A 73-Year-Old Female With Palpitations

Background Atrial fibrillation is a commonly encountered clinical problem. Although a large percentage of patients have no dearly identifiable precipitant, secondary atrial fibrillation is a well-documented clinical entity.\u27 Case presentation A 73-year-old female with a history of obstructive sleep apnea, hypertension, and chronic obstructive pulmonary disease presents with complaints of intermittent palpitations, substernal squeezing chest pressure, and shortness ofbreath for two weeks. Her most recent episode occurred on the bus, prompting her to come to the emergency room for evaluation. Further questioning revealed mild weight loss and diarrhea over the prior few weeks. Home medications included amlodipine, baby aspirin, albuterol as needed, and ciprofloxacin for a recently diagnosed URI

Using Markov chains to determine expected propagation time for probabilistic zero forcing

Zero forcing is a coloring game played on a graph where each vertex is initially colored blue or white and the goal is to color all the vertices blue by repeated use of a (deterministic) color change rule starting with as few blue vertices as possible. Probabilistic zero forcing yields a discrete dynamical system governed by a Markov chain. Since in a connected graph any one vertex can eventually color the entire graph blue using probabilistic zero forcing, the expected time to do this studied. Given a Markov transition matrix for a probabilistic zero forcing process, we establish an exact formula for expected propagation time. We apply Markov chains to determine bounds on expected propagation time for various families of graphs

The Grizzly, September 28, 2006

Anti-Racist Writer and Educator Speaks to Ursinus Community • Spinach Recall and Dining at Ursinus • Smoking Ban Introduced • Images from Annual Fringe Festival • USGA Town Hall Meeting • Shades of Clay Closes • Beyond the Condom: Guide to Safe Sex • Constitution Day: A Review • An Afternoon with Johnny Knoxville and Bam Margera • Watson Fellowship • Opinions: The Core ; New Zack City • Soccer Struggles • Letter to the Editor • NCAA Drug Testinghttps://digitalcommons.ursinus.edu/grizzlynews/1719/thumbnail.jp

Narcissism and the strategic pursuit of short-term mating : universal links across 11 world regions of the International Sexuality Description Project-2.

Previous studies have documented links between sub-clinical narcissism and the active pursuit of short-term mating strategies (e.g., unrestricted sociosexuality, marital infidelity, mate poaching). Nearly all of these investigations have relied solely on samples from Western cultures. In the current study, responses from a cross-cultural survey of 30,470 people across 53 nations spanning 11 world regions (North America, Central/South America, Northern Europe, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, Southeast Asia, and East Asia) were used to evaluate whether narcissism (as measured by the Narcissistic Personality Inventory; NPI) was universally associated with short-term mating. Results revealed narcissism scores (including two broad factors and seven traditional facets as measured by the NPI) were functionally equivalent across cultures, reliably associating with key sexual outcomes (e.g., more active pursuit of short-term mating, intimate partner violence, and sexual aggression) and sex-related personality traits (e.g., higher extraversion and openness to experience). Whereas some features of personality (e.g., subjective well-being) were universally associated with socially adaptive facets of Narcissism (e.g., self-sufficiency), most indicators of short-term mating (e.g., unrestricted sociosexuality and marital infidelity) were universally associated with the socially maladaptive facets of narcissism (e.g., exploitativeness). Discussion addresses limitations of these cross-culturally universal findings and presents suggestions for future research into revealing the precise psychological features of narcissism that facilitate the strategic pursuit of short-term mating

Narcisismo y búsqueda estratégica del emparejamiento a corto plazo a través de las culturas: Enlaces omnipresentes a través de 11 regiones mundiales del Proyecto de la descripción de la sexualidad internacional 2

Previous studies have documented links between sub-clinical narcissism and the active pursuit of short-term mating strategies (e.g., unrestricted sociosexuality, marital infidelity, mate poaching). Nearly all of these investigations have relied solely on samples from Western cultures. In the current study, responses from a cross-cultural survey of 30,470 people across 53 nations spanning 11 world regions (North America, Central/South America, Northern Europe, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, Southeast Asia, and East Asia) were used to evaluate whether narcissism (as measured by the Narcissistic Personality Inventory; NPI) was universally associated with short-term mating. Results revealed narcissism scores (including two broad factors and seven traditional facets as measured by the NPI) were functionally equivalent across cultures, reliably associating with key sexual outcomes (e.g., more active pursuit of short-term mating, intimate partner violence, and sexual aggression) and sex-related personality traits (e.g., higher extraversion and openness to experience). Whereas some features of personality (e.g., subjective well-being) were universally associated with socially adaptive facets of Narcissism (e.g., self-sufficiency), most indicators of short-term mating (e.g., unrestricted sociosexuality and marital infidelity) were universally associated with the socially maladaptive facets of narcissism (e.g., exploitativeness). Discussion addresses limitations of these cross-culturally universal findings and presents suggestions for future research into revealing the precise psychological features of narcissism that facilitate the strategic pursuit of short-term mating.Estudios previos, en primer lugar a través de las muestras de culturas occidentales, han documentado asociaciones sistemáticas del narcisismo subclínico con múltiples indicadores de estrategias del emparejamiento a corto plazo (p. ej. sociosexualidad ilimitada, infidelidad, caza de pareja). En este estudio se han usado respuestas de la encuesta transcultural de 30.470 personas de 53 naciones de 11 regiones mundiales (América del Norte, América del Sur/América Central, Europa del Norte, Europa del Oeste, Europa del Este, Europa del Sur, Oriente Próximo, África, Asia del Sur/Sudoeste de Asia, Asia del Este y Oceanía) para evaluar si el narcisismo (medido por el Inventario de Personalidad Narcisista; NPI) se asocia panuniversalmente con los indicadores del emparejamiento a corto plazo, tanto en la dirección, como en la intensidad. Los resultados sugieren que el narcisismo (incluidos muchos aspectos suyos medidos por el NPI) tiene las mismas asociaciones básicas con los rasgos de personalidad relacionados con el sexo (p. ej. extraversión alta) y con los resultados sexuales claves (p. ej. búsqueda más activa de las estrategias del emparejamiento a corto plazo) a través de las 11 mayores regiones mundiales del PDSI 2. La discusión se enfoca en las implicaciones y limitaciones del estudio actual

Discharge Summaries: How Long Is Too Long?

The Graduate Medical Education (GME) committee is composed of all Jefferson residency and fellowship program directors, as well as ten selected housestaff members. The committee meets monthly to discuss a wide array of topics, including Accreditation Council for Graduate Medical Education compliance, duty hours violations, and program reviews. One recently covered topic was the timeliness of discharge summary dictations. Implementing changes to improve transitions of care remains a focus of all healthcare systems. Jefferson is attempting to take an innovative approach to this issue, and discharge summaries are only one of the areas being examined. The current policy requires house staff to dictate the discharge summary within 14 days of discharge. Delinquent summaries receive a monetary fine on a weekly basis. Attending physicians have up to 120 days from discharge to finalize the summary, which is currently not in line with the Joint Commission mandate of finalized summaries within 30 days of hospital discharge. With increasing emphasis on early outpatient follow-up, many primary care physicians are seeing patients prior to having access to the discharge summary. Because of the disparity between the current policy and goal of timely clinical follow-up, Jefferson is examining the current timeline to address this issue

Anomalous Left Main Coronary Artery Originating from the Right Sinus of Valsalva

Introduction An anomalous left main coronary artery is a rarely seen clinical entity, particularly when it arises from the right sinus of Valsalva. This case report highlights this uncommon finding and how it affects the care of a patient with significant coronary artery disease. Case Presentation A 66 year-old male with a history of hypertension, hyperlipidemia, and type II diabetes presented with progressive exertional mid-epigastric and mid-chest discomfort. The patient stated that he had been feeling this “heaviness” with various activities and occasionally at rest for the past nine months. When it occurred with activity, the pain was generally relieved by rest within several minutes. His medications on presentation included insulin glargine, glyburide, metformin, simvastatin, pioglitazone, and lisinopril. Vital signs at the time of presentation included a temperature of 98.2°F, heart rate of 82 beats per minute, and blood pressure of 130/70 mmHg in both arms. Laboratory investigation showed a total cholesterol of 178 mg/dL (normal range = 150-250), high-density lipoprotein (HDL) cholesterol of 42 mg/dL, low-density lipoprotein (LDL) cholesterol of 111 mg/dL, triglycerides of 123 mg/dL, and hemoglobin A1C of 7.9% (normal range = \u3c5.7%). Pharmacologic nuclear stress testing revealed a severe, medium sized defect in the inferolateral wall that was predominately reversible. Thus, the patient underwent a cardiac catheterization which revealed an anomalous left main (LM) coronary artery arising from the right sinus of Valsalva separately from the origin of the right coronary artery (RCA). The distal left anterior descending artery (LAD) had a total occlusion, while the RCA had several areas of 70% stenosis. A subsequent coronary CT scan displayed an anomalous left coronary artery coursing anterior to the pulmonary artery (Figures 1, 2). The CT scan also showed moderate to high grade RCA stenosis in the mid to distal area of the vessel, as well as high-grade stenoses in the small-sized LAD and left circumflex arteries

Sustained Achromobacter Xylosoxidans Bacteremia in a Patient with Adenocarcinoma of the Colon

Introduction Achromobacter xylosoxidans is a rare cause of bacteremia; however patients with underlying illness, especially malignancies, are at increased risk of infection. Antibiotic therapy against this pathogen can be difficult owing to its inherent resistance to multiple common antibiotics. Case Presentation A 69-year-old male with adenocarcinoma of the colon status post right hemicolectomy and chemotherapy presented with fever and fatigue 10 days following endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement for new liver metastases. The patient had undergone partial hemicolectomy and had completed 12 cycles of adjuvant FOLFOX (leucovorin, 5-fluorouracil, and oxaliplatin) at the time of initial diagnosis. Two years following the completion of chemotherapy, the patient was found to have obstructive jaundice and new liver metastases on CT scan. He underwent an ERCP procedure with biliary stenting for palliation and was discharged home. Ten days following the procedure, the patient presented with complaints of fever to 102oF and fatigue. Vital signs revealed a fever of 101.3oF but were otherwise unremarkable. Physical examination revealed improvement of his jaundice, normal cardiopulmonary examination, and right upper quadrant tenderness. Despite four days of vancomycin and piperacillintazobactam, the patient continued to be febrile to 102.5oF

Using Markov Chains to Determine Expected Propagation Time for Probabilistic Zero Forcing

Zero forcing is a coloring game played on a graph where each vertex is initially colored blue or white and the goal is to color all the vertices blue by repeated use of a (deterministic) color change rule starting with as few blue vertices as possible. Probabilistic zero forcing yields a discrete dynamical system governed by a Markov chain. Since in a connected graph any one vertex can eventually color the entire graph blue using probabilistic zero forcing, the expected time to do this is studied. Given a Markov transition matrix for a probabilistic zero forcing process, an exact formula is established for expected propagation time. Markov chains are applied to determine bounds on expected propagation time for various families of graphs.This article is published as Chan, Yu, Emelie Curl, Jesse Geneson, Leslie Hogben, Kevin Liu, Issac Odegard, and Michael Ross. "Using Markov Chains to Determine Expected Propagation Time for Probabilistic Zero Forcing." The Electronic Journal of Linear Algebra 36, no. 36 (2020): 318-333. DOI: 10.13001/ela.2020.5127. Posted with permission.</p