bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Digital Multimedia Educational Aids Produced by Intensive Care Unit Providers
Authors: Amherdt Sarah , Kim U. , Basir Mir
Published: March 2018

Multimedia improves understanding of information. Professionally developed digital multimedia educational modules are expensive. We tested educational modules developed by a medical student without extensive multimedia production training. The modules were developed with neonatologist collaboration, uploaded to YouTube, and presented via iPad to neonatal intensive care unit family members who were ≥ 18 years, English literate, and unexposed to topic they were reviewing. Thirty-six participants viewed the modules once and then answered topic-specific key questions. Thirty of 36 (83%) of the participants answered 4/4 (100%) of questions correctly and 6/36 (17%) answered three-fourths (75%) correctly, demonstrating success of the educational modules. Health care workers can economically create effective digital multimedia educational materials without extensive training.
Thyreotoxische Krise und Myxödemkoma
Authors: Milkau Malte , Sayk Friedhelm
Published: March 2018

Thyroid storm and myxedema coma are the most severe clinical forms of thyroid dysfunction. While both hyper- and hypothyroidsm are common diseases, thyroid storm and myxedema coma are rare. Due to their unspecific signs and symptoms they are often difficult to diagnose. Both disorders are medical emergencies, which still show a significant mortality. The following article summarizes diagnostic tools and treatment options for these disorders
Diabetologische Notfälle: Ketoazidose und hyperglykämes Koma
Authors: Schumann Christina , Faust Michael
Published: March 2018

Background Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in diabetic ketoacidosis equivalent to a torturous death. Today, mortality from diabetic ketoacidosis is low at approximately 2 %. But each death from these two acute metabolic complications of diabetes is potentially avoidable by improved patient and healthcare professional education. Therefore, there is a need to raise awareness of hyperglycemic crisis and its management amongst physicians.

Pathogenesis Insulin deficiency or resistence and increased concentrations of counterreulatory hormones (glucagon, catecholamines, cortisol and growth hormone) are responsible for the development of diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Hyperglycemia develops as a result of increased gluconeogenesis and accelerated glyconeogenesis. In DKA, the absolute insulin deficiency additionally leads to increased lipolysis and production of ketone bodies and resulting metabolic acidosis.

Diagnosis Both DKA and HHS require prompt recognition and management. The diagnosis can be suspected by clinical features and confirmed by laboratory findings.

Treatment The treatment of DKA and HHS is similar, including correction of fluid and electrolyte abnormalities and the administration of insulin.
Gastrointestinale Mikrobiota und Tumorerkrankungen – ein „pas de deux“?
Authors: Stallmach Andreas , Steube Arndt
Published: March 2018

Tumorerkrankungen stellen unser heutiges Gesundheitssystem vor große Herausforderungen. Das in den letzten Dekaden gewachsene pathophysiologische Verständnis der gastrointestinalen Mikrobiota und ein möglicher kausaler Zusammenhang mit der Entstehung von Malignomen rücken daher zunehmend in den Fokus der Forschung. Der folgende Beitrag gibt einen Einblick in zahlreiche Pathomechanismen, über die sich Mikrobiota und Malignome gegenseitig beeinflussen, und beleuchtet außerdem die Rolle der Ernährung in diesem System.
Emotionsregulation – Trend in der
Psychotherapie
Authors: Lammers Claas-Hinrich , Berking Matthias
Published: March 2018

Emotionen und deren Regulation sind entscheidend dafür, wie Personen mit
bedürfnisrelevanten Situationen umgehen können. Die Fähigkeit zur adaptiven
Regulation von Emotionen wird in direkten Zusammenhang mit der sozialen
Anpassung sowie der psychischen Gesundheit gebracht. Defizite finden sich oft
bei Patienten mit einer psychischen Erkrankung. Deswegen ist die Kenntnis der
funktionalen Emotionsregulation für die Psychotherapie unerlässlich.
Emotionen als Ressourcen in der psychotherapeutischen
Praxis – eine Reise
Authors: Glasenapp Jan
Published: March 2018

Emotionen können hilfreiche Ressourcen darstellen. Doch oft wird die
Auseinandersetzung mit ihnen vermieden – auch in der Psychotherapie. Der Beitrag
beschreibt in Form eines Reiseberichts ein Vorgehen für die Arbeit mit
Emotionen, das sich durch Komplexitätsreduktion, Fokussierung vermiedener
Emotionen und einen strukturierten Übergang von kalten zu heißen Lernprozessen
auszeichnet.
Training emotionaler Kompetenzen
Authors: Berking Matthias , Hondong Sinja
Published: March 2018

Defizite in der Emotionsregulation tragen zur Entstehung und Aufrechterhaltung
vieler psychischer Störungen bei. Vor diesem Hintergrund wurde das Training
emotionaler Kompetenzen (TEK) entwickelt. Als transdiagnostisch ausgerichtetes
Verfahren fokussiert das TEK auf die Förderung des adaptiven Umgangs mit
unerwünschten Gefühlen. Es kann zur Behandlung und Prävention psychischer
Störungen sowie zur Förderung der Persönlichkeitsentwicklung eingesetzt
werden.
Medizinisches Vorgehen in der Orthopädischen Rheumatologie
Authors: Henniger Martina , Rehart Stefan
Published: March 2018

Die orthopädische Rheumatologie befasst sich mit der Diagnostik und der konservativen sowie der operativen Behandlung von rheumatischen Erkrankungen am muskulo-skelettalen System. Um eine dauerhafte Remission der entzündlichen Aktivität einer rheumatischen Erkrankung zu erreichen, ist ein multidisziplinäres Therapiekonzept notwendig. Begleitend zur medikamentösen Therapie und angepasst an die Schwere der Erkrankung, bzw. die entzündliche Aktivität und den Grad der Destruktion von Gelenken, umfasst dieses verschiedene konservative und operative Maßnahmen. Die enge interdisziplinäre Kooperation mit internistischen Rheumatologen, Radiologen, Nuklearmedizinern, Anästhesisten und nicht zuletzt Ergo- und Physiotherapeuten sowie Orthopädietechnikern ist dabei unabdingbar. In der Therapie von rheumatischen Erkrankungen erfolgt in der Regel neben einer medikamentösen Basistherapie eine konservative Therapie an den Strukturen des muskulo-skelettalen Systems. Je nach Gelenk und Zustand umfasst diese alle lokalen Maßnahmen der physikalischen Therapie, Physiotherapie, Ergotherapie, Schienenversorgung, Einlagen- und Schuhversorgung, bzw. zuletzt Gelenkinfiltrationen. Erst, wenn mit diesen konservativen Maßnahmen keine ausreichende Wirkung erzielt wird, kommen operative Maßnahmen zum Einsatz. Ausnahmen hiervon sind absolute oder dringliche OP-Indikationen wie Nervenausfälle, ausgeprägte Achsabweichungen von Gelenken, ein rasches Fortschreiten der Destruktionen oder Sehnenrupturen. Je nach Gelenk und radiologischem Destruktionsgrad werden bei der operativen Therapie präventive/gelenkerhaltende von rekonstruktiven/gelenkersetzenden Verfahren unterschieden. Aufgrund des multilokulären Befalls sowohl artikulärer als auch ligamentärer Strukturen, v. a. aber der besonderen Medikation und deren potentiellen Nebenwirkungen gilt es, im operativen Bereich die Besonderheiten dieser Patientengruppe zu berücksichtigen.
Onset of turbulence induced by electron nonthermality in a complex plasma in presence of positively charged dust grains
Authors: Sarkar Susmita , Bhakta Subrata
Published: March 2018

In this paper onset of turbulence has been detected from the study of non linear dust acoustic wave propagation in a complex plasma considering electrons nonthermal and equilibrium dust charge positive. Dust grains are charged by secondary electron emission process. Our analysis shows that increase in electron nonthermality makes the grain charging process faster by reducing the magnitude of the nonadiabaticity induced pseudo viscosity. Consequently nature of dust charge variation changes from nonadiabatic to adiabatic one. For further increase of electron nonthermality, this pseudo viscosity becomes negative and hence generates a turbulent grain charging behaviour. This turbulent grain charging phenomenon is exclusively the outcome of this nonlinear study which was not found in linear analysis.
360° deterministic magnetization rotation in a three-ellipse magnetoelectric heterostructure
Authors: Kundu Auni A. , Chavez Andres C. , Keller Scott M. , Carman Gregory P. , Lynch Christopher S.
Published: March 2018

A magnetic dipole-coupled magnetoelectric heterostructure comprised of three closely spaced ellipse shapes was designed and shown to be capable of achieving deterministic in-plane magnetization rotation. The design approach used a combination of conventional micromagnetic simulations to obtain preliminary configurations followed by simulations using a fully strain-coupled, time domain micromagnetic code for a detailed assessment of performance. The conventional micromagnetic code has short run times and was used to refine the ellipse shape and orientation, but it does not accurately capture the effects of the strain gradients present in the piezoelectric and magnetostrictive layers that contribute to magnetization reorientation. The fully coupled code was used to assess the effects of strain and magnetic field gradients on precessional switching in the side ellipses and on the resulting dipole-field driven magnetization reorientation in the center ellipse. The work led to a geometry with a CoFeB ellipse (125 nm × 95 nm × 4 nm) positioned between two smaller CoFeB ellipses (75 nm × 50 nm × 4 nm) on a 500 nm PZT-5H film substrate clamped at its bottom surface. The smaller ellipses were oriented at 45° and positioned at 70° and 250° about the central ellipse due to the film deposition on a thick substrate. A 7.3 V pulse applied to the PZT for 0.22 ns produced 180° switching of the magnetization in the outer ellipses that then drove switching in the center ellipse through dipole-dipole coupling. Full 360° deterministic rotation was achieved with a second pulse. The temporal response of the resulting design is discussed.
First-principles study of magnetic properties of ultra-thin MoSi2 films
Authors: Peng Qiong , Li Jin , He Chaoyu , Tang Chao , Zhong Jianxin
Published: March 2018

