Compulsory Psychotropic Medication in the California State Prison System.

In Washington v. Harper, the U.S. Supreme Court established that an administrative review conducted by prison staff was the minimum constitutionally appropriate due process for the administration of compulsory nonemergent antipsychotic medication. California's current process, Penal Code section 2602 (PC2602), uses a judicial review allowing for either emergent (medication beginning with application) or nonemergent routes. This article describes the history culminating with PC2602, beginning with the notion of civil death enacted in 1850, followed by the 1986 Keyhea injunction. Framed by problems that emerged, PC2602 was enacted in 2011, which is described from both legal-administrative and clinical perspectives.

Cancer Clinic Redesign: Opportunities for Resource Optimization.

Ambulatory cancer centers face a fluctuating patient demand and deploy specialized personnel who have variable availability. This undermines operational stability through the misalignment of resources to patient needs, resulting in overscheduled clinics, budget deficits, and wait times exceeding provincial targets. We describe the deployment of a Learning Health System framework for operational improvements within the entire ambulatory center. Known methods of value stream mapping, operations research and statistical process control were applied to achieve organizational high performance that is data-informed, agile and adaptive. We transitioned from a fixed template model by an individual physician to a caseload management by disease site model that is realigned quarterly. We adapted a block schedule model for the ambulatory oncology clinic to align the regional demand for specialized services with optimized human and physical resources. We demonstrated an improved utilization of clinical space, increased weekly consistency and improved distribution of activity across the workweek. The increased value, represented as the ratio of monthly encounters per nursing worked hours, and the increased percentage of services delivered by full-time nurses were benefits realized in our cancer system. The creation of a data-informed demand capacity model enables the application of predictive analytics and business intelligence tools that will further enhance clinical responsiveness.

Examining the factor structure of ICD-11 posttraumatic stress disorder (PTSD) and complex-PTSD among prison staff exposed to potentially traumatic experiences.

The recently released 11th edition of the International Classification of Diseases (ICD-11) classifies posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as distinct, yet related, disorders within the spectrum of trauma and stress-related disorders. This study aimed to explore the construct validity of the International Trauma Questionnaire (ITQ), a measure of ICD-11 PTSD and CPTSD symptoms among prison governors (i.e., wardens in the U.S. and Canada). Trauma-exposed prison governors (N = 409) aged 26 to 82 years (M = 50.04, SD = 7.97) provided their data online anonymously. Confirmatory factor analyses were performed to evaluate the construct validity of ITQ scores. When using the five-point item response scale, our five first-order factor model produced the best fit to the data; however, when using a dichotomous item scale, the first-order two-factor PTSD and disturbances of self-organization (DSO) model produced the best fit to the data. These results indicate that item-coding and estimation methods can significantly impact conclusions about the best-fitting model for this measure among trauma-exposed prison governors.

Suicide Ideation Among Male Prisoners: Preliminary Evidence That Psychopathic Traits are Indirectly Linked to Suicide Ideation Through Thwarted Interpersonal Needs.

BACKGROUND: The relation between psychopathic traits and suicide ideation (SI) is frequently discussed but little research has examined potential mechanisms underlying this association. The interpersonal theory of suicide (ITS) proposes two mechanisms in the pathogenesis of suicidal desire: thwarted belongingness (TB) and perceived burdensomeness (PB). This study cross-sectionally tested TB and PB as possible explanatory links in the relation between psychopathic traits and SI. METHOD: Archival data from 784 male U.K. prisoners (Mage  = 37.21, SD = 9.97) were analyzed using structural equation modeling. RESULTS: Psychopathic traits were indirectly associated with SI through more specific suicide-promoting processes - namely TB and PB. More specifically, results indicated that Egocentricity and Stimulus Seeking were indirectly associated with SI through PB and TB in combination. However, results indicated specific indirect effects of TB in the relations between the Antisocial Behavior, Egocentricity, and Stimulus Seeking facets, and SI, whereas specific indirect effects for PB were only significant in the relations between Egocentricity and Stimulus Seeking facets and SI. CONCLUSION: Preliminary results are consistent with the ITS and suggest that psychopathic traits may be distal risk markers for SI and provide direction for future research that could inform suicide prevention efforts among male prisoners high in such traits.

Ozone impacts on vegetation in a nitrogen enriched and changing climate.

This paper provides a process-oriented perspective on the combined effects of ozone (O3), climate change and/or nitrogen (N) on vegetation. Whereas increasing CO2 in controlled environments or open-top chambers often ameliorates effects of O3 on leaf physiology, growth and C allocation, this is less likely in the field. Combined responses to elevated temperature and O3 have rarely been studied even though some critical growth stages such as seed initiation are sensitive to both. Under O3 exposure, many species have smaller roots, thereby enhancing drought sensitivity. Of the 68 species assessed for stomatal responses to ozone, 22.5% were unaffected, 33.5% had sluggish or increased opening and 44% stomatal closure. The beneficial effect of N on root development was lost at higher O3 treatments whilst the effects of increasing O3 on root biomass became more pronounced as N increased. Both responses to gradual changes in pollutants and climate and those under extreme weather events require further study.