From third-degree to third-generation interrogation strategies: putting science into the art of criminal interviewing

The interviewing strategies of the American law-enforcement system are more than seventy-five years old. Psychologically manipulative and guilt-presumptive, these methodologies replaced the brutal third-degree interrogation tactics of the previous century, but have recently come under scrutiny for being both ethically and operationally unsound. These findings have prompted a paradigm shift toward more ethical, effective, and scientifically validated tactics. This thesis set out to explore the advantages of integrating next-generation practices into the interview-training ethos of the Department of Homeland Security (DHS) Office of Professional Responsibility (OPR)—the internal affairs component of Immigration and Customs Enforcement. An evaluation of evidence-based interrogation practices and governmental policy analyses, along with insight from subject-matter experts, provided the data for this exploration. A series of recommendations derived from the lessons learned of the U.K. PEACE model, the practices of the Federal Law Enforcement Training Center, and research by the High-Value Detainee Interrogation Group offered insight for the optimal training of interviewing techniques and their long-term retention in the field. Assuming the recommendations for OPR are both scalable and replicable, this model should be relevant and valuable for the professional practices of other DHS agencies responsible for conducting interrogations as well as for law-enforcement agencies nationwide.http://archive.org/details/fromthirddegreet1094553028Senior Special Agent, Department of Homeland Security Immigration and Customs Enforcement, Office of Professional ResponsibilityApproved for public release; distribution is unlimited

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

<p>Abstract</p> <p>Background</p> <p>Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care.</p> <p>Methods</p> <p>Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation.</p> <p>Results</p> <p>Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care.</p> <p>Conclusion</p> <p>General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care.</p

Elevated white cell count in acute coronary syndromes: relationship to variants in inflammatory and thrombotic genes

BACKGROUND: Elevated white blood cell counts (WBC) in acute coronary syndromes (ACS) increase the risk of recurrent events, but it is not known if this is exacerbated by pro-inflammatory factors. We sought to identify whether pro-inflammatory genetic variants contributed to alterations in WBC and C-reactive protein (CRP) in an ACS population. METHODS: WBC and genotype of interleukin 6 (IL-6 G-174C) and of interleukin-1 receptor antagonist (IL1RN intronic repeat polymorphism) were investigated in 732 Caucasian patients with ACS in the OPUS-TIMI-16 trial. Samples for measurement of WBC and inflammatory factors were taken at baseline, i.e. Within 72 hours of an acute myocardial infarction or an unstable angina event. RESULTS: An increased white blood cell count (WBC) was associated with an increased C-reactive protein (r = 0.23, p < 0.001) and there was also a positive correlation between levels of β-fibrinogen and C-reactive protein (r = 0.42, p < 0.0001). IL1RN and IL6 genotypes had no significant impact upon WBC. The difference in median WBC between the two homozygote IL6 genotypes was 0.21/mm(3 )(95% CI = -0.41, 0.77), and -0.03/mm(3 )(95% CI = -0.55, 0.86) for IL1RN. Moreover, the composite endpoint was not significantly affected by an interaction between WBC and the IL1 (p = 0.61) or IL6 (p = 0.48) genotype. CONCLUSIONS: Cytokine pro-inflammatory genetic variants do not influence the increased inflammatory profile of ACS patients

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes

From third-degree to third-generation interrogation strategies: putting science into the art of criminal interviewing

The interviewing strategies of the American law-enforcement system are more than seventy-five years old. Psychologically manipulative and guilt-presumptive, these methodologies replaced the brutal third-degree interrogation tactics of the previous century, but have recently come under scrutiny for being both ethically and operationally unsound. These findings have prompted a paradigm shift toward more ethical, effective, and scientifically validated tactics. This thesis set out to explore the advantages of integrating next-generation practices into the interview-training ethos of the Department of Homeland Security (DHS) Office of Professional Responsibility (OPR)—the internal affairs component of Immigration and Customs Enforcement. An evaluation of evidence-based interrogation practices and governmental policy analyses, along with insight from subject-matter experts, provided the data for this exploration. A series of recommendations derived from the lessons learned of the U.K. PEACE model, the practices of the Federal Law Enforcement Training Center, and research by the High-Value Detainee Interrogation Group offered insight for the optimal training of interviewing techniques and their long-term retention in the field. Assuming the recommendations for OPR are both scalable and replicable, this model should be relevant and valuable for the professional practices of other DHS agencies responsible for conducting interrogations as well as for law-enforcement agencies nationwide.http://archive.org/details/fromthirddegreet1094553028Senior Special Agent, Department of Homeland Security Immigration and Customs Enforcement, Office of Professional ResponsibilityApproved for public release; distribution is unlimited

K-12 School Shooting Database Methodology

To answer the question 'How many school shootings have occurred' and address the void of centralized and available data, the K-12 School Shooting Database (K-12 SSDB) has been created as a research product of the Center for Homeland Defense and Security. The product is a filtered, deconflicted, and cross-referenced database of more than 1,300 K-12 school shootings from 1970 to the time of publication (updates will be made as new incidents occur) collated from the previously referenced sources as well as new and continued research by the authors. The K-12 SSDB includes detailed information about each incident, a reliability score that quantifies the dependability of the information, and the verified primary source citation(s) (e.g., newspaper article, court records, interviews, police reports) to allow for further academic research

"B in IT" - a community-based model for the management of hepatitis B patients in primary care clinics using a novel web-based clinical tool.

Background: The current model of care for the treatment of chronic hepatitis B (CHB) in Australia is through specialist Hepatology or Infectious Diseases clinics, and limited accredited primary care practices. Capacity is limited, and less than 5% of Australians living with CHB currently access therapy. Increasing treatment uptake is an urgent area of clinical need. Nucleos(t)ide analogue therapy is safe and effective treatment for CHB that is suitable for community prescribing. We have evaluated the success of a community-based model for the management of CHB in primary care clinics using a novel web-based clinical tool. Methods: Using guidelines set out by the Gastroenterological Society of Australia, we developed an interactive online clinical management tool for the shared care of patients with CHB in primary care clinics, with remote oversight from tertiary hospital-based hepatologists and a project officer. We call this model of care the "B in IT" program. Suitable patients were referred from the specialist liver clinic back to primary care for ongoing management. Compliance with recommended appointments, pathology tests and ultrasounds of patients enrolled in "B in IT" was assessed and compared to that of the same patients prior to community discharge, as well as a matched control group of CHB outpatients continuing to attend a specialist clinic. Results: Thirty patients with CHB were enrolled in the "B in IT" program. Compliance with attending scheduled appointments within 1 month of the suggested date was 87% across all 115 visits scheduled. Compliance with completing recommended pathology within 1 month of the suggested date was 94% and compliance with completing recommended liver ultrasounds for cancer screening within 1 month of the suggested date was 89%. The compliance rates for visit attendance and ultrasound completion were significantly higher than the control patient group (p < 0.0001) and the "B in IT" patients prior to community discharge (p = 0.002 and p = 0.039, respectively). Conclusions: The "B in IT" program's novel web-based clinical tool supports primary care physicians to treat and monitor patients with CHB. This program promotes community-based care and increases system capacity for the clinical care of people living with CHB