An evaluation of the incorporation of psychological interventions into the care of patients with a diagnosis of emotionally unstable personality disorder following admission to the general adult inpatient setting

AimsTo assess incorporation of and access to psychological therapies for patients with a diagnosis of emotionally unstable personality (EUPD) who were discharged from the inpatient wards at Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust.MethodA retrospective analysis of the electronic record of 50 patients discharged from Clock View Hospital between 1st of January 2020 and 1st of November 2020 was performed to assess whether patients were engaged with psychotherapy and whether they had an extended care plan in place.25 patients with EUPD and no associated psychiatric comorbidities were included in the sample, as well as 25 patients with EUPD and associated psychiatric comorbidities.ResultThose EUPD patients with no psychiatric comorbidities were more likely to be under the care of the Liverpool Personality Disorder (PD) Hub compared to those with psychiatric comorbidities (12 vs seven patients). Of the 19 patients under the PD Hub, 11 had a Case Manager, four were engaged with the PD Hub's day services / safe service and one with a PD Hub readiness group. Six of the 50 patients had a documented refusal to engage with the PD Hub.Only 27 of the patients had either received psychological intervention, were on a waiting list, or had a referral in place. 16% of patients refused a psychotherapy referral. Of the 20 patients who received psychological treatment, eight completed a form of psychotherapy (cognitive analytic therapy, dialectical behaviour therapy, cognitive behavioural therapy, eye movement desensitisation and reprocessing) and 12 psychological intervention (either structured case management, psychoeducation or emotional coping skills).Only 28 of 50 patients had an extended care plan and 28 had a collaborative risk management plan in place.ConclusionThere was no obvious correlation between previous completion of psychological therapy and degree of polypharmacy. Median admission time was reduced for patients under the PD Hub (six vs 14 days). This was also reduced for patients who accessed psychotherapy or psychotherapeutic interventions (nine vs 10 days).This audit coincided with the COVID-19 pandemic and subsequent reduced access to the PD Hub and psychotherapy service. There is a need to consider barriers to EUPD patients receiving psychotherapy.EUPD patients may have numerous hospital admissions and frequently present in crisis. Given the iatrogenic harm from prolonged hospital admission, there is a need to consider incorporating a collaborative extended care plan and risk management plan as part of discharge planning, following admission to hospital.

Risk-Based Design of Socio-Cyber-Physical Systems

The aim of risk management of socio-cyber-physical systems at designing is the integral safety, which ensures their coexistence with their vicinity throughout their life cycles. On the basis of present knowledge and experience, part of risks that threaten socio-cyber-physical systems shall be mitigated by preentive measures during their designing and manufacturing. Due to dynamic changes of the world, the conditions of socio-cyber-physical systems at operation change. If changes exceed the socio-cyber-physical systems´ safety limits which were inserted into their designs, the accidents or socio-cyber-physical sysems´ failures occur. The presented risk management plan is tool which ensures the prevention of such unaccepted situations and the safety.

Combining open channel and sewer system network modelling to develop the Hydraulic Risk Management Plan for Brescia (Northern Italy)

<p>Flood risk management is one of priorities set by the European Union to protect population and assets. In a very recent report of the European Environment Agency dealing with urban adaptation to climate change (EEA, 2020), extreme weather events (heatwaves, heavy precipitation, flooding and droughts) are expected to cause the most pronounced impacts in European cities, besides vector‑borne diseases. Italian regions are taclking flood risk management also by setting regulations on the runoff production in urban areas.</p><p>According to a recent regulation approved by Regione Lombardia municipalities are requested to prepare the Hydraulic Risk Management Plan, including measures to ensure compliance with the principle of the ‘hydraulic’ and ‘hydrological’ invariance for the urban area, in which runoff volumes generated by an intense meteoric event must remain unchanged or at least must be limited. The idea arises from the need to manage the rainwater drainage in urban contexts, where the existing sewerage system has been designed based on an inadequate return time period.</p><p>The planning activity requires a modelling framework accounting for both the open channel network (mainly addressing irrigation demand) and the sewer pipe network. While separate hydraulic models might help the management provided by separate authorities, an integrated model is ensuring a complete representation of the system hydrodynamics. This type of model is characterized by a much more complex structure which requires greater data accuracy for the construction and calibration of the model in order to obtain realistic results.</p><p>Some critical issues are being presented for Brescia, a town located in Northern Italy, at the foothills of the Alps.  Potential flood risk is linked to the dense historical irrigation and drainage channels network that cross the urban area from north to south and the old city centre. Critical areas are those hosting the post-war urban development where the waterways have been uncovered and covered in a chaotic and uncontrolled way, in some cases even under houses and other buildings.</p>

Risk Management in the Design of the Organization and Technology for the Construction of Buried Structures in Conditions of Compacted Development

The article substantiates the feasibility of developing and implementing a risk management plan for the implementation of construction projects in the conditions of compacted construction on the basis of risk identification at the stages of development of projects of organization and construction technology. The risk management algorithm is given. Design of construction of structures in conditions of compacted development usually requires consideration of many factors (risks) that affect the safety and quality of construction, but, as a rule, the most significant risks arise in the construction of the deepened part of the structure - "zero cycle". With this in mind, a Risk Management Plan for the construction of the "zero cycle" is proposed and emphasis is placed on the need to develop a strategy for the protection of the surrounding area and buildings. The conditions for achieving optimal efficiency of the Risk Management Plan are determined.