Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs

Unusual Formation of Point-Defect Complexes in the Ultrawide-Band-Gap Semiconductor β-Ga2 O3

Understanding the unique properties of ultra-wide band gap semiconductors requires detailed information about the exact nature of point defects and their role in determining the properties. Here, we report the first direct microscopic observation of an unusual formation of point defect complexes within the atomic-scale structure of β-Ga2O3 using high resolution scanning transmission electron microscopy (STEM). Each complex involves one cation interstitial atom paired with two cation vacancies. These divacancy-interstitial complexes correlate directly with structures obtained by density functional theory, which predicts them to be compensating acceptors in β-Ga2O3. This prediction is confirmed by a comparison between STEM data and deep level optical spectroscopy results, which reveals that these complexes correspond to a deep trap within the band gap, and that the development of the complexes is facilitated by Sn doping through increased vacancy concentration. These findings provide new insight on this emerging material's unique response to the incorporation of impurities that can critically influence their properties

Insulin-like signalling influences the coordination of larval hemocyte number with body size in Drosophila melanogaster

Blood cells, known as hemocytes in invertebrates, play important and conserved roles in immunity, wound healing and tissue remodelling. The control of hemocyte number is therefore critical to ensure these functions are not compromised, and studies using Drosophila melanogaster are proving useful for understanding how this occurs. Recently, the embryonic patterning gene, torso-like (tsl), was identified as being required both for normal hemocyte development and for providing immunity against certain pathogens. Here, we report that Tsl is required specifically during the larval phase of hematopoiesis, and that tsl mutant larvae likely have reduced hemocyte numbers due to a reduced larval growth rate and compromised insulin signaling. Consistent with this, we find that impairing insulin-mediated growth, either by nutrient deprivation or genetically, results in fewer hemocytes. This is likely the result of impaired insulin-like signaling in the hemocytes themselves, since modulation of Insulin-like Receptor (InR) activity specifically in hemocytes causes concomitant changes to their population size in developing larvae. Taken together, our work reveals the strong relationship that exists between body size and hemocyte number, and suggests that insulin-like signaling contributes to, but is not solely responsible for, keeping these tightly aligned during larval development

Perspectives on the insidious nature of pain metaphor: we literally need to change our metaphors.

Metaphorical language is used to convey one thing as representative or symbolic of something else. Metaphor is used in figurative language but is much more than a means of delivering "poetic imagination". A metaphor is a conceptual tool for categorising, organizing, thinking about, and ultimately shaping reality. Thus, metaphor underpins the way humans think. Our viewpoint is that metaphorical thought and communication contribute to "painogenicity", the tendency of socio-ecological environments (settings) to promote the persistence of pain. In this perspectives article, we explore the insidious nature of metaphor used in pain language and conceptual models of pain. We explain how metaphor shapes mental organisation to govern the way humans perceive, navigate and gain insight into the nature of the world, i.e., creating experience. We explain how people use metaphors to "project" their private sensations, feelings, and thoughts onto objects and events in the external world. This helps people to understand their pain and promotes sharing of pain experience with others, including health care professionals. We explore the insidious nature of "warmongering" and damage-based metaphors in daily parlance and demonstrate how this is detrimental to health and wellbeing. We explore how metaphors shape the development and communication of complex, abstract ideas, theories, and models and how scientific understanding of pain is metaphorical in nature. We argue that overly simplistic neuro-mechanistic metaphors of pain contribute to fallacies and misnomers and an unhealthy focus on biomedical research, in the hope of developing medical interventions that "prevent pain transmission [sic]". We advocate reconfiguring pain language towards constructive metaphors that foster a salutogenic view of pain, focusing on health and well-being. We advocate reconfiguring metaphors to align with contemporary pain science, to encourage acceptance of non-medicalised strategies to aid health and well-being. We explore the role of enactive metaphors to facilitate reconfiguration. We conclude that being cognisant of the pervasive nature of metaphors will assist progress toward a more coherent conceptual understanding of pain and the use of healthier pain language. We hope our article catalyses debate and reflection

