bluuebunny/crossref_metadata_2025 huggingface dataset:
A Behavioral Approach to Pain Control
Authors: You Dokyoung S.
Published: March 2022

Multidisciplinary and biopsychosocial treatments are the evidence-based approach for chemotherapy-induced neuropathic and cancer pain. The goals for pain treatments are to optimize pain and symptom management, physical function, and quality of life and prevent symptom progression. The first step in developing the optimal care plan is to assess a patient’s goals and expectations about pain treatments. Then clinicians can discuss a biopsychosocial approach to pain care, which includes medical treatments, complementary and alternative medicine (CAM) treatment, physical therapy, behavioral medicine, lifestyle management, and social supports. Importantly, after discussing the initial individualized care plan, clinicians need to assess and address a patient’s readiness to and barriers in utilizing a multidisciplinary and biopsychosocial approach, which often takes time for patients to accept and engage in.
Chiropractic Treatment of Cancer Pain
Authors: Daniels Brandon
Published: March 2022

Palliative care is an interdisciplinary approach toward improving the quality of life of patients and their families when faced with life-threatening illness. A skilled Doctor of Chiropractic (DC), Doctor of Osteopathy (DO), or Doctor of Physical Therapy (DPT) properly trained in chiropractic manipulative therapy (CMT), also referred to as spinal manipulative therapy (SMT), is able to provide treatment that may significantly enhance a patient’s quality of life. A properly trained practitioner will be able to successfully assess the spine and determine when adjusting is needed. There are various other skills and techniques, including viscero-somatic reflexes such as referred pain, Chapman’s reflexes, functional medicine, and acupuncture. This case discussion contains important tips for the conservative healthcare practitioner in palliative care. These are all effective ways to alleviate the patient’s suffering from both the side effects of treatment or from the disease process itself.
Virtual Reality for Pain in Palliative Care
Authors: Nakad Lynn
Published: March 2022

It is important to consider nonpharmacological interventions and address psychological distress, especially when adequate pain control is not achieved with pharmacologic intervention. Virtual reality (VR) is an emerging treatment modality for patients with life-limiting illness who are experiencing both acute and chronic pain. This technology can be used for procedural, breakthrough, and background pain. Careful consideration in how VR is administered should be undertaken, with special attention paid to patient-specific variables and individual tolerability. Several contraindications to VR use exist; these include a history of motion sickness, visual deficits, history of seizure disorder, cognitive impairment, psychiatric disorders, claustrophobia, head trauma, or current contact precautions.
Non-Opioid Analgesic Side Effects
Authors: Clark Matthew D.
Published: March 2022

The euphoric effects of opioids have been understood since the Mesopotamian period when spiritual leaders used opium to relieve grief, worry, and regret. Opioid use has risen since the nineteenth century, leading to the crisis known today as the “opioid epidemic.” This resulted in an increase in opioid-related morbidity and mortality. In the midst of this epidemic, healthcare providers can turn to non-opioid analgesics for non-malignant pain. Agents such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, anticonvulsants, muscle relaxants, and corticosteroids are useful for managing pain associated with headaches, osteoarthritis, neuropathy, and bone pain. Non-opioids have little to no risk for abuse and addiction. Although generally well tolerated, these agents can be associated with unfavorable adverse reactions that may lead to the discontinuation of the agent or even hospitalization. These adverse reactions can be avoided with proper understanding of the side-effect profiles, contraindications, warnings, and drug interactions of each analgesic. Acknowledging these safety considerations of non-opioid analgesics can optimize a patient’s quality of life.
Supplement Use in Pain Treatment
Authors: Rosselli Jennifer L.
Published: March 2022

Numerous limitations of conventional medications for the treatment of pain exist and often lead patients to seek out complementary and alternative medicine (CAM) therapies. Dietary supplements are the most accessible and utilized type of CAM for pain treatment. Many clinicians are hesitant to include supplements as part of multimodal care due to the lack of safety and efficacy data supporting this approach and limited regulatory oversight of dietary supplements. Health professionals should lead patient-centered discussions about conventional, complementary, and alternative therapy options for pain. Identify all therapies the patient has tried or is engaged in. Involve patients in an integrative approach that includes consideration of supplements as a component of pain treatment when appropriate. Leverage up-to-date information from clinical resources about the safety and efficacy of supplements to improve shared decision-making. Respect the patient’s choice to consume dietary supplements and provide education to identify and purchase products meeting quality standards.
Methadone and Levorphanol
Authors: Persico Amelia L. , Wegrzyn Erica L. , Fudin Jeffrey
Published: March 2022