The magnetic properties of ultra-thin tetragonal MoSi2 thin films were investigated by the first-principles method. Our results indicate that the Si terminated MoSi2 film is always metallic independent of its thickness and non-magnetic when its thickness is larger than three atomic layers. However, the three-atomic-layer MoSi2 film (1L MoSi2) exhibits magnetism with magnetic moments of ∼0.274 μB/atom for Mo atoms and ∼0.096 μB/atom for Si atoms. The system shows weaker magnetism with magnetic moments of ∼0.184 μB/atom for Mo and ∼0.079 μB/atom for Si after unilateral surface hydrogenation and becomes non-magnetic after bilateral hydrogenation. By comparing the ferromagnetic (FM) configuration with antiferromagnetic configurations, we found that the FM order is the ground state with the lowest energy. Furthermore, it is found that the magnetic properties of 1L MoSi2 can be tuned effectively by strain.
The effect of molecular shape on oligomerization of hydrophobic drugs: Molecular simulations of ciprofloxacin and nutlin
Authors: Li Jianguo , Beuerman Roger , Verma Chandra
Published: March 2018

Molecular aggregation plays a significant role in modulating the solubility, permeability, and bioactivity of drugs. The propensity to aggregate depends on hydrophobicity and on molecular shape. Molecular dynamics simulations coupled with enhanced sampling methods are used to explore the early stages of oligomerization of two drug molecules which have a strong aggregation propensity, but with contrasting molecule shapes: the antibiotic ciprofloxacin and the anticancer drug Nutlin-3A. The planar shape of ciprofloxacin induces the formation of stable oligomers at all cluster sizes. The aggregation of ciprofloxacin is driven by two-body interactions, and transferring one ciprofloxacin molecule to an existing cluster involves the desolvation of two faces and the concomitant hydrophobic interactions between the two faces; thus, the corresponding free energy of oligomerization weakly depends on the oligomer size. By contrast, Nutlin-3A has a star-shape and hence can only form stable oligomers when the cluster size is greater than 8. Free energy simulations further confirmed that the free energy of oligomer formation for Nutlin-3A becomes more favorable as the oligomer becomes larger. The aggregation of star-shaped Nutlin-3A results from many-body interactions and hence the free energy of cluster formation is strongly dependent on the size. The findings of this study provide atomistic insights into how molecular shape modulates the aggregation behavior of molecules and may be factored into the design of drugs or nano-particles.
An improved molecular dynamics algorithm to study thermodiffusion in binary hydrocarbon mixtures
Authors: Antoun Sylvie , Saghir M. Ziad , Srinivasan Seshasai
Published: March 2018

In multicomponent liquid mixtures, the diffusion flow of chemical species can be induced by temperature gradients, which leads to a separation of the constituent components. This cross effect between temperature and concentration is known as thermodiffusion or the Ludwig–Soret effect. The performance of boundary driven non-equilibrium molecular dynamics along with the enhanced heat exchange (eHEX) algorithm was studied by assessing the thermodiffusion process in n-pentane/n-decane (nC5–nC10) binary mixtures. The eHEX algorithm consists of an extended version of the HEX algorithm with an improved energy conservation property. In addition to this, the transferable potentials for phase equilibria-united atom force field were employed in all molecular dynamics (MD) simulations to precisely model the molecular interactions in the fluid. The Soret coefficients of the n-pentane/n-decane (nC5–nC10) mixture for three different compositions (at 300.15 K and 0.1 MPa) were calculated and compared with the experimental data and other MD results available in the literature. Results of our newly employed MD algorithm showed great agreement with experimental data and a better accuracy compared to other MD procedures.
Comparative study of active plasma lenses in high-quality electron accelerator transport lines
Authors: van Tilborg J. , Barber S. K. , Benedetti C. , Schroeder C. B. , Isono F. , Tsai H.-E. , Geddes C. G. R. , Leemans W. P.
Published: March 2018

Electrically discharged active plasma lenses (APLs) are actively pursued in compact high-brightness plasma-based accelerators due to their high-gradient, tunable, and radially symmetric focusing properties. In this manuscript, the APL is experimentally compared with a conventional quadrupole triplet, highlighting the favorable reduction in the energy dependence (chromaticity) in the transport line. Through transport simulations, it is explored how the non-uniform radial discharge current distribution leads to beam-integrated emittance degradation and a charge density reduction at focus. However, positioning an aperture at the APL entrance will significantly reduce emittance degradation without additional loss of charge in the high-quality core of the beam. An analytical model is presented that estimates the emittance degradation from a short beam driving a longitudinally varying wakefield in the APL. Optimizing laser plasma accelerator operation is discussed where emittance degradation from the non-uniform discharge current (favoring small beams inside the APL) and wakefield effects (favoring larger beam sizes) is minimized.
Dispersion transitions and pole-zero characteristics of finite inertially amplified acoustic metamaterials
Authors: Al Ba'ba'a H. , DePauw D. , Singh T. , Nouh M.
Published: March 2018

This work presents a comprehensive analysis of wave dispersion patterns and band gap formation associated with Inertially Amplified Acoustic Metamaterials (IAAM). The findings explain the different mechanisms by which inertial amplification affect wave dispersion in the individual IAAM cell as well as the evolution of such effects in finite configurations of these cells. Derived expressions for acoustic wave dispersion in IAAMs reveal unique features including flat dispersion branches with zero group velocity and a transition from a metamaterial (local resonance) to a phononic behavior that is directly related to the location and magnitude of the inerter elements. Using a closed-form transfer function approach, the translation of such effects to IAAM realizations with a known number of cells is interpreted from the pole-zero distributions of the resultant finite structures. It is also shown that band gaps are not always necessarily enlarged in the presence of inertial amplification. Comparing with benchmark conventional acoustic metamaterials, the conditions leading up to favorable as well as inferior IAAM designs are fully derived. Finally, an alternative resonator-free acoustic metamaterial is presented and shown to exhibit local resonance effects under appropriately tuned conditions.
Influence of dust particles on positive column of DC glow discharge
Authors: Tian Ruihuan , Yuan Chengxun , Li Hui , Liang Yonggan , Wu Jian , Kudryavtsev A. A. , Kirsanov G. V. , Zhou Zhongxiang , Jiang Yongyuan
Published: March 2018

A self-consistent model of a DC glow discharge with dust particles based on orbital motion limited theory, collision enhanced collection approximation, and a fluid approach extended by energy conservation equation is presented. The model indicates the influence of dust particles on radical distributions of plasma parameters in positive columns. Dust particles are embedded in the positive column with the density profile prescribed as a given step function. It is shown that with the increase in dust particle density, electron density and the radical electric field decrease in the dust region. For high dust density, especially when the loss of ions and electrons on the dust surface exceeds their production in ionization collisions in the dust region, a local minimum of electron density forms in the discharge axis and the radical electric field obtained from the Poisson equation becomes non-monotonous. The addition of dust increases the longitudinal electric field and electron temperature simultaneously to compensate the electron and ion loss on dust particles and preserve the discharge.
Add-drop double bus microresonator array local oscillators for sharp multiple Fano resonance engineering
Authors: Li Jiahua , Qu Ye , Wu Ying
Published: March 2018

Asymmetric resonances are currently the subject of considerable research efforts in photonic nanostructures. Here we propose a feasible method to achieve multiple Fano resonances and their control in an optical compound system consisting of an array of on-chip microresonators without mutual coupling and two parallel fiber waveguides side-coupled to the microresonator array by means of a local oscillator. We derive analytical and transparent expressions for the power transmission function summing over the two light transporting paths within the framework of quantum optics. It is clearly shown that introducing the local oscillator as an additional light propagating path plays an important role in the formation of narrow and multiple Fano resonance lineshapes. The power transmission spectrum through the combination of both the microresonator array and the local oscillator is very sensitive to the system parameters, for example, the intrinsic decay rate of the resonator, the phase shift factor of the local oscillator, the transmission coefficient of the fiber beam splitter, and the total number of the microresonators. Through detailed analysis, we identify the optimums for generating Fano resonance lineshapes. Also, we assess the experimental feasibility of the scheme using currently available technology. The proposed method is relatively straightforward as it requires only one local oscillator as one interferometer arm and it is mostly fiber-based. We believe that our work will help to understand and improve multiple Fano resonance engineering.
Transition probability spaces in loop quantum gravity
Authors: Guo Xiao-Kan
Published: March 2018

We study the (generalized) transition probability spaces, in the sense of Mielnik and Cantoni, for spacetime quantum states in loop quantum gravity. First, we show that loop quantum gravity admits the structures of transition probability spaces. This is exemplified by first checking such structures in covariant quantum mechanics and then identifying the transition probability spaces in spin foam models via a simplified version of general boundary formulation. The transition probability space thus defined gives a simple way to reconstruct the discrete analog of the Hilbert space of the canonical theory and the relevant quantum logical structures. Second, we show that the transition probability space and in particular the spin foam model are 2-categories. Then we discuss how to realize in spin foam models two proposals by Crane about the mathematical structures of quantum gravity, namely, the quantum topos and causal sites. We conclude that transition probability spaces provide us with an alternative framework to understand various foundational questions of loop quantum gravity.
Direct View of Cr Atoms Doped in Anatase TiO2(001) Thin Film
Authors: Tang Hao-qi , Lin Yue , Cheng Zheng-wang , Cui Xue-feng , Wang Bing
Published: March 2018

Imaging the doping elements is critical for understanding the photocatalytic activity of doped TiO2 thin film. But it is still a challenge to characterize the interactions between the dopants and the TiO2 lattice at the atomic level. Here, we use high angle annular dark-field/annular bright-field scanning transmission electron microscope (HAADF/ABF-STEM) combined with electron energy loss spectroscopy (EELS) to directly image the individual Cr atoms doped in anatase TiO2(001) thin film from [100] direction. The Cr dopants, which are clearly imaged through the atomic-resolution EELS mappings while can not be seen by HADDF/ABF-STEM, occupy both the substitutional sites of Ti atoms and the interstitial sites of TiO2 matrix. Most of them preferentially locate at the substitutional sites of Ti atoms. These results provide the direct evidence for the doping structure of Cr-doped A-TiO2 thin film at the atomic level and also prove the EELS mapping is an excellent technique for characterizing the doped materials.
Anti-Müllerian hormone receptor type 2 is expressed in gonadotrophs of postpubertal heifers to control gonadotrophin secretion
Authors: Kereilwe Onalenna , Pandey Kiran , Borromeo Vitaliano , Kadokawa Hiroya
Published: March 2018

Preantral and small antral follicles may secret anti-Müllerian hormone (AMH) to control gonadotrophin secretion from ruminant gonadotrophs. The present study investigated whether the main receptor for AMH, AMH receptor type 2 (AMHR2), is expressed in gonadotrophs of postpubertal heifers to control gonadotrophin secretion. Expression of AMHR2 mRNA was detected in anterior pituitaries (APs) of postpubertal heifers using reverse transcription–polymerase chain reaction. An anti-AMHR2 chicken antibody was developed against the extracellular region near the N-terminus of bovine AMHR2. Western blotting using this antibody detected the expression of AMHR2 protein in APs. Immunofluorescence microscopy using the same antibody visualised colocalisation of AMHR2 with gonadotrophin-releasing hormone (GnRH) receptor on the plasma membrane of gonadotrophs. AP cells were cultured for 3.5 days and then treated with increasing concentrations (0, 1, 10, 100, or 1000 pg mL−1) of AMH. AMH (10–1000 pg mL−1) stimulated (P < 0.05) basal FSH secretion. In addition, AMH (100–1000 pg mL−1) weakly stimulated (P < 0.05) basal LH secretion. AMH (100–1000 pg mL−1) inhibited GnRH-induced FSH secretion, but not GnRH-induced LH secretion, in AP cells. In conclusion, AMHR2 is expressed in gonadotrophs of postpubertal heifers to control gonadotrophin secretion.
Arabidopsis
TSO1 and MYB3R1 form a regulatory module to coordinate cell proliferation with differentiation in shoot and root
Authors: Wang Wanpeng , Sijacic Paja , Xu Pengbo , Lian Hongli , Liu Zhongchi
Published: March 2018

Significance

Plant postembryonic development relies on a small pool of stem cells at the shoot and root tip. The question of how the cell cycle regulatory activities are integrated into the specific stem cell context is not well understood. This study identifies a previously unknown regulatory module in the flowering plant consisting of two regulatory genes,
TSO1
and
MYB3R1
. TSO1 negatively regulates
MYB3R1
to control cell division activity, maintain proper stem cell pool size, and balance cell proliferation with differentiation in shoot and root. Significantly, animal homologs of TSO1 and MYB3R1 are members of a cell cycle regulatory complex, suggesting that this conserved module operates in both plants and animals.
Climate warming enhances snow avalanche risk in the Western Himalayas
Authors: Ballesteros-Cánovas J. A. , Trappmann D. , Madrigal-González J. , Eckert N. , Stoffel M.
Published: March 2018

Significance

Climate warming is impacting the cryosphere in high mountain ranges, thereby enhancing the probability for more and larger mass-wasting processes to occur. This tree-ring–based snow avalanche reconstruction in the Indian Himalayas shows an increase in avalanche occurrence and runout distances in recent decades. Statistical modeling suggests that this increase in avalanche activity is linked to contemporaneous climate warming. These findings contradict the intuitive assumption that warming results in less snow, and thus fewer snow avalanches in the region, with major implications for disaster risk management and risk mitigation in a region with steadily increasing human occupation.
The traces that novel morphologically complex words leave in memory are abstract in nature
Authors: de Vaan Laura , Van Krieken Kobie , Van den Bosch Winie , Schreuder Robert , Ernestus Mirjam
Published: March 2018

Previous work has shown that novel morphologically complex words (henceforth neologisms) leave traces in memory after just one encounter. This study addressed the question whether these traces are abstract in nature or exemplars. In three experiments, neologisms were either primed by themselves or by their stems. The primes occurred in the visual modality whereas the targets were presented in the auditory modality (Experiment 1) or vice versa (Experiments 2 and 3). The primes were presented in sentences in a selfpaced reading task (Experiment 1) or in stories in a listening comprehension task (Experiments 2 and 3). The targets were incorporated in lexical decision tasks, auditory or visual (Experiment 1 and Experiment 2, respectively), or in stories in a self-paced reading task (Experiment 3). The experimental part containing the targets immediately followed the familiarization phase with the primes (Experiment 1), or after a one week delay (Experiments 2 and 3). In all experiments, participants recognized neologisms faster if they had encountered them before (identity priming) than if the familiarization phase only contained the neologisms’ stems (stem priming). These results show that the priming effects are robust despite substantial differences between the primes and the targets. This suggests that the traces novel morphologically complex words leave in memory after just one encounter are abstract in nature.
An investigation of the accuracy and reliability of body composition assessed with a handheld electrical impedance myography device
Authors: McLester Cherilyn N. , Dewitt Alex D. , Rooks Rasmus , McLester John R.
Published: March 2018

The purpose of this study was to compare the body fat per cent (BF%) assessed with a unique handheld electrical impedance myography (EIM) device, along with other popular methods, to dual‐energy X‐ray absorptiometry (DXA). Participants included 33 males (aged 24.3 ± 4.6 years) and 38 females (aged 25.3 ± 8.9 years) who completed 2 visits separated by 24–72 h. The assessments included DXA, bioelectrical impedance analysis (BIA), skinfold measures (SKF), and three separate EIM measurements. No significant differences in BF% (P > 0.05) were found between all EIM assessments when compared against DXA for both males and females for each visit. All methods showed no significant differences in BF% (P > 0.05) between days within themselves. Across both days, the standard error of the estimate (SEE) for the EIM measurements ranged from 2.66% to 3.15%, the SEE for BIA was 2.80 and 2.85, and for SKF was 2.90 and 2.82. The 95% limits of agreement ranged from ±5.34% to ±6.38% for EIM measurements and were highest for SKF (±7.42% and ±7.47%). The total error for both days was largest for SKF (5.20% and 5.35%) and lowest for the EIM measurements (2.48–3.24%). This investigation supports use of a handheld EIM device as an accurate and reliable method of estimating BF% compared to DXA in young, apparently healthy individuals with BF% in the range of 10–22% for males and 20–32% in females and suggests this EIM device be considered a viable alternative to other established field measurements in this population.
Financing and Insurance
Authors: Zuvekas Samuel H , Lingle Earle Buddy , Hanson Ardis , Levin Bruce Lubotsky
Published: March 2018

The complexity of US healthcare systems is staggering. In 2015, Americans spent approximately $3.7 trillion on healthcare, averaging almost $10,000 per person. Further, Americans rely on a mixture of public and private health insurance coverage to pay for the bulk of the healthcare services they receive. To provide a better understanding of the financing of healthcare in the United States, this chapter examines major government healthcare programs and funding. It begins with a look at the US public health insurance system and the healthcare “safety net,” comprised of a patchwork of public, private, and philanthropic providers and programs. The next sections look at how US insurers and families pay doctors, hospitals, nursing homes, and other healthcare providers to deliver services in the United States and how pharmacy services are financed in public health.
Pharmacoeconomics
Authors: Griggs Scott K , Hurd Peter
Published: March 2018

Although pharmacoeconomic justifications often examine dollars spent or lives saved, the implications for the health of communities are equally important. Given the significant and growing cost of health care and medications, decision-makers face the difficult dilemma of choosing how best to optimize resources efficiently and effectively (relating to outcomes in the real world). This chapter defines terms and categories commonly used in pharmacoeconomic evaluations and offers a comparative review of four commonly used methodologies. It also examines the steps involved in pharmacoeconomic evaluation, as well as how to critically evaluate published studies. This leads to a discussion on the use of decision analysis in pharmacoeconomic studies. The chapter argues that a background in pharmacoeconomics is essential for pharmacists as drug therapy becomes more complicated and their roles as members of interdisciplinary teams of health care providers expand.
Breast Cancer Epidemiology
Authors: Smith Robert A. , DeSantis Carol E.
Published: March 2018

The epidemiology of breast cancer measures the occurrence of the disease and trends in various populations. Breast cancer is the most common cause of cancer and the leading cause of cancer death in the world. Most risk factors have a modest effect, but lifestyle changes could reduce the risk of breast cancer, and we can also better identify women at greater risk who are candidates for more aggressive prevention and early detection strategies. The absence of an organized health system is a barrier to ensuring that women get the best advice about risk and prevention and identifying those at high risk early to offer tailored prevention and screening. Radiologists can play a greater role in breast care, through support and communication with referring practices, and to insure more complete risk assessment and education for their patients.
Overview of Digital Breast Tomosynthesis
Authors: Conant Emily F.
Published: March 2018

Digital breast tomosynthesis (DBT) is a relatively new X-ray technique that allows quasi–three-dimensional imaging of the breast to overcome limitations of conventional 2-D digital mammography (DM). Several early screening studies have shown that DBT reduces the number of false-positive recalls while simultaneously improving the cancer detection rate. Cost-effectiveness studies have shown that incorporating DBT in screening has the potential to save health care dollars due to lower recall rates as well as reduced treatment costs resulting from the earlier detection of breast cancer. In the diagnostic setting, DBT imaging may allow a more efficient work-up of breast lesions due to improved lesion conspicuity and the ability to better localize lesions within the breast.
Multiple Circumscribed Masses
Authors: Prince Erin L. , Umphrey Heidi R.
Published: March 2018

A circumscribed mass is a mass with margins demonstrating a sharp demarcation between the lesion and surrounding tissue. On mammography, at least 75% of the margin must be well defined in order for the mass to qualify as circumscribed. Multiple circumscribed masses may be seen unilaterally or bilaterally and can be seen on up to 1.7% of screening mammograms. After mammography, these masses may need to be further evaluated with ultrasound and correlated with clinical information. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple circumscribed masses. Topics discussed include cysts, fibroadenomas, oil cysts, metastases, lymph nodes, and neurofibromas.
Mass in Male (Gynecomastia, Cancer)
Authors: Foo Eric , Joe Bonnie N.
Published: March 2018

Gynecomastia is a benign condition manifesting as enlarged breasts in men and boys. This increased breast tissue is caused by excess fibroglandular deposits and is caused by hormonal imbalances, commonly due to estrogen excess or from various drugs, such as spironolactone, ketoconazole, cimetidine, ranitidine, and specific HIV therapies. Patients generally present with bilateral subareolar enlarged breasts (however, unilateral gynecomastia also occurs), which commonly exhibit tenderness on palpation, swelling, palpable lumps, or nipple discharge. This chapter reviews the important imaging protocols, pitfalls, differential diagnoses, radiology–pathology correlation, and management recommendations for gynecomastia and cancer of the male breast. Topics discussed include gynecomastia, breast cancer, pseudogynecomastia, hypogonadism, and lymphangioma.
Architectural Distortion (Radial Scar)
Authors: Butler Reni S.
Published: March 2018

Radial scars are benign lesions of the breast characterized pathologically by a fibroelastic core containing entrapped ducts and lobules that radiate outwards in a stellate pattern. This chapter, highlighting radial scar as a cause of architectural distortion, reviews its imaging features and differential diagnosis on mammography, digital breast tomosynthesis, ultrasound, and MRI; its diagnostic workup using multiple modalities; and its histological confirmation with image-guided core needle biopsy. The particular challenge of radial scar presenting as architectural distortion seen only with tomosynthesis is discussed, along with an algorithm for imaging evaluation and biopsy guidance in this setting. As radial scar, which is histologically related to complex sclerosing lesion and radial sclerosing lesion, is considered a high-risk lesion, management recommendations are also reviewed.
Dystrophic Calcifications
Authors: Holbrook Anna I.
Published: March 2018

Dystrophic calcifications are typically large (usually >1 mm), coarse, irregular or plaque-like and associated with lucent centers. They also may be thin, smooth, and round or oval, with lucent centers, called “rim” (previously also known as “eggshell”) calcifications. They form in response to trauma, including surgery or irradiation. They can be seen in association with other findings of breast trauma, including surgical clips, architectural distortion, skin retraction, skin thickening, oil cysts, or trabecular thickening. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for dystrophic calcifications. Topics discussed include findings after breast trauma or surgery/radiation treatment and the evolution of fat necrosis.
Secretory Calcifications
Authors: Ho Christopher P.
Published: March 2018

Secretory calcifications are large rod-like calcifications that are often seen in a linear or segmental distribution. They can often be easily differentiated from more malignant-appearing calcifications because they are smooth and much coarser than calcifications seen with ductal carcinoma in situ (DCIS). Secretory calcifications are thought to be associated with duct ectasia and have been historically referred to as “plasma cell mastitis” because of the close association of plasma cells within the ductal infiltrates and epithelial hyperplasia. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for secretory calcifications. Topics discussed include appropriate use of magnification views, how to differentiate the calcifications from more suspicious ones, and appropriate follow-up.
Pleomorphic Calcifications
Authors: Lee-Felker Stephanie A. , Wells Colin J.
Published: March 2018

Pleomorphic calcifications are categorized among calcifications with suspicious morphology: amorphous, coarse heterogeneous, fine linear or fine-linear branching, and fine pleomorphic calcifications. Unlike amorphous calcifications, pleomorphic calcifications are more conspicuous, with discernible shapes that appear predominantly irregular, and are variable in size and configuration. A segmental distribution, seen as a triangular shape with its apex centered at the nipple, is especially suspicious for ductal carcinoma in situ (DCIS) or multifocal breast cancer, as its pattern of calcium deposition suggests involvement of a duct system within the breast. This chapter, appearing in the section on calcifications, reviews the key clinical and imaging features, imaging protocols, differential diagnoses, and management recommendations for pleomorphic calcifications. Topics discussed include characteristic morphology and distribution of pleomorphic calcifications, BI-RADS assessments, core needle biopsy, and radiological–pathological correlation.
Intracystic/Intraductal Mass
Authors: Winkler Nicole S.
Published: March 2018

This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for intracystic and intraductal masses. The differential diagnoses of intraductal and intracystic masses are similar, with papilloma the most common cause for both. Therefore, we review descriptive terms for both together, with similar implications and management recommendations. Intracystic masses have a higher association with malignancy than intraductal masses, due in part to overlap of imaging appearances of intracystic mass and complex cystic and solid mass. Topics discussed include intraductal and intracystic masses, evaluation of ducts, papilloma, papillary carcinoma and nipple discharge.
Lymphadenopathy
Authors: Stein Matthew A.
Published: March 2018

Lymphadenopathy is a pathological or abnormal state of one or more lymph nodes in a nodal basin that occurs in response to pathogens, immunogens, or malignant cells that are detected within the lymph. Malignant lymphadenopathy may be detected by physical exam and/or imaging findings, but it is ultimately confirmed or excluded by histological evaluation. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of lymphadenopathy detected by mammography, tomosynthesis, and ultrasound (US). Topics include the anatomy and physiology of breast lymphatic function, the anatomy and imaging features of lymph nodes, differential diagnosis of lymphadenopathy, and the imaging assessment of the axillary nodal basin in the context of known breast cancer.
Pre-Operative Localization
Authors: Loving Vilert A.
Published: March 2018

Non-palpable, surgical breast lesions require image guidance to direct the site of excision. With the widespread adoption of screening mammography and increased identification of non-palpable breast cancers, image guidance is critical to support the surgeon in successful breast-conserving surgery. Pre-operative localization procedures are typically performed under mammography guidance or ultrasound guidance, and less commonly under magnetic resonance imaging (MRI) guidance. This chapter, appearing in the section on interventions and surgical changes, reviews protocols and pitfalls, pre-/peri-/post-procedure clinical management, and imaging follow-up of pre-operative localization procedures. Topics discussed include mammography-guided, ultrasound-guided, and MRI-guided localization procedures. This chapter also introduces the radioactive seed and radiofrequency identification localization procedures and discusses post-operative specimen radiographs.
Post-Lumpectomy/Post-Radiation Breast
Authors: Lee Amie Y. , Joe Bonnie N.
Published: March 2018

