A Next Generation Launch Capacity Model for the U.S. Eastern Range

2nd NRO/AIAA Workshop on Space Launch Integration presentatio

The association between academic pressure and adolescent mental health problems: A systematic review

BACKGROUND: Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised. METHODS: We conducted the first systematic review of the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702). RESULTS: We included 52 studies. Most studies assessed mixed anxiety and depressive symptoms (n = 20) or depressive symptoms (n = 19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome. LIMITATIONS: Most studies were cross-sectional (n = 39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences. CONCLUSIONS: We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions. FUNDING: UCL Health of the Public; Wellcome Institutional Strategic Support Fund

Space launch operations and capacity modeling : a system dynamics methodology for advanced analysis of the U.S. eastern range

Thesis (S.M.)--Massachusetts Institute of Technology, Technology and Policy Program, 2000.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Includes bibliographical references (p. 127-128).by David H.W. Steare.S.M

Smartphone-delivered self-management for first-episode psychosis: the ARIES feasibility randomised controlled trial

OBJECTIVES: To test the feasibility and acceptability of a randomised controlled trial (RCT) to evaluate a Smartphone-based self-management tool in Early Intervention in Psychosis (EIP) services. DESIGN: A two-arm unblinded feasibility RCT. SETTING: Six NHS EIP services in England. PARTICIPANTS: Adults using EIP services who own an Android Smartphone. Participants were recruited until the recruitment target was met (n=40). INTERVENTIONS: Participants were randomised with a 1:1 allocation to one of two conditions: (1) treatment as usual from EIP services (TAU) or (2) TAU plus access to My Journey 3 on their own Smartphone. My Journey 3 features a range of self-management components including access to digital recovery and relapse prevention plans, medication tracking and symptom monitoring. My Journey 3 use was at the users' discretion and was supported by EIP service clinicians. Participants had access for a median of 38.1 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility outcomes included recruitment, follow-up rates and intervention engagement. Participant data on mental health outcomes were collected from clinical records and from research assessments at baseline, 4 months and 12 months. RESULTS: 83% and 75% of participants were retained in the trial at the 4-month and 12-month assessments. All treatment group participants had access to My Journey 3 during the trial, but technical difficulties caused delays in ensuring timely access to the intervention. The median number of My Journey 3 uses was 16.5 (IQR 8.5 to 23) and median total minutes spent using My Journey 3 was 26.8 (IQR 18.3 to 57.3). No serious adverse events were reported. CONCLUSIONS: Recruitment and retention were feasible. Within a trial context, My Journey 3 could be successfully delivered to adults using EIP services, but with relatively low usage rates. Further evaluation of the intervention in a larger trial may be warranted, but should include attention to implementation. TRIAL REGISTRATION: ISRCTN10004994

Initial evidence review - Strategies for encouraging psychological and emotional resilience in response to loneliness 2019

