Medical Decision Making in Correctional Facilities: Highlighting Gaps and Advocating for Policy Change.

In the United States, a disproportionately high number of incarcerated individuals suffer from serious mental illnesses, substance use disorders, chronic medical conditions, infectious diseases, and traumatic brain injuries. Correctional facilities are often ill-equipped to address the incarcerated community's physical and mental health needs. Current laws and policies remain outdated and do not adequately address the complex health issues faced by incarcerated individuals, particularly the aging and terminally ill patients in correctional settings. We present a case of a male with schizophrenia whose ongoing psychiatric symptoms impaired his decisional capacity, leading to him to refuse medical treatment for an initially treatable medical condition, ultimately resulting in his death due to the lack of a surrogate decision-maker. This case underscores the urgent need for policy revisions to assign medical decision-making authority for individuals in custody and highlights potential interventions to bridge existing gaps in care for this population.

Systematic Review of Surgical Care in the Incarcerated Population: Identifying Knowledge Gaps for Future Research.

Objective: This study, examining literature up to December 2023, aims to comprehensively assess surgical care for incarcerated individuals, identifying crucial knowledge gaps for informing future health services research and interventions. Background: The US prison system detains around 2 million individuals, mainly young, indigent males from ethnic and racial minorities. The constitutional right to healthcare does not protect this population from unique health challenges and disparities. The scarcity of literature on surgical care necessitates a systematic review to stimulate research, improve care quality, and address health issues within this marginalized community. Methods: A systematic review, pre-registered with the International Prospective Register of Systematic Reviews (CRD42023454782), involved searches in PubMed, Embase, and Web of Science. Original research on surgical care for incarcerated individuals was included, excluding case reports/series (<10 patients), abstracts, and studies involving prisoners of war, plastic surgeries for recidivism reduction, transplants using organs from incarcerated individuals, and nonconsensual surgical sterilization. Results: Out of 8209 studies screened, 118 met inclusion criteria, with 17 studies from 16 distinct cohorts reporting on surgical care. Predominantly focusing on orthopedic surgeries, supplemented by studies in emergency general, burns, ophthalmology, and kidney transplantation, the review identified delayed hospital presentations, a high incidence of complex cases, and low postoperative follow-up rates. Notable complications, such as nonfusion and postarthroplasty infections, were more prevalent in incarcerated individuals compared with nonincarcerated individuals. Trauma-related mortality rates were similar, despite lower intraabdominal injuries following penetrating abdominal injuries in incarcerated patients. Conclusion: While some evidence suggests inferior surgical care in incarcerated patients, the limited quality of available studies underscores the urgency of addressing knowledge gaps through future research. This is crucial for patients, clinicians, and policymakers aiming to enhance care quality for a population at risk of surgical complications during incarceration and postrelease.

Enhancing social cohesion with cooperative bots in societies of greedy, mobile individuals.

Addressing collective issues in social development requires a high level of social cohesion, characterized by cooperation and close social connections. However, social cohesion is challenged by selfish, greedy individuals. With the advancement of artificial intelligence (AI), the dynamics of human-machine hybrid interactions introduce new complexities in fostering social cohesion. This study explores the impact of simple bots on social cohesion from the perspective of human-machine hybrid populations within network. By investigating collective self-organizing movement during migration, results indicate that cooperative bots can promote cooperation, facilitate individual aggregation, and thereby enhance social cohesion. The random exploration movement of bots can break the frozen state of greedy population, help to separate defectors in cooperative clusters, and promote the establishment of cooperative clusters. However, the presence of defective bots can weaken social cohesion, underscoring the importance of carefully designing bot behavior. Our research reveals the potential of bots in guiding social self-organization and provides insights for enhancing social cohesion in the era of human-machine interaction within social networks.

Distinguishing fast change in social norms and slow change in personal norms in cooperative decision-making.

Psychological research on norms has shown that norms are highly relevant for individuals' decision-making. Yet, there is so far little understanding of how norms change over time. Knowledge about how norms change may help better understanding their potential for as well as limitations in guiding decision-making and changing behavior. The present work investigated change in individuals' cooperation norms. As an indicator of different underlying processes of norm change, the temporal dynamics of different types of norms were examined. It was assumed that participants' social norms are adapted quickly whenever the social situation changes, while personal norms change more slowly and gradually, abstracting part of the situational learning in interaction with one's personality. In an experimental study, participants played a repeated prisoner's dilemma game with artificial co-players representing a predominantly cooperative or uncooperative social setting, depending on the experimental condition. The condition was expected to affect slow learning of personal norms. Additionally, the cooperativeness of the social setting was varied repeatedly within conditions, expected to result in fast changes in social norms. Participants' personal and social norms were assessed throughout the game. As predicted, the temporal dynamics differed between norms with social norms changing quickly and personal norms more slowly. Personal norms strongly predicted behavioral decision-making and were predicted by situational and personality factors. Potential qualitative differences of the underlying norm change processes are discussed.

Evolution of cooperation in social dilemmas with assortment in finite populations.

We investigate conditions for the evolution of cooperation in social dilemmas in finite populations with assortment of players by group founders and general payoff functions for cooperation and defection within groups. Using a diffusion approximation in the limit of a large population size that does not depend on the precise updating rule, we show that the first-order effect of selection on the fixation probability of cooperation when represented once can be expressed as the difference between time-averaged payoffs with respect to effective time that cooperators and defectors spend in direct competition in the different group states. Comparing this fixation probability to its value under neutrality and to the corresponding fixation probability for defection, we deduce conditions for the evolution of cooperation. We show that these conditions are generally less stringent as the level of assortment increases under a wide range of assumptions on the payoffs such as additive, synergetic or discounted benefits for cooperation, fixed cost for cooperation and threshold benefit functions. This is not necessarily the case, however, when payoffs in pairwise interactions are multiplicatively compounded within groups.

Prison and forensic mental health staff after suicides in their care. A narrative review of international and German national evidence.

There is a growing body of international research investigating the impact of patient suicide on mental health professionals. The experience of losing a patient to suicide can have a significant and, in some cases, long-lasting (negative) impact on mental health professionals. However, the nature and extent of the impact on prison staff or forensic mental health professionals in particular is less clear. This narrative review summarises both quantitative and qualitative studies and key findings in this area, focusing on the above professions. A literature search was conducted using PsychInfo and Google Scholar, covering the period from 2000 onwards. The vast majority of findings relate to mental health professionals in general. We were unable to identify any published reports on the responses of forensic psychiatric staff. The majority of identified studies in the prison context are qualitative. Studies from German-speaking countries are particularly scarce in both the prison and mental health contexts. We conclude that there is a profound lack of knowledge about the impact of client/patient suicide on the subgroups of (German) prison and forensic psychiatric staff. Clearly, more research is needed on both the nature and extent of the impact, as well as on the specific organisational and supportive factors that help to mitigate the negative effects of suicide.

Evolution of reciprocity with limited payoff memory.

Direct reciprocity is a mechanism for the evolution of cooperation in repeated social interactions. According to the literature, individuals naturally learn to adopt conditionally cooperative strategies if they have multiple encounters with their partner. Corresponding models have greatly facilitated our understanding of cooperation, yet they often make strong assumptions on how individuals remember and process payoff information. For example, when strategies are updated through social learning, it is commonly assumed that individuals compare their average payoffs. This would require them to compute (or remember) their payoffs against everyone else in the population. To understand how more realistic constraints influence direct reciprocity, we consider the evolution of conditional behaviours when individuals learn based on more recent experiences. Even in the most extreme case that they only take into account their very last interaction, we find that cooperation can still evolve. However, such individuals adopt less generous strategies, and they cooperate less often than in the classical setup with average payoffs. Interestingly, once individuals remember the payoffs of two or three recent interactions, cooperation rates quickly approach the classical limit. These findings contribute to a literature that explores which kind of cognitive capabilities are required for reciprocal cooperation. While our results suggest that some rudimentary form of payoff memory is necessary, it suffices to remember a few interactions.

Ovarian hormones predict cooperative strategies updating during multiple rounds of the prisoner's dilemma.

