Reducing the Risk of Suicide on an Inpatient Acute Behavioral Health Unit

Evidence suggest for those who have successfully committed suicide in the form of asphyxiation inside locked facilities are more than likely due to patient bathroom doors. The current unit consists of 30 inpatient medical-psychiatric beds serving the adult and geriatric populations. The goal is to ensure patient safety by removing patient bathroom doors and replacing them with breakaway shower curtains for those exhibiting direct signs and symptoms of suicidal ideations with a plan. The specific aim is to improve patient outcomes by decreasing the number of deaths or attempted suicides. With great results, this type of project has been implemented within other acute psychiatric settings, which is considered best practice in acute mental health. Suicide has ranked in the top five most frequently reported events to the Joint Commission since 1995 (Joint Commission, 2010). A random sample questionnaire was distributed to 20 fulltime behavioral health registered nurses, which yielded16 completed questionnaires. Of the 16 completed questionnaires, 13 of the nurses (81%) were in favor of this project. Nurses play a crucial role in making recommendations for the design of psychiatric units, not only in securing the units but also in creating a culture of safety. References American Nurses Association. (2015). Nursing world. Florence Nightingale Pledge. Retrieved on October 28, 2015, from: http://www.nursingworld.org/FlorenceNightingalePledge Bowers, L., Dack, C., Gul, N., Thomas, B., & James, K. (2011). Learning from prevented suicide in psychiatric inpatient care: An analysis of data from the National Patient Safety Agency. International Journal Of Nursing Studies, 481459-1465. Cardell, R., Bratcher, K., & Quinnett, P. (2009). Revisiting \u27suicide proofing\u27 an inpatient unit through environmental safeguards: a review. Perspectives In Psychiatric Care, 45(1), 36-44. Hunt, I. M., Bickley, H., Windfuhr, K., Shaw, J., Appleby, L., & Kapur, N. (2013). Suicide in recently admitted psychiatric in-patients: A case-control study. Journal Of Affective Disorders, (1-2), 123. Joint Commission Resources. (2007). Suicide prevention: Toolkit for implementing national patient safety goal 15A. Oakbrook Terrace, IL: Author. Tishler, C., & Reiss, N. (2009). Inpatient suicide: preventing a common sentinel event. General Hospital Psychiatry, 31(2), 103-10

Changes over time in socioeconomic inequalities in breast and rectal cancer survival in England and Wales during a 32-year period (1973-2004): the potential role of health care.

BACKGROUND: Socioeconomic inequalities in cancer survival are well documented but they vary for different cancers and over time. Reasons for these differences are poorly understood. PATIENTS AND METHODS: For England and Wales, we examined trends in socioeconomic survival inequalities for breast cancer in women and rectal cancer in men during the 32-year period 1973-2004. We used a theoretical framework based on Victora's 'inverse equity' law, under which survival inequalities could change with the advent of successive new treatments, of varying effectiveness, which are disseminated with different speed among patients of different socioeconomic groups. We estimated 5-year relative survival for patients of different deprivation quintiles and examined trends in survival inequalities in light of major treatment innovations. RESULTS: Inequalities in breast cancer survival (921,611 cases) narrowed steadily during the study (from -10% to -6%). In contrast, inequalities in rectal cancer survival (187,104 cases) widened overall (form -5% to -11%) with fluctuating periods of narrowing inequality. CONCLUSIONS: Trends in socioeconomic differences in tumour or patient factors are unlikely explanations of observed changes over time in survival inequalities. The sequential introduction into clinical practice of new treatments of progressively smaller incremental benefit may partly explain the reduction in inequality in breast cancer survival

Hall-effect evolution across a heavy-fermion quantum critical point

A quantum critical point (QCP) develops in a material at absolute zero when a new form of order smoothly emerges in its ground state. QCPs are of great current interest because of their singular ability to influence the finite temperature properties of materials. Recently, heavy-fermion metals have played a key role in the study of antiferromagnetic QCPs. To accommodate the heavy electrons, the Fermi surface of the heavy-fermion paramagnet is larger than that of an antiferromagnet. An important unsolved question concerns whether the Fermi surface transformation at the QCP develops gradually, as expected if the magnetism is of spin density wave (SDW) type, or suddenly as expected if the heavy electrons are abruptly localized by magnetism. Here we report measurements of the low-temperature Hall coefficient ($R_H$) - a measure of the Fermi surface volume - in the heavy-fermion metal YbRh2Si2 upon field-tuning it from an antiferromagnetic to a paramagnetic state. $R_H$ undergoes an increasingly rapid change near the QCP as the temperature is lowered, extrapolating to a sudden jump in the zero temperature limit. We interpret these results in terms of a collapse of the large Fermi surface and of the heavy-fermion state itself precisely at the QCP.Comment: 20 pages, 3 figures; to appear in Natur

Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample

Background: While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP). Methods: Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks). Results: The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 – 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 – 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 – 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 – 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 – 1.07, p = 0.74). Conclusions: Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised

Connecting the Holographic and Wilsonian Renormalization Groups

Inspired by the AdS/CFT correspondence, we develop an explicit formal duality between the planar limit of a d-dimensional gauge theory and a classical field theory in a (d+1)-dimensional anti-de Sitter space. The key ingredient is the identification of fields in AdS with generalized Hubbard-Stratonovich transforms of single-trace couplings of the QFT. We show that the Wilsonian renormalization group flow of these transformed couplings matches the holographic (Hamilton-Jacobi) flow of bulk fields along the radial direction in AdS. This result allows one to outline an AdS/CFT dictionary that does not rely on string theory.Comment: 11 pages, 1 figure; metadata modified in v2; added references and minor changes in v3; v4 as published in JHE

BRCA1 and BRCA2 mutations in a population-based study of male breast cancer

Background: The contribution of BRCA1 and BRCA2 to the incidence of male breast cancer (MBC) in the United Kingdom is not known, and the importance of these genes in the increased risk of female breast cancer associated with a family history of breast cancer in a male first-degree relative is unclear. Methods: We have carried out a population-based study of 94 MBC cases collected in the UK. We screened genomic DNA for mutations in BRCA1 and BRCA2 and used family history data from these cases to calculate the risk of breast cancer to female relatives of MBC cases. We also estimated the contribution of BRCA1 and BRCA2 to this risk. Results: Nineteen cases (20%) reported a first-degree relative with breast cancer, of whom seven also had an affected second-degree relative. The breast cancer risk in female first-degree relatives was 2.4 times (95% confidence interval [CI] = 1.4–4.0) the risk in the general population. No BRCA1 mutation carriers were identified and five cases were found to carry a mutation in BRCA2. Allowing for a mutation detection sensitivity frequency of 70%, the carrier frequency for BRCA2 mutations was 8% (95% CI = 3–19). All the mutation carriers had a family history of breast, ovarian, prostate or pancreatic cancer. However, BRCA2 accounted for only 15% of the excess familial risk of breast cancer in female first-degree relatives. Conclusion: These data suggest that other genes that confer an increased risk for both female and male breast cancer have yet to be found

On The Stability Of Non-Supersymmetric AdS Vacua

We consider two infinite families of Non-Supersymmetric $AdS_4$ vacua, called Type 2) and Type 3) vacua, that arise in massive IIA supergravity with flux. We show that both families are perturbatively stable. We then examine non-perturbative decays of these vacua to other supersymmetric and non-supersymmetric $AdS_4$ vacua mediated by instantons in the thin wall approximation. We find that many decays are ruled out since the tension of the interpolating domain wall is too big compared to the energy difference in AdS units. In fact, within our approximations no decays of Type 2) vacua are allowed, although some decays are only marginally forbidden. This can be understood in terms of a "pairing symmetry" in the landscape which relate Type 2) vacua with supersymmetric ones of the same energy.Comment: 50 pages, Minor changes in section 2.2.

Molecular and clinical predictors of improvement in progression-free survival with maintenance PARP inhibitor therapy in women with platinum-sensitive, recurrent ovarian cancer: A meta-analysis

BACKGROUND: The authors performed a meta‐analysis to better quantify the benefit of maintenance poly(ADP‐ribose) polymerase inhibitor (PARPi) therapy to inform practice in platinum‐sensitive, recurrent, high‐grade ovarian cancer for patient subsets with the following characteristics: germline BRCA mutation (gBRCAm), somatic BRCA mutation (sBRCAm), wild‐type BRCA but homologous recombinant‐deficient (HRD), homologous recombinant‐proficient (HRP), and baseline clinical prognostic characteristics. METHODS: Randomized trials comparing a PARPi versus placebo as maintenance treatment were identified from electronic databases. Treatment estimates of progression‐free survival were pooled across trials using the inverse variance weighted method. RESULTS: Four trials included 972 patients who received a PARPi (olaparib, 31%; niraparib, 35%; or rucaparib, 34%) and 530 patients who received placebo. For patients who had germline BRCA1 mutation (gBRCAm1) (N = 471), the hazard ratio (HR) was 0.29 (95% CI, 0.23‐0.37); for those who had germline BRCA2 mutation (gBRCAm2) (N = 236), the HR was 0.26 (95% CI, 0.17‐0.39); and, for those who had sBRCAm (N = 123), the HR was 0.22 (95% CI, 0.12‐0.41). The treatment effect was similar between the gBRCAm and sBRCAm subsets (P = .48). In patients who had wild‐type BRCA HRD tumors (excluding sBRCAm; N = 309), the HR was 0.41 (95% CI, 0.31‐0.56); and, in those who had wild‐type BRCA HRP tumors (N = 346), the HR was 0.64 (95% CI, 0.49‐0.83). The relative treatment effect was greater for the BRCAm versus HRD (P = .03), BRCAm versus HRP (P < .00001), and HRD versus HRP (P < .00001) subsets. There was no difference in benefit based on age, response after recent chemotherapy, and prior bevacizumab. CONCLUSIONS: In platinum‐sensitive, recurrent, high‐grade ovarian cancer, maintenance PARPi improves progression‐free survival for all patient subsets. PARPi therapy has a similar magnitude of benefit for sBRCAm and gBRCAm. Although patients with BRCAm derive the greatest benefit, the absence of a BRCAm or HRD could not be used to exclude patients from maintenance PARPi therapy

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning