Do GPs want or need formal support following a patient suicide?: a mixed methods study.

BACKGROUND: Patient suicide can be a devastating event for some general practitioners (GPs). Few guidelines exist to aid or support GPs in the aftermath of patient suicide. AIM: To explore GPs views on how they are affected by a patient suicide and the formal support available to them following a patient suicide. DESIGN: Questionnaires and semi-structured interviews. SETTING: General practices in the northwest of England. METHODS: About 198 semi-structured interviews were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using descriptive statistics and a framework thematic approach. RESULTS: GPs were aged between 31 and 67 years, 144 (73%) were male and the number of years in practice varied between 8 and 40 years (median = 24 years). GPs were based at 133 (67%) urban and 65 (33%) rural practices, 30 (15%) were single-handed GP practices and 168 (85%) practices had two or more GPs. About 131 (66%) GPs reported being affected by patient suicide through feelings of grief, guilt and self-scrutiny. A greater number of years in practice may have been protective against these effects. About 54 (27%) GPs reported having mostly 'informal' support from peers or colleagues and support was less available to younger and single handed GPs. CONCLUSIONS: Our findings suggest that the majority of GPs are affected by patient suicide and most seek informal support from their peers and colleagues. Although many indicated that informal support systems were adequate and provided a protective environment, procedures should be developed to ensure the availability of guidelines for those who may require formal support

Generative adversarial networks: an overview

Generative adversarial networks (GANs) provide a way to learn deep representations without extensively annotated training data. They achieve this by deriving backpropagation signals through a competitive process involving a pair of networks. The representations that can be learned by GANs may be used in a variety of applications, including image synthesis, semantic image editing, style transfer, image superresolution, and classification. The aim of this review article is to provide an overview of GANs for the signal processing community, drawing on familiar analogies and concepts where possible. In addition to identifying different methods for training and constructing GANs, we also point to remaining challenges in their theory and application

Does clinical management improve outcomes following self-Harm? Results from the multicentre study of self-harm in England

Background Evidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice. Aims To examine how the management that patients receive in hospital relates to subsequent outcome. Methods We identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford) over a 10 year period (2000 to 2009). We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up) and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics. Results 35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs): Centre A 0.99 (0.90–1.09); Centre B 0.59 (0.48–0.74); Centre C 0.59 (0.52–0.68). There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas. Conclusion These findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups

Brauer-Thrall for totally reflexive modules over local rings of higher dimension

Let $R$ be a commutative Noetherian local ring. Assume that $R$ has a pair $\{x,y\}$ of exact zerodivisors such that $\dim R/(x,y)\ge2$ and all totally reflexive $R/(x)$-modules are free. We show that the first and second Brauer--Thrall type theorems hold for the category of totally reflexive $R$-modules. More precisely, we prove that, for infinitely many integers $n$, there exists an indecomposable totally reflexive $R$-module of multiplicity $n$. Moreover, if the residue field of $R$ is infinite, we prove that there exist infinitely many isomorphism classes of indecomposable totally reflexive $R$-modules of multiplicity $n$.Comment: to appear in Algebras and Representation Theor

Improving Many-Objective Evolutionary Algorithms by Means of Edge-Rotated Cones

Given a point in $m$-dimensional objective space, any $\varepsilon$-ball of a point can be partitioned into the incomparable, the dominated and dominating region. The ratio between the size of the incomparable region, and the dominated (and dominating) region decreases proportionally to $1/2^{m-1}$, i.e., the volume of the Pareto dominating orthant as compared to all other volumes. Due to this reason, it gets increasingly unlikely that dominating points can be found by random, isotropic mutations. As a remedy to stagnation of search in many objective optimization, in this paper, we suggest to enhance the Pareto dominance order by involving an obtuse convex dominance cone in the convergence phase of an evolutionary optimization algorithm. We propose edge-rotated cones as generalizations of Pareto dominance cones for which the opening angle can be controlled by a single parameter only. The approach is integrated in several state-of-the-art multi-objective evolutionary algorithms (MOEAs) and tested on benchmark problems with four, five, six and eight objectives. Computational experiments demonstrate the ability of these edge-rotated cones to improve the performance of MOEAs on many-objective optimization problems

