Medication noncompliance in schizophrenia: codification and update

Risk of relapse and recidivism makes the failure to take antipsychotic medication as prescribed a significant issue in forensic psychiatry. This question may arise in such contexts as the setting of bail, plea bargaining, the insanity defense, and sentencing. We have reviewed the literature on medication noncompliance in schizophrenia and present here the results, organized by topics relevant for the work of forensic mental health experts. Reported rates of noncompliance vary widely, reflecting major differences in the populations studied and the methods used as well as the complexities involved in defining noncompliant behavior. A noncompliance rate of 50 percent has been attributed globally to chronic patients, both medical and psychiatric. The tendency of significant factors to interact precludes a simple typology of noncompliance. However, environmental security and supportiveness correlate positively with adherence; whereas anxiety, paranoia, grandiosity, depression, and side effects correlate negatively. Clinicians' assessments of whether medication is being taken have proven to be unreliable. Although monitoring by chemical measurement, particularly a radioreceptor assay for urine samples, can be useful, depot injection ensures that prescribed medication is being taken. Less invasive means of promoting compliance are described; psychodynamic and ethical issues to be considered in the monitoring and promotion of compliance over extended time periods are presented. We also probe the link between medication noncompliance and behavioral relapse. The time between default and relapse is most often measured in weeks. Whether due to medication withdrawal or not, the relapse pattern of each individual tends to repeat, allowing its recognition before recidivism occurs. Restarting medication at this stage, especially with a dosage increase, is usually effective. In sum, the forensic mental health expert can now readily use a large and diverse literature to assist with a variety of significant issues.     

Suicide by exposure to sulfuryl fluoride

The insecticide fumigant, sulfuryl fluoride, was used as an instrument of self destruction in at least two of the three fatal exposures detailed in this report. The autopsy findings, while nonspecific, have a confirmatory value. Toxicologic analysis should include a plasma and a urine fluoride level, since the toxic effects of exposure are probably related to this ion. Concentrations of fluoride in our cases were: 50.42 mg/L (Case 1) and 20 mg/L (Case 3). However, the values must be interpreted in light of all known information as a result of the paucity of reported cases of fatal sulfuryl fluoride exposures. The cases described provide a model for the investigation of tent fumigation deaths. Proper investigation of fumigant deaths requires knowledge of the insecticide, the fumigation procedure, and the implementation of warning devices. Guidelines are offered along with a procedural checklist for the investigation of tent fumigation deaths.     

Priority of multiple gunshot injuries of the skull

In accordance with Puppe's rule, the analysis of skull fractures may provide evidence on the sequence in which multiple blunt injuries of the skull occurred. In cases of multiple gunshot wounds of the skull determination of the sequence in which the gunshot wounds took place is much more difficult. In some cases, however, analysis of the skull fractures here can also allow the order in which gunshot wounds occurred to be established.     

明诺布鲁克:反思与观察

新公共行政学在公共行政领域具有重要的地位，对公共行政理论与实务的发展，产生了重要而持续的影响。作为对20世纪60年代美国动荡不安的社会现状的回应，新公共行政学者们对主流行政学研究方法进行了质疑与批判，并对当时的主流价值提出抗衡性观点。新公共行政学的理论意涵经由三次明诺布鲁克会议（1968年、1988年和2008年）而延续，尽管三次会议的背景与主题各不相同。然而，在其发展过程中，新公共行政的影响力仍然无法扩展至整个学科领域。     

Transnational Competence in an Emergent Epoch

The article elaborates a framework for understanding the relevance of transnational competence to the dynamics that mark the transformations of our time. Nongovernmental stakeholders interacting through dense civil-society networks that permeate domestic-foreign frontiers bear increasing responsibility for the course of events. Based on linked interests, interorganizational knowledge generation and aggregation, partnerships, and interpersonal/intercultural interactions, they are deeply involved in addressing the many challenges posed by an ever more interdependent world. Transnational competence lubricates transterritorial networks and projects. Here, the authors extend earlier work that posited a worldwide skill revolution both by developing explicit dimensions of transnational competence and by introducing a behavioral component. The new framework provides analytical groundwork for explaining why some people, groups, and networks are more effective than others in forging meaningful transnational solidarities, negotiating and benefiting from the intensifying experience of globalization, and waging successful transnational campaigns. The article also probes how the spread of transnational competence is being facilitated by global migration and transmigration trends. The final section explores the governance implications of expanding transnational competency for the emergent epoch.