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Mentally disordered offenders may be vulnerable yet also pose particular risk to the public. Achieving appropriate sentencing poses complex challenges for judges in properly determining culpability and punishment, protecting the public, and meeting any identified treatment needs of the defendant. With respect to all three elements there is likely to be necessary reliance upon psychiatric expertise. Despite much previous statutory guidance, there has not – until very recently – been available specific sentencing guidelines from the Sentencing Council (SC) to assist the judiciary in what is a profoundly difficult exercise. This review describes and considers the guidance available to the judiciary in the Crown Courts of England and Wales regarding the various disposal options – including that which 'hybridises' penal and treatment disposal – in addition to facilitating and properly limiting the role of expert evidence. A specific focus is on contextualising, and commenting upon, the SC's recently published Guidance, Sentencing Offenders with Mental Disorders, Developmental Disorders or Neurological Impairments, which seeks to consolidate information, improve knowledge, reduce confusion, and assist the courts towards properly and consistently addressing the relevance of mental disorder to sentencing. In doing so, in the authors' view, it privileges punishment over public safety, leaving judges to address public safety largely without the benefit of the explicit 'routes to sentencing' approach of the Guidance. [ABSTRACT FROM AUTHOR]

Humans generally exhibit a pervasive future bias in favour of optimism. We overestimate the likelihood of success in work, relationships and fi nancial investments. Similarly, we underestimate the probability of experiencing negative events such as, serious illness or fi nancial ruin. The optimism bias is widely considered as one of the most reproducible, prevalent and robust cognitive biases observed in psychology and behavioural economics. The catastrophic impact of the recent economic collapse has laid this cognitive bias bare. In this introductory overview, current understanding of the neural basis of the optimism bias is explored. Topics considered include: converse negative biases in depressive illnesses, the role of dopamine in optimism bias generation and modulation and evidence from functional neuroimaging studies. Research on the optimism bias has afforded us a unique window into decision-making, reward-processing and the potential for systematic irrationality in the human mind. [ABSTRACT FROM AUTHOR]

Decision-making has traditionally been viewed as detached from the neural systems of sensory perception and motor function. Consequently, motor areas have played a relatively minor role in discussions surrounding the control processes and neural origins of decision-making. Empiric evidence, catalysed by technological advances in the past two decades, has proven that motor areas have an integral role in decision-making. They are involved in the generation, modulation, maintenance and execution of decisions and actions. They also take part in a complex hierarchical assessment of multi-modal inputs to ensure that the most appropriate action is generated given the context presented. Clinical conditions such as, alien hand syndrome and utilisation behaviour exemplify the importance of these regulatory controls. This review charts the trajectory of our understanding of the hidden role of motor areas in decision-making and reflects upon the implications of our deepened understanding. The convergence of evidence from multiple modalities underpinning our current knowledge is discussed and the potential applications thereof considered. [ABSTRACT FROM AUTHOR]

Background: Detailed description of the tasks anesthetists undertake during the performance of a complex procedure, such as ultrasound-guided peripheral nerve blockade, allows elements that are vulnerable to human error to be identified. We have applied 3 task analysis tools to one such procedure, namely, ultrasound-guided axillary brachial plexus blockade, with the intention that the results may form a basis to enhance training and performance of the procedure. Methods: A hierarchical task analysis of the procedure was performed with subsequent analysis using systematic human error reduction and prediction approach (SHERPA). Failure modes, effects, and criticality analysis was applied to the output of our SHERPA analysis to provide a definitive hierarchy to the error analysis. Results: Hierarchical task analysis identified 256 tasks associated with the performance of ultrasound-guided axillary brachial plexus blockade. Two hundred twelve proposed errors were analyzed using SHERPA. Failure modes, effects, and criticality analysis methodology was applied to the output of SHERPA analysis to prioritize 20 errors. Conclusions: This study presents a formal analysis of (i) the specific tasks that might be associated with the safe and effective performance of the procedure and (ii) the most critical errors likely to occur as trainees learn to perform the procedure. Potential applications of these data include curricular development and the design of tools to teach and assess block performance. [Copyright &y& Elsevier]

While spinal anaesthesia is preferred for caesarean section, spinal-induced hypotension remains a significant problem and may adversely affect mother and baby. Identifying both mothers at particular risk of hypotension and babies at risk of its detrimental effect on uteroplacental circulation may allow a more targeted management. The mainstay of current management includes vasopressors, intravenous fluids and avoidance of aorto-caval compression. Low-dose spinal anaesthesia can also reduce the incidence but risks inadequate anaesthesia. Novel means of predicting or more rapidly detecting spinal-induced hypotension include the use of continuous non-invasive blood pressure monitoring devices and cerebral oximetry. More timely treatment of hypotension can be achieved with the use of computer-aided automated delivery of vasopressors. Future study of this problem would be aided by a common consensus on the definition of hypotension in this context. [ABSTRACT FROM AUTHOR]