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Introduction: Coercion is frequently used in mental health practice. Since it overrides some patients' fundamental human rights, adequate use of coercion requires legal and ethical justifications. Having internationally standardised datasets to benchmark and monitor coercion reduction programs is desirable. However, only a few countries have specific, open, publicly accessible registries for this issue. Methods: This study aims to assemble expert opinions regarding strategies that might be feasible for promoting, developing, and implementing an integrated and differentiated coercion data collection system in Europe at national and international levels. A concept mapping methodology was followed, involving 59 experts from 27 countries in generating, sorting and rating strategies regarding relevance and feasibility. The experts were all researchers and/or practitioner members of an EU-COST-Action focused on coercion reduction Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services (FOSTREN). Results: A hierarchical cluster analysis revealed a conceptual map of 41 strategies organized in seven clusters. These clusters fit into two higher-order domains: "Advancing Global Health Research: Collaboration, Accessibility, and Technological Innovations/Advancing International Research" and "Strategies for Comprehensive Healthcare Data Integration, Standardization, and Collaboration." Regarding the action with the higher priority, relevance was generally rated higher than feasibility. No differences could be found regarding the two domains regarding the relevance rating or feasibility of the respective strategies in those domains. The following strategies were rated as most relevant: "Collection of reliable data", "Implementation of nationwide register, including data on coercive measures", and "Equal understanding of different coercive measures". In analysing the differences in strategies between countries and their health prosperity, the overall rating did not differ substantially between the groups. Conclusion: The strategy rated as most relevant was the collection of reliable data in the nationwide health register, ensuring that countries share a standard understanding/definition of different coercive measures. Respondents did not consider the feasibility of establishing a shared European database for coercive measures to be high, nor did they envision the unification of mental health legislation in the future. There is some consensus on the most suitable strategies that can be adopted to enable international benchmarking of coercion in mental health settings. [ABSTRACT FROM AUTHOR]

Court-ordered treatment for offenders who suffer from psychiatric disorders or addiction has been the subject of controversy in all Western countries, but opposition in France has been more widespread than elsewhere. Based on 100 interviews, this article nonetheless reveals that healthcare professionals have gradually accepted court-ordered treatment, which they provide both inside and outside correctional facilities. We argue that, with few exceptions, they now agree that given offenders’ frequent unwillingness to seek treatment, constraint can lead to creating a therapeutic alliance, although it is a complex process that involves employing a variety of techniques. To overcome offenders’ suspicions that they are working with the courts, they claim to be complete outsiders who keep their distance from the judicial system and its expectations. We find that, despite greater acceptance of court-ordered treatment, these professionals perpetuate France’s distinctive system and fuel the growing criticism from prosecutors, judges, and corrections system personnel. [ABSTRACT FROM AUTHOR]

The MacArthur Admission Experience Survey was developed to evaluate perceived coercion in psychiatric inpatients and comprises of three subscales: “Perceived coercion”, “Negative pressures” and “Voice”. The present study aims to evaluate the psychometric properties of a Romanian language version of the AES (R-AES) and to identify predictors for higher perceived coercion. We developed the R-AES using a translation/back-translation procedure and administered it to 137 patients admitted to the “Profesor Doctor Alexandru Obregia” psychiatric hospital in Bucharest, Romania. Discriminatory power was evaluated by comparing the scores of voluntarily and involuntarily admitted patients. The R-AES showed satisfactory internal consistency (Crohnbach’s alpha = 0.92). Principal components analysis disclosed a three-factor solution explaining 69.1% of variance. Factor components roughly corresponded to the original subscales. Higher scores were associated with involuntary admission, objective coercive measures, younger age, frequent past hospitalisations, treatment non-compliance, psychosis, mania, greater disease severity, aggression, and presentation by police or ambulance. [ABSTRACT FROM AUTHOR]

