bluuebunny/crossref_metadata_2025 huggingface dataset:
EPSILON-STRONGLY GROUPOID-GRADED RINGS, THE PICARD INVERSE CATEGORY AND COHOMOLOGY
Authors: NYSTEDT PATRIK , ÖINERT JOHAN , PINEDO HÉCTOR
Published: March 2019

We introduce the class of partially invertible modules and show that it is an inverse category which we call the Picard inverse category. We use this category to generalize the classical construction of crossed products to, what we call, generalized epsilon-crossed products and show that these coincide with the class of epsilon-strongly groupoid-graded rings. We then use generalized epsilon-crossed groupoid products to obtain a generalization, from the group-graded situation to the groupoid-graded case, of the bijection from a certain second cohomology group, defined by the grading and the functor from the groupoid in question to the Picard inverse category, to the collection of equivalence classes of rings epsilon-strongly graded by the groupoid.
Endogenous development of Cystoisospora belli in intestinal and biliary epithelium of humans
Authors: Dubey J. P. , Evason Kimberley J. , Walther Zenta
Published: March 2019

Cystoisospora(Isospora)belliis a coccidian parasite of humans. It can cause serious digestive disorders involving infection of intestines, biliary tract and gallbladder, especially in those with depressed immunity. It has a direct fecal–oral transmission cycle. After ingestion of sporulated oocysts, the parasite multiplies asexually and sexually within host epithelial cells, resulting in unsporulated oocysts that are excreted in feces. The details of asexual and sexual stages are not known and certain inclusions in epithelial cells in biopsy samples have been erroneously identified recently asC. belli. Here, we provide details of developmental stages ofC. belliin two patients, in duodenal biopsy of one and biliary epithelium of the other. Immature and mature asexual stages (schizonts/meronts) were seen in epithelial cells. The merozoites were seen singly, in pairs and in groups in single parasitophorous vacuole (pv) in host cytoplasm. Immature and mature meronts were seen together in the same pv; up to eight nuclei were seen in meronts that retained elongated crescent shape; round multinucleated schizonts, seen in other coccidians, were not found. Meronts were up to 25µm long and contained up to ten merozoites that were 8–11µm long. The merozoites and meronts contained PAS-positive granules. Microgamonts (male) contained up to 30 nuclei that were arranged at the periphery and had condensed chromatin; 1–3 PAS-positive, eosinophilic, residual bodies were left when microgametes were formed. The microgametes were 4µm long and PAS-negative. All stages of macrogamonts, including oocysts were PAS-positive. The detailed description of the life cycle stages ofC. bellireported here should facilitate in histopathologic diagnosis of this parasite.
The prevalence of agranulocytosis and related death in clozapine-treated patients: a comprehensive meta-analysis of observational studies
Authors: Li Xiao-Hong , Zhong Xiao-Mei , Lu Li , Zheng Wei , Wang Shi-bin , Rao Wen-wang , Wang Shuai , Ng Chee H. , Ungvari Gabor S. , Wang Gang , Xiang Yu-Tao
Published: March 2019

Background

Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients.

Methods

A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model.

Results

Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3–0.6%) and 0.05% (95% CI 0.03–0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection.

Conclusions

The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.
Hospitalisations with infections related to antimicrobial-resistant bacteria from the French nationwide hospital discharge database, 2016
Authors: Opatowski M. , Tuppin P. , Cosker K. , Touat M. , De Lagasnerie G. , Guillemot D. , Salomon J. , Brun-Buisson C. , Watier L.
Published: March 2019

Massive use of antibiotics has led to increased bacterial resistance to these drugs, making infections more difficult to treat. Few studies have assessed the overall antimicrobial resistance (AMR) burden, and there is a paucity of comprehensive data to inform health policies. This study aims to assess the overall annual incident number of hospitalised patients with AMR infection in France, using the National Hospital Discharge database. All incident hospitalisations with acute infections in 2016 were extracted. Infections which could be linked with an infecting microorganism were first analysed. Then, an extrapolation of bacterial species and resistance status was performed, according to age class, gender and infection site to estimate the total number of AMR cases. Resistant bacteria caused 139 105 (95% CI 127 920–150 289) infections, resulting in a 12.3% (95% CI 11.3–13.2) resistance rate. ESBL-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the most common resistant bacteria (>50%), causing respectively 49 692 (95% CI 47 223–52 142) and 19 493 (95% CI 15 237–23 747) infections. Although assumptions are needed to provide national estimates, information from PMSI is comprehensive, covering all acute bacterial infections and a wide variety of microorganisms.
The health and economic impact of acute gastroenteritis in Belgium, 2010–2014
Authors: Papadopoulos Theofilos , Klamer Sofieke , Jacquinet Stephanie , Catry Boudewijn , Litzroth Amber , Mortgat Laure , Mamouris Pavlos , Rebolledo Javiera , Vaes Bert , Van Cauteren Dieter , Van der Heyden Johan , Beutels Philippe , Devleesschauwer Brecht
Published: March 2019

Acute gastroenteritis (AGE) remains a common condition in both low- and high-income countries. In Belgium, however, there is currently a lack of information on the societal health and economic impact of AGE. We conducted a retrospective study using mortality and cause-of-death data, hospital data, primary care data, health interview survey data and other published data. We estimated the burden of illness during a 5-year period (2010–2014) in Belgium in terms of deaths, patients admitted to hospitals, patients consulting their general practitioner (GP) and cases occurring in the community. We further quantified the health impact in terms of disability-adjusted life years (DALYs) and the economic impact in terms of cost-of-illness estimates. We estimated 343 deaths, 27 707 hospitalised patients, 464 222 GP consultations and 10 058 741 episodes occurring in the community (0.91 cases/person) on average per year. AGE was associated with 11 855 DALYs per year (107 DALY per 100 000 persons). The economic burden was estimated to represent direct costs of €112 million, indirect costs of €927 million (90% of the total costs) and an average total cost of €103 per case and €94 per person. AGE results in a substantial health and economic impact in Belgium, justifying continued mitigation efforts.
A systematic review on neuropsychological function in bipolar disorders type I and II and subthreshold bipolar disorders—something to think about
Authors: King Sinead , Stone James M , Cleare Anthony , Young Allan H
Published: March 2019

Neuropsychological dysfunction is a well-established finding in individuals with bipolar disorder type I (BP-I), even during euthymic periods; however, it is less clear whether this also pertains to bipolar disorder type II (BP-II) or those with subthreshold states (SBP; subthreshold bipolar disorder), such as bipolar not otherwise specified (BP-NOS). Herein, we compare the literature regarding neuropsychological performance in BP-II vs BP-I to determine the extent of relative impairment, and we present and review all related studies on cognition in SBP. After systematically searching PubMed, Medline, PsycINFO, and The Cochrane Library, we found 17 papers that comprise all the published studies relevant for this review. The areas that are consistently found to be impaired in BP are executive function, verbal memory, visual spatial working memory, and attention. More studies than not show no significant difference between BP-I and BP-II, particularly in euthymic samples. Preliminary evidence suggests that patients experiencing major depressive episodes who also meet criteria for SBP show similar profiles to BP-II; however, these results pertain only to a depressed sample. SBP were found to perform significantly better than both MDD and healthy controls in a euthymic sample. A consensus on mood state, patient selection, and neuropsychological testing needs to be agreed on for future research. Furthermore, no studies have used the most recent DSM-5 criteria for SBP; future studies should address this. Finally, the underlying bases of cognitive dysfunction in these diagnostic groups need to be further investigated. We suggest recommendations on all of the above current research challenges.
10 Pharmacodynamics and Tolerability of Intranasally Administered Immediate-Release Amphetamine Sulfate Among Recreational Intranasal StimulantUsers
Authors: Setnik Beatrice , Caras Steve , Sharpe Terrilyn , Faraone Stephen V.
Published: March 2019

Study Objective

Despite increased nonmedical use of ADHD prescription stimulants, there are limited data to inform selection of intranasal doses for abuse-potential evaluations. This study determined a dose of amphetamine sulfate that is tolerable and distinguishable from placebo on pharmacodynamic (PD) measures.

Methods

In this randomized, double-blind, placebo-controlled, dose-escalation study, healthy, nondependent, recreational stimulant users received a single intranasal dose of amphetamine sulfate (20, 30, or 40mg ; n=6 per group) or placebo (n=2 per group). PD and safety were assessed pre-dose and ≤24hours post-dose. Drug Liking was measured using a bipolar Visual Analogue Scale (VAS; 0–100). Dose selection criteria were complete dose insufflation (≥95%); demonstration of peak Drug Liking ≥75 points, and ≥15 points greater than placebo in ≥3 participants receiving active drug; and tolerability.

Results

Peak Drug Liking criteria were met in the 20-, 30-, and 40-mg groups by 2, 0, and 6 participants, respectively. Mean (SD) peak Drug Liking was 62 (13.0), 71 (17.8), and 93 (8.7) for amphetamine sulfate versus 54 (3.5), 76 (34.6), and 51 (0) for placebo in the 20-, 30-, and 40-mg groups, respectively. Thirteen participants experienced mild AEs (n=1, 4, 6, and 1 in 20-, 30-, 40-mg, and placebo groups, respectively), there were no serious or clinically significant AEs. The most common AE was nostril burning sensation (active drug, n=7). There were no instances of an incompletely insufflateddose.

Conclusion

A 40-mg intranasal dose produced distinguishable PD effects and was well tolerated. This dose has been selected for further abuse-potential evaluations.

Funding Acknowledgements: This study was funded by Arbor Pharmaceuticals, LLC.
29 Cryptococcal Meningitis Leading to Fatal Outcomes in Immunocompetent Patients: A Case Study and Review of Literature
Authors: Ramirez-Ramos Cristhian Felipe , Salinas-Cortes Diego , Rivera-Marin Juan Diego , Peralta-Agudelo Maria , Escobar-Montealegre Freddy
Published: March 2019

Introduction

Cryptococcal Meningitis is a fungal infectious disease of worldwide distribution, primarily associated with underlying immunosuppression conditions such as HIV infection, glucocorticoid treatment, status post organ transplantation and oncological treatments. Prevalence is particularly high in third-world countries where it constitutes one of the primary causes of central nervous system infections and may carry fatal outcomes. We present two cases of Cryptococcal Meningitis that portray the vast spectrum of clinical presentations associated with Cryptococcal Meningitis as well as relevant diagnostic and therapeutic implications.

Methods

Case study - These adult otherwise healthy patients presented at a public urban university hospital in southern Colombia. Both had an unusual clinical course and suffered fatal outcomes despite being seemingly immunocompetent at baseline. A diagnosis of hepatic cirrhosis could have been considered a cause of immunosuppression in one of the patients and the diagnostic work-up for the other patient revealed no evidence of immunological deficiency.

Discussion

Cryptococcal Meningitis affecting immunocompetent individuals has been increasingly reported in recent years. Furthermore, outcomes in this population are particularly worse than those generally affected by the disease. A review of the literature related to the possible immunological mechanisms’ underlying the presented clinical course is included. We emphasize the importance of considering Cryptococcus spp. as a possible etiologic agent among differential diagnoses upon encountering suggestive meningeal conditions in immunocompetent patients.

Key words: Cryptococcus neoformans, Meningitis, Immunocompetent

Funding: None.
42 Training Forgiveness – A Novel Approach to Reducing Physician Burnout
Authors: Firulescu Lidia , May Ross W. , Fincham Frank D. , Arocha Emelina A. , Sanchez-Gonzalez Marcos A.
Published: March 2019

Study Objective

Psychological risk factors that lead to impaired work performance, negatively impacting mental and physical health, have emerged as a concern across clinical settings. Although depression and anxiety are linked to poor physician mental health, physician burnout characterized by work related stress due to chronic exhaustion from clinical work, cynicism toward meaning of the medical profession, and feelings of inadequacy toward work related accomplishments, may be an even stronger indicator of well-being. Literature suggests that work satisfaction among physicians is rapidly deteriorating owing to high rates of burn out and poor mental health. Although the relationship between work burnout (WB) and negative affectivity has been well documented, the association with positive affect, such as trait forgiveness (TF) has been overlooked. On that note, research shows that lifetime stress severity and lower levels of forgiveness predict worse mental and physical health. Since TF has been linked strongly with healthy workplace relationships, positive occupational outcomes and general well-being, its association with WB remains to be investigated. Therefore, the aim of the present study was to explore the link between TF and WB among physicians. We hypothesized that TF would be associated with reduced levels of burnout.

Method

A total of 62 (F=23) medical residents at a Teaching Hospital consented for the study. Residents were administered surveys on WB (Maslach BurnoutInventory), workplace bullying, personal bullying (PB), interpersonal rejection sensitivity (IRS), perceived stress scale (PSS), TF, anxiety, and depression, all of which were anonymously submitted via electronically. Hierarchical multiple regression (HMR) models were used to determine the associations between WB, work environment social factors and TF. A p-value of <0.05 was considered significant.

Results

The mean age 33.1±SD 4.2 years. HMR analysis using WB as main outcome contained 6 predictors: Model 1 contained depression and anxiety, Model 2 added PB, Model 3 added IRS and PSS, Model 4 added TF. Anxiety and TF were the only significant predictors (p= >0.05) accounting for 10.4% and 17.5% of the variance in WB scores, respectively.

Conclusions

The novel finding of the present study is that TF was associated with low levels of burnout. Additionally, WB was found to be linked to anxiety and depression which is in line with previous research. These data suggest that TF could be a potential resolution to the deleterious influence of burnout. Further exploration is needed in order to understand the psychology of forgiveness as a potential adjuvant and/or therapeutic intervention for physicians’ burnout. These results suggest that strategies including forgiveness training aimed at decreasing WB while increasing job satisfaction among physicians warrant further exploration.

Funding Acknowledgements: no funding
43 Tinnitus as an Aura for Sleep Paralysis
Authors: Shergill Luvleen , Nayati Jasir , Nair Reshma , Hirsch Alan R.
Published: March 2019

Objective

To understand that tinnitus may be an aura for sleep paralysis.

Background

Sleep paralysis is a transient-paralysis which occurs during awakening or falling asleep (Wilson, 1928). Those affected experience symptoms including visual, auditory, and haptic hallucinations, voluntary motor paralysis with intact ocular and respiratory motor movements, and diffuse or localized paresthesias. Sleep paralysis associated with tinnitus as an aura, has not heretofore been described.

Methods

A 34 year-old, right-handed female presented with a 13 year history of sleep paralysis. One month prior, she began to notice tinnitus prior to the onset of sleep paralysis. The tinnitus was bilateral, high-pitched, with a volume intensity of 5/10, lasting seven seconds prior to sleep initiation. She denied hearing loss, vertigo, dizziness, cataplexy, deja vu and jamais vu. After termination of tinnitus, she experienced paresthesia, “like at a dentist’s office” radiating from her posterior neck, to her tongue and down to her toes. She described seeing a white-shadowy male figure moving around her room, lasting seven seconds. Accompanied by a masculine “ahh” sound, lasting for three seconds. The sleep paralysis occurred after these events, lasting up to eight hours, or until her husband wakes her.

Results

Abnormalities in Physical Examination: General Examination: right arm hemangioma 4 by 5cm. Reflexes: absent bilateral brachioradialis, 1+ bilateral quadriceps femoris and bilateral Achilles tendon. Neuropsychiatric Examination: Calibrated Finger Rub Auditory Screening Test: faint 70 AU (normal).

Discussion

Tinnitus has been described as an aura for migraines (Schankin, 2014), temporal lobe epilepsy (TLE) (Florindo, 2006), and narcolepsy-cataplexy (Marco, 1978). These epochs may represent amigranous migraines, which initially present with tinnitus that occurs both during the day and night, forcing the patient to be partially awoken at night with induction of the sleep paralysis sequence. It would be worthwhile to query those with narcolepsy or sleep paralysis if tinnitus precedes the event.
65 A Retrospective Study of Aripiprazole Long-acting Once-Monthly Introduction Patterns in Galicia
Authors: Iglesias Rebeca Méndez , Arias Daniel Núñez
Published: March 2019

Background

Antipsychotic drug treatment is a key component of multiple psychiatric treatment algorithms. Second-generation long-acting injectable antipsychotics (LAIs) have been shown to improve adherence in numerous clinical trials. Patients who can benefit from LAIs therapy can be treated with aripiprazole long acting once-monthly (AOM). However the nature of the introduction patterns of AOM is not well characterized in clinical practice.

Methods

A retrospective observational study of AOM introduction was conducted on 157 patients aged 18–75 years-old (95 males, 62 females) who were initiated on AOM treatment between January 2017 – December 2017 in two independent Mental Health Units in the autonomous region of Galicia (Spain). An analysis of the different trends in switching strategies and its adaptation to the prescribing information was carried out. Results were compared between different dose treatment plans and a comparison between inpatients and outpatients’ outcomes was also undertaken. Additional data regarding off-label use was obtained from the sample.

Results

The sample was composed of 157 patients: 31% diagnosed of Schizophrenia (n=48), 14% Schizoaffective Disorder (n=22), 21% Delusional Disorder (n=33), 17% Bipolar Disorder (n=27), 10% Brief Psychotic Disorder (n=15), 4% Psychotic Disorder Not Specified (n=6), 2% Obsessive-Compulsive Disorder (n=3), 2% Paranoid Personality Disorder (n=3). Regarding the location of the first dose administration: 44% (n=69) were administered in an Acute Psychiatric Inpatient Unit, 44% (n=65) were administered in Mental Health Outpatient Clinics, 11% (n=18) in Psychiatric Day Hospitals and 3% (n=5), in Assertive Community Treatment Programs. 74% (n=116) of patients received an initial dose of 400mg of AOM whereas 26% (n=41) were given 300mg of AOM. The previous antipsychotic was aripiprazole orale (OA) in 61% (n=96) of the cases. The most frequent switch between LAIs was “immediate switch” and in the switch between orale antipsychotics and AOM “tapering and overlap” was found to be the most common pattern. The average dose was 20mg/day in all groups except for patients diagnosed with Delusional Disorder (15mg/day). The average duration of treatment with OA after the first dose was: 32days for patients with Schizophrenia, 23days for Delusional Disorder, 30days for Bipolar Disorder and 19days in Schizoaffective Disorder.

Conclusions

Our analysis identified two main patterns of drug switching, the most frequent being “tapering and overlap” in oral treatment, followed by “immediate switch” in patients treated with LAIs.

Although our patients are unlike many of those enrolled in clinical trials, the present study indicates that the predominant switching strategies conforms with the Safety Data Sheet.
92 Effects of Smartphone Coaching Intervention on Dietary Intake for Bariatric Surgery Candidates: A Pilot Randomized Controlled Trial
Authors: Kim Youngjung , Sysko Robyn , Michaeledes Andreas , Ramos Tatiana , Hildebrandt Tom
Published: March 2019

Introduction

Bariatric surgery outcomes are variable, often with suboptimal weight loss and/or weight relapse. Smartphone coaching applications offer a potential window of affecting behavioral change to improve outcomes in a widespread and cost-effective way, but clinical efficacy is unknown. In phase I of this pilot study, we investigated effects of pre-surgical treatment with a mobile coaching platform Noom Coach for Bariatric Health.

Methods

Forty adult candidates (82.5% female) for bariatric surgery were recruited for pilot randomized controlled trial (Noom Bariatric Health vs. Standard Care). All participants’ dietary intake was assessed initially and after 8weeks of intervention, with the 24-hour dietary recall (ASA24) to analyze food intake. Paired t-tests were used to compare within group changes in dietary parameters. Independent t-tests were used to assess inter-group differences at the end of treatment.

Results

Post intervention, both Noom and Control groups consumed numerically less total calories, empty calories, fat, and carbohydrates compared to their baseline. Reduction in empty calorie consumption was significant only in Noom (t=2.39, p=0.04, Cohen’s d=0.96) and not in Control (t=0.89, p=0.40, Cohen’s d=0.30). Both total kcal and total fat intake showed larger numerical reductions within Noom (kcal,fat: t=1.94,2.07; p=0.08,0.07; Cohen’s d=1.03,1.06) compared to reductions seen within Control (kcal,fat; t=0.41,0.48; p=0.69,0.64; Cohen’s d=0.14,0.16). There were no other significant changes in macronutrients and micronutrients within groups. At the end of treatment, Noom compared to Control groups had significantly lower percentage fat intake (t=3.02, p=0.008, Cohen’s d=1.42) without initial difference at screening (t=1.12, p=0.27, Cohen’s d=0.36).

Discussion

Though limited due to small sample size, preliminary results appear promising that mobile coachingintervention may have beneficial effects on diet pre-bariatric surgery. We will discuss the impact of these findings on potential post-surgery outcomes.

