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

Housing markets and independence in old age: expanding the opportunities

This report highlights the benefits of specialised private retirement accommodation and recommends a number of simple policy changes at no cost to the public purse to help increase its supply and address the challenges of housing an ageing population

A study of commuter airplane design optimization

Problems of commuter airplane configuration design were studied to affect a minimization of direct operating costs. Factors considered were the minimization of fuselage drag, methods of wing design, and the estimated drag of an airplane submerged in a propellor slipstream; all design criteria were studied under a set of fixed performance, mission, and stability constraints. Configuration design data were assembled for application by a computerized design methodology program similar to the NASA-Ames General Aviation Synthesis Program

Local dynamics in high-order harmonic generation using Bohmian trajectories

We investigate high-order harmonic generation from a Bohmian-mechanical perspective, and find that the innermost part of the core, represented by a single Bohmian trajectory, leads to the main contributions to the high-harmonic spectra. Using time-frequency analysis, we associate this central Bohmian trajectory to an ensemble of unbound classical trajectories leaving and returning to the core, in agreement with the three step model. In the Bohmian scenario, this physical picture builds up non-locally near the core via the quantum mechanical phase of the wavefunction. This implies that the flow of the wavefunction far from the core alters the central Bohmian trajectory. We also show how this phase degrades in time for the peripheral Bohmian trajectories as they leave the core region.Comment: 7 pages, 3 figures; the manuscript has been considerably extended and modified with regard to the previous version

Interference in Bohmian Mechanics with Complex Action

In recent years, intensive effort has gone into developing numerical tools for exact quantum mechanical calculations that are based on Bohmian mechanics. As part of this effort we have recently developed as alternative formulation of Bohmian mechanics in which the quantum action, S, is taken to be complex [JCP {125}, 231103 (2006)]. In the alternative formulation there is a significant reduction in the magnitude of the quantum force as compared with the conventional Bohmian formulation, at the price of propagating complex trajectories. In this paper we show that Bohmian mechanics with complex action is able to overcome the main computational limitation of conventional Bohmian methods -- the propagation of wavefunctions once nodes set in. In the vicinity of nodes, the quantum force in conventional Bohmian formulations exhibits rapid oscillations that pose severe difficulties for existing numerical schemes. We show that within complex Bohmian mechanics, multiple complex initial conditions can lead to the same real final position, allowing for the description of nodes as a sum of the contribution from two or more crossing trajectories. The idea is illustrated on the reflection amplitude from a one-dimensional Eckart barrier. We believe that trajectory crossing, although in contradiction to the conventional Bohmian trajectory interpretation, provides an important new tool for dealing with the nodal problem in Bohmian methods

On the observability of resonant structures in planetesimal disks due to planetary migration

We present a thorough study of the impact of a migrating planet on a planetesimal disk, by exploring a broad range of masses and eccentricities for the planet. We discuss the sensitivity of the structures generated in debris disks to the basic planet parameters. We perform many N-body numerical simulations, using the symplectic integrator SWIFT, taking into account the gravitational influence of the star and the planet on massless test particles. A constant migration rate is assumed for the planet. The effect of planetary migration on the trapping of particles in mean motion resonances is found to be very sensitive to the initial eccentricity of the planet and of the planetesimals. A planetary eccentricity as low as 0.05 is enough to smear out all the resonant structures, except for the most massive planets. The planetesimals also initially have to be on orbits with a mean eccentricity of less than than 0.1 in order to keep the resonant clumps visible. This numerical work extends previous analytical studies and provides a collection of disk images that may help in interpreting the observations of structures in debris disks. Overall, it shows that stringent conditions must be fulfilled to obtain observable resonant structures in debris disks. Theoretical models of the origin of planetary migration will therefore have to explain how planetary systems remain in a suitable configuration to reproduce the observed structures.Comment: 16 pages, 13 figures. Accepted for publication in A&

Steady-state evolution of debris disks around A stars

In this paper a simple analytical model for the steady-state evolution of debris disks due to collisions is confronted with Spitzer observations of main sequence A stars. All stars are assumed to have planetesimal belts with a distribution of initial masses and radii. In the model disk mass is constant until the largest planetesimals reach collisional equilibrium whereupon the mass falls off oc 1/t. We find that the detection statistics and trends seen at both 24 and 70um can be fitted well by the model. While there is no need to invoke stochastic evolution or delayed stirring to explain the statistics, a moderate rate of stochastic events is not ruled out. Potentially anomalous systems are identified by a high dust luminosity compared with the maximum permissible in the model (HD3003, HD38678, HD115892, HD172555). Their planetesimals may have unusual properties (high strength or low eccentricity) or this dust could be transient. While transient phenomena are also favored for a few systems in the literature, the overall success of our model, which assumes planetesimals in all belts have the same strength, eccentricity and maximum size, suggests a large degree of uniformity in the outcome of planet formation. The distribution of planetesimal belt radii, once corrected for detection bias, follows N(r) oc r^{-0.8+-0.3} for 3-120AU. Since the inner edge is often attributed to an unseen planet, this provides a unique constraint on the planetary systems of A stars. It is also shown that P-R drag may sculpt the inner edges of A star disks close to the Spitzer detection threshold (HD2262, HD19356, HD106591, HD115892). This model can be readily applied to the interpretation of future surveys, and predictions are made for the upcoming SCUBA-2 survey, including that >17% of A stars should be detectable at 850um.Comment: Accepted by Ap