bluuebunny/crossref_metadata_2025 huggingface dataset:
Examination of Surface Wind Asymmetries in Tropical Cyclones. Part I: General Structure and Wind Shear Impacts
Authors: Klotz Bradley W. , Jiang Haiyan
Published: July 2017

Because surface wind speeds within tropical cyclones are important for operational and research interests, it is vital to understand surface wind structure in relation to various storm and environmental influences. In this study, global rain-corrected scatterometer winds are used to quantify and evaluate characteristics of tropical cyclone surface wind asymmetries using a modified version of a proven aircraft-based low-wavenumber analysis tool. The globally expanded surface wind dataset provides an avenue for a robust statistical analysis of the changes in structure due to tropical cyclone intensity, deep-layer vertical wind shear, and wind shear’s relationship with forward storm motion. A presentation of the quantified asymmetry indicates that wind shear has a significant influence on tropical storms at all radii but only for areas away from the radius of maximum wind in both nonmajor and major hurricanes. Evaluation of a shear’s directional relation to motion indicates that a cyclonic rotation of the surface wind field asymmetry from downshear left to upshear left occurs in conjunction with an anticyclonic rotation of the directional relationship (i.e., from shear direction to the left, same, right, or opposite of the motion direction). It was discovered that in tropical cyclones experiencing effects from wind shear, an increase in absolute angular momentum transport occurs downshear and often downshear right. The surface wind speed low-wavenumber maximum in turn forms downwind of this momentum transport.
Optical Absorption Characteristics For  7F0'→5L6' and  7F0'→ 7F6' Transitions of Trivalent Americium Ion in Aqueous Electrolyte Mixtures
Authors: Zalupski Peter R. , Grimes Travis S. , Heathman Colt R. , Peterman Dean R.
Published: July 2017

Optical absorption features for [Formula: see text] and [Formula: see text] transitions of trivalent americium ion were investigated in a wide range of aqueous combinations of perchloric and nitric acids (0.1–6.0 mol L−1). The developed qualitative matrix of extinction coefficients measures the cumulative impact of increasing electrolyte content, changes in the hydration zones of americium ion, and inner-sphere perturbation by nitrate on the absorbance. The effects of growing complexity of aqueous electrolyte medium were highlighted for the [Formula: see text] transition. Spectroscopy indicates the perturbation of the inner hydration sphere of trivalent f-element by one nitrate ligand.
A Simulation-Free Exact Conditional Goodness-of-Fit Test for The Binomial Distribution
Authors: Hazra Arnab
Published: July 2017

ABSTRACT:

Several exact testing methods for continuous distributions, asymptotic as well as simulation based exact methods for both- discrete and continuous cases have been developed for analyzing goodness-of-fit, a priori. An exact Kolmogorov-Smirnov type goodness-of-fit test is developed for checking whether the data comes from a binomial distribution or not. This is a conditional test; p-value is calculated as the conditional probability given the sample total and hence the success probability need not be specified under the null hypothesis. Instead of using simulation, p-value is calculated using a sequential procedure and hence the inference procedure is simulationfree. Properties of the test, some examples, power comparisons with other existing techniques are also provided.
Parametric Analysis of Lifetime Data With Multiple Causes of Failure Using Cause Specific Reversed Hazard Rates
Authors: Anjana S. , Sankaran P. G.
Published: July 2017

ABSTRACT:

Lifetime data with multiple causes of failure is a common phe-nomenon in survival studies. The present paper focuses on the parametric regression analysis of lifetime data with multiple causes of failure. We define the cause specific reversed hazards model in the presence of covariates with inverse Weibull as baseline distribution. This parametric regression approach facilitates analysis of lifetime data with multiple causes of failure under left-censoring. We discuss the estimation of the parameters of the model. Simulation studies are carried out to examine the finite sample behaviour of the estimators. We illustrate the applicability of the proposed model using a real-life data set.
Optimal Block Designs for Diallel and Double Cross Experiments
Authors: Sharma M. K.
Published: July 2017

ABSTRACT:

Methods of construction of optimal block designs for a diallel cross and double cross experiments are proposed for even value of p of parental lines. The proposed designs are obtained by using unreduced balanced incomplete block designs.
Choosing A Coalition Partner
Authors: Norpoth Helmut
Published: July 2017

In political systems governed by coalitions of parties, popular representation greatly hinges on the extent to which elite political actors heed the coalition preferences of the mass public in their coalition behavior. This article examines elite responsiveness of this type in the German Federal Republic during the 1961–1976 period. The coalition preferences of the German public are shown to favor heavily the party coalitions formed by party elites. While this may hint at popular influence, the probing of change in coalition preferences demonstrates that influence occurs in the reverse direction. That is, most voters attached to one of the major parties (SPD or CDU/CSU), adopt the coalition decisions of their party's leaders as their own preferences. These leaders, as a result, enjoy great leeway in their coalition behavior. However, voters aligned with the third party (FDP) prove far less obliging toward their party leaders. The behavior of these voters, ironically, preserves some leverage at the mass level regarding elite coalition behavior.
Education, Ethnicity, and Political Socialization In Kenya
Authors: Keller Edmond J.
Published: July 2017

This study of a purposively selected cohort group of 525 Kenyan adolescents at varying levels of education (no education, primary education only, and secondary education) attempts to shed light on the role of education in the political socialization of youth in Africa. Hypotheses relating to the effects of education and selected demographic variables on the level of political information and interest, value orientations, and the level of diffuse support found among the members of this cohort group are tested. Employing cross tabulation, bivariate analysis, and regression analysis, it is found that education has an extremely important effect on the levels of political interest and knowledge of individuals. Findings with respect to values are less convincing, but education does appear to be closely related to support for the political system. Of the demographic variables, ethnic identity explains the most variance in levels of diffuse support, but this effect diminished when education was controlled. Given the volatile nature of ethnically based political competition in Africa, the primary implications of this study relate to conditions under which the level of education becomes a less significant influence on level of diffuse support and ethnicity becomes more important, as well as the content and context of education.
Authoritarianism and the Growth of the State in Latin America
Authors: Most Benjamin A.
Published: July 2017

The discussion focuses on the effects that changing forms of authoritarian rule and the growth of a bureaucratic state had on A gentine public policies during the 1930-1970 interval. Hitherto quite separate literatures are brought together in the examination of two different arguments. The first, drawn from the emerging literature on authoritarianism and corporatism in Latin America, suggests that the trends in Argentine public policies should have been interrupted whenever different types of authoritarian coalitions sequentially replaced each other in power. The second thesis, drawn primarily from research on Latin American bureaucracies and North American policy analyses, suggests that there is a need to disaggregate the coalition/policy linkage. It hypothesizes that four factors which developed at about the midpoint of the 1930-1970 period in Argentina—the growth of a large and well-entrenched public sector, limitations on the ability of political elites to press their policy demands, limitations on previously uncommitted resources, and the existence of a crisis of hegemony—should have increasingly constrained the policy-making importance of the coalitions and the leaders who represented them in the highest levels of government. Coalitions and elites should have been increasingly unable to direct and indirect policies in the ways which they preferred. Interrupted time-series analyses of seven policy series provided support for the constraints thesis. Coalitions and those who governed at the top were once important in Argentina as the authoritarian literature suggests. Coalition changes did not occur in a vacuum, however. Once the four state-related constraints developed, such shifts came to have only marginal impacts on the examined policy indicators.
Feminist Perspectives on Bible and Theology An Introduction to Selected Issues and Literature
Authors: Sakenfeld Katharine Doos
Published: July 2017

In feminist approaches to Scripture, the question of the source of authority for the Christian faith plays a central role, especially for those who name themselves both feminist and Christian.
The Emerging Church and the Problem of Authority in Acts
Authors: Tyson Joseph B.
Published: July 2017

The interpreter must keep constantly in mind the fact that Luke did not intend to write a constitution for the emerging church but rather a narrative of its beginnings which stressed equally both continuity and change.
Toward a Theology of Acts
Authors: Gaventa Beverly Roberts
Published: July 2017

To see in Acts only the triumphalist theology of a God who overruns all opposition is to miss the equally strong emphasis in this narrative on the rejection of the gospel and the persecution of its apostles; both are needed if Acts' theology is to be correctly understood.
“Eyewitnesses and Ministers of the Word”
Authors: Willimon William H.
Published: July 2017

While history is important to Luke as he writes his “orderly account,” history here is the vehicle of kerygmatic art, not art in its modern expression—the chic pastime of a jaded bourgeoisie—but art in service of the conversion and sanctification of the church.
On the Road Again
Authors: Wharton James A.
Published: July 2017

If Abraham is on the road again in the Christian movement, he will provoke preachers to think unaccustomed thoughts, and listeners will recapture something of the Abrahamic character of the Christian journey with God through real history.
Immediate Verbal Memory and Linguistic Sophistication in a Group of Six-Year-Old Children
Authors: Bruce D.J. , Pugh Hazel M.
Published: July 2017

Thirty-three six-year-olds were given an immediate memory task, the material for which consisted of various orders of statistical approximation to English, plus extracts from actual text. The children were found to differ in the extent to which they utilised the available contextual constraint as an aid to recall, and these differences were shown to be associated with the level of linguistic sophistication reached by the children on several established tests of language development. In addition to these tests, a newly devised test of " linguistic restructuring" was administered to the children. The results of this test showed a significant degree of relationship between linguistic restructuring and immediate recall, and they also seemed to be related to performance on the statistical approximations task.
Naming Sequentially Presented Letters and Words
Authors: Kolers Paul A. , Katzman Martin T.
Published: July 2017

Subjects were presented with sequences of letters six units long. The sequences were presented serially so that each letter of a sequence fell upon the same part of a viewing screen as every other one. The task was to name the letters or to name the words they formed. The principal variables were the kinds of words, the duration of a blank interval between the third and fourth letters of a sequence, and the duration of the individual letters.

Correct responses were found to increase toward 100% as the duration of the letters approached about 1/3 sec. The magnitude of the interval between the third and fourth letters had little effect upon recognition. Contextual factors were found to exert influences that enabled the words to be grouped over relatively long temporal separations. A distinction can be made experimentally between naming letters and naming the word they spell. In addition, it was found that the subject could sometimes name all the letters in a sequence but got their order wrong. This is taken to indicate differences in the mechanisms associated with identifying events and identifying their temporal order.
The Speech Production and Spoken Language of the Deaf
Authors: Brannon John B.
Published: July 2017

The distinction was made between speech production and spoken language in analysing the oral output of those with hearing impairment. A brief review of studies in both areas was undertaken, including the report of a new electronic visual monitoring device, the glossal transducer. It was postulated that the deaf utilise a unique visual-to-motor conversion within the brain when speaking and monitor consciously by tactile-kinæsthetic control. The more recent studies relate to the syntactical features of the speech of the deaf. These show that deafness creates telegraphic speech with reduced sentence length and omissions of essential words such as functors. The speech of the deaf seems to contain mostly nouns and verbs, with a limited number of words used to expand verb forms.
On the Relation Between Processing the Roman and the Cyrillic Alphabets: a Preliminary Analysis with Bi-Alphabetical Readers
Authors: Lukatela G. , Savić M.D. , Ognjenović P. , Turvey M.T.
Published: July 2017

Serbo-Croatian is read, to a greater or lesser degree depending on locale, in two alphabets, the Roman and the Cyrillic. While most letters are solely members of one or the other alphabet, some letters are shared and of these, some are ambiguous in that they are read differently in the two alphabets. The order in which the alphabets are acquired depends on geography: in the eastern part of the country the order is Cyrillic then Roman; in the western part of the country the order is Roman then Cyrillic. A series of six experiments is reported examining the relation, in processing terms, between the two alphabets. Evidence is presented for a processing asymmetry. Processing the letters of the first-acquired alphabet is more similar to processing the letters of the second-acquired alphabet than vice versa. Additionally, it is shown that searching for a letter in the other alphabet is faster than searching for a letter in the same alphabet, suggesting that alphabet categorization may precede letter identification. The results are discussed in terms of the general problem of operating with two separately used symbol systems.
Comprehension of Relative Clauses By Children Aged Five To Nine Years
Authors: Fluck Michael J.
Published: July 2017

Although studies of children's speech suggest that sentences with object relative clauses ( O) are mastered before those with subject clauses (S), there are reasons for predicting that children comprehend the latter first. The present research confirms the findings of an earlier study which supported this. In addition, the results indicate that the O form is not reliably comprehended until nine years, some two years after the S form. Evidence was obtained which lends support to the hypothesis that interpretation of O, but not S, sentences dedepends on the attainment of a certain level of operational thought, although further research is required.
Using Centering to Relax Gricean Informational Constraints on Discourse Anaphoric Noun Phrases
Authors: Passonneau Rebecca J.
Published: July 2017

In this paper, I explore the interaction among several factors argued to constrain discourse anaphoric expressions: the local centering context consisting of successive pairs of utterances; the informational content of a discourse anaphoric expression relative to the set of entities that need to be discriminated; the choice among different kinds of discriminating information; and the global attentional state that derives from the structure of an entire discourse. Specifications for the model are based on analysis of such factors in a corpus of spontaneous oral narratives. Then I use a reserved set of narratives for evaluating a simplified version of the generation model. The model integrates informational constraints, based on Dale's (1992) model, with centering. I show that by integrating centering constraints, the integrated model can account for two types of violation of informational constraints: informationally inadequate pronouns where the pronoun realizes the current backward-looking center, and certain full noun phrases in utterances where the backward-looking center is not overtly mentioned, and use of a pronoun would produce garden-path effects. I argue that for generation, centering constraints take precedence over informational constraints. The evaluation tests three conditions: informational constraints (1) with no focus structure imposed on the discourse, (2) with an empirically derived global focus structure, and (3) with global focus plus centering. Results improve dramatically under each subsequent condition.
Least Preferred Co-Worker Score as a Measure of Cognitive Complexity
Authors: Arnett Matthew D.
Published: July 2017

To test the assertion by Foa, Mitchell, and Fiedler (1971) and by Mitchell (1970) that Fiedler's Least Preferred Co-worker scale measures cognitive complexity, questionnaires from 357 subjects were subjected to the complexity analysis of Foa, et al. (1971). The perceptions of high scorers were not more complex than those of low scorers. Self-ratings of effectiveness of performance of 88 leaders of small groups were correlated with the ratings of their 269 subordinates. Self-assessments of high scoring leaders were not more accurate than those of low scoring leaders. Results seem to question cognitive complexity as an interpretation of scores on the Least Preferred Co-worker scale. In a second analysis, the variance score of the questionnaire, another measure of cognitive complexity (Evans & Dermer, 1974), showed subjects with high variance held more complex perceptions of their least preferred co-workers and made more accurate assessments of their own performance than did subjects with low variance.
The Role of Dihydrocodeine in Causing Death among Drug Users in the West of Scotland
Authors: Seymour A. , Black M. , Jay J. , Oliver J. S.
Published: July 2017

There has been a wealth of information relating to the role of methadone in fatalities over the past decade. However, a dearth exists in the literature of deaths involving dihydrocodeine, a substitute that is being increasingly prescribed by general practitioners for drug harm reduction purposes. Over the past five years in the Strathclyde region of Scotland there has been an increase in the number of drug related deaths involving dihydrocodeine with the largest increase occurring in the latter two years. This in combination with a general acceptance for this drug as a substitute for methadone amongst general practitioners highlights its potential abuse factor which is addressed in this paper. As the number of methadone deaths in relation to the total number of accidental drug related deaths per annum decrease, those related to dihydrocodeine are shown to be increasing.
Lymphangioleiomyomatosis A Series of Three Case Reports Illustrating the Link with High Oestrogen States
Authors: Wilson A.M. , Slack H.L. , Soosay S.A. , Taylor T. , Carey F.A. , Grove A. , Brown P.H. , Winter J.H.
Published: July 2017

Lymphangioleiornyomatosis is a rare lung disorder characterised by cystic air spaces and smooth muscle proliferation. The condition, which most commonly presents with dyspnoea, pneumothoraces or cough, is only described in fernales and is most commonly diagnosed during childbearing years. Three cases are presented which illustrate typical features of the disease and the association with high oestrogen levels. The first had recurrent pneumothoraces during her first pregnancy. The second lady was post menopausal at diagnosis but her symptoms predated her menopause. The third, presented with dyspnoea, abnormal chest sensations and a pneumothorax. She had a history of hyperprolactinaemia with secondary amenorhoea due to low oestrogen levels which had been corrected prior to her presentation. All three patients had reduced gas transfer and abnormalities in spirometry, two had reticular shadowing on their chest radiograph and all had typical appearances on lung computerised tomography. Although disease progression was variable, all patients showed a gradual decline in lung function.
Hypothermia in Elderly Patients Presenting to Accident & Emergency During the Onset of Winter
Authors: Pedley D.K. , Paterson B. , Morrison W.
Published: July 2017

It is well established that the elderly population is vulnerable to hypothermia, leading to increased morbidity. A prospective observational study took place between 1 October 1999 and 31 December 1999 in a large teaching hospital Accident and Emergency department. Core temperature was assessed at presentation using a tympanic probe on patients over 65 years of age. A total of 1543 eligible patients attended during the study period. Complete data was available on 958 patients. Forty-eight patients (5%) were found to be hypothermic (core temperature <350Celcius). There were two peaks in hypothermic presentations; these corresponded to periods of cold weather. The incidence of hypothermia was higher in non-ambulant patients and those with co-morbidity; the majority of patients lived in relatively deprived areas by a postcode derived deprivation index. Mortality was 34% in patients hypothermic at presentation.

Hypothermia contributes to mortality and morbidity in elderly patients; its incidence may be higher than previously reported.
Atypical Presentation of Tuberculosis Meningitis: A Case Report
Authors: Souza R. D , Franklin D. , Simpson J. , Kerr F.
Published: July 2017

A 19 year old woman presented with atypical symptoms of tuberculous meningitis. Meningitis is the most serious form of tuberculosis (TB) and it often presents with nonspecific signs and symptoms. Delayed diagnosis can result in rapid progression of neurological deficits and poor prognosis. Polymerase chain reaction and other nucleic acid amplification methods are becoming increasingly useful for the rapid detection of Mycobacterium tuberculosis in the cerebrospinal fluid. Early treatment reduces morbidity and mortality of this serious condition.
A Medical Bouquet Poppies, Cinchona and Willow
Authors: Fleming L. W.
Published: July 2017

The poppy, the cinchona tree and the willow tree have all provided medicines of undoubted value during past milleniums and form a “medical bouquet” worthy of consideration as this century ends. The use of these plants by ancient peoples has gradually evolved into a more informed understanding and application of the compounds initially isolated and purified from their extracts. There has been a Scottish contribution to the medical history of all three plants.
Care takers’ recall of Integrated Management of Childhood Illness counselling messages in Benin
Authors: Kelly Jane M , Rowe Alexander K , Onikpo Faustin , Lama Marcel , Cokouits Francois , Deming Michael S
Published: July 2017

