Violent Behavior Preceding Hospitalization Among Persons with Severe Mental Illness

The need to better understand and manage risk of violent behavior among persons with severe mental illness (SMI) in community care is increasingly being recognized. Of particular concern is a subset of the SMI population characterized by a revolving door pattern of institutional recidivism and poor adherence to outpatient treatment. Little empirical research exists which examines the specific dimensions of violent incidents and their surrounding context in this population. The present paper describes characteristics of violent behavioral events in a sample of 331 people with psychotic or major mood disorders who were placed on involuntary outpatient commitment in North Carolina. By pooling baseline data from respondents' self-report, collateral informant interviews, and hospital records, the study found violent behavior to be a problem affecting over half the sample in a 4-month period preceding hospitalization. The study also found considerable variability in the frequency of violent events, severity, weapon use, subjective state when incidents occurred, initiation of fights, settings, relationship to others involved, and associated threat of victimization. Multivariable analyses showed that cooccurring substance abuse problems, history of criminal victimization, and age (being younger) were significantly associated with violent behavior when all sources of data were taken into account. Clinical diagnosis and symptom variables were not related to violence in this sample. Implications of these findings for service delivery priorities and future research are discussed.     

Social capital and crime in New York City's low‐income housing

Abstract

This article presents evidence that components of social capital can play a prospective role in preventing crime in low‐income housing. It develops a conceptual approach to crime prevention involving social capital, alternative forms of ownership, and environmental design considerations. The study compares five programs that house New York City's poorest, mostly minority residents. The effectiveness of social capital in preventing crime is assessed using data from surveys of 487 buildings in Brooklyn, NY, and crime data from the New York City Police Department.

Results of the analysis indicate that three components of social capital—basic participation in tenant associations, tenant prosocial norms, and a building's formal organization—were all related to reducing various types of crime in the buildings under study 6 to 12 months after social capital was measured. The effectiveness of social capital was related to alternative ownership structures, building characteristics, and housing policy.     

“When perhaps the real problem is money itself!”: the practical materiality of Bitcoin

This paper investigates the semiotics of Bitcoin, an electronic cash system that uses decentralized networking to enable irreversible payments. For enthusiasts, Bitcoin provides an alternative to currencies and payment systems that are seen to threaten users' privacy, limit personal liberty, and undermine the value of money through state and corporate oversight. Bitcoin's promise lies in its apparent capacity to resolve these concerns not through regulatory institutions or interpersonal trust, but through its cryptographic protocols. We characterize this semiotics as a “practical materialism” and suggest it replays debates about privacy, labor, and value.     

Postmortem Aortic Dissection: An Artifact of the Embalming Process

Aortic dissection (AD) is a serious condition that affects 3/100,000 individuals a year. Recently, a case report was published describing an embalmed patient with an aortic dissection. The purpose of this study was to examine the frequency of AD among 80 embalmed cadavers and confirm the AD with histopathologic evaluation. In seven cases of grossly identified AD, six were determined to be due to the embalming procedure and only one case of true antemortem AD was confirmed. These results suggest that aortic morphology can be altered by administration of the embalming fluid and that alterations can mimic AD, not only on gross inspection but also on postmortem imaging. Awareness of this embalming artifact may prevent misdiagnosis of an aortic dissection in an embalmed patient, a point particularly useful for autopsy pathology that may include postmortem examination of an embalmed patient.     

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.