The #MeToo movement and social media have increased public awareness of sexual violence, particularly when committed by high-profile celebrities. Presently, we are within a unique sociocultural space, often referred to as "cancel culture," in which perpetrators of sexual violence may face increased accountability. However, "cancelation" is not equally applied to all perpetrators. The purpose of this study was to explore the roles of perpetrator likeability and tactic (i.e., force and coercion) on the degree to which perpetrators are "canceled" (i.e., held accountable through personal, professional, and legal repercussions) for sexual assault. Among a sample of 238 participants, results of this experimental vignette study revealed that perpetrators viewed as unlikeable received more blame than those who were likeable or described in a neutral manner, with the survivors in the likeable perpetrator and neutral scenarios receiving greater blame. Moreover, perpetrators who used coercion were less likely to be blamed and be held accountable than those who used force, with the survivors in the coercive scenarios receiving greater blame. No interaction effects emerged between likeability and tactic, suggesting that the main effects operate independently of one another. Though the #MeToo movement and cancel culture have created cultural change in the United States, the findings from this study suggest that perpetrators continue to be held less accountable, so long as they are not unlikeable and do not use force. [ABSTRACT FROM AUTHOR]

Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women's autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers' and women's moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a survey of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women's decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women's autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women's enfranchisement in their own care. [ABSTRACT FROM AUTHOR]

We argue that copular constructions that relate two referring expressions are based on small clauses with an asymmetrical semantics. The small clauses in question are headed by a relational item that selects for an individual and an individual concept, along the lines proposed by Heycock (Canadian Journal of Linguistics/Revue canadienne de linguistique 57: 209–240, 2012). Our analysis allows us to explain the asymmetric properties of these constructions when they occur as complements to think. Additional motivation comes from facts that involve questions based on copular clauses. [ABSTRACT FROM AUTHOR]

When considering drones’ impact on modern conflict, strategic studies scholars typically focus on the most sophisticated systems in states’ arsenals: costly and hard-to-acquire military drones, which are necessarily few in number. This article questions this conventional emphasis, proposing in its place that easy-to-produce and cheap(er) one-way attack (OWA) drones hold underappreciated war-shaping potential. Through analysis of recent and ongoing conflicts, we argue that OWA drones’ complementary characteristics are yielding tactical gains and can, under certain circumstances, generate strategic effects when employed against an adversary’s homeland. The findings show a need for scholars to further study the implications of innovative low-tech developments in drones. [ABSTRACT FROM AUTHOR]

Despite many calls to reduce or eliminate the use of mechanical restraint, it is still widely used in many countries. Studies using patient interviews have a very clear message: Patients experience mechanical restraint as the most humiliating intervention. There seems to be a lack of alternatives for violent patients if all other approaches to prevent the use of coercion have failed. We developed a method using 30 kg bags, originally designed for fitness purposes, to be attached to a patient's wrist or ankle under 1:1 supervision. The method was tested with 10 experienced nurses and de-escalation trainers. A video was made and presented to six outpatients who had previously experienced mechanical restraint. All participants were interviewed. Transcribed interviews were analysed using qualitative content analysis. All participants approved of the method as a milder and less humiliating alternative to mechanical restraint. The nurses' main concerns were the risk of falls and the use of the bags as weapons. The latter could be controlled by using an additional bag. Patients were generally positive, especially if there was a history of abuse. The method should be further developed to replace at least some mechanical restraints. As with all 'milder means', care should be taken to really replace restraint and not to introduce additional coercion. [ABSTRACT FROM AUTHOR]

Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review. [ABSTRACT FROM AUTHOR]

The number of Australians subject to coercive interventions in community mental health services continues to increase. This is in the context of a growing awareness of the harms from coercion, increasing concerns about potential breaches of human rights and an ongoing uncertainty regarding the clinical benefits of community treatment orders, the primary instrument of legislated coercion in community mental health services. Nurses in community mental health services are on the frontline with regard to coercion. They police the requirements of the community treatment order, administer medication to people in community settings without their consent and facilitate re‐hospitalisation if indicated. Coercive practice contradicts the person‐centred, recovery‐oriented and trauma‐informed care principles that inform contemporary mental health nursing. This contradiction may generate ethical challenges for nurses and result in ethical distress. The aim of this scoping review was to map the research literature on how nurses in community mental health settings recognise and manage the harm associated with the administration of coercive interventions and consider the ethical challenges that may arise within this practice. The search strategy yielded 562 studies with author consensus determining a total of three articles as meeting the inclusion criteria. The resulting literature identified three themes: (1) maintaining the therapeutic relationship, (2) promoting autonomy and (3) using subtle forms of control. This review demonstrated that there is minimal research that has considered the ethical challenges related to the use of coercion by nurses in community mental health settings. [ABSTRACT FROM AUTHOR]

