bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact decades-long dependence on hydropower in El Niño impact-prone Zambia is having on carbon emissions through backup diesel generation
Authors: Ahmed Imaduddin , Parikh Priti , Sianjase Graham , Coffman D’Maris
Published: September 2020

Emissions associated with hydropower are often forgotten. Lifecycle assessments of greenhouse gas emissions emanating from hydropower must count embedded carbon, emissions from reservoir lakes and the loss of carbon sinks, as well as backup diesel generation emissions when dependence on hydropower fails to deliver energy. Using Zambia as a case study, we estimate using a bottom-up approach that the emissions associated with backup diesel generation from Zambia’s power utility ZESCO and three largest sectors of consumers were up to 27 000 tonnes of

C

O

2

in the worst months of drought in 2019. This is significantly higher than what a previous top-down approach would have estimated.

We worked out ZESCO’s diesel generation attributable to drought using trend analysis. We worked out the mining sector’s emissions using copper production data, on-grid electricity consumption and calculated electricity intensity to infer off-grid electricity consumption in years of drought. From our household survey we learned average duration of generator use, average capacities of generators and acquired household income and generator use data which we ran in a Tobit regression. These together with labour force survey data helped us infer the level of diesel generation by households of different income brackets. For manufacturing firms we surveyed 123 firms. We collected rich diesel generation use data covering years of drought, input this into an OLS regression to identify predictors of diesel generation use (installed capacity of generator in kVA, in litres and whether generation was in a drought year) which we then used to extrapolate implied diesel generation for the firms for which we had less rich data.

As global average temperatures and the frequency of El Niño droughts rise in hydropower dependent countries which account for a fifth of the world’s population, backup generation emissions have implications for the formulation of low carbon energy policy.
Improved adaptive particle refinement in δ-SPH and application to flow around bluff bodies simulation in different reynolds numbers
Authors: Yang Caihong , Kang Zhuang , Guan Yanmin
Published: September 2020

Particle refinement technique uses spatially varying particle distributions that focus fine resolution on areas of interest to improve accuracy and computational efficiency of the smooth particle hydrodynamics (SPH) method, but its stability at coarse/fine interfaces can be problematic. Aiming at this problem, this paper improved adaptive particle refinement (APR) technology by optimizing the interpolation method of the particle parameters in buffer area and correcting the kernel gradient of particles troubled with boundary truncation to eliminate the truncation error. Based on the improved APR adopted in δ-SPH, the numerical simulation of the viscous flows around the bluff bodies under different Reynolds numbers were carried out. Additionally, the wake flows and hydrodynamic coefficients of the bluff bodies were systematically analyzed, respectively. The validity of the improved model was verified by comparing with the values in experiment and related literature, respectively. The calculated hydrodynamic coefficient achieves good agreement with the experimental data and the wake flow phenomena observed in experiment are clearly captured. The method adopted in this paper is effective and reliable, and has certain reference value for the research of fluid dynamics fields.
Positive intertwiners for Bessel functions of type B
Authors: Rösler Margit , Voit Michael
Published: September 2020

LetVkV_kdenote Dunkl’s intertwining operator for the root sytemBnB_nwith multiplicityk=(k1,k2)k=(k_1,k_2)withk1≥0,k2>0k_1\geq 0, k_2>0. It was recently shown that the positivity of the operatorVk′,k=Vk′∘Vk−1V_{k^\prime \!,k} = V_{k^\prime }\circ V_k^{-1}which intertwines the Dunkl operators associated withkkandk′=(k1+h,k2)k^\prime =(k_1+h,k_2)implies that<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="h element-of left-bracket k 2 left-parenthesis n minus 1 right-parenthesis comma normal infinity left-bracket union left-parenthesis StartSet 0 comma k 2 comma ellipsis comma k 2 left-parenthesis n minus 1 right-parenthesis EndSet minus double-struck upper Z Subscript plus Baseline right-parenthesis">h∈[k2(n−1),∞[∪({0,k2,…,k2(n−1)}−Z+)h\in [k_2(n-1),\infty [\,\cup \,(\{0,k_2,\ldots ,k_2(n-1)\}-\mathbb Z_+). This is also a necessary condition for the existence of positive Sonine formulas between the associated Bessel functions. In this paper we present two partial converse positive results: fork1≥0,k2∈{1/2,1,2}k_1 \geq 0, \,k_2\in \{1/2,1,2\}andh>k2(n−1)h>k_2(n-1), the operatorVk′,kV_{k^\prime \!,k}is positive when restricted to functions which are invariant under the Weyl group, and there is an associated positive Sonine formula for the Bessel functions of typeBnB_n. Moreover, the same positivity results hold for arbitraryk1≥0,k2>0k_1\geq 0, k_2>0andh∈k2⋅Z+.h\in k_2\cdot \mathbb Z_+.The proof is based on a formula of Baker and Forrester on connection coefficients between multivariate Laguerre polynomials and an approximation of Bessel functions by Laguerre polynomials.
Unique jet determination and extension of germs of CR maps into spheres
Authors: Mir Nordine , Zaitsev Dmitri
Published: September 2020

