Barriers and Facilitators of Suicide Risk Assessment in Emergency Departments: A Qualitative Study of Provider Perspectives

Objective To understand emergency department (ED) providers’ perspectives regarding the barriers and facilitators of suicide risk assessment and to use these perspectives to inform recommendations for best practices in ED suicide risk assessment. Methods Ninety-two ED providers from two hospital systems in a Midwestern state responded to open-ended questions via an online survey that assessed their perspectives on the barriers and facilitators to assess suicide risk as well as their preferred assessment methods. Responses were analyzed using an inductive thematic analysis approach. Results Qualitative analysis yielded six themes that impact suicide risk assessment. Time, privacy, collaboration and consultation with other professionals and integration of a standard screening protocol in routine care exemplified environmental and systemic themes. Patient engagement/participation in assessment and providers’ approach to communicating with patients and other providers also impacted the effectiveness of suicide risk assessment efforts. Conclusions The findings inform feasible suicide risk assessment practices in EDs. Appropriately utilizing a collaborative, multidisciplinary approach to assess suicide-related concerns appears to be a promising approach to ameliorate the burden placed on ED providers and facilitate optimal patient care. Recommendations for clinical care, education, quality improvement and research are offered

Hybrid receiver study

The results are presented of a 4 month study to design a hybrid analog/digital receiver for outer planet mission probe communication links. The scope of this study includes functional design of the receiver; comparisons between analog and digital processing; hardware tradeoffs for key components including frequency generators, A/D converters, and digital processors; development and simulation of the processing algorithms for acquisition, tracking, and demodulation; and detailed design of the receiver in order to determine its size, weight, power, reliability, and radiation hardness. In addition, an evaluation was made of the receiver's capabilities to perform accurate measurement of signal strength and frequency for radio science missions

Protocol for the development of the Master Chemical Mechanism, MCM v3 (Part A): tropospheric degradation of non-aromatic volatile organic compounds

Kinetic and mechanistic data relevant to the tropospheric degradation of volatile organic compounds (VOC), and the production of secondary pollutants, have previously been used to define a protocol which underpinned the construction of a near-explicit Master Chemical Mechanism. In this paper, an update to the previous protocol is presented, which has been used to define degradation schemes for 107 non-aromatic VOC as part of version 3 of the Master Chemical Mechanism (MCM v3). The treatment of 18 aromatic VOC is described in a companion paper. The protocol is divided into a series of subsections describing initiation reactions, the reactions of the radical intermediates and the further degradation of first and subsequent generation products. Emphasis is placed on updating the previous information, and outlining the methodology which is specifically applicable to VOC not considered previously (e.g. <font face='Symbol' >a</font>- and <font face='Symbol' >b</font>-pinene). The present protocol aims to take into consideration work available in the open literature up to the beginning of 2001, and some other studies known by the authors which were under review at the time. Application of MCM v3 in appropriate box models indicates that the representation of isoprene degradation provides a good description of the speciated distribution of oxygenated organic products observed in reported field studies where isoprene was the dominant emitted hydrocarbon, and that the <font face='Symbol' >a</font>-pinene degradation chemistry provides a good description of the time dependence of key gas phase species in <font face='Symbol' >a</font>-pinene/NO_X photo-oxidation experiments carried out in the European Photoreactor (EUPHORE). Photochemical Ozone Creation Potentials (POCP) have been calculated for the 106 non-aromatic non-methane VOC in MCM v3 for idealised conditions appropriate to north-west Europe, using a photochemical trajectory model. The POCP values provide a measure of the relative ozone forming abilities of the VOC. Where applicable, the values are compared with those calculated with previous versions of the MCM

Discrete Formulation for the dynamics of rods deforming in space

We describe the main ingredients needed to create, from the smooth lagrangian density, a variational principle for discrete motions of a discrete rod, with corresponding conserved Noether currents. We describe all geometrical objects in terms of elements on the linear Atiyah bundle, using a reduced forward difference operator. We show how this introduces a discrete lagrangian density that models the discrete dynamics of a discrete rod. The presented tools are general enough to represent a discretization of any variational theory in principal bundles, and its simplicity allows to perform an iterative integration algorithm to compute the discrete rod evolution in time, starting from any predefined configurations of all discrete rod elements at initial times

Making postgraduate students and supervisors aware of the role of emotions in the PhD process

Emotions are an integral part of the PhD process. A range of emotions are common and to be expected. How do emotions affect the PhD process for both postgraduate students and their supervisors? How can we make our emotions work positively for us in the PhD process? To explore answers to these questions, three lecturers currently supervising postgraduates and three postgraduates at various stages in their doctoral studies collectively pooled their experiences. We developed an interactive workshop that was recently conducted for postgraduate students at Murdoch University and at the Australian Association for Social Research annual conference 2002. This presentation will explore the role that emotions play in the PhD process and how supervisors and postgraduates alike can benefit from reflecting on this issue. A number of practical (and humorous) tips will be provided as well as examples from others' PhD experiences. The role of emotions at the beginning, middle and end of a PhD program will be explored. The data collection and analysis phases are a time when emotions may run riot. Trepidation is especially common when fieldwork or data collection is involved, as is anger when postgraduate's views about how the world works are challenged and then sadness (and relief!) when the data collection phase is finished. We will discuss how supervisors can assist their postgraduates to make these feelings work for them. The presentation will also explore the emotions that arise from the supervisor-postgraduate partnership

Learning To Be Affected: Social suffering and total pain at life’s borders.

The practice of Live Sociology in situations of pain and suffering is the author’s focus. An outline of the challenges of understanding pain is followed by a discussion of Bourdieu’s ‘social suffering’ (1999) and the palliative care philosophy of ‘total pain’. Using examples from qualitative research on disadvantaged dying migrants in the UK, attention is given to the methods that are improvised by dying people and care practitioners in attempts to bridge intersubjective divides, where the causes and routes of pain can be ontologically and temporally indeterminate and/or withdrawn. The paper contends that these latter phenomena are the incitement for the inventive bridging and performative work of care and Live Sociological methods, both of which are concerned with opposing suffering. Drawing from the ontology of total pain, I highlight the importance of (i) an engagement with a range of materials out of which attempts at intersubjective bridging can be produced, and which exceed the social, the material, and the temporally linear; and (ii) an empirical sensibility that is hospitable to the inaccessible and non-relational

Modelling of the photooxidation of toluene: conceptual ideas for validating detailed mechanisms

Toluene photooxidation is chosen as an example to examine how simulations of smog-chamber experiments can be used to unravel shortcomings in detailed mechanisms and to provide information on complex reaction systems that will be crucial for the design of future validation experiments. The mechanism used in this study is extracted from the Master Chemical Mechanism Version 3 (MCM v3) and has been updated with new modules for cresol and g-dicarbonyl chemistry. Model simulations are carried out for a toluene-NO_x experiment undertaken at the European Photoreactor (EUPHORE). The comparison of the simulation with the experimental data reveals two fundamental shortcomings in the mechanism: OH production is too low by about 80%, and the ozone concentration at the end of the experiment is over-predicted by 55%. The radical budget was analysed to identify the key intermediates governing the radical transformation in the toluene system. Ring-opening products, particularly conjugated g-dicarbonyls, were identified as dominant radical sources in the early stages of the experiment. The analysis of the time evolution of radical production points to a missing OH source that peaks when the system reaches highest reactivity. First generation products are also of major importance for the ozone production in the system. The analysis of the radical budget suggests two options to explain the concurrent under-prediction of OH and over-prediction of ozone in the model: 1) missing oxidation processes that produce or regenerate OH without or with little NO to NO₂ conversion or 2) NO₃ chemistry that sequesters reactive nitrogen oxides into stable nitrogen compounds and at the same time produces peroxy radicals. Sensitivity analysis was employed to identify significant contributors to ozone production and it is shown how this technique, in combination with ozone isopleth plots, can be used for the design of validation experiments

Bayes-X: a Bayesian inference tool for the analysis of X-ray observations of galaxy clusters

We present the first public release of our Bayesian inference tool, Bayes-X, for the analysis of X-ray observations of galaxy clusters. We illustrate the use of Bayes-X by analysing a set of four simulated clusters at z=0.2-0.9 as they would be observed by a Chandra-like X-ray observatory. In both the simulations and the analysis pipeline we assume that the dark matter density follows a spherically-symmetric Navarro, Frenk and White (NFW) profile and that the gas pressure is described by a generalised NFW (GNFW) profile. We then perform four sets of analyses. By numerically exploring the joint probability distribution of the cluster parameters given simulated Chandra-like data, we show that the model and analysis technique can robustly return the simulated cluster input quantities, constrain the cluster physical parameters and reveal the degeneracies among the model parameters and cluster physical parameters. We then analyse Chandra data on the nearby cluster, A262, and derive the cluster physical profiles. To illustrate the performance of the Bayesian model selection, we also carried out analyses assuming an Einasto profile for the matter density and calculated the Bayes factor. The results of the model selection analyses for the simulated data favour the NFW model as expected. However, we find that the Einasto profile is preferred in the analysis of A262. The Bayes-X software, which is implemented in Fortran 90, is available at http://www.mrao.cam.ac.uk/facilities/software/bayesx/.Comment: 22 pages, 11 figure