Telephone delivery of psychological interventions: Balancing protocol with patient-centred care.

Common mental health problems of anxiety and depression affect significant proportions of the global population. Within the UK, and increasingly across western countries, a key policy response has been the introduction of high volume, low intensity psychological assessment and treatment services, such as the NHS's Improving Access to Psychological Therapies (IAPT) service, the largest service delivery model yet to be implemented at a national level (England). IAPT may be delivered in face-to-face meetings or over the telephone, as well as through other media. In order to increase access and achieve wide reach with efficient use of resources, IAPT's service models utilise relatively structured and standardised protocols, whilst aiming simultaneously to deliver a tailored and personalised experience for patients. Previous research has revealed that this can be a challenging balance for front-line practitioners to strike. Here we report research into the telephone delivery of guided self-help, low intensity interventions within IAPT, examining the challenges faced in remote delivery when combining structure with personalisation during assessment and treatment sessions. We show the ways in which the lack of flexibility in adhering to a system-driven structure can displace, defer or disrupt the emergence of the patient's story, thereby compromising the personalisation and responsiveness of the service. Our study contributes new insights to our understanding of the association between personalisation, engagement and patient experience within high volume, low-intensity psychological treatment services. Our research on the telephone delivery of IAPT is particularly timely in view of the current global Covid-19 health crisis, as a result of which face-to-face delivery of IAPT has had to be (temporarily) suspended.

Predicting rapid herbicide leaching to surface waters from an artificially drained headwater catchment using a one dimensional two-domain model coupled with a simple groundwater model.

Pesticide losses to water can present problems for environmental management, particularly in catchments where surface waters are abstracted for drinking water supply. The relative role of different transfer pathways (spray drift, spills, overland flow and leaching from soils) is often uncertain, and there is a need for experimental observation and modelling to ensure that processes are understood under a range of conditions. Here we examine the transport of propyzamide and carbetamide in a small (15.5 ha) headwater sub-catchment dominated by an artificially drained field with strongly undulating topography (topographic gradients >1:10). Specifically, we explore the validity of the "field-scale lysimeter" analogy by applying the one dimensional mathematical model MACRO. Although one dimensional representation has been shown to be reasonable elsewhere, the scale and topography of the monitored system challenge many of the underlying assumptions. MACRO considers two interacting flow domains: micropores and macropores. The effect of subsurface drains can also be included. A component of the outflow from the main drain was identified as originating from an upslope permeable shallow aquifer which was represented using a simple groundwater model. Predicted herbicide losses were sensitive to drain spacing and the organic carbon to water partition coefficient, K(OC). The magnitude of the peak water and herbicide transport and their timing were simulated satisfactorily, although model performance was poor following a period of one month when snow covered the ground and precipitation was underestimated by the rain gauge. Total herbicide loads were simulated adequately by MACRO, suggesting that the field-scale lysimeter analogy is valid at this scale, although baseflow contributions to flow needed to be accounted for separately in order to adequately represent hydrological response.

Measurement and conceptual modelling of herbicide transport to field drains in a heavy clay soil with implications for catchment-scale water quality management.

Propyzamide and carbetamide are essential for blackgrass control in oilseed rape production. However, both of these compounds can contaminate surface waters and pose compliance problems for water utilities. The transport of propyzamide and carbetamide to an instrumented field drain in a small clay headwater tributary of the Upper Cherwell catchment was monitored over a winter season. Despite having very different sorption and dissipation properties, both herbicides were transported rapidly to the drain outlet in the first storm event after application, although carbetamide was leached more readily than propyzamide. A simple conceptual model was constructed to represent solute displacement from mobile pore water and preferential flow to drains. The model was able to reproduce the timing and magnitude of herbicide losses well, lending support to its conceptual basis. Measured losses in drainflow in the month following application were 1.1 and 8.1%, respectively, for propyzamide and carbetamide. Differences were due to a combination of differences in herbicide mobility and due to the fact that the monitoring period for carbetamide was hydrologically more active. For both compounds, losses were greater than those typically reported elsewhere for other herbicides. The data suggest that drainflow is the dominant pathway for the transfer of these herbicides to the catchment outlet, where water is abstracted for municipal supply. This imposes considerable constraints on the management options available to reduce surface water concentrations of herbicides in this catchment.

The effect of annealing on the variation of glass refractive index.

The variation of refractive index (RI) over a non-toughened, float pane of glass and a toughened, float pane of glass was investigated. The two panes of colourless, float glass were cut into 150 5 cm × 5 cm squares. The pre- and post-annealing RI values from three random areas from each square were measured. Bayesian statistical hierarchical modelling of the results showed that for the non-toughened, float glass pane annealing increased the variability in RI by a factor of 1.29-1.58, with a mean of 1.43 (with 95% probability); and for the toughened, float pane of glass annealing decreased the variability in RI by a factor of 0.63-0.76, with a mean of 0.69 (with 95% probability). In addition it was found that although there were no systematic differences in ΔRI across either pane of glass, there were observable differences across both panes of glass. These results provide information regarding the expected RI variation over entire panes of both non-toughened and toughened float window glass for both pre- and post-annealing RI measurements.

Synaesthesia in the normal limb.

We explored the degree to which vision may alter kinaesthetic perception by asking participants to view their hand through a prism, introducing different horizontal deviations, while trying to align their fingers above and below a thin table. When the visual image of one hand was displaced this overwhelmed kinaesthetic judgements and participants reliably reported that they felt their limbs were aligned, even when they were laterally mis-aligned by as much as 10 cm. This effect, however, was mediated by 'visual capture' and when the task was attempted in a darkened room with limb position indicated by an LED taped to the finger, kinaesthesis dominated and participants reported that the LED seemed to become detached from their finger tip. In both light and dark conditions the finger was clearly visible and only the background detail was extinguished. Hence, in perceiving limb position, it appears that we believe in what we see, rather than in what we feel, when the visual background is rich, and in what we feel when the visual background is sparse.