Taxing working memory to modulate mental imagery of the 9/11 terrorist attacks following media exposure during childhood: a pilot study in young adult UK residents.

BACKGROUND AND OBJECTIVES: Media trauma in civilians is linked to intrusive imagery-based memory symptoms. We investigated whether mental imagery of the 9/11 terrorist attacks following media exposure is dampened by taxing working memory (WM). METHODS: Forty-five young adult UK residents, who were exposed to the 9/11 terrorist attacks as children via the media, identified a personally-relevant mental image of the attacks. They were then randomly allocated to: (1) recall + Tetris, (2) recall + eye movements (EMs), or (3) recall-only. Ratings on imagery vividness and emotionality were provided at three time points: pre-, post-manipulations, and at 24-hr follow-up. RESULTS: Repeated measures ANOVAs revealed that recall + Tetris and recall + EMs (relative to recall-only) significantly reduced imagery vividness and emotionality from pre- to post-manipulations, but not to follow-up. LIMITATIONS: A passive control group is needed to fully rule out the role of natural memory decay; the follow-up was exploratory and took place outside the laboratory with reduced experimental control. CONCLUSIONS: Aversive memory imagery from media trauma in civilians can be dampened by taxing WM, at least temporarily, which could be therapeutically useful. The use of such cognitive techniques may also hold relevance for public health approaches to address the impact of collective trauma.

Pre-trauma Growth under Terror Threat: Suggestive Communication Method in Anticipatory Trauma.

Counterterror measures put communities in a state of alertness for several years. Jewish schools in Europe respond with higher security measures, going through transformations in their daily routines and environments, marked by security rituals. Anticipating the trauma creates extreme situations that polarizes the sense of agency and alters the state of consciousness, having a collective impact. Analyzing the anticipatory trauma within the framework of the altered state of consciousness opens the possibility for intervening with suggestive communication methods that aim to increase the sense of agency. The positive effect of teachers learning the suggestive communication methods on the sense of agency was measured with the Sense of Agency Scale. The altered state of consciousness in anticipatory trauma opens the mind for the sense of agency changing in a signature pattern, in a way that is typical for a group, allowing cultural reproduction.

Hyperbaric oxygen therapy for severe blast injury of lower extremity after terrorist attack: case report.

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair.

Either or? Reconciling Findings on Mental Health and Extremism using a Dimensional Rather than Categorical Paradigm.

The background for this paper is the debate over what role mental illness plays in radicalization to violent extremism. While one camp points to cases of abnormal functioning of perpetrators, another argues that normal psychological mechanisms are central. Through a review of these perspectives, it becomes clear that mental illness cannot be ruled out as an epi-phenomenon, but is not a necessary condition either. The paper draws on work in psychiatric nosology on dimensional and categorical conceptions of illness and argues that the perspectives in this literature reflect a categorical approach to normal and abnormal functioning. Under a dimensional perspective, findings converge. The paper concludes by showing how this new dimensional approach to the role of mental illness in radicalization has implications for the design of risk assessment tools and leads to the recommendation for stronger inter-agency cooperation between mental health professionals, social services, and police and intelligence services.

Plausible folk theories: throwing veils of plausibility over zones of ignorance in global governance.

In an age of expertise, where knowledge ostensibly reigns, global governance not infrequently settles for ignorance. To understand this puzzle, this article draws upon extensive empirical research on two sites within the global governance of finance. One is directed to the suppression of money laundering and combating the financing of terrorism by the Financial Action Task Force and International Monetary Fund. Another intends to stimulate the supply of otherwise scarce money to financial markets through global lawmaking by the UN Commission on International Trade Law. In both cases vast enterprises of global regulation and lawmaking proceed on weakly founded justificatory rhetorics designated here as 'plausible folk theories.' Six properties make a folk theory plausible: parsimony, face validity, rhetorical compactness, ambiguity, affinity with extant beliefs, and unexamined premises and logics. Plausible folk theories offer organizational benefits to IOs. They also allow a politics of temporality that may shorten temporal horizons, or weaken and eliminate IO accountability. Finally, three variants of ignorance contribute to choices by international organizations not to get beyond plausible folk theories to justify their regulatory and lawmaking initiatives: inadvertent ignorance, willful ignorance, and strategic or rational ignorance.

Otologic Outcomes After Blast Injury: The Brussels Bombing Experience.

OBJECTIVE: After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included. INTERVENTION: All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient. MAIN OUTCOME MEASURES: Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations. RESULTS: Fifty-six patients were included in our population with an average age of 27 ±â€Š13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ±â€Š74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups. CONCLUSIONS: Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.

