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

Comparing the influence of ‘describing findings to the examiner’ or ‘examining as in usual practice’ on the students’ performance and assessors’ judgements during physical examination skills assessment

Background: Within assessment of physical examination skills, two approaches are common: “Describing Findings” (students comment throughout); and examining as “Usual Practice” (students only report findings at the end). Despite numerous potential influences on both students’ performances and assessors’ judgements, no prior studies have investigated the influence of either approach on assessments. Methods: Two group, randomised, crossover design. Within a 2-station simulated physical examination OSCE, we manipulated whether students “described findings” or examined as “usual practice”, collecting 1/. performance scores; 2/. Students’/examiners’ cognitive load ratings; ratings of the 3/. fluency and 4/. completeness of students’ presentations and 5/. Students’ task-finishing, comparing all 5 end-points across conditions. Results: Neither students’ performance scores nor examiners’ cognitive load were influenced by experimental condition. Students reported higher cognitive load (7/9) when “describing findings” than “usual practice” (6/9, p=0.002), and were less likely to finish (4 vs 12, p=0.007). Presentation completeness was higher for “describing findings” (mean=2.40, (95CIs=2.05-2.74)) than “usual practice” (mean=1.92 (1.65-2.18),p=0.016), whilst fluency ratings showed a similar trend. Conclusions: The decision to “Describe Findings” or examine as “Usual Practice” does not appear neutral, potentially influencing students’ efficiency, recall and (by inference) learning. Institutions should explicitly select one option based on assessment goals

A dynamics-driven approach to precision machines design for micro-manufacturing and its implementation perspectives

Precision machines are essential elements in fabricating high quality micro products or micro features and directly affect the machining accuracy, repeatability and efficiency. There are a number of literatures on the design of industrial machine elements and a couple of precision machines commercially available. However, few researchers have systematically addressed the design of precision machines from the dynamics point of view. In this paper, the design issues of precision machines are presented with particular emphasis on the dynamics aspects as the major factors affecting the performance of the precision machines and machining processes. This paper begins with a brief review of the design principles of precision machines with emphasis on machining dynamics. Then design processes of precision machines are discussed, and followed by a practical modelling and simulation approaches. Two case studies are provided including the design and analysis of a fast tool servo system and a 5-axis bench-top micro-milling machine respectively. The design and analysis used in the two case studies are formulated based on the design methodology and guidelines

NMDA receptor content of synapses in stratum radiatum of the hippocampal CA1 area

Glutamate receptors activated by NMDA (NMDARs) or AMPA (AMPARs) are clustered on dendritic spines of pyramidal cells. Both the AMPAR-mediated postsynaptic responses and the synaptic AMPAR immunoreactivity show a large intersynapse variability. Postsynaptic responses mediated by NMDARs show less variability. To assess the variability in NMDAR content and the extent of their coexistence with AMPARs in Schaffer collateral-commissural synapses of adult rat CA1 pyramidal cells, electron microscopic immunogold localization of receptors has been used. Immunoreactivity of NMDARs was detected in virtually all synapses on spines, but AMPARs were undetectable, on average, in 12% of synapses. A proportion of synapses had a very high AMPAR content relative to the mean content, resulting in a distribution more skewed toward larger values than that of NMDARs. The variability of synaptic NMDAR content [coefficient of variation (CV), 0.64-0.70] was much lower than that of the AMPAR content (CV, 1.17-1.45). Unlike the AMPAR content, the NMDAR content showed only a weak correlation with synapse size. As reported previously for AMPARs, the immunoreactivity of NMDARs was also associated with the spine apparatus within spines. The results demonstrate that the majority of the synapses made by CA3 pyramidal cells onto spines of CA1 pyramids express both NMDARs and AMPARs, but with variable ratios. A less-variable NMDAR content is accompanied by a wide variability of AMPAR content, indicating that the regulation of expression of the two receptors is not closely linked. These findings support reports that fast excitatory transmission at some of these synapses is mediated by activation mainly of NMDARs

High-rate, high-fidelity entanglement of qubits across an elementary quantum network

We demonstrate remote entanglement of trapped-ion qubits via a quantum-optical fiber link with fidelity and rate approaching those of local operations. Two ${}^{88}$Sr${}^{+}$ qubits are entangled via the polarization degree of freedom of two photons which are coupled by high-numerical-aperture lenses into single-mode optical fibers and interfere on a beamsplitter. A novel geometry allows high-efficiency photon collection while maintaining unit fidelity for ion-photon entanglement. We generate remote Bell pairs with fidelity $F=0.940(5)$ at an average rate $182\,\mathrm{s}^{-1}$ (success probability $2.18\times10^{-4}$).Comment: v2 updated to include responses to reviewers, as published in PR

Efficient Hadronic Operators in Lattice Gauge Theory

We study operators to create hadronic states made of light quarks in quenched lattice gauge theory. We construct non-local gauge-invariant operators which provide information about the spatial extent of the ground state and excited states. The efficiency of the operators is shown by looking at the wave function of the first excited state, which has a node as a function of the spatial extent of the operator. This allows one to obtain an uncontaminated ground state for hadrons.Comment: 18 pages, Latex text, followed by 11 postscript figures in self-unpacking file. Also available at ftp://suna.amtp.liv.ac.uk/pub/cmi/wavefn