Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event

OBJECTIVE: Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS: In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children’s hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS: We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS: We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.

For Honor, for Toxicity

Is it possible to detect toxicity in games just by observing in-game behavior? If so, what are the behavioral factors that will help machine learning to discover the unknown relationship between gameplay and toxic behavior? In this initial study, we examine whether it is possible to predict toxicity in the MOBA gameFor Honor by observing in-game behavior for players that have been labeled as toxic (i.e. players that have been sanctioned by Ubisoft community managers). We test our hypothesis of detecting toxicity through gameplay with a dataset of almost 1,800 sanctioned players, and comparing these sanctioned players with unsanctioned players. Sanctioned players are defined by their toxic action type (offensive behavior vs. unfair advantage) and degree of severity (warned vs. banned). Our findings, based on supervised learning with random forests, suggest that it is not only possible to behaviorally distinguish sanctioned from unsanctioned players based on selected features of gameplay; it is also possible to predict both the sanction severity (warned vs. banned) and the sanction type (offensive behavior vs. unfair advantage). In particular, all random forest models predict toxicity, its severity, and type, with an accuracy of at least 82%, on average, on unseen players. This research shows that observing in-game behavior can support the work of community managers in moderating and possibly containing the burden of toxic behavior.

Is There Such a Thing as a Hate Crime Paradigm? An Integrative Review of Bias-Motivated Violent Victimization and Offending, Its Effects and Underlying Mechanisms

Despite the growing number of bias-motivated violence studies, the evidence available remains limited, and there are several gaps in our understanding of the complex relationship between negative attitudes and biased violence. In addition, the literature on this topic has many facets and nuances and is often contradictory, so it is difficult to obtain a clear overall picture. Research has made good progress in this area, but it still suffers from a lack of systematization and from a highly segmented approach to victimization and offending. To contribute to a more comprehensive understanding of the subject, this integrative narrative review provides a critical reappraisal of the theoretical, methodological, and empirical research from a systemic perspective. To this end, 134 academic publications on personality and social psychology, clinical psychology, sociology, criminology, and related disciplines were examined. The evidence suggests that although bias-motivated violence shares characteristics with other types of offensive behavior, it is actually a unique phenomenon due to its background rooted in prejudice, identity, and attitudes in which the intersection of individual, psychosocial, and ecological factors is especially relevant. The impact on the victim and their community is diverse, but it has a series of distinctive severe psychological consequences that significantly reduce the probability that incidents will be reported. Here, we present a series of findings and reflections on bias-motivated violence and provide recommendations for research, practice, and policy.

Offensive Behavior, Striatal Glutamate Metabolites, and Limbic–Hypothalamic–Pituitary–Adrenal Responses to Stress in Chronic Anxiety

Variations in anxiety-related behavior are associated with individual allostatic set-points in chronically stressed rats. Actively offensive rats with the externalizing indicators of sniffling and climbing the stimulus and material tearing during 10 days of predator scent stress had reduced plasma corticosterone, increased striatal glutamate metabolites, and increased adrenal 11-dehydrocorticosterone content compared to passively defensive rats with the internalizing indicators of freezing and grooming, as well as to controls without any behavioral changes. These findings suggest that rats that display active offensive activity in response to stress develop anxiety associated with decreased allostatic set-points and increased resistance to stress.

Isn’t high school bad enough already? Rates of gender harassment and institutional betrayal in high school and their association with trauma-related symptoms

Germinal studies have described the prevalence of sex-based harassment in high schools and its associations with adverse outcomes in adolescents. Studies have focused on students, with little attention given to the actions of high schools themselves. Though journalists responded to the #MeToo movement by reporting on schools’ betrayal of students who report misconduct, this topic remains understudied by researchers. Gender harassment is characterized by sexist remarks, sexually crude or offensive behavior, gender policing, work-family policing, and infantilization. Institutional betrayal is characterized by the failure of an institution, such as a school, to protect individuals dependent on the institution. We investigated high school gender harassment and institutional betrayal reported retrospectively by 535 current undergraduates. Our primary aim was to investigate whether institutional betrayal moderates the relationship between high school gender harassment and current trauma symptoms. In our pre-registered hypotheses (https://osf.io/3ds8k), we predicted that (1) high school gender harassment would be associated with more current trauma symptoms and (2) institutional betrayal would moderate this relationship such that high levels of institutional betrayal would be associated with a stronger association between high school gender harassment and current trauma symptoms. Consistent with our first hypothesis, high school gender harassment significantly predicted college trauma-related symptoms. An equation that included participant gender, race, age, high school gender harassment, institutional betrayal, and the interaction of gender harassment and institutional betrayal also significantly predicted trauma-related symptoms. Contrary to our second hypothesis, the interaction term was non-significant. However, institutional betrayal predicted unique variance in current trauma symptoms above and beyond the other variables. These findings indicate that both high school gender harassment and high school institutional betrayal are independently associated with trauma symptoms, suggesting that intervention should target both phenomena.

