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Background Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. Aims To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. Method Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. Results In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7–8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0–22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1–10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. Conclusions Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.

Disseminated Mycobacterium chimaera infections following cardiovascular procedures using Heater-Cooler systems have been associated with significant morbidity and mortality. We identified 2 patients, age 62 and 65 years, with disseminated Mycobacterium chimaera infection, following aortic valve surgery with graft involvement, diagnosed in 16 months and 3 years following their respective index surgeries. Mycobacterium chimaera was isolated from peri-graft tissue in one case and para-aortic tissue in the other. Neither of these cases had any evidence of infective endocarditis. Our cases highlight that disseminated infection with Mycobacterium chimaera , after valve surgery may occur without prosthetic valve involvement. The role of surgery to remove suspected infected valve, grafts and peri-graft tissue should be considered. Extensive review of the literature was performed.

In April 1868, Regina v. Hicklin refined the 1857 Obscene Publications Act by establishing the legal test for obscenity. The case concerned The Confessional Unmasked, until now read as sincere religious controversy. It was in fact flaunting pornography, paradigmatic of the material the 1857 Act prohibited. The story of The Confessional Unmasked and its ineffectual suppression significantly shifts understanding of mid-Victorian practices of censorship. It reveals surprising state tolerance, a decade after the statute passed into law, of a cheap pornographic pamphlet in widespread circulation throughout the United Kingdom for three long and turbulent years.

BACKGROUNDCatheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.OBJECTIVETo implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.METHODSA project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.RESULTSThe CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.CONCLUSIONSEffectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.Infect Control Hosp Epidemiol 2017;38:186–188

OBJECTIVE Ethnicity may affect presentation to clinical services in people with dementia; however, no studies have examined this in Māori or Pacific peoples in New Zealand (NZ). Our objective was to examine the routinely collected clinical data from a memory assessment service in South Auckland to examine the presentation of dementia in the major NZ ethnic groups. METHODS A total of 360 patients presenting to a memory service with a new diagnosis of dementia were included in this study. Demographic data (age, sex, and ethnicity) and dementia sub-type and severity were analyzed. RESULTS There were 142 NZ European (mean age: 79.2, SD 7.4), 43 Māori (mean age: 70.2, SD 7.6), 126 Pacific (mean age: 74.3, SD 7.6), and 49 other ethnicities (mean age: 78.0, SD 8.5) presenting with a new diagnosis of dementia. After adjustment for gender and dementia subtype, Māori and Pacific patients were 8.5 and 5.3 years younger than NZ European patients (P

This article investigates James Joyce's fascination with a wide variety of medical texts, sexual folklores, religious beliefs, and persistent superstitions about menstruation. That fascination finds its way into Ulysses , which draws upon a number of intertexts to inform a curiosity about the female body most strikingly articulated by Bloom, Molly, and Gerty MacDowell. These intertexts are not simply imported into the novel but are dismantled and interrogated, as Joyce exposes, rather than endorses, cliches of essential femininity.

Background There has been an intensified focus on quality initiatives within health care. Clinical Networks have been established in Alberta as a structure to improve care within and across settings. One method used by Clinical Networks to improve care is clinical care pathways. The objective of this study was to evaluate an evidence-informed hip fracture acute care pathway before broad implementation. Methods The pathway was developed by a provincial Clinical Network and implemented at four of 14 hospitals across the province. Within four months of implementing the pathway, experienced interviewers conducted focus groups with end-users at the four sites. Domains of inquiry focused on indentifying barriers and facilitators to use of the pathway. Results Fifteen physicians and 29 other health-care providers participated in eight focus groups. Common themes identified around the pathway order sets included issues with format, workflow and workload, and dissemination. The patient/family educational materials were deemed to be beneficial. Health-care provider education required better support. Overall the pathway was seen to be comprehensive. However, communication about the pathway could have been improved. Conclusions This care model is novel in that it combines the concepts of clinical networks, care pathways, and knowledge translation in an effort to provide high-quality, evidence-informed care in a standardized equitable manner across a diverse geographic area.

This article uncovers the complex and tangled intertextual relationship between the 'Sirens' episode of James Joyce's Ulysses and the many competing narratives about barmaids at the turn of the century. For some, barmaids were ambiguous sexual personae who characterized a modern and freer age. For others, barmaids were in acute moral peril, in need of rescue and salvation. While 'Sirens' has often been read as a chapter more preoccupied with style than with politics, it seems that Joyce was intimately engaged with intensely political debates over the role of women in the public sphere. Through satirizing contemporary moral unease surrounding the figure of the barmaid, Joyce covertly attacks those moral reformers who would also successfully censor his own work.

Objective: To compare the symptoms and function of patients with psychosis who have ceased using substances to those who have psychosis but do not have a history of substance use. Method: The databases EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English reporting the characteristics of patients with psychotic illness who had stopped using substances and those who had never used substances. The searches yielded 20 articles that met the inclusion criteria. Four key outcome variables – positive symptoms, negative symptoms, depression and global function – and four other outcome measures reported in five or more studies were examined using meta-analysis. Results: Former substance-using patients were significantly younger than non-substance-using patients and were more likely to be male, but did not differ in age at onset of psychosis or in their level of education. There were no significant differences between former substance users and non-substance users in ratings of positive symptoms, negative symptoms, depression or global function. Among first-episode patients there was a trend towards former substance users having less severe depressive symptoms than non-substance users. In contrast, among non-first-episode patients, former substance users had significantly more depressive symptoms than non-substance users. In studies rated as being of higher quality, former substance users had significantly less severe positive symptoms than non-substance users. Conclusion: The absence of significant differences between the two groups suggests that a history of substance use is not a poor prognostic indicator for patients who are able to stop using substances.

Objective: To assess the extent to which ceasing the use of cannabis or other substances reduces the symptoms and social disability associated with psychotic illness. Methods: The electronic databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that report data about the characteristics of current and former substance-using patients diagnosed with psychotic illnesses. The searches yielded 328 articles, of which 23 studies met the inclusion criteria. Four key outcome variables; positive symptoms, negative symptoms, ratings of depression and global function, and five other measures of outcome that were reported in five or more studies were examined using meta-analysis. Results: Current substance-using patients were significantly younger than former substance-using patients (standardised mean difference (SMD) = −0.38), but did not differ in age at onset of psychosis, sex, level of education or marital status. Current substance users had higher scores on rating scales of positive symptoms (SMD = 0.29) and depression (SMD = 0.36), and lower scores on global function (SMD = −0.26) when compared with former substance users. There was a significant improvement in the ratings of positive symptoms, mood and global function among patients who stopped using substances during the first episode of psychosis, while improvements in the symptoms of patients with a more established psychotic illness did not reach statistical significance. Conclusion: The results suggest that substance use contributes to both the symptoms and the burden of disability experienced by patients with psychosis. Patients in the early stages of psychotic illness should be informed about the benefits of giving up substances earlier, rather than later in the illness. Psychiatric services should regard the treatment of substance use as an integral part of the treatment of psychotic disorders.

This essay investigates the tangled and often contradictory relationship between two notoriously complex ideological forms. Just as there are many feminisms, so there are many modernisms. A range of diverse, even incompatible aesthetic practices are commonly labeled modernist, including Futurism, Symbolism, Imagism, Vorticism, Expressionism, and Surrealism. Attempts to define modernism, then, are often made with the broadest of brushstrokes. Modernism can be characterized as a set of “multiple revolts against traditional realism and romanticism.” Its preoccupations might include a commitment to paradox and ambiguity, a tendency toward aesthetic self-consciousness, an interest in techniques of montage and juxtaposition, or a fascination with the demise of the integrated individual personality. Or modernism can simply be labeled an art of crisis, a term Michael Levenson finds to be inevitably central in discussions of this turbulent cultural moment. Studies of literary modernism tend to focus on the period 1890 to 1930 as the years when a new kind of writing emerged, one characterized by new aesthetic codes, unprecedented experimentations with literary form, and radical transformations in social, philosophical, and cultural themes. This common definition of modernism as the art of a specific historical period in one sense evades the difficulties of defining the movement in other ways. Yet, importantly, it also emphasizes its historical coincidence with feminism. The period 1890 to 1930 was simultaneously a time of increasing feminist agitation, as women in various countries entered higher education and the workplace in unprecedented numbers, campaigned for the vote, and placed issues of sexuality and gender firmly on the political agenda.