The Index Offence Representation Scales; a predictive clinical tool in the management of dangerous, violent patients with personality disorder?

Forensic mental health professionals attach considerable importance to their patient's description of his or her index offence. Despite this, there is no systematic approach to examining and formulating the patient's offence narrative

Factors associated with the unresolved classification of the Adult Attachment Interview in women who have suffered stillbirth.

Abstract The "unresolved" state of mind with respect to loss or trauma as assessed in the Adult Attachment Interview is common in clinical and forensic groups, as well as in mothers whose infants are classified as disorganized in their attachment relationship to them. However, questions remain about what the unresolved state represents and what factors predict the unresolved state. This case controlled study reports on 64 women who had suffered stillbirth and who were pregnant with their next child. The study explores attachment, psychiatric, and social factors associated with the unresolved state or higher unresolved scores with respect to stillbirth. Women who had experienced stillbirth were more likely to be unresolved than control women. Although a similar number of stillbirth and control women had experienced childhood trauma, only women who had experienced stillbirth were unresolved with respect to this trauma, suggesting the unresolved state may be evoked or reevoked by subsequent traumatic loss. Higher unresolved scores in relation to stillbirth were predicted by childhood trauma, poor support from family after the loss, and having a funeral for the infant. The results are discussed in terms of the woman's sense of being causal in the loss

Group cognitive analytic music therapy: a quasi-experimental feasibility study conducted in a high secure hospital

This study conducted a feasibility patient preference quasi-experimental study of group cognitive analytic music therapy (G-CAMT) for mentally disordered offenders. Participants either chose or were randomised to 16 sessions of manualised G-CAMT (N = 10) plus treatment as usual (TAU) or TAU alone (N = 10). Self-rated and staff-rated outcomes were assessed at baseline, post-intervention and 8-weeks post-intervention. Residency was assessed at 2-year follow-up. Results indicate that G-CAMT was easily implemented; 9/10 participants completed G-CAMT and attendees had high satisfaction with the approach. Session attendance was high; 4/10 participants attended all sessions. At the 8-week follow-up, 3/9 G-CAMT participants had reliable reductions (i.e. statistically reliable pre to 8-week follow-up change results) in intrusive/possessive behaviours and fear of separation/abandonment. On the staff-rated outcome measure G-CAMT participants as a group were statistically significantly friendlier compared to TAU at 8-week follow-up (U = 0.50, p = 0.009, d = 1.92, CI 0.44 to 3.11). There were no differences between the arms in terms of residency outcomes at 2-year follow-up. The study is discussed in terms of G-CAMT’s theoretical grounding and high acceptability. The study is limited by its small sample size, but indicates the possibility of progressing onto a full trial

Understanding and meeting the needs of those using growth hormone injection devices

BACKGROUND: Recombinant human growth hormone (r-hGH) is used to treat: growth hormone deficiency in children and adults; children born small for gestational age; Turner's syndrome; and chronic renal failure. r-hGH is administered by daily subcutaneous injection and may be given using a number of different administration devices. The aim of this survey was, firstly, to identify which attributes of an r-hGH administration device are considered most important to physicians, teenage patients, parents of young children requiring GH and nurses who have experience of r-hGH administration, and, secondly, to determine how they rate existing devices in each of these key attributes. METHODS: The opinions of 67 individuals with experience in r-hGH administration were captured in discussion sessions. Parents, physicians and nurses were asked to rate 19 device attributes by completing a questionnaire, and to rank four different r-hGH administration devices (including a conceptual electronic device) in order of preference. RESULTS: Reliability, ease of use, lack of pain during injection, safety in use, storage, and number of steps in preparation before use, during use and after were considered to be the five most desirable attributes of an r-hGH administration device. An electronic device was preferred to an automatic, multi-dose injection device, a needle-free injection device or a manual, ready-to-use, disposable injection device. CONCLUSION: In the opinion of physicians, nurses and parents using r-hGH injection devices, an ideal device must combine reliability with simplicity, while delivering treatment with minimal pain. An electronic device, which combines many of the most useful features of existing devices with novel functions, was the preferred option for r-hGH administration

Understanding Environmental Favorability for Tropical Cyclogenesis by Analysis of Threshold Parameters

As the climate changes, the ability to predict changes in the frequency of tropical cyclogenesis is becoming of increasing interest. A unique approach is proposed that utilizes threshold values in potential intensity, wind shear, vorticity, and normalized saturation deficit. Prior statistical methods generally involve creating an index or equation based on averages of important meteorological parameters for a given region. The new method assumes that threshold values exist for each important parameter for which cyclogenesis is unlikely to develop. This technique is distinct from previous approaches that seek to determine how each of these parameters interdependently favors cyclogenesis. To determine three of the individual threshold values (shear, potential intensity, and vorticity), an idealized climate is first established that represents the most advantageous but realistic (MABR) environment. An initial numerical simulation of tropical cyclone genesis in the MABR environment confirms that it is highly favorable for cyclogenesis. Subsequent numerical simulations vary each parameter individually until no tropical cyclone develops, thereby determining the three threshold values. The new method of point downscaling, whereby background meteorological features are represented by a single vertical profile, is used in the numerical simulations to greatly simplify the approach. The remaining threshold parameter (normalized saturation deficit) is determined by analyzing the climatological record and choosing a value that is statistically observed to prevent cyclogenesis. Once each threshold value is determined, the fraction of time each is exceeded in the location of interest is computed from the reanalysis dataset. The product of each fraction for each of the relevant parameters then gives a statistical probability as to the likelihood of cyclogenesis. For predicting regional and monthly variations in frequency of genesis, this approach is shown to generally meet or exceed the predictive skills of earlier statistical attempts with some failure only during several off-season months. This method also provides a more intuitive rationale of the results. Since the genesis frequency index (GFI) method has shown to meet or exceed the predictive skill of other indices, analysis of the impact of El Niño and La Niña on cyclogenesis is performed for each of the six ocean basins. Although the GFI method generally corroborates other studies that have shown El Niño years are conducive for storms in the eastern Pacific and detrimental to storms in the Atlantic, the GFI method reveals important differences within each basin that other studies have not found. In particular the GFI method shows a region north of South America, known for its paucity of storms regardless of global weather phenomenon, is not greatly affected by El Niño events reinforcing the claim the GFI method is a more robust predictor of cyclogenesis. The first calculation of GFI used NCEP reanalysis to determine each of the four fractions (or frequencies). Since the NCEP reanalysis data has shown to underestimate mid and upper-level humidity, two other data sources are used to determine if a more accurate humidity profile can improve the GFI method. Although some of the basins did show an improved skill, there was not a global improvement from a particular data set and therefore the reanalysis data set chosen to calculate GFI was not deemed an important consideration. In an attempt to explain the threshold nature of cyclogenesis, analyses of momentum and moisture budgets on a nascent vortex were performed. Although momentum budgets revealed that friction did not contribute significantly to whether the storm would develop or not, no other processes revealed a threshold-like behavior in cyclogenesis. The moisture budgets, however, revealed an inverse relationship of advected water vapor to latitude. The cause of this was found to be that radial winds are significantly affected by the Coriolis parameter and at higher latitudes these winds (and therefore advected water vapor) were reduced. Since a developing storm requires the latent heat release from moisture and with less moisture available at higher latitudes, the storm must be more efficient at converting this heat to kinetic energy. Investigation into inertial stability found that although the Coriolis parameter was responsible for reduced radial winds at higher latitudes, it was also responsible for the increased stability. With increased stability, the heat produced within the inner vortex was confined to the same region. At low latitudes, even though there was abundant moisture, the inertial stability was too low to allow development, therefore revealing part of the threshold-like behavior of cyclogenesis

Measuring Environmental Favorability for Tropical Cyclogenesis by Statistical Analysis of Threshold Parameters

Abstract As the climate changes, the ability to predict changes in the frequency of tropical cyclogenesis is becoming of increasing interest. A unique approach is proposed that utilizes threshold values in potential intensity, wind shear, vorticity, and normalized saturation deficit. Prior statistical methods generally involve creating an index or equation based on averages of important meteorological parameters for a given region. The new method assumes that threshold values exist for each important parameter for which cyclogenesis is unlikely to develop. This technique is distinct from previous approaches that seek to determine how each of these parameters interdependently favors cyclogenesis. To determine three of the individual threshold values (shear, potential intensity, and vorticity), an idealized climate is first established that represents the most advantageous but realistic (MABR) environment. An initial numerical simulation of tropical cyclone genesis in the MABR environment confirms that it is highly favorable for cyclogenesis. Subsequent numerical simulations vary each parameter individually until no tropical cyclone develops, thereby determining the three threshold values. The new method of point downscaling, whereby background meteorological features are represented by a single vertical profile, is used in the simulations to greatly simplify the approach. The remaining threshold parameter (normalized saturation deficit) is determined by analyzing the climatological record and choosing a value that is statistically observed to prevent cyclogenesis. Once each threshold value is determined, the fraction of time each is exceeded in the location of interest is computed from the reanalysis dataset. The product of each fraction for each of the relevant parameters then gives a statistical probability as to the likelihood of cyclogenesis. For predicting regional and monthly variations in frequency of genesis, this approach is shown to generally meet or exceed the predictive skills of earlier statistical attempts with some failure only during several off-season months. This method also provides a more intuitive rationale of the results

The Air-Sea Interface as a Factor in Rapid Intensification of Tropical Cyclones

Observations suggest that under extreme wind speed conditions there is a widespread disruption of the air-sea interface. The mechanisms that control disruption of the air-sea interface in tropical cyclones are somewhat analogous to the process of atomization that is well studied in such engineering applications as fuel injection in combustion and cryogenic rocket engines, food processing, and inkjet printing. The related instabilities may include the well-known interfacial mode (Kelvin-Helmholtz instability) and the “liquid” mode (which has some resemblance to the Holmboe instability). In this work, computational fluid dynamics experiments have been performed using a multi-phase volume of fluid large eddy simulation model (ANSYS Fluent) to reproduce properties of the air-sea interface under tropical cyclone conditions. A very fine resolution mesh 0.75 mm x 0.75 mm x 0.75 mm and a realistic surface tension coefficient (0.072 N/m) were set at the air-water interface. The model was forced with hurricane force wind stress at the top of the air layer. The periodic boundary condition along the wind direction was equivalent to an infinite fetch. The model reveals a noticeable asymmetry between the air and water sides of the interface (most of the action is on the air side), which has previously been observed in laboratory experiments. Such asymmetry is typical for the Kelvin-Helmholtz instability at a gas-liquid interface with a significant density difference. Computational and laboratory experiments have resulted in the development of a non-monotonous parameterization of the air-sea drag coefficient dependence on wind speed that can contain the aerodynamic drag well near 60 m/s wind and can explain the rapid intensification and rapid decline of tropical cyclones (Soloviev et al., JGR-Oceans, 2017). One serious complication is that the enthalpy exchange coefficient is still a poorly known parameter in tropical cyclones. A volume of fluid to discrete phase model is under development for a more realistic enthalpy exchange parameterization. We are considering other related factors involved in the tropical cyclone intensification and decline including vapor advection in the cyclone, coupled air-sea system effects, and atmospheric conditions