Assessing the probability of patients reoffending after discharge from low to medium secure forensic mental health services: An inductive prevention paradox

Citizens of developed societies are troubled by those who commit ‘irrational' crimes against the person. Reoffending by ex-patients following their release from secure mental health services triggers particularly intense angst when amplified by media and political scrutiny. Forensic mental health service providers are expected to minimise the occurrence of such transgressions by releasing only those patients who are judged acceptably unlikely to reoffend. However, reoffending probabilities can only be estimated by observing behaviour in secure institutional settings designed specifically to prevent patients from transgressing. The article explores this ‘inductive prevention paradox' which arises when the implementation of measures designed to avoid an adverse event obscures direct observation of what might have happened if prophylaxis had not been attempted. The analysis presented draws on data obtained in 1999–2003 from two qualitative studies in medium to low secure UK institutions, one providing forensic mental health services and the other forensic learning disability services. We explored the views of 56 staff members and 21 patients about risk management in forensic services and undertook additional 25 staff interviews for case studies of the 21 patients. The wider applicability of the inductive prevention paradox will be considered in the Discussion. We argue that the prognostic limitations arising from prevention have been underestimated by policy makers and in official inquiries; and that the prevailing personal risk assessment framework needs to be complemented by greater attention to the environments which patients will be discharged into

A Tool for Custom Construction of QMC and RQMC Point Sets

We present LatNet Builder, a software tool to find good parameters for lattice rules, polynomial lattice rules, and digital nets in base 2, for quasi-Monte Carlo (QMC) and randomized quasi-Monte Carlo (RQMC) sampling over the s-dimensional unit hypercube. The selection criteria are figures of merit that give different weights to different subsets of coordinates. They are upper bounds on the worst-case error (for QMC) or variance (for RQMC) for integrands rescaled to have a norm of at most one in certain Hilbert spaces of functions. We summarize what are the various Hilbert spaces, discrepancies, types of weights, figures of merit, types of constructions, and search methods supported by LatNet Builder. We briefly discuss its organization and we provide simple illustrations of what it can do.NSERC Discovery Grant, IVADO Grant, Corps des Mines Stipend, ERDF, ESF, EXP. 2019/0043

Electrostatic Patch Effect in Cylindrical Geometry. I. Potential and Energy between Slightly Non-Coaxial Cylinders

We study the effect of any uneven voltage distribution on two close cylindrical conductors with parallel axes that are slightly shifted in the radial and by any length in the axial direction. The investigation is especially motivated by certain precision measurements, such as the Satellite Test of the Equivalence Principle (STEP). By energy conservation, the force can be found as the energy gradient in the vector of the shift, which requires determining potential distribution and energy in the gap. The boundary value problem for the potential is solved, and energy is thus found to the second order in the small transverse shift, and to lowest order in the gap to cylinder radius ratio. The energy consists of three parts: the usual capacitor part due to the uniform potential difference, the one coming from the interaction between the voltage patches and the uniform voltage difference, and the energy of patch interaction, entirely independent of the uniform voltage. Patch effect forces and torques in the cylindrical configuration are derived and analyzed in the next two parts of this work.Comment: 26 pages, 1 Figure. Submitted to Classical and Quantum Gravit

Algorithmic decidability of Engel's property for automaton groups

We consider decidability problems associated with Engel's identity ($[\cdots[[x,y],y],\dots,y]=1$ for a long enough commutator sequence) in groups generated by an automaton. We give a partial algorithm that decides, given $x,y$, whether an Engel identity is satisfied. It succeeds, importantly, in proving that Grigorchuk's $2$-group is not Engel. We consider next the problem of recognizing Engel elements, namely elements $y$ such that the map $x\mapsto[x,y]$ attracts to $\{1\}$. Although this problem seems intractable in general, we prove that it is decidable for Grigorchuk's group: Engel elements are precisely those of order at most $2$. Our computations were implemented using the package FR within the computer algebra system GAP

Fermat Principle in Finsler Spacetimes

It is shown that, on a manifold with a Finsler metric of Lorentzian signature, the lightlike geodesics satisfy the following variational principle. Among all lightlike curves from a point (emission event) to a timelike curve (worldline of receiver), the lightlike geodesics make the arrival time stationary. Here ``arrival time'' refers to a parametrization of the timelike curve. This variational principle can be applied (i) to the vacuum light rays in an alternative spacetime theory, based on Finsler geometry, and (ii) to light rays in an anisotropic non-dispersive medium with a general-relativistic spacetime as background.Comment: 18 pages, submitted to Gen. Rel. Gra

Influence of topography on tide propagation and amplification in semi-enclosed basins

An idealized model for tide propagation and amplification in semi-enclosed rectangular basins is presented, accounting for depth differences by a combination of longitudinal and lateral topographic steps. The basin geometry is formed by several adjacent compartments of identical width, each having either a uniform depth or two depths separated by a transverse topographic step. The problem is forced by an incoming Kelvin wave at the open end, while allowing waves to radiate outward. The solution in each compartment is written as the superposition of (semi)-analytical wave solutions in an infinite channel, individually satisfying the depth-averaged linear shallow water equations on the f plane, including bottom friction. A collocation technique is employed to satisfy continuity of elevation and flux across the longitudinal topographic steps between the compartments. The model results show that the tidal wave in shallow parts displays slower propagation, enhanced dissipation and amplified amplitudes. This reveals a resonance mechanism, occurring when\ud the length of the shallow end is roughly an odd multiple of the quarter Kelvin wavelength. Alternatively, for sufficiently wide basins, also Poincaré waves may become resonant. A transverse step implies different wavelengths of the incoming and reflected Kelvin wave, leading to increased amplitudes in shallow regions and a shift of amphidromic points in the direction of the deeper part. Including the shallow parts near the basin’s closed end (thus capturing the Kelvin resonance mechanism) is essential to reproduce semi-diurnal and diurnal\ud tide observations in the Gulf of California, the Adriatic Sea and the Persian Gulf

Looking inside the black box : a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada

Background: Randomised controlled trials of implementation strategies tell us whether (or not) an intervention results in changes in professional behaviour but little about the causal mechanisms that produce any change. Theory-based process evaluations collect data on theoretical constructs alongside randomised trials to explore possible causal mechanisms and effect modifiers. This is similar to measuring intermediate endpoints in clinical trials to further understand the biological basis of any observed effects (for example, measuring lipid profiles alongside trials of lipid lowering drugs where the primary endpoint could be reduction in vascular related deaths). This study protocol describes a theory-based process evaluation alongside the Ontario Printed Educational Message (OPEM) trial. We hypothesize that the OPEM interventions are most likely to operate through changes in physicians' behavioural intentions due to improved attitudes or subjective norms with little or no change in perceived behavioural control. We will test this hypothesis using a well-validated social cognition model, the theory of planned behaviour (TPB) that incorporates these constructs. Methods/design: We will develop theory-based surveys using standard methods based upon the TPB for the second and third replications, and survey a subsample of Ontario family physicians from each arm of the trial two months before and six months after the dissemination of the index edition of informed, the evidence based newsletter used for the interventions. In the third replication, our study will converge with the "TRY-ME" protocol (a second study conducted alongside the OPEM trial), in which the content of educational messages was constructed using both standard methods and methods informed by psychological theory. We will modify Dillman's total design method to maximise response rates. Preliminary analyses will initially assess the internal reliability of the measures and use regression to explore the relationships between predictor and dependent variable (intention to advise diabetic patients to have annual retinopathy screening and to prescribe thiazide diuretics for first line treatment of uncomplicated hypertension). We will then compare groups using methods appropriate for comparing independent samples to determine whether there have been changes in the predicted constructs (attitudes, subjective norms, or intentions) across the study groups as hypothesised, and will assess the convergence between the process evaluation results and the main trial results.The OPEM trial and OPEM process evaluation are funded by the Canadian Institute of Health Research (CIHR). The OPEM process evaluation study was developed as part of the CIHR funded interdisciplinary capacity enhancement team KT-ICEBeRG. Gaston Godin, Jeremy Grimshaw and France Légaré hold Canada Research Chairs. Louise Lemyre holds an R.S. McLaughlin Research Chair

The problems of offenders with mental disorders: A plurality of perspectives within a single mental health care organisation

Managers, doctors, nurses, occupational therapists, social workers, psychologists, unqualified staff and service users were interviewed for a qualitative study of risk management and rehabilitation in an inner city medium secure forensic mental health care unit. Different professional orientations to service user problems were identified. Doctors focused primarily on the diagnosis of mental disorder, which they managed mainly through pharmaceutical interventions. Psychologists were principally concerned with personal factors, for example service user insight into their biographical history. Occupational therapists concentrated mainly on daily living skills, and social workers on post-discharge living arrangements. Some front line nurses, held accountable for security lapses, adopted a criminogenic approach. Service users were more likely than professionals to understand their needs in terms of their wider life circumstances. These differences are explored qualitatively in relation to four models of crossdisciplinary relationships: monoprofessional self-organisation combined with restricted communication; hermeneutic reaching out to other perspectives; the establishment of interdisciplinary sub-systems; and transdisciplinary merger. Relationships between professions working in this unit, as portrayed in qualitative interviews, corresponded mainly to the first model of monoprofessional self-organisation. Reasons for restricted crossdisciplinary understanding, particularly the wide power/status differences between the medical and other professions, and between staff and patients, are discussed

The Effect of the Environment on alpha-Al_2O_3 (0001) Surface Structures

We report that calculating the Gibbs free energy of the alpha-Al_2O_3 (0001) surfaces in equilibrium with a realistic environment containing both oxygen and hydrogen species is essential for obtaining theoretical predictions consistent with experimental observations. Using density-functional theory we find that even under conditions of high oxygen partial pressure, the metal terminated surface is surprisingly stable. An oxygen terminated alpha-Al_2O_3 (0001) surface becomes stable only if hydrogen is present on the surface. In addition, including hydrogen on the surface resolves discrepancies between previous theoretical work and experimental results with respect to the magnitude and direction of surface relaxations.Comment: 4 pages including 2 figures. Submitted to Phys. Rev. Lett. Related publications can be found at http://www.fhi-berlin.mpg.de/th/paper.htm