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Physical health outcomes in severe mental illness are worse than in the general population. Routine physical health check completion in this group is poor.
To quantitatively and qualitatively evaluate the impact of point of care (POC) blood testing on physical health check completion in community mental health services.
In a prospective cohort design, we equipped an early intervention service (EIS) and a community mental health team (CMHT) with a POC blood testing device for 6 months. We compared rates of blood test and full physical health check completion in the intervention teams with a matched EIS and CMHT, historically and during the intervention. We explored attitudes to POC testing using thematic analysis of semi-structured interviews with patients and clinicians.
Although the CMHT scarcely used the POC device and saw no change in outcomes, direct comparison of testing rates in the intervention period showed increased physical health check completion in the EIS with the device (rate ratio RR = 5.18; 95% CI 2.54–12.44; P < 0.001) compared with usual care. The rate was consistent with the EIS's increasing rate of testing over time (RR = 0.45; 95% 0.09–2.08; P = 0.32). Similar trends were seen in blood test completion. POC testing was acceptable to patients but clinicians reported usability, provision and impact on the therapeutic relationship as barriers to uptake.
POC testing was beneficial and acceptable to patients and may increase physical health check uptake. Further research, accounting for clinician barriers, is needed to evaluate its clinical and cost-effectiveness.
Cognitive deficits at the first episode of schizophrenia are predictive of functional outcome. Interventions that improve cognitive functioning early in schizophrenia are critical if we hope to prevent or limit long-term disability in this disorder.
We completed a 12-month randomized controlled trial of cognitive remediation and of long-acting injectable (LAI) risperidone with 60 patients with a recent first episode of schizophrenia. Cognitive remediation involved programs focused on basic cognitive processes as well as more complex, life-like situations. Healthy behavior training of equal treatment time was the comparison group for cognitive remediation, while oral risperidone was the comparator for LAI risperidone in a 2 × 2 design. All patients were provided supported employment/education to encourage return to work or school.
Both antipsychotic medication adherence and cognitive remediation contributed to cognitive improvement. Cognitive remediation was superior to healthy behavior training in the LAI medication condition but not the oral medication condition. Cognitive remediation was also superior when medication adherence and protocol completion were covaried. Both LAI antipsychotic medication and cognitive remediation led to significantly greater improvement in work/school functioning. Effect sizes were larger than in most prior studies of first-episode patients. In addition, cognitive improvement was significantly correlated with work/school functional improvement.
These results indicate that consistent antipsychotic medication adherence and cognitive remediation can significantly improve core cognitive deficits in the initial period of schizophrenia. When combined with supported employment/education, cognitive remediation and LAI antipsychotic medication show separate significant impact on improving work/school functioning.
This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.
Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.
The IPS–WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS–WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS–WFM intervention (45 v. 26 weeks, p < 0.004).
The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
A national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey.
Ninety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.
A national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.
This paper presents the results of a detailed experimental investigation into the effectiveness of sinusoidal leading edge serrations on aerofoils for the reduction of the noise generated by the interaction with turbulent flow. A detailed parametric study is performed to investigate the sensitivity of the noise reductions to the serration amplitude and wavelength. The study is primarily performed on flat plates in an idealized turbulent flow, which we demonstrate captures the same behaviour as when identical serrations are introduced onto three-dimensional aerofoils. The influence on the noise reduction of the turbulence integral length scale is also studied. An optimum serration wavelength is identified whereby maximum noise reductions are obtained, corresponding to when the transverse integral length scale is approximately one-fourth the serration wavelength. This paper proves that, at the optimum serration wavelength, adjacent valley sources are excited incoherently. One of the most important findings of this paper is that, at the optimum serration wavelength, the sound power radiation from the serrated aerofoil varies inversely proportional to the Strouhal number
are frequency, serration amplitude and flow speed, respectively. A simple model is proposed to explain this behaviour. Noise reductions are observed to generally increase with increasing frequency until the frequency at which aerofoil self-noise dominates the interaction noise. Leading edge serrations are also shown to reduce aerofoil self-noise. The mechanism for this phenomenon is explored through particle image velocimetry measurements. Finally, the lift and drag of the serrated aerofoil are obtained through direct measurement and compared against the straight edge baseline aerofoil. It is shown that aerodynamic performance is not substantially degraded by the introduction of the leading edge serrations on the aerofoil.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
Nanoindentation experiments have been carried on Arabidopsis thaliana using spherical tungsten tips. Load–displacement plots obtained from experiments suggest that there is an optimum diameter of tip size which can be used to safely penetrate the tip through the cell wall. Based on the exact tip size used in the experiments and the measured load–displacement response, the failure stress was calculated using the experimental data in conjunction with a computational model. The value of failure stress was investigated in hypertonic (plasmolyzed), isotonic, and hypotonic (turgid) samples.
Rubberlike insect cuticle is a light fibrous composite, which exhibits great deformability and long-range elasticity due to the presence of a large amount of the elastomeric protein resilin. The presence of resilin in specific locations in the insect body leads to the assumption that its main function is loss-free storage of energy. Rubberlike cuticle was identified, for the first time, in the femur base of the sand field cricket, Gryllus firmus, using fluorescence microscopy and various staining methods. Dynamic nanoindentation testing was then used to investigate the differences in the mechanical properties of rubberlike cuticle between males and females and wing morphs of this species. Significant changes in storage, loss moduli, and resilience were captured between female wing morphs. The results provide insight into the structure–function relations associated with the properties of insect joints from different morphs and genders.
The electronic properties of ThO2 single crystals were studied using x-ray photoemission spectroscopy (XPS). The XPS results show that the Th 4f core level is in an oxidation state that is consistent with that expected for Th in ThO2. The effective Debye temperature is estimated from the temperature dependent photoemission intensities of the Th 4f core level over the temperature range of 290 to 360 K. A Debye temperature of 468±32 K has been determined.