bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidisciplinary management, including chemotherapy of solid tumours (lung, breast, and colon)
Authors: Battisti Nicolò Matteo Luca , Extermann Martine 
Published: December 2017

Abstract
Cancer is a common disease in geriatric patients and its biology and prognosis are affected by age. The comprehensive geriatric assessment addresses the complex management of the older population, which is still underrepresented in clinical trials despite its rapid expansion in Western countries. Thus, it is crucial to develop a multidisciplinary approach to geriatric oncology care considering functional disability, competing comorbidities, cognitive impairment, nutritional status, psychosocial distress, and polypharmacy as major issues. Fit elderly breast cancer patients should be treated similarly to younger women, whereas the management of frail patients should be individualized. Special considerations may apply to the postoperative treatment of elderly colon cancer patients, and in the setting of metastases, toxicities, and quality of life should be balanced. The same concerns are valid for the management of lung cancer in elderly patients. Accordingly, geriatricians should be aware of oncological approaches and oncologists should be trained in geriatric management.
Cardiac and vascular ageing
Authors: Ota Hidetaka , Akishita Masahiro 
Published: December 2017

Abstract
There is a continuum of expression of cardiac structural and functional alterations that occurs with ageing in healthy humans, and these age-associated cardiac changes seem to be relevant to the increase in left ventricular hypertrophy, chronic heart failure, and arrhythmia that are commonly observed with increasing age. This chapter describes the structural and functional changes in the ageing process of the heart and blood vessels, and provides an overview of representative cardiovascular disease caused by ageing including hypertension, atherosclerosis, and heart failure. In addition, an outline of interventions that have be utilized to prevent and treat ageing related cardiovascular diseases is provided.
Hypertension in older adults
Authors: Rakugi Hiromi , Kawai Tatsuo 
Published: December 2017

Abstract
Hypertension is very common in older adults and highly clinically relevant to manage as it remains a strong risk factor of cardiovascular diseases and cognitive decline. Active reduction in hypertension in even the very oldest adults has demonstrated efficacy in the prevention of cardiovascular and cerebrovascular diseases and reduction in hip fracture. Hypertension in older adults is characterized by high prevalence of isolated systolic hypertension, increased fluctuation of blood pressure, and having various comorbidities which affect not only management of hypertension but also activities of daily living and quality of life. It is important to pay attention to these characteristics for diagnosis of hypertension, introducing lifestyle modification, selection who should be treated with antihypertensive drugs, choice of antihypertensive drugs, and setting the target blood pressure. This careful management is especially required in the very old or frail, and those with cognitive dysfunction.
Ischaemic heart disease
Authors: Rafanelli Martina , Orso Francesco , Marchionni Niccolò 
Published: December 2017

Abstract
Advancing age is associated with changes in vascular and cardiac properties that increase the likelihood of atherosclerosis, which is the basic pathophysiological mechanism in most of the clinical presentations of ischaemic heart disease (IHD). Recovery, once the tissue’s damage has occurred, is more difficult because of age-related changes in damage responsiveness. Clinical management of IHD in older people is complicated by atypical presentation that often makes the diagnosis challenging and causes treatment delay. The management of acute coronary syndromes (ACS) and stable coronary artery disease in this population should be driven by current clinical guidelines, even though older people are poorly represented in clinical trials. The choice of pharmacological therapy needs a careful balance between risks and benefits. Given the increase in morbidity and mortality in older patients with ACS, aggressive risk factor modification is vital for decreasing recurrent events.
Heart failure: definitions, investigation, and management
Authors: Cleland John G. F. , Baxter John 
Published: December 2017

Abstract
Heart failure is among the most common chronic debilitating conditions among older adults. The diagnosis is complex and usually made late, only after severe symptoms develop. Natriuretic peptides (BNP or NT-proBNP) are the key to early diagnosis of heart failure and echocardiography to its cause; most commonly ventricular dysfunction [either with a reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction] or valve disease. For patients with HFrEF, pharmacological treatment with angiotensin converting-enzyme (ACE) inhibitors and mineralo-corticoid receptor antagonists and for those in sinus rhythm beta-blockers and ivabradine have transformed prognosis. For patients with a QRS duration &gt;140 msec, cardiac resynchronization with atrio-biventricular pacing should be considered. Iron deficiency should be sought for and treated. For patients with HFpEF, robust evidence that treatments improve outcome is lacking but for symptoms, the pharmacological treatment of HFpEF and HFrEF may be rather similar.
Neuropsychological evaluation of cognition
Authors: Tuokko Holly , Smart Colette 
Published: December 2017

Abstract
This chapter describes the components of a comprehensive neuropsychological evaluation including the approaches taken and domains of importance for the performance-based measurement of cognitive functions in older adults. Normative and non-normative factors associated with the ageing process that may be of importance in the interpretation of the neuropsychological information are briefly described. These include normative changes associated with ageing, medical disorders affecting cognition, and characteristic patterns of cognitive impairment. The integration of the neuropsychological performance-based information with information obtained from other sources is discussed. In closing, we address the interpretation of the neuropsychological evaluation in relation to the purpose for which it was undertaken, as well as a conceptual framework for intervention in older adults with cognitive or neuropsychiatric impairments.
Management of comorbidities in dementia patients
Authors: Gold Gabriel , Zekry Dina 
Published: December 2017

Abstract
Despite recent evidence for a marked decrease in dementia incidence over the past decades, it is highly likely that the absolute number of people with dementia will continue to increase as a function of population ageing. Furthermore, two-thirds of the population with dementia live in developing countries where this entity is already responsible for 25% of cases with severe incapacity. Thus, dementia will remain a worldwide public health concern in the twenty-first century. Interaction between comorbidities and dementia is complex: are comorbidities dementia- or age-related? Presentation of illness is atypical in older populations but particularly so in individuals with dementia. How should one then detect and measure the comorbidity burden, what is the best management and the most ethically correct approach to decision-making? This chapter will review current knowledge in the field and discuss basic principles that can be applied to ensure optimal care of comorbidities in people with dementia.
Functional psychoses
Authors: Agüera-Ortiz Luis 
Published: December 2017

Abstract
Psychotic symptoms are more common in older people than in any other age. The most frequent psychotic disorders in older people are juvenile-onset schizophrenia in ageing patients, psychosis in Alzheimer’s disease, and the late- and very late-onset schizophrenia-like psychosis. Drug treatment of all types of psychosis is essential and often achieves similar levels of efficacy than in younger adults. The treatment of choice for any psychotic condition is atypical antipsychotics. Rather than being based on specific diagnosis, the choice of drug must be highly personalized, depending on the efficacy for the particular patient, drug’s profile of adverse effects, medical comorbidities, and concomitant medications. Attention should be paid to the emergence of adverse effects that are in general more frequently found with conventional than with atypical antipsychotics. Clinical and psychological management includes the need to establish a therapeutic alliance with the patient and ensure adherence to treatment in the long term.
Endocrinology of ageing
Authors: McKee Alexis , Morley John E. 
Published: December 2017

Abstract
Attempts to stave off ageing through a search for the fountain of eternal youth date back to biblical stories where the Garden of Eden was said to contain the river of immortality. Ageing is a multifaceted process with physiological, psychological, and societal impact. Life expectancy continues to increase globally. Thus it is relevant for physicians to discern between physiological and pathological hormonal changes associated with ageing. Diagnosing endocrine disorders in older people is challenging because the symptoms of endocrine disease often imitate normal physiological changes with ageing and because of the effect of polypharmacy on hormone levels. This chapter will serve as a guide for the diagnosis and treatment of endocrine disorders in this population.
Prognostication and recognition of dying
Authors: Forte Viviana , Gambassi Giovanni 
Published: December 2017

Abstract
Prognosis is the science of evaluating what is like to happen in term of health outcomes (recovery, death, disability) related to a patient’s condition (cancer, chronic disease, accident). Estimating the likelihood of a life-threatening illness becomes crucial, especially among older people. It allows us to balance the benefits and burdens of diagnostic tests and treatments, to plan with the patient and family by their values, and to take care of physical, psychological, and social suffering when the disease is incurable. Validated prognostication tools are available for cancer, chronic conditions, and advanced dementia to help decision-making in the terminal phase of illness. Recognition of dying and care during the last days/hours of life should be a core competency of every physician. When a patient is actively dying, common signs tend to be present and if symptoms are not well controlled, the dying process may be prolonged and the patient may suffer unnecessarily.
Optimizing cognition in older adults: lifestyle factors, neuroplasticity, and cognitive reserve
Authors: Berardi Nicoletta , Sale Alessandro , Maffei Lamberto 
Published: December 2017

Abstract
Cognitive decline with age shows strong interindividual variance. Several epidemiological studies have shown that some of the factors associated with maintaining a good cognitive performance with age are lifestyle factors, such as practising physical activity and being engaged in cognively stimulating activities, which are potentially modifiable even in old age. In parallel, studies in animal models have shown that physical exercise and environmental stimulation result in better cognitive performance, potentiation of neural plasticity, neuroprotection. More recently, intervention studies in humans begin to show that training based on cognitive or physical activity enhance cognitive performance in older adults. At the core of lifestyle effects on cognitive ageing is neural plasticity and the action of multiple molecular factors which translate physical and cognitive activity into adaptive and protective changes in the brain, allowing elders to better face ageing-related cognitive changes.
Introduction to medical mycology
Authors: Warnock David W. 
Published: December 2017

Abstract
The pattern of fungal diseases has changed with the emergence of new pathogens and the resurgence of old ones. Many factors have contributed to this, including medical progress, environmental changes, and the development of drug resistance. The impact of these diseases on human health is not widely recognized, largely because of the many gaps in epidemiological surveillance data. Access to affordable diagnostics and antifungal drugs are critical issues in the developing world. New approaches to prevention and control will be needed if we are to reduce the substantial global burden of ill health and death due to fungal diseases.
Fungal genetics
Authors: Dyer Paul S. , Munro Carol A , Bradshaw Rosie E. 
Published: December 2017

Abstract
Fungi have been long used as model organisms to investigate genetic and cellular processes. An overview is provided of how fungi function at a genetic level, including ploidy, gene structure, and gene flow by sexual and asexual processes. The tools used to study fungal genetics are then described, such techniques having widespread applications in medical mycology research. Classical genetic analysis includes the use of gene mapping by sexual crossing and tetrad analysis, and forward genetic experimentation based on mutagenesis, for which various mutant screening approaches are described. Molecular genetic analysis includes gene manipulation by transformation; different methods for gene knockout and targeting, and their application for forward and reverse genetic approaches, are outlined. Finally, molecular genetic methods used to study gene expression and function are reviewed, including use of inducible or constitutive overexpression, real-time PCR, cellular localization of gene products by fluorescent tagging, and detection of protein–protein interactions.
Fungal genomics and transcriptomics
Authors: Munro Carol A. , Wilson Duncan 
Published: December 2017

Abstract
The advent of whole-genome sequencing has resulted in a range of platforms for large-scale analysis of the DNA (genomics), RNA (transcriptomics), protein (proteomics), and metabolite (metabolomics) content of cells. These inclusive ‘omics’ approaches have allowed for unparalleled insights into fungal biology. In this chapter we will discuss how genomics and transcriptomics have been used to broaden our understanding of the biology of human pathogenic fungi and their interactions with their hosts.
Aspergillus species
Authors: Smith Stephanie J. , Manuel Rohini J. , Kibbler Christopher C. 
Published: December 2017

Abstract
There are more than 200 Aspergillus species, with over 30 known to be human pathogens. The fungus is also commercially important. Aspergillus niger is the source of enzymes such as amylases, lipases, and proteases and is used to produce the majority of the world’s citric acid. Diseases caused by Aspergillus species can vary widely, from superficial colonization to invasive and allergic disease. Mortality from invasive disease remains high, despite an increase in the number of antifungals available for therapy. Azole resistance is increasing, especially in Europe, and appears to be related to the use of azoles for agriculture.
Other yeasts
Authors: Linton Chris , Howell Susan 
Published: December 2017

Abstract
The yeasts described in this chapter are, in general, rare causes of serious human infection. Many are commonly found in the environment or as human commensals. The chapter provides a very brief summary of the following six yeast genera: Malassezia, Rhodotorula, Saccharomyces, Saprochaete, Sporobolomyces, and Trichosporon. Current taxonomy and significant species are also discussed although many fungal taxonomic groups are being re-evaluated in the light of DNA sequencing data, resulting in the renaming of some species and the regrouping of others. Pathogenicity, epidemiology, and clinical aspects are included, and treatment options are discussed. However, as infections caused by these yeasts are uncommon, there is sometimes a lack of supporting data. Culture and identification methods are also summarized, details of which will be presented in other chapters
Endemic dimorphic fungi
Authors: Restrepo Angela , Gónzalez Angel A. , Gómez Beatriz L. 
Published: December 2017

Abstract
Endemic dimorphic infections are acquired by inhalation of fungal spores which undergo a thermal transition to a yeast-like phase in the host. The causative organisms are geographically restricted and are isolated from the environment; likewise, the infections are associated with people living in, or visiting, these endemic regions. The clinical presentations range from asymptomatic to chronic, and disseminated, depending on the host immune status and other risk factors. The infections and their causative agents are: histoplasmosis (Histoplasma capsulatum), paracoccidioidomycosis (Paracoccidioides brasiliensis/lutzii), blastomycosis (Blastomyces dermatitidis/gilchristii), coccidioidomycosis (Coccidioides immitis/posadasii), talaromycosis (previously penicilliosis; Talaromyces [Penicillium] marneffei), and emmonsiosis (Emmonsia species). Diagnosis relies on microscopy and culture, histology, and immunological detection. Owing to their infectious nature, all of these organisms must be handled using biosafety level-3 containment. Treatment is based around azole administration, usually itraconazole, with amphotericin B for the more severe forms or for the most at risk patients.
Fungal disease in cystic fibrosis and chronic respiratory disorders
Authors: Kosmidis Chris , Denning David W. , Muldoon Eavan G. 
Published: December 2017

Abstract
A range of fungal disease syndromes affect patients with chronic respiratory diseases and cystic fibrosis (CF). Invasive aspergillosis is increasingly recognized in seriously ill patients with chronic obstructive pulmonary disease, especially after high-dose steroids. Chronic pulmonary aspergillosis affects patients with pre-existing cavities or bullae, such as those with previous tuberculosis or atypical mycobacterial disease, bullous emphysema, sarcoidosis, pneumothorax, or treated lung cancer. In addition, fungi have become one of the most important trigger agents for asthma, and allergic bronchopulmonary aspergillosis may complicate up to 3.5% of cases of asthma and up to 15% of cases of CF, starting in childhood. CF patients are commonly colonized with fungal organisms, although the impact of such colonization on outcome is not clear. Aspergillus is the most common mould isolated from CF patients. Distinguishing between colonization and infection remains challenging. Candida is thought to be of no clinical significance; however, it has been associated with decline in lung function.
Antifungal treatment guidelines
Authors: Cottom Laura , Jones Brian L. 
Published: December 2017

Abstract
The management of invasive fungal infection remains challenging. Given the ever-expanding body of published data and advances to scientific knowledge and technology, clinical guidance plays a greater role in supporting clinicians in making patient-centred treatment decisions, and it is essential that the guidance has been subject to rigorous scrutiny to ensure that the recommendations are based upon sound evidence. Numerous guidelines on the treatment of invasive fungal infection are available; however, differences in their recommendations exist. The relative paucity of high-quality trials is a likely contributing factor, and analysis and interpretation of clinical data have also led to conflicting conclusions. The differences in guideline remit and methodology often make direct comparison of guidance impractical. The chapter aims to present and evaluate the main recommendations set out in the Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines.
Segregation, Stigma, and Stratification: A Biosocial Model
Authors: Massey Douglas S. , Wagner Brandon 
Published: December 2017

Abstract
This chapter reviews research on segregation’s effect in generating concentrated poverty and stigma, and it explores the biological consequences of exposure to these conditions for health and socioeconomic status. High levels of segregation interact with high levels of poverty to produce concentrated poverty for African Americans and Hispanics in many metropolitan areas. In addition to objective circumstances of deprivation, the concentration of poverty also brings about the stigmatization of the segregated group. The differential exposure of Blacks and Hispanics to concentrated neighborhood disadvantage and its correlates, in turn, functions to shorten telomeres, increase allostatic load, and alter gene expression in deleterious ways. In so doing, it compromises health and cognitive ability, the two critical components of human capital formation, thus systematically undermining the socioeconomic prospects of African Americans and Hispanics in today’s post-industrial, information economy.
When Stigma Is Concealable: The Costs and Benefits for Health
Authors: Quinn Diane M. 
Published: December 2017

Abstract
Research on the effects of concealing a stigmatized identity on health outcomes is remarkably mixed, with results showing both health costs and benefits to concealing. This chapter reviews the literature and presents a framework for conceptualizing the moderators and mediators of the concealment–health relationship. It is proposed that people who reveal their stigmatized identity within supportive environments reap health benefits, whereas those living in more hostile environments benefit by greater concealment. However, if concealment leads to greater cognitive burden, then negative health outcomes can occur. If people do disclose their stigmatized identity, the confidants they choose, the level of social support received, and the negativity of the reactions will all influence the relationship between disclosure and health outcomes. Future research is needed to clarify which variables are most important for health and to examine differences between identity types and environments.
The Negative and Bidirectional Effects of Weight Stigma on Health
Authors: Major Brenda , Tomiyama Janet , Hunger Jeffrey M. 
Published: December 2017

Abstract
This chapter introduces a model describing the mechanisms by which weight stigma can lead to poorer health outcomes among people who are or who perceive themselves to be overweight. It is proposed that enacted weight stigma (discrimination) directly impairs the health of heavier weight individuals by changing the social and material aspects of their lives in ways that are detrimental to health. It is also proposed that perceived weight stigma can lead to social identity threat, which in turn can indirectly impair health by increasing stress and negative emotions, physiological reactivity, calorie intake, and stigma-avoidance behaviors. Finally, it is proposed that weight stigma is bidirectional, in that experiencing weight stigma leads to weight gain or inhibits weight loss through increased eating and other biobehavioral mechanisms, which in turn lead to further stigmatization. Implications for health and recommendations for future research are discussed.