bluuebunny/crossref_metadata_2025 huggingface dataset:
LIM and SH3 protein 1 localizes to the leading edge of protruding lamellipodia and regulates axon development
Authors: Pollitt Stephanie L. , Myers Kenneth R. , Yoo Jin , Zheng James Q.
Published: September 2020

This study reports that the actin-binding protein, LIM and SH3 Protein 1 (LASP1), regulates actin-based protrusions underlying axon elongation and branching in hippocampal neurons in culture. LASP1 also plays an important role in axon development in vivo, as loss of the Drosophila homologue LASP disrupts the commissural axon development.
Receptivity and Readiness for Cultural Competence Training Amongst the Social Workers in Hong Kong
Authors: Lee Vincent W P , Lai Daniel W L , Ruan Yong-Xin
Published: September 2020

This research examined understandings of cultural competence of social workers in Hong Kong, their needs and challenges in serving culturally diverse groups, and their willingness and receptivity to receive cultural competence training by using constructivist grounded theory. Individual qualitative interviews were conducted with thirteen frontline and managerial practitioners and educators in training institutions in the social work profession. Data were analysed by identifying major themes. The findings show that social workers in Hong Kong tend to encounter language barriers and various forms of cultural shocks in serving ethnoculturally diverse clients. The professional code of practice is not sufficient in promoting culturally competent practice and there are institutional barriers to the enhancement of cultural competence of the social services. Mainstream social work units are generally not well prepared to provide services to non-Chinese communities. In response to these obstacles, professional training should provide future Hong Kong social workers with opportunities to interact with ethnoculturally diverse communities through service-learning. To tackle institutional racism, leaders should have cultural awareness and promote culturally inclusive practices. Inclusion of staff members from diverse cultural backgrounds would increase the capacity of the organisations to better serve clients of diverse needs. Anti-racism training should be made as an essential professional development component for social work students, practicum students, practitioners and managers.
Dopaminergic imaging and clinical predictors for phenoconversion of REM sleep behaviour disorder
Authors: Arnaldi Dario , Chincarini Andrea , Hu Michele T , Sonka Karel , Boeve Bradley , Miyamoto Tomoyuki , Puligheddu Monica , De Cock Valérie Cochen , Terzaghi Michele , Plazzi Giuseppe , Tachibana Naoko , Morbelli Silvia , Rolinski Michal , Dusek Petr , Lowe Val , Miyamoto Masayuki , Figorilli Michela , Verbizier Delphine de , Bossert Irene , Antelmi Elena , Meli Riccardo , Barber Thomas R , Trnka Jiří , Miyagawa Toji , Serra Alessandra , Pizza Fabio , Bauckneht Matteo , Bradley Kevin M , Zogala David , McGowan Daniel R , Jordan Lennon , Manni Raffaele , Nobili Flavio
Published: September 2020

This is an international multicentre study aimed at evaluating the combined value of dopaminergic neuroimaging and clinical features in predicting future phenoconversion of idiopathic REM sleep behaviour (iRBD) subjects to overt synucleinopathy. Nine centres sent 123I-FP-CIT-SPECT data of 344 iRBD patients and 256 controls for centralized analysis. 123I-FP-CIT-SPECT images were semiquantified using DaTQUANTTM, obtaining putamen and caudate specific to non-displaceable binding ratios (SBRs). The following clinical variables were also analysed: (i) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale, motor section score; (ii) Mini-Mental State Examination score; (iii) constipation; and (iv) hyposmia. Kaplan-Meier survival analysis was performed to estimate conversion risk. Hazard ratios for each variable were calculated with Cox regression. A generalized logistic regression model was applied to identify the best combination of risk factors. Bayesian classifier was used to identify the baseline features predicting phenoconversion to parkinsonism or dementia. After quality check of the data, 263 iRBD patients (67.6 ± 7.3 years, 229 males) and 243 control subjects (67.2 ± 10.1 years, 110 males) were analysed. Fifty-two (20%) patients developed a synucleinopathy after average follow-up of 2 years. The best combination of risk factors was putamen dopaminergic dysfunction of the most affected hemisphere on imaging, defined as the lower value between either putamina (P < 0.000001), constipation, (P < 0.000001) and age over 70 years (P = 0.0002). Combined features obtained from the generalized logistic regression achieved a hazard ratio of 5.71 (95% confidence interval 2.85–11.43). Bayesian classifier suggested that patients with higher Mini-Mental State Examination score and lower caudate SBR asymmetry were more likely to develop parkinsonism, while patients with the opposite pattern were more likely to develop dementia. This study shows that iRBD patients older than 70 with constipation and reduced nigro-putaminal dopaminergic function are at high risk of short-term phenoconversion to an overt synucleinopathy, providing an effective stratification approach for future neuroprotective trials. Moreover, we provide cut-off values for the significant predictors of phenoconversion to be used in single subjects.
A Theory of Equality Before the Law
Authors: Acemoglu Daron , Wolitzky Alexander
Published: September 2020

We propose a simple model of the emergence of equality before the law. A society can support effort (‘cooperation’, ‘prosocial behaviour’) using the carrot of future cooperation or the stick of coercive punishment. Community enforcement relies only on the carrot and involves low coercion, low inequality and low effort. A society in which elites control the means of violence supplements the carrot with the stick, and involves high coercion, high inequality and high effort. In this regime, elites are privileged by both laws and norms: because they are not subject to the same punishments as non-elites, norms are also more favourable for them. Nevertheless, it may be optimal—even from the elites’ perspective—to establish equality before the law, where all agents are subject to the same coercive punishments and norms are more equal. The key mechanism is that equality before the law increases elites’ effort, which improves the carrot of future cooperation and thus encourages even higher effort from non-elites. Equality before the law combines high coercion and low inequality. Factors that make equality before the law more likely to emerge include limits on the extent of coercion, greater marginal returns to effort, increases in the size of the elite group, greater political power for non-elites and, under some additional conditions, lower economic inequality.
Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study
Authors: Sun Shengzhi , Cao Wangnan , Ge Yang , Ran Jinjun , Sun Feng , Zeng Qiang , Guo Mengdi , Huang Jianxiang , Lee Ruby Siu-Yin , Tian Linwei , Wellenius Gregory A
Published: September 2020

Aims

We estimated the association between outdoor light at night at the residence and risk of coronary heart disease (CHD) within a prospective cohort of older adults in Hong Kong.

Methods and results

Over a median of 11 years of follow-up, we identified 3772 incident CHD hospitalizations and 1695 CHD deaths. Annual levels of outdoor light at night at participants’ residential addresses were estimated using time-varying satellite data for a composite of persistent night-time illumination at ∼1 km2 scale. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between outdoor light at night at the residence and risk of CHD. The association between light at night and incident CHD hospitalization and mortality exhibited a monotonic exposure-response function. An interquartile range (IQR) (60.0 nW/cm2/sr) increase in outdoor light at night was associated with an HR of 1.11 (95% CI: 1.03, 1.18) for CHD hospitalizations and 1.10 (95% CI: 1.00, 1.22) for CHD deaths after adjusting for both individual and area-level risk factors. The association did not vary across strata of hypothesized risk factors.

Conclusion

Among older adults, outdoor light at night at the residence was associated with a higher risk of CHD hospitalizations and deaths. We caution against causal interpretation of these novel findings. Future studies with more detailed information on exposure, individual adaptive behaviours, and potential mediators are warranted to further examine the relationship between light at night and CHD risk.
Extra-pulmonary vein driver mapping and ablation for persistent atrial fibrillation in obese patients
Authors: Hu Xiaofeng , Jiang Weifeng , Wu Shaohui , Xu Kai , Zhang Daoliang , Zhang Yu , Liu Xu , Qin Mu
Published: September 2020

Aims

The aim of this study was to determine whether driver ablation effectively treats persistent atrial fibrillation (AF) in obese patients.

Methods and results

We randomly assigned 124 persistent AF obese patients to two groups, one undergoing conventional ablation (n = 62) and the other undergoing driver ablation (n = 62). Sixty-two non-obese patients with persistent AF undergoing driver ablation served as matched controls. Bipolar electrogram dispersion was analysed for driver mapping. Epicardial adipose tissue (EAT) volume was measured using cardiac computed tomography. Obese patients had a higher proportion of driver regions in the posterior wall (56.5% vs. 32.3%, P = 0.007). Driver complexity, measured as the average number and area of driver regions, was higher in the obese group than in the non-obese group (3.5 ± 1.0 vs. 2.9 ± 0.9, P < 0.001; 15.5% ± 4.2% vs. 9.8 ± 2.6%, P < 0.001, respectively). Left atrial EAT volume correlated better with the proportion of area of driver regions than did body mass index (BMI) and total EAT (BMI: r2 = 0.250, P < 0.001; total EAT: r2 = 0.379, P < 0.001; and left atrial EAT: r2 = 0.439, P < 0.001). The rate of AF termination was significantly higher in the driver ablation group than in the conventional ablation group (82.9% vs. 22.8%, P < 0.001). During the follow-up period of 16.9 ± 6.5 months, patients in the driver ablation group had significantly better AF-free survival (91.91% vs. 79.0%, log rank test, P = 0.026) and AF/atrial tachycardia-free survival (83.9% vs. 64.5%, log rank test, P = 0.011) than did patients in the conventional ablation group.

Conclusion

Obesity is associated with increased driver complexity. Driver ablation improves long-term outcomes in obese patients with persistent AF.
Challenges for obesity management in a unified health system: the view of health professionals
Authors: Lopes Mariana S , Freitas Patrícia P , Carvalho Maria C R , Ferreira Nathália L , Campos Suellen F , Menezes Mariana C , Lopes Aline C S
Published: September 2020

Background

Obesity is an increasingly prevalent chronic condition. Its multiple causes and the complexity of its treatment pose challenges for health professionals.

