bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tool for Predicting Medical Student Burnout From Sustained Stress Levels: Factor Analysis of the Medical Education Hassles Scale-R
Authors: Johnson Jane C. , Degenhardt Brian F. , Smith Carol K. , Wolf Thomas M. , Peterson D. Fred 
Published: February 2018

Abstract

Context
Acute stress during medical school affects the health of students and is associated with burnout. The Medical Education Hassles Scale-R (MEHS-R) is designed to measure acute stress among medical students. Researchers using the MEHS-R primarily report overall hassles scores, which are unable to discriminate between different categories of hassles encountered.

Objective
The present study examined the factor structure of the MEHS-R to identify subscales that would be useful to categorize hassles for research and assessment purposes.

Design
Longitudinal, observational study.

Setting
Two osteopathic medical schools.

Participants
Five hundred six first-year medical students.

Main Outcome Measure
The MEHS-R was administered at orientation and 9 to 10 times throughout the first year, classified into examination, vacation, and routine medical school activity periods. Students rated the 101 items on a 4-point scale (0=none to 3=a great deal) to indicate how much of a hassle each item had been during the previous week. Demographic subgroups were males, females, married students, single students, whites, and ethnic minorities.

Results
Exploratory factor analysis was conducted on data collected at the first school during orientation. Seven subscales were identified: Academic and Time Pressures, Financial, Social, External Influences, Day-to-Day Functioning, Relationships With Immediate Family, and Health. Cronbach α were ≥0.75. Stability of these subscales was examined using confirmatory factor analysis. Both of the fit indices used indicated the 7-subscale model for the MEHS-R adequately fit the data obtained during examination and routine medical school activity periods, one fit index indicated adequate fit for the vacation period, and neither indicated adequate fit for the data from the second school. Of the 7 subscales, 5 had a strong correspondence with categories identified by the scale developers. Fit indices also indicated the 7-subscale model was adequately generalizable to the demographic subgroups with the exception of the ethnic minorities subgroup.

Conclusions
Exploratory factor analysis performed on the MEHS-R supported formation of subscales similar to categories identified during MEHS-R development. Results of the current study supported the use of the MEHS-R for the investigation of acute stress in medical students. In future research, targeted wellness interventions for medical students may be developed based on student responses to this instrument.
Overcoming barriers to monitoring patients taking second-generation antipsychotics
Authors: Peña Anita , DeJongh Beth , Haas Matthew , Harms Michelle 
Published: February 2018

Abstract

Introduction:
Patients taking second-generation antipsychotics (SGAs) are at increased risk of developing metabolic syndrome because of the side effect profiles of these medications. A medication use evaluation (MUE) was conducted and showed that baseline monitoring rates of metabolic parameters in patients taking SGAs are low. A pharmacist-run metabolic syndrome monitoring clinic (MSMC) is available to mental health (MH) outpatients; however, the clinic is underused by providers. The purpose of this project was to increase baseline metabolic syndrome monitoring rates in patients taking SGAs by implementing interventions to overcome barriers to monitoring and to accessing the MSMC.

Methods:
Appropriate tools to improve monitoring were obtained, and an electronic consult for the MSMC was created. A presentation and pamphlet were developed to improve awareness. Information about free patient transportation was obtained and distributed. Efficacy was assessed by evaluating patient referrals to the clinic before and after intervention, comparing baseline monitoring rates after implementation with the MUE data, and administering an anonymous survey to outpatient MH providers.

Results:
There was a 37.5% increase in overall referral rates to the MSMC after intervention, but only 51.5% of patients attended appointments as scheduled. Monitoring of vital signs increased, but monitoring of laboratory parameters decreased. A total of 60% (9 of 15) of providers completed a survey, of which one third indicated they still forget to refer patients to the MSMC.

Discussion:
Overall, baseline metabolic monitoring rates remained low despite implementing several interventions. Patient and provider outreach is crucial for initiating and maintaining a successful metabolic monitoring system for patients taking SGAs.
Assessing prescribing practices of clozapine before and after the implementation of an updated risk evaluation and mitigation strategy
Authors: Curry Brent , Palmer Emma , Mounce Crystal , Smith Gilbert , Shah Vital 
Published: February 2018

Abstract

Introduction:
Clozapine is an atypical antipsychotic medication approved for treatment-resistant schizophrenia and suicidal behavior in schizophrenia or schizoaffective disorders. Despite its therapeutic efficacy, clozapine is associated with several adverse effects, including agranulocytosis. In late 2015, the Food and Drug Administration updated the risk evaluation and mitigation strategy (REMS) for clozapine with new requirements for monitoring, prescribing, and dispensing. The purpose of this study was to evaluate clozapine prescribing practices at a Kentucky state psychiatric hospital before and after the implementation of the updated REMS program.

Methods:
The primary outcome of this study was to evaluate clozapine prescribing practices by identifying the number of patients on clozapine therapy in the 6 months pre and post updated REMS implementation. Included in the study were patients at a Kentucky state psychiatric hospital on clozapine therapy for the 24 months before the updated REMS implementation and in the 6-month study period after the implementation. The secondary objective of this study examined psychiatrist comfort level of prescribing clozapine.

Results:
Since the implementation of the updated REMS program, there has been an increased percentage of patients that were prescribed clozapine at a Kentucky state psychiatric hospital. This increase was not statistically significant (P = .2610).

Discussion:
The prescribing practices of clozapine within this facility did not differ significantly comparing pre- and post-REMS change in terms of number of patients prescribed clozapine, patient's dose, and therapy duration. Data from this study contributes to the body of knowledge evaluating this new standard of practice under the updated REMS.
Valproic acid–induced hyperammonemia: Incidence, clinical significance, and treatment management
Authors: Baddour Elisa , Tewksbury Ashley , Stauner Nick 
Published: February 2018

Abstract

Introduction:
Valproic acid (VPA)–induced hyperammonemia poses several clinical challenges in psychiatric medicine. The reported incidence of this adverse effect varies widely across the literature. Furthermore, practitioners treat hyperammonemia in asymptomatic patients although studies suggest this practice is unnecessary. The purpose of this study is to evaluate if patients with VPA-induced hyperammonemia are appropriately identified for treatment based on their symptom presentation as well as determine the most efficacious treatment approach for VPA-induced hyperammonemia.

Methods:
This study was completed at a community teaching hospital, and patients were retrospectively identified from June 1, 2011, to June 30, 2016, and included if they were admitted to a psychiatric unit, received at least 1 dose of VPA, and had at least 1 ammonia level drawn during admission. Hyperammonemia was defined as greater than 47 μmol/L, and symptomatic hyperammonemia was defined based on specific symptom presentation. The treatment modality was successful if the ammonia level was within normal range at discharge.

Results:
Of the 357 patients screened, 347 patients met all inclusion criteria for analysis. The reported incidence of hyperammonemia was found to be 36% with 43.2% of those patients presenting with symptoms. Lactulose initiation was the most common treatment modality chosen (48.7%). Discontinuation of VPA was the most effective treatment (56.3% success rate).

Discussion:
The results demonstrate that many patients with elevated ammonia levels are asymptomatic and therefore, based on findings within the literature, may not require treatment. Although lactulose was found to be the most common treatment initiated, the most effective was discontinuation of VPA.
Review of pharmacotherapy for smoking cessation in patients with schizophrenia
Authors: Shawen Avery E. , Drayton Shannon J. 
Published: February 2018

Abstract
Smoking cessation is a chronic issue surrounding individuals with schizophrenia. It is estimated that up to 90% of patients diagnosed with schizophrenia smoke cigarettes. The purpose of this article is to provide a nonsystematic review of the efficacy of smoking cessation interventions as well as to explore the potential neuropsychiatric adverse effects of these agents in patients with schizophrenia. Eighteen studies were found and included in the review. Overall, nicotine replacement therapy, bupropion, and varenicline have all proven their effectiveness at either promoting smoking abstinence or a significant reduction in cigarette use.
A review of medical marijuana for the treatment of posttraumatic stress disorder: Real symptom re-leaf or just high hopes?
Authors: Shishko Ilona , Oliveira Rosana , Moore Troy A. , Almeida Kenneth 
Published: February 2018

Abstract

Introduction:
The incidence of posttraumatic stress disorder (PTSD) is common within the population and even more so among veterans. Current medication treatment is limited primarily to antidepressants. Such medicines have shown to produce low remission rates and may require 9 patients to be treated for 1 to have a response. Aside from the Veterans Affairs/Department of Defense guidelines, other guidelines do not recommend pharmacotherapy as a first-line option, particularly in the veteran population. Marijuana has been evaluated as an alternative and novel treatment option with 16 states legalizing its use for PTSD.

