Mental Health Referral in Primary Care: Influence of a Screening Instrument and a Brief Educational Intervention

Although less than half of all patients with mental disorders seek mental health treatment per se, approximately 80% of all people will visit their primary care physician (PCPs) within a year (Strosahl, 1998). However, it is not well understood how to best handle patients presenting with mental health issues in primary care practices. The purpose of this project was to implement an intervention involving a screening measure for anxiety and mood disorders in a primary care setting to increase the volume of anxiety and mood disorder screening, to increase the accuracy of disorder detection, and to also enhance PCPs patterns of referral to mental health professionals (MHPs). Though starting with a quantitative design, difficulties encountered throughout the project eventually led to a largely qualitative analysis, which did yield useful information. A pilot project demonstrated anxiety and mood disorders were commonly noted in patients’ medical charts (46%), but also found referrals were rarely made for mental health services (7%), despite colocation of a licensed psychologist and licensed clinical social worker within the practice. This indicated that services available to provide comprehensive integrated total health care may not be have been used to their full potential. In the main project, 59 participants from a family medicine clinic and 20 PCPs from that clinic participated. The My Mood Monitor (M3) was administered to the patients and became part of their Electronic Medical Records (EMR). The M3 screens for anxiety, depression, and bipolar disorders within primary care settings. In 2 separate noon conferences, PCPs were trained on diagnostic criteria for anxiety disorders and mood disorders, interpretation of M3 results, and the internal Mental Health Professional referral process. The project was hampered by a full-scale switch from paper-based medical records to an EMR and accompanying lack of user experience with EMR functions, lack of efficient transfer of M3 results into the EMR, and an unforeseen switch of psychologists mid-way through the study. However, results were obtained that showed relatively low levels of PCP review of M3 results, potentially high rates of anxiety disorders and mood disorders within the setting, relatively high levels of PCP knowledge of diagnostic criteria for anxiety and mood disorders, and that patients may not prefer a ‘warm handoff’ model of mental health referral. These findings are couched within a number of important caveats, but future directions for research were clearly implied

Advanced Inverse Modeling of Sediment Thermal Diffusion Processes : Reconstructing Temporal Variant Boundary Conditions for the One-Dimensional Heat Equation

Temperatures in marine sediments are driven by the geothermal heat flow from the Earth's crust and the evolution of the bottom water temperature. Mathematically, the temperature field can be modeled with the heat equation, a Robin boundary condition at the sediment-water interface, and a Neumann condition at the lower boundary. Given the thermal properties of the sediment and a model for the bottom water temperature function the forward problem is well-posed. The inverse problem, i.e. reconstructing the bottom water temperature function from measurements of the sediment temperature, on the other hand is ill-posed; the parameterized model is non-linear but low-dimensional. Different Newton-linke methods, as well as a linear fitting approach with Tikhonov minimization, and a Markov Chain Monte Carlo method are shown and their performances for this problem are compared. The algorithms work differently well on this problem, and regularising methods are not necessarily better. The heuristic linear fitting has the best accuracy in reasonable computing time, while the Markov Chain Monte Carlo method has proven convergence for enlarging ensembles

Brief communication: Testing a portable Bullard-type temperature lance confirms highly spatially heterogeneous sediment temperatures under shallow bodies of water in the Arctic

The thermal regime in the sediment column below shallow bodies of water in Arctic permafrost controls benthic habitats and permafrost stability. We present a robust, portable device that measures detailed temperature–depth profiles of the near-surface sediments in less than 1 h. Test campaigns in the Canadian Arctic and on Svalbard have demonstrated its utility in a range of environments during winter and summer. Measured temperatures were spatially heterogeneous, even within single bodies of water. We observed the broadest temperature range in water less than 1 m deep, a zone that is not captured by single measurements in deeper water.Peer Reviewe

Der Einfluss der Experimentellen Autoimmunen Enzephalomyelitis auf die Expression von Connexinen im Nervus opticus der Maus

