How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of self-referral is understood and responded to by such patients. Aims: This paper examines how IAPT referrals are made by GPs and how these referrals are perceived and acted on by patients from low-income backgrounds Method: Findings are drawn from in-depth interviews with low-income patients experiencing mental distress (n = 80); interviews with GPs (n = 10); secondary analysis of video-recorded GP-patient consultations for mental health (n = 26). Results: GPs generally supported self-referral, perceiving it an important initial step towards patient recovery. Most patients however, perceived self-referral as an obstacle to accessing IAPT, and felt their mental health needs were being undermined. The way that IAPT was discussed and the pathway for referral appears to affect uptake of these services. Conclusions: A number of factors deter low-income patients from self-referring for IAPT. Understanding these issues is necessary in enabling the development of more effective referral and support mechanisms within primary care

The suppression of fluorescence peaks in energy-dispersive X-ray diffraction

A novel method to separate diffraction and fluorescence peaks in energy- dispersive X-ray diffraction (EDXRD) is described. By tuning the excitation energy of an X-ray tube source to just below an elemental absorption edge, the corresponding fluorescence peaks of that element are completely suppressed in the resulting spectrum. Since Bremsstrahlung photons are present in the source spectrum up to the excitation energy, any diffraction peaks that lie at similar energies to the suppressed fluorescence peaks are uncovered. This technique is an alternative to the more usual method in EDXRD of altering the scattering angle in order to shift the energies of the diffraction peaks. However, in the back-reflection EDXRD technique [Hansford (2011). J. Appl. Cryst. 44, 514–525] changing the scattering angle would lose the unique property of insensitivity to sample morphology and is therefore an unattractive option. The use of fluorescence suppression to reveal diffraction peaks is demonstrated experimentally by suppressing the Ca K fluorescence peaks in the back-reflection EDXRD spectra of several limestones and dolomites. Three substantial benefits are derived: uncovering of diffraction peak(s) that are otherwise obscured by fluorescence; suppression of the Ca K escape peaks; and an increase in the signal-to-background ratio. The improvement in the quality of the EDXRD spectrum allows the identification of a secondary mineral in the samples, where present. The results for a pressed-powder pellet of the geological standard JDo-1 (dolomite) show the presence of crystallite preferred orientation in this prepared sample. Preferred orientation is absent in several unprepared limestone and dolomite rock specimens, illustrating an advantage of the observation of rocks in their natural state enabled by back-reflection EDXRD

A prototype ASIC for APD array readout of scintillating plastic fibers

We report on the development of custom front-end electronics for use with avalanche photodiode (APD) arrays as part of a NASA technology study for the readout of scintillating plastic fibers. APD arrays featuring 64 1 mm square pixels are used. We demonstrate that a pixel of these APD arrays coupled to relatively thin (0.25 mm) and short (15 cm) scintillating plastic fibers can be used to detect and measure the tracks of even minimum ionizing particles (MIPs). An applicationspecific integrated circuit (ASIC) implementation of the electronics is required to produce a detector sufficiently compact for practical use in a flight experiment featuring many thousands of channels. This paper briefly describes the detector concept and performance and presents the design and performance of a four-channel prototype ASIC fabricated using the 0.35 micron TSMC process

A scintillating plastic fiber tracking detector for neutron and proton imaging and spectroscopy

We report the results of recent calibration data analysis of a prototype scintillating fiber tracking detector system designed to perform imaging, spectroscopy and particle identification on 20 to 250 MeV neutrons and protons. We present the neutron imaging concept and briefly review the detection principle and the prototype description. The prototype detector system records ionization track data on an event-by-event basis allowing event selection criteria to be used in the off-line analysis. Images of acrylic phantoms from the analysis of recent proton beam calibrations (14 to 65 MeV range) are presented as demonstrations of the particle identification, imaging and energy measurement capabilities. The measured position resolution is c 500 pm. The measured energy resolution (AE/E, FWHM) is 14.2% at 35 MeV. An effective technique for track identification and data compression is presented. The detection techniques employed can be applied to measurements in a variety of disciplines including solar and atmospheric physics, radiation therapy and nuclear materials monitoring. These applications are discussed briefly as are alternative detector configurations and future development plans

High-resolution X-ray diffraction with no sample preparation

It is shown that energy-dispersive X-ray diffraction (EDXRD) implemented in a back-reflection geometry is extremely insensitive to sample morphology and positioning even in a high-resolution configuration. This technique allows high quality X-ray diffraction analysis of samples that have not been prepared and is therefore completely non-destructive. The experimental technique was implemented on beamline B18 at the Diamond Light Source synchrotron in Oxfordshire, UK. The majority of the experiments in this study were performed with pre-characterized geological materials in order to elucidate the characteristics of this novel technique and to develop the analysis methods. Results are presented that demonstrate phase identification, the derivation of precise unit-cell parameters and extraction of microstructural information on unprepared rock samples and other sample types. A particular highlight was the identification of a specific polytype of a muscovite in an unprepared mica schist sample, avoiding the time-consuming and difficult preparation steps normally required to make this type of identification. The technique was also demonstrated in application to a small number of fossil and archaeological samples. Back-reflection EDXRD implemented in a high-resolution configuration shows great potential in the crystallographic analysis of cultural heritage artefacts for the purposes of scientific research such as provenancing, as well as contributing to the formulation of conservation strategies. Possibilities for moving the technique from the synchrotron into museums are discussed. The avoidance of the need to extract samples from high-value and rare objects is a highly significant advantage, applicable also in other potential research areas such as palaeontology, and the study of meteorites and planetary materials brought to Earth by sample-return missions