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Objective: To compare the detection of diabetic neuropathy by clinical assessment and nerve conduction study in type 2 diabetes mellitus patients. Study Design: Prospective comparative study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi Pakistan, Jan 2020 to May 2021. Methodology: A total of 300 patients having type 2 diabetes mellitus for more than ten years were included in the study. Revised neuropathy disability score was calculated by the consultant medical specialist on all the patients to make a clinical diagnosis of neuropathy. Nerve conduction studies were performed in the Department of Neurology. Findings of both methods to diagnose the patterns of diabetic neuropathy were compared. Results: Out of 300 patients suffering from type 2 diabetes mellitus, 188 (62.7%) were males, while 112 (37.3%) were females. The mean age of the study participants was 53.33±4.55 years, and the mean duration of diabetes mellitus was 11.22±5.71 years. Symmetrical neuropathy, motor polyneuropathy and sensory neuropathy had a statistically significant diagnostic pattern when assessed from clinical method and nerve conduction study (p-value

Leadership skills are a critical component of effective social work practice in interdisciplinary healthcare and mental healthcare settings. Over the last two decades there has been increased attention to the importance of social work leadership skills for clinical practice. Moreover, social workers display essential leadership skills when supporting individuals and communities amid large-scale crises such as pandemics, natural disasters, wars, and other sociopolitical crises. Currently, there is an absence of literature on social work leadership skills for effective practice in healthcare and mental healthcare settings during times of crisis. To bridge this knowledge gap, this scoping review aimed to synthesize and map the current literature on social work leadership competencies in healthcare and mental healthcare amid crises. Arksey and O’Malley’s five-stage framework for scoping reviews guided this project. Six academic databases were searched, and a total of nine articles met inclusion criteria. A thematic analysis was conducted to identify recurrent themes among these articles. Results highlight that leadership was defined as both a role and a skill set, and identified collaboration, connection, and shared learning as key leadership competencies for social workers. Implications for social work practice, education, and research are discussed.

Objective: To evaluate the effectiveness of awake proning on bedside oxygen saturation in non-intubated severe COVID-19 cases and its association with high-resolution CT chest severity score. Study Design: Prospective observational study. Place and Duration of Study: Pak Emirates Military Hospital Pakistan, from Jun to Jul 2020. Methodology: This study was conducted on 150 laboratories confirmed SARS-CoV-2 infected cases with moderate to severe category pneumonia, requiring supplemental oxygen but not mechanical ventilation, admitted in the High Dependency Unit of the Military Hospital. Bedside oxygen saturation was recorded via pulse oximeter before and after proning of 10 minutes to evaluate whether oxygen saturation increased, decreased or remained the same post proning. Results: Out of 150 patients, it was observed that 67 (45%) patients showed 2% increase of oxygen saturation over 10 minutes of proning, 48 (32%) patients showed an increase of 1% while 20 (13%) patients showed an increase of 3%. It was also observed that 13 (14.7%) patients out of 88 patients, with HRCT severity score of >50% showed an increase of 3% compared to 7 (11%) patients out of 62 patients with HRCT severity score of

Objective: To assess the vitamin D levels among patients presenting with acute ischemic stroke and relationship of these levels with short-term outcome and the severity of stroke. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2019 to Feb 2021. Methodology: A total of 300 patients with ischemic stroke diagnosed by the consultant medical specialist or neurologist on the basis of clinical and neuro-radiological findings were included in this study. Serum Vitamin D levels were assessed along with other baseline investigations among the study participants. Severity of stroke was assessed via National Institutes of Health Stroke scale and short-term outcome was assessed by modified Rankin scale. Results: Out of 300 patients of acute ischemic stroke, 183 (62.3%) were males while 117 (37.3%) were females. 151 (50.3%) of the patients had Vitamin D levels within range while 149 (49.7%) had deficient vitamin levels. On National Institutes of Health Stroke scale, 163 (54.3%) had mild, 87 (29%) had mild to moderately severe, 33 (11%) had severe and 17 (5.7%) had very severe symptoms. Statistical analysis revealed that short-term outcome and stroke severity had a statistically significant relationship (p-value