Methods:
A systematic search was conducted to evaluate the evidence for the use of marijuana for PTSD. Studies for the review were included based on a literature search from Ovid MEDLINE and Google Scholar.

Results:
Five studies were identified that evaluated the use of marijuana for PTSD. One trial was conducted in Israel and actively used marijuana. Three studies did not use marijuana in the treatment arm but instead evaluated the effects postuse. A retrospective chart review from New Mexico relied on patients to recall their change in PTSD symptoms when using marijuana. Three studies concluded there might be a benefit, but two discouraged its use. Although the two negative studies show a statistical difference in worse PTSD outcomes, clinical significance is unclear.

Discussion:
Conflicting data exist for the use of marijuana for PTSD; however, current evidence is limited to anecdotal experiences, case reports, and observational studies, making it difficult to make clinical recommendations.
Teachers' and Parents' Knowledge about Disabilities and Inclusion in Nigeria
Authors: Barrio Brenda L. , Miller Darcy , Ojeme Caroline , Tamakloe Deborah 
Published: February 2018

Abstract
There has been a gradual move toward the inclusion of students with disabilities in Nigeria promoted by the National Policy of Education, as well as polices emerging from UNESCO; however, the infrastructure and resources to make inclusion happen are generally lacking. Based on this report and the need for more information on teachers' and parents' understanding about disabilities and inclusion as demonstrated in the literature, this study explored disability-related knowledge and understanding among teachers and parents in Nigeria. Specifically, using an exploratory case study including quantitative and qualitative data, this research was designed to explore teachers' and parents' knowledge about and understanding of students with disabilities and inclusion in the southwest region of Nigeria. Findings revealed that there is a need for more teacher and parent training in Nigeria regarding students with disabilities, especially as their willingness to support students who are struggling is positive. This willingness is a key component and first steps for moving schools and communities in Nigeria toward more inclusive environments.
The Southwest Indian Ocean Bathymetric Compilation (swIOBC)
Authors: Dorschel B. , Jensen L. , Arndt J. E. , Brummer G.‐J. , de Haas H. , Fielies A. , Franke D. , Jokat W. , Krocker R. , Kroon D. , Pätzold J. , Schneider R. R. , Spieß V. , Stollhofen H. , Uenzelmann‐Neben G. , Watkeys M. , Wiles E. 
Published: February 2018

AbstractWe present a comprehensive regional bathymetric data compilation for the southwest Indian Ocean (swIOBC) covering the area from 4°S to 40°S and 20°E to 45°E with a spatial resolution of 250 m. For this, we used multibeam and singlebeam data as well as data from global bathymetric data compilations. We generated the swIOBC using an iterative approach of manual data cleaning and gridding, accounting for different data qualities and seamless integration of all different kinds of data. In comparison to existing bathymetric charts of this region, the new swIOBC benefits from nearly four times as many data‐constrained grid cells and a higher resolution, and thus reveals formerly unseen seabed features. In the central Mozambique Basin a surprising variety of landscapes were discovered. They document a deep reaching influence of the Mozambique Current eddies. Details of the N‐S trending Zambezi Channel could be imaged in the central Mozambique Basin.
Differentiation of a Hydrous Arc Magma Recorded in Melt Inclusions in Deep Crustal Cumulate Xenoliths from Ichinomegata Maar, NE Japan
Authors: Yanagida Y. , Nakamura M. , Yasuda A. , Kuritani T. , Nakagawa M. , Yoshida T. 
Published: February 2018

AbstractThe Ichinomegata maar, located in the back‐arc side of the northeastern Japan arc, erupted calc‐alkaline andesitic magma with abundant deep‐crustal and mantle xenoliths at about 60–80 ka. We investigated the relationship between fractionated solids and differentiated silicic melts at middle to lower crust conditions through petrologic analyses of hornblende‐bearing cumulate xenoliths and melt inclusions. The Sr and Nd isotope compositions are similar to those of the host magmas, suggesting their cognate origin. The crystallization sequence is determined to be olivine, spinel → clinopyroxene → hornblende, magnetite → plagioclase → apatite, based on the observation of texture and solid solution compositions. Of the five types of xenolith studied, the leuco‐hornblende gabbro preserved interstitial glass and melt inclusions with a silica content (SiO2) of 63.9–74.0 wt % and high water content (up to 8.1 wt %). Hornblende geobarometry indicates an equilibrium pressure of 0.39–0.64 GPa, which corresponds to a depth of 15–24 km. The delay of plagioclase crystallization due to high water content characterizes differentiation of the hydrous arc magma. We successfully constructed an internally consistent differentiation model of the corundum‐normative calc‐alkaline trend to the silicic melt inclusions, starting from primitive basalt via successive fractionation of a calculated wherlite and cumulate xenoliths. In middle to late stage differentiation, hornblende gabbros are the dominantly fractionated assemblages. Our results are consistent with published differentiation experiments of hydrous arc magmas and the lithology of the deep crust beneath the back arc of the NE Japan arc as estimated from seismic tomography.
Geology of the Alarcon Rise, Southern Gulf of California
Authors: Clague David A. , Caress David W. , Dreyer Brian M. , Lundsten Lonny , Paduan Jennifer B. , Portner Ryan A. , Spelz‐Madero Ronald , Bowles Julie A. , Castillo Paterno R. , Guardado‐France Rigoberto , Le Saout Morgane , Martin Julie F. , Santa Rosa‐del Río Miguel A. , Zierenberg Robert A. 
Published: February 2018

AbstractMeter‐scale AUV bathymetric mapping and ROV sampling of the entire 47 km‐long Alarcon Rise between the Pescadero and Tamayo transforms show that the shallowest inflated portion of the segment hosts all four active hydrothermal vent fields and the youngest, hottest, and highest effusion rate lava flows. This shallowest inflated part is located ∼1/3 of the way between the Tamayo and Pescadero transforms and is paved by a 16 km2 channelized flow that erupted from 9 km of en echelon fissures and is larger than historic flows on the East Pacific Rise or on the Gorda and Juan de Fuca Ridges. Starting ∼5 km south of the Pescadero transform, 6.5 km of the Alarcon Rise is characterized by faulted ridges and domes of fractionated lavas ranging from basaltic andesite to rhyolite with up to 77.3 wt % SiO2. These are the first known rhyolites from the submarine global mid‐ocean ridge system. Silicic lavas range from >11.7 ka, to as young as 1.1 ka. A basalt‐to‐basaltic andesite sequence and an andesite‐to‐dacite‐to‐rhyolite sequence are consistent with crystal fractionation but some intermediate basaltic andesite and andesite formed by mixing basalt with dacite or rhyolite. Magmatism occurred along the bounding Tamayo and Pescadero transforms as extensive channelized flows. The flows erupted from ring faults surrounding uplifted sediment hills inferred to overlie sills. The transforms are transtensional to accommodate magma migration from the adjacent Alarcon Rise.
Climatic Constraints on Growth Rate and Geochemistry (Sr/Ca and U/Ca) of the Coral Siderastrea stellata in the Southwest Equatorial Atlantic (Rocas Atoll, Brazil)
Authors: Evangelista H. , Sifeddine A. , Corrège T. , Servain J. , Dassié E. P. , Logato R. , Cordeiro R. C. , Shen C.‐C. , Le Cornec F. , Nogueira J. , Segal B. , Castagna A. , Turcq B. 
Published: February 2018

