Evaluation of the Primary Care Mental Health Specialist role: Final Report

This report details an evaluation to assess the impact of the new primary care mental health specialist (PCMHS) role in Kent and Medway. The evaluation was undertaken by the Centre for Health Services Studies (CHSS) at the University of Kent and was conducted June 2013 to December 2014. The evaluation was commissioned by NHS Kent and Medway and supported by Kent and Medway Commissioning Support. The evaluation encompasses six CCG areas across Kent and Medway, with 13 PCMHS employed in these areas (see Table 1-1 for breakdown). The number of posts per CCG is dependent on the amount CCGs invest (roughly equating to population size), rather than prevalence of illness. The PCMHS have been seconded from Kent and Medway NHS and Social Care Partnership Trust (KMPT) for the duration of the pilot, and are either community psychiatric nurses (CPN) or occupational therapists (OT) by profession. The majority of PCMHS are hosted by a voluntary organisation (mcch); three are hosted by GP practices and two by a community Interest Company, Invicta CIC. The main objectives of the evaluation are: 1. To assess the impact on patients by capturing their experience of the service; 2. To assess the impact by capturing experiences of those delivering the service (i.e., PCMHS); 3. To assess the impact by capturing experiences of other professions who work alongside the service (i.e., mental health professionals in secondary care, GPs); 4. To assess the economic cost of the new service via a unit cost analysis

Filler bar heating due to stepped tiles in the shuttle orbiter thermal protection system

An analytical study was performed to investigate the excessive heating in the tile to tile gaps of the Shuttle Orbiter Thermal Protection System due to stepped tiles. The excessive heating was evidence by visible discoloration and charring of the filler bar and strain isolation pad that is used in the attachment of tiles to the aluminum substrate. Two tile locations on the Shuttle orbiter were considered, one on the lower surface of the fuselage and one on the lower surface of the wing. The gap heating analysis involved the calculation of external and internal gas pressures and temperatures, internal mass flow rates, and the transient thermal response of the thermal protection system. The results of the analysis are presented for the fuselage and wing location for several step heights. The results of a study to determine the effectiveness of a half height ceramic fiber gap filler in preventing hot gas flow in the tile gaps are also presented

Local light-ray rotation

We present a sheet structure that rotates the local ray direction through an arbitrary angle around the sheet normal. The sheet structure consists of two parallel Dove-prism sheets, each of which flips one component of the local direction of transmitted light rays. Together, the two sheets rotate transmitted light rays around the sheet normal. We show that the direction under which a point light source is seen is given by a Mobius transform. We illustrate some of the properties with movies calculated by ray-tracing software.Comment: 9 pages, 6 figure

Biochemical and metabolic effects of a six- month exposure of small animals to a helium- oxygen atmosphere

Biochemical and metabolic effects of exposure of mice to helium-oxygen atmospher

Objective cough frequency in Idiopathic Pulmonary Fibrosis

Background: Cough is a common presenting symptom in patients with Idiopathic Pulmonary Fibrosis (IPF). This study measured cough rates in IPF patients and investigated the association between cough and measures of health related quality of life and subjective cough assessments. In addition, IPF cough rates were related to measures of physiological disease severity and compared to cough rates in health and other respiratory conditions.Methods: Nineteen IPF patients, mean age 70.8 years ± 8.6, five female (26.3%) were studied. Subjects performed full pulmonary function testing, 24 hour ambulatory cough recordings, completed a cough related quality of life questionnaire (Leicester Cough Questionnaire) and subjectively scored cough severity with a visual analogue scale. Ambulatory cough recordings were manually counted and reported as number of coughs per hour.Results: The 24hr cough rates were high (median 9.4, range 1.5-39.4), with day time rates much higher than night time (median 14.6, range 1.9-56.6 compared to 1.9, range 0-19.2, p = 0.003). Strong correlations were found between objective cough frequency and both the VAS (day r = 0.80, p &lt; 0.001, night r = 0.71, p = 0.001) and LCQ (r = -0.80, p &lt; 0.001), but not with measures of pulmonary function. Cough rates in IPF were higher than healthy subjects (p &lt; 0.001) and asthma patients (p &lt; 0.001) but similar to patients with chronic cough (p = 0.33).Conclusions: This study confirms objectively that cough is a major, very distressing and disabling symptom in IPF patients. The strong correlations between objective cough counts and cough related quality of life measures suggest that in IPF patient's, perception of cough frequency is very accurate.</p

Straw Decomposition

When straw is plowed into moist warm soil, the straw almost immediately begins to decompose. Billions of microorganisms that are always living in fertile soils use the straw for energy and mineral nutrients that they require for growth and reproduction. Nitrogen is one of the nutrients and it is frequently in short supply in straw. During straw decomposition the microorganisms use the nitrogen and conserve it very efficiently while much of the carbon in the straw is used and given off as carbon dioxide. Under conditions of extreme nitrogen deficiency, decomposition may be slowed from lack of nitrogen

Consequences of warming and acidification for the temperate articulated coralline alga, Calliarthron tuberculosum (Florideophyceae, Rhodophyta)

Global climate changes, such as warming and ocean acidification (OA), are likely to negatively impact calcifying marine taxa. Abundant and ecologically important coralline algae may be particularly susceptible to OA; however, multi-stressor studies and those on articulated morphotypes are lacking. Here, we use field observations and laboratory experiments to elucidate the impacts of warming and acidification on growth, calcification, mineralogy, and photophysiology of the temperate articulated coralline alga, Calliarthron tuberculosum. We conducted a 4-week fully factorial mesocosm experiment exposing individuals from a southern CA kelp forest to current and future temperature and pH/pCO2 conditions (+2°C, −0.5 pH units). Calcification was reduced under warming (70%) and further reduced by high pCO2 or high pCO2 x warming (~150%). Growth (change in linear extension and surface area) was reduced by warming (40% and 50%, respectively), high pCO2 (20% and 40%, respectively), and high pCO2 x warming (50% and 75%, respectively). The maximum photosynthetic rate (Pmax) increased by 100% under high pCO2 conditions, but we did not detect an effect of pCO2 or warming on photosynthetic efficiency (α). We also did not detect the effect of warming or pCO2 on mineralogy. However, variation in Mg incorporation in cell walls of different cell types (i.e., higher mol % Mg in cortical vs. medullary) was documented for the first time in this species. These results support findings from a growing body of literature suggesting that coralline algae are often more negatively impacted by warming than OA, with the potential for antagonistic effects when factors are combined

An algorithm for the direct reconstruction of the dark matter correlation function from weak lensing and galaxy clustering

The clustering of matter on cosmological scales is an essential probe for studying the physical origin and composition of our Universe. To date, most of the direct studies have focused on shear-shear weak lensing correlations, but it is also possible to extract the dark matter clustering by combining galaxy-clustering and galaxy-galaxy-lensing measurements. In this study we develop a method that can constrain the dark matter correlation function from galaxy clustering and galaxy-galaxy-lensing measurements, by focusing on the correlation coefficient between the galaxy and matter overdensity fields. To generate a mock galaxy catalogue for testing purposes, we use the Halo Occupation Distribution approach applied to a large ensemble of N-body simulations to model pre-existing SDSS Luminous Red Galaxy sample observations. Using this mock catalogue, we show that a direct comparison between the excess surface mass density measured by lensing and its corresponding galaxy clustering quantity is not optimal. We develop a new statistic that suppresses the small-scale contributions to these observations and show that this new statistic leads to a cross-correlation coefficient that is within a few percent of unity down to 5 Mpc/h. Furthermore, the residual incoherence between the galaxy and matter fields can be explained using a theoretical model for scale-dependent bias, giving us a final estimator that is unbiased to within 1%. We also perform a comprehensive study of other physical effects that can affect the analysis, such as redshift space distortions and differences in radial windows between galaxy clustering and weak lensing observations. We apply the method to a range of cosmological models and show the viability of our new statistic to distinguish between cosmological models.Comment: 23 pages, 14 figures, accepted by PRD; minor changes to V1, 1 new figure, more detailed discussion of the covariance of the new ADSD statisti

Forecasting Economic and Financial Variables with Global VARs

This paper considers the problem of forecasting real and financial macroeconomic variables across a large number of countries in the global economy. To this end a global vector autoregressive (GVAR) model previously estimated over the 1979Q1-2003Q4 period by Dees, di Mauro, Pesaran, and Smith (2007), is used to generate out-of-sample one quarter and four quarters ahead forecasts of real output, inflation, real equity prices, exchange rates and interest rates over the period 2004Q1-2005Q4. Forecasts are obtained for 134 variables from 26 regions made up of 33 countries covering about 90 % of world output. The forecasts are compared to typical benchmarks: univariate autoregressive and random walk models. Building on the forecast combination literature, the effects of model and estimation uncertainty on forecast outcomes are examined by pooling forecasts obtained from different GVAR models estimated over alternative sample periods. Given the size of the modelling problem, and the heterogeneity of economies considered — industrialised, emerging, and less developed countries — as well as the very real likelihood of possibly multiple structural breaks, averaging forecasts across both models and windows makes a significant difference. Indeed the double-averaged GVAR forecasts perform bette