Bioethics: Using Its Historical and Social Context

History of Scienc

Improving Global Knowledge Exchange for Mental Health Systems Improvement

Policymakers globally are paying increasing attention to the challenges of providing more accessible and integrated mental health care. For transformative change to take place, thought needs to be given to the structure and form of evidence-informed change strategies at all levels: individual, organizational, community and complex, large systems. Yet few frameworks specifically consider the transfer of evidence-based programs across jurisdictions at regional and national levels; most are focused on local service implementation. This paper examines how a specific analytical model developed to assess and develop Knowledge Exchange (KE) can be applied to regional and national KE initiatives.  It specifically examines the efforts of the International Knowledge Exchange Network for Mental Health (IKEN-MH), and the associated community of interest on change and improvement, to support mental health systems change at these levels. Using a theoretical model, the Promoting Action on Research Implementation in Health Services framework (Kitson, Harvey, & McCormack, 1998, Rycroft-Malone, et al., 2002), we explore systems change efforts according to the constructs of evidence, context and facilitation. By matching some exemplars in the use of KE for mental health best practice against this model, the potential strategies of the IKEN-MH to assist transformational change emerge

Improving Global Knowledge Exchange for Mental Health Systems Improvement

Policymakers globally are paying increasing attention to the challenges of providing more accessible and integrated mental health care. For transformative change to take place, thought needs to be given to the structure and form of evidence-informed change strategies at all levels: individual, organizational, community and complex, large systems. Yet few frameworks specifically consider the transfer of evidence-based programs across jurisdictions at regional and national levels; most are focused on local service implementation. This paper examines how a specific analytical model developed to assess and develop Knowledge Exchange (KE) can be applied to regional and national KE initiatives.  It specifically examines the efforts of the International Knowledge Exchange Network for Mental Health (IKEN-MH), and the associated community of interest on change and improvement, to support mental health systems change at these levels. Using a theoretical model, the Promoting Action on Research Implementation in Health Services framework (Kitson, Harvey, & McCormack, 1998, Rycroft-Malone, et al., 2002), we explore systems change efforts according to the constructs of evidence, context and facilitation. By matching some exemplars in the use of KE for mental health best practice against this model, the potential strategies of the IKEN-MH to assist transformational change emerge

One Year Out: An Assessment of DADT Repeal’s Impact on Military Readiness

Prior to the repeal of “don’t ask, don’t tell” (DADT) on September 20, 2011, many observers predicted that allowing lesbian, gay and bisexual (LGB) troops to serve openly would harm the military. This study is the first scholarly effort to assess the accuracy of such predictions about the impact of DADT repeal on military readiness. Our conclusions are based on a consideration of all of the evidence that was available to us at the time our research was conducted, the half- year period starting six months after repeal and concluding at the one-year mark. We sought to maximize the likelihood of identifying evidence of damage caused by repeal by pursuing ten separate research strategies, each of which was designed to uncover data indicating that repeal has undermined the military. Our research strategies included outreach to 553 generals and admirals who predicted that repeal would undermine the military, to all major activists and expert opponents of DADT repeal and to 18 watchdog organizations, including opponents and advocates of repeal, who are known for their ability to monitor Pentagon operations. In addition, we conducted in-depth interviews with 18 scholars and practitioners and 62 active-duty heterosexual, lesbian, gay and bisexual troops from every service branch, as well as on-site field observations of four military units. We analyzed relevant media articles published during the research period, administered two surveys and conducted secondary source analysis of surveys independently administered by outside organizations. Our vigorous effort to collect data from opponents of DADT repeal, including anti-repeal generals and admirals, activists, academic experts, service members and watchdog organizations, should sustain confidence in the validity and impartiality of our findings. Our study team includes distinguished scholars from the US Military Academy, US Air Force Academy, US Naval Academy and US Marine Corps War College, as well as scholars with internationally recognized expertise on the issue of gays in the military. Several members advised the Pentagon’s 2010 DADT working group, and one member led the team that drafted the Defense Department’s plan for implementing DADT repeal

Mental Health Response in Haiti in the Aftermath of the 2010 Earthquake: A Case Study for Building Long-Term Solutions

Significant challenges exist in providing safe, effective, and culturally sound mental health and psychosocial services when an unforeseen disaster strikes in a low-resource setting. We present here a case study describing the experience of a transnational team in expanding mental health and psychosocial services delivered by two health care organizations, one local (Zanmi Lasante) and one international (Partners in Health), acting collaboratively as part of the emergency response to the 2010 Haiti earthquake. In the year and a half following the earthquake, Zanmi Lasante and Partners in Health provided 20,000 documented individual and group appointments for mental health and psychosocial needs. During the delivery of disaster response services, the collaboration led to the development of a model to guide the expansion and scaling up of community-based mental health services in the Zanmi Lasante health care system over the long-term, with potential for broader scale-up in Haiti. This model identifies key skill packages and implementation rules for developing evidence-based pathways and algorithms for treating common mental disorders. Throughout the collaboration, efforts were made to coordinate planning with multiple organizations interested in supporting the development of mental health programs following the disaster, including national governmental bodies, nongovernmental organizations, universities, foreign academic medical centers, and corporations. The collaborative interventions are framed here in terms of four overarching categories of action: direct service delivery, research, training, and advocacy. This case study exemplifies the role of psychiatrists working in low-resource settings as public health program implementers and as members of multidisciplinary teams. (Harv Rev Psychiatry 2012;20:68–77.

The Ups and Downs in Women's Employment: Shifting Composition or Behavior from 1970 to 2010?

This paper tracks factors contributing to the ups and downs in women’s employment from 1970 to 2010 using regression decompositions focusing on whether changes are due to shifts in the means (composition of women) or due to shifts in coefficients (inclinations of women to work for pay). Compositional shifts in education exerted a positive effect on women’s employment across all decades, while shifts in the composition of other family income, particularly at the highest deciles, depressed married women’s employment over the 1990s contributing to the slowdown in this decade. A positive coefficient effect of education was found in all decades, except the 1990s, when the effect was negative, depressing women’s employment. Further, positive coefficient results for other family income at the highest deciles bolstered married women’s employment over the 1990s. Models are run separately for married and single women demonstrating the varying results of other family income by marital status. This research was supported in part by an Upjohn Institute Early Career Research Award

Endothelium-Derived Netrin-4 Supports Pancreatic Epithelial Cell Adhesion and Differentiation through Integrins α2β1 and α3β1

BACKGROUND: Netrins have been extensively studied in the developing central nervous system as pathfinding guidance cues, and more recently in non-neural tissues where they mediate cell adhesion, migration and differentiation. Netrin-4, a distant relative of Netrins 1-3, has been proposed to affect cell fate determination in developing epithelia, though receptors mediating these functions have yet to be identified. METHODOLOGY/PRINCIPAL FINDINGS: Using human embryonic pancreatic cells as a model of developing epithelium, here we report that Netrin-4 is abundantly expressed in vascular endothelial cells and pancreatic ductal cells, and supports epithelial cell adhesion through integrins α2β1 and α3β1. Interestingly, we find that Netrin-4 recognition by embryonic pancreatic cells through integrins α2β1 and α3β1 promotes insulin and glucagon gene expression. In addition, full genome microarray analysis revealed that fetal pancreatic cell adhesion to Netrin-4 causes a prominent down-regulation of cyclins and up-regulation of negative regulators of the cell cycle. Consistent with these results, a number of other genes whose activities have been linked to developmental decisions and/or cellular differentiation are up-regulated. CONCLUSIONS/SIGNIFICANCE: Given the recognized function of blood vessels in epithelial tissue morphogenesis, our results provide a mechanism by which endothelial-derived Netrin-4 may function as a pro-differentiation cue for adjacent developing pancreatic cell populations expressing adhesion receptors α2β1 and α3β1 integrins

Practical counseling in the schools

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