Dealing with the difficult older patient.

Physicians are often asked to intervene when elderly patients in acute or long-term care facilities are disruptive, demanding or abusive. Though medication may be the immediate response, it often fails to solve the problem, which, being situational and behavioural, calls for a situational and behavioural solution. An organized approach to solving such problems is presented that takes into account the interactions among the patient, family, staff, setting and circumstances. The role of the physician as leader in the process is also discussed.     

PTSD and alcoholism

PTSD is the development of symptoms after a distressful response. 52.20% of the respondents suffering from PTSD used to drink either moderately or excessively during the war. Some of their alcoholism stems from the pre-war period. According to our researches, more than one fifth (22.92%) of the respondents with PTSD consume alcohol more than they used to before the war. PTSD is frequently associated with chronic alcoholism as a kind of "self-healing". Alcoholism problem is particularly unfavourably reflected on the family of a PTSD patient, whose quality of life is already poor, due to their basic disease. Treatment of alcoholism with PTSD patients is rather demanding; emerging of PTSD is noticeable with a part of the staff who treat chronic alcoholism; what is noticed was the similarity in the intensity and frequency of the stressful responses, which is proportional to the one noticed with the staff treating AIDS patients. Chronic alcoholics are the source of strong and repetitive traumas for those who try to treat them. That is why the concern for the counter-transference responses is important while treating alcoholism.     

The Executive and Neurosis

Executives are prone to overwork, to need to achieve and to need to compete. The dynamics responsible for this pattern were also the dynamics of the breakdown in 16 executives with neurosis. Overcompensation for inferiority feelings, often originating in low socioeconomic childhood background, and ambivalence to the father with repression of hostility were prominent, the main ego mechanisms of defence being repression and denial. The patients often attempted to turn psychotherapy into discussions and had difficulty in accepting a non-directive approach.     

Serum concentration of nine hormones in aging male population and association with potency and libido problems

Aim was to determine if a serum levels of free testosterone and selected eight hormones are in correlation with potency and libido problems in aging male. Male population older then 45 years of two Slavonian villages was called for voluntary examination. Every patient filled a questionnaire concerning medical history, operations and potency and libido problems. Based on answers we formed six groups of patients, but only three were analyzed further. Population with potency and libido problems is on average older. In group of patients with normal potency and libido (PNLN group) average levels of free testosterone are 46.01 pmol/L, LH 4.62 IU/L and FSH 6.20 IU/L. In group of patients with mild-damaged potency and normal libido (PMLN group) average levels of free testosterone are 44.61 pmol/L, LH 6.19 IU/L and FSH 8.18 IU/L. In PALA group of patients with absent potency and libido (PALA group) average levels of free testosterone are 41,89 pmol/L, LH 8.07 IU/L and FSH 11.27 IU/L. Significant higher levels of FSH and LH were found compared with the control group (for FSH p<0.001 and p < 0.003, and for LH p <0.003 and p < 0.021). No significant difference in serum levels of free or binned testosterone were found between three groups. Even if average serum levels of free testosterone is found lower in patients with libido and potency problems, this difference is not significant and testosterone deficiency itself can not explain potency and libido problems in aging male.     

Dynamics of granzyme B-induced apoptosis: mathematical modeling

Apoptosis is mediated by an intracellular biochemical system that mainly includes proteins (procaspases, caspases, inhibitors, Bcl-2 protein family as well as substances released from mitochondrial intermembrane space). The dynamics of caspase activation and target cleavage in apoptosis induced by granzyme B in a single K562 cell was studied using a mathematical model of the dynamics of granzyme B-induced apoptosis developed in this work. Also the first application of optimization approach to determination of unknown kinetic constants of biochemical apoptotic reactions was presented. The optimization approach involves solving of two problems: direct and inverse. Solving the direct optimization problem, we obtain the initial (baseline) concentrations of procaspases for known kinetic constants through conditional minimization of a cost function based on the principle of minimum protein consumption by the apoptosis system. The inverse optimization problem is aimed at determination of unknown kinetic constants of apoptotic biochemical reactions proceeding from the condition that the optimal concentrations of procaspases resulting from the solution of the direct optimization problem coincide with the observed ones, that is, those determined by biochemical methods. The Multidimensional Index Method was used to perform numerical solution of the inverse optimization problem.     

