bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department utilisation and diagnoses in adolescents with postural orthostatic tachycardia syndrome
Authors: Boris Jeffrey R. , Bernadzikowski Thomas 
Published: March 2023

AbstractIntroduction:Data for Emergency Department utilisation and diagnoses in adolescents with postural orthostatic tachycardia syndrome are lacking, making prevention of these visits more difficult to achieve.Materials and methods:We performed a retrospective study of patients with postural orthostatic tachycardia syndrome between ages 12 and 18 years seen in the Emergency Department at a large tertiary care children’s hospital. These subjects were age- and sex-matched with controls, with volume of primary and total diagnoses assessed. Due to the relatively small number of subjects, a ± 3-year variance was used among control patients for age matching.Results:A total of 297 patients in each group were evaluated. The percentage of female patients was 80.5%. The median age of the subjects was 15.1 years (interquartile range 14.1–15.9), and the median age of controls was 16.1 years (interquartile range 14.4–17.4) (p < 0.00001). Patients with postural orthostatic tachycardia syndrome had greater gastroenterologic and headache diagnoses (p < 0.00001); controls had greater autonomic and psychiatric diagnoses.Discussion:Adolescent patients with postural orthostatic tachycardia syndrome who present to the Emergency Department have a preponderance of gastroenterologic and headache complaints versus controls.
Revealing the Statistics of Extreme Events Hidden in Short Weather Forecast Data
Authors: Finkel Justin , Gerber Edwin P. , Abbot Dorian S. , Weare Jonathan 
Published: March 2023

AbstractExtreme weather events have significant consequences, dominating the impact of climate on society. While high‐resolution weather models can forecast many types of extreme events on synoptic timescales, long‐term climatological risk assessment is an altogether different problem. A once‐in‐a‐century event takes, on average, 100 years of simulation time to appear just once, far beyond the typical integration length of a weather forecast model. Therefore, this task is left to cheaper, but less accurate, low‐resolution or statistical models. But there is untapped potential in weather model output: despite being short in duration, weather forecast ensembles are produced multiple times a week. Integrations are launched with independent perturbations, causing them to spread apart over time and broadly sample phase space. Collectively, these integrations add up to thousands of years of data. We establish methods to extract climatological information from these short weather simulations. Using ensemble hindcasts by the European Center for Medium‐range Weather Forecasting archived in the subseasonal‐to‐seasonal (S2S) database, we characterize sudden stratospheric warming (SSW) events with multi‐centennial return times. Consistent results are found between alternative methods, including basic counting strategies and Markov state modeling. By carefully combining trajectories together, we obtain estimates of SSW frequencies and their seasonal distributions that are consistent with reanalysis‐derived estimates for moderately rare events, but with much tighter uncertainty bounds, and which can be extended to events of unprecedented severity that have not yet been observed historically. These methods hold potential for assessing extreme events throughout the climate system, beyond this example of stratospheric extremes.
Male crayfish (Faxonius obscurus, Decapoda: Cambaridae) claws are longer and stronger yet comparable in shape during the reproductive season
Authors: Graham Zackary A , Stubbs Megan B , Loughman Zachary J 
Published: March 2023

Abstract
Animal weapons are diverse and often exaggerated structures associated with sexual selection and male–male combat. Despite their diversity, our knowledge of these structures comes primarily from studies that focus on the size of the weapons and neglect other components, such as their shape or performance. Furthermore, weapons can exhibit species-level plasticity based on nutrition and other ecological variables, but few studies have documented seasonal variation in weapon plasticity. Here, we investigate how weapon size, shape and performance differ across adult male reproductive and non-reproductive Allegheny crayfish, Faxonius obscurus. Given that F. obscurus and other cambarid crayfishes exhibit cyclical moulting between reproductive and non-reproductive states, they provide an ideal system in which to investigate such questions. We found that claws of reproductive and non-reproductive male F. obscurus differ in all three weapon components we investigated; claws from reproductive males were longer, stronger and different in shape compared with claws from non-reproductive males. Wielding longer and stronger claws is likely to confer greater competitive success during the mating season, which demonstrates an unexplored pattern of seasonal weapon plasticity. We discuss these results considering our knowledge of the seasonality of weapon phenotypes and propose several avenues of future research using cambarid crayfish as a model system.
Knocking at the Door
Authors: Engel Kirsten G. , Derse Arthur 
Published: March 2023

