bluuebunny/crossref_metadata_2025_split huggingface dataset:
157 Treatment-Refractory Mania With Psychosis in Post-Transplant Patient on Tacrolimus: A Case Report
Authors: Bordoloi Meelie , Singh Garima , Ithman Muaid Hilmi 
Published: June 2018

AbstractWe present a case of a 66 year old Caucasian female with Bipolar type 1 disorder, status post right renal transplant (5/8/14) on maintenance immunosuppression who presented with mania and psychosis. The previous weeks had her being sleep deprived, talkative, making random calls to family members at odd hours, demonstrating pressured speech and also having erotomania regarding Joshua Bell, the violinist. She had recently been switched from Divalproex sodium (on which she had been stable for years) to Quetiapine due to thrombocytopenia attributed to the former. Quetiapine was optimized to 800 mg over two weeks without any improvement. She continued to be severely manic with new delusions of being in a World War II zone and the staff being NAZIs. She continued to be tangential with disorganized behavior and inability to care for self. She was then restarted on Divalproex sodium (for mood) with close monitoring of her counts along with Risperidone (for psychosis). Divalproex sodium was optimized to 1500mg and Risperidone to 6 mg over the next 2 weeks without much improvement. Risperidone was then cross tapered with Olanzepine. We also began to pursue other causes of treatment refractory mania withpsychosis, namely her immunosuppressant medications. She had been placed on maintenance immunosuppression withtacrolimus (Prograf) 3mg BID, Mycophenolic acid (Myfortic) 360 mg BID and Prednisone 5 mg. Though the most recent Tacrolimus level was within therapeutic range, they were still higher than her baseline levels. Based on few case reports of psychosis associated with Tacrolimus and per discussion with nephrology, we planned cross taper of Tacrolimus and Cyclosporin. Tacrolimus was eventually tapered off and Cyclosporine was maintained at 125 mg qam and 100 mg qpm. Prednisone was maintained at 5 mg daily. Her mania and psychosis improved and she was ultimately discharged on Olanzepine 20mg qhs, Divalproex sodium 1500mg qhs, The problems encountered during this case were plenty due to multiple comorbid conditions including a right adrenal adenoma, hypertension, impaired glucose tolerance, thyroid dysfunction, hyperlipidemia and having bio-prosthetic aortic valve due to Aortic stenosis (2013). In conclusion, psychosis can be precipitated in renal transplant patient with Bipolar disorder I with previously maintained stability on Tacrolimus with other comorbid conditions. So, It would be important to re-evaluate the use of Tacrolimus or the possibility of switching to another immunosuppressive agent withcareful consideration of risks versus benefits. Case management should include good coordination of care with Family medicine, Transplant/nephrology team and social services for efficacious and successful management of patient.Funding AcknowledgementsNo funding.
162 Add-on Filgrastim During Clozapine Rechallenge Unsuccessful in Treating Benign Ethnic Neutropenia
Authors: Britton Molly , Gunasekar Palanikumar , Selvaraj Vithyalakshmi 
Published: June 2018

AbstractClozapine is an atypical antipsychotic approved by the Food and Drug Administration for treatment-resistant schizophrenia and also indicated for the reduction in risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder. The most serious side effect of clozapine treatment is agranulocytosis, which is defined as an absolute neutrophil count (ANC) < 0.50 × 109 per L. Benign ethnic neutropenia (BEN) is a condition found in members of African or Middle Eastern descent that is characterized by ANC < 1.50 × 109 per L in the absence of other causes. Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that has shown efficacy in reducing the duration of agranulocytosis in some patients who develop clozapine-induced agranulocytosis. It is currently unknown whether filgrastim is beneficial in the treatment of neutropenia due to BEN. We here, for first the time report a case of a patient with BEN who developed agranulocytosis both during the first clozapine trial for schizophrenia and during the rechallenge, despite early stabilization with filgrastim treatment, which highlights the failure of filgrastim in treating BEN.Funding AcknowledgementsNo funding.
170 Prospective Evaluation of the Economic Utility of Combinatorial Pharmacogenomics in Generalized Anxiety Disorder and Major Depressive Disorder
Authors: Roe Nathan , Passariello Catherine , Brown Lisa , Li James , Jablonski Michael , Dechairo Bryan M 
Published: June 2018

