An evaluation of subjective experiences, effects and overall satisfaction with clozapine treatment in a UK forensic service

Objectives: Patients prescribed clozapine were surveyed to assess (a) the effects, both positive and adverse, and overall satisfaction with clozapine in comparison to previously prescribed antipsychotics and (b) the relative significance of effects experienced, both positive and adverse, in terms of impact on subjective well-being. Methods: A total of 56 male patients prescribed clozapine at a forensic psychiatric hospital were surveyed using a 27-item questionnaire. All patients had been prescribed clozapine for a minimum of 3 months. Respondents were asked to rate effects and satisfaction with clozapine treatment in comparison with previously prescribed antipsychotic medication on a five-point scale. Respondents were also asked to rate effects experienced with clozapine treatment in terms of impact on subjective well-being on a five-point scale. Results: A total of 89% of respondents reported greater satisfaction with clozapine than with previously prescribed antipsychotic medication. A majority of patients reported positive effects in terms of an improvement in their quality of life (68%) and social abilities (52%) with clozapine in comparison with previously prescribed antipsychotics. Nocturnal hypersalivation (84%) and weight gain (57%) were the most common adverse effects. Hedonic responses were assessed for each effect in order to determine the associated subjective experiences. The most positive hedonic responses were for quality of life, mood and alertness. In terms of adverse impact on subjective well-being, nocturnal hypersalivation ranked highest. Conclusions: Patients in a UK forensic sample are largely satisfied with clozapine treatment. The subjective effects of clozapine treatment should be taken into account by clinicians when assessing response. This may provide an opportunity to highlight the positive changes and prioritize management of the most undesirable adverse effects, which is likely to promote compliance and improve longer term treatment outcomes

Missense mutations in the perforin (PRF1) gene as a cause of hereditary cancer predisposition

Perforin, a pore-forming toxin released from secretory granules of NK cells and CTLs, is essential for their cytotoxic activity against infected or cancerous target cells. Bi-allelic loss-of-function mutations in the perforin gene are invariably associated with a fatal immunoregulatory disorder, familial haemophagocytic lymphohistiocytosis type 2 (FHL2), in infants. More recently, it has also been recognized that partial loss of perforin function can cause disease in later life, including delayed onset FHL2 and haematological malignancies. Herein we report a family in which a wide range of systemic inflammatory and neoplastic manifestations have occurred across three generations. We found that disease was linked to two missense perforin gene mutations (encoding A91V, R410W) that cause protein misfolding and partial loss of activity. These cases link the partial loss of perforin function with some solid tumours that are known to be controlled by the immune system, as well as haematological cancers. Our findings also demonstrate that perforin gene mutations can contribute to hereditary cancer predisposition

Moving forward in GME reform: a 4 + 1 model of resident ambulatory training

Traditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed. To compare the impact of a traditional ambulatory training model with a templated 4 + 1 model. A large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices. Residents, faculty, and administrative staff. Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously. A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents\u27 learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p \u3c 0.0001). Satisfaction with ambulatory training improved (p \u3c 0.0001). Self-reported empanelment also increased (p \u3c 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p \u3c 0.0001). A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes. (C) Society of General Internal Medicine 201

Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry?

The article describes the reasons why psychiatrists working in the field of consultation-liaison should be trained and aware of the relevance of culture in their everyday work. Moreover, the article aims at advertising the special-interest group on cultural CLP, a network of clinicians and researchers within the European Association of Psychosomatic Medicine that share their interest and activities in this subject

Alternative splicing and protein diversity: plants versus animals

Plants, unlike animals, exhibit a very high degree of plasticity in their growth and development and employ diverse strategies to cope with the variations during diurnal cycles and stressful conditions. Plants and animals, despite their remarkable morphological and physiological differences, share many basic cellular processes and regulatory mechanisms. Alternative splicing (AS) is one such gene regulatory mechanism that modulates gene expression in multiple ways. It is now well established that AS is prevalent in all multicellular eukaryotes including plants and humans. Emerging evidence indicates that in plants, as in animals, transcription and splicing are coupled. Here, we reviewed recent evidence in support of co-transcriptional splicing in plants and highlighted similarities and differences between plants and humans. An unsettled question in the field of AS is the extent to which splice isoforms contribute to protein diversity. To take a critical look at this question, we presented a comprehensive summary of the current status of research in this area in both plants and humans, discussed limitations with the currently used approaches and suggested improvements to current methods and alternative approaches. We end with a discussion on the potential role of epigenetic modifications and chromatin state in splicing memory in plants primed with stresses

A Human Subject Evaluation of Airport Surface Situational Awareness Using Prototypical Flight Deck Electronic Taxi Chart Displays

The advent of Instrument Landing Systems has allowed aircraft to safely takeoff and land in low visibility conditions. However, the lack of a means by which pilots can safely navigate on the ground in poor visibility conditions has been the cause of many runway incursions and several fatal aircraft accidents. Currently flight crews use paper chart depictions of the airport surface and out-the-window visual cues to navigate on the surface. In addition they can be provided some feedback about their position on the surface from ATC. In clear, daylight environmental conditions flight crews can correlate airport features and navigation signs from the out-the-window view with the chart features to maintain airport surface situational awareness. In conditions of fog and darkness however, out-the-window cues are less available and it becomes a difficult task for flight crews to maintain situational awareness. Low visibility conditions also prevent ATC from tracking aircraft position on the airport surface from the tower

What Beer’s theory of viability can offer to the field of workforce emotions

The study of emotions is the most densely populated field of organisational behaviour academic research. However, the application of systemic approaches to the field of workforce emotions is marginal. The current theoretical study intends to reveal the suitability of a systemic approach – the theory of viability (i.e., viable system model – VSM) for comprehending, diagnosing and managing employees’ emotions. The study illustrates how the realm of emotions management research can be enriched by the using VSM criteria and principles for managing complexity, to guide and organise existing research on emotions management. This conceptual review of existing theories is useful then for inspiring a more structured survey into investigating emotional management at the workplace. In this paper, we present the conceptual framework developed to conduct a recent PhD project based on this approach, as well as the design of the related survey and analysi

2-size resolvability in graphs

Abstract: A vertex u in a graph G resolves a pair of distinct vertices x, y of G if the distance between u and x is different from the distance between u and y. A set W of vertices in G resolves the graph G if every pair of distinct vertices of G is resolved by some vertices in W . The metric dimension of a graph, denoted by dim (G), is the smallest cardinality of a resolving set. A resolving set W for a connected graph G of order n ≥ 3 is called 2-size resolving set if the size of the subgraph < W > induced by W is two. The minimum cardinality of a 2-size resolving set is called the 2-size metric dimension of G, denoted by tr(G). A 2-size resolving set of cardinality tr(G) is called a tr-set. In this paper, we study 2-size resolving sets in some well-known classes of graphs and give some realizable results