A key goal of the Integrated Management of Childhood Illness (IMCI) strategy is to improve the management of childhood illness at health facilities. IMCI guidelines contain many counselling messages, and as it is not known how well caretakers recall these messages, we studied caretakers’ recall of IMCI messages when given under ideal conditions. At a clinic in Benin, a study clinician performed counselling and confirmed caretakers’ comprehension of all messages. Caretakers were randomly assigned to be interviewed either immediately after the consultation or a day later. Recall was assessed with general and focused open-ended questions. Recall was assessed for 55 caretakers, 29.1% of whom were literate. Caretakers received 3-75 messages (mean = 38.7). The mean percentage of messages recalled was 89.7% immediately after the consultation and 81.9% one day later. These results support IMCI's recommendation that health workers should verify caretakers’ comprehension by asking caretakers to repeat counselling messages during consultations.
Obstetric complications, intervention rates and maternofetal outcome in teenage nullipara in Benin City, Nigeria
Authors: Ebeigbe Peter N , Gharoro Etedafe P
Published: July 2017

An audit to determine the incidence of births to teenage nullipara, pregnancy complications, obstetric intervention rates, maternal and fetal outcomes in 114 teenage nullipara compared with 700 randomly selected older nullipara (age 20–29 years), was undertaken in a tertiary Institution. Births to teenage nullipara contributed 1.7% of all deliveries. Teenagers were significantly more likely to be unbooked for antenatal care(P < 0.0001), book late (P < 0.0001) and be single mothers (P < 0.0001). Teenagers were also significantly more likely to have primary education (P < 0.0001), secondary education (P < 0.001) or be apprentices (P < 0.0001). Teenagers had a significantly higher incidence of caesarean sections (P = 0.0002). There were no significant differences in the incidence of pregnancy complications, induction oraugmentation of labour, preterm delivery, instrumental deliveries and fetal outcome. The maternal mortality ratio for teenagers was 1835 per 100,000 live births. There were no deaths among the older nullipara. It is concluded that the differences in obstetric intervention rates and maternal outcome are due to poor utilization of antenatal care and other social disparity.
Maternal mortality in a Nigerian teaching hospital - a continuing tragedy
Authors: Aboyeji A P , Ijaiya M A , Fawole A A
Published: July 2017

The aim of this review is to determine the maternal mortality ratio (MMR) in a Nigerian tertiary health institution (University of Ilorin Teaching Hospital, Ilorin, Nigeria). The review was done through a retrospective analysis of maternal mortality records. The MMR for the 6-year period (1997-2002) was 825 per 100,000 live births. The common causes of maternal mortality included severe pre-eclampsia/eclampsia, 30 (27.8%); haemorrhage, 22 (20.4%) and complications of unsafe abortion 16 (14.8%). Grandmultiparous and patients aged 40 years and above were at the highest risk. This hospital-based MMR is very high and when compared with previous reports showed a 150% increase. Most of the maternal deaths are, however, preventable. Increased efforts at educating women, improvement of the socioeconomic conditions of the populace and strong political commitment in making emergency obstetric care available in rural and district hospitals are some of the measures that need to be adopted to reduce this avoidable tragedy.
Fetal sex-determination in Delhi: A population-based investigation
Authors: Chaturvedi S , Chhabra P , Bharadwaj S , Smanla S , Kannan A T ,   Students Study Group
Published: July 2017

A population-based cross-sectional inquiry was carried out in Delhi to assess the practice of fetal sex determination, sex-selective abortions and awareness about the related law. Atotal of 1514 respondents, selected through multistage cluster sampling from all across Delhi, were interviewed using a pretested, semistructured questionnaire.

Legal awareness (73.6%) was significantly better among the male and urban respondents. Only 39 (2.6%) of the respondents had ever gone for fetal sex determination. In 17 (43.6%) of them, it was done in spite of being aware of its unlawfulness, and in 33 (84.6%), the couple had one or more living male children. Frequency of fetal sex determination was comparable for slum and urban areas. Fifty-six additional cases of fetal sex determination, occurring in the neighbourhood of the respondents, were also reported. A total of 28 cases of female feticide were reported.

Awareness about the illegality of fetal sex determination has improved, compared with the 1997-1998 data collected from East Delhi (55.3-73.6%). However, this comparison also shows a marginal increase in the practice of fetal sex determination (2.1-2.6%). In all cases of feticide, a qualified doctor was involved.

