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Objective: A diagnosis of Parkinson's often leads to uncertainty about the future and loss of perceived control. Peer support may offer a means to address these concerns and promote self-management. Design: A programme evaluation of the feasibility and potential effects of 'First Steps', utilising a pragmatic step wedge approach. Comparing First Steps (intervention) to (control) conditions. Setting: In the community at four sites in southern England. Participants: Newly diagnosed (≤ 12months) people with Parkinson's. Intervention: First Steps was a 2-day peer-conceived, developed and led intervention to support self-management. Main measures: At 0, 12 and 24 weeks anxiety and depression (Hospital, Anxiety and Depression Scale, HADS), daily functioning (World Health Organisation Disability Assessment Schedule, WHODAS), physical activity, quality of life (EQ5D), carer strain and service utilisation were assessed. Results: Between February 2018 and July 2019, 36 participants were enrolled into intervention and 21 to control conditions, all were included in statistical analysis. Lost to follow up was n = 1 (intervention) and n = 1 adverse event was reported (control, unrelated). Of the 36 allocated to the intervention n = 22 participants completed both days of First Steps during the study period. Completion of outcome measures was >95% at 24 weeks. Small effects favouring the intervention were found for HADS (odds ratio (OR) = 2.06, 95% confidence interval (CI) 0.24:17.84), Carer Strain Index (OR = 2.22, 95% CI 0.5:9.76) and vigorous (d = 0.42, 95% CI −0.12:0.97) and total physical activity (d = 0.41, 95% CI −0.13:0.95). EQ5D, WHOSDAS and service utilisation, was similar between groups. Conclusions: First Steps was feasible and safe and we found potential to benefit physical activity, mental health and carer strain. Further research with longer-term follow up is warranted. [ABSTRACT FROM AUTHOR]

To explore, in a European cohort of people living with Parkinson's (PD), issues affecting employment and economic consequences, considering age at diagnosis. A cross-sectional survey (European convenience sample). Inclusion criteria were ≥18 years, a PD diagnosis and in work when diagnosed. Data were collected online on demographics, employment status, occupation, and perceived health. For those no longer in paid work, time from diagnosis until loss of employment, reasons for leaving and enablers to stay in work were ascertained. Between April and November 2019, n = 692 enrolled and n = 560 were eligible. Those who had lost paid work (n = 190, 34%) reported worse fatigue, sleep, and general health than those still in work (p < 0.05). Average annual income reduced from €26973.48 ± 12013.22 (year-1) to €14843.85 ± 16969.84 (year-10). Post-diagnosis lost employment potential was 20.1 (95% confidence interval (CI): 16.6–23.6) years at career establishment, 9.8 (95%CI: 8.9–10.7) years at mid working and 1.2 (95%CI: 0.6–1.6) years for those nearing retirement age. A greater proportion of individuals at career establishment age reported dexterity, eating, sleep, fatigue, and anxiety as factors for leaving work (p < 0.05). This study confirms lost productivity after a PD diagnosis, especially in those with many years of potential employment ahead. The study also identified potential targets for interventions. Clinical trial registration: Clincaltrials.gov (NCT03905954). People with Parkinson's diagnosed at career establishment or at mid working age risk losing many years of potential employment. Most people with Parkinson's do not receive early intervention to support self-management of problems identified with leaving work early, such as fatigue. Adaptations to the work environment and more flexible working patterns were identified factors that may help people remain in work. [ABSTRACT FROM AUTHOR]

Before the U.S. Equal Employment Opportunity Commission may sue an employer for violating federal antidiscrimination law, it must first seek to engage the employer in conciliation. Conciliation offers employers an opportunity to resolve discrimination charges voluntarily in a setting analogous to settlement negotiations. In January 2021, EEOC promulgated a rule mandating that, as part of conciliation, employers be given certain information about the underlying charge. Congress subsequently rescinded the rule, however, citing its ostensible pro-employer/anti-worker bias. Congress’s nullification of the conciliation rule has generated considerable uncertainty not only for employers and workers but also for the Commission itself. That is because the rule was rescinded using the Congressional Review Act (CRA), which prohibits a rule from being issued “in substantially the same form” as one previously disapproved. Yet, the Act does not define “in substantially the same form” or otherwise specify what criteria should be used in assessing rules’ similarity. Nor has any court interpreted the phrase in the specific context of CRA. This article examines three possible methodologies for how the Commission might go about issuing a conciliation rule consistent with CRA— based on proposals from the academic literature, other agencies’ experience in reissuing disapproved rules, and procedures specified in CRA’s post-enactment legislative history—and demonstrates that while EEOC retains the discretion to issue a new conciliation rule, it is effectively barred from doing so absent further action by Congress. [ABSTRACT FROM AUTHOR]

Whereas Title VII has always contained an express exemption for religious organizations, ambiguities in the statutory text and legislative history render the exemption susceptible to three conflicting interpretations. This Article provides a detailed critique of each interpretation and demonstrates that while LGBTQ persons stand to retain meaningful employment protections under two Of the three interpretations, the third construction threatens to leave LGBTQ individuals-together with women, pregnant persons, and racial and ethnic minorities-vulnerable to discrimination in a host of non-ministerial, ostensibly secular positions. [ABSTRACT FROM AUTHOR]

Human genetic studies have pointed to a prominent role for innate immunity and lipid pathways in immunological and neurodegenerative disorders. Our understanding of the composition and function of immunomodulatory lipid networks in innate immune cells, however, remains incomplete. Here, we show that phospholipase Cγ2 (PLCγ2 or PLCG2)--mutations in which are associated with autoinflammatory disorders and Alzheimer's disease--serves as a principal source of diacylglycerol (DAG) pools that are converted into a cascade of bioactive endocannabinoid and eicosanoid lipids by DAG lipase (DAGL) and monoacylglycerol lipase (MGLL) enzymes in innate immune cells. We show that this lipid network is tonically stimulated by disease-relevant human mutations in PLCγ2, as well as Fc receptor activation in primary human and mouse macrophages. Genetic disruption of PLCγ2 in mouse microglia suppressed DAGL/MGLL-mediated endocannabinoid-eicosanoid cross-talk and also caused widespread transcriptional and proteomic changes, including the reorganization of immune-relevant lipid pathways reflected in reductions in DAGLB and elevations in PLA2G4A. Despite these changes, Plcg2-/- mice showed generally normal proinflammatory cytokine and chemokine responses to lipopolysaccharide treatment, instead displaying a more restricted deficit in microglial activation that included impairments in prostaglandin production and CD68 expression. Our findings enhance the understanding of PLCγ2 function in innate immune cells, delineating a role in cross-talk with endocannabinoid/eicosanoid pathways and modulation of subsets of cellular responses to inflammatory stimuli. [ABSTRACT FROM AUTHOR]

Whereas the Supreme Court recently held that LGBTQ employment bias is actionable under Title VII as a form of sex discrimination, the statute does not protect persons working at small firms, i.e., businesses with fewer than fifteen employees. For these individuals, state law provides the exclusive means of redressing workplace bias, yet only twenty-two states prohibit discrimination on the basis of sexual orientation and gender identity. This article examines a subset of the twenty-eight states lacking explicit, LGBTQ-inclusive employment protections--those with antidiscrimination statutes applying to small firms otherwise exempt from Title VII--and demonstrates that, to varying degrees, these states would be justified in construing their statutes' existing bans on sex discrimination to protect LGBTQ workers. [ABSTRACT FROM AUTHOR]

Because federal law does not expressly prohibit employment discrimination on the basis of sexual orientation or gender identity, LGBTQ Americans were thrilled to learn that a preliminary draft of the United States–Mexico–Canada Agreement (USMCA) included a provision (the Provision) requiring each nation to enact LGBTQ‐inclusive nondiscrimination laws. That excitement promptly turned to despair, however, after the Trump administration insisted on the addition of a footnote (the Footnote) designed to exempt the United States from the Provision. To date, the Footnote has been derided by scholars and trade experts alike as a transparent attempt to evade the Provision's LGBTQ‐inclusive mandate. Yet, by focusing only on what the USMCA does not do, these analyses overlook what the agreement does do, even if unintended, to benefit LGBTQ Americans. This article provides the first comprehensive analysis of the USMCA's implications for federal antidiscrimination law and demonstrates that—regardless of how the Supreme Court rules in a trio of LGBTQ employment cases—the Footnote actually stands to help, not hinder, the cause of LGBTQ equality. [ABSTRACT FROM AUTHOR]

The article focuses on the Dementia Training Australia (DTA) Fellowship program that focuses on training and mentoring of staff in an organization. INSET: Building leadership capacity.

The article focuses on proof structure should be modified to ensure that lesbian, gay, and bisexual (LGB) persons' allegations of religious nonadherence discrimination as proxy claims for sexual orientation bias. It mentions de facto sexual orientation exception to the Title VII of the U.S. Civil Rights Act of 1964 ban on religious discrimination and same employment protections. It mentions arguments for repudiating the sexual orientation exception in the context of religious discrimination.

Background and Objectives: Chief resident leadership competencies are neither clear nor standardized. The goal of this project was to identify specific leadership skills for chief residents and to develop a self-assessment tool.Methods: Chief residents from 10 family medicine residencies participated in focus groups to identify leadership skills required to be an effective chief resident. The ideas generated by participants were grouped into 10 competencies and a self-assessment tool was developed. The tool has been used to help chief residents self-assess their leadership strengths and weaknesses, and to identify teaching priorities for biannual leadership workshops.Results: The self-assessment instrument was completed by 83 chief residents over 5 years. Mean ratings range from 3.19 to 3.57 on a 5-point scale (low to high competency). The self-ratings of residents starting their chief year compared to residents at the end of their chief year showed an increase in 9 of the 10 competencies.Conclusions: The leadership competencies are a useful tool to identify training priorities and to help chief residents or other leaders within a residency program identify skills for further development. [ABSTRACT FROM AUTHOR]

The article informs about the initiative driven by IRT Group's Journey of Care model which personalizes the care experience for every resident through dedicated care neighborhoods and specialist programs. It mentions that the Journey of Care program has since rolled out across all Intensive Residential Treatment (IRT) aged care centers a desire has grown to extend templates to also include photos and images chosen by the residents and for these to be trialed in non-dementia secure unit areas.

Background: Rural communities throughout the United States are eager to recruit and retain family physicians. This study examined factors that may contribute to a medical student's decision to consider rural family medicine practice using the Community Apgar Questionnaire (CAQ).Methods: Third- and fourth-year medical students from 10 medical schools responded to a survey of 62 identified factors deemed to be present when assessing the strengths and challenges of recruiting family physicians to rural communities. Participants could also respond to six demographic questions. Factors were ranked based on importance to respondents and were compared using demographic information.Results: A total of 282 MS-3 and MS-4 students interested in family medicine from 10 US medical schools completed the survey (response rate 19.5%). Forty percent of participants anticipate practicing in a rural setting, followed by 31% for suburban and 29% for urban. The top three factors participants considered when anticipating a rural practice setting were spousal satisfaction, call frequency, and competition/collegiality. Additional differences were found across CAQ factors by future practice setting, gender, and location where the student was raised.Conclusions: Medical schools, rural preceptors, and rural communities may wish to consider highly rated factors found in the CAQ in the effort to increase the recruitment of family physicians interested in rural practice. [ABSTRACT FROM AUTHOR]

Background: Practice-based research networks (PBRNs) promote the conduct of research in real-world settings by engaging primary care clinicians as champion research collaborators. Card studies are brief surveys administered to patients or clinicians at the point of care. The objective of this paper is to describe the design and evaluation of a card study methodology that the WWAMI Region Practice and Research Network (WPRN) used to develop research partnerships across multiple member sites. Methods: We used a collaborative model to develop, implement and disseminate the results of a network-wide card study to assess patient preferences for weight loss in primary care. After the card study data collection was completed, we conducted individual and focus group interviews and a brief survey of participating practice champions. Results: Increased research engagement and personal and professional developments were the primary motivators for participating in the development of the card study. Increasing research activity at practices and learning information about patients were motivators for implementing the study. Their participation resulted in champions reporting increased confidence in collaborating on research projects as well as the development of new clinical services for patients. Discussion: This collaborative model positively influenced research capacity in the WPRN and may be a useful strategy for helping PBRNs conducted translational research. [ABSTRACT FROM AUTHOR]

The article focuses on the U.S. Employment Non-Discrimination Act (ENDA) and mentions the need of executive order for legislation to protect LGBT persons against employment discrimination. Topics discussed include opposition of ENDA by legislators, U.S. President Barack Obama may extend explicit status-based protections to a significant number of LGBT workers and LGBT-related employment discrimination is also actionable as sex discrimination under Title VII of the Civil Rights Act of 1964.

