Treatment of paraphilia in young adults with leuprolide acetate: a preliminary case report series

Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.     

Legal,ethical and clinical implications of prescribing involuntary,life-threatening treatment: the case of the Sunshine Kid

Involuntary treatment is a concept often familiar to psychiatrists. In clinical practice, it usually involves the hospitalization and pharmacological management of patients with severe mental disorders. However, the scope of involuntary treatment is not limited to the management of mental illness alone. Psychiatric patients afflicted with medical illnesses may require hospitalization and invasive procedures for optimal management of these disorders. The following case illustrates a dilemma in which a psychotic patient refuses life-saving medical treatment; however, the treatment itself carries significant risk of morbidity and mortality. This article reviews the ethical, legal and clinical implications of making such difficult treatment decisions.     

The reciprocal dynamics of organizing and sense‐making in the implementation of major public‐sector reforms

Abstract: Drawing on a longitudinal study from the early years of implementation of health‐care networks in Quebec, this article describes how public‐sector managers deal with complex challenges when both organizational structures and organizational strategies are radically transformed simultaneously. The new organizations studied had to completely re‐shuffle roles and responsibilities of their management teams while making sense of their new mandate of developing a population‐focused approach to health problems – all the time maintaining day‐to‐day operations. The four health‐care networks studied proceeded somewhat differently to meet these reciprocal challenges. The study reveals the importance of balancing organizing initiatives (focused on structures) with “sense‐making” initiatives (focused on strategies), of developing capacities for sense‐making through the creation of key “sense‐maker/sense‐giver” positions whose occupants are able to ensure that conceptual activities engage people working at different levels, even as organizational structures are in flux, and of mobilizing external constraints and influences as opportunities and resources in sense‐making and organizing. Sommaire : Se fondant sur une étude longitudinale des premières années de la mise en œuvre des réseaux de soins de santé au Québec, cet article décrit la manière dont les gestionnaires du secteur public font face à des défis complexes, alors que les structures et les stratégies organisationnelles sont radicalement transformées simultanément. Les nouveaux organismes étudiés ont dû complètement remanier les rôles et les responsabilités de leurs équipes de gestion et comprendre leur nouveau mandat d'élaborer une approche axée sur la population pour ce qui est des problèmes de santé, tout en maintenant leurs activités au jour le jour. Les quatre réseaux de soins de santéétudiés ont travailléà relever ces défis réciproques d'une manière assez différente. L'étude révèle l'importance de trouver un équilibre entre les initiatives consistant à organiser (axées sur les structures) et les initiatives consistant à interpréter les faits (axées sur les stratégies) ; de perfectionner les capacités à interpréter les faits grâce à la création de postes clés d'«interpréteurs de faits», dont les titulaires veilleraient à ce que des activités conceptuelles fassent intervenir les gens travaillant à différents niveaux même lorsque les structures organisationnelles fluctuent continuellement; et enfin de tirer parti des contraintes et influences externes comme autant d'occasions et de ressources pour interpréter et organiser les faits.     

Characterization of human DNA in environmental samples

Environmental samples from indoor surfaces can be confounded by dust, which is composed largely of human skin cells and has been documented to contain roughly tens of micrograms of total DNA per gram of dust. This study complements previous published work by providing estimates of the quantity of amplifiable human DNA found in environmental samples from a typical indoor environment, categorized by the intensity of human traffic and visible quantity of dust. Dust was collected by surface swabbing standard 576 cm² areas in eight locations, and evaluated for total DNA quantity, presence of human DNA (mitochondrial and nuclear loci using conventional PCR), quantity of human nuclear DNA using quantitative PCR, and STR analysis. The total DNA content of 36 dust samples ranged from 9 to 28 ng/cm², and contained 0.2–1.1 pg/cm² of human DNA. Overall, human DNA was detected in 97% of 36 dust samples and 61% of samples yielded allele distributions of varying degrees of complexity when subjected to STR analysis. The implications of this study are twofold. First, the presence of dust in evidence can be a significant contamination source in forensic investigations because the human DNA component is of sufficient quality and quantity to produce allele calls in STR analysis. This can be effectively managed by implementing stringent protocols for collection and analysis of potential biological samples. A second implication is the use of dust as a source of evidence for identification of inhabitants within a defined location. In the latter case, a number of additional studies would be necessary to identify relevant pretreatments for environmental dust samples and to develop the necessary deconvolution techniques to separate the composite genotypes obtained.     

Australian Rules: The Rise of Rights and the Demise of the Right

Over a number of years there has been a public debate in Australia over the place of legal rights in the struggle for Indigenous economic, social and cultural gains. Most Indigenous leaders have called for a rights agenda as a solution to Indigenous disadvantage. However, one leader has been a vocal critic of this approach. This paper considers the possibility that although the debates may fundamentally represent different views as to how best to improve conditions for Indigenous Nations, they also represent differing approaches to harnessing the support of mainstream Australia in a politically conservative environment. In coming to this position, I am reminded of the arguments put by proponents of the Critical Legal Studies movement in US, that rights are merely abstractions, and the counter by Patricia Williams, a Critical Race Theorist, that as a result, they can be framed in a variety of ways and can take the form required by the community in which they are found. In Australia, minority groups must find an indexically-open vehicle, fitting to the Australian rhetorical structure(s), to represent their struggle for economic, social and cultural rights. Tracey Summerfield is a white woman born in Perth, Western Australia. Thanks to Stephanie Monck, a Kungarakan/Warramungu woman from the Northern Territory, who provided assistance and feedback on an earlier version. The views expressed here are, of course, those of the writer alone.     

A functional approach to sudden unexplained infant deaths

There is a great deal of variation in the methods and wording used by medical examiners in the medicolegal investigation and certification of infant deaths. This paper was created by the NAME Ad Hoc Committee on Sudden Unexplained Infant Death to address several specific issues, namely: * To establish a functional approach to the investigation of sudden unexplained infant deaths; * To outline a "bare minimum" set of recommendations to define the scope of investigation required; * To recommend methods and wording to be used when certifying infant deaths; * To develop a list of potential stressors or possible external causes of death that should be identified and reported on the death certificate and/or within a medical examiner/coroner office database. This paper was electronically posted for NAME member review and comment for a period of 30 days. The paper was further revised based on member comments and then submitted to the NAME board of directors in the fall of 2005 prior to the annual meeting. This text of this paper was officially approved and endorsed by the NAME board of directors on October 14, 2005, at the annual meeting in Los Angeles, CA.     

‘Good neighbours or distant relatives?’ Regional identity and cooperation in the South Caucasus

Conceptualization of the South Caucasus as a distinct regional unit is a relatively new development. Notwithstanding geographic proximity, the three states of the region face different political, economic and security realities, precipitating different strategic orientations. Conflicting dynamics complicate relations between states and serve to undermine efforts, both internal and external, to establish a sense of regional identity and advance inter-state cooperation. This paper argues that the concept of a distinct ‘South Caucasus’ region is an externally generated, geographical label, which implies a certain degree of unity and positive interdependence that does not exist. The three states may be geographical neighbours, but they are not ‘good neighbours’, as the complex web of enmities that has developed over the centuries means the three states tend to look externally to ‘distant relatives’, undermining both regional cohesion and awareness.     

The Salience of Social Contextual Factors in Appraisals of Police Interactions with Citizens: A Randomized Factorial Experiment

Objectives

Prior research indicates that public assessments of the manner in which the police exercise their authority are a key antecedent of judgments about the legitimacy of the police. In this study, the importance of context in influencing people’s assessment of police wrongdoing is examined.

Methods

A randomized factorial experiment was used to test how respondents perceive and evaluate police–citizens interactions along a range of types of situations and encounters. 1,361 subjects were surveyed on factors hypothesized to be salient influences on how citizens perceive and evaluate citizen interactions with police. Subjects viewed videos of actual police–citizen encounters and were asked for their evaluations of these observed encounters. Contextual primes were used to focus subjects on particular aspects of the context within which the encounter occurs.

Results

Structural equation models revealed that social contextual framing factors, such as the climate of police–community relations and the legality of the stop that led to the encounter, influence citizen appraisals of police behavior with effects comparable in size to and even larger than demographic variables such as education, race, and income.

Conclusions

These results suggest that the understandings and perceptions that people bring to a situation are important determinants of their assessment of police fairness. The police can positively influence citizen interpretations of police actions by striving to create a climate of positive police–community relationships in cities.     

Desistance and Legitimacy: The Impact of Offender Notification Meetings on Recidivism among High Risk Offenders

Legitimacy-based approaches to crime prevention assume that individuals will comply with the law when they believe that the law and its agents are legitimate and act in ways that are “fair” and “just.” Currently, legitimacy-based programs are shown to lower aggregate levels of crime; yet, no study has investigated whether such programs influence individual offending. Using quasi-experimental design and survival analyses, this study evaluates the effectiveness of one such program—Chicago’s Project Safe Neighborhoods’ (PSN) Offender Notification Forums—at reducing individual recidivism among a population of returning prisoners. Results suggest that involvement in PSN significantly reduces the risk of subsequent incarceration and is associated with significantly longer intervals that offenders remain on the street and out of prison. As the first study to provide individual-level evidence promoting legitimacy-based interventions on patterns of individual offending, out study suggests these interventions can and do reduce rates of recidivism.