Reconsidering risk assessment with insanity acquittees.

States continue to rely on conditional release (CR) as an effective and cost-effective way to manage individuals found not guilty by reason of insanity (NGRI). Research has demonstrated that insanity acquittees returning to the community have low recidivism rates and moderately low revocation rates. This study followed 238 individuals found NGRI in Oregon who were evaluated with the Historical, Clinical, Risk-20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997) and placed in the community on CR. The majority of individuals on CR (n = 157, 66%) maintained their release throughout the entire follow-up period (between 4 and 9 years), but 81 (33.6%) had their release revoked during the follow up. In considering the efficacy of violence risk assessment in predicting CR outcome with NGRI acquittees, the HCR-20 was mostly unrelated to CR outcome. Only two items from the HCR-20, both from the Risk Management scale (exposure to destabilizers and stress) predicted revocation, but not imminence to CR revocation. This paper reconsiders how risk assessments are utilized with insanity acquittees and provides a roadmap for improving risk assessments with this unique population by relying on risk assessment results to plan effective interventions to reduce the likelihood of revocation and violence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Oregon Court of Appeals and the State Civil Commitment Statute.

In 1973 the Oregon Legislature passed a major revision of its civil commitment law adopting changes that mirrored those taking place across the United States. The new sections offered significant protections of the rights of individuals who are alleged to have mental illness, a limitation on the length of commitment, the adoption of both dangerousness and gravely disabled type commitment criteria and the adoption of "beyond a reasonable doubt" as the standard of proof for commitment hearings. From 1973 to the present time, the Oregon Court of Appeals adjudicated a large number of appeals emanating from civil commitment courts. This article is based on a review of 98 written Oregon Court of Appeals commitment decisions from the years 1998 through 2015 and is accompanied by a review of legislative intent in 1973. It appears that the court of appeals has significantly altered the 1973 legislative changes by moving the dangerousness criteria to imminence and the gravely disabled criteria to a focus on survival. Empirically, civil commitment has dramatically decreased in Oregon over a 40-year period and the case law, as developed by Oregon Court of Appeals, has had a significant contributing role in this reduction.

Conditional Release Placements of Insanity Acquittees in Oregon: 2012-2014.

Between January 1, 2012 and December 31, 2014, there was a large population (N = 200) of insanity acquittees placed on conditional release (CR) in the state of Oregon. This article looks at the demographic and system characteristics of this large group of individuals. The authors then focus on the initial housing placement and what happens to individuals after their release in relation to their housing placement. In Oregon, insanity acquittees are either conditionally released directly by the court or placed in the hospital prior to potential CR by a supervising board. In general, once CR occurs, individuals tend to stay in their initial placement without moving to less structured levels of care, raising concerns about transinstitutionalization. This is especially true for individuals released to the most structured living arrangement (secure residential treatment facility). Those individuals who are conditionally released to less structured settings have a higher rate of revocation back to the hospital. Those individuals who do move to less structured levels of care usually have longer hospital stays and start off in more structured levels of care to start their CR. Copyright © 2016 John Wiley & Sons, Ltd.

Oregon's Gun Relief Program for Adjudicated Mentally Ill Persons: The Psychiatric Security Review Board.

This article describes the State of Oregon's implementation of two programs designed to comply with federal gun laws regarding reporting individuals who have received mental health adjudications in criminal and civil courts. One mandate requires that states submit names of adjudicated individuals to the National Instant Criminal Background Check System (NICS) while the second requires that the state establish a qualifying gun restoration program for those disqualified from gun ownership. In 2009, Oregon's Legislature developed an administrative approach to gun restoration and assigned the responsibility for conducting these hearing to the Oregon Psychiatric Security Review Board (PSRB). The PSRB is a state administrative board that has existed since 1977 and has been primarily focused on the supervision and treatment of adult and juvenile insanity acquittees. The gun restoration program began in 2010, but to date has only received three completed petitions requesting restoration of firearm rights. The article concludes with a discussion that surmises why very few of the Oregonians who are listed in NICS have submitted petitions for relief.

Location of gliomas in relation to mobile telephone use: a case-case and case-specular analysis.

The energy absorbed from the radio-frequency fields of mobile telephones depends strongly on distance from the source. The authors' objective in this study was to evaluate whether gliomas occur preferentially in the areas of the brain having the highest radio-frequency exposure. The authors used 2 approaches: In a case-case analysis, tumor locations were compared with varying exposure levels; in a case-specular analysis, a hypothetical reference location was assigned for each glioma, and the distances from the actual and specular locations to the handset were compared. The study included 888 gliomas from 7 European countries (2000-2004), with tumor midpoints defined on a 3-dimensional grid based on radiologic images. The case-case analyses were carried out using unconditional logistic regression, whereas in the case-specular analysis, conditional logistic regression was used. In the case-case analyses, tumors were located closest to the source of exposure among never-regular and contralateral users, but not statistically significantly. In the case-specular analysis, the mean distances between exposure source and location were similar for cases and speculars. These results do not suggest that gliomas in mobile phone users are preferentially located in the parts of the brain with the highest radio-frequency fields from mobile phones.

Pattern of recurrence in paediatric malignant glioma: an institutional experience.

BACKGROUND: The purpose of this retrospective study was to investigate the pattern of recurrence in paediatric malignant gliomas. MATERIAL AND METHODS: We reviewed the notes, diagnostic imaging and treatment charts of 30 consecutive paediatric patients (age less than 18 years at diagnosis, range 0.5-17 years) presenting with a malignant glioma presenting to the paediatric oncology unit at the Royal Marsden Hospital over a 10-year period. The imaging at the time of first relapse was compared with the initial diagnostic scans to define a relapse as local, marginal or distant. RESULTS: Median follow-up was 13 months (range 1-99 months). Twenty-four of 30 patients (80%) showed evidence of progression with a median time to progression of 8.5 months (range 3-64 months). Thirteen out of 24 patients developed local or marginal recurrences while 11/24 patients recurred at distant sites as site of first relapse (46%). CONCLUSION: Our series suggests that the pattern of relapses in paediatric malignant gliomas could be different from that reported in adult studies as we observed a significant incidence of distant relapses. Larger prospective series need to be conducted to investigate the clinico-biological characteristics of the population at high risk for leptomeningeal dissemination.

Godfrey Hounsfield and the dawn of computed tomography.

OBJECTIVE: To provide a historical account of the events surrounding the development of the computed tomography scanner. METHODS: Information was obtained by interviewing people who worked with Sir Godfrey Hounsfield and Dr. James Ambrose at Atkinson Morley's Hospital in the 1970s, and from published books, articles, and several web sites, including the Nobel web site. RESULTS: The computed tomography scanner was successfully developed because of the collaboration between an imaginative engineer, Godfrey Hounsfield, who created the machine, and a brilliant neuroradiologist, James Ambrose, who demonstrated its wide clinical significance. CONCLUSION: The computed tomography scanner represents one of the most important contributions to neurosurgical practice in the past 100 years, and its development is a remarkable story of scientific endeavor.