Predictive validity of the HCR-20 for inpatient aggression:the effect of intellectual disability on accuracy

BackgroundPeople with intellectual disability (ID) account for a large proportion of aggressive incidents in secure and forensic psychiatric services. Although the Historical, Clinical, Risk Management 20 (HCR-20) has good predictive validity in inpatient settings, it does not perform equally in all groups and there is little evidence for its efficacy in those with ID.MethodA pseudo-prospective cohort study of the predictive efficacy of the HCR-20 for those with ID (n = 109) was conducted in a UK secure mental health setting using routinely collected risk data. Performance of the HCR-20 in the ID group was compared with a comparison group of adult inpatients without an ID (n = 504). Analysis controlled for potential covariates including security level, length of stay, gender and diagnosis.ResultsThe HCR-20 total score was a significant predictor of any aggression and of physical aggression for both groups, although the area under the curve values did not reach the threshold for a large effect size. The clinical subscale performed significantly better in those without an ID compared with those with. The ID group had a greater number of relevant historical and risk management items. The clinicians' summary judgment significantly predicted both types of aggressive outcomes in the ID group, but did not predict either in those without an ID.ConclusionsThis study demonstrates that, after controlling for a range of potential covariates, the HCR-20 is a significant predictor of inpatient aggression in people with an ID and performs as well as for a comparison group of mentally disordered individuals without ID. The potency of HCR-20 subscales and items varied between the ID and comparison groups suggesting important target areas for improved prediction and risk management interventions in those with ID

Key constituents for integration of care for children assisted with long-term home ventilation: a European study.

The number of children requiring long-term home ventilation has consistently increased over the last 25 years. Given the growing population of children with complex care needs (CCNs), this was an important area of focus within the Models of Child Health Appraised (MOCHA) project, funded by the European Union (EU) under the Horizon 2020 programme. We examined the structures and processes of care in place for children with CCNs and identified key constituents for effective integration of care for these children at the community and acute care interface across 30 EU/ European Economic Area (EEA) countries. This was a non-experimental descriptive study with an embedded qualitative element. Data were collected by a Country Agent in each of the 30 countries, a local expert in child health services. Data were analysed using descriptive statistics and a thematic analysis was undertaken of the free text data provided. A total of 27 surveys were returned from a possible 30 countries (90.0%) countries. One respondent indicated that their country does not have children on long-term ventilation (LTV) in the home, therefore, responses of 26 countries (86.7%) were analysed. None of the responding countries reported that they had all of the core components in place in their country. Three themes emerged from the free text provided: 'family preparedness for transitioning to home', 'coordinated pathway to specialist care' and 'legal and governance structures'. While the clinical care of children on LTV in the acute sector has received considerable attention, the results identify the need for an enhanced focus on the care required following discharge to the community setting. The results highlight the need for a commitment to supporting care delivery that acknowledges the complexity of contemporary child health issues and the context of the families that become their primary care givers

The prediction and management of aquatic nitrogen pollution across Europe: an introduction to the Integrated Nitrogen in European Catchments project (INCA)

International audienceExcess nitrogen in soils, fresh water, estuarine and marine systems contributes to nutrient enrichment in key ecosystems throughout Europe, often leading to detrimental environmental impacts, such as soil acidification or the eutrophication of water bodies. The Integrated Nitrogenmodel for European Catchments (INCA) project aims to develop a generic version of the Integrated Nitrogen in Catchments (INCA) model to simulate the retention and transport of nitrogen within river systems, thereby providing a tool to aid the understanding of nitrogen dynamics and for river-basin management/policy-making. To facilitate the development of the model, 10 partners have tested the INCA model with data collected in study sites located in eight European countries as part of the INCA project. This paper summarises the key nitrogen issues within Europe, describes the main aims and methodology of the INCA project, and sets the project in the context of the current major research initiatives at a European level. Keywords: Europe, European Union, nitrogen, nitrate, ammonium, river basin management, modelling, water chemistry, acidification, eutrophication, Water Framework Directive, INCA

The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial.