Segregation-induced finger formation in granular free-surface flows

Geophysical granular flows, such as landslides, pyroclastic flows and snow avalanches, consist of particles with varying surface roughnesses or shapes that have a tendency to segregate during flow due to size differences. Such segregation leads to the formation of regions with different frictional properties, which in turn can feed back on the bulk flow. This paper introduces a well-posed depth-averaged model for these segregation-mobility feedback effects. The full segregation equation for dense granular flows is integrated through the avalanche thickness by assuming inversely graded layers with large particles above fines, and a Bagnold shear profile. The resulting large particle transport equation is then coupled to depth-averaged equations for conservation of mass and momentum, with the feedback arising through a basal friction law that is composition dependent, implying greater friction where there are more large particles. The new system of equations includes viscous terms in the momentum balance, which are derived from the -rheology for dense granular flows and represent a singular perturbation to previous models. Linear stability calculations of the steady uniform base state demonstrate the significance of these higher-order terms, which ensure that, unlike the inviscid equations, the growth rates remain bounded everywhere. The new system is therefore mathematically well posed. Two-dimensional simulations of bidisperse material propagating down an inclined plane show the development of an unstable large-rich flow front, which subsequently breaks into a series of finger-like structures, each bounded by coarse-grained lateral levees. The key properties of the fingers are independent of the grid resolution and are controlled by the physical viscosity. This process of segregation-induced finger formation is observed in laboratory experiments, and numerical computations are in qualitative agreement

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses

A revised classification of temperate lowland groundwater‐fed headwater streams based on their flora

Prolonged drought leads to the temporary simplification or loss of aquatic biological communities, as surface water is progressively reduced or dry phases are extended in intermittent streams. Using surveys of aquatic and semi‐aquatic plants, and recording non‐aquatic grasses and herbs, we classify the communities within 24 groundwater‐fed streams in south England. We examine changes over a 21‐year period following a 3‐year drought. Our classification reveals a simplification of communities driven by a decline in the abundance of obligate aquatic taxa and an increase in the abundance of semi‐aquatic taxa. We demonstrate plant community structure as a strong indicator of a site’s flow history, including intermittence, but interactions with channel morphology also influence communities and need further investigation. We recommend that future surveys encompass terrestrial, semi‐aquatic and aquatic plants, as well as habitat assessments, to improve the understanding of how instream communities change between flowing, ponded and dry phases in intermittent streams

Visual art inspired by the collective feeding behavior of sand-bubbler crabs

Sand--bubblers are crabs of the genera Dotilla and Scopimera which are known to produce remarkable patterns and structures at tropical beaches. From these pattern-making abilities, we may draw inspiration for digital visual art. A simple mathematical model is proposed and an algorithm is designed that may create such sand-bubbler patterns artificially. In addition, design parameters to modify the patterns are identified and analyzed by computational aesthetic measures. Finally, an extension of the algorithm is discussed that may enable controlling and guiding generative evolution of the art-making process

Moving Branes with Background Massless and Tachyon Fields in the Compact Spacetime

In this article we shall obtain the boundary state associated with a moving $Dp$-brane in the presence of the Kalb-Ramond field $B_{\mu\nu}$, an internal U(1) gauge field $A_{\alpha}$ and a tachyon field, in the compact spacetime. According to this state, properties of the brane and a closed string, with mixed boundary conditions emitted from it, will be obtained. Using this boundary state we calculate the interaction amplitude of two moving $Dp_{1}$ and $Dp_{2}$-branes with above background fields in a partially compact spacetime. They are parallel or perpendicular to each other. Properties of the interaction amplitude will be analyzed and contribution of the massless states to the interaction will be extracted.Comment: 13 pages, Latex, no figur

Safety and efficacy of fluticasone propionate in the topical treatment of skin diseases

Fluticasone propionate - the first carbothioate corticosteroid - has been classified as a potent anti-inflammatory drug for dermatological use. It is available as 0.05% cream and 0.005% ointment formulations for the acute and maintenance treatment of patients with dermatological disorders such as atopic dermatitis, psoriasis and vitiligo. This glucocorticoid is characterized by high lipophilicity, high glucocorticoid receptor binding and activation, and a rapid metabolic turnover in skin. Although skin blanching following fluticasone propionate exceeds that of corticosteroids of medium strength, several clinical trials demonstrate a low potential for cutaneous and systemic side-effects, even in difficult-to-treat areas like the face, the eyelids and intertriginous areas. Even among paediatric patients with atopic dermatitis, fluticasone propionate proved to be safe and effective. These pharmacological and clinical properties are reflected by the high therapeutic index of this glucocorticoid