scholarly journals The Contribution of Cognitive Impulsivity to Criminal Risk

2021 ◽  
Author(s):  
◽  
Rebecca K. Bell
Keyword(s):  
Impulse Control ◽  
Post Treatment ◽  
Trait Anger ◽  
Special Treatment ◽  
Treatment Programme ◽  
Treatment Change ◽  
Anger Control ◽  
Treatment Unit ◽  
Cognitive Behavioural ◽  
Pre Treatment

<p>Impulsivity increases risk for general, violent and sexual offending. Accordingly, helping offenders to become better regulators of their impulses is one goal of offender rehabilitation. In a correctional setting, the assessment of impulsivity focuses on personality and behaviour, but not cognition; cognitive impulse control impairments are inferred from personality styles and behavioural patterns suggestive of acting before thinking. However, empirical findings challenge the validity of inferring cognition from personality and behavioural measures. Additionally, without assessing cognition, practitioners are limited in their ability to isolate which cognitive processes are most impaired and therefore worthy of intervention for individual offenders.  To establish the contribution of cognitive impulse control to criminal risk, a theoretically derived, empirically supported neurocognitive assessment framework was adopted. The framework is based on the notion that impulsive behaviour arises from three, potentially dissociable skill domains that support impulse control: decisionmaking, perceptual and motor impulse control. A cohort of 77 men attending intensive cognitive-behavioural rehabilitation was recruited from four of New Zealand’s prison-based Special Treatment Unit Rehabilitation Programmes (STURPs). A neurocognitive battery of five tasks collectively representing each cognitive impulse control domain was administered before and after the 8-month treatment programme.  Study One explored pre-treatment clinically impaired performance within and across each cognitive impulse control domain. Compared to normative data, performance was typically in the average to below average range, but it was not clinically impaired overall. When performance was clinically impaired, it was most pronounced on tasks requiring cognitive flexibility.  Study Two explored treatment change in cognitive impulse control. The study also compared pre-treatment cognitive impulse control between offenders who went on to complete the treatment programme and those who were prematurely removed for responsivity or conduct-related issues. No pre-treatment cognitive impulse control differences were found between treatment completers and non-completers. Treatment completers displayed small pre-post treatment improvements in some areas of cognitive impulse control, but not others.  Study Three explored cross-sectional and predictive relationships between cognitive impulse control, dynamic criminal risk, trait anger and anger control. Although there was little association between these variables before treatment, some cognitive impulse control outcomes predicted post-treatment dynamic criminal risk, trait anger and anger control. Thus, the evidence suggested that certain aspects of cognitive impulse control might function as facilitators of treatment change.  Together, the findings highlighted the importance of evaluating cognitive impulse control as part of the risk assessment, and clinical formulation process. The findings also suggested that interventions designed to develop cognitive impulse control abilities either before, or as a complement to traditional cognitive-behavioural interventions, have the potential to maximise treatment response.</p>

scholarly journals The Contribution of Cognitive Impulsivity to Criminal Risk

2021 ◽  
Author(s):  
◽  
Rebecca K. Bell
Keyword(s):  
Impulse Control ◽  
Post Treatment ◽  
Trait Anger ◽  
Special Treatment ◽  
Treatment Programme ◽  
Treatment Change ◽  
Anger Control ◽  
Treatment Unit ◽  
Cognitive Behavioural ◽  
Pre Treatment

<p>Impulsivity increases risk for general, violent and sexual offending. Accordingly, helping offenders to become better regulators of their impulses is one goal of offender rehabilitation. In a correctional setting, the assessment of impulsivity focuses on personality and behaviour, but not cognition; cognitive impulse control impairments are inferred from personality styles and behavioural patterns suggestive of acting before thinking. However, empirical findings challenge the validity of inferring cognition from personality and behavioural measures. Additionally, without assessing cognition, practitioners are limited in their ability to isolate which cognitive processes are most impaired and therefore worthy of intervention for individual offenders.  To establish the contribution of cognitive impulse control to criminal risk, a theoretically derived, empirically supported neurocognitive assessment framework was adopted. The framework is based on the notion that impulsive behaviour arises from three, potentially dissociable skill domains that support impulse control: decisionmaking, perceptual and motor impulse control. A cohort of 77 men attending intensive cognitive-behavioural rehabilitation was recruited from four of New Zealand’s prison-based Special Treatment Unit Rehabilitation Programmes (STURPs). A neurocognitive battery of five tasks collectively representing each cognitive impulse control domain was administered before and after the 8-month treatment programme.  Study One explored pre-treatment clinically impaired performance within and across each cognitive impulse control domain. Compared to normative data, performance was typically in the average to below average range, but it was not clinically impaired overall. When performance was clinically impaired, it was most pronounced on tasks requiring cognitive flexibility.  Study Two explored treatment change in cognitive impulse control. The study also compared pre-treatment cognitive impulse control between offenders who went on to complete the treatment programme and those who were prematurely removed for responsivity or conduct-related issues. No pre-treatment cognitive impulse control differences were found between treatment completers and non-completers. Treatment completers displayed small pre-post treatment improvements in some areas of cognitive impulse control, but not others.  Study Three explored cross-sectional and predictive relationships between cognitive impulse control, dynamic criminal risk, trait anger and anger control. Although there was little association between these variables before treatment, some cognitive impulse control outcomes predicted post-treatment dynamic criminal risk, trait anger and anger control. Thus, the evidence suggested that certain aspects of cognitive impulse control might function as facilitators of treatment change.  Together, the findings highlighted the importance of evaluating cognitive impulse control as part of the risk assessment, and clinical formulation process. The findings also suggested that interventions designed to develop cognitive impulse control abilities either before, or as a complement to traditional cognitive-behavioural interventions, have the potential to maximise treatment response.</p>

Post-treatment of anaerobic effluents in constructed wetland systems

2001 ◽  
Vol 44 (4) ◽  
pp. 213-219 ◽  
Author(s):  
J. T. de Sousa ◽  
A. C. van Haandel ◽  
A. A.V. Guimarães
Keyword(s):  
Suspended Solids ◽  
Control Unit ◽  
Coarse Sand ◽  
Post Treatment ◽  
Uasb Reactor ◽  
Municipal Sewage ◽  
Nitrogen And Phosphorus ◽  
Treatment Unit ◽  
Hydraulic Load ◽  
Pre Treatment

This papers describes the behaviour of wetlands as a post-treatment unit for anaerobically treated sewage for the removal of organic matter, suspended solids, nutrients (nitrogen and phosphorus) and faecal coliforms. Raw sewage was treated in a UASB reactor with a retention time of 5 h and the effluent was used in four units of wetlands with coarse sand as the medium and operated with different hydraulic loads. Three of the units had emerging macrophytes (Juncus sp), whereas the fourth one was operated as a control unit without plants. During the 12 months of operation, the organic material removal efficiency (measured as COD) was in the range of 79 to 85%, whereas suspended solids removal varied from 48 to 71%. Faecal coliform removal was very high (99,99%); phosphorus was also efficiently removed (average efficiency of 90% for the lowest hydraulic load), but nitrogen removal was only partial (45 to 70% for ammonia and 47 to 70% for TKN). The experimental results clearly show the technical feasibility of using wetlands for treatment of municipal sewage after a pre-treatment in the UASB reactor.

Effectiveness of mycophenolate mofetil as first-line therapy in AQP4-IgG, MOG-IgG, and seronegative neuromyelitis optica spectrum disorders

2016 ◽  
Vol 23 (10) ◽  
pp. 1377-1384 ◽  
Author(s):  
Alexis Montcuquet ◽  
Nicolas Collongues ◽  
Caroline Papeix ◽  
Helene Zephir ◽  
Bertrand Audoin ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Neuromyelitis Optica ◽  
Post Treatment ◽  
First Line ◽  
Treatment Change ◽  
Good Tolerability ◽  
First Line Therapy ◽  
Line Therapy ◽  
Pre Treatment

Objective: To evaluate the effectiveness and tolerance of mycophenolate mofetil (MMF) as a first-line treatment in neuromyelitis optica spectrum disorder (NMOSD). Methods: In all, 67 NMOSD patients treated by MMF as first-line therapy, from the NOMADMUS cohort were included. A total of 65 fulfilled 2015 NMOSD criteria, and 5 were myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) positive. Effectiveness was evaluated on percentage of patients continuing MMF, percentage of patients free of relapse, pre- and post-treatment change in the annualized relapse rate (ARR), and Expanded Disability Status Scale (EDSS). Results: Among 67 patients, 40 (59.7%) continued treatment till last follow-up. A total of 33 (49.3%) were relapse-free. The median ARR decreased from one pre-treatment to zero post-treatment. Of 53 patients with complete EDSS data, the score improved or stabilized in 44 (83%; p < 0.05). Effectiveness was observed in aquaporin-4 (AQP4)-IgG (57.8% continued treatment, 46.7% relapse-free), MOG-IgG (3/5 continued treatment, 4/5 relapse-free), and seronegative NMOSD (64.7% continued treatment, 61.3% relapse-free). In 16 patients with associated steroids, 13 (81.2%) continued MMF till last follow-up versus 15 of 28 (53.6%) in the non-steroid group. Nine patients discontinued treatment for tolerability purpose. Conclusion: MMF showed effectiveness and good tolerability as a first-line therapy in NMOSD, whatever the AQP4-IgG status. Concomitant use of oral steroids at start could limit the risk of treatment failure.

Cognitive-Behavioural Treatment of Tinnitus in Otosclerosis: A Case Report

1997 ◽  
Vol 25 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Gerhard Andersson ◽  
Hans-Christian Larsen
Keyword(s):  
Psychological Distress ◽  
Case Report ◽  
Successful Treatment ◽  
Post Treatment ◽  
Treatment Programme ◽  
Behavioural Treatment ◽  
Cognitive Behavioural Treatment ◽  
Cognitive Behavioural

Tinnitus is a symptom of ear disease that may cause psychological distress. We report here on the successful treatment of stress-related tinnitus in a patient with otosclerosis (an ear disease). The patient experienced stress-induced attacks during which tinnitus became unbearable. A cognitive-behavioural treatment programme of 10 sessions was given during two weeks. Results assessed at pre-and post-treatment showed decreased annoyance and increased coping with tinnitus. The attacks became less frequent and easier to handle. The results support the application of cognitive-behavioural treatment in cases with difficult tinnitus.

Individualized Cognitive Behavioural Treatment of Chronic Pain

1986 ◽  
Vol 14 (3) ◽  
pp. 210-225 ◽  
Author(s):  
Beverly E. Thorn ◽  
David A. Williams ◽  
Patrick R. Johnson
Keyword(s):  
Chronic Pain ◽  
Treatment Outcome ◽  
Outcome Measures ◽  
Post Treatment ◽  
Relaxation Techniques ◽  
Behavioural Treatment ◽  
Treatment Assessment ◽  
Cognitive Behavioural Treatment ◽  
Cognitive Behavioural ◽  
Pre Treatment

Cognitive behavioural treatment for chronic pain was individually tailored based on pre-treatment assessment of the subjective pain experience of each patient. Eight chronic pain patients completed the individualized treatment program which consisted of relaxation techniques, hypnotic deepening strategies, a relabeling hierarchy based upon pain descriptors, positive self-statements, didactic information, and cognitive-restructuring techniques. Patients self-monitored their pain during a two week pre-treatment baseline period, during the eight weeks of treatment and for one week post-treatment. Additional treatment outcome measures were also taken. Compared to baseline data, patients reported positive changes on many of the treatment outcome criteria, including McGill Pain Questionnaire indices, reduction in the number of hours spent in pain, and follow-up questionnaire responses. Treatment outcome measures collected at one week, six months, and 15 months post-treatment all suggested positive treatment gains. The greatest gains were reported at the six month post-treatment assessment suggesting a generalization or practice component to the therapy. Additionally, patients with constant pain were found more refractory to treatment than patients with intermittent pain.

A novel and cost-effective sewage treatment system consisting of UASB pre-treatment and aerobic post-treatment units for developing countries

1997 ◽  
Vol 36 (12) ◽  
pp. 189-197 ◽  
Author(s):  
Izarul Machdar ◽  
Hideki Harada ◽  
Akiyoshi Ohashi ◽  
Yuji Sekiguchi ◽  
Hiroyuki Okui ◽  
...  
Keyword(s):  
Developing Countries ◽  
Low Cost ◽  
Sewage Treatment ◽  
Cost Effective ◽  
Post Treatment ◽  
Cod Removal ◽  
Treatment System ◽  
Treatment Unit ◽  
Pre Treatment ◽  
Sewage Treatment System

A novel sewage treatment system was proposed, which consists of a UASB anaerobic pre-treatment unit and the following DHS (downflow hanging sponge-cubes) aerobic post-treatment unit, as a low-cost and easy-maintenance process for developing countries. Over six months experiment by feeding sewage our proposed system achieved 94% of total-COD removal, 81% of soluble-COD removal, and nearly perfect SS removal and total-BOD removal at the overall HRT of 8.3 hr (7 hr in UASB and 1.3 hr in DHS unit). Moreover, the DHS reactor was capable of performing high (73–78%) nitrification. Our whole system requires neither external aeration input nor withdrawal of excess sludge.

scholarly journals What is the best soft-tissue reference plane to quantify lip change in bimaxillary protrusion cases? A retrospective cohort study

2020 ◽  
Vol 10 ◽  
pp. 178-184
Author(s):  
Mustafa Nasar ◽  
Donald J. Ferguson ◽  
Johnny Joung-Lin Liaw ◽  
Laith Makki ◽  
Nikhilesh R. Vaid
Keyword(s):  
Soft Tissue ◽  
Post Treatment ◽  
Reference Plane ◽  
Treatment Change ◽  
Lower Lip ◽  
Soft Tissue Profile ◽  
Lateral Cephalograms ◽  
Significant Difference ◽  
Pre Treatment ◽  
Bimaxillary Protrusion

