bluuebunny/crossref_metadata_2025 huggingface dataset:
3. Computer programs and databases
Authors: Press Tim
Published: September 2019

This chapter deals with copyright in computer programs and databases for which the EU Software and Database Directives set special rules, which are implemented in the Copyright, Designs and Patents Act 1988 (CDPA). In addition, it deals with database right, also created by the Directive, which is implemented by the Copyright and Rights in Databases Regulations 1997. There are particular defences to copyright infringement in relation to computer programs that allow decompilation and the development of compatible software. Database right is intended to protect the investment in gathering the data into a database; it does not protect data that is created by the database owner. Database right protects against the extraction or re-utilization of the contents of the database for a period of 15 years.
4. The relationship between international and domestic law
Authors: Bantekas Ilias , Papastavridis Efthymios
Published: September 2019

This chapter analyses the relationship between international and domestic law and particularly the reception of the former in domestic legal systems. This matter is regulated in the receiving State’s constitutional law and is generally based on the doctrine of incorporation and that of transformation. The former does not require any further implementing legislation by the receiving State but where it is applied it is subject to several limitations, particularly where the treaty in question is not sufficiently clear or precise, in which case it is not automatically self-executing. The philosophical foundations of the relationship between international and domestic law are explained by reference to the monist and dualist theories. Besides treaties, domestic law also regulates the reception of custom and UN Security Council resolutions. However, in respect of Security Council resolutions, international human rights law determines their legality.
Mayson, French & Ryan on Company Law
Authors: French Derek
Published: September 2019

Mayson, French & Ryan on Company Law looks at all aspects of current UK company law. The 36th edition continues the tradition of providing accurate technical detail, examination of theory and quotations from key cases. The volume starts with an overview of the topic. Next it looks at the establishment of companies. It moves on to consider finance which includes an examination of shares, accounts, loans, market abuse, capital and borrowing. The next part of the text considers governance. It looks at shareholders, directors, duties of directors, company secretaries and auditors, remedies and acting for a company. The last part of the text examines insolvency and liquidation.
3. Registration
Authors: French Derek
Published: September 2019

This chapter discusses the process of registration for the incorporation of companies under the Companies Act 2006. It considers the distinction between private and public companies, the meaning of limited liability and the significant characteristics of the company created by the registration procedure (separate corporate personality, members, shareholding, directors, secretary, name, constitution and a registered office and domicile). The chapter discusses re-registration as a means of altering a company.
5. Corporate personality
Authors: French Derek
Published: September 2019

This chapter deals with the legal personality of a company which is separate from its members, capable of owning property, entering into contracts and being a party to legal proceedings. It considers the case Salomon v A Salomon and Co Ltd [1897] AC 22, in which the House of Lords affirmed separate corporate personality by rejecting attempts, on behalf of creditors, to impose liability for a failed company’s debts on its controlling shareholder. The consequences of separate corporate personality are also discussed, particularly with respect to a company’s human rights (or personal rights). In addition, the chapter examines the process known as ‘piercing the corporate veil’ in relation to the evasion principle; how an artificial entity can have legal personality; and a number of particularly significant court cases. Finally, it looks at corporate law theory and considers whether companies are grammatically singular or plural.
7. Offering shares to the public
Authors: French Derek
Published: September 2019

This chapter focuses on public offering of shares as a source of finance for companies, with emphasis on the legal requirements to provide the necessary information to prospective investors. It also considers the importance of a marketplace for selling shares at the best possible price, as well as the regulation of the financial services industry by the Financial Services and Markets Act 2000. In addition, it discusses two controls on share offers to the public under the Companies Act 2006 with respect to payment of underwriting commission and repayment of subscribers’ money if a share offer is not completely successful. The chapter examines the regulatory regimes for securities markets, some of the main reasons or advantages for going public, the prospectus requirement and any exemptions to it and how the law deals with misleading statements and omissions in prospectuses.
9. Control of a company
Authors: French Derek
Published: September 2019

This chapter discusses how control of a company can be identified and how it can change. It considers takeovers, the City Code and compulsory acquisition of remaining shares. There is full discussion of the provisions for disclosure of significant holdings both to warn of potential takeover moves and to disclose in the public interest who has significant control of a company. The statutory definitions of holding company, subsidiary and wholly owned subsidiary are considered.
11. Borrowing and security
Authors: French Derek
Published: September 2019

This chapter considers borrowing as an important method of financing a company’s activities, and security as a right of recourse against company property if the loan is not repaid on time. It begins by discussing security for financial obligations, paying particular attention to security contracts, the redemption or discharge of security and the realisation of security. It then turns to the registration of non-possessory security contracts, the priorities of legal and equitable charges and floating charges as a form of security and their crystallisation. The extent to which the assets of a company, to which anyone is considering extending credit, are already charged as security is also explained. The chapter considers three particularly significant court cases: Evans v Rival Granite Quarries Ltd [1910] 2 KB 979; Re Spectrum Plus Ltd [2005] UKHL 41, [2005] 2 AC 680; and Re Yorkshire Woolcombers Association Ltd [1903] 2 Ch 284.
13. Corporate governance
Authors: French Derek
Published: September 2019

This chapter surveys corporate governance. It identifies the key problem of the separation of ownership and control in companies that are not owner-managed. Shareholders are seen as the owners of the company but directors manage the company and can do so for their own benefit rather than the shareholders’. There is a list of the numerous legal controls on directors, which are studied in other chapters. There is discussion of two ways of looking at directors, either as stewards who must account for their actions to the owners or as entrepreneurs whose wealth-creating work deserves reward. The UK Corporate Governance Code, which applies to premium listed companies, is discussed, as are shareholder activism and investor stewardship.
14. Members
Authors: French Derek
Published: September 2019

This chapter focuses on the members or shareholders of a company and the way in which they take decisions on the company’s affairs. It begins by considering the rules which determine who is a member of a company and the information on the members which a company must record. It then describes the mandatory rules of company law that allow members to participate in decision-making with regard to a company’s affairs; members’ class rights and the alteration of such rights. Relevant provisions of the Companies Act 2006 governing written resolutions of private companies, meetings and annual general meetings, voting, adjournment of meetings and authorisation of political donations by companies are discussed. The chapter analyses a number of particularly significant cases.
19. Acting for a company: agency and attribution
Authors: French Derek
Published: September 2019

This chapter deals with the legal relationship of agency that exists between the company and the agent, explaining the process involved in an agent’s authentication and the execution of documents for the company he or she represents. It considers two ways in which a company may become contractually bound to another person (a ‘contractor’) under the provisions of the Companies Act 2006: through a written contract to which the company’s common seal is affixed, or when someone has made a contract on behalf of the company. It also discusses the company’s capacity to enter into contracts, including the ultra vires rule, and attribution by a court so as to impose criminal liability on a company. A number of court cases relevant to the discussion are cited.
Generation of Norovirus-Specific T Cells From Human Donors With Extensive Cross-Reactivity to Variant Sequences: Implications for Immunotherapy
Authors: Hanajiri Ryo , Sani Gelina M , Saunders Devin , Hanley Patrick J , Chopra Abha , Mallal Simon A , Sosnovtsev Stanislav V , Cohen Jeffrey I , Green Kim Y , Bollard Catherine M , Keller Michael D
Published: September 2019

Background

Chronic norovirus infection in immunocompromised patients can be severe, and presently there is no effective treatment. Adoptive transfer of virus-specific T cells has proven to be safe and effective for the treatment of many viral infections, and this could represent a novel treatment approach for chronic norovirus infection. Hence, we sought to generate human norovirus-specific T cells (NSTs) that can recognize different viral sequences.

Methods

Norovirus-specific T cells were generated from peripheral blood of healthy donors by stimulation with overlapping peptide libraries spanning the entire coding sequence of the norovirus genome.

Results

We successfully generated T cells targeting multiple norovirus antigens with a mean 4.2 ± 0.5-fold expansion after 10 days. Norovirus-specific T cells comprised both CD4+ and CD8+ T cells that expressed markers for central memory and effector memory phenotype with minimal expression of coinhibitory molecules, and they were polyfunctional based on cytokine production. We identified novel CD4- and CD8-restricted immunodominant epitopes within NS6 and VP1 antigens. Furthermore, NSTs showed a high degree of cross-reactivity to multiple variant epitopes from clinical isolates.

Conclusions

Our findings identify immunodominant human norovirus T-cell epitopes and demonstrate that it is feasible to generate potent NSTs from third-party donors for use in antiviral immunotherapy.
Long-term risk of hepatocellular carcinoma mortality in 23220 hospitalized patients treated with micafungin or other parenteral antifungals
Authors: Schneeweiss Sebastian , Carver Peggy L , Datta Kausik , Galar Alicia , Johnson Melissa D , Letourneau Alyssa R , Marty Francisco M , Nagel Jerod , Najdzinowicz Maryann , Saul Melissa , Schuster Mindy , Shoham Shmuel , Silveira Fernanda P , Varughese Christy , Wilck Marissa , Weatherby Lisa , Oene Joop van , Walker Alexander M
Published: September 2019

Background

Liver tumours observed in rats exposed to micafungin led to a black box warning upon approval in Europe in 2008. Micafungin’s risk for liver carcinogenicity in humans has not been investigated. We sought to describe the risk of fatal hepatocellular carcinoma (HCC) among persons who received micafungin and other parenteral antifungals (PAFs) with up to 12 years of follow-up.

Methods

We assembled a US multicentre cohort of hospitalized patients who received micafungin or other PAFs between 2005 and 2012. We used propensity score (PS) matching on patient characteristics from electronic medical records to compare rates of HCC mortality identified through the National Death Index though to the end of December 2016. We computed HRs and 95% CIs.

Results

A total of 40110 patients who received a PAF were identified; 6903 micafungin recipients (87% of those identified) were successfully matched to 16317 comparator PAF users. Ten incident HCC deaths, one in the micafungin-exposed group and nine among comparator PAF users, occurred in 71285 person-years of follow-up. The HCC mortality rate was 0.05 per 1000 person-years in micafungin patients and 0.17 per 1000 person-years in comparator PAF patients. The PS-matched HR for micafungin versus comparator PAF was 0.29 (95% CI 0.04–2.24).

