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Over the past few years, the scale of sensor networks has greatly expanded. This generates extended spatiotemporal datasets, which form a crucial information resource in numerous fields, ranging from sports and healthcare to environmental science and surveillance. Unfortunately, these datasets often contain missing values due to systematic or inadvertent sensor misoperation. This incompleteness hampers the subsequent data analysis, yet addressing these missing observations forms a challenging problem. This is especially the case when both the temporal correlation of timestamps within a single sensor and the spatial correlation between sensors are important. Here, we apply and evaluate 12 imputation methods to complete the missing values in a dataset originating from large-scale environmental monitoring. As part of a large citizen science project, IoT-based microclimate sensors were deployed for six months in 4400 gardens across the region of Flanders, generating 15-min recordings of temperature and soil moisture. Methods based on spatial recovery as well as time-based imputation were evaluated, including Spline Interpolation, MissForest, MICE, MCMC, M-RNN, BRITS, and others. The performance of these imputation methods was evaluated for different proportions of missing data (ranging from 10% to 50%), as well as a realistic missing value scenario. Techniques leveraging the spatial features of the data tend to outperform the time-based methods, with matrix completion techniques providing the best performance. Our results therefore provide a tool to maximize the benefit from costly, large-scale environmental monitoring efforts. [ABSTRACT FROM AUTHOR]

Background: Assisted dying for adults with psychiatric conditions (APC) is highly controversial but legally possible in a few countries, including Belgium. Previous research has suggested that the complex euthanasia assessment procedure may cause additional suffering in APC but may also induce positive experiences. This study reports on the impact of the euthanasia assessment procedure as experienced by APC on three counts: 1) their mental state, including death ideation; 2) their treatment trajectory; 3) their social relationships. Methods: We performed an in-depth qualitative interview study with 16 APC in Flanders, Belgium, who had voiced a euthanasia request between 2016–2020. Thematic coding was used. Findings: We interviewed 16 APC. Euthanasia assessment procedures brought out a plethora of experiences in APC, both favourable and unfavourable. Whereas thoughts of suicide remain present to a certain extent, being in the assessment procedure allows some APC to reconsider alternatives towards life, and also to attempt new treatment options. However, many APC experience ambivalence about the supposedly inherent desirability and dignity in euthanasia. Worries also surfaced about the rationale behind and effects of involvement of APCs' social circle, and about the impact it could have on them. Conclusion: Further research, including other stakeholder perspectives, is recommended with a view to maximising favourable and minimising unfavourable impacts for all involved. In clinical practice attention to these impacts is paramount, and clear communication and management of expectations between physician and patient, seems appropriate to address the many ambivalent experiences that accompany APC during the euthanasia assessment procedure. Policy attention could in this regard go to clarifying certain sources of ambivalence and issues that are insufficiently addressed, such as modalities of relatives' involvement. [ABSTRACT FROM AUTHOR]

Background: Although the Belgian assessment pathway for legal euthanasia requires the engagement of at least one psychiatrist, little is known about psychiatrists' attitudes towards euthanasia for adults with psychiatric conditions (APC). This study aims to gauge psychiatrists' attitudes towards and readiness to engage in euthanasia assessment and/or performance procedures in APC. Methods: This cross-sectional survey study was performed between November 2018 and April 2019. The survey was sent to a sample of 499 eligible psychiatrists affiliated to the Flemish Association for Psychiatry, a professional association that aims to unite and represent all psychiatrists working in Flanders, the Dutch-speaking, northern part of Belgium. The Association's members comprise an estimated 80–90% of all psychiatrists active in Flanders. Only psychiatrists working with APC (83% of the association's total membership) were included. Factorial Anova and Chi Square tests were performed to examine if and to what extent psychiatrists' backgrounds were associated with, respectively, their attitudes and their readiness to play a role in euthanasia procedures concerning APC. Results: One hundred eighty-four psychiatrists completed the questionnaire (response rate 40.2%); 74.5% agree that euthanasia should remain permissible for APC. However, 68.9% question some of the approaches taken by other physicians during the euthanasia assessment and only half consider euthanasia assessment procedures compatible with the psychiatric care relationship. Where active engagement is concerned, an informal referral (68%) or preliminary advisory role (43.8%) is preferred to a formal role as a legally required advising physician (30.3%), let alone as performing physician (< 10%). Conclusion: Although three quarters agree with maintaining the legal option of euthanasia for APC, their readiness to take a formal role in euthanasia procedures appears to be limited. More insight is required into the barriers preventing engagement and what psychiatrists need, be it education or clarification of the legal requirements, to ensure that patients can have their euthanasia requests assessed adequately. [ABSTRACT FROM AUTHOR]

