Introduction
Psychiatric treatment on a ward with open-door policy is associated with reduced numbers of coercive measures. The effect of the door policy of previous stays, however, has not been ...investigated.
Methods
The data set consisted of 22,172 stays by adult inpatients in a psychiatric university hospital between 2010 and 2019. Pairs of consecutive stays were built. The outcome variable was the occurrence of coercive measures during the second stay.
Results
Compared to treatments on wards with a closed-door policy at both stays, treatments on wards with an open-door policy at the second stay had smaller odds for coercive measures (OR ranging between 0.09 and 0.33,
p
< 0.01). In addition, coercive measures were more frequent in treatment histories where patients previously treated on a closed ward were admitted to a ward with an open-door policy and subsequently transferred to a ward with a closed-door policy at the second stay (OR=2.97,
p
= 0.046).
Discussion
Treatment under open-door policy is associated with fewer coercive measures, even in patients with previous experience of closed-door settings. The group of patients who were admitted to a ward with an open-door, then transmitted to a ward with a closed-door policy seem to be prone to experience coercive measures. Clinical strategies to keep these patients in treatment in an open-door setting could further reduce coercive measures.
Background:
According to federal and cantonal law, persons with an acute mental illness can be admitted to a psychiatric hospital or another suitable institution against their will, when other ...therapeutic options are not available or have been exhausted. In the canton of Basel-Stadt, this is the responsibility of public health officers employed by the division of Social Medicine of the cantonal Health Department.
Aims:
This study aims to elucidate which factors influence the decision-making of public health officers regarding compulsory admissions over the period from September 2013 to April 2022 in the canton of Basel-Stadt.
Method:
Leveraging comprehensive clinical data from the health department of the canton Basel-Stadt (N = 5,′550), we estimated a mixed effects logistic regression model to identify factors contributing to the decision of public-health officers to compulsorily admit patients, while controlling for potential clustering effects among public health officers.
Results:
The risk for compulsory admissions was most strongly predicted by the presence of potential self-harm. In comparison, while being a strong predictor, potential harm to others played a considerably lesser role. Furthermore, psychiatric syndrome, previous compulsory admissions, and the specific context of evaluation were significant predictors. Finally, we found no meaningful personal bias among public health officers.
Conclusion:
The results suggest that public health officers’ decision-making regarding compulsory admissions focuses on preventing self-harm and, to a lesser degree, harm to others. This indicates that such measures are only used as a measure of last resort, which is in line with current evidence regarding the detrimental effects of compulsory measures on treatment outcomes in psychiatry. Our findings suggest that all relevant stakeholders, including the police, share this perspective. Decision-making regarding compulsory admissions was mostly free of personal biases, suggesting adherence to shared professional standards by public health officers.
Milling tools are subjected to severe loading conditions causing different wear mechanisms. Among others, the dominating tool wear mechanism depends on the combination of workpiece material and tool ...material, cutting parameters and the mode of operation. Usually, in industrial milling processes, the mode of operation is a combination of up- and down-milling. The present work is devoted to the question how up-milling and down-milling processes differ with respect to the thermomechanical loading and the tool wear, particularly in the case of milling titanium alloy Ti-6Al-4V. To this end, cutting tests for both modes of operation have been performed. The cutting inserts have been evaluated in certain intervals via optical and electron microscopy. Finite element simulations provide the corresponding thermal and mechanical loading at the cutting edge during service. Experiment and simulation consistently show the detrimental effect of up-milling in comparison to down-milling. However, the wear analysis suggests the same mechanism for both modes of operation but with higher rate of wear in up-milling. The cutting experiments show that wear is driven by the growth of fatigue cracks and thus indicate a mechanical reason for tool wear. From the simulations, it is clear that the specific interaction between thermal and mechanical loading in up-milling is the reason for accelerated tool wear in up-milling compared to down-milling. The higher rate of wear in up-milling is attributed to its specific thermomechanical loading.
•2D-modeling approach for circular shaped cutting inserts in Ti6Al4V milling•Experimental and numerical investigation and correlation of local loading and wear•Revealing the reason for accelerated wear in up-milling compared to down-milling•Wear mechanism in Ti6Al4V milling is rather fatigue- than diffusion-controlled.
After over a hundred years of research, the question whether the symptoms of schizophrenia are rather trait-like (being a relatively stable quality of individuals) or state-like (being substance to ...change) is still unanswered. To assess the trait and the state component in patients with acute schizophrenia, one group receiving antipsychotic treatment, the other not. Data from four phase II/III, 6-week, randomized, double-blind, placebo-controlled trials of similar design that included patients with acute exacerbation of schizophrenia were pooled. In every trial, one treatment group received a third-generation antipsychotic, cariprazine, and the other group placebo. To assess symptoms of schizophrenia, the Positive and Negative Symptom Scale (PANSS) was applied. Further analyses were conducted using the five subscales as proposed by Wallwork and colleagues. A latent state-trait (LST) model was developed to estimate the trait and state components of the total variance of the observed scores. All symptom dimensions behaved more in a trait-like manner. The proportions of all sources of variability changed over the course of the observational period, with a bent around weeks 3 and 4. Visually inspected, no major differences were found between the two treatment groups regarding the LST structure of symptom dimensions. This high proportion of inter-individual stability may represent an inherent part of symptomatology that behaves independently from treatment status.
Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this ...setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry.
Background
During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and ...telepsychiatry boomed.
Objective
The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees’ mental health in a large psychiatric university hospital in Switzerland.
Methods
We obtained and analyzed home office implementation and use data from the psychiatric university hospital’s information technology services. We also conducted a cross-sectional web-based survey to assess the employees’ attitudes toward the clinic’s crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire PHQ–2), anxiety (General Anxiety Disorder GAD–2), and stress factors (stress module of the PHQ-D); a cut-off score ≥3 was used for the PHQ-2 and GAD-2.
Results
Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (χ162=72.72, P≤.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (χ42=9.72, P=.04).
Conclusions
In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees’ work–life balance, to save employers costs and foster other benefits.
During manufacturing and use printed circuit boards (PCB) are subjected to different mechanical and thermal loads. These loads can cause the PCBs to develop a delamination between the insulating ...layers of pre-preg and conducting copper which can lead to failure of the entire electronic device. Therefore, it is critical to understand the delamination process and to know the adhesion strengths of the interfaces in a PCB to improve the device reliability. To evaluate the copper/pre-preg interface properties in PCBs a combination of experiments and modeling is used. The experimental characterization of interfacial adhesion strength was measured with a 4 point bending (4PB) technique. To find a context with application, the adhesion strength was determined as a function of reflow cycles. Finite element (FE) modeling was utilized to determine the optimum layer structure and the stiffness for the test specimens. In a second step, the FE model was used to study the influence of plastic deformation of the copper foils and the residual stresses developing during the reflow process on the adhesion strength. It could be shown that the calculated adhesion strength changed with the number of reflow cycles. The measured adhesion strengths were influenced by plastic deformation of the specimen and by residual stresses within the specimen.
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