Showing papers in "Criminal Behaviour and Mental Health in 2012"

A joint offender personality disorder pathway strategy: an outline summary.

Abstract: Background and purpose In 1999, the Home Office published a public consultation on the need for better management of offenders with severe personality disorders. The Dangerous and Severe Personality Disorder (DSPD) Programme was launched in 2001. Following a stocktake of the DSPD Programme in 2008, the Department of Health and the National Offender Management Service (NOMS) started the next phase of strategic development for the management of offenders with personality disorder. This paper presents the key features of the Coalition Government's strategy for offenders with personality disorders. Conclusion This strategy offers a co-ordinated joint approach by both the National Health Service and the NOMS to the co-commissioning and development of pathway services. Copyright © 2012 John Wiley & Sons, Ltd.

MicroRNA-21 is a new marker of circulating tumor cells in gastric cancer patients

Abstract: The detection of circulating tumor cells (CTCs) has received great attention. MicroRNA-21 (miR-21) plays crucial roles in carcinogenesis and is considered as one of the most studied oncomiRNAs. We determined if miR-21 could be used a marker for the detection of CTCs in gastric cancer patients. Peripheral blood samples were collected from 53 preoperative patients with gastric cancer and 20 healthy volunteers. Real-time reverse transcription-polymerase chain reaction was used to detect the level of miR-21. Receiver operator characteristic curves (ROC) were constructed. Patients with gastric cancer display a significantly higher level of miR-21 in peripheral blood than those from controls. The miR-21 level was associated with the tumor node metastasis (TNM) stage, tumor size and tissue categories. The area under ROC curve was up to 0.853 ± 0.086. This study highlights the potential of the detection of miR-21 in peripheral blood as a novel tool for monitoring CTCs in gastric cancer patients.

MicroRNAs and breast cancer malignancy: an overview of miRNA-regulated cancer processes leading to metastasis.

Abstract: Cancer statistics show significant diagnosis numbers amongst men and women worldwide, where breast cancer is by far the most frequently diagnosed cancer in women. Multiple mechanisms and molecules have been shown to occupy major roles in cancer progression and aggressivity. Recently, small non-coding RNA molecules, called micro-RNAs, have become the subject of interest in many molecular pathways in relation to breast cancer, amongst many other pathologies. MiRNAs are capable of regulating gene expression in a sequence-specific manner and regulate diverse expression patterns which are dependent on the cell's state and identity. Studies have brought forward specific miRNAs that have the innate ability to govern unique gene expression profiles regulating cancer cell aggressivity. This review will outline recent findings of characterized miRNAs in relation to their molecular targets leading to cancer malignancy and progression. More specifically, we will focus on miRNAs associated with breast cancer metastatic processes including epithelial to mesenchymal and mesenchymal to epithelial transitioning (EMT/MET transition), migration, invasion and angiogenesis.

Recidivism in subgroups of serious juvenile offenders: Different profiles, different risks?

Abstract: BACKGROUND: Research has shown that the treatment of juvenile offenders is most effective when it takes into account the possible risk factors for re-offending. It may be asked whether juvenile offenders can be treated as one homogeneous group, or, if they are divisible into subgroups, whether different risk factors are predictive of recidivism. AIMS AND HYPOTHESES: Our aims were to find out whether serious juvenile offenders may be subdivided into clearly defined subgroups and whether such subgroups might differ in terms of the risk factors that predict recidivism. METHODS: In a sample of 1111 serious juvenile offenders, latent class analysis was used to identify subgroups. For each juvenile offender, 70 risk factors were registered. Severity of recidivism was measured on a 12-point scale. Analysis was then conducted to identify the risk factors that best predicted the different patterns of recidivism. RESULTS: Four distinct subgroups of juvenile offenders were identified: serious violent offenders, violent property offenders, property offenders, and sex offenders. Violent property offenders were the most serious recidivists and had the highest number of risk factors. Serious violent offenders and property offenders were characterised by overt and covert behaviour, respectively. Sex offenders differed from the other three groups in the rarity of their recidivism and in the risk factors that are present. For each of these four subgroups, a different set of risk factors was found to predict severity of recidivism. CONCLUSIONS: Differences in recidivism rates occurred in spite of the fact that most of these youngsters had been in the standard treatment programme offered to serious juvenile offenders in the Netherlands. This was not a treatment outcome study, but the indication that two of the groups identified in our study appeared to be worse after going through this programme, whereas the other two did quite well in terms of recidivism lends weight to our idea that such classification of juvenile offenders may lead to more targeted treatment programmes that would better serve both the general public and the youths concerned. Copyright © 2011 John Wiley & Sons, Ltd. Language: en

Sex differences in offending trajectories in a Swedish cohort

Abstract: Background Despite the increased interest in female offending trajectories over the last decades, knowledge is still limited. Aim To meet the need for more knowledge on female offending trajectories by studying sex differences in criminal career patterns. Method Data on 518 female and 2567 male offenders up to age 30 from the Swedish longitudinal Project Metropolitan study were analysed using latent class analysis. Results The female offenders were much less predisposed to offend than the males, but when they did, they tended to follow a similar set of trajectories to males in their criminal development over time. Four criminal career patterns were identified for each sex. Two patterns were the same between the sexes, and two were gender unique. All career patterns had meaningful and distinct associations with crime characteristics. Conclusions Our study presents indicators relating both to gender differences and to heterogeneity within the group of female offenders. One important finding was the identification of an adult-onset offender group unique to females. This group was characterised by high criminal activity over the years following their late onset. Further research will focus on the childhood origins, pathways and outcomes of different female antisocial and criminal careers. Copyright © 2012 John Wiley & Sons, Ltd.

The prognostic values of CA125, CA19.9, NSE, AND SCC for stage I NSCLC are limited

Abstract: Objective: Amongst the current detections of tumor markers, measurement of serum tumor markers is the most convenient and the safest way. However, there are few promising serum tumor markers with confirmed prognostic value in NSCLC (non-small-cell lung cancer, NSCLC). Therefore, scientists only grafted the useful tumor markers, such as CA125, CA19.9, NSE, SCC, CEA and CYFRA21.1 which have been found in other solid tumors. However, previous reports about this issue remain controversial. This study is to analyze the prognostic values of these 6 markers in stage I NSCLC. Methods: OnehundredandsixtyfourpatientswithstageINSCLCwhounderwentoperationbysingle-surgery-teaminDepartment I of Thoracic Surgery, Peking University Cancer Hospital between March 2000 and March 2011 were included. These patients had measurement of CA125, CA19.9, NSE, SCC, CEA and CYFRA21.1 using electrochemiluminescence immunoassay one week before operation. The relationship between the level of these 6 tumor markers and long term survival rate was analyzed. Results: The positive rate for CA125, CA19.9, NSE, SCC, CEA and CYFRA 21.1 in the 121 adenocarcinoma patients was 5.7%, 5.7%, 18.3%, 5.3%, 18.3%, and 20.7% respectively; whereas 3.1%, 2.6%, 23.8%, 26.8%, 14.0%, and 42.9% in 43 non- adenocarcinoma patients, respectively. Inunivariate analysis, theoverall 5year survival rateof patientswithelevated CYFRA21.1 level was lower than that of patients with normal level in ADC subgroup (54.5% vs. 83.8%, p< 0.05) and in all 164 cases (49.5% vs. 76.4%, p< 0.05). In multivariate analysis, the level of CYFRA21.1 was an independent prognostic factor. But the other 5 markers didn't show significant prognostic value. Conclusions: Wefound that theprognostic values of CA125, CA19.9, NSE,and SCCfor stageI NSCLCarelimited. CYFRA21.1 might be a hopeful prognostic serum tumor marker for stage I NSCLC.

Development and validation of a measure of criminal social identity within a sample of Polish recidivistic prisoners.

Abstract: Social identity is a well-established theoretical concept within psychological research; however, the role of criminal social identity has received far less research attention. One salient reason for the limited research relating to the concept of criminal social identity is the absence of a specific measure. The eight-item MCSI was used to collect data from recidivists incarcerated in high-security prison (N = 312) to assess criminal social identification. These data were subjected to confirmatory factor analysis. Three alternative models of criminal social identity were specified and tested in Mplus 6, and results revealed that the data were best explained by a three-factor model of criminal social identity (cognitive centrality, in-group affect and in-group ties). The current study is important in terms of future research in criminology and psychology because the MCSI provides the first reliable MCSI, which was developed and validated on a relatively large recidivistic prison sample.

Investigating changes in anger and aggression in offenders with high levels of psychopathic traits attending the Chromis violence reduction programme.

Abstract: Background Chromis was accredited by the Correction Services Accreditation Panel in 2005 as an intervention designed to reduce violence in offenders whose level or combination of psychopathic traits disrupts their ability to engage in treatment and change. It runs as part of the regime in the dangerous and severe personality disorder unit in HM Prison Frankland (Westgate). A multiple case study investigation into changes over time in participants is currently underway, part of which is reported here. Aims This paper reports on information relating to changes in anger and aggression in Chromis completers. Methods Change in psychometrics and observed incidents of verbal and physical aggression are considered for five case study participants who have completed Chromis and progressed from Westgate to a different location. Results Findings suggest that cases experienced a reduction in self-reported anger, and expected incidents of physical aggression but had higher than expected levels of verbal aggression after leaving Westgate. Conclusions These findings offer cautious optimism for the effectiveness of Chromis, although methodological limitations must also be considered. Findings may be seen as positive indicators of Chromis, or at least the approach to working with these offenders across Westgate, in reducing violence. Implications for practice Findings support the continued delivery and evaluation of Chromis. There may be benefit in exploring ways to further understand and address verbal aggression in participants. Copyright © 2012 John Wiley & Sons, Ltd.

The mutational spectrum of HRAS, KRAS, NRAS and FGFR3 genes in bladder cancer

Abstract: Bladder cancer is one of the most common cancers worldwide. A number of genetic and epigenetic alterations have been identified in bladder tumorigenesis, including activating mutations in fibroblast growth factor receptor 3 (FGFR3) and RAS family genes. In this study, we have analysed the mutational spectrum of FGFR3 and RAS genes (HRAS, NRAS and KRAS). We have also studied the relationship between mutations. A total of 234 patients with different stages and grades were included in the present study (58 superficial low-grade, 53 superficial high-grade and 123 muscle-invasive tumours). Mutations in exons 1 and 2 of HRAS, KRAS and NRAS genes were screened by PCR and direct sequencing. The hot spot mutations in exons 7, 10 and 15 of the FGFR3 oncogene were studied by multiplex PCR and the SNaP-shot protocol. Overall, 8.97% (21/234) of samples were mutant for one of the RAS genes. Among these mutations 47.61% were detected in KRAS, 33.33% in HRAS and only 19.04% most frequent RAS mutations were KRAS p.G12C and p.G12D. The correlation between RAS mutations and tumour subgroups does not report a statistical significant association (p=0.876). The FGFR3 mutations were detected in 31.19% (73/234) of bladder tumours and were associated with low stages and grades. The study of relationship between RAS and FGFR3 genes revealed that FGFR3 mutations were mutually exclusive with RAS ones (p=10(-4)). In conclusion we retain that activated RAS and FGFR3 do not appear to be drivers in bladder cancer but the mutually exclusive relationship between RAS and FGFR3 mutations indicates a possible clonal advantage of modified signaling via a common pathway.

Milestones to recovery: Preliminary validation of a framework to promote recovery and map progress through the medium secure inpatient pathway

Abstract: Background Forensic mental health care in the UK has undergone a rapid expansion since the late 1990s. In medium secure units (MSUs), there is growing emphasis on developing care pathways without much theoretical underpinning. We developed a concept of ‘Milestones to Recovery’ (MTR) to measure progress through the MSU pathway. Aims Our aim was to validate the MTR framework. Our hypotheses were that patients scoring higher on the MTR Scale would be more likely to be aggressive to others in the following 6 months and resident in the acute areas of the unit and that those scoring lower would be more likely to be discharged within 6 months of the assessment. Methods An MTR scale was developed to enable the investigation of the validity of the MTR framework and evaluated with staff evaluations of 80 resident patients using a prospective, longitudinal and naturalistic design. Results The results suggest that the MTR framework is valid in discriminating between different stages on the MSU pathway. Therapeutic engagement was particularly important in terms of progress through the MSU, whereas current behaviour was important in predicting future aggression. Conclusions Further research is required to test the MTR framework across different levels of security, with larger samples and within different populations. Implications for practice Provides a framework to map progress through the service. Identifies key factors that influence recovery and rehabilitation. Potential to promote dialogue between patients and staff, and enhance motivation. Copyright © 2011 John Wiley & Sons, Ltd.

Individual-level interventions for alcohol-related violence: A rapid evidence assessment

Abstract: BACKGROUND: Alcohol-related violence is of major concern to society. Around half of all violent crimes are alcohol related, and yet interventions for alcohol-related violence are under-developed. Often, offenders receive treatment for substance use or violence, but not the two in nexus. AIM: My aim was to conduct a Rapid Evidence Assessment of interventions with a focus on treating established nonsexual violence in the context of alcohol use, to describe the content of these interventions, where they take place and their effectiveness in reducing alcohol problems and/or violence. METHODS: The electronic databases Embase, Medline, National Criminal Justice Reference Service, Cumulative Index to Nursing and Allied Health Literature were searched together with the Campbell Collaboration; Cochrane Reviews and selected government websites using terms for alcohol, violence and treatment/interventions. The search excluded sexual and intimate partner violence. The focus was on psychosocial interventions with people already in difficulties, not prevention. All empirical study types with people of any age and in any setting (criminal justice, health, social services or education) were included. The principal outcomes of interest were change in alcohol use, violence and alcohol-related violence. RESULTS: Only four studies of two different interventions were identified. Control of Violence for Angry Impulsive Drinkers has been evaluated with small samples using a nonequivalent comparison group and a single case methodology. Changes were evident on measures of alcohol-related aggression. In a randomised controlled trial, SafERteens participants showed greater improvements in attitudes to alcohol and violence compared with a leaflet only condition. DISCUSSION: Directions for developing interventions based on alcohol and aggression research are discussed. Interventions targeting primarily alcohol consumption, primarily violence and alcohol-related violence in nexus should be compared. In evaluating these interventions, robust outcome measures should be used across studies to allow comparisons to be made. Copyright © 2011 John Wiley & Sons, Ltd. CLINICAL IMPLICATIONS: Skills for coping with perceived provocation may be taught, so that nonviolent options are available and so that they become more accessible when people are under the influence of alcohol. Alcohol's effect on reducing self-awareness may be counteracted by teaching mindfulness techniques and the ability to 'act sober' in provocative situations. Setting individual implementation intentions may facilitate harm avoidance in high-risk social situations through preplanning of specific sensible behavioural strategies. Language: en

The dangerous and severe personality disorder experiment--review of empirical research.

Abstract: Background A pilot programme for the treatment of individuals with dangerous and severe personality disorder (DSPD) was established in the UK in 2001. A substantial investment had been made into research and evaluation of the initiative, but it is not clear what the outcomes of this research have been. Aim This study aimed to review empirical research on the DSPD programme. Method We conducted a systematic literature review by using electronic searches of the databases MEDLINE, PsycINFO and EMBASE, complemented by hand searches of key journals and websites. Results We identified a total of 29 empirical research papers and three comprehensive research reports. Most studies were concerned with describing the DSPD population and confirmed that the projects targeted high-risk personality disordered offenders. Qualitative research identified a number of concerns regarding stigma, restrictiveness of the environment and indeterminate detention. Organisational enquiries recognised inefficiencies in assessment and treatment delivery. No high-quality trials were carried out of specific treatments or service environments. Conclusions/implications for practice The key question – what treatments are effective for high-risk personality disordered offenders – remains unanswered. More time would be needed to fully assess the impact of this programme, and similar future initiatives should allow longer observation periods. Copyright © 2012 John Wiley & Sons, Ltd.

Is SCUBE 1 a new biomarker for gastric cancer

Abstract: Purposes: This study was intended to determine the diagnostic significance of signal peptide-CUB-EGF domain- containing protein 1 (SCUBE 1) levels in gastric cancer. Methods: This retrospective study was conducted with patients with gastric cancer. SCUBE 1 titers of plasma in patients with gastric cancer were determined using an enzyme-linked immunosorbent assay (ELISA). Results: SCUBE 1 titers of gastric cancer patients were significantly higher compared with the control group (P = 0.0001). At a SCUBE 1 cut-off point of 43 ng/mL, sensitivity was 67%, specificity 91%, positive predictive values (PPV) 92% and negative predictive values(NPV) 63%. SCUBE 1 levels of patients with methastase were not different from patients without methastase ( P> 0.05). Dicussions: SCUBE 1 levels in patients with gastric cancer were found higher compared to healthy subjects.

The London Pathways Project: evaluating the effectiveness of a consultation model for personality disordered offenders.

Abstract: Background A recent government strategy has been developed to meet the challenges posed by personality disordered offenders. A ‘pathways project’ was piloted in four London boroughs to assess the implementation of some elements of the strategy. Aims This paper focuses on the scope and the effectiveness of 2 years of the project. Method Probation caseloads were screened for personality disorder. Risk information and pathways were monitored and recorded over 2 years. Psychologists provided consultation, training and direct co-working as interventions. Results The findings include a description of the samples identified, the range of project activity, pathway outcomes and factors associated with or predictive of successes and failures. Conclusions The findings supported the implementation of the pathways model to fulfil aspects of the offender personality disorder strategy, such as facilitating entry into treatment and interventions and to a lesser extent planning safer return to the community. The consultation model, including low-intensity direct contact with project psychologists, improved outcomes for personality disordered offenders. Implications Observations from experiences of the 2-year pilot and ideas to assist with a wider implementation of the strategy are provided. Copyright © 2012 John Wiley & Sons, Ltd.

Gene expression profiling identifies ARSD as a new marker of disease progression and the sphingolipid metabolism as a potential novel metabolism in chronic lymphocytic leukemia

Abstract: BACKGROUND Several studies demonstrated IGVH mutational status and ZAP70 expression as the most relevant prognostic markers in Chronic Lymphocytic Leukemia (CLL), suggesting the separation of two patient subgroups: with good mutated ZAP70 negative (MTZAP70(-) and poor unmutated ZAP70 positive (UMZAP70(+)) prognosis. DESIGN AND METHODS We determined the gene expression of B cells in 112 CLL patients divided into three classes: class 1 with MTZAP70(-), class 2 with UMZAP70(+), and class 3 included both UMZAP70(-) and MTZAP70(+). RESULTS We found LPL, AGPAT2, MBOAT1, CHPT1, AGPAT4, PLD1 genes encoding enzymes involved in lipid metabolism overexpressed in UMZAP70(+). In addition, this study identified ARSD, a gene belonging to the sphingolipid metabolism, as a new gene significantly overexpressed in UMZAP70(+) compared to MTZAP70(-). Western blots confirmed that ARSD protein levels were significantly different between the 3 classes of patients and normal controls. Statistical analysis identified a significant correlation between ARSD and IGVH; however, both ARSD protein level and IGVH were independently associated with the need for therapy of CLL patients. CONCLUSIONS ARSD is a novel prognostic factor as the time to start therapy is shorter in patients with high levels of ARSD protein and sphingolipid metabolism could represent a new biological mechanism in CLL.

Engagement in psychosocial treatment: its relationship to outcome and care pathway progress for women in medium-secure settings.

Abstract: Background Engaging patients in treatment in secure settings is a major challenge. Engagement is associated with a shorter length of stay, whereas treatment non-completion is associated with an increased risk of recidivism. Aims The aims of this study were to assess differences between high and low treatment attendees in a women's medium secure unit and to compare progress over the course of their stay. Methods Sixty consecutive admissions to a women's medium secure unit were classified into high and low treatment attendee groups. The two groups were compared in terms of risk behaviours and psychometric measures of symptomatology, impulsivity and personality. Results High treatment attendees had a shortened length of stay, showed less disturbed behaviour and made more progress in terms of a reduction in symptoms overall and traumatic stress symptoms specifically. Low treatment attendees were more likely to have a diagnosis of schizophrenia/schizotypal illness than personality disorder, less likely to be impulsive and more likely to have scores indicative of severe disorder on the personality subscales of the Millon Clinical Multiaxial Inventory—III. Conclusion Attendance at groups in this medium security unit had clear advantages for patients and potential cost savings for services and the community, but we found a subgroup of women who found it difficult to attend. Given the small sample size, we advocate replication, but our findings suggest the following: Implications for practice development of motivational interventions to help patients make a therapeutic alliance more accurate assessment of treatment readiness, to avoid mistimed interventions that are counterproductive more effective deployment of milieu therapeutic approaches to stabilise behaviour at an early stage of hospitalisation abandonment of a ‘one size fits all’ approach to groups for mixed patient populations. More ‘customised’ approaches would allow more appropriate ‘pacing’ of treatment and adaptations of interventions according to need during the treatment course. Copyright © 2012 John Wiley & Sons, Ltd.

Teaching forensic psychiatry in Europe

Abstract: Background Forensic psychiatry was long regarded as sufficiently defined by the laws of a country to be restricted by national boundaries in all but a few areas. European Union (EU) employment rights and travel facilities have changed that within the EU. Aims The goal of this research is to explore the role and development of a network of teachers and trainees in forensic psychiatry. Information and discussion European Union countries differ widely in the extent to which they recognise forensic psychiatry as a specialty and thus also in the amount of training clinicians receive before they present themselves as expert witnesses in court, or develop or run services, or manage and treat individual offender patients. Nevertheless, a summer seminar for practicing clinicians, who also present evidence to court and for bodies considering discharge of potentially dangerous patients, has proved a useful forum for joint ‘European learning’. Participants have left with a sense of improved understanding of their own law and practices as well as new perspectives on what works for offenders with mental disorder. Copyright © 2012 John Wiley & Sons, Ltd.

Testing the Cambridge quality checklists on a review of disrupted families and crime.

Abstract: Background: Systematic reviews of the relationship between non-manipulated factors (e.g. low empathy) and offending are becoming more common, and it is important to consider the methodological quality of studies included in such reviews. Aims: To assess aspects of the reliability and validity of the Cambridge Quality Checklists, a set of three measures for examining the methodological quality of studies included in systematic reviews of risk factors for offending. Methods: All 60 studies in a systematic review of disrupted families and offending were coded on the CQC and codes compared with the effect sizes derived from the studies. Results: Overall, the CQC was easy to score, and the relevant information was available in most studies. The scales had high inter-rater reliability. Only 13 studies scored high on the Checklist of Correlates, 18 scored highly on the Checklist of Risk Factors and none scored highly on the Checklist of Causal Risk Factors. Generally, studies that were of lower quality had higher effect sizes. Conclusions: The CQC could be a useful method of assessing the methodological quality of studies of risk factors for offending but might benefit from additional conceptual work, changes to the wording of some scales and additional levels for scoring. Copyright © 2012 John Wiley & Sons, Ltd.

The best interest of the child-questionnaire, reliability and validity: preliminary data on the question 'where to live after detention or secure treatment?'.

