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.     

Fatal poisoning due to ingestion of boiled oleander leaf extract

Nerium oleander is an ornamental evergreen shrub belonging to the family Apocynaceae. The Apocynaceae family includes the attractive evergreen shrub known as oleander. The cardiotoxic glycoside, oleandrin, is present in all portions of the common oleander plant. Oleander consumption can result in deadly situations accidentally or as a suicide attempt. After consuming kettle-boiled oleander leaf extract as part of a suicide attempt, an 80-year-old man was discovered comatose in his home and taken to our emergency room. The patient's heart rate was 30 beats per minute, and he had hypotension. Arterial blood gas analysis revealed remarkable metabolic acidosis and hyperkalemia (K: 7.7 mEq/L). An electrocardiogram showed a wide QRS wave, similar to a sine curve. The patient collapsed following cardiac arrest soon after hospital arrival. Veno-arterial extracorporeal membrane oxygenation was initiated; however, the patient eventually died. The serum level of oleandrin at hospital arrival, subsequently measured by LC–MS/MS, was found to be 33.4 ng/mL, far above the levels reported in previous fatal cases.     

Terrorism as Cancer: How to Combat an Incurable Disease

ABSTRACT

This paper provides an alternative framework that conceptualizes the threat posed by terrorism based on an epidemiological approach that views it as a chronic disease like cancer rather than as a military, ideological, or socio-economic problem. After highlighting the similarities in the causes, behavior, treatments, and challenges of combating terrorism and cancer, this paper presents a staging system policymakers can use to educate the public and allocate counterterrorism resources more efficiently. This approach encourages policymakers to see terrorism for what it is (an all but inevitable facet of modern life that can be managed but never fully eliminated), and not what they wish terrorism to be (a national security problem that can be solved, defeated, or vanquished). It provides policymakers with a useful model to conceptualize the threat and treat terrorism in a comprehensive manner, from preventing future attacks to effectively responding to them when they will inevitably occur.     

What do NHS staff learn from training on the Mental Capacity Act (2005)?

Purpose. Many studies have reported that professionals have a limited understanding of mental capacity issues. Implementation (in England and Wales) of the Mental Capacity Act (MCA) (2005) presents a challenge to services. The aim of this study was to evaluate the extent to which National Health Service (NHS) staff benefited from attending MCA training courses. Methods. Participants were assessed before and after MCA training using a structured interview, which included three scenarios describing mental capacity dilemmas, four vignettes addressing the role of the Independent Mental Capacity Advocate (IMCA), and 16 true–false items. Results. Interview performance improved post‐training, but this could be largely ascribed to an increased awareness of mental capacity issues, with minimal improvements in the knowledge that would be needed to undertake the assessments. Nine areas were identified where there remained significant gaps in participants’ knowledge post‐training. Participants with experience of dealing with mental capacity issues performed better than those without. Conclusions. The results suggest that methods other than formal training events may be needed to prepare health staff to implement new legislation.     

A modified Stroop task with sexual offenders: Replication of a study

Abstract

Cognitive–behavioural treatment of sexual offenders assumes that sexual offenders are motivated by deviant attitudes, perceptions and values. Although aspects of deviant schema can be assessed by questionnaires, self-report measures are limited by the respondent's willingness to be forthright and by the fact that, typically, these cognitive processes occur quickly, revealing signs of automaticity. Recent research by Smith and Waterman has suggested that the deviant schema of sexual offenders could be assessed using a version of the Stroop colour-naming task. Long latency periods to sexual colour words imply a longer information-processing route and evidence of pre-established (deviant) sexual cognitive schema. Stroop techniques may offer the advantage of eliminating limitations that arise when using self-report techniques, such as fakeability and social desirability concerns. The current study replicates and extends Smith and Waterman's results using samples of sexual offenders, non-sexual violent offenders and non-violent offenders. The cumulative results of the two studies suggests that Stroop techniques have promise, but that further work is required before measures are available that have sufficient reliability and validity to be used in applied contexts.     

When an Alibi Is Not Enough: Judgments of Evidence Needed to Lay Charges in a Burglary Case

Laypersons were asked to assume the role of investigators to explore judgments of what evidence is needed to make an arrest in a criminal investigation when an alibi witness is present. Participants were sensitive to the relationship between the alibi witness and the suspect and were more likely to believe an alibi provided by someone unrelated to the suspect, as evidenced by requests for more physical evidence against the suspect than when the alibi corroborator was a family member. In addition, when presented with contradictory evidence, the age of the alibi witness became an important consideration. Age alone did not impact perceptions of evidence adequacy; however, when an (adult) eyewitness provided testimony that contradicted a child alibi witness, participants demonstrated partiality towards believing the child as evidenced by (a) more requests for physical evidence to be convinced the child was wrong and to arrest the suspect and (b) higher ratings of alibi witness credibility. This effect was not seen when the eyewitness’s testimony contradicted an alibi provided by an adult. The results provide insight for investigators and legal counsel regarding the influence of varying types of alibi witness evidence.