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Frequent attenders to the Accident & Emergency (A&E) can cause a huge burden on the services.
Objectives
To screen this group of patients for any previous existing psychiatric background as well as to identify patients with Medically Unexplained Physical Symptoms (MUPS) in order to sign post them to the appropriate services and to create a joint management plan with the A&E department.
Aims
Not different from the objectives.
Method
The list top 52 frequent attenders to two busy A&E departments in the North East of England for the period between Jan-Jun 2012, was obtained. Their records been verified on PARIS (the local Psychiatric Services Electronic Notes System) looking for at least one previous encounter with the services, if the patient was open to mental health and if the patient was care coordinated during that period. Diagnosis, history of substance misuse and significant alerts as well as housing were recorded. For the MUPS main reason for presentation was recorded. Joint care plan with A&E was also verified.
Results
This group generated 851 attendance to A&E during this period. Mean attendance 16 (12-41). Nearly 80% of the sample had at least one encounter with the psychiatric services. 40% were actively open to the services. 18 patients were care cordinated. 30% had significant alert to harm others. 9 patients in total were classified as homeless.
Conclusion
Significant number of regular patients at the A&E department have psychiatric background. There was limitation in identifying MUPS due to anomalies in coding.
Through the lens of lesbian and gay parenthood we ask how individuals who experience “legal status ambiguity”—that which emerges when legal fluctuations combine with divided attitudes, ignorance of the law, and autonomous institutional gatekeepers—exercise their legal rights and responsibilities. The results from thirty-one interviews with lesbian and gay parents in Oregon and their six adult children suggest that the state's fluctuating legal and social climates for lesbian and gay parenting between 1985 and 2013 presented significant challenges for two generations of same-sex parents. Although both cohorts created and utilized a range of legal and social mechanisms to assert their legal rights, they found these rights to be controlled as much by gatekeeper perspectives as by legal force. After the 2015 Obergefell ruling on marriage equality, lesbian and gay parenting status remains a site of ongoing legal and social contestation, providing insight into the risks and challenges of legal status ambiguity.
A cryogenic plant will be installed at the National Synchrotron Light Source II (NSLS-II) to supply the liquid helium for six superconducting cavities. This paper describes the configuration of the cryogenic plant and the main design considerations for selecting equipment and components.
National Synchrotron Light Source II (NSLS-II) will be a 3-GeV, 792-m circumference third-generation synchrotron radiation facility with ultralow emittance and extremely high brightness. Front ends are required to transmit synchrotron radiation from the storage ring to the beam line while providing equipment and personnel protection. There will be up to 57 front ends in the NSLS-II facility with six in the baseline. Original designs are being developed and will be manufactured for three non-canted in-vacuum undulators, one canted in-vacuum undulator, one elliptically polarized undulator and one damping wiggler. Bending magnet and three-pole wiggler front ends are also being designed. Power densities range from 0.3 to 89.8 kW mrad−2, with total powers ranging from 0.34 to 64.5 kW. All components intercepting synchrotron radiation are water cooled and were analysed to confirm acceptable thermal limits.
Heroes play collectivist or individualist roles in imagination and self-development. Representations of heroic figures in questionnaires given to French (n = 241) and Spanish (n = 227) samples of 10 and 15-year-olds were examined to assess the extent that heroes originated in digital media, and whether they were proximal or distal personalities. There is strong evidence that heroes in this sample were largely learned about in digital media (France 45%, Spain 50%): family and community heroes were a minority (France 11%, Spain 9%). Male heroes were more important to Spanish participants compared to their French peers. The acquisition sequence for hero type reported in the pre-television era, proximal (family and community) to distal (beyond the neighbourhood), is reversed in this study. Generally, 10-year-olds preferred heroes with collectivist qualities and 15 year olds with individualised qualities. Findings are discussed in terms of the emergence of social capital.
This volume features a distinguished, international group of scholars and practitioners who provide a comparative account of ethics regulations across four Western democracies: the United States, the United Kingdom, Canada, and Italy. They situate conflict-of-interest regulations within a broader discourse involving democratic theory; identify the structural, political, economic, and cultural factors that have contributed to the development of these regulations over time; and assess the extent to which these efforts have succeeded or failed across and within different branches and systems of government. Collectively, they provide an invaluable survey of the development, function, and impact of conflict-of-interest regimes in public life.
By
Bruce E. Cain, Robson Professor of Political Science, University of California at Berkeley; Director, University of California's Washington Center,
Alison L. Gash,
Mark J. Oleszek, Doctoral candidate in American politics, University of California at Berkeley
If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed; and in the next place oblige it to control itself.
James Madison, Federalist No. 51
In an effort to oblige the United States government to control itself, the Framers of the Constitution divided its legislative, executive, and judicial responsibilities into three distinct but inter-related branches. James Madison, the principal architect of the Constitution, viewed men as instruments of their own desires, and this Hobbesian understanding of human nature was the dominant one among participants at the Constitutional Convention. In the Framers' view, if ambitions for power remained unchecked, then public officials would expand their powers at the expense of the public good. The constitutionally mandated separation of powers and the various requirements for cooperation in national policy making among the legislative, executive, and judicial branches of government were written into the Constitution to minimize concentrations of power and the potential for the misuse of public office.
The Framers also added several specific provisions to limit the potential for conflicts of interest to color decision making by elected officials. One provision bars federal officials from accepting gifts, employments, or titles from foreign governments.