Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

Discrete focusing effect of positive ions by a plasma-sheath lens

We demonstrate that the sheath created adjacent to the surface of a negatively biased electrode that interfaces an insulator acts as a lens that focuses the positive ions to distinct regions on the surface. Thus, the positive ion flux is discrete, leading to the formation of a passive surface, of no ion impact, near the edge and an active surface at the center. Trajectories of positive ions within the sheath are obtained by solving in three dimensions the Poisson equation for electrodes of different geometry. Simulations are confirmed by developing the ion flux profile on the electrode surface as the sputtering pattern produced by ion impact. Measurements are performed in a dc plasma produced in Ar gas.

Modal focusing effect of positive and negative ions by a three-dimensional plasma-sheath lens

A complex focusing effect of positive and negative ions caused by the sheath forming to biased electrodes that interface insulators has been found by solving in three dimensions the potential distribution and ion kinetics within the sheath. Thus, intrinsically correlated with the sheath shape, certain electrical charges are focused on the surface, forming well defined patterns named modal lines and modal spots. Their superposition to the previously reported discrete focusing leads to a total flux that represents a "fingerprint" of the entire sheath on the electrode surface. The ion flux pattern is developed experimentally on the surface of square and octagonal electrodes exposed to Ar/SF(6) and CF4 plasmas. Present results are of high potential importance for fundamental studies concerning sheath formation and charge kinetics and also in a wide range of plasma applications.

[The Weill-Marchesani syndrome in a mother and son--its evolution with time]

Two patients with brachymorphy, mother and son, were admitted into the Hospital of Constanţa, in 1965. The child underwent several surgeries on the ectopic, spheric crystalline lens. The patients were followed in time and their present states are reported. Considerations are made on the evolution of surgical techniques in the crystalline ectopia and the present opinions about this problem.