Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.

Managing enterprises and ERP systems:a contingency model for the enterprization of operations

Purpose: The purpose of this paper is to investigate enterprise resource planning (ERP) systems development and emerging practices in the management of enterprises (i.e. parts of companies working with parts of other companies to deliver a complex product and/or service) and identify any apparent correlations. Suitable a priori contingency frameworks are then used and extended to explain apparent correlations. Discussion is given to provide guidance for researchers and practitioners to deliver better strategic, structural and operational competitive advantage through this approach; coined here as the "enterprization of operations". Design/methodology/approach: Theoretical induction uses a new empirical longitudinal case study from Zoomlion (a Chinese manufacturing company) built using an adapted form of template analysis to produce a new contingency framework. Findings: Three main types of enterprises and the three main types of ERP systems are defined and correlations between them are explained. Two relevant a priori frameworks are used to induct a new contingency model to support the enterprization of operations; known as the dynamic enterprise reference grid for ERP (DERG-ERP). Research limitations/implications: The findings are based on one longitudinal case study. Further case studies are currently being conducted in the UK and China. Practical implications: The new contingency model, the DERG-ERP, serves as a guide for ERP vendors, information systems management and operations managers hoping to grow and sustain their competitive advantage with respect to effective enterprise strategy, enterprise structure and ERP systems. Originality/value: This research explains how ERP systems and the effective management of enterprises should develop in order to sustain competitive advantage with respect to enterprise strategy, enterprise structure and ERP systems use. © Emerald Group Publishing Limited.

MEG and complex systems

MEG beamformer algorithms work by making the assumption that correlated and spatially distinct local field potentials do not develop in the human brain. Despite this assumption, images produced by such algorithms concur with those from other non-invasive and invasive estimates of brain function. In this paper we set out to develop a method that could be applied to raw MEG data to explicitly test his assumption. We show that a promax rotation of MEG channel data can be used as an approximate estimator of the number of spatially distinct correlated sources in any frequency band.

A predictive in vitro model of the impact of drugs with anticholinergic properties on human neuronal and astrocytic systems

The link between off-target anticholinergic effects of medications and acute cognitive impairment in older adults requires urgent investigation. We aimed to determine whether a relevant in vitro model may aid the identification of anticholinergic responses to drugs and the prediction of anticholinergic risk during polypharmacy. In this preliminary study we employed a co-culture of human-derived neurons and astrocytes (NT2.N/A) derived from the NT2 cell line. NT2.N/A cells possess much of the functionality of mature neurons and astrocytes, key cholinergic phenotypic markers and muscarinic acetylcholine receptors (mAChRs). The cholinergic response of NT2 astrocytes to the mAChR agonist oxotremorine was examined using the fluorescent dye fluo-4 to quantitate increases in intracellular calcium [Ca2+]i. Inhibition of this response by drugs classified as severe (dicycloverine, amitriptyline), moderate (cyclobenzaprine) and possible (cimetidine) on the Anticholinergic Cognitive Burden (ACB) scale, was examined after exposure to individual and pairs of compounds. Individually, dicycloverine had the most significant effect regarding inhibition of the astrocytic cholinergic response to oxotremorine, followed by amitriptyline then cyclobenzaprine and cimetidine, in agreement with the ACB scale. In combination, dicycloverine with cyclobenzaprine had the most significant effect, followed by dicycloverine with amitriptyline. The order of potency of the drugs in combination frequently disagreed with predicted ACB scores derived from summation of the individual drug scores, suggesting current scales may underestimate the effect of polypharmacy. Overall, this NT2.N/A model may be appropriate for further investigation of adverse anticholinergic effects of multiple medications, in order to inform clinical choices of suitable drug use in the elderly.

About Problems of Decision Making in Social and Economic Systems

The reasons of a restricted applicability of the models of decision making in social and economic systems. 3 basic principles of growth of their adequacy are proposed: "localization" of solutions, direct account of influencing of the individual on process of decision making ("subjectivity of objectivity") and reduction of influencing of the individual psychosomatic characteristics of the subject (" objectivity of subjectivity ") are offered. The principles are illustrated on mathematical models of decision making in ecologically- economic and social systems.

Receiver sensitivity in optical and microwave, heterodyne and homodyne systems

In this paper, we analyze the sensitivities of coherent optical receivers and microwave receivers. We derive theoretical limits of signal-to-noise ratio and bit error rate. By applying a generic approach to a broad range of receivers, we can compare their performance directly. Other publications have considered some of these receivers. However, their diverse nature obscures the big picture. Using our results as a unifying platform, previous publications can be compared and discrepancies between them identified.

Direct real-time cavity mode assessment and optimization technique for fiber lasers

A simple technique for direct real-time assessment of a fiber laser cavity-mode condition during operation is demonstrated. Mode stabilization and optimization with this cavity-mode monitoring and conditioning feedback scheme shows significant improvements to the output performance.

Diagonalizable Complex Systems, Reduced Dimension and Hermitian Systems II

2002 Mathematics Subject Classification: 35L40

Optimizing storage and memory systems for energy and performance

Electrical energy is an essential resource for the modern world. Unfortunately, its price has almost doubled in the last decade. Furthermore, energy production is also currently one of the primary sources of pollution. These concerns are becoming more important in data-centers. As more computational power is required to serve hundreds of millions of users, bigger data-centers are becoming necessary. This results in higher electrical energy consumption. Of all the energy used in data-centers, including power distribution units, lights, and cooling, computer hardware consumes as much as 80%. Consequently, there is opportunity to make data-centers more energy efficient by designing systems with lower energy footprint. Consuming less energy is critical not only in data-centers. It is also important in mobile devices where battery-based energy is a scarce resource. Reducing the energy consumption of these devices will allow them to last longer and re-charge less frequently. Saving energy in computer systems is a challenging problem. Improving a system's energy efficiency usually comes at the cost of compromises in other areas such as performance or reliability. In the case of secondary storage, for example, spinning-down the disks to save energy can incur high latencies if they are accessed while in this state. The challenge is to be able to increase the energy efficiency while keeping the system as reliable and responsive as before. This thesis tackles the problem of improving energy efficiency in existing systems while reducing the impact on performance. First, we propose a new technique to achieve fine grained energy proportionality in multi-disk systems; Second, we design and implement an energy-efficient cache system using flash memory that increases disk idleness to save energy; Finally, we identify and explore solutions for the page fetch-before-update problem in caching systems that can: (a) control better I/O traffic to secondary storage and (b) provide critical performance improvement for energy efficient systems.

Application and evaluation of an Institute of Medicine approach to dietary assessment and planning in long -term care

The primary purpose of these studies was to determine the effect of planning menus using the Institute of Medicine's (IOMs) Simple Nutrient Density Approach on nutrient intakes of long-term care (LTC) residents. In the first study, nutrient intakes of 72 subjects were assessed using Dietary Reference Intakes (DRIs) and IOM methodology. The intake distributions were used to set intake and menu planning goals. In the second study, the facility's regular menus were modified to meet the intake goals for vitamin E, magnesium, zinc, vitamin D and calcium. An experiment was used to test whether the modified menu resulted in intakes of micronutrients sufficient to achieve a low prevalence (<3%) of nutrient inadequacies. Three-day weighed food intakes for 35 females were adjusted for day-to-day variations in order to obtain an estimate of long-term average intake and to estimate the proportion of residents with inadequate nutrient intakes. ^ In the first study, the prevalence of inadequate intakes was determined to be between 65-99% for magnesium, vitamin E, and zinc. Mean usual intakes of Vitamin D and calcium were far below the Adequate Intakes (AIs). In the experimental study, the prevalence of inadequacies was reduced to <3% for zinc and vitamin E but not magnesium. The groups' mean usual intake from the modified menu met or exceeded the AI for calcium but fell short for vitamin D. Alternatively, it was determined that addition of a multivitamin and mineral (MVM) supplement to intakes of the regular menu could be used to achieve goals for vitamin E, zinc and vitamin D but not calcium and magnesium. ^ A combination of menu modification and MVM supplementation may be necessary to achieve a low prevalence of micronutrient inadequacies among LTC residents. Menus should be planned to optimize intakes of those nutrients that are low in an MVM, such as calcium, magnesium, and potassium. A MVM supplement should be provided to fill the gap for nutrients not provided in sufficient amounts by the diet, such as vitamin E and vitamin D. ^

Experimental and Analytical Methodologies for Predicting Peak Loads on Building Envelopes and Roofing Systems

The performance of building envelopes and roofing systems significantly depends on accurate knowledge of wind loads and the response of envelope components under realistic wind conditions. Wind tunnel testing is a well-established practice to determine wind loads on structures. For small structures much larger model scales are needed than for large structures, to maintain modeling accuracy and minimize Reynolds number effects. In these circumstances the ability to obtain a large enough turbulence integral scale is usually compromised by the limited dimensions of the wind tunnel meaning that it is not possible to simulate the low frequency end of the turbulence spectrum. Such flows are called flows with Partial Turbulence Simulation. In this dissertation, the test procedure and scaling requirements for tests in partial turbulence simulation are discussed. A theoretical method is proposed for including the effects of low-frequency turbulences in the post-test analysis. In this theory the turbulence spectrum is divided into two distinct statistical processes, one at high frequencies which can be simulated in the wind tunnel, and one at low frequencies which can be treated in a quasi-steady manner. The joint probability of load resulting from the two processes is derived from which full-scale equivalent peak pressure coefficients can be obtained. The efficacy of the method is proved by comparing predicted data derived from tests on large-scale models of the Silsoe Cube and Texas-Tech University buildings in Wall of Wind facility at Florida International University with the available full-scale data. For multi-layer building envelopes such as rain-screen walls, roof pavers, and vented energy efficient walls not only peak wind loads but also their spatial gradients are important. Wind permeable roof claddings like roof pavers are not well dealt with in many existing building codes and standards. Large-scale experiments were carried out to investigate the wind loading on concrete pavers including wind blow-off tests and pressure measurements. Simplified guidelines were developed for design of loose-laid roof pavers against wind uplift. The guidelines are formatted so that use can be made of the existing information in codes and standards such as ASCE 7-10 on pressure coefficients on components and cladding.

English Language Learners: A Correlational Study of the Relationship Between A Proficiency Level Assessment and End of Course Test Scores at one Georgia High School

Understanding the language of one’s cultural environment is important for effective communication and function. As such, students entering U.S. schools from foreign countries are given access to English to Speakers of Other Languages (ESOL) programs and they are referred to as English Language Learner (ELL) students. This dissertation examined the correlation of ELL ACCESS Composite Performance Level (CPL) score to the End of Course tests (EOCTs) and the Georgia High School Graduation Tests (GHSGTs) in the four content courses (language arts, mathematics, science, and social studies). A premise of this study was that English language proficiency is critical in meeting or exceeding state and county assessment standards. A quantitative descriptive research design was conducted using Cross-sectional archival data from a secondary source. There were 148 participants from school years 2011-2012 to 2013- 2014 from Grades 9-12. A Pearson product moment correlation was run to assess the relationship between the ACCESS CPL (independent variable) and the EOCT scores and the GHSGT scores (dependent variables). The findings showed that there was a positive correlation between ACCESS CPL scores and the EOCT scores where language arts showed a strong positive correlation and mathematics showed a positive weak correlation. Also, there was a positive correlation between ACCESS CPL scores and GHSGT scores where language arts showed a weak positive correlation. The results of this study indicated that that there is a relationship between the stated variables, ACCESS CPL, EOCT and GHSGT. Also, the results of this study showed that there were positive correlations at varying degrees for each grade levels. While the null hypothesis for Research Question 1 and Research Question 2 were rejected, there was a slight relationship between the variables.

Understanding Ten-Eleven Translocation-2 in Hematological and Nervous Systems

I proposed the study of two distinct aspects of Ten-Eleven Translocation 2 (TET2) protein for understanding specific functions in different body systems. In Part I, I characterized the molecular mechanisms of Tet2 in the hematological system. As the second member of Ten-Eleven Translocation protein family, TET2 is frequently mutated in leukemic patients. Previous studies have shown that the TET2 mutations frequently occur in 20% myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN), 10% T-cell lymphoma leukemia and 2% B-cell lymphoma leukemia. Genetic mouse models also display distinct phenotypes of various types of hematological malignancies. I performed 5-hydroxymethylcytosine (5hmC) chromatin immunoprecipitation sequencing (ChIP-Seq) and RNA sequencing (RNA-Seq) of hematopoietic stem/progenitor cells to determine whether the deletion of Tet2 can affect the abundance of 5hmC at myeloid, T-cell and B-cell specific gene transcription start sites, which ultimately result in various hematological malignancies. Subsequent Exome sequencing (Exome-Seq) showed that disease-specific genes are mutated in different types of tumors, which suggests that TET2 may protect the genome from being mutated. The direct interaction between TET2 and Mutator S Homolog 6 (MSH6) protein suggests TET2 is involved in DNA mismatch repair. Finally, in vivo mismatch repair studies show that the loss of Tet2 causes a mutator phenotype. Taken together, my data indicate that TET2 binds to MSH6 to protect genome integrity. In Part II, I intended to better understand the role of Tet2 in the nervous system. 5-hydroxymethylcytosine regulates epigenetic modification during neurodevelopment and aging. Thus, Tet2 may play a critical role in regulating adult neurogenesis. To examine the physiological significance of Tet2 in the nervous system, I first showed that the deletion of Tet2 reduces the 5hmC levels in neural stem cells. Mice lacking Tet2 show abnormal hippocampal neurogenesis along with 5hmC alternations at different gene promoters and corresponding gene expression downregulation. Through the luciferase reporter assay, two neural factors Neurogenic differentiation 1 (NeuroD1) and Glial fibrillary acidic protein (Gfap) were down-regulated in Tet2 knockout cells. My results suggest that Tet2 regulates neural stem/progenitor cell proliferation and differentiation in adult brain.

Regional Magma Plumbing and emplacement mechanisms of the Faroe-Shetland Sill Complex : Implications for magma transport and petroleum systems within sedimentary basins

Peer reviewed

Regional Magma Plumbing and emplacement mechanisms of the Faroe-Shetland Sill Complex : Implications for magma transport and petroleum systems within sedimentary basins

Peer reviewed