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BACKGROUND: There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is to increase patient access to psychological therapies on acute mental health inpatient wards. Stage one of the programme (which is complete) aimed to identify barriers and facilitators to delivering therapy in these settings through a large qualitative study. The key output of stage one was an intervention protocol that is designed to be delivered on acute wards to increase patient access to psychologically-informed care and therapy. Stage two of the programme aims to test the effects of the intervention on patient wellbeing and serious incidents on the ward (primary outcomes), patient social functioning and symptoms, staff burnout, ward atmosphere from staff and patient perspectives and cost effectiveness of the intervention (secondary outcomes). METHODS: The study is a single blind, pragmatic, cluster randomised controlled trial and will recruit thirty-four wards across England that will be randomised to receive the new intervention plus treatment as usual, or treatment as usual only. Primary and secondary outcomes will be assessed at baseline and 6-month and 9-month follow-ups, with serious incidents on the ward collected at an additional 3-month follow-up. DISCUSSION: The key output will be a potentially effective and cost-effective ward-based psychological intervention that increases patient access to psychological therapy in inpatient settings, is feasible to deliver in inpatient settings and is acceptable to patients. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT03950388. Registered 15th May 2019. https://clinicaltrials.gov/ct2/show/NCT03950388.

Contains fulltext : 237675.pdf (Publisher’s version ) (Open Access), In the face of the COVID-19 pandemic, the swift response of mental health research funders and institutions, service providers, and academics enabled progress toward understanding the mental health consequences. Nevertheless, there remains an urgent need to understand the true extent of the short- and long-term effects of the COVID-19 pandemic on mental health, necessitating ongoing research. Although the speed with which mental health researchers have mobilized to respond to the pandemic so far is to be commended, there are valid concerns as to whether speed may have compromised the quality of our work. As the pandemic continues to evolve, we must take time to reflect on our initial research response and collectively consider how we can use this to strengthen ensuing COVID-19 mental health research and our response to future crises. Here, we offer our reflections as members of the UK mental health research community to discuss the continuing progress and persisting challenges of our COVID-19 response, which we hope can encourage reflection and discussion among the wider research community. We conclude that (1) Fragmentation in our infrastructure has challenged the efficient, effective and equitable deployment of resources, (2) In responding quickly, we may have overlooked the role of experts by experience, (3) Robust and open methods may have been compromised by speedy responses, and (4) This pandemic may exacerbate existing issues of inequality in our workforce.

Contains fulltext : 237675.pdf (Publisher’s version ) (Open Access), In the face of the COVID-19 pandemic, the swift response of mental health research funders and institutions, service providers, and academics enabled progress toward understanding the mental health consequences. Nevertheless, there remains an urgent need to understand the true extent of the short- and long-term effects of the COVID-19 pandemic on mental health, necessitating ongoing research. Although the speed with which mental health researchers have mobilized to respond to the pandemic so far is to be commended, there are valid concerns as to whether speed may have compromised the quality of our work. As the pandemic continues to evolve, we must take time to reflect on our initial research response and collectively consider how we can use this to strengthen ensuing COVID-19 mental health research and our response to future crises. Here, we offer our reflections as members of the UK mental health research community to discuss the continuing progress and persisting challenges of our COVID-19 response, which we hope can encourage reflection and discussion among the wider research community. We conclude that (1) Fragmentation in our infrastructure has challenged the efficient, effective and equitable deployment of resources, (2) In responding quickly, we may have overlooked the role of experts by experience, (3) Robust and open methods may have been compromised by speedy responses, and (4) This pandemic may exacerbate existing issues of inequality in our workforce.

Contains fulltext : 237675.pdf (Publisher’s version ) (Open Access), In the face of the COVID-19 pandemic, the swift response of mental health research funders and institutions, service providers, and academics enabled progress toward understanding the mental health consequences. Nevertheless, there remains an urgent need to understand the true extent of the short- and long-term effects of the COVID-19 pandemic on mental health, necessitating ongoing research. Although the speed with which mental health researchers have mobilized to respond to the pandemic so far is to be commended, there are valid concerns as to whether speed may have compromised the quality of our work. As the pandemic continues to evolve, we must take time to reflect on our initial research response and collectively consider how we can use this to strengthen ensuing COVID-19 mental health research and our response to future crises. Here, we offer our reflections as members of the UK mental health research community to discuss the continuing progress and persisting challenges of our COVID-19 response, which we hope can encourage reflection and discussion among the wider research community. We conclude that (1) Fragmentation in our infrastructure has challenged the efficient, effective and equitable deployment of resources, (2) In responding quickly, we may have overlooked the role of experts by experience, (3) Robust and open methods may have been compromised by speedy responses, and (4) This pandemic may exacerbate existing issues of inequality in our workforce.

AIM: Many young people at ultra-high risk (UHR) of developing psychosis exhibit marked and persistent impairments in social and occupational functioning. We aimed to explore UHR patients' subjective experiences of these difficulties and their causes. METHODS: We conducted semi-structured interviews with 20 UHR individuals recruited from Early Detection and Intervention Teams in Northwest England. Topics covered included how participants spent their time, their interpersonal relationships, academic and occupational performance, premorbid functioning and clinical treatment. Thematic analysis was used to examine the prevailing themes. RESULTS: The sample included individuals with varying degrees of functional impairment, ranging from mild to severe difficulties in functioning. Analysis of the qualitative data elicited themes around 2 topics: breadth of functional difficulties and subjective reasons for poor functioning. Participants reported a range of impairments in their social and occupational functioning which they attributed to a combination of clinical, cognitive and psychological factors. These included variables previously identified in the quantitative literature such as psychiatric symptoms, adverse life experiences and cognitive deficits. However, our findings also included other factors which have received comparably little attention such as self-stigmatizing attitudes and dysfunctional metacognitive beliefs. CONCLUSIONS: We propose a model that attempts to explain how these variables interact to drive and sustain functional impairment in the UHR population. This will assist in the development of clinical interventions aimed at promoting functional recovery among UHR individuals.

We examine the response of the Indian and East Asian summer monsoons to separate precession and obliquity forcing, using a set of fully coupled high-resolution models for the first time: EC-Earth, GFDL CM2.1, CESM and HadCM3. We focus on the effect of insolation changes on monsoon precipitation and underlying circulation changes, and find strong model agreement despite a range of model physics, parameterization, and resolution. Our results show increased summer monsoon precipitation at times of increased summer insolation, i.e. minimum precession and maximum obliquity, accompanied by a redistribution of precipitation and convection from ocean to land. Southerly monsoon winds over East Asia are strengthened as a consequence of an intensified land-sea pressure gradient. The response of the Indian summer monsoon is less straightforward. Over south-east Asia low surface pressure is less pronounced and winds over the northern Indian Ocean are directed more westward. An Indian Ocean Dipole pattern emerges, with increased precipitation and convection over the western Indian Ocean. Increased temperatures occur during minimum precession over the Indian Ocean, but not during maximum obliquity when insolation is reduced over the tropics and southern hemisphere during northern hemisphere summer. Evaporation is reduced over the northern Indian Ocean, which together with increased precipitation over the western Indian Ocean dampens the increase of monsoonal precipitation over the continent. The southern tropical Indian Ocean as well as the western tropical Pacific (for precession) act as a moisture source for enhanced monsoonal precipitation. The models are in closest agreement for precession-induced changes, with more model spread for obliquity-induced changes, possibly related to a smaller insolation forcing. Our results indicate that a direct response of the Indian and East Asian summer monsoons to insolation forcing is possible, in line with speleothem records but in contr

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We examine the response of the Indian and East Asian summer monsoons to separate precession and obliquity forcing, using a set of fully coupled high-resolution models for the first time: EC-Earth, GFDL CM2.1, CESM and HadCM3. We focus on the effect of insolation changes on monsoon precipitation and underlying circulation changes, and find strong model agreement despite a range of model physics, parameterization, and resolution. Our results show increased summer monsoon precipitation at times of increased summer insolation, i.e. minimum precession and maximum obliquity, accompanied by a redistribution of precipitation and convection from ocean to land. Southerly monsoon winds over East Asia are strengthened as a consequence of an intensified land-sea pressure gradient. The response of the Indian summer monsoon is less straightforward. Over south-east Asia low surface pressure is less pronounced and winds over the northern Indian Ocean are directed more westward. An Indian Ocean Dipole pattern emerges, with increased precipitation and convection over the western Indian Ocean. Increased temperatures occur during minimum precession over the Indian Ocean, but not during maximum obliquity when insolation is reduced over the tropics and southern hemisphere during northern hemisphere summer. Evaporation is reduced over the northern Indian Ocean, which together with increased precipitation over the western Indian Ocean dampens the increase of monsoonal precipitation over the continent. The southern tropical Indian Ocean as well as the western tropical Pacific (for precession) act as a moisture source for enhanced monsoonal precipitation. The models are in closest agreement for precession-induced changes, with more model spread for obliquity-induced changes, possibly related to a smaller insolation forcing. Our results indicate that a direct response of the Indian and East Asian summer monsoons to insolation forcing is possible, in line with speleothem records but in contrast

Item does not contain fulltext

Item does not contain fulltext

We examine the response of the Indian and East Asian summer monsoons to separate precession and obliquity forcing, using a set of fully coupled high-resolution models for the first time: EC-Earth, GFDL CM2.1, CESM and HadCM3. We focus on the effect of insolation changes on monsoon precipitation and underlying circulation changes, and find strong model agreement despite a range of model physics, parameterization, and resolution. Our results show increased summer monsoon precipitation at times of increased summer insolation, i.e. minimum precession and maximum obliquity, accompanied by a redistribution of precipitation and convection from ocean to land. Southerly monsoon winds over East Asia are strengthened as a consequence of an intensified land-sea pressure gradient. The response of the Indian summer monsoon is less straightforward. Over south-east Asia low surface pressure is less pronounced and winds over the northern Indian Ocean are directed more westward. An Indian Ocean Dipole pattern emerges, with increased precipitation and convection over the western Indian Ocean. Increased temperatures occur during minimum precession over the Indian Ocean, but not during maximum obliquity when insolation is reduced over the tropics and southern hemisphere during northern hemisphere summer. Evaporation is reduced over the northern Indian Ocean, which together with increased precipitation over the western Indian Ocean dampens the increase of monsoonal precipitation over the continent. The southern tropical Indian Ocean as well as the western tropical Pacific (for precession) act as a moisture source for enhanced monsoonal precipitation. The models are in closest agreement for precession-induced changes, with more model spread for obliquity-induced changes, possibly related to a smaller insolation forcing. Our results indicate that a direct response of the Indian and East Asian summer monsoons to insolation forcing is possible, in line with speleothem records but in contrast

UNLABELLED: WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT: Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on th

This paper addresses the key questions of the conference theme. First, consideration is given to the forms of mathematical knowledge, tools, and communications that students need for success in the new millennium. Second, the question of how we can promote all students' access to these powerful mathematical constructs and conceptual tools is examined. The remaining part of the paper considers one approach to creating this learning access, namely, through implementing ends-in-view problems within the mathematics curriculum. These authentic problems present students with criteria for generating purposeful, complex, and multifaceted products that go beyond the given information. The mathematics embedded within these problems can be accessed at many different levels of sophistication, enabling every student to engage with core constructs.

This non-experimental study attempted to determine how the different prescribed mathematic tracks offered at a comprehensive technical high school influenced the mathematics performance of low-achieving students on standardized assessments of mathematics achievement. The goal was to provide an analysis of any statistically significant differences in student achievement, as related to the prescribed tracks the below proficient students in the high school were enrolled in. Ex-post facto data collected by the school district for all students entering the different tracks was analyzed for test years 2006 through 2010.