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Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.
Our primary objective was to determine whether cognitive–behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide.
A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline.
A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.
Psychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.
Declaration of interest
The trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.
Sulfur loss from the surface of MoS2(0001) is observed following the adsorption of methanol on MoS2 at 86 K and subsequent annealing of MoS2 near 300 K. This sulfur loss, at the MoS2 surface, leads to suppression of inverse photoemission features characteristic of the unoccupied states associated with MoS2. This sulfur loss is counteracted by further annealing to 350 K, as is evident in the temperature dependent sulfur to molybdenum integrated X-ray photoemission intensity ratios near 300 to 350 K. Upon further annealing to 350 K, inverse photoemission additionally indicates a reestablishment of characteristic features associated with the unoccupied states of MoS2. These results are indicative of sulfur segregation to the surface and compensation of surface vacancy sites.
We built an app to help clients of food pantries. The app offers vegetable-based recipes, food tips and no-cost strategies for making mealtimes healthier and for bargain-conscious grocery shopping, among other themes. Users customize materials to meet their own preferences. The app, available in English and Spanish, has been tested in a randomized field trial.
A randomized controlled trial with repeated measures across 10 weeks.
Clients of fifteen community food pantry distributions in Los Angeles County, USA.
Distributions were randomized to control and experimental conditions, and 289 household cooks and one of their 9–14-year-old children were enrolled as participants. Experimental dyads were given a smartphone with our app and a phone use-plan, then trained to use the app. ‘Test vegetables’ were added to the foods that both control and experimental participants received at their pantries.
After 3–4 weeks of additional ‘test vegetables’, cooks at experimental pantries had made 38 % more preparations with these items than control cooks (P = 0·03). Ten weeks following baseline, experimental pantries also scored greater gains in using a wider assortment of vegetables than control pantries (P = 0·003). Use of the app increased between mid-experiment and final measurement (P = 0·0001).
The app appears to encourage household cooks to try new preparation methods and widen their incorporation of vegetables into family diets. Further research is needed to identify specific app features that contributed most to outcomes and to test ways in which to disseminate the app widely.
Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers’ levels of evidence. Randomized controlled trials were assessed for bias according to the Cochrane Collaboration Tool and Cohort studies were evaluated for bias using the Newcastle-Ottawa Scale. We performed univariate meta-regression analysis in an attempt to identify a relationship between VTEp timing and hemorrhagic progression and assess study heterogeneity using an I2 statistic. Results: Twenty-one studies were included in the systematic review. Eighteen total studies demonstrated that VTEp postinjury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration 24 to 72 hours postinjury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive intracranial hemorrhage. Overall, meta-regression analysis demonstrated that there was no relationship between rate of hemorrhagic progression and VTEp timing. Conclusions: Literature suggests that administering VTEp 24 to 48 hours postinjury may be safe for patients with low-hemorrhagic-risk TBIs and stable injury on repeat imaging.
Challenging behaviour, especially in intellectual disability, covers a
wide range that is in need of further evaluation.
To develop a short but comprehensive instrument for all aspects of
In the first part of a two-stage enquiry, a 28-item scale was constructed
to examine the components of challenging behaviour. Following a simple
factor analysis this was developed further to create a new short scale,
the Problem Behaviour Checklist (PBCL). The scale was subsequently used
in a randomised controlled trial and tested for interrater reliability.
Scores were also compared with a standard scale, the Modified Overt
Aggression Scale (MOAS).
Seven identified factors – personal violence, violence against property,
self-harm, sexually inappropriate, contrary, demanding and disappearing
behaviour – were scored on a 5-point scale. A subsequent factor analysis
with the second population showed demanding, violent and contrary
behaviour to account for most of the variance. Interrater reliability
using weighted kappa showed good agreement (0.91; 95% CI 0.83–0.99). Good
agreement was also shown with scores on the MOAS and a score of 1 on the
PBCL showed high sensitivity (97%) and specificity (85%) for a threshold
MOASscore of 4.
