Self-harm in a primary care cohort of older people: incidence, clinical management, and risk of suicide and other causes of death

BACKGROUND: Self-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide. METHODS: The UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001-14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks. FINDINGS: Overall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03-2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17-1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9-392·3]) was observed in the self-harm cohort. INTERPRETATION: Within primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions. FUNDING: National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre

Teaching with Digital 3D Models of Minerals and Rocks

The disruption to geoscience curricula due to the COVID-19 pandemic highlights the difficulty of making mineral and rock samples accessible to students online rather than through traditional lab classes. In spring 2020, our community had to adapt rapidly to remote instruction; this transition amplified existing disparities in access to geoscience education but can be a catalyst to increase accessibility and flexibility in instruction permanently. Fortunately, a rich collection of 3D mineral and rock samples is being generated by a community of digital modelers (e.g., Perkins et al., 2019)

The influence of defined ante-mortem stressors on the early post-mortem biochemical processes in the abdominal muscle of the Norway lobster, Nephrops norvegicus (Linnaeus, 1758)

The effects of four different ante-mortem stressors (exercise, emersion, starvation and a patent infection with the parasite Hematodinium sp.) on post-mortem processes have been investigated in the abdominal muscle of Norway lobster Nephrops norvegicus by measuring changes in the pH, the levels of glycogen, l-lactate, arginine phosphate, ATP, ADP, AMP, IMP, HxR, Hx and the adenylate energy charge (AEC) over a time course of 24 h with samples being taken at 0, 3, 6, 12 and 24 h. The acute stresses of intense exercise and 2 h emersion resulted in a premature onset of anaerobic glycolysis, leading both to an enhanced glycogen depletion rate and an early accumulation of l-lactate. The chronic stressors, starvation and parasite infection, resulted in a complete ante-mortem depletion of muscle glycogen and consequently the failure of post-mortem glycolytic fermentation. Post-mortem pH and ATP inter-conversion were significantly altered in chronically stressed animals. Ante-mortem, a rapid, almost complete depletion of arginine phosphate was observed in all stress groups. The AEC was altered significantly by all stresses, indicating a strong energy demand. The findings suggest that ante-mortem stressors strongly influence the post-mortem biochemical processes. The laboratory-based results are compared to 'field' data and effects on post-harvest product quality are discussed

The Galaxy Structure-Redshift Relationship

There exists a gradual, but persistent, evolutionary effect in the galaxy population such that galaxy structure and morphology change with redshift. This galaxy structure-redshift relationship is such that an increasingly large fraction of all bright and massive galaxies at redshifts 2 < z < 3 are morphologically peculiar at wavelengths from rest-frame ultraviolet to rest-frame optical. There are however examples of morphologically selected spirals and ellipticals at all redshifts up to z ~ 3. At lower redshift, the bright galaxy population smoothly transforms into normal ellipticals and spirals. The rate of this transformation strongly depends on redshift, with the swiftest evolution occurring between 1 < z < 2. This review characterizes the galaxy structure-redshift relationship, discusses its various physical causes, and how these are revealing the mechanisms responsible for galaxy formation.Comment: 20 pages, 8 figures. Invited Review to appear in "Penetrating Bars Through Masks of Cosmic Dust: The Hubble Tuning Fork Strikes A New Note", ed. D. Block et a

The Fold Illusion: The Origins and Implications of Ogives on Silicic Lavas

Folds on the surfaces of mafic lavas are among the most readily recognized geological structures and are used as first-order criteria for identifying ancient lavas on Earth and other planetary bodies. However, the presence of surface-folds on the surface of silicic lavas is contested in this study and we challenge the widely accepted interpretation that silicic lava surfaces contain folds using examples from the western United States and Sardinia, Italy. We interpret the ridges and troughs on their upper surfaces, typically referred to as ‘ogives’ or ‘pressure ridges’, as fracture-bound structures rather than folds. We report on the absence of large-scale, buckle-style folds and note instead the ubiquitous presence of multiple generations and scales of tensile fractures comparable to crevasses in glaciers and formed in ways similar to already recognized crease structures. We report viscosity data and results of stress analyses that preclude folding (ductile deformation in compression) of the upper surface of silicic lavas at timescales of emplacement (weeks to months). Therefore, analysis of fold geometry (wavelength, amplitude, etc.) is erroneous, and instead the signal produced reflects the strength and thickness of the brittle upper surface stretching over a ductile interior. The presence of ogives on the surfaces of lavas on other planetary bodies may help to elucidate their rheological properties and crustal thicknesses, but relating to their tensile strength, not viscosity

