Understanding Misdemeanor Enforcement: The Roles of Calls for Service and Community Characteristics.

This study examines the roles of calls for service (i.e., police-related 911 calls) and community characteristics in explaining variation in enforcement rates for low-level, misdemeanor offenses, which make up the large majority of police enforcement activity. The study site is Prince George's County, Maryland, and the unit of analysis is the police department's 65 patrol beats, studied over a 10-year period, during 2006-2015. Overall, misdemeanor enforcement rates vary at the beat level, and that variation can be largely explained using a combination of indicators about community characteristics and calls for service. The findings indicate, though, that the calls for service rate is the most important variable in explaining misdemeanor enforcement variation. These findings inform both future research on police activity, and current policy debates about what drives enforcement rates and the role of discretion in enforcement outcomes.

The contribution of age structure to the international homicide decline.

BACKGROUND: Since 1990, the world's homicide rate has declined by nearly 20%. While prior research has documented parallel homicide declines across many individual countries, the causes of a shared international homicide decline remain unknown. Drawing on a worldwide process of population ageing, and on research linking age to criminal activity, this study investigates the contribution of global demographic shifts to the international homicide decline. METHODS: We draw from (1) a High Coverage Sample of 126 countries since 1990, and (2) a Long Series Sample of 26 countries since 1960 and utilize fixed-effect regressions to evaluate the impact of age structure on homicide trends. In addition, we use a quantile regression to explore variations in the relationship between age structure and homicide conditional on homicide levels. FINDINGS: Results using the High Coverage Sample suggest no relationship between age structure and homicide. However, results from the Long Series Sample suggest that changes in the relative size of countries' youth population is a major predictor of homicide trends since 1960. In exploring this divergence, we find that the influence of age structure on homicide becomes less evident as other risk factors for violence gain prominence. Thus, while high homicide countries had the most to gain from falling homicide rates, the safety benefits of an ageing population have been concentrated among the least violent countries. INTERPRETATION: While the homicide declines of individual countries have often been attributed to domestic policies, the universality of international homicide trends suggests the influence of broader global phenomenon. We find that countries' homicide trends are strongly associated with changes in the size of their youth populations, particularly where there are few competing criminogenic forces. Based on these results, we propose an explanation for the international homicide decline, while highlighting the importance of demographic patterns in explaining homicide trends.

Sildenafil increases muscle protein synthesis and reduces muscle fatigue.

Reductions in skeletal muscle function occur during the course of healthy aging as well as with bed rest or diverse diseases such as cancer, muscular dystrophy, and heart failure. However, there are no accepted pharmacologic therapies to improve impaired skeletal muscle function. Nitric oxide may influence skeletal muscle function through effects on excitation-contraction coupling, myofibrillar function, perfusion, and metabolism. Here we show that augmentation of nitric oxide-cyclic guanosine monophosphate signaling by short-term daily administration of the phosphodiesterase 5 inhibitor sildenafil increases protein synthesis, alters protein expression and nitrosylation, and reduces fatigue in human skeletal muscle. These findings suggest that phosphodiesterase 5 inhibitors represent viable pharmacologic interventions to improve muscle function.

Early use of allograft skin: are 3-day microbiologic cultures safe?

BACKGROUND: Under the guidance of the American Association of Tissue Banks and the Food and Drug Administration, the use of allograft skin is safer than ever. In addition to the donor selection process and serology studies, current practice is to wait until 7 days of negative microbiologic cultures are completed before use. However, we have used 3 days of negative cultures in special cases as needed for clinical use. But how safe is this practice? METHODS: Between 2002 and 2003, 735 allograft skin donors were authorized for exceptional release. Exceptional release forms were signed by surgeons to document knowledge of the 3-day microbiologic cultures. RESULTS: Only three donors were recalled for positive cultures. The recall rate was 0.41%. CONCLUSIONS: The use of 3-day microbiologic cultures is 99.59% safe. Thus, the early use of allograft skin does not increase the chances of microbiologic contamination to patients.

The effect of premedication with OTFC, with or without ondansetron, on postoperative agitation, and nausea and vomiting in pediatric ambulatory patients.