Increasing research has focused on how ovarian hormones influence individual prosocial motivation and cooperation. However, most results remain ambiguous and contradictory. Here, we collected progesterone (PROG) and oestradiol from 62 healthy women with regular menstrual cycles to explore whether variations in ovarian hormones could flexibly change their cooperative preference according to their opponents' strategies in multiple rounds of a prisoner's dilemma (PD) game. Participants in different menstrual phases (32 in the follicular phase [FP] and 30 in the luteal phase [LP]) were asked to complete 20 rounds of PD games with each of three computer opponents holding different cooperative strategies. The results revealed that in PD games that did not require cooperation for increased outcomes, women in the LP (high PROG) reduced their cooperation rate more significantly than women in the FP (low PROG). In contrast, when the game design required reciprocity, simultaneously elevated levels of PROG and oestradiol predicted greater instances of participants choosing to cooperate. Furthermore, we found that elevated PROG levels accounted for women's elevated prosocial choices, regardless of the need to increase outcomes through cooperation. These results implied higher levels of PROG and oestradiol influence women's cooperative strategies resulting in increased social interactions.

RISE-Vac-Co-production of Vaccine Education Materials with Persons Living in Prison.

Increasing vaccination knowledge is effective in addressing hesitancy and is particularly important in populations deprived of liberty who may not routinely have access to health information, ensuring health equity. RISE-Vac is a European Union-funded project aiming to promote vaccine literacy, offer, and uptake in prisons in Europe. We consulted persons living in prisons in the United Kingdom (through the Prisoner Policy Network), France, and Moldova to determine their vaccination knowledge gaps, the information they would like to receive, and how they would like to receive it. We received 344 responses: 224 from the United Kingdom, 70 from France, and 50 from Moldova. Participants were particularly interested in learning about the effectiveness, side effects, and manufacturing of vaccines. Their responses guided the development of educational materials, including a brochure that will be piloted in prisons in Europe. Persons with experience of imprisonment were involved at every stage of this project.

Belief Updating during Social Interactions: Neural Dynamics and Causal Role of Dorsomedial Prefrontal Cortex.

In competitive interactions, humans have to flexibly update their beliefs about another person's intentions in order to adjust their own choice strategy, such as when believing that the other may exploit their cooperativeness. Here we investigate both the neural dynamics and the causal neural substrate of belief updating processes in humans. We used an adapted prisoner's dilemma game in which participants explicitly predicted the coplayer's actions, which allowed us to quantify the prediction error between expected and actual behavior. First, in an EEG experiment, we found a stronger medial frontal negativity (MFN) for negative than positive prediction errors, suggesting that this medial frontal ERP component may encode unexpected defection of the coplayer. The MFN also predicted subsequent belief updating after negative prediction errors. In a second experiment, we used transcranial magnetic stimulation (TMS) to investigate whether the dorsomedial prefrontal cortex (dmPFC) causally implements belief updating after unexpected outcomes. Our results show that dmPFC TMS impaired belief updating and strategic behavioral adjustments after negative prediction errors. Taken together, our findings reveal the time course of the use of prediction errors in social decisions and suggest that the dmPFC plays a crucial role in updating mental representations of others' intentions.

Better-than-chance prediction of cooperative behaviour from first and second impressions.

Could cooperation among strangers be facilitated by adaptations that use sparse information to accurately predict cooperative behaviour? We hypothesise that predictions are influenced by beliefs, descriptions, appearance and behavioural history available for first and second impressions. We also hypothesise that predictions improve when more information is available. We conducted a two-part study. First, we recorded thin-slice videos of university students just before their choices in a repeated Prisoner's Dilemma with matched partners. Second, a worldwide sample of raters evaluated each player using videos, photos, only gender labels or neither images nor labels. Raters guessed players' first-round Prisoner's Dilemma choices and then their second-round choices after reviewing first-round behavioural histories. Our design allows us to investigate incremental effects of gender, appearance and behavioural history gleaned during first and second impressions. Predictions become more accurate and better-than-chance when gender, appearance or behavioural history is added. However, these effects are not incrementally cumulative. Predictions from treatments showing player appearance were no more accurate than those from treatments revealing gender labels and predictions from videos were no more accurate than those from photos. These results demonstrate how people accurately predict cooperation under sparse information conditions, helping explain why conditional cooperation is common among strangers.

Individualistic attitudes in Iterated Prisoner's Dilemma undermine evolutionary fitness and may drive cooperative human players to extinction.

Inarguably, humans perform the richest plethora of prosocial behaviours in the animal kingdom, and these are important for understanding how humans navigate their social environment. The success and failure of strategies human players devise also have implications for determining long-term socio-economic/evolutionary fitness. Following the footsteps of Press and Dyson (2012), I implemented their evolutionary game-theoretic modelling from Iterated Prisoner's Dilemma (a behavioural economic probe of interpersonal cooperation) and re-analysed already published data on human proposer behaviour in the Ultimatum Game (a behavioural economic probe of altruistic punishment) involving 50 human participants versus stochastic computerized opponents with prosocial and individualistic social value orientations. Although the results indicate that it is more likely to break cycles of mutual defection in ecosystems in which humans interact with individualistic opponents, analysis of social-economic fitness at the Markov stationary states suggested that this comes at an evolutionary cost. Overall, human players acted in a significantly more cooperative manner than their opponents, but they failed to overcome extortion from individualistic agents, risking 'extinction' in 70% of the cases. These findings demonstrate human players might be short-sighted, and social interactive decision strategies they devise while adjusting to different types of opponents may not be optimal in the long run.

What is Quantum in probabilistic explanations of the sure-thing principle violation?

The Prisoner's Dilemma game (PDG) is one of the simple test-beds for the probabilistic nature of the human decision-making process. Behavioral experiments have been conducted on this game for decades and show a violation of the so-called sure-thing principle, a key principle in the rational theory of decision. Quantum probabilistic models can explain this violation as a second-order interference effect, which cannot be accounted for by classical probability theory. Here, we adopt the framework of generalized probabilistic theories and approach this explanation from the viewpoint of quantum information theory to identify the source of the interference. In particular, we reformulate one of the existing quantum probabilistic models using density matrix formalism and consider different amounts of classical and quantum uncertainties for one player's prediction about another player's action in PDG. This enables us to demonstrate that what makes possible the explanation of the violation is the presence of quantum coherence in the player's initial prediction and its conversion to probabilities during the dynamics. Moreover, we discuss the role of other quantum information-theoretical quantities, such as quantum entanglement, in the decision-making process. Finally, we propose a three-choice extension of the PDG to compare the predictive powers of quantum probability theory and a more general probabilistic theory that includes it as a particular case and exhibits third-order interference.

An evolutionary model of personality traits related to cooperative behavior using a large language model.

This study aims to demonstrate that Large Language Models (LLMs) can empower research on the evolution of human behavior, based on evolutionary game theory, by using an evolutionary model positing that instructing LLMs with high-level psychological and cognitive character descriptions enables the simulation of human behavior choices in game-theoretical scenarios. As a first step towards this objective, this paper proposes an evolutionary model of personality traits related to cooperative behavior using a large language model. In the model, linguistic descriptions of personality traits related to cooperative behavior are used as genes. The deterministic strategies extracted from LLM that make behavioral decisions based on these personality traits are used as behavioral traits. The population is evolved according to selection based on average payoff and mutation of genes by asking LLM to slightly modify the parent gene toward cooperative or selfish. Through experiments and analyses, we clarify that such a model can indeed exhibit evolution of cooperative behavior based on the diverse and higher-order representation of personality traits. We also observed repeated intrusion of cooperative and selfish personality traits through changes in the expression of personality traits. The words that emerged in the evolved genes reflected the behavioral tendencies of their associated personalities in terms of semantics, thereby influencing individual behavior and, consequently, the evolutionary dynamics.

An analysis of published study designs in PubMed prisoner health abstracts from 1963 to 2023: a text mining study.

BACKGROUND: The challenging nature of studies with incarcerated populations and other offender groups can impede the conduct of research, particularly that involving complex study designs such as randomised control trials and clinical interventions. Providing an overview of study designs employed in this area can offer insights into this issue and how research quality may impact on health and justice outcomes. METHODS: We used a rule-based approach to extract study designs from a sample of 34,481 PubMed abstracts related to epidemiological criminology published between 1963 and 2023. The results were compared against an accepted hierarchy of scientific evidence. RESULTS: We evaluated our method in a random sample of 100 PubMed abstracts. An F1-Score of 92.2% was returned. Of 34,481 study abstracts, almost 40.0% (13,671) had an extracted study design. The most common study design was observational (37.3%; 5101) while experimental research in the form of trials (randomised, non-randomised) was present in 16.9% (2319). Mapped against the current hierarchy of scientific evidence, 13.7% (1874) of extracted study designs could not be categorised. Among the remaining studies, most were observational (17.2%; 2343) followed by systematic reviews (10.5%; 1432) with randomised controlled trials accounting for 8.7% (1196) of studies and meta-analysis for 1.4% (190) of studies. CONCLUSIONS: It is possible to extract epidemiological study designs from a large-scale PubMed sample computationally. However, the number of trials, systematic reviews, and meta-analysis is relatively small - just 1 in 5 articles. Despite an increase over time in the total number of articles, study design details in the abstracts were missing. Epidemiological criminology still lacks the experimental evidence needed to address the health needs of the marginalized and isolated population that is prisoners and offenders.

