Variations in the hospital management of self harm in adults in England: observational study

More than 140 000 people present to hospital after an episode of self harm each year in England and Wales. Improving the general hospital management of these people is a key area in preventing suicide. Although professional consensus has been reached on how self harm services should be organised and delivered, wide variations in care delivery have been reported in two regions in England. Using a nationally representative sample, we investigated the variation in services and delivery of care for self harm patients in hospitals in England

Collective Oscillations of Vortex Lattices in Rotating Bose-Einstein Condensates

The complete low-energy collective-excitation spectrum of vortex lattices is discussed for rotating Bose-Einstein condensates (BEC) by solving the Bogoliubov-de Gennes (BdG) equation, yielding, e.g., the Tkachenko mode recently observed at JILA. The totally symmetric subset of these modes includes the transverse shear, common longitudinal, and differential longitudinal modes. We also solve the time-dependent Gross-Pitaevskii (TDGP) equation to simulate the actual JILA experiment, obtaining the Tkachenko mode and identifying a pair of breathing modes. Combining both the BdG and TDGP approaches allows one to unambiguously identify every observed mode.Comment: 5 pages, 4 figure

Sound design for a system of 1000 distributed independent audio-visual devices

This paper describes the sound design for Bloom, a light and sound installation made up of 1000 distributed independent audio-visual pixel devices, each with RGB LEDs, Wifi, Accelerometer, GPS sensor, and sound hardware. These types of systems have been explored previously, but only a few systems have exceeded 30-50 devices and very few have included sound capability, and therefore the sound design possibilities for large systems of distributed audio devices are not well understood. In this article we describe the hardware and software implementation of sound synthesis for this system, and the implications for design of media for this context

Sound Design for a System of 1000 Distributed Independent Audio-Visual Devices

This paper describes the sound design for Bloom, a light and sound installation made up of 1000 distributed independent audio-visual pixel devices, each with RGB LEDs, Wifi, Accelerometer, GPS sensor, and sound hardware. These types of systems have been explored previously, but only a few systems have exceeded 30-50 devices and very few have included sound capability, and therefore the sound design possibilities for large systems of distributed audio devices are not yet well understood. In this article we describe the hardware and software implementation of sound synthesis for this system, and the implications for design of media for this context

Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE) guidelines being met?

<p>Abstract</p> <p>Background</p> <p>Most patients contact their general practitioner (GP) following presentation to an Emergency Department (ED) after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE) guidelines on the short-term management of people who self-harm.</p> <p>Methods</p> <p>An audit of medical records (ED and Psychiatric) on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital.</p> <p>Results</p> <p>We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist.</p> <p>Conclusion</p> <p>Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS) trusts would establish if this is a problem elsewhere.</p

Reduction in young male suicide in Scotland

<p>Abstract</p> <p>Background</p> <p>Rates of suicide and undetermined death increased rapidly in Scotland in the 1980's and 1990's. The largest increases were in men, with a marked increase in rates in younger age groups. This was associated with an increase in hanging as a method of suicide. National suicide prevention work has identified young men as a priority group. Routinely collected national information suggested a decrease in suicide rates in younger men at the beginning of the 21^stcentury. This study tested whether this was a significant change in trend, and whether it was associated with any change in hanging rates in young men.</p> <p>Methods</p> <p>Joinpoint regression was used to estimate annual percentage changes in age-specific rates of suicide and undetermined intent death, and to identify times when the trends changed significantly. Rates of deaths by method in 15 – 29 year old males and females were also examined to assess whether there had been any significant changes in method use in this age group.</p> <p>Results</p> <p>There was a 42% reduction in rates in 15 – 29 year old men, from 42.5/100,000 in 2000 to 24.5/100,000 in 2004. A joinpoint analysis confirmed that this was a significant change. There was also a significant change in trend in hanging in men in this age group, with a reduction in rates after 2000. No other male age group showed a significant change in trend over the period 1980 – 2004. There was a smaller reduction in suicide rates in women in the 15 – 29 year old age group, with a reduction in hanging from 2002.</p> <p>Conclusion</p> <p>There has been a reduction in suicide rates in men aged 15 – 29 years, and this is associated with a significant reduction in deaths by hanging in this age group. It is not clear whether this is related to a change in method preference, or an overall reduction in suicidal behaviour, and review of self-harm data will be required to investigate this further.</p

Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE) guidelines being met?

<p>Abstract</p> <p>Background</p> <p>Most patients contact their general practitioner (GP) following presentation to an Emergency Department (ED) after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE) guidelines on the short-term management of people who self-harm.</p> <p>Methods</p> <p>An audit of medical records (ED and Psychiatric) on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital.</p> <p>Results</p> <p>We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist.</p> <p>Conclusion</p> <p>Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS) trusts would establish if this is a problem elsewhere.</p

Can We Really Prevent Suicide?

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essentia

Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross-sectional study.

BACKGROUND: The unfair treatment of individuals with severe mental illness has been linked to poorer physical and mental health outcomes. Additionally, anticipation of discrimination may lead some individuals to avoid participation in particular life areas, leading to greater isolation and social marginalisation. This study aimed to establish the levels and clinical and socio-demographic associations of anticipated and experienced discrimination amongst those diagnosed with a schizophrenia and comparator severe mental illnesses (bipolar and major depressive disorders). METHODS: This study was a cross-sectional analysis of anticipated and experienced discrimination from 202 individuals in South London (47% with schizophrenia, 32% with depression and 20% with bipolar disorder). RESULTS: 93% of the sample anticipated discrimination and 87% of participants had experienced discrimination in at least one area of life in the previous year. There was a significant association between the anticipation and the experience of discrimination. Higher levels of experienced discrimination were reported by those of a mixed ethnicity, and those with higher levels of education. Women anticipated more discrimination than men. Neither diagnosis nor levels of functioning were associated with the extent of discrimination. Clinical symptoms of anxiety, depression and suspiciousness were associated with more experienced and anticipated discrimination respectively. CONCLUSIONS: The unfair treatment of individuals with severe mental illnesses remains unacceptably common. Population level interventions are needed to reduce levels of discrimination and to safeguard individuals. Interventions are also required to assist those with severe mental illness to reduce internalised stigma and social avoidance

Metabolic markers in relation to hypoxia; staining patterns and colocalization of pimonidazole, HIF-1α, CAIX, LDH-5, GLUT-1, MCT1 and MCT4

Contains fulltext : 96097.pdf (postprint version ) (Open Access)BACKGROUND: The cellular response of malignant tumors to hypoxia is diverse. Several important endogenous metabolic markers are upregulated under hypoxic conditions. We examined the staining patterns and co-expression of HIF-1alpha, CAIX, LDH-5, GLUT-1, MCT1 and MCT4 with the exogenous hypoxic cell marker pimonidazole and the association of marker expression with clinicopathological characteristics. METHODS: 20 biopsies of advanced head and neck carcinomas were immunohistochemically stained and analyzed. All patients were given the hypoxia marker pimonidazole intravenously 2 h prior to biopsy taking. The tumor area positive for each marker, the colocalization of the different markers and the distribution of the markers in relation to the blood vessels were assessed by semiautomatic quantitative analysis. RESULTS: MCT1 staining was present in hypoxic (pimonidazole stained) as well as non-hypoxic areas in almost equal amounts. MCT1 expression showed a significant overall correlation (r = 0.75, p < 0.001) and strong spatial relationship with CAIX. LDH-5 showed the strongest correlation with pimonidazole (r = 0.66, p = 0.002). MCT4 and GLUT-1 demonstrated a typical diffusion-limited hypoxic pattern and showed a high degree of colocalization. Both MCT4 and CAIX showed a higher expression in the primary tumor in node positive patients (p = 0.09 both). CONCLUSIONS: Colocalization and staining patterns of metabolic and hypoxia-related proteins provides valuable additional information over single protein analyses and can improve the understanding of their functions and environmental influences