Objective

To explore and describe the challenges for obesity management in the Brazilian Unified Health System according to health professionals.

Methods

An exploratory quantitative web-based study, carried out in 2018 with health professionals, developed from the first stage of a national project that aims to examine the management of obesity in Brazil. The questionnaire was self-applied. Invitations to participate in the research were sent by the Ministry of Health, Health Department of Minas Gerais and members of the research group. We collected data on sex, age, professional category, region and level of care. The challenges were investigated using a Likert scale and categorized into structure and work process.

Results

We evaluated 1323 professionals, of which about 45% were dietitians, 90.2% were women, and 83.1% self-reported working in primary health care. The main barriers cited included a high demand for curative and individual assistance, the presence of comorbidities, and the absence or insufficient access to instructional materials, professional qualification and lack of support.

Conclusion

Obesity management is a critical challenge for all professionals. Barriers were related to the work process and structural aspects and reinforce the need to empower health teams. We propose that permanent education activities should be established, as well as the development of instructional materials that are applicable to routine work. Finally, the results may be used to develop policies and strategies to improve obesity management.
7. A child’s parents: parentage, parenthood, and parental responsibility
Authors: Gilmore Stephen , Glennon Lisa
Published: September 2020

This chapter examines the law on legal parenthood (including establishing paternity) and the allocation, acquisition, nature and scope of parental responsibility. The law has had to address a number of questions in light of medical advances and social change. Who is a child’s mother when a woman gives birth to a child conceived as a result of egg donation by another woman? How is the law on surrogacy to be regulated? Can a female-to-male transsexual person become a child’s father via assisted conception (or indeed a mother if he gives birth)? Is a mother’s same-sex partner to be recognised as her child’s parent too? If so, in what sense? As this last question suggests, the law’s response is also complicated by the fact that the notion of ‘being a parent’ has several different facets.
Cross-cultural validation and psychometric testing of the counseling center assessment of psychological symptoms: experience of Serbia
Authors: Cvjetkovic Smiljana , Bjegovic-Mikanovic Vesna , Langher Viviana
Published: September 2020

Psychological distress in university students represents a rising public health concern. The complexity of this phenomenon calls for a more in-depth scrutiny, in order to address the wide diversity of mental health issues that may arise in this population. The instrument designed for the purpose of measuring the student-specific distress is needed. An appropriate tool is the Counseling Center Assessment of Psychological Symptoms 62 (CCAPS-62), multidimensional scale widely used at many universities. The objective of the present study was to translate, culturally adapt and psychometrically validate CCAPS-62 in Serbian student population. A total of 1326 Belgrade University students were recruited from twelve different faculties. Considering the possible culturally conditioned differences in the quality of distress both exploratory and confirmatory factor analyses were performed. The results of the exploratory factor analysis supported the eight-factor model with the item composition of the factors different to a certain extent from the original version. This measurement model was verified by confirmatory factor analysis. Findings demonstrated good internal consistency for the total scale as well as for the eight subscales applied among Serbian students. Implications are discussed with respect to the cultural context of mental health concerns in student population.
High-throughput multivariable Mendelian randomization analysis prioritizes apolipoprotein B as key lipid risk factor for coronary artery disease
Authors: Zuber Verena , Gill Dipender , Ala-Korpela Mika , Langenberg Claudia , Butterworth Adam , Bottolo Leonardo , Burgess Stephen
Published: September 2020

Background

Genetic variants can be used to prioritize risk factors as potential therapeutic targets via Mendelian randomization (MR). An agnostic statistical framework using Bayesian model averaging (MR-BMA) can disentangle the causal role of correlated risk factors with shared genetic predictors. Here, our objective is to identify lipoprotein measures as mediators between lipid-associated genetic variants and coronary artery disease (CAD) for the purpose of detecting therapeutic targets for CAD.

Methods

As risk factors we consider 30 lipoprotein measures and metabolites derived from a high-throughput metabolomics study including 24 925 participants. We fit multivariable MR models of genetic associations with CAD estimated in 453 595 participants (including 113 937 cases) regressed on genetic associations with the risk factors. MR-BMA assigns to each combination of risk factors a model score quantifying how well the genetic associations with CAD are explained. Risk factors are ranked by their marginal score and selected using false-discovery rate (FDR) criteria. We perform supplementary and sensitivity analyses varying the dataset for genetic associations with CAD.

Results

In the main analysis, the top combination of risk factors ranked by the model score contains apolipoprotein B (ApoB) only. ApoB is also the highest ranked risk factor with respect to the marginal score (FDR <0.005). Additionally, ApoB is selected in all sensitivity analyses. No other measure of cholesterol or triglyceride is consistently selected otherwise.