Medically compromised people with anorexia nervosa are cared for in inpatient settings where clinicians closely monitor health and safety. Clinicians are in a position of power, with the capacity to impose mandated weight gain to achieve medical stabilisation. Consumers are in a vulnerable position, compelled to temporarily relinquish autonomy and to accept coercive practices that often diminish the quality of the therapeutic relationship. Clinicians' position of power in mental healthcare has a dual potential for both healing and harm, and limited attention has been given to consumers' views of clinicians' power. The aim of this qualitative descriptive study was to investigate the consumer perspective of clinicians' power in the inpatient care of anorexia nervosa, establishing insight into the beneficence and maleficence of the power asymmetry. Ten women with anorexia nervosa in the community participated in semi‐structured interviews online. The COREQ checklist was used to ensure accuracy and completeness of reporting. Thematic analysis revealed that abuses of power were common in the course of inpatient AN care, however life‐saving measures were regarded as defensible. The perception of clinicians' power was determined by the strength of interpersonal relationships and clinicians' clinical competence. To mitigate the potential for harmful experiences, clinicians' use of power must be exercised with close consideration for consumer perspectives, with the integration of person‐centred care and trauma‐informed care principles. [ABSTRACT FROM AUTHOR]

The integrity of electronic voting systems is critical in safeguarding the democratic process worldwide. This study addresses the twin challenges of bribery and coercion that undermine most existing electronic voting systems. Recognizing the limitations of current security measures, which fail to protect voter autonomy even after the disclosure of voting secrets, we propose an innovative level-five secure e-voting system. By integrating an additional setup phase, our system maintains voter volition, ensuring security even when key secrets are compromised. Utilizing cryptographic techniques, blind signatures, and subliminal channels in conjunction with smart card PIN mechanisms, our approach not only bolsters system security but also enhances its potential for widespread adoption. This work underscores the importance of advanced cryptographic methods in developing coercion-resistant electronic voting systems that prioritize voter privacy and choice. [ABSTRACT FROM AUTHOR]

Critical systems heuristics (CSH) has been influential in the development of critical systems thinking. However, it is a relatively underutilised method compared with soft systems approaches such as soft systems methodology (SSM) and cognitive mapping. This may be in part due to the complexity of ideas underpinning CSH. Core ideas with which users must feel confident include boundary critique, coercion, emancipation, and "is" vs "ought to be" framings. These ideas were the subject of the early discourse surrounding CSH, which considered the role of boundary critique in systems research, the extent to which CSH could meaningfully address coercion, and the claims of CSH as an emancipatory approach. The purpose of this review is to provide clarity on these key concepts by reflecting on how they have been addressed in the CSH literature to date. We find that CSH has been applied in a range of problem contexts and is most frequently applied to address coercion or power asymmetries. CSH research is frequently associated with advocacy for marginalised groups, and we believe this is a natural extension of the methodological emancipation to which CSH aspires. In providing an overview of the key ideas underpinning CSH, we hope to lower the barrier to application for systems researchers and practitioners. [ABSTRACT FROM AUTHOR]

Background: The community treatment order (CTO) is designed to deliver mental healthcare in the community and has been introduced in around 75 jurisdictions worldwide. It constitutes a legal obligation in which individuals with severe mental illness must adhere to out‐of‐hospital treatment plans. Despite intense criticism and the debated nature of published evidence, it has emerged as a clinical and policy response to frequent hospital readmissions and to enhance adherence in cases where there is refusal of pharmacological treatments. This systematic review outlines findings on CTO long‐term adherence, after mandatory outpatient treatment has ended, in studies that include people with psychiatric disorders. Method: Following PRISMA guidelines, we performed a review of published articles from PubMed, PsycINFO, EMBASE, and CINAHL up to January 15, 2023. We included studies that assessed adherence after CTO ends. The study is registered with PROSPERO number CRD42022360879. Results: Six independent studies analyzing the main indicators of long adherence: engagement with services and medication adherence, were included. The average methodological quality of the studies included is fair. Long‐term adherence was assessed over a period ranging from 11 to 28 months. Only two studies reported a statistically significant improvement. Regarding the remaining studies, no positive correlation was observed, except for certain subgroup samples, while in one study, medication adherence decreased. Conclusion: Scientific evidence supporting the hypothesis that CTO has a positive role on long‐term adherence post‐obligation is currently not sufficient. Given the importance of modern recovery‐oriented approaches and the coercive nature of compulsory outpatient treatment, it is necessary that future studies ensure the role of CTO in effectively promoting adherence. [ABSTRACT FROM AUTHOR]

