Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Aims.Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.Methods.Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.Results.PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.Conclusions.Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics

Predictors of tropical cyclone-induced urban tree failure: an international scoping review

Background: Trees are critical components of rural and urban ecosystems throughout the world. While they have adapted to the historic conditions of their native environments, climate change, urbanization, and human-assisted range expansion may test the storm resiliency of many tree species. Objective: In this global multilingual scoping review, we investigate a range of intrinsic (i.e., tree characteristics) and external (i.e., environmental and management) factors which have been used to predict tree failure during tropical cyclones. Design: We searched online databases and journals in English, Chinese, French, Japanese, Portuguese, and Spanish to find peer-reviewed papers and dissertations. We retained papers that used ground-based methods to study tree damage following a tropical cyclone and conducted a statistical analysis of factors that influence tree resistance to damage. From each paper we extracted details of study methods, and the relationships between damage and predictors. Results: Our efforts generated 65 peer-reviewed papers and dissertations that met our final criteria for inclusion (i.e., data on the relative proportion of trees failed/intact as assessed no more than a year after the storm event). Of these papers 37 independent variables were assessed to predict tree failure. Research in both urban and rural settings tends to be concentrated in regions frequently impacted by tropical cyclones. Characteristics of species such as wood density have been studied in rural environments and are also relevant predictors for tree failure in urban trees. Environmental characteristics unique to urban settings such as planting areas surrounded by pavement need further research. Several urban studies demonstrate that risk assessment methods can predict tree failure during a storm. Conclusion: Results can be used by future storm researchers to identify both predictors may warrant inclusion in their models as well as predictors which have yet to be tested. Results can also inform planning and activities that can mitigate tropical cyclone damage to the urban forest

The motion of trees in the wind : a data synthesis

Interactions between wind and trees control energy exchanges between the atmosphere and forest canopies. This energy exchange can lead to the widespread damage of trees, and wind is a key disturbance agent in many of the world’s forests. However, most research on this topic has focused on conifer plantations, where risk management is economically important, rather than broadleaf forests, which dominate the forest carbon cycle. This study brings together tree motion time-series data to systematically evaluate the factors influencing tree responses to wind loading, including data from both broadleaf and coniferous trees in forests and open environments. Wefoundthatthetwomostdescriptive features of tree motion were (a) the fundamental frequency, which is a measure of the speed at which a tree sways and is strongly related to tree height, and (b) the slope of the power spectrum, which is related to the efficiency of energy transfer from wind to trees. Intriguingly, the slope of the power spectrum was found to remain constant from medium to high wind speeds for all trees in this study. This suggests that, contrary to some predictions, damping or amplification mechanisms do not change dramatically at high wind speeds, and therefore wind damage risk is related, relatively simply, to wind speed. Conifers from forests were distinct from broadleaves in terms of their response to wind loading. Specifically, the fundamental frequency of forest conifers was related to their size according to the cantilever beam model (i.e. vertically distributed mass), whereas broadleaves were better approximated by the simple pendulum model (i.e. dominated by the crown). Forest conifers also had a steeper slope of the power spectrum. We interpret these finding as being strongly related to tree architecture; i.e. conifers generally have a simple shape due to their apical dominance, whereas broadleaves exhibit a much wider range of architectures with more dominant crowns

Predictors of tropical cyclone-induced urban tree failure: an international scoping review

BackgroundTrees are critical components of rural and urban ecosystems throughout the world. While they have adapted to the historic conditions of their native environments, climate change, urbanization, and human-assisted range expansion may test the storm resiliency of many tree species.ObjectiveIn this global multilingual scoping review, we investigate a range of intrinsic (i.e., tree characteristics) and external (i.e., environmental and management) factors which have been used to predict tree failure during tropical cyclones.DesignWe searched online databases and journals in English, Chinese, French, Japanese, Portuguese, and Spanish to find peer-reviewed papers and dissertations. We retained papers that used ground-based methods to study tree damage following a tropical cyclone and conducted a statistical analysis of factors that influence tree resistance to damage. From each paper we extracted details of study methods, and the relationships between damage and predictors.ResultsOur efforts generated 65 peer-reviewed papers and dissertations that met our final criteria for inclusion (i.e., data on the relative proportion of trees failed/intact as assessed no more than a year after the storm event). Of these papers 37 independent variables were assessed to predict tree failure. Research in both urban and rural settings tends to be concentrated in regions frequently impacted by tropical cyclones. Characteristics of species such as wood density have been studied in rural environments and are also relevant predictors for tree failure in urban trees. Environmental characteristics unique to urban settings such as planting areas surrounded by pavement need further research. Several urban studies demonstrate that risk assessment methods can predict tree failure during a storm.ConclusionResults can be used by future storm researchers to identify both predictors may warrant inclusion in their models as well as predictors which have yet to be tested. Results can also inform planning and activities that can mitigate tropical cyclone damage to the urban forest

Utility of the Health of the Nation Outcome Scales (HoNOS) in Predicting Mental Health Service Costs for Patients with Common Mental Health Problems : Historical Cohort Study

BACKGROUND: Few countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health 'payment by results' (PbR). The system depends on the ability of patient 'clusters' derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at baseline with mental health service costs at one year follow-up.METHODS: An historical cohort study using secondary care patient records from the UK financial year 2012-2013. Included were 1,343 patients with 'common mental health problems', represented by ICD-10 disorders between F32-48. Costs were based on patient contacts with community-based and hospital-based mental health services. The costs outcome was transformed into 'high costs' vs 'regular costs' in main analyses.RESULTS: After adjustment for covariates, 11 HoNOS items were not associated with costs. The exception was 'self-injury' with an odds ratio of 1.41 (95% CI 1.10-2.99). Population attributable fractions (PAFs) for the contribution of HoNOS items to high costs ranged from 0.6% (physical illness) to 22.4% (self-injury). After adjustment, the Total HoNOS score was not associated with costs (OR 1.03, 95% CI 0.99-1.07). However, the PAF (33.3%) demonstrated that it might account for a modest proportion of the incidence of high costs.CONCLUSIONS: Our findings provide limited support for the utility of the self-injury item and Total HoNOS score in predicting costs. However, the absence of associations for the remaining HoNOS items indicates that current PbR clusters have minimal ability to predict costs, so potentially contributing to a misallocation of NHS resources across England. The findings may inform the development of mental health payment systems internationally, especially since the vast majority of countries have not progressed past the early stages of this development. Discrepancies between our findings with those from Australia and New Zealand point to the need for further international investigations

Plakophilin-2: a cell-cell adhesion plaque molecule of selective and fundamental importance in cardiac functions and tumor cell growth

Within the characteristic ensemble of desmosomal plaque proteins, the armadillo protein plakophilin-2 (Pkp2) is known as a particularly important regulatory component in the cytoplasmic plaques of various other cell–cell junctions, such as the composite junctions (areae compositae) of the myocardiac intercalated disks and in the variously-sized and -shaped complex junctions of permanent cell culture lines derived therefrom. In addition, Pkp2 has been detected in certain protein complexes in the nucleoplasm of diverse kinds of cells. Using a novel set of highly sensitive and specific antibodies, both kinds of Pkp2, the junctional plaque-bound and the nuclear ones, can also be localized to the cytoplasmic plaques of diverse non-desmosomal cell–cell junction structures. These are not only the puncta adhaerentia and the fasciae adhaerentes connecting various types of highly proliferative non-epithelial cells growing in culture but also some very proliferative states of cardiac interstitial cells and cardiac myxomata, including tumors growing in situ as well as fetal stages of heart development and cultures of valvular interstitial cells. Possible functions and assembly mechanisms of such Pkp2-positive cell–cell junctions as well as medical consequences are discussed

