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Civilly committed sexually violent persons (SVPs) are a select group of individuals designated as high risk for future sexual violence. Despite risk reduction in older age, SVP programs are seeing aging client populations, with many individuals remaining committed after age 60 (60+). Recent research found a sexual recidivism rate of 7.5% for 60+ individuals released from an SVP civil commitment program. The current paper follows up by examining reasons why individuals remain committed after age 60. It compares SVPs discharged after age 60 to those who are 60+ but remain civilly committed. Results of bivariate analyses reveal older SVPs who remain committed have significantly higher actuarial risk scores and are more likely to be of minority race. Multivariate logistic regression analyses found actuarial risk scores (Static-99R) predicted continued commitment, after controlling for other relevant variables. Barriers to community reintegration and suggestions for multi-disciplinary case management for older SVPs are discussed.

The present study is part of a larger project aiming to more closely integrate theory with empirical research into dynamic risk. It seeks to generate empirical findings with the dynamic risk factors contained in the Violence Risk Scale—Sexual Offense version (VRS-SO) that might constrain and guide the further development of Thornton’s theoretical model of dynamic risk. Two key issues for theory development are (a) whether the structure of pretreatment dynamic risk factors is the same as the structure of the change in the dynamic risk factors that occurs during treatment, and (b) whether theoretical analysis should focus on individual dynamic items or on the broader factors that run through them. Factor analyses and item-level prediction analyses were conducted on VRS-SO pretreatment, posttreatment, and change ratings obtained from a large combined sample of men ( Ns = 1,289–1,431) convicted and treated for sexual offenses. Results indicated that the latent structure of pretreatment dynamic risk was best described by a three-factor model while the latent structure of change items was two dimensional. Prediction analyses examined the degree to which items were predictive beyond prediction obtained from the broader factor that they loaded on. Results showed that for some items, their prediction appeared to be largely carried by the three broad factors. In contrast, other items seem to operate as funnels through which the broader factors’ predictiveness flowed. Implications for theory development implied by these results are identified.

This prospective study examined the predictive validity of the Sex Offender Treatment Intervention and Progress Scale (SOTIPS; McGrath et al., 2012), a sexual recidivism risk/need tool designed to identify dynamic (changeable) risk factors relevant to supervision and treatment. The SOTIPS risk tool was scored by probation officers at two sites ( n = 565) for three time points: near the start of community supervision, at 6 months, and then at 12 months. Given that conventions for analyzing dynamic prediction studies have yet to be established, one of the goals of the current paper was to demonstrate promising statistical approaches for the analysis of longitudinal studies in corrections. In most analyses, static SOTIPS scores predicted all types of recidivism (sexual, violent, and general [any]). Dynamic SOTIPS scores, however, only improved the prediction of general recidivism, and only when the analyses with the greatest statistical power were used (Cox regression with time dependent covariates).

Although individuals with a history of sexual crime are often viewed as a lifelong risk, recent research has drawn attention to consistent declines in recidivism risk for those who remain offense free in the community. Because these declines are predictable, this article demonstrates how evaluators can use the amount of time individuals have remained offense free to (a) extrapolate to lifetime recidivism rates from rates observed for shorter time periods, (b) estimate the risk of sexual recidivism for individuals whose current offense is nonsexual but who have a history of sexual offending, and (c) calculate yearly reductions in risk for individuals who remain offense free in the community. In addition to their practical utility for case-specific decision making, these estimates also provide researchers an objective, empirical method of quantifying the extent to which individuals have desisted from sexual crime.

Sensorimotor activity in speech perception tasks varies as a function of context, cognitive load, and cognitive ability. This study investigated listener sex as an additional variable. Raw EEG data were collected as 21 males and 21 females discriminated /ba/ and /da/ in quiet and noisy backgrounds. Independent component analyses of data from accurately discriminated trials identified sensorimotor mu components with characteristic alpha and beta peaks from 16 members of each sex. Time-frequency decompositions showed that in quiet discrimination, females displayed stronger early mu-alpha synchronization, whereas males showed stronger mu-beta desynchronization. Findings indicate that early attentional mechanisms for speech discrimination were characterized by sensorimotor inhibition in females and predictive sensorimotor activation in males. Both sexes showed stronger early sensorimotor inhibition in noisy discrimination conditions versus in quiet, suggesting sensory gating of the noise. However, the difference in neural activation between quiet and noisy conditions was greater in males than females. Though sex differences appear unrelated to behavioral accuracy, they suggest that males and females exhibit early sensorimotor processing for speech discrimination that is fundamentally different, yet similarly adaptable to adverse conditions. Findings have implications for understanding variability in neuroimaging data and the male prevalence in various neurodevelopmental disorders with inhibitory dysfunction.

