“Someone’s got to do it” – Primary care providers (PCPs) describe caring for rural women with mental health problems

Objective: Little is known about how primary care providers (PCPs) approach mental health care for low-income rural women. We developed a qualitative research study to explore the attitudes and practices of PCPs regarding the care of mood and anxiety disorders in rural women. Method: We conducted semi-structured interviews with 19 family physicians, internists, and obstetrician-gynecologists (OBGYNs) in office-based practices in rural central Pennsylvania. Using thematic analysis, investigators developed a coding scheme. Questions focused on 1) screening and diagnosis of mental health conditions, 2) barriers to treatment among rural women, 3) management of mental illnesses in rural women, and 4) ideas to improve care for this population. Results: PCP responses reflected these themes: 1) PCPs identify mental illnesses through several mechanisms including routine screening, indicator-based assessment, and self-identification by the patient; 2) Rural culture and social ecology are significant barriers to women in need of mental healthcare; 3) Mental healthcare resource limitations in rural communities lead PCPs to seek creative solutions to care for rural women with mental illnesses; 4) To improve mental healthcare in rural communities, both social norms and resource limitations must be addressed. Conclusion: Our findings can inform future interventions to improve women\u27s mental healthcare in rural communities. Ideas include promoting generalist education in mental healthcare, and expanding access to consultative networks. In addition, community programs to reduce the stigma of mental illnesses in rural communities may promote healthcare seeking and receptiveness to treatment

METHOD TO PREVENT SULFUR ACCUMULATION INSIDE MEMBRANE ELECTRODE ASSEMBLY

HyS is conceptually the simplest of the thermochemical cycles and involves only sulfur chemistry. In the HyS Cycle hydrogen gas (H{sub 2}) is produced at the cathode of the electrochemical cell (or electrolyzer). Sulfur dioxide (SO{sub 2}) is oxidized at the anode to form sulfuric acid (H{sub 2}SO{sub 4}) and protons (H{sup +}) as illustrated below. A separate high temperature reaction decomposes the sulfuric acid to water and sulfur dioxide which are recycled to the electrolyzers, and oxygen which is separated out as a secondary product. The electrolyzer includes a membrane that will allow hydrogen ions to pass through but block the flow of hydrogen gas. The membrane is also intended to prevent other chemical species from migrating between electrodes and undergoing undesired reactions that could poison the cathode or reduce overall process efficiency. In conventional water electrolysis, water is oxidized at the anode to produce protons and oxygen. The standard cell potential for conventional water electrolysis is 1.23 volts at 25 C. However, commercial electrolyzers typically require higher voltages ranging from 1.8 V to 2.6 V [Kirk-Othmer, 1991]. The oxidation of sulfur dioxide instead of water in the HyS electrolyzer occurs at a much lower potential. For example, the standard cell potential for sulfur dioxide oxidation at 25 C in 50 wt % sulfuric acid is 0.29 V [Westinghouse, 1980]. Since power consumption by the electrolyzers is equal to voltage times current, and current is proportional to hydrogen production, a large reduction in voltage results in a large reduction in electrical power cost per unit of hydrogen generated

Limits on a Composite Higgs Boson

Precision electroweak data are generally believed to constrain the Higgs boson mass to lie below approximately 190 GeV at 95% confidence level. The standard Higgs model is, however, trivial and can only be an effective field theory valid below some high energy scale characteristic of the underlying non-trivial physics. Corrections to the custodial isospin violating parameter T arising from interactions at this higher energy scale dramatically enlarge the allowed range of Higgs mass. We perform a fit to precision electroweak data and determine the region in the (m_H, Delta T) plane that is consistent with experimental results. Overlaying the estimated size of corrections to T arising from the underlying dynamics, we find that a Higgs mass up to 500 GeV is allowed. We review two composite Higgs models which can realize the possibility of a phenomenologically acceptable heavy Higgs boson. We comment on the potential of improvements in the measurements of m_t and M_W to improve constraints on composite Higgs models.Comment: 9 pages, 2 eps figures. Shortened for PRL; some references elminate

Selective Serotonin Reuptake Inhibitors and Associated Bleeding Risks: A Narrative and Clinical Review.

Major Depressive Disorder (MDD) is a major cause of disability worldwide and is associated with serious lasting impairment. A leading hypothesis of the pathophysiology of MDD is the monoamine deficiency hypothesis which suggests that depression is caused by depletion of serotonin, norepinephrine, or dopamine in the central nervous system. Serotonin is the most widely studied neurotransmitter in the pathophysiology of depression, with studies showing that reduced central serotonin synthesis leads to depressive symptoms in individuals at risk for depression. Selective Serotonin Reuptake Inhibitors (SSRI) inhibit serotonin reuptake and subsequently increase the amount of serotonin available in synapses. Common side effects of SSRIs include increased suicidality of patients under the age of 25, sexual dysfunction, anxiety, dizziness, weight gain, gastrointestinal distress, and headache. Other side effects include prolonging the QT interval, coagulopathy, and the risk of serotonin syndrome, as well as SSRI discontinuation syndrome. Sites of increased bleeding related to SSRI use have been reported to occur in the upper gastrointestinal tract, as well as intracranially. Based on the current literature, three studies have found that SSRIs are not associated with increased bleeding and/or increased perioperative risk, while others have demonstrated that SSRIs are associated with an increased risk in perioperative use. The inhibition of serotonin reuptake can affect platelet aggregation since platelets also express the serotonin transporter. SSRIs can result in decreased storage of serotonin in platelet dense granules. Increased serotonin can also increase gastric acid secretion, which increases the risk for ulceration. SSRIs in combination with NSAIDs also show a significantly increased risk of upper GI bleeding. Some studies show an increased bleeding risk from 30% to 70% when taking a combination of vitamin K antagonists and SSRIs in hospitalized patients. Related to the high prevalence of conditions that are treated with SSRIs, the bleeding risk associated with this class of medication merits further study