Funding Acknowledgements: NIH R44DK116370, Mount Sinai Hospital
96 The Cat’s Meow? Feline Warning of Imminent Seizures
Authors: Winchester Chevelle R. , Chioma Emeto B. , Hirsch Alan R.
Published: March 2019

Study Objective

Cats may respond to seizures with a threat response (Strong, 1999). Detailed description of this for seizures or pseudoseizures has not heretofore been described.

Method

Case study: A 29-year-old right handed female, two years prior to presentation, developed onset of seizures which last approximately one minute, almost on a daily basis. These are associated with shortness of breath and postictal blurred vision. During these epoch, she would experience temporary amnesia; a feeling as if she had lost a couple years of memory which gradually returned within an hour. Pain and stress would precipitate a seizure. There were two different types of seizures. The first type was with an aura of white visual entopias in the center of her visual field without postictal amnesia. The second type is without aura, but there is amnesia for the event. In neither type would she bite her tongue nor manifest urinary or fecal incontinence. Just preceding either type of seizures, her cat, would uncharacteristically meow, saunter over to her, and nudge her head against her legs or scratch her with her front paws. In response to this, the patient would move as fast as she could to a safe place where she would be cushioned if she were to fall. Less than a minute after the cat would warn her, a seizure would manifest. During this event the cat would meow and lay beside her “as if guarding me” until the seizure would resolve. The cat has never displayed these behaviors unless a seizure was eminent. She admitted to daily panic attacks which the cat appeared to ignore.

Results

Abnormalities in physical examinations: General: 1+ bilateral pedal edema. Neurological examination: Mental status examination: Digit span: 7 forward and 2 backwards. Able to spell the word “world” forwards but not backwards. (CN) examination: CN III, VI and IV: Right lateral rectus weakness. Reflexes: bilateral 3+ brachioradialis and quadriceps femoris. Absent ankle jerk. Positive jaw jerk with clonus. Bilateral positive Hoffman’s reflexes. Neuropsychiatric testing: Clock drawing test: 3 (abnormal). Go-No-Go Test: 6/6 (normal). 72-hour EEG normal.

Conclusion

Olfactory emanations occur (Brown, 2011) several hours prior to seizures (Litt, 2009; Rajna, 1997) which the feline may be sensitive due to its superior olfactory ability. The cat’s comportment may have induced anxiety in the patient, which then may have precipitated the seizure. The animal thus may be an epileptogenic animal rather than a warning animal. The cat may detect changes in emotion, which predicts the pseudoseizures. On the other hand, the cat may have been acting as an anxiogenic agent, precipitating a pseudoseizure. There may have been a misattribution error, such that she recalled the cat in a position of warning seizures but did not recall when the cat did not warn the seizures. Further investigation in the use of alarm cats as warning for imminent seizures is warranted.
98 Dronabinol-Induced Hypomania: A Case Report and Literature Review
Authors: Sinha Shirshendu , Umbreit Audrey , Sieberg Charles
Published: March 2019

Purpose

Present a case of dronabinol-induced hypomania.

Background

Dronabinol is a synthetic derivative of cannabis that is commonly prescribed for chemotherapy-induced nausea and vomiting or cachexia due to HIV/AIDS. The safety in those with bipolar disorder warrants further investigation as previous studies suggest that the use of cannabis may be associated with exacerbation of manic symptoms. The risk of developing manic symptoms in patients with bipolar disorder who use dronabinol is largely unknown. Clinical Case: A 55-year-old Caucasian male, following with psychiatry since July of 2016 for substance use disorder (alcohol, cocaine and cannabis), bipolar I disorder, generalized anxiety, PTSD, and intermittent sleep disturbances, was prescribed dronabinol 2.5mg twice daily on 5/19/17 to treat wasting syndrome and significant weight loss due to underlying HIV. He has been abstinent from alcohol, tobacco, and illicit substances for more than a year. The patient’s relevant medication list includes: bupropion XL 150mg daily, quetiapine 300mg daily at bedtime, and trazodone 50–100mg at bedtime. At psychiatrist visit on 7/10/17, his bipolar disorder was noted to be stable. But, after his dose of dronabinol was increased on 7/21/17 to 5mg twice daily, the patient presented to psychiatrist on 8/1/2017 in a state of hypomania, with symptoms including: increased interest in sex, insomnia and increased animation. His judgment and impulse control were slightly impaired. Excluding the dronabinol dose increase, no other medication changes had taken place and the patient was not using alcohol or other substances. Quetiapine was discontinued and olanzapine 10mg at bedtime was started. Bupropion was discontinued, trazodone was tapered off, and dronabinol was discontinued. Upon follow up within a month, our patient’s hypomania symptoms resolved. He was also gaining weight with the olanzapine and reported improved sleep. He was continued on olanzapine 10mg at bedtime and continued off the trazodone, bupropion and dronabinol. He continues to remain abstinent from alcohol and illicit drugs.

Discussion

The underlying mechanism of dronabinol-induced manic symptoms in those with bipolar disorder remains unclear but may involve dopamine. Sensitization of the dopaminergic system by THC is thought to be associated with the development of manic symptoms in those that use cannabis. THC is associated with increased dopaminergic cell firing, dopamine synthesis, and dopamine release when used acutely.

Other medications associated with causing manic symptoms include bupropion and trazodone, as relevant to our case. However, our patient was stable on these medications before the addition of dronabinol. Thus, it is reasonable to conclude that the dronabinol likely caused our patient’s hypomania symptoms.

