bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in disease by time, place, and person: Background and a framework for analysis of genetic and environmental effects
Authors: Bhopal Raj S. 
Published: November 2017

Abstract
Diseases wax and wane in their population frequency. The underlying reasons are often difficult to detect and may remain a mystery. The principles behind the investigation of clusters, outbreaks, epidemics, and inequalities in both of communicable and non-communicable diseases, are similar. On those occasions when the mystery is solved we tend to gain huge insights, both scientific and practical to help in disease control. Disease variations are often, however, artefactual, and arise from data errors. A systematic approach to the analysis of variation in disease begins by differentiating artefactual change from real change. Real change results from changes in host susceptibility, in the agent’s capacity to cause disease, and in the influence of the environment. The epidemiological challenge is to pinpoint the causal factors.
The epidemiology, burden, and treatment of mental disorders in primary care
Authors: Puschner Bernd , Kösters Markus , Bouché Lea , Weinmann Stefan 
Published: November 2017

Abstract
Mental disorders have elevated prevalence rates worldwide. As a group, these disorders are leading causes of disability and impose elevated costs as well as suffering to those affected and their families. Furthermore, mental disorders are often comorbid with physical conditions with an acknowledged bidirectional negative impact on outcomes. Primary care providers are the first contact point for most people with a mental illness seeking treatment. Low detection rates of mental illness among general practitioners (GPs) are an ongoing source of concern. A wide range of interventions are effective for the treatment of common mental disorders in primary care. Pharmacotherapy can be an effective treatment, and evidence-based psychosocial interventions may improve outcome, especially when integrated in coherent collaborative care models. This chapter reports important recent findings on the epidemiology of mental disorders in the community and in primary care. Furthermore, issues related to the recognition of common mental disorders in primary care settings as well as the effectiveness of different interventions are thoroughly discussed.
Across the spectrum: Strategies to improve recognition and treatment of mental disorders in primary care
Authors: Palmer Victoria J. , Whitley Rob 
Published: November 2017

Abstract
There is an abundance of published literature documenting the important role of primary care in the recognition, treatment and management of mental disorders. Despite this, general practitioners, nurses, social workers, occupational therapists, physiotherapists, and other primary health care professionals remain under acknowledged, and the multidisciplinary team arrangements needed for effective management elusive. Individual and community stigma attached to seeking help has not been removed. This chapter provides an overview of these existing barriers and outlines strategies for implementation to improve recognition and treatment of mental disorders across the spectrum in primary care. These strategies are focused on the delivery of whole person, resulting in integrated and person-centred care.
Collaborative care models for the management of mental disorders in primary care
Authors: van der Feltz-Cornelis Christina , van Marwijk Harm , Hakkaart-van Roijen Leona 
Published: November 2017

Abstract
This critical review sketches the principles of collaborative care models in general practice for treatment of common mental disorders, such as depressive, anxiety, or somatoform disorders. Such disorders may not be self-limiting and have a tendency to become chronic, and their treatment in the general-practice setting demands a change in organization of general practice according to a chronic care model, i.e. collaborative care. In collaborative care, at least two of the following three professionals work together to alleviate the mental health burden of the patient: the general practitioner (GP), the nurse care-manager (CM), and the consultant psychiatrist (CL). The model is commonly effective but it is also more expensive. The implementation of collaborative care depends on the availability of CMs and CLs, guidelines for psychiatric consultation, reimbursement, and adequate web-based decision aids for the professionals. Its structural implementation in general practice requires a sustained effort at national level.
Anxiety disorders in primary care
Authors: Dold Markus , Kasper Siegfried 
Published: November 2017

Abstract
Chapter 7 summarizes the epidemiology, clinical characteristics, and evidence for pharmacological treatment options of generalized anxiety disorder, panic disorder, agoraphobia, specific phobia, and social anxiety disorder. With regard to the pharmacological management, serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) represent the well-established first-line medication for generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social anxiety disorder. In GAD, also the calcium channel modulator pregabalin can be regarded as evidence-based treatment option. In simple cases of specific phobia, however, the initiation of a pharmacotherapy is not recognized as standard treatment according to international treatment guidelines and psychotherapeutic interventions should be preferred. Besides illustrating the pharmacological treatment options, we described the actualized diagnostic criteria for anxiety disorders established in the newly introduced fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).
Suicide and suicidal behaviour
Authors: Isometsä Erkki 
Published: November 2017

