Suicidal intent within an acute Australian self-harming cohort

The relationship between predisposing risk factors and precipitating life events of individuals presenting to an emergency department with Deliberate Self-Harm was investigated. Poor mental health and childhood abuse were related to suicide intent, only individuals' perceptions regarding their current life events were directly associated with lethality of the self-harm act. The portfolio illustrates the issues inherent in the treatment and management of schizophrenia and the potential of CBT in addressing symptoms and sequelae of acute psychosis. Four case studies are presented.

Self-injury and eating pathology

It was found that Urgency and lack of Perseverance were significantly elevated in women with self-injury or eating pathology, and significantly higher again in women with both these syndromes. A longitudinal design found that self-injury tends to progress from milder, compulsive forms, to more severe, impulsive forms over time. The portfolio examines the frequent co-occurrence of substance use and psychiatric disorders (Dual Diagnosis). Four primary conceptualisations of how dual diagnoses develop and present are discussed. These models are then applied to inform four case studies.

Self-assembly behavior of colistin and its prodrug colistin methanesulfonate : implications for solution stability and solubilization

Colistin is an amphiphilic antibiotic that has re-emerged into clinical use due to the increasing prevalence of difficult-to-treat Gram-negative infections. The existence of self-assembling colloids in solutions of colistin and its derivative prodrug, colistin methanesulfonate (CMS), was investigated. Colistin and CMS reduced the air−water interfacial tension, and dynamic light scattering (DLS) studies showed the existence of 2.07 ± 0.3 nm aggregates above 1.5 mM for colistin and of 1.98 ± 0.36 nm aggregates for CMS above 3.5 mM (mean ± SD). Above the respective critical micelle concentrations (CMC) the solubility of azithromycin, a hydrophobic antibiotic, increased approximately linearly with increasing surfactant concentration (5:1 mol ratio colistin:azithromycin), suggestive of hydrophobic domains within the micellar cores. Rapid conversion of CMS to colistin occurred below the CMC (60% over 48 h), while conversion above the CMC was less than 1%. The formation of colistin and CMS micelles demonstrated in this study is the proposed mechanism for solubilization of azithromycin and the concentration-dependent stability of CMS.

The natural history of self-harm from adolescence to young adulthood : a population-based cohort study

Background Knowledge about the natural history of self-harm is scarce, especially during the transition from adolescence to young adulthood, a period characterised by a sharp rise in self-inflicted deaths. From a repeated measures cohort of a representative sample, we describe the course of self-harm from middle adolescence to young adulthood.

Methods A stratified, random sample of 1943 adolescents was recruited from 44 schools across the state of Victoria, Australia, between August, 1992, and January, 2008. We obtained data pertaining to self-harm from questionnaires and telephone interviews at seven waves of follow-up, commencing at mean age 15·9 years (SD 0·49) and ending at mean age 29·0 years (SD 0·59). Summary adolescent measures (waves three to six) were obtained for cannabis use, cigarette smoking, high-risk alcohol use, depression and anxiety, antisocial behaviour and parental separation or divorce.

Findings 1802 participants responded in the adolescent phase, with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1·6, 95% CI 1·2–2·2). We recorded a substantial reduction in the frequency of self-harm during late adolescence. 122 of 1652 (7%) participants who reported self-harm during adolescence reported no further self-harm in young adulthood, with a stronger continuity in girls (13/888) than boys (1/764). During adolescence, incident self-harm was independently associated with symptoms of depression and anxiety (HR 3·7, 95% CI 2·4–5·9), antisocial behaviour (1·9, 1·1–3·4), high-risk alcohol use (2·1, 1·2–3·7), cannabis use (2·4, 1·4–4·4), and cigarette smoking (1·8, 1·0–3·1). Adolescent symptoms of depression and anxiety were clearly associated with incident self-harm in young adulthood (5·9, 2·2–16).

Interpretation Most self-harming behaviour in adolescents resolves spontaneously. The early detection and treatment of common mental disorders during adolescence might constitute an important and hitherto unrecognised component of suicide prevention in young adults.

Funding National Health and Medical Research Council, Australia, and operational infrastructure support programme, Government of Victoria, Australia.

