Emergency department contact prior to suicide in mental health patients

ObjectivesTo describe attendance at emergency departments (EDs) in the year prior to suicide for a sample of mental health patients. To examine the characteristics of those who attended (particularly those who attended frequently) prior to suicide.DesignCase review of ED records for 286 individuals who died within 12 months of mental health contact in North West England (2003-2005).MethodCases identified through the National Confidential Inquiry into Suicide were checked against regional EDs to establish attendance in the year prior to death. Records were examined to establish the number of attendances, reason for the final, non-fatal attendance, treatment offered and outcome.ResultsOne hundred and twenty-four (43%) individuals had attended the ED at least once in the year prior to their death, and of these, 35 (28%) had attended the ED on more than three occasions. These frequent attenders died by suicide significantly sooner after their final, non-fatal attendance than other attenders. A clinical history of alcohol misuse was also associated with early death following ED attendance.ConclusionsOver 40% of our clinical sample attended an ED in the year prior to death, and some individuals attended particularly frequently. EDs may therefore represent an important additional setting for suicide prevention in mental health patients. The majority of attendances prior to suicide were for self-harm or to request psychiatric help. Clinicians should be alert to the risk associated with such presentations and to the possible association between frequent attendance and suicide

North-South Distribution of Solar Flares during Cycle 23

In this paper, we investigate the spatial distribution of solar flares in the northern and southern hemisphere of the Sun that occurred during the period 1996 to 2003. This period of investigation includes the ascending phase, the maximum and part of descending phase of solar cycle 23. It is revealed that the flare activity during this cycle is low compared to previous solar cycle, indicating the violation of Gnevyshev-Ohl rule. The distribution of flares with respect to heliographic latitudes shows a significant asymmetry between northern and southern hemisphere which is maximum during the minimum phase of the solar cycle. The present study indicates that the activity dominates the northern hemisphere in general during the rising phase of the cycle (1997-2000). The dominance of northern hemisphere is shifted towards the southern hemisphere after the solar maximum in 2000 and remained there in the successive years. Although the annual variations in the asymmetry time series during cycle 23 are quite different from cycle 22, they are comparable to cycle 21.Comment: 6 pages, 2 figures, 1 table; Accepted for the publication in the proceedings of international solar workshop held at ARIES, Nainital, India on "Transient Phenomena on the Sun and Interplanetary Medium" in a special issue of "Journal of Astrophysics and Astronomy (JAA)

Is knife seizure imagery an effective crime deterrent? A multi-method study

The urgency to reduce knife carrying has been recognised by the police services in Scotland and has been addressed by the introduction of various initiatives to deter knife carrying and crime. One tactic includes the sharing of knife seizure images, where pictures of knives recovered by police are shared on media outlets, however, little research has explored whether this is an effective deterrent. The study sought to explore adults' views of the use of knife images as a deterrent to carrying knives utilising a multi-method approach: (1) a cross-sectional online survey (n= 553), and (2) individual, online semi-structured interviews with adults (n = 20). Fearful, worried and angry reactions towards the use of knife seizure images were expressed among adults and concern was raised that the use of such images may reinforce rather than deter knife carrying. Adults expressed concerns that the use of such images served to reinforce negative stereotypes and stigma within communities affected by high knife crime. The implications of these findings emphasise the limitations to the use of knife seizure images as a deterrent against knife carrying and the importance of community involvement in developing preventative and non-discriminatory approaches to tackling knife carrying throughout Scotland

DEVELOPMENT OF A FAST MICRON-RESOLUTION BEAM POSITION MONITOR SIGNAL PROCESSOR FOR LINEAR COLLIDER BEAMBASED FEEDBACK SYSTEMS

We present the design of a prototype fast beam position monitor (BPM) signal processor for use in inter-bunch beam-based feedbacks for linear colliders and electron linacs. We describe the FONT4 intra-train beam-based digital position feedback system prototype deployed at the Accelerator test facility (ATF) extraction line at KEK, Japan. The system incorporates a fast analogue beam position monitor front-end signal processor, a digital feedback board, and a fast kicker-driver amplifier. The total feedback system latency is less than 150ns, of which less than 10ns is used for the BPM processor. We report preliminary results of beam tests using electron bunches separated by c. 150ns. Position resolution of order 1 micron was obtained

BEAM TEST RESULTS WITH THE FONT4 ILC PROTOTYPE INTRA-TRAIN BEAM FEEDBACK SYSTEM

We present the design and beam test results of a prototype beam-based digital feedback system for the Interaction Point of the International Linear Collider. A custom analogue front-end processor, FPGA-based digital signal processing board, and kicker drive amplifier have been designed, built, and tested on the extraction line of the KEK Accelerator Test Facility (ATF). The system was measured to have a latency of approximately 140 ns

Latest Beam Test Results of the FONT4 ILC Intra-train Feedback System Prototype

We present the design and preliminary results of a prototype beam-based digital feedback system for the Interaction Point of the International Linear Collider. A custom analogue front-end processor, FPGA-based digital signal processing board, and kicker drive amplifier have been designed, built, and tested on the extraction line of the KEK Accelerator Test Facility (ATF). The system was measured to have a latency of approximately 140 ns.Comment: 4 pages, 6 figures, Proceedings of LCWS/ILC0

Are images of seized knives an effective crime deterrent? Views of young people within the Scottish context

The urgency to reduce knife carrying has been recognised by police services within Scotland and has been addressed by initiatives such as the sharing of knife seizure images on media outlets. This study sought to explore young peoples' views on the use of knife seizure images as a deterrent to carrying knives by using comparative individual interviews (N = 20) with photo elicitation. Three themes were discovered: (1) negative reactions towards images of seized knives, (2) images of knives may encourage rather than deter knife carrying, and (3) reinforcement of existing beliefs, stereotypes and stigma. These findings highlight the limitations of using knife seizure images as a deterrent and the importance of involving young people in developing preventative and non-discriminatory approaches to tackling knife crime

