A conceptual model of suicide in rural areas

Context: Suicide is an important public health issue among rural communities although there is no single pattern of suicide in rural areas. Despite this, there are common themes in much of the research evidence on suicide in rural areas. From the published research in the area, a conceptual model of rural suicide has been developed which can be used by clinical and public health services when considering possible routes of intervention.Issue: A conceptual model can be defined as 'a type of diagram which shows a set of relationships between factors that are believed to impact or lead to a target condition'. The model presented here uses the 'Cry of pain/ Entrapment' model of suicide risk to build a framework of factors which are associated with suicide in rural areas. Cross-setting factors associated with suicide rates include gender, poverty, mental illness, substance use, biological factors including apparent genetic risk, coping skills and media coverage of suicide. There are, however, other factors that appear to have particular importance in rural areas. These include rural stressors, such as isolation and political and social exclusion; factors affecting support, including social support, cultural norms on help-seeking, stigma associated with mental illness service availability; factors affecting the decision to self-harm, including modelling and cultural views on self-harm, and issues affecting the likelihood of self-harm resulting in death, including method availability, norms on methods of self-harm and treatment availability after harm occurs. Identifying which of these areas are the greatest local priorities helps to target activity.Lessons learned: This model provides a way of considering suicide in rural areas. Local staff can use it to consider which issues are most relevant to their area. It allows classification of existing interventions, and deciding which other areas of work might be of local value. For researchers and service planners, it provides a way of classifying interventions and describing projects

Motivation, Justification, Normalization: Talk Strategies Used by Canadian Medical Tourists Regarding Their Choices to Go Abroad for Hip and Knee Surgeries

Contributing to health geography scholarship on the topic, the objective of this paper is to reveal Canadian medical tourists’ perspectives regarding their choices to seek knee replacement or hip replacement or resurfacing (KRHRR) at medical tourism facilities abroad rather than domestically. We address this objective by examining the ‘talk strategies’ used by these patients in discussing their choices and the ways in which such talk is co-constructed by others. Fourteen interviews were conducted with Canadians aged 42-77 who had gone abroad for KRHRR. Three types of talk strategies emerged through thematic analysis of their narratives: motivation, justification, and normalization talk. Motivation talk referenced participants’ desires to maintain or resume physical activity, employment, and participation in daily life. Justification talk emerged when participants described how limitations in the domestic system drove them abroad. Finally, being a medical tourist was talked about as being normal on several bases. Among other findings, the use of these three talk strategies in patients’ narratives surrounding medical tourism for KRHRR offers new insight into the language-health-place interconnection. Specifically, they reveal the complex ways in which medical tourists use talk strategies to assert the soundness of their choice to shift the site of their own medical care on a global scale while also anticipating, if not even guarding against, criticism of what ultimately is their own patient mobility. These talk strategies provide valuable insight into why international patients are opting to engage in the spatially explicit practice of medical tourism and who and what are informing their choices

Tackling wicked problems in the Malaysian water industry: A framework for university-industry research partnerships

Despite the relative abundance of rainfall and plentiful surface water resources, recent reports suggest that Malaysia is faced with the prospect of water scarcity.The predicted scarcity is less related to changes in rainfall patterns but in the diminishing availability of water resources and treatment capacity for urban populations, both of which are linked to the inadequacy of the current water management regime.Further to this, growing concerns over dilapidated infrastructure, urban water pollution, institutional weaknesses, and political interference to the implementation of recent water reforms have sought to characterize Malaysia’s modern day water industry.One way of addressing the current un sustainability of the water industry is for greater collaboration and partnership between the industry’s key players, including developing robust and relevant university-industry collaborative partnerships. To date, there is no evidence of a strategy to coordinate and integrate broad interests of industry and university stakeholders; instead, research tends to be done in an ad hoc manner, focused on specific technical issues without addressing some of the more fundamental and complex industry challenges.With this in mind, this paper aims to present the findings of a recent research project aimed at developing an interdisciplinary research framework for university-industry collaboration in the Malaysian water industry

Metagenomics, gene discovery and the ideal biocatalyst

With the rapid development of powerful protein evolution and enzyme-screening technologies, there is a growing belief that optimum conditions for biotransformation processes can be established without the constraints of the properties of the biocatalyst. These technologies can then be applied to find the ‘ideal biocatalyst’ for the process. In identifying the ideal biocatalyst, the processes of gene discovery and enzyme evolution play major roles. However, in order to expand the pool genes for in vitro evolution, new technologies, which circumvent the limitations of microbial culturability, must be applied. These technologies, which currently include metagenomic library screening, gene-specific amplification methods and even full metagenomic sequencing, provide access to a volume of ‘sequence space’ that is not addressed by traditional screening

The Peterborough Exemplar: a protocol to evaluate the impact and implementation of a new patient-centred, system-wide community mental healthcare model in England.

BACKGROUND: Community mental healthcare has significantly grown since de-institutionalization. Despite progress, service fragmentation and gaps in service provision remain key barriers to effective community care in England. Recent mental healthcare policies highlighted the need to transform service provision by developing patient-centred, joined-up community mental healthcare. In response to policy guidance, a system-wide community mental healthcare model was developed in Peterborough (England). The "Peterborough Exemplar" is based on two main pillars: (1) the creation of knowledge exchange pathways to strengthen interorganizational relationships, and (2) the development of new, accessible community services addressing existing service gaps. This paper presents the protocol developed to evaluate the Peterborough Exemplar. METHODS: A quasi-experimental design with an intervention group and a nonequivalent comparator group has been developed to compare service provision provided in Peterborough pre- and post-intervention with services provided in Fenland, a neighbouring area where service users access usual care. Two evaluation methods will be employed to compare service provision between the two groups: (1) outcome measures completed by service users and carers will be analysed to assess quality of life and service satisfaction, and (2) service activity data will be analysed to assess service usage. In addition, qualitative interviews will be conducted with staff members of participating organizations to explore the implementation of the Exemplar in Peterborough and evaluate knowledge exchange processes among local service providers. A matched control approach will be used to compare outcome measures between the two areas. Descriptive and inferential statistics, including chi-square tests, will be used to analyse service activity data and examine differences between the two areas. A thematic analysis will be adopted to analyse qualitative data. DISCUSSION: Outcomes of the evaluation will contribute to understanding the contribution of the Peterborough Exemplar on mental health service provision locally. Evaluation findings and intermediate reporting will be shared with organizations involved in the implementation of the Peterborough Exemplar and with local decision-makers to inform the Exemplar delivery. As the Peterborough Exemplar is an Early Implementer (EI) site funded by NHS England, findings will be shared with policy-makers to inform national policy on community mental healthcare and integrated care

Correcting errors from spatial upscaling of nonlinear greenhouse gas flux models

Ecological models are used to quantify processes over large regions. When the model is nonlinear and input variables are spatially averaged, the regional mean will be in error. A formula for estimating the upscaling error can be derived from Taylor expansion of the model (Bresler and Dagan 1988). We test this for simple models under three different input distributions (Gaussian, exponential, lognormal). In several cases the formula is exact, in others it provides a reasonable approximation. We then study models for emissions of methane, ammonia, and nitrous oxide across the UK. We scale from 1 × 1 km to 32 × 32 km. The UK-average upscaling errors are −12%, −48% and −3%, well estimated using the formula. The formula is a useful tool for modellers desiring to correct upscaling error for their application. Calculation of second-order partial derivatives of model output is required, for which we provide R-code

What outcomes matter to service users who experience persistent depression: A mixed-method narrative review and synthesis

Background: It is unclear whether current outcome measures capture what is important to service users experiencing treatment-resistant depression (TRD). This review aims to understand what outcomes are important to people receiving treatment for TRD, and to ascertain how this is being measured or could be measured to aid values-based commissioning in the implementation of specialist services. Methods: A systematic search was conducted across nine databases: EMBASE, PSychINFO, AMED, EMCARE, PubMed, BNI, HMIC, CINHAL, and Medline. Quantitative and qualitative studies, and non-empirical work were included. No publication date restrictions were set. Included studies were appraised for quality. Results: Twenty-two studies met inclusion for the review, including two opinion pieces. Thematic analysis was used to extract five themes: important outcomes beyond recovery from symptoms; differentiations in perspectives; patient preferences; essential sets of outcome measures; and underdeveloped outcome measures from the patient's perspective. Limitations: The search strategy was partially systematic due to the exploratory nature of the subject and the lack of available research in the field. Studies included collect data on patient perspectives but did not demonstrate co-production throughout the whole research process. Conclusions: Outcomes in persistent depression have been neglected, especially from the patient perspective. The findings from this review make an important contribution to agreeing desirable outcomes for people with TRD by drawing together the literature and highlighting how and why it is necessary to apply certain methods to persistent depression. The report identifies areas where further understanding and research is needed and how to inform current service commissioning practices

Relief of neuropathic pain through epidermal growth factor receptor inhibition: a randomized proof-of concept trial

Objective. Case reports and a case series have described relief of neuropathic pain (NP) after treatment with epidermal growth factor receptor inhibitors (EGFR-Is). These observations are supported by preclinical findings. The aim of this trial was to explore a potential clinical signal supporting the therapeutic efficacy of EGFR-Is in NP. Methods. In a proof-of-concept trial using a randomized, double-blind, placebo-controlled design, 14 patients with severe, chronic, therapy-resistant NP due to compressed peripheral nerves or complex regional pain syndrome were randomized to receive a single infusion of the EGFR-I cetuximab and placebo in crossover design, followed by a single open-label cetuximab infusion. Results. The mean reduction in daily average pain scores three to seven days after single-blinded cetuximab infusion was 1.73 points (90% confidence interval [CI] = 0.80 to 2.66), conferring a 1.22-point greater reduction than placebo (90% CI = -0.10 to 2.54). Exploratory analyses suggested that pain reduction might be greater in the 14 days after treatment with blinded cetuximab than after placebo. The proportion of patients who reported &gt;= 50% reduction in average pain three to seven days after cetuximab was 36% (14% after placebo), and comparison of overall pain reduction suggests a trend in favor of cetuximab. Skin rash (grade 1-2) was the most frequent side effect (12/14, 86%). Conclusions. This small proof-of-concept evaluation of an EGFR-I against NP did not provide statistical evidence of efficacy. However, substantial reductions in pain were reported, and confidence intervals do not rule out a clinically meaningful treatment effect. Evaluation of EGFR-I against NP therefore warrants further investigation.</p

A hepatitis C avidity test for determining recent and past infections in both plasma and dried blood spots

DBS testing has been used successfully to detect HCV antibody positive individuals. Determining how long someone has been infected is important for surveillance initiatives. Antibody avidity is a method that can be used to calculate recency of infection. A HCV avidity assay was evaluated for both plasma and DBS. Study design: To measure antibody avidity a commercial HCV ELISA was modified using 7 M urea. The plasma samples were split into: group 1 (recently infected N = 19), group 2 (chronic carrier N = 300) and group 3 (resolved infection N = 82). Mock DBS made from group 1 (N = 12), group 2 (N = 50), group 3 (N = 25) and two seroconverter panels were evaluated. 133 DBS taken from patients known to have a resolved infection or be a chronic carrier were also tested. The avidity assay cut-off was set at AI ≤ 30 for a recent infection. Using sequential samples the assay could detect a recent infection in the first 4–5 months from the point of infection. Most of the false positive results (AI < 30 among cases known not to have had recent infection) were detected among known resolved infections, in both the plasma and DBS; as a result, a testing algorithm has been designed incorporating both PCR and two dilution factors. The sensitivity and specificity of the assay on plasma was 100% and 99.3%, respectively, while DBS had 100% sensitivity and 98.3% specificity. The HCV avidity assay can be used to distinguish between chronic and recent infection using either plasma or DBS as the sample type

Understanding uptake of digital health products: Methodology tutorial for a discrete choice experiment using the Bayesian efficient design

Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals’ preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method—a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique