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Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need.
To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England.
We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula.
Higher costs were associated with: being 30–50 years old, compared with 20–24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost.
The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.
Geologists and archaeologists have long known that the bluestones of Stonehenge came from the Preseli Hills of west Wales, 230km away, but only recently have some of their exact geological sources been identified. Two of these quarries—Carn Goedog and Craig Rhos-y-felin—have now been excavated to reveal evidence of megalith quarrying around 3000 BC—the same period as the first stage of the construction of Stonehenge. The authors present evidence for the extraction of the stone pillars and consider how they were transported, including the possibility that they were erected in a temporary monument close to the quarries, before completing their journey to Stonehenge.
Bede frequently used dating formulas to frame his narrative. In some cases these simply reflect the wording of his sources, whether he states that he is quoting from them or not. More often, however, the types of phrasing he uses reflect conscious construction on his part. Such formulas drew attention to key people and passages in the work and so assisted in the achievement of Bede's authorial intentions in the Historia ecclesiastica. These phrases also imitated and developed previous exemplars from earlier historiography thus enabling Bede to situate and validate his work within the genre.
Four new species of the Aleiodes apicalis (Brullé) species group (Hymenoptera: Braconidae: Rogadinae) from the Neotropical Region are described and illustrated: Aleiodes ambrosiaenew species. from Peru, A. aquilesinew species from Costa Rica, and A. sachambrosiaenew species and A. tapirapenew species from Brazil. We also add new distribution records for Aleiodes molestus Cresson, from Costa Rica. With the addition of the new species, the A. apicalis species group has 11 species from the New World, six of which are recorded from Neotropical Region.
We have obtained high signal-to-noise ratio CCD spectra at ≤ 150 km/s resolution for 6 high-ionization Seyfert galaxies. We analyzed the profiles of the emission-lines over a wide range in both ionization potential (IP) and critical density (Ncr) in order to study the fundamental problem of cloud motion in the narrow-line region (NLR). Using the known correlations between FWHM and IP and/or Ncr for these galaxies, and assuming that the blueward profile asymmetries result from the combined effects of radially infalling or outflowing clouds and extinction within or between them, we deconvolve these effects by analyzing the correlation between emission-line asymmetries and both IP and Ncr. We find fair to good correlations in the sense that lines with high IP and Ncr also tend to have high asymmetry, while lines with low IP and Ncr have low but usually non-zero asymmetry. Simulated emission-line profiles generated with a spherically-symmetric model of a NLR suggest that the extinction arises primarily within radially infalling clouds.
The European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) was launched by the European Commission in 2011 to promote innovation in ageing research. This paper explores the experiences of partners delivering frailty interventions within Europe, registering their programmes with the EIP-AHA. Data were collected using an online survey from 21 partners in seven countries. A mixed-method approach was used with inductive thematic analysis of free-text responses to improve data richness. Responses indicated that there was a lack of consistency between EIP-AHA partners in methods of defining, screening and measuring for frailty and pre-frailty. Open responses to survey questions about intervention facilitators, moderators and barriers were coded into two themes: working with stakeholders and project management. We concluded that EIP-AHA partners are providing interventions addressing physical, cognitive and wellbeing elements of frailty. However, there needs to be an increase in the proportion of interventions that consistently apply valid methods of screening and/or measuring frailty and pre-frailty. Most, but not all projects are targeting pre-frail older adults, suggesting an appropriate balance of prevention in a useful ‘intervention window’ but also a growing understanding that frailty at later stages is amenable to intervention. Findings suggest design manipulations to improve outcomes and adherence to interventions, specifically inclusion of a perceived benefit/reward for older adults, e.g. a social aspect or health-care promotion.
This study details the characterization of a glass sample exposed to hyperalkaline water and calcium-rich sediment for an extended time period (estimated as 2 - 70 years) at a lime (CaO) waste site in the UK. We introduce this site, known as Peak Dale, in reference to its use as a natural analogue for nuclear waste glass dissolution in the high pH environment of a cementitious engineered barrier of a geological disposal facility. In particular, a preliminary assessment of alteration layer chemistry and morphology is described and the initiation of a long-term durability assessment is outlined.
The interaction of Stokes’ edge waves with a developing near-shore ice zone is examined from two points of view. First, the effect of a well-fragmented ice suspension on the classical Stokes’ edge wave is discussed. Secondly, the possibility that ice-cusp formation (and, thereafter, ice mounds or volcanoes) can be initiated by edge waves is examined. Results indicate a negligible effect of a well-fragmented floating ice field on the Stokes’ dispersion equation for typical wave periods, but do indicate that the presence of a standing Stokes’ edge wave may lead to the initiation of ice-field cusps as ice formation occurs in the near-shore zone.