Mammography is currently the primary imaging modality for post-operative evaluation and surveillance of the conservatively treated breast. Tumor recurrence has been shown to occur at a rate of approximately 1–2% per year, and the goal of imaging surveillance is to detect recurrent and new cancers at the earliest stages while avoiding unnecessary biopsies for characteristically benign findings. The radiologist should be familiar with the expected mammographic appearance and evolution of benign post-lumpectomy/post-radiation change, while also recognizing findings suspicious for residual and recurrent disease. This chapter, appearing in the section on intervention and surgical changes, reviews the key imaging and clinical features, imaging protocols and pitfalls, and clinical recommendations for the post-lumpectomy and post-radiation breast. Topics discussed include the evolution of benign post-surgical/post-radiation findings and the detection of suspicious lesions. The primary emphasis will be on mammographic surveillance. The role of ultrasound and MRI will also be discussed.
Biological Effects of Depression
Authors: Hayhow Bradleigh , Starkstein Sergio
Published: March 2018

This chapter examines the bidirectional relationship between depression and stroke. It is now clearly established that depression is a significant risk factor for stroke, and vice-versa. We review the main biological and demographic factors underlying the association between stroke and depression, the predicted mortality, the mechanism of post-stroke depression, and recent findings on its pharmacological prevention. We conclude by stressing the need for developing effective strategies to manage the burden of illness associated with these interacting conditions. As with the cardiovascular system depression has major effects on the occurrence of stroke. Morbidity and mortality are increased for patients with cerebral vascular accidents (CVA) who are depressed and is seen even in a 10-year follow-up. Depression should be treated concurrently with the management of the acute phase of a CVA.
Psychopharmacology of Depression as a Systemic Illness for Primary and Specialty Care Clinicians
Authors: Cozza Kelly L. , Rein Rita , Wynn Gary H. , Meyer Eric G.
Published: March 2018

There are nearly 4 million patients with depression followed by primary care in the United States, with nearly 80% of prescriptions for antidepressants written by non-psychiatrists (Mark et al. 2009). Understanding and utilizing psychopharmacology is a critical skill for primary care physicians, who are often initial or sole prescribers. Persons with medical illnesses and depression are often prescribed a multitude of medications, necessitating attention to pharmacodynamic, pharmacokinetics, and an understanding of intended effects, side effects, toxicities, and drug interactions. This chapter begins with a brief review of drug mechanisms of action, metabolism, and interaction principles; addressing the interplay between depression, the medications used to treat depression, co-prescribed medications, and medical illness. The chapter includes a discussion of drugs used to treat depression in text and table format, highlighted with case examples. Details about mechanism of action, common side effects and adverse reactions, drug interactions, and other clinical implications are provided.
Ptosis
Authors: Shaibani Aziz
Published: March 2018

Having droopy eyelids is a common problem. Causes may range from disorders that are simple and not progressive, such as congenital ptosis, to progressive, multisystemic disorders, such as mitochondrial disease. Myasthenia gravis (MG) is a very significant and treatable cause of ptosis that should always be part of the differential diagnosis. Apraxia of the eyelid opening can be confused with ptosis or blepharospasm, leading to a delay in reaching the correct diagnosis. Horner’s syndrome has different causes and management approaches. Knowledge of the anatomy and physiology of the eyelids is crucial for understanding the pathological processes that affect them.
Diplopia
Authors: Shaibani Aziz
Published: March 2018

Diplopia is a very bothersome symptom, which very often leads to early medical attention. However, some patients modify their lifestyle, wear dark glasses, prisms, or eye patches, and seek medical advice only if these measures fail. A careful knowledge and examination of the extraocular muscles and their nerves from the orbit to the brain stem is crucial to obtain the right diagnosis. Myasthenia gravis (MG) can mimic any single or combined oculomotor nerves palsy and should always be considered in the differential diagnosis of diplopia. The presence of sensory symptoms or severe retrooribital pain should prompt looking for a different cause than MG.
Ophthalmoplegia
Authors: Shaibani Aziz
Published: March 2018

Ophthalmoplegia is usually chronic, and therefore diplopia is not a feature. There is enough time for the brain to suppress one image. It is amazing how much of impairment of eye movement has to occur before the patient becomes concerned or considers it as abnormal. Neglected myasthenia gravis (MG) may be confused with mitochondrial ophthalmoplegia or oculopharyngeal muscular dystrophy (OPMD) or even congenital myasthenic syndrome (CMS). Central causes of ophthalmoplegia should be ruled out first by performing doll’s eye movement. A number of cases of different types of ophthalmoplegia are presented, along with clinical and laboratory methods to differentiate them.
Scapular Winging
Authors: Shaibani Aziz
Published: March 2018

Scapulae play a central role in arm abduction, and their failure causes poor abduction despite preserved arm abductors (deltoids and supraspinati). A good knowledge about the anatomy of the scapulae and their muscles and nerves is necessary. Unilateral winging is usually due to nerve pathology, but frank asymmetry is typical for facioscapulohumeral muscular dystrophy (FSHD). Progressive bilateral scapular winging is seen in many myopathies, including muscular dystrophy (MD) and scapuloperoneal syndrome (SPS). Weakness of different scapular muscles leads to different scapular positions during arm movement. When the underlying disease is not treatable, surgical fixation of the scapulae on the chest wall improves arm abduction.