Refusing medical treatment after attempted suicide: rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case

The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of the common law right to refuse medical treatment where a patient is distressed, depressed or actively suicidal. In Australia, a patient's wishes need not be honoured if the patient is not legally competent, if he or she falls within the ambit of the compulsory treatment provisions in the mental health legislation, and possibly also if there is a recognised public interest in preventing suicide which is sufficient to override the patient's choice. This article argues that decisions about whether to give medical treatment despite an apparent refusal should be based solely on a determination of the patient's competence to make their own choice. However, the test for legal competence must take into account the person's agency in making the decision, and decisions which will effectively end the person's life must be shown to be thought through.     

A simple checklist,that is all it takes: a cluster randomized controlled field trial on improving the treatment of suspected terrorists by the police

Journal of Experimental Criminology - When it comes to interviewing suspected terrorists, global evidence points to harsh interrogation procedures, despite the likelihood of false positives. How...     

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis

Objectives

This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons.

Methods

The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program.

Results

When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget.

Conclusions

In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

     

A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects

Objective

In the present randomized controlled trial, the effectiveness of multisystemic therapy (MST) in The Netherlands was examined. Moderator tests were conducted for ethnicity, age and gender.

Methods

The sample consisted of N?=?256 adolescents, referred because of conduct problems, and randomized to MST or treatment as usual (TAU). Assessments (questionnaires and observational ratings) took place before and immediately after the treatment.

Results

MST was more effective than TAU in decreasing externalizing behavior, ODD, CD and property offences, but not for violence. Findings were mixed for adolescents’ and parental cognitions: the MST group, compared to TAU, showed an improvement in parental sense of competence, and a decrease in adolescents’ hostility, but no change in self-esteem and an increase in personal failure. MST was effective for positive dimensions of parenting and associations with prosocial peers, but not for relationships with deviant peers. MST was equally effective for adolescents of different ages and with different ethnicities. However, MST showed larger (and more positive) effects for adolescent cognitions for boys than for girls.

Conclusions

Effects of MST in The Netherlands are generally comparable to the positive findings reported in American and Norwegian trials. MST seems equally effective across age and ethnic minority groups, but some gender moderator effects were found for adolescent cognitions.     

A qualitative analysis of the use of community treatment orders in Saskatchewan

This study examined the opinions of patients who have been placed on a community treatment order (CTO), their relatives, mental health clinicians and representatives of community agencies about the use of CTOs in Saskatchewan. Patients were assessed using indepth interviews, while their relatives, mental health professionals and representatives of community agencies took part in facilitated focus groups. Patients had contradictory feelings about CTOs. Most experienced some degree of coercion while on the orders but many believed that CTOs provided necessary structure in their lives. Clinicians were more consistently positive but recognized the difficult choices in balancing the subject's right to self-determination with the benefits of a treatment order. Family members viewed CTOs as necessary to control a chaotic situation caused by the subject's limited insight.     

Long-term effects of two childhood psychosocial interventions on adolescent delinquency,substance use,and antisocial behavior: a cluster randomized controlled trial

Objectives

Examine the long-term effects of two childhood universal prevention programs on adolescent delinquency, substance use, and antisocial behavior.

Methods

The cluster randomized controlled trial involved 56 schools and 1,675 children in Zurich, Switzerland. Two evidence-based interventions, namely the social-emotional skills program Promoting Alternative Thinking Strategies (PATHS) and the cognitive-behavioral parenting program Triple P, were implemented during the first two years of primary school, at ages 7 and 8 years. Outcomes were measured at ages 13 and 15 years, and included youth self-reports and teacher assessments. Multilevel models were used to account for the clustered nature of the interventions. Effects were estimated with the inclusion of baseline covariates.

Results

Across 13 outcomes related to delinquency, substance use, and antisocial behavior at ages 13 and 15 years, only two non-negligible effects were found. The first was a reduced prevalence of police contacts in the PATHS condition [effect size (ES)?=??0.225). The second was a difference in competent conflict resolution skills in the combined PATHS?+?Triple P condition compared to the context (ES?=?0.259), but in the unexpected direction: participants in the combined treatment appeared to be less competent than their control group peers. All other effects were either statistically non-significant or negligible in size (i.e., ES?<?|0.200|).

Conclusions

Even “evidence-based” interventions may have few long-term effects on delinquency, substance use, and antisocial behavior. Our findings add to the small literature on the long-term effectiveness of early universal prevention in field settings.

     

The use and abuse of the rape treatment center.

The author acknowledges the fact that the new system of managing alleged rape victims via the RTC is superior to the former method. The RTC has performed very well, giving aid and succor to rape victims. However, it appears that the unit has attracted some individuals who are not completely truthful and have given fraudulent accounts to investigators. Methods have been suggested to screen out these persons.     

The effects of a group batterer treatment program: A randomized experiment in Brooklyn

Despite numerous evaluations of batterer treatment programs, most lack sufficient methodological rigor to yield valid answers about the programs' effectiveness. This paper presents results from an experimental evaluation in which 376 adult males convicted of domestic violence were randomly assigned to either a 40-hour batterer treatment program or 40 hours of community service that did not include any therapeutic treatment. We examined both official records and victims' reports of recidivism. Those assigned to the treatment program showed significantly lower recidivism, on the basis of all outcome measures from official records. Although victims' reports also recorded fewer failures among the batterers assigned to the treatment group, the differences in failure rates were not large enough to be statistically significant. Overall results suggest that therapeutic treatment for batterers may reduce domestic violence among convicted batterers who agree to this sentence.     

The impact of reentry court on recidivism: a randomized controlled trial in Harlem,New York

Journal of Experimental Criminology - This randomized controlled trial evaluates the effectiveness of the Harlem Parole Reentry Court, an innovative reentry court model implemented by the Harlem...     

Justifying the use of non-experimental methods and disqualifying the use of randomized controlled trials: challenging folklore in evaluation research in crime and justice

The key limitation of non-experimental evaluation methods is that they require an assumption that all confounding factors related to treatment are identified in the statistical models developed. The key advantage of randomized experiments is that this assumption can be relaxed. In this paper, I describe and explain why this assumption is so critical for non-experiments and why it can be ignored in randomized controlled trials (RCTs). I also challenge what I describe as “folklores” that are used to justify the use of non-randomized studies despite this statistical limitation, and to justify the failure of evaluation researchers in crime and justice to use randomized experiments despite their unique ability to overcome this limitation. I conclude by reinforcing what Joan McCord had argued after a life time of review of evaluations: “(W)henever possible” evaluation studies “should employ random assignment.”     

Effects of prefrontal cortical stimulation on aggressive and antisocial behavior: A double-blind,stratified, randomized,sham-controlled,parallel-group trial

Journal of Experimental Criminology - This study examines the influence of high-definition transcranial direct current stimulation (HD-tDCS) of the prefrontal cortex (PFC) on aggressive behavior...     

WTO体制下艾滋病药物强制许可的合法性探析--兼论我国艾滋病药物强制许可的启动

随着艾滋病在世界的不断蔓延 ,一些发展中国家纷纷启动艾滋病药物的强制许可 ;而一些西方国家及医药公司则反对艾滋病药物的强制许可 ,认为其是非法的。本文以WTO为视野 ,从国际法的角度论证了艾滋病药物强制许可的合法性 ,并提出了艾滋病药物强制许可对我国的借鉴意义     

Effect sizes in the treatment of sexual offenders

This article considers the benefits of sexual offender treatment in terms of the magnitude of the effect size produced by these interventions. Comparisons are made of the effect sizes with those generated by treatment of other offenders, by treatment for mental health problems, and by treatment for physical health problems. In all cases, effect sizes with sexual offenders are comparable to (and in some cases better than) effect sizes for the treatment of the other groups. As a final note, it is suggested that using a harm reduction index to estimate effect sizes for treatment with sexual offenders would produce more meaningful results.     

Attorney views on the use of private agencies for probation supervision and treatment

The exponential rise in probation caseloads has necessitated that some jurisdictions contract with private probation agencies and community-based private treatment providers. Regulations that monitor private providers are ill defined or absent, leaving standards open to broad interpretation. Attorneys in one jurisdiction that used private providers were surveyed to measure their beliefs about private treatment providers for people sentenced to probation. The research found that attorneys supported private provider representatives being present in court to contact defendants and to provide evidence to strengthen probation violations. Private agency reputation and standardized criteria were important to establish qualifications in offering supervision and treatment services.     

房地产分别抵押情形中抵押权优先效力之研讨

我国《物权法》第182条对房地产"视为一同抵押"的规定引起较大争议。抵押权的效力扩张应受到严格限制,《物权法》第182条的立法目的在于保障抵押权的实现,因此,抵押权对于没有设定抵押的财产无优先受偿权,房地产分别抵押时抵押权各得就其抵押财产变价所得价款优先受偿。     

美国企业并购中涉税影响的评介

合理的企业并购战略既重新配置经济中存量资源,促进经济发展,还是企业经营迈向成功的契机。随着我国海内外并购活动的日趋活跃,税收已经成为影响企业并购形式、交易成本等方面的重要因素,但并未引起国内学者的重视。本文主要依据美国《国内税收法典》、《1986年税收改革法案》,简要综述国外学者对美国企业并购中涉税问题的研究成果,阐明税收因素对美国企业并购的重要影响,为我国企业并购提供借鉴,也为国内并购交易的税收法规研究提供新的思路。     

Legitimating drug use: A note on the impact of gang membership and drug sales on the use of illicit drugs

A good deal is known about gang members' involvement as sellers of drugs. We know little, however, about the extent to which gang members are involved in the drug market as users, and about the role that involvement in drug sales plays in the use of drugs. This paper presents data from an 11-city survey of arrestees that includes a substantial number of gang members, to explore the relationship between demographic characteristics such as age and race, gang membership, drug sales, and drug use. In addition, the gang members views' regarding drug use by their associates are explored. The contrast between the drug-using behavior and norms designed to control such behavior is examined in the group context of adolescent gang membership.     

A study on the use of photopolymer reflex plate in the forgery of Chinese seals

This study compares the identifying characteristics between the impressions made with original Chinese seals and photopolymer replicate seals, and between the impressions made with two photopolymer replicate seals that originate from one single negative. Various seal materials common to the Chinese community such as cow's horns and ivory are employed. Other than the common factors such as different incident angle upon imprinting or different degree of inking that constitute the natural variation in impressions, the physical changes of the seal materials with temperature will be considered. This study concludes that photopolymer replicate seal impressions can be differentiated from the originals in respect to print density and stroke morphology, but it is very difficult to differentiate between two photopolymer replicate seal impressions with the same origin. This study also proposes a simple method for the examination of forged Chinese seal impressions.     

Medicolegal system in Greece. A combination of clinical and forensic pathology

At the Annual Meeting of the National Association of Medical Examiners in Chicago, Illinois, in November 1981, Dr. W. Sturner, Chief Medical Examiner of the State of Rhode Island, gave his perspectives as far as clinical forensic medicine and pathology are concerned. This topic, therefore, brought to mind the idea of writing an analysis of the medicolegal system in Greece. This article attempts to show the advantages, problems, and the perspectives of an old-style medicolegal investigation system, existing in Greece since 1910. The clinical aspects of forensic medicine and pathology is exemplified by the presentation of the preliminary results of the study of injuries in traffic accident victims, 1,600 cases examined by the author with the support of other colleagues in Athens, Greece.     

A review of the methodological aspects of aspartic acid racemization analysis for use in forensic science.

Accurate age determination of adult cadavers and human remains is a key requirement in forensic practice. The current morphological methods lack accuracy and precision, require specialist training and are costly. The use of aspartic acid racemization (AAR) in human dentine provides a simple, cost-effective solution and the method can achieve accuracies of +/- 3 years at best. Currently, there are differences in AAR methodology between laboratories which produce different results on the rate of racemization in teeth. These inconsistencies must be resolved if the technique is to be successfully applied to age determinations in forensic cases. This paper reviews the differences in protocol which have been used, discusses how each method will affect the results obtained from AAR analysis and gives recommendations for optimization of the methological protocol as a first step towards international standardization.