Background: In mental health care, experienced coercion, also known as perceived coercion, is defined as the patient's subjective experience of being submitted to coercion. Besides formal coercion, many other factors have been identified as potentially affecting the experience of being coerced. This study aimed to explore the interplay between these factors and to provide new insights into how they lead to experienced coercion. Methods: Cross-sectional network analysis was performed on data collected from 225 patients admitted to six psychiatric hospitals. Thirteen variables were selected and included in the analyses. A Gaussian Graphical Model (GGM) using Spearman's rank-correlation method and EBICglasso regularisation was estimated. Centrality indices of strength and expected influence were computed. To evaluate the robustness of the estimated parameters, both edge-weight accuracy and centrality stability were investigated. Results: The estimated network was densely connected. Formal coercion was only weakly associated with both experienced coercion at admission and during hospital stay. Experienced coercion at admission was most strongly associated with the patients' perceived level of implication in the decision-making process. Experienced humiliation and coercion during hospital stay, the most central node in the network, was found to be most strongly related to the interpersonal separation that patients perceived from staff, the level of coercion perceived upon admission and their satisfaction with the decision taken and the level of information received. Conclusions: Reducing formal coercion may not be sufficient to effectively reduce patients' feeling of being coerced. Different factors seemed indeed to come into play and affect experienced coercion at different stages of the hospitalisation process. Interventions aimed at reducing experienced coercion and its negative effects should take these stage-specific elements into account and propose tailored strategies to address them. [ABSTRACT FROM AUTHOR]

Proper names are typically considered to be devices of individual reference. Since Frege (1882), the debate has mainly concerned the proper semantic characteristics of this individual reference. Burge (J Philos 70:425–439, 1973) challenged this focus by highlighting the predicative uses of proper names and proposed that names are predicates even if they appear as bare singulars in the argument position. In turn, this unificatory account was subjected to criticism by Böer, Jeshion, and others, who provided counterexamples to the predicativist analysis of proper names. In this paper, I want to analyze the nonreferential uses of proper names, which, by being nonreferential, provide a challenge for both predicativism and referentialism about proper names. I critically examine the processes proposed as possible accounts of the problematic examples, i.e. deferred reference, meaning transfer, and coercion, and argue that they do not provide an adequate analysis. I propose an interpretive mechanism that accounts for these problematic uses of proper names, as well as a new principle for classifying the kinds of uses of proper names based on the interpretive mechanisms underlying those uses and which includes all of the kinds of uses discussed in the literature. [ABSTRACT FROM AUTHOR]

Patient refusal of care often puts healthcare professionals in an ethical dilemma. The ethics of refusing nursing care are examined in this editorial, which emphasizes the patient's autonomy and the healthcare professional's duty to provide care. Coercion and information manipulation to override patient's refusal contradict principles of autonomy and justice.... [ABSTRACT FROM AUTHOR]

Many liberal philosophers claim that people are free to do as they will by default; any interference must be justified. This supposed presumption of liberty does a significant amount of theoretical work for public reason liberals such as Gerald Gaus and John Rawls. This paper shows that Gaus’s explicit defense of a presumption of liberty fails. Gausa and his many followers repeatedly appeal to a particular thought experiment from Stanley Benn. We argue that this thought experiment fails to show that there is a presumption of liberty, but instead shows, at best, the trivial point that when any particular moral concern is specified to be the only relevant concern, then there is a presumption in favor of that concern. Further, Gaus, along with Shaun Nichols, has tried to demonstrate empirically that the intuitions and conclusions he draws from this example are fairly uniform and universal among other moral agents, but we explain why their experimental results do not vindicate any such conclusion. We conclude that undermining the alleged presumption of liberty places public reason liberalism in serious jeopardy. [ABSTRACT FROM AUTHOR]

Relational autonomy is a concept that describes the interdependent nature of decision making by individuals. Relational autonomy is distinct from the traditional concept of autonomy, which asserts the need for each individual to make choices based on their own values and without influence by others. We present a case in which a patient made decisions that appeared contrary to his own desires. The case raises questions about the line between appropriate and coercive family influence. We also explore the moral distress generated by the attempt to reconcile his expressed desires and the decisions he made. We propose that examining the case with a relational autonomy lens may have helped clinical staff understand his decision and thus mitigate moral distress. [ABSTRACT FROM AUTHOR]

