bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrast-Induced Encephalopathy following Coronary Angiography with No Radiological Features: A Case Report and Literature Review
Authors: Dattani Abhishek , Au Laura , Tay Kok Hoon , Davey Patrick
Published: February 2018

Contrast-induced encephalopathy (CIE) following coronary angiography (CAG) is a very rare complication. Radiological signs such as cerebral oedema and cortical enhancement are of great importance in the diagnosis. We report a case of probable CIE in a 76-year-old gentleman following a normal diagnostic CAG that involved 120 mL of the iodinated contrast agent iohexol (Omnipaque 300). At 90 min postprocedure he became acutely confused with a normal non-contrast CT of the head. After 9 days of conservative treatment, the patient recovered spontaneously with no neurological deficits. This case and a review of the literature highlights that contrast-induced neurotoxicity may not always present with the typical radiological signs that are described in association with CIE. Given the excellent prognosis with supportive management only, interventional cardiologists should be well aware of this condition despite the absence of radiological features.
Chorioamnionitis Induces a Specific Signature of Placental ABC Transporters Associated with an Increase of miR-331-5p in the Human Preterm Placenta
Authors: do Imperio Guinever Eustaquio , Bloise Enrrico , Javam Mohsen , Lye Phetcharawan , Constantinof Andrea , Dunk Caroline , dos Reis Fernando Marcos , Lye Stephen James , Gibb William , Ortiga-Carvalho Tania M. , Matthews Stephen Giles
Published: February 2018

Background/Aims: The ATP-binding cassette (ABC) transporters mediate drug biodisposition and immunological responses in the placental barrier. In vitro infective challenges alter expression of specific placental ABC transporters. We hypothesized that chorioamnionitis induces a distinct pattern of ABC transporter expression. Methods: Gene expression of 50 ABC transporters was assessed using TaqMan® Human ABC Transporter Array, in preterm human placentas without (PTD; n=6) or with histological chorioamnionitis (PTDC; n=6). Validation was performed using qPCR, immunohistochemistry and Western blot. MicroRNAs known to regulate P-glycoprotein (P-gp) were examined by qPCR. Results: Up-regulation of ABCB9, ABCC2 and ABCF2 mRNA was detected in chorioamnionitis (p<0.05), whereas placental ABCB1 (P-gp; p=0.051) and ABCG2 (breast cancer resistance protein-BCRP) mRNA levels (p=0.055) approached near significant up-regulation. In most cases, the magnitude of the effect significantly correlated to the severity of inflammation. Upon validation, increased placental ABCB1 and ABCG2 mRNA levels (p<0.05) were observed. At the level of immunohistochemistry, while BCRP was increased (p<0.05), P-gp staining intensity was significantly decreased (p<0.05) in PTDC. miR-331-5p, involved in P-gp suppression, was upregulated in PTDC (p<0.01) and correlated to the grade of chorioamnionitis (p<0.01). Conclusions: Alterations in the expression of ABC transporters will likely lead to modified transport of clinically relevant compounds at the inflamed placenta. A better understanding of the potential role of these transporters in the events surrounding PTD may also enable new strategies to be developed for prevention and treatment of PTD.
Uso de registro informatizado de imunização na vigilância de eventos adversos pós-vacina
Authors: Sato Ana Paula Sayuri , Ferreira Vinícius Leati de Rossi , Tauil Márcia de Cantuária , Rodrigues Laura Cunha , Barros Mariana Bernardes , Martineli Edmar , Costa Ângela Aparecida , Inenami Marta , Waldman Eliseu Alves
Published: February 2018

OBJETIVO: Descrever os eventos adversos pós-vacina ocorridos em crianças com até dois anos de idade e analisar a tendência desses eventos, entre 2000 e 2013, em Araraquara, SP, Brasil. MÉTODOS: Estudo descritivo com dados da vigilância passiva de eventos adversos pós-vacina, disponíveis no registro informatizado de imunização do prontuário eletrônico do serviço municipal de saúde (Sistema Juarez). As variáveis de estudo foram: idade, sexo, vacina, dose, manifestações clínicas e hospitalização. As taxas foram estimadas tomando-se os casos de eventos adversos pós-vacina como numerador e as doses aplicadas, como denominador. Estimou-se a sensibilidade da vigilância de eventos adversos pós-vacina aplicando-se o método proposto pelo Centers for Disease Control and Prevention. Para análise de tendência utilizou-se a regressão de Prais-Winsten, considerando o nível de significância de 5,0%. RESULTADOS: A taxa anual média de eventos adversos pós-vacina foi de 11,3/10.000 doses aplicadas, porém, sem tendência no período estudado (p  =  0,491). Houve predomínio de casos após a primeira dose (41,7%) e entre menores de um ano de idade (72,6%). As vacinas com componente pertussis, de febre amarela e de sarampo-caxumba-rubéola foram as mais reatogênicas. Destacou-se a frequência de episódio hipotônico hiporresponsivo e convulsão, com taxas de 4,1/10.000 e 1,5/10.000 doses de vacinas com componente pertussis, respectivamente, mais elevadas na primeira dose; 60,0% dos casos apresentaram sintomas nas primeiras 24 horas após a vacinação e 18,6% apresentaram-se após 96 horas. A sensibilidade da vigilância foi estimada em 71,9% e 78,9% para episódio hipotônico hiporresponsivo e convulsão, respectivamente. CONCLUSÕES: O sistema de vigilância de eventos adversos pós-vacina com base no registro informatizado de imunização mostrou-se útil e dotado de elevada sensibilidade para descrever o perfil de segurança das vacinas em um município de médio porte. Adicionalmente, a expressiva ampliação, na última década, das vacinas incluídas no esquema básico de vacinação na infância não alterou o elevado padrão de segurança do Programa Nacional de Imunizações.
The general movement assessment in non-European low- and middle-income countries
Authors: Tomantschger Iris , Herrero Dafne , Einspieler Christa , Hamamura Cristina , Voos Mariana Calil , Marschik Peter B
Published: February 2018

Abnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.
Effectiveness of breast cancer screening policies in countries with medium-low incidence rates
Authors: Kong Qingxia , Mondschein Susana , Pereira Ana
Published: February 2018

Chile has lower breast cancer incidence rates compared to those in developed countries. Our public health system aims to perform 10 biennial screening mammograms in the age group of 50 to 69 years by 2020. Using a dynamic programming model, we have found the optimal ages to perform 10 screening mammograms that lead to the lowest lifetime death rate and we have evaluated a set of fixed inter-screening interval policies. The optimal ages for the 10 mammograms are 43, 47, 51, 54, 57, 61, 65, 68, 72, and 76 years, and the most effective fixed inter-screening is every four years after the 40 years. Both policies respectively reduce lifetime death rate in 6.4% and 5.7% and the cost of saving one life in 17% and 9.3% compared to the 2020 Chilean policy. Our findings show that two-year inter-screening interval policies are less effective in countries with lower breast cancer incidence; thus we recommend screening policies with a wider age range and larger inter-screening intervals for Chile.
Breastfeeding and behavior disorders among children and adolescents: a systematic review
Authors: Poton Wanêssa Lacerda , Soares Ana Luiza Gonçalves , Oliveira Elizabete Regina Araújo de , Gonçalves Helen
Published: February 2018

OBJECTIVE: This systematic review study aimed to assess the evidence available for the association between breastfeeding and behavior disorders in childhood and adolescence. METHODS: The search was carried out in the PubMed, Lilacs, and PsycINFO databases up to December 2016. Inclusion criteria were as follows: prospective, retrospective and cross-sectional studies assessing the association between breastfeeding and behavior disorders in childhood or adolescence, using psychometric tests, carried out in humans and published in Portuguese, English, or Spanish. The search was performed in several stages by two independent researchers using pre-established criteria. RESULTS: Eighteen studies met the inclusion criteria. Breastfeeding for a period equal to or higher than three or four months seemed to be inversely associated with total behavior and conduct disorders in childhood; however, the association remains unclear for other behavior disorders. Only four studies assessed behavior disorders in adolescence, and when an association was found, it was likely to be positive. The duration of breastfeeding seemed to be more important than the exclusive or non-exclusive pattern of breastfeeding. CONCLUSIONS: Breastfed children for at least three to four months had fewer total behavior and conduct disorders in childhood. Further studies are needed to better understand this association, particularly in adolescence and involving other behavioral profiles.
2017 George Lyman Duff Memorial Lecture
Authors: Goldberg Ira J.
Published: February 2018

Cholesterol is not the only lipid that causes heart disease. Triglyceride supplies the heart and skeletal muscles with highly efficient fuel and allows for the storage of excess calories in adipose tissue. Failure to transport, acquire, and use triglyceride leads to energy deficiency and even death. However, overabundance of triglyceride can damage and impair tissues. Circulating lipoprotein-associated triglycerides are lipolyzed by lipoprotein lipase (LpL) and hepatic triglyceride lipase. We inhibited these enzymes and showed that LpL inhibition reduces high-density lipoprotein cholesterol by >50%, and hepatic triglyceride lipase inhibition shifts low-density lipoprotein to larger, more buoyant particles. Genetic variations that reduce LpL activity correlate with increased cardiovascular risk. In contrast, macrophage LpL deficiency reduces macrophage function and atherosclerosis. Therefore, muscle and macrophage LpL have opposite effects on atherosclerosis. With models of atherosclerosis regression that we used to study diabetes mellitus, we are now examining whether triglyceride-rich lipoproteins or their hydrolysis by LpL affect the biology of established plaques. Following our focus on triglyceride metabolism led us to show that heart-specific LpL hydrolysis of triglyceride allows optimal supply of fatty acids to the heart. In contrast, cardiomyocyte LpL overexpression and excess lipid uptake cause lipotoxic heart failure. We are now studying whether interrupting pathways for lipid uptake might prevent or treat some forms of heart failure.
Cytosolic DNA Sensing Promotes Macrophage Transformation and Governs Myocardial Ischemic Injury
Authors: Cao Dian J. , Schiattarella Gabriele G. , Villalobos Elisa , Jiang Nan , May Herman I. , Li Tuo , Chen Zhijian J. , Gillette Thomas G. , Hill Joseph A.
Published: February 2018

Background:

Myocardium irreversibly injured by ischemic stress must be efficiently repaired to maintain tissue integrity and contractile performance. Macrophages play critical roles in this process. These cells transform across a spectrum of phenotypes to accomplish diverse functions ranging from mediating the initial inflammatory responses that clear damaged tissue to subsequent reparative functions that help rebuild replacement tissue. Although macrophage transformation is crucial to myocardial repair, events governing this transformation are poorly understood.

