Experiences of self-injury among staff and patients in a forensic psychiatric hospital

PurposeSelf-injury is common in forensic psychiatric settings. Recent research offers some insights into the functions and management of self-injurious behaviour but generally focusses on either the experiences of staff or patients. This study aims to explore the experiences of both staff and patients with non-suicidal self-injury in a Dutch forensic psychiatric hospital.Design/methodology/approachIn total, 6 patients and 11 staff members were interviewed about the functions they ascribe to self-injurious behaviour, the emotional experience provoked by this behaviour and the management of self-injurious behaviour. The interviews were transcribed and analysed using a thematic analysis.FindingsFour main themes resulted from the analysis: functions; emotional distancing; patient needs; and management. Overall, findings illustrate that staff reports limited knowledge of the different functions of self-injury. To circumvent potential automatic stereotypical judgement, staff should proactively engage in conversation about this topic with their patients. In managing self-injurious behaviour, clarity and uniformity among staff members should be promoted, and collaboration between the staff and patients is desirable. Staff recognised the potential benefit of a management guideline. Staff may find detached coping strategies to be effective but should be vigilant to not let this evolve into excessive detachment.Practical implicationsIncreased knowledge and awareness of self-injury functions among staff can allow for better understanding and evaluation of self-injury incidents. Circumvention of automatic, stereotypical judgement of self-injurious behaviour is warranted, and more accessible explanations of the variety of functions of self-injury should be used. More proactive engagement in conversations about functions of self-injury by staff, can facilitate this. Detached coping can help staff to remain resilient in their job, but requires vigilance to prevent this from turning into excessive detachment. Clarity and uniformity among staff when managing self-injury incidents is considered beneficial by both patients and staff. A guideline may facilitate this. When imposing restrictions on patients, staff should strive to establish collaboration with the patient in determining the course of action and ensure the restriction is temporary.Originality/valueThe impact of self-injurious behaviour on all those involved can be enormous. More research is needed into experiences of both patients and staff members regarding the impact, motivations, precipitants and functions of self-injurious behaviour, and effective treatment of it

Temporal lobectomy evidence for the role of the amygdala in early emotional face and body processing

The amygdala is believed to make invaluable contributions to visual emotion processing. Yet how this subcortical body contributes to emotion perception across time is contended. Here, we measured differences in the perceptual processing of emotional stimuli after unilateral temporal lobe and amygdala resection (TLR) in humans, using EEG. Through mass univariate analysis of brain activity, we compared responses to fearful and neutral faces (left TLR N = 8, right TLR N = 8, control N = 8), and fearful and neutral bodies (left TLR N = 9, right TLR N = 9, control N = 9). We found that TLR impaired the early-stage perceptual processing of emotional stimuli seen in the control group. Indeed, in controls a heightened responses to fearful faces was found in the 140–170 ms time window, over temporoparietal electrodes. This effect was also present in the left TLR group but disappeared in the right TLR group. For emotional bodies, brain activity was differentially sensitive to fearful stimuli at 90–120 ms in the control group, but this effect was eliminated in both TLR groups. Collectively, these results reveal the amygdala contributes to the early stages of perceptual processing that discriminate emotional stimuli from neutral stimuli. Further, they emphasize the unique role of the right medial temporal structures such as the amygdala in emotional face perception.</p

Inequality, social mobility and redistributive preferences

In an online experiment, we provide US citizens with information on both inequality of outcomes and opportunities and test the impact on preferences for redistribution. Information on wealth inequalities in the US increases consensus on a more progressive tax system, whereas information on lack of social mobility in the US increases participants’ preferences for redistribution via fiscal spending. Both informational treatments have a stronger impact when participants also learn that higher inequality is not a necessary part of economic development. All informational treatments have a stronger impact for citizens who underestimate the current level of inequality, trust the government, or belong to the middle-income group, while there is no clear relationship between political position and the impact of information on preferences for redistribution

Generalizability, robustness, and correction bias of segmentations of thoracic organs at risk in CT images

Objective: This study aims to assess and compare two state-of-the-art deep learning approaches for segmenting four thoracic organs at risk (OAR)—the esophagus, trachea, heart, and aorta—in CT images in the context of radiotherapy planning. Materials and methods: We compare a multi-organ segmentation approach and the fusion of multiple single-organ models, each dedicated to one OAR. All were trained using nnU-Net with the default parameters and the full-resolution configuration. We evaluate their robustness with adversarial perturbations, and their generalizability on external datasets, and explore potential biases introduced by expert corrections compared to fully manual delineations. Results: The two approaches show excellent performance with an average Dice score of 0.928 for the multi-class setting and 0.930 when fusing the four single-organ models. The evaluation of external datasets and common procedural adversarial noise demonstrates the good generalizability of these models. In addition, expert corrections of both models show significant bias to the original automated segmentation. The average Dice score between the two corrections is 0.93, ranging from 0.88 for the trachea to 0.98 for the heart. Conclusion: Both approaches demonstrate excellent performance and generalizability in segmenting four thoracic OARs, potentially improving efficiency in radiotherapy planning. However, the multi-organ setting proves advantageous for its efficiency, requiring less training time and fewer resources, making it a preferable choice for this task. Moreover, corrections of AI segmentation by clinicians may lead to biases in the results of AI approaches. A test set, manually annotated, should be used to assess the performance of such methods. Key Points: Question While manual delineation of thoracic organs at risk is labor-intensive, prone to errors, and time-consuming, evaluation of AI models performing this task lacks robustness. Findings The deep-learning model using the nnU-Net framework showed excellent performance, generalizability, and robustness in segmenting thoracic organs in CT, enhancing radiotherapy planning efficiency. Clinical relevance Automatic segmentation of thoracic organs at risk can save clinicians time without compromising the quality of the delineations, and extensive evaluation across diverse settings demonstrates the potential of integrating such models into clinical practice.</p

Left atrial strain predicts long-term heart failure outcomes after ST-elevation myocardial infarction

Background: Left atrial (LA) strain reflects not only LA function but also systolic and diastolic left ventricular function. We therefore hypothesize that LA strain may be a comprehensive predictor of heart failure related endpoints after ST-elevation myocardial infarction (STEMI). We aim to assess the impact of LA reservoir strain on the long-term prognosis following ST-elevation myocardial infarction (STEMI). Method and results: LA strain was measured in 287 first-time STEMI patients using two-dimensional speckle tracking echocardiography at hospitalization. Patients were categorized according to quartiles of LA reservoir strain for the analysis of population characteristics and assessment of event-free survival. Predictors of the composite heart failure endpoint of cardiac death, heart failure hospitalization, and new-onset heart failure were identified using Cox regression. The study population was 57.8 ± 11.3 years of age and predominantly male (74.6 %). After a median follow-up of 8.8 years, 33 (11.5 %) patients reached the composite endpoint. Mean LA reservoir strain was 27.5 ± 7.97 %. Patients with lower LA reservoir strain were older (p = 0.003) and had a lower left ventricular ejection fraction (LVEF, p &lt; 0.001) at admission. Independent predictors for the composite endpoint were higher age (HR = 1.07, p = 0.001), lower LVEF (HR = 0.94, p = 0.015), lower diastolic blood pressure (HR = 0.97, p = 0.034), and lower LA reservoir strain (HR = 0.90, p = 0.003). Adding LA reservoir strain to a clinical risk prediction model significantly improved its performance (C-statistic 0.838 vs. 0.784, p = 0.003). Conclusion: The LA reservoir strain has incremental value in the prediction of long-term heart failure outcomes in patients after a first STEMI

Widening the price gap:the effect of the Netherlands' 2020 tax increase on tobacco prices

Introduction: The public health impact of a tobacco tax increase depends on the extent to which the industry passes the increase onto consumers, also known as tax-pass through. In 2020, the Netherlands announced tax increases aimed at increasing the retail price by €1 per 20 factory-made (FM) cigarettes and €2.50 per 50 g of roll-your-own (RYO) tobacco. This study examines the pass-through rate after the tax increase, and whether this differed by type of tobacco and brand segment. Aims and Methods: Self-reported prices of 117 tobacco brand varieties (cigarettes = 72, RYO = 45) pre- and post-tax increases were extracted from the 2020 International Tobacco Control Netherlands Surveys (n = 2959 respondents). We calculated the tax pass-through rate per variant, examining differences between the type of tobacco and brand segments. Results: On average, cigarette prices increased by €1.12 (SD = 0.49; 112% of €1) and RYO prices by €2.53 (SD = 0.60; 101% of €2.50). Evidence of differential shifting across segments was found, with evidence of overshifting in non-discount varieties. The average price of discount varieties increased by €0.20 less than non-discount varieties. Similarly, the net-of-tax price decreased in discount varieties (cigarettes = -€0.02; RYO = -€0.05), but increased in non-discount varieties (cigarettes = +€0.14; RYO = +€0.20). Conclusions: Despite the large tax increase, the industry increased prices in line with or above the required level. Through differential shifting, the price gap between discount and non-discount varieties has widened, which may reduce the public health impact of the tax increase. Measures aimed at reducing price variability should be strengthened in taxation policy, such as the European Tobacco Tax Directive (TTD). Implications: We found that the industry used differential shifting after a significant tobacco tax increase in the Netherlands. Prices increased more than required in higher-priced products, but not in lower-priced products. This pattern was found both for FM cigarettes and RYO tobacco. Through differential shifting, the industry undermines the potential public health impact of tobacco tax increases, by offering a relatively cheaper alternative, which discourages people to quit or reduce consumption. The revision of the European TTD provides an opportunity to address the widening price gap - both between and within product segments - across the European Union.</p

