathogen-specific immune competence as well as better laboratory assessment of overall immune competence, a more granular identification of those SOT recipients at highest risk for infection will allow for optimization of prophylaxis and other infection prevention strategies.
The Troll of Transplantation Rears Its Head
Authors: Sharff Katie A.
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain the state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlight the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
While the T Cells Were Sleeping
Authors: Strasfeld Lynne
Published: November 2017

These case studies illustrate infections encountered in hospitals among patients with compromised immune systems. As a result of immunocompromise, the patients are vulnerable to common and uncommon infections. These cases are carefully chosen to reflect the most frequently encountered infections in the patient population, with an emphasis on illustrations and lucid presentations to explain the state-of-the-art approaches in diagnosis and treatment. Common and uncommon presentations of infections are presented while the rare ones are not emphasized. The cases are written and edited by clinicians and experts in the field. Each of these cases highlight the immune dysfunction that uniquely predisposed the patient to the specific infection, and the cases deal with infections in the cancer patient, infections in the solid organ transplant recipient, infections in the stem cell recipient, infections in patients receiving immunosuppressive drugs, and infections in patients with immunocompromise that is caused by miscellaneous conditions.
Introduction
Authors: Blumberg Emily A.
Published: November 2017

This chapter discusses the infections in patients receiving immunosuppressive drugs. Immunosuppressive medications are a mainstay of treatment for diverse immunologically mediated conditions. The impact of these medications on the risk for infection is variable and sometimes difficult to determine. Immunosuppressive agents can be divided into a heterogeneous set of classes with unique effects on the immune system; the risks for infections reflect the specific immunological perturbation associated with the medication. Currently, guidelines have been published recommending specific preventive measures to limit the likelihood that these immunosuppressive agents will be associated with infection. The chapter concludes that future study will be important to develop algorithms to define risk and specify appropriate preventive interventions.
Multi-electrode Recording of Neural Activity in Awake Behaving Animals
Authors: Summerson Samantha R. , Kemere Caleb
Published: November 2017

Systems neuroscience is being revolutionized by the ability to record the activity of large numbers of neurons simultaneously. Chronic recording with multi- electrode arrays in animal models is a critical tool for studies of learning and memory, sensory processing, motor control, emotion, and decision-making. The experimental process for gathering large amounts of neural ensemble data can be very time consuming, however, the resulting data can be incredibly rich. We present a detailed overview of the process of acquiring multichannel neural data, with a particular focus on chronic tetrode recording in rodents.
Pyruvate Dehydrogenase Complex Deficiency
Authors: Janssen Mirian C. H. , Rahman Shamima
Published: November 2017

Pyruvate dehydrogenase complex (PDHc) deficiency usually first manifests at a young age and is rarely diagnosed in adulthood. The clinical picture varies from neonatal death with overwhelming lactic acidosis to a relatively benign course early in life. The three main presentations are congenital lactic acidosis, Leigh syndrome, and episodic ataxia. Treatment consists of a ketogenic diet and cofactor supplementation with thiamine. Successful therapy is rare.
Case 32
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 39
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 50
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Retroperitoneum section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 58
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Adrenal section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 59
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Adrenal section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 66
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ureter and Bladder section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 85
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Urethra, Vagina, and Penis section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 90
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Urethra, Vagina, and Penis section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 94
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Testis, Epididymis, and Scrotum section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 105
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 113
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 114
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Uterus and Fallopian Tube section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 125
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ovary section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 126
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ovary section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 127
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Ovary section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Laboratory Testing for Microbial Detection
Authors: Arce Michael
Published: November 2017

The approach to microbial detection in patients who present to acute settings should be focused and should aim to result in clinically significant findings while minimizing the chances of a missed diagnosis or missed complications related to a patient’s existing disease burden. Judicious selection of laboratory tests, efficient sample collection, and laboratory reporting are all important considerations. This chapter provides general guidelines for the initial evaluation of potential microbial infections in patients presenting to the Emergency Department (ED). In some cases, the diagnosis will remain uncertain during the patient’s stay, but diagnostic testing initiated in the ED may be beneficial for the inpatient or outpatient team and the future care of the patient.
Bacterial Meningitis
Authors: Chang Mary P.
Published: November 2017