Conclusions

Our agnostic genetic investigation prioritizes ApoB across all datasets considered, suggesting that ApoB, representing the total number of hepatic-derived lipoprotein particles, is the primary lipid determinant of CAD.
Effectiveness of doxycycline 100 mg twice daily for 7 days and azithromycin 1 g single dose for the treatment of rectalChlamydia trachomatisinfection among men who have sex with men
Authors: Mizushima Daisuke , Takano Misao , Uemura Haruka , Yanagawa Yasuaki , Aoki Takahiro , Watanabe Koji , Gatanaga Hiroyuki , Kikuchi Yoshimi , Oka Shinichi
Published: September 2020

Objectives

To compare the effectiveness of doxycycline 100 mg twice daily for 7 days and azithromycin 1 g single dose for the treatment of rectal Chlamydia trachomatis infection among MSM in a real clinical setting.

Methods

A prospective study was performed to compare the effectiveness of doxycycline and azithromycin for the treatment of rectal C. trachomatis among MSM in Tokyo, Japan. Subjects diagnosed with rectal C. trachomatis infection were treated and test-of-cure examination (TOC) was performed at least 3 weeks after the treatment. Treatment of rectal C. trachomatis infection was decided prospectively in a time-dependent manner; in the period between January 2017 and October 2018, azithromycin was administered to all subjects, whereas from October 2018 through March 2020, doxycycline was administered to all subjects. Effectiveness of these treatments was calculated by the number of rectal C. trachomatis-negative subjects at TOC divided by the number of subjects treated.

Results

Two hundred and ninety-six MSM with rectal C. trachomatis infection were treated with azithromycin (80 patients) and doxycycline (216 patients) in a time-dependent manner. Of the 296 MSM, 274 (92.6%) were treated successfully [67 (83.7%, 95% CI = 79.6%–87.9%) in the azithromycin group versus 207 (95.8%, 95% CI = 94.5%–97.2%) in the doxycycline group, P < 0.001]. To evaluate factors associated with treatment failure, we performed logistic regression analysis. In univariate and multivariate analysis, only doxycycline treatment was inversely associated with treatment failure (OR = 0.29, 95% CI = 0.084–0.976, P = 0.046).

Conclusions

The treatment with doxycycline 100 mg twice daily for 7 days was superior to that with azithromycin 1 g single dose for rectal C. trachomatis among MSM in a real-world setting.
Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department
Authors: Fouquet Sarah D , Fitzmaurice Laura , Chan Y Raymond , Palmer Evan M
Published: September 2020

Objective

The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework.

Materials and Methods

In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system.

Results

Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record.

Discussion

Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses.

Conclusion

Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.
Disparity of selenourea and selenocystine on methaemoglobinemia in non-diabetics and diabetics
Authors: Das Debashree , Sen Souvik , Sen Kamalika
Published: September 2020

Organoselenium drugs like selenourea (SeU) and selenocystine (SeC) are found to exhibit several medicinal properties and have reported roles in the field of cancer prevention. However, studies related to their interactions with the major erythroid protein, haemoglobin (HbA) are still in dearth despite being of prime importance. In view of this, it was considered essential to investigate the interaction of these two anticancer drugs with Hb. Both the drugs showed significant changes in absorption spectra of Hb at wavelength of maximum absorption (λmax) 630 nm. SeU itself had no effect on the absorbance value at 630 nm with respect to time even with 400 µM concentration. However, it was rapidly converted to nanoselenium in presence of nitrite and there was an increase in the absorbance rate at 630 nm from 3.39 × 10−3 min−1 (without nitrite) to 8.94 × 10−3 min−1 in presence of nitrite (200 µM) owing to the generation of reactive oxygen species in the medium. Although the generation and increase in peak intensity at 630 nm in Hb generally indicates the formation and rise in the levels of methaemoglobin (metHb), nanoselenium was observed to follow a different path. Instead of causing oxidation of Fe2+ to Fe3+ responsible for metHb formation, nanoselenium was found to interact with the protein part, thereby causing changes in its secondary structure which is reflected in the increasing absorbance at 630 nm. SeC, however, showed a different effect. It was shown to act as a novel agent to reduce nitrite-induced metHb formation in a dose-dependent manner. The efficiency of SeC was again found to be less in diabetic blood samples as compared to the non-diabetic ones. For similar ratio of metHb to SeC (1:8), % reduction of metHb was found to be 27.46 ± 0.82 and 16.1 ± 2.4 for non-diabetic and diabetic samples, respectively, with a two tailed P-value much <0.05 which implies that the data are highly significant.
An unusual case of hyalinizing clear cell carcinoma in a sinonasal cavity and cranial base
Authors: Gudelj Goran , Simunjak Tena , Zizic Marica , Simunjak Boris , Jurlina Martin
Published: September 2020

