Tuesday Morning Research Articles

EP15 A self-limiting symmetrical polyarthritis following COVID-19 infection

Case report - IntroductionWe describe an acute onset self-limiting seronegative non-destructive symmetrical polyarthritis five weeks after laboratory confirmed COVID-19 infection.Case report - Case descriptionA 37-year-old male hospital doctor of presented to the Early Inflammatory Arthritis clinic with a four-week history of acute onset joint pain, swelling and early morning stiffness in excess of two hours. The symptoms began at the left ankle with Achilles’ tendonitis but progressed over the following 72 hours to a symmetrical polyarthritis affecting the wrists, proximal interphalangeal joints, shoulders, elbows, and knees. Approximately five weeks prior to the onset of his joint symptoms he had laboratory confirmed SARS-CoV-2 infection with six days of fever, non-productive cough, and fatigue. He did not require hospitalisation. His past medical history was significant for biopsy proven non-alcoholic fatty liver disease. There was no prior history of inflammatory arthritis and no personal or family history of skin psoriasis, inflammatory bowel disease or uveitis. There was no preceding genitourinary or gastrointestinal upset. His family history was significant for a sister with seronegative rheumatoid arthritis for which she was taking sulfasalazine. Examination revealed a normal BMI, synovitis at the wrists and proximal interphalangeal joints without evidence of joint effusion in the large joints. Blood tests revealed elevations in the ESR (83 mm/hour, reference range 0-10 mm/hour) and CRP (25mg/dL, reference range <5mg/dL). Serology was negative for the rheumatoid factor, anti-CCP antibodies, antinuclear antibodies, and an extractable nuclear antigen panel. Radiographs of the affected joints were unremarkable. Serological testing was positive for anti-SARS-CoV-2 IgG antibodies.He was started on oral Prednisolone 20mg daily and an NSAID with good symptomatic response and normalisation of his ESR (5mm/hour) and CRP (<1mg/dL). The course of prednisolone was tapered over a 6-week period and he is still in steroid free remission with normal inflammatory markers at follow up. The patient was given a diagnosis of a post-viral reactive arthritis which was attributed to the preceding COVID-19 illness. Case report - DiscussionPost infectious inflammatory arthritis has been described with many viral infections including: hepatitis virus, parvovirus B19, enterovirus, rubella, alphavirus (including Chikungunya), flavivirus (including Zika), herpes viruses (including Epstein-Barr virus), varicella, cytomegalovirus and human immunodeficiency virus (HIV). Interestingly, viral arthritis has not been reported in influenza and human coronaviruses (including SARS and MERS). Arthralgia was reported in 14.9% of laboratory confirmed COVID-19 cases in China during the early phases of the pandemic but inflammatory arthritis was not well described. The clinical course of the inflammatory arthritis in this case was self-limiting with enthesitis and synovitis resolving within six weeks of onset with the mainstay of treatment being symptomatic relief in the form of non-steroidal anti-inflammatory drugs and corticosteroids.Patient perspective: When I woke up that Tuesday morning with severe joint pains and stiffness, I knew something was not right. It was not like anything I have felt before in terms of my joints, having had sports injuries in the past. It was to the point where I was even struggling to go from sitting to standing. Without Prednisolone, I feel as if I would not have been able to work and may even have been house bound. I was relieved that this inflammatory arthritis did respond to Prednisolone. After six weeks of taking Prednisolone, the condition seemed to settle. Case report - Key learning pointsA self-limiting episode of inflammatory arthritis may occur following COVID-19 infection.

A Lebanese contemporary female mystic and her counter-conducts

ABSTRACT A network of Christian female mystics in Lebanon and Syria has been forming since the early 1980s. Composed of women from large cities, such as Beirut or Damascus, it is characterized by its denominational and social diversity. This article will focus on one of these mystics: Catherine Fahmi, who has been living, and officiating, in her apartment in the suburbs of Beirut since the late 1990s. Catherine is a Maronite. She is a married mother of three, in her forties. Each Tuesday morning, she experiences a public ecstasy. Every year, on Good Friday, surrounded by a number of faithful followers, she sees and experiences the Way of the Cross. My aim here is to grasp the complex interplay between this female mystic, her followers and the Maronite Church. Her activities, and the rituals surrounding her stigmatized body, will be analyzed in terms of ‘counter-conducts,’ a notion developed by Michel Foucault.

Ngā whānau [The families

Ngā whānau [The families] Vaughan Rapatahana (bio) "Jenny, don't be late home from school today, please. We have to get your ballet gear organized for Saturday." Jenny's mother repeated herself and then added, "Didn't you hear me the first time?" "Yes, Mum," was all Jenny had to say, as she grabbed her bag and closed the front door behind her. Jenny already had a bit of a headache, and it was only Tuesday morning. School went pretty much the same as any other day. The usual lessons. The usual stupid boys with smirky faces. The usual homework tasks set. The only thing that was different was that Jenny, now a senior, was asked to go to a lunchtime meeting with the other prefects. Ms. Gilhooley smiled at them all and went right to her point. "I won't keep you long because I know some of you have other duties. But we would like some volunteers to help with the new students this term. We would like some of you to volunteer to be mentors, please." She glanced around the prefects. One or two put their hands up straight away. Jenny was not one of them. "Thank you for volunteering, Isaiah," smiled Ms. Gilhooley. "Miss, I wasn't volunteering. I wanted to ask when we were meant to mentor these new kids?" Isaiah had a rather patronizing tone to his voice. "I mean, I have sports practice most days after school ..." A few affirmative nods and a "yeah" or two greeted his comment. "We were thinking Tuesdays and Thursdays during term one. Perhaps for half an hour at this stage. We would like you to get to know some of the new students who we think may need a little bit of support at school. You could ask them if they had any questions and give them assistance with studies perhaps—and definitely give support if they feel lonely ..." Isaiah was sighing, and one or two others looked supremely uninterested. Joanna Skipper and Gerald Hope, however, did volunteer. "What about you, Jenny? Can you help us, please?" Jenny was reluctant, but she was also aware that she "should set an example" because her mother always said so. "OK. I will help," she replied softly. At 3:15 that afternoon Jenny was introduced to Charm. Charm had recently moved into the district, although Jenny later learned that Charm's family had once [End Page 408] lived in the area several years previously. They were nearly seven years apart in terms of their ages and in terms of their year level at the small area school. Charm lived up to her name: she smiled at Jenny when the two were introduced and seemed very happy to have a "senior" to help her settle into the school. In fact, that's what she said straight away. Jenny asked if the younger girl had any questions, to which Charm immediately responded with, "My form teacher is Mr. Sellars. He is trying to be a funny guy because he keeps on telling us jokes all the time. But his jokes aren't funny." Jenny did not know what to say. She did not know Mr. Sellars as he had never taught her. So she smiled and said nothing. "Do you play any sports?" was Charm's next sally. "I used to play netball ...," Jenny trailed off. She wasn't going to tell the younger girl that her own mother had nagged Jenny about quitting netball, because "it takes up too much of your time." Charm was waiting for the rest of the sentence, but all she received was, "How about I meet up with you tomorrow at lunchtime and you can tell me about anything at school that you need help with?" Jenny knew her mother would probably berate her for not going home straight after school, so she was attempting to scale down the conversation. "OK,'" smiled Charm. "But where?" she added. "How about I come and find you in Mr. Sellar's room when the lunch bell goes?" "Sure," Charm said. ________ Jenny found her mother drinking wine on the front porch. Their small car was out on the...

Ngā whānau: [The families

Ngā whānau [The families] Vaughan Rapatahana (bio) "Jenny, don't be late home from school today, please. We have to get your ballet gear organized for Saturday." Jenny's mother repeated herself and then added, "Didn't you hear me the first time?" "Yes, Mum," was all Jenny had to say, as she grabbed her bag and closed the front door behind her. Jenny already had a bit of a headache, and it was only Tuesday morning. School went pretty much the same as any other day. The usual lessons. The usual stupid boys with smirky faces. The usual homework tasks set. The only thing that was different was that Jenny, now a senior, was asked to go to a lunchtime meeting with the other prefects. Ms. Gilhooley smiled at them all and went right to her point. "I won't keep you long because I know some of you have other duties. But we would like some volunteers to help with the new students this term. We would like some of you to volunteer to be mentors, please." She glanced around the prefects. One or two put their hands up straight away. Jenny was not one of them. "Thank you for volunteering, Isaiah," smiled Ms. Gilhooley. "Miss, I wasn't volunteering. I wanted to ask when we were meant to mentor these new kids?" Isaiah had a rather patronizing tone to his voice. "I mean, I have sports practice most days after school ..." A few affirmative nods and a "yeah" or two greeted his comment. "We were thinking Tuesdays and Thursdays during term one. Perhaps for half an hour at this stage. We would like you to get to know some of the new students who we think may need a little bit of support at school. You could ask them if they had any questions and give them assistance with studies perhaps—and definitely give support if they feel lonely ..." Isaiah was sighing, and one or two others looked supremely uninterested. Joanna Skipper and Gerald Hope, however, did volunteer. "What about you, Jenny? Can you help us, please?" Jenny was reluctant, but she was also aware that she "should set an example" because her mother always said so. "OK. I will help," she replied softly. At 3:15 that afternoon Jenny was introduced to Charm. Charm had recently moved into the district, although Jenny later learned that Charm's family had once [End Page 408] lived in the area several years previously. They were nearly seven years apart in terms of their ages and in terms of their year level at the small area school. Charm lived up to her name: she smiled at Jenny when the two were introduced and seemed very happy to have a "senior" to help her settle into the school. In fact, that's what she said straight away. Jenny asked if the younger girl had any questions, to which Charm immediately responded with, "My form teacher is Mr. Sellars. He is trying to be a funny guy because he keeps on telling us jokes all the time. But his jokes aren't funny." Jenny did not know what to say. She did not know Mr. Sellars as he had never taught her. So she smiled and said nothing. "Do you play any sports?" was Charm's next sally. "I used to play netball ...," Jenny trailed off. She wasn't going to tell the younger girl that her own mother had nagged Jenny about quitting netball, because "it takes up too much of your time." Charm was waiting for the rest of the sentence, but all she received was, "How about I meet up with you tomorrow at lunchtime and you can tell me about anything at school that you need help with?" Jenny knew her mother would probably berate her for not going home straight after school, so she was attempting to scale down the conversation. "OK,'" smiled Charm. "But where?" she added. "How about I come and find you in Mr. Sellar's room when the lunch bell goes?" "Sure," Charm said. ________ Jenny found her mother drinking wine on the front porch. Their small car was out on the...

Media Theory and the 2016 Election

By the morning of Tuesday, November 8, 2016, journalists and pundits had settled into a comfortable narrative—Hillary Clinton would be the first female president of the United States, most likely b...

PO-208 Effect of resistance training on functional fitness and bone mineral density in elderly women

Objective Try to carry out the intervention experiment of the strength exercise of the elderly in the community, aiming to provide theoretical and data basis for the daily strength exercises of the elderly in China.&#x0D; Methods Recruiting 18 elderly female volunteers in Xicheng District, Beijing, required independent living ability and were willing to participate in the experiment. They were randomly divided into intervention group (N=9, 62.0±6.0 years) and control group (N=9, 63.0 ± 4.8 years). On Tuesday afternoon and Thursday morning, under the leadership of a professional coach, follow the planned "Resistance Exercise Plan" to carry out resistance training. Each practice time is about 90min for 9 weeks. The exercise intensity control is divided into two phases: the first phase lasts for one week, mainly the learning and adaptation phase of the action, and the heart rate control in the 30%~40%HRR or RPE 10 subscale is 4 (a little easy); The stage lasts for 8 weeks of the medium-intensity practice phase, the heart rate control in the 40%~60%HRR or RPE 10 subscale is 5~6 (moderate, slightly strenuous).&#x0D; Results Intervention group before and after experiment, the grip strength (25.0±5.0 VS 26.8±3.9 kg, P&lt;0.05) and the 30s arm curl test (23.1±5.2 VS 25.4±4.0 reptitions, P&lt;0.05) increased. Five sit-up tests (6.99±2.01 VS 6.51±2.00 s, P&lt;0.05) and the 8-foot standing walk (5.13±1.03 VS 5.07±1.01 s, P&lt;0.05) were all shortened. The bone density T value (-1.3±0.4 VS -1.0±0.4, P&lt;0.05) increased. After intervention, the intervention group compared with the control group, grip strength (26.8 ± 3.9 VS 22.1 ± 4.5 kg, P &lt;0.05), 30s arm curl test(25.4 ± 4.0 VS 22.1 ± 3.0 reptitions, P &lt;0.05) increased. Five sit-up tests (6.51 ± 2.00 VS 6.94 ± 1.05 s, P &lt; 0.05) and 8 feet of standing walk (5.07 ± 1.01 VS 5.27 ± 0.97 s, P &lt; 0.05) were all shortened. Bone density T value (-1.0 ± 0.4 VS - 1.4 ± 0.4, P &lt; 0.05) increased. There was no significant change in the 30-second chair stand test.&#x0D; Conclusions Through 9 weeks of progressive resistance exercise, the experiment made the upper limb explosive force, upper limb muscle endurance, lower limb explosive power, flexibility and dynamic balance enhanced, and bone density increased. The enhancement of lower limb endurance is not obvious, which may be the reason for short experimental time and small exercise intensity of lower limbs.

Exposure to Metal Fume Particulate Matter and NO in Exhaled Breath in Shipyard Welders

Exposure to metal fume particulate matter has been linked to numerous adverse health endpoints. Clinical researches have been clarifying the relation of Fractional nitric oxide (FeNO) with airway inflammation in asthma. Despite this, limited data examining the relation of metal fume particulate matter exposure and NO in exhaled breath in welders.We conducted a cross-sectional study. Study participants consisted of 52 welders and 29 office workers. Exposure assessment was based on eight-hour measurement with a personal PM2.5 sampler of exposure to metal fume fine particle matter on Monday. On Tuesday morning, participants were instructed to fast for at least 10 hours prior to urine sampling. The concentration of NO in exhaled breath, an indicator of acute bronchial inflammation and oxidative stress, was measured first, using the portable analyzer. Then a portable spirometer was used to perform the forced expiratory measurements.PM2.5 exposure concentrations were 379.9&amp;#177;4.7 &amp;#956;g/m3 and 154.5&amp;#177;3.6 &amp;#956;g/m3 in welders and office workers, respectively. Welders had lower levels of NO in exhaled breath than that of office workers after adjusting for confounds, though the difference was not significant. Participants with current smoking habit had significant lower NO levels compared to non-smokers. Individual urinary metal such as Mn, Co, Ni, and Fe was associated with NO in exhaled breath in all workers after adjusting for confounds. However, only individual urinary Ni, or Fe metal was associated with NO in exhaled breath in welders. No association between any lung function indicators and NO level in exhaled breath was found.We concluded that some particular metals from metal fume particulate matter exposure may be associated with decreasing NO level in exhaled breath in welders.

Exposure to Metal Fume Particulate Matter and Receptor for Advanced Glycation End Products in Shipyard Welders

Inhalation of metal-rich PM2.5 produces reactive oxygen species (ROS) in the body, which may cause Maillard reactions, produce advanced glycation end products (AGEs). The interaction between the receptor of AGEs (RAGE) and its ligand AGEs triggers the inflammatory signal transduction, elevating risk of chronic diseases including diabetes mellitus. This study was assess the association between exposure to metal fume fine particle matter and production of AGE and RAGE.This study conducted in cross-sectional design and consisted of 52 welding workers and 29 office workers. The exposure assessment was performed for all individuals with a personal sampler to measure eight working hours exposure to metal-rich PM2.5 on Monday. On Tuesday morning, participants were instructed to fast for at least 10 hours prior to urine and blood sampling. Urinary metals were measured by ICP-MS. AGE and RAGE product was analyzed by ELISA and Flow Cytometry respectively. Multivariable linear regression model was used to assess association between urinary metals concentration and AGE and RAGE expression.PM2.5 exposure concentrations were 379.93&amp;#177;4.71 &amp;#956;g/m3 and 154.47&amp;#177;3.56 &amp;#956;g/m3 in welders and administrative personnel, respectively. RAGE expressions were 1500.78&amp;#177;1743.56 a. u. and 741.05&amp;#177; 537.03 a. u. in welders and administrative personnel, respectively. However, AGE did not significantly differ between these two groups. There was no significant correlation between PM2.5 and AGE or RAGE. After adjusted for confounders, urinary chromium concentration (&amp;#946;&amp;#61;0.242, 95%CI 0.024-0.339, P&amp;#61;0.025) and urinary cadmium concentration (&amp;#946;&amp;#61;0.333, 95%CI 0.017-0.165, P&amp;#61;0.017) were significantly associated with RAGE expression. However, no significant effect of urinary metals concentration on AGE was found.Exposure to metal fume particulate matter in welders were significantly associated with increasing RAGE expression. Inflammatory response of increased RAGE expression of welders should be further investigated.

Routinizing Mathematics Vocabulary: The Vocab Grid

One Tuesday morning, my sixth graders were faced with the following task:

The Monkey’s Uncle Louis

The Monkey’s Uncle Louis Christine Sneed (bio) Louis’s younger sister Anne had adopted a monkey, news she shared with him over the phone, her call waking him early on a Tuesday morning, on the first day of the fall semester. She wanted to know if he’d like to come to Florida to meet the monkey. It was a white-bellied capuchin, a female. She was very sweet-natured, smart, and funny. Anne sounded smitten, a little dazed, the happiest she’d sounded in a while. “I suppose I could,” he said. “The first few weeks of the term aren’t too busy.” He could hear noises in the background, a series of beeps followed by laughter. “What’s her name?” he asked. “We haven’t decided yet,” said Anne. “I’ll send you an e-mail with the names we’re considering.” “All right. If you want to.” “You’re not happy for us,” she said flatly. “That’s not true. I am happy for you,” he said. “You sound good.” “I’m glad you think so.” Before they hung up he asked, “Is it legal to have a monkey in Florida? Don’t you need a permit or something?” His sister hesitated, a sound escaping her throat that he’d been familiar with since childhood. She was trying not to cry. “Yes, of course. We have one, Louis. We’re not criminals.” ________ The e-mail with the proposed monkey names arrived that evening while he was eating dinner alone in an Olive Garden near his house. He only cooked on weekends when his wife was home. Nearly every Friday, she flew back to Chicago from Hartford where she worked as a hospital administrator, or he flew to her. They’d been making these trips for six of the nine years they’d been married. Louis was a tenured professor in American history at a college three miles from their house, and when Sandra was hired by the hospital in Hartford, they’d both agreed his job was too good to give up with its summers off and generous pension and periodic sabbaticals. They had a cat, Jules, but no children; Jules was Sandra’s cat and pre-dated Louis, although the cat lived in Chicago instead of Hartford. In the last year, Jules had developed diabetes, and in Sandra’s absence, it was Louis who administered the insulin shots, the cat submitting to them with disappointment on his owlish face. His disappointment was even plainer when he peered each morning into his food bowl: the vet had put him on a special diet, one with more protein but less flavor. [End Page 82] ________ Dear Louis, Here are the names we’re thinking about for our monkey. Can you rank them from 1 to 5, with 1 being your first choice and send them back to me? Lucinda Molly Jeannie Becky Claire Bill and I would love it if you’d come down the next weekend you’re free—what about Labor Day? If Sandra isn’t planning to be in Hartford that weekend, maybe she can come too. Love, Anne P.S. We are already so in love with our little monkey! ________ He had misgivings about his sister’s plan to make a home for a wild creature that was likely soon to bring its new keepers to their knees. What would happen if in the middle of the night the monkey escaped the house, and homesick for its native jungle, started screeching from the treetops and rattling neighbors’ doors and windows? Online he found a video of a gang of capuchins chasing after four fawn-colored Chihuahuas, someone off-screen laughing maniacally. The Chihuahuas looked terrified, their eyes bulging even more than Louis thought was normal. The monkeys screamed and pogoed up and down when they overtook the horrified dogs. Another video showed a tufted capuchin feverishly pulling socks and underwear out of a chest of drawers and flinging them over its shoulders. ________ Dear Anne, Just curious, do monkeys like bananas as much as they say? Of the names you sent, I think I like Lucinda the best, Claire...

Any A

Any A B.J. Best It was another Current Events quiz in Mrs. Cunningham’s class. We were supposed to know what was happening in Djibouti or Brussels or wherever. We were provided magazines at the front of the classroom, and fifteen minutes on Tuesday and Thursday mornings to study them. I spent most of my time studying the dark hair that cascaded down Tracy’s back like coils in a spiral notebook. Tracy wore a white blouse. Tracy wore a brassiere. Sometimes, from sidelong angles, you could see a hint of it between the buttons of her blouse, the same way you can sometimes see a sliver of moon between the scalloped clouds. There were questions about Congress, Libya, the Winter Olympics, and I didn’t know most of them. I drummed my pencil. Then—who knows why—I read the directions. They began: “This is an exercise in following directions. Do not complete this quiz. Only fill in your name in the space provided.” I did as I was told, and then sat there, smug, while the rest of my classmates sweated about Sudan. What an object lesson in democracy! What a signal to send to our garden of growing citizens! You must always read the directions, no matter how many times you may have done something before! The governing lies in the process, not the product. We would no longer be able to fake enough of our knowledge about Pakistan to earn our Bs. Mrs. Cunningham collected the quizzes, an aberration from our typical method of grading by passing them back one student (Tracy always over her left shoulder). She separated what I knew was mine from the stack, then made a display of ripping the rest into neat quarters. She trundled past Tracy, put a hand on my shoulder, and said, “Here. Here is someone who knows how to follow directions!” She smelled of floral perfume that didn’t quite mask the pall of cigarettes. I burned for the rest of the day. It was that desperation that led me, six days later, to ask Tracy to the winter dance. She looked at me like you might a dissected frog. She tilted her head. The pause swung like a blade. Finally, she said yes, provided she could copy from me for all future Current Events quizzes. Her parents would pay her fifty dollars for an A, any A. “It’s difficult to copy from someone who sits directly behind you,” I said. She stood straight, squared her shoulders, and my eyes—so help me—my eyes drifted downward. She traced a fingernail along my left cheek. “Here is someone who knows how to follow directions,” she said. [End Page 97] Copyright © 2018 Pleiades and Pleiades Press

Sharing the Secret Sauce: Engaging Early Childhood Educators in Library Storytime Practices

If you peek into Kirsten’s preschool classroom in suburban Denver early on a Tuesday morning, you’ll quickly notice that the eager three-year-olds are not the only ones enthusiastically singing, “Go Bananas!”The students bring up flannelboard pieces for Karen Beaumont’s Dini Dinosaur while answering, “What do you think will happen next?” In another story, Ding Dong Gorilla by Nicola O’Byrne, Kirsten and her children gather around the “library lady” who is visiting the classroom.

55 ‘Mini Sim’ – innovative bite sized simulation teaching in a busy children’s emergency department

Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts...

The Effect of Alternative E-mail Contact Timing Strategies on Response Rates in a Self-administered Web Survey

The Federal Employee Viewpoint Survey is an annual survey of over 800,000 permanently employed civilian personnel from 87 agencies. First administered in 2002, the web-based survey measures a broad range of employee perceptions, attitudes, and behaviors, serving as a valuable tool for human resources managers to determine which aspects of an organization are working well and which may require intervention. The data collection protocol begins by sending all sampled individuals an initial invitation to participate. Thereafter, nonrespondents are sent weekly reminder e-mails. These notifications are typically sent on Tuesday mornings. In this article, we present results from an experiment investigating two alternative protocols varying when survey notification and reminder e-mails are sent. Interestingly, the stable Tuesday morning strategy produced a significantly higher response rate than the two alternatives, and we analyze timestamp information from one of the alternatives to help provide insight as to why.

The Association Between Assigned Independent Learning Schedule and Medical Student Performance on Examinations

Studies of college bound high school students found that these learners base study practices on their beliefs about how they perceive they learn best. Research on study habits and examination performance is absent in medical education but is important because it suggests potential ways a learner can regulate performance. We tested the hypothesis that students whose independent learning time was assigned to occur on Thursday afternoon would perform better on weekly Friday examinations compared to students who have independent study time on Monday afternoon or Tuesday morning. To test this hypothesis, we linked data on timing of assigned independent learning sessions to student demographic characteristics and MCAT scores and then to performance on weekly examinations among 148 medical students undertaking the first 12 months of Oregon Health & Science University’s School of Medicine curriculum. The mean age of students in our study sample was 26.3 years with a range of 22–42. Most identified as female (54.1%), white (76.0%), non-Hispanic (95.9%), and single (74.2%) without children (96.6%). Total MCAT scores averaged 31.2 with a range of 24–40. Mean Friday examination scores ranged from 84.0 to 85.8 in Term 1 (p = 0.23), 84.8 to 85.1 in Term 2 (p = 0.96), and 84.1 to 85.5 in Term 3 (p = 0.40). We found no statistical differences in students’ demographic and MCAT scores according to either term or timing of assigned independent learning sessions. Thus, the timing of assigned independent learning sessions made no difference on weekly examination scores. More research is needed on study patterns to help inform students on how habits could be regulated to help improve performance.

The Silver Voices: A possible model for senior singing

Abstract Every Tuesday morning, 150 people from the age of 62 and above gather to sing in Kilden Performing Arts Centre, Kristiansand, Norway. A case study of this choir, The Silver Voices, was conducted. The aim of the study was to understand the practice and how an art institution can play a role in developing such an activity. As a point of departure the following questions were formulated: What is going on in the choir? Why and how is the activity organized? What is the meaning of the participation for the singers? The collection techniques utilized were participant observation, semi-structured interviews and document analysis. Perspectives from the fields of music education, community music and music and health will illuminate the analysis. The study shows that a musical activity such as The Silver Voices transcends distinctions between disciplinary fields.

Cardiac Autonomic and Salivary Responses to a Repeated Training Bout in Elite Swimmers.

This study examined the acute training responses of heart rate variability (HRV) and salivary biomarkers (immunoglobulin A and alpha-amylase) following a standardised training bout in Paralympic swimmers. Changes in HRV, sIgA and sAA were documented Monday morning, Monday afternoon and Tuesday morning over a 14-week monitoring period leading into international competition. Magnitude based inferences with effect sizes (ES) were used to assess the practical significance of changes each week. Normal training responses elicited increases in HR, α1, sAA and sIgA, accompanied by decreases in HF(nu), standard deviation of instantaneous RR variability (SD1) and the root mean square of successive differences (RMSSD) from Monday morning to Monday afternoon, and to Tuesday morning with similar week to week responses for most variables. Changes in RMSSD from Monday a.m. to p.m. were likely smaller (less negative) for Week 7 (78/18/3, ES = 0.40) following a competition weekend with similar changes observed from Monday a.m. to Tuesday a.m. (90/5/5, ES = 1.30). In contrast, the change in sAA from Monday a.m. to p.m. was very likely less (more negative) at Week 7 (0/0/99, ES = −2.46), with similar changes observed from Monday a.m. to Tuesday a.m. (0/0/99, ES = −4.69). During the taper period, there were also likely increases in parasympathetic modulations (RMSSD, Weeks 12–14) along with increased immune function (sIgA, Week 13) that demonstrated a favourable state of athlete preparedness. Used together, HRV and sAA provide coaches with valuable information regarding physiological changes in response to training and competition.

An Underutilized, Evidence-Based Treatment for Alcohol Use Disorder

Back to table of contents Previous article Residents’ ForumFull AccessAn Underutilized, Evidence-Based Treatment for Alcohol Use DisorderCornel N. StanciuM.D.Cornel N. StanciuSearch for more papers by this authorM.D.Published Online:29 Sep 2015https://doi.org/10.1176/appi.pn.2015.10a18It was 1 a.m. on a Tuesday morning, and I was covering psychiatric consults when I got paged to see Mr. W., a 38-year-old man well known to our department for multiple ED visits while intoxicated. This time, he had a blood alcohol level of .496 endorsing suicidality. A feeling of extreme frustration and agony rushed through me. Why can’t this man maintain abstinence despite numerous therapy sessions and seven-day detox admissions, and what do we even have to offer him at this point?As psychiatrists, we encounter many patients with alcohol use disorder (AUD) either as a primary or comorbid diagnosis. With 80 percent of our American adolescents having reported using alcohol in the past year and with the emergence of new, more dangerous formulations such as Palcohol, this problem will only continue to grow. A greater prevalence of AUD is noted among psychiatric patients, and ongoing use complicates the course of medical and psychiatric disorders, carrying significant social and financial costs.Despite the difficulty of treating AUD, diverse pharmacological treatment options are available and can be pursued with minimal disruption to home and work life. To date, medication-assisted treatment (MAT) is vastly underutilized, with only 3 percent of sufferers receiving FDA-approved treatment. Many trainees may have never prescribed or even considered such medications. Despite modest effect sizes in randomized, controlled trials to date, efficacy has been demonstrated with regard to reducing relapse rates and the overall severity of drinking days. Regardless of the severity of alcohol use, these individuals suffer from a potentially fatal chronic disease characterized by frequent relapses. Evidence indicates that recovery rates are highest when addiction treatment includes continuous abstinence monitoring, yet management today remains largely limited to short, episodic inpatient detoxifications and psychosocial therapies. After six hours in the ED, Mr. W. had become clinically sober. Similar to prior presentations, he then denied suicidal thoughts and expressed disappointment at his relapse, stating he planned to never drink again. With his therapy appointment in two days, discharge planning began. On his way out, he asked, “Is there a magic pill I can take to help me stop drinking?” The physician was vaguely aware of medications for alcohol use disorder, but due to lack of familiarity, he told the patient that attending substance abuse group therapy and discussing stressors with the counselor would be more beneficial. This case left me wondering: Why are both patients and providers ambivalent about using medication to achieve lasting recovery? Medication initiation certainly requires both parties to be in agreement. Prescribers also fail to offer medications due to lack of familiarity with medications, the guidelines for their use, or even a lack of belief in their effectiveness. Given that treatment is often based on 12-step models such as Alcoholics Anonymous (AA), providers may hesitate to prescribe medication for an illness thought to be managed through psychosocial interventions like group therapy, AA, and motivational therapy. Patients may decline medications due to a fear of dependence on them or patients’ overestimating their ability to achieve remission on their own.The choice of medication depends on the comfort level of the prescriber, reputation of the medication, side-effect profile, and affordability. However, the most important consideration should be the overall goal and expectation of the patient. It is advised to start with FDA-approved meds such as disulfiram for the motivated patient who has a collaborator and is desiring complete sobriety, naltrexone for those desiring to cut down (a long-acting formulation can be used for noncompliant patients), and acamprosate for patients with at least some established sobriety who need help with postwithdrawal sleep problems. With regard to off-label medications, topiramate has the highest evidence for efficacy. Gabapentin can augment naltrexone and also helps with sleep, anxiety, withdrawal, and cravings.Use of FDA-approved medications in conjunction with psychosocial interventions should be considered an integral part of our training and, ultimately, a part of our daily practice for the treatment of alcohol use disorder. ■Cornel N. Stanciu, M.D., is a PGY-3 psychiatry resident at the East Carolina University Brody School of Medicine. He wishes to thank Thomas Penders, M.D., in assisting in the preparation of this article. Penders is the inpatient medical director at the Brody School of Medicine. ISSUES NewArchived

In Memoriam William Martin Gelbart (1945-2015).

WILLIAM Martin Gelbart died Tuesday morning, August 11, 2015, after a valiant fight with cancer. Bill was born September 11, 1945, in Brooklyn, New York. He obtained a Bachelor of Science degree from Brooklyn College in 1966 and a Ph.D. in Genetics from the University of Wisconsin in 1971, working

Innovative Scheduling Solutions for Graduate Medical Education.

Innovative Scheduling Solutions for Graduate Medical Education.