Linking serial sexual offences:Moving towards an ecologically valid test of the principles of crime linkage

Purpose: To conduct a test of the principles underpinning crime linkage (behavioural consistency and distinctiveness) with a sample more closely reflecting the volume and nature of sexual crimes with which practitioners work, and to assess whether solved series are characterized by greater behavioural similarity than unsolved series. Method: A sample of 3,364 sexual crimes (including 668 series) was collated from five countries. For the first time, the sample included solved and unsolved but linked-by-DNA sexual offence series, as well as solved one-off offences. All possible crime pairings in the data set were created, and the degree of similarity in crime scene behaviour shared by the crimes in each pair was quantified using Jaccard's coefficient. The ability to distinguish same-offender and different-offender pairs using similarity in crime scene behaviour was assessed using Receiver Operating Characteristic analysis. The relative amount of behavioural similarity and distinctiveness seen in solved and unsolved crime pairs was assessed. Results: An Area Under the Curve of.86 was found, which represents an excellent level of discrimination accuracy. This decreased to.85 when using a data set that contained one-off offences, and both one-off offences and unsolved crime series. Discrimination accuracy also decreased when using a sample composed solely of unsolved but linked-by-DNA series (AUC =.79). Conclusions: Crime linkage is practised by police forces globally, and its use in legal proceedings requires demonstration that its underlying principles are reliable. Support was found for its two underpinning principles with a more ecologically valid sample

Using offender crime scene behavior to link stranger sexual assaults:A comparison of three statistical approaches

Purpose This study compared the utility of different statistical methods in differentiating sexual crimes committed by the same person from sexual crimes committed by different persons. Methods Logistic regression, iterative classification tree (ICT), and Bayesian analysis were applied to a dataset of 3,364 solved, unsolved, serial, and apparent one-off sexual assaults committed in five countries. Receiver Operating Characteristic analysis was used to compare the statistical approaches. Results All approaches achieved statistically significant levels of discrimination accuracy. Two out of three Bayesian methods achieved a statistically higher level of accuracy (Areas Under the Curve [AUC]=0.89 [Bayesian coding method 1]; AUC=0.91 [Bayesian coding method 3]) than ICT analysis (AUC=0.88), logistic regression (AUC=0.87), and Bayesian coding method 2 (AUC=0.86). Conclusions The ability to capture/utilize between-offender differences in behavioral consistency appear to be of benefit when linking sexual offenses. Statistical approaches that utilize individual offender behaviors when generating crime linkage predictions may be preferable to approaches that rely on a single summary score of behavioral similarity. Crime linkage decision-support tools should incorporate a range of statistical methods and future research must compare these methods in terms of accuracy, usability, and suitability for practice

Long-Term Weight Changes After Starting Anti-IL-5/5Ra Biologics in Severe Asthma: The Role of Oral Corticosteroids

BACKGROUND Many patients with severe asthma are overweight or obese, often attributed to unintentional weight gain as a side effect of oral corticosteroids (OCSs). Anti-IL-5/5Ra biologics significantly reduce OCS use, but their long-term effects on weight are unknown. OBJECTIVES To examine (1) weight change up to 2 years after anti-IL-5/5Ra initiation in subgroups on the basis of maintenance OCS use at start of treatment and (2) whether cumulative OCS exposure before or changes in OCS exposure during treatment are related to weight change. METHODS Real-world data on weight and cumulative OCS dose from adults included in the Dutch Registry of Adult Patients with Severe asthma for Optimal DIsease management before and at least 2 years after starting anti-IL-5/5Ra were analyzed using linear mixed models and linear regression analyses. RESULTS For the included 389 patients (55% female; mean body mass index, 28 ± 5 kg/m$^{2}$; 58% maintenance OCS), mean weight decreased -0.27 kg/y (95% CI, -0.51 to -0.03; P = .03), with more weight loss in patients with maintenance OCS use than in those without maintenance OCS use (-0.87 kg/y [95% CI, -1.21 to -0.52; P < .001] vs +0.54 kg/y [0.26 to 0.82; P < .001]). Greater weight loss at 2 years was associated with higher cumulative OCS dose in the 2 years before anti-IL-5/5Ra initiation (β = -0.24 kg/g; 95% CI, -0.38 to -0.10; P < .001) and, independently, greater reduction in cumulative OCS dose during follow-up (β = 0.27 kg/g; 95% CI, 0.11 to 0.43; P < .001). CONCLUSIONS Anti-IL-5/5Ra therapy is associated with long-term weight reduction, especially in patients with higher OCS exposure before treatment and those able to reduce OCS use during treatment. However, the effect is small and does not apply to all patients, and so additional interventions seem necessary if weight change is desired

