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Sample records for deliberate self-harm dsh

  1. Deliberate Self-Harm (DSH): a follow-up study of Irish children.

    LENUS (Irish Health Repository)

    Cassidy, C

    2012-02-01

    This study aimed to look at rates of repetition in children presenting with Deliberate Self-Harm (DSH) to a paediatric A&E department. Children presenting with DSH to a paediatric A&E between 2000 and 2005 were invited to participate in the study. Telephone interviews collected information on demographic details and mental health functioning, including repetition of DSH. Data was obtained from 39 parents and 10 children (31 girls and 8 boys, mean age 15) 1 in 5 females (20%) had made a repeat attempt of DSH and 1 in 10 (10%) had repeated more than once. No males repeated self-harm. On going parental concern rather than clinician risk assessment at index episode predicted subsequent DSH. Given the poor predictive value of clinician risk assessment, all attempts of DSH must be taken seriously, especially those associated with ongoing parental concern.

  2. Deliberate Self-Harm (DSH): a follow-up study of Irish children.

    LENUS (Irish Health Repository)

    Cassidy, C

    2009-04-01

    This study aimed to look at rates of repetition in children presenting with Deliberate Self-Harm (DSH) to a paediatric A&E department. Children presenting with DSH to a paediatric A&E between 2000 and 2005 were invited to participate in the study. Telephone interviews collected information on demographic details and mental health functioning, including repetition of DSH. Data was obtained from 39 parents and 10 children (31 girls and 8 boys, mean age 15) 1 in 5 females (20%) had made a repeat attempt of DSH and 1 in 10 (10%) had repeated more than once. No males repeated self-harm. On going parental concern rather than clinician risk assessment at index episode predicted subsequent DSH. Given the poor predictive value of clinician risk assessment, all attempts of DSH must be taken seriously, especially those associated with ongoing parental concern.

  3. Deliberate Self Harm Behavior

    Directory of Open Access Journals (Sweden)

    Fatma Gul Helvaci Celik

    2017-06-01

    Full Text Available The deliberate self-harm behaviour which defined as attempting to own body resulting in tisue damage without conscious desire of peolple to die, is a major public health problem worldwide. The causes of deliberate self- harm, risk factors, the relationship between mental disorders and treatment strategies are not fully known. Deliberate self- harm can be observed together with psychiatric disorders such as borderline personality disorder, histrionic personality disorder, eating disorders and mood disorders. Also, deliberate self-harm must be distinguished from suicidal behavior. Psychologi-cal trauma has been suggested as a risk factor for deliberate self- harm behavior. Trauma and traumatic events have long been associated with deliberate self- harm behavior. The aim of this review article is to investigate the etiology and epidemiology of deliberate self-harm behaviour and relationship between psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(2.000: 209-226

  4. Psychiatric Impairment among Adolescents Engaging in Different Types of Deliberate Self-Harm

    Science.gov (United States)

    Jacobson, Colleen M.; Muehlenkamp, Jennifer J.; Miller, Alec L.; Turner, J. Blake

    2008-01-01

    This retrospective chart review study of 227 participants examined the psychiatric profiles of outpatient adolescents ages 12 to 19 years (M = 15.08 years, SD = 1.72 years) engaging in different types of deliberate self-harm (DSH) behaviors. Participants were divided into four groups: no deliberate self-harm (NoDSH; n = 119), nonsuicidal…

  5. Deliberate self-harm before psychiatric admission and risk of suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Agerbo, Esben; Mortensen, Preben B

    2013-01-01

    Psychiatric illness and deliberate self-harm (DSH) are major risk factors of suicide. In largely 15 % of psychiatric admissions in Denmark, the patient had an episode of DSH within the last year before admission. This study examined the survival and predictors of suicide in a suicidal high...

  6. The prevalence of self-reported deliberate self harm in Irish adolescents

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    Arensman Ella

    2008-02-01

    Full Text Available Abstract Background Deliberate self harm is major public health problem, in particular among young people. Although several studies have addressed the prevalence of deliberate self harm among young people in the community, little is known about the extent to which deliberate self harm comes to the attention of medical services, the self harm methods used and the underlying motives. The aim of this study was to determine the prevalence of deliberate self harm in adolescents and the methods, motives and help seeking behaviour associated with this behaviour. Methods A cross-sectional survey using an anonymous self-report questionnaire was administered in 39 schools in the Southern area of the Health Service Executive, Ireland. Of the 4,583 adolescents aged 15–17 years who were invited to participate in the survey, 3,881 adolescents took part (response: 85%. Results A lifetime history of DSH was reported by 9.1% (n = 333 of the adolescents. DSH was more common among females (13.9% than males (4.3%. Self cutting (66.0% and overdose (35.2% were the most common DSH methods. A minority of participants accessed medical services after engaging in DSH (15.3%. Conclusion DSH is a significant problem in Irish adolescents and the vast majority do not come to the attention of health services. Innovative solutions for prevention and intervention are required to tackle DSH in adolescents.

  7. The prevalence of self-reported deliberate self harm in Irish adolescents.

    LENUS (Irish Health Repository)

    Morey, Carolyn

    2008-01-01

    BACKGROUND: Deliberate self harm is major public health problem, in particular among young people. Although several studies have addressed the prevalence of deliberate self harm among young people in the community, little is known about the extent to which deliberate self harm comes to the attention of medical services, the self harm methods used and the underlying motives. The aim of this study was to determine the prevalence of deliberate self harm in adolescents and the methods, motives and help seeking behaviour associated with this behaviour. METHODS: A cross-sectional survey using an anonymous self-report questionnaire was administered in 39 schools in the Southern area of the Health Service Executive, Ireland. Of the 4,583 adolescents aged 15-17 years who were invited to participate in the survey, 3,881 adolescents took part (response: 85%). RESULTS: A lifetime history of DSH was reported by 9.1% (n = 333) of the adolescents. DSH was more common among females (13.9%) than males (4.3%). Self cutting (66.0%) and overdose (35.2%) were the most common DSH methods. A minority of participants accessed medical services after engaging in DSH (15.3%). CONCLUSION: DSH is a significant problem in Irish adolescents and the vast majority do not come to the attention of health services. Innovative solutions for prevention and intervention are required to tackle DSH in adolescents.

  8. Suicide Following Deliberate Self-Harm.

    Science.gov (United States)

    Olfson, Mark; Wall, Melanie; Wang, Shuai; Crystal, Stephen; Gerhard, Tobias; Blanco, Carlos

    2017-08-01

    The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm. A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models. During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days. Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.

  9. Ethnic density and deliberate self harm; a small area study in south east London

    NARCIS (Netherlands)

    Neeleman, J; Wilson-Jones, C; Wessely, S

    Study objective-Relative risks are frequently used to convey how strongly outcomes like mental illness and suicidal behaviour are associated with personal characteristics Like ethnic background. This study examined whether RRs for deliberate self harm (DSH) in ethnic groups vary between small areas

  10. Adolescent Deliberate Self-Harm: Linkages to Emotion Regulation and Family Emotional Climate

    Science.gov (United States)

    Sim, Leslie; Adrian, Molly; Zeman, Janice; Cassano, Michael; Friedrich, William N.

    2009-01-01

    Parents' responses to their children's emotional expressivity have been shown to significantly influence children's subsequent psychosocial functioning. This study hypothesized that adolescents' deliberate self-harm (DSH) may be an outcome associated with poor emotion regulation as well as an invalidating family environment. The mediational role…

  11. RESEARCH The burden of deliberate self-harm on the critical care ...

    African Journals Online (AJOL)

    (collectively referred to as deliberate self-harm (DSH)) are limited.3-6. Reasons for this include ... using the Department of Health 2012 fee schedule. Results. A total of 419 ... There is a need to better control the unregulated availability of CIs ...

  12. Problem solving ability and repetition of deliberate self-harm: a multicentre study.

    NARCIS (Netherlands)

    McAuliffe, C.; Corcoran, P.; Keeley, H.S.; Arensman, E.; Bille Brahe, U.; Leio, de D.; Fekete, S.; Hawton, K.; Hjelmeland, H.; Kelleher, M.; Kerkhof, A.J.F.M.; Lonnqvist, J.; Michel, K.; Salander Renberg, E.; Schmidtke, A.; Heeringen, van K.; Wasserman, D.

    2006-01-01

    Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated

  13. An examination of emergency department nurses' attitudes towards deliberate self-harm in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McCarthy, Linda

    2010-01-01

    The purpose of this study was to examine emergency department (ED) nurses\\' attitudes towards individuals presenting with deliberate self-harm (DSH), including the relationship between attitudes and factors such as age, academic achievements, length of experience, and self-harm education.

  14. Repeat deliberate self-harm: a link with childhood sexual abuse?

    OpenAIRE

    Yeo, H M; Yeo, W. W.

    1993-01-01

    The purpose of this study was to identify whether a past history of childhood sexual abuse is a risk factor for repeated Deliberate Self-Harm (DSH). The study was a 6-month prospective study of 178 patients responsible for 190 consecutive cases of DSH seen during a 3-month censoring period. Patients were identified by review of the in-patient and accident and emergency (A&E) records of all cases of DSH at the A&E department of a major teaching hospital. Patients with a history of childhood se...

  15. Deliberate self-harm among Chinese medical students: A population-based study.

    Science.gov (United States)

    Wu, Dan; Rockett, Ian R H; Yang, Tingzhong; Feng, Xueying; Jiang, Shuhan; Yu, Lingwei

    2016-09-15

    The phenomenon of deliberate self-harm (DSH) among college students has received increased attention in recent decades. Adopting a psychosocial perspective, this study aims to describe self-reported DSH among Chinese medical college students, assess respective associations between uncertainty stress and social capital with DSH, and explore the mechanism linking these three phenomena. A cross-sectional survey employing multi-stage, sampling was conducted. 4446 undergraduate students were recruited from 22 participating Chinese medical universities. Perceived stress from uncertainty and social capital were assessed among the students. The Chi-square test and multiple logistic regression models assessed correlates of DSH. Relationship among social capital, uncertainty stress, and DSH were examined by means of Structural Equation Modeling. The prevalence of DSH in the past 12 months among Chinese students was 9.6%. The most common types of physical DSH reported were scratching, cutting, and pinching. Age (χ(2)=26.63, pstress is a unique correlate of DSH, and shows a stronger association than do three certainty stressors. Social capital is also a strong correlate of DSH, especially cognitive social capital. Moreover, social capital may be indirectly associated with DSH through impacting uncertainty stress. This study was a cross-sectional and thus could not evaluate causal relationships. We recommend that a DSH intervention study should target uncertainty stress management and social capital accumulation. This study provides scientific evidence and theoretical foundation for future DSH interventions, with a view to enhancing the mental health of medical college students. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Clinical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal

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    Diogo F Guerreiro

    2009-11-01

    Full Text Available Diogo F Guerreiro, Ema L Neves, Rita Navarro, Raquel Mendes, Ana Prioste, Diana Ribeiro, Tiago Lila, António Neves, Mónica Salgado, Nazaré Santos, Daniel SampaioYouth Suicide Study Group (NES, The Hospital Santa Maria, Psychiatry Department, Lisbon Faculty of Medicine, PortugalAbstract: Deliberate self-harm (DSH among adolescents is a high-risk condition for suicide. The aim of the present study is to describe the characteristic clinical features of adolescents with DSH according to our local context (Lisbon, Portugal, using easily available information from clinical settings. A case control study was constructed from a sample of 100 adolescents (aged 12 to 21 years. The sample was divided into two groups: adolescents with and without DSH. Case files were examined and data was completed by clinical interviews. Demographic, psychosocial, and psychopathological data were assessed and compared. Ninety-eight subjects completed the protocol. The DSH group was associated with the following: suicidal ideation or suicidal behavior as consultation motive, emergency room referral, previous follow-up attempts, suicidal ideation, psychosocial difficulties, or lack of therapeutic goals. There was a nonsignificant trend towards diagnosis of depression in the DSH group. These results reflect our clinical practice with adolescents and add data about teenagers who self-harm to the literature. Prevention and early recognition of DSH (and frequently associated depression in adolescents are essential and could be life-saving measures. An integrated approach, which takes into account psychosocial difficulties, family dysfunction, and negative expectations, seems to be of great importance.Keywords: deliberate self-harm, suicide, adolescents, suicide risk, case control

  17. The incidence and repetition of hospital-treated deliberate self harm: findings from the world's first national registry.

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    Ivan J Perry

    Full Text Available BACKGROUND: Suicide is a significant public health issue with almost one million people dying by suicide each year worldwide. Deliberate self harm (DSH is the single most important risk factor for suicide yet few countries have reliable data on DSH. We developed a national DSH registry in the Republic of Ireland to establish the incidence of hospital-treated DSH at national level and the spectrum and pattern of presentations with DSH and repetition. METHODS AND FINDINGS: Between 2003 and 2009, the Irish National Registry of Deliberate Self Harm collected data on DSH presentations to all 40 hospital emergency departments in the country. Data were collected by trained data registration officers using standard methods of case ascertainment and definition. The Registry recorded 75,119 DSH presentations involving 48,206 individuals. The total incidence rate fell from 209 (95% CI: 205-213 per 100,000 in 2003 to 184 (95% CI: 180-189 per 100,000 in 2006 and increased again to 209 (95% CI: 204-213 per 100,000 in 2009. The most notable annual changes were successive 10% increases in the male rate in 2008 and 2009. There was significant variation by age with peak rates in women in the 15-19 year age group (620 (95% CI: 605-636 per 100,000, and in men in the 20-24 age group (427 (95% CI: 416-439 per 100,000. Repetition rates varied significantly by age, method of self harm and number of previous episodes. CONCLUSIONS: Population-based data on hospital-treated DSH represent an important index of the burden of mental illness and suicide risk in the community. The increased DSH rate in Irish men in 2008 and 2009 coincided with the advent of the economic recession in Ireland. The findings underline the need for developing effective interventions to reduce DSH repetition rates as a key priority for health systems.

  18. Six case studies depicting the deliberate self-harm syndrome.

    Science.gov (United States)

    Rosen, S; Collins, K J

    1993-04-01

    This article comprises information on self-mutilation (and specifically on the Deliberate Self-harm Syndrome) which obtained from a study of mainly American and British literature. Included is data obtained from interviews conducted with a sample of South Africans suffering from the syndrome. Etiology was explained from both a psychological and biological perspective. The former highlighted deficiencies in coping and communication skills while the latter highlighted the compulsive and pain-killer role that endorphines play. From case studies and literature it was possible to clearly distinguish the Deliberate Self-harm Syndrome as a distinct disorder-a syndrome consisting of deliberate, repetitive and private acts of self-harm in the form of cutting, burning and banging oneself. This culminates in extreme tension release.

  19. Measuring emergency department nurses' attitudes towards deliberate self-harm using the Self-Harm Antipathy Scale.

    LENUS (Irish Health Repository)

    Conlon, Mary

    2012-01-31

    The emergency department is an important gateway for the treatment of self-harm patients. Nurses\\' attitudes towards patients who self-harm can be negative and often nurses experience frustration, helplessness, ambivalence and antipathy. Patients are often dissatisfied with the care provided, and meeting with positive or negative attitudes greatly influences whether they seek additional help. A quantitative design was utilised to measure emergency department nurses\\' attitudes towards deliberate self-harm. The \\'Self-Harm Antipathy Scale\\

  20. Comparative study of personality disorder associated with deliberate self harm in two different age groups (15–24 years and 45–74 years)

    OpenAIRE

    Nath, Saswati; Patra, Dipak Kumar; Biswas, Srilekha; Mallick, Asim Kumar; Bandyopadhyay, Gautam Kumar; Ghosh, Srijit

    2008-01-01

    Aims: To study the presence of personality disorder in cases of deliberate self harm (DSH) in young (15–24 years) and elderly (45–74 years) and compare. Materials and Methods: Deliberate self harm cases admitted in Medical and surgical departments and cases attending psychiatry department of R.G. Kar Medical College, Kolkata were studied. For diagnosis of personality disorder ICD 10 International Personality Disorder Examination (IPDE) questionnaire was used. Results: Percentage of elderly pa...

  1. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm

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    Muehlenkamp Jennifer J

    2012-03-01

    Full Text Available Abstract Background The behaviours of non-suicidal self-injury (NSSI and deliberate self-harm (DSH are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research. Methods We conducted a systematic review of current (2005 - 2011 empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe. Results Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3 and DSH (16.1% SD = 11.6 studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization. Conclusion NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.

  2. Deliberate self-harm: A search for distinct group of suicide

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    Amit Kumar Bhattacharya

    2011-01-01

    Full Text Available Objective: Some persons attempt suicide with a strong intention to die and some are not. Presently, no distinctive grouping has been done on the basis of the suicidal intention, though there is a significant variation in the psycho-socio-demographic profile, suicidal ideation, and intent within the persons making suicidal attempt. The aim of our study was to find the psycho-socio-demographic profile, suicide intent in survivors of suicide attempt, categorizing them by suicide intent, and finally to define the deliberate self-harm (DSH group. Materials and Methods: It was a cross-sectional study. Two hundred patients who survived suicide attempt were evaluated by a psychiatrist. The data were recorded for sociodemographic variables, psychiatric disorder, suicide intent, and lethality of suicide attempt. Grouping was done by using suicide intent as the determining dimension. The DSH group was defined by psycho-socio-demographic characteristics of the patient. Results: The mean age of the DSH group was 26.72 years, mostly females (50.5%, semiskilled workers (43.43% and housewives (32.32%, from nuclear family (60.6% with no psychiatric disorder (35.35%. Most of them attempted a nonlethal suicide attempt (87.87% by organophosphorus poisoning (87.87%. Conclusions: The DSH group is a distinct group among suicide attempters, having different psycho-socio-demographic characteristics.

  3. Personality and non-suicidal deliberate self-harm: Trait differences among a non-clinical population.

    Science.gov (United States)

    Brown, Seth A

    2009-08-30

    Limited information is available on understanding why particular individuals engage in non-suicidal deliberate self-harm (DSH), especially among non-clinical populations. An array of personality traits, such as those included in the five-factor model of personality, may further an understanding of DSH. The purpose of this study was to examine personality traits among non-clinical groups with or without a history of DSH. College students (N=238) completed self-report measures of DSH and personality. Both multivariate (MANOVA, discriminant analysis) and univariate (ANOVA) statistical procedures supported the hypothesis that those with a history of DSH (n=59) had significantly higher levels of neuroticism and openness to experience, and significantly lower levels of agreeableness and conscientiousness. Contrary to expectations, there were no differences in extraversion between the two groups. These results indicate personality differences among those with a history of DSH, which with additional research, may prove to be risk factors or targets of intervention for future DSH or collateral problems.

  4. Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder.

    Science.gov (United States)

    Gratz, Kim L; Bardeen, Joseph R; Levy, Roy; Dixon-Gordon, Katherine L; Tull, Matthew T

    2015-02-01

    Despite growing evidence for the efficacy of Gratz and colleagues' emotion regulation group therapy (ERGT) for deliberate self-harm (DSH) among women with borderline personality disorder (BPD), the proposed mechanism of change in this treatment (i.e., emotion regulation) remains largely unexamined. This study examined change in emotion dysregulation as a mediator of the effects of this ERGT on DSH and BPD symptoms, as well as the extent to which change in emotion dysregulation during treatment predicts further improvements in DSH during a 9-month follow-up. Participants included 61 female outpatients with BPD and recent DSH who were randomly assigned to receive this ERGT in addition to their ongoing outpatient therapy immediately (n = 31) or after 14 weeks (n = 30). Measures of emotion dysregulation, DSH, and BPD symptoms were administered pre- and post-treatment or -waitlist, and at 9-months post-treatment (for participants in both conditions who received ERGT). Results from a series of mediation analyses provide further support for emotion regulation as a mechanism of change in this treatment. Specifically, results revealed that improvements in emotion dysregulation over the course of treatment mediated the observed reductions in BPD cognitive and affective symptoms during treatment and predicted further improvements in DSH during follow-up.

  5. The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature.

    Science.gov (United States)

    Plener, Paul L; Schumacher, Teresa S; Munz, Lara M; Groschwitz, Rebecca C

    2015-01-01

    Non-suicidal self-injury (NSSI) has been proposed as diagnostic entity and was added to the section 3 of the DSM 5. Nevertheless, little is known about the long-term course of this disorder and many studies have pointed to the fact that NSSI seems to be volatile over time. We aimed to assemble studies providing longitudinal data about NSSI and furthermore included studies using the definition of deliberate self-harm (DSH) to broaden the epidemiological picture. Using a systematic search strategy, we were able to retrieve 32 studies reporting longitudinal data about NSSI and DSH. We furthermore aimed to describe predictors for the occurrence of NSSI and DSH that were identified in these longitudinal studies. Taken together, there is evidence for an increase in rates of NSSI and DSH in adolescence with a decline in young adulthood. With regards to predictors, rates of depressive symptoms and female gender were often reported as predictor for both NSSI and DSH.

  6. Suicide and Deliberate Self-harm in Children and Adolescents. A Research Update. Research Review.

    Science.gov (United States)

    Kerfoot, Michael

    1996-01-01

    Reviews research on adolescent suicide and deliberate self-harm. Shows that in the UK suicide is the second most common cause of death among 15- to 24-year-olds, and that deliberate self-harm is linked to depression, substance misuse, and family functioning and precedes one-third of adolescent suicides. Discusses problems in aftercare of…

  7. Incidence Rates of Deliberate Self-Harm in Denmark 1994-2011

    DEFF Research Database (Denmark)

    Reuter Morthorst, Britt; Soegaard, Bodil; Nordentoft, Merete

    2016-01-01

    BACKGROUND: The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate self-harm have been presented. AIM: To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records. MET...

  8. Deliberate self-harm in rural and urban regions: a comparative study of prevalence and patient characteristics.

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    Harriss, Louise; Hawton, Keith

    2011-07-01

    In countries like the U.K., people living in urban regions are more likely to suffer poor physical and mental health than rural populations, and to have increased rates of psychiatric disorder. Urban/rural differences in suicidal behaviour have most frequently focussed on variations in the occurrence of suicide. We have investigated rates of deliberate self-harm (DSH) in urban and rural districts of Oxfordshire, England, and compared characteristics of DSH patients resident in these two areas. Information was collected on 6833 DSH episodes by 4054 persons aged 15 years and over presenting to the local general hospital between 2001 and 2005. We found that urban DSH rates were substantially higher than rural rates amongst both males and females aged between 15 and 64 years. This relationship was sustained even when socio-economic deprivation and social fragmentation were taken into account. There was little difference between urban and rural rates for patients aged 65 years and over. Urban DSH patients were more likely to be younger, non-white in ethnic origin, unemployed, living alone, to have a criminal record, to have previously engaged in DSH, and to report problems with housing. Rural DSH patients were more likely to suffer from physical illness, and to have higher suicide intent scores. Results of studies such as this can help identify where resources for preventive initiatives should be primarily directed and also what types of individuals may be at most risk in different areas. However, since variation by area will in part be due to differences at the individual level, further research utilising multi-level modelling techniques would be useful.

  9. Dialectical behaviour therapy-informed skills training for deliberate self-harm: a controlled trial with 3-month follow-up data.

    LENUS (Irish Health Repository)

    Gibson, Jennifer

    2014-09-01

    Dialectical Behaviour Therapy (DBT) has been shown to be an effective treatment for deliberate self-harm (DSH) and emerging evidence suggests DBT skills training alone may be a useful adaptation of the treatment. DBT skills are presumed to reduce maladaptive efforts to regulate emotional distress, such as DSH, by teaching adaptive methods of emotion regulation. However, the impact of DBT skills training on DSH and emotion regulation remains unclear. This study examined the Living Through Distress (LTD) programme, a DBT-informed skills group provided in an inpatient setting. Eighty-two adults presenting with DSH or Borderline Personality Disorder (BPD) were offered places in LTD, in addition to their usual care. A further 21 clients on the waiting list for LTD were recruited as a treatment-as-usual (TAU) group. DSH, anxiety, depression, and emotion regulation were assessed at baseline and either post-intervention or 6 week follow-up. Greater reductions in the frequency of DSH and improvements in some aspects of emotion regulation were associated with completion of LTD, as compared with TAU. Improvements in DSH were maintained at 3 month follow-up. This suggests providing a brief intensive DBT-informed skills group may be a useful intervention for DSH.

  10. Household Survey of Pesticide Practice, Deliberate Self-Harm, and Suicide in the Sundarban Region of West Bengal, India

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    Sohini Banerjee

    2013-01-01

    Full Text Available The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH and suicides (suicidal behaviour and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar’s test were used to assess the level of agreement and association between respondents’ and investigators’ opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%. The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2–195.5, and for suicide it was 73.4 (95% CI 52.2–100.3 per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem.

  11. A review of patients presenting to accident and emergency department with deliberate self-harm, KwaZulu-Natal, South Africa

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    Josephat O. Ani

    2017-01-01

    Full Text Available Background: The World Health Organization has described deliberate self-harm (DSH as a major global health challenge. Little is known about the profile of patients admitted following DSH at district and regional combo hospitals in KwaZulu-Natal, South Africa.Aim: The aim of this study was to assess the profiles of patients and reasons for admission following DSH.Setting: The study was conducted on data from a busy Accident and Emergency (A&E department in a combination district and regional hospital situated in Empangeni in northern KwaZulu-Natal.Method: This was a retrospective descriptive study. Data were collected from charts of all patients admitted to the A&E department from April 2012 to March 2013 following DSH. Variables assessed included age, gender, race, occupation, religion, education level, coexisting medical and mental health conditions, and reasons for DSH. Data were entered into SPSS and analysed descriptively.Results: A total of 262 charts were identified and 215 (82% were selected for inclusion. Most patients admitted following DSH were young, single African women with at least secondary-level education. Most (169/215;78% admissions were for parasuicide, with relational issues contributing in more than 50% of cases and circumstance challenges contributing in just under 30%.Conclusion: Although an underestimation, DSH is not an uncommon reason for patients to present in the A&E at this district and regional combo hospital. Findings from this study are consistent with those of other studies on DSH and highlight the need for a validated screening tool for the identification of patients at risk of DSH. There is a need to explore community-based intervention, which could address reasons for DSH and prevent future admissions.

  12. A review of patients presenting to accident and emergency department with deliberate self-harm, KwaZulu-Natal, South Africa.

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    Ani, Josephat O; Ross, Andrew J; Campbell, Laura M

    2017-05-29

    The World Health Organization has described deliberate self-harm (DSH) as a major global health challenge. Little is known about the profile of patients admitted following DSH at district and regional combo hospitals in KwaZulu-Natal, South Africa. The aim of this study was to assess the profiles of patients and reasons for admission following DSH. The study was conducted on data from a busy Accident and Emergency (A&E) department in a combination district and regional hospital situated in Empangeni in northern KwaZulu-Natal. This was a retrospective descriptive study. Data were collected from charts of all patients admitted to the A&E department from April 2012 to March 2013 following DSH. Variables assessed included age, gender, race, occupation, religion, education level, coexisting medical and mental health conditions, and reasons for DSH. Data were entered into SPSS and analysed descriptively. A total of 262 charts were identified and 215 (82%) were selected for inclusion. Most patients admitted following DSH were young, single African women with at least secondary-level education. Most (169/215;78%) admissions were for parasuicide, with relational issues contributing in more than 50% of cases and circumstance challenges contributing in just under 30%. Although an underestimation, DSH is not an uncommon reason for patients to present in the A&E at this district and regional combo hospital. Findings from this study are consistent with those of other studies on DSH and highlight the need for a validated screening tool for the identification of patients at risk of DSH. There is a need to explore community-based intervention, which could address reasons for DSH and prevent future admissions.

  13. Antecedents of hospital admission for deliberate self-harm from a 14-year follow-up study using data-linkage

    Directory of Open Access Journals (Sweden)

    Silburn Sven R

    2010-10-01

    Full Text Available Abstract Background A prior episode of deliberate self-harm (DSH is one of the strongest predictors of future completed suicide. Identifying antecedents of DSH may inform strategies designed to reduce suicide rates. This study aimed to determine whether individual and socio-ecological factors collected in childhood and adolescence were associated with later hospitalisation for DSH. Methods Longitudinal follow-up of a Western Australian population-wide random sample of 2,736 children aged 4-16 years, and their carers, from 1993 until 2007 using administrative record linkage. Children were aged between 18 and 31 years at end of follow-up. Proportional hazards regression was used to examine the relationship between child, parent, family, school and community factors measured in 1993, and subsequent hospitalisation for DSH. Results There were six factors measured in 1993 that increased a child's risk of future hospitalisation with DSH: female sex; primary carer being a smoker; being in a step/blended family; having more emotional or behavioural problems than other children; living in a family with inconsistent parenting style; and having a teenage mother. Factors found to be not significant included birth weight, combined carer income, carer's lifetime treatment for a mental health problem, and carer education. Conclusions The persistence of carer smoking as an independent risk factor for later DSH, after adjusting for child, carer, family, school and community level socio-ecological factors, adds to the known risk domains for DSH, and invites further investigation into the underlying mechanisms of this relationship. This study has also confirmed the association of five previously known risk factors for DSH.

  14. Cross-National Comparisons of the Association between Alcohol Consumption and Deliberate Self-Harm in Adolescents

    Science.gov (United States)

    Rossow, Ingeborg; Ystgaard, Mette; Hawton, Keith; Madge, Nicola; van Heeringen, Kees; de Wilde, Erik Jan; DeLeo, Diego; Fekete, Sandor; Morey, Carolyn

    2007-01-01

    How differences in drinking patterns may affect the impact of alcohol consumption on deliberate self-harm among adolescents is explored in this international comparative study. Schools in Australia, Belgium, England, Hungary, Ireland, the Netherlands, and Norway (N = 30,532) were surveyed. In all countries the risk of deliberate self-harm was…

  15. Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study.

    Science.gov (United States)

    Madge, Nicola; Hawton, Keith; McMahon, Elaine M; Corcoran, Paul; De Leo, Diego; de Wilde, Erik Jan; Fekete, Sandor; van Heeringen, Kees; Ystgaard, Mette; Arensman, Ella

    2011-10-01

    There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

  16. Associations of deliberate self-harm with loneliness, self-rated health and life satisfaction in adolescence: Northern Finland Birth Cohort 1986 Study.

    Science.gov (United States)

    Rönkä, Anna Reetta; Taanila, Anja; Koiranen, Markku; Sunnari, Vappu; Rautio, Arja

    2013-01-01

    Deliberate self-harm (DSH) is an act with a non-fatal outcome in which an individual initiates a behavior, such as self-cutting or burning, with the intention of inflicting harm on his or her self. Interpersonal difficulties have been shown to be a risk factor for DSH, but the association between subjective experience of loneliness and DSH have rarely been examined. To examine the frequency of DSH or its ideation and loneliness among 16-year-olds to determine if associations exist between DSH and loneliness, loneliness-related factors, self-rated health and satisfaction with life. The study population (n = 7,014) was taken from Northern Finland Birth Cohort 1986 (N = 9,432). Cross-tabulations were used to describe the frequency of DSH by factors selected by gender. Logistic regression analysis was used to describe the association between DSH and loneliness and other selected factors. Nearly 8.7% (n = 608) of adolescents reported DSH often/sometimes during the preceding 6 months, with girls (n = 488, 13.4%) reporting DSH almost 4 times than that of boys (n = 120, 3.6%). Nearly 3.2% of the adolescents (girls: n = 149, 4.1%; boys: n = 72, 2.2%) expressed that the statement I feel lonely was very/often true, and 26.4% (girls: n = 1,265, 34.8%; boys: n = 585, 17.4%) expressed that the statement was somewhat/sometimes true. Logistic regression showed that those who reported to be very/often lonely (girls: odds ratio (OR) 4.1; boys: OR 3.2), somewhat/sometimes lonely (girls: OR 2.4; boys: OR 2.4) were dissatisfied with life (girls: OR 3.3; boys: OR 3.3), felt unliked (girls: OR 2.2; boys: OR 6.0) and had moderate self-rated health (girls: OR 2.0; boys: OR 1.7), were more likely to report DSH than those without these feelings. The results show that loneliness is associated with DSH, and that loneliness should be considered as a risk for individual health and well-being.

  17. Associations of deliberate self-harm with loneliness, self-rated health and life satisfaction in adolescence: Northern Finland Birth Cohort 1986 Study

    Directory of Open Access Journals (Sweden)

    Anna Reetta Rönkä

    2013-08-01

    Full Text Available Background. Deliberate self-harm (DSH is an act with a non-fatal outcome in which an individual initiates a behaviour, such as self-cutting or burning, with the intention of inflicting harm on his or her self. Interpersonal difficulties have been shown to be a risk factor for DSH, but the association between subjective experience of loneliness and DSH have rarely been examined. Objective. To examine the frequency of DSH or its ideation and loneliness among 16-year-olds to determine if associations exist between DSH and loneliness, loneliness-related factors, self-rated health and satisfaction with life. Design. The study population (n=7,014 was taken from Northern Finland Birth Cohort 1986 (N=9,432. Cross-tabulations were used to describe the frequency of DSH by factors selected by gender. Logistic regression analysis was used to describe the association between DSH and loneliness and other selected factors. Results. Nearly 8.7% (n=608 of adolescents reported DSH often/sometimes during the preceding 6 months, with girls (n=488, 13.4% reporting DSH almost 4 times than that of boys (n=120, 3.6%. Nearly 3.2% of the adolescents (girls: n=149, 4.1%; boys: n=72, 2.2% expressed that the statement I feel lonely was very/often true, and 26.4% (girls: n=1,265, 34.8%; boys: n=585, 17.4% expressed that the statement was somewhat/sometimes true. Logistic regression showed that those who reported to be very/often lonely (girls: odds ratio (OR 4.1; boys: OR 3.2, somewhat/sometimes lonely (girls: OR 2.4; boys: OR 2.4 were dissatisfied with life (girls: OR 3.3; boys: OR 3.3, felt unliked (girls: OR 2.2; boys: OR 6.0 and had moderate self-rated health (girls: OR 2.0; boys: OR 1.7, were more likely to report DSH than those without these feelings. Conclusion. The results show that loneliness is associated with DSH, and that loneliness should be considered as a risk for individual health and well-being.

  18. A Systematic Review of Social Media Use to Discuss and View Deliberate Self-Harm Acts.

    Science.gov (United States)

    Dyson, Michele P; Hartling, Lisa; Shulhan, Jocelyn; Chisholm, Annabritt; Milne, Andrea; Sundar, Purnima; Scott, Shannon D; Newton, Amanda S

    2016-01-01

    To conduct a systematic review of studies of social media platforms used by young people to discuss and view deliberate self-harm. 11 electronic databases were searched from January 2000 to January 2012 for primary research; in June 2014 an updated search of Medline was conducted. Grey literature sources were also searched. Search results were screened by two reviewers. Data were extracted by one reviewer and verified by another. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Due to heterogeneity in study objectives and outcomes, results were not pooled; a narrative analysis is presented. 26 studies were included. Most were conducted in Canada or the UK (30.8% each), used qualitative designs (42.3%), and evaluated discussion forums (73.1%). Participants were most often aged 19-21 years (69.2%), female (mean 68.6%), and 19.2% had a documented history of depression. The social media platforms evaluated were commonly supportive and provided a sense of community among users. Support included suggestions for formal treatment, advice on stopping self-harming behavior, and encouragement. Harms included normalizing and accepting self-harming behavior; discussion of motivation or triggers, concealment, suicidal ideation or plans; and live depictions of self-harm acts. Although this evidence is limited by its descriptive nature, studies identify beneficial and detrimental effects for young people using social media to discuss and view deliberate self-harm. The connections users make online may be valuable to explore for therapeutic benefit. Prospective, longitudinal investigations are needed to identify short- and long-term potential harms associated with use.

  19. From efficacy to effectiveness: managing organisational change to improve health services for young people with deliberate self harm behaviour.

    Science.gov (United States)

    Tobin, M J; Clarke, A R; Buss, R; Einfeld, S L; Beard, J; Dudley, M; Knowles, M; Dietrich, U

    2001-01-01

    Repeat Deliberate Self Harm is a recognised risk factor for completed suicide and therefore reduction by effective health service response represents a valid contribution to suicide prevention. However, only a small fraction of people with deliberate self harm presentations to general health settings actually reach specialist mental health follow-up appointments. Therefore, even if responses at that point are known to be effective they do not make a significant contribution to reducing repeat self-harm overall. We describe health system organisational change strategies to improve health service engagement for the target group, and present data demonstrating the effectiveness of these strategies.

  20. Predictors of treatment response to an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder.

    Science.gov (United States)

    Gratz, Kim L; Dixon-Gordon, Katherine L; Tull, Matthew T

    2014-01-01

    Despite evidence for the efficacy of several treatments for deliberate self-harm (DSH) within borderline personality disorder (BPD), predictors of response to these treatments remain unknown. This study examined baseline demographic, clinical, and diagnostic predictors of treatment response to an adjunctive emotion regulation group therapy (ERGT) for DSH among women with BPD. A recent RCT provided evidence for the efficacy of this ERGT (relative to a treatment-as-usual only waitlist condition). Participants in this study include the full intent-to-treat sample who began ERGT (across treatment and waitlist conditions; n = 51). Baseline diagnostic and clinical data were collected at the initial assessment, and outcome measures of DSH and self-destructive behaviors, emotion dysregulation/avoidance, and BPD symptoms (among others) were administered at pretreatment, posttreatment, and 3- and 9-months posttreatment. Notably, both demographic variables and characteristics of participants' ongoing therapy in the community had minimal impact on treatment response. However, several indicators of greater severity in domains relevant to this ERGT (i.e., baseline emotion dysregulation and BPD criteria, lifetime and recent DSH, and past-year hospitalization and suicide attempts) predicted better responses during treatment and follow-up across the primary targets of treatment. Likewise, several co-occurring disorders (i.e., social phobia, panic disorder, and a cluster B personality disorder) predicted greater improvements in BPD symptoms during treatment or follow-up. Finally, although co-occurring generalized anxiety disorder, posttraumatic stress disorder, and cluster A and C personality disorders were associated with poorer treatment response during follow-up, most of these effects reflected a lack of continued improvements during this period (vs. worsening of symptoms).

  1. Psychosocial therapy and causes of death after deliberate self-harm

    DEFF Research Database (Denmark)

    Birkbak, J; Stuart, E A; Lind, B D;

    2016-01-01

    .9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.......5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS: Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death...

  2. [Depression, deliberate self-harm and suicidal behaviour in adolescents engaging in risky and pathological internet use].

    Science.gov (United States)

    Fischer, Gloria; Brunner, Romuald; Parzer, Peter; Klug, Katja; Durkee, Tony; Carli, Vladimi; Wasserman, Danuta; Vonderlin, Eva; Resch, Franz; Kaess, Michael

    2012-01-01

    To investigate associations between risky and pathologic internet use with depression, deliberate self-harm and suicidal behaviour among a representative sample of German adolescents. A total of 1,435 students (48% boys, 52% girls) from the area of Heidelberg/Germany were recruited during the SEYLE study, a European school-based intervention study and completed an assessment of different questionnaires, including the Young Diagnostic Questionnaire for the assessment of risky and pathological internet use, the Beck Depression Inventory, the Deliberate Self Harm Inventory, and the Paykel Suicide Scale. 80.7% of the students reported regular, 14.5% risky, and 4.8% pathological internet use. The risky and the pathological internet users showed significant higher rates of depression, deliberate self-harm and suicidal behaviour compared to students with regular internet use. Remarkably, there were no significant differences of levels of depression and suicidal behaviour between risky and pathological users. These results suggest that not only pathologic internet use but also risky internet use is associated with symptoms of depression, self-harm and suicidal behaviour. Therefore, more attention should be paid to adolescents with risky internet use for the early recognition of depression, self-harm and suicidality in adolescence.

  3. The effect of the September 11 terrorist attacks on suicide and deliberate self-harm : A time trend study

    NARCIS (Netherlands)

    De Lange, AW; Neeleman, J

    2004-01-01

    Suicide rates may be affected by world news. Our objective was to investigate the possible impact of the terrorist attacks of September 11, 2001, on suicidal behavior in the Netherlands. There was evidence of an increase in rates of suicide and deliberate self-harm in the weeks immediately following

  4. The effect of the September 11 terrorist attacks on suicide and deliberate self-harm : A time trend study

    NARCIS (Netherlands)

    De Lange, AW; Neeleman, J

    2004-01-01

    Suicide rates may be affected by world news. Our objective was to investigate the possible impact of the terrorist attacks of September 11, 2001, on suicidal behavior in the Netherlands. There was evidence of an increase in rates of suicide and deliberate self-harm in the weeks immediately following

  5. [The evaluation of the stress coping styles and emotional intelligence in psychiatrically treated adolescent patients with deliberate self-harm in relation to chosen clinical features].

    Science.gov (United States)

    Gmitrowicz, Agnieszka; Szczepaniak, Anna; Jabłkowska-Górecka, Karolina

    2012-01-01

    The primary goal of the study was an evaluation of the dominating stress coping styles in adolescent patients with self-harm records, who were psychiatrically treated, taking into account the level of their emotional intelligence vs. the psychiatric diagnosis, the type of motives and decision involved in self-harming and the presence of suicidal attempts (SA) in the past. The secondary goal included an analysis of the correlations between particular stress coping skills and the level of emotional intelligence. The reported studies involved self-harming patients aged of 13-18 years during their psychiatric hospitalisation (n=31). The applied tools included the Coping Inventory for Stressful Situations (CISS) and the Two-Dimensional Inventory of Emotional Intelligence (DINEMO). An evaluation of the correlation between stress coping styles and the levels of emotional intelligence in the studied group and the types of mental disorders did not reveal any significant differences between the evaluated subgroups. Patients, who confirmed an instrumental motive, obtained statistically significantly higher scores on the task-oriented scale vs. those who performed the acts of DSH for reactive or pathological reasons. Taking into consideration the type of decision, involved in self-harming acts, did not show any differences in the stress coping styles of the patients, however, those patients, who had planned an act of DSH, achieved statistically significantly higher scores in the OTHERS scale of the DINEMO. Patients with DSH and with SA in the past (77% studied group), achieved similar results in CISS and DINEMO vs. the self-harming patients without SA in the past. In the study group, one statistically significant correlation was demonstrated between CISS--the avoidance-oriented style--and the I in DINEMO. 1. Patients with DSH records and without SA constitute a fairly uniform group with regards to stress coping styles, taking into account the type of psychic disorders and the

  6. Incidence and Risk Factors for Deliberate Self-harm, Mental Illness, and Suicide Following Bariatric Surgery: A State-wide Population-based Linked-data Cohort Study.

    Science.gov (United States)

    Morgan, David J R; Ho, Kwok M

    2017-02-01

    Assess the incidence and determinants of hospitalization for deliberate self-harm and mental health disorders, and suicide after bariatric surgery. Limited recent literature suggests an increase in deliberate self-harm following bariatric surgery. A state-wide, population-based, self-matched, longitudinal cohort study over a 5-year period between 2007 and 2011. Utilizing the Western Australian Department of Health Data Linkage Unit records, all patients undergoing bariatric surgery (n = 12062) in Western Australia were followed for an average 30.4 months preoperatively and 40.6 months postoperatively. There were 110 patients (0.9%) hospitalized for deliberate self-harm, which was higher than the general population [incidence rate ratio (IRR) 1.47, 95% confidence interval (CI) 1.11-1.94, P = 0.005]. Compared with before surgery, there was no significant increase in deliberate self-harm hospitalizations (IRR 0.79, 95% CI 0.54-1.16; P = 0.206) and a reduction in overall mental illness related hospitalizations (IRR 0.76, 95% CI 0.63-0.91; P = 0.002) after surgery. Younger age, no private-health insurance cover, a history of hospitalizations due to depression before surgery, and gastrointestinal complications after surgery were predictors for deliberate self-harm hospitalizations after bariatric surgery. Three suicides occurred during the follow-up period, a rate comparable to the general population during the same time period (IRR 0.61, 95% CI 0.11-2.27, P = 0.444). Hospitalization for deliberate self-harm in bariatric patients was more common than the general population, but an increased incidence of deliberate self-harm after bariatric surgery was not observed. Hospitalization for depression before surgery and major postoperative gastrointestinal complications after bariatric surgery are potentially modifiable risk factors for deliberate self-harm after bariatric surgery.

  7. Identifying the Risk of Deliberate Self-Harm among Young Prisoners by Means of Coping Typologies

    Science.gov (United States)

    Kirchner, Teresa; Forns, Maria; Mohino, Susana

    2008-01-01

    Self-harming behavior during incarceration has been a topic of increasing attention in recent years. Some authors attribute these episodes to the high level of stress that imprisonment generates coupled with a low quality of coping strategies employed by inmates. The main aim of this study was to identify, by means of coping typologies, prisoners…

  8. Self-Harm and Suicidal Behaviors in Hong Kong Adolescents: Prevalence and Psychosocial Correlates

    Directory of Open Access Journals (Sweden)

    Daniel T. L. Shek

    2012-01-01

    Full Text Available The present paper examined the prevalence and psychosocial correlates of adolescent deliberate self-harm (DSH and suicidal behavior in a representative sample of 3,328 secondary school students in Hong Kong. With reference to the previous year, 32.7% of the students reported at least one form of DSH, 13.7% of the respondents had suicide thoughts, 4.9% devised specific suicidal plans, and 4.7% had actually attempted suicide. Adolescent girls had significantly higher rates of DSH and suicidal behavior than did adolescent boys. Having remarried parents was related to an increased likelihood of DSH and suicide. While high levels of family functioning, overall positive youth development, and academic and school performance predicted low rates of DSH and suicidal behavior, cognitive and behavioral competencies were unexpectedly found to be positively associated with DSH and suicidal behavior. Theoretical and practical implications of the findings are discussed.

  9. Adolescents' Deliberate Self-Harm, Interpersonal Stress, and the Moderating Effects of Self-Regulation: A Two-Wave Longitudinal Analysis

    Science.gov (United States)

    Jutengren, Goran; Kerr, Margaret; Stattin, Hakan

    2011-01-01

    The predictive effects of peer victimization and harsh parenting on deliberate self-harm were examined. As derived from the experiential avoidance model, the study also tested whether these links were moderated by individual self-regulation approaches. Data were collected at two points in time from 880 junior high school students (mean age =…

  10. Parents of young people with self-harm or suicidal behaviour who seek help - a psychosocial profile.

    LENUS (Irish Health Repository)

    Morgan, Sophia

    2013-04-23

    Deliberate Self-Harm (DSH) is a common problem among children and adolescents in clinical and community populations, and there is a considerable amount of literature investigating factors associated with DSH risk and the effects of DSH on the child. However, there is a dearth of research examining the impact of DSH on parents, and there are few support programmes targeted at this population. This cross-sectional study examines the profile of a sample of parents of young people with DSH who participated in a support programme (Supporting Parents and Carers of young people with self-harm: the SPACE programme), with the goal of investigating pre-test parental well-being, family communication, parental satisfaction, perceived parental social support, and child strengths and difficulties.

  11. Suicide in rural central India: Profile of attempters of deliberate self harm presenting to padhar hospital in Madhya Pradesh

    Directory of Open Access Journals (Sweden)

    Johann Alex Ebenezer

    2016-01-01

    Full Text Available Background: Suicide is a significant public health issue. India currently has the largest number of suicides in the world and has a disproportionate number of youth suicides including young women. The studies on patterns of suicide in rural central India are sparse, particularly among tribal communities. Aims: The aim of this study is to describe the profile of suicide attempters presenting to a secondary-level hospital in rural central India and identify areas for potential future research toward preventive strategies. Materials and Methods: A retrospective chart review was carried out of eighty patients who were admitted with presenting complaints of deliberate self-harm and survived until psychiatric consultation. Descriptive statistics was employed to generate the results. Results and Conclusions: 86% of the attempts were isolated impulsive attempts following triggers, the most common of which was interpersonal disputes (71%. Only 67% of patients had a mental health condition, the most common syndrome being alcohol use disorder, followed by depression, and personality disorders. Although 45% of attempters had background interpersonal conflicts, only 5% reported financial stressors as contributory. Psychosocial stressors, especially interpersonal conflicts within the family, appear to be at least as important factors as mental illnesses in contributing to suicide attempts in the area.

  12. Deliberate Self-Harm and the Elderly: A Volatile Combination—An Overview from the Plastic Surgery Perspective

    Directory of Open Access Journals (Sweden)

    J. Packer

    2012-01-01

    Full Text Available Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80% of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90% were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life.

  13. Helping Self-Harming Students

    Science.gov (United States)

    Selekman, Matthew D.

    2009-01-01

    Approximately 14 to 17 percent of adolescents today self-harm, deliberately cutting, burning, or bruising themselves. Most self-harming adolescents use the behavior as a coping strategy to get immediate relief from emotional distress or other stressors in their lives. Stressors include fitting in with peers, activity and homework overload, fears…

  14. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Lind, Bertel Dam; Stuart, Elizabeth A.

    2015-01-01

    score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. FINDINGS: 5678 recipients of psychosocial therapy (followed up for 42·828 person...... Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark....

  15. Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm

    Directory of Open Access Journals (Sweden)

    Richard Tanner

    2014-01-01

    Full Text Available Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses (n=49 were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, P<0.001. The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, P<0.001.

  16. Associations of deliberate self-harm with loneliness, self-rated health and life satisfaction in adolescence: Northern Finland Birth Cohort 1986 Study

    National Research Council Canada - National Science Library

    Rönkä, Anna Reetta; Taanila, Anja; Koiranen, Markku; Sunnari, Vappu; Rautio, Arja

    2013-01-01

    .... To examine the frequency of DSH or its ideation and loneliness among 16-year-olds to determine if associations exist between DSH and loneliness, loneliness-related factors, self-rated health and satisfaction with life...

  17. Psychometric analysis of the self-harm inventory using Rasch modelling.

    Science.gov (United States)

    Latimer, Shane; Covic, Tanya; Cumming, Steven R; Tennant, Alan

    2009-08-19

    Deliberate Self-Harm (DSH) is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI) is a widely used measure of DSH in clinical populations (mental and physical health) and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts). The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD) using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples. The SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30). External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21) to a sub-sample (n = 221). Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score. The SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related. The recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.

  18. Psychometric analysis of the Self-Harm Inventory using Rasch modelling

    Directory of Open Access Journals (Sweden)

    Cumming Steven R

    2009-08-01

    Full Text Available Abstract Background Deliberate Self-Harm (DSH is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI is a widely used measure of DSH in clinical populations (mental and physical health and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts. The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples. Methods The SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30. External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21 to a sub-sample (n = 221. Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score. Results The SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related. Conclusion The recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.

  19. Self-harm by severe glossal injury in schizophrenia

    OpenAIRE

    Bhat, Pookala S.; Pardal, P.K.; M Diwakar

    2011-01-01

    Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia. Treatment and management issues are di...

  20. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

    DEFF Research Database (Denmark)

    Lind, Bertel; Erlangsen, Anette; Stuart, Elisabeth

    2014-01-01

    score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. Findings 5678 recipients of psychosocial therapy (followed up for 42·828 person...... Insurance Foundation; the Research Council of Psychiatry, Region of Southern Denmark; the Research Council of Psychiatry, Capital Region of Denmark; and the Strategic Research Grant from Health Sciences, Capital Region of Denmark....

  1. Self-harm by severe glossal injury in schizophrenia

    Directory of Open Access Journals (Sweden)

    Pookala S Bhat

    2011-01-01

    Full Text Available Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia.Treatment and management issues are discussed.

  2. Alcohol and self-harm in Anuradhapura

    DEFF Research Database (Denmark)

    Sørensen, Jane Brandt; Jayasena, Chandima; Agampodi, Thilini Chanchala

    drinking to social, occasional and even first time drinking. All women had alcohol indirectly involved in their case of self-harm through the negative effects of a relative’s drinking. Findings indicate that two categories of the alcohol-self-harm complex exist, with different characteristics for men...... the personal network of the drinker and lead to secondary traumatization. This can appear as emotional distress, financial difficulties and lead to domestic violence and in some cases self-harm and suicide. This interplay between alcohol and self-harm was investigated in individuals, families and communities...

  3. Reprint of: bullying victimisation, self harm and associated factors in Irish adolescent boys.

    Science.gov (United States)

    McMahon, Elaine M; Reulbach, Udo; Keeley, Helen; Perry, Ivan J; Arensman, Ella

    2012-02-01

    School bullying victimisation is associated with poor mental health and self harm. However, little is known about the lifestyle factors and negative life events associated with victimisation, or the factors associated with self harm among boys who experience bullying. The objectives of the study were to examine the prevalence of bullying in Irish adolescent boys, the association between bullying and a broad range of risk factors among boys, and factors associated with self harm among bullied boys and their non-bullied peers. Analyses were based on the data of the Irish centre of the Child and Adolescent Self Harm in Europe (CASE) study (boys n = 1870). Information was obtained on demographic factors, school bullying, deliberate self harm and psychological and lifestyle factors including negative life events. In total 363 boys (19.4%) reported having been a victim of school bullying at some point in their lives. The odds ratio of lifetime self harm was four times higher for boys who had been bullied than those without this experience. The factors that remained in the multivariate logistic regression model for lifetime history of bullying victimisation among boys were serious physical abuse and self esteem. Factors associated with self harm among bullied boys included psychological factors, problems with schoolwork, worries about sexual orientation and physical abuse, while family support was protective against self harm. Our findings highlight the mental health problems associated with victimisation, underlining the importance of anti-bullying policies in schools. Factors associated with self harm among boys who have been bullied should be taken into account in the identification of boys at risk of self harm.

  4. Bullying victimisation, self harm and associated factors in Irish adolescent boys.

    Science.gov (United States)

    McMahon, Elaine M; Reulbach, Udo; Keeley, Helen; Perry, Ivan J; Arensman, Ella

    2010-10-01

    School bullying victimisation is associated with poor mental health and self harm. However, little is known about the lifestyle factors and negative life events associated with victimisation, or the factors associated with self harm among boys who experience bullying. The objectives of the study were to examine the prevalence of bullying in Irish adolescent boys, the association between bullying and a broad range of risk factors among boys, and factors associated with self harm among bullied boys and their non-bullied peers. Analyses were based on the data of the Irish centre of the Child and Adolescent Self Harm in Europe (CASE) study (boys n = 1870). Information was obtained on demographic factors, school bullying, deliberate self harm and psychological and lifestyle factors including negative life events. In total 363 boys (19.4%) reported having been a victim of school bullying at some point in their lives. The odds ratio of lifetime self harm was four times higher for boys who had been bullied than those without this experience. The factors that remained in the multivariate logistic regression model for lifetime history of bullying victimisation among boys were serious physical abuse and self esteem. Factors associated with self harm among bullied boys included psychological factors, problems with schoolwork, worries about sexual orientation and physical abuse, while family support was protective against self harm. Our findings highlight the mental health problems associated with victimisation, underlining the importance of anti-bullying policies in schools. Factors associated with self harm among boys who have been bullied should be taken into account in the identification of boys at risk of self harm.

  5. Self-harm reasons, goal achievement, and prediction of future self-harm intent.

    Science.gov (United States)

    Lewis, Stephen P; Santor, Darcy A

    2010-05-01

    Self-harm may have several reasons, and these reasons may have corresponding implied goals. The current study examined reasons for self-harm and whether the a priori goals intended by these reasons were achieved. Fifty-seven individuals with a history of self-harm were recruited online and volunteered their time to complete a series of online questionnaires assessing past self-harm frequency, self-harm reasons, whether the goal associated with these reasons was achieved, and future self-harm intent. Reasons to reduce tension and dissociation associated with more past self-harm, a higher intent to self-harm again, and it was reported that the goals associated with reasons were achieved (i.e., these internal states were extinguished). Achievement of these goals (i.e., reported reductions in tension and dissociation) mediated the relation between corresponding self-harm reasons and intent to self-harm in the future. Findings support the view that self-harm is a maladaptive coping strategy and the reinforcement component of the experiential avoidance model of self-harm. Results have clinical implications and heuristic value for future research, which are discussed.

  6. Self-harm and homeless adults.

    Science.gov (United States)

    Pluck, Graham; Lee, Kwang-Hyuk; Parks, Randolph W

    2013-01-01

    Homelessness is associated with an increased incidence of mental illness and risk of self-harm, including suicide. To assess the prevalence of self-harm (including nonsuicidal self-injury and attempted suicide) among a UK sample of homeless adults and to compare demographic, clinical, and homeless-related variables to determine which are linked to self-harm in this population. A sample of 80 homeless adults were interviewed regarding history of self-harm, mental health history, demographic, and homeless-related information. Sixty-eight percent of the sample reported past acts of self-harm. Those with histories of self-harm started using significantly more substances since becoming homeless and were younger when they first became homeless. They were also significantly more likely to have a past psychiatric admission and thoughts of self-harm in the past year. Self-harm is common among homeless adults and linked to long-term and enduring social and mental health concerns.

  7. Practitioner Review: Self-Harm in Adolescents

    Science.gov (United States)

    Ougrin, Dennis; Tranah, Troy; Leigh, Eleanor; Taylor, Lucy; Asarnow, Joan Rosenbaum

    2012-01-01

    Background: Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic. Aims: The main aim of this article is to review randomised controlled…

  8. Alcohol and self-harm in Anuradhapura

    DEFF Research Database (Denmark)

    Sørensen, Jane Brandt; Jayasena, Chandima; Agampodi, Thilini Chanchala

    in the Anuradhapura area. Objectives: The objective of this study was to explore alcohol’s role in cases of self-harm in individuals, families and communities. Methods: A qualitative, exploratory study, was conducted utilizing: (i) serial, narrative, life-story interviews with 19 individuals (12 men and 7 women...... between 20-69 years of age) who self-harmed and where alcohol was involved, and with 22 of their relatives; (ii) 10 focus-group discussions with community members; and (iii) observations in villages and alcohol-selling centers. Results: Only men drank alcohol before self-harm, spanning from heavy, daily...... drinking to social, occasional and even first time drinking. All women had alcohol indirectly involved in their case of self-harm through the negative effects of a relative’s drinking. Findings indicate that two categories of the alcohol-self-harm complex exist, with different characteristics for men...

  9. prevalence of major depression in deliberate self~harm individuals ...

    African Journals Online (AJOL)

    2002-05-01

    May 1, 2002 ... and without major depression related to age, education, life events and number of previous attempts. ... Malaysia, Maniam( 1 0) found the ingestion ofagricultural ... which is a public hospital and two private hospitals, Baines.

  10. Digital Self-Harm Among Adolescents.

    Science.gov (United States)

    Patchin, Justin W; Hinduja, Sameer

    2017-09-18

    Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. "Digital self-harm" is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents. Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12-17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm. About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms. Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  11. [Self-harm in fiction literature].

    Science.gov (United States)

    Skårderud, Finn

    2009-04-16

    European literature contains fictional descriptions of self-harm and self-punishment over a time span of almost 2 500 years. This article presents such descriptions, from Sofocles' tragedy about King Oedipus to contemporary literature. Particular interest is dedicated to the Austrian Nobel prize laureate Elfriede Jelinek and the Norwegian author Karl Ove Knausgård. In Jelinek's fictional universe, self-harm is particularly related to the topic of autonomy in a family context; while Knausgård describes the role of shame in triggering and sustaining self-harming behaviour.

  12. Caring for children who self-harm.

    Science.gov (United States)

    2017-05-09

    Aim [Figure: see text] To co-produce, with children and young people (CYP) and registered children's nurses, a digital education programme to improve nurses' knowledge and confidence in the care of CYP injured through self-harm.

  13. Self-harm in young offenders.

    Science.gov (United States)

    Borschmann, Rohan; Coffey, Carolyn; Moran, Paul; Hearps, Stephen; Degenhardt, Louisa; Kinner, Stuart A; Patton, George

    2014-12-01

    The prevalence and correlates of self-harm and suicidal behavior in 515 young offenders (mean age 17.3 years, SD = 1.7) serving community-based orders (CBOs; n = 242) or custodial sentences (n = 273) in Victoria, Australia, are described. Results from structured interviews showed that 83 (16.1%) participants reported self-harming in the previous 6 months, and this was more common among those serving custodial sentences than those serving CBOs (19.4% vs. 12.4%; OR 3.10, 95% CI: 1.74-5.55). Multiple incidents were more common in females and 24% (95% CI: 19-39) of participants who had self-harmed reported having done so with suicidal intent. Self-harm was associated with recent bullying victimization, expulsion from school, past year violent victimization, cannabis dependence, and risk-taking behavior in the preceding year. The epidemiological profile of self-harm in this population appears to be distinct from that seen in the general population. Young offenders who self-harm are a vulnerable group with high rates of psychiatric morbidity, substance misuse problems, and social risk factors. They may benefit from targeted psychological interventions designed specifically to address impulsivity, delivered both within-and during the transition from-the youth justice system.

  14. Self-harm and the positive risk taking approach. Can being able to think about the possibility of harm reduce the frequency of actual harm?

    Science.gov (United States)

    Birch, Sarah; Cole, Samantha; Hunt, Kate; Edwards, Blossom; Reaney, Emma

    2011-06-01

    This article presents the results of an audit of self-harming across three women's units over a period of 6 years. All three units use a positive risk-taking approach to self-harm whereby the risk that this behaviour presents is considered in an effort to reduce actual harm. To explore patterns and frequency of self-harm across three units within a women's service. Incidents of deliberate self-harm were collected from incident forms completed across the units from 2004 to 2009. Frequency graphs show a reduction of self-harm over the course of admission, and parametric analyses show that there was a significant difference in the frequency of self-harm during the first and last 3 months of admission. These results are discussed within a psychoanalytical framework, with particular reference to relational security and the value of positive risk-taking.

  15. Pregabalin-induced self-harm behavior

    Directory of Open Access Journals (Sweden)

    Vishal R Tandon

    2013-01-01

    Full Text Available Antiepileptic Drugs (AEDs such as lamotrigine, gabapentin, and oxcarbazepine may have the potential to increase the risk of self-harm or suicidal behavior. We report a case of pregabalin-induced self-inflicted multiple injuries on forearm after its continuous use. This is an interesting adverse drug reaction (ADR that is rare, unusual, and potentially serious.

  16. Acute IPPS - Disproportionate Share Hospital - DSH

    Data.gov (United States)

    U.S. Department of Health & Human Services — There are two methods for a hospital to qualify for the Medicare DSH adjustment. The primary method is for a hospital to qualify based on a statutory formula that...

  17. Nurses' attitudes towards patients hospitalised for self-harm.

    Science.gov (United States)

    Hodgson, Kimberley

    2016-03-30

    Self-harm is a public health issue that accounts for thousands of presentations at hospital each year. Self-harm commonly involves self-injury by cutting, burning or poisoning. The incidence of self-harm is increasing in the UK, particularly in young people. Research suggests that people who self-harm experience negative attitudes from healthcare staff, including nurses, on presentation to healthcare services. This is an ethical issue in nursing practice that has implications for the quality of care provided. Nurses with a lack of mental health training provide care for patients who self-harm in emergency departments and acute medical settings. This article presents a literature review exploring the factors affecting nurses' attitudes towards patients hospitalised for self-harm and makes recommendations for improving practice. The article identifies requirements for nurse education and training in mental health and effective provision of care for patients who self-harm and present at the emergency department.

  18. Danish emergency nurses' attitudes towards self-harm - a cross-sectional study

    DEFF Research Database (Denmark)

    Perbøll, Penille Wimmer; Hammer, N. M.; Østergaard, Birte

    2015-01-01

    %. Results show that the emergency nurses generally held positive attitudes toward patients with acetaminophen poisoning. Nurses with longer ED experience held more positive attitudes, and women scored significantly higher than men on the whole scale. Only 19% of the respondents had received education......AIM: The aim of this study was to examine Danish emergency nurses' attitudes toward people hospitalized after an acetaminophen poisoning. Furthermore, the study examined the relationship between attitudes and factors such as age, gender, and education on self-harm. METHODS: A cross-sectional design...... was applied. Nurses from seven emergency departments (EDs) in a region in Denmark were asked to complete the Danish version of Attitudes towards Deliberate Self-Harm Questionnaire (ADSHQ). RESULTS: Of the 254 eligible nurses working in the ED, 122 returned the questionnaires, leaving the response rate at 48...

  19. The surgeon and self-harm: at the cutting edge.

    Science.gov (United States)

    Kinahan, James C; MacHale, Siobhan

    2014-12-01

    Surgeons frequently treat the consequences of self-harm. Self-harm is a common problem and presentations to Irish hospitals are increasing. It increases the risk of suicide and is associated with long term morbidity. Appropriate management can improve the prognosis. Surgeons require a number of skills to appropriately manage patients who self-harm. In this review we outline those skills including diagnosis, communication, capacity and risk assessment.

  20. Primary care management of patients who self-harm.

    Science.gov (United States)

    Allan, Charlotte L; Behrman, Sophie; Ebmeier, Klaus P

    2012-05-01

    Self-harm is best defined as 'any act of self-poisoning or self-injury carried out by an individual irrespective of motivation'. With a 10.5% lifetime risk, self-reported self-harm is common in the community. Self-harm can occur at any age but is most common in young people. Prior self-harm is the key risk factor both for repeated self-harm and also for subsequent suicide. The presence of depressive symptoms predicts repeated self-harm, as does any history of psychiatric illness. Assessment of self-harm (actual or planned) should include: details of preplanning; final acts; the event itself; what happened afterwards; as well as broader psychosocial risk factors. Patients should be asked to reflect on the episode to consider whether they regret it, or whether they are likely to repeat it. Patients should be screened for depression, anxiety, psychosis and history of self-harm. Physical illness and substance misuse increase risk. Referral to secondary care community mental health teams should be considered for patients who present in primary care with a history of self-harm and a risk of repetition. Patients with continuing thoughts or serious intent of self-harm, where supportive or protective factors cannot be identified, may need urgent referral to secondary care. Prediction of further episodes of self-harm is difficult. Some clinicians may find the use of standardised rating scales, such as the SAD PERSONS scale, a useful way to identify patients who warrant referral and further assessment. The GP should provide long-term continuity of care, and maintain a holistic awareness of a patient's life events enabling discussion of the patient's emotional problems at an early stage with the aim of intervening before a crisis.

  1. Self-Harm and Conventional Gender Roles in Women

    Science.gov (United States)

    Straiton, Melanie L.; Hjelmeland, Heidi; Grimholt, Tine K.; Dieserud, Gudrun

    2013-01-01

    A total of thirty-two women admitted to a general hospital for medical treatment after self-harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self-harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women.…

  2. Nurses’ attitudes towards self-harm: a literature review

    NARCIS (Netherlands)

    Karman, P.; Kool, Nienke; Poslawsky, I.E.; Meijel, Berno van

    2014-01-01

    Self-harm is a growing health problem. Nurses in a variety of healthcare settings play a central role in the care of people who self-harm. Their professional attitudes towards these people are essential for high-quality care. This review aims to develop insight into nurses’ attitudes towards self-ha

  3. HDU Deep Space Habitat (DSH) Overview

    Science.gov (United States)

    Kennedy, Kriss J.

    2011-01-01

    This paper gives an overview of the National Aeronautics and Space Administration (NASA) led multi-center Habitat Demonstration Unit (HDU) project Deep Space Habitat (DSH) analog that will be field-tested during the 2011 Desert Research and Technologies Studies (D-RATS) field tests. The HDU project is a technology pull project that integrates technologies and innovations from multiple NASA centers. This project will repurpose the HDU Pressurized Excursion Module (PEM) that was field tested in the 2010 D-RATS, adding habitation functionality to the prototype unit. The 2010 configuration of the HDU-PEM consisted of a lunar surface laboratory module that was used to bring over 20 habitation-related technologies together in a single platform that could be tested as an advanced habitation analog in the context of mission architectures and surface operations. The 2011 HDU-DSH configuration will build upon the PEM work, and emphasize validity of crew operations (habitation and living, etc), EVA operations, mission operations, logistics operations, and science operations that might be required in a deep space context for Near Earth Object (NEO) exploration mission architectures. The HDU project consists of a multi-center team brought together in a skunkworks approach to quickly build and validate hardware in analog environments. The HDU project is part of the strategic plan from the Exploration Systems Mission Directorate (ESMD) Directorate Integration Office (DIO) and the Exploration Mission Systems Office (EMSO) to test destination elements in analog environments. The 2011 analog field test will include Multi Mission Space Exploration Vehicles (MMSEV) and the DSH among other demonstration elements to be brought together in a mission architecture context. This paper will describe overall objectives, various habitat configurations, strategic plan, and technology integration as it pertains to the 2011 field tests.

  4. Mental health nurses' attitudes toward self-harm: Curricular implications

    Directory of Open Access Journals (Sweden)

    David G. Shaw

    2016-12-01

    Conclusion: The FASH Model may inform future curriculum innovation. Adopting a holistic approach to education of nurses about self-harm may assist in developing attitudes and skills to make care provision more effective in secure mental health settings.

  5. Pharmacological interventions for self-harm in adults.

    Science.gov (United States)

    Hawton, Keith; Witt, Katrina G; Taylor Salisbury, Tatiana L; Arensman, Ella; Gunnell, David; Hazell, Philip; Townsend, Ellen; van Heeringen, Kees

    2015-07-06

    Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and strongly associated with suicide. This is an update of a broader Cochrane review on psychosocial and pharmacological treatments for deliberate SH, first published in 1998 and previously updated in 1999. We have now divided the review into three separate reviews. This review is focused on pharmacological interventions in adults who self harm. To identify all randomised controlled trials of pharmacological agents or natural products for SH in adults, and to conduct meta-analyses (where possible) to compare the effects of specific treatments with comparison types of treatment (e.g., placebo/alternative pharmacological treatment) for SH patients. For this update the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN) Trials Search Co-ordinator searched the CCDAN Specialised Register (September 2014). Additional searches of MEDLINE, EMBASE, PsycINFO, and CENTRAL were conducted to October 2013. We included randomised controlled trials comparing pharmacological treatments or natural products with placebo/alternative pharmacological treatment in individuals with a recent (within six months) episode of SH resulting in presentation to clinical services. We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean difference (MD) and 95% CI. Meta-analysis was only possible for one intervention (i.e. newer generation antidepressants) on repetition of SH at last follow-up. For this analysis, we pooled data using a random-effects model. The overall quality of evidence for the primary outcome was appraised for each intervention using the GRADE approach. We included seven trials with a total of 546 patients. The largest trial included 167 participants. We found no significant treatment effect on repetition of SH for newer

  6. Suicidality and self-harm among sexual minorities in Japan.

    Science.gov (United States)

    DiStefano, Anthony S

    2008-10-01

    In this study, I used ethnographic methods to examine suicidality and nonsuicidal self-harm among gay, lesbian, bisexual, and transgender persons in Japan. Participants (N = 84) indicated that suicidality and self-harm are serious problems among sexual minorities and tend to be driven by (a) a homophobic/transphobic environment and the negative consequences of sexual minorities either disclosing their true selves or remaining hidden and silent within such an environment; (b) various antecedents to poor mental health; and (c) factors not directly related to being a sexual minority, particularly unemployment and debt in the context of a protracted national economic decline in Japan prior to the study period of 2003--2004. Participants also perceived a potentially higher risk for suicidality and self-harm among sexual minority adolescents and persons in their early 20s; those who work in the entertainment, bar, or sex industries; and survivors of violence perpetrated by intimate partners or family members.

  7. First Episode of Self-Harm in Older Age : A Report From the 10-Year Prospective Manchester Self-Harm Project

    NARCIS (Netherlands)

    Voshaar, Richard C. Oude; Cooper, Jayne; Murphy, Elizabeth; Steeg, Sarah; Kapur, Nay; Purandare, Nitin B.

    2011-01-01

    Objective: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm

  8. First episode of self-harm in older age: a report from the 10-year prospective Manchester Self-Harm project

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Cooper, J.; Murphy, E.; Steeg, S.; Kapur, N.; Purandare, N.B.

    2011-01-01

    OBJECTIVE: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm

  9. Foreign bodies in the abdomen: self-harm and personality disorders.

    Science.gov (United States)

    Dunphy, Louise; Syed, Farah; Raja, Mazhar

    2015-08-05

    A 52-year-old woman presented to the accident and emergency department 5 h after deliberately stabbing herself with two pens through her midline laparotomy scar. Her medical history included an emotionally unstable (borderline) personality disorder and she was currently an inpatient in a psychiatric hospital. She had multiple accident and emergency attendances with previous episodes of self-harm. Clinical examination revealed evidence of trauma to her midline laparotomy scar with congealed blood covering the puncture site. Her abdomen was soft and non-tender on palpation. A chest radiograph revealed no air beneath her diaphragm and her abdominal radiograph identified a radiopacity in her upper right abdomen and dilated loops of small bowel. CT of the abdomen and pelvis confirmed two pens, with the lower pen tip reaching the pancreas. A midline laparotomy was performed and both foreign bodies were extricated unremarkably. The patient's postoperative recovery was uneventful. The second case involves a 22-year-old woman, a psychiatric hospital resident, presenting to the accident and emergency department 5 h after deliberately inserting the metal nib and inner plastic ink containing tube of a pen through her umbilicus. Her medical history included an emotionally unstable (borderline) personality disorder and paranoid schizophrenia. She had multiple accident and emergency department attendances with previous episodes of self-harm. Clinical examination revealed a soft, non-tender abdomen. Her chest radiograph was unremarkable and her abdominal radiograph identified a radiopaque foreign body at the right upper quadrant of the abdomen. CT of the abdomen and pelvis confirmed a metallic foreign body in the small bowel mesentery. An exploratory laparotomy converted to a midline laparotomy was performed and the foreign body was extricated. The patient's postoperative recovery was uneventful.

  10. Self-harm and attempted suicide within inpatient psychiatric services: a review of the literature.

    Science.gov (United States)

    James, Karen; Stewart, Duncan; Bowers, Len

    2012-08-01

    Self harm is a major public health concern, yet there are considerable challenges in providing support for those who self harm within psychiatric inpatient services. This paper presents the first review of research into self harm within inpatient settings. Searches of the main electronic databases were conducted using key words for self harm and inpatient care. There was substantial variation in the rates of self-harm and attempted suicide between studies, but rates were highest on forensic wards. There was no evidence of differences in prevalence of self-harm between men and women; women, however, were at increased risk of attempting suicide. People were more likely to self-harm in private areas of the ward and in the evening hours, and often self-harmed in response to psychological distress, or elements of nursing care that restricted their freedom. Wards used a variety of strategies to prevent self-harm; however, there is little research into their effectiveness.

  11. Does clinical management improve outcomes following self-harm? Results from the multicentre study of self-harm in England.

    Directory of Open Access Journals (Sweden)

    Nav Kapur

    Full Text Available BACKGROUND: Evidence to guide clinical management of self-harm is sparse, trials have recruited selected samples, and psychological treatments that are suggested in guidelines may not be available in routine practice. AIMS: To examine how the management that patients receive in hospital relates to subsequent outcome. METHODS: We identified episodes of self-harm presenting to three UK centres (Derby, Manchester, Oxford over a 10 year period (2000 to 2009. We used established data collection systems to investigate the relationship between four aspects of management (psychosocial assessment, medical admission, psychiatric admission, referral for specialist mental health follow up and repetition of self-harm within 12 months, adjusted for differences in baseline demographic and clinical characteristics. RESULTS: 35,938 individuals presented with self-harm during the study period. In two of the three centres, receiving a psychosocial assessment was associated with a 40% lower risk of repetition, Hazard Ratios (95% CIs: Centre A 0.99 (0.90-1.09; Centre B 0.59 (0.48-0.74; Centre C 0.59 (0.52-0.68. There was little indication that the apparent protective effects were mediated through referral and follow up arrangements. The association between psychosocial assessment and a reduced risk of repetition appeared to be least evident in those from the most deprived areas. CONCLUSION: These findings add to the growing body of evidence that thorough assessment is central to the management of self-harm, but further work is needed to elucidate the possible mechanisms and explore the effects in different clinical subgroups.

  12. Trends in Self-Harm in Kuala Lumpur, 2005-2011.

    Science.gov (United States)

    Armitage, Christopher J; Abdul Rahim, Wirda; Rowe, Richard; O'Connor, Rory C

    2016-01-01

    Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the 7-year period, with a significant peak in 2007-2009. The average rate of self-harm (7.7 per 100,000 population per year) was similar or lower than the rate of suicide (6-8 or 8-13 per 100,000) suggesting that genuine cases of self-harm are often attributed to other causes. Nevertheless, over-representation of young people, women and Indians suggest areas in which resources to prevent self-harm might usefully be targeted. Estimating rates of self-harm are fraught with problems and further research is needed to understand the economic and cultural barriers around seeking treatment for self-harm, reporting self-harm and classifying self-harm.

  13. Self harm and attempted suicide in adults: 10 practical questions and answers for emergency department staff

    OpenAIRE

    Mitchell, A.J.; Dennis, M.

    2006-01-01

    Self harm is a complex behaviour that can be best thought of as a maladaptive response to acute and chronic stress, often but not exclusively linked with thoughts of dying. Patients presenting with self harm usually have current psychosocial difficulties, are likely to be suffering from mental health problems, and are at significant risk of further self harm and suicide. Recent guidelines suggest that all self harm attendees should receive an initial risk assessment at triage in the emergency...

  14. Explaining Self-Harm: Youth Cybertalk and Marginalized Sexualities and Genders

    Science.gov (United States)

    McDermott, Elizabeth; Roen, Katrina; Piela, Anna

    2015-01-01

    This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people's cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found…

  15. Differential Profiles of Risk of Self-Harm among Clinically Referred Primary School Aged Children

    Science.gov (United States)

    Angelkovska, Anne; Houghton, Stephen; Hopkins, Sarah

    2012-01-01

    Risk of self-harm among clinic referred children aged 6- to 12-years-old was investigated using the recently developed Self-Harm Risk Assessment for Children (SHRAC) instrument which comprises six factors: Affect traits; verbalizing of self-harm; socialization; dissociation; self-directing; and self-appraisal. The SHRAC was completed by the…

  16. Explaining Self-Harm: Youth Cybertalk and Marginalized Sexualities and Genders

    Science.gov (United States)

    McDermott, Elizabeth; Roen, Katrina; Piela, Anna

    2015-01-01

    This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people's cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found…

  17. Managing young people with self-harming or suicidal behaviour.

    Science.gov (United States)

    Fisher, Gemma

    2016-02-01

    This literature review aimed to determine the risk factors being used to identify children and young people who are at increased risk of engaging in self-harm and suicidal behaviour, so that optimal care can be provided for this patient group in children's medical ward settings. The two main themes that emerged were mental and neurodevelopmental disorders, and external factors. Management strategies to aid healthcare professionals in caring for this patient group were also identified. The review concludes by highlighting the need to provide healthcare professionals with continuing education about the mental health problems of children and young people, including risk factors and management strategies.

  18. Getting out of (self-) harm's way: A study of factors associated with self-harm among asylum seekers in Australian immigration detention.

    Science.gov (United States)

    Hedrick, Kyli

    2017-07-01

    The monitoring of self-harm among asylum seekers in Australian immigration detention has not occurred routinely or transparently. Thus whilst concerns regarding rates of self-harm among asylum seekers have been frequently raised, a paucity of systematic information regarding key factors associated with self-harm among asylum seekers exists. The present study was designed therefore to fill a number of gaps in government monitoring by examining the government's own archived self-harm data. Via a descriptive analysis of self-harm incident reports from all operational Australian immigration detention facilities over a 20-month period to May 2011, obtained under Freedom of Information, the present study identified that 959 incidents of self-harm occurred during this period. A gender bias towards men was also found. In addition to this, 10 different methods of self-harm were identified, the four most common being: cutting (47%), attempted hanging (19%), head hitting (12%) and self-poisoning by medication (6%). Seven different precipitating factors for self-harm were also identified, the four most common were: detention conditions (39%), processing arrangements (27%), negative decisions (24%) and family separation (3%). These findings point strongly to the health benefits of considering alternatives to held immigration detention, such as community based processing. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  19. Mapping non suicidal self-injury in adolescence: Development and confirmatory factor analysis of the Impulse, Self-harm and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A).

    Science.gov (United States)

    Carvalho, Célia Barreto; Nunes, Carolina; Castilho, Paula; da Motta, Carolina; Caldeira, Suzana; Pinto-Gouveia, José

    2015-06-30

    Non-suicidal self-injury (NSSI) is the deliberate, self-inflicted destruction of body tissue without suicidal intent and an important clinical phenomenon. Rates of NSSI appear to be disproportionately high in adolescents and young adults, and is a risk factor for suicidal ideation and behavior. The present study reports the psychometric properties of the Impulse, Self-harm and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A), a measure designed to comprehensively assess the impulsivity, NSSI behaviors and suicide ideation. An additional module of this questionnaire assesses the functions of NSSI. Results of Confirmatory Factor Analysis (CFA) of the scale on 1722 youths showed items' suitability and confirmed a model of four different dimensions (Impulse, Self-harm, Risk-behavior and Suicide ideation) with good fit and validity. Further analysis showed that youth׳s engagement in self-harm may exert two different functions: to create or alleviate emotional states, and to influence social relationships. Our findings contribute to research and assessment on non-suicidal self-injury, suggesting that the ISSIQ-A is a valid and reliable measure to assess impulse, self-harm and suicidal thoughts, in adolescence.

  20. Interventions to prevent self-harm: what does the evidence say?

    Science.gov (United States)

    Saunders, Kate E; Smith, Katharine A

    2016-08-01

    Self-harm is a major public health concern and a risk factor for future suicide. It predominantly occurs in young people with around 65% of self-harm occurring before the age of 35. Self-harm causes distress to families and is associated with poorer educational outcomes as well as increased health and social care costs. Repetition is common with a quarter of individuals presenting to hospital with a further episode of self-harm within a year. We review the evidence from randomised controlled trials of treatments for self-harm, focusing on pharmacological and psychological approaches. We then contrast this with the current observational evidence and reflect on the challenges and limitations of randomised controlled trials for the treatment of self-harm.

  1. Attempted Suicide, Self-Harm, and Psychological Disorder Among Young Offenders in Custody.

    Science.gov (United States)

    Moore, Elizabeth; Gaskin, Claire; Indig, Devon

    2015-07-01

    This study aims to identify risk factors for suicide and self-harm among young offenders. The data are from the 2009 New South Wales Young People in Custody Health Survey. The sample (N = 313) were 88% male and 48% Aboriginal. Sixteen percent reported ever having suicidal thoughts and 10% reported a suicide attempt. Twenty-one percent reported thoughts of self-harm and 16% reported actual self-harm. Female young offenders reported higher rates of suicidal behavior and self-harm compared to males. Significant correlates of attempted suicide and self-harm included childhood adversity and psychiatric disorder. This study finds that young offenders are at high risk of suicidal and self-harm behaviors. Early identification and support among this vulnerable group are critical.

  2. Why do adolescents self-harm?: An investigation of motives in a community sample

    OpenAIRE

    Rasmussen, Susan; Hawton, Keith; Philpott-Morgan, Sion; O'Connor, Rory C.

    2016-01-01

    Background: Given the high rates of self-harm among adolescents, recent research has focused on a better understanding of the motives for the behavior. Aims: The present study had three aims: to investigate (a) which motives are most frequently endorsed by adolescents who report self-harm; (b) whether motives reported at baseline predict repetition of self-harm over a 6-month period; and (c) whether self-harm motives differ between boys and girls. Method: In all, 987 school pupils aged 14–16 ...

  3. The prevalence of previous self-harm amongst self-poisoning patients in Sri Lanka

    DEFF Research Database (Denmark)

    Mohamed, Fahim; Perera, Aravinda; Wijayaweera, Kusal;

    2011-01-01

    BACKGROUND: One of the most important components of suicide prevention strategies is to target people who repeat self-harm as they are a high risk group. However, there is some evidence that the incidence of repeat self-harm is lower in Asia than in the West. The objective of this study was to in......BACKGROUND: One of the most important components of suicide prevention strategies is to target people who repeat self-harm as they are a high risk group. However, there is some evidence that the incidence of repeat self-harm is lower in Asia than in the West. The objective of this study...... was to investigate the prevalence of previous self-harm among a consecutive series of self-harm patients presenting to hospitals in rural Sri Lanka. METHOD: Six hundred and ninety-eight self-poisoning patients presenting to medical wards at two hospitals in Sri Lanka were interviewed about their previous episodes...... of self-harm. RESULTS: Sixty-one (8.7%, 95% CI 6.7-11%) patients reported at least one previous episode of self-harm [37 (10.7%) male, 24 (6.8%) female]; only 19 (2.7%, 95% CI 1.6-4.2%) patients had made more than one previous attempt. CONCLUSION: The low prevalence of previous self-harm is consistent...

  4. Do Coping Strategies Mediate the Relationship Between Parental Attachment and Self-Harm in Young People?

    Science.gov (United States)

    Glazebrook, Katie; Townsend, Ellen; Sayal, Kapil

    2016-01-01

    Insecure attachment is associated with self-harm in young people, but little research has explored the pathways through which this relationship develops. We investigated whether attachment impacts on self-harm via its effect on coping strategies and appraisal of problem-solving abilities. A total of 314 students aged 18-20 years completed an online survey with measures of parental attachment, emotion-focused and problem-focused coping strategies, and psychological distress and self-harm. A mediational model was not supported as there were no direct effects between parental attachment and self-harm. However, analysis of specific indirect pathways revealed that perceived parental attachment impacts on self-harm through problem-focused coping. Higher quality of attachment was associated with greater reliance on problem-focused (adaptive) coping, which in turn was associated with a decreased risk of having self-harmed. Furthermore, poorer paternal attachment was associated with lower appraisal of problem-solving skills, which in turn was associated with an increased risk of having self-harmed. Individuals with insecure attachment may be more vulnerable to self-harm because they lack other more constructive coping strategies for relieving stress.

  5. Stock Market Fluctuations and Self-Harm among Children and Adolescents in Hong Kong.

    Science.gov (United States)

    Wong, Wilfred Hing-Sang; Lee, James Chun-Yin; Ho, Frederick Ka-Wing; Li, Tim Man-Ho; Ip, Patrick; Chow, Chun-Bong

    2017-06-09

    Although a few studies investigated the impact of stock market fluctuations on population health, the question of whether stock market fluctuations have an impact on self-harm in children and adolescents remain unanswered. This study therefore investigated the association between stock market fluctuations and self-harm among children and adolescents in Hong Kong. Daily self-harm attendance records were retrieved from all 18 local Accident and Emergency Departments (AED) from 2001 to 2012. 4931 children and adolescents who committed self-harm were included. The results indicated positive correlation between daily change in stock market index, Hang Seng Index (∇HSI, per 300 points), and daily self-harm incident risk of children and adolescents, without time lag between the two. The incident risk ratio for ∇HSI was 1.09 (p = 0.0339) in children and 1.06 (p = 0.0246) in adolescents. Importantly, non-trading days were found to impose significant protective effect in both groups against self-harm risk. Our results showed that stock market fluctuations were related to self-harm behaviors in children and adolescents. Parents and professionals should be educated about the potential harm of stock market fluctuations and the importance of effective parenting in reducing self-harm among children and adolescents.

  6. Stock Market Fluctuations and Self-Harm among Children and Adolescents in Hong Kong

    Science.gov (United States)

    Wong, Wilfred Hing-Sang; Lee, James Chun-Yin; Ho, Frederick Ka-Wing; Li, Tim Man-Ho; Ip, Patrick; Chow, Chun-Bong

    2017-01-01

    Although a few studies investigated the impact of stock market fluctuations on population health, the question of whether stock market fluctuations have an impact on self-harm in children and adolescents remain unanswered. This study therefore investigated the association between stock market fluctuations and self-harm among children and adolescents in Hong Kong. Daily self-harm attendance records were retrieved from all 18 local Accident and Emergency Departments (AED) from 2001 to 2012. 4931 children and adolescents who committed self-harm were included. The results indicated positive correlation between daily change in stock market index, Hang Seng Index (∇HSI, per 300 points), and daily self-harm incident risk of children and adolescents, without time lag between the two. The incident risk ratio for ∇HSI was 1.09 (p = 0.0339) in children and 1.06 (p = 0.0246) in adolescents. Importantly, non-trading days were found to impose significant protective effect in both groups against self-harm risk. Our results showed that stock market fluctuations were related to self-harm behaviors in children and adolescents. Parents and professionals should be educated about the potential harm of stock market fluctuations and the importance of effective parenting in reducing self-harm among children and adolescents. PMID:28598378

  7. Help-Seeking for Suicidal Thoughts and Self-Harm in Young People: A Systematic Review

    Science.gov (United States)

    Michelmore, Lisa; Hindley, Peter

    2012-01-01

    There is a growing body of evidence to suggest that only a minority of young people experiencing suicidal thoughts or self-harm present to any health services. This is of concern given that young people with suicidal thoughts or self-harm often require treatment for mental illness as well as to reduce their risk of completed suicide. We reviewed…

  8. Deliberate honesty

    NARCIS (Netherlands)

    Bereby-Meyer, Y.; Shalvi, S.

    2015-01-01

    Studies on lying, especially on inhibiting honest responses and generating dishonest responses, suggest that honesty is the default behavior and dishonesty requires deliberate effort. Here, we argue that when lying serves self-interest, that is, when lying is tempting and lies are easy to craft,

  9. The Role of Attachment Style in Predicting Repetition of Adolescent Self-Harm: A Longitudinal Study.

    Science.gov (United States)

    Glazebrook, Katie; Townsend, Ellen; Sayal, Kapil

    2015-12-01

    This study investigated whether insecure attachment is associated with poorer outcomes at 6-month follow-up in adolescents who self-harm. At baseline the Child Attachment Interview was administered to 52 adolescents (13-17 years) referred to specialist child and adolescent mental health services and with a recent history of self-harm. Participants also completed self-report measures of self-harm, peer attachment, anxiety, and depression and were administered the means end problem-solving task. Self-harm behavior and problem-solving skills were assessed again at 6-month follow-up. At baseline, 14 (27%) were securely attached to their mothers. In the 49 (94%) adolescents followed-up, those with insecure maternal attachment and insecure peer attachment were more likely to have repeated self-harm. In addition, securely attached adolescents showed greater improvement in problem-solving skills. These findings indicate that secure maternal and peer attachments may help recovery from self-harm, possibly by supporting the acquisition of problem-solving skills, and highlights the importance of social connections and attachments for youth with a history of self-harm.

  10. From Childhood Trauma to Self-Harm: An Investigation of Theoretical Pathways among Female Prisoners.

    Science.gov (United States)

    Howard, Ruth; Karatzias, Thanos; Power, Kevin; Mahoney, Adam

    2017-07-01

    Despite empirical evidence suggesting complex associations between childhood trauma and self-harm, there is a dearth of research investigating this association in the female prison population. The current study explored pathways to self-harm following childhood trauma, by investigating the mediating roles of Post-traumatic Stress Disorder (PTSD) symptoms, emotion regulation and dissociation, in this relationship, within a sample of 89 female prisoners. Cross-sectional, interview-format, questionnaire study within a female prison population. Measures of childhood trauma, self-harm, PTSD, emotion regulation and dissociation were administered. The majority of the sample (58.4%) reported history of self-harm. Bootstrapped mediation analyses indicated an indirect effect of emotion regulation on the relationship between childhood trauma and self-harm. An indirect effect was also found for PTSD arousal/reactivity cluster of symptoms. Multiple mediation analyses revealed that interactional effects were present for emotion regulation and arousal/reactivity, and emotion regulation and dissociation, respectively. Self-harm is highly prevalent among female prisoners. Interventions promoting emotion regulation and addressing arousal/reactivity symptoms following traumatization may provide an effective way of addressing this problem. Copyright © 2016 John Wiley & Sons, Ltd. Self-harm is highly prevalent amongst female prisoners, occurring in 58.4% of this sample. Emotion regulation and the arousal/reactivity symptom cluster of PTSD were found to mediate the relationship between childhood trauma and self-harm, both independently and simultaneously. Emotion regulation and dissociation were found to interactionally mediate this relationship. Strategies targeting emotion dysregulation and hyperarousal symptoms, amongst female prisoners who have experienced childhood trauma, may be helpful in reducing self-harming behaviours. Copyright © 2016 John Wiley & Sons, Ltd.

  11. Self-harm and psychosocial characteristics of looked after and looked after and accommodated young people.

    Science.gov (United States)

    Harkess-Murphy, E; Macdonald, J; Ramsay, J

    2013-01-01

    Children and young people who are classed as "looked after" and "looked after and accommodated", have been identified as being especially at risk of self-harm, however there is little research that has assessed self-harm among these groups. This study investigates self-harm rates, distinguishing between cognitions and behaviours with non-suicidal and suicidal intent among the looked after and looked after and accommodated population of young people educated within mainstream institutions in West Central Scotland. Looked after young people who self-harmed were compared with looked after young people who had never self-harmed on reasons for living, self-critical style, common life problems and academic self-esteem. An anonymous self-report questionnaire was used to survey 102 looked after (LAC) and looked after and accommodated (LAAC) children and young people across 10 schools within 6 local authority regions in West Central Scotland that compared self-harmers (n = 32) with those who never self-harmed (n = 70). Thirty-two per cent of the looked after sample reported they had either thought about harming themselves or had actually engaged in self-harm behaviour. Self-harmers (including those who either thought about harming themselves and/or engaged in self-harm) differed from those who had never thought about harming themselves or engaged in self-harm behaviour, with significantly fewer reasons for living (RFL-A) and a more maladaptive self-critical style. The self-critical form of self-hate was found to be particularly important in predicting self-harm (thoughts and behaviours) among this sample of looked after and looked after and accommodated young people. Understanding the factors associated with self-harm and suicide risk is especially important given the already existing vulnerabilities to adverse outcomes associated with being looked after and looked after and accommodated. Strategies for the early identification of maladaptive behaviours among risk

  12. Predictive Factors of Suicide Attempt and Non-Suicidal Self-Harm in Emergency Department

    OpenAIRE

    Saad Salman; Jawaria Idrees; Fahad Hassan; Fariha Idrees; Mashaal Arifullah; Sareer Badshah

    2014-01-01

    Introduction: Suicide is the third cause of mortality in America, second leading cause of death in developed countries, and one of the major health problems. Self-harm is self-inflicted damage to one’s self with or without suicidal intent. In the present study, the predictive factors of suicide attempt and non-suicidal self-harm were evaluated in patients referred to emergency department (ED) with these problem. Methods: The total number of 45 patients with suicide attempt or self-harm admitt...

  13. Suicidal behavior and self-harm in girls with eating disorders

    Directory of Open Access Journals (Sweden)

    Koutek J

    2016-04-01

    Full Text Available Jiri Koutek, Jana Kocourkova, Iva Dudova Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic Abstract: Comorbid psychopathology, including self-harm and suicidal behavior, is often found in patients with eating disorders. To better understand the reasons for high comorbid psychopathology among eating disorders, self-harm, and suicidal behavior, we examined this comorbidity in female patients hospitalized with eating disorders. In a sample of 47 girls admitted for anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa, 72% had depressive symptoms, 11% had obsessive-compulsive symptoms, 9% had anxiety disorder, 23% had substance abuse, and 57% had disharmonious personality development. Suicidal behavior was present in 60% of patients and self-harm in 49%. Association was found between self-harm and suicidality. In all, 68% of girls with eating disorders had a positive score in the Children’s Depression Inventory questionnaire and 62% of them in the Child Adolescent Suicidal Potential Index questionnaire. Clinical examination of girls with eating disorders should focus on identifying the risk of suicidal behavior and self-harm. Keywords: eating disorders, child, adolescent, self-harm, suicidal behavior

  14. Do schools differ in suicide risk? the influence of school and neighbourhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils

    Directory of Open Access Journals (Sweden)

    Young Robert

    2011-11-01

    Full Text Available Abstract Background Rates of suicide and poor mental health are high in environments (neighbourhoods and institutions where individuals have only weak social ties, feel socially disconnected and experience anomie - a mismatch between individual and community norms and values. Young people spend much of their time within the school environment, but the influence of school context (school connectedness, ethos and contextual factors such as school size or denomination on suicide-risk is understudied. Our aim is to explore if school context is associated with rates of attempted suicide and suicide-risk at age 15 and self-harm at age 19, adjusting for confounders. Methods A longitudinal school-based survey of 1698 young people surveyed when aged 11, (primary school, 15 (secondary school and in early adulthood (age 19. Participants provided data about attempted suicide and suicide-risk at age 15 and deliberate self-harm at 19. In addition, data were collected about mental health at age 11, social background (gender, religion, etc., and at age 15, perception of local area (e.g. neighbourhood cohesion, safety/civility and facilities, school connectedness (school engagement, involvement, etc. and school context (size, denomination, etc.. A dummy variable was created indicating a religious 'mismatch', where pupils held a different faith from their school denomination. Data were analysed using multilevel logistic regression. Results After adjustment for confounders, pupils attempted suicide, suicide-risk and self-harm were all more likely among pupils with low school engagement (15-18% increase in odds for each SD change in engagement. While holding Catholic religious beliefs was protective, attending a Catholic school was a risk factor for suicidal behaviours. This pattern was explained by religious 'mismatch': pupils of a different religion from their school were approximately 2-4 times more likely to attempt suicide, be a suicide-risk or self-harm

  15. Do schools differ in suicide risk? the influence of school and neighbourhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils

    Science.gov (United States)

    2011-01-01

    Background Rates of suicide and poor mental health are high in environments (neighbourhoods and institutions) where individuals have only weak social ties, feel socially disconnected and experience anomie - a mismatch between individual and community norms and values. Young people spend much of their time within the school environment, but the influence of school context (school connectedness, ethos and contextual factors such as school size or denomination) on suicide-risk is understudied. Our aim is to explore if school context is associated with rates of attempted suicide and suicide-risk at age 15 and self-harm at age 19, adjusting for confounders. Methods A longitudinal school-based survey of 1698 young people surveyed when aged 11, (primary school), 15 (secondary school) and in early adulthood (age 19). Participants provided data about attempted suicide and suicide-risk at age 15 and deliberate self-harm at 19. In addition, data were collected about mental health at age 11, social background (gender, religion, etc.), and at age 15, perception of local area (e.g. neighbourhood cohesion, safety/civility and facilities), school connectedness (school engagement, involvement, etc.) and school context (size, denomination, etc.). A dummy variable was created indicating a religious 'mismatch', where pupils held a different faith from their school denomination. Data were analysed using multilevel logistic regression. Results After adjustment for confounders, pupils attempted suicide, suicide-risk and self-harm were all more likely among pupils with low school engagement (15-18% increase in odds for each SD change in engagement). While holding Catholic religious beliefs was protective, attending a Catholic school was a risk factor for suicidal behaviours. This pattern was explained by religious 'mismatch': pupils of a different religion from their school were approximately 2-4 times more likely to attempt suicide, be a suicide-risk or self-harm. Conclusions With

  16. Predictive Factors of Suicide Attempt and Non-Suicidal Self-Harm in Emergency Department

    Directory of Open Access Journals (Sweden)

    Saad Salman

    2014-09-01

    Full Text Available Introduction: Suicide is the third cause of mortality in America, second leading cause of death in developed countries, and one of the major health problems. Self-harm is self-inflicted damage to one’s self with or without suicidal intent. In the present study, the predictive factors of suicide attempt and non-suicidal self-harm were evaluated in patients referred to emergency department (ED with these problem. Methods: The total number of 45 patients with suicide attempt or self-harm admitted to ED were included. Clinical symptoms, thoughts and behaviors of suicidal, and non-suicidal self-harm in these patients were evaluated at baseline. Suicidality, suicidal intent and ideation, non-suicidal self-injury, social withdrawal, disruptive behavior, and poor family functions were evaluated at admission time. Brief clinical visits were scheduled for the twelfth weeks. In the twelfth week, patients returned for their final visit to determine their maintenance treatment. Finally data were analyzed using chi-squared and multiple logistic regression. Results: Forty five patients were included in the study (56.1% female. The mean age of patients was 23.3±10.2 years (range: 15-75; 33.3% married. Significant association of suicide and self-injury was presented at the baseline and in the month before attempting (p=0.001. The most important predictive factors of suicide and self-harm based on univariate analysis were depression (suicidal and non-suicidal items of Hamilton depression rating scale, anxiety, hopelessness, younger age, history of non-suicidal self-harm and female gender (p<0.05. The participants’ quality of life analysis showed a significant higher quality in physical component summary (p=0.002, mental component summary (p=0.001, and general health (p=0.001 at follow up period. Conclusion: At the time of admission in ED, suicide attempt and non-suicidal self-harm are subsequent clinical markers for the patient attempting suicide again. The

  17. Prevalence and Correlates of Self-Harm in the German General Population.

    Directory of Open Access Journals (Sweden)

    Astrid Müller

    Full Text Available The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15, the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4, and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49% acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2 = 5.38, p = 0.020. Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4, higher impulsivity scores (BIS-15, and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming

  18. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study

    Science.gov (United States)

    Moffitt, Terrie E; Houts, Renate M; Belsky, Daniel W; Arseneault, Louise; Caspi, Avshalom

    2012-01-01

    Objectives To test whether frequent bullying victimisation in childhood increases the likelihood of self harming in early adolescence, and to identify which bullied children are at highest risk of self harm. Design The Environmental Risk (E-Risk) longitudinal study of a nationally representative UK cohort of 1116 twin pairs born in 1994-95 (2232 children). Setting England and Wales, United Kingdom. Participants Children assessed at 5, 7, 10, and 12 years of age. Main outcome measures Relative risks of children’s self harming behaviour in the six months before their 12th birthday. Results Self harm data were available for 2141 children. Among children aged 12 who had self harmed (2.9%; n=62), more than half were victims of frequent bullying (56%; n=35). Exposure to frequent bullying predicted higher rates of self harm even after children’s pre-morbid emotional and behavioural problems, low IQ, and family environmental risks were taken into account (bullying victimisation reported by mother: adjusted relative risk 1.92, 95% confidence interval 1.18 to 3.12; bullying victimisation reported by child: 2.44, 1.36 to 4.40). Victimised twins were more likely to self harm than were their non-victimised twin sibling (bullying victimisation reported by mother: 13/162 v 3/162, ratio=4.3, 95% confidence interval 1.3 to 14.0; bullying victimisation reported by child: 12/144 v 7/144, ratio=1.7, 0.71 to 4.1). Compared with bullied children who did not self harm, bullied children who self harmed were distinguished by a family history of attempted/completed suicide, concurrent mental health problems, and a history of physical maltreatment by an adult. Conclusions Prevention of non-suicidal self injury in young adolescents should focus on helping bullied children to cope more appropriately with their distress. Programmes should target children who have additional mental health problems, have a family history of attempted/completed suicide, or have been maltreated by an adult

  19. Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation.

    Science.gov (United States)

    Green, J M; Wood, A J; Kerfoot, M J; Trainor, G; Roberts, C; Rothwell, J; Woodham, A; Ayodeji, E; Barrett, B; Byford, S; Harrington, R

    2011-04-01

    To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people. Two arm, single (assessor) blinded parallel randomised allocation trial of a group therapy intervention in addition to routine care, compared with routine care alone. Randomisation was by minimisation controlling for baseline frequency of self harm, presence of conduct disorder, depressive disorder, and severity of psychosocial stress. Adolescents aged 12-17 years with at least two past episodes of self harm within the previous 12 months. Exclusion criteria were: not speaking English, low weight anorexia nervosa, acute psychosis, substantial learning difficulties (defined by need for specialist school), current containment in secure care. Setting Eight child and adolescent mental health services in the northwest UK. Manual based developmental group therapy programme specifically designed for adolescents who harm themselves, with an acute phase over six weekly sessions followed by a booster phase of weekly groups as long as needed. Details of routine care were gathered from participating centres. Primary outcome was frequency of subsequent repeated episodes of self harm. Secondary outcomes were severity of subsequent self harm, mood disorder, suicidal ideation, and global functioning. Total costs of health, social care, education, and criminal justice sector services, plus family related costs and productivity losses, were recorded. 183 adolescents were allocated to each arm (total n = 366). Loss to follow-up was low (self harm, proportional odds ratio of group therapy versus routine care adjusting for relevant baseline variables was 0.99 (95% confidence interval 0.68 to 1.44, P = 0.95) at 6 months and 0.88 (0.59 to 1.33, P = 0.52) at 1 year. For severity of subsequent self harm the equivalent odds ratios were 0.81 (0.54 to 1.20, P = 0.29) at 6 months and 0.94 (0.63 to 1.40, P = 0.75) at 1 year. Total 1 year costs were higher in the group therapy arm (£21,781) than

  20. Prevalence and Correlates of Self-Harm in the German General Population.

    Science.gov (United States)

    Müller, Astrid; Claes, Laurence; Smits, Dirk; Brähler, Elmar; de Zwaan, Martina

    2016-01-01

    The study aimed at evaluating the psychometric properties of the German version of the Self- Harm Inventory (SHI) and examining the lifetime prevalence and correlates of self-harm in a representative German population sample (N = 2,507; age mean = 48.79, SD = 18.11; range 14 to 94 years; 55.5% women) using the SHI. All participants answered the German SHI, the short form of the Barratt Impulsiveness Scale (BIS-15), the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and provided sociodemographic information. The one-factorial structure of the SHI was replicated using a confirmatory factor analysis. Internal consistency coefficients were sufficient and in line with previous studies. Almost half of the sample (49%) acknowledged at least one self-harming behavior over the life-span, most frequently indirect forms of self-harm. The rate of participants who engaged in at least one SHI behavior was higher among men than women (51.6% vs. 46.9%, respectively, χ2 = 5.38, p = 0.020). Higher SHI scores were related to younger age, male gender, living alone, more symptoms of anxiety and depression (PHQ-4), higher impulsivity scores (BIS-15), and suffering from obesity grade 2. Women engaged more often in discreet forms of self-harm than men, e.g., preventing wounds from healing, exercising an injury, starving, and abusing laxatives. In terms of other indirect self-harming behaviors, men admitted more often driving recklessly, being promiscuous and losing a job on purpose, while women reported more frequently engaging in emotionally abusive relationships. With respect to direct self-harm, women were more likely to endorse suicide attempts and cutting, while men admitted more often head-banging. The findings suggest that self-harm constitutes a common problem. Future longitudinal studies are required to examine the natural course, sociodemographic and psychopathological risk factors, as well as possible time-trends of self-harming behaviors in more

  1. Varenicline and Risk of Self-Harm: A Nested Case-Control Study

    Science.gov (United States)

    Martins, Diana; Yao, Zhan; Mamdani, Muhammad M.; Juurlink, David N.; Gomes, Tara; Antoniou, Tony

    2016-01-01

    Background Smoking remains a serious public health concern. Pharmacotherapy for smoking cessation, including bupropion and varenicline, are proven means to increase quit rates. Post-marketing reports describing suicidal behaviours have raised concerns about the safety of varenicline. However, whether varenicline imparts a higher risk of suicide relative to bupropion remains uncertain. Methods A population-based nested case-control study in Ontario, Canada, from April 1, 2011 to March 31, 2015 was conducted. Subjects were residents of Ontario aged 18 years and older with publicly funded drug coverage receiving either bupropion or varenicline for smoking cessation. We defined cases were those with a hospitalization or emergency department visit for suicide or non-fatal self-harm within 90 days of treatment. For each case, we identified up to fifty controls from the same cohort matched on age, sex, history of self-harm, use of selected psychotropic medications, alcohol abuse and prior admission to a mental health unit. Adjusted odds ratio were used to compare the risk of suicide/self-harm of varenicline to bupropion. Results We identified 331 cases and 5,346 matched-controls. Following adjustment for potential confounders, we found that varenicline was not associated with an increased risk of suicide/self-harm relative to bupropion (adjusted odds ratio 1.15; 95% confidence interval 0.71 to 1.87). Interpretation Treatment with varenicline does not appear to significantly increase the risk of suicide or self-harm relative to bupropion. PMID:27662654

  2. Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial

    DEFF Research Database (Denmark)

    Morthorst, Britt; Krogh, Jesper; Erlangsen, Annette

    2012-01-01

    attempt, compared with 13/120 (11%) in the control group (odds ratio 1.60, 95% confidence interval 0.76 to 3.38; P=0.22). By contrast, self reported data on new events showed 11/95 (12%) in the intervention group versus 13/74 (18%) in the control group (0.61, 0.26 to 1.46; P=0.27). By imputing missing....... INTERVENTION: Case management through assertive outreach that provided crisis intervention and flexible problem solving. This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to standard treatment. MAIN...... data on the selfreported outcomes, we estimated 15/123 (12%) events in the intervention group and 23/120 (19%) in the control group (0.69, 0.34 to 1.43; P=0.32). CONCLUSION: Assertive outreach showed no significant effect on subsequent suicide attempt. The difference in rates of events between register...

