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To address appropriateness of antibiotic use, we implemented an electronic framework to evaluate antibiotic “never events” (NEs) at 2 medical centers. Patient-level vancomycin administration records were classified as NEs or non-NEs. The objective framework allowed capture of true-positive vancomycin NEs in one-third of patients identified by the electronic strategy.
Subglacial sediments have the potential to reveal information about the controls on glacier flow, changes in ice-sheet history and characterise life in those environments. Retrieving sediments from beneath the ice, through hot water drilled access holes at remote field locations, present many challenges. Motivated by the need to minimise weight, corer diameter and simplify assembly and operation, British Antarctic Survey, in collaboration with UWITEC, developed a simple mechanical percussion corer. At depths over 1000 m however, manual operation of the percussion hammer is compromised by the lack of clear operator feedback at the surface. To address this, we present a new auto-release-recovery percussion hammer mechanism that makes coring operations depth independent and improves hammer efficiency. Using a single rope tether for both the corer and hammer operation, this modified percussion corer is relatively simple to operate, easy to maintain, and has successfully operated at a depth of >2130 m.
We present a detailed overview of the cosmological surveys that we aim to carry out with Phase 1 of the Square Kilometre Array (SKA1) and the science that they will enable. We highlight three main surveys: a medium-deep continuum weak lensing and low-redshift spectroscopic HI galaxy survey over 5 000 deg2; a wide and deep continuum galaxy and HI intensity mapping (IM) survey over 20 000 deg2 from
$z = 0.35$
to 3; and a deep, high-redshift HI IM survey over 100 deg2 from
$z = 3$
to 6. Taken together, these surveys will achieve an array of important scientific goals: measuring the equation of state of dark energy out to
$z \sim 3$
with percent-level precision measurements of the cosmic expansion rate; constraining possible deviations from General Relativity on cosmological scales by measuring the growth rate of structure through multiple independent methods; mapping the structure of the Universe on the largest accessible scales, thus constraining fundamental properties such as isotropy, homogeneity, and non-Gaussianity; and measuring the HI density and bias out to
$z = 6$
. These surveys will also provide highly complementary clustering and weak lensing measurements that have independent systematic uncertainties to those of optical and near-infrared (NIR) surveys like Euclid, LSST, and WFIRST leading to a multitude of synergies that can improve constraints significantly beyond what optical or radio surveys can achieve on their own. This document, the 2018 Red Book, provides reference technical specifications, cosmological parameter forecasts, and an overview of relevant systematic effects for the three key surveys and will be regularly updated by the Cosmology Science Working Group in the run up to start of operations and the Key Science Programme of SKA1.
Complex challenges may arise when patients present to emergency services with an advance decision to refuse life-saving treatment following suicidal behaviour.
To investigate the use of advance decisions to refuse treatment in the context of suicidal behaviour from the perspective of clinicians and people with lived experience of self-harm and/or psychiatric services.
Forty-one participants aged 18 or over from hospital services (emergency departments, liaison psychiatry and ambulance services) and groups of individuals with experience of psychiatric services and/or self-harm were recruited to six focus groups in a multisite study in England. Data were collected in 2016 using a structured topic guide and included a fictional vignette. They were analysed using thematic framework analysis.
Advance decisions to refuse treatment for suicidal behaviour were contentious across groups. Three main themes emerged from the data: (a) they may enhance patient autonomy and aid clarity in acute emergencies, but also create legal and ethical uncertainty over treatment following self-harm; (b) they are anxiety provoking for clinicians; and (c) in practice, there are challenges in validation (for example, validating the patient’s mental capacity at the time of writing), time constraints and significant legal/ethical complexities.
The potential for patients to refuse life-saving treatment following suicidal behaviour in a legal document was challenging and anxiety provoking for participants. Clinicians should act with caution given the potential for recovery and fluctuations in suicidal ideation. Currently, advance decisions to refuse treatment have questionable use in the context of suicidal behaviour given the challenges in validation. Discussion and further patient research are needed in this area.
Declaration of interest
D.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Greater Manchester Mental Health NHS Foundation Trust.
Inappropriate antibiotic use is associated with increased antimicrobial resistance and adverse events that can lead to further downstream patient harm. Preventative strategies must be employed to improve antibiotic use while reducing avoidable harm. We use the term “antibiotic never events” to globally recognize and define the most inappropriate antibiotic use.
Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.
To evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.
A multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.
In total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0–5) for the SAD PERSONS scale, to 97% (95% CI 93–99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2–47) for the Modified SAD PERSONS Scale to 47% (95% CI 41–53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50–0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69–0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P < 0.001).
Risk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.
