Psychopathy among condemned capital murderers.

Psychopathy is an important forensic mental health construct. Despite this importance, the research base of psychopathy among individuals convicted of capital murder is limited. Archival data were collected from a sample of 636 persons convicted of capital murder and sentenced to death in the State of California. Psychopathy was assessed using the Psychopathy Checklist - Revised (PCL-R) instrument. Data on criminal careers and other behavioral disorders were also extracted. The sample mean PCL-R total score was 23.31 (SD = 9.92) and one-third of individuals in this sample were considered clinically psychopathic with PCL-R total scores of 30 or greater. Factor analytic examination yielded support for four facets: affective, interpersonal, lifestyle, and antisocial. Criterion validity findings revealed positive correlations of psychopathy scores with Antisocial Personality Disorder (ρ = 0.72), Conduct Disorder (ρ = 0.46), sexual sadism (ρ = 0.24), Oppositional Defiant Disorder (ρ = 0.20), ADHD (ρ = 0.15), arrest charges (r = 0.56), prison sentences (r = 0.53), and age of arrest onset (r = -0.57). Individuals convicted of capital murder and sentenced to death reflect heterogeneity in psychopathy with some individuals exhibiting pronounced psychopathic features.

Prescription Opioid Resiliency and Vulnerability: A Mixed-Methods Comparative Case Study.

Despite declines in prescription opioid overdoses, rural areas continue to have higher prescription opioid overdose rates than urban areas. We aim to understand high overdose places were resilient to the prescription opioid overdose crisis (better than predicted), while others were vulnerable (worse than predicted). First, we predicted prescription opioid overdose mortality in 2016-18 for N = 2,013 non-metropolitan counties using multivariable regression accounting. Second, we constructed a resiliency-vulnerability typology using observed, predicted, and residual values from the regression. Third, we selected a high-overdose resilient and vulnerable community for case study analysis using interviews, focus groups, and observations. High-overdose resilient and vulnerable places had disability-dispensing-overdose pathways, legacies of mining, and polysubstance drug abuse. Resilient places were larger population micropolitans with extensive health and social services, norms of redemption and acceptance of addiction, and community-wide mobilization of public and non-profit resources. Vulnerable places were smaller, more remote, lacked services, and stigmatized addiction.

Behavioral Monitoring Tool for Pig Farmers: Ear Tag Sensors, Machine Intelligence, and Technology Adoption Roadmap.

Precision swine production can benefit from autonomous, noninvasive, and affordable devices that conduct frequent checks on the well-being status of pigs. Here, we present a remote monitoring tool for the objective measurement of some behavioral indicators that may help in assessing the health and welfare status-namely, posture, gait, vocalization, and external temperature. The multiparameter electronic sensor board is characterized by laboratory measurements and by animal tests. Relevant behavioral health indicators are discussed for implementing machine learning algorithms and decision support tools to detect animal lameness, lethargy, pain, injury, and distress. The roadmap for technology adoption is also discussed, along with challenges and the path forward. The presented technology can potentially lead to efficient management of farm animals, targeted focus on sick animals, medical cost savings, and less use of antibiotics.

Community Susceptibility and Resiliency to COVID-19 Across the Rural-Urban Continuum in the United States.

PURPOSE: This study creates a COVID-19 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural-urban continuum. METHODS: Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC. RESULTS: About 33% of rural counties are highly susceptible to COVID-19, driven by older and health-compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social services may hinder local pandemic recovery. Meat processing facilities drive risk in micropolitan counties. Although metropolitan counties are less susceptible due to healthier and younger populations, about 6% are at risk due to community spread from dense populations. Metropolitan vulnerabilities include minorities at higher health and diabetes risk, language barriers, being a transportation hub that helps spread infection, and acute housing distress. CONCLUSIONS: There is an immediate need to know specific types of susceptibilities and vulnerabilities ahead of time to allow local and state health officials to plan and allocate resources accordingly. In rural areas it is essential to shelter-in-place vulnerable populations, whereas in large metropolitan areas general closure orders are needed to stop community spread. Pandemic response plans should address vulnerabilities.

The Opioid Hydra: Understanding Overdose Mortality Epidemics and Syndemics Across the Rural-Urban Continuum.

The rapid increase of fatal opioid overdoses over the past two decades is a major U.S. public health problem, especially in non-metropolitan communities. The crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures, especially in urban areas. Using latent profile analysis, we classify n = 3,079 counties into distinct classes using CDC fatal overdose rates for specific opioids in 2002-2004, 2008-2012, and 2014-2016. We identify three distinct epidemics (prescription opioids, heroin, and prescription-synthetic opioid mixtures) and one syndemic involving all opioids. We find that prescription-related epidemic counties, whether rural or urban, have been "left behind" the rest of the nation. These communities are less populated and more remote, older and mostly white, have a history of drug abuse, and are former farm and factory communities that have been in decline since the 1990s. Overdoses in these places exemplify the "deaths of despair" narrative. By contrast, heroin and opioid syndemic counties tend to be more urban, connected to interstates, ethnically diverse, and in general more economically secure. The urban opioid crisis follows the path of previous drug epidemics, affecting a disadvantaged subpopulation that has been left behind rather than the entire community. County data on opioid epidemic class membership are provided.

Using Census Data to Understand County-Level Differences in Overall Drug Mortality and Opioid-Related Mortality by Opioid Type.

Objectives. To examine associations of county-level demographic, socioeconomic, and labor market characteristics on overall drug mortality rates and specific classes of opioid mortality. Methods. We used National Vital Statistics System mortality data (2002-2004 and 2014-2016) and county-level US Census data. We examined associations between several census variables and drug deaths for 2014 to 2016. We then identified specific classes of counties characterized by different levels and rates of growth in mortality from specific opioid types between 2002 to 2004 and 2014 to 2016. We ran multivariate and multivariable regression models to predict probabilities of membership in each "opioid mortality class" on the basis of county-level census measures. Results. Drug mortality rates overall are higher in counties characterized by more economic disadvantage, more blue-collar and service employment, and higher opioid-prescribing rates. High rates of prescription opioid overdoses and overdoses involving both prescription and synthetic opioids cluster in more economically disadvantaged counties with larger concentrations of service industry workers. High heroin and "syndemic" opioid mortality counties (high rates across all major opioid types) are more urban, have larger concentrations of professional workers, and are less economically disadvantaged. Syndemic opioid counties also have greater concentrations of blue-collar workers. Conclusions. Census data are essential tools for understanding the importance of place-level characteristics on opioid mortality. Public Health Implications. National opioid policy strategies cannot be assumed universally applicable. In addition to national policies to combat the opioid and larger drug crises, emphasis should be on developing locally and regionally tailored interventions, with attention to place-based structural economic and social characteristics.

American income inequality across economic and geographic space, 1970-2010.

This analysis examines the spatial clustering of income inequality and its socioeconomic correlates at the meso-scale over the past four decades. Cluster analysis is used to group N=3078 counties into five inequality clusters; and multinomial logistic regression is used to assess the effects of socioeconomic correlates. High and extreme inequality places are concentrated in large metropolitan centers, high amenity rural areas, and parts of the Great Plains and Mountain West. They tend to have better socioeconomic outcomes, with fewer at-risk populations, higher incomes, lower poverty, and greater economic participation. Unequal places are more specialized in high-skill finance and professional services, and in energy-based mining. By contrast, equality places are associated with low-skill services, education and health services, manufacturing, and stable farm economies.

Synchronous proximal polyps and cancer in patients with polyps detected at sigmoidoscopy: results of a single, rural-based sigmoidoscopy clinic.

The prevalence of polyps and cancer in the proximal colon among patients who have polyps detected on sigmoidoscopy was determined in a large rural referral hospital in north central Pennsylvania. Eleven thousand one hundred sixty patients underwent sigmoidoscopy between 1991 and 1997. Polyps were detected in 709 patients. Five hundred twenty-three patients who had a polyp at sigmoidoscopy and full colonoscopy completed within one year were included in this study. 120 patients (23%) had a proximal polyp detected at colonoscopy. The prevalence of proximal polyps and histologically advanced polyps was related to the size, number, and histology of the distal index polyp found at sigmoidoscopy. However, the absolute difference in prevalence of proximal polyps stratified by dings at sigmoidoscopy was small. A total of 5 adenocarcinomas were detected in the proximal colon. All proximal cancers detected at colonoscopy occurred in patients with a distal polyp less than 10 mm. Our data emphasize the importance of colonoscopy in all patients with a polyp detected at sigmoidoscopy independent of its size and histology.