Abstract
In the emergency department (ED), many of our patients face critical illness or injury, with impact that extends far beyond themselves and profoundly affects their families and loved ones. While our primary obligation is to our patients, the engagement and support of families are important aspects of providing high-quality care in any setting. In the most acute and desperate moments, family presence during resuscitation, also known as family witnessed resuscitation (FWR), provides families with the opportunity to be present and connected with their loved one. Given the poor outcomes associated with cardiopulmonary resuscitation, FWR frequently results in families witnessing the final moments of the patient’s life. This experience is associated with many positive effects for survivors, including a more fluid transition to a healthy grief and bereavement process. Moreover, this intervention can have important benefits for patients and healthcare providers. Despite its recognized positive effects, FWR has evoked significant opposition and controversy because it represents a dramatic paradigm shift in our approach to care in the ED. This type of momentous change challenges the healthcare system and requires time, patience, and thoughtful consideration about how to overcome barriers and ensure best practice. For FWR, candid discussion among providers, with opportunities for education and training, is extremely important to facilitating change and improving the care of our patients and their families in the future.
Let’s Get It Right
Authors: Lamba Sangeeta , Goett Rebecca 
Published: March 2023

Abstract
Hospice care is a type of interdisciplinary healthcare for patients at the end of life that focuses on quality of life, comfort, and caring along the course of a patient’s terminal illness. In the United States, hospice care is defined by the Medicare Hospice Benefit and requires the patient to have a limited prognosis with a limited life expectancy as well as the goals of care that are aligned with comfort care. Most hospice care is provided at home with the family as the primary caregivers, although it may be provided in other settings, such as assisted living, long-term care facilities, and other community settings. Hospice providers manage the full spectrum of patient needs, including physical, spiritual, psychosocial, and emotional distress. Inpatient hospice units, where available, are utilized for patients when their care needs cannot be managed at home, such as those with significant and refractory symptoms. Referral to the hospice system of care, whether inpatient or outpatient, can be accomplished directly from the emergency department, provided that there are operational mechanisms in place to allow for transitions of care to hospice.
Global Aspect of Palliative Care
Authors: Flynn Emilee , Majzoub Imad El 
Published: March 2023

Abstract
Access to palliative care services remains extremely inadequate in resource-limited settings throughout the world. In nearly one-third of the world, there is no access to palliative care services. Yet low- and middle-income countries (LMICs) often have a much higher need for palliative care. Individuals in LMICs have limited access to regular surveillance and preventative care and therefore are diagnosed at more advanced stages of disease where options for curative therapy are sparse. Eighty-one percent of the individuals who experience significant suffering near the end of life died in LMICs. Access to opioid medications, which are essential analgesics, remains a challenge in LMICs. Over 5 billion people worldwide have extremely limited to no access to such medications. Opiophobia, lack of provider knowledge and comfort with opioid medications, restrictive national government policies and regulations, high medication cost, and cultural norms and values contribute to this disparity. While providers and policymakers should continue to advocate for improved access to opioids, the use of alternative symptom management strategies, including nonsteroidal anti-inflammatory drugs, antidepressants, anticonvulsants, antispasmodics, bisphosphonates, and corticosteroids, should be considered. In remote and rural areas, where access to palliative care would otherwise be nonexistent, trained community health workers (CHWs) can help provide support and guidance to patients and their families. The presence of CHWs has immensely contributed to reduced patient suffering at the end of life, even when opioids were unavailable or inaccessible.
Not One More Thing
Authors: Neugarten Carter , Wang David 
Published: March 2023