A cross-sectional examination of non-suicidal self-injury, disordered eating, impulsivity, and compulsivity in a sample of adult women

Non-suicidal self-injury has been classed as having both impulsive and compulsive characteristics (Simeon & Favazza, 2001). These constructs have been related to disordered eating behaviors such as vomiting (Favaro & Santonastaso, 1998). Utilizing an international sample of adult females, this paper further explored this model, aiming to identify whether all types of disordered eating could be classified as impulsive or compulsive, and whether the impulsive and compulsive groupings reflect underlying trait impulsivity and compulsivity. The hypothesized impulsive and compulsive dimensions did not emerge from the data. Notably however, all self-injurious and disordered eating behaviors were linked to Urgency (an impulsivity facet) to varying degrees; no relationship with trait compulsivity was found. These findings are discussed, study limitations are noted, and relevance for clinical practice is outlined.

Self-assembly and film stability of a micelle of a single-chain quaternary ammonium amphiphile containing azobenzene on mica

The self-assembling behavior of a single-chain quaternary ammonium amphiphile bearing azobenzene (C₁₂AzoC₆N⁺) on freshly cleaved mica sheet has been investigated by atomic force microscopy (AFM) method. Confocal microscopic Raman spectra confirm the adsorption of the self-assembled monolayer structure. Ex-situ AFM reveals that C₁₂AzoC₆N⁺ forms branch-like stripes indicating the fusion and reorganization of the micelles during drying in air as the in-situ AFM has revealed that surfactant forms spherical micelles on the mica surface. The nano-sized surface structure is strongly dependent on the change of molecular structure, which resulted from photo-induced isomerization. The nano-sized stripe is quite stable even being annealed at 90 °C for 4 h.

Measuring self-care in chronic heart failure : a review of the psychometric properties of clinical instruments

Background : Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care.

Objective : The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties.

Methods : A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines.

Results : The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments.

Conclusion : Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.

Development of mental health first aid guidelines for deliberate non-suicidal self-injury: a Delphi study

BACKGROUND: It is estimated that around 4% of the population engages, or has engaged, in deliberate non-suicidal self-injury. In clinical samples, the figures rise as high as 21%. There is also evidence to suggest that these figures may be increasing. A family member or friend may suspect that a person is injuring themselves, but very few people know how to respond if this is the case. Simple first aid guidelines may help members of the public assist people to seek and receive the professional help they require to overcome self-injury.

METHODS: This research was conducted using the Delphi methodology, a method of reaching consensus in a panel of experts. Experts recruited to the panels included 26 professionals, 16 people who had engaged in self-injurious behaviour in the past and 3 carers of people who had engaged in self-injurious behaviour in the past. Statements about providing first aid to a person engaged in self-injurious behaviour were sought from the medical and lay literature, but little was found. Panel members were asked to respond to general questions about first aid for NSSI in a variety of domains and statements were extracted from their responses. The guidelines were written using the items most consistently endorsed by the consumer and professional panels.

RESULTS: Of 79 statements rated by the panels, 18 were accepted. These statements were used to develop the guidelines appended to this paper.

CONCLUSION: There are a number of actions which are considered to be useful for members of the public when they encounter someone who is engaging in deliberate, non-suicidal self-injury. These guidelines will be useful in revising curricula for mental health first aid and NSSI first aid training programs. They can also be used by members of the public who want immediate information about how to assist a person who is engaging in such behaviour.

Characteristics of non-suicidal self-injury in women accessing internet help sites

Background: This article aimed to examine and compare the frequency of occurrence of a broad range of non-suicidal self-injury (NSSI) behaviours in an international sample of women. Methods: Female participants with NSSI (n = 464) were recruited via a range of websites and completed a questionnaire examining 17 different types of NSSI types and their frequency, severity, and duration. Results: Prevalent acts were cutting, scratching, and word carving; cutting and scratching occurred frequently, whilst word carving most often occurred as a single episode. Analyses revealed significant differences between Australian and U.S. participants, with U.S. participants having significantly higher rates of cutting, wound interference, carving, scratching, and sharp object sticking. Participants also reported on other self-harm methods not assessed by the questionnaire. Conclusions: Word carving may be qualitatively different from other forms of NSSI. More severe NSSI methods (e.g., bone breaking) are less prevalent than less dangerous methods (e.g., scratching). Participants considered a range of indirectly harmful or suicidal behaviours as self-injury contrary to researcher or clinician understanding. Finally, there may be cultural differences in relation to NSSI between countries where such behaviours are common, although further research is required to determine this.

Impact of an empowerment-based parent education program on the reduction of youth suicide risk factors

Purpose: To evaluate the impact of parent education groups on youth suicide risk factors. The potential for informal transmission of intervention impacts within school communities was assessed.