A number of couples abandoned the abortion plan midway, even after detecting that the fetus was female, and there were occasional cases where the doctor refused to abort the female fetus.
Conceptual model for the prevention of maternal mortality in Nigeria
Authors: Inegbenebor Ute
Published: July 2017

Maternal mortality rates are much higher in developing countries than in the developed countries. In Nigeria, rates between 500 and 1500 per 100,000 are common. Questionnaires were administered to 30 primary health centres in Edo central senatorial district of Nigeria in order to find out the staffing, 24 h staff coverage of the primary health centre and difficulties encountered in referring patients. It was found that most of the primary health centres had no doctor coverage. The average number of midwives per centre was two, and transport was not usually available for transfers especially at night. It was concluded that lack of commitment on the part of all tiers of government was the reason behind the high mortality rates, and a conceptual model of one resident doctor per centre, with a 24 h coverage by midwives and a central ambulance centre for each local government area, was proposed for the reduction of maternal mortality, using the available resources in Nigeria.
Critical care management of gynaecological patients in Enugu, Nigeria
Authors: Okafor U V , Efetie R E
Published: July 2017

A retrospective study of the management of gynaecological patients admitted to the general intensive care unit (ICU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, over a 6-year span was carried out. Out of a total of 816 patients admitted to the ICU during the study period, 21 (2.6%) were gynaecological patients with the following diagnoses: generalized sepsis, postoperative respiratory distress, hypovolaemic shock, preoperative anaemia and mennorhagia, and major surgery with potential for major complications. The mortality rate was 28.6% with six deaths, sepsis being the major cause of death (four fatalities).
The Relationship between Language Skills and Competence to Stand Trial Abilities in Persons with Mental Retardation
Authors: Everington Caroline , DeBerge Katherine , Mauer Daria
Published: July 2017

Competence to stand trial is a critical issue for persons with mental retardation. Information on related abilities such as cognitive and linguistic functioning can enhance the accuracy of evaluations. This study examined the relationship between language ability and competence to stand trial in 39 adults with mild to moderate mental retardation. Language ability was measured by the language subtests of the Woodcock-Johnson Tests of Cognitive Ability and competence to stand trial ability by Section I, Basic Legal Concepts, and Section II, Skills to Assist in Defense, of the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR). The results indicated that individuals scoring in the competent range on the CAST-MR scored significantly higher on several Woodcock-Johnson subtests and achieved significantly higher language total scores. A discriminant analysis indicated that three Woodcock-Johnson subtests predicted a competence classification accuracy rate of 78%. Implications for competence evaluation and restoration for persons with mental retardation are discussed.
Automatic Commitment of Insanity Acquittees: Keeping up with the Jones?
Authors: Miller Robert D.
Published: July 2017

Ever since the inception of insanity as a formal defense, the laws have required that successful insanity acquittees be hospitalized, usually indefinitely. While hospitalization is typically appropriate clinically, and is necessary for public protection until the acquittee's mental disorder is under adequate control, a number of acquittees have been living successfully in the community awaiting trial and do not require hospitalization. The author presents several illustrative cases and discusses the legal and social barriers preventing many of these acquittees from remaining in the community after an insanity acquittal.
Competency to Stand Trial: A Law, Psychology, and Policy Assessment
Authors: Bardwell Mark C. , Arrigo Bruce A.
Published: July 2017

Competency to stand trial (CST) is a contentious pretrial issue, confounded by ambiguous legal standards and inaccurate clinical tools. This article systematically explores both the controlling case law and the evolving assessment instruments, mindful of where and how they advance (or not) effective courtroom decision making. In the wake of our analysis, we propose a series of (criminal justice) policy reforms that address the problems posed by the CST legal doctrine and assessment technology. In brief, we call for changes with the competency evaluation procedures, the psychological instruments, and the legal remedies and/or strategies made available to the accused. We conclude by arguing that these revisions must be implemented if meaningful reform is to be effected for defendants whose competency is called into question prior to a criminal trial.
Nonsexual Boundary Violations: Sauce for the Gander
Authors: Miller Robert D. , Maier Gary J.
Published: July 2017

Numerous articles in the mental health literature concern sexual contact between therapists and patients, which is explicitly prohibited by all four mental health professions' ethical codes. There is relatively little about nonsexual boundary violations, which are often covert and much more difficult to recognize (particularly in their early stages) than sexual violations; what little there is assumes that the clinician has the power in the relationship and uses that power for personal advantage. In this article the authors discuss the situation, rare in civil mental health facilities but common in correctional and forensic mental health facilities, in which personality-disordered patients manipulate and coerce clinicians to cross appropriate professional nonsexual boundaries for the patients' benefit; this reversal of the usual power dynamics between treaters and patients requires recognition of the role reversals present and requires different strategies for preventing such violations (hence “sauce for the gander”).
Improving the Reliability of Expert Testimony in Suicide Litigation
Authors: White Thomas W.
Published: July 2017