Abstract
Over 800 000 people are estimated to die worldwide by suicide. Based on psychological autopsy studies, nine out of ten subjects who die by suicide have likely suffered from a diagnosable mental disorder preceding death. Because primary health care in most countries provides services for the majority of patients with depressive or substance use disorders, this setting should be the first point of call for suicide prevention. However, despite this central importance, research on incidence and prevalence of suicide deaths, attempts, ideation, or risk factors for suicidal behaviour in primary care settings is quite limited. Information on risk factors is mostly extrapolated from psychiatric or general population epidemiological studies. For purposes of prevention, improving quality and continuity of care of depression and substance use disorders, as well as integrating brief psychosocial interventions into primary care to target suicidal behaviour, are factors of central importance.
Substance use disorders in primary care settings
Authors: Broad Kathleen , George Tony P. 
Published: November 2017

Abstract
This chapter provides a practical and evidence-based approach to the screening, assessment, and treatment of substance use disorders (SUDs) in the primary care setting. SUDs according to the DSM-5 is defined and the evidence for validated screening tools in the primary care setting is discussed. A primary care approach to the assessment of SUDs is described in detail including assessing readiness to change using the transtheoretical model, motivational interviewing techniques, assessing medical and psychiatric comorbidities, and determining treatment setting using the ASAM Criteria. A detailed overview of the epidemiology, acute and chronic effects, and withdrawal syndromes associated with alcohol, opioid, stimulant, cannabis, and nicotine is provided. Finally, behavioural interventions for SUDs including relapse-prevention and evidence-based pharmacotherapies for tobacco, alcohol, and opioids use disorders are reviewed.
Psychosis
Authors: Kulkarni Jayashri , Gavrilidis Emorfia , Nathoo Shainal , Grigg Jasmin 
Published: November 2017

Abstract
Treating patients with psychotic disorders like schizophrenia can be challenging for many primary care practitioners. Many health professionals are intimidated by the prospect of treating severe mental illness, and most do not have the training or experience required to deliver newer psychosis interventions.
Psychotherapeutic interventions
Authors: Cosci Fiammetta , Fava Giovanni Andrea 
Published: November 2017

Abstract
Primary care physicians may offer a comprehensive care of patients having psychiatric ailments. Psychological interventions are effective in treating major depressive disorder, anxiety disorders, somatic symptom disorders, and tobacco use disorders in primary care settings. Psychotherapeutic approaches are effective either as an alternative or as an adjunct to pharmacotherapy, with enduring benefits after discontinuation of drug treatment. Psychotherapy also represents a pilot area of intervention to treat withdrawal symptoms and disorders due to the tapering or discontinuation of psychotropic medications, in particular selective serotonin reuptake inhibitors (SSRIs). This chapter illustrates the basic steps to establish routine evidence-based psychotherapy for unipolar depression, anxiety disorders, somatic symptom disorder, and substance use disorders in primary care settings. Some factors should be considered to formulate a proper treatment plan for mental disorders in primary care, including primary care physicians’ clinical judgment, availability of treatment, and patient’s preference.
Major depressive disorder: how to evaluate and manage patients with psychiatric and medical comorbidities
Authors: Wang Sheng-Min , Pae Chi-Un 
Published: November 2017

Abstract
Major depressive disorder (MDD) is a highly prevalent, chronic, and recurring mental health condition. A substantially high rate of psychiatric and medical comorbidities occurs in individuals with MDD. Furthermore, MDD and these related comorbidities often exhibit bidirectional and reciprocal relationships, where psychiatric and medical comorbidities worsen the prognosis of MDD, and vice-versa. However, the significant symptomatic overlap between MDD and other chronic psychiatric and medical comorbid conditions imposes significant challenges for the assessment and management of these patients in primary care settings. Thus, the influence of psychiatric and medical comorbidities in the treatment of MDD has increasingly become an issue of major public health concern. Collaborative care models hold promise as an effective strategy for the management MDD and comorbid conditions in primary care. This chapter comprehensively reviews evidence pertaining to the evaluation and treatment of MDD and comorbid chronic health conditions in primary care.
Acute Human Immunodeficiency Virus (HIV) Infection Presenting With Bilateral Interstitial Pneumonia: Case Report and Discussion of Potential HIV-Induced Interstitial Pneumonia
Authors: Peri Anna Maria , Alagna Laura , Trovati Serena , Sabbatini Francesca , Rona Roberto , Simonetti Francesco Roberto , Foresti Sergio , Migliorino Guglielmo Marco , Gori Andrea , Bandera Alessandra 
Published: November 2017

Abstract
A 50-year-old man was admitted to intensive care unit because of acute respiratory failure due interstitial pneumonia; after admission, a diagnosis of acute human immunodeficiency virus (HIV)-1 infection was made. Clinical and radiological improvement was observed only after introduction of antiretroviral treatment. We discuss the hypothesis of interstitial pneumonia induced by the acute HIV-1 infection.
Student Perceptions of Clinical Instructor Characteristics Affecting Clinical Experiences
Authors: Reising Deanna L. , James Breya , Morse Ben 
Published: November 2017

Abstract

AIM
The purpose of this study was to explore and describe students’ perceptions of clinical instructor characteristics that affect their clinical experiences.

BACKGROUND
Clinical instructors can have a profound impact on student clinical experiences, yet little is known about what clinical instructor characteristics promote and hinder quality clinical experiences from the student perspective.

METHOD
A multisite prospective, descriptive exploratory design was used.

RESULTS
Students ranked instructor knowledge and support as the highest desirable characteristics, followed by patience, creating challenges, enthusiasm, and organization. Emerging themes from the content analysis revealed that the ability of the instructor to convey knowledge, demonstrate professionalism, and exhibit enthusiasm and caring were key characteristics that influence the clinical experience.

CONCLUSION
Nurse educators can use the results of this study to target hiring and placing of desired characteristics of clinical instructors and to support mentoring programs that promote clinical teaching excellence.
Bilateral Sacral Ala Fractures Are Strongly Associated With Lumbopelvic Instability
Authors: Bishop Julius A. , Dangelmajer Sean , Corcoran-Schwartz Ian , Gardner Michael J. , Routt Milton L. Chip , Castillo Tiffany N. 
Published: November 2017

Objectives:
To quantify the incidence of lumbopelvic instability in the setting of unilateral and bilateral sacral fractures and assess whether the presence of bilateral sacral fractures on axial imaging is a useful screening test for lumbopelvic instability.

Design:
Retrospective case series.

Setting:
Level I trauma center at an academic medical center.

Patients/Participants:
A hospital database was used to identify patients diagnosed with a sacral fracture by The International Classification of Diseases, Ninth Revision (ICD-9) code from 2000 to 2014.

Intervention:
Axial cross-sectional imaging was reviewed to confirm the presence of unilateral or bilateral sacral ala fractures. Sagittal reconstructions were scrutinized for a transverse fracture line separating the lumbar spine from the pelvis, which was used to define lumbopelvic instability.

Main Outcome Measurements:
The Roy-Camille classification system was applied to all identified cases of lumbopelvic instability.

Results:
One thousand five hundred twenty-six patients were diagnosed with sacral fractures by the ICD-9 code. Four hundred ninety had adequate axial and sagittal cross-sectional imaging. Four hundred forty-three of these patients had unilateral sacral ala fractures, and none of these were associated with lumbopelvic instability. Forty-seven patients had bilateral sacral ala fractures, and 41 of these (87%) had a transverse component indicating some degree of lumbopelvic instability. The presence of bilateral sacral fractures was 100% sensitive and 99% specific for lumbopelvic instability. Among fractures with lumbopelvic instability, 27 (66%) were Roy-Camille type 1, 11 (27%) were type 2, and 3 (7%) were type 3.

