Does involuntary outpatient commitment lead to more intensive treatment?

Studies of involuntary outpatient commitment (OPC) among persons with severe mental illness have concluded that OPC is only effective in improving treatment outcomes when it is sustained for 6 months or longer and is combined with frequent outpatient services. This article explores factors that influence the delivery of outpatient services to subjects in a randomized trial of OPC and finds 2 general patterns. Outpatient visits were more frequent among all subjects with apparent clinical need, regardless of study assignment, and among subjects whose OPC was sustained beyond an initial court order. These results suggest that, in practice, sustained OPC represents a consensual agreement between clinicians and the court to more intensively address the complex needs of persons with severe and persistent mental illness.     

Preventing violence and trauma in the next generation

Research in recent times has clearly demonstrated that violence is predictable and preventable; however, the primary prevention of abusive and violent behavior will not occur without personal, interpersonal, and social change. This article reviews the empirical research supporting hypotheses for primary prevention of many risks associated with children becoming abusive.     

Clothing damage analysis in alleged sexual assaults--the need for a systematic approach

Clothing damage analysis is an integral part of the examinations carried out in sexual assault type cases. This analysis can be used to corroborate different versions of events and is at its most powerful in elucidating false allegation cases and consent cases. The purpose of this study was to determine to what extent people with varying levels of forensic awareness, experience and training could correctly carry out damage analysis. Two participant groups were asked to take part in this study. Group A ('forensic group') comprised participants at a forensic science conference, and Group B ('student group') comprised students undertaking a degree course in Forensic Science. Each group was given a practical workshop consisting of a lecture outlining common fabric types and general features observed in different damage types. Each participant was subsequently shown 25 pieces of 'damage' and asked to identify both the type of fabric construction (knit or weave) and the type of damage (cut, tear, rip, wear and tear). The ability to identify fabric construction and damage types varied within the two groups studied and across the groups. The forensic group performed better both in fabric and damage assessment than the student group. This paper suggests a systematic approach to clothing damage analysis to maximise the benefits that can be obtained from this area of forensic science and to minimise the subjectivity within the field.     

Trust in the clouds

The “cloud” is not new, and its roots go back to the original plans for computing from the 1950s. Now that computing is moving back to the original cloud-based models that were envisioned more than 60 years ago, with it, consumers are realizing the increases in security and safety that accompany the move to centralized servers. Yet the perception of “trust” in this context is often still formed by views that people have from their use of computers over the past two decades, which is localized in nature (“if I can see it, I can control it”). This view is based on perception more than fact. Our paper discusses different views of trust in other contexts (such as banking and travel) and concludes that users of cloud computing should recast their view of trust in a similar way that consumers of banking and travel have changed their perceptions of trust in the last 100 years.     

Withdrawal of life-sustaining treatment from a patient in a minimally conscious state

This column reports on a recent decision, the first in England in which a court was asked to authorise the withdrawal of artificial nutrition and hydration from a patient in a "minimally conscious state". Since the seminal decision in 1993 in Airedale NHS Trust v Bland [1993] AC 789, in which the House of Lords authorised withdrawal of artificial nutrition and hydration from a patient in a persistent vegetative state, the relatively new diagnosis of a "minimally conscious state" has been recognised. In deciding whether it was in the patient's best interests that artificial nutrition and hydration be withdrawn and withheld, the court made a key legal determination, with precedential effect, as to whether the so-called "balance sheet" approach to determining a patient's best interests, as opposed to the (discredited) "futility" principle, applies to a patient in a minimally conscious state. The merit of the former approach is that it forces explicit consideration of quality-of-life assessments in favour of and against withdrawing life-sustaining treatment. A significant pitfall of the English position, as it is currently developing, is the premium it places on accurate diagnosis, whether of vegetative state or minimally conscious state. These issues will have to be faced sooner or later by Australasian courts.     

Secondary missile injury from lightning strike

A 48-year-old-woman was struck dead by lightning on October 24, 2010, in Pretoria, South Africa. The cause of death was due to direct lightning strike. Examination showed secondary missile injury on her legs. This secondary missile (shrapnel) injury was caused by the lightning striking the concrete pavement next to her. Small pieces of concrete were located embedded within the shrapnel wounds. This case report represents the first documented case of secondary missile formation (shrapnel injury) due to lightning strike in the literature.     

Does Self-Control Influence Maternal Attachment? A Reciprocal Effects Analysis from Early Childhood Through Middle Adolescence

Objectives

The purpose of this study is twofold. First, this study assesses the extent to which self-control and maternal attachment mutually influence one another. Second, it investigates whether this process continues to occur during adolescence. To date, studies of the etiology of self-control have yet to adequately address these issues, despite the fact that a number of theoretical perspectives emphasize the reciprocal nature of the parent-child relationship.

Methods

The current study seeks to shed light on these issues by examining the relationship between self-control and maternal attachment using structural equation modeling for eight waves of data spanning a period of time that encompasses early childhood through middle adolescence.

Results

The results yield two findings bearing on the adequacy of Gottfredson and Hirschi??s model of self-control development. First, measures of self-control and maternal attachment were found to mutually influence one another during childhood. Second, these effects were reduced to nonsignificance during adolescence.

Conclusions

This study finds that self-control emerges during childhood in a complex manner in which it both shapes and is shaped by parental attachment.     

Physical Health in Preschool Children Exposed to Intimate Partner Violence

Exposure to violence and traumatic events during childhood has long been associated with poor physical and psychological health during adulthood. Very few studies, however, have taken steps to understand the immediate relationship between exposure to intimate partner violence (IPV) and physical health problems in young children. In this study, we examined the mother-reported physical health problems of 102 preschool-age children who have been exposed to IPV. We found that children exhibiting more traumatic stress symptoms displayed fewer total health problems; however, gastrointestinal problems and asthma were related to poor psychological adjustment. We also found that preschool-age girls were more likely to display health problems than boys. Future studies of the physical health consequences of exposure to IPV in young children would benefit from examinations of specific changes in physiological processes to draw conclusions about the effects of violence on immune system functioning and physical health.