The topic of suicide assessment is of interest to mental health practitioners because it is one where they often feel very susceptible to criticism in the event of a completed suicide. In the absence of defined academic or professional standards, practitioners rightfully feel vulnerable to the potential consequences of a legally challenged assessment. The lack of recognized standards is also problematic for trial courts because it forces them to rely heavily on the testimony of expert witnesses. In recent years the standard for admissibility of proposed expert testimony in federal court has changed significantly, shifting from emphasizing experts' credentials as the primary bases for their testimony to a more scientific analysis of the methods and practices they used in reaching their conclusions. The federal standard gives far more latitude to trial judges to accept or reject an expert's proposed testimony based on its perceived relevance and reliability. These new standards permanently change the criteria attorneys will use in selecting experts to provide mental health testimony. Now attorneys must find experts who not only are qualified but whose testimony can withstand rigorous examination to determine its scientific merit. This paper acquaints potential mental health experts with these new guidelines and presents criteria for developing more objective guidelines to evaluate the adequacy of any suicide assessment while ensuring the scientific reliability of testimony.
Call 911: Psychiatry and the New Emergency Medical Treatment and Active Labor Act (EMTALA) Regulations
Authors: Saks Samuel J.
Published: July 2017

The Emergency Medical Treatment and Active Labor Act (EMTALA), enacted in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985, aims to prevent “patient dumping” by requiring hospitals to screen and stabilize patients who come to an emergency room seeking medical attention. For many reasons, recovery under EMTALA is rare, especially when psychiatric treatment is called for. New regulations of EMTALA went into effect on November 10, 2003. These new regulations helpfully clarify the applicability of EMTALA. However, the bias against recovery in cases involving psychiatric emergencies is likely to remain.
The Challenges of Sexual Offense Treatment Programs in Correctional Facilities
Authors: Schneider Jennifer , Bosley Jackson Tay , Ferguson Glenn , Main Merrill
Published: July 2017

This article addresses issues surrounding the organizational planning and evaluation of specialized sex offender treatment programs in secure correctional environments. The authors describe the problems of designing and establishing a therapy program in an anti-therapeutic environment and techniques for maintaining treatment integrity through the adoption of a structured planning and review process. Educating the public about program clientele and the development of relationships with local policymakers and community-based agencies through networking and public relations plays an influential role in the success or failure of any treatment program by ensuring the accuracy of information and preventing rumors regarding risk to the community. Program evaluation assists in the measurement of program efficacy, provides tangible proof of success or failure, and facilitates the improvement of programming and services.
Reasonable Medical Certainty: A Rose by Any other Name
Authors: Miller Robert D.
Published: July 2017

The phrase “reasonable certainty” has become embedded in the legal world of expert testimony, the version used with physicians being “reasonable medical certainty,” and with psychologists usually “reasonable scientific certainty.” Such experts are required to sanctify their opinions in court in virtually every jurisdiction by uttering the magic words before their testimony will be admitted as expert. Unfortunately, the phrase has no consistent legal meaning, often no specified meaning at all. Courts differ as to its definition, if they define it at all. The author reviews case law and the legal and forensic clinical literature on the subject, and discusses options for expert witnesses forced to couch their opinions within the standard.
Shaken Baby Syndrome
Authors: Isser Natalie K. , Schwartz Lita Linzer
Published: July 2017

“Shaken Baby Syndrome (SBS)” is described by a number of symptoms (not always agreed upon by experts) and can lead to lifelong problems or death. There are many possible motives for shaking a baby, usually six months old or younger, some of which might be averted by better parent education. The legal ramifications of shaking a baby resulting in severe physical stress or death vary to some extent by perpetrator and/or by state.
Termination of Parental Rights: Focus on Defendants
Authors: Bogacki David F. , Weiss Kenneth J.
Published: July 2017

The result of investigations of child abuse and neglect allegations may include the State's taking action to terminate parental rights (TPR). Though unification is ostensibly the goal in the early stages of the proceedings, the defendants with the most difficulty complying with the demands of the child-protection agency—those with mental illness, developmental disabilities, learning disabilities, and other cognitive deficits—often find themselves on an inexorable course toward termination. The authors have drawn upon a sample of 300 cases from New Jersey to explore the diagnostic types among defendants in these cases. The results include a significant proportion of individuals with readily treatable conditions, such as mood and anxiety disorders, as well as those with varying degrees of cognitive deficits, whose needs often go unmet. The authors identified a high percentage of defendants with learning disorders and borderline intellectual functioning. The article concludes by discussing ways in which defense expert witnesses can enlighten the parties in TPR cases, thereby enhancing prospects for reunification where appropriate.
Institutional Risk Management Education and Consultation (IRMEC): A Jurisprudent Science Perspective
Authors: Gutheil Thomas G. , Drogin Eric Y. , Friedman Rohn S.
Published: July 2017

Institutional Risk Management Education and Consultation (IRMEC) represents an application of the combined knowledge bases of occupational and organizational psychiatry, organizational psychology, and forensic psychiatry and psychology, to the specific context of risk management in hospitals and other healthcare organizations. The two primary dimensions of IRMEC are: (1) evaluation and education with respect to psychiatric risk management; and (2) consultation and education with respect to psychiatric aspects of general medical practice. From a “jurisprudent science” perspective, the “science” underlying IRMEC-based treatment interventions is well founded, its “practice” includes harmonizing institutional policy and clinical judgment, and its “roles” are grounded in traditional sources of ethical guidance for psychiatrists and psychologists.
The “Revival of Memory” of Childhood Sexual Abuse: Is the Tolling of the Statute of Limitations Justified?
Authors: Slovenko Ralph
Published: July 2017

This article examines the effect of freshly-revived-memory evidence on the tolling of statutes of limitations in civil and criminal cases involving adult victims of childhood sexual abuse. Specifically, the author criticizes the application of the discovery rule, which may operate to toll the statute of limitations for many years after the alleged incident(s), to cases in which recently revived memories of childhood sexual abuse constitute the only evidence of such abuse. Arguing that these memories may be falsely implanted or encouraged by mental health professionals without regard for their accuracy, the author would require corroborating evidence of abuse in order to justify the application of the discovery rule in such cases.
Confidentiality of Psychiatric Examinations in Criminal Cases
Authors: Slovenko Ralph
Published: July 2017

This article covers the confidentiality of communications made to a psychotherapist and communications to a forensic examiner. Following an introduction distinguishing the two situations, there is a discussion of: (1) confidentiality when a plea of insanity is entered; (2) discovery by law-enforcement officials in non-insanity cases; and (3) discovery by the defendant. The use of search warrants is also discussed.
Domiciliary visits to the old and the mentally ill: How valuable?
Authors: Crome Peter , Malham Alison , Baker Dereth , Smith Allison E , Bloor Roger
Published: July 2017

In the early days of the British National Health Service, domiciliary visits were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patient's home. The nature of domiciliary visits, which still attract a special fee, has since changed. We analysed the effectiveness of all domiciliary visits undertaken in a NHS trust providing primary care, mental health and elderly care services to a population of 470 000. Data were obtained from domiciliary visit claim forms and from questionnaires completed by the consultant, the referring GP and consultant peer reviewers. The largest number of visits (total 234) was in geriatric medicine 48.9%, followed by old-age psychiatry 44.9%. Geriatric medicine was more likely than psychiatry to admit patients to hospital (19%) after a visit. All domiciliary visits in old-age psychiatry were done during the day (9 am to 5 pm). Only 2% of GPs stated that they attended any of the domiciliary visits; almost all thought that the outcome of domiciliary visits was of value. Old-age-psychiatry peer reviewers believed that all visits in that specialty were appropriate; in geriatric medicine this figure was 77% and in other psychiatric specialties 65%. The findings indicate that domiciliary visits were not being used routinely as a pathway to hospital admission, though they were often used to expedite admission or gain a quick consultant opinion; the visits were valued by GPs. The practice of domiciliary visits differs greatly from the definition in NHS terms and conditions of service. One or other should be altered.
Consultation skills of medical students before and after changes in curriculum
Authors: Utting M R , Campbell F , Rayner C , Whitehouse C R , Dornan T L
Published: July 2017

The University of Manchester Medical School has adopted problem-based learning as its main educational method, with a change of emphasis from a biomedical to a biopsychosocial approach. The training of junior medical students in clinical interviewing is intended to reinforce and develop their interpersonal skills. We measured the impact of this new curriculum by assessing two intakes of students covering the period before and after its introduction; a third intake was later added to examine the effect of further curriculum adjustments. 86 students, randomly selected, were videorecorded conducting diagnostic interviews with standardized patients 10 weeks after they had started to learn clinical interviewing. Two instruments were developed—a 23-item communication skills scale and a 13-item information-gathering scale and both showed acceptable inter-rater and test-retest reliability. Communication skills did not differ between years. The total score for information-gathering fell by 13% (95% confidence interval –20 to –6%, P 0.001) in the first year after introduction of the new educational approach but returned to baseline the following year after further modification of the course. Although the new approach yielded no measurable improvement in the process of communication, assessment 10 weeks after the start of interview training may be too early to permit definitive conclusions. We conclude that it is possible to change to a more patient-centred emphasis in teaching medical interviewing. Some initial loss of information content was rectified by adjustment of the course. Our unfavourable early experience highlights the need to evaluate educational change.
Adverse effects of spinal manipulation
Authors: Barrett Ailsa J , Breen Alan C
Published: July 2017

Guidelines on acute back pain recommend spinal manipulation, but some commentators express concern that the adverse effects are under-reported. Eleven chiropractors distributed questionnaires to 108 consecutive new patients aged >18 years, enquiring about adverse effects one hour, one day and two days after spinal manipulation. The forms were to be completed anonymously. 80 questionnaires (74%) were returned, 68 suitable for analysis. 28 patients reported adverse effects at one hour after treatment, the most common of which were extra pain (14) and radiating pain (9). 8 had reactions beginning the morning after. No serious adverse effects were reported. The adverse reactions, recorded in 53% of respondents, are those to be expected from a treatment that entails initial discomfort. They need to be set against the long-term benefits of spinal manipulation.