Physical restraint of people experiencing mental health problems is a coercive and traumatic procedure which is only legally permitted if it is proportionate to the risk presented. This study sought to examine the decision-making processes used by mental health staff involved in a series of restraint episodes in an acute care setting. Thirty nurses were interviewed either individually or in focus groups to elicit their views on restraint and experience in specific incidents. Four factors which influenced the decision to restrain were identified: contextual demands; lack of alternatives; the escalatory effects of restraint itself; and perceptions of risk. While some of these factors are amenable to change through improvements in practice, training and organisational culture, nurses viewed restraint as a necessary evil, justified on the basis of the unpredictable nature of mental illness and the environment in which they worked.

The aim of this study was to examine the risk of injury among patients and staff following involvement in a restraint episode in relation to restraint position (standing, supine or prone) and other aspects of the pre-incident behaviour including perceived causation. Mixed effects logistic regression was used to estimate the relative odds of injury to staff or patient in a series of 680 restraint episodes involving 260 patients in an adult mental health service in England between 1999 and 2001. There was no statistically significant association between patient injury and restraint position in this sample, but a prone restraint position was weakly associated with staff injury. Staff injury was most likely when an actual assault had occurred prior to the incident. Patient injury was more likely when the patient had self-harmed, had been abusing substances and had used a weapon prior to the incident, and less likely when the patient was showing signs of frustration with their environment. The use of prone restraint may be weakly associated with an increased risk of injury to staff. However, other aspects of the incident are stronger predictors and should be considered when planning training for front line staff.

The NOAA National Weather Service's current capabilities for producing real-time, multisensor precipitation estimates have been focused on providing input to hydrologic prediction models for mainstem rivers and larger headwaters. New functions are now being implemented to produce analyses and short-range forecasts for flash flood prediction operations, using a grid mesh of 1 km and a 5-minute update cycle with minimal time lag. The functionality produces rainrate and rainfall analyses and forecasts from multiple radars, covering entire County Warning Areas. The characteristics of the new High-resolution Precipitation Estimator and High-resolution Precipitation Nowcaster and their output products are described below.

AIM:The use of physical intervention on psychiatric inpatient units continues to be a source of debate and controversy. Some studies and national clinical guidelines have identified particular restraint positions as both dangerous and undesirable. The following study attempts to identify clinical variables that may make physical restraint in a particular position more likely.METHOD:A cross-sectional survey design was adopted and data was obtained from a violence and aggression audit form used by the trust. This form has 122 items to be completed by staff within 72 hours of an episode of patient aggression or self-harm. Ten variables were selected for scrutiny on the basis of their potential clinical importance.RESULTS:The survey found that prone restraint was significantly associated with others reporting the patient's imminent violence and high-intensity observation after the incident. Supine restraint was significantly associated with the patient being withdrawn and/or refusing to communicate prior to the episode and with a high severity incident rating after the incident.CONCLUSION:If we work on the premise that restraint in the prone position is less desirable than interventions undertaken with the patient in the supine position, this study clearly suggests that we have an opportunity to influence the nature of intervention through quite minimal changes to training programmes. It is important that any change in emphasis around intervention does not create a sense that controlled descent to the floor is inevitable. The principle of its use as a 'last resort in the event of loss of control on the feet' has to be maintained.

Based on the author's work with the American Indian Housing Initiative, this essay presents the reflections of a faculty member whose experiences with public scholarship have shaped his views on teaching global citizenship.

Physical restraint of potentially violent patients can take place on the floor in prone or supine positions (horizontal restraint) or, less intrusively, in standing or sitting positions (vertical restraint). The decision to use horizontal restraint may be made unnecessarily if the level of risk in an interaction is overestimated and/or the capacity to otherwise control the situation is underestimated by staff. A model of the decision-making process in this situation based on the concept of cognitive appraisal of imminent threat is proposed here. The aim of the study reported here was to test this model by examining the patient, staff, and environmental factors associated with the use of horizontal (as opposed to vertical) restraint. Logistic regression analysis of secondary data on the first-recorded episode of restraint of 261 patients occurring over a three-year period (1999-2001) in an acute care psychiatric trust in the UK was conducted, followed by a ROC analysis of the discriminative ability of the derived model to predict horizontal restraint. It was found that patients admitted under Section 2 of the Mental Health Act, those committing self-harm, and those with unclear thoughts and increased vocal volume prior to the incident were more likely to be restrained horizontally. Older people, those with perceived rational causation such as bad news and personal gain, and those with no obvious warning signs were less likely to be restrained horizontally. The AUC of the model was .76 (95% CI .70-.82), indicating acceptable discriminative ability. It is concluded that certain patient characteristics and certain staff appraisals of pre-incident behaviour are associated with an increased risk of horizontal restraint.

Using the current world's largest data sample of psi(3770) decays, we present results of a search for the non-D (D) over bar decay psi(3770)->(KSKL0)-K-0. We find no signal, and obtain an upper limit of sigma(e(+)e(-)->psi(3770)->(KSKL0)-K-0)< 0.07 pb at 90% confidence level (CL). Our result tests a theoretical prediction for the upper bound on B(psi(3770)->(KSKL0)-K-0) based on a charmonia-mixing model.

Using the 9 inverse femtobarn data sample collected with the CLEO II.V detector at the Cornell Electron Storage Ring, we have studied the resonant substructure of the Cabibbo suppressed decay D0 -> pi+ pi- pi0. We observe significant contributions from the rho- pi+, rho+ pi-, rho0 pi0, and non-resonant channels, and present preliminary results of the amplitudes, phases, and fit fractions for these sub-modes. No evidence for the sigma(500) or more massive rho resonances was found. We observe no CP violation, finding Acp = 0.01 +0.09 -0.07 +- 0.09.