The predictive validity of the short-term assessment of risk and treatability (START) for multiple adverse outcomes in a secure psychiatric inpatient setting

The Short-Term Assessment of Risk and Treatability (START) aims to assist mental health practitioners to estimate an individual’s short-term risk for a range of adverse outcomes via structured consideration of their risk (“Vulnerabilities”) and protective factors (“Strengths”) in 20 areas. It has demonstrated predictive validity for aggression but this is less established for other outcomes. We collated START assessments for N = 200 adults in a secure mental health hospital and ascertained 3-month risk event incidence using the START Outcomes Scale. The specific risk estimates, which are the tool developers’ suggested method of overall assessment, predicted aggression, self-harm/suicidality, and victimization, and had incremental validity over the Strength and Vulnerability scales for these outcomes. The Strength scale had incremental validity over the Vulnerability scale for aggressive outcomes; therefore, consideration of protective factors had demonstrable value in their prediction. Further evidence is required to support use of the START for the full range of outcomes it aims to predict

Predictive validity of the Short-Term Assessment of Risk and Treatability (START) for multiple adverse outcomes:the effect of diagnosis

The Short-Term Assessment of Risk and Treatability (START) assists risk assessment for seven risk outcomes based on scoring of risk and protective factors and assignment of clinically-informed risk levels. Its predictive validity for violence and self-harm has been established in males with schizophrenia, but accuracy across pathologically diverse samples is unknown. Routine START assessments and 3-month risk outcome data of N = 527 adult, inpatients in a UK secure mental health facility were collected. The sample was divided into diagnostic groups; predictive validity was established using receiver operating characteristics regression (rocreg) analysis in which potential covariates were controlled. In most single-diagnosis groups START risk factors ('vulnerabilities'), protective factors ('strengths'), and clinically-informed estimates predicted multiple risk outcomes with effect sizes similar to previous research. Self-harm was not predicted among patients with an organic diagnosis. The START risk estimates predicted physical aggression in all diagnostic groups, and verbal aggression, self-harm and self-neglect in most diagnostic groups. The START can assist assessment of aggressive, self-harm, and self-neglect across a range of diagnostic groups. Further research with larger sample sizes of those with multiple diagnoses is required.</p

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

Sustainable EPM rubber compounds

Two important aspects that should be considered when designing new, sustainable rubber products are the bio-based character of the rubber compound ingredients and the recyclability of the vulcanized rubber product. In this work, both are addressed by compounding a thermoreversible cross-linked EPM rubber with pyrolysis carbon black and squalane as sustainable filler and plasticizer, respectively. The resulting rubber product is fully reprocessable in the melt and it displays material properties comparable to those of compounds with conventional additives with high retention of the material properties upon reprocessing

Practical application of thermoreversibly Cross-linked rubber products

Currently, rubber products cannot simply be reprocessed after their product life, due to the irreversible cross-linking methods traditionally applied. The purpose of this work is to investigate how thermoreversible cross-linking of rubbers via Diels Alder chemistry can be used for the development of recyclable rubber products. Unfortunately, the applicability of the thermoreversible EPM-g-furan/BM system appears to be limited to room temperature applications, because of the rapid deterioration of the compression set at elevated temperatures compared to irreversibly cross-linked EPM. However, the use of EPM rubber modified with thiophene or cyclopentadiene moieties may extend the temperature application range and results in rubber products with acceptable properties. Finally, rubber products generally comprise fillers such as silica, carbon black or fibers. In this context, the reinforcing effect of short cut aramid fibers on the material properties of the newly developed thermoreversibly cross-linked EPM rubbers was also studied. The material properties of the resulting products were found to be comparable to those of a fiber reinforced, peroxide cured reference sample

Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service

BackgroundViolent and non-violent sexual behaviour is a fairly common problem among secure mental health service patients, but specialist sexual violence risk assessment is time-consuming and so performed infrequently.AimsWe aimed to establish whether a commonly used violence risk assessment tool, the Health Clinical Risk management 20(HCR-20), has predictive validity specifically for inappropriate sexual behaviour.MethodsA pseudo-prospective cohort design was used for a study in the adult wards of a large provider of specialist secure mental health services. Routine clinical team HCR-20 assessments were extracted from records, and incidents involving inappropriate sexual behaviour were recorded for the 3 months following assessment.ResultsOf 613 patients, 104 (17%) had engaged in at least one inappropriate sexual behaviour; in 65 (10.6%), the sexual act was violent. HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90%.ConclusionsPrediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour

Exploring the influence of electron beam crosslinking in SEBS/TPU and SEBS-g-MA/TPU thermoplastic elastomer blends

The effects of electron beam (EB) radiation in thermoplastic elastomers based on SEBS/TPU and SEBS-g-MA/TPU are evaluated. 60/40 blend of both the systems were subjected to EB using an ILU type industrial accelerator. Radiation dose was varied from 0 to 100 kGy, and the sol–gel content evaluation along with detailed analysis of mechanical, thermal, rheological, and morphological implications was conducted. The interplay between crosslinking and chain scission was quantified using the Charlesby-Pinner equation. Both the blends showed the presence of a three-dimensional cross-linked network in them after the irradiation. The tensile strength of SEBS/TPU was found to deteriorate with an increase in radiation dose, but an opposite trend was observed in SEBS-g-MA/TPU. Improvement in interfacial adhesion between SEBS-g-MA and TPU was confirmed. The morphological analysis through atomic force microscopy and scanning electron microscopy clearly showed the appearance of rough ridges and pits due to irradiation along with the cross-linked networks. From differential scanning calorimetry analysis, the changes in glass transitions and melting endotherm were assessed. Thermogravimetric analysis results indicated an improvement in the thermal stability of the blends. The storage modulus and complex viscosity of the samples enhanced as perceived from the rheological measurements. X-ray diffraction patterns of the blends also showed considerable variation after irradiation

Telemedicine as a Medical Examination Tool During the Covid-19 Emergency: The Experience of the Onco-Haematology Center of Tor Vergata Hospital in Rome

Background: Our study analysed the outpatient activity of the onco-hematology Complex Operative Unit (UOC) of Tor Vergata Hospital, Rome coronavirus disease 2019 (Covid-19) center, where, as a result of the sudden and unexpected emergency, healthcare services were provided through telemedicine procedures that can be considered very close to Telehealth. Aim of the study: our retrospective study aimed to assess the widespread use of telemedicine in terms of feasibility and safety related to adverse events, a crucial experience which will make it possible to predict any effective use of such a method in patients with hematological disorders even after the end of the Covid-19 emergency. Materials and methods: At the Day Hospital clinic, from 8 March to 31 May 2020, an outpatient group received 3828 medical teleconsultations and 11,484 additional contacts following the first examination; each patient examined through the telematic method required an average of three supplementary contacts via e-mail or telephone. Results: The follow-up lasted 145 days, and all the events that occurred were monitored. In total, we recorded 16 clinical adverse events, 5 of which classified as major events, and 11 as minor events. Conclusion: The 3828 telematic clinical examinations and the 11,484 additional contacts following the first examination carried out by the onco-haematology UOC of Tor Vergata Hospital, proved how telemedicine, albeit in its basic form, was a key tool in facing the sanitary emergency caused by the sudden spread of Covid-19. An experience that can be considered reliable enough to be replicated in possible post-Covid-19 emergencies. From a medical forensic point of view, the main issues to consider are informed consent, personal data management and professional responsibility profiles

Cross-linking of rubber in the presence of multi-functional cross-linking aids via thermoreversible Diels-Alder chemistry

Furan-functionalized polyketone (PK-FU) was added to a furan-functionalized ethylene-propylene rubber (EPM-FU). The mixture was subsequently cross-linked with a bismaleimide through Diels-Alder chemistry in order to improve the mechanical properties of the rubber. Infrared spectroscopy showed the reversible interaction between both polymers and the bismaleimide cross-linker. Likewise, mechanical measurements indicated the re-workability of the mixtures with no evident differences in storage modulus and mechanical properties after several heating cycles. The cross-link density and mechanical properties, such as hardness, tensile properties and compression set, could be modulated by changing the degree of furan functionalization of PK-FU and the PK-FU loading in the blends. It is concluded that PK-FU has some characteristics of an inert filler, but mainly acts as a multi-functional cross-linking aid, enabling larger amounts of bismaleimide to cross-link EPM-FU

Experiences of women in secure care who have been prescribed clozapine for borderline personality disorder

Background: Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. Findings: Adult females (N=20) participated in audio-taped semi-structured interviews. Transcripts were subject to thematic analysis. The central themes related to evaluation, wellbeing, understanding and self-management; for many, their subjective wellbeing on clozapine was preferred to prior levels of functioning and symptomatology, sometimes profoundly so. The negative and potentially adverse effects of clozapine were explained as regrettable but relatively unimportant. Conclusions: When psychological interventions are, at least initially, ineffective then clozapine treatment is likely to be evaluated positively by a group of women with borderline personality disorder in secure care despite the potential disadvantages