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The deep subsurface of other planetary bodies is of special interest for robotic and human exploration. The subsurface provides access to planetary interior processes, thus yielding insights into planetary formation and evolution. On Mars, the subsurface might harbour the most habitable conditions. In the context of human exploration, the subsurface can provide refugia for habitation from extreme surface conditions. We describe the fifth Mine Analogue Research (MINAR 5) programme at 1 km depth in the Boulby Mine, UK in collaboration with Spaceward Bound NASA and the Kalam Centre, India, to test instruments and methods for the robotic and human exploration of deep environments on the Moon and Mars. The geological context in Permian evaporites provides an analogue to evaporitic materials on other planetary bodies such as Mars. A wide range of sample acquisition instruments (NASA drills, Small Planetary Impulse Tool (SPLIT) robotic hammer, universal sampling bags), analytical instruments (Raman spectroscopy, Close-Up Imager, Minion DNA sequencing technology, methane stable isotope analysis, biomolecule and metabolic life detection instruments) and environmental monitoring equipment (passive air particle sampler, particle detectors and environmental monitoring equipment) was deployed in an integrated campaign. Investigations included studying the geochemical signatures of chloride and sulphate evaporitic minerals, testing methods for life detection and planetary protection around human-tended operations, and investigations on the radiation environment of the deep subsurface. The MINAR analogue activity occurs in an active mine, showing how the development of space exploration technology can be used to contribute to addressing immediate Earth-based challenges. During the campaign, in collaboration with European Space Agency (ESA), MINAR was used for astronaut familiarization with future exploration tools and techniques. The campaign was used to develop primary and secondary school and primary to secondary transition curriculum materials on-site during the campaign which was focused on a classroom extra vehicular activity simulation.
Although architects collaborate with engineers in the design of buildings, the contribution of the latter is seldom known to historians. This paper examines the design of the Snowdon Aviary at London Zoo, which is typically attributed to Lord Snowdon and Cedric Price. However, the vast majority of surviving design sketches are in the hand of Frank Newby, the structural engineer. Apart from giving clues about the way in which the design developed, these sketches leave the strong impression that Newby was taking the lead in proposing specific forms that the structure might take, because he alone was aware of the structural possibilities. The sketches raise the question: how common was this dynamic? Examples of Newby's contribution to other projects are suggested.
The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining.
We propose a ‘drug-centred’ framework for understanding the nature of drug treatment in psychiatry. In contrast to the prevailing ‘disease-centred’ model, which suggests that drugs work by targeting underlying abnormalities, the drug-centred model maintains that drugs exert their effects through their psychoactive properties. According to this view, distinctive drug-induced alterations to normal cognition, emotion and behaviour can modify the manifestations of mental disorders independent of diagnosis or aetiological theory. The drug-centred approach already forms the basis of some current practice, particularly off-label prescribing. Within this framework, the matching of drug-induced effects to symptoms or difficulties, taking into account the unwanted aspects of the drug-induced state, becomes the focus of a collaborative endeavour between doctor and patient, consistent with the principles of the recovery model. More research into the full range of effects that psychiatric drugs produce is required to ground a judicious drug-centred practice and inform psychiatric training.
People with severe mental illness (SMI) die relatively young, with mortality rates four times higher than average, mainly from natural causes, including heart disease. We developed a computer-based physical health screening template for use with primary care information systems and evaluated its introduction across a whole city against standards recommended by the National Institute for Health and Care Excellence for physical health and cardiovascular risk screening.
A significant proportion of SMI patients were excluded from the SMI register and only a third of people on the register had an annual physical health check recorded. The screening template was taken up by 75% of GP practices and was associated with better quality screening than usual care, doubling the rate of cardiovascular risk recording and the early detection of high cardiovascular risk.
A computerised annual physical health screening template can be introduced to clinical information systems to improve quality of care.
Mental health payment by results (PbR) is a disruptive new prospective payment system intended to replace National Health Service block contracts in England and provide a mechanism for opening up the mental health economy. Patients are allocated to one of 21 treatment clusters, each with a different price or tariff. Clinicians perform cluster allocation using the Mental Health Clustering Tool. The clustering process makes demands on clinicians' time even with support from information systems. Clustering is novel and it is unclear how it will work in practice. The process is likely to be susceptible to gaming.
Understand that the clinical process of diagnostic classification is different from the financial process of clustering categorisation.
Understand the importance of learning the clustering tool ratings definitions in order to make accurate cluster allocations.
Recognise that mental health payment by results is driving the widespread adoption of outcomes measurement.
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
line, n. […] 4. cord for measuring, levelling etc. […] 6. long narrow mark traced on surface. O.E.D.
Between the design and the realization of a building there are a number of ‘drawing’ processes, either on the building site or in the workshop, which range from the setting out of the plan to the production of ‘shop drawings’ from which details are derived. Unfortunately, while the latter have survived in sufficient numbers to have attracted scholarly attention, the setting out of the ground plan leaves no trace. Nevertheless, it is that process that determines the building's basic geometry. While much scholarly effort has gone into attempting to divine the geometrical principles behind designs from Antiquity to the Gothic period, it has not always been informed by an understanding of the setting-out process. Without taking the constraints of that process into account, one is reduced to looking for geometrical relationships within the building, and of course one will find some. Clearly, there were geometrical principles behind almost all buildings, if only that they should be rectangular or symmetrical, but the difficulty is that a few simple rules can easily result in a large number of geometrical relationships within the building that were not used, and possibly not even recognized, by their designers. At the very least, therefore, we should consider how to distinguish those relationships that were actually used by the designers and builders from those that are merely epiphenomenal.
Remission is a new research outcome indicating long-term wellness. Remission not only sets a standard for minimal severity of symptoms and signs (resolution); it also sets a standard for how long symptoms and signs need to remain at this minimal level (6 months). Individuals who achieve remission from schizophrenia have better subjective well-being and better functional outcomes than those who do not. Research suggests that remission can be achieved in 20–60% of people with schizophrenia. There is some evidence of the usefulness of remission as an outcome indicator for clinicians, service users and their carers. This article reviews the literature on remission in schizophrenia and asks whether it could be a useful clinical standard of well-being and a foundation for functional improvement and recovery.
Michael Smith's article considering the present and future of ‘public psychiatry’ assumes the continued existence of psychiatry following a conversation with the public. But what if the public does not want psychiatry?
Cardiovascular disease is more prevalent in patients with severe mental illness (SMI) than in the general population.
Seven geographically diverse centres were assigned a nurse to monitor the physical health of SMI patients in secondary care over a 2-year period in the “Well-being Support Programme” (WSP). A physical health screen was performed and patients were given individual weight and lifestyle advice including smoking cessation to reduce cardiovascular risk.
Nine hundred and sixty-six outpatients with SMI >2 years were enrolled. The completion rate at 2 years was 80%. Significant improvements were observed in levels of physical activity (p < 0.0001), smoking (p < 0.05) and diet (p < 0.0001). There were no changes in mean BMI although 42% lost weight over 2 years. Self-esteem improved significantly. Low self-esteem decreased from 43% at baseline to 15% at 2 years (p < 0.0001). At the end of the programme significant cardiovascular risk factors remained, 46% of subjects smoked, 26% had hypertension and 81% had BMI >25.
Physical health problems are common in SMI subjects. Many patients completed 2 years follow up suggesting that this format of programme is an acceptable option for SMI patients. Cardiovascular risk factors were significantly improved. interventions such as the Well-being Support Programme should be made widely available to people with SMI.
Partnership working with the voluntary sector is developing across mental health services. Such partnerships have the support of the Royal College of Psychiatrists and the Department of Health. Setting up a partnership requires enthusiastic psychiatrists who are willing to work in new ways. These psychiatrists will face issues of personal and clinical responsibility, confidentiality and fairness. They will also have to deal with continuing changes that could unsettle a new and developing collaboration. Early intervention services may use partnerships more than other adult psychiatry services, but partnerships could be established in any specialty. Psychiatrists should make sure that appropriate evaluation is built into any new partnership.
The WGNEO, a Working Group of Divisions I and III, was formed in the early 1990s to coordinate study of Earth-approaching asteroids and comets (NEOs) and provide timely advice to the General Secretary and officers of the IAU on discovery of any objects that threaten collision with the Earth. Since then, the WGNEO has steadily grown, reflecting increasing international interest and concern over impacts, especially from asteroids (which dominate over comets in their risk to Earth). In this triennium, the WGNEO had a membership of 49 (including the Organizing Committee of 17 members), plus 10 consultants. The Chair is David Morrison (USA), Vice-Chair Andrea Milani (Italy), Secretary Richard Binzel (USA), and Past-Chair Andrea Carusi (Italy).
An audit of case notes and a survey of in-patients was carried out to evaluate risk assessment on an in-patient ward. We found considerable inconsistencies between the risk assessment records in medical and nursing notes. A systematic survey found higher levels of risk than either set of notes, but combining the notes improved the quality of risk assessment compared to the survey. We suggest three key areas for action to improve risk assessment.