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

Flexible copper-indium-diselenide films and devices for space applications

With the ever increasing demands on space power systems, it is imperative that low cost, lightweight, reliable photovoltaics be developed. One avenue of pursuit for future space power applications is the use of low cost, lightweight flexible PV cells and arrays. Most work in this area assumes the use of flexible amorphous silicon (a-Si), despite its inherent instability and low efficiencies. However, polycrystalline thin film PV such as copper-indium-diselenide (CIS) are inherently more stable and exhibit better performance than a-Si. Furthermore, preliminary data indicate that CIS also offers exciting properties with respect to space applications. However, CIS has only heretofore only produced on rigid substrates. The implications of flexible CIS upon present and future space power platforms was explored. Results indicate that space qualified CIS can dramatically reduce the cost of PV, and in most cases, can be substituted for silicon (Si) based on end-of-life (EOL) estimations. Furthermore, where cost is a prime consideration, CIS can become cost effective than gallium arsenide (GaAs) in some applications. Second, investigations into thin film deposition on flexible substrates were made, and data from these tests indicate that fabrication of flexible CIS devices is feasible. Finally, data is also presented on preliminary TCO/CdS/CuInSe2/Mo devices

Gall Bladder And Common Bile Duct Stones – When Is Direct Cholangiography Indicated?

The medical records of 277 consecutive patients who underwent cholecystectomy for benign gall stone disease, were reviewed to determine the incidence and cause of biliary tract obstructuion

Self-harm in midlife: an analysis using data from the Multicentre Study of Self-harm in England

Background: Suicide rates in England are highest in men and women in midlife (defined here as people aged 40-59 years). Despite the link between self-harm and suicide there has been little focus on self-harm in this age-group.Method: Data from the Multicentre Study of Self-harm in England were used to examine rates over time and characteristics of men and women who self-harm in midlife. Data on self-harm presentations 2000-2013 were collected via specialist assessments or hospital records. Trends were assessed using negative binomial regression models. Comparative analysis used logistic regression models for binary outcomes. Repetition of self-harm and suicide mortality were assessed using Cox proportional hazards models.Results: A quarter of self-harm presentations were made by people in midlife (n=24,599, 26%).Incidence rates increased over time in men, especially after 2008 (incidence rate ratio (IRR) 1.07;95%CI 1.02-1.12; p [less than] 0.01) and were positively correlated with national suicide incidence rates (r=0.52, p=0.05). Rates in women remained relatively stable (IRR 1.00; 95%CI 1.00-1.02; p=0.39) and not correlated with suicide. Alcohol use, unemployment, housing and financial factors were more common in men, while indicators of poor mental health were more common in women. Twelvemonth repetition was 25% in men and women, and during follow-up 2.8% of men and 1.2% of women died by suicide.Conclusion: People in midlife who self-harm represent a key target for intervention. Addressing underlying mental health issues, alcohol use, and economic factors—potentially working with organisations offering advice on employment, housing and debt—may help prevent further self harm and suicide

Boltzmann-Shannon Entropy: Generalization and Application

The paper deals with the generalization of both Boltzmann entropy and distribution in the light of most-probable interpretation of statistical equilibrium. The statistical analysis of the generalized entropy and distribution leads to some new interesting results of significant physical importance.Comment: 5 pages, Accepted in Mod.Phys.Lett.

Screening of patients with tuberculosis for diabetes mellitus in China.

Objective  There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and this study aimed to assess feasibility and results of screening patients with TB for DM within the routine healthcare setting of six health facilities. Method  Agreement on how to screen, monitor and record was reached in May 2011 at a stakeholders' meeting, and training was carried out for staff in the six facilities in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. Results  There were 8886 registered patients with TB. They were first asked whether they had DM. If the answer was no, they were screened with a random blood glucose (RBG) followed by fasting blood glucose (FBG) in those with RBG ≥ 6.1 mm (one facility) or with an initial FBG (five facilities). Those with FBG ≥ 7.0 mm were referred to DM clinics for diagnostic confirmation with a second FBG. Altogether, 1090 (12.4%) patients with DM were identified, of whom 863 (9.7%) had a known diagnosis of DM. Of 8023 patients who needed screening for DM, 7947 (99%) were screened. This resulted in a new diagnosis of DM in 227 patients (2.9% of screened patients), and of these, 226 were enrolled to DM care. In addition, 575 (7.8%) persons had impaired fasting glucose (FBG 6.1 to <7.0 mm). Prevalence of DM was significantly higher in patients in health facilities serving urban populations (14.0%) than rural populations (10.6%) and higher in hospital patients (13.5%) than those attending TB clinics (8.5%). Conclusion  This pilot project shows that it is feasible to screen patients with TB for DM in the routine setting, resulting in a high yield of patients with known and newly diagnosed disease. Free blood tests for glucose measurement and integration of TB and DM services may improve the diagnosis and management of dually affected patients

Status of flexible CIS research at ISET

Polycrystalline thin film solar cells fabricated on light-weight, flexible substrates are very attractive for space applications. In this work CulnSe2 (CIS) based thin film devices were processed on metallic foil substrates using the selenization technique. CIS deposition method involved reaction of electron-bean evaporated Cu-In precursor layers with a selenizing atmosphere at around 400 C. Several metallic foils such as Mo, Ti, Al, Ni, and Cu were evaluated as possible substrates for these devices. Solar cells with AM1.5 efficiencies of 9.0-9.34 percent and good mechanical integrity were demonstrated on Mo and Ti foils. Monolithic integration of these devices was also demonstrated up to 4 in x 4 in size