Conclusions:
Bilateral sacral ala fractures are strongly associated with lumbopelvic instability and can be used as a very sensitive and specific screening tool. All patients with bilateral sacral fractures on axial computed tomography or magnetic resonance imaging should have close assessment of the sagittal plane images to evaluate for this pathology.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Transfusion of Red Blood Cells Stored More Than 28 Days is Associated With Increased Morbidity Following Spine Surgery
Authors: Purvis Taylor E. , Goodwin C. Rory , Molina Camilo A. , Frank Steven M. , Sciubba Daniel M. 
Published: November 2017

Study Design.
A retrospective study.

Objective.
The aim of this study was to describe the association between storage duration of packed red blood cells (PRBCs) and perioperative adverse events in patients undergoing spine surgery at a tertiary care center.

Summary of Background Data.
Despite retrospective studies that have shown that longer PRBC storage duration worsens patient outcomes, randomized clinical trials have found no difference in outcomes. However, no studies have examined the impact of giving the oldest blood (28 days old or more) on morbidity within spine surgery.

Methods.
The surgical administrative database at our institution was queried for patients transfused with PRBCs who underwent spine surgery between December 4, 2008, and June 26, 2015. Patients undergoing spinal fusion, tumor-related surgeries, and other identified spine surgeries were included. Patients were divided into two groups on the basis of storage duration of blood transfused: exclusively ≤28 days’ storage or exclusively >28 days’ storage. The primary outcome was composite in-hospital morbidity, which included (1) infection, (2) thrombotic event, (3) renal injury, (4) respiratory event, and/or (5) ischemic event.

Results.
In total, 1141 patients who received a transfusion were included for analysis in this retrospective study; 710 were transfused exclusively with PRBCs ≤28 days’ storage and 431 exclusively with PRBCs >28 days’ storage. Perioperative complications occurred in 119 patients (10.4%). Patients who received blood stored for >28 days had higher odds of developing any one complication [odds ratio (OR) = 1.82; 95% confidence interval (95% CI), 1.20–2.74; P = 0.005] even after adjusting for competing perioperative risk factors.

Conclusion.
Blood stored for >28 days is independently associated with higher odds of developing perioperative complications in patients transfused during spinal surgery. Our results suggest that blood storage duration may be an appropriate parameter to consider when developing institutional transfusion guidelines that seek to optimize patient outcomes.

Level of Evidence: 3
Immunomodulation of Human Mesenchymal Stem/Stromal Cells in Intervertebral Disc Degeneration
Authors: Teixeira Graciosa Q. , Pereira Catarina Leite , Ferreira Joana R. , Maia André F. , Gomez-Lazaro Maria , Barbosa Mário A. , Neidlinger-Wilke Cornelia , Goncalves Raquel M. 
Published: November 2017

Study Design.

Ex vivo experimental study.

Objective.
To investigate the effect of proinflammatory/degenerative intervertebral disc (IVD) microenvironment on the regenerative and immunomodulatory behavior of mesenchymal stem/stromal cells (MSCs), using an ex vivo model from bovine origin.

Summary of Background Data.
Low back pain is a cause of disability worldwide, most frequently associated with IVD degeneration and inflammation, and characterized by increased levels of inflammatory mediators, often disregarded. MSC-based therapies to low back pain have been advocated, but the involvement of inflammation in IVD remodeling mechanism, promoted by MSCs has not yet been explored.

Methods.
Bovine IVD organ cultures of nucleus pulposus punches were stimulated with needle puncture and culture medium supplementation with 10 ng/mL of interleukin (IL)-1β, to induce a proinflammatory/degenerative environment, as previously established. Human bone marrow–derived MSCs were cultured on top of transwells, placed above nucleus pulposus punches, for up to 16 days. MSCs were analyzed by screening cell viability/apoptosis, metabolic activity, migration, and inflammatory cytokines production in response to the proinflammatory environment. IVD extracellular matrix (ECM) remodeling, gene expression profile of IVD cells, and inflammatory cytokine profile in the presence of MSCs in basal versus proinflammatory conditions were also evaluated.

Results.
Proinflammatory/degenerative IVD conditions did not affect MSCs viability, but promoted cell migration, while increasing IL-6, IL-8, monocyte chemoattractant protein-1, and prostaglandin E2 and reducing transforming growth factor-β1 production by MSCs. MSCs did not stimulate ECM production (namely type II collagen or aggrecan) in neither basal nor inflammatory conditions, instead MSCs downregulated bovine proinflammatory IL-6, IL-8, and TNF-α gene expression levels in IL-1β-stimulated IVDs.

Conclusion.
The present study provides evidence for an immunomodulatory paracrine effect of MSCs in degenerated IVD without an apparent effect in ECM remodeling, and suggest an MSCs mechanism-of-action dependent on a cytokine feedback loop.

Level of Evidence: 5
Anesthesia and Young Brains
Authors: Hall Keeley , Derouin Anne 
Published: November 2017

Abstract
Millions of children undergo anesthesia each year, and although some surgeries are medically necessary, the possible neurocognitive benefits of delaying elective surgeries in young pediatric patients need to be discussed between families and healthcare professionals as repeated or prolonged exposure to anesthesia in children less than 3 years old may negatively affect brain development. Nurses must be aware of the U.S. Food and Drug Administration recommendation and evolving research as they serve a key role in educating and supporting families through the perioperative process. This article discusses the recent U.S. Food and Drug Administration statement recommendations and its implications in clinical practice.
Selective Filopodia Adhesion Ensures Robust Cell Matching in theDrosophilaHeart
Authors: Zhang Shaobo , Amourda Christopher , Saunders Timothy E. 
Published: November 2017

SummaryThe ability to form specific cell-cell connections within complex cellular environments is critical for multicellular organisms. However, the underlying mechanisms of cell matching that instruct these connections remain elusive. Here, we explore the dynamic regulation of matching processes utilizingDrosophilacardiogenesis. During embryonic heart formation, cardioblasts (CBs) form precise contacts with their partners after long-range migration. We find that CB matching is highly robust at the boundaries between distinct CB subtypes. Filopodia in these CB subtypes have different binding affinities. We identify the adhesion molecules Fasciclin III (Fas3) and Ten-m as having complementary differential expression in CBs. Altering Fas3 expression influences the CB filopodia selective binding activities and CB matching. In contrast to single knockouts, loss of both Fas3 and Ten-m dramatically impairs CB alignment. We propose that differential expression of adhesion molecules mediates selective filopodia binding, and these molecules work in concert to instruct precise and robust cell matching.
Dietary and behavioral inferences from dental pathology and non-masticatory wear on dentitions from a British medieval town
Authors: Towle Ian , Davenport Carole , Irish Joel D. , De Groote Isabelle 
Published: November 2017

AbstractDental pathology and wear data can provide valuable insights into diet, cultural practices, and the health of populations. In this study, various dental pathologies and types of wear were recorded for 41 individuals (914 permanent teeth), excavated from the medieval cemetery of St. Owens Church in Southgate Street, Gloucester. Teeth were studied macroscopically with a 10x hand lens to confirm the presence of specific pathologies. Relatively high rates of antemortem chipping on the anterior teeth, and the presence of maxillary central incisor notches, suggested that the Gloucester population commonly used their teeth for non-masticatory activities. Abscessing and antemortem tooth loss fell within previously reported ranges for British medieval sites (2.6% and 6% respectively). However, the sample exhibits extremely high levels of carious lesions and calculus. Nearly 24% of teeth have at least one carious lesion, and the presence of calculus was recorded in 74% of teeth within the sample. Overall caries frequency is similar to sites from later time periods. This frequency may reflect Gloucester’s location as a large port town. Remains from the same area, but the earlier Roman period, also shows high rates of both caries and calculus, suggesting a continuation of consuming certain cariogenic foods is likely.