Patients' and health professionals' views on primary care for people with serious mental illness : focus group study

Objective To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. Design Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. Setting Six primary care trusts in the West Midlands. Participants Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. Results Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and prefer-red to consult their own GP, who listened and was willing to learn, rather than be referred to a different,GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. Conclusions Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness

The Winner Takes it All, but Who Gets to Play? The False Claims Act’s First to File Rule and Jurisdiction

In 2019, the United States Court of Appeals for the First Circuit held, in United States v. Millenium Laboratories, Inc., that the False Claims Act’s first to file rule is nonjurisdictional. This decision followed those by the United States Courts of Appeals for the Second and D.C. Circuits that came to the same conclusion. These decisions stand in opposition to a number of other circuits that, prior to 2015, held the first to file rule as jurisdictional. This split emerged after the Supreme Court’s 2015 decision in Kellogg Brown & Root Services v. United States ex rel. Carter, a False Claims Act case where the Court considered the first to file rule after considering other nonjurisdictional items, leading some circuits to infer that the Supreme Court considered the rule nonjurisdictional. In holding the first to file rule nonjurisdictional, the First Circuit followed the Supreme Court’s bright line rule preventing jurisdictional treatment absent clear Congressional intent. This Comment argues that the First Circuit’s treatment of the first to file rule as nonjurisdictional is correct and fulfills the legislative intent of the False Claims Act while still preventing parties from overburdening the judiciary with opportunistic suits

Correction to the pathogenic alternative splicing, caused by the common GNB3 c.825C>T allele, using a novel, antisense morpholino

The very common GNB3 c.825C>T polymorphism (rs5443), is present in approximately half of all human chromosomes. Significantly the presence of the GNB3 825T allele has been strongly associated, with predisposition to essential hypertension. Paradoxically the presence of the GNB3 825T allele, in exon 10, introduces a pathogenic alternative RNA splice site into the middle of exon 9. To attempt to correct this pathogenic aberrant splicing, we therefore bioinformatically designed, using a Gene Tools® algorithm, a GNB3 specific, antisense morpholino. It was hoped that this morpholino would behave in vitro as either a potential “ splice blocker and/or exon skipper, to both bind and inhibit/reduce the aberrant splicing of the GNB3, 825T allele. On transfecting a human lymphoblast cell line homozygous for the 825T allele, with this antisense morpholino, we encouragingly observed both a significant reduction (from ~58% to ~5%) in the production of the aberrant smaller GNB3 transcript, and a subsequent increase in the normal GNB3 transcript (from ~42% to ~95%). Our results demonstrate the potential use of a GNB3 specific antisense morpholino, as a pharmacogenetic therapy for essential hypertension

Interactions between ICP4 and the Cellular Transcription Machinery that Mediate HSV-1 Gene Expression

Herpes simplex virus type 1 (HSV-1) infected cell polypeptide 4 (ICP4) is a critical regulator of viral gene expression that is required for productive infection. ICP4 has been shown to act, depending on the promoter structure, as both an activator or repressor of viral genes. ICP4 has two broad transcriptional regulatory domains, the N-terminal domain, which exhibits both repression and transactivation, and the C-terminal domain, which is involved exclusively in transactivation. ICP4 regulates transcription through interactions between ICP4's transcriptional regulatory domains and cellular general transcription factors including components of TFIID. Although it has been shown that a region in the amino-terminus of ICP4 corresponding to aa 30-210 is necessary for appropriate transactivation and repression of viral genes, specific domains responsible for these activities remain uncharacterized. Using deletion mutants spanning this region, we show that the entire region is necessary for ICP4 function, but that loss of aa 30-142 has a greater detrimental impact on the ability of ICP4 to transactivate E and L genes. Neither deletion had a significant impact on ICP4 repression, however. The protein interactions made by ICP4 in vivo during infection were also studied. We show ICP4 forms complexes with TFIID, thus verifying previous in vitro data. Novel interactions between TFII-I and components of the Mediator complex were also identified. In addition, Mediator was found to colocalize with ICP4 starting at early and continuing into late times of infection. Mediator was also recruited to viral promoters in an ICP4-dependent manner, showing a direct role for Mediator in ICP4-mediated transcription. Together, the data show that ICP4 regulates transcription through interactions between its complex regulatory domains and a diverse set of cellular protein complexes, including components of the basal transcription machinery and coactivator complexes

Investigation of the applicability of neural-fuzzy logic modeling for culvert hydrodynamics

