Predicting criminal and violent outcomes in psychiatry : a meta-analysis of diagnostic accuracy

Although reducing criminal outcomes in individuals with mental illness have long been a priority for governments worldwide, there is still a lack of objective and highly accurate tools that can predict these events at an individual level. Predictive machine learning models may provide a unique opportunity to identify those at the highest risk of criminal activity and facilitate personalized rehabilitation strategies. Therefore, this systematic review and meta-analysis aims to describe the diagnostic accuracy of studies using machine learning techniques to predict criminal and violent outcomes in psychiatry. We performed meta-analyses using the mada, meta, and dmetatools packages in R to predict criminal and violent outcomes in psychiatric patients (n = 2428) (Registration Number: CRD42019127169) by searching PubMed, Scopus, and Web of Science for articles published in any language up to April 2022. Twenty studies were included in the systematic review. Overall, studies used single-nucleotide polymorphisms, text analysis, psychometric scales, hospital records, and resting-state regional cerebral blood flow to build predictive models. Of the studies described in the systematic review, nine were included in the present meta-analysis. The area under the curve (AUC) for predicting violent and criminal outcomes in psychiatry was 0.816 (95% Confidence Interval (CI): 70.57–88.15), with a partial AUC of 0.773, and average sensitivity of 73.33% (95% CI: 64.09–79.63), and average specificity of 72.90% (95% CI: 63.98–79.66), respectively. Furthermore, the pooled accuracy across models was 71.45% (95% CI: 60.88–83.86), with a tau squared (τ 2 ) of 0.0424 (95% CI: 0.0184–0.1553). Based on available evidence, we suggest that prospective models include evidence-based risk factors identified in prior actuarial models. Moreover, there is a need for a greater emphasis on identifying biological features and incorporating novel variables which have not been explored in prior literature. Furthermore, available models remain preliminary, and prospective validation with independent datasets, and across cultures, will be required prior to clinical implementation. Nonetheless, predictive machine learning models hold promise in providing clinicians and researchers with actionable tools to improve how we prevent, detect, or intervene in relevant crime and violent-related outcomes in psychiatry

The need for ethical guidance for the use of patient-reported outcomes (PROs) in 2 research and clinical practice

To the Editor—Patient-reported outcomes (PROs) are increasingly being used in clinical research to provide evidence of the benefits and risk of therapy from a patient perspective. PRO data from clinical trials can inform regulatory approvals and drug labeling, clinical guideline development and health policy1. Approximately one third of clinical trials include PROs collected through the use of patient questionnaires2. Beyond trials, PRO data are also increasingly captured in observational research and routine clinical care to provide information on the burden of disease and real-world evidence of treatment safety and effectiveness3, for audit and benchmarking1, and to monitor the status of patients and provide timely care tailored to individual needs. For instance, a study demonstrated that systematic web-based collection of information on symptoms led to improved health-related quality of life, survival and quality-adjusted survival, and fewer visits to the emergency room and hospitalization, among patients receiving chemotherapy for advanced solid tumors4. Patients value PRO trial results, as they can enhance clinician–patient communication about treatment options, which helps patients to feel more empowered in shared decision-making around their care5

Report of the AACP Task Force on Patient-Centered Medical Homes and Accountable Care Organizations

A task force was convened by the American Association of Colleges of Pharmacy (AACP) to provide rationale for academic pharmacy engagement with organizations/institutions providing new models of team-based patient care designed to improve patient access, care quality, and affordable care. Descriptions of new care models, such as patient centered medical homes (PCMHs) and accountable care organizations (ACO), were included as well as descriptions of existing partnerships with academic pharmacy

Comparison of F(ab') versus Fab antivenom for pit viper envenomation: A prospective, blinded, multicenter, randomized clinical trial

BACKGROUND: Crotalidae Polyvalent Immune Fab (Ovine) has been the only antivenom commercially available in the US since 2007 for treatment of Crotalinae envenomation. Late coagulopathy can occur or recur after clearance of Fab antivenom, often after hospital discharge, lasting in some cases more than 2 weeks. There have been serious, even fatal, bleeding complications associated with recurrence phenomena. Frequent follow-up is required, and additional intervention or hospitalization is often necessary. F(ab')2 immunoglobulin derivatives have longer plasma half life than do Fab. We hypothesized that F(ab')2 antivenom would be superior to Fab in the prevention of late coagulopathy following treatment of patients with Crotalinae envenomation. METHODS: We conducted a prospective, double-blind, randomized clinical trial, comparing late coagulopathy in snakebitten patients treated with F(ab')2 with maintenance doses [F(ab')2/F(ab')2], or F(ab')2 with placebo maintenance doses [F(ab')2/placebo], versus Fab with maintenance doses [Fab/Fab]. The primary efficacy endpoint was coagulopathy (platelet count < 150 K/mm(3), fibrinogen level < 150 mg/dL) between end of maintenance dosing and day 8. RESULTS: 121 patients were randomized at 18 clinical sites and received at least one dose of study drug. 114 completed the study. Of these, 11/37 (29.7%) in the Fab/Fab cohort experienced late coagulopathy versus 4/39 (10.3%, p < 0.05) in the F(ab')2/F(ab')2 cohort and 2/38 (5.3%, p < 0.05) in the F(ab')2/placebo cohort. The lowest heterologous protein exposure was with F(ab')2/placebo. No serious adverse events were related to study drug. In each study arm, one patient experienced an acute serum reaction and one experienced serum sickness. CONCLUSIONS: In this study, management of coagulopathic Crotalinae envenomation with longer-half-life F(ab')2 antivenom, with or without maintenance dosing, reduced the risk of subacute coagulopathy and bleeding following treatment of envenomation

Oseltamivir-Resistant Pandemic A/H1N1 Virus Is as Virulent as Its Wild-Type Counterpart in Mice and Ferrets

The neuraminidase inhibitor oseltamivir is currently used for treatment of patients infected with the pandemic A/H1N1 (pH1N1) influenza virus, although drug-resistant mutants can emerge rapidly and possibly be transmitted. We describe the characteristics of a pair of oseltamivir-resistant and oseltamivir-susceptible pH1N1 clinical isolates that differed by a single change (H274Y) in the neuraminidase protein. Viral fitness of pH1N1 isolates was assessed in vitro by determining replication kinetics in MDCK α2,6 cells and in vivo by performing experimental infections of BALB/c mice and ferrets. Despite slightly reduced propagation of the mutant isolate in vitro during the first 24 h, the wild-type (WT) and mutant resistant viruses induced similar maximum weight loss in mice and ferrets with an identical pyrexic response in ferrets (AUC of 233.9 and 233.2, P = 0.5156). Similarly, comparable titers were obtained for the WT and the mutant strains on days 1, 3, 6 and 9 post-infection in mouse lungs and on days 1–7 in ferret nasal washes. A more important perivascular (day 6) and pleural (days 6 and 12) inflammation was noted in the lungs of mice infected with the H274Y mutant, which correlated with increased pulmonary levels of IL-6 and KC. Such increased levels of IL-6 were also observed in lymph nodes of ferrets infected with the mutant strain. Furthermore, the H274Y mutant strain was transmitted to ferrets. In conclusion, viral fitness of the H274Y pH1N1 isolate is not substantially altered and has the potential to induce severe disease and to disseminate

Coping with stress in deprived urban neighbourhoods:What is the role of green space according to life stage?

This study follows previous research showing how green space quantity and contact with nature (via access to gardens/allotments) helps mitigate stress in people living in deprived urban environments (Ward Thompson et al., 2016). However, little is known about how these environments aid stress mitigation nor how stress levels vary in a population experiencing higher than average stress. This study used Latent Class Analysis (LCA) to, first, identify latent health clusters in the same population (n = 406) and, second, to relate health cluster membership to variables of interest, including four hypothetical stress coping scenarios. Results showed a three-cluster model best fit the data, with membership to health clusters differentiated by age, perceived stress, general health, and subjective well-being. The clusters were labeled by the primary health outcome (i.e., perceived stress) and age group (1) Low-stress Youth characterized by ages 16–24; (2) Low-stress Seniors characterized by ages 65+ and (3) High-stress Mid-Age characterized by ages 25–44. Next, LCA identified that health membership was significantly related to four hypothetical stress coping scenarios set in people's current residential context: “staying at home” and three scenarios set outwith the home, “seeking peace and quiet,” “going for a walk” or “seeking company.” Stress coping in Low stress Youth is characterized by “seeking company” and “going for a walk”; stress coping in Low-stress Seniors and High stress Mid-Age is characterized by “staying at home.” Finally, LCA identified significant relationships between health cluster membership and a range of demographic, other individual and environmental variables including access to, use of and perceptions of local green space. Our study found that the opportunities in the immediate neighborhood for stress reduction vary by age. Stress coping in youth is likely supported by being social and keeping physically active outdoors, including local green space visits. By contrast, local green space appears not to support stress regulation in young-middle aged and older adults, who choose to stay at home. We conclude that it is important to understand the complexities of stress management and the opportunities offered by local green space for stress mitigation by age and other demographic variables, such as gender

Neighborhoods and health

Features of neighborhoods or residential environments may affect health and contribute to social and race/ethnic inequalities in health. The study of neighborhood health effects has grown exponentially over the past 15 years. This chapter summarizes key work in this area with a particular focus on chronic disease outcomes (specifically obesity and related risk factors) and mental health (specifically depression and depressive symptoms). Empirical work is classified into two main eras: studies that use census proxies and studies that directly measure neighborhood attributes using a variety of approaches. Key conceptual and methodological challenges in studying neighborhood health effects are reviewed. Existing gaps in knowledge and promising new directions in the field are highlighted.http://deepblue.lib.umich.edu/bitstream/2027.42/78378/1/DiezRouxMair2010_AnnNYAcadSci.pd

Knowledge and imagery of contractile mechanisms do not improve muscle strength

Improving performance in strength tasks requires modifications characteristic of motor skill learning, such as more efficacious motor-unit firing behavior. Because domain-specific knowledge is integral to learning and performing motor skills, the present purpose was to examine selected factors of strength-specific knowledge and effects they might have on acquiring strength. Following baseline testing for maximal strength on a knee-extension task, participants were matched by sex and strength and placed into control (n = 8) and treatment (n = 8) groups, Quadriceps muscle electromyographic data were also collected. The treatment group underwent two educational sessions detailing muscle physiology, neural control of muscle force, and imagery training using this knowledge. The control group underwent two educational sessions about health and fitness. Following the educational sessions the participants were retested for strength. Analysis indicated that the education and imagery treatment had no effect on strength, nor did electromyographic measures indicate that the treatment group benefitted from intervention. It was concluded that the knowledge was simply not relevant to knee extension-force production or that use of the knowledge involved a disadvantageous internal focus of attention away from relevant task demands