Do GPs want or need formal support following a patient suicide?: a mixed methods study.

BACKGROUND: Patient suicide can be a devastating event for some general practitioners (GPs). Few guidelines exist to aid or support GPs in the aftermath of patient suicide. AIM: To explore GPs views on how they are affected by a patient suicide and the formal support available to them following a patient suicide. DESIGN: Questionnaires and semi-structured interviews. SETTING: General practices in the northwest of England. METHODS: About 198 semi-structured interviews were conducted as part of a retrospective study. Interviews were transcribed verbatim and analysed using descriptive statistics and a framework thematic approach. RESULTS: GPs were aged between 31 and 67 years, 144 (73%) were male and the number of years in practice varied between 8 and 40 years (median = 24 years). GPs were based at 133 (67%) urban and 65 (33%) rural practices, 30 (15%) were single-handed GP practices and 168 (85%) practices had two or more GPs. About 131 (66%) GPs reported being affected by patient suicide through feelings of grief, guilt and self-scrutiny. A greater number of years in practice may have been protective against these effects. About 54 (27%) GPs reported having mostly 'informal' support from peers or colleagues and support was less available to younger and single handed GPs. CONCLUSIONS: Our findings suggest that the majority of GPs are affected by patient suicide and most seek informal support from their peers and colleagues. Although many indicated that informal support systems were adequate and provided a protective environment, procedures should be developed to ensure the availability of guidelines for those who may require formal support

Premature death among primary care patients with a history of self-harm

PURPOSE Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. METHODS During 2001–2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice. RESULTS We found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1–4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3–86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%–7.1%) for all-cause mortality and 1.3% (95% CI, 1.2%–1.5%) for suicide. CONCLUSIONS Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches

Emergency department contact prior to suicide in mental health patients

ObjectivesTo describe attendance at emergency departments (EDs) in the year prior to suicide for a sample of mental health patients. To examine the characteristics of those who attended (particularly those who attended frequently) prior to suicide.DesignCase review of ED records for 286 individuals who died within 12 months of mental health contact in North West England (2003-2005).MethodCases identified through the National Confidential Inquiry into Suicide were checked against regional EDs to establish attendance in the year prior to death. Records were examined to establish the number of attendances, reason for the final, non-fatal attendance, treatment offered and outcome.ResultsOne hundred and twenty-four (43%) individuals had attended the ED at least once in the year prior to their death, and of these, 35 (28%) had attended the ED on more than three occasions. These frequent attenders died by suicide significantly sooner after their final, non-fatal attendance than other attenders. A clinical history of alcohol misuse was also associated with early death following ED attendance.ConclusionsOver 40% of our clinical sample attended an ED in the year prior to death, and some individuals attended particularly frequently. EDs may therefore represent an important additional setting for suicide prevention in mental health patients. The majority of attendances prior to suicide were for self-harm or to request psychiatric help. Clinicians should be alert to the risk associated with such presentations and to the possible association between frequent attendance and suicide

Multi-objective shop floor scheduling using monitored energy data

Modern factories will become more and more directly connected to intermittent energy sources like solar systems or wind turbines as part of a smart grid or a self-sufficient supply. However, solar systems or wind turbines are not able to provide a continuous energy supply over a certain time period. In order to enable an effective use of these intermittent energy sources without using temporary energy storages, it is necessary to rapidly and flexibly adapt the energy demand of the factory to the constantly changing requirements of the energy supply. The adaption of the energy demand to the intermittent supply results in different energy-related objectives for the production system of the factory, such as reducing energy consumption, avoiding power peaks, or achieving a power use within the available power supply. Shop Floor Scheduling can help to pursue these objectives within the production system. For this purpose, a solution methodology based on a meta-heuristic will be described for Flexible Job Shop Scheduling taking into account different energy- as well as productivity-related objectives

Shuttle Entry Air Data System (SEADS) hardware development. Volume 2: History

Hardware development of the Shuttle Entry Air Data System (SEADS) is described. The system consists of an array of fourteen pressure ports, installed in an Orbiter nose cap, which, when coupled with existing fuselage mounted static pressure ports permits computation of entry flight parameters. Elements of the system that are described include the following: (1) penetration assemblies to place pressure port openings at the surface of the nose cap; (2) pressure tubes to transmit the surface pressure to transducers; (3) support posts or manifolds to provide support for, and reduce the length of, the individual pressure tubes; (4) insulation for the manifolds; and (5) a SEADS nose cap. Design, analyses, and tests to develop and certify design for flight are described. Specific tests included plasma arc exposure, radiant thermal, vibration, and structural. Volume one summarizes highlights of the program, particularly as they relate to the final design of SEADS. Volume two summarizes all of the Vought responsible activities in essentially a chronological order

Shuttle Entry Air Data System (SEADS) hardware development. Volume 1: Summary

Hardware development of the Shuttle Entry Data System (SEADS) is described. The system consists of an array of fourteen pressure ports, installed in an Orbiter nose cap, which, when coupled with existing fuselage mounted static pressure ports permits computation of entry flight parameters. Elements of the system that are described include the following: (1) penetration assemblies to place pressure port openings at the surface of the nose cap; (2) pressure tubes to transmit the surface pressure to transducers; (3) support posts or manifolds to provide support for, and reduce the length of, the individual pressure tubes; (4) insulation for the manifolds; and (5) a SEADS nose cap. Design, analyses, and tests to develop and certify design for flight are described. Specific tests include plasma arc exposure, radiant thermal, vibration, and structural. Volume one summarizes highlights of the program, particularly as they relate to the final design of SEADS. Volume two summarizes all of the Vought responsible activities in essentially a chronological order

Simvastatin improves the sexual health-related quality of life in men aged 40 years and over with erectile dysfunction : Additional data from the Erectile Dysfunction and Statin trial

© 2014 Trivedi et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background: Erectile dysfunction is prevalent in men over 40 years, affecting their quality of life and that of their partners. The aims of this study were:a)To evaluate the internal reliability of the male erectile dysfunction specific quality of life (MED-QoL) scale and explore its factor structure.b)To evaluate the effect of simvastatin on subscales of the MED-QoL in men over forty years with erectile dysfunction. Methods: This is a double blind randomised controlled trial of 40 mg simvastatin or placebo given once daily for six months to men over forty years with untreated erectile dysfunction, who were not at high cardiovascular risk and were not on anti-hypertensive or lipid-lowering medication. 173 eligible men were recruited from 10 general practices in East of England. Data were collected at two points over 30 weeks. We report on the factor structure of MED-QoL, the internal reliability of the scale and the derived subscales, and the effect of simvastatin on MED-QoL subscales. Results: An initial analysis of the MED-QoL items suggested that a number of items should be removed (MED-QoL-R). Exploratory factor analysis identified three subscales within the MED-QoL-R which accounted for 96% of the variance, related to feelings of Control, initiating Intimacy, and Emotional response to erectile dysfunction. The alpha value for the revised scale (MED-Qol-R) was >0.95 and exceeded .82 for each subscale. Regression analysis showed that patients in the placebo group experienced a significantly reduced feeling of Control over erectile dysfunction than those in the statin group. Those in the placebo group had significantly lower Emotional response than those in the statin group at the close of trial, but there was no significant treatment effect on Intimacy. Conclusions: Our revised MED-QoL-R identified three subscales. Secondary analysis showed a significant improvement in sexual health related quality of life, specifically in relation to perception of control and emotional health in men with untreated erectile dysfunction given 40 mg simvastatin for six months. Trial registration: Current Controlled Trials ISRCTN66772971.Peer reviewe

Integrating personality research and animal contest theory: aggressiveness in the green swordtail <i>Xiphophorus helleri</i>

&lt;p&gt;Aggression occurs when individuals compete over limiting resources. While theoretical studies have long placed a strong emphasis on context-specificity of aggression, there is increasing recognition that consistent behavioural differences exist among individuals, and that aggressiveness may be an important component of individual personality. Though empirical studies tend to focus on one aspect or the other, we suggest there is merit in modelling both within-and among-individual variation in agonistic behaviour simultaneously. Here, we demonstrate how this can be achieved using multivariate linear mixed effect models. Using data from repeated mirror trials and dyadic interactions of male green swordtails, &lt;i&gt;Xiphophorus helleri&lt;/i&gt;, we show repeatable components of (co)variation in a suite of agonistic behaviour that is broadly consistent with a major axis of variation in aggressiveness. We also show that observed focal behaviour is dependent on opponent effects, which can themselves be repeatable but were more generally found to be context specific. In particular, our models show that within-individual variation in agonistic behaviour is explained, at least in part, by the relative size of a live opponent as predicted by contest theory. Finally, we suggest several additional applications of the multivariate models demonstrated here. These include testing the recently queried functional equivalence of alternative experimental approaches, (e. g., mirror trials, dyadic interaction tests) for assaying individual aggressiveness.&lt;/p&gt

A hybrid actuator disc - full rotor CFD methodology for modelling the effects of wind turbine wake interactions on performance

The performance of individual wind turbines is crucial for maximum energy yield, however, their performance is often reduced when turbines are placed together in an array. The wake produced by the rotors interacts with downstream turbines, resulting in a reduction in power output. In this paper, we demonstrate a new and faster modelling technique which combines actuator disc theory, modelled using wind tunnel validated Computational Fluid Dynamics (CFD), and integrated into full rotor CFD simulations. This novel hybrid of techniques results in the ability to analyse performance when simulating various array layouts more rapidly and accurately than using either method on its own. It is shown that there is a significant power reduction from a downstream turbine that is subjected to the wake of an upstream turbine, and that this is due to both a reduction in power in the wind and also due to changes in the aerodynamics. Analysis of static pressure along the blade showed that as a result of wake interactions, a large reduction in the suction peak along the leading edge reduced the lift generated by the rotor and so reduced the torque production and the ability for the blade to extract energy from the wind

Identification of Radiopure Titanium for the LZ Dark Matter Experiment and Future Rare Event Searches

The LUX-ZEPLIN (LZ) experiment will search for dark matter particle interactions with a detector containing a total of 10 tonnes of liquid xenon within a double-vessel cryostat. The large mass and proximity of the cryostat to the active detector volume demand the use of material with extremely low intrinsic radioactivity. We report on the radioassay campaign conducted to identify suitable metals, the determination of factors limiting radiopure production, and the selection of titanium for construction of the LZ cryostat and other detector components. This titanium has been measured with activities of $^{238}$U$_{e}$~$<$1.6~mBq/kg, $^{238}$U$_{l}$~$<$0.09~mBq/kg, $^{232}$Th$_{e}$~$=0.28\pm 0.03$~mBq/kg, $^{232}$Th$_{l}$~$=0.25\pm 0.02$~mBq/kg, $^{40}$K~$<$0.54~mBq/kg, and $^{60}$Co~$<$0.02~mBq/kg (68\% CL). Such low intrinsic activities, which are some of the lowest ever reported for titanium, enable its use for future dark matter and other rare event searches. Monte Carlo simulations have been performed to assess the expected background contribution from the LZ cryostat with this radioactivity. In 1,000 days of WIMP search exposure of a 5.6-tonne fiducial mass, the cryostat will contribute only a mean background of $0.160\pm0.001$(stat)$\pm0.030$(sys) counts.Comment: 13 pages, 3 figures, accepted for publication in Astroparticle Physic