Conclusions

Both micafungin and comparator PAFs were associated with HCC mortality rates of <0.2 per 1000 person-years. Given the very low event rates, any potential risk for HCC should not play a role in clinical decisions regarding treatment with micafungin or other PAFs investigated in this study.
Introductory Information for Practitioners
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Chapter 1 provides an introduction to the practitioner guide and the corresponding client workbook, outlining the sessions and topics to be covered. There are many different types of substance use problems in terms of severity and adverse effects on the client, family, and significant others. Therefore, treatment will be more effective if the approach is tailored to the needs and problems of each client. A challenge for practitioners is to adapt treatment strategies for each client to address the substance use problem and other medical, psychiatric, family, or social problems.
Treatment Settings for Substance Use Problems
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

A continuum of care is needed to meet the needs of clients with substance use problems. The least restrictive level of treatment should be used unless the severity of the diagnosed substance use disorder (SUD) and related medical, psychiatric, and social problems are such that medically managed or monitored treatment is needed. Levels of care include early intervention, outpatient and aftercare or continuing care programs, non-residential addiction rehabilitation programs, and inpatient hospital and residential rehabilitation programs.
Assessment of Co-occurring Psychiatric Disorders
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Co-occurring disorders (CODs) refers to the occurrence of both a substance use disorder (SUD) and a psychiatric disorder, such as mood disorder, anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, schizophrenia, eating disorder, antisocial personality disorder, and borderline personality disorder. This chapter reviews the prevalence, patterns, and effects of CODs. Next, the relationships between psychiatric disorders and SUDs, challenges for practitioners, and types and causes of psychiatric disorders are discussed. The chapter continues with the process of conducting a comprehensive and thorough assessment using the format of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The authors also discuss the importance of conveying assessment findings to the client and/or family and concerned significant others, as well as getting the client to accept help.
Reducing the Risk of Relapse
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Any client who attempts to modify alcohol, tobacco, or drug use behavior faces the possibility of lapse or relapse. A lapse refers to the initial episode of use following a period of abstinence. A lapse may be quickly stopped by the client or it may lead to a relapse or continued use of a substance. How a client interprets and responds to a lapse plays a significant role in whether or not it leads to a relapse. The risk of lapse or relapse is highest in the first 3 months of recovery, when most relapses occur. Low motivation and poor participation in therapy or mutual support programs can raise the risk of relapse, even for clients who recently completed a residential or ambulatory treatment program. Other precipitants of relapse include psychiatric illness or an inability to cope with the challenges of recovery. Helping clients remain in therapy and identify and manage early relapse warning signs and high-risk situations are ways to lower the client’s risk of relapse.
Strategies for Balanced Living
Authors: Daley Dennis C. , Douaihy Antoine
Published: September 2019

Achieving balance in life can protect clients from relapse. The more balanced and satisfying a client’s life is, the less the client needs to use substances to feel good, escape, gain excitement, or cope with problems. Balance refers to one’s ability to meet responsibilities and obligations and to take care of personal needs and wants. A healthy lifestyle involves the ability to reasonably balance various aspects of one’s life, which enhances one’s quality of life. Because life is full of demands and responsibilities, it isn’t unusual for some areas to become unbalanced from time to time. The important issue for clients is learning to live with temporary periods of imbalance when they are unavoidable or necessary and to work toward better balance when possible. The objectives of this chapter are to help the client evaluate the major dimensions of life to determine which areas are out of balance and how to work toward better balance, to teach the client how to use a daily inventory to catch problems that could lead to imbalance in life, and to teach the client how to build structure and pleasant activities into daily life.
Conflict of Interest and the Code of Ethics
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

Conflict of interest (COI) can be defined as a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest (e.g., a patient’s best interests) will be unduly influenced by a secondary interest (e.g., financial or professional gain for the counselor). Although conscious and intended unethical behavior resulting from a COI, most COIs occur at a subconscious level and are a normal aspect of human psychology and behavior. It can be very difficult for any professional to recognize a COI, and even more difficult for highly ethical people to realize that they may be making unethical choices. As such, COI is a critical professional issue that is largely inevitable and, like countertransference, needs to be managed, ideally with the help of professional supervision and/or a disinterested third party. The National Society of Genetic Counselors offers resources for addressing COI and its Code of Ethics provides a professional ethos and guidelines for helping to guide ethical behavior for the practice and profession of genetic counseling.
Relational Genetic Counseling
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