Bones heal, teeth don't! The involvement of dentists in the acute and long-term management of patients injured in the Manchester Arena Bomb.

This paper outlines the involvement of dentists in the treatment of patients following the terror attack at Manchester Arena on 22 May 2017. It predominantly describes the role of the authors - a paediatric dental consultant and maxillofacial surgery dental core trainee (DCT). As a result of the incident a number of patients suffered oro-facial injuries, with many treated at Central Manchester Foundation Trust Hospitals' Manchester Royal Infirmary and Royal Manchester Children's Hospital. The major incident response of the trust is discussed, as are the presentation of blast injuries and corresponding NHS guidance. Two paediatric cases present the role of the paediatric dental consultant in the acute, intermediate and long-term management of these patients. The presentation of unique dento-alveolar injuries in the context of other trauma and their subsequent treatment demanded true multidisciplinary management. The importance of teeth and oral health to physical and psycho-social wellbeing and recovery was clear and recognised by other teams involved in the patients' management. The experience reinforced the overall impact dental health has on physical and psycho-social health, and how a holistic approach is integral to treatment of major trauma.

Medical Effects of a Transuranic "Dirty Bomb".

The modern military battlefields are characterized by the use of nonconventional weapons such as encountered in the conflicts of the Gulf War I and Gulf War II. Recent warfare in Iraq, Afghanistan, and the Balkans has introduced radioactive weapons to the modern war zone scenarios. This presents the military medicine with a new area of radioactive warfare with the potential large scale contamination of military and civilian targets with the variety of radioactive isotopes further enhanced by the clandestine use of radioactive materials in the terrorist radioactive warfare. Radioactive dispersal devices (RDDs), including the "dirty bomb," involve the use of organotropic radioisotopes such as iodine 131, cesium 137, strontium 90, and transuranic elements. Some of the current studies of RDDs involve large-scale medical effects, social and economic disruption of the society, logistics of casualty management, cleanup, and transportation preparedness, still insufficiently addressed by the environmental and mass casualty medicine. The consequences of a dirty bomb, particularly in the terrorist use in urban areas, are a subject of international studies of multiple agencies involved in the management of disaster medicine. The long-term somatic and genetic impact of some from among over 400 radioisotopes released in the nuclear fission include somatic and transgenerational genetic effects with the potential challenges of the genomic stability of the biosphere. The global contamination is additionally heightened by the presence of transuranic elements in the modern warzone, including depleted uranium recently found to contain plutonium 239, possibly the most dangerous substance known to man with one pound of plutonium capable of causing 8 billion cancers. The planning for the consequences of radioactive dirty bomb are being currently studied in reference to the alkaline earths, osteotropic, and stem cell hazards of internally deposited radioactive isotopes, in particular uranium and transuranic elements. The spread of radioactive materials in the area of the impact would expose both military and civilian personnel to the blast and dust with both inhalational, somatic, and gastrointestinal exposure, in the aftermath of the deployment of RDDs. The quantities of radioactive materials have proliferated from the original quantity of plutonium first isolated in 1941 from 0.5 mg to the current tens of thousands of kilograms in the strategic nuclear arsenal with the obvious potential consequences to the biosphere and mankind. In an event of RDD employment, the immediate goal of disaster and mass casualty medicine would be a synchronized effort to contain the scope of the event, followed by cleanup and treatment procedures. A pragmatic approach to this problem is not always possible because of unpredictability of the terrorist-use scenarios.

Management of Vascular Trauma during the Paris Terrorist Attack of November 13, 2015.

BACKGROUND: On November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The Public Hospitals of Paris Organization and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study is to analyze the management of the victims presenting with a nonthoracic vascular trauma (NTVT). METHODS: All the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively. A 6-month follow-up was obtained for all the patients. RESULTS: Among the 351 wounded, 20 (5.7%) patients had an NTVT and were dispatched in 8 hospitals (11 men of average age 32). NTVTs were gunshots in 17 cases (85%) or due to a handmade bomb in 3 cases (15%). Twelve patients (60%) received cardiopulmonary resuscitation during prehospital care. NTVT affected the limbs (14 cases, 70%) and the abdomen or the small pelvis (6 cases, 30%). All the patients were operated in emergency. Arterial lesions were treated with greater saphenous vein bypasses, by ligation, and/or embolization. Eleven venous lesions were treated by direct repair or ligation. Associated lesions requiring a specific treatment were present in 19 patients (95%) and were primarily osseous, nervous, and abdomino-pelvic. Severe postoperative complications were observed in 9 patients (45%). Fourteen patients (70%) required blood transfusion (6.4 U of packed red blood cells on average, range 0-48). There were no deaths or amputation and all vascular reconstructions were patent at 6 months. CONCLUSIONS: The effectiveness of the prehospital emergency services and a multisite and multidisciplinary management made it possible to obtain satisfactory results for NTVT casualties. All the departments of vascular surgery must be prepared to receive many wounded victims in the event of terrorist attacks.