  3. Effect of assertive outreach after suicide attempt in the AID (assertive intervention for deliberate self harm) trial

    DEFF Research Database (Denmark)

    Morthorst, Britt; Krogh, Jesper; Erlangsen, Annette;

    2012-01-01

    To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment.......To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts, compared with standard treatment....

  4. Self-harm in prisons in England and Wales: an epidemiological study of prevalence, risk factors, clustering, and subsequent suicide

    Science.gov (United States)

    Hawton, Keith; Linsell, Louise; Adeniji, Tunde; Sariaslan, Amir; Fazel, Seena

    2014-01-01

    Summary Background Self-harm and suicide are common in prisoners, yet robust information on the full extent and characteristics of people at risk of self-harm is scant. Furthermore, understanding how frequently self-harm is followed by suicide, and in which prisoners this progression is most likely to happen, is important. We did a case-control study of all prisoners in England and Wales to ascertain the prevalence of self-harm in this population, associated risk factors, clustering effects, and risk of subsequent suicide after self-harm. Methods Records of self-harm incidents in all prisons in England and Wales were gathered routinely between January, 2004, and December, 2009. We did a case-control comparison of prisoners who self-harmed and those who did not between January, 2006, and December, 2009. We also used a Bayesian approach to look at clustering of people who self-harmed. Prisoners who self-harmed and subsequently died by suicide in prison were compared with other inmates who self-harmed. Findings 139 195 self-harm incidents were recorded in 26 510 individual prisoners between 2004 and 2009; 5–6% of male prisoners and 20–24% of female inmates self-harmed every year. Self-harm rates were more than ten times higher in female prisoners than in male inmates. Repetition of self-harm was common, particularly in women and teenage girls, in whom a subgroup of 102 prisoners accounted for 17 307 episodes. In both sexes, self-harm was associated with younger age, white ethnic origin, prison type, and a life sentence or being unsentenced; in female inmates, committing a violent offence against an individual was also a factor. Substantial evidence was noted of clustering in time and location of prisoners who self-harmed (adjusted intra-class correlation 0·15, 95% CI 0·11–0·18). 109 subsequent suicides in prison were reported in individuals who self-harmed; the risk was higher in those who self-harmed than in the general prison population, and more than

  5. Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort.

    Science.gov (United States)

    Mars, Becky; Heron, Jon; Crane, Catherine; Hawton, Keith; Kidger, Judi; Lewis, Glyn; Macleod, John; Tilling, Kate; Gunnell, David

    2014-10-01

    There is a lack of consensus about whether self-harm with suicidal intent differs in aetiology and prognosis from non-suicidal self-harm, and whether they should be considered as different diagnostic categories. Participants were 4799 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort who completed a postal questionnaire on self-harm with and without suicidal intent at age 16 years. Multinomial logistic regression analyses were used to examine differences in the risk factor profiles of individuals who self-harmed with and without suicidal intent. Many risk factors were common to both behaviours, but associations were generally stronger in relation to suicidal self-harm. This was particularly true for mental health problems; compared to those with non-suicidal self-harm, those who had harmed with suicidal intent had an increased risk of depression (OR 3.50[95% CI 1.64, 7.43]) and anxiety disorder (OR 3.50[95% CI 1.72, 7.13]). Higher IQ and maternal education were risk factors for non-suicidal self-harm but not suicidal self-harm. Risk factors that appeared specific to suicidal self-harm included lower IQ and socioeconomic position, physical cruelty to children in the household and parental self-harm. i) There was some loss to follow-up, ii) difficulty in measuring suicidal intent, iii) we cannot rule out the possibility of reverse causation for some exposure variables, iv) we were unable to identify the subgroup that had only ever harmed with suicidal intent. Self-harm with and without suicidal intent are overlapping behaviours but with some distinct characteristics, indicating the importance of fully exploring vulnerability factors, motivations, and intentions in adolescents who self harm. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Attitudes towards young people who self-harm: age, an influencing factor

    OpenAIRE

    Cleaver, Karen; Meerabeau, Liz; Maras, Pam

    2014-01-01

    Aim: To determine the attitudes of emergency care staff towards young people (aged 12–18 years) who self-harm and to gain an understanding of the basis of attitudes that exist.\\ud \\ud Background: Young people frequently attend emergency services following self-harm; it is unclear whether being a young person influences attitudes held.\\ud \\ud Design: Mixed methods using a triangulation convergent design.\\ud \\ud Methods: Survey of 143 staff members from four accident & emergency departments and...

  7. Self harm through foreign bodies ingestion - rare cause of digestive perforation.

    Science.gov (United States)

    Petrea, S; Brezean, I

    2014-06-15

    Self-harm is a rare pathology, often seen in psychiatric patients but more frequently in the penitentiary environment. Of the many possible forms of self-harm, foreign bodies (FB) ingestion is by far the most usual in the Romanian prison environment. The paper aims to present the diagnostic and therapeutic aspects arising as a consequence of the digestive tract perforations consequent upon foreign bodies ingestion; a number of 45 cases which occurred over a 7-year period (2003-2010) in "Rahova" Penitentiary Hospital, were analyzed. We also examined the surgical particularities of case resolution.

  8. A Population-Based Study of the Prevalence and Correlates of Self-Harm in Juvenile Detention.

    Directory of Open Access Journals (Sweden)

    Hygiea Casiano

    Full Text Available Suicide is the number one cause of death among incarcerated youth. We examined the demographic and forensic risk factors for self-harm in youth in juvenile detention using a Canadian provincial correctional database.We analyzed data from de-identified youth aged 12 to 18 at the time of their offense who were in custody in a Manitoba youth correctional facility between January 1, 2005 and December 30, 2010 (N = 5,102. Univariate and multivariate logistic regression analyses determined the association between staff-identified self-harm events in custody and demographic and custodial variables. Time to the event was examined based on the admission date and date of event.Demographic variables associated with self-harm included female sex, lower educational achievement, older age, and child welfare involvement. Custodial variables associated with self-harm included higher criminal severity profiles, younger age at first incarceration, longer sentence length, disruptive institutional behavior, and a history of attempting escape. Youth identified at entry as being at risk for suicide were more likely to self-harm. Events tended to occur earlier in the custodial admission.Self-harm events tended to occur within the first 3 months of an admission stay. Youth with more serious offenses and disruptive behaviors were more likely to self-harm. Individuals with problematic custodial profiles were more likely to self-harm. Suicide screening identified youth at risk for self-harm. Strategies to identify and help youth at risk are needed.

  9. [An investigation on self-harm episodes and their relationship with suicidal psychology and behaviors in 2713 college students].

    Science.gov (United States)

    Su, Pu-Yu; Hao, Jia-Hu; Huang, Zhao-Hui; Tao, Fang-Biao

    2010-11-01

    To investigate the episodes and influencing factors on self-harm and to explore the relationship between self-harm episodes and suicidal psychology and behaviors in college students. Four universities were selected using cluster sampling method in Anqing city and Chaohu city. Totally, 2713 college students completed this survey. Data were analyzed by Pearson Chi-square and logistic regression. In the last six months, rates of highly lethal self-harm, less lethal self-harm with visible tissue damage, self-injury without visible tissue damage, self-harmful behaviors with latency damage, other self-harmful behaviors with menticide were 1.9%, 5.5%, 15.3%, 21.2% and 17.0% respectively. The total rate of self-harm was 31.3%. 73.1% of the students with self harmful experiences had the above mentioned behaviors more than 3 times in the last six months. The top 3 reasons for taking self-harm actions were: having learning problems (43.1%), failed love affairs (25.0%) and having conflicts with others (23.9%). There were different influencing factors among different kinds of self-harm episodes. Depression was the risk factor of self-harm. The higher score of having high self-esteem was the protective factor of all kinds of self-harm actions except highly lethal ones. Higher score of difficulties in identifying feelings was one of the risk factors. The rates of suicidal psychology and behaviors in students with self-harm were significantly higher than those in students without those behaviors. Result from linear χ(2) test indicated that the graveness of tissue damage of self-harm was higher along with the rates of suicidal psychology and behaviors (P students, about 1/3 adolescents having experienced self-harm in the last 6 months, many with repeated ones. Depression and difficulties in identifying feelings were the two risk factors while self-esteem was the protective factor related to most of the self-harm cases.

  10. A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan

    Directory of Open Access Journals (Sweden)

    Chung Chi-Hsiang

    2012-09-01

    Full Text Available Abstract Background Previous follow-up studies of repeated self-harm show that the cumulative risk of repeated self-harm within one year is 5.7%–15%, with females at greatest risk. However, relatively few studies have focused on the Far East. The objective of this study was to calculate the cumulative risk of repeated self-harm over different lengths of follow-up time (3 months, 6 months, and 1–8 years, to determine factors influencing repeated self-harm and to explore the interaction between gender and self-harm methods. Methods We used self-harm patient who hospitalized due to first-time self-harm between 2000 and 2007 from 1,230 hospitals in Taiwan. Hospitalization for repeated self-harm among members of this cohort was tracked after 3 months, 6 months, and 1–8 years. Tracking continued until December 31, 2008. We analyzed the cumulative risk and risk factors of repeated self-harm by using negative binomial regression. Results Of the 39,875 individual study samples, 3,388 individuals (8.50% were found to have repeatedly self-harmed. The cumulative risk of repeated self-harm within three months was 7.19% and within one year was 8%. Within 8 years, it was 8.70%. Females were more likely to repeatedly self-harm than males (RR = 1.21, 95% CI = 1.15–1.76. The main method of self-harm was solid or liquid substances (RR = 1.88, 95% CI = 1.23–2.04 or cutting or piercing (RR = 1.36, 95% CI = 1.02–1.82, and in patients with psychiatric disorders were more likely to self-harm (RR = 1.61, 95% CI = 1.48–1.75. Conclusions The key time for intervention for repeated self-harm is within three months. Appropriate prevention programs should be developed based on gender differences.

  11. Appropriate interventions for the prevention and management of self-harm: a qualitative exploration of service-users' views

    Directory of Open Access Journals (Sweden)

    Platt Stephen

    2007-01-01

    Full Text Available Abstract Background The engagement of service-users in exploring appropriate interventions for self-harm has been relatively neglected in comparison with clinical studies focusing on the management and prevention of self-harm. The purpose of this study was to investigate perceptions of interventions for self-harm (formal and informal, prevention and treatment among people who have first-hand experience as a result of their own behaviour. Methods Semi-structured interviews were undertaken with 14 patients admitted to hospital following a repeat act of self-harm. Data analysis was undertaken thematically, drawing broadly on some of the principles and techniques of grounded theory Results The patients were a heterogeneous group with respect to their personal characteristics and the nature of their self-harm. Thirteen of the 14 patient accounts could be assigned to one or more of three overlapping experiential themes: the experience of psychiatric illness, the experience of alcohol dependency, and the experience of traumatic life events and chronic life problems. These themes were related to the nature of patients' self-harm and their experiences of, and attitudes towards, interventions for self-harm and their attitudes towards these. There was a clear preference for specialist community-based interventions, which focus on the provision of immediate aftercare and acknowledge that the management of self-harm may not necessarily involve its prevention. The findings generate the preliminary hypothesis that personal circumstances and life history are major influences on the choice of interventions for self-harm. Conclusion This study attests to the importance of recognising differences within the self-harming population, and acknowledging patients' personal circumstances and life history. These may provide clues to the antecedents of their self-harm, and lead to more acceptable and appropriate treatments.

  12. Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care.

    Science.gov (United States)

    Selenius, Heidi; Leppänen Östman, Sari; Strand, Susanne

    2016-10-01

    Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing. The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients' self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression. Female forensic psychiatric patients (n = 130) from a high security hospital were included. The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff. These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor 'Symptom of major mental illness' within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.

  13. Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies.

    Directory of Open Access Journals (Sweden)

    Celine Larkin

    Full Text Available BACKGROUND: Self-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition. OBJECTIVE: This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent. DATA SOURCES: PubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form. RESULTS: A total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity. CONCLUSIONS: Many risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode

  14. Mortality and Self-Harm in Association With Clozapine in Treatment-Resistant Schizophrenia

    DEFF Research Database (Denmark)

    Wimberley, Theresa; Maccabe, James H; Laursen, Thomas M

    2017-01-01

    OBJECTIVE: This study evaluated rates of all-cause mortality and self-harm in association with clozapine treatment in individuals with treatment-resistant schizophrenia. METHOD: A population-based cohort of 2,370 individuals with treatment-resistant schizophrenia after Jan. 1, 1996, was followed...

  15. Non-Suicidal Self-Injury and Indirect Self-Harm among Danish High School Students

    DEFF Research Database (Denmark)

    Møhl, Bo; la Cour, Peter; Skandsen, Annika

    2014-01-01

    Background: Non-suicidal self-injury (NSSI) and indirect self-harm are prevalent among adolescents, but it is rare to see them described as related topics. Objective: The purpose of this study was to investigate whether there is a correlation between the frequencies of NSSI and indirect self...

  16. Thoughts of Self-Harm and Help-Seeking Behavior among Youth in the Community

    Science.gov (United States)

    Goodwin, Renee D.; Mocarski, Michelle; Marusic, Andrej; Beautrais, Annette

    2013-01-01

    The association between thoughts of self-harm and help-seeking among youth with symptoms of depression was examined. Data were drawn from the Health Behavior of School-aged Children Study ("n" = 15, 686), a nationally representative sample of youth in the United States. Analyses focused on comparing help-seeking behaviors among youth…

  17. Bullying Victimization and Adolescent Self-Harm: Testing Hypotheses from General Strain Theory

    Science.gov (United States)

    Hay, Carter; Meldrum, Ryan

    2010-01-01

    Self-harm is widely recognized as a significant adolescent social problem, and recent research has begun to explore its etiology. Drawing from Agnew's (1992) social psychological strain theory of deviance, this study considers this issue by testing three hypotheses about the effects of traditional and cyber bullying victimization on deliberate…

  18. Self-Harm through Cutting: Evidence from a Sample of Schools in the North of England

    Science.gov (United States)

    Hall, Brian; Elliott, Joe; Place, Maurice

    2010-01-01

    This project explored the prevalence of self-harm by cutting in a geographically circumscribed area of the North of England, using a school-based survey. Twenty-three per cent of the young people reported they had cut themselves at least once, with no major changes evident at different age groups or with gender. There were clear differences in…

  19. Health Communication and Psychological Distress: Exploring the Language of Self-Harm

    Science.gov (United States)

    Harvey, Kevin; Brown, Brian

    2012-01-01

    This study explores adolescents' accounts of self-harm with a view to elucidate the implications for health care practitioners seeking to administer care to teenagers in English. Drawing on a corpus of 1.6 million words from messages posted on a UK-hosted adolescent health Web site, analysis began by identifying a range of keywords relating to…

  20. Bullying Victimization and Adolescent Self-Harm: Testing Hypotheses from General Strain Theory

    Science.gov (United States)

    Hay, Carter; Meldrum, Ryan

    2010-01-01

    Self-harm is widely recognized as a significant adolescent social problem, and recent research has begun to explore its etiology. Drawing from Agnew's (1992) social psychological strain theory of deviance, this study considers this issue by testing three hypotheses about the effects of traditional and cyber bullying victimization on deliberate…

  1. An investigation into the role of alcohol in self-harm in rural Sri Lanka

    DEFF Research Database (Denmark)

    Sørensen, Jane Brandt; Rheinländer, Thilde; Sørensen, Birgitte Refslund

    2014-01-01

    and families; six focus group discussions with community members; and key-informant interviews with 15-25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm. ETHICS AND DISSEMINATION: The study has received ethical approval from...

  2. Self harm and attempted suicide in adults: 10 practical questions and answers for emergency department staff.

    Science.gov (United States)

    Mitchell, A J; Dennis, M

    2006-04-01

    Self harm is a complex behaviour that can be best thought of as a maladaptive response to acute and chronic stress, often but not exclusively linked with thoughts of dying. Patients presenting with self harm usually have current psychosocial difficulties, are likely to be suffering from mental health problems, and are at significant risk of further self harm and suicide. Recent guidelines suggest that all self harm attendees should receive an initial risk assessment at triage in the emergency department. A more detailed mental health assessment and an assessment of psychological and social needs should then be performed by trained staff, ideally specialist mental professionals experienced in this area. Risk of subsequent suicide is particularly high in those with high unresolved suicidal intent, depressive disorder, chronic alcohol and drug misuse, social isolation, and current physical illness. Patients with one or more of these risk factors should be offered enhanced care that may include inpatient or outpatient follow up care, a list of local support resources, and, where possible, self help material. Frequent repeaters, those with alcohol and substance use problems, those with physical or mental illness, and those who are isolated also require input from specialist mental health professionals. It is also recommended that adolescents and elderly people warrant a mandatory specialist assessment.

  3. Decisional support for young people who self-harm: protocol for a feasibility trial

    Science.gov (United States)

    Rowe, Sarah L; French, Rebecca S; Henderson, Claire; Ougrin, Dennis; Slade, Mike; Moran, Paul

    2016-01-01

    Introduction Self-harm is common in adolescents, and it is the strongest predictor of suicide. Young people who self-harm are often unsure of how and where to get help. Decision aids (DAs) have been shown to help with decisional conflict where there is uncertainty around different options. We have developed an online DA to support young people in help-seeking for self-harm. A feasibility trial will examine the acceptability of the online intervention and the ability to recruit and follow-up participants within a school setting. Methods and analysis In this parallel arm, single-blind feasibility trial, 60 participants aged 12–18 years who have self-harmed in the past 12 months, will be randomised to either (1) a group receiving the online DA or (2) a control group receiving general information about feelings and emotions. Both groups will complete measures assessing decision-making and help-seeking behaviour. The school counsellor will be notified of any participants who have been randomised to ensure safeguarding for the young person. Participants in both groups will be followed up at 4 weeks, and the measures will be repeated. Qualitative interviews will be conducted with a subset of participants to explore their views and experiences of the DA and of participation in the study. Ethics and dissemination Ethical approval was granted by King's College London (KCL) College Research Ethics Committee. Results of this study will help to clarify if we can recruit and administer an online decisional support intervention within a school setting for young people who self-harm. The study will inform the design and implementation of a larger randomised controlled trial to test the effectiveness of the DA. Dissemination of the study findings will target publication in peer-reviewed journals of general and special interest. The funder will be sent a report outlining the major findings of the study. Trial registration number ISRCTN11230559. PMID:27683517

  4. Self-harm, Assault, and Undetermined Intent Injuries Among Pediatric Emergency Department Visits.

    Science.gov (United States)

    Ballard, Elizabeth D; Kalb, Luther G; Vasa, Roma A; Goldstein, Mitchell; Wilcox, Holly C

    2015-12-01

    Although injuries are a known cause of morbidity and mortality among children and adolescents, little is known about the epidemiology of injury-related emergency department (ED) visits in the United States by injury intent. The objective of this analysis was to examine ED outcomes, defined as death in the ED, inpatient admission, and visit cost, among ED visits stratified by injury intent (i.e., self-harm, assault, and injury with undetermined intent, as compared with unintentional injuries). All injury-related ED visits in the United States for children and adolescents, ages 8 to 17 years, were identified using the 2008 Nationwide Emergency Department Sample. Multivariate survey weighted logistic and linear regression analyses were then used to estimate the likelihood of death on ED visit, inpatient admission, and cost across the 4 injury types. In 2008, with the use of weighted estimates, there were 66,895 self-harm, 176,125 assault, 24,144 undetermined injury, and 4,244,589 unintentional injury ED visits among children 8 to 17 years. Visits due to self-harm, assault and undetermined injuries were more likely to result in death during the ED visit compared with visits due to unintentional injuries. Self-harm and undetermined intent were also associated with greater odds of inpatient admission as well as 90% and 60% higher ED visit costs, respectively. Data from this nationwide sample of pediatric ED visits highlight the resource burden of self-harm, undetermined intent, and assault injury visits. Pediatric EDs may provide a window of opportunity for better case identification and intervention with children experiencing violence and injury.

  5. The Social Norms of Suicidal and Self-Harming Behaviours in Scottish Adolescents

    Science.gov (United States)

    Quigley, Jody; Rasmussen, Susan; McAlaney, John

    2017-01-01

    Although the suicidal and self-harming behaviour of individuals is often associated with similar behaviours in people they know, little is known about the impact of perceived social norms on those behaviours. In a range of other behavioural domains (e.g., alcohol consumption, smoking, eating behaviours) perceived social norms have been found to strongly predict individuals’ engagement in those behaviours, although discrepancies often exist between perceived and reported norms. Interventions which align perceived norms more closely with reported norms have been effective in reducing damaging behaviours. The current study aimed to explore whether the Social Norms Approach is applicable to suicidal and self-harming behaviours in adolescents. Participants were 456 pupils from five Scottish high-schools (53% female, mean age = 14.98 years), who completed anonymous, cross-sectional surveys examining reported and perceived norms around suicidal and self-harming behaviour. Friedman’s ANOVA with post-hoc Wilcoxen signed-ranks tests indicated that proximal groups were perceived as less likely to engage in or be permissive of suicidal and self-harming behaviours than participants’ reported themselves, whilst distal groups tended towards being perceived as more likely to do so. Binary logistic regression analyses identified a number of perceived norms associated with reported norms, with close friends’ norms positively associated with all outcome variables. The Social Norms Approach may be applicable to suicidal and self-harming behaviour, but associations between perceived and reported norms and predictors of reported norms differ to those found in other behavioural domains. Theoretical and practical implications of the findings are considered. PMID:28294999

  6. Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth.

    Science.gov (United States)

    Liu, Richard T; Mustanski, Brian

    2012-03-01

    Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population. This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth. A community sample of 246 LGBT youth (aged 16-20 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011. A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (pLGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Self-harm and risk of motor vehicle crashes among young drivers : findings from the DRIVE Study

    NARCIS (Netherlands)

    Martiniuk, Alexandra L. C.; Ivers, Rebecca Q.; Glozier, Nick; Patton, George C.; Lam, Lawrence T.; Boufous, Soufiane; Senserrick, Teresa; Williamson, Ann; Stevenson, Mark; Norton, Robyn

    2009-01-01

    Background: Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers. Methods: We prospectively linked survey data

  8. The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder

    NARCIS (Netherlands)

    C.L. Taylor (Clare L.); L.M. Van Ravesteyn (Leontien M.); M.P. Lambregtse-van den Berg (Mijke); R.J. Stewart (Robert J.); L.M. Howard (Louise M.)

    2016-01-01

    textabstractWomen with severe mental illness are at increased risk of suicide in the perinatal period, and these suicides are often preceded by self-harm, but little is known about self-harm and its correlates in this population. This study aimed to investigate the prevalence of suicidal ideation an

  9. The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder.

    Science.gov (United States)

    Taylor, Clare L; van Ravesteyn, Leontien M; van denBerg, Mijke P Lambregtse; Stewart, Robert J; Howard, Louise M

    2016-10-01

    Women with severe mental illness are at increased risk of suicide in the perinatal period, and these suicides are often preceded by self-harm, but little is known about self-harm and its correlates in this population. This study aimed to investigate the prevalence of suicidal ideation and self-harm, and its correlates, in women with psychotic disorders and bipolar disorder during pregnancy. Historical cohort study using de-identified secondary mental healthcare records linked with national maternity data. Women pregnant from 2007 to 2011, with ICD-10 diagnoses of schizophrenia and related disorders, bipolar disorder or other affective psychoses were identified. Data were extracted from structured fields, natural language processing applications and free text. Logistic regression was used to examine the correlates of self-harm in pregnancy. Of 420 women, 103 (24.5 %) had a record of suicidal ideation during the first index pregnancy, with self-harm recorded in 33 (7.9 %). Self-harm was independently associated with younger age (adjusted odds ratio (aOR) 0.91, 95 % CI 0.85-0.98), self-harm in the previous 2 years (aOR 2.55; 1.05-6.50) and smoking (aOR 3.64; 1.30-10.19). A higher prevalence of self-harm was observed in women with non-affective psychosis, those who discontinued or switched medication and in women on no medication at the start of pregnancy, but these findings were not statistically significant in multivariable analyses. Suicidal thoughts and self-harm occur in a significant proportion of pregnant women with severe mental illness, particularly younger women and those with a history of self-harm; these women need particularly close monitoring for suicidality.

  10. Designing Deliberation Systems

    DEFF Research Database (Denmark)

    Rose, Jeremy; Sæbø, Øystein

    2010-01-01

    In a liberal democracy, the evolution of political agendas and formation of policy involves deliberation: serious consideration of political issues.  Modern day political participation is dependent on widespread deliberation supported by information and communication technologies, which also offe...

  11. Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: a self-report survey in England

    Directory of Open Access Journals (Sweden)

    Kidger Judi

    2012-06-01

    Full Text Available Abstract Background Substantial numbers of adolescents self-harm, but the majority of cases do not reach the attention of medical services, making community studies essential. The prevalence of suicidal thoughts and plans at this age, and the inter-relationships between suicidal thoughts, plans and self-harm remain largely unexplored. Method Cross-sectional analysis of self-reported questionnaire data collected from members of the Avon Longitudinal Study of Parents and Children (ALSPAC birth cohort, England. Respondents (n = 4810 were aged 16–17 years old and have been followed up since birth. Results Altogether 905 (18.8% respondents had ever self-harmed. The prevalence of lifetime self-harm was higher in females (25.6% than males (9.1%. The most commonly used method was self-cutting: this was used alone or in combination in 73.5% of episodes, compared to 10.0% who took overdoses alone or in combination with other methods. Of those who reported self-harm, 25.3% wanted to die during the most recent episode. Concurrent depression was associated with a greatly increased risk of self-harm (OR 5.43. Only 12.4% of participants sought medical help following their most recent episode of self-harm, although this figure was higher (30.1% where self-harm was carried out with desire to die. Of the whole sample, 15.8% had ever thought of killing themselves, and 4.3% had ever made plans to kill themselves. Compared to those who had never self-harmed, those who had self-harmed but not wanted to die during the most recent episode were at increased risk of ever having had suicidal thoughts (37.6% compared to 7.8% χ2 =102.3, p 2 =166.9, p  Conclusions Self-harm and suicidal thoughts are common among 16/17 year olds. Although the majority of self-harm behaviour is not accompanied by a desire to die, all self-harm regardless of motivation is associated with increased risk of suicidal thoughts and plans, particularly when it is carried out repeatedly.

  12. Voluntarism and transparent deliberation

    DEFF Research Database (Denmark)

    Steglich-Petersen, Asbjørn

    2006-01-01

    It is widely assumed that doxastic deliberation is transparent to the factual question of the truth of the proposition being considered for belief, and that this sets doxastic deliberation apart from practical deliberation. This feature is frequently invoked in arguments against doxastic voluntar...... theoretical from practical rationality....

  13. Risk of self-harm and nonfatal suicide attempts, and completed suicide in patients with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, A; Hansen, P R; Gislason, G H;

    2016-01-01

    BACKGROUND: Psoriasis is a common inflammatory skin disease, and inflammation may affect suicidal behaviour. Current data on the incidence and risk of suicidal behaviour in patients with psoriasis are scarce. OBJECTIVES: We investigated the association between psoriasis and the risk of self......-harm and suicide attempts and suicides. METHODS: All Danish patients aged ≥ 18 years with mild or severe psoriasis (cases) from 1 January 1997 to 31 December 2011 were matched on age, sex and calendar time 1 : 5 with healthy controls. The outcome was a diagnosis of self-harm or a nonfatal suicide attempt......, or completed suicide. Incidence rates per 10 000 person-years were calculated, and incidence rate ratios (IRRs) and confidence intervals (CIs) were estimated by Poisson regression models. RESULTS: The study cohort comprised 408 663 individuals, including 57 502 and 11 009 patients with mild and severe...

  14. Selvskadende adfærd blandt børn og unge

    DEFF Research Database (Denmark)

    Søgaard, Lisa Eilenberg; Christensen, Cathrine Lundgaard; Bilenberg, Niels

    2009-01-01

    The present paper is a review of recent research on the prevalence of deliberate self-harm (DSH) in a non-clinical background population of adolescents during the period 2002-2008. Cutting and overdosing are the most common methods used, and the majority of adolescents engaging in DSH are girls...

  15. Differences between suicide and non-suicidal self-harm behaviours: a literary review.

    Directory of Open Access Journals (Sweden)

    Joanna Halicka

    2015-06-01

    Full Text Available According to the current information of WHO, suicide is one of the 20 most common causes of death in the whole population. Suicides constitute one of the most common causes of death amongst teenagers. Apart from suicide, another significant, however much less known phenomenon is the non-suicidal self-injury. Despite the fact that we know much less about self-harm than about suicide, the results of research during the last years indicate that self-harm occurs more frequently in the population of adolescents – suicides constitute 10% in the population of teenagers, and 7-14% of adolesncets report to have performed a self-harm act at least once in their live. The last transnational research shows that the frequency of self-destructive behaviours in adolescents is at the level of 24% of the whole population, which might indicate an intensification of this phenomenon. In some cases self-injury takes place with a clear intention of committing suicide, or a self-destructive act, which often precedes a suicidal attempt long before the final decision to carry it out. Nevertheless, In the majority of cases self-injury is not performed with the intention of death. Therefore a question might be posed: do self-harm acts constitute a separate category of behaviours, or do they inevitably lead to a suicidal death? When answering this question, we ought to take a closer look at both phenomena to have a better knowledge about their etiology, risk factors, and to understand when they co-occur, and when they belong to different categories of self-aggressive behaviours.

  16. Characteristics of soldiers with self-harm in the israeli defense forces.

    Science.gov (United States)

    Shelef, Leah; Fruchter, Eyal; Spiegel, Dror Ortasse; Shoval, Gal; Mann, J John; Zalsman, Gil

    2014-01-01

    Suicide is the leading cause of soldier death in the Israeli Defense Forces (IDF) in peace time. Suicide attempt (SA) and non-suicidal self-injury (NSSI) are risk factors for death by suicide in civilian studies and therefore their predictive value needs to be determined in the military. All army screening, psychometric and demographic data on consecutive cases of IDF soldier self-harm during the years 2010-2011 were analyzed. The Columbia Suicide Severity Rating Scale was used retrospectively to classify self-harm as suicidal or NSSI. The Suicide Ideation Scale and the Suicide Intent Scale were scored retrospectively by trained clinical psychologists. A total of 107 soldiers reported self-harm during the study period, comprising 70 SA and 37 with NSSI. The most prevalent diagnosis was personality disorder (n = 48). Soldiers with any mood/anxiety disorders comprised the smallest group (n = 21) and included major depression, dysthymia, anxiety, and posttraumatic stress disorder. Soldiers with NSSI (n = 37) did not differ in any of the characteristics from those who attempted suicide (n = 70). Unlike the well-known female dominance in both SA and NSSI patients in other settings, males dominated this army sample in both groups. Soldiers with self-harm (both SA and NSSI) cannot be easily distinguished by any demographics or specific psychological attributes detectable at induction, and the scales used in suicide research cannot predict an attempt or NSSI. Unlike civilian samples, males dominated attempter and NSSI groups and the reason for this may be multifactorial. These retrospective findings, if replicated, indicate the need for different screening strategies at induction into the military.

  17. The addictive model of self-harming (non-suicidal and suicidal behavior

    Directory of Open Access Journals (Sweden)

    Hilario eBlasco-Fontecilla

    2016-02-01

    Full Text Available Introduction: Behavioral addictions such as gambling, sun-tanning, shopping, internet use, work, exercise, or even love and sex are frequent, and share many characteristics and common neurobiological and genetic underpinnings with substance addictions (i.e., tolerance, withdrawal, and relapse. Recent literature suggests that both non-suicidal self-injury (NSSI and suicidal behavior (SB can also be conceptualized as addictions. The major aim of this mini review is to review the literature and explore the neurobiological and psychological mechanisms underlying the addiction to self-harming behaviors.Method: This is a narrative review. The authors performed literature searches on PubMed and Google for suicidal behavior, self-harming, addiction, and major repeaters. Given the scarce literature on the topic, a subset of the most closely related studies was selected. The authors also focused on three empirical studies testing the hypothesis that major repeaters (individuals with ≥5 lifetime suicide attempts represent a distinctive suicidal phenotype, and are the individuals at risk of developing an addiction to SB. Results: The authors reviewed the concept of behavioral addictions and major repeaters, current empirical evidence testing concerning whether or not NSSI and SB can be understood as addictions, and the putative mechanisms underlying them.Conclusion: Our review suggests that both NSSI and SB can be conceptualized as addictions. This is relevant because if some individual’s self-harming behaviors are better conceptualized as an addiction, treatment approaches could be tailored to this addiction.

  18. Defining and refining self-harm: a historical perspective on nonsuicidal self-injury.

    Science.gov (United States)

    Angelotta, Cara

    2015-02-01

    Nonsuicidal self-injury (NSSI) is a newly proposed diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Some contemporary historiography dismisses NSSI as a fiction of modern psychiatry. Although the exact definition and psychological meaning attributed to self-harm has not been static over history, there is a clear thread that connects Western asylum psychiatrists' thinking about self-harm to the current stand-alone diagnostic category of NSSI. Nineteenth-century psychiatrists identified a clinically meaningful difference between self-harm with and without the intent to die, between self-injurers who were psychotic and those who were not, and between self-injurers who made a single, serious mutilation and those who repetitively self-injured without causing permanent bodily damage. These same distinctions are apparent in the definition of NSSI. Thus, NSSI is a formalization of long-held observations about a category of people who repetitively self-injure without suicidal intent.

  19. Manual-assisted cognitive therapy for self-harm in personality disorder and substance misuse: a feasibility trial.

    Science.gov (United States)

    Davidson, Kate M; Brown, Tom M; James, Vairi; Kirk, Jamie; Richardson, Julie

    2014-06-01

    Aims and method To assess the feasibility of conducting a larger, definitive randomised controlled trial of manual-assisted cognitive therapy (MACT), a brief focused therapy to address self-harm and promote engagement in services. We established recruitment, randomisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm. We assessed symptoms of depressed mood, anxiety and suicidality at baseline and at 3 months' follow-up. Results Twenty patients were randomised to the trial following an index episode of self-harm, and those allocated to MACT demonstrated improvement in anxiety, depression and suicidal ideation. Clinical implications It is feasible to recruit a sample of these complex patients to a randomised controlled trial of MACT following an index episode of self-harm. There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse.

  20. A Wnt-Frz/Ror-Dsh pathway regulates neurite outgrowth in Caenorhabditis elegans.

    Directory of Open Access Journals (Sweden)

    Song Song

    2010-08-01

    Full Text Available One of the challenges to understand the organization of the nervous system has been to determine how axon guidance molecules govern axon outgrowth. Through an unbiased genetic screen, we identified a conserved Wnt pathway which is crucial for anterior-posterior (A/P outgrowth of neurites from RME head motor neurons in Caenorhabditis elegans. The pathway is composed of the Wnt ligand CWN-2, the Frizzled receptors CFZ-2 and MIG-1, the co-receptor CAM-1/Ror, and the downstream component Dishevelled/DSH-1. Among these, CWN-2 acts as a local attractive cue for neurite outgrowth, and its activity can be partially substituted with other Wnts, suggesting that spatial distribution plays a role in the functional specificity of Wnts. As a co-receptor, CAM-1 functions cell-autonomously in neurons and, together with CFZ-2 and MIG-1, transmits the Wnt signal to downstream effectors. Yeast two-hybrid screening identified DSH-1 as a binding partner for CAM-1, indicating that CAM-1 could facilitate CWN-2/Wnt signaling by its physical association with DSH-1. Our study reveals an important role of a Wnt-Frz/Ror-Dsh pathway in regulating neurite A/P outgrowth.

  1. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Anthony Charles Ruocco

    2016-05-01

    Full Text Available Self-harm is a potentially lethal symptom of borderline personality disorder (BPD that often improves with dialectical behavior therapy (DBT. While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

  2. Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review

    Directory of Open Access Journals (Sweden)

    McKenzie Kwame

    2007-11-01

    Full Text Available Abstract Background Studies suggest that the rates of self harm vary by ethnic group, but the evidence for variation in risk factors has not been synthesised to inform preventive initiatives. Methods We undertook a systematic literature review of research about self harm that compared at least two ethnic groups in the United Kingdom. Results 25 publications from 1765 titles and abstracts met our inclusion criteria. There was higher rate of self harm among South Asian women, compared with South Asian men and White women. In a pooled estimate from two studies, compared to their white counterparts, Asian women were more likely to self harm (Relative Risk 1.4, 95%CI: 1.1 to 1.8, p = 0.005, and Asian men were less likely to self harm (RR 0.5, 95% CI: 0.4 to 0.7, p Conclusion This review finds some ethnic differences in the nature and presentation of self harm. This argues for ethnic specific preventive actions. However, the literature does not comprehensively cover the UK's diverse ethnic groups.

  3. Rates, risk factors & methods of self harm among minority ethnic groups in the UK: a systematic review.

    Science.gov (United States)

    Bhui, Kamaldeep; McKenzie, Kwame; Rasul, Farhat

    2007-11-19

    Studies suggest that the rates of self harm vary by ethnic group, but the evidence for variation in risk factors has not been synthesised to inform preventive initiatives. We undertook a systematic literature review of research about self harm that compared at least two ethnic groups in the United Kingdom. 25 publications from 1765 titles and abstracts met our inclusion criteria. There was higher rate of self harm among South Asian women, compared with South Asian men and White women. In a pooled estimate from two studies, compared to their white counterparts, Asian women were more likely to self harm (Relative Risk 1.4, 95%CI: 1.1 to 1.8, p = 0.005), and Asian men were less likely to self harm (RR 0.5, 95% CI: 0.4 to 0.7, p refugees. This review finds some ethnic differences in the nature and presentation of self harm. This argues for ethnic specific preventive actions. However, the literature does not comprehensively cover the UK's diverse ethnic groups.

  4. Aristotle on Deliberation

    DEFF Research Database (Denmark)

    Kock, Christian Erik J

    2014-01-01

    Aristotle differs from most later philosophers in distinguishing clearly between epistemic reasoning, which aims for truth, and practical reasoning, which does not. How can he posit this distinction and yet not dismiss practical reasoning as flattery and manipulation, as Plato did? The answer lies...... in the concepts of deliberation (boulē, bouleusis) and deliberate choice (proairesis). They link Aristotle's rhetoric, ethics, and politics together and help provide definitions of all three: Ethics is about deliberate choices by individuals. Politics and rhetoric are about the collective deliberate choices...

  5. Investigating the role of executive attentional control to self-harm in a non-clinical cohort with borderline personality features.

    Directory of Open Access Journals (Sweden)

    Jennifer eDrabble

    2014-08-01

    Full Text Available Self-injurious behavior (or self-harm is a frequently reported maladaptive behavior in the general population and a key feature of borderline personality disorder (BPD. Poor affect regulation is strongly linked to a propensity to self-harm, is a core component of BPD, and is linked with reduced attentional control abilities. The idea that attentional control difficulties may provide a link between BPD, negative affect and self-harm has yet to be established, however. The present study explored the putative relationship between levels of BPD features, three aspects of attentional/executive control, affect, and self-harm history in a sample of 340 non-clinical participants recruited online from self-harm forums and social networking sites. Analyses showed that self-reported levels of BPD features and attentional focusing predicted self-harm incidence, and high attentional focusing increased the likelihood of a prior self-harm history in those with high BPD features. Ability to shift attention was associated with a reduced likelihood of self-harm, suggesting that good attentional switching ability may provide a protective buffer against self-harm behavior for some individuals. These attentional control differences mediated the association between negative affect and self-harm, but the relationship between BPD and self-harm appears independent.

  6. Intentional self-harm in children and adolescents: A study from psychiatry consultation liaison services of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2015-01-01

    Full Text Available Objective: The objective of this study was to evaluate the socio-demographic and the clinical profile of children and adolescents presenting with Intentional self-harm. Materials and Methods: Records of all children and adolescents (≤19 years seen by the consultation liaison (CL services during the period of 2000-2012 were screened. Patients with a diagnosis of intentional self-harm (at the time of assessment were taken up for this study. Data was extracted from the records, to study the socio-demographic and clinical profile. Results: During the study period, 101 patients aged ≤19 years and diagnosed with intentional self-harm at the time of admission were evaluated by the psychiatry CL services in various emergency and medical surgical wards. In the study population, females (N = 61; 60.4% outnumbered males. The age of the patients ranged from 12 to 19 with a median and mean of 17.0 years (standard deviation-1.6 years; interquartile range 16-18 years. Children and adolescent with self harm were more commonly females, from nuclear families, middle socio-economic status and Hindu by religion. The common method of self-harm in adolescents is by ingestion of insecticides (65% and the self-harm behavior was often precipitated by interpersonal problems in the family context. About one-fifth of the patients have psychiatric morbidity. Conclusion: Findings suggest that the most common method of intentional self-harm in children and adolescents is consumption of insecticides and precipitated by interpersonal problems in the family context.

  7. The mediating roles of stress and maladaptive behaviors on self-harm and suicide attempts among runaway and homeless youth.

    Science.gov (United States)

    Moskowitz, Amanda; Stein, Judith A; Lightfoot, Marguerita

    2013-07-01

    Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12-24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these

  8. Non-Suicidal Self-Injury and Indirect Self-Harm among Danish High School Students

    DEFF Research Database (Denmark)

    Møhl, Bo; la Cour, Peter; Skandsen, Annika

    2014-01-01

    -harm (e.g., eating problems, alcohol and drug use) and how this may be influenced by gender. Method: Questionnaires about NSSI (e.g., cutting, burning, scratching, hitting oneself) and indirect self-harm were distri­buted to high school students in theCopenhagen area (N = 5650; response rate 53%; females...... of NSSI as compared with females, and clinicians must look for gender-specific signs of NSSI. It is argued that NSSI can be perceived as a “social pathology,” but it is also indicated that NSSI and indirect self-harm can be evaluated as an expression of ordinary behavior among modern high school students...... 60.8%). Results: A total of 21.5% of the survey respondents had engaged in NSSI (lifetime prevalence), and 16.2% had practiced NSSI within the previous year. Gender differences in NSSI methods were identified. A total of 53.9% of the students had engaged in one or more types of indirect self...

  9. Quality Assessment of Economic Evaluations of Suicide and Self-Harm Interventions

    DEFF Research Database (Denmark)

    Madsen, Lizell B; Hansen, Kristian Schultz; Eddleston, Michael Philip

    2017-01-01

    Background: Death following self-harm constitutes a major global public health challenge and there is an urgent need for governments to implement cost-effective, national suicide prevention strategies. Aim: To conduct a systematic review and quality appraisal of the economic evaluations of interv......Background: Death following self-harm constitutes a major global public health challenge and there is an urgent need for governments to implement cost-effective, national suicide prevention strategies. Aim: To conduct a systematic review and quality appraisal of the economic evaluations...... of interventions aimed at preventing suicidal behavior. Method: A systematic literature search was performed in several literature databases to identify relevant articles published from 2003 to 2016. Drummond’s 10-item appraisal tool was used to assess the methodological quality of the included studies. Results......: In total, 25 documents encompassing 30 economic evaluations were included in the review. Of the identified evaluations, 10 studies were found to be of poor quality, 14 were of average quality, and six studies were considered of good quality. The majority of evaluations found the interventions to be cost...

  10. Fractured Identity: A Framework for Understanding Young Asian American Women's Self-harm and Suicidal Behaviors.

    Science.gov (United States)

    Hahm, Hyeouk Chris; Gonyea, Judith G; Chiao, Christine; Koritsanszky, Luca Anna

    2014-01-01

    Despite the high suicide rate among young Asian American women, the reasons for this phenomenon remain unclear. This qualitative study explored the family experiences of 16 young Asian American women who are children of immigrants and report a history of self-harm and/or suicidal behaviors. Our findings suggest that the participants experienced multiple types of "disempowering parenting styles" that are characterized as: abusive, burdening, culturally disjointed, disengaged, and gender-prescriptive parenting. Tied to these family dynamics is the double bind that participants suffer. Exposed to multiple types of negative parenting, the women felt paralyzed by opposing forces, caught between a deep desire to satisfy their parents' expectations as well as societal expectations and to simultaneously rebel against the image of "the perfect Asian woman." Torn by the double bind, these women developed a "fractured identity," which led to the use of "unsafe coping" strategies. Trapped in a "web of pain," the young women suffered alone and engaged in self-harm and suicidal behaviors.

  11. Maladaptive perfectionism's link to aggression and self-harm: Emotion regulation as a mechanism.

    Science.gov (United States)

    Chester, David S; Merwin, Lauren M; DeWall, C Nathan

    2015-01-01

    The negative affect that results from negative feedback is a substantial, proximal cause of aggression. People high in maladaptive perfectionism, the tendency to focus on the discrepancy between one's standards and performance, are characterized by an exaggerated negative affective response to negative feedback. This exacerbated affective response to failure may then dispose them to hurt others and themselves as aggression and self-harm are often perceived as a means to regulate negative affect. In Study 1, we demonstrated that maladaptive perfectionism was linked to greater aggressive behavior towards others after receiving negative feedback. Suggesting the presence of an emotion regulation strategy, this effect was mediated by the motivation to use aggression to improve mood. In Study 2, maladaptive perfectionism was linked to self-harm, an effect exacerbated by negative feedback and mediated by negative affect. These findings suggest that maladaptive perfectionists are at risk for greater harm towards others and the self because negative feedback has a stronger affective impact and harming others and the self is perceived a means to alleviate this aversive state. © 2014 Wiley Periodicals, Inc.

  12. Emergency mental health nursing for self-harming refugees and asylum seekers.

    Science.gov (United States)

    Procter, Nicholas G

    2005-09-01

    This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

  13. Non-Suicidal Self-Injury and Indirect Self-Harm among Danish High School Students

    DEFF Research Database (Denmark)

    Møhl, Bo; la Cour, Peter; Skandsen, Annika

    2014-01-01

    -harm (e.g., eating problems, alcohol and drug use) and how this may be influenced by gender. Method: Questionnaires about NSSI (e.g., cutting, burning, scratching, hitting oneself) and indirect self-harm were distri­buted to high school students in theCopenhagen area (N = 5650; response rate 53%; females...... 60.8%). Results: A total of 21.5% of the survey respondents had engaged in NSSI (lifetime prevalence), and 16.2% had practiced NSSI within the previous year. Gender differences in NSSI methods were identified. A total of 53.9% of the students had engaged in one or more types of indirect self...... of NSSI as compared with females, and clinicians must look for gender-specific signs of NSSI. It is argued that NSSI can be perceived as a “social pathology,” but it is also indicated that NSSI and indirect self-harm can be evaluated as an expression of ordinary behavior among modern high school students...

  14. Incidence and outcomes of emergency self-harm among adolescents: a descriptive epidemiological study in Osaka City, Japan

    Science.gov (United States)

    Matsuyama, Tasuku; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Hayashida, Sumito; Nitta, Masahiko; Kawamura, Takashi; Iwami, Taku; Ohta, Bon

    2016-01-01

    Objectives To evaluate the incidence and outcomes of self-harm from ambulance records. Design A retrospective, observational study. Setting Osaka City, Japan. Participants A total of 365 adolescents aged 10–19 years with emergency self-harm such as poisoning by drugs or gas, cutting skin, jumping from heights, hanging and drowning and treated by emergency medical service personnel from January 2010 through December 2012. Primary outcome measurements Incidence per 100 000 persons and outcome at the scene or hospital arrival by age and gender. Poisson regression models for incidence evaluation were used; reporting relative risks (RRs) and their 95% CIs. Results During the study period, a total of 425 self-harm events were documented in 365 adolescents. The incidence of self-harm increased significantly between the ages of 11 and 19 years, from 6.3 to 81.0 among boys and the ages of 12 and 19 years from 6.3 to 228.3 among girls, respectively (both p<0.001). Although there was no incidence difference between girls and boys in the group aged 11–14 years (RR 1.20; 95% CI 0.59 to 2.47), the incidence was significantly higher among girls than boys in the group aged 15–19 years (RR 4.18; 95% CI 3.20 to 5.45). The overall proportion of death by self-harm was 4.9%. The proportion of hospital admission and death by self-harm was higher among boys than among girls (38.6% vs 25.2%, p=0.016 and 14.8% vs 2.4%, p<0.001). Conclusions The incidence of emergency treatment for self-harm by adolescents increased with age and our findings also demonstrated the gender paradox. It would be necessary to establish active, gender-specific and comprehensive prevention strategies for adolescent self-harm, based on our findings showing the age and gender differences of self-harm among adolescents. PMID:27381208

  15. Understanding self-harm in victims of intimate partner violence: a qualitative analysis of calls made by victims to a crisis hotline in China.

    Science.gov (United States)

    Wong, Susan P Y; Wang, Cuiling; Meng, Mei; Phillips, Michael R

    2011-04-01

    Text analysis of the transcripts of 26 calls made to a Chinese crisis hotline by victims of intimate partner violence (IPV) reporting thoughts or acts of self-harm abstracted information on victims' patterns of self-harm and the relationship of their self-harm to IPV. Specific violent episodes often triggered self-harm. Victims considered self-harm a method for airing painful emotions caused by abuse or as a last resort to escape by dying when they saw no other options and were no longer able to endure the violence. We also elaborate on callers' discussions of barriers to accessing support, sociocultural pressures to preserve "face" and family, and restrictive gender roles that contribute to their self-harm behaviors.

  16. Penile self-harm: a case report and concise clinical review.

    Science.gov (United States)

    Raslan, Mutie; Donaldson, James; Royle, Justine

    2015-01-01

    Male genital self-mutilation is extremely rare and may be associated with severe psychopathology. This study reports the case of a 26-year-old man who presented after incising his prepuce with a knife and placing a rubber band around his foreskin. A plastic ring was also found underneath the prepuce. Clinical examination revealed a lateral preputial laceration with gross preputial oedema and dark red discoloration with a clear demarcation where the elastic band had been placed. A pelvic X-ray revealed no other foreign bodies. Following 72 h of observation he developed signs of preputial necrosis, which prompted urgent circumcision; this revealed a healthy underlying glans. In conclusion, male genital self-harm requires urgent urological and psychiatric assessments to prevent surgical and psychiatric sequelae including necrotizing fasciitis and suicide.

  17. Suicidality, Self-Harm, and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria.

    Science.gov (United States)

    Peterson, Claire M; Matthews, Abigail; Copps-Smith, Emily; Conard, Lee Ann

    2016-08-19

    Prevalence of suicide attempts, self-injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty-seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self-injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female-to-male youth reported a history of suicide attempts and self-harm behaviors than male-to-female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life-threatening behaviors.

  18. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis.

    Science.gov (United States)

    Tsiachristas, Apostolos; McDaid, David; Casey, Deborah; Brand, Fiona; Leal, Jose; Park, A-La; Geulayov, Galit; Hawton, Keith

    2017-09-07

    Self-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs. In a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm. Between April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; pCosts were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean costs of

  19. "This is a question we have to ask everyone": asking young people about self-harm and suicide.

    Science.gov (United States)

    O'Reilly, M; Kiyimba, N; Karim, K

    2016-10-01

    WHAT IS KNOWN ON THE SUBJECT?: An essential part of the mental health assessment is to evaluate the risk of harm to self. Fundamentally this involves asking directly about self-harming behaviour and suicidal thoughts or urges, but practitioners often find it difficult to open up these conversations. This evaluation of risk is particularly important as self-harm and suicidal thoughts are frequently found in young people who attend mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Young people are not always routinely asked directly about self-harm or suicidal thoughts when they are assessed. There are two ways that mental health practitioners introduce this topic: first, by building up to it by initially asking about general feelings, and second by stating that it is a requirement to ask everyone. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These questions should not be avoided by mental health practitioners just because they are difficult. We offer suggestions as to how to ask questions about self-harm and suicide based on real-world practice.

  20. Adolescents' Self-Reported Suicide Attempts, Self-Harm Thoughts and Their Correlates across 17 European Countries

    Science.gov (United States)

    Kokkevi, A.; Rotsika, V.; Arapaki, A.; Richardson, C.

    2012-01-01

    Background: Suicide is a leading cause of death among adolescents in Europe. Self-harm thoughts and behaviours are documented precursors of completed suicide. It is therefore of great importance to investigate the prevalence of suicide thoughts and attempts and their correlates, with the aim of preventing this major life-threatening public health…

  1. The Mediating Roles of Stress and Maladaptive Behaviors on Self-Harm and Suicide Attempts among Runaway and Homeless Youth

    Science.gov (United States)

    Moskowitz, Amanda; Stein, Judith A.; Lightfoot, Marguerita

    2013-01-01

    Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and…

  2. The Mediating Roles of Stress and Maladaptive Behaviors on Self-Harm and Suicide Attempts among Runaway and Homeless Youth

    Science.gov (United States)

    Moskowitz, Amanda; Stein, Judith A.; Lightfoot, Marguerita

    2013-01-01

    Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and…

  3. An audit of the NICE self-harm guidelines at a local Accident and Emergency department in North Wales.

    Science.gov (United States)

    Jones, Russell; Avies-Jones, Alison

    2007-10-01

    This paper reports the findings of a self-harm audit based on data collected at an A&E department in North Wales. The National Institute for Clinical Excellence (NICE) guidelines on the short term physical and psychological management of self-harm were published in 2004 and the audit was based on technical criteria recommended in the guideline booklet, including standards of psychosocial assessment, staff training and patient satisfaction information. The data in this study related to fifty consecutive self-harm attendances at the A&E department Ysbyty Glan Clwyd in the Spring of 2007. The hospital serves a mixed rural/urban population of approximately 250,000. Patient satisfaction questionnaires were made available to the group subsequently, whilst the staff training audit was distributed more widely to include emergency, medicine and mental health divisions of the Conwy & Denbighshire NHS Trust. The results demonstrated generally high standards of care on psychosocial assessment, though information relating to initial ambulance involvement in treatment was often unclear. The response to the staff-training questionnaire was an encouraging 44% and indicated wide variations between staff groups and areas of work. The patient satisfaction returns demonstrated favourable responses, with several comments added to expand on tick box replies. Service developments, as a result of the audit, include the proposal to provide mental health and self-harm training to all those staff likely to encounter the behaviour--not just to those who work in mental health. Patients, from the questionnaire, who express a willingness to become part of a mental health planning group are now provided details of the patient participation involvement (PPI) group, where their experiences can often inform service improvement. Meanwhile the case note audit has reinforced the need for a practical self-harm pathway which will ensure consistency.

  4. Systematic Review and Meta-Analysis of Interventions Relevant for Young Offenders with Mood Disorders, Anxiety Disorders, or Self-Harm

    Science.gov (United States)

    Townsend, Ellen; Walker, Dawn-Marie; Sargeant, Sally; Vostanis, Panos; Hawton, Keith; Stocker, Olivia; Sithole, Jabulani

    2010-01-01

    Background: Mood and anxiety disorders, and problems with self-harm are significant and serious issues that are common in young people in the Criminal Justice System. Aims: To examine whether interventions relevant to young offenders with mood or anxiety disorders, or problems with self-harm are effective. Method: Systematic review and…

  5. Improving communication and practical skills in working with inpatients who self-harm : A pre-test/post-test study of the effect of a training programme

    NARCIS (Netherlands)

    Kool, Nienke; Meijel, Berno van; Koekkoek, Bauke; Bijl, Jaap van der; Kerkhof, Ad

    2014-01-01

    Background Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and

  6. Harm avoidance, self-harm, psychic pain, and the borderline personality: life in a "haunted house".

    Science.gov (United States)

    Korner, Anthony; Gerull, Friederike; Stevenson, Janine; Meares, Russell

    2007-01-01

    This article investigates the pattern of temperament for patients with borderline personality disorder and the impact of psychotherapeutic treatment on temperamental variables. A cohort of patients treated in the Westmead Borderline Personality Disorder Psychotherapy research project completed the Tridimensional Personality Questionnaire. All patients had a diagnosis of borderline personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria. This group scored highly on novelty-seeking and harm avoidance scales and moderately on reward dependence. There was a significant reduction in harm avoidance after 12 months of psychotherapy with a further reduction after 2 years in therapy. Although at variance with Cloninger's original prediction of low harm avoidance in histrionic and borderline patients, results are consistent with other studies in this patient group. The paradox of "self-harmers" scoring highly on harm avoidance may be explained by recognition of the intensity of "psychic pain" in this group. Self-harming behaviors may frequently be motivated by avoidance of a "greater harm" in terms of the inner psychic reality for these patients. Reduction in harm avoidance with psychotherapy could suggest an impact of treatment on temperament or may indicate that the harm avoidance construct is influenced by state variables such as mood.

  7. Self-harm in children placed in a Court-Mandated Holding and Education Centre: analysis of socio-demographic variables and influence of implementation of judicial measures

    Directory of Open Access Journals (Sweden)

    G. García

    2015-10-01

    Full Text Available Objectives: To analyze and understand the existence of self-harming behavior in a detention centre for minors. Methods: Review of self-harm cases detected in a population of 94 inmates in 2013. Results: 26.5% of young offenders have conducted some form of self injury. 28% of individuals with self harming behaviors have more than 6 episodes over the period of internment. Self-beating is the most common type of self-harm performed by this group. Inmates serving sentences in the therapeutic section tend to present spillover effects in terms of self-injury. Discussion: The population held in prison show higher percentages of self-harm than amongst the general population. The chosen type of behavior is determined by the institution. Inmates that present greater mental fragility tend to perform these behaviors and in greater number.

  8. Self-harm in children placed in a Court-Mandated Holding and Education Centre: analysis of socio-demographic variables and influence of implementation of judicial measures.

    Science.gov (United States)

    García, G

    2015-01-01

    To analyze and understand the existence of self-harming behavior in a detention centre for minors. Review of self-harm cases detected in a population of 94 inmates in 2013. 26.5% of young offenders have conducted some form of self injury. 28% of individuals with self harming behaviors have more than 6 episodes over the period of internment. Self-beating is the most common type of self-harm performed by this group. Inmates serving sentences in the therapeutic section tend to present spillover effects in terms of self-injury. The population held in prison show higher percentages of self-harm than amongst the general population. The chosen type of behavior is determined by the institution. Inmates that present greater mental fragility tend to perform these behaviors and in greater number.

  9. Investigating the feasibility of an enhanced contact intervention in self-harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH)

    Science.gov (United States)

    John, Ann; Islam, Saiful; Jones, Richard; Anderson, Pippa; Davies, Charlotte; Khanom, Ashra; Harris, Shaun; Huxley, Peter

    2016-01-01

    Introduction Self-harm is a strong predictor for suicide. Risks for repeat behaviour are heightened in the aftermath of an index episode. There is no consensus on the most effective type of intervention to reduce repetition. Treatment options for patients who do not require secondary mental health services include no support, discharge to general practitioner or referral to primary care mental health support services. The aim of this study is to assess whether it is feasible to deliver a brief intervention after an episode and whether this can reduce depressive symptoms and increase the sense of well-being for patients who self-harm. Methods This is a non-blinded parallel group randomised clinical trial. 120 patients presenting with self-harm and/or suicidal ideation to mental health services over a 12-month period who are not referred to secondary services will be randomised to either intervention plus treatment as usual (TAU), or control (TAU only). Patients are assessed at baseline, 4 and 12 weeks with standardised measures to collect data on depression, well-being and service use. Primary outcome is depression scores and secondary outcomes are well-being scores and use of services. The findings will indicate whether a rapid response brief intervention is feasible and can reduce depression and increase well-being among patients who self-harm and do not require secondary services. Ethics and dissemination Ethical approval was granted by the UK National Health Service (NHS) Ethics Committee process (REC 6: 14/WA/0074). The findings of the trial will be disseminated through presentations to the participating Health Board and partners, peer-reviewed journals and national and international conferences. Trial registration number ISRCTN76914248; Pre-results. PMID:27630071

  10. Establishing Political Deliberation Systems

    DEFF Research Database (Denmark)

    Rose, Jeremy; Sæbø, Øystein

    2008-01-01

    headings: stakeholder engagement, web platform design, web platform management, political process re-shaping and evaluation and improvement. We review the existing literature and present a longitudinal case study of a political discussion forum: the Norwegian DemokratiTorget (Democracy Square).  We define...... key problems in each of the five areas which need to be overcome in order to launch and sustain a successful net-based political deliberation forum....

  11. Preference for Solitude, Social Isolation, Suicidal Ideation, and Self-Harm in Adolescents.

    Science.gov (United States)

    Endo, Kaori; Ando, Shuntaro; Shimodera, Shinji; Yamasaki, Syudo; Usami, Satoshi; Okazaki, Yuji; Sasaki, Tsukasa; Richards, Marcus; Hatch, Stephani; Nishida, Atsushi

    2017-08-01

    Social isolation is associated with suicidal ideation (SI) and self-harm (SH) among adolescents. However, the association between preference for solitude (PfS), SI, and SH is unknown. The prevalence of adolescents who have both of PfS and social isolation and the risks for SI and SH among them are also unknown. Information on PfS, social isolation, SI, and SH was collected in a large-scale school-based survey on adolescents, using a self-report questionnaire. Associations between PfS, SI, and SH were examined by logistic regression analysis. The interactions between PfS and social isolation on SI and SH were also investigated. The odds of SI and SH were examined for groups defined by presence of PfS and social isolation. Responses from 17,437 students (89.3% of relevant classes) were available. After adjusting for demographic characteristics and social isolation, PfS was associated with increased odds of SI (odds ratio [OR] = 3.1) and SH (OR = 1.9). There was no interaction between PfS and social isolation on SI and SH. After adjusting for demographic characteristics, the odds for SI (OR = 8.6) and SH (OR = 3.8) were highest among adolescents with both PfS and social isolation (8.4% of all respondents). PfS was associated with increased odds of SI and SH in adolescents. No interaction effect between PfS and social isolation on SI and SH was found, but adolescents with PfS and social isolation had the highest risk for SI and SH. Parents and professionals should pay attention to suicide risk in adolescents with PfS. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  12. Suicide and the 'Poison Complex': Toxic Relationalities, Child Development, and the Sri Lankan Self-Harm Epidemic.

    Science.gov (United States)

    Widger, Tom

    2015-01-01

    Suicide prevention efforts in Asia have increasingly turned to 'quick win' means restriction, while more complicated cognitive restriction and psychosocial programs are limited. This article argues the development of cognitive restriction programs requires greater consideration of suicide methods as social practices, and of how suicide cognitive schemata form. To illustrate this, the article contributes an ethnographically grounded study of how self-poisoning becomes cognitively available in Sri Lanka. I argue the overwhelming preference for poison as a method of self-harm in the country is not simply reflective of its widespread availability, but rather how cognitive schemata of poison-a 'poison complex'-develops from early childhood and is a precondition for suicide schemata. Limiting cognitive availability thus requires an entirely novel approach to suicide prevention that draws back from its immediate object (methods and causes of self-harm) to engage the wider poison complex of which suicide is just one aspect.

  13. Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE guidelines being met?

    Directory of Open Access Journals (Sweden)

    Jordan Rita

    2008-10-01

    Full Text Available Abstract Background Most patients contact their general practitioner (GP following presentation to an Emergency Department (ED after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE guidelines on the short-term management of people who self-harm. Methods An audit of medical records (ED and Psychiatric on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital. Results We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist. Conclusion Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS trusts would establish if this is a problem elsewhere.

  14. The Relationship between Problem-Solving Ability and Self-Harm amongst People with Mild Intellectual Disabilities

    Science.gov (United States)

    Rees, Joanna; Langdon, Peter E.

    2016-01-01

    Background The purpose of this study was to investigate the relationship between depression, hopelessness, problem-solving ability and self-harming behaviours amongst people with mild intellectual disabilities (IDs). Methods Thirty-six people with mild IDs (77.9% women, M[subscript age] = 31.77, SD = 10.73, M[subscript IQ] = 62.65, SD = 5.74) who…

  15. Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the 'failed' self.

    Science.gov (United States)

    McDermott, Elizabeth

    2015-11-01

    International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) 'tell' their selves as 'failed'. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective.

  16. Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers

    Directory of Open Access Journals (Sweden)

    Britt-Marie Lindgren

    2010-09-01

    Full Text Available The aim of the study was to discover and describe lived experiences of professional care and caregivers among parents of adults who self-harm. Narrative interviews were conducted with six parents of daughters with self-harming behaviours and analysed using a phenomenological hermeneutic approach. The meanings of the parents’ narratives of their lived experiences of professional care and caregivers were interpreted as their being involved in ‘limit situations’ comparable to hostage dramas. Several meaningful themes contributed to this interpretation: being trapped in a situation with no escape; being in the prisoner's dock; groping in the dark; and finding glimmers of hope. Parents of daughters who were in care because of self-harming often felt obliged to pay an emotional ransom, which included feelings of being accused, being ‘broken’, being confused, and feeling lost. Moments of peace occurred as welcome breaks offering a short time of rest for the parents. Situations that were understood by the parents and solved in a peaceful way were experienced as a respite and inspired parents with hope for their daughters’ recovery.

  17. Self-harm in laboratory-housed primates: where is the evidence that the Animal Welfare Act amendment has worked?

    Science.gov (United States)

    Balcombe, Jonathan; Ferdowsian, Hope; Durham, Debra

    2011-01-01

    The 1985 amendment to the United States Animal Welfare Act (AWA) to promote psychological well being of primates in the laboratory represents an acknowledgment of an important welfare problem concerning nonhuman animals. How effective has this amendment been? Perhaps the best-known contributor to psychological distress in primates in the laboratory is nonsocial housing; yet, available analyses suggest that little progress has been made in avoiding single-caging of these animals. Another way to assess psychological well being is to examine rates of self-abusive behavior in laboratory primates. If the AWA has been effective, then post-AWA self-harm rates might be lower than pre-AWA rates. However, when we attempted to determine those rates from published studies, data were too sparse to allow a rigorous statistical analysis; of 139 studies reporting primate self-harming behavior, only 9 contained data allowing estimation of self-harming behavior rates. We conclude that the current system of laboratory animal care and record keeping is inadequate to properly assess AWA impacts on primate psychological well being and that more is required to ensure the psychological well being of primates.

  18. 初中生自我伤害行为危险因素分析%Risk factor analysis for self-harm behavior in junior high school students

    Institute of Scientific and Technical Information of China (English)

    王蕾; 孙月吉; 林媛; 金鑫; 李旭红; 刘媛; 梁杰

    2014-01-01

    目的:调查大连市1463名在校初中生的自伤发生率及其相关危险因素。方法以符合CCMD-3蓄意自我伤害诊断标准的75名初中生为研究组(自伤组),匹配正常者为对照组。方法采用一般问卷、青少年生活事件量表(ASLEC)、父母养育方式评价量表(EMBU)和应付方式问卷(CSA)进行调查。结果自伤检出率为5.4%,其中男生2.8%,女生2.6%,性别间差异无显著性意义(χ2=1.636, P=0.441)。13岁为蓄意自伤高发年龄,各年龄组间差异明显(χ2=20.827, P=0.000)。 ASLEC量表中的人际关系、学习压力因子,组间差异明显( t1-2=2.082,4.033;P1-2=0.039,0.000),“学习压力”是初中生主要压力源;EMBU量表中父母“情感温暖”在自伤组得分显著低于正常组(父亲t=-3.839, P=0.000;母亲t=-4.007, P=0.000);CSA量表的自责、退避、幻想因子分组间差异显著(自责t=3,577,P=0.000;退避t=4.294, P=0.000;幻想t=2.589, P=0.011)。二元Logistic回归分析揭示初中生自伤行为危险因素包括:自责、退避、合理化、学习压力和被惩罚;自伤行为的危险因素存在性别差异。结论初中生自伤行为发生率较高,主要危险因素是学习压力、父母关爱不足、人际交往问题。%Objective To investigate self-harm incidence and risk factors in junior high school students in Dalian city . Methods 75 junior high school students , who met the DSH diagnosis standards of CCMD -3, were recruited in the study group.Control group included matched normal students .The study used General Screening Questionnaire , Adolescent Life Event Scale (ASLEC), EMBU (Egma Minnen av Bardndosnauppforstran ) and Coping Style Questionnaire (CSA).Re-sults The rate of self-harm behavior was 5.4%in the junior high school students with 2.8%in boys and 2.6%in girls

  19. Deliberate Perspectival Obstructions

    DEFF Research Database (Denmark)

    Mikkelsen, Henrik Hvenegaard; Rasmussen, Anders Emil

    2016-01-01

    to a radical shift in perspective that allows partly for the invisible and absent to emerge as visible and present, and for different potentialities of persons and social relations to be brought to light. Hence the article demonstrates how obstruction and intervention as parts of the ethnographic methodology...... may help elicit perspectives that are otherwise kept hidden (deliberately or not), such as power-relations or the occluded side of a friendship or a kinship relation. This, in turn, also poses a danger to the otherwise collaborative ideal of modern ethnographic fieldwork in literally challenging...

  20. Emotion regulation, depression and self-harming behaviours in people with borderline personality disorder: the moderating role of action vs. state orientation

    Directory of Open Access Journals (Sweden)

    Sybilla Blasczyk-Schiep

    2016-01-01

    Full Text Available Background The aim of this research is to determine the level of emotion regulation, studied through the method of variable action orientation vs. state and its relationship with depressiveness and dimension of the reasons for living and self-harming behaviour of patients with borderline personality disorder. Participants and procedure The research studied 61 patients diagnosed with an emotionally unstable personality of borderline type. The research used the Polish adaptation of tests to measure the action vs. state orientation (SSI-K, the self-harming behaviour (SHI, depression (BDI and the reasons for living vs. suicidal tendency (RFL-I. Results In people with borderline personality disorder, the level of emotion regulation (action vs. state orientation, reasons for living and depression are predictors of self-harming behaviour. The experience of a depressive episode or lack thereof does not have a relationship with the increase of self-harming. Analysis of the interaction between variables showed that the reasons for living and the action orientation after failure are related to the reduction of self-harming behaviour in all subjects. In depressed people, state orientation is associated with an increase in the action orientation with decreased self-destructive behaviours. Conclusions High levels of reasons for living in interaction with the action orientation have a negative relationship with the self-harming behaviour of patients diagnosed with borderline personality disorder. Among those subjects, depressive patients, a statistically lower level of self-harm is related to the action orientation. These results suggest that therapeutic treatment is important to activate both reasons for living as well as action orientation as effective dimensions in preventing self-harming.

  1. The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people.

    Science.gov (United States)

    Daine, Kate; Hawton, Keith; Singaravelu, Vinod; Stewart, Anne; Simkin, Sue; Montgomery, Paul

    2013-01-01

    There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating. Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to 'cyber-bully' peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm. Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

  2. The Power of the Web: A Systematic Review of Studies of the Influence of the Internet on Self-Harm and Suicide in Young People

    OpenAIRE

    Kate Daine; Keith Hawton; Vinod Singaravelu; Anne Stewart; Sue Simkin; Paul Montgomery

    2013-01-01

    BACKGROUND: There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. METHODS: An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-...

  3. Emotion regulation, depression and self-harming behaviours in people with borderline personality disorder: the moderating role of action vs. state orientation

    Directory of Open Access Journals (Sweden)

    Sybilla Blasczyk-Schiep

    2016-01-01

    Full Text Available Background The aim of this research is to determine the level of emotion regulation, studied through the method of variable action orientation vs. state and its relationship with depressiveness and dimension of the reasons for living and self-harming behaviour of patients with borderline personality disorder. Participants and procedure The research studied 61 patients diagnosed with an emotionally unstable personality of borderline type. The research used the Polish adaptation of tests to measure the action vs. state orientation (SSI-K, the self-harming behaviour (SHI, depression (BDI and the reasons for living vs. suicidal tendency (RFL-I. Results In people with borderline personality disorder, the level of emotion regulation (action vs. state orientation, reasons for living and depression are predictors of self-harming behaviour. The experience of a depressive episode or lack thereof does not have a relationship with the increase of self-harming. Analysis of the interaction between variables showed that the reasons for living and the action orientation after failure are related to the reduction of self-harming behaviour in all subjects. In depressed people, state orientation is associated with an increase in the action orientation with decreased self-destructive behaviours. Conclusions High levels of reasons for living in interaction with the action orientation have a negative relationship with the self-harming behaviour of patients diagnosed with borderline personality disorder. Among those subjects, depressive patients, a statistically lower level of self-harm is related to the action orientation. These results suggest that therapeutic treatment is important to activate both reasons for living as well as action orientation as effective dimensions in preventing self-harming.

  4. Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study.

    LENUS (Irish Health Repository)

    O'Farrell, I B

    2014-10-15

    Previous research has shown an inconsistent relationship between the spatial distribution of hospital treated self-harm and area-level factors such as deprivation and social fragmentation. However, many of these studies have been confined to urban centres, with few focusing on rural settings and even fewer studies carried out at a national level. Furthermore, no previous research has investigated if travel time to hospital services can explain the area-level variation in the incidence of hospital treated self-harm.

  5. The power of the web: a systematic review of studies of the influence of the internet on self-harm and suicide in young people.

    Directory of Open Access Journals (Sweden)

    Kate Daine

    Full Text Available BACKGROUND: There is concern that the internet is playing an increasing role in self-harm and suicide. In this study we systematically review and analyse research literature to determine whether there is evidence that the internet influences the risk of self-harm or suicide in young people. METHODS: An electronic literature search was conducted using the PsycINFO, MEDLINE, EMBASE, Scopus, and CINAHL databases. Articles of interest were those that included empirical data on the internet, self-harm or suicide, and young people. The articles were initially screened based on titles and abstracts, then by review of the full publications, after which those included in the review were subjected to data extraction, thematic analysis and quality rating. RESULTS: Youth who self-harm or are suicidal often make use of the internet. It is most commonly used for constructive reasons such as seeking support and coping strategies, but may exert a negative influence, normalising self-harm and potentially discouraging disclosure or professional help-seeking. The internet has created channels of communication that can be misused to 'cyber-bully' peers; both cyber-bullying and general internet use have been found to correlate with increased risk of self-harm, suicidal ideation, and depression. Correlations have also been found between internet exposure and violent methods of self-harm. CONCLUSIONS: Internet use may exert both positive and negative effects on young people at risk of self-harm or suicide. Careful high quality research is needed to better understand how internet media may exert negative influences and should also focus on how the internet might be utilised to intervene with vulnerable young people.

  6. Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners.

    Science.gov (United States)

    James, Karen; Samuels, Isaac; Moran, Paul; Stewart, Duncan

    2017-05-01

    Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents. Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves. This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice. Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  7. Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors

    Directory of Open Access Journals (Sweden)

    Angela C. Jones

    2012-01-01

    Full Text Available The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131, a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies.

  8. The role of schools in children and young people's self-harm and suicide: systematic review and meta-ethnography of qualitative research.

    Science.gov (United States)

    Evans, Rhiannon; Hurrell, Chloe

    2016-05-14

    Evidence reports that schools influence children and young people's health behaviours across a range of outcomes. However there remains limited understanding of the mechanisms through which institutional features may structure self-harm and suicide. This paper reports on a systematic review and meta-ethnography of qualitative research exploring how schools influence self-harm and suicide in students. Systematic searches were conducted of nineteen databases from inception to June 2015. English language, primary research studies, utilising any qualitative research design to report on the influence of primary or secondary educational settings (or international equivalents) on children and young people's self-harm and suicide were included. Two reviewers independently appraised studies against the inclusion criteria, assessed quality, and abstracted data. Data synthesis was conducted in adherence with Noblit and Hare's meta-ethnographic approach. Of 6744 unique articles identified, six articles reporting on five studies were included in the meta-ethnography. Five meta-themes emerged from the studies. First, self-harm is often rendered invisible within educational settings, meaning it is not prioritised within the curriculum despite students' expressed need. Second, where self-harm transgresses institutional rules it may be treated as 'bad behaviour', meaning adequate support is denied. Third, schools' informal management strategy of escalating incidents of self-harm to external 'experts' serves to contribute to non-help seeking behaviour amongst students who desire confidential support from teachers. Fourth, anxiety and stress associated with school performance may escalate self-harm and suicide. Fifth, bullying within the school context can contribute to self-harm, whilst some young people may engage in these practices as initiation into a social group. Schools may influence children and young people's self-harm, although evidence of their impact on suicide remains

  9. Deliberate practice in teacher education

    NARCIS (Netherlands)

    Bronkhorst, L.H.; Meijer, P.C.; Koster, B.; Vermunt, J.D.H.M.

    2014-01-01

    Deliberate practice is increasingly recognised as necessary for professional development. This paper sets out to explore in what ways student teachers’ learning activities in a teacher education programme can be characterised as deliberate practice. Based on an in-depth exploration of 574 learning

  10. Supportive interchanges and face-work as 'protective talk' in an online self-harm support forum.

    Science.gov (United States)

    Sharkey, Siobhan; Smithson, Janet; Hewis, Elaine; Jones, Ray; Emmens, Tobit; Ford, Tamsin; Owens, Christabel

    2012-01-01

    Within a context of concern about inappropriate advice-giving online, we examined how young people who self-harm behave online, and how professionals might engage with them. We use Discourse Analysis to focus on participant interactions (posts)from a forum's crisis/support rooms, and highlight the prevalence of disclaimers, hedges, questions and tags in the young people's online interactions. We use the concept of face-work as a framework to help understand interactions in the forum SharpTalk. The findings demonstrate the use of a range of mitigation devices, and suggest that the young people orientate to a 'protective' line in their supportive interactions. These findings echo Goffman's (1967) 'supportive interchanges' in that the young people's online interactions may help to preserve face, in an emotionally complex setting, whose vulnerable members also need 'protective'and sensitive support. Taking this 'line' may enable members to create a more open and trusting context for support, and to remain in a forum which they find both helpful and challenging. In light of concerns about online support, the findings provide a new perspective on online peer-support for young people who self-harm.

  11. Medico legal aspects of self-injection of metallic mercury in cases of suicide or self-harming.

    Science.gov (United States)

    Da Broi, Ugo; Moreschi, Carlo; Colatutto, Antonio; Marcon, Barbara; Zago, Silvia

    2017-08-01

    Metallic mercury may be self-injected for suicidal or self-harm purposes or sometimes for superstitious or other inadvisable reasons. Local tissue or systemic consequences such as mercurialism can frequently occur in cases of subcutaneous or deep injection, while death due to pulmonary embolism and cardiac, brain, hepatic or renal toxicity may occur in cases of high dosage intravenous administration. The aim of this review is to focus on the diagnostic difficulties facing coroners and forensic pathologists when the courts require confirmation that evidence of self-injection of metallic mercury is the result of suicide or self-harming. Forensic examination performed on the corpses of victims who died in or out of hospital or on surviving injured or intoxicated victims showing signs of mercurialism, demands the careful evaluation of the death scene, of all related circumstances and of the clinical and autopsy data. Close interaction between forensic pathologists and toxicologists is also needed to identify and quantify mercury levels in blood, urine and tissue. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  12. Deliberate change without hierarchical influence?

    DEFF Research Database (Denmark)

    Nørskov, Sladjana; Kesting, Peter; Ulhøi, John Parm

    2017-01-01

    Purpose This paper aims to present that deliberate change is strongly associated with formal structures and top-down influence. Hierarchical configurations have been used to structure processes, overcome resistance and get things done. But is deliberate change also possible without formal...... reveals that deliberate change is indeed achievable in a non-hierarchical collaborative OSS community context. However, it presupposes the presence and active involvement of informal change agents. The paper identifies and specifies four key drivers for change agents’ influence. Originality....../value The findings contribute to organisational analysis by providing a deeper understanding of the importance of leadership in making deliberate change possible in non-hierarchical settings. It points to the importance of “change-by-conviction”, essentially based on voluntary behaviour. This can open the door...

  13. Trauma typology as a risk factor for aggression and self-harm in a complex PTSD population: the mediating role of alterations in self-perception.

    Science.gov (United States)

    Dyer, Kevin F W; Dorahy, Martin J; Shannon, Maria; Corry, Mary

    2013-01-01

    This study examined the role of prolonged, repeated traumatic experiences such as childhood and sectarian trauma in the development of posttraumatic aggression and self-harm. Forty-four adult participants attending therapy for complex trauma in Northern Ireland were obtained via convenience sampling. When social desirability was controlled, childhood emotional and physical neglect were significant correlates of posttraumatic hostility and history of self-harm. These relationships were mediated by alterations in self-perception (e.g., shame, guilt). Severity of sectarian-related experiences was not related to self-destructive behaviors. Moreover, none of the trauma factors were related to overt aggressive behavior. The findings have implications for understanding risk factors for posttraumatic aggression and self-harm, as well as their treatment.

  14. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER

    DEFF Research Database (Denmark)

    Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina

    2016-01-01

    were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS: At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14......BACKGROUND: Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN: The DiaS trial was designed...... behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes...

  15. Management of suicidal and self-harming behaviors in prisons: systematic literature review of evidence-based activities.

    Science.gov (United States)

    Barker, Emma; Kõlves, Kairi; De Leo, Diego

    2014-01-01

    The purpose of this study was to systematically analyze existing literature testing the effectiveness of programs involving the management of suicidal and self-harming behaviors in prisons. For the study, 545 English-language articles published in peer reviewed journals were retrieved using the terms "suicid*," "prevent*," "prison," or "correctional facility" in SCOPUS, MEDLINE, PROQUEST, and Web of Knowledge. In total, 12 articles were relevant, with 6 involving multi-factored suicide prevention programs, and 2 involving peer focused programs. Others included changes to the referral and care of suicidal inmates, staff training, legislation changes, and a suicide prevention program for inmates with Borderline Personality Disorder. Multi-factored suicide prevention programs appear most effective in the prison environment. Using trained inmates to provide social support to suicidal inmates is promising. Staff attitudes toward training programs were generally positive.

  16. Emotion talk in the context of young people self-harming: facing the feelings in family therapy.

    Science.gov (United States)

    Rogers, Alice; Schmidt, Petra

    2016-04-01

    This article describes the use of emotion talk in the context of using a manualised approach to family therapy where the presenting problem is self-harm. Whilst we understand that there is an internal aspect to emotion, we also consider emotions to be socially purposeful, culturally constructed and interactional. We found that within the presenting families, negative emotions were often talked about as located within the young person. Through using 'emotion talk' (Fredman, 2004) in deconstructing and tracking emotions and exploring how emotions connected to family-of-origin and cultural contexts, we developed an interactional understanding of these emotions. This led to better emotional regulation within the family and offered alternative ways of relating. The article discusses the use of relational reflexivity, and using the therapist and team's emotions to enable the therapeutic process, encouraging reflexivity on the self of the therapist in relation to work with emotions.

  17. Safety, Acceptability, and Use of a Smartphone App, BlueIce, for Young People Who Self-Harm: Protocol for an Open Phase I Trial.

    Science.gov (United States)

    Stallard, Paul; Porter, Joanna; Grist, Rebecca

    2016-11-16

    Up to 18% of adolescents will engage in an act of self-harm before young adulthood, with the majority of acts occurring in private. Mobile apps may offer a way of providing support for young people at times of distress to prevent self-harm. This is a proof-of-concept study designed to explore the safety, acceptability, feasibility, and usability of a smartphone app, BlueIce, with young people who are self-harming. In this phase I open trial we will evaluate BlueIce, a smartphone app developed and coproduced with young people with lived experience of self-harm. BlueIce includes a mood-monitoring diary, selection of mood-lifting techniques based on cognitive behavior therapy and dialectical behavior therapy, and direct access to emergency telephone numbers. We will recruit young people (n=50) attending specialist child and adolescent mental health services with a current or past history of self-harm to trial BlueIce as an adjunct to their usual care. Questionnaires and interviews will be completed at baseline, postfamiliarization (2 weeks), and at follow-up (12 weeks after baseline) to assess safety, app use, and acceptability. Interviews will be undertaken with clinicians to assess the feasibility of BlueIce within a clinical setting. Recruitment occurred between May and November 2016. The recruitment target was 50, and by the beginning of November 54 young people had been referred. This study is the first to evaluate an app specifically developed with young people for young people (under the age of 18 years) who self-harm. It will determine whether BlueIce is acceptable, how often it is used, and whether it is safe and does not have any unintentional adverse effects. This information will determine whether a feasibility trial to test recruitment, randomization, retention, and appropriate outcome measures should be pursued.

  18. Deliberating emission reduction options

    Energy Technology Data Exchange (ETDEWEB)

    Dowd, A.M.; Rodriguez, M.; Jeanneret, T. [Commonwealth Scientific and Industrial Research Organisation CSIRO, 37 Graham Rd, Highett VIC 3190 (Australia); De Best-Waldhober, M.; Straver, K.; Mastop, J.; Paukovic, M. [Energy research Centre of the Netherlands ECN, Policy Studies, Amsterdam (Netherlands)

    2012-06-15

    participants to evaluate and choose between several options tend to lead to pseudo-opinions, incorrect assumptions and isolated responses. In order to address these methodological issues, researchers in the Netherlands created an Information Choice Questionnaire (ICQ). The ICQ provides the respondent with: (1) the entire (complex) policy problem, (2) expert information that is independent and balanced, (3) in a way that is understandable for the general public, (4) is a comparative process, and (5) asks for an evaluation. The aim of this research was to develop an online decision guide to aid public awareness, knowledge, deliberation and choice around carbon dioxide capture and storage (CCS) compared with other greenhouse gas mitigation options. More specifically, the objectives were to: (a) compare the Australian survey results to Dutch respondents; and (b) examine the most effective way to make online information and opinion formation more interactive and engaging. The following research questions are addressed: (1) How do Australian opinions on energy options differ from the Dutch when measured using the ICQ? ; (2) Is it possible to enhance the quality of the original ICQ by making the questionnaire an interactive application?.

  19. Examining the scope and patterns of deliberate self-injurious cutting content in popular social media.

    Science.gov (United States)

    Miguel, Elizabeth M; Chou, Tommy; Golik, Alejandra; Cornacchio, Danielle; Sanchez, Amanda L; DeSerisy, Mariah; Comer, Jonathan S

    2017-09-01

    Social networking services (SNS) have rapidly become a central platform for adolescents' social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram. Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching "#cutting" on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined. Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and Mental health professionals must recognize the rapidly changing landscape of adolescent media consumption, influences, and social interaction as they may pertain to self-harm patterns. © 2017 Wiley Periodicals, Inc.

  20. Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS)

    Science.gov (United States)

    Shergill, Sukhwinder S.; David, Anthony S.; Fonagy, Peter; Zaman, Rashid; Downar, Jonathan; Eliott, Emma; Bhui, Kamaldeep

    2015-01-01

    Summary Suicidal thinking, self-harm and suicidal acts are common, although determining their precise prevalence is complex. Epidemiological work has identified a number of associated demographic and clinical factors, though, with the exception of past acts of self-harm, these are non-specific and weak future predictors. There is a critical need shift focus from managing ‘suicidality-by-proxy’ through general mental health treatments, to better understand the neuropsychology and neurophysiology of such behaviour to guide targeted interventions. The model of the cognitive control of emotion (MCCE) offers such a paradigm, with an underlying pan-diagnostic pathophysiology of a hypoactive prefrontal cortex failing to suitably inhibit an overactive threat-responding limbic system. The result is a phenotype – from any number of causative gene–environment interactions – primed to impulsively self-harm. We argue that such neural dysconnectivity is open to potential therapeutic modification from repetitive transcranial magnetic stimulation (rTMS). The current evidence base for this is undoubtedly extremely limited, but the societal and clinical burden self-harm and suicide pose warrants such investigation. Declaration of interest K.B. is the Editor of BJPsych Open, but had no editorial involvement in the review or decision process regarding this paper. Copyright and usage © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703728

  1. Observer Ratings of Interpersonal Behavior as Predictors of Aggression and Self-Harm in a High-Security Sample of Male Forensic Inpatients.

    Science.gov (United States)

    Vernham, Zarah; Tapp, James; Moore, Estelle

    2016-05-01

    Incidents of aggression and self-harm in forensic mental health inpatient settings present a significant challenge to practitioners in terms of safely managing and reducing the harm they cause. Research has been conducted to explore the possible predictors of these incidents and has identified a range of environmental, situational, and individual risk factors. However, despite the often interpersonal nature of the majority of aggressive incidents, few studies have investigated forensic inpatient interpersonal styles as predictors of aggression and even fewer have explored the potential interpersonal function of self-harming behaviors. The current study investigated the predictive validity of the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE) for incidents of verbal and physical aggression, and self-harm recorded from 204 high-secure forensic inpatients. Means comparisons, correlations, and receiver operating characteristics (ROC) were conducted on recorded incident data at 12, 24, and 48 months following baseline assessment using the CIRCLE. Dominant and coercive interpersonal styles were significant predictors of aggression, and a coercive interpersonal style was a significant predictor of self-harm, over the recorded time periods. When categorizing the inpatients on the basis of short- and long-term admissions, these findings were only replicated for inpatients with shorter lengths of stay. The findings support previous research which has demonstrated the benefits of assessing interpersonal style for the purposes of risk planning and management of forensic inpatients. The predictive value may be time-limited in terms of stage of admission.

  2. Clinical reasoning as social deliberation

    DEFF Research Database (Denmark)

    2014-01-01

    the ends are contested. The clinician deliberates together with colleagues and patients if particular means should be used under these circumstances. Deliberation is a public process and is not just taking place in the mind of the individual decision maker. It is a social and dialogical negotiation......In this paper I will challenge the individualistic model of clinical reasoning. I will argue that sometimes clinical practice is rather machine-like, and information is called to mind and weighed, but the clinician is not just calculating how to use particular means to reach fixed ends. Often...

  3. Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy

    Science.gov (United States)

    Quinlivan, L; Cooper, J; Davies, L; Hawton, K; Gunnell, D; Kapur, N

    2016-01-01

    Objectives The aims of this review were to calculate the diagnostic accuracy statistics of risk scales following self-harm and consider which might be the most useful scales in clinical practice. Design Systematic review. Methods We based our search terms on those used in the systematic reviews carried out for the National Institute for Health and Care Excellence self-harm guidelines (2012) and evidence update (2013), and updated the searches through to February 2015 (CINAHL, EMBASE, MEDLINE, and PsychINFO). Methodological quality was assessed and three reviewers extracted data independently. We limited our analysis to cohort studies in adults using the outcome of repeat self-harm or attempted suicide. We calculated diagnostic accuracy statistics including measures of global accuracy. Statistical pooling was not possible due to heterogeneity. Results The eight papers included in the final analysis varied widely according to methodological quality and the content of scales employed. Overall, sensitivity of scales ranged from 6% (95% CI 5% to 6%) to 97% (CI 95% 94% to 98%). The positive predictive value (PPV) ranged from 5% (95% CI 3% to 9%) to 84% (95% CI 80% to 87%). The diagnostic OR ranged from 1.01 (95% CI 0.434 to 2.5) to 16.3 (95%CI 12.5 to 21.4). Scales with high sensitivity tended to have low PPVs. Conclusions It is difficult to be certain which, if any, are the most useful scales for self-harm risk assessment. No scales perform sufficiently well so as to be recommended for routine clinical use. Further robust prospective studies are warranted to evaluate risk scales following an episode of self-harm. Diagnostic accuracy statistics should be considered in relation to the specific service needs, and scales should only be used as an adjunct to assessment. PMID:26873046

  4. Public deliberation in municipal planning

    DEFF Research Database (Denmark)

    Bohøj, Morten; Borchorst, Nikolaj Gandrup; Bødker, Susanne

    2011-01-01

    This paper reports on an exploratory participatory design process aimed at supporting citizen deliberation in municipal planning. It presents the main outcomes of this process in terms of selected prototypes and an approach to the use setting. We support and discuss different ways for citizens to...

  5. Suicide, Self-Harm and Survival Strategies in Contemporary Heavy Metal Music: A Cultural and Literary Analysis.

    Science.gov (United States)

    Baker, Charley; Brown, Brian

    2016-03-01

    This paper seeks to think creatively about the body of research which claims there is a link between heavy metal music and adolescent alienation, self-destructive behaviours, self-harm and suicide. Such research has been criticised, often by people who belong to heavy metal subcultures, as systematically neglecting to explore, in a meaningful manner, the psychosocial benefits for individuals who both listen to contemporary heavy metal music and socialize in associated groups. We argue that notions of survival, strength, community, and rebellion are key themes in contemporary heavy metal music. Through literary-lyrical analysis of a selection of heavy metal tracks, this paper aims to redress the balance of risk and benefit. We argue that listening to this type of music, the accompanying social relationships, sense of solidarity and even the type of dancing can ameliorate tumultuous and difficult emotions. Songs which could be read as negative can induce feelings of relief through the sense that someone else has felt a particular way and recovered enough to transform these emotions into a creative outlet. This genre of music may therefore not increase the risk of untoward outcomes in any simple sense but rather represent a valuable resource for young people in difficulty.

  6. Relational hopes: A study of the lived experience of hope in some patients hospitalized for intentional self-harm

    Directory of Open Access Journals (Sweden)

    Henning Herrestad

    2010-02-01

    Full Text Available Hopelessness is a well-established predictor of suicide, and inspiring hope is an important goal in mental health care, but there are few studies of hope among persons with suicidal behavior. The aim of this study was to interpret the lived experience of hope in some patients hospitalized for intentional self-harm. Twelve persons that had engaged in suicidal behavior by ingesting an overdose of medication were interviewed shortly after hospitalization and asked to narrate about their hopes. The transcripts were analyzed using a phenomenological hermeneutic method inspired by Ricoeur's theory of interpretation. The naïve reading was one of hope being relational. The structural analysis identified three themes: hopes for life, hopes for death, and the act of hoping. We interpreted the common theme of the interviews as being definite and indefinite relational hopes for life and death. For clinicians, expressions of indefinite hopes may raise concerns about the low likelihood of fulfillment. However, the expression of indefinite hope may serve to avoid experiencing failure, disappointment, and hopelessness.

  7. Help-seeking behavior among Japanese school students who self-harm: results from a self-report survey of 18,104 adolescents

    Directory of Open Access Journals (Sweden)

    Furukawa TA

    2012-11-01

    Full Text Available Norio Watanabe,1,* Atsushi Nishida,2,* Shinji Shimodera,3 Ken Inoue,4 Norihito Oshima,5 Tsukasa Sasaki,6 Shimpei Inoue,3 Tatsuo Akechi,1 Toshi A Furukawa,7 Yuji Okazaki81Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 2Department of Schizophrenia Research, Tokyo Institute of Psychiatry, Tokyo, 3Department of Neuropsychiatry, Kochi Medical School, Kochi, 4Department Public Health, Fujita Health University School of Medicine, Aichi, 5Office for Mental Health Support, Division for Counseling and Support, University of Tokyo, Tokyo, 6Health Service Center, University of Tokyo, Tokyo, 7Department of Cognitive-Behavioral Medicine, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, 8Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan *These authors contributed equally to this workBackground: The aim of this study was to determine the prevalence of and factors associated with poor help-seeking among adolescents who self-harm and to explore the resources used for help.Methods: A cross-sectional survey using an anonymous questionnaire was conducted in 47 junior and 30 senior high schools in Japan. Adolescent self-harm was defined as an adolescent who had harmed himself or herself in the previous year, as in previous studies reported in Western countries. Poor help-seeking was defined as not consulting anyone despite reporting current psychological or somatic complaints. Information about sociodemographic and psychological factors possibly associated with help-seeking, such as suicidal thoughts, depression, anxiety, and psychotic-like experiences, was also collected. Regression analyses were performed to examine associated factors.Results: A total of 18,104 students (8620 aged 12–15 years, 9484 aged 15–18 years, accounting for 93% of all students in the relevant student classes, participated in the study. Two hundred and

  8. Prevention of: self harm in British South Asian women: study protocol of an exploratory RCT of culturally adapted manual assisted Problem Solving Training (C- MAP

    Directory of Open Access Journals (Sweden)

    Nagaraj Diwaker

    2011-06-01

    Full Text Available Abstract Background Suicide is a major public health problem worldwide. In the UK suicide is the second most common cause of death in people aged 15-24 years. Self harm is one of the commonest reasons for medical admission in the UK. In the year following a suicide attempt the risk of a repeat attempt or death by suicide may be up to 100 times greater than in people who have never attempted suicide. Research evidence shows increased risk of suicide and attempted suicide among British South Asian women. There are concerns about the current service provision and its appropriateness for this community due to the low numbers that get involved with the services. Both problem solving and interpersonal forms of psychotherapy are beneficial in the treatment of patients who self harm and could potentially be helpful in this ethnic group. The paper describes the trial protocol of adapting and evaluating a culturally appropriate psychological treatment for the adult British South Asian women who self harm. Methods We plan to test a culturally adapted Problem Solving Therapy (C- MAP in British South Asian women who self harm. Eight sessions of problem solving each lasting approximately 50 minutes will be delivered over 3 months. The intervention will be assessed using a prospective rater blind randomized controlled design comparing with treatment as usual (TAU. Outcome assessments will be carried out at 3 and 6 months. A sub group of the participants will be invited for qualitative interviews. Discussion This study will test the feasibility and acceptability of the C- MAP in British South Asian women. We will be informed on whether a culturally adapted brief psychological intervention compared with treatment as usual for self-harm results in decreased hopelessness and suicidal ideation. This will also enable us to collect necessary information on recruitment, effect size, the optimal delivery method and acceptability of the intervention in preparation for a

  9. Self Harm - Cutting

    Science.gov (United States)

    ... not be able to cope with feelings of loneliness, confused sexuality, deep anger, rejection, guilt, self-hatred, ... be at the root of your emotional stress.Mindfulness-based therapy, which teaches you how to live ...

  10. Self-Harm

    Science.gov (United States)

    ... NAMI to 741741 Find Help Living with a Mental Health Condition Family Members and Caregivers Teens and Young Adults Veterans & Active Duty Diverse Communities LGBTQ NAMI Programs Discussion Groups NAMI HelpLine Get Involved stigma free Learn how you can help replace stigma ...

  11. 10 CFR 72.12 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 72.12 Section 72.12 Energy NUCLEAR... Deliberate misconduct. (a) Any licensee, certificate holder, applicant for a license or certificate, employee... applicant's activities subject to this part, may not: (1) Engage in deliberate misconduct that causes...

  12. 10 CFR 63.11 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 63.11 Section 63.11 Energy NUCLEAR... MOUNTAIN, NEVADA General Provisions § 63.11 Deliberate misconduct. (a) Any licensee, applicant for a..., may not: (1) Engage in deliberate misconduct that causes or would have caused, if not detected,...

  13. 10 CFR 50.5 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Deliberate misconduct. 50.5 Section 50.5 Energy NUCLEAR... Deliberate misconduct. (a) Any licensee, applicant for a license, employee of a licensee or applicant; or any... licensee's or applicant's activities in this part, may not: (1) Engage in deliberate misconduct that...

  14. 10 CFR 30.10 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Deliberate misconduct. 30.10 Section 30.10 Energy NUCLEAR... Provisions § 30.10 Deliberate misconduct. (a) Any licensee, certificate of registration holder, applicant for... deliberate misconduct that causes or would have caused, if not detected, a licensee, certificate...

  15. 10 CFR 52.4 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 52.4 Section 52.4 Energy NUCLEAR... Provisions § 52.4 Deliberate misconduct. (a) Applicability. This section applies to any: (1) Licensee; (2..., or a standard design approval. (b) Definitions. For purposes of this section: Deliberate...

  16. 10 CFR 71.8 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 71.8 Section 71.8 Energy NUCLEAR... § 71.8 Deliberate misconduct. (a) This section applies to any— (1) Licensee; (2) Certificate holder; (3... deliberate misconduct that causes or would have caused, if not detected, a licensee, certificate...

  17. 10 CFR 40.10 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Deliberate misconduct. 40.10 Section 40.10 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF SOURCE MATERIAL General Provisions § 40.10 Deliberate misconduct... applicant's activities in this part, may not: (1) Engage in deliberate misconduct that causes or would...

  18. 10 CFR 70.10 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 70.10 Section 70.10 Energy NUCLEAR... Deliberate misconduct. (a) Any licensee, applicant for a license, employee of a licensee or applicant; or any... licensee's or applicant's activities in this part, may not: (1) Engage in deliberate misconduct that...

  19. 10 CFR 76.10 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 76.10 Section 76.10 Energy NUCLEAR... Deliberate misconduct. (a) The Corporation or any employee of the Corporation and any contractor (including a... in deliberate misconduct that causes or, but for detection, would have caused, the Corporation to...

  20. How deliberation makes better citizens

    DEFF Research Database (Denmark)

    Hansen, Kasper Møller; Normann Andersen, Vibeke

    2007-01-01

    This article presents results from a Danish national Deliberative Poll on the single European currency. A representative sample of 364 Danish citizens assembled to deliberate on Denmark's participation in the single currency. As a quasi-experiment, the Deliberative Poll is an example...... of deliberative democracy. Four research questions regarding these deliberative processes are analyzed: openness and access, the quality of deliberation, efficiency and effectiveness, and publicity and accountability. The participants' responses reflect a deliberative process characterized by considerable changes...... in political opinions as the Poll proceeds, increase in level of knowledge and an improved ability to form reasoned opinions. A mutual understanding on the subject matter prevailed among the participants. At the same time, self-interest and domination also appeared during the deliberative process. The article...

  1. Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents.

    Science.gov (United States)

    Liu, Hui-Ching; Liu, Shen-Ing; Tjung, Jin-Jin; Sun, Fang-Ju; Huang, Hui-Chun; Fang, Chun-Kai

    2017-03-01

    Self-harm (SH) is a risk factor for suicide. We aimed to determine whether internet addiction and internet exposure to confided suicidal ideation are associated with SH in adolescents. This study was a cross-sectional survey of students who self-completed a series of online questionnaires including a sociodemographic information questionnaire, questionnaire for suicidality and SH, Chen Internet Addiction Scale (CIAS), Patient Health Questionnaire (PHQ-9), multi-dimensional support scale (MDSS), Rosenberg self-esteem scale (RSES), Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and questionnaire for substance abuse. A total of 2479 students completed the questionnaires (response rate = 62.1%). They had a mean age of 15.44 years (range 14-19 years; standard deviation 0.61), and were mostly female (n = 1494; 60.3%). The prevalence of SH within the previous year was 10.1% (n = 250). Among the participants, 17.1% had internet addiction (n = 425) and 3.3% had been exposed to suicidal content on the internet (n = 82). In the hierarchical logistic regression analysis, internet addiction and internet exposure to suicidal thoughts were both significantly related to an increased risk of SH, after controlling for gender, family factors, exposure to suicidal thoughts in the real life, depression, alcohol/tobacco use, concurrent suicidality, and perceived social support. However, the association between internet addiction and SH weakened after adjusting for the level of self-esteem, while internet exposure to suicidal thoughts remained significantly related to an increased risk of SH (odds ratio = 1.96; 95% confidence interval: 1.06-3.64). Online experiences are associated with SH in adolescents. Preventive strategies may include education to increase social awareness, to identify the youths most at risk, and to provide prompt help. Copyright © 2016. Published by Elsevier B.V.

  2. Self-harm and violent criminality among young people who experienced trauma-related hospital admission during childhood: a Danish national cohort study.

    Science.gov (United States)

    Webb, Roger T; Antonsen, Sussie; Carr, Matthew J; Appleby, Louis; Pedersen, Carsten B; Mok, Pearl L H

    2017-07-01

    Development of a better understanding of subsequent pathways for individuals who experienced trauma during childhood might usefully inform clinicians and public health professionals regarding the causes of self-harm and interpersonal violence. We aimed to examine these risks during late adolescence and early adulthood among people admitted to hospital following injuries or poisonings during their childhood. This national cohort study included Danish people born between Jan 1, 1977, and Dec 31, 1997, and was linked to the National Patient Register and Psychiatric Central Research Register to identify all people exposed to hospital admissions for injuries or poisonings due to self-harm, interpersonal violence, or accidents before their 15th birthday. Linkage to these two registers and to the National Crime Register enabled ascertainment of self-harm and violent offending, respectively, as adverse outcomes at ages 15-35 years. Sex-specific incidence rate ratios (IRRs; relative risks) and cumulative incidence percentage values (absolute risks) were estimated. The confounding influence of parental socioeconomic status was also explored. 1 087 672 Danish people were included in this study. The prevalence of any trauma-related hospital admission was 10% (105 753 per 1 087 672; males: 64 454 [11%]; females: 44 299 [8%]) and for both sexes, accident was by far the most prevalent of the categories assessed (males: 59 011 [11%]; females: 40 756 [8%]). Similar patterns of increased risk for self-harm and violent criminality were observed in both sexes, although the IRRs were consistently and significantly larger in women (self-harm: IRR 1·94 [95% CI 1·85-2·02]; violent criminality: 2·16 [1·97-2·36]) than in men (self-harm: 1·61 [1·53-1·69]; violent criminality: 1·58 [1·53-1·63]). Confounding by parental socioeconomic status explained little of the increased risks observed. For young adult men, the highest absolute risk observed was for violent

  3. Temperature-strain rate dependence of mechanical properties of a beryllium of the DShG-200 brand

    Energy Technology Data Exchange (ETDEWEB)

    Khomutov, A.M.; Gorokhov, V.A.; Mikhailov, V.S.; Nikolaev, G.N.; Timofeev, R.Yu.; Chernov, V.M. [Vserossijskij Nauchno-Issledovatel' skij Inst. Neorganicheskikh Materialov, Moscow (Russian Federation)

    2000-04-01

    Beryllium preforms of the DShG-200 brand of improved quality were manufactured by the method of a powder metallurgy and the mechanical tests on tension in longitudinal and transversal directions in temperature range 20-600 C and strain rates of 0,02 - 20 mm/min were held. It was shown, that at an alteration of strain rate within the indicated limits the values of stresses of flow and of the relative elongation can vary by several times. Comparison testing for tension by the Russian and American procedures (GOST and ASTM) was made. The obtained results can be beneficial at calculations of thermal stresses originating in fusion reactors (FR). (orig.)

  4. Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression

    Science.gov (United States)

    Robinson, Jo; Spittal, Matthew J; Carter, Greg

    2016-01-01

    Objective To examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm. Design We conducted a systematic review, meta-analysis and meta-regression to examine the efficacy of psychological and psychosocial interventions to reduce repeat self-harm in adults. We included a sensitivity analysis of studies with a low risk of bias for the meta-analysis. For the meta-regression, we examined whether the type, intensity (primary analyses) and other components of intervention or methodology (secondary analyses) modified the overall intervention effect. Data sources A comprehensive search of MEDLINE, PsycInfo and EMBASE (from 1999 to June 2016) was performed. Eligibility criteria for selecting studies Randomised controlled trials of psychological and psychosocial interventions for adult self-harm patients. Results Forty-five trials were included with data available from 36 (7354 participants) for the primary analysis. Meta-analysis showed a significant benefit of all psychological and psychosocial interventions combined (risk ratio 0.84; 95% CI 0.74 to 0.96; number needed to treat=33); however, sensitivity analyses showed that this benefit was non-significant when restricted to a limited number of high-quality studies. Meta-regression showed that the type of intervention did not modify the treatment effects. Conclusions Consideration of a psychological or psychosocial intervention over and above treatment as usual is worthwhile; with the public health benefits of ensuring that this practice is widely adopted potentially worth the investment. However, the specific type and nature of the intervention that should be delivered is not yet clear. Cognitive–behavioural therapy or interventions with an interpersonal focus and targeted on the precipitants to self-harm may be the best candidates on the current evidence. Further research is required. PMID:27660314

  5. The effect of using NHS number as the unique identifier for patients who self-harm: a multi-centre descriptive study

    Directory of Open Access Journals (Sweden)

    Lilley Rachael

    2007-09-01

    Full Text Available Abstract Background Processing personal data for research purposes and the requirement of anonymity has been the subject of recent debate. We aimed to determine the proportion of individuals who present to emergency departments with non-fatal suicidal behavior where an NHS number has been successfully traced and to investigate the characteristics of patients associated with non-capture. Method This was a descriptive study of people attending after self-harm using allocation of NHS numbers as main outcome measurement. Data from the Multicentre Monitoring of Self-Harm Project from 3 centres in England were used to identify consecutive patients (N = 3000 who were treated in six emergency departments in Oxford, Manchester and Leeds in 2004 and 2005 following self-harm. Results NHS number was available between 55–73% of individuals across centres. Characteristics associated with non-recording of NHS number in more than one centre included those from ethnic minority groups (Oxford: chi-squared statistic = 13.6, df = 3, p = 0.004; Manchester: chi-squared statistic = 13.6, df = 3, p ≤0.001 and the homeless or living in a hostel or other institution (Oxford: chi-squared statistic = 40.9, df = 7, p = Conclusion Basing research studies on NHS number as the unique identifier, as suggested by the Data Protection Act 1998 and the Patient Information Advisory Group, would exclude some of the most vulnerable groups for further self-harm or suicide. This bias may also affect other research registers.

  6. Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity

    OpenAIRE

    Young, Robert; Sproeber, Nina; Groschwitz, Rebecca C; Preiss, Marthe; Plener, Paul L

    2014-01-01

    Background: The term ‘self-harm’ encompasses both attempted suicide and non-suicidal self-injury (NSSI). Specific adolescent subpopulations such as ethnic or sexual minorities, and more controversially, those who identify as ‘Alternative’ (Goth, Emo) have been proposed as being more likely to self-harm, while other groups such as ‘Jocks’ are linked with protective coping behaviours (for example exercise). NSSI has autonomic (it reduces negative emotions) and social (it communicates distres...

  7. Habitat Demonstration Unit-Deep Space Habitat (HDU-DSH) Integration and Preparation for Desert RATS 2011

    Science.gov (United States)

    Barbeau, Zack

    2011-01-01

    The Habitat Demonstration Unit, or HDU, is a multi-purpose test bed that allows NASA scientists and engineers to design, develop, and test new living quarters, laboratories, and workspaces for the next generation space mission. Previous testing and integration has occurred during 2010 at the annual Desert Research and Technology Studies (Desert RATS) field testing campaign in the Arizona desert. There the HDU team tests the configuration developed for the fiscal year, or FY configuration. For FY2011, the NASA mission calls for simulating a deep space condition. The HDU-DSH, or Deep Space Habitat, will be configured with new systems and modules that will outfit the test bed with new deep space capabilities. One such addition is the new X-HAB (eXploration Habitat) Inflatable Loft. With any deep space mission there is the need for safe, suitable living quarters. The current HDU configuration does not allow for any living space at all. In fact, Desert RATS 2010 saw the crew sleeping in the Space Exploration Vehicles (SEV) instead of the HDU. The X-HAB Challenge pitted three universities against each other: Oklahoma State University, University of Maryland, and the University of Wisconsin. The winning team will have their design implemented by NASA for field testing at DRATS 2011. This paper will highlight the primary objective of getting the X-HAB field ready which involves the implementation of an elevator/handrail system along with smaller logistical and integration tasks associated with getting the HDU-DSH ready for shipment to DRATS.

  8. Public deliberation in municipal planning

    DEFF Research Database (Denmark)

    Bohøj, Morten; Borchorst, Nikolaj Gandrup; Bødker, Susanne

    2011-01-01

    This paper reports on an exploratory participatory design process aimed at supporting citizen deliberation in municipal planning. It presents the main outcomes of this process in terms of selected prototypes and an approach to the use setting. We support and discuss different ways for citizens...... to act and reflect on proposed plans: in-situ, while physically close to the planning object, and ex-situ, when citizens are remote from this. The support of in-situ and ex-situ participation allows citizens to engage in continuous reflection-in and on-action as a collaborative activity with other...

  9. Online Public Deliberation in China

    DEFF Research Database (Denmark)

    Medaglia, Rony; Yang, Yang

    2017-01-01

    Internet discussion platforms in China provide a hugely interesting and relevant source for understanding dynamics of online discussions in a unique context. Adopting the theoretical lens of public deliberation, this paper investigates the evolution of patterns of similar-minded and different......-minded interactions over time on a Chinese online discussion forum. We analyse the content and reply networks of 18,000+ messages on four highly debated topics on the Bulletin Board System (BBS) platform Tianya. Findings provide nuanced evidence to the phenomenon of increased network homophily over time, mitigated...

  10. Tax Salience, Voting, and Deliberation

    DEFF Research Database (Denmark)

    Sausgruber, Rupert; Tyran, Jean-Robert

    Tax incentives can be more or less salient, i.e. noticeable or cognitively easy to process. Our hypothesis is that taxes on consumers are more salient to consumers than equivalent taxes on sellers because consumers underestimate the extent of tax shifting in the market. We show that tax salience...... biases consumers' voting on tax regimes, and that experience is an effective de-biasing mechanism in the experimental laboratory. Pre-vote deliberation makes initially held opinions more extreme rather than correct and does not eliminate the bias in the typical committee. Yet, if voters can discuss...... their experience with the tax regimes they are less likely to be biased....

  11. Tax Salience, Voting, and Deliberation

    DEFF Research Database (Denmark)

    Sausgruber, Rupert; Tyran, Jean-Robert

    biases consumers' voting on tax regimes, and that experience is an effective de-biasing mechanism in the experimental laboratory. Pre-vote deliberation makes initially held opinions more extreme rather than correct and does not eliminate the bias in the typical committee. Yet, if voters can discuss...... their experience with the tax regimes they are less likely to be biased.......Tax incentives can be more or less salient, i.e. noticeable or cognitively easy to process. Our hypothesis is that taxes on consumers are more salient to consumers than equivalent taxes on sellers because consumers underestimate the extent of tax shifting in the market. We show that tax salience...

  12. Aims and harvest of moral case deliberation.

    Science.gov (United States)

    Weidema, Froukje C; Molewijk, Bert A C; Kamsteeg, Frans; Widdershoven, Guy A M

    2013-09-01

    Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses' empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members.

  13. Challenges of Deliberation and Participation

    Directory of Open Access Journals (Sweden)

    John Forester

    2006-12-01

    Full Text Available The future of sustainability is tied to the future of our ability to manage interconnectedness and interdependence, and thus to our abilities to engage in cooperative, value-creating public deliberations and negotiations. To understand these issues, we need a better understanding of the micro-politics of planning and public participation,the relationships between our received theories and our practices, and in particular, the work of public dispute resolution and its implications for democratic deliberation and governance. We need better to understand the differences between dialogue, debate, and negotiation, as well as the corresponding work of facilitating a dialogue, moderating a debate, and mediating an actual negotiation. Contrasting processes and practical attitudes of dialogue, debate, and negotiation can teach us, in the context of creating a sustainable future, that we must devise discursive and conversational political processes and institutions that explore possible commitments so that we not only know the right things to do but actually bring ourselves and one another to do those right things.

  14. [THE FORMS OF DELIBERATION INVOLVED IN THE FIELD OF BIOETHICS: TECHNIQUE DELIBERATION AND ETHICS DELIBERATION].

    Science.gov (United States)

    Neves Pinto, Gerson

    2015-12-01

    In this article the author examines the formulation of the problem of new technologies with their ethical limits and legal. To do this, in a first it is d'assess the contribuitions of the two most important contemporary philosophers who have treated this subject: Jürgen Habermas and Ronald Dworkin, while trying to put them into dialog with the one who has been one of the founders of l'classic ethics: Aristotle. Then, it tries to answer the question of how could we understand this notion that Dworkin nome "moral dislocation" between the random and the choice or well, as the appointed Habermas, "l'extension of the contingency". Finally, we questioned how the Aristotelian distinction between the technical deliberation and deliberative ethical-moral can contribute to a better understanding of the questions on the decisions and choices that will make the moral agents (such as patients or the judges), as well as those relating to the type of deliberation technique chosen by the doctor or by the health professional.

  15. The Dysregulation Profile in middle childhood and adolescence across reporters: factor structure, measurement invariance, and links with self-harm and suicidal ideation.

    Science.gov (United States)

    Deutz, Marike H F; Geeraerts, Sanne B; van Baar, Anneloes L; Deković, Maja; Prinzie, Peter

    2016-04-01

    Recently, a phenotype of severe dysregulation, the Dysregulation Profile (DP), has been identified. DP consists of elevated scores on the Anxious/Depressed (AD), Aggressive Behavior (AGG) and Attention Problems (AP) scales of the Child Behavior Checklist (CBCL), Teacher Report Form (TRF), or Youth Self Report (YSR). A drawback in current research is that DP has been conceptualized and operationalized in different manners and research on the factor structure of DP is lacking. Therefore, we examined the factor structure of DP across multiple reporters, measurement invariance across gender, parents, and time, as well as links between DP and self-harm and suicidal ideation. Data from a large community sample were used (N = 697), covering middle childhood (Mage = 7.90, (SD = 1.16) and adolescence (Mage = 13.93, SD = 1.14). Mothers, fathers, teachers, and youth themselves reported on children's emotional and behavioral problems using the CBCL, TRF, and YSR. Results indicated that in middle childhood and in adolescence, a bifactor model with a general factor of Dysregulation alongside three specific factors of AD, AGG, and AP fitted best, compared to a second-order or one-factor model. The model showed good fit for mother, father, teacher, and youth reports and showed invariance across gender, parents and time. Youth, mother, and father reported Dysregulation was uniquely and positively related to adolescent-reported self-harm and suicidal ideation. The DP is best conceptualized as a broad dysregulation syndrome, which exists over and above anxiety/depression, aggression, and attention problems as specific problems. The bifactor model of DP explains the uniqueness and interrelatedness of these behavioral problems and can help explaining shared and non-shared etiology factors. The exclusive link between the general dysregulation factor and adolescents' self-harm and suicidal ideation further established the clinical relevance of the bifactor model.

  16. Deliberate Evolution in Multi-Agent Systems

    NARCIS (Netherlands)

    Brazier, F.M.T.; Jonker, C.M.; Treur, J.; Wijngaards, N.J.E.

    2000-01-01

    This paper presents an architecture for an agent capable of deliberation about the creation of new agents, and of actually creating a new agent in the multi-agent system, on the basis of this deliberation. The agent architecture is based on an existing

  17. 10 CFR 60.11 - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 60.11 Section 60.11 Energy NUCLEAR... Provisions § 60.11 Deliberate misconduct. (a) Any licensee, applicant for a license, employee of a licensee... misconduct that causes or would have caused, if not detected, a licensee or applicant to be in violation...

  18. Deliberate evolution in multi-agent systems

    NARCIS (Netherlands)

    Brazier, F.M.T.; Jonker, C.M.; Treur, J.; Wijngaards, N.J.E.

    1998-01-01

    This paper presents an architecture for an agent capable of deliberation about the creation of new agents, and of actually creating a new agent in the multi-agent system, on the basis of this deliberation. After its creation the new agent participates fully in the running multi-agent system. The age

  19. Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms.

    Science.gov (United States)

    Perseius, K-I; Kåver, A; Ekdahl, S; Asberg, M; Samuelsson, M

    2007-10-01

    The aim of the study was to investigate how starting to use dialectical behavioural therapy (DBT) in the work with young self-harming women showing symptoms of borderline personality disorder affected the psychiatric professionals (n = 22) experience of occupational stress and levels of professional burnout. The study was carried out in relation to an 18-month clinical psychiatric development project, and used a mix of quantitative and qualitative research methods [a burnout inventory, the Maslach burnout inventory-General Survey (MBI-GS), free format questionnaires and group interviews]. The result confirms previous reports that psychiatric health professionals experience treatment of self-harming patients as very stressful. DBT was seen as stressful in terms of learning demands, but decreased the experience of stress in the actual treatment of the patients. The teamwork and supervision were felt to be supportive, as was one particular facet of DBT, namely mindfulness training which some therapists felt also improved their handling of other work stressors not related to DBT. The inventory for professional burnout, the MBI-GS, showed no significant changes over the 18-month period, although there was a tendency for increased burnout levels at the 6-month assessment, which had returned to baseline levels at 18 months.

  20. Enhanced measurement sensitivity of hopeless ideation among older adults at risk of self-harm: Reliability and validity of Likert-type responses to the Beck Hopelessness Scale.

    Science.gov (United States)

    Neufeld, Eva; O'Rourke, Norm; Donnelly, Martha

    2010-08-01

    Responses to the Beck Hopelessness Scale (BHS) have been identified as a significant predictor of suicide-related ideation and self-harm, of note, to a greater degree than severity of depressive symptoms. The BHS is the most widely used instrument to assess this construct, yet concern has been expressed about the traditional true/false response format of this instrument. For this study, we obtained responses from older adults to a revised four-point Likert-type BHS response format. A national sample of 117 older Canadians at risk of self-harm was recruited from multiple sources for this study over a one-year period. Most participants were women (65%) with an average age of 68.47 years (SD = 9.02, range 50-92). Exploratory factor analysis suggests the existence of two factors labeled Powerlessness/Disappointment and Negative Future Expectancies. Concurrent validity of this two-factor model of BHS responses is provided vis-a-vis suicide-related ideation subsequent to statistical control for socio-demographic factors, physical health, and depressive symptomatology. Of note, the relative contribution to the measurement of BHS factors is proportionately equal and greater than all other independent variables. We contend that this revised BHS response format may be appropriate for use in clinical and research applications though replication with other samples and populations is warranted.

  1. A new psychometric instrument assessing vulnerability to risk of suicide and self-harm behaviour in offenders: Suicide Concerns for Offenders in Prison Environment (SCOPE).

    Science.gov (United States)

    Perry, Amanda E; Olason, Daniel T

    2009-08-01

    This study aimed to develop a new psychometric instrument to assess vulnerability to risk of suicide and nonfatal self-harm behaviour in young adult male and female offenders. In total three studies were conducted to assess the psychometric properties of the new instrument using both exploratory and confirmatory factor analysis in different samples. Participants in all three studies included a total of 1,166 young adult offenders across six Her Majesty's Prisons. The new instrument, Suicide Concerns for Offenders in Prison Environment (SCOPE), contained 28 items scoring on two subscales. The factorial structure of the new instrument initially obtained with exploratory factor analysis was subsequently confirmed in a new sample. The internal consistency of the two subscales were acceptable but the test-retest reliability coefficients were moderate. Concurrent validation with the Beck Hopelessness Scale was acceptable and SCOPE showed the ability to discriminate between those at risk and those with no known history of attempted suicide and nonfatal self-harm behaviour ( p < 0.01).

  2. Screen time on school days and risks for psychiatric symptoms and self-harm in mainland Chinese adolescents: A multicenter cross-sectional study

    Directory of Open Access Journals (Sweden)

    Mingli eLiu

    2016-04-01

    Full Text Available Objective To investigate associations of television and of video game or non-educational computer use (VG/CU exposure volumes in a typical school day with psychiatric symptoms and suicidal ideation/self-injurious behavior (self-harm, in mainland Chinese adolescents.Methods Secondary school pupils (N = 13,659; mean age: 15.18 ± 1.89 from 10 urban areas sampled from different regions of mainland China were recruited. The subjects were divided into the follow four screen exposure volume groups for television and VG/CU respectively based on a self-administered questionnaire: 0 h/d, >0 to ≤1 h/d, >1 to ≤2 h/d, and >2 h/d. Demographic and psychiatric symptoms were recorded for each respondent. Odds ratios (ORs and 95% confidence intervals (CIs for several types of psychological problems and self-harm were calculated.Results For television, >2 hours per school day was associated with greater risk of depression in both boys (OR = 1.33, 95%CI: 1.02–1.73 and girls (OR = 1.62, 95%CI: 1.19– 2.21, of anxiety in boys (OR = 1.43, 95%CI: 1.05–1.95, of general emotional, behavioral, and social problems (GEBSPs in girls (OR = 1.55, 95%CI: 1.01–2.39, and of oppositional defiant problems (ODPs in girls (OR = 1.65, 95% CI: 1.09–2.50, compared with the reference group. Conversely, television exposure of >0 to ≤1 hour per school day was associated with lower self-harm risk in boys (OR = 0.81, 95%CI: 0.67–0.99 compared with the no television exposure group. For VG/CU, higher risks of anxiety (OR = 1.40, 95%CI: 1.06–1.86 and of attention deficit/hyperactivity problems (ADHPs (OR = 1.56, 95%CI: 1.02–2.38 were associated with excessive VG/CU time (>2 h per school day in boys compared with the no VG/CU exposure group. Higher risks of self-harm and all other psychiatric problems (including anxiety and ADHPs in girls were associated with any school-day VG/CU exposure, compared to no VG/CU exposure, in both genders.Conclusion For mainland Chinese

  3. Could a brief assessment of negative emotions and self-esteem identify adolescents at current and future risk of self-harm in the community? A prospective cohort analysis.

    Science.gov (United States)

    Phillips, Rhiannon; Spears, Melissa R; Montgomery, Alan A; Millings, Abigail; Sayal, Kapil; Stallard, Paul

    2013-06-22

    Self-harm is common in adolescents, but it is often unreported and undetected. Available screening tools typically ask directly about self-harm and suicidal ideation. Although in an ideal world, direct enquiry and open discussion around self-harm would be advocated, non-psychiatric professionals in community settings are often reluctant to ask about this directly and disclosure can be met with feeling of intense anxiety. Training non-specialist staff to directly ask about self-harm has limited effects suggesting that alternative approaches are required. This study investigated whether a targeted analysis of negative emotions and self-esteem could identify young adolescents at risk of self-harm in community settings. Data were collected as part of a clinical trial from young people in school years 8-11 (aged 12-16) at eight UK secondary schools (N = 4503 at baseline, N = 3263 in prospective analysis). The Short Mood and Feelings Questionnaire, Revised Child Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, personal failure (Children's Automatic Thoughts Scale), and two items on self-harm were completed at baseline, 6 and 12 months. Following a process of Principal Components Analysis, item reduction, and logistic regression analysis, three internally reliable factors were identified from the original measures that were independently associated with current and future self-harm; personal failure (3 items), physical symptoms of depression/anxiety (6 items), positive self-esteem (5 items). The summed score of these 14 items had good accuracy in identifying current self-harm (AUC 0.87 girls, 0.81 boys) and at six months for girls (0.81), and fair accuracy at six months for boys (AUC 0.74) and 12 months for girls (AUC 0.77). A brief and targeted assessment of negative emotions and self-esteem, focusing on factors that are strongly associated with current and future self-harm, could potentially be used to help identify adolescents who are at risk in

  4. The Use of Dialectical Behavior Therapy and Prolonged Exposure to Treat Comorbid Dissociation and Self-Harm: The Case of a Client With Borderline Personality Disorder and Posttraumatic Stress Disorder.

    Science.gov (United States)

    Granato, Hollie F; Wilks, Chelsey R; Miga, Erin M; Korslund, Kathryn E; Linehan, Marsha M

    2015-08-01

    There is a high rate of comorbidity between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD; Pagura et al., 2010). Preliminary studies have evaluated the treatment of PTSD in a BPD population and found positive outcomes for the integration of dialectical behavior therapy (DBT) and prolonged exposure (PE). This case study illustrates the implementation of a PE protocol into standard DBT treatment, specifically focusing on the management of self-harm and severe dissociation for a client with co-occurring PTSD and BPD. The client entered into treatment with severe and persistent dissociation and a recent history of self-harm, and the case includes consideration of two separate pauses in PTSD treatment related to elevated dissociation and self-harm behaviors. The client successfully completed the DBT PE protocol and results indicate significant improvements in PTSD symptoms as well as outcomes related to self-harm and dissociation. These findings demonstrate the efficacy of combining DBT with PE for clients with comorbid BPD and PTSD and exemplify how complex clients with BPD who present with severe dissociation and self-harm behavior can safely and successfully receive treatment for PTSD.

  5. Case fatality rates of different suicide methods within Ilam province of Iran

    OpenAIRE

    2012-01-01

    Background: There are few diverse studies that have reported the case fatality rates of different methods of suicide, none of them are originated from developing countries. The aim of the present article is to report the case fatality rates of different methods of suicide in Ilam province of Iran. Materials and Methods: Data on 611 cases of suicide and 1807 cases of deliberate self harm (DSH) that were recorded in a comprehensive registry during 1995 through 2002 were analyzed for both gender...

  6. Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm.

    Science.gov (United States)

    Owens, Christabel; Farrand, Paul; Darvill, Ruth; Emmens, Tobit; Hewis, Elaine; Aitken, Peter

    2011-09-01

    OBJECTIVE To engage a group of people with relevant lived experience in the development of a text-messaging intervention to reduce repetition of self-harm. BACKGROUND Contact-based interventions, such as follow-up letters, postcards and telephone calls, have shown potential to reduce repetition of self-harm in those who present at Accident and Emergency departments. Text messaging offers a low-cost alternative that has not been tested. We set out to develop a text-based intervention. The process of intervention development is rarely reported and little is known about the impact of service user involvement on intervention design. METHOD We held a series of six participatory workshops and invited service users and clinicians to help us work out how to get the right message to the right person at the right time, and to simulate and test prototypes of an intervention. RESULTS Service users rejected both the idea of a generic, 'one size fits all' approach and that of 'audience segmentation', maintaining that text messages could be safe and effective only if individualized. This led us to abandon our original thinking and develop a way of supporting individuals to author their own self-efficacy messages and store them in a personal message bank for withdrawal at times of crisis. CONCLUSIONS This paper highlights both the challenge and the impact of involving consumers at the development stage. Working with those with lived experience requires openness, flexibility and a readiness to abandon or radically revise initial plans, and may have unexpected consequences for intervention design.

  7. Intuition, deliberation, and the evolution of cooperation.

    Science.gov (United States)

    Bear, Adam; Rand, David G

    2016-01-26

    Humans often cooperate with strangers, despite the costs involved. A long tradition of theoretical modeling has sought ultimate evolutionary explanations for this seemingly altruistic behavior. More recently, an entirely separate body of experimental work has begun to investigate cooperation's proximate cognitive underpinnings using a dual-process framework: Is deliberative self-control necessary to reign in selfish impulses, or does self-interested deliberation restrain an intuitive desire to cooperate? Integrating these ultimate and proximate approaches, we introduce dual-process cognition into a formal game-theoretic model of the evolution of cooperation. Agents play prisoner's dilemma games, some of which are one-shot and others of which involve reciprocity. They can either respond by using a generalized intuition, which is not sensitive to whether the game is one-shot or reciprocal, or pay a (stochastically varying) cost to deliberate and tailor their strategy to the type of game they are facing. We find that, depending on the level of reciprocity and assortment, selection favors one of two strategies: intuitive defectors who never deliberate, or dual-process agents who intuitively cooperate but sometimes use deliberation to defect in one-shot games. Critically, selection never favors agents who use deliberation to override selfish impulses: Deliberation only serves to undermine cooperation with strangers. Thus, by introducing a formal theoretical framework for exploring cooperation through a dual-process lens, we provide a clear answer regarding the role of deliberation in cooperation based on evolutionary modeling, help to organize a growing body of sometimes-conflicting empirical results, and shed light on the nature of human cognition and social decision making.

  8. Freedom of Expression, Deliberation, Autonomy and Respect

    DEFF Research Database (Denmark)

    Rostbøll, Christian F.

    2011-01-01

    This paper elaborates on the deliberative democracy argument for freedom of expression in terms of its relationship to different dimensions of autonomy. It engages the objection that Enlightenment theories pose a threat to cultures that reject autonomy and argues that autonomy-based democracy...... is not only compatible with but necessary for respect for cultural diversity. On the basis of an intersubjective epistemology, it argues that people cannot know how to live on mutually respectful terms without engaging in public deliberation and develop some degree of personal autonomy. While freedom...... of expression is indispensable for deliberation and autonomy, this does not mean that people have no obligations regarding how they speak to each other. The moral insights provided by deliberation depend on the participants in the process treating one another with respect. The argument is related to the Danish...

  9. Pre-Himalayan tectono-magmatic imprints in the Darjeeling-Sikkim Himalaya (DSH) constrained by 40Ar/39Ar dating of muscovite

    Science.gov (United States)

    Acharyya, Subhrangsu K.; Ghosh, Subhajit; Mandal, Nibir; Bose, Santanu; Pande, Kanchan

    2017-09-01

    The Lower Lesser Himalayan Sequence (L-LHS) in Darjeeling-Sikkim Himalaya (DSH) displays intensely deformed, low-grade meta-sedimentary rocks, frequently intervened by granite intrusives of varied scales. The principal motivation of our present study is to constrain the timing of this granitic event. Using 40Ar/39Ar geochronology, we dated muscovite from pegmatites emplaced along the earliest fabric in the low grade Daling phyllite, and obtained ∼1850 Ma Ar-Ar muscovite cooling age, which is broadly coeval with crystallization ages of Lingtse granite protolith (e.g., 1800-1850 Ma U-Pb zircon ages) reported from the L-LHS. We present here field observations to show the imprints (tectonic fabrics) of multiple ductile deformation episodes in the LHS terrain. The earliest penetrative fabric, axial planar to N-S trending reclined folds, suggest a regional tectonic event in the DSH prior to the active phase of Indo-Asia collision. Based on the age of granitic bodies and their structural correlation with the earliest fabric, we propose that the L-LHS as a distinct convergent tectono-magmatic belt, delineating the northern margin of Indian craton in the framework of the ∼1850 Ma Columbia supercontinent assembly.

  10. Te Ira Tangata: A Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in Maori who present to hospital after self harm

    Directory of Open Access Journals (Sweden)

    Wikiriwhi Karen

    2011-05-01

    Full Text Available Abstract Background Maori, the indigenous people of New Zealand, who present to hospital after intentionally harming themselves, do so at a higher rate than non-Maori. There have been no previous treatment trials in Maori who self harm and previous reviews of interventions in other populations have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and sending regular postcards after the self harm attempt may be an effective treatment. There is also a small literature on sense of belonging in self harm and the importance of culture. This protocol describes a pragmatic trial of a package of measures which include problem solving therapy, postcards, patient support, cultural assessment, improved access to primary care and a risk management strategy in Maori who present to hospital after self harm using a novel design. Methods We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enrol a representative cohort of patients. The main outcome will be the number of Maori scoring below nine on the Beck Hopelessness Scale. Secondary outcomes will be hospital repetition at one year; self reported self harm; anxiety; depression; quality of life; social function; and hospital use at three months and one year. Discussion A strength of the study is that it is a pragmatic trial which aims to recruit Maori using a Maori clinical team and protocol. It does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. This study is the first randomised control trial to explicitly use cultural assessment and management. Trial

  11. ‘Our Care through Our Eyes’: a mixed-methods, evaluative study of a service-user, co-produced education programme to improve inpatient care of children and young people admitted following self-harm

    Science.gov (United States)

    Latif, Asam; Carter, Tim; Cooper, Joanne; Horsley, Angela; Armstrong, Marie; Wharrad, Heather

    2015-01-01

    Introduction Within Europe, the UK has one of the highest rates of self-harm, with a particularly high prevalence in children and young people (CYP). CYP who are admitted to paediatric hospital wards with self-harm are cared for by registered children's nurses who have been identified to lack specific training in caring for this patient group. This may impede the delivery of high quality care. Therefore, this study aims to co-produce, implement and evaluate an education programme for registered children's nurses to improve their knowledge, attitudes and confidence when caring for CYP admitted with self-harm. Methods and analysis This mixed-methods evaluative study will involve a three-stage design. Stage 1: A priority-setting workshop will be conducted with 19 registered children's nurses. A Delphi technique will be used to establish consensus of information needs. Stage 2: An online educational intervention will be co-produced with 25 CYP and 19 registered children's nurses based on the priorities identified in Stage 1. Stage 3: The intervention will be implemented and evaluated with 250 registered children's nurses at a single hospital. Online Likert scale questionnaires will be administered at baseline and postintervention to assess levels of knowledge, attitudes and confidence in caring for CYP who self-harm. Descriptive and inferential statistics will be used to analyse the data. Statistical significance will be assessed at the 5% (two-sided) level. One-to-one qualitative interviews will also be undertaken with approximately 25 participants to explore any perceived impact on clinical practice. An interpretive descriptive approach will guide qualitative data collection and analysis. Ethics and dissemination This study aims to develop, trial and evaluative a service-user, co-produced education programme for acute hospital registered children's nurses to improve the care of CYP admitted due to self-harm. The study has ethical approval from the National Health

  12. Deliberate ambiguity in slogans: recognition and appreciation

    NARCIS (Netherlands)

    Lagerwerf, Luuk

    2002-01-01

    In slogans used in public information, politics, and advertising, and also in titles of books, documentaries, or articles, ambiguity is often employed to pique the interest of the reader in the message that is conveyed. According to several theories of text processing, this deliberate ambiguity may

  13. Working with chronic and relentless self-hatred, self-harm, and existential shame: a clinical study and reflections (Paper 2 of 2).

    Science.gov (United States)

    Austin, Sue

    2016-09-01

    This second of two papers focuses on the shame which emerged in the first 14 years of analysis of a woman who was bulimic, self-harmed, and repeatedly described herself as 'feeling like a piece of shit'. To explore this intense and pervasive shame I draw on Jung's and Laplanche's emphasis on experiences of unresolvable, non-pathological 'foreignness' or 'otherness' at the heart of the psyche. Images, metaphors, elements of clinical experience, and working hypotheses from a number of analytic traditions are used to flesh out this exploration. These include Kilborne's use of Pirandello's image of shame as like a 'hole in the paper sky' which, I suggest, points to a crack in subjectivity, and reveals our belief in the efficacy of the self to be illusory. Hultberg's observations on shame as having an existential mode (function) are also explored, as is the nature of analytic truth. Using these ideas I describe my patient's process of finding some small but freeing space in relation to her shame and self-hatred. Through enduring and learning from her shame in analysis she realized that it was part of a desperate unconscious attempt to draw close to her troubled father and so to 'love him better'.

  14. Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt

    Directory of Open Access Journals (Sweden)

    Madison L. Gates

    2017-03-01

    Full Text Available Substance use disorders (SUD and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079 to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking, mental health disorders (anxiety, bipolar, depression, and psychotic disorders, and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings.

  15. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial.

    Science.gov (United States)

    Grimholt, Tine K; Jacobsen, Dag; Haavet, Ole Rikard; Sandvik, Leiv; Jorgensen, Trond; Norheim, Astrid Berge; Ekeberg, Oivind

    2015-01-01

    To assess whether systematic follow-up by general practitioners (GPs) of cases of deliberate self-poisoning (DSP) by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice. Randomised clinical trial with two parallel groups. General practices in Oslo and the eastern part of Akershus County. Patients aged 18-75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge. The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78) or treatment as usual (n = 98). Primary outcome measure was the Beck Scale for Suicide Ideation (SSI). Secondary outcomes were Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS), self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA). We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records. There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009). Readmissions to general hospitals were similar (13% in both groups (P = 0.963), while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103). Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in

  16. Effect of Systematic Follow-Up by General Practitioners after Deliberate Self-Poisoning: A Randomised Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Tine K Grimholt

    Full Text Available To assess whether systematic follow-up by general practitioners (GPs of cases of deliberate self-poisoning (DSP by their patients decreases psychiatric symptoms and suicidal behaviour compared with current practice.Randomised clinical trial with two parallel groups.General practices in Oslo and the eastern part of Akershus County.Patients aged 18-75 years admitted to hospital for DSP. We excluded patients diagnosed with psychoses, without a known GP, those not able to complete a questionnaire, and patients admitted to psychiatric in-patient care or other institutions where their GP could not follow them immediately after discharge.The GPs received a written guideline, contacted the patients and scheduled a consultation within one week after discharge, and then provided regular consultations for six months. We randomised the patients to either intervention (n = 78 or treatment as usual (n = 98.Primary outcome measure was the Beck Scale for Suicide Ideation (SSI. Secondary outcomes were Beck Depression Inventory (BDI and Beck Hopelessness Scale (BHS, self-reported further self-harm and treatment for DSP in a general hospital or an emergency medical agency (EMA. We assessed patients on entry to the trial and at three and six months. We collected data from interviews, self-report questionnaires, and hospital and EMA medical records.There were no significant differences between the groups in SSI, BDI, or BHS mean scores or change from baseline to three or six months. During follow-up, self-reported DSP was 39.5% in the intervention group vs. 15.8% in controls (P = 0.009. Readmissions to general hospitals were similar (13% in both groups (P = 0.963, while DSP episodes treated at EMAs were 17% in the intervention group and 7% in the control group (P = 0.103.Structured follow-up by GPs after an episode of DSP had no significant effect on suicide ideation, depression or hopelessness. There was no significant difference in repeated episodes of DSP in

  17. Self-Harm and Trauma

    Science.gov (United States)

    ... Contact Us: ncptsd@va.gov Also see: VA Mental Health Connect with us return to top CONNECT Veterans Crisis Line: 1-800-273-8255 (Press 1) Social Media Complete Directory EMAIL UPDATES Email Address Required Button ...

  18. Self-Harm and Trauma

    Science.gov (United States)

    ... Care Apply Online Application Process Veteran Eligibility Active Duty Families of Veterans Women Veterans Determine Costs Copays ... Vets Performance Based Interviewing Clinical Trainees (Academic Affiliations) Employees & Contractors Talent Management System (TMS) VA Learning University ( ...

  19. 10 CFR 110.7b - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 110.7b Section 110.7b Energy... Provisions § 110.7b Deliberate misconduct. (a) Any licensee, applicant for a license, employee of a licensee... deliberate misconduct that causes or would have caused, if not detected, a licensee or applicant to be...

  20. 10 CFR 61.9b - Deliberate misconduct.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Deliberate misconduct. 61.9b Section 61.9b Energy NUCLEAR... Provisions § 61.9b Deliberate misconduct. (a) Any licensee, applicant for a license, employee of a licensee... deliberate misconduct that causes or would have caused, if not detected, a licensee or applicant to be...

  1. Deliberate Switching of Single Photochromic Triads

    Science.gov (United States)

    Maier, Johannes; Pärs, Martti; Weller, Tina; Thelakkat, Mukundan; Köhler, Jürgen

    2017-01-01

    Photochromic molecules can be reversibly converted between two bistable conformations by light, and are considered as promising building blocks in novel macromolecular structures for sensing and imaging techniques. We have studied individual molecular triads consisting of two strong fluorophores (perylene bisimide) that are covalently linked via a photochromic unit (dithienylcyclopentene) and distinguished between deliberate switching and spontaneous blinking. It was verified that the probability for observing deliberate light-induced switching of a single triad (rather than stochastic blinking) amounts to 0.8 ± 0.1. In a few exceptional cases this probability can exceed 0.95. These numbers are sufficiently large for application in sensitive biosensing, and super-resolution imaging. This opens the possibility to develop devices that can be controlled by an external optical stimulus on a truly molecular length scale.

  2. Freedom of Expression, Deliberation, Autonomy, and Respect

    DEFF Research Database (Denmark)

    Rostbøll, Christian Fogh

    diversity. On the basis of an intersubjective epistemology, I argue that citizens cannot know how to live on mutually respectful terms without engaging in public deliberation. Moreover, to be successful deliberation must foster some degree of personal autonomy, at least the ability to distinguish what......The strongest versions of the democracy argument for freedom of expression rely on the deliberative conception of democracy. Deliberative democracy entails both an ideal of political autonomy and of autonomous preference formation. This paper elaborates the deliberative democracy argument...... for freedom of expression in terms of its relationship to different dimensions of autonomy. In response to the objection that Enlightenment theories pose a threat to cultures that reject autonomy, it is argued that autonomy-based democracy is not only compatible with but necessary for respect for cultural...

  3. Post Rio Communication Styles for Deliberation

    DEFF Research Database (Denmark)

    Holm, Jesper; Almlund, Pernille

    2015-01-01

    : health promotion. The paper explores a research approach to compare two different policy communication tracks in order to conceive various impacts on deliberation. The tracks are constructed along the narratives individual-collective & consensus-conflictual in the discursive framing of political......The communicative turn in planning, multi-layered governance and governmentality are analytical concepts from various schools of thought to comprehend the emergence of new types of publicprivate politics when it comes to complex, wicked issues such as sustainability or the 3rd wave of public health...... communication. We build on an ANT inspired methodology and look into two simultaneously evolving political agendas during the last two decades - sustainability and health promotion - that have framed communication efforts, campaigns and politics in general. How is public participation and deliberation...

  4. Six Common Listening Question Types in the German DSH Test---Taking DSH Tests of University of Freiburg 2007-2013 For Example%德语DSH考试听力理解的常见六大题型分析--以德国弗莱堡大学2007-2013年真题为例

    Institute of Scientific and Technical Information of China (English)

    赵梦迪

    2015-01-01

    The DSH test is a language proficiency test for non-native German language speakers who plan to enroll in a German university. The section of “listening comprehension and use of the language from a listening text” is an important part of the examination and also one of the greatest weaknesses for Chinese students. In order to test the listening skills comprehensively and objectively, the questions are always designed in flexible and diverse forms and becomes increasingly difficult step by step. Six DSH listening tests of University of Freiburg from 2007 to 2013 for example are selected and the test structure,the evaluation criteria and the common question types are analyzed,among which,the most common questions including filling in the blanks,table completion,true or false,order sentences,induction and iteration are mainly summarized. In addition,effective skills are summarized by analyzing the DSH characteristics in order to help Chinese examinees pass the DSH test.%DSH考试是为外国学生申请在德国高校入学而组织的一项语言考试,能够全面考察考生的德语语言水平。其中听力理解考试是重要的组成部分,也是中国考生的传统弱项。为了对考生的听力技能进行全面客观的考察,DSH听力考试的题目设置也往往灵活多样,难度逐级递增,并与其他语言能力紧密结合。本文选取德国弗莱堡大学2007-2013年间六次DSH考试的听力理解部分,解析DSH听力考试的组织形式、评估标准以及常见题目类型,其中重点总结了六大最常见的题型,即填空、补充表格、判断正误、排列顺序、理解归纳和总结复述。此外,本文通过分析DSH听力考试的特点,总结解题技巧,给中国考生备考DSH提供了科学的建议。

  5. Discourse and Deliberation Testing a Collaborative Strategy

    CERN Document Server

    Walker, M A

    1995-01-01

    A discourse strategy is a strategy for communicating with another agent. Designing effective dialogue systems requires designing agents that can choose among discourse strategies. We claim that the design of effective strategies must take cognitive factors into account, propose a new method for testing the hypothesized factors, and present experimental results on an effective strategy for supporting deliberation. The proposed method of computational dialogue simulation provides a new empirical basis for computational linguistics.

  6. Reorienting Deliberation: Identity Politics in Multicultural Societies

    Directory of Open Access Journals (Sweden)

    Rebecca Mason

    2010-03-01

    Full Text Available Many political theorists argue that cross-cultural communication within multicultural democracies is not best served by a commitment to identity politics. In response, I argue that identity politics only interfere with democratic participation according to an erroneous interpretation of the relationship between identity and reasoning. I argue that recognizing the importance of identity to the intelligibility of reasons offered in the context of civic deliberation is the first step towards the kind of dialogue that democratic participation requires.

  7. The ACCESS study a Zelen randomised controlled trial of a treatment package including problem solving therapy compared to treatment as usual in people who present to hospital after self-harm: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Parag Varsha

    2011-05-01

    Full Text Available Abstract Background People who present to hospital after intentionally harming themselves pose a common and important problem. Previous reviews of interventions have been inconclusive as existing trials have been under powered and done on unrepresentative populations. These reviews have however indicated that problem solving therapy and regular written communications after the self-harm attempt may be an effective treatment. This protocol describes a large pragmatic trial of a package of measures which include problem solving therapy, regular written communication, patient support, cultural assessment, improved access to primary care and a risk management strategy in people who present to hospital after self-harm using a novel design. Methods We propose to use a double consent Zelen design where participants are randomised prior to giving consent to enrol a large representative cohort of patients. The main outcome will be hospital attendance following repetition of self-harm, in the 12 months after recruitment with secondary outcomes of self reported self-harm, hopelessness, anxiety, depression, quality of life, social function and hospital use at three months and one year. Discussion A strength of the study is that it is a pragmatic trial which aims to recruit large numbers and does not exclude people if English is not their first language. A potential limitation is the analysis of the results which is complex and may underestimate any effect if a large number of people refuse their consent in the group randomised to problem solving therapy as they will effectively cross over to the treatment as usual group. However the primary analysis is a true intention to treat analysis of everyone randomised which includes both those who consent and do not consent to participate in the study. This provides information about how the intervention will work in practice in a representative population which is a major advance in this study compared to what has

  8. Reorienting Deliberation: Identity Politics in Multicultural Societies

    Directory of Open Access Journals (Sweden)

    Rebecca Mason

    2010-04-01

    Full Text Available

    Many political theorists argue that cross-cultural communication within multicultural democracies is not best served by a commitment to identity politics. In response, I argue that identity politics only interfere with democratic participation according to an erroneous interpretation of the relationship between identity and reasoning. I argue that recognizing the importance of identity to the intelligibility of reasons offered in the context of civic deliberation is the first step towards the kind of dialogue that democratic participation requires.


  9. Transmission network expansion planning under deliberate outages

    Energy Technology Data Exchange (ETDEWEB)

    Alguacil, Natalia; Carrion, Miguel; Arroyo, Jose Manuel [E.T.S. de Ingenieros Industriales, Universidad de Castilla - La Mancha, Campus Universitario s/n, 13071 Ciudad Real (Spain)

    2009-10-15

    The reasons why the transmission network is a potentially attractive target for deliberate outages are twofold: (i) its crucial importance as a critical infrastructure for the society welfare, and (ii) its high level of vulnerability due to the current operation close to its static and dynamic limits. This new context where destructive agents come into play has been recognized by several agencies in Europe and North America, and various initiatives have been launched worldwide in order to assess and mitigate the vulnerability of transmission. Within this framework, this paper proposes the reinforcement and expansion of the transmission network as a way of mitigating the impact of increasingly plausible deliberate outages. The network planner selects the new lines to be built accounting not only for economic issues, as traditionally done, but also for the vulnerability of the transmission network against a set of credible intentional outages. The resulting vulnerability- and economic-constrained transmission expansion planning problem is formulated as a mixed-integer linear program. A number of case studies numerically illustrate the tradeoff between economic- and vulnerability-related issues and its impact on the expansion plans. In addition, we compare the results with those achieved by a traditional expansion planning model based on cost minimization. (author)

  10. Deliberate Practice for Achieving and Maintaining Expertise in Anesthesiology

    National Research Council Canada - National Science Library

    Hastings, Randolph H; Rickard, Timothy C

    2015-01-01

    .... We begin by reviewing the attributes that characterize expert performance and discussing how a specific training format, known as deliberate practice, contributes to acquisition and maintenance of expertise...

  11. Decision making uncertainty, imperfection, deliberation and scalability

    CERN Document Server

    Kárný, Miroslav; Wolpert, David

    2015-01-01

    This volume focuses on uncovering the fundamental forces underlying dynamic decision making among multiple interacting, imperfect and selfish decision makers. The chapters are written by leading experts from different disciplines, all considering the many sources of imperfection in decision making, and always with an eye to decreasing the myriad discrepancies between theory and real world human decision making. Topics addressed include uncertainty, deliberation cost and the complexity arising from the inherent large computational scale of decision making in these systems. In particular, analyses and experiments are presented which concern: • task allocation to maximize “the wisdom of the crowd”; • design of a society of “edutainment” robots who account for one anothers’ emotional states; • recognizing and counteracting seemingly non-rational human decision making; • coping with extreme scale when learning causality in networks; • efficiently incorporating expert knowledge in personalized...

  12. Investigating intuitive and deliberate processes statistically

    Directory of Open Access Journals (Sweden)

    Andreas Glockner

    2009-04-01

    Full Text Available One of the core challenges of decision research is to identify individuals' decision strategies without influencing decision behavior by the method used. Br"oder and Schiffer (2003 suggested a method to classify decision strategies based on a maximum likelihood estimation, comparing the probability of individuals' choices given the application of a certain strategy and a constant error rate. Although this method was shown to be unbiased and practically useful, it obviously does not allow differentiating between models that make the same predictions concerning choices but different predictions for the underlying process, which is often the case when comparing complex to simple models or when comparing intuitive and deliberate strategies. An extended method is suggested that additionally includes decision times and confidence judgments in a simultaneous Multiple-Measure Maximum Likelihood estimation. In simulations, it is shown that the method is unbiased and sensitive to differentiate between strategies if the effects on times and confidence are sufficiently large.

  13. The effects of deliberate practice in undergraduate medical education

    NARCIS (Netherlands)

    Moulaert, Véronique; Verwijnen, Maarten GM; Rikers, Remy; Scherpbier, Albert JJA

    2004-01-01

    INTRODUCTION: Ericsson and colleagues introduced the term 'deliberate practice' to describe training activities that are especially designed to maximise improvement. They stressed that how much one practises is as important as how one practises. Essential aspects of deliberate practice are the prese

  14. The effects of deliberate practice in undergraduate medical education

    NARCIS (Netherlands)

    Moulaert, Véronique; Verwijnen, Maarten GM; Rikers, Remy; Scherpbier, Albert JJA

    2004-01-01

    INTRODUCTION: Ericsson and colleagues introduced the term 'deliberate practice' to describe training activities that are especially designed to maximise improvement. They stressed that how much one practises is as important as how one practises. Essential aspects of deliberate practice are the

  15. Curricular Deliberation about "Hamlet": An Exercise in the Practical.

    Science.gov (United States)

    Siegel, Judith Susan

    This study attempts to clarify and exploit Joseph Schwab's recent and current work on "practical" and "eclectic" curriculums in a simulated deliberation about a concrete curricular question, How might "Hamlet" be taught to one group of high school juniors? By exemplifying curricular deliberation, it aims to clarify…

  16. Curricular Deliberation about "Hamlet": An Exercise in the Practical.

    Science.gov (United States)

    Siegel, Judith Susan

    This study attempts to clarify and exploit Joseph Schwab's recent and current work on "practical" and "eclectic" curriculums in a simulated deliberation about a concrete curricular question, How might "Hamlet" be taught to one group of high school juniors? By exemplifying curricular deliberation, it aims to clarify…

  17. Good Will: Cosmopolitan Education as a Site for Deliberation

    Science.gov (United States)

    Roth, Klas

    2011-01-01

    Why should we deliberate? I discuss a Kantian response to this query and argue that we cannot as rational beings avoid deliberation in principle; and that we have good reasons to consider the value and strength of Kant's philosophical investigations concerning fundamental moral issues and their relevance for the question of why we ought to…

  18. The Effect Specialization and Diversification Involvement on Learning of Sports Skills According To Deliberate Practice and Deliberate Play

    Directory of Open Access Journals (Sweden)

    Mahdi Fahimi

    2016-12-01

    Full Text Available Objective: The aim was effect deliberate practice and deliberate play on sports skills with emphasis on specialization and diversification in boys 10-12. Methods: The 120 male students randomly divided into four groups of volleyball, soccer, basketball deliberate practice and deliberate play. Pretest and posttest were AAHPERD volleyball, soccer, and Basketball sports skills. Duration of the project was 16 weeks and 3 sessions per week and 90 minutes each session began. Data obtained from questionnaires and personal details about sports experience and test were adjusted using parametric tests, such as T-dependent test and MANOVA with Tukey post hoc test, and software Statistical SPSS19. Results: The results of the study showed that compared four groups, deliberate plays to other deliberate practices have a better motor skill in volleyball, soccer and Basketball sports skills (P<0.05. Volleyball and soccer deliberate practice group had developed Soccer Dribble Test and Control dribble and Defensive movement basketball skills test. Basketball deliberate practice group had not developed the others soccer and volleyball skills. Conclusion: The results showed that diversification participation in some exercises during the early stages of growth, can facilitate the development of general cognitive and physiological skills and create a rich environment for children.

  19. Collaborative deliberation: a model for patient care.

    Science.gov (United States)

    Elwyn, Glyn; Lloyd, Amy; May, Carl; van der Weijden, Trudy; Stiggelbout, Anne; Edwards, Adrian; Frosch, Dominick L; Rapley, Tim; Barr, Paul; Walsh, Thom; Grande, Stuart W; Montori, Victor; Epstein, Ronald

    2014-11-01

    Existing theoretical work in decision making and behavior change has focused on how individuals arrive at decisions or form intentions. Less attention has been given to theorizing the requirements that might be necessary for individuals to work collaboratively to address difficult decisions, consider new alternatives, or change behaviors. The goal of this work was to develop, as a forerunner to a middle range theory, a conceptual model that considers the process of supporting patients to consider alternative health care options, in collaboration with clinicians, and others. Theory building among researchers with experience and expertise in clinician-patient communication, using an iterative cycle of discussions. We developed a model composed of five inter-related propositions that serve as a foundation for clinical communication processes that honor the ethical principles of respecting individual agency, autonomy, and an empathic approach to practice. We named the model 'collaborative deliberation.' The propositions describe: (1) constructive interpersonal engagement, (2) recognition of alternative actions, (3) comparative learning, (4) preference construction and elicitation, and (5) preference integration. We believe the model underpins multiple suggested approaches to clinical practice that take the form of patient centered care, motivational interviewing, goal setting, action planning, and shared decision making. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Deliberating on intersectionality: women’s conferences in Recife

    Directory of Open Access Journals (Sweden)

    Maria-Hélène Sa Vilas Boas

    2015-12-01

    Full Text Available Under what conditions can deliberation include marginalized social groups? Several feminist authors criticize deliberative theory for reproducing power relations between social groups. They defend the explicit recognition of marginalized social groups within deliberative devices. This article aims to analyze the dynamics of deliberation when it gathers a traditionally underrepresented group, women. Based on the study of women’s conferences in Recife, it shows that the combination the politics of recognition and deliberation can lead both to the integration and marginalization of different actors within the group of women, depending on the resources they have available to voice their perspectives.

  1. Engaging Youth and Pre-Service Teachers in Immigration Deliberations

    Science.gov (United States)

    Daniel, Shannon M.

    2015-01-01

    In this report of innovative teacher practice, the author describes an arts-based event which brought together adolescent refugee and immigrant students and pre-service teachers to deliberate about immigration policies and attitudes in the United States.

  2. The Efficacy of Deliberate Practice Delivered Using Asynchronous Training Technology

    Directory of Open Access Journals (Sweden)

    Colleen E. McEdwards

    2014-04-01

    Full Text Available Employee productivity is key to survival in business. Senior employees require access to advanced training that does not necessitate extended periods away from their work. Once performance begins to plateau, it can be difficult to reach experienced employees with cost-effective, timely, and relevant training opportunities. Organizations must find ways to enhance employee performance; however, research suggests workplace training is too expensive and is too often without lasting benefit. The purpose of this study is to further quantify deliberate practice as a potentially efficient, customizable mode of training using asynchronous e-learning. The study compared traditional seminars with online deliberate practice training. While additional research is needed in wider learning contexts and with larger sample sizes, improvements among the deliberate practice groups were significant. Using a mixed methods pretest/posttest research design, the deliberate practice training showed improved performance and increased satisfaction compared with the traditional seminar approach.

  3. Conditions for religious discourse in secularized ethical health care deliberation.

    Science.gov (United States)

    van Nistelrooy, Inge; Vosman, Frans

    2012-01-01

    Religious discourse is no longer self-evident in professional health care ethical deliberation in the North Atlantic cultural sphere. However, in a world of pluralism, care professionals still seek substantive views of good care. Religious and non-religious beliefs should not be excluded from ethical deliberation. They offer patients and professionals a helpful language for expressing values and beliefs. Chaplains have a role to play as allies in sense-making processes and resourcing care.

  4. Procedures and Methods for Cross-community Online Deliberation

    Directory of Open Access Journals (Sweden)

    Cyril Velikanov

    2010-09-01

    Full Text Available In this paper we introduce our model of self-regulated mass online deliberation, and apply it to a context of cross-border deliberation involving translation of contributions between participating languages, and then to a context of cross-community online deliberation for dispute resolution, e.g. between opposing ethnic or religious communities. In such a cross-border or cross-community context, online deliberation should preferably progress as a sequence of segmented phases each followed by a combining phase. In a segmented phase, each community deliberates separately, and selects their best contributions for being presented to all other communities. Selection is made by using our proposed mechanism of mutual moderation and appraisal of contributions by participants themselves. In the subsequent combining phase, the selected contributions are translated (by volunteering or randomly selected participants among those who have specified appropriate language skills and presented to target segments for further appraisal and commenting. Our arguments in support of the proposed mutual moderation and appraisal procedures remain mostly speculative, as the whole subject of mass online self-regulatory deliberation still remains largely unexplored, and there exist no practical realisation of it .

  5. Condutas autolesivas entre detentas da Colônia Penal Feminina do Recife Conductas auto lesivas entre detenidas de la "Colonia Penal Femenina de Recife" Self-harm behavior among Brazilian Women in Recife Prison

    Directory of Open Access Journals (Sweden)

    Marcus Túlio Caldas

    2009-09-01

    presidio e intento de comunicación y afirmación de la individualidad en un ambiente colectivo.This study intends to analyse possible influence factors on self-harm among incarcerated Brazilian women from the feminine criminal colony of Recife. Its specific objectives include formulating intervention strategies to reduce the incidence of those behaviors. Two questionnaires were elaborated: the first one to carry through a census with all prisoners and select the sample, determining the extension of self-harm; the second one is for specific application with selected prisoners, to go deeper in self-harm study. Qualitative data were collected through observation notes and half-directed interviews in groups. Data analysis included quantitative method of descriptive statistics analysis and qualitative method of thematic analysis. Several factors correlated to self-harm were found: relief of psychological suffering as a result from the incarceration environment; self-anger or anger of others; drug use; manipulative attempts to get advantages in the prison and attempts to communicate and affirmation of individuality in a collective environment.

  6. The myth of the best argument: power, deliberation and reason.

    Science.gov (United States)

    Pellizzoni, L

    2001-03-01

    Power in communication takes two main forms. As 'external' power, it consists in the ability to acknowledge or disregard a speaker or a discourse. As 'internal' power, it is the ability of an argument to eliminate other arguments by demonstrating its superiority. A positive or negative value may be ascribed to these forms of power. Four ideal-typical positions are discussed--strategy, technocracy, constructionism, and deliberation. Public deliberation has three virtues--civic virtue, governance virtue and cognitive virtue. Deliberation lowers the propensity to, and the benefit of, strategic behaviour. It also increases knowledge, enhancing the quality of decisions. For Habermas, the unity of reason is expressed in the possibility of agreement on the most convincing argument. However, sometimes conflicts are deep-lying, principles and factual descriptions are profoundly different, and uncertainty is radical. The best argument cannot be found. There is no universal reason. The question is whether non-strategic agreement may spring from the incommensurability of languages. In search of an answer, Rawls's concept of overlapping consensus, the feminist theory of the public sphere, and the idea of deliberation as co-operation are discussed. The argument developed is that the approach to deliberative democracy may be renewed by rethinking its motivational and cognitive elements. Public deliberation is grounded on a pre-political level of co-operation. Intractable controversies may be faced at the level of practices, looking for local, contextual answers.

  7. Sustainability and deliberate transition of socio-technical systems

    DEFF Research Database (Denmark)

    Hansen, Ole Erik; Søndergård, Bent; Stærdahl, Jens;

    The article suggests that deliberate planning for sustainability demands a focus on the transition of socio-technical systems in order to establish robust and more sustainable patterns of production and consumption. This implies the necessity of a new perspective for environmental planning...... and policy. Deliberate planning for sustainability becomes a question of addressing governance structures of socio-technical systems, calling attention to how such governance structures emerge, stabilize and become dominant, which functions governance structures have to serve to become efficient, and how...... they can be made subject to deliberate and purposeful shaping and transition. It is not possible for government or others in detail to decide what future practices are the most sustainable. Government, however, has an important role in order to stimulate reflexive processes in actor networks in existing...

  8. Using deliberation to address controversial issues: Developing Holocaust education curriculum.

    Directory of Open Access Journals (Sweden)

    THOMAS MISCO

    2007-10-01

    Full Text Available This paper explores how a cross-cultural project responded to the need for new Holocaust educational materials for the Republic of Latvia through the method of curriculum deliberation. Analysis of interview, observational, and document data drawn from seven curriculum writers and numerous project members suggest that curriculum deliberation helped awaken a controversial and silenced history while attending to a wide range of needs and concerns for a variety of stakeholders. The findings highlight structural features that empowered the curriculum writers as they engaged in protracted rumination, reflected upon competing norms, and considered the nuances of the curriculum problem in relation to implementation. Understanding the process, challenges, and promises of cross-cultural curriculum deliberation holds significance for educators, curricularists, and educational researchers wishing to advance teaching and learning within silenced histories and controversial issues.

  9. Deliberate interventions in the availability and circulation of practice elements

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Hoffmann, Birgitte

    of which daily lives are made (Shove, Pantzar and Watson 2012). This points towards a need to understand how deliberate interventions may help to support changes in systems of practices, which are not immediately governable (Shove and Walker 2010). Whereas there are indications about how a social theory......Cities are increasingly becoming sites of low-carbon transitions, as Bulkeley et al. (2011) have demonstrated. For example, urban governments increasingly tend to gain degrees of control over regimes in order to achieve territorial priorities (Hodson and Marvin 2011). This reflects how urban...... governments deliberately attempt to intervene in existing sociotechnical systems in order to establish low-carbon configurations in practice. Such deliberate interventions tend to merely improve the efficiency with which contemporary standards are met, hereby neglecting the need to change systems of practices...

  10. 2713名大学生自伤行为及其与自杀心理行为的关联研究%An investigation on self-harm episodes and their relationship with suicidal psychology and behaviors in 2713 college students

    Institute of Scientific and Technical Information of China (English)

    苏普玉; 郝加虎; 黄朝辉; 陶芳标

    2010-01-01

    Objective To investigate the episodes and influencing factors on self-harm and to explore the relationship between self-harm episodes and suicidal psychology and behaviors in college students. Methods Four universities were selected using cluster sampling method in Anqing city and Chaohu city. Totally, 2713 college students completed this survey. Data were analyzed by Pearson Chi-square and logistic regression. Results In the last six months, rates of highly lethal self-harm,less lethal self-harm with visible tissue damage, self-injury without visible tissue damage,self-harmful behaviors with latency damage, other self-harmful behaviors with menticide were 1.9%,5.5%, 15.3%, 21.2% and 17.0% respectively. The total rate of self-harm was 31.3%. 73.1% of the students with self harmful experiences had the above mentioned behaviors more than 3 times in the last six months. The top 3 reasons for taking self-harm actions were: having learning problems (43. 1% ), failed love affairs (25.0%) and having conflicts with others (23.9%). There were different influencing factors among different kinds of self-harm episodes. Depression was the risk factor of self-harm. The higher score of having high self-esteem was the protective factor of all kinds of self-harm actions except highly lethal ones. Higher score of difficulties in identifying feelings was one of the risk factors. The rates of suicidal psychology and behaviors in students with self-harm were significantly higher than those in students without those behaviors. Result from linear x2 test indicated that the graveness of tissue damage of self-harm was higher along with the rates of suicidal psychology and behaviors (P<0.01). Conclusion Among 2713 college students, about 1/3adolescents having experienced self-harm in the last 6 months, many with repeated ones. Depression and difficulties in identifying feelings were the two risk factors while self-esteem was the protective factor related to most of the self-harm cases

  11. Youth on the virtual edge: researching marginalized sexualities and genders online.

    Science.gov (United States)

    McDermott, Elizabeth; Roen, Katrina

    2012-04-01

    Research shows clear links between lesbian, gay, bisexual, and transgender (LGBT) youth and deliberate self-harm (DSH), but there is a lack of research investigating the social context of young LGBT people's lives and helping to explain the higher DSH risk. In this article, we report on a small-scale methodological study intended to test the feasibility of online qualitative interviews for investigating young people, sexual and gender identity, and emotional distress. There are many methodological dilemmas arising from researching such sensitive issues with marginalized groups. The study reported here was designed to examine (a) sampling diversity in terms of sexuality, gender identities, and class; and (b) the type of data produced. We found that a virtual methodology was effective in recruiting young LGBT participants who might otherwise not take part in research. Online interviewing successfully produced in-depth, "immediate" data that potentially gave access to insights that might not emerge through face-to face interviews.

  12. Experimental evidence on deliberate misrepresentation in referendum contingent evaluation

    NARCIS (Netherlands)

    Polome, Philippe

    2003-01-01

    The paper presents an experiment on deliberate misrepresentation in referendum contingent valuation (RCV) surveys. The experiment consists in inducing willingness to pay (WTP) for a credible laboratory public good with an uncertain cost and asking subjects to vote in an advisory referendum on the

  13. A Deliberate Practice Approach to Teaching Phylogenetic Analysis

    Science.gov (United States)

    Hobbs, F. Collin; Johnson, Daniel J.; Kearns, Katherine D.

    2013-01-01

    One goal of postsecondary education is to assist students in developing expert-level understanding. Previous attempts to encourage expert-level understanding of phylogenetic analysis in college science classrooms have largely focused on isolated, or "one-shot," in-class activities. Using a deliberate practice instructional approach, we…

  14. Dewey's Ethical Justification for Public Deliberation Democracy

    Science.gov (United States)

    Shook, John

    2013-01-01

    Interpretations of John Dewey's political theory grasp his respect for public deliberation, but typically overlook his ethical justification for democracy. Dewey gave two primary reasons why democracy is superior to other forms of government. First, a public educated in the tools of social intelligence can be more effective at managing their…

  15. Deliberations on the Development of an Intercultural Competence Curriculum

    Science.gov (United States)

    Punteney, Katherine

    2016-01-01

    Committed to developing an institution-wide intercultural competence curriculum for master's-level students preparing for international careers, a team of nine professors from across disciplines deliberated for a year on their fundamental understandings of intercultural competence and what it would mean to facilitate the development of that…

  16. The Relationship between Deliberate Practice and Reading Ability

    Science.gov (United States)

    Hanlon, Sean Thomas

    2013-01-01

    Many students are not prepared to meet the literacy demands of college and career as defined by the Common Core State Standards (2010). Literacy researchers have struggled to define the frequency and type of reading practice necessary to nurture the development of reading ability. The principles of deliberate practice provide a theoretical…

  17. Intuitive and Deliberate Judgments Are Based on Common Principles

    Science.gov (United States)

    Kruglanski, Arie W.; Gigerenzer, Gerd

    2011-01-01

    A popular distinction in cognitive and social psychology has been between "intuitive" and "deliberate" judgments. This juxtaposition has aligned in dual-process theories of reasoning associative, unconscious, effortless, heuristic, and suboptimal processes (assumed to foster intuitive judgments) versus rule-based, conscious, effortful, analytic,…

  18. Suicides and suicide attempts among active component members of the U.S. Armed Forces, 2010-2012; methods of self-harm vary by major geographic region of assignment.

    Science.gov (United States)

    Corr, William P

    2014-10-01

    This report analyzed data from the Department of Defense Suicide Event Report program about suicide events (suicide attempts and suicides) among active component service members during 2010-2012. Most attempts (85.2%) and suicides (83.5%) occurred among service members stationed in the U.S. Drugs were identified as the method of self-harm in 54.8% of attempts but in only 3.6% of suicides. Firearms were the leading method of suicide in both the U.S. and combat zones (61.1% and 97.2%, respectively) but accounted for only 5.4% of suicides in those stationed in Europe/Asia. Hanging/asphyxiation (22.9% overall) was the second most common method in suicides. For suicides using firearms, the rates of suicide and the types of firearm used varied according to service members' geographically related access to firearms. Challenges to reducing the frequency of service member suicides by firearms are discussed.

  19. Democratic Deliberations in the Finnish Elementary Classroom: The Dilemmas of Deliberations and the Teacher's Role in an Action Research Project

    Science.gov (United States)

    Tammi, Tuure

    2013-01-01

    Finnish youth are found to be, despite their broad knowledge, uninterested in politics and in societal participation. As a remedy, international studies suggest enabling democratic experiences in schools. This article discusses an action research project aimed at developing deliberation-based democratic practice in an elementary classroom. Results…

  20. 42 CFR 480.139 - Disclosure of QIO deliberations and decisions.

    Science.gov (United States)

    2010-10-01

    ... HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF... decisions. (a) QIO deliberations. (1) A QIO must not disclose its deliberations except to— (i) CMS, at the QIO office or at a subcontracted organization; (ii) CMS, to the extent that the deliberations...

  1. [Vulnerability to self-harm in autism].

    Science.gov (United States)

    Paula-Perez, I; Artigas-Pallares, J

    2016-01-01

    Introduccion. El porque de la autolesion en las personas con autismo no parece tener una explicacion simple, sencilla y unica. La predisposicion biologica, determinados estados psicologicos de estres, un procesamiento sensorial atipico, alteraciones en la comunicacion, problemas medicos, limitaciones en la regulacion emocional, entre otros, pueden llevan a la persona con autismo a dañarse. Objetivo. En este articulo se diferencia, en primer lugar, la autolesion relacionada con alteraciones del neurodesarrollo, como el autismo y la autolesion vinculada a otras condiciones psiquiatricas; y en segundo lugar, se propone una primera aproximacion a un modelo integral de comprension de la autolesion en el autismo. Desarrollo. Algunas de las hipotesis explicativas de la autolesion en el autismo estan centradas en el procesamiento sensorial atipico, en alteraciones de la comunicacion y problemas medicos, y en la desregulacion emocional. Conclusiones. La limitada investigacion al respecto y la confusion de los datos que se arrojan ha generado un especial esfuerzo por separar los hechos de las suposiciones en todo lo relativo a este tema. Esta modesta propuesta inicial permite elaborar una hoja de ruta que oriente y ayude a las personas con autismo, a sus familias y a los profesionales en el proceso de disminuir o eliminar este comportamiento. Se sugiere dejar de hablar de la autolesion como comportamiento disruptivo y mas bien interpretarla como una (inadecuada) respuesta autorregulatoria al estres.

  2. Perfectionism: A Risk to Self-Harm

    Science.gov (United States)

    Cranab, A. Linsey; Raja, B. William Dharma

    2015-01-01

    Naturally humans strive to do their work. But when it exceeds a limit, it becomes neurotic and also not healthy perfectionism. Perfectionism is always not pleasurable, and people typically confuse their talents and capabilities with their perfectionism. In fact, perfectionism interferes with a person's ability to do well (Hummel, 2000). This paper…

  3. Problem music and self-harming.

    Science.gov (United States)

    North, Adrian C; Hargreaves, David J

    2006-10-01

    Academics and protest groups have claimed that "problem music" (hard rock, hip hop/rap, & punk) causes self-injurious thoughts/behaviors among fans. In this study we investigated whether the relationship is mediated by self-esteem, delinquency, and conservatism; and whether first exposure to problem music preceded self-injurious thoughts. A liking for problem music was associated with four of the five self-injurious measures, although these significant relationships were weakened (into nonsignificance in the case of two self-injurious measures) when the mediating variables were included. Listening to problem music did not precede self-injurious thoughts. Problem music is associated with self-injurious thoughts and behaviors, but this relationship is mediated by other factors and the former does not seem to cause the latter.

  4. Complexity and deliberation in collaborative socioscientific issues (SSI) inquiry discourse

    OpenAIRE

    Byhring, Anne Kristine

    2014-01-01

    Argumentation in science classrooms may be modeled on the practices of ‘science proper’, as in experimental work and inquiry learning. Consequentially, argumentation is oriented around matters of truth, or at least on matters of probability. Regarding less clear cut matters of opinion and of priorities of action, as is often the case when deliberating on socioscientific issues (SSI), neither science knowledge alone nor empirical evidence are able to provide sufficient grounds f...

  5. Robust learning experiments: Evidence for learning and deliberation

    OpenAIRE

    Güth, Werner

    2000-01-01

    Robust learning experiments confront participants with structurally different decision environments which they encounter, furthermore, repeatedly. Since the decision format does not depend on the rules (of game), forward looking deliberation (the shadow of the future) can be detected by anticipation of rule changes. Adaptation to past success (the shadow of the past) is revealed when playing the same game repeatedly. The experiments of bidding behavior, reputation formation, endogenous timing...

  6. Intermediary role of social supports between loneliness and deliberate self-harm in rural left-home children%社会支持在农村留守初中生孤独感与自我伤害间的中介作用

    Institute of Scientific and Technical Information of China (English)

    孔祥军; 刘艺; 张敬军

    2016-01-01

    目的 探讨社会支持在农村留守初中生孤独感与自我伤害间的中介作用.方法 采用孤独感量表、社会支持评定量表、青少年自我伤害问卷对474名农村留守初中生进行调查.结果 (1)相关分析发现,孤独感与社会支持存在显著的负相关(r =-0.555),社会支持与自我伤害存在显著的负相关(r=-0.537),孤独感与自我伤害存在着显著的正相关(r =0.674).(2)社会支持在留守初中生孤独感与自我伤害之间起部分中介作用,中介效应占总效应的比例为19.47%.结论 社会支持在留守初中生孤独感与自我伤害之间起中介作用.

  7. Sociocultural Context of Suicidal Behaviour in the Sundarban Region of India

    Directory of Open Access Journals (Sweden)

    A. N. Chowdhury

    2013-01-01

    Full Text Available The role of mental illness in nonfatal deliberate self-harm (DSH is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC, and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2% and married (65.2%. Most of them (69.7% were uncertain about their “intention to die,” and pesticide poisoning was the commonest method (95.5%. Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6% was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%; however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

  8. Neural basis of moral verdict and moral deliberation

    Science.gov (United States)

    Borg, Jana Schaich; Sinnott-Armstrong, Walter; Calhoun, Vince D.; Kiehl, Kent A.

    2011-01-01

    How people judge something to be morally right or wrong is a fundamental question of both the sciences and the humanities. Here we aim to identify the neural processes that underlie the specific conclusion that something is morally wrong. To do this, we introduce a novel distinction between “moral deliberation,” or the weighing of moral considerations, and the formation of a “moral verdict,” or the commitment to one moral conclusion. We predict and identify hemodynamic activity in the bilateral anterior insula and basal ganglia that correlates with committing to the moral verdict “this is morally wrong” as opposed to “this is morally not wrong,” a finding that is consistent with research from economic decision-making. Using comparisons of deliberation-locked vs. verdict-locked analyses, we also demonstrate that hemodynamic activity in high-level cortical regions previously implicated in morality—including the ventromedial prefrontal cortex, posterior cingulate, and temporoparietal junction—correlates primarily with moral deliberation as opposed to moral verdicts. These findings provide new insights into what types of processes comprise the enterprise of moral judgment, and in doing so point to a framework for resolving why some clinical patients, including psychopaths, may have intact moral judgment but impaired moral behavior. PMID:21590588

  9. Exploring Complexity of Deliberate Self-Poisoning through Network Analysis

    Science.gov (United States)

    Farahbakhsh, Mostafa; Fein, Rebecca A.; Moftian, Nazila; Nasiry, Zahra

    2017-01-01

    The purpose of this research was to examine the complexity of circumstances that result in deliberate self-poisoning cases. For the purposes of this paper, the cases were patients that presented for care and were admitted to the specialty hospital in Northwest of Iran. The research examined the problems preceding deliberate self-poisoning and the interrelations among them by applying network analysis methods. The network was scored for degrees of centrality and betweenness centrality. Structural analysis of network also was conducted using block modelling. The results showed that family conflicts had the highest score for degree of centrality among women, while the highest score for degree of centrality among men belonged to those dealing with drug addiction. Analysis for degree of betweenness centrality revealed that drug addiction had the highest score among men, whereas the highest score for women on betweenness centrality was related to physical illness. Structural analysis of the network showed differences in role that various problems played in intentional self-poisoning. The findings from this research can be used by public health authorities to create prevention programs that address the problems leading to deliberate self-poisoning. PMID:28251146

  10. Barriers to Effective Deliberation in Clinical Research Oversight.

    Science.gov (United States)

    Wenner, Danielle M

    2016-09-01

    Ethical oversight of clinical research is one of the primary means of ensuring that human subjects are protected from the natural bias of researchers and research institutions in favor of experimentation. At a minimum, effective oversight should ensure that risks are minimized and reasonable in relation to anticipated benefits, protect vulnerable subjects from potential coercion or undue influence, ensure full and informed consent, and promote the equitable distribution of the risks and benefits of research. Because these assessments often involve value judgments for which there are no agreed-upon objective standards, we rely on deliberative procedures thought to have the greatest likelihood of producing the right or best outcomes. Concerns about the potential for improperly functioning IRBs to waste scarce human and institutional resources and impede biomedical progress have motivated a surge in empirical research assessing their procedures and outcomes. Yet within this literature, there has been minimal attention paid to the social scientific evidence regarding how individuals and deliberating groups make decisions, nor how those data might inform IRB practice. This essay seeks to fill that gap, locating recent empirical data on IRB composition and process within the context of data regarding what I call "deliberative pathologies," or instances when deliberation fails to live up to one or more aspect of the deliberative ideal because of systematic biases in the ways participants interact. The paper goes on to make evidence-based recommendations to reduce the vulnerability of IRB deliberations to the kinds of pathologies discussed and indicate directions for future research.

  11. Sexual abuse and substance abuse increase risk of suicidal behavior in Malaysian youth.

    Science.gov (United States)

    Chan, Lai Fong; Maniam, T; Saini, Suriati Mohamed; Shah, Shamsul Azhar; Loh, Sit Fong; Sinniah, Aishvarya; Idris, Zawaha Haji; Che Rus, Sulaiman; Hassan Nudin, Siti Sa'adiah; Tan, Susan Mooi Koon

    2013-04-01

    The aim of this study was to determine the association between sexual abuse, substance abuse and socio-demographic factors with suicidal ideation (SI), plans (SP) and deliberate self-harm (DSH) and propose steps to prevent youth suicidal behavior. This was a cross-sectional study of 6786 adolescents aged 17-18 years, selected randomly from all Malaysian adolescents to undergo compulsory youth camps located in Selangor, Malaysia (2008-2009). Participants were assessed using self-administered questionnaires developed to reflect the local cultural setting. However, only 4581 subjects were analyzed after excluding incomplete data. The rates of SI, SP and DSH were 7.6%, 3.2% and 6.3%, respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 1.99 (95% CI: 1.56-2.55), SP 1.57 (95% CI: 1.09-2.27) and DSH 2.26 (95% CI: 1.75-2.94); illicit drug use was associated with SI 4.05 (95% CI: 2.14-7.67), SP 2.62 (95% CI: 1.05-6.53) and DSH 2.06, (95% CI: 1.05-4.04); for alcohol use DSH was 1.34 (95% CI: 1.00-1.79). Being female was associated with all suicidal behaviors: SI 2.51 (95% CI: 1.91-3.30), SP 2.07 (95% CI: 1.39-3.08) and DSH 1.59 (95% CI: 1.19-2.11). Given the well-founded concern of increasing risk of suicidal behavior among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and substance abuse, and their sequelae, especially in girls. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

  12. Seeking Deliberation on the Unborn in International Law

    Directory of Open Access Journals (Sweden)

    SA de Freitas

    2011-08-01

    Full Text Available International human rights instruments and jurisprudence radiate an understanding of international law as also serving to protect fundamental rights and the interests of the individual. The idea that human rights provide a credible framework for constructing common norms among nations and across cultures is both powerful and attractive. If the protection of being human serves as the common denominator in human rights discussion, and if human rights are deeply inclusive, despite being culturally and historically diverse, then a failure to deliberate on the legal status and protection of the unborn may be seen as a failure to extend respect where it is due. Such deliberation is required, irrespective of the fact that jurisprudential debate on the unborn and on abortion is complex and controversial. The protection of human life, well-being, and dignity are essential aims of the United Nations Charter and the international system created to implement it. Although there have been collective efforts resulting in substantial development in international human rights law, the international community has not approached the legal status and protection of the unborn as a matter of urgency – this, while much has been accomplished regarding women, children, animals and cloning. This article therefore argues for the development of a deliberative framework so as to further the recognition (not necessarily in an absolute sense of the unborn in international law, bearing in mind that opposition to abortion does not of itself constitute an attack on a woman's right to respect for privacy in her life. The article also sets out what such deliberation on the legal status and protection of the unborn entails, against the background of a procedurally-rational approach.

  13. Citizens' perspectives on personalized medicine: a qualitative public deliberation study.

    Science.gov (United States)

    Bombard, Yvonne; Abelson, Julia; Simeonov, Dorina; Gauvin, Francois-Pierre

    2013-11-01

    Our objective was to explore citizens' informed and reasoned values and expectations of personalized medicine, a timely yet novel genomics policy issue. A qualitative, public deliberation study was undertaken using a citizens' reference panel on health technologies, established to provide input to the health technology assessment process in Ontario, Canada. The citizens' panel consisted of five women and nine men, aged 18-71 years, with one member selected from each health authority region. There were shared expectations among the citizens' panel members for the potential of personalized medicine technologies to improve care, provided they are deemed clinically valid and effective. These expectations were tempered by concerns about value for money and the possibility that access to treatment may be limited by personalized medicine tests used to stratify patients. Although they questioned the presumed technological imperative presented by personalized medicine technologies, they called for increased efforts to prepare the health-care system to effectively integrate these technologies. This study represents an early but important effort to explore public values toward personalized medicine. This study also provides evidence of the public's ability to form coherent judgments about a new policy issue. Concerned that personalized tests might be used to ration care, they suggested that treatment should be made available if patients wanted it, irrespective of tests that indicate little benefit. This issue raises clinical and policy challenges that may undermine the value of personalized medicine. Further efforts to deliberate with the public are warranted to inform effective, efficient and equitable translation of personalized medicine.

  14. Mirror man: a case of skilled deliberate mirror writing.

    Science.gov (United States)

    McIntosh, Robert D; De Lucia, Natascia; Della Sala, Sergio

    2014-01-01

    Mirror writing is a striking behaviour that is common in children and can reemerge in adults following brain damage. Skilled deliberate mirror writing has also been reported, but only anecdotally. We provide the first quantitative study of skilled deliberate mirror writing. K.B. can write forward or backward, vertically upright or inverted, with the hands acting alone or simultaneously. K.B. is predominantly left handed, but writes habitually with his right hand. Of his writing formats, his left hand mirror writing is by far the most similar in style to his normal handwriting. When writing bimanually, he performs better when his two hands make mirror-symmetrical movements to write opposite scripts than if they move in the same direction to write similar scripts. He has no special facility for reading mirrored text. These features are consistent with prior anecdotal cases and support a motor basis for K.B.'s ability, according to which his skilled mirror writing results from the left hand execution of a low-level motor program for a right hand abductive writing action. Our methods offer a novel framework for investigating the sharing of motor representations across effectors.

  15. A pilot study evaluating a support programme for parents of young people with suicidal behaviour.

    LENUS (Irish Health Repository)

    Power, Lorna

    2009-01-01

    ABSTRACT: BACKGROUND: Deliberate self harm (DSH) is a major public health concern and has increased among young people in Ireland. While DSH is undoubtedly the result of interacting factors, studies have identified an association between DSH and family dysfunction as well as the protective role of positive family relationships. Following a focus group meeting held to identify the needs of parents and carers of young people with DSH, a support programme (SPACE) was developed. The aims of the current study are to evaluate the effectiveness of the SPACE programme in decreasing parental psychological distress, reducing parental report of young peoples\\' difficulties, increasing parental satisfaction and increasing parents\\' ratings of their own defined challenges and goals. METHODS: Participants were recruited from a Mental Health Service within a paediatric hospital, Community Child and Adolescent Mental Health Teams and family support services. All services were located within the greater Dublin area in Ireland. Forty-six parents of children who had engaged in or expressed thoughts of self harm attended the programme and participated in the evaluation study. The programme ran once a week over an 8-week period and included topics such as information on self harm in young people, parenting adolescents, communication and parental self-care. Seventy percent (N = 32) of the original sample at Time 1 completed measures at Time 2 (directly following the programme) and 37% (N = 17) of the original sample at Time 1 completed them at Time 3 (6 months following the programme).A repeated measures design was used to identify changes in parental wellbeing after attendance at the programme as well as changes in parental reports of their children\\'s difficulties. RESULTS: Participants had lower levels of psychological distress, increased parental satisfaction, lower ratings of their own defined challenges and higher ratings of their goals directly after the programme. These

  16. A pilot study evaluating a support programme for parents of young people with suicidal behaviour

    Directory of Open Access Journals (Sweden)

    Crowley Sinead

    2009-07-01

    Full Text Available Abstract Background Deliberate self harm (DSH is a major public health concern and has increased among young people in Ireland. While DSH is undoubtedly the result of interacting factors, studies have identified an association between DSH and family dysfunction as well as the protective role of positive family relationships. Following a focus group meeting held to identify the needs of parents and carers of young people with DSH, a support programme (SPACE was developed. The aims of the current study are to evaluate the effectiveness of the SPACE programme in decreasing parental psychological distress, reducing parental report of young peoples' difficulties, increasing parental satisfaction and increasing parents' ratings of their own defined challenges and goals. Methods Participants were recruited from a Mental Health Service within a paediatric hospital, Community Child and Adolescent Mental Health Teams and family support services. All services were located within the greater Dublin area in Ireland. Forty-six parents of children who had engaged in or expressed thoughts of self harm attended the programme and participated in the evaluation study. The programme ran once a week over an 8-week period and included topics such as information on self harm in young people, parenting adolescents, communication and parental self-care. Seventy percent (N = 32 of the original sample at Time 1 completed measures at Time 2 (directly following the programme and 37% (N = 17 of the original sample at Time 1 completed them at Time 3 (6 months following the programme. A repeated measures design was used to identify changes in parental wellbeing after attendance at the programme as well as changes in parental reports of their children's difficulties. Results Participants had lower levels of psychological distress, increased parental satisfaction, lower ratings of their own defined challenges and higher ratings of their goals directly after the programme. These

  17. Democracy and the Internet: Access, Engagement and Deliberation

    Directory of Open Access Journals (Sweden)

    Roman Gerodimos

    2005-12-01

    Full Text Available The internet has the capacity to facilitate the creation of new forms of civic engagement, but the realisation of these opportunities requires institutional and cultural reinforcement. The democratic character of e-citizenship and the equal distribution of online resources to the public require the fulfilment of four conditions: access, engagement (incorporating education, motivation and trust, meaningful deliberation and a link between civic input and public policy output. Furthermore, the gap between the main features of cyberspace and the inherent prerequisites of democracy, such as a finite space and a set of rules, create tensions that need to be negotiated politically. Although the empirical evidence available includes some encouraging signs regarding the future use of the internet for civic engagement, the existing limitations and obstacles mean that the new media will complement, rather than replace, the old media as a democratic public sphere.

  18. Fairness requires deliberation: the primacy of economic over social considerations.

    Science.gov (United States)

    Hochman, Guy; Ayal, Shahar; Ariely, Dan

    2015-01-01

    While both economic and social considerations of fairness and equity play an important role in financial decision-making, it is not clear which of these two motives is more primal and immediate and which one is secondary and slow. Here we used variants of the ultimatum game to examine this question. Experiment 1 shows that acceptance rate of unfair offers increases when participants are asked to base their choice on their gut-feelings, as compared to when they thoroughly consider the available information. In line with these results, Experiments 2 and 3 provide process evidence that individuals prefer to first examine economic information about their own utility rather than social information about equity and fairness, even at the price of foregoing such social information. Our results suggest that people are more economically rational at the core, but social considerations (e.g., inequality aversion) require deliberation, which under certain conditions override their self-interested impulses.

  19. Reinforcement learning for mobile robot: from reaction to deliberation

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Reinforcement learning has been widely used for mobile robot learning and control. Some progress of this kind of approaches is surveyed and argued in a new way which emphasizes on different levels of algorithms according to different complexity of tasks. The central conjecture is that approaches which combine reactive and deliberative control to robotics scale better to complex real-world applications than purely reactive or deliberative ones. This paper describes basic reactive reinforcement learning algorithms and two classes of approaches to achieve deliberation, which are modular methods and hierarchical methofs. By combining reactive and deliberative paradigms, the whole system gains advantages froh different control levels. The paper gives results of experiments as a case study to verify the effectiveness of the propos ed approaches.

  20. Deliberation and scale in Mekong region water governance.

    Science.gov (United States)

    Dore, John; Lebel, Louis

    2010-07-01

    Understanding the politics of deliberation, scales, and levels is crucial to understanding the social complexity of water-related governance. Deliberative processes might complement and inform more conventional representational and bureaucratic approaches to planning and decision-making. However, they are also subject to scale and level politics, which can confound institutionalized decision-making. Scale and level contests arise in dialogues and related arenas because different actors privilege particular temporal or spatial scales and levels in their analysis, arguments, and responses. Scale contests might include whether to privilege administrative, hydrological, ecosystem, or economic boundaries. Level contests might include whether to privilege the subdistrict or the province, the tributary watershed or the international river basin, a river or a biogeographic region, and the local or the regional economy. In the Mekong Region there is a recurrent demand for water resources development projects and major policies proposed by governments and investors to be scrutinized in public. Deliberative forms of engagement are potentially very helpful because they encourage supporters and critics to articulate assumptions and reasoning about the different opportunities and risks associated with alternative options, and in doing so, they often traverse and enable higher-quality conversations within and across scales and within and between levels. Six case studies from the Mekong Region are examined. We find evidence that scale and level politics affects the context, process, content, and outcomes of deliberative engagement in a region where public deliberation is still far from being a norm, particularly where there are sensitive and far-reaching choices to be made about water use and energy production.

  1. In search of online deliberation : Towards a new method for examining the quality of online discussions

    NARCIS (Netherlands)

    Graham, Todd; Witschge, Tamara

    2003-01-01

    Many advocates of deliberative democracy see in the Internet a new opportunity for the development of public spaces, public spheres, and places where deliberation can take place. An important element of the notion of the public sphere in general and of deliberation specifically, is the quality of th

  2. Implementing moral case deliberation in a psychiatric hospital : process and outcome

    NARCIS (Netherlands)

    Molewijk, B.; Verkerk, M.; Milius, H.; Widdershoven, G.

    2008-01-01

    BACKGROUND: Clinical moral case deliberation consists of the systematic reflection on a concrete moral case by health care professionals. This paper presents the study of a 4-year moral deliberation project. OBJECTIVES: The objectives of this paper are to: (a) describe the practice and the

  3. Team Deliberate Practice in Medicine and Related Domains: A Consideration of the Issues

    Science.gov (United States)

    Harris, Kevin R.; Eccles, David W.; Shatzer, John H.

    2017-01-01

    A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing…

  4. Fostering Meaning-Oriented Learning and Deliberate Practice in Teacher Education

    Science.gov (United States)

    Bronkhorst, Larike H.; Meijer, Paulien C.; Koster, Bob; Vermunt, Jan D.

    2011-01-01

    Meaning-oriented learning and deliberate practice may be expected to promote student teachers' continuous professional development. We interviewed twelve expert teacher educators to explore their understanding of these concepts, as well as pedagogies to stimulate them in teacher education. The experts understood deliberate practice in two ways: an…

  5. Team Deliberate Practice in Medicine and Related Domains: A Consideration of the Issues

    Science.gov (United States)

    Harris, Kevin R.; Eccles, David W.; Shatzer, John H.

    2017-01-01

    A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing…

  6. Deliberation, Tradition, and the Problem of Incommensurability: Philosophical Reflections on Curriculum Decision Making.

    Science.gov (United States)

    Cohen, Jonathan

    1999-01-01

    Discusses curriculum decision making, drawing on Joseph Schwab's framework of deliberation and explaining three foundations upon which the deliberative orientation to the justification of curriculum decisions is predicated. The paper examines what might happen to Schwab's framework of deliberation if it were exposed to various questions raised by…

  7. Implementing moral case deliberation in a psychiatric hospital : process and outcome

    NARCIS (Netherlands)

    Molewijk, B.; Verkerk, M.; Milius, H.; Widdershoven, G.

    2008-01-01

    BACKGROUND: Clinical moral case deliberation consists of the systematic reflection on a concrete moral case by health care professionals. This paper presents the study of a 4-year moral deliberation project. OBJECTIVES: The objectives of this paper are to: (a) describe the practice and the theoretic

  8. Deliberation versus intuition: Global versus local processing in judgment and choice

    NARCIS (Netherlands)

    Dijkstra, K.A.; Pligt, J. van der; Kleef, G.A. van; Kerstholt, J.H.

    2012-01-01

    Decisions and judgments made after deliberation can differ from expert opinion and be more regretted over time than intuitive judgments and decisions. We investigated a possible underlying process of this phenomenon, namely global versus local processing style. We argue that deliberation induces a l

  9. The research-policy-deliberation nexus: a case study approach.

    Science.gov (United States)

    La Brooy, Camille; Kelaher, Margaret

    2017-09-02

    Decision-makers tend to make connections with researchers far too late in the game of public policy, expecting to find a retail store in which researchers are busy filling shop-front shelves with a comprehensive set of all possible relevant studies that a decision-maker might some day drop by to purchase. This linear type of relation between research and policy needs to be replaced by a more interactive model that facilitates both researchers obtaining a better understanding of policy processes and policymakers being more aware and involved in the conceptualisation and conduct of research. This paper explores the role of governance in facilitating the research-policy nexus, testing a typology of research utilisation based on Murray's (Soc Policy Society 10(4):459-70, 2011) analysis that considers various degrees of researcher-policymaker deliberation in decision-making processes. The projects were all part of various evaluation efforts carried out by the researchers to explore the use of governance in health promotion activities. Three case studies were chosen to provide some specific examples that illustrate each level of Murray's typology. The examples involve intersectoral health promotion collaborations that combine evidence-based research in health policy initiatives with various levels of researcher involvement. For all three projects, interview data was collated in the same way, coded thematically and analysed to consider the relationship between researchers and policymakers. Comparing the three models and their applicability to health promotion interventions, it could be observed that all programmes demonstrated successful examples of research translation. Strong governance imperatives structuring relationships led to more successful outcomes, whereby research was successfully translated into a public policy initiative that also led to improved health outcomes. The key idea across all of these models was that strong governance arrangements mitigated some of

  10. Disorderly Deliberation? Generative Dynamics of Global Climate Justice

    Directory of Open Access Journals (Sweden)

    James Goodman

    2011-12-01

    Full Text Available Theorisations of global governance invariably conceive of it as bringing order to disorder, whether by increasing the ‘density’ of interstate society, or by expressing the leverage of global civil society. This paper seeks to invert the frame, and to take seriously the active disordering of governance, as a generative challenge, that creates new justice claims, and opens-up new fields of public deliberation. Global climate governance is a particularly powerful context in which to track these dynamics. Climate change imposes its own pace of policy reform, forcing new imperatives; it also imposes its own remarkable scope, in terms of global reach and all-encompassing depth. The paper seeks-out generative disjunctures, where existing justice principles that underpin climate governance are challenged, disestablished, and reordered. The paper explores these themes as a way of mapping contending and conflicting trajectories in the development of climate justice as a principle of governance. The disordering effects of climate governance, the social and political forces that arise out of them and their roles in producing contender principles and practices are highlighted. We may then arrive at a conceptualization of climate governance as a necessarily disorderly process, which addresses cumulative and unanticipated challenges of climate change through successive reorientations in its modus operandi. As such, climate governance may be enabled to proceed through and beyond immediate accommodations, to offer new possibilities grounded in new rules of the game that widen realms of engagement and more effectively apprehend the challenges posed.

  11. Public Participation in Scientific Research: a Framework for Deliberate Design

    Directory of Open Access Journals (Sweden)

    Jennifer L. Shirk

    2012-06-01

    Full Text Available Members of the public participate in scientific research in many different contexts, stemming from traditions as varied as participatory action research and citizen science. Particularly in conservation and natural resource management contexts, where research often addresses complex social-ecological questions, the emphasis on and nature of this participation can significantly affect both the way that projects are designed and the outcomes that projects achieve. We review and integrate recent work in these and other fields, which has converged such that we propose the term public participation in scientific research (PPSR to discuss initiatives from diverse fields and traditions. We describe three predominant models of PPSR and call upon case studies suggesting that - regardless of the research context - project outcomes are influenced by (1 the degree of public participation in the research process and (2 the quality of public participation as negotiated during project design. To illustrate relationships between the quality of participation and outcomes, we offer a framework that considers how scientific and public interests are negotiated for project design toward multiple, integrated goals. We suggest that this framework and models, used in tandem, can support deliberate design of PPSR efforts that will enhance their outcomes for scientific research, individual participants, and social-ecological systems.

  12. Political debate on weblogs: a virtual public sphere for deliberation?

    Directory of Open Access Journals (Sweden)

    Gil Baptista Ferreira

    2011-12-01

    Full Text Available Taking as reference the deliberative democracy model, my aim is to assess the democratic potential of online discursive spaces to 1 characterize the communication observed within them and 2 critically evaluate that potential and ask whether or not blogging is consistent with the main theoretical norms of deliberative democracy. The main question asked is whether these electronic debates stimulate deliberation within the public sphere, through non-coercive communication, freedom of expression, an unrestricted agenda. I argue that while it has the potential to be a valuable practice that can expand the opportunities for citizens to engage politically, so far this initial promise remains unfulfilled. Considering the different types of uses that individuals make of these spaces, it seems that the political communication exchange on weblogs do not meet the ideal requirements of the public sphere, and blogging fails to satisfy several important criterion of deliberative democracy. I conclude suggesting explanations for online political apathy and lack of deliberative debate.

  13. Hierarchy, Dominance, and Deliberation: Egalitarian Values Require Mental Effort.

    Science.gov (United States)

    Van Berkel, Laura; Crandall, Christian S; Eidelman, Scott; Blanchar, John C

    2015-09-01

    Hierarchy and dominance are ubiquitous. Because social hierarchy is early learned and highly rehearsed, the value of hierarchy enjoys relative ease over competing egalitarian values. In six studies, we interfere with deliberate thinking and measure endorsement of hierarchy and egalitarianism. In Study 1, bar patrons' blood alcohol content was correlated with hierarchy preference. In Study 2, cognitive load increased the authority/hierarchy moral foundation. In Study 3, low-effort thought instructions increased hierarchy endorsement and reduced equality endorsement. In Study 4, ego depletion increased hierarchy endorsement and caused a trend toward reduced equality endorsement. In Study 5, low-effort thought instructions increased endorsement of hierarchical attitudes among those with a sense of low personal power. In Study 6, participants' thinking quickly allocated more resources to high-status groups. Across five operationalizations of impaired deliberative thought, hierarchy endorsement increased and egalitarianism receded. These data suggest hierarchy may persist in part because it has a psychological advantage. © 2015 by the Society for Personality and Social Psychology, Inc.

  14. Deliberate introduction of the European rabbit, Oryctolagus cuniculus, into Australia.

    Science.gov (United States)

    Fenner, F

    2010-04-01

    The European rabbit was brought to Australia as a companion animal by early settlers. It sometimes escaped, but failed to survive in the Australian bush. In 1879 wild rabbits were deliberately sent to Victoria to provide game for wealthy settlers to shoot. They soon spread all over Australia, except in the tropics, and became Australia's major animal pest. After careful testing in Australian wildlife and in humans, control by myxoma virus was introduced at various sites between 1937 and 1950, spreading all over the Murray-Darling Basin in 1950. Within one year mutations in the virus had led to slightly less virulence, and these continued for the next 50 years. In the early 21st Century testing viruses obtained from wild rabbits showed that the majority of these viruses were more virulent than the virus used to initiate the epidemic. In 1995 another virus specific for European rabbits, rabbit haemorrhagic disease virus, escaped from areas in which field trials were being carried out and spread around Australia. It was more successful than myxomatosis for rabbit control in arid regions.

  15. Implementing moral case deliberation in a psychiatric hospital: process and outcome.

    Science.gov (United States)

    Molewijk, Bert; Verkerk, Maarten; Milius, Henk; Widdershoven, Guy

    2008-03-01

    Clinical moral case deliberation consists of the systematic reflection on a concrete moral case by health care professionals. This paper presents the study of a 4-year moral deliberation project. The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of the evaluation of the moral case deliberation sessions, and (d) present the implementation process. The implementation process is both monitored and supported by an interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists). Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects.

  16. Clinical simulation using deliberate practice in nursing education: a Wilsonian concept analysis.

    Science.gov (United States)

    Chee, Jennifer

    2014-05-01

    Effective use of simulation is dependent on a complete understanding of simulation's central conceptual elements. Deliberate practice, a constituent of Ericsson's theory of expertise, has been identified as a central concept in effective simulation learning. Deliberate practice is compatible with simulation frameworks already being suggested for use in nursing education. This paper uses Wilson's Method of concept analysis for the purpose of exploring the concept of deliberate practice in the context of clinical simulation in nursing education. Nursing education should move forward in a manner that reflects best practice in nursing education.

  17. A Decision Support Framework For Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

    Science.gov (United States)

    We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environ...

  18. A Decision Support Framework For Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

    Science.gov (United States)

    We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environ...

  19. Place and Situated Deliberation in Participatory Planning – A Research Proposal

    DEFF Research Database (Denmark)

    Korn, Matthias

    2011-01-01

    Within the domain of participatory urban planning, this position paper argues for a focus on the notion of place in the design of mobile and/or ubiquitous systems that are used in deliberation processes with central spatial references. I discuss (1) leveraging properties of place as a resource...... for users in the design of such systems and (2) situating, or merely co-locating, deliberation activities within the places these discussions are concerned with. To support my argument, I outline two exemplary cases that explore this focus on place and situated deliberation to further motivate research...... for everyone and everywhere through a mobile augmented reality application that visualizes future, planned buildings on capable mobile phones. I conclude with the central questions and problems for future research that focuses on place and situated deliberation....

  20. Deliberate practice and performance in music, games, sports, education, and professions: a meta-analysis.

    Science.gov (United States)

    Macnamara, Brooke N; Hambrick, David Z; Oswald, Frederick L

    2014-08-01

    More than 20 years ago, researchers proposed that individual differences in performance in such domains as music, sports, and games largely reflect individual differences in amount of deliberate practice, which was defined as engagement in structured activities created specifically to improve performance in a domain. This view is a frequent topic of popular-science writing-but is it supported by empirical evidence? To answer this question, we conducted a meta-analysis covering all major domains in which deliberate practice has been investigated. We found that deliberate practice explained 26% of the variance in performance for games, 21% for music, 18% for sports, 4% for education, and less than 1% for professions. We conclude that deliberate practice is important, but not as important as has been argued.

  1. Why human health and health ethics must be central to climate change deliberations.

    Directory of Open Access Journals (Sweden)

    Jerome Amir Singh

    Full Text Available Jerome Singh argues that health ethics principles must be afforded equal status to economics principles in climate change deliberations, and that the health community must play more of a leadership role.

  2. Which public and why deliberate?--A scoping review of public deliberation in public health and health policy research.

    Science.gov (United States)

    Degeling, Chris; Carter, Stacy M; Rychetnik, Lucie

    2015-04-01

    Deliberative methods are of increasing interest to public health researchers and policymakers. We systematically searched the peer-reviewed literature to identify public health and health policy research involving deliberative methods and report how deliberative methods have been used. We applied a taxonomy developed with reference to health policy and science and technology studies literatures to distinguish how deliberative methods engage different publics: citizens (ordinary people who are unfamiliar with the issues), consumers (those with relevant personal experience e.g. of illness) and advocates (those with technical expertise or partisan interests). We searched four databases for empirical studies in English published 1996-2013. This identified 78 articles reporting on 62 distinct events from the UK, USA, Canada, Australasia, Europe, Israel, Asia and Africa. Ten different types of deliberative techniques were used to represent and capture the interests and preferences of different types of public. Citizens were typically directed to consider community interests and were treated as a resource to increase democratic legitimacy. Citizens were preferred in methodological studies (those focused on understanding the techniques). Consumers were directed to focus on personal preferences; thus convened not as a source of policy decisions, but of knowledge about what those affected by the issue would accept. Advocates-who are most commonly used as expert witnesses in juries-were sometimes engaged to deliberate with consumers or citizens. This almost always occurred in projects directly linked to policy processes. This suggests health policymakers may value deliberative methods as a way of understanding disagreement between perspectives. Overall however, the 'type' of public sought was often not explicit, and their role not specified. This review provides new insight into the heterogeneity and rising popularity of deliberative methods, and indicates a need for greater

  3. Deliberate and Crisis Action Planning and Execution Segments Increment 2A (DCAPES Inc 2A)

    Science.gov (United States)

    2016-03-01

    2016 Major Automated Information System Annual Report Deliberate and Crisis Action Planning and Execution Segments Increment 2A (DCAPES Inc 2A...Acquisition Program Baseline BY - Base Year CAE - Component Acquisition Executive CDD - Capability Development Document CPD - Capability Production ...Program Name Deliberate and Crisis Action Planning and Execution Segments Increment 2A (DCAPES Inc 2A) DoD Component Air Force Responsible Office Program

  4. Development of an instrument to measure deliberate practice in professional nurses.

    Science.gov (United States)

    Bathish, Melissa; Aebersold, Michelle; Fogg, Louis; Potempa, Kathleen

    2016-02-01

    This paper describes the development of the Deliberate Practice in Nursing Questionnaire (DPNQ) and the reliability and validity characteristics of the instrument. A cross-sectional, descriptive study assessed the DPNQ in a sample of critical care registered nurses (RN). It was conducted at one large Midwestern teaching hospital. A medical intensive care unit (ICU), a surgical ICU, and a trauma/burn ICU participated. Instrument construction involved item development based on a literature review, an existing deliberate practice questionnaire and existing parameters of deliberate practice in nursing. Content reliability and validity were established by expert panel review and survey testing. Probit analysis of survey data was used to develop a composite score for the DPNQ. Expert panel review revealed an inter-rater agreement (80% reliability) of .92-.96 and a content validity index of 0.94. The final DPNQ consists of 24 items with six subcategories and a composite score of 96. Cronbach's alpha coefficient for the DPNQ in this study was .660 (standardized, .703). The instrument was further validated with the Nurse Competence Scale. Deliberate practice was significantly, positively correlated with competence (rs=.366, p=001). Findings from the expert panel provided guidance for development and revision of the DPNQ. Survey testing of the instrument revealed a promising measure of deliberate practice with good reliability and validity characteristics. Identification of a relationship between deliberate practice and competence confirms existing evidence in other domains, providing further validation. Understanding deliberate practice provides a unique way to examine nursing expertise. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. The role of deliberate practice in the acquisition of clinical skills

    Directory of Open Access Journals (Sweden)

    Duvivier Robbert J

    2011-12-01

    Full Text Available Abstract Background The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training. Methods Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results. Results 875 students participated (90%. Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1. Conclusions The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.

  6. Not all mind wandering is created equal: dissociating deliberate from spontaneous mind wandering.

    Science.gov (United States)

    Seli, Paul; Carriere, Jonathan S A; Smilek, Daniel

    2015-09-01

    In two large samples we show a dissociation between trait-level tendencies to mind-wander spontaneously (unintentionally) and deliberately (intentionally). Participants completed online versions of the Mind Wandering Spontaneous (MW-S) and the Mind Wandering Deliberate (MW-D) self-report scales and the Five Facet Mindfulness Questionnaire (FFMQ). The results revealed that deliberate and spontaneous mind wandering were uniquely associated with some factors of the FFMQ. Notably, while the MW-D and the MW-S were positively associated with each other, the MW-D was uniquely positively associated with the 'Non-Reactivity to Inner Experience' factor of the FFMQ, whereas the MW-S was uniquely negatively associated with this factor. We also showed that conflating deliberate and spontaneous mind wandering can result in a misunderstanding of how mind wandering is related to other traits. We recommend that studies assessing individual differences in mind wandering should distinguish between deliberate and spontaneous subtypes of mind wandering to avoid possibly erroneous conclusions.

  7. The Relationship Between Deliberate Practice and Performance in Sports: A Meta-Analysis.

    Science.gov (United States)

    Macnamara, Brooke N; Moreau, David; Hambrick, David Z

    2016-05-01

    Why are some people more skilled in complex domains than other people? According to one prominent view, individual differences in performance largely reflect individual differences in accumulated amount of deliberate practice. Here, we investigated the relationship between deliberate practice and performance in sports. Overall, deliberate practice accounted for 18% of the variance in sports performance. However, the contribution differed depending on skill level. Most important, deliberate practice accounted for only 1% of the variance in performance among elite-level performers. This finding is inconsistent with the claim that deliberate practice accounts for performance differences even among elite performers. Another major finding was that athletes who reached a high level of skill did not begin their sport earlier in childhood than lower skill athletes. This finding challenges the notion that higher skill performers tend to start in a sport at a younger age than lower skill performers. We conclude that to understand the underpinnings of expertise, researchers must investigate contributions of a broad range of factors, taking into account findings from diverse subdisciplines of psychology (e.g., cognitive psychology, personality psychology) and interdisciplinary areas of research (e.g., sports science). © The Author(s) 2016.

  8. Pathways to support genetically modified (GM) foods in South Korea: Deliberate reasoning, information shortcuts, and the role of formal education.

    Science.gov (United States)

    Kim, Sei-Hill; Kim, Jeong-Nam; Besley, John C

    2013-02-01

    Analyzing survey data on the issue of GM foods in South Korea, this study examines two competing routes - deliberate reasoning versus information shortcuts - to forming opinions on controversial science. Findings indicated that both deliberate reasoning and information shortcuts were in play; but the process was moderated by a person's education level. The well educated were more likely than the less educated to engage in deliberate reasoning when shaping their support for GM foods. Implications of the findings are discussed in detail.

  9. Deliberation at the hub of medical education: beyond virtue ethics and codes of practice.

    Science.gov (United States)

    Barilan, Y M; Brusa, M

    2013-02-01

    Although both codes of practice and virtue ethics are integral to the ethos and history of "medical professionalism", the two trends appear mutually incompatible. Hence, in the first part of the paper we explore and explicate this apparent conflict and seek a direction for medical education. The theoretical and empirical literature indicates that moral deliberation may transcend the incompatibilities between the formal and the virtuous, may enhance moral and other aspects of personal sensitivity, may help design and improve other parts of the curricula, and may foster self-awareness and clarification of the professional role. Not only are these goals essential for good and conscientious doctoring, but they may also reduce physicians' "burn-out". We argue that medical education should focus on the ubiquitous practice of deliberation in contemporary medicine, and especially the practice of moral deliberation.

  10. Place and Situated Deliberation in Participatory Planning – A Research Proposal

    DEFF Research Database (Denmark)

    Korn, Matthias

    2011-01-01

    Within the domain of participatory urban planning, this position paper argues for a focus on the notion of place in the design of mobile and/or ubiquitous systems that are used in deliberation processes with central spatial references. I discuss (1) leveraging properties of place as a resource fo...... for everyone and everywhere through a mobile augmented reality application that visualizes future, planned buildings on capable mobile phones. I conclude with the central questions and problems for future research that focuses on place and situated deliberation.......Within the domain of participatory urban planning, this position paper argues for a focus on the notion of place in the design of mobile and/or ubiquitous systems that are used in deliberation processes with central spatial references. I discuss (1) leveraging properties of place as a resource...

  11. Kasıtlı Kendine Zarar Verme Davranışı

    OpenAIRE

    Fatma Gul Helvaci Celik; Cicek Hocaoglu

    2017-01-01

    The deliberate self-harm behaviour which defined as attempting to own body resulting in tisue damage without conscious desire of peolple to die, is a major public health problem worldwide. The causes of deliberate self- harm, risk factors, the relationship between mental disorders and treatment strategies are not fully known. Deliberate self- harm can be observed together with psychiatric disorders such as borderline personality disorder, histrionic personality disorder, eating disorders and ...

  12. Immigration, Suicidal Ideation and Deliberate Self-Injury in the Boston Youth Survey 2006

    Science.gov (United States)

    Borges, Guilherme; Azrael, Deborah; Almeida, Joanna; Johnson, Renee M.; Molnar, Beth E.; Hemenway, David; Miller, Matthew

    2011-01-01

    The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By…

  13. Applying What Works: A Case for Deliberate Psychological Education in Undergraduate Business Ethics

    Science.gov (United States)

    Schmidt, Christopher Drees; Davidson, Kathleen M.; Adkins, Christopher

    2013-01-01

    The teaching of business ethics continues to be a topic of great concern as both businesses and business schools seek to develop effective approaches for fostering ethical behavior. Responses to this objective have been varied, and consistent empirical evidence for a particular approach has not emerged. One approach, deliberate psychological…

  14. Personal Characteristics of Teachers, Situational Variables and Deliberations in Planning Instruction.

    Science.gov (United States)

    Kremer, Lya

    This study reveals possible relationships among teachers' personality traits, situational variables, and deliberation characteristics in planning instruction. Dogmatism and locus of control perceptions were the personality traits studied, and the situations compared student teachers with elementary and secondary school teachers. Both groups were…

  15. The Use of Expressives in Online Political Talk : Impeding or Facilitating the Normative Goals of Deliberation?

    NARCIS (Netherlands)

    Graham, T.S.; Tambouris, E; Macintosh, A; Glassey, O

    2010-01-01

    Net-based public sphere researchers have questioned whether the internet presents the public sphere with a new opportunity for the development of public spaces where free, equal and open deliberation among citizens can flourish. However, much of the research has operationalized a formal notion of de

  16. Discursive power in deliberations: a case of redevelopment for the creative economy in the Netherlands

    NARCIS (Netherlands)

    Metze, T.A.P.

    2009-01-01

    This paper examines the power of discourse in experiments with deliberative governance. It argues that discursive power enters deliberations regardless of the procedural attempts to ensure an optimal deliberative setting. This papers focuses on the experiences of a Community of Practice (CoP) that w

  17. The Use of Expressives in Online Political Talk : Impeding or Facilitating the Normative Goals of Deliberation?

    NARCIS (Netherlands)

    Graham, T.S.; Tambouris, E; Macintosh, A; Glassey, O

    2010-01-01

    Net-based public sphere researchers have questioned whether the internet presents the public sphere with a new opportunity for the development of public spaces where free, equal and open deliberation among citizens can flourish. However, much of the research has operationalized a formal notion of de

  18. Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.

    Science.gov (United States)

    Udani, Ankeet D; Macario, Alex; Nandagopal, Kiruthiga; Tanaka, Maria A; Tanaka, Pedro P

    2014-01-01

    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  19. Practical Deliberation in Local School Districts: A South Carolina Experiment. CSE Technical Report.

    Science.gov (United States)

    McDonnell, Lorraine M.; Weatherford, M. Stephen

    Despite its growing prominence as a political reform strategy, it is still unclear whether deliberation, with its emphasis on an inclusive process where citizens and politicians listen to each other and are open to persuasion, is a feasible strategy for engaging citizens in public education. This paper explores the feasibility of practical…

  20. Deliberate Language Planning in Environmental Education: A CRT/LatCrit Perspective

    Science.gov (United States)

    Arreguin-Anderson, Maria G.; Kennedy, Kimberley D.

    2013-01-01

    In this study, the authors narrate a deliberate language planning experience within the dynamics of the first Project WILD environmental workshop conducted in Spanish. Using critical race theory and critical Latino theory the authors explore ways in which an environmental program can be infused with Latino culture and Spanish language to address…

  1. From Group Member to Democratic Citizen: How Deliberating with Fellow Jurors Reshapes Civic Attitudes

    Science.gov (United States)

    Gastil, John; Black, Laura W.; Deess, E. Pierre; Leighter, Jay

    2008-01-01

    This investigation assesses the attitudinal impact of one of America's most distinctive and famous group activities--jury deliberation. Tocqueville and the U.S. Supreme Court have both reasoned that jury service can promote civic engagement and recent research supports this view. The present study examines whether the attitudinal impact of jury…

  2. Applying What Works: A Case for Deliberate Psychological Education in Undergraduate Business Ethics

    Science.gov (United States)

    Schmidt, Christopher Drees; Davidson, Kathleen M.; Adkins, Christopher

    2013-01-01

    The teaching of business ethics continues to be a topic of great concern as both businesses and business schools seek to develop effective approaches for fostering ethical behavior. Responses to this objective have been varied, and consistent empirical evidence for a particular approach has not emerged. One approach, deliberate psychological…

  3. Discursive power in deliberations: a case of redevelopment for the creative economy in the Netherlands

    NARCIS (Netherlands)

    Metze, T.A.P.

    2009-01-01

    This paper examines the power of discourse in experiments with deliberative governance. It argues that discursive power enters deliberations regardless of the procedural attempts to ensure an optimal deliberative setting. This papers focuses on the experiences of a Community of Practice (CoP) that w

  4. Deliberate Science, Continuum Magazine: Clean Energy Innovation at NREL, Winter 2012 (Book)

    Energy Technology Data Exchange (ETDEWEB)

    2012-02-01

    This quarterly magazine is dedicated to stepping beyond the technical journals to reveal NREL's vital work in a real-world context for our stakeholders. Continuum provides insights into the latest and most impactful clean energy innovations, while spotlighting those talented researchers and unique facilities that make it all happen. This edition focuses on deliberate science.

  5. Ethical Tools to Support Systematic Public Deliberations about the Ethical Aspects of Agricultural Biotechnologies

    NARCIS (Netherlands)

    Beekman, V.; Brom, F.W.A.

    2007-01-01

    This special issue of the Journal of Agricultural and Environmental Ethics presents so-called ethical tools that are developed to support systematic public deliberations about the ethical aspects of agricultural biotechnologies. This paper firstly clarifies the intended connotations of the term ¿eth

  6. Does arm swing emphasized deliberately increase the trunk stability during walking in the elderly adults?

    Science.gov (United States)

    Nakakubo, Sho; Doi, Takehiko; Sawa, Ryuichi; Misu, Shogo; Tsutsumimoto, Kota; Ono, Rei

    2014-09-01

    The purpose of this study was to determine whether trunk stability while walking changes when arm swing is deliberately altered in elderly individuals. Participants included 21 community-dwelling elderly individuals (7 men and 14 women; age, 81.8 ± 5.0 years). We measured trunk acceleration by using a wireless miniature sensor unit containing a tri-axial linear accelerometer under 3 walking conditions: normal walking (normal condition), deliberately walking without any arm swing (no swing condition), and walking with a deliberately emphasized arm swing (over swing condition). To evaluate trunk stability during walking, we calculated harmonic ratios (HRs) based on trunk tri-axial acceleration signals (anteroposterior: AP, vertical: VT, and mediolateral: ML). HR-AP and HR-VT were not significantly different across the 3 conditions, but HR-ML in the over swing condition was significantly higher than that in the other 2 conditions by generalized estimating equations (GEE) adjusted for walking speed (p<0.05). These findings indicate that trunk stability in the ML direction increased when the elderly individuals walked with a deliberately emphasized arm swing.

  7. Assessing the associations among trait and state levels of deliberate and spontaneous mind wandering.

    Science.gov (United States)

    Seli, Paul; Risko, Evan F; Smilek, Daniel

    2016-04-01

    Recent research has demonstrated that mind wandering can be subdivided into spontaneous and deliberate types, and this distinction has been found to hold at both the trait and state levels. However, to date, no attempts have been made to link trait-level spontaneous and deliberate mind wandering with state-level assessments of these two subtypes of mind wandering. Here we evaluated whether trait-level deliberate and spontaneous mind wandering map onto state levels of these subtypes of mind wandering. Results showed correspondence between trait-level reports of spontaneous and deliberate mind wandering and their state-level counterparts, indicating that people's reports on the intentionality of their mind wandering in the laboratory correspond to their reports of the intentionality of mind wandering in everyday life. Thus, the trait- and state-level scales of mind wandering were found to validate each other: Whereas the state-level measures provided some construct validity for the trait-level measures, the trait-level measures indicated that the state-level measures may be generalizable to everyday situations.

  8. Young People and Caregivers' Perceptions of an Intervention Program for Children Who Deliberately Light Fires

    Science.gov (United States)

    Lambie, Ian; Seymour, Fred; Popaduk, Tanya

    2012-01-01

    A significant number of children and adolescents engage in deliberate fire setting, beyond the scope of curiosity and experimentation. Interventions developed to respond to the needs of such fire setters generally involve educational and/or psychosocial approaches. Research evaluating the effectiveness of these interventions is dominated by…

  9. Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Ankeet D. Udani

    2014-01-01

    Full Text Available Introduction. Properly performing a subarachnoid block (SAB is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR. Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02. The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03. The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  10. The Cognitive-Miser Response Model: Testing for Intuitive and Deliberate Reasoning

    Science.gov (United States)

    Bockenholt, Ulf

    2012-01-01

    In a number of psychological studies, answers to reasoning vignettes have been shown to result from both intuitive and deliberate response processes. This paper utilizes a psychometric model to separate these two response tendencies. An experimental application shows that the proposed model facilitates the analysis of dual-process item responses…

  11. Competencies in nursing students for organized forms of clinical moral deliberation and decision-making

    NARCIS (Netherlands)

    Uil-Westerlaken, Jeanette den; Cusveller, Bart

    2013-01-01

    Bachelor-prepared nurses are expected to be competent in moral deliberation and decision-making (MDD) in clinical practice. It is unclear, however, how this competence develops in nursing students. This study explores the development of nursing students’ competence for participating in organized for

  12. "Here's my dilemma". Moral case deliberation as a platform for discussing everyday ethics in elderly care.

    Science.gov (United States)

    van der Dam, S; Abma, T A; Kardol, M J M; Widdershoven, G A M

    2012-09-01

    Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: 'resident's behavior', 'divergent perspectives on good care' and 'organizational context'. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical 'blind spots'.

  13. Developing Emotionally Intelligent Leadership: The Need for Deliberate Practice and Collaboration across Disciplines

    Science.gov (United States)

    Allen, Scott J.; Shankman, Marcy Levy; Haber-Curran, Paige

    2016-01-01

    This chapter continues the discussion of what leadership education is and highlights the importance of emotionally intelligent leadership. The authors assert the need for deliberate practice and better collaboration between student affairs, academic affairs, and academic departments to develop emotionally intelligent leaders.

  14. Competencies in nursing students for organized forms of clinical moral deliberation and decision-making

    NARCIS (Netherlands)

    Jeanette den Uil-Westerlaken; dr. Bart Cusveller

    2013-01-01

    Bachelor-prepared nurses are expected to be competent in moral deliberation and decision-making (MDD) in clinical practice. It is unclear, however, how this competence develops in nursing students. This study explores the development of nursing students’ competence for participating in organized

  15. Discursive power in deliberations: a case of redevelopment for the creative economy in the Netherlands

    NARCIS (Netherlands)

    Metze, T.A.P.

    2009-01-01

    This paper examines the power of discourse in experiments with deliberative governance. It argues that discursive power enters deliberations regardless of the procedural attempts to ensure an optimal deliberative setting. This papers focuses on the experiences of a Community of Practice (CoP) that

  16. Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: A pilot study

    NARCIS (Netherlands)

    W. Seekles (Wike); G.A. Widdershoven (Guy); P.B.M. Robben (Paul); G. Van Dalfsen (Gonny); B. Molewijk (Bert)

    2016-01-01

    textabstractBackground: Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regul

  17. Sophistic Ethics in the Technical Writing Classroom: Teaching "Nomos," Deliberation, and Action.

    Science.gov (United States)

    Scott, J. Blake

    1995-01-01

    Claims that teaching ethics is particularly important to technical writing. Outlines a classical, sophistic approach to ethics based on the theories and pedagogies of Protagoras, Gorgias, and Isocrates, which emphasizes the Greek concept of "nomos," internal and external deliberation, and responsible action. Discusses problems and…

  18. Ethical Tools to Support Systematic Public Deliberations about the Ethical Aspects of Agricultural Biotechnologies

    NARCIS (Netherlands)

    Beekman, V.; Brom, F.W.A.

    2007-01-01

    This special issue of the Journal of Agricultural and Environmental Ethics presents so-called ethical tools that are developed to support systematic public deliberations about the ethical aspects of agricultural biotechnologies. This paper firstly clarifies the intended connotations of the term ¿eth

  19. Deliberate termination of life of newborns with spina bifida, a critical reappraisal

    NARCIS (Netherlands)

    T.H.R. Jong (Rob)

    2008-01-01

    textabstractObjects: Deliberate termination of life of newborns (involuntary euthanasia) with meningomyelocele (MMC) is practiced openly only in the Netherlands. 'Unbearable and hopeless suffering' is the single most cited criterion for this termination, together with the notion that 'there are no o

  20. Public Deliberation as a Teaching Andragogy: Implications for Adult Student Learning from a Doctoral Higher Education Policy Course

    Science.gov (United States)

    Johnson, Matthew; Partlo, Margaret; Hullender, Tammy; Akanwa, Emmanuel; Burke, Heather; Todd, Jerry; Alwood, Christine

    2014-01-01

    Public deliberation provides an inclusive and robust mechanism for making shared decisions in community and political settings; however, its application to teaching and learning remains underutilized (McMillan & Harriger, 2007). This manuscript reports on a case study of the use of public deliberation as a teaching andragogy in a graduate…

  1. To Think or Not to Think:The Effect of Cognitive Deliberation on the Influence of Injunctive Versus Descriptive Social Norms

    NARCIS (Netherlands)

    Melnyk, V.; Herpen, van E.; Fischer, A.R.H.; Trijp, van H.C.M.

    2011-01-01

    Consumers can process information containing social norms at different cognitive deliberation levels. This paper investigates the effect of cognitive deliberation for both descriptive and injunctive norms. The experimental study examines the consequences for attitudes and behavioral intentions of th

  2. "While you still think, I already type": experienced social power reduces deliberation during e-mail communication.

    Science.gov (United States)

    Scholl, Annika; Sassenberg, Kai

    2014-11-01

    E-mail allows individuals to deliberate on their communication before sending it off. For instance, communication partners can easily take their time to ponder how best to frame a request before they actually send a message. Individuals at times strategically exploit this opportunity to deliberate in order to tailor messages to their communication partner, such as when communicating with a relatively more powerful person. As social power reduces concerns about impression management, we predicted that individuals deliberate more while composing e-mail messages under low (vs. high) power. This assumption was tested with well-established power priming. As such, we expected that experienced power in one context would diminish deliberation times during a subsequent e-mail communication. An experiment manipulating the experience of (low vs. high) power and measuring deliberation times during e-mail composition supported this hypothesis. The findings thus indicate how social power alters deliberation times. More importantly, the results show that individuals not only strategically deliberate during e-mail communication in line with their current situation, but also in line with their social standing in a previous situation (here, their experience of power).

  3. Deliberation favors social efficiency by helping people disregard their relative shares: Evidence from US and India

    CERN Document Server

    Capraro, Valerio; Espín, Antonio M; Hernán-González, Roberto

    2016-01-01

    Groups make decisions on both the production and the distribution of resources. These decisions typically involve a tension between increasing the total level of group resources (i.e. social efficiency) and distributing these resources among group members (i.e. individuals' relative shares). This is the case because the redistribution process may destroy part of the resources, thus resulting in socially inefficient allocations. Here we apply a dual-process approach to understand the cognitive underpinnings of this fundamental tension. We conducted a set of experiments to examine the extent to which different allocation decisions respond to intuition or deliberation. In a newly developed approach, we assess intuition and deliberation at both the trait level (using the Cognitive Reflection Test, henceforth CRT) and the state level (through the experimental manipulation of response times). To test for robustness, experiments were conducted in two countries: the US and India. Despite aggregate differences across ...

  4. Deliberate ingestion of foreign bodies by institutionalised psychiatric hospital patients and prison inmates.

    LENUS (Irish Health Repository)

    O'Sullivan, S T

    2012-02-03

    Deliberate and recurrent foreign body ingestion is a common problem among institutionalised patients. We review our experience with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric patients, thirty of whom were institutionalised at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in contrast, psychiatric patients presented with few, if any, symptoms. A majority of objects pass spontaneously or remain in situ without complication. Twenty-four patients were discharged following initial evaluation and without specific treatment. Eight of these were reviewed electively and discharged within one week. Twelve patients were admitted for observation, seven of whom were discharged within 48 hrs. Upper gastrointestinal endoscopy was performed in four patients and an intragastric foreign body identified in two cases. Laparotomy was performed in two cases for unresolving mechanical intestinal obstruction. Management should be conservative when possible, with surgery indicated only for complications.

  5. Managing distance and covariate information with point-based clustering

    Directory of Open Access Journals (Sweden)

    Peter A. Whigham

    2016-09-01

    Full Text Available Abstract Background Geographic perspectives of disease and the human condition often involve point-based observations and questions of clustering or dispersion within a spatial context. These problems involve a finite set of point observations and are constrained by a larger, but finite, set of locations where the observations could occur. Developing a rigorous method for pattern analysis in this context requires handling spatial covariates, a method for constrained finite spatial clustering, and addressing bias in geographic distance measures. An approach, based on Ripley’s K and applied to the problem of clustering with deliberate self-harm (DSH, is presented. Methods Point-based Monte-Carlo simulation of Ripley’s K, accounting for socio-economic deprivation and sources of distance measurement bias, was developed to estimate clustering of DSH at a range of spatial scales. A rotated Minkowski L1 distance metric allowed variation in physical distance and clustering to be assessed. Self-harm data was derived from an audit of 2 years’ emergency hospital presentations (n = 136 in a New Zealand town (population ~50,000. Study area was defined by residential (housing land parcels representing a finite set of possible point addresses. Results Area-based deprivation was spatially correlated. Accounting for deprivation and distance bias showed evidence for clustering of DSH for spatial scales up to 500 m with a one-sided 95 % CI, suggesting that social contagion may be present for this urban cohort. Conclusions Many problems involve finite locations in geographic space that require estimates of distance-based clustering at many scales. A Monte-Carlo approach to Ripley’s K, incorporating covariates and models for distance bias, are crucial when assessing health-related clustering. The case study showed that social network structure defined at the neighbourhood level may account for aspects of neighbourhood clustering of DSH. Accounting for

  6. Teoria democrática e deliberação pública Democratic theory and public deliberation

    Directory of Open Access Journals (Sweden)

    Leonardo Avritzer

    2000-01-01

    Full Text Available A questão da deliberação na teoria democrática é examinada mediante o confronto entre dois modelos de deliberação: o decisionista e o argumentativo. A questão subjacente é a de onde e por que mecanismos se dá a deliberação.The question about deliberation in democratic theory is examined through the opposition between two models of deliberation: the decisionist and the argumentative. The underlying question concerns where and through which mechanisms does deliberation occur.

  7. Deliberate Establishment of Asymptomatic Bacteriuria—A Novel Strategy to Prevent Recurrent UTI

    OpenAIRE

    2016-01-01

    We have established a novel strategy to reduce the risk for recurrent urinary tract infection (UTI), where rapidly increasing antibiotic resistance poses a major threat. Epidemiologic studies have demonstrated that asymptomatic bacteriuria (ABU) protects the host against symptomatic infections with more virulent strains. To mimic this protective effect, we deliberately establish ABU in UTI-prone patients, who are refractory to conventional therapy. The patients are inoculated with Escherichia...

  8. Deliberation before determination: the definition and evaluation of good decision making

    Science.gov (United States)

    Elwyn, Glyn; Miron‐Shatz, Talya

    2009-01-01

    Abstract Objectives  In this article, we examine definitions of suggested approaches to measure the concept of good decisions, highlight the ways in which they converge, and explain why we have concerns about their emphasis on post‐hoc estimations and post‐decisional outcomes, their prescriptive concept of knowledge, and their lack of distinction between the process of deliberation, and the act of decision determination. Background  There has been a steady trend to involve patients in decision making tasks in clinical practice, part of a shift away from paternalism towards the concept of informed choice. An increased understanding of the uncertainties that exist in medicine, arising from a weak evidence base and, in addition, the stochastic nature of outcomes at the individual level, have contributed to shifting the responsibility for decision making from physicians to patients. This led to increasing use of decision support and communication methods, with the ultimate aim of improving decision making by patients. Interest has therefore developed in attempting to define good decision making and in the development of measurement approaches. Method  We pose and reflect whether decisions can be judged good or not, and, if so, how this goodness might be evaluated. Results  We hypothesize that decisions cannot be measured by reference to their outcomes and offer an alternative means of assessment, which emphasizes the deliberation process rather than the decision’s end results. We propose decision making comprises a pre‐decisional process and an act of decision determination and consider how this model of decision making serves to develop a new approach to evaluating what constitutes a good decision making process. We proceed to offer an alternative, which parses decisions into the pre‐decisional deliberation process, the act of determination and post‐decisional outcomes. Discussion  Evaluating the deliberation process, we propose, should comprise

  9. Detecting the Evolution of Deliberate Fertility Control before the Demographic Transition in Germany

    Directory of Open Access Journals (Sweden)

    Aliaksandr Amialchuk

    2012-10-01

    Full Text Available BACKGROUND Pervious literature has established the existence of deliberate non-parity-specific fertility control in pre-transitional populations. However, less focus has been given to the timing of its onset. In addition, previous studies focused on the changes in fertility in response to the local prices of grains, which may be endogenous. OBJECTIVE This paper studies the emergence and evolution of deliberate fertility control by investigating the link between child mortality and economic stress on the one hand and non-parity-specific birth control on the other, in historic German villages between 1700 and 1900. METHODS Birth histories from fourteen German villages (1700-1900 and rye price series are used in a micro-level event history analysis. The fertility response of second and higher-order births to the mortality of children over age two and exogenous fluctuations in rye price are used as measures of the extent of deliberate non-parity-specific birth control. RESULTS Over the course of the demographic transition, the effect of the death of children generally increases after controlling for the effect of the death of children less than two years old. The negative fertility response to high rye prices before and in the year immediately following the price change occurred only after 1800. CONCLUSIONS The replacement and insurance effects associated with child mortality generally increased before the demographic transition. The emergence of the negative effect of high rye prices on fertility after 1800 further supports the presence and evolution of deliberate non-parity-specific fertility control before the demographic transition.

  10. The control of deliberate waiting strategies in a stop-signal task

    Directory of Open Access Journals (Sweden)

    R.P. Sylwan

    2004-06-01

    Full Text Available To inhibit an ongoing flow of thoughts or actions has been largely considered to be a crucial executive function, and the stop-signal paradigm makes inhibitory control measurable. Stop-signal tasks usually combine two concurrent tasks, i.e., manual responses to a primary task (go-task are occasionally countermanded by a stimulus which signals participants to inhibit their response in that trial (stop-task. Participants are always instructed not to wait for the stop-signal, since waiting strategies cause the response times to be unstable, invalidating the data. The aim of the present study was to experimentally control the strategies of waiting deliberately for the stop-signal in a stop-task by means of an algorithm that measured the variation in the reaction times to go-stimuli on-line, and displayed a warning legend urging participants to be faster when their reaction times were more than two standard deviations of the mean. Thirty-four university students performed a stop-task with go- and stop-stimuli, both of which were delivered in the visual modality and were lateralized within the visual field. The participants were divided into two groups (group A, without the algorithm, vs group B, with the algorithm. Group B exhibited lower variability of reaction times to go-stimuli, whereas no significant between-group differences were found in any of the measures of inhibitory control, showing that the algorithm succeeded in controlling the deliberate waiting strategies. Differences between deliberate and unintentional waiting strategies, and anxiety as a probable factor responsible for individual differences in deliberate waiting behavior, are discussed.

  11. Competencies in nursing students for organized forms of clinical moral deliberation and decision-making

    OpenAIRE

    Uil-Westerlaken, Jeanette den; Cusveller, Bart

    2013-01-01

    Bachelor-prepared nurses are expected to be competent in moral deliberation and decision-making (MDD) in clinical practice. It is unclear, however, how this competence develops in nursing students. This study explores the development of nursing students’ competence for participating in organized forms of MDD in clinical practice, with an eye to improve nursing education. A cross-sectional descriptive survey was conducted by a questionnaire among first and fourth year bachelor nursing students...

  12. Conscious versus unconscious thinking in the medical domain: the deliberation-without-attention effect examined

    OpenAIRE

    Bonke, Benno; Zietse, Robert; Norman, Geoff; Schmidt, Henk G.; Bindels, Roger; Mamede, Sílvia; Rikers, Remy

    2014-01-01

    Previous studies have shown that with important decisions, unconscious thought has surprisingly led to better choices than conscious thought. The present study challenges this so-called ‘deliberation-without-attention effect’ in the medical domain. In a computerized study, physicians and medical students were asked, after either conscious or unconscious thought, to estimate the 5-year survival probabilities of four fictitious patients with varying medical characteristics. We assumed that expe...

  13. Media deliberation on intra-EU migration. A qualitative approach to framing based on rhetorical analysis

    OpenAIRE

    Alexandru Cârlan; Mălina Ciocea

    2016-01-01

    In this paper we investigate how the model of deliberation proposed by Isabela and Norman Fairclough can be used for a better clarification and understanding of the framing processes in media – especially in opinion articles. We thus aim at integrating theoretical contributions from critical discourse analysis and argumentation theory with standard approaches to framing, originating in media studies. We emphasize how a rhetorical approach to framing can provide analytical insights into framin...

  14. Self-harm and self-poisoning in southern India

    DEFF Research Database (Denmark)

    Bose, Anuradha; Sandal Sejbaek, Camilla; Suganthy, Pearline

    2009-01-01

    OBJECTIVE: To record cases of suicide and attempted suicide among a population of 108 000 people living in a primarily rural area of southern India, with the aim of guiding policies and strategies to restrict access to poisonous compounds at community level. METHOD: Community-based surveillance...

  15. Intense suicidal thoughts and self-harm following escitalopram treatment

    Directory of Open Access Journals (Sweden)

    Farooq Khan

    2011-01-01

    Full Text Available In a minority of depressed patients, treatment with an antidepressant drug appears to initiate intense suicidal thoughts and actions. We describe this phenomenon in a 52-year-old woman treated with escitalopram. She did not experience this when treated with six other antidepressants, which were not Selective Serotonin Reuptake Inhibitors. Clinicians need to warn patients and their relatives of the risk that intense suicidal thoughts may develop after an antidepressant drug is started and encourage them to seek help immediately should this occur.

  16. TRUTH OR DARE: ONLINE DELIBERATION. A CASE STUDY OF TWO INTERNET BASED DELIBERATIVE PLATFORMS

    Directory of Open Access Journals (Sweden)

    Luana Maria BIDAȘCĂ

    2011-06-01

    Full Text Available In this article, I attempt to discuss how the internet can be used to stimulate an effective communication between citizens and decision-makers. In particular, I will aim to see if it can facilitate a greater degree of deliberation among citizens, if it can make democracy more inclusive and if it can make decision makers more responsible. I will first look at the definition and characteristics of deliberative democracy. Then after looking at what has been written so far about the effect of online discussions on democracy, I shall analyze the role the internet played in two case studies: web based participatory budgeting (PB and domnuleprimar.ro (DearMrMayor.ro. Both of these platforms were designed to create a closer bond between decisionmakers and citizens and will thus prove relevant to the discussion. Finally, I conclude that while the two case studies seem to favor increased inclusiveness, it only partially increases accountability and does not register any significant progress with regard to deliberation. Still, I argue that reasons for optimism exist even with regard to the deliberative aspect. Since the debate regarding the value of online deliberation is far from over, more research is needed in order to perhaps design a framework which will allow us to exploit the democratic value of the internet to its full potential.

  17. Deliberating death.

    Science.gov (United States)

    Landes, Scott D

    2010-01-01

    Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.

  18. Deliberate Indiscretion?

    DEFF Research Database (Denmark)

    Loftis, Matthew

    2015-01-01

    This article reports the first empirical evidence that politicians delegate to trusted bureaucrats to diminish political responsibility for policy. Political science has been perennially concerned with why political leaders delegate authority to bureaucrats, but this work’s focus on advanced...... democracies has overlooked how corruption and political influence over bureaucrats can turn delegation into a means of obfuscating responsibility. Using a measure that differentiates political corruption from corruption at lower levels of government and a new data set of policy making on more than 600...... European Commission directives in the 10 former communist European Union (EU) member states, I show that political-level corruption is associated with increased delegation to bureaucrats. This relationship between political corruption and bureaucratic discretion is conditional upon the political...

  19. Animal Deliberation

    NARCIS (Netherlands)

    Driessen, C.P.G.

    2014-01-01

    While much has been written on environmental politics on the one hand, and animal ethics and welfare on the other, animal politics, as the interface of the two, is underexamined. There are key political implications in the increase of animal protection laws, the rights of nature, and political parti

  20. Deliberate Indiscretion?

    DEFF Research Database (Denmark)

    Loftis, Matthew

    2015-01-01

    This article reports the first empirical evidence that politicians delegate to trusted bureaucrats to diminish political responsibility for policy. Political science has been perennially concerned with why political leaders delegate authority to bureaucrats, but this work’s focus on advanced...... democracies has overlooked how corruption and political influence over bureaucrats can turn delegation into a means of obfuscating responsibility. Using a measure that differentiates political corruption from corruption at lower levels of government and a new data set of policy making on more than 600...... independence of the bureaucracy, such that politicians engaged in corruption delegate more to reduce clarity of responsibility only when they possess informal means to influence bureaucrats....

  1. The shared circuits model (SCM): how control, mirroring, and simulation can enable imitation, deliberation, and mindreading.

    Science.gov (United States)

    Hurley, Susan

    2008-02-01

    Imitation, deliberation, and mindreading are characteristically human sociocognitive skills. Research on imitation and its role in social cognition is flourishing across various disciplines. Imitation is surveyed in this target article under headings of behavior, subpersonal mechanisms, and functions of imitation. A model is then advanced within which many of the developments surveyed can be located and explained. The shared circuits model (SCM) explains how imitation, deliberation, and mindreading can be enabled by subpersonal mechanisms of control, mirroring, and simulation. It is cast at a middle, functional level of description, that is, between the level of neural implementation and the level of conscious perceptions and intentional actions. The SCM connects shared informational dynamics for perception and action with shared informational dynamics for self and other, while also showing how the action/perception, self/other, and actual/possible distinctions can be overlaid on these shared informational dynamics. It avoids the common conception of perception and action as separate and peripheral to central cognition. Rather, it contributes to the situated cognition movement by showing how mechanisms for perceiving action can be built on those for active perception.;>;>The SCM is developed heuristically, in five layers that can be combined in various ways to frame specific ontogenetic or phylogenetic hypotheses. The starting point is dynamic online motor control, whereby an organism is closely attuned to its embedding environment through sensorimotor feedback. Onto this are layered functions of prediction and simulation of feedback, mirroring, simulation of mirroring, monitored inhibition of motor output, and monitored simulation of input. Finally, monitored simulation of input specifying possible actions plus inhibited mirroring of such possible actions can generate information about the possible as opposed to actual instrumental actions of others, and the

  2. Judge-Jury Interaction in Deliberation: Enhancement or Obstruction of Independent Jury Decision-Making?

    Directory of Open Access Journals (Sweden)

    Jae-Hyup Lee

    2016-06-01

    Full Text Available In the Korean jury system, jurors deliberate without interference of anyone, except when they cannot reach a unanimous verdict, in which case they must hear the judge’s opinion. If jurors convict the defendant, they also deliberate with the judge on sentencing and provide their opinions. This unique feature of the Korean jury system provides rare opportunities to examine the interaction of the lay people and judges in deliberation. Through direct observation and the content analysis of the shadow jury deliberations on actual cases in Korea, we will examine whether the judge’s intervention was helpful in jury decision-making or hampers the independent judgment of the jury. The result shows the collaborative deliberation amongst jurors and judges in sentencing, and in some cases in conviction, will mutually benefit both. In turn, jurors will retain the credibility of the judiciary while the judges will reflect upon their decisions in accordance with the legal consciousness of the lay people. En el sistema de jurados de Corea, los miembros del jurado deliberan sin interferencia de nadie, excepto cuando no pueden llegar a un veredicto unánime, en cuyo caso deben escuchar la opinión del juez. Si los miembros del jurado condenan al acusado, también deliberan con el juez a la hora de dictar sentencia y expresan sus opiniones. Esta característica única del sistema de jurados de Corea ofrece pocas oportunidades para examinar la interacción del jurado popular y los jueces durante su deliberación. A través de la observación directa y el análisis del contenido de las deliberaciones del jurado en la sombra sobre casos reales en Corea, se analizará si la intervención del juez fue útil en la toma de decisiones del jurado o dificulta su independencia de criterio. El resultado demuestra que la deliberación entre los miembros del jurado y los jueces a la hora de dictar sentencia, y en algunos casos al declarar culpable al acusado, beneficia a

  3. How Distinct are Intuition and Deliberation? An Eye-Tracking Analysis of Instruction-Induced Decision Modes

    OpenAIRE

    Nina Horstmann; Andrea Ahlgrimm; Andreas Gloeckner

    2009-01-01

    In recent years, numerous studies comparing intuition and deliberation have been published. However, until now relatively little is known about the cognitive processes underlying the two decision modes. Therefore, we analyzed processes of information search and integration using eye-tracking technology. We tested hypotheses derived from dual-process models which postulate that intuition and deliberation are completely distinct processes against predictions of interventionist models. The latte...

  4. Deliberate release of genetically modified plants into the environment in Slovenia

    Directory of Open Access Journals (Sweden)

    Zlata LUTHAR

    2015-11-01

    Full Text Available Deliberate release of genetically modified higher plants (GMHPs into the environment in Slovenia is regulated by the Law on the Management of Genetically Modified Organisms (ZRGSO Ur. l. RS 23/2005 and 21/2010, III chapter. For each deliberate release of GMPs into the environment a license issued by the Ministry of Environment and Spatial Planning (MESP must be acquired. The application or notification should contain a very accurate and complex description of the GMP, of the field where it will be released and of wider surroundings or environment. The application consists of Annex 2 with accessories: 1. Part A (technical data for the authorization of deliberate GMP release into the environment; 2. Part B (environmental risk assessment; 3. Application summary in Slovenian and English language for the release of GMP into environment, which is transmitted to Brussels by MESP; 4. Extract from the Land Cadastre of the field to which the GMP will be released. The release procedure runs (till here under the above mentioned Law, which has been in place for several years and which clearly defines that it is possible to release GMP in Slovenia. In the case of GM rice in 2011, the law applied till the site selection of the experiment. Here, the law was not sufficiently taken into account. It was prevailed by the regulation of Farmland and Forest Fund of the Republic of Slovenia and municipal decision, which was stronger than the national law and prevented the cultivation of GM rice in an area that is legally suitable for release of GMO into the environment. Rice is not grown in Slovenia and does not have wild ancestors or close relatives with whom it might mate. Nearest area of cultivation is in neighboring Italy, which is from potentially selected location in Slovenia more than 70 km away.

  5. Governance networks as a frame for inter-demoi participation and deliberation

    DEFF Research Database (Denmark)

    Sørensen, Eva

    2012-01-01

    to identify standards for institutional setups that facilitate inter-demoi participation and deliberation. Governance networks represent a part of the challenge posed by the emerging pluricentric system of governance. They may be a central means to cope with the new call for democratic regulation across demoi...... between demoi. The need to find ways to increase the democratic quality of inter-demoi interaction is growing rapidly due to the emergence of a pluricentric political system in which cross-demoi decision-making is more the rule than the exception. There is an urgent call for new theories of democracy able...

  6. Deliberate practice theory: relevance, effort, and inherent enjoyment of music practice.

    Science.gov (United States)

    Hyllegard, Randy; Bories, Tamara L

    2008-10-01

    This study examined three assumptions of the theory of deliberate practice for practice playing music on an electronic keyboard. 40 undergraduate students, divided into two separate groups, practiced one of two music sequences and rated the relevance of practice for improving performance on the sequences, the amount of effort needed to learn the sequences, and the inherent enjoyment of practice sessions. Findings for each assumption were consistent with those suggested by theory but also showed that perceptions are affected by the amount of practice completed and performance of the skill.

  7. Emotions and clinical ethics support. A moral inquiry into emotions in moral case deliberation.

    Science.gov (United States)

    Molewijk, Bert; Kleinlugtenbelt, Dick; Pugh, Scott M; Widdershoven, Guy

    2011-12-01

    Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants' conclusion that "compassion" is a more adequate emotion than "sadness". The emotion "sadness" is pointed towards the tragedy that is happening to the woman. The emotion "compassion" is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to

  8. Deliberation and Collaboration in the Policy Process: A Web 2.0 approach

    Directory of Open Access Journals (Sweden)

    Klaus Petrik

    2010-04-01

    Full Text Available This paper is a summary of a PhD thesis proposal. It will explore how the Web 2.0 platform could be applied to enable and facilitate the large-scale participation, deliberation and collaboration of both governmental and non-governmental actors in an ICT supported policy process. The paper will introduce a new democratic theory and a Web 2.0 based e-democracy platform, and demonstrate how different actors would use the platform to develop and justify policy issues.

  9. Heart-rate control during pain and suggestions of analgesia without deliberate induction of hypnosis.

    Science.gov (United States)

    Santarcangelo, Enrica L; Carli, Giancarlo; Migliorini, Silvia; Fontani, Giuliano; Varanini, Maurizio; Balocchi, Rita

    2008-07-01

    Heart rate and heart-rate variability (HRV) were studied through a set of different methods in high (highs) and low hypnotizable subjects (lows) not receiving any deliberate hypnotic induction in basal conditions (simple relaxation) and during nociceptive-pressor stimulation with and without suggestions of analgesia. ANOVA did not reveal any difference between highs and lows for heart rate and for the HRV indexes extracted from the series of the interbeat intervals (RR) of the ECG in the frequency (spectral analysis) and time domain (standard deviation, Poincare plot) in both basal and stimulation conditions. Factors possibly accounting for the results and likely responsible for an underestimation of group differences are discussed.

  10. United Nations deliberations of the use of nuclear power sources in space: 1978-1987

    Science.gov (United States)

    Bennett, Gary L.; Sholtis, Joseph A., Jr.; Rashkow, Bruce C.

    1988-01-01

    The United Nations (U.N.) is continuing its deliberations on the use of nuclear power sources (NPS) in space. Although no complete set of legal principles has yet been agreed upon, certain scientific and technical criteria for the safe design and use of NPS have been accepted. In this respect, it should be noted that in its 1981 report, the Working Group on the Use of Power Sources in Outer Space concluded that power sources can be used safely in outer space, provided that all necessary safety requirements are met. This is also a succinct statement of the U.S. position.

  11. Om begrepene selvmordsforsøk, selvmutilering og villet egenskade blant ungdom – klinisk relevant slektskap og ulikhet.

    OpenAIRE

    2006-01-01

    Abstract A brief discussion about the terms suicidal attempt, self-mutilation and deliberate self-harm among adolescents. Background: A number of clinicians and researchers support a distinction between suicide-attempters and self-mutilators. On the other side, we find those who call both the phenomena deliberate self-harm. Issue questioned: The question is whether we can regard all the young people who practice self-harm as one group, or if they represent two different groups (...

  12. Investigation of Groundwater Flow Variations near a Recharge Pond with Repeat Deliberate Tracer Experiments

    Directory of Open Access Journals (Sweden)

    Jordan F Clark

    2014-06-01

    Full Text Available Determining hydraulic connections and travel times between recharge facilities and production wells has become increasingly important for permitting and operating managed aquifer recharge (MAR sites, a water supply strategy that transfers surface water into aquifers for storage and later extraction. This knowledge is critical for examining water quality changes and assessing the potential for future contamination. Deliberate tracer experiments are the best method for determining travel times and identifying preferential flow paths between recharge sites over the time scales of weeks to a few years. This paper compares the results of two deliberate tracer experiments at Kraemer Basin, Orange County, CA, USA. Results from the first experiment, which was conducted in October 1998, showed that a region of highly transmissive sedimentary material extends down gradient from the basin for more than 3 km [1]. Mean groundwater velocities were determined to be approximately 2 km/year in this region based on the arrival time of the tracer center of mass. A second experiment was initiated in January 2008 to determine if travel times from this basin to monitoring and production wells changed during the past decade in response to new recharge conditions. Results indicate that flow near Kraemer Basin was stable, and travel times to most wells determined during both experiments agree within the experimental uncertainty.

  13. You can't teach speed: sprinters falsify the deliberate practice model of expertise.

    Science.gov (United States)

    Lombardo, Michael P; Deaner, Robert O

    2014-01-01

    Many scientists agree that expertise requires both innate talent and proper training. Nevertheless, the highly influential deliberate practice model (DPM) of expertise holds that talent does not exist or makes a negligible contribution to performance. It predicts that initial performance will be unrelated to achieving expertise and that 10 years of deliberate practice is necessary. We tested these predictions in the domain of sprinting. In Studies 1 and 2 we reviewed biographies of 15 Olympic champions and the 20 fastest American men in U.S. history. In all documented cases, sprinters were exceptional prior to initiating training, and most reached world class status rapidly (Study 1 median = 3 years; Study 2 = 7.5). In Study 3 we surveyed U.S. national collegiate championships qualifiers in sprinters (n = 20) and throwers (n = 44). Sprinters recalled being faster as youths than did throwers, whereas throwers recalled greater strength and throwing ability. Sprinters' best performances in their first season of high school, generally the onset of formal training, were consistently faster than 95-99% of their peers. Collectively, these results falsify the DPM for sprinting. Because speed is foundational for many sports, they challenge the DPM generally.

  14. Toward a science of exceptional achievement: attaining superior performance through deliberate practice.

    Science.gov (United States)

    Ericsson, K Anders; Nandagopal, Kiruthiga; Roring, Roy W

    2009-08-01

    Exceptional performance is frequently attributed to genetic differences in talent. Since Sir Francis Galton's book, Hereditary Genius, many scientists have cited heritable factors that set limits of performance and only allow some individuals to attain exceptional levels. However, thus far these accounts have not explicated the causal processes involved in the activation and expression of unique genes in DNA that lead to the emergence of distinctive physiological attributes and cognitive capacities (innate talent). This article argues on the basis of our current knowledge that it is possible to account for the development of elite performance among healthy children without recourse to innate talent (genetic endowment)--excepting the innate determinants of body size. Our account is based on the expert-performance approach and proposes that the distinctive characteristics of exceptional performers are the result of adaptations to extended and intense practice activities that selectively activate dormant genes that are contained within all healthy individuals' DNA. Furthermore, the theoretical framework of expert performance explains the apparent emergence of early talent by identifying factors that influence starting ages for training and the accumulated engagement in sustained extended deliberate practice, such as motivation, parental support, and access to the best training environments and teachers. In sum, our empirical investigations and extensive reviews show that the development of expert performance will be primarily constrained by individuals' engagement in deliberate practice and the quality of the available training resources.

  15. You can’t teach speed: sprinters falsify the deliberate practice model of expertise

    Directory of Open Access Journals (Sweden)

    Michael P. Lombardo

    2014-06-01

    Full Text Available Many scientists agree that expertise requires both innate talent and proper training. Nevertheless, the highly influential deliberate practice model (DPM of expertise holds that talent does not exist or makes a negligible contribution to performance. It predicts that initial performance will be unrelated to achieving expertise and that 10 years of deliberate practice is necessary. We tested these predictions in the domain of sprinting. In Studies 1 and 2 we reviewed biographies of 15 Olympic champions and the 20 fastest American men in U.S. history. In all documented cases, sprinters were exceptional prior to initiating training, and most reached world class status rapidly (Study 1 median = 3 years; Study 2 = 7.5. In Study 3 we surveyed U.S. national collegiate championships qualifiers in sprinters (n = 20 and throwers (n = 44. Sprinters recalled being faster as youths than did throwers, whereas throwers recalled greater strength and throwing ability. Sprinters’ best performances in their first season of high school, generally the onset of formal training, were consistently faster than 95–99% of their peers. Collectively, these results falsify the DPM for sprinting. Because speed is foundational for many sports, they challenge the DPM generally.

  16. How distinct are intuition and deliberation? An eye-tracking analysis of instruction-induced decision modes

    Directory of Open Access Journals (Sweden)

    Nina Horstmann

    2009-08-01

    Full Text Available In recent years, numerous studies comparing intuition and deliberation have been published. However, relatively little is known about the cognitive processes underlying the two decision modes. In two studies, we analyzed the effects of decision mode instructions on processes of information search and integration, using eye-tracking technology in a between-participants (Study 1 and a within-participants (Study 2 design. Our findings indicate that the instruction to deliberate does not necessarily lead to qualitatively different information processing compared to the instruction to decide intuitively. We found no difference in mean fixation duration and the distribution of short, medium and long fixations. Short fixations in particular prevailed under both decision mode instructions, while long fixations indicating a conscious and calculation-based information processing were rarely observed. Instruction-induced deliberation led to a higher number of fixations, a more complete information search and more repeated information inspections. We interpret our findings as support for the hypothesis that intuitive and deliberate decision modes share the same basic processes which are supplemented by additional operations in the deliberate decision mode.

  17. Motive Matters! An exploration of the notion ‘deliberate breach of contract’ and its consequences for the application of remedies

    OpenAIRE

    Kogelenberg, Martijn

    2012-01-01

    textabstractThis thesis explores the notion of deliberate breach of contract and its potential remedial consequences. In the major jurisdictions in Europe and in the United States the notion of deliberate breach of contract is generally not coherently and officially defined and acknowledged as an independent legal phenomenon. The ultimate added value of this thesis intends to be a first coherent comparative research on deliberate breach of contract and its potential consequences for the core ...

  18. Transforming a 4th year Modern Optics Course Using a Deliberate Practice Framework

    CERN Document Server

    Jones, David J; Wieman, Carl E

    2015-01-01

    We present a study of active learning pedagogies in an upper division physics course. This work was guided by the principle of deliberate practice for the development of expertise, and this principle was used in the design of the materials and the orchestration of the classroom activities of the students. We present our process for efficiently converting a traditional lecture course based on instructor notes into activities for such a course with active learning methods. Ninety percent of the same material was covered and scores on common exam problems showed a 15 % improvement with an effect size greater than 1 after the transformation. We observe that the improvement and the associated effect size is sustained after handing off the materials to a second instructor. Because the improvement on exam questions was independent of specific problem topics and because the material tested was so mathematically advanced and broad (including linear algebra, Fourier Transforms, partial differential equations, vector ca...

  19. Public voices in pharmaceutical deliberations: negotiating "clinical benefit" in the FDA's Avastin Hearing.

    Science.gov (United States)

    Teston, Christa B; Graham, S Scott; Baldwinson, Raquel; Li, Andria; Swift, Jessamyn

    2014-06-01

    This article offers a hybrid rhetorical-qualitative discourse analysis of the FDA's 2011 Avastin Hearing, which considered the revocation of the breast cancer indication for the popular cancer drug Avastin. We explore the multiplicity of stakeholders, the questions that motivated deliberations, and the kinds of evidence presented during the hearing. Pairing our findings with contemporary scholarship in rhetorical stasis theory, Mol's (2002) construct of multiple ontologies, and Callon, Lascoumes, and Barthe's (2011) "hybrid forums," we demonstrate that the FDA's deliberative procedures elides various sources of evidence and the potential multiplicity of definitions for "clinical benefit." Our findings suggest that while the FDA invited multiple stakeholders to offer testimony, there are ways that the FDA might have more meaningfully incorporated public voices in the deliberative process. We conclude with suggestions for how a true hybrid forum might be deployed.

  20. Smooth criminal: convicted rule-breakers show reduced cognitive conflict during deliberate rule violations.

    Science.gov (United States)

    Jusyte, Aiste; Pfister, Roland; Mayer, Sarah V; Schwarz, Katharina A; Wirth, Robert; Kunde, Wilfried; Schönenberg, Michael

    2017-09-01

    Classic findings on conformity and obedience document a strong and automatic drive of human agents to follow any type of rule or social norm. At the same time, most individuals tend to violate rules on occasion, and such deliberate rule violations have recently been shown to yield cognitive conflict for the rule-breaker. These findings indicate persistent difficulty to suppress the rule representation, even though rule violations were studied in a controlled experimental setting with neither gains nor possible sanctions for violators. In the current study, we validate these findings by showing that convicted criminals, i.e., individuals with a history of habitual and severe forms of rule violations, can free themselves from such cognitive conflict in a similarly controlled laboratory task. These findings support an emerging view that aims at understanding rule violations from the perspective of the violating agent rather than from the perspective of outside observer.

  1. Big losses lead to irrational decision-making in gambling situations: relationship between deliberation and impulsivity.

    Directory of Open Access Journals (Sweden)

    Yuji Takano

    Full Text Available In gambling situations, we found a paradoxical reinforcing effect of high-risk decision-making after repeated big monetary losses. The computerized version of the Iowa Gambling Task (Bechara et al., 2000, which contained six big loss cards in deck B', was conducted on normal healthy college students. The results indicated that the total number of selections from deck A' and deck B' decreased across trials. However, there was no decrease in selections from deck B'. Detailed analysis of the card selections revealed that some people persisted in selecting from the "risky" deck B' as the number of big losses increased. This tendency was prominent in self-rated deliberative people. However, they were implicitly impulsive, as revealed by the matching familiar figure test. These results suggest that the gap between explicit deliberation and implicit impulsivity drew them into pathological gambling.

  2. E-learning and deliberate practice for oral case presentation skills: a randomized trial.

    Science.gov (United States)

    Heiman, Heather L; Uchida, Toshiko; Adams, Craig; Butter, John; Cohen, Elaine; Persell, Stephen D; Pribaz, Paul; McGaghie, William C; Martin, Gary J

    2012-01-01

    Oral case presentations are critical for patient care and student assessment. The best method to prepare early medical students for oral presentations is unknown. We aimed to develop and evaluate a curriculum of on-line learning and deliberate practice to improve pre-clinical students' case presentation skills. We developed a web-based, interactive curriculum emphasizing conciseness and clinical reasoning. Using a waitlist control design, we randomly assigned groups of second-year students to receive the curriculum in December 2010 or in April 2011. We evaluated their presentations at three time points. We also examined the performance of an untrained class of students as a historical comparison. We evaluated 132 second-year medical students at three time points. After the curriculum, mean scores of the intervention students improved from 60.2% to 70.1%, while scores of the waitlist control students improved less, from 61.8% to 64.5% (p oral presentation skills.

  3. Because Political Knowledge Matters: The Impact of Deliberation on Young Citizens’ Opinions

    Directory of Open Access Journals (Sweden)

    Anastasia Deligiaouri

    2016-12-01

    Full Text Available This paper addresses the importance of “knowledge” and “access to information” in the formation of young citizens’ opinion through deliberative procedures. The research presented in this paper is grounded in the theoretical framework of deliberative democracy as a democratic model and procedure that allows participants to be engaged in a rational and open dialogue before deciding on a particular issue. Our research draws empirically upon a deliberative event that took place in October 2014 at the Western Macedonia University of Applied Sciences in Greece. The topic of deliberation was “Political Public Opinion Polls.” The results of this study are commensurate with the dominant thesis in the relevant literature, which underlines that the deliberative procedure enriches the knowledge of citizens and thus enables them to participate effectively in the decision making process.

  4. Burdens of non-conformity: Motor execution reveals cognitive conflict during deliberate rule violations.

    Science.gov (United States)

    Pfister, Roland; Wirth, Robert; Schwarz, Katharina A; Steinhauser, Marco; Kunde, Wilfried

    2016-02-01

    Rule compliance is pivotal for the regulation of social behavior. Still, humans deliberately violate rules at times - be it for personal reasons or for a higher good. Whereas previous research has studied the preconditions and consequences of rule violations, essentially nothing is known about the cognitive processes right at the moment a rule violation takes place. Here we show that merely labeling an action as rule violation induces substantial conflict between rule violation and compliance, as revealed by participants' bias towards rule-complying motor actions. Moreover, conflict that comes with violating a rule was much stronger than conflict that comes with following an alternative rule, even if both decisions result in the same observable behavior. These observations open a new theoretical perspective on rule violation behavior, shifting the focus toward the cognitive processes operating during the very act of rule violation.

  5. Comparison of heuristics for an economic lot scheduling problem with deliberated coproduction

    Directory of Open Access Journals (Sweden)

    Pilar I. Vidal-Carreras

    2009-12-01

    Full Text Available We built on the Economic Lot Scheduling Problem Scheduling (ELSP literature by making some modifications in order to introduce new constraints which had not been thoroughly studied with a view to simulating specific real situations. Specifically, our aim is to propose and simulate different scheduling policies for a new ELSP variant: Deliberated Coproduction. This problem comprises a product system in an ELSP environment in which we may choose if more than one product can be produced on the machine at a given time. We expressly consider the option of coproducing two products whose demand is not substitutable. In order to draw conclusions, a simulation model and its results were developed in the article by employing modified Bomberger data which include two items that could be produced simultaneously.

  6. Big losses lead to irrational decision-making in gambling situations: relationship between deliberation and impulsivity.

    Science.gov (United States)

    Takano, Yuji; Takahashi, Nobuaki; Tanaka, Daisuke; Hironaka, Naoyuki

    2010-02-23

    In gambling situations, we found a paradoxical reinforcing effect of high-risk decision-making after repeated big monetary losses. The computerized version of the Iowa Gambling Task (Bechara et al., 2000), which contained six big loss cards in deck B', was conducted on normal healthy college students. The results indicated that the total number of selections from deck A' and deck B' decreased across trials. However, there was no decrease in selections from deck B'. Detailed analysis of the card selections revealed that some people persisted in selecting from the "risky" deck B' as the number of big losses increased. This tendency was prominent in self-rated deliberative people. However, they were implicitly impulsive, as revealed by the matching familiar figure test. These results suggest that the gap between explicit deliberation and implicit impulsivity drew them into pathological gambling.