Methods: Parent education groups were offered to volunteers from 14 high schools that were closely matched to 14 comparison schools. The professionally led groups aimed to empower parents to assist one another to improve communication skills and relationships with adolescents. Australian 8th-grade students (aged 14 years) responded to classroom surveys repeated at baseline and after 3 months. Logistic regression was used to test for intervention impacts on adolescent substance use, deliquency, self-harm behavior, and depression. There were no differences between the intervention (n = 305) and comparison (n = 272) samples at baseline on the measures of depression, health behavior, or family relationships.

Results: Students in the intervention schools demonstrated increased maternal care (adjusted odds ratio [AOR] 1.9), reductions in conflict with parents (AOR .5), reduced substance use (AOR .5 to .6), and less delinquency (AOR .2). Parent education group participants were more likely to be sole parents and their children reported higher rates of substance use at baseline. Intervention impacts revealed a dose-response with the largest impacts associated with directly participating parents, but significant impacts were also evident for others in the intervention schools. Where best friend dyads were identified, the best friend’s positive family relationships reduced subsequent substance use among respondents. This and other social contagion processes were posited to explain the transfer of positive impacts beyond the minority of directly participating families.

Conclusions: A whole-school parent education intervention demonstrated promising impacts on a range of risk behaviors and protective factors relevant to youth self-harm and suicide.

Complexity theory and organizing form dualities

Purpose – The purpose of this paper is to describe how order-generated rules applied to organizing form dualities can assist in creating the conditions for emergent, self-organized behavior in organizations, thereby offering an operational deployment of complexity theory.

Design/methodology/approach – The paper begins by showing that the concept of dualities is consistent with complexity-thinking. In addition, when applied to organizing forms, dualities represent a practical way of affecting an organization's balance between chaos and order. Thus, when augmented with order-generating rules, organizing form dualities provide an access point for the practical instigation of edge of chaos conditions and the potential for emergence.

Findings – The paper maintains that many attempts to “manage” complexity have been associated with changes to organizing forms, specifically toward new forms of organizing. It is suggested that organizing form dualities provide some management guidance for encouraging the “edge of chaos” conditions advocated in complexity theory, although the details of self-organization cannot be prescribed given the assumptions of non-linearity associated with complexity theory perspectives. Finally, it is proposed that organizing dualities can elucidate the nature and application of order-generating rules in non-linear complex systems.

Practical implications – Dualities offer some guidance toward the practical implementation of complexity theory as they represent an accessible sub-system where the forces for order and chaos – traditional and new forms of organizing respectively – are accessible and subject to manipulation.

Originality/value – The commonalities between dualities and complexity theory are intuitive, but little conceptual work has shown how the former can be employed as a guide to managing organizing forms. Moreover, this approach demonstrates that managers may be able to stimulate “edge of chaos” conditions in a practical way, without making positivistic assumptions about the causality associated with their efforts.

Synthesis and mechanistic insights of macromolecular assemblies from ABA triblock copolymer blends

Macromolecular assembly of block copolymers into numerous nanostructures resembles self-organization of proteins and cellular components found in nature. In order to mimic nature’s assemblies either to cure a disease or construct functional devices, the organization principles underpinning the emergence of complex shapes need to be understood. In the same vein, this study aimed at understanding morphology evolution in a triblock copolymer blend in aqueous solution. An ABA type amphiphilic triblock copolymer (polystyrene-b-polyethylene oxide-b-polystyrene, PS-b-PEO-b-PS) was synthesized at different compositions via atom transfer radical polymerization (ATRP) and self-assembly behavior of a binary mixture in aqueous solution was studied. Block copolymers that form worms and vesicles in its pristine state was shown to form complex morphologies such as fused rings, “jellyfish”, toroid vesicles, large compound vesicles and large lamellae after blending. The tendency of vesicle-forming block copolymer to form bilayers may be responsible for triggering complex morphologies when mixed with a worm or micelle-forming polymer. In other words, the interplay between curvature effects produced by two distinct polymers with different hydrophobic block lengths results in complex morphologies due to chain segregation within the nanostructure.

High-performance multifunctional graphene yarns: toward wearable all-carbon energy storage textiles

The successful commercialization of smart wearable garments is hindered by the lack of fully integrated carbon-based energy storage devices into smart wearables. Since electrodes are the active components that determine the performance of energy storage systems, it is important to rationally design and engineer hierarchical architectures atboth the nano- and macroscale that can enjoy all of the necessary requirements for a perfect electrode. Here we demonstrate a large-scale flexible fabrication of highly porous high-performance multifunctional graphene oxide (GO) and rGO fibers and yarns by taking advantage of the intrinsic soft self-assembly behavior of ultralarge graphene oxide liquid crystalline dispersions. The produced yarns, which are the only practical form of these architectures for real-life device applications, were found to be mechanically robust (Young's modulus in excess of 29 GPa) and exhibited high native electrical conductivity (2508 ± 632 S m(-1)) and exceptionally high specific surface area (2605 m(2) g(-1) before reduction and 2210 m(2) g(-1) after reduction). Furthermore, the highly porous nature of these architectures enabled us to translate the superior electrochemical properties of individual graphene sheets into practical everyday use devices with complex geometrical architectures. The as-prepared final architectures exhibited an open network structure with a continuous ion transport network, resulting in unrivaled charge storage capacity (409 F g(-1) at 1 A g(-1)) and rate capability (56 F g(-1) at 100 A g(-1)) while maintaining their strong flexible nature.

Phase behavior, crystallization, and hierarchical nanostructures in self-organized thermoset blends of epoxy resin and amphiphilic poly(ethylene oxide)-block-poly(propylene oxide)-block-poly(ethylene oxide) triblock copolymers

Nanostructured thermoset blends of bisphenol A-type epoxy resin (ER) and amphiphilic poly(ethylene oxide)-block-poly(propylene oxide)-block-poly(ethylene oxide) (PEO-PPO-PEO) triblock copolymers were successfully prepared. Two samples of PEO-PPO-PEO triblock copolymer with different ethylene oxide (EO) contents, denoted as EO30 with 30 wt % EO content and EO80 with 80 wt % EO content, were used to form the self-organized thermoset blends of varying compositions using 4,4'-methylenedianiline (MDA) as curing agent. The phase behavior, crystallization, and morphology were investigated by differential scanning calorimetry (DSC), transmission electron microscopy (TEM), atomic force microscopy (AFM), and small-angle X-ray scattering (SAXS). It was found that macroscopic phase separation took place in the MDA-cured ER/EO30 blends containing 60-80 wt % EO30 triblock copolymer. The MDA-cured ER/EO30 blends with EO30 content up to 50 wt % do not show macroscopic phase separation but exhibit nanostructures on the order of 10-30 nm as revealed by both the TEM and SAXS studies. The AFM study further shows that the ER/EO30 blend at some composition displays structural inhomogeneity at two different nanoscales and is hierarchically nanostructured. The spherical PPO domains with an average size of about 10 nm are uniformly dispersed in the 80/20 ER/EO30 blend; meanwhile, a structural inhomogeneity on the order of 50-200 nm is observed. The ER/EO80 blends are not macroscopically phase-separated over the entire composition range because of the much higher PEO content of the EO80 triblock copolymer. However, the ER/EO80 blends show composition-dependent nanostructures on the order of 10-100 nm. The 80/20 ER/EO80 blend displays hierarchical structures at two different nanoscales, i.e., a bicontinuous microphase structure on the order of about 100 nm and spherical domains of 10-20 nm in diameter uniformly dispersed in both the continuous microphases. The blends with 60 wt % and higher EO80 content are completely volume-filled with spherulites. Bundles of PEO lamellae with spacing of 20-30 nm interwoven with a microphase structure on the order of about 100 nm are revealed by AFM study for the 30/70 ER/EO80 blend.

Azobenzene moiety variation directing self-assembly and photoresponsive behavior of azo-surfactants

The effect of varying the position of the azobenzene group within two comparable photoresponsive amphiphiles on their capability to form lyotropic liquid crystals (LLCs) was investigated in detail in this study. Two photoresponsive amphiphiles having comparable structures were designed and synthesized consisting of hydrophilic oligooxyethylene units, a hydrophobic alkyl chain and a light-sensitive azobenzene moiety. When the azobenzene group was located in the middle of the hydrophobic alkyl chain, multiple LLC phases were observed at various water contents in the azo-surfactant–water binary system. In contrast, when the azobenzene group was directly attached to the hydrophilic domain, the azo-surfactant–water binary system exhibited only lamellar phases. The temperature dependence of these self-organised nanostructures was also investigated by the combination of small angle X-ray scattering (SAXS), differential scanning calorimetry (DSC), and rheology. Under alternating UV and visible light irradiation, reversible trans–cis photoisomerization of the azobenzene group occurred efficiently in dilute solution for both azo-surfactants. However, only photoisomerization of the surfactant possessing the azobenzene group localized in the middle of the alkyl chain induced significant changes in the self-assembled structure and its bulk properties. This study demonstrates that self-assembly and photoresponsive behaviour of photosensitive amphiphiles is extremely sensitive to the position of the photoactive moiety within the surfactant molecular architecture.