Use of the Violence Risk Scale – Sexual Offense version (VRS-SO) within sexually violent persons evaluations

In many parts of the United States, individuals can be civilly committed as Sexually Violent Persons (SVP) to a secure treatment center based on their history of sexual offenses, current mental disorder, and current risk for sexual recidivism. While the specific criteria vary between jurisdictions, SVP civil commitment is indefinite, and periodic examinations occur to determine if ongoing commitment is necessary. Release recommendations may be made in part based on patients’ treatment progress. Therefore, incorporating treatment change into periodic risk assessments is an important role of the SVP evaluator. The current paper sought to explore the benefits of using an actuarial tool within SVP populations to measure decreased sexual recidivism risk as a result of treatment change. Specific discussion of the use of the Violence Risk Scale – Sexual Offense version (Olver et al., 2007, https://doi.org/10.1037/1040-3590.19.3.318) is provided.

The Relationship between the Fear, the Perceived Risk of COVID-19 and Compliance with Standard Precautions of Nurses

Aim: it was aimed to examine the correlation between the fear of COVID-19 and the perceived risk of COVID-19 and compliance with standard precautions of nurses working in pandemic clinics. Materials and Methods: The study conducted in a cross-sectional research design. The sample consists of 194 participants who worked in COVID-19 clinics between November 2020 - January 2021 in an Education and Research Hospital in Ankara, and met the inclusion criteria. Data collection form consisted of the Introductory Information Form (18 questions), the The Fear of COVID-19 Scale (7 items), the Perceived COVID-19 Risk Scale (8 items) and the Standard Precautions Scale (20 items). The data were collected by considering the pandemic conditions, using an online questionnaire. Mann Whitney U Test and Kruskal Wallis Variance Analysis were used to compare continuous data. Spearman Correlation Analysis was used to determine the correlation between the scales’ scores. Results: The mean age of the participants was 29.01 ± 6.73. Participants’ mean scores were on the The Fear of COVID-19 Scale, Perceived COVID-19 Risk Scale, and Standard Precautions Scale were 19.83 ± 6.36, 29.89 ± 5, and 14.05 ± 2.81, respectively. It was determined that there was a moderate and positive significant correlation between the The Fear of COVID-19 Scale mean scores of the participants and the Perceived COVID-19 Risk Scale (r = 0.619; p = 0.001). There was no statistically significant correlation between the mean scores of the Compliance with Standard Precautions Scale and the mean scores of the The Fear of COVID-19 Scale and Perceived COVID-19 Risk Scale (p>0.05). Conclusion: In line with the results obtained in the study, it was determined that the nurses’ fear of COVID-19 and the perceived risk of COVID-19 were above average. However, it was revealed that fear of COVID-19 and perceived risk were not related to Compliance with Standard Precautions.

Understanding the Relevance of Triarchic Psychopathy for the Reintegration of New Zealand High-Risk Violent Offenders

<p>A significant number of male New Zealand high-risk violent offenders are released from prison onto parole each year. Many of these will also present with elevated psychopathic traits which have been hypothesised to cause significant difficulty in desisting from offending, often leading parolees to quickly recidivate or breach parole, and return to prison. Despite personality disorders having pervasive effects on functioning, other reintegration outcomes such as parolee experiences and reconviction risk on parole have previously been unlinked with personality disorders and even less so the specific components of psychopathy. Using an exploratory design, this study firstly investigated the relationships between the triarchic conceptualisation of psychopathy constructs of Disinhibition, Boldness, and Meanness individually with pre-release (Violence Risk Scale, Release Plan Quality, and RoC*RoI), and post-release (Dynamic Risk Assessment for Offender Re-entry, Probation Relationship Quality, Parole Experiences Measure, and recidivism) measures of reintegration outcomes. These measures were completed by a sample of high-risk violent offenders imminently before their release onto parole after serving custodial sentences of two years or more for a violent offence (pre-release), and at two months in the community (post-release). Secondly, the controversial question of whether boldness exacerbates or attenuates negative outcomes on parole over and above disinhibition or meanness was tested. Thirdly, relationships between psychopathy and recidivism mediated by reintegration outcome measures were examined. The triarchic scales were hypothesised to be relevant for reintegration outcomes, with poorer outcomes expected for disinhibition and meanness, and better outcomes expected for boldness. Further, boldness was expected to ameliorate negative outcomes when strongly present. Results indicated that the triarchic scales evinced differential relationships with reintegration outcomes, although boldness revealed non-significant outcomes in opposing directions from those hypothesised. Disinhibition and meanness evinced expected outcomes with reintegration outcome measures. An interaction effect was found between meanness and reconviction risk on parole at moderate and high levels of boldness; boldness potentiated the effect of meanness on reconviction risk on parole when meanness was already present. Finally, a significant partial mediation was revealed, where disinhibition and recidivism were mediated by parole experiences in three out of four recidivism outcomes. Implications for the theoretical and practical relevance of triarchic psychopathy for the reintegration of high-risk violent offenders, are discussed.</p>

Understanding the Relevance of Triarchic Psychopathy for the Reintegration of New Zealand High-Risk Violent Offenders

<p>A significant number of male New Zealand high-risk violent offenders are released from prison onto parole each year. Many of these will also present with elevated psychopathic traits which have been hypothesised to cause significant difficulty in desisting from offending, often leading parolees to quickly recidivate or breach parole, and return to prison. Despite personality disorders having pervasive effects on functioning, other reintegration outcomes such as parolee experiences and reconviction risk on parole have previously been unlinked with personality disorders and even less so the specific components of psychopathy. Using an exploratory design, this study firstly investigated the relationships between the triarchic conceptualisation of psychopathy constructs of Disinhibition, Boldness, and Meanness individually with pre-release (Violence Risk Scale, Release Plan Quality, and RoC*RoI), and post-release (Dynamic Risk Assessment for Offender Re-entry, Probation Relationship Quality, Parole Experiences Measure, and recidivism) measures of reintegration outcomes. These measures were completed by a sample of high-risk violent offenders imminently before their release onto parole after serving custodial sentences of two years or more for a violent offence (pre-release), and at two months in the community (post-release). Secondly, the controversial question of whether boldness exacerbates or attenuates negative outcomes on parole over and above disinhibition or meanness was tested. Thirdly, relationships between psychopathy and recidivism mediated by reintegration outcome measures were examined. The triarchic scales were hypothesised to be relevant for reintegration outcomes, with poorer outcomes expected for disinhibition and meanness, and better outcomes expected for boldness. Further, boldness was expected to ameliorate negative outcomes when strongly present. Results indicated that the triarchic scales evinced differential relationships with reintegration outcomes, although boldness revealed non-significant outcomes in opposing directions from those hypothesised. Disinhibition and meanness evinced expected outcomes with reintegration outcome measures. An interaction effect was found between meanness and reconviction risk on parole at moderate and high levels of boldness; boldness potentiated the effect of meanness on reconviction risk on parole when meanness was already present. Finally, a significant partial mediation was revealed, where disinhibition and recidivism were mediated by parole experiences in three out of four recidivism outcomes. Implications for the theoretical and practical relevance of triarchic psychopathy for the reintegration of high-risk violent offenders, are discussed.</p>

Assessing Acceptance Level of a Hybrid Clinical Decision Support Systems

We present a user acceptance study of a clinical decision support system (CDSS) for Type 2 Diabetes Mellitus (T2DM) risk prediction. We focus on how a combination of data-driven and rule-based models influence the efficiency and acceptance by doctors. To evaluate the perceived usefulness, we randomly generated CDSS output in three different settings: Data-driven (DD) model output; DD model with a presence of known risk scale (FINDRISK); DD model with presence of risk scale and explanation of DD model. For each case, a physician was asked to answer 3 questions: if a doctor agrees with the result, if a doctor understands it, if the result is useful for the practice. We employed a Lankton’s model to evaluate the user acceptance of the clinical decision support system. Our analysis has proved that without the presence of scales, a physician trust CDSS blindly. From the answers, we can conclude that interpretability plays an important role in accepting a CDSS.

Risky Business: Evaluating the Dynamic Risk Assessment for Offender Re-entry for Use with New Zealand Youth

<p>An important assumption that decisions based on criminal risk assessments rely on is that our assessments of someone’s likelihood of reoffending are accurate. It is well known that young people share many risk factors for criminal conduct with adults, but there is also research to suggest that some factors may be more important at different ages. This research examined how well an adult dynamic risk assessment tool, The Dynamic Risk Assessment for Offender Re-entry (DRAOR), was able to predict any new criminal conviction as well as any new violent conviction in a sample of New Zealand youth (17-19 years) serving community supervision sentences. It was found that DRAOR scores were moderately strong predictors of future criminal conduct for youth, with better results being found for any reconvictions compared to violent reconvictions. The more recent an assessment was, the more accurate it was too. It was also found that those who did not go on to be reconvicted showed greater improvements on the risk scale throughout the course of their sentence than those who were reconvicted. These findings support the continued use of the DRAOR for youth in New Zealand who are serving community supervision sentences.</p>

Risky Business: Evaluating the Dynamic Risk Assessment for Offender Re-entry for Use with New Zealand Youth

<p>An important assumption that decisions based on criminal risk assessments rely on is that our assessments of someone’s likelihood of reoffending are accurate. It is well known that young people share many risk factors for criminal conduct with adults, but there is also research to suggest that some factors may be more important at different ages. This research examined how well an adult dynamic risk assessment tool, The Dynamic Risk Assessment for Offender Re-entry (DRAOR), was able to predict any new criminal conviction as well as any new violent conviction in a sample of New Zealand youth (17-19 years) serving community supervision sentences. It was found that DRAOR scores were moderately strong predictors of future criminal conduct for youth, with better results being found for any reconvictions compared to violent reconvictions. The more recent an assessment was, the more accurate it was too. It was also found that those who did not go on to be reconvicted showed greater improvements on the risk scale throughout the course of their sentence than those who were reconvicted. These findings support the continued use of the DRAOR for youth in New Zealand who are serving community supervision sentences.</p>

Impact of Polypharmacy and Potentially Inappropriate Medications Among Older Adults with Blood Cancers

Background. Polypharmacy and potentially inappropriate medications (PIMs) are common among older adults with blood cancer and can lead to adverse effects and poor outcomes. Polypharmacy is commonly defined as taking ≥5 or ≥8 medications, depending on the population. PIMs can cause adverse side effects for certain patients, e.g. diphenhydramine and benzodiazepines. We sought to define the prevalence of polypharmacy and PIMs in older adults with blood cancers, and to examine the association between both with cognitive impairment and frailty in this population. Methods. From February 2015 to November 2019, all transplant-ineligible patients ages 75 and older who presented for initial consultation for hematologic malignancy at the Dana-Farber Cancer Institute (Boston, MA) were approached by a research assistant (RA) for a 15-minute screening geriatric assessment. The RA assessed 42 aging-related health deficits using patient-reported and objective performance measures spanning the domains of function, cognition, comorbidity, and mobility. Patients were determined to be frail, pre-frail or robust via two approaches: deficit accumulation approach (Rockwood, JGMedSci 2007) and phenotypic approach (Fried, JGMedSci 2001). Cognition was measured using the delayed recall section of the Montreal Cognitive Assessment (MoCA; Nasreddine, JAGS 2005) and Clock-In-Box test (CIB; Chester, Am J Med 2011). In addition, we collected data via electronic medical record review of all prescribed and over-the-counter medications patients were taking at the time of initial consultation. These data were reconciled and reviewed for quality by two board-certified geriatricians. The geriatricians identified 2 types of PIMs: anticholinergic PIMs per the Anticholinergic Risk Scale (Rudolph, Arch Intern Med 2008) and cancer-specific PIMs per the National Cancer Care Network Medications of Concern (NCCN Older Adult Oncology 2020). For patients recommended for active cancer treatment, the association between polypharmacy and PIMs with frailty was assessed using ordinal logistic regression. The association between polypharmacy and PIMs with cognitive impairment (by MoCA delayed recall and CIB) was assessed using logistic regression. All models controlled for age, gender, and comorbidity (via Charlson Comorbidity Index). Results. In this patient cohort (N=785), 286 (36%) were female with 240 (30%) in the leukemia disease group, 272 (35%) lymphoma and 273 (35%) multiple myeloma. 603 (77%) patients had polypharmacy (≥5 medications) and 421 (54%) were taking ≥8 medications. 201 (25%) patients were taking at least one PIM based on the Anticholinergic Risk Scale (Rudolph) and 343 (44%) based on the NCCN guidelines. Overall, 131 (17%) were frail, 457 (58%) pre-frail and 197 (25%) robust. 541 (69%) patients had Charlson Co-morbidity Index ≥3; 111 (14%) patients had "probable" cognitive impairment by MoCA Delayed Recall and 147 (19%) had "probable" cognitive impairment by CIB. In the 468 (60%) patients on active cancer treatment, there was an association of frailty with polypharmacy defined by a cutoff of ≥8 (adjusted odds ratio [aOR]=2.82, 95% confidence interval [CI] 1.92-4.17), but not ≥5 medications (aOR=1.42, 95% CI 0.91-2.22; Table 1). With each additional medication on a patient's medication list, their odds of being more frail increased by 8% (aOR=1.08, 95% CI 1.04-1.12). With each one-point increase on the Anticholinergic Risk Scale, odds of being more frail increased by 19% (aOR=1.19, 95% CI 1.03-1.39). With each additional PIM based on NCCN guidelines, odds of being more frail increased by 65% (aOR=1.65, 95% CI 1.34-2.04). Polypharmacy and PIMs were not associated with cognitive impairment by either MoCA Delayed Recall or CIB. Conclusion. Polypharmacy and PIMs are prevalent among older patients with blood cancers and are strongly associated with frailty but not cognitive impairment, independent of comorbidity. Increasing number of anticholinergic and especially cancer-specific PIMs have a stronger association with frailty compared to increasing number of medications in general. Our findings highlight that the types of medications contributing to polypharmacy may be more important than number of total medications. This suggests the need for streamlined ways of identifying specific PIMs in practice to deprescribe medications that may be associated with cumulative harm in older adults with cancer. Figure 1 Figure 1. Disclosures Stone: Aprea: Consultancy; Boston Pharmaceuticals: Consultancy; BerGen Bio: Membership on an entity's Board of Directors or advisory committees; Arog: Consultancy, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; OncoNova: Consultancy; Syndax: Membership on an entity's Board of Directors or advisory committees; Syntrix/ACI: Membership on an entity's Board of Directors or advisory committees; Jazz: Consultancy; Macrogenics: Consultancy; Novartis: Consultancy, Research Funding; Glaxo Smith Kline: Consultancy; Innate: Consultancy; Janssen: Consultancy; Elevate Bio: Membership on an entity's Board of Directors or advisory committees; Foghorn Therapeutics: Consultancy; Gemoab: Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Research Funding; Actinium: Membership on an entity's Board of Directors or advisory committees; Bristol Meyers Squibb: Consultancy; Celgene: Consultancy; Abbvie: Consultancy; Syros: Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy. Soiffer: Rheos Therapeutics, USA: Consultancy; Kiadis, Netherlands: Membership on an entity's Board of Directors or advisory committees; Juno Therapeutics, USA: Other: Data Safety Monitoring Board; Precision Biosciences, USA: Consultancy; Jazz Pharmaceuticals, USA: Consultancy; Takeda: Consultancy; Jasper: Consultancy; Gilead, USA: Other: Career Development Award Committee; NMPD - Be the Match, USA: Membership on an entity's Board of Directors or advisory committees.

Water network functional analysis

Water distribution systems should have a high level of reliability and availability. Water distribution system failures should be diagnosed and categorised, according to their consequences, causes, frequency, and other important factors. A failure analysis of the water distribution system is considered in this study, as well as a method for establishing a failure susceptibility index and evaluating the risk of failures within a defined area, based on categories and zonal characteristics. A risk scale, such as tolerable, controlled, and unacceptable, will be used to assess the risk of failure. The methodology is provided to help in the performance and risk assessments of water distribution systems, as well as decision-making.