Exploring emotions and cognitions in hoarding: a Q-methodology analysis.

BACKGROUND: The cognitions and emotions of people prone to hoarding are key components of the dominant cognitive behavioural model of hoarding disorder. AIMS: This study sought to use Q-methodology to explore the thoughts and feelings of people that are prone to hoarding, to identify whether distinct clusters of participants could be found. METHOD: A 49-statement Q-set was generated following thematic analysis of initial interviews (n = 2) and a review of relevant measures and literature. Forty-one participants with problematic hoarding met various study inclusion criteria and completed the Q-sort (either online or offline). A by-person factor analysis was conducted and subsequent participant clusters compared on psychometric measures of mood, anxiety, hoarding and time taken on the online task as proxy for impulsivity. RESULTS: Four distinct participant clusters were found constituting 34/41 (82.92%) of the participants, as the Q-sorts of n = 7 participants failed to cluster. The four clusters found were 'overwhelmed' (n = 11 participants); 'aware of consequences' (n = 13 participants); 'object complexity' (n = 6 participants) and 'object-affect fusion' (n = 4 participants). The clusters did not markedly differ with regard to hoarding severity, anxiety, depression or impulsivity. CONCLUSIONS: Whilst the participant clusters reflect extant research evidence, they also reveal significant heterogeneity and so prompt the need for further research investigating emotional and cognitive differences between people prone to hoarding.

Predicting the Mpemba effect using machine learning.

The Mpemba effect can be studied with Markovian dynamics in a nonequilibrium thermodynamics framework. The Markovian Mpemba effect can be observed in a variety of systems including the Ising model. We demonstrate that the Markovian Mpemba effect can be predicted in the Ising model with several machine learning methods: the decision tree algorithm, neural networks, linear regression, and nonlinear regression with the least absolute shrinkage and selection operator (LASSO) method. The positive and negative accuracy of these methods are compared. Additionally, we find that machine learning methods can be used to accurately extrapolate to data outside the range in which they were trained. Neural networks can even predict the existence of the Mpemba effect when they are trained only on data in which the Mpemba effect does not occur. This indicates that information about which coefficients result in the Mpemba effect is contained in coefficients where the results does not occur. Furthermore, neural networks can predict that the Mpemba effect does not occur for positive J, corresponding to the ferromagnetic Ising model even when they are only trained on negative J, corresponding to the antiferromagnetic Ising model. All of these results demonstrate that the Mpemba effect can be predicted in complex, computationally expensive systems, without explicit calculations of the eigenvectors.

Neurosyphilis: A Monkey Among Men.

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous systemat any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called "The Great Pretender" or "Themonkey among diseases"(Krämer et al., 2018).12 This is a case report of an 83-year-old female with a history of multiple TIAs, dementia, and breast cancer who presented to the emergency department with complaints of her head "not feeling right" and intermittent ataxia (episodes of imbalance and difficulty ambulating) reported by patient and patients' son. Physical exam only pertinent for chronic shuffling gait, but no ataxia. The patient underwent further work-up, demonstrating negative brain imaging for cerebral vascular accident and laboratory findings negative initially, for acute infection. An RPR was drawn as part of an broadened altered mental status workup as the patient and family stated she was not back to baseline mental status and was positive with a quantitative titer of 1:8. Fluorescent treponemal antibody absorption (FTA-ab) was found to be positive as well. The patient was started on three million units intravenous Penicillin G every 4 h and was discharged with a peripherally inserted central catheter in order to receive two weeks of Rocephin at two grams daily. Patient returned to prior baseline following completion of treatment. Through this case, we hope to provide information on neurosyphilis and its differentiation from other disease processes and when neurosyphilis should be suspected during an evaluation of altered mental status.

An unusual case of severe hypercalcemia: as dehydrated as a bone.

Objective: Severe hypercalcemia is a medical emergency. Hyperparathyroidism, malignancy, vitamin D toxicity, infections such as tuberculosis, or systemic illness such as sarcoidosis are all possible etiologies. Among the less studied causes is dehydration. Our objective is to identify dehydration as an etiology of hypercalcemia. Methods: Extensive literature review did not recognize dehydration as an etiology of hypercalcemia. We present a case of dehydration leading to severe hypercalcemia in a 60-years-old female with a presentation of altered mental status and corrected calcium level of 19 mg/dL in the absence of parathyroid abnormality, vitamin D toxicity, systemic disease, or malignancy. Results: Dehydration caused hypercalcemia which led to a feed-forward mechanism and caused further worsening dehydration, worsening kidney function, and severe hypercalcemia. The patient responded very well to intravenous fluid and at the time of discharge had a serum calcium of 9.8 mg/dL with improved mental status back to the baseline. Conclusion: Our literature review demonstrated many causes of hypercalcemia, with dehydration being exceptionally rare. It is our hope that this case report may serve as evidence of one such instance, allowing providers to keep a working differential of dehydration in severely elevated calcium levels.