bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Affect in Suicidal Thoughts and Behaviors
Authors: Yamokoski Cynthia A. , Scheel Karen R. , Rogers James R.
Published: May 2011

Risk factors, theoretical explanations, and treatment suggestions for suicidal behaviors have historically focused largely on cognitions, but a more comprehensive picture may be provided by examining the role of affect in suicidal thoughts and behaviors. In the current study the link between affect and suicide within the theoretical framework of the circumplex model was examined empirically. Data from 104 participants demonstrated that both positive and negative affect are related to suicidal thoughts and behaviors, and that affect provided additional information about suicidality over and above the cognitive variable of hopelessness. The findings support that suicidal risk assessment may be enhanced by evaluating both hopelessness and affect, and that negative affect, in particular, is important to address in the treatment of suicidal individuals.
Marital Breakdown, Shame, and Suicidality in Men: A Direct Link?
Authors: Kõlves Kairi , Ide Naoko , De Leo Diego
Published: May 2011

The influence of feelings of shame originating from marital breakdown on suicidality is examined. The role of mental health problems as probable mediating factors is also considered. Internalized shame, state (related to separation) shame, and mental health problems were significantly correlated with the score for suicidality during separation in both genders. Tested structural equation model indicated that internalized shame was not directly linked to suicidality, but was mediated either by state shame or mental health problems in males in the context of separation. Our findings seem to indicate that separated males are more vulnerable to the experience of state shame in the context of separation, which might lead to the development of suicidality.
The Role of Optimism in the Interpersonal‐Psychological Theory of Suicidal Behavior
Authors: Rasmussen Kathy A. , Wingate LaRicka R.
Published: May 2011

A possible relationship between Joiner’s (2005) interpersonal‐psychological theory of suicidal behavior and optimism was investigated by examining the ability of optimism to act as a moderator of perceived burdensomeness, thwarted belongingness, and acquired capability to engage in self‐injury in the prediction of suicidal ideation. Results supported hypotheses that optimism would serve as a moderator of the effects of thwarted belongingness and perceived burdensomeness in the prediction of suicidal ideation; however, similar results were not found regarding the acquired capability to engage in self‐injury. How optimism might play a role in alleviating suicidal ideation and clinical implications of the findings are discussed.
Do Suicides’ Characteristics Influence Survivors’ Emotions?
Authors: Schneider Barbara , Grebner Kristin , Schnabel Axel , Georgi Klaus
Published: May 2011

The suicide of a related person can often induce severe negative emotional reactions. The objective of this study was to explore the relationships between sociodemographic and diagnostic data of suicides and survivors’ emotions and to close this substantial gap. The main outcome of this study was that survivors’ severity of emotional disturbance was inversely correlated with age of suicides. In the multivariable approach, only age remained related to the majority of the assessed survivors’ emotions, whereas other characteristics, such as gender, presence of psychiatric disorder, or suicide method were not associated with survivors’ emotions. Age had a dominant impact on the relationship between suicides’ characteristics and survivors’ emotional reactions and supersedes the effect of most suicides’ characteristics including diagnoses.
Sex Differences in Childhood Sexual Abuse and Suicide‐Related Behaviors
Authors: Rhodes Anne E. , Boyle Michael H. , Tonmyr Lil , Wekerle Christine , Goodman Deborah , Leslie Bruce , Mironova Polina , Bethell Jennifer , Manion Ian
Published: May 2011

Child sexual abuse and suicide‐related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross‐sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.
Characteristics and VA Health Care Utilization of U.S. Veterans Who Completed Suicide in Oregon Between 2000 and 2005
Authors: Basham Chandra , Denneson Lauren M. , Millet Lisa , Shen Xun , Duckart Jonathan , Dobscha Steven K.
Published: May 2011

Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty‐two percent had received health care in the VA system. Of these, 57% did not have mental health diagnoses and 58% had not seen mental health professionals. A larger proportion of those who accessed care were VA‐enrolled and received service‐connected disability benefits. Fifty‐five veterans were hospitalized during the year prior to death. Of these, 33% completed suicide within 30 days of a hospitalization. Further development of suicide prevention strategies for veterans in the community, including general medical treatment settings, is indicated.
Sadness, Suicide, and Their Association with Video Game and Internet Overuse among Teens: Results from the Youth Risk Behavior Survey 2007 and 2009
Authors: Messias Erick , Castro Juan , Saini Anil , Usman Manzoor , Peeples Dale
Published: May 2011

We investigated the association between excessive video game/Internet use and teen suicidality. Data were obtained from the 2007 and 2009 Youth Risk Behavior Survey (YRBS), a high school‐based, nationally representative survey (N = 14,041 and N = 16,410, respectively). Teens who reported 5 hours or more of video games/Internet daily use, in the 2009 YRBS, had a significantly higher risk for sadness (adjusted and weighted odds ratio, 95% confidence interval = 2.1, 1.7–2.5), suicidal ideation (1.7, 1.3–2.1), and suicide planning (1.5, 1.1–1.9). The same pattern was found in the 2007 survey. These findings support an association between excessive video game and Internet use and risk for teen depression and suicidality.
Risk for Suicidal Ideation and Suicide Attempts Associated with Co‐occurring Depression and Conduct Problems in Early Adolescence
Authors: Vander Stoep Ann , Adrian Molly , Mc Cauley Elizabeth , Crowell Sheila E. , Stone Andrea , Flynn Cynthia
Published: May 2011

This study investigates the early manifestation of co‐occurring depression and conduct problems as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self‐reported symptoms of depression and conduct problems were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct problem symptoms only, or low psychopathology, those with co‐occurring depression and conduct problem symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.
Familism, Family Environment, and Suicide Attempts among Latina Youth
Authors: Peña Juan B. , Kuhlberg Jill A. , Zayas Luis H. , Baumann Ana A. , Gulbas Lauren , Hausmann‐Stabile Carolina , Nolle Allyson P.
Published: May 2011

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight‐knit, intermediate‐knit, and loose‐knit. Tight‐knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate‐knit families or loose‐knit families. Moreover, familism increased the odds of being in a tight‐knit family versus a loose‐knit family and the odds of being in a tight‐knit family versus a intermediate‐knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.
Perceived Racism, Discrimination, and Acculturation in Suicidal Ideation and Suicide Attempts among Black Young Adults
Authors: Castle Kathryn , Conner Kenneth , Kaukeinen Kimberly , Tu Xin
Published: May 2011

During young adulthood the suicide rate among Blacks rises dramatically and approaches that of the U.S. general population, requiring that prevention efforts include a focus on Black young adults. Although most research on suicidality among Blacks has focused on risk factors observed in the dominant culture, in this study the authors examined associations between perceived discrimination, racism, and acculturation with lifetime suicidal ideation (SI) and suicide attempt (SA) among Black young adults. Two hundred fifty Black or African American individuals aged 18–24 residing in a midsize northeastern city were recruited to participate through advertisements. Participants filled out self‐report questionnaires. Logistic regressions were used to examine the association of each predictor with SI and SA. Greater perceived acculturation was associated with SI in univariate and multivariate models. There were no other statistically significant results concerning the predictors of interest. The link between perceived acculturation and SI is consistent with limited available data, indicating the need for further study including the potential mechanism(s) for the association. Limitations include the cross‐sectional design and reliance on subjective measures.
Rate, Relative Risk, and Method of Suicide by Students at 4‐Year Colleges and Universities in the United States, 2004–2005 through 2008–2009
Authors: Schwartz Allan J.
Published: May 2011

A total of 622 suicides were reported among students attending 645 distinct campuses from 2004–2005 through 2008–2009. Adjusting for gender in the population at risk of 14.9 million student‐years and for the source of these data, the student suicide rate of 7.0 was significantly and substantially lower than for a matched national sample. Suicide rates by firearm were significantly and substantially lower for both female and male students. Hanging was significantly and substantially lower for male students, less prominently so for female students. It is principally the ninefold decrease in the availability of firearms on campuses (vs. homes) and secondarily other features of the campus environment that are the bases for lower student suicide rates.
Prevalence and Correlates of Suicidal Behavior among Adult Female Victims of Intimate Partner Violence
Authors: Cavanaugh Courtenay E. , Messing Jill Theresa , Del‐Colle Melissa , O’Sullivan Chris , Campbell Jacquelyn C.
Published: May 2011

The prevalence and correlates of suicidal threats and attempts among 662 racially and ethnically diverse adult female victims of intimate partner violence (IPV) were studied. One in five women had threatened or attempted suicide during her lifetime. They observed that multiple logistic regression results indicated that women at greater risk of severe or potentially lethal assaults as measured by the Danger Assessment and those who reported having a chronic or disabling illness were more likely to have threatened or attempted suicide. A linear association was found between age and suicide threats/attempts, with younger women having increased odds. Finally, African American IPV victims were less likely to have threatened or attempted suicide as compared to Latina victims. Study implications are discussed.
Suicidal Behavior and Firearm Access: Results from the Second Injury Control and Risk Survey
Authors: Betz Marian E. , Barber Catherine , Miller Matthew
Published: May 2011

The association between home firearms and the likelihood and nature of suicidal thoughts and plans was examined using the Second Injury Control and Risk Survey, a 2001–2003 representative telephone survey of U.S. households. Of 9,483 respondents, 7.4% reported past‐year suicidal thoughts, 21.3% with a plan. Similar proportions of those with and without a home firearm reported suicidal thoughts, plans, and attempts. Among respondents with suicidal plans, the odds of reporting a plan involving a firearm were over seven times greater among those with firearms at home, compared with those without firearms at home. The results suggest people with home firearms may not be more likely to be suicidal, but when suicidal they may be more likely to plan suicide by firearm.
Don't worry, be constructive: A randomized controlled feasibility study comparing behaviour therapy singly and combined with constructive worry for insomnia
Authors: Jansson‐Fröjmark Markus , Lind Marcus , Sunnhed Rikard
Published: May 2011

Objectives. Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry (CW) intervention adds to the effects of behaviour therapy (BT).

Design. A randomized, controlled design was used. The design included a 2‐week baseline, a 4‐week intervention phase (sleep restriction and stimulus control [BT] or sleep restriction and stimulus control plus constructive worry [BT + CW]), and a 2‐week follow‐up.

Methods. Twenty‐two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index (ISI), and the Work and Social Adjustment Scale (WSAS).

Results. Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time (TWT) and total sleep time (TST). Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT + CW led to a larger decrease in insomnia severity at all three time points (controlled d= 1.10–1.68). In comparison with BT, BT + CW resulted in a larger reduction in worry at two of the time points (controlled d= 0.76–1.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT + CW (80–100%) than in the BT condition (18–27%), none of the participants remitted.

Conclusions. The findings suggest that, compared to BT alone, CW might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow‐up, future studies are warranted.
Self‐knowledge in childhood: Relations with children's imaginary companions and understanding of mind
Authors: Davis Paige E. , Meins Elizabeth , Fernyhough Charles
Published: May 2011

Relations between interior self‐knowledge and (a) imaginary companion (IC) status and (b) theory of mind (ToM) abilities were investigated in a sample (N= 80) of 4‐ to 7‐year‐olds. Interior self‐knowledge was assessed in terms of the extent to which children acknowledged that they (rather than an adult) were the authority on unobservable aspects of themselves (e.g., dreaming, thinking, hunger). Compared with children without an IC, those who possessed a parentally corroborated IC ascribed less interior self‐knowledge to an adult, with a trend for them to assign more interior self‐knowledge to themselves. Children's interior self‐knowledge judgments were not associated with their ToM performance. IC status was also unrelated to ToM performance. We consider how having an IC may provide children with opportunities to distinguish between knowledge that is inaccessible to an external observer and that which an external observer may glean without being told.
Can infants’ orientation to social stimuli predict later joint attention skills?
Authors: Schietecatte Inge , Roeyers Herbert , Warreyn Petra
Published: May 2011

From the moment infants are born, they seem to prefer orienting to social stimuli, over objects and non‐social stimuli. This preference lasts throughout adulthood and is believed to play a crucial role in social‐communicative development. By following up a group of infants at the age of 6, 8, and 12 months, this study explored the role of social orienting in the early development of joint attention skills. The expected association between social orienting and joint attention was partially confirmed. Social orienting in real‐life photographs of everyday situations was not related to later joint attention skills, however fixation to the eyes in a neutral face was related to response to joint attention skills, and fixation to the eyes in a dynamic video clip of a talking person was predictive of initiating joint attention skills. Several alternative interpretations of the results are discussed.
Numerical Investigation on Heat Transfer and Residual Stress in a Butt Welded Plate
Authors: Kumaresan D. , Asraff A. K. , Muthukumar R.
Published: May 2011

It is a well known fact that during welding, the metal at the welding zone gets melted and then solidifies, which results in shrinkage in all directions. Residual strain and stress distributions coming from shrinking are largely influenced by the nature and configuration of the welding process, metallurgical characteristics of weld, and the geometrical shape of the weld joint. The residual stress mainly depends on the thermal history cycle through which the specimen undergoes in the welding process. So these thermal history cycles are to be known in order to get a better knowledge of the welding phenomenon and to minimize the risk of failures. In this work, a detailed analysis has been carried out for predicting the heat flow pattern and stress distribution in an aluminum alloy plate during welding. In this study, the modified double ellipsoidal heat source distribution pattern is modeled and considered for the weld pool design. Elastic-plastic material properties at various temperatures are also considered for simulation. A detailed finite element analysis is carried out to predict the welding residual stress. In this, thermal analysis is carried out for actual variable welding speed and these transient thermal histories at various locations were numerically predicted and compared with experimental results. Further, these thermal results are used to predict the residual stress on the weld plate using finite element method.
Permeability Measurement of Graphite Compression Packings
Authors: Lasseux Didier , Jolly Pascal , Jannot Yves , Omnes Emmanuel Sauger Benoit
Published: May 2011

In this work, we address the issue of the sealing performance of ring-shape valve compression packings. Our analysis is focused on the characterization of the permeability of the rings made of die-formed exfoliated graphite. Because of the tight character of the material, significant Klinkenberg effects are expected. In addition, due to the manufacturing process, permeabilities kz and kr as well as Klinkenberg coefficients bz and br in the respective axial and radial directions are markedly different and strongly dependent upon the applied stress. A specific experimental device based on pressure pulse decay of nitrogen through the material was designed for the measurement in each direction under a controlled axial compression. Determination of kz and kr and bz and br is performed on the basis of a nonstationary gas flow model in the radial and axial directions using an inverse procedure applied to the pressure decay signal. Our results confirm the efficiency of the method developed here. They clearly show the anisotropic character of the material (kz is roughly one order of magnitude larger than kr) and the dependence upon axial compression. The present analysis is the key step before further quantification of the leak rate that may result from the permeation through the material as envisaged here as well as through interfaces between the housing, the packings, and the stem.
Effect of Bolt Spacing on the Circumferential Distribution of the Gasket Contact Stress in Bolted Flange Joints
Authors: Do Tan Dan , Bouzid Abdel-Hakim , Dao Thien-My
Published: May 2011

Bolted flange joints are part of pressure vessel and piping components and are extensively used in the chemical, petrochemical, and nuclear power industries. They are simple structures and offer the possibility of disassembly, which makes them attractive to connect pressurized equipment and piping. In addition to being prone to leakage, they often require maintenance while in operation in which case the bolts are either retightened as in hot torquing or untightened to be replaced. Although costly shutdowns are avoided, such maintenance work exposes the operator to a potential risk because the bolt load alteration can produce a gasket load unbalance, which results in the local gasket contact stress to drop below some critical value, causing major leak and hence jeopardizing the life of the worker. This paper addresses the issue of the contact stress level unbalance around the flange when the bolts are subjected to initial tightening. The study compares the contact stress distribution variations, an analytical developed model based on the theory of rings on elastic foundation, to those given by the finite element model and the simple beam on elastic foundation model developed by Koves (2007, “Flange Joint Bolt Spacing Requirements,” Proceedings of PVP2007, ASME Pressure Vessel and Piping Division Conference). This study is developed for the purpose of helping limit the degree of load increase in hot torquing or the maximum number of bolts to be replaced at a time and identify those flanges for which the bolt cannot be replaced in service.
Computational Fluid Dynamic Studies of Vortex Amplifier Design for the Nuclear Industry—I. Steady-State Conditions
Authors: Parker D. , Birch M. J. , Francis J.
Published: May 2011

In this study the effects of changes to the geometry of a vortex amplifier are investigated using computational fluid dynamics (CFD) techniques, in the context of glovebox operations for the nuclear industry. These investigations were required because of anomalous behavior identified when, for operational reasons, a long-established vortex amplifier design was reduced in scale. The aims were (i) to simulate both the anomalous back-flow into the glovebox through the vortex amplifier supply ports, and the precessing vortex core in the amplifier outlet, then (ii) to determine which of the various simulated geometries would best alleviate the supply port back-flow anomaly. Various changes to the geometry of the vortex amplifier were proposed; smoke and air tests were then used to identify a subset of these geometries for subsequent simulation using CFD techniques. Having verified the mesh resolution was sufficient to reproduce the required effects, the code was then validated by comparing the results of the steady-state simulations with the experimental data. The problem is challenging in terms of the range of geometrical and dynamic scales encountered, with consequent impact on mesh quality and turbulence modeling. The anomalous nonaxisymmetric reverse flow in the supply ports of the vortex amplifier has been captured and the mixing in both the chamber and the precessing vortex core has also been successfully reproduced. Finally, by simulating changes to the supply ports that could not be reproduced experimentally at an equivalent cost, the geometry most likely to alleviate the back-flow anomaly has been identified.
Flow Past a Rotating Cylinder at Low and High Rotation
Rates
Authors: Kumar S. , Cantu C. , Gonzalez B.
Published: May 2011

