Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences.

This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men

Large-scale general practice in England: what can we learn from the literature?

Traditional general practice is changing. Three-quarters of practices are now working collaboratively in larger-scale organisations – albeit with varying degrees of ambition and organisational integration. Policy-makers and practitioners have high hopes for these organisations and their potential to transform services both within primary care and beyond. But can we be confident that they can live up to these expectations? This report presents findings of an extensive literature review on the subject of large-scale general practice, and contributes to a stream of work by the Nuffield Trust in this area, details of which can be found at: www.nuffieldtrust.org.uk/large-scale-general-practice

Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers.

BACKGROUND: Ticagrelor is an oral P2Y12 inhibitor that is used with aspirin to reduce the risk of ischemic events among patients with acute coronary syndromes or previous myocardial infarction. Spontaneous major bleeding and bleeding associated with urgent invasive procedures are concerns with ticagrelor, as with other antiplatelet drugs. The antiplatelet effects of ticagrelor cannot be reversed with platelet transfusion. A rapid-acting reversal agent would be useful. METHODS: In this randomized, double-blind, placebo-controlled, phase 1 trial, we evaluated intravenous PB2452, a monoclonal antibody fragment that binds ticagrelor with high affinity, as a ticagrelor reversal agent. We assessed platelet function in healthy volunteers before and after 48 hours of ticagrelor pretreatment and again after the administration of PB2452 or placebo. Platelet function was assessed with the use of light transmission aggregometry, a point-of-care P2Y12 platelet-reactivity test, and a vasodilator-stimulated phosphoprotein assay. RESULTS: Of the 64 volunteers who underwent randomization, 48 were assigned to receive PB2452 and 16 to receive placebo. After 48 hours of ticagrelor pretreatment, platelet aggregation was suppressed by approximately 80%. PB2452 administered as an initial intravenous bolus followed by a prolonged infusion (8, 12, or 16 hours) was associated with a significantly greater increase in platelet function than placebo, as measured by multiple assays. Ticagrelor reversal occurred within 5 minutes after the initiation of PB2452 and was sustained for more than 20 hours (P\u3c0.001 after Bonferroni adjustment across all time points for all assays). There was no evidence of a rebound in platelet activity after drug cessation. Adverse events related to the trial drug were limited mainly to issues involving the infusion site. CONCLUSIONS: In healthy volunteers, the administration of PB2452, a specific reversal agent for ticagrelor, provided immediate and sustained reversal of the antiplatelet effects of ticagrelor, as measured by multiple assays. (Funded by PhaseBio Pharmaceuticals; ClinicalTrials.gov number, NCT03492385.)

The Legacy of the U. S. Public Health Service Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years after President Clinton's Apology

http://dx.doi.org/10.1080/10508422.2012.73080

Validation for global solar wind prediction using Ulysses comparison: Multiple coronal and heliospheric models installed at the Community Coordinated Modeling Center

The prediction of the background global solar wind is a necessary part of space weather forecasting. Several coronal and heliospheric models have been installed and/or recently upgraded at the Community Coordinated Modeling Center (CCMC), including the Wangâ Sheelyâ Arge (WSA)â Enlil model, MHDâ Aroundâ aâ Sphere (MAS)â Enlil model, Space Weather Modeling Framework (SWMF), and heliospheric tomography using interplanetary scintillation data. Ulysses recorded the last fast latitudinal scan from southern to northern poles in 2007. By comparing the modeling results with Ulysses observations over seven Carrington rotations, we have extended our thirdâ party validation from the previous nearâ Earth solar wind to middle to high latitudes, in the same late declining phase of solar cycle 23. Besides visual comparison, we have quantitatively assessed the models’ capabilities in reproducing the time series, statistics, and latitudinal variations of solar wind parameters for a specific range of model parameter settings, inputs, and grid configurations available at CCMC. The WSAâ Enlil model results vary with three different magnetogram inputs. The MASâ Enlil model captures the solar wind parameters well, despite its underestimation of the speed at middle to high latitudes. The new version of SWMF misses many solar wind variations probably because it uses lower grid resolution than other models. The interplanetary scintillationâ tomography cannot capture the latitudinal variations of solar wind well yet. Because the model performance varies with parameter settings which are optimized for different epochs or flow states, the performance metric study provided here can serve as a template that researchers can use to validate the models for the time periods and conditions of interest to them.Key PointsPerformance metrics for the global solar wind prediction are developedEight model combinations are validated with strengths and weaknesses identified for each modelEffect of model internal parameter settings and magnetogram input is discussedPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134247/1/swe20343_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134247/2/swe20343.pd

The consequences of perceived age discrimination amongst older police officers : is social support a buffer ?

This paper considers the possible psychological consequences of perceived agediscrimination, and the possible buffering effect of social support. Findings, based on a studyof perceived age discrimination amongst police officers in the North of England, suggest thatage discrimination acts as a stressor, with officers experiencing negative effects of perceivedage discrimination on job and life satisfaction, perceived power and prestige of the job, andaffective and normative commitment, along with positive effects on withdrawal cognitionsand continuance commitment. For work-based social support, there were positive maineffects on job and satisfaction, power and prestige of the job, and affective and normativecommitment, and a negative main effect on withdrawal cognitions. However, there were nosignificant moderating effects for work-based social support, and we found the anticipatedbuffering effect for non-work-based social support only for life satisfaction, with reversebuffering for job satisfaction and normative commitment. The limitations and implications ofthe study are discussed

Describing interruptions, multi-tasking and task-switching in the community pharmacy: A qualitative study in England

Background: There is growing evidence base around interruptions and distractions in the community pharmacy setting. There is also evidence to suggest these practices may be associated with dispensing errors. Up to date, qualitative research on this subject is limited. Objective: To explore interruptions and distractions in the community setting; utilising an ethnographic approach to be able to provide a detailed description of the circumstances surrounding such practices. Setting: Community pharmacies in England, July to October 2011. Method: An ethnographic approach was taken. Non participant, unstructured observations were utilised to make records of pharmacists’ every activities. Case studies were formed by combining field notes with detailed information on pharmacists and their respective pharmacy businesses. Content analysis was undertaken both manually and electronically, utilising NVivo 10. Results: Response rate was 12% (n=11). Over fifteen days, a total of 123 hours and 58 minutes of observations were recorded in 11 separate pharmacies of 11 individual pharmacists. The sample was evenly split by gender (female n=6; male n=5) and pharmacy ownership (independent n=5; multiple n=6). Employment statuses included employee pharmacists (n=6), owners (n=4) and a locum (n=1). Average period of registration as a pharmacist was 19 years (range 5-39 years). Average prescriptions busyness of pharmacies ranged from 2,600 – 24,000 items dispensed per month. Two key themes were: “Interruptions and task-switching” and “distractions and multi-tasking.” All observed pharmacists’ work was dominated by interruptions, task-switches, distractions and multi-tasking, often to manage a barrage of conflicting demands. These practices were observed to be part of a deep-rooted culture in the community setting. Directional work maps illustrated the extent and direction of task switching employed by pharmacists. Conclusions: In this study pharmacists’ working practices were permeated by interruptions and multi-tasking. These practices are inefficient and potentially reduce patient safety in terms of dispensing accuracy