As a result of an earlier WV DOH study, the idea came to the forefront of using a completely new approach to analyzing the complex subject of culvert hydrodynamics. The literature indicates that there have been no reports of artificial intelligence, to include neural networks, fuzzy logic, or combined neural-fuzzy logic, used to investigate and predict culvert hydrodynamics.;The scope of this dissertation is to investigate the applicability of using neural-fuzzy logic to predict culvert diameters. To analyze these flows, commercial culvert software was employed to account for all types of flow conditions. This included different slopes, lengths, flow-rates, pipe sizes, and headwater and tail water conditions. For all of the variables included in the analysis of culvert flow, some are complex in nature and require selection of different parameters. A large data set was created, from which to draw out different flow types for analysis. The use of fuzzy logic enables the user to enter variables and the developed code then interprets the data and solves for diameter. These trained data sets have a compliment checking data which is derived from similar calculations, with one variable slightly larger. These data sets were trained in a neural-fuzzy model and the result was a predicted culvert diameter data set. The predicted diameters were then compared to the actual diameters to determine the accuracy of the model. For all data sets evaluated, the root mean square error was less than 12 inches. The overall weighted root mean squared error for the training data sets was 1.989 inches and 2.658 inches for the checking data sets

The True Benefit of the Bargain: How Emotional Distress Damages Make Fraud Victims Whole

For over a century, American courts have recognized emotional distress damages in tort. Initially, these decisions limited recovery for emotional distress to cases where the victim experienced a physical impact. Throughout the twentieth century, that requirement largely fell out of favor as courts began to recognize emotional injury in the absence of physical harm, supported by new psychiatric research. Despite this, the availability of emotional distress damages in fraud cases continues to divide jurisdictions. Many jurisdictions refuse to recognize any more than pecuniary damages to plaintiffs in fraud, characterizing fraud as a purely economic tort. The experience of victims challenges this assumption, as individuals report significant psychiatric and physical maladies resulting from fraud. Jurisdictions that award emotional distress damages in fraud divide further still about the appropriate standard. Some courts focus on the plaintiff’s severity of harm or physical manifestation of distress. Others look to the defendant’s malice, intent, or ability to foresee emotional harm. This Note argues that current psychiatric research and self-reported emotional distress of fraud victims demonstrate the need to universally recognize emotional distress damages. This Note further argues the severity standard offers the best combination of flexibility for plaintiffs and protection for defendants against frivolous claims. Only with the recognition of emotional distress damages can fraud victims become genuinely whole

Aplicacion, Registro y Pago de los Ttributos En la Empresa Uno la Virgen de la ciudad de Matagalpa, en el periodo 2016

El presente Seminario de Graduación está centrado en los Tributos aplicados por las empresas de la ciudad de Matagalpa en el año 2016, tomándose como punto de referencia la Gasolinera UNO La Virgen S.A. El propósito principal es evaluar la aplicación, registro y pago de los Impuestos en la Gasolinera UNO La Virgen S.A, en el periodo 2016, debido a que los impuestos son siempre una obligación que es establecida por la Ley para con los contribuyentes. Este tema se considera de mucha importancia ya que el correcto registro, aplicación y pago de los Tributos está regido por las leyes tributarias y como contribuyente lo ideal es cumplir con cada uno de estos rubros al pie de la letra, y así, evitar posibles sanciones, además permitirá a individuos interesados en la temática obtener un mayor conocimiento sobre la recaudación de impuestos en Matagalpa. Como conclusiones se ha podido apreciar que la Gasolinera UNO La Virgen S.A, es una empresa dedicada al comercio, por lo tanto aplica tributos nacionales y municipales, de acuerdo a nuestro criterio, la empresa realiza sus registros contables de manera correcta, aplicando las tarifas establecidas en los diferentes reglamentos y decretos, mientras sus declaraciones las realiza siguiendo lo citado en cada ley y sus pagos los lleva a cabo a través de la Ventanilla Electrónica Tributaria para Impuestos Nacionales, visitas a la Alcaldía Municipal para los Municipales y a través del SIE para las contribuciones de INS

Promoting teacher engagement with research evidence

The Centre was asked by the Cabinet Secretary for Education to review the evidence on how best to support teacher engagement with research. Working with colleagues at the Evidence for Policy and Practice Information and Co‑ordinating Centre (EPPI Centre) at University College London (UCL), we have: 1) Reviewed and synthesised what is known about what works when seeking to improve teacher engagement with, and use of, evidence. 2) Started to build a picture of existing initiatives in Wales (particularly at national and regional level) that seek to improve teacher engagement with, and use of, evidence. 3) Provided some suggestions for how teacher engagement with, and use of, evidence can be supported and improved in Wales in the short, medium, and long term