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Trials involving police as defendants are rare but are significant events that give insight into police violence and its adjudication. This article explores the reasoning practices through which court actors navigate the disjunctive accounts created by competing claims of “what happened” in a police shooting. The data is drawn from trial testimony of officers and “use of force experts” in police deadly force cases in the United States. We focus on use of force experts who use a veneer of science and police logic to assert particular visions of officer “reasonableness.” We suggest that the systems of reasoning that lawyers and witnesses use in these cases create accounts of police violence that conflict with mundane reasoning and challenge credibility. We show that the proliferation of different reasoning practices and the elaboration of a “police logic” serve to insulate officers from criticism and accountability—albeit, not always successfully.
Effective treatments for patients with high levels of negative symptoms of schizophrenia are lacking. Brexpiprazole is a serotonin–dopamine activity modulator that is a partial agonist at 5-HT1A and dopamine D2 receptors, and an antagonist at 5-HT2A and noradrenaline alpha1B/2C receptors, all with subnanomolar potency. Long-term treatment with brexpiprazole demonstrated broad efficacy across all five Marder factor groupings, including positive, negative, disorganized thoughts, uncontrolled hostility/excitement, and anxiety/depression. This post-hoc analysis of long-term effects of brexpiprazole in patients with clinically relevant levels of negative symptoms of schizophrenia is based on data from two similarly designed short-term, placebo-controlled studies (Vector; NCT01396421 or Beacon; NCT01393613) for the brexpiprazole-treated patients who continued into an open-label extension study (Zenith; NCT01397786).
Methods
In the short-term studies, patients with acute schizophrenia were randomly assigned to fixed once-daily doses of brexpiprazole 0.25mg (Vector), 1mg (Beacon), 2mg , 4mg or placebo for 6weeks. The long-term study was an open-label, 52-week (amended to 26weeks), safety extension study with flexible-dose (1–4mg/day) brexpiprazole. The post-hoc analyses were performed on brexpiprazole-treated patients from the short-term studies who continued into the long-term study, and who had clinically relevant negative symptoms, defined as PANSS Factor Score for Negative Symptoms (PANSS-FSNS; N1, N2, N3, N4, G7, G16) of ≥24, and score of ≥4 on at least two of three core negative symptom PANSS items at randomization in the parent study. The outcome of the analysis included change from baseline to up to 58weeks in PANSS-FSNS, PANSS Total, and PSP. Safety was also assessed.
Results
A total of 187 patients with clinically relevant levels of negative symptoms in the parent study rolled-over into the open-label extension study and were available for analysis. Eighty-three of these patients remained in the studies for 58weeks. Due to the study amendment, not all patients had the opportunity of complete 52weeks of open-label treatment. Baseline PANSS Total score was 104.4, while baseline PANSS-FSNS was 27.6 and baseline PSP Total score was 41.3. Mean change (SD) from baseline in PANSS-FSNS was –10.9 (5.0), and –44.2 (17.5) for PANSS Total score at Week 58. Change from baseline (SD) to Week 58 for PSP Total score was 24.8 (12.9) with improvement in all domains (socially useful activities, personal and social relationship, self-care, and disturbing and aggressive behaviors). The TEAEs reported ≥5% were schizophrenia (18.9%), insomnia (8.6%), weight increased (5.9%) and akathisia (5.9%).
Conclusion
This post-hoc analysis suggests that brexpiprazole has long-term effectiveness on negative symptoms and functioning in patients with schizophrenia and clinically relevant levels of negative symptoms.
Funding Acknowledgements: The study was funded by Otsuka Pharmaceutical Development & Commercialization Inc. and H. Lundbeck A/S
We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.
SETTING
A 2,000-bed tertiary-care psychiatric hospital.
METHODS
Active surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.
RESULTS
The study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.
CONCLUSIONS
WGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.
By
Mary Meehan, Columbia University, New York, USA,
Maria Wawer, Columbia University, New York, USA,
David Serwadda, Institute of Public Health, Kampala, Uganda,
Ronald Gray, Johns Hopkins University, Baltimore, USA,
Thomas Quinn, Johns Hopkins University, Baltimore, USA
This chapter focuses on advances in reproductive health research that permit sample and data collection within population-based studies in a wide range of nonclinical settings, including the home. Areas of interest are assessment of classical sexually transmitted infections (STIs) and other reproductive tract infections, including oncogenic human papillomavirus (HPV), the principal causal agent of cervical cancer. Assessment of pregnancy loss is also addressed. The importance of linking behavioural data with biological sampling, in order to provide interpretable information for the development and evaluation of disease prevention and control programmes, is discussed. Finally, a number of strategies are proposed for the incorporation of biological sampling into survey research.
The study of reproductive morbidity in population-based studies was hindered for many years by the difficulty of diagnosis and the selectivity of the populations studied. Biological samples to assess many reproductive tract infections and STIs could only be obtained through genital and/or pelvic examination. In addition, available tests for many conditions required specialized handling of samples (in the case of gonorrhoea culture, for example) or immediate testing (such as wet mounts for trichomonas). Thus, studies were largely restricted to selected clinic-based populations, including users of antenatal or STD (sexually transmitted diseases) clinics, and results could not be generalized to the population as a whole. These limitations were particularly acute in rural settings with poor access to clinical services and laboratories, to say nothing of basics such as water and electricity
Distressing mental imagery is hard to study experimentally in obsessive–compulsive disorder (OCD).
Aims
To develop a way to assess mental imagery in OCD during functional magnetic resonance imaging (fMRI).
Method
A small randomised study, controlled for type and order of mental imagery and for treatment condition (exposure therapy guided by a computer or by a therapist, or relaxation guided by audio-tape). Before and after treatment, during fMRI scanning, patients imagined previously-rehearsed scenarios that evoked an urge to ritualise or non-OCD anxiety or a neutral state, and rated their discomfort during imagery.
Results
The method evoked greater discomfort during OCD imagery and anxiety (non-OCD) imagery than during neutral imagery. Discomfort was reduced by cancelling imagery. Discomfort during OCD imagery (but not during anxiety non-OCD imagery) fell after exposure therapy but not after relaxation.
Conclusions
Results showed differences between OCD and non-OCD images and their change after successful treatment, and confirmed clinical suggestions that cancelling images reduced OCD discomfort. The method's success paves the way for further studies of mental imagery in OCD: for instance, during fMRI.
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