This article offers some reflections on how my practice as a systemic psychotherapist has been influenced by my interests in Appreciative Inquiry (AI) and Zen Buddhism. The discussion will particularly focus on how these influences inform my thinking about the therapeutic relationship. From Zen, the idea of 'beginner's mind' is helpful in enhancing appreciative curiosity within the therapist. [ABSTRACT FROM AUTHOR]

This article provides the first comprehensive analysis of ENDA's shortcomings vis- ` a-vis Title VII of the Civil Rights Act of 1964. Whereas federal courts are increasingly likely to perceive LGBT-related employment discrimination as actionable sex discrimination under Title VII, the inclusion of gender identity protections in recent versions of ENDA has significantly diminished the bill's prospects for passage. This article contends that advocates should abandon their efforts to enact ENDA in favor of allowing Title VII's "sex" provision to continue on its LGBT-inclusive evolution. Title VII stands to provide LGBT persons with three distinct advantages relative to ENDA. First, Title VII allows plaintiffs to contest discrimination on either a disparate treatment or disparate impact theory. ENDA, in contrast, would permit only disparate treatment claims such that facially neutral employment practices having a disproportionately adverse effect on LGBT persons would not be actionable. Second, Title VII permits voluntary affirmative action plans whereas ENDA would prohibit preferential treatment on the basis of sexual orientation or gender identity even if LGBT persons were significantly underrepresented in a given workforce. Third, Title VII allows religious organizations to discriminate on the basis of religion but not race, color, ethnicity, or sex. ENDA, conversely, would allow religious organizations to discriminate on the basis of sexual orientation or gender identity without having to justify the discrimination on religious precepts. This article examines the feasibility of applying Title VII's protections to LGBT persons and concludes that, notwithstanding certain logistical difficulties in the short-run, LGBT individuals would benefit from the availability of disparate impact claims, voluntary affirmative action plans, and limited exemptions for religious organizations so that ENDA should be abandoned in favor of Title VII. [ABSTRACT FROM AUTHOR]

Jaakko Seikkula (2008) has pointed towards the importance of practitioners working in the present moment in dialogical therapy. Extrapolating from Seikkula's work, this article considers the significance of the qualities of therapist attentiveness, generosity and negative capability in dialogical family meetings for psychosis. It is proposed that these qualities are of particular importance when family meetings occur in crisis situations, as when under pressure practitioners can easily be drawn into prematurely interventionist stances that may unintentionally promote chronicity for the person experiencing psychosis. The value of co-working arrangements in enabling practitioners to maintain attentiveness and negative capability in this work is also considered. [ABSTRACT FROM AUTHOR]

For more than sixty years, the Internal Revenue Service has employed a methodology test in determining whether a nonprofit organization's advocacy of a particular viewpoint is sufficiently educational to warrant its designation as a public charity. The test's focus is not upon the viewpoint advocated, but upon the method used by the organization to communicate its viewpoint to others. Consistent with this purpose, the Service has identified four factors that are indicative of a noneducational methodology. The Service's application of the test, however, suggests the existence of an additional, previously undisclosed factor. This factor regards a refusal to present opposing viewpoints as indicative of a noneducational methodology. This article concludes that the methodology test is unconstitutional for three reasons. First, the test is void for vagueness because it does not disclose one of the factors considered by the Service in evaluating whether an advocacy organization may be said to employ an educational methodology. Second, the test violates the compelled speech doctrine by requiring advocacy organizations to accommodate the very speech they are organized to oppose. Third, the test imposes an unconstitutional condition by conditioning advocacy organizations' eligibility to receive tax-deductible contributions on the absolute forfeiture of their First Amendment rights. [ABSTRACT FROM AUTHOR]

Meeting a service user with his or her family in acute care settings to discuss their thoughts, hopes and concerns provides important therapeutic benefits. It can help counter some of the potentially negative consequences of hospital admission for the service user and family. Because people usually enter hospital during a period of crisis, approaches that are flexible and responsive to the specific needs of each client and family are required. To practise in this way, staff require access to training and continuing supervision that also needs to be delivered flexibly and responsively. [ABSTRACT FROM AUTHOR]

Meeting a service user with his or her family in acute care settings to discuss their thoughts, hopes and concerns provides important therapeutic benefits. It can help counter some of the potentially negative consequences of hospital admission for the service user and family. Because people usually enter hospital during a period of crisis, approaches that are flexible and responsive to the specific needs of each client and family are required. To practise in this way, staff require access to training and continuing supervision that also needs to be delivered flexibly and responsively. INSETS: Case study one;Case study two. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the decision of the U.S. Supreme Court in the foreign-squared (f-squared) securities fraud case Morrison versus National Australia Bank Ltd. The author says that the court uses the transactional test, where Section 10(b) of the Securities Exchange Act of 1934 applies to securities trading on U.S. stock exchanges and domestic transactions. He argues that the basis of the test is simple and direct means for disposing such claims.

