HEARTBEAT4D: An Open-source Toolbox for Turning 4D Cardiac CT into VR/AR.

Four-dimensional data sets are increasingly common in MRI and CT. While clinical visualization often focuses on individual temporal phases capturing the tissue(s) of interest, it may be possible to gain additional insight through exploring animated 3D reconstructions of physiological motion made possible by augmented or virtual reality representations of 4D patient imaging. Cardiac CT acquisitions can provide sufficient spatial resolution and temporal data to support advanced visualization, however, there are no open-source tools readily available to facilitate the transformation from raw medical images to dynamic and interactive augmented or virtual reality representations. To address this gap, we developed a workflow using free and open-source tools to process 4D cardiac CT imaging starting from raw DICOM data and ending with dynamic AR representations viewable on a phone, tablet, or computer. In addition to assembling the workflow using existing platforms (3D Slicer and Unity), we also contribute two new features: 1. custom software which can propagate a segmentation created for one cardiac phase to all others and export to surface files in a fully automated fashion, and 2. a user interface and linked code for the animation and interactive review of the surfaces in augmented reality. Validation of the surface-based areas demonstrated excellent correlation with radiologists' image-based areas (R > 0.99). While our tools were developed specifically for 4D cardiac CT, the open framework will allow it to serve as a blueprint for similar applications applied to 4D imaging of other tissues and using other modalities. We anticipate this and related workflows will be useful both clinically and for educational purposes.

Factors differentiating successful versus unsuccessful malingerers.

Relatively little is known about the processes in which "successful" malingerers engage to avoid detection. This study summarizes the response strategies used by participants (N = 540) instructed to feign a specific mental disorder while completing various self-report instruments designed to detect faking. Postexperiment questionnaires indicated that those who were able to appear symptomatic while avoiding being detected as feigning (n = 60) were more likely to endorse a lower rate of legitimate symptoms, to avoid overly unusual or bizarre items, and to base their responses on their own personal experiences.

Juveniles adjudicated incompetent to proceed: a descriptive study of Florida's Competence Restoration program.

Although competence to stand trial is perhaps the most studied area of mental health law, most of the research has been focused on adults. This study describes a population of 471 juveniles committed for treatment/habilitation and restoration of their competence to proceed in the delinquency process. This population differed from their adult counterparts in important ways. For example, 58 percent of the juveniles had a diagnosis of mental retardation, and 57 percent of the juveniles with an Axis I diagnosis also had a diagnosis of conduct disorder. Only 17 percent had a diagnosed psychotic disorder. Diagnoses among cohorts of adults found incompetent differ markedly. However, similar to adult defendants who are adjudicated incompetent to proceed, the majority of these children were returned to court after treatment staff determined that they were competent to proceed. Contrary to expectation, there were no significant age-related differences with respect to the recommendation of clinical staff regarding restoration of competence. The data suggest the need for further research examining that subset of children in the juvenile justice system whose competence to proceed is questionable.

Assessing and managing violence risk in outpatient settings.

Psychologists and other mental health professionals practicing in essentially all clinical settings are called on to assess and manage clients who may pose a risk of violence to third parties. Over the past 25 years much has been learned about the relationship between violence and mental disorder, and about assessing violence risk. In this article risk factors for violence among persons with mental disorder are reviewed, clinical assessment strategies are discussed, and a model for thinking about treatment and other types of interventions designed to minimize violence risk is offered.

Utility of the structured inventory of malingered symptomatology in identifying persons motivated to malinger psychopathology.

The Structured Inventory of Malingered Symptomatology (SIMS) is one of a number of recently developed instruments designed to identify persons exaggerating and/or fabricating psychiatric and cognitive symptomatology. Preliminary analog research indicated that the SIMS showed some promise as a screening device for identifying malingerers. This study examined the utility of the SIMS for identifying malingerers and, more importantly, its ability to distinguish truly symptomatic persons from persons fabricating symptomatology. In a sample of 197 participants who completed the SIMS and Symptom Checklist-90-Revised (SCL-90-R) under both honest and malingering instructional sets, sensitivity and specificity rates were generally high for the SIMS Total score and subscales. However, moderate correlations with the SCL-90-R were obtained in this sample, and specificity rates were lowest among a subset of participants reporting clinically significant levels of distress; both findings raise concerns regarding the potential for high false positive rates among clinical populations. Implications for clinical forensic practice are discussed and recommendations for future research are offered.

Effects of state organizational structure and forensic examiner training on pretrial competence assessments.

