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711.
Stephanie R. Penney Lisa Marshall Alexander I. F. Simpson 《The journal of forensic psychiatry & psychology》2018,29(3):368-386
Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue. 相似文献
712.
Miranda warnings are remarkably heterogeneous in their language, length, and content. Past research has focused mostly on individual Miranda warnings. Lacking in generalizability, these studies have limited applicability to both public policy and professional practice. A large-scale survey by R. Rogers et al. [2007b, Law and Human Behavior, 31, 177-192] examined Miranda warnings from across the United States and documented striking differences in the length, content, and reading comprehension. In moving from single jurisdiction studies to nationally representative research, the replication of the Rogers et al. survey is essential. With an additional 385 general Miranda warnings, most of the original findings were confirmed; this replication allows Miranda researchers to use findings based upon nationally-representative warnings for their subsequent research. Beyond reading comprehension, the study makes an original contribution to the understanding of Miranda vocabulary that is often infused with abstruse words and legalistic terms. It provides the first analysis of sentence complexity, which affects both Miranda comprehension and retention. As a result of these analyses, preliminary guidelines are provided for increasing the comprehension and understanding of Miranda warnings. 相似文献
713.
Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research. 相似文献
714.
Kacinko SL Barnes AJ Kim I Moolchan ET Wilson L Cooper GA Reid C Baldwin D Hand CW Huestis MA 《Forensic science international》2004,141(1):41-48
Oral fluid is an interesting alternative matrix for drug testing in many environments, including law enforcement, workplace drug testing, and drug treatment facilities. Performance characteristics of the FDA-cleared, qualitative, Cozart RapiScan Opiate Oral Fluid Drug Testing System (Opiate Cozart RapiScan System or Opiate CRS) were compared to the semi-quantitative Cozart Microplate EIA Opiate Oral Fluid Kit (Opiate ELISA) and to gas chromatography/mass spectrometry (GC/MS). The following oral fluid opiate cutoffs were evaluated: the GC/MS limit of quantification (LOQ) of 2.5 mg/l; 15 microg/l currently used for oral fluid testing in the United Kingdom (UK); 30 microg/l (Opiate CRS cutoff); and 40 microg/l, the proposed Substance Abuse and Mental Health Services Administration (SAMHSA) cutoff. Subjects provided informed consent to participate in this IRB-approved research and resided on the closed research ward throughout the study. Three oral codeine doses of 60 mg/70 kg were administered over a 7-day period. After a 3-week break, subjects received three doses of 120 mg/70 kg within 7 days. Oral fluid specimens (N = 1273) were analyzed for codeine (COD), norcodeine (NCOD), morphine (MOR) and normorphine (NMOR) by GC/MS with an LOQ of 2.5 microg/l for all analytes. MOR and NMOR were not detected in any sample; 26.5% of the specimens were positive for COD and 13.7% for NCOD. Opiate CRS uses a preset, qualitative cutoff of 10 microg/l; this is equivalent to 30 microg/l in undiluted oral fluid as the oral fluid collection process involves a 1:3 dilution with buffer. Sensitivity, specificity, and efficiency of Opiate CRS compared to Opiate ELISA were 98.6, 98.1, and 98.2% at a 30 microg/l cutoff and 99.0, 96.2, and 96.6% at a 40 microg/l cutoff. Compared to the much lower GC/MS LOQ of 2.5 microg/l, sensitivity, specificity and efficiency were 66.8, 99.3 and 90.7%. Increasing the GC/MS cutoff to the current UK level yielded performance characteristics of 81.5% (sensitivity), 99.3% (specificity), and 95.4% (efficiency). Using a GC/MS cutoff identical to the preset Opiate CRS cutoff yielded sensitivity, specificity, and efficiency of 88.5, 99.2, and 97.5%, respectively. At the proposed SAMSHA confirmation cutoff of 40 microg/l, sensitivity increased with little change in specificity and efficiency (91.3% sensitivity, 98.9% specificity, and 97.5% efficiency). Oral fluid is a suitable matrix for detecting drugs of abuse. Opiate CRS, with a 30 microg/l cutoff, is sufficiently sensitive, specific and efficient for oral fluid opiate analysis, performing similarly to Opiate ELISA at the same cutoff, and having performance characteristics >91% when compared to GC/MS at the proposed SAMHSA cutoff. 相似文献
715.
716.
Allen J Mohatt GV Rasmus SM Hazel KL Thomas L Lindley S 《Journal of prevention & intervention in the community》2006,32(1-2):41-59
A collaborative research process engaging Alaska Native communities in the study of protective factors in Alaska Native sobriety and the design of a preventative intervention using its findings is described. Study 1 was discovery oriented qualitative research whose objectives were identification of protective factors and development of a heuristic model. Study 2 involved quantitative survey methods to develop and test ameasure of protective factors identified by the qualitative study. Empirical data from these studies is presented, and the role of Alaska Native co-researchers who did not possess specialist research training is described in the design and implementation of the study, interpretation of findings, and design of the intervention model and tools. Benefits that emerged from co-researcher involvement in this process, to the community and to the co-researchers themselves, are described. 相似文献
717.
Elder abuse and neglect refers to an act or omission resulting in harm, including death, or threatened harm to the health or welfare of an elderly person. Between one and two million elderly Americans experience some form of mistreatment annually. A ten-year (1992-2001) retrospective case review of morbidity and mortality among elders (age > 60 years) was conducted at a State Medical Examiner's Office serving a major metropolitan region in Kentucky and Indiana. This study addresses cases of two categories: 1) medicolegal autopsies and 2) examinations of living subjects pursuant to a Clinical Forensic Medicine Program. The authors present 74 postmortem cases, in which 52 deaths were attributed to a homicidal act and 22 deaths were suspicious for neglect. Of the 22 living victims of elder abuse and neglect, 19 cases constituted physical and/or sexual assault and three individuals suffered from neglect. This study summarizes the characteristic features of elder abuse in both postmortem and living cases and underscores the necessity for multi-agency collaboration in order to reach an accurate conclusion in case work. Policies established by a well-established elder abuse task force promote the collaborative interaction necessary to formulate criteria for prevention of abuse and death within this vulnerable population. 相似文献
718.
Rannefeld L 《Journal of law and health》2004,19(1):75-105
This article examines the problems currently associated with the practice of telemedicine and suggests that the best solution for this particular field of medicine is a national standard of care. This article also suggests that the Food and Drug Administration's (FDA) current functions are easily expandable to the telemedicine context; therefore, the agency should regulate the implementation of such a standard in the telemedicine field. This article proposes that the FDA use medical practice guidelines in developing the applicable standard. Other agencies, such as the American Medical Association (AMA) and other website alliances, could also aid the FDA in implementing this standard because of their experience in setting such guidelines for the traditional medical context. Finally, this article suggests that in implementing the national standard of care, the FDA should increase the standard of care that telephysicians, as compared to traditional physicians, owe their patients because of the risks associated with treating patients in the absence of hands-on consultations. By implementing a national standard of care, problems currently associated with telemedicine will be resolved, and physicians and patients will have more confidence in telemedicine. 相似文献
719.
Carvalho M Anjos MJ Andrade L Lopes V Santos MV Gamero JJ Corte Real F Vide MC 《Forensic science international》2003,134(1):29-35
The Y-chromosome haplotypes defined by nine STRs (DYS19, DYS385, DYS389I, DYS389II, DYS390, DYS391, DYS392 and DYS393) were studied in 207 unrelated individuals from Central Portugal and 63 from Azores Islands. The most common haplotype in Central Portugal was shared by 3.4% of the males, while 160 haplotypes were unique. In Azores Islands the most common haplotype was shared by 6.4% of the males, while 40 haplotypes were unique. The values of haplotype diversity were 0.993 for Central Portugal and 0.976 for Azores Islands. 相似文献
720.
Bloodhounds are used to trail fleeing felons and missing persons. In order to start a trail, the dog must be presented with a person's scent. There are many hypotheses on what a bloodhound smells while trailing. The present study attempts to identify whether human scent is genetic, and if it is influenced by one's environment. Bloodhounds trained in human scent discrimination were used to differentiate between monozygotic twins, related and nonrelated persons, living together and apart. The first test required the dogs to run blind trails after being presented with the scent of one person in the pair, while the opposite person was hidden. The second test allowed the dogs to trail one person in the pair after both people were hidden. Results appear to demonstrate that bloodhounds rely heavily on genetic cues when differentiating between people. Environmental cues do not appear to significantly aid the bloodhound in scent discrimination. 相似文献