Can APB 2000 Be Used to Discern Sincerity of Effort in Unimpaired Subjects from Maximal Performance in Subjects with Shoulder Pain?

The automated pegboard (APB 2000), which has been found to objectively quantify motor performance, was used to differentiate maximal motor performance among subjects with shoulder pain, healthy unimpaired subjects performing normally and also while feigning shoulder pain. Six participants with shoulder pain and 15 healthy unimpaired individuals participated. Individuals with shoulder pain were tested on the APB 2000 using their affected upper extremity. Unimpaired participants were instructed to perform normally on the test with randomly selected upper extremity and to feign shoulder pain with the other upper extremity. The two tests for the unimpaired participants were conducted 1 week apart. There were significant differences in mean performance time for normal, patient, and feigned performance, with 80, 111, and 149 sec for the three groups respectively (p < 0.0005). There was also considerable overlap in the three distributions of performance times. These preliminary findings suggest that the APB 2000 is able to distinguish performance time between these three groups. Whether it can be used to distinguish between maximal performance and submaximal performance in individuals suspected of submaximal performance requires further study.     

Performance characteristics of the Cozart RapiScan Oral Fluid Drug Testing System for opiates in comparison to ELISA and GC/MS following controlled codeine administration

Oral fluid is an interesting alternative matrix for drug testing in many environments, including law enforcement, workplace drug testing, and drug treatment facilities. Performance characteristics of the FDA-cleared, qualitative, Cozart RapiScan Opiate Oral Fluid Drug Testing System (Opiate Cozart RapiScan System or Opiate CRS) were compared to the semi-quantitative Cozart Microplate EIA Opiate Oral Fluid Kit (Opiate ELISA) and to gas chromatography/mass spectrometry (GC/MS). The following oral fluid opiate cutoffs were evaluated: the GC/MS limit of quantification (LOQ) of 2.5 mg/l; 15 microg/l currently used for oral fluid testing in the United Kingdom (UK); 30 microg/l (Opiate CRS cutoff); and 40 microg/l, the proposed Substance Abuse and Mental Health Services Administration (SAMHSA) cutoff. Subjects provided informed consent to participate in this IRB-approved research and resided on the closed research ward throughout the study. Three oral codeine doses of 60 mg/70 kg were administered over a 7-day period. After a 3-week break, subjects received three doses of 120 mg/70 kg within 7 days. Oral fluid specimens (N = 1273) were analyzed for codeine (COD), norcodeine (NCOD), morphine (MOR) and normorphine (NMOR) by GC/MS with an LOQ of 2.5 microg/l for all analytes. MOR and NMOR were not detected in any sample; 26.5% of the specimens were positive for COD and 13.7% for NCOD. Opiate CRS uses a preset, qualitative cutoff of 10 microg/l; this is equivalent to 30 microg/l in undiluted oral fluid as the oral fluid collection process involves a 1:3 dilution with buffer. Sensitivity, specificity, and efficiency of Opiate CRS compared to Opiate ELISA were 98.6, 98.1, and 98.2% at a 30 microg/l cutoff and 99.0, 96.2, and 96.6% at a 40 microg/l cutoff. Compared to the much lower GC/MS LOQ of 2.5 microg/l, sensitivity, specificity and efficiency were 66.8, 99.3 and 90.7%. Increasing the GC/MS cutoff to the current UK level yielded performance characteristics of 81.5% (sensitivity), 99.3% (specificity), and 95.4% (efficiency). Using a GC/MS cutoff identical to the preset Opiate CRS cutoff yielded sensitivity, specificity, and efficiency of 88.5, 99.2, and 97.5%, respectively. At the proposed SAMSHA confirmation cutoff of 40 microg/l, sensitivity increased with little change in specificity and efficiency (91.3% sensitivity, 98.9% specificity, and 97.5% efficiency). Oral fluid is a suitable matrix for detecting drugs of abuse. Opiate CRS, with a 30 microg/l cutoff, is sufficiently sensitive, specific and efficient for oral fluid opiate analysis, performing similarly to Opiate ELISA at the same cutoff, and having performance characteristics >91% when compared to GC/MS at the proposed SAMHSA cutoff.     

Husbands who harm: Predicting spousal violence by men

Previous research on spouse abuse has frequently focused on bivariate relationships between theoretically derived variables and marital violence. This study utilizes a multivariate approach in order to explore the independent and combined effects of several variables derived from the social learning and the frustration/strain perspectives on self-reported violence by husbands against wives. Data for married and/or cohabiting males are derived from a national stratified random sample of couples in the United States. Loglinear analysis is used to identify the main and interactive effects of age, occupational status, employment status, subjective economic strain, and observation of parental violence on reports of violence toward one's wife. Results indicate that age, occupational status, parental modeling and employment status affect the likelihood of violence. Employment status more strongly increases the likelihood of violence for younger men, as opposed to older men, which supports the strain perspective. The independent effect of the observation of parental violence lends support to the social learning approach. Social policy implications are discussed.     

Violence and abuse in psychiatric in-patient institutions: a South African perspective

Institutionalisation of psychiatric patients was a prevalent treatment approach in the apartheid era of South Africa. Allegations of violence and abuse towards patients frequently arose during this time. The post-apartheid Department of Health prioritised improvements in mental health care by recommending, inter alia, deinstitutionalisation and reintegration of patients into the community. Ten years later, these interventions have proved difficult to institute and many patients are still hospitalised. The present study investigated whether currently hospitalised patients continued to experienced violence and abuse. This was an exploratory naturalistic study in which both qualitative and quantitative data were collected. Of the 127 who completed the study, more than 50% reported experiences of abuse. The main perpetrators were other patients, although violence by staff was reported. Reasons for the tardiness of implementation of deinstitutionalisation and the prevalence of ongoing violence and abuse in psychiatric hospitals are complex. Factors inherited from the pre-democratic system coupled with increased urban violence and financial constraints appear to be some of the major causes of ongoing dependency upon hospitalisation of mental health care users. The present study highlighted the urgency of implementing mental health care improvements.