Objectives: The objective of the study was to evaluate the validity of five soft-tissue profile planes to actual horizontal lower lip changes following treatment of severe bimaxillary protrusion patients with vertical maxillary excess using extra-alveolar miniscrews. The null hypothesis was no differences in the incremental changes of horizontal lower lip changes from pre-treatment to post-treatment of the five methods compared to actual changes. Materials and Methods: Seventy adults were treated orthodontically with extractions for bimaxillary protrusion and “gummy” smile using extra-alveolar miniscrews. Lower lip horizontal position was assessed with pre- and post-treatment lateral cephalograms and five commonly used soft-tissue reference lines were used to measure horizontal lower lip treatment change. Results: Compared to actual therapeutic lower lip horizontal retraction (4.38 mm), soft-tissue references Ricketts’ E-line (3.89 mm) and Steiner’s S-line (3.88 mm) demonstrated no statistical difference (P > 0.05) from actual change. The five profile plane measures showed moderately high to high intercorrelations among themselves, but none of them were related to the actual amount of anteroposterior lip change that occurred. None of the five soft-tissue measurements showed a statistically significant difference (P > 0.05) between subgroups with least and greatest lower lip retraction. Conclusion: Under conditions of maximum lower lip retraction, Rickett’s E-line and Steiner’s S-line were fair measures of horizontal lower lip change. Although actual lower lip change and soft-tissue reference plane changes were correlated poorly, intercorrelations among the five soft-tissue references planes were moderately high. None of the five soft-tissue measurements was able to discriminate (P > 0.05) between treatments with least and greatest lower lip retraction. It may be concluded that Rickett’s E-line and Steiner’s S-line soft-tissue profile references are valid when there is considerable therapeutic retraction (4+ mm) of the lower lip.

scholarly journals P13 An analysis of multidisciplinary care in systemic auto-immune rheumatic disease in a single centre

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Kieran Sandhu ◽  
Nadia Ahmad ◽  
Ayna Verdiyeva ◽  
Raashid Luqmani
Keyword(s):  
Disease Activity ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Multidisciplinary Care ◽  
Post Treatment ◽  
Response To Therapy ◽  
High Morbidity ◽  
Treatment Change ◽  
Treatment Changes ◽  
Pre Treatment

Abstract Background Auto-immune rheumatic diseases are multisystem conditions with high morbidity and mortality, where co-ordinated multidisciplinary (MDT) care is necessary to ensure effective and timely treatment. An NHS England Commissioning for Quality and Innovation was implemented in 2016 to support development of MDTs to achieve earlier diagnosis and intervention and standardise quality of care and access to high-cost drugs. Methods A regional network for MDTs was established in one centre, led by Rheumatology with input from other specialities. MDT outcomes are recorded in a bespoke database. We analysed MDT outcomes over a two-year period from September 2017 to August 2019 for the following: disease activity assessments, investigations requested, referrals to other specialists, treatment changes and the reasons for these. Results During this period, 2,750 MDT discussions were recorded for 1,270 patients. The most common diagnoses were giant cell arteritis (30%), systemic lupus erythematosus (9%) and granulomatosis with polyangiitis (6%). Disease activity scores were recorded on 2,744 (99.8%) occasions with BVAS (n = 1,658, mean 0.82, range 0-21) and SLEDAI (n = 379, mean 2.04, range 0-20) used most. This underlines that decisions were consistently based on validated outcome measures. Investigations were ordered on 1165 (42%) occasions. Imaging was requested in 1,124 cases, biopsy in 37, functional tests in 221 and other tests in 18. Ultrasound was requested most often (614). Onward referrals were made in 237 (9%), most frequently to respiratory (32) and ENT (32). On 1550 occasions (56%) a treatment change was made: 1049 (38%) had a new change and 501 (18%) had a previously planned change. The most common reasons were good response to therapy (354 [23%]), inefficacy (345 [22%]) or starting additional therapy (214 [14%]). This shows that a significant number of treatment changes were approved by the MDT, both for treatment reduction as well as escalation. A biologic was added on 65 occasions (4% of treatment changes), most commonly in GCA (8 started on tocilizumab), SLE (5) and GPA (5). Biologics were repeated in 121 (8%) and stopped in 25 (2%). Where biologics were added, mean pre-treatment BVAS was 4.7 and post-treatment was 0.6. Mean reduction in BVAS after treatment was 5.2. The equivalent mean scores for SLEDAI were 7 (pre-treatment), 2 (post-treatment) and 7.7 (reduction). On average, the addition of biologics resulted in reductions in disease activity scores, which provides justification for their use. Conclusion Our data suggest that the large number of MDT reviews over this two-year period contributed significantly to management of systemic auto-immune rheumatic diseases by approving investigations, referrals and treatment changes. This facilitated timely intervention and avoidance of overtreatment. The auditable recording of these reviews and disease activity scores ensured decisions were guided by objective assessments and the use of high-cost drugs was standardised and justifiable. Disclosures K. Sandhu None. N. Ahmad None. A. Verdiyeva None. R. Luqmani None.

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