Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment

Background A National Clinical Programme for the Management of Hospital-Presenting Self-Harm (NCP-SH) was introduced in Ireland in 2014. This involved the development of a model of care to standardise the management of self-harm in emergency departments, to be delivered by dedicated clinical nurse specialists. The core components of the programme were to: ensure an empathic and timely response, conduct a biopsychosocial assessment, involve family members in assessment and discharge planning, and provide a bridge to next care. The overall aim of the programme was to reduce the rate of repeat self-harm. This multistage study will evaluate the impact of the NCP-SH on hospital-presenting self-harm and to identify determinants influencing its implementation. Methods Employing a sequential mixed methods design, the first stage will use data from the National Self-Harm Registry Ireland to examine the impact of the NCP-SH on self-harm repetition, along with other aspects of care, including provision of psychosocial assessments and changes in admissions and postdischarge referrals. A cost-effectiveness analysis will assess the cost per repeat self-harm attendance avoided as a result of the NCP-SH. The second stage will identify the influences of implementation fidelity—adherence to the programme’s core components—using a combination of document analysis and semistructured interviews with staff of the programme, guided by the Consolidated Framework for Implementation Research. Ethics and dissemination This study has received full ethical approval and will run until August 2023. This study is novel in that it will identify important factors influencing successful implementation of complex programmes. It is expected that the findings will provide important learnings for the integration of mental health services in general hospital settings and will be disseminated via peer-review publications along with reports for clinicians and policy-makers

A survey and classification of software-defined storage systems

The exponential growth of digital information is imposing increasing scale and efficiency demands on modern storage infrastructures. As infrastructure complexity increases, so does the difficulty in ensuring quality of service, maintainability, and resource fairness, raising unprecedented performance, scalability, and programmability challenges. Software-Defined Storage (SDS) addresses these challenges by cleanly disentangling control and data flows, easing management, and improving control functionality of conventional storage systems. Despite its momentum in the research community, many aspects of the paradigm are still unclear, undefined, and unexplored, leading to misunderstandings that hamper the research and development of novel SDS technologies. In this article, we present an in-depth study of SDS systems, providing a thorough description and categorization of each plane of functionality. Further, we propose a taxonomy and classification of existing SDS solutions according to different criteria. Finally, we provide key insights about the paradigm and discuss potential future research directions for the field.This work was financed by the Portuguese funding agency FCT-Fundacao para a Ciencia e a Tecnologia through national funds, the PhD grant SFRH/BD/146059/2019, the project ThreatAdapt (FCT-FNR/0002/2018), the LASIGE Research Unit (UIDB/00408/2020), and cofunded by the FEDER, where applicable

Generalized high availability via virtual machine replication

Allowing applications to survive hardware failure is a expensive undertaking, which generally involves re-engineering software to include complicated recovery logic as well as deploying special-purpose hardware; this represents a severe barrier to improving the dependability of large or legacy applications. We describe the construction of a general and transparent high-availability service that allows existing, unmodified software to be protected from the failure of the physical machine on which it runs. Remus provides an extremely high degree of fault tolerance, to the point that a running system can transparently continue execution on an alternate physical host in the face of failure with only seconds of downtime, completely preserving host state such as active network connections. We describe our approach, which encapsulates protected software in a virtual machine, asynchronously propagates VM state to a backup host at frequencies as high as forty times a second, and uses speculative execution to concurrently run the active VM slightly ahead of the replicated system state.Science, Faculty ofComputer Science, Department ofGraduat

Extending systems with virtual hardware aggregation

Hardware has physical limitations. It has fixed performance limits, and may fail. Applications suffer from the limitations of the physical hardware on which they run. Making applications able to take advantage of multiple hardware instances to avoid these limitations is complex. Since this effort must be expended for every application, it is impractical for most of them. In this thesis, we show that we can aggregate multiple physical machines at the virtual machine interface, allowing them to transcend the limitations of single machines without changing the applications themselves.Science, Faculty ofComputer Science, Department ofGraduat