Exploring Identity Dynamics from a Combined Social Exchange and Social Identity Perspective

The aim of this article is to explore identity dynamics of unit and department leaders in a healthcare setting using both social identity and social exchange theories. In particular, we developed a mediational moderated model in which supervisor trust indirectly influences identification with a subordinate level (i.e., the clinical unit) through its effect on identification with a superordinate level (i.e., the organization as a whole). Furthermore, we predicted and found that this relation is moderated by organizational tenure, contract breach, and the clinical-manager's role (heads of clinical units vs. chairs of departments). We tested our hypotheses with doctors of a large public hospital in northern Italy. A total of 370 doctors completed questionnaires measuring organizational and unit identification, supervisor trust, and contract breach. Results supported our hypotheses: supervisor trust was related to unit identification through its effect on organizational identification. As expected, this relation was stronger for more tenured department chairs, and for those doctors who perceived less contract breach.     

Attachment Models in Incarcerated Sex Offenders: A Preliminary Italian Study Using the Adult Attachment Interview

A group of sex offenders (clinical group: n = 19) was compared to a nonclinical sample matched by age, years of education, and gender (control group A: n = 19) to verify a higher incidence of insecure attachment models among sex offenders. In addition, we tested whether sex offenders were characterized by specific childhood experiences, compared to control adults (control group B: n = 19) with the same secure/insecure attachment classification. Results showed significant differences between offenders and control adults on both the AAI continuous score and the distribution of the two-way attachment classifications. Furthermore, sex offenders reported more intense experiences of rejection by the father figure and abuse in the family context during early childhood compared to not offenders subjects with the same attachment classification.     

Re Lavigne and Ontario Public Service Employees Union: public administration and remedial decree litigation under the Charter of Rights and Freedoms

Abstract: Analysts studying the political impact of the Charter of Rights and Freedoms have tended to focus on the role of the Supreme Court of Canada and on the formulation of remedies for Charter violations under s. 52(1) of the Constitution Act, 1982 (judicial nullification) and s. 24(2) of the Charter (exclusion of evidence). Without denying the importance of the Supreme Court, or the impact of nullification and exclusion of evidence, it is important to recognize that s. 24(1) of the Charter provides a remedial alternative whose implementation is likely to occur primarily within lower courts, and whose potential policy consequences are vast. What makes s. 24(1) so potentially important is that it provides courts the opportunity to shape and administer social policy directly through positive and prospective remedies. This article offers a preliminary exploration of this phenomenon by utilizing a model of remedial decree litigation developed in the United States to examine the most interesting s. 24(1) case yet considered by lower courts: Re Lavigne and Ontario Public Service Employees Union. The aim of the article is to explore the extent to which Canadian courts are restructuring their decision-making processes to undertake the institutional obligations imposed on them by remedial decree litigation under the Charter. Sommaire: Les analystes qui étudient l'impact politique de la Charte des droits et Iibertés axent leurs travaux sur le rôle de la Cour suprême du Canada et sur la formulation des sanctions pour violation de la Charte en vertu de l'art. 52(1) de la Loi constitutionnelle de 1982 (invalidation judiciaire) et de l'art. 24(2) de la Charte (exclusion de preuve). Sans nier ni l'importance de la Cour suprême, ni celle de l'impact de l'invalidation ou de l'exclusion de preuve, il est important de reconnaître que l'art 24(1) de la Charte fournit un mode de sanctions dont l'application est plus susceptible de se produire de-vant les tribunaux inférieurs et dont les conséquences politiques éventuelles sont nom-breuses. L'importance de l'art 24(1) tient à ce qu'il donne aux tribunaux la possibilité de formuler et d'appliquer directement des politiques sociales par le biais de sanctions positives et prospectives. Cet article étudie ce phénomène en utilisant un modéle de jugement réparateur élaboré aux États-Unis pour examiner au titre de l'art. 24(1) un tribunal inférieur: Re Lavigne et le Syndicat des employés de Infection publiyue de l'Ontorio. L'objet de cet article est d'étudier dans quelle mesure les tribunaux canadiens restructuring leurs procédures de prise de décisions pour mettre en oeuvre les obligations institutionalism qui leur sont attribuées par les recours réparateurs qu'autorise la Charte.     

