Ambiguity Uncertainty and Risk: Reframing the task of suicide risk assessment and prevention in acute in-patient mental health

The work of the National Confidential Inquiry into Suicide by People with Mental Illness has served to draw attention to the issue of suicide amongst users of mental health services including inpatient and provided the basis for a series of recommendations aimed at improving practice (Appleby et al., 2001, NIMHE 2003). Such recommendations include further training on risk assessment for practitioners. However, representing the problem of suicide as one which can be 'managed' by risk assessment particularly quantitative actuarial approaches implicitly misrepresents the phenomena of suicidality as something which can predicted and therefore managed may be inherently unpredictable at the level of the individual over the short term. We need instead to acknowledge that our work with service users who may be contemplating suicide embraces and acknowledges both uncertainty and ambiguity and seeks to assess risk phenomenologically at the level of the individual such that by understanding their reasons for living and dying we can work in partnership with them to find hope

Ablation debris control by means of closed thick film filtered water immersion

The performance of laser ablation generated debris control by means of open immersion techniques have been shown to be limited by flow surface ripple effects on the beam and the action of ablation plume pressure loss by splashing of the immersion fluid. To eradicate these issues a closed technique has been developed which ensured a controlled geometry for both the optical interfaces of the flowing liquid film. This had the action of preventing splashing, ensuring repeatable machining conditions and allowed for control of liquid flow velocity. To investigate the performance benefits of this closed immersion technique bisphenol A polycarbonate samples have been machined using filtered water at a number of flow velocities. The results demonstrate the efficacy of the closed immersion technique: a 93% decrease in debris is produced when machining under closed filtered water immersion; the average debris particle size becomes larger, with an equal proportion of small and medium sized debris being produced when laser machining under closed flowing filtered water immersion; large debris is shown to be displaced further by a given flow velocity than smaller debris, showing that the action of flow turbulence in the duct has more impact on smaller debris. Low flow velocities were found to be less effective at controlling the positional trend of deposition of laser ablation generated debris than high flow velocities; but, use of excessive flow velocities resulted in turbulence motivated deposition. This work is of interest to the laser micromachining community and may aide in the manufacture of 2.5D laser etched patterns covering large area wafers and could be applied to a range of wavelengths and laser types

Improvement in immune parameters and human immunodeficiency virus-1 viral response in individuals treated with 16α-bromoepiandrosterone (HE2000)

ABSTRACTA randomised, double-blind, placebo-controlled study examined the safety, tolerance, immunological effect and anti-human immunodeficiency virus (HIV) activity of sub-cutaneously administered HE2000 (16α-bromoepiandrosterone) as monotherapy in treatment-naïve patients with HIV-1. Twenty-four patients received five sequential daily doses of 50 or 100 mg of HE2000 or placebo every 6 weeks for up to three courses, and were followed thereafter for 3 months. HE2000 was safe, with transient injection site reactions being the main side-effect. Peripheral blood samples, collected serially, were analysed for changes in immune cell phenotypes. Significant increases were observed in the numbers of circulating dendritic cells, early activated (CD69+CD25–) CD8 T-cells and T-NK cells after administration of 50-mg doses of HE2000 (p <0.05). Gene expression in peripheral blood mononuclear cells was analysed by real-time RT-PCR. Before treatment, HIV-1-infected patients had significantly elevated transcripts for a number of inflammatory mediators (p <0.012). After 50 mg or 100 mg HE2000, but not after placebo, there were significant sustained decreases in IL-1β, TNF-α, IL-6 and Cox-2 transcripts (p <0.05). There were no significant differences in CD4 cell numbers, although patients receiving 50-mg doses demonstrated a significant decrease in viral load (– 0.6 log; p <0.01). Anti-HIV-1 T-cell responses were analysed serially using GAG-peptides to stimulate cytoplasmic IFN-γ responses. After three courses, the 50-mg dose group demonstrated a significant increase in CD8 T-cell response against two distinct GAG peptide pools (p <0.03). These findings suggest that immune-based therapies may be able to impact viral load by decreasing inflammation and/or stimulating CD8 T-cells

Underperforming policy networks : the biopesticides network in the United Kingdom

Loosely integrated and incomplete policy networks have been neglected in the literature. They are important to consider in terms of understanding network underperformance. The effective delivery and formulation of policy requires networks that are not incomplete or underperforming. The biopesticides policy network in the United Kingdom is considered and its components identified with an emphasis on the lack of integration of retailers and environmental groups. The nature of the network constrains the actions of its agents and frustrates the achievement of policy goals. A study of this relatively immature policy network also allows for a focus on network formation. The state, via an external central government department, has been a key factor in the development of the network. Therefore, it is important to incorporate such factors more systematically into understandings of network formation. Feedback efforts from policy have increased interactions between productionist actors but the sphere of consumption remains insufficiently articulated

Analyzing the properties promoting shear bands and damage initiation in 3-point bending of ultra-high strength steel

