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We report a case which was processed by the Philadelphia Office of the Medical Examiner in which a person with a previous known suicide attempt clearly provoked the Philadelphia police into shooting him. We believe that this is but one of many such incidents in which the victim provokes another into administering fatal injury. This is a mechanism of suicide which, we believe, is exemplified by the case presented.
A case is presented of self-inflicted injuries alleged to have been sustained during an assault by police. A summary is given of the factors in this case differentiating between self-inflicted injuries and those due to an assault. The desirability of taking photographs of injuries in cases of alleged assault and the importance of keeping an open mind when assessing injuries are emphasised. The need for greater awareness in the medical and legal professions of the advantages of a forensic medical opinion in the assessment of injuries is mentioned.
We investigated worker policing by egg eating in the ponerine ant Pachycondyla inversa, a species with morphologically distinct queens and workers. Colonies were split into one half with the queen and one half without. Workers in queenless colony fragments started laying unfertilized male eggs after three weeks. Worker-laid eggs and queen-laid eggs were introduced into five other queenright colonies with a single queen and three colonies with multiple queens, and their fate was observed for 30 min. Significantly more worker-laid eggs (range of 35-62%, mean of 46%) than queen-laid eggs (range of 5-31%, mean of 15%) were eaten by workers in single-queen colonies, and the same trend was seen in multiple-queen colonies. This seems to be the first well-documented study of ants with a distinct caste polymorphism to show that workers kill worker-laid eggs in preference to queen-laid eggs. Chemical analyses showed that the surfaces of queen-laid and worker-laid eggs have different chemical profiles as a result of different relative proportions of several hydrocarbons. Such differences might provide the information necessary for differential treatment of eggs. One particular alkane, 3,11-dimeC27, was significantly more abundant on the surfaces of queen-laid eggs. This substance is also the most abundant compound on the cuticles of egg layers.
The Emergency Treatment Center, a new program of crisis intervention services, has been in operation since February 1975. This seven-day-week, twenty-four-hour-a-day program backs up ten Northern California police departments to provide help to people who are experiencing psychological emergencies such as violent family fights, suicide attempts, and severe emotional disturbance; in addition, the Center responds to any kind of crisis call involving adolescents. The population of the area served is approximately 750,000 of whom approximately 110,000 are adolescents between 10 and 17 years of age.
BACKGROUND: By national statistics, Japanese ischemic heart disease (IHD) mortality is one of the lowest of all industrialized countries, and the proportion of deaths due to heart failure in heart disease is the highest. There may be a difference in diagnostic preference between Japan and other industrialized countries. METHODS AND RESULTS: IHD deaths according to the death certificates were reevaluated with World Health Organization MONICA criteria for those 25 to 74 years old by use of clinical and police records in a Japanese city with a population of 347,000. Their cause of death was given on the death certificates as IHD (International Classification of Diseases [ICD], ninth revision, codes 410-414), heart failure (428), or other heart diseases (393-405, 415-427, 429) in 1984 through 1986. Some deaths in 1985 through 1986 from stroke (430-438) or other diseases (250, 272, 278, 440-448, 797-799) were added. Of 409 subjects, 397 (97%) could be examined. Reevaluation of the 106 deaths originally diagnosed as IHD yielded 73 IHDs and 11 sudden deaths of unknown origin (SD), and reevaluation of 160 deaths originally called heart failure yielded 26 IHDs and 50 SDs. In total, reevaluation of all 397 deaths yielded 101 IHDs and 69 SDs. Some 88% of SD cases were originally certified as heart failure (72%) or IHD (16%). Only two SDs were originally certified as stroke. CONCLUSIONS: Assuming that 30% of SDs were due to IHD, the number of IHD deaths would be 122, which is 11% larger than the number of IHD deaths according to the death certificates. After reevaluation, the IHD mortality in this study area still was the lowest in the industrialized countries.
The authors evaluated the impact of short-term intensive instruction by mental health professionals on police officers' attitudes toward the mentally ill and on their ability to distinguish between mental illness and other behavior. Compared with a control group who did not receive the special training the 80 officers showed increased interest in and sympathy for psychiatric problems.
Twenty-six state police officers referred by their department or self-referred were evaluated by a university department of psychiatry over a 28-month period. The most common primary diagnosis was adjustment disorder, followed by substance abuse and personality disorder. Sixteen of the officers were assessed to be psychiatrically capable of returning to duty; concurrent outpatient treatment was recommended for most of them. The most challenging cases for evaluation were those involving psychiatric symptoms after trauma on duty, behavioral manifestations of personality disorder, and substance abuse.
Among HIV-infected individuals, skin diseases cause significant morbidity and are frequently the initial indication of immunosuppression. From an on-going cohort study to determine prevalence and incidence of HIV infection among police officers (POs) and their suitability for HIV vaccine trials, a sub-study was carried out to determine the prevalence and pattern of skin diseases among HIV-infected POs and relate this to their immunodeficiency status. Consenting HIV-infected POs and their age and sex-matched HIV-negative officers were assessed for presence and type of skin diseases at their workplaces. A questionnaire was used for data collection. Immunodeficiency was measured by plasma CD4+ lymphocytes using flow cytometry. Between November 1998 and 31 December 2000, 716 POs were assessed. Overall HIV-1 prevalence was 17.7% (127/716). One hundred and ninety-one POs (26.7%) had at least one skin diagnosis. HIV-infected POs had significantly higher (41.7%) prevalence of skin diseases than HIV-uninfected POs (26.4%), P = 0.002. Fungal infections were common in both HIV-infected and uninfected POs. Among the HIV infected, other common diseases were: herpes zoster (11.8%); pruritic papular eruption (PPE) (7.1%); seborrheic dermatitis (5.5%); and Kaposi's sarcoma (KS) (1.6%). KS and PPE were associated with severe immunodeficiency, with mean absolute (percentage) CD4+ counts of 75.5 cells/microL (4.0%) and 71.7 cells/microL (4.8%), respectively. The values for herpes zoster and seborrheic dermatitis were 271.1 cells/micronL (12.4%) and 206.3 cells/microL (11.3%), respectively. Skin diseases were common among HIV-infected POs. PPE and KS are markers of severe immunodeficiency due to HIV. PPE, herpes zoster and KS strongly suggest underlying HIV-related immunodeficiency and patients with these conditions should be counselled and tested for HIV.
The World Trade Center attack cast some physicians in roles outside their usual hospital practice. The incident required several physicians to function in the dangerous environment of the disaster. Priorities and triage strategies established by the police, emergency medical service and fire departments, while adhered to, required instantaneous modification and upgrading given the vast loss of civilian and rescue personnel lives. Many civilian medical staff presented themselves with good intentions but needed to be placed out of the collapse zone for fear of incurring additional casualties. In addition, problems with re-establishment of command and control, communications, personnel and equipment replacement all impacted on the rescue effort. This article recounts the roles played by the two coauthors during the World Trade Center attack.
Between October 1983 and December 1985, 268 patients were brought by police to a psychiatric hospital in south London under section 136 of the Mental Health Act 1983. Comparisons were made between 'blacks' and 'whites' on several clinical and demographic variables. The vast majority of admissions received a psychiatric diagnosis. An excess of black admissions was recorded. Black men were younger, were more likely than whites to be given neuroleptics, to be put on compulsory orders, and to be given an out-patient appointment when discharged from hospital. More black men were given a case-note diagnosis of schizophrenia or drug-induced psychosis. The differences in clinical management between ethnic groups could be at least partly accounted for by these differences in diagnosis. Treatment did not appear to be independent of diagnosis among the black admissions.
This study reports the results of an unusual opportunity to follow up a group of police officers who were involved in body-handling duties following the Piper Alpha disaster, and for whom there were available data from pre-disaster assessments. In addition, after these duties, the officers were compared with a matched control group of officers who had not been involved in such work. The comparisons failed to demonstrate high levels of post-traumatic distress or psychiatric morbidity. The results are interpreted in terms of issues such as the officers' own coping strategies, and major organisational and managerial factors.
Thirty-five police officers were followed up three years after they had been first assessed following their involvement in the retrieval and identification of human remains after a major disaster. Most of these officers were free from signs of psychiatric morbidity. Organisational and managerial practices appear to be powerful antidotes to adverse post-traumatic reactions. In this study the use of a longitudinal design, with a pre-disaster baseline and a control group, suggests that these are robust findings.
The much-publicized 2000 case of Frew v. Gilbert, in which a federal judge castigated the State of Texas for deficiencies in its Medicaid program, brought renewed attention to the issue of regulating the quality of care in Medicaid and Medicare HMOs. Frew and other recent cases highlight both the promise and the pitfalls of relying on courts to correct deficiencies in public managed care programs. This article argues that while litigation over inadequacies in Medicare and Medicaid managed care can serve an important signaling function in alerting agencies and legislatures about the need for reform, the role of the courts in policing public managed care is circumscribed by several constraints. Barriers to class action litigation and differences in the institutional capacities of courts and administrative agencies mean that litigation is best viewed as a supplement, not an alternative, to a renewed commitment to strong quality monitoring on the part of Centers for Medicare and Medicaid Services and state Medicaid agencies.
Why is it that many of the often-cited narratives about butch, FTM, and/or transgender masculinity happen to be fictions that highlight suffering as a de facto rite of passage for the butch, FTM, or transgendered protagonist? This essay attempts to answer that question, first by outlining the "coherentist assumptions" of lesbian feminism and the forms of gender-policing that cast butch, FTM, and transgendered subjectivities as "false consciousness." It then analyzes the practice of anchoring butch, FTM, and/or transgender identity claims in pain-filled narratives such as "The Well of Loneliness," "Stone Butch Blues," and "Boys Don't Cry." While these narratives do important cultural work-exposing the violence heaped upon butches, FTMs, and transgendered guys-it may be time to imagine alternative narratives that are less invested in suffering as a barometer of masculine authenticity.
The reactive airway dysfunction syndrome (RADS) is a recently described syndrome in which bronchial hyperreactivity and asthmatic symptoms develop in previously healthy individuals after a single large exposure to an irritating gas, fume, or vapor. We report a cluster of three Philadelphia police officers who developed RADS after a common exposure to toxic fumes from a roadside truck accident. Results of initial pulmonary function testing were normal in all three, and methacholine challenge was required for diagnosis in two out of the three. This syndrome needs to be recognized by physicians dealing with environmental or industrial medicine as a potential cause of loss of work or inability to perform on the job. Also, there is a potential for multiple individuals to develop this syndrome from a single incident.
The effects of a carefully monitored and increased police patrol on the report of crime were examined in four patrol zones. Overall patrol movement was increased to four times normal levels and slow patrol movement (under 20 mph) to around 30 times normal levels for 10 days. The patrol was active in two zones between 9:00 a.m. and 5:00 p.m. and in the other two zones between 7:00 p.m. and 3:00 a.m. A multiple-baseline design and time-series statistical analyses showed statistically reliable changes in reported levels of Part I crime (such as robbery, burglary, and aggravated assault) during both night patrols, but not in the day patrols. In both night-patrol zones, there were also reliable increases from saturation patrol to postsaturation patrol in report of Part I crime after the night patrol was terminated. Neither of the day patrols showed significant crime report changes on termination. Despite statistically reliable decreases in report of crime during nighttime hours, the value of saturation patrolling as a crime-prevention technique was questioned on cost/benefit grounds.
This study presents two experiments that evaluate strategies to reduce violations of a handicapped parking ordinance. The first experiment compared effects of upright versus ground handicapped parking signs on percentage of intervals in which cars were parked illegally. Introducing upright signs produced an immediate reduction in the percentage of intervals of inappropriate use of parking spaces. The second experiment examined effects of a police enforcement program on percentage of intervals of inappropriate use of parking spaces and frequency of inappropriately parked cars. Results showed consistent reductions in percentage of intervals of inappropriate use and number of inappropriately parked cars compared with a control site where no enforcement program was introduced. Implications of the research data for law enforcement and public policy are discussed.
The earlier observation that students who had attempted suicide had lower scores on external locus of control than nonsuicidal ones was confirmed for 63 police officers. However, depression was associated with higher external scores.