Predictive validity of the Short-Term Assessment of Risk and Treatability (START) for multiple adverse outcomes:the effect of diagnosis

The Short-Term Assessment of Risk and Treatability (START) assists risk assessment for seven risk outcomes based on scoring of risk and protective factors and assignment of clinically-informed risk levels. Its predictive validity for violence and self-harm has been established in males with schizophrenia, but accuracy across pathologically diverse samples is unknown. Routine START assessments and 3-month risk outcome data of N = 527 adult, inpatients in a UK secure mental health facility were collected. The sample was divided into diagnostic groups; predictive validity was established using receiver operating characteristics regression (rocreg) analysis in which potential covariates were controlled. In most single-diagnosis groups START risk factors ('vulnerabilities'), protective factors ('strengths'), and clinically-informed estimates predicted multiple risk outcomes with effect sizes similar to previous research. Self-harm was not predicted among patients with an organic diagnosis. The START risk estimates predicted physical aggression in all diagnostic groups, and verbal aggression, self-harm and self-neglect in most diagnostic groups. The START can assist assessment of aggressive, self-harm, and self-neglect across a range of diagnostic groups. Further research with larger sample sizes of those with multiple diagnoses is required.</p

Predictive validity of the short-term assessment of risk and treatability (START) for aggression and self-harm in a secure mental health service:gender differences

The START predicts aggressive outcomes and to some extent self-harm. However, it is not known whether gender moderates its performance. This study used routinely collected data to investigate the predictive ability of the START for aggression and self-harm in secure psychiatric patients. Utility of the START was examined separately for men and women. The START was a stronger predictor of aggression and self-harm in women than men. The specific risk estimates produced large effect sizes for the prediction of aggression and self-harm in women; none of the AUC values reached the threshold for a large effect size in the male sample

Use of the HCR-20 for violence risk assessment:views of clinicians working in a secure inpatient mental health setting

Purpose: To explore how raters combine constituent components of HCR-20 risk assessment for inpatient aggression, and how relevant they rate the tool for different diagnostic and demographic groups.Design/methodology/approach: A cross-sectional survey design was used. N=45 mental health clinicians working in a secure hospital responded to an online survey about their risk assessment practice.Findings: HCR-20 Historical and Clinical sub-scales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women respectively.Research limitations/ implications: This was an exploratory survey and results should be verified using larger samples.Practical implications: Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may over-value historical factors. They believe that recent violent behaviour is important in risk formulation; however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified.Social implications: It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention.Originality/ value: Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice

Rheo-processing of an alloy specifically designed for semi-solid metal processing on the Al-Mg-Si system

Semi-solid metal (SSM) processing is a promising technology for forming alloys and composites to near-net shaped products. Alloys currently used for SSM processing are mainly conventional aluminium cast alloys. This is an obstacle to the realisation of full potential of SSM processing, since these alloys were originally designed for liquid state processing and not for semi-solid state processing. Therefore, there is a significant need for designing new alloys specifically for semi-solid state processing to fulfil its potential. In this study, thermodynamic calculations have been carried out to design alloys based on the Al-Mg-Si system for SSM processing via the ‘Rheo-route’. The suitability of a selected alloy composition has been assessed in terms of the criteria considered by the thermodynamic design process, mechanical properties and heat treatability. The newly designed alloy showed good processability with rheo-processing in terms of good control of solid fraction during processing and a reasonably large processing window. The mechanical property variation was very small and the alloy showed good potential for age hardening by T5 temper heat treatment after rheo-processing

Predictive validity of the START for unauthorised leave and substance abuse in a secure mental health setting:a pseudo-prospective cohort study

Background Risk assessment and management is central to the nursing role in forensic mental health settings. The Short Term Assessment of Risk and Treatability (START) aims to support assessment through identification of risk and protective factors. It has demonstrated predictive validity for aggression; it also aims to aid risk assessment for unauthorised leave and substance abuse where its performance is relatively untested. Objectives To test the predictive validity of the START for unauthorised leave and substance abuse. Design A naturalistic, pseudo-prospective cohort study. Settings Four centres of a large UK provider of secure inpatient mental health services. Participants Inpatients resident between May 2011 and October 2013 who remained in the service for 3-months following assessment with the START by their clinical team. Exclusion criteria were missing assessment data in excess of prorating guidelines. Of 900 eligible patients 73 were excluded leaving a final sample size of n = 827 (response rate 91.9%). Mean age was 38.5 years (SD = 16.7); most participants (72.2%) were male; common diagnoses were schizophrenia-type disorders, personality disorders, organic disorders, developmental disorders and intellectual disability. Methods Routinely conducted START assessments were gathered. Subsequent incidents of substance abuse and unauthorised leave were coded independently. Positive and negative predictive values of low and elevated risk were calculated. Receiver Operating Characteristic analysis was conducted to ascertain the predictive accuracy of the assessments based on their sensitivity and specificity. Results Patient-based rates of unauthorised leave (2.4%) and substance abuse (1.6%) were low. The positive and negative predictive values for unauthorised leave were 5.9% and 98.4%; and for substance abuse 8.1% and 99.0%. The START specific risk estimate for unauthorised leave predicted its associated outcome (Area under the curve = .659, p &lt; .05, 95% CI .531, .786); the substance abuse risk estimate predicted its outcome with a large effect size (Area under the curve = .723, p &lt; .01, 95% CI .568, .879). Conclusions The study provides limited support for the START by demonstrating the predictive validity of its specific risk estimates for substance abuse and unauthorised leave. High negative predictive values suggest the tool may be of most utility in screening out low risk individuals from unnecessary restrictive interventions; very low positive predictive values suggest caution before implementing restrictive interventions in those rated at elevated risk. Researchers should investigate how multidisciplinary teams formulate risk assessments for these outcomes since they outperform the quantitative element of this tool

Preliminary Study on Treatment of Contaminated Groundwater from the Taylorville Gasifier Site

Groundwater and soil at the site of an abandoned coal gasification plant in Taylorville, Illinois have been contaminated with compounds associated with coal conversion process waters. A preliminary study to assess the feasibility of using ethanol as a means of increasing the solubility of compounds adsorbed within the soil matrix followed by treatment of the ethanol/groundwater extract in an expanded-bed anaerobic granular activated carbon (GAC) reactor was conducted. Results of the study indicate that compounds in the groundwater are highly adsorb able on GAC, and do not interfere with the anaerobic degradation of ethanol in the reactor. Soil extractions with varying ethanol/water ratios were able to remove many additional low water solubility compounds from the soil.ENR Contract Number HWR87035published or submitted for publicationis peer reviewe

The Impact of Capsid Proteins on Virus Removal and Inactivation During Water Treatment Processes

This study examined the effect of the amino acid composition of protein capsids on virus inactivation using ultraviolet (UV) irradiation and titanium dioxide photocatalysis, and physical removal via enhanced coagulation using ferric chloride. Although genomic damage is likely more extensive than protein damage for viruses treated using UV, proteins are still substantially degraded. All amino acids demonstrated significant correlations with UV susceptibility. The hydroxyl radicals produced during photocatalysis are considered nonspecific, but they likely cause greater overall damage to virus capsid proteins relative to the genome. Oxidizing chemicals, including hydroxyl radicals, preferentially degrade amino acids over nucleotides, and the amino acid tyrosine appears to strongly influence virus inactivation. Capsid composition did not correlate strongly to virus removal during physicochemical treatment, nor did virus size. Isoelectric point may play a role in virus removal, but additional factors are likely to contribute

The protective scale of the Armidilo‐S:the importance of forensic and clinical outcomes

Background: The Armidilo has two scales—the risk scale and the protective scale. Research has been confined to the risk scale which appears to predict future incidents with medium to large effect sizes. There have been no publications on the use of the protective scale.Methods: The Armidilo was completed on four individuals with IDD who were either moving on from their placement or whose placement was in jeopardy because of new information or altered policies in the organization. The Armidilo was completed in the usual fashion.Results: Risk and protective results show that for each individual, recommendations could be made that ensured the best outcome. For two participants, restrictive placements were avoided because of the data on protective factors.Conclusions: The protective scale can be a powerful support for the clinician's case in offenders with IDD. The protective scale should be completed routinely for clinical evaluation

Penetration and effectiveness of micronized copper in refractory wood species

The North American wood decking market mostly relies on easily treatable Southern yellow pine (SYP), which is being impregnated with micronized copper (MC) wood preservatives since 2006. These formulations are composed of copper (Cu) carbonate particles (CuCO3 center dot Cu(OH)(2)), with sizes ranging from 1 nm to 250 mu m, according to manufacturers. MC-treated SYP wood is protected against decay by solubilized Cu2+ ions and unreacted CuCO3 center dot Cu(OH)(2) particles that successively release Cu2+ ions (reservoir effect). The wood species used for the European wood decking market differ from the North American SYP. One of the most common species is Norway spruce wood, which is poorly treatable i.e. refractory due to the anatomical properties, like pore size and structure, and chemical composition, like pit membrane components or presence of wood extractives. Therefore, MC formulations may not suitable for refractory wood species common in the European market, despite their good performance in SYP. We evaluated the penetration effectiveness of MC azole (MCA) in easily treatable Scots pine and in refractory Norway spruce wood. We assessed the effectiveness against the Cu-tolerant wood-destroying fungus Rhodonia placenta. Our findings show that MCA cannot easily penetrate refractory wood species and could not confirm the presence of a reservoir effect

Evidence-based decision support for pediatric rheumatology reduces diagnostic errors.

BACKGROUND: The number of trained specialists world-wide is insufficient to serve all children with pediatric rheumatologic disorders, even in the countries with robust medical resources. We evaluated the potential of diagnostic decision support software (DDSS) to alleviate this shortage by assessing the ability of such software to improve the diagnostic accuracy of non-specialists. METHODS: Using vignettes of actual clinical cases, clinician testers generated a differential diagnosis before and after using diagnostic decision support software. The evaluation used the SimulConsult® DDSS tool, based on Bayesian pattern matching with temporal onset of each finding in each disease. The tool covered 5405 diseases (averaging 22 findings per disease). Rheumatology content in the database was developed using both primary references and textbooks. The frequency, timing, age of onset and age of disappearance of findings, as well as their incidence, treatability, and heritability were taken into account in order to guide diagnostic decision making. These capabilities allowed key information such as pertinent negatives and evolution over time to be used in the computations. Efficacy was measured by comparing whether the correct condition was included in the differential diagnosis generated by clinicians before using the software ( unaided ), versus after use of the DDSS ( aided ). RESULTS: The 26 clinicians demonstrated a significant reduction in diagnostic errors following introduction of the software, from 28% errors while unaided to 15% using decision support (p \u3c 0.0001). Improvement was greatest for emergency medicine physicians (p = 0.013) and clinicians in practice for less than 10 years (p = 0.012). This error reduction occurred despite the fact that testers employed an open book approach to generate their initial lists of potential diagnoses, spending an average of 8.6 min using printed and electronic sources of medical information before using the diagnostic software. CONCLUSIONS: These findings suggest that decision support can reduce diagnostic errors and improve use of relevant information by generalists. Such assistance could potentially help relieve the shortage of experts in pediatric rheumatology and similarly underserved specialties by improving generalists\u27 ability to evaluate and diagnose patients presenting with musculoskeletal complaints. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02205086