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Clozapine is the antipsychotic medication with the greatest efficacy in treatment-resistant schizophrenia (TRS). Unfortunately, clozapine is ceased in approximately 0.2% to 8.5% of people due to concerns about clozapine-associated myocarditis (CAM). The opportunity for clozapine rechallenge is important for people with TRS and CAM, due to limited alternative treatments. However, there is a lack of consensus regarding the optimal process, monitoring, and dose titration to achieve successful clozapine rechallenge. The study aimed to review the process, monitoring, and dose titration within cases of clozapine rechallenge after CAM, to identify features associated with successful rechallenge.
Methods
A systematic review of clozapine rechallenge cases following CAM was conducted. PubMed, EMBASE, Cinahl, and PsycINFO were searched for cases. Reference lists of retrieved articles and field experts were consulted to identify additional studies.
Results
Forty-five cases were identified that described clozapine rechallenge, 31 of which were successful. Successful rechallenge cases generally used a slower dose titration regime with more frequent monitoring than standard clozapine initiation protocols; however, this data was not always completely recorded within cases. Six cases referred to published rechallenge protocols to guide their rechallenge.
Conclusions
The process, monitoring, and dose titration of clozapine rechallenge are inconsistently reported in the literature. Despite this, 69% of case reports detailed a successful rechallenge post CAM; noting limitations associated with reliance on case data. Ensuring published clozapine rechallenge cases report standardised data, including titration speed and monitoring frequencies, is required to guide the development and validation of guidelines for clozapine rechallenge.
Radio Haïti-Inter, Haiti’s most prominent independent radio station and the first station to regularly broadcast news, reportage, and interviews in Haitian Creole, is best known for its investigative journalism, political analysis, and pro-democracy activism under its famous director, Jean Léopold Dominique. But Radio Haiti was also a place where artists of all kinds, especially literary writers, presented, discussed, and declaimed their work to a wide public over the airwaves. In fact, there is no clear line between Radio Haiti’s political content and its literary content. Many of Radio Haiti’s journalists, including Dominique himself and his daughter, novelist Jan J. Dominique, were also literary writers. A literary sensibility suffused much of their content; discussing art or literature allowed them to talk about the country’s social and political situation in a hostile realm; and much of the literary work contains implicit or explicit political meaning. Creating a platform that allowed a wider audience to experience literary works through programs like Radio Haiti’s “Entre Nous” was a political, revolutionary act.
We investigated older children’s (7–12 years) ability to comprehend before and after sentences. Results found that three factors that influence pre-school aged children’s learning of these words continues to influence older children’s comprehension. Specifically, children’s accuracy is improved when the events can be naturally (vs. arbitrarily) ordered; when the clauses in the sentence iconically match (vs. mismatch) the order of the events in the world; and when sentences use before (vs. after). The first two factors are argued to directly facilitate the building of mental models while the last one does so indirectly because of patterns of input usage.
Chapter 19 opens by asking readers to reflect on prior collaborations, writing down their views on what makes people easy to work with and what makes them hard to work with. The chapter argues for a team-based approach to public engagement, and suggests ways to build effective teams. Also, it’s important to trust our partners at informal learning venues, as they have expertise on the audiences and logistics in these settings. Emphasizing that communication with these partners is still a conversation, the chapter returns to the principles of a successful conversation described in Chapter 3 and unpacks each one with reference to venue partners. A case study exemplifies these points, describing a partnership between university students and faculty and museum professionals. Details are given of negotiation about institutional missions and daily operations through to a demonstration on children’s science practices in a game about vowel sounds. This chapter’s Closing Worksheet asks readers to make a detailed plan for getting their demonstration into a specific place or event.
Chapter 8 opens by asking readers to reflect on the attributes of someone who they find trustworthy and believable. It then describes three attributes that Aristotle described for credible people: practical intelligence, virtuous character, and goodwill. Modern research on people’s perceptions of scientific sources finds similar attributes: expertise, integrity, and benevolence. The chapter reviews ways that science communicators can show these attributes. For example, we need to understand the phenomenon we’re sharing; we need to be honest, which can include saying "I don’t know" when applicable; and we need to be respectful. Being clear is a sign of respect for our conversational partners, as is sincere listening. This chapter returns to a comparison of the deficit model and funds of knowledge approaches before discussing ways to handle opinions that contradict the scientific consensus or that are in some way offensive. The Worked Example concerns stereotypes. This chapter’s Closing Worksheet asks readers to identify three things about their demonstrations that they are confident about and three things that they do not know related to their demonstrations.
Emphasizing preparing for a range of different audiences, Chapter 17 opens by asking readers to think about who might respond particularly well to the demonstrations that they are developing. The chapter contrasts audiences in informal learning settings and elsewhere. For the former, it’s important to have a pitch that is friendly and enthusiastic, and to be clear that your activities are free for everyone. Strategies for increased inclusivity are suggested. Summarizing some guiding principles, the chapter returns to the strands of science learning in the context of knowing your goals; considering how given and new vary across people, and planning ahead are also emphasized. Concerning applied audiences such as teachers or lawyers or policy makers and academic audiences, the principle that incomplete is not incorrect is again stressed. With all kinds of audiences, practice is paramount. The Worked Example uses a demonstration with George Bernard Shaw’s "ghoti" spelling, adjusting the spin for several different audiences.
Chapter 16 opens by asking readers to identify the elements in their developing demonstrations that are in good shape and those that still need work. The chapter organizes such elements by analogy to a three-legged stool: One leg is a demonstration’s materials; another is a comprehensive plan; the third is the person doing the demonstration. Discussion of materials emphasizes practical considerations such as visual or manipulable items that are exciting, portability, backups, links to core points, and even duct tape. Discussion of plans emphasizes clarity on the demonstration’s goals, knowing how to use the materials, and having a stock of juicy questions; detailed plans make it easier to be flexible in the face of surprises. Discussion of the person emphasizes how people are crucial to cooperative conversations, how they make the materials more interesting and more entertaining, how their questions guide other people’s learning, and how they represent their fields. This chapter’s Closing Worksheet asks readers to write demonstration guidelines modeled in the Worked Example about a demonstration using dinosaurs to compare human language to other forms of communication.
Chapter 9 opens with an overly detailed recipe for lentil soup that readers remove steps from. Many people new to public engagement express concern about "dumbing down" their science, for example by leaving out critical nuance. The chapter discusses examples like the recipe exercise, in which some details are omitted without compromising truth. In these examples, fewer details effectively enhance clarity. Three suggestions for balancing the Maxim of Quality (tell the truth) with the Maxim of Quantity (say as much as you need but not more) are: to distinguish phenomena from explanations, to distinguish classics from hot news, and to emphasize process. Readers are encouraged to take the long view, thinking of every science conversation as contributing a little to someone’s learning. If nothing else, a demonstration that generates people’s interest and excitement is likely to inspire them to learn more later. This chapter’s Closing Worksheet asks readers to go through the explanations in their demonstrations and to keep cutting out 10 percent until they are left with a reasonable description of the phenomenon and a one-sentence take-home message.
Chapter 13 opens by asking readers to look at a bubble chart showing numbers of native speakers of various languages, then to describe the figure in words, and finally to compare these visual and verbal ways of conveying information about speakers. The chapter encourages demonstrations that start with memorable and fun examples, emphasizing that the free-choice setting means people can walk away if they are not immediately intrigued. Again, research articles can be mined for classic phenomena. The chapter also exemplifies several ways of giving people something to talk about: Using one’s own body can launch demonstrations of speech articulation. Special hardware or software can launch demonstrations of speech acoustics. Video such as fMRI of arias and beatboxing can catch people’s attention and start the desired conversations. Pictures and objects that can be handled, as well as games and puzzles such as tongue twisters, are a rich ground for juicy questions. The Worked Example shows different ways to build a demonstration with the Stroop task, interactive with low-tech or high-tech support. Giveaway materials are also emphasized as making a demonstration memorable and fun.
Chapter 2 opens by asking readers to reflect on strengths and weaknesses of experts of their choice and then to consider overlap between their own strengths and weaknesses and those of these experts. Variation in personalities and styles is useful in public engagement because we meet many different kinds of people in informal learning venues. The chapter thus encourages readers to be themselves as they talk about their science. Genuine passion combines well with any level of expertise. Further, saying "I don’t know" when you reach the edge of your expertise shows your conversational partners that you are honest. A demonstration of counting in different sign languages exemplifies these concepts. This chapter also encourages a growth mindset so that both success and failure during public engagement contribute to improved skills. This chapter’s Closing Worksheet asks readers to choose the topic area that they’ll develop into a demonstration through activities later in the book.