The PBCL appears to be a suitable and practical scale for assessing all
aspects of challenging behaviour.
When the agricultural value chain involves profit making, it results in changes in the production and distribution relationships among men and women in terms of access to and control of markets, resources and benefits emanating from product value chain participation. This affects not only individual incomes but also gender equality. This study examined gender relationships in the cassava value chain in the Kigoma region of Tanzania. The aim was to assess gender participation in the cassava value chain. Multi-stage sampling was used to select the respondents in four districts. A structured questionnaire was administered to 384 randomly selected household heads. A chi-square test was used to test for significant relationships among the variables. Results indicated that gender was significantly related to socio-economic characteristics. About 34% of the women participating in the cassava value chain were young, some below 17 years of age. There were significant relationships between gender and access to resources (land, extension services and markets), control over resources (land, house and household assets) and benefits (revenue) generated from cassava value chains. Overall, there was gender disparity in participation along the cassava value chain. These results suggest that any intervention in the cassava value chain should consider gender relations to benefit men and women and alleviate household poverty.
OBJECTIVES/SPECIFIC AIMS: Patients with locally advanced pancreatic cancer typically have poor outcomes, with a median survival of ~16 months. Novel methods to improve local control are needed. Nab-paclitaxel (abraxane) has shown efficacy in pancreatic cancer and is FDA approved for metastatic disease in combination with gemcitabine. Nab-paclitaxel is also a promising radiosensitizer based on laboratory studies, but it has never been clinically tested with definitive radiotherapy for locally advanced disease. METHODS/STUDY POPULATION: We performed a phase 1 study using a 3+3 dose-escalation strategy to determine the safety and tolerability of dose escalated nab-paclitaxel with fractionated radiotherapy for patients with unresectable or borderline resectable pancreatic cancer. Following induction chemotherapy with 2 cycles of nab-paclitaxel and gemcitabine, patients were treated with weekly nab-paclitaxel and daily radiotherapy to a dose of 52.5 Gy in 25 fractions. Final dose-limiting toxicity (DLT) determination was performed at day 65 after the start of radiotherapy. RESULTS/ANTICIPATED RESULTS: Nine patients received nab-paclitaxel at a dose level of either 100 mg/m2 (n=3) or 125 mg/m2 (n=6). One DLT (grade 3 neuropathy) was observed in a patient who received 125 mg/m2 of nab-paclitaxel. Other grade 3 toxicities included fatigue (11%), anemia (11%), and neutropenia (11%). No grade 4 toxicities were observed. With a median follow-up of 8 months (range 5–28 months), median survival was 19 months and median progression-free survival was 10 months. Following chemoradiation, 3 patients underwent surgical resection, all with negative margins and limited tumor viability. Of the 3 patients, 2 initially had borderline resectable tumors and 1 had an unresectable tumor. Tumor (SMAD-4, Caveolin-1) and peripheral (circulating tumor cells and microvesicles) biomarkers were collected and are being analyzed. DISCUSSION/SIGNIFICANCE OF IMPACT: The combination of fractionated radiation and weekly nab-paclitaxel was safe and well tolerated. This regimen represents a potentially promising therapy for patients with unresectable and borderline resectable pancreatic cancer and warrants further investigation.
Failure of metallic materials due to plastic and/or creep deformation occur by the emergence of necking, microvoids, and cracks at heterogeneities in the material microstructure. While many traditional deformation modeling approaches have difficulty capturing these emergent phenomena, the discrete element method (DEM) has proven effective for the simulation of materials whose properties and response vary over multiple spatial scales, e.g., bulk granular materials. The DEM framework inherently provides a mesoscale simulation approach that can be used to model macroscopic response of a microscopically diverse system. DEM naturally captures the heterogeneity and geometric frustration inherent to deformation processes. While DEM has recently been adapted successfully for modeling the fracture of brittle solids, to date it has not been used for simulating metal deformation. In this paper, we present our progress in reformulating DEM to model the key elastic and plastic deformation characteristics of FCC polycrystals to create an entirely new crystal plasticity modeling methodology well-suited for the incorporation of heterogeneities and simulation of emergent phenomena.