Levorphanol and methadone share the unique pharmacology of potent, full mu-opioid receptor agonism combined with inhibition of the reuptake of norepinephrine and serotonin as well as NMDA receptor blockade. Of note, methadone is a more potent serotonin reuptake inhibitor than levorphanol, and serotonin does not contribute to its anti-nociceptive activity. In addition to their overlapping pharmacology, levorphanol is also a kappa opioid and delta opioid receptor agonist. Given their shared activity as mu opioid agonists, NMDA antagonists, and noradrenergic activity, both therapies reduce the perception of nociceptive and neuropathic pain; NMDA antagonism blocks the flood of glutamate associated with neuropathic pain from binding to NMDA receptors thus reducing neuropathic pain experience, and inhibiting the reuptake of norepinephrine leaves more norepinephrine available in neuronal synapses to bind alpha-2-adrenergic receptors. These unique properties make the use of levorphanol and methadone valuable in palliative care.
Mixed Agonist/Antagonist Opioids in the Treatment of Pain
Authors: Mullins Amanda
Published: March 2022

Mixed agonist/antagonist opioids have recently been gaining popularity among pain and palliative care providers due to their decreased likelihood of causing fatal adverse events, such as respiratory depression. However lack of comfort with dosing and administration severely reduces use. This class of opioids consists of buprenorphine, pentazocine, butorphanol, and nalbuphine and can offer significant pain relief, similar to that of full mu opioid receptor agonists, if used appropriately. Patient selection for these medications is particularly important, along with transitioning and timing of administration of the first dose. If given too soon after a full agonist, this may precipitate withdrawal and put the patient in even more discomfort than before. For this reason, understanding the fundamental pharmacology and pharmacokinetic properties of these agents is vital.
Opioid-Induced Constipation
Authors: Pawasauskas Jayne
Published: March 2022

Opioid-induced constipation (OIC) is a common occurrence for patients using opioid agonist analgesics. Assessment tools are available to aid in determining the severity of constipation and its associated symptoms and appropriateness for escalation of therapy. While lifestyle modifications may be attempted, there are little data to support their efficacy in OIC, and most patients require drug therapy to effectively prevent or treat constipation. Laxatives are recommended as initial medication approaches. Prescription drug therapies for OIC may be implemented after failure of laxatives and may include lubiprostone, methylnaltrexone, naloxegol, and naldemedine. Current guidelines give strongest recommendations for the use of naloxegol and naldemedine.
Non-Gastrointestinal/Central Nervous System Side Effects of Opioid Analgesics
Authors: Houchard Gary , Kullgren Justin
Published: March 2022

Although constipation and respiratory depression are the adverse effects that clinicians most often associate with opioids, several others can negatively influence palliative care patient experiences and outcomes. For example, pruritus can result in refusal to take opioids, resulting in increased symptom burden. Some palliative care patients will be on long-term opioids, and evidence of long-term adverse effects continue to emerge, including endocrine dysfunction, immunosuppression, and decreased bone mineral density. In this chapter, research into these adverse effects is reviewed along with treatment recommendations. The scarcity of high-quality research studies into these adverse effects has led to limited treatment recommendations and a lack of consensus among palliative specialist.
Palliative Sedation as a Means for Pain Control
Authors: Toledo-Franco L. , Loitman Jane E. , Clark Matthew D.
Published: March 2022

Palliative sedation (PS) is a useful procedure for treating refractory symptoms such as pain that have been unresponsive to standard palliative measures. PS, which has previously been referred to as “terminal sedation,” has long been a source of controversy in the care of those with serious life-limiting illness. Sedation prior to death by natural causes is often misinterpreted as euthanasia or physician-assisted suicide. In contrast to those practices, the intent of providing palliative sedation is to relieve symptoms without hastening death. Sedative agents used for palliative sedation are similar to agents used for standard management of symptoms, including pain, in palliative care. These agents are titrated to the minimum sedation required to alleviate symptoms. Midazolam is the most commonly used agent though there are several others. Implementing palliative sedation requires consent from the patient and/or family with consensus of the treating team. This practice should be carried out by an experienced palliative care team. Several steps, including consent, communication, documentation, and medications are introduced. Palliative sedation is considered a sage practice and can optomize quality of life for a terminally ill patient.
Bone Pain in Metastatic Disease
Authors: Smith Michael A.
Published: March 2022

Bone pain is a common symptom of many metastatic cancers, most frequently seen in patients with breast or prostate cancer. Bone pain in metastatic disease is associated with poor patient outcomes and should be managed aggressively. Treatment of bone pain includes treating bone turnover and pain management. Bisphosphonates and denosumab, in addition to interrupting bone turnover, have pain benefits and should be considered first-line. Corticosteroids and nonsteroidal anti-inflammatory drugs should be considered the backbone of any analgesic regimen for bone pain in metastatic disease. Opioids should only be considered after these therapies have been optimized.
Bone-Directed Therapy for Metastatic Cancer
Authors: Hecht Keith A.
Published: March 2022

Bone is one of the most common sites of metastases in patients with advanced cancer. Bone metastases are painful for patients and can result in clinical consequences such as fractures. In addition to systemic analgesics, other treatment options are useful in the management of patients with bone metastases, such as radiation therapy and bone-modifying agents. Single-fraction external beam radiation therapy is the most effective bone-directed therapy for treating single location pain from skeletal metastases. Systemic radiation therapy using radiopharmaceuticals should be considered in patients with widespread skeletal metastases but should be used with caution due to potential myelosuppressive affects. Bone-modifying agents including bisphosphonates or RANK ligand inhibitors can prevent complications of bone metastases but have less benefit for treating pain.
Breakthrough Pain
Authors: Boehr Nathan , Macchi Zachary
Published: March 2022