Parental Gender Stereotypes and Student Well-Being in China

A prominent gender stereotype claims that "boys are better at learning mathematics than girls." Confronted with such a parental attitude, how does this affect the well-being of 11- to 18-year-old students in Chinese middle schools? Although well-being has often been shown to be not much gender-diverse, the intergenerational consequences of such stereotypes are not well studied. Expecting too much from boys and too little from girls might damage self-esteem among school kids. Using large survey data covering districts all over China reveals that one-quarter of the parents agree with the math stereotype. It is shown that this has strong detrimental consequences for the offspring's well-being. Students are strongly more depressed, feeling blue, unhappy, not enjoying life, and sad with no male-female differences, whereas parental education does not matter for this transfer. Various robustness tests including other than math stereotypes and an IV analysis confirm the findings. Moderating such effects, which is in line with societal objectives in many countries, not only supports gender equality but also strengthens the mental health of children

Affective Atmosphere in an Art Fair Jewel Heist

In mid 2022, social media videos of an armed jewel heist during opening hours at the TEFAF art fair baffled the public. The thieves wore seemingly absurd costumes, and the art fair attendees only showed muted reactions to a violent and dramatic crime. Drawing on first-hand observational research at TEFAF before and after the heist, and on an extended observational methodology focused on the atmosphere of art commercial spaces, we argue that the affective atmosphere of the art fair had a direct influence both on how the thieves committed and how onlookers experienced crime. Within the art fair space, thieves conformed to art world conventions and fair attendees experienced dangerous events as being significantly less sinister. With this paper, we contribute to the growing concept of sensory criminology and the role that atmosphere and affect play in crime

Determinants of physical activity maintenance and the acceptability of a remote coaching intervention following supervised exercise oncology rehabilitation:a qualitative study

PurposeThe purpose of the study was to investigate perceived determinants of physical activity (PA) maintenance following supervised exercise oncology rehabilitation and the acceptability of a remote coaching intervention during this period.MethodsA phenomenological qualitative study with semi-structured interviews was conducted. Nineteen participants (16 women, 3 men) were recruited from the intervention (n = 12) and control group (n = 7) of a randomized controlled trial on the effectiveness of remote coaching following hospital-based, supervised exercise oncology rehabilitation. Participants in the intervention group received a 6-month remote coaching intervention after completing the exercise program, aimed at stimulating PA maintenance. The interviews were based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B model) and the framework of acceptability (TFA) and were coded using template analysis.ResultsKey themes regarding determinants of PA maintenance were self-efficacy, PA habits, accountability, physical complaints, and facilities. Remote coaching was perceived acceptable because it stimulated PA maintenance by offering a source of structure and social support and thereby increased accountability. Moreover, it improved confidence to perform PA, leading to increased levels of self-efficacy. The remote nature of the intervention was perceived as convenient by some of the participants, while others would have preferred additional physical appointments.ConclusionsCancer survivors considered remote coaching acceptable to stimulate PA maintenance following supervised rehabilitation. Interventions should focus on increasing accountability, self-efficacy, forming habits, and helping cancer survivors to overcome barriers.Implications for Cancer SurvivorsThe ability to maintain PA beyond supervised exercise oncology programs depends on many determinants. Remote coaching interventions have potential to target individually relevant determinants following exercise programs in cancer survivors

Toward a Generative Model for Emotion Dynamics

Most theories of emotion suggest that emotions are reactions to situations we encounter in daily life. Process theories of emotion further specify a feedback loop between our environment, attention, emotions, and action that clarifies the adaptive nature of emotions. In principle, such process theories describe how emotions develop in daily life, and consequently, emotion measures collected from individuals many times a day in studies using the experience sampling methodology should be highly useful in advancing these theories. However, current emotion theories are predominantly verbal theories and therefore do not make clear predictions about such data. In this article, we take a first step toward a generative model of emotion dynamics by formalizing the link between situations and emotions, which provides us with a basic generative model of emotions in daily life. We show that this incomplete model already reproduces nine empirical phenomena in emotion time series related to (temporal) statistical associations between emotions and their distributional form. We then discuss how we can draw on existing (process) theories of emotion to extend our basic model into a complete generative model of emotion dynamics. Finally, we discuss how generative models of emotion dynamics can facilitate theory development and advance measurement, study design, and statistical analysis