Assessment and Management of Suicide Risk in Primary Care

Abstract Background Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aim To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method Data collection from clinical proformas, case records, and semi-structured face–to-face interviews with general practitioners. Results Primary and secondary care data was available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall kappa = 0.127; p = 0.10). Depression, care setting (post discharge), suicidal ideation at last contact and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices and 33% of staff received training in suicide risk assessments. Conclusion Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care

Determination of optimal conditions for pressure oxidative leaching of Sarcheshmeh Molybdenite concentrate using Taguchi method

The present research work is based on finding the optimum conditions for pressure oxidative leaching of the molybdenite concentrate to produce technical-grade molybdic oxide (MoO3) with high recovery through further treatment of the filtrate solution. The Taguchi method was used to design and minimize the number of experiments. By using Taguchi orthogonal (L25) array, five parameters (time, temperature, oxygen pressure, pulp density and acid concentration) at five levels were selected for 25 experiments. The experiments were designed and carried out in a high-pressure reactor in the presence of nitric acid as solvent and oxidizing agent for the molybdenite concentrate and its ReS2 content. The optimum conditions for pressure leaching of molybdenite were obtained through using Signal to Noise analysis and modified by using Minitab software prediction tool. Furthermore, the optimum condition for an economical pressure leaching of rhenium sulfide (ReS2) was achieved with the same process. Analysis of variance (ANOVA) showed that the pulp density is of paramount importance in this process

Primary care contact prior to suicide in individuals with mental illness

BACKGROUND: Previous studies have reported differing rates of consultation with GPs prior to suicide. Patients with a psychiatric history have higher rates of consultation and consult closer to the time of their death. AIM: To investigate the frequency and nature of general practice consultations in the year before suicide for patients in current, or recent, contact with secondary mental health services. DESIGN OF STUDY: Retrospective case-note study and semi-structured interviews. SETTING: General practices in the northwest of England. METHOD: General practice data were obtained by a retrospective review of medical records (n = 247) and semi-structured interviews with GPs (n = 159). RESULTS: GP records were reviewed in 247 of the 286 cases (86%). Overall, 91% of individuals (n = 224) consulted their GP on at least one occasion in the year before death. The median number of consultations was 7 (interquartile range = 3–10). Interviews were carried out with GPs with regard to 159 patients. GPs reported concerns about their patient's safety in 43 (27%) cases, but only 16% of them thought that the suicide could have been prevented. Agreement between GPs and mental health teams regarding risk of suicide was poor. Both sets of clinicians rated moderate to high levels of risk in only 3% of cases for whom information was available (n = 139) (overall κ = 0.024). CONCLUSION: Consultation prior to suicide is common but suicide prevention in primary care is challenging. Possible strategies might include examining the potential benefits of risk assessment and collaborative working between primary and secondary care

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

Designing Comminution Circuits with a Multi-Objective Evolutionary Algorithm

Mining is an important industry in Australia, contributing billions of dollars to the economy. The performance of a processing plant has a large impact on the profitability of a mining operation, yet plant design decisions are typically guided more by intuition and experience than by analysis. In this paper, we motivate the use of an evolutionary algorithm to aid in the design of such plants. We formalise plant design in terms suitable for application in a multi-objective evolutionary algorithm and create a simulation to assess the performance of candidate solutions. Results show the effectiveness of this approach with our algorithm producing designs superior to those used in practice today, promising significant financial benefits

Challenges in developing a generic monitoring framework for pan-European energy usage and environmental monitoring

The ability to easily monitor different aspects of the environment is essential to achieve the aspirations of smart homes, smart buildings and smart cities across Europe. A wide range of sensors are available for both the domestic and commercial markets to enable different aspects of the environment to be monitored. These sensors are disparate, requiring different interfaces and utilizing conflicting data formats. This paper reports on the development of a generic monitoring framework to capture and analyse data from ubiquitous sensing devices in smart cities. The framework has been tested by capturing energy usage data from both public and commercial buildings, and domestic homes in three cities across two European countries. Dashboards were created to enable facility managers and home owners to compare energy usage with similar buildings in different cities. The paper discusses the technical and data quality challenges encountered with capturing data from domestic and non-domestic buildings and highlights the need for a generic context framework to support monitoring and analysis of the pan-European data captured

Extra-pair parentage and personality in a cooperatively breeding bird

Why so much variation in extra-pair parentage occurs within and among populations remains unclear. Often the fitness costs and benefits of extra-pair parentage are hypothesised to explain its occurrence; therefore, linking extra-pair parentage with traits such as personality (behavioural traits that can be heritable and affect reproductive behaviour) may help our understanding. Here, we investigate whether reproductive outcomes and success are associated with exploratory behaviour in a natural population of cooperatively breeding Seychelles warblers (Acrocephalus sechellensis) on Cousin Island. Exploratory behaviour correlates positively with traits such as risk-taking behaviour and activity in other wild bird species and might promote extra-pair mating by increasing the rate at which potential extra-pair partners are encountered. We therefore predicted that fast-exploring individuals would have more extra-pair offspring. There is also a potential trade-off between pursuing extra-pair parentage and mate guarding in males. We therefore also predicted that fast-exploring males would be more likely to pursue extra-pair parentage and that this would increase the propensity of their mate to gain extra-pair parentage. We found that neither the total number of offspring nor the number of extra-pair offspring were associated with a male’s or female’s exploratory behaviour. However, there was a small but significant propensity for females to have extra-pair fertilisations in pairs that were behaviourally disassortative. Overall, we conclude that, due to the small effect size, the association between exploratory behaviour and extra-pair paternity is unlikely to be biologically relevant. Significance statement: True genetic monogamy is rare, even in socially monogamous systems, and multiple factors, such as behaviour, social structure, morphology and physiology, determined by the biological system can cause variation in extra-pair parentage (EPP). Therefore, investigating the inherent differences in these factors among individuals could be informative. We investigated whether reproductive outcomes/success are associated with differences in the propensity to explore novel environments/objects in a promiscuous, island-dwelling cooperatively breeding bird, the Seychelles warbler. Our results showed that exploratory behaviour was not associated with the number of offspring produced by an individual, and thus the long-term fitness consequences of different exploratory tendencies did not differ. We also found that the propensity to engage in EPP in females was higher in dissimilar behavioural pairs, but due to the small effect size, we hesitate to conclude that there are personality-dependent mating outcomes in the population

Rapid urbanisation and security: Holistic approach to enhancing security of urban spaces

Rapid urbanisation, particularly driven by rural-urban migration, can pose a wide range of security challenges in the global south and global north. The management of such a transition, in terms of the provision of social goods and quality of life raises significant challenges. Security of contemporary urban environments has become more complex due to a greater range of risk drivers, many of which can be exacerbated by the observed and portended impacts of climate change. This chapter outlines the phenomena underlying the transition to urbanisation - and the security challenges that have been exacerbated by these transitions. In doing so this work a holistic approach to security and highlights a gradual trend in the increased securitisation of issues (such as climate change) that in the past were not considered part of typical ‘security’ dialogues. It also introduces a decision support framework that can aid a broad range of stakeholders in making decisions about the enhancement of security of urban spaces in a context of multiple threats exacerbated by these new security challenges

Soft Targets: Nurses and the Pharmaceutical Industry

The nursing literature has yet to pay much attention to the expansive reach of the pharmaceutical industry into the nursing profession