The Management of Performance Anxiety with Beta-Adrenergic Blocking Agents

Performance anxiety consists of several symptoms experienced in the context of public performance and is classified in DSM-III-R under social phobia. Performance anxiety must be distinguished from panic disorder, generalized social phobia, and generalized anxiety disorder. Performance anxiety symptoms can be detrimental to both performer and performance. These symptoms can be controlled by the judicious use of beta-adrenergic blocking agents. The use of beta-adrenergic blocking agents should be considered as part of a psychiatric stress-management program for these patients

Persistent lithium-induced neurotoxicity: direct effect of lithium and/or hypernatremia?

Abstract Lithium has been used in the treatment of bipolar affective disorder (BAD) for more than 50 years. Features of lithium toxicity include drowsiness, slurred speech, ataxia, psychomotor slowing, polyneuropathy, impaired memory, seizures, coma and death. Lithium neurotoxicity is usually reversible on cessation of its administration, and irreversible toxicity is uncommon. However, persistent neurological sequelae may follow lithium intoxication. There may be a contribution to neurotoxicity from the SIADH associated with lithium toxicity in addition to the direct effects of lithium itself. We describe a case of lithium toxicity with persistent delirium in a patient with a brief period of severe hypernatremia and persistent neurological signs for more than one month after the discontinuation of the medication

Clozapine, Fluoxetine, and Benztropine- associated Ileus: Case Report

Gastrointestinal complications of anticholinergic medications are prevalent, potentially life-threatening, and could be more actively prevented. We present a case report of an ileus that required surgical intervention and developed in the context of clozapine, benztropine, and fluoxetine use. The case exemplifies the potential anticholinergic toxicities of clozapine and benztropine as well as possible pharmacokinetic interactions between fluoxetine, clozapine, and benztropine. We discuss ways to minimize the likelihood of anticholinergic complications with these medications

Ice Cores from the St. Elias Mountains, Yukon, Canada: Their Significance for Climate, Atmospheric Composition and Volcanism in the North Pacific Region

A major achievement in research supported by the Kluane Lake Research Station was the recovery, in 2001 –02, of a suite of cores from the icefields of the central St. Elias Mountains, Yukon, by teams of researchers from Canada, the United States, and Japan. This project led to the development of parallel, long (103 – 104 year) ice-core records of climate and atmospheric change over an altitudinal range of more than 2 km, from the Eclipse Icefield (3017 m) to the ice-covered plateau of Mt. Logan (5340 m). These efforts built on earlier work recovering single ice cores in this region. Comparison of these records has allowed for variations in climate and atmospheric composition to be linked with changes in the vertical structure and dynamics of the North Pacific atmosphere, providing a unique perspective on these changes over the Holocene. Owing to their privileged location, cores from the St. Elias Icefields also contain a remarkably detailed record of aerosols from various sources around or across the North Pacific. In this paper we review major scientific findings from the study of St. Elias Mountain ice cores, focusing on five main themes: (1) The record of stable water isotopes (δ18O, δD), which has unique characteristics that differ from those of Greenland, other Arctic ice cores, and even among sites in the St. Elias; (2) the snow accumulation history; (3) the record of pollen, biomass burning aerosol, and desert dust deposition; (4) the record of long-range air pollutant deposition (sulphate and lead); and (5) the record of paleo-volcanism. Our discussion draws on studies published since 2000, but based on older ice cores from the St. Elias Mountains obtained in 1980 and 1996

A Model for Basic Emotions Using Observations of Behavior in Drosophila

Emotion plays a crucial role, both in general human experience and in psychiatric illnesses. Despite the importance of emotion, the relative lack of objective methodologies to scientifically studying emotional phenomena limits our current understanding and thereby calls for the development of novel methodologies, such us the study of illustrative animal models. Analysis of Drosophila and other insects has unlocked new opportunities to elucidate the behavioral phenotypes of fundamentally emotional phenomena. Here we propose an integrative model of basic emotions based on observations of this animal model. The basic emotions are internal states that are modulated by neuromodulators, and these internal states are externally expressed as certain stereotypical behaviors, such as instinct, which is proposed as ancient mechanisms of survival. There are four kinds of basic emotions: happiness, sadness, fear, and anger, which are differentially associated with three core affects: reward (happiness), punishment (sadness), and stress (fear and anger). These core affects are analogous to the three primary colors (red, yellow, and blue) in that they are combined in various proportions to result in more complex “higher order” emotions, such as love and aesthetic emotion. We refer to our proposed model of emotions as called the “Three Primary Color Model of Basic Emotions.

Engaging adolescents in using online patient portals

IMPORTANCE: Many health care systems offer adolescents access to health information through online patient portals, but few studies have explored how to engage adolescents in using and benefiting from online portals. OBJECTIVE: To determine how US children\u27s hospitals have attempted to encourage adolescent portal use, barriers to engaging adolescents, and ideal future goals for engagement. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study performed structured qualitative interviews with informatics administrators from children\u27s hospitals across the US between February and July 2022. Informatics administrators were employed by US health care systems that managed a children\u27s hospital with at least 50 dedicated pediatrics beds. Data analysis was performed from November 2022 to January 2023. MAIN OUTCOMES AND MEASURES: This study used thematic analysis of (1) current steps that health care systems had taken to engage adolescents in using their online patient portals and (2) barriers to engaging adolescents and ideal future goals and outcomes of engagement. RESULTS: Among 58 total interviews with 65 informatics administrators who represented 63 hospitals across 58 health care systems, 6 themes of approaches to engaging adolescents in portal use were identified: (1) promoting and educating adolescents about portal enrollment, (2) establishing workflows to support enrollment, (3) seeking and incorporating feedback, (4) creating a culture or environment supporting engagement, (5) increasing portal utility, and (6) limited efforts. Barriers to engaging adolescents in portal use related to either (1) stakeholder investment, interest, and capabilities or (2) intersecting technical, ethical, and legal factors. Participants identified 4 ideal future efforts to engage adolescents: (1) develop adaptable private means of communication with adolescents, (2) use adolescent-centric user design, (3) enhance promotion and education about portal use, and (4) simplify and adapt workflows to encourage enrollment. Participants described 3 ideal outcomes of this future engagement: (1) provide education about current health, (2) prepare for transition to adulthood, and (3) improve digital health education of adolescents. CONCLUSIONS AND RELEVANCE: In this qualitative study of informatics administrators, children\u27s hospitals across the US were found to have varying degrees of efforts to engage adolescents in using their portals. Most of these efforts focused on supporting adolescent enrollment, but fewer efforts focused on making the portal useful and interesting to adolescents

Vaccines for protecting infants from bacterial causes of diarrheal disease

The global diarrheal disease burden fo

Liver transplant and hepatitis C in methadone maintenance therapy: a case report

Methadone maintenance therapy for the treatment of opioid dependence continues to carry a social stigma. Until recently, patients on methadone were not considered for liver transplantation. We describe the first case of a patient on methadone who received a liver transplant for end stage liver disease and was successfully treated for recurrent hepatitis C. More than five years post transplant and three years post viral clearance, the patient continues to do well and is stable on low-dose methadone. This case emphasizes the need to reconsider the non-evidence based policy adopted by transplant centers that require methadone maintenance therapy patients to stop methadone prior to consideration for transplant evaluation

Distributed Computation and Reconfiguration in Actively Dynamic Networks

In this paper, we study systems of distributed entities that can actively modify their communication network. This gives rise to distributed algorithms that apart from communication can also exploit network reconfiguration in order to carry out a given task. At the same time, the distributed task itself may now require a global reconfiguration from a given initial network Gs to a target network Gf from a family of networks having some good properties, like small diameter. To formally capture costs associated with creating and maintaining connections, we define three reasonable edge-complexity measures: the total edge activations, the maximum activated edges per round, and the maximum activated degree of a node. We give (poly)log(n) time algorithms for the general task of transforming any Gs into a Gf of diameter (poly)log(n), while minimizing the edge-complexity. There is a natural trade-off between time and edge complexity. Our main lower bound shows that Ω(n) total edge activations and Ω(n/log n) activations per round must be paid by any algorithm (even centralized) that achieves an optimum of Θ(log n) rounds. On the positive side, we give three distributed algorithms for our general task. The first runs in O(log n) time, with at most 2n active edges per round, a total of O(n log n) edge activations, a maximum degree n − 1, and a target network of diameter 2. The second achieves bounded degree by paying an additional logarithmic factor in time and in total edge activations. It gives a target network of diameter O(log n) and uses O(n) active edges per round. Our third algorithm shows that if we slightly increase the maximum degree to polylog(n) then we can achieve a running time of o(log2n). This novel model of distributed computation and reconfiguration in actively dynamic networks and the proposed measures of the edge complexity of distributed algorithms, may open new avenues for research in the algorithmic theory of dynamic networks