It is now widely accepted that loneliness is influenced by a combination of psychological factors, including attitudes to participating in social interactions and mental health problems, as well as environmental factors such as living far from family and friends and life events and transitions such as bereavement and moving away from home. Despite increased recognition of the importance of individual-level processes and meanings that influence the experience of loneliness, there is a gap in our knowledge of how best to address the psychological factors that contribute to chronic loneliness. In this report, we aim to synthesise information from a range of sources in order to identify the psychological pathways to loneliness and relevant psychological barriers to accessing strategies which target social isolation. The report highlights promising interventions that have potential to target the psychological aspects of loneliness. It makes a series of recommendations to improve understanding and delivery of effective psychological interventions to address loneliness and how the interaction between such strategies and community-based interventions. We conducted an extensive scoping review of the academic literature, including online database searches and broader searches reviewing conference abstracts and reports from the Third Sector. We obtained expert opinions by speaking to relevant stakeholders including people with lived experiences of loneliness, charitable organisations working with people who are experiencing chronic loneliness, and those involved in developing and evaluating interventions to tackle loneliness. Much of the work focused on older adults but we also looked at interventions delivered across the age range. We report the findings from this work, including an overview of the wide range of psychological factors which might explain why some people who are chronically lonely struggle to engage with community strategies and other sources of support that are available. These factors include having mental health problems, personality characteristics and having unhelpful beliefs and behaviours related to social interactions. We recommend that interventions that target either the psychological or social aspects of loneliness should not be provided in isolation, and that multi-modal interventions are likely to be most successful. Further research evidence is needed to evaluate the feasibility, acceptability, effectiveness and cost-effectiveness of delivering psychological interventions in conjunction with community-based strategies. Social prescribing is a potential opportunity for the successful delivery of psycho-social interventions. For example, integration of psychological and community-based support could be promoted by including directories of psychological support in guides to community based resources, and by connecting social prescribing link workers with their local improving access to psychological therapies services. The social psychological approaches such as the Groups 4 Health model (Haslam et al., 2019; Haslam, Cruwys, Haslam, Dingle & Chang, 2016) show promise and potentially could bridge psychological and social understandings of loneliness. There is preliminary research evidence that interventions that address the psychological factors involved in loneliness can be successful, and there are various approaches to addressing these factors across the UK, although many initiatives have not yet been fully evaluated. The strongest research evidence was found for cognitive behavioural interventions, and there are some promising developments, including digital initiatives which are designed to change individuals’ thoughts and feelings about loneliness, that are worthy of further evaluation. We would also recommend that acceptance and commitment therapy is formally evaluated as an intervention for loneliness. We noted that the research base in this area is still underdeveloped and more work is needed to demonstrate which interventions are most accessible to people who are chronically lonely and can feasibly be delivered within NHS and community settings. Research into the potential adverse effects of psychological interventions, individual differences in responsiveness and the longer term impact on loneliness is also needed. It is likely that including measures of loneliness in evaluations of interventions for social anxiety and grief and in routine work with older adults in improving access to psychological therapies services would yield data that will contribute to the growing evidence base in this area. We hope that bringing together the research evidence and expert opinion in this report will increase awareness of the wide range of psychological factors implicated in loneliness and lead to further provision of psychological interventions for loneliness, in combination with community based support for social isolation

Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis

INTRODUCTION: The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of 'personality disorder') is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. AIM: To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. METHODS: Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. RESULTS: Twenty-nine papers were eligible for inclusion, most with samples given a 'personality disorder' diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. DISCUSSION: Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support

A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England.

BACKGROUND: For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. AIMS: We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. METHOD: We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick-Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS: We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54-1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4-3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4-2.1, P = 0.004), and lower depression scores (-1.7, 95% CI -2.7 to -0.8, P < 0.001), than CRT participants. CONCLUSIONS: Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research

Community interventions for people with complex emotional needs that meet the criteria for personality disorder diagnoses: systematic review of economic evaluations and expert commentary

Background: Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources. / Aims: To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making. / Method: Systematic review (PROSPERO: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement. / Results: Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified. / Conclusions: Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these

Current state of the evidence on community treatments for people with complex emotional needs:a scoping review

BACKGROUND: Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS: We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS: We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS: Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group

App to support Recovery in Early Intervention Services (ARIES) study: protocol of a feasibility randomised controlled trial of a self-management Smartphone application for psychosis

INTRODUCTION: Mental health interventions delivered through digital technology have potential applications in promoting recovery and improving outcomes among people in the early stages of psychosis. Self-management approaches are recommended for the treatment of psychosis and could be delivered via applications (apps) installed on Smartphones to provide low-cost accessible support. We describe the protocol for a feasibility trial investigating a self-management Smartphone app intervention for adults using Early Intervention in Psychosis (EIP) services. METHODS AND ANALYSIS: In this feasibility randomised controlled trial, 40 participants will be recruited from EIP services in London and Surrey. Twenty participants will be randomised to receive a supported self-management Smartphone app (My Journey 3) plus Treatment As Usual (TAU), while the other 20 participants will receive TAU only. The primary objective of this study is to evaluate the feasibility of conducting a full-scale trial of this intervention in EIP services. Participant data will be collected at baseline and at two follow-up assessments conducted 4 months and 12 months post-baseline. Analysed outcome measures will include relapse of psychosis (operationalised as admission to a hospital or community acute alternative), mental health and well-being, recovery, quality of life and psychopathology. Semi-structured interviews with participants and EIP service clinicians will additionally explore experiences of using My Journey 3 and participating in the trial and suggestions for improving the intervention. ETHICS AND DISSEMINATION: The App to support Recovery in Early Intervention Services study has been reviewed and approved by the National Research Ethics Service Committee London-Brent (Research Ethics Committee reference: 15/LO/1453). The findings of this study will be disseminated through peer-reviewed scientific journals and conferences, magazines and web publications. TRIAL REGISTRATION NUMBER: ISRCTN10004994