Variation in compulsory psychiatric inpatient admission in England:a cross-sectional, multilevel analysis

Background: Rates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes. Objectives: To quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places. Design: Cross-sectional analysis using multilevel statistical modelling. Setting: England, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services. Participants: 1,287,730 patients. Main outcome measure: The study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period. Data sources: The Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers. Results: A total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models. Conclusions: This was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Processes and patterns of glacier-influenced sedimentation and recent tidewater glacier dynamics in Darbel Bay, western Antarctic Peninsula

AbstractBathymetric data of unprecedented resolution are used to provide insights into former ice dynamics and glacial processes in a western Antarctic Peninsula embayment. An assemblage of submarine glacial landforms, which includes subglacially produced streamlined features and ice-marginal ridges, reveals the former pattern of ice flow and retreat. A group of more than 250 small (< 1–3 m high, 10–20 m wide) and relatively evenly spaced recessional moraines was identified beyond the margin of Philippa Glacier. The small recessional moraines are interpreted to have been produced during short-lived, possibly annual re-advances of a grounded ice margin during overall retreat. This is the first time that these features have been shown to be part of the assemblage of landforms produced by tidewater glaciers on the Antarctic Peninsula. Glacier-terminus changes during the last four decades, mapped from LANDSAT satellite images, were analysed to determine whether the moraines were produced during recent still-stands or re-advances of Philippa Glacier and to further investigate the short-term (annual to decadal) variability in ice-marginal position in tidewater glacier systems. The asynchronous response of individual tidewater glaciers in Darbel Bay is interpreted to be controlled mainly by local topography rather than by glacier catchment-area size.C.L. Batchelor was in receipt of a Junior Research Fellowship from Newnham College, Cambridge during this work. K.A Hogan and R.D Larter are supported by the Polar Science for Planet Earth programme funded by the Natural Environment Research Council, U.K

Cavitation inception of a van der Waals fluid at a sack-wall obstacle

Cavitation in a liquid moving past a constraint is numerically investigated by means of a free-energy lattice Boltzmann simulation based on the van der Waals equation of state. The fluid is streamed past an obstacle and, depending on the pressure drop between inlet and outlet, vapor formation underneath the corner of the sack-wall is observed. The circumstances of cavitation formation are investigated and it is found that the local bulk pressure and mean stress are insufficient to explain the phenomenon. Results obtained in this study strongly suggest that the viscous stress, interfacial contributions to the local pressure, and the Laplace pressure are relevant to the opening of a vapor cavity. This can be described by a generalization of Joseph's criterion that includes these contributions. A macroscopic investigation measuring mass flow rate behavior and discharge coefficient was also performed. As theoretically predicted, mass flow rate increases linearly with the square root of the pressure drop. However, when cavitation occurs, the mass flow growth rate is reduced and eventually it collapses into a choked flow state. In the cavitating regime, as theoretically predicted and experimentally verified, the discharge coefficient grows with the Nurick cavitation number

Unique Thermal Properties of Clothing Materials.

Cloth wearing seems so natural that everyone is self-deemed knowledgeable and has some expert opinions about it. However, to clearly explain the physics involved, and hence to make predictions for clothing design or selection, it turns out to be quite challenging even for experts. Cloth is a multiphased, porous, and anisotropic material system and usually in multilayers. The human body acts as an internal heat source in a clothing situation, thus forming a temperature gradient between body and ambient. But unlike ordinary engineering heat transfer problems, the sign of this gradient often changes as the ambient temperature varies. The human body also perspires and the sweat evaporates, an effective body cooling process via phase change. To bring all the variables into analysis quickly escalates into a formidable task. This work attempts to unravel the problem from a physics perspective, focusing on a few rarely noticed yet critically important mechanisms involved so as to offer a clearer and more accurate depiction of the principles in clothing thermal comfort

Sites of Biosynthesis of Outer and Inner Membrane Proteins of Neurospora crassa Mitochondria

Outer and inner membranes of Neurospora crassa mitochondria were separated by the combined swelling, shrinking, sonication procedure. Membranes were characterized by electron microscopy and by marker enzyme activities. A red carotenoid pigment was found to be concentrated in the outer membrane. The inner mitochondrial membrane was resolved into about 20 protein bands on polyacrylamide gel electrophoresis, whereas the outer membrane shows essentially one single protein band. Only negligible incorporation of radioactive amino acids occurs into outer membrane when isolated mitochondria are synthesizing polypeptide chains. In agreement with this observation labeling of outer membrane protein is almost entirely blocked, when whole Neurospora cells are incubated with radioactive amino acids in the presence of cycloheximide, an inhibitor of cytoplasmic protein synthesis. Finally, the essential electrophoretic protein band from outer membrane does not become labeled when mitochondria are incubated with radioactive amino acids either in vitro or in vivo in the presence of cycloheximide. It is concluded that the vast majority, if not all, of the outer membrane protein is synthesized by the cytoplasmic system and that polypeptide chains formed by the mitochondrial ribosomes are integrated into the inner mitochondrial membrane

Cultural and economic complementarities of spatial agglomeration in the British television broadcasting industry: Some explorations.

This paper considers the processes supporting agglomeration in the British television broadcasting industry. It compares and contrasts the insights offered by the cultural turn in geography and more conventionally economic approaches. It finds that culture and institutions are fundamental to the constitution of production and exchange relationships and also that they solve fundamental economic problems of coordinating resources under conditions of uncertainty and limited information. Processes at a range of spatial scales are important, from highly local to global, and conventional economics casts some light on which firms are most active and successful

Healthier diet quality and dietary patterns are associated with lower risk of mobility limitation in older men

Purpose To investigate associations between diet quality, dietary patterns and mobility limitation 15 years later in a population-based sample of older British men. Methods We used longitudinal data from 1234 men from the British Regional Heart Study, mean age 66 years at baseline. Mobility limitation was defined as difficulty going up- or downstairs or walking 400 yards as a result of a long-term health problem. Dietary intake was measured using a food frequency questionnaire data from which the Healthy Diet Indicator (HDI), the Elderly Dietary Index (EDI), and three a posteriori dietary patterns were derived. The a posteriori dietary patterns were identified using principal components analysis: (1) high fat/low fibre, (2) prudent and (3) high sugar. Results Men with greater adherence to the EDI or HDI were less likely to have mobility limitation at follow-up, top vs bottom category odds ratio for the EDI OR 0.50, 95% CI 0.34, 0.75, and for the HDI OR 0.55, 95% CI 0.35, 0.85, after adjusting for age, social class, region of residence, smoking, alcohol consumption and energy intake. Men with a higher score for the high-fat/low-fibre pattern at baseline were more likely to have mobility limitation at follow-up, top vs bottom quartile odds ratio OR 3.28 95% CI 2.05, 5.24. These associations were little changed by adjusting for BMI and physical activity. Conclusion Our study provides evidence that healthier eating patterns could contribute to prevention or delay of mobility limitation in older British men

Early multi-wavelength emission from Gamma-ray Bursts: from Gamma-ray to X-ray

The study of the early high-energy emission from both long and short Gamma-ray bursts has been revolutionized by the Swift mission. The rapid response of Swift shows that the non-thermal X-ray emission transitions smoothly from the prompt phase into a decaying phase whatever the details of the light curve. The decay is often categorized by a steep-to-shallow transition suggesting that the prompt emission and the afterglow are two distinct emission components. In those GRBs with an initially steeply-decaying X-ray light curve we are probably seeing off-axis emission due to termination of intense central engine activity. This phase is usually followed, within the first hour, by a shallow decay, giving the appearance of a late emission hump. The late emission hump can last for up to a day, and hence, although faint, is energetically very significant. The energy emitted during the late emission hump is very likely due to the forward shock being constantly refreshed by either late central engine activity or less relativistic material emitted during the prompt phase. In other GRBs the early X-ray emission decays gradually following the prompt emission with no evidence for early temporal breaks, and in these bursts the emission may be dominated by classical afterglow emission from the external shock as the relativistic jet is slowed by interaction with the surrounding circum-burst medium. At least half of the GRBs observed by Swift also show erratic X-ray flaring behaviour, usually within the first few hours. The properties of the X-ray flares suggest that they are due to central engine activity. Overall, the observed wide variety of early high-energy phenomena pose a major challenge to GRB models.Comment: Accepted for publication in the New Journal of Physics focus issue on Gamma Ray Burst