A quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England

Objectives: Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information requests made to NHS trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS trusts. Design: A cross-sectional survey of suicide risk assessment tools and training gathered via Freedom of Information requests and subjected to a content analysis. Setting: Freedom of Information requests were submitted to NHS trusts across England. Results: A wide variety of suicide risk assessments tools were identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment whilst 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. Conclusions: There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the numbers of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention

A horizontal ice core from Taylor Glacier, its implications for Antarctic climate history, and an improved Taylor Dome ice core time scale

Ice core records from Antarctica show mostly synchronous temperature variations during the last deglacial transition, an indication that the climate of the entire continent reacted as one unit to the global changes. However, a record from the Taylor Dome ice core in the Ross Sea sector of East Antarctica has been suggested to show a rapid warming, similar in style and synchronous with the Oldest Dryas—Bølling warming in Greenland. Since publication of the Taylor Dome record, a number of lines of evidence have suggested that this interpretation is incorrect and reflects errors in the underlying time scale. The issues raised regarding the dating of Taylor Dome currently linger unresolved, and the original time scale remains the de facto chronology. We present new water isotope and chemistry data from nearby Taylor Glacier to resolve the confusion surrounding the Taylor Dome time scale. We find that the Taylor Glacier record is incompatible with the original interpretation of the Taylor Dome ice core, showing that the warming in the area was gradual and started at ∼18 ka BP (before 1950) as seen in other East Antarctic ice cores. We build a consistent, up‐to‐date Taylor Dome chronology from 0 to 60 ka BP by combining new and old age markers based on synchronization to other ice core records. The most notable feature of the new TD2015 time scale is a gas age—ice age difference of up to 12,000 years during the Last Glacial Maximum, by far the largest ever observed

Synchronous volcanic eruptions and abrupt climate change ∼17.7 ka plausibly linked by stratospheric ozone depletion.

Glacial-state greenhouse gas concentrations and Southern Hemisphere climate conditions persisted until ∼17.7 ka, when a nearly synchronous acceleration in deglaciation was recorded in paleoclimate proxies in large parts of the Southern Hemisphere, with many changes ascribed to a sudden poleward shift in the Southern Hemisphere westerlies and subsequent climate impacts. We used high-resolution chemical measurements in the West Antarctic Ice Sheet Divide, Byrd, and other ice cores to document a unique, ∼192-y series of halogen-rich volcanic eruptions exactly at the start of accelerated deglaciation, with tephra identifying the nearby Mount Takahe volcano as the source. Extensive fallout from these massive eruptions has been found >2,800 km from Mount Takahe. Sulfur isotope anomalies and marked decreases in ice core bromine consistent with increased surface UV radiation indicate that the eruptions led to stratospheric ozone depletion. Rather than a highly improbable coincidence, circulation and climate changes extending from the Antarctic Peninsula to the subtropics-similar to those associated with modern stratospheric ozone depletion over Antarctica-plausibly link the Mount Takahe eruptions to the onset of accelerated Southern Hemisphere deglaciation ∼17.7 ka

A new bipolar ice core record of volcanism from WAIS Divide and NEEM and implications for climate forcing of the last 2000 years

Volcanism is a natural climate forcing causing short-term variations in temperatures. Histories of volcanic eruptions are needed to quantify their role in climate variability and assess human impacts. We present two new seasonally resolved, annually dated non-sea-salt sulfur records from polar ice cores - WAIS Divide (WDC06A) from West Antarctica spanning 408 B.C.E. to 2003 C.E. and NEEM (NEEM-2011-S1) from Greenland spanning 78 to 1997 C.E. - both analyzed using high-resolution continuous flow analysis coupled to two mass spectrometers. The high dating accuracy allowed placing the large bi-hemispheric deposition event ascribed to the eruption of Kuwae in Vanuatu (previously thought to be 1452/1453 C.E. and used as a tie-point in ice core dating) into the year 1458/1459 C.E. This new age is consistent with an independent ice core timescale from Law Dome and explains an apparent delayed response in tree rings to this volcanic event. A second volcanic event is detected in 1453 C.E. in both ice cores. We show for the first time ice core signals in Greenland and Antarctica from the strong eruption of Taupo in New Zealand in 232 C.E. In total, 133 volcanic events were extracted from WDC06A and 138 from NEEM-2011-S1, with 50 ice core signals - predominantly from tropical source volcanoes - identified simultaneously in both records. We assess the effect of large bipolar events on temperature-sensitive tree ring proxies. These two new volcanic records, synchronized with available ice core records to account for spatial variability in sulfate deposition, provide a basis for improving existing time series of volcanic forcing

A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study

BackgroundAdvances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. ObjectiveThe goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). MethodsWe conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. ResultsThe CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. ConclusionsAlthough perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial RegistrationClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT0375806

High resolution impurity data for the NorthGRIP ice core

High resolution aerosol data from Greenland NGRIP and NEEM ice cores. All data was measured using continuous flow analysis with the Bern CFA system during the respective field campaigns. Data is provided at 1mm depth resolution and 10yr averages on the GICC05 age scale of the respective core

High resolution aerosol concentration data from the Greenland NorthGRIP and NEEM deep ice cores

High resolution aerosol data from Greenland NGRIP and NEEM ice cores. All data was measured using continuous flow analysis with the Bern CFA system during the respective field campaigns. Data is provided at 1mm depth resolution and 10yr averages on the GICC05 age scale of the respective core

High resolution impurity data for the NEEM ice core

High resolution aerosol data from Greenland NGRIP and NEEM ice cores. All data was measured using continuous flow analysis with the Bern CFA system during the respective field campaigns. Data is provided at 1mm depth resolution and 10yr averages on the GICC05 age scale of the respective core