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PURPOSE OF REVIEW: Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide. RECENT FINDINGS: The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools. SUMMARY: The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Background: Sudden death from stable coronary artery atherosclerosis (SCAA) is well recognized. However, individuals can have ischemic heart disease or coronary artery atherosclerosis but die of noncardiac causes. Recently, it has been recognized that increased epicardial fat is detrimental to normal heart function. We hypothesize that individuals who die of SCAA have increased epicardial fat. Aim: The aim of this study was to investigate whether there is an increase in epicardial fat in individuals who suddenly died of SCAA. Methods: This was a 1-year retrospective study comparing the average epicardial fat thickness using postmortem computed tomography scan between individuals who suddenly died of SCAA (SCAA group) with individuals who primarily died of natural noncardiac causes but had established ischemic heart disease or significant coronary artery atherosclerosis (NCC group). Results: Average epicardial fat thickness was significantly higher in the SCAA group (8 ± 2 mm) than in the NCC group (6 ± 2 mm, P = 0.008). Conclusions: Individuals who die of SCAA appear to have higher epicardial fat thickness. The increase in epicardial fat may have an additional detrimental effect to the heart predisposing sudden death in individuals with coronary artery atherosclerosis.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Background: Sudden death from stable coronary artery atherosclerosis (SCAA) is well recognized. However, individuals can have ischemic heart disease or coronary artery atherosclerosis but die of noncardiac causes. Recently, it has been recognized that increased epicardial fat is detrimental to normal heart function. We hypothesize that individuals who die of SCAA have increased epicardial fat. Aim: The aim of this study was to investigate whether there is an increase in epicardial fat in individuals who suddenly died of SCAA. Methods: This was a 1-year retrospective study comparing the average epicardial fat thickness using postmortem computed tomography scan between individuals who suddenly died of SCAA (SCAA group) with individuals who primarily died of natural noncardiac causes but had established ischemic heart disease or significant coronary artery atherosclerosis (NCC group). Results: Average epicardial fat thickness was significantly higher in the SCAA group (8 ± 2 mm) than in the NCC group (6 ± 2 mm, P = 0.008). Conclusions: Individuals who die of SCAA appear to have higher epicardial fat thickness. The increase in epicardial fat may have an additional detrimental effect to the heart predisposing sudden death in individuals with coronary artery atherosclerosis.

Aim To assess trends in medical imaging requests before and after the 4-hour rule commenced and to assess the imaging time component of emergency department (ED) length of stay (LOS). Materials and methods Retrospective analysis of ED patients and imaging requests 1 year prior to and 3 years after implementation of the 4-hour rule (April to December for 2011-2014) was performed at a single adult tertiary referral Level 1 trauma hospital with Level 6 ED. Logistic regression was used to evaluate trends in the number of ED patient presentations, patient triage categories, and imaging requests for these patients. The imaging component of the total ED LOS was compared for patients who met the 4-hour target and patients who did not. Results Compared to 2011 (before the 4-hour rule), ED presentations increased 4.74% in 2012, 12.7% in 2013, 21.28% in 2014 (p<0.01). Total imaging requests increased 23.05% in 2012, 48.04% in 2013, 60.77% in 2014 (p<0.01). For patients breaching the 4-hour rule, the mean time before radiology request was 2.4-2.8 hours; mean time from imaging request to completion was 1.2-1.3 hours; mean time from imaging completion to discharge from ED was the longest component of ED LOS (4.9-5.9 hours). Conclusions There has been a significant increase in imaging requests, with a trend towards more CT and less radiography requests. Imaging requests for patients who breached the 4-hour target were made on average 2.4-2.8 hours after triage and average time after imaging in itself, exceeded 4 hours. Imaging is not likely a causative factor for patients breaching the 4-hour target.

Aim To assess trends in medical imaging requests before and after the 4-hour rule commenced and to assess the imaging time component of emergency department (ED) length of stay (LOS). Materials and methods Retrospective analysis of ED patients and imaging requests 1 year prior to and 3 years after implementation of the 4-hour rule (April to December for 2011-2014) was performed at a single adult tertiary referral Level 1 trauma hospital with Level 6 ED. Logistic regression was used to evaluate trends in the number of ED patient presentations, patient triage categories, and imaging requests for these patients. The imaging component of the total ED LOS was compared for patients who met the 4-hour target and patients who did not. Results Compared to 2011 (before the 4-hour rule), ED presentations increased 4.74% in 2012, 12.7% in 2013, 21.28% in 2014 (p<0.01). Total imaging requests increased 23.05% in 2012, 48.04% in 2013, 60.77% in 2014 (p<0.01). For patients breaching the 4-hour rule, the mean time before radiology request was 2.4-2.8 hours; mean time from imaging request to completion was 1.2-1.3 hours; mean time from imaging completion to discharge from ED was the longest component of ED LOS (4.9-5.9 hours). Conclusions There has been a significant increase in imaging requests, with a trend towards more CT and less radiography requests. Imaging requests for patients who breached the 4-hour target were made on average 2.4-2.8 hours after triage and average time after imaging in itself, exceeded 4 hours. Imaging is not likely a causative factor for patients breaching the 4-hour target.

When a delay occurs in a project, there are basically two options: prescribing overtime work and injecting additional resources, in order to meet the project schedule of certain activities. This paper uses economic analysis to demonstrate that a decision maker will select the most suitable alternative by considering productivity losses in overtime work and the relative unit costs between different labor and resource inputs. The paper also suggests some avenues for future empirical research in construction overtime work.

Project time-cost relationships were examined by using project scope factors as predictors for 161 construction projects that were completed in various Australian States using the multiple regression technique of weighted least squares. The analysis was performed between project duration (i.e., time), project type, procurement method, tender type, gross floor area (GFA), and number of stories. An alternative model to that proposed by Bromilow more than three decades ago for forecasting time and cost performance is proposed. It is shown that GFA and the number of stories in a building are key determinants of time performance in projects. Furthermore, the results indicate that cost is a poor predictor of time performance. Limitations and practical implications of the research are also presented.

Project time–cost relationships were examined by using project scope factors as predictors for 161 construction projects that were completed in various Australian States using the multiple regression technique of weighted least squares. The analysis was performed between project duration (i.e., time), project type, procurement method, tender type, gross floor area (GFA), and number of stories. An alternative model to that proposed by Bromilow more than three decades ago for forecasting time and cost performance is proposed. It is shown that GFA and the number of stories in a building are key determinants of time performance in projects. Furthermore, the results indicate that cost is a poor predictor of time performance. Limitations and practical implications of the research are also presented.