Introduction Corona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative “cocooning” or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. Materials and methods Prospective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. Results 302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RTPCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow up period. Conclusion The results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period., Graphical abstract Image 1

This study aimed to gain deeper knowledge about the relationship between vitamin D and physical activity in a sample of forensic inpatients. Sixty-seven male forensic inpatients participated. Participants were randomly assigned into an Intervention group (vitamin D) or a Control group (placebo). The Physical Activity–Rating (PA-R) questionnaire was used to measure physical activity from January to May. Vitamin D status was measured as 25-hydroxy vitamin D (25-OHD) pre- and post-intervention. The results revealed that vitamin D status at post-test was positively correlated with physical activity, but there was no effect of vitamin D supplementation looking at the two randomized groups. However, controlling for body mass index (BMI), the results showed an effect of BMI and a main effect of groups with a higher level of physical activity in the Intervention group. No interaction effects were found. Participants were also assigned into High and Low vitamin D groups based on the vitamin D status at post-test, i.e., the upper (75.1 nmol/L) and lower quartile (46.7 nmol/L). T-tests revealed that participants with a vitamin D status above 75 nmol/L showed significantly higher levels of physical activity than participants with a vitamin D status below 46.7 nmol/L. Thus, a vitamin D status above 75 nmol/L seems to be an optimal level.

Vitamin D status may be important for stress resilience. This study investigated the effects of vitamin D supplements during winter on biological markers of stress resilience such as psychophysiological activity, serotonin, and cortisol in a placebo-controlled, randomized clinical trial. Eighty-six participants were randomly assigned to the Intervention (vitamin D) or Control (placebo) groups. Before and after the intervention participants were exposed to an experimental stress procedure. Psychophysiological activity was measured during three main conditions: baseline, stress, and recovery. Fasting blood samples were taken in the morning and saliva samples were collected at seven different time points across 24 h. Prior to intervention both groups had normal/sufficient vitamin D levels. Both groups showed a normal pattern of psychophysiological responses to the experimental stress procedure (i.e., increased psychophysiological responses from resting baseline to stress-condition, and decreased psychophysiological responses from stress-condition to recovery, all p &lt, 0.009). Post-intervention, the Intervention group showed increased vitamin D levels (p &lt, 0.001) and normal psychophysiological responses to the experimental stress procedure (p &lt, 0.001). Importantly, the Control group demonstrated a classic nadir in vitamin D status post-intervention (spring) (p &lt, 0.001) and did not show normal psychophysiological responses. Thus, physiologically the Control group showed a sustained stress response. No significant effects of vitamin D were found on serotonin and cortisol.

The sensorimotor dorsal stream is known to activate in both overt and covert speech production. However, overt production produces sensory consequences that are absent during covert production. Thus, the purpose of the current study is to investigate differences in dorsal stream activity between these two production conditions across the time course of utterances. Electroencephalography (EEG) was recorded from 68 channels while 23 participants overtly (Op) and covertly (Cp) produced orthographically cued bisyllabic targets. Sensorimotor mu and auditory alpha components (from anterior and posterior aspects of the dorsal stream) were identified using independent component analysis (ICA). Event-related spectral perturbation (ERSP) analyses identified changes in mu and alpha oscillatory power over time, while intercomponent phase coherence (IPC) measured anterior–posterior connectivity in the two conditions. Results showed greater beta (15–25 Hz) suppression during speech planning across left and right hemisphere sensorimotor and temporal ICs for Op relative to Cp. By contrast, greater intrahemispheric beta coherence was observed for Cp compared to Op during speech planning. During execution, greater beta suppression was observed along with greater low frequency (

Forensic evaluators may be assisted by comparing their use of instruments with that of their peers. This article reports the results of a 2017 survey of instrument use by forensic evaluators carrying out sexual recidivism risk assessments. Results are compared with a similar survey carried out in 2013. Analysis focuses primarily on adoption of more recently developed instruments and norms, and on assessment of criminogenic needs and protective factors, and secondarily, on exploring factors related to differences in evaluator practice. Findings indicate that most evaluators have now adopted modern actuarial instruments, with the Static-99R and Static-2002R being the most commonly used. Assessment of criminogenic needs is now common, with the STABLE-2007 being the most frequently used instrument. Evaluators are also increasingly likely to consider protective factors. While a majority of evaluators uses actuarial instruments, a substantial minority employs Structured Professional Judgment (SPJ) instruments. Few factors discriminated patterns of instrument use.

The present study sought to develop updated risk categories and recidivism estimates for the Violence Risk Scale-Sexual Offense version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003-2017), a sexual offender risk assessment and treatment planning tool. The overarching purpose was to increase the clarity and accuracy of communicating risk assessment information that includes a systematic incorporation of new information (i.e., change) to modify risk estimates. Four treated samples of sexual offenders with VRS-SO pretreatment, posttreatment, and Static-99R ratings were combined with a minimum follow-up period of 10-years postrelease (N = 913). Logistic regression was used to model 5- and 10-year sexual and violent (including sexual) recidivism estimates across 6 different regression models employing specific risk and change score information from the VRS-SO and/or Static-99R. A rationale is presented for clinical applications of select models and the necessity of controlling for baseline risk when utilizing change information across repeated assessments. Information concerning relative risk (percentiles) and absolute risk (recidivism estimates) is integrated with common risk assessment language guidelines to generate new risk categories for the VRS-SO. Guidelines for model selection and forensic clinical application of the risk estimates are discussed. (PsycINFO Database Record

To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ. A randomized controlled trial. A forensic facility. Eighty-four young to middle aged male forensic inpatients with psychiatric disorders. Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks. Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention. Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ. Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.

This article describes principles for developing risk category labels for criterion referenced prediction measures, and demonstrates their utility by creating new risk categories for the Static-99R and Static-2002R sexual offender risk assessment tools. Currently, risk assessments in corrections and forensic mental health are typically summarized in 1 of 3 words: low, moderate, or high. Although these risk labels have strong influence on decision makers, they are interpreted differently across settings, even among trained professionals. The current article provides a framework for standardizing risk communication by matching (a) the information contained in risk tools to (b) a broadly applicable classification of "riskiness" that is independent of any particular offender risk scale. We found that the new, common STATIC risk categories not only increase concordance of risk classification (from 51% to 72%)-they also allow evaluators to make the same inferences for offenders in the same category regardless of which instrument was used to assign category membership. More generally, we argue that the risk categories should be linked to the decisions at hand, and that risk communication can be improved by grounding these risk categories in evidence-based definitions. (PsycINFO Database Record

Relative to the general population, individuals with psychotic disorders have a higher risk of suicide. Suicide risk is also elevated in criminal offenders. Thus, psychotic-disordered individuals with antisocial tendencies may form an especially high-risk group. We built upon prior risk analyses by examining whether neurobehavioral correlates of social cognition were associated with suicidal behavior in criminal offenders with psychotic disorders. We assessed empathic accuracy and brain structure in four groups: (i) incarcerated offenders with psychotic disorders and past suicide attempts, (ii) incarcerated offenders with psychotic disorders and no suicide attempts, (iii) incarcerated offenders without psychotic disorders and (iv) community non-offenders without psychotic disorders. Established suicide risk variables were examined along with empathic accuracy and gray matter in brain regions implicated in social cognition. Relative to the other groups, offenders with psychotic disorders and suicide attempts had lower empathic accuracy and smaller temporal pole volumes. Empathic accuracy and temporal pole volumes were significantly associated with suicide attempts independent of other risk variables. The results indicate that brain and behavioral correlates of social cognition may add incremental value to models of suicide risk.

Sensorimotor activity during speech perception is highly variable and is thought to be related to the underlying cognitive processes recruited to meet task demands. The purpose of the current study was to evaluate the impact of cognitive load on sensorimotor-based attention and working memory processes during speech perception. Manipulations of set size and signal clarity were employed to alter cognitive load. Raw EEG data recorded from 42 subjects during accurate discrimination of CV syllable pairs were decomposed by Independent component analysis; identifying sensorimotor mu components from 37 subjects. Time-frequency analyses revealed event related desynchronization (ERD) across alpha and beta frequency bands during and following stimulus presentation in all conditions, reflecting working memory maintenance through covert articulatory rehearsal. No early attentional activity was observed, suggesting adaptation to tasks. However, modulation of late working memory activity was observed between degraded and non-degraded conditions. Weak and delayed alpha and beta ERD in degraded conditions were interpreted as evidence of delayed implementation of covert rehearsal due to the prolonged time necessary to extract a phonological representation from the auditory signal. Findings are interpreted within Analysis by Synthesis to characterize the multi-faceted and temporally distinct contributions of anterior sensorimotor regions to working memory in support of speech discrimination.

The present study investigated whether a latency-based Go/No-Go Association Task (GNAT) could be used as an indirect measure of sexual interest in children. A sample of 29 individuals with a history of exclusive extrafamilial offenses against a child and 15 individuals with either a history of exclusive intrafamilial or mixed offenses (i.e., against both adults and children) were recruited from a treatment center in the United States. Also, a sample of 26 nonoffenders was recruited from a university in the United Kingdom. All participants completed the Sexual Fantasy-GNAT, a Control-GNAT, and two self-report measures of sexual fantasy. It was hypothesized that, relative to the two comparison groups, the extrafamilial group would respond faster on the block that paired "sexual fantasy" and "children." Also, GNAT scores were expected to correlate with child-related sexual fantasies. Support was found for both hypotheses. Response-latency indices were also found to effectively distinguish the extrafamilial group, as well as those who self-reported using child-related sexual fantasies. The implications of these findings, along with the study's limitations and suggestions for future research, are discussed.

This paper reviews recent research into four different approaches to the assessment of offense-related sexual deviance. Two of these approaches, structured rating scales and phallometry, have a sufficient basis in research for clinical use but have undergone significant refinements in recent years. One approach, the use of cognitive tasks to indirectly assess sexual deviance, is approaching the point where it has a sound research basis for clinical use though too many promising tasks have yet to make the transition from laboratory to clinical practice. This approach has however begun to map the earlier stages of sexual response including preconscious processes. The final approach, assessment through neuroimaging, is at the earliest stage of development with research findings having yet to reach sufficient stability for clinical application. Existing assessment technologies, despite their limitations, allow professionals to assess offense-related sexual deviance. New approaches, currently being developed, potentially allow a better understanding of underlying processes and, when sufficiently mature, will be more therapeutically useful.

Psychotic disorders are associated with neurobehavioral impairments in mental state attribution (mentalizing). These impairments are most severe in psychotic patients with elevated symptom levels, particularly negative and cognitive symptoms. There have been few studies of functional connectivity related to mentalizing in psychotic disorders and associations with symptoms. We conducted a functional MRI study of affective mentalizing in individuals with psychotic disorders and varying symptom levels (positive, negative, cognitive). Participants were drawn from an adjudicated inpatient forensic psychiatric population (criminal offenders). Functional MRI scans were acquired using a 32-channel ultra-fast multiband imaging sequence. Mentalizing task performance and functional connectivity were assessed in psychotic criminal offenders (n = 46) and nonpsychotic offenders (n = 41). Temporal coherent brain networks were estimated with group independent component analysis (ICA). Relative to nonpsychotic offenders, psychotic offenders showed impaired task performance and reduced activation in a component comprising the dorsomedial prefrontal cortex, superior temporal gyrus, and ventrolateral prefrontal cortex. Positive and cognitive symptoms were inversely correlated with component activity and task performance. The results are discussed with reference to potential mechanisms underlying impaired social cognition in psychotic disorders and across symptom types.

Neutrophils represent the most abundant immune cells recruited to inflamed tissues. A lack of dedicated tools has hampered their detection and study. We show that a synthesized peptide, MUB

Recently, Wollert and colleagues proposed that sex offender recidivism estimates should be stratified by age and they developed an age-stratified scale called the MATS-1 (Multisample Age-Stratified Table of Sexual Recidivism). The purpose of this article is to highlight concerns with the development of the MATS-1 and to validate the scale using 3,510 sex offenders from 14 unique samples. Concerns with the scale’s development fall into three categories: approximations leading to considerable loss of precision, absence of appropriate statistical tests, and the use of inappropriate statistical techniques. The predictive accuracy of the MATS-1 (Area Under the Curve [AUC] = .663) was significantly lower than Static-99R (AUC = .708). The MATS-1 also significantly underestimated recidivism for some offenders. Both the relative and absolute predictive properties of the MATS-1 were not stable across samples. We conclude that the MATS-1 is not appropriate to use for applied risk assessment. Proposals are made for alternate ways to develop risk scales using the age-stratification method.

This article describes the construction and testing of a newly designed instrument to assess psychological factors associated with increased rates of sexual recidivism. The new instrument (Structured Risk Assessment–Forensic Version or SRA-FV) was based on previous research using the SRA framework. This article describes the results of testing SRA-FV with a large sample ( N = 566) of sexual offenders being evaluated for an early civil commitment program. SRA-FV was found to significantly predict sexual recidivism for both child molesters and rapists and to have incremental predictive value relative to two widely used static actuarial instruments (Static-99R; Risk Matrix 2000/S).

Introduction: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services. Objective: To explore inpatients' expectations and experiences of hospital-based pharmacy services. Study setting and design: Face-to-face semi-structured interviews with inpatients admitted to acute medical wards of three NHS general hospitals. Principal findings: Seventy-four inpatients were interviewed: 37 were male with average age 73 years (age range of 19 -86 years). The predominate number of participants (62/74, 84%) being in the 65-80 years of age group. Thematic analysis of the data was driven by three themes; patients' expectations of the pharmacist's involvement in their treatment and care, the patients' experiences of any interaction that may have taken place and the patients' evaluation of their interaction with the pharmacist. Conclusions: There was a dichotomy of expectations and opinions from patients about the role of hospital pharmacists and the services being provided. As pharmacists' roles are developing towards a patient-orientated model in which pharmacists have direct contact with patients and their care, it is important to ensure that patients are aware of these developments to help them maximize the benefit they derive from their country's health-care system.

This review summarizes and critically examines the changes in how the Diagnostic and Statistical Manual of Mental Disorders (DSM) characterizes paraphilias. Attention is paid to the diagnostic options that were included in DSM-5, the decision not to include criterion sets for two additional disorders (paraphilic coercive disorder and hypersexual behavior disorder), and the further decision not to modify the diagnosis of pedophilic to pedohebephilic disorder. The three most significant changes are (a) the move to distinguish paraphilias from paraphilic disorders (allowing unusual sexual interests to be studied by researchers but only regarded as disorders when they cause distress or dysfunction), (b) introducing criteria describing paraphilic disorders as being in remission (when they no longer cause distress or dysfunction), and (c) clarifying the relationship between behavior and paraphilias. Concerns are noted about the forensic use of diagnoses and the lack of funding for field trials in this revision of the DSM. Suggestions are given for future directions in order to further research efficacy and clinical diagnosis.

The current study examines the relationship between therapeutic climate of sexual offender treatment groups, risk level, psychopathy and phase (i.e., early/later) of treatment. The participants were 137 sexual offenders detained indefinitely under Wisconsin’s Sexually Violent Person’s Law who attended a treatment group based on their level of psychopathy: higher levels of psychopathy (i.e., PCL-R scores of 25 or above) or lower levels of psychopathy (i.e., PCL-R scores of less than 25). Using MANOVA with aspects of the therapeutic climate as the dependent variables, the therapeutic climate did not differ as a function of the risk level of the participants. However, the overall therapeutic climate of the two treatment tracks (Lower vs. Higher PCL-R) differed significantly. The mean therapeutic climate scores for both treatment tracks were in the medium to high range (with exception of group cohesion, which was low in the Higher PCL-R track), indicating a fairly positive therapeutic climate in both treatment tracks overall. The therapeutic climate also differed as a function of phase of treatment for each of the treatment tracks, with some aspects being rated more positively early in treatment and others in more positively in later phases. In particular, group cohesion was viewed more positively for the Higher PCL-R group in later phases of treatment.

Actuarial risk assessment scales and their associated recidivism estimates are generally developed on samples of offenders whose average age is well below 50 years. Criminal behavior of all types declines with age; consequently, actuarial scales tend to overestimate recidivism for older offenders. The current study aimed to develop a revised scoring system for two risk assessment tools (Static-99 and Static-2002) that would more accurately describe older offenders’ risk of recidivism. Using data from 8,390 sex offenders derived from 24 separate samples, age was found to add incremental predictive validity to both Static-99 and Static-2002. After creating new age weights, the resulting instruments (Static-99R and Static-2002R) had only slightly higher relative predictive accuracy. The absolute recidivism estimates, however, provided a substantially better fit for older offenders than the recidivism estimates from the original scales. We encourage evaluators to adopt the revised scales with the new age weights.

A recent paper by Tyrer et al. in this journal has reviewed the dangerous and severe personality disorder (DSPD) initiative in the assessment and management of severe personality disorder associated with high risk. This previous paper summarized the authors' perceptions of the successes and failures of the DSPD pilot. In the present paper we identify some inaccuracies in the previous review and provide a critique of the conclusions reached.

The predictive accuracy of Static-2002 (Hanson & Thornton, Notes on the development of Static-2002 (Corrections Research User Report No. 2003-01), 2003) was examined in eight samples of sexual offenders (five Canadian, one U.S., one U.K., one Danish; total sample of 3,034). Static-2002 showed moderate ability to rank order the risk for sexual, violent and general (any) recidivism (AUCs of .68, .71, and .70, respectively), and was more accurate than Static-99. These findings support the use of Static-2002 in applied assessments. There were substantial differences across samples, however, in the observed sexual recidivism rates. These differences present new challenges to evaluators wishing to use actuarial risk scores to estimate absolute recidivism rates.

Evidence relevant to a potential diagnosis of Paraphilic Coercive Disorder is reviewed. Salient cues indicating that their partner is feeling coerced normally at least partially inhibit male sexual arousal while cues indicating mutual interest heighten arousal. However, for a minority of males, this pattern reverses with salient coercion cues leading to heightened arousal. This unusual pattern of arousal and fantasy is associated with a self-reported willingness to rape among non-convicted samples and is more common among convicted rapists than in other offender groups. It is inconsistently associated with Sadism as defined by the DSM-IV-TR and only weakly associated with psychopathy or general criminality. Evidence for it as an abnormal and persistent sexual interest comes from behavioral patterns, self-reported sexual fantasy, and laboratory tests. Two possible ways of incorporating it into a future version of the DSM are outlined.

Empirical actuarial risk tools are routinely used to assess the recidivism risk of adult sexual offenders. Compared with other forms of risk assessment, one advantage of actuarial risk tools is that they provide recidivism rate estimates. Previous research, however, suggests that there is considerable variability in the recidivism rates associated with the most commonly used sexual offender risk assessment tools (Static-99/R, Static-2002/R). The current study examined the extent to which the variability in the recidivism rates across 21 Static-99R studies ( N = 8,805) corresponded to the normative groups proposed by the STATIC development group (routine, treatment, high risk/high need). We found strong evidence that routine (i.e., complete) samples were, on average, less likely to reoffend with a sexual offense than offenders in the high-risk/high-need samples (i.e., those explicitly preselected on risk-relevant variables external to STATIC scales). The differences between routine/complete and high-risk/high-need samples, however, were only consistently observed for offenders with low or moderate scores; for offenders with high STATIC scores, the 5-year sexual recidivism rates for these two groups were not meaningfully different. There was only limited evidence to support treatment samples as a distinct sample type; consequently, the use of separate normative tables for treatment samples is not recommended. The current results reinforce the value of regularly updating the norms for empirical actuarial risk tools. Options are discussed on how STATIC scores could be used to inform recidivism rates estimates in applied assessments.

This study was designed to compare the Adam Walsh Act (AWA) classification tiers with actuarial risk assessment instruments and existing state classification schemes in their respective abilities to identify sex offenders at high risk to re-offend. Data from 1,789 adult sex offenders released from prison in four states were collected (Minnesota, New Jersey, Florida, and South Carolina). On average, the sexual recidivism rate was approximately 5% at 5 years and 10% at 10 years. AWA Tier 2 offenders had higher Static-99R scores and higher recidivism rates than Tier 3 offenders, and in Florida, these inverse correlations were statistically significant. Actuarial measures and existing state tier systems, in contrast, did a better job of identifying high-risk offenders and recidivists. As well, we examined the distribution of risk assessment scores within and across tier categories, finding that a majority of sex offenders fall into AWA Tier 3, but more than half score low or moderately low on the Static-99R. The results indicate that the AWA sex offender classification scheme is a poor indicator of relative risk and is likely to result in a system that is less effective in protecting the public than those currently implemented in the states studied.

This article considers factors that support or assist desistance from sexual offending in those who have previously offended. Current risk assessment tools for sexual offending focus almost exclusively on assessing factors that raise the risk for offending. The aim of this study was to review the available literature on protective factors supporting desistance from sexual offending. This article discusses the potential value of incorporating protective factors into the assessment process, and examines the literature on this topic to propose a list of eight potential protective domains for sexual offending. The inclusion of notions of desistance and strengths may provide additional guidance to the assessment and treatment of those who sexually offend. Further research investigations are recommended to consolidate the preliminary conclusions from this study regarding the nature and influence of protective factors in enabling individuals to desist from further offending.

This paper describes the construction and testing of a framework for dynamic risk assessment. A review of previous studies identified 4 domains into which dynamic risk factors for sexual offending seem to fall. These were sexual interests, distorted attitudes, socioaffective functioning, and self-management. Psychometric indicators for 3 of the domains were identified, and 2 studies are reported using these indicators to test the framework. Study 1 divided men serving a prison sentence for a sexual offense against a child into 2 groups-those with a previous conviction of this kind (Repeaters) and those for whom this was the only time they had been sentenced for such an offense (Current Only). The Repeaters were found to show more distorted attitudes, worse socioaffective functioning, and poorer self-management than did the Current Only group. Study 2 used a simple algorithm to combine these psychometric indicators into an overall "Deviance" classification. Reconviction data was obtained for offenders classified as high, moderate, or low on Deviance. Sexual reconviction was found to be monotonically associated with the Deviance classification. Logistic regression analysis showed that both static variables (Static-99) and the Deviance classification made independent contributions to prediction. It is suggested that risk assessment procedures should combine these 2 approaches.

This study examined the extent to which sexual offenders present an enduring risk for sexual recidivism over a 20-year follow-up period. Using an aggregated sample of 7,740 sexual offenders from 21 samples, the yearly recidivism rates were calculated using survival analysis. Overall, the risk of sexual recidivism was highest during the first few years after release, and decreased substantially the longer individuals remained sex offense–free in the community. This pattern was particularly strong for the high-risk sexual offenders (defined by Static-99R scores). Whereas the 5-year sexual recidivism rate for high-risk sex offenders was 22% from the time of release, this rate decreased to 4.2% for the offenders in the same static risk category who remained offense-free in the community for 10 years. The recidivism rates of the low-risk offenders were consistently low (1%-5%) for all time periods. The results suggest that offense history is a valid, but time-dependent, indicator of the propensity to sexually reoffend. Further research is needed to explain the substantial rate of desistance by high-risk sexual offenders.

Objectives/hypothesis: the aim of our study was the objective assessment of endolymphatic hydrops in asymptomatic ears in unilateral Meniere's disease with a noninvasive electrophysiological test and investigation of significant clinical signs. The null hypothesis was that there would be no signs of endolymphatic hydrops in the asymptomatic ear. Study design: prospective study using the traveling wave velocity test for endolymphatic hydrops. METHODS: The traveling wave velocity test was used in conjunction with standard audiological tests to investigate both ears of 181 Meniere's patients attending the Medical Research Council Institute of Hearing Research in Southampton, United Kingdom. The test uses derived auditory brainstem responses to estimate the velocity of the cochlear traveling wave that is altered in endolymphatic hydrops. Meniere's disease was assessed using Arenberg's five staging criteria. Significant correlations were evaluated using standard statistical methods. Results: of 100 patients with clinically unilateral Meniere's disease, 27% showed evidence of endolymphatic hydrops in their asymptomatic ear. There was a significant correlation between signs of hydrops and the mean air-conduction threshold at 500 Hz. Conclusions: we recommend that a full assessment of incipient disease in the asymptomatic ear in unilateral Meniere's disease should be undertaken before offering any treatment options to patients. Any suspicion of early disease in the asymptomatic ear in unilateral Meniere's disease should lead to full electrophysiological assessment to assess the evidence of endolymphatic hydrops in that ear

Its controversial past notwithstanding, psychopathy has emerged as one of the most important clinical constructs in the criminal justice and mental health systems. One reason for the surge in theoretical and applied interest in the disorder is the development and widespread adoption of reliable and valid methods for its measurement. The Hare PCL-R provides researchers and clinicians with a common metric for the assessment of psychopathy, and has led to a surge in replicable and meaningful findings relevant to the issue of risk for recidivism and violence, among other things. Most of the research thus far has been based on North American samples of offenders and forensic psychiatric patients. We summarize this research and compare it with findings from several other countries, including England and Sweden. We conclude that the ability of the PCL-R to predict recidivism, violence, and treatment outcome has considerable cross-cultural generalizability, and that the PCL-R and its derivatives play a major role in the understanding and prediction of crime and violence.

Given the widespread use of empirical actuarial risk tools in corrections and forensic mental health, it is important that evaluators and decision makers understand how scores relate to recidivism risk. In the current study, we found strong evidence for a relative risk interpretation of Static-99R scores using 8 samples from Canada, United Kingdom, and Western Europe ( N = 4,037 sex offenders). Each increase in Static-99R score was associated with a stable and consistent increase in relative risk (as measured by an odds ratio or hazard ratio of approximately 1.4). Hazard ratios from Cox regression were used to calculate risk ratios that can be reported for Static-99R. We recommend that evaluators consider risk ratios as a useful, nonarbitrary metric for quantifying and communicating risk information. To avoid misinterpretation, however, risk ratios should be presented with recidivism base rates.

Context Sexual sadism is a psychiatric disorder in which sexual pleasure is derived from inflicting pain, suffering, or humiliation on others. While the psychological and forensic aspects of sexual sadism have been well characterized, little is known about the neurocognitive circuitry associated with the disorder. Sexual sadists show increased peripheral sexual arousal when observing other individuals in pain. The neural mechanisms underlying this unusual response are not well understood. We predicted that sadists relative to nonsadists would show increased responses in brain regions associated with sexual arousal (amygdala, hypothalamus, and ventral striatum) and affective pain processing (anterior cingulate and anterior insula) during pain observation. Objective To study the neural correlates of pain observation in sadists and nonsadists. Design Case-control cross-sectional study. Sadists and nonsadists viewed 50 social scenes, 25 that depicted a person in pain (eg, one person stabbing another person's hand with scissors) and 25 thematically matched no-pain pictures (eg, one person stabbing a table with scissors, with another person's hand nearby). Pain severity ratings (range, 0 [none] to 4 [severe]) were acquired following each picture presentation. Setting Sand Ridge Secure Treatment Center, Mauston, Wisconsin. Participants Fifteen violent sexual offenders, including 8 sadists and 7 nonsadists (defined using the Severe Sexual Sadism Scale) who were matched for age, IQ, and education. Main Outcome Measures Hemodynamic response revealed by functional magnetic resonance imaging and pain severity ratings. Results Sadists relative to nonsadists showed greater amygdala activation when viewing pain pictures. They also rated pain pictures higher on pain severity than nonsadists. Sadists but not nonsadists showed a positive correlation between pain severity ratings and activity in the anterior insula. Conclusion These results provide neurobehavioral evidence of unusually heightened sensitivity to the pain of others in sadists.

Risk assessment and treatment for sexual offenders should focus on individual characteristics associated with recidivism risk. Although it is possible to conduct risk assessments based purely on empirical correlates, the most useful evaluations also explain the source of the risk. In this review, the authors propose that the basic requirements for a psychologically meaningful risk factor are (a) a plausible rationale that the factor is a cause of sexual offending and (b) strong evidence that it predicts sexual recidivism. Based on the second of these criteria, the authors categorize potential risk factors according to the strength of the evidence for their relationship with offending. The most strongly supported variables should be emphasized in both assessment and treatment of sexual offenders. Further research is required, however, to establish causal connections between these variables and recidivism and to examine the extent to which changes in these factors leads to reductions in recidivism potential.

Meta-analysis (R. K. Hanson & M. T. Bussière, 1998) has indicated an overall negative correlation between age and sexual recidivism, but also found that the size of this inverse relationship varies significantly between samples. The present study examined the relationship between age on release and sexual recidivism in a large (N = 75 2), nationally representative, sample of imprisoned male sexual offenders followed up for 10 years. Sexual offenders released at a younger age tended to be more general criminals while those released at an older age tended to be sexual specialists. Consistent with C. F. Roberts, D. M. Doren, and D. Thornton (2002), age on release was found to make a significant contribution to the prediction of sexual reconviction when two aspects of criminal history (sexual deviance and general criminality) were controlled. Overall, the odds of being sexually reconvicted declined by about 0.02 with each year of increasing age. In addition to this general decline in recidivism with increasing age, there was also a cubic effect of age for the offenders who had been sentenced for sexual offenses on at least two prior occasions. This group showed an exceptionally high sexual recidivism rate when released between the ages of 18-24 (80%). For those aged between 25 and 59 their sexual reconviction rate was consistently just under 50% regardless of age. Then for the small group aged 60+ no further sexual reconvictions were found.

A two-dimensional risk assessment system for sexual offenders was created that can classify them for risk of sexual recidivism, risk of nonsexual violent recidivism, and the composite risk of reconviction for sexual or nonsexual assaults. Receiver operating characteristic (ROC) analyses of separate follow-up samples were used for cross-validation. The system is easier to score than Static-99, and substantially easier to score than the VRAG or SORAG, while yielding comparable predictive accuracy in cross-validation samples with follow-ups from 2 years to 19 years. ROC AUC coefficients between .74 and .81 were found for the different scales and samples.

This paper describes an approach to treatment for sexual offenders who are in categorical denial. Other efforts to have them, at least partially, admit responsibility had failed and they were to be released from prison without any treatment. Evidence that suggests denial is not predictive of risk and that treatment may reduce the risk of these offenders is reviewed. Essentially, this paper offers a possible approach to dealing with these intractable deniers which, it is suggested, is better than not trying to modify their risk, and that may prove to be effective.

In the correctional field, treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majesty's Prison Service has, in 3.5 years, accelerated the effectiveness of correctional treatment programming, established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales.

The study compared the predictive accuracy of three sex offender risk-assessment measures: the RRASOR (Hanson, 1997), Thornton's SACJ-Min (Grubin, 1998), and a new scale, Static-99, created by combining the items from the RRASOR and SACJ-Min. Predictive accuracy was tested using four diverse datasets drawn from Canada and the United Kingdom (total n = 1301). The RRASOR and the SACJ-Min showed roughly equivalent predictive accuracy, and the combination of the two scales was more accurate than either original scale. Static-99 showed moderate predictive accuracy for both sexual recidivism (r = 0.33, ROC area = 0.71) and violent (including sexual) recidivism (r = 0.32, ROC area = 0.69). The variation in the predictive accuracy of Static-99 across the four samples was no more than would be expected by chance.