A tale of two cultures: examining patient-centered care in a forensic mental health hospital

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers' perceptions of safety is needed.     

Sequential Lineup Laps and Eyewitness Accuracy

Police practice of double-blind sequential lineups prompts a question about the efficacy of repeated viewings (laps) of the sequential lineup. Two laboratory experiments confirmed the presence of a sequential lap effect: an increase in witness lineup picks from first to second lap, when the culprit was a stranger. The second lap produced more errors than correct identifications. In Experiment 2, lineup diagnosticity was significantly higher for sequential lineup procedures that employed a single versus double laps. Witnesses who elected to view a second lap made significantly more errors than witnesses who chose to stop after one lap or those who were required to view two laps. Witnesses with prior exposure to the culprit did not exhibit a sequential lap effect.     

Reliability and Validity of Prisoner Self-Reports Gathered Using the Life Event Calendar Method

Data collection using the life event calendar method is growing, but reliability is not well established. We examine test–retest reliability of monthly self-reports of criminal behavior collected using a life event calendar from a random sample of minimum and medium security prisoners. Tabular analysis indicates substantial agreement between self-reports of drug dealing, property, and violent crime during a baseline interview (test) and a follow-up (retest) approximately 3 weeks later. Hierarchical analysis reveals that criminal activity reported during the initial test is strongly associated with responses given in the retest, and that the relationship varies only by the lag in days between the initial interview and the retest. Analysis of validity reveals that self-reported incarceration history is strongly predictive of official incarceration history although we were unable to address whether subjects could correctly identify the months they were incarcerated. African Americans and older subjects provide more valid responses but in practical terms the differences in validity are not large.     

Temporal variation of oxygen isotope ratios (δ18O) in drinking water: implications for specifying location of origin with human scalp hair

Previous work suggests that δ(18)O values of human hair can be used to constrain the region-of-origin of unknown individuals, but robust assessments of uncertainties in this method are lacking. Here we assess one source of uncertainty - temporal variation in the δ(18)O value of drinking water - using a monthly tap water survey of δ(18)O to develop geospatial models (i.e., maps) of the intra-annual variation (seasonality) in tap water δ(18)O for the contiguous USA. Temporal variation in tap water δ(18)O was correlated with water-supply type, and was related to geographic patterns of precipitation δ(18)O seasonality and water residence time. The maps were applied in a Bayesian framework to identify the geographic origin of an unidentified woman found in Utah, based on measured δ(18)O of scalp hair. The results are robust in specifying parts of the western USA as the most likely region-of-origin. Incorporation of tap water δ(18)O seasonality in the analysis reduces the precision of geographic assignments, but other sources of uncertainty (e.g., spatial interpolation uncertainty) have an equal or larger effect.     

Pilot Study of Automated Bullet Signature Identification Based on Topography Measurements and Correlations*†

Abstract: A procedure for automated bullet signature identification is described based on topography measurements using confocal microscopy and correlation calculation. Automated search and retrieval systems are widely used for comparison of firearms evidence. In this study, 48 bullets fired from six different barrel manufacturers are classified into different groups based on the width class characteristic for each land engraved area of the bullets. Then the cross‐correlation function is applied both for automatic selection of the effective correlation area, and for the extraction of a 2D bullet profile signature. Based on the cross‐correlation maximum values, a list of top ranking candidates against a ballistics signature database of bullets fired from the same model firearm is developed. The correlation results show a 9.3% higher accuracy rate compared with a currently used commercial system based on optical reflection. This suggests that correlation results can be improved using the sequence of methods described here.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Estimation of body exposure to explosion

An ordnance-disposal expert was killed while disposing of a cache of explosives. The likely position of the body was reconstructed by modeling the explosion as an omnidirectional emission of particles from a model of the explosion site and noting the distribution of particles on a model of a human. The applications and limitations of this method in reconstructing the events and correlation with the injuries noted at autopsy are discussed.