Hyalinizing clear cell carcinoma (HCCC) is a rare, predominantly minor salivary gland tumor. Most of these tumors occur in the oral cavity, mainly the palate and tongue. Primary localization of the tumor in the region of the nasal cavity and paranasal sinuses is extremely rare and, with only a few cases reported in the literature so far. We present an extremely rare case of a 61-year-old woman with hyalinizing clear cell carcinoma (HCCC), occupying the left posterior nasal and nasopharyngeal cavity, as a primary tumor location. The patient total recovery was uneventful, and she is now free of disease at three years postoperative follow-up.
Case series of hyena bite injuries and their surgical management in a resource-limited setup: 1-year experience
Authors: Abebe Metasebia W , Tefera Tezazu , Mengesha Mengistu G , Mengesha Mulualem W , Teshome Sisay
Published: September 2020

Animal bites are a significant cause of morbidity and mortality and pose a major public health problem worldwide. Children are reportedly the most common victims of animal bites. Bites may be limited to superficial tissues or lead to extensive disfiguring injuries, fractures, infections and rarely result in death. Recently, human injuries caused by non-domesticated animals are increasingly common as ecosystems change and humans encroach on previously wild land. Wild animals like hyenas have been reported to prey on humans and cattle in parts of Africa. Discussed here are four children out of 11 patients that presented with hyena bites—the children had severe bites to the face and head with extensive soft tissue loss, fractures and concomitant severe infections that led to high mortality, indicating the necessity for advanced intensive care and multidisciplinary treatment needed in such situations.
Dynamics of endoreduplication in developing barley seeds
Authors: Nowicka Anna , Kovacik Martin , Tokarz Barbara , Vrána Jan , Zhang Yueqi , Weigt Dorota , Doležel Jaroslav , Pecinka Ales
Published: September 2020

Seeds are complex biological systems comprising three genetically distinct tissues: embryo, endosperm, and maternal tissues (including seed coats and pericarp) nested inside one another. Cereal grains represent a special type of seeds, with the largest part formed by the endosperm, a specialized triploid tissue ensuring embryo protection and nourishment. We investigated dynamic changes in DNA content in three of the major seed tissues from the time of pollination up to the dry seed. We show that the cell cycle is under strict developmental control in different seed compartments. After an initial wave of active cell division, cells switch to endocycle and most endoreduplication events are observed in the endosperm and seed maternal tissues. Using different barley cultivars, we show that there is natural variation in the kinetics of this process. During the terminal stages of seed development, specific and selective loss of endoreduplicated nuclei occurs in the endosperm. This is accompanied by reduced stability of the nuclear genome, progressive loss of cell viability, and finally programmed cell death. In summary, our study shows that endopolyploidization and cell death are linked phenomena that frame barley grain development.
Module 9: Emotion Coaching
Authors: Chronis-Tuscano Andrea , O’Brien Kelly , Danko Christina M.
Published: September 2020

In Module 9, parents are introduced to their important role in helping their children with attention-deficit/hyperactivity disorder (ADHD) learn to regulate strong emotions. Parents are the child’s first teachers for how to regulate emotions and serve the role of “external regulator” for their children. Children with ADHD are more sensitive to their environments and look to their parents for signs of how to react to a situation or stressor. The goal is for parents to stay calm and collected, modeling effective emotion regulation for their child during periods of stress. When parents learn to be “emotion coaches,” they are more likely to consider the child’s emotions without judgment and decrease critical or invalidating responses. By serving as the child’s “emotion coach” (noticing, tolerating and labeling the child’s emotion), the child learns “emotion language” so that acting out in response to emotions is not necessary to express how they are feeling.
Nutrition and Cerebrovascular Disease
Authors: Benameur Karima
Published: September 2020

Stroke is a major public health burden in the United States and worldwide and is a leading cause of long-term disability and lost wages. The southeastern United States, nicknamed the “stroke belt,” is disproportionately affected by stroke, with African Americans being the most affected. Multiple theories exist about the basis for this, one of which is the diet quality that prevails in the southern United States. Indeed, diet has long been known to be an independent risk factor for cardiovascular disease in general, and stroke in particular. This chapter discusses the relation between diet and stroke. We explore the intersections of cardiovascular and nutrition science and discuss the different components of diet as well as the different dietary patterns and how they affect stroke risk. Finally, we recommend how physicians and healthcare providers can mitigate cardiovascular risk by properly counseling their patients. This chapter is meant to be used as guidance for the data needed to support our daily decisions when counseling patients.
Sleep Health and Sleep Disorders
Authors: Gray Weili
Published: September 2020

