Interventions to reduce suicides at suicide hotspots: a systematic review

Background: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. Methods. We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?'. Results: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. Conclusions: More well-designed intervention studies are needed to strengthen this evidence base. © 2013 Cox et al.; licensee BioMed Central Ltd.published_or_final_versio

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety

An artificial X-ray wire test emitter and calculations on the resolution and field of view of X-ray pinhole optics by simulation

The PENELOPE Monte Carlo simulation code was used to evaluate pinhole mask parameters for X-ray backscatter imaging in a security application. This work makes four major contributions: it describes a convenient efficient test object for evaluating X-ray optics, it converts the PENELOPE output into a simulated CCD image, it compactly outlines how image characteristics can be simply and reproducibly quantified, and it gives guidance on suitable materials and geometries for pinhole masks for X-ray imaging that could be applied to more complicated X-ray optics, such as coded masks. A novel test object X-ray emitter with the shape of a thin wire was specifically designed to explore the effect of mask material thickness and pinhole aperture diameter on image quality. Setting the test object to be the X-ray emitter rather than being a passive scatterer increases computational speed. The photon energy distribution of the artificial test object was set flat between selected energy limits to avoid the model being specific to any particular X-ray source technology. The modelled detector is an array of 1040 x 1392 pixels’ area detector inside a lead-lined camera housing. The pixelated detector was modelled by digitising the surface area represented by the PENELOPE phase space file and integrating the energies of the photons impacting each pixel with MATLAB code. The pinhole must be wide enough for sufficient field of view, whilst narrow enough for sufficient spatial resolution and the mask material needs to be thick enough to absorb most X-rays. When the mask material was too thick and the aperture too narrow, a collimation effect occurred. The consequence of excess collimation in a coded aperture is partial coding giving poor image reconstruction. Pure tungsten appears the most versatile material tested, where a 2 mm thickness and 2 mm aperture gives the most appropriate image characteristics for X-ray security imaging

How was it for you? Experiences of participatory design in the UK health service

Improving co-design methods implies that we need to understand those methods, paying attention to not only the effect of method choices on design outcomes, but also how methods affect the people involved in co-design. In this article, we explore participants' experiences from a year-long participatory health service design project to develop ‘Better Outpatient Services for Older People’. The project followed a defined method called experience-based design (EBD), which represented the state of the art in participatory service design within the UK National Health Service. A sample of participants in the project took part in semi-structured interviews reflecting on their involvement in and their feelings about the project. Our findings suggest that the EBD method that we employed was successful in establishing positive working relationships among the different groups of stakeholders (staff, patients, carers, advocates and design researchers), although conflicts remained throughout the project. Participants' experiences highlighted issues of wider relevance in such participatory design: cost versus benefit, sense of project momentum, locus of control, and assumptions about how change takes place in a complex environment. We propose tactics for dealing with these issues that inform the future development of techniques in user-centred healthcare design

Low open fraction coded masks for x-ray backscatter imaging

Previous research has indicated that coded masks with open fractions <0.5 are optimal for imaging some types of far-field scenes. The open fraction, in this case, refers to the ratio of open elements in the mask, with values <0.5 considered as low open fraction. Research is limited by the sparsity of <0.5 open fractions masks; thus a further 94 lower open fraction arrays are calculated and presented. These include the dilute uniformly redundant array and singer set, along with information on imaging potential, array sizes, and open fractions. Signal-to-noise ratio reveals the 0.5 open fraction modified uniformly redundant array to be the optimal coded mask for near-field x-ray backscatter imaging, over the lower open fraction singer set, dilute uniformly redundant and random arra

Data citizenship: rethinking data literacy in the age of disinformation, misinformation, and malinformation

In this paper we examine what ‘data literacy’ – under various definitions – means at a time of persistent distribution of ‘dis-/mis-/mal-information’ via digital media. The paper first explores the definition of literacies (written, media, information, digital and data literacies) considering the various parameters and considerations they have gone through. We then examine the intersection of dis-/mis-/mal-information and ‘fake-news’ and these literacies. The paper explores what types of literacies are needed today and the important role of variations in citizens' social context. We highlight three main gaps in current data literacy frameworks – 1. going beyond the individual; 2. critical thinking of the online ecosystem; and 3. designing skills for proactive citizens. We discuss these gaps while highlighting how we integrated these into our survey of UK citizens' data literacies as part of our Nuffield Foundation funded project - Me and My Big Data. By discussing our theoretical and methodological challenges we aim to shed light on not only how the definition of data literacy changes but also how we can develop education programmes that take into account information distortions and put proactive citizens at the centre

