A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

<p>Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.</p> <p>Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.</p> <p>Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.</p> <p>Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.</p&gt

Design and Performance of the Wide-Field X-Ray Monitor on Board the High-Energy Transient Explorer 2

The Wide-field X-ray Monitor (WXM) is one of the scientific instruments carried on the High Energy Transient Explorer 2 (HETE-2) satellite launched on 2000 October 9. HETE-2 is an international mission consisting of a small satellite dedicated to provide broad-band observations and accurate localizations of gamma-ray bursts (GRBs). A unique feature of this mission is its capability to determine and transmit GRB coordinates in almost real-time through the burst alert network. The WXM consists of three elements: four identical Xe-filled one-dimensional position-sensitive proportional counters, two sets of one-dimensional coded apertures, and the main electronics. The WXM counters are sensitive to X-rays between 2 keV and 25 keV within a field-of-view of about 1.5 sr, with a total detector area of about 350 cm$^2$. The in-flight triggering and localization capability can produce a real-time GRB location of several to 30 arcmin accuracy, with a limiting sensitivity of $10^{-7}$ erg cm$^{-2}$. In this report, the details of the mechanical structure, electronics, on-board software, ground and in-flight calibration, and in-flight performance of the WXM are discussed.Comment: 28 pages, 24 figure

Global Characteristics of X-Ray Flashes and X-Ray-Rich GRBs Observed by HETE-2

We describe and discuss the global properties of 45 gamma-ray bursts (GRBs) observed by HETE-2 during the first three years of its mission, focusing on the properties of X-Ray Flashes (XRFs) and X-ray-rich GRBs (XRRs). We find that the numbers of XRFs, XRRs, and GRBs are comparable. We find that the durations and the sky distributions of XRFs and XRRs are similar to those of GRBs. We also find that the spectral properties of XRFs and XRRs are similar to those of GRBs, except that the values of the peak energy $E^{\rm obs}_{\rm peak}$ of the burst spectrum in $\nu F_\nu$, the peak energy flux \Fp, and the energy fluence $S_E$ of XRFs are much smaller -- and those of XRRs are smaller -- than those of GRBs. Finally, we find that the distributions of all three kinds of bursts form a continuum in the [$S_E$(2-30 keV),$S_E$(30-400) keV]-plane, the [$S_E$(2-400 keV), $E_{\rm peak}$]-plane, and the [$F_{\rm peak}$(50-300 keV), $E_{\rm peak}$]-plane. These results provide strong evidence that all three kinds of bursts arise from the same phenomenon.Comment: 33 pages, 15 figures, submitted to Ap

The social cognition of medical knowledge, with special reference to childhood epilepsy

This paper arose out of an engagement in medical communication courses at a Gulf university. It deploys a theoretical framework derived from a (critical) sociocognitive approach to discourse analysis in order to investigate three aspects of medical discourse relating to childhood epilepsy: the cognitive processes that are entailed in relating different types of medical knowledge to their communicative context; the types of medical knowledge that are constituted in the three different text types analysed; and the relationship between these different types of medical knowledge and the discursive features of each text type. The paper argues that there is a cognitive dimension to the human experience of understanding and talking about one specialized from of medical knowledge. It recommends that texts be studied in medical communication courses not just in terms of their discrete formal features but also critically, in terms of the knowledge which they produce, transmit and reproduce

HETE Observations of the Gamma-Ray Burst GRB030329: Evidence for an Underlying Soft X-ray Component

An exceptionally intense gamma-ray burst, GRB030329, was detected and localized by the instruments on board the High Energy Transient Explorer satellite (HETE) at 11:37:14 UT on 29 March 2003. The burst consisted of two \~10s pulses of roughly equal brightness and an X-ray tail lasting >100s. The energy fluence in the 30-400 keV energy band was 1.08e-4 erg/cm2, making GRB030329 one of the brightest GRBs ever detected. Communication of a 2 arcmin error box 73 minutes after the burst allowed the rapid detection of a counterpart in the optical, X-ray, radio and the ensuing discovery of a supernova with most unusual characteristics. Analyses of the burst lightcurves reveal the presence of a distinct, bright, soft X-ray component underlying the main GRB: the 2-10 keV fluence of this component is ~7e-6 erg/cm2. The main pulses of GRB030329 were preceded by two soft, faint, non-thermal bumps. We present details of the HETE observations of GRB030329.Comment: 22 pages, 5 figures, to be published in ApJ 617, no. 2 (10 December 2004). Referee comments have been incorporated; results of improved spectral analysis are include

HETE-2 Observation of two gamma-ray bursts at z > 3

GRB 020124 and GRB 030323 constitute half the sample of gamma-ray bursts with a measured redshift greater than 3. This paper presents the temporal and spectral properties of these two gamma-ray bursts detected and localized with HETE-2. While they have nearly identical redshifts (z=3.20 for GRB 020124, and z=3.37 for GRB 030323), these two GRBs span about an order of magnitude in fluence, thus sampling distinct regions of the GRB luminosity function. The properties of these two bursts are compared with those of the bulk of the GRB population detected by HETE-2. We also discuss the energetics of GRB 020124 and GRB 030323 and show that they are compatible with the Epeak - Eiso relation discovered by Amati et al. (2002). Finally, we compute the maximum redshifts at which these bursts could have been detected by HETE-2 and we address various issues connected with the detection and localization of high-z GRBs.Comment: 19 pages, 4 figures, submitted to Ap

Full potential LAPW calculation of electron momentum density and related properties of Li

Electron momentum density and Compton profiles in Lithium along $$,$$, and $$ directions are calculated using Full-Potential Linear Augmented Plane Wave basis within generalized gradient approximation. The profiles have been corrected for correlations with Lam-Platzman formulation using self-consistent charge density. The first and second derivatives of Compton profiles are studied to investigate the Fermi surface breaks. Decent agreement is observed between recent experimental and our calculated values. Our values for the derivatives are found to be in better agreement with experiments than earlier theoretical results. Two-photon momentum density and one- and two-dimensional angular correlation of positron annihilation radiation are also calculated within the same formalism and including the electron-positron enhancement factor.Comment: 11 pages, 7 figures TO appear in Physical Review