Overriding Psychiatric Advance Directives: Factors Associated with Psychiatrists' Decisions to Preempt Patients' Advance Refusal of Hospitalization and Medication

Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.     

Elemental analysis of 3,4-methylenedioxymethamphetamine (MDMA): A tool to determine the synthesis method and trace links

The elemental composition of 3,4-methylenedioxymethamphetamine (MDMA) powders and tablets was determined. The objective was the identification of the synthesis method and application of the elemental profile in comparative analysis. The developed analytical method comprised the digestion of a sample followed by quantitative analysis with inductive coupled plasma mass spectrometry (ICP-MS) and inductive coupled plasma atomic emission spectroscopy (ICP-AES). The sample collection consisted of a unique set of MDMA powders (57) from illicit production sites and MDMA tablets (97) taken from large seizures (over 500 tablets) in the Netherlands. The production method of MDMA could be determined for 89 of the 97 tablets. In 84 cases reductive amination using Pt as the catalyst was used, in four cases reductive amination using NaBH(4) or a similar reducing agent was employed and one mixed sample (Pt and B) was found. None of the MDMA tablets were assigned to the aluminium amalgam method. Using the elemental profile, 13 links were identified within the 97 MDMA tablets using cluster analysis based on Pearson correlations. Of these links 10 were corroborated by additional analyses.     

Development of a harmonised method for the profiling of amphetamines: III. Development of the gas chromatographic method

This study focused on gas chromatographic analysis of target compounds found in illicit amphetamine synthesised by the Leuckart reaction, reductive amination of benzyl methyl ketone, and the nitrostyrene route. The analytical method was investigated and optimised with respect to introduction of amphetamine samples into the gas chromatograph and separation and detection of the target substances. Sample introduction using split and splitless injection was tested at different injector temperatures, and their ability to transfer the target compounds to the GC column was evaluated using cold on column injection as a reference. Taking the results from both techniques into consideration a temperature of 250 degrees C was considered to be the best compromise. The most efficient separation was achieved with a DB-35MS capillary column (35% diphenyl 65% dimethyl silicone; 30 m x 0.25 mm, d(f) 0.25 microm) and an oven temperature program that started at 90 degrees C (1 min) and was increased by 8 degrees C/min to 300 degrees C (10 min). Reproducibility, repeatability, linearity, and limits of determination for the flame ionisation detector (FID), nitrogen phosphorous detector (NPD), and mass spectrometry (MS) in scan mode and selected ion monitoring (SIM) mode were evaluated. In addition, selectivity was studied applying FID and MS in both scan and SIM mode. It was found that reproducibility, repeatability, and limits of determination were similar for FID, NPD, and MS in scan mode. Moreover, the linearity was better when applying FID or NPD whereas the selectivity was better when utilising the MS. Finally, the introduction of target compounds to the GC column when applying injection volumes of 0.2 microl, 1 microl, 2 microl, and 4 microl with splitless injection respectively 1 microl with split injection (split ratio, 1:40) were compared. It was demonstrated that splitless injections of 1 microl, 2 microl, and 4 microl could be employed in the developed method, while split injection and splitless injections of 0.2 microl should be avoided.     

Mafia markers: assessing organized crime and its impact upon societies

This study develops a causal model of the independent effect of organized crime, rule of law, and corruption on national wealth. To measure the level of organized crime a Composite Organized Crime Index (COCI) is constructed combining data on the perceived prevalence of organized crime, unsolved homicides, grand corruption, money-laundering and the extent of the black economy, drawing on the World Economic Forum’s annual surveys among CEOs of larger companies, the Merchant International Group’s assessments of investment risks in 150 countries, studies by the World Bank Institute, and official crime statistics. The findings of the explorative analysis show that a political strategy of tolerating activities of local criminal groups in the hope of beneficial effects on the wealth of a nation is unlikely to bring the expected results. Although some types of organized crime may bring in significant revenues, tolerating Mafia-type activities implies letting the Trojan horse of racketeering and grand corruption into the walls of government.

Ideological Party Cohesion in Macro‐comparative Politics: The Nordic Social Democratic Parties from a Comparative Perspective

‘Party cohesion’ is a central concept in the analysis of agenda‐setting, veto players and coalition‐building as well as in the analysis of policy efficiency and party responsiveness. However, there is no indicator to measure party cohesion in a systematic manner over time and across parties. As a consequence, most established studies treat political parties as unitary actors although from an analytical point of view they should be considered collective actors. In order to overcome this deficiency, in this article a time‐variant and party‐specific index of party cohesion is developed which can be used in macro‐comparative statistical analysis. The concept of ‘ideological cohesion’ is developed along the Left–Right dimension. This index is applied in order to compare the party cohesion of Nordic social democratic parties (SDs) with their counterparts in 17 additional countries. The results show that the myth of the cohesion of Nordic SDs is only true for the golden age of the welfare state. Currently, most of the Nordic SDs actually have a lower party cohesion than their counterparts in many other countries.     

Strategic electoral considerations under proportional representation

Scholars have long assumed that voters do not employ strategic considerations when casting a vote in systems of proportional representation. Either this would not be necessary because few votes were wasted or impossible because the calculations involved would be too difficult to make. This research note examines the latter and concludes that (Dutch) voters are better able to make such calculations than traditionally has been presumed. Under quasi-experimental conditions that involved what can be called coalition preference voting, voters show tendencies to react to strategic considerations when determining their vote preference.     

Criminal Behavior in Opioid‐Dependent Patients Before and During Maintenance Therapy: 6‐year Follow‐Up of a Nationally Representative Cohort Sample

Lifetime prevalence of opioid dependence is about 0.4% in western countries. Opioid‐dependent patients have high morbidity and mortality and a high risk of criminal behavior. Few studies have addressed the long‐term impact of opioid maintenance therapy on convictions and criminal behavior. The PREMOS study is a prospective, longitudinal, naturalistic clinical study of a nationally representative sample of 2694 opioid‐dependent patients to investigate convictions and criminal behavior at baseline and after 6 years of maintenance treatment. At follow‐up, 2284 patients still were eligible (84.7%). A comprehensive assessment including a patient and doctor questionnaire, and the EuropASI was completed at baseline and follow‐up. Data on criminality at follow‐up had been received for 1147 (70.6%) patients. A large number (84.5%) of them had been charged or convicted at any time before baseline assessment, most frequently with drug‐related offenses (66.8%), acquisitive crime (49.1%), or acts of violence (22.0%). Reported charges and convictions had declined to 17.9% for the last 12 months before follow‐up, which was also reflected by a significant decrease in the EuropASI subscore “legal problems” from 1.52 at baseline to 0.98 after 6 years. These data indicate a significant and clinically relevant reduction in criminal behavior in opioid‐dependent patients in long‐term maintenance treatment. Maintenance therapy is effective in the reduction in both narcotics‐related and acquisition crime.     

The predictive validity of criminogenic needs for male and female offenders: Comparing the relative impact of needs in predicting recidivism

Most instruments used to assess offenders' risk of recidivism were developed and validated on male samples. Use of these instruments with female offenders is, however, common practice. This use with female offenders implies the assumption that the risk of recidivism can be predicted on the basis of the same risk factors for women as for men. Yet, this implied gender-neutrality of offender risk instruments has been the topic of much debate. This study compared criminogenic needs in male and female offenders and their relevance in predicting recidivism. A large sample of male and female offenders (N = 16,239) charged with a range of index offenses was studied. Results mainly support the gender neutrality of existing offender risk and needs assessment. However, results do suggest that some criminogenic needs may indeed have a different impact on recidivism for men and women. Problems with accommodation, education and work, and relationships with friends were more strongly correlated to general recidivism in men than in women. For women, difficulties with emotional well-being had a stronger correlation with recidivism than for men. In addition, relative to all other criminogenic needs, problems with emotional well-being were more important for women than for men in predicting general as well as violent recidivism. However, because the bivariate correlation for female offenders between emotional difficulties and recidivism is weak (as it is for male offenders), the question remains whether the relative importance of emotional difficulties in predicting recidivism in women actually has clinical relevance. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Dancing on coke: smuggling cocaine dispersed in polyvinyl alcohol

Recent trends suggest that cocaine smugglers have become more and more inventive to avoid seizures of large amounts of cocaine transported between countries. We report a case of a mail parcel containing a dance pad which was seized at the Customs Department of Brussels Airport, Belgium. After investigation, the inside of the dance pad was found to contain a thick polymer, which tested positive for cocaine. Analysis was performed using a routine colorimetric swipe test, gas chromatography coupled with mass spectrometry and nuclear magnetic resonance spectroscopy. The polymer was identified as polyvinyl alcohol (PVA) and contained 18% cocaine, corresponding to a street value of € 20,000. Laboratory experiments showed that cocaine could be easily extracted from the PVA matrix. This case report reveals a new smuggling technique for the transportation of large amounts of cocaine from one country to another.     

The effect of offenders' sex on reporting crimes to the police

This article examines the difference in victims' reporting behavior regarding crimes committed by males and by females. The authors expect that victims of female offenders are less likely to report to the police than victims of male offenders because of differences in the victim-offender relationship as well as in the victim's sex. With recent developments in Bayesian statistics, new tools have become available that enable the direct evaluation of researchers' expectations. All cases of robbery with assault from the National Crime Victimization Survey have been investigated (n = 478). Findings reveal that female offenders are underreported compared with male offenders and that this can be explained by the victim characteristics but only in combination with the offender's sex.