Possible geopotential improvement from satellite altimetry

Possible geopotential improvement from satellite altimetr

Challenges and implications of routine depression screening for depression in chronic disease and multimorbidity: a cross sectional study

<b>Background</b> Depression screening in chronic disease is advocated but its impact on routine practice is uncertain. We examine the effects of a programme of incentivised depression screening in chronic disease within a UK primary care setting.<p></p> <b>Methods and Findings</b> Cross sectional analysis of anonymised, routinely collected data (for 2008-9) from family practices in Scotland serving a population of circa 1.8 million. Patients registered in primary care with at least one of three chronic diseases, coronary heart disease, diabetes and stroke, underwent incentivised depression screening using the Hospital Anxiety and Depression Score (HADS). <p></p> 125143 patients were identified with at least one chronic disease. 10670 (8.5%) were under treatment for depression and exempt from screening. Of the remaining, HADS were recorded for 35537 (31.1%) patients. 7080 (19.9% of screened) had raised HADS (≥8); the majority had indications of mild depression with a HADS between 8 and 10. Over 6 months, 572 (8%) of those with a raised HADS (≥8) were initiated on antidepressants, while 696 (2.4%) patients with a normal HADS (<8) were also initiated on antidepressants (relative risk of antidepressant initiation with raised HADS 3.3 (CI 2.97-3.67), p value <0.0001). Of those with multimorbidity who were screened, 24.3% had a raised HADS (≥8). A raised HADS was more likely in females, socioeconomically deprived, multimorbid or younger (18-44) individuals. Females and 45-64 years old were more likely to receive antidepressants.<p></p> <b>Limitations</b> – retrospective study of routinely collected data.<p></p> <b>Conclusions </b> Despite incentivisation, only minority of patients underwent depression screening, suggesting that systematic depression screening in chronic disease can be difficult to achieve in routine practice. Targeting those at greatest risk such as the multimorbid or using simpler screening methods may be more effective. Raised HADS was associated with a higher number of new antidepressant prescriptions which has significant resource implications. The clinical benefits of such screening remain uncertain and merit investigation

Microspectroscopy and Imaging in the THz Range Using Coherent CW Radiation

A novel THz near-field spectrometer is presented which allows to perform biological and medical studies with high spectral resolution combined with a spatial resolution down to l/100. In the setup an aperture much smaller than the used wavelength is placed in the beam very close to the sample. The sample is probed by the evanescent wave behind the aperture. The distance is measured extremely accurate by a confocal microscope. We use monochromatic sources which provide powerful coherent cw radiation tuneable from 50 GHz up to 1.5 THz. Transmission and reflection experiments can be performed which enable us to study solids and molecules in aqueous solution. Examples for spectroscopic investigations on biological tissues are presented.Comment: 4 pages, 5 figures, email: [email protected]

The Community Order and the Suspended Sentence Order: The views and attitudes of sentencers

On 4 April 2005 two new sentences for adults aged 18 and above became available to the courts in England and Wales: the Community Order and the Suspended Sentence Order (SSO). Both sentences are intended to narrow the custody/community divide, and therefore are important factors for the development of the National Offender Management Service (NOMS). Both are also intended to offer more robust, demanding and credible alternatives to short custodial sentences, thereby contributing to reductions in the prison population which, at 16 May 2008, stood at 82,682.1 Both should be served in the community and both have the same number of requirements available. Essentially, the Community Order is a restructuring of what were the available community sentences – the Community Rehabilitation Order (CRO), the Community Punishment Order (CPO), the Community Punishment and Rehabilitation Order (CPRO), the Drug Treatment and Testing Order (DTTO), the Curfew Order and the Attendance Centre Order – and the various conditions that could be attached to the CRO and the CPRO. The SSO, on the other hand, can be seen as an attempt to revive the old-style suspended sentence by adding conditions to it

The Use & Impact of The Community Order & The Suspended Sentence Order

This is the first in a series of reports as part of the Centre for Crime and Justice Studies Community Sentences project. The project was initially established to investigate and monitor the new Community Order introduced in the Criminal Justice Act 2003 by providing good quality, objective information about the way it was used and managed during a period of great change following the creation of the National Offender Management Service(NOMS). However, as this report demonstrates, soon after the implementation of the Community Order on 4 April 2005, it became clear that the new Suspended Sentence Order, sometimes referred to as ‘custody minus’, was playing a significant role in sentencing and impacting directly on the work of the Probation Service. The project’s remit was therefore expanded to examine the Suspended Sentence Order. These new sentences raise significant issues for the courts, the Probation Service, the wider penal system, and, of course, the offenders who are sentenced. For the courts, they represent a new approach to sentencing that involves delivering a preliminary indication of seriousness prior to the preparation of a pre-sentence report and juggling with a range of possible requirements that can make up either order. For the Probation Service, the arrival of the Community Order and the Suspended Sentence Order, although legally the latter is a custodial sentence, signals the end of operating a variety of different sentences and facing up to the challenges of a single order with a range of possible requirements. With regard to the wider criminal justice system, both sentences – and the Suspended Sentence Order in particular – are part of an attempt to narrow the custody/community divide alongside the creation of a combined prison and probation structure under the National Offender Management Service.1 It is also worth noting that they are both intended to affect the custody rate and to address the issue of uptariffing2 highlighted by the Carter report (Carter 2003) and accepted by the government (Home Office 2004a). For offenders, there is the challenge of understanding and reacting positively to the new sentences which are made up of separate parts, and which may appear fragmented and therefore operate less effectively than they might. The introduction of new court sentences is always a significant event (cf. the Community Service Order, the Combination Order, the Drug Treatment and Testing Order), but the arrival of the Community Order and the Suspended Sentence Order signals a radical and profound change with considerable implications. This report begins by exploring the background to the new sentences and their origins. It looks at the aims of the sentences and the possible problems that may emerge. It presents an analysis of the available sentencing data in order to examine how the sentences are being used (it should be noted that it is still early days for the new sentences) and examines probation officer views about the orders. Finally, it draws conclusions about the extent of the changes that have occurred so far as a result of the introduction of the new orders

From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument

<b>Background</b> Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.<p></p> <b>Methods</b> A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.<p></p> <b>Results</b> The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.<p></p> <b>Conclusions</b> To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study

Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol

<b>Background</b> Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.<p></p> <b>Objectives</b> The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures.<p></p> <b>Methods</b> A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings.<p></p> <b>Discussion</b> The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices