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Abstract Emotional speech perception is a multisensory process. When speaking with an individual we concurrently integrate the information from their voice and face to decode e.g., their feelings, moods, and emotions. However, the physiological reactions—such as the reflexive dilation of the pupil—associated to these processes remain mostly unknown. That is the aim of the current article, to investigate whether pupillary reactions can index the processes underlying the audiovisual integration of emotional signals. To investigate this question, we used an algorithm able to increase or decrease the smiles seen in a person’s face or heard in their voice, while preserving the temporal synchrony between visual and auditory channels. Using this algorithm, we created congruent and incongruent audiovisual smiles, and investigated participants’ gaze and pupillary reactions to manipulated stimuli. We found that pupil reactions can reflect emotional information mismatch in audiovisual speech. In our data, when participants were explicitly asked to extract emotional information from stimuli, the first fixation within emotionally mismatching areas (i.e., the mouth) triggered pupil dilation. These results reveal that pupil dilation can reflect the dynamic integration of audiovisual emotional speech and provide insights on how these reactions are triggered during stimulus perception.

Abstract Communication between sound and music experts is based on the shared understanding of a metaphorical vocabulary derived from other sensory modalities. Yet, the impact of sound expertise on the mental representation of these sound concepts remains blurry. To address this issue, we investigated the acoustic portraits of four metaphorical sound concepts (brightness, warmth, roundness, and roughness) in three groups of participants (sound engineers, conductors, and non-experts). Participants (N = 24) rated a corpus of orchestral instrument sounds (N = 520) using Best–Worst Scaling. With this data-driven method, we sorted the sound corpus for each concept and population. We compared the population ratings and ran machine learning algorithms to unveil the acoustic portraits of each concept. Overall, the results revealed that sound engineers were the most consistent. We found that roughness is widely shared while brightness is expertise dependent. The frequent use of brightness by expert populations suggests that its meaning got specified through sound expertise. As for roundness and warmth, it seems that the importance of pitch and noise in their acoustic definition is the key to distinguishing them. These results provide crucial information on the mental representations of a metaphorical vocabulary of sound and whether it is shared or refined by sound expertise.

People have a well-described advantage in identifying individuals and emotions in their own culture, a phenomenon also known as the other-race and language-familiarity effect. However, it is unclear whether native-language advantages arise from genuinely enhanced capacities to extract relevant cues in familiar speech or, more simply, from cultural differences in emotional expressions. Here, to rule out production differences, we use algorithmic voice transformations to create French and Japanese stimulus pairs that differed by exactly the same acoustical characteristics. In two cross-cultural experiments, participants performed better in their native language when categorizing vocal emotional cues and detecting non-emotional pitch changes. This advantage persisted over three types of stimulus degradation (jabberwocky, shuffled and reversed sentences), which disturbed semantics, syntax, and supra-segmental patterns, respectively. These results provide evidence that production differences are not the sole drivers of the language-familiarity effect in cross-cultural emotion perception. Listeners' unfamiliarity with the phonology of another language, rather than with its syntax or semantics, impairs the detection of pitch prosodic cues and, in turn, the recognition of expressive prosody.

Background: About 80% of cardiovascular diseases (including heart failure [HF]) occur in low‐income and developing countries. However, most clinical trials are conducted in developed countries. Hypothesis: The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. Methodology: Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro–Wilk test. Results: This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7–75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta‐blockers (BB), 77.4% for angiotensin‐converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor‐neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium–glucose cotransporter type‐2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet‐warm (68.3%). Conclusions: AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two‐thirds do not receive SGLT2i. [ABSTRACT FROM AUTHOR]

Introduction: Unhoused individuals have high rates of suicidal ideation (SI) and suicidal behaviors (SB), but few have studied the relative timing of homelessness and SI/SB. Our study examines the potential to use state‐wide electronic health record data from Rhode Island's health information exchange (HIE) to identify temporal relationships, service utilization, and associations of SI/SB among unhoused individuals. Methods: We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI/SB onset. Multivariable models identified associations of SI/SB, hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE. Results: The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide‐related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI/SB result in hospitalization. Of those engaging in acute care for suicide‐related reasons, we found high rates of repeat acute care encounters. Conclusion: HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi‐institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co‐occurring SI/SB, mental health, and substance use is needed. [ABSTRACT FROM AUTHOR]