AbstractAlthough relatively rare compared to similar latitudes in the Pacific or Indian Oceans, massive coral colonies are present in the Tropical/Equatorial Southwestern Atlantic Ocean. However, detailed geochemical compositions of these corals are still largely unknown. In this work, we present growth rates, Sr/Ca, and U/Ca ratios of the coral colony (Siderastrea stellata) sampled at Rocas Atoll, off the Brazilian coast. These variables are primarily affected by sea surface temperature (SST) at seasonal scale, and by wind stress at interannual scale, these results represent a broad new finding. A lower significance at the interannual time scale between Sr/Ca and U/Ca with respect to SST is attributed to the low SST amplitude closed to Equator. An investigation on the dependence of coral growth rates with respect to the “cloud shading effect” promoted by the Intertropical Convergence Zone (ITCZ) does not show significant influence. Additionally, rain seems to act on local geochemistry of Sr/Ca ratios and growth rate at the decadal scale.
High‐Resolution Integrated Cyclostratigraphy From the Oyambre Section (Cantabria, N Iberian Peninsula): Constraints for Orbital Tuning and Correlation of Middle Eocene Atlantic Deep‐Sea Records
Authors: Dinarès‐Turell Jaume , Martínez‐Braceras Naroa , Payros Aitor 
Published: February 2018

AbstractThe astronomical timescale accuracy generally exceeds other dating methods. Precise age models are pivotal for paleoclimatic research. The middle Eocene astronomical timescale has been poorly constrained due to scarcity of suitable records leading to the so call “Eocene astronomical timescale gap.” We present magnetic susceptibility and color proxy records from an expanded 60 m long cyclic hemipelagic succession from the Oyambre Cape in northern Spain (∼1.3 My long stratigraphic section tuned to the ∼43.1–44.4 Ma interval in the Lutetian stage). We use the strong eccentricity amplitude modulation of precession in the sedimentary record for orbital tuning. The tuned record is correlated at precession level with previously tuned Ocean Drilling Program (ODP) Site 1260 from the equatorial Atlantic (the only oceanic record that registers geochemical variations in the precession band) and to other lower resolution deep‐sea records at eccentricity level from the Southern Atlantic. Our data is consistent with a very long eccentricity minimum (driven by a ∼2.4 My periodicity) at 43.15 Ma in the orbital solutions and an age for the C20n/C20r reversal boundary at ∼43.45 Ma. However, we challenge previous correlations between these Atlantic sites (shifts of one 100 ky eccentricity cycle). Data allows to rule out correlation to either younger or older 405 ky eccentricity cycles, which constrains chronologies for the middle Eocene, emphasizing the need for consistent astrochronological frameworks involving expanded outcrops. This should aid to overcome oceanic drilling shortcomings and sedimentary complexities. Our study highlights this integration need to achieve accuracy and stability of orbital timescales underpinning Eocene paleoclimatic records.
Calibrating the Spatiotemporal Root Density Distribution for Macroscopic Water Uptake Models Using Tikhonov Regularization
Authors: Li N. , Yue X. Y. 
Published: February 2018

AbstractMacroscopic root water uptake models proportional to a root density distribution function (RDDF) are most commonly used to model water uptake by plants. As the water uptake is difficult and labor intensive to measure, these models are often calibrated by inverse modeling. Most previous inversion studies assume RDDF to be constant with depth and time or dependent on only depth for simplification. However, under field conditions, this function varies with type of soil and root growth and thus changes with both depth and time. This study proposes an inverse method to calibrate both spatially and temporally varying RDDF in unsaturated water flow modeling. To overcome the difficulty imposed by the ill‐posedness, the calibration is formulated as an optimization problem in the framework of the Tikhonov regularization theory, adding additional constraint to the objective function. Then the formulated nonlinear optimization problem is numerically solved with an efficient algorithm on the basis of the finite element method. The advantage of our method is that the inverse problem is translated into a Tikhonov regularization functional minimization problem and then solved based on the variational construction, which circumvents the computational complexity in calculating the sensitivity matrix involved in many derivative‐based parameter estimation approaches (e.g., Levenberg‐Marquardt optimization). Moreover, the proposed method features optimization of RDDF without any prior form, which is applicable to a more general root water uptake model. Numerical examples are performed to illustrate the applicability and effectiveness of the proposed method. Finally, discussions on the stability and extension of this method are presented.