bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discontinuation of Cardiac Therapies
Authors: Fogelman Patricia Maani , Gerringer Janine A. 
Published: May 2023

Abstract
Advanced practice registered nurses (APRNs) play a key role in the care of the cardiac patient. They order and interpret diagnostic data, perform physical examinations, make diagnoses, and formulate individualized treatment plans. This may include education about lifestyle modifications, the introduction and titration of cardiac medications, and referral for more advanced cardiac treatments, such as vasoactive or inotropic medications, cardiovascular implantable electronic devices, extracorporeal membrane oxygenation, and ventricular assist devices. Often patients decide to discontinue these therapies. This chapter reviews the factors surrounding the decision-making process for managing end-stage heart failure, ethical considerations for device discontinuation, processes for cessation, and aggressive symptom management to assure comfort, dignity, and freedom from suffering.
Discontinuation of Other Life-Sustaining Therapies
Authors: Plakovic Kathy , Donoghue Jennifer 
Published: May 2023

Abstract
Technological advances allow healthcare providers to delay the dying process for critically and terminally ill patients. For patients lingering between life and death, decisions frequently need to be made regarding withholding or withdrawing life-sustaining treatments such as antibiotics, blood products, dialysis, and medically administered nutrition. The ethical principle of autonomy gives patients or their healthcare power of attorney/surrogate decision-maker the right to accept or reject any treatment. This chapter reviews these treatments and the decision-making process that must be part of any discussion to discontinue treatments.
An Initial Approach to the Emergency Evaluation
Authors: Richmond Janet 
Published: May 2023

Abstract
The emergency psychiatric interview combines rapid and accurate diagnostic and risk assessments with a biopsychosocial formulation and, optimally, treatment. This is all done in a brief evaluation while simultaneously building and sustaining rapport within a chaotic environment that may require the clinician to attend to multiple patients and tasks simultaneously. This requires flexibility and awareness of one’s biases and countertransference reactions so that the clinician can then use them to facilitate empathic connections with patients. There are unique interviewing skills that help the clinician make rapid clinical decisions. These techniques are different yet draw from those of the traditional psychotherapist.
Telepsychiatry and Beyond
Authors: Maloy Katherine 
Published: May 2023

Abstract
Telemedicine has expanded rapidly in the context of the global COVID-19 pandemic, and psychiatry is no exception. Telepsychiatry in the emergency setting can be a way to expand access to care, particularly in rural or understaffed settings. Federal and local regulations should be considered, as well as issues of privacy and technology requirements. These legal and regulatory requirements continue to evolve and change. Clinicians need training and practice in performing a telepsychiatry evaluation. Overall, telepsychiatry has been shown to be well-accepted by patients, and it has been used in a variety of settings to expand access. Future directions should include exploration of provision of crisis services, aftercare, and supervision via telepsychiatry.
Altered Mental Status and Neurologic Syndromes
Authors: Heinrich Thomas W. , Steele Ian , Brady Sara 
Published: May 2023

Abstract
A patient presenting to the emergency department often represents a diagnostic enigma. The patient may present with a single pathognomonic symptom or sign or a myriad of vague, inconclusive signs and symptoms. The differential diagnosis for patients presenting to the emergency department with signs and symptoms suggestive of a psychiatric condition should include various medical conditions, delirium, and/or complications of psychiatric pharmacotherapy. This chapter addresses some of the more common etiologies of neuropsychiatric presentations in the emergency department, including delirium, catatonia, seizures, serotonin syndrome, and neuroleptic malignant syndrome. These disorders should be among those considered in an informed differential diagnosis of various patients in the emergency department.
Intoxication, Withdrawal, and Symptoms of Substance Use Disorders
Authors: Shumate Annaliese Koller 
Published: May 2023

Abstract
Substance Use disorders are quite common leading to significant morbidity and mortality. Over 19.3 million people aged 18 and older had a substance use disorder, in the US alone. Substance use, and psychiatric illness are commonly comorbid. The etiology of substance use disorders are a multifactorial interplay between nature and nurture drawing on genetics, neuronal circuitry reinforcement and environmental factors. Substance use of any kind triggers the brain’s meso-limbic dopaminergic reward pathway and reinforcement occurs both as a result of acute intoxication but also becomes hardwired into the brain by activating the amygdala. Unfortunately, those with substance use disorders (SUD) continue to be a highly stigmatized patient population and deserve non-judgemental treatment and access to pharmacologic treatment and therapy. Substance use, though prevalent, is treatable and early intervention and action in places like a psychiatric emergency service (PES) can lead to improved long term sequalae in patients with substance use disorders.
Psychosis, Psychotic Disorders, and the Schizophrenia Spectrum
Authors: Wolf Chelsea , Winston Helena 
Published: May 2023

Abstract
Psychosis is common among patients presenting to an emergency department with mental health concerns and should be considered a medical emergency. Although many of these patients may indeed have a long-standing psychiatric history, others may present with a new, acute onset of psychotic symptoms. The possible etiologies of psychosis are broad and include substance-induced, psychiatric, and other medical causes. It is important that emergency providers be able to appropriately evaluate and manage patients who present with psychotic symptoms. This chapter provides information regarding the initial assessment and management of patients with psychosis, the diagnostic workup and differential diagnosis, as well as the treatment of psychotic symptoms.
Personality Disorders
Authors: Bond Joseph B. , Smith Nicole R. 
Published: May 2023

Abstract
This chapter provides an overview of the prevalence, assessment, and management of personality disorders (PDs) in the emergency department (ED). Patients with PDs are often seen in the ED, and their complex clinical features and challenging behaviors can pose significant difficulties for ED staff. The chapter begins defining PDs and dividing them into clusters. Whether they are evident in the chief complaint or comorbid with another condition, ED clinicians are likely to encounter the symptoms of PDs. The chapter highlights the importance of a comprehensive evaluation that includes a thorough history, mental status examination, and consideration of comorbid conditions. Using case examples and clinical pearls, the chapter also discusses the various management strategies available to ED staff when caring for patients with PDs including de-escalation techniques, crisis management tools, guidance in using empathy in difficult encounters.
Children and Adolescents
Authors: Burns Heidi , Biermann Bernard , Malas Nasuh 
Published: May 2023

Abstract
Pediatric behavioral emergencies are an increasingly prevalent and important aspect of emergency psychiatric care. The incidence of mental illness in the United States is rising with limited access to preventative and mental health resources in the community. The result is an increasing number of youth seeking out emergency psychiatric services in the emergency department (ED) setting. Presentations in youth can be more undifferentiated, atypical, and more challenging to assess and manage due to developmental, familial, and systems-based factors. There is a dearth of training and education among primary care providers, ED providers, and general psychiatrists in the care of pediatric behavioral emergencies and a limited number of child and adolescent psychiatrists available to address these concerns. This can lead to missed opportunities to intervene, misdiagnosis, delays in care, or challenges in management. Given the breadth and volume of need, and the limited access to resources, it is incumbent on providers who interface with youth at risk for psychiatric emergencies to develop an improved understanding of the factors influencing these presentations in youth and how to address them. This chapter describes evidence-based evaluation and management strategies, as well as practical clinical pearls and expert opinion, regarding the care of youth presenting to the ED setting for emergency psychiatric care.
Victims of Physical and Sexual Violence
Authors: Ladegard Kristie , Tse Jessica 
Published: May 2023

Abstract
As experts who understand the biological aspects of violence as well as the societal, environmental, and economic conditions that affect health, psychiatrists are uniquely positioned to help prevent violence. This chapter reviews the most current literature regarding the different types of violence that an emergency psychiatric provider may encounter. It suggests clinical recommendations for approaching patients suspected of experiencing interpersonal violence, and it provides guidance in assessment, treatment, and reporting guidelines. In addition, current definitions, statistical data, identification, approach recommendations, and reporting considerations are summarized. Specific types of interpersonal violence discussed include homicide, sexual violence, intimate partner violence, child abuse, human trafficking, and elder abuse.
Documenting Risk Assessments and High-Acuity Discharge Presentations
Authors: Lodhi Shafi 
Published: May 2023

Abstract
Psychiatrists receive substantial training in the assessment of suicidal and homicidal ideation but minimal training in documentation of these assessments. Research has demonstrated that a significant portion of patients seen in a psychiatric emergency room do not have a proper risk assessment documented. There is a gap in the literature in regard to guidelines or practical advice that can help a psychiatrist learn how to document risk assessment in a proper manner. This chapter comprehensively discusses the documentation of risk assessments in the emergency psychiatry setting, with particular emphasis on high-acuity discharge presentations. The chapter first discusses the relevant legal background, the importance of documentation, and the purpose of a risk assessment. Next, it focuses on the practical aspects of documentation, with a discussion of key elements of a risk assessment to document, general guidelines, and specific examples of “do’s and do not’s” of documentation. Finally, the chapter presents a practical guide to quickly documenting a risk assessment. A step-by-step guide is provided, as well as boilerplate text that can serve to help the reader create their own “dot phrase” in order to aid in documentation.
Taking the Pulse
Authors: Feingold Jordyn , Kaplan Carly 
Published: May 2023

