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Background Crisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users’ needs, this study used qualitative methods to investigate stakeholders’ experiences and views of CRTs, and what is important in good quality home-based crisis care. Method Semi-structured interviews and focus groups were conducted with service users ( n  = 41), carers ( n  = 20) and practitioners (CRT staff, managers and referrers; n  = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers ( n  = 11). Data were analysed using thematic analysis. Results Three domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users’ experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable. Conclusions Stakeholders’ views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.

The Himalaya, Kohistan, and Karakoram ranges comprise Proterozoic to Cenozoic crystalline complexes exposed in northern Pakistan. Numerous hot springs in the area indicate high subsurface temperatures, prompting a need to evaluate the local contribution of radiogenic heat to the general orogenic-related elevated geothermal gradients. The current study employed a portable gamma spectrometer to estimate the in-situ radiogenic heat production in the Nanga Parbat Massif, Kohistan–Ladakh batholith, and the Karakoram batholith. Heat production in the Nanga Parbat Massif is high, with a range from 0.2 to 10.8 µWm−3 and mean values of 4.6 ± 2.5 and 5.9 ± 1.9 µWm−3 for gneisses and granites, respectively. By contrast, the heat production is low in the Kohistan–Ladakh batholith, ranging from 0.1 to 3.1 µWm−3, with the highest mean of 2.0 ± 0.5 µWm−3 in granites. The Karakoram batholith shows a large variation in heat production, with values ranging from 0.4 to 20.3 µWm−3 and the highest mean of 8.4 ± 8.3 µWm−3 in granites. The in-situ radiogenic heat production values vary in different ranges and represent considerably higher values than those previously used for the thermal modeling of Himalaya. A conductive 1D thermal model suggests 93–108 °C hotter geotherms, respectively, at 10 and 20 km depths due to the thick heat-producing layer in the upper crust, resulting in a surface heat flow of 103 mWm−2. The present study provides first-order radiogenic heat production constraints for developing a thermal model for geothermal assessment.

Background A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). Methods A five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4). Results Existing evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of the intervention by PSWs; however, the structured self-management booklet was underutilised. Modifications to the self-management intervention manual and PSWs’ training were made before piloting, which confirmed the acceptability and feasibility of the intervention for testing in a future, definitive trial. Conclusions A manualised intervention and operating procedures, focusing on the needs and priorities of the target client group, have been developed through iterative stages of intervention development and feedback for testing in a trial context. Trial Registration ISRCTN01027104 date of registration: 11/10/2012

High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis. We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104. 221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43–0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group). Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission. National Institute for Health Research.

The Late Cretaceous intraplate shortening event in central western Europe is associated with a number of marine basins of relatively high amplitude and short wavelength (2–3 km depth and 20–100 km width). In particular, the Harz Mountains, a basement uplift on a single, relatively steeply dipping basement thrust, have filled the adjacent Subhercynian Cretaceous Basin with their erosive product, proving that the two were related and synchronous. The problem of generating subsidence of this general style and geometry in an intraplate setting is dealt with here by using an elastic flexural model conditioned to take account of basement thrusts as weak zones in the lithosphere. Using a relatively simple configuration of this kind, we reproduce many of the basic features of the Subhercynian Cretaceous Basin and related basement thrusts. As a result, we suggest that overall, it shares many characteristics with larger-scale foreland basins associated with collisional orogens on plate boundaries.

The fourth-order differential equation describing elastic flexure of the lithosphere is one of the cornerstones of geodynamics that is key to understanding topography, gravity, glacial isostatic rebound, foreland basin evolution, and a host of other phenomena. Despite being fully formulated in the 1940s, a number of significant issues concerning the basic equation have remained overlooked to this day. We first explain the different fundamental forms the equation can take and their difference in meaning and solution procedures. We then show how numerical solutions to flexure problems as they are currently formulated are in general potentially unreliable in an unpredictable manner for cases in which the coefficient of rigidity varies in space due to variations of the elastic thickness parameter. This is due to fundamental issues related to the numerical discretisation scheme employed. We demonstrate an alternative discretisation that is stable and accurate across the broadest conceivable range of conditions and variations of elastic thickness, and we show how such a scheme can simulate conditions up to and including a completely broken lithosphere more usually modelled as an end-loaded, single, continuous plate. Importantly, our scheme will allow breaks in plate interiors, allowing, for instance, the creation of separate blocks of lithosphere which can also share the support of loads. The scheme we use has been known for many years but remains rarely applied or discussed. We show that it is generally the most suitable finite-difference discretisation of fourth-order, elliptic equations of the kind describing many phenomena in elasticity, including the problem of bending of elastic beams. We compare the earlier discretisation scheme to the new one in one-dimensional form and also give the two-dimensional discretisation based on the new scheme. We also describe a general issue concerning the numerical stability of any second-order finite-difference discretisation of a fourth-order differential equation like that describing flexure wherein contrasting magnitudes of coefficients of different summed terms lead to round-off problems, which in turn destroy matrix positivity. We explain the use of 128 bit floating-point storage for variables to mitigate this issue.

Background Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence. Methods A concept mapping process was used to develop a CRT fidelity scale. Participants ( n  = 68) from a range of stakeholder groups prioritised and grouped statements ( n  = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers ( n  = 16) rated CRT service fidelity in a vignette exercise to test the scale’s inter-rater reliability. Results There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). Conclusions The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.

New field work, combined with analysis of high-resolution aerial photographs, digital elevation models, and satellite imagery, has identified an active fault that is traceable for ∼90 km across the Seymchan Basin and is part of the Ulakhan fault system, which is believed to form the Okhotsk–North America plate boundary. Age dating of alluvial fan sediments in a channel system that is disturbed by fault activity suggests the current scarp is a result of a series of large earthquakes (≥Mw 7.5) that have occurred since 11.6±2.7 ka. A possible channel feature offset by 62±4 m associated with these sediments yields a slip rate of 5.3±1.3 mm yr−1, in broad agreement with rates suggested from global plate tectonics. Our results clearly identify the Ulakhan fault as the Okhotsk–North America plate boundary and show that tectonic strain release is strongly concentrated on the boundaries of Okhotsk. In light of our results, the likelihood of recurrence of Mw 7.5 earthquakes is high, suggesting a previously underestimated seismic hazard across the region.