Life-long deficits in social adaptation and the frontal lobes: New evidence, seventy-five years after Ackerly and Benton's landmark case report of JP.

The case of JP, reported by Ackerly and Benton in 1948 with a detailed follow-up by Ackerly in 1964, stands as the index case of developmental prefrontal damage and its impact on social adaptation. Although the 1948 case report included findings from a 1933 pneumoencephalogram and exploratory craniotomy, a definitive cause was never established for JP's prefrontal damage. Etiologies were never determined for the left-sided seizures that occurred when JP was age four, nor for the progressive anterograde amnesia that JP developed in middle age. Given Ackerly's thoroughness and long-term follow-up of his patient, it was hoped that a brain cutting would have been done, though no report of a post-mortem examination was published. The lead author of this paper (SB) set out to discover what had happened to JP after Ackerly's 1964 report and whether a brain cutting had in fact occurred. Using a variety of investigative approaches, it was discovered that a post-mortem brain examination had taken place. Those present at the brain cutting were identified, and the still-living witnesses to the brain cutting were interviewed. Previously unpublished, relevant materials were uncovered from archival sources. A film of the brain cutting, as well as photos, were located. A film of Ackerly interviewing JP prior to JP's death at age sixty-four also was found. The authors studied autopsy findings in the newly discovered video and still images. These findings were judged consistent with massive perinatal hemorrhagic damage to both frontal lobes. JP's left-sided seizures were likely due to activation of a focus from his congenital brain damage. The anterograde amnesia that was documented when JP was twenty-five and that was noted to worsen when he was forty-nine remains unexplained but may have been related to slowly progressive hydrocephalus. This paper expands what is known about the case of JP, making it the only report of a person with congenital frontal injury followed for their entire life including post-mortem brain examination.

Operative Management of Thoracic Gunshot Wounds: More Aggressive Treatment Has Been Required over Time.

Our department has a database of thoracic gunshot wounds (GSWs), which has cataloged these injury patterns over the past five decades. Prevailing wisdom on the management of these injuries suggested operative treatment beyond tube thoracostomy is not commonly required. It was our clinical impression that the operative treatment required beyond chest tube placement has greatly increased over the past several decades, whereas the operative management of cardiac GSWs seemed to be increasingly infrequent events. To test these observations, we analyzed the treatment of GSWs to the chest and heart in four distinct time periods, categorized as "historical" (1973-1975 and 1988-1990) and "modern" (2005-2007 and 2015-2017). There was a significant increase in emergent thoracotomy, delayed thoracic operations, overall operative interventions, and pulmonary resections from the historical period to the modern era. There was a decline in cardiac injuries treated, whereas the number of injuries remained constant. Mortality was unchanged between the early and later periods. Operative treatment beyond tube thoracostomy was much more prevalent for noncardiac thoracic GSWs in the past two decades than in the prior decades, whereas the number of cardiac wounds treated decreased by half.

Conducted-Energy Device (Taser) Usage in Subjects With Mental Illness.

Use of a conducted-energy device (CED), or Taser, by law enforcement officers (LEOs) is recommended over more lethal forms of force. LEOs interact with a wide variety of people including individuals with mental illness and those with substance use disorders. The literature is devoid of data regarding the effect of CEDs on this special population. We used data collected by LEOs from 2008 to 2009. There were 233 cases over the two-year period. Of the 233 individuals on whom the Taser was used, 38 had a mental illness and 91 were under the influence of substances (not mutually exclusive). The average number of shocks necessary to achieve compliance was 1.92 for persons with a mental illness (t(231) = 2.565; p = .011, versus nonintoxicated control subjects without mental illness and 2.55 for persons under the influence of stimulants (t(143) = 3.027; p = .003, versus nonintoxicated control subjects without mental illness). The results of this study serve to inform LEOs and administrators of the patterns of use of CEDs in communities.

Responding to sexual violence: critical issues for healthcare providers.

Sexual violence is a monumental problem in Kentucky and elsewhere, and healthcare providers play a critical role in its identification, treatment, and prevention. This article provides essential information for physicians treating survivors of sexual violence, including treatment options, protocol for medical-forensic examinations, tips for documentation, and information about community resources that can facilitate treatment outcomes and proide follow-up services.