Police use of force standards and mental health crises in the United States: Identifying research and policymaking targets.

An area of psychology-law research and policy that requires increased attention is the use of force during encounters with someone in mental health crisis. Cases in which law enforcement officer (LEO) intervention during a mental health crisis leads to injury or death of the person in crisis underscore the need to understand what behaviors and circumstances are relevant in excessive force litigation, what concepts may benefit from empirical research, and what facets of policies and precedent may require modification. In particular, the current national and international attention to the United States' external mechanisms of control over police conduct (i.e., criminal and civil proceedings against officers) suggests that excessive force jurisprudence is ripe for examination of its utility and fairness in shaping how police should interact with people with mental illness. Excessive force jurisprudence contains complex legal standards with which many psychology-law practitioners, researchers, and even policymakers are likely unfamiliar, however. The current paper explicates external methods of control over police conduct in the United States by reviewing excessive force jurisprudence and identifying points in need of research and policy attention.

Factors associated with work productivity among people with COPD: Birmingham COPD Cohort.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. AIM: To assess the factors associated with work productivity among COPD patients. METHODS: Cross-sectional analysis of baseline data from a subsample (those in paid employment) of the Birmingham COPD Cohort study. Absenteeism was defined by self-report over the previous 12 months. Presenteeism was assessed using the Stanford Presenteeism Scale. Logistic regression analysis was used to assess the effects of sociodemographic, clinical and occupational characteristics on work productivity. RESULTS: Among 348 included participants, increasing dyspnoea was the only factor associated with both absenteeism and presenteeism (p for trend<0.01). Additionally, increasing history of occupational exposure to vapours, gases, dusts or fumes (VGDF) was independently associated with presenteeism (p for trend<0.01). CONCLUSIONS: This is the first study to identify important factors associated with poor work productivity among patients with COPD. Future studies should evaluate interventions aimed at managing breathlessness and reducing occupational exposures to VGDF on work productivity among patients with COPD.

Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD.

BACKGROUND: Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. METHODS: Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. RESULTS: In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. CONCLUSION: This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.

[Long-term trends in the metabolic profile test results in German Holstein dairy herds in Thuringia, Germany]. / Langfristige Trends im metabolischen Profil von Deutsch-Holstein-Milchviehherden in Thüringen.

OBJECTIVE: Systematic metabolic profile tests at regular intervals provide important information to meet the increasing challenges in managing dairy herds. This study aimed at deriving long-term trends from the results of metabolic profile tests in Thuringian German Holstein dairy herds. MATERIAL AND METHODS: Blood and urine samples were collected from 710 fresh, high yielding, and dry cows, respectively, to monitor 13 parameters including the serum non-esterified fatty acids (NEFA), ß-hydroxybutyrate (BHB), bilirubin, ß-carotene and urea concentrations, the serum of aspartate aminotransferase and glutamate dehydrogenase activities, the serum concentrations of the minerals calcium, inorganic phosphate and selenium, the urine potassium and sodium concentrations, and the net acid-base excretion (NABE). A total of 17,070 group samples from 103 herds were collected during 1997-2014. Period prevalence of aberrant groups was calculated for each parameter and year accordingly. Using a linear regression model, a long-term trend of the period prevalence was determined. RESULTS: To account for the 15 aberrancies possible for each stage of lactation, seven significant trends were found for dry, nine for fresh, and ten for lactating cows. A decrease of the period prevalence was detected for increased NEFA, for low serum ß-carotene, selenium, inorganic phosphate, and urea concentrations, for low sodium and high potassium urine concentrations, and for increased NABE. In contrast, period prevalence increased significantly for cases with increased serum aspartate aminotransferase and glutamate dehydrogenase activities, increased bilirubin concentration, and low NABE. CONCLUSION AND CLINICAL RELEVANCE: Metabolic profile tests enable a description of the herd health status using objectively measured data as a basis for the implementation of measures to optimize herd management to improve the herd health status.

[10-Year Follow-Up of the NexGen CR Total Knee Prosthesis]. / Zehn-Jahres-Ergebnisse nach bikondylärem Kniegelenksersatz mit der kreuzbanderhaltenden Knietotalendoprothese NexGen CR.

BACKGROUND: The purpose of this study was to evaluate long-term clinical and radiological results as well as survival rates of the NexGen® CR posterior cruciate retaining prosthesis. PATIENTS AND METHODS: We evaluated a consecutive series of 761 total knee replacements performed on 716 patients from 1999 to 2001 at our institution. All patients had been recorded prospectively in our in-house arthroplasty register. Follow-up data were available for 379 patients at 10 years postoperatively. Functional outcome was evaluated using the Knee Society score. An additional radiographic evaluation was performed on 224 patients at 10 years. The mean age of the patients at the time of surgery was 71 years. 75 % of the patients were female, 25 % were male. Mean BMI of the patients was 29.2 kg/m(2). The preoperative diagnosis was osteoarthritis in 91 %, rheumatoid arthritis in 5,5 % and posttraumatic osteoarthritis in 2 %. Patella resurfacing was performed in 4 %. All components were cemented. RESULTS AND DISCUSSION: Mean Knee Society clinical score improved from 26.7 points preoperatively to 88.5 points at the time of the latest follow-up, and mean Knee Society function score improved from 48.3 to 55.2 points. Flexion improved from a mean of 106.7° preoperatively to 111.4° at 10 years. Patellofemoral pain was indicated by 66 % of the patients before surgery and 4 % at the latest follow-up. 96 % were satisfied with the result of the surgery at 10 years. Radiographic evaluation was performed on 224 patients at the time of the latest follow-up. 203 patients (91 %) had normal radiographic findings, 21 patients (9 %) showed pathological findings. Radiolucencies were seen in 18 patients on the AP view of the tibia, 1 patient had an additional femoral radiolucency. There was an osteolysis located in the lateral tibia seen in 1 patient and an occurrence of heterotopic ossification in another patient. One knee showed a patella subluxation. No patient had radiographic evidence of loosening. 17 knees had required revision surgery with exchange of at least one of the components up to 10 years after the index procedure. 5 of the patients had revision for a deep infection, 2 for periprosthetic fractures of the distal femur with loosening of the prosthesis, 1 for fracture of the proximal tibia due to osteoporosis, 4 for aseptic loosening, 3 for instability and 2 for severe pain. Kaplan-Meier survival of all components using revision for any reason as the end point was 97.8 % at 10 years. CONCLUSION: The good clinical and radiological long-term results as well as the satisfactory survival rate after total knee replacement with the NexGen CR® prosthesis are comparable with the results of other long-term studies using the NexGen CR® and assimilable prosthesis. Our results demonstrate that quality of life was improved by the implantation of the NexGen CR® prosthesis even a long time after the index procedure despite old age and comorbidity of the patients.

Requirement for cardiac telemetry during intravenous phenytoin infusion: guideline fact or guideline fiction?

Guidelines recommend the use of cardiac telemetry when phenytoin is administered intravenously. Clinical areas where telemetry is available may not always be the most suitable place to monitor and treat these sick patients. We sought to clarify the evidence regarding the need for cardiac telemetry during intravenous infusion of phenytoin.

Complementary and alternative medicines and dietary interventions in multiple sclerosis: what is being used in South Australia and why?

OBJECTIVES: To investigate the usage patterns of complementary and alternative medicines (CAMs), as well as dietary interventions, by South Australian people with multiple sclerosis (MS). DESIGN: Self-administered postal survey. SETTING: Questionnaire mailed to recipients of the South Australian (SA) MS Society newsletter (n=1230). MAIN OUTCOME MEASURES: Patterns of CAMs use and dietary interventions, reasons for using/not using CAMs in MS, sources of CAMs information and monthly expenditure on CAMs/dietary interventions. RESULTS: A total of 428 surveys were returned (response rate 34.8%) of which 416 met the inclusion criteria for analysis. The majority of SA people with MS who responded reported using CAMs/dietary interventions (64.7%). Respondents with tertiary education and those with mild and moderate disease reported highest CAM use. The most frequently used CAM product categories were vitamins (81.8%), essential fatty acids (80.7%) and minerals (62.5%). Commonly used herbal products included Ginkgo biloba (18.2%) and valerian (16.4%). Popular diets were the low fat (39.8%), low/no sugar (23.8%) and gluten-free (16.4%) diets. The majority of those using CAMs/dietary interventions did so concurrently with conventional treatments (72.1%). Reasons for use included: general health and well-being; to alleviate 'general' as well as specific MS symptoms such as muscle weakness, urinary or memory problems and mobility. Conventional health professionals, and friends/family, were the most common sources of information. Monthly expenditure was most commonly AUD$20-49/month. CONCLUSION: This study reports frequent use of CAM/dietary intervention amongst SA people with MS. The majority of users did so in conjunction with conventional treatments.

The results of the titanium-coated RM acetabular component at 20 years: a long-term follow-up of an uncemented primary total hip replacement.

In a prospective study, 93 unselected consecutive uncemented hip arthroplasties were performed in 80 patients using the titanium-coated RM acetabular component and the CLS femoral component. The mean age of the patients at operation was 52 years (28 to 81). None were lost to follow-up. In the 23 patients who had died (26 hips) only one acetabular component had been revised. In the 57 living patients (67 hips), 13 such revisions had been performed. Of the 14 revisions, seven were for osteolysis, five for loosening and two for infection. Survival analysis of this implant showed a total probability of survival of 83% (95% confidence interval 73 to 90), with all revisions as the endpoint, and a probability of 94% (95% confidence interval 87 to 98) with revision for aseptic loosening as the endpoint, indicating reliable long-term fixation of the titanium-coated RM acetabular component.

[Determining the indication for primary total hip and knee replacement. Results of external quality assurance of over 270,000 primary total hip and knee replacements]. / Indikationsstellung in der primären Hüft- und Kniegelenkendoprothetik. Ergebnisse der externen Qualitätssicherung von über 270.000 primären Hüft- und Kniegelenkendoprothesen.

BACKGROUND: The German mandatory quality assurance programme collects data from all primary total hip and knee replacements. The quality of the indication is measured by clinical and radiological criteria. The results were analysed in terms of differences in establishing the indication subject to patient and hospital characteristics. MATERIALS AND METHODS: Data on more than 270,000 primary total hip and knee replacements that were operated in 2006 in Germany were analysed concerning differences in the quality of the indication subject to age, gender, hospital volume and density of population and hospitals (metropolitan vs rural areas). The statistical analysis was done by exact Fisher's test. RESULTS: The quality of the indication was statistically significantly better in men, patients 60 and older, in rural areas and in high volume hospitals (50 and more joint replacements per year). DISCUSSION: Data of this mandatory German quality assurance programme are useful to describe differences in medical care. The results are valid and complete. An exact analysis of the reasons for these differences is difficult though. Data focus is on quality assurance and represent only in-hospital results. CONCLUSION: Further analyses are necessary to ascertain whether the differences in quality of care are deficits or only variances in medical care.

Hydrogenation of molecular cyclic diborane4 compounds featuring B-B bonds and olefinic or aromatic bridges: a quantum chemical study.

Hydrogenation reactions starting with di- or oligonuclear boron compounds featuring direct B-B bonds with the B atoms in the formal oxidation state +II are analyzed with the aid of ab initio quantum chemical (RI-MP2) calculations. The products of these reactions are B(III) hydrides which might be useful starting reagents for stoichiometric hydrogenation reactions and possibly in special cases also for hydrogen storage. Several different isomers of these B(III) hydrides featuring either terminal or bridging H atoms were considered. The results are compared to hydrogenation reactions of related molecules.

[Extracorporeal shockwave therapy in symptomatic heel spurs. An overview]. / Extrakorporale Stosswellentherapie beim symptomatischen Fersensporn. Eine Ubersicht.

Extracorporeal shock wave application (ESWA) has been successfully used for years in routine clinical management of plantar fasciitis. So far no clinical trails have shown the efficiency in placebo-controlled protocols. This paper presents an overview of conservative and operative treatment modalities with respect to their efficacy. Results of a prospective randomized placebo-controlled double-blind multicenter trial to show efficiency and safety of ESWT are presented. In patients treated conservatively without success, a single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002 of the shock wave device used.

The coracoacromial ligament: anatomical and biomechanical properties with respect to age and rotator cuff disease.

The coracoacromial ligament (CAL) plays an important role in the pathoetiology of the subacromial impingement syndrome especially in those patients who do not have bony abnormalities. A total of 40 shoulders were dissected to determine the anatomical and biomechanical properties of the CAL in shoulders with either intact rotator cuffs or rotator cuff disease, taken from cadavers of persons who were of various ages at death. The specimens from cadavers with rotator cuff degeneration had a shorter lateral and medial band of the CAL than those of the specimens taken from shoulders with intact rotator cuffs. The cross-sectional area of the lateral band was also enlarged in older specimens with rotator cuff degeneration. Analysis of the structural properties showed a higher load to failure and a higher stiffness in the younger than in older specimens. In material properties, there was a higher failure stress in specimens with normal rotator cuffs than in the specimens with rotator cuff disease but only in older specimens. The decreased material properties in older specimens with rotator cuff disease may be caused by the previously reported histological differences with tissue disorganization and a lack of parallel bundle orientation associated with rotator cuff disease.

Experimental photodynamic laser therapy for rheumatoid arthritis with a second generation photosensitizer.

Photodynamic laser therapy has been shown to be a new method for the treatment of synovitis in various animal models. Its principle is the accumulation of a photosensitizing drug in the inflamed synovium which is destroyed by photoactivation of the drug. In the present animal study we demonstrate the effect of a second-generation photosensitizer and suggest a concept for light dosimetry within the joint. We used 38 inbred rabbits for the IgG-induced arthritis model; 2 mg/kg of the benzoporphyrin derivative monoacid ring-A (BPD-MA) Verteporfin were administered 3 h before irradiation, which was performed using a 690-nm diode laser coupled to quartz glass fiber with a cylinder diffusor tip at a total light energy of either 180 or 470 J. During irradiation specific fluorescence of BPD-MA was monitored using a spectroscopy unit. The effect of the photodynamic laser therapy was documented grossly and histologically after 1 week. Within the 470 J-group a complete necrosis of the inflamed synovium was observed. The bradytrophic structures of the joint, however, remained unchanged. Throughout the 180 J-group the extent of necrosis was minor. During irradiation the tissue fluorescence of BPD-MA showed a dose-dependent decrease. Using BPD-MA as a photosensitizer a highly selective and minimal invasive synoviorthesis can be performed. At a dose of 2 mg/kg the histological effect depends on the light dose. For optimum efficacy a total energy of 470 J seems favorable. Online fluorescence detection can be used to monitor the effect of light administration. For dosimetry therefore an online tissue fluorescence detection may represent a technical solution.

Macrocyclic Imidazolylboranes.

Cycles, not chains: 1-imidazolylboranes exist in polymeric form as a consequence of donor/acceptor interactions. Through the use of suitable substituents and under high dilution tetrameric and pentameric macrocyclic imidazolylboranes were synthesized. The picture shows the structure of the tetrameric 4,5-dimethylimidazolylborane (black: C, gray: B, white: N).

[Percutaneous nucleotomy procedures in lumbar intervertebral disk displacement. Current status]. / Perkutane Nukleotomieverfahren beim lumbalen Bandscheibenvorfall. Eine Bestandsaufnahme.

The discussion on the results of open spinal surgery, in particular, on complications as a result of open surgery, e.g., the so-called post-discotomy syndrome, has led to the development of less invasive methods, especially for treatment of lumbar disc prolapses. Percutaneous nucleotomy procedures are based on a variety of intradiscal diagnostic and therapy methods, such as discography, retroperitoneal spinal disc fenestration or chemonucleolysis. Since the 1970s, various methods such as mechanical percutaneous nucleotomy, automated percutaneous nucleotomy, intradiscal laser procedures and, in part, endoscopic intradiscal procedures have been developed and also used clinically. The clinical results vary from 30% good/very good results to almost 100% good/very good results, depending on the author and study. It is obvious that not many prospective randomized studies using either conservatively or surgically treated control groups have been conducted. The results of these studies on intradiscal therapy methods are often analyzed more critically and with lower success rates than the partially retrospective stuides of a single method, which often have large case numbers, but do not always meet the demanding criteria for scientific study design. To attain good results, percutaneous nucleotomy procedures can only be used to treat select cases of lumbar disc disorders according to strict indication criteria. At the present time it can be concluded that, in comparison to endoscopic und microsurgical methods, percutaneous nucleotomy procedures must be restricted to a small number of cases.

Percutaneus nucleotomy procedures in lumbar spinal disc prolapse.

The discussion on the results of open spinal surgery, in particular, on complications as a result of open surgery, e. g., the so-called post-discotomy syndrome, has led to the development of less invasive methods, especially for treatment of lumbar disc prolapses. Percutaneous nucleotomy procedures are based on a variety of intradiscal diagnostic and therapy methods, such as discography, retroperitoneal spinal disc fenestration or chemonucleolysis. Since the 1970 s, various methods such as mechanical percutaneous nucleotomy, automated percutaneous nucleotomy, intradiscal laser procedures and, in part, endoscopic intradiscal procedures have been developed and also used clinically. The clinical results vary from 30 % good/very good results to almost 100 % good/very good results, depending on the author and study. It is obvious that not many prospective randomized studies using either conservatively or surgically treated control groups have been conducted. The results of these studies on intradiscal therapy methods are often analyzed more critically and with lower success rates than the partially retrospective studies of a single method, which often have large case numbers, but do not always meet the demanding criteria for scientific study design. To attain good results, percutaneous nucleotomy procedures can only be used to treat select cases of lumbar disc disorders according to strict indication criteria. At the present time it can be concluded that, in comparison to endoscopic und microsurgical methods, percutaneous nucleotomy procedures must be restricted to a small number of cases.

Serum mucin antigen (CASA) as a marker of amiodarone-induced pulmonary toxicity.

Amiodarone is used to treat life-threatening cardiac arrhythmias. Amiodarone-induced pulmonary toxicity (APT) can be difficult to diagnose. APT may result in increased mucus production and mucin expression. Thus, serum mucin-1 was evaluated as a marker for amiodarone-induced pulmonary toxicity. Concentrations of mucin-1 in peripheral blood were determined using cancer-associated serum antigen (CASA) assay in patients taking amiodarone. Eight of ten patients who developed major amiodarone toxicity had high serum CASA levels. Patients with toxicity had a significantly higher mean rank CASA concentration compared with those without major toxicity. CASA shows potential as a marker for amiodarone-induced toxicity, particularly pulmonary toxicity.