Community Occupational Therapy in Dementia intervention for people with mild to moderate dementia and their family carers in the UK: the VALID research programme including RCT

BACKGROUND: People with dementia find it increasingly difficult to carry out daily activities (activities of daily living), and may require increasing support from family carers. Researchers in the Netherlands developed the Community Occupational Therapy in Dementia intervention, which was delivered in 10 1-hour sessions over 5 weeks to people with dementia and their family carers at home. Community Occupational Therapy in Dementia was found to be clinically effective and cost-effective. OBJECTIVES: Translate and adapt Community Occupational Therapy in Dementia to develop the Community Occupational Therapy in Dementia - the UK version intervention and training programme and to optimise its suitability for use within the UK. To estimate the clinical effectiveness and cost-effectiveness of Community Occupational Therapy in Dementia - the UK version for people with mild to moderate dementia and their family carers compared with treatment as usual. DESIGN: The development phase used mixed methods to develop Community Occupational Therapy in Dementia - the UK version: translation, expert review, and adaptation of the manual and training materials; training occupational therapists; focus groups and interviews, including occupational therapists, managers, people with dementia and family carers; consensus conference; and an online survey of occupational therapists to scope UK practice. A multicentre, two-arm, parallel-group, single-blind individually randomised pragmatic trial was preceded by an internal pilot. Pairs were randomly allocated between Community Occupational Therapy in Dementia - the UK version and treatment as usual. A cost–utility analysis, fidelity study and qualitative study were also completed. SETTING: Community services for people with dementia across England. PARTICIPANTS: People with mild to moderate dementia recruited in pairs with a family carer/supporter. INTERVENTIONS: Community Occupational Therapy in Dementia - the UK version is an activity-based, goal-setting approach for people with dementia and family carers, and is delivered at home by an occupational therapist for 10 hours over 10 weeks. Treatment as usual comprised the usual local service provision, which may or may not include standard occupational therapy. MAIN OUTCOMES MEASURES: Data were collected through interviews conducted in person with dyads at baseline and at 12 and 26 weeks post randomisation, and then over the telephone with a reduced sample of just carers at 52 and 78 weeks post randomisation. The primary outcome was the Bristol Activities of Daily Living Scale at 26 weeks. The secondary outcomes were as follows: person with dementia – cognition, activities of daily living, quality of life and mood; carer – sense of competence, quality of life and mood; all participants – social contacts, leisure activities and serious adverse events. RESULTS: The Community Occupational Therapy in Dementia manual and training materials were translated and reviewed. In total, 44 occupational therapists were trained and delivered Community Occupational Therapy in Dementia to 130 pairs. A total of 197 occupational therapists completed the survey, of whom 138 also provided qualitative data. In total, 31 people attended the consensus conference. Community Occupational Therapy in Dementia - the UK version has more flexibility than Community Occupational Therapy in Dementia in terms of content and delivery; for example, occupational therapists can use the wider range of assessment tools that are already in regular use within UK practice and the time span for delivery is 10 weeks to better meet the needs of pairs and be more feasible for services to deliver. In total, 31 occupational therapists provided Community Occupational Therapy in Dementia - the UK version within the randomised controlled trial. A total of 468 pairs were randomised (249 pairs to Community Occupational Therapy in Dementia - the UK version, 219 pairs to treatment as usual). People with dementia ranged in age from 55 to 97 years (mean 78.6 years), and family carers ranged in age from 29 to 94 years (mean 69.1 years). The majority of those with dementia (74.8%) were married; 19.2% lived alone. Most family carers (72.6%) were spouses but 22.2% were adult children. At 26 weeks, 406 (87%) pairs remained in the trial, and the Bristol Activities of Daily Living Scale total score did not differ at the 5% level when comparing groups (adjusted mean difference estimate 0.35, 95% confidence interval –0.81 to 1.51; p = 0.55). The adjusted (for baseline Bristol Activities of Daily Living Scale total score and randomised group) intracluster correlation coefficient estimate at week 26 was 0.043. There were no significant differences in secondary outcomes. At 52 and 78 weeks, there were no differences between the two groups in Bristol Activities of Daily Living Scale total score and secondary outcomes. The probability that Community Occupational Therapy in Dementia - the UK version is cost-effective at a threshold of willingness to pay per quality-adjusted life-year of £20,000 is 0.02%. In the qualitative interviews, participants reported positive benefits and outcomes. Of the 249 pairs allocated to Community Occupational Therapy in Dementia - the UK version, 227 reached the goal-setting phase, and 838 of the 920 goals set (90.8%) were fully or partially achieved. LIMITATIONS: The development phase took longer than estimated because of translation time and organisational delays in delivering the intervention. Recruitment to the randomised controlled trial took longer than expected. Fidelity overall was moderate, with variation across sites and therapists. It is possible that Community Occupational Therapy in Dementia - the UK version did not work well in the UK service model in which usual care differs from that in the Netherlands. CONCLUSIONS: This programme used a rigorous process to develop Community Occupational Therapy in Dementia - the UK version but found no statistical evidence of clinical effectiveness or cost-effectiveness compared with usual care. Qualitative findings provided positive examples of how Community Occupational Therapy in Dementia - the UK version had enabled people to live well with dementia. FUTURE WORK: Developing tools to measure more meaningful outcomes, such as goals achieved or the quantity and quality of activity participation, with less reliance on proxy data, to collect the views and experiences of people with dementia themselves. TRIAL REGISTRATION: This trial was registered as ISRCTN10748953 (WP3 and WP4). FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information