We provide a new way of simultaneously parametrizing arbitrary local CR maps from real-analytic generic manifolds

M
⊂

C

N

M\subset \mathbb {C}^N

into spheres

S

2

N
′

−
1

⊂

C

N
′

\mathbb {S}^{2N’-1}\subset \mathbb {C}^{N’}

of any dimension. The parametrization is obtained as a composition of universal rational maps with a holomorphic map depending only on

M
M

. As applications, we obtain rigidity results of different flavours such as unique jet determination and global extension of local CR maps.
Deep-Kcr: accurate detection of lysine crotonylation sites using deep learning method
Authors: Lv Hao , Dao Fu-Ying , Guan Zheng-Xing , Yang Hui , Li Yan-Wen , Lin Hao
Published: September 2020

As a newly discovered protein posttranslational modification, histone lysine crotonylation (Kcr) involved in cellular regulation and human diseases. Various proteomics technologies have been developed to detect Kcr sites. However, experimental approaches for identifying Kcr sites are often time-consuming and labor-intensive, which is difficult to widely popularize in large-scale species. Computational approaches are cost-effective and can be used in a high-throughput manner to generate relatively precise identification. In this study, we develop a deep learning-based method termed as Deep-Kcr for Kcr sites prediction by combining sequence-based features, physicochemical property-based features and numerical space-derived information with information gain feature selection. We investigate the performances of convolutional neural network (CNN) and five commonly used classifiers (long short-term memory network, random forest, LogitBoost, naive Bayes and logistic regression) using 10-fold cross-validation and independent set test. Results show that CNN could always display the best performance with high computational efficiency on large dataset. We also compare the Deep-Kcr with other existing tools to demonstrate the excellent predictive power and robustness of our method. Based on the proposed model, a webserver called Deep-Kcr was established and is freely accessible at http://lin-group.cn/server/Deep-Kcr.
The uniform general signed rank test and its design sensitivity
Authors: Howard S R , Pimentel S D
Published: September 2020

A sensitivity analysis in an observational study tests whether the qualitative conclusions of an analysis would change if we were to allow for the possibility of limited bias due to confounding. The design sensitivity of a hypothesis test quantifies the asymptotic performance of the test in a sensitivity analysis against a particular alternative. We propose a new, nonasymptotic, distribution-free test, the uniform general signed rank test, for observational studies with paired data, and examine its performance under Rosenbaum’s sensitivity analysis model. Our test can be viewed as adaptively choosing from among a large underlying family of signed rank tests, and we show that the uniform test achieves design sensitivity equal to the maximum design sensitivity over the underlying family of signed rank tests. Our test thus achieves superior design sensitivity, indicating it will perform well in sensitivity analyses on large samples. We support this conclusion with simulations and a data example, showing that the advantages of our test extend to moderate sample sizes as well.
Higher Completion Rates With Self-administered Once-weekly Isoniazid-rifapentine Versus Daily Rifampin in Adults With Latent Tuberculosis
Authors: Haas Michelle K , Aiona Kaylynn , Erlandson Kristine M , Belknap Robert W
Published: September 2020

Background

Treatment of latent tuberculosis (LTBI) is important for tuberculosis (TB) prevention, and short course rifamycin-based therapies are preferred. Once-weekly isoniazid-rifapentine by self-administered therapy (3HP-SAT) has never been compared with 4 months of daily rifampin (4R).

Methods

Retrospective cohort study of adults ≥18 years of age initiating LTBI treatment with either 3HP-SAT or 4R in a United States (US)–based TB clinic between 11 April 2016 and 31 December 2018. We evaluated treatment completion through pharmacy fills and reviewed charts for reasons of noncompletion, including adverse events (AEs). The χ 2 test and a log-binomial multivariable model were used to compare treatment completion and AEs.

Results

Five hundred sixty individuals (42%) initiated 3HP-SAT and 773 (58%) initiated 4R. Median age was 38, 55% were female, and 89% were born outside of the US. Among those aged 18–49 years, treatment completion with 3HP-SAT was 79% compared to 68% with 4R (adjusted risk ratio [aRR], 1.17 [95% CI, 1.17–1.27]; P < .0001). Among individuals aged ≥50 years, treatment completion with 3HP-SAT was 87% compared to 64% with 4R (aRR, 1.35 [95% CI, 1.19–1.52]; P < .0001). Compared to 4R, there was no difference in risk of AEs in the 18–49 age group (aRR, 0.93 [95% CI, .58–1.48]; P = .75). Reduced risk of AEs was noted among patients aged ≥50 years who received 3HP-SAT (aRR, 0.37 [95% CI, .16–.85]; P = .02).

Conclusions

3HP-SAT was associated with higher LTBI treatment completion and lower rates of AEs compared to 4R in individuals aged 50 and older. Expanding 3HP-SAT as an option for patients with LTBI may enhance TB prevention strategies in the US.
Development, validation, and implementation of biomarker testing in cardiovascular medicine state-of-the-art: proceedings of the European Society of Cardiology—Cardiovascular Round Table
Authors: Elliott Perry , Cowie Martin R , Franke Jennifer , Ziegler André , Antoniades Charalambos , Bax Jeroen , Bucciarelli-Ducci Chiara , Flachskampf Frank A , Hamm Christian , Jensen Magnus T , Katus Hugo , Maisel Alan , McDonagh Theresa , Mittmann Clemens , Muntendam Pieter , Nagel Eike , Rosano Giuseppe , Twerenbold Raphael , Zannad Faiez
Published: September 2020

Many biomarkers that could be used to assess ejection fraction, heart failure, or myocardial infarction fail to translate into clinical practice because they lack essential performance characteristics or fail to meet regulatory standards for approval. Despite their potential, new technologies have added to the complexities of successful translation into clinical practice. Biomarker discovery and implementation require a standardized approach that includes: identification of a clinical need; identification of a valid surrogate biomarker; stepwise assay refinement, demonstration of superiority over current standard-of-care; development and understanding of a clinical pathway; and demonstration of real-world performance. Successful biomarkers should improve efficacy or safety of treatment, while being practical at a realistic cost. Everyone involved in cardiovascular healthcare, including researchers, clinicians, and industry partners, are important stakeholders in facilitating the development and implementation of biomarkers. This article provides suggestions for a development pathway for new biomarkers, discusses regulatory issues and challenges, and suggestions for accelerating the pathway to improve patient outcomes. Real-life examples of successful biomarkers—high-sensitivity cardiac troponin, T2* cardiovascular magnetic resonance imaging, and echocardiography—are used to illustrate the value of a standardized development pathway in the translation of concepts into routine clinical practice.
Incremental prognostic value of hybrid [15O]H2O positron emission tomography–computed tomography: combining myocardial blood flow, coronary stenosis severity, and high-risk plaque morphology
Authors: Driessen Roel S , Bom Michiel J , van Diemen Pepijn A , Schumacher Stefan P , Leonora Remi M , Everaars Henk , van Rossum Albert C , Raijmakers Pieter G , van de Ven Peter M , van Kuijk Cornelis C , Lammertsma Adriaan A , Knuuti Juhani , Ahmadi Amir , Min James K , Leipsic Jonathon A , Narula Jagat , Danad Ibrahim , Knaapen Paul
Published: September 2020

Aims 

This study sought to determine the prognostic value of combined functional testing using positron emission tomography (PET) perfusion imaging and anatomical testing using coronary computed tomography angiography (CCTA)-derived stenosis severity and plaque morphology in patients with suspected coronary artery disease (CAD).

Methods and results 

In this retrospective study, 539 patients referred for hybrid [15O]H2O PET-CT imaging because of suspected CAD were investigated. PET was used to determine myocardial blood flow (MBF), whereas CCTA images were evaluated for obstructive stenoses and high-risk plaque (HRP) morphology. Patients were followed up for the occurrence of all-cause death and non-fatal myocardial infarction (MI). During a median follow-up of 6.8 (interquartile range 4.8–7.8) years, 42 (7.8%) patients experienced events, including 23 (4.3%) deaths, and 19 (3.5%) MIs. Annualized event rates for normal vs. abnormal results of PET MBF, CCTA-derived stenosis, and HRP morphology were 0.6 vs. 2.1%, 0.4 vs. 2.1%, and 0.8 vs. 2.8%, respectively (P < 0.001 for all). Cox regression analysis demonstrated prognostic values of PET perfusion imaging [hazard ratio (HR) 3.75 (1.84–7.63), P < 0.001], CCTA-derived stenosis [HR 5.61 (2.36–13.34), P < 0.001], and HRPs [HR 3.37 (1.83–6.18), P < 0.001] for the occurrence of death or MI. However, only stenosis severity [HR 3.01 (1.06–8.54), P = 0.039] and HRPs [HR 1.93 (1.00–3.71), P = 0.049] remained independently associated.

Conclusion 

PET-derived MBF, CCTA-derived stenosis severity, and HRP morphology were univariably associated with death and MI, whereas only stenosis severity and HRP morphology provided independent prognostic value.
The market for traceability with applications to U.S. feeder cattle
Authors: Mitchell James , Tonsor Glynn T , Schulz Lee
Published: September 2020

For voluntary traceability programs, a key interest for program designers and policymakers is how to encourage participation. We contend that participating in voluntary traceability can be viewed as a product characteristic, and thus serves as a source of product differentiation. We study the implicit market for traceability systems for the first known time. In our empirical example, we use stated choice experiments to link feeder cattle sellers and buyers through premiums and discounts for cattle traceability systems. Using results from discrete choice models, we simulate changes in traceability supply and demand in response to prices and policies. We find that cost-share policies might be an effective way of encouraging participation for feeder cattle sellers and could serve as an alternative to mandating traceability.
Airway Gene Expression Correlates of Respiratory Syncytial Virus Disease Severity and Microbiome Composition in Infants
Authors: Chu Chin-Yi , Qiu Xing , McCall Matthew N , Wang Lu , Corbett Anthony , Holden-Wiltse Jeanne , Slaunwhite Christopher , Grier Alex , Gill Steven R , Pryhuber Gloria S , Falsey Ann R , Topham David J , Caserta Mary T , Walsh Edward E , Mariani Thomas J
Published: September 2020

Background

Respiratory syncytial virus (RSV) is the leading cause of severe respiratory disease in infants. The causes and correlates of severe illness in the majority of infants are poorly defined.

Methods

We recruited a cohort of RSV-infected infants and simultaneously assayed the molecular status of their airways and the presence of airway microbiota. We used rigorous statistical approaches to identify gene expression patterns associated with disease severity and microbiota composition, separately and in combination.

Results

We measured comprehensive airway gene expression patterns in 106 infants with primary RSV infection. We identified an airway gene expression signature of severe illness dominated by excessive chemokine expression. We also found an association between Haemophilus influenzae, disease severity, and airway lymphocyte accumulation. Exploring the time of onset of clinical symptoms revealed acute activation of interferon signaling following RSV infection in infants with mild or moderate illness, which was absent in subjects with severe illness.

Conclusions

Our data reveal that airway gene expression patterns distinguish mild/moderate from severe illness. Furthermore, our data identify biomarkers that may be therapeutic targets or useful for measuring efficacy of intervention responses.
Practical application of an impractical bovine genotype: creating bilateral twin pregnancies in Trio allele carriers
Authors: Madureira Guilherme , Gomez-León Victor , Grillo Gustavo Fernandes , Nascimento Andrade João Paulo , Lett Beth , Moghbeli Sadrollah Molaei , Wiltbank Milo C , Kirkpatrick Brian W
Published: September 2020

Bovine twin birth is associated with detriments, including increased embryo/fetal losses, malpresentation, and dystocia. Incidence of these is lessened in bilateral compared with unilateral twin pregnancy. This study was undertaken to assess the use of follicular ablation by aspiration to create bilateral twin pregnancies in females with genetic potential for ~3.5 ovulations per cycle (Trio allele carriers). In experiment 1, carriers (n = 30) and noncarriers (n = 10) were synchronized for ovulation and timed artificial insemination (TAI). Follicles (>5 mm) in excess of one per ovary were aspirated ~16 h preceding TAI. Follicle count for females with follicles on only one ovary was reduced to two. Blood was sampled 2 wk post-TAI to assess progesterone (P4) concentrations; embryo count was determined by ultrasound 6 wk post-TAI. Circulating P4 concentration post-TAI was significantly (P < 0.001) associated with both genotype and subsequent pregnancy status (pregnant noncarriers: 7.06 ± 0.68 ng/mL; pregnant carriers: 5.54 ± 0.55 ng/mL; nonpregnant noncarriers: 5.22 ± 1.05 ng/mL; nonpregnant carriers: 3.13 ± 0.42 ng/mL). Experiment 2 was undertaken to offset the negative effects of follicular aspiration on subsequent P4 concentration observed in experiment 1. Carriers (n = 38) and noncarriers (n = 32) were submitted to TAI and follicle ablation as described for experiment 1. Additionally, accessory corpora lutea (CL) were induced in carriers by the administration of human chorionic gonadotropin (carriers) at day 6 post-TAI. Consequently, P4 concentration post-TAI was significantly (P < 0.05) associated with subsequent pregnancy status (pregnant: 8.48 ± 0.61 ng/mL; nonpregnant: 6.70 ± 0.63 ng/mL) but not with genotype (carrier: 8.01 ± 0.59 ng/mL; noncarrier: 7.17 ± 0.64 ng/mL). Embryo number was greater in carriers (exp. 1: 1.64 ± 0.81; exp 2: 1.45 ± 0.09) vs. noncarriers (1.00 ± 0.00, both experiments). Single, twin, and triplet pregnancies occurred in carriers in experiment 1, whereas multiples in experiment 2 were limited to twin pregnancies. Genotype effects on pregnancy rate were not significant (P > 0.10) in either experiment. Results suggest that follicular ablation to create bilateral twin pregnancies in Trio carriers is feasible but requires the induction of accessory CL to offset the negative effects of follicular aspiration on subsequent P4 concentration and associated fertility outcomes.
Accidental Nasal Myiasis Caused by Megaselia rufipes (Diptera: Phoridae) in a Child
Authors: Giangaspero A , Barlaam A , Pane S , Marchili M R , Onetti Muda A , Putignani L , Hall M J R
Published: September 2020

A case of a nasal myiasis in a 3-yr-old Italian girl who was referred to Bambino Gesù Hospital in Rome, Italy, is reported. Larvae discharged with the nasal mucus were microscopically identified as Megaselia spp.; DNA barcoding analysis showed that they belonged to the ‘scuttle fly’ species Megaselia rufipes (Meigen). Based on the patient’s history, she became infected when she played outside. This is the first report of myiasis in humans due to M. rufipes (Diptera: Phoridae).
Multicenter Interim Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Chiotos Kathleen , Hayes Molly , Kimberlin David W , Jones Sarah B , James Scott H , Pinninti Swetha G , Yarbrough April , Abzug Mark J , MacBrayne Christine E , Soma Vijaya L , Dulek Daniel E , Vora Surabhi B , Waghmare Alpana , Wolf Joshua , Olivero Rosemary , Grapentine Steven , Wattier Rachel L , Bio Laura , Cross Shane J , Dillman Nicholas O , Downes Kevin J , Oliveira Carlos R , Timberlake Kathryn , Young Jennifer , Orscheln Rachel C , Tamma Pranita D , Schwenk Hayden T , Zachariah Philip , Aldrich Margaret L , Goldman David L , Groves Helen E , Rajapakse Nipunie S , Lamb Gabriella S , Tribble Alison C , Hersh Adam L , Thorell Emily A , Denison Mark R , Ratner Adam J , Newland Jason G , Nakamura Mari M
Published: September 2020

Background

Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing agents with potential antiviral activity continue to expand such that updated guidance is needed regarding use of these agents in children.

Methods

A panel of pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of the best available evidence and expert opinion.

Results

Given the typically mild course of COVID-19 in children, supportive care alone is suggested for most cases. For children with severe illness, defined as a supplemental oxygen requirement without need for noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO), remdesivir is suggested, preferably as part of a clinical trial if available. Remdesivir should also be considered for critically ill children requiring invasive or noninvasive mechanical ventilation or ECMO. A duration of 5 days is appropriate for most patients. The panel recommends against the use of hydroxychloroquine or lopinavir-ritonavir (or other protease inhibitors) for COVID-19 in children.

Conclusions

Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For children with severe or critical disease, this guidance offers an approach for decision-making regarding use of remdesivir.
Twenty-five years: GeoSentinel’s impact on travel-related surveillance and its vision for the future
Authors: Angelo Kristina M
Published: September 2020

GeoSentinel has been successful in advancing public health and clinical practice since its inception, by informing disease- and population-specific travel medicine topics, provision of healthcare of ill travelers, and pre-travel preparation strategies for healthcare providers. Recent hepatitis E and animal exposures publications reinforce these successes and present questions for the future.
Justification awareness
Authors: Artemov Sergei
Published: September 2020

We offer a new semantic approach to formal epistemology that incorporates two principal ideas: (i) justifications are prime objects of the model: knowledge and belief are defined evidence-based concepts; (ii) awareness restrictions are applied to justifications rather than to propositions, which allows for the maintaining of desirable closure properties. The resulting structures, Justification Awareness Models, JAMs, naturally include major justification models, Kripke models and, in addition, represent situations with multiple possibly fallible justifications which, in full generality, were previously off the scope of rigorous epistemic modeling.
Caring for the Family Caregiver
Authors: Wittenberg Elaine , Goldsmith Joy , Ragan Sandra L. , Parnell Terri Ann
Published: September 2020

This remarkable work reveals the plight of the family caregiver in chronic illness through the prism of communication. Examining the high cost and poorly addressed exigencies of the caregiver, including health literacy, palliative care, and health outcomes, Elaine Wittenberg, Joy V. Goldsmith, Sandra L. Ragan, and Terri Ann Parnell use an interdisciplinary approach in an effort to identify the impact of communication and its burdens on the caregiver. This team of scholars present four caregiver profiles, the Manager, Carrier, Partner, and Lone caregiver, each emerging from a family system with different patterns of conversational sharing and expectations of conformity. This volume presents a picture of the costs and losses for caregivers that go unseen and remain invisible for stakeholders in the healthcare experience. By synthesizing current data assessing the experiences of caregivers, as well as integrating the narrative experiences of a range of caregivers living through a variety of illnesses and their specific demands, the writers deliver an unflinching gaze at the journey of the caregiver. With an author team comprised of three health communication researchers and a nurse and health literacy expert, this volume integrates literature addressing caregiver needs and burdens, communication theory and practice, and palliative care and health literacy research to present the groundbreaking concept of the caregiver types and an innovative set of support resources to facilitate improved pathways to better care for the caregiver. Their engaging and rigorous writing style integrates the real stories of caregivers across the scope of the book connecting the reader with the people inside the pages and making the book essential for providers, students, clinicians, policymakers, and family caregivers alike.
The Lone Caregiver
Authors: Wittenberg Elaine , Goldsmith Joy V. , Ragan Sandra L. , Parnell Terri Ann
Published: September 2020

Lone caregivers derive from families with low conformity and conversation. Regular exchanges of interaction are not part of their family experience, nor are ritualized dates, behaviors, and times together. The members of this family group are stars in the same constellation but have no responsibility or time dedicated to one another. LOW/COLD conformity is demonstrated through a lack of consistency in family rules, sharing beliefs that demonstrate inequity, not recognizing protected family times/rituals, and avoiding the cultivation of family closeness. LOW/COLD communication is characterized by low expectation for agreement and assimilation in conversational topics and frequency of interaction. The dyadic dynamic with the care recipient may serve to be its own significant support for some Lone caregivers. These two collaborators, in some care situations, may share the burdens of decision-making, planning, and even care management. The absence of a family support network moves the Lone caregiver outside of family structures to develop resources and help in caregiving. Healthcare providers and system resources are especially vital in supporting care decisions, goals, and self-care. The Lone caregiver has high levels of facility with information seeking and care navigation/pursuit and presents to others as seeking of the most effective physical relief for the care recipient. This caregiver is particularly bound to the care recipient, vigilant about an unfolding disease path, and in high need of self-care resources and respite.
Inhalants
Authors: Rastegar Darius A.
Published: September 2020

Inhalants are a pharmacologically diverse group of substances with a common route of use. An estimated half million Americans are current inhalant users. Use is highest among adolescents and declines with age. Nitrous oxide is the most commonly used, followed by amyl nitrite and organic compounds. There are clues on history and examination that should raise the suspicion of inhalant use. Metabolites of some organic compounds can be detected on urine testing. Volatile organic compounds are found in a wide variety of household and industrial products. They are associated with a number of medical complications, the most serious of which is encephalopathy. Nitrous oxide and other volatile anesthetic agents are commonly used. The most serious complication associated with their use is hypoxia. Amyl nitrite and related compounds are potent vasodilators. The most serious complications associated with their use are hypotension and methemoglobinemia. There are few data on treatment of individuals who use inhalants.
Anabolic Steroids and Athletes
Authors: Fingerhood Michael I.
Published: September 2020

Anabolic steroids are used to promote growth of skeletal muscle, increase lean body mass, and improve athletic performance. There are an estimated 1 million current or former users of anabolic steroids in the United States. Unlike other substances used nonmedically, anabolic steroids produce no acute psychoactive effects. Repeated use results in increased muscle mass and strength; many feel an increased level of aggression. There is no typical withdrawal syndrome, but reported symptoms include mood swings, restlessness, drug craving, loss of appetite, insomnia, reduced sex drive, and depression. Specific questions related to the use of anabolic steroids should be pursued with athletes and bodybuilders. Most medical complications of anabolic steroid use are the direct result of excessive exogenous androgens. There are no reports in the literature of treatment specific to nonmedical anabolic steroid use. Other drugs used to enhance athletic performance include growth hormone, stimulants, erythropoietin, blood products, gonadotrophins, beta-blockers, and diuretics.
Psychopharmacology
Authors: Ansari Arash , Osser David
Published: September 2020

Psychopharmacology: A Concise Overview, 3rd Edition discusses and reviews currently available psychiatric medications and their evidence-supported use in current clinical practice. It discusses the therapeutic uses of antidepressants, anti-anxiety medications, antipsychotics, mood stabilizers, stimulants, and other medications for attention-deficit/hyperactivity disorder (ADHD), as well as medicines for substance use disorders. It reviews the medications’ mechanisms of action, therapeutic effects, potential drug–drug interactions and short- and long-term adverse effects and risks. It includes sections on complementary and alternative pharmacotherapies as well as on emerging therapies. Every chapter includes an in-depth discussion of the clinical use of the reviewed classes of medications as they are used for the alleviation of their target psychiatric disorders, such as depression, anxiety disorders, schizophrenia, bipolar disorder, ADHD, and opioid, alcohol, and tobacco use disorders. Treatment challenges and controversies are reviewed. In addition, each chapter discusses the use of these medications in other psychiatric and medical conditions as well. Each chapter also discusses the use of these medications in women of childbearing age, especially in light of pregnancy and breastfeeding considerations. Finally, each chapter includes a table that provides each reviewed medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications. This book provides a concise and accessible overview that would be helpful to medical students, psychiatric residents, psychiatrists, primary care physicians, clinical nurse specialists, and nonmedical mental health practitioners.
The history and scope of neuropsychiatry
Authors: Trimble Michael
Published: September 2020

This chapter discusses the clinical necessity from which the intersection of neurology and psychiatry arose, exploring different eras and their associated intellectual milestones in order to understand the historical framework of contemporary neuropsychiatry. Identifying Hippocrates’ original acknowledgement of the relation of the human brain to epilepsy as a start point, the historical development of the field is traced. This encompasses Thomas Willis and his nascent descriptions of the limbic system, the philosophical and alchemical strides of the Enlightenment, and the motivations behind the Romantic era attempts to understand the brain. It then follows the growth of the field through the turn of the twentieth century, in spite of the prominence of psychoanalysis and the idea of the brainless mind, and finally the understanding of the ‘integrated action’ of the body and nervous system, which led to the integration of psychiatry and neurology, allowing for the first neuropsychiatric examinations of epilepsy.
Neurophysiology in neuropsychiatry
Authors: Sokolov Elisaveta , Mullatti Nandini
Published: September 2020

Electroencephalography (EEG) is a widely available, non-invasive, and relatively inexpensive test that can determine or rule out which functional or structural factors may be contributing to psychiatric syndromes. In this chapter, the clinical usefulness of EEG in evaluating neuropsychiatric disorders is defined, while the application of other techniques, such as transcranial magnetic stimulation, is highlighted. The chapter presents different diseases, such as Alzheimer’s disease, epilepsy, and various forms of encephalitis, and describes how each would present itself on an EEG. Case studies are presented to demonstrate the role EEG plays in determining neuropsychiatric disorders and monitoring their treatment.
Inflammatory and autoimmune disorders in neuropsychiatry
Authors: Pollak Thomas A. , Coutinho Ester , Palmer-Cooper Emma , Vincent Angela
Published: September 2020

Evidence continues to be found to suggest a close link between the central nervous system and the immune system in neuropsychiatric disorders. With increasing interest over the last decade in autoimmune encephalitides, caused by the interaction of neuronal surface antibodies (NSAbs) with proteins, such as the NMDA receptor (NMDAR) and leucine-rich glioma inactivated 1 (LGI1), the clinical interface between psychiatry and neurology has undergone significant advances. This chapter provides a basic overview of autoimmunity, before discussing recent findings. Firstly, autoimmune disorders which commonly present with psychiatric comorbidities are explored such as systemic lupus erythematosus (SLE) and multiple sclerosis (MS). Then, the psychiatric presentations of various autoimmune forms of encephalitis are discussed, along with their treatment and outcomes. Finally, the relevance of NSAbs to psychiatry is discussed in greater detail.
Neuropsychiatry and sleep disorders
Authors: Leschziner Guy , Rosenzweig Ivana , Kent Brian
Published: September 2020

Sleep problems can cause or exacerbate neuropsychiatric disease, influence the course of its treatment, or serve as a diagnostic signpost for a range of neuropsychiatric disorders. For instance, depressive episodes are frequently preceded by insomnia, while dream enactment behaviour may be an indicator of a neurodegenerative disorder. This chapter focuses on a number of sleep disorders, from insomnia and various hypersomnias to circadian sleep disorders, exploring their clinical features, pathophysiology, and treatment. It begins by delineating the two main types of sleep—rapid eye movement (REM) and non-REM (NREM)—along with their stages, before moving on to the examination of specific disorders. Finally, neuropsychiatric conditions, such as Alzheimer’s and Parkinson’s disease, are discussed, relating the way they present themselves through sleep problems.
Neuropsychiatry of nutritional disorders
Authors: Medford Nick
Published: September 2020

Malnutrition is a hugely extensive global health issue, with an estimated 800 million affected worldwide and almost 2 billion when those with specific nutritional deficiencies are taken into account. This chapter discusses the link between nutritional deficiency and neuropsychiatric disorder. In some cases, this can take the form of a clear cause and effect such as the prevalence of Wernicke’s encephalopathy in those with thiamine deficiency. However, it is important to develop means to determine the relationship between malnutrition and neuropsychiatric disorders in general. It focuses firstly on malnutrition, exploring the cognitive and central nervous system changes in those who would be found malnourished by the Waterlow criteria, before moving on to specific deficiencies and their associated neuropsychiatric presentations, such as B6 (pyridoxine) and epilepsy, or iron and neurodevelopmental disorders such as autism and attention-deficit/hyperactivity disorder.
Models of neuropsychiatry services and neuropsychiatric care pathways
Authors: Faruqui Rafey , El-Nimr George
Published: September 2020

This chapter aims to provide broad principles of service development underpinning good neuropsychiatric care. Learning from a British service provision context has been utilized to articulate service design issues relevant to an international health development agenda. The chapter further aims to clarify the purpose and composition of a specialist and multidisciplinary neuropsychiatry team. A ‘bridging model’ is advocated for development of future services in order to embed a holistic care delivery approach into service planning. A three-tier model of service provision and referral pathways in the context of a typical resource-rich health economy are described. However, the key lessons from this chapter could be easily applied to international health contexts where health budgets may be very limited in terms of service provision and human resource development.
Assessing the health of populations
Authors: Flowers Julian , Evans Sian
Published: September 2020

Assessing population health is a fundamental element of most public health activity. We cannot improve health and measure success without being able to conduct health assessments. These may be components of, for example: measuring burden of disease; needs assessment; assessing health equity and health inequality; resource allocation; planning; health impact assessment (HIA); service evaluation.
Economic assessment
Authors: Brambleby Peter
Published: September 2020

This chapter will help the reader to: understand the tools, techniques, and approaches of health economics; apply a health economics way of framing a discussion when the need arises in management situations, pose better questions when important choices are apparent and when the help of a professional health economist is involved.
Understanding data, information, and knowledge
Authors: Tennison Barry , Manzoli Lamberto
Published: September 2020

The aim of this chapter is to help the public health practitioner to: appreciate the subtleties of the varied forms of information about the health of a population and related matters; develop a toolkit for thinking about the complexity of information, its interpretation and uses; orientate positively towards the decisions and actions needed, applying wisely the information and knowledge available. In addition, the classification (taxonomy) of types of information given in this chapter should support the public health practitioner to: assess the relevance, timeliness, accuracy, and completeness of available information; decide which types of information are most appropriate for a particular public health task; make optimal use of information that is not ideal, and assess the effects of its departure from perfection.
Information technology and informatics
Authors: Detmer Don
Published: September 2020

After reading this chapter, you should be able to: identify the emerging sub-disciplines within biomedical and health; informatics that are critical to the skilful use of health information and communications technology in the health sciences; appreciate how informatics is applied to public health, clinical medicine, and research, and that its roles are in rapid evolution; consider clinical informatics as a professional career choice regardless of your health discipline.
Epidemiological approach and design
Authors: Ricciardi Walter , Boccia Stefania
Published: September 2020

Understand epidemiological thinking and approaches in a public health context; Use the most appropriate measures of disease occurrence; Measure the association between an exposure and a health event by using a two-by-two table; Measure the impact of a certain disease at the population level; Identify the main epidemiological studies.
Communicable disease epidemics
Authors: O’Brien Sarah
Published: September 2020

After reading this chapter you should be able to: define the terms ‘communicable disease’, ‘epidemic’, and ‘outbreak’; explain the principles of preventing communicable disease; explain the key features of different types of outbreaks or epidemics; understand the key steps in investigating an outbreak or epidemic.
Engaging communities in participatory research and action
Authors: Minkler Meredith , Chang Charlotte
Published: September 2020

After reading this chapter you will be able to: define participatory research and its core principles; describe how engaging communities in participatory research and action can add value to research, while building community capacity and helping achieve action to promote community health; identify some of the challenges that arise in such work and how they may be addressed; describe a case study that started with an important issue in the community and demonstrates core principles of community-based participatory research (CBPR), challenges faced in such work, and subsequent community action for change.
Assuring screening programmes
Authors: Raffle Angela , Barratt Alex , Gray J.A. Muir
Published: September 2020

After reading this chapter, you will: understand why screening needs a programme, not just a test; recognize the biases that limit the validity of observational evidence; be clearer about the public health tasks in screening; understand that values and beliefs shape screening policy as much as evidence.
Developing healthy public policy
Authors: Nutbeam Don
Published: September 2020

Reading this chapter should help you better understand: the process of policy making and the role of public health information and evidence in shaping policy; the role of public health practitioners in influencing the policy process through the provision of evidence and advocacy.
Influencing international policy
Authors: Lang Tim , Caraher Martin
Published: September 2020

This chapter will help you understand: the relationships between international policy and policy action at multiple levels; why public health practitioners should build an international dimension into their work; how to influence and advance public health internationally, even through local action. The chapter uses examples from the world of food and health policy (on which the authors work) to illustrate the structures and processes of engagement you may encounter. In the policy worlds of both global public health and food, there is a mix of improvement and threats, inequalities alongside progress, fragmentation, and coherence. Similar trends in the global South and developed countries may have underlying drivers at work, resulting in the double burden of disease. It is preferable to ensure that international policies tackle rather than ignore those determinants.
Improving public health in low-and middle-income countries
Authors: Heymann Eric , Banatvala Nicholas
Published: September 2020

This chapter looks at the broader determinants of health and current approaches to tackling public health in poorer countries. Reading this chapter will help you understand: the major public health issues in low- and low middle-income countries; the approaches used to tackle them.
Working with the media
Authors: Maryon-Davis Alan
Published: September 2020

After reading this chapter you should be able to: develop a strategy for working with the media, either as an individual practitioner or as a representative of your team or organization; review and strengthen your strategy, if you already have one in place; undertake simple media tasks, such as writing a press release or being interviewed by a journalist, with more confidence; make creative use of social media to highlight and reinforce your messages. This chapter addresses the basics of working with the print, broadcast, and social media. More provocative engagement with the media is described elsewhere in this handbook.
Getting research into practice
Authors: Ward Jeanette , Grimshaw Jeremy
Published: September 2020

After reading this chapter, you will be able to: identify and respond to situations in clinical and public health practice that require research transfer; apply a systematic approach to research transfer, learning from the work of others and planning locally in context; contribute to a growing body of evidence about research transfer itself
Cardiac rehabilitation: referral and barriers
Authors: Piepoli Massimo Francesco , Cupples Margaret E.
Published: September 2020

For many patients with CVD, CR offers an important introduction to secondary prevention. However, many do not enjoy the benefits of CR, often because they are not referred. Internationally, levels of CR attendance vary; overall, less than half of those eligible to attend do so. Patients who are least likely to be referred may benefit most from attendance: structured referral systems increase referral rates. Barriers to CR uptake exist at the levels of patients (education; adherence to healthy lifestyle advice; adherence to medication), healthcare providers (knowledge and motivation; risk stratification; post-discharge plans; inter-professional communication), and healthcare systems (availability of structured programmes; referral processes; performance measures). Multilevel interdisciplinary interventions are required to address these barriers.
Early assessment and risk stratification
Authors: Iliou Marie Christine , Monpere Catherine
Published: September 2020

A pre-participation medical assessment before cardiac rehabilitation (CR) is mandatory in order to deliver a safe programme tailored to the individual patient. This initial evaluation also aims to increase patient adherence and the efficiency of the programme. The entry assessment includes the following components: history, global patient evaluation including clinical questionnaires, physical examination, laboratory analysis, and non-invasive cardiovascular testing. Following this assessment, a risk stratification should be performed to determine the appropriate CR modalities.