The gender and access to health services study: final report

Men and women frequently think and behave differently. To observe this is not to suggest anything so absurdly simple as that there are only male and female ways of being; behaviours and thought processes vary according to numerous other factors besides gender. That this is very generally the case however, does mean that there are broad - and often broadly predictable - differences in the way men and women engage with the world. Most commercial organisations understand this very well and plan accordingly. Many public authorities recognise it too and take these differences into account when developing and providing services. For historical reasons however the NHS has rarely done so. It is widely known that there are differences between men and women in the incidence and prevalence of most health conditions. Sometimes there are clear biological reasons for these differences but often there are not. Where biology offers little or no enlightenment, other questions need to be asked: · Do men and women behave in ways that predispose them to particular health conditions to different degrees? · Do men and women use health services with different degrees of effectiveness? · Do men and women receive differerent kinds of service from the NHS? The answer is – yes, these things happen frequently. This is sometimes to the disadvantage of one sex and sometimes to the disadvantage of the other. Sometimes it is to the disadvantage of both. And when these things happen, health outcomes are often affected. This report looks at the reasons why gender is such an important and fundamental determinant of health status and considers the ways in which gender inequalities can be tackled within the present legislative and policy framework. It also brings together the knowledge and evidence in relation to six specific areas of health concerns

Championing mental health at work: emerging practice from innovative projects in the UK.

This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based 'business champions' to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the 'business champion' emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments

Complex circular subsidence structures in tephra deposited on large blocks of ice: Varða tuff cone, Öræfajökull, Iceland

Several broadly circular structures up to 16 m in diameter, into which higher strata have sagged and locally collapsed, are present in a tephra outcrop on southwest Öræfajökull, southern Iceland. The tephra was sourced in a nearby basaltic tuff cone at Varða. The structures have not previously been described in tuff cones, and they probably formed by the melting out of large buried blocks of ice emplaced during a preceding jökulhlaup that may have been triggered by a subglacial eruption within the Öræfajökull ice cap. They are named ice-melt subsidence structures, and they are analogous to kettle holes that are commonly found in proglacial sandurs and some lahars sourced in ice-clad volcanoes. The internal structure is better exposed in the Varða examples because of an absence of fluvial infilling and reworking, and erosion of the outcrop to reveal the deeper geometry. The ice-melt subsidence structures at Varða are a proxy for buried ice. They are the only known evidence for a subglacial eruption and associated jökulhlaup that created the ice blocks. The recognition of such structures elsewhere will be useful in reconstructing more complete regional volcanic histories as well as for identifying ice-proximal settings during palaeoenvironmental investigations

A public and patient consultation process as an aid to design a person-centred randomized clinical trial.

BACKGROUND: Involving patients and members of the public, together with researchers, in decisions about how studies are designed and conducted can create a study that is more person-centred. The aim of this consultation process was to explore ways of designing a study which takes the person into consideration for the randomized clinical study entitled 'Biomechanical Effects of Manual Therapy-A Feasibility Study' using the novel approach of usability testing. DESIGN: Patient and public volunteers were sought with experience of low back pain. Volunteers were invited to participate in usability testing (a physical walkthrough) of the proposed study method. This was followed by a discussion of areas where usability testing could not be used, such as recruitment strategies, continuity of participant care and dissemination of results. Resulting feedback was considered by the research team and alterations to the original study method were incorporated, provided the research questions could be answered and were practical within the resources available. RESULTS: Additional recruitment strategies were proposed. Alterations to the study included reduction in study time burden; completion of study paperwork in a quieter location; continuity of participant care after the study; and methods of dissemination of overall study results to participants. CONCLUSION: The consultation process used the unique method of usability testing, together with a post-usability discussion, and resulted in alterations to the future study which may facilitate making it more person-centred. PATIENT AND PUBLIC CONTRIBUTION: Patients and public developed the future study design but did not participate in manuscript preparation

Services just for men? Insights from a national study of the well men services pilots.

Men continue to have a lower life expectancy in most countries compared to women. Explanations of this gendered health inequality tend to focus on male risk taking, unhealthy lifestyle choices and resistance to seeking help from health services. In the period 2005-2008 the Scottish Government funded a nationwide community health promotion programme aimed at improving men's health, called Well Men Service Pilots (henceforth WMS)

A one-shot deviation principle for stability in matching problems

This paper considers marriage problems, roommate problems with nonempty core, and college admissions problems with responsive preferences. All stochastically stable matchings are shown to be contained in the set of matchings which are most robust to one-shot deviation

Hidden, visceral and traumatic: a dramaturgical approach to men talking about their penis after surgery for penile cancer

YesDrawing upon concepts of expressive equipment and body image, the aim of this study is to explore how men diagnosed and treated for penile cancer construct their penis and its surgical disfigurement (penectomy). Using maximum variation sampling with the intention to acquire the broadest range of experiences of stage of disease and treatment, 27 cisgender men (aged 48-83, x=63) who had surgical treatment consented for their data to be archived for analysis. From a dramaturgical perspective, the constructionist thematic analysis explored direct and indirect talk about the penis after surgery. The analysis showed that through graphic and sequential narratives of dismemberment revealed, participants constructed a post-surgery period in which they both wanted and did-not-want to see their penis. Additionally, participants constructed themselves managing difficult emotions through others and seeing themselves being rejected by a potentially desiring (female) Other. The findings extend research on male genitals by showing how the post-surgery penis can function as something hidden but visceral and traumatic when revealed. Importantly, this paper illustrates body image as expressive equipment where body and identity are formed in the image of manhood, which is an intersubjective (sexual) object between self and other.This paper presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0808-17158).Research Development Fund Publication Prize Award winner, October 2019

Discovery of two new super-eruptions from the Yellowstone hotspot track (USA): is the Yellowstone hotspot waning?

Super-eruptions are amongst the most extreme events to affect Earth’s surface, but too few examples are known to assess their global role in crustal processes and environmental impact. We demonstrate a robust approach to recognize them at one of the best-preserved intraplate large igneous provinces, leading to the discovery of two new super-eruptions. Each generated huge and unusually hot pyroclastic density currents that sterilized extensive tracts of Idaho and Nevada in the United States. The ca. 8.99 Ma McMullen Creek eruption was magnitude 8.6, larger than the last two major eruptions at Yellowstone (Wyoming). Its volume exceeds 1700 km3, covering ≥12,000 km2. The ca. 8.72 Ma Grey’s Landing eruption was even larger, at magnitude of 8.8 and volume of ≥2800 km3. It covers ≥23,000 km2 and is the largest and hottest documented eruption from the Yellowstone hotspot. The discoveries show the effectiveness of distinguishing and tracing vast deposit sheets by combining trace-element chemistry and mineral compositions with field and paleomagnetic characterization. This approach should lead to more discoveries and size estimates, here and at other provinces. It has increased the number of known super-eruptions from the Yellowstone hotspot, shows that the temporal framework of the magmatic province needs revision, and suggests that the hotspot may be waning

The Dialectics of Identity of the Modern and Postmodern Art

Ako pojam identiteta shvatimo u hegelijanskom smislu kao iskustvo što ga svijest stječe o sebi, onda se taj pojam nameće kao ključan u razmatranju (vizualne) umjetnosti XX. stoljeća. Prema Hegelu, moderna umjetnost transcendira mogućnost adekvatnog izražavanja svoga duhovnog sadržaja pukom osjetilnom reprezentacijom (koja je kao takvu određuje) te stoga zahtijeva pojmovnu refleksiju. Budući da je umjetnost uvijek i dio stvarnosti i o stvarnosti, propitivanje njezina vlastita pojma ide ruku pod ruku s ontološkom problematikom. Epistemološke promjene koje konstituiraju i modernu i postmodernu odražavaju se tako u dijalektici pojma moderne i postmoderne umjetnosti. Prema nekim autorima ta je dijalektika određena značajnim promjenama u teoriji subjekta, kulturalnim razlikama i tehnologiji.If the notion of identity is considered in the Hegelian sense as the experience of the consciousness about itself, then this notion becomes of key importance in reflecting upon the 20th-century (visual) art. Modern art, in Hegel’s view, transcends the possibility of an adequate expression of its spiritual content by its merely sensuous representation (that defines it as such) and hence calls for a reflection on its notion. Since art has always been both part of and about reality, the questioning of its own notion goes hand in hand with the ontological problematics. The epistemological changes that constitute both Modernism and Postmodernism thus reflect themselves in the dialectics of the notion of modern and postmodern art. According to some authors, such dialectics is determined by important changes which took place in the theory of the subject, in cultural differences as well as in technology

Sprouty2 mediated tuning of signalling is essential for somite myogenesis

Background: Negative regulators of signal transduction cascades play critical roles in controlling different aspects of normal embryonic development. Sprouty2 (Spry2) negatively regulates receptor tyrosine kinases (RTK) and FGF signalling and is important in differentiation, cell migration and proliferation. In vertebrate embryos, Spry2 is expressed in paraxial mesoderm and in forming somites. Expression is maintained in the myotome until late stages of somite differentiation. However, its role and mode of action during somite myogenesis is still unclear. Results: Here, we analysed chick Spry2 expression and showed that it overlaps with that of myogenic regulatory factors MyoD and Mgn. Targeted mis-expression of Spry2 led to inhibition of myogenesis, whilst its C-terminal domain led to an increased number of myogenic cells by stimulating cell proliferation. Conclusions: Spry2 is expressed in somite myotomes and its expression overlaps with myogenic regulatory factors. Overexpression and dominant-negative interference showed that Spry2 plays a crucial role in regulating chick myogenesis by fine tuning of FGF signaling through a negative feedback loop. We also propose that mir-23, mir-27 and mir-128 could be part of the negative feedback loop mechanism. Our analysis is the first to shed some light on in vivo Spry2 function during chick somite myogenesis