Aims and objectives. The Forensic Early Warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying early warning signs and constructing individual early detection plans (EDP) for the prevention of aggressive incidents. The aims of this research were as follows: First, to study the prevalence of early warning signs of aggression, measured with the FESAI, in a sample of forensic patients, and second, to explore whether there are any types of warning signs typical of diagnostic subgroups or offender subgroups. Background. Reconstructing patients’ changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management. Design. An explorative design was used to review existing records and to monitor frequencies of early warning signs. Methods. Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs. Results. The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs. Conclusion. The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type. Relevance to clinical practice. Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management.
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The central goal of this study is to gain insight into students' study approach, their personal reasons and the relations between them regarding students who continue or withdraw from the educational system within one year. Results of our questionnaire study show that students who continue their educational careers show higher scores on a meaningful integrative study approach when entering Higher Education, than students who withdraw. Our questionnaire on personal reasons for withdraw revealed three scales: (1) perception and experience of educational and organizational aspects, (2) pragmatic and personal circumstances and (3) loss of interest in the future occupations. Personal reasons for continuing also produced three scales: (1) perception and experience of learning environment quality, (2) pragmatic and personal orientation and (3) future occupational identity. Withdrawing students' scores on meaningful integrative study approach are negatively related to perception and experience of educational and organizational aspects, whereas the superficial study approach positively correlates with pragmatic and personal circumstances. With regard to students who continue, high scores on the meaningful integrative study approach relate positively to all three reasons: future occupational identity, perception and experience of learning environment quality and pragmatic and personal orientation.
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PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807).
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There is an emerging interest in understanding the cognitive, emotional and motivational processes that drive tourists’ behaviour using neuroscientific research methods. This chapter briefly reviews the main methods of interest to tourism researchers, to then focuses on electroencephalography, which reflects electrical activity from the brain. Event-related potentials or electroencephalography oscillations reflect cognitive and affective processes. Components of the former can index emotional brain responses, and alpha oscillations are related to attention and approach/withdrawal. Existing tourism literature/using electroencephalography are reviewed. This is a promising tool for studying a range of phenomena that are of interest to tourism scholars, but require careful use of methods and interpretation.
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This study utilized the Dutch translation of the Adjustment Scales for Early Transition in Schooling (ASETS), assessed in 323 kindergarten children across 30 regular schools in the Netherlands. Culturally-tailored, context-informed assessments are essential to address childhood adaptation challenges in early schooling. The analysis included EFA and CFA, revealing three behavioral problem categories: Aggressive/Oppositional (α = .86), Withdrawal/Low energy (α = .87), and Hyperactive/Attention seeking (α = .92). In addition, three situational contexts were identified: Contexts Requiring Discipline (α = .84), Contexts of Teaching and Learning (α = .85), and problems in Contexts Requiring Engagement (aka Disengagement) (α = .80). The 3-factor situational model demonstrated a good fit, RMSEA = .056, CFI = .97, and Pearson correlations highlighting distinct associations between behavioral dimensions and situational requirements.
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Forensic psychiatric inpatients are frequently exposed to aggression from fellow patients during their treatment, but research on how this impacts patients’ well-being and treatment progress is lacking. In this study, we interviewed nine patients on their experiences of victimization during mandatory psychiatric treatment. The interviews were analyzed using a Grounded Theory approach combined with elements from Consensual Qualitative Research and Interpretative Phenomenological Analysis. Three main themes emerged from the data, namely situational descriptives, intrapersonal and interpersonal consequences. Patients were not only exposed to both physical violence and verbal aggression by other patients, but also to a more ubiquitous flow of micro- aggressive comments. Options to escape these situations were limited. This means that victimization processes, which for most patients started much earlier in life, continue during forensic psychiatric treatment. Intrapersonal consequences include fear, hypervigilance, reactive aggression, flashbacks and avoidance and withdrawal. Interpersonal consequences include increased power differences between patients and adverse treatment consequences, such as difficulties with self-esteem. Victimization processes are not always timely noticed in an environment that focuses on risks and treatment of delinquent behavior. A higher level of trauma sensitivity in forensic mental health care is thus required. Recommendations for the implementation of trauma informed care are provided.
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A key element in social development is interaction with others, and preterm infants have an increased risk for problems in this aspect. We aimed to gain additional insight into parents’ perception about their preterm child’s social interaction upon reaching school age. Parents informed us about their child being a little fighter, having issues of coping with their disabilities in social contexts, and how their child withdraws from situations that are overlystimulating. They also expressed their concerns about the future, how they encourage their child, and how they experience the transition to primary school. Parents’ experiences concerning the social interaction of their preterm child can be categorized into eight themes of processes in social interaction: child factors, self-regulation, real-time social interaction, long-term social interaction, parental factors, parenting, social environment, and social experiences. Our proposed model of social interaction in preterm infants visualizes theinterrelatedness between these themes in social interaction
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Presentation SECREV 2022
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This study was commissioned by the European Parliament’s Policy Department for Citizens’ Rights and Constitutional Affairs at the request of the Committee on Constitutional Affairs of the European Parliament. It analyses the political and legal dynamics behind referendums on EU-related matters. It argues that we have entered a period of increasing political uncertainty with regard to the European project and that this new political configuration will both affect and be affected by the politics of EU-related referendums. Such referendums have long been a risky endeavour and this has been accentuated in the wake of the Great Recession with its negative ramifications for public opinion in the European Union. It is clear that referendums on EU matters are here to stay and will continue to be central to the EU’s future as they are deployed to determine the number of Member States within the EU, its geographical reach, its constitutional evolution and adherence to EU policies. Only now they have become an even riskier endeavour.
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