Breakthrough pain can be classified as end-of-dose failure, incident, or idiopathic. When creating a clinical plan to treat breakthrough pain, a comprehensive pain assessment should be performed. In the palliative care setting, opioids are commonly used to treat breakthrough pain. An opioid regimen should be custom-tailored for each patient, and clinicians should be aware of the utility of both short-acting and long-acting opioids. Adverse effects of opioids may limit their use and should always be considered when initiating or titrating an opioid regimen. Nonopioids analgesics and disease-directed therapy and procedures should all be considered when forming a plan to address breakthrough pain.
Pain Management in Palliative Care for Infants
Authors: Dallara-Marsh Alexis , Ermer Sarah
Published: March 2022

Compared with adult patients, pediatric patients who receive hospital-based palliative care services tend to have a greater diversity of medical conditions as well as longer duration of survival, which in turn may require a longer duration of services. Palliative care practices in infants vary significantly among institutions, and research is lacking in many subspecialities such as pediatric neurology. In addition, correctly identifying and evaluating pain in the neonatal population is challenging and time-consuming. Opioids are the drug of choice for management of moderate to severe pain in infants, and careful monitoring is indicated due to metabolic variability. Parents or caregivers should be encouraged to take an active role in pain management alongside healthcare providers to optimally identify and treat pain. Along with utilizing opioids for moderate to severe pain, multimodal analgesia including nonpharmacologic interventions should be a standard approach for treatment of pain in infants.
Geriatric Pain Pharmacotherapy
Authors: Persico Amelia L. , Wegrzyn Erica L.
Published: March 2022

The care of older patients requiring pain and symptom management is complex because special attention must be paid to physiologic changes as aging progresses. An array of age-related pharmacokinetic changes occur in the aging adult, often exacerbated by polypharmacy and anticholinergic medications. The approach to an elderly patient requires review of all potentially inappropriate medications (PIMs), assessment for drug-drug and drug-disease state interactions, and a focus on rational opioid therapy. Medications no longer considered necessary should be de-prescribed when possible to reduce the risk of adverse drug reactions and, as importantly, pill burden. As patients age, a predictable reduction in renal function and in some metabolism pathways should be anticipated. Finally, the aging brain becomes significantly more sensitive to medications, especially drugs with high anticholinergic properties, opioids, and benzodiazepines.
Overview of Seizure Semiology
Authors: Abou-Khalil Bassel
Published: March 2022

Seizure semiology consists of a host of clinical findings and manifestations which, when properly identified, characterized, and classified, are key to epilepsy diagnosis. This chapter discusses many of these manifestations.
Epilepsy Classification
Authors: Abou-Khalil Bassel
Published: March 2022

Epilepsy classification has evolved along with seizure classification, and, as a result, we have new schemes for the classification of epilepsies and epilepsy syndromes. These are based on consensus within the International League Against Epilepsy (ILAE) and correlate with the seizure classification discussed in prior chapters.
Select Epilepsy Syndromes Seen in Adulthood
Authors: Abou-Khalil Bassel
Published: March 2022

Select epilepsy syndromes can begin in childhood but are also seen in adulthood. Among these are the family of absence epilepsies, generalized tonic-clonic seizures, Lennox-Gastaut syndrome, and a host of focal epilepsy syndromes. This chapter discusses the clinical features of many of these epilepsy syndromes.
Terminology and Definitions
Authors: Misulis Karl E. , Abou-Khalil Bassel
Published: March 2022

In the diagnosis of epilepsy, observed events include both clinical events and electroencephalographic (EEG) events. Clinical events are the epileptic seizures and nonepileptic events of many types. EEG events are the spikes, sharp waves, epileptiform discharges, and other findings which, when observed, help the clinician make the diagnosis of epilepsy.
Normal EEG
Authors: Abou-Khalil Bassel
Published: March 2022

Part of the reason that electroencephalogram (EEG) interpretation is so difficult is that there is a very broad range of normal, and identifying what is normal or abnormal depends on many factors (age, state, and comorbid conditions). The normal EEG is defined by the absence of abnormalities. The normal adult EEG is characterized by a complex series of rhythms, transients, and variants which are interpreted as normal or abnormal based on age, state, and other clinical parameters. This is the foundation on which is built the types of abnormalities which are identified to produce an accurate diagnosis. This chapter discusses the features of the normal adult EEG.
Normal Pediatric EEG
Authors: Ess Kevin C.
Published: March 2022

This chapter focuses on the normal pediatric EEG, from premature neonatal period to near adult stages. This information is used as a foundation for interpretation of abnormal EEG in the following chapter.
Abnormal Pediatric EEG
Authors: Ess Kevin C.
Published: March 2022

The pediatric electroencephalogram (EEG) can be abnormal in a variety of ways. As with adults, there can be epileptiform and nonepileptiform abnormalities. In addition, there are disorders of maturation and background which are specific to children. This chapter discusses both epileptiform and nonepileptiform abnormalities.
Pediatric Seizures
Authors: Ess Kevin C.
Published: March 2022

Pediatric seizures include a host of conditions, some of which are encountered also in adult life. These include absence epilepsy, juvenile myoclonic epilepsy, and Rasmussen syndrome. This chapter discusses these and other conditions which begin and are prominent in childhood.
Psychogenic Nonepileptic Events
Authors: Misulis Karl E.
Published: March 2022

Psychogenic nonepileptic events are spells that can look very much like seizures yet are not epileptic. A sizeable proportion of patients presenting for epilepsy evaluation have this diagnosis. This chapter discusses the clinical and electroencephalogram (EEG) findings with this disorder.
Management of Status Epilepticus
Authors: Sonmezturk Hasan H.
Published: March 2022

Status epilepticus is a medical emergency. Urgent assessment and treatment is key to a good outcome. This chapter discusses the medications used for status epilepticus, including the protocols in use at the authors’ institution, Vanderbilt University Medical Center.
Surgical Treatment of Epilepsy
Authors: Sonmezturk Hasan H.
Published: March 2022

Surgical treatments for epilepsy are typically used for drug-resistant epilepsy. This chapter discusses the options available for surgical treatment, when these treatments should be considered, and postsurgical management of anti-seizure medications.
Comorbidities
Authors: Misulis Karl E.
Published: March 2022

Comorbid conditions influence epilepsy care in multiple ways, including affecting choice of medications, altering the prognosis of a patient with epilepsy, and highlighting the need for other assistance, such as personal or occupational counseling. This chapter discusses some of the important comorbidities and how they affect epilepsy care.
Medications A–Z
Authors: Abou-Khalil Bassel , Misulis Karl E.
Published: March 2022

There are a wide variety of medications available for the treatment of seizures, and most have been mentioned earlier in this text. For up-to-date prescribing information, the reader is referred to the National Institutes of Health (NIH) site dailymed.nlm.nih.gov, which is a source for information on approved uses by the US Food and Drug Administration (FDA). Of course, common medical use extends beyond the FDA-approved documentation in the spectrum of efficacy and dosing of anti-seizure medications. This chapter discusses those medications in common use in many countries, with regulatory information focused on their use in the United States.
Teaching Case Discussions with Dr. Abou-Khalil
Authors: Abou-Khalil Bassel
Published: March 2022

This chapter presents 10 cases that are taken from the teaching files of Dr. Abou-Khalil, who is Division Chief of Epilepsy and Director of the Epilepsy Monitoring Unit at Vanderbilt University Hospital.
Teaching Case Discussions with Dr. Sonmezturk
Authors: Sonmezturk Hasan H.
Published: March 2022

This chapter presents a series of three cases from the teaching files of Dr. Sonmezturk, who is Director of the Intraoperative Neuro-Monitoring Service and ICU EEG Monitoring Services at Vanderbilt University Hospital.
EEG Examples
Authors: Abou-Khalil Bassel , Ess Kevin C.
Published: March 2022

This chapter presents a series of short case presentations from the teaching files of Dr. Abou-Khalil (Adult epilepsy) and Dr. Ess (Pediatric epilepsy)
Global Perspectives in Cancer Care
Authors: Silbermann Michael , Berger Ann
Published: March 2022

In this book, we focused on different cultures, traditions and faiths. Many parts of the world have indigenous cultures and spiritual beliefs in addition to the primary religion. There are chapters on indigenous religions as well as indigenous traditional healers. People everywhere experience trouble, sorrow, need and sickness and they develop skills and knowledge in response to these adversaries. This book provides insightful models of these parameters and serves as a valuable resource for healthcare providers and policymakers by taking a global approach to cultural diversity in the world. By understanding this cultural diversity and the many faces of psychological, social and spiritual dimensions of health and healing, we can learn from one another.
The Soul of Health Care
Authors: Puchalski Christina M.
Published: March 2022

Whole-person care recognizes the complexities of assessing and treating patients’ distress and illness, but it also acknowledges their strengths. Contemporary medical models focus predominantly on the technical and financial aspects of care. While these aspects of care are important, they fail to include what may be the most critical need of patients and families—that is, the whole-person approach to care, where psychosocial and spiritual needs are viewed as essential and just as important as the physical. Whole-person care is increasingly recognized as a more holistic model of care. Essential to that model is addressing the spiritual health and needs of patients. National and international guidelines have been developed to support the biopsychosocial and spiritual model of care as a framework for care of the whole person. This chapter presents an overview of how whole-person care, including attention to spiritual health, can be integrated into health systems.
Psychosocial Factors of Healthcare Professionals and Their Influence on Quality of Care for their Cancer Patient, United States
Authors: Nakash Ora , Granek Leeat
Published: March 2022

People with cancer have an increased risk for mental health distress and suicidality when compared to the general population. While this increased risk has been robustly documented in the literature, health care professionals often fail to identify mental health distress and suicidality in their patients. In addition, despite the growing awareness of the need to consider race/ethnicity and culture when assessing and providing mental health care, this issue has received less attention in oncology. This chapter reviews recent literature on barriers to identifying mental health distress and suicidality among cancer patients. The focus is on variables related to systemic, psychosocial, and cultural barriers that oncology health care providers face, including, explicit and implicit attitudes regarding mental health and suicide, moral views related to providers’ cultural background, and perceptions of distress, including: possible bias toward patients from ethnically/racially diverse backgrounds. The chapter concludes with recommendations for best practices to address these barriers.
The Health-Care Team and Culture in an Israeli Cancer Center, Israel
Authors: Cohen Tzeela , Wein Simon
Published: March 2022

Health care decisions are significantly influenced by individual and cultural factors. There is no universal agreement on how to make health care decisions. This chapter describes the impact of Israeli culture and faith on decision making in a comprehensive cancer center. Israel’s demographics include several large cultural and religious groups. Topics of analysis include the process of making decisions; the value of life; definition of “dying”; rabbinical medical brokers; withdrawal of treatment; minimal medical care for the dying; cultural paternalism; and what in Israel constitutes the ethical unit. Clinical cases illustrate principles. The chapter also looks at practical ways of improving the decision-making process by documenting the culture of the health care team, minimizing bias, and determining the wishes of the individual patient in the context of their subculture.
Enhancing Dignity and Hope in Caring for Cancer Patients through Palliative Care, Italy
Authors: Buonaccorso Loredana , Miccinesi Guido , Ripamonti Carla Ida
Published: March 2022

Enhancing dignity and hope has a positive impact on the quality of life. Palliative care makes this possible in appropriate ways for cancer patients and their families. This chapter deals with the components of these two common dimensions of human life, dignity and hope, and the ways to evaluate and enhance them in care relationships. Dignity is personal, subject to changes depending on the experience and path of life, linked to personal goals and the social, cultural, and educational contexts to which the person belongs. Some patients feel that their dignity is directly related to the disease, such as the management of symptoms (physical and mental pain) and to the high level of autonomy that is maintained—physically, cognitively, and socially. Other patients believe that it is linked more to the continuity of the self, the perception of being oneself in confronting the disease or the possibility of another life after death. The first studies on the dimension of hope were conducted in life-threatening situations; therefore, they found that hope was associated with the person’s ability to find meaning in that particular situation. Later studies investigated the elements that promote the experience of hope, such as feeling loved and giving love, especially within families; having goals (short- and long-term); maintaining as much autonomy as possible (both physical and mental, such as being involved in the process of care and daily decision making); and having a good relationship with health care professionals.
Meaning-Making in Coping with Cancer
Authors: Calimag Maria Minerva P.
Published: March 2022

As the global burden of cancer rises, Asia finds itself largely beleaguered by limited access to timely diagnosis and treatment, a higher frequency of certain types of cancer associated with poorer prognosis and higher mortality rates. In the Philippines, cancer is the third leading cause of morbidity and mortality. Among Filipinos, meaning-making and perspectives on death and dying among cancer survivors center on culture, religiosity, and spirituality focused on a Supreme Being and the role of the family in providing psychosocial support. Respecting cultural differences and beliefs is key in cancer care especially in the Philippines whose population comprises diverse cultural ethnicities. The concept of “care” is likewise strongly related to the cultural and historical roots of a society, so that it is differently interpreted and applied in diverse sociocultural contexts. As a nation, and individually as well, Filipinos are known for their grit and resilience. The Filipinos’ spiritual richness–their great faith and hope in God’s plan for their lives and their attitude regarding God’s Providence—have given substance to the physical pain and the feelings of emptiness produced by their disease status. In clinical practice therefore, the culturally competent oncologist must be aware of his own cultural beliefs and values and be able to communicate with cancer patients in culturally sensitive ways.
Support and Palliative Care for Cancer Patients in Mexico, Mexico
Authors: Becerril Maricela Salas , Cruz Noemi Hernández
Published: March 2022

The mortality rate for oncological diseases has been steadily increasing, and nowadays it is even more necessary to provide vulnerable end-of-life patients with care that will help to improve their quality of life. This improvement can be achieved through palliative care. The best recommendation for palliative care is a multidisciplinary team that addresses the patients’ and their families’ physical, psychological, social, and spiritual needs, based on dignified and humanized care. In order to achieve the goal of palliative care—to improve the quality of life of patients and their families—it is essential to provide support in the following pillars of health care: symptom control, communication, and alleviation of physical and emotional suffering. In addition, it is important to recognize the role of culture in cancer treatment. In each pillar, it is up to nursing professionals to offer the appropriate care to help improve the patients’ sense of well-being during their last days of life.
The Impact of Latin American Cultural Values, Attitudes, and Preferences on Palliative Cancer Care
Authors: Turrillas Pamela , Dittborn Mariana
Published: March 2022

