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The practice of transplanting hepatitis C (HCV)-infected livers into HCV-uninfected recipients has not previously been recommended in transplant guidelines, in part because of concerns over uncontrolled HCV infection of the allograft. Direct-acting antivirals (DAAs) provide an opportunity to treat donor derived HCV-infection, and should be administered early in the post-transplant period. However, evidence on the safety and efficacy of an immediate DAA treatment approach, including how to manage logistical barriers surrounding timely DAA procurement, are required prior to broader use of HCV-positive donor organs. We report the results of a trial in which fourteen HCV-negative patients underwent successful liver transplantation from HCV-positive donors. Nine patients received viremic (nucleic acid testing (NAT)-positive) livers, and started a 12-week course of oral glecaprevir-pibrentasvir (GP) within 5 days of transplant. Five patients received livers from HCV antibody-positive non-viremic donors and were followed using a reactive approach. Survival in NAT-positive recipients is 100% at a median follow-up of 46 weeks. An immediate treatment approach for HCV NAT-positive liver transplantation into uninfected recipients is safe and efficacious. Securing payer approval for DAAs early in the post-transplant course could enable need-based allocation of HCV-positive donor organs irrespective of candidate HCV status, while averting chronic HCV allograft infection.

Highlights • Alexithymia is more closely related to suicide ideation than to suicide behaviour. • The subcomponents of difficulty identifying and describing feelings are more closely related to suicide ideation and behaviour than the subcomponent of externally oriented thinking. • The relationship between alexithymia and suicide ideation appears robust when controlling for confounding variables, though the relationship between suicide behaviour and alexithymia is not so robust. • Future research should aim to examine causality in this relationship through using longitudinal designs., Background Alexithymia reflects a difficulty with identifying and expressing emotions. This experience has been proposed as having an association with suicide ideation and behaviour. This review aimed to synthesise the evidence to establish the bivariate and multivariate relationships between alexithymia, and its subcomponents, with suicide ideation and behaviour. Methods Search terms related to alexithymia and suicide ideation and behaviour were searched across nine prominent databases in May 2018. Studies were eligible for inclusion if they reported original empirical quantitative findings from adult samples, used a validated measure of alexithymia, and any measure of suicide ideation or behaviour. Results Thirty-four studies were eligible for inclusion in this review. The review found a large effect size for the relationship between alexithymia and suicide ideation (r = 0.54, 95% CI= 0.40–0.65) and a small effect size for the relationship between alexithymia and suicide behaviour (r = 0.25, 95% CI = 0.16–0.34). Limitations A high level of heterogeneity was found in the meta-analysis meaning that results should be interpreted with caution. Conclusion A positive association was found between alexithymia and suicide ideation and, to a lesser extent, behaviour across a range of clinical and general population samples. This review has potentially important clinical implications, and promotes the need for suicide prevention to focus on emotion regulation skills.

Industry 4.0 is taking process information to the next level with improved exchange of data, analytics and relevant feedback regarding the process, equipment health and dynamics. Quality Control needs to adapt to new requirements of 100% inspection and additive manufacturing (AM) to enable high-speed inspection of internal and external features, rapidly accommodate part design changes, tie results to unique part numbers, perform automated metrology and make a final decision on the condition of a measured part. All of this must happen at a rapid pace, permitting inspection of internal and external features simultaneously. Computed tomography (CT) offers needed flexibility and, with recent technological advancement, part throughput of a few seconds is possible, even while performing complex metrology and inspection tasks simultaneously. With defect analysis and feedback, virtually defect-free production is achievable. In this paper, authors will discuss implementation of complete solutions enabling greater process control, digital part tracking as well as flexibility and throughput of parallel metrology with industrial CT.

Background\ud \ud Hopelessness is frequently observed in people who harm themselves and is an established risk factor for nonfatal self-harm repetition and suicide. Little is known about how the presence of hopelessness in addition to other risk factors affects subsequent risk.\ud \ud Method\ud \ud Prospective cohort of 19,479 individuals presenting with self-harm to one of three English Emergency Departments between 1st January 2000 and 31st December 2010. Repeat self-harm and suicide deaths within twelve months of the first assessed episode were identified. Cox Proportional Hazards models were used to estimate Hazard Ratios (HRs) for risk factors with and without hopelessness.\ud \ud Results\ud \ud A clinical impression of hopelessness was associated with increased risk of further self-harm (HR 1.35, 95% CI 1.16–1.58) and suicide (HR 2.56, CI 1.10–5.96) in the year following an index episode. For individuals who were living alone or homeless, unemployed, reported problems with housing, had received psychiatric treatment in the past, were currently receiving treatment or used alcohol during the self-harm episode, an exacerbation of an already elevated risk of repetition was observed amongst those who were assessed as hopeless. Where individuals presented with forensic problems, physical health problems or bereavement, an increase in risk was only observed for those who were also assessed as hopeless.\ud \ud Limitations\ud \ud A clinical impression of hopelessness was assigned using a binary “yes”/“no” classification rather than a validated scale.\ud \ud Conclusions\ud \ud Hopelessness intensifies the impact of several known risk factors for adverse outcomes following self-harm. These findings highlight the importance of identifying and therapeutically addressing this dynamic but potentially modifiable clinical risk factor during the psychosocial assessment and in subsequent care.

Suicidal ideation and behaviour are common among inmates. Anger is found at exaggerated levels and has been associated with suicidal ideation and behaviour in inmate samples suggesting its possible salience in the prediction of suicide. The study investigated relationships between anger, psychological distress, and self-harm/suicidal ideation among inmates. The principles of Ecological Momentary Assessment were considered and a structured self-assessment diary was utilised to examine relationships between the variables of interest. Participants completed a structured self-assessment diary for six consecutive days which included momentary ratings of items describing psychological states of concurrent affects, thoughts, and appraisals related to anger, psychological distress, and self-harm/suicidal ideation. Psychometric assessment measures were also conducted. Temporal associations between predictors and outcomes were investigated. Multilevel modelling analyses were performed. Increased anger was significantly associated with concurrent high levels of self-harm ideation in inmates, when controlling for depression and hopelessness. Temporal analyses also revealed that anger at one time point did not predict suicidal ideation at the next time point. Elucidating the temporal nature of the relationship between anger, psychological distress, and self-harm/suicidal ideation has advanced understanding of the mechanisms of suicidal behaviour, by demonstrating an increased risk of suicide when a male inmate is angry.

The current study tests whether perceptions of defeat and entrapment are the psychological mechanisms underlying the link between positive psychotic symptoms and suicidal ideation in schizophrenia. A sample of 78 patients with schizophrenia spectrum disorders completed self-report measures and a clinical interview. Of this sample, 21.8% reported a single past suicide attempt and 50% reported multiple past attempts. It was found that perceptions of defeat and entrapment, conceptualised as a single variable, accounted for a large proportion (31%) of the variance in suicidal ideation and behaviour. Defeat and entrapment also mediated the relationship between positive symptom severity and suicidal ideation. This result held whilst controlling for levels of hopelessness and depression. Secondary analyses suggested that suspiciousness in particular was linked to suicidal ideation. The results support a socio-cognitive model (The Schematic Appraisals Model of Suicide: SAMS) of suicide in psychosis.

The transformation of a trainee into a surgeon is influenced strongly by communication patterns in the operating room (OR). In the current era of limited educational opportunities, elucidation of teaching and learning strategies in this environment is critical. The aim of this study was to further understand the elements of an effective communicative instructional interaction (CII) as perceived by surgical residents.Qualitative research methodology was used to explore University of British Columbia surgery residents' perceptions of what constitutes an effective CII in the OR. Purposeful sampling was used to select participants from various years of training. Eighteen residents participated in semistructured interviews to facilitate reflection of their OR experiences. Interviews were transcribed, analyzed, and fed back to residents to confirm their accuracy. Independent coding and analysis led to the development of key emergent themes.Themes represented the interplay of ideals expressed by the residents. The primary emergent theme was that both teacher and learner play a major role in the creation of an effective CII. The ideal teacher had an instructional plan, facilitated surgical independence, and showed support and empathy for the surgical resident. The ideal resident was receptive, prepared, and acknowledged limitations. The contextual constraints of the OR played a central role in learning, and residents identified ways to maintain educational value despite primarily nonmodifiable contextual elements (ie, time constraints).In a unique environment such as the OR, both teacher and learner may benefit by an enhanced understanding of the elements of an effective CII.

This report outlines a study which examined certain approaches to- and practices of peer observation of teaching. Participants observed and free-form evaluated the effectiveness of two different teaching scenarios. These were evaluated both before and after identifying their own dominant perspective on teaching and attending a workshop which detailed five perspectives on teaching. Analysis of their effectiveness ratings as well as interview transcripts revealed that preconceived notions of what constitutes excellent teaching as well as the tendency to look for themselves (or their practices) in the teaching of others are both strong influences. Nonetheless, an increased awareness of their own teaching perspective and exposure to different perspectives allowed for a less judgmental approach to peer observation.

Cultural, social, political, and psychological influences are shown to result in different conceptions of self within China and the United States. The Chinese construction of self emphasizes continuity of family, societal roles, the supremacy of hierarchical relationships, compliance with authority, and the maintenance of stability. Identity is, largely, externally ascribed, subordinated to the collective, and seeks fulfillment through performance of duty, ordained roles, and patterns of filial loyalty. Within the United States the individual is recognized as the starting point for construing the social order, and the self is considered a psychological construct as much as an artifact of cultural, social, and political influences. These differences are shown to provide different foundations for thinking about the provision of education for adults.