Effects of advanced age and dementia on restoration of competence to stand trial

Elderly defendants (age 65+) and defendants with dementia adjudicated incompetent to stand trial and hospitalized for restoration to competence (RTC) often present unique challenges to clinicians charged with their restoration. In this study, we attempted to better identify predictors of successful RTC by building upon previous research correlating increased age with decreased likelihood of RTC. We identified elderly non-demented defendants (n = 31) and defendants diagnosed with dementia (n = 47) from a state database of 1380 individuals hospitalized for competence restoration from 1988–2004. Using regression analysis and correcting for demographic variables and common admission psychiatric diagnoses, we studied the relationship of age at hospital admission and dementia diagnosis on the likelihood of successful RTC. Both advanced age and dementia diagnosis were associated with decreased RTC. After correcting for dementia diagnosis, increased age retained its negative correlation with restoration success. Both elderly non-demented defendants and defendants diagnosed with dementia were significantly less likely to be restored to competence than all other RTC admissions (n = 1302). However, a substantial percentage of both demented and elderly non-demented defendants were successfully restored to competence, potentially justifying restoration attempts for both of these groups of defendants.     

The Impact of the Work Environment on Prison Staff: The Issue of Consideration, Structure, Job Variety, and Training

Correctional staff are instrumental in ensuring the success of any correctional institution; therefore, investigating how the work environment impacts correctional workers is essential. To determine the effects of supervisory consideration, supervisory structure, job variety, and perceptions of training on correctional staff job stress, job satisfaction, and organizational commitment, data from a survey of staff at a Midwestern private correctional facility were examined. The Ordinary Least Squares regression results indicate that each of the work environment factors had a significant impact on one or more of the three outcomes. Specifically, supervisory consideration and perceptions of training decreased job stress. Supervisory consideration, job variety, and perceptions of training had positive effects on job satisfaction. Finally, supervisory consideration, supervisory structure, job variety, and perceptions of training had positive relationships with organizational commitment.     

Evaluation of serum cortisol in the postmortem diagnosis of acute adrenal insufficiency

Normal adrenocortical activity is necessary for electrolyte regulation and the maintenance of cardiovascular function. Although chronic adrenal insufficiency generally presents with the gradual onset of a set of characteristic symptoms and signs, the more sudden loss of adrenal activity can present with acute, rapidly progressive cardiovascular dysfunction that can be fatal if not recognized and treated promptly. We herein describe a patient who had most of his adrenal tissue removed during resection of metastatic renal carcinoma, conventional clear cell type, with much of the remaining adrenal tissue undergoing necrosis during or shortly after surgery. Although the patient appeared to be stable and progressing adequately well, he died suddenly 2 days postoperatively. When the gross autopsy findings suggested the possibility of adrenal insufficiency, clinical laboratory assessment of adrenocortical activity was sought. Analysis of stored antemortem serum samples and of blood obtained at autopsy demonstrated a progressive decrease in cortisol levels which, in this stressed postsurgical patient, proved fatal. The use of both antemortem and postmortem blood in the demonstration of acute adrenal insufficiency at autopsy is discussed.     

Stepping Out: Rhetorical Devices and Culture Change Management in the UK Civil Service

Organizational culture is the pattern of values and beliefs held by members of an organization and the management of culture is now one of the most frequently discussed of all organizational concepts. The excitement associated with culture is attributable to two factors. First, it is argued that culture is the key to organizational performance; simply stated, a strong organizational culture can be a source of competitive advantage. Second, culture is perceived as an alternative method of control to traditional and technocratic forms of management and can be manipulated to ensure that employees are enthusiastic and committed to organizational objectives.
Despite the extensive interest in this topic, culture remains an elusive concept. This paper investigates the nature of culture and considers strategies for introducing cultural change. Specifically, the aims of the paper are threefold. First, to locate and explain the interests and significance of culture change for the public sector. Second, using a case study of a newly created agency, to investigate the problems and issues affecting cultural change in the civil service. Third, to reassess and critically evaluate the claims for culture management made in the literature. Finally, this paper questions some of the assumptions in the literature, which with few exceptions are biased toward top management and the unitary conception of organization, an ideological frame of reference which is particularly problematic in the public sector.     

A U.S.-China Green Deal?

The year 2020 was a turning point in many ways. A pandemic tested our capacity for international cooperation. Our impact on the changing environment became more urgent.     

Developmental Pathways from Genetic,Prenatal, Parenting and Emotional/Behavioral Risk to Cortisol Reactivity and Adolescent Substance Use: A TRAILS Study

Journal of Youth and Adolescence - Cortisol reactivity is a frequently studied biomarker of substance use, though infrequently examined in adolescence. However, past research provides evidence that...