Effectiveness of current policing-related mental health interventions in England and Wales and Crisis Intervention Teams as a future potential model: a systematic review

Background Experiencing mental ill health adds a layer of complexity for individuals in touch with the justice system and for those responsible for working in the justice service with these individuals, such as frontline police officers. In England and Wales, there are three commonly used but not necessarily commonly designed or operated, mental health interventions associated with policing, Liaison and Diversion, Street Triage and specialist staff embedded in Police Contact Control Rooms. A fourth US designed model, Crisis Intervention Teams (CITs), is now attracting some interest in England and Wales, and these four are to be considered in this review. A fifth intervention, Mental Health Courts, was trialed but has now been abandoned in England and Wales and so has been excluded, but remains in use elsewhere. In recent years, there has been an increase in the level of investment related to these intervention options. This has largely been without an evidence base being available to aid design, structure, and consistency of approach. The review will address this gap and provide a systematic review of each of these options. This will provide a baseline of research evidence for those who commission and provide services for individuals experiencing mental ill health and who are in contact with the justice system. Methods Twenty-nine relevant databases and sources have been selected which will be systematically searched to locate relevant studies. These studies have to meet the set inclusion criteria which require them to report an objective outcome measure(s) in respect of offending or mental health outcomes and to have an experimental or quasi-experimental design including a comparator group(s) or a pre/post comparison. The review will exclude PhD theses, papers in non-English languages and papers published prior to 1980. Keywords have been collected through canvassing experts’ opinion, literature review, controlled vocabulary and reviewing the results of a primary scoping review carried out to aid the development of the PICO, composed of Population/Participants, Intervention/Indicator, Comparator/Control, and Outcomes. For the proposed review, the key elements of the PICO are the following: persons with mental health problems, symptoms or diagnoses who come into contact with the police; interventions involving partnership working between police and mental health nurses and related professionals to divert those with mental health problems away from criminal justice processes; comparisons with control groups or areas where such interventions have not been introduced; and outcomes concerning criminal justice and health outcomes. The results of the searches will be screened using the set criteria and the selected papers reviewed and analysed to allow findings regarding these interventions to be reported. Discussion The objectives of the review are firstly to identify and report research on the relevant interventions, nationally and internationally and then secondly to consider, when possible, which interventions or aspects of those interventions are effective. This is judged with regard to changes in mental health status or service use and future offending behaviour. The approaches to be considered have gained a good deal of support and funding over recent years, and this review will provide a systematic review of the underpinning research evidence to inform future commissioning, service design and investment decisions

A Galactic Wind at z = 5.190

We report the serendipitous detection in high-resolution optical spectroscopy of a strong, asymmetric Ly-alpha emission line at z = 5.190. The detection was made in a 2.25 hour exposure with the Echelle Spectrograph and Imager on the Keck II telescope through a spectroscopic slit of dimensions 1" x 20". The progenitor of the emission line, J123649.2+621539 (hereafter ES1), lies in the Hubble Deep Field North West Flanking Field where it appears faint and compact, subtending just 0.3" (FWHM) with I(AB) = 25.4. The ES1 Ly-alpha line flux of 3.0 x 10^(-17) ergs/cm^2/s corresponds to a luminosity of 9.0 x 10^(42) ergs/s, and the line profile shows the sharp blue cut-off and broad red wing commonly observed in star-forming systems and expected for radiative transfer in an expanding envelope. We find that the Ly-alpha profile is consistent with a galaxy-scale outflow with a velocity of v > 300 km/s. This value is consistent with wind speeds observed in powerful local starbursts (typically 10^2 to 10^3 km/s), and compares favorably to simulations of the late-stage evolution of Ly-alpha emission in star-forming systems. We discuss the implications of this high-redshift galactic wind for the early history of the evolution of galaxies and the intergalactic medium, and for the origin of the UV background at z > 3.Comment: 12 pages, 7 figures, accepted for publication in the Astrophysical Journa

Why Wait Until Our Community Gets Cancer?: Exploring CRC Screening Barriers and Facilitators in the Spanish-Speaking Community in North Carolina

Colorectal cancer (CRC) is a leading cause of death among Hispanics in the United States. Despite the benefits of CRC screening, many Hispanics are not being screened. Using a combined methodology of focus groups and discrete choice experiment (DCE) surveys, the objectives for this research were as follows: (1) to improve understanding of preferences regarding potential CRC screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. Four gender-stratified focus groups were conducted and DCE surveys were administered to 38 Spanish-speaking individuals across four counties in North Carolina. In-depth content analysis was used to examine the focus group data; descriptive analyses and mean attribute importance scores for cost of screening and follow-up care, travel time, and test options were calculated from DCE data. Data analyses showed that this population has a strong interest in CRC screening but experience barrier such as lack of access to resources, cost uncertainty, and stigma. Some of these barriers are unique to their cultural experiences in the United States, such as an expressed lack of tailored CRC information. Based on the DCE, cost variables were more important than testing options or travel time. This study suggests that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened. Special attention should be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics

Patient Decision Aids for Colorectal Cancer Screening

Decision aids (DAs) prepare patients to make decisions about healthcare options consistent with their preferences. Helping patients choose among available options for colorectal cancer (CRC) screening is important because rates are lower than screening for other cancers. This systematic review describes studies evaluating patient DAs for CRC screening in average-risk adults and their impact on knowledge, screening intentions, and uptake

A pre-post study testing a lung cancer screening decision aid in primary care

Abstract Background The United States Preventive Services Task Force (USPSTF) issued recommendations for older, heavy lifetime smokers to complete annual low-dose computed tomography (LDCT) scans of the chest as screening for lung cancer. The USPSTF recommends and the Centers for Medicare and Medicaid Services require shared decision making using a decision aid for lung cancer screening with annual LDCT. Little is known about how decision aids affect screening knowledge, preferences, and behavior. Thus, we tested a lung cancer screening decision aid video in screening-eligible primary care patients. Methods We conducted a single-group study with surveys before and after decision aid viewing and medical record review at 3 months. Participants were active patients of a large US academic primary care practice who were current or former smokers, ages 55–80 years, and eligible for screening based on current screening guidelines. Outcomes assessed pre-post decision aid viewing were screening-related knowledge score (9 items about screening-related harms of false positives and overdiagnosis, likelihood of benefit; score range = 0–9) and preference (preferred screening vs. not). Screening behavior measures, assessed via chart review, included provider visits, screening discussion, LDCT ordering, and LDCT completion within 3 months. Results Among 50 participants, knowledge increased from pre- to post-decision aid viewing (mean = 2.6 vs. 5.5, difference = 2.8; 95% CI 2.1, 3.6, p < 0.001). Preferences across the overall sample remained similar such that 54% preferred screening at baseline and 50% after viewing; however, 28% of participants changed their preference (to or away from screening) from baseline to after viewing. We assessed screening behavior for 36 participants who had a primary care visit during the 3-month period following enrollment. Eighteen of 36 preferred screening after decision aid viewing. Of these 18, 10 discussed screening, 8 had a test ordered, and 6 completed LDCT. Among the 18 who preferred no screening, 7 discussed screening, 5 had a test ordered, and 4 completed LDCT. Conclusions In primary care patients, a lung cancer screening decision aid improved knowledge regarding screening-related benefits and harms. Screening preferences and behavior were heterogeneous. Trial registration This study is registered at www.clinicaltrials.gov . NCT03077230 (registered retrospectively,November 22, 2016)

Colorectal Cancer Screening in Vulnerable Patients

Low-income, low-literacy, limited English–proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient–provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits

CO line emission in the halo of a radio galaxy at z=2.6

We report the detection of luminous CO(3-2) line emission in the halo of the z=2.6 radio galaxy (HzRG) TXS0828+193, which has no detected counterpart at optical to mid-infrared wavelengths implying a stellar mass < few x10^9 M_sun and relatively low star-formation rates. With the IRAM PdBI we find two CO emission line components at the same position at ~80 kpc distance from the HzRG along the axis of the radio jet, with different blueshifts of few 100 km s^-1 relative to the HzRG and a total luminosity of ~2x10^10 K km s^-1 pc^2 detected at 8 sigma significance. HzRGs have significant galaxy overdensities and extended halos of metal-enriched gas often with embedded clouds or filaments of denser material, and likely trace very massive dark-matter halos. The CO emission may be associated with a gas-rich, low-mass satellite galaxy with little on-going star formation, in contrast to all previous CO detections of galaxies at similar redshifts. Alternatively, the CO may be related to a gas cloud or filament and perhaps jet-induced gas cooling in the outer halo, somewhat in analogy with extended CO emission found in low-redshift galaxy clusters.Comment: MNRAS Letters, accepte