This chapter emphasizes the importance of the relational components of a psychotherapeutic approach to genetic counseling. It outlines the steps to developing a therapeutic alliance with a client that are implied but not stated in the Reciprocal Engagement Model. Reinforced are the need for safety and trust for the client, conveying respect, and being genuine in the relationship. Contracting is described as an exchange between the counselor and client to establish the session goals. Relational counseling skills are used to establish a relationship that fully addresses the implications of genetic information. These skills include asking open-ended questions, followed by closed-ended questions; clarifying understanding; paraphrasing; reflecting feelings; and summarizing the client’s perceptions and needs. They constitute the process used to establish a therapeutic relationship that is essential to addressing the threat of genetic information and clients’ related fears and hopes. What results from this process is an empathic connection with clients where informed decisions are made, coping is enhanced, and/or adaptation is facilitated.
Research in Genetic Counseling
Authors: Biesecker Barbara B. , Peters Kathryn F. , Resta Robert
Published: September 2019

The field of genetic counseling has historically valued the role of research. More recently, graduate programs have raised the standards for student thesis projects so that a greater percent are of publishable quality. The profession has acknowledged key research gaps, such as a lack of consensus on the primary client outcomes of counseling. Further, the National Society of Genetic Counselors has endorsed the importance of evidence that may be used to guide practice. Herein we present the role of genetic counselors as researchers and discuss approaches to designing research studies to answer key service delivery questions and patient-reported outcomes. To frame research in genetic counseling, health behavior and social psychology theories offer models for identifying key variables likely to predict client decisions and their outcomes. To date, studies in genetic counseling have been framed by the self-regulation model and the theory of planned behavior. A systematic review of randomized controlled trials in genetic counseling identified psychological well-being and gain in knowledge as the most prevalent patient outcomes. Evidence can be used to predict decisions to undergo genetic testing or follow up on results.
Nonaneurysmal Subarachnoid Hemorrhage
Authors: Nakaji Peter , Levitt Michael R.
Published: September 2019

Abstract: Spontaneous subarachnoid hemorrhage can arise from several possible sources, including cerebrovascular malformations, malignancy, or other disorders. Careful clinical examination as well as specialized radiological studies are essential to ensure correct diagnosis and develop a treatment plan. This chapter reviews the diagnostic workup and additional considerations in the management of spontaneous subarachnoid hemorrhage from a nonaneurysmal source. This form of subarachnoid hemorrhage is a distinct clinical entity with a generally more benign course. However, proper work-up and management are necessary both to ensure that a more serious form of subarachnoid hemorrhage does not exist and that the complications that can arise do not cause patient morbidity.
Medium-Sized Incidental Anterior Choroidal Artery Aneurysm
Authors: Burkhardt Jan-Karl , Lawton Michael T.
Published: September 2019

Abstract: Anterior choroidal artery (AChA) aneurysms are rare and can present a particular anatomical challenge in that they often incorporate the origin of the AChA. The success of aneurysm treatment in this location depends on completely occluding the aneurysm and preserving the AChA parent vessel to avoid a devastating AChA infarct, with deficits that can include hemiplegia and hemianopsia. This chapter presents the case of a female patient with an unruptured AChA aneurysm treated with microsurgical clipping. In addition to meticulous microsurgical technique based on anatomic knowledge, intraoperative monitoring including somatosensory evoked potentials, motor evoked potentials, and indocyanine green angiography is an important adjunct for a successful aneurysm occlusion without complications.
Ruptured Pericallosal Artery Aneurysm
Authors: Ravina Kristine , Russin Jonathan J. , Giannotta Steven L.
Published: September 2019

Abstract: Distal anterior cerebral artery aneurysms are rare, tend to rupture at a smaller size than other aneurysms, and are associated with unique challenges posed by their anatomic location. These aneurysms tend to be broad-necked, and this morphology, combined with the relatively small size of the parent artery, tends to favor open surgical management. The interhemispheric approach, typically required for the open surgical management of these aneurysms, can yield favorable outcomes, comparable to those of other intracranial location aneurysms. The presented case of a patient with a ruptured A3 segment aneurysm illustrates key points in diagnosis, preoperative planning, management, surgical technique, and postoperative care.
Trauma and Disaster Management
Authors: Person Joshua , Kao Lillian S.
Published: September 2019

Trauma patients are seen at nearly every facility with varying degree of intensity and frequency, and management of the trauma patient is reliably within the expected knowledge and scope of a perioperative intensivist. The range of clinical issues potentially seen in the trauma patient span all systems and frequently necessitate a risk benefit assessment in a systematic manner in order to optimal manage a complex patient. Keeping that in mind, there are fundamental concerns that are frequently encountered in trauma patients, and a systematic and thorough approach to this population is necessary in order to provide excellent care. This chapter is structured to provide a review of common concerns in the management of trauma and to reveal common pitfalls of trauma and disaster management that are easily testable.
Immunology and Infectious Diseases
Authors: Mucci Joti Juneja
Published: September 2019

An understanding of infectious diseases and immunology has a substantial role in the practice of critical care medicine, most commonly seen in sepsis or postoperative care. Infectious diseases are not a subject heavily emphasized in core anesthesiology training (the other being nutrition). In many instances, the intricate details of immunologic management are frequently relegated to consulting subspecialists by the average practicing intensivist. Familiarity with the content of this chapter allows an intensivist to demonstrate detailed knowledge of the management of patients with this pathology and of organ transplant recipients. This chapter has an additional emphasis on clinically challenging concepts that likely prepare the reader for practice as well as abstruse questions that could be present on the examination.
Cardiovascular I
Authors: Young Linda W.
Published: September 2019

