Developing the mental health workforce capacity in primary care: implementing the role of graduate primary care mental health workers in England

The scale of current demand on primary care services from people seeking help with common mental health problems places enormous pressure on the existing front line workers in general practice. The paucity of training opportunities and competing pressures to deliver improved services across a range of general practice targets remains a major challenge for primary care professionals. The impact of government policy, to improve both access to and choice of treatments, has raised public expectations. The commissioning of the graduate workforce, the graduate worker in primary care mental health(GWPCMH), commenced in 2002, in response to the publication of target numbers detailed in the Priorities and Planning Framework, (DoH, 2002). It signalled a determination to expand the workforce provision and improve the quality of care for service users with common mental health problems. This paper examines the scale of common mental health problems, the policy response and the commissioning process. Particular attention is given to examining the barriers that have been shown to affect implementation, identifying the key influencers and the resources required to train these workers

Why were New Zealand levels of life-expectation so high at the dawn of the twentieth century?

With population ageing becoming an issue of major importance for societies in the developed countries, in both the scientific and policy communities there is widespread interest in the determinants of these structural changes. The focus has been on declines in fertility, arguably the major causal factor, but increasingly analyses are turning to the other major determinant, improving survivorship. This paper relates to this aspect of ageing but not to fertility per se

Differential trends in the compression of mortality: Assessing the antecedents to current gaps in health expectancy in New Zealand

Health Expectancies (HEs) for New Zealand show significant differentials between Maori and non-Maori, but also by gender and period. These differentials correlate with findings from both generation and synthetic life-tables relating to New Zealand’s epidemiologic transition. At the beginning of that transition quartile 1 (Q(1)), and Median (Med) d(x) values were close and centred at young ages; during the transition the gap became very wide; at the transition’s end the gap again narrowed. Cohort and synthetic trends in d(x), l(x), M, Qs and Meds are reviewed and linked to recent HEs. Data point to epidemic polarisation. Cohort analysis allows the evaluation of the role of past experiences on the recent HEs, and thus point to possible strategies for reducing gaps in both d(x), and HEs

Development Of Fuzzy Logic Model For Turning Process Of Steel Alloy And Titanium Alloys

The study is about the application of fuzzy logic in representing the machinability data for the turning process. Machining is a very complex process with respect to the influences of the machining parameters such as cutting speed, feed rate, and depth of cut. In order to perform a good machining practice the proper selection of the machinability data, which includes the machining parameters and cutting tools is very important. Normally, the selection of the machinability data is done by the skilled machinist. The manufacturer may face trouble without the presence of the skilled machinists. Thus, there is a necessity to represent the knowledge of the skilled machinists into model, so that any normal machinists will be able to perform a good machining practice by retrieving the information which prescribed in the model. Consequently, fuzzy logic was chosen as a tool to describe the strategy and action of the skilled machinist. In this study, two types of fuzzy models for different workpiece material have been developed, and they are alloy steel and titanium alloys fuzzy models. Both fuzzy models serve the purpose of predicting the appropriate cutting speed and feed rate with respect to the corresponding input variables. Generally, the development of fuzzy model involves the design of three main elements, which are inputs membership functions, fuzzy rules (inference mechanism), and output membership functions. So far, there is no any clear procedure that can be used to develop these three elements. Thus, the strategy for generalizing the development of alloy steel fuzzy model has been suggested. This strategy is useful and less effort is required for developing a related new fuzzy models. The design of fuzzy rules is always the difficult part in developing the fuzzy model due to the tedious way of defining fuzzy rules with the conventional method. Therefore, a new method of developing fuzzy rules, namely fuzzy rule mapping has been introduced and implemented. Through fuzzy rule mapping method, the effort and the time required in developing the fuzzy rules has been reduced. This method has been applied in the developing the fuzzy model for alloy steel. All the predicted outputs (cutting speed and feed rate) from the alloy steel (with general strategy and fuzzy rule mapping) and titanium alloys fuzzy models were being compared with the data obtained from “Machining Data Handbook”, by Metcut Research Associate, and a good match have been obtained throughout the comparison. The average percentage errors for alloy steel fuzzy models with the implementation of general strategy and fuzzy rule mapping are about the ranges of 3.1% to 5.6% and 3.0% to 10.7%, respectively. On the other hand, the average percentage error for titanium alloys fuzzy model is about 1.8% to 5.1%. These results have showed that the machinability data information for the turning of alloy steel and titanium alloys can be represented by fuzzy model. Besides that, it has also proved the feasibility of using the suggested strategy and fuzzy rule mapping method

Strongly-interacting fermions in an optical lattice

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Physics, 2007.Includes bibliographical references (p. 131-138).Two sets of studies are described in this thesis. The first describes studies conducted with sodium Bose-Einstein condensates (BEC) while the second focuses on the pairing of fermionic lithium-6 pairs in an optical lattice within the strongly interacting BEC-BCS regime. Common to both sets of studies is the use of a magnetically tunable Feshbach resonance to manipulate interactions between the atoms. In the first experiment, we destabilize a sodium BEC by switching its interactions from repulsive to attractive and studied the resulting dynamics. A local amplification of low momentum energetic instabilities was observed and the measured rate of amplification agreed well with theoretical predictions. For large condensates, this process depleted the condensate faster than the global inward collapse. Subsequently, I describe the major construction effort that was undertaken to convert our BEC machine to a two-species machine capable of cooling fermionic lithium-6. Upon its completion, we obtained a resonance superfluid of loosely bound 6Li pairs in the BECBCS crossover. When placed in a shallow optical lattice, long range phase coherence of this resonance superfluid was inferred from the presence of sharp interference peaks after ballistic expansion. With this observation we have obtained the first evidence of superfluidity of fermions in an optical lattice. A loss in phase coherence occurred when the lattice depth was increased past a critical value, possibly signaling a transition to an insulating state. Further preliminary explorations of this novel system is described followed by an outline of its potential for studying condensed matter phenomena like high temperature superconductivity.by Jit Kee Chin.Ph.D

Microarray Analyses of Grain Filling in Malaysian Indica Rice Varieties (Oryza Sativa L.) Mr84 And Mr219

Rice is a dominant staple food in Asia, including Malaysia. In this study, microarray analysis has been undertaken to identify the genes that were expressed at different stages of rice grain filling in MR219 and MR84 as it is a vital factor that affects the yield of rice directly. Two microarrays were used in this present study: cDNA microarray developed from 3840 PCR-amplified cDNAs from flag leaves and panicles; and commercial NSF 20 K rice oligonucleotide array. cDNA microarray analysis of panicles at 1, 5, 10 and 15 days after heading (DAH) of MR219 compared to heading revealed that a high proportion of storage proteins (glutelin and prolamin) were differentially expressed at 5, 10 and 15 DAH compared to heading in MR219. To compare the expressed genes in MR219 and MR84 at early grain filling period (5 and 10 DAH), microarray data generated from NSF 20K rice oligonucleotide array was analyzed using limmaGUI. Differentially expressed genes at 5-10 DAH from both MR219 and MR84 exhibited diversified functions, suggesting that rice grain filling is a complex biological process involving many different biochemical pathways. Genes encoding transcripts related to transcriptional regulation and signal transduction were differentially expressed at 5 and 10 DAH. In MR84, transcriptional factor EREBP, ethylene receptor, ERF-like protein and 1-aminocyclopropane-1-carboxylate oxidase 1 were up-regulated at 10 DAH while other transcription factors such as RING finger, zinc finger, GRAS family transcription factor were up-regulated in MR219. The up-regulation of genes related to sugar signaling and sensing may correlate to the assimilate partitioning and transport which occurred during 5-10 DAH in both varieties. Changes in gene expression caused by „varieties‟ and „developmental stage‟ effects involved transcripts related to stress and defense response, signal transduction and assimilate transportation in MR84 only. The expression patterns of 2 out of 3 selected genes examined were consistent when analyzed with microarray and RT-PCR. Southern analyses showed that putative ethylene responsive transcriptional coactivator and putative ABI3 interacting protein 2 may exist in more than one copy in the genome of both MR84 and MR219 whereas putative BRASSINOSTEROID INSENSITIVE 1-associated receptor kinase 1 precursor may be a single copy gene in both varieties. Real time RT-PCR analysis demonstrated that putative BRASSINOSTEROID INSENSITIVE 1-associated receptor kinase 1 precursor and putative ethylene responsive transcriptional coactivator were differentially expressed at heading, fertilized and 9-12 DAH compared to booting in MR84 and MR219

Population Ageing and Government Health Expenditures in New Zealand, 1951-2051

The paper uses a simulation model to assess the effects of population ageing on government health expenditures in New Zealand. Population ageing is defined to include disability trends and “distance to death”; government health expenditures are defined to include both acute and long-term care. The model results suggest that population ageing is associated with a large increase in expenditure share of people aged 65 and over, which rises from about 29% of total government health expenditure in 1951 to 63% in 2051. Analysis of demographic and health trends over the period 1951 to 2002 suggests, however, that these trends account for only a small proportion of the total growth in health expenditure. Most expenditure growth is attributable to other factors, such as an expansion in the range of treatments provided, and increases in input prices such as wages. Growth in this non-demographic component of health expenditures has reached 3-4% per year over recent years. Projection results for the period 2002 to 2051 suggest that restraining government expenditure on health to 6-12% of GDP would require long-run growth rates for the non-demographic component of health expenditure that are significantly lower than current rates. In other words, future demographic changes may be less threatening than is often assumed, but it would still not be possible to maintain current growth rates for government health expenditure and avoid substantial increases in the ratio between expenditure and GDP.Fiscal projections; Government health expenditure; Health status; New Zealand

Methodological Challenges to Economic Evaluations of Vaccines: Is a Common Approach Still Possible?

Economic evaluation of vaccination is a key tool to inform effective spending on vaccines. However, many evaluations have been criticised for failing to capture features of vaccines which are relevant to decision makers. These include broader societal benefits (such as improved educational achievement, economic growth and political stability), reduced health disparities, medical innovation, reduced hospital beds pressures, greater peace of mind and synergies in economic benefits with non-vaccine interventions. Also, the fiscal implications of vaccination programmes are not always made explicit. Alternative methodological frameworks have been proposed to better capture these benefits. However, any broadening of the methodology for economic evaluation must also involve evaluations of non-vaccine interventions, and hence may not always benefit vaccines given a fixed health-care budget. The scope of an economic evaluation must consider the budget from which vaccines are funded, and the decision-maker's stated aims for that spending to achieve

A two-dimensional (2D) potential distribution model for the short gate-length ion-implanted GaAs mesfets under dark and illuminated conditions

An analytical 2D model to predict the potential distribution of short-channel ionimplanted GaAs MESFETs has been presented. The 2D potential distribution in the channel of the short-channel device has been obtained by solving the 2D Poisson’s equation in conjunction with suitable boundary conditions using superposition method. The remarkable feature of the proposed model is that the implanted doping profile has been treated in completely analytical manner. A double-integrable Gaussian-like function has been assumed as the doping distribution profile in the vertical direction of the channel. The effects of excess carrier generation due to the incident optical radiation in channel region have been included in the Poisson’s equation to study the optical effects on the device. The photovoltage developed across the gate metal has also been modeled. The proposed model has been verified by comparing the theoretically predicted results with simulated data obtained by using the commercially available ATLASTM2D device simulator. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/2785

Religion as an Unemployment Insurance and the Basis of Support for Public Safety Nets: The Case of Latin America and the Caribbean

This paper explores the role of religion in mitigating the degree to which unemployment reduces subjective well-being and it examines its support of social programs. The paper goes beyond existing literature in three ways: It extends existing literature to Latin America and Caribbean countries; it explicitly includes analysis of two confounders (social capital and personal traits) ignored in existing literature; and it moves beyond correlation by using the propensity score method to tease out a causal relation between religion and well-being. We find that religion acts as a buffer: Unemployed religious people are relatively happier than are nonreligious unemployed people. However, in contrast with the existing literature, we find that religious people are relatively more supportive of public social policy