30 years of solitary confinement: what has changed, and what still needs to happen

Solitary confinement cells are where those considered to be too dangerous to themselves or to others, too troublesome, too mentally unwell, or simply different, will be locked away, spending 22-24 hours a day alone, out of sight and out of mind. Solitary confinement is an extreme and harmful practice on the cusp of prohibited treatment of people deprived of their liberty, with potentially grave consequences for the individuals concerned and the societies to which they eventually return.      This article reflects on some of the achievements, and remaining challenges, around the use and regulation of solitary confinement practices internationally in the last 30 years, drawing on recent developments and the author’s work in the area

PMS5 PERSISTENCE WITH BISPHOSPHONATE THERAPY AND RISK OF HIP FRACTURE

Primer pla d'un senzill edifici d'habitatges de principis del s. XIX. Consta de planta baixa i quatre plantes pis, separades cada una de les plantes per impostes. S'estructura sobre la base d'eixos de simetria verticals

Cognitive Flexibility Predicts PTSD Symptoms: Observational and Interventional Studies

Introduction: Post-Traumatic Stress Disorder (PTSD) is a prevalent, severe and tenacious psychopathological consequence of traumatic events. Neurobehavioral mechanisms underlying PTSD pathogenesis have been identified, and may serve as risk-resilience factors during the early aftermath of trauma exposure. Longitudinally documenting the neurobehavioral dimensions of early responses to trauma may help characterize survivors at risk and inform mechanism-based interventions. We present two independent longitudinal studies that repeatedly probed clinical symptoms and neurocognitive domains in recent trauma survivors. We hypothesized that better neurocognitive functioning shortly after trauma will be associated with less severe PTSD symptoms a year later, and that an early neurocognitive intervention will improve cognitive functioning and reduce PTSD symptoms.Methods: Participants in both studies were adult survivors of traumatic events admitted to two general hospitals’ emergency departments (EDs) in Israel. The studies used identical clinical and neurocognitive tools, which included assessment of PTSD symptoms and diagnosis, and a battery of neurocognitive tests. The first study evaluated 181 trauma-exposed individuals one-, six-, and 14 months following trauma exposure. The second study evaluated 97 trauma survivors 1 month after trauma exposure, randomly allocated to 30 days of web-based neurocognitive intervention (n = 50) or control tasks (n = 47), and re-evaluated all subjects three- and 6 months after trauma exposure.Results: In the first study, individuals with better cognitive flexibility at 1 month post-trauma showed significantly less severe PTSD symptoms after 13 months (p = 0.002). In the second study, the neurocognitive training group showed more improvement in cognitive flexibility post-intervention (p = 0.019), and lower PTSD symptoms 6 months post-trauma (p = 0.017), compared with controls. Intervention- induced improvement in cognitive flexibility positively correlated with clinical improvement (p = 0.002).Discussion: Cognitive flexibility, shortly after trauma exposure, emerged as a significant predictor of PTSD symptom severity. It was also ameliorated by a neurocognitive intervention and associated with a better treatment outcome. These findings support further research into the implementation of mechanism-driven neurocognitive preventive interventions for PTSD

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

A sourcebook on solitary confinement

"As this sourcebook clearly demonstrates, solitary confinement has a well documented negative impact on mental health and wellbeing and may amount to cruel, inhuman or degrading treatment or punishment, particularly when used for a prolonged time. The use of solitary confinement should therefore be strictly limited to exceptional cases or where it is absolutely necessary for criminal investigation purposes. The severe suffering caused by solitary confinement means that in all cases it should only be used as a last resort, and then for the shortest possible period of time. When used for interrogation purposes, either in combination with other methods or on its own, solitary confinement can amount not only to cruel, inhuman or degrading treatment but even to torture. This comprehensive sourcebook brings together the accumulated knowledge and standards relating to solitary confinement and its harmful consequences. It identifies how solitary confinement may be misused and the protections that should be put in place. It is a valuable resource for prison staff and policy makers in the effort to promote the respect and protection of the rights and wellbeing of prisoners and detainees. Let us not forget that persons deprived of liberty are among the most vulnerable human beings in every society." - Manfred Nowak, Preface

Solitary confinement

"This website is dedicated to examining the practice of solitary confinement in its various forms. It is designed to accompany the Sourcebook on Solitary Confinement and expand on issues discussed therein. The website is managed and maintained by Sharon Shalev." - Home page, 11 January 2013

Solitary confinement and supermax prisons: a human rights and ethical analysis

This article examines how the prolonged solitary confinement and additional deprivations in supermax prisons measure up against legal protections afforded to those deprived of their liberty. It suggests that if the prohibition against cruel, inhuman or degrading treatment were to be taken at face value, supermax confinement would meet the definition of what constitutes such treatment, and urges the courts to re-examine their position regarding supermax confinement. It also suggests that health professionals are well placed, and ethically bound, to play a more active part in efforts to curtail the use of prolonged solitary confinement in all places of detention

Supermax: controlling risk through solitary confinement

This book examines the rise and proliferation of ‘supermax’ prisons in the United States since the late 1980s. It describes the daily reality of life for the tens of thousands of prisoners labelled the ‘worst of the worst’ in the American prison system and subjected to strict solitary confinement and extreme measures of control, inspection and surveillance in these prisons. It asks why solitary confinement, which had been discredited in the past, is now proposed as the solution for dealing with ‘difficult’, ‘dangerous’ or ‘disruptive’ prisoners. Drawing on unique access to supermax prisons and on in‐depth interviews— with prison officials, prison architects, current and former prisoners, mental health professionals, penal, legal and human rights experts, the book offers a comprehensive review of the theory, practice and consequences of these prisons