Cost implications of treatment non-completion in a forensic personality disorder service

Background A high proportion of individuals admitted to specialist secure hospital services for treatment of personality disorder do not complete treatment. Non-completion has been associated with poorer treatment outcomes and increased rates of recidivism and hospital readmission, when compared with individuals who do complete treatment or who do not receive treatment at all. Aims In this study, we sought to determine the economic consequences of non-completion of treatment, using case study data from a secure hospital sample. Both health and criminal justice service perspectives were taken into account. Methods Data were collected from a medium secure hospital personality disorder unit. A probabilistic decision-analytic model was constructed, using a Markov cohort simulation with 10,000 iterations. The expected cost differential between those who do and those who do not complete treatment was estimated, as was the probability of a cost differential over a 10-year post-admission time horizon. Results On average, in the first 10 years following admission, those who do not complete treatment go on to incur £52,000 more in costs to the National Health Service and criminal justice system than those who complete treatment. The model estimates that the probability that non-completers incur greater costs than completers is 78%. Conclusion It is possible that an improvement in treatment completion rates in secure hospital personality disorder units would lead to some cost savings. This might be achievable through better selection into treatment or improved strategies for engagement and retention. Our study highlights a financial cost to society of individuals discharged from secure hospital care when incompletely treated. We suggest that it could, therefore, be useful for secure hospitals to introduce routine monitoring of treatment completion

Views of people living with dementia and their carers on their present and future: A qualitative study

BACKGROUND: Dementia leads to multiple issues including difficulty in communication and increased need for care and support. Discussions about the future often happen late or never, partly due to reluctance or fear. In a sample of people living with dementia and carers, we explored their views and perceptions of living with the condition and their future. METHODS: Semi-structured interviews were conducted in 2018-19 with 11 people living with dementia and six family members in England. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. RESULTS: Findings were explored critically within the theory of social death and three themes were developed: (1) loss of physical and cognitive functions, (2) loss of social identity, and (3) social connectedness. Most participants living with dementia and carers wanted to discuss the present, rather than the future, believing a healthy lifestyle would prevent the condition from worsening. Those with dementia wanted to maintain control of their lives and demonstrated this by illustrating their independence. Care homes were often associated with death and loss of social identity. Participants used a range of metaphors to describe their dementia and the impact on their relationships and social networks. CONCLUSION: Focusing on maintaining social identity and connectedness as part of living well with dementia may assist professionals in undertaking advance care planning discussions

Allergenicity assessment of genetically modified crops—what makes sense?

GM crops have great potential to improve food quality, increase harvest yields and decrease dependency on certain chemical pesticides. Before entering the market their safety needs to be scrutinized. This includes a detailed analysis of allergenic risks, as the safety of allergic consumers has high priority. However, not all tests currently being applied to assessing allergenicity have a sound scientific basis. Recent events with transgenic crops reveal the fallacy of applying such tests to GM crops

Launch Pad Flame Trench Refractory Materials

The launch complexes at NASA's John F. Kennedy Space Center (KSC) are critical support facilities for the successful launch of space-based vehicles. These facilities include a flame trench that bisects the pad at ground level. This trench includes a flame deflector system that consists of an inverted, V-shaped steel structure covered with a high temperature concrete material five inches thick that extends across the center of the flame trench. One side of the "V11 receives and deflects the flames from the orbiter main engines; the opposite side deflects the flames from the solid rocket boosters. There are also two movable deflectors at the top of the trench to provide additional protection to shuttle hardware from the solid rocket booster flames. These facilities are over 40 years old and are experiencing constant deterioration from launch heat/blast effects and environmental exposure. The refractory material currently used in launch pad flame deflectors has become susceptible to failure, resulting in large sections of the material breaking away from the steel base structure and creating high-speed projectiles during launch. These projectiles jeopardize the safety of the launch complex, crew, and vehicle. Post launch inspections have revealed that the number and frequency of repairs, as well as the area and size of the damage, is increasing with the number of launches. The Space Shuttle Program has accepted the extensive ground processing costs for post launch repair of damaged areas and investigations of future launch related failures for the remainder of the program. There currently are no long term solutions available for Constellation Program ground operations to address the poor performance and subsequent failures of the refractory materials. Over the last three years, significant liberation of refractory material in the flame trench and fire bricks along the adjacent trench walls following Space Shuttle launches have resulted in extensive investigations of failure mechanisms, load response, ejected material impact evaluation, and repair design analysis (environmental and structural assessment, induced environment from solid rocket booster plume, loads summary, and repair integrity), assessment of risk posture for flame trench debris, and justification of flight readiness rationale. Although the configuration of the launch pad, water and exhaust direction, and location of the Mobile Launcher Platform between the flame trench and the flight hardware should protect the Space Vehicle from debris exposure, loss of material could cause damage to a major element of the ground facility (resulting in temporary usage loss); and damage to other facility elements is possible. These are all significant risks that will impact ground operations for Constellation and development of new refractory material systems is necessary to reduce the likelihood of the foreign object debris hazard during launch. KSC is developing an alternate refractory material for the launch pad flame trench protection system, including flame deflector and flame trench walls, that will withstand launch conditions without the need for repair after every launch, as is currently the case. This paper will present a summary of the results from industry surveys, trade studies, life cycle cost analysis, and preliminary testing that have been performed to support and validate the development, testing, and qualification of new refractory materials

Biology, Ecology, and Management of Nonnative Ambrosia Beetles (Coleoptera: Curculionidae: Scolytinae) in Ornamental Plant Nurseries

Xylosandrus germanus (Blandford) and Xylosandrus crassiusculus (Motschulsky) (Coleoptera: Curculionidae: Scolytinae) are two of the most damaging nonnative ambrosia beetle pests in ornamental plant nurseries. Adult females tunnel into the stems and branches of host plants to create galleries with brood chambers. Hosts are infected with symbiotic Ambrosiella spp. fungi that serve as food for the larvae and adults. Plants can also become infected with secondary opportunistic pathogens, including Fusarium spp. Both X. germanus and X. crassiusculus have broad host ranges, and infestations can result in “toothpicks” of extruded chewed wood and sap flow associated with gallery entrances, canopy dieback, stem and trunk cankers, and plant death. Beetles efficiently locate and preferentially attack living, weakened plants, especially those physiologically stressed by flooding, inadequate drainage, frost injury, or winter injury and low temperature. Maintaining plant health is the foundation of a management plan. Vulnerable hosts can be partially protected with preventive pyrethroid applications in the spring before peak flight and attack, which are monitored using ethanol-based trapping tactics

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