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

Simulating Impacts of Extreme Weather Events on Urban Transport Infrastructure in the UK

Urban areas face many risks from future climate change and their infrastructure will be placed under more pressure due to changes in climate extremes. Using the Tyndall Centre Urban Integrated Assessment Framework, this paper describes a methodology used to assess the impacts of future climate extremes on transport infrastructure in London. Utilising high-resolution projections for future climate in the UK, alongside stochastic weather generators for downscaling, urban temperature and flooding models are used to provide information on the likelihood of future extremes. These are then coupled with spatial network models of urban transport infrastructure and, using thresholds to define the point at which systems cease to function normally, disruption to the networks can be simulated. Results are shown for both extreme heat and urban surface water flooding events and the impacts on the travelling population, in terms of both disruption time and monetary cost

Mental Health of Children and Young People in England, 2017: Trends and characteristics

This survey series provides England’s best source of data on trends in child mental health. Emotional, behavioural, hyperactivity, and other types of mental disorder were assessed in 5 to 15 year olds in 1999, 5 to 16 year olds in 2004, and 5 to 19 year olds in 2017. One in eight (12.8%) 5 to 19 year olds had a mental disorder when assessed in 2017. Rates were similar in boys and girls. Data for 5 to 15 year olds show a slight upward trend over time in the prevalence of emotional disorders.Rates for behavioural, hyperactivity and other disorders have remained broadly stable

Brownian Motion in Robertson-Walker Space-Times from electromagnetic Vacuum Fluctuations

We consider classical particles coupled to the quantized electromagnetic field in the background of a spatially flat Robertson-Walker universe. We find that these particles typically undergo Brownian motion and acquire a non-zero mean squared velocity which depends upon the scale factor of the universe. This Brownian motion can be interpreted as due to non-cancellation of anti-correlated vacuum fluctuations in the time dependent background space-time. We consider several types of coupling to the electromagnetic field, including particles with net electric charge, a magnetic dipole moment, and electric polarizability. We also investigate several different model scale factors.Comment: 29 pages, 7 figure

Quantum Inequalities and Singular Energy Densities

There has been much recent work on quantum inequalities to constrain negative energy. These are uncertainty principle-type restrictions on the magnitude and duration of negative energy densities or fluxes. We consider several examples of apparent failures of the quantum inequalities, which involve passage of an observer through regions where the negative energy density becomes singular. We argue that this type of situation requires one to formulate quantum inequalities using sampling functions with compact support. We discuss such inequalities, and argue that they remain valid even in the presence of singular energy densities.Comment: 18 pages, LaTex, 2 figures, uses eps

A Preliminiary Investigation to Determine the Economic Implications of the 404 Permit for Constructing Agriculturally Related Reservoirs in Arkansas

A descriptive inquiry of the economic consequences of federal regulations which restrict the construction of agriculturally related reservoirs in Arkansas\u27s wetlands is presented in this report. The applicable economic principles are identifyed and applied to the situation without the quantifiable information necessary to evaluate the alternatives. The difficulty of collecting the required quantifiable information necessitates the formulation of a different technique to unravel the dilemma. An alternative method for resolving the wetlands allocation question is presented for a public sector decision maker. This unconventional technique suggests that it may be desirable to estimate and compare the costs associated with the possible errors of a wetlands land use regulation in terms of both their consequences and likelihood

Nevirapine- and efavirenz-associated hepatotoxicity under programmatic conditions in Kenya and Mozambique.

To describe the frequency, risk factors, and clinical signs and symptoms associated with hepatotoxicity (HT) in patients on nevirapine- or efavirenz-based antiretroviral therapy (ART), we conducted a retrospective cohort analysis of patients attending the ART clinic in Kibera, Kenya, from April 2003 to December 2006 and in Mavalane, Mozambique, from December 2002 to March 2007. Data were collected on 5832 HIV-positive individuals who had initiated nevirapine- or efavirenz-based ART. Median baseline CD4+ count was 125 cells/μL (interquartile range [IQR] 55-196). Over a median follow-up time of 426 (IQR 147-693) days, 124 (2.4%) patients developed HT. Forty-one (54.7%) of 75 patients with grade 3 HT compared with 21 (80.8%) of 26 with grade 4 had associated clinical signs or symptoms (P = 0.018). Four (5.7%) of 124 patients with HT died in the first six months compared with 271 (5.3%) of 5159 patients who did not develop HT (P = 0.315). The proportion of patients developing HT was low and HT was not associated with increased mortality. Clinical signs and symptoms identified 50% of grade 3 HT and most cases of grade 4 HT. This suggests that in settings where alanine aminotransferase measurement is not feasible, nevirapine- and efavirenz-based ART may be given safely without laboratory monitoring

Previously Claimed(/Unclaimed) X-ray Emission Lines in High Resolution Afterglow Spectra

We review the significance determination for emission lines in the Chandra HETGS spectrum for GRB020813, and we report on a search for additional lines in high resolution Chandra spectra. No previously unclaimed features are found. We also discuss the significance of lines sets reportedly discovered using XMM data for GRB011211 and GRB030227. We find that these features are likely of modest, though not negligible, significance.Comment: 4 pages, 1 figures, to appear in Santa Fe GRB Conference Proceedings, 200

Chandra Observations of the Optically Dark GRB030528

The X-ray-rich GRB030528 was detected by the HETE satellite and its localization was rapidly disseminated. However, early optical observations failed to detect a counterpart source. In a 2-epoch ToO observation with Chandra, we discovered a fading X-ray source likely counterpart to GRB030528. The source brightness was typical of X-ray afterglows observed at similar epochs. Other observers detected an IR source at a location consistent with the X-ray source. The X-ray spectrum is not consistent with a large absorbing column.Comment: 4 pages, 1 figures, to appear in Santa Fe GRB Conference Proceedings, 200

Quantum interest in two dimensions

The quantum interest conjecture of Ford and Roman asserts that any negative-energy pulse must necessarily be followed by an over-compensating positive-energy one within a certain maximum time delay. Furthermore, the minimum amount of over-compensation increases with the separation between the pulses. In this paper, we first study the case of a negative-energy square pulse followed by a positive-energy one for a minimally coupled, massless scalar field in two-dimensional Minkowski space. We obtain explicit expressions for the maximum time delay and the amount of over-compensation needed, using a previously developed eigenvalue approach. These results are then used to give a proof of the quantum interest conjecture for massless scalar fields in two dimensions, valid for general energy distributions.Comment: 17 pages, 4 figures; final version to appear in PR