Finding the niche: A review of market assessment methodologies for rural electrification with small scale wind power

The mass roll out of solar PV across the Global South has enabled electricity access for millions of people. In the right context, Small Wind Turbines (SWTs) can be complementary, offering the potential to generate at times of low solar resource (night, monsoon season, winter, etc.) and increasing the proportion of the total energy system that can be manufactured locally. However, many contextual factors critically affect the viability of the technology, such as the extreme variability in the wind resource itself and the local availability of technical support. Therefore, performing a detailed market analysis in each new context is much more important. The Wind Empowerment Market Assessment Methodology (WEMAM) is a multi-scalar, transdisciplinary methodology for identifying the niche contexts where small wind can make a valuable contribution to rural electrification. This paper aims to inform the development of WEMAM with a critical review of existing market assessment methodologies. By breaking down WEMAM into its component parts, reflecting upon its practical applications to date and drawing upon insights from the literature, opportunities where it could continue to evolve are highlighted. Key opportunities include shifting the focus towards development outcomes; creating community archetypes; localised studies in high potential regions; scenario modelling and MCDA ranking of proposed interventions; participatory market mapping; and applying socio-technical transitions theory to understand how the small wind niche can break through into the mainstream

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.

BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence

Integrating personality research and animal contest theory: aggressiveness in the green swordtail <i>Xiphophorus helleri</i>

&lt;p&gt;Aggression occurs when individuals compete over limiting resources. While theoretical studies have long placed a strong emphasis on context-specificity of aggression, there is increasing recognition that consistent behavioural differences exist among individuals, and that aggressiveness may be an important component of individual personality. Though empirical studies tend to focus on one aspect or the other, we suggest there is merit in modelling both within-and among-individual variation in agonistic behaviour simultaneously. Here, we demonstrate how this can be achieved using multivariate linear mixed effect models. Using data from repeated mirror trials and dyadic interactions of male green swordtails, &lt;i&gt;Xiphophorus helleri&lt;/i&gt;, we show repeatable components of (co)variation in a suite of agonistic behaviour that is broadly consistent with a major axis of variation in aggressiveness. We also show that observed focal behaviour is dependent on opponent effects, which can themselves be repeatable but were more generally found to be context specific. In particular, our models show that within-individual variation in agonistic behaviour is explained, at least in part, by the relative size of a live opponent as predicted by contest theory. Finally, we suggest several additional applications of the multivariate models demonstrated here. These include testing the recently queried functional equivalence of alternative experimental approaches, (e. g., mirror trials, dyadic interaction tests) for assaying individual aggressiveness.&lt;/p&gt

Identification of Radiopure Titanium for the LZ Dark Matter Experiment and Future Rare Event Searches

The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a detector containing a total of 10 tonnes of liquid xenon within a double-vessel cryostat. The large mass and proximity of the cryostat to the active detector volume demand the use of material with extremely low intrinsic radioactivity. We report on the radioassay campaign conducted to identify suitable metals, the determination of factors limiting radiopure production, and the selection of titanium for construction of the LZ cryostat and other detector components. This titanium has been measured with activities of $^{238}$U$_{e}$~$<$1.6~mBq/kg, $^{238}$U$_{l}$~$<$0.09~mBq/kg, $^{232}$Th$_{e}$~$=0.28\pm 0.03$~mBq/kg, $^{232}$Th$_{l}$~$=0.25\pm 0.02$~mBq/kg, $^{40}$K~$<$0.54~mBq/kg, and $^{60}$Co~$<$0.02~mBq/kg (68\% CL). Such low intrinsic activities, which are some of the lowest ever reported for titanium, enable its use for future dark matter and other rare event searches. Monte Carlo simulations have been performed to assess the expected background contribution from the LZ cryostat with this radioactivity. In 1,000 days of WIMP search exposure of a 5.6-tonne fiducial mass, the cryostat will contribute only a mean background of $0.160\pm0.001$(stat)$\pm0.030$(sys) counts.Comment: 13 pages, 3 figures, accepted for publication in Astroparticle Physic