Muslim Spirituality, Religious Coping, and Reactions to Terrorism Among Pakistani University Students.

Pakistani Muslim university students (N = 207) displayed Personal Distress, Public Distress, and Personal Defeat Reactions to Terrorism. All three reactions predicted poorer mental health with Personal Defeat being especially disturbed in its adjustment implications. In line with the assumptions of coping theory, scores on the Negative Religious Coping Scale correlated positively with Personal Distress and with Personal Defeat. However, Positive Religious Coping, the spirituality of Muslim Experiential Religiousness, and the Intrinsic and Extrinsic Personal Religious Orientations exhibited positive rather than the expected negative linkages with Personal Distress and Public Distress. Muslim Experiential Religiousness moderated associations of Positive and Negative Religious Coping with Public Distress. When spirituality was high, these relationships were negative. When spirituality was low, they became positive. These data documented the negative impacts that terrorism can have on Pakistanis and suggested that Muslim religious commitments may have an important role to play in resisting those influences.

Civilian casualties of terror-related explosions: The impact of vascular trauma on treatment and prognosis.

OBJECTIVES: A high prevalence (10%) of vascular trauma (VT) was previously described in terror-related trauma as compared with non-terror-related trauma (1%), in a civilian setting. No data regarding outcome of VT casualties of improvised explosive device (IED) explosions, in civilian settings, are available. The aim of the current study is to present the prognosis of civilian casualties of IED explosions with and without VT. METHODS: A retrospective analysis of the Israeli National Trauma Registry was performed. All patients in the registry from September 2000 to December 2005 who were victims of explosions were included. These patients were subdivided into patients with VT (n = 109) and non-VT (NVT) (n = 1,152). Both groups were analyzed according to mechanism of trauma, type and severity of injury, and treatment. RESULTS: Of 1,261 explosion casualties, there were 109 VT victims (8.6%). Patients with VT tended to be more complex, with a higher injury severity score (ISS): 17.4% with ISS 16 to 24 as compared with only 10.5%. In the group of critically injured patients (ISS, 25-75), 51.4% had VT compared with only 15.5% of the NVT patients. As such, a heavy share of hospitals' resources were used-trauma bay admission (62.4%), operating rooms (91.7%), and intensive care unit beds (55.1%). The percentage of VT patients who were admitted for more than 15 days was 2.3 times higher than that observed among the NVT patients. Lower-extremity VT injuries were the most prevalent. Although many resources are being invested in treating this group of patients, their mortality rate is approximately five times more than NVT (22.9% vs. 4.9%). CONCLUSIONS: Vascular trauma casualties of IED explosions are more complex and have poorer prognosis. Their higher ISS markedly increases the hospital's resource utilization, and as such, it should be taken into consideration either upon the primary evacuation from the scene or when secondary modulation is needed in order to reduce the burden of the hospitals receiving the casualties. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level V.

Psychosocial Interventions for Children and Adolescents after a Disaster: A Systematic Literature Review (1991–2015)

OBJECTIVES: The aim of this systematic literature review is to analyze the psychosocial interventions for children and adolescents after disasters. METHODS: We conducted a review of the extant research literature from 1991 to 2015 via a comprehensive search of the MEDLINE, EMBASE, Cochrane CENTRAL, PubMed and PsyclNFO databases. The keywords employed in this research included: ‘child’, ‘adolescent’, ‘youth’, ‘disaster’, ‘posttraumatic’, ‘psychosocial’, ‘therapy’ and ‘intervention’. The researchers followed the PRISMA guidelines. A total of 850 articles were screened for their eligibility and fifty-nine were found to meet the study criteria. The final data analysis was performed based on the disaster type, study design, type of intervention, sample size, age, school grade, number of sessions, setting of intervention delivery, providers, approach and parent involvement. RESULTS: Countries worldwide have experienced various kinds of disasters, including earthquakes, hurricanes, vessel accidents, tornados, tsunamis, volcanic eruptions, war, fire, terrorism, and traffic accidents. The types of psychosocial intervention that were conducted after these disasters included: psychological first aid, psychological debriefing, psychoeducation, trauma focused cognitive behavior therapy, eye movement desensitization reprocessing, prolonged exposure therapy, group play therapy and arts therapy, project interventions, school-based interventions and web-based interventions. CONCLUSION: The findings of the systematic literature review suggest that an appropriate psychosocial intervention could be utilized as evidence-based mental health treatment for children and adolescents after disasters.