Perinatal fluoxetine treatment and dams’ early life stress history have opposite effects on aggressive behavior while having little impact on sexual behavior of male rat offspring

Rationale Many depressed women continue antidepressant treatment during pregnancy. Selective serotonin reuptake inhibitor (SSRI) treatment during pregnancy increases the risk for abnormal social development of the child, including increased aggressive or defiant behavior, with unknown effects on sexual behavior. Objectives Our aim was to investigate the effects of perinatal SSRI treatment and maternal depression, both separately and combined, on aggressive and sexual behavior in male rat offspring. Methods Heterozygous serotonin transporter (SERT± ) knockout dams exposed to early life stress (ELSD) were used as an animal model of maternal depression. Early life stress consisted of separating litters from their mother for 6 h a day on postnatal day (PND)2–15, resulting in a depressive-like phenotype in adulthood. Depressive-like dams were treated with fluoxetine (FLX, 10 mg/kg) or vehicle throughout pregnancy and lactation (gestational day 1 until PND 21). Male offspring were tested for aggressive and sexual behavior in adulthood. As lifelong reductions in SERT expression are known to alter behavioral outcome, offspring with normal (SERT+/+) and reduced (SERT± ) SERT expression were assessed. Results Perinatal FLX treatment reduced offensive behavior and the number of animals attacking and increased the latency to attack, especially in SERT+/+ offspring. Perinatal FLX treatment reduced the mounting frequency in SERT+/+ offspring. ELSD increased offensive behavior, without affecting sexual behavior in SERT± offspring. Conclusions Overall, our research demonstrates that perinatal FLX treatment and ELSD have opposite effects on aggressive behavior, with little impact on sexual behavior of male offspring.

A pragmatic view of hashtags: the case of impoliteness and offensive verbal behavior in the Brazilian Twitter

Studies on impoliteness have encompassed a wide range of social relations and scenarios, including some in which the means for achieving impoliteness is solely, or at least, more saliently linguistic. Among these scenarios, Digital Communication (DC) media, such as Twitter and blogs may incite linguistic manifestations of impoliteness. Since hashtags are ubiquitous in the interpersonal spaces of Twitter, the aim of this study is to investigate how hashtags were used to express offensive behavior and to convey impoliteness in the Brazilian Twitter. We compiled a corpus of 512 hashtags extracted from Brazilian Twitter in 2017 and 2018. Hashtags were manually collected from Twitter ‘trending topics’, and from 3 media sources, written in Brazilian Portuguese. Hashtags associated with offense, including derogatory language, taboo words and mockery were analyzed. Our findings suggest that hashtags served as strategies of impoliteness, since they intensified the contents of the tweets and framed the interpretation of verbal aggressiveness. While they did that, they also helped maximize face attacks in that they inscribed the tweets in a bounded communicative sphere of aggressiveness, mockery and derogatory language. Verbal attacks were mainly intended to politicians and to Brazilian public figures in general. While this permissiveness allowed for greater spontaneity and agility in the exchanges, it also encouraged outrageous uses, which would not be otherwise accomplished were it not for the transient and ephemeral framework of DC. This study shed light on the Pragmatics of DC, showing how ‘new’ features of the medium can be used to convey impoliteness.

Automated Elephant Entry Prevention for Human and Crop Protection

Farming in areas with elephants has been the norm in many parts of Asia for thousands of years. In particular, farmers have settled closer to areas where elephants are present and started growing crops. Elephant raids occur in the night time where people do not notice the presence of an elephant until it starts an offensive behavior. Such raids damage the crops, harvest storages and homes in addition to causing deaths of humans. A multitude of traditional methods have been developed through the ages to reduce and prevent crop raiding by elephants like shouting, drum-beating, noise-making, use of fire crackers, electric fencing, lights and torches. Such activities may also indicate to elephants that their presence is detected, and that they have to contend with aggressive humans. In the proposed system, automated detection of the presence of elephant is done by analyzing the infrasonic sounds produced by elephants and they are prevented from entering into farms by propagating the offensive sounds in low frequencies without human intervention.

As relações de paz e guerra entre Peru e Equador no contexto do complexo de segurança regional / The relations of peace and war between Peru and Ecuador in the context of regional security complex

O presente estudo procura analisar os acontecimentos centrais relativos à Guerra do Cenepa ocorrida em 1995 na fronteira entre Peru e Equador, situando a mesma no contexto da segurança regional do complexo americano. Argumentamos que a Guerra do Cenepa produziu três resultados básicos: apontou para a existência de uma balança de poder entre os dois países; não gerou nenhuma alteração substancial no conteúdo do tratado firmado anteriormente sobre a fronteira na base do Rio Cenepa; nem tampouco implicou em transferência de território. Então, como podemos explicar a dinâmica do conflito entre Peru e Equador? A tese central da análise que será aqui empreendida é que, em primeiro lugar, um padrão recorrente de hostilidades favorece um comportamento ofensivo e, em segundo lugar, a certeza sobre a balança de poder favorece as negociações. Como tese subjacente defendemos que a prevalência da hegemonia norte-americana contribuiu para o desenlace do conflito.ABSTRACTThe present study aims to analyze the central events related to the Cenepa War that occurred in 1995 on the border between Peru and Ecuador, into regional security of the American complex. We argue that the Cenepa War produced three basic results: pointed to the existence of a balance of power between the two countries; did not generate any substantial change in the content of the previously signed treaty on the border at the base of the Rio Cenepa; nor did it entail transfer of territory. How can we explain the dynamics of the conflict between Peru and Ecuador? Central thesis of the analysis that will be undertaken here is that, first, a recurrent pattern of hostility favors offensive behavior, and secondly, certainty about the balance of power favors negotiations. As an underlying thesis, we argue that the prevalence of US hegemony contributed to the outcome of the conflict.Palavras-chave: segurança regional; fronteira; conflito. Keywords: regional security; border; conflict.Recebido em 26 de Julho de 2016 | Aceito em 07 de Agosto de 2017Received on July 26, 2016 | Accepted on August 7, 2017DOI: 10.12957/rmi.2016.24824