Mainstreamed Genetic Testing in Ovarian Cancer: Patient Experience of the Testing Process

Objective: Pathogenic BRCA variants account for between 5.8-24.8% of ovarian cancers. The identification of such a variant can have a significant impact on the affected individual and their relatives – determining eligibility for targeted therapies, predicting treatment response and granting access to disease prevention strategies. Cancer services are responding to the increased demand for genetic testing with the introduction of mainstreamed genetic testing via oncology clinics. The study aimed to evaluate patient experience of the mainstreamed genetic testing pathway at a tertiary referral centre in London. / Methods: Study participants were patients diagnosed with high-grade non-mucinous ovarian cancer, tested via a mainstreamed genetic testing pathway at the tertiary referral centre between February 2015 and June 2017. Eligible participants were invited to complete the retrospective study questionnaire. Five quantitative measures with additional free-text items evaluated the patient experience of mainstreamed genetic testing. / Results: The tertiary referral centre tested 170 ovarian cancer patients. Twenty-three pathogenic BRCA mutations were identified (23/170, 13.5%). One-hundred and six patients (106/170, 62.4%) met the study inclusion criteria. Twenty-nine of those invited (29/106, 27.4%) to participate returned the retrospective study questionnaire. Pathogenic BRCA1/2 variants were identified within four respondents (4/29, 13.8%). Motivations for genetic testing related to improved medical management, and the ability to provide relatives with genetic information. Participants did not appear to be adversely affected by result disclosure post mainstreamed genetic testing. Two individuals with a pathogenic variant reported that the support provided by the tertiary referral centre post-result disclosure could have been improved. / Conclusion: Results of the current study support further psychosocial research into the expansion of the mainstreamed genetic testing pathway. The results although promising have also highlighted the importance of genetic awareness within the multidisciplinary team and the provision of timely psychological support from genetic specialists

Neither bones nor feet: track morphological variation and “preservation quality”

As purely sedimentary structures, fossil footprints are all about shape. Correctly interpreting the significance of their surface topography requires understanding the sources of morphological variation. Differences among specimens are most frequently attributed to either taxonomy (trackmaker) or to preservation quality. “Well-preserved” tracks are judged more similar to pedal anatomy than “poorly preserved” ones, but such broad-brush characterizations confound two separate episodes in a track’s history. Current evaluations of track quality fail to distinguish among behavioral, formational, intravolumetric, and post-formational sources of variation. Based on analogy with body fossils, we recommend restricting assessments of track preservation quality to modifications that take place only after a track is created. Ichnologists need to try to parse the relative influence of factors affecting disparity, but we currently lack an adequate vocabulary to describe the overall shapes and specific features of formational variants

Dinosaur tracks from the Kilmaluag Formation (Bathonian, Middle Jurassic) of Score Bay, Isle of Skye, Scotland, UK

Tracks of a juvenile theropod dinosaur with footprint lengths of between 2 and 9 cm as well as adults of the same ichnospecies with footprints of about 15–25 cm in length were found in the Bathonian (Middle Jurassic) Kilmaluag Formation of Score Bay, northwestern Trotternish Peninsula, Isle of Skye, Scotland, UK. Two footprint sizes occur together on the same bedding plane in the central portion of Score Bay, both in situ and on loose blocks. Another horizon containing footprints above this was also identified. The footprints from the lowest horizon were produced in a desiccated silty mud that was covered with sand. A close association of both adults and juveniles with similar travel direction indicated by the footprints may suggest post-hatching care in theropod dinosaurs. Other footprints, produced on a rippled sandy substrate, have been found on the slightly higher bedding plane at this locality. Loose blocks found 130 m to the northeast in the central part of Score Bay have not been correlated with any in situ sediments, but were preserved in a similar manner to those from the higher bedding plane. These tracks represent the youngest dinosaur remains yet found in Scotland