Heritage organizations in Flanders started using thesauri fairly recently compared to other countries. This paper starts with examining the historical use of thesauri and controlled vocabularies in computer systems by the Flemish Government dealing with immovable cultural heritage. Their evolution from simple, flat, controlled lists to actual thesauri with scope notes, hierarchical and equivalence relations and links to other thesauri will be discussed. An explanation will be provided for the evolution in our approach to controlled vocabularies and how they radically changed querying and the way data is indexed in our systems. Technical challenges inherent to complex thesauri and how to overcome them will be outlined. These issues being solved, thesauri have become an eessential feature of the Flanders Heritage inventory management system. The number of vocabularies rose over the years and became an essential tool for integrating heritage from different disciplines. As a final improvement, thesauri went from being a core part of one application (the inventory management system) to forming an essential part of a new general resource oriented system architecture for Flanders Heritage influenced by Linked Data. For this purpose, a generic SKOS based editor was created. Due to the SKOS model being generic enough to be used outside of Flanders Heritage, the decision was made early on to develop this editor as an open source project called Atramhasis and share it with the larger heritage world. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate attitudes towards physician-assisted death in minors among all physicians involved in the treatment of children dying in Flanders, Belgium over an 18-month period, and how these are related to actual medical end-of-life practices. DESIGN: Anonymous population-based postmortem physician survey. SETTING: Flanders, Belgium. PARTICIPANTS: Physicians signing death certificates of all patients aged 1–17 years who died between June 2007 and November 2008. MAIN OUTCOME MEASURES: Attitudes towards physician-assisted death in minors and actual end-of-life practices in the deaths concerned. RESULTS: 124 physicians for 70.5% of eligible cases (N=149) responded. 69% favour an extension of the Belgian law on euthanasia to include minors, 26.6% think this should be done by establishing clear age limits and 61% think parental consent is required before taking life-shortening decisions. Cluster analysis yielded a cluster (67.7% of physicians) accepting of, and a cluster (32.2% of physicians) reluctant towards physician-assisted death in minors. Controlling for physician specialty and patient characteristics, acceptant physicians were more likely to engage in practices with the intention of shortening a patient's life than were reluctant physicians. CONCLUSION: A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group. [ABSTRACT FROM AUTHOR]

This paper presents the experiences and interpretations of children, parents, teachers and support persons concerning the implementation of supports in regular school environments in Flanders, Belgium. The data were gathered through observations, interviews and focus group meetings. Those multiple perspectives provide insights into the complexity of implementing supports in a regular education context. The conclusions offer some possibilities for debate and alternative ways of thinking about supports that facilitate inclusive school communities by tapping into resources such as the children, the environment, creativity and courage to leave the beaten path. [ABSTRACT FROM AUTHOR]

Background: Belgium's law on euthanasia allows only physicians to perform the act. We investigated the involvement of nurses in the decision- making and in the preparation and administration of life-ending drugs with a patient's explicit request (euthanasia) or without an explicit request. We also examined factors associated with these deaths. Methods: In 2007, we surveyed 1678 nurses who, in an earlier survey, had reported caring for one or more patients who received a potential life-ending decision within the year before the survey. Eligible nurses were surveyed about their most recent case. Results: The response rate was 76%. Overall, 128 nurses reported having cared for a patient who received euthanasia and 120 for a patient who received life-ending drugs without his or her explicit request. Respectively, 64% (75/117) and 69% (81/118) of these nurses were involved in the physician's decision-making process. More often this entailed an ex change of information on the patient's condition or the patient's or relatives' wishes (45% [34/117] and 51% [41/118]) than sharing in the decision-making (24% [18/117] and 31% [25/118]). The life-ending drugs were administered by the nurse in 12% of the cases of euthanasia, as compared with 45% of the cases of assisted death without an explicit re quest. In both types of assisted death, the nurses acted on the physician's orders but mostly in the physician's absence. Factors significantly associated with a nurse administering the life- ending drugs included being a male nurse working in a hospital (odds ratio [OR] 40.07, 95% confidence interval [CI] 7.37-217.79) and the patient being over 80 years old (OR 5.57, 95% CI 1.98-15.70). Interpretation: By administering the life-ending drugs in some of the cases of euthanasia, and in almost half of the cases without an explicit request from the patient, the nurses in our study operated beyond the legal margins of their profession. [ABSTRACT FROM AUTHOR]

Background: Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. Methods: We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. Results: The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient's explicit re quest, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. Interpretation: Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects. [ABSTRACT FROM AUTHOR]

The article presents a study on the evolution of continuous deep sedation until death in Flanders, Belgium between 2001 and 2007. The study sent questionnaires to the reporting physicians of death certificate samples, dated between June 1 and November 30, 2007, from the Flemish Agency for Care and Health. Results show that total prevalence of deep sedation until death increased from 8.2% in 2001 to 14.5% in 2007, and that 83% of the sedation practices used opioids.