During custodial interrogations, law enforcement officers are permitted to use various methods of deception to entice a suspect to give a confession. Two of these commonly used methods include the False Evidence Ploy (FEP), and its less deceptive variant, the bluff tactic. While the bluff may appear to be less deceptive than the FEP, it also influences innocent suspects to confess. In the present study, participants were shown 1 of 6 possible videos that varied the type of deception (control/FEP/bluff) along with interrogation length (1/12 hours). Participants rated how deceptive and coercive the interrogation was and rendered guilt judgments. The results indicates that participants failed to distinguish between the FEP and the bluff in terms of either deceptiveness or coercion, and neither deception type nor interrogation length impacted guilt judgments. Judgments of deception, coercion, and guilt intercorrelated, but participants did not distinguish between the deception tactics in any of these measures. The implications for juror evaluations of videotaped confessions during trial and the potential for wrongful convictions are discussed. [ABSTRACT FROM AUTHOR]

How is the validity of our consent, and others' moral permission to act on our consent affected by coercion? Everyone agrees that in cases of two-party coercion—when X coerces Y to do something with or for X—the consent of the coerced is invalid, and the coercer is not permitted to act upon the consent they receive. But coercers and the recipients of consent are not always identical. Sometimes a victim, Y, agrees to do something to, with, or for Z because they are being coerced by X. Recently, several philosophers have argued that consent under third-party coercion can be fully valid. We argue that this view has troubling implications. We develop a novel view of consent in third-party coercion cases, which we call the partial validity account. The core idea is that, under severe coercion, Y's consent is at most partially valid—it reduces the strength of, but does not completely dissolve, Z's consent-sensitive duties. We argue that the partial validity account gets the right results in important cases and explains the moral factors at play better than alternative accounts. [ABSTRACT FROM AUTHOR]

Even if coercive measures are widely applied in psychiatry and have numerous well-known drawbacks, there is limited known on the agreement among mental healthcare professionals' opinions on their use. In a questionnaire study using standardized scenarios, we investigated variation in staff opinions on coercion. In a web-based survey distributed to staff at three psychiatry hospitals, respondents were asked to consider if and what coercion to use by introducing two hypothetical scenarios involving involuntary psychiatric admission and in-hospital coercion. One hundred thirty-two out of 601 invited staff members responded to the survey (Response Rate = 22%). There was large variation in participating staff members' opinions on how to best manage critical situations and what coercive measures were warranted. In the first scenario, 57% of respondents (n = 76) believed that the patient should be involuntarily admitted to hospital while the remaining respondents believed that the situation should be managed otherwise. Regarding the second scenario, 62% of respondents responded that some in-hospital coercion should be used. The majority of respondents believed that colleagues would behave similarly (60%) or with a tendency towards more coercion use (34%). Male gender, being nursing staff and having less coercion experience predicted being less inclined to choose involuntary hospital admission. There is a high degree of variation in coercion use. This study suggests that this variation persists despite staff members being confronted with the same standardized situations. There is a need for evidence-based further guidance to minimize coercion in critical mental healthcare situations. [ABSTRACT FROM AUTHOR]

We conceptualize the reach of the state by examining how the physical presence of the state helps the state project its power by signaling state interests and strength. We present a new measurement strategy to capture the territorial reach of the state using points-of-interest data provided by location-based service companies. Our measure exhibits several advantages: (1) it draws on firm-produced or crowd-sourced (rather than government-produced) data, (2) it includes highly precise, geo-referenced location information, which can be aggregated to any geographical or administrative level, (3) it traces temporal changes, and (4) it covers different types of state agencies. We illustrate its features using original databases that we compiled on state agencies in China and other countries. We demonstrate how researchers can use our measure by examining the locations and effects of coercive organizations and provide our data, code, and a tutorial to help researchers explore new avenues of inquiry. [ABSTRACT FROM AUTHOR]

In the framework of Relevance Theory, this paper discusses the coercion cases imposed by nominal classifiers in Chinese and proposes a translation strategy. The results show that the coercion imposed by nominal classifiers in Chinese appears in the cases of metaphor or metonymy. In these cases, the conflict between procedural semantics and conceptual semantics is always resolved in favor of the procedural one. Therefore, when we translate them from Chinese to Spanish, to get a correct translation, we should find out firstly the procedural semantics of the nominal classifiers and then combine them with the metaphor or metonymy meaning of the nouns generated in coercion contexts. [ABSTRACT FROM AUTHOR]

The notion of a defendant submitting a false guilty plea due to the penal incentive offered is not an uncommon phenomenon. While the practice has been legitimised based on the defendant's voluntary informed consent, it has often been argued that the structure of the plea-bargaining practice is coercive. Such can be the case whenever the plea offer entails a significant sentence differential, discrepancy in the form of punishment (a non-custodial sentence relative to a custodial one), or when the alternative of pleading guilty includes the risk of capital punishment. Having said that, plea-bargains have often been classified as a "non-coercive offer", whether due to their advantageous mutual character according to a baseline conception of coercion or being an offer that one can overcome according to an irresistible psychological account. While many scholars have struggled with the ambiguous notion of "coercive offers," the paper offers an alternative approach, arguing that it is the type of reasons to be considered within the offer that renders the bargain less than fully autonomous. It will be argued that the plea-bargain proposition infuses irrelevant (guilt-uncorrelated) penal considerations unrelated to the question of guilt. Such considerations are the wrong kind of reason for the guilty-plea decision, and due to the defendant's dependency on the plea offer, they distort the defendant's intentional character of her autonomous decision. It is part of the conception of the guilty plea. Though a defendant may autonomously intend to consider irrelevant penal considerations, such a decision cannot be genuinely considered a decision regarding the admission of guilt. [ABSTRACT FROM AUTHOR]

Heavy metals refer to metal elements with a density greater than 4.5 g/cm3. In recent years, human activities have increasingly exacerbated heavy metal pollution, and people are increasingly paying attention to the harm of heavy metal pollution to agricultural products. Tea is a common food, and the accumulation and physiological response of its parent Camellia sinensis to heavy metals have received increasing attention from scholars. Studies have shown that heavy metals can enter and accumulate in Camellia sinensis in various ways, and their toxicological effects on Camellia sinensis mainly include inhibiting growth and development, disrupting physiological and metabolic balance, and reducing the concentration of various chemicals in the body. This article summarizes the pathways by which heavy metals enter Camellia sinensis; the accumulation, physiological response, and tolerance effects of heavy metals in Camellia sinensis; and the underlying mechanisms involved. Finally, suggestions and prospects are made for the shortcomings of current research and future research directions. [ABSTRACT FROM AUTHOR]

Abstract Background In mental health care, experienced coercion, also known as perceived coercion, is defined as the patient’s subjective experience of being submitted to coercion. Besides formal coercion, many other factors have been identified as potentially affecting the experience of being coerced. This study aimed to explore the interplay between these factors and to provide new insights into how they lead to experienced coercion. Methods Cross-sectional network analysis was performed on data collected from 225 patients admitted to six psychiatric hospitals. Thirteen variables were selected and included in the analyses. A Gaussian Graphical Model (GGM) using Spearman’s rank-correlation method and EBICglasso regularisation was estimated. Centrality indices of strength and expected influence were computed. To evaluate the robustness of the estimated parameters, both edge-weight accuracy and centrality stability were investigated. Results The estimated network was densely connected. Formal coercion was only weakly associated with both experienced coercion at admission and during hospital stay. Experienced coercion at admission was most strongly associated with the patients’ perceived level of implication in the decision-making process. Experienced humiliation and coercion during hospital stay, the most central node in the network, was found to be most strongly related to the interpersonal separation that patients perceived from staff, the level of coercion perceived upon admission and their satisfaction with the decision taken and the level of information received. Conclusions Reducing formal coercion may not be sufficient to effectively reduce patients’ feeling of being coerced. Different factors seemed indeed to come into play and affect experienced coercion at different stages of the hospitalisation process. Interventions aimed at reducing experienced coercion and its negative effects should take these stage-specific elements into account and propose tailored strategies to address them.

Patient refusal of care often puts healthcare professionals in an ethical dilemma. The ethics of refusing nursing care are examined in this editorial, which emphasizes the patient’s autonomy and the healthcare professional’s duty to provide care. Coercion and information manipulation to override patient’s refusal contradict principles of autonomy and justice. Through ethical analysis and case examples of assisting post-operative patients with early ambulation, it is clear that an excessive focus on patient’s autonomy and the duty to provide care could jeopardize ethical practice.

Abstract Background Despite the low-risk nature of participation in most clinical anesthesia trials, subject recruitment on the same day as surgery is often restricted due to the concerns of researchers and local research ethics boards that same-day consent may not afford adequate time and opportunity for patients to weigh and make decisions, as well as perceptions of patient vulnerability immediately prior to surgery that could impact the voluntary nature and the rigor of the informed consent process. However, specialties such as anesthesiology, critical care, interventional radiology, and emergency medicine have a varied pattern of practice and patient acquaintance that does not typically afford the luxury of time or, in many cases, advance consent for participation in research. Indeed, the initial encounter between anesthesiologists and patients undergoing elective procedures routinely occurs on the day of surgery. Concerns of coercion related to same-day consent for clinical anesthesia research trials have not been borne out in the literature, and represent a significant obstacle to clinical researchers, as well as to the patients who are denied opportunities for potential benefit through participation in research studies. Methods We describe the protocol for a prospective randomized controlled trial examining the voluntariness of patient consent, solicited either in advance of surgery or on the same day, to participate in an anesthesia research study at Women’s College Hospital. One hundred fourteen patients scheduled to undergo ambulatory anterior cruciate ligament repair facilitated by general anesthesia with an adductor canal block will be randomized for recruitment either (a) in the pre-operative assessment clinic before the day of surgery or (b) on the day of surgery, to be approached for consent to participate in a fabricated research study of adjunct medications in adductor canal blocks. Regardless of allocation, patients in both groups will receive the same routine standard of care and will complete a post-operative questionnaire to signal perceptions of undue influence in the process of providing informed consent for the fabricated trial. Discussion This study will inform trial design and practice guidelines surrounding the amount of time patients ought to be afforded in order to make durable decisions to participate (or not) in clinical research studies. This is expected to impact trial recruitment in a variety of clinical settings where researchers have only brief opportunities to interface with patients. Trial registration The trial was registered prospectively on the Open Science Framework (OSF), registration #46twc, on 2023-Mar-17.

Abstract Background Involuntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL. Methods We conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care. Results Cases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low. Conclusion We found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.

El presente trabajo identifica en la obra de Wilfrid Sellars dos tesis relevantes para el debate contemporáneo en ontología social. La primera dice que podemos entender la realidad social como estando compuesta parcialmente por estructuras causales o coercitivas. La segunda, que la realidad social se le presenta a los agentes como estando constituida por estructuras coercitivas. El trabajo defiende estas tesis interpretativas recurriendo a los escritos de filosofía práctica de Sellars, y especialmente a su explicación del funcionamiento de los imperativos hipotéticos y categóricos. A su vez, contrasta esta interpretación de corte causal con las concepciones —de índole normativa— predominantes tanto en la ontología social contemporánea como entre los seguidores de Sellars.

Abstract Background Psychiatrists face a major ethical challenge when deciding whether to make use of coercive measures in the treatment process of patients suffering from severe and persistent mental illness (SPMI). As India and Switzerland show major cultural, political and financial differences, it is hypothesized that attitudes towards coercive measures among Indian and Swiss psychiatrists will vary too. Exploring differences in attitudes between cultures strengthens the critical reflection on one’s own stances and in consequence, on our way of action. Especially when it comes to situations involving power imbalances between patients and health practitioners, self-reflection is essential to prevent ethically inappropriate behavior. Methods An online survey on aspects of care for patients with SPMI was sent to 3’056 members of the Indian Psychiatric Society between April and June 2020 and to 1’311 members of the Swiss Society for Psychiatry and Psychotherapy between February and March 2016. The respondents’ answers were compared. This article deals with the questionnaire’s items on autonomous decision making and the implementation of coercive measures in clinical practice. More precisely, participating psychiatrists were asked to rate the importance of patient’s autonomy in general and their willingness to apply coercive measures regarding two specific case vignettes depicting a patient with schizophrenia and one with depression. The statistical analysis, namely descriptive data analysis and calculation of arithmetic means, Shapiro Wilks tests and Mann-Whitney U tests, was carried out using IBM SPSS Statistics version 27. Results Answers were received from 206 psychiatrists in India and 457 psychiatrists in Switzerland. Indian participants tended to value autonomous decision making as slightly less important than Swiss participants (62.2% vs. 91%, p =.01). Regarding a case of severe and persistent depression, psychiatrists in the Indian group were on average more in favor of acting against the wishes of the patient (55% vs. 34.1%, p