People have a well-described advantage in identifying individuals and emotions in their own culture, a phenomenon also known as the other-race and language-familiarity effect. However, it is unclear whether native-language advantages arise from genuinely enhanced capacities to extract relevant cues in familiar speech or, more simply, from cultural differences in emotional expressions. Here, to rule out production differences, we use algorithmic voice transformations to create French and Japanese stimulus pairs that differed by exactly the same acoustical characteristics. In two cross-cultural experiments, participants performed better in their native language when categorizing vocal emotional cues and detecting non-emotional pitch changes. This advantage persisted over three types of stimulus degradation (jabberwocky, shuffled and reversed sentences), which disturbed semantics, syntax, and supra-segmental patterns, respectively. These results provide evidence that production differences are not the sole drivers of the language-familiarity effect in cross-cultural emotion perception. Listeners' unfamiliarity with the phonology of another language, rather than with its syntax or semantics, impairs the detection of pitch prosodic cues and, in turn, the recognition of expressive prosody. [ABSTRACT FROM AUTHOR]

Gray mold caused by Botrytis cinerea is a major disease that affects berries cultivation worldwide. This work studied fruits of Rubus glaucus infected at different levels with the fungus Botrytis cinerea by evaluating the total phenol content and the antioxidant capacity using the Folin-Ciocalteu and DPPH methods, respectively. The results showed that the total phenolics and the antioxidant capacity of the inoculated fruits increased significantly (p < 0.01) compared with those of the non-inoculated fruits. It was found that these two parameters were associated with the degree of pathogen severity in the fruits, they increased in the first stages of infection and reached maximum levels at 60% of severity; 336.65 mg gallic acid/g sample for total phenols, and 130.08 mmol ascorbic acid/100 g sample for the antioxidant capacity. This study demonstrates that the fruits of Rubus glaucus infected with the fungus Botrytis cinerea show an increase in the total phenolics and the antioxidant capacity compared with healthy fruits. As a matter of fact a positive correlation between 0% and 60% of damage was observed for both parameters according to the diagrammatic scale of severity for this pathosystem. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the psychometric and predictive performance of the Columbia‐Suicide Severity Rating Scale (C‐SSRS) in emergency department (ED) patients with suicidal ideation or attempts (SI/SA). Methods: Participants (n = 1,376, mean age 36.8, 55% female, 76.8% white) completed the C‐SSRS during the ED visit and were followed for one year. Reliability analyses, exploratory structural equation modeling, and prediction of future SA were explored. Results: Reliability of the Suicidal Ideation subscale was adequate, but was poor for the Intensity of Ideation and Suicidal Behavior subscales. Three empirically derived factors characterized the C‐SSRS. Only Factor 1 (Suicidal Ideation and Attempts) was a reliable predictor of subsequent SA, though odds ratios were small (ORs: 1.09–1.10, CI95%: 1.04, 1.15). The original C‐SSRS Suicidal Ideation and Suicidal Behavior subscales and the C‐SSRS ED screen predicted subsequent SA, again with small odds ratios (ORs: 1.07–1.19, CI95%: 1.01, 1.29). In participants without a SA history, no C‐SSRS subscale predicted subsequent SA. History of any SA (OR: 1.98, CI95%: 1.43, 2.75) was the strongest predictor of subsequent SA. Conclusions: The psychometric evidence for the C‐SSRS was mixed. History of a prior SA, as measured by the C‐SSRS, provided the most parsimonious and powerful assessment for predicting future SA. [ABSTRACT FROM AUTHOR]

To compare Emergency Department (ED) care of suicidal patients with and without documented acute alcohol use. Retrospective chart review of randomly sampled patient visits (n = 800; January 2014 to December 2015) at an urban ED with universal screening for suicide risk. Eligible visits were by adults (18+ years) who screened positive for suicide risk at the ED visit (i.e., suicidal ideation in past two weeks or suicide attempt in past six months). Analyses compared those with and without documentation of acute alcohol use. Among these patients with suicide risk, 19% had documented acute alcohol use (versus 43% with no use and 38% without documentation); individuals with acute alcohol use were more often male and aged 35–59 years. Overall, 62% were evaluated by a mental health professional in the ED. Individuals with acute alcohol use were significantly less likely (vs those without use) to be evaluated by a mental health professional in the ED (odds ratio 0.49, 95%CI 0.28–0.87) after adjustment for age, recent suicide ideation, current suicide plan, self-harm as a chief complaint, contact with family, and ED disposition. Although alcohol use can increase suicide risk, ED patients with acute use appear to receive less thorough suicide risk assessments. [ABSTRACT FROM AUTHOR]

Objective: Suicide screening followed by an intervention may identify suicidal individuals and prevent recurring self-harm, but few cost-effectiveness studies have been conducted. This study sought to determine whether the increased costs of implementing screening and intervention in hospital emergency departments (EDs) are justified by improvements in patient outcomes (decreased attempts and deaths by suicide).Methods: The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study recruited participants in eight U.S. EDs between August 2010 and November 2013. The eight sites sequentially implemented two interventions: universal screening added to treatment as usual and universal screening plus a telephone-based intervention delivered over 12 months post-ED visit. This study calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves to evaluate screening and suicide outcome measures and costs for the two interventions relative to treatment as usual. Costs were calculated from the provider perspective (e.g., wage and salary data and rental costs for hospital space) per patient and per site.Results: Average per-patient costs to a participating ED of universal screening plus intervention were $1,063 per month, approximately $500 more than universal screening added to treatment as usual. Universal screening plus intervention was more effective in preventing suicides compared with universal screening added to treatment as usual and treatment as usual alone.Conclusions: Although the choice of universal screening plus intervention depends on the value placed on the outcome by decision makers, results suggest that implementing such suicide prevention measures can lead to significant cost savings. [ABSTRACT FROM AUTHOR]

In an emergency department (ED) sample, we investigated the concordance between identification of suicide-related visits through standardized comprehensive chart review versus a subset of 3 specific chart elements: ICD-9-CM codes, free-text presenting complaints, and free-text physician discharge diagnoses. The method for this study was review of medical records for adults (≥18 years) at 8 EDs across the United States. A total of 3,776 charts were reviewed. A combination of the 3 chart elements (ICD-9-CM, presenting complaints, and discharge diagnoses) provided the most robust data with 85% sensitivity, 96% specificity, 92% PPV, and 92% NPV. These findings highlight the use of key discrete fields in the medical record that can be extracted to facilitate identification of whether an ED visit was suicide-related. [ABSTRACT FROM AUTHOR]

Importance: Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped.Objective: To determine whether an ED-initiated intervention reduces subsequent suicidal behavior.Design, Setting, and Participants: This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013.Interventions: Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk.Main Outcomes and Measures: The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed.Results: A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts than participants in the TAU phase (incidence rate ratio, 0.72; 95% CI, 0.52-1.00; P = .05) but no differences between the TAU and screening phases (incidence rate ratio, 1.00; 95% CI, 0.71-1.41; P = .99).Conclusions and Relevance: Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior. [ABSTRACT FROM AUTHOR]

Objectives To estimate the prevalence of self-harm, suicidal ideation ( SI), and suicide attempts ( SA) in older adults in the emergency department ( ED), including differences according to age, sex, and race and ethnicity. Design Quasi-experimental, multiphase, eight-center study with prospective review of consecutive charts during enrollment shifts (November 2011-December 2014). Setting Eight EDs in seven states, all with protocols for nurses to screen every patient for suicide risk (universal screening). Participants Adults (≥18 years) registered in the ED. Measurements Demographic characteristics; documented screening for self-harm, SI, or SA; and positive self-harm, SI, or SA in those with screening performed. Results Of 142,534 visits, 23.3% were of individuals aged 60 and older. Documented screening for self-harm, SI, or SA declined with age, from approximately 81% in younger age groups to a low of 68% in those aged 85 and older. The prevalence of positive screens for self-harm, SI, or SA also declined with age, with peaks in young and middle-age (9.0%) and reaching the lowest point after the age of 75 (1.2%). Conclusion Documented screening for suicide risk declined with age in this large sample of individuals in the ED. Although the reason for this finding is unclear, at least part of the decline may be related to increasing rates of altered mentation or other individual-level barriers to screening in the older population. These findings support the need for more-detailed examination of the best methods for identifying-and treating-suicide risk in older adults. [ABSTRACT FROM AUTHOR]

Objective: The main objective was to identify which patient characteristics have the strongest association with suicide outcomes in the 12 months after an index emergency department (ED) visit. Methods: Data were analyzed from the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE). The ED-SAFE study, a quasi-experimental, interrupted time-series design, involved participation from eight general medical EDs across the United States. Participants included adults presenting to the ED with active suicidal ideation or an attempt in the past week. Data collection included baseline interview; six- and 12-month chart reviews; and six-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. Regression analyses were conducted. Results: Among 874 participants, the median age was 37 years (interquartile range 27-47), with 56% of the sample being female (N=488), 74% white (N=649), and 13% Hispanic (N=113). At baseline, 577 (66%) participants had suicidal ideation only, whereas 297 (34%) had a suicide attempt in the past week. Data sufficient to determine outcomes were available for 782 (90%). In the 12 months after the index ED visit, 195 (25%) had documentation of at least one suicide attempt or suicide. High school education or less, an ED visit in the preceding six months, prior nonsuicidal self-injury, current alcohol misuse, and suicidal intent or plan were predictive of future suicidal behavior. Conclusions: Continuing to build an understanding of the factors associated with future suicidal behaviors for this population will help guide design and implementation of improved suicide screening and interventions in the ED and better allocation of scarce resources. [ABSTRACT FROM AUTHOR]

Background Although research suggests that crisis hotlines are an effective means of mitigating suicide risk, lack of empirical evidence may limit the use of this method as a research safety protocol. Purpose This study describes the use of a crisis hotline to provide clinical backup for research assessments. Methods Data were analyzed from participants in the Emergency Department Safety and Follow-up Evaluation (ED-SAFE) study (n = 874). Socio-demographics, call completion data, and data available on suicide attempts occurring in relation to the crisis counseling call were analyzed. Pearson chi-squared statistic for differences in proportions were conducted to compare characteristics of patients receiving versus not receiving crisis counseling. P < 0.05 was considered statistically significant. Results Overall, there were 163 counseling calls (6% of total assessment calls) from 135 (16%) of the enrolled subjects who were transferred to the crisis line because of suicide risk identified during the research assessment. For those transferred to the crisis line, the median age was 40 years (interquartile range 27–48) with 67% female, 80% white, and 11% Hispanic. Conclusions Increasing demand for suicide interventions in diverse healthcare settings warrants consideration of crisis hotlines as a safety protocol mechanism. Our findings provide background on how a crisis hotline was implemented as a safety measure, as well as the type of patients who may utilize this safety protocol. [ABSTRACT FROM AUTHOR]

Objective: The study examined changes in self-reported attitudes and practices related to suicide risk assessment among providers at emergency departments (EDs) during a three-phase quasi-experimental trial involving implementation of ED protocols for suicidal patients. Methods: A total of 1,289 of 1,828 (71% response rate) eligible providers at eight EDs completed a voluntary, anonymous survey at baseline, after introduction of universal suicide screening, and after introduction of suicide prevention resources (nurses) and a secondary risk assessment tool (physicians). Results: Among participants, the median age was 40 years old, 64% were female, and there were no demographic differences across study phases; 68% were nurses, and 32% were attending physicians. Between phase 1 and phase 3, increasing proportions of nurses reported screening for suicide (36% and 95%, respectively, pc.001) and increasing proportions of physicians reported further assessment of suicide risk (63% and 80%, respectively, pc.01). Although increasing proportions of providers said universal screening would result in more psychiatric consultations, decreasing proportions said it would slow down clinical care. Increasing proportions of nurses reported often or almost always asking suicidal patients about firearm access (18%-69%, depending on the case), although these numbers remained low relative to ideal practice. Between 35% and 87% of physicians asked about firearms, depending on the case, and these percentages did not change significantly over the study phases. Conclusions: These findings support the feasibility of implementing universal screening for suicide in EDs, assuming adequate resources, but providers should be educated to ask suicidal patients about firearm access. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To monitor the frequency of sepsis visits in U.S. emergency departments and assess the appropriateness of antibiotic utilization. DESIGN: We analyzed data from the National Hospital Ambulatory Medical Care Survey, defining sepsis as an explicit diagnosis of sepsis via International Classification of Diseases, 9th Revision, Clinical Modification codes 038, 995.91, 995.92, or 785.52. We also monitored trends using cases inferred by infection plus organ dysfunction without explicit diagnosis of sepsis, which we refer to as implicit sepsis cases. We assess changes in visit frequency and ascertain emergency department antibiotic administration rates. SETTING: Four-stage probability sample of visits to U.S. emergency departments, excluding Federal/military. PATIENTS: Adult emergency department visits, United States, 1994-2009. MEASUREMENTS AND MAIN RESULTS: Sepsis was diagnosed explicitly at 260,000 visits per year in U.S. emergency departments (95% CI, 251,000-270,000) or 1.23 visits per 1,000 U.S. population. The visit rate remained stable from 1994 to 2009 (p for trend 0.42). By contrast, the rate of visits with an implicit diagnosis of sepsis increased by 0.07 every 2 years (95% CI, 0.04-0.10; p for trend 0.002). Antibiotics were prescribed in the emergency department during 61% (95% CI, 57-65) of explicit sepsis visits. This increased from 52% in 1994-1997 to 69% in 2006-2009 (difference, 17%; 95% CI, 16.8-17.2). Of antibiotic regimens, 18% covered methicillin-resistant Staphylococcus aureus, 27% Pseudomonas, and 10% extended-spectrum beta-lactamase-producing bacteria, without evidence of targeting according to known risk factors. Of explicit sepsis cases, 31% were admitted to the ICU with 40% mortality (95% CI, 30-51). Overall hospital mortality was 17% (95% CI, 11-22). CONCLUSIONS: Explicitly diagnosed sepsis visits did not become more common during 1994-2009. Our data suggest that many emergency department patients with sepsis do not receive antibiotics until they arrive on the inpatient unit. When antibiotics are used among septic emergency department patients, drug-resistant bacteria are covered infrequently. These methods provide a simple approach to tracking the frequency with which sepsis is diagnosed among emergency department patients and to monitoring antibiotic therapy. [ABSTRACT FROM AUTHOR]

Introduction: The Emergency Department Safety Assessment and Follow-up Evaluation Screening Outcome Evaluation examined whether universal suicide risk screening is feasible and effective at improving suicide risk detection in the emergency department (ED).Methods: A three-phase interrupted time series design was used: Treatment as Usual (Phase 1), Universal Screening (Phase 2), and Universal Screening + Intervention (Phase 3). Eight EDs from seven states participated from 2009 through 2014. Data collection spanned peak hours and 7 days of the week. Chart reviews established if screening for intentional self-harm ideation/behavior (screening) was documented in the medical record and whether the individual endorsed intentional self-harm ideation/behavior (detection). Patient interviews determined if the documented intentional self-harm was suicidal. In Phase 2, universal suicide risk screening was implemented during routine care. In Phase 3, improvements were made to increase screening rates and fidelity. Chi-square tests and generalized estimating equations were calculated. Data were analyzed in 2014.Results: Across the three phases (N=236,791 ED visit records), documented screenings rose from 26% (Phase 1) to 84% (Phase 3) (χ(2) [2, n=236,789]=71,000, p<0.001). Detection rose from 2.9% to 5.7% (χ(2) [2, n=236,789]=902, p<0.001). The majority of detected intentional self-harm was confirmed as recent suicidal ideation or behavior by patient interview.Conclusions: Universal suicide risk screening in the ED was feasible and led to a nearly twofold increase in risk detection. If these findings remain true when scaled, the public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.Trial Registration: Emergency Department Safety Assessmentand Follow-up Evaluation (ED-SAFE) ClinicalTrials.gov: (NCT01150994). https://clinicaltrials.gov/ct2/show/NCT01150994?term=ED-SAFE&rank=1. [ABSTRACT FROM AUTHOR]

It is essential that investigators in clinical research settings follow ethical guidelines for monitoring, assessing, and responding to suicide risk. Given the unique considerations associated with suicide risk assessment in a research context, resources informing the development of research-specific suicide risk management procedures are needed. With decades of collective experience across heterogeneous contexts, we discuss approaches to monitoring, assessing, and responding to suicide risk as a function of study sample (e.g., students, psychiatric inpatients), data collection methodologies (e.g., interview, self-report, or ecological momentary assessment), and study design (e.g., treatment research). Additional considerations include training and supervision of staff to identify suicide risk, coordination of others to respond to risk, and documentation of procedures. Finally, we attend to the impact of these procedures on the external validity of outcome data. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Abstract: Background: Due to the concentration of individuals at-risk for suicide, an emergency department visit represents an opportune time for suicide risk screening and intervention. Purpose: The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) uses a quasi-experimental, interrupted time series design to evaluate whether (1) a practical approach to universally screening ED patients for suicide risk leads to improved detection of suicide risk and (2) a multi-component intervention delivered during and after the ED visit improves suicide-related outcomes. Methods: This paper summarizes the ED-SAFE's study design and methods within the context of considerations relevant to effectiveness research in suicide prevention and pertinent human participants concerns. 1440 suicidal individuals, from 8 general ED's nationally will be enrolled during three sequential phases of data collection (480 individuals/phase): (1) Treatment as Usual; (2) Universal Screening; and (3) Intervention. Data from the three phases will inform two separate evaluations: Screening Outcome (Phases 1 and 2) and Intervention (Phases 2 and 3). Individuals will be followed for 12months. The primary study outcome is a composite reflecting completed suicide, attempted suicide, aborted or interrupted attempts, and implementation of rescue procedures during an outcome assessment. Conclusions: While ‘classic’ randomized control trials (RCT) are typically selected over quasi-experimental designs, ethical and methodological issues may make an RCT a poor fit for complex interventions in an applied setting, such as the ED. ED-SAFE represents an innovative approach to examining the complex public health issue of suicide prevention through a multi-phase, quasi-experimental design embedded in ‘real world’ clinical settings. [Copyright &y& Elsevier]

This article describes the protocol for a randomized effectiveness and cost-effectiveness trial of Stanley and Brown's Safety Planning Intervention (SPI) during pretrial jail detention to reduce post-release suicide events (suicide attempts, suicide behaviors, and suicide-related hospitalizations). With 10 million admissions per year and short stays (often days), U.S. jails touch many individuals at risk for suicide, providing an important opportunity for suicide prevention that is currently being missed. This study (N = 800) is the first randomized evaluation of an intervention to reduce suicide risk in the vulnerable year after jail release. Given that roughly 10% of all suicides in the U.S. with known circumstances occur in the context of a criminal legal stressor, reducing suicide risk in the year after arrest and jail detention could have a noticeable impact on national suicide rates. Pretrial jail detainees at risk for suicide were randomized to SPI during jail detention plus post-release phone follow-up or to enhanced Standard Care. Outcomes assessed through 12 months post-release include suicide events, suicide attempts, weeks of active suicide ideation, severity of suicide ideation, time to first event, psychiatric symptoms, functioning, and cost-effectiveness. Methods accommodate short jail stays and maximize trial safety and follow-up in a large sample with severe suicide risk, access to lethal means including substances and firearms, high rates of psychiatric illness, and unstable circumstances. Adequate funding was important to create the infrastructure needed to run this large trial cleanly. We encourage funders to provide adequate resources to ensure clean, well-run trials. [ABSTRACT FROM AUTHOR]