How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of self-referral is understood and responded to by such patients. Aims: This paper examines how IAPT referrals are made by GPs and how these referrals are perceived and acted on by patients from low-income backgrounds Method: Findings are drawn from in-depth interviews with low-income patients experiencing mental distress (n = 80); interviews with GPs (n = 10); secondary analysis of video-recorded GP-patient consultations for mental health (n = 26). Results: GPs generally supported self-referral, perceiving it an important initial step towards patient recovery. Most patients however, perceived self-referral as an obstacle to accessing IAPT, and felt their mental health needs were being undermined. The way that IAPT was discussed and the pathway for referral appears to affect uptake of these services. Conclusions: A number of factors deter low-income patients from self-referring for IAPT. Understanding these issues is necessary in enabling the development of more effective referral and support mechanisms within primary care

Use of the Patient Health Questionnaire (PHQ-9) in Practice: Interactions between patients and physicians

We analyze the use of nine-item Patient Health Questionnaire (PHQ-9), an instrument that is widely used in diagnosing and determining the severity of depression. Using conversation analysis, we show how the doctor deploys the PHQ-9 in response to the patient's doubts about whether she is depressed. Rather than relaying the PHQ-9 verbatim, the doctor deviates from the wording so that the response options are selectively offered to upgrade the severity of the patient's symptoms. This works in favor of a positive diagnosis and is used to justify a treatment recommendation that the patient previously resisted. This contrasted with the rest of the data set, where diagnosis was either not delivered (as patients are presenting with ongoing problems) or delivered without using the PHQ-9. When clinician-administered, the PHQ-9 can be influenced by how response items are presented. This can lead to either downgrading or upgrading the severity of depression

Modified cell cycle status in a mouse model of altered neuronal vulnerability (slow Wallerian degeneration; Wlds)

Profiling of gene expression changes in mice harbouring the neurodegenerative Wlds mutation shows a strong correlation between changes in cell cycle pathways and altered vulnerability of terminally differentiated neurons

April 15, 2004

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia

What makes for prize-winning television?

We investigate the determinants of success in four international television awards festivals between 1994 and 2012. We find that countries with larger markets and greater expenditure on public broadcasting tend to win more awards, but that the degree of concentration in the market for television and rates of penetration of pay-per-view television are unrelated to success. These findings are consistent with general industrial organisation literature on quality and market size, and with media policy literature on public service broadcasting acting as a force for quality. However, we also find that ‘home countries’ enjoy a strong advantage in these festivals, which is not consistent with festival success acting as a pure proxy for television quality

Adiposity, Cardiometabolic Risk, and Vitamin D Status: The Framingham Heart Study

OBJECTIVE: Because vitamin D deficiency is associated with a variety of chronic diseases, understanding the characteristics that promote vitamin D deficiency in otherwise healthy adults could have important clinical implications. Few studies relating vitamin D deficiency to obesity have included direct measures of adiposity. Furthermore, the degree to which vitamin D is associated with metabolic traits after adjusting for adiposity measures is unclear. RESEARCH DESIGN AND METHODS: We investigated the relations of serum 25-hydroxyvitamin D (25[OH]D) concentrations with indexes of cardiometabolic risk in 3,890 nondiabetic individuals; 1,882 had subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes measured by multidetector computed tomography (CT). RESULTS: In multivariable-adjusted regression models, 25(OH)D was inversely associated with winter season, waist circumference, and serum insulin (P < 0.005 for all). In models further adjusted for CT measures, 25(OH)D was inversely related to SAT (−1.1 ng/ml per SD increment in SAT, P = 0.016) and VAT (−2.3 ng/ml per SD, P < 0.0001). The association of 25(OH)D with insulin resistance measures became nonsignificant after adjustment for VAT. Higher adiposity volumes were correlated with lower 25(OH)D across different categories of BMI, including in lean individuals (BMI <25 kg/m2). The prevalence of vitamin D deficiency (25[OH]D <20 ng/ml) was threefold higher in those with high SAT and high VAT than in those with low SAT and low VAT (P < 0.0001). CONCLUSIONS: Vitamin D status is strongly associated with variation in subcutaneous and especially visceral adiposity. The mechanisms by which adiposity promotes vitamin D deficiency warrant further study.National Institutes of Health's National Heart, Lung, and Blood Institute (N01-HC-25195, R01-DK-80739): American Heart Associatio

Structure and magnetic properties of the cubic oxide fluoride BaFeO2F

Fluorination of the parent oxide, BaFeO3- δ, with polyvinylidine fluoride gives rise to a cubic compound with a = 4.0603(4) Å at 298K. 57Fe Mössbauer spectra confirmed that all the iron is present as Fe3+. Neutron diffraction data showed complete occupancy of the anion sites indicating a composition BaFeO2F, with a large displacement of the iron off-site. The magnetic ordering temperature was determined as TN = 645±5K. Neutron diffraction data at 4.2K established G-type antiferromagnetism with a magnetic moment per Fe3+ ion of 3.95μB. However, magnetisation measurements indicated the presence of a weak ferromagnetic moment which is assigned to the canting of the antiferromagnetic structure. 57Fe Mössbauer spectra in the temperature range 10 to 300K were fitted with a model of fluoride ion distribution that retains charge neutrality of the perovskite unit cel

Workplace bullying and employee outcomes: a moderated mediated model

This paper investigates the relationship between workplace bullying and employee outcomes in a healthcare setting. Drawing on HR process theory, we investigate the mediating role of the perceived effectiveness of implementation of anti-bullying practices on employee outcomes and whether targeted line manager training was a moderator of that relationship. Our multi-level analysis (utilising responses from 1,507 employees within forty-seven hospitals with matched HR Director interviews), finds that the relationship between workplace bullying and employee outcomes is partially mediated by employees’ perceived effective implementation of intended anti-bully practices. The mediated relationship is moderated by targeted line manager training in anti-bullying practices. The mediated moderation model illustrates that it is effective implementation of anti-bullying practices enhanced by targeted training that is required to reduce bullying probabilities and their associated negative employee outcomes. The paper contributes to resource based view (RBV) of the firm, HR process and human capital theories. The implications for future research and practice are discussed

Fingerprinting the oxidation state of U(IV) by emission spectroscopy

The solid-state structure of the known complex [Et4N][U(NCS)5(bipy)2] has been re-determined and a detailed spectroscopic and magnetic study has been performed in order to confirm the oxidation states of both metal and bipy ligand. Electronic absorption and infrared spectroscopy suggest that the uranium is in its +4 oxidation state and this has been corroborated by emission spectroscopy and variable temperature magnetic measurements, as well as theoretical calculations. Therefore the bipy ligands are neutral, innocent ligands and not, as would be inferred from just a solid state structure, radical anions.We thank TCD and MINECO (MAT2012-38318-C03), and EC for a Marie Curie-IEF (PIEF-GA-2011-299356 to GL) for funding this work.Peer reviewe