Zusammenfassung Die Multiple Sklerose (MS) ist eine Erkrankung des Zentralen Nervensystems mit verschiedenen pathophysiologischen Merkmalen wie Demyelinisierung, Axonschädigung und Inflammation. Diese resultieren hauptsächlich in motorischen, sensiblen oder auch kognitiven Beeinträchtigungen. Viele Patienten berichten von Sehstörungen als erste Symptome der MS, noch bevor sie motorische Beeinträchtigungen wahrnehmen. Daher steht der Nervus opticus (N. opticus) im Fokus dieser Arbeit. Zur Aufrechterhaltung der Funktion von Nervenzellen und deren umgebenden Gliazellen sind die Connexine von großer Bedeutung, deren Subtypen eine Zelltyp-spezifische Expression aufweisen. Connexine können Hemikanäle bilden und so die Kommunikation zwischen Zytoplasma und Extrazellularraum ermöglichen; sie können sich aber auch zu Gap Junctions zusammenlagern und somit den interzellulären Stoffaustausch ermöglichen. Für einige Erkrankungen des Nervensystems, wie z.B. der hypoxisch-ischämischen Hirnläsion, ist bekannt, dass sie Veränderungen in der Connexin-Expression nach sich ziehen. Daher wurde in dieser Arbeit postuliert, dass Connexine bei der MS bzw. im korrespondierenden Tiermodell bei der Experimentellen Autoimmunen Enzephalomyelitis (EAE) ebenfalls eine Rolle spielen. In dieser Arbeit wurde untersucht, ob im murinen EAE-Modell Veränderungen der Connexin Expression im N. opticus zu beobachten sind. Mittels CD3-Immunfluoreszenz wurden T-Zellen in den Nerven gezeigt; mittels histologischer Färbungen das Myelin (Luxol-Fast-Blue) bzw. eine Zellinfiltration (Hämatoxylin-Eosin). Zur Analyse der mRNA-Expression wurde eine quantitative Real-Time Polymerase-Kettenreaktion für astrozytäre, oligodendrozytäre und neuronale Connexine durchgeführt. Die entsprechenden Proteine wurden mittels Immunfluoreszenz-Färbungen nachgewiesen. Es konnte gezeigt werden, dass die EAE einen deutlichen Einfluss auf astrozytäre und oligodendrozytäre Gap Junction-Proteine hat: Insbesondere in der Phase der EAE-bedingten Demyelinisierung kam es zur Reduktion der Connexin 43-Expression im N. opticus. In dieser Phase der Erkrankung konnte ebenfalls eine Erhöhung der Connexin 47-Protein-Expression, bei verminderter mRNA-Expression, beobachtet werden. Auch die Gen-Expression von Connexin 29 und Connexin 36 war bei EAE vermindert. Somit wurde in dieser Arbeit der Einfluss einer EAE auf Gliazellen des N. opticus bestätigt und erstmalig Änderungen der Connexin-Expression auf mRNA und Proteinebene im N. opticus unter EAE nachgewiesen. Die pathophysiologischen Veränderungen beziehen somit auch die Kanalproteine der interzellulären Kommunikation via Gap Junctions mit ein.Summary Multiple sclerosis (MS) is a disease of the central nervous system with various pathophysiological features such as demyelination, axonal damage and inflammation. These mainly result in motor, sensory or cognitive impairments. Many patients report impaired vision as one of the first symptoms of MS even before they experience motor impairment. Therefore, this work focuses on the optic nerve. In order to control the function of nerve cells and their surrounding glial cells, the connexins, whose sub-types present a cell type specific expression, are of great importance. Connexins can form hemichannels and thus enable communication between cytoplasm and extracellular space; they can also assemble into gap junctions and thus facilitate intercellular mass transfer. Some diseases of the nervous system, such as the hypoxic-ischemic brain lesion, are known to cause changes in connexin expression. Therefore, it was postulated that connexins also play a role in MS or in the corresponding animal model of experimental autoimmune encephalomyelitis (EAE). In this work, it was investigated whether changes in connexin expression in the optic nerve can be observed in the murine EAE model. By CD3 immunofluorescence, T-cells were shown in the nerves; with the use of histological staining with myelin (Luxol Fast Blue) or cell infiltration (Hematoxylin Eosin). To analyze mRNA expression, quantitative real-time polymerase chain reaction was performed for astrocytic, oligodendrocytic and neuronal connexins. The corresponding proteins were detected by immunofluorescence. It was shown that EAE has a distinct influence on astrocytic and oligodendrocyte gap junction proteins. Especially in the phase of EAE-induced demyelination, connexin 43-expression in the optic nerve was reduced. An increase in connexin 47- protein-expression, with reduced connexin 47-gene-expression, was also observed at this stage of the disease. Gene expression of connexin 29 and connexin 36 was also reduced in EAE. Thereby, the influence of an EAE on the glial cells of the optic nerve was confirmed and for the first time, changes in connexin expression on mRNA and protein level in the optic nerve under EAE were detected. The pathophysiological changes, therefore, also include the channel proteins of intercellular communication via gap junctions