This chapter examines Latin American cultural values and their impact on patients’ and families’ attitudes and preferences regarding palliative and end-of-life (PEoL) cancer care. PEoL care is a patient-centered model of care, whereby understanding the community’s and each person’s particular beliefs, values, and needs is central to the provision of appropriate care. Literature on Latin American culture reveals common Latin values such as Familismo, Personalismo, Respect, Religiosity, Fatalismo, and Dignidad. This chapter discusses how these values shape different dimensions of PEoL care: (1) understanding of PEoL care and pain relief; (2) preferences regarding information disclosure and participation in decision making; (3) the key role of the family as caregivers (who are frequently overburdened due to the lack of professional homecare support); and (4) the relevance of faith and the religious community during the illness and dying experience. Integrating stakeholders’ values, views, and experiences is key to forming and designing policies regarding palliative care services adapted to the Latin American region.
Spirituality, Culture, Traditions, and Other Beliefs Affecting Cancer Care, Uganda
Authors: Merriman Anne , Natuhwera Germans , Namisango Eve
Published: March 2022

Spirituality, culture, traditions, and other beliefs affecting cancer care vary with time. Today, in 2021, they are most affected by poverty and, more recently, by COVID-19 and lockdowns. This chapter discusses how, on three continents, beliefs, sometimes changing with time and circumstances, affect cancer care and access to curative or palliative services. It also explores how a person’s approach to cancer care is affected by country of origin, culture, traditions, spiritual beliefs, life experience, family, and community approaches, as well as by income and the availability of curative or palliative services. It is based on those countries where author A.M. has lived and worked on three continents—Southeast Asia, Europe, and Africa—and in seven countries—Ireland, the United Kingdom, India, Singapore, Malaysia, Nigeria, Kenya, and Uganda. It also draws on the lived experience in Africa of authors E.N. and G.N. A.M.’s experience of practicing, researching, and teaching medicine on three continents draws attention to why one approach does not fit all.
Emotional State, Spirituality, and Religion’s Effect on the Acceptance of Cancer, Morocco
Authors: El Azhari Asmaa , Benider Abdellatif
Published: March 2022

Spiritual well-being and religious coping play an essential role in the process of cancer acceptance. The patient’s quality of life influences their spirituality and faith in God, and vice versa. The complex interaction of all these elements evolves dynamically throughout the patient’s illness. The evolution of the patient’s various emotional and spiritual states and level of hope fluctuates and reflects their biopsychosocial suffering. The patient’s caregivers, treatment received and relatives and friends are a vital source of keeping up hope. At an advanced stage of cancer, the often overlapping faith and spiritual well-being will determine the emotional outcome of the disease. In Islam, cancer does not mean failure but rather a liberation of the soul and an expression of divine love toward its followers.
Differences in Attitudes toward Advanced Cancer Care Planning through the Scope of Culture, Israel
Authors: Bar-Sela Gil , Mitnik Inbal
Published: March 2022

Advance Care Planning aims to define the appropriate end-of-life care for cancer patients. It is designed to help patients acknowledge their preferences, values, and goals and to make decisions regarding their care accordingly. The process is beneficial for strengthening communication patterns and increasing quality of care; however, this process encounters several challenges such as patients’ difficulty in acknowledging the harsh existential truth regarding their mortality. Cultural perceptions and traditions, such as the idea of a “good death,” the role of family members, and attitudes regarding patient’s autonomy, have been found to significantly impact a person’s outlook toward end-of-life care. These values should be acknowledged and considered during Advance Care Planning in order to provide the most appropriate, culturally sensitive care.
Functional brain imaging in bipolar disorder
Authors: Kirsch Dylan E. , Tretyak, Valeria , Strakowski, Stephen M. , Lippard Elizabeth T.C.
Published: March 2022

Functional activation studies have the power to inform our understanding of the neurobiological mechanisms underlying bipolar disorder. A better understanding of the neural correlates of affective lability, reward sensitivity, and disruptions in executive function—characteristic traits of bipolar disorder—can inform development of novel intervention strategies and improve upon existing pharmacological and behavioral treatment approaches. This chapter provides an overview of what we know from functional activation studies of emotion regulation, reward processing, and executive functioning in bipolar disorder. To date, findings converge to suggest differences from healthy subjects in activation across frontal, limbic, and striatal regions. Hyperactivation in limbic structures may be a trait-based feature of bipolar disorder and may, at least in part, be associated with decreased engagement in frontal regions, although specific activation patterns vary across mood states and differ depending on sample demographics and experimental paradigms. Longitudinal treatment studies have also shown prospective changes in activation patterns following pharmacological intervention. Findings highlight the need for larger longitudinal studies that combine assessment of both neural structure and function and have adequate power to examine how findings may be influenced by differing medication regimens, mood states, bipolar subtypes (bipolar type I, II, not otherwise specified), and the presence of co-occurring mental health conditions such as substance use disorders, attention-deficit hyperactivity disorder, anxiety, and history of early life trauma.
Functional brain imaging in bipolar disorder
Authors: Siegel-Ramsay Jennifer E. , Almeida Jorge R.C.
Published: March 2022

Connectivity, as applied in neuroimaging research, is a statistical method of measuring relationships in neurofunctional activity. When comparing connectivity in participants with bipolar disorder to healthy individuals, the most consistent patterns of altered connectivity were localized in the salience network, central executive network, default mode network and sensory-motor cortex. Across bipolar mood states, researchers reported increased within–salience network connectivity and less efficient coupling between amygdala and ventrolateral prefrontal cortex compared to healthy participants. This evidence suggests overactive emotional and sensory processing combined with dysregulation of these brain regions by ventrolateral prefrontal cortex. There was also evidence of more widespread disconnect of prefrontal regions with salience and other central executive network regions in association with an acute affective bipolar state. Although the evidence was less consistent, we also discuss altered connectivity in association with the default mode network and sensory-motor cortex in individuals with bipolar disorder. Connectivity studies more fully represent the bipolar brain as an interconnected unit and characterize aberrant traits and state markers of the condition.
Neuroimaging studies of bipolar disorder in youth
Authors: Singh Manpreet K. , DelBello Melissa P.
Published: March 2022

Bipolar disorder is defined by the onset of the first manic episode, which typically occurs in late adolescence or early adulthood. However, it is increasingly recognized that many people with bipolar disorder experience significant premorbid symptoms, prior to an initial disorder-defining onset of mania. Combined with the heritability of bipolar disorder, it is likely that the underlying biological basis of the disorder produces premorbid and early-course neurophysiological abnormalities that might help to identify at-risk cases and herald an early onset and progression of illness course. This chapter will focus on neuroimaging in bipolar disorder in youth, as well as in at-risk individuals (unaffected and subthreshold affected children of parents with bipolar disorder), to inform models of early bipolar development. This edition’s chapter adds more emphasis on at-risk individuals and progression of neurobiological changes at illness onset, as well as the potential implications for early intervention in an effort to interrupt illness progression.
Neuroimaging differences between bipolar and unipolar depression
Authors: Bertocci Michele A. , Siegel-Ramsay Jennifer E. , Almeida Jorge R.C. , Strakowski Stephen M. , Phillips Mary L.
Published: March 2022

Bipolar disorder is defined by the onset of mania; however, most of the bipolar disorder illness course is spent struggling with depression. Patients presenting with depression in the context of bipolar disorder describe similar symptoms to unipolar depression, and the two disorders are not currently distinguishable by clinical presentations. This similarity results in half of individuals with bipolar disorder being misdiagnosed for up to 10 years with unipolar depression and thus provided with inappropriate treatments. This chapter describes the neural networks believed to be related to mood disorder pathology and methods for acquiring these neural measures. It also examines neuroimaging findings from studies directly comparing bipolar disorder and unipolar depression to understand network dysfunctions that may aid in early diagnosis. Studies comparing neural measures of white matter structure, grey matter structure, neural activity, and connectivity will be reviewed. Finally, to identify neural abnormalities that are evident early in the development of the pathology, comparisons of youth with bipolar disorder versus unipolar depression and comparisons of youth at familial risk for the development of mood disorders will be reviewed.
Neuroimaging in bipolar disorder and schizophrenia
Authors: Du Grace , Öngür Dost
Published: March 2022

Bipolar disorder and schizophrenia share some biological and clinical features, and neuroimaging research may provide insights into mechanistic relationships between the two disorders. This chapter reviews studies using structural magnetic resonance imaging (MRI), diffusion tensor imaging, task-related and resting state functional MRI, and magnetic resonance spectroscopy techniques to collect data from individuals with bipolar disorder and schizophrenia in the same experiment. The chapter concludes that these two disorders share many neurobiological features, but some distinctions are also evident. A high degree of heterogeneity and lack of replication among published studies hampers the ability to draw strong conclusions concerning some important details such as relationship between brain abnormalities and clinical presentation and treatment effects. Technological advances coupled with precise phenotyping are likely to provide deeper insights into the relationship between bipolar disorder and schizophrenia.
Genetics of bipolar disorder and schizophrenia
Authors: Bigdeli Tim B. , Harvey Philip D.
Published: March 2022

Schizophrenia and bipolar disorder have been considered to be separate conditions since their initial definition by Kraepelin in the late 1890s. Despite the distinctions between the conditions in terms of their definitional criteria (delusions and hallucinations versus wide-ranging changes in mood), there are multiple shared phenotypic features. These features include cognitive impairments, everyday disability, and suicidal ideation and behavior. Genomic approaches initially focused on family and population characteristics, findings overlapping risk within families. Recent efforts have shifted to large-scale genome-wide association studies, targeting both susceptibility to the conditions and genomic correlates of the shared phenotypic features. Among the major shared phenotypic features, it appears that polygenic risk for schizophrenia and bipolar disorder also overlaps with the genomics of cognitive functioning, including cognitive functioning in the general population. Polygenic risk for depression is also associated with both schizophrenia and bipolar disorder. While most of the genomic influence to date in these two conditions has arisen from common variants, rare variants such as alterations in copy number variations have been seen to be more strongly associated with schizophrenia than bipolar disorders, but sample size differences may be responsible for the lack of effects in bipolar disorder. As sample sizes increase, it is anticipated that even more overlap between bipolar disorder and schizophrenia will be detected, as well as the continued exploration of aggregated phenotypic and genomic features in the two conditions.
YY1 safeguard multidimensional epigenetic landscape associated with extended pluripotency
Authors: Dong Xiaotao , Guo Rong , Ji Tianrong , Zhang Jie , Xu Jun , Li Yaoyi , Sheng Yingliang , Wang Yuxiang , Fang Ke , Wen Yulin , Liu Bei , Hu Gongcheng , Deng Hongkui , Yao Hongjie
Published: March 2022

Although extended pluripotent stem cells (EPSCs) have the potential to form both embryonic and extraembryonic lineages, how their transcriptional regulatory mechanism differs from that of embryonic stem cells (ESCs) remains unclear. Here, we discovered that YY1 binds to specific open chromatin regions in EPSCs. Yy1 depletion in EPSCs leads to a gene expression pattern more similar to that of ESCs than control EPSCs. Moreover, Yy1 depletion triggers a series of epigenetic crosstalk activities, including changes in DNA methylation, histone modifications and high-order chromatin structures. Yy1 depletion in EPSCs disrupts the enhancer-promoter (EP) interactions of EPSC-specific genes, including Dnmt3l. Yy1 loss results in DNA hypomethylation and dramatically reduces the enrichment of H3K4me3 and H3K27ac on the promoters of EPSC-specific genes by upregulating the expression of Kdm5c and Hdac6 through facilitating the formation of CCCTC-binding factor (CTCF)-mediated EP interactions surrounding their loci. Furthermore, single-cell RNA sequencing (scRNA-seq) experiments revealed that YY1 is required for the derivation of extraembryonic endoderm (XEN)-like cells from EPSCs in vitro. Together, this study reveals that YY1 functions as a key regulator of multidimensional epigenetic crosstalk associated with extended pluripotency.
Comparison of population structure, vertical distribution and growth of sympatric, carnivorous, mesopelagic copepods,Paraeuchaeta glacialisandHeterorhabdus norvegicus, in the western Arctic Ocean
Authors: Yamaguchi Atsushi , Ashjian Carin J , Campbell Robert G
Published: March 2022

In the Arctic Ocean, the life cycles of interzonal omnivorous copepods have been studied, whereas little information is available on the life cycles of mesopelagic carnivorous species. Here, the life cycles of two mesopelagic carnivorous copepods (Paraeuchaeta glacialis and Heterorhabdus norvegicus) are described from vertically stratified samples collected at an annual ice-station (SHEBA) in the western Arctic Ocean during 1996–1997. Reproduction estimated to occur between January and March for both species. Vertical distributions and population growth varied between the species. Early copepodite stages and adult males of P. glacialis were distributed in deeper layers, whereas late copepodite stages and adult females were observed in shallower layers. The skewed sex ratio towards females was observed for adults, which may be related to the cease feeding and short longevity for adult males. In contrast, all the H. norvegicus life stages were distributed in the mesopelagic layer. Clear peaks of the young stages and their sequence suggest that H. norvegicus may complete its life cycle within 1 year. A specialized feeding mode (incorporating a venomous injection spine and large beak) could be a key trait facilitating the achievement of rapid growth in H. norvegicus in the food-limited mesopelagic layer.
The annotation and analysis of complex 3D plant organs using 3DCoordX
Authors: Vijayan Athul , Strauss Soeren , Tofanelli Rachele , Mody Tejasvinee Atul , Lee Karen , Tsiantis Miltos , Smith Richard S , Schneitz Kay
Published: March 2022

A fundamental question in biology concerns how molecular and cellular processes become integrated during morphogenesis. In plants, characterization of 3D digital representations of organs at single-cell resolution represents a promising approach to addressing this problem. A major challenge is to provide organ-centric spatial context to cells of an organ. We developed several general rules for the annotation of cell position and embodied them in 3DCoordX, a user-interactive computer toolbox implemented in the open-source software MorphoGraphX. 3DCoordX enables rapid spatial annotation of cells even in highly curved biological shapes. Using 3DCoordX, we analyzed cellular growth patterns in organs of several species. For example, the data indicated the presence of a basal cell proliferation zone in the ovule primordium of Arabidopsis (Arabidopsis thaliana). Proof-of-concept analyses suggested a preferential increase in cell length associated with neck elongation in the archegonium of Marchantia (Marchantia polymorpha) and variations in cell volume linked to central morphogenetic features of a trap of the carnivorous plant Utricularia (Utricularia gibba). Our work demonstrates the broad applicability of the developed strategies as they provide organ-centric spatial context to cellular features in plant organs of diverse shape complexity.