While Bede did not know the year of Augustine's death, he possessed papal letters which provide sufficient information to deduce it with some confidence. The early epistles from popes which Bede quoted or referred to in the ‘Historia ecclesiastica’ associated journeys by delegations sent by the early Church in Kent to Rome with the request for, and collection of, the pallium for the new bishop of Canterbury. In this light the likely purpose for the otherwise unexplained visit of Mellitus to Rome in 610 becomes clear: he had come to ask Pope Boniface IV for the pallium for Laurence, following the death of Augustine on 26 May 609.
The study of the formation and evolution of planetary nebulae (PNs) has been a subject of active investigation for several decades. In the past 15 years the relationship between nebular morphology and nebular/stellar evolution has been investigated in some detail. Although important insights have been gained, the connection between PN formation and even basic morphological features of the evolving nebula is far from clear. One of the most vexing problems to overcome is the difficulty of obtaining, at least for Galactic PNs where statistical distances must be adopted, reliable dimensions, ages, luminosities, and other physical quantities that are essential for understanding the evolutionary state of individual nebulae. Our emphasis of late has been to obtain high-resolution images of a large sample of PNs in the Magellanic Clouds, where uncertainties in the distances are minimal and selection effects due to, e. g., dust absorption in the Galactic plane do not apply.
This work provides new insights into human responses to and perceptions of sea-level rise at a time when the landscapes of north-west Europe were radically changing. These issues are investigated through a case study focused on the Channel Islands. We report on the excavation of two sites, Canal du Squez in Jersey and Lihou (GU582) in Guernsey, and the study of museum collections across the Channel Islands. We argue that people were drawn to this area as a result of the dynamic environmental processes occurring and the opportunities these created. The evidence suggests that the area was a particular focus during the Middle Mesolithic, when Guernsey and Alderney were already islands and while Jersey was a peninsula of northern France. Insularisation does not appear to have created a barrier to occupation during either the Middle or Final Mesolithic, indicating the appearance of lifeways increasingly focused on maritime voyaging and marine resources from the second half of the 9th millennium BC onwards.
Physical health has been demonstrated to mediate the mental health and mortality risk association. The current study examines an alternative hypothesis that mental health mediates the effect of physical health on mortality risk.
Participants (N = 14,019; women = 91%), including eventual decedents (n = 3,752), were aged 70 years and older, and drawn from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Participants were observed on two to four occasions, over a 10-year period. Mediation analysis compared the converse mediation of physical and mental health on mortality risk.
For men, neither physical nor mental health was associated with mortality risk. For women, poor mental health reported only a small effect on mortality risk (Hazard Risk (HR) = 1.01; p < 0.001); more substantive was the risk of low physical health (HR = 1.04; p < 0.001). No mediation effects were observed.
Mental health effects on mortality were fully attenuated by physical health in men, and partially so in women. Neither mental nor physical health mediated the effect of each other on mortality risk for either gender. We conclude that physical health is a stronger predictor of mortality risk than mental health.
Did Neanderthal hunters drive mammoth herds over cliffs in mass kills? Excavations at La Cotte de St Brelade in the 1960s and 1970s uncovered heaps of mammoth bones, interpreted as evidence of intentional hunting drives. New study of this Middle Palaeolithic coastal site, however, indicates a very different landscape to the featureless coastal plain that was previously envisaged. Reconsideration of the bone heaps themselves further undermines the ‘mass kill’ hypothesis, suggesting that these were simply the final accumulations of bone at the site, undisturbed and preserved in situ when the return to a cold climate blanketed them in wind-blown loess.
The ‘ethnic density hypothesis' is a proposition that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. Investigations into this hypothesis have resulted in a complex and sometimes disparate literature.
To systematically identify relevant studies, summarise their findings and discuss potential explanations of the associations found between ethnic density and mental disorders.
A narrative review of studies published up to January 2011, identified through a systematic search strategy. Studies included have a defined ethnic minority sample; some measure of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder.
A total of 34 papers from 29 data-sets were identified. Protective associations between ethnic density and diagnosis of mental disorders were most consistent in older US ecological studies of admission rates. Among more recent multilevel studies, there was some evidence of ethnic density being protective against depression and anxiety for African American people and Hispanic adults in the USA. However, Hispanic, Asian–American and Canadian ‘visible minority’ adolescents have higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses.
The most consistent associations with ethnic density are found for psychoses. Ethnic density may also protect against other mental disorders, but presently, as most studies of ethnic density have limited statistical power, and given the heterogeneity of their study designs, our conclusions can only be tentative.