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

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

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

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&

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

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

High resolution Cherenkov detectors for cosmic ray isotope experiment

Cerenkov detectors are used to measure the velocity of particles in configurations designed to study the isotopic composition of galactic cosmic rays. The geometrical properties of the detector are outlined. Monte-Carlo simulations of photon propagation in a diffusive detector were undertaken. The scattering properties of diffusively reflecting white paint and of surface treatments for the radiator material were measured. It is found that the absorption of light in the radiator is an important light loss mechanism. The simulations are used to find optimal mapping techniques and data reduction strategies. The application of these techniques are discussed with respect to the large area isotopic composition experiment (ALICE) Cerenkov detector

Trajectories of loneliness and objective social isolation and associations between persistent loneliness and self-reported personal recovery in a cohort of secondary mental health service users in the UK

Background: Loneliness is a frequent and distressing experience among people with mental health problems. However, few longitudinal studies have so far investigated the trajectories of loneliness and objective social isolation, and the extent to which both issues may impact mental health outcomes among mental health service users. Therefore, this study aims to describe the trajectories of loneliness and objective social isolation and their associations with self-rated personal recovery among people leaving crisis resolution teams (CRTs). Methods: A total of 224 participants receiving care from CRTs (recruited for a large multi-site randomised controlled trial) were included in this longitudinal cohort study. They completed the eight-item University of California at Los Angeles Loneliness Scale (ULS-8), Lubben-Social Network Scale (LNSN-6), and the Questionnaire about the Process of Recovery (QPR) (primary outcome) at baseline, 4- and 18-month follow-up, as well as baseline sociodemographic and clinical variables. Results: We compared groups who were persistently lonely (at all time points), intermittently lonely (at one or two time points) and never lonely. After adjusting for all potential confounders and baseline predictive variables, persistent severe loneliness was associated with worse personal recovery at 18-month follow-up compared with the never lonely (reference group) (coef. = − 12.8, 95% CI -11.8, − 3.8, p < .001), as was being intermittently lonely (coef. = − 7.8, 95% CI -18.8, − 6.8, p < .001). The persistently objectively social isolated group (coef. = − 9.8, 95% CI -15.7, − 3.8, p = .001) also had poorer self-rated recovery at 18-month follow-up than those who were not socially isolated at any timepoint (i.e., reference category). Conclusion: Results suggest that both persistent loneliness and objective social isolation are associated with poorer self-rated recovery following a crisis, compatible with a causal relationship. These findings suggest a potential role for interventions aimed at alleviating loneliness and objective social isolation in improving recovery outcomes for people with mental health symptoms. Increased awareness of both issues among health practitioners is also warranted

Loneliness in early psychosis: a qualitative study exploring the views of mental health practitioners in early intervention services

BACKGROUND: Loneliness is an important public health problem with established adverse effects on physical and mental health. Although people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions. METHODS: Semi-structured face-to-face interviews were conducted with mental health practitioners (n = 20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted. RESULTS: Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. CONCLUSIONS: This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions