Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Immersive co-operative psychological virtual environments (ICPVE)

Virtual Reality (VR) has been used in a variety of forms to assist in the treatment of a wide range of psychological illness. VR can also fulfil the need that psychologists have for safe environments in which to conduct experiments. Currently the main barrier against using this technology is the complexity in developing applications. This paper presents two different co-operative psychological applications which have been developed using a single framework. These applications require different levels of co-operation between the users and clients, ranging from full psychologist involvement to their minimal intervention. This paper will also discuss our approach to developing these different environments and our experiences to date in utilising these environments.

Williams Syndrome: the extent of agreement between parent and self report of psychological difficulties

Background and Objectives: People with Williams syndrome (WS) have been reported by their carers to have problems with attention, anxiety and social relationships. People with WS have been shown to report their anxieties. This study extends our knowledge of how people with WS see themselves in terms of behaviour and social relationships. Methods: A survey using self and parent report forms of the Strengths and Difficulties Questionnaire. Results: Both parents and individuals with WS (N = 31) reported difficulties in emotional disorder and hyperactivity symptoms and strengths in prosocial behaviours such as altruism and empathy. They disagreed about peer problems. Conclusions: People with WS understand some but not all of their difficulties. In particular they fail to recognize their social difficulties which may lead them to be vulnerable to exploitation.

The climate response to CO2 of the Hadley Centre coupled AOGCM with and without flux adjustment

Coupled atmosphere‐ocean general circulation models have a tendency to drift away from a realistic climatology. The modelled climate response to an increase of CO2 concentration may be incorrect if the simulation of the current climate has significant errors, so in many models, including ours, the drift is counteracted by applying prescribed fluxes of heat and fresh water at the ocean‐atmosphere interface in addition to the calculated surface exchanges. Since the additional fluxes do not have a physical basis, the use of this technique of “flux adjustment” itself introduces some uncertainty in the simulated response to increased CO2. We find that the global‐average temperature response of our model to CO2 increasing at 1% per year is about 30% less without flux adjustment than with flux adjustment. The geographical patterns of the response are similar, indicating that flux adjustment is not causing any gross distortion. The reduced size of the response is due to more effective vertical transport of heat into the ocean, and a somewhat smaller climate sensitivity. Although the response in both cases lies within the generally accepted range for the climate sensitivity, systematic uncertainties of this size are clearly undesirable, and the best strategy for future development is to improve the climate model in order to reduce the need for flux adjustment.

Asymmetric adjustment in the City of London office market

Earlier estimates of the City of London office market are extended by considering a longer time series of data, covering two cycles, and by explicitly modeling of asymmetric space market responses to employment and supply shocks. A long run structural model linking real rental levels, office-based employment and the supply of office space is estimated and then rental adjustment processes are modeled using an error correction model framework. Rental adjustment is seen to be asymmetric, depending both on the direction of the supply and demand shocks and on the state of the space market at the time of the shock. Vacancy adjustment does not display asymmetries. There is also a supply adjustment equation. Two three-equation systems, one with symmetric rental adjustment and the other with asymmetric adjustment, are subjected to positive and negative shocks to employment. These illustrate differences in the two systems.

Output envelope adjustment for an environmental fuzzy logic controller

A two-level fuzzy logic controller for use in air-conditioning systems is outlined in this paper. At the first level a simplified controller is produced from expert knowledge and envelope adjustment is introduced, while the second level provides a means for adapting this controller to different working spaces. The mechanism for adaption is easily implemented and can be used in real time. A series of simulations is presented to illustrate the proposed schema.

Evidence-based psychological therapies: from bench to bedside

Patients with mental health difficulties do not always receive appropriate and recommended psychological treatment for their difficulties, and clinicians are not always appropriately trained to deliver them. This paper considers why this might be the case and provides an overview of the Charlie Waller Institute, a not-for-profit organisation funded by the NHS, University of Reading, and the Charlie Waller Memorial Trust. The Institute seeks to address this problem by training clinicians in wide variety of evidence-based therapies and assessing the impact of this training on clinician knowledge and skill.

Spin-up and adjustment of the Antarctic Circumpolar Current and global pycnocline

A theory is presented for the adjustment of the Antarctic Circumpolar Current (ACC) and global pycnocline to a sudden and sustained change in wind forcing. The adjustment timescale is controlled by the mesoscale eddy diffusivity across the ACC, the mean width of the ACC, the surface area of the ocean basins to the north, and deep water formation in the North Atlantic. In particular, northern sinking may have the potential to shorten the timescale and reduce its sensitivity to Southern Ocean eddies, but the relative importance of northern sinking and Southern Ocean eddies cannot be determined precisely, largely due to limitations in the parameterization of northern sinking. Although it is clear that the main processes that control the adjustment timescale are those which counteract the deepening of the global pycnocline, the theory also suggests that the timescale can be subtly modified by wind forcing over the ACC and global diapycnal mixing. Results from calculations with a reduced-gravity model compare well with the theory. The multidecadal-centennial adjustment timescale implies that long observational time series will be required to detect dynamic change in the ACC due to anthropogenic forcing. The potential role of Southern Ocean mesoscale eddy activity in determining both the equilibrium state of the ACC and the timescale over which it adjusts suggests that the response to anthropogenic forcing may be different in coupled ocean-atmosphere climate models that parameterize and resolve mesoscale eddies.