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The article discusses the implications of change in work environment in technical training programme. The rate of progress is such that man will need re-training many times over to new tasks or completely new ways of handling the old task. The article points out that human interpretation of a situation depends not only upon intellectual perception but also on emotional reaction and intention. The guidelines on which the change has taken or the technical content of the system on to which the change is to be made will involve the top management and the policy decision makers, the middle level of management concerned with implementing the policy decision and also the workers affected by the technical change. Only the minimum training necessary for the job should be given. Over-training is bad training. Training should always aim at Metric Thinking and not conversion. Analysis of the job needs and, the incumbent's need should always be carried out to eliminate redundancy.

A 61 year old hypertensive woman presented in 1986 with a right scapular chondrosarcoma. She developed type 1 diabetes mellitus in 1991 and suffered a stroke in 1991. Chest radiography showed pulmonary metastases in 1997. Further radiological staging detected a right sided phaeochromocytoma, which was subsequently removed in 1998. Before this, repeated urine estimations of vanillylmandelic acid had been normal. Her diabetes was cured by adrenalectomy. It is believed that the combination of phaeochromocytoma and extrapulmonary chondrosarcoma represents a new variant of Carney's triad. [ABSTRACT FROM AUTHOR]

Focuses on a study which analyzed the control of several physiological processes among diabetics with nephropathy and its relationship to other complications. Related literature; Subjects; Conclusion.

Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD., (© 2023. The Author(s).)

Introduction: There is little systematized research on the postsex phase of the sexual cycle, due in part to the absence of literature on the period immediately following sexual activity., Aim: The paper describes the development and validation of the Postsex Experience Scale (P-SES), an instrument designed to measure the psychological dimensions of the postsex period of the human sexual response cycle., Methods: Scale development involved (a) item construction, selection, and subsequent validation through item analysis, and (b) a factor analysis of the item intercorrelations of the P-SES and the establishment of its factorial validity, based upon an online survey of 4,217 respondents., Results: In the exploratory factor analysis of the psychometric structure of the scale, structures for males and females differed. 3 factors emerged, which captured the male postsex experience. These factors were labeled Sense of Sexual Alienation, Positive Connection with Self, and Feeling Connected with Partner. 4 factors best captured the female postsex experience and were labeled Self-Loathing, Positive Connection with Self, Sense of Being Emotionally Overwhelmed, and Feeling Connected with Partner., Clinical Implications: There is strong evidence for acknowledging a wide variation in postsex experience in both men and women across sexual orientations., Strengths & Limitations: Strengths include a large heterogeneous sample leading to the provision of a metric to investigate novel aspects of human sexuality. Limitations include the potential underreporting of experiences due to the structure of the scale and its reference to "general experiences" and presentation bias., Conclusions: The P-SES provides a framework for assessing the postsex experience in women and men, providing opportunities to gain a better understanding of the variations in postsex experience. Schweitzer RD, du Plessis G, Maczkowiack J, et al. Development and Validation of the Post Sex Experience (P-SES) Scale. Sex Med 2021;9:100291., (Copyright © 2021. Published by Elsevier Inc.)

Background: Insomnia and low iron stores are common in children with autism spectrum disorders, and low iron stores have been associated with sleep disturbance., Methods: We performed a randomized placebo-controlled trial of oral ferrous sulfate to treat insomnia in children with autism spectrum disorders and low normal ferritin levels. Twenty participants who met inclusion criteria and whose insomnia did not respond to sleep education were randomized to 3 mg/kg/day of ferrous sulfate (n = 9) or placebo (n = 11) for three months., Results: Iron supplementation was well tolerated, and no serious adverse events were reported. Iron supplementation improved iron status (+18.4 ng/mL active versus -1.6 ng/mL placebo, P = 0.044) but did not significantly improve the primary outcome measures of sleep onset latency (-11.0 minutes versus placebo, 95% confidence interval -28.4 to 6.4 minutes, P = 0.22) and wake time after sleep onset (-7.7 minutes versus placebo, 95% confidence interval -22.1 to 6.6 min, P = 0.29) as measured by actigraphy. Iron supplementation was associated with improvement in the overall severity score from the Sleep Clinical Global Impression Scale (-1.5 points versus placebo, P = 0.047). Changes in measures of daytime behavior did not differ between groups., Conclusion: This trial demonstrated no improvement in primary outcome measures of insomnia in subjects treated with ferrous sulfate compared with placebo. Interpretation was limited by low enrollment., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We tested the feasibility and preliminary effectiveness of an acceptance and commitment therapy self-help intervention for grief and psychological distress in carers of patients in palliative care. Carers were randomised to the control group, which received treatment as usual, or the intervention group, which received treatment as usual plus an acceptance and commitment therapy-based self-help booklet and telephone support call. Questionnaires were completed at baseline, 1-month post-allocation and 6 months post-loss. Results indicated that the intervention was generally feasible and viewed as acceptable to carers. Preliminary effectiveness analyses showed at least a small effect in acceptance, valued-living, grief and psychological distress.

ABSTRACTObjective:The provision of psychological support to caregivers is an important part of the role of the clinical staff working in palliative care. Staff knowledge and attitudes may determine their openness to referring caregivers to a psychological intervention. We recently developed a self-help intervention for grief and psychological distress among caregivers and were interested in exploring the extent to which staff knowledge and attitudes might affect future implementation. The aims of our study were to: (1) examine the acceptability of self-help psychological intervention for caregivers among palliative care clinical staff; (2) examine potential attitudinal barriers toward prolonged grief disorder (PGD) as a diagnosis and interventions for grief; and (3) bolster staff confidence in skills and knowledge in identifying and managing caregiver psychological distress., Method: An anonymous survey was distributed among clinical staff at two inpatient units and two community health services that assessed the acceptability of self-help interventions for caregivers, attitudes about PGD diagnosis and grief intervention, and staff confidence in skills and knowledge in assessing caregiver psychological distress., Results: Overall, clinical staff were positively oriented toward self-help for caregivers and intervention for grief. They were also basically confident in their skills and knowledge. While it was positive PGD attitudes that were associated with acceptability of self-help for caregivers, it was both positive and negative PGD attitudes that were associated more specifically with a willingness to refer caregivers to such an intervention., Significance of Results: Our findings are useful in highlighting the issues to be considered in the implementation of a self-help intervention within the healthcare service. Clinical staff seemed positively oriented toward engaging with a psychological intervention for caregivers and likely to act as key allies in implementation.

The following is a summary of the recommendations and good practice points for the BTS Guideline for the initial outpatient management of pulmonary embolism. Please refer to the full guideline for full information about each section., Competing Interests: Competing interests: RC received funding from BTG, Actelion and MSD; BE received funding from Astra Zeneca and Diageo; DH received finding from Creavotech; LSH received funding from GSK, Endotronix, Actelion, Bayer, MSD, BTG and BMS; RP received funding from Bayer and Daiichi Sankyo; KS received funding from Actelion; CT received funding from Bayer, Daiichi Sankyo and Novo Nordisk; CNP received funding from UCB and Alliance; WP received funding from ARNS, AZ and BI.

To address the lack of a truly portable, universal reference mapping population for perennial ryegrass, we have been developing a recombinant inbred line (RIL) mapping population of perennial ryegrass derived via single seed descent from a well-characterized F2 mapping population based on genetically distinct inbred parents in which the natural self-incompatibility (SI) system of perennial ryegrass has been overcome. We examined whether it is possible to create a genotyping by sequencing (GBS) based genetic linkage map in a small population of the F6 generation of this population. We used 41 F6 genotypes for GBS with PstI/MspI -based libraries. We successfully developed a genetic linkage map comprising 6074 SNP markers, placing a further 22080 presence and absence variation (PAV) markers on the map. We examined the resulting genetic map for general and RIL specific features. Overall segregation distortion levels were similar to those experienced in the F2 generation, but segregation distortion was reduced on linkage group 6 and increased on linkage group 7. Residual heterozygosity in the F6 generation was observed at a level of 5.4%. There was a high proportion of chromosomes (30%) exhibiting the intact haplotype of the original inbred parents of the F1 genotype from which the population is derived, pointing to a tendency for chromosomes to assort without recombining. This could affect the applicability of these lines and might make them more suitable for situations where repressed recombination is an advantage. Inter- and intra-chromosomal linkage disequilibrium (LD) analysis suggested that the map order was robust. We conclude that this RIL population, and subsequent F7 and F8 generations will be useful for genetic analysis and phenotyping of agronomic and biological important traits in perennial ryegrass.

