Non-fatal injuries among police officers during use-of-force encounters.

BACKGROUND: Occupational injuries are common in police work due to routine exposure to conflict, violence, accidents, and other hazards. However, little is known about the factors associated with non-fatal job-related injuries among police officers. AIMS: To study the factors associated with non-fatal job-related injuries among Tucson, AZ, police officers during encounters involving the use of force. METHODS: Data were analysed on all use-of-force cases involving Tucson police officers from January 2018 through June 2020. Logistic regression models were used to assess the factors that influence the likelihood of officer injuries. RESULTS: Overall, about 11% of officers involved in a use-of-force encounter were injured. Multivariate analyses reveal that defensive physical resistance by the suspect increases injury risk among officers. When suspects assault officers or others during the encounter, the risk of officer injury also increases significantly. Certain types of force used by police, such as hands-on tactics and TASER use are also associated with increased risk of injury among officers. The age and race of the suspect are not associated with the likelihood of injury among officers. CONCLUSIONS: Certain suspect behaviours and use-of-force modalities increase the risk of injury among officers. Understanding these risk factors can help employers put in place appropriate measures to reduce the risk of occupational injuries among police officers.

Functional brain plasticity following childhood maltreatment: A longitudinal fMRI investigation of autobiographical memory processing.

Altered autobiographical memory (ABM) processing characterizes some individuals with experiences of childhood maltreatment. This fMRI study of ABM processing evaluated potential developmental plasticity in neural functioning following maltreatment. Adolescents with (N = 19; MT group) and without (N = 18; Non-MT group) documented childhood maltreatment recalled specific ABMs in response to emotionally valenced cue words during fMRI at baseline (age 12.71 ± 1.48) and follow-up (14.88 ± 1.53 years). Psychological assessments were collected at both timepoints. Longitudinal analyses were carried out with BOLD signal changes during ABM recall and psychopathology to investigate change over time. In both groups there was relative stability of the ABM brain network, with some developmental maturational changes observed in cortical midline structures (ventromedial PFC (vmPFC), posterior cingulate cortex (pCC), and retrosplenial cortex (rSC). Significantly increased activation of the right rSC was observed only in the MT group, which was associated with improved psychological functioning. Baseline group differences in relation to hippocampal functioning, were not detected at follow-up. This study provides preliminary empirical evidence of functional developmental plasticity in children with documented maltreatment experience using fMRI. This suggests that altered patterns of brain function, associated with maltreatment experience, are not fixed and may reflect the potential to track a neural basis of resilience.

Children, seen and heard: a descriptive study of all children (aged 12 years and under) referred for acute psychiatric assessment in Tallaght University Hospital over a 10-year period.

OBJECTIVES: A review of the literature demonstrates that relatively little is known about acute psychiatric presentations in children (0-12 years), compared with adolescents or young adults (12 years+). This study aims to review psychiatric presentations of children to a CAMHS Liaison Service at Children's Hospital Ireland (CHI) at Tallaght University Hospital over a 10-year period. METHODS: A retrospective study was undertaken of case notes of all children aged 12 years and under who were referred to the CAMHS Liaison Service between January 2009 and December 2018 (n = 318). Data were anonymised and inputted into SPSSv25 for analysis. The relationships between presentations and methods of self-harm over time were measured using Pearson's correlation. Associations between categorical variables were analysed using chi-squared tests. RESULTS: There was a significant increase in presentations of under-12s over the 10-year period (r(8)=0.66, p = 0.02). There was also a significant increase in children presenting with a disturbance of conduct and/or emotions over time (r(8) = 0.79, p < 0.001). There was a significant association between female gender and ingestion (X2 = 12.73, df = 1, p < 0.05) and between male gender and ligature as a method of self-harm (X2 = 5.54, df = 1, p < 0.05). Over half (53%) of children presented with suicidal thoughts and 22% presented with suicidal behaviours. The reported use of ligature as a method of self-harm emerged only from 2012 among cases studied. CONCLUSIONS: Children aged 12 years and under are presenting in increasing numbers with acute mental health difficulties, including suicidal thoughts and behaviours. There is a worrying trend in methods of self-harm, particularly in high lethality behaviours such as attempted strangulation.

Substance use and self-harm emergency department presentations during COVID19: evidence from a National Clinical Programme for Self-Harm.

INTRODUCTION: Given the evidence that drinking patterns and self-harm hospital presentations have changed during COVID-19, this study aimed to examine any change in self-harm and suicide-related ideation presentations, together with any possible contribution made by alcohol or substance misuse, to Irish Emergency Departments in 2020, compared with 2018 and 2019. METHODS: A population-based cohort with self-harm and suicide-related ideation presenting to Irish hospitals derived from the National Clinical Programme for Self-Harm was analysed. Descriptive analyses were conducted based on sociodemographic variables and types of presentation for the period January to August 2020 and compared with the same period in 2018 and 2019. Binomial regression analyses were performed to investigate the independent effect of demographic characteristics and pre/during COVID-19 periods on the use of substances as contributory factors in the self-harm and suicide-related ideation presentations. RESULTS: 12,075 presentations due to self-harm and suicide-related ideation were recorded for the periods January-August 2018-2020 across nine emergency departments. The COVID-19 year was significantly associated with substances contributing to self-harm and suicide-related ideation ED presentations (OR = 1.183; 95% CI, 1.075-1.301, p < 0.001). No changes in the demographic characteristics were found for those with self-harm or suicide-related ideation across the years. Suicide-related ideation seemed to be increased after May 2020 compared with previous years. In terms of self-harm episodes with comorbid drug and alcohol overdose and poisoning, these were significantly increased in January-August 2020, compared with previous timepoints (χ2 = 42.424, df = 6, p < 0.001). CONCLUSION: An increase in suicide-related ideation and substance-related self-harm presentations may indicate longer term effects of the pandemic and its relevant restrictions. Future studies might explore whether those presenting with ideation will develop a risk of suicide in post-pandemic periods.

The unseen epidemic: trauma and loneliness in urban midlife women.

BACKGROUND: Connectedness and attachment are vital parts of humanity. Loneliness, a state of distress in reaction to perceived detachment and isolation, is reported by over one-third of U.S. adults and is associated with numerous physical and mental health consequences. What contributes to loneliness, especially in women and minority populations, is poorly understood, but this population is also at greater risk for abuse and trauma. Our study aimed to further understand loneliness in urban midlife women and to explore the relationship that may exist with trauma(s). METHODS: To identify primacies for mental health care, female midlife participants (N=50) of a long-standing urban community-based cohort focused on health improvement completed a one-time audiotaped interview with both quantitative assessments and a qualitative interview. Loneliness was assessed by the UCLA 3-item Loneliness Scale. Using semi-structured interviews, open-ended questions facilitated a discussion regarding mental health needs and experiences. Interview transcripts were coded and analyzed following a grounded theory methodology. Themes around loneliness and trauma emerged. The transcripts were coded using the same methodology and coders as the individual interviews. Twenty women participated in two optional focus groups. RESULTS: Participants had a mean age of 50, with the majority identifying as Black/African American (N=37) and unemployed (N=33). Three themes emerged regarding perceived causes of loneliness: trauma, the burden of responsibilities for others, and secondary to unhealthy relationships. Loneliness associated with trauma will be explored here; other themes are beyond the scope of this paper and will be discussed in subsequent analyses. Quantitative results suggest that physical abuse (loneliness scores 5.4 vs. 4.0, p=0.003), as well as emotional abuse and neglect (loneliness scores 5.6 vs. 4.4, p=0.01), were associated with greater loneliness. CONCLUSION: In urban midlife low-income women, lifetime physical abuse and emotional abuse/neglect are associated with increased feelings of loneliness. Qualitative data provide insight into how participants viewed their traumatic histories, ways in which the trauma has ongoing influence, and how they experience loneliness. Though further investigation is needed, trauma-informed approaches should be considered in both primary care and mental health settings with a focus on mitigating loneliness and providing appropriate support and trauma treatment.

Autism spectrum disorder in older adults with intellectual disability: a scoping review.

INTRODUCTION: Ireland has an ageing population of persons with intellectual disability (ID), autism spectrum disorder (ASD) and both (ID/ASD). Despite this, little is known about the prevalence of ASD and its effect on functional outcomes, psychiatric comorbidity or diagnostic issues in an older population with ID. This article reviews the literature on older adults with ID/ASD and identifies opportunities for future research in this population. METHOD: The authors searched the Medline, Pubmed, Embase, CINAHL and PsychInfo databases using the search terms using key words: (older adults) AND (ID OR mental retardation OR learning disability) AND (autism OR ASD). After excluding articles for relevance, a scoping review was carried out on the results retrieved. RESULTS: Of the 1227 articles retrieved from the literature on ID and autism/ASD in older adults, 85 articles were relevant to an adult population with ID/ASD. The data were collated and are presented covering domains of diagnosis, prevalence, psychiatric comorbidities and functional outcomes. CONCLUSIONS: Despite increased prevalence in childhood ASD in the last 20 years, there is a lack of research regarding adults, especially older adults, with ASD, up to half of whom will have some level of ID. The existing literature suggests that older adults with ID/ASD may have reduced functional independence, increased psychiatric comorbidity and psychotropic prescribing and more behavioural presentations than the older population generally or those with ID only. There is a need for longitudinal data to be collected on this ageing population so that care and management needs can be met in the future.

Disclosing large scale adverse events in the US Veterans Health Administration: lessons from media responses.

OBJECTIVES: We examined print, broadcast and social media reports about health care systems' disclosures of large scale adverse events to develop future effective messaging. STUDY DESIGN: Directed content analysis. METHODS: We systematically searched four communication databases, YouTube and Really Simple Syndication (RSS) feeds relating to six disclosures of lapses in infection control practices in the Department of Veterans Affairs occurring between 2009 and 2012. We assessed these with a coding frame derived from effective crisis and risk communication models. RESULTS: We identified 148 unique media reports. Some components of effective communication (discussion of cause, reassurance, self-efficacy) were more present than others (apology, lessons learned). Media about 'promoting secrecy' and 'slow response' appeared in reports when time from event discovery to patient notification was over 75 days. Elected officials' quotes (n = 115) were often negative (83%). Hospital officials' comments (n = 165) were predominantly neutral (92%), and focused on information sharing. CONCLUSIONS: Health care systems should work to ensure that they develop clear messages focused on what is not well covered by the media, including authentic apologies, remedial actions taken, and shorten the timeframe between event identification and disclosure to patients.

Assessment of the environmental microbiological cross contamination following hand drying with paper hand towels or an air blade dryer.

AIMS: This study compared the potential for cross contamination of the surrounding environment resulting from two different hand-drying methods: paper towels and the use of an air blade dryer. METHODS AND RESULTS: One hundred volunteers for each method washed their hands and dried them using one of the two methods. Bacterial contamination of the surrounding environment was measured using settle plates placed on the floor in a grid pattern, air sampling and surface swabs. Both drying methods produced ballistic droplets in the immediate vicinity of the hand-drying process. The air blade dryer produced a larger number of droplets which were dispersed over a larger area. Settle plates showed increased microbial contamination in the grid squares which were affected by ballistic droplets. Using the settle plates counts, it was estimated that approx. 1.7 × 10(5) cfu more micro-organisms were left on the laboratory floor (total area approx. 17.15 m(2)) after 100 volunteers used an air blade dryer compared to when paper towels were used. CONCLUSIONS: The two drying methods led to different patterns of ballistic droplets and levels of microbial contamination under heavy use conditions. Whilst the increase in microbial levels in the environment is not significant if only nonpathogenic micro-organisms are spread, it may increase the risk of pathogen contamination of the environment when pathogens are occasionally present on people's hands. SIGNIFICANCE AND IMPACT OF THE STUDY: The study suggests that the risk of cross contamination from the washroom users to the environment and subsequent users should be considered when choosing a hand-drying method. The data could potentially give guidance following the selection of drying methods on implementing measures to minimise the risk of cross contamination.

Taxonomy-Based Glyph Design—with a Case Study on Visualizing Workflows of Biological Experiments.

Glyph-based visualization can offer elegant and concise presentation of multivariate information while enhancing speed and ease in visual search experienced by users. As with icon designs, glyphs are usually created based on the designers' experience and intuition, often in a spontaneous manner. Such a process does not scale well with the requirements of applications where a large number of concepts are to be encoded using glyphs. To alleviate such limitations, we propose a new systematic process for glyph design by exploring the parallel between the hierarchy of concept categorization and the ordering of discriminative capacity of visual channels. We examine the feasibility of this approach in an application where there is a pressing need for an efficient and effective means to visualize workflows of biological experiments. By processing thousands of workflow records in a public archive of biological experiments, we demonstrate that a cost-effective glyph design can be obtained by following a process of formulating a taxonomy with the aid of computation, identifying visual channels hierarchically, and defining application-specific abstraction and metaphors.

The neuroscience of remote spatial memory: a tale of two cities.

Most of our everyday activities take place in familiar environments learned in the past which we need to constantly navigate. Despite our obvious reliance on these remote spatial memories, until quite recently relatively little was known about how they are instantiated in the human brain. Here we will consider developments in the neuropsychological and neuroimaging domains where innovative methodologies and novel analysis techniques are providing new opportunities for exploring the brain dynamics underpinning the retrieval and use of remotely learned spatial information. These advances allow three key questions to be considered anew: What brain areas in humans support the retrieval and use of remotely learned spatial information? Where in the brain are spatial memories stored? Do findings relating to remote spatial memory inform theoretical debates about memory consolidation? In particular, the hippocampus, parahippocampus, retrosplenial and parietal cortices are scrutinized, revealing new insights into their specific contributions to representing spaces and places from the past.

Cardiac luxation: an unusual complication of a log roll.

Cardiac luxation is a rare but potentially fatal consequence of blunt thoracic trauma. We present a case of a pericardial tear with cardiac luxation following blunt chest trauma. It is hypothesised that the cardiac luxation occurred while log rolling the patient during the initial assessment. This report stresses the need to be aware of the potential for such a complication.

Anterior prefrontal involvement in episodic retrieval reflects contextual interference.

Different patterns of prefrontal activation are commonly found in studies of episodic and source memory (typically anterior and lateral) compared to those found in studies of autobiographical memory (typically ventromedial). We investigated a proposal that the former pattern reflects contextual interference when retrieving events that occurred in similar contexts. We used virtual reality to simulate contextually varied life-like events, in which subjects received distinct objects from a number of people in a number of locations. We compared fMRI data from two experiments in which the number of events per context varied. The first experiment (Burgess, N., Maguire, E.A., Spiers, H.J., and O'Keefe, J. 2001. A temporoparietal and prefrontal network for retrieving the spatial context of lifelike events. Neuroimage 14, 439-453) involved 16 objects received from one of two people in one of two locations. The second experiment involved 20 objects, each received from a different person in a different location. The first experiment showed extensive bilateral activation of anterior and lateral prefrontal cortex, as well as a medial temporal and parietal network characteristic of both autobiographical and episodic memory. In the second study, the prefrontal activations were largely absent, while the medial parietal and temporal activations remained, and a ventromedial prefrontal area was additionally activated. Direct comparisons revealed large areas of significantly reduced activation in BA10, with lesser reductions in lateral prefrontal regions. We suggest that involvement of these prefrontal regains in episodic and source memory reflects the use of paradigms involving many events and few sources rather than any fundamental processing requirement of contextual retrieval in the absence of interference.

Remembering the past: neuroimaging studies of human memory.

The ability to find our way around an environment and to remember the events that occur within it are fundamental to normal functioning in daily life. Impairment of these abilities are among the first symptoms to be reported in patients with pathologies such as Alzheimer's disease and anoxia that are linked to the hippocampus and other limbic structures. However, many questions remain unanswered regarding the nature and neural bases of these memories. Findings from functional neuroimaging studies offer insights into the anatomy of memory and the presentation of memory impairments. In particular, neuroimaging is well placed to inform about the functionality of residual brain tissue, and the plasticity of memory anatomy in the context of hippocampal damage, and normal ageing.

Emergency contraception. Has over the counter availability reduced attendances at emergency departments?

Legislation introduced in January 2001 has meant that progestogen only contraception is now available without prescription for women aged 16 years and over. Patient records of two emergency departments in the South East Thames region between 2000 and 2001 were reviewed and it was found that there was a 52% reduction in the number of women attending these emergency departments with requests for emergency contraception. These findings suggest that the legislation has meant that more women are getting their emergency contraception without prescription from pharmacies as compared with emergency departments.

A combined neuropsychological and neuroimaging study of topographical and non-verbal memory in semantic dementia.

A combined neuropsychological and neuroimaging investigation was carried out on a patient (O.I.) with semantic dementia who had asymmetrical temporal lobe atrophy, greater on the left. His performance on tests of verbal memory was gravely impaired. Similarly, his visual memory as indexed by recognition of unfamiliar faces was impaired. By contrast, his recognition memory for topographical memoranda (e.g. buildings, landscapes) and ability to find his way around was preserved. In order to identify the neural substrates supporting the preserved recognition of static topographical memoranda, O.I. was scanned using positron emission tomography (PET) during the encoding and recognition of building and landscape stimuli. In common with control subjects, during encoding O.I. activated parahippocampal cortex bilaterally, along with bilateral temporo-parietal, retrosplenial and left frontal cortices. During recognition, both patient and controls activated right parahippocampal, right superior parietal and right frontal cortices. Notably, control subjects, but not O.I., also activated at encoding the precuneus and at recognition the retrosplenial cortex. This allows the conclusion that these two areas while involved may not be necessary for topographical memory. Interestingly, the patient also activated regions that were not evident in control subjects both during encoding and recognition. These additional areas of activation may be necessary in a compensatory role. Overall, these data represent the first reported assessment of the functional integrity of degenerating brain tissue and its contribution to preserved topographical memory. The combination of the neuropsychological and neuroimaging approaches may provide insights into the functional-anatomy of memory while having clinical utility for the assessment of residual brain tissue.

Progressive age-related impairment of cognitive behavior in APP23 transgenic mice.

Transgenic APP23 mice expressing human APP(751) with the K670N/M671L mutation, were compared at ages 3, 18 or 25 months to non-transgenic littermates in passive avoidance and in a small and large Morris maze. The task in the smaller pool habituated their flight response to the platform. Impairments in passive avoidance and small pool performance in APP23 mice were clearly age-related. In the larger Morris maze APP23 mice at all ages were impaired in latency and distance swum before finding the platform. Identical performance of 18-month APP23 and controls in a visible platform condition indicates that the Morris maze performance deficit was not due to sensory, motor or motivational alterations. At age 3 months both groups initially unexpectedly avoided the visible platform, suggesting that in young mice neophobia may contribute significantly to performance in cognitive tests. In conclusion, APP23 mice exhibit both early behavioral impairment in the large Morris maze as well as impairments in passive avoidance and small pool performance that are marked only in old age.

Hippocampal amnesia.

This article reviews 147 cases of amnesia following damage including the hippocampus or fornix as reported in 179 publications. The aetiology, mnestic abilities and reference(s) are tabulated for each case. Consistent findings across cases include the association of bilateral hippocampal damage with a deficit in anterograde episodic memory combined with spared procedural and working memory. The limited nature of retrograde amnesia following lesions to the fornix is also noted. Less consistent and thus more controversial findings, include effects of lesion size or laterality, deficits in semantic memory or familiarity-based recognition and the extent of retrograde amnesia. The evidence concerning these issues is reviewed across cases.

Unilateral temporal lobectomy patients show lateralized topographical and episodic memory deficits in a virtual town.

A large-scale virtual reality town was used to test the topographical and episodic memory of patients with unilateral temporal lobe damage. Seventeen right and 13 left temporal lobectomy patients were compared with 16 healthy matched control subjects. After they had explored the town, subjects' topographical memory was tested by requiring them to navigate to specific locations in the town. The ability to recognize scenes from and draw maps of the virtual town was also assessed. Following the topographical memory tests, subjects followed a route around the same town but now collected objects from two different characters in two different locations. Episodic memory for various aspects of these events was then assessed by paired forced-choice recognition tests. The results showed an interaction between laterality and test type such that the right temporal lobectomy (RTL) patients were worse on tests of topographical memory, and the left temporal lobectomy (LTL) patients worse on tests of context-dependent episodic memory. Specifically, the RTL group was impaired on navigation, scene recognition and map drawing relative to control subjects. They were also impaired on recognition of objects in the episodic memory task. The LTL group was impaired relative to control subjects on their memory for contextual aspects of the events, such as who gave them the objects, the order in which objects were received and the locations in which they received them. They were also mildly impaired on topographical memory, but less so than the RTL group. These results suggest that topographical memory is predominately mediated by structures in the right medial temporal lobe, whereas the context-dependent aspects of episodic memory in this non-verbal test are more dependent on the left medial temporal lobe.

Neuroimaging, memory and the human hippocampus.

The hippocampus has long been implicated in mnemonic function, although its precise role is still keenly debated. Neuroimaging techniques such as positron emission tomography, functional magnetic resonance imaging and structural MRI, provide the means to examine in vivo the dynamic nature of human memory. Here, I briefly discuss how neuroimaging has investigated complex real-world memories of the kind typically reported lost by patients in the clinical context. A role, paralleling that documented in animals, for the right hippocampus in navigation is clearly apparent from functional and structural neuroimaging findings. In contrast, the left hippocampus is more responsive to memories for events that occur in a specific time and place (episodic memory) that characterise one's personal, or autobiographical, memory store from throughout the lifetime. Neuroimaging is well-placed to extend our understanding of the differential contributions the left and right hippocampi make to aspects of memory and how they interface to produce a unitary representation of the past.