Continuity of care for carers of people with severe mental illness: results of a longitudinal study

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer’s assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer’s assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user’s immediate family, lived with them and had had a carer’s assessment. Conclusion: The vast majority of the carers had not had a carer’s assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers’ reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.

Enhancement of buffer strips can improve provision of multiple ecosystem services

Farmland invertebrates play a pivotal role in the provision of ecosystem services, i.e. services that benefit humans. For example, bumblebees, solitary bees and honeybees, are crucial to the pollination of many of the world's crops and wildflowers, with over 70% of the world's major food crops dependent on the pollination services provided by these insects. The larvae of some butterfly species are considered to be pests; however, together with moth and sawfly larvae, they represent a key dietary component for many farmland birds. Spiders and ground beetles predate on crop pests including aphids, whilst soil macrofauna such as earthworms are vital for soil fertility services and nutrient recycling. Despite their importance, population declines of invertebrates have been observed during the last sixty years in the UK and NW Europe. For example, seven UK bumblebee species are in decline, and in the last 20 years, the species Bombus subterraneus (short-haired bumblebee) has become extinct, whilst there was a 54% decline in honeybee colony numbers in England from 1985 to 2005. Comparable trends have been documented for butterflies with a 23% decline in UK farmland species such as Anthocharis cardamines (orange tip) between 1990 and 2007. These declines have been widely attributed to the modern intensive arable management practices that have been developed to maximise crop yield. For example, loss and fragmentation of foraging and nesting habitats, including species-rich meadows and hedgerows, have been implicated in the decline of bees and butterflies. Increased use of herbicides and fertilisers has caused detrimental effects on many plant species with negative consequences for predatory invertebrates such as spiders and beetles which rely on plants for food and shelter.

Influence of the Antarctic ozone hole on the polar mesopause region as simulated by the Canadian Middle Atmosphere Model

It is well established that variations in polar stratospheric winds can affect mesospheric temperatures through changes in the filtering of gravity wave fluxes, which drive a residual circulation in the mesosphere. The Canadian Middle Atmosphere Model(CMAM) is used to examine this vertical coupling mechanism in the context of the mesospheric response to the Antarctic ozone hole. It is found that the response differs significantly between late spring and early summer, because of a changing balance between the competing effects of parametrised gravity wavedrag (GWD)and changes in resolved wave drag local to the mesosphere. In late spring, the strengthened stratospheric westerlies arising from the ozone hole lead to reduced eastward GWD in the mesosphere and a warming of the polar mesosphere, just as in the well known mesospheric response to sudden stratospheric warmings, but with an opposite sign.In early summer, with easterly flow revailing over most of the polar stratosphere,the strengthened easterly wind shear within the mesosphere arising from the west ward GWD anomaly induces a positive resolved wave drag anomaly through baroclinic instability. The polar cooling induced by this process completely dominates the upper mesospheric response to the ozone hole in early summer. Consequences for the past and future evolution of noctilucent clouds are discussed

Synergetic effect of carbon nanopore size and surface oxidation on CO2 capture from CO2/CH4 mixtures

We have studied the synergetic effect of confinement (carbon nanopore size) and surface chemistry (the number of carbonyl groups) on CO2 capture from its mixtures with CH4 at typical operating conditions for industrial adsorptive separation (298 K and compressed CO2CH4 mixtures). Although both confinement and surface oxidation have an impact on the efficiency of CO2/CH4 adsorptive separation at thermodynamics equilibrium, we show that surface functionalization is the most important factor in designing an efficient adsorbent for CO2 capture. Systematic Monte Carlo simulations revealed that adsorption of CH4 either pure or mixed with CO2 on oxidized nanoporous carbons is only slightly increased by the presence of functional groups (surface dipoles). In contrast, adsorption of CO2 is very sensitive to the number of carbonyl groups, which can be examined by a strong electric quadrupolar moment of CO2. Interestingly, the adsorbed amount of CH4 is strongly affected by the presence of the co-adsorbed CO2. In contrast, the CO2 uptake does not depend on the molar ratio of CH4 in the bulk mixture. The optimal carbonaceous porous adsorbent used for CO2 capture near ambient conditions should consist of narrow carbon nanopores with oxidized pore walls. Furthermore, the equilibrium separation factor was the greatest for CO2/CH4 mixtures with a low CO2 concentration. The maximum equilibrium separation factor of CO2 over CH4 of ∼18–20 is theoretically predicted for strongly oxidized nanoporous carbons. Our findings call for a review of the standard uncharged model of carbonaceous materials used for the modeling of the adsorption separation processes of gas mixtures containing CO2 (and other molecules with strong electric quadrupolar moment or dipole moment).

