Self‐Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review

Self‐embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty‐two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two‐thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.     

Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid.     

Analysis of the Federal District’s Legislative Chamber in the Information Age

The study investigates the satisfaction with the work of the parliament of Brazilian Federal District. The survey was based on the competencies extracted from the institutional mission and targeted citizens who frequently use social networks. Inferential statistics were used to analyse the data. The results showed a great unsatisfaction about the institution. The most satisfied respondents are the less educated, while the most educated, older, and highest income respondents are the most unsatisfied. The results also highlighted the low interaction between respondents and the Chamber, the absence of an effective official communication channel, and actions associated with sustainable economic development will be more effective in increasing satisfaction.     

Critical social media information flows: political trust and protest behaviour among Kazakhstani college students

ABSTRACT

In political regimes where traditional mass media are under state control, social networking sites may be the only place where citizens are exposed to and exchange dissident information. Despite all the attempts, complete control of social media seems to be implausible. We argue that the critical information that people see, read and share online undermines their trust in political institutions. This diminishing trust may threaten the legitimacy of the ruling regime and stimulate protest behaviour. We rely on original survey data of Kazakhstani college students to confirm these expectations. The data are unique in that they directly measure exposure to critical/dissident information, as opposed to simply assuming it. The analysis leverages Coarsened Exact Matching to simulate experimental conditions. This allows us to better identify the consequential mechanism and the attitudinal precursor by which social media influence protest in an authoritarian context.     

Low-income preschoolers' behavior with anatomically detailed dolls

The present study examined nonabused children's responses to anatomically detailed (AD) dolls among diverse populations. Thirty six low-income, predominantly African-American preschoolers from a Head Start center participated in an AD interview. Interviews were videotaped and coded for the presence of eight behaviors and eight parallel verbalizations. Results indicated that the children spent the majority of the interview without engaging in any behaviors which are often associated with sexual abuse. Sexual interaction between the dolls was seldom demonstrated, particularly when compared to exploration of the dolls' genitalia. Some differences were noted in the way low-income, predominantly African-American preschoolers responded to the dolls, when contrasted with the results of studies using predominantly middle-income, White preschoolers. The need for the consideration of environmental factors in interpreting children's responses to AD dolls is discussed.     

The Legal Discourse of the Common Law: A Game of Chess

English law, like any otherspecialized topic, needs a particular languagefor its understanding. The legal discourse ofthe common law gathers a set of theoretical andcustomary mechanisms subject to internal orexternal intrusions into its directions foruse. Two ideas are highlighted: the rigidity ofthe overall regulating structure of the law,and the use of `fuzzy sets' to provideflexibility to legal discourse. This unsteadyor fuzzy discourse production proves thislanguage to be the result of a long and complexhistorical process of socialisation. Theseinteractions of reference and of wordinglegitimate a mode of precise and technicalinstitutional stratification, combining bothconstruction and argumentation.     

Special report on health care delivery systems. Trends in the integrated delivery of health care and the corporate practice of medicine

The prospects for federal legislation preempting state corporate practice restrictions are unclear. The health care reform bill originally introduced by President Clinton contained a provision that would have preempted "any state law related to the corporate practice of medicine" insofar as it applied to the arrangements between non-fee-for-service health plans and their participating providers. H.R. 3600/S. 1757, 103d Cong., 1st Sess. 1407(b) (1993). Whether and in what form a preemption provision may survive the legislative process and see a Presidential signature remains to be seen. The particular fate of the federal legislation notwithstanding, however, health care executives can nevertheless remain confident that the legal treatment of the "corporate practice" of medicine will continue to be of vital concern as the various forms of health care organizations evolve in the ongoing struggle to deliver quality medicine at affordable prices.