ABSTRACT Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high‐level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re‐extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy–based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand‐alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff‐related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity‐informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups. [ABSTRACT FROM AUTHOR]

Background: Involuntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL. Methods: We conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care. Results: Cases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low. Conclusion: We found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field. [ABSTRACT FROM AUTHOR]

In this article I aim to counter Jason Brennan's principled objection to the Representativeness Argument for compulsory voting, and to criticize the case in favour of voting lotteries, on which this challenge is predicated. In brief, Brennan claims that compulsory voting should be rejected because there is an alternative system, i.e. a voting lottery, which is able to ensure demographic proportionality in electoral turnouts without diminishing the freedom of citizens. But even on the most favourable conception of freedom which the argument can employ, voting lotteries raise a number of serious concerns in respect to this value. Furthermore, while comparing voting lotteries and compulsory voting on the basis of freedom cannot provide any generalizable support for the former, a plausible case can instead be offered in support of the opposite idea, namely that compulsory voting outperforms voting lotteries with respect to freedom. [ABSTRACT FROM AUTHOR]

The use of seclusion to manage conflict behaviours in psychiatric inpatient settings is increasingly viewed as an intervention of last resort. Many protocols have, thus, been developed to reduce the practice. We conducted a systematic review to determine the effectiveness of protocols to reduce seclusion on process outcomes (e.g., seclusion, restraint), patient outcomes (e.g., injuries, aggressive incidents, satisfaction), and staff outcomes (e.g., injuries, satisfaction). We searched Medline, Embase, the Cochrane Register of Clinical Trials, PsycINFO, CINAHL, cairn.info, and ClinicalTrials.gov for protocols to reduce seclusion practices for adult patients on inpatient mental health units (from inception to September 6, 2022). We summarised and categorised reported elements of the protocols designed to reduce seclusion using the Behaviour Change Wheel Intervention Functions and resources needed to implement the protocol in psychiatric units. We assessed risk of bias and determined certainty of evidence using GRADE. Forty‐eight reports addressed five approaches to reduce seclusion: hospital/unit restructuring (N = 4), staff education/training (N = 3), sensory modulation rooms (N = 7), risk assessment and management protocols (N = 7), and comprehensive/mixed interventions (N = 22; N = 6 without empirical data). The relationship between the various protocols and outcomes was mixed. Psychiatric units that implement architecturally positive designs, sensory rooms, the Brøset Violence Checklist, and various multi‐component comprehensive interventions may reduce seclusion events, though our certainty in these findings is low due to studies' methodological limitations. Future research and practice may benefit from standardised reporting of process and outcome measures and analyses that account for confounders. [ABSTRACT FROM AUTHOR]

By bestowing honours, states produce subjects. But what kind of subjects are created if those honoured do not seek state honours, because they find the honours not worth the responsibilities they have to shoulder, or because they do not internalise the state's values that the honours embody? Building on ethnographic materials from Vietnam, this article explores how some who receive honours are "grateful coerced subjects" on whom state honours are imposed through social pressure, persistent persuasion, or as a matter of fait accompli they cannot refuse. The bestowal of honours exposes them to pressure from the wider society to comply with state's goals and values to prove themselves worthy of the honours, in ways they find physically burdensome and morally problematic. Yet the coerced subjects do not hold a grudge against the state, and even feel grateful to the state for conferring honours on them. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is an urgent, global threat to public health. The development and implementation of effective measures to address AMR is vitally important but presents important ethical questions. This is a policy area requiring further sustained attention to ensure that policies proposed in National Action Plans on AMR are ethically acceptable and preferable to alternatives that might be fairer or more effective, for instance. By ethically analysing case studies of coercive actions to address AMR across countries, we can better inform policy in a context‐specific manner. In this article, I consider an example of coercive antimicrobial stewardship policy in Canada, namely restrictions on livestock farmers' access to certain antibiotics for animal use without a vet's prescription. I introduce and analyse two ethical arguments that might plausibly justify coercive action in this case: the harm principle and a duty of collective easy rescue. In addition, I consider the factors that might generally limit the application of those ethical concepts, such as challenges in establishing causation or evidencing the scale of the harm to be averted. I also consider specifics of the Canadian context in contrast to the UK and Botswana as example settings, to demonstrate how context‐specific factors might mean a coercive policy that is ethically justified in one country is not so in another. [ABSTRACT FROM AUTHOR]