The impacts of climate change on river flow regimes at the global scale

This paper presents an assessment of the impacts of climate change on a series of indicators of hydrological regimes across the global domain, using a global hydrological model run with climate scenarios constructed using pattern-scaling from 21 CMIP3 (Coupled Model Intercomparison Project Phase 3) climate models. Changes are compared with natural variability, with a significant change being defined as greater than the standard deviation of the hydrological indicator in the absence of climate change. Under an SRES (Special Report on Emissions Scenarios) A1b emissions scenario, substantial proportions of the land surface (excluding Greenland and Antarctica) would experience significant changes in hydrological behaviour by 2050; under one climate model scenario (Hadley Centre HadCM3), average annual runoff increases significantly over 47% of the land surface and decreases over 36%; only 17% therefore sees no significant change. There is considerable variability between regions, depending largely on projected changes in precipitation. Uncertainty in projected river flow regimes is dominated by variation in the spatial patterns of climate change between climate models (hydrological model uncertainty is not included). There is, however, a strong degree of consistency in the overall magnitude and direction of change. More than two-thirds of climate models project a significant increase in average annual runoff across almost a quarter of the land surface, and a significant decrease over 14%, with considerably higher degrees of consistency in some regions. Most climate models project increases in runoff in Canada and high-latitude eastern Europe and Siberia, and decreases in runoff in central Europe, around the Mediterranean, the Mashriq, central America and Brasil. There is some evidence that projecte change in runoff at the regional scale is not linear with change in global average temperature change. The effects of uncertainty in the rate of future emissions is relatively small

Are the winters 2010 and 2012 archetypes exhibiting extreme opposite behavior of the North Atlantic jet stream?

The atmospheric circulation over the North Atlantic-European sector experienced exceptional but highly contrasting conditions in the recent 2010 and 2012 winters (November-March; with the year dated by the relevant January). Evidence is given for the remarkably different locations of the eddy-driven westerly jet over the North Atlantic. In the 2010 winter the maximum of the jet stream was systematically between 30ºN and 40ºN (in the ‘south jet regime’), while in the 2012 winter it was predominantly located around 55ºN (north jet regime). These jet features underline the occurrence of either weak flow (2010) or strong and persistent ridges throughout the troposphere (2012). This is confirmed by the very different occurrence of blocking systems over the North Atlantic, associated with episodes of strong cyclonic (anticyclonic) Rossby wave breaking in 2010 (2012) winters. These dynamical features underlie strong precipitation and temperature anomalies over parts of Europe, with detrimental impacts on many socioeconomic sectors. Despite the highly contrasting atmospheric states, mid and high-latitude boundary conditions do not reveal strong differences in these two winters. The two winters were associated with opposite ENSO phases, but there is no causal evidence of a remote forcing from the Pacific sea surface temperatures. Finally, the exceptionality of the two winters is demonstrated in relation to the last 140 years. It is suggested that these winters may be seen as archetypes of North Atlantic jet variability under current climate conditions.

Regional changes in wind energy potential over Europe using regional climate model ensemble projections

The impact of climate change on wind power generation potentials over Europe is investigated by considering ensemble projections from two regional climate models (RCMs) driven by a global climate model (GCM). Wind energy density and its interannual variability are estimated based on hourly near-surface wind speeds. Additionally, the possible impact of climatic changes on the energy output of a sample 2.5-MW turbine is discussed. GCM-driven RCM simulations capture the behavior and variability of current wind energy indices, even though some differences exist when compared with reanalysis-driven RCM simulations. Toward the end of the twenty-first century, projections show significant changes of energy density on annual average across Europe that are substantially stronger in seasonal terms. The emergence time of these changes varies from region to region and season to season, but some long-term trends are already statistically significant in the middle of the twenty-first century. Over northern and central Europe, the wind energy potential is projected to increase, particularly in winter and autumn. In contrast, energy potential over southern Europe may experience a decrease in all seasons except for the Aegean Sea. Changes for wind energy output follow the same patterns but are of smaller magnitude. The GCM/RCM model chains project a significant intensification of both interannual and intra-annual variability of energy density over parts of western and central Europe, thus imposing new challenges to a reliable pan-European energy supply in future decades.

