Technology-facilitated sexual assault in children and adolescents; is there a cause for concern? Fourteen years of experience at a metropolitan forensic paediatric medical service.

AIM: To quantify and characterise sexual assaults occurring after 12-17-year-old children connect with an alleged offender online (technology-facilitated sexual assault: TFSA) examined at a paediatric forensic medical service in Melbourne, Australia between 2014 and 2020. To compare these findings to a previous 7-year audit (2007-2013) to determine if there has been an increase in TFSA over the last 14 years. METHODS: A retrospective audit was undertaken of medical records of children aged 12-17 who underwent forensic medical examinations at the Victorian Forensic Paediatric Medical Service following an allegation of sexual assault, between 1 January 2014 and 31 December 2020. Cases identified as being technology facilitated were further analysed. Results from 2014 to 2020 7-year cohort were then compared to an existing audit over the preceding 7-year period (2007-2013). RESULTS: Of 515 sexual assault cases between 2014 and 2020, 70 (14%) victims reported connecting with the offender on a technological platform, compared to 4% of cases between 2007 and 2013. In 2019 and 2020, TFSA comprised almost one-fifth of caseload. Of the 70 TFSA cases, the majority occurred at the first face-to-face meeting following a variable period of online communication. Approximately one-third of TFSA's occurred at the offender's residence, and another third in a public place (park, public toilets). Technological platforms used evolved over the 14-year study period. CONCLUSIONS: The proportion of TFSA caseload seen at an Australian paediatric forensic medical service increased over the last 14 years, with common characteristics to these sexual assaults suggested.

Antecedents to cardiac arrests in a teaching hospital intensive care unit.

BACKGROUND: In hospital cardiac arrests (CA) treated with cardio-pulmonary resuscitation (CPR) outside of the intensive care unit (ICU) have poor outcomes. Most are preceded by deranged vital signs. There are, however, limited studies assessing antecedents to CAs inside the ICU. OBJECTIVES: To study the antecedents to, and characteristics of CAs in ICU. STUDY POPULATION: We prospectively identified CA cases that occurred inside our ICU between January 2010 and July 2012. Controls were obtained by sequentially matching ICU patients based on APACHE III diagnosis, APACHE III score, age, gender and length of stay in ICU. RESULTS: Thirty-six patients had a CA during the study period (6.28/1000 admissions). In the 12h prior to CA, index patients had higher maximum (22 breaths/min vs. 18 breaths/min, p=0.001) and minimum respiratory rates (16 breaths/min vs. 12 breaths/min, p=0.031), a lower median mean arterial pressure (65 mmHg vs. 70 mmHg, p=0.029) and systolic blood pressure (97 mmHg vs. 106 mmHg, p=0.033), a higher central venous pressure (14 cm H2O vs. 11 cm H2O, p=0.008) and a lower bicarbonate level (20.5 mmol vs. 26 mmol, p=0.018) compared to controls. CA patients also had a higher maximum dose of noradrenaline (norepinephrine) (17.5 mcg/min vs. 8.0 mcg/min, p=0.052) but there was no difference in any other levels of intensive care support. Two-thirds of CA's occurred within the first 48 h of ICU admission. The initial monitored rhythm was non-shock responsive (pulseless electrical activity, bradycardia or asystole) in 26/36 (72%). Return of spontaneous circulation was achieved in 29/36 (80.6%) patients, with 16/36 (44.4%) surviving to hospital discharge. CONCLUSIONS: In the period leading up to the CA inside ICU, there were signs of physiological instability and the need for higher doses of noradrenaline. Return of spontaneous circulation was achieved in 80%. However, in-hospital mortality was greater than 50%.