Who Are the Scrooges? Personality Predictors of Holiday Spending

The sharp increase in consumption over the holiday season has important economic implications, yet the psychology underlying this phenomenon has received limited attention. Here, we evaluate the role of individual differences in holiday spending patterns. Using 2 million transactions across 2,133 individuals, we investigate the relationship between the Big 5 personality traits on spending at Christmas. Zero-order correlations suggest holiday spending is associated with conscientiousness, neuroticism and extraversion; the relationship with neuroticism persists after accounting for possible confounders, including income and demographics. These results improve our understanding of how different personality traits predict how people respond to the environmental demands of the holiday season and have broader implications for how personality relates to consumer behavior

Who Are the Scrooges? Personality Predictors of Holiday Spending

The sharp increase in consumption over the holiday season has important economic implications, yet the psychology underlying this phenomenon has received limited attention. Here, we evaluate the role of individual differences in holiday spending patterns. Using 2 million transactions across 2,133 individuals, we investigate the relationship between the Big 5 personality traits on spending at Christmas. Zero-order correlations suggest holiday spending is associated with conscientiousness, neuroticism and extraversion; the relationship with neuroticism persists after accounting for possible confounders, including income and demographics. These results improve our understanding of how different personality traits predict how people respond to the environmental demands of the holiday season and have broader implications for how personality relates to consumer behavior

Knowledge brokering: Exploring the process of transferring knowledge into action

There are many theories about knowledge transfer but there are few clear descriptions of knowledge transfer interventions or the processes they involve. This failure to characterise structure and process in proposed KT interventions is a major barrier to the design and implementation of evaluations of particular KT strategies. This study is designed to provide a detailed description of the processes involved in a knowledge transfer intervention and to develop and refine a useful model of the knowledge transfer process

Extremely high He isotope ratios in MORB-source mantle from the proto-Iceland plume

The high &lt;sup&gt;3&lt;/sup&gt;He/&lt;sup&gt;4&lt;/sup&gt;He ratio of volcanic rocks thought to be derived from mantle plumes is taken as evidence for the existence of a mantle reservoir that has remained largely undegassed since the Earth's accretion. The helium isotope composition of this reservoir places constraints on the origin of volatiles within the Earth and on the evolution and structure of the Earth's mantle. Here we show that olivine phenocrysts in picritic basalts presumably derived from the proto-Iceland plume at Baffin Island, Canada, have the highest magmatic &lt;sup&gt;3&lt;/sup&gt;He/&lt;sup&gt;4&lt;/sup&gt;He ratios yet recorded. A strong correlation between &lt;sup&gt;3&lt;/sup&gt;He/&lt;sup&gt;4&lt;/sup&gt;He and &lt;sup&gt;87&lt;/sup&gt;Sr/&lt;sup&gt;86&lt;/sup&gt;Sr, &lt;sup&gt;143&lt;/sup&gt;Nd/&lt;sup&gt;144&lt;/sup&gt;Nd and trace element ratios demonstrate that the &lt;sup&gt;3&lt;/sup&gt;He-rich end-member is present in basalts that are derived from large-volume melts of depleted upper-mantle rocks. This reservoir is consistent with the recharging of depleted upper-mantle rocks by small volumes of primordial volatile-rich lower-mantle material at a thermal boundary layer between convectively isolated reservoirs. The highest &lt;sup&gt;3&lt;/sup&gt;He/&lt;sup&gt;4&lt;/sup&gt;He basalts from Hawaii and Iceland plot on the observed mixing trend. This indicates that a &lt;sup&gt;3&lt;/sup&gt;He-recharged depleted mantle (HRDM) reservoir may be the principal source of high &lt;sup&gt;3&lt;/sup&gt;He/&lt;sup&gt;4&lt;/sup&gt;He in mantle plumes, and may explain why the helium concentration of the 'plume' component in ocean island basalts is lower than that predicted for a two-layer, steady-state model of mantle structure