Extra information about treatment is too much for the patient with psychosis

BackgroundCase law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment.AimsTo determine whether giving extra information impairs the mental capacity to make decisions about treatment.MethodThe MacCAT-T, MacCAT-FP, PANSS and GAF were administered to 88 detained forensic patients with psychosis. Two positive and two negative facts were given about each of two anti-psychotic drugs, and no treatment (twelve items). A choice was elicited. The criterion for incompetence was inability to express a choice. Two extra positive and two extra negative facts about each of the three options were given (twelve extra items) and a choice was again elicited, while repeating the MacCAT-T.ResultsGiving extra information led to a decline in the total score on the MacCAT-T. Twenty one were initially unable to make a choice (24%). After additional information, 33 were incapable (37.5%, Chi-squared p < 0.001). Those initially incapable had the lowest scores on all measures of functional capacity and GAF, with highest scores for symptoms. Those able to choose a treatment option had the highest levels of function and least symptoms. Those who became incapable had intermediate scores.ConclusionsGiving extra information made an extra 15% unable to choose. Clinical judgement must be exercised concerning the amount of information disclosed. Deciding what is material to the individual is arbitrary when so few items of information can be processed. Greater use of guardianship and independent second opinions is recommended.     

Strategic agricultural trade policy interdependence and the exchange rate: A game theoretic analysis

Strategic Agricultural Trade Policy Interdependence is modeled using a game theoretic framework. The model distinguishes between the European Community, the United States and a politically passive rest-of-the-world. Particular emphasis is placed on the effect of the exchange rate on the equilibrium outcome of this game. Without compensatory payments to those with the highest political influence, the results suggest that only modest reform is possible. With compensation, liberalization occurs but free trade is not obtained. Simulations also indicate that the U.S. gains incentive to reduce protection given a depreciation of the dollar, while incentive to liberalize trade policies decreases as the dollar appreciates. Research was supported by Minnesota Agricultural Experiment Station project 14065 “Economic Integration and Disintegration in Europe: Implications for U.S. Agriculture.”     

Morphological variations in ulnar supinator crests and fossae as identifying markers of occupational stress

Recent morphometric studies of ulnae of prehistoric skeletal remains from populations known to have used spears, atlatls, and similar projectile weapons for hunting and warfare reveal a high incidence of hypertrophy of the ulnar crest, to which the supinator muscle is attached, along with pronounced depth of the adjacent supinator fossa, especially in the upper extremities of males. Similar features occur in the right ulnae of living persons of both sexes who are habitually engaged in certain occupational and athletic activities involving angular displacement of the forearm as a result of medial rotation of the arm at the shoulder, shoulder and arm rapid extension, and abrupt shifts from forearm supination to pronation. Aside from its forensic science implications in determination of right- or left-handedness as a trait peculiar to the individual, observation of these markers of stress on the proximal end of the ulna are significant in identification of skeletal remains of persons known to have engaged in specific brachial activities during life. The biomechanics of these movement patterns and activities in which they occur, when properly interpreted, are relevant to forensic science problems of individual identification and paleoanthropological studies of occupational stress factors in extinct populations for which a skeletal record is available.     

Crime waves, culture wars and societal transformations

This paper argues that during key periods of social change in American history attempts to reform deviants and the debate over how to do it plays an important role the redefinition of values and norms and the achievement of a new consensus as to those values and norms in society. The current period (1968-present) is identified as one such period. The paper compares the current period with two other periods in American history, the antebellum period (1820–1860) and the Progressive Period (1890–1920). During both periods there was a wide spread sense of growing social disorder-fear of the dangerous classes in urban areas; a sense that cities were being overrun by immigrants; a general feeling that crime, dependant poverty, and delinquency were out of control. The wide spread sense of social breakdown during both periods was a response to fundamental changes going on at a societal level and resulted in significant social transformations. Basic changes in institutions of social control play a significant role in these social transformations during both these earlier periods. The paper argues that the current period (1968-present) is strikingly similar to the previous two, both in terms of the wide spread popular fear of social breakdown and in terms of the fundamental social changes taking place in society. The paper concludes with an exploration of the role reforms in institutions of social control broadly conceived might play in the general social transformations now occrring in American society.