Cardiovascular disease management is a hallmark skill in critical care medicine, and the most common data source includes the classic electrocardiogram (ECG); as such, ECG findings are frequently used in this chapter. Critical care board examinations frequently require the examinee to be able to recognize various key illnesses, sometimes with limited information; in order to solve such problem, gleaning an appropriate differential diagnosis from the question stem is needed in order to generate the correct solution. Reflecting this concept, images provided on an exam may be of limited diagnostic value and of low quality. This chapter aims to provide the reader with an experience in this realm that would be useful for success on the examination and at the bedside.
Expert Testimony
Authors: Soloway Scott , Shelby Bryan C. , Cucolo Heather Ellis , Colley Jeremy
Published: September 2019

Chapter 4 reviews the major cases related to the admissibility and presentation of expert witness testimony in the courtroom. The majority of the cases involve general standards for medical and scientific evidence (Frye v. U.S., Daubert v. Merrell Dow Pharmaceutical, General Electric v. Joiner, Kumho Tire Co. v. Carmichael) that can be applied to psychiatry. The remaining cases (State v. Hurd, People v. Shirley, Rock v. Arkansas) relate to the admissibility – or not – of hypnotically-refreshed testimony and hypnosis as a scientific practice. The newest (Buck v. Davis) involves the risk assessment testimony adn unconstitutionality of incorporating race as a factor.
Right to Treatment
Authors: Subedi Bipin
Published: September 2019

Chapter 8 focuses on cases that involve the rights of individuals to receive adequate mental health treatment while involuntarily hospitalized either through civil commitment or insanity defense proceedings. These cases set the stage, many years ago, for environmental and clinical expectations of appropriate care. The cases in this chapter are Rouse v. Cameron, Wyatt v. Stickney, and Youngberg v. Romeo. Cases involving a right to treatment for prisoners are included in Chapter 25.
Right to Refuse Treatment
Authors: Lewis Rebecca
Published: September 2019

Chapter 9 describes cases related to one of the most important autonomy issues involved in the involuntary hospitalization of individuals with mental illness - the right to refuse treatment. These cases highlight the different judicial opinions about how to manage patients who refuse treatment as exemplified by the contrast between a treatment-driven approach in Rennie v. Klein, to a right-driven approach in Rogers v. Commissioner. Other cases included in this chapter are Application of Presidents and Directors of Georgetown, Superintendent of Belchertown State School v. Saikowitz and In the Matter of the Guardianship of Richard Roe III.
Clinical Practice Liability
Authors: Shelby Bryan C. , Rotter Merrill , Ford Elizabeth
Published: September 2019

Chapter 18 includes cases that focus on potential clinician liability in working within managed care health insurance coverage, as well as cases that involve the adjudication of malpractice claims for alleged doctor-patient sexual activity. The cases included in this chapter are Roy v. Hartogs, Aetna v. McCabe, Mazza v. Medical Mutual Insurance Company, Wickline v. State, and Wilson v. Blue Cross of Southern California.
Death Penalty
Authors: Straka Tara , Cucolo Heather Ellis , Rotter Merrill , Colley Jeremy
Published: September 2019

Chapter 26 describes the cases that have defined the evolution of the United States’ relationship with the death penalty. Over time, the country has gradually narrowed the pool of those eligible to be executed, prohibiting the infliction of death on individuals the mental retardation, mental illness, and most, recently, adolescents. These cases are important for forensic professionals who may be involved in the evaluation or treatment of capital defendants. The cases in this chapter are Estelle v. Smith, Ake v. Oklahoma, Ford v. Wainwright, Payne v. Tennessee, State v. Perry, Atkins v. Virginia, Roper v. Simmons and Panetti v. Quarterman. The new cases further refine issues related to intellectual disability standards and procedural protections. These include Ryan v. Gonzales, Hall v. Florida, Moore v. Texas and Mcwilliams v. Dunn.
Allergic disease
Authors: Spickett Gavin
Published: September 2019

Allergic diseases are common: it has been estimated that 15% of the population will suffer from some sort of allergic reaction during their lifetime. There has been an increase in atopic diseases since the Second World War. This chapter discusses the presentation, immunological features, diagnosis, testing, and treatment for a wide range of allergic diseases. When appropriate, differential diagnoses are included.
Autoimmunity in gastrointestinal disease
Authors: Spickett Gavin
Published: September 2019

This chapter covers issues of autoimmunity in gastrointestinal disease. It features the clinical presentation, immunology, and testing for diagnosis and management. It features autoimmune enteropathy, achalasia, eosinophilic gastroenteritis, Crohn’s disease, ulcerative colitis, Whipple’s disease, Coeliac disease, sclerosing mesenteritis, pancreatitis, and irritable bowel syndrome. Differential diagnoses are also highlighted where appropriate.
Autoimmune skin disorders
Authors: Spickett Gavin
Published: September 2019

This chapter covers the presentation, immunogenetics, immunopathology, diagnosis, treatment, and testing for a range of skin disorders. The skin is a very easy organ in which to investigate autoimmune disease, due to its accessibility for biopsy. It covers fourteen separate skin disorders.
Detection of exoplanet as a binary source of microlensing events in WFIRST survey
Authors: Bagheri Fatemeh , Sajadian Sedighe , Rahvar Sohrab
Published: September 2019

We investigate the possibility of exoplanet detection orbiting source stars in microlensing events through WFIRST observations. We perform a Monte Carlo simulation on the detection rate of exoplanets via microlensing, assuming that each source star has at least one exoplanet. The exoplanet can reflect part of the light from the parent star or emit internal thermal radiation. In this new detection channel, we use microlensing as an amplifier to magnify the reflection light from the planet. In the literature, this mode of detecting exoplanets has been investigated much less than the usual mode in which the exoplanets are considered as one companion in binary-lens events. Assuming 72 d of observation per season with the cadence of 15 min, we find the probability of rocky planet detection with this method to be virtually zero. However, there is non-zero probability, for the detection of Jovian planets. We estimate the detection rates of the exoplanets by this method, using WFIRST observation to be $0.012{{\ \rm per\ cent}}$ in single-lens events and $0.9{{\ \rm per\ cent}}$ in the binary-lens events.
Gaussian mixture models for blended photometric redshifts
Authors: Jones Daniel M , Heavens Alan F
Published: September 2019

Future cosmological galaxy surveys such as the Large Synoptic Survey Telescope (LSST) will photometrically observe very large numbers of galaxies. Without spectroscopy, the redshifts required for the analysis of these data will need to be inferred using photometric redshift techniques that are scalable to large sample sizes. The high number density of sources will also mean that around half are blended. We present a Bayesian photometric redshift method for blended sources that uses Gaussian mixture models to learn the joint flux–redshift distribution from a set of unblended training galaxies, and Bayesian model comparison to infer the number of galaxies comprising a blended source. The use of Gaussian mixture models renders both of these applications computationally efficient and therefore suitable for upcoming galaxy surveys.
A global functional analysis of missense mutations reveals two major hotspots in the PALB2 tumor suppressor
Authors: Rodrigue Amélie , Margaillan Guillaume , Torres Gomes Thiago , Coulombe Yan , Montalban Gemma , da Costa e Silva Carvalho Simone , Milano Larissa , Ducy Mandy , De-Gregoriis Giuliana , Dellaire Graham , Araújo da Silva Jr Wilson , Monteiro Alvaro N , Carvalho Marcelo A , Simard Jacques , Masson Jean-Yves
Published: September 2019

While biallelic mutations in the PALB2 tumor suppressor cause Fanconi anemia subtype FA-N, monoallelic mutations predispose to breast and familial pancreatic cancer. Although hundreds of missense variants in PALB2 have been identified in patients to date, only a few have clear functional and clinical relevance. Herein, we investigate the effects of 44 PALB2 variants of uncertain significance found in breast cancer patients and provide detailed analysis by systematic functional assays. Our comprehensive functional analysis reveals two hotspots for potentially deleterious variations within PALB2, one at each terminus. PALB2 N-terminus variants p.P8L [c.23C>T], p.Y28C [c.83A>G], and p.R37H [c.110G>A] compromised PALB2-mediated homologous recombination. At the C-terminus, PALB2 variants p.L947F [c.2841G>T], p.L947S [c.2840T>C], and most strikingly p.T1030I [c.3089C>T] and p.W1140G [c.3418T>C], stood out with pronounced PARP inhibitor sensitivity and cytoplasmic accumulation in addition to marked defects in recruitment to DNA damage sites, interaction with BRCA2 and homologous recombination. Altogether, our findings show that a combination of functional assays is necessary to assess the impact of germline missense variants on PALB2 function, in order to guide proper classification of their deleteriousness.
22. Systemic onset juvenile idiopathic arthritis with multi-organ failure in a teenager
Authors: Law Hannah , Kelly Alison , Teoh Lisa
Published: September 2019

Introduction

Systemic onset juvenile idiopathic arthritis (JIA) is an often severe and potentially life-threatening subtype of chronic arthritis starting under the age of 16 years. It is characterised by fevers, rash and arthritis, although this may not be apparent until later in the disease course, which can add difficulty to making the diagnosis. We present a case of systemic onset JIA with multi-organ impairment to showcase its mimicry of other diseases and highlight importance of awareness

Case description

A 15-year-old girl presented with a 7 day history of fever, cough, sore neck, enlarged lymph nodes and widespread macular rash. She had been started on penicillin in the community for presumed scarlet fever, but was hospitalised due to worsening symptoms. Differential diagnoses discussed were lymphadenitis and EBV, due to ongoing fevers, high inflammatory markers, and raised liver function tests. She then developed an acute kidney injury and profound hypotension. She was treated with immunoglobulin for possible Kawasaki disease, broad spectrum antibiotics for possible toxic shock syndrome/sepsis, and transferred to the regional PICU for ongoing inotropic support and management of her multi-system illness.

She was found to have a non-dilated cardiomyopathy with poor left ventricular function, low complement and positive anti-streptolysin titres. No postive cultures or focus of infection were found. Antibody tests including dsDNA were negative. She required CPAP for respiratory support and was treated with pulsed methylprednisolone for systemic onset JIA. She then received a weaning course of prednisolone over several months and made an excellent recovery.

Discussion

This was an interesting case for those involved because the initial symptoms, evolving signs and investigation results didn’t easily tie together to give one suitable diagnosis. Several avenues of treatment were explored, including a range of antibiotics and immunoglobulin, before methylprednisolone. The patient also remained remarkably ‘well’ looking despite her multi-organ impairment.

Key learning points

This case highlighted the importance of awareness of systemic onset JIA and its complications, particularly in a non-typical age group, for the general paediatrician. Early discussion with and involvement of tertiary rheumatology services served to optimise management and outcome, and will hopefully also improve long-term prognosis.

Conflicts of interest

The authors have declared no conflicts of interest.
III–3 Low-Intensity Pulsed Ultrasound (LIPUS) for the Treatment of Massive Osteonecrosis Following Carbon Ion Radiotherapy for Malignant Bone Tumor
Authors: Muramatsu Keiichi , Iwanaga Ryuta , Sakai Takashi
Published: September 2019

Objective:

Carbon ion radiotherapy (CIR) can be applied for unresectable malignant bone tumors, especially arising from the pelvis and spine. The most serious adverse effect of CIR is a massive osteonecrosis of healthy bone surrounding the tumor. We applied LIPUS therapy in 2 cases and report here their clinical courses.

Materials and Methods:

Two cases with the pelvic sarcoma were treated by CIR. Thirteen year-old-male had a metastasis of osteosarcoma at the acetabulum. Seventy three year-old-male had a chondrosarcoma in the pubis, acetabulum and iliac bone.

Results:

Malignant tumors were controlled by CIR only and at present, we find no evidence of disease. Both cases complained of severe hip pain after CIR due to osteonecrosis of the acetabulum. Their pains were well improved at 1 month after LIPUS therapy. Destruction of the hip joint was not observed at the final follow-up.

Discussion:

Until now, positive effect of LIPUS have been reported on osteonecrosis of knee, hip joint and jaw bone. However, there have been, to our knowledge, no report on applying LIPUS for these difficult conditions. LIPUS therapy seems beneficial for pain relief and bone regeneration for massive osteonecrosis after CIR.
Mycobacterial Blood Culture for Diagnosis of Tuberculosis in Vietnamese Children
Authors: Tran Sinh Thi , Le Hai Thanh , Dang Hang Thi Thu , Dao Tuan Minh , Van Nguyen Lam , Van Nguyen Hung , Nguyen Ngoan Thi , Nguyen Nhung Viet , Thwaites Guy , Caws Maxine , van Doorn H. Rogier , Wertheim Heiman FL
Published: September 2019

Diagnosis of pediatric tuberculosis is notoriously difficult. We investigated the additional yield of blood culture in hospitalized children in Vietnam. Among 554 enrolled clinically suspected patients, an additional 6 cases were diagnosed, while the incremental cost per case was USD500. Addition of blood culture is therefore not recommended for our total patient population, but may be considered in specific groups.
Neonatal Antifungal Consumption Is Dominated by Prophylactic Use; Outcomes From The Pediatric Antifungal Stewardship: Optimizing Antifungal Prescription Study
Authors: Ferreras-Antolín Laura , Irwin Adam , Atra Ayad , Dermirjian Alicia , Drysdale Simon B. , Emonts Marieke , McMaster Paddy , Paulus Stephane , Patel Sanjay , Kinsey Sally , Vergnano Stefania , Whittaker Elisabeth , Warris Adilia
Published: September 2019

Background:

Diagnostic challenges combined with the vulnerability of neonates to develop invasive candidiasis (IC) may lead to antifungal administration in the absence of IC. A modified point-prevalence study was performed to obtain an improved insight and understanding of antifungal prescribing in this specific patient population.

Methods:

Neonates and infants ≤90 days of age receiving systemic antifungals from 12 centers in England were included. Data were collected prospectively during 26 consecutive weeks and entered into an online REDCap database.

Results:

Two hundred eighty neonates and infants were included, the majority ≤1 month of age (68.2%). Prematurity was the commonest underlying condition (68.9%). Antifungals were prescribed for prophylactic reason in 79.6%; of those, 64.6% and 76.3% were extreme low birth weight infants and prematurely born neonates, respectively. Additional risk factors were present in almost all patients, but only 44.7% had ≥3 risk factors rendering them more susceptible to develop IC. Nonpremature and non extremely low birth weight premature infants only scored ≥3 risk factors in 32.6% and 15%, respectively. Fluconazole was the most common antifungal used (76.7% of all prescriptions), and commonly underdosed as treatment. The number of microbiologic proven IC was low, 5.4%.

