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Although there is some evidence that duration of untreated psychosis (DUP) is geographically stable, few have examined whether the phenomenon is temporally stable. We examined DUP in two cohorts within two discrete time periods (1995–1999 and 2003–2005) spanning a decade in the same geographically defined community psychiatric service with no early intervention programme. Patients were diagnosed by Structured Clinical Interview for DSM (SCID) and we determined the DUP using the Beiser Scale. The DUP of the 240 participants did not differ significantly between study periods.
Cancer is the second leading cause of death worldwide. Lifestyle choices play an important role in the aetiology of cancer with up to 4 in 10 cases potentially preventable. Interventions delivered by healthcare professionals (HCPs) that incorporate risk information have the potential to promote behaviour change. Our aim was to develop a very brief intervention incorporating cancer risk, which could be implemented within primary care.
Guided by normalisation process theory (NPT), we developed a prototype intervention using literature reviews, consultation with patient and public representatives and pilot work with patients and HCPs. We conducted focus groups and interviews with 65 HCPs involved in delivering prevention activities. Findings were used to refine the intervention before 22 HCPs completed an online usability test and provided further feedback via a questionnaire incorporating a modified version of the NoMAD checklist.
The intervention included a website where individuals could provide information on lifestyle risk factors view their estimated 10-year risk of developing one or more of the five most common preventable cancers and access lifestyle advice incorporating behaviour change techniques. Changes incorporated from feedback from the focus groups and interviews included signposting to local services and websites, simplified wording and labelling of risk information. In the usability testing, all participants felt it would be easy to collect the risk information. Ninety-one percent felt the intervention would enable discussion about cancer risk and believed it had potential to be easily integrated into National Health Service (NHS) Health Checks. However, only 36% agreed it could be delivered within 5 min.
With the use of NPT, we developed a very brief intervention that is acceptable to HCPs in primary care and could be potentially integrated into NHS Health Checks. However, further work is needed to assess its feasibility and potential effectiveness.
Opioids are more commonly prescribed for chronic pain in rural settings in the USA, yet little is known about how the rural context influences efforts to improve opioid medication management.
The Six Building Blocks is an evidence-based program that guides primary care practices in making system-based improvements in managing patients using long-term opioid therapy. It was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. To gain further insight about their experience with implementing the program, interviews and focus groups were conducted with staff and clinicians at the six organizations at the end of the 15 months and transcribed. Team members used a template analysis approach, a form of qualitative thematic analysis, to code these data for barriers, facilitators, and corresponding subcodes.
Facilitators to making systems-based changes in opioid management within a rural practice context included a desire to help patients and their community, external pressures to make changes in opioid management, a desire to reduce workplace stress, external support for the clinic, supportive clinic leadership, and receptivity of patients. Barriers to making changes included competing demands on clinicians and staff, a culture of clinician autonomy, inadequate data systems, and a lack of patient resources in rural areas.
The barriers and facilitators identified here point to potentially unique determinants of practice that should be considered when addressing opioid prescribing for chronic pain in the rural setting.
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.
Artificial lighting is a significant threat to biodiversity. Although efforts to reduce lighting are crucial for species’ conservation efforts, management is challenging because light at night is integral to modern society and light use is increasing with population and economic growth. The development and evaluation of appropriate light management strategies will require positive public support, and a comprehensive understanding of public engagement with light pollution. This is the first study to examine public engagement with reducing light at night for the protection of a threatened species. A community campaign to reduce artificial light use was initiated in 2008 to protect marine turtles at a globally significant nesting beach. Semi-structured questionnaires assessed community engagement with light-glow reduction, using an existing theoretical constraints framework. Despite high levels of cognitive and affective engagement (knowledge and concern), behavioural engagement (action) with light reduction in this community was limited. Community perceptions of light reduction were dominated by ‘uncertainty and scepticism’ and ‘externalizing responsibility/blame’, implying that behavioural engagement in this community may be increased by addressing these widely-held perceptions using modified campaign materials and/or strategic legislation. Further refinement of the theoretical constraints framework would better guide future empirical and conceptual research to improve understanding of public engagement with critical environmental issues.
Introduction: While numerous barriers to smoking cessation in pregnancy have been identified, less is known about the role of pregnant smokers’ beliefs in promoting and inhibiting abstinence. This study explored these beliefs and how they might interact with psychosocial factors related to pregnancy and antenatal care.
Methods: In-depth face-to-face semi-structured interviews were conducted with 20 women with experience of prenatal smoking. Grounded theory and the constant comparative approach guided the analysis towards a theoretical explanation of the women's experiences.
Results: Cognitive dissonance generated by the discrepancy between smoking-related prenatal harm beliefs and continued smoking was a strong motivator to quit. However, difficulty in quitting led many to resolve this dissonance by endorsing disengagement beliefs which downplayed the threat of smoking. Four main types of disengagement belief were identified. The tendency to endorse disengagement beliefs appeared to be influenced by two factors: uncertainty about how smoking caused foetal harm and reassurance from health professionals and others that reduced smoking was sufficient for harm minimisation.
Conclusions: Disengagement belief endorsement is common among pregnant smokers and enables the justification of continued smoking, potentially hindering efforts to quit. Increased promotion of complete abstinence by antenatal care professionals and health education interventions targeting risk comprehension and disengagement belief endorsement should be considered to promote greater efforts to quit among pregnant smokers.
Behavioural science is concerned with predicting, explaining and changing behaviour. Taking a personal perspective, this article aims to show how behavioural science can contribute to primary care research, specifically in relation to the development and evaluation of interventions to change behaviour. After discussing the definition and measurement of behaviour, the principle of compatibility and theories of behaviour change, the article outlines two examples of behaviour change trials (one on medication adherence and the other on physical activity), which were part of a research programme on prevention of chronic disease and its consequences. The examples demonstrate how, in a multidisciplinary context, behavioural science can contribute to primary care research in several important ways, including posing relevant research questions, defining the target behaviour, understanding the psychological determinants of behaviour, developing behaviour change interventions and selection or development of measures. The article concludes with a number of recommendations: (i) whether the aim is prediction, explanation or change, defining the target behaviour is a crucial first step; (ii) interventions should be explicitly based on theories that specify the factors that need to be changed in order to produce the desired change in behaviour; (iii) intervention developers need to be aware of the differences between different theories and select a theory only after careful consideration of the alternatives assessed against relevant criteria; and (iv) developers need to be aware that interventions can never be entirely theory based.
With the marine environment under increasing threat from multiple sources, the ability of managers to generate support from stakeholders will be vital for the success of conservation initiatives. In 2004, a new zoning plan for the Great Barrier Reef Marine Park increased no-take areas from 4.5% to 33% of the total Park area. The aims of this study were to measure recreational fishers' level of support for the plan and understand how they form attitudes towards conservation initiatives in the Park. A survey of Great Barrier Reef Marine Park recreational fishers conducted three years after implementation of the new zoning plan revealed that 68% of fishers believed that, in general, rezoning the Marine Park was a good idea, whereas 57% supported the actual zoning plan that was implemented. A majority of fishers believed that rezoning the Marine Park was necessary, that the new zoning plan had high conservation value, and that the plan had little impact on their recreational fishing activity. However, most fishers had low to moderate satisfaction with the programme used to consult the public throughout the rezoning process. Logistic regression models revealed a strong relationship between level of support for the plan and fishers' perceptions about the necessity of the plan and its conservation value, the adequacy of the consultation process, and the impact of the plan on their fishing activity. Results indicate that recreational fishers can be strong supporters of conservation initiatives in the Great Barrier Reef Marine Park if these initiatives are consistent with their values, and if efforts are made to engage them in the decision making process. These results will enhance the ability of managers to generate support from the recreational fishing community for conservation initiatives in marine environments.
Stage theories of health behaviour assume that behaviour change involves movement through a set of discrete stages, that different factors influence the different stage transitions and that interventions should be matched to a person's stage (Sutton, 2005; Weinstein et al., 1998).
The transtheoretical model (TTM; Prochaska & DiClemente, 1983; Prochaska et al., 1992, 2002; Prochaska & Velicer, 1997) is the dominant stage model in health psychology and health promotion. It was developed in the 1980s by a group of researchers at the University of Rhode Island. The model has been used in a large number of studies of smoking cessation, but it has also been applied to a wide range of other health behaviours (Prochaska et al., 1994). Although it is often referred to simply as the stages of change model, the TTM includes several different constructs: the ‘stages of change’, the ‘pros and cons of changing’ (together known as ‘decisional balance’), ‘confidence and temptation’ and the ‘processes of change’. The TTM was an attempt to integrate these different constructs drawn from different theories of behaviour change and systems of psychotherapy into a single coherent model; hence the name transtheoretical (for example, see ‘Health belief model’, ‘Self-efficacy and health behaviour’ and ‘Theory of planned behaviour’).
The stages of change provide the basic organizing principle. The most widely used version of the model specifies five stages: precontemplation, contemplation, preparation, action and maintenance.
Using an experimental manipulation embedded in a national survey, this study investigated the effect on smokers' risk judgments of receiving accurate information about the cigarette consumption of the average smoker. It was hypothesized that this information would reduce smokers' estimates of the risk of lung cancer faced by the average smoker (‘other's risk’) and hence influence their comparative risk judgments. As predicted, the information made lighter smokers more optimistic and heavier smokers less optimistic. However, the experimental manipulation had no effect on intention to give up smoking. The difference score (other's risk minus own risk) correlated 0.52 with the single-item comparative risk measure. The former measure showed a small but significant optimistic bias whereas the latter measure showed a small but significant pessimistic bias. The findings are discussed in terms of measurement issues and the implications for interventions designed to influence risk perceptions.
Austinite belongs to the adelite mineral group of calcium and lead arsenates, and has the conichalcite/descloizite type of crystal structure. The crystal structure of nearly pure austinite, CaZn(AsO4)OH, was redetermined (R = 0.014) and the absolute configuration identified. The space group P212121 and cell parameters a 7.5092(8), b 9.0438(9), c 5.9343(8) Å match previous data. Zinc octahedra share edges to form chains parallel to c. Arsenic tetrahedra share vertices with the Zn octahedra to generate a compact framework. Calcium square antiprisms share edges to make chains parallel to a that occupy the channels in the zinc-arsenic framework.
The Advanced Photon Source (APS) at Argonne National Laboratory is a third-generation synchrotron x-ray source, optimized for producing x-rays from undulators. Such undulator sources provide extremely bright, quasi-monochromatic radiation which is ideal for an x-ray microprobe. Such microprobes can be used for trace element quantification with x-ray fluorescence, or for chemical state determination with x-ray absorption spectroscopy. The GeoSoilEnviroCARS (GSECARS) sector at the APS is building an x-ray microprobe for research in earth, planetary, soil and environmental sciences.
The GSECARS undulator source is a standard APS Undulator “A” which is a 3.3 cm period device with 72 periods. The energies of the undulator peaks can be varied by adjusting the gap, and hence the magnetic field of the undulator. The energy of the first harmonic can be varied in this way from approximately 3.1 keV to 14 keV. A measured undulator spectrum is shown in Figure 1.
This paper is concerned with an investigation into the use of artificial neural networks in the design of fuzzy autopilots for controlling the yaw dynamics of a modern Royal Navy warship model. Results are presented to show the viability of such an approach and that effective designs can be produced.
Few workers in the addictions field can fail to have noticed the ‘stages of change’ model of Prochaska and DiClemente (Prochaska and DiClemente, 1986; Prochaska et al., 1992). The model appears to offer a general, comprehensive, and theoretically coherent account of how people change their behaviour. It clearly has immense intuitive appeal to teachers, practitioners and researchers in the addictions field. With one exception (Davidson, 1992), commentators have been unanimous in their praise and enthusiasm for the model. Orford (1992) likened the development of the model to a Kuhnian paradigm shift, and Stockwell (1992) compared the reaction of some of his colleagues to the recent announcement that a fifth stage of change had been identified to the awe that might accompany the discovery of a new planet.
This chapter provides a critical assessment of the stages of change model. It addresses two key assumptions of the model: (1) that change in addictive behaviour involves movement through a sequence of stages; and (2) that different processes of change are emphasised in different stages and promote progression through the sequence. The questionnaire instruments designed to assess the stages and processes of change are also examined. The chapter does not attempt to give an exhaustive review of the literature in this area. It focuses on Prochaska and DiClemente's own published papers. Related work on readiness to change (Rollnick et al., 1992; Heather et al., 1993) is not discussed, though some of the comments also apply to that approach. Nor do we compare the stages of change model with other decision-making models that have been applied to addictive behaviours such as the Theory of Reasoned Action/Planned Behaviour and the Subjective Expected Utility Model (Sutton, 1987, 1989). Most applications of the stages of change model have been to smoking. Orford (1992) has suggested that decision-making approaches may be less applicable to alcohol and drug abuse.
The stages of change
The stages of change model
The stages of change have been described in terms of a revolving door metaphor, as depicted in Figure 12.1. As an aside, it is worth noting that the metaphor is not strictly accurate since a person entering a revolving door stays in the same compartment ('stage’) until exiting.
In humid forests tree buttresses and tree trunks are used as diurnal resting sites by phlebotomine sandflies (Diptera: Psychodidae). When several species are present on the same buttress, the sandfly species are spatially segregated resulting in a pattern of vertical stratification on the buttress within 100 cm of ground level. A change in the distribution of one species induces a change in the distribution of an adjacent species. This is demonstrated under both natural and experimental conditions. Observations of sandflies at dawn and dusk have revealed that the buttress is used as a swarming site; this behaviour provides our favoured explanation for the patterns of vertical stratification on tree buttresses.
Synchrotron x-ray fluorescence experiments were performed using a prototype undulator for the Advanced Photon Source installed on the CESR storage ring at Cornell University during a run in May, 1988. Fluorescence spectra were collected from a number of standard references and unknowns. Thick target minimum detectable limits (MDL) were about a factor of two higher than those obtained using white bending magnet radiation at the NSLS. The higher MDLs could be due to lower polarization and/or imperfect alignment of the Si(Li) detector. Thin target MDLs were about 10 times lower than the NSLS since the undulator produced a usable spot size which was also 10 times smaller. Several one dimensional multi-elemental scans and two dimensional images were made with 10 μm resolution and 30 ppm MDL. These experiments demonstrate that undulators on the proposed Advanced Photon Source will be ideal for a trace element x-ray fluorescence microprobe with excellent elemental sensitivity and spatial resolution.