Self-centering seismic-resistant structures: Historical overview and state-of-the-art

This state-of-the-art review provides an overview of the evolution of self-centering structures from early historical structures that inherently exhibited a recentering response to modern systems engineered for enhanced seismic resilience. From the early research investigations that were conducted since the 1960s, to the sharp increase of interest in this topic over the last two decades, self-centering seismic-resistant structures that can mitigate both damage and residual drifts following major earthquakes have seen significant advances. These systems achieve the intended self-centering response by either allowing for the rocking of primary structural elements in a controlled manner, commonly coupled with mechanical restraints and energy dissipation devices, or by including self-centering devices as main structural or supplemental structural members. To better explain the concepts and the underlying mechanics governing their seismic response, detailed schematic illustrations were developed in this article, highlighting the fundamentals behind each of these systems. This article covers a historical overview, presents the state of the research and of the art, discusses general design challenges and practical considerations, and concludes with future research needs to advance the development and broader application of self-centering systems in real structures.

Participation in Post Incident Reviews after Restraint in Mental Health Services: A qualitative study

Background: Evaluation of all kinds of use of force in mental health services was mandated by law in Norway in 2017. Debriefing, or “Post Incident reviews” (PIRs), have been implemented in several western countries since early 2000, often as one part of Seclusion and Restraint (S/R) reduction projects. The factual or theoretical basis of PIR’s is, however, scarce despite the growing focus on prevention of harm and use of restraint in mental health services. Aims: The overall aim of this thesis was to explore PIRs’ potential to promote improvement in terms of human values like participation, influence and collaboration, according to the body of scientific knowledge and experiences developed by care receivers and care providers. The study consisted of four steps. The specific aim of step 1 was to explore the body of scientific literature regarding PIRs. Based on the findings in step 1, the specific aim of step 2 was to explore professionals’ experiences and considerations with PIRs’ after having used physical and mechanical restraints in a Norwegian context. Step 3 was to explore patients’ experiences and considerations with PIRs’ after having physical and mechanical restraints applied to them in a Norwegian context. Step 4 was a synthesizing analysis of the results to summarize the findings regarding PIRs related to scientific knowledge and experiences from care receivers and care providers. Methods: This thesis has a phenomenological-hermeneutic approach with an explorative design. Data were collected by means of the three sub-studies (Articles I, II and III) which contain a scoping review of 12 scientific publications and in-depth interviews with 19 multidisciplinary care providers and 10 patients. Data analyses methods include narrative descriptions (Article I and III) and qualitative content analyses (Article I, II and III). Findings: Article I reports findings from a scoping review where the aim was to identify the prevailing knowledge basis of PIRs. PIRs were often found to be one of several components in seclusion and restraint (S/R) reduction programs, but there was no significant outcome related to PIRs alone. Patients and care providers reported participation in PIRs to be an opportunity to review restraint events they would not have had otherwise, to promote patients’ personal recovery processes and stimulate professional reflection on organizational development and care. The review revealed, however, a knowledge gap; patients’ and care providers’ experiences and considerations of PIRs were scarcely explored. Consequently, the findings provided the basis for article II and III. Article II reports care providers’ experiences and considerations of PIRs. Main theme 1 was PIRs’ potential to improve the quality of care based on knowledge about other perspectives and solutions, increased professional and ethical awareness and emotional and relational processing. Main theme 2 was struggling to get a hold on patients’ voices in the PIRs. Care providers considered that issue to be attributable to the patients conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions. Article III reports patients’ experiences and considerations of PIRs. The findings resulted in two overarching themes: (1)‘PIRs as an arena for recovery promotion based on experiences of being strengthened, developing new coping strategies and processing the restraint event’ and (2)‘PIRs as continuation of coercive contexts based on experiencing PIRs as meaningless, feeling objectified and longing for living communication and closeness. Conclusion: The three sub-studies represented different knowledge sources as scientific knowledge and experiences from care receivers and care providers and were thus parts of a larger whole. The findings show that PIRs can be an appropriate and valuable tool both to patients and care providers as PIRs were found to 1) promote the patients’ personal recovery processes, (2) improve the quality of care and (3) facilitate processing of the restraint incident. The thesis’ main findings of PIRs between authoritarian and dialogical approaches point to both the procedure’s possibilities and limitations. The study identified pitfalls that may influence patients’ active participation in the PIRs. The practice of implementing PIRs as an isolated procedure, and thus not a part of a S/R reduction program, as well as unresolved care philosophies in the services seem to be limitations with respect to the Norwegian authorities’ objectives with the procedure. Conducting PIRs in services that base their practices on human care philosophies and values in line with care ethics, that is, acknowledging the stakeholders’ vulnerability and the power-dependence imbalance, may support and empower both patients’ and care providers’ participation and collaboration and thus the patients’ influence in the encounters.

