Shifts in positive and negative psychotic symptoms and anger: effects on violence.

BACKGROUND: Changes in positive and negative symptom profiles during acute psychotic episodes may be key drivers in the pathway to violence. Acute episodes are often preceded by fluctuations in affect before psychotic symptoms appear and affective symptoms may play a more important role in the pathway than previously recognised. METHODS: We carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Positive and Negative Syndrome Scale. Information on violence was obtained using the McArthur Community Violence Instrument and Police National Computer. RESULTS: The larger the shift in positive symptoms the more likely violence occurred in each 6-month period. However, shifts in angry affect were the main driving factor for positive symptom shifts associated with violence. Shifts in negative symptoms co-occurred with positive and conveyed protective effects, but these were overcome by co-occurring shifts in anger. Severe but stable delusions were independently associated with violence. CONCLUSIONS: Intensification of angry affect during acute episodes of psychosis indicates the need for interventions to prevent violence and is a key driver of associated positive symptoms in the pathway to violence. Protective effects against violence exerted by negative symptoms are not clinically observable during symptom shifts because they are overcome by co-occurring anger.

Use of urgent, emergency and acute care by mental health service users: A record-level cohort study.

BACKGROUND: People with serious mental illness experience worse physical health and greater mortality than the general population. Crude rates of A&E attendance and acute hospital admission are higher in people with serious mental illness than other hospital users. We aimed to further these findings by undertaking a standardised comparison of urgent and emergency care pathway use among users of mental health services and the general population. METHODS: Retrospective cohort analysis using routine data from 2013-2016 from the CUREd dataset for urgent and emergency care contacts (NHS 111, ambulance, A&E and acute admissions) and linked mental health trust data for Sheffield, England. We compared annual age- and sex-standardised usage rates for each urgent and emergency care service between users of mental health services and those without a recent history of mental health service use. RESULTS: We found marked differences in usage rates for all four urgent and emergency care services between the general population and users of mental health services. Usage rates and the proportion of users were 5-6 times and 3-4 times higher in users of mental health services, respectively, for all urgent and emergency care services. Users of mental health services were often more likely to experience the highest or lowest acuity usage characteristics. CONCLUSIONS: Current users of mental health services were heavily over-represented among urgent and emergency care users, and they made more contacts per-person. Higher service use among users of mental health services could be addressed by improved community care, more integrated physical and mental health support, and more proactive primary care. A complex pattern of service use among users of mental health services suggests this will need careful targeting to reduce avoidable contacts and optimise patient outcomes.

Biological solids reduction using the Cannibal process.

A laboratory study of the Cannibal process was undertaken to determine if the Cannibal system would generate less sludge compared with a conventional activated sludge system. Side-by-side sequencing batch reactors were operated--one using the Cannibal configuration and the other as conventional activated sludge. It was found that the Cannibal process generated 60% less solids than the conventional activated sludge system, without any negative effect on the effluent quality or the settling characteristics of the activated sludge. The oxygen uptake rate for the centrate from the Cannibal bioreactor showed that readily biodegradable organic matter was released from the recycled biomass in the Cannibal bioreactor. It is proposed that the mechanism for reduced solids from the Cannibal system is that, in the Cannibal bioreactor, iron is reduced, releasing iron-bound organic material into solution. When the Cannibal biomass is recirculated back to the aeration basin, the released organic material is rapidly degraded.

Discovery of a Selective and Potent Inhibitor of Mitogen-Activated Protein Kinase-Interacting Kinases 1 and 2 (MNK1/2) Utilizing Structure-Based Drug Design.

The discovery of a highly potent and selective small molecule inhibitor 9 for in vitro target validation of MNK1/2 kinases is described. The aminopyrazine benzimidazole series was derived from an HTS hit and optimized by utilization of a docking model, conformation analysis, and binding pocket comparison against antitargets.

Pilot-scale demonstration of phytofiltration for treatment of arsenic in New Mexico drinking water.

Arsenic contamination of drinking water poses serious health risks to millions of people worldwide. To reduce such risks, the United States Environmental Protection Agency recently lowered the Maximum Contaminant Level for arsenic in drinking water from 50 to 10 microgL(-1). The majority of water systems requiring compliance are small systems that serve less than 10,000 people. Current technologies used to clean arsenic-contaminated water have significant drawbacks, particularly for small treatment systems. In this pilot-scale demonstration, we investigated the use of arsenic-hyperaccumulating ferns to remove arsenic from drinking water using a continuous flow phytofiltration system. Over the course of a 3-month demonstration period, the system consistently produced water having an arsenic concentration less than the detection limit of 2 microgL(-1), at flow rates as high as 1900 L day(-1) for a total treated water volume of approximately 60,000 L. Our results demonstrate that phytofiltration provides the basis for a solar-powered hydroponic technique to enable small-scale cleanup of arsenic-contaminated drinking water.

Identifying Causal Risk Factors for Violence among Discharged Patients.

BACKGROUND: Structured Professional Judgement (SPJ) is routinely administered in mental health and criminal justice settings but cannot identify violence risk above moderate accuracy. There is no current evidence that violence can be prevented using SPJ. This may be explained by routine application of predictive instead of causal statistical models when standardising SPJ instruments. METHODS: We carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Historical, Clinical and Risk-20 items version 3 (HCR-20v3) and Structural Assessment of Protective Factors (SAPROF). Information on violence was obtained via the McArthur community violence instrument and the Police National Computer. RESULTS: In a lagged model, HCR-20v3 and SAPROF items were poor predictors of violence. Eight items of the HCR-20v3 and 4 SAPROF items did not predict violent behaviour better than chance. In re-analyses considering temporal proximity of risk/ protective factors (exposure) on violence (outcome), risk was elevated due to violent ideation (OR 6.98, 95% CI 13.85-12.65, P<0.001), instability (OR 5.41, 95% CI 3.44-8.50, P<0.001), and poor coping/ stress (OR 8.35, 95% CI 4.21-16.57, P<0.001). All 3 risk factors were explanatory variables which drove the association with violent outcome. Self-control (OR 0.13, 95% CI 0.08-0.24, P<0.001) conveyed protective effects and explained the association of other protective factors with violence. CONCLUSIONS: Using two standardised SPJ instruments, predictive (lagged) methods could not identify risk and protective factors which must be targeted in interventions for discharged patients with severe mental illness. Predictive methods should be abandoned if the aim is to progress from risk assessment to effective risk management and replaced by methods which identify factors causally associated with violence.

Pre-admission nursing assessment in a Welsh Medium Secure Unit (1991-2000): Part 2--comparison of traditional nursing assessment with the HCR-20 risk assessment tool.

Pre-admission forensic nursing assessment is a tradition that has no research evidence base, little documentary support and is an expensive drain on nursing resources from clinical environments. Such an expensive practice warrants some evaluation of the quality of these nursing assessments. This study assessed the quality of nursing risk assessments through comparison with the HCR-20, a well-established and widely validated violence risk assessment instrument. There was a high degree of correspondence between nurse assessments and the contents of the HCR-20. The results offer support for forensic nurses' abilities to develop effective measures and practices based upon nursing knowledge and experience where no formal evidence base previously existed.