Bacterial meningitis is a bacterial infection causing inflammation of the meninges, the lining around the brain and spinal cord. It is important for emergency physicians to recognize potential bacterial meningitis early. They are usually the providers that the patient will present to first. If the patient is critically ill and suspicion for meningitis is high, immediately give steroids followed by antibiotics and then pursue diagnostic workup. Lumbar puncture will aid in definitive diagnosis. If this procedure will be delayed and suspicion for bacterial meningitis is high, give dexamethasone followed by antibiotics, even in a currently stable patient. Meningitis is a treatable condition, and early intervention will have a great impact on reducing morbidity and mortality.
Aseptic Meningitis
Authors: Sharp Michelle
Published: November 2017

Aseptic meningitis is defined as acute meningeal inflammation, fever, and headache in the absence of detectable organisms in the cerebral spinal fluid (CSF). Organisms involved can include viruses (enteroviruses being most common), fungi, atypical bacteria, or parasites. Often, encephalitis (inflammation of the brain) and meningitis overlap. In contrast to the mental status changes typical of encephalitis, however, aseptic meningitis characteristically presents as a headache without alteration of mentation or personality. Additional causes include drug-induced aseptic meningitis (eg, NSAIDs and antibiotics); chemical meningitis from the rupture of an epidermoid cyst or malignancy; and autoimmune diseases, such as lupus. Aseptic meningitis is typically self-limited, and, therefore, treatment is supportive. Most patients require treatment with antibiotics until CSF is obtained to rule out bacterial meningitis.
Brain Abscess
Authors: Chinai Sneha A.
Published: November 2017

A brain abscess is a life-threatening infection within the brain that originates as cerebritis and evolves into an encapsulated collection of purulent material. Epidemiologically, brain abscesses are seen more frequently in immunocompromised patients. The signs and symptoms of a brain abscess are influenced by the location and size of the infection, the causative pathogen, and the patient’s immune status and medical comorbidities. This diagnosis requires neurosurgical consultation for management and inpatient admission. The majority of patients undergo either needle aspiration or surgical excision. This is critical for obtaining a specimen for culture in order to direct accurate and specific antimicrobial therapy. Needle aspiration is more commonly utilized and has a lower mortality rate than surgical excision. Repeat imaging is required for any change in mental status. Empiric antibiotic selections are guided by the most likely source of infection and are adjusted for renal function.
Atypical Pulmonary Infections
Authors: Rahimi Rod
Published: November 2017

Legionellosis or Legionnaires’ disease (LD) is a common cause of community-acquired pneumonia and can cause rapidly progressive respiratory failure and septic shock. Respiratory symptoms generally predominate; nonspecific symptoms include fever, malaise, myalgias, anorexia, and headache. There are no characteristic presenting clinical or radiological features, and the severity of illness can range from mild to severe. Although erythromycin was initially used to treat LD, trials have demonstrated that the newer macrolides and the respiratory fluoroquinolones are the antimicrobial agents of choice. Given the potential for outbreaks of LD, documented cases should be reported to the local or state health department. Along with LD, Legionella may cause Pontiac Fever, an influenza-like illness without pneumonia, which is self-limiting and does not require treatment.
Cholecystitis and Cholangitis
Authors: Carle Sarah
Published: November 2017

Cholangitis is a bacterial infection of the biliary system that is commonly associated with mechanical obstruction of the cystic or common bile duct (CBD). Obstruction is usually caused by choledocholithiasis (which results from gallstone obstruction of the CBD) but may also be seen with biliary stricture, malignancy, or cyst. Bacterial proliferation may lead to gangrenous cholecystitis, gallbladder perforation (with potential for cholecystoenteric fistula creation), and/or sepsis. Patients should be managed based on clinical severity and symptoms with attention paid to volume and electrolyte status. General surgery should be consulted early in the course of acute cholecystitis and cholangitis. Many patients with acute cholangitis respond to antibiotic therapy and supportive treatments. Disposition decisions should be made in conjunction with consultants, but patients with acute cholecystitis and cholangitis generally require admission and prompt surgical intervention.
Hepatitis
Authors: Wilson Deanna
Published: November 2017

Hepatitis A (HAV) and E (HEV) viruses are spread via the fecal-oral route. Hepatitis B virus (HBV) exposure is via occupational or recreational activities. Hepatitis D virus (HDV; also spread parentally) can only coinfect or superinfect those with chronic HBV. Hepatitis C (HCV) transmission is predominantly parenteral; the highest risk group is injection drug users. Prodromal-period patients with acute hepatitis present with vague constitutional symptoms when serum transaminases peak, with elevated serum bilirubin and varying levels of hepatic protein synthesis impairment; during the icteric phase, patients develop abdominal pain, hepatomegaly, and jaundice. Acute hepatitis has limited therapy; treatment is predominantly supportive. However, most adults with acute phase HAV, HBV, HDV, and HEV spontaneously clear the virus. Most individuals with HCV develop chronic hepatitis. Patients with known HAV, HBV, or HEV exposures may be eligible for post-exposure prophylaxis to reduce their risk of infection.
Cervicitis and Vulvovaginitis
Authors: Putman Shannon B.
Published: November 2017

Cervicitis is inflammation and irritation of uterine cervix often caused by sexually transmitted infection (STI); it can lead to pelvic inflammatory disease, endometritis, and pregnancy complications. Vulvovaginitis (inflammation of vagina and/or vulva with itching, erythema, and mucopurulent discharge) may or may not be related to STI. Sexually active women 25 years or younger with STIs should be offered empiric treatment for gonorrhea and chlamydia in addition to counseling regarding safe sex and testing for syphilis, HIV, and viral hepatitis at the time of presentation and prior to nucleic acid amplification testing results. Sexual partners of women testing positive for gonorrhea, chlamydia, or trichomoniasis should be informed and treated to prevent reinfection, with patients and their partners abstaining from intercourse until treatment is complete and symptoms resolve. High-risk patients with STI should be retested at 6 months given recurrent infection rates. Prophylaxis, vaccination, high degree of suspicion, and early intervention can help improve morbidity and mortality.
Mammalian and Reptile Bites
Authors: Scordino David , Peterson Susan
Published: November 2017

Bites from animals and humans can result in significant infections, morbidity, and mortality if not managed well. Individuals who are unable to provide an adequate history or who are unaware of if they were bitten or scratched require skin evaluation that may show puncture wounds, suggesting a bite, or simple scrapes, suggesting a scratch. A thorough exam of the bite for evidence of contamination or infection as well as the location and type of wound is critical for wound management, follow-up, and disposition. Treatment includes addressing the patient’s airway, breathing, and circulation; wound irrigation and management as well as tetanus prophylaxis should be provided because the skin has been broken. In general, bite wounds should not be closed unless the bite wound is in a highly vascular area such as the face.
Septic Arthritis
Authors: Baydoun Hasan E. , Hamade Bachar , Bayram Jamil D.
Published: November 2017

Septic arthritis is an infectious inflammation of a joint. It usually presents as acute, progressive pain that increases with motion and eventually leads to the inability to bear weight. The most common presenting features include joint pain, swelling, and fever. Pediatric cases are often associated with bacteremia. Gonococcal arthritis is migratory and associated with dermatitis and tenosynovitis. Optimal positioning of the joint to avoid future contractures is essential, and joint aspiration should be done as soon as possible. IV antibiotics should be given only after aspiration unless the patient is septic, in which case antibiotics should not be delayed. Orthopedic consultation is mandatory in cases of septic arthritis. In documented gonococcal arthritis with no suspicion for other concomitant infection, nonsurgical treatment may be considered if there is complete symptom resolution with IV antibiotics and joint aspiration.
Prosthetic Joint Infections
Authors: Mabey David , Baydoun Hasan E. , Bayram Jamil D.
Published: November 2017

Prosthetic joint infection (PJI), a complication of joint replacement surgery, presents with fever, joint pain, erythema, effusion, and joint loosening. Many advances have decreased the risk of infection, such as the use of perioperative antimicrobial prophylaxis and intraoperative laminar airflow. Joint fluid analysis should be pursued by the orthopedic surgeons; primary and acute care providers should consult the definitive care team and refer these patients for admission. Organisms causing prosthetic joint infections often grow in biofilms, which make them difficult to treat. Surgical treatment options include one or two-stage prosthesis exchange, debridement with retention of the prosthesis, resection arthroplasty, arthrodesis, or amputation. Antibiotic therapy should be guided by intraoperative cultures and selected in consultation with the infectious disease service.
Viral Hemorrhagic Fevers (Ebola, Lassa, Hantavirus)
Authors: Schechter Marcos
Published: November 2017

Viral hemorrhagic fever (VHF) designates diseases caused by enveloped, single-stranded RNA viruses belonging to the families Ebola, Lassa, Hantavirus, and yellow fever. Unifying features include fever, capillary leak, and coagulation defects. These viruses can affect all organ systems; transmission occurs via contact with rodent excretions, either by ingestion or through mucosa or non-intact skin. Aerosolized rodent urine and saliva are also infectious. Person-to-person spread has been documented in Lassa and Machupo viruses, both by direct contact with bodily fluids and by airborne transmission. Thrombocytopenia is a common laboratory finding. Most acutely ill patients have high concentrations of virus in the blood as measured by polymerase chain reaction assay. Clinical differentiation between the various causes of VHF is difficult. Care is supportive. No antiviral drug, including ribavirin, has activity against these viruses. Most of these diseases do not occur naturally in the United States; however, some are considered viable for bioterrorism.
The Nineteenth-Century Origins of the Mayo Practice
Authors: Fye W. Bruce
Published: November 2017

The Mayo Clinic had its origins in a small town medical practice. William Worrall Mayo, a British immigrant, arrived in America in 1846 and settled in Rochester, Minnesota, in 1864. The general medical practice that he launched in that town of 3,000 thrived. After a deadly tornado struck in 1883, the leader of an order of Catholic sisters offered to build a hospital in the town if Doctor Mayo would take charge of it. By the time St. Mary’s Hospital opened in 1889, Mayo’s sons, William J. (Will) and Charles H. (Charlie), had joined his practice. Will and Charlie Mayo learned surgery by watching prominent urban surgeons operate using antiseptic techniques. They began performing a range of procedures at the hospital in Rochester. The Mayo brothers and the Sisters of Saint Francis collaborated in providing care to patients who were attracted by reports of excellent surgical results and compassionate care.
Pioneering Open-Heart Surgery at the University of Minnesota and the Mayo Clinic
Authors: Fye W. Bruce
Published: November 2017

During the early 1950s, several dozen surgeons were attempting to develop technologies and techniques that would allow them to operate inside the heart. The challenge was to develop a safe way to temporarily take over the functions of the heart and lungs so the heart could be opened and drained of blood. A surgeon could then see and repair abnormal or damaged structures inside the organ. The first patients were children or adolescents with congenital heart defects that had caused heart failure. Mayo surgeon John Kirklin led a multidisciplinary team in the testing and clinical use of a heart-lung machine that had been refined in Rochester from plans provided by IBM and John Gibbon Jr. of Philadelphia. Although initial mortality was high, experience with the Mayo-Gibbon machine proved that it was possible to operate inside the hearts and save the lives of patients who were destined to die without surgery.
Analyzing and Managing Abnormal Heart Rhythms
Authors: Fye W. Bruce
Published: November 2017

Cardiac arrhythmias (abnormal heart rhythms) can be life-threatening or simply annoying. Implantable pacemakers were introduced around 1960 to treat slow heart rates that might cause a patient to faint. Sudden cardiac death is usually due to ventricular fibrillation, a very fast chaotic heart rhythm that immobilizes the heart. External defibrillators were used in CCUs, but most patients who experience sudden death are not in hospitals. The introduction of automatic implantable cardiac defibrillators (ICDs) in the mid-1980s provided a safety net for patients at high risk for sudden death. These heart rhythm technologies were expensive, and concerns were raised about their costs and appropriate use. During the final quarter of the century, catheter-based diagnostic techniques were developed to evaluate patients with known or suspected arrhythmias. Cardiologists who focused on heart rhythm disorders were known as electrophysiologists. The emergence of clinical cardiac electrophysiology is an example of continuing subspecialization within cardiology.
Positron annihilation in the nuclear outflows of the Milky Way
Authors: Panther Fiona H , Crocker Roland M , Birnboim Yuval , Seitenzahl Ivo R , Ruiter Ashley J
Published: November 2017

Observations of soft gamma rays emanating from the Milky Way from SPI/INTEGRAL reveal the annihilation of ∼2 × 1043 positrons every second in the Galactic bulge. The origin of these positrons, which annihilate to produce a prominent emission line centred at 511 keV, has remained mysterious since their discovery almost 50 yr ago. A plausible origin for the positrons is in association with the intense star formation ongoing in the Galactic centre. Moreover, there is strong evidence for a nuclear outflow in the Milky Way. We find that advective transport and subsequent annihilation of positrons in such an outflow cannot simultaneously replicate the observed morphology of positron annihilation in the Galactic bulge and satisfy the requirement that 90 per cent of positrons annihilate once the outflow has cooled to 104 K.
X-ray mapping of the stellar wind in the binary PSR J2032+4127/MT91 213
Authors: Petropoulou M , Vasilopoulos G , Christie I M , Giannios D , Coe M J
Published: November 2017

PSR J2032+4127 is a young and rapidly rotating pulsar on a highly eccentric orbit around the high-mass Be star MT91 213. X-ray monitoring of the binary system over an ∼4000 d period with Swift has revealed an increase of the X-ray luminosity which we attribute to the synchrotron emission of the shocked pulsar wind. We use Swift X-ray observations to infer a clumpy stellar wind with r−2 density profile and constrain the Lorentz factor of the pulsar wind to 105 < γw < 106. We investigate the effects of an axisymmetric stellar wind with polar gradient on the X-ray emission. Comparison of the X-ray light curve hundreds of days before and after the periastron can be used to explore the polar structure of the wind.
Antimicrobial Resistance of Sterile Site Infections in Sub-Saharan Africa: A Systematic Review
Authors: Workneh Meklit , Katz Morgan J , Lamorde Mohammed , Cosgrove Sara E , Manabe Yukari C
Published: November 2017

Sparse data exist from sub-Saharan Africa (SSA) on the prevalence of antimicrobial resistance (AMR). A prior review of antimicrobial resistance in SSA from 1990 to 2013 showed a high prevalence of AMR to commonly used antibiotics in this setting. We reviewed the literature published since 2013. Four databases (PubMed, EMBASE, Cochrane, and African Journals Online) were searched for articles between February 2013 and March 2016 with a focus on sterile site infections (bacteremia, urinary tract infections [UTIs], and meningitis). We focused on the original World Health Organization–identified priority pathogens and antibiotics, prior to the release of the most recently updated and expanded list in 2017. There were 19 eligible studies: bacteremia (12), UTI (6), and meningitis (1). Eight studies were from Western and Central Africa, 8 from Eastern Africa, and 4 from Southern Africa. Prevalence of Escherichia coli resistance to third-generation cephalosporins ranged from 0% to 75%. No studies reported resistance to carbapenems among Klebsiella spp. Prevalence of fluoroquinolone resistance ranged from 8.3% to 100% among E. coli and 0% to 15% among Salmonella spp. Prevalence of resistance to penicillin among Streptococcus pneumoniae isolates ranged from 25% to 100%. Testing for extended-spectrum beta-lactamase was reported in 7 studies (range, 1.3–60% among tested isolates). Methods for evaluating AMR varied across studies; standardized approaches are needed in the region. Testing for mechanisms of resistance is low even in research settings, but important mechanisms of resistance such as ESBL production are present.
Partisan differences and the interventionist state in advanced democracies
Authors: Schmitt Carina , Zohlnhöfer Reimut
Published: November 2017

We present new evidence on whether political parties still matter in economic policy-making. We investigate four policy instruments (changes in product market regulation (PMR), subsidies, business taxation, social spending) in 21 Organisation for Economic Co-operation and Development countries between 1980 and 2015. We systematically consider how cabinet duration and the challenges of globalization, the European Union and economic problems (debt, unemployment, economic growth) condition partisan differences. Partisan differences only really make themselves felt after about one term in office. Moreover, with the exception of PMR, partisan differences tend to become more pronounced as globalization increases while European integration does not condition partisan effects. The conditioning effect of domestic economic problems on partisan differences depends on a policy instrument’s salience. In highly salient issue areas (social expenditure, corporate taxation), we only find partisan differences when problems are low; in contrast, economic problems emphasize partisan differences in non-salient issue areas (PMR, subsidies).
Whole Root Transcriptomic Analysis Suggests a Role for Auxin Pathways in Resistance toRalstonia solanacearumin Tomato
Authors: French Elizabeth , Kim Bong-Suk , Rivera-Zuluaga Katherine , Iyer-Pascuzzi Anjali S.
Published: November 2017

The soilborne pathogen Ralstonia solanacearum is the causal agent of bacterial wilt and causes significant crop loss in the Solanaceae family. The pathogen first infects roots, which are a critical source of resistance in tomato (Solanum lycopersicum L.). Roots of both resistant and susceptible plants are colonized by the pathogen, yet rootstocks can provide significant levels of resistance. Currently, mechanisms of this ‘root-mediated resistance’ remain largely unknown. To identify the molecular basis of this resistance, we analyzed the genome-wide transcriptional response of roots of resistant ‘Hawaii 7996’ and susceptible ‘West Virginia 700’ (WV) tomatoes at multiple timepoints after inoculation with R. solanacearum. We found that defense pathways in roots of the resistant Hawaii 7996 are activated earlier and more strongly than roots of susceptible WV. Further, auxin signaling and transport pathways are suppressed in roots of the resistant variety. Functional analysis of an auxin transport mutant in tomato revealed a role for auxin pathways in bacterial wilt. Together, our results suggest that roots mediate resistance to R. solanacearum through genome-wide transcriptomic changes that result in strong activation of defense genes and alteration of auxin pathways.
Confirmation that the Novel Cercozoa Phytocercomonas venanatans Is the Cause of the Disease Chlorotic Streak in Sugarcane
Authors: Braithwaite Kathryn S. , Ngo Chuong N. , Croft Barry J.
Published: November 2017

A cercomonad, named Phytocercomonas venanatans, is confirmed as the cause of the sugarcane disease chlorotic streak. This was achieved by establishing aseptic liquid cultures of the pathogen isolated from internal pieces of sugarcane stalk tissue. Actively motile cultures of the pathogen were inoculated into sugarcane roots, stalks, and leaf whorls. Infected plants subsequently developed the characteristic symptoms of chlorotic streak. Infection was confirmed by PCR screening of plant tissues and by reisolation of the pathogen into aseptic culture followed by PCR and microscopic confirmation. P. venanatans is the first reported pathogenic cercomonad able to systemically infect higher plants and the first plant pathogenic cercozoan able to be successfully grown in axenic culture on common microbiological media.
Nail and Locking Plate for Periprosthetic Fractures
Authors: Kanabur Pratik , Sandilands Scott M. , Whitmer Kelley K. , Owen Trevor M. , Coniglione Franco M. , Shuler Thomas E.
Published: November 2017

The incidence of periprosthetic fractures have been increasing, and in patients with osteopenic bone, high body mass index, or a combination both, they are difficult to treat and pose a high risk for malunion. Previous studies have compared the use of locking plates and intramedullary nails, and have found that each has its own strengthens and drawbacks, but neither is superior in terms of treating periprosthetic fractures. Here, we present the technique and series of patients treated with a combination of a retrograde intramedullary nail and flare-to-flare lateral locking plate without the use of allograft or autograft supplementation.