The Power Spectrum of Mass Fluctuations Measured from the Lyman-alpha Forest at Redshift z=2.5

We measure the linear power spectrum of mass density fluctuations at redshift z=2.5 from the \lya forest absorption in a sample of 19 QSO spectra, using the method introduced by Croft et al. (1998). The P(k) measurement covers the range 2\pi/k ~ 450-2350 km/s (2-12 comoving \hmpc for \Omega=1). We examine a number of possible sources of systematic error and find none that are significant on these scales. In particular, we show that spatial variations in the UV background caused by the discreteness of the source population should have negligible effect on our P(k) measurement. We obtain consistent results from the high and low redshift halves of the data set and from an entirely independent sample of nine QSO spectra with mean redshift z=2.1. A power law fit to our measured P(k) yields a logarithmic slope n=-2.25 +/- 0.18 and an amplitude \Delta^2(k_p) = 0.57^{+0.26}_{-0.18}, where $\Delta^2$ is the contribution to the density variance from a unit interval of lnk and k_p=0.008 (km/s)^{-1}. Direct comparison of our mass P(k) to the measured clustering of Lyman Break Galaxies shows that they are a highly biased population, with a bias factor b~2-5. The slope of the linear P(k), never previously measured on these scales, is close to that predicted by models based on inflation and Cold Dark Matter (CDM). The P(k) amplitude is consistent with some scale-invariant, COBE-normalized CDM models (e.g., an open model with \Omega_0=0.4) and inconsistent with others (e.g., \Omega=1). Even with limited dynamic range and substantial statistical uncertainty, a measurement of P(k) that has no unknown ``bias factors'' offers many opportunities for testing theories of structure formation and constraining cosmological parameters. (Shortened)Comment: Submitted to ApJ, 27 emulateapj pages w/ 19 postscript fig

Effects of Energetic Solar Emissions on the Earth–Ionosphere Cavity of Schumann Resonances

© 2016, Springer Science+Business Media Dordrecht. Schumann resonances (SR) are the electromagnetic oscillations of the spherical cavity bounded by the electrically conductive Earth and the conductive but dissipative lower ionosphere (Schumann in Z Naturforsch A 7:6627–6628, 1952). Energetic emissions from the Sun can exert a varied influence on the various parameters of the Earth’s SR: modal frequencies, amplitudes and dissipation parameters. The SR response at multiple receiving stations is considered for two extraordinary solar events from Solar Cycle 23: the Bastille Day event (July 14, 2000) and the Halloween event (October/November 2003). Distinct differences are noted in the ionospheric depths of penetration for X-radiation and solar protons with correspondingly distinct signs of the frequency response. The preferential impact of the protons in the magnetically unshielded polar regions leads to a marked anisotropic frequency response in the two magnetic field components. The general immunity of SR amplitudes to these extreme external perturbations serves to remind us that the amplitude parameter is largely controlled by lightning activity within the Earth–ionosphere cavity

What are the patient reported facilitators and barriers to physical activity following pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD)? A systematic review of qualitative research

Objectives/purpose: This study aimed to determine and understand COPD patients’ perceived facilitators and barriers to physical activity after completion of pulmonary rehabilitation. Pulmonary rehabilitation, a multidisciplinary treatment for COPD incorporating exercise trail. Design: A systematic review of qualitative research. Methods: Electronic databases of published, (MEDLINE, Embase, Web of Science, CINAHL, ASSIA, PsycINFO and SPORTDiscus), non-published data and conference proceedings (DART Europe E theses, EThOS, Open Grey, The New York Academy of Medicine, ProQuest Dissertations and theses), and trial registers (ClinicalTrials.gov and Current Controlled Trials) were searched to identify qualitative studies (interviews, focus groups) including COPD patients following pulmonary rehabilitation. Qualitative data relevant to the research question were synthesised using an inductive, thematic approach. Results: 14 studies (n= 12 published articles, n= 2 theses) including 167 COPD patients (male = 92, female = 75) met the inclusion criteria. Analytical themes were beliefs, motivation and social support, which encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation. Facilitators included positive intentions, support from health care professionals (HCPs), positive feedback regarding health, access and opportunities to attend physical activity maintenance groups, peer and family interaction. Barriers included negative beliefs, lack of 27 support from HCPs and peers, as well as practical issues surrounding travel and home responsibilities following pulmonary rehabilitation. Conclusions: Our findings reflect the complexity of physical activity behaviour and provide implications regarding the importance of continued social support and feedback in the maintenance of physical activity. These factors should be considered in the development of future interventions that target physical activity following pulmonary rehabilitation in patients with COPD

Supporting social prescribing in primary care by linking people to local assets: A realist review

© 2020 The Author(s). Background: Social prescribing is a way of addressing the 'non-medical' needs (e.g. loneliness, debt, housing problems) that can affect people's health and well-being. Connector schemes (e.g. delivered by care navigators or link workers) have become a key component to social prescribing's delivery. Those in this role support patients by either (a) signposting them to relevant local assets (e.g. groups, organisations, charities, activities, events) or (b) taking time to assist them in identifying and prioritising their 'non-medical' needs and connecting them to relevant local assets. To understand how such connector schemes work, for whom, why and in what circumstances, we conducted a realist review. Method: A search of electronic databases was supplemented with Google alerts and reference checking to locate grey literature. In addition, we sent a Freedom of Information request to all Clinical Commissioning Groups in England to identify any further evaluations of social prescribing connector schemes. Included studies were from the UK and focused on connector schemes for adult patients (18+ years) related to primary care. Results: Our searches resulted in 118 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs). These CMOCs underpinned our emerging programme theory that centred on the essential role of 'buy-in' and connections. This was refined further by turning to existing theories on (a) social capital and (b) patient activation. Conclusion: Our realist review highlights how connector roles, especially link workers, represent a vehicle for accruing social capital (e.g. trust, sense of belonging, practical support). We propose that this then gives patients the confidence, motivation, connections, knowledge and skills to manage their own well-being, thereby reducing their reliance on GPs. We also emphasise within the programme theory situations that could result in unintended consequences (e.g. increased demand on GPs)

Effectiveness and cost-effectiveness of a self-guided internet intervention for social anxiety symptoms in a general population sample : randomized controlled trial

Background: Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness.Social anxiety is one of the most common sources of mental distress in the population and many people with symptoms do not seek help for what represents a significant public health problem. Objective: Two group randomized controlled trial conducted in England between 11th May 2016 and 27th June 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a web-based unguided self-help intervention based on cognitive-behavioural principles, or to a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item self-report Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all timepoints (6 weeks, 3, 6, 12 months). Methods: Two group randomized controlled trial conducted in England between 11th May 2016 and 27th June 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a web-based unguided self-help intervention based on cognitive-behavioural principles, or to a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item self-report Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all timepoints (6 weeks, 3, 6, 12 months). Results: 2212 participants were randomized. Six were excluded from analyses as ineligible. Of the 2116 eligible randomized participants (mean age 37 years, 80% women), 70.1% (1484/2116) had follow-up data available for analysis, and 56.9% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks the mean (95% CI, P value) adjusted difference in change in SPIN-17 score in the intervention group compared to control, was -1.94 (-3.13 to -0.75, P=0.0014), a standardised mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high drop-out, sensitivity analyses explored missing data assumptions and were consistent with the primary analysis finding. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilisation. Conclusions: For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that an online self-help tool based on cognitive behavioural principles can provide a small improvement in social anxiety symptoms compared with no intervention, although drop-out rates were high. Clinical Trial: ClinicalTrials.gov NCT02451878. https://clinicaltrials.gov/ct2/show/NCT0245187

Effectiveness and cost-effectiveness of a fully self-guided internet-based intervention for sub-clinical social anxiety symptoms : protocol for a randomised controlled trial

Design and objective: This paper describes the protocol for a large-scale pragmatic, randomised controlled trial and economic evaluation to investigate the effectiveness and cost-effectiveness of the self-directed E-Couch social anxiety module versus a waiting list control condition, for reducing sub-clinical social anxiety symptoms in the general population. Study population: Community-based adults (aged 18+) with social anxiety symptoms that do not meet the criteria for social anxiety disorder recruited via a direct-to-consumer advertisement on national websites. Intervention and control: Intervention is the self-guided E-Couch social anxiety module. Control group participants are placed on a waiting list to receive the intervention at the end of the trial. Both groups receive email and text message reminders. Outcome measures: The primary outcome will be change in self-reported social anxiety score using the Social Phobia Inventory (SPIN). Secondary outcomes will be the changes in the following self-report measures: Brief Fear of Negative Evaluation scale (BFNE-S); depression (CES-D); mental wellbeing (SWEMWEBS); health status (SF36); use of health services; safety events; and adherence, retention, and attrition rates. All measures will be administered at baseline, 6 weeks, and 3, 6 and 12 months. Analysis: A mixed effects model will be used to analyse the effect of the intervention on the primary and secondary outcomes (intention to treat analysis). Secondary analyses will explore moderators and mediators of effect. A prospective economic evaluation, conducted from a NHS and social care perspective, will provide estimates of cost utility and cost-effectiveness. An interview study will be conducted with 20 participants to explore issues including acceptability, adherence, retention and attrition

Effectiveness and cost-effectiveness of a fully self-guided internet-based intervention for sub-clinical social anxiety symptoms: Protocol for a randomised controlled trial

DESIGN AND OBJECTIVE: This paper describes the protocol for a large-scale pragmatic, randomised controlled trial and economic evaluation to investigate the effectiveness and cost-effectiveness of the self-directed E-Couch social anxiety module versus a waiting list control condition, for reducing sub-clinical social anxiety symptoms in the general population. STUDY POPULATION: Community-based adults (aged 18þ) with social anxiety symptoms that do not meet the criteria for social anxiety disorder recruited via a direct-to-consumer advertisement on national websites. INTERVENTION AND CONTROL: Intervention is the self-guided E-Couch social anxiety module. Control group participants are placed on a waiting list to receive the intervention at the end of the trial. Both groups receive email and text message reminders. OUTCOME MEASURES: The primary outcome will be change in self-reported social anxiety score using the Social Phobia Inventory (SPIN). Secondary outcomes will be the changes in the following self-report measures: Brief Fear of Negative Evaluation scale (BFNE-S); depression (CES-D); mental wellbeing (SWEMWEBS); health status (SF36); use of health services; safety events; and adherence, retention, and attrition rates. All measures will be administered at baseline, 6 weeks, and 3, 6 and 12 months. ANALYSIS: A mixed effects model will be used to analyse the effect of the intervention on the primary and secondary outcomes (intention to treat analysis). Secondary analyses will explore moderators and mediators of effect. A prospective economic evaluation, conducted from a NHS and social care perspective, will provide estimates of cost utility and costeffectiveness. An interview study will be conducted with 20 participants to explore issues including acceptability, adherence, retention and attrition.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the MQ charity under its PsyIMPACT funding call (www.joinMQ.org). KG is supported by NHMRC Fellowship 1059620. The ongoing delivery of E-Couch is enabled by funding from the Australian Commonwealth Department of Health. HA was funded by a NIHR National School for Primary Care Research Fellowship (up to September 2015). LL and YY are funded by the NIHR Oxford Biomedical Research Centre (Oxford BRC)