Ultra-high strength steels (UHSS) have been developed to reduce the weight and increase strength capability of high value products such as crane structures. The bendability of UHSS steels has limited its application in production as their yield strength has increased, the bendability has been found to reduce with the reduction of tensile ductility. In this paper, the material properties affecting bendability in UHSS have been investigated and factors have been identified by analysing specimens pre and post bend testing [1-3] using a combined approach of in- and ex-situ small mechanical testing, Digital Image Correlation (DIC), modelling and characterisation. The propagation of shear bands in bending has been identified as the mechanism promoting damage in the tensile face to occur in the bending of steels. Identifying these factors combined to promote failure is of great importance while also developing a practical approach to identifying procedures to improve bendability. A small-scale bend test with new tooling and specimen geometry has been conducted inside the chamber of a Camscan SEM to observe the propagation of shear bands and damage initiation at the scale of the microstructure. Micrographs produced during the test were processed using DIC to study shear band formation in relation to strain distributions. Using these techniques shear bands and damage are observed at the tensile surface of the bend test. The strain localises in shear bands in a bifurcating pattern from the tensile surface in bending. Damage initiates at the surface where these shear bands intersect promoting a high strain at the surface. This damage promotes the shear bands to move through the sub-surface promoting further deformation then promoting more damage when the plasticity is exhausted. In this test a large 5µm inclusion is observed to interact with shear bands and seen to affect the damage propagation of the specimen and localise high strains at a region local to it. This region is where the failure originates from. Further analysis of the interaction between subsurface properties and the localisation of strain and shear bands will be studied

Localized damage analysis for high strength S960 steel using micro-tensile testing and digital image correlation

In-situ interrupted tensile tests combined with Digital Image Correlation (DIC) were performed on S960 hot rolled steel to identify damage initiation on the surface of the sample. Shear bands and damage initiation and evolution in the microstructure were observed during the test. It was found that shear bands are generated on the surface as plastic deformation occurs. Void nucleation was found to be initiated where a large plastic deformation gradient is observed

Multimode VIS–NIR transmission through silver coated hollow optical waveguides

Multimode transmission of continuous wave 633 nm radiation and 1064 nm Q-switched Nd:YAG pulses using silver coated hollow core optical waveguides (HCWs) with bore diameters of 700 μm and 1000 μm is reported. The effect of launch conditions, input beam polarization and waveguide bore diameter on the pulse energy transmission and potential for focussing the beam effectively at the HCW exit is detailed. An optimal launch f-number range of 155–165 is identified for minimizing the exit angle

Towards improved decision support in the assessment and management of pain for people with dementia in hospital: a systematic meta-review and observational study

This is the final version. Available from NIHR Journals Library via the DOI in this record.Background Pain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed. Aims and objectives Two studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals. Methods For the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four carers, informal conversations with staff and carers and analysis of ward documents and policies. Thematic analysis of the data was undertaken by the project team. Results Data from eight systematic reviews including 28 tools were included in the meta-review. Most tools showed moderate to good reliability, but information about validity, feasibility and clinical utility was scarce. The observational study showed complex ward cultures and routines, with variations in time spent with patients, communication patterns and management practices. Carer involvement was rare. No pain decision support tools were observed in practice. Information about pain was elicited in different ways, at different times, by different health-care staff and recorded in separate documents. Individual staff made sense of patients’ pain by creating their own ‘overall picture’ from available information. Limitations Grey literature and non-English-language papers were excluded from the meta-review. Sample sizes in the observational study were smaller than planned owing to poor documentation of patients’ dementia diagnoses, gatekeeping by staff and difficulties in gaining consent/assent. Many patients had no or geographically distant carers, or a spouse who was too unwell and/or reluctant to participate. Conclusions No single observational pain scale was clearly superior to any other. The traditional linear concept of pain being assessed, treated and reassessed by single individuals did not ‘fit’ with clinical reality. A new approach enabling effective communication among patients, carers and staff, centralised recording of pain-related information, and an extended range of pain management interventions is proposed [Pain And Dementia Decision Support (PADDS)]. This was not tested with users, but a follow-on study aims to codesign PADDS with carers and clinicians, then introduce education on staff/patient/carer communications and use of PADDS within a structured implementation plan. PADDS will need to be tested in differing ward contexts.National Institute for Health Research Health Services and Delivery Research programm

Security governance and networks: New theoretical perspectives in transatlantic security

The end of the Cold War has not only witnessed the rise of new transnational threats such as terrorism, crime, proliferation and civil war; it has also seen the growing role of non-state actors in the provision of security in Europe and North America. Two concepts in particular have been used to describe these transformations: security governance and networks. However, the differences and potential theoretical utility of these two concepts for the study of contemporary security have so far been under-examined. This article seeks to address this gap. It proposes that security governance can help to explain the transformation of Cold War security structures, whereas network analysis is particularly useful for understanding the relations and interactions between public and private actors in the making and implementation of national and international security policies