Facilitating access to voluntary and community services for patients with psychosocial problems: a before-after evaluation

Background: Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs) facilitating access to voluntary and community sector services for patients with psychosocial problems. Methods: Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated. Results: 108 patients consented to take part in the study. At three-month follow-up, 63 (58%) had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%). Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced. Conclusion: Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems

Model Checking Control Communication of a FACTS Device

This paper concerns the design and verification of a realtime communication protocol for sensor data collection and processing between an embedded computer and a DSP. In such systems, a certain amount of data loss without recovery may be tolerated. The key issue is to define and verify the correctness in the presence of these lost data frames under real-time constraints. This paper describes a temporal verification that if the end processes do not detect that too many frames are lost, defined by comparison of error counters against given threshold values, then there will be a bounded delay between transmission of data frames and reception of control frames. This verification and others presented herein were performed with the model checkers SPIN and RT-SPIN

Evaluation of the pathways of tropospheric nitrophenol formation using a multiphase model

International audiencePhenols are a major class of volatile organic compounds (VOC) whose reaction within, and partitioning between, the gas and liquid phases affects their lifetime within the atmosphere, the local oxidising capacity, and the extent of production of nitrophenols, which are toxic chemicals. In this work, a zero-dimension box model was constructed to quantify the relative nitration pathways, and partitioning into the liquid phase, of mono-aromatic compounds in order to help elucidate the formation pathways of 2- and 4-nitrophenol in the troposphere. The liquid phase contributed significantly to the production of nitrophenols for liquid water content (Lc) values exceeding 3×10-9, and for a range of assumed liquid droplet diameter, even though the resultant equilibrium partitioning to the liquid phase was much lower. For example, in a ''typical'' model scenario, with Lc=3×10-7, 58% of nitrophenol production occurred in the liquid phase but only 2% of nitrophenol remained there, i.e. a significant proportion of nitrophenol observed in the gas phase may actually be produced via the liquid phase. The importance of the liquid phase was enhanced at lower temperatures, by a factor ~1.5?2 at 278 K cf. 298 K. The model showed that nitrophenol production was particularly sensitive to the values of the rate coefficients for the liquid phase reactions between phenol and OH or NO3 reactions, but insensitive to the rate coefficient for the reaction between benzene and OH, thus identifying where further experimental data are required

Operation of EMEP ‘supersites’ in the United Kingdom. Annual report for 2008.

As part of its commitment to the UN-ECE Convention on Long-range Transboundary Air Pollution the United Kingdom operates two ‘supersites’ reporting data to the Co-operative Programme for Monitoring and Evaluation of the Long-range Transmission of Air Pollutants in Europe (EMEP). This report provides the annual summary for 2008, the second full calendar year of operation of the first EMEP ‘supersite’ to be established in the United Kingdom. Detailed operational reports have been submitted to Defra every 3 months, with unratified data. This annual report contains a summary of the ratified data for 2008. The EMEP ‘supersite’ is located in central southern Scotland at Auchencorth (3.2oW, 55.8oN), a remote rural moorland site ~20 km south-west of Edinburgh. Monitoring operations started formally on 1 June 2006. In addition to measurements made specifically under this contract, the Centre for Ecology & Hydrology also acts as local site operator for measurements made under other UK monitoring networks: the Automated Urban and Rural Network (AURN), the UK Eutrophication and Acidification Network (UKEAP), the UK Hydrocarbons Network, and the UK Heavy Metals Rural Network. Some measurements were also made under the auspices of the ‘Air Pollution Deposition Processes’ contract. All these associated networks are funded by Defra. This report summarises the measurements made between January and December 2008, and presents summary statistics on average concentrations. The site is dominated by winds from the south-west, but wind direction data highlight potential sources of airborne pollutants (power stations, conurbations). The average diurnal patterns of gases and particles are consistent with those expected for a remote rural site. The frequency distributions are presented for data where there was good data capture throughout the whole period. Some components (e.g. black carbon) show log-normal frequency distributions, while other components (e.g. ozone) have more nearly normal frequency distributions. A case study is presented for a period in June 2008, showing the influence of regional air pollutants at this remote rural site. All the data reported under the contract are shown graphically in the Appendix

Survey of Infections Transmissible Between Baboons and Humans, Cape Town, South Africa

Baboons on South Africa’s Cape Peninsula come in frequent contact with humans. To determine potential health risks for both species, we screened 27 baboons from 5 troops for 10 infections. Most (56%) baboons had antibodies reactive or cross-reactive to human viruses. Spatial overlap between these species poses low but potential health risks

Dynamic interpersonal therapy for moderate to severe depression: A pilot randomized controlled and feasibility trial

Background: Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated. Methods: 147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion. Results: The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes.ConclusionsDIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs

“You know that's a rip-off”: policies and practices surrounding micro-enterprises and poverty alleviation in South African township tourism

Supporting the development of small tourism businesses has been seen by policy-makers as a valuable means of alleviating poverty in South African townships. This perspective has been endorsed by several ‘responsible’ tourism businesses and academics. Following a review of the literature, this paper reports the findings of an empirical study that examined the practices of micro-business owners and the factors that shape their behaviour in two South African townships. In spite of significant visitor numbers, it finds that their narrow social networks and the imbalances of power between them and intermediaries such as travel agencies and tour operators prevent them from developing their businesses and sharing in the material gains that become available because of tourism. This analysis has important implications for local policy-makers and those advocating responsible tourism. For the former, it suggests a cessation of current initiatives in favour of greater regulation and alternative forms of investment. For the latter, it implies the need to reassess the utility of advocating responsible tourism to consumers in a context where they do not understand the dynamics which fashion what is on offer or the full implications of their choices

Verifying Noninterference in a Cyber-Physical System the Advanced Electric Power Grid

The advanced electric power grid is a complex real-time system having both cyber and physical components. While each component may function correctly, independently, their composition may yield incorrectness due to interference. One specific type of interference is in the frequency domain, essentially, violations of the Nyquist rate. The challenge is to encode these signal processing problem characteristics into a form that can be model checked. To verify the correctness of the cyber-physical composition using model-checking techniques requires that a model be constructed that can represent frequency interference. In this paper, RT-PROMELA was used to construct the model, which was checked in RT-SPIN. In order to reduce the state explosion problem, the model was decomposed into multiple sub-models, each with a smaller state space that can be checked individually, and then the proofs checked for noninterference. Cooperation among multiple clock variables due to their lack of notion of urgency and their asynchronous interactions, are also addressed

In the Interests of clients or commerce? Legal aid, supply, demand, and 'ethical indeterminacy' in criminal defence work

As a professional, a lawyer's first duty is to serve the client's best interests, before simple monetary gain. In criminal defence work, this duty has been questioned in the debate about the causes of growth in legal aid spending: is it driven by lawyers (suppliers) inducing unnecessary demand for their services or are they merely responding to increased demand? Research reported here found clear evidence of a change in the handling of cases in response to new payment structures, though in ways unexpected by the policy's proponents. The paper develops the concept of 'ethical indeterminacy' as a way of understanding how defence lawyers seek to reconcile the interests of commerce and clients. Ethical indeterminacy suggests that where different courses of action could each be said to benefit the client, the lawyer will tend to advise the client to decide in the lawyer's own interests. Ethical indeterminacy is mediated by a range of competing conceptions of 'quality' and 'need'. The paper goes on to question the very distinction between 'supply' and 'demand' in the provision of legal services