Conclusions:

Neonatal antifungal prophylaxis is commonly prescribed outside the recommendations based on known risk profiles. Fluconazole is the main antifungal prescribed in neonates and infants, with underdosing frequently observed when prescribed for treatment. Number of proven IC was very low. These observations should be taken into consideration to develop a national pediatric Antifungal Stewardship program aiming to guide rational prescribing.
Characteristics and practice patterns of advanced practice registered nurses caring for older adults: A survey of Gerontological Advanced Practice Nurses Association members
Authors: Clevenger Carolyn , Li Yin , Evans Katherine A. , Cacchione Pamela Z.
Published: September 2019

Background:

Advanced practice registered nurses (APRNs) play a pivotal role in meeting the increasing needs of elder care given the aging population. A good understanding of the characteristics of gerontological APRNs is important for future workforce planning.

Purpose:

To understand the demographic, employment, and practice characteristics of APRNs who provide elder care.

Methods:

A 34-item survey was distributed to 2,500 current members of the Gerontological Advanced Practice Nurses Association. Three hundred and sixty-four members provided demographic information and employment and practice patterns. To examine the sample representativeness, the survey sample was compared with a sample drawn from the National Sample Survey of Nurse Practitioners 2012. Descriptive statistics were used for analysis.

Results:

Most respondents were older than 55 years, held a master's degree, were certified as a Gerontology APRN, worked in a long-term/elder care setting as an APRN, earned a salary ranging from $105,001 to $125,000, and practiced in urban or suburban areas. Most respondents worked full time, provided care for people who were 55 to 75 years old, and prescribed under a collaborative agreement.

Implications for practice:

The study results suggested that gerontological APRNs have the experience and competence to meet the increasing needs of elder care, practice in a variety of settings, including in rural areas, and spend much time with patients. Future efforts are needed to support APRN practice, such as improving their autonomy and independence.
Kuntai capsules improve glucolipid metabolism in patients with polycystic ovary syndrome
Authors: Liang Ruining , Liu Zhen , Li Peishuang , Fan Pei , Xu Ling , Sun Xueyan , Peng Jiahua , Peng Xuemei , Zhang Meinan
Published: September 2019

Background:

The aim of this study was to observe the effect and safety of Heyan Kuntai Capsule (HYKT) on glucose and lipid metabolism in patients with polycystic ovary syndrome (PCOS).

Methods:

Hundred patients with PCOS were randomly divided into HYKT group (n = 50) and placebo groups (n = 50) in which the individuals were treated with HYKT and its placebo continuously for 6 months. Meanwhile, all participants received health education (such as exercise and diet). The primary outcomes were serum sex hormone levels, a series of blood lipid, fasting and postprandial 2 hours blood glucose. Body mass index (BMI), waist–hip ratio (WHR), insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and insulin-sensitive index (ISI) were also observed. In addition, adverse events were recorded to evaluate the drug safety.

Results:

After treatment, the BMI and WHR of all the patients were decreased. The fasting and postprandial 2 hours blood glucose levels were significantly declined when treated with HYKT, which were not observed in the placebo group. Similarly, serum sex hormones including luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), and testosterone were lowered after treated with HYKT instead of the placebo. Besides, blood lipids outcomes such as total cholesterol, triglyceride, and low-density lipoprotein cholesterol, as well as insulin and HOMA-IR were decreased with significance in HYKT group when compared with those in the placebo group, whereas high-density lipoprotein cholesterol and ISI increased obviously.

Conclusion:

HYKT showed the effect on ameliorating the glucose and lipid metabolism disorder and improving insulin resistance and increase insulin sensitivity of PCOS patients, which is similar to insulin sensitizing agent.
Reduction of intra-abdominal pain through transcranial direct current stimulation
Authors: Bayer Kian-Elias , Neeb Lars , Bayer Arian , Wiese Jakob Johann , Siegmund Britta , Prüß Magdalena Sarah
Published: September 2019

Background:

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique to modulate cortical excitability and to induce neuronal plasticity. With a wide range of applications in neurological and psychiatric disorders, the efficiency of tDCS is also studied in the treatment of various pain conditions. Treatment with tDCS might accordingly provide pain relief for patients with acute or chronic pain and thus lead to an increase in quality of life. Moreover, applied as an adjunct therapy, tDCS can reduce help to reduce pain medication intake and accompanying adverse events. To this end, this review examines studies evaluating the efficacy of tDCS in pain relief in patients with intra-abdominal pain.

Methods:

A structured search of the PubMed medical database was carried out to identify possibly relevant studies. Studies were compared in terms of treatment characteristics, general conditions, and results. Jadad scale was applied for quality analyses.

Results:

Out of 289 articles that were found initially, 6 studies were identified that met eligibility criteria. Five out of 6 studies reported significant effects for pain reduction in different types of intra-abdominal pain.

Conclusions:

Results indicate that tDCS might be able to reduce intra-abdominal pain. However, more randomized-controlled trials with larger sample size are necessary to define clinically relevant effects as well as treatment characteristics such as duration of stimulation.