The evaluation tool was first derived from the formerly Consortium of British Humanitarian Agencies’ (CBHA; United Kingdom), now “Start Network’s,” Core Humanitarian Competency Framework and formatted in an electronic data capture tool that allowed for offline evaluation. During a 3-day humanitarian simulation event, participants in teams of eight to 10 were evaluated individually at multiple injects by trained evaluators. Participants were assessed on five competencies and a global rating scale. Participants evaluated both themselves and their team members using the same tool at the end of the simulation exercise (SimEx).
All participants (63) were evaluated. A total of 1,008 individual evaluations were completed. There were 90 (9.0%) missing evaluations. All 63 participants also evaluated themselves and each of their teammates using the same tool. Self-evaluation scores were significantly lower than peer-evaluations, which were significantly lower than evaluators’ assessments. Participants with a medical degree, and those with humanitarian work experience of one month or more, scored significantly higher on all competencies assessed by evaluators compared to other participants. Participants with prior humanitarian experience scored higher on competencies regarding operating safely and working effectively as a team member.
This study presents a novel electronic evaluation tool to assess individual performance in five of six globally recognized humanitarian competency domains in a 3-day humanitarian SimEx. The evaluation tool provides a standardized approach to the assessment of humanitarian competencies that cannot be evaluated through knowledge-based testing in a classroom setting. When combined with testing knowledge-based competencies, this presents an approach to a comprehensive competency-based assessment that provides an objective measurement of competency with respect to the competencies listed in the Framework. There is an opportunity to advance the use of this tool in future humanitarian training exercises and potentially in real time, in the field. This could impact the efficiency and effectiveness of humanitarian operations.
EvansAB, HulmeJM, NugusP, CranmerHH, CoutuM, JohnsonK. An Electronic Competency-Based Evaluation Tool for Assessing Humanitarian Competencies in a Simulated Exercise. Prehosp Disaster Med. 2017;32(3):253–260.
The romantic musicals that paired Fred Astaire and Ginger Rogers in the mid-1930s did much to rescue the financially troubled RKO studio from the bankruptcy it had declared in the depths of the Great Depression. From The Gay Divorcee (1934) to Swing Time (1936) the six movies in which they starred all made handsome profits. The most lucrative of these, Top Hat, broke box-office records at Radio City, taking $350,000 in its first three weeks, and was the second-highest grossing film of 1935. In the respected Quigley poll of Hollywood's top box-office stars, Astaire and Rogers ranked fourth in 1935, third in 1936, and seventh in 1937 (all years when Shirley Temple was at number one).
Among the first to blend musical duets and solos into the unfolding relationships of the principal characters, the Astaire/Rogers films mediate notions of selfhood, sexuality and national identity. The glamour and charm of the central couple, the dazzling décor, and the brilliance of the song and dance routines projected the wish-fulfilment fantasies of Depression-audiences. In some of their best films – The Gay Divorcee, Top Hat, Swing Time and Shall We Dance – the couple's personification of wide-ranging questions of self and society is nuanced by the contribution of the comic secondary character players such as Helen Broderick, Edward Everett Horton, Eric Blore, Erik Rhodes and Victor Moore, who refine the ideology of individual or national identity and, especially, of romantic love through badinage, displays of affection and comic turns. Honouring a tradition found in stage as well as film comedy that gently mocks the high-fl own fantasies of the lovers, the secondary characters in the Astaire/Rogers films sometimes additionally gesture to the hardships of the Depression, as when in Swing Time the famished ‘Pop’ (Victor Moore) wolfs the club sandwich brought for her lunch by Mabel (Helen Broderick), or when, in the same film, the Dance Academy director (Eric Blore) threatens everyone with the sack if they do not step up to the mark.
Described by Arlene Croce as a ‘key film’, and by John Mueller as the film that established Astaire and Rogers as a team, Roberta features none of the comic secondary performers found in the aforementioned films.