HST/ACS Emission Line Imaging of Low Redshift 3CR Radio Galaxies I: The Data

We present 19 nearby (z<0.3) 3CR radio galaxies imaged at low- and high-excitation as part of a Cycle 15 Hubble Space Telescope snapshot survey with the Advanced Camera for Surveys. These images consist of exposures of the H-alpha (6563 \AA, plus [NII] contamination) and [OIII] 5007 \AA emission lines using narrow-band linear ramp filters adjusted according to the redshift of the target. To facilitate continuum subtraction, a single-pointing 60 s line-free exposure was taken with a medium-band filter appropriate for the target's redshift. We discuss the steps taken to reduce these images independently of the automated recalibration pipeline so as to use more recent ACS flat-field data as well as to better reject cosmic rays. We describe the method used to produce continuum-free (pure line-emission) images, and present these images along with qualitative descriptions of the narrow-line region morphologies we observe. We present H-alpha+[NII] and [OIII] line fluxes from aperture photometry, finding the values to fall expectedly on the redshift-luminosity trend from a past HST/WFPC2 emission line study of a larger, generally higher redshift subset of the 3CR. We also find expected trends between emission line luminosity and total radio power, as well as a positive correlation between the size of the emission line region and redshift. We discuss the associated interpretation of these results, and conclude with a summary of future work enabled by this dataset.Comment: 18 pages, 12 figures, accepted for publication in ApJ

Gas Accretion and Giant Lyman-alpha Nebulae

Several decades of observations and discoveries have shown that high-redshift AGN and massive galaxies are often surrounded by giant Lyman-alpha nebulae extending in some cases up to 500 kpc in size. In this review, I discuss the properties of the such nebulae discovered at z>2 and their connection with gas flows in and around the galaxies and their halos. In particular, I show how current observations are used to constrain the physical properties and origin of the emitting gas in terms of the Lyman-alpha photon production processes and kinematical signatures. These studies suggest that recombination radiation is the most viable scenario to explain the observed Lyman-alpha luminosities and Surface Brightness for the large majority of the nebulae and imply that a significant amount of dense, ionized and cold clumps should be present within and around the halos of massive galaxies. Spectroscopic studies suggest that, among the giant Lyman-alpha nebulae, the one associated with radio-loud AGN should have kinematics dominated by strong, ionized outflows within at least the inner 30-50 kpc. Radio-quiet nebulae instead present more quiescent kinematics compatible with stationary situation and, in some cases, suggestive of rotating structures. However, definitive evidences for accretion onto galaxies of the gas associated with the giant Lyman-alpha emission are not unambiguously detected yet. Deep surveys currently ongoing using other bright, non-resonant lines such as Hydrogen H-alpha and HeII1640 will be crucial to search for clearer signatures of cosmological gas accretion onto galaxies and AGN.Comment: Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dave', to be published by Springe

Mid-Infrared Spectra of High Redshift (z>2) Radio Galaxies

We present the first mid-infrared Spitzer/Infrared Spectrograph (IRS) observations of powerful radio galaxies at z>2. These radio galaxies, 4C +23.56 (z=2.48) and 6C J1908+7220 (z=3.53), both show strong mid-infrared continua, but with 6C J1908+7220 also showing strong PAH emission at rest-frame 6.2 and 7.7um. In 4C+23.56 we see no obvious PAH features above the continuum. The PAH emission in 6C J1908+7220 is the amongst the most distant observed to date and implies that there is a large instantaneous star formation rate (SFR). This is consistent with the strong detection of 6C J1908+7220 at far-IR and sub-mm wavelengths, indicative of large amounts of cold dust, ~10^9Msun. Powerful radio galaxies at lower redshifts tend to have weak or undetectable PAH features and typically have lower far-IR luminosities. In addition, 4C 23.56 shows moderate silicate absorption as seen in less luminous radio galaxies, indicating tau_{9.7um}=0.3+/-0.05. This feature is shifted out of the observed wavelength range for 6C J1908+7220. The correlation of strong PAH features with large amounts of cold dust, despite the presence of a powerful AGN, is in agreement with other recent results and implies that star formation at high redshift is, in some cases at least, associated with powerful, obscured AGN.Comment: 6 pages, 3 figures, includes emulateapj.cls, in press ApJ