Introduction
In Camden and Islington (North Central London) we have restructured our emergency mental health services significantly. Prior to January 2020 all emergency mental health presentations, ...including those detained in public by the police (S136) were supported through our three emergency departments and their respective liaison mental health teams. In January 2020 a new ‘Health Based Place of Safety’ (for those detained by police) was opened to avoid people spending time in emergency departments unnecessarily. When the COVID-19 pandemic first took hold in the UK in March 2020 a second unit, a ‘Mental Health Crisis Assessment Service’ (MHCAS) was set up again away from the acute sites, encouraging people in MH crisis to attend a designated MH ED away from the acute sites. This study aims to review the system and patient outcomes since the development of the pathway.
Objectives
Relieving pressures on ED by reduction in patient numbers that could be better supported elsewhere and free up resource for alternative assessments and patient needs.
Methods
A retrospective cohort study to review the outcomes of the new system in relation to emergency mental health crisis presentations. Comparison to be made with ED data for 2 years prior to new system.
Results
Pending final results but initial data suggests 25% reduction in ED presentation for MH cause with new system. Reduction in psychiatric inpatient admissions of between 3-5%.
Conclusions
Creative system wide initiatives to provide alternatives to emergency departments for people in emergency mental health crisis can lead to significantly improved patient outcomes and experience.
Disclosure
No significant relationships.
The fundamental building blocks of the proton-quarks and gluons-have been known for decades. However, we still have an incomplete theoretical and experimental understanding of how these particles and ...their dynamics give rise to the quantum bound state of the proton and its physical properties, such as its spin
. The two up quarks and the single down quark that comprise the proton in the simplest picture account only for a few per cent of the proton mass, the bulk of which is in the form of quark kinetic and potential energy and gluon energy from the strong force
. An essential feature of this force, as described by quantum chromodynamics, is its ability to create matter-antimatter quark pairs inside the proton that exist only for a very short time. Their fleeting existence makes the antimatter quarks within protons difficult to study, but their existence is discernible in reactions in which a matter-antimatter quark pair annihilates. In this picture of quark-antiquark creation by the strong force, the probability distributions as a function of momentum for the presence of up and down antimatter quarks should be nearly identical, given that their masses are very similar and small compared to the mass of the proton
. Here we provide evidence from muon pair production measurements that these distributions are considerably different, with more abundant down antimatter quarks than up antimatter quarks over a wide range of momenta. These results are expected to revive interest in several proposed mechanisms for the origin of this antimatter asymmetry in the proton that had been disfavoured by previous results
, and point to future measurements that can distinguish between these mechanisms.
Aims/hypothesis
Low 25-hydroxyvitamin D levels predict future cardiovascular events and are common in patients with type 2 diabetes. We compared the effect of 100,000 and 200,000 IU doses of vitamin ...D
3
on endothelial function, blood pressure and markers of glycaemic control in patients with type 2 diabetes.
Methods
This was a randomised, parallel group, placebo-controlled trial. Patients with type 2 diabetes and baseline 25-hydroxyvitamin D levels <100 nmol/l were enrolled from community and hospital-based diabetes clinics. Participants were assessed in a university department of clinical pharmacology and received a single oral dose of placebo or vitamin D
3
(100,000 IU or 200,000 IU) at baseline, randomly allocated via numbered bottles prepared offsite; participants and investigators were both blinded to treatment allocation. Endothelial function, office blood pressure, B-type natriuretic peptide, insulin resistance and glycosylated haemoglobin were measured at baseline, and at 8 and 16 weeks.
Results
We randomised 61 participants to the three groups (placebo 22, 100,000 IU vitamin D
3
19, 200,000 IU vitamin D
3
20). There was no significant difference in the primary outcome of endothelial function at 8 weeks (placebo 5.2%,
n
= 22; 100,000 IU 4.3%,
n
= 19; 200,000 IU 4.9%,
n
= 17) or at 16 weeks. Insulin resistance and glycosylated haemoglobin did not improve with either dose of vitamin D
3
. On covariate analysis, systolic blood pressure was significantly lower in both treatment arms than in the placebo group at 8 weeks (placebo 146.4 mmHg, 100,000 IU 141.4 mmHg
p
= 0.04 vs placebo, 200,000 IU 136.8 mmHg
p
= 0.03 vs placebo). B-type natriuretic peptide levels were significantly lower in the 200,000 IU group by 16 weeks (placebo 34 pg/ml, 200,000 IU 21 pg/ml,
p
= 0.02). No significant excess of adverse effects was noted in the treatment arms.
Conclusions/interpretation
High-dose vitamin D
3
improved systolic blood pressure and B-type natriuretic peptide levels, but not endothelial function, insulin resistance or glycosylated haemoglobin in patients with type 2 diabetes.
Trial registration
ISRCTN50587697 (
www.controlled-trials.com
)
Funding
Diabetes UK, grant number 06/0003429. M. D. Witham is funded by a Scottish Government NES/CSO Clinician Scientist Award.
Excitability of individual neurons dictates the overall excitation in specific brain circuits. This process is thought to be regulated by molecules that regulate synapse number, morphology and ...strength. Neuronal excitation is also influenced by the amounts of neurotransmitter receptors and signaling molecules retained at particular synaptic sites. Recent studies revealed a key role for PSD-95, a scaffolding molecule enriched at glutamatergic synapses, in modulation of clustering of several neurotransmitter receptors, adhesion molecules, ion channels, cytoskeletal elements and signaling molecules at postsynaptic sites. In this review we will highlight mechanisms that control targeting of PSD-95 at the synapse, and discuss how this molecule influences the retention and clustering of diverse synaptic proteins to regulate synaptic structure and strength. We will also discuss how PSD-95 may maintain a balance between excitation and inhibition in the brain and how alterations in this balance may contribute to neuropsychiatric disorders.