States differ widely in their delivery of pretrial forensic evaluation services, in terms of organizational structure and training requirements of forensic examiners. It was hypothesized that defendants adjudicated incompetent to proceed in states using community-based, private-practitioner systems would show less impairment on a competence assessment measure, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), than defendants adjudicated incompetent in states using traditional, inpatient systems. It also was hypothesized that mean MacCAT-CA scores for incompetent defendants from states requiring forensic training/certification would be lower than for defendants from states lacking such requirements. Results indicated significant differences across the four types of service delivery systems examined. However, planned comparisons revealed no differences between a state using a traditional, inpatient model and a state employing a community-based, private-practitioner model. Analyses examining the effects of mandatory forensic training failed to support the hypothesis that training requirements result in the adoption of higher thresholds for determining incompetence.

Susceptibility of the trauma symptom inventory to malingering.

This study examined the sensitivity and specificity of the Trauma Symptom Inventory (TSI; Briere, 1995), a self-report measure of psychological sequelae of potentially traumatic events, to malingering. An optimal cutting score for a validity scale--Atypical Responding (ATR)--designed to identify exaggeration or other unusual response sets was developed in an analogue sample of 155 college students and subsequently applied to TSI profiles from several samples of patients with various psychiatric disorders. Use of a cross-validated T-score cutoff of 61 and below on the ATR scale produced good sensitivity (81%) and specificity (92%) rates in the analogue sample. Participants in the analogue sample who reported a history of traumatic experiences were no more able to successfully malinger trauma symptoms than were participants without such histories. Furthermore, false-positive rates in the clinical samples were generally low, suggesting that relatively few genuinely symptomatic individuals would be misclassified as malingering.

An empirical study of the reports of APA's peer review panel in the congressional review of the U.S.S. IOWA incident.

The U.S. House of Representatives Armed Services Committee (HASC) review of the US. Navy's investigation of the U.S.S. IOWA incident provides a case study of the problems with reconstructive psychological evaluations. The US. Navy attributed the explosion on board the U.S.S. IOWA to the intentional suicidal acts of Gunner's Mate Clayton Hartwig, a conclusion supported primarily by an Equivocal Death Analysis (EDA) conducted by the FBI. Systematic analysis of the reports of the expert panelists who consulted to the NASC reveals that 11 of the 14 panelists were critical of the conclusions reached by the Navy/FBI. There was considerable variability among the judgments of the panelists, who reached consensus only for broad categories. Because the reliability and validity of postmortem psychological reconstructions such as EDA and psychological autopsy have not been established, clinicians are urged to exercise caution in the use of such procedures and to be sensitive to ethical obligations to consumers when using such techniques.

APA's expert panel in the congressional review of the USS Iowa incident.

In 1989, an explosion aboard the USS Iowa killed 47 sailors. The Navy attributed the explosion to the intentional suicidal acts of Gunners Mate Clayton Hartwig, a conclusion supported primarily by an "equivocal death analysis" conducted by the Federal Bureau of Investigation (FBI). The U.S. House of Representatives Armed Services Committee (HASC) was highly critical of the FBI's report and the Navy's conclusions, in part because of the peer review provided by 12 psychologists organized by the American Psychological Association (APA). This article (a) reviews the nature of equivocal death analysis and related reconstructive psychological evaluations, (b) describes the nature of APA's consultation and involvement with the HASC, (c) discusses the conclusions reached by the HASC and the influence of the APA panelists, and (d) suggests limitations on the use of equivocal death analysis and related procedures in light of scientific concerns and ethical considerations.

Pretrial evaluations for criminal courts: contemporary models of service delivery.

Pretrial forensic evaluations are provided for the criminal courts throughout the United States. A variety of models of service delivery exists, and these models vary in ways that are important to the organization and finding of state mental health services. The first part of this paper describes several models of service delivery, which vary primarily in terms of centrality (central state institution vs. community service provider) and the use of inpatient vs. outpatient procedures. The second part compares these models on a number of important measures, including cost and efficiency. The final section of the paper indicates the importance of specialized forensic training and describes important components of such training.

The utility of the Michigan Alcoholism Screening Test in the detection of alcoholics and problem drinkers.

This study examined the vulnerability of the Michigan Alcoholism Screening Test (MAST), a widely used, direct alcohol inventory, to positive dissimulation. An earlier study by developers of the MAST suggested that most alcoholics were unable to alter their scores and thereby avoid detection by the instrument. But closer examination indicated that a standard scoring procedure was not employed. This study examined the ability of alcoholics to avoid detection by the MAST when using a standard scoring procedure. As predicted, alcoholics readily manipulated their MAST scores and avoided detection when so motivated. These results are discussed, indications and contraindications for use are included, and recommendations regarding future research are made.