  7. Media deliberation on intra-EU migration. A qualitative approach to framing based on rhetorical analysis

    Directory of Open Access Journals (Sweden)

    Alexandru Cârlan

    2016-04-01

    Full Text Available In this paper we investigate how the model of deliberation proposed by Isabela and Norman Fairclough can be used for a better clarification and understanding of the framing processes in media – especially in opinion articles. We thus aim at integrating theoretical contributions from critical discourse analysis and argumentation theory with standard approaches to framing, originating in media studies. We emphasize how a rhetorical approach to framing can provide analytical insights into framing processes and complement the typical quantitative approaches with qualitative analysis based on textual reconstruction. Starting from an issue-specific approach to framing, we discuss a particular case of framing of intra-EU migration, analyzing four opinion articles selected from a larger corpus of Romanian, British and French media. We highlight, along our analysis, various methodological options and analytical difficulties inherent to such an approach.

  8. Moral deliberation and nursing ethics cases: elements of a methodological proposal.

    Science.gov (United States)

    Schneider, Dulcinéia Ghizoni; Ramos, Flávia Regina Souza

    2012-11-01

    A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations.

  9. Mistakes or deliberate violations? A study into the origins of rule breaking at pedestrian train crossings.

    Science.gov (United States)

    Freeman, James; Rakotonirainy, Andry

    2015-04-01

    Train pedestrian collisions are the most likely to result in severe injuries and fatalities when compared to other types of rail crossing accidents. However, there is currently scant research that has examined the origins of pedestrians' rule breaking at level crossings. As a result, this study examined the origins of pedestrians' rule breaking behaviour at crossings, with particular emphasis directed towards examining the factors associated with making errors versus deliberation violations. A total of 636 individuals volunteered to participate in the study and completed either an online or paper version of the questionnaire. Quantitative analysis of the data revealed that knowledge regarding crossing rules was high, although up to 18% of level crossing users were either unsure or did not know (in some circumstances) when it was legal to cross at a level crossing. Furthermore, 156 participants (24.52%) reported having intentionally violated the rules at level crossings and 3.46% (n=22) of the sample had previously made a mistake at a crossing. In regards to rule violators, males (particularly minors) were more likely to report breaking rules, and the most frequent occurrence was after the train had passed rather than before it arrives. Regression analysis revealed that males who frequently use pedestrian crossings and report higher sensation seeking traits are most likely to break the rules. This research provides evidence that pedestrians are more likely to deliberately violate rules (rather than make errors) at crossings and it illuminates high risk groups. This paper will further outline the study findings in regards to the development of countermeasures as well as provide direction for future research efforts in this area.

  10. Shifting Gear. The daily deliberation between arts and economics in cultural and creative organisations in Utrecht, 2010–2012

    NARCIS (Netherlands)

    Kolsteeg, J

    2014-01-01

    This research analyses strategic practice and discourse in ten cultural and for-profit creative organisations in the Dutch city of Utrecht, between 2010 and 2012. The main question of this research is how deliberations on culture, creativity and business structure strategic discourse and practice in

  11. Cooperation, Fast and Slow: Meta-Analytic Evidence for a Theory of Social Heuristics and Self-Interested Deliberation.

    Science.gov (United States)

    Rand, David G

    2016-09-01

    Does cooperating require the inhibition of selfish urges? Or does "rational" self-interest constrain cooperative impulses? I investigated the role of intuition and deliberation in cooperation by meta-analyzing 67 studies in which cognitive-processing manipulations were applied to economic cooperation games (total N = 17,647; no indication of publication bias using Egger's test, Begg's test, or p-curve). My meta-analysis was guided by the social heuristics hypothesis, which proposes that intuition favors behavior that typically maximizes payoffs, whereas deliberation favors behavior that maximizes one's payoff in the current situation. Therefore, this theory predicts that deliberation will undermine pure cooperation (i.e., cooperation in settings where there are few future consequences for one's actions, such that cooperating is not in one's self-interest) but not strategic cooperation (i.e., cooperation in settings where cooperating can maximize one's payoff). As predicted, the meta-analysis revealed 17.3% more pure cooperation when intuition was promoted over deliberation, but no significant difference in strategic cooperation between more intuitive and more deliberative conditions.

  12. Deliberate Practice in Medicine: The Motivation to Engage in Work-Related Learning and Its Contribution to Expertise

    Science.gov (United States)

    van de Wiel, Margje W. J.; Van den Bossche, Piet

    2013-01-01

    This study examined physicians' motivation to engage in work-related learning and its contribution to expertise development beyond work experience. Based on deliberate practice theory, semi-structured interviews were conducted with 17 residents and 28 experienced physicians in internal medicine, focusing on the activities they engaged in during…

  13. The Problem of Character Education and Kohlberg's Moral Education: Critique from Dewey's Moral Deliberation

    Science.gov (United States)

    Liu, Xiangdong

    2014-01-01

    In this article, the author examines Dewey's moral deliberation. Liu argues that Dewey's work will enrich both character education and Kohlberg's moral education. Liu focuses on character education and on Kohlberg's moral education because these are the two dominant approaches. Character education seeks to cultivate good…

  14. The Socialization of Children's Memory: Linking Maternal Conversational Style to the Development of Children's Autobiographical and Deliberate Memory Skills

    Science.gov (United States)

    Langley, Hillary A.; Coffman, Jennifer L.; Ornstein, Peter A.

    2017-01-01

    Data from a large-scale, longitudinal research study with an ethnically and socioeconomically diverse sample were utilized to explore linkages between maternal elaborative conversational style and the development of children's autobiographical and deliberate memory. Assessments were made when the children were aged 3, 5, and 6 years old, and the…

  15. Deliberate practice predicts performance throughout time in adolescent chess players and dropouts: A linear mixed models analysis.

    NARCIS (Netherlands)

    Bruin, de A.B.H.; Smits, N.; Rikers, R.M.J.P.; Schmidt, H.G.

    2008-01-01

    In this study, the longitudinal relation between deliberate practice and performance in chess was examined using a linear mixed models analysis. The practice activities and performance ratings of young elite chess players, who were either in, or had dropped out of the Dutch national chess training,

  16. Shifting Gear. The daily deliberation between arts and economics in cultural and creative organisations in Utrecht, 2010–2012

    NARCIS (Netherlands)

    Kolsteeg, J

    2014-01-01

    This research analyses strategic practice and discourse in ten cultural and for-profit creative organisations in the Dutch city of Utrecht, between 2010 and 2012. The main question of this research is how deliberations on culture, creativity and business structure strategic discourse and practice in

  17. Socio-Technical Deliberation about Free and Open Source Software: Accounting for the Status of Artifacts in Public Life

    Science.gov (United States)

    Benoit-Barne, Chantal

    2007-01-01

    This essay investigates the rhetorical practices of socio-technical deliberation about free and open source (F/OS) software, providing support for the idea that a public sphere is a socio-technical ensemble that is discursive and fluid, yet tangible and organized because it is enacted by both humans and non-humans. In keeping with the empirical…

  18. One angry woman: Anger expression increases influence for men, but decreases influence for women, during group deliberation.

    Science.gov (United States)

    Salerno, Jessica M; Peter-Hagene, Liana C

    2015-12-01

    We investigated whether expressing anger increases social influence for men, but diminishes social influence for women, during group deliberation. In a deception paradigm, participants believed they were engaged in a computer-mediated mock jury deliberation about a murder case. In actuality, the interaction was scripted. The script included 5 other mock jurors who provided verdicts and comments in support of the verdicts; 4 agreed with the participant and 1 was a "holdout" dissenter. Holdouts expressed their opinions with no emotion, anger, or fear and had either male or female names. Holdouts exerted no influence on participants' opinions when they expressed no emotion or fear. Participants' confidence in their own verdict dropped significantly, however, after male holdouts expressed anger. Yet, anger expression undermined female holdouts: Participants became significantly more confident in their original verdicts after female holdouts expressed anger-even though they were expressing the exact same opinion and emotion as the male holdouts. Mediation analyses revealed that participants drew different inferences from male versus female anger, which created a gender gap in influence during group deliberation. The current study has implications for group decisions in general, and jury deliberations in particular, by suggesting that expressing anger might lead men to gain influence, but women to lose influence over others (even when making identical arguments). These diverging consequences might result in women potentially having less influence on societally important decisions than men, such as jury verdicts.

  19. Deliberative Communication Goes to College: The "Deliberation Forum" Project as a Democratic Agent of Empowerment for Communication Students

    Science.gov (United States)

    Malka, Vered

    2016-01-01

    A new field of research has developed over the last few decades, called "Deliberative Communication". It focuses on the potential contribution of public deliberations to strengthening the foundations of democracy and the promotion of social-political goals and objectives. The current research focuses on a unique case study, the…

  20. Deliberate practice predicts performance throughout time in adolescent chess players and dropouts: A linear mixed models analysis.

    NARCIS (Netherlands)

    Bruin, de A.B.H.; Smits, N.; Rikers, R.M.J.P.; Schmidt, H.G.

    2008-01-01

    In this study, the longitudinal relation between deliberate practice and performance in chess was examined using a linear mixed models analysis. The practice activities and performance ratings of young elite chess players, who were either in, or had dropped out of the Dutch national chess training,

  1. Informed decision making about predictive DNA tests: arguments for more public visibility of personal deliberations about the good life.

    Science.gov (United States)

    Boenink, Marianne; van der Burg, Simone

    2010-05-01

    Since its advent, predictive DNA testing has been perceived as a technology that may have considerable impact on the quality of people's life. The decision whether or not to use this technology is up to the individual client. However, to enable well considered decision making both the negative as well as the positive freedom of the individual should be supported. In this paper, we argue that current professional and public discourse on predictive DNA-testing is lacking when it comes to supporting positive freedom, because it is usually framed in terms of risk and risk management. We show how this 'risk discourse' steers thinking on the good life in a particular way. We go on to argue that empirical research into the actual deliberation and decision making processes of individuals and families may be used to enrich the environment of personal deliberation in three ways: (1) it points at a richer set of values that deliberators can take into account, (2) it acknowledges the shared nature of genes, and (3) it shows how one might frame decisions in a non-binary way. We argue that the public sharing and discussing of stories about personal deliberations offers valuable input for others who face similar choices: it fosters their positive freedom to shape their view of the good life in relation to DNA-diagnostics. We conclude by offering some suggestions as to how to realize such public sharing of personal stories.

  2. The Socialization of Children's Memory: Linking Maternal Conversational Style to the Development of Children's Autobiographical and Deliberate Memory Skills

    Science.gov (United States)

    Langley, Hillary A.; Coffman, Jennifer L.; Ornstein, Peter A.

    2017-01-01

    Data from a large-scale, longitudinal research study with an ethnically and socioeconomically diverse sample were utilized to explore linkages between maternal elaborative conversational style and the development of children's autobiographical and deliberate memory. Assessments were made when the children were aged 3, 5, and 6 years old, and the…

  3. Motive Matters! An exploration of the notion ‘deliberate breach of contract’ and its consequences for the application of remedies

    NARCIS (Netherlands)

    M. van Kogelenberg (Martijn)

    2012-01-01

    textabstractThis thesis explores the notion of deliberate breach of contract and its potential remedial consequences. In the major jurisdictions in Europe and in the United States the notion of deliberate breach of contract is generally not coherently and officially defined and acknowledged as an in

  4. The Quality of Deliberation in Two Committees of the European Parliament: The Neglected Influence of the Situational Context and the Policymaking Stage

    Directory of Open Access Journals (Sweden)

    Léa Roger

    2013-10-01

    Full Text Available In our paper we try to answer two empirical research questions. First, we assess the deliberative quality of discussions in two committees of the EU Parliament. In order to do so, we use a slightly revised version of the DQI. Second, we identify and empirically measure those variables that systematically influence the quality of deliberation in interviews with debate actors. We argue that the quality of deliberation in EU committees is influenced by two normative values: deliberation (common good orientation and responsiveness (particular interest orientation, with the guiding value determined by the particular situation. Using a multidimensional concept of deliberation, we empirically test the impact of situational variables on specific aspects of deliberative quality. In addition, we take into account the temporal dimension of deliberation.

  5. Unconscious intuition or conscious analysis? Critical questions for the Deliberation-Without-Attention paradigm

    Directory of Open Access Journals (Sweden)

    Balazs Aczel

    2011-06-01

    Full Text Available The Deliberation without Attention (DWA effect refers to apparent improvements in decision-making following a period of distraction. It has been presented as evidence for beneficial unconscious cognitive processes. We identify two major concerns with this claim: first, as these demonstrations typically involve subjective preferences, the effects of distraction cannot be objectively assessed as beneficial; second, there is no direct evidence that the DWA manipulation promotes unconscious decision processes. We describe two tasks based on the DWA paradigm in which we found no evidence that the distraction manipulation led to decision processes that are subjectively unconscious, nor that it reduced the influence of presentation order upon performance. Crucially, we found that a lack of awareness of decision process was associated with poorer performance, both in terms of subjective preference measures used in traditional DWA paradigm and in an equivalent task where performance can be objectively assessed. Therefore, we argue that reliance on conscious memory itself can explain the data. Thus the DWA paradigm is not an adequate method of assessing beneficial unconscious thought.

  6. Islamic bioethical deliberation on the issue of newborns with disorders of sex development.

    Science.gov (United States)

    Mohamed, Mohd Salim; Noor, Siti Nurani Mohd

    2015-04-01

    This article presents the Islamic bioethical deliberation on the issue of sex assignment surgery (SAS) for infants with disorders of sex development (DSD) or intersexed as a case study. The main objective of this study is to present a different approach in assessing a biomedical issue within the medium of the Maqasid al-Shari'ah. Within the framework of the maqasidic scheme of benefits and harms, any practice where benefits are substantial is considered permissible, while those promoting harms are prohibited. The concept of Maqasid al-Shari'ah which is the mechanistic interpretation of Qur'an and Hadith presents the holistic attention of Islam on many life activities, including healthcare. Indeed, this concept encompasses many aspects of worldly life, both for the human individual and collectively for the whole society. In healthcare, the practice of SAS on DSD newborns has presented an assortment of implications on the future livelihood of the affected individual. The process of decision-making seems to be very multifaceted since every element such as the determination of the 'correct' sex and the urgency of early surgery must consider the benefits and harms, as well as the child's rights and best interest. The application of the concept of Maqasid al-Shari'ah, would convey a pragmatic approach that is often disregarded in Western medicine. This approach considers the right of the individual to live life optimally, individually and socially and practice his faith, precisely, in accordance with the assigned gender.

  7. Deliberate Establishment of Asymptomatic Bacteriuria-A Novel Strategy to Prevent Recurrent UTI.

    Science.gov (United States)

    Wullt, Björn; Svanborg, Catharina

    2016-07-29

    We have established a novel strategy to reduce the risk for recurrent urinary tract infection (UTI), where rapidly increasing antibiotic resistance poses a major threat. Epidemiologic studies have demonstrated that asymptomatic bacteriuria (ABU) protects the host against symptomatic infections with more virulent strains. To mimic this protective effect, we deliberately establish ABU in UTI-prone patients, who are refractory to conventional therapy. The patients are inoculated with Escherichia coli (E. coli) 83972, now widely used as a prototype ABU strain. Therapeutic efficacy has been demonstrated in a placebo-controlled trial, supporting the feasibility of using E. coli 83972 as a tool to prevent recurrent UTI and, potentially, to outcompete antibiotic-resistant strains from the human urinary tract. In addition, the human inoculation protocol offers unique opportunities to study host-parasite interaction in vivo in the human urinary tract. Here, we review the clinical evidence for protection using this approach as well as some molecular insights into the pathogenesis of UTI that have been gained during these studies.

  8. Deliberate Establishment of Asymptomatic Bacteriuria—A Novel Strategy to Prevent Recurrent UTI

    Directory of Open Access Journals (Sweden)

    Björn Wullt

    2016-07-01

    Full Text Available We have established a novel strategy to reduce the risk for recurrent urinary tract infection (UTI, where rapidly increasing antibiotic resistance poses a major threat. Epidemiologic studies have demonstrated that asymptomatic bacteriuria (ABU protects the host against symptomatic infections with more virulent strains. To mimic this protective effect, we deliberately establish ABU in UTI-prone patients, who are refractory to conventional therapy. The patients are inoculated with Escherichia coli (E. coli 83972, now widely used as a prototype ABU strain. Therapeutic efficacy has been demonstrated in a placebo-controlled trial, supporting the feasibility of using E. coli 83972 as a tool to prevent recurrent UTI and, potentially, to outcompete antibiotic-resistant strains from the human urinary tract. In addition, the human inoculation protocol offers unique opportunities to study host-parasite interaction in vivo in the human urinary tract. Here, we review the clinical evidence for protection using this approach as well as some molecular insights into the pathogenesis of UTI that have been gained during these studies.

  9. Quantifying Reaeration Rates in Alpine Streams Using Deliberate Gas Tracer Experiments

    Directory of Open Access Journals (Sweden)

    Andrew Benson

    2014-04-01

    Full Text Available Gas exchange across the air-water interface is a critical process that maintains adequate dissolved oxygen (DO in the water column to support life. Oxygen reaeration rates can be accurately measured using deliberate gas tracers, like sulfur hexafluoride (SF6 or xenon (Xe. Two continuous release experiments were conducted in different creeks in the Sierra Nevada of California: Sagehen Creek in September, 2009, using SF6 and Martis Creek in August, 2012, using both SF6 and Xe. Measuring gas loss along the creek, which was approximated with the one-dimensional advection-dispersion equation, allows for the estimation of the SF6 or Xe reaeration coefficient (KSF6, KXe, which is converted to DO reaeration (KDO or K2 using Schmidt numbers. Mean KSF6 for upper and lower Sagehen and Martis Creeks were, respectively, 34 day−1, 37 day−1 and 33 day−1, with corresponding KDOs of 61 day−1, 66 day−1 and 47 day−1. In Martis Creek, KXe was slightly higher (21% than KSF6, but the calculated KDO from SF6 agreed with the calculated KDO from Xe within about 15%; this difference may be due to bubble-enhanced gas transfer. Established empirical equations of KDO using stream characteristics did a poor job predicting KDO for both creeks.

  10. Teamwork and healthy workplaces: strengthening the links for deliberation and action through research and policy.

    Science.gov (United States)

    Oandasan, Ivy

    2007-01-01

    The two lead articles for this issue by Shamian and El-Jardali and by Clements, Dault and Priest provide an opportunity to consider how two agendas - teamwork in healthcare and the healthy workplace - can be strengthened to gain mutual advancement. Both agendas are in the pan-Canadian Health Human Resource (HHR) strategic plan in Canada and were also identified within the Health Council of Canada's 2005 Annual Report. Strong links have yet to be made related to the teamwork in healthcare agenda and its relationship with the workplace environment. Significant research has been conducted, and advocates are pushing for policy change. It is recommended that those engaged in the research in these two domains dialogue with each other and collectively consider ways in which they could advance the policy directions required to enhance both patient and provider satisfaction in our healthcare system. The teamwork and healthy workplace agendas require thoughtful deliberation between researchers and policy-makers to inform action. This commentary provides an example of how the Ontario government has been able to engage within an evidence-informed process to develop inter-professional care that may ultimately positively impact the teamwork in healthcare agenda and the healthy workplace agenda in the future.

  11. A method for the deliberate and deliberative selection of policy instrument mixes for climate change adaptation

    Directory of Open Access Journals (Sweden)

    Heleen L. P. Mees

    2014-06-01

    Full Text Available Policy instruments can help put climate adaptation plans into action. Here, we propose a method for the systematic assessment and selection of policy instruments for stimulating adaptation action. The multi-disciplinary set of six assessment criteria is derived from economics, policy, and legal studies. These criteria are specified for the purpose of climate adaptation by taking into account four challenges to the governance of climate adaptation: uncertainty, spatial diversity, controversy, and social complexity. The six criteria and four challenges are integrated into a step-wise method that enables the selection of instruments starting from a generic assessment and ending with a specific assessment of policy instrument mixes for the stimulation of a specific adaptation measure. We then apply the method to three examples of adaptation measures. The method's merits lie in enabling deliberate choices through a holistic and comprehensive set of adaptation specific criteria, as well as deliberative choices by offering a stepwise method that structures an informed dialog on instrument selection. Although the method was created and applied by scientific experts, policy-makers can also use the method.

  12. Transforming a fourth year modern optics course using a deliberate practice framework

    Science.gov (United States)

    Jones, David J.; Madison, Kirk W.; Wieman, Carl E.

    2015-12-01

    [This paper is part of the Focused Collection on Upper Division Physics Courses.] We present a study of active learning pedagogies in an upper-division physics course. This work was guided by the principle of deliberate practice for the development of expertise, and this principle was used in the design of the materials and the orchestration of the classroom activities of the students. We present our process for efficiently converting a traditional lecture course based on instructor notes into activities for such a course with active learning methods. Ninety percent of the same material was covered and scores on common exam problems showed a 15% improvement with an effect size greater than 1 after the transformation. We observe that the improvement and the associated effect size is sustained after handing off the materials to a second instructor. Because the improvement on exam questions was independent of specific problem topics and because the material tested was so mathematically advanced and broad (including linear algebra, Fourier transforms, partial differential equations, and vector calculus), we expect the transformation process could be applied to most upper-division physics courses having a similar mathematical base.

  13. Retractions in the scientific literature: do authors deliberately commit research fraud?

    Science.gov (United States)

    Steen, R Grant

    2011-02-01

    Papers retracted for fraud (data fabrication or data falsification) may represent a deliberate effort to deceive, a motivation fundamentally different from papers retracted for error. It is hypothesised that fraudulent authors target journals with a high impact factor (IF), have other fraudulent publications, diffuse responsibility across many co-authors, delay retracting fraudulent papers and publish from countries with a weak research infrastructure. All 788 English language research papers retracted from the PubMed database between 2000 and 2010 were evaluated. Data pertinent to each retracted paper were abstracted from the paper and the reasons for retraction were derived from the retraction notice and dichotomised as fraud or error. Data for each retracted article were entered in an Excel spreadsheet for analysis. Journal IF was higher for fraudulent papers (pfraud than error among retracted papers from the USA (χ(2)=8.71; pfraud' hypothesis. The results suggest that papers retracted because of data fabrication or falsification represent a calculated effort to deceive. It is inferred that such behaviour is neither naïve, feckless nor inadvertent.

  14. Individual differences in preference for epistemic versus teleologic strategies of deliberate self-persuasion.

    Science.gov (United States)

    Taylor, Cheryl A; Lord, Charles G; Morin, Amanda L; Brady, Sara E; Yoke, Kristin; Lu, Tong

    2014-03-01

    People are often dissatisfied with their attitudes (e.g., liking their jobs too little or junk food too much) and would like to evaluate differently. On the basis of theory and research, a scale was developed to measure individual differences in preference for 2 types of cognitive tactics (epistemic or teleologic [E or T]) that people use when they try to change their own attitudes (Maio & Thomas, 2007). For each of 3 attitude objects (my life, a romantic partner, Arabs), the scale items loaded on the 2 intended factors, and E - T scale scores were significantly correlated across the 3 attitude objects (Study 1). Scale scores also displayed satisfactory internal and test-retest reliability and discriminant validity (Study 2). In addition, E - T scores (i.e., mean preference for epistemic vs. teleologic tactics) displayed satisfactory predictive and construct validity by predicting the extent to which individuals would recall negative attributes of their lives (Study 3) and of going to a counseling center (Study 4) after a session of deliberate self-persuasion. The discussion centers on theoretical and practical applications of the new scale. 2014 APA

  15. Transforming a fourth year modern optics course using a deliberate practice framework

    Directory of Open Access Journals (Sweden)

    David J. Jones

    2015-09-01

    Full Text Available [This paper is part of the Focused Collection on Upper Division Physics Courses.] We present a study of active learning pedagogies in an upper-division physics course. This work was guided by the principle of deliberate practice for the development of expertise, and this principle was used in the design of the materials and the orchestration of the classroom activities of the students. We present our process for efficiently converting a traditional lecture course based on instructor notes into activities for such a course with active learning methods. Ninety percent of the same material was covered and scores on common exam problems showed a 15% improvement with an effect size greater than 1 after the transformation. We observe that the improvement and the associated effect size is sustained after handing off the materials to a second instructor. Because the improvement on exam questions was independent of specific problem topics and because the material tested was so mathematically advanced and broad (including linear algebra, Fourier transforms, partial differential equations, and vector calculus, we expect the transformation process could be applied to most upper-division physics courses having a similar mathematical base.

  16. Influencing health policy through public deliberation: Lessons learned from two decades of Citizens'/community juries.

    Science.gov (United States)

    Degeling, Chris; Rychetnik, Lucie; Street, Jackie; Thomas, Rae; Carter, Stacy M

    2017-04-01

    Citizens'/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have successfully been used to influence health policy decision-making. Despite this evidence of success, there appears to be a gap between the goals of health researchers who organize CJs and the needs of policy actors and decision makers. Drawing on our experiences working with CJs and recent research on CJ methods, we describe a synopsis of the current state of the art organized around four key questions, and informed by insights from deliberative theory and critical policy studies. Our intention is to stimulate further discussion as to the types of health policy questions that can be usefully addressed through public deliberation, and provide guidance on the methodological and political dimensions that need to be considered in deciding whether a CJ is an appropriate approach for informing a policy decision-making process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Democracy or war? The communication and deliberation of the climate issue online

    Directory of Open Access Journals (Sweden)

    Tomas Moe Skjølsvold

    2015-06-01

    Full Text Available For years, technology optimists have hoped that the internet might serve as a vehicle for democratization. Meanwhile, many STS-scholars have called for a democratization of scientific practices through increased transparency and inclusion of lay-persons in scientific knowledge production. Many expect this to result in increased scientific quality and more legitimate knowledge claims. In this article, we explore what happens when science related communication moves online. Do climate scientists and climate ‘skeptics’ use the internet to engage lay persons in factual deliberations and debate? Does the rise of the internet as a channel of science communication herald a new, democratic scientific era? Our paper suggests that such claims should be made with caution. Instead we identify two ways that the internet is used by climate scientists. First, it is a tool to fight a cold war with climate skeptics, a dynamic which is hidden from public view. Second, it is a site of education, where ready-made packets of facts should be transported to lay-people to mitigate perceived knowledge deficits. This strategy is mimicked by climate skeptics who attempt to make their communication appear more scientific than the scientists.

  18. Deliberate Design of TiO2 Nanostructures towards Superior Photovoltaic Cells.

    Science.gov (United States)

    Sun, Ziqi; Liao, Ting; Sheng, Liyuan; Kou, Liangzhi; Kim, Jung Ho; Dou, Shi Xue

    2016-08-01

    TiO2 nanostructures are being sought after as flexibly utilizable building blocks for the fabrication of the mesoporous thin-film photoelectrodes that are the heart of the third-generation photovoltaic devices, such as dye-sensitized solar cells (DSSCs), quantum-dot-sensitized solar cells (QDSSCs), and the recently promoted perovskite-type solar cells. Here, we report deliberate tailoring of TiO2 nanostructures for superior photovoltaic cells. Morphology engineering of TiO2 nanostructures is realized by designing synthetic protocols in which the precursor hydrolysis, crystal growth, and oligomer self-organization are precisely controlled. TiO2 nanostructures in forms varying from isolated nanocubes, nanorods, and cross-linked nanorods to complex hierarchical structures and shape-defined mesoporous micro-/nanostructures were successfully synthesized. The photoanodes made from the shape-defined mesoporous TiO2 microspheres and nanospindles presented superior performances, owing to the well-defined overall shapes and the inner ordered nanochannels, which allow not only a high amount of dye uptake, but also improved visible-light absorption. This study provides a new way to seek an optimal synthetic protocol to meet the required functionality of the nanomaterials.

  19. Shifting Gear. The daily deliberation between arts and economics in cultural and creative organisations in Utrecht, 2010–2012

    OpenAIRE

    Kolsteeg, J.

    2014-01-01

    This research analyses strategic practice and discourse in ten cultural and for-profit creative organisations in the Dutch city of Utrecht, between 2010 and 2012. The main question of this research is how deliberations on culture, creativity and business structure strategic discourse and practice in cultural and creative organisations in the midst of current institutional change. The methodological framework is based on structuration theory as developed by Anthony Giddens, applied in a discou...

  20. Participatory Sustainability Approach to Value Capture-Based Urban Rail Financing in India through Deliberated Stakeholder Engagement

    Directory of Open Access Journals (Sweden)

    Satya Sai Kumar Jillella

    2015-06-01

    Full Text Available Increasingly, cities around the world are seeking innovative financial mechanisms to build rail transit projects. Land value capture (VC is a financing mechanism to fund urban rail transit. Often VC mechanisms are viewed only as a financing tool applied in relation to increased land values from the administration and legislation perspectives, without actively involving the community in the process. The lack of such participation has resulted in the under collection of the true value established. The transit beneficiary community and city tax payers are especially important stakeholders in this process as their willingness to participate is really critical to the overall VC success and transport outcome. This paper introduces a participatory sustainability approach to enable a more deliberated stakeholder engagement intervention across the VC life cycle. A four-step “Participatory Strategic Value Capture (PSVC” framework is proposed offering step-by-step guidance toward facilitating a meaningful stakeholder dialogue, deliberation, and collaboration around the stated engagement interests. The PSVC framework, applied to the proposed Bangalore sub-urban rail project in India, has demonstrated the importance of stakeholder engagement using deliberated participatory approaches from a win-win perspective.

  1. Deliberate ambiguity in a finite environment: The urban ecology of artificial items

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    Abraham Akkerman

    2000-01-01

    Full Text Available A distinction is made between visual declaration and virtual usage of artificial items within a physical environment, such as a street. Visual declaration is a formal pictorial designation, or a function, e.g. “decoration,” of an item, such as a “planter.” Virtual usage refers to the item when it is used in lieu of another item. The formal designation, “sitting,” customarily designated to an item such as “bench,” could also be a virtual usage of the item “planter.” The question asked is, “What is the relationship between items, given their formal, visual declaration and their informal, virtual, usage?” An artificial item, according to its visual declaration, is referred to as a ‘visual’ or ‘real item’. Each visual item has the property of being used as another item by virtue of its undeclared usage. Pending on the item's design and configuration, a visual item can be then substituted for another visual item. An artificial item, thus, attains deliberate ambiguity between its formal designation and its virtual usage. This ambiguity between visual declaration and virtual usage can be quantified. Within the full domain of n possible usages, this relationship can be conveniently presented in a nonnegative matrix. It is shown that the inverse of this matrix belongs to a class of well-known matrices. This being the case, the relationship between visual and virtual properties of items within the environment can be formalized. The formalization throws further light on the emerging opportunities in streetscape design.

  2. Applying the balanced scorecard to local public health performance measurement: deliberations and decisions

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    Kurji Karim

    2009-05-01

    Full Text Available Abstract Background All aspects of the heath care sector are being asked to account for their performance. This poses unique challenges for local public health units with their traditional focus on population health and their emphasis on disease prevention, health promotion and protection. Reliance on measures of health status provides an imprecise and partial picture of the performance of a health unit. In 2004 the provincial Institute for Clinical Evaluative Sciences based in Ontario, Canada introduced a public-health specific balanced scorecard framework. We present the conceptual deliberations and decisions undertaken by a health unit while adopting the framework. Discussion Posing, pondering and answering key questions assisted in applying the framework and developing indicators. Questions such as: Who should be involved in developing performance indicators? What level of performance should be measured? Who is the primary intended audience? Where and how do we begin? What types of indicators should populate the health status and determinants quadrant? What types of indicators should populate the resources and services quadrant? What type of indicators should populate the community engagement quadrant? What types of indicators should populate the integration and responsiveness quadrants? Should we try to link the quadrants? What comparators do we use? How do we move from a baseline report card to a continuous quality improvement management tool? Summary An inclusive, participatory process was chosen for defining and creating indicators to populate the four quadrants. Examples of indicators that populate the four quadrants of the scorecard are presented and key decisions are highlighted that facilitated the process.

  3. Determinants of resident competence in mastoidectomy: role of interest and deliberate practice.

    Science.gov (United States)

    Malik, Mohammad U; Varela, David A Diaz Voss; Park, EunMi; Masood, Hamid; Laeeq, Kulsoom; Bhatti, Nasir I; Francis, Howard W

    2013-12-01

    This study explores the influence of selected factors on achievement of competency in mastoid surgery. A prospective study of surgical performance and a retrospective survey of learner and training factors. The longitudinal performance of 15 residents was evaluated using the mastoidectomy task-based checklist (TBC). The influence of surgical experience, resident interest, and training factors (course attendance, voluntary use of simulation laboratory) was also examined and compared for the acquisition of distinct levels of technical skill difficulty (cortical mastoidectomy vs. facial recess). Ninety-six observations made during the first otology rotation were analyzed. Cortical mastoidectomy tasks showed positive associations with cumulated case numbers (OR 1.13, CI 1.04-1.23, P = .003) and interest in otology (OR 3.86, CI 1.21-12.27, P = .022). Facial recess tasks showed a larger positive association with interest in otology (OR 10.38, CI 2.25-47.94, P = .003), and negative association with extra time spent in laboratory practice (OR .05, CI 0.011-0.23, P = .000). Learning trajectory for cortical mastoidectomy and facial recess may be influenced by different factors. Interest in otology, in particular, may have a moderating effect on the acquisition of more complex skills in mastoid surgery. A negative association between self-directed laboratory simulation and performance may reflect the impact of assessment-guided feedback in promoting deliberate practice. Further investigations are suggested to explore the interactions between individual trainee differences, educational models, and learning outcomes. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  4. A Decision Support Framework for Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

    Science.gov (United States)

    Rehr, Amanda P.; Small, Mitchell J.; Bradley, Patricia; Fisher, William S.; Vega, Ann; Black, Kelly; Stockton, Tom

    2012-12-01

    We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environmental stressors, processes, and outcomes; and a Decision Landscape analysis to depict the legal, social, and institutional dimensions of environmental decisions. The Decision Landscape incorporates interactions among government agencies, regulated businesses, non-government organizations, and other stakeholders. It also identifies where scientific information regarding environmental processes is collected and transmitted to improve knowledge about elements of the DPSIR and to improve the scientific basis for decisions. Our application of the decision support framework to coral reef protection and restoration in the Florida Keys focusing on anthropogenic stressors, such as wastewater, proved to be successful and offered several insights. Using information from a management plan, it was possible to capture the current state of the science with a DPSIR analysis as well as important decision options, decision makers and applicable laws with a the Decision Landscape analysis. A structured elicitation of values and beliefs conducted at a coral reef management workshop held in Key West, Florida provided a diversity of opinion and also indicated a prioritization of several environmental stressors affecting coral reef health. The integrated DPSIR/Decision landscape framework for the Florida Keys developed based on the elicited opinion and the DPSIR analysis can be used to inform management decisions, to reveal the role that further scientific information and research might play to populate the framework, and to facilitate better-informed agreement among participants.

  5. A Disease-Specific Hybrid Rotation Increases Opportunities for Deliberate Practice.

    Science.gov (United States)

    Cook, Mackenzie R; Graff-Baker, Amanda N; Moren, Alexis M; Brown, Sarah; Fair, Kelly A; Kiraly, Laszlo N; De La Melena, Violeta Tammy; Pommier, SuEllen J; Deveney, Karen E

    2016-01-01

    Incorporating deliberate practice (DP) into residency curricula may optimize education. DP includes educationally protected time, continuous expert feedback, and a focus on a limited number of technical skills. It is strongly associated with mastery level learning. Determine if a multidisciplinary breast rotation (MDB) increases DP opportunities. Beginning in 2010, interns completed the 4-week MDB. Three days a week were spent in surgery and surgical clinic. Half-days were in breast radiology, pathology, medical oncology, and didactics. The MDB was retrospectively compared with a traditional community rotation (TCR) and a university surgical oncology service (USOS) using rotation feedback and resident operative volume. Data are presented as mean ± standard deviation. Oregon Health and Science University in Portland, Oregon; an academic tertiary care general surgery residency program. General surgery residents at Oregon Health and Science University participating in either the MDB, TCR or USOS. A total of 31 interns rated the opportunity to perform procedures significantly higher for MDB than TCR or USOS (4.6 ± 0.6 vs 4.2 ± 0.9 and 4.1 ± 1.0, p rotation or USOS. The MDB incorporates multidisciplinary care into a unique, disease-specific, and educationally focused rotation. It is highly rated and affords a greater opportunity for DP than either the USOS or TCR. DP is strongly associated with mastery learning and this novel rotation structure could maximize intern education in the era of limited work hours. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. Feasibility of large scale deliberate tracer release experiments in or below the oceanic thermocline

    Energy Technology Data Exchange (ETDEWEB)

    Shepherd, J.G.; Broecker, W.S.

    1981-02-01

    The relative importance of lateral and vertical mixing in the interior of the oceans cannot be reliably determined from conventional oceanographic measurements, nor from observations of fallout radionuclides. It is suggested that the problem could be most effectively studied by an experiment in which a large quantity of a suitable tracer was deliberately released in deep water, and its subsequent dispersion was followed for at least one year. The feasibility of such an experiment is examined. It is concluded that it is indeed feasible, and that helium-3 would be the most suitable tracer, with tritium as a possible alternative. About 30 g f Helium-3 would be needed for each release. Such a quantity may be dissoled in about 1 m/sup 3/ of water at pressures greater than 500 dbar, is easily available, and would cost about $100K. Concentrations would have fallen to unmeasurable levels by the time the patch had spread sufficiently to interfere with measurements of natural or radiogenic helium-3. The patch would need to be marked with dusters of neutrally buoyant floats in order that its movement may be followed. It is estimated that it would be around 1000 km across after one year, and anything from a few meters to a few hundred meters thick. Vertically integrating samples would probably be most suitable, used in conjunction with ship-board helium-3 mass spectrometer. Methods of dissolving the helium in situ, and making the release with minimum disturbance are also proposed. The cost would be several million dollars, spread over several years.

  7. Deliberate self-injury functions and their clinical correlates among adolescent psychiatric inpatients.

    Science.gov (United States)

    Radziwiłłowicz, Wioletta; Lewandowska, Magdalena

    2017-04-30

    The aim of the study was to analyze the relationships between clinical variables (the severity of depression symptoms, feelings towards the body, dissociation, number and type of traumatic events) and deliberate self-injury functions. Moreover, we investigated whether the of group self-mutilating adolescents is internally diverse in terms of how important individual functions of self-mutilation are, and whether the subgroups singled out by these functions differ between each other in terms of clinical variables. The Inventory of Statements about Self-Injury was used. Characterizations of examined individuals and other research tools are included in our previous article (year, issue, pages). Associated with negative feelings towards the body are the functions of self-injuries (anti-dissociation, self-punishment) that can be described as interpersonal. High levels of depression symptoms (self-depreciation included) are mainly associated with the self-injury functions: self-punishment, anti-dissociation, establishing interpersonal boundaries. Affect regulation becomes more important as a function of self-inflicted injuries in cases of biological dysregulation and intense dissociative symptoms. The adolescents psychiatric inpatients are internally diverse in terms of dominant functions of self-injuries, which can be categorized into intra- and interpersonal. Intrapersonal functions dominate when an individual experiences severe depression, dissociative symptoms, and negative feelings towards the body. In cases of moderate intensity of depression, dissociative symptoms and negative feelings towards the body, both intrapersonal and interpersonal functions of self-mutilation are similarly important. Further research is required to explain the lowest severity of depression symptoms, dissociative symptoms and negative feelings towards the body co-occurs with no awareness of self-injuries functions.

  8. Learning by doing. Training health care professionals to become facilitator of moral case deliberation.

    Science.gov (United States)

    Stolper, Margreet; Molewijk, Bert; Widdershoven, Guy

    2015-03-01

    Moral case deliberation (MCD) is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire expertise in dealing with moral questions independent of the expertise of an (external) ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: 'learning by doing', 'reflection instead of ready made knowledge', and 'dialogue on dialogue'. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions.

  9. Deliberate play and preparation jointly benefit motor and cognitive development: mediated and moderated effects

    Directory of Open Access Journals (Sweden)

    Caterina ePesce

    2016-03-01

    Full Text Available In light of the interrelation between motor and cognitive development and the predictive value of the former for the latter, the secular decline observed in motor coordination ability as early as preschool urges identification of interventions that may jointly impact motor and cognitive efficiency.The aim of this study was twofold. It (1 explored the outcomes of enriched physical education, centered on deliberate play and cognitively challenging variability of practice, on motor coordination and cognitive processing; (2 examined whether motor coordination outcomes mediate intervention effects on children’s cognition, while controlling for moderation by lifestyle factors as outdoor play habits and weight status. Four hundred and sixty children aged 5-10 years participated in a 6-month group randomized intervention in physical education, with or without playful coordinative and cognitive enrichment. The weight status and spontaneous outdoor play habits of children (parental report of outdoor play were evaluated at baseline. Before and after the intervention, motor developmental level (Movement Assessment Battery for Children was evaluated in all children, who were then assessed either with a test of working memory (Random Number Generation task, or with a test of attention (from the Cognitive Assessment System, CAS.Children assigned to the ‘enriched’ intervention showed more pronounced improvements in all motor coordination assessments (manual dexterity, ball skills, static/dynamic balance. The beneficial effect on ball skills was amplified by the level of spontaneous outdoor play and weight status. Among indices of executive function and attention, only that of inhibition showed a differential effect of intervention type. Moderated mediation showed that the better outcome of the enriched physical education on ball skills mediated the better inhibition outcome, but only when the enrichment intervention was paralleled by a medium

  10. Deliberate Play and Preparation Jointly Benefit Motor and Cognitive Development: Mediated and Moderated Effects.

    Science.gov (United States)

    Pesce, Caterina; Masci, Ilaria; Marchetti, Rosalba; Vazou, Spyridoula; Sääkslahti, Arja; Tomporowski, Phillip D

    2016-01-01

    In light of the interrelation between motor and cognitive development and the predictive value of the former for the latter, the secular decline observed in motor coordination ability as early as preschool urges identification of interventions that may jointly impact motor and cognitive efficiency. The aim of this study was twofold. It (1) explored the outcomes of enriched physical education (PE), centered on deliberate play and cognitively challenging variability of practice, on motor coordination and cognitive processing; (2) examined whether motor coordination outcomes mediate intervention effects on children's cognition, while controlling for moderation by lifestyle factors as outdoor play habits and weight status. Four hundred and sixty children aged 5-10 years participated in a 6-month group randomized intervention in PE, with or without playful coordinative and cognitive enrichment. The weight status and spontaneous outdoor play habits of children (parental report of outdoor play) were evaluated at baseline. Before and after the intervention, motor developmental level (Movement Assessment Battery for Children) was evaluated in all children, who were then assessed either with a test of working memory (Random Number Generation task), or with a test of attention (from the Cognitive Assessment System). Children assigned to the 'enriched' intervention showed more pronounced improvements in all motor coordination assessments (manual dexterity, ball skills, static/dynamic balance). The beneficial effect on ball skills was amplified by the level of spontaneous outdoor play and weight status. Among indices of executive function and attention, only that of inhibition showed a differential effect of intervention type. Moderated mediation showed that the better outcome of the enriched PE on ball skills mediated the better inhibition outcome, but only when the enrichment intervention was paralleled by a medium-to-high level of outdoor play. Results suggest that

  11. Linking science, public values, and decision-making: Case study development for public deliberations about climate change resilience

    Science.gov (United States)

    Weller, N.; Bennett, I.; Bernstein, M.; Farooque, M.; Lloyd, J.; Lowenthal, C.; Sittenfeld, D.

    2016-12-01

    Actionable science seeks to align scientific inquiry with decision-making priorities to overcome rifts between scientific knowledge and the needs of decision makers. Combining actionable science with explorations of public values and priorities creates useful support for decision makers facing uncertainty, tradeoffs, and limited resources. As part of a broader project to create public forums about climate change resilience, we convened workshops with decision makers, resilience experts, and community stakeholders to discuss climate change resilience. Our goals were 1) to create case studies of resilience strategies for use in public deliberations at science museums across 8 U.S. cities; and 2) to build relationships with decision makers and stakeholders interested in these public deliberations. Prior to workshops, we created summaries of resilience strategies using academic literature, government assessments, municipal resilience plans, and conversations with workshop participants. Workshops began with example deliberation activities followed by semi-structured discussions of resilience strategies centered on 4 questions: 1) What are the key decisions to be made regarding each strategy? 2) What stakeholders and perspectives are relevant to each strategy? 3) What available data are relevant to each strategy? 4) What visualizations or other resources are useful for communicating things about each strategy? Workshops yielded actionable dialogue regarding issues of justice, feasibility, and the socio-ecological-technical systems impacted by climate change hazards and resilience strategies. For example, discussions of drought revealed systemic and individual-level challenges and opportunities; discussions of sea level rise included ways to account for the cultural significance of many coastal communities. The workshops provide a model for identifying decision-making priorities and tradeoffs and building partnerships among stakeholders, scientists, and decision makers.

  12. Deliberate and emergent strategies for implementing person-centred care: a qualitative interview study with researchers, professionals and patients.

    Science.gov (United States)

    Naldemirci, Öncel; Wolf, Axel; Elam, Mark; Lydahl, Doris; Moore, Lucy; Britten, Nicky

    2017-08-04

    The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies. This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT). In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication. NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients' perceptions to evaluate outcomes.

  13. Deliberately dispatched SCR firing angles for harmonic mitigation in three-phase multi-drive systems without communication

    DEFF Research Database (Denmark)

    Yang, Yongheng; Davari, Pooya; Zare, Firuz;

    2016-01-01

    Adjustable Speed Drives (ASDs) are widely used in threephase multi-drive applications in industry, where low-cost Diode Rectifiers (DRs) or Silicon-Controlled Rectifiers (SCRs) are still employed as the front-ends in practice, also for simplicity. However, the associated harmonics are produced...... witnessed in industry. In this sense, this paper proposes a harmonic mitigation strategy for multiple parallel ASD systems, where the firing angles of the SCR units are deliberately dispatched among the SCR drive units, resulting in certain phase shifts of the SCR currents on purpose. In such a manner...

  14. The influence of several changes in atmospheric states over semi-arid areas on the incidence of mental health disorders

    Science.gov (United States)

    Yackerson, Naomy S.; Zilberman, Arkadi; Todder, Doron; Kaplan, Zeev

    2011-05-01

    The incidence of suicide attempts [Deliberate Self Harm (DSH); ICD-10: X60-X84] and psychotic attacks (PsA; ICD-10, F20-F29) in association with atmospheric states, typical for areas close to big deserts, was analyzed. A retrospective study is based on the 4,325 cases of DSH and PsA registered in the Mental Health Center (MHC) of Ben-Gurion University (Be'er-Sheva, Israel) during 2001-2003. Pearson and Spearman test correlations were used; the statistical significance was tested at p 0.1). Correlation coefficients between N SU and N PS and speed WS of westerly wind reaches 0.3 ( p 0.09). Variations in easterly wind direction WD influence N SU and N PS values ( p 0.3). Obviously ,in transition areas located between different regions ,the main role of air streams in meteorological-biological impact can scarcely be exaggerated. An unstable balance in the internal state of a weather-sensitive person is disturbed when the atmospheric state is changed by specific desert winds, which can provoke significant perturbations in meteorological parameters. Results indicate the importance of wind direction, defining mainly the atmospheric situation in semi-arid areas: changes in direction of the easterly wind influence N SU and N PS , while changes in WS are important for mental health under westerly air streams. Obviously, N SU and N PS are more affected by the disturbance of weather from its normal state, for a given season, to which the local population is accustomed, than by absolute values of meteorological parameters.

  15. Analysis and deliberation as a mechanism to assess changes in preferences for indicators of sustainable forest management: a case study in Puebla, Mexico.

    Science.gov (United States)

    Rodriguez-Piñeros, Sandra; Lewis, David K

    2013-10-15

    The purpose of this study was to assess changes in forest owners' preferences regarding indicators of sustainable forest management. The analysis and deliberation framework served as a platform upon which to explore these changes in a rural community in Puebla, Mexico. Sixty-two indicators were selected from existing sets to design a five-point Likert survey instrument. The instrument was administered three times: early in the study to capture the forest owners' preferences before intervention (baseline); following an educational meeting in which the participants learned of three alternative forest management plans (analysis); and following a community meeting in which the forest owners deliberated to choose one of the alternatives (deliberation). As forest owners were exposed to knowledge (analysis) and deliberation, their preferences for the indicators changed significantly. An examination of the instrument demonstrated how the indicators increased or decreased in importance. Social and economic indicators tended to be ranked differently following analysis and again following deliberation because of the commitment to pursue a forest management plan that would benefit the community without jeopardizing stakeholder values. The ecological indicators directly associated with forest structure gained relevance following the analysis meeting. The deliberation process elucidated the importance of forest administration and professional help. Forest owners' preferences were reflected by the selection of the management plan that included good science and accommodated community values. The forest owners changed their preferences in response to new knowledge, management objectives, and their commitment to safeguarding the future condition of the forest. Analysis and deliberation is a participatory forum that facilities communication and learning and allows stakeholders to share values; thus, it serves as a mechanism for forest planning. Copyright © 2013 Elsevier Ltd. All

  16. A study on the degree of deliberation and meditation of cyber poll respondents for nuclear-related decision making

    Energy Technology Data Exchange (ETDEWEB)

    Park, Moon Soo [Department of Nuclear Engineering, Seoul National University, San 56-1 Shilim-dong, Gwanak-gu, Seoul 151-742 (Korea, Republic of)]. E-mail: insrec1@freechal.com; Moon, Joo Hyun [Department of Nuclear Engineering, Seoul National University, San 56-1 Shilim-dong, Gwanak-gu, Seoul 151-742 (Korea, Republic of); Kang, Chang Sun [Department of Nuclear Engineering, Seoul National University, San 56-1 Shilim-dong, Gwanak-gu, Seoul 151-742 (Korea, Republic of)

    2006-01-15

    Public participation is essential in each step of the nuclear-related decision-making process. Recently, the electronic systems using the Internet have become quite popular, and have emerged as a good medium for communicating with the public. In this study, a comprehensive utilization of electronic public participation was used to analyze public opinion on a given nuclear-related decision-making process. The degree of deliberation and meditation of the public participating in an electronic poll survey was evaluated, and the decision-making factors representing the personal characteristics of the poll respondents such as age, income, education, residence, degree of knowledge and concern were carefully incorporated when preparing the poll-survey questionnaire for its evaluation. Fuzzy analysis was used to assess and aggregate the responses to each decision-making factor. As a case study, this procedure was used to analyzing public opinion on the location of a low-level radioactive waste disposal facility on the campus of Seoul National University. The results show that there is a tendency of respondents who are on the negative side of the argument to be more deliberate and meditative in their decision-making process than those on the positive side. Knowledge and residence were found to be important decision-making factors.

  17. Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders.

    Science.gov (United States)

    Burden, Amanda R; Pukenas, Erin W; Deal, Edward R; Coursin, Douglas B; Dodson, Gregory M; Staman, Gregory W; Gratz, Irwin; Torjman, Marc C

    2014-09-01

    Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6 months after the initial assessment. At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n  =  26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P  =  .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P benefit of the SIM sessions.

  18. Natural or deliberate outbreak in Pakistan: how to prevent or detect and trace its origin: biosecurity, surveillance, forensics.

    Science.gov (United States)

    Shinwari, Zabta Khan; Khalil, Ali Talha; Nasim, Anwar

    2014-08-01

    Over the last few decades biosecurity and biosafety have emerged as a prominent public health concern due to some high-profile accidents. Effective strategies to deal with the outbreak, whether deliberate or non-deliberate requires a multidisciplinary approach and coordinated decision-making by various state departments such as health, forensics, agriculture, environment, intelligence, law and enforcement, etc. In a dynamic global environment and the overwhelming asymmetric threats from the non-state actors, it is of utmost importance to understand the biosecurity issues and initiate a coordinated global effort to cope with biosecurity and biosafety breaches and develop an as effective response mechanism. An attractive choice for the terrorists, state enemies and non-state actors is the use of biological weapons. An unwanted incident may not only bring chaos to the people, but also can inflict severe economic damage industrially and locally as was in the notorious foot-and-mouth disease outbreak. Because of special geopolitical compulsion, Pakistan is one of the hot spots where special action needs to be taken. The current review focuses on the various approaches, technologies that can be used to alleviate the chances of biosafety and biosecurity incident and emphasizes the role of modern technology that can be used in this regard.

  19. The effectiveness of the Geritalk communication skills course: a real-time assessment of skill acquisition and deliberate practice.

    Science.gov (United States)

    Gelfman, Laura P; Lindenberger, Elizabeth; Fernandez, Helen; Goldberg, Gabrielle R; Lim, Betty B; Litrivis, Evgenia; O'Neill, Lynn; Smith, Cardinale B; Kelley, Amy S

    2014-10-01

    Communication skills are critical in Geriatrics and Palliative Medicine because these patients confront complex clinical scenarios. We evaluated the effectiveness of the Geritalk communication skills course by comparing pre- and post-course real-time assessment of the participants leading family meetings. We also evaluated the participants' sustained skills practice. We compare the participants' skill acquisition before and after Geritalk using a direct observation Family Meeting Communication Assessment Tool and assess their deliberate practice at follow-up. First-year Geriatrics or Palliative Medicine fellows at Mount Sinai Medical Center and the James J. Peters Bronx VA Medical Center participated in Geritalk. Pre- and post-course family meeting assessments were compared. An average net gain of 6.8 skills represented a greater than 20% improvement in use of applicable skills. At two month follow-up, most participants reported deliberate practice of fundamental and advanced skills. This intensive training and family meeting assessment offers evidence-based communication skills training. Published by Elsevier Inc.

  20. The impact of psychological illness on outcome of corrosive ...

    African Journals Online (AJOL)

    2012-02-22

    Feb 22, 2012 ... Key words: Corrosive, deliberate self harm, outcome. Date of Acceptance: ... Nigeria is currently going through a very stressful period in her history, with high ... accidentally among which 60% were children. He also reported ...