Embedding effective depression care: using theory for primary care organisational and systems change

Background: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depressio

Non-detection of previously reported transits of HD 97658b with MOST photometry

The radial velocity-discovered exoplanet HD 97658b was recently announced to transit, with a derived planetary radius of 2.93 \pm 0.28 R_{Earth}. As a transiting super-Earth orbiting a bright star, this planet would make an attractive candidate for additional observations, including studies of its atmospheric properties. We present and analyze follow-up photometric observations of the HD 97658 system acquired with the MOST space telescope. Our results show no transit with the depth and ephemeris reported in the announcement paper. For the same ephemeris, we rule out transits for a planet with radius larger than 2.09 R_{Earth}, corresponding to the reported 3\sigma lower limit. We also report new radial velocity measurements which continue to support the existence of an exoplanet with a period of 9.5 days, and obtain improved orbital parameters.Comment: 16 pages, 4 figures; 1 Table; accepted for publication in ApJL, includes changes made in response to the referee repor

Belonging: A Phenomenological Study of Systemic Racism Experienced Among Black Students in Occupational Therapy Programs

Belonging, a crucial aspect of humanity and justice, is negated by racism. Formal analyses have shown that racial and ethnic minorities experience significantly higher rates of racial discrimination, with the greatest disparity being among Blacks. Incidences of racism toward healthcare professionals of color indicate that comprehensive and unbiased academic content is warranted in occupational therapy education. This study explored the lived experiences of systemic racism among Black occupational therapy students and their preparation to deal with racism and bias within didactic and clinical settings. This study featured a phenomenological design with data collection through semi-structured interviews and focus groups. Transcripts were coded and inductively analyzed using Qualitative Data Analysis (QDA) Miner software, and intercoder agreement was established. Themes were organized using Wilcock\u27s Occupational Perspective of Health (OPH) framework (Doing, Being, Becoming, and Belonging). The results revealed that the prevailing themes that emerged were Anxiety from Lack of Black Representation, Education through Lived Experience, including family, media, and self-education, and Initiating Change as the Diversity Person. Participants’ sense of Belonging was most affected of all the constructs in the OPH. In conclusion, the tapestry of occupational therapy curricula may benefit from incorporating explicit threads addressing the lasting effects of historic and current systemic racism, thus severely limiting students’ awareness and comprehension of occupational injustices. Recommendations are outlined to identify gaps in current occupational therapy curricula and to guide occupational therapy administrators (Chairs/Program Directors) in developing programs that acknowledge, educate, and combat the effects of systemic racism, thereby enhancing the sense of belonging for all

Flexible work design and employee commitment : when socio-demographic characteristics are introduced?

Purpose: In this study, we contribute to the existing literature by examining the relationship between military spending changes and economic growth in China over the period 1995 to 2018 using Granger causality test. We would also explore short and long run relationship between GDP growth and military expenditure of China. Approach/Methodology/Design: Data used in this study are yearly data covering the period of 1995 to 2018 and the variables are Gross Domestic product (GDP) and Military Expenditure (ME). Data were collected from World Bank. GDP is at 2010 constant US prices and ME is expressed as a percentage of economic growth. All variables are transformed into the natural logarithmics to obtain growth effects. Findings: Using causality test, the causal relationship between the variables revealed that the alternative hypothesis should be accepted which is lagged GDP variable (proxy of economic growth) does not cause ME in our first VAR Granger causslity Wald test model. However, we discover and verified that there is one-way causality from economic growth to military spending, but no causality from military spending to economic growth is observed in this study. China’s positive economic growth can finance its military expenditure. Practical Implications: The study will contribute positively to the understanding of influence of GDP on military expenditure for emerging and developed ecconomies. Originality/value: This study innovates by using Cointegration, E-granger and Granger causality test to find out economic growth causing military expenditure in developing economies like China.peer-reviewe

Pathways to Resilience: Enhancing Family Well-Being with a Home Visitation Model

This paper highlights a study that examined outcome measures of a home visitation program, which provided services to first-born children and their parents living in Southwestern New Mexico. Home visitation workers conducted pre/posttest assessments for prenatal and postpartum periods for 109 families. The Revised North Carolina Family Assessment Scale measured family resilience. Paired sample t test and effect size analyses assessed for intervention effects. OLS regression measured effect of increased home visitation services on family well-being. Significant improvements with moderate to large effect sizes were observed for measures of social support, caregiver characteristics, family interaction, and a reduction in personal problems affecting parenting. These preliminary findings suggest that early intervention home visitation programs is an effective and acceptable method to enhance family well-being. Future directions could involve more comprehensive randomized controlled trials to examine the effectiveness of the group intervention. Practice implications are discussed