Parasite prevalence and sample size: misconceptions and solutions

Parasite prevalence (the proportion of infected hosts) is a common measure used to describe parasitaemias and to unravel ecological and evolutionary factors that influence host-parasite relationships. Prevalence estimates are often based on small sample sizes because of either low abundance of the hosts or logistical problems associated with their capture or laboratory analysis. Because the accuracy of prevalence estimates is lower with small sample sizes, addressing sample size has been a common problem when dealing with prevalence data. Different methods are currently being applied to overcome this statistical challenge, but far from being different correct ways of solving a same problem, some are clearly wrong, and others need improvement.     

Forensic psychiatric evaluation of persons with posttraumatic stress disorder undergoing criminal trial

The aim of our study was to determine if there is a difference between the type of crime committed by persons diagnosed with posttraumatic stress disorder (PTSD) and that committed by other offenders. The study included 389 male patients at the Department of Forensic Psychiatry in Popovaca who underwent forensic psychiatric evaluation to establish a psychiatric diagnosis, evaluate the mental capacity, and provide advice on further treatment. The data on the number of individuals with PTSD vs. other psychiatric disorders and the data on family violence vs. other criminal acts were analyzed with chi2 test. Of a total of 389 forensically evaluated male patients, 45 (11.6%) suffered from PTSD. Study subjects with PTSD only or PTSD comorbid with the other psychiatric disorders committed family violence significantly more often than subjects diagnosed with the other psychiatric disorders chi2(1) = 40.092, P < 0.001. Subjects with PTSD, whether or not comorbid with the other psychiatric disorders, committed family violence significantly more often than subjects with other psychiatric diagnoses.     

The genes gmdA, encoding an amidase, and bzuA, encoding a cytochrome P450, are required for benzamide utilization in Aspergillus nidulans

Two unlinked loci, gmdA and bzuA, have previously been identified as being required for the utilization of benzamide as the sole nitrogen source by Aspergillus nidulans. We have cloned each of these genes via direct complementation. The gmdA gene encodes a predicted product belonging to the amidase signature sequence family that displays similarity to AmdS from A. nidulans. However, identity is significantly higher to the amdS gene from Aspergillus niger. The bzuA gene encodes a protein belonging to the cytochrome P450 superfamily and is orthologous to the benzoate para-hydroxylase-encoding gene bphA of A. niger. The bzuA1 mutation prevents the use of benzoate as a carbon source and intracellular accumulation of benzoate results in growth inhibition on benzamide. Northern blot analysis has shown that gmdA expression is subject solely to AreA-dependent nitrogen metabolite repression while bzuA is strongly benzoate inducible and subject to CreA-mediated carbon catabolite repression and a probable inactivation of benzoate induction by glucose. Fluorescence microscopy of a fusion of the N-terminal end of BzuA to green fluorescent protein revealed that this protein localizes to the endoplasmic reticulum.     

Marital therapy for the elderly.

Little attention has been paid to marital therapy for the elderly in spite of its relevance to morale and emotional problems. Physical illness is of particular significance in altering the dynamics of the marital relationship. Retirement and financial problems, as well as changes in sexual activity and gender roles, are also important. However, radical changes in patterns of behaviour cannot be expected. Therapeutic techniques must be altered for this age group, and the therapist must be active, giving and concretely helpful. As with therapy for younger couples, children may need to be involved in the therapy sessions. Family physicians should be a main source of help for marital problems among the elderly. However, because problems related to countertransference must be faced, working with the elderly will not be for everyone.     

Problem Solving in the Presence of Others: How Rank and Relationship Quality Impact Resource Acquisition in Chimpanzees (Pan troglodytes)

In the wild, chimpanzees (Pan troglodytes) are often faced with clumped food resources that they may know how to access but abstain from doing so due to social pressures. To better understand how social settings influence resource acquisition, we tested fifteen semi-wild chimpanzees from two social groups alone and in the presence of others. We investigated how resource acquisition was affected by relative social dominance, whether collaborative problem solving or (active or passive) sharing occurred amongst any of the dyads, and whether these outcomes were related to relationship quality as determined from six months of observational data. Results indicated that chimpanzees obtained fewer rewards when tested in the presence of others compared to when they were tested alone, and this loss tended to be greater when paired with a higher ranked individual. Individuals demonstrated behavioral inhibition; chimpanzees who showed proficient skill when alone often abstained from solving the task when in the presence of others. Finally, individuals with close social relationships spent more time together in the problem solving space, but collaboration and sharing were infrequent and sessions in which collaboration or sharing did occur contained more instances of aggression. Group living provides benefits and imposes costs, and these findings highlight that one cost of group living may be diminishing productive individual behaviors.     

Temporal dynamics of mental impasses underlying insight-like problem solving

Insight problem solving is characterized by mental impasses,states of mind in which the problem solver does not know what to do next.Although many studies have investigated the neural correlates of insight problem solving,however,the question when mental impasses occur during insight problem solving has been rarely studied.The present study adopted high temporal resolution ERPs to investigate the temporal dynamics of an impasse underlying insight problem solving.Time locked ERPs were recorded associated with problems with impasses(PWI) and problems without impasses(POI).The problem types were determined by participants’ subjective responses.The results revealed an early frontocentral P2 was linked with the preconscious awareness of mental impasses and a P3a was associated with fixed attention when the impasse formed.These findings suggest the impasse may occur initially at a relatively early stage and metacognition plays an important role in insight problem solving.     

The use of family medical practices by patients with drinking problems.

The annual rate of consultation with family physicians was compared between 108 problem drinkers and a matched group of control subjects; the first group contacted physicians about twice as often as the second one, especially because of psychosocial problems and acute injuries. However, this increased rate among the problem drinkers was also due to a higher prevalence of other health-related problems for which they sought care at least once. The results are discussed in terms of the need for more definitive interventions to identify alcohol abusers, to decrease their consumption and to improve their psychosocial and physical status.     

Family perceptions of post-deployment healthcare needs of Iraq/Afghanistan military personnel

Nearly 40 000 service members returning from Iraq and Afghanistan have suffered traumatic injuries, with over 300 000 at risk for post-traumatic stress disorder (PTSD) or other psychiatric problems. These veterans face numerous post-deployment health concerns, sharing substantial burdens with their families. Although many rely upon community-based health care, little is known about how these individuals present at family medicine clinics for perceived medical and psychological issues. We surveyed 347 patients during visits at six clinics, and respondents reported whether they,a family member or a close acquaintance had been deployed since 2001. Patients identified traumatic military experiences, plus any attributable health or social problems. The mean patient age was 47.5 years, with 71% women and 55% Hispanic individuals. Nearly one-quarter reported family members serving overseas while 52% knew someone deployed. Significant events included nearby explosion (21%) or combat injury (9%), along with a variety of other incidents. Among the half of individuals perceiving significant health or social ramifications, the most prevalent consequences were PTSD, depression and alcohol abuse. Divorce or marital problems were noted by13%, while many reported employment, legal or other difficulties. This study offers insights into post-deployment needs of military personnel and subsequent problems reported by family members. A high prevalence of traumatic combat events translated into serious health needs, plus social disruptions for veterans and their loved ones. As the long-term problems disclosed by returning service personnel continue to ripple across community clinics and other health systems, effective treatment planning mandates coordinated attention from multiple providers and service organisations.     

Substrate recognition mechanism and substrate-dependent conformational changes of an ROK family glucokinase from Streptomyces griseus

Carbon catabolite repression (CCR) is a widespread phenomenon in many bacteria that is defined as the repression of catabolic enzyme activities for an unfavorable carbon source by the presence of a preferable carbon source. In Streptomyces, secondary metabolite production often is negatively affected by the carbon source, indicating the involvement of CCR in secondary metabolism. Although the CCR mechanism in Streptomyces still is unclear, glucokinase is presumably a central player in CCR. SgGlkA, a glucokinase from S. griseus, belongs to the ROK family glucokinases, which have two consensus sequence motifs (1 and 2). Here, we report the crystal structures of apo-SgGlkA, SgGlkA in complex with glucose, and SgGlkA in complex with glucose and adenylyl imidodiphosphate (AMPPNP), which are the first structures of an ROK family glucokinase. SgGlkA is divided into a small α/β domain and a large α+β domain, and it forms a dimer-of-dimer tetrameric configuration. SgGlkA binds a β-anomer of glucose between the two domains, and His157 in consensus sequence 1 plays an important role in the glucose-binding mechanism and anomer specificity of SgGlkA. In the structures of SgGlkA, His157 forms an HC3-type zinc finger motif with three cysteine residues in consensus sequence 2 to bind a zinc ion, and it forms two hydrogen bonds with the C1 and C2 hydroxyls of glucose. When the three structures are compared, the structure of SgGlkA is found to be modified by the binding of substrates. The substrate-dependent conformational changes of SgGlkA may be related to the CCR mechanism in Streptomyces.     

