Facilitating access to voluntary and community services for patients with psychosocial problems: a before-after evaluation

Background: Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs) facilitating access to voluntary and community sector services for patients with psychosocial problems. Methods: Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated. Results: 108 patients consented to take part in the study. At three-month follow-up, 63 (58%) had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%). Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced. Conclusion: Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems

A New Interpretation for the Second Peak of T Coronae Borealis Outbursts: A Tilting Disk around a Very Massive White Dwarf

A new interpretation for the second peak of T Coronae Borealis (T CrB) outbursts is proposed based on a thermonuclear runaway (TNR) model. The system consists of a very massive white dwarf (WD) with a tilting accretion disk and a lobe-filling red-giant. The first peak of the visual light curve of T CrB outbursts is well reproduced by the TNR model on a WD close to the Chandrasekhar mass ($M_{\rm WD} \gtrsim 1.35 ~M_\odot$), while the second peak is reproduced by the combination of the irradiated M-giant and the irradiated tilting disk. The derived fitting parameters are the WD mass $M_{\rm WD} \sim 1.35 ~M_\odot$, the M-giant companion mass $M_{\rm RG} \sim 0.7 M_\odot$ ($0.6-1.0 M_\odot$ is acceptable), the inclination angle of the orbit i \sim 70 \arcdeg, and the tilting angle of the disk i_{\rm prec} \sim 35 \arcdeg. These parameters are consistent with the recently derived binary parameters of T CrB.Comment: 6 pages including 2 figures, to be published in ApJ Letter

Hypothalamic Α 2 -Noradrenergic Receptor System Relation to Dietary, Genetic, and Hormonally Induced Obesity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73970/1/j.1749-6632.1989.tb53313.x.pd

The RET/PTC3 oncogene activates classical NF-κB by stabilizing NIK.

The oncogenic fusion protein RET/PTC3 (RP3) that is expressed in papillary thyroid carcinoma (PTC) and thyroid epithelia in Hashimoto\u27s thyroiditis activates nuclear factor-kappa B (NF-κB) and induces pro-inflammatory gene expression; however, the mechanism of this activation is unknown. To address this, we expressed RP3 in murine embryonic fibroblasts (MEFs) lacking key classical and noncanonical NF-κB signaling components. In wild-type MEFs, RP3 upregulated CCL2, CXCL1, granulocyte-macrophage colony-stimulating factor and tumor necrosis factor expression and activated classical but not noncanonical NF-κB. RP3-activated NF-κB in IκB kinase (IKK)β(-/-) MEFs but not IKKα- or NF-κB essential modulator (NEMO)-deficient cells and activation was inhibited by a peptide that blocks NEMO binding to the IKKs. RP3 increased the levels of NF-κB-inducing kinase (NIK) and did not activate NF-κB in NIK-deficient MEFs. Notably, NIK stabilization was not accompanied by TRAF3 degradation demonstrating that RP3 disrupts normal basal NIK regulation. Dominant-negative NIK blocked RP3-induced NF-κB activation and an RP3 signaling mutant (RP3(Y588F)) did not stabilize NIK. Finally, examination of PTC specimens revealed strong positive staining for NIK. We therefore conclude that RP3 activates classical NF-κB via NIK, NEMO and IKKα. Importantly, our findings reveal a novel mechanism for oncogene-induced NF-κB activation via stabilization of NIK

The 69 ms Radio Pulsar Near the Supernova Remnant RCW 103

We report the detection of the radio pulsar counterpart to the 69 ms X-ray pulsar discovered near the supernova remnant RCW 103 (G332.4-0.4). Our detection confirms that the pulsations arise from a rotation-powered neutron star, which we name PSR J1617-5055. The observed barycentric period derivative confirms that the pulsar has a characteristic age of only 8 kyr, the sixth smallest of all known pulsars. The unusual apparent youth of the pulsar and its proximity to a young remnant requires that an association be considered. Although the respective ages and distances are consistent within substantial uncertainties, the large inferred pulsar transverse velocity is difficult to explain given the observed pulsar velocity distribution, the absence of evidence for a pulsar wind nebula, and the symmetry of the remnant. Rather, we argue that the objects are likely superposed on the sky; this is reasonable given the complex area. Without an association, the question of where is the supernova remnant left behind following the birth of PSR J1617-5055 remains open. We also discuss a possible association between PSR J1617-5055 and the gamma-ray source 2CG 333+01. Though an association is energetically plausible, it is unlikely given that EGRET did not detect 2CG 333+01.Comment: 18 pages, 2 encapsulated Postscript figures, uses AAS LaTeX style files. Accepted for publication in The Astrophysical Journal Letter

U Sco 2010 outburst: a new understanding of the binary accretion disk and the secondary star

We present optical and NIR spectroscopic observations of U Sco 2010 outburst. From the analysis of lines profiles we identify a broad and a narrow component and show that the latter originates from the reforming accretion disk. We show that the accretion resumes shortly after the outburst, on day +8, roughly when the super-soft (SSS) X-ray phase starts. Consequently U Sco SSS phase is fueled (in part or fully) by accretion and should not be used to estimate $m_{\mathrm{rem}}$, the mass of accreted material which has not been ejected during the outburst. In addition, most of the He emission lines, and the HeII lies in particular, form in the accretion flow/disk within the binary and are optically thick, thus preventing an accurate abundance determination. A late spectrum taken in quiescence and during eclipse shows CaII H&K, the G-band and MgI b absorption from the secondary star. However, no other significant secondary star features have been observed at longer wavelengths and in the NIR band.Comment: Accepted for publication on A&A. 12 pages and 12 figures (a few are multiple figures

Asteroseismological Observations of the Central Star of the Planetary Nebula NGC 1501

We report on a global CCD time-series photometric campaign to decode the pulsations of the nucleus of the planetary nebula NGC1501. The star is hot and hydrogen-deficient, similar to the pre-white-dwarf PG 1159 stars. NGC1501 shows pulsational brightness variations of a few percent with periods ranging from 19 to 87 minutes. The variations are very complex, suggesting a pulsation spectrum that requires a long unbroken time series to resolve. Our CCD photometry of the star covers a two-week period in 1991 November, and used a global network of observatories. We obtained nearly continuous coverage over an interval of one week in the middle of the run. We have identified 10 pulsation periods, ranging from 5235 s down to 1154 s. We find strong evidence that the modes are indeed nonradial g-modes. The ratios of the frequencies of the largest-amplitude modes agree with those expected for modes that are trapped by a density discontinuity in the outer layers. We offer a model for the pulsation spectrum that includes a common period spacing of 22.3 s and a rotation period of 1.17 days; the period spacing allows us to assign a seismological mass of 0.55+/-0.03 Msun.Comment: 12 pages, AASTEX, 7 tables, 6 EPS figures, to appear in AJ, 12/96 Corrected version repairs table formatting and adds missing Table

Improvement in IAPT outcomes over time: are they driven by changes in clinical practice?

Treatment outcomes across Improving Access to Psychological Therapies (IAPT) services in England have improved year-on-year, with the national average proportion of patients in recovery at the end of treatment now exceeding the 50% target. This is despite the number of referrals and numbers of treated patients also increasing year-on-year, suggesting that services have evolved local practices and treatment delivery to meet needs whilst improving performance. This study explores whether there have been changes in clinical practice with regard to: (1) the number of sessions and length of treatments; (2) the number of cancellations and non-attendance; and (3) the recording of problem descriptor information, and the association with treatment outcomes in IAPT. Routinely collected data from seven IAPT services involved in the North and Central East London (NCEL) IAPT Service Improvement and Research Network (SIRN) were brought together to form a dataset of nearly 88,000 patients who completed a course of IAPT treatment. Results showed that there was a slight increase in the average number of sessions, and decreases in the length of time in treatment, as well as decreases in both the number of non-attended appointments and the use of inappropriate problem descriptors. These findings highlight a number of areas where potentially small changes to clinical practice may have had positive effects on patient outcomes. The value of using IAPT data to inform service improvement evaluations is discussed