Abstract
Burnout, a work-related phenomenon of emotional exhaustion, depersonalization, and low sense of personal accomplishment that interferes with one’s relationship to work, is highly prevalent among medical students in undergraduate medical education (UME) and residents and clinical fellows during graduate medical education (GME). This chapter provides an overview of burnout prevalence, consequences, and correlates in premedical students, medical students, residents, and clinical fellows, both in the United States and globally. While a lack of standardization in measurement poses challenges to accurate and reliable prevalence data across diverse populations, most studies report an approximately 50% prevalence of burnout among medical students, residents, and clinical fellows globally. More robust, systematic, and standardized methodology is needed to enable meaningful comparisons of burnout prevalence by populations across studies.
Components of a Comprehensive Well-Being Program
Authors: Duncan Jennifer G. , Maguire Michael , Slavin Stuart J. 
Published: May 2023

Abstract
A comprehensive well-being program should include multiple components in order to address the multifaceted nature of well-being. Medical students and GME trainees are a heterogenous group with numerous personal factors that impact their well-being while functioning within the larger culture of an institution, which also has a significant influence. As such, well-being initiatives should address both individual-level factors, such as physical and mental health, resilience, and professional growth, as well as institutional or systems factors, such as the learning environment, workload, and culture within teams. This chapter provides for consideration an overview of the component parts of a well-being program with attention to each of these areas of focus.
System-Level Interventions
Authors: Quinn Mariah A. , Banaszak Lauren , McFadden Kathleen , McGrath Kerri Palamara 
Published: May 2023

Abstract
Interventions that address systems of learning and work have the potential to impact learners broadly rather than only at an individual level. Systems-level interventions are essential—on aggregate they have greater impact on burnout than do individual-level interventions. These interventions in general target the learning environment, workplace culture, and workload demands. This chapter provides an overview of types of system-level interventions that are known to be effective for medical students and residents and fellows, as well as areas in which evidence is emerging, including for critical topics such as diversity, equity, and inclusion; learner mistreatment; evaluation and assessment; efficiency and workload; and the learning environment. Specific recommendations for each of these areas are provided.
Diagnosing Your Institution’s Readiness to Address Trainee Well-Being
Authors: Thomas Larissa R. , Kryzhanovskaya Irina , Akhtar Saadia 
Published: May 2023

Abstract
A number of theories regarding change management exist that can help leaders and their institutions thrive amid change by using practical strategies to solve common problems related to clinician well-being. This chapter reviews some theories of change management and describes a practical approach for assessing an organization’s readiness for change to improve well-being. In complex adaptive systems, controlled interventions are rarely feasible, and the dynamic environment means that unintended impacts should be expected and examined. Considerations for successful change management in dynamic systems include identifying stakeholders, building alliances, anticipating roadblocks, and reflecting on progress. While change management is a daunting part of any well-being leader’s job, using a strategic approach to plan, implement, and reflect on change can help an organization successfully progress along a continuum of organizational change for well-being.
Preparing Your Pitch
Authors: Chelminski Paul , Panda Mukta 
Published: May 2023

Abstract
Change in health care organizations requires multiple skills: sophisticated communication, systematic planning, and implementation expertise. Such skills for achieving change are often based on relationships rather than transactions. This chapter outlines the communication skills and organizational approaches needed to prepare an institution for positive change in an environment where health care professionals are the leaders in fulfilling missions of patient care, education, and research. The chapter describes a creative approach to fostering organizational change. The chapter presents tools such as the elevator speech (or pitch) and the Logic Model which, respectively, create institutional awareness and a systematic framework for implementing change. The chapter also reviews developments in communications and psychological sciences from the past 50 years that can catalyze the respectful, inclusive, and productive conversations that motivate teams and drive change.
Initial Steps in Program Development
Authors: Akhtar Saadia , Dua Sakshi , Rosenfield Paul , Ripp Jonathan A. 
Published: May 2023

Abstract
This chapter outlines a stepwise approach to forming an institutional well-being program. It discusses the importance of establishing support and engaging stakeholders, and it highlights the importance of data gathering and conducting a needs assessment. The chapter presents a process for prioritizing efforts and generating a proposal to establish a well-being program. It reviews the development of a mission, vision, purpose, and model for well-being. It examines the governance, organizational, and reporting structure for a comprehensive well-being program. The roles of constituent-based well-being leaders such as undergraduate medical education (UME) well-being champions/directors and graduate medical education (GME) well-being champions/directors are also discussed. The chapter also describes well-being committee structures that provide an opportunity for members to share perspectives and solutions for well-being matters. The chapter also includes the process of instituting policies and guidelines that advance well-being.
Novel Technology and Discoveries: The Future of Physician Well-Being
Authors: Horvath Keith A. , Berry Anne J. 
Published: May 2023

Abstract
Advancements in technology change the way that clinicians practice medicine. The field is ever evolving, and clinicians must learn and implement new approaches to treatment and care delivery. This chapter explores three examples of how new technologies have transformed health care: the transition to electronic health records, adoption of telehealth, and introduction of artificial intelligence. These cases highlight the tension between embracing novel innovations with the need to guard against unintended consequences that result from their adoption. There is also recognition of the need to effectively teach innovation as well as consideration for ways to support clinician well-being when introducing new technologies.
Attending to Medical Student and GME Trainee Well-Being in the Midst of Crisis
Authors: DePierro Jonathan , Peccoralo Lauren , Hurtado Alicia , Akhtar Saadia , Ripp Jonathan A. 
Published: May 2023

Abstract
A major crisis such as a natural disaster, pandemic, or man-made attack can have a major impact on medical student and physician trainee well-being. This chapter details a number of efforts to preserve and promote trainee well-being, including meeting basic needs and safety, robust and supportive communications, psychosocial and mental health support, “on the ground” resources, and support from and for leadership. Basic needs of medical students and trainees during a crisis include housing, transportation, childcare, and resources to maintain physical health and personal safety. Robust and supportive communication includes attention to the purpose of communication, anticipation of needs, addressing of concerns, and sharing of mental health and well-being related resources. Psychosocial and mental health support may include group discussions, one-on-one support, psychiatric care, and spiritual care support. Finally, support for leaders can involve leadership trainings and resources. Strategically supporting medical student and GME trainee needs during a crisis can maintain and enhance their well-being.
The period–luminosity relation for Mira variables in the Milky Way using Gaia DR3: a further distance anchor for H0
Authors: Sanders Jason L 
Published: May 2023

ABSTRACT
Gaia DR3 parallaxes are used to calibrate preliminary period–luminosity relations of O-rich Mira variables in the 2MASS J, H, and Ks bands using a probabilistic model accounting for variations in the parallax zero-point and underestimation of the parallax uncertainties. The derived relations are compared to those measured for the Large and Small Magellanic Clouds, the Sagittarius dwarf spheroidal galaxy, globular cluster members, and the subset of Milky Way Mira variables with VLBI parallaxes. The Milky Way linear JHKs relations are slightly steeper and thus fainter at short period than the corresponding LMC relations, suggesting population effects in the near-infrared are perhaps larger than previous observational works have claimed. Models of the Gaia astrometry for the Mira variables suggest that, despite the intrinsic photocentre wobble and use of mean photometry in the astrometric solution of the current data reduction, the recovered parallaxes should be on average unbiased but with underestimated uncertainties for the nearest stars. The recommended Gaia EDR3 parallax zero-point corrections evaluated at $\nu _\mathrm{eff}=1.25\, \mu \mathrm{m}^{-1}$ require minimal ($\lesssim 5\, \mu \mathrm{as}$) corrections for redder five-parameter sources, but overcorrect the parallaxes for redder six-parameter sources, and the parallax uncertainties are underestimated at most by a factor ∼1.6 at $G\approx 12.5\, \mathrm{mag}$. The derived period–luminosity relations are used as anchors for the Mira variables in the Type Ia host galaxy NGC 1559 to find $H_0=(73.7\pm 4.4)\, \mathrm{km\, s}^{-1}\, \mathrm{Mpc}^{-1}$.
Galaxy morphology classification using multiscale convolution capsule network
Authors: Li Guangping , Xu Tingting , Li Liping , Gao Xianjun , Liu Zhijing , Cao Jie , Yang Mingcun , Zhou Weihong 
Published: May 2023

ABSTRACT
Classification of galaxy morphology is a hot issue in astronomical research. Although significant progress has been made in the last decade in classifying galaxy morphology using deep learning technology, there are still some deficiencies in spatial feature representation and classification accuracy. In this study, we present a multiscale convolutional capsule network (MSCCN) model for the classification of galaxy morphology. First, this model improves the convolutional layers using a multibranch structure to extract the multiscale hidden features of galaxy images. In order to further explore the hidden information in the features, the multiscale features are encapsulated and fed into the capsule layer. Second, we use a sigmoid function to replace the softmax function in dynamic routing, which can enhance the robustness of MSCCN. Finally, the classification model achieves 97 per cent accuracy, 96 per cent precision, 98 per cent recall, and 97 per cent F1-score under macroscopic averaging. In addition, a more comprehensive model evaluation was accomplished in this study. We visualized the morphological features for the part of sample set that used the t-distributed stochastic neighbour embedding (t-SNE) algorithm. The results show that the model has a better generalization ability and robustness, and it can be effectively used in the galaxy morphological classification.