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Experiences of racism can be a cumulative risk factor for developing mental health problems. Cognitive Behaviour Therapists working with Black and Minority Ethnic (BME) service users should be confident in their ability to establish the necessary rapport to ask about these experiences and be able to incorporate this information into longitudinal formulations and as part of maintenance cycles. This paper sets out guidelines as to how to do this as part of a wider engagement process.
Recently there have been a number of developments in cognitive behaviour therapy (CBT) that have led to cultural adaptations of specific interventions and a greater awareness of how in general CBT might be adapted for Black and Minority Ethnic (BME) service users. These developments, however, involve change at the level of the individual therapist and particular treatment approach, but involve very few considerations of what needs to happen at the levels of teams or services in order to best meet the mental health needs of British South Asian and other BME populations. This paper summarizes the way that services need to understand how minority populations use services and how to involve those populations in developing services in order to ensure their needs are best met.
Cognitive behaviour therapy (CBT) has become the first line of treatment for a wide range of mental health problems across many countries. The flexibility of CBT, and a strong evidence base and good track record of training and dissemination, has lent itself to scaling up of this therapy, and projects such as the Improving Access to Psychological Therapies (IAPT) programme in England have shown that large-scale projects to roll out CBT at a national level are possible (Clark, 2011).
An assemblage of killer whales that has been sighted in waters off the west coast of the British Isles and Ireland has previously been shown to be isolated from other North Atlantic killer whale communities based on association patterns. By applying a Bayesian formulation of the Jolly–Seber mark-recapture model to the photo-identification data compiled from opportunistic photographic encounters with this population of killer whales, we show that such sparse and opportunistically-collected data can still be valuable in estimating population dynamics of small, wide-ranging groups. Good quality photo-identification data was collected from 32 encounters over 19 years. Despite a cumulative total of 77 identifications from these encounters, just ten individuals were identified and the remaining 67 identifications were re-sights of these ten animals. There was no detected recruitment through births during the study and, as a result, the population appears to be in a slight decline. The demography of the population was highly skewed towards older individuals and had an unusually high ratio of adult males, and we suggest that demographic stochasticity due to a small population size may be further impacting the population growth rate. We recommend that this population be managed as a separate conservation unit from neighbouring killer whale populations.
We report a range-wide status assessment of a key Neotropical ecosystem architect, the white-lipped peccary Tayassu pecari, categorized as Near Threatened on the IUCN Red List, using published information and unpublished data from 41 scientists in 15 range countries. We estimate that the white-lipped peccary has been extirpated in 21% of its historical range over the last 100 years, with reduced abundance and a low to medium probability of long-term survival in another 48% of its current range. We found major range declines in Argentina, Paraguay, southern Brazil, Colombia, Venezuela, north-east Brazil, Mexico and Costa Rica. This species is particularly at risk in more xeric ecosystems, especially the caatinga, cerrado and pampas. Hunting and habitat destruction are the most severe threats, although there are also unexplained sudden die-offs suggestive of disease. We evaluate our results in light of this species’ important interspecific interactions and its role as an ecosystem architect. One of our recommendations is that conservation efforts should focus on landscape conservation of large, continuous and ecologically intact areas containing a mosaic of different habitat types.
This pilot study evaluated the addition of 1 to 6 sessions of cognitive–behavioural therapy (CBT) for patients of a mental health acute assessment and treatment team. A pre-post design for 12 months of consecutive referrals used the Health of the Nation Outcome Scale (HONOS), Depression, Anxiety, Stress Scales (DASS), and patient satisfaction. Forty-two patients who attended CBT were compared with 19 patients who were referred but did not attend therapy due to refusal, referral to another service, or loss to follow-up. With a mean of 3.2 sessions, HONOS scores improved by a mean of 1.02 SD in patients who attended CBT and 0.72 SD in nonattenders. DASS results showed a mean reduction of 0.55 SD in symptoms of depression, anxiety and stress in those who attended. Patients' overall satisfaction averaged 4.7/5. Results showed brief CBT was feasible in this setting, with high patient satisfaction and some evidence of improved patient outcomes compared with usual care.
Observational techniques with high angular and high spectral resolution have become available in recent years and have had a major impact on the study of Herbig-Haro outflows from very young stars. We discuss new results obtained using WFPC2, ACS and STIS onboard the Hubble Space Telescope, as well as spectroscopic data obtained at the Keck telescope and with the Integral Field Unit at the Gemini telescope. We also discuss centimeter radio continuum maps from the Very Large Array and their importance in testing scenarios for the formation of giant Herbig-Haro flows.
Mental health provider trusts in England were required in 1994 to establish local Supervision Registers of patients at risk.
To identify the factors associated with registration, and obtain clinicians' views on its effectiveness.
At a random sample of 14 trusts data were collected from case notes, keyworkers and responsible medical officers.
A sample of 133 registered patients were more disabled and had more extensive histories of violence and self-harm than 126 comparison patients on the upper tier of the Care Programme Approach (CPA). Those registered were a heterogeneous group. For some there was little evidence of risk. In most cases clinicians did not believe registration had improved care.
The Supervision Register policy has not resulted in the identification of a well-defined group. Its effectiveness is limited by the lack of operationalised measures of risk.
The Care Programme Approach (CPA) and supervision register policies in England are intended to prioritise patients to receive specialist mental health care.
To describe and evaluate the practical application of the policies.
A questionnaire survey of key informants in mental health provider trusts and an analysis of aggregated data collected by health authorities using the Mental Illness Needs Index as a measure of population need.
On average, 1175 per 100 000 total population are subject to the CPA (95% Cl=1055–1309) and 8.6 per 100 000 (95% Cl=7.5–9.9) are on supervision registers. Wide local variations in the number of people subject to the CPA and supervision registers are not explained by variations in population need.
Prioritisation to receive specialist mental health services is carried out inconsistently, and inequitable use of resources may result.
Two recently developed measures intended for clinical use are HoNOS (Health of the Nation Outcome Scales), measuring social functioning, and CANSAS (Camberwell Assessment of Need Short Appraisal Schedule), for measuring need.
We investigated the association between CANSAS and HoNOS.
For some domains there were substantial associations, with high HoNOS rating correlated with CANSAS rating of the presence of a need. For other areas the agreement was less than might be expected. Seven factors were identified within the 22 CANSAS domains, and the presence of needs in the Drug/alcohol and Activities of daily living factors was associated with high scores in the related HoNOS domains.
CANSAS and HoNOS assessments differ. HoNOS can track changes in social functioning over time, but may be less useful for treatment planning, and should not be used to infer the level of morbidity in a case-load. CANSAS indicates when treatment should be commenced or continued. It can also be used as a case-load measure, but may be insufficiently sensitive to be used as an outcome measure at the individual level.
Supervised discharge orders were introduced in April 1996. This paper describes two national surveys of their use in all mental health provider trusts in England. Data were collected from key informants in mental health provider trusts using a postal survey in 1997, and a follow-up telephone survey in 1998.
The total number of patients subject to supervised discharge in 1997 was 160, a mean of one per trust. In 1998, there were 378 cases, a mean of two cases per trust. The annual period prevalence in 1998 can be estimated as 510 cases, approximately one per 100000 total population per year. Seventeen applications of the ‘power to convey’ were identified.
Supervised discharge is regarded as suitable for very few patients, though its use is growing. The controversial power to convey is seldom used in practice and barriers to its use are described.
The case notes of 100 consecutive admissions to a general adult psychiatry service revealed that no sexual history was recorded in 73 cases. Only one patient had a detailed sexual history taken. In 22 cases the sex history was limited to a single mention of ‘reduced libido’ and in another four cases a brief explanation was done. Sexual side-effects of medication were not explored in any case. Sex history was more likely to be recorded when the doctor and patient were of the same sex; in cases with a history of sexual abuse or relationship problems; and where psychopathology had a sexual content.
Progress is reported in developing reliable methodology for imaging silicon surfaces with the atomic force microscope (AFM). A new form of AFM, known as tapping mode AFM, has been found to provide the best quality data for surface roughness determinations. Commercially available colloidal gold spheres have been used to fabricate tip characterization standards and are used to report tip size with roughness data. Power spectral density calculations are shown to provide a useful roughness calculation based on lateral wavelength.
In political science research these days, the R2 is out of fashion. A chorus of our best methodologists sounds notes of caution, at varying degrees of pitch. Berry and Feldman (1985, 15) remark in their popular regression monograph: “A researcher should be careful to recognize the limitations of R2 as a measure of goodness of fit.” In their more general statistics text, Hanushek and Jackson (1977, 59) claim that “one must be extremely cautious in interpreting the R2 value for an estimation and particularly in comparing R2 values for models that have been estimated with different data sets.” Perhaps the most pointed attack comes from Achen (1982, 61), who argues that the R2 “measures nothing of serious importance.” His contention is that it should be abandoned, and the standard error of the regression (SEE) substituted as a goodness-of-fit measure. Developing these lines of inquiry further, King (1986) provides the latest set of criticisms. Accordingly, “In most practical political science situations, it makes little sense to use [the R2]” (King 1986, 669). And, concerning the “proportion of variance explained” definition more particularly, “it is not clear how this interpretation adds meaning to political analyses.” (King 1986, 678).
Political science, unlike economics, does not have a long tradition of forecasting models. However, this is changing. Currently, there is considerable interest in election forecasting. The basis for the interest is a flurry of related publications on House, Senate and presidential elections. A common goal for these studies is the development of a model, inevitably based on aggregate time-series data, which predicts election returns. The resulting models, some of which are quite accurate, can differ a good deal in specification and estimation. Also, they vary in complexity, making them more or less accessible to the engaged voter.