Abstract
Palliative care consultation in the emergency department (ED) can be helpful to ED teams, patients, and families alike. The emergency clinician may, through a more objective approach, be able to identify unmet palliative care needs, such as functional debility, symptom burden, and lack of prognostic awareness. Earlier palliative care involvement has been shown to significantly decrease hospital length of stay and cost, and it has demonstrated marked improvements in depression, anxiety, and well-being across multiple disease states. Subspecialty palliative care consultation in the ED can be helpful in several ways. First, it can assist with gaining a broader view of the clinical course and gather additional history and perspective that might not have been gained through coordination with other providers or additional historians. Consultants can help clarify a patient’s goals of care, assist with difficult symptom management, and help provide guidance on patients enrolled in hospice or with hospice enrollment from the ED. Palliative care consultants can also assist in disposition determination and help to create safe discharge and follow-up plans. There is a spectrum of models for how palliative care can support the ED, ranging from “as needed” palliative consultation by standard ED practice, to dedicating and embedding a multidisciplinary palliative care team into the ED.
Ibogaine: Ibogaine therapy as a method of care treatment for opioid dependence
Authors: Mash Deborah C. 
Published: March 2023

Abstract
Ibogaine has been used as a botanical preparation from the root bark of Tabernanthe iboga for over one hundred years, both as a crude preparation and as semisynthetic ibogaine. Extracts derived from this plant have a long history of traditional medicinal and ceremonial use in Western Africa. Ibogaine is a polypharmacology drug that acts on several neurotransmitter systems, including biogenic amines (dopamine and serotonin [5-HT]), and peptidergic (opioid), cholinergic (neuronal nicotinic), and glutamatergic systems. The UK Medicines and Healthcare Products Regulatory Agency (MHRA) recently granted approval to commence subject enrolment in a Phase 1/2a clinical trial of ibogaine. The Phase 1 part of the study will provide an assessment of safety at escalating doses of ibogaine, while the randomized, placebo-controlled Phase 2 part of the study is designed to provide proof of concept in patients who seek to detoxify from opioids. While there are no other ongoing GLP clinical trials in the United States or elsewhere, there is a large amount of information on the clinical use of ibogaine. These reports demonstrate that the drug not only helps manage the physical symptoms of opioid withdrawal, but also the behavioural aspects of addiction that drive relapse.
Other psychedelics
Authors: Linden James , Robin Daniel 
Published: March 2023

Abstract
This chapter will detail some of the lesser-known psychedelics. While lesser known, some of these are arguably the most potent molecules, and one could argue these hold the most potential for medicine. We will go on a small journey into a lesser-understood corner of plant medicine and psychedelics. Many of the psychedelics discussed so far in this publication have well-elucidated and reasonably well-developed psychopharmacology. The lesser knowns are similarly less understood and have novel effects, the causes of which are still essentially baffling. In the great pursuit of psychedelic science there has been an increased interest to understand the potential of these lesser knowns, which will be overviewed here. There are also significantly fewer clinical data available for these, in fact, none in some cases, at least not of huge or encouraging impact to humanity thus far. It gives great pleasure to present five lesser knowns.
Suicidal Narrative
Authors: Galynker Igor 
Published: March 2023

Abstract
This chapter introduces the concept of the suicidal narrative component of the narrative-crisis model of suicide, a coherent life story of progressive failure and alienation culminating in the perception of no future, which may trigger suicide crisis syndrome, thus increasing an imminent risk of suicidal behavior. Seven stages of the suicidal narrative, including entitlement to happiness, failure to redirect to more realistic goals, humiliating personal or social defeat, perceived burdensomeness, thwarted belongingness, and perception of no future, are described in great detail and illustrated with clinical case examples. The suicidal narrative interview algorithm outlined in this chapter can be used to assess suicide risk. The interview starts with a careful assessment of each of the suicidal narrative stages and concludes with the construction of the suicidal narrative, an outline of a life story that has gone awry. The proposed interview algorithm should be personalized to reflect the uniqueness of each clinical situation. Clinical cases provided in this chapter illustrate how the algorithm can be adjusted depending on the course of the interview.
The Narrative-Crisis Model of Suicide as a Framework for Suicide Prevention
Authors: Goncearenco Inna , Chennapragada Lakshmi , Rogers Megan L. 
Published: March 2023

Abstract
Chapter 10 provides an overview of applicable clinical interventions that have demonstrated promise in mitigating suicide risk at each stage of the suicidal process. The interventions are: lethal means counseling, safety planning, psychopharmacology, crisis management, psychotherapy, and skills coaching. Each treatment modality is placed in the framework of the narrative-crisis model of suicide (NCM) and addresses symptoms arising over the course of a suicidal episode and across all NCM stages: suicidal crisis syndrome, suicidal narrative, and trait vulnerabilities. The chapter also provides a brief overview of recent developments in digital interventions targeting suicidal thoughts and behaviors. Cultural considerations applicable to suicidality treatment are outlined, emphasizing the need for culturally competent approaches to suicide prevention and intervention. In conclusion, implications for future research and clinical practice are discussed.
Brain and Spinal Cord Function
Authors: Gluncic Vicko 
Published: March 2023

Abstract
The central nervous system (CNS) has two major subdivisions: the brain and the spinal cord. The brain controls the majority of body functions, including awareness, memory, thoughts, emotions, movements, speech, and sensations. In addition to being an “interface” between the brain and the spinal nerves, the spinal cord has some functional autonomy and participates in regulation of both ascending and descending signals. Both CNS components share embedded in cerebrospinal fluid, and their blood flow is tightly regulated. Moreover, their parenchyma is separated from the blood by the blood-brain barrier. As many anesthetic procedures interfere with CNS activities, either as the primary mode of action or as a side effect, sound knowledge of CNS anatomy and physiology is a basis for good anesthesia practice.
ASA Monitoring Standards
Authors: Eden Nikki , Rajan Shobana 
Published: March 2023

Abstract
The American Society of Anesthesiologists sets a standard for monitoring during all anesthetic cases. Oxygenation, ventilation, circulation, and temperature are the four key components being measured. Included in these are pulse oximetry, capnography, end-tidal CO2, electrocardiography, arterial blood pressure, and temperature. With these, the anesthesiologist is able to obtain objective information that, when used with clinical acumen, will provide the highest level of patient care and safety. These standards must be met for every case, whether the anesthetic being delivered is general, regional, or monitored anesthesia care. However, these are only the minimum requirements, and further monitoring may be used at the discretion of the anesthesiologist.
Brain Volume
Authors: Shin John S. , Bui Timothy T. 
Published: March 2023

Abstract
Brain volume consists of cells, intracellular and extracellular fluid, and blood within cerebral vasculature. An increase in brain volume beyond the compliance of the system can lead to elevated intracranial pressure and irreversible ischemia. Brain fluid content can be rapidly reduced by an osmotic diuretic and/or a loop diuretic. Methods for decreasing cerebral blood flow include positioning to maximize venous drainage (head elevated, neck neutral); minimizing intrathoracic pressure; hyperventilating; inducing mild hypothermia; and administering intravenous anesthetics rather than inhaled agents. If not appropriately treated, increased brain volume can lead to compression of the vasculature, brain ischemia, and infarct, which can result in permanent neurologic deficits and death.
Truncal Nerve Blocks
Authors: Scholzen Elizabeth , Klesius Lisa 
Published: March 2023

Abstract
Truncal nerve blocks encompass a wide variety of nerve blocks. Intercostal, paravertebral somatic, ilioinguinal, and genitofemoral nerve blocks are described in this chapter. Intercostal and paravertebral blocks can be used as surgical or analgesic blocks for cases involving the chest wall, including thoracic and breast surgery, or for traumatic rib fractures. Ilioinguinal and genitofemoral nerve blocks come off the L1 and L2 nerve roots and can be used for inguinal hernia repair surgery as well as others. All of these nerve blocks can be performed with either a landmark-based or ultrasound-based approach. Complications of these nerve blocks vary depending on the block but share in common the complications of bleeding, infection, and potential nerve damage. Truncal nerve blocks are a broad category describing several nerve blocks. Intercostal, paravertebral somatic, ilioinguinal, and genitofemoral nerve blocks are described here.
Innervation of Pelvic Structures
Authors: Yi Peter , Vorenkamp Kevin E. 
Published: March 2023

Abstract
Structures of the pelvis are innervated by a complex array of nerves. The autonomic nervous system contributes the sympathetic and parasympathetic innervations of the pelvic organs, which have opposing actions. The sacral splanchnic nerves contribute sympathetic innervation to the pelvic organs, while the pelvic splanchnic nerves contribute parasympathetic innervation. Visceral nerve fibers converge with other types of nerves, forming a complicated network responsible for visceral innervation of the pelvic structures. Finally, somatic nerves from various plexuses send terminal nerves (sensory, motor, or a combination) to pelvic organs. Although the innervation of the pelvis may seem complicated, careful study of each component of the nervous system can be helpful for understanding the innervation of the organs in the pelvis.
Pharmacogenetics and Genetic Factors in Drug Dose-Response Relationships
Authors: Kapp Daniel Gonzalez 
Published: March 2023

Abstract
Pharmacogenetics and pharmacogenomics are related areas of research that aim to determine the relationship between genotypic variation, including changes in gene expression, and variations in drug response seen across patient groups. Understanding the genetic bases of variability in drug response due to altered pharmacokinetics (e.g., drug absorption, distribution, metabolism, excretion) or pharmacodynamics (e.g., drug receptor up- or downregulation) is essential for the practitioner to fully anticipate, recognize, and mitigate potential drug toxicity or ineffectiveness. The ultimate goal of pharmacogenetics and pharmacogenomics is to develop personalized medicine for individuals by leveraging knowledge of phenotypic variation in drug response due to genetic mutations, polymorphisms, or gene expression.
Malignant Hyperthermia
Authors: Papapetrou Peter , Ferguson Kris 
Published: March 2023

Abstract
Malignant hyperthermia (MH) is a rare genetic disorder than can be fatal in affected individuals that are exposed to potent volatile anesthetic agents and succinylcholine. Proper preoperative assessment and preparation can help avoid exposure of a patient to a triggering agent. In the event of exposure, prompt recognition of a suspected MH crisis is critical. Signs and symptoms of a hypermetabolic state could include hyperthermia, increased ETCO2, muscle rigidity, metabolic acidosis, and dysrhythmias. Treatment is made with dantrolene; treating manifestations of the hypermetabolic state such as cooling mechanisms, correcting acid-base imbalances and electrolyte abnormalities; as well as close monitoring for a recurrence of an MH crisis.
Rapid Metabolizers
Authors: Parker Nicholas M. 
Published: March 2023

Abstract
Enzymes in the family known as cytochrome P450 (CYP450) are involved in the metabolism of many drugs. A few key enzymes involved in drug metabolism (namely CYP2D6 and CYP2C19) may be overexpressed in some patients, known as ultrametabolizers. These patients are usually identified by genetic testing only after experiencing treatment failure or adverse reactions with certain drugs. Genetic variation in drug metabolism may exacerbate the effect of drug-drug interactions. Drugs that are metabolized by these two enzymes should be used cautiously in known or suspected ultrametabolizers. Anesthesiologists may have an important role in identifying ultrametabolizers given their ability to closely monitor their patients’ response to medications.