bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AbstractStudy ObjectivePsychological 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.MethodA 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.ResultsThe 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.ConclusionsThe 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

AbstractObjectiveTo understand that tinnitus may be an aura for sleep paralysis.BackgroundSleep 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.MethodsA 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.ResultsAbnormalities 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).DiscussionTinnitus 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

AbstractBackgroundAntipsychotic 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.MethodsA 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.ResultsThe 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.ConclusionsOur 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

AbstractIntroductionBariatric 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.MethodsForty 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.ResultsPost 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).DiscussionThough 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

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

AbstractPurposePresent a case of dronabinol-induced hypomania.BackgroundDronabinol 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.DiscussionThe 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.ConclusionThis 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

AbstractObjectiveTo 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.DesignAn 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.SettingFour Minnesota food pantries, USA.ParticipantsClients visiting intervention pantries before (n 71) and after (n 70) the intervention.ResultsFidelity 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&lt;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).ConclusionsWhen 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

AbstractSurface 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

AbstractIn 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

AbstractAlthough 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.