[Abstract] Sentencing intoxicated offenders: does alcoholism excuse drunkenness?

Criminal responsibility is founded on the volitional control of action, yet many offences are committed whilst intoxicated. Alcohol is a widely-used intoxicant known to impair behavioural control and memory, opening the door to claims of partial or absent responsibility. Criminal law rules have developed to resist such claims. In particular, findings of criminal responsibility in intoxicated offenders frequently call on ‘prior fault’ logic: the intoxicated offender may claim to have been irrational, but culpability can be imported from their earlier, rational choice to consume intoxicants (Robinson, 1985). That drunkenness does not excuse derives from an unforced choice to become drunk. Yet this raises questions over the extent to which an alcoholic’s choice to drink is unforced. Current neurobiological models of addiction stress compulsion as a primary component, bringing into question the volitional nature of continued consumption (Volkow & Fowler, 2000; Dalley, Everitt, & Robbins, 2011). At the same time, some legal scholars have noted that the potentially fatal nature of alcoholic withdrawal could likewise undermine suggestion that consumption is voluntary, drawing analogy to a defence of duress where actions have been forced under the threat of death (Husak, 1999; Yaffe, 2013). We asked 290 UK Magistrates to consider a criminal sentencing scenario in which evidence of a defendant’s state of intoxication at the time of the offence was presented in tandem with information that they were either teetotal, a casual drinker or an alcoholic. We found that intoxication reduced blameworthiness for criminal acts if the offender had no previous experience with alcohol whilst, in direct contrast, intoxication served to aggravate offending if the defendant was an alcoholic. The likelihood of our defendant receiving a reduced sentence was over ten times greater in the event that, though intoxicated, they were not also an alcoholic. Leniency was blocked by alcoholism despite Magistrates’ qualitative responses suggesting its understanding as a generally mitigating factor, revealing a disconnect between expressed opinion and sentencing behaviour in practice. Our results indicate that, far from excusing drunkenness, the state of being an alcoholic is more frequently deemed to aggravate offending, being associated with harsher sentencing even where the offence in question was committed whilst sober

Global Policy and Practice for Intrauterine Fetal Resuscitation During Fetal Surgery for Open Spina Bifida Repair

IMPORTANCE: Globally accepted recommendations suggest that a woman should be between 19 weeks and 25 weeks plus 6 days of pregnancy to be considered eligible for fetal closure of open spina bifida. A fetus requiring emergency delivery during surgery is therefore potentially considered viable and thus eligible for resuscitation. There is little evidence, however, to support how this scenario is addressed in clinical practice. OBJECTIVE: To explore current policy and practice for fetal resuscitation during fetal surgery for open spina bifida in centers undertaking fetal surgery. DESIGN, SETTING, AND PARTICIPANTS: An online survey was designed to identify current policies and practices in place to support fetal surgery for open spina bifida, exploring experiences and management of emergency fetal delivery and fetal death during surgery. The survey was emailed to 47 fetal surgery centers in 11 countries where fetal spina bifida repair is currently performed. These centers were identified through the literature, the International Society for Prenatal Diagnosis center repository, and an internet search. Centers were contacted between January 15 and May 31, 2021. Individuals volunteered participation through choosing to complete the survey. MAIN OUTCOMES AND MEASURES: The survey comprised 33 questions of mixed multiple choice, option selection, and open-ended formats. Questions explored policy and practice supporting fetal and neonatal resuscitation during fetal surgery for open spina bifida. RESULTS: esponses were obtained from 28 of 47 centers (60%) in 11 countries. Twenty cases of fetal resuscitation during fetal surgery during the last 5 years were reported across 10 centers. Four cases of emergency delivery during fetal surgery after maternal and/or fetal complications during the last 5 years were reported across 3 centers. Fewer than half the 28 centers (n = 12 [43%]) had policies in place to support practice in the event of either imminent fetal death (during or after fetal surgery) or the need for emergency fetal delivery during fetal surgery. Twenty of 24 centers (83%) reported preoperative parental counseling on the potential need for fetal resuscitation prior to fetal surgery. The gestational age at which centers would attempt neonatal resuscitation after emergency delivery varied from 22 weeks and 0 days to more than 28 weeks. CONCLUSIONS: In this global survey study of 28 fetal surgical centers, there was no standard practice about how fetal resuscitation or subsequent neonatal resuscitation was managed during open spina bifida repair. Further collaboration between professionals and parents is required to ensure sharing of information to support knowledge development in this area

Incentive learning underlying cocaine relapse requires mGluR5 receptors located on dopamine D1 receptor-expressing neurons

Understanding the psychobiological basis of relapse remains a challenge in developing therapies for drug addiction. Relapse in cocaine addiction often occurs following exposure to environmental stimuli previously associated with drug taking. The metabotropic glutamate receptor, mGluR5, is potentially important in this respect; it plays a central role in several forms of striatal synaptic plasticity proposed to underpin associative learning and memory processes that enable drug-paired stimuli to acquire incentive motivational properties and trigger relapse. Using cell type-specific RNA interference, we have generated a novel mouse line with a selective knock-down of mGluR5 in dopamine D1 receptor-expressing neurons. Although mutant mice self-administer cocaine, we show that reinstatement of cocaine-seeking induced by a cocaine-paired stimulus is impaired. By examining different aspects of associative learning in the mutant mice, we identify deficits in specific incentive learning processes that enable a reward-paired stimulus to directly reinforce behavior and to become attractive, thus eliciting approach toward it. Our findings show that glutamate signaling through mGluR5 located on dopamine D1 receptor-expressing neurons is necessary for incentive learning processes that contribute to cue-induced reinstatement of cocaine-seeking and which may underpin relapse in drug addiction

Extinction of cue-evoked food seeking recruits a GABAergic interneuron ensemble in the dorsal medial prefrontal cortex of mice

Animals must quickly adapt food-seeking strategies to locate nutrient sources in dynamically changing environments. Learned associations between food and environmental cues that predict its availability promote food-seeking behaviors. However, when such cues cease to predict food availability, animals undergo 'extinction' learning, resulting in the inhibition of food-seeking responses. Repeatedly activated sets of neurons, or 'neuronal ensembles', in the dorsal medial prefrontal cortex (dmPFC) are recruited following appetitive conditioning and undergo physiological adaptations thought to encode cue-reward associations. However, little is known about how the recruitment and intrinsic excitability of such dmPFC ensembles are modulated by extinction learning. Here, we used in vivo 2-Photon imaging in male Fos-GFP mice that express green fluorescent protein (GFP) in recently behaviorally-activated neurons to determine the recruitment of activated pyramidal and GABAergic interneuron mPFC ensembles during extinction. During extinction, we revealed a persistent activation of a subset of interneurons which emerged from a wider population of interneurons activated during the initial extinction session. This activation pattern was not observed in pyramidal cells, and extinction learning did not modulate the excitability properties of activated neurons. Moreover, extinction learning reduced the likelihood of reactivation of pyramidal cells activated during the initial extinction session. Our findings illuminate novel neuronal activation patterns in the dmPFC underlying extinction of food-seeking, and in particular, highlight an important role for interneuron ensembles in this inhibitory form of learning

An open-source pipeline for analysing changes in microglial morphology

Changes in microglial morphology are powerful indicators of the inflammatory state of the brain. Here, we provide an open-source microglia morphology analysis pipeline that first cleans and registers images of microglia, before extracting 62 parameters describing microglial morphology. It then compares control and 'inflammation' training data and uses dimensionality reduction to generate a single metric of morphological change (an 'inflammation index'). This index can then be calculated for test data to assess inflammation, as we demonstrate by investigating the effect of short-term high-fat diet consumption in heterozygous Cx3CR1-GFP mice, finding no significant effects of diet. Our pipeline represents the first open-source microglia morphology pipeline combining semi-automated image processing and dimensionality reduction. It uses free software (ImageJ and R) and can be applied to a wide variety of experimental paradigms. We anticipate it will enable others to more easily take advantage of the powerful insights microglial morphology analysis provides

'We did everything we could'- A qualitative study exploring the acceptability of maternal-fetal surgery for spina bifida to parents

OBJECTIVE: To explore the concepts and strategies parents employ when considering maternal-fetal surgery (MFS) as an option for the management of spina bifida (SB) in their fetus, and how this determines the acceptability of the intervention. METHODS: A two-centre interview study enrolling parents whose fetuses with SB were eligible for MFS. To assess differences in acceptability, parents opting for MFS (n=24) were interviewed at three different moments in time: prior to the intervention, directly after the intervention and 3-6 months after birth. Parents opting for termination of pregnancy (n=5) were interviewed only once. Themes were identified and organised in line with the framework of acceptability. RESULTS: To parents opting for MFS, the intervention was perceived as an opportunity that needed to be taken. Feelings of parental responsibility drove them to do anything in their power to improve their future child's situation. Expectations seemed to be realistic yet were driven by hope for the best outcome. None expressed decisional regret at any stage, despite substantial impact and, at times, disappointing outcomes. For the small group of participants, who decided to opt for termination of pregnancy (TOP), MFS was not perceived as an intervention that substantially could improve the quality of their future child's life. CONCLUSION: Prospective parents opting for MFS were driven by their feelings of parental responsibility. They recognise the fetus as their future child and value information and care focusing on optimising the child's future health. In the small group of parents opting for TOP, MFS was felt to offer insufficient certainty of substantial improvement in quality of life and the perceived severe impact of SB drove their decision to end the pregnancy This article is protected by copyright. All rights reserved

Dealing with False Memories in Children and Adults: Recommendations for the Legal Arena

Children are often viewed as poor eyewitnesses. Fact-finders, lawyers, and researchers assume that children are exceptionally prone to accept external suggestive (leading) questions and to create false memories. Is this assumption justified? This review will show it is not. First, studies on spontaneous false memories— elicited without any suggestive pressure—reveal that children are less likely than adults to produce them. Second, under certain circumstances, children are even less prone to accept external suggestions than adults. This counterintuitive finding happens when false suggestions contain information that is associatively related but in actuality not experienced by children or adults. Using empirically-based interview protocols can maximize the retrieval of accurate memories in children and adults. Furthermore, expert witnesses should use alternative scenarios in order to better evaluate whether statements by children or adults are based on truth or fiction

[Abstract] Impact of disease model of addiction on judgements of criminal responsibility: pivotal role of perceived choice

Debates continue over whether the prevailing neuroscientific model of addiction as a brain disease informs questions around moral and criminal responsibility, but little empirical work has been conducted with those tasked to address this question in practical terms on a daily basis. We have explored this point over two studies, respectively sampling 110 and 276 Magistrates active in the UK. In the first study we asked them to consider a criminal sentencing scenario in which evidence of a defendant’s brain damage and impaired impulse control was presented. This neurological damage was attributed to either a (fictional) disease or to addiction. When the same neuropsychiatric profile resulted from disease, rather than heroin use and addiction, custodial sentences were significantly reduced. The pivotal factor denying addiction the mitigating power of disease was perceived choice in the initial acquisition; removing choice from addiction dramatically increased the odds of sentence reduction, while attaching choice to disease tended to aggravate or reverse earlier leniency. The second study presented another criminal sentencing scenario in which the defendant exhibited similar neurological impairment, but additionally included ‘mixed’ aetiologies in which either disease led to addiction or addiction led to disease. Our results confirm the dramatic effect which the aetiology of impairment can have on judgements of criminal responsibility, whilst moreover give suggestion that drug-use tips the balance in favour of the punitive element when weighing criminal sentencing decisions

Current practice of first-trimester ultrasound screening for structural fetal anomalies in developed countries

Objectives: First-trimester ultrasound screening is increasingly performed to detect fetal anomalies early in pregnancy, aiming to enhance reproductive autonomy for future parents. This study aims to display the current practice of first-trimester ultrasound screening in developed countries. Method: An online survey among 47 prenatal screening experts in developed countries. Results: First-trimester structural anomaly screening is available in 30 of the 33 countries and is mostly offered to all women with generally high uptakes. National protocols are available in 23/30 (76.7%) countries, but the extent of anatomy assessment varies. Monitoring of scan quality occurs in 43.3% of the countries. 23/43 (53.5%) of the respondents considered the quality of first-trimester ultrasound screening unequal in different regions of their country. Conclusions: First-trimester screening for structural fetal anomalies is widely offered in developed countries, but large differences are reported in availability and use of screening protocols, the extent of anatomy assessment, training and experience of sonographers and quality monitoring systems. Consequently, this results in an unequal offer to parents in developed countries, sometimes even within the same country. Furthermore, as offer and execution differ widely, this has to be taken into account when results of screening policies are scientifically published or compared.</p

Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed‐methods systematic review

BACKGROUND: People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low. OBJECTIVES: To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. METHODS: Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three‐stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. RESULTS: Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of services were found to be important facilitators. Evidence from Black, Asian and minority ethnic groups is limited. CONCLUSIONS: People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems. Although some barriers are readily amenable to change, others are more difficult to modify. The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness. Research is warranted into successful models to promote screening, diagnosis and treatment. PATIENT OR PUBLIC CONTRIBUTION: Our team includes a peer advocate, a hepatology nurse and a community volunteer, all with significant experience in promoting and engaging in HCV care and outreach for people experiencing homelessness. They contributed to the protocol, interpretation and reporting of the review findings