A Wearable Wideband Analog Bio-Impedance Analyzer for Real-Time Monitoring of Human Physiology.

Continuous monitoring of electrophysiological activities of the human body is a significant step toward the effective prognosis, diagnosis, and management of functional disorders and cardiovascular diseases. This paper presents the development of a wireless system for the real-time acquisition of hemodynamics data and ambulatory monitoring of body composition based on electrical bio-impedance (Bio-Z) analysis. The developed system is composed of a low-power wearable unit and a stationary unit connected to a computer. The system conducts the non-radiative non-invasive Bio-Z analysis over a wide bandwidth of 1 MHz through four independent channels. The proposed analog approach detects the physiological activity by extracting the magnitude of the mixed Bio-Z signal, in real-time. A graphical user interface was designed for monitoring, analysis, and storage of the processed data. Moreover, the amplitude and frequency of the electrical excitation signals can be instructed through the user interface, wirelessly. Bench-top validation of the system demonstrated the delivery of current signals over a wide frequency range of 1 kHz - 1 MHz and peak-to-peak amplitude of up to 20 mA. Besides, the system was able to detect the magnitude of the envelope of the mixed signal with amplitude modulation depths as low as 0.1 %. Clinical Relevance- The system provides the real-time monitoring of cardiac activity and blood pulsation in human arteries. In addition, due to the configurability of the frequency and amplitude of the current injection circuit, the system is an excellent candidate to be utilized for real-time medical imaging through electrical bio-impedance tomography as well as electrical bio-impedance spectroscopy.

Psychopathy Profiles and Personality Assessment Inventory Scores in a Sex Offender Risk Assessment Field Setting.

A growing body of research suggests there are identifiable psychopathy subtypes among offenders scored on Hare's Psychopathy Checklist-Revised (PCL-R; Hare, 2003). We used latent profile analysis to examine the generalizability of these subtype findings to PCL-R scores (N = 615) assigned in a sex offender risk assessment field setting and to examine how offender subtypes differ on measures of comorbid psychopathology, risk, and treatment amenability from the Personality Assessment Inventory. Consistent with prior research, we identified four subtypes when using PCL-R scores from all offenders: Prototypic psychopathy (n = 239, 38.9%), callous-conning (n = 154, 25.0%), sociopathic (n = 96, 15.6%), and general offenders (n = 126, 20.5%). Prototypic and sociopathic subtypes exhibited the highest levels of comorbid psychopathology and risk for potential violence. We identified classes consistent with primary (n = 66, 36.7%) and secondary (n = 114, 63.3%) psychopathy among offenders with PCL-R total scores ≥ 25, and found higher levels of comorbid psychopathology and potential for violence among those in the secondary psychopathy class. Findings provide support the generalizability of existing PCL-R subtype findings to field scores and show how those with similar PCL-R total scores may differ on scores from commonly used multiscale inventories.

Tipping the scales of justice: the role of forensic evaluations in the criminalization of mental illness.

An unprecedented number of individuals with mental illness are represented in the criminal justice system. The unending growth of mentally ill populations in the justice system has led to jails and court dockets being increasingly overwhelmed with cases involving mental illness, state hospitals devoting far more beds and resources to forensic cases, and people without a criminal commitment left waiting for mental health services as forensic cases are prioritized. Although a forensic mental health evaluation is only one component of this larger system, common problems with forensic mental health evaluations can exacerbate the criminalization of persons with mental illness in many ways. This article reviews the current literature regarding issues of quality, reliability, and validity of forensic mental health evaluations, discusses the broader impact of these issues, and offers potential solutions for the field.

Diagnostic field reliability in forensic mental health evaluations.

How likely are multiple forensic evaluators to agree on defendants' diagnoses in routine forensic mental health evaluations? A total of 720 evaluation reports were examined from 240 cases in which 3 evaluators, working independently, provided diagnoses for the same defendant. Results revealed perfect agreement across 6 independent diagnostic categories in 18.3% of cases. Agreement for individual diagnostic categories was higher, with all 3 evaluators agreeing on the separate presence of psychotic, mood, or substance disorders in more than 64.7% of cases and agreeing on the presence of cognitive or developmental disorders in more than 89.7% of cases. However, evaluators agreed about the combination of psychotic and substance-related diagnoses in only 46.5% of cases. Agreement was enhanced by diagnoses with low base rates, and it was suppressed in evaluations conducted in jails. Psychiatrists and contracted evaluators were more likely to provide dissenting diagnostic categories than psychologists and state-employed evaluators. These results are among the first to document diagnostic agreement among nonpartisan practitioners in forensic evaluations conducted in the field, and they allow for practice and policy recommendations for evaluators in routine forensic practice to be made. (PsycINFO Database Record

The impact of defendant ethnicity on the psycholegal opinions of forensic mental health evaluators.

The impact of ethnicity on clinicians' decision making has received a great deal of attention and research. Several studies have documented that client ethnicity significantly influences diagnoses, testing and assessment protocols, recommendations for treatment, and expected outcomes. However, there is limited research examining the impact of a criminal defendant's ethnicity upon forensic mental health experts. To examine this issue, the authors reviewed 816 forensic reports on competency to stand trial submitted to the Hawaii judiciary between 2007 and 2008 and compared recommendation rates across categories of defendant ethnicity. Significant differences between ethnic groups were found in recommendations of competency to stand trial. Specifically, Asian misdemeanant populations were found to be incompetent to stand trial at higher rates than other ethnic groups. These findings highlight the potential impact that ethnicity may have on clinicians' decision making in certain forensic settings.