BACKGROUND: The purpose of this study was to evaluate, in the pediatric ambulatory surgical population, the efficacy of: (i) oral transmucosal fentanyl citrate (OTFC), when given preoperatively, to reduce postoperative excitement associated with sevoflurane, and (ii) intravenous ondansetron to reduce postoperative nausea and vomiting (PONV) associated with OTFC. METHODS: This randomized, double-blinded, placebo controlled study evaluated the efficacy of OTFC [normal dose (ND) = 10-15 microg x kg(-1) or low dose = 100 microg] compared with placebo in the prevention of postoperative agitation; and the efficacy of ondansetron (0.1 mg x kg(-1) to 4 mg) compared with placebo to reduce PONV associated with OTFC. RESULTS: There were 125 patients evaluated (2-10 years old, ASA class I or II and weight 10-40 kg). Preoperatively OTFC was associated with an increased likelihood of cooperation at baseline (P = 0.018). Postoperatively there was a higher incidence of vomiting in children that received OTFC. The anxiety/agitation of patients entering the PACU was significantly less in children who received OTFC ND (P < 0.001). This effect decreased over time. Patients with respiratory adverse events related to the study drug were significantly higher in groups who received OTFC, however, they were not of clinical significance. OTFC was associated with delays in time for eligibility to PACU discharge (P = 0.003). CONCLUSIONS: Even though OTFC reduced early postoperative agitation the increase in side effects, namely PONV and prolonged recovery times, limits its clinical usefulness. The study demonstrates the tradeoffs between anxiety and agitation vs vomiting, respiratory events and prolonged recovery times. Ambulatory pediatric patients undergoing procedures in which opioids would be routinely used might benefit the most from OTFC combined with ondansetron as part of the anesthetic technique.

Transcutaneous electrical acupoint stimulation potentiates analgesic effect of morphine.

Pain is the major complaint of patients who choose acupuncture treatment. Transcutaneous electrical acupoint stimulation (TEAS) provides a safe, standardized technique without needle insertion. TEAS can be tested with the cold-pressor test, a simple, reliable, and widely used model in humansfor the induction of tonic pain. In this controlled study, the effects of TEAS on cold-pressor-induced pain were evaluated in 20 healthy human subjects. Electrical stimulation electrodes were applied to He-Gu (LI 4) and Nui-Guan (P 6) acupoints. The effects of saline plus no TEAS, 15-minute TEAS alone, 0.05 mg/kg morphine alone, and 15-minute TEAS plus morphine were assessed. Pain score ratings were evaluated at four time points from 30 to 170 seconds during the cold-pressor test. The authors observed analgesic effects in both TEAS-alone and morphine-alone sessions, and pain score rating reductions were statistically significant compared to unstimulated control (both p < 0.01). The degree of TEAS analgesia combined with 0.05 mg/kg morphine was significantly higher than TEAS alone (p < 0.01). The results support the efficacy of TEAS analgesia and suggest that combination of TEAS with low-dose morphine can achieve better pain control in a variety of clinical settings.

Use of the BIS monitor to detect onset of naturally occurring sleep.

OBJECTIVES: Inadvertent sleep episodes are a recognized complication of sleep deprivation. Although such events can be life threatening, no system currently exists to detect and prevent sleep onset. Because sleep shares electroencephalographic similarities with the anesthetized state, we hypothesized that the BIS monitor, a currently available EEG-based monitor of anesthetic depth, would detect the onset of physiologic sleep. To test our hypothesis, we monitored volunteers during the transition from waking to sleep. METHODS: Non-medicated volunteers were asked to lie down in a dark room for 30-minutes and fall asleep while attached to a BIS monitor located outside the room. A laptop computer was used to generate an audio tone inside the room. Speaker volume was adjusted to the lowest level detectable by the awake subject. Testing was begun by activating a computer to play a tone at random intervals. The subject was instructed to click a mouse connected to the computer upon hearing the tone to verify wakefulness. The session was terminated upon loss of response to three consecutive tones or after 30 minutes. Subjects were questioned afterwards regarding their perceptions of sleep during testing. RESULTS: 11 out of 28 self-described good sleepers could not sleep under testing conditions. BIS values for the remaining 17 fell from 96.4 +/- 2.1 to 86.5 +/- 0.79 (p < 0.01) upon sleep onset. All subjects responded to audio stimuli at BIS values >90, and were asleep either by subjective or objective report at BIS values <80. Three subjects retained the mouse-click response despite low BIS scores and subjective descriptions of sleep. CONCLUSION: Although variability in the BIS value marking sleep onset was noted, the BIS monitor detected all episodes of sleep onset in our testing regimen. We conclude that a threshold BIS value can be defined to allow the BIS monitor to detect sleep onset.