One of the most notable currents in social, cultural and political historiography is the interrogation of the categories of 'elite' and 'popular' politics and their relationship to each other, as wellas the exploration of why and how different sorts of people engaged with politics and behaved politically. While such issues are timeless, they hold a special importance for a society experiencing rapid political and social change, like early modern England. No one has done more to define these agendas for early modern historians than John Walter. His work has been hugely influential, and at itsheart has been the analysis of the political agency of ordinary people. The essays in this volume engage with the central issues of Walter's work, ranging across the politics of poverty, dearth and household, popular political consciousness and practice more broadly, and religion and politics during the English revolution. This outstanding collection, bringing together some of the leading historians of this period with some of the field's rising stars, will appeal to anyone interested in the social, cultural and political history of early modern England or issues of popular political consciousness and behaviour more generally.
MICHAEL J. BRADDICK is professor of history at the University of Sheffield. PHIL WITHINGTON is professor of history at the University of Sheffield.
CONTRIBUTORS: Michael J. Braddick, J. C. Davis, Amanda Flather, Steve Hindle, Mark Knights, John Morrill, Alexandra Shepard, Paul Slack, Richard M. Smith, Clodagh Tait, Keith Thomas, Phil Withington, Andy Wood, Keith Wrightson.
In 1642, Anne Read's husband died of grief. In the same year, Sir Con Magennis died tormented by his evil deeds and ‘much … affrighted with the apprehension and conceipt that … Mr Tudge [a minister he had slain] was still in his presence’.Early modern people attributed huge consequence to ‘passions’ (they would not have used the word ‘emotion’) like grief, anger and fear. When uncontrolled, ‘passion’ started wars and ended life. Little wonder that contemporaries urged the restraint of potentially damaging feelings. However, there were times when emotions were particularly difficult to check.
John Walter's recent work on the collection of documents called the 1641 Depositions has assisted in building a new understanding of the outbreak of waves of violence in Ireland in 1641–2 and subsequently. The depositions contain testimonies from about 3,000 people, mostly British Protestant settlers, who had been dispossessed of their lands, homes and goods by Catholic rebels. Some had been confronted by crowds of local people, though as the rebellion continued, gentlemen tended to take over the leadership of these attacks. Either way, most of the deponents could identify at least some of those involved. The majority had been threatened with violence, and many bore tales of loss of property, personal injury and the torture and violent deaths of their family members, friends and neighbours. There were also accounts of incidents of desecration of sacred space and iconoclasm and of the deliberate humiliation of victims, who were routinely stripped and insulted. The depositions also contain a later set of ‘examinations’, usually conducted to probe particular crimes that had occurred in the early 1640s. The testimonies here included those of both settler and native witnesses and alleged perpetrators. It is no surprise, therefore, that Nicholas Canny should have described the depositions as ‘a body of material which is emotional’. Historians of the period often reflect on the emotional state of the Gaelic Irish and Old English participants, to paint a picture of simmering humiliation, shame, resentment, hostility, fear, hatred, anxiety and despair that led to outpourings of vengeful rage. Though economic and other grievances are pinpointed as arousing these emotions, they are regularly fathered above all on religion: Inga Jones argues that ‘religion has the capacity to arouse passions which go beyond what political and localist concerns can stimulate, a passion which … could and did spill over into unrestrained slaughter’.
In this study photo-identification data were used to better understand movements, population structure and abundance of common bottlenose dolphin (Tursiops truncatus) in south-west England and surrounding waters, to inform conservation efforts. A catalogue of 485 photographic sightings of 113 individuals was compiled from ~150 common bottlenose dolphin encounters made on 87 dates between March 2007 and January 2014. From these and other data, three likely sub-populations were identified in the western English Channel, demarcated by bathymetry and distance to land: (1) south-west England – inshore Cornwall to Devon, (2) offshore English/French waters and (3) inshore France from Brittany to Normandy. Maximum abundance estimates for south-west England coastal waters, using two methods, ranged between 102 and 113 (range 87–142, 95% CL) over the period 2008–2013, likely qualifying the region as nationally important, whilst the yearly maximum was 58 in 2013. The population was centred on Cornwall, where 19 well-marked animals were considered ‘probable’ residents. There were no ‘probable’ resident well-marked individuals found to be restricted to either Devon or Dorset, with animals moving freely within coastal areas across the three counties. Movements were also detected within offshore English waters and French waters (from other studies) of the western English Channel, but no interchange has as yet been detected between the three regions, highlighting the possible separation of the populations, though sample sizes are insufficient to confirm this. Given the findings, south-west England waters should be considered as a separate management unit requiring targeted conservation efforts.