Abstract: Background The Best Interest of the Child-Questionnaire (BIC-Q) has been designed as an instrument for screening the quality of the rearing situation of children with behavioural problems or delinquency. It is intended to aid legal decisions in juvenile and family law. Aims The aim of the study was to establish the reliability and validation of the BIC-Q. Methods Records of 83 children in detention or secure treatment centres and 58 children with no delinquent behaviours were rated by trained researchers. Interrater reliability was tested with a sub-sample of 31 of the former. Content validity was evaluated across the whole group, using Cronbach's alpha to check internal consistency, Spearman's rho to examine correlations and explorative principal component analysis (PCA) to test the extent to which variance in the 14 underlying conditions could be accounted for by a single factor 'quality of rearing'. Results Interrater reliability was good (r = 0.89). The PCA lent support to the content validity of the questionnaire with four factors, which together explained 66% of the variance in child rearing: (1) attachment and bonding; (2) rules and provisions; (3) health care and physical care in the family context; and (4) care and models provided for in the societal environment.

Cortactin (CTTN) overexpression in osteosarcoma correlates with advanced stage and reduced survival

Abstract: Background: The cortactin (CTTN) gene has been found, by transcriptomic profiling, to be overexpressed in pediatric osteosarcoma. The location of CTTN at 11q13 and the role of cortactin in cytoskeleton restructuring make CTTN of interest as a potential biomarker for osteosarcoma. Materials and methods: Osteoblasts were isolated from 20 high-grade osteosarcomas before chemotherapy, and paired with cell samples from normal tissue, prior to RNA expression analysis on HG-U133A chips (Affymetrix). Semiquantitative CTTN mRNA expression was analyzed by real-time PCR. An osteosarcoma tissue microarray (TMA) containing 233 tissue spots from 48 patients was used for an immunohistochemical (IHC) study of cortactin. Results: Transcriptomic profiling and real-time PCR analysis indicated increased CTTNexpression in osteosarcomas (p = 0.001, Student's T test). TMA IHC showed cortactin to be present more frequently and in greater abundance in osteosarcomas than non-tumoral osteoblastic samples ( p< 0.006, Mann-Withney test). Analysis of clinical outcomes indicated that overall survival for patients with primary tumors positive for cortactin was significantly lower than that for patients with cortactin negative (or only weakly staining) tumors (p = 0.0278, Log-rank test). Conclusions: Our preliminary data support the hypothesis that over-expression of cortactin, contained in the 11q13 amplicon, is involved in osteosarcoma carcinogenesis. The potential of cortactin overexpression as a biomarker for osteosarcoma is consolidated.

Application of HBx-induced anti-URGs as early warning biomarker of cirrhosis and HCC

Abstract: Background Hepatitis B virus (HBV) carriers are at high risk for the development of hepatocellular carcinoma (HCC), but there are no reliable markers that will identify such high-risk patients HBV up-regulates the expression of selected genes (URGs) in the liver during chronic infection These aberrantly expressed proteins trigger corresponding antibodies (anti-URGs) that appear prior to the detection of HCC This study was undertaken to see if the anti-URGs could be used as early warning biomarker of HBV-induced liver cirrhosis and HCC Methods A cross sectional study using a total of 625 serum samples from HBV infected and uninfected controls were tested for the anti-URGs using specific ELISAs Results The number and specificity of anti-URGs correlated with the severity of liver disease Anti-URGs were predominantly present among patients with HBV-associated HCC (552%) and cirrhosis (607%), and at a lower frequency among patients with chronic hepatitis (358%), and at still lower frequencies in most asymptomatic carriers (123%) with normal ALT, among patients with chronic hepatitis C (385%) and blood donors (09%) These anti-URGs were rarely detected in sera from those with tumors other than HCC, except among HBV infected patients with cholangioicarcinoma and in some patients with drug induced hepatitis 3 or more anti-URGs could precede the diagnosis of cirrhosis or HCC 118 months on average, and HBV hepatitis patients with 3 or more anti-URGs have much higher risk (5/20 vs 0/30) to develop cirrhosis and HCC than those patients with less anti-URGs As the early warning biomarker, 3 or more anti-URGs were served as the threshold to separate the cirrhosis and HCC from others with a moderate sensitivity (583%) and specificity (800%), which was better than other biomarkers (AFP, AFP-L3, GPC3 and GP73) and would improve up to 703% when combined with another biomarker Conclusions The results of this clinical validation study suggest that the anti-URGs might have diagnostic/prognostic utility among patients at high risk for the development of cirrhosis and HCC

The treating psychiatrist as expert in the courts: is it necessary or possible to separate the roles of physician and expert?

Abstract: Background Certified medical specialists, including forensic psychiatrists, from the 27 member states of the European Union (EU) may practise in each other's countries, but there are professional and legal differences between them. One may lie in whether a patient's treating doctor/clinician may give expert evidence about that person in court. Aims To examine similarities and differences between EU jurisdictions in law and practice in combining or separating such roles and to review the evidence in support of either position. Methods A psychiatrist with court experience was contacted in each EU country about law, practice and guidance on division of clinician–expert roles. Published literature was searched for an evidence base for practice in the field. Additional material is from discussion at a residential meeting of practising forensic psychiatrists from Austria, Belgium, Denmark, Germany, Hungary, the Netherlands, Switzerland and the UK. Results All acknowledge that a treating clinician can never be an independent expert in that case, but the 22 (of 27) EU countries responding vary in law and practice on whether the dual role may be assumed. There has been almost no research interest in factors relevant to separation of roles. International discussion revealed that ethical and practice issues are not straightforward. Conclusions On current evidence, either separation or combination of clinical and expert roles in a particular case may be acceptable. Insofar as there are national legal or professional guidelines on this issue, anyone practising in that country must follow them and may safely do so, regardless of practice in their native country. The most important ethical issue lies in clarity for all parties on the nature and extent of roles in the case. This paper has additional material online. Copyright © 2012 John Wiley & Sons, Ltd.

Are patients deemed ‘dangerous and severely personality disordered’ different from other personality disordered patients detained in forensic settings?

Abstract: BACKGROUND: In 1999, the UK government initiated a programme for the assessment and treatment of individuals deemed to have 'dangerous and severe personality disorder' (DSPD). After over 10 years of specialist service development, it is not clear whether DSPD patients represent a distinct group. AIMS: The aim of this study was to establish whether people admitted to DSPD hospital units could be distinguished in presentation or personality traits from people with personality disorder admitted to standard secure hospital services. METHODS: Thirty-eight men detained in high-security hospital DSPD units were compared with 62 men detained in conventional medium or high security hospital units, using the Psychopathy Checklist-Revised (PCL-R) and other standard personality disorder, clinical and offending measures. RESULTS: Compared with their counterparts in standard services, the DSPD group had higher scores on PCL-R psychopathy, significantly more convictions before age 18 years, greater severity of institutional violence and more prior crimes of sexual violence. Regression analysis confirmed that only PCL-R Factor 1, reflecting core interpersonal and affective features of psychopathy, predicted group membership. CONCLUSION: The DSPD group emerged as having higher psychopathy scores, but as there is currently no evidence that the core personality features of psychopathy are amenable to treatment, there is little justification for treating high-psychopathy forensic patients differently from those with other disorders of personality. Copyright © 2011 John Wiley & Sons, Ltd. Language: en

The cost-effectiveness of the dangerous and severe personality disorder programme.

Abstract: Background Much resource (c £500M) has been spent in setting up the programme of treatment for those deemed to be suffering from dangerous and severe personality disorder (DSPD). It has now begun to contract, and it is an appropriate time to evaluate its cost-effectiveness. Aims The aim of the study was to review all published and known unpublished material, examining the cost, cost function and cost-effectiveness of the DSPD programme since its introduction in 1999. Methods Narrative review of studies was used. Results Four studies, one unpublished, were identified. The costs of treating people in the DSPD programme are considerably higher than those in other parts of the prison service. This could be justified if the gains justified this increased investment, but the evidence suggests that the outcomes in the short term are not good, and the monetary value of reductions in serious offences is very small compared with the extent of the higher costs incurred. There is a dearth of randomised trials that would allow an adequate assessment of cost-effectiveness. Implications for practice Future plans for expansion or development of DSPD and similar services need to have cost-effectiveness of agreed outcomes assessed as a central element. Copyright © 2012 John Wiley & Sons, Ltd.

The prognostic potential of keratin 18 in breast cancer associated with tumor dedifferentiation, and the loss of estrogen and progesterone receptors.

Abstract: The differential expression profiling with breast normal and tumor tissues, and a breast cancer cell line led to identification of cytokeratin 18 (KT18) gene over-expressed in breast cancer. The expression pattern of KT18 in breast cancer was compared to those of conventional tumor markers such as proliferating cell nuclear antigen (PCNA) and minichromosome maintenance protein 3 (MCM3). Their expression patterns in breast cancer were almost identical, suggesting that KT18 might be useful for detection of proliferating fractions in the breast cancer. The immunohistochemical analyses on the tissue microarray consisting of invasive ductal carcinomas revealed that the up-regulation of KT18 is observed in a majority of breast carcinomas whereas its down-regulation also occurs at a less frequency. Of particular interest, KT18 down-regulation was associated with histologically poorly differentiated carcinomas than well differentiated carcinomas. In addition, it was also significantly associated with the loss of estrogen receptor (ER) and progesterone receptor (PR), the prognostic markers of the breast cancer (P < 0.05), while not with HER2, tumor size, and lymph node metastasis. This result suggests that KT18 correlated with ER and PR may be utilized for the prognosis of breast cancer. Furthermore, the forced down-regulation of KT18 enhanced the growth of tumor xenografts in vivo and invasiveness in vitro. Therefore, our findings suggest that loss of KT18 expression might be a good indicator of the poor prognosis of the breast cancer and it may play an active role in the breast tumorigenesis.

Prisoners holding their own medications during imprisonment in England and Wales: a survey and qualitative exploration of staff and prisoners' views.

Abstract: Background Traditionally, medication in prison has been administered in single, supervised doses. Prisons in England and Wales, however, have now been encouraged to allow prisoners to hold and manage their own medication themselves as ‘in-possession’ medication, in line with community practices. Aims We aimed to examine the range of policies and practices used to manage in-possession medication in prisons, and to explore staff and patient perspectives. Methods A mixed methods design was selected. Questionnaires were sent to all prisons throughout England and Wales in 2008, and follow-up interviews were completed with 68 staff and 24 patients at 12 prisons. Results In-possession medication was permitted to some degree within all prisons. Interviewees identified its principal benefit in terms of empowerment, whilst acknowledging the need to minimise health and security risks. Structured methods of risk assessment were used in 93% of establishments, although content and structure varied widely. Conclusion There is still some way to go before in-possession medication policies are fully embraced in prisons. Staff and patients recognise its benefits, but some remain uneasy around the perceived risks. Risk management processes in some establishments may still require development. Key messages Prisoners and staff generally find it acceptable for prisoners to have their own medication in their possession, to manage themselves, unless individual risk assessment indicates otherwise. Achievement of the optimum balance between security, safety and empowering patients is difficult in practice. Robust, specific methods of risk management in relation to in-possession medication may help prisons move from being ‘risk averse’ to ‘risk aware’. Copyright © 2011 John Wiley & Sons, Ltd.

Different expression of EZH2, BMI1 and Ki67 in low and high grade neuroendocrine tumors of the lung.

Abstract: BACKGROUND Enhancer of Zeste Homolog 2 (EZH2) and B lymphoma Mo-MLV Insertion region 1 polycomb ring finger (BMI1) are involved in malignant transformation of many human carcinomas. Still, in neuroendocrine tumors of the lung (NELT) their expression pattern is largely unknown. This study evaluated their expression in 96 NELT and correlated it to clinical features including survival. MATERIALS AND METHODS Paraffin embedded material from 50 typical carcinoids (TC), 13 atypical carcinoids (AC), 23 large cell neuroendocrine carcinomas (LCNEC) and 10 small cell lung carcinomas (SCLC) was evaluated by immunohistochemisty. RESULTS Significantly higher expression of EZH2 was found in high grade NELT (LCNEC + SCLC) versus low grade NELT (TC + AC) (p < 0.0001). High expression of BMI1 was observed in low grade NELT (TC + AC) in contrast to the expression in high grade NELT (LCNEC+SCLC) (p=0.004). In multivariate models, diagnosis was the strongest predictor of survival. CONCLUSION The immunohistochemical expression of EZH2 and BMI1 are significantly different in low versus high grade NELT. This difference might be related to NELT tumorigenesis. These markers have no independent prognostic impact in NELT. Whether EZH2 could become target in new treatments strategies against NELT remains to be elucidated.

Service user involvement in risk assessment and management: The Transition Inventory

Abstract: Background Drawing on self-prediction theory and the positive benefits of increasing health service user participation in risk assessments, the Transition Inventory (TI) was developed. It is an aid to the assessment of areas that people anticipate will be of difficulty in the next stage of transition, for example from open hospital to the community. Aims The aim of this paper is to determine reliability and convergent/discriminant validity data for the TI and its subscales, including behavioral impulsivity, social pressure, substance misuse, financial/employment, leisure, negative affect, interpersonal and family concerns and social alienation. Methods Eighty-eight male offenders coming towards the end of a period of imprisonment were asked to complete the TI. Their results were compared with the staff-rated Measures of Criminal Attitudes and Associates (MCAA) scale, alcohol blame and causation of crime items. Comparisons with the MCAA's antisocial intent scale, which is a future-orientated scale, and the associates scale allowed for convergent/discriminant validity to be examined with TI scales. With a community offender sample, TI results were used to predict researcher ratings. Results The TI scales demonstrated adequate internal consistency. Overall, the MCAA's antisocial intent scale had higher correlations with the TI than with a nonfuture-orientated scale. TI scales also demonstrated convergent validity with other measures and preliminary predictive validity with researcher ratings. Conclusions/implications for practice The TI provides a way to increase service user involvement in the assessments that determine when and how they transfer to settings where they will have more independence. Copyright © 2012 John Wiley & Sons, Ltd.