Oil terrorism-militancy link: Mediating role of moral disengagement in emergency and crisis management.

The controversial issues of terrorism and militancy have generated contemporary interests and different interpretations have emerged on how to combat and manage these dangerous events. This study widens understanding of moral disengagement mechanism application in the perpetuation of inhumanities within the context of oil terrorist and militant behaviors. The research findings and model are explicit on how people form moral evaluations of agents who are forced to make morally relevant decisions over times in context of crisis situations. Quite crucially, understanding the context of terrorism and militancy provides policymakers, emergency and crisis managers better analysis and response to such events. The research fundamental purpose was to investigate the mediating role of moral disengagement on delinquency of oil terrorism and militancy; and considered implications for emergency and crisis management practices. The study found that situational-induced crises such as oil terrorism and militancy were sufficient to account for an individual's misdeeds and unethical or inhumane decisions made under frustration and agitation may be perceived as less indicative of one's fundamental character. Findings suggest that more repugnant delinquencies could have been committed in the name of justice than in the name of injustice, avenues for future research. In context, the result of the moral disengagement scale shows that morality of delinquency (oil terrorism and militancy) is accomplished by cognitively redefining the morality of such acts. The main finding is that people in resistance movements are rational actors making rational choices. The authors argue that theorists, policymakers, and practitioners must give meaningful attention to understanding the multidimensional nature of emergency, crisis and disaster management for better strength of synthesis between theory and practice. The research is concluded by thorough examination of the implication and limitations for future research and practice.

Preclinical development of a bridging therapy for radiation casualties: appropriate for high risk personnel.

The authors demonstrate the efficacy of a bridging therapy in a preclinical animal model that allows the lymphohematopoietic system of severely immunocompromised individuals exposed to acute, high-dose ionizing irradiation to recover and to survive. CD2F1 mice were irradiated acutely with high doses causing severe, potentially fatal hematopoietic or gastrointestinal injuries and then transfused intravenously with progenitor-enriched, whole blood, or peripheral blood mononuclear cells from mice injected with tocopherol succinate- and AMD3100- (a chemokine receptor anatogonist used to improve the yield of mobilized progenitors). Survival of these mice over a 30-d period was used as the primary measured endpoint of therapeutic effectiveness. The authors demonstrate that tocopherol succinate and AMD3100 mobilize progenitors into peripheral circulation and that the infusion of mobilized progenitor enriched blood or mononuclear cells acts as a bridging therapy for lymphohematopoietic system recovery in mice exposed to whole-body ionizing irradiation. The results demonstrate that infusion of whole blood or blood mononuclear cells from tocopherol succinate (TS)- and AMD3100-injected mice improved the survival of mice receiving high radiation doses significantly. The efficacy of TS-injected donor mice blood or mononuclear cells was comparable to that of blood or cells obtained from mice injected with granulocyte colony-stimulating factor. Donor origin-mobilized progenitors were found to localize in various tissues. The authors suggest that tocopherol succinate is an optimal agent for mobilizing progenitors with significant therapeutic potential. The extent of progenitor mobilization that tocopherol succinate elicits in experimental mice is comparable quantitatively to clinically used drugs such as granulocyte-colony stimulating factor and AMD3100. Therefore, it is proposed that tocopherol succinate be considered for further translational development and ultimately for use in humans.

Mental health interventions for children exposed to disasters and terrorism.

OBJECTIVE: The purpose of this review is to describe interventions used with children who are exposed to disasters and terrorism and to present information about the potential benefits of these interventions. METHODS: A literature search conducted in January 2013 using relevant databases and literature known to the authors that was not generated by the search yielded a total of 85 studies appropriate for review. RESULTS: Intervention approaches used with children exposed to disasters and terrorism included preparedness interventions, psychological first aid, psychological debriefing, psychoeducation, cognitive behavioral techniques, exposure and narrative techniques, eye movement desensitization and reprocessing, and traumatic grief interventions. The investigation of these interventions is complex, and studies varied in methodological rigor (e.g., sample size, the use of control groups, outcomes measured). CONCLUSIONS: Given the limitations in the currently available empirical information, this review integrates the literature, draws tentative conclusions about the current state of knowledge, and suggests future directions for study.