Methodological issues in monitoring the use of coercive measures

PurposeIn many European countries, initiatives have emerged to reduce the use of seclusion and restraint in psychiatric institutions. To study the effects of these initiatives at a national and international level, consensus on definitions of coercive measures, assessment methods and calculation procedures of these coercive measures are required. The aim of this article is to identify problems in defining and recording coercive measures. The study contributes to the development of consistent comparable measurements definitions and provides recommendations for meaningful data-analyses illustrating the relevance of the proposed framework.MethodsRelevant literature was reviewed to identify various definitions and calculation modalities used to measure coercive measures in psychiatric inpatient care. Figures on the coercive measures and epidemiological ratios were calculated in a standardized way. To illustrate how research in clinical practice on coercive measures can be conducted, data from a large multicenter study on seclusion patterns in the Netherlands were used.ResultsTwelve Dutch mental health institutes serving a population of 6.57 million inhabitants provided their comprehensive coercion measure data sets. In total 37 hospitals and 227 wards containing 6812 beds were included in the study. Overall seclusion and restraint data in a sample of 31,594 admissions in 20,934 patients were analyzed. Considerable variation in ward and patient characteristics was identified in this study. The chance to be exposed to seclusion per capita inhabitants of the institute's catchment areas varied between 0.31 and 1.6 per 100.000. Between mental health institutions, the duration in seclusion hours per 1000 inpatient hours varied from less than 1 up to 18 h. The number of seclusion incidents per 1000 admissions varied between 79 up to 745. The mean duration of seclusion incidents of nearly 184 h may be seen as high in an international perspective.ConclusionCoercive measures can be reliably assessed in a standardized and comparable way under the condition of using clear joint definitions. Methodological consensus between researchers and mental health professionals on these definitions is necessary to allow comparisons of seclusion and restraint rates. The study contributes to the development of international standards on gathering coercion related data and the consistent calculation of relevant outcome parameters.     

Increased sensitivity for amplified STR alleles on capillary sequencers with BigDye XTerminator™

Free fluorescent dyes from PCR primers or amplification products can interfere with the interpretation of STR alleles in an electropherograph especially when the profiles have a low signal intensity. These artefacts can be removed by using a simple procedure based on BigDye^® XTerminator™. This procedure requires limited amounts of PCR product, allows to do several loadings on a capillary sequencer starting from the same purified PCR product and also increases the sensitivity for detection of less amplified loci.     

Mystifying but not misleading: when does political ambiguity not confuse voters?

The purpose of political campaigns in democracies is to provide voters with information that allows them to make “correct” choices, that is, vote for the party/candidate whose proposed policy or “position” is closest to their ideal position. In a world where political talk is often ambiguous and imprecise, it then becomes important to understand whether correct choices can still be made. In this paper we identify two elements of political culture that are key to answering this question: (i) whether or not political statements satisfy a so-called “grain of truth” assumption, and (ii) whether or not politicians make statements that are comparative, that is contain information about politicians’ own positions relative to that of their adversaries. The “grain of truth” assumption means that statements, even if vague, do not completely misrepresent the true positions of the parties. We find that only when political campaigning is comparative and has a grain of truth, will voters always make choices as if they were fully informed. Therefore, the imprecision of political statements should not be a problem as long as comparative campaigning is in place.     

STR primer concordance study.

Over 1500 population database samples comprising African Americans, Caucasians, Hispanics, Native Americans, Chamorros and Filipinos were typed using the PowerPlex 16 and the Profiler Plus/COfiler kits. Except for the D8S1179 locus in Chamorros and Filipinos from Guam, there were eight examples in which a typing difference due to allele dropout was observed. At the D8S1179 locus in the population samples from Guam, there were 13 examples of allele dropout observed when using the Profiler Plus kit. The data support that the primers used in the PowerPlex 16, Profiler Plus, and COfiler kits are reliable for typing reference samples that are for use in CODIS. In addition, allele frequency databases have been established for the STR loci Penta D and Penta E. Both loci are highly polymorphic.     

Report of Increasing Overdose Deaths that include Acetyl Fentanyl in Multiple Counties of the Southwestern Region of the Commonwealth of Pennsylvania in 2015–2016

Acetyl fentanyl is a Schedule I controlled synthetic opioid that is becoming an increasingly detected “designer drug.” Routine drug screening procedures in local forensic toxicology laboratories identified a total of 41 overdose deaths associated with acetyl fentanyl within multiple counties of the southwestern region of the state of Pennsylvania. The range, median, mean, and standard deviation of blood acetyl fentanyl concentrations for these 41 cases were 0.13–2100 ng/mL, 11 ng/mL, 169.3 ng/mL, and 405.3 ng/mL, respectively. Thirty‐six individuals (88%) had a confirmed history of substance abuse, and all but one case (96%) were ruled multiple drug toxicities. This report characterizes this localized trend of overdose deaths associated with acetyl fentanyl and provides further evidence supporting an alarmingly concentrated opiate and opioid epidemic of both traditional and novel drugs within this region of the United States.     

Unintentional gunshot during police intervention

33 cases of unintentional handgun use by police officers during operation since 1983 in Northern Germany have been evaluated. These cases have been selected from our own investigations and from prosecutors' and police departments' files and records. It was intended to find out criteria for forensic expertise. The unintended use of a handgun was always influenced in a decisive and causal manner by the behaviour of the delinquents (resistance, assault, escape). The confrontation of the police officer with the violence of aggressive offenders was of immediate importance for triggering the shot in various kinds of police operation. Sensorically caused, reflex muscle contractions as a consequence of a great effort, a loss of balance or fright when simultaneously protecting oneself with weapon in hand can be made responsible for the unvoluntary shot. In 10 cases (30%) persons were injured, 2 times lethally. As a whole, the consequences were of random nature, they could be explained by the series of actions in each case. The type and technical state of the weapons in use have not influenced the unintentional use. A behaviour of the police officers offending against the legally required care was stated in two of the investigated cases. Considering our investigations and the many policemen killed in duty we state that securing oneself in time with a weapon at the ready in critical phases of operations cannot be successfully replaced by any other method of self defense.     

Of mice and men: will the intersection of social science and genetics create new approaches for intimate partner violence?

The past two decades have yielded a recognition that intimate partner violence is ubiquitous. Although violence within relationships is bidirectional, there is acknowledgment that violence directed against women is more persistent and dangerous. Strategies for treatment of men have been largely unsuccessful, and studies of women centered approaches to prevention are in their infancy. An emerging concept in the brain-behavior field is the recognition of genetics as a powerful influence on aggressive and violent behaviors. Mouse models of human health and disease have facilitated our understanding of the role of genetics in the manifestation of these traits. There is a need to push the boundaries of research on intimate partner violence by adopting biosocial approaches to understand its causes.