Search

Study Objectives This study aimed to quantify the temporal associations between nightly sleep quantity and timing with daytime eating behavior and activity levels in free-living (i.e. non-experimental) settings. Methods Generally healthy young adults (N = 63; 28.9 ± 7.1 years) completed concurrent sleep (wrist actigraphy), eating (photo-assisted diet records), and activity (waist actigraphy) assessments over 14 days. Multilevel models quantified the associations between nightly sleep (total sleep time, timing of sleep and wake onset) with next-day eating behavior (diet quality, caloric intake, timing of eating onset/offset, eating window duration) and activity levels (total physical activity, sedentary time). Associations in the reverse direction (i.e. eating and activity predicting sleep) were explored. Models adjusted for demographic and behavioral confounders and accounted for multiple testing. Results At within- and between-subject levels, nights with greater-than-average total sleep time predicted a shorter eating window the next day (all p ≤ 0.002). Later-than-average sleep and wake timing predicted within- and between-subject delays in next-day eating onset and offset, and between-subject reductions in diet quality and caloric intake (all p ≤ 0.008). At within- and between-subject levels, total sleep time was bidirectionally, inversely associated with sedentary time (all p < 0.001), while later-than-average sleep and wake timing predicted lower next-day physical activity (all p ≤ 0.008). Conclusions These data underscore the complex interrelatedness between sleep, eating behavior, and activity levels in free-living settings. Findings also suggest that sleep exerts a greater influence on next-day behavior, rather than vice versa. While testing in more diverse samples is needed, these data have potential to enhance health behavior interventions and maximize health outcomes.

The SARS-CoV-2 pandemic has been associated with dramatic increases in substance use, as marked by increased alcohol, nicotine, and cannabis sales. Lethal opioid overdoses also increased dramatically, especially during the initial phases of the epidemic when lockdowns and social isolation combined with increasing fentanyl contamination of the illicit drug supply resulted in more overdoses and fewer opportunities for rescue. Substance use, and especially inhalational drug use, increases the likelihood of both transmission and severe infection. Youth are especially vulnerable to substance use and have increased risk of long-term problems. These outcomes highlight the need for greater access to substance use treatment. Virtual treatment, which emerged as a promising format during the pandemic, may reduce access barriers. This article reviews trends in substance use during the pandemic, explores root causes of increased use and overdose, and examines the potential to increase treatment through virtual care, especially during future periods of disruption.

BackgroundSocial isolation is prevalent and associated with dementia, yet the directionality and mechanisms are less understood. This study examined the association between social isolation and cognitive functioning and explored the mediating role of sleep disturbance on the social isolation–cognition relationship.MethodsData from 5 753 dementia-free Americans aged ≥50 of 2006 (T1), 2010 (T2), and 2014 (T3) waves of the Health and Retirement Study. Social isolation was measured by the Steptoe Social Isolation Index. Cognitive functioning was measured by the Telephone Interview of Cognitive Status. Sleep disturbance was measured with the modified Jenkins Sleep Scale. We used cross-lagged panel models to determine the associations between social isolation, sleep disturbance, and cognitive functioning.ResultsSocial isolation is significantly associated with subsequent cognitive functioning (T1 to T2: β = −0.055, standard error [SE] = 0.014, p < .001; T2 to T3: β = −0.044, SE = 0.016, p < .001). Lower cognitive functioning is significantly associated with greater subsequent social isolation (T1 to T2: β = −0.101, SE = 0.020, p < .001; T2 to T3: β = −0.058, SE = .011, p < .001). Sleep disturbance at T2 partially mediated the effect of social isolation (T1) on cognitive functioning (T3), accounting for 6.2% of the total effect (β = −0.003, SE = 0.001, p < .01).ConclusionsSocial isolation may deteriorate cognitive functioning and vice versa. The association between social isolation and cognition is partially explained by sleep disturbance.

The High-Altitude Water Cherenkov (HAWC) observatory is a second-generation continuously operated, wide field-of-view, TeV gamma-ray observatory. The HAWC observatory and its analysis techniques build on experience of the Milagro experiment in using ground-based water Cherenkov detectors for gamma-ray astronomy. HAWC is located on the Sierra Negra volcano in M\'exico at an elevation of 4100 meters above sea level. The completed HAWC observatory principal detector (HAWC) consists of 300 closely spaced water Cherenkov detectors, each equipped with four photomultiplier tubes to provide timing and charge information to reconstruct the extensive air shower energy and arrival direction. The HAWC observatory has been optimized to observe transient and steady emission from sources of gamma rays within an energy range from several hundred GeV to several hundred TeV. However, most of the air showers detected are initiated by cosmic rays, allowing studies of cosmic rays also to be performed. This paper describes the characteristics of the HAWC main array and its hardware., Comment: Accepted for publications in Nuclear Inst. and Methods in Physics Research, A (2023) 168253 ( https://www.sciencedirect.com/science/article/abs/pii/S0168900223002437 ); 39 pages, 14 Figures

Rapid advances in the field of hematopoietic cell transplantation (HCT), as well as the advent of immune effector cell therapy (IEC), have resulted in an increasing number of patients undergoing these therapies and an increasing level of expertise required to manage them. Previous guidelines for the training of HCT physicians were last published in 2012. In recognition of the expanding knowledge base and increasing skill set essential to the delivery of these treatment modalities, the American Society for Transplantation and Cellular Therapy Committee on Education has updated these guidelines to reflect nearly a decade of new knowledge in the field of HCT, as well as the evolution of IEC from an experimental modality to a widely used and mainstream therapy. The resulting document reflects the Committee on Education's recommended educational structure for programs engaged in the training, evaluation, and mentorship of HCT/IEC trainees.

We report TeV gamma-ray observations of the ultra-high-energy source MGRO J1908+06 using data from the High Altitude Water Cherenkov (HAWC) Observatory. This source is one of the highest-energy known gamma-ray sources, with emission extending past 200 TeV. Modeling suggests that the bulk of the TeV gamma-ray emission is leptonic in nature, driven by the energetic radio-faint pulsar PSR J1907+0602. Depending on what assumptions are included in the model, a hadronic component may also be allowed. Using the results of the modeling, we discuss implications for detection prospects by multi-messenger campaigns., Comment: accepted by ApJ, in press

B cells, also known as B lymphocytes or lymphoid lineage cells, are a historically understudied cell population with regard to brain-related injuries and diseases. However, an increasing number of publications have begun to elucidate the different phenotypes and roles B cells can undertake during central nervous system (CNS) pathology, including following ischemic and hemorrhagic stroke. B cell phenotype is intrinsically linked to function following stroke, as they may be beneficial or detrimental depending on the subset, timing, and microenvironment. Factors such as age, sex, and presence of co-morbidity also influence the behavior of post-stroke B cells. The following review will briefly describe B cells from origination to senescence, explore B cell function by integrating decades of stroke research, differentiate between the known B cell subtypes and their respective activity, discuss some of the physiological influences on B cells as well as the influence of B cells on certain physiological functions, and highlight the differences between B cells in healthy and disease states with particular emphasis in the context of ischemic stroke.

The radio galaxy M87 is the central dominant galaxy of the Virgo Cluster. Very high-energy (VHE, ≳0.1 TeV) emission from M87 has been detected by imaging air Cherenkov telescopes. Recently, marginal evidence for VHE long-term emission has also been observed by the High Altitude Water Cherenkov Observatory, a gamma-ray and cosmic-ray detector array located in Puebla, Mexico. The mechanism that produces VHE emission in M87 remains unclear. This emission originates in its prominent jet, which has been spatially resolved from radio to X-rays. In this paper, we construct a spectral energy distribution from radio to gamma rays that is representative of the nonflaring activity of the source, and in order to explain the observed emission, we fit it with a lepto-hadronic emission model. We found that this model is able to explain nonflaring VHE emission of M87 as well as an orphan flare reported in 2005.

Automated insulin delivery (AID) systems are likely of value in individuals with long-standing T1D where recurrent hypoglycemia reduces counterregulatory response. This study assessed the impact of 18M AID on counterregulatory response to insulin-induced hypoglycemia in individuals with long-standing T1D and impaired awareness of hypoglycemia. participants mean±SD age 49±16 years and diabetes duration 34±16 years were initiated on AID systems. CGM outcomes were paired with actigraphy data to assess daytime and sleep hypoglycemia exposure every 3 months. Hyperinsulinemic stepped-hypoglycemic clamp experiments were performed at baseline, 6 and 18 months. Ten and nine participants have been followed-up to 6M and 18M respectively. Severe hypoglycemia events were reduced from median (IQR) 3 (3-10) to 0 (0-1) events/person·year over 18M (p=0.005) with improved hypoglycemia severity (HYPO, Pre:1134 (808-1686) to 18M:26 (0-128) , p The autonomic symptom response to hypoglycemia improved (Pre:6±2, 6M:6±2, 18M:10±2, p AID systems lead to a sustained reduction of hypoglycemia exposure and improvement in symptom and epinephrine response however with persistent impairment in glucose counterregulation and so ongoing compromised physiologic defense against hypoglycemia. Disclosure A.Flatt: None. I.Lee: Other Relationship; VitalCore Software. M.R.Rickels: Advisory Panel; Sernova, Corp., Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Consultant; L-Nutra Inc. A.J.Peleckis: None. C.V.Dalton-bakes: None. H.T.Nguyen: None. S.Ilany: None. A.M.Matus: None. S.K.Malone: None. S.Jang: None. J.Weimer: Other Relationship; Neuralert Technologies, Vasowatch. Funding Public Health Services research grants: RDK091331, UDK070430, UL1 TR001878, and P30 DK19525

Background: In the US, approximately 10 million people with diabetes require insulin; the vast majority using MDI therapy. Diabetes is associated with sustained daily burdens due to complex, demanding, and often confusing self-care directives, which may be more pronounced with MDI. Bigfoot Unity is a unique, interconnected smart pen cap diabetes management system designed to address an unmet medical need to support MDI therapy, incorporating CGM data (Abbott FreeStyle Libre 2) , real-time alerts and clinician-directed dose recommendations. Methods: The Bigfoot Unity System received FDA clearance in May 2021. We report a retrospective analysis on an initial cohort (N=49 at 11 clinics) with insulin-requiring diabetes managing MDI with Bigfoot Unity for 90 days. Deidentified data were evaluated to analyze glycemic metrics during use, and HbA1c obtained from medical records prior to use. Results: Within the cohort, mean age was 60 years and 40 (82%) had T2D. The mean HbA1c prior to Bigfoot Unity use was 8.5±2.0% (N=43) . Mean GMI was 7.5±0.9% after 3 months use. Discussion: These data show that for people using MDI with suboptimal glycemic control, using the Bigfoot Unity System has the potential for rapid and durable improvement in glycemic control. Considering the mean age of the cohort, results demonstrate close adherence to established glycemic targets including a short time spent in the hypoglycemia range. Further studies are planned to investigate this hypothesis. Disclosure B. Baliga: Speaker’s Bureau; Abbott Diabetes, Amarin Corporation, AstraZeneca, Bigfoot Biomedical, Inc., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Intuity Medical, Inc., Merck & Co., Inc., Novo Nordisk, Stock/Shareholder; Amarin Corporation, Insulet Corporation, Merck & Co., Inc., Moderna, Inc., Senseonics. J. Tillman: Employee; Bigfoot Biomedical, Inc. B. P. Olson: Employee; Bigfoot Biomedical, Inc. S. Vaughan: Employee; Bigfoot Biomedical, Inc. F. Sheikh: Employee; Bigfoot Biomedical, Inc. J. K. Malone: Consultant; Eli Lilly and Company, Insulet Corporation, Thermalin Inc., Employee; Bigfoot Biomedical, Inc. Funding Bigfoot Biomedical

The High Altitude Water Cherenkov (HAWC) gamma-ray observatory observes atmospheric showers produced by incident gamma rays and cosmic rays with energy from 300 GeV to more than 100 TeV. A crucial phase in analyzing gamma-ray sources using ground-based gamma-ray detectors like HAWC is to identify the showers produced by gamma rays or hadrons. The HAWC observatory records roughly 25,000 events per second, with hadrons representing the vast majority ($>99.9\%$) of these events. The standard gamma/hadron separation technique in HAWC uses a simple rectangular cut involving only two parameters. This work describes the implementation of more sophisticated gamma/hadron separation techniques, via machine learning methods (boosted decision trees and neural networks), and summarizes the resulting improvements in gamma/hadron separation obtained in HAWC., 35 pages, 9 figures, published in Nuclear Instruments and Methods in Physics Research Section A

Introduction: Short sleep duration ( Methods: Over a 14-day period, 30 healthy, non-shift working adults wore wrist actigraphs to evaluate sleep duration and onset timing, and completed image-assisted diet records to estimate eating onset (time of first caloric intake after awakening) and offset (time of last caloric intake before sleep). Fasted morning systolic (SBP) and diastolic BP (DBP) were obtained. Regression models of SBP and DBP tested associations with sleep onset, eating onset, and eating offset. Sleep duration ( Results: Participants were 28±7y, 43% male, BMI 23.9±2.6 kg/m 2 , and BP 114±10/70±7 mmHg. Sleep duration was 6.8±0.8 h, sleep onset 23:45±1.3 h, eating onset 08:49±1.5 h, and eating offset 20:40±1.2 h. Independent of age and sex, later sleep onset was associated with higher SBP (B= 3.0±1.3 mmHg/h, p =0.03) and DBP (B= 2.5±0.9 mmHg/h, p =0.01). Later eating onset was associated with higher DBP (B= 2.1±0.9 mmHg/h, p =0.03), and later offset with higher SBP (B= 4.1±1.4 mmHg/h, p p p =0.03) and tended to exhibit higher SBP and DBP vs short sleep OR late timing (both p =0.07). Conclusion: These data indicate later sleep and eating timing, especially in the setting of short sleep, exemplifies a chrono-behavioral phenotype of CVD risk.

The extragalactic background light (EBL) contains all the radiation emitted by nuclear and accretion processes in stars and compact objects since the epoch of recombination. Measuring the EBL density directly is challenging, especially in the near- to far-infrared waveband, mainly due to the zodiacal light foreground. Instead, gamma-ray astronomy offers the possibility to indirectly set limits on the EBL by studying the effects of gamma-ray absorption in the very high energy (VHE:$>$100 GeV) spectra of distant blazars. The High Altitude Water Cherenkov gamma ray observatory (HAWC) is one of the few instruments sensitive to gamma rays with energies above 10 TeV. This offers the opportunity to probe the EBL in the near/mid IR region: $\lambda$ = 1 $\mu$m - 100 $\mu$m. In this study, we fit physically motivated emission models to Fermi Large Area Telescope (LAT) GeV data to extrapolate the intrinsic TeV spectra of blazars. We then simulate a large number of absorbed spectra for different randomly generated EBL model shapes and calculate Bayesian credible bands in the EBL intensity space by comparing and testing the agreement between the absorbed spectra and HAWC extragalactic observations of two blazars. The resulting bands are in agreement with current EBL lower and upper limits, showing a downward trend towards higher wavelength values $\lambda>10\, \mu$m also observed in previous measurements., Comment: Submitted to ApJ

In this time of Covid-19, life in healthcare has changed immeasurably. It has rapidly been injected with an ‘all hands-on deck’ approach, to facilitate the necessary adaptations required to reduce the spread of the virus and deliver frontline clinical care. Inevitably aspects of these changes have disrupted the delivery of medical education, notably clinical placements have been cancelled and social distancing guidelines prohibit face-to-face teaching. The training of future doctors is an essential part of this effort. Indeed, the emergence of a global health threat has underlined its continued importance. For medical educators and students alike, we have been presented with a challenge. Concurrently, this presents us with an impetus and opportunity for innovation. For some time now, a transformation in medical education has been called for, with an increasing recognition of the need to prepare students for the changing landscape of healthcare systems. This has included a focus on the use of technology-enhanced and self-directed learning. As a team of educators and clinicians in psychiatry, working in the School of Medicine and Medical Sciences (SMMS) in University College Dublin (UCD), we will share how we have responded. We outline the adaptations made to our ‘Psychiatry’ module and consider the influence this may have on its future delivery. These changes were informed by direct student input.

Introduction Tumors of the lateral skull base often require collaboration between neurosurgeons and neurotologists for the surgical approach. The three main transosseous surgical approaches are retrosigmoid (RS), translabyrinthine (TL), and middle fossa (MF). The literature reflects a relative paucity regarding the various closure techniques for these approaches and the postoperative complications. We have performed a systematic review comparing closure techniques from each approach. Methods A systematic review was performed using Ovid MEDLINE (1990–2016) on closure technique and postoperative complications for patients undergoing lateral skull base surgery via the TL, RS, or MF approach. Studies were included if they contained at least 10 patients, described their closure technique, and provided data on postoperative complications. Results A total of 1,403 studies were reviewed. Of these, 53 studies met inclusion criteria yielding a total of 10,466 subjects in this analysis. The average rate of cerebrospinal fluid leak was 5.3% in the TL approach, 9% in the RS approach, and 6.2% in the MF approach. There was no significant effect of various closure techniques on postoperative wound complications in the MF approach. Multiple factors were identified which affected postoperative wound complication in the RS and TL approaches. Conclusion There are a plethora of closure techniques for lateral skull base surgery. Several techniques were identified in this review that may affect the postoperative wound complication rates in lateral skull base surgery.

Within a football team, it is vital for coaches to acknowledge the importance of their players having the knowledge of what is required in specific roles in the team and what their other team membe...

The effects of tungsten (W) doping on the material properties of VO2 films and the magnetic properties of VO2/Ni bilayers were investigated. Doped VO2 films are fabricated using a sol-gel synthesis technique. As seen in previous studies, the vanadium dioxide metal to insulator transition (MIT) is shifted to lower temperature and reduced in magnitude with increased W doping. While the impact on transport is quite dramatic, morphology of VO2 is only slightly affected by W doping. We find that there is a stabilization of the rutile phase of VO2 at room temperature and formation of a small amount of V2WO6 phase. VO2/Ni bilayers show a sharp decrease in the coercivity and increase in the magnetic moment at the VO2 structural phase transition. W doping decreases the temperature of these magnetic properties and also decreases their magnitude. The decreased magnitude of the magnetic effects, along with the stabilization of the rutile phase seen in the X-ray data, suggests that the degradation of the MIT is due to structural reasons and not solely because of added carriers to the system.

Background and Aims Stop Before You Block (SBYB)1 is an established initiative to prevent wrong-sided regional anaesthesia (RA). Despite this, compliance with SBYB has been poor in our institution and a recent wrong-sided block (‘A Never Event’) prompted a re-audit of local processes. Methods We prospectively examined all unilateral RA performed in a six-week period starting in May 2021. Data on SBYB compliance and risk factors for failing to SBYB were sought. An anonymous online survey was sent out to all anaesthetists regarding SBYB to collect qualitative opinion and suggestions for improved SBYB compliance. Local audit committee authorised and registered this work as not needing ethics committee approval. Results Twenty-eight regional nerve blocks were observed. Risk factors present included surgical site marking not being visible, repositioning of patients and additional distractions (table 1). Although SBYB compliance improved to 82%, in two cases without SBYB there were no risk factors present. Of the 29 survey results received, all agreed a physical reminder needed to be introduced, with posters on ultrasound machines achieving the most favourable response followed by a physical barrier on the syringe. Conclusions We identified improved compliance in our re-audit, but nearly a fifth of blocks occurred without SBYB. With risk factors for failing to SBYB prevalent including distraction, we suggest a non-user dependent step is needed to improve compliance. We believe this could be achieved if needle manufacturers incorporate a pre-packaged fail-safe barrier into their syringe design or RA needle sheaths.

International audience; The High Altitude Water Cherenkov (HAWC) observatory and the High Energy Stereoscopic System (H.E.S.S.) are two leading instruments in the ground-based very-high-energy γ-ray domain. HAWC employs the water Cherenkov detection (WCD) technique, while H.E.S.S. is an array of Imaging Atmospheric Cherenkov Telescopes (IACTs). The two facilities therefore differ in multiple aspects, including their observation strategy, the size of their field of view, and their angular resolution, leading to different analysis approaches. Until now, it has been unclear if the results of observations by both types of instruments are consistent: several of the recently discovered HAWC sources have been followed up by IACTs, resulting in a confirmed detection only in a minority of cases. With this paper, we go further and try to resolve the tensions between previous results by performing a new analysis of the H.E.S.S. Galactic plane survey data, applying an analysis technique comparable between H.E.S.S. and HAWC. Events above 1 TeV are selected for both data sets, the point-spread function of H.E.S.S. is broadened to approach that of HAWC, and a similar background estimation method is used. This is the first detailed comparison of the Galactic plane observed by both instruments. H.E.S.S. can confirm the γ-ray emission of four HAWC sources among seven previously undetected by IACTs, while the three others have measured fluxes below the sensitivity of the H.E.S.S. data set. Remaining differences in the overall γ-ray flux can be explained by the systematic uncertainties. Therefore, we confirm a consistent view of the γ-ray sky between WCD and IACT techniques.

OBJECTIVE To evaluate survival times for dogs with previously untreated, peripheral nodal, intermediate- or large-cell lymphoma treated with prednisone alone. ANIMALS 109 client-owned dogs recruited from 15 institutions in the United States. PROCEDURES Dogs were treated with prednisone at a dosage of 40 mg/m2, PO, once daily for 7 days and at a dosage of 20 mg/m2, PO, once daily thereafter. Quality of life (QOL) was assessed by owners with a visual analog scale when treatment was started (day 0), 1 and 2 weeks after treatment was started, and every 4 weeks thereafter. The primary outcome of interest was survival time as determined by the Kaplan-Meier method. Factors potentially associated with survival time were examined. RESULTS Median overall survival time was 50 days (95% CI, 41 to 59 days). Factors associated with survival time included substage (a vs b) and immunopheno-type (B cell vs T cell). Owner-assigned QOL scores on days 0 and 14 were significantly positively correlated with survival time. When QOL score was dichotomized, dogs with day 0 or day 14 QOL scores ≥ 50 had significantly longer survival times, compared with dogs with day 0 or day 14 QOL scores < 50. No variables were predictive of long-term (> 120 days) survival. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that survival times were short for dogs with previously untreated, peripheral nodal, intermediate- or large-cell lymphoma treated with prednisone alone. Owner-perceived QOL and clinician-assigned sub-stage were both associated with survival time. Findings provide potentially important information for clinicians to discuss with owners of dogs with lymphoma at the time treatment decisions are made. (J Am Vet Med Assoc 2021;259:62–71)

A patient with relapsed/refractory B-cell acute lymphoblastic leukemia developed babesiosis before allogeneic hematopoietic cell transplantation while on atovaquone for Pneumocystis jirovecii pneumonia prophylaxis. Despite receiving a prolonged course of atovaquone and azithromycin until whole-blood Babesia microti DNA was no longer detected by polymerase chain reaction, her post-transplant course was complicated by relapsed babesiosis. We investigate the potential host and parasite characteristics causing relapsing/persistent infection.

The High Altitude Water Cherenkov (HAWC) gamma-ray observatory is located close to the equator (latitude $18^{\circ }$ N), at an altitude of 4100 m above sea level. HAWC has 295 water Cherenkov detectors (WCD), each containing four photomultiplier tubes (PMT). The main purpose of HAWC is the determination of the energy and arrival direction of very high energy gamma rays produced by energetic processes in the universe, HAWC also has a scaler system which counts the arrival of secondary particles to the detector. In this work we show that the scaler system of HAWC is an ideal instrument for solar modulation and space-weather studies due to its large area and high sensitivity. In order to prepare the scaler system for low energy heliospheric studies, we model and correct the efficiency variation of each PMT of the array, which result in a capability to measure variations $> 0.01\%$ with high accuracy. Using the singular value decomposition method, we correct the rate deviations of all PMTs of the array, due to changes in efficiency, gain and operational voltage. We isolate and remove the atmospheric modulations of the PMTs count rates measured by the TDC-scaler data acquisition system. In particular, the atmospheric pressure at the HAWC site exhibits an oscillating behavior with a period of ∼12 hours and we make use of this periodic property to estimate the pressure coefficients for the HAWC TDC-scaler system. These corrections performed on the TDC-scaler system make the HAWC TDC-scaler system an ideal instrument for solar modulation and space-weather studies. As examples of this capability, we present the preliminary analysis of the solar modulation of cosmic rays at three time scales observed by HAWC, with an unprecedented accuracy.

Background Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. Methods The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners’ registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners’ records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. Conclusions The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.