Conclusion

This case emphasizes the need to evaluate mental health conditions before prescribing cannabis derivatives such as dronabinol.
A behavioural economics approach to improving healthy food selection among food pantry clients
Authors: Caspi Caitlin E , Canterbury Marna , Carlson Samantha , Bain Jamie , Bohen Laura , Grannon Katherine , Peterson Hikaru , Kottke Thomas
Published: March 2019

Objective

To test the effect of a behavioural economics intervention in two food pantries on the nutritional quality of foods available at the pantries and the foods selected by adults visiting food pantries.

Design

An intervention (SuperShelf) was implemented in two food pantries (Sites A and B), with two other pantries (Sites C and D) serving as a control for pantry outcomes. The intervention aimed to increase the amount and variety of healthy foods (supply), as well as the appeal of healthy foods (demand) using behavioural economics strategies. Assessments included baseline and 4-month follow-up client surveys, client cart inventories, pantry inventories and environmental assessments. A fidelity score (range 0–100) was assigned to each intervention pantry to measure the degree of implementation. A Healthy Eating Index-2010 (HEI-2010) score (range 0–100) was generated for each client cart and pantry.

Setting

Four Minnesota food pantries, USA.

Participants

Clients visiting intervention pantries before (n 71) and after (n 70) the intervention.

Results

Fidelity scores differed by intervention site (Site A=82, Site B=51). At Site A, in adjusted models, client cart HEI-2010 scores increased on average by 11·8 points (P<0·0001), whereas there was no change at Site B. HEI-2010 pantry environment scores increased in intervention pantries (Site A=8 points, Site B=19 points) and decreased slightly in control pantries (Site C=−4 points, Site D=−3 points).

Conclusions

When implemented as intended, SuperShelf has the potential to improve the nutritional quality of foods available to and selected by pantry clients.
Investigation of Coatings for Langmuir Probes: Effect of Surface Oxidation on Photoemission Characteristics
Authors: Samaniego Joseph I. , Wang Xu , Andersson Laila , Malaspina David , Ergun Robert E. , Horányi Mihály
Published: March 2019

Surface oxidation of Langmuir probes is an important issue for probe measurements in space environments. Followed by our previous work about the oxidation effect on the collection of ambient plasma electrons and ions, here we present its effect on photoemission from the probe surface of various materials. Photoemission is either a contamination for traditional Langmuir probes or a necessity for electric field probes in low‐density plasma. Our results show that all materials after oxidation have a varying degree of reduction in photoemission. The photoemission of copper, gold, and niobium drops most significantly followed by DAG213 (a resin‐based graphite coating), TiN (titanium nitride), and rhenium. Iridium, DAG213, and AquaDAG (graphite coating) have the largest photoemission after oxidation, making them appropriate coating candidates for electric field probes. Both DAG materials show a large photoemission enhancement after the oxidation products are cleaned off the surface. A long exposure test shows that the photoemission from iridium slowly degrades. Due to the high surface conductivity of oxidized iridium shown in previous work, it is suggested that iridium can be oxidized before flight to minimize the photoemission when being used as a coating for Langmuir probes. Overall, iridium is found to be a coating material appropriate for both electric field probes and Langmuir probes.
Factors Influencing Dynamic Nonequilibrium Effects in Drainage Processes of an Air‐Water Two‐Phase Fine Sandy Medium
Authors: Li Jing , He Xinya , Li Chengfeng , Du Yijin , Li Yan , Xia Jiankang , Gao Jingyi , Yang Ying , Li Yan
Published: March 2019

In efforts to reduce uncertainties about effects of minor changes in the pore structure of porous media on dynamic nonequilibrium effects (DNEs), we monitored water saturation‐capillary pressure relationships in both dynamic flow and static states in stepwise drainage processes of a sandy medium. The acquired data were used to detect DNE and their changes with time in each drainage step and construct new parameters to characterize DNE. Effects of factors affecting water flow—including capillary number, water saturation, rate of change of water saturation with time (△Sw/△t), and the maximum value of this rate (RSMAX)—on the magnitude of the DNE were then determined. Results show that entry pressures are considerably larger under dynamic flow conditions than under static flow conditions, and DNE only occurs when the water saturation exceeds a threshold value in a drainage process. During either a smooth drainage or drainage step, the maximum capillary pressure (PMAX) is reached before the minimum water saturation (SMIN). Moreover, in drainage steps RSMAX occurs before the maximum difference between the capillary pressures associated with the static and dynamic states (DPMAX), except when they start from the saturated state. Accordingly, DNEs in a drainage step are mainly reflected in the time between PMAX and SMIN (△t), DPMAX, the average sum of the squares of the difference between capillary pressures of the static and dynamic states (DPAVE), and the dynamic coefficient τ (which is often used to characterize DNE). Furthermore, our results indicate that the water saturation and its rate of change with time are more important parameters than the capillary number for modeling DNE in a drainage process, and we detected no clear correlation between either maximum or minimum values of τ and the timing of the most significant DNE during drainages. τ appears to characterize DNE effectively in smooth drainage processes, while △t, DPAVE, and DPMAX constitute meaningful supplementary parameters for the characterization of DNE in a drainage step of a stepwise drainage.
Temporal Fluctuations and Poroelasticity Can Generate Chaotic Advection in Natural Groundwater Systems
Authors: Trefry M. G. , Lester D. R. , Metcalfe G. , Wu J.
Published: March 2019