The climate resilience cycle: Using scenario analysis to inform climate-resilient business strategies

Climate change affects the business environment, and companies need future-oriented information to build climate resilience. To this end, companies are encouraged to conduct climate change scenario analysis, as recommended by the Task Force on Climate-Related Financial Disclosures (TCFD). However, companies' actual adoption of this practice is limited as they lack a straightforward scenario analysis implementation process and relevant climate change knowledge. This research develops an implementation process by clarifying the concept of resilience into a stability and a change domain and by specifying the type of focal questions for these two domains. Next, a scenario typology guides the selection of reference scenarios, and two standard scenario methods guide the tailoring of these reference scenarios to company-specific scenarios. By structuring this process in five steps and specifying input and process requirements, we provide an implementation process called the climate resilience cycle. By applying the cycle in transdisciplinary teams of climate change experts and company staff with knowledge about the company value chain, we bring in the required knowledge. To become climate resilient, the outcomes of the climate resilience cycle need to be integrated in the business planning and the overall company strategy. We argue that implementing the cycle as a new company routine contributes to the development of dynamic capabilities like sensing, seizing and transforming, which have been proven to be essential for integrating sustainability in company strategies. Once begun, we show how the cycle can become part of a company strategy process

Small stitches with small suture distances increase laparotomy closure strength

BACKGROUND: There is no conclusive evidence which size of suture stitches and suture distance should be used to prevent burst abdomen and incisional hernia. METHODS: Thirty-eight porcine abdominal walls were removed immediately after death and divided into 2 groups: A and B (N = 19 each). Two suturing methods using double-loop polydioxanone were tested in 14-cm midline incisions: group A consisted of large stitches (1 cm) with a large suture distance (1 cm), and group B consisted of small stitches (.5 cm) with a small suture distance (.5 cm). RESULTS: The geometric mean tensile force in group B was significantly higher than in group A (787 N vs 534 N; P = .006). CONCLUSIONS: Small stitches with small suture distances achieve higher tensile forces than large stitches with large suture distances. Therefore, small stitches may be useful to prevent the development of a burst abdomen or an incisional hernia after midline incisions. (C) 2009 Elsevier Inc. All rights reserved

The climate resilience cycle: Using scenario analysis to inform climate-resilient business strategies

Climate change affects the business environment, and companies need future-oriented information to build climate resilience. To this end, companies are encouraged to conduct climate change scenario analysis, as recommended by the Task Force on Climate-Related Financial Disclosures (TCFD). However, companies' actual adoption of this practice is limited as they lack a straightforward scenario analysis implementation process and relevant climate change knowledge. This research develops an implementation process by clarifying the concept of resilience into a stability and a change domain and by specifying the type of focal questions for these two domains. Next, a scenario typology guides the selection of reference scenarios, and two standard scenario methods guide the tailoring of these reference scenarios to company-specific scenarios. By structuring this process in five steps and specifying input and process requirements, we provide an implementation process called the climate resilience cycle. By applying the cycle in transdisciplinary teams of climate change experts and company staff with knowledge about the company value chain, we bring in the required knowledge. To become climate resilient, the outcomes of the climate resilience cycle need to be integrated in the business planning and the overall company strategy. We argue that implementing the cycle as a new company routine contributes to the development of dynamic capabilities like sensing, seizing and transforming, which have been proven to be essential for integrating sustainability in company strategies. Once begun, we show how the cycle can become part of a company strategy process

Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy

Background: It is unclear whether asthma and asthma medications increase or decrease the risk of severe COVID-19, and this is particularly true for patients with severe asthma receiving biologics. Objectives: The aim of this study was to assess incidence and disease course of COVID-19 in patients with severe asthma on biologic therapy (omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab), as compared with COVID-19 data from the general Dutch population. Methods: COVID-19 cases were identified through a prospective ongoing survey between March 17 and April 30, 2020 among all severe asthma specialists from 15 hospitals of the Dutch Severe Asthma Registry RAPSODI. From these cases, data was collected on patient characteristics, including co-morbidities, COVID-19 disease progression and asthma exacerbations. Findings were then compared with COVID-19 data from the general Dutch population. Results: Of 634 severe asthma patients who received biologic therapy in RAPSODI, 9 (1.4%) were diagnosed with COVID-19. Seven patients (1.1%) required hospitalization for oxygen therapy, of which 5 were admitted to the intensive care for intubation and mechanical ventilation. One patient died (0.16%). All intubated patients had ≥1 co-morbidities. Odds (95%CI) for COVID-19 related hospitalization and intubations were 14 (6.6–29.5) and 41 (16.9–98.5) times higher, respectively, compared to the Dutch population. One patient presented with an asthma exacerbation. Conclusion: Patients with severe asthma using biologic therapy showed to have a more severe course of COVID-19 compared to the general population. This may be due to co-morbidities, the severity of asthmatic airway inflammation, the use of biologics, or a combination of these

Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease:a Qualitative Study

Reducing sodium intake can prevent cardiovascular complications and further decline of kidney function in patients with chronic kidney disease. However, the vast majority of patients fail to reach an adequate sodium intake, and little is known about why they do not succeed. This study aims to identify perceived barriers and support strategies for reducing sodium intake among both patients with chronic kidney disease and health-care professionals. A purposive sample of 25 patients and 23 health-care professionals from 4 Dutch medical centers attended 8 focus groups. Transcripts were analyzed thematically and afterwards organized according to the phases of behavior change of self-regulation theory. Multiple themes emerged across different phases of behavior change, including the patients' lack of practical knowledge and intrinsic motivation, the maladaptive illness perceptions and refusal skills, the lack of social support and feedback regarding disease progression and sodium intake, and the availability of low-sodium foods. The results indicate the need for the implementation of support strategies that target specific needs of patients across the whole process of changing and maintaining a low-sodium diet. Special attention should be paid to supporting patients to set sodium-related goals, strengthening intrinsic motivation, providing comprehensive and practical information (e.g., about hidden salt in products), increasing social support, stimulating the self-monitoring of sodium intake and disease progression, and building a supportive patient-professional relationship that encompasses shared decision making and coaching. Moreover, global programs should be implemented to reduce sodium levels in processed foods, introduce sodium-related product labels, and increase consumer awareness

Treatment Eligibility of Real-Life Mepolizumab-Treated Severe Asthma Patients

Background: Patients with severe asthma not meeting the strict trial eligibility criteria for mepolizumab are now routinely treated with this biological in clinical practice, but it remains unclear whether these ineligible patients respond differently to mepolizumab treatment. Objective: This study investigated the extent and reasons for trial ineligibility of real-life, mepolizumab-treated patients with severe asthma and compared the characteristics of these patients with trial populations. Subsequently, therapeutic response in ineligible patients was assessed on the basis of oral corticosteroid (OCS) reduction. Methods: Trial eligibility, population differences, and therapeutic response were assessed using the baseline characteristics of mepolizumab-receiving patients with severe asthma treated in the Amsterdam University Medical Centres and OCS dose at 6 months for OCS-dependent patients extracted from patients' electronic health records. Eligibility criteria and population characteristics from trials investigating mepolizumab were extracted from their original publications. Results: A total of 82.4% of 119 mepolizumab-receiving, real-life patients with severe asthma were ineligible for trial inclusion, wherein 42.9% and 39.5% were excluded on the basis of inclusion and exclusion criteria, respectively. The clinical care population was older, more often male and demonstrating a better lung function under lower OCS maintenance dosages in comparison with trial populations. A total of 50% of 66 ineligible, OCS-dependent mepolizumab-treated patients were able to reduce their maintenance OCS dosage to ≤5 mg prednisone/day. Conclusions: A large proportion of the real-life, mepolizumab-treated population with severe asthma would be excluded from trial participation, and significant differences in population characteristics exist. Regardless, a large fraction of ineligible patients in clinical care can reduce maintenance OCS dosage under mepolizumab therapy