Empirically supported psychological therapies have been developed for many mental health conditions. However, in most countries only a small proportion of the public benefit from these advances. The ...English Improving Access to Psychological Therapies (IAPT) program aims to bridge the gap between research and practice by training over 10,500 new psychological therapists in empirically supported treatments and deploying them in new services for the treatment of depression and anxiety disorders. Currently IAPT treats over 560,000 patients per year, obtains clinical outcome data on 98.5% of these individuals, and places this information in the public domain. Around 50% of patients treated in IAPT services recover, and two-thirds show worthwhile benefits. The clinical and economic arguments on which IAPT is based are presented, along with details of the service model, how the program was implemented, and recent findings about service organization. Limitations and future directions are outlined.
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Urban World/Global City Clark, David
1996, 20040601, 2003, 2004-06-01, 2003-10-30, 20030101
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This book identifies and accounts for the characteristics of the contemporary city and of urban society. It analyzes the distribution and growth of settlements and explores the social and behavioral ...characteristics of urban living. The latest theoretical and empirical developments and insights are synthesized and presented in an accessible and engaging way.This second edition has been extensively updated and referenced. Each chapter includes sets of learning objectives, annotated readings and topics for discussion. Well-illustrated throughout, it will be essential reading for students of geography, sociology and development studies and all who seek an understanding of how the urban world has evolved and how it will change in the twenty-first century.
Automaticity is a hallmark feature of walking in adults who are healthy and well-functioning. In the context of walking, "automaticity" refers to the ability of the nervous system to successfully ...control typical steady state walking with minimal use of attention-demanding executive control resources. Converging lines of evidence indicate that walking deficits and disorders are characterized in part by a shift in the locomotor control strategy from healthy automaticity to compensatory executive control. This is potentially detrimental to walking performance, as an executive control strategy is not optimized for locomotor control. Furthermore, it places excessive demands on a limited pool of executive reserves. The result is compromised ability to perform basic and complex walking tasks and heightened risk for adverse mobility outcomes including falls. Strategies for rehabilitation of automaticity are not well defined, which is due to both a lack of systematic research into the causes of impaired automaticity and to a lack of robust neurophysiological assessments by which to gauge automaticity. These gaps in knowledge are concerning given the serious functional implications of compromised automaticity. Therefore, the objective of this article is to advance the science of automaticity of walking by consolidating evidence and identifying gaps in knowledge regarding: (a) functional significance of automaticity; (b) neurophysiology of automaticity;
Medicinal chemistry and, in particular, drug design have often been perceived as more of an art than a science. The many unknowns of human disease and the sheer complexity of chemical space render ...decision making in medicinal chemistry exceptionally demanding. Computational models can assist the medicinal chemist in this endeavour. Provided here is an overview of recent examples of automated de novo molecular design, a discussion of the concepts and computational approaches involved, and the daring prediction of some of the possibilities and limitations of drug design using machine intelligence.
Starting from scratch: How close are we to the vision of fully automated de novo drug design? The field is more than 20 years old now and in this Minireview the progress is surveyed and the state‐of‐the‐art is assessed with reference to experimentally validated test cases from the literature. Also included is a look ahead to predict some of the possibilities and limitations of drug design using machine intelligence.
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This book explores the ways in which contemporary authors respond to and rework key aspects of Old Norse history and viking culture for young twenty-first-century audiences. Why are contemporary ...authors and audiences so manifestly attracted to the viking past? In what ways do writers respond to Norse sources? How do the narratives they tell reflect our beliefs about and desires for the past, our constructions of childhood and adolescence, our anxieties around gender, sexuality, and ethnicity? How do these texts engage with a future occluded by apocalyptic ecological threat? David Clark explores these questions through readings of a rich body of diverse material which retells, updates, and transforms Norse culture. The volume contextualizes Norse medievalism and explores how thematic foci on gender, sexuality, disability, and ethnicity relate to contemporary concerns around these topics, and the construction of childhood.
The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National ...Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.
Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).
Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.
Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.
•We studied clinical outcomes in 19,395 patients who completed treatment in year one of the IAPT programme.•Overall 40.3% of patients showed reliable recovery, 63.7% showed reliable improvement and 6.6% showed reliable deterioration.•Considerable between service variability in outcomes was observed.•Several service and patient level predictors of outcome were identified.•Compliance with NICE treatment guidelines was associated with improved outcomes.
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This book explores the ways in which contemporary authors respond to and rework key aspects of Old Norse history and viking culture for young twenty-first-century audiences. Why are contemporary ...authors and audiences so manifestly attracted to the viking past? In what ways do writers respond to Norse sources? How do the narratives they tell reflect our beliefs about and desires for the past, our constructions of childhood and adolescence, our anxieties around gender, sexuality, and ethnicity? How do these texts engage with a future occluded by apocalyptic ecological threat? David Clark explores these questions through readings of a rich body of diverse material which retells, updates, and transforms Norse culture. The volume contextualizes Norse medievalism and explores how thematic foci on gender, sexuality, disability, and ethnicity relate to contemporary concerns around these topics, and the construction of childhood.
Abstract
The Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to greatly increase the availability of NICE recommended psychological treatment for ...depression and anxiety disorders within the National Health Service in England. This article describes the background to the programme, the arguments on which it is based, the therapist training scheme, the clinical service model, and a summary of progress to date. At mid-point in a national roll-out of the programme progress is generally in line with expectation, and a large number of people who would not otherwise have had the opportunity to receive evidence-based psychological treatment have accessed, and benefited from, the new IAPT services. Planned future developments and challenges for the programme are briefly described.
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Summary Palliative care and hospices have developed rapidly since the late 1960s. The pioneering work of Cicely Saunders was instrumental in drawing attention to the end-of-life care needs of ...patients with advanced malignant disease. Palliative care began to be defined as a subject of activity in the 1970s and came to be synonymous with the physical, social, psychological, and spiritual support of patients with life-limiting illness, delivered by a multidisciplinary team. Palliative care services have developed in many settings and have often been closely related to oncology. The worldwide need for this type of care remains much greater than the available provision, but there are encouraging signs of recognition by policymakers and influential bodies, and interest in palliative care has never been greater. This paper charts the modern history of such care around the world and concludes on some current issues and future challenges.
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Self-focused attention and safety behaviours are both associated with adolescent social anxiety. In adults, experimental studies have indicated that the processes are causally implicated in social ...anxiety, but this hypothesis has not yet been tested in a youth sample.
This experiment explored this possibility by asking high and low socially anxious adolescents (N = 57) to undertake conversations under different conditions. During one conversation they were instructed to focus on themselves and use safety behaviours, and in the other they focused externally and did not use safety behaviours. Self-report, conversation partner report and independent assessor ratings were taken.
Self-focus and safety behaviours increased feelings and appearance of anxiety and undermined performance for all participants, but only high socially anxious participants reported habitually using self-focus and safety behaviours.
The findings provide support for the causal role of self-focus and safety behaviours in adolescent social anxiety and point to the potential clinical value of techniques reversing them to treat the disorder.
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