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Compulsory admission is commonly regarded as necessary and justified for patients whose psychiatric condition represents a severe danger to themselves and others. However, while studies on compulsory admissions have reported on various clinical and social outcomes, little research has focused specifically on dangerousness, which in many countries is the core reason for compulsory admission.
To study changes in dangerousness over time in adult psychiatric patients admitted by compulsory court order, and to relate these changes to these patients' demographic and clinical characteristics.
In this explorative prospective observational cohort study of adult psychiatric patients admitted by compulsory court order, demographic and clinical data were collected at baseline. At baseline and at 6 and 12 month follow-up, dangerousness was assessed using the Dangerousness Inventory, an instrument based on the eight types of dangerousness towards self or others specified in Dutch legislation on compulsory admissions. We used descriptive statistics and logistic regression to analyse the data.
We included 174 participants with a court-ordered compulsory admission. At baseline, the most common dangerousness criterion was inability to cope in society. Any type of severe or very severe dangerousness decreased from 86.2% at baseline to 36.2% at 6 months and to 28.7% at 12 months. Being homeless at baseline was the only variable which was significantly associated with persistently high levels of dangerousness.
Dangerousness decreased in about two-thirds of the patients after court-ordered compulsory admission. It persisted, however, in a substantial minority (approximately one-third).
Introduction: The proportion of Canadians receiving anticoagulation medication is increasing. Falls in the elderly are the most common cause of minor head injury and an increasing proportion of these patients are prescribed anticoagulation. Emergency department (ED) guidelines advise performing a CT head scan for all anticoagulated head injured patients, but the risk of intracranial hemorrhage (ICH) after a minor head injury (patients who have a Glasgow comma score (GSC) of 15) is unclear. We conducted a systematic review and meta-analysis to determine the point incidence of ICH in anticoagulated ED patients presenting with a minor head injury. Methods: We systematically searched Pubmed, EMBASE, Cochrane database, DARE, google scholar and conference abstracts (May 2017). Experts were contacted. Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE) guidelines were followed with two authors reviewing titles, four authors reviewing full text and four authors performing data extraction. We included all prospective studies recruiting consecutive anticoagulated ED patients presenting with a head injury. We obtained additional data from the authors of the included studies on the subset of GCS 15 patients. We performed a meta-analysis to estimate the point incidence of ICH among patients with a GCS score of 15 using a random effects model. Results: A total of five studies (and 4,080 GCS 15, anticoagulated patients) from the Netherlands, Italy, France, USA and UK were included in the analysis. One study contributed 2,871 patients. Direct oral anticoagulants were prescribed in only 60 (1.5%) patients. There was significant heterogeneity between studies with regards to mechanism of injury, CT scanning and follow up method (I2 =93%). The random effects pooled incidence of ICH was 8.9% (95% CI 5.0-13.8%). Conclusion: We found little data to reflect contemporary anticoagulant prescribing practice. Around 9% of warfarinized patients with a minor head injury develop ICH. Future studies should evaluate the safety of selective CT head scanning in this population.
This collection of nineteen early English charters, in Old English and Latin, was formed in the eighteenth century, lost from sight for one hundred years in Ireland, and sent for auction in the early 1890s, when it was purchased by the Bodleian Library, Oxford. It includes original charters of Anglo-Saxon kings including Aethelstan and Aethelred, and refers to estates as far apart as Cornwall and St Albans. The documents were edited by A. S. Napier (1853–1916) and W. H. Stevenson (1858–1924), and published in 1895. The book contains thorough notes on historical and philological aspects of the texts, and a detailed index. The editors set new standards, voicing stern criticism of the pioneering works of Kemble and Birch (also reissued in this series) as regards authenticity and dating. Their work inspired new editions of the Anglo-Saxon charters, one in the first half of the twentieth century, the other still ongoing.
Geothermal energy has the potential to provide long-term, secure base-load energy and greenhouse gas (GHG) emissions reductions. Accessible geothermal energy from the Earth's interior supplies heat for direct use and to generate electric energy. Climate change is not expected to have any major impacts on the effectiveness of geothermal energy utilization, but the widespread deployment of geothermal energy could play a meaningful role in mitigating climate change. In electricity applications, the commercialization and use of engineered (or enhanced) geothermal systems (EGS) may play a central role in establishing the size of the contribution of geothermal energy to long-term GHG emissions reductions.
The natural replenishment of heat from earth processes and modern reservoir management techniques enable the sustainable use of geothermal energy as a low-emission, renewable resource. With appropriate resource management, the tapped heat from an active reservoir is continuously restored by natural heat production, conduction and convection from surrounding hotter regions, and the extracted geothermal fluids are replenished by natural recharge and by injection of the depleted (cooled) fluids.
Global geothermal technical potential is comparable to global primary energy supply in 2008. For electricity generation, the technical potential of geothermal energy is estimated to be between 118 EJ/yr (to 3 km depth) and 1,109 EJ/yr (to 10 km depth). For direct thermal uses, the technical potential is estimated to range from 10 to 312 EJ/yr. The heat extracted to achieve these technical potentials can be fully or partially replenished over the long term by the continental terrestrial heat flow of 315 EJ/yr at an average flux of 65 mW/m2.