Coronal prominence cavities may be manifestations of twisted or sheared magnetic fields capable of storing the energy required to drive solar eruptions. The Coronal Multi-Channel Polarimeter (CoMP), ...recently installed at Mauna Loa Solar Observatory, can measure polarimetric signatures of current-carrying magnetohydrodynamic (MHD) systems. For the first time, this instrument offers the capability of daily full-Sun observations of the forbidden lines of Fe XIII with high enough spatial resolution and throughput to measure polarimetric signatures of current-carrying MHD systems. By forward-calculating CoMP observables from analytic MHD models of spheromak-type magnetic flux ropes, we show that a predicted observable for such flux ropes oriented along the line of sight is a bright ring of linear polarization surrounding a region where the linear polarization strength is relatively depleted. We present CoMP observations of a coronal cavity possessing such a polarization ring.
The coronal magnetic field is the primary driver of solar dynamic events. Linear and circular polarization signals of certain infrared coronal emission lines contain information about the magnetic ...field, and to access this information either a forward or an inversion method must be used. We study three coronal magnetic configurations that are applicable to polar-crown filament cavities by doing forward calculations to produce synthetic polarization data. We analyze these forward data to determine the distinguishing characteristics of each model. We conclude that it is possible to distinguish between cylindrical flux ropes, spheromak flux ropes, and sheared arcades using coronal polarization measurements. If one of these models is found to be consistent with observational measurements, it will mean positive identification of the magnetic morphology that surrounds certain quiescent filaments, which will lead to a better understanding of how they form and why they erupt.
COVID-19 has had a profound effect on mental health. Liaison psychiatry teams assess and treat people in mental health crises in emergency departments (EDs) and on hospital wards. During the first ...pandemic wave, new Mental Health Crisis Assessment Services (MHCAS) were created to divert people away from EDs. Our objective was to describe patterns in referrals to psychiatric liaison services across the North Central London care sector (NCL) and explore the impact of a new MHCAS.
Retrospective study using routinely collected data (ED and ward referrals) from five liaison psychiatry services across NCL (total population 1.5 million people). We described referrals (per week and month) by individual liaison services and cross-sector, and patterns of activity (January 1st 2020 -September 31st 2020, weeks 1–39) compared with the same period in 2019. We calculated changes in the proportion of ED attendees (all-cause) referred to liaison psychiatry.
From 2019–2020, total referrals decreased by 16.5% (12,265 to 10,247), a 16.4% decrease in ED referrals (9528 to 7965) and 16.6% decrease in ward referrals (2737 to 2282). There was a marked decrease in referrals during the first pandemic wave (March/April 2020), which increased after lockdown ended. The proportion of ED attendees referred to liaison psychiatry services increased compared to 2019.
People in mental health crisis continued to seek help via ED/MHCAS and a higher proportion of people attending ED were referred to liaison psychiatry services just after the first pandemic wave. MHCAS absorbed some sector ED activity during the pandemic.
We present spectral fits and timing analysis of Rossi X-ray Timing Explorer observations of GX 339−4. These observations were carried out over a span of more than two years and encompassed both the ...soft/high and hard/low states. Two observations were simultaneous with Advanced Satellite for Cosmology and Astrophysics observations. Hysteresis in the soft–hard state transition is observed. The hard state exhibits a possible anticorrelation between coronal compactness (i.e. spectral hardness) and the covering fraction of cold, reflecting material. The correlation between ‘reflection fraction’ and soft X-ray flux, however, appears to be more universal. Furthermore, low-flux, hard-state observations – taken over a decline into quiescence – show that the Fe line, independent of ‘reflection fraction’, remains broad and at a roughly constant equivalent width, counter to expectations from advection-dominated accretion flow models. All power spectral densities of the hard-state X-ray light curves are describable as the sum of just a few broad, quasi-periodic features with frequencies that roughly scale as coronal compactness, ℓc, to the −3/2 power. This is interpretable in a simple, toy model of an efficient spherical corona as variations of ℓc∝Rt, where Rt is the ‘transition radius’ between the corona and an outer thin disc. Similar to observations of Cyg X-1, time lags between soft and hard variability anticorrelate with coronal compactness, and peak shortly after the transition from the soft to the hard state. A stronger correlation is seen between the time lags and the ‘reflection fraction’. These latter facts might suggest that the time lags are associated with the known, spatially very extended, synchrotron-emitting outflow.
Jumonji (JmjC) domain proteins are known regulators of gene expression and chromatin organization by way of histone demethylation. Chromatin modification and remodeling provides a means to modulate ...the activity of large numbers of genes, but the importance of this class of predicted histone-modifying enzymes for different aspects of post-developmental processes remains poorly understood. Here we test the function of all 11 non-lethal members in the regulation of circadian rhythms and sleep. We find loss of every Drosophila JmjC gene affects different aspects of circadian behavior and sleep in a specific manner. Together these findings suggest that the majority of JmjC proteins function as regulators of behavior, rather than controlling essential developmental programs.
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