This chapter reviews the architecture and functions of sleep, how to interview patients on their sleep histories, how to evaluate for sleep disorders, commonly encountered sleep disorders and their pathophysiology, and the conventional and integrative therapies for each. The evaluation process includes a conventional sleep study as well as addressing vitamin D, B, and magnesium status. Sleep disorders discussed in this chapter are obstructive sleep apnea, insomnia, restless legs syndrome, periodic limb movement disorder, rapid-eye-movement behavior disorder, circadian rhythm disorders, and narcolepsy and other central hypersomnias. The role of conventional tools and times when alternative and complementary therapies may be considered are discussed in detail. Treatment covered include continuous positive airway pressure, oral appliance, myofunctional therapy, cognitive-behavioral therapy for insomnia, physical modalities, acupuncture, light therapy, melatonin, nutraceuticals, and other supplements that aid with sleep and daytime symptoms.
The Endocannabinoid System in the Aging Brain and Neurodegenerative Diseases
Authors: Paredes Daniel A. , Catlow Briony J. , Sanchez-Ramos Juan
Published: September 2020

Aging is the major risk factor for development of cognitive decline and neurodegenerative disease. The aging brain undergoes gradual neuroanatomical and neurochemical changes, including alterations in components of the endocannabinoid system. These changes impact brain functions controlling motoric, emotive, and cognitive activities. Some degree of age-related cognitive decline occurs independent of the presence of neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. However, neurodegenerative diseases can also develop in younger individuals who exhibit what appears to be accelerated “aging” of selective populations of neurons. The discovery of the endogenous cannabinoid system is relatively recent and began with identification of receptors in brain that interacted and bound with the main psychoactive component of the phytocannabinoid delta-9-tetrahydrocannabinol (THC). At present, the various components of the endocannabinoid system (endogenous ligands, receptors, biosynthetic and degradative enzymes) have been characterized, and research in this field is rapidly growing. In this brief review, the changes in the endocannabinoid system that occur with aging and in several classical neurodegenerative diseases are discussed with a focus on the therapeutic potential of agents that interact with various components of the endocannabinoid system.
Assessment and Monitoring of Patients With Chronic Pain and Co-occurring Substance Use and Abuse
Authors: Streltzer Jon
Published: September 2020

Substance abuse complicates pain management. The comorbidity of substance abuse and pain is particularly problematic in the United States and Canada, substantially more than in most countries with advanced health care systems. Treatment of pain with long-term opioids, particularly in high doses, is known to be associated with substantial medical comorbidity, unintentional overdoses, and death. Treatment of opioid dependence in the chronic pain patient is necessary for effective pain management, whether or not the patient uses drugs illicitly. Opioids, particularly in high doses, produce central nervous system neuroadaptations that reduce or eliminate analgesic effectiveness and enhance sensitivity to pain in general. The neuroadaptations often result in opioid dependency and, in the long-term, craving. Weaning patients from chronic opioids can be exquisitely difficult if simple dose reduction is attempted. The process can be quite successful and gratifying, however, if certain principles are followed. These include education, comfortable detoxification using long-acting opioids, usually methadone or buprenorphine, nonopioid pain management, psychological support, and coordinated care.
Alcohol and Chronic Pain
Authors: Frohe Tessa M. , Berey Benjamin L. , Witkiewitz Katie , McCallion Elizabeth A. , Vowles Kevin E.
Published: September 2020

Both chronic pain and alcohol use disorders (AUDs) are public health problems, affecting millions each year. Given the cyclical nature of alcohol as an analgesic and alcohol withdrawal pain as a symptom of AUD, it is likely that these two experiences are related, yet the nature of their relation is not well understood. Pain may occur during detoxification from alcohol, and persistent pain may increase the odds of substance use lapses. People experiencing pain often use alcohol to reduce it, which may be due to analgesic effects of alcohol. This chapter highlights the prevalence and clinical characteristics of chronic pain and alcohol use, followed by an overview of underlying neural mechanisms associated with each. Beneficial behavioral and pharmacological interventions are addressed, and future directions are discussed. It is important to understand how pain and alcohol interact and to address interventions aimed at reducing one, which may also subsequently affect the other.
Innovative Management of Chronic Pain and Psychiatric Comorbidities
Authors: Hobelmann J. Gregory , Clark Michael R.
Published: September 2020

Chronic debilitating pain causes physical, emotional, cognitive, and spiritual suffering. Chronic pain is frequently associated with psychiatric comorbidities, such as affective and anxiety disorders, further enhancing the suffering and functional disability of patients with pain. For much of the past three decades, treatment for pain has focused on the physical aspect of pain with little attention to emotional, cognitive, and spiritual maladies. We aim to describe comprehensive rehabilitation programs that take into consideration the entire patient. While the concept is not novel, comprehensive programs became nearly extinct for many years because of a variety of factors. Possibly the most innovative concept in pain medicine is the re-emergence of these programs, along with a variety of newer treatment modalities.
Introduction
Authors: Snyder Jeremy
Published: September 2020

Hope presents a duality where it creates both sustaining promise for the future and vulnerability to those acting on this promise. There is a need to understand how hope can be taken advantage of or exploited while still acknowledging the power and importance of sustained hope. This introduction provides background on the concept of exploitation and outlines the structure of the book. It surveys various accounts of the wrongness of exploitation, grounded both in interpretations of Marx’s concept of exploitation and contemporary authors. Exploitation can be understood as a form of unfairness in specific transactions and exchanges, unfairness stemming from unjust background conditions, or a failure to express appropriate respect for others. While these accounts each capture dimensions of exploitation, this introduction makes the positive argument that exploitation – including the exploitation of hope – consists most fully of a form of disrespect for others, namely taking advantage of a partial entrustment of another person’s well-being.
Networks of Hope
Authors: Snyder Jeremy
Published: September 2020

Chapter 8 looks at crowdfunding for unproven medical interventions, which typically are not paid for by public or private insurance. This system of fundraising plays a significant role in the exploitation of hope by funneling resources to exploiters and creating a pool of hopeful donors who are often misled about the interventions they are supporting. This case demonstrates the sometimes complex web of the exploitation of hope, where even ill and exploited individuals can be complicit in exploitation given the need to build hope in others in order to fund their own hopes.
Conclusion
Authors: Snyder Jeremy
Published: September 2020

The author argues in this book that the exploitation of hope should be understood as inappropriately taking advantage of a partial entrustment with aspects of others’ well-being. This respect-based account should lead individuals to ask the following questions: (1) Should this interaction happen at all or the partial entrustment be accepted? (2) If the entrustment is accepted, how can the hopeful relationship be managed most respectfully? (3) As these relationships develop, new information is gained, and conditions change, should the hopeful relationship be continued? He concludes by arguing that respect-based accounts of exploitation should be emphasized or even replace fairness-based accounts. The account of exploitation developed in this book should be applied to exploiting hope in non-medical contexts and to exploitation more generally.
The biopsychosocial model in psychiatry: Engel and beyond
Authors: Roache Rebecca
Published: September 2020

This chapter examines the biopsychosocial model in psychiatry. The term ‘biopsychosocial’ is most strongly associated with George L. Engel, whose most famous article on the biopsychosocial model was published in 1977. In advancing the model, Engel aimed to make explicit how the biological, the psychological, and the social all had a place in conceptualizing mental disorder, and to systematize and enshrine this recognition in the way in which psychiatry is practised. In making decisions about how to treat mental illness, or a given patient, adopting a biopsychosocial approach should involve keeping in mind that the most effective treatment may involve a solely biological intervention, a solely psychological one, a solely social one, or a combination of these. Indeed, a useful and effective biopsychosocial approach reminds one to consider all of these possibilities, and select the most promising one, based on the available empirical evidence.
When answers are hard to find, change the question: Asking different causal questions can enable progress
Authors: Cooper Rachel
Published: September 2020

This chapter argues that changing the causal questions asked by psychiatric research programmes might facilitate progress in finding the causes of mental disorders. K. Codell Carter’s (2003) The Rise of Causal Concepts of Disease shows that empirical progress sometimes requires a change in the causal questions that researchers ask. The philosophical claim that causal explanation is contrastive implies that projects that seek ‘the causes of disorder’ might pursue this aim in multiple ways. Some causal questions will turn out to be easier to address than others. This means that when research programmes stall, it is worth trying to restart progress through switching the causal questions asked. The chapter considers one type of causal question, ‘Why do some people with condition X find it harmful and others harmless?’, that might plausibly be fruitfully addressed more often than at present.
Which biopsychosocial view of mental illness?
Authors: Sinnott-Armstrong Walter , Summers Jesse S.
Published: September 2020

Biopsychosocial theories of mental illness claim that biological, psychological, and social factors are all central to every mental illness. This general approach cannot be assessed or employed properly without specifying the precise relation between mental illnesses and these three levels of understanding. This chapter distinguishes disjunctive, causal, explanatory, therapeutic (or treatment), and constitutive (or definitional) versions of biopsychosocial theories. However, all of these claims are uncontroversial and not distinctive of the biopsychosocial approach, except the constitutive claim. That constitutive claim is inaccurate, because almost all mental illnesses are and should be defined by their psychological symptoms instead of their biological or social causes. These lessons are applied to case studies of post-traumatic stress disorder, disinhibited social engagement disorder, obsessive–compulsive disorder, and scrupulosity.
The truth in social construction
Authors: Levy Neil
Published: September 2020