AbstractMental illness is one of the leading causes of disability, with direct and indirect costs posing a significant financial burden. Previously, a large prospective economic utility study (n>13,000) showed that the GeneSight® test, a psychiatric pharmacogenomic decision support tool powered by CPGx® technology, reduced medication costs, increased adherence, andreduced polypharmacy for patients who had failed monotherapy for psychiatric disorders. The current study, which is a sub-analysis of this larger study, assessed cost savings associated with combinatorial pharmacogenomic testing in patients with generalized anxiety disorder (GAD) and major depressive disorder (MDD). Medication costs were extracted using pharmacy claims data provided by Medco, a large pharmacy benefits manager, for patients with GAD (n=318) and MDD (n=459). Medication cost savings per member per year (PMPY) for 1 year following the test were compared between patients whose medication regimens were congruent with the test recommendations and those whose medication regimens were incongruent with these recommendations. When healthcare providers’ decisions were congruent with combinatorial pharmacogenomic testing, PMPY savings was $6,747 (p<0.004) for GAD patients and $3,738 (p<0.004) for MDD patients versus incongruent decisions within these disease states. Among the congruent group, GAD patients experienced greater savings in central nervous system (CNS) medications (2-fold) compared to MDD patients. Additionally, analysis of a subset of patients prescribed at least one benzodiazepine six months prior to testing (n=660) demonstrated a significant decrease in benzodiazepine drug counts (p<0.001) and refills (p<0.001) after testing. Using the GeneSight test as a treatment decision support tool for patients with GAD or MDD resulted in significant medication cost savings when HCPs made congruent decisions with the combinatorialpharmacogenomic results. Furthermore, use of the GeneSight test decreased the use of benzodiazepines.Funding AcknowledgementsResearch was funded by Assurex Health, Inc.
180 Efficacy of Dasotraline in Children With Attention Deficit Hyperactivity Disorder in a Laboratory Classroom Setting
Authors: Goldman Robert , Childress Ann , Wigal Sharon B , Hopkins Seth C , Koblan Kenneth S , Sarma Kaushik , Hsu Jay , Loebel Antony 
Published: June 2018

AbstractObjectivesOnce-daily dosing with dasotraline, a novel dopamine and norepinephrine reuptake inhibitor, achieves stable plasma concentrations over 24 hours. This phase 3 study evaluated the efficacy and safety of dasotraline in children with attention deficithyperactivity disorder (ADHD) throughout the day, in a laboratory classroom setting (NCT02734693).MethodsChildren (6–12 years) meeting DSM-5 criteria for ADHD were randomized to 2 weeks of dasotraline or placebo (dosed daily at home at approximately 8 PM). Following an abbreviated practice day, laboratory classroom evaluations took place at baseline and on Day 15. The primary endpoint was mean change from baseline at Day 15 in ADHD symptoms, as measured by the Swanson, Kotkin, Agler, M-Flynn, and Pelham Combined Score (SKAMP-CS), obtained from the average of 7 assessments collected across the 12-hour laboratory classroom day (12–24 hours post-dose). Secondary endpoints included SKAMP scores obtained throughout the day at individual timepoints from 8 AM through 8 PM (12–24 hours post-dose), and measures of safety and tolerability.ResultsThe ITT population comprised 112 patients. Mean age was 9.5 years, 68.8% were male; 92% completed the study. Dasotraline 4 mg/day significantly improved mean SKAMP-CS versus placebo (p<0.0001, effect size 0.85) with significant effects persisting throughout the day. Mean SKAMP subscores improved significantly versus placebo (Attention p<0.0001, effect size 0.81; Deportment p<0.001, effect size 0.70). Treatment-emergent adverse events were generally mild or moderate in severity; most frequent (with dasotraline 4 mg/day; placebo) included: insomnia (19.6%; 3.6%, all terms combined), decreased appetite (10.7%; 3.6%), headache (10.7%; 8.9%), affect lability (8.9%; 7.1%), irritability (5.4%; 3.6%), postural orthostatic tachycardia syndrome (5.4%; 0%), and perceptual disturbances (5.4%; 0%).ConclusionsIn this 2-week, randomized, double-blind, laboratory classroom study in children with ADHD, once-daily dasotraline significantly improved ADHD symptoms (including deportment and attention), compared with placebo, and demonstrated sustained efficacyup to 24 hours post-dose. The most common adverse events were insomnia, decreased appetite, and headache.Funding AcknowledgementsStudy sponsored by Sunovion Pharmaceuticals Inc.
188 Buspirone-Induced Somnambulism
Authors: Egal Sulekho , Hirsch Alan R 
Published: June 2018

AbstractObjectiveBuspirone has not heretofore been reported to trigger somnambulism. Such a case is described.BackgroundBuspirone is a partial 5HT1A agonist, which acts to suppress REM sleep and increase sleep fragmentation (Ware, 1994).Design/MethodsA 36-year old right handed woman presented with one-year of constant anxiety and panic attacks with epochs of dyspnea, tachycardia, diaphoresis,paresthesias of both hands, and out of body sensations. She affirmed déjà vu and PM insomnia, and vivid dreams. When in high school she had one sleepwalking event, without recurrence. The patient was begun on buspirone, initially 2.5 mg and raised to 5 mg QHS. Within a day of increasing the dose, she experienced an episode whereby in the early hours in the morning, she removed her pajamas, folded them neatly into a stack next to the bed, and returned to bed, sans clothes. She was amnestic for this event, but based this history on her husband’s report. She discontinued the buspironeand for over 1 year, there has been no recurrence of such events.ResultsAbnormalities in her neurological examination: Mental StatusExaminationAnxious. Memory: immediate recall: 7 digits forwards and 4 digits backwards: Cranial Nerve Examination: Cranial Nerve I: Alcohol Sniff Test: 8 cm (hyposmia), Reflexes: 3+ throughout. Neuropsychiatric testing: Clock Drawing test: 4 (Normal). Animal Fluency test: 20 (normal).ConclusionsBuspirone induced somnambulism may relate directly to its mechanism of action, as a 5HT1A partial agonist. Since other 5HT1A agonists, to cause noctambulism (Raja2012). Buspirone increases sleep fragmentation (Wilson, 2005), and thus may act to disrupt slow wave sleep, promoting susceptibility to somnambulism. Alternatively, her somnambulism may be a nocturnal variant of Buspirone induced dissociative state (Bystritsky, 2013). Given the above, it is worthwhile to query those who are undergoing therapy with buspirone for the development of somnambulism.Funding AcknowledgementsNo funding.
192 Multi-Watt Near Infrared Phototherapy is an Effective Treatment for Depression
Authors: Henderson Theodore , Morries Larry D. 
Published: June 2018

AbstractBackgroundDepression treatment is hampered by low efficacy of antidepressant medications and concerns about alternative modalities. Animal studies of treatment with low-level (0.5 Watt or less) near infrared (NIR) light from diodes has shown some benefit in models of traumatic brain injury (TBI) with evidence of reduced lesion size, increased neurotrophin production, synaptogenesis, fewer apoptotic cells, and improved neurological function. Two small case series have demonstrated transient clinical improvement with low-level NIR treatment given on a daily basis over several weeks. We have previously shown marked and persistent clinical improvement in a case series of patients with chronic mild-to-moderate (m-MTBI) after treatmentwith NIR at a power of 9 Watts or greater. We also have published a review of the potential for application of NIR for the treatment of depression. The current study explores NIR efficacy in a proof-of-concept study as a treatment for depression.MethodsThirty-nine sequential patients treated for TBI between March 2013 and May 2017 provided depression self-assessment data and/or were administered the Hamilton Depression Rating Scale. Each completed the Quick Inventory of Depression Symptomatology-Self Reports (QIDS) before and after treatment. Patients received transcranial multi-Watt near-infrared light treatment (NILT) using near-infrared lasers (810/980 nm at 8-15 Watts) applied to forehead and temporal regions bilaterally for 9-12 minutes to each area.ResultsFor 36 of the 39 patients, after 16.82 + 6.26 treatments, QIDS scores indicated a robust response (decrease of QIDS total score by > 50%). For 32 of 39 patients post-treatment QIDS scores indicated a remission from depression (decrease of QIDS total score < 5). Overall, the QIDS score fell from 14.10 + 3.39 to 3.44 + 3.39 SD (p=6.29 X 10-19). With 12 or fewer treatments, QIDS score dropped from 14.83 + 2.55 to 4.17 + 3.93. Patients receiving 13 or more treatments showed a change in QIDS score from 13.67 + 3.64 to 3.11 + 3.14. Those (N=15) who received the entire treatment course within 8 weeks or less (5.33 + 1.72 weeks) showed a change in QIDS score from 13.86 + 3.14 to 4.5 + 3.94. Suicidal ideation resolved in all, but two patients. The non-responsive patients are described in detail. Patients remained in remission for up to 55 months after a single course of treatment.ConclusionThis is the first report of high-powered NILT showing efficacy for depression. Patients saw benefit often within 4 treatments and some had resolution of depressive symptoms in as little as 4 weeks. These data raise an intriguing possibility – that NILT may be a safe, effective, and rapid treatment for depression. A double-blind, placebo controlled trial is warranted to verify these proof-of-concept data.Funding AcknowledgementsNeuro-Laser Foundation
‘A little bit offended and slightly patronised’: parents’ experiences of National Child Measurement Programme feedback
Authors: Gainsbury Alexa , Dowling Sally 
Published: June 2018

AbstractObjectiveTo develop a descriptive account of parents’ experiences of written feedback from the National Child Measurement Programme (NCMP), based on primary data collected from semi-structured focus groups.DesignFour focus groups were held with a purposive sample of parents who had recently received written weight feedback from the NCMP in one local authority in England. Thematic data analysis was undertaken to develop a narrative of emergent themes regarding parents’ experiences and the social influences shaping this.Setting/SubjectsThe population of interest was parents of 4- and 5-year-olds who had recently received written feedback from the NCMP. Eighteen parents participated and represented the full spectrum of categories provided in NCMP feedback (under-, healthy, over- and very overweight).ResultsParticipants often rejected overweight feedback as lacking in credibility and considered NCMP communication to be targeting parents other than themselves. Family and peers collaborated in the dismissal of overweight feedback, further legitimising participants’ decision to disregard their child’s overweight categorisation.ConclusionsOur study provides an insight into parents’ experiences of NCMP feedback, including how they relate to and understand that experience within a social context. By doing so, it makes a unique contribution to the existing body of evidence. Recommendations for practice based on the findings include further efforts to raise parents’ and communities’ awareness of childhood obesity, risks associated with childhood excess weight and obesity prevalence as a mainstream issue.
In situ Observation of Compression Damage in a Three-Dimensional Braided Carbon Fiber Reinforced Carbon and Silicon Carbide (C/C-SiC) Ceramic Composite
Authors: Wan Fan , Zhao Shixiang , Liu Rongjun , Zhang Changrui , Marrow Thomas J. 
Published: June 2018

AbstractDeformation and mechanical damage in a three-dimensional braided carbon fiber reinforced carbon and silicon carbide ceramic composite, subjected to compressive loading, has been studied in situ by laboratory X-ray computed tomography. Dimensional change was measured and damage visualized by digital volume correlation analysis of tomographs. Cracks nucleated from defects within the fiber bundles and tended to propagate along the fiber bundle/matrix interface. For longitudinal compression, parallel to the fiber bundles, the initial elastic modulus decreased with increasing compressive strain while significant transverse tensile strains developed due to distributed cracking. For transverse compression, perpendicular to the fiber bundles, the compressive elastic modulus was effectively constant; the tensile strains developed along the fiber direction were small, whereas macroscopic fracture between the fiber bundles caused very large bulk tensile strain perpendicular to the loading. The observations suggest that the mechanical strength might be improved through control of pre-existing defects and application of stitch fibers in the transverse direction.
Assessing Soft-Tissue Shrinkage Estimates in Museum Specimens Imaged With Diffusible Iodine-Based Contrast-Enhanced Computed Tomography (diceCT)
Authors: Hedrick Brandon P. , Yohe Laurel , Vander Linden Abby , Dávalos Liliana M. , Sears Karen , Sadier Alexa , Rossiter Stephen J. , Davies Kalina T. J. , Dumont Elizabeth 
Published: June 2018

AbstractThe increased accessibility of soft-tissue data through diffusible iodine-based contrast-enhanced computed tomography (diceCT) enables comparative biologists to increase the taxonomic breadth of their studies with museum specimens. However, it is still unclear how soft-tissue measurements from preserved specimens reflect values from freshly collected specimens and whether diceCT preparation may affect these measurements. Here, we document and evaluate the accuracy of diceCT in museum specimens based on the soft-tissue reconstructions of brains and eyes of five bats. Based on proxies, both brains and eyes were roughly 60% of the estimated original sizes when first imaged. However, these structures did not further shrink significantly over a 4-week staining interval, and 1 week in 2.5% iodine-based solution yielded sufficient contrast for differentiating among soft-tissues. Compared to six “fresh” bat specimens imaged shortly after field collection (not fixed in ethanol), the museum specimens had significantly lower relative volumes of the eyes and brains. Variation in field preparation techniques and conditions, and long-term storage in ethanol may be the primary causes of shrinkage in museum specimens rather than diceCT staining methodology. Identifying reliable tissue-specific correction factors to adjust for the shrinkage now documented in museum specimens requires future work with larger samples.
Not ‘us’ and ‘them’: towards a normative legal theory of mental health vulnerability
Authors: Bielby Phil 
Published: June 2018

AbstractIn this paper, I develop the basis of a normative legal theory of mental health vulnerability. In Section 2, I conceptualise mental health vulnerability by integrating a universal understanding of vulnerability with a subjective-evaluative, psychosocial and dimensional account of mental health. In Section 3, I move on to consider the significance of mental health vulnerability for legal theory through an encounter with perspectives on vulnerability offered by MacIntyre, Fineman and Del Mar. This offers an insight into the normative foundations of mental health vulnerability. In Section 4, I outline a normative framework for mental health vulnerability that involves a synergy of rights and care. This extends Engster's idea of ‘a right to care’ to mental health and highlights the role of care and rights in mitigating power imbalances and inequality in relation to mental health. In concluding, I suggest future directions for research on mental health vulnerability.
Does Shared Social Disadvantage Cause Black–Latino Political Commonality?
Authors: Israel-Trummel Mackenzie L. , Schachter Ariela 
Published: June 2018

AbstractShared social disadvantage relative to Whites is assumed to motivate inter-minority political behavior but we lack causal evidence. Using a survey experiment of 1,200 African Americans, we prompt respondents to consider group social position when evaluating political commonality with Latinos. The experiment describes racial disparities in a randomized domain (education or housing), varies the description of inequality (either Black versus White, Latino versus White, or Black and Latino versus White), and offers half of the respondents a political cue to test whether shared social disadvantage causes Blacks’ perceptions of political commonality with Latinos. We find little evidence of a causal relationship. We conclude that cross-racial minority political coalitions may be more difficult to activate than previously thought.
Horseshoes in the High‐Latitude Ionosphere
Authors: Wang Ningchao , Datta‐Barua Seebany , Chartier Alex T. , Ramirez Uriel , Mitchell Cathryn N. 
Published: June 2018

AbstractIn the high‐latitude ionosphere, predicting transport of polar cap patches is important because of their impact on radio communications and navigation systems. Lagrangian coherent structures (LCSs) are barriers to transport in nonlinear time‐varying flow fields, found by computing the local maximum finite‐time Lyapunov exponent (FTLE). We propose that LCSs are barriers governing patch formation. In this work, we compute and visualize the LCSs in high‐latitude ionospheric convection by computing the FTLE field with the Ionosphere‐Thermosphere Algorithm for Lagrangian Coherent Structures (ITALCS). The Weimer 2005 high‐latitude electric potential model and the 12th‐generation International Geomagnetic Reference Field (IGRF‐12) are used to generate the
drift field at each gridpoint in the ionosphere. The
drifts are used as the input to ITALCS. Time‐varying structures are detected in two‐dimensional ionospheric drifts at high latitudes based on locally maximum forward time FTLE values for both geomagnetically stormy and quiet periods. Typically, the dominant structure is shaped like the letter “U,” or a “horseshoe,” oriented with the curved portion of the “U” on the dayside around local noon. The LCSs during the geomagnetically stormy period have more complex topology and shift equatorward compared to the LCSs during quiet times. Analysis of a polar cap patch observed on 17 March 2015 with the Multi‐Instrument Data Analysis System indicates that a necessary condition for its formation and transport is that storm enhanced density exist poleward of the LCS.