Staff perceptions of risk of assault in psychiatric settings

This thesis examined current perceptions and experiences of staff relating to threatening and assaultive patient behaviours in mental health and forensic settings. The research uncovered the interrelated nature of staff experiences of assault and perceived vulnerability, with the view to optimising patient care and staff wellbeing in psychiatric settings

Maltreatment, Child Welfare, and Recidivism in a Sample of Deep-End Crossover Youth

Although research has oft-documented a maltreatment-delinquency link, the effect of involvement in-and timing of-child welfare system involvement on offending has received less attention. We examine whether the timing of child welfare involvement has differential effects on recidivism of deep-end juvenile offenders (youth who have been adjudicated delinquent by the court and placed in juvenile justice residential programs). The current study uses a large, diverse sample of 12,955 youth completing juvenile justice residential programs between 1 January 2010 and 30 June 2013 in Florida (13 % female, 55 % Black, 11 % Hispanic). Additionally, we explore the direct effects of childhood traumatic events on delinquency, as well as their indirect effects through child welfare involvement using structural equation modeling. The findings indicate that adverse childhood experiences fail to exert a direct effect on recidivism, but do exhibit a significant indirect effect on recidivism through child welfare involvement, which is itself associated with recidivism. This means that while having exposures to more types of childhood traumatic events does not, in and of itself, increase the likelihood of re-offending, effects of such experiences operate through child welfare placement. Differences in the effects of maltreatment timing and of adverse childhood experiences are observed across sex and race/ethnicity subgroups. Across all racial subgroups, exposures to adverse childhood experiences have a significant effect on the likelihood of child welfare placement, yet child welfare placement exerts a significant effect on recidivism for White and Hispanic youth, but not for Black youth. Only Hispanic female and White male youth with overlapping child welfare and juvenile justice cases (open cases in both systems at the same time during the study period) were more likely to recidivate than their delinquent-only counterpart youth. Crossover status (child welfare and juvenile justice involvement, whether prior or open cases) was essentially irrelevant with respect to the re-offending of Black youth completing juvenile justice residential programs. The findings indicate the effects of exposure to adverse childhood experiences, and child welfare system and juvenile justice system involvement on re-offending are not uniform across subgroups of youth but that earlier child welfare involvement is more detrimental than concurrent child welfare system involvement when it does matter

CMR of microvascular obstruction and hemorrhage in myocardial infarction

<p>Abstract</p> <p>Microvascular obstruction (MO) or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR) is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.</p