Through an epistemological stance of post-structural feminism, this conceptual paper explores the use of language within eating disorders (ED) intervention articles, and the problematic narratives and power dynamics that are reinforced through this discourse. The paper begins with a vignette coupled with reflexive analysis of the authors’ experiences within a hospital-based ED unit. The authors then engage in a post-structural feminist analysis to discuss how language within ED intervention research relay problematic narratives of: (1) the individual with an ED as passively, not actively, engaged in care; (2) that their experiences can be captured and categorized; and (3) that measurement based scientific knowledge is more valuable than the lived experiences of clients. Overall, the authors argue that these narratives not only shape how social work researchers think of EDs, but also what we think of those with EDs. These themes also signal a larger power dynamic that continuously favours the epistemic value of researchers’ knowledge over that of the client’s, which runs contrary to the guiding principles of client-centered care in social work. To address these critiques, the authors recommend that social work researchers adopt an eco-social phenomenological approach informed by post-structural feminism when conducting ED intervention research.

In present study, diverse Litchi chinensis-mediated nanostructures in combination with 5-fluorouracil drug were fabricated viz. Au, Se, Ag, Ag–Se, Ag–Au, 5-FU Ag–Se and 5-FU Ag–Au with subsequent characterization and scrutinization of their anticarcinogenic capabilities. UV–Visible spectroscopic analysis confirmed the state transition for each precursor salt. XRD and transmission electron microscopy analysis revealed spherical/quasispherical nanostructures with monoclinic crystalline organization ranged between 18 nm and 38 nm. FTIR analysis revealed fabricated nanoparticles to be capped with various phytoconstituents. DLS and Zeta potential analysis of unloaded and drug-loaded bielemental nanoparticles (BNPs) showed comparatively large hydrodynamic particle size distribution and sufficient stability of nanoparticles. BNPs showed promising lethality concentrations for brine shrimp (LC50

Multiple therapeutic hydrophobic drugs can be delivered simultaneously by inorganic, biocompatible iron core mesoporous silica shell nanoparticles. We synthesized superparamagnetic iron oxide nanocrystals encapsulated within mesostructured silica spheres through the sol-gel process. The dose of hydrophobic drugs Paclitaxel (PTX) and Camptothecin (CPT) loading and released on Fe3 O4 @SiO2 core/shell nanoparticle detected by U.V-visible spectrophotometry using a platform of nanoparticles (NPS). After being subjected to external heating, the drug release efficiency of paclitaxel (PTX) and camptothecin (CPT) Fe3 O4 @SiO2 core/shell nanoparticles is increased. Paclitaxel (PTX) and Camptothecin (CPT) Fe3 O4 @SiO2 core/shell nanoparticles did not heat the solution when an alternating magnetic field (AMF) was applied, and there was only mild drug leakage. When compared to Fe3 O4 @MSNs, the nanoparticles (PTX) and (CPT) Fe3 O4 @MSNs function as cancer-targeting mediators, increasing the killing of PANC-1 cancer cells. Human cancer cells were given these therapeutic anticancer water-insoluble drugs with nanoparticles, which is a valuable vehicle for drug delivery, and induced the inhibition of proliferation. Therefore, the goal of this study to emphasize Fe3 O4 @SiO2 core/shell potential as a superior candidate for hydrophobic drug delivery to the PANC-1 cancer cell.

Background: The overrepresentation of Black families in child welfare systems across the various geographical locations (e.g. America, Canada, United Kingdom) is a growing concern. There are competing explanations for the causes of overrepresentation and recommendations for eliminating racial disproportionalities and disparities in child welfare system. This systemic scoping review will provide a succinct synthesis of the current literature on Black disproportionality and disparity in child welfare. Methods/Design: This systemic scoping review will employ Arksey and O’Malley’s (2005) five stage framework. This will direct our search of the seven academic databases (EBSCO: Criminal Justice Abstracts OVID: Social Work Abstracts Pro Quest: PsychINFO, ERIC, Sociological Abstracts, International Bibliography of Social Sciences and Web of Science Core Collections). These seven databases have been chosen due to their interdisciplinary resources on the issue of overrepresentation of Black families in the child welfare sector. The thematic findings will be systemically synthesized using qualitative analysis and presented visually through a chart. Eligible articles for this scoping review include literature that speaks directly to the experiences of Black families involved with the child welfare system. The results of this scoping review will increase the understanding of how racial disproportionalities and disparities emerge, common outcomes and ways to begin tackling this phenomenon for Black families. Discussion: In order to tackle this gap in knowledge regarding the overrepresentation of Black families in the child welfare system, this comprehensive scoping review will systematically organize the literature in order to understand how this issue manifests and to fill this gap in research. This methodological approach will allow for the development of practical and intentional methods to move forward in mitigating this issue.

