The Missed Appointment: A Resident\u27s Journal through Activity to Introspection

There was one experience during my medical school psychiatry rotation that I could not forget. In a classroom on the cardiology ward, I listened, transfixed like a child at a magic show, as a psychiatrist interviewed a man who was recovering from a heart attack. Initially the man denied any stresses in his life that might have affected his health, but as he went on, a different story unfolded. He spoke of his recent retirement, his wife\u27s dissatisfactions and hostility, his disappointment with his children, his growing sense of failure and futility, and the recurring tightness in his chest that he had tried to ignore. His doctors colluded in his denial, for they were too busy with his EKGs and cardiac enzymes to wonder about his emotional well-being. I could see the despair, but also the hope in his face as he talked with the psychiatrist. At the end of the interview the patient was in tears, and though I hid them from my colleagues, so was I. Powerful and mysterious stuff, this business of feelings, much more complicated than anything I had yet encountered in my medical training, but also much more threatening. It seemed that talking to patients about their feelings would bring into question my own feelings, a Pandora\u27s box I wasn\u27t ready to open. A seed had been planted, but it was not to be tended to for some time to come

Replacement for the 10 page paper? A pilot project using blogs and wikis for a collaborative EBM assignment in a 3rd year internal medical clerkship

Objective Pilot a group assignment using blogs and wikis to develop evidence-based medicine skills in third year medical students on an internal medicine clerkship. Instead of the clerkship’s previous individual ten-page paper assignment, the students were divided into four groups of sixteen. During the clerkship, students are on geographically dispersed rotations. The earlier ten-page paper had required the students to complete a patient history and physical write-up. With the pilot project, each group was assigned a librarian and a physician faculty mentor. Each student recorded on the blog a clinical scenario and question they encountered. They were encouraged to communicate with the librarian to construct a well formed clinical question. Each student group then came to consensus on which question to pursue and collaborated on a wiki including a list of citations to the best available evidence, a critique of the studies, and implications for the patient

Problematic online gaming. Is it real and does it matter to our teenagers?

Background: Video games and social media have become an ubiquitous part of our society. Video games have been associated with both positive and negative health consequences. There is a growing body of literature supporting the idea that users can develop problematic interactive media use. We hypothesized that teenagers who screened positive for internet gaming disorder would have correlations with other psychosocial and behavioral concerns when compared to their peers. Methods: An urban cohort of high school students aged 14-18 years completed validated self-reported questionnaires to screen for internet gaming disorder, risk of depression, daytime sleepiness, and quality of life measures. Results: Internet gaming disorder was present in 11.9% of participants. Teens screening positive for problematic online gaming also had significantly elevated risk of depression and a lower quality of life. Conclusion: High school aged students were screened for video game addiction through a self-reported questionnaire. Participants were separated into two groups, those who were identified as meeting criteria for video game addiction and those who did not. The group who screened positive for video game addiction also were at a higher risk for depression and scored lower on a quality-of-life survey. Video game addiction, although likely not causative, may be an indicator of other psychosocial issues faced by high school aged teenagers

Parkinson disease clinical subtypes: Key features & clinical milestones

OBJECTIVES: Based on multi-domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones. METHODS: Prospective cohort of 162 PD participants with ongoing, longitudinal follow-up. Latent class analysis (LCA) delineated subtypes based on score patterns across baseline motor, cognitive, and psychiatric measures. Discriminant analyses identified key features that distinguish subtypes at baseline. Cox regression models tested PD subtype differences in longitudinal conversion to clinical milestones, including deep brain stimulation (DBS), dementia, and mortality. RESULTS: LCA identified distinct subtypes: motor only (N = 63) characterized by primary motor deficits; psychiatric & motor (N = 17) characterized by prominent psychiatric symptoms and moderate motor deficits; cognitive & motor (N = 82) characterized by impaired cognition and moderate motor deficits. Depression, executive function, and apathy best discriminated subtypes. Since enrollment, 22 had DBS, 48 developed dementia, and 46 have died. Although there were no subtype differences in rate of DBS, dementia occurred at a higher rate in the cognitive & motor subtype. Surprisingly, mortality risk was similarly elevated for both cognitive & motor and psychiatric & motor subtypes compared to the motor only subtype (relative risk = 3.15, 2.60). INTERPRETATION: Psychiatric and cognitive features, rather than motor deficits, distinguish clinical PD subtypes and predict greater risk of subsequent dementia and mortality. These results emphasize the value of multi-domain assessments to better characterize clinical variability in PD. Further, differences in dementia and mortality rates demonstrate the prognostic utility of PD subtypes

Cognitive-Behavioral Treatment of the Paraphilias

AbstrAct Background: Sexual offenders continue to occupy the public's attention; a significant proportion of this population is diagnosed with paraphilias. Cognitivebehavioral treatment has been the mainstay of treatment for sex offenders and for the paraphilias for the past three decades. This article will review the history of cognitivebehavioral therapy, its techniques, and its efficacy

Free Wave Propagation in Plates of General Anisotropic Media

The propagation of Lamb waves in plates has been the subject of numerous investigations since their postulation by Lamb in 1916 [1,2]. Most of the work in existence deals with various aspects of these guided waves in plates of isotropic materials. Comparatively speaking a limited number of results has appeared in which Lamb or horizontaly polarized SH wave propagation in anisotropic plates has been considered in any detail. For Lamb waves, theoretical analyses have been reported in plates of cubic [3,4], transversely isotropic [5,6], and orthotropic [7,9] media

Simultaneous Denoising and Motion Estimation for Low-dose Gated PET using a Siamese Adversarial Network with Gate-to-Gate Consistency Learning

Gating is commonly used in PET imaging to reduce respiratory motion blurring and facilitate more sophisticated motion correction methods. In the applications of low dose PET, however, reducing injection dose causes increased noise and reduces signal-to-noise ratio (SNR), subsequently corrupting the motion estimation/correction steps, causing inferior image quality. To tackle these issues, we first propose a Siamese adversarial network (SAN) that can efficiently recover high dose gated image volume from low dose gated image volume. To ensure the appearance consistency between the recovered gated volumes, we then utilize a pre-trained motion estimation network incorporated into SAN that enables the constraint of gate-to-gate (G2G) consistency. With high-quality recovered gated volumes, gate-to-gate motion vectors can be simultaneously outputted from the motion estimation network. Comprehensive evaluations on a low dose gated PET dataset of 29 subjects demonstrate that our method can effectively recover the low dose gated PET volumes, with an average PSNR of 37.16 and SSIM of 0.97, and simultaneously generate robust motion estimation that could benefit subsequent motion corrections.Comment: Accepted at MICCAI 202