BREAKING BAD NEWS IN HEALTHCARE ORGANIZATIONS: APPLICATION OF THE SPIKES PROTOCOL

Organizational downsizing has increased exponentially worldwide and is also affecting the healthcare industry. It is one thing to speak abstractly of the need to reduce costs and quite another to actually tell a worker the bad news that he or she has been laid off. This paper offers practical advice to healthcare managers on conducting unpleasant conversations with employees based on a widely used medical model—the SPIKES protocol. This strategy has been extensively employed by physicians and other health care professionals who frequently communicate negative information to patients and is offered as an approach that can be easily and effectively adapted by healthcare managers when they must tell a person they have been terminated. Although breaking the bad news of a cutback will never be easy, having a plan of action that entails sound business and medical advice and is also the necessary thing to do can help firms carefully manage and execute reorganizations for the well-being of the organization and the terminated worker

Influence of the state of light on the optically induced interparticle interaction

A general expression for the energy of interparticle interaction induced by an arbitrary mode of light is determined using quantum electrodynamics, and it is shown that the Casimir-Polder potential is included within this quantum result. Equations are also derived for the corresponding coupling induced by multimode number states of light, and the dependence of the pair energy on the Poynting vector and polarization state is determined. Attention is then focused on the interactions between particles trapped in counterpropagating coherent beams, both with and without interference, and it is shown that the results afford insights into the multiparticle structures that can be optically fabricated with counterpropagating input. Brief consideration is also given to the effect of squeezing the optical coherent state. Extending previous studies of optical binding in Laguerre-Gaussian beams, results are given for the case of particles trapped at radially different locations within the beam structure. Finally, consideration is given to interparticle interactions induced by broadband light, and it is shown how the length of optically fabricated particle chains can be controlled by the use of wavelength filters

Ocular and adnexal anomalies in craniofacial microsomia: a systematic review

Ocular anomalies may occur in craniofacial microsomia (CFM). The aim of this systematic review was to review the literature on ocular anomalies and their incidence, in order to estimate the need for ophthalmological screening in CFM patients. Online databases were searched, and data on the number of patients, type and incidence of ocular anomalies, and visual acuity were extracted. Four subgroups of ocular and adnexal anomalies were identified, to provide an overview of the different anomalies. Twenty-five papers analysing 1419 patients in total were included. Ocular anomalies were documented in 6.7–100% of patients. The most reported type I ocular anomalies were eyelid coloboma, lipodermoids, and orbital dystopia. The most reported type II ocular anomalies were epibulbar dermoid, microphthalmia, and anophthalmia. Ptosis

A photonic basis for deriving nonlinear optical response

Nonlinear optics is generally first presented as an extension of conventional optics. Typically the subject is introduced with reference to a classical oscillatory electric polarization, accommodating correction terms that become significant at high intensities. The material parameters that quantify the extent of the nonlinear response are cast as coefficients in a power series - nonlinear optical susceptibilities signifying a propensity to generate optical harmonics, for example. Taking the subject to a deeper level requires a more detailed knowledge of the structure and properties of each nonlinear susceptibility tensor, the latter differing in form according to the process under investigation. Typically, the derivations involve intricate development based on time-dependent perturbation theory, assisted by recourse to a set of Feynman diagrams. This paper presents a more direct route to the required results, based on photonic rather than semiclassical principles, and offers a significantly clearer perspective on the photophysics underlying nonlinear optical response. The method, here illustrated by specific application to harmonic generation and down-conversion processes, is simple, intuitive and readily amenable for processes of arbitrary photonic order. © 2009 IOP Publishing Ltd

A back-to-front derivation: the equal spacing of quantum levels is a proof of simple harmonic oscillator physics

The dynamical behaviour of simple harmonic motion can be found in numerous natural phenomena. Within the quantum realm of atomic, molecular and optical systems, two main features are associated with harmonic oscillations: a finite ground-state energy and equally spaced quantum energy levels. Here it is shown that there is in fact a one-to-one mapping between the provision of equally spaced quantum energy levels and simple harmonic motion. The analysis establishes that the Hamiltonian of any system featuring quantized energy levels in an evenly spaced, infinite set must have a quadratic dependence on a pair of canonically conjugate variables. Moreover, specific physical inferences can be drawn. For example, exploiting this 'back-to-front' derivation, and based on the known existence of photons, it can be proved that an electromagnetic energy density is quadratic in both the electric and magnetic fields

The clock gene <i>Bmal1</i> inhibits macrophage motility, phagocytosis, and impairs defense against pneumonia

The circadian clock regulates many aspects of immunity. Bacterial infections are affected by time of day, but the mechanisms involved remain undefined. Here we show that loss of the core clock protein BMAL1 in macrophages confers protection against pneumococcal pneumonia. Infected mice show both reduced weight loss and lower bacterial burden in circulating blood. In vivo studies of macrophage phagocytosis reveal increased bacterial ingestion following Bmal1 deletion, which was also seen in vitro. BMAL1−/− macrophages exhibited marked differences in actin cytoskeletal organization, a phosphoproteome enriched for cytoskeletal changes, with reduced phosphocofilin and increased active RhoA. Further analysis of the BMAL1−/− macrophages identified altered cell morphology and increased motility. Mechanistically, BMAL1 regulated a network of cell movement genes, 148 of which were within 100 kb of high-confidence BMAL1 binding sites. Links to RhoA function were identified, with 29 genes impacting RhoA expression or activation. RhoA inhibition restored the phagocytic phenotype to that seen in control macrophages. In summary, we identify a surprising gain of antibacterial function due to loss of BMAL1 in macrophages, associated with a RhoA-dependent cytoskeletal change, an increase in cell motility, and gain of phagocytic function

Genome-wide association analysis identifies novel loci for chronotype in 100,420 individuals from the UK Biobank

Our sleep timing preference, or chronotype, is a manifestation of our internal biological clock. Variation in chronotype has been linked to sleep disorders, cognitive and physical performance, and chronic disease. Here we perform a genome-wide association study of self-reported chronotype within the UK Biobank cohort (n=100,420). We identify 12 new genetic loci that implicate known components of the circadian clock machinery and point to previously unstudied genetic variants and candidate genes that might modulate core circadian rhythms or light-sensing pathways. Pathway analyses highlight central nervous and ocular systems and fear-response-related processes. Genetic correlation analysis suggests chronotype shares underlying genetic pathways with schizophrenia, educational attainment and possibly BMI. Further, Mendelian randomization suggests that evening chronotype relates to higher educational attainment. These results not only expand our knowledge of the circadian system in humans but also expose the influence of circadian characteristics over human health and life-history variables such as educational attainment

The histone methyltransferase Ezh2 restrains macrophage inflammatory responses

From Wiley via Jisc Publications RouterHistory: received 2021-02-16, rev-recd 2021-07-06, accepted 2021-07-23, pub-electronic 2021-08-31, pub-print 2021-10Article version: VoRPublication status: PublishedFunder: Medical Research Council Canada (MRC); Id: http://dx.doi.org/10.13039/501100007155; Grant(s): MR/N002024/1Funder: RCUK | Medical Research Council (MRC); Id: http://dx.doi.org/10.13039/501100000265; Grant(s): MRNO2995X/1Funder: Wellcome Trust (Wellcome); Id: http://dx.doi.org/10.13039/100010269; Grant(s): 107849/Z/15/Z, 107851/Z/15/ZFunder: RCUK | Biotechnology and Biological Sciences Research Council (BBSRC); Id: http://dx.doi.org/10.13039/501100000268; Grant(s): BB/L000954/1, BB/K003097/1Abstract: Robust inflammatory responses are critical to survival following respiratory infection, with current attention focused on the clinical consequences of the Coronavirus pandemic. Epigenetic factors are increasingly recognized as important determinants of immune responses, and EZH2 is a prominent target due to the availability of highly specific and efficacious antagonists. However, very little is known about the role of EZH2 in the myeloid lineage. Here, we show EZH2 acts in macrophages to limit inflammatory responses to activation, and in neutrophils for chemotaxis. Selective genetic deletion in macrophages results in a remarkable gain in protection from infection with the prevalent lung pathogen, pneumococcus. In contrast, neutrophils lacking EZH2 showed impaired mobility in response to chemotactic signals, and resulted in increased susceptibility to pneumococcus. In summary, EZH2 shows complex, and divergent roles in different myeloid lineages, likely contributing to the earlier conflicting reports. Compounds targeting EZH2 are likely to impair mucosal immunity; however, they may prove useful for conditions driven by pulmonary neutrophil influx, such as adult respiratory distress syndrome

Identification of Melatonin-Regulated Genes in the Ovine Pituitary Pars Tuberalis, a Target Site for Seasonal Hormone Control

The pars tuberalis (PT) of the pituitary gland expresses a high density of melatonin (MEL) receptors and is believed to regulate seasonal physiology by decoding changes in nocturnal melatonin secretion. Circadian clock genes are known to be expressed in the PT in response to the decline (Per1) and onset (Cry1) of MEL secretion, but to date little is known of other molecular changes in this key MEL target site. To identify transcriptional pathways that may be involved in the diurnal and photoperiod-transduction mechanism, we performed a whole genome transcriptome analysis using PT RNA isolated from sheep culled at three time points over the 24-h cycle under either long or short photoperiods. Our results reveal 153 transcripts where expression differs between photoperiods at the light-dark transition and 54 transcripts where expression level was more globally altered by photoperiod (all time points combined). Cry1 induction at night was associated with up-regulation of genes coding for NeuroD1 (neurogenic differentiation factor 1), Pbef / Nampt (nicotinamide phosphoribosyltransferase) , Hif1α (hypoxia-inducible factor-1α), and Kcnq5 (K channel) and down-regulation of Rorβ, a key clock gene regulator. Using in situ hybridization, we confirmed day-night differences in expression for Pbef / Nampt, NeuroD1, and Rorβ in the PT. Treatment of sheep with MEL increased PT expression for Cry1, Pbef / Nampt, NeuroD1, and Hif1α, but not Kcnq5. Our data thus reveal a cluster of Cry1-associated genes that are acutely responsive to MEL and novel transcriptional pathways involved in MEL action in the PT