Higgs-Boson Mass Limits and Precise Measurements beyond the Standard Model

The triviality and vacuum stability bounds on the Higgs-boson mass (\mh) were revisited in presence of weakly-coupled new interactions parameterized in a model-independent way by effective operators of dimension 6. The constraints from precision tests of the Standard Model were taken into account. It was shown that for the scale of new physics in the region \Lambda \simeq 2 \div 50 \tev the Standard Model triviality upper bound remains unmodified whereas it is natural to expect that the lower bound derived from the requirement of vacuum stability is substantially modified depending on the scale \La and strength of coefficients of effective operators. A natural generalization of the standard triviality condition leads also to a substantial reduction of the allowed region in the (\Lambda,\mh) space.Comment: 18 pages 3 eps figures. The discussion in the appendix was modified slightly and some typographical errors were correcte

A Universal Phase Diagram for PMN-xPT and PZN-xPT

The phase diagram of the Pb(Mg1/3Nb2/3)O3 and PbTiO3 solid solution (PMN-xPT) indicates a rhombohedral ground state for x < 0.32. X-ray powder measurements by Dkhil et al. show a rhombohedrally split (222) Bragg peak for PMN-10%PT at 80 K. Remarkably, neutron data taken on a single crystal of the same compound with comparable q-resolution reveal a single resolution-limited (111) peak down to 50 K, and thus no rhombohedral distortion. Our results suggest that the structure of the outer layer of these relaxors differs from that of the bulk, which is nearly cubic, as observed in PZN by Xu et al.Comment: Replaced Fig. 3 with better versio

Rimegepant for the treatment of migraine.

Migraine is a common form of primary headache, affecting up to 1 in every 6 Americans. The pathophysiology is an intricate interplay of genetic factors and environmental influence and is still being elucidated in ongoing studies. The trigeminovascular system is now known to have a significant role in the initiation of migraines, including the release of pain mediators such as CGRP and substance P. Traditional treatment of migraine is usually divided into acute and preventive treatment. Acute therapy includes non-specific therapy, such as NSAIDs and other analgesics, which may provide relief in mild to moderate migraines. 5-HT1 agonists may provide relief in severe migraine, but are not universally effective and carry a significant side-effect profile with frequent redosing requirement. Prophylactic therapy may reduce the occurrence of acute migraine attacks in selected patients, but does not completely eliminate it. More recently, CGRP antagonism has been studied and shown to be effective in both abortion and prevention of migraine. Novel medications, targeting CGRP, divide into CGRP antibodies and receptor antagonists (gepants). Rimegepant, a second-generation gepant, has shown efficacy in several clinical trials in treating acute migraine. Ongoing trials are also evaluating its role in migraine prophylaxis, and results are promising. It is also generally safer for use than existing options, does not appear to increase the chance of developing chronic migraines, and carries a very tolerable side effects profile. It is a part of a growing arsenal in migraine treatment, and may present the silver bullet for treatment of this disease

Colorectal cancer linkage on chromosomes 4q21, 8q13, 12q24, and 15q22

A substantial proportion of familial colorectal cancer (CRC) is not a consequence of known susceptibility loci, such as mismatch repair (MMR) genes, supporting the existence of additional loci. To identify novel CRC loci, we conducted a genome-wide linkage scan in 356 white families with no evidence of defective MMR (i.e., no loss of tumor expression of MMR proteins, no microsatellite instability (MSI)-high tumors, or no evidence of linkage to MMR genes). Families were ascertained via the Colon Cancer Family Registry multi-site NCI-supported consortium (Colon CFR), the City of Hope Comprehensive Cancer Center, and Memorial University of Newfoundland. A total of 1,612 individuals (average 5.0 per family including 2.2 affected) were genotyped using genome-wide single nucleotide polymorphism linkage arrays; parametric and non-parametric linkage analysis used MERLIN in a priori-defined family groups. Five lod scores greater than 3.0 were observed assuming heterogeneity. The greatest were among families with mean age of diagnosis less than 50 years at 4q21.1 (dominant HLOD = 4.51, α = 0.84, 145.40 cM, rs10518142) and among all families at 12q24.32 (dominant HLOD = 3.60, α = 0.48, 285.15 cM, rs952093). Among families with four or more affected individuals and among clinic-based families, a common peak was observed at 15q22.31 (101.40 cM, rs1477798; dominant HLOD = 3.07, α = 0.29; dominant HLOD = 3.03, α = 0.32, respectively). Analysis of families with only two affected individuals yielded a peak at 8q13.2 (recessive HLOD = 3.02, α = 0.51, 132.52 cM, rs1319036). These previously unreported linkage peaks demonstrate the continued utility of family-based data in complex traits and suggest that new CRC risk alleles remain to be elucidated. © 2012 Cicek et al

Paternal obesity is associated with IGF2 hypomethylation in newborns: results from a Newborn Epigenetics Study (NEST) cohort

Data from epidemiological and animal model studies suggest that nutrition during pregnancy may affect the health status of subsequent generations. These transgenerational effects are now being explained by disruptions at the level of the epigenetic machinery. Besides in vitro environmental exposures, the possible impact on the reprogramming of methylation profiles at imprinted genes at a much earlier time point, such as during spermatogenesis or oogenesis, has not previously been considered. In this study, our aim was to determine associations between preconceptional obesity and DNA methylation profiles in the offspring, particularly at the differentially methylated regions (DMRs) of the imprinted Insulin-like Growth Factor 2 (IGF2) gene