Changing Northern Hemisphere storm tracks in an ensemble of IPCC climate change simulations

Winter storm-track activity over the Northern Hemisphere and its changes in a greenhouse gas scenario (the Special Report on Emission Scenarios A1B forcing) are computed from an ensemble of 23 single runs from 16 coupled global climate models (CGCMs). All models reproduce the general structures of the observed climatological storm-track pattern under present-day forcing conditions. Ensemble mean changes resulting from anthropogenic forcing include an increase of baroclinic wave activity over the eastern North Atlantic, amounting to 5%–8% by the end of the twenty-first century. Enhanced activity is also found over the Asian continent and over the North Pacific near the Aleutian Islands. At high latitudes and over parts of the subtropics, activity is reduced. Variations of the individual models around the ensemble average signal are not small, with a median of the pattern correlation near r = 0.5. There is, however, no evidence for a link between deviations in present-day climatology and deviations with respect to climate change.

An insight into the public acceptance of nutrigenomic-based personalised nutrition.

It is predicted that non-communicable diseases will account for over 73 % of global mortality in 2020. Given that the majority of these deaths occur in developed countries such as the UK, and that up to 80 % of chronic disease could be prevented through improvements in diet and lifestyle, it is imperative that dietary guidelines and disease prevention strategies are reviewed in order to improve their efficacy. Since the completion of the human genome project our understanding of complex interactions between environmental factors such as diet and genes has progressed considerably, as has the potential to individualise diets using dietary, phenotypic and genotypic data. Thus, there is an ambition for dietary interventions to move away from population-based guidance towards 'personalised nutrition'. The present paper reviews current evidence for the public acceptance of genetic testing and personalised nutrition in disease prevention. Health and clear consumer benefits have been identified as key motivators in the uptake of genetic testing, with individuals reporting personal experience of disease, such as those with specific symptoms, being more willing to undergo genetic testing for the purpose of personalised nutrition. This greater perceived susceptibility to disease may also improve motivation to change behaviour which is a key barrier in the success of any nutrition intervention. Several consumer concerns have been identified in the literature which should be addressed before the introduction of a nutrigenomic-based personalised nutrition service. Future research should focus on the efficacy and implementation of nutrigenomic-based personalised nutrition.

Predictable climate impacts of the decadal changes in the ocean in the 1990s

During the 1990s there was a major change in the state of the world's oceans. In particular, the North Atlantic underwent a rapid warming, with sea surface temperatures (SSTs) in the subpolar gyre region increasing by 1°C in just a few years. Associated with the changes in SST patterns were changes in the surface climate, in particular, a tendency for warm and dry conditions over areas of North America in all seasons, and warm springs and wet summers over areas of Europe. Here, the extent to which a climate prediction system initialized using observations of the ocean state is able to capture the observed changes in seasonal mean surface climate is investigated. Rather than examining predictions of the mid-1990s North Atlantic warming event itself, this study compares hindcasts started before and after the warming, relative to hindcasts that do not assimilate information. It is demonstrated that the hindcasts capture many aspects of the observed changes in seasonal mean surface climate, especially in North, South, and Central America and in Europe. Furthermore, the prediction system retains skill beyond the first year. Finally, it is shown that, in addition to memory of Atlantic SSTs, successfully predicting Pacific SSTs was likely important for the hindcasts to predict surface climate over North America.

Cloud optical and microphysical properties derived from ground-based and satellite sensors over a site in the Yangtze Delta region

Comprehensive surface-based retrievals of cloud optical and microphysical properties were made at Taihu, a highly polluted site in the central Yangtze Delta region, during a research campaign from May 2008 to December 2009. Cloud optical depth (COD), effective radius (Re), and liquid water path (LWP) were retrieved from measurements made with a suite of ground-based and spaceborne instruments, including an Analytical Spectral Devices spectroradiometer, a multi␣lter rotating shadowband radiometer, a multichannel microwave radiometer profiler, and the Moderate Resolution Imaging Spectroradiometer (MODIS) on Terra and Aqua satellites. Retrievals from zenith radiance measurements capture better the temporal variation of cloud properties than do retrievals from hemispherical fluxes. Annual mean LWP, COD, and Re are 115.8 ± 90.8 g/m2, 28.5 ± 19.2, and 6.9 ± 4.2 microns. Over 90% of LWP values are less than 250 g/m2. Most of the COD values (>90%) fall between 5 and 60, and ~80% of Re values are less than 10 microns. Maximum (minimum) values of LWP and Re occur in summer (winter); COD is highest in winter and spring. Raining and nonraining clouds have signi␣cant differences in LWP, COD, and Re. Rainfall frequency is best correlated with LWP, followed by COD and Re. Cloud properties retrieved from multiple ground-based instruments are also compared with those from satellite retrievals. On average, relative to surface retrievals, mean differences of satellite retrievals in cloud LWP, COD, and Re were -33.6 g/m2 (-26.4%), -5.8 (-31.4%), and 2.9 ␣m (29.3%) for 11 MODIS-Terra overpasses and -43.3 g/m2 (-22.3%), -3.0 (-10.0%), and -1.3 ␣m (-12.0%) for 8 MODIS-Aqua overpasses, respectively. These discrepancies indicate that MODIS cloud products still suffer from large uncertainties in this region.

The influence of stratospheric vortex displacements and splits on surface climate

A strong link exists between stratospheric variability and anomalous weather patterns at the earth’s surface. Specifically, during extreme variability of the Arctic polar vortex termed a “weak vortex event,” anomalies can descend from the upper stratosphere to the surface on time scales of weeks. Subsequently the outbreak of cold-air events have been noted in high northern latitudes, as well as a quadrupole pattern in surface temperature over the Atlantic and western European sectors, but it is currently not understood why certain events descend to the surface while others do not. This study compares a new classification technique of weak vortex events, based on the distribution of potential vorticity, with that of an existing technique and demonstrates that the subdivision of such events into vortex displacements and vortex splits has important implications for tropospheric weather patterns on weekly to monthly time scales. Using reanalysis data it is found that vortex splitting events are correlated with surface weather and lead to positive temperature anomalies over eastern North America of more than 1.5 K, and negative anomalies over Eurasia of up to −3 K. Associated with this is an increase in high-latitude blocking in both the Atlantic and Pacific sectors and a decrease in European blocking. The corresponding signals are weaker during displacement events, although ultimately they are shown to be related to cold-air outbreaks over North America. Because of the importance of stratosphere–troposphere coupling for seasonal climate predictability, identifying the type of stratospheric variability in order to capture the correct surface response will be necessary.

The lottery-panel task for bi-dimensional parameter-free elicitation of risk attitudes

We propose first, a simple task for the eliciting attitudes toward risky choice, the SGG lottery-panel task, which consists in a series of lotteries constructed to compensate riskier options with higher risk-return trade-offs. Using Principal Component Analysis technique, we show that the SGG lottery-panel task is capable of capturing two dimensions of individual risky decision making i.e. subjects’ average risk taking and their sensitivity towards variations in risk-return. From the results of a large experimental dataset, we confirm that the task systematically captures a number of regularities such as: A tendency to risk averse behavior (only around 10% of choices are compatible with risk neutrality); An attraction to certain payoffs compared to low risk lotteries, compatible with over-(under-) weighting of small (large) probabilities predicted in PT and; Gender differences, i.e. males being consistently less risk averse than females but both genders being similarly responsive to the increases in risk-premium. Another interesting result is that in hypothetical choices most individuals increase their risk taking responding to the increase in return to risk, as predicted by PT, while across panels with real rewards we see even more changes, but opposite to the expected pattern of riskier choices for higher risk-returns. Therefore, we conclude from our data that an “economic anomaly” emerges in the real reward choices opposite to the hypothetical choices. These findings are in line with Camerer's (1995) view that although in many domains, paid subjects probably do exert extra mental effort which improves their performance, choice over money gambles is not likely to be a domain in which effort will improve adherence to rational axioms (p. 635). Finally, we demonstrate that both dimensions of risk attitudes, average risk taking and sensitivity towards variations in the return to risk, are desirable not only to describe behavior under risk but also to explain behavior in other contexts, as illustrated by an example. In the second study, we propose three additional treatments intended to elicit risk attitudes under high stakes and mixed outcome (gains and losses) lotteries. Using a dataset obtained from a hypothetical implementation of the tasks we show that the new treatments are able to capture both dimensions of risk attitudes. This new dataset allows us to describe several regularities, both at the aggregate and within-subjects level. We find that in every treatment over 70% of choices show some degree of risk aversion and only between 0.6% and 15.3% of individuals are consistently risk neutral within the same treatment. We also confirm the existence of gender differences in the degree of risk taking, that is, in all treatments females prefer safer lotteries compared to males. Regarding our second dimension of risk attitudes we observe, in all treatments, an increase in risk taking in response to risk premium increases. Treatment comparisons reveal other regularities, such as a lower degree of risk taking in large stake treatments compared to low stake treatments and a lower degree of risk taking when losses are incorporated into the large stake lotteries. Results that are compatible with previous findings in the literature, for stake size effects (e.g., Binswanger, 1980; Antoni Bosch-Domènech & Silvestre, 1999; Hogarth & Einhorn, 1990; Holt & Laury, 2002; Kachelmeier & Shehata, 1992; Kühberger et al., 1999; B. J. Weber & Chapman, 2005; Wik et al., 2007) and domain effect (e.g., Brooks and Zank, 2005, Schoemaker, 1990, Wik et al., 2007). Whereas for small stake treatments, we find that the effect of incorporating losses into the outcomes is not so clear. At the aggregate level an increase in risk taking is observed, but also more dispersion in the choices, whilst at the within-subjects level the effect weakens. Finally, regarding responses to risk premium, we find that compared to only gains treatments sensitivity is lower in the mixed lotteries treatments (SL and LL). In general sensitivity to risk-return is more affected by the domain than the stake size. After having described the properties of risk attitudes as captured by the SGG risk elicitation task and its three new versions, it is important to recall that the danger of using unidimensional descriptions of risk attitudes goes beyond the incompatibility with modern economic theories like PT, CPT etc., all of which call for tests with multiple degrees of freedom. Being faithful to this recommendation, the contribution of this essay is an empirically and endogenously determined bi-dimensional specification of risk attitudes, useful to describe behavior under uncertainty and to explain behavior in other contexts. Hopefully, this will contribute to create large datasets containing a multidimensional description of individual risk attitudes, while at the same time allowing for a robust context, compatible with present and even future more complex descriptions of human attitudes towards risk.

The effect of a new drag-law parameterization on ice shelf water plume dynamics

A drag law accounting for Ekman rotation adjacent to a flat, horizontal bou ndary is proposed for use in a plume model that is written in terms of the depth-mean velocity. The drag l aw contains a variable turning angle between the mean velocity and the drag imposed by the turbulent bound ary layer. The effect of the variable turning angle in the drag law is studied for a plume of ice shelf wat er (ISW) ascending and turning beneath an Antarctic ice shelf with draft decreasing away from the groundi ng line. As the ISW plume ascends the sloping ice shelf–ocean boundary, it can melt the ice shelf, wh ich alters the buoyancy forcing driving the plume motion. Under these conditions, the typical turning ang le is of order 10° over most of the plume area for a range of drag coefficients (the minus sign arises for th e Southern Hemisphere). The rotation of the drag with respect to the mean velocity is found to be signifi cant if the drag coefficient exceeds 0.003; in this case the plume body propagates farther along and across the b ase of the ice shelf than a plume with the standard quadratic drag law with no turning angle.

Simulations of the impact of orbital forcing and ocean on the Asian summer monsoon during the Holocene

The importance of orbital forcing and ocean impact on the Asian summer monsoon in the Holocene is investigated by comparing simulations with a fully coupled ocean–atmosphere general circulation model (FOAM) and with the atmospheric component of this model (FSSTAM) forced with prescribed modern sea-surface temperatures (SSTs). The results show: (1) the ocean amplifies the orbitally-induced increase in African monsoon precipitation, makes somewhat increase in southern India and damps the increase over the southeastern China. (2) The ocean could change the spatial distribution and local intensity of the orbitally-induced latitudinal atmospheric oscillation over the southeastern China and the subtropical western Pacific Ocean. (3) The orbital forcing mostly enhances the Asian summer precipitation in the FOAM and FSSTAM simulations. However, the ocean reduces the orbitally-induced summer precipitation and postpones the time of summer monsoon onset over the Asian monsoon region. (4) The orbital forcing considerably enhances the intensity of upper divergence, which is amplified by ocean further, over the eastern hemisphere. But the divergence is weaker in the FOAM simulations than in the FSSTAM simulations when the orbital forcing is fixed. (5) The orbital forcing can enhance the amplitude of precipitation variability over the subtropical Africa, the southeastern China and northwestern China, inversely, reduce it over central India and North China in the FOAM and FSSTAM simulations. The ocean obviously reduces the amplitude of precipitation variability over most of the Asian monsoon regions in the fixed orbital forcing simulations. (6) The areas characterized by increased summer precipitation in the long-term mean are mostly characterized by increased amplitude of short-term variability, whereas regions characterized by decreased precipitation are primarily characterized by decreased amplitude of short-term variability. However, the influences of orbital forcing or dynamical ocean on regional climate depend on the model.