ObjectivesThe diagnosis of surgical site infection following endoprosthetic reconstruction for bone tumours is frequently a subjective diagnosis. Large clinical trials use blinded Central Adjudication Committees (CACs) to minimise the variability and bias associated with assessing a clinical outcome. The aim of this study was to determine the level of inter-rater and intra-rater agreement in the diagnosis of surgical site infection in the context of a clinical trial.Materials and methodsThe Prophylactic Antibiotic Regimens in Tumour Surgery (PARITY) trial CAC adjudicated 29 non-PARITY cases of lower extremity endoprosthetic reconstruction. The CAC members classified each case according to the Centers for Disease Control (CDC) criteria for surgical site infection (superficial, deep, or organ space). Combinatorial analysis was used to calculate the smallest CAC panel size required to maximise agreement. A final meeting was held to establish a consensus.ResultsFull or near consensus was reached in 20 of the 29 cases. The Fleiss kappa value was calculated as 0.44 (95% confidence interval (CI) 0.35 to 0.53), or moderate agreement. The greatest statistical agreement was observed in the outcome of no infection, 0.61 (95% CI 0.49 to 0.72, substantial agreement). Panelists reached a full consensus in 12 of 29 cases and near consensus in five of 29 cases when CDC criteria were used (superficial, deep or organ space). A stable maximum Fleiss kappa of 0.46 (95% CI 0.50 to 0.35) at CAC sizes greater than three members was obtained.ConclusionsThere is substantial agreement among the members of the PARITY CAC regarding the presence or absence of surgical site infection. Agreement on the level of infection, however, is more challenging. Additional clinical information routinely collected by the prospective PARITY trial may improve the discriminatory capacity of the CAC in the parent study for the diagnosis of infection.Cite this article: J. Nuttall, N. Evaniew, P. Thornley, A. Griffin, B. Deheshi, T. O'Shea, J. Wunder, P. Ferguson, R. L. Randall, R. Turcotte, P. Schneider, P. McKay, M. Bhandari, M. Ghert. The inter-rater reliability of the diagnosis of surgical site infection in the context of a clinical trial. Bone Joint Res 2016;5:347-352. DOI: 10.1302/2046-3758.58.BJR-2016-0036.R1

A study on PDC drill bits quality

The quality of innovating PDC (Polycrystalline Diamond Compact) bits materials needs to be determined with accuracy by measuring cutting efficiency and wear rate, both related to the overall mechanical properties. An original approach is developed to encompass cutting efficiency and wear contribution to the overall sample quality. Therefore, a lathe-type test device was used to abrade specific samples from various manufacturers. Post-experiment analyzes are based on models establishing coupled relationships between cutting and friction stresses related to the drag bits excavation mechanism. These models are implemented in order to evaluate cutting efficiency and to estimate wear of the diamond insert. Phase analysis by XRD and finite element simulations were performed to explain the role of physicochemical parameters on the calculated quality factor values. Four main properties of PDC material were studied to explain quality results obtained in this study: cobalt content in samples that characterizes hardness/fracture toughness compromise, undesired phase as tungsten carbide weakening diamond structure, diamond grains sizes and residual stresses distribution affecting abrasion resistance

Optical bistability in Er-Yb co-doped phosphate glass microspheres at room temperature

We experimentally demonstrate optical bistability in Er3+-Yb3+ phosphate glass microspheres at 295 K. Bistability is associated with both Er3+ fluorescence and lasing behavior, and chromatic switching. The chromatic switching results from an intrinsic mechanism exploiting the thermal coupling of closely-spaced energy levels, and occurs simultaneously with the intensity switching. A contrast ratio of 3.2 has been obtained for chromatic switching, and the intensity switching shows ratios of 2.4 for 550 nm and, 1.8 for the 660 nm fluorescence emissions, and 11 for the IR lasing at 1.5 um. Concurrent with these observations, we investigate a temperature dependent absorption of pump power which exhibits bistable behavior. The influences of the host matrix on lasing and fluorescence mechanisms are highlighted.Comment: 22 pages, 6 figure