Involving patients and families in the analysis of suicides, suicide attempts, and other sentinel events in mental healthcare: A qualitative study in The Netherlands

Involving patients and families in mental healthcare is becoming more commonplace, but little is known about how they are involved in the aftermath of serious adverse events related to quality of care (sentinel events, including suicides). This study explores the role patients and families have in formal processes after sentinel events in Dutch mental healthcare. We analyzed the existing policies of 15 healthcare organizations and spoke with 35 stakeholders including patients, families, their counselors, the national regulator, and professionals. Respondents argue that involving patients and families is valuable to help deal with the event emotionally, provide additional information, and prevent escalation. Results indicate that involving patients and families is only described in sentinel event policies to a limited extent. In practice, involvement consists mostly of providing aftercare and sharing information about the event by providers. Complexities such as privacy concerns and involuntary admissions are said to hinder involvement. Respondents also emphasize that involvement should not be obligatory and stress the need for patients and families to be involved throughout the process of treatment. There is no one-size-fits-all strategy for involving patients and families after sentinel events. The first step seems to be early involvement during treatment process itself

Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care.</p> <p>Methods</p> <p>A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality.</p> <p>Results</p> <p>Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey) and the immigrant host countries (mainly the Netherlands). The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are often quite influential in end-of-life decisions, such as the decision to withdraw or withhold treatments. The diagnosis, prognosis and end-of-life decisions are seldom discussed with the patient, and communication about pain and mental problems is often limited. Language barriers and the dominance of the family may exacerbate communication problems.</p> <p>Conclusions</p> <p>This review confirms the view that family members of patients with a Turkish or Moroccan background have a central role in care, communication and decision making at the end of life. This, in combination with their continuing hope for the patient’s recovery may inhibit open communication between patients, relatives and professionals as partners in palliative care. This implies that organizations and professionals involved in palliative care should take patients’ socio-cultural characteristics into account and incorporate cultural sensitivity into care standards and care practices<it>.</it></p

Гарантоздатність як фундаментальний узагальнюючий та інтегруючий підхід

Представлені головні принципи та умови становлення і етапи розвитку фундаментальної теорії і практики узагальнюючих та інтегруючих концепцій гарантоздатності, починаючи з першої об’єднаної конференції двох наукових шкіл Дж. фон Неймана і Н. Вінера. Приведені основні положення розвитку теоретичних засад і результатів прикладних досліджень інтеграційних процесів безвідмовності (надійності), відмовостійкості та гарантоздатності інформаційно-управляючих комп’ютерних систем (ІУКС).Представлены главные принципы, условия становления и этапы развития фундаментальной теории и практики обобщающих и интегрирующих концепций гарантоспособности, начиная с первой объединённой конференции двух научных школ Дж. фон Неймана и Н. Винера. Приведены основные положения развития теоретических основ и результатов прикладных исследований интеграционных процессов безотказности (надёжности), отказоустойчивости и гарантоспособности информационно-управляющих компьютерных систем (ИУКС).The main principles and conditions of formation and stages of development of the fundamental theory and practice of the generalizing and integrating concepts of dependability were presented after the leadthrough the first joint conference of two scientific schools of J. von Neumann and N. Wiener. The basic aspects of development of theoretical principles and results of applied researches of integration processes of reliability (fail-safety)

Elevated CO₂ does not increase eucalypt forest productivity on a low-phosphorus soil

Rising atmospheric CO2 stimulates photosynthesis and productivity of forests, offsetting CO2 emissions. Elevated CO2 experiments in temperate planted forests yielded ~23% increases in productivity over the initial years. Whether similar CO2 stimulation occurs in mature evergreen broadleaved forests on low-phosphorus (P) soils is unknown, largely due to lack of experimental evidence. This knowledge gap creates major uncertainties in future climate projections as a large part of the tropics is P-limited. Here,we increased atmospheric CO2 concentration in a mature broadleaved evergreen eucalypt forest for three years, in the first large-scale experiment on a P-limited site. We show that tree growth and other aboveground productivity components did not significantly increase in response to elevated CO2 in three years, despite a sustained 19% increase in leaf photosynthesis. Moreover, tree growth in ambient CO2 was strongly P-limited and increased by ~35% with added phosphorus. The findings suggest that P availability may potentially constrain CO2-enhanced productivity in P-limited forests; hence, future atmospheric CO2 trajectories may be higher than predicted by some models. As a result, coupled climate-carbon models should incorporate both nitrogen and phosphorus limitations to vegetation productivity in estimating future carbon sinks

christelijk, islamitisch en seculier apocalyptisch geweld door de eeuwen heen

the author has researched Christian, post-Christian and Islamic narrative structures that during the previous thousand years advocated of facilitated millenarium violence.Dit onderzoek richt zich op verhaalstructuren die de afgelopen duizend jaar millenaristisch geweld propageerden of daartoe aangegrepen konden worden. Daarbij zijn in het bijzonder christelijke en post-christelijke varianten van apocalyptische narratieven in West-Europa en de Verenigde Staten bestudeerd, alsmede islamitische apocalyptische voorstellingen van in het bijzonder de laatste eeuw. INHOUD: 1. Fanatisme als begrip 2. Fanatisme als dynamisch idee 3. De onderzochte en aangetroffen varianten 4. De verkondigers van het fanatisme 5. Het appèl van de oproep tot fanatisme 6. Van religieus tot ideologisch fanatisme 7. Convergentie en interferenti

Traces of Fallback Breccia on the Rim of Barringer Meteorite Crater (a.k.a. Meteor Crater), Arizona

Barringer Meteorite Crater (a.k.a. Meteor Crater), Arizona, is one of the youngest and best preserved impact craters on Earth. For that rea-son, it provides a baseline for similar craters formed in the geologic past, formed elsewhere in the Solar Sys-tem, and illuminates the astronomical and geological processes that produce them. The crater has not, how-ever, escaped erosion completely. While Shoemaker [1] mapped a breccia with fallback components inside the crater, he did not locate it beyond the crater rim. He only found remnants of that type of debris in re-worked alluvium [1; see also 2]. Fallback breccia and any base-surge deposits have, thus, been missing components in studies of material ejected beyond the transient crater rim

HTA between theory and practice:Exploring boundary work in broadening HTA For MedTech governance

Objectives: In this paper, we explore the social and political practices involved in broadening health technology assessment (HTA) for medical technology (MedTech) governance. We take as our case study the Dutch HTA Methodology 2021–2024 Program, which aimed to broaden HTA methodologies to the assessment of MedTech, and in so doing, broadened the stakeholders involved. Our research question is as follows: How do stakeholders involved in the program interpret HTA (methodologies) for MedTech, and how do they envision multi-stakeholder collaboration on HTA (methodologies)?Methods: We conducted 19 semi-structured interviews with program participants, including committee members and grant applicants. We also spent 120 hours observing program meetings as non-participants and conducted document analysis.Results: Using boundary work as a sensitizing concept, we describe how broadening the actors involved both introduced and exposed different interpretations of HTA and HTA methodologies for MedTech. We describe three ways in which participants envisioned (potential) integration of these interpretations, which we term collaboration hybrids. Each collaboration hybrid encapsulates a way of navigating across boundaries.Conclusions: Our findings highlight that attempts to broaden HTA into a more prominent aspect of MedTech governance challenge the boundaries of what is understood as proper HTA. We argue that reflecting explicitly on these different interpretations, and the diverse ways to integrate them, increases the relevance of the HTA methodologies developed and the collaborations initiated in the governance of MedTech through HTA

Interactive analysis of SDN-driven defence against Distributed Denial of Service attacks

The Secure Autonomous Response Networks (SARNET) framework introduces a mechanism to respond autonomously to security attacks in Software Defined Networks (SDN). Still the range of responses possible and their effectiveness need to be properly evaluated such that the decision making process and the self-learning capability of such systems are optimized. To this purpose we developed a touch-table driven interactive SARNET prototype, named VNET, and we demonstrated its use through real-time monitoring and control of real and virtualised networks. By observing users interacting with the system at SC15 in Austin, we concluded that in a SDN it is possible to achieve high effectiveness of responses by carefully choosing a relatively minor number of actions