Cultural Consensus Theory for the evaluation of patients’ mental health scores in forensic psychiatric hospitals

In many forensic psychiatric hospitals, patients’ mental health is monitored at regular intervals. Typically, clinicians score patients using a Likert scale on multiple criteria including hostility. Having an overview of patients’ scores benefits staff members in at least three ways. First, the scores may help adjust treatment to the individual patient; second, the change in scores over time allows an assessment of treatment effectiveness; third, the scores may warn staff that particular patients are at high risk of turning violent, either before or after release. Practical importance notwithstanding, current practices for the analysis of mental health scores are suboptimal: evaluations from different clinicians are averaged (as if the Likert scale were linear and the clinicians identical), and patients are analyzed in isolation (as if they were independent). Uncertainty estimates of the resulting score are often ignored. Here we outline a quantitative program for the analysis of mental health scores using cultural consensus theory (CCT; Anders and Batchelder, 2015). CCT models take into account the ordinal nature of the Likert scale, the individual differences among clinicians, and the possible commonalities between patients. In a simulation, we compare the predictive performance of the CCT model to the current practice of aggregating raw observations and, as an alternative, against often-used machine learning toolboxes. In addition, we outline the substantive conclusions afforded by the application of the CCT model. We end with recommendations for clinical practitioners who wish to apply CCT in their own work

Single-Cell Analyses of Prostate Cancer Liquid Biopsies Acquired by Apheresis

Purpose: Circulating tumor cells (CTCs) have clinical relevance, but their study has been limited by their low frequency. Experimental Design: We evaluated liquid biopsies by apheresis to increase CTC yield from patients suffering from metastatic prostate cancer, allow precise gene copy-number calls, and study disease heterogeneity. Results: Apheresis was well tolerated and allowed the separation of large numbers of CTCs; the average CTC yield from 7.5 mL of peripheral blood was 167 CTCs, whereas the average CTC yield per apheresis (mean volume: 59.5 mL) was 12,546 CTCs. Purified single CTCs could be isolated from apheresis product by FACS sorting; copy-number aberration (CNA) profiles of 185 single CTCs from 14 patients revealed the genomic landscape of lethal prostate cancer and identified complex intrapatient, intercell, genomic heterogeneity missed on bulk biopsy analyses. Conclusions: Apheresis facilitated the capture of large numbers of CTCs noninvasively with minimal morbidity and allowed the deconvolution of intrapatient heterogeneity and clonal evolution

Increase in short-chain ceramides correlates with an altered lipid organization and decreased barrier function in atopic eczema patients

A hallmark of atopic eczema (AE) is skin barrier dysfunction. Lipids in the stratum corneum (SC), primarily ceramides, fatty acids, and cholesterol, are crucial for the barrier function, but their role in relation to AE is indistinct. Filaggrin is an epithelial barrier protein with a central role in the pathogenesis of AE. Nevertheless, the precise causes of AE-associated barrier dysfunction are largely unknown. In this study, a comprehensive analysis of ceramide composition and lipid organization in nonlesional SC of AE patients and control subjects was performed by means of mass spectrometry, infrared spectroscopy, and X-ray diffraction. In addition, the skin barrier and clinical state of the disease were examined. The level of ceramides with an extreme short chain length is drastically increased in SC of AE patients, which leads to an aberrant lipid organization and a decreased skin barrier function. Changes in SC lipid properties correlate with disease severity but are independent of filaggrin mutations. We demonstrate for the first time that changes in ceramide chain length and lipid organization are directly correlated with the skin barrier defects in nonlesional skin of AE patients. We envisage that these insights will provide a new therapeutic entry in therapy and prevention of AE

The 1957 Martin Buber-Carl Rogers Dialogue, as Dialogue

This study offers an understanding of human dialogue by examining a 1957 conversation between two of this century\u27s leading proponents of dialogue, philosopher Martin Buber and psychologist Carl Rogers. The study assumes that this conversation was a dialogue (as those principally involved said it was) and asks what we can learn about dialogue through a study of this one instance. We conduct and report a close analysis of the conversation. For all the difficulties caused by the roles assigned to Buber and Rogers, the presence of two silent audiences, and the interpersonal styles of the men themselves, and despite the encounter not matching some idealized conceptions ofdialogue, this study demonstrates that dialogue is not an \u27ideal possibility seldom realized but a concretely realizable and practical accomplishment