Acute Cardiomyopathy in a Prisoner on a Hunger Strike.

Chronic starvation and its associated metabolic derangements are known to have dangerous cardiovascular implications in the long term, but less is known about the cardiovascular consequences of acute starvation, such as in the context of a hunger strike. This case describes a patient who presented with signs and symptoms of acute coronary syndrome which began two weeks into a hunger strike and was ultimately found to have stress cardiomyopathy with complete resolution on subsequent imaging.

Children cooperate more with in-group members than with out-group members in an iterated face-to-face Prisoner's Dilemma Game.

Adults are more likely to cooperate with in-group members than with out-group members in the context of social dilemmas, situations in which self-interest is in conflict with collective interest. This bias has the potential to profoundly shape human cooperation, and therefore it is important to understand when it emerges in development. Here we asked whether 6- to 9-year-old children (N = 146) preferentially cooperate with in-group members in the context of a well-studied social dilemma, the iterated Prisoner's Dilemma Game. We assigned children to minimal groups and paired them with unfamiliar same-age and same-gender peers. Consistent with our predictions, children were more likely to cooperate with in-group members than with out-group members in this minimal group context. This finding adds to the current literature on group bias in children's prosocial behavior by showing that it affects decision making in a context that calls on strategic cooperation. In addition, our analyses revealed an effect of gender, with girls more likely to cooperate than boys regardless of the group membership of their partner. Exploring this gender effect further, we found an interaction between gender and age across condition, with older girls showing less sensitivity to the group membership of their partner than younger girls and with older boys showing more sensitivity to the group membership of the partner than younger boys. Our findings suggest that risky cooperation in the face of social dilemmas is shaped by group bias during childhood, highlighting the potentially deeply rooted ties between cooperation and parochialism in humans.

Prisoners regulating prisons: Voice, action, participation and riot.

Prisoners are a critical source of prison regulation around the world, but regulation by (rather than of) prisoners remains little analysed. In this article, we utilise the 1990 riots at HMP Strangeways (England), as a case study of prisoners (re)shaping imprisonment. We examine prisoners' roles in these riots and subsequent cross-sectoral regulatory activities. We innovatively use the four-phase process of translation from actor-network theory to guide document analysis of (1) Lord Woolf's official inquiry into the riots and (2) the voluntary organisation Prison Reform Trust's follow-up report. We explore how participatory approaches could inform prison regulation through (former) prisoners partnering with external regulators throughout the processes of identifying problems and solutions to establish broader alliances seeking social change.

Computer anthropomorphisation in a socio-economic dilemma.

In the study of human behaviour, non-social targets are often used as a control for human-to-human interactions. However, the concept of anthropomorphisation suggests that human-like qualities can be attributed to non-human objects. This can prove problematic in psychological experiments, as computers are often used as non-social targets. Here, we assessed the degree of computer anthropomorphisation in a sequential and iterated prisoner's dilemma. Participants (N = 41) faced three opponents in the prisoner's dilemma paradigm-a human, a computer, and a roulette-all represented by images presented at the commencement of each round. Cooperation choice frequencies and transition probabilities were estimated within subjects, in rounds against each opponent. We found that participants anthropomorphised the computer opponent to a high degree, while the same was not found for the roulette (i.e. no cooperation choice difference vs human opponents; p = .99). The difference in participants' behaviour towards the computer vs the roulette was further potentiated by the precedent roulette round, in terms of both cooperation choice (61%, p = .007) and cooperation probability after reciprocated defection (79%, p = .007). This suggests that there could be a considerable anthropomorphisation bias towards computer opponents in social games, even for those without a human-like appearance. Conversely, a roulette may be a preferable non-social control when the opponent's abilities are not explicit or familiar.