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UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care.
To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners).
A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders.
A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test).
There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Research in developmental neuropsychiatric conditions has revealed morphological and functional divergences in the brain. In some cases, the divergences occur due to one or two highly penetrant genomic mutations. In case such as autism, mutations in varied sets of genes may produce a convergent autism behavioral phenotype. It is thus likely that there may be other forms of non-genomic regulation of gene expression during development affecting behavioral outcome. Epigenetic gene regulation is one such mechanism that can permanently switch on or switch off gene expression, and these epigenetic changes can be inherited from one cell stage to another during differentiation, mimicking the effects of genomic mutations. Epigenetic gene regulation occurring during early developmental stages of cellular differentiation, which are highly sensitive to environmental cues, is the primary mechanism responsible for the phenomenon known as evolutionary development or “evo-devo.” This chapter discusses these mechanisms in the context of autism and the environmental factors that influence it.
Optimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions.
To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition.
Surveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires.
Questionnaire response was 79% at baseline and 82% at follow-up. For those aged 17–19, incident rate (range adjusted for non-response) of transition need was 202–511 per 100 000 people aged 17–19 per year, with successful transition of 38–96 per 100 000 people aged 17–19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.
As inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.
Workforce shortages in psychiatry are common worldwide. The international literature provides insights into factors influencing decisions to train in psychiatry but is predominately survey based. This national cohort study aimed to identify the characteristics of doctors who were most likely to apply to psychiatry training programmes. The sample comprised doctors who entered UK medical schools in 2007/8 and who made first-time specialty training applications in 2015. The association between application to psychiatry and doctors' sociodemographic and educational characteristics was examined using multivariable logistic regression.
Those most likely to apply were White, privately educated older doctors with below average performance at medical school.
To reduce workforce shortages, psychiatry must make itself more attractive to all doctors, especially those from underrepresented groups such as state-educated Black and minority ethnic individuals. Otherwise, national policies to widen participation in the study of medicine by such groups may exacerbate the current recruitment crisis.
To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).
PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed.
Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness.
This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.
At the end of 2013 the real yields that the UK government had to pay on its debt were negative over the whole curve. Several possible explanations are available for this phenomenon – central bank action, regulatory changes, demographic developments and economic conditions. The first two can result from deliberate interaction by the state into the financial markets and can be labelled as financial repression. We explain the historic precedents for Governments to use financial repression to manage their debt, look into the influence of regulation on asset allocation for insurers and pension funds, and introduce the concept of a balance-sheet recession.
We use a WISE-2MASS-Pan-STARRS1 galaxy catalog to search for a supervoid in the direction of the Cosmic Microwave Background Cold Spot. We obtain photometric redshifts using our multicolor data set to create a tomographic map of the galaxy distribution. The radial density profile centred on the Cold Spot shows a large low density region, extending over 10's of degrees. Motivated by previous Cosmic Microwave Background results, we test for underdensities within two angular radii, 5°, and 15°. Our data, combined with an earlier measurement by Granett et al. 2010, are consistent with a large Rvoid=(192 ± 15)h−1 Mpc (2σ) supervoid with δ ≃ −0.13 ± 0.03 centered at z=0.22 ± 0.01. Such a supervoid, constituting a ∼3.5 σ fluctuation in the ΛCDM model, is a plausible cause for the Cold Spot.
This paper presents some new observations concerning the construction of the Sutton Hoo helmet, as a point of entry to a wider discussion of pre-Christian religious and ideological links across Scandinavia. It will be argued that in certain circumstances and locations, such as the firelit interior of the hall, the wearer of the helmet was seen as both war leader and war god, a literal personification of Odin. This interpretation is supported and extended with a variety of Scandinavian finds from the sixth to tenth centuries, and arguably represents an unusually physical manifestation of the ritual border-crossing between human and divine elites. In the socio-political context of early medieval kingdoms, the dramatic imagery of the helmets and related military equipment had a critical role to play in the communication of power, the origin of military prowess, and the religious allegiance of a warlord.
Pragmatists have traditionally been enemies of representationalism but friends of naturalism, when naturalism is understood to pertain to human subjects, in the sense of Hume and Nietzsche. In this volume Huw Price presents his distinctive version of this traditional combination, as delivered in his René Descartes Lectures at Tilburg University in 2008. Price contrasts his view with other contemporary forms of philosophical naturalism, comparing it with other pragmatist and neo-pragmatist views such as those of Robert Brandom and Simon Blackburn. Linking their different 'expressivist' programmes, Price argues for a radical global expressivism that combines key elements from both. With Paul Horwich and Michael Williams, Brandom and Blackburn respond to Price in new essays. Price replies in the closing essay, emphasising links between his views and those of Wilfrid Sellars. The volume will be of great interest to advanced students of philosophy of language and metaphysics.
The origins of this volume lie in a kind invitation from the Tilburg Center for Logic and Philosophy of Science (TiLPS), to deliver their inaugural René Descartes Lectures in May 2008. I was delighted to accept, and presented the lectures under the title ‘Three Themes in Contemporary Pragmatism’ (the themes in question being naturalism, representationalism and pluralism). The lecture series was held in conjunction with a research workshop on pragmatism and naturalism, providing me with a remarkable opportunity to discuss some of my recent work with the best kind of philosophical audience – broadly sympathetic to a considerable extent, yet challenging on many points. I am very grateful indeed to Professor Stephan Hartmann and his colleagues at TiLPS for their hospitality, and for doing me the honour of inviting me in the first place. I am also greatly indebted to the workshop speakers and participants, for their part in making it such a memorable and educational experience, from my point of view.
With the promise of such an excellent audience, I tried to use the lectures to do two things: first, to present what I felt to be the most interesting ideas in my recent work at that time, and, second, to try to think through some succeeding steps (very much work in progress, at that stage). Accordingly, I used the first lecture to present some material that was then recently in print, on the role and significance of representationalist presuppositions in conventional forms of philosophical naturalism.