Chapter 10 opens by asking readers to choose two kinds of people they might encounter in informal learning settings and to identify questions those people might have about their general topic and about their specific activity. Returning to the fact that a successful conversation is cooperative, this chapter emphasizes asking questions and listening. Asking questions of an audience gives the expert substantive information to listen to. Sets of questions give people choice, and the sets can include questions about explanations of the phenomena being shown. A "juicy question," for example, is one that nonexperts can address by using the materials/examples at hand – in effect, encouraging scientific reasoning. Giving people time to answer questions and then listening carefully as they do so shows respect, as does asking new questions that reflect people’s earlier responses. Readers are cautioned to avoid testing their audience or to feel that they themselves are being tested. The Worked Example finds juicy questions in a map-based demonstration of variation in regional dialects.
Chapter 11 opens by asking readers to imagine what different kinds of people likely know and don’t know. For example, everyone knows that things fall when you drop them. But details of social etiquette and childhood memories will vary across people. This exercise relates to the Maxim of Manner, which focuses on brevity, clarity, and orderliness for contributions to successful conversations. Information structure is central here: Learning is enhanced when learners meet given or familiar information before new or unfamiliar information. In other words, we build on what we already know. One reason that this point is critical to public engagement is that we compute meaning for words and sentences as we hear/read them. The Worked Example uses a demonstration in which we write people’s names in the International Phonetic Alphabet to compare two orders for presenting critical information. This chapter’s Closing Worksheet asks readers to write down an ideal interaction they want with the demonstrations they are developing and then to change the order of the elements around.
Chapter 4 opens by asking readers to compare learning in formal and free-choice situations. This proceeds to a core goal of conversations for public engagement, which is to make our exchanges interesting enough that people want to talk with us. This chapter compares two approaches to teaching and learning: A deficit model approach assumes that the learner is in some sense empty or flawed, while the funds of knowledge approach assumes that the learner has a rich base of relevant prior knowledge. The latter approach is encouraged so that a science demonstration begins by probing an audience’s interests and then using that as a hook and an organizing principle. Six strands of science learning are introduced, with emphasis on the strand referring to a learner’s interest and excitement. Practical considerations include recognizing that no single science demonstration is likely to hit all strands equally well. The Worked Example shows this with detailed comments on a demonstration of language lateralization. Because public engagement often occurs in free-choice situations, getting and keeping an audience’s interest is critical.
Chapter 5 opens by asking readers to consider the audience in an informal learning venue. What might those people want from the demonstration that a reader is developing, and what might be most appealing about it? The ideal conversation considers both where the expert, regardless of level, is coming from and where the audience, regardless of goals, is coming from. Brief description of goals that such audiences might have refers to a study of science center visitors. The study identified people looking to feed their general curiosity, people looking to learn about a specific topic, people helping others learn (such as parents or teachers), and people looking for new and fun experiences. Readers are encouraged to look for and embrace these and other differences in whatever public they interact with, which differences can reflect types of venues and local populations. Discussion of two demonstrations exemplifies these points. One demonstration is on the linguistic elements in dinosaur names, and the other is on stressed syllables in Spanish. The chapter also tackles exclusion, as when a museum is unaffordable or signage is monolingual.
Chapter 1 introduces the book’s structure and emphases, noting what is and is not directly addressed. It links successful science communication to two critical lessons from the language sciences and motivates the need for public engagement by experts in the language sciences. One lesson concerns cooperative conversations in which all parties listen to and learn from each other. Another lesson concerns information structure where familiar (given) information precedes unfamiliar (new) information. This chapter also highlights free choice and diversity of audience while defining and exemplifying informal learning venues, and it asks readers to consider their expectations for working in such venues. Also included are suggestions for the use of each chapter’s opening and closing worksheets: The opening worksheets are designed to encourage individual and personal reflection, and the closing worksheets are designed to help readers develop interactive and engaging demonstrations of their own topic areas. This chapter’s Worked Example introduces the book’s authors, their research and teaching areas, the kinds of public engagement they have done, and their reasons for doing this work.
Chapter 3 opens by asking readers to recall a problematic conversation like an argument. It reviews what the language sciences have learned about what people expect when going into conversations, what makes conversations go horribly wrong, and what makes them run beautifully. The chapter emphasizes four principles of a successful conversation: The Maxim of Quality is described as a rule to tell the truth. This rule relates to people’s conversational expectations, as well as to our credibility as experts. The Maxim of Quantity is described as a rule to say as much as you need to but not more. This rule relates to respect because adjusting how much we share to what our listeners already know requires finding out about them. The Maxim of Relevance is described as a rule to stick to the point. This also relates to respect because adjusting what we share to what our listeners want to know also requires finding out about them. The Maxim of Manner is described as a rule to be clear. This relates to both style and substance, again emphasizing adjustments for our audiences. This chapter’s Worked Example shows how an airport staff morale problem stemmed from violated maxims.