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As consultation-liaison psychiatrists to a cardiac transplantation team, we have observed various informed consent issues that are particularly associated with evaluation for cardiac transplantation. We discuss complicating factors that relate to each component of informed consent and present the defense mechanism of denial as a barrier to making the decision to accept or refuse transplantation. Changes in the evaluation protocol could preclude existing impediments to provision of information and patient autonomy; however, certain intrapsychic issues must be recognized as ongoing clinical realities to be addressed as the doctrine of informed consent continues to evolve. 相似文献
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Schechter DS Willheim E McCaw J Turner JB Myers MM Zeanah CH 《Journal of interpersonal violence》2011,26(18):3699-3719
This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS), related to maternal report of interpersonal violence, mediates the effects of such violence on (a) child PTSS as well as on (b) child externalizing and internalizing symptoms. Study participants were mothers (N = 77) and children 18 to 48 months recruited from community pediatric clinics. Data were analyzed continuously via bivariate correlations and then multiple linear regression. Post hoc Sobel tests were performed to confirm mediation. Paternal violence accounted for 15% of the variance of child PTSS on the PCIP-OR (β = .39, p ≤ .001). While the child's father being violent significantly predicts child PTSS related to domestic violence, as mentioned, when maternal PTSS is included in the multiple regression model, father's being violent becomes less significant, while maternal PTSS remains strongly predictive. Sobel tests confirmed that maternal PTSS severity mediated effects of paternal violence on clinician-assessed child PTSS as well as on maternal report of child externalizing and internalizing symptoms. When presented with a preschool-aged child who is brought to consultation for behavioral difficulties, dysregulated aggression, and/or unexplained fears, clinicians should evaluate maternal psychological functioning as well as assess and treat the effects of interpersonal violence, which otherwise may be avoided during the consultation. 相似文献
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Victoria A. Smith M.N.S. Angi M. Christensen Ph.D. Sarah W. Myers B.S. 《Journal of forensic sciences》2010,55(6):1413-1415
Abstract: Several studies have investigated frontal sinus comparison for personal identification. One study addressed the statistical reliability of correct identification using automated digital methods and resulted in a 96% accuracy rate. Missed matches with the digital methods generally involved small, less featured sinuses. This study investigates the hypothesis that human examiners may be able to more accurately identify correct matches than digital methods, even when the comparisons involve small frontal sinuses. Participants were provided two sets of 28 radiographs and were instructed to identify matching radiographs and list the radiographs that did not have a corresponding match. Overall, error rates were low, with correct associations identified at a rate of 0.983. No incorrect associations (“false positives”) were made. Correct association rates were highest among participants “experienced” examining radiographs. Results support previous assertions that frontal sinus radiographs are a reliable means of personal identification even when the frontal sinuses are small. 相似文献
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This article uses fine-grained data to demonstrate that, since 1996, the State of Texas has undergone a process of ‘secular geographical polarization’ – a continuous divergence in the geographical bases of its political parties. It is suggested that this process exemplifies a new era of partisan politics in the American South. Analyses of spatial regression models show that the geographical polarization can be partially explained by a tighter link between demographic characteristics and aggregate voting patterns, but that growth in spatial clustering cannot be attributed entirely to demographics. The possibility that spatially-bounded social contexts are affecting partisan change is thus explored. Finally, the article's findings are considered in light of the growing debate about geographical polarization in the American electorate. 相似文献
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Saliva stains present a unique challenge in the forensic setting, often challenging the analyst to weigh the value of presumptive indication of the fluid versus the potential for DNA analysis to yield identification information. There are many situations in which determining the presence of a body fluid is probative and further corroborates DNA evidence. That said, even a minute portion of sample consumed by a screening test could mean the difference between a full, partial, or null profile obtained through DNA analysis. The basis of presumptive testing or screening of saliva has historically been based on the presence of amylase, a component found in relatively high concentrations in human saliva versus other body fluids and substances. Though the current available methods for the screening of saliva in a forensic application have grown in number, the popularity of these methods seemingly has not. This study attempts to identify a specific and sensitive saliva screening test by comparing three modern techniques--the recently released SALIgAE, Phadebas, and starch-iodine mini-centrifuge test--on the basis of sensitivity, specificity, mixtures, and simulated casework samples while also considering sample consumption. The Phadebas method for presumptive saliva testing detected dilutions of neat saliva down to 1:200 versus considerably less sensitive results with SALIgAE and the starch-iodine mini-centrifuge test. Utilizing a screening test with a high degree of sensitivity, such as Phadebas, allows an analyst to gain a maximum amount of information in the form of body fluid indication and DNA results because of the consumption of a small portion of sample. 相似文献
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Myers WC Bukhanovskiy A Justen E Morton RJ Tilley J Adams K Vandagriff VL Hazelwood RR 《Forensic science international》2008,176(2-3):187-195
This case series documents and examines the association between autoerotic asphyxiation, sadomasochism, and serial sexual murderers. Autoerotic asphyxiation, along with other paraphilias found in this population, is reviewed. Five cases of serial sexual killers who engaged in autoerotic asphyxiation were identified worldwide: four from the United States and one from Russia. Case reports for each are provided. All (100%) were found to have sexual sadism in addition to autoerotic asphyxiation. Furthermore, two (40%) had bondage fetishism, and two (40%) had transvestic fetishism, consistent with these paraphilias co-occurring in those with autoerotic asphyxiation. Overall the group averaged 4.0 lifetime paraphilias. Some possible relationships were observed between the offenders' paraphilic orientation and their modus operandi, e.g., all of these serial killers strangled victims-suggesting an association between their sadistic and asphyxiative paraphilic interests. The overlap of seemingly polar opposite paraphilias in this sample--sexual sadism and autoerotic asphyxiation--is explored from a historical and clinical perspective. Multiple commonalities shared between these five offenders and serial sexual murderers in general are addressed. A primary limitation of this study is its small sample size and empirical basis; the results may not be generalizable beyond the sample. The findings from this study support the supposition that crime scene behaviors often reflect paraphilic disturbances in those who commit serial sexual homicides. 相似文献