Presenting dialogical approaches to therapy calls for training approaches that are themselves participatory and dialogical. The use of chance operations is one way of enhancing an interactive and co-constructive learning process. [ABSTRACT FROM AUTHOR]

This article describes a single session aimed at helping participants on a family therapy foundation course to move from a position of anxiety and discomfort about completing a written assignment to a position of safe uncertainty. Evaluation from the perspectives of course participants, course facilitators and assignment markers has shown participants engaging more enthusiastically with the writing of the assignment and expressing less anxiety about the process. [ABSTRACT FROM AUTHOR]

The highly lethal brain cancer glioblastoma (GBM) poses a daunting challenge because the blood-brain barrier renders potentially druggable amplified or mutated oncoproteins relatively inaccessible. Here, we identify sphingomyelin phosphodiesterase 1 (SMPD1), an enzyme that regulates the conversion of sphingomyelin to ceramide, as an actionable drug target in GBM. We show that the highly brain-penetrant antidepressant fluoxetine potently inhibits SMPD1 activity, killing GBMs, through inhibition of epidermal growth factor receptor (EGFR) signaling and via activation of lysosomal stress. Combining fluoxetine with temozolomide, a standard of care for GBM, causes massive increases in GBM cell death and complete tumor regression in mice. Incorporation of real-world evidence from electronic medical records from insurance databases reveals significantly increased survival in GBM patients treated with fluoxetine, which was not seen in patients treated with other selective serotonin reuptake inhibitor (SSRI) antidepressants. These results nominate the repurposing of fluoxetine as a potentially safe and promising therapy for patients with GBM and suggest prospective randomized clinical trials. [Display omitted] • The unique membrane lipid composition makes GBMs sensitive to SMPD1 inhibition • Fluoxetine inhibits SMPD1, sphingomyelin metabolism, and EGFR signaling in GBM • Fluoxetine safely and potently shrinks GBM tumors and prevents recurrence in mice • Addition of fluoxetine to standard-of-care chemotherapy improves patient survival Bi et al. reveal an actionable lipid vulnerability in GBM that can be exploited with a safe, highly brain-penetrant, FDA-approved drug. They show that fluoxetine kills GBMs by blocking acid sphingomyelinase, and they demonstrate that, when added to standard of care, fluoxetine, unlike other SSRIs, significantly improves patient survival. [ABSTRACT FROM AUTHOR]

In this article the authors reflect on the impact of differences in accent, dialect, and vocabulary in a family meeting that occurred in a family therapy training clinic. Some ways in which these linguistic factors may provoke social distancing between participants and impede the development of meaning between therapist, family, and reflecting team are examined. Because language is constructive of our personal and social worlds, dilemmas associated with these aspects of communication are framed as ethical in nature. Some tentative implications for a relationally responsive ethical practice are discussed. [ABSTRACT FROM AUTHOR]

Examines the work of R.D. Scott regarding crisis intervention in psychiatry in London, England. Career background of Scott; Issues increasing public anxiety about mental illness; Relevance of research of Scott to mental health nurses and psychiatric professionals.

Aim: The dual aim of this research was to consider the impact of providing the First Steps program on the stories of people with Parkinson's Disease (PD) and to investigate the psychosocial and emotional mechanisms which may explain this impact. Methods: A qualitative study using a subtle realist paradigm and hermeneutic phenomenological methodology was undertaken. A single semi-structured interview was used to consider the impact and experiences of people with PD who completed either the intervention (2-day peer-led behavior intervention using storytelling 6–8 weeks apart) or received telephone support calls as part of the active control group. Descriptive statistics and a narrative analysis were undertaken on the results. Results: Forty-two participants were invited to participate, forty of whom completed the interview. This included 18 from the intervention group and 22 from the active control group. The intervention group identified the value of the program as worth-while, demonstrating improved exercise behavior and coping mechanisms following the intervention. Three major stories (the affirmed, the validated and the transformed story) identified the impact of the intervention. Three internal mechanisms (perceived control, hope and action, and the individual's mind set) alongside three social mechanisms (social comparison, social control and the first opportunity to share with peers) appeared to explain this impact. Conclusion: This study provides exciting and novel evidence of the impact of a peer-led psycho-educational intervention for people newly diagnosed with PD. Further research is needed to consider the impact of stories-based approaches on participants and consider a critical evaluation of the mechanisms which may explain changes in stories and self-reported behaviour. [ABSTRACT FROM AUTHOR]

Purpose Of Review: Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care.Recent Findings: Two trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs' MI-related language and patients' arguments for positive behavior changes, "change talk," appeared to explain the positive effects of MI training on depression outcome. MI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting "change talk" from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature. [ABSTRACT FROM AUTHOR]

An introduction to the journal focusing on international research studies of undergraduate is presented.