The desmosome and pemphigus

Desmosomes are patch-like intercellular adhering junctions (“maculae adherentes”), which, in concert with the related adherens junctions, provide the mechanical strength to intercellular adhesion. Therefore, it is not surprising that desmosomes are abundant in tissues subjected to significant mechanical stress such as stratified epithelia and myocardium. Desmosomal adhesion is based on the Ca2+-dependent, homo- and heterophilic transinteraction of cadherin-type adhesion molecules. Desmosomal cadherins are anchored to the intermediate filament cytoskeleton by adaptor proteins of the armadillo and plakin families. Desmosomes are dynamic structures subjected to regulation and are therefore targets of signalling pathways, which control their molecular composition and adhesive properties. Moreover, evidence is emerging that desmosomal components themselves take part in outside-in signalling under physiologic and pathologic conditions. Disturbed desmosomal adhesion contributes to the pathogenesis of a number of diseases such as pemphigus, which is caused by autoantibodies against desmosomal cadherins. Beside pemphigus, desmosome-associated diseases are caused by other mechanisms such as genetic defects or bacterial toxins. Because most of these diseases affect the skin, desmosomes are interesting not only for cell biologists who are inspired by their complex structure and molecular composition, but also for clinical physicians who are confronted with patients suffering from severe blistering skin diseases such as pemphigus. To develop disease-specific therapeutic approaches, more insights into the molecular composition and regulation of desmosomes are required

Thickness and nanomechanical properties of protective layer formed by TiF4 varnish on enamel after erosion

Abstract The layer formed by fluoride compounds on tooth surface is important to protect the underlying enamel from erosion. However, there is no investigation into the properties of protective layer formed by NaF and TiF4 varnishes on eroded enamel. This study aimed to evaluate the thickness, topography, nanohardness, and elastic modulus of the protective layer formed by NaF and TiF4 varnishes on enamel after erosion using nanoindentation and atomic force microscopy (AFM). Human enamel specimens were sorted into control, NaF, and TiF4 varnish groups (n = 10). The initial nanohardness and elastic modulus values were obtained and varnishes were applied to the enamel and submitted to erosive challenge (10 cycles: 5 s cola drink/5 s artificial saliva). Thereafter, nanohardness and elastic modulus were measured. Both topography and thickness were evaluated by AFM. The data were subjected to ANOVA, Tukey’s test and Student’s t test (α = 0.05). After erosion, TiF4 showed a thicker protective layer compared to the NaF group and nanohardness and elastic modulus values were significantly lower than those of the control group. It was not possible to measure nanohardness and elastic modulus in the NaF group due to the thin protective layer formed. AFM showed globular deposits, which completely covered the eroded surface in the TiF4 group. After erosive challenge, the protective layer formed by TiF4 varnish showed significant properties and it was thicker than the layer formed by NaF varnish

Diameter at breast height distributions in America's urban forests - an overview of structural diversity

Background and Objectives: The structural diversity of an urban forest affects ecosystem service provision, and can inform management, planning, as well as policy. Trunk diameter at breast height (DBH) is amongst the most common measures of tree structure due to its ease of measurement and strong relationships with other structural and non-structural urban forest characteristics. Materials and Methods: In this study, the DBH distributions of urban forests are summarised for 38 American cities with a combined population of over 30 million people and a range of geographic, climatic, and demographic conditions. The Anderson–Darling (AD) test was used to test the hypothesis that all DBH distributions came from a common population. Moreover, structural diversity was compared using the Shannon–Wiener index. Results: The AD test results failed to identify any statistically significant differences in DBH distributions. However, qualitatively, the DBH distributions have two primary forms, which have important functional, management, and planning implications. The vast majority of cities have an exponentially inverse-proportional distribution, such that the proportion of trees in each successively larger DBH class decreases exponentially. The Shannon–Wiener index indicates an uneven DBH distribution in the cities with an exponentially inverse-proportional diameter distribution; these cities are dominated by trees in the smallest diameter class. Potential explanations for a large proportion of trees in the smallest diameter classes include a large number of small, naturally regenerating trees; a preference for smaller trees in urban areas; or a recent increase in tree planting efforts. Conclusions: Despite no statistical differences in DBH distributions for the 38 study cities, the functional, management, and planning implications will differ considerably