Central strands of biological psychiatry, such as the Research Domain Criteria championed by Thomas Insel, aim to identify mental illnesses with genetic and/or neural dysfunctions. Such approaches are justified by the mismatch between psychopathologies picked out by descriptive criteria (such as those used by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) and neural correlates: patients presenting with the same symptoms may share little at the neural level, while those who share dysfunction at the neural level may exhibit quite different symptoms. Biological psychiatry is typically understood as opposed to social constructionist approaches to mental illness. This chapter argues that because symptomatology and disorders of neural circuits fail to match, biological psychiatry needs to embrace social construction, broadly understood. The differences at the level of symptomatology will often be explicable by differences in patients’ individual histories and social and cultural settings. The notion that social construction and biological psychiatry are mutually exclusive arises from an inchoate and incoherent feeling on both sides that only the second offers a physicalist explanation of mind and behaviour; in fact, a social explanation can ultimately be cashed out in physicalist terms. Nevertheless, systematicity of the kind sciences seek will need to be sought at the level of representations, as well as at the level of the brain, since cultural and social factors are unlikely to be able to be cashed out in terms of physical natural kinds.
Developmental risk and resilience: The challenge of translating multilevel data to concrete interventions
Authors: Viding Essi
Published: September 2020

Disorders are classified at the level of behaviour, yet individuals arrive at the same behavioural outcomes via multiple different developmental trajectories. The current diagnostic categories identify clinically disturbed functioning, but they do not identify a homogeneous group of individuals. Furthermore, identical risk indicators do not always result in the same outcome. Getting better at individuating distinct pathways to a disordered or resilient outcome is only part of the challenge. Once risk (or protective) factors for a specific developmental trajectory are identified, their modus operandi still need to be understood. Both biology and the social environment play a role in the emergence of psychopathology and resilience, but meaningfully studying their interplay is far from trivial. This chapter outlines the challenges of integrating different methodologies to improve the understanding of developmental risk and resilience. A strong case is made for the importance of studying individuals as active co-creators of their social ecologies.
Reacting to abuse
Authors: Holton Richard
Published: September 2020

This chapter assesses the effects of childhood abuse and neglect. It begins by discussing the ‘overgeneral memory effect’. This is the finding that abused children tend to forget many of the specific happenings in their childhoods. Reflection on it can perhaps help to shed some light on how memory, and its suppression, works. The chapter then draws some parallels with the findings on delayed gratification. It is striking that in both cases one finds a need to shut down certain sorts of thought; the therapeutic interest is in how and when one might get it going again. The chapter also poses a question about how much the effects of childhood abuse are mediated by the expectations of the subjects. Many have claimed, with some plausibility, that one finds such mediation in various psychological illnesses: that the way that subjects understand their own condition affects the symptoms that they display.
Psychiatry, folk psychology, and the impact of neuroscience—a response to Steven Hyman’s Loebel Lectures
Authors: Glover Jonathan
Published: September 2020

This chapter reflects on Steven Hyman's Loebel Lectures, which revolve around a contrast between folk psychology and what neuroscience is starting to reveal. Folk psychology is the unscientific picture of what goes on in people’s minds when they perceive, remember, think, feel, decide, and act. It is based on introspection and on intuitive ‘reading’ of other people. In contrast to folk psychology is the fine structure neuroscience is starting to reveal: the brain mechanisms underlying perception, memory, thought, emotion, decision, and action. Hyman says that mapping out this fine structure has the promise of changing the understanding and treatment of psychiatric disorders. Out of this emerges Hyman’s philosophical claim that neuroscience radically challenges the status of folk psychology. Folk psychology, being in conflict with neuroscience, is largely false.
Diagnosing Death
Authors: Gardiner Dale , McGee Andrew
Published: September 2020

It was not always doctors who diagnosed death. Advances in resuscitation and fears of premature burial led to doctors having a duty to diagnose death in a safe and timely way. The birth of intensive care in the twentieth century demonstrated that it was possible for the heart to keep beating even after the brain had permanently ceased functioning. A worldwide, unifying, brain-based definition of death could be termed ‘permanent brain arrest’. The clinical characteristics of permanent brain arrest would be the permanent loss of capacity for consciousness and loss of all brainstem functions (including the capacity to breathe), which might arise from primary brain injury or secondary to circulatory arrest. Three sets of criteria are used by doctors to diagnose death, depending on the clinical circumstances: forensic, circulatory, and neurological. All three sets of criteria point to the same brain-based definition of death. While there is widespread consensus for these standards—in practice and in law—they are not without criticism.
OSCE 3
Authors: Hersey Peter , O’Connor Laura , Sams Tom , Sturman Jon
Published: September 2020

Divided into 13 stations on professionalism, resuscitation, data, and equipment, OSCE 3 is mapped to the Fellowship of the Faculty of Intensive Care Medicine (FFICM) and Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) curricula. Structured to reflect the real exam, answers are accompanied by syllabus references for the FFICM and CoBaTrICE domains for self-assessment, along with further reading for self-assessment.
OSCE 5
Authors: Hersey Peter , O’Connor Laura , Sams Tom , Sturman Jon
Published: September 2020

Divided into 13 stations on professionalism, resuscitation, data, and equipment, OSCE 5 is mapped to the Fellowship of the Faculty of Intensive Care Medicine (FFICM) and Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) curricula. Structured to reflect the real exam, answers are accompanied by syllabus references for the FFICM and CoBaTrICE domains for self-assessment, along with further reading for self-assessment.