We investigated on a nationwide level the attitudes of nurses towards end-of-life decisions (ELDs) that may hasten death and towards their role in those decisions. We took a representative random sample of 6000 nurses in Flanders, Belgium. Response rate was 62.5%. Most nurses agreed with the practice of withholding/withdrawing potentially life-prolonging treatments (93%), with decisions to alleviate symptoms with possible life-shortening side effects (96%) and with the practice of euthanasia (92%). Their support for the different decisions existed regardless of whether they had cared for terminally ill patients or not. Most nurses also thought that they have an important role to play especially in the ELD-making process. Nurses' views on their proper role in the administration of drugs in euthanasia and continuous deep sedation showed a large dispersal. Overall, nurses' work setting determines their opinions on nurses' role in ELDs. In conclusion, nurses accept a wide variety of ELDs being practiced with terminally ill patients. [ABSTRACT FROM AUTHOR]

This article examines the experience of inclusive education from the perspective of disabled children. We worked with the observations of, and interviews with, 15 children, aged 5–17 who go to a mainstream school. The study is set in the context of a 3-year research project exploring the practice of inclusive education in Flanders. Here, we report on the key findings from the children’s accounts, focusing on what they had to say about themselves, what they think about school, friends, support and their future prospects. [ABSTRACT FROM AUTHOR]

Steel production is an energy- and water-intensive process: large quantities of water are used for cooling, process and environmental-technical applications. In the mid-1990s, Arcelor Gent, a large integrated carbon steel producing company in Flanders (Belgium), started a number of water-related projects: the existing water infrastructure was adapted: the water from the coke plant was biologically treated; canal water was demineralised using reverse osmosis; waste water from the blast furnaces was neutralised with alkaline water from the steel plant. As a result of these projects, the quantity of discharged waste water was reduced by a factor of 2 (water recycling doubled from a factor of 10 to a factor of 20), and the discharge of pollutants decreased. Also resource consumption decreased: lime used in the steel plant, could be recovered to precipitate Zn in the waste water of the blast furnaces. [ABSTRACT FROM AUTHOR]

SummaryBackground: Our study is a repeat of the Dutch death-certificate study on end-of-life decisions (ELDs). The main objective was to estimate the frequency of euthanasia (the administration of lethal drugs with the explicit intention of shortening the patient's life at the patient's explicit request), physician-assisted suicide (PAS), and other ELDs in medical practice in Flanders, Belgium.Methods: A 20% random sample of 3999 deaths was selected from all deaths recorded between Jan 1 and April 30, 1998. The physicians who signed the corresponding death certificates received one questionnaire by post per death.Findings: The physicians' response rate was 1355 (52%). 1925 deaths were described. The results were corrected for non-response bias, and extrapolated to estimated annual rates after seasonal adjustment for death causes, and we estimate that 705 (1.3%, 95% CI 1.0-1.6) deaths resulted from euthanasia or PAS. In 1796 (3.2%, 2.7-3.8) cases, lethal drugs were given without the explicit request of the patient. Alleviation of pain and symptoms with opioids in doses with a potential life-shortening effect preceded death in 10416 (18.5%, 17.3-19.7) cases and non-treatment decisions in 9218 (16.4%, 15.3-17.5) cases, of which 3261 (5.8%, 5.1-6.5) with the explicit intention of ending the patient's life.Interpretation: ELDs are prominent in medical practice in Flanders. The frequency of deaths preceded by an ELD is similar to that in the Netherlands, but lower than that in Australia. However, in Flanders the rate of administration of lethal drugs to patients without their explicit request is similar to Australia, and significantly higher than that in the Netherlands. [ABSTRACT FROM AUTHOR]

The identification of all people with a diagnosis of Prader-Willi syndrome (PWS) confirmed by DNA methylation analysis living in Flanders was attempted through contact with the four genetic centres and the PWS Association. The birth incidence for the period 1993-2001 was 1:26?676, the minimum prevalence at 31 December 2001 was 1:76?574. A decreasing number of cases with age was found, which can be explained by a number of missing cases in the older population, a higher neonatal mortality in the past and an increasing mortality with age. Childhood death is usually sudden and associated with respiratory infection and high temperature, while the cause of death in adults is considered to be circulatory or respiratory in origin.European Journal of Human Genetics (2004) 12, 238-240. doi:10.1038/sj.ejhg.5201135 Published online 17 December 2003 [ABSTRACT FROM AUTHOR]

This article focuses on a study on the rate at which physicians in Flanders, Belgium report euthanasia cases to the Federal Control and Evaluation Committee. In 2007, the estimated reporting rate for euthanasia in Flanders is 52.8%. Under Belgian law, physicians are required to report each euthanasia case to the committee to provide societal control over this practice. Results showed that there were 1,040 cases of euthanasia in 2007, with an incidence rate of 1.9% of all deaths. It also found that there was a lack of written request for euthanasia.

To examine the prevalence of 12-month mood disorders and receipt of mental health treatment among a volunteer sample of higher education students during the 2nd and 3rd COVID-19 wave in the Flanders region. Web-based self-report surveys were obtained from 9101 students in higher education in the Flemish College Surveys (FLeCS) in Flanders, Belgium. As part of the World Health Organization's World Mental Health–International College Student Initiative, we screened for 12-month mood disorders (major depressive episode (MDE), mania/hypomania), and service use. We used poststratification weights to generate population-representative data on key socio-demographic characteristics. 50.6% of the respondents screened positive for 12-month mood disorders (46.8% MDE, of which 22.9% with very severe impact). Use of services was very low, with estimates of 35.4% for MDE, 31.7% for mania, and 25.5% for hypomania. Even among students with very severe disorders, treatment rates were never higher than 48.3%. Most common barriers for not using services were: the preference to handle the problem alone (83.4%) and not knowing where to seek professional help (79.8%). We found a high unmet need for mood problems among college students; though caution is needed in interpreting these findings given the volunteer nature of the sample. A reallocation of treatment resources for higher education students should be considered, particulary services that focus on innovative, low-threshold, and scalable interventions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nurses have an important role in caring for terminally ill patients. They are also often involved in euthanasia. However, little is known about their attitudes towards it. Objectives: To investigate on a nationwide level nurses’ attitudes towards euthanasia and towards their role in euthanasia, and the possible relation with their socio-demographic and work-related characteristics. Design and participants: A cross-sectional design was used. In 2007, a questionnaire was mailed to a random sample of 6000 of the registered nurses in Flanders, Belgium. Response rate was 62.5% and after exclusion of nurses who had no experiences in patient care, a sample of 3321 nurses remained. Methods: Attitudes were attained by means of statements. Logistic regression models were fitted for each statement to determine the relation between socio-demographic and work-related characteristics and nurses’ attitudes. Results: Ninety-two percent of nurses accepted euthanasia for terminally ill patients with extreme uncontrollable pain or other distress, 57% accepted using lethal drugs for patients who suffer unbearably and are not capable of making decisions. Seventy percent believed that euthanasia requests would be avoided by the use of optimal palliative care. Ninety percent of nurses thought nurses should be involved in euthanasia decision-making. Although 61% did not agree that administering lethal drugs could be a task nurses are allowed to perform, 43% would be prepared to do so. Religious nurses were less accepting of euthanasia than non-religious nurses. Older nurses believed more in palliative care preventing euthanasia requests and in putting the patient into a coma until death as an alternative to euthanasia. Female and home care nurses were less inclined than male and hospital and nursing home nurses to administer lethal drugs. Conclusions: There is broad support among nurses for euthanasia for terminally ill patients and for their involvement in consultancy in case of euthanasia requests. There is, however, uncertainty about their role in the performance of euthanasia. Guidelines could help to make their role more transparent, taking into account the differences between health care settings. [Copyright &y& Elsevier]

Abstract: Context: Few guidelines have yet been put forth for continuous deep sedation in pediatrics, and empirical data on the use of this practice in minors are rare. Objectives: To estimate the incidence of continuous deep sedation in minor patients (aged 1–17) and describe the characteristics of, and the decision-making process before, continuous deep sedation. Methods: An anonymous population-based postmortem survey was mailed to all physicians signing the death certificates of all patients aged 1–17 years who died between June 2007 and November 2008 in Flanders, Belgium. The questionnaire concerned whether or not continuous deep sedation was used at the end of life and measured characteristics of sedation and the decision-making process preceding it. Results: Response rate was 70.5% (n =165). Of all children, 21.8% had been continuously and deeply sedated at the end of life. Duration of sedation was one week or less in 72.4% of cases, and artificial nutrition and hydration were administered until death in 54.3% of cases. Benzodiazepines were used as the sole drug for sedation in 19.4% of cases, benzodiazepines combined with morphine in 50%, and morphine as the sole drug in 25%. In 23.5% of cases, physicians had the explicit intention, or the concurrent intention, to hasten death. Only 3.0% of patients requested sedation and 6.1% consented. Parents consented in 77.8% of cases and requested sedation in 16.7%. Conclusion: Minor patients were commonly kept in continuous deep sedation or coma until death in Flanders, Belgium. Given the high incidence of the practice and indications that it is often used without involving the patient—and sometimes with a life-shortening intention—the development of specific guidelines for sedation in children might contribute to due care practice. [Copyright &y& Elsevier]