The objective was to determine the prevalence of habitual snoring and obstructive sleep apnea (OSA) in a cohort of children referred for elevated blood pressure (BP), and to determine the association between OSA and BP elevation, learning difficulties, and behavioral problems. We performed a retrospective review of 446 consecutive new patients referred for elevated BP. One hundred four (23%) had habitual snoring. Patients with habitual snoring were more likely to be obese (86.5 vs. 55.6%, P < .001) and to have Medicaid insurance (52.4 vs. 36%, P = .004). Seventy-four patients had polysomnography, of which 57 (77%) had OSA; 21 (37%) had severe OSA. Severe OSA was associated with higher office systolic BP index after adjusting for body mass index, age, sex, and socioeconomic status (β = 0.07, P = .014). Fifty-two percent of patients with severe OSA had office systolic BP in the Stage 2 hypertension range. Children with habitual snoring or OSA were not at increased risk of receiving school services for a learning disability or receiving medications for inattention or mood problems. In summary, habitual snoring is common in children referred for elevated BP, and those with severe OSA are at higher risk of significantly increased BP., (Copyright © 2018 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Objective: To pilot a clinician-based outcome measure that provides complementary information to objective measures and parent-based questionnaires for insomnia in children with autism spectrum disorders (ASD)., Method: The authors developed a Pediatric Sleep Clinical Global Impressions Scale (CGI). Questions included (1) the child's ability to fall asleep and remain sleeping independently (i.e., apart from parents); (2) bedtime resistance; (3) sleep onset delay; (4) night awakening; (5) parental satisfaction with their child's current sleep patterns; (6) family functioning as affected by their child's current sleep patterns; and (7) clinician's overall concern with the child's sleep. After refining the instrument through the evaluation of vignettes by ASD and sleep experts, the authors piloted the Pediatric Sleep CGI in a 12-week randomized trial of iron supplementation in children with ASD. Clinicians completed Pediatric Sleep CGIs and structured sleep histories, parents completed the Children's Sleep Habits Questionnaire (CSHQ), and children wore actigraphy watches., Results: In repeated measures models, the Pediatric Sleep CGI and CSHQ were correlated for sleep onset delay (r = .66, p < .001), night wakings (r = .40, p < .001), and total score (r = .29, p < .001). The CGI-S sleep onset delay and actigraphy sleep onset delay scores (r = .75, p = .0095) were also correlated. The overall CGI-S showed improvement with therapy (p = .047)., Conclusion: The Pediatric Sleep CGI shows promise in measuring clinician-rated outcomes in pediatric insomnia in children with ASD. Larger samples will be necessary to examine reliability, validity, and measure to change, as well as applicability to other populations with pediatric insomnia.

Objectives: Sleep difficulties are common in children with autism spectrum disorders, with wide-ranging effects on the child's daytime behavior. We reviewed data within our Autism Speaks Autism Treatment Network Registry to determine the prevalence of sleep difficulties and patterns of medication use., Methods: Data from 1518 children ages 4 to 10 years were analyzed to determine the number of children documented to have sleep difficulties by parent-completed questionnaires and clinician-completed forms and how these findings related to the use of sleep medications., Results: The Children's Sleep Habits Questionnaire total score was ≥41 (associated with clinically significant sleep problems in past research) in 71% of children. The prevalence of sleep diagnoses was less frequent (30% of children aged 4-10 years; P < .0001). Medications for sleep were prescribed in 46% of 4- to 10-year-olds given a sleep diagnosis. The most common medication used for sleep was melatonin followed by α-agonists, with a variety of other medications taken for sleep (anticonvulsants, antidepressants, atypical antipsychotics, and benzodiazepines). Children taking medications for sleep had worse daytime behavior and pediatric quality of life than children not taking sleep medications., Conclusions: Parent concerns about sleep may not be reflected in the information gathered during a clinic visit, supporting the need to develop screening practice pathways for sleep in autism spectrum disorders. Furthermore, many medications taken for sleep have adverse effects, supporting the need for evidence-based interventions in this population., (Copyright © 2016 by the American Academy of Pediatrics.)

This article discusses four models of ambulatory emergency care (AEC), a form of clinical care that allows practitioners to assess, diagnose, treat and discharge patients on the same days that they present to emergency departments. The article recommends one model in particular, the process model, and sets out four questions practitioners who want to deliver AEC should ask of patients at the point of referral.

Patients admitted to A&E in the evening can stay in hospital up to four days longer than morning admissions. Trusts can take targeted action during the assessment phase to reduce patient stays, explain Seamus McGirr and colleagues

Study Objectives: Down syndrome (DS) is a neurodevelopmental disorder characterized by multiple comorbidities. Sleep disorders are common among children with DS and can cause significant distress for families. However, research is limited describing sleep problems and correlates in large population-based samples. Accordingly, we aimed to describe sleep behavior among children with DS and its relationship with medical conditions in this population., Methods: We conducted a population-based, cross-sectional study (2009-2011) of sleep disturbances in children and adolescents with DS 7 to 17 years of age (N = 107). We assessed sleep problems using caregiver report on two validated screening tools: the Childhood Sleep Habits Questionnaire (CSHQ) and the Pediatric Sleep Questionnaire (PSQ). The prevalence of sleep problems was compared in children with and without important comorbidities using modified Poisson regression with robust standard errors., Results: 65% of children screened positive on the CSHQ for significant sleep problems in the past month, but their parents often did not report sleeping difficulties in their children. On the PSQ, 46% screened positive for sleep related breathing problems and 21% screened positive for sleep related movement disorders. Children with asthma, autism, and a history of enlarged adenoids and tonsils had more current sleep problems than children without these comorbidities., Conclusions: Our findings suggest that sleep problems may be an important but under-recognized problem in children with DS. Sleep problems appear to be correlated with prevalent comorbidities, which may provide guidance to augment current practice guidelines to evaluate sleep problems in this population.