Sadism among sexual homicide offenders:Validation of the Sexual Sadism Scale

Sexual sadism is assumed to be a crucial factor in sexual homicide. Prevalence estimates vary greatly due to differences in the definition of sexual sadism. A nationwide sample of 350 male perpetrators who had committed a sexual homicide offense against a female 14 years of age or above in England or Wales was assessed based on archival records. Sexual sadism was assessed using the Sexual Sadism Scale (SeSaS). Item response theory (IRT) analyses were conducted focusing on the 2-parameter logistic model. The single-factor structure of the SeSaS Part 1 was tested using confirmatory factor analysis. Estimates of both internal consistency and interrater agreement were satisfactory to substantial. IRT analysis showed that the Part 1 items captured moderate to severe levels of the latent construct (i.e., theta levels >0). Based on the Posterior Probability of Diagnosis index, the prevalence of the disorder was estimated at 37% in the sample. The substantial correlation between the SeSaS Part 1 total score and original clinical diagnoses of sadism confirms the criterion validity of the scale. Exertion of control and infliction of torture were among the more informative items. In sum, the results support the usefulness of the SeSaS instrument for assessing forensically relevant forms of sadism

If you can’t measure it- you can’t change it – a longitudinal study on improving quality of care in hospitals and health centers in rural Kenya

Background: The Kenyan Ministry of Health- Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end an integrated quality management system based on validated indicators derived from the Kenya Quality Model for Health (KQMH) was developed and adapted to the area of Reproductive and Maternal and Neonatal Health, implemented and analysed. Methods: An integrated quality management (QM) approach was developed based on European Practice Assessment (EPA) modified to the Kenyan context. It relies on a multi-perspective, multifaceted and repeated indicator based assessment, covering the 6 World Health Organization (WHO) building blocks. The adaptation process made use of a ten step modified RAND/UCLA appropriateness Method. To measure the 303 structure, process, outcome indicators five data collection tools were developed: surveys for patients and staff, a self-assessment, facilitator assessment, a manager interview guide. The assessment process was supported by a specially developed software (VISOTOOL®) that allows detailed feedback to facility staff, benchmarking and facilitates improvement plans. A longitudinal study design was used with 10 facilities (6 hospitals; 4 Health centers) selected out of 36 applications. Data was summarized using means and standard deviations (SDs). Categorical data was presented as frequency counts and percentages. Results: A baseline assessment (T1) was carried out, a reassessment (T2) after 1.5 years. Results from the first and second assessment after a relatively short period of 1.5 years of improvement activities are striking, in particular in the domain ‘Quality and Safety’ (20.02%; p < 0.0001) with the dimensions: use of clinical guidelines (34,18%; p < 0.0336); Infection control (23,61%; p < 0.0001). Marked improvements were found in the domains ‘Clinical Care’ (10.08%; p = 0.0108), ‘Management’ (13.10%: p < 0.0001), ‘Interface In/out-patients’ (13.87%; p = 0.0246), and in total (14.64%; p < 0.0001). Exemplarily drilling down the domain ‘clinical care’ significant improvements were observed in the dimensions ‘Antenatal care’ (26.84%; p = 0.0059) and ‘Survivors of gender-based violence’ (11.20%; p = 0.0092). The least marked changes or even a -not significant- decline of some was found in the dimensions ‘delivery’ and ‘postnatal care’. Conclusions: This comprehensive quality improvement approach breathes life into the process of collecting data for indicators and creates ownership among users and providers of health services. It offers a reflection on the relevance of evidence-based quality improvement for health system strengthening and has the potential to lay a solid ground for further certification and accreditation

Maize haplotype with a helitron-amplified cytidine deaminase gene copy

BACKGROUND: Genetic maps are based on recombination of orthologous gene sequences between different strains of the same species. Therefore, it was unexpected to find extensive non-collinearity of genes between different inbred strains of maize. Interestingly, disruption of gene collinearity can be caused among others by a rolling circle-type copy and paste mechanism facilitated by Helitrons. However, understanding the role of this type of gene amplification has been hampered by the lack of finding intact gene sequences within Helitrons. RESULTS: By aligning two haplotypes of the z1C1 locus of maize we found a Helitron that contains two genes, one encoding a putative cytidine deaminase and one a hypothetical protein with part of a 40S ribosomal protein. The cytidine deaminase gene, called ZmCDA3, has been copied from the ZmCDA1 gene on maize chromosome 7 about 4.5 million years ago (mya) after maize was formed by whole-genome duplication from two progenitors. Inbred lines contain gene copies of both progenitors, the ZmCDA1 and ZmCDA2 genes. Both genes diverged when the progenitors of maize split and are derived from the same progenitor as the rice OsCDA1 gene. The ZmCDA1 and ZmCDA2 genes are both transcribed in leaf and seed tissue, but transcripts of the paralogous ZmCDA3 gene have not been found yet. Based on their protein structure the maize CDA genes encode a nucleoside deaminase that is found in bacterial systems and is distinct from the mammalian RNA and/or DNA modifying enzymes. CONCLUSION: The conservation of a paralogous gene sequence encoding a cytidine deaminase gene over 4.5 million years suggests that Helitrons could add functional gene sequences to new chromosomal positions and thereby create new haplotypes. However, the function of such paralogous gene copies cannot be essential because they are not present in all maize strains. However, it is interesting to note that maize hybrids can outperform their inbred parents. Therefore, certain haplotypes may function only in combination with other haplotypes or under specialized environmental conditions

Gain-of-function human STAT1 mutations impair IL-17 immunity and underlie chronic mucocutaneous candidiasis

Chronic mucocutaneous candidiasis disease (CMCD) may be caused by autosomal dominant (AD) IL-17F deficiency or autosomal recessive (AR) IL-17RA deficiency. Here, using whole-exome sequencing, we identified heterozygous germline mutations in STAT1 in 47 patients from 20 kindreds with AD CMCD. Previously described heterozygous STAT1 mutant alleles are loss-of-function and cause AD predisposition to mycobacterial disease caused by impaired STAT1-dependent cellular responses to IFN-γ. Other loss-of-function STAT1 alleles cause AR predisposition to intracellular bacterial and viral diseases, caused by impaired STAT1-dependent responses to IFN-α/β, IFN-γ, IFN-λ, and IL-27. In contrast, the 12 AD CMCD-inducing STAT1 mutant alleles described here are gain-of-function and increase STAT1-dependent cellular responses to these cytokines, and to cytokines that predominantly activate STAT3, such as IL-6 and IL-21. All of these mutations affect the coiled-coil domain and impair the nuclear dephosphorylation of activated STAT1, accounting for their gain-of-function and dominance. Stronger cellular responses to the STAT1-dependent IL-17 inhibitors IFN-α/β, IFN-γ, and IL-27, and stronger STAT1 activation in response to the STAT3-dependent IL-17 inducers IL-6 and IL-21, hinder the development of T cells producing IL-17A, IL-17F, and IL-22. Gain-of-function STAT1 alleles therefore cause AD CMCD by impairing IL-17 immunity

Sexueller Sadismus: Aktueller Wissensstand und die Codierung gemäß DSM-5-TR und ICD-11

<jats:title>Zusammenfassung</jats:title><jats:p>Sexualsadismus bezeichnet eine lustvolle Erregbarkeit durch die Kontrolle, Erniedrigung oder Schmerzzufügung zulasten einer anderen Person. In den psychiatrischen Klassifikationskatalogen wird heute auf Zwang und Nichteinvernehmlichkeit abgestellt, um die forensische Ausprägung des Sexualsadismus von der konsensuellen Spielart im Sinne sadomasochistischer Rollenspiele abzugrenzen („bondage“ und Disziplinierung, Dominanz und Submission, Sadismus und Masochismus; kurz: BDSM). Ferner ist zwischen diesen Formen des Sexualsadismus und dem sog. Charakter- oder Alltagssadismus als Persönlichkeitszug zu unterscheiden. Im vorliegenden Beitrag wird die aktuelle Nosologie der forensisch-psychiatrisch bedeutsamen zwangsweisen sexuell-sadistischen Störung („coercive sexual sadism disorder“) gemäß ICD-11 erläutert. Die <jats:italic>Sexual Sadism Scale</jats:italic> wird als diagnostisches Hilfsmittel für die gutachterliche Beurteilung vorgestellt. Befunde zur Kriminalprognose werden dargestellt, wobei die Diagnose per se nicht nennenswert mit erneuter Sexual- oder Gewaltdelinquenz nach Entlassung assoziiert ist, aber einen starken Zusammenhang mit äußerst schwerwiegenden Einweisungsdelikten zeigt (konkret: sexuell motivierte Tötungsdelikte). Wie aktuelle Literaturrecherchen ergeben, liegen aus den letzten Jahren keine Behandlungsstudien vor.</jats:p&gt

Forensische Modelle zur Gewaltprävention an der Schnittstelle zur Allgemeinpsychiatrie: der forensisch-psychiatrische Konsildienst

Obwohl bei einer Untergruppe psychisch kranker Menschen ein erhöhtes Gewaltrisiko verortet werden kann und Patienten der Maßregelvollzugskliniken in der Regel eine allgemeinpsychiatrische Vorgeschichte haben, existieren bislang nur vereinzelt präventiv ausgerichtete Behandlungsmodelle an der Schnittstelle zwischen forensischer und allgemeiner Psychiatrie. Im vorliegenden Artikel werden unterschiedliche Ansätze einer interdisziplinären Zusammenarbeit vorgestellt und das Angebot des forensisch-psychiatrischen Konsildiensts der Fachstelle Forensic Assessment & Risk Management (FFA) der Klinik für Forensische Psychiatrie (KFP) der Psychiatrischen Universitätsklinik Zürich (PUK) beschrieben