Characterization of the steroid degrading bacterium S19-1 from the Baltic Sea at Kiel, Germany

Steroid contamination of sea water is an ever growing problem and impacts population dynamics of all kinds of sea animals. We have long experience with the soil bacterium Comamonas testosteroni ATCC11996 which is able to catabolize a variety of steroids and polycyclic aromatic hydrocarbons, and which might be used in the bioremediation of contaminated places. In C. testosteroni about 20 enzymes which are involved in steroid degradation could be induced by 0.5 mM testosterone. In this work, we isolated a marine bacterial strain, S19-1, from the Baltic Sea at Kiel (Germany) which degrades steroids and is able to use steroids as carbon source. S19-1 was characterized as being Gram negative, and 16S rRNA analysis showed that it belongs to the genus Buttiauxella of the Enterobacteriaceae family. Strain S19-1 could be best grown in SIN medium supplemented with 0.6-4.1% NaCl at 20°C. As a carbon source, testosterone, estradiol or cholesterol in minimal medium could be used by S19-1. Moreover, S19-1 could grow up in medium with 50 μg/ml erythromycin. Plasmids pK18 and other plasmids were successfully transformed into S19-1 by chemical transformation (CaCl(2)) and shown to replicate in the cells. Currently, work is ongoing to find the steroid inducible genes.     

Efficient formulations for exact stochastic simulation of chemical systems

One can generate trajectories to simulate a system of chemical reactions using either Gillespie's direct method or Gibson and Bruck's next reaction method. Because one usually needs many trajectories to understand the dynamics of a system, performance is important. In this paper, we present new formulations of these methods that improve the computational complexity of the algorithms. We present optimized implementations, available from http://cain.sourceforge.net/, that offer better performance than previous work. There is no single method that is best for all problems. Simple formulations often work best for systems with a small number of reactions, while some sophisticated methods offer the best performance for large problems and scale well asymptotically. We investigate the performance of each formulation on simple biological systems using a wide range of problem sizes. We also consider the numerical accuracy of the direct and the next reaction method. We have found that special precautions must be taken in order to ensure that randomness is not discarded during the course of a simulation.     

Active review sessions can advance student learning

Traditional review sessions are intended to help students learn and prepare for upcoming exams. Most sessions are passive question and answer sessions that look backward at content deficits rather than advancing student learning. By incorporating active and cooperative learning approaches during a review session, students are able to recognize critical concepts and better prepare for physiological problem solving. Active review sessions help students prioritize the knowledge and develop the thinking skills will be required of them on the exam.     

Learning to Obtain Reward,but Not Avoid Punishment,Is Affected by Presence of PTSD Symptoms in Male Veterans: Empirical Data and Computational Model

Post-traumatic stress disorder (PTSD) symptoms include behavioral avoidance which is acquired and tends to increase with time. This avoidance may represent a general learning bias; indeed, individuals with PTSD are often faster than controls on acquiring conditioned responses based on physiologically-aversive feedback. However, it is not clear whether this learning bias extends to cognitive feedback, or to learning from both reward and punishment. Here, male veterans with self-reported current, severe PTSD symptoms (PTSS group) or with few or no PTSD symptoms (control group) completed a probabilistic classification task that included both reward-based and punishment-based trials, where feedback could take the form of reward, punishment, or an ambiguous “no-feedback” outcome that could signal either successful avoidance of punishment or failure to obtain reward. The PTSS group outperformed the control group in total points obtained; the PTSS group specifically performed better than the control group on reward-based trials, with no difference on punishment-based trials. To better understand possible mechanisms underlying observed performance, we used a reinforcement learning model of the task, and applied maximum likelihood estimation techniques to derive estimated parameters describing individual participants’ behavior. Estimations of the reinforcement value of the no-feedback outcome were significantly greater in the control group than the PTSS group, suggesting that the control group was more likely to value this outcome as positively reinforcing (i.e., signaling successful avoidance of punishment). This is consistent with the control group’s generally poorer performance on reward trials, where reward feedback was to be obtained in preference to the no-feedback outcome. Differences in the interpretation of ambiguous feedback may contribute to the facilitated reinforcement learning often observed in PTSD patients, and may in turn provide new insight into how pathological behaviors are acquired and maintained in PTSD.     

Social support and posttraumatic stress disorder in combat veterans in Croatia

Recent studies have shown that greater social support after combat stress is associated with better psychological posttraumatic outcomes. By comparison of a group of veterans (n = 71) who sought psychiatric help and were diagnosed with PTSD (clinical group) and a group of veterans (n = 43) without PTSD (control group) we examined various components of structural and functional social support in war veterans in Croatia. The measures of social support were assessed for two time periods: a) immediately after the war, and b) at the present time. Results of two-way analysis of variance indicate that veterans without PTSD tend to report significantly higher number of persons who provide them different forms of social support than veterans with PTSD. Perceived family and friends support is higher in veterans without PTSD than in veterans with PTSD. Support received from friends and fellow soldiers decreases over time in both groups, whereas for the clinical group support of friends decreases significantly more.