Flow past a rotating circular cylinder is studied experimentally. The experiments are carried out in a water tunnel at Reynolds numbers of 200, 300, and 400 and nondimensional rotation rates (ratio of surface speed of the cylinder to the free stream velocity), α, varying from 0 to 5. The diagnostic is done by flow visualization using hydrogen bubble technique and quantitative measurements using a particle image velocimetry technique. We present the global view of the wake structure at the three Reynolds numbers and various rotation rates. Vortex shedding activity is observed to occur from α=0 to α~1.95, after which it is suppressed. Reynolds number is found to have a strong effect on the wake morphology near the suppression rotation rate, α=1.95. Interestingly, the vortex shedding activity again resumes in the range 4.34<α<4.70 as first discovered numerically (Mittal and Kumar, 2003, “Flow past a rotating cylinder,” J. Fluid Mech., 476, 303) for Re = 200. The shed vortices are of one sign in this range of rotation rates. Experimental evidence of this new vortex shedding mode is presented, for the first time, at α=4.45 in the newly discovered window of rotation rates, using flow visualization and particle image velocimetry measurements. Strouhal number measurements and global wake patterns agree well with the computations of Mittal and Kumar at a Reynolds number of 200.
Growth of AlGaN containing nanometer scale compositional inhomogeneities for ultraviolet light emitters
Authors: Sampath A. V. , Garrett G. A. , Enck R. W. , Rottella P. , Shen H. , Wraback M.
Published: May 2011

The incorporation of nanometer scale compositional inhomogeneities in AlGaN has a great promise for improving the performance of UV light emitting diodes based on these materials by suppressing nonradiative recombination associated with dislocations. In this article, the authors report on the growth and characterization of AlGaN containing nanometer scale compositional inhomogeneity (NCI-AlGaN) alloys deposited by plasma-assisted molecular beam epitaxy. Growth under N-limited and nearly stoichiometric growth is observed to enhance the photoluminescence intensity in AlGaN alloys by promoting the spontaneous formation of these NCI regions. This is attributed to the lower adatom mobility of group III and N species on the AlGaN layer surface under these conditions as well as the formation of beneficial surface faceting.
Quantitative depth profiling of ultrathin high-k stacks with full spectrum time of flight–secondary ion mass spectrometry
Authors: Py Matthieu , Barnes Jean-Paul , Boujamaa Rachid , Gros-Jean Michael , Nakajima Kaoru , Kimura Kenji , Roukoss Charbel , Pelissier Bernard , Gambacorti Narciso
Published: May 2011

Elemental concentration depth profiles of high-k material stacks for 32 nm node devices and below were acquired by high resolution backscattering spectrometry (HRBS), parallel angle resolved-x-ray photoelectron spectroscopy (pAR-XPS), and time of flight–secondary ion mass spectrometry (ToF-SIMS). ToF-SIMS data were analyzed using an original calibration method which the authors shall refer to as the full spectrum protocol. Three different samples were studied in this work, one ultrathin insulating layer (IL) alone and two nitridized high-k/IL samples with different nitridation conditions for the IL. Although HRBS and AR-XPS already proved their ability in this domain, SIMS or ToF-SIMS characterization of high-k material stacks is still hampered by various matrix effects. Comparison of the elemental profiles obtained by all three techniques allows the accuracy of the full spectrum ToF-SIMS protocol to be assessed, both in terms of chemical composition quantification and depth resolution. This study reveals the feasibility of quantitative and depth resolved ToF-SIMS profiling of ultrathin high-k material stacks.
Fabrication of InAlAs/InGaAsSb/InGaAs double heterojunction bipolar transistors
Authors: Lo C. F. , Ren F. , Chang C. Y. , Pearton S. J. , Chen S.-H. , Chang C.-M. , Wang S.-Y. , Chyi J.-I. , Kravchenko I. I.
Published: May 2011

A trilevel resist system was employed to fabricate self-aligned, submicron emitter finger In0.52Al0.48As/In0.42Ga0.58As0.77Sb0.23/In0.53Ga0.47As double heterojunction bipolar transistors (DHBTs). Selective wet-etchants were used to define the emitter fingers and to form an InGaAs guard-ring around the emitter fingers. Due to the low energy bandgap of the InGaAsSb base layer and type II base-collector junction, a low turn-on voltage of 0.38 V at 1 A/cm2 and a high dc current gain of 123.8 for a DHBT with a 0.65×8.65 μm2 emitter area were obtained. A unity gain cutoff frequency (fT) of 260 GHz and a maximum oscillation frequency (fmax) of 485 GHz at JC=302 kA/cm2 were achieved.
Medical-device recalls in the UK and the device-regulation process: retrospective review of safety notices and alerts
Authors: Heneghan C , Thompson M , Billingsley M , Cohen D
Published: May 2011

Background

Medical devices are used widely for virtually every disease and condition. Although devices are subject to regulation, the number of recalls, the clinical data requirements for regulation and the impact on patient safety are poorly understood.

Methods

The authors defined a device using European directives and used publicly available information on the Medicines and Health Regulatory Authority website to determine the number of devices recalled from January 2006 to December 2010. Two reviewers independently assessed Field Safety Notices and Medical Device Alerts. The authors wrote to manufacturers to obtain further information and clinical data, and summarised data by year, Conformité Européenne classification, indication, and Food and Drug Administration recall system of severity.

Results

In total, 2124 field safety notices were issued over the 5-year period, an increase of 1220% (62 in 2006 to 757 in 2010). 447 Medical Device Alerts were issued in the same period, and 44% were assessed as a reasonable probability of causing serious adverse health consequences or death. The authors wrote to 192 manufacturers of withdrawn devices and received 101 (53%) replies; only four (2.1%) provided the clinical data the authors requested. A lack of available transparent data prevented full analyses of the safety impact. Of the highest-risk recalled devices, more than half were related to the cardiovascular system (25%) or musculoskeletal system (33%), and 88% (95% CI 80% to 97%) were assessed as a reasonable probability of causing serious adverse health consequences or death. For low-risk devices, the figure was 34% (95% CI 26% to 42%).

Conclusion

The number of medical devices subject to recalls or warnings in the UK has risen dramatically. A substantial number of these devices may have caused serious adverse effects in patients and contributed to healthcare costs. Significant problems exist in the UK with a lack of access to transparent data and a registry of the highest-risk devices.
Symptom management research in cancer patients: state of the art
Authors: Kroenke K
Published: May 2011

Both physical symptoms (eg, pain, fatigue, insomnia) and psychological symptoms (eg, depression, anxiety) are prevalent in all types and stages of cancer, from newly diagnosed patients to disease-free cancer survivors to individuals with recurrent or progressive disease. Also, patients often have multiple symptoms, so programmes that focus on single symptoms often fail to optimize treatment outcomes. Additionally, effective treatments include both medications and nonpharmacological interventions, so that administration of only one type of treatment likewise may fail to optimize therapy.

Key concepts in symptom management research derived from several practical clinical trials will be discussed, including:

Management of patients with multiple as well as single symptoms;

Integrated approach to physical and psychological symptoms;

Measurement of outcomes relevant to symptom therapy;

Use of technology (eg, automated home-based symptom monitoring) to augment clinical care;

Adoption of a ‘treat-to-target’ approach;

Decisions regarding medication versus nonpharmacological therapies;

Roles of different types of clinicians in cancer symptom care;

Focusing on specific cancers versus multiple types of cancer.

Finally, several promising areas for future research in the management of cancer-related symptoms will be highlighted.
Co-ordination of generalist end of life care in the UK: a multi-site ethnographic study
Authors: Mason B L , Barclay S , Dale J , Daveson B , Donaldson A , Epiphaniou E , Harding R , Higginson I J , Kendall M , Munday D , Nanton V , Shipman C , Murray S A
Published: May 2011

Introduction and aims

Appropriate, effective and timely generalist care for patients and their families towards the end of life is recognised as an essential component of high quality, equitable care. Improving coordination of care is one of the core objectives of the UK Department of Health End of Life Care Strategy. We aimed to identify the contextual complexities and challenges to well co-ordinated care delivery for people towards the end of life in different generalist settings.

Method

We used organisational ethnography among staff who were not specialist palliative care providers in three locations; an acute receiving unit, a respiratory outpatient clinic, and a primary care practice. The protocol included sustained interactions with health providers and interviews with patients and their carers over 9 months. The integrated datasets offer an understanding of how end-of-life care co-ordination is understood, initiated and conducted within patient trajectories and in the context of everyday healthcare provision.

Results

The patient-centred, long term focus of primary care drives individual and team activity and requires flexibility and collaboration. In the secondary care short-term, acute setting, role boundaries and a clearly defined process, in which time constraints are paramount, may result in a less personalised experience for patients.

Conclusions

Coordination of care for patients and their families with advanced progressive diseases undergoing emergency admissions or transition across settings is important. The level of coordination and the systems in place influences people's experience of coordination of generalist settings. Further research regarding how collaboration influences coordination of care is required.
National snapshot study of end of life care in the community for cancer and non-cancer patients
Authors: Thomas K , Clifford C M , de Silva D
Published: May 2011

Introduction

Primary care provision of end-of-life care is crucial in achieving high quality care and reducing hospitalisation. The 2009 National Primary Care Snapshot Audit in End-of-Life Care provided the largest assessment of community provision, revealing key areas for further improvement.

Aims

To realistically assess current provision and explore differences between cancer and non-cancer patients, those on the palliative care register, and other factors leading to quality end-of-life care.

Methods

502 General Practitioner practices in 15 PCTs (60% uptake ) submitted data from 4500 patients for every death over a 2 month period. The GSF After Death Analysis Audit Tool providing outcome data for individual patients, and compared with recommended best practice standards.

Results

Only 27% of patients who died were included on the palliative care register, of these 23% were non-cancer, 17%unknown and 69% cancer, compared with 26% patient deaths from cancer. Those on the register were more likely to receive well coordinated care but 42% were considered unpredictable.

Conclusion

This snapshot provides an objective overview of current community end-of-life care, demonstrating key areas for further improvement. Patients on the register received more proactive, better coordinated care than those not on the register, and cancer patients were well represented on the registers and more likely to receive good end-of-life care, in contrast to non-cancer patients. Only a quarter of all patients who died were on the register, suggesting a need for earlier recognition and better coordination of care, particularly for non-cancer patients.
Development of guidelines for oncologists to manage emotional distress in cancer patients
Authors: Holch P , Velikova G
Published: May 2011

Introduction

Emotional distress (ED) is a significant unmet need experienced by up to a third of cancer patients. Many oncologists are reluctant to broach these issues perhaps due to (i) lack of awareness of referral pathways and (ii) a perception that it may increase the length of the consultation length. We propose that a clearly defined referral pathway to services and interventions to manage ED would help to overcome these barriers.

Aims

To develop brief, accessible, evidence based guidelines for oncologists outlining local interventions and services to support the management of distress.

Methods

Guidelines were developed using the National Institute of Clinical Excellence stepped psychosocial care and support model. This constituted a consensus based iterative approach involving:

▶

literature review

▶

local information gathering on services

▶

consultation with both professionals and patient groups.

Results

Evidence based guidelines have been produced which reflect the range of interventions and services available and provide oncologists with clear pathways for management of ED. They and are now being disseminated for independent review and the resulting feedback will be incorporated to make further improvements.

Conclusion

It has been possible to incorporate the views of professionals, service users and existing information services within the guidance. The efficacy of the guidelines will be evaluated via an audit of referrals to services, consultation analysis, assessment of patient centeredness and completion of outcome measures.
A novel intervention for post-treatment oxaliplatin chemotherapy-induced neuropathy
Authors: Storey D J , Colvin L A , Boyle D , Fallon M T
Published: May 2011

Introduction/aims

Oxaliplatin chemotherapy-induced peripheral neuropathy (OxCIPN) is a common post-treatment toxicity. Many patients are left with long-term pain and disability. Available systemic agents have limited efficacy, cause significant side-effects and take several weeks/months to work. Colleagues' preclinical work showed analgesic effects of topical transient receptor potential melastatin receptor activators in neuropathic pain. We therefore conducted a proof-of-concept study using menthol in patients with OxCIPN.

Methods

21 patients a median of 19 months post-treatment (range 3–35) applied 1% topical menthol, twice daily to affected areas and skin overlying corresponding dorsal root ganglia. At baseline, 2 and 6 weeks, patients completed: Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale and underwent objective assessments of gait (electronic walkway), hand dexterity (peg-board) and Quantitative Sensory Testing. Analysis: Wilcoxon signed-rank test and Pearson product-moment correlation.

Results

Between baseline and 6 weeks, total BPI scores decreased (median 3.6 (range 1.1–7.9) versus 0.7 (0–8.3), p=0.002). 83% described less pain and 52% had ≤30% BPI decrease (deemed clinically significant). There were corresponding improvements in mood (r=0.442, p=0.045), walking velocity (r=-0.797, p=0.026) and cadence (r=-0.823, p=0.012) and trends for improved hand dexterity (r=0.487, p=0.065) and mechanical pain thresholds (r=0.447, p=0.072). Four patients discontinued treatment after 2 weeks: two had difficulty applying the cream, two described worse pain. BPI changes were predicted by pre-treatment mechanical detection thresholds (r=0.534, p=0.027).

Conclusion

Topical menthol appeared to improve OxCIPN pain and physical function. It also seems to be well tolerated, have minimal side-effects, works relatively quickly and warrants further study.
Community pharmacists' contribution to the management of cancer pain in the community
Authors: Savage I , Blenkinsopp A , Bennett M I
Published: May 2011

Aim

To explore community pharmacists' role in educating and advising cancer patients and their carers on optimum use of opioids for pain relief.

Methods

Semi-structured interviews with a maximum diversity sample of 25 community pharmacists in three areas of England.

Results

Pharmacists had no reliable method to identify a patient with cancer, had few face to face contacts with patients and no means of accessing relevant medical information. Patients' medicines were often collected by carers or delivered to their homes, and reliable access to palliative care medicines remains problematic. Pharmacists reported that a wide range of issues are raised with them by carers but these rarely included questions about opioid medicines. For some pharmacists, proactive involvement appeared to be inhibited by fear of discussing emotional and wider social aspects. Many pharmacists assumed information had already been provided by another clinician and felt isolated from other members of the care team. Medicines Use Reviews for cancer patients regarding their analgesia were rarely undertaken.

Conclusions

Community pharmacists felt that their potential contribution to cancer pain management is constrained but they aspired to do more. Since they generally did not know which patients have cancer their provision of information and advice was ad hoc. There was little evidence of routine communication about patient care in relation to analgesia either from or to pharmacists. People with cancer and their families may currently have less access to information and support from community pharmacists than people with other conditions.
The supportive care needs of the partners and family members of long-term survivors of breast, colorectal and prostate cancer
Authors: Watson E K , Turner D , Adams E , Boulton M , Harrison S , Khan N , Rose P , Ward A
Published: May 2011

Introduction and aims

There are an estimated 2 million cancer survivors in the UK today, with earlier diagnosis and improved treatments leading to an increasing number of long-term survivors. Partners and/or close family members are often a key source of support to the patient, and yet they themselves may experience significant levels of distress and have unmet needs. The main aim of this study was to describe the supportive care needs of the partners/ family members of patients who had survived breast, colorectal or prostate cancer for at least 5 years.

Method

This study was linked to a study of cancer survivors, recruited via cancer registries in the Thames Valley and North Yorkshire areas. Patients were asked to invite their partner or close family member to participate in a postal questionnaire. The questionnaire measured health status (EQ5D), levels of anxiety and depression (HADS), unmet needs (CASPUN) and positive outcomes.

Results

257 (78%) completed questionnaires were returned. Overall, levels of anxiety and depression were comparable with population norms. Accessible hospital parking (20%), information about familial risk (18%), managing fear of recurrence (16%) and co-ordination of care (14%) were the most cited unmet needs.

Conclusions

Most partners/family members of long term survivors report few ongoing issues. However, a minority do have high levels of anxiety and/or moderate or strong unmet needs. Strategies are required to identify and support those with needs, while allowing the majority to resume normal life beyond cancer.
Evaluating a training package for health professionals and community workers to spread breast cancer awareness messages
Authors: Atkins L , Forbes L , Scanlon K , Jupp D , Carroll L , Ramirez A-J
Published: May 2011

Introduction and aims

Delayed presentation in breast cancer leads to more advanced stage at diagnosis and ultimately poorer survival. Delays in presentation are associated with low breast cancer awareness.

Breast Cancer Care delivers the Train the Trainer: Breast Health Promotion programme to train people across England to deliver messages to increase breast cancer awareness: knowing how breasts normally look and feel and what breast changes to look for; encouraging regularly looking and feeling for breast changes; early symptomatic presentation and breast screening uptake. We measured trainees' knowledge and confidence to deliver these messages in a before and after observational design.

Methods

We recruited 126 trainees attending nine courses over 6 months. Trainees included volunteers, community workers and health professionals. They completed the Cancer Research UK Breast Cancer Awareness Measure at baseline and 1 and 6 months after attending. We also collected information about recipients of the breast cancer awareness messages during the 6 months after training.

Results

At baseline, 46% trainees identified five or more non-lump symptoms of breast cancer; 21% identified a 70-year-old woman as at higher risk of breast cancer than a 30 or 50 year old. 50% reported looking and feeling their breasts at least monthly. These proportions are higher than the general population (18%, 14% and 23% respectively).1 Follow-up will finish in March 2011.

Conclusion

Breast cancer awareness at baseline was higher than in the general population. We will present 1-month follow-up data at the meeting. The findings will provide the rationale for future investment and improvements in the programme.
Identifying patients with chronic heart failure who may benefit from palliative care: a comparison of the Gold Standards Framework with a clinical prognostic mode
Authors: Haga K K , Denvir M A , Reid J , Ness A , O'Donnell M , Yellowlees D , Murray S A
Published: May 2011

Introduction

Heart failure has a worse survival rate than many cancers, yet few patients receive palliative care. The aim of this project was to evaluate the use of Gold Standards Framework (Seattle Heart Failure (SHF)) criteria and the SHF Model in patients with heart failure.

Methods

Chronic heart failure patients, in NYHA class III or IV, who were being managed by a heart failure nursing service, were identified. The GSF criteria were assessed by interviewing the specialist nurse responsible for each patient's care. The SHF data were used to estimate mean life expectancy and predicted mortality at 1 year. Patients were followed up after 1 year, to evaluate; (1) all-cause mortality and (2) the sensitivity and specificity of the GSF and SHF to predict death at 1 year.

Results

138 patients were identified through our search. GSF criteria identified 119/138 (86%) patients that met the minimum requirement for palliative care input. However, the SHF model predicted that only 6/138 patients (4.3%) had a predicted life expectancy of less than 1 year. At follow-up, 43/138 patients had died (31%). The sensitivity and specificity for the GSF and SHF model were 22%/83% and 98%/12% respectively.

Discussion

Neither the GSF nor the SHF accurately predicted which patients were in the last year of life. The implementation of palliative care in heart failure patients may require a shift away from the traditional ‘end of life’ model used in cancer, and focus on the patient's increasing needs, understanding that death, itself, may remain unpredictable.