Acute inpatient mental health wards and inpatient alternatives: a quantitative comparison of the care provided

Background: Literature indicates widespread dissatisfaction with UK acute psychiatric wards. Patients report boredom and insufficient time with staff. Residential alternatives to acute wards have been developed. Aims: 1) To review literature for the effectiveness and acceptability of alternatives 2) To identify or develop measures of content of care for acute inpatient and residential crisis services 3) To compare the content of care at alternatives and standard services and understand its relationship to patient satisfaction. Hypotheses tested were that alternatives provide greater total care, more social and psychological interventions but fewer physical and pharmacological interventions than standard wards. Method: A systematic review of studies evaluating alternatives was conducted. Measures of content of care were reviewed. New measures were developed (CaSPAR, CaRICE and CCCQ-P) and their psychometrics explored. Data were collected from 4 alternatives and 4 standard services using CaSPAR (n=224), CaRICE (1 recording week per service), CCCQ-P and CSQ (n=314). The relationship of service type, patient characteristics and CCCQ-P scores to patient satisfaction was explored. Results: The limited current evidence does not contra-indicate alternatives and suggests patient satisfaction may be greater at community alternatives than standard wards. No study hypotheses were corroborated. Sub-group analysis indicated community alternatives provided more psychological and less physical and pharmacological care than standard wards. All CCCQ-P variables were significantly associated with patient satisfaction. Patient satisfaction was greatest at community alternatives. It remained significantly greater at alternatives than standard wards after adjusting for CCCQ-P variables. Discussion: Community alternatives are a promising service model. Their greater acceptability than standard wards was not explained by measured differences in care. Intensity of care may influence patient satisfaction more than the types of intervention provided. Increasing staff-patient contact should be an aim for alternative and standard services. There may be differing, valid perspectives about what constitutes care: multi-methods assessment is required

An Assessment of Past NASA Program Sponsored Pre-service and In-service Teachers to Determine the Impact of Their Training and Preparation for the Computer Technology Standards of Learning for Virginia Public School Educators

To assist in solving these problems, the following objectives have been established: 1. To measure how well prepared the pre-service teachers are to use and teach instructional computer technology; 2. To measure in-service teachers\u27 computer technology skills; 3. Assess teachers\u27 integration of computer technology into the core curriculum; 4. Conduct a diminutive program evaluation of NASA computer technology education programs

To what extent does severity of loneliness vary among different mental health diagnostic groups: A cross-sectional study.

Loneliness is a common and debilitating problem in individuals with mental health disorders. However, our knowledge on severity of loneliness in different mental health diagnostic groups and factors associated with loneliness is poor, thus limiting the ability to target and improve loneliness interventions. The current study investigated the association between diagnoses and loneliness and explored whether psychological and social factors were related to loneliness. This study employed a cross-sectional design using data from a completed study which developed a measure of social inclusion. It included 192 participants from secondary, specialist mental health services with a primary diagnosis of psychotic disorders (n = 106), common mental disorders (n = 49), or personality disorders (n = 37). The study explored differences in loneliness between these broad diagnostic groups, and the relationship to loneliness of: affective symptoms, social isolation, perceived discrimination, and internalized stigma. The study adhered to the STROBE checklist for observational research. People with common mental disorders (MD = 3.94, CI = 2.15 to 5.72, P < 0.001) and people with personality disorders (MD = 4.96, CI = 2.88 to 7.05, P < 0.001) reported higher levels of loneliness compared to people with psychosis. These differences remained significant after adjustment for all psychological and social variables. Perceived discrimination and internalized stigma were also independently associated with loneliness and substantially contributed to a final explanatory model. The severity of loneliness varies between different mental health diagnostic groups. Both people with common mental disorders and personality disorders reported higher levels of loneliness than people with psychosis. Addressing perceived mental health discrimination and stigma may help to reduce loneliness

Validity, reliability, acceptability, and utility of the Social Inclusion Questionnaire User Experience (SInQUE): a clinical tool to facilitate social inclusion amongst people with severe mental health problems.

BACKGROUND: Individuals with severe mental health problems are at risk of social exclusion, which may complicate their recovery. Mental health and social care staff have, until now, had no valid or reliable way of assessing their clients' social inclusion. The Social Inclusion Questionnaire User Experience (SInQUE) was developed to address this. It assesses five domains: social integration; productivity; consumption; access to services; and political engagement, in the year prior to first psychiatric admission (T1) and the year prior to interview (T2) from which a total score at each time point can be calculated. AIMS: To establish the validity, reliability, and acceptability of the SInQUE in individuals with a broad range of psychiatric diagnoses receiving care from community mental health services and its utility for mental health staff. METHOD: Participants were 192 mental health service users with psychosis, personality disorder, or common mental disorder (e.g., depression, anxiety) who completed the SInQUE alongside other validated outcome measures. Test-retest reliability was assessed in a sub-sample of 30 participants and inter-rater reliability was assessed in 11 participants. SInQUE ratings of 28 participants were compared with those of a sibling with no experience of mental illness to account for shared socio-cultural factors. Acceptability and utility of the tool were assessed using completion rates and focus groups with staff. RESULTS: The SInQUE demonstrated acceptable convergent validity. The total score and the Social Integration domain score were strongly correlated with quality of life, both in the full sample and in the three diagnostic groups. Discriminant validity and test-retest reliability were established across all domains, although the test-retest reliability on scores for the Service Access and Political Engagement domains prior to first admission to hospital (T1) was lower than other domains. Inter-rater reliability was excellent for all domains at T1 and T2. CONCLUSIONS: The component of the SInQUE that assesses current social inclusion has good psychometric properties and can be recommended for use by mental health staff

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs

Keplerian discs around post-AGB stars: a common phenomenon?

Aims: We aim at showing that the broad-band SED characteristics of our sample of post-AGB stars are best interpreted, assuming the circumstellar dust is stored in Keplerian rotating passive discs. Methods: We present a homogeneous and systematic study of the Spectral Energy Distributions (SEDs) of a sample of 51 post-AGB objects. The selection criteria to define the whole sample were tuned to cover the broad-band characteristics of known binary post-AGB stars. The whole sample includes 20 dusty RV Tauri stars from the General Catalogue of Variable Stars (GCVS). We supplemented our own Geneva optical photometry with literature data to cover a broad range of fluxes from the UV to the far-IR. Results: All the SEDs display very similar characteristics: a large IR excess with a dust excess starting near the sublimation temperature, irrespective of the effective temperature of the central star. Moreover, when available, the long wavelength fluxes show a black-body slope indicative of the presence of a component of large mm sized grains. Conclusions: We argue that in all systems, gravitationally bound dusty discs are present. The discs must be puffed-up to cover a large opening angle for the central star and we argue that the discs have some similarity with the passive discs detected around young stellar objects. We interpret the presence of a disc to be a signature for binarity of the central object, but this will need confirmation by long-term monitoring of the radial velocities. We argue that dusty RV Tauri stars are those binaries which happen to be in the Population II instability strip.Comment: 29 pages, 5 figures, accepted for publication in A&

A Systematic Review of the Characteristics and Efficacy of Recovery Training for Mental Health Staff: Implications for Supported Accommodation Services

Evidence suggests a link between recovery-oriented practise and service user outcomes in supported accommodation settings. Current clinical guidelines recommend recovery training for supported accommodation staff, however evidence relating to the effectiveness of this type of training is unclear. This review aimed to describe and compare the characteristics and efficacy of existing recovery training packages for mental health staff. The appropriateness and applicability of the interventions was considered in relation to UK supported accommodation services. Initial search processes returned 830 papers. After duplicate removal, inclusion and exclusion criteria were applied to 489 papers, leaving a final sample of seven papers. Data were reviewed using a narrative synthesis approach. The reviewed papers showed variation in the aims, frequency, and duration of the training interventions, although all included content consistent with the five-domains of the CHIME model. All interventions used direct, in-person teaching, and prioritised interactive, experiential learning, however a number were limited by the absence of feedback, the use of one-off, rather than repeated/follow-up sessions, and a reliance on classroom-based, rather than in-vivo, training. There was limited evidence to suggest a consistent effect of training on staff or service user outcomes, and there was no clear association between the delivery and design characteristics of the interventions and reported outcomes. In considering the development of recovery training for supported accommodation staff, little guidance can be taken from the reviewed literature. Any training package must be developed with consideration of the unique contextual and organisational characteristics of these services. The authors recommend viewing training as one component of a broader goal of service transformation

The design of an experiment to detect low energy antiprotons

The techniques to be used in a balloon borne experiment APEX to detect 220 MeV antiprotons are described, paying particular attention to potential sources of background. Event time history is shown to be very effective in eliminating this background. Results of laboratory tests on the timing resolution which may be achieved are presented

The Chemical Compositions of the Type II Cepheids -- The BL Her and W Vir Variables

Abundance analyses from high-resolution optical spectra are presented for 19 Type II Cepheids in the Galactic field. The sample includes both short-period (BL Her) and long-period (W Vir) stars. This is the first extensive abundance analysis of these variables. The C, N, and O abundances with similar spreads for the BL Her and W Vir show evidence for an atmosphere contaminated with $3\alpha$-process and CN-cycling products. A notable anomaly of the BL Her stars is an overabundance of Na by a factor of about five relative to their presumed initial abundances. This overabundance is not seen in the W Vir stars. The abundance anomalies running from mild to extreme in W Vir stars but not seen in the BL Her stars are attributed to dust-gas separation that provides an atmosphere deficient in elements of high condensation temperature, notably Al, Ca, Sc, Ti, and $s$-process elements. Such anomalies have previously been seen among RV Tau stars which represent a long-period extension of the variability enjoyed by the Type II Cepheids. Comments are offered on how the contrasting abundance anomalies of BL Her and W Vir stars may be explained in terms of the stars' evolution from the blue horizontal branch.Comment: 41 pages including 11 figures and 4 tables; Accepted for publication in Ap