S ince the first edition of this handbook was published, rapid progress has been made in the science of gratitude, due in large part to advances in measurement. In this chapter we describe these recent developments in the measurement of gratitude across the lifespan. We emphasize self-reported gratitude measures, since these have dominated research.Efforts to develop measures of gratitude have increased as accumulating research has demonstrated that gratitude is foundational to well-being and mental health throughout the lifespan. From childhood to old age, a wide array of psychological, physical, and relational benefits are associated with gratitude. Gratitude has been shown to contribute not only to an increase in happiness, health, and other desirable life outcomes but also to a decrease in negative affect and problematic functioning, including in patients with neuromuscular disease, college students, hypertensives, patients with cancer, health care providers, and early adolescents (

Objective: Healthcare organizations are increasingly engaging the voice of patients and families through storytelling initiatives in hopes that this will yield compassionate and humanistic outcomes. To date, very little research is available that directly guides and justifies storytelling initiatives as a mechanism for promoting humanistic culture shifts in healthcare. This review aimed to uncover diverse research and evidence on how storytelling can be utilized to promote humanistic shifts in healthcare organizations. Methods: A meta-narrative review and analysis was undertaken including qualitative, quantitative, theoretical, and conceptual papers. Searches were restricted to English Language journals, and no time frame restrictions were made. A literature assessment form was created to guide the review using a consistent taxonomy to appraise each paper. Analysis was done in two-stages: firstly, identifying emergent themes within each research discipline; secondly, comparing and contrasting themes from the different disciplines. Results: A total of 115 papers were identified for review resulting from the literature review protocol. Eighty-three papers were included in the final review: 48 papers from Healthcare/Medicine combined, 28 from Business, 14 from Education, 5 from Organizational Development and 19 from Humanities (inclusive of Psychology and Communications). There were three key findings: 1) Storytelling promotes sense-making while also perpetuating bias; 2) Stories are uniquely primed to elicit empathy and compassion; 3) Story listening and how stories are interacted with by the listener are key considerations for organizations aiming to shift culture. Conclusions: This review solidifies storytelling as a mechanism suited to furthering humanistic practices in healthcare while contributing new knowledge in support of developing policies, strategies and research initiatives that account for how stories are understood and the processes that encourage reflection and interaction by listeners.

The inverse cubic phase derived from the self-assembly of surfactants in water offers a unique threedimensional platform for protein binding. Colloidally stable, sub-micron dispersions of the inverse bicontinuous cubic phase (cubosomes) impart an unusually large interfacial area for presentation of small molecules to selectively bind proteins of interest. Cubosomes of the phytantriol/water system were prepared and the receptor for cholera toxin (CT), monosialoganglioside G M1 (G M1 ), was integrated within the cubic phase. Our results show that G M1 -functionalised cubosomes display a strong inhibitory response against CT with a high specificity for the toxin. Surface plasmon resonance (SPR) studies demonstrate that CT and cholera toxin B subunit (CT B ) both specifically bind and form a very stable complex with G M1 -phytantriol cubosomes, demonstrated by an absence of binding to control proteins (mouse IgG, lysozyme and ricin). The inhibitory activity of the G M1 -phytantriol cubosomes against CT was evaluated by a modified enzyme linked immunosorbent assay (ELISA). Using this method we have determined a nanomolar inhibitory activity (e.g., IC 50 ¼ 2.31 nM against 10 ng ml À1 CT) for these particles and a dissociation constant of the G M1 -CT complex (K D ) of 1.75 nM, highlighting the remarkable inhibitory activity of the self-assembled cubic phase systems.

Antibody-mediated removal of aggregated βamyloid (Aβ) is the current, most clinically advanced potential disease-modifying treatment approach for Alzheimer's disease. We describe a quantitative systems pharmacology (QSP) approach of the dynamics of Aβ monomers, oligomers, protofibrils, and plaque using a detailed microscopic model of Aβ 40 and Aβ 42 aggregation and clearance of aggregated Aβ by activated microglia cells, which is enhanced by the interaction of antibody-bound Aβ. The model allows for the prediction of Aβ positron emission tomography (PET) imaging load as measured by a standardized uptake value ratio. A physiology-based pharmacokinetic model is seamlessly integrated to describe target exposure of monoclonal antibodies and simulate dynamics of cerebrospinal fluid (CSF) and plasma biomarkers, including CSF Aβ 42 and plasma Aβ 42 /Aβ 40 ratio biomarkers. Apolipoprotein E genotype is implemented as a difference in microglia clearance. By incorporating antibody-bound, plaque-mediated macrophage activation in the perivascular compartment, the model also predicts the incidence of amyloid-related imaging abnormalities with edema (ARIA-E). The QSP platform is calibrated with pharmacological and clinical information on aducanumab, bapineuzumab, crenezumab, gantenerumab, lecanemab, and solanezumab, predicting adequately the change in PET imaging measured amyloid load and the changes in the plasma Aβ 42 /Aβ 40 ratio while slightly overestimating the change in CSF Aβ 42 . ARIA-E is well predicted for all antibodies except bapineuzumab. This QSP model could support the clinical trial design of different amyloid-modulating interventions, define optimal titration and maintenance schedules, and provide a first step to understand the variability of biomarker response in clinical practice.

This article, based on a presentation given at the First National Personality Disorder Congress, provides a brief descriptive overview of the occupation-based intervention group programme, the Journey day service, with contributions from a former group member, Rachel, of her experience of participating in and completing the programme.

Clinicians caring for patients with dementia are often at a loss when trying to manage dementia-related behavioral disturbances pharmacologically because no drugs have been proven effective for this indication. Antipsychotics are commonly prescribed for these patients despite a US Food and Drug Administration (FDA)–mandated boxed warning about the heightened risk of death in patients with dementia treated with antipsychotic drugs. This boxed warning does not prevent clinicians from prescribing antipsychotics to patients with dementia. However, it serves as a heightened warning to prescribers to include the specific risks mentioned in the boxed warning in their discussion of risks and benefits of the proposed therapy with their patients or their patients’ health care proxy and to document this informed consent conversation in the medical record. By documenting that the risks of the treatment, including those the FDA has deemed serious enough to include in a boxed warning, were discussed and accepted by the medical decision maker, the prescriber also reduces the risk of liability should an adverse event ensue.

Stroke is one of the most common conditions neurologists treat in emergency situations. This article examines the issues of surrogate decision makers and the physician’s potential legal liability in the context of the administration or nonadministration of recombinant tissue plasminogen activator (rtPA) in a common emergency department scenario.

No abstract