Methods:

Here, we set out to determine whether innate immune responses triggered by cytoplasmic DNA play a role.

Results:

We report that ischemic myocardial injury, along with the resulting release of nucleic acids, activates the recently described cyclic GMP-AMP synthase–stimulator of interferon genes pathway. Animals lacking cyclic GMP-AMP synthase display significantly improved early survival after myocardial infarction and diminished pathological remodeling, including ventricular rupture, enhanced angiogenesis, and preserved ventricular contractile function. Furthermore, cyclic GMP-AMP synthase loss of function abolishes the induction of key inflammatory programs such as inducible nitric oxide synthase and promotes the transformation of macrophages to a reparative phenotype, which results in enhanced repair and improved hemodynamic performance.

Conclusions:

These results reveal, for the first time, that the cytosolic DNA receptor cyclic GMP-AMP synthase functions during cardiac ischemia as a pattern recognition receptor in the sterile immune response. Furthermore, we report that this pathway governs macrophage transformation, thereby regulating postinjury cardiac repair. Because modulators of this pathway are currently in clinical use, our findings raise the prospect of new treatment options to combat ischemic heart disease and its progression to heart failure.
Stress Elevates Frontal Midline Theta in Feedback-based Category Learning of Exceptions
Authors: Paul Marcus , Fellner Marie-Christin , Waldhauser Gerd T. , Minda John Paul , Axmacher Nikolai , Suchan Boris , Wolf Oliver T.
Published: February 2018

Adapting behavior based on category knowledge is a fundamental cognitive function, which can be achieved via different learning strategies relying on different systems in the brain. Whereas the learning of typical category members has been linked to implicit, prototype abstraction learning, which relies predominantly on prefrontal areas, the learning of exceptions is associated with explicit, exemplar-based learning, which has been linked to the hippocampus. Stress is known to foster implicit learning strategies at the expense of explicit learning. Procedural, prefrontal learning and cognitive control processes are reflected in frontal midline theta (4–8 Hz) oscillations during feedback processing. In the current study, we examined the effect of acute stress on feedback-based category learning of typical category members and exceptions and the oscillatory correlates of feedback processing in the EEG. A computational modeling procedure was applied to estimate the use of abstraction and exemplar strategies during category learning. We tested healthy, male participants who underwent either the socially evaluated cold pressor test or a nonstressful control procedure before they learned to categorize typical members and exceptions based on feedback. The groups did not differ significantly in their categorization accuracy or use of categorization strategies. In the EEG, however, stressed participants revealed elevated theta power specifically during the learning of exceptions, whereas the theta power during the learning of typical members did not differ between the groups. Elevated frontal theta power may reflect an increased involvement of medial prefrontal areas in the learning of exceptions under stress.
Embryonic exposure of chicken chicks (Gallus gallus domesticus) leads to heightened sensitivities towards the exposed scent
Authors: Hughes Ryan , Cunningham Gregory B.
Published: February 2018

In chickens, food consumption can be altered by exposing the chicks to scents as embryos. We exposed eggs to an orange-scented food additive in the final days of incubation. Following hatching, we tested these exposed chicks’ ability to detect this scent at a variety of concentrations. We found that orange-exposed chicks responded to an orange-scented solution at lower concentrations than control chicks. This sensitization may allow chicks to be more effective at locating acceptable food items but requires further testing to determine its significance. Orange-exposed and control chicks were also tested with the scent of raspberry. Orange-exposed chicks responded to the raspberry presentation significantly more than the control chicks did, suggesting that the embryonic exposure to orange may have influenced how the chicks responded towards another fruity smell. This result suggests that chicks may be learning general characteristics of exposed scents while in the egg, though this needs further research.
Protecting Outstanding Underwater Cultural Heritage through the World Heritage Convention: The Titanic and Lusitania as World Heritage Sites
Authors: Martin Josh B.
Published: February 2018