Fatal intoxication with 1,4-butanediol: Case report and comprehensive review of the literature

A fatal case of 1,4-butanediol (1,4-BD) oral ingestion is reported here, in which a 51-year-old man was found dead in his bed. According to the police report, the deceased was a known drug user. A glass bottle labeled (and later confirmed to be) “Butandiol 1,4” (1,4-BD) was found in the kitchen. Furthermore, the deceased's friend stated that he consumed 1,4-BD on a regular basis. The autopsy and histological examination of postmortem parenchymatous organ specimens did not revealed a clear cause of death. Chemical-toxicological investigations revealed gammahydroxybutyrat (GHB) in body fluids and tissues in the following quantities: femoral blood 390 mg/L, heart blood 420 mg/L, cerebrospinal fluid 420 mg/L, vitreous humor 640 mg/L, urine 1600 mg/L, and head hair 26.7 ng/mg. In addition, 1,4-BD was qualitatively detected in the head hair, urine, stomach contents, and the bottle. No other substances, including alcohol, were detected at pharmacologically relevant concentrations. 1,4-BD is known as precursor substance that is converted in vivo into GHB. In the synoptic assessment of toxicological findings, the police investigations and having excluded other causes of death, a lethal GHB-intoxication following ingestion of 1,4-BD, can be assumed in this case. Fatal intoxications with 1,4-BD have seldom been reported due to a very rapid conversion to GHB and, among other things, non-specific symptoms after ingestion. This case report aims to give an overview to the published of fatal 1,4-BD-intoxications and to discuss the problems associated with detection of 1,4-BD in (postmortem) specimens.     

The effects of the (fentanyl-fueled) drug overdose epidemic on medicolegal death investigation in the United States

The evolving opioid epidemic in the United States, fueled by illicit fentanyl, has greatly increased deaths from illicit drug use. These nonnatural deaths require formal death investigation. The National Association of Medical Examiners states in its Forensic Autopsy Performance Standards that autopsy remains a necessary component for proper investigation of suspected acute overdose deaths. If a death investigation office lacks adequate resources to investigate all deaths under its jurisdiction while meeting expected standards, then that office may be forced to consider altering its protocols for investigation by changing the types of deaths investigated or the extent of its investigations. Drug death investigations take longer to complete because novel illicit drugs and mixtures of drugs complicate toxicological analyses, prolonging a family's wait for completion of a death certificate and autopsy report. Public health agencies must also wait for results, but some agencies have developed mechanisms for rapid notification of preliminary results to allow timely deployment of public health resources. The increased deaths have strained the resources of medicolegal death investigation systems throughout the United States. Given the significant workforce shortage of forensic pathologists, newly trained forensic pathologists are too few to meet the demand. Nevertheless, forensic pathologists (and all pathologists) must make time to present their work and themselves to medical students and pathology trainees to encourage an understanding of the importance of quality medicolegal death investigation and autopsy pathology and to provide a model that can encourage interest in a career in forensic pathology.     

Development and validation of a LC–MS/MS method for analysis of vortioxetine in postmortem specimens. First data from an authentic case

Vortioxetine is an antidepressant recently licensed in USA and EU for the treatment of major depressive disorder. Neither fatal case due to overdose nor data about postmortem concentrations on blood or other specimens have been reported. The aims of this study were the development and validation of a method for vortioxetine analysis by Liquid Chromatography Tandem Mass Spectrometry (LC–MS/MS) in postmortem samples and its application in an authentic case. The method was validated and applied on blood, vitreous humor, bile, brain, liver, kidney, and gastric content. After protein precipitation, the supernatant was directly injected into LC–MS/MS. Analysis was carried out by Multiple Reaction Monitoring (MRM) mode. The authentic case concerned a 38 years-old woman, affected by depression, who was found hanged at home. The method determined an acceptable sensitivity, selectivity, linearity, precision, and accuracy for all matrices. No interference was shown for all matrices. The matrices do not significantly reduce the peak intensity of vortioxetine. No carryover was shown. Toxicological analysis of the authentic case showed vortioxetine in blood (234 ng/ml), vitreous humor (10.5 ng/ml), brain (490 ng/g), lung (479 ng/g), liver (3751 ng/g), kidney (798 ng/g), bile (2267 ng/ml) and gastric content (253 ng/ml). Our case suggests that even at blood concentrations of vortioxetine equal to 234 ng/ml, the subject was able to stage and carry out the hanging. Vortioxetine concentrations found in the other cadaveric samples (biological fluids, organs, and gastric content) may be helpful to evaluate further similar comparable cases.     

Death by compaction in a robotic dumpster

Robotic waste management automation systems are increasingly utilized around the globe as a user-friendly, ecological and hygienic alternative to waste disposal, simultaneously reducing the volume and frequency of waste collection. The present paper aims to report a case of death by compaction in an automated robotic waste management system and review relevant literature on compactor-related fatalities. The unusual fatal accident involved a 37-year-old male citizen who deliberately entered the robotic dumpster to retrieve his accidentally discarded medication. Upon entering the robotic chamber, the compaction system was automatically activated, although all safety measures were in full operation. This paper highlights the lack of standardized reporting on compactor-related mortality, which however is of importance both in terms of its social impact and public safety. These deaths occur rarely, in scattered areas of the globe, associated with various situations (e.g., occupational fatalities, homeless people, infanticide) and trash compactors of different types, technology, age, maintenance quality, warning signage and safety interlocks. In all previously reported fatalities, the technology involved was considerably older (as in conventional waste containers, garbage compaction trucks, chute-fed compactors in buildings, etc.). The case described in the present report is a rare event in both literature and international news coverage as it encompasses a fully automated technology intended for unsupervised, direct use by the public being located in public spaces where all citizens can interact with it. The aim of this report is to raise awareness and improve knowledge about safety parameters so that similar incidents can be avoided in the future.     

An Antinomy in Alexy's Theory of Balancing

This article argues that Robert Alexy's influential theory of balancing is affected by a contradiction that makes it unfeasible as an instrument by which to explain some aspects of law and legal reasoning it aims to clarify. In particular, I will show that one of the premises of Alexy's theory of balancing is incompatible with its conclusion. Alexy's theory is based upon a sharp distinction between rules and principles. However, as my analysis will demonstrate, its conclusion implies that it is impossible to distinguish between rules and principles. This is because the so-called weight formula and the law of colliding principles (i.e., the two main notions used by Alexy to explain balancing) cancel out any difference between these two types of norms.     

Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases

The US corrections system is the largest provider of mental health care in the country. Suicide is a leading cause of death in corrections facilities with rates of inmate suicide being far higher than the national average. Suicide is an event that can lead to legal action against the facility, staff, and treating health-care providers. Some claims are based on medical malpractice. In this setting, claims may also be brought based on violations of the detainee's constitutional rights. Pretrial detainees and prisoners, alike, have a constitutional right to adequate medical and psychiatric care through the Fourteenth Amendment and Eighth Amendment, respectively. But, there is limited information on constitutional claims made against correctional health-care providers for cases of inmate suicide. To help bridge this gap, the authors conducted a search of federal legal case decisions involving claims against health-care providers for deliberate indifference to a detainee's serious illness or injury in the event of attempted suicide or death by suicide over a 5 year period from 2016 to 2021. Fifteen cases were identified. Five themes emerged from the cases, which could serve as bases for claims against health-care professionals: receiving screening, mental health assessment, treatment, documentation, and attention to facility policies. The cases and their clinical significance are summarized in this article. The materials provide an overview of the problems surrounding correctional suicides and can serve as practice pointers in the corporeal setting.     

Deep learning for sex determination: Analyzing over 200,000 panoramic radiographs

The objective of this study is to assess the performance of an innovative AI-powered tool for sex determination using panoramic radiographs (PR) and to explore factors affecting the performance of the convolutional neural network (CNN). The study involved 207,946 panoramic dental X-rays and their corresponding reports from 15 clinical centers in São Paulo, Brazil. The PRs were acquired with four different devices, and 58% of the patients were female. Data preprocessing included anonymizing the exams, extracting pertinent information from the reports, such as sex, age, type of dentition, and number of missing teeth, and organizing the data into a PostgreSQL database. Two neural network architectures, a standard CNN and a ResNet, were utilized for sex classification, with both undergoing hyperparameter tuning and cross-validation to ensure optimal performance. The CNN model achieved 95.02% accuracy in sex estimation, with image resolution being a significant influencing factor. The ResNet model attained over 86% accuracy in subjects older than 6 years and over 96% in those over 16 years. The algorithm performed better on female images, and the area under the curve (AUC) exceeded 96% for most age groups, except the youngest. Accuracy values were also assessed for different dentition types (deciduous, mixed, and permanent) and missing teeth. This study demonstrates the effectiveness of an AI-driven tool for sex determination using PR and emphasizes the role of image resolution, age, and sex in determining the algorithm's performance.