A 26-Year Study of Restraint Fatalities Among Children and Adolescents in the United States: A Failure of Organizational Structures and Processes

Background Physical and mechanical restraints used in treatment, care, education, and corrections programs for children are high-risk interventions primarily due to their adverse physical, emotional, and fatal consequences. Objective This study explores the conditions and circumstances of restraint-related fatalities in the United States by asking (1) Who are the children that died due to physical restraint? and (2) How did they die? Method The study employs internet search systems to discover and compile information about restraint-related fatalities of children and youth up to 18 years of age from reputable journalism sources, advocacy groups, activists, and governmental and non-governmental agencies. The child cohort from a published study of restraint fatalities in the United States from 1993 to 2003 is combined with restraint fatalities from 2004 to 2018. This study’s scope has expanded to include restraint deaths in community schools, as well as undiscovered restraint deaths from 1993 to 2003 not in the 2006 study. Results Seventy-nine restraint-related fatalities occurred over the 26-year period from across a spectrum of children’s out-of-home child welfare, corrections, mental health and disability services. The research provides a data snapshot and examples of how fatalities unfold and their consequences for staff and agencies. Practice recommendations are offered to increase safety and transparency. Conclusions The study postulates that restraint fatalities result from a confluence of medical, psychological, and organizational causes; such as cultures prioritizing control, ignoring risk, using dangerous techniques, as well as agencies that lack structures, processes, procedures, and resources to promote learning and to ensure physical and psychological safety.

From Wish to Reality: Soteria in Regular Care—Proof of Effectiveness of the Implementation of Soteria Elements in Acute Psychiatry

Objective: This article examines the influence of the implementation of Soteria elements on coercive measures in an acute psychiatric ward after reconstruction in 2017, thereby comparing the year 2016 to the year 2019. The special feature is that this is the only acute psychiatric ward in Hennigsdorf Hospital, connected now both spatially and therapeutically to an open ward and focusing on the treatment of patients suffering from schizophrenia and schizophrenia spectrum disorders.Methods: The following parameters were examined: aggressive assaults, use of coercion (mechanical restraints), duration of treatment in open or locked ward, type of discharge, coercive medication, and dosage of applied antipsychotics. For this purpose, the data of all legally accommodated patients in the year 2016 (before the reconstruction) and 2019 (after the reconstruction) were statistically analyzed in a pre–post mirror quasi-experimental design.Results: In 2019, the criteria of the Soteria Fidelity Scale for a ward with Soteria elements were reached. In comparison to 2016 with a comparable care situation and a comparable patient clientele, there was now a significant decrease in aggressive behavior toward staff and fellow patients, a significantly reduced number of fixations, a significantly reduced overall duration of inpatient stay, and a significant increase in treatment time in the open area of our acute ward.Conclusion: The establishment of Soteria elements in the acute psychiatric ward leads to a verifiable less violent environment of care for severely ill patients and to a drastic reduction in coercive measures.

Reducing the Use of Mechanical Restraints in the Medical–Surgical Department

BACKGROUND The most crucial discussion in psychiatric hospitals is the safety of patients, especially during incidents that have the potential to cause physical harm such as those where mechanical restraints are used. AIM The goal of the project was to reduce the use of mechanical restraints by 25% within 10 weeks in two piloted medical–surgical units. METHOD A total of 60 articles were examined for relevance; out of these, the author used 30 studies that were based on observational, literature review, quantitative analysis, or clinical trial methodologies to conduct a comprehensive literature review. The author used a retrospective and descriptive design of chart review data collection to implement the project. The six core strategies framework, coupled with the creation of mental health championship role, was implemented to mitigate the problem. RESULTS This study shows that the implementation of the six core strategies and the role of a mental health champion helped reduce the use of mechanical restraints by 100%. CONCLUSION A total of 3,072 patients’ charts were reviewed in which there were three PERT (Psychiatric Emergency Response Team) activation and no mechanical restraint events, which showed a considerable quality improvement compared to the pre-implementation data collection of 37 PERT and 14 mechanical restraint events. The implications for practice and further study in the field are the involvement of more authors with similar expertise, the use of a control group for comparison, and a longer length of study duration.

Overcoming the Use of Mechanical Restraints in Psychiatry: A New Challenge in the Everyday Clinical Practice at the Time of COVID-19

Restraining interventions, which comprise physical (PR) and mechanical restraint (MR), have a long history in mental health services [...]

Impact of the nucleosome histone core on the structure and dynamics of DNA containing pyrimidine-pyrimidone (6-4) photoproduct

ABSTRACTThe pyrimidine-pyrimidone (6-4) photoproduct (64-PP) is an important photoinduced DNA lesion, which constitutes a mutational signature for melanoma. The structural impact of 64-PP on DNA complexed with compaction proteins, and notably histones, affects the mechanism of its mutagenicity and repair but remains poorly understood. Here we investigate the conformational dynamics of DNA containing 64-PP lesions within the nucleosome core particle by atomic-resolution molecular dynamics simulations at the multi-microsecond time scale. We demonstrate that the histone core exerts important mechanical restraints that largely decrease global DNA structural fluctuations. However, we also show that local DNA flexibility at the damaged site is enhanced, due to imperfect structural adaptation to restraints imposed by the histone core. In particular, if 64-PP faces the histone core and is therefore not directly accessible by the repair protein, the complementary strand facing the solvent exhibits higher flexibility than the corresponding strand in a naked, undamaged DNA. This may serve as an initial recognition signal for repair. Our simulations also pinpoint the structural role of proximal residues from the truncated histone tails.

Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital

INTRODUCTION: The application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care to assure patient safety and expedite release at the earliest opportunity. While current Centers for Medicare & Medicaid Services regulations require trained staff to continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. The experience of an acute psychiatric hospital demonstrates that more frequent registered nurse assessments can decrease duration of mechanical restraint episodes. AIMS: The aim of this three-part quality improvement project was to decrease duration of mechanical restraint episodes by increasing the frequency of registered nurse assessment and surveillance. METHODS: First, the requirement for frequency of face-to-face registered nurse assessment during episodes of mechanical restraint was increased from once every hour to once every 30 minutes. Second, the frequency of assessment was increased on half the hospital’s units, from every 30 minutes to continuous registered nurse presence during restraint. Finally, the remaining units adopted 1:1 registered nurses during restraint. Mean hours of restraint per episode were measured and compared before and after each practice change. RESULTS: Mean duration of restraint episodes decreased 23% in the first change cycle, 12% in the second, and 44% in the third. Overall, there was a statistically significant 30% decrease in mean duration of restraint episodes. CONCLUSIONS: Increased frequency of registered nurse assessment and surveillance can significantly decrease duration of mechanical restraint episodes. Nurses are encouraged to adopt mechanical restraint practice standards that provide continuous psychiatric intensive care by a registered nurse.