There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers.Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data.The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic.At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.RéSUMé: OBJECTIFS: Les effets indésirables de la pandémie de COVID-19 sur les jeunes (16 à 24 ans) du Canada suscitent des inquiétudes, car ce sont les jeunes qui présentent les taux les plus élevés de problèmes de santé mentale. Nous avons voulu explorer les expériences de jeunes aux prises avec des problèmes de santé mentale et/ou de toxicomanie et de leurs familles durant la pandémie, et à déterminer si les services de santé mentale sont suffisants et équitables pour les jeunes et leurs familles du point de vue de jeunes, de parents et de prestataires de services. MéTHODE: À l’aide d’un plan de recherche qualitative descriptive et d’un partenariat entre les milieux universitaire et associatif, nous avons mené des entretiens individuels avec des jeunes, des parents et des prestataires de services. Vingt-cinq personnes ont participé à l’étude (n = 15 utilisateurs et utilisatrices de services, n = 10 prestataires de services). Parmi les utilisateurs et utilisatrices de services, 11 étaient des parents et 4 étaient des jeunes. Nous avons eu recours à l’analyse thématique pour analyser les données des entretiens. RéSULTATS: Trois thèmes se sont dégagés de l’analyse thématique des données : 1) les problèmes de santé mentale des jeunes augmentent, tandis que les mesures d’aide diminuent, 2) ce sont les familles qui finissent par constituer l’équipe de traitement, ce qui représente un fardeau accru, peu de soutien et un manque de reconnaissance, et 3) l’insuffisance et l’iniquité des services de santé mentale offerts aux jeunes et à leurs familles ont été amplifiées durant la pandémie. CONCLUSION: Alors que les besoins en santé mentale étaient plus élevés, le système de soins de santé mentale a offert moins de soutien aux jeunes et à leurs familles. Pour une intervention plus équitable face à la pandémie, nous avons besoin d’un système de soins de santé mentale accessible et intégré, manifestement engagé à aborder les déterminants sociaux et à réduire les disparités d’état de santé et les iniquités d’accès aux services de santé mentale.

BackgroundFindings of new targeted treatments with adequate safety evaluations are essential for better cancer cures and mortality rates. Immunotherapy holds promise for patients with relapsed disease, with the ability to elicit long-term remissions. Emerging promising clinical results in B-cell malignancy using gene-altered T-lymphocytes uttering chimeric antigen receptors have sparked a lot of interest. This treatment could open the path for a major difference in the way we treat tumors that are resistant or recurring.Main bodyGenetically altered T cells used to produce tumor-specific chimeric antigen receptors are resurrected fields of adoptive cell therapy by demonstrating remarkable success in the treatment of malignant tumors. Because of the molecular complexity of chimeric antigen receptors-T cells, a variety of engineering approaches to improve safety and effectiveness are necessary to realize larger therapeutic uses. In this study, we investigate new strategies for enhancing chimeric antigen receptors-T cell therapy by altering chimeric antigen receptors proteins, T lymphocytes, and their relations with another solid tumor microenvironment (TME) aspects. Furthermore, examine the potential region of chimeric antigen receptors-T cells therapy to become a most effective treatment modality, taking into account the basic and clinical and practical aspect.Short conclusionsChimeric antigen receptors-T cells have shown promise in the therapy of hematological cancers. Recent advancements in protein and cell editing, as well as genome-editing technologies, have paved the way for multilayered T cell therapy techniques that can address numerous important demands. At around the same time, there is crosstalk between various intended aspects within the chimeric antigen receptors-T cell diverse biological complexity and possibilities. These breakthroughs substantially improve the ability to comprehend these complex interactions in future solid tumor chimeric antigen receptor-T cell treatment and open up new treatment options for patients that are currently incurable.

PurposeThe purpose of this paper is to examine the relationship between perceived organizational support (POS), organizational commitment and job satisfaction among special education teachers in Pakistan. The data were collected from 85 special education teachers from different special education centers in Punjab, Pakistan. POS was measured using a survey of POS developed by Eisenbergeret al.(1986). Affective continuance and normative commitment are measured by affective continuance and normative commitment scales developed by Meyer and Allen’s (1984) and Allen and Meyer (1990), respectively. Results of the current study show that POS and job satisfaction are positively correlated with affective and normative commitment. POS and job satisfaction are not associated with continuance organizational commitment. This suggests that a teacher’s commitment can be improved by increasing organizational support, underprivileged working environment and job satisfaction. Limitations and implication of the study are discussed.Design/methodology/approachIn the current study, cross-sectional research design and non-probability purposive sampling technique were used. A sample of 85 special education teachers was collected from different special education institutes of Punjab and federal, Pakistan. Inclusion criteria were teacher with specialization in all disabilities (mentally challenged, deaf, blind, physical handicapped and slow learners), informed consent and age range 20‒55 years, at least 6-month teaching experience in special education. Exclusion criteria were teaching experience less than 6 months and age less than 20 or more than 55 years. The demographic characteristics of teachers are presented in Table II.FindingsFindings of the present study suggest a positive association between POS, affective commitment, normative commitment and job satisfaction, whereas there is no association between POS and continuance commitment as well as between job satisfaction and continuance commitment among special education teachers in Pakistan. Organization should consider the exclusive support of the special education teachers.Research limitations/implicationsThe current study also has some limitation. The sample size is very small. In the current study, data are collected from 85 special education teachers from federal and few cities of Punjab, Pakistan. Hence, data are not true representative. Data for current study are collected through self-reported scales and only collected from academic staff.Practical implicationsIn the current study, special education teachers have identified factors that promote organizational support, commitment and job satisfaction, such as reasonable workloads, sound working environment, unbiased and fair working conditions, and administrative support. It has been found that decreased level of POS, commitment and job satisfaction damage the organization, special educators and special students. Therefore, special education department should develop and implement policies that strengthen these dimensions. A broad recommendation can be made on the basis of these findings: affective and normative commitment increases when individuals have satisfying experience with organization. Thus, this may be improved by providing special educators with the opportunity to work in a better work environment, with proper work load, as it would increase emotional and normative attachment of the individuals with their institutes. The current study would be helpful for policy makers in the field of education and administration in order to work on these dimensions to increase the teacher’s job satisfaction and organizational commitment. It would also create awareness among the general public about the potential problems of special education teachers in Pakistan affecting the quality of life of children with special needs. Results suggest that by providing organizational support, appropriate work load and unbiased attitude, a teacher’s commitment can be improved.Social implicationsThe current research helps academics and administration to improve social functioning of special education teachers by improving their job satisfaction and organizational support.Originality/valueThe prevalence rate of children with disabilities is increasing rapidly in Pakistan. Since stigma is associated with individuals with disabilities, parents hide disabilities of their children so that other relatives may not face any problems, such as being doubted of carrying defective genes. Families have to cope with financial crises due to lack of institutional support, extra expense to deal with disabled person and loss of work. In such circumstances, special education institutions are only hopes for such people to assist them in dealing with their disabled children. However, the strength of teachers in these institutions is not enough to fulfill needs of such children. A number of researches have examined the role of organizational support, job satisfaction and organizational commitment of teachers in western countries (Makanjeeet al., 2006; Alijanpouet al., 2013; Batool and Ullah, 2013). However, to the best of the authors’ knowledge, no study has yet investigated this serious issue in Pakistan. This study provides valuable information on organizational support, commitment and job satisfaction among special educators, and recommendation on how organizational commitment can be improved.

IntroductionSocial work is a key profession in the field of mental health worldwide and the profession has values that are aligned with a recovery paradigm. However, there are gaps in understanding how social workers are applying the recovery paradigm in practice. This study will scope and synthesise the literature related to recovery and social work practice in mental health and addictions. There will also be an exploration of best practices and gaps in recovery-oriented social work practice.Methods and analysisUsing a scoping review framework developed by Arksey and O’Malley, we will conduct our search in five academic databases: PsycINFO, Medline, CINAHL Plus, Sociological Abstracts and Social Services Abstracts. Articles meeting inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach.Ethics and disseminationThis review will provide relevant information about best practices and gaps in recovery-oriented social work practice in mental health and addictions. The study will inform the development of mental health curricula in social work programmes and clinical settings. Results will be disseminated through a peer-reviewed journal and at conferences focusing on mental health, addictions, and social work education. Ethics approval is not required for this scoping review.

Ifosfamide is a widely used chemotherapeutic agent having broad-spectrum efficacy against several tumors. However, nephro, hepato, neuro cardio, and hematological toxicities associated with ifosfamide render its use limited. These side effects could range from organ failure to life-threatening situations. The present study aimed to evaluate the attenuating efficiency of Berberis vulgaris root extract (BvRE), a potent nephroprotective, hepatoprotective, and lipid-lowering agent, against ifosfamide-induced toxicities. The study design comprised eight groups of Swiss albino rats to assess different dose regimes of BvRE and ifosfamide. Biochemical analysis of serum (serum albumin, blood urea nitrogen, creatinine, alanine transaminase, aspartate transaminase, alkaline phosphatase, lactate dehydrogenase, total cholesterol, and triglycerides) along with complete blood count was performed. Kidney, liver, brain, and heart tissue homogenates were used to find malondialdehyde, catalase, and glutathione S-transferase levels in addition to the acetylcholinesterase of brain tissue. The results were further validated with the help of the histopathology of the selected organs. HeLa cells were used to assess the effect of BvRE on ifosfamide cytotoxicity in MTT assay. The results revealed that pre- and post-treatment regimens of BvRE, as well as the combination therapy exhibited marked protective effects against ifosfamide-induced nephro, hepato, neuro, and cardiotoxicity. Moreover, ifosfamide depicted a synergistic in vitro cytotoxic effect on HeLa cells in the presence of BvRE. These results corroborate that the combination therapy of ifosfamide with BvRE in cancer treatment can potentiate the anticancer effects of ifosfamide along with the amelioration of its conspicuous side effects.

IntroductionThe COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic.Methods and analysisThe scoping review follows Arksey and O’Malley’s five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research.Ethics and disseminationResults will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.

Aims and methodTo evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents.ResultsOverall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm.Clinical implicationsSecure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.

Cisplatin is amongst the most potent chemotherapeutic drugs with applications in more than 50% of cancer treatments, but dose-dependent side effects limit its usefulness. Berberis vulgaris L. (B. vulgaris) has a proven role in several therapeutic applications in the traditional medicinal system. High-performance liquid chromatography was used to quantify berberine, a potent alkaloid in the methanolic root extract of B. vulgaris (BvRE). Berberine chloride in BvRE was found to be 10.29% w/w. To assess the prophylactic and curative protective effects of BvRE on cisplatin-induced nephrotoxicity, hepatotoxicity, and hyperlipidemia, in vivo toxicity trials were carried out on 25 healthy male albino Wistar rats (130&ndash, 180 g). Both prophylactic and curative trials included a single dose of cisplatin (4 mg/kg, i.p.) and nine doses of BvRE (500 mg/kg/day, orally). An array of marked toxicity effects appeared in response to cisplatin dosage evident by morphological condition, biochemical analysis of serum (urea, creatinine, total protein, alanine transaminase, aspartate transaminase, total cholesterol, and triglyceride), and organ tissue homogenates (malondialdehyde and catalase). Statistically-significant (p &lt, 0.05) variations were observed in various parameters. Moreover, histological studies of liver and kidney tissues revealed that the protective effect of BvRE effectively minimized and reversed nephrotoxic, hepatotoxic, and hyperlipidemic effects caused by cisplatin in both prophylactic and curative groups with relatively promising ameliorative effects in the prophylactic regimen. The in vitro cell viability effect of cisplatin, BvRE, and their combination was determined on HeLa cells using the tetrazolium (MTT) assay. MTT clearly corroborated that HeLa cells appeared to be less sensitive to cisplatin and berberine individually, while the combination of both at the same concentrations resulted in growth inhibition of HeLa cells in a remarkable synergistic way. The present validated the use of BvRE as a protective agent in combination therapy with cisplatin.

The Objective of current study was to investigate the relationship between emotional contagion, job satisfaction and different demographic variables among special education teachers. A sample of 80 special education teachers with age range of 20 to 50 years, from all kinds of learning disabilities, more than six months teaching experience were recruited from different special education centers of federal and Punjab. Emotional contagion was measured by Emotional Contagion Scale developed by Doherty (1997) and job satisfaction of teachers was measured by Teaching Satisfaction Scale (TSS) developed by Ho and Au (2002). Result showed that happiness is positively associated with job satisfaction and anger and sadness are negatively associated with job satisfaction, whereas emotions of love and fear were not associated with job satisfaction. Moreover, it has been found that different demographic variables of special education teachers such as education and pay scale are associated with job satisfaction whereas gender, age, job experience and marital status are not associated with job satisfaction. Results suggest that in order to improve job satisfaction of teachers, emotional contagion should be considered.&nbsp

Antisocial personality disorder (ASPD) often presents with highly impulsive, violent behavior, and pathological changes in the orbitofrontal cortex (OFC) and ventral striatum (VS) are implicated. Several compelling reasons support a relationship between low monoamine oxidase-A (MAO-A), an enzyme that regulates neurotransmitters, and ASPD. These include MAO-A knockout models in rodents evidencing impulsive aggression and positron emission tomography (PET) studies of healthy subjects reporting associations between low brain MAO-A levels and greater impulsivity or aggression. However, a fundamental gap in the literature is that it is unknown whether brain MAO-A levels are low in more severe, clinical disorders of impulsivity, such as ASPD. To address this issue, we applied [(11)C] harmine PET to measure MAO-A total distribution volume (MAO-A VT), an index of MAO-A density, in 18 male ASPD participants and 18 age- and sex-matched controls. OFC and VS MAO-A VT were lower in ASPD compared with controls (multivariate analysis of variance (MANOVA): F2,33=6.8, P=0.003; OFC and VS MAO-A VT each lower by 19%). Similar effects were observed in other brain regions: prefrontal cortex, anterior cingulate cortex, dorsal putamen, thalamus, hippocampus, and midbrain (MANOVA: F7,28=2.7, P=0.029). In ASPD, VS MAO-A VT was consistently negatively correlated with self-report and behavioral measures of impulsivity (r=-0.50 to -0.52, all P-values0.05). This study is the first to demonstrate lower brain MAO-A levels in ASPD. Our results support an important extension of preclinical models of impulsive aggression into a human disorder marked by pathological aggression and impulsivity.

Although many authors of biomedical journal articles have financial competing interests, they often fail to disclose them.1–3 Editors have been concerned about this for a long time. In 1985, the International Committee of Medical Journal Editors produced a statement on conflicts of interest, and journal editors adopted individual policies.4 But how effective have their policies been in practice? Krimsky et al investigated the financial interests of over 1000 authors whose articles appeared in 14 scientific and medical journals in 1992.3 Although 15% of authors had financial ties relevant to one of their publications, no voluntary disclosures were published. In 1998, Stelfox et al showed that 23/24 authors (96%) defending the safety of calcium channel antagonists had financial ties with manufacturers of these drugs compared with 11/30 (37%) who were critical of their use.1 Only 2/70 articles disclosed the authors' potential conflicts of interest. These findings confirmed that little had …

www.safersex.org refers to itself as the pre-eminent resource for information on safer sex on the Internet. I doubt many would disagree after visiting it. It is explicit, but necessarily so, as it points to the fact that the failure of condoms to protect against sexually transmitted diseases and pregnancy almost always results from incorrect use. The site offers the browser the option of viewing a short video clip showing how to put on and take off a condom correctly, using a realistic plastic penis. For the more easily embarrassed, there is a series of cartoons that show step-by-step how to use a condom (including tips for the uncircumcised male). Parents who are uncomfortable or unable to broach such issues, yet feel a duty to make sure their child is responsibly informed, should consider visiting this site. They can then decide whether or not the information is suitable for their teens. www.safersex.org is a clear example of how the Web can be a useful resource for honest discussion of safer sex aimed specifically at teens.

Leading economists say that the Scottish parliament should be given complete control over taxation and spending in Scotland. Making the devolved administration fully responsible for raising its own funds would, they say, force the Scottish Executive to be more accountable for its spending decisions. Welcoming the proposal, the leader of the Scottish National Party (SNP), John Swinney, said, “I want to see that the wealth of Scotland works for the people of Scotland.” But other parties have been more sceptical. Sean Connery opens the Scottish …

Applying for preregistration posts in Scotland Amina Hussain reports on a new preregistration house officer allocation scheme that has just completed its first year of operation in Scotland. Traditionally, Scottish medical students were left to make their own arrangements for preregistration posts with the individual consultants they had come to know, or they were entered into regional matching schemes. Postgraduate departments often had little to do with the allocation of places and merely dispatched contracts once informed to do so by consultants. There has always been a mismatch in the supply of and demand for medical graduates within the various regions of Scotland. Traditionally, this would result in the most popular posts in a region being filled by the local medical graduates who knew the consultants, while the least popular were filled by the “overflow” of students from regions where there weren't enough posts for the local graduates. Increasingly, panic stricken students were approaching consultants earlier and earlier in their academic careers to negotiate their preferred house officer posts. Consultants felt under strain at having to conduct so many exploratory discussions and to remember preliminary “deals” made as long ago as when students were only in their third year of medical school. The problem was most acute in regions where there were not enough posts for local graduates, like the north east of Scotland. It has always been a “net exporter” of graduates, whereas the west coast has always been a “net importer.” Overall, there are enough house officer posts in Scotland to match the number of Scottish medical graduates. In some instances, however, medical graduates from other EU countries were filling remaining posts, usually in the west coast, before their Scottish counterparts even knew that the vacancies existed. This meant that some Scottish graduates, especially from the north east, …

Payment of tuition fees should be deferred, and grants should be reintroduced. These are the main findings of a Scottish inquiry into student finance, chaired by Sir Andrew Cubie. The recommendations laid out in the report, published on 21 December 1999, would require a package of financial measures from the Scottish Executive to the tune of an additional £63m. The proposals would mean that once the income of graduates reaches £25 000 per year or more, they will be expected to contribute an overall total of £3075 to a planned education fund, irrespective of their degree course. This would be index linked to …

Amina Hussain offers some tips on arranging an elective in the world9s most exciting and diverse city

Healthcare professionals should be communicating to under 17 year olds that it is medically unwise to have sex, according to Dr Stammer, a general practice tutor at St George's Hospital Medical School, London. His controversial statement was recently reported in the Postgraduate Medical Journal (1999;75:641-2) and comes at a time of increasing unease about the unremittingly high rate of teenage pregnancies in the United Kingdom-the highest in western Europe, with more than 8000 unplanned pregnancies per year …

I commend The Royal College of Surgeons' drive to train more female surgeons, as outlined in last month's Student BMJ News.1 The college has identified key stages to tackle in the progression from school leaver to qualified surgeon, in an attempt to increase recruitment and retention of women. Although I do not doubt the college's commitment, I do wonder about its members' insight into the roots of the problem as illustrated by their proposed strategies. For a student who has entered medical school the college's suggested tactic for redressing the imbalance of the sexes is to organise social events, giving students the opportunity to talk to male and female surgeons. This is a welcome proposition, but is it really all we can look forward to? Is the college really that bereft of appropriate ideas to entice more women into the profession? As a female medical student who intends to follow a career in surgery I feel qualified to comment from my own experiences in coming to this evidently monumental decision. The desire to pursue a surgical career has not always been there. Like many others I have experienced fleeting aspirations of becoming a surgeon, usually following a brief stint in theatre, where I have been asked to assist. I would come away expressing my gratitude to the consultant and feeling extremely lucky for this rare opportunity. The excitement would soon disappear, along with the fading memory of the event. My current and sustained enthusiasm to pursue this career path has come from undertaking …

Amina Hussain discovers carnivals, and other delights, on offer in this twin island country of the eastern Caribbean

“The NHS is a crap employer. It has the crappiest record on employment of any west European country,” said Dr Chris Manning, the co-chair of Primary Care Mental Health Education, at a conference on doctors under stress at the Royal Society of Medicine in London on 15 November. Although he admitted to having had depression for a long time, Dr Manning was the most ebullient speaker of the day. With regard to stress in general practitioners, he believed that a lot of the newer recruits were going to put themselves first, “because the message they get is that the country doesn't care about you.” Having retired from the NHS …