Despite growing recognition of the global value of underwater cultural heritage (uch), along with intensified international efforts to ensure its protection, the possibility of its inscription on the World Heritage List has never been comprehensively examined. Arguing that the unesco 2001 Convention on the Protection of Underwater Cultural Heritage (uch Convention) is insufficient alone to protect globally outstanding wrecks, such as the Titanic and the Lusitania, this article examines in detail the many legal and practical challenges involved with listing such sites under the World Heritage Convention. By reviewing key international agreements such as the uch Convention, World Heritage Convention, Law of the Sea Convention and the International Titanic Agreement, it draws the conclusion that it is the improved offshore management of uch—through ‘cultural’ marine protected areas operating under the framework of the uch Convention—which would open the possibility of nomination to the World Heritage List.
Seed morphology of perennial taxa of Euphorbia section Pithyusa (Euphorbiaceae) in Turkey
Authors: GENÇ İLKER , KÜLTÜR ŞÜKRAN
Published: February 2018

A comprehensive study based on seed morphology of perennial Euphorbia (Euphorbiaceae) sect. Pithyusa species occurring in Turkey is presented. A total of 14 species were studied. Seed characteristics were examined using scanning electron microscopy (SEM) as well as dissecting light microscopy. Significant features are: seed size, seed shape, shape of caruncle and seed surface ornamentation. Three different seed surface types (smooth, pitted, and wrinkled) were observed. Four main seed shapes (ovoid, oblong, quadrangular, and globose), as well as seven types of seed coat ornamentation (reticulate-areolate, areolate, alveolate, falsifoveate, pusticulate, colliculate and smooth) were found. The number of testa cells per 100 µm2 and also its range, from 8–12 to 57–63, are given.
A new species of Umanella Gauld (Hymenoptera: Ichneumonidae: Pimplinae) from Colombia
Authors: HERRERA-FLOREZ ANDRES FABIAN , MOLINA OSCAR EFRAIN ORTEGA
Published: February 2018

A new species of Umanella Gauld 1991, U. tricoloripes Herrera-Florez, sp. n., is described from two males collected in Colombia. Umanella tricoloripes sp. nov. differs substantially from the other species of the genus in color pattern.
Crenicichla ploegi, a new species of pike-cichlid of the C. saxatilis group from the Rio Juruena and upper Rio Paraguai basins in Brazil, with an updated diagnosis and biogeographical comments on the group (Teleostei: Cichlidae)
Authors: VARELLA HENRIQUE R. , LOEB MARINA V. , LIMA FLÁVIO C.T. , KULLANDER SVEN O.
Published: February 2018

Crenicichla ploegi, new species, is described based on material from the Rio Juruena (Rio Papagaio, Rio do Sangue, Rio Arinos, and Rio Juruena itself) and from tributaries of the upper Rio Paraguai (upper Rio Jauru, upper Rio Cabaçal and upper Rio Sepotuba) in Mato Grosso, Brazil. Crenicichla ploegi is the twenty-third species of the C. saxatilis group. It is distinguished from all other species of the group by the presence of dark spots and vermiculations on snout, interorbital area and dorsally on head in adults vs. dark markings absent or present only in juveniles but absent in adults, and by the presence of a deep and strongly pigmented lateral band present in both juveniles and adults, occupying a depth of 4–6 horizontal scale rows vs. lateral band narrower, occupying a depth of 2–3 horizontal scale rows, and conspicuous only in juveniles and smaller specimens, faded or absent in larger specimens. Diagnostic characteristics of the C. saxatilis group proposed in previous studies were discussed to update the diagnosis of the group, and morphological comparisons among the species included in the group, with biogeographical comments, are provided. The presence of conspicuous dark markings dorsally on the head and the presence of a prominent midlateral band are hypothesized to be paedomorphic characteristics, retained from juvenile conditions in the context of the species of the C. saxatilis group.
Understanding Model-Based Probable Maximum Precipitation Estimation as a Function of Location and Season from Atmospheric Reanalysis
Authors: Chen Xiaodong , Hossain Faisal
Published: February 2018

Extreme precipitation events bring huge societal and economic loss around the world every year, and they have undergone spatially heterogeneous changes in the past half-century. They are fundamental to probable maximum precipitation (PMP) estimation in engineering practice, making it important to understand how extreme storm magnitudes are related to key meteorological conditions. However, there is currently a lack of information that can potentially inform the engineering profession on the controlling factors for PMP estimation. In this study, the authors present a statistical analysis of the relationship between extreme 3-day precipitation and atmospheric instability, moisture availability, and large-scale convergence over the continental United States (CONUS). The analysis is conducted using the North America Regional Reanalysis (NARR) and ECMWF ERA-Interim reanalysis data and a high-resolution regional climate simulation. While extreme 3-day precipitation events across the CONUS are mostly related to vertical velocity and moisture availability, those in the southwestern U.S. mountain regions are also controlled by atmospheric instability. Vertical velocity and relative humidity have domainwide impacts, while no significant relationship is found between extreme precipitation and air temperature. Such patterns are stable over different seasons and extreme precipitation events of various durations between 1 and 3 days. These analyses can directly help in configuring the numerical models for PMP estimation at a given location for a given storm.
Marginalised young people’s healthcare journeys: Professionals’ perspectives
Authors: Robards Fiona , Kang Melissa , Tolley Kate , Hawke Catherine , Sanci Lena , Usherwood Tim
Published: February 2018

Introduction:

The pursuit of social justice includes a commitment to health equity for marginalised young people. Health professionals are central to marginalised young people’s engagement and access to health care and their navigation of health systems. They are also uniquely positioned to shed insight into structures and inefficiencies within the health system, including the role of technology, and to advocate for system change.

Methods:

This qualitative cross-sectional study employed in-depth semi-structured interviews with 22 health service managers and experienced clinicians to better understand service providers’ perspectives. The sampling frame comprised professionals from different sectors and levels of the health system. Analysis used Grounded Theory methods.

Results:

Three major themes were identified in the data: (1) intersectionalities – understanding the complexity of multiple disadvantage; (2) health system fragmentation – leading to inefficiencies, inertia and advocacy; and (3) services needing to be ‘turned on their head’ – rethinking service delivery and models of care.

Conclusion:

A better understanding of marginalised young people’s healthcare experiences, including the complexities of multiple disadvantage, and how this contributes to health inequalities could lead to more welcoming and respectful services. Services can reconceptualise their roles by reaching out to young people, both physically and online, to make the navigation of the health system easier. Marginalised young people’s healthcare journeys can be supported by advocates that help them navigate the health system.
Rebel Natural Resource Exploitation and Conflict Duration
Authors: Conrad Justin M. , Greene Kevin T. , Walsh James Igoe , Whitaker Beth Elise
Published: February 2018

How does natural resource wealth influence the duration of civil conflicts? We theorize that the exploitation of natural resources can strengthen rebels’ “power to resist” the government, but this depends on how rebels earn funding from those resources. Distinguishing between the extortion and smuggling of natural resources, we posit that smuggling in particular is more likely to give rebels the flexibility and mobility needed to effectively resist government repression. We then test this proposition empirically using new data that identify not only whether rebels profit from resources but also how they do so. We find that only when rebels smuggle natural resources do civil conflicts last significantly longer. In contrast, conflicts in which rebel groups earn money from extorting natural resource production are not significantly more likely to endure. This finding is of special interest because past work has largely ignored how rebels earn income from natural resources and the implication this distinction might have on conflict processes.
A preliminary investigation into the knowledge of and attitudes toward the legal rights of mental patients
Authors: Laves Rona , Cohen Alan
Published: February 2018

Three questionnaires assessing attitudes toward and knowledge of the legal rights of mental patients were distributed to mental health workers in the state of New Jersey. Attitudes of all groups toward the issues presented in the questionnaires were generally favorable. However, knowledge of the legal rights of mental patients, as assessed by the questionnaire, was considered to be deficient. Nurses and psychiatrists scored significantly higher on this questionnaire than the three other groups of mental health workers. Implications for the education of mental health workers in this area are discussed.
A New Right to Treatment
Authors: Fremouw William J.
Published: February 2018

This paper examines the historical and legal evolution of the right to treatment, the complexity of creating standards, and problems of enforcing this right. During the last decade, several court cases have challenged the adequacy of the care and treatment received in mental hospitals by patients involuntarily institutionalized. Within the last 3 years, the courts have heard cases arguing the right to adequate treatment for all, voluntary and involuntary, residents of mental institutions and institutions for the retarded. The issue of the right to treatment is potentially the most significant in the mental health field today.
Some Superego Considerations in Crime and Punishment
Authors: Asch Stuart S.
Published: February 2018

Various criminal acts, and varieties of criminals are examined from a psychoanalytic viewpoint. The many ways by which the “normal” individual can evade his superego restrictions and commit antisocial acts are discussed. The habitual criminal can be considered to have specific defects in both ego and superego. In addition, the various aims and effectiveness of our systems of punishment are examined in relation to the psychopathology which they are supposed to correct. Some modifications of existing punishments are suggested, that seem more compatible with our psychoanalytic understanding of the individual.
Notes on the Attorney-Client Relationship: A Psycholegal Overview
Authors: Saxe David B. , Kuvin Seymour F.
Published: February 2018

The attorney-client relationship is often exacerbated by the psychopathology of the attorney as well as the client. The authors explore problems that an attorney may face in everyday legal practice, resulting from his own emotional problems, that may have a detrimental effect on the conduct of a successful practice. A variety of examples are given to serve as a checklist and warning guide for the perceptive attorney. The authors conclude that a successful attorney-client relationship necessitates an emotional alertness on the part of the attorney to his own difficulties. Ideally the attorney should have undergone psychoanalysis or have familiarity with its technique.
The Forensic Psychologist as an Expert Witness in the District of Columbia
Authors: Smith Joseph T.
Published: February 2018

The author notes that the evolution from nonacceptance to the present day full acceptance of psychologists as expert witnesses in the District of Columbia court system is complete. This acceptance has been gained despite the opposition, among others, of the American Psychiatric Association. District of Columbia appellate court decisions are cited to show the resolution of the conflict about whether to accept psychologists as experts in the field of mental health.
The Right of the Psychiatric Patient to Refuse Treatment
Authors: Stone Marvin A.
Published: February 2018

A comprehensive review of the psychiatric patient's right to refuse treatment is presented and compared to a right to treatment. Involuntary psychiatric patients are still denied an adequate right to refuse treatment based largely on their involuntary status. An argument is presented which explores the lack of a rational basis for this denial based on the involuntary v. voluntary status classification as used in the New York State Mental Hygiene Law and the New York State Department of Mental Hygiene's regulations. This would be in violation of the equal protection and due process clauses of the 14th amendment. A more strict view of the right to refuse treatment which could only be denied by a judicial decree of incompetency would promote a better therapeutic alliance that will be in the patient's interest.
Custody by Agreement: Child Psychiatrist as Child Advocate
Authors: Solow Robert A. , Adams Paul L.
Published: February 2018

The authors offer a new plan to help not only the large numbers of children involved in their parents’ divorces, but all the participants in divorce and custody disagreements. This plan stresses psychiatric values above legal ones and involves the fuller participation of the child psychiatrists in advocating for the welfare of the child. The paper presents an historical context for custody rights as well as currently emerging concepts and practices. A review of the child psychiatrist's role as an objective expert and as an expert witness is given, and also a brief review of what is helpful to children whose parents divorce. The authors’ nonadversarial model for determining child custody is proffered with a consideration of the benefits of an agreed judgment on child custody.
Mental Health Expert Testimony: Current Problems
Authors: Poythress Norman G.
Published: February 2018

In spite of the increasing utilization of mental health professionals as expert witnesses in the courts, neither the mental health professions nor the legal profession finds the present state of affairs concerning expert testimony to be satisfactory. This paper extensively reviews the literature which points to problems with both the mental health and the legal personnel who play major roles in mental health litigation. Also reviewed are the various proposals for change that have been suggested to date.
The Role and Functions of the Attorney in the Civil Commitment Process: The District of Columbia's Approach
Authors: Cyr Joseph P.
Published: February 2018

During the last 2 decades, the general concern over individual rights and liberties has influenced the nature of public and professional interest regarding the involuntary commitment of the mentally ill. The commitment of mentally ill persons for the humanitarian purpose of providing them care or for protecting them or others from possible future harm contrasts sharply with libertarian ideals. The complex issue of balancing individual freedom against social interests is further complicated by our quasi-judicial procedures of determining when and how a person should be hospitalized against his will. This article proposes that the role and functions of appointed counsel are essential to establishing procedures which adequately balance social interests and individual rights. The civil commitment process in the District of Columbia is presented with the intent of highlighting an adequate system of legal representation.
Mercy Killing and the Law—A Psychoanalytically Oriented Analysis
Authors: Schoenfeld C.G.
Published: February 2018

Traditional arguments for and against mercy killing are first discussed, and it is concluded that this is a subject upon which moral and intelligent men may disagree. Then, the disparity between the law's condemnation of mercy killing and society's usual failure to punish it is stressed, as are the ways in which modern medical technology has intensified the plight of the hopelessly ill and their families. Much of this is then detailed in an analysis of the celebrated Quinlan case. Problems faced by physicians in dealing with the hopelessly ill are considered, as is the view—found wanting—that these physicians should have the right to decide whether terminally ill patients should live or die. Finally, a psychoanalytic explanation of the disparity between the law in words and the law in action is offered.
The Resolution of Child Custody Cases—the Courtroom or the Consultation Room
Authors: Levy Alan M.
Published: February 2018

A consultation room approach to the reduction or resolution of the human problems involved in child custody follows a therapeutic model in which open and frank discussions occur between all parties. Information obtained through psychological tests, clinical interviews, etc., is fed back into the consultation process in order to further clarify and define the existing problems. Legal restraints to the use of the therapeutic consultation room approach are more apparent than real. A willing psychiatrist may find the court and attorneys very cooperative in assisting the consultation room process.
Professional liability of the Psychiatric Nurse
Authors: Andrade Pamela D. , Andrade John C.
Published: February 2018

Medical malpractice is an increasing problem for members of the health care professions. Nurses have, up to this point, been excluded from much of the litigations surrounding malpractice. Since making strides in upgrading their profession, nurses should be finding themselves held more accountable for their professional practice and thus, will be involved in malpractice claims.

There are no guidelines for liability of the psychiatric nurse; it is developed by investigating cases and facts surrounding psychiatric and nonpsychiatric nurses. Since nurses are functioning in expanded roles of practice, it is recommended that nurses secure malpractice insurance for their own protection.
MMPI Discrimination between Violent and Nonviolent State Hospital Adult Male Inpatients
Authors: Betancourt Antonio M. , Albott William L.
Published: February 2018

In this investigation comparisons between 24 violent and 24 nonviolent male psychiatric inpatients indicated that the possibilities of accurate prediction of violence by means of the MMPI are higher than previously noted in the literature. Analysis of MMPI profiles indicated that single and 2-point coding is not as efficient or accurate as use of multiple scales–-i.e. the entire profile. Multiple discriminant function analysis correctly classified 75% of the two groups. Discussion of the results pointed to future research needs and to some theoretical problems that make interpretation difficult at this time.
Informed Consent: Legal Requirements in Psychiatric Practice
Authors: Sherman Mary C. , Abuzzahab F.S.
Published: February 2018

Psychiatry and the law interface on the issue of informed consent in a singular way, because of the nature of the psychiatric patient. In the 1970's, with the increase in societal consciousness about psychiatric treatment and commitment procedures, principles regarding informed consent in psychiatric practice have been enunciated in case law. Some fundamental conflicts between psychiatry and the law remain, however, leaving the patient in the middle. No methods of care have been designed by religious and professional groups who oppose psychiatric treatment for those patients who “refuse” treatment. Systematic research is needed to test methods of consent and contents of consent disclosure.
Patient Rights and Patient Chronicity
Authors: Peele Roger , Palmer Richard R.
Published: February 2018

Uncritical efforts to extend and promote rights for the mentally ill may ameliorate the degree of chronicity for some patients, but can also contribute to chronicity for others. A positive definition of chronicity emphasizes the need for psychiatric services to attain maximum possible independence from the consequences of illness. Three categories of rights–-autonomy, equality and entitlements–-each contribute to chronicity for some patients. Successful programs for chronic patients display assertive, innovative and pragmatic characteristics that, in effect, incorporate the advocacy of “rights” into the armamentarium of humanistic medicine. Medicine–-not the judiciary–-is better able to act on these discoveries for the benefit of the patients.
Should Juries be Informed of the Consequences of the Insanity Verdict?
Authors: Schwartz Bart R.
Published: February 2018

When a criminal defendant is acquitted by reason of insanity, he is either automatically committed to a sanatorium, or subjected to further proceedings to determine whether he is dangerous to himself or to society and therefore should be committed. If the jurors in the criminal trial are unaware of these safeguards against releasing dangerous persons, they may be inclined to return a guilty verdict. A number of factors must be evaluated to determine whether, in a particular case, the dangers outweigh the benefits of telling jurors about postverdict commitment procedures. Therefore, trial judges must be free to decide on a case-by-case basis exactly how much to tell jurors about what happens to defendants acquitted by reason of insanity.
Insanity Plea: Defense Attorneys' Views
Authors: Pasewark Richard A. , Craig Paul L.
Published: February 2018

Groups of Wyoming attorneys who had entered or not entered the insanity plea on behalf of clients were interviewed to determine their beliefs about the insanity plea, bifurcation of trial procedures, reasons for entering the plea in specific cases, and their satisfaction with the outcome of making the plea.
Psychological Aspects of Jury Performance in a Nonviolent Criminal Trial
Authors: Goldman Jacquelin , Casey Victoria A.
Published: February 2018

Subjects who were matched for self-acceptance and assigned to juries by level of moral judgment (MJ) attended a law school reinactment of a breaking and entering trial. After testimony three juries deliberated the case separately. Control juries registered individual verdicts, were retested, and dismissed. All jurors were tested on mood measures at pretrial, posttestimony and at follow-up. Results indicate that the deliberation process itself is anxiety producing. Only juries at lower levels of MJ experienced longer lasting feelings of hostility and depression. Evidence is suggestive that at high levels of MJ subjects may have responded more cognitively than emotionally.
The Limited-Commitment Model and Forensic Patients: A Research Note
Authors: Decker Frederic H.
Published: February 2018

One model for providing procedural protections in forensic commitments is to set limit on the length of treatment, requiring a judicial hearing at expiration to extend the commitment. This article investigates the hearing procedure that existed in Florida under previous statute. The specific focus is on the procedure as applied to mentally disordered sex offenders and defendants found incompetent to stand trial. Problems with the Florida procedure are discussed, suggesting the conclusion that the jurisdiction of the committing court–-as well as, the hospital–-must be restricted for protection by limited commitment to be effective. Changes in, and for commitment procedures regarding forensic patients are also discussed.
Attorney's Role as Advocate in Civil Commitment Hearings
Authors: Engum Eric S. , Cuneo Daniel J.
Published: February 2018

Defending the proposed mental patient in civil commitment hearings forces the attorney to choose between two conflicting roles–-guardian ad litem versus adversary counsel. This article explores why the attorney must choose the adversary counsel position. In addition it lists a compilation of duties and responsibilities of counsel to assist him in his effective representation of the proposed mentally ill individual in civil commitment hearings.
Social Functions of Prison Families: The Female Solution
Authors: Van Wormer Katherine Stuart
Published: February 2018

A participant-observation study was conducted in the women's prison in central Alabama. The psychological adaptation of inmates to an extreme situation was examined. Basically, it was found that women without men play the same roles that they have always played, that they reconstruct a family structure and that these surrogate families help insulate them from the pains of imprisonment.
Episodic Cerebral Dysfunction: A Defense in Legal Limbo
Authors: Feldman Walter S.
Published: February 2018

Located in an uncertain, indefinite, and inconsistent legal area somewhere between insanity and an involuntary act, there exists a form of physiological reaction which may result in violent behavior patterns that have the characteristics of both insanity and an involuntary act. These phenomena occupy a blurry place in the criminal act defense armamentarium. As a result, the defense faces an uncertain fate in the courts.
The use of Hypnotic Techniques in the Evaluation of Criminal Defendants
Authors: Packer Ira K.
Published: February 2018

Hypnosis and narcoanalysis have received mixed acceptance in the legal system. Some of the inconsistencies in legal rulings on these, matters are the result of the courts not receiving accurate scientific information. A review of the psychological and psychiatric literature reveals that these techniques can be valid diagnostic tools, particularly in cases of psychogenic amnesia. Thus, expert testimony concerning a defendant's mental state which is based in part on hypnotic interviews should be accepted by the courts. However, these techniques are not “truth serums” and are thus properly excluded from testimony when offered as proof of the truthfulness of a defendant's statements.
Insanity Plea: A Review of the Research Literature
Authors: Pasewark Richard A.
Published: February 2018

This article summarizes the limited number of data-based research studies relating to the insanity plea that are to be found in the literature. Although some tentative conclusions might be made concerning some aspects of the plea's operation, the limited data base available makes these conclusions highly tentative and demonstrates the need of much further research in this area.
The Role of the Lawyer for the Preschool Child in Custody Litigation
Authors: Radin Mitchell E.
Published: February 2018

This article delineates the various responsibilities and functions of a lawyer representing a preschool child in a contested custody case. Within the context of a case history, the author discusses and recommends procedures and techniques for dealing with many of the problems and questions encountered during such a representation. The article stresses that the attorney's effectiveness is enhanced by a knowledge of child psychology, in general, and of attachment behavior and separation reactions, in particular.
The Adequacy of Commitment Evaluations Performed by Psychiatric and Non-psychiatric Physicians
Authors: Miller Robert D. , Fiddleman Paul B.
Published: February 2018

An examination of 200 involuntarily committed adult psychiatric patients to a state mental hospital revealed that 82% were evaluated by psychiatrists and 18% by non-psychiatric physicians. Seventy-eight percent of the evaluations were done in one of the facilities belonging to the public mental health care system. Ninety-four point five percent of the psychiatric evaluations provided adequate evidence of mental illness and dangerousness, as compared to 55.6% of the non-psychiatric evaluations. Only 9% of the evaluations provided necessary medical information as requested on the form. These data are contrasted with other studies which have been highly critical of the performance of physicians in the commitment process.
Romeo, Romeo, where Art Thou Romeo: Before the Court at the Mercy of Institutional Professionals
Authors: Meyer Steven M. , Soskin Ronald M.
Published: February 2018

The legal ramifications of treatment in psychiatric and mental institutions have stirred significant comment over the past decade. The court decisions in Romeo v. Youngberg consider the damages to individuals receiving treatment in these institutions. In a sharp departure from the past, the court has established standards of care that must be met by professionals and institutions with regard to (1) shackling, (2) protection of patients from attack, (3) adequacy of treatment, and (4) deprivation of liberty.
Role of the Psychiatrist in Personal Injury Litigation
Authors: Whittington H. G.
Published: February 2018

Psychiatry has been insufficiently attendant to the demands being placed on it by an ever-growing volume of personal injury or tort litigation. Increasing attention to chronic pain problems and the subtle behavioral sequelae of closed head injuries often challenge the diagnostic skills of psychiatrists. This article reviews additional diagnostic approaches that are perhaps insufficiently utilized. It is suggested that increasing attention be paid in both training and the quality of services in this area.
Admission Patterns at South Carolina's State Psychiatric Hospitals following Legislative Reform
Authors: Mestrovic Stjepan
Published: February 2018

Despite the last revision of South Carolina's mental health law in 1977, multivariate analyses of social, legal, and clinical variables for inpatient hospitalization in 1981 reveal that the state's mental hospitals are still a dumping ground for minority groups and those who are at a disadvantage with regard to the law. Emergency commitments have increased over 300% since passage of the new law, and approximately half of these commitments result in release at the subsequent probate hearing.
Disorders of Visitation in Child Custody Cases
Authors: Levy Alan M.
Published: February 2018

No post-divorce or separation problem is more perplexing, aggravating, or has a greater potential for explosive outcome than when a child is reluctant or refuses to visit the noncustodial parent. This article offers a classification of these disorders of visitation, listing five distinct groups. To assist in the evaluation of such cases a format is suggested which includes the three essential areas to be explored. The use of a systematic approach to the understanding of these cases permits a more meaningful and useful recommendation to be made to the court or the family.
Alternatives to the Insanity Defense
Authors: Lagrone Randy G. , Combs Don C.
Published: February 2018

The insanity defense, so named from the verdict of “not guilty by reason of insantiy” (NGRI), has been a source of empassioned debate since its inception. More recently, the NGRI controversy was renewed by the verdict of NGRI in the case of John Hinckley, Jr. This article examines various issues and alternatives to the insanity defense, i.e., “guilty but mentally ill” (GBMI) and “not responsible by reason of insanity” (NRRI), that are evolving in the public arena today. An argument favoring NRRI is presented.