Pathways to Resilience: Enhancing Family Well-Being with a Home Visitation Model

This paper highlights a study that examined outcome measures of a home visitation program, which provided services to first-born children and their parents living in Southwestern New Mexico. Home visitation workers conducted pre/posttest assessments for prenatal and postpartum periods for 109 families. The Revised North Carolina Family Assessment Scale measured family resilience. Paired sample t test and effect size analyses assessed for intervention effects. OLS regression measured effect of increased home visitation services on family well-being. Significant improvements with moderate to large effect sizes were observed for measures of social support, caregiver characteristics, family interaction, and a reduction in personal problems affecting parenting. These preliminary findings suggest that early intervention home visitation programs is an effective and acceptable method to enhance family well-being. Future directions could involve more comprehensive randomized controlled trials to examine the effectiveness of the group intervention. Practice implications are discussed

Spatio-temporal variation in click production rates of beaked whales : implications for passive acoustic density estimation

T.A.M. was funded under Grant No. N000141010382 from the Office of Naval Research (LATTE project) and thanks support by CEAUL (funded by FCT - Fundação para a Ciência e a Tecnologia, Portugal, through the project UID/MAT/00006/2013). M.P.J. was funded by a Marie Curie Career Integration Grant and M.P.J. and P.L.T. were funded by MASTS (The Marine Alliance for Science and Technology for Scotland, a research pooling initiative funded by the Scottish Funding Council under grant HR09011 and contributing institutions). L.S.H. thanks the BRS Bahamas team that helped collect the Bahamas data, and A. Bocconcelli. D.H. and L.T. were funded by the Office of Naval Research (Award No. N00014-14-1-0394). N.A.S. was funded by an EU-Horizon 2020 Marie Slodowska Curie fellowship (project ECOSOUND). DTAG data in the Canary Islands were collected with funds from the U.S. Office of Naval Research and Fundación Biodiversidad (EU project LIFE INDEMARES) with permit from the Canary Islands and Spanish governments.Passive acoustic monitoring has become an increasingly prevalent tool for estimating density of marine mammals, such as beaked whales, which vocalize often but are difficult to survey visually. Counts of acoustic cues (e.g., vocalizations), when corrected for detection probability, can be translated into animal density estimates by applying an individual cue production rate multiplier. It is essential to understand variation in these rates to avoid biased estimates. The most direct way to measure cue production rate is with animal-mounted acoustic recorders. This study utilized data from sound recording tags deployed on Blainville's (Mesoplodon densirostris, 19 deployments) and Cuvier's (Ziphius cavirostris, 16 deployments) beaked whales, in two locations per species, to explore spatial and temporal variation in click production rates. No spatial or temporal variation was detected within the average click production rate of Blainville's beaked whales when calculated over dive cycles (including silent periods between dives); however, spatial variation was detected when averaged only over vocal periods. Cuvier's beaked whales exhibited significant spatial and temporal variation in click production rates within vocal periods and when silent periods were included. This evidence of variation emphasizes the need to utilize appropriate cue production rates when estimating density from passive acoustic data.PostprintPeer reviewe

Paradoxical activation of the protein kinase-transcription factor ERK5 by ERK5 kinase inhibitors.

The dual protein kinase-transcription factor, ERK5, is an emerging drug target in cancer and inflammation, and small-molecule ERK5 kinase inhibitors have been developed. However, selective ERK5 kinase inhibitors fail to recapitulate ERK5 genetic ablation phenotypes, suggesting kinase-independent functions for ERK5. Here we show that ERK5 kinase inhibitors cause paradoxical activation of ERK5 transcriptional activity mediated through its unique C-terminal transcriptional activation domain (TAD). Using the ERK5 kinase inhibitor, Compound 26 (ERK5-IN-1), as a paradigm, we have developed kinase-active, drug-resistant mutants of ERK5. With these mutants, we show that induction of ERK5 transcriptional activity requires direct binding of the inhibitor to the kinase domain. This in turn promotes conformational changes in the kinase domain that result in nuclear translocation of ERK5 and stimulation of gene transcription. This shows that both the ERK5 kinase and TAD must be considered when assessing the role of ERK5 and the effectiveness of anti-ERK5 therapeutics

Do UK universities communicate their brands effectively through their websites?

This paper attempts to explore the effectiveness of UK universities’ websites. The area of branding in higher education has received increasing academic investigation, but little work has researched how universities demonstrate their brand promises through their websites. The quest to differentiate through branding can be challenging in the university context, however. It is argued that those institutions that have a strong distinctive image will be in a better position to face a changing future. Employing a multistage methodology, the web pages of twenty UK universities were investigated by using a combination of content and multivariable analysis. Results indicated ‘traditional values’ such as teaching and research were often well communicated in terms of online brand but ‘emotional values’ like social responsibility and the universities’ environments were less consistently communicated, despite their increased topicality. It is therefore suggested that emotional values may offer a basis for possible future online differentiation