Compulsory treatment with clozapine: a retrospective long-term cohort study

BACKGROUND: Clozapine is the gold standard in treatment of treatment-resistant psychotic patients. We know little about the effects of compulsory treatment in patients unwilling to accept the necessary treatment. AIMS: To assess the effectiveness, tolerability and safety of compulsory treatment with clozapine (CTC). METHOD: A cohort of 17 consecutive patients given compulsory treatment with clozapine were rated retrospectively by their treating psychiatrists on the basis of their case notes. RESULTS: CGI-S decreased significantly over time until last observation after a mean of more than 15 months. No patient deteriorated as measured by CGI-I. At last observation as many as ten of the 11 patients still on clozapine were classified as much to very much improved. The degree of custodial restriction at last observation showed improvement in 11 patients and no change in six. No serious adverse events were observed. CONCLUSION: A trial of compulsory treatment with clozapine showed this treatment to be feasible, effective, safe and well tolerated.     

Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

Uncertainty of calculation results in vehicle collision analysis

In the analysis of road accidents two types of calculation result uncertainty can be distinguished: modelling uncertainty and uncertainty in calculation results [R.M. Brach, M. Brach, Vehicle Accident Analysis & Reconstruction Methods, SAE International Publisher, Warrendale, 2005]. The problem becomes very important first of all when minor modifications of input parameters or application of different models of the phenomenon lead to a fundamentally different answer to the question posed by the court. The aim of the paper was to prove the necessity of including the problem of uncertainty in calculations related to vehicle collision mechanics and to justify the application of different error analysis methods recommendable in vehicle collision reconstruction. The data file from crash test No. 7 [H. Burg, M. Lindenmann, Unfallversuche, Verlag Information Ambs, Kippenheim, 1982] was used, the selection restricted to the range typical of average police records of collision place. Collision speeds were calculated using two methods: reconstruction and simulation. The analysis of uncertainty was carried out. Maximum and mean square uncertainty were calculated by means of total differential of relevant forms. Since the reconstruction resulted in very broad error intervals of uniform distribution, additional calculations were performed by the Monte Carlo method using algorithm described in [W. Wach, J. Unarski, Determination of vehicle velocities and collision location by means of Monte Carlo simulation method, Special Publication Accident Reconstruction SP-1999, SAE Paper No. 2006-01-0907, 2006].     

Quantitative indices for anti-human trafficking policies: based on reports of the U.S. State Department and the Council of Europe

Quantitative ratings of policies of national governments are an important tool for the monitoring of compliance with international standards in many domains. In this article we present a global index of anti-human trafficking policies developed by a research consortium using the TIP country reports of the U.S. State Department (the 3P index) and an index based on the reports of the monitoring body of the Council of Europe Convention against Human Trafficking (GRETA). Although the global 3P index gives more favorable ratings to most European countries than the GRETA-based index, a moderately strong correlation was found between the two indices. This is an encouraging result lending support to the validity of the assessments of both monitoring mechanisms as well as to their transformation into quantitative scores. We also demonstrate that the detailed GRETA-based index can be used to identify best practices in anti-trafficking policies and specific areas where these policies are most in need of improvement, e.g. legal aid and compensation for victims. Our analyses of the relationships between the various items of the index revealed positive correlations between the existence of units of specialized prosecutors and the numbers of convictions of traffickers. Our paper, then, demonstrates the potential of quantitative indices of counter human trafficking policies as tools for both effective monitoring of the implementation of international standards and for analytical purposes.     

Policy work at the sub‐national level: Analytical styles of Canadian and Czech directors and managers

This paper uses data from two countries to develop profiles of policy directors and managers in the sub‐national public bureaucracies of Canada and the Czech Republic. Canadian directors and managers undertake more analytically complex tasks for which research and evaluation is necessary. In comparison, Czech managers are more firmly engaged in project management agendas, and Czech directors tend to rely on personal experience and routine approaches. Overall, the sample shows that different policy styles are emphasized in each country and at different levels ranging from rational‐technical and advisory‐interactive (Canadian directors and managers), process expertise (Czech managers), and a combination of analytical rationality and issue activism (Czech directors).     

The trust deficit in Sino-Japanese relations

Abstract

Recent years have seen a deterioration in political relations between China and Japan, in particular over the disputed Senkaku/Diaoyu islands and history-related problems. Commentators have noted an attendant decline in trust between the two sides and have stressed the need for confidence-building measures in order to address the trust deficit. This article explores the origins of declining trust between the Chinese and Japanese leaderships. It argues that attempts to build a friendly and trusting relationship in the early post-war and post-normalisation periods began to fail in the 1980s, and have been in a gradual state of decline ever since. Using the concepts of trust and friendship, the article suggests that the lack of trust properties such as empathy, bonding, reliability and predictability have contributed to the deterioration of trust at both elite and popular levels.     

Getting to Sweden,Part II: Breaking with Corruption in the Nineteenth Century

Issues about corruption and other forms of ‘bad government’ have become central in large parts of the social sciences. An unresolved question, however, is how countries can solve the issue of systemic corruption. In this article, based on Elinor Ostrom's theory of common pool resource appropriation, a new theoretical model for explaining this type of institutional change is developed. Sweden during the nineteenth century is used as an illustration of the model by showing how the country made a transition from being largely patrimonial, nepotistic and corrupt to a modern, Weberian, efficient and impartial state structure. Building upon a companion article about the importance of losing a war as a precondition for breaking systematic corruption, this article stresses the importance of three additional factors in Sweden: previous changes in courts and the legal system; recognition of the problem by the main contemporary political actors as shown in debates in the Diet; and the new liberal ideology that made an important impact on the Swedish political scene during this period.