Although steady, isotropic Darcy flows are inherently laminar and nonmixing in the absence of diffusion, it is well understood that transient forcing via engineered pumping schemes can induce rapid, chaotic mixing flows in groundwater. In this study we explore the propensity for such mixing to arise in natural groundwater systems subject to cyclical forcings, for example, tidal or seasonal influences. Using a conventional linear groundwater flow model subject to tidal forcing, we show that under certain conditions these flows generate Lagrangian transport and mixing phenomena (chaotic advection) near the tidal boundary. We show that aquifer heterogeneity, storativity, and forcing magnitude cause reversals in flow direction over the forcing cycle which, in turn, generate coherent Lagrangian structures and chaos. These features significantly augment fluid mixing and transport, leading to anomalous residence time distributions, flow segregation, and the potential for profoundly altered reaction kinetics. We define the dimensionless parameter groups which govern this phenomenon and explore these groups in connection with a set of well‐characterized tidal systems. The potential for Lagrangian chaos to be present near discharge boundaries must be recognized and assessed in field studies.
Estimating Methane Emissions From Underground Coal and Natural Gas Production in Southwestern Pennsylvania
Authors: Barkley Z. R. , Lauvaux T. , Davis K. J. , Deng A. , Fried A. , Weibring P. , Richter D. , Walega J. G. , DiGangi J. , Ehrman S. H. , Ren X. , Dickerson R. R.
Published: March 2019

Production of coal and natural gas is responsible for one third of anthropogenic methane (CH4) emissions in the United States. Here we examine CH4 emissions from coal and natural gas production in southwestern Pennsylvania. Using a top‐down methodology combining measurements of CH4 and ethane, we conclude that while Environmental Protection Agency inventories appear to report emissions from coal accurately, emissions from unconventional natural gas are underreported in the region by a factor of 5 (±3). However, production‐scaled CH4 emissions from unconventional gas production in the Marcellus remain small compared to other basins due to its large production per well. After normalizing emissions by energy produced, total greenhouse gas emissions from Pennsylvania unconventional natural gas production produce half the carbon footprint compared to regionally produced coal, with carbon dioxide emissions from combustion being the dominant source of greenhouse gas emissions for both sources.
Towards precision medicine for stress disorders: diagnostic biomarkers and targeted drugs
Authors: Le-Niculescu H. , Roseberry K. , Levey D. F. , Rogers J. , Kosary K. , Prabha S. , Jones T. , Judd S. , McCormick M. A , Wessel A. R. , Williams A. , Phalen P. L. , Mamdani F. , Sequeira A. , Kurian S. M. , Niculescu A. B.
Published: March 2019

The biological fingerprint of environmental adversity may be key to understanding health and disease, as it encompasses the damage induced as well as the compensatory reactions of the organism. Metabolic and hormonal changes may be an informative but incomplete window into the underlying biology. We endeavored to identify objective blood gene expression biomarkers for psychological stress, a subjective sensation with biological roots. To quantify the stress perception at a particular moment in time, we used a simple visual analog scale for life stress in psychiatric patients, a high-risk group. Then, using a stepwise discovery, prioritization, validation, and testing in independent cohort design, we were successful in identifying gene expression biomarkers that were predictive of high-stress states and of future psychiatric hospitalizations related to stress, more so when personalized by gender and diagnosis. One of the top biomarkers that survived discovery, prioritization, validation, and testing was FKBP5, a well-known gene involved in stress response, which serves as a de facto reassuring positive control. We also compared our biomarker findings with telomere length (TL), another well-established biological marker of psychological stress and show that newly identified predictive biomarkers such as NUB1, APOL3, MAD1L1, or NKTR are comparable or better state or trait predictors of stress than TL or FKBP5. Over half of the top predictive biomarkers for stress also had prior evidence of involvement in suicide, and the majority of them had evidence in other psychiatric disorders, providing a molecular underpinning for the effects of stress in those disorders. Some of the biomarkers are targets of existing drugs, of potential utility in patient stratification, and pharmacogenomics approaches. Based on our studies and analyses, the biomarkers with the best overall convergent functional evidence (CFE) for involvement in stress were FKBP5, DDX6, B2M, LAIR1, RTN4, and NUB1. Moreover, the biomarker gene expression signatures yielded leads for possible new drug candidates and natural compounds upon bioinformatics drug repurposing analyses, such as calcium folinate and betulin. Our work may lead to improved diagnosis and treatment for stress disorders such as PTSD, that result in decreased quality of life and adverse outcomes, including addictions, violence, and suicide.
Dynamic emission Stokes shift and liquid-like dielectric solvation of band edge carriers in lead-halide perovskites
Authors: Guo Yinsheng , Yaffe Omer , Hull Trevor D. , Owen Jonathan S. , Reichman David R. , Brus Louis E.
Published: March 2019

Lead-halide perovskites have emerged as promising materials for photovoltaic and optoelectronic applications. Their significantly anharmonic lattice motion, in contrast to conventional harmonic semiconductors, presents a conceptual challenge in understanding the genesis of their exceptional optoelectronic properties. Here we report a strongly temperature dependent luminescence Stokes shift in the electronic spectra of both hybrid and inorganic lead-bromide perovskite single crystals. This behavior stands in stark contrast to that exhibited by more conventional crystalline semiconductors. We correlate the electronic spectra with the anti-Stokes and Stokes Raman vibrational spectra. Dielectric solvation theories, originally developed for excited molecules dissolved in polar liquids, reproduce our experimental observations. Our approach, which invokes a classical Debye-like relaxation process, captures the dielectric response originating from the incipient anharmonicity of the LO phonon at about 20 meV (160 cm−1) in the lead-bromide framework. We reconcile this liquid-like model incorporating thermally-activated dielectric solvation with more standard solid-state theories of the emission Stokes shift in crystalline semiconductors.
Nanofiber network with adjustable nanostructure controlled by PVP content for an excellent microwave absorption
Authors: Lv Jing , Gu Weihua , Cui Xiaoqing , Dai Sisi , Zhang Baoshan , Ji Guangbin
Published: March 2019

Carbon nanofibers were widely utilized to improve microwave absorption properties since they are a promising lightweight candidate. Adjustable conductive nanostructures of carbon nanofibers were synthesized by electrospinning technique. The conductive network is controlled by the polyvinyl pyrrolidone (PVP) content due to the special hygroscopicity of PVP. The increased adhesive contacts of nanofibers provide more transmission paths for electrons to reduce the effect of air dielectric. Satisfactorily, the carbon nanofibers that carbonized from the polyacrylonitrile (PAN) and PVP (the mass ratio is 6:4) show excellent microwave absorption performance. The minimum reflection loss (RL) value is −51.3 dB at 15.2 GHz and the maximum effective absorption frequency width (<−10 dB) is 5.1 GHz with the matching thickness of only 1.8 mm. Thereby, we believe that this research may offer an effective way to synthesize lightweight carbon nanofibers microwave absorbents.
Deletion of tumour necrosis factor α receptor 1 elicits an increased TH17 immune response in the chronically inflamed liver
Authors: Berkhout Laura , Barikbin Roja , Schiller Birgit , Ravichandran Gevitha , Krech Till , Neumann Katrin , Sass Gabriele , Tiegs Gisa
Published: March 2019

Tumour necrosis factor α receptor 1 (TNFR1) activation is known to induce cell death, inflammation, and fibrosis but also hepatocyte survival and regeneration. The multidrug resistance protein 2 knockout (Mdr2−/) mice are a model for chronic hepatitis and inflammation-associated hepatocellular carcinoma (HCC) development. This study analysed how the absence of TNFR1 mediated signalling shapes cytokine and chemokine production, immune cell recruitment and ultimately influences liver injury and fibrotic tissue remodelling in the Mdr2−/− mouse model. We show that Tnfr1−/−/Mdr2−/− mice displayed increased plasma levels of ALT, ALP, and bilirubin as well as a significantly higher collagen content, and markers of fibrosis than Mdr2−/− mice. The expression profile of inflammatory cytokines (Il1b, Il23, Tgfb1, Il17a), chemokines (Ccl2, Cxcl1, Cx3cl1) and chemokine receptors (Ccr6, Cxcr6, Cx3cr1) in livers of Tnfr1−/−/Mdr2−/− mice indicated TH17 cell infiltration. Flow cytometric analysis confirmed that the aggravated tissue injury in Tnfr1−/−/Mdr2−/− mice strongly correlated with increased hepatic recruitment of TH17 cells and enhanced IL-17 production in the injured liver. Moreover, we observed increased hepatic activation of RIPK3 in Tnfr1−/−/Mdr2−/− mice, which was not related to necroptotic cell death. Rather, frequencies of infiltrating CX3CR1+ monocytes increased over time in livers of Tnfr1−/−/Mdr2−/− mice, which expressed significantly higher levels of Ripk3 than those of Mdr2−/− mice. Overall, we conclude that the absence of TNFR1-mediated signalling did not improve the pathological phenotype of Mdr2−/− mice. It instead caused enhanced infiltration of TH17 cells and CX3CR1+ monocytes into the injured tissue, which was accompanied by increased RIPK3 activation and IL-17 production.
A scavenger receptor B (CD36)-like protein is a potential mediator of intestinal heme absorption in the hematophagous ectoparasite Lepeophtheirus salmonis
Authors: Heggland Erna Irene , Eichner Christiane , Støve Svein Isungset , Martinez Aurora , Nilsen Frank , Dondrup Michael
Published: March 2019

Intestinal absorption of heme has remained enigmatic for years, even though heme provides the most bioavailable form of iron. The salmon louse,Lepeophtheirus salmonis, is a heme auxotrophic ectoparasite feeding on large quantities of blood from its host, the salmon. Here we show that a scavenging CD36-like receptor is a potential mediator of heme absorption in the intestine of the salmon louse. The receptor was characterized by a heme binding assay using recombinantly expressed protein,in situhybridization and immunohistochemistry, as well as functional knockdown studies in the louse. A computational structural model of the receptor predicted a binding pocket for heme, as also supported byin silicodocking. The mRNA and protein were expressed exclusively in the intestine of the louse. Further, knocking down the transcript resulted in lower heme levels in the adult female louse, production of shorter egg strings, and an overall lower hatching success of the eggs. Finally